RickM

Pretty much every day. Raspberries and blueberries with yogurt as part of breakfast or afternoon snack. Tomatoes (depending upon whether one classifies them as a fruit or a veg...) and avocado most every day in a lunch salad. Occasionally tangerines and grapefruit in the salad instead. My overall goal is for ten servings of fruit and veg per day - which I rarely hit but do consistently get 7-8, and 5 as a bare minimum. I'm ten years out, but it's been that way for at least the past 7-8 years, and lesser amounts but a similar ratio to other foods before that.

Likewise, they wanted to keep the water consumption down until after the leak test (which was frustratingly delayed) so it was mostly those foam popsickle sticks and a few ice chips until then.

Are these foods that were in your normal diet and tolerated well before surgery? It sounds like it may be a matter of adaptation of your gut biome (all those little buggers that live in your intestines that help digest your food.) A probiotic may help repopulate your gut with the bacterial species appropriate for digesting what you are now eating. This is an adaptive thing, and our gut adapts to what we eat; make big changes to our diet and the gut needs to adapt to the new diet. Vegetarians can eat a lot of legumes and cruciferous veg that would have most of us farting to the moon are hardly bothered by them because their gut has adapted. Just having WLS and the major dietary changes (along with the anti-biotics that can kill of some of the gut bacteria) that typically go along with it can cause digestive problems owing to the biome no longer being compatible with the diet; a malabsorptive procedure such as the RNY or DS compounds this as it also changes the way digestion is done, but we adapt over time. Now you are adding in a new phase of changes that the gut needs to adapt to. It will pass in time (so to speak) but a broad spectrum probiotic can help speed the process.

Here in the US, the MGB is not a common option, though it has been adopted by bariatric groups in other countries. When my wife and I were first investigating WLS some twenty years ago, the MGB was kicking around the sidelines of the bariatric field trying to find its place, but it never did here, failing to gain acceptance of either the ASBS/ASMBS or the insurance industry. In the meantime, both the DS and VSG have gone mainstream. There may still be a few isolated practices that offer it on a self pay basis, and there are several groups in Mexico that offer it, mainly as a cheaper, but not necessarily better, alternative to the RNY. The main bugaboo that I recall with it has been a greater propensity toward bile reflux, which is easy to understand if you look at its anatomy. As for a revision to counter regain, It doesn't make a lot of sense to me, as its metabolic strength is so similar to the RNY - much the same as switching between the VSG and RNY, or vice versa, for weightloss/gain reasons, doesn't make a lot of sense. To counter a regain problem, one should look to a stronger procedure, which in the current world is the duodenal switch (DS). Unfortunately, that is a very complex revision which only a half dozen or so surgeons around the country are capable of doing. That would be your best shot at losing a major part of your regain, but also the hardest. There is the newer SIPS/SADI/"Loop DS" that is a simpler and more accessible procedure that seems to sit between the RNY/VSG in DS in effectiveness, but it is still working on gaining acceptance from the ASMBS and insurance industry, but it doesn't seem far off now; that would be a compromise worth looking into, but it's not an easy revision, either, as it is sleeve based procedure, so the stomach first needs to be but back together before proceeding with the revision. The RNY, overall, is a difficult configuration to work with if it's not working right. The "simple" regain fixes such as re-doing the pouch, tightening the stoma or putting a band over the pouch don't seem to work all that well - figure on losing maybe 20 lb, on average, mostly from having to go through all of the restrictive diets around surgery time again, but beyond that it is mostly individual effort (which is what one does without surgery.) The other major option may be offered is to change it to a distal RNY (as opposed to the familiar proximal RNY) which dramatically increases the malabsorption component, with the trade off of the expected increase in supplement needs and potential for more significant nutritional problems. It is not usually approved by US insurance as a primary WLS procedure, but sometimes can be justified for special circumstances. Revisions are not a simple thing - research them carefully to fully understand what is involved, and what the potential risks and benefits are. Good luck,

It seems to be more of an imbalance of things, rather than strictly too much or little. My wife had them for a while, even though she was strictly on calcium citrate as specified.

