2 Years Post-Op: Can't Lose More Weight

[BrandiBird 23]

It's been a while since I've been active on here, but I'm really struggling. Any advice or encouragement would be a huge help. 😥

Almost right at my year mark post-op, I stopped losing weight. My doctor said that I should still be losing 1-2 pounds a week. Around this time I was eating 1400-1500 calories, so they recommended I scale back to 1200. I try to eat whole, unprocessed foods about 80% of the time, I still track what I eat, count my calories, prioritize Protein, and exercise 4-5 times a week for 30 minutes (usually cardio, but I do resistance train, just not faithfully).

I am eating 1200-1400 calories a day, and I'm struggling so bad. My weight sits somewhere between 211 - 219, depending on Water retention, my cycle, travel, stress, etc, and it really hasn't changed since I saw my doctor last. I would love to try the GLP-1 class drugs to see if that could help, but my insurance doesn't cover it, so that's not an option.

I'm really depressed over this, which I know doesn't help things. I feel like I've worked so hard, and I've just barely gotten halfway there. Now I'm terrified I'll start gaining weight again, and I've caught myself obsessing over my eating to the point it's feeling disordered and mentally unhealthy.

Has anyone else had this struggle? If so, what helped you - either with losing more weight, or just coping with being at a plateau? 😭

[SpartanMaker 1,025]

So if I'm understanding your post correctly, you've been eating 1200-1400 kcal per day yet your weight has been stable at ~215 pounds. This either means:

1. Your total daily energy expenditure (TDEE) is also around 1200-1400 calories per day, OR
2. You're eating a lot more calories than you think.

Let's explore each of these in more detail.

Based on your height and weight, your TDEE should probably be 1800 to 2200 calories per day. Just your BMR or Basal Metabolic Rate (the number of calories your body burns per day just to keep you alive), should be ~1500-1800 calories per day. There are lots of reasons this could be lower, but for your TDEE to be 1300, you'd have to have a BMR in the neighborhood of ~900 calories per day or as much as HALF of what we'd expect. This would be exceptionally low considering your size. BMRs that low tend to only be seen in elderly frail women. To be clear, without having a metabolic test, we can't know for sure, but this does seem unlikely.

A more logical reason for this discrepancy is that you're actually eating a lot more than you think. Calorie overestimation is extremely common (unlike extremely low BMRs), thus I lean toward this as an explanation. I have seen some suggestions stating that the magnitude of this may be as high as 40-50% underestimated. In other words, someone could think they're eating 1500 calories, but they are actually eating 2200+. So where do people go wrong?

1. Misreading/misunderstanding nutrition labels. It's not uncommon for people to confuse a serving with a container of food. Sometimes, manufacturers will list a serving of something, but what you're actually eating may be 2 or more servings.
2. Accepting as fact the calorie counts on nutrition labels. In the US, calorie counts on nutrition labels can be off by as much as 10% before manufacturers would be expected to adjust the calorie count. Keep in mind, though that manufacturers are self policing here and really don't have a lot on incentive to make sure these are correct.
3. Many people simply guess at serving sizes, especially if it's a meal they made themselves. This can lead to wildly inaccurate calorie counts
4. Also very common when they are making meals themselves is to just look up a calorie count for a similar food, but this also can be really inaccurate.
5. Lots of people guess at amounts, thus you may think you're getting say 1 cup of a food, when it's actually 1.5 cups.
6. Speaking of measuring by cups, this also is wildly inaccurate. To properly measure calories, you really need to weigh EVERYTHING you eat IN GRAMS. Any other method just isn't very accurate.

I also wanted to touch briefly on your comment on exercise. While I think it's great that you're exercising, this really has nothing to do with weight loss. Lot;s of studies show that increasing energy expenditure through lower levels of exercise like you're getting typically leads to lowering your energy expenditure elsewhere throughout the day. This means you really have no increased calories burned and shouldn't think this means it's okay to eat more as a result.

