GSVguy

Thanks for not reading what I wrote. Very helpful.

Remember, I am at 275 and 7+ years post-op. One thousand to 1,500 calories would be unhealthy for me, and there have been times in the last few years that I have done that and I do not lose. I once fasted for a week and gained a pound. I'm thinking when I go too low on calories, my body goes into fat storing mode.

Short version:
I'm 45 yo, 6'3", 275. Pre-surgery eight years ago, I was about 440. Weight has plateaued for the last 15 months, whether I eat well or carelessly. A dietitian has recommended that I need significantly more calories and Protein than I've been getting, but I'm having a very difficult time getting close to her recommendations though I'm constantly eating throughout the day, while still stopping when I start to get full. Having a very hard time exercising because of debilitating back pain.
My questions:
1) What's your opinion on the dietitian's recommendations of 2,700 cal and 220g of protein per day?
2) How do you all (especially guys) get enough calories and protein given our small stomachs?
3) Are there any good resources for long-term post-sleeve eating plans? All I can seem to find on here and elsewhere are focused on the weeks and months after surgery.
Long version/background:
I'm 7.5 years post-gastric sleeve, and am currently at 275 lbs., close to my lowest post-surgery weight of 267. (I'm 45 years old and 6'3", with, my doctors and massage therapists tell me, a very large, wide frame.) In the nine months to a year after my surgery, I got down to 285, then plateaued there for a while. I have spent most of my time since between 290 and 305, once getting up to 330. In 2017, I nearly died from a massive, undiagnosed liver infection, and after my three-week hospital stay, I was down to 267. I was back up to 310 in Jan. 2019, and since then a year-long progress to 270, and I've been between 270-280 for the last 15 months or so.
During those 15 months, I have had a couple of months-long periods of being very careful and planned, logging food and staying under 2,200 calories and over 100g of protein per day. I have also had a couple of extended stretches of not being as careful eating—consuming more junk calories, but being pretty consistent not over-eating and stopping when I'm full.
I was confused as to why my weight stayed the same no matter what I did, so I consulted a regular dietitian, someone who is not focused on bariatric patients, but who has worked with several before me.
Her opinion was that I wasn't getting enough calories, that I should be aiming for 2,700 calories per day, with macros of 220g protein, 200g carbs, and 110g fats.
I have tried doing this, but am finding it very, very difficult to hit those marks. To get even close while stopping when I start to get full, it seems like I am eating all day long every couple of hours.
(One more note: I have been getting little to no exercise mainly because of debilitating back pain (from degenerative disc disease and arthritis) that just keeps getting worse and does not respond to any medications or treatments. Hydrocodone, which I'm not taking currently, does nothing, I feel zero effects from it, like they were placebos. Nerve ablation made it worse, and one highly respected back surgeon says all I can do is lose weight.)

As it was explained to me by a plastic surgeon I chose not to go with (I didn’t want to wait) :
It tends to be a long process to get insurance to pay for plastics. The need must be demonstrated over a period of time.
A patient would have to have documentation over six months to a year from doctors about the skin issues and rashes, be prescribed medication for it, have the medication fail to treat it for Insurance companies to even consider paying for it.
While that’s not an impossible task, it’s long. Also the surgeon must be willing to wait to be reimbursed after surgery (often less than their self pay prices) if prior authorization is not available for the procedure from your insurance company. This is likely the reason why many plastic surgeons do not want to deal with insurance companies.

Or you can pay upfront and ask the surgeon to submit a claim to insurance for reimbursement but there’s no guarantee you’ll actually be reimbursed.
Most people shop around while looking into plastics anyway, so you may be able to find surgeons who will except insurance if the surgeon you prefer cannot accommodate you.

Good Luck!

I recently asked my primary care doc to see if we can get a panniculectomy approved by Anthem because of the under the belly button chafing issue, and that I think the extra skin is contributing to chronic back pain from degenerative disc disease. Also, I think I might have an abdominal hernia.
I had some non-elective skin surgery because of a bad injury, and the plastics doc I had was so great, I would like to deal with him again. My primary care doc agreed to refer me to him.
When I talked to his office, they said they do deal with insurance for non-elective procedures, but not for cosmetic procedures—and they consider a panniculectomy to be cosmetic even if it's for medical reasons.
What should I do here? I'd like to see if Anthem will approve the panniculectomy, let me go to my preferred plastics doc, and then reimburse me. Anyone have experience doing this? It sounds like a nightmare even trying and I'm not sure what my next step would be—but I really like this plastics doc.
Or should I just take my chances at another doc who will submit to insurance?

