BigSue

This is going to depend on your insurance and your surgeon. Your best bet is to call the surgeon’s office and ask. They should be well-versed in insurance requirements and tell you what the surgeon requires as well.

I didn't get one just for my gastric bypass, but I later needed one for another condition, so I included: NO NSAIDS NO BLIND NG TUBE I got a tag that slides onto my watchband from Road ID, so it is pretty inconspicuous.

First of all, you’ve already done something right by continuing to monitor your weight and taking action quickly when you see it going in the wrong direction. That’s exactly what you need to do to maintain your weight loss long term. How did you succeed in losing weight and what has changed? Are you logging your food and tracking calories? Consistently doing physical activity? Eating protein and vegetables first? It’s normal to be really strict at the beginning and relax a bit as you get farther out from surgery, so you may just need to refocus on the good habits that helped you succeed in the first place. Also, don't be afraid to reach out to your clinic for support. They’re on your team and want you to succeed. Sometimes people feel like they’re going to be “in trouble” if the clinic finds out they’ve regained, but your team wants to help you.

Sorry you have endured so much pain and suffering. I do not have EDS, but I had a midgut volvulus and it was the worst thing I have ever been through. Although we all sign a release saying that the risks of surgery have been explained, it seems hypothetical until it actually happens. It's important for people to be aware of the potential for complications even years down the road. I was 4+ years out from gastric bypass when I had the volvulus. I hope your upcoming surgery successfully resolves your problems.

Thanks! I hope this isn't too arrogant, but I like to think that I can give some encouragement to people who are so terrified of loose skin. I certainly have my share of it after a 200-pound weight loss, but if I dress strategically, no one would know. And strength training can actually make a difference in reducing arm flab. Then again, I wore a sleeveless top to this appointment and the nurse was clearly not impressed. Based on a lifetime of personal experience, I'm not usually surprised when medical professionals use BMI as a health metric, but I guess I was caught off guard to hear this from a nurse who specializes in bariatric patients, and who knows that I used to have a BMI over 60.

Thanks... I actually have an appointment with my PCP this week, so I can ask her about this. My PCP is really good, but she's never claimed to have any expertise in weight loss or bariatric surgery patients, so I'm not sure if she would be comfortable with this. She's in the same hospital system as my bariatric surgeon, so she already has access to all of my records and knows what bloodwork the bariatric clinic wants. Even if this isn't her area of expertise, she's still more knowledgeable about it than this nurse.

Thanks... I did feel as though she was viewing me as a number on the scale and reading from a script or perhaps a flowchart. I imagine her looking at a flowchart that says, "Compare patient's current weight to previous weight," with one arrow for "higher" and another for "same or lower." She followed the arrow directly to the "REGAIN!!!" path and looked at me the same as if I had regained, say, 100 of the 200 pounds I lost. I suppose I shouldn't be so shocked to encounter unhelpful weight management advice from a medical professional, considering that I've had a lifetime of hearing generic weight and nutrition counseling everywhere I went. Still, I expected a full-time bariatric clinic nurse to have a little more expertise and nuanced understanding of weight management, nutrition, and health metrics. My A1C was 4.8 and she's telling me I'm eating too many carbs?!

Thank you... I wouldn't say she changed the diet, but I don't think she's interpreting the manual the way it was intended. I haven't looked at it in years, but after her comment, I had to check, and this carb limit shows up in the section on diet progression after surgery. There's a page for each phase (clear liquids, full liquids, purees, soft foods, and regular solid foods). The "Regular solid foods" page says "Week 7 - Lifelong," which I suppose implies that this is intended to be a lifelong diet. However, there's a whole separate section for "Lifelong Diet: Successful Eating Plan," and this has more general guidelines and lists of recommended foods, but no hard limits on carbs or anything else, and recommends using a calorie tracking app to understand calorie and protein needs. I think the "Regular solid foods" section is intended for patients who still have significant weight to lose after the first 6 weeks post-op, as I did, and continued to lose weight for over a year after surgery. The "Lifelong Diet" section seems directed more toward maintenance. It's alarming that this is so unclear, even to the nurse who is providing direction to the patients! It also makes me wonder if she is directing everyone to follow the same diet and same limits, whether it's a 5'3" woman or a 6'6" man?

