SpartanMaker

Am I understanding you've lost over 60 pounds in 3 months and you think that's "not much weight?" By my perspective, you're doing fantastic and should be very proud of your success so far. I'm not sure where your expectations came from regarding weight loss, but I feel like maybe you had unrealistic expectations here?

You make an important point and I would encourage @AmberFL to think about this more and perhaps search their feelings. There is certainly a lot of danger in moralizing food by labeling things "Good", "Bad", "Healthy", "Unhealthy", etc. The flip side is that totally ignoring nutrient density can also be really problematic for some people. Left unchecked, it can be permission to eat nothing but highly-processed foods or to completely ignore macro and micronutrient content. It also can be a trigger for some people in that they lack the self-control to just eat one piece of that cheesecake. Instead, they eat the entire thing. (Not ragging on cheesecake, I had a piece last night, so it was top of mind.) Instead of moral judgements, I think a better guideline might be how what you're eating makes you feel physically. Especially for athletes, are your food choices making you feel energized and ready for your workouts, or are you always dragging? Are you recovering well? These are the main things to focus on. We can successfully eat a wide variety of foods and be healthy, happy and maintain at our optimal weight. The trick is finding that balance.

Please talk to a doctor ASAP. This is not normal and you could be having a serious complication. Now is not the time to be looking for advise on the internet.

As a general rule, I would not recommend eating back calories burned for a few reasons: People misunderstand metabolism. Our bodies are highly adaptable and our non-exercise calorie burn is also highly variable day-to-day. We know from recent research that your body tends to try to conserve energy balance, meaning unless your burning over ~400 calories per day in exercise, your body will lessen your calorie burn elsewhere during the day to try to "make up" for the exercise calories. In short, you're not burning as many overall calories on those exercise days as you think you are. Our ability to accurately determine calorie burn from exercise is hard and often we think we've burned more calories than we actually have. For example, you may think you've burned say 400 calories, but it may have only been 250. We also aren't very good at accurately tracking caloric intake, so you may be eating a lot more than you think you are. Adding in even more calories to "eat back" your exercise calories is not going to be accurate, even if the two points above were not true. Something here is not adding up for me. You mentioned you're trying to do a body recomp, but also that you still have a lot of weight to lose. That just doesn't make sense. It's fine to say you want to lose fat and gain muscle, and as a newbie to weight training, you can do both, but you really need to make fat loss the priority here. At best as an untrained woman, you might be able to add 10 or 12 pounds of muscle in the course of a year, but in all likelihood it will be less. I don't mean to discourage you, but most obese people already have more muscle mass than a "normal" person, so you can't expect to add as much muscle as they might be able to. My point is that when we talk about a recomp, what we really mean is trying to stay at about the same weight, but simultaneously lose fat and gain muscle. In my opinion, you need to focus on fat loss first, then try a recomp once you're closer to your goal weight. My suggestion would be to focus on two things: Most importantly, are you still losing weight? If not, then you're eating too much. If you are still losing, is it at a reasonable and sustainable rate? I'd want to see no more than about 3% per month considering that you should hopefully be also adding some muscle mass. This factor is really the primary determinant of where your calories should be. If you're losing faster than ~3%, then it's probably a good idea to eat a bit more, but don't change things by more than a couple hundred calories a day. If you're not losing weight, then as I said, you're eating too much and need to consider scaling back. The second factor here is how you're feeling. If you're eating so little that you can't even think about completing your workouts, or you're just exhausted all the time, then that's a sign you probably need to be eating more. Even so, take it slow here. Add in a couple hundred calories a day and see if you feel better. You can go up to where you need to, but keep in mind, you may also slow or even stop the weight loss. If that happens, you may need to modify your workouts. The flip side of this is if you are feeling good, but not losing, that's probably a sign you're eating too much. In the end, it's a balancing act of eating enough to fuel your workouts, but no so much you stop the weight loss. It will take some time to find the right point for you. Best of luck. (Oh, and in the future, I'd strongly recommend just starting a new thread. This one is several years old.)