Five and a half years out, it's a mixed bag for me.
Positives:
Went from 425+ to about 285 in 18 months, stayed between that and 305 since.
no more sleep apnea
no more knee/foot pain
I met my wife post-surgery after a lifetime of never having a longterm relationship
Negatives:
No matter what I do, I can't get under 285. Calorie restriction, even extreme calorie restriction, yields very low results.
Because of this, I am almost back at the point I was emotionally pre-surgery: can't look at myself in the mirror, clothed or not, without feeling very upset and angry at myself.
Incredibly bad and worsening back pain from degenerative discs. No physical therapy/exercise has helped, injections don't work at all, and I can get only very short term relief from hydrocodone, which doctors are reluctant to prescribe.
So, I'm better than I was, but am coming to the realization that I will continue to be morbidly obese and in constant pain for the rest of my life.

Five and a half years out, it's a mixed bag for me.
Positives:
Went from 425+ to about 285 in 18 months, stayed between that and 305 since.
no more sleep apnea
no more knee/foot pain
I met my wife post-surgery after a lifetime of never having a longterm relationship
Negatives:
No matter what I do, I can't get under 285. Calorie restriction, even extreme calorie restriction, yields very low results.
Because of this, I am almost back at the point I was emotionally pre-surgery: can't look at myself in the mirror, clothed or not, without feeling very upset and angry at myself.
Incredibly bad and worsening back pain from degenerative discs. No physical therapy/exercise has helped, injections don't work at all, and I can get only very short term relief from hydrocodone, which doctors are reluctant to prescribe.
So, I'm better than I was, but am coming to the realization that I will continue to be morbidly obese and in constant pain for the rest of my life.

Five and a half years out, it's a mixed bag for me.
Positives:
Went from 425+ to about 285 in 18 months, stayed between that and 305 since.
no more sleep apnea
no more knee/foot pain
I met my wife post-surgery after a lifetime of never having a longterm relationship
Negatives:
No matter what I do, I can't get under 285. Calorie restriction, even extreme calorie restriction, yields very low results.
Because of this, I am almost back at the point I was emotionally pre-surgery: can't look at myself in the mirror, clothed or not, without feeling very upset and angry at myself.
Incredibly bad and worsening back pain from degenerative discs. No physical therapy/exercise has helped, injections don't work at all, and I can get only very short term relief from hydrocodone, which doctors are reluctant to prescribe.
So, I'm better than I was, but am coming to the realization that I will continue to be morbidly obese and in constant pain for the rest of my life.

I had gastric sleeve in Dec. 2013 after having reached a weight of about 440-450 and everything went according to plan the first 18 months or so.
Since the spring of 2015 or so, I have been stuck in the 285-305 range (I'm 6'3" and 43 yo) and have been unable to get out of that no matter what I try, to the point where emotionally, I am basically back where I was at my highest weight. I can't stand to look at myself in the mirror, and I'm either a) obsessively counting carbs or calories or b) not caring what I eat and engaging in secret compulsive eating (though on a much, much smaller scale—instead of a dozen donuts, I'm going for one or two and not telling my wife or anyone else).
The latest emotional defeat is this: I've spent the last three weeks doing a keto/Atkins-type thing, which was the only thing that ever worked for me before my surgery. Meticulous tracking, urine sticks showing I'm in ketosis, moderate walking exercise, and—here's the catch—a pretty extreme calorie deficit. Most days less than 2k per day, never more than 2,500, and in one four day period, I basically did the surgery prep diet of only Protein Shakes and broth, at about 800-1200 calories.
After all that, I lost 2 pounds, which, when you're 292 pounds, is nothing.
I'm already planning to eat poorly and secretly tomorrow, and I have absolutely no idea what to do. I feel essentially the same way I did before my surgery, though less intense, in that it seems like there's really nothing I can do.
This is driving my wife crazy, and she's unable to understand or emotionally support me. I'm also trying very hard to not go back to some other addictive patterns.
I know the first thing some are going to say is exercise more. I haven't done that lately, and there are two things holding me back on that point. At various periods in the last 4 years, I have done serious, several weeks-long programs with personal trainers in tandem with calorie deficit, and have had literally no success, other than gaining a little muscle, which resulted in a net weight gain. Also, I have some pretty extreme chronic degenerative disc pain, and it's hard to motivate myself to work past that pain when past results from diet and exercise have yielded little to no tangible benefit after great effort.
One other thing that may be a factor: I had my gallbladder removed in 2017, and it had been basically shot since at least fall of 2015. I also had hiatal hernia repair the same time I had the gallbladder out.
To be honest, I'm not really expecting any useful feedback. This may just be what life is for me now. But I had to say it somehow to someone.

