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48yr Male, 5/18/20 VSG HW 382, SW 309, CW 282, GW 240/225 First visit to the nutritionist was 7/3/2019. Had a long pre-op program then was delayed by COVID-19, so wasn't sleeved until 5/18/20. Lost 73# pre-op, 27# since - for a total of 100! Excited to hit this goal, and only have about 42/57 lbs left to meet my first and second goal. You can do it, stick to the program, Proteins + fluids, you know the drill. 

48yr Male, 5/18/20 VSG HW 382, SW 309, CW 282 First visit to the nutritionist was 7/3/2019. Had a long pre-op program then was delayed by COVID-19, so wasn't sleeved until 5/18/20. Lost 73# pre-op, 27# since - for a total of 100! Excited to hit this goal, and only have about 40-60 lbs left to meet my first and second goal. You can do it, stick to the program, proteins + fluids, you know the drill. The second pic isn't great - I'm about to have to retire another size of shirts in the next few weeks.

... but not for the reasons you might think. I questioned whether I should make this post in the preop section or here, but since it's my first post on the forum, it might as well serve as an introduction as well. My apologies in advance for the verbosity, as I have a tendency to ramble. At age 54, I've been morbidly obese since I was a teen. I have no personal frame of reference as to what it means to be fit or eat healthily. Sure, there's the cognitive recognition of what those concepts are and what they should mean, but nothing in my own life experiences that are relatable. I'm 6'1" and at my heaviest weighed 410. Five years ago I was diagnosed with high blood pressure, which medication has fortunately kept under control. In June of 2019, when I weighed 385, I was diagnosed with Type 2 diabetes. It was at this point, that I realized I actually needed to do something about losing weight beyond paying lip service. I've been feeling it more in my knees and ankles the last few years, and the notion that should I ever need a knee replacement or other major joint surgery, that I would likely be denied due to my weight wasn't an enticing prospect. I've made token efforts at points in my life to dieting and exercise, but nothing consistent; nothing that "stuck". So I spoke with my primary physician about bariatric surgery options and started down this road. After consultations and doing my own research, I decided on the sleeve gastrectomy. Over the several month "trial period" (not sure what the technical term is), meeting with dieticians, the surgeon, the psychologist, etc., my surgery was approved and scheduled for mid April of this year... well, you can guess what happened. Thanks to COVID-19 everything was put on hold. I freaked out a bit at that point. My work schedule is such that certain times of the year are no-go as far as being away for extended periods. What if my recovery takes longer than expected? What if due to the quarantine and stress eating (believe me, it's a thing), I gain weight again and they kick me out of the program? Having all this uncertainty on top of all the uncertainty going on in the world... being in a high-risk group for COVID, the business I work for having to completely retool how it does business, the financial market crash (at the time), the civil unrest in an election year, etc.,put my head in a not very happy place. I'm also stressed by the fact that I have no immediate support structure in the event things go wrong (either medically or if I slip with respect to eating habits). I have no family, no significant other, and I live alone. Under normal circumstances, I'm perfectly fine and dandy with all three of those things, but for the first time in my life, I'm faced with the prospect of not having support when I might need it. I've never head surgery in my life, outside of two colonoscopies, which all things considered, I've been blessed in that regard, but again I have no frame of reference of what to expect and what to do in the event things don't proceed as planned. I've avoided reading many of the threads here simply because I don't want to read about worst-case scenarios, as I know that my mind will tend to drift there, and I don't want the negatives of what *might* happen to dominate my thoughts right now. So back to the present... at the beginning of June things started to open back up in the state, at least as far as allowing elective surgeries to be back on the docket. I'm scheduled for surgery on July 13. The 14-day preop diet (which I started on June 29) that my hospital prescribes is more restrictive than many others. No meat in addition to no carbs or fats. It's a 1000-1150 calorie per day diet. As someone who normally would eat 3000-5000 calories per day, that's effectively a snack. So I'm in the middle of day 6... and everything is fine. And I have no idea why. I *SHOULD* be frothing at the mouth, hangry, threatening to eat the neighbor's cats, etc., but for some reason I'm not hungry at all, and this cognitively makes no sense to me based upon my "normal" eating habits. I've been actually eating less than 800 calories per day, not even up to the recommended 1000-1150 calories. Breakfast: protein shake (30g protein, 140-160 calories depending on brand) Morning snack: Yoplait light yogurt (90 calories) Lunch: 12-oz pouch of steamed vegetables with garlic and pepper (80-140 calories depending on what mix I use) Afternoon snack: apple slices (50-80 calories) Dinner: Another protein shake (140-160 calories) Evening snack: another yogurt (90 calories) I'll mix in sugar-free jello (5 calories) throughout the day or some celery sticks as needed, and if feeling peckish will do an extra pouch of steamed vegetables. What's freaking me out is why I'm not freaking out... if that makes any sense. It shouldn't be this easy, and I worrying that I ma be lulling myself into a false sense of security/complacency. Or is my brain somehow making this easier on me, as somewhere deep down in the depths of my subconscious I fundamentally realize that I *have* to make this work? I don't know; it's hard to convey. I was at 351 on Sunday prior to starting the diet (and yes, I pigged out on Saturday and Sunday knowing what was ahead) and am now down to 339 as of this morning, which is a good thing. Just trying to get a handle on why my brain is operating the way it is... At any rate, good to be aboard.

