It's all new

I started out a 44H and ended up a 34D before I had my lift. Before my lift I had been left with something resembling a tube sock with a ball in the bottom. With a lift I am a 34C. I had enough breast tissue left to have proportionate and perkier breasts - but they don't have the amount of volume in the upper breast as implants. I do prefer that about implants -that your breasts can appear to be those of an 18 year old... However, given the lower cost and that I had enough breast tissue left to look somewhat proportional I ended up with the lift. I retained normal sensation, it was a far easier recovery than my other plastics, and I would do it again.

So - what I was told is that I likely a medical condition that has made me overly hungry - probably involving leptin rather than grehlin. I haven't been able to afford the testing, it is not covered by my inadequate insurance. The specialist I saw thinks this explains why after the surgery I never had a decrease in my hunger - none, whatsoever. The doc thinks that reducing grehlin didn't help me because I have too much leptin. I was more than adequately treated with PPI's for acid reflux etc. Anyway - my obesity was due to regular and continuous overeating. I was hungry every few hours, no matter what I ate. That remains true. The difference is twofold: 1) my metabolism has improved because I am far more active 2) I don't have enough capacity to meet my caloric needs, especially if I get busy and miss an opportunity for a meal or snack - there isn't a way to make up for that easily. Currently, I have an added issue that my stomach has tightened up severely with stress and so my capacity is way down. I am drinking a lot of fruit juice, ensure, Protein Drinks, and soft foods seem to be working better like cheese grits, pastries, chocolate, etc. I just go for any high calorie food that my stomach will tolerate. I gravitate towards lots and lots of carbs and fats, as I can physically fit more into my sleeve. I aim for enough protein to maintain muscle. Also, the caloric fruit juices. My weight has just recently stabilized and I have put a pound back on, which is moving back in the right direction. I did once accidentally gain weight after surgery - not just a normal fluctuation or muscle gain, but fat. And it was when I drank 3-4 8oz glasses of fresh orange juice every day for 10 days, combined with eating out for every meal and not exercising at all. I think I gained about 3-4 lbs. So, it's not impossible for me to gain weight. It is just really unlikely in my normal lifestyle. But... that should explain, in a nutshell, how someone who was obese can end up with this problem. There are plenty of medical issues that can lead to obesity and aren't very well understood. Bariatric surgeons are not very good at diagnosing or recognizing these issues as it is not their area of expertise - not really. They treat obesity thru surgery, and that is usually their focus.

CBT, it's good to see you in this thread! There are too few of us with this issue represented on this site. I really feel this is more common than folks realize... but that those of us who are dealing with this are not as likely to come to the site. I've had some statements that I should exercise less. Given that my doc feels that my exercise is totally appropriate - actually, my primary doc and my bariatric doc both - I would say I am on the right track! Yet, for those who are not fighting the same issue with keeping up sufficient weight, I suppose it does seem like an easy enough solution - it's just that I didn't make the change to be thin and sedentary! I made the change to be athletic. Trim is helpful, athletic - athletic is awesome. The OP seems to have had similar sentiments thrown her way. I understand the reticence to give up exercise. It does force you to bring up the calories to match your body's requirements if you want to improve, though. Also, I have found that nutritionists don't have a lot of experience with this issue. I have recently found a helpful and more nutritious way to up calories. It isn't cheap, though. I have been juicing. I am mixing fruits and veggies, with a slightly higher proportion of fruits to keep up the calorie count. As it is a liquid I have almost no restriction (I do have to drink more slowly than water) and am able to get far more nutrients and calories than I would otherwise. Now that I have dropped to 120, I am feeling like I absolutely have to make myself get more calories in. So... juicing. I think it is a good recommendation for the OP. Ice cream is good - but if you feel like it isn't a great answer for you, juicing tastes far cleaner and healthier. By adding kale, cucumber, and lime when you make it, the sweetness is balanced out and it tastes pretty good, too!