Five and a half years out, it's a mixed bag for me.
Positives:
Went from 425+ to about 285 in 18 months, stayed between that and 305 since.
no more sleep apnea
no more knee/foot pain
I met my wife post-surgery after a lifetime of never having a longterm relationship
Negatives:
No matter what I do, I can't get under 285. Calorie restriction, even extreme calorie restriction, yields very low results.
Because of this, I am almost back at the point I was emotionally pre-surgery: can't look at myself in the mirror, clothed or not, without feeling very upset and angry at myself.
Incredibly bad and worsening back pain from degenerative discs. No physical therapy/exercise has helped, injections don't work at all, and I can get only very short term relief from hydrocodone, which doctors are reluctant to prescribe.
So, I'm better than I was, but am coming to the realization that I will continue to be morbidly obese and in constant pain for the rest of my life.

I had gastric sleeve in Dec. 2013 after having reached a weight of about 440-450 and everything went according to plan the first 18 months or so.
Since the spring of 2015 or so, I have been stuck in the 285-305 range (I'm 6'3" and 43 yo) and have been unable to get out of that no matter what I try, to the point where emotionally, I am basically back where I was at my highest weight. I can't stand to look at myself in the mirror, and I'm either a) obsessively counting carbs or calories or b) not caring what I eat and engaging in secret compulsive eating (though on a much, much smaller scale—instead of a dozen donuts, I'm going for one or two and not telling my wife or anyone else).
The latest emotional defeat is this: I've spent the last three weeks doing a keto/Atkins-type thing, which was the only thing that ever worked for me before my surgery. Meticulous tracking, urine sticks showing I'm in ketosis, moderate walking exercise, and—here's the catch—a pretty extreme calorie deficit. Most days less than 2k per day, never more than 2,500, and in one four day period, I basically did the surgery prep diet of only Protein Shakes and broth, at about 800-1200 calories.
After all that, I lost 2 pounds, which, when you're 292 pounds, is nothing.
I'm already planning to eat poorly and secretly tomorrow, and I have absolutely no idea what to do. I feel essentially the same way I did before my surgery, though less intense, in that it seems like there's really nothing I can do.
This is driving my wife crazy, and she's unable to understand or emotionally support me. I'm also trying very hard to not go back to some other addictive patterns.
I know the first thing some are going to say is exercise more. I haven't done that lately, and there are two things holding me back on that point. At various periods in the last 4 years, I have done serious, several weeks-long programs with personal trainers in tandem with calorie deficit, and have had literally no success, other than gaining a little muscle, which resulted in a net weight gain. Also, I have some pretty extreme chronic degenerative disc pain, and it's hard to motivate myself to work past that pain when past results from diet and exercise have yielded little to no tangible benefit after great effort.
One other thing that may be a factor: I had my gallbladder removed in 2017, and it had been basically shot since at least fall of 2015. I also had hiatal hernia repair the same time I had the gallbladder out.
To be honest, I'm not really expecting any useful feedback. This may just be what life is for me now. But I had to say it somehow to someone.

