SpartanMaker

I want to challenge your ideas a bit here. This concept that there is some underlying mechanism at work that controls our weight and that we don't have any say in the matter is based on something called set-point theory. In short, the theory is that some as yet undetermined mechanism (likely in our brain), wants us to be a certain weight and thus actively regulates both calories in and calories burned to keep us around the same weight. Anecdotally, most people can attest to the fact that there seems to be a specific weight where they naturally settle when they aren't actively trying to gain or lose weight, so the theory makes intuitive sense. That said, there are some big problems with this theory: Why have we not been able to find the actual mechanism for this set-point if it really does exist? How are some people able to change their set-point? How do we explain that overweight and obesity are significantly more prevalent in some parts of the world vs. others? In those parts of the world where overweight and obesity are more prevalent, how do we account for the fact that these issues were much less prevalent until very recently? (For example, the rate of overweight and obesity in the USA has tripled since about 1980.) To explain this, more modern interpretations have suggested a more nuanced approach. We know that historically, food scarcity was the norm. It's logical to assume our bodies are well adapted to dealing with this as a result. Unlike set-point theory, we do have a solid understanding of the physical processes involved in regulating metabolism during scarcity. This means our bodies know how to handle a lack of food pretty well by down-regulating metabolism. (There are several ways it does that, but I'm going so skip discussing those specific mechanisms for now) What our bodies are less good at is up-regulating metabolism in an environment of where there is an extreme availability of highly palatable foods like we have today. We often think of our bodies like a car that's always running. This is somewhat problematic, but let's go with the analogy for now. Just like a car idling will burn some fuel, our bodies burn some calories just keeping us alive. If there's a shortage of food/petrol, (either because I can't afford it, or because there's a true shortage), I can curtail my movment/driving to conserve how much I use. Likewise, if food/fuel is cheap and readily available, I can move/drive a lot and even fill my fuel tank (fat stores), whenever I want. Unlike a car that has a limited fuel tank that can only hold a specific amount of fuel, humans have a theoretically unlimited ability to store excess fuel in the form of fat. TL;DR: It's not so much that our bodies decide what weight to be. It's more that we were never designed to deal with cheap, easy access to super tasty food. At the end of the day, what determines whether or not you have more fat stores than you might want is whether or not you eat more calories than you burn in a day. The entire point of this overly long post is that there's no mechanism working against you that's keeping you from reaching your goal. Our bodies were designed to store excess calories to keep from starving to death when food was scarce. We rarely experience scarcity anymore, but our bodies don't know that. They still will do everything they can to hold onto those stored calories "just in case". There are ways to get beyond this, but that will have to wait for another post.

I think the thing many people get wrong when trying to transition between weight loss and weight maintenance is using an all-or-nothing mentality. By that I mean they expect to be either in "diet" mode, or "maintenance" mode, but that's not really how things work. To me, that would be like sprinting on a treadmill and thinking I can just stop running. Um, no. That would have really unpleasant consequences. You're not going to simply wake up one day and immediately go back to eating "normally". Instead, think of this more like a baby learning to walk. You're going to have some false starts. You're going to fall down a lot. In fact, you're probably going to fail more than you succeed. This is completely normal and is how you learn. Over time, you'll hopefully learn what works for you and what level of caloric intake is right. The point is, there are no "tricks" here. If you feel like you've lost too much, then just try different things to up your calories. Alternately, if you're heavier than you want, try different strategies to lower your calories, since there is no perfect solution for everyone. There's only what works for you. You didn't ask, but there are a couple of points I want to make here as well: There is no perfect number of calories for you to maintain. Let me say that again so you don't forget: there is no perfect number of calories for you! Our bodies are wonderfully adaptive and can maintain a healthy weight across a wide spectrum of calorie intake. It does this by up and down regulating your metabolism in response to intake. There is no ticking clock here whereby you have to lose the weight by a certain date after surgery or you won't lose anymore. It just does not work that way. I don't care if it takes you 9 months or 9 years to get to your ideal weight, you can get there and you can maintain at that weight. Best of luck.

Maybe a new pair if running shoes? 😉 Always works for me! 😁

So sorry you're struggling @Arabesque! I know how frustrating it is when you go from thinking you're got weight maintenance down, to finding that no matter what you try, you can't get things under control. You may not be looking for advice here, but as a guy it's in my nature to try to "fix" the issue. Please forgive me if I'm off base. I may be misremembering, but I think at one point you mentioned you don't really workout. While I'd never recommend exercise as a way to lose weight, we know from a significant amount of data that it is really beneficial in helping those that have lost weight to maintain that weight loss. You may not be in love with the idea, but it might be time to consider a change? Aside from the benefits for maintaining weight loss, we also know that cardiovascular endurance is actually a better predictor of overall health and longevity than any other single factor including obesity and smoking! This means the single best thing any of us can do for long term health is improve our cardiovascular health. In addition, we also know that regular strength training is important for several reasons, but in your case I want to point out three of them: Regular strength training improves muscle mass, which is probably the single biggest way any of us can actually improve our long-term metabolism. Overall strength is highly predictive of minimizing fall risk as we age. Since falls in older people can be catastrophic, it's something all older people need to keep in mind. There is a significant link between strength training and bone health. As I'm assuming you already know, osteoporosis is a particular problem for post-menopausal women. I wasn't very familiar with the Australian recommendations for physical activity, but unsurprisingly it's almost identical to the US recommendations: https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years Best of luck. I hope you get this figured out.