While this issue is unusual - I don't think as uncommon as you might think. I only personally know three other sleevers. All four of us had no problem hitting goal, and two of the four of us struggle with keeping our weight up. For both of us, keeping weight on under stress is the biggest problem. And, when you add exercise it gets even trickier. Recently I have been under enough stress to have to switch to primarily liquids. My stomach is too tight to allow for enough solids to get my calories - it has been a physiological reaction to stress. My weight has dropped to 121 lbs, and it drops more every day. My doctors goal weight for me was 155. My goal was initially 145, although I ended up thinking that 130-135 wasn't bad. It sounds like you went to the doc already, which is what I did as well. I also had testing to find my BMR so I would know my actual calories needed - and I need at least 2,000 calories to maintain my weight if I don't exercise, and more when I do exercise. My approach is to add high calorie liquids. A combination of Peanut Butter and Protein shakes is good. Other foods to try are: Guacamole. Ice cream. Whole milk and heavy cream. Ensure. Etc. The healthy fats are obviously from nuts, avocados, coconut oil, olive oil, etc. Unhealthy fats are from dairy. At this point, it is more important to me to keep my weight on than to worry too much about unhealthy fat (within reason). The problem is, being underweight has the same increased mortality that being obese has - and we did not go through all of this to end up with essentially the same issues we started out with. I just try to force the liquids in, don't worry too much about the comments from others, and know that under less stress it will get better.

Yes - the tummy tuck process is a tough one. But it is totally doable. Just one day at a time and before you know it, you get to enjoy your new svelte figure! All the work for your weight loss will be shown to its best advantage. I had a harder than average recovery yet never regretted it for one moment. You just look down and know - those difficult days will soon be behind you and will mean nothing in the context of a lifetime of enjoying your new look! Just relax, make sure you have the support you need for afterwards, and stay calm.

Looking fabulous, 2.0! You have worked hard to be where you are - repeatedly. It's admirable, and so important to let others know that it CAN be done. It's nice to see you back in action and with such a good attitude about it all.

I am struggling to find anyone else for support who is in a similar situation - whether it is because I am a rarity or that those of us with this issue don't frequent the support forum... I am not sure. I am getting frustrated over time and tired of working hard not to lose weight. I would never have expected this to be a problem! I had my surgery in May 2012 at 255 lbs and have been at goal for a bit over a year. I am currently struggling with a recurrence of depression, so the energy that I have typically been putting into getting all of my calories and exercise is flagging - I am getting treatment for the depression but it takes some time. I have worked very hard not to lose weight during this time and to keep my calories up. Typically I am very, very active. I expect that within a few weeks I will be feeling enough better to be back to exercising more. I usually exercise about 15 hours per week, taking one or two days off. Usually at least one day per week I get four to six hours of exercise, even as much as eight hours. I am an avid cyclist, hiker, skier, etc. My problem seems to be that I have a very high BMR of 2,000. So, I need at least that many calories on days with no exercise. Then, add exercise and I have days where I need 5,000 and even up to 7,000 calories in order to maintain my weight. Obviously those super high calorie days are rare, but I regularly have 3,000+ calorie days. Typically I am using lots of whole milk (at least 750 calories of whole milk per day) and on days when my weight has dropped below my comfort zone I start adding heavy cream or half and half. I also eat avocados, nuts, olive oil, butter, premier Protein shakes, etc. I also make green shakes - blended Protein powder, Greek yogurt, fruits, veggies. I use chocolate on days when I am desperate for more calories but don't have more room for real food - it's a total slider. I probably get minimum 1,000-1,300 calories from liquids and the rest from solid food. I have to choose the highest calorie foods out there - looking at a menu I will intentionally choose whatever has the most possible calories. My goal is to maintain at 130 when not working out and up to 135 if I am working out a lot. I was at lower weights initially (down to 123 at 5'6") and looked way too thin. At the lower weight I had too little muscle, was a size 0, and was told that I looked like a victim of weight loss. It wasn't a kind thing for someone to say but was accurate - at just a slightly higher weight I look far healthier and more proportionate. I am on the mobile app and have not updated my ticker from my lowest weight probably - but that is where I am at today and what I have decided is healthiest for me. It took a lot of effort to add muscle weight. When I was obese I didn't exercise and I am sure my metabolism wasn't this high. But now that I have lost the weight I worry that I will be thinner, fit, and set myself up for the same health problems by eating unhealthy foods in order to maintain my weight. I hear that weight gain is common at the 3 year mark. I also worry that the way I have to eat now in order to maintain my weight could set me up for problems later on. I currently weight myself regularly to make sure I am not losing weight rather than to make sure not to gain, though. I think if the depression would improve I would have more energy to pursue healthier high calorie food options. Looking for suggestions and other people in the same boat...

I read a 2012 Bariatric Times article that gave me some insight on this. The article said that "an increasing number of studies have shown that gastric emptying after LSG (laparoscopic sleeve gastrectomy) is accelerated by as much as two-fold." I have to eat similarly frequently, and it's not acid - I take 30mg Prevacid twice daily. I would probably try an acid blocker in your situation since it is such a common sleeve issue, but you are not alone! I think for those who don't experience hunger, the rapid gastric emptying isn't noticeable - but for someone like me who never lost my hunger, it's a problem!

