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As you note, the scales and calculators are mostly a "best guess", as they are highly algorithmic. The more direct measures like the vox tests and the like are better, but still have some population algorithms in there that can go astray of one is far outside normal population standards, as WLS patients often are. Similar for body composition checks - the scales are OK if you know how to correct them, but the more direct measures such as bodpod, water displacement and even dexascan are trying to solve for more variables than they can measure, so they are comparing to norms. Getting into BMRs and the like, of course there is the judgement as to burn rates and exertion levels above resting, but then with our WLS of different flavors, that impacts the intake caloric level that we consuming and absorbing, and how the body adjusts to the insult of surgery over time, what the surgery that you had does to the absorption of different foods (fats absorbed differently from carbohydrates which are different from proteins, simple carbs different from complex carbs.) In short, you may get a number from some lab testing as to what calories are appropriate for you, but the ultimate test is whether your weight is stable at that point, or gaining or losing so that you need to make adjustments.

+1 i had like 4-5 partial drinks during entire weight loss phase. Now, i am what one would call a regular drinker (some may even, dare i say, call me an alcoholic). I was a drinker before surgery as well. (Though before surgery I would drink lots in a short amount of time, every few weeks, now i drink less at a time, but more often). My increased drinking frequency had a lot to do with Covid lockdowns starting in 2020 though. From a weight-loss perspective, what little i did drink during weight loss phase did not seem to affect ME in getting to goal. Nor does the amounts i drink now seem to affect my ability to maintain my current weight (note though that i simultaneously keep an eye on my total calories - alcohol or otherwise- , so there’s also that) I get tipsy quite fast post-wls (and on small amounts), but I also sober up in record speed. As others said above, if you really want to, try it out and observe how you react, and then decide if want to again. Or, don’t. Up to you…you know yourself best. Sincerely, An alcohol-drinking-DRINKER (from Canada). (i also smoke, drive above the speed limit, and am late paying my taxes this year…)

It's not uncommon that bariatric programs warn people not to drink alcohol post-op. Some, like your team seem to take a "never again" approach, while some say avoid it for a specific length of time, such as the first year. As I understand it, here are the biggest concerns those programs have: The biggest concern by far is that there is an increased risk of developing Alcohol Use Disorder. As @Starwarsandcupcakes mentioned, some research suggest that susceptible patients transfer disordered eating onto alcohol. Some studies have even found that the incidence is as high as 20% of bariatric surgery patients. The second concern is that alcohol affects our altered biology differently. Honestly this is worse for gastric bypass patients, but sleeve patients still have have issues with getting drunk much faster, on much less alcohol. Further, it can take a lot longer to metabolize the alcohol you do consume, meaning you'll stay drunk longer. Bottom line, it's really easy to overdo things and end up completely drunk on a lot less booze than before. There is also the concern that this is wasted calories that provide no nutritional benefit and can slow your weight loss. Obviously for those in maintenance, this doesn't really matter, but for those still losing, it might be a concern for some.

Doctors are all over the map with their opinions on drinking post WLS, probably similar to their views on drinking to begin with if I had to guess. My team said it was okay at three months for a special occasion. I have to say it’s not the same as it was pre WLS. I may be one of the few willing to admit but when I drink I do it to get a buzz, lol. Post WLS the buzz comes and goes in like ten minutes for me. I can’t drink fast enough to maintain it and probably would kill myself trying. It’s almost not worth it to me. Waste of calories. That being said my real advice is if you do decide you want to do it try it at home first. Your body may react welrd and the last thing you want is to feel sick or get sloppy drunk on your birthday off one drink. And make sure there is a designated driver around. I still worry about how long it stays in our system and all that being different than before.

Thanks, I definitely do feel like some days I am way hungrier than others. I have gone from the 600s to 700-800 in terms of calories but that’s with adding exercise back in this week so it probably makes sense.