Most programs prescribe a PPI such as omeprazole for a while after surgery because heartburn is not uncommon. It also sounds like something like gas-x would be appropriate. Programs vary widely on dietary progressions, and if yours calls for mushies, at this time, that is fine, though you personally may not yet be ready for it. We were on purees and mushy things from the hospital on out, though not all could handle them that early, and much of the early diet was still a lot of liquid. Our general rule was to try new foods one at a time to test for tolerance; if it worked, great, if not, go back to what was working and try that food again in a week or two. So, you may be trying something that you aren't ready for yet, but something else mushy may work. Or, you may have to stick to liquids a few more days. People will have varying amounts of inflammation in their newly cut stomachs, so will vary widely on how easily things move through for a while - for some, just water is very slow to go through while others can easily handle yogurt and other soft and mushy things - both are within normal expectations so don't worry if things aren't going through that well yet, (or conversely, if things are going through easily while others struggle.)

I have seen such devices being developed to treat diabetes, which makes sense as they emulate the surgical changes done in the biliopancreatic diversion (BPD) part of the BPD/DS bariatric procedure which yields exceptionally good results on resolving type II diabetes. It makes some sense that there will be some interest in trying to develop the concept for weight loss, but I suspect that they are climbing a very tall tree to get significant results. At best, I would expect it to be no better than the existing restrictive balloons and bands. Back in the 1960's and 70's one of the common weight loss procedures was the jejunoileal bypass (JIB), which was a purely malabsorptive procedure that resulted in pretty good weight loss performance, but at the cost of significant nutritional problems and other significant complications. It was largely supplanted by the RNY gastric bypass, which is highly restrictive, with a minor malabsorptive kicker, and that overall works well. Subsequently, the duodenal switch (the BPD/DS of above) came along which combines a more moderate amount of restriction with a moderate level of malabsorption, which has shown to work even better overall, but at the cost of being more complicated to perform. The lesson that I get from all of this is that for there to be enough malabsorption to yield the weight loss that we see in the current mainstream bariatric procedures (the VSG, RNY, SIPS/SADI and BPD/DS) it would probably have similar metabolic complications of the old JIB. Something with lesser malabsorption, such as these proposed sleeves, would likely yield relatively poor weight loss results - on the order of what is seen with other implantable weightloss devices (balloons, bands, etc.) and would likely have similar lifespan and foreign body issues. The other concern that I would have with these is how do they handle the bile and pancreatic enzymes that are released in the duodenum? presumably they flow down outside the sleeve to be introduced to the food flow at the end of the sleeve (perhaps that is the source of the pancreatitis and liver issues that Foxbins noted?) Overall it does seem like a neat idea, at least for some cases, but is not yet ready for prime time (and probably won't supplant the existing surgical weight loss interventions.)

As noted, the difference in weight loss performance between the VSG and RNY is minimal - there is more variation between individuals than there is between the procedures themselves. If one wants/needs something demonstrably better than the VSG/RNY, then there is the DS available; if ones needs are less than that provided by the VSG/RNY, then there are the balloons and lapbands available. The bypass will be somewhat fussier than the sleeve when it comes to supplements and some medications (some time release meds may not work well with it, and some meds that are known to possibly be ulcer prone are more restricted or forbidden.} Diet may be a little more restricted, but there isn't a great difference. What I would be concerned about is whether the finding of this benign tumor makes you any more susceptible to something more malignant that should be monitored? One of the drawbacks or the RNY is the loss of the ability to easily scope the remnant stomach post-op, as that is left in a blind loop along with the duodenum and associated bile and pancreatic ducts. I assume that the tumor was found somewhere in the lower part of the stomach near the pyloric valve, and that is why they are interested in doing a bypass instead of a sleeve as that would naturally remove the tumor and surrounding tissue (if it were found in the central fundus, that would naturally be removed as part of the VSG). If this is a concern to them, the RNY can be performed without leaving a remnant stomach behind (it's basically what's done in many cased of stomach cancer); I have run into a few who have had WLS/RNY performed that way for various reasons and while there are some tradeoffs to doing it that way, they are not real big ones - most don't know the difference other than it removes the theoretical reversibility of the bypass. In short, the difference in making the switch is not great, but my biggest concern would be what the tumor finding means to you long term and how do you mitigate whatever tendencies there might be (for instance, I am subject to stomach polyps, which like those in the colon are considered to be pre-cancerous, so that is something that we monitor with periodic endoscopies.)