I never lost my hair - been at goal a year. I was good about my protein and had good luck, too.

I got down to a 0, and worked hard to gain muscle in my thighs and rear and got my size up to a 4/6 with 6 additional lbs. I feel I appear much healthier and my athletic performance has improved. It is not difficult to maintain - however my lifestyle is dramatically different than when I was a size 24. If I had stayed at a 10/12 and not strived for the additional loss, I imagine maintaining it would be almost the same as maintaining my weight now. But... time will tell. I have been at goal for a year, there is plenty of time to find out that it is more difficult than it has been thus far!

I am not sure on this - but was told the same thing at a group presentation on fitness recovery. It was not a presentation for WLS folks, and was given by a nutritionist. I have since wondered whether or not it was accurate!

Looking great! What parts of the process are you finding hardest? What do you enjoy the most?

I had the same thought, to get rid of all my clothes as I lost and not regain a singe lb., except it turned out not to be the best plan for me... I was too small when I finished, at a size 0 or 2, 5"6' 124 lbs, and I have a larger frame. So, with a lot of work I put muscle back on, and my posterior and thighs got bigger (up to 130 currently, I go as high as 135 when I am working out long hours and my muscle mass is higher). I look much, much healthier. I now wear a size 4 if my clothes are fitted, or a size 6 if I am wearing a belt and want them to be a little loose and accommodate a lot of movement - like hiking and climbing. So, I did have to buy bigger clothes once I reached my goal, but I am not complaining. I look healthier, I am stronger, and so I accept it. But man... it was really, really hard to get my mind around the fact that smaller isn't always the best answer (for me). These are difficult issues!

I can understand, sort of, how the woman might have been initially offended... but she should have cut you some slack as soon as you explained! I still have times when in my mind I label myself as obese, even though I weigh 130... and then I remind myself of the reality. After many years of being obese, and only 1 year of being thinner - its still an adjustment. Particularly if the woman was overweight, she probably felt judged somehow, even though it had nothing to do with her and everything to do with what is going on in YOUR life. It's true, you just have to work a distinctive new look - a haircut, those red boots, the flower gman mentioned... something that people can identify immediately as YOU. It's nice to have to find a new trademark!

I don't think it's bad to share that there can be major 'costs' to the surgery that people might never imagine. If it us helpful to talk about what is going on, you should. Sharing what happened can be really cathartic. I think that a year from now, and even two years from now you will have much better perspective on the experience. By then, the dust will have settled and you will have had time to establish some new friendships, for example. The huge highs and lows will have settled a lot, and life will seem more manageable. It is a hard journey for folks without major complications... just the tincture of time can be very healing.

I have the exact same problem area remaining as well! The darn side boob. And totally agree - it is going too far to have surgery for that. It bothers me a little, but looking for perfection is not going to happen. I had the thigh lift, tummy tuck, breast lift (no implants), and some work to tighten up my face - three separate surgeries though. With the breast lift they chased the scar farther back than normal, basically in a straight line from the bottom of the breast somewhat where the bottom of your bra sits, stopping about 4-6 inches below my armpit. It helped with the extra side boob skin but by no means solved the problem. The doc said she would have to do a zig zag incision up my armpit for that and that it would be quite difficult to heal properly and that the scar would be more disfiguring than the excess skin. Yep. I'm good. Leave me with the skin! I'm glad to hear that your healing process has gone well and that ultimately you found a surgeon with whom you were so happy. That's awesome.

Well... my hunger never went away to begin with, so my answer isn't quite as useful! I am just over 18 months out. I've had the exact same level of hunger from day 3 post surgery to today, which was unchanged from prior to surgery. I would say that in some ways it was a benefit, because there wasn't a time where I had to struggle with hunger returning. However it made the weight loss phase very hard as I had the sensation that I was starving myself, whereas most people don't feel the hunger in that time. Perhaps six of one, half dozen of the other!

Just to chime in in the iron issue - I haven't found any iron supplements I can tolerate. I have had to have quite a few infusions since my surgery in May 2012. I ended up getting an endometrial ablation in August 2013 to help with at least one cause of low iron, and it has improved my levels. Obviously it isn't an option for women who are interested in having children, but as I was infertile already it was a non-issue for me. I will be keeping an eye on this long term though, especially after reading the experiences of some of the other folks here. Thanks!