So sorry you're struggling right now. I think if we're all being honest, we're ALL been there. I've said this before, but I strongly believe anyone that is or was obese has an eating disorder or at least suffers from disordered eating. You simply don't get that big unless you have an unhealthy relationship with food. The thing is, none of us magically got better by having bariatric surgery. If you think you need it, please reachout to a mental health professional to help you get back on track. If you don't feel ready for therapy, that's okay too. You have to do what's right for you. Just know that there is help out there if you need it. I want you to know that I personally have faith in you, even if you don't right now. You are an inspiration to many people here, me included. You've already shown how strong you are and how hard you're willing to work for your goals. I know this is just a temporary setback, and I'm guessing a lot of it was brought on by extra stress due to surgery and your routine being thrown off. As they say, this too will pass. I know you can get your mojo back, so please give yourself some grace. We're often our worst critics. I'm honestly just guessing based on your previous posts, but I'd think you're a very goal-oriented person. It might be beneficial to stop thinking "I need to get back on track". That's just too nebulous. Instead set yourself small, time-bound concrete goals. Only you can decide what those should be, but it might be as simple as "get at least 120 grams of lean protein tomorrow". Forget everything else that part of your personal idea about what "back on track" means and just work on that one small goal until it's become habitual. Only then, add in a new goal to work on. Just keep them small, easily attainable based on where you're at today, and make sure they have a time component such as my goal for tomorrow is..., or my goal this week is... you get the idea. If you need any help with diet or exercise as you work through this, please feel free to PM me and I'll do my best to help. Wishing you all the success in the world!

Decided to have something different for breakfast today. A bit eclectic I know, but it used up some leftovers. BTW, the toast is from some of my homemade sourdough.

Wednesdays are salad days in the SpartanMaker household. Tonight it was Cobb Salad. Here's mine, followed my my wife's for comparison:

I think it's a sad state of affairs when we feel like we have to hide our decisions from others because of how we know others will react. I'm not judging anyone that makes that choice since I did it too. I told my family, but specifically decided not to tell my co-workers since I was expecting people to say dumb things like this. The cheating comment I find specifically odd, personally. To me this was life or death, and I chose life. It definitely wasn't some game where the concept of cheating might be meaningful. I feel like it would be no different than if someone were to say to me that I "cheated" when I had open heart surgery. How could you even think that? My choices were either have the surgery, or die. As to weight loss surgery being "the easy way", as all of us here know there is nothing easy about this. Those of us that have reached our goal weights know that the surgery was just a tool, but the important change is what had to happen between my ears. Nothing about that was or is easy. It's still hard work every. single. day. I also wanted to comment on this: I can virtually guarantee you I eat better and workout harder than your son. I NEVER would have been able to workout as hard while I was still obese. It took losing almost 100 pounds before I could even really walk much. Now I run 40+ miles a week. It's hard for people that are not obese to understand just how hard even simple movement can be. Weight loss surgery was the catalyst that allowed me to be where I'm at today.

Why not just spit? True wine connoisseurs routinely do this as there's no way to get through multiple tastings without getting sloppy drunk. After all, you can't properly appreciate good wine if you're intoxicated. This is expected and even encouraged at proper tasting rooms. If you prefer, you can even ask for an individual spittoon rather than use the communal one.

Well, I finally decided to join the fun here in this thread: I pretty typical breakfast for me: This is ~3/4 cups of 2% Greek Yogurt, some thawed frozen cherries and some protein boosted granola. I don't really log my food, so I'm just guessing as to nutrition, but I'd think this is ~250 cals and ~22 grams of protein. Why 2% Greek Yogurt? Because that's what my wife prefers, so that's what we buy. I don't have a strong preference, but personally would probably buy full fat if I were buying it just for me. Note that I often change out the fruit based on what we have and what's fresh in the store.

