SpartanMaker

I realised my response above was a bit lacking on practical recommendations. Let me try to summarize what I'd suggest: Since you're right where I'd want you to be in terms of weight loss per month, don't change anything at this point. Only consider changing if you find the weight loss completely stops for 2 months or more. If weight loss does stop for at least 2 months, I'd actually recommend UPPING calories by 250-300 calories a day. I know that sounds counter-intuitive, especially considering that a negative energy balance is the only way to lose weight, but let me explain. Remember when I said above that one of the main jobs of our metabolic regulation system is to keep us from dying? No matter what we do, our metabolism slows when we diet. The rationale behind upping calories (by a small amount), is that we want to convince that system that the "bad times" have passed, and it's okay to ratchet up metabolic processes again. I'd recommend eating this increased calorie amount for at least a month, but two months would be better. Somewhat surprisingly, most people won't gain weight if they do this because their metabolism will increase to compensate. After that diet break, only then do we drop calories for a month or two in order to drop some more weight. You can keep up this intermittent dieting (not to be confused with intermittent fasting), until you get to your goal weight. I know this sounds like a slow process, but I promise, in the long run it's actually faster than if you just tried to keep cutting calories to get to your goal. Please keep exercising for your health, but also so that once you do get to your goal, you'll have a much easier time maintaining the loss. I would strongly recommend a minimum of 3 days per week of aerobic exercise and 2 days per week of strength training. This will set you up really well to maintain weight, as well as for excellent health as you get older. Don't be afraid to seek out a good mental health counselor. None of us got as big as we were by having a healthy relationship with food. The vast majority of people that fail to lose weight or that regain lots of weight after bariatric surgery do so because they fall back into old poor eating habits.

I LOVE Pea soup, though I don't make it much because apparently I'm the only one in my family that does like it. Weirdos! 😜

1kg a month is perfect right now. Instead of thinking in terms of a specific number you should be losing, think in terms of a percentage of your overall weight. This has an advantage in that the actual number to shoot for drops as your weight goes down. The ideal amount for most people would be one to two percent per month (and certainly no more than three percent). This is right where you're at. Believe it or not, slower is actually better here. The faster your weight loss, the more likely you are to be causing your body to decide you're starving to death. When this happens, your body starts doing things that slow down your metabolism to try to keep you from dying. Of course we know intellectually that we're not actually dying, but your body's metabolic regulation system doesn't know that. It's an amazing system, but it was designed before we had almost instant access to unlimited amounts of highly palatable foods. Thanks for clarifying on the new goal. 65kg sounds like a good goal for now and there's nothing wrong with adjusting up or down even more as you get closer to that. Regarding diet, calories and macros, I'd obviously tell you to defer to your dietitian, though I will say I'm very surprised by the recommendation to lower your protein. When dieting, there are literally hundreds of studies that show the advantages of eating more protein. You should know that overall, I personally am not a huge fan of tracking calories. I know that some people here seem to do so effectively, but for me it just does not work. As I mentioned, most of us aren't very good at actually tracking calorie intake accurately. Even more important to me, none of us have any way at all to know how many calories we are actually burning in a day so tracking intake is only showing you one side of the energy balance equation. Plus, energy expenditure can be highly variable day to day, so even if you did somehow know the exact amount you burned today, it's not going to be the same in one month or one year from now. With all that said, if tracking is working for you, don't change it. Do keep in mind that you may have to reduce calories as you continue to lose since the biggest contributor to metabolism day-to-day is body size. Regarding exercise, I'm going to recommend you stop thinking of exercise as part of your weight loss goal. It simply doesn't work. I don't say this lightly, nor to discourage you, simply to state fact. We have a huge amount of evidence now to show that our bodies tend to slow down in other ways in response to exercise. This is something called the constrained energy model. On a practical level, exercise is still critically important for your overall health. In addition, we do have a lot of data that shows people that have lost a lot of weight are better able to maintain the loss if they exercise on average 1 hour or more per day. In short, do it because you'll feel better, because you'll live longer, AND because once you reach goal, you'll have a much easier time keeping the weight off. I think I can speak for most of us here on this board that we have experienced the exact mental anguish you're feeling. It's normal to worry and let doubt creep in, so know that you are not alone, Mental health is not my area of expertise, so my advice will always be please seek help from a mental health professional if you think you need it.

Yogurt Marinated Grilled Shrimp, Prosciutto-Wrapped Grilled Asparagus & Wild Rice Salad:

GERD can be a possible side-effect of sleeve surgery, but not bypass. Medications like omeprazole work for some people, but severe GERD can lead to revision surgery. Typically these patients are converted to gastric bypass to relieve their issues. There are a few people here that have been through this, so hopefully they'll chime in.