I am 19 days away from surgery!! I have my endoscopy on Thursday. I’m so afraid of pain. What was your pain level? Were you in much pain? This will be my first surgery & my first time under anesthesia.

There are *many* evidence-based clinical bariatric surgical and nutrition guidelines available to health care professionals. They are updated regularly based on the quantity and quality of the best available scientific studies. I’m attaching just one example here: it’s the most recent (2019) guideline provided by the American Association of Clinical Endocrinologists, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologist (and endorsed by the American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, International Federation for the Surgery of Obesity and Metabolic Disorders, International Society for the Perioperative Care of the Obese Patient, and Obesity Action Coalition). In my experience at the intersection of biology and medicine, I've observed that eminence-based medicine tends to be the rule, not the exception. Medicine functions in the gulf between ideas/beliefs and science. Science is based on doubt. Medicine is a road built upon a foundation of good ideas and beliefs put into practice, but it is also a road literally paved with the cadavers of every good idea and belief that didn’t pan out. Even when they do pan out, they still need to be meticulously studied and regularly verified and updated to determine precisely how, why, and which patients benefit the most and the least. The results are not straightforward because bodies are not straightforward: there are incalculable external/environmental variables that are constantly in flux colliding with incalculable internal/genetic variables that are constantly in flux. I don't know any good scientist or clinician that wouldn't trade everything they know for everything they didn't know in a heartbeat. All researchers and practitioners, including bariatric clinicians, should ideally continually examine and assess their own results, making changes where and when necessary, to ensure they are delivering the best outcomes for their patients. Even though this inevitably leads to variations in form -- but not function -- it's just good medical practice. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures 2019 Update.pdf

You have difficult decisions to make and it’s completely understandable that you’re obsessing about all of it – how could you not? I, too, am a strong advocate of the “think a million times, cut once” philosophy. With regard to being a pioneer patient, from extensive research conducted prior to my own bariatric surgery, and as a medical scientist, please allow me to offer an assessment: no surgeon would select a ultra-low or even low-volume surgeon for him-/herself or his/her relatives for any surgery. The correlation between high volume and quality of surgical outcomes is empirically well documented, meaning that the outcome of every surgical procedure is directly dependent on the number of operations performed at a given hospital as well as by the designated surgeon. In other words, the higher the number of operations of a specific type a surgeon performs, the more likely optimum treatment results and low complication rates are achieved. This fact is supported by a large volume* of studies and meta-analyses that have been conducted, peer-reviewed, and published between 1979 and 2019. Because of comorbidities and lower cardiopulmonary reserve thresholds, bariatric patients are often high risk patients. In complex procedures like bariatric surgery – and particularly with riskier procedures such as RYGB, BPD/DS, and SIPS – it is worth paying extra attention to the correlation of procedure-specific skills of the surgeon and the complication rate. Since you’re several months away from surgery, I’d encourage you to keep researching extensively, and talk with as many people as possible who have recently had DS and VSG, and particularly those who are at least 5 years out from both surgeries. I hope that by the time you reach a final decision, you’re able to do so with clarity and a sense of ease. Wishing you all the very best! ****** *A small sampling of available data includes: 1. Zevin B, Aggarwal R, Grantcharov TP: Volume-outcome association in bariatric surgery: a systematic review. Ann Surg 2012;256:60-67. 2. Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE: The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 2004;240:586-593; discussion 593-594. 3. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD; Michigan Bariatric Surgery Collaborative: Hospital complication rates with bariatric surgery in Michigan. JAMA 2010;304:435-442. 4. Birkmeyer JD, Finks JF, O'Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ; Michigan Bariatric Surgery Collaborative: Surgical skill and complication rates after bariatric surgery. N Engl J Med 2013;369:1434-1442. 5. Chowdhury MM, Dagash H, Pierro A: A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 2007;94:145-161. 6. Luft HS, Bunker JP, Enthoven AC: Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301:1364-1369. 7. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FE, Batista I, Welch HG, Wennberg DE: Hospital volume and sugical mortality in the United States. N Engl J 2002;346:1128-1137. 8. Amato L, Colais P, Davoli M, Ferroni E, Fusco D, Minocci S, Moirano F, Sciatella P, Vecchi S, Ventura M, Perucci CA: Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data (Article in Italian). Epidemiol Prev 2013;37(suppl 2):1-100. 9. Pieper D, Mathes T, Neugebauer EAM, Eikermann M: State of evidence on the relationship between high-volume hospitals and outcomes in surgery: a systematic review of systematic reviews. J Am Coll Surg 2013;216:1015-1025. 10. Al-Sahaf M, Lim E: The association between surgical volume, survival and quality of care. J Thorac Dis 2015;7(suppl 2):152-155. 11. Maruthappu M, Duclos A, Lipsitz RS, Orgill D, Carty MJ: Surgical learning curves and operative efficiency: a cross-specialty observational study. BMJ Open 2015;5:e006679. 12. Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, Begg CB: Hospital and surgeon procedure volume as predictors of outcome following GI resection. Ann Surg 2002;236:583-592.

