SpartanMaker

Thanks for clarifying. This may become important if you do go down the surgical route. You didn't say where you live, or what it might look like in terms of paying for surgery, but this may also play a role in your decision-making. What I mean is that if you're in the US, whether or not your insurance plan covers weight loss surgery is an important thing to note. Almost all insurance plans that cover surgery also require some prerequisites that may include a history of previous weight loss interventions. Of course if you're not in the US or you don't have coverage with your insurance plan, then YMMV. @summerseeker makes an important point for you to consider as well. ALL medical and non-medical interventions for weight loss work by reducing calorie intake (for the record, I'm including malabsorption in that bucket since it also reduces the number of calories you functionally have available for your body.) Whether it's surgery, pharmaceuticals, or specific dietary plans, they all work by creating a negative energy balance. With that in mind, it's not so much which is "best" for everyone since they all can work, it's about which is best for you individually to safely lose the weight and keep it off long term.

For clarity, I purposefully chose not to go down the rabbit hole of discussing diet since you mentioned being under the care of a "nutritionist". (I hope by that you mean an RDN "Registered Dietitian Nutritionist".) None of us here are qualified to promote one way of eating over any other, especially when you have multiple disease states you're dealing with. Let me explain. I'm currently working to become a certified sports nutritionist, and one of the most important things that was drilled into me early on was that I needed to stay within my practice guidelines. This means ONLY physicians and RDs can develop a diet for the treatment of specific medical conditions. If you want to know how to maximize your diet for athletic endeavors, I can help. If you need a diet to help with managing or treating a medical disease, I'm woefully underprepared and will always advise seeking out an RD or RDN. The reality is that dietary options abound, but medical conditions greatly impact not only what your dietary needs are, but also how you respond to various dietary options and even what's potentially safe (or not), for you to eat.

At the end of the day, no one here can tell you if it's right for you. Keep in mind that obesity is a disease and it definitely needs a treatment plan, just like your other conditions. The right treatment for any given person varies based on a lot of factors, so don't automatically decide yourself what the right treatment should be. The best thing for you to do is seek out a GOOD bariatric center that has lots of options available to you and not just surgery. Personally, my gut tells me that it's too soon to go this route since obesity is such a recent issue for you. I'm not a doctor, and certainly not a bariatric surgeon, but just thinking through how recent this obesity disease is for you, I personally would want to try some more conservative treatments first?

I'm team both? My diet mantra is 80/20. What I mean is: I try to focus on getting ~80% of my calories from minimally processed foods. (AKA, I try to eat clean.) I don't really track this, I just focus on making good food choices when I can. I try to eat a wide variety of foods, so nothing's off limits. To me, there are no bad foods, there are just some that provide more nutritional value than others. Plus, the more variety i have in my diet, the better overall nutritional profile I'll have. I try to shoot for 80% of what I eat being things that have a bit more nutritional value. For example, most of the time, I might pick spinach or kale over lettuce. I eat carb centered. It's not quite 80%, so my mantra may be a bit off? I suppose between carbs and protein, it probably is 80%, so I'll settle for that. I know this one will be controversial here since the bariatric dietitians push protein so heavily (and don't misunderstand me, protein is critically important), but as endurance athlete at maintenance and 2.5 years out from surgery, I need more carbs than I did during the weight loss phase. Critical to the above is that I don't obsess over any of it. I guess my point in the above is that if you're trying to determine the "best" protein source, maybe the real right answer is there is no best. Once your body starts breaking down the protein you consume into the component amino acids, your body doesn't know where those amino acids came from. The advantage of not focusing on just one source of protein is that there are vastly different micronutrient profiles across foods. The more variety you eat, the better off you are nutritionally.

We've had a number of veterans that have come back here recently after getting to goal (or mostly to goal), but then life got in the way and they had a significant amount of regain. I wanted to ask those that have gone through this, what thoughts you have for the rest of us on how to prevent the regain? It's easy for someone like me that's not faced this to think "it's easy, if regain starts, just do xyz", but I know it's never that simple. Maybe said differently, in hindsight would you have done anything differently? I know some of you went through some really rough patches mentally & emotionally and your health took a back seat. Maybe your options were limited and you might not have been able to do much about it. I still think it would be nice to hear what thoughts you have for the rest of us that maybe have not faced this (yet).