I had gastric sleeve in Dec. 2013 after having reached a weight of about 440-450 and everything went according to plan the first 18 months or so.
Since the spring of 2015 or so, I have been stuck in the 285-305 range (I'm 6'3" and 43 yo) and have been unable to get out of that no matter what I try, to the point where emotionally, I am basically back where I was at my highest weight. I can't stand to look at myself in the mirror, and I'm either a) obsessively counting carbs or calories or b) not caring what I eat and engaging in secret compulsive eating (though on a much, much smaller scale—instead of a dozen donuts, I'm going for one or two and not telling my wife or anyone else).
The latest emotional defeat is this: I've spent the last three weeks doing a keto/Atkins-type thing, which was the only thing that ever worked for me before my surgery. Meticulous tracking, urine sticks showing I'm in ketosis, moderate walking exercise, and—here's the catch—a pretty extreme calorie deficit. Most days less than 2k per day, never more than 2,500, and in one four day period, I basically did the surgery prep diet of only Protein Shakes and broth, at about 800-1200 calories.
After all that, I lost 2 pounds, which, when you're 292 pounds, is nothing.
I'm already planning to eat poorly and secretly tomorrow, and I have absolutely no idea what to do. I feel essentially the same way I did before my surgery, though less intense, in that it seems like there's really nothing I can do.
This is driving my wife crazy, and she's unable to understand or emotionally support me. I'm also trying very hard to not go back to some other addictive patterns.
I know the first thing some are going to say is exercise more. I haven't done that lately, and there are two things holding me back on that point. At various periods in the last 4 years, I have done serious, several weeks-long programs with personal trainers in tandem with calorie deficit, and have had literally no success, other than gaining a little muscle, which resulted in a net weight gain. Also, I have some pretty extreme chronic degenerative disc pain, and it's hard to motivate myself to work past that pain when past results from diet and exercise have yielded little to no tangible benefit after great effort.
One other thing that may be a factor: I had my gallbladder removed in 2017, and it had been basically shot since at least fall of 2015. I also had hiatal hernia repair the same time I had the gallbladder out.
To be honest, I'm not really expecting any useful feedback. This may just be what life is for me now. But I had to say it somehow to someone.

My surgery team is no longer an option. Price of surgery included one year of checkups. They were great, but what they provided was a surgically re-sized stomach—not sure what else I could expect.
I will probably go back to a doctor to rule out other problems, but I'm certain they won't find anything. Test after test even at my highest weight showed I was perfectly healthy in every way except for the weight.
What could a dietitian tell me that I've not already tried? Plus, throughout my years of dealing with this dietitians have been the most clueless, least inquisitive people—they just hand you a one-size-fits-all print out of some government food plate diagram.
And I am well aware that this is all emotional. I have been in therapy for years and years and years. I understand exactly why I have the addictions I have, and I have been in a 12-step program for one of the more damaging ones for almost five years, with pretty decent success. But closing off that avenue means that food is the thing I can turn to with the least damaging short-term consequence.
I try really hard to remind myself of the weight loss success I've had—but then there's the mirror and I see the same person I've always seen.
I don't see the upside of pushing through the physical pain to exercise and going through the emotional turmoil to eat right when the tangible physical benefits are small to non-existent and there's no emotional benefit at all.
This most recent emotional crisis comes after a round of consultations with a neurosurgeon with my back. After trying different types of pain injections, physical therapy, etc. that had no effect other than to aggravate my pain, the last thing he said to me was, "You just need to lose weight, that's really the only thing that will help."

What team?