I lost 10 lbs the week before surgery - the darn pre op diet was a requirement. I would still count that week as perhaps the most difficult aspect of the entire journey! I was self pay, but the surgeon was strict about the preop diet and the need to lose the 10 lbs that week before.

I had group health with a plan that specifically wouldn't cover any bariatric surgeries... not very helpful, sadly. It was a county employee plan. I had to private pay, ultimately. Sounds like you have a better plan - hope you were approved!!

I take gabapentin for neuropathy related to tarsal tunnel. I lost all my excess weight and have no issues maintaining. My excess was gone in 8 months and I have been at goal for a year. My only issue has been needing to lower the dose due to increased sedation - weighing half as much and never having much in my stomach doesn't help the sedation side effect.

This was really painful for me at one point too. My hip bones and tail bone both. It was miserable! The answer was to work out and build my posterior. I spent my summer cycling hundreds and hundreds of miles and listening to booty songs - lol - for inspiration. (Baby got back, Honky Tonk Badonkadonk, Rump Shaker... you get the idea!). I also added a few lbs back to my frame from my lowest weight. At 5'6" 123/124 was too low, ultimately. Now I fluctuate between 130-135 depending on my level of exercise. More exercise = more weight. It has really helped to build my glutes.

Yay! I have found another!! I've taken to eating all sorts of things - and plenty of carbs. You should see the huge glass of OJ I'm sitting here with at the moment. I don't have a carb monster anymore, as there isn't a food that is off limits or even a food to limit. I just try to meet my nutritional needs and caloric needs. Don't let the saggy skin fool you!! My photos before my plastic surgery made me look as if I was still obese, yet I am only 5-10 lbs less now. 5 lbs when I am exercising heavily and my muscle mass is better, 10 when I have lost muscle. (Which happens quickly!). Point being, looking at the photos I looked obese, but obviously it was just skin. I think I read you are planning plastics - it can be very hard to maintain weight after plastics as you can't exercise. (I expected the opposite problem, but with the high metabolism, and the fact that without exercising the appetite is even less, it was a problem). I lost a lot of muscle, and had to really fight to get the calories in. I didn't find that I needed to triple my calories, but I had a very hard time getting in even the same number of calories as usual.

So, I got my BMR testing and VO2 max testing at Seattle Performance medicine. I saw a great doc, and was very happy with the info they provided. It helped me because I had been taking in far fewer calories than I needed to support my activity based on my WLS telling me I would have to stick to a 1,200 calorie diet the rest of my life. Given that my BMR is about 2,000 that wasn't working well for me! It was maybe $350, and while that is a lot of money for my budget it was really worth the information I received. I got heart rate training recommendations, found out I had been overtraining (just pushing my heart rate a bit too high to properly improve performance), and learned how to figure out the number of additional calories I would need each day based on my heart rate during exercise. When I eat solid foods I do tend to choose a lot of high carb options - I try to balance so that my plate looks like 3/4 carbs and 1/4 Protein by volume. I still get in enough protein each day given the milk I drink and the number of meals and Snacks, and then I eat a lot of high calorie carbs - mashed potatoes with heavy whipping cream and butter, or a part of a roll with butter, and then I bake Cookies and apple crisp and eat them with ice cream as a snack later in the evening.. It sounds kind of awful... but if I didn't do those things I would lose weight that I don't want to lose. I get in my fruits and veggies as liquids in my green shakes that I make. I appreciate that you understand that the activities I am choosing are part of an active lifestyle - and by their nature take long periods of time. Similar to a trail ride, they burn lots of calories at lower heart rates over many hours. But the joy is in the things you do and see over those hours! There are some beautiful places in the Pacific Northwest. Thank you for the suggestions!

I have had my thyroid checked - I have hypothyroid that is regulated into the normal range with meds. I've also had other lab work. In terms of exercise I am not at the gym working out obsessively, I am outdoors doing things that take long periods of time. In order to ride a century ride it is necessary to train for long periods of time, in order to take long hikes it necessary to take longer hikes for training, and skiing and snowshoeing also are endurance activities. I am slow paced, and these are endurance events. I also lift weights just a few hours per week in order to have better strength for so many things - like chopping wood, for example. My physician and therapist and WLS are all on board with the quantity of exercise. I have also been to a specialist in sports exercise performance/nutrition etc. and have had my VO2 max tested, know my calories burned at different heart rates, etc. I strive to keep up with this stuff and make sure I am getting the calories I need for my activities. I do catch flack for the quality of my nutrients though! I appreciate the concern. I am hoping to find some other people who have to work to keep their weight on and get some new ideas for how to make it happen.