Three Weight Loss Surgery Maintenance Models - Abstinence, No Dieting, or Mindful Moderation

[VSGAnn2014 12,992]

After you've lost all your excess weight and are in the maintenance phase of WLS life -- either newly or several years down the road -- what's the best eating path for you to follow?

There are at least three major schools of thought about how to eat during WLS maintenance, with hybrids of these approaches. Each approach has enthusiastic boosters and rabid opponents among WLS patients. Each approach is espoused by some WLS surgeons, nutritionists, psychologists, bloggers, coaches, and those who sell WLS products.

(1) Abstinence Approach: WLS patients should abstain forever from specific foods, especially those that contain sugar, processed carbs or alcohol. Proponents of the abstinence approach to maintenance offer advice to WLS patients like this:

"Bread is empty calories and a waste of valuable pouch space." At http://www.bariatriceating.com/2016/02/can-versus-difference/

"Say no to alcohol." At http://www.bariatricpal.com/topic/364081-bariatric-realities-%E2%80%93-medical-professionals%E2%80%99-guidelines-about-alcohol-use-wls/?hl=%20stapleton

(2) No Dieting Approach: Some WLS patients report that they have maintained their weight losses by eating in moderation all foods that appeal to them. "I didn't have WLS to be on a diet the rest of my life" is a refrain often heard from this group. The major tool in this approach to WLS maintenance is Portion Control.

(3) Mindful Moderation Approach: This approach has a foot in both the abstinence and non-dieting camps. Those who follow this approach select their foods based primarily on nutritional content, but indulge occasionally in the kinds of "treats" eschewed by abstainers. They endeavor to observe their feelings and behaviors around food choices and use this information to inform future choices.

Recognizing that all WLS patients are not alike -- we vary considerably with regard to our surgery types, complications, physical and mental health challenges, emotional resources, basal metabolic rates, degree of family support, access to therapy/counseling, macronutrient tracking (with an app or mentally), physical exercise (intensity and frequency), etc. -- which maintenance approach works best for you?

EDIT: Or if you know of other approaches to successful maintenance you think work well, please describe them here.

[lifeofblair 308]

I'm super new to maintenance, so I haven't figured out my approach. I'd love to be in the "no diet", but I don't know if I trust myself to be in that category. I'll probably stick to #1.

[JamieLogical 8,708]

I guess I fall under #3. I definitely don't abstain completely from anything, except soda. I learned long ago that the second I tell myself I absolutely can't have something is the second I start desperately craving it. I do MUCH better lying to myself and saying, "oh you can have that tomorrow or next week". Most of the time I never end up having it, but if I do, then I can move on and be content.

I'd like to aim for #2. The vast majority of the time since my surgery, I haven't tracked my food. I've tried to eat intuitively and just put Protein first and let that kind of dictate my eating each day. However, I was losing weight in "maintenance" once I started training for a half marathon, so I've gone back to tracking food in order to make sure I'm eating ENOUGH, which is kind of weird and mind blowing.

And even in maintenance and trying to force myself to eat enough, there are some things I can't help but try to avoid or I feel guilty if I eat. So, I guess it's ultimately just trying to strike a balance every day still.

[CowgirlJane 14,259]

Clearly #3. I don't abstain from anything and I don't track, but I definately have a mental checklist, an internal guidance on my eating habits. I also rely on Portion Control because I have been known to eat healthy foods and still be fat....

[Cape Crooner 589]

I am aspiring to #3, but only time will tell..

[CowgirlJane 14,259]

Which do you follow Ann?

Sent from my SAMSUNG-SGH-I337 using the BariatricPal App

[Babbs 14,681]

#3.

In MY opinion, #2 is a cop out and just another way of saying " I know I should be following a certain eating plan, but because I can only eat small amounts I'm not going to and see how long it will work for me".

It never ends well because NEWSFLASH, we will be able to eat close to normal portions someday. And if we couldn't eat in moderation before, why could we now? Without the benefit of mega restriction, not doing a complete overhaul of our diets is putting us back at square one. We've seen it over and over again in these forums, haven't we?

[VSGAnn2014 12,992]

@@Cowgirl Jane ...

I like to think I'm doing #3, mindful moderation And I really am, pretty much. That's a great mode for me to learn more about weight maintenance -- and we all know that maintenance is the greatest challenge of WLS.

However, I suspect there will be times in the coming years when I switch back and forth among all of these models. (FTR, I'm a relative newbie -- only 19.5 months out and still in the early, easy days of maintenance.)

For instance, over the 2015-16 holidays hubby and I went on a long, luscious cruise, and I definitely was doing the "no diet, portion control" approach. Happily, I didn't gain an ounce in 3 weeks. But I sure don't trust myself to go that route long-term. At least not now.

Obviously, when I was still losing weight a lot of things were on my abstinence list, but that's not the topic of this thread. I still abstain from soda, beer and a few other things.

Six to eight weeks ago I realized it was "Danger, Will Robinson!" time with respect to dark chocolate with sea salt, so I abstained from that until it released me from its claws. If I were to regain 10 or more pounds, I would definitely go into major abstinence mode and abstain from a lot of foods until I lost the regain. But I suppose that's just another way of being mindful and recalibrating appropriately.