To be clear, the gas used in abdominal surgery is not inside your digestive tract, thus medications to address that issue won't help. Typically they use CO2 and it's actually pumped into your peritoneal cavity to help create space between the abdominal wall and your organs. This gives the surgeon room to work more safely, as well as help visually distinguish everything. The reason it hurts so much is because basically your abdomen has been blown up like a balloon. This pushes up on your diaphragm, which in turn irritates the phrenic nerve. It's not uncommon to have referred pain in the chest, shoulder and neck as a result. Eventually the surgical gas will be absorbed into your bloodstream and you'll breathe it out, but until then this can be quite painful. Walking helps, but won't fix it. Overall, it should pass in a few days. I'd also make sure you're drinking enough because headaches are a classic symptom of dehydration. Dehydration is one of the main reasons bariatric surgery patients end up back in the hospital in the early post-op period, so please do everything you can to keep up with your fluid intake.

I'll do my best to help, but I'm going to have to start by asking some questions: When you say the weight is "barely coming off", can you be more specific? How much in the last week, two weeks, last month? Can you clarify what your goal weight really is? In your profile, you're showing that you're currently at 78kg and your goal is 75kg. That's only about 6-7 pounds, not the 33-44 you listed. I'm thinking you probably have a new goal and have not updated your profile, but it's important to understand what you really are trying to do. When you say you are "eating pretty well", can you give some examples of what a typical day looks like? What is your daily caloric goal? What about protein, fat and carbs? How are you determining your what you caloric and macronutrient intake should be? How are you tracking your intake? Do you weigh everything in grams before it goes into your mouth? Let me explain why I'm asking these questions. Typically when people are struggling with weight loss, we see a few common issues: Unrealistic expectations. Especially if weight loss early on after surgery was easy, people tend to think it will continue that way until they reach goal weight. Unfortunately, that's not how this works. The heavier we are, the more we'll lose at first. The closer we get to goal, the harder it becomes. It can take months just to lose a few pounds if you are already pretty lean. You also have to really have your nutrition dialed in at that point.. I won't get too deep into the physiology here, but there are multiple reasons for this and it's 100% normal for this to happen. My point is that you may be right where you need to be. It's hard to know just that just based on what you posted above. Eating more than you think. Study after study shows that almost everyone thinks they eat less than they really do, even those that log their food using calorie tracking apps. It's sometimes simple things like those little tastes while preparing a meal, or that handful of nuts they forgot to log. Others, they just guess at calories because accurate tracking is really hard. Burning less than you think. Most people have absolutely no idea how many calories they actually burn in a day. We often use estimates based on height and weight, but these can be off by may hundreds of calories depending on age, lifestyle, percent body fat, etc. Further, your calorie burn isn't the same all the time. It can vary by hundreds of calories per day even before you consider exercise. Speaking of exercise, we drastically overestimate the impact of exercise calories. For the vast majority of people, the calories they burn in a day don't actually change all that much due to exercise. Blaming things outside your control. It's natural for people look for causes for problems. If we take ownership of the problem, we can then take steps to correct it. It's when we place the blame on something we perceive to be outside our control that we can run into serious problems. Let me give you an example here. We can't escape simple physics. If you burn more calories in a day than you consume, you'll lose weight. Eat more than you burn and you gain weight. If I take responsibility for this, then it means I need to eat less or burn more to lose weight. I realize that's easier said than done, but without first taking responsibility for the problem, I'd have no hope of fixing the issue. If on the other hand, I were to say "I have a slow metabolism", I'd essentially be saying this issue is outside my control, even though the solution is the same as before: eat less than you burn. Thinking a particular diet/macronutrient is more important than calories. I noticed you hinted at that in your post. Calories are king here. Specific diets that emphasize one or more macronutrients can help, but they never trump calories. I can go into more detail later, but this post is already getting overly long so I think I'll stop here. Please provide some additional detail and I may be able to provide better guidance.

Just be careful with selecting meal replacements since a lot of them won't meet the guidelines as outlined by your team. As an example, the Bariatric Pal creamy chicken soup meal replacement mentioned above is too low in protein. While there are a few products out there that will meet those guidelines, most won't. They'll either be too low in protein, or too high in carbs. This includes the vast majority of products you'll find at grocery & drug stores.