Don't beat yourself up for one bad day! Thats also not too bad of a day compared to where we were before the surgery. I know I've come close to 1000 a couple of times because I'm trying to find foods that I like that have a ton of protein and sometimes those are also high calorie. I also can pretty much eat anything and have no nausea so its harder to keep on track when our tool is a little more lenient than others. Its a long journey, so don't stress too much about the bumps, we'll get there!

Today is the first day I really stepped off the program. My kid handed me a piece of pizza and I ate all the toppings but not the bread:(. If I eat dinner later it will put me at 925 calories for the day. My doctor said at this point I should be at 600-800 no matter how much I exercise unless I am running marathons. Idk how much I buy into that… I’m not doing anything amazing but managed 25 minutes on the elliptical today. I think my main issue at this point is I really have been able to eat pretty much anything.

Can you please provide references for this? Everything I've seen or read in the scientific literature suggests that RMR testing by direct calorimetry is considered the gold standard for determining calories burned. Indirect calorimetry may be slightly less accurate, but is still far and away better than anything else available to us. Where things get "fuzzy", is that we are not always at rest, so just knowing your RMR is not enough. This is where activity level estimates or heart-rate based calorie estimators like fitbits try to make up the difference. These will obviously be less accurate, but are certainly better than a wild guess or deciding based on something much less accurate like height and weight charts.

Adding to the good points that have been made here, metabolic rates are somewhat individual, beyond genetics but personal history and even your gut flora that helps digestion and absorption. The BMR tests are interesting as a reference, but they mostly tell you what the algorithm thinks your metabolism should be, but not what it actually is. Also, this is a somewhat tough time for a bypass post op, as the caloric malabsorption of the bypass dissipates after a year or two - you tend to lose that extra help in losing weight and become a more "normal" person in that regard. Some may never notice the effect if they lost quickly and early, but it can also bite you in maintenance if one gets used to being stable at say, 1700 calories, but then that stability point drops to maybe 1600 or 1500. So, stay flexible and try to keep the calories down as much as you can until you get to the weight you desire (or to where it just won't go down anymore) and adjust to maintenance Good luck....

Sometimes too much info is bad. I follow what my surgery information booklet tells me. It lays out days and weekly schedule. It tells me food to eat during these times and I'm following it to the letter. I have added a copy of the guide I use. Hope it will help. It had guided me well and I only move on to my next stage only when I am ready I never get ahead of this schedule. That was the best advice I gotten from my surgeon and nutritionist and I'm greatfull for it. Best wishes on your weight loss journey. !! TWH_dietexcerpt_dec2013.pdf I also wanted to add that I use MyFitnessPal to track my food and nutrition and it help me track my calories, carbs and salt intake.

I feel your pain. I’m maintaining between 214-220 lbs at 1000-1200 calories. There really isn’t anything to cut out and still be healthy. I’m fighting to stay at this by logging meals, measuring but not being totally obsessed. The goal all along has to be as healthy as I can be, not wearing a bikini or posting on popular social media. I hope your health choices are what you can live with long term. That’s what I ask myself too, every day. Are you mobile, in reasonable health, can you continue to do the active things you love with people who love you? Is your health limiting your job choices? I feel that this is something that we don’t talk about enough on here. What happens when you stop loosing weight and you are not at goal, and the calories are as low as you can reasonably eat? I think this happens more often than gets posted.

My maintenance calories is around 1700-1800. Everyone's maintenance calories differs though...

Dinner! (Salad with chicken): 214 calories. Ate all the important stuff (i.e., the chicken and cheese), lol…leftovers is basically lettuce.

Its a pita chip kind of day 1st and 2nd meals of the day: 2 poached eggs with 1/2 oz of pita chips: 190 calories; and homemade guac and pita chips and an espresso martini (not shown): 321 calories. Ate everything shown.