Stopping ketosis? Yes and no, depending upon how one defines it. As far dropping ketones that are detectable in a urine test, that is a normal result of burning off your fat stores - which is what we are trying to do - irrespective what diet is used. All it takes is a suitable caloric deficit, so that is pretty much unavoidable if you are losing the weight that you want to lose. If one is aiming for high numbers or pretty colors on a keto stick, and gushes about how the bad breath and body odors that they are getting is a sign of burning fat, then no, that is not at all necessary. I followed a very strict "no fad diet" regimen - no Atkins, Ornish, Paleo, South Beach, Zone, Keto, etc., and had to work to stop the loss when I approached goal weight. I quite specifically avoided symptomatic ketosis (along with other classic low carb diet symptoms such as fatigue, lethargy, brain fade, hypoglycemia, etc.) by maintaining as balanced a diet as reasonably possible within our post bariatric protein and low calorie requirements, though ketones were detectable in the normal urine tests - that is normal when metabolizing the fat. One does not need to go overboard on consuming excess fats to drive one into ketosis - that is just part of the keto fad and has nothing to do with burning your fat stores in losing weight. The protein in your urine may just be a passing thing (no pun intended...) or may be indicative of something else. I have often passed detectable amounts of protein in my urine, even well before WLS, but that's just me. It can be a sign of possible kidney problems, or maybe not - it is something that we monitor. Our post bariatric diets are not so much high protein, as they are adequate protein bur low on everything else; in a year or two when you are much lighter and maintaining your weight, your protein levels should be about the same as they are now, but everything else will be higher to fill out the extra calories that you need to maintain, and to provide the nutrition that you need. If you look at bariatrics historically, you find that dietary style (low fat, low carb, keto, paleo, etc.) makes very little difference to overall weight loss, as that is primarily determined by the caloric deficit created by eating so little for that first year or so. Indeed, if you look back 20-30 years ago, patients were often advised to "eat like you always have, just less...." and it worked. Of course, what didn't work was them maintaining the loss as they never learned to eat sustainably to maintain their weight. So, it is entirely reasonable to eat a basically healthy diet that, for a time, is protein biased (we can supplement most everything else) and not worry about whatever the fad diet of the day happens to be - eat with an eye towards how you should be eating five years from now. Those who follow the fad diets have the same problem that non-WLS dieters have - learning how to eat sustainably once they have lost the weight and no long have to "diet".

They are guaranteed to help lighten your wallet. Beyond that, it's very unlikely that they will do anything to help your weight - just like all those other miracle weight loss pills. They might have some caffeine in them to make your feel more energetic or something, but given that keto diets don't do much for your weight (other than some temporary water weight loss, which we all get when we go into a significant caloric deficit) these things aren't going to do anything for you, either. You would be better off putting the money spent on these types of things into a few sessions with an RD to learn how to eat to sustainably manage your weight in the long term.

It is basically another tool for the surgeon to use. Assuming that he has learned how to use the tool, the outcome still fundamentally comes back to the surgeon - the tool isn't going to make up for poor technique or inexperience, but when used properly, can make the surgery easier and quicker.

The short answer is yes - by and large, the bariatric recommendations largely reflect our normal maintenance needs for protein. Now, that amount varies from person to person, primarily based upon their lean body mass (muscles, organs, skin, etc.) A short woman of normalish weight, say 5' 0" and 100-110lb, would need around 50g of protein to maintain her 75lb or so of lean body mass, while a 6'0" 180lb man with around 150 lb of lean body mass will need twice that, around 100g. If one is actively trying to build additional muscle mass (and doing the work to do so,) then they will need additional protein, maybe up to around another 40g or so depending upon what they are trying to do. But as an average, what the bariatric programs usually recommend is in line with the normal recommendations for normal people, though maybe a bit simplified, and sometimes with a bit of overkill added in (a bit too much is better than not enough.)

Only to the extent that you may still be on narcotic pain relievers post-op.

It really is anybody's guess. The typical rationale for a pre-op diet is to improve the liver condition to make surgery easier, so both the patient and the surgeon come into play here (some patients will have more problematic livers, some surgeons are less comfortable than others in working around them). Some talk in terms of getting the patient used to the post op diet, but by my experience, that isn't needed as you don't feel like having anything overly solid for a while (maybe these are programs that do post op liquid diets much longer than needed?) The liver thing is usually best addressed with a very low carb diet, so lean meats and green veg are usually fine, though that is often restricted to one or maybe two meals a day with the rest being protein shakes or other liquids. Some do a purely liquid diet for some unknown reason, usually two weeks but it can be more (I have seen up to six months - yikes!) Some don't do any pre-op diet at all if they know their way around the liver. We only had a day before diet to clear out the GI tract before surgery. Overall, it sounds like your diet is relatively average - not overly long or only liquid, but not just a quicky, either. Overall, being on only liquids for as long as some do, combined with post op liquid diets, isn't really that great of an idea, and it is best to minimize that to the extent possible (within doctors' instructions, of course!) Have fun going through all of this!