[ynotiniowa 26]

Good morning. I'm not discounting anything SpartanMaker posted above. However, I was in the exact same boat as you. I was eating 1200-1400 calories, religiously measured/counted everything, plenty of Water, I played with my macros till I was blue in the face and for 10 months I did not lose and I did not gain. I'm a nurse so I probably have more background in nutrition than most, so I'm confident in how I was eating was appropriate and what most providers would "recommend". In February I went to my two year follow up. My labs were perfect, my vitals on point and I had not lost one ounce since the last visit nearly a year prior. After having a long conversation with my bariatric provider, the only change since the losing stopped was I was pretty much into full menopause. We discussed options and ideas on how to "overcome" the hormone influencing my insulin processes that was affecting my metabalism hurdle I may possibly be facing. She said based on her research Zepbound might be a great option as it also can help in reducing "hot flashes" which I was having twice a day, everyday. Long story short, even with my insurance, zepbound would have been around $700 a month, so I choose to do the my budget friendly compound Tirzepatide route (the compound equivalent to zepbound) with my provider's blessing. I have been on the weekly injections for 6 weeks and have already been able to shed 19#. I have not ate any differently, no change in my physical activity AND the hot flashes are gone. I'm not suggesting this would be the answer you need, but it's been a game changer for my journey. Good luck ❤️

[SpartanMaker 1,025]

I guess I shouldn't respond late at night like I did above because I left out some common mistakes people make when logging calories:

1. Mindless eating: either failing to log those little nibbles here and there (including when tasting food during prep), or trying to log it, but guessing after the fact as to how much they actually ate.
2. Not understanding that raw vs cooked food can have vastly different calories. A classic example: The USDA says 100 grams of raw chicken has ~106 to 120 calories per 100 grams. The problem is that when cooked, 100 grams of this same chicken is ~165 calories. The primary reason is due to Water lost during the cooking process. This is not an issue if you properly portion out how much of the chicken breast you ate, but if you are using the raw calories and weighing it when cooked, you'd actually be eating a lot more calories than you think.
3. This is a big one: not counting liquid calories. for reasons I don't fully understand, a lot of people just either ignore or don't log liquid calories. That juice they drank for Breakfast? Didn't log it. The milk in their coffee? Nope, not logged. That energy drink they had in the afternoon? Not logged either. I think you get the idea.

If you haven't figured it out yet, I'm not a huge fan of logging calories since it's really hard to do correctly and even when done to the best of our ability, it's still often wrong. I think, as it may be in your case, it also can become a crutch.

There is no cheating physics here. If you eat more calories than you burn in a day, you'll gain weight and if you eat less, you'll lose. As I hope you'll see from what I've posted, in all likelihood, you're eating more than you think. Let's just for the sake of argument say you're really great at logging and you really are just eating 1200-1400 kcal a day. The only other explanation would be an exceptionally low BMR. This would really suck if it's true, but if we assume it is true, then that would still mean you're eating too much. Either way, you have to eat less than you're eating now if you want to lose.

[SpartanMaker 1,025]

15 minutes ago, ynotiniowa said:

I have been on the weekly injections for 6 weeks and have already been able to shed 19#. I have not ate any differently, no change in my physical activity AND the hot flashes are gone. I'm not suggesting this would be the answer you need, but it's been a game changer for my journey. Good luck ❤️

This isn't surprising. In addition to their appetite suppression benefits, GLP-1s also can increase metabolism, meaning you'll burn more calories per day without a change in activity levels.

[ynotiniowa 26]

7 minutes ago, SpartanMaker said:

This isn't surprising. In addition to their appetite suppression benefits, GLP-1s also can increase metabolism, meaning you'll burn more calories per day without a change in activity levels.

Exactly on point and why it was a fit for me as I was in full menopause with my hormone changes basically stalling my metabolism. I haven't experienced my appetite suppression as other have but regardless, due to my particular medical needs, it's working for me 🙂 Also, as an endocrine nurse, I have found my personal experience during all this as an amazing way to connect with my patients who are facing similar challenges. Everything happens for a reason ❤️

[SpartanMaker 1,025]

3 minutes ago, ynotiniowa said:

Exactly on point and why it was a fit for me as I was in full menopause with my hormone changes basically stalling my metabolism. I haven't experienced my appetite suppression as other have but regardless, due to my particular medical needs, it's working for me 🙂 Also, as an endocrine nurse, I have found my personal experience during all this as an amazing way to connect with my patients who are facing similar challenges. Everything happens for a reason ❤️

If the OP thinks it's the solution and can find a way to pay for it, then they can certainly try a GLP-1. Keep in mind current studies suggest up to 20% of people are non-responders, meaning they don't work for everyone. Also, even compounded versions can be prohibitively expensive for some people. I would also caution the OP to be careful when seeking out compounded versions. As a nurse, you're in a better position to find a decent compounding pharmacy and also not make medication administration errors. Unfortunately compounded GLP-1s are a bit like the wild west right now, with shady operations and less than ideal directions/administration of the drug. So much so that the FDA has put out an advisory:

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss

Caveat emptor was never more true.