Research does support the idea that BMR will be lower in a formerly obese person vs. someone of the same body composition that was never obese, but the magnitude of the effect was only 3-5%. I'm not discounting the 300-400 calorie number entirely, I'm just saying that if it's accurate, only maybe 50-70 calories of that is coming from BMR. The rest is coming from something else like activity level. Keep in mind that the most common way to quantify total daily energy expenditure (TDEE), is with a 4 component model: Basal Metabolic Rate (BMR). This is sometimes listed as Resting Metabolic Rate (RMR), although that is slightly different. Either way, this is a way of quantifying how much energy your body burns just to keep you alive. Exercise Activity Thermogenesis (EAT). This is calories burned in intentional exercise, such as running, cycling, etc. Non-Exercise Activity Thermogenesis (NEAT). This is all the other activity you do aside from intentional exercise. You can think of this as things like cooking, cleaning, shopping, etc. Some people refer to this type of thing as "activities of daily living", although other things also fall into the NEAT bucket like fidgeting, how much you stand vs. sit, etc. Thermic Effect of Food (TEF). Note there is no such thing as a negative calorie food. That said, it does take some calories to digest the food we eat. On average, it's about 10% (so if you eat 1500 calories, it takes 150 calories to digest that). Note that protein tends to be a higher percentage, yet another reason to eat more protein. While it's potentially possible that formerly obese people are somehow more efficient at digestion (meaning some of the effect could come from here), this could only account for a very small difference since TEF is just a small percent of your overall calorie burn to start with. The reason I wanted to list all that is if BMR of formerly obese people is only downregulated 3-5%, then any potential 300-400 kcal/day difference would have to come from somewhere else like NEAT. Since NEAT is known to be lower in obese people as well, it's likely the bulk of the difference here is simply coming from less daily movement (perhaps habit?). This also means it's likely highly variable. The good news to me is this should also mean it's changeable as well. Food for thought.

Getting back to the OP's question about what do do: If they really feel they are accurately logging and are also having a hard time eating less, then the option would be to take steps to increase metabolism. Yes, GLP-1 drugs can do this, but there are other options. First, would be adding muscle mass from strength training. Estimates are that each pound of muscle increases calories burned per day by roughly 6 calories, Each pound of fat contributes ~2 calories burned per day. This latter fact surprises some people, but fat is metabolically active tissue. It's just that muscle is more metabolically active. If someone were to gain ten pounds of muscle and lose ten pounds of fat, that would lead to an increase in BMR of roughly 40 calories. That doesn't sound like much, but it adds up over time. If you also add in EPOC (Excess Post-exercise Oxygen Consumption), from the strength training needed to add muscle mass, then I'd estimate this would over time lead to ~400-450 extra calories burned in a week. That would lead to a loss of ~6 pounds in a year even while eating the exact same amount of food. If this is not a sufficient amount, then one can always reduce calories a bit as well. Alternately (I know this will sound counter-intuitive), but the OP might well want to consider UPPING their calories a bit for a while. Our bodies were designed to upregulate our metabolisms slightly when calories are available and downregulate it when calories are scarce. This means our bodies can maintain weight at a wide range of calorie intake. If we're constantly in a calorie restrictive diet, our bodies do downregulate metabolism to keep us from what it perceives as starving to death. What I'd recommend instead is going up 200-300 calories per day for about a month. After this "diet reset", drop down again to 1200-1400 for no longer than 2 months before cycling back up again. You can keep this cycle going on indefinitely. One of 2 things will happen here. Most likely the OP won't gain anything during the increased calorie intake diet reset because their metabolism will increase to compensate. However, when they start back at the ~1300 calorie range, their metabolism may not drop immediately, meaning they'll lose a little bit in the following 2 months. If they do find that they gained during the diet reset, but fail to lose when back in the diet phase, then worst case it shouldn't be more than about 2 pounds (less than 1% of body weight). This isn't likely, but even if this does happen, it will at least tell us that 1300 won't work for weight loss for them and they'll need to go lower. I'd also be remiss if I didn't come back to exercise here. I mentioned that low levels of exercise (30 minutes of cardio), really are not going to do anything toward weight loss. It's obviously going to be different for everybody, but current research seems to suggest that the tipping point is about 400 calories per day. What I mean by that is if you can burn OVER 400 calories in exercise in a day, the body can't suppress your metabolism enough in other ways to keep you from going net-negative for the day. Said differently, you'd need to do something that burns more than 400 calories before it "counts" for weight loss and the only part that counts is the part above 400 calories. Unfortunately, 400 calories is A LOT for most people. The good news is the heavier you are the more you burn, but even at 215 pounds, you'd probably have to run over 3 miles to hit 400 calories. Keep in mind, this would just be to break even, so if you're actually trying to burn more calories this way, it will take even more. I'll use myself as an example here. I'm not trying to lose weight right now, but I have found that if I run over roughly 28 miles in a week, I tend to lose weight. If I run less miles, I maintain. Do the math, and for me that's right at about the 400 calories a day mark. In my use case of one, I'm pretty close to the statistical average as shown in the research. Best of luck whatever you decide.