If you haven't run into this in your research, I found this to be an interesting point/counterpoint discussion of the LINX (the "Yes" vote is linked at the bottom). http://agaperspectives.gastro.org/is-linx-the-way-to-go-for-gerd-surgery-no/#.X7K6SWhKiUk I also found another source that indicated that LINX was not appropriate for bariatric patients, but didn't explain why (possibly simply because that group didn't have much experience with bariatric patients?) The "No" vote above did lift out the prospect of erosion from the foreign body, and given the history of the lapband, that is probably a good point of caution. I would suggest getting a second (and possibly third) opinion on this. I am a fan of second opinions, particularly when it comes to revisions and complications, as both the causes and solutions are often more varied than the original surgery, and hence the opinions as to the best way to go often vary more widely - what one doc is comfortable doing to solve the problem may not be the ideal for you, while another doc may have different experiences that allows him to offer something better for your need. Or maybe not - but as patients it is hard for us to evaluate, but one solution may make more sense to us than another. I have found that with the sleeve, being a relatively new procedure to most of the bariatric world, the solutions to problems that may crop up are often limited - some docs are limited to simply revising to a bypass as they don't have much experience with anything else. Most bariatric surgeons here in the States are fairly well experienced with the sleeve by now (as opposed to 6-10 years ago) but may not yet have that much experience in correcting problems with them, which is why it can pay to seek out alternate opinions. Sometimes there are shape issues with the sleeve, stemming from either the original surgery or from subsequent evolutions, and surgeons can vary widely on their ability to address these. Some can do fundoplications to address the hiatal hernia, while others can't (there isn't that much fundus to plicate after our VSG.) I would suggest a second opinion from Dr. Ara Keshishian, who does a lot of complex revisions (people come from across the country to see him, particularly as he is one of the few who can do the RNY/DS revision) and if anyone can get things working better without a major revision or devices, it is him. If one can avoid an RNY or an implanted device, that would be ideal. Conveniently, he is right around the corner from you in the Glendale/Pasadena area. I do have a hiatal hernia, though a fundoplication is inappropriate for my case, and as GERD is mild and well controlled with moderate OTC meds, and EGD shows nothing exciting happening, it is a wait and see thing for me at this point. Hope yours comes out well, whatever path you take,

Guys do too ("I'm not usually bitchy...!")

Hiatal hernia repairs are quite common along with WLS, as they are a common problem amongst the morbidly obese. Ditto with gallbladders - it is not overly unusual to see them removed along with WLS if they had been causing problems, or can be anticipated to cause problems. My surgeon routinely removes them when he does the DS (which is a sleeve along with malabsorptive intestinal rerouting) but only removes them with the VSG if he feels stones when he is in there doing the surgery. Based upon that, I wouldn't expect the trifecta to be all that unusual, though I haven't gone through that myself.

I would try to get the word of the surgeon, rather than nurse or office staff, as he is the one who will get to repair any hernias that you create. The typical advice is no more than 10 lb for sometime on the order of 3-6 weeks, maybe a bit more after 3 weeks or so, but usually nothing substantial for at least 6-8 weeks. My doc was a bit more conservative in that he specified no serious core work such as sit ups and crunches for 12 weeks. Arguably, that may not be enough for some. One of the problems that I learned about talking with the physical therapists after some orthopedic work, is that while your muscles may heal quickly and feel up to more work, the connective tissues like the tendons and ligaments don't have as much blood flow as the muscles, so they heal more slowly and are more vulnerable to being torn (and this would include the fascia that holds the abdominal muscles together, which they cut through for your surgery.) It is not unusual for a sharp sneeze or cough to cause an incisional hernia many weeks or even months after surgery. Real story here, of my sister's octogenarian FIL who had some sort of hand surgery, After all of the recovery and physical therapy, the surgeon cleared him for all normal activities. His wife, a retired nurse, called the surgeon asked what he had told him - "just that he could go back to normal activities.... " "Did you know that he is back under the house digging ditches and pouring concrete? " "Oh **** I didn't mean that!" So, it pays to go to the source and to be specific. Related to that, after my post WLS reconstructive/plastic surgery, when discussing with the surgeon what I could do at the gym and when, he told me that crunches and such loaded, bending abdominal work was out, but surprisingly twisting was fine - he knew exactly what he had done inside, and where the strengths and weaknesses were. Also, your surgeon may be able to suggest appropriate protective gear - straps or supports - that may help you during this period. But do be specific as to what you do. Good luck on continued recovery

