Asking ? for cousin with sleeve...

[marfar7 1,533]

CROSS POST

Hey all!

I'm a 3 timer (I've had all 3 surgeries: lap band, sleeve, and bypass, currently underweight, struggling to keep weight up after losing colon in emergency surgery about 10mths ago but still remember what being overweight was like). My cousin had the VSG about 2 yrs ago at almost 400 lbs and has been semi successful and has lost close to 175lbs but over the past 9 mths or so has plateaued becuz of numerous "reasons" (moving across country marital woes, works stress, you name the stress, heredity,, etc.). She has reached out to me for help, as I admin a FB group for people with wls's + i was fairly successful (before I lost my colon, lol ) as she's desperate for help before it gets out of hand. She's gained 10 lbs in the past 10 mths since moving cross country and doesn't want to continue on. So, for the past month (and yes, even during the holidays), she's kept a strict journal which she always during her active losing phase. She sent me the last few days worth. I was dismayed to see her intake/output. Literally I think she's starving herself.

She's taking in 662 calories a day and exercising 280 . This means she's getting in maybe 380 cals a day. And shes' a special needs teacher and a mom of a 6 yr old! OMG! She's drinking a lo cal Protein Shake for bfast and lunch and eating a super lo cal protein/veg dinner. She's getting in plenty of Water and her vits, luckily. I think she's starving. But she said she's tried every variation of every single meal variation out there and she's frustrated she wants to cry. She's been on every "diet" her entire life and this sleeve was her saving grace and the only thing that worked - for a minute. Until the honeymoon was over. It's been about 2 yrs and now the hard work actually starts and I've told her this.

Ok, I just got this info from her when I asked her how much Protein she was getting: 109 gms a day. MFP shows only 35%. And she downloaded the ACTUAL MFP pie chart to prove to me this WAS the case and OMG! This is TRUE. Since when is MFP encouraging people to get almost 300 gms of protein a day? What protein u don't use, u pee out. Unless u r an unlucky few that r prone to kidney disease and then u get kidney dz! Seems ridiculous. Almost 300 gms!? And now they charge u? I told her she really doesn't need more than 70-80.

I need some input on how to help her. Some ,meal/snacking solutions. I dont think she needs to know that she needs to increase her protein as she's already getting an overabundance in that department. Maybe something her dr can do for her? Tests or something? Metabolism tests? Is this done with blood or what? Or can it be done by a RD? HELP!

Marci

X POSTED

[catwoman7 11,212]

at two years out, she should be getting double the number of calories she's getting now (if not more - depends on her height, weight, activity level, etc) - unless she's super short or has really screwed up metabolism or something. 662 calories is only common in the first few months after surgery, not at two years out.

re: the 10 lb gain, most of us gain 10-20 lbs after hitting our lowest weight, so that's not uncommon. It's almost expected...(not inevitable, but it happens to most people)

Protein - most of us are encouraged to get 60-80 grams a day. I need 100, but that's because we discovered early on that I malabsorb it - my prealbumin level tanks if I don't get that much. But I'm not the norm. 300 is crazy. No one needs that much - not even body builders. That's so weird that the app is telling her that!!

you mentioned an RD - might be a good idea for her to see one to get some good advice and guidelines on what/how she should be eating. She may have some issues that we don't necessarily know about (like me and my protein issue....)

[The Greater Fool 2,024]

I'll add that she may very well be falling back on food as a coping mechanism for her current and/or recent woes. It may be a wise move for her to connect with a therapist to help with coping with her situation and to help establish new and healthier coping mechanisms.

Good luck to her.

Tek

[RickM 1,747]

Something isn't adding up here. If she's getting in 109g Protein, that's 436 calories right there. If she's only taking in 662 calories, then her protein would be about 65% of that. Maybe some misinterpretation of what MFP is reading? I can see that they might "recommend" 35% protein for her low calories - a typical normal diet might be 15-20%, and a bariatric weight loss diet might well be 50-60% (or more, at the beginning when we are eating little else other than protein.)

60-80g would be a typical recommendation for a woman with a sleeve, as there is no significant malabsorption involved, though some go higher than that as a means of avoiding "carbs", or under the false assumption that the extra will help avoid loss of muscle mass (it will to the point that one is actually working to build muscle mass, but the only thing the excess does, other than make expensive urine, is to avoid deficiency, but one doesn't need much extra to avoid that - the typical bariatric recommendations will cover it.)

It does sound like a bariatric RD would be a good person to consult, and if she is truly only getting 6-700 calories and still struggling, then there may be some other metabolic issue going on, and some other appropriate specialist may be in order. But a good RD would be a great start in getting a good baseline of what is really happening dietwise. Starting at 400 lb, a sleeve is often somewhat marginal for getting to normal, particularly for a woman of that size (how tall is she - that's a factor as well in determining an appropriate goal and understanding metabolic issues.)

You say that she recently moved cross country - where is she now - that can be a help in finding new specialists. It might be that the VSG is indeed marginal for her needs, and she really needs something stronger. A DS is a straightforward conversion from the VSG (as it uses the sleeve as its basis) and is typically the strongest metabolic tool of the mainstream procedures, so that is also a longer term consideration.

[Arabesque 7,245]

Maybe finding a good therapist & a dietician will help your cousin get back on track. They can be very helpful during this process - supporting her through the emotional turmoil & sorting out her dietary concerns & issues. Also speaking with her surgeon (via Skype or similar) or asking them for a referral to another surgeon close to her now may be helpful too.

There is no need to go back to the very low calorie, shake diet. This was in place for a specific period of time to support healing. Sure people lose weight on very low calorie shake diets but they are not sustainable & regain is usually inevitable. Eating in a way that was more like what she was doing when she well into her weight loss (say the 6 or 12 month mark) would be more beneficial: observing portions, Protein & fluid goals, & eating a range of vegetables, fruit, dairy, & small amounts of low processed multi/whole grains.

As @catwoman7 said a bounce back regain of 10-20lbs is very common in the 2nd/3rd years so her regain could be just that. Also I wonder if she was given reasonable expectations as to what her weight loss could be after surgery? The average weight loss after sleeve or bypass is about 65%+/- of the weight you have to lose to put you in the healthy BMI weight range. (Yes, the healthy BMI range is not always the best weight range for someone & yes, some people do exceed the average result.) She may be beating herself up with somewhat unrealistic goals ( though I understand her desire to lose more). This video may be of assistance to help your cousin look at her achievement of losing 175lbs in a different way: a success.

[catwoman7 11,212]

^^^ this is such a terrific video. It's my second time watching it. Clinics should be recommending this to all pre-op patients!