I'm not really surprised considering the amount of money involved here. That said I'm seeing reports that many providers of Tirzepatide have already stopped providing it. I would expect the same for semaglutide soon. I guess time will tell if the FDA will allow other companies that are essentially skirting the rules to continue to do what your provider is doing. Keep in mind that dosing schedules within 10% or compounding 2 drugs not on the shortage list are not allowed as ways around this restriction. It may suck for consumers, but cost alone is not a factor in whether or not the FDA allows medications to be manufactured and sold by someone other than the patent holder. Any compounding pharmacy that tries to get around the rules is at least subjecting themselves to more regulatory scrutiny. Some may find themselves out of business. I honestly don't have a dog in this hunt, but I do think folks here need to be aware that the playing field may be changing if they already have, or are planning to try compounded GLP-1 drugs.

Just doing some looking and it looks like the supply of compounded semaglutide and tirzepatide is about to dry up. This compounding was only allowed by the FDA because the patented drugs were on the FDA shortage list. Both those drugs have since been removed from said list, meaning compounded pharmacies won't be able to keep selling these. (With some possible tiny exceptions like custom dosing protocols.) Dulaglutide or liraglutide are still on the shortage list, so these may need to be the drugs of choice for those seeking compounded versions.

If the OP thinks it's the solution and can find a way to pay for it, then they can certainly try a GLP-1. Keep in mind current studies suggest up to 20% of people are non-responders, meaning they don't work for everyone. Also, even compounded versions can be prohibitively expensive for some people. I would also caution the OP to be careful when seeking out compounded versions. As a nurse, you're in a better position to find a decent compounding pharmacy and also not make medication administration errors. Unfortunately compounded GLP-1s are a bit like the wild west right now, with shady operations and less than ideal directions/administration of the drug. So much so that the FDA has put out an advisory: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss Caveat emptor was never more true.

This isn't surprising. In addition to their appetite suppression benefits, GLP-1s also can increase metabolism, meaning you'll burn more calories per day without a change in activity levels.

I guess I shouldn't respond late at night like I did above because I left out some common mistakes people make when logging calories: Mindless eating: either failing to log those little nibbles here and there (including when tasting food during prep), or trying to log it, but guessing after the fact as to how much they actually ate. Not understanding that raw vs cooked food can have vastly different calories. A classic example: The USDA says 100 grams of raw chicken has ~106 to 120 calories per 100 grams. The problem is that when cooked, 100 grams of this same chicken is ~165 calories. The primary reason is due to water lost during the cooking process. This is not an issue if you properly portion out how much of the chicken breast you ate, but if you are using the raw calories and weighing it when cooked, you'd actually be eating a lot more calories than you think. This is a big one: not counting liquid calories. for reasons I don't fully understand, a lot of people just either ignore or don't log liquid calories. That juice they drank for breakfast? Didn't log it. The milk in their coffee? Nope, not logged. That energy drink they had in the afternoon? Not logged either. I think you get the idea. If you haven't figured it out yet, I'm not a huge fan of logging calories since it's really hard to do correctly and even when done to the best of our ability, it's still often wrong. I think, as it may be in your case, it also can become a crutch. There is no cheating physics here. If you eat more calories than you burn in a day, you'll gain weight and if you eat less, you'll lose. As I hope you'll see from what I've posted, in all likelihood, you're eating more than you think. Let's just for the sake of argument say you're really great at logging and you really are just eating 1200-1400 kcal a day. The only other explanation would be an exceptionally low BMR. This would really suck if it's true, but if we assume it is true, then that would still mean you're eating too much. Either way, you have to eat less than you're eating now if you want to lose.