I had gastric sleeve in Dec. 2013 after having reached a weight of about 440-450 and everything went according to plan the first 18 months or so.
Since the spring of 2015 or so, I have been stuck in the 285-305 range (I'm 6'3" and 43 yo) and have been unable to get out of that no matter what I try, to the point where emotionally, I am basically back where I was at my highest weight. I can't stand to look at myself in the mirror, and I'm either a) obsessively counting carbs or calories or b) not caring what I eat and engaging in secret compulsive eating (though on a much, much smaller scale—instead of a dozen donuts, I'm going for one or two and not telling my wife or anyone else).
The latest emotional defeat is this: I've spent the last three weeks doing a keto/Atkins-type thing, which was the only thing that ever worked for me before my surgery. Meticulous tracking, urine sticks showing I'm in ketosis, moderate walking exercise, and—here's the catch—a pretty extreme calorie deficit. Most days less than 2k per day, never more than 2,500, and in one four day period, I basically did the surgery prep diet of only Protein Shakes and broth, at about 800-1200 calories.
After all that, I lost 2 pounds, which, when you're 292 pounds, is nothing.
I'm already planning to eat poorly and secretly tomorrow, and I have absolutely no idea what to do. I feel essentially the same way I did before my surgery, though less intense, in that it seems like there's really nothing I can do.
This is driving my wife crazy, and she's unable to understand or emotionally support me. I'm also trying very hard to not go back to some other addictive patterns.
I know the first thing some are going to say is exercise more. I haven't done that lately, and there are two things holding me back on that point. At various periods in the last 4 years, I have done serious, several weeks-long programs with personal trainers in tandem with calorie deficit, and have had literally no success, other than gaining a little muscle, which resulted in a net weight gain. Also, I have some pretty extreme chronic degenerative disc pain, and it's hard to motivate myself to work past that pain when past results from diet and exercise have yielded little to no tangible benefit after great effort.
One other thing that may be a factor: I had my gallbladder removed in 2017, and it had been basically shot since at least fall of 2015. I also had hiatal hernia repair the same time I had the gallbladder out.
To be honest, I'm not really expecting any useful feedback. This may just be what life is for me now. But I had to say it somehow to someone.

I had gastric sleeve in Dec. 2013 after having reached a weight of about 440-450 and everything went according to plan the first 18 months or so.
Since the spring of 2015 or so, I have been stuck in the 285-305 range (I'm 6'3" and 43 yo) and have been unable to get out of that no matter what I try, to the point where emotionally, I am basically back where I was at my highest weight. I can't stand to look at myself in the mirror, and I'm either a) obsessively counting carbs or calories or b) not caring what I eat and engaging in secret compulsive eating (though on a much, much smaller scale—instead of a dozen donuts, I'm going for one or two and not telling my wife or anyone else).
The latest emotional defeat is this: I've spent the last three weeks doing a keto/Atkins-type thing, which was the only thing that ever worked for me before my surgery. Meticulous tracking, urine sticks showing I'm in ketosis, moderate walking exercise, and—here's the catch—a pretty extreme calorie deficit. Most days less than 2k per day, never more than 2,500, and in one four day period, I basically did the surgery prep diet of only Protein Shakes and broth, at about 800-1200 calories.
After all that, I lost 2 pounds, which, when you're 292 pounds, is nothing.
I'm already planning to eat poorly and secretly tomorrow, and I have absolutely no idea what to do. I feel essentially the same way I did before my surgery, though less intense, in that it seems like there's really nothing I can do.
This is driving my wife crazy, and she's unable to understand or emotionally support me. I'm also trying very hard to not go back to some other addictive patterns.
I know the first thing some are going to say is exercise more. I haven't done that lately, and there are two things holding me back on that point. At various periods in the last 4 years, I have done serious, several weeks-long programs with personal trainers in tandem with calorie deficit, and have had literally no success, other than gaining a little muscle, which resulted in a net weight gain. Also, I have some pretty extreme chronic degenerative disc pain, and it's hard to motivate myself to work past that pain when past results from diet and exercise have yielded little to no tangible benefit after great effort.
One other thing that may be a factor: I had my gallbladder removed in 2017, and it had been basically shot since at least fall of 2015. I also had hiatal hernia repair the same time I had the gallbladder out.
To be honest, I'm not really expecting any useful feedback. This may just be what life is for me now. But I had to say it somehow to someone.

When is the last time you had lab work done? If it hasn't been recently that might really help as a starting point.
What are your macros like daily for ketosis? What are your carbs at?

Thanks for the responses.
When I was doing the low-carb diet recently, I was doing less than 30g total carbs per day, and the urinalysis strips measuring ketosis were deep maroon.
I have an appt. with a new primary care doctor on April 4 to ask about getting blood work and to have her review the tests done by my last doctor (who left her practice for another gig).
I will update you all then.
In the meantime, am I right that the impaired processing of incoming fat could cause the body to hold on to stores of fat while I'm in ketosis?