Still looking for ways to use up all the smoked chicken! Last night it was a Southwest-style salad with some of the smoked chicken. Tonight I'm planning on loaded baked potatoes with BBQ smoked chicken. I also made some Jambalaya style soup and added smoked chicken to that. I froze most of it, but perhaps weirdly, I like soup as a post-workout recovery meal, so I suspect I'll be eating a lot of that most weeks!

@Dub My heart goes out to you. I honestly suspect I wouldn't have handled it as well as you. I do worry sometimes that I could end up in the same situation since my wife does not exercise and is pretty heavy. Her health seems okay for now, but I doubt that will last considering her health risks. I'm trying (gently), to encourage healthier behaviors, but it's slow going. Anyway, I'm so glad you're back here and working to get your health back! Our health is a gift. It's one I didn't value for the longest time. Now, I recognize it's the most precious thing I have.

Thanks for your post! To be clear, I'm not fighting regain, I'm more trying to hone in on understanding what those that faced it would have done differently. I'm especially interested in those that regained a lot. A common theme for some of these folks has been significant life events and I'm curious if they feel they would have done anything differently given the chance?

As a general rule, the effects of supplementation of any kind on weight loss will be extremely minimal. If I had to hazard a guess, I'd say for most people, 90-95% of weight loss is calorie intake alone. Other factors like exercise might make up a few percent, and supplements would be down at the bottom of the list probably only making 1% or less of the impact. Since 1% might mean something like 20 calories a day, you can see how it would be really easy to overcome that effect just by eating a tiny bit more. Keep in mind there is no overcoming basic physics. If you want to lose weight, you have to consume fewer calories than you burn. Things people worry wat too much about in my opinion instead of placing the focus where it matters on calories: Types of diets: Things like keto, low fat, low carb, intermittent fasting, etc. may help with compliance, but otherwise make no appreciable difference in weight loss. Bottom line, eat the way you want as long as you meet your nutrient goals and eat less than you burn in a day. Exercise: Exercise is critical for overall health and fitness, but as a general rule, you are not going to lose much if any weight from exercising. The reason is that your body is really good at stabilizing your overall calories burned in a day/week/month. What I mean is that studies show that for the most part, your body will slow down other processes to "make-up" for the exercise calories you burned, so whether or not you exercised won't actually mean you burn more calories per day. Exercise CAN help in weight loss for some people, but as a general rule, you'd probably need to be doing something that burned more than 400 calories a day, every day for you to see any impact at all. One place where exercise really comes into its own is in weight maintenance post-weight loss. Here the data is super clear. Those that exercise at least 1 hour per day were significantly more likely to maintain their weight loss than those that don't exercise. Supplements: As I pointed out above, at best, supplements might have a very small impact on on weight loss and this impact is really easy to negate by simply eating more. Typically weight loss supplements fall into two categories: Thermogenics (things that increase metabolism), and Appetite Suppressants. Some claim to have both effects. Without going into too much detail, the vast majority of thermogenics work simply because they are stimulants. Caffeine is the most well known and well studied (and frankly probably the most effective), but since you already are a coffee drinker, you're pretty unlikely to get any additional benefit from switching to another source such as green tea. Appetite suppressants are really a mixed bag. These sometimes work for some people, but again, the effects are really small. This is a little old, but I still think worth taking a gander: https://pmc.ncbi.nlm.nih.gov/articles/PMC8406948/#:~:text=A total of 1945 participants,morbidity%2C costs or patient satisfaction. It's a meta-analysis of the impact of green tea on weight loss. The conclusion they came to after looking at 15 different studies: "Green tea preparations appear to induce a small, statistically non‐significant weight loss in overweight or obese adults. Because the amount of weight loss is small, it is not likely to be clinically important." Best of luck.

Sure, I understand. It was just the way you worded your original post. It came across to me as if you were telling everyone else to avoid sugar. I wanted to make it clear that we're all different and some of actually do legitimately need it (or at least perform better when we have it).