[ynotiniowa 26]

11 minutes ago, SpartanMaker said:

If the OP thinks it's the solution and can find a way to pay for it, then they can certainly try a GLP-1. Keep in mind current studies suggest up to 20% of people are non-responders, meaning they don't work for everyone. Also, even compounded versions can be prohibitively expensive for some people. I would also caution the OP to be careful when seeking out compounded versions. As a nurse, you're in a better position to find a decent compounding pharmacy and also not make medication administration errors. Unfortunately compounded GLP-1s are a bit like the wild west right now, with shady operations and less than ideal directions/administration of the drug. So much so that the FDA has put out an advisory:

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss

Caveat emptor was never more true.

All excellent information and points which is why I always direct my patients and anyone I give advice/an opinion to that it's best to discuss your specific medical needs with your bariatric provider to choose what "tools" are best to fit your goals.

Every "tool" will have non-responders or "failures". Having a open, close dialog with your provider will ensure a better rate of success. No ones medical history is the same nor will be what they need to do, take or undertake to achieve said goals.

[SpartanMaker 1,025]

Just doing some looking and it looks like the supply of compounded semaglutide and Tirzepatide is about to dry up. This compounding was only allowed by the FDA because the patented drugs were on the FDA shortage list. Both those drugs have since been removed from said list, meaning compounded pharmacies won't be able to keep selling these. (With some possible tiny exceptions like custom dosing protocols.) Dulaglutide or Liraglutide are still on the shortage list, so these may need to be the drugs of choice for those seeking compounded versions.

[ynotiniowa 26]

5 minutes ago, SpartanMaker said:

Just doing some looking and it looks like the supply of compounded semaglutide and Tirzepatide is about to dry up. This compounding was only allowed by the FDA because the patented drugs were on the FDA shortage list. Both those drugs have since been removed from said list, meaning compounded pharmacies won't be able to keep selling these. (With some possible tiny exceptions like custom dosing protocols.) Dulaglutide or Liraglutide are still on the shortage list, so these may need to be the drugs of choice for those seeking compounded versions.

Actually, compounded Tirzepatide is compounded with Vit D and/or L-carnitine with provides different dosing levels than prescribed Zepbound hence it is still available for purchase as it does not "duplicate" the medication per FDA guidelines. This new guideline was effective March 19th and I have had a compound Rx script filled since then with L-carnitine compounded with it, no issues or problems. Works just the same as before.

Edited April 17 by ynotiniowa

[SpartanMaker 1,025]

29 minutes ago, ynotiniowa said:

Actually, compounded Tirzepatide is compounded with Vit D and/or L-carnitine with provides different dosing levels than prescribed Zepbound hence it is still available for purchase as it does not "duplicate" the medication per FDA guidelines. This new guideline was effective March 19th and I have had a compound Rx script filled since then with L-carnitine compounded with it, no issues or problems. Works just the same as before.

I'm not really surprised considering the amount of money involved here. That said I'm seeing reports that many providers of Tirzepatide have already stopped providing it. I would expect the same for semaglutide soon. I guess time will tell if the FDA will allow other companies that are essentially skirting the rules to continue to do what your provider is doing. Keep in mind that dosing schedules within 10% or compounding 2 drugs not on the shortage list are not allowed as ways around this restriction. It may suck for consumers, but cost alone is not a factor in whether or not the FDA allows medications to be manufactured and sold by someone other than the patent holder. Any compounding pharmacy that tries to get around the rules is at least subjecting themselves to more regulatory scrutiny. Some may find themselves out of business.

I honestly don't have a dog in this hunt, but I do think folks here need to be aware that the playing field may be changing if they already have, or are planning to try compounded GLP-1 drugs.

Edited April 17 by SpartanMaker

[ynotiniowa 26]

👌

[SpartanMaker 1,025]

Getting back to the OP's question about what do do: If they really feel they are accurately logging and are also having a hard time eating less, then the option would be to take steps to increase metabolism. Yes, GLP-1 drugs can do this, but there are other options.

First, would be adding muscle mass from strength training. Estimates are that each pound of muscle increases calories burned per day by roughly 6 calories, Each pound of fat contributes ~2 calories burned per day. This latter fact surprises some people, but fat is metabolically active tissue. It's just that muscle is more metabolically active. If someone were to gain ten pounds of muscle and lose ten pounds of fat, that would lead to an increase in BMR of roughly 40 calories. That doesn't sound like much, but it adds up over time. If you also add in EPOC (Excess Post-exercise Oxygen Consumption), from the strength training needed to add muscle mass, then I'd estimate this would over time lead to ~400-450 extra calories burned in a week. That would lead to a loss of ~6 pounds in a year even while eating the exact same amount of food.