There is no magic bullet here. In terms of protein density, you're just not going to beat whey or soy protein isolate. If you don't like them as shakes, you might try mixing with less water or milk into protein pudding? It may take some experimentation to find one you like the taste of that way. I've never tried them, but bariatric pal does sell some that are prepackaged and designed specifically for making pudding. If you want to go the whole food route, eggs and chicken breast probably come in next in terms of protein density.

So this idea that you can stretch your pouch somehow and make it permanently bigger is mostly myth. First, right after surgery your stomach is swollen. Over time, the swelling goes down, thus you can accommodate more food. This is normal and to be expected. Second, your stomach is designed to stretch. This too is normal. Think of it like a balloon. With nothing in it, it's small. Fill it up and it gets bigger. Let out what you put in it and it goes back to its original shape. Third, while you can't really make your stomach any bigger, you can train it over time to handle more food. If anything, this is what's happening to people that think they "stretched out" their stomach after surgery. It's not really any bigger, but you have trained it to not "complain" as much when it is over full. There's certainly a limit here though to how much you can stuff in and I promise it's always going to be less than it was pre-surgery. I would caution you to be careful about frequent eating. If you're eating multiple times a day just to put something in your stomach, it is possible to outeat your smaller stomach. It's best at first to eat on a regular schedule because as you alluded to, it's hard to understand both hunger and fullness queues.

Just based on what you've written, this really wouldn't be either Reactive Hypoglycemia or Dumping Syndrome since both of those would be reactions to what you've eaten, not external stimuli. There is a chance that an already low blood sugar level prior to your shower or exercise is pushed even further down due to rising body temperature. This isn't a common reaction, but it's not completely unheard of either. If you don't have a blood glucose monitor, it may be a good idea to invest in one. Were I you, I'd track my blood sugar before eating, after eating, before exercise or a shower, and then at the point where your blood sugar feels like it's crashed. It would also be advisable to note exactly what you ate and the time of ingestion. This should help you uncover what's going on. I suspect it may have more to do what what you've eaten vs. temperature, but you really won't know without some data. Best of luck.

A very high protein diet can do that. I'm a bit surprised your doctor's office didn't cover this with you. It's primarily due to a significant reduction of fiber in your diet. i strongly recommend starting some fiber supplementation and in addition, consider the following: You may need to take a regular dose of a stool softener such as magnesium hydroxide or polyethylene glycol If needed, consider a stimulant such as senna or bisacodyl Acutely, If you're still having severe issues getting things moving, a saline enema may be needed. Otherwise, regular does of the above should be sufficient It can take a while to get all the above dialed in. Keep in mind, you're likely to need some or all of the above until well after surgery since your fiber intake will be really low until you're eating regular foods again.

So the reality is that we can't cheat physics. I want you to remember this both now and after your surgery. While I can't make an super accurate assessment of your total kcal expenditure per day right now, I'd guess it's probably in the range of 3000 to 4000 kcal per day based on your current weight. I'd also guess that your total intake right now is around 800-1000 kcal. This means you are absolutely burning massive amounts of fat currently. So I know you're thinking if that's true, then why isn't it reflected on the scale? The short answer is scales lie. They only show total weight, but as you alluded to above, our bodies are made up of lots of "stuff" other than fat, so scale weight can vary widely just based on how hydrated you are, how much glycogen you're storing, and the weight of your stool. In short, trust the process. You'll be fine.

So I'm a little more than 2 years out and for probably the last 6-8 weeks, I've gotten to where I just don't really enjoy eating most things. I'd say 90% of what I'm eating, I eat because I know I need to eat, not because I particularly enjoy it. Most things just taste off somehow to me, including things I used to really enjoy. I'm wondering if any other folks had anything similar happen? I will preface this by saying there's a possibility this is medication related, as I think I made a change to my meds about that same time. I'm investigating that separately.

I do think there's an element of "meh" going on with me as well. I'm not entirely sure if that's all due to things tasting a bit off, feeling tired (I've been really upping my workouts lately), or if I'm just losing some of the joy from eating. I'm sort of in the opposite boat in terms of food prep. I do almost all the food planning and shopping, as well as 90%+ of the cooking around my house. This is mostly because I'm retired and my wife is still working. When we were both still working, it was closer to 50/50. I do think if I didn't feel obliged to make food for her, I probably wouldn't bother for myself.

