BigSue

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.

I was feeling tired and weak all the time. My surgeon referred me to a cardiologist because my resting heart rate was below 40 bpm. He said that when I had 200 pounds of excess weight, my heart had to pump really hard, and when I rapidly lost weight, it suddenly had much less work to do and compensated by slowing way down. I ended up getting a pacemaker that kicks in when my heart rate goes too low.

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.

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.

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.

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.

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?

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?!

Girl, just take a look at those arms! Man they're impressive! Totally fangirling right now.
On a more serious note, BMI, the number on the scale ....etc. interpretations are nuanced and should never be taken at face value. You're 144 lbs but probably have a high muscle mass, skeletal muscle, lean body mass etc. which translates into a higher number on the scale, that is just a fact. Had this nurse known these nuances and cared to research (or just be kind and nonjudgmental for that matter) she would've commended you on the great work you've done.
Maintenance is not easy, I know many many WLS patients who never got to their goal weights, others who gained a ton back, and others who totally spiraled due to the lack of discipline and commitment to the after. From what I gather from your replies and posts, you are 100% a success story a million times over, never doubt that or let a sleazy nurse make you feel anything but.
As for tracking, I'm almost at the 2 year mark and I don't track nothing, I have done random checks here and there but I never track my carbs or even my calories, I eat a well balanced diet and focus on my protein, but I eat all the carbs (bread, rice, potatoes, chips, dessert) and I never want to live a life where I have to be carb counting everyday, it's just not for me.
Please be kind to yourself and celebrate what you've achieved, I certainly look up to you and people like you :)

Well, I am not five years out from my revision, but I think I have a pretty good understanding of what works and what did not for me and that we are all different. This time, I have a nutritionist who actually looks at my logs from the Baritastic app as well as my fitness stuff on my Apple Watch and she told me to add in more carbs because of my exercise!

The fact that your nurse didn’t even bother to ask you about your nutrition, activity or medication changes, etc means she has no clue what she’s talking about and I would’ve checked out right there.

Honestly, the fact that she is working for a weight loss clinic with that level of ignorance and attitude is just baffling. Whether you decide to report her or not is entirely up to you, but at the very least, I would ask for any follow ups to be with a different practitioner at that office or just go to another one. What you were doing is clearly working for you. I mean you don’t fit into her little mold but that’s because there is no one size fits all mold. You are doing great and certainly don’t need her reckless advice to break what isn’t broken. 😡

this is ridiculous! Can you switch over to your regular PCP, maybe? (we were encouraged to have our annual check-ins with our regular PCP once we were 5+ years out and had had no issues). I wouldn't want to see a nurse like that again. And no, I don't eat an obscenely low level of carbs (my surgeon's program wasn't ultra-low carb to begin with - they stressed balance - protein, healthy carbs, and healthy fats). And you have been amazingly successful. Most successful bariatric patients make it down to "overweight" or "class I obese" (which is not very obese - we're talking like 30 lbs overweight). You're only barely in the "overweight" category - and like you said, you've got loose skin, which probably counts for a good 4 or 5 lbs. Sheesh. That nurse needs a new profession.
(P.S. I'm 10 years out)

ugh.
i learned early in my WLS experience to take the things my "team" advised me with a grain of salt (i'm looking at you nurses, NUTs and dieticians in MY program, YMMV). It was obvious even in my pre-surgery appointments that they were reading from a script and dispensing a one-size-fits-all solution. um, i am not the same size as the lovely lady next to me, nor are we the same age, have the same metabolic makeup, genetics, weight history, mental state, etc, etc.
i basically discovered what worked for me via trial and error - always letting them know what i was doing, and always being low-key scolded for doing so. ASIDE: On top of that they would also marvel at my weight loss as i progressed, so wtf, really. but i get it, they see hundreds of us a week, in 15 min increments, its difficult to give personalized attention. if i wanted personalized attention, i'd been better off hiring private assistance. but i didn't, so i went to my mandatory appts and just smiled and nodded.
sorry you left that appt feeling sh*tty. she was looking at a number not at you.
from what i have seen of you on here over the years, you are doing/have done marvellously. you've lost 200 lbs and maintaining. you've navigated up to now with no saltiness, you've displayed patience are not a huge stresser nor display huge anxiety, you provide helpful and encouraging advice to others kindly and funny ways, plus you look HAWT in that pink dress.
was she out of line? maybe. do her words make you any less marvellous? hecks, no.

I think that is a concern and maybe why you should lodge a complaint @BigSue: if her comments made you feel like this what is she saying to those staring out or early on the journey. Have to admit I did think I bet she’s never had to battle with her weight at any point in her life.
May be in your complaint suggest the need for a program to support those like you who are more advanced, informed and been maintaining successfully for a number of years. I think that’s a great idea & there would be others like you at the clinic. It would be an incentive for everyone to keep up with check ins and to check they’re still on the best path for them.

I can only pray to be as "unsuccessfull" as you are!! Lol...She is out of her mind, and I'm not a veteran yet, but I would report her. Tell the doctor. She needs to have an appropriate bedside manner that she lacks. You deserve better!

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?

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.

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.

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.

OMG how rude. Can you report her? Can you request she doesn’t meet with you again! An important component of her role is to be supportive yet she tore you down and made you doubt yourself. Did she even actually read your file and review your progress? Seems like she just looked at the number on the scales and made judgement. I mean how many times do we tell each other not to focus on just the number on the scale.
I have admired your progress and successful maintenance over the years @BigSue. You have been a great mentor & role model here & I am so angry that this person has damaged your confidence.
My follow ups are 6 monthly and I see a doctor. (I’ll be seeing her again in a couple of weeks.) She reviews my bloods, has a chat with me about any things I’ve noticed, have concerns about, happy about, etc. Yes, she does weigh me but generally makes no comment excepted to maybe to say about the same as last time. When I saw her 6 months ago, I was having issues of weight gain (which was strongly hormonally driven) and we discussed that but she never once spoke to me about what I ate. I know if the gain had continued I know I could have rung her and asked for further support and advice.
As you may recall, I was never a food tracker. I still do random checks of calories, protein and fluids though. And I like to ensure I’m getting in a balance of nutrient sources so ensure I have fruit, vegetables, complex grains, dairy, seeds & nuts & meat every day and occasionally legumes. I have no idea how many carbs I eat or fat for that matter. I just know I have 2 - 3 serves of carbs a day.
Remember you know your body best. Your fluctuations, your general health and well being, what you need to support your activity routines & for your body to function, etc. You know if you’re retaining fluid, constipated, been unwell, where you carry loose skin, your muscle development & if there have been any changes in your usual routines lately (like a bit more socialising, been on holidays, work been more stressful,…). Are your clothes tighter? Is your general doctor happy?
I’d give her a big F you & stick to what you’ve been doing.
PS - You look great in that pxt.

@BigSue I am feeling so angry and upset for you, how damn dare she. You are a success, you look amazing. You did this really difficut surgery. You changed your life. You lost the weight. You work your butt off to keep it off.
No a measure of carbs has never been in my diet plan. My main instructions were at least 60 -80 grams of protein a day and drink plenty of water.
I am with @Arabesque here, the nurse needs to give her head a wobble, if they have changed the diet for you then they should have alerted you beforehand.
I am a great believer of a complaining email. They work for you and with you. Maybe this lady forgot

I am so sorry and upset that she treated you this way!
Her job is to be supportive, not to diminish your amazing achievements for a minor (and very normal) fluctuation in your weight.
I would put your feelings in writing to the clinic.
Don't let her or anyone steal your light! You're doing a amazing job! 🤗