Thank you for this! I see several doctors in this hospital system, and they almost always send me a survey after each visit, but go figure, this time, they didn't. I hate to lodge complaints because I don't like the idea of getting someone in trouble, and I don't want to look like an entitled brat, but this encounter seriously bothered me to the point of making me lose sleep. I thought she was going to congratulate me on maintaining a weight loss of over half of my starting weight, 5 whole years out from surgery, but no, my BMI is a hair over 25 and suddenly I'm a failure and all I get is, "You've gained weight" and a lecture about carbs. I like to think that I've learned a lot about maintaining a healthy lifestyle and mindset about food and eating. I've had a lot of time to think about how I gained so much weight and why I was unable to lose it for so long, and I've come to believe that this type of judgment has been a huge part of it. I'm 5 years out and I know better, but this visit really shook my confidence, and I hate to think what it could do to a patient who is struggling pre-op or still trying to adjust in the early post-op phase. I already have an appointment with her for next year, and I hate the thought of subjecting myself to this again. I almost wonder if I should consider myself to have "graduated" from the WLS program -- not that I know everything and can stop working to maintain my weight loss, but maybe move on to a more advanced program or trainer with expertise in healthy, fit people. In the last couple of years, I've worked really hard to improve my fitness rather than just being "not fat," and I'm not sure the bariatric surgery nurse is equipped to support my changing needs. But I felt that her comments went beyond ill-informed and ventured into harmful.

I recently had my 5-year post-op follow-up. I haven't seen my actual surgeon in years; my follow-ups after year 2 have just been with his nurse. Before this appointment, I considered myself a WLS success story. I lost about 200 pounds from my highest weight and have maintained a healthy weight for years. I have completely overhauled my diet and developed healthy eating habits. All of my health markers like blood pressure, glucose, lipids, etc. are excellent, and I have gotten in great shape with both cardio and weight training. I weighed in at this appointment, fully clothed, at 144 pounds, which puts me at a BMI of 25.5, 4 pounds into the overweight range. I'm not that concerned about BMI because I believe that actual health metrics are more meaningful, especially considering that I have several pounds of loose skin after massive weight loss. DEXA scans show my body fat percentage around 21%. When the nurse came into the exam room, the first thing she said was, "You've gained some weight. How do you feel about that?" I was taken by surprise and said that obviously, I want to maintain my weight loss, but I'm also trying to build muscle. She asked how many carbs I'm eating and I said it varies, and I mainly focus on calories and protein. She said, "You need to keep your total carbs under 60 grams per day." I said, "That seems pretty low." She replied (in a condescending tone), "Well, that's what you have to do to maintain your weight loss. It's in the manual. Carbs are the foods that sneak back into your diet and cause weight gain." I was pretty shocked and offended by what she said. First of all, I find it hard to believe that they expect WLS patients to stick to a carb limit of 60 grams/day for life. I think that's unsustainable for most people, especially for someone like me who works out for 2-3 hours per day (not that she asked how much I exercise). And I'm shocked that someone who works with bariatric patients speaks in such judgmental and insulting terms about food. Saying that carbs "sneak back into your diet" implies that I'm stupid and/or dishonest for eating more than an absurdly low level of carbs. And then she told me to schedule the next follow-up in a year, but if I gain any more weight, I should come back sooner because I might need to consider GLP-1 medications (which she noted wouldn't be covered by insurance at a BMI of 26). I went in thinking that I was a model patient, and left feeling like a complete failure. I thought I was a success story, and now I'm doubting myself entirely, wondering if I'm deluding myself and really on the road back to morbid obesity. I haven't felt this demoralized in a long time, and it makes me never want to talk to that nurse again. But I also know that long-term success with WLS is strongly associated with continuing follow-up, and I'm afraid it's a red flag that I'd give up just because a nurse shamed me about 4 pounds. I'd really like some outside perspective on this, especially from other WLS veterans 5+ years out. Do you still stick to a strict carb limit? Am I overreacting, or was this nurse out of line? P.S. My weight often fluctuates by up to 5 pounds in the same day. This morning, I weighed in at 139 pounds. And here is a picture of WLS failure.

The easy answer is: don't go to buffet restaurants. This is just not the best setting for someone trying to lose weight or for WLS patients who can't eat much. But I realize that you don't always get to choose the restaurant, and if you end up in a buffet situation, you may need to adjust your mindset about food. Value isn't just about getting the biggest quantity of food for the money, or the most calories per dollar. You have to account for the value of your health. You don't get more value by eating more food. You get more value by eating an enjoyable meal in good company (I hope, if you choose to spend your time and money with whoever wants to go to the buffet!) that meets your health goals. Don't think of it as wasting money by eating less food; think of the value to your health of NOT eating excessive food. Even if I'm eating at a non-buffet restaurant, I will ask them not to give me the rice, bread, etc., even if it's included in the price of the meal, and it's worth getting less food for my money if it helps me maintain my weight loss. Also, I have never heard of Huhot Mongolian Grill, so I had to look it up, and it looks freaking amazing. Too bad there aren't any locations anywhere near me!