800 kcal per day is a very typical number and consistent with good weight loss. Our loss tends to be heavily forward loaded with a lot of water weight loss early on - your loss rate should be slowing right about now (do a search for the "three week stall") as your body pauses to catch up. As a reference, I lost 32lb the first month, and then 15 each of the next two months, so things do slow down. (What is happening is that your body, when it goes into a big caloric deficit as it does immediately after your WLS, starts drawing of your body's glycogen reserves - basically stored carbohydrate - which takes a lot of water to stay in solution. So your body is throwing off a lot of water as it burns the glycogen. Then, when that runs out (after 2-3 weeks typically) the body has to start drawing on its stored fat (which is what we want!) but it can take a few days (or weeks for some) for the body to shift gears to do that, so don't panic if your loss suddenly stops for a while. Also, your loss rate will be lower once you start burning your fat reserves, as the fat burns more slowly than the glycogen. The glycogen burn may also be why you are feeling a bit weak and tired, as that is your quick response energy store, and you are running low. Try working in a little more carbohydrate - oat meal, cream of wheat, unsweetened apple sauce are common - to help keep those levels up a bit more. In theory, our body is supposed to burn our excess fat to make glycogen, but that doesn't always happen as quickly as we need it (this is why marathoners will "carb load" with a lot of bread and pasta the day before an event - to make sure their glycogen levels are as high as possible before they go burning it all off the next day - we don't need to go that far, but the same principle applies.) Overall, it looks like your are doing great, and I wouldn't worry about losing too fast until you are within maybe five kilos of your goal weight - if you get there withing six months, then you may need to slow things down so that you don't overshoot the mark too far; otherwise, I wouldn't worry about it. (And yes, my doc's RN also told me to cut back the exercise because I was losing too fast - but that was at six months, and about 10 lb from goal weight, and while I wasn't inclined to cut back on what is my normal maintenance level of exercise, I did start ramping up the calories to start slowing things down.)

It can happen early on, and yes, it does seem as if we are eating and drinking all the time. Running out of gas and/or having to take a nap midday is not unusual for a while. Hydration, or lack thereof, can do it (how is your urine - clear and pale is good and a sign of adequate hydration, more deeply colored is not?) Does your program have you taking iron and/or B12 - those are the typical micronutrient causes early on (B12 not so much with the sleeve, but some people run short anyway.) Protein might be part of the problem particularly if you are depending upon genepro for it - that's a questionable product that doesn't provide as much protein as they imply (what exactly does "equates to 30g" mean?). Try changing product or doubling up on it. Our diets early on are heavily biased toward protein (and water!) with everything else being secondary, which means that we often aren't getting the carbohydrates needed to maintain our energy balance (and some go overboard on that under the belief that it will improve their weight loss.) Some programs specifically have their patients doing a bit of mild "carb loading" to help avoid this problem. Try having some oatmeal or cream of wheat for breakfast, or unsweetened apple sauce as a snack and see if that improves things.

We (my wife and I) usually see him (talk on the phone lately) every year, though there were a few years a while go when we skipped it after they closed their local office (they moved up to SF around 20 years ago, but maintained a local office for many years to serve all of their legacy patients and any new recruits from the area). He mostly go over the same things that our PCP does looking at the labs (much more extensive for my wife with her DS than for me with a VSG) so there normally isn't much added, though he often has preferred or recommended levels that he likes to see that may differ from the basic :normal" ranges called out on the lab sheets. We haven't had any show stopping problems with our WLS over the years, but I look at the annual check with the surgeon as something of a retainer fee so that he keeps us on his radar and current in his files in case something odd shows up, the PCP can give him a call and ask about it (or we can zap him an email.) Generally, the PCP is just fine for routine monitoring; it's when something questionable shows up that's beyond her experience where it's handy to still have a relationship with the surgeon.