The changes that would drive me much farther into the abstinence camp would be if my metabolism lowered or my activity level declined and I couldn't maintain my weight eating as much as I do right now (1,800 calories/day) or if I lost my ability to control my portions of "treats."

But for now, mindful moderation is working well for me.

EDIT: P.S. I'm a pretty consistent menu planner and tracker using My Fitness Pal.

[needtorecover 574]

Interesting topic for us "losers" to read, too! I aspire to become number 3 myself. It's never been my goal to be rail thin with <15% body fat... I want to be healthy AND happy. When I was thin in the past, I was kind of miserable because I subsisted on plain canned tuna, Diet Pepsi, and zero carb bread. I was skinny but my diet was bland and kind of awful.

My hope is that I'll be able to just eat like a normal person without wanting to shovel tons of food in my face.

[AvaFern 3,516]

As I was reading this, first I was like, well I'm totally #2, but then as I continued reading, nope, I'm #3. I do eat what I want to, except I don't want to eat crap, lol. I used to love sweets and now the sweetest thing I have is a skinny caramel macchiato and maybe some graham cracker goldfish. Part of the reason is that it tends make me queasy when I eat too much sugar, so that helps. I was never really big into Pasta, breads, or fried stuff so that wasn't really hard to stop eating. I don't drink, primarily because I work a lot and people frown on having their work done by a drunk/ hungover person. I don't tend to eat a lot of things that have been prepared elsewhere because it seems like everywhere has to put butter on or in stuff and if they don't use butter it's oil. Butter, oil, regular milk, eggs, and sometimes sugar are pretty much an instant puke, so while it took awhile to learn what I can and cannot eat, now I'm just not interested in the foods that make me sick. It was like being conditioned- like Pavlov's dogs- I see butter and my cheeks get that twingey-going-to-barf feeling.

So, while to be fair there isn't anything that I say I can't eat, I choose not to eat a lot of stuff because it either makes me sick or I don't want to gain weight and it isn't worth the gain. I think not having anything being off limits is what helps me. In the past I was always dieting with all or nothing, so when I slipped up and ate something bad, then it was like, well I messed up once, the streak is broken, chocolate cake for every meal! Now, if I want something that isn't healthy, I have it, and since there was no real denial or build-up, I'm fine not having it again for awhile. My mom sent me this awesome Easter basket full of candy I normally love and some Cookies. I poured it all into a gallon plastic bag and stuck it in my pantry for when I needed a sweets fix. It's been two weeks and I haven't had a single piece, whereas in the past it would have been forbidden so I would have had to eat it all and then go back to dieting afterward. Funny how our brains work when it comes to food...

[OKCPirate 5,323]

I tend toward option #3 - but I still track 85% of the time, and I'm inspired to make a push right now to lose 20 more in the Memorial Challenge. The guys forum has some great before and after shots and the thought of have hardened abs before swim suit season is a compelling goal.

But I like my barbaric diet. Most of my carbs are small amounts of veggies and fruit.< /p>

[BestDayEver 418]

I'm using the #3 approach. I decided there are 12 days of the year when I can eat whatever I want. I plan what treats I want those days and eat as much as I want, and when the day is over I go right back to my normal low carb/high Protein diet that works for me. If I crave something, I remind myself that I can indulge on my treat day.

I like tracking my food and still do it daily using the LoseIt! app. I'm weighing myself nearly every day now so I can make sure I stay on track. I pretty much don't eat bread, rice, potatoes or Pasta except for the rare occasion and I plan to keep it this way. I don't really miss or crave these foods anyway. I keep chocolate out of the house except for when I plan to indulge.

I've given all of this a lot of thought because I've been overweight my entire life and NEVER maintained a weight loss before. I always returned to old eating habits. Since that's never worked for me in the past, I plan to stick to my new plan. Wish me luck. I hope I post a year from now that I've been able to maintain my weight.

Edited April 4, 2016 by BestDayEver

[VSGAnn2014 12,992]

@@BestDayEver -- Thanks for that description of how you're doing it. I actually think that's a whole new fourth maintenance model. I'm going to call it:

(4) Splurge Days Approach

Or, since it's YOUR model, you can name it anything you want.

[VSGAnn2014 12,992]

Of possible interest to those who are now in maintenance is this BP post about a five-year study of sleeve maintenance performance.

"Benefits of Sleeve Gastrectomy Wane at 5 Years"

At http://www.bariatricpal.com/topic/349472-benefits-of-sleeve-gastrectomy-wane-at-5-years/#entry3933756

This study's findings mean, to me, that my choice of maintenance model(s) matters considerably!

[B-52 7,113]

I've had the Lap band, so I am in the minority here....

For me, there is no such thing as maintenance.

Ever since surgery, I have had to learn to eat differently, eat less portions and less often. I've also learned to give up certain foods.It was never a diet for me, but a new learning experience.

So I would say I developed a new lifestyle, in #3...I eat and drink whatever I choose to, but everything in moderation.

Overeating the wrong foods is what made me Obese and gave me all those medical problems.

Now I eat less (a lot less) and I eat the right foods.

It's what I had to adapt to over the years with the lapband, and it is what it will be for the rest of my life.

I can't turn it on and off....

I've been on numerous diets that ended with a maintenance phase, and I failed at everyone! That was why I needed surgery, to make a permanent "Fix"