I'm glad you found something that's working for you. I tried Contrave years ago and it worked for a while, but then the effect faded. Hopefully that won't happen for you. I also wanted to comment on sugar. There's a lot of evidence that our bodies were designed to seek out calorically dense foods (like fat and simple sugars), since historically food was a lot harder to come by. We see this even today in traditional hunter-gatherer societies. Honey is sometimes a significant part of their diet. Imagine having to climb a tree, meanwhile getting stung multiple times, just to pull out a few handfuls of honeycomb. Interestingly, these people know to only take a part of the hive because they want the bees to stay at this location so the hunter can return to it over and over. My point in telling you all that is that it's perfectly normal to crave sugar. If avoiding it for the rest of your life is something you're able to do, then I think that's great. If you know it's not something you can do forever, then you may need to make peace with the cravings and find a way to have some when you can, but be sure to "leave some of the hive alone" till next time. Personally as an endurance athlete, I do consume a lot of simple carbs and so completely avoiding sugar just isn't really something I could do. Keep in mind that glucose (a simple sugar), is the primary fuel that your body uses. It stores glucose in the form of glycogen, but the reservoir is somewhat limited. This means that for longer, harder endurance efforts, it's important for me to consume simple sugars during those runs or rides that will help replenish my dwindling supply of glucose. My normal diet also consists of about 65% of my daily calories coming from carbs to help keep my glycogen supply as topped off as possible. This is a combination of both simple sugars and more complex carbs like fruits, vegetables, bread, pasta, potatoes and rice. If I didn't do this, I simply could not exercise for the duration or at the intensity that I do. My point here is that I've had to come to grips with the fact that for me, carbs are not the devil. They are in fact a necessary and healthy thing. This was a big change for me since historically as an obese individual, I tried to eat low carb most of the time. I now believe there are no bad foods and the best thing for me is to eat a wide variety of foods like most normal weight healthy folks do. Please don't think I'm trying to tell you what you should do! If what you're doing is working, that's fantastic!. I'm more responding to the comment you made that sugar was bad and we shouldn't eat it. For you that may be true, but it's not true for everyone, and certainly not for me.

I don't have experience with that personally, but I'd suggest talking to your dietitian about it. Coming up with meal plans for diverse patients is literally a big part of what they do. As I think through possible issues, a couple of things come to mind that you should discuss with them: What can you eat to meet your nutritional needs that don't require a lot of meal prep? Obviously there are protein shakes and meal replacement shakes, but as much as possible, it would be good to eat more real food. Are your caloric or macronutrient needs different due to the long work hours? The kind of work you do will probably dictate this to a large extent, as a physically demanding job like construction would be really different than what you'd need to power through long hours in front of a computer where mental acuity is important. Best of luck.

So true. Sometimes I'm still not used to it though and it's weird. I now buy jeans in a 30in waist and medium shirts, whereas at my heaviest I was wearing a 44in waist and xxl or even xxxl shirts. Sometimes l will pull something out of my closet and think there's no way I can fit in that, yet I do. Edited to add that sometimes I even buy a small in some things! That's just unreal to me. Body image distortion is real.

I LOVE that you're losing at a sustainable rate. There is so much data to suggest that crash diets almost never work, so losing ~1-3% of your total body weight per month is the sweet spot. I'd take it even further and say 1-2%, which is right where you're at. If I could give advice to anyone either trying to maintain after initial weight loss, or fighting regain like you are, it would be threefold: Focus more initially on learning to eat a healthy diet and less on the weight loss itself. People that follow the fad diet du jour when losing weight almost always regain because they very quickly go back to their old eating habits. If instead you focus on first learning to eat like a normal weight person that eats a healthy diet, you'll be setup for real success. Many people find that if they do this first, they don't really have to "diet" because their bodies actually start to self-regulate calories. Part of this is because when we eat a wide variety of foods that are nutrient rich, our bodies don't fire off signals to eat more. If that doesn't happen for you, there are strategies to slowly reduce intake while still maintaining your healthy diet. The second thing is to focus on instituting a regular physical activity routine. I feel like way too many people skip this, but the data is clear: up to 90% of people that have lost a lot of weight and successfully kept it off for years do a lot of exercise. In fact, the average for those successful losers is ~1 hour per day on most days of the week (roughly 300+ minutes a week.) This is twice the minimum recommended amount to stay healthy, and twice what someone needs that was never significantly overweight. I want to be clear, this is not really a huge factor in weight loss, but in weight maintenance, it's critical. Finally, focus on behavioral modification. Let's be honest. Most of us got as big as we did because we had an unhealthy relationship with food. We may never actually "cure" ourselves of that, but we can learn to fight back. Probably the best thing to do is work with a therapist that specializes in behavior modification, especially regarding weight. I realize this is not an option for everyone due to cost or availability, but there are also lots of good resources available online. Anyway, best of luck and keep up the good work!