Is it just me, or is it really odd they'd tell you what not to use, but didn't tell you what you should be using? Surely they must have some suggestions that fit what they want here? As far as I know, all meal replacement shakes contain added vitamins as that's sort of the point. They also contain added carbs and fats that most protein shakes don't have. I'd say the vast majority of people here were told to just use protein shakes. That's typically for a few reasons: First, especially if you also take a vitamin supplement, you're not going to suffer any long term harm using protein shakes instead of meal replacement shakes for a few weeks. Second, most meal replacement shakes are lower in protein than a typical protein shake. We want as much protein as possible to help prevent the breakdown of muscle tissue when dieting. Third, most bariatric doctors don't actually want you consuming very many carbs, since one of the main goals of the pre-surgical diet is to shrink your liver to make the surgery safer. The best way to do that is a very low carb diet. (The liver is one of the main ways your body stores glycogen, so by depleting it of glycogen (carbs), it will get smaller, even if no other changes take place.) TL;DR: Ask your team what they want you to use.

This doesn't strike me as self-sabotage, as much as addictive behavior. I should clarify that I'm not a therapist, but even if I were, no one can be diagnosed simply based on a post on a message board. Transfer addiction post-bariatric surgery is incredibly common so I feel like it's worth it to seek help ASAP and get this sorted out.

There's really no reason for your insurance company to deny coverage here. While gastric bypass is obviously performed for weight loss, that's not the only reason. There are normal weight people that sometimes have it done for various issue like severe GERD and issues with gastric emptying. My point is that even though we think of it as a bariatric procedure, in your case, you need it purely for medical reasons. They can't deny it on the basis that they don't cover bariatric surgery, since that's not why you need the surgery.

In honor of spring, I made Vietnamese Spring Rolls with Peanut Dipping Sauce tonight: These take a lot of work to make, but they are quite tasty. I at ~1 3/4 rolls. For contrast, my wife had four.

@NickelChip made a great point about photos. Another really good way to "see" the difference is to take measurements with a tape measure. I wouldn't do so more than about once a month, personally. There are multiple places you can measure and you certainly don't have to do them all, but I'd say the most common would be: Neck (probably more for men since this is good to know for dress shirts) Bust / Chest (at widest part) Under Bust (mostly for women only since this is needed for bra size) Each Upper Arm (either at the largest point or midway between the shoulder and elbow if you can't tell) Belly / Natural Waist Under belly (especially for men since this is where casual men's pants typically sit) Hips / Butt (you can do both if your hips and your butt are perhaps larger at different places) Each Thigh (typically at the widest point) Each Calf If you do this, it's important to try to be consistent in where and how you measure. It can also be really helpful to have help for some of these.

Wow, that's a bit concerning for sure. Hopefully you've already seen a doctor and discussed this issue? There are some medical conditions completely unrelated to weight that can cause a sudden rise in blood pressure, so I would think it's worth a visit to your doctor to discuss what may have caused this. Also, have you noticed any patterns where it's high vs. low, or is it just high all the time? For example, times of day, before vs. after eating, sodium intake, life stresses, that sort of thing?

My "American take on a Greek salad" from dinner last night:

Simple answer, Yes. Slightly more complex answer, ALL protein is made up of amino acids. That's sort of the definition of a protein. I suspect what you may be asking is does protein powder contain all the essential amino acids? For those that don't know, there are some amino acids that our bodies can manufacture themselves, and others, called essential amino acids (EAAs), that we have to get from dietary sources to stay healthy. For the most part, protein powders do contain all the EAAs. Some are better quality than others however. I personally would focus on "Whey Protein Isolate" because it's fairly pure and has a more rounded amino acid profile compared to some other sources. If you are vegan or just prefer to avoid whey for some reason, soy also is pretty good, but pea and rice tend to be a bit lacking in one or more EAAs, so caution is advised there. A mix of various sources is probably the way to go for vegans

You didn't know it @AmberFL, but this statement has been stuck in my head almost all day. Let me explain. Earlier I spent ~1.5 hours running in a cold hard rain and frankly it kinda sucked. My mind started wandering (as it often does when I run), and I was asking myself why I was out there running in such lousy conditions. That's when determination popped into my head and that's when I remembered this thread. It made me think of all the folks that say "I just don't feel motivated to do XYZ today". I was thinking on my run though that I wasn't feeling motivated either, but I was still out there running (and partly questioning my sanity). It occurred to me that it was in fact determination, stubbornness, perseverance, resilience or just plain refusal to quit. I wasn't out there because I wanted to be, or because it was fun, I was out there because I HAD to be to be. I guess my point here is that I think of motivation as fleeting. It's the spark that sets me off to accomplish hard things and set lofty goals, but it's determination that keeps me going toward reaching those goals day-to-day. I short, your statement above was perhaps more spot on and profound than you might have realized. Of course it's your determination to do hard things that's keeping you going. That's perfectly normal and as it should be! Anyway, thanks for motivating me through a hard workout!