If this is not a sufficient amount, then one can always reduce calories a bit as well.

Alternately (I know this will sound counter-intuitive), but the OP might well want to consider UPPING their calories a bit for a while. Our bodies were designed to upregulate our metabolisms slightly when calories are available and downregulate it when calories are scarce. This means our bodies can maintain weight at a wide range of calorie intake. If we're constantly in a calorie restrictive diet, our bodies do downregulate metabolism to keep us from what it perceives as starving to death. What I'd recommend instead is going up 200-300 calories per day for about a month. After this "diet reset", drop down again to 1200-1400 for no longer than 2 months before cycling back up again. You can keep this cycle going on indefinitely. One of 2 things will happen here.

1. Most likely the OP won't gain anything during the increased calorie intake diet reset because their metabolism will increase to compensate. However, when they start back at the ~1300 calorie range, their metabolism may not drop immediately, meaning they'll lose a little bit in the following 2 months.
2. If they do find that they gained during the diet reset, but fail to lose when back in the diet phase, then worst case it shouldn't be more than about 2 pounds (less than 1% of body weight). This isn't likely, but even if this does happen, it will at least tell us that 1300 won't work for weight loss for them and they'll need to go lower.

I'd also be remiss if I didn't come back to exercise here. I mentioned that low levels of exercise (30 minutes of cardio), really are not going to do anything toward weight loss. It's obviously going to be different for everybody, but current research seems to suggest that the tipping point is about 400 calories per day. What I mean by that is if you can burn OVER 400 calories in exercise in a day, the body can't suppress your metabolism enough in other ways to keep you from going net-negative for the day. Said differently, you'd need to do something that burns more than 400 calories before it "counts" for weight loss and the only part that counts is the part above 400 calories.

Unfortunately, 400 calories is A LOT for most people. The good news is the heavier you are the more you burn, but even at 215 pounds, you'd probably have to run over 3 miles to hit 400 calories. Keep in mind, this would just be to break even, so if you're actually trying to burn more calories this way, it will take even more.

I'll use myself as an example here. I'm not trying to lose weight right now, but I have found that if I run over roughly 28 miles in a week, I tend to lose weight. If I run less miles, I maintain. Do the math, and for me that's right at about the 400 calories a day mark. In my use case of one, I'm pretty close to the statistical average as shown in the research.

Best of luck whatever you decide.

[AmberFL 980]

I agree with @SpartanMaker eating more might sound crazy but it works!

Resistance training has completely transformed my body. I started incorporating it around 4–5 months post-op, and the weight started dropping like crazy. My body looked significantly better compared to when I was just doing cardio. Around 6–7 months post-op, I added 30 minutes of running at least 5 days a week, and at that time, I was eating between 2,100–2,300 calories daily. Even with that intake, I was losing weight and had actually dropped below my goal weight.

I had to take a break due to surgery, and during that time my weight fluctuated upward—which was really frustrating. Even though I cut my calories and kept my macros on point, the scale wasn’t moving the way I wanted it to. But now that I’m back to resistance training (I’m not cleared to run yet), my weight is slowly trending back down again.

I say try it! If you would like some guidance I have a few circuits that I do and has worked really well! I am happy to share ❤️

Edited April 17 by AmberFL

[catwoman7 11,233]

just a note on BMR - I've heard this from both a former dietitian of mine and from a nutrition class I took a couple of years ago at UW-Milwaukee on obesity and weight loss, so it's likely true (seems to be the case with me, anyway...). It's very common for formerly obese people to need to eat 300-400 calories less per day than a person of the same height/weight/activity level who's never been obese in order to maintain their weight. So in other words (and I'm just pulling this example out of the blue), if a calorie calculator tells you that it takes about 1800 cal/day to maintain your weight, if you were formerly obese, that could mean that for you, it's probably more like 1400-1500 calories to maintain. That being said, I do agree with some of the others that you may be underestimating your calorie intake since I would think you'd be losing weight at that intake level. It might be helpful to cut back by about 100 cal/day for a couple of weeks and see if the scale starts moving again. if not, cut another 100 calories for a couple of weeks. Rinse and repeat until the scale starts moving. I've had to do this a few times to get things moving..