I never had any nausea or vomiting as a result of the VSG; other causes on occasion, as happens in normal life, sure, but not from the surgery. I never even used the anti nausea meds that they prescribed post op. As with most things, it is one of those YMMV things, and some will have more problems than others, but it is nothing inherent in the procedure.

You have been through the wringer on this, so sorry you have had to go through it. I don't have any experience specific to this, but some maybe distantly related. I have seen that when they have an intransigent ulcer problem, classically it's around the anastomosis between the pouch and intestine, they usually just reverse the bypass, though that isn't really an option for you as that would put you back to your sleeve, which implicitly may not have been that well done in the first place. By reputation, I would try to seek a second opinion with Dr. Michel Gagner, who I believe has a presence in Toronto. He was one of the early adopters of the duodenal switch back in New York and has done some fairly complex revisions (such as RNY to DS) so is familiar with more complex problems. As to "done as much as we can" there is more that can be done. The most extreme thing would be a total gastrectomy, which isn't all that far from where you are now with an RNY, and is done in some cases of gastric cancer or gastroparesis. Basically they remove the remainder of the stomach and hook up the esophagus directly to the intestine, where your pouch is now. or close to it. Between surgery and adaptation, they form a new pouch in the intestine. Surgically, it is a bigger deal than it sounds as they don't like attaching the esophagus to anything other than itself (you would likely be on a feeding tube while it heals, but you've already been through that,) but it is a not uncommon configuration that people live well with (similar to your typical RNY lifestyle once everything heals.) Your average bariatric practice may or may not have the experience to do this, and you might have to go to a hospital that has a specialized gastric surgery department and/or cancer center. Simpler than the above, I have seen reference to a few people who were having significant RNY ulcer problems, again in the typical anastomosis region, where they went in and moved the anastomosis down the intestine a bit farther to a fresh spot, so that might be an option depending upon circumstances. Those are a couple of ideas that you can look into and question your docs about, and maybe seek out ones with a somewhat different specialty that may be able to help. Good luck in working through this,

For a regain problem I would not generally go from a sleeve to a bypass, as metabolically the two are too similar and one usually winds up in the same place after a couple of years. Indeed, most revisions don't yield a lot of additional weight loss; those that do mostly seem to be those who really crack the whip and get their dietary and psych acts together for the second try. One will usually lose a few pounds, typically twenty, give or take - mostly what one would expect from having to go through all the diet restrictions associated with going through the surgery again. The simple minded way I like to think of the reasoning for the general poor results is that our stomachs started out being able to hold 32-64 oz before our original WLS, and now, a few years post op, our stomachs, even after some adaptation and stretching, hold 4-6 oz (maybe 8 in some cases), we have gotten used to living with that, so there isn't nearly as much of a difference going through the surgery again. The DS will usually provide better results, particularly in being more regain resistant. As with the others, it is hard to expect as good results as with virgin DS, but it should still work better than the others. When I discussed this matter with our surgeon when I had my VSG - the prospect of using a DS revision as a "plan B" backup to the VSG, he cautioned about the problem of losing that regain; he said that the revision works best if you catch it early, before substantial regain has occurred, as the biggest strength of the DS is its ability to resist regain. You are fortunate in starting with the sleeve, as that has maintained more options for you - revising an RNY to anything else that may work better (like the DS) is a very complex undertaking that few surgeons can do; as the sleeve is the basis of the DS, changing to the DS is more of a "completion" of the DS rather than an outright revision and is a pretty straightforward procedure for any DS qualified surgeon. You seem to be doing the right things, in working out the problems that led to your regain, as that will be a key to your future success. Good luck!

It's very common - often patients don't even know that they had a hernia, whether it be a hiatal, umbilical, or whatever, before surgery and the doc just fixes it as part of the WLS. As to what you can eat for the rest of your life, most likely it can be whatever you are eating now. The problem is that whatever you are eating now is what got you to 400 lb and you will likely be back there again if you don't learn how to eat to maintain your weight in a healthy range. Think of WLS as more of a "do over" rather than a total fix - it helps get you back to where you should be so that you can start over again, but if you don't correct what got you morbidly obese (whether it be strictly diet, or psych issues, or likely a combination,) you will likely work your way back to where you are now. The good news is that you can start that now, working with a dietician and/or therapist to start correcting things and learning how to eat and live for the rest of your life, and that all carries forward making the WLS and post op processes that much easier. Good luck