Hope you had your surgery and are recovering nicely. My surgery was rescheduled twice due to covid-19, and am now slotted in for August. It's been very stressful, but on the plus side there's a lot of pre-op weight loss due to multiple liquid diet adventures...

Hm, I had my first surgery in 2001. I don't know though if my weight would be different if I didn't have these intolerances and complications. If you maintained for 10 years - do you have any idea what caused the weight gain? Like having a new job and being less active or entering retirement or something like this?

According to his profile he had the Bypass in Oct 2019 as his first surgery. No one can understand this revision stuff unless they have been through it. Wishing you all the best

I lost 130+ pounds (surgery was 7/10/18) and I’ve stuck to my lifestyle meal plan. I can’t eat sweet things anymore, they taste terrible to me. I drink a gallon of water a day, exercise 4-5 times per week and stopped using food as comfort

I began the WLS process 16 months ago at 292lbs. I lost 50 lbs during the 6 month wait for surgery by following a 1100 kcal/day whole-foods plant based lifestyle (which I'd already been following for over 6 years), and exercising at least 150 minutes per week (beginning with daily yoga and simply walking as far as I could each day, slowly working up to 10,000 steps/day and adding weight training, cycling, hill hiking, and indoor rowing). After surgery, I reached my goal weight in 7 months, and am continuing to lose rapidly without the slow-down that is commonly experienced at the 6 month mark. Currently, I have lost not only 100% of my EBW, but 58% of my entire body weight. I now expect to reach the weight I was in high school, 112-114 lbs, and to maintain long-term in the 115-120lb range. The rapid loss window after surgery is finite: only about 6 months. How much weight one loses in those 6 months is primarily determined by genes, but all gene expression is dependent upon environmental variables, so I did everything I possibly could to maximize loss during that time. For me that meant: protein first veggies second; eating only nutrient-dense whole, clean, plant-based foods (meaning no processed or packaged foods, no animal products, no nutrient-poor foods); staying hydrated; waiting 30 mins before and 45 mins after drinking to eat; consuming no more than 600-800 kcal/day; practicing portion control; being mindful while eating and chewing food extremely well before swallowing; no snacking or grazing or emotional eating; weighing and tracking all food; taking all of the required vitamin and mineral supplements; weighing myself daily; using a fitness tracker and logging all exercise; exercising upwards of 15 hours per week (because I really enjoy it; I never had to force myself); meditation; taking good care of my emotional and mental health, and sleeping 8 hours minimum per night. I still do every single one of these things, except now I eat more (not too much, but enough to healthfully support my activity levels) and exercise more (upwards of 25 hours per week training for eventual distance cycling and triathlon events, as well as many other sports including weight training and squash especially). Though it's all just my regular, everyday, normal life now, I'm still only 8.5 months out from surgery, so it’s all relatively effortless. I'm fully committed to doing all of these things for the rest of my life, however. I will *never* forget how disabled I was -- how limited I was, and how limited my life was -- because of morbid obesity. Edited to add: According to several bariatric experts that I've spoken with, the "honeymoon stage" basically ends when people resume some or all of their old habits: making poor food choices, eating too much, not exercising, and not following evidence-based best practices for long-term weight loss and maintenance (based on observing 5 and 10 year outcomes for hundreds of thousands of bariatric patients). Obesity is a disease and WLS is a treatment, not a cure. If you have heart disease and undergo a triple bypass but start eating burgers and fries again 6 months after surgery, you’re still going to die of heart disease because you’re not addressing the underlying cause of disease unless you change your diet and lifestyle. 50%-60% average weight loss after VSG is just that, an average. So if you don't want to end up with average results over either the short or long term, then definitely do not do what the average person does. Use the first year after surgery to entrench yourself in an entirely new way of eating and moving your body (including weight bearing exercises to build muscle), regularly examining what's working and what isn't, and adjusting or pivoting as needed over time to continue seeing the desired results.