@MrBeeswax I'd say the same thing, there are no limits here. I've looked through a number of scientific papers on weight regain and insufficient weight loss after bariatric surgery and about the only thing you'd find if you do the same is that the data is all over the place. I've seen numbers from as low at 10%, all the way up to 80% of patients regain some weight. The reason for that is there's very little consensus on defining what weight regain even means. If, for example, I lose too much weight, then gain back a bit, some studies would include me the the weight regain numbers. I'd say that's a healthy thing to have happened. I suspect @SouthernSleever fits into that category, though I obviously don't know for sure. One other thing you'll find in those studies is that a lot of the patients that regain a lot of weight or failed to lose enough weight tend to be "non-adherent", meaning it's their behaviors, not the tool that's the real issue. We say this a lot here on this board, but it's worth repeating: Bariatric surgery does not fix your head. If you're not willing to commit to learning how to eat better and move more, then you too may be one of those that "fails" bariatric surgery. I would strongly urge you to keep that in mind if you do pursue surgery. You absolutely can reach a healthy weight, but surgery is not a miracle cure. I takes a ton of hard work and commitment to be successful.

Just got done with a long cold rainy run and needed something to warm me up, so it's leftover Japanese curry time. This is around a cup of curry and roughly 1/2 cup of rice.:

There are no limits to what you can lose, nor is there anything that says you will regain any specific amount, or frankly that you will regain anything at all. I think we do ourselves a HUGE disservice (and bariatric doctors are bad about this), by thinking in terms of what's "normal" or "average". Keep in mind that averages are determined by people that regained everything, as well as those the are clinically underweight. I would strongly urge you to stop thinking about what you can expect, and start thinking about what you want.

@WendyJane made a great point. I sort of assumed you were getting your protein other ways, since it's certainly possible to do so without eating meat. That said, transitioning to vegetarian or vegan would be really hard to do right after bariatric surgery. While that sort of diet can be a healthy choice, getting enough protein has to be your main goal. Hopefully your team gave you a minimum protein goal. If not, at 3 months out I would want to see at least 70 grams per day minimum, with 100 as a better goal. As you get to 6 months, 120+ would be ideal, though even more is beneficial. We focus on protein during weight loss for several reasons: Protein is essential to your body. While you also need a small amount of essential fats, you could in theory get those from a supplement. Dietary carbs are not essential because your body can convert protein and fat to glycogen to fuel your body. Protein is highly satiating compared to carbs, plus it takes longer to digest than fats, meaning you'll be full longer. Protein is actually harder to digest, meaning on average, for every 100 calories on protein you eat, you burn about 20 calories just to digest it. This means the more protein you eat, the lower your overall caloric intake compared to carbs and fats. Higher levels of dietary protein help you preserve more muscle mass as you lose weight. Because muscle is more metabolically active than fat, the more muscle mass you preserve as you lose weight, the more calories you'll burn, even at rest. In short, protein, protein, protein. You really can't eat too much protein at this point after surgery.

I eat a lot of soup, especially in the winter. Now that it's warming up, I don't eat nearly as much soup, but we had a cooler day today, so I made Moroccan-Style Chickpea, Carrot, and Spinach Soup. It's topped with some chopped pistachios. I served myself about one cup, but couldn't eat it all: We also had some toasted Pita slices with Muhammara. This is a shared plate. I only had one slice: We ate alfresco on the porch to enjoy the nice weather. All In all a nice evening meal. 😊

This is the most important thing of all! Well done.

But you are smaller! By my calculation, you've lost ~15% of your overall bodyweight in just 3 months! That's an amazing amount of weight loss. If you were thinking you'd be at a normal weight in 3 months, that's just not even close to realistic or in fact possible considering where you started. Most people will continue to lose for at least a year, some for much, much longer. You're doing great so far and as long as you keep following the plan outlined by your team, you'll continue to lose for some time to come.

If you want to try collagen supplementation, you certainly can, though the scientific evidence is a bit of a mixed bag. Some studies seem to show benefit, but I think we have to keep in mind this condition is also a temporary issue brought on by the stress and dietary deficiencies you went through. In short, it's going to resolve by itself over time and thus it's really hard to know if the collagen is actually doing anything. IMO, the best possible thing you can do for your health, for your hair loss, as well as to speed your weight loss would be to really double down on dietary protein intake and not supplements. For those about to jump in and mention that collagen IS protein, yes that's true, but it does not contain all the essential amino acids. As such, you really should not count it toward your daily protein intake. Plus, a capsule isn't going to contain very much protein anyway. I'd guess less than a gram per capsule, though I suspect it might vary based on the source and size of the capsule itself.