It's not, I promise! I could go into a lot of detail about why, but to make things short, I'd almost guarantee it's simply fluid retention. You recently had a long break from working out due to your surgery and now that you've started back working out, it's totally normal for your body to store a bit of extra fluid. Add in the implant weight and I think you're doing just fine.

I agree with @DaisyChainOz. There's probably a lot going into his feelings and communication is really important. As a man, I do also understand that some men (me included), just are not good at talking about our feelings. It's partly that we've been conditioned over a lifetime that feelings make us weak and thus we are "lesser" because of it. Also, we've just never learned how to express our feelings, nor to really understand them at all. It's not that we don't have feelings, we just don't really understand them in a way that can be expressed. I tell you all this so you can be patient with your husband. It may take some time for him to share what he's really feeling. The best thing to do is just be supportive and make sure he understands it's okay to share what he's thinking instead of what he's feeling. "Feeling" can be a trigger word for some men. One thing that may (or may not), help the discussion is understanding the risks involved. Again. I don't know what's going on in his head, but if he is fearful of change, or the risks of you having surgery, it's important to help him understand that by far, the riskier thing is NOT having the surgery. I don't know your age or current weight, but I'm assuming you are pretty heavy and likely older just based on the need for a hip replacement and the fact that your orthopedic surgeon won't do the surgery at your current weight. If you are in what's termed "Class III obesity" (in other words, you have a BMI over 40), that alone shortens your life expectancy by 10 to 14 YEARS. I think it's important for both of you to understand this. If he truly loves you, then he should want you to stick around longer.

I'd try to get your insurance company to pay for both. Gastric bypass is sometimes performed for reasons other than weight loss. Most commonly that would be for severe GERD and/or issues with gastric emptying. This happens even in patients that are not overweight and never had a previous sleeve procedure. My point is that I'd be willing to bet those procedures are covered by your insurance company since it's being done for strictly medical reasons. (Technically so is weight loss surgery, but insurance companies are stupid.) In your case it seems pretty obvious there's also medical need, so your insurance should pay for it. They'll probably deny it at first, so be prepared to fight them.

Forgot to add that the constipation was probably worse than any surgical pain. If your surgical team hasn't already communicated a plan to you for dealing with the constipation, talk to them ASAP. It's not nearly as bad if you stay ahead of it, but God forbid you wait until it's really bad!

I also had no nausea. I think the pain I had was mild compared to many other surgeries I've had. Probably the worst thing was the surgical gas pain. This is not pain in your intestines like some people think. It's from the CO2 or Nitrogen that they inject into your abdomen during the surgery. This will slowly be absorbed, but in the meantime, it puts pressure on your diaphragm and this irritates the phrenic nerve. This can cause referred pain into your shoulder that can be pretty painful. They'll tell you this, but the best thing to do is move!

Are you allergic to whey?

Welcome to getting old! I doubt this has anything to do with your bariatric surgery. Declining appetite as we get older is really common. in fact it's so common, they coined a term for it called the anorexia of aging. Obviously being really sick can drastically reduce appetite, but even in otherwise healthy people, there are multiple things that lead to appetite reduction. Common things are slowed gastric emptying, hormonal changes and impaired sense of smell and taste. Certain medications can also reduce appetite and since older folks are a lot more likely to be taking these meds, that can also contribute.

Gastric bypass patients should be taking at a minimum a bariatric multivitamin, as well as 1200-1500 mg of calcium per day. Vitamin D3 is also recommended, but most people get enough with just the above because typically both bariatric multivitamins and calcium supplements already contain additional D3. Some people also need B12 supplementation, however since I eat a lot of dairy, I've never had a problem with my B12 being low. Keep in mind that due to the surgery, we don't absorb nutrients like the did before. This is why we need to take these supplements for life. It's critical to have routine blood work and adjust what you take due to the results. For example, I had to change from a "normal" bariatric multivitamin so one with reduced B12 because my B12 was actually too high. In addition to the above, I also take probiotics and fiber pills daily.