@Bari_Hopeful Sorry you're not getting much in the way of responses. We don't have a lot of UK members to begin with, and so the likelihood of having one that's still active here and then also had their surgery at Queen Victoria Hospital is probably pretty low. Just a thought, but you might try checking with the Tier 4 team at Queen Victoria to see if they have a post-surgery support group? A lot of Hospitals (at least in the US), have their own local support groups, so they would be worth seeking out. Alternatively, if you have more general questions that might apply regardless of where the surgery is done, please feel free to post and hopefully we'll better be able to assist.

First of all, great job so far. You're doing fantastic! My understanding is the same as @catwoman7 regarding insurance companies. They typically don't want to pay for anything they don't absolutely have to and that definitely includes anything they consider purely cosmetic. Aetna may be different, but I doubt it. Up front, I wanted to mention that not everyone actually even needs plastic surgery. The younger you are and the less weight you had to lose, the more likely it is that eventually your body will adjust to the weight loss. Yes, it can take a few years, but you may find in the long run you're better off not going down that route. I also wanted to comment on your timeline. I think there's a bit of a misunderstanding that we somehow stop losing at 1 year, 2 years, or some other defined date. That's rarely true, so I would suggest not thinking that your weight will stabilize at 12 months. You may get to 12 months and decide you'd like to go lower. Heck, I'm 2.5 years out and still losing (albeit really slowly). I'd suggest waiting until you you feel like you want to start maintaining, rather than just going by an arbitrary date. If your weight stays stable for a while (I personally would go longer than 6 months, but that's me), then looking to plastics may be appropriate. I mention this because I think it would be awful to have plastic surgery, especially if self-pay, then lose even more weight and still end up with sagging skin that you dislike.

I personally have a somewhat pathological dislike for those calculators. I just tried the one @Bari_Hopeful posted and supposedly I should have stopped losing around 225 lbs. Even using the interquartile range listed, I shouldn't have made it past 200. I don't think of myself as exceptional in any way, though this calculator might make it look like it. If anything, I'm maybe just more stubborn and was willing to do whatever was needed so I could finally get to a normal weight. Settling for just overweight instead of obese was not really an option for me. I guess it just seems to me we set our expectations too low when we use an average like this. I know it's hard, but everyone can potentially make it to a "normal" weight range if they are willing to work at it.

Hydrolysed Whey Protein Isolate (also known as Whey Protein Hydrolysate), tends to dissolve a little better than regular non-hydrolysed whey, so that might be something to look for? The hydrolyzed version is also a bit more bioavailable, so that's also a good reason to choose it. Unfortunately it's typically more pricey, so keep that in mind. You can also look for "Clear Whey". As far as I know, clear whey is all whey protein hydrolysate, but you should double-check before buying anything. I don't really have any brand recommendations, but as long as it's pure 100% hydrolysed whey protein isolate, brand shouldn't matter. Plus, I don't know this for sure, but I've been told by others that most whey on the market is produced in just a few manufacturing plants and thus most of the "manufacturers" are not really making it themselves. They just contract out the work to one of these plants. My point is, I'm not sure there's a ton of difference between any of them. One caution here. No whey is going to dissolve well into hot liquids (like coffee). Think of it sort of like what happens when milk curdles if put into something really hot. What happens to whey is somewhat similar (the proteins start to clump), so the best bet in this instance is to dissolve it first into a little bit of cool water before adding it to anything hot.

Good point. People need to be careful when making comparisons. The good news is (at least in the US), as long as you look at the "Iron" content on the supplement label. it's all been standardized based on the elemental iron amount. In other words, if it lists Iron specifically, even if it has the source listed in parentheses (ferrous sulfate, ferrous fumarate, ferrous gluconate, iron carbonyl, etc.), one listing of 45mg is roughly the same as any other 45mg listing even if the sources are different. This is required by US law. Now there are individual differences between people in terms of how well we absorb iron from various sources and as I mentioned before, all bariatric surgery patients don't tend to absorb iron as well as the gen pop. That said, I'm not sure any of us will know how well we absorb iron from these different sources unless we're doing frequent blood tests and trying various forms. For most of us (as has already been said), the most important thing is to get regular blood tests and not to make any changes unless directed by your doctor.