So if I'm understanding your post correctly, you've been eating 1200-1400 kcal per day yet your weight has been stable at ~215 pounds. This either means: Your total daily energy expenditure (TDEE) is also around 1200-1400 calories per day, OR You're eating a lot more calories than you think. Let's explore each of these in more detail. Based on your height and weight, your TDEE should probably be 1800 to 2200 calories per day. Just your BMR or Basal Metabolic Rate (the number of calories your body burns per day just to keep you alive), should be ~1500-1800 calories per day. There are lots of reasons this could be lower, but for your TDEE to be 1300, you'd have to have a BMR in the neighborhood of ~900 calories per day or as much as HALF of what we'd expect. This would be exceptionally low considering your size. BMRs that low tend to only be seen in elderly frail women. To be clear, without having a metabolic test, we can't know for sure, but this does seem unlikely. A more logical reason for this discrepancy is that you're actually eating a lot more than you think. Calorie overestimation is extremely common (unlike extremely low BMRs), thus I lean toward this as an explanation. I have seen some suggestions stating that the magnitude of this may be as high as 40-50% underestimated. In other words, someone could think they're eating 1500 calories, but they are actually eating 2200+. So where do people go wrong? Misreading/misunderstanding nutrition labels. It's not uncommon for people to confuse a serving with a container of food. Sometimes, manufacturers will list a serving of something, but what you're actually eating may be 2 or more servings. Accepting as fact the calorie counts on nutrition labels. In the US, calorie counts on nutrition labels can be off by as much as 10% before manufacturers would be expected to adjust the calorie count. Keep in mind, though that manufacturers are self policing here and really don't have a lot on incentive to make sure these are correct. Many people simply guess at serving sizes, especially if it's a meal they made themselves. This can lead to wildly inaccurate calorie counts Also very common when they are making meals themselves is to just look up a calorie count for a similar food, but this also can be really inaccurate. Lots of people guess at amounts, thus you may think you're getting say 1 cup of a food, when it's actually 1.5 cups. Speaking of measuring by cups, this also is wildly inaccurate. To properly measure calories, you really need to weigh EVERYTHING you eat IN GRAMS. Any other method just isn't very accurate. I also wanted to touch briefly on your comment on exercise. While I think it's great that you're exercising, this really has nothing to do with weight loss. Lot;s of studies show that increasing energy expenditure through lower levels of exercise like you're getting typically leads to lowering your energy expenditure elsewhere throughout the day. This means you really have no increased calories burned and shouldn't think this means it's okay to eat more as a result.

They probably didn't give you any calorie values because they don't want you worrying about that yet. As long as you're not eating more than the recommended amounts, you'll be fine. As to macros, the absolute minimum recommended protein amount would be 60 grams, but really, shooting for 100+ would be better. It can be hard for some folks to hit that higher value early on, so as long as you're getting a minimum of 60, you should be okay for now. Just try to work up to 100+ as time goes on. Eventually, ~1 gram per pound of bodyweight would be a better target for protein, but I'd be surprised if you're able to get there at 2 months post-op. I wouldn't worry too much about carbs and fats at this point other than to say you do need a bare minimum of fats to make sure you get your essential fatty acids. In short, eat the recommended portion sizes, aspirationally shoot for 100 grams of good quality protein per day, at least 30 grams of (good), fats per day, and the rest can be carbs. Your carbs should ideally be from whole food sources like veggies, grains and fruits.