I found this statement interesting. Can you define what real hunger is for you? What I mean is what are you actually feeling? I'm not claiming to be an expert, but I sometimes think we overuse this concept of "head hunger" vs. "real hunger". I know I've been guilty of that as much as anyone, but i think we should keep in mind that much of what people call real hunger is also "in our heads". A better way of differentiating hunger signals may be to call them homeostatic hunger and hedonic hunger since these happen somewhat differently. While this is oversimplified, homeostatic hunger starts as a signal from our stomach by way of production of ghrelin, which in turn activates AgRP neurons in the hypothalamus. Simply put, it may originate when the stomach is empty, but it's our brains that tell us it's time to eat again. This is not something we actively control. It's the bodies way of trying to keep you from starving to death. Hedonic hunger on the other hand is your body seeking pleasure from food. We like to say this is the one we want to control if weight loss is the goal, under the assumption that overall calorie intake will be less if we don't "give in" to cravings. Here's the thing, though. While scientists don't fully understand what's happening, we do know that dopamine and endocannabinoid receptors are being activated in our brains. Interestingly, just seeing or smelling certain foods can trigger these same processes. I wanted to explain this because it wouldn't be wrong to say all hunger is head hunger. The good news there is we also can be in control of both types of hunger, since they are both "in our heads". In terms of your specific situation, I think it would be rare to already be experiencing a lot of homeostatic hunger this early after surgery. On the other hand, it's probably not unheard of. For me personally, I was really bad at understanding what true hunger felt like. As a former obese person, I hated feeling hungry and would rather feel the overstuffed feeling in my guts since at least then my brain would quiet down. I'm not saying I've got it mastered, but I'm beginning to understand that when I'm truly hungry, I have other things going on like feeling weak, feeling irritated, and/or having brain fog. The strong urge to eat that i sometimes feel without those symptoms is probably more just my brain trying hard to either seek pleasure, or keep me from starving to death.

Have you already talked to a doctor? I believe the most common reason for this would be reactive hypoglycemia, but I'm sure there are other potential causes. Only a doctor can properly diagnose the problem.

Off hand, I'm not aware of any premade protein drinks that are readily available. You could always buy a vegan protein powder and mix your own. I'm curious, is there a reason you're wanting one without whey?

I strongly believe there is no perfect goal weight. I think the goal should rather be how you feel and how you feel you look. If you feel good and are happy with how you look, then you're at your goal. If you think you'd like to shed a few more pounds, then do so. If you feel like you look underweight, then it might be time to gain a bit. I would never recommend BMI as a guideline. A much better guideline would be % body fat, but accurate testing is expensive and not readily available. Keep in mind if you were obese for any length of time, your organs are likely bigger and your bones denser. This means you might look identical at 170 to someone that was never obese that weighs 150. Also, as most folks know, since muscle is denser than fat, the scale just does not tell the full story. There are people with a "normal" BMI that are carrying too much fat because they have so little muscle mass. I get it, especially for very goal-oriented people, they want something exact to shoot for, but when you think about all the above factors, picking a goal weight is just so random and almost certainly to be wrong for you.

10/10 would do again. I only wish I'd done it sooner. While no surgery is risk free, the mortality rate for bariatric surgery is pretty similar to other major elective surgeries, with the overall mortality rate at this point being right around ~1 in 1000, The factors that increase risk the most are higher BMI, older age, being male, as well as having pulmonary hypertension, heart disease, or liver disease. Obviously the more of those you have, the higher the risk. If you are younger, female, only moderately obese, and don't have any major illnesses, the risks should be much lower. It's also pretty well documented that the mortality rate from being obese is higher than the surgery, meaning the riskier thing to do is NOT have the surgery. I honestly feel like my bypass surgery probably saved my life. I felt at the time like I had one foot in the grave, but now feel so much better and healthier.

^ This. Post bariatric surgery eating is really hard! Never let anyone tell you that bariatric surgery is "the easy way out"! Regarding your protein intake, let's start with an understanding of why a protein-first diet is recommended post-surgery: Primarily, we are hoping to stave off something called muscle catabolism. This is when your body basically breaks down your own muscles. This happens mostly but not entirely to meet your daily essential amino acid needs. If we eat enough protein, this significantly reduces the amount of muscle mass your body will burn. That's important because the more muscle you have, the higher your metabolism, meaning you'll burn more calories even at rest. Most scientific literature suggests that 60 grams per day of protein is sufficient to meet your essential amino acid needs and thus hold off the bulk of the muscle catabolism that happens while on a weight loss diet. Note that some muscle catabolism is inevitable and no amount of protein intake is going to prevent that. The second reason protein is important is because protein is filling and relatively slow to digest. Studies have shown that eating more protein than the 60 grams per day minimum can help you feel more full. That basically will result in reduced overall calorie consumption. For this, amounts between 1.6 grams to 2.2 grams per day per kilogram of ideal body weight have been shown to be effective. For example, if 60 kg was your ideal body weight. protein intake between 96 and 132 grams would be suggested. I'm not sure what your surgical team told you, but since you're already getting over the 60 grams per day minimum, I'd say you're doing fantastic! As you get further out from surgery, you'll probably want to consume more, but keep in mind that all it's really doing is keeping you full longer. It's not going to sabotage your weight loss due to excess muscle loss. TL;DR: You're going fine on protein, don't sweat it.