I don't know that I agree that using sugar free creamer is an automatic one-way trip back to Fattown. However, ANYTHING you consume that is a) easy to use much more of than you realize or b) previously didn't consider to be caloric or worth logging, can make you gain weight. Know what your limits and capabilities are, and if it's too much temptation, don't. At the risk of inciting the "I only eat 'real food'" crowd, I drink sugar free creamer every day, but it's measured and logged like anything else. I use 30 calories' worth, and I know that because I measure it. TL;DR I don't think it's the creamer, it could be anything you don't consider to be "food". You could easily make the same mistake with condiments, salad dressing, cooking oil, butter, or anything else. If it has calories, measure and log it.

I totally get your worries too - I have also been eating noticeably more in the last few weeks because I am hungrier, and I am fearful that it will just keep increasing and increasing until I'm back to eating too much of the wrong foods again and regaining everything. That's my big fear. And it does happen to some people who did really well post op. I think all we can do is keep tracking, keep observing the effects of a higher calorie intake on our bodies and try and get help early if eating does actually get out of hand again. There's lots of help here, and you should be able to ask your surgeon/dietician too. I really hope that you lose those final 20lbs, you have done so well it would be lovely to get where you really want to be. But even if you don't I hope you're fine in the long term and happy with all you've achieved - it's amazing.

Sounds like a plan. I would also definitely recommend strength training. It does not have to be anything fancy, even a solid bodyweight only routine would help. You can google something like "bodyweight exercises for beginners" and use that to get started. Note that it's not unusual for beginners to see both extra water retention and even muscle growth when starting strength training, so don't be surprised if you see a jump up on the scale. This type of exercise will not only burn calories, but will also boost your overall metabolic rate, meaning you'll burn more calories, even at rest.

An endocrinologist works with pretty much any issue related to the endocrine system, meaning your thyroid, pituitary gland, hypothalamus, adrenal gland, etc. Basically most anything hormone related is something they can help treat. You can always ask you PCP for a referral, but depending on your doc and your insurance, they may be loathe to do so if you don't have anything showing up on your blood tests. If you're insurance does not require a referral to see a specialist, the you can always just make an appointment. There definitely are some hormone imbalances that can slow your metabolism such that your maintenance calories will be pretty low. Alternately, it may not be a hormone imbalance at all. It may just be what's normal for you. One additional thing for you to consider is that exercise, especially strength training, would allow you to eat more without gaining. What's your exercise routine look like right now?

Do you know what all an endocrinologist tests for? It’s not just hypo and hyperthyroidism, right?? I am in maintenance and struggling big time. I feel like the only way to maintain my weight is to be on a diet (and hungry) for the rest of my life cause I add in a few calories and I gain. I feel like there is something going on with my hormones that my primary doc is missing. I see him today and plan to ask a lot of questions. Just wondering what conditions cause weight gain that I should be questioning him about.

Don't panic. 1500 calories is not a lot. If you are still loosing (even slower) then you are fine. If you are comfortable where you are and stop loosing, then you are fine. Either way, just try it an adjust. Everyone is different and there are so many factors to take in account. My Dietician told me at my last apt that I will most likely be around 2000-2200 calories (very tall) once I get to maintenance! I eat around 1000-1200 a day now and on the higher end days I am munchy and having snacks. I am already trying to figure out how I would double that. It makes me worry about eating more high calorie foods or more snacks and then spiraling out of control. I am trying not to over think it as I am still a bit away from that point. My point is, I understand your worries but slow down and take it day to day. You can do it, hell, you already have.

To add to everyone’s great advice above, don’t forget, your rate of loss slow as you get nearer to your body’s set weight. This is the weight your body is happiest at & will settle at. The surgery resets this from where it was but it may not be the weight you want to be. To get below this weight you will have to consume less & do more. It will be more of a struggle & difficult to maintain that lower weight because you’re fighting your body. Personally I’d put on weight at 1500 but I’m short at 5’3”, not very active, more finely built & 57. But before surgery I couldn’t lose eating 900 calories. But don’t think your weight loss is over yet. You’ll get where you’re supposed to be in your time & there’s nothing wrong with that.