For those that don't live in the US, today was a Federal holiday called Memorial Day. It's a day when we honor those that made the ultimate sacrifice in service to our country in the Armed Services. Because it's always on the last Monday in May, it's also considered the unofficial start to summer. As such, it's traditional to have a cookout, meaning cooking outside on a grill or smoker. Today I made Smoked Chicken, Red, Hot & Blue Style Potato Salad (if you know, you know!), and Smoked BBQ Beans. By the way, since it's not really much more work to make LOTS of smoked chicken vs. just a little, I smoked four whole chickens. If you have recipe ideas for how to use up smoked chicken, let me hear it, because my freezer is going to be full!

lol. I mean that's sort of how they make toupees, so you may be on to something...

@Dub "Androgenetic Alopecia" (the hair loss you have now), is different than "Telogen Effluvium", the hair loss that most of us have immediately after weight loss surgery. You hair loss is not the result of diet issues. The good news is there are treatments available if you want to pursue them. Probably your best bet is to talk to your primary care doc to start the process. They'll know which specialists to refer you to in your area.

I should have posted this last Sunday, but I ran a half marathon and broke 2 hours for the first time. I know a lot of runners train for years to complete that milestone, so I'm pretty happy with that!

Moroccan Fish, Roasted Cauliflower with Lemon and Cumin & Bakoula with Spinach and Kale. I intended to have some sourdough as well, but after I got all this on my plate, I knew I'd never eat it all so I skipped the bread. I'll need to make up the carbs later.

For anyone that may be confused by this thread, here are some things to think about related to vitamin supplements: The most important thing is to follow your doctor's recommendations. All bariatric programs I've seen have specific recommendations and you would be well advised to follow these. The vast majority seem to recommend a bariatric specific vitamin supplement. Some may also recommend specific brands of over-the-counter vitamins as well. That said, at least from what I've seen, typically when recommending over-the-counter options, they will suggest taking these twice a day (AM & PM) instead of just once. There are a few reasons for the above recommendations. First of all, you'll be eating a very low calorie diet and thus vitamin supplements formulated for "normal" people may not be sufficient. Also, while malabsorption for bypass patients is a concern, sleeve patients aren't immune to reduced absorption. Some vitamins & minerals are dependent on stomach acid to be properly absorbed. Since all WLS patients will have reduced stomach acid production (at least for a while, if not forever), higher than normal amounts of some vitamins are needed. From a cost perspective, yes, bariatric vitamins tend to be more expensive, but if you have to take twice as many of an over-the-counter supplement, the costs aren't very different after all. Especially if you take advantage of subscriptions like those offered by sites like bariatricpal, the cost of a good quality bariatric multivitamin isn't that much. Keep in mind your food bill should also drop, so at the end of the day you should still be spending less per month. If for some reason you still think vitamins are just too much for your budget, please discuss this with your surgical team. They may be able to help you find a less expensive option that still meets your needs. It's never a good idea to make decisions that can impact your health simply based on things you may have seen on the web. Aside form the cost concerns I mentioned above, there is very little to no downside of taking bariatric specific vitamins, even though some have really high levels of certain vitamins. For some specific vitamins, there is no established upper limit, meaning there's no health risk in taking too much. If you take in more than your body needs, then you'll just safely eliminate the excess. Yes, there are established upper limits for a few vitamins & minerals and this is taken into account in the vitamin formulation. Iron, is an example. The established upper limit is 45 mg/day, which is also the max you'll see in most supplements. Keep in mind this upper limit was established because some people had digestive upset at higher doses. You'd have to take considerably more than 45 mg/day to actually have a significant impact on your body. Further, remember when I said that some vitamins & minerals need stomach acid to be properly absorbed? Iron is one of those, meaning that you're probably not actually getting a full 45 mg/day dose as a bariatric surgery patient. Regardless of which surgery you have, you should be getting regular blood tests for life that check for nutrient deficiencies. if you don't get these from your surgeon (for example, you went out of country for surgery), then please get them from your primary care physician. This is really important because some studies have shown up to 30% of WLS patients end up with nutritional deficiencies post-surgery. Don't be a statistic. Human bodies are not all the same, nor are our diets. This means one person may be successful stopping vitamin supplementation, whereas someone else that had the exact same surgery from the same doctor won't be able to do that. Please don't decide what you should do based on another person, even if it's your best friend, a family member, etc. Only with your doctor's blessing should you consider changing or stopping your vitamin supplementation routine. Regardless of which surgery you have, there is a real possibility you may need to take at least some form of supplements for life. The effects of nutritional deficiencies can be severe, so think of your vitamin supplements as insurance against potentially debilitating or even life threatening problems. Best of luck.