Congrats on a successful year! My starting weight was the same as yours: 341 pounds. My surgery day weight was lower than yours (277) and by my 1-year post-op date, I was at 144. Everybody has a different rate of weight loss, and it's not a race. I don't like the fact that some doctors act like there are deadlines or milestones for weight loss, because these are based on statistical patient data. There's not a clock that runs out after the 1-year or 2-year or whatever date. You can continue to lose weight as long as you're in a calorie deficit. You've done great so far, and you have to remember that the less excess weight you have, the slower it goes. For most people who have not had weight loss surgery, 1 pound per week is considered a good rate of weight loss. What you consider "slow" (13 pounds in 2 months) is what most people would consider fantastic. As long as the scale is trending down (aside from normal fluctuations and short-term plateaus), you're heading in the right direction, and the pace is not important. For many people, the first year or so is the "honeymoon period" because that's when the effects of surgery are the strongest and make it easier to lose weight. You're getting to a point where you need to transition from being a weight loss surgery patient to being a regular healthy person and adopting long-term sustainable habits. If you want to keep losing weight, you may have to track your calories more closely (and your smaller body burns fewer calories than when you were 341 pounds, so you have to eat even less to maintain a calorie deficit). You are way ahead of where I was in terms of fitness. Diet is far more important than exercise for weight loss, but exercise is more important for maintaining weight loss, so A+ for getting into good habits so early. It's also great that you have started weight training now because massive weight loss comes with some muscle loss, and weight training can help to maintain your muscle mass to the extent possible, which is also great for long-term maintenance. Everything you've said indicates that you are doing it right, so if you keep on doing what you're doing, I think you'll be happy with the results. The best thing to do is start shifting your focus to maintaining your weight loss in the long term.

I just watched the miniseries and I was also wondering if anybody here had watched it! I never watched a full season of The Biggest Loser, but I've seen a few random episodes, and I have so many feelings. It was one of the worst reality shows in history for so many reasons! Its portrayal of weight loss makes it look impossible. It gives the impression that weight loss requires spending all day at the gym doing impossibly strenuous workouts. It also portrays the gym as a humiliating experience where trainers berate fat people. This leads many people who want to lose weight to either attempt the process portrayed in the show, realize it's basically impossible, and give up, or not even try in the first place because they can't fathom enduring this kind of torture. It leads thin people to believe that it's acceptable and even beneficial to shame fat people "for their own good." It portrays unsafe and virtually impossible rates of weight loss. The miniseries didn't address this, but I've read that the timeline on the show is misleading, because they say the weigh-ins are a week apart, but they're really longer. Contestants are shown losing 12 pounds in a week when the actual weigh-ins were 2 weeks apart. Either way, it gives unrealistic expectations of weight loss, which are very discouraging to those trying to lose weight. People who "only" lose 2 pounds in a week think they've failed and give up. The challenges are detrimental to the contestants. The miniseries mentioned this, and I remember seeing something like this in one of the random episodes I watched, where "temptations" were presented, and the contestants had to do something detrimental to their weight loss (like eat donuts or give up a day in the gym) to earn privileges like talking to their family. If the show wanted to pretend to care about the contestants, they could have made it the opposite: resist the temptations to earn rewards. The more broccoli you eat, the sooner you get to talk to your family. They exploited people who needed legitimate medical help. I'm guessing many of the contestants would have had WLS if they had access to it, but wanted to go on the show either because they couldn't afford it or because the stigma of WLS made them believe they had to do it the "right" way. The miniseries mentioned this as the concept of the show, losing weight "the old fashioned way, without surgery" Which is quitting your job to spend all day at the gym and work out until you vomit, I guess? I wonder what people would think of a reality show that made cancer patients compete for treatment. The contestants who were interviewed seemed so traumatized by the experience. Even the ones who didn't regain all of the weight, even the ones who said they were glad they were on the show, went through so much pain. It's outrageous and disgusting that the show preyed on these people.

You've lost 28 pounds in 6 weeks and 45 pounds in 2 months. The weight IS melting off. For most people, losing 1 pound per week is considered good, and 2 pounds per week is aggressive. You've more than doubled that. Now, having more excess weight than the average person will allow you to lose weight faster, but averaging 5 pounds per week is an amazing success. Have you had follow-up visits with your surgeon/team? What have they said about your rate of weight loss? Weight loss is neither linear nor instantaneous, so it is extremely normal to have fluctuations and sometimes even stalls (when you don't lose any weight for a period of time, sometimes weeks). As long as your weight is decreasing, you're headed in the right direction. I know that when you get to the point of making the decision to have weight loss surgery, it feels urgent. You've probably gone through a long process just to qualify for the surgery and you're ready to be thin NOW. But remember that you didn't gain all the weight overnight and you're not going to lose it overnight. You need to have patience and remember that you have the rest of your life to be thin. There are actually potential hazards with losing weight too quickly, so don't be in such a rush.

I will add that the cardiologist said this is common in people with massive weight loss and not necessarily a concern (and may not even be noticed) if there are no symptoms. In my case, however, I was experiencing symptoms that were not attributable to my bloodwork results, so that is why a pacemaker was indicated for me.