(Warning: this is long) tldr; for ME, in MAINTENANCE, carbs consumption makes little difference to my weight. K. My NUT didn’t give me a carb goal/limit per se, but did instruct me to aim for my meals to consist of 25% carbs/starches (with another 25% being protein and the remaining 50% to be low-glycemic veggies). With that said, i did my own thing (and told her so): i ended up doing ultra-low carb, i.e., less than 25g NET carbs per day. Got to goal in 7 months, remained carbophobic, lost a few more pounds and basically still went out of my way to avoid them. I wasn’t ultra-low carb as during weight loss phase, but i was still pretty low. Eventually, i started eating more and nowadays (4 years post), i probably eat as much carbs as a “regular” person. I have remained under goal weight this entire time. These are my takeaways of going low-carb (and this is from MY experience, YMMV) 1) weight loss is rapid. but you need to remain low carb for an extended period. If i carb up on a day, the weight loss slows down or pauses. There is a science to this phenomenon regarding ketosis, the explanation of which is beyond the scope of my post (just google it if ur interested). Also want to say that i was also ultra-low calorie so obvs that contributed! 2) there is a period of a few days that, once passed, my cravings for carbohydrates went away. (Which is why once u start, stick to it because u may have to go thu the “white-knuckle” phase again to alleviate urself of the cravings (see note 1 above) 3) now here is the kicker: during MAINTENANCE (i cant say if this applies to weight loss phase because i didn’t try it)…i discovered that, for ME, it does not matter if my 1800 cals average i eat a day consists of 20g of carbs or 200g. My weight stays the same regardless. What does make a difference is CALORIES. So long as my calories stay at around 1800 (however it is comprised) then im good. 4) carb consumption affects my looks. When i low carb, my body is more defined (which i like) and my face more gaunt (which I don’t like). These days my face is lovely (lol), but my body could be better. Mind u i have also been slacking on the exercise front so that is also a factor, but i digress. In any case, the point is i am still basically the same weight as my low-carb maintenance days. And that concludes my dissertation for this evening lol. P.S. I want to point out also that i am NOT insulin-resitant, nor suffer any other medical conditions that affect my weight, nor take any medications that would either. So this may not be everyone’s experience. P.P.S. Sorry this was so long!

it's hard to say. I would lose weight on 1500 calories (albeit slowly), but some people would gain. I've been in maintenance for several years (and have been hanging out on bariatric boards for about eight years). I know people who can maintain on 2000 calories, and others who can only eat 1200. You can always experiment with different calorie ranges and see at what point you lose, at what point you maintain, and at what point you start gaining. That's really the only way to do it other than the RMR test that someone above mentioned. at any rate, 1500 calories isn't that much. Some people do gain on that, but then, you're pretty tall so I'm guessing you'd either maintain or lose on that much. also, the closer you get to a normal BMI, the slower weight loss becomes. That's just a fact. 1200 calories is super low, unless you're short or have an incredibly low metabolism. Most people can't really sustain that forever. Personally, I'd give up the ghost on that one. As I said, even 1500 is pretty low for most people....sustainable, but low. I wouldn't worry about it unless you're gaining on that. for the record, I can maintain on 1500-1700 calories. If I'm doing some heavy exercise, I can go up to 1800 or so - maybe even higher.

Can I ask how many calories you’re at now, ShoppGirl?

Everyone is different In terms of what amount of calories they need to eat to continue losing. It depends on metabolism, activity level, age, etc. You may find that you do not lose at 1500 and need to add more exercise or cut calories but you also may lose just fine at that amount. You may find that you aren’t able to maintain the level of calories required to keep losing the closer you get to a “normal” bmi. I got to six pounds away and I just couldn’t do it. I was hungry and just had to accept that since I didn’t want to add more exercise and couldn’t eat less that I am just not going to reach that goal. I am 5’8” female and I got to 169 and stayed there for months before I decided to go to maintenance which basically meant to keep doing what I was doing. I am not by any means saying give up cause you may still have some to lose but not all WLS patients get to a “normal” BMI.