Obviously you need to decide what's right for you. I was in the same boat as you in that they discovered inflammation during my EGD. I had already been leaning toward RYGB anyway, but that sealed the deal as far as I was concerned. My doctor stressed that even though I wasn't having issues with GERD, there was a strong possibility I'd develop issues if I insisted on SG. As far as risk is concerned, all surgeries carry some risk and since RYGB is a more complex surgery, you are correct that some studies show a marginally higher risk profile. Interestingly, other studies show no difference. Keep in mind that obese people are all going to have a higher surgical risk for ANY procedure than a normal sized person. Other factors that increase risk are things like heart disease, diabetes, smoking, etc. Also, surgical experience and the quality of the facilities play a huge role in overall risk. My point is that cross sectional studies showing risk are not equivalent to YOUR risks of surgery. In terms of "convertability", I think my opinion is somewhat the opposite of yours. Technically, RYGB is completely reversible, since unlike SG, nothing is removed from your body. This to me was a huge plus in my decision making process. When we look at revisions, keep in mind that revision of SG due to GERD is pretty common and those revision surgeries basically revise the patient to gastric bypass to alleviate the GERD. I can't speak to your malabsorption concerns since first of all, malabsorption in and of itself is potentially a good thing for weight loss. i can see a concern for malnutrition, but I was willing to commit to a lifetime of vitamin and calcium supplementation. I also try hard to eat a fairly healthy diet, thus also upping the chances that I have no issues with malnutrition. If you are not willing to commit you those things then yes, this may be an issue for you. Keep in mind that while it's less common, SG patients can also suffer from malnutrition. It's actually recommended that all bariatric surgery patients use supplements and eat a healthy diet and I think as long as you do those things, neither surgery is going to be an issue. Best of luck whatever you decide.

Honestly Herbalife as a company has pretty a bad reputation, so I personally would steer clear. I'm also not a fan of soy protein (which I believe is what they use), so that to me is another red flag. A third red flag for me is the sheer number of ingredients in their protein powder. I'd rather have a cleaner product personally. At the end of the day, it's going to be better for you to use this and meet your protein goal vs. avoid it and not hit your protein goal. For me, I'd look elsewhere.

Why are you against RYGB? If that's the best surgery for you, it seems like the logical choice?

Sorry to hear your team is not being helpful. I'm not too sure anyone here would be comfortable telling you what to eat instead of what your surgeon said to eat. If someone here did that, I'm frankly not sure I'd be willing to follow that advice since they're not the one doing your surgery. It sucks, but you're going to have to be your own advocate and talk to them again to make them understand your issues. I'm sure they hear from patients all the time that say they don't like vegetables, so they may just be thinking you're one of those. In this instance, the're probably just thinking they want you to "man up" and do what your supposed to, even if you don't like it. In this instance, it sounds like your issues go beyond that, so you're going to have to make sure they know this. Even to the point that you may have to delay your surgery, or find another surgeon. Best of luck.

Honestly these are questions best answered by your surgical team and dietitian. The presurgical diets vary widely from surgical team to surgical team, so they're in the best position to advise you on when to start it and what to eat. While as you said, it may not hurt to start early, it also may not really do much either. Keep in mind that the main goal of a liver reduction diet for most patients is to reduce stores of glycogen and water in your liver. 2 weeks is plenty of time to accomplish that. For larger patients, or patients with a fatty liver, they sometimes have to have an extended pre-surgical diet of 4 weeks plus to try to also reduce the excess fat that has been deposited there. This is really a patient by patient thing based on the surgeon's preferences. I for example, had a 21 day liquid only pre-surgical diet.

I slept on my back in a recliner for the first week or two. If you don't have a recliner, i don't know that I'd go out and buy one just for this, but I found it really helpful during the early recovery period. I don't really know, but I'd think it would be a bit longer for sleeve patients to recover to the point that stomach sleeping was comfortable again? Your profile doesn't seem to have that info, so I'm not sure which surgery you're planning to have.