I am 10 years out. Lost 140 pounds. In last 5 years gained 40back. Life happens. In the last year I have lost 36 of those pounds. How ? Back to basics. Protein - I grill fish or chicken or beef. Portion it up - then I make lots of vegetables - fresh riced cauliflower brocolli carrots and chop in onions or garlic fresh herbs steamed and then a quick sautéed in olive oil - meals for lunch and dinner for a few days. Hot cold - over salad - add stir fry veggies to that .... filling and all healthy. My carbs come from the veggies and fresh fruit. I also will have a daily treat that I don’t count - as anything. One skinny cow ice cream or a piece of chocolate - 2 little dove bites are heaven. And I am in control !!! Intentional eating.

At 30 days post surgery I was 9kg down from my surgical weight. At 3 months I was 16kg down. At 6 months I was at my goal of 60kg. At 10 months I’d lost another 9kg and have maintained between 50 & 51kg for the last 3.5months. That was my journey. Yours will be different because of all the factors @catwoman7 mentioned. Best advice is don’t compare your rate of loss with others. For every fast loser there’s a slow loser. If you’re determined, focussed & willing to make long term changes you will be successful. I’m very glad I had the sleeve surgery & I hope you will be too. Good luck.

I would love to hear from any of you, but especially those who are post surgery 10+ years and struggling to keep from gaining weight. I was very successful in my weight loss journey but slowly started gaining in 2017 and now my weight is up. Any suggestions for how to lose the weight now and/or suggestions for staying the course? Thank you in advance.

After 10 days post OP I went from liquids to puree. Liquids: shakes, sugar free or fat free versions of pudding, Jello, popsicles, Soup broth, gatorade, yogurt, milk. Puree: eggs, melted cheese or string cheese, mashed potatoes, bananas, peanut butter, applesauce, lean ground meats like turkey, and cooked carrots. Cheese and potatoes are not foods you want to plan to eat everyday in your future diet plan. The Puree stage is short so I had one string cheese stick everyday. I only had mashed potatoes once.

it seems like most people have had their lapbands removed - so they've been an issue for a LOT of people, it seems. Most surgeons refuse to place them anymore. VSG has pretty much replaced it. rate of weight loss depends on so many factors that knowing where other people were at various junctures probably isn't going to be of much help. I was a very slow loser, but I was very committed, and I lost 100% of my excess weight. factors in your rate of weight loss include gender, age, metabolic rate, how active you are, starting BMI, whether or not you lost a fair amount of weight before surgery - I'm sure I'm leaving some out, but those are all major ones. P.S. it's very common to gain back 10-20 lbs during year 3 post-op. So besides that bounce back, yes, I've been able to keep my weight off. But it's a struggle every day. There's a significant minority of patients who stop paying attention and gain back a lot weight - and unfortunately, a few gain all of it back. You really have to commit to monitoring yourself for the rest of your life.

How much weight you lose is incredibly variable. As catwoman7 says, people who start heavier lose faster. Men usually lose faster than women. People also tend to lose slower if they lost a lot of weight pre-op because a lot of the initial weight loss in any diet is water and sugar and fat stored in your liver. This will be at least 2 lbs, but up to 10 lbs of the initial weight you lose, and happens pretty quickly in a week or two. If you did a pre-op diet, you already lost that 'easy' weight, so it doesn't come off so quickly post-op. Still - 20 lbs in 3.5 weeks is a resounding success for just about anyone. If it's all fat, that corresponds to about a 3,000 calorie deficit a day. If you're hardly eating anything now - that's actually a little faster than you'd expect from doing the math, unless you're a super muscly weight lifter with a fast metabolism. For comparison, I lost 15 lbs in the same time period. I started out at 210 lbs, 5'5'', 40 year old woman. Now 4 months out I am losing about 1.5-2 lbs a week. WLS isn't about losing weight super fast - it's about losing it permanently! Also, I can really sympathize with your feeling that it is hard to swallow anything - like it kind of gets stuck. It felt like that for me for about 1-2 months. It slowly got better over time, and I was able to take bigger and bigger swallows until it finally went away completely. I think it has to do with the swelling around the incisions on your stomach. That will get better soon.

For me, it was getting back to eating very intentionally - protein first and foremost then vegetables. Then fruit and a sprinkle of carbs. I was never able to do protein drinks - ever. i react to every kind of artificial sugar and artificial type ingredient with horrible digestive problems that put me in the hospital..... but YOU DO know what will work and what will not for YOU. Go back to what you were eating at the start - and start from there. You may want to see if another doctor took over your surgeon's practice or find a doctor who is knowledgeable about post surgery issues for bariatric patients. Mostly it is diet and getting enough vitamins and minerals into you and then exercise / moving more ! Personally, I started in the 300's had a sleeve 10 years ago. Lost about 140 pounds then gained back 40. I have spent the last year losing 5 pounds at a time. My first goal was that 5 pounds with a desire to lose 20 in a year. I have lost to date 36 and a half pounds. I am still "overweight" according to BMI for my age (64) and obese if you don't put in my age... but I am very pleased with where I am !!! One meal at a time, one healthy snack at a time, lots of water. Be safe out there !

I started with a gastric sleeve surgery done in July 2019 weighing just shy of 350lbs. I had a lot of issues and tough recovery and it required a revision to a gastric bypass at the end of February 2020. I do not own a scale in my home as I would obsess over the number and with the whole Covid situation I was not going to in person dr appointments but today finally I was able to go and I weighed in at 187lbs!!!! That number seems crazy to me. I was over 200 at the age of 12 and I’m now 46. I want to laugh and cry at the same time. This last year was probably the hardest thing I’ve ever been through and I am not back to being 100% healthy yet but I am so excited to finally be under the 200lb mark.

I had a sleeve in July 2019 got incredibly sick after the surgery. Developed awful reflux developed a hernia from vomiting literally lost my mind from a lack of protein after all the vommitting couldn’t walk ended up in a rehab hospital still couldn’t keep any food down as a life saving measure they converted my sleeve to a bypass in February 2020 and fixed the hernia at the same time. Since the conversion thank god my memory is slowly coming back and my strength is also slowly returning. On the plus side I am doing much better with being able to eat and haven’t vomited except 2xs since the revision With all that being said due to all my issues I had no insurance requirements that I had to meet. The drs just scheduled the surgery I arrived had the surgery and repair and then was hospitalized for 3 days afterward to ensure everything worked the way it was supposed to.

Hi! I had my lapband out in Aug 2019 and Gastric Bypass end of December. I hit a stall at 2 1/2 weeks that lasted 3 weeks. It's very common - search 3 week stall. Yours may have started a little later but don't worry. Keep following your plan and you'll be fine. (BTW - 30 lbs in 5 weeks is amazing!) Lori

I had my lapband removed Dec. 2019. Gastric bypass in May. I'm down almost 30 lbs. I feel like I've hit a plateau. Is this normal almost 5 weeks out? Also, premier protein drinks and eggs make me want to gag since surgery. I loved them before. I'm not getting enough calories in currently. Any suggestions? Thank you so much!

I bought this dress for less than $10 and I've been wearing it nonstop. It's butter soft and extremely form fitting. Seriously it's so tight you can see my gas bubbles 😂 20200701_111913.mp4 20200701_111913.mp4 (Dark grainy video/BF was asleep)

Hi I am so excited my insurance (US Family Health Plan subsidiary of Tricare) just approved my sleeve. My consult was 6/10 then had testing done. Insurance was submitted Fri 6/26 and approved today! I had a lapband in 2010 and due to complications has to have it removed less the 6 months after getting it. I was 430 ish pounds post band. I lost 60lbs before surgery and have kept off most of my weight from that time. Currently in the 285 ish lb range. Now I am just waiting on a surgery date and hoping for August!

My surgeon says no to premier protein because the protein is not a protein isolate😢 So 5 more days of the nasty stuff. I have gotten this far without cheating, so pretty sure I got this, thanks in part to all the encouragement here. I also started a day early because I wanted to start on a day off rather than a Monday, so I am 10 days in. Just a bit jelly of your haul😊 I like premier protein shakes. We have had them around for quick meals for years. Wishing you a wonderful pre-op diet, buddy!