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I agree with @NickelChip, this seems quite off. I've seen 800 calorie plans for bypass patients in the active weight loss phase, but most people are in the 1200 calorie range for maintenance... And your portion size will naturally increase a bit over time as you are able to eat more as your pouch heals. It won't be as much as a "matured sleeve" can eat, but it won't be a few tablespoons either. At the bariatric clinic I go to I attended nutrition class with sleeve patients and bypass patients, even though I'm a DS patient. We were all told to keep each meal to 10 grams of fat or less (general aim at 1 year out is 60 grams of total fat as per the ASMBS guidelines for a year out), and 10 grams of carbs or less, for less than 50 total grams of carbs a day, as they want us in ketosis during the active fat loss phase (this amount will double to about 100 grams of total carbs in maintenance). And protein varies for each group but bypass was to aim for 80 grams of protein a day, since they malabsorb some compared to the sleeve patients. NONE of us were given a calorie goal, only macro goals. We were ALL told to aim for 5-6 small meals a day for consistent energy, aiming for 4-5 meals if we go to bed early or get up late. So we were encouraged to eat about every 3 hours, allowing 2-3 hours between our last meal and bed. And told a fair amount of our carbs should come from high fiber, low carb vegetables and low sugar fruits, with a fiber supplement (SunFiber is amazing and non-bloating) and Miralax as needed to maintain regularity.

I'm so sorry you are experiencing this!! This isn't a you problem!! If you aren't losing sufficient weight you are either being given poor advice from your nutrition team, poor medical support from your surgeon, or it is possible your body is under significant stress for whatever reason and isn't losing weight. There are rare cases when someone with a sleeve doesn't respond but often those are people who have low starting weights. If they had a high starting weight and don't respond to the sleeve surgery, these people generally end up revised to bypass or a DS/SADI, and then lose weight, but again, that should be a convo being initiated by your surgeon as a future possibility if food modification and medications don't work. Some people take GLP-1 meds to help jumpstart their weight loss if the surgery hasn't triggered it, but again, at the 6 month mark this should be something the surgeon initiates conversation about. You shouldn't be living in fear of your appointments with them. If you aren't feeling supported you might consider getting a second opinion from another bariatric surgeon in the area not affiliated with this practice. I strongly believe in second opinions when talking things like surgery... It may sound like I'm being harsh on your team, but lets be clear. They made a nice chunk of money off of your surgery. You deserve good aftercare!! Some surgeons, like my own, believe that the best way to lose weight in the first 6 months to a year after surgery is through being in ketosis. This involves a good protein intake (60-80 grams with the sleeve) and carbs below 50 total carbs or 30 grams net carbs. You can get pee strips to test if you are in ketosis. Once in ketosis you should go through regular periods when you lose some weight, followed by periods where you lose none as your body stabilizes from the previous loss and recalibrates. If this doesn't happen, I'd definitely be communicating with the surgeon about it! What dietary advice did your team give you? Hydration is important for weight loss. If you aren't able to eat enough calories or drink enough water your body will go into starvation mode like @summerseeker mentioned. This is a huge stressor to the body!! And huge stress will cause weight loss to stop. Sleep is also crucial to weight loss, often more important than exercise. If you aren't getting regular sleep for enough hours per night, this can stall your weight loss. Physical activity of some kind is important, but it accounts for less weight loss than proper nutrition and sleep. And if you are under calories and under hydrated exercise will just further stress out your body.

Honestly, this seems way off-base, with the exception of 60-80 grams protein, which is completely sufficient for most people (but not all!). Your calorie estimations are much too low for the vast majority of people in maintenance mode. So rest assured, you won't be on 650 calories for life! Also, 25g carb is extremely low carb and not a lifestyle most people are eager to embrace. If a doctor insisted on 25g carb for life as the only way to succeed, I would seek out a second opinion for sure. From what I see people saying around here, 1200 to 1500 is a much more realistic calorie range for the long term, although that is for maintenance, not for weight loss or for early days after surgery. If you eat to maintain your current weight right now, that would seem to go against your goal of losing 20-50lbs more. I have two suggestions. First, check out some bariatric cookbooks because they will tell you appropriate portion sizes for maintenance as well as give you some ideas for what types of foods to be eating. My favorite is Kristin Willard's Bariatric Meal Prep Made Easy: 6 Weeks of Portion Controlled Recipes to Keep the Weight off. She's a registered dietician specializing in bariatrics and every recipe has a gorgeous color illustration. Second, take a look at the Portion Perfection brand bariatric plate. It's kind of expensive, so you may not want to buy it, but the concept is really good. Basically it's an 8 inch plate (with a one inch rim all the way around, so a 6 inch circle of eating space). There are lines and illustrations to divide up the plate and show you where to put your foods and how much. If you're a visual person, this may really help. Other than that, you may want to check out some of the nutrition videos as well as the weekly podcast done by Dr. Matthew Weiner (Pound of Cure). I find them so insightful and he and his dietician, Zoe, are very keen on plant-based nutrition, which may be perfect for you. Edited to add: Here is a link to a dietician article about post-op goals that might help: https://www.mybariatricdietitian.com/mbd-blog/portion-sizes-after-weight-loss-surgery

It really is amazing to see how all the different doctors approach the pre diet, surgery, out patient vs hospital stay, post diet length of phases, what you can eat, what you can't in each phase. Of course we probably all think / hope that our own doc is doing it right. I'm trying hard to follow my doctor's course, even though when I read where some of you are, it gets difficult. Had first puree tonight (cheated by starting 12hrs early.. Oh well!) It was really good but really surprising how different your stomach reacts to it. I was definitely full after a few teaspoons as compared to eating pudding. I have a nutribullet, so you really end up making many servings so there's enough volume to puree. The mental part of the recovery has been awful. Hoping that being on the puree for the next two weeks will start to bring up the mood. FYI.. My insurance doesn't cover a nutritionist/dietician. Some of my doctor's dietician appts are considered part of the procedure and thus discounted cost. I paid almost nothing for the procedure itself, but not the dietician part. I looked online and found Health Loft. Many insurances cover them, including mine. They advertise as services for eating disorders, but they also have specialists for bariatric. It's virtual. Now I can use a dietician and get some counseling for many more visits as I try to change my life. Even though I've known for decades how I should be eating, I need all the help I can get.

I am enjoying the chicken soup flavored shake from Bariatric Fusion, which is funny because when I tried it pre-op, I thought it was terrible and nearly threw it out. Now, it's great. Celebrate and Unjury also make protein shake soups. I was also able to mix the unflavored Syntrax Nectar into a cup of organic tomato soup and it blended really well.

I’m really excited about the progress being made in pharmacology to manage obesity! This medication works well but is still generally considered a lifetime or long term treatment. Some can manage to keep the additional weight lost off with intensive lifestyle changes. However its so new there is much data on this for our population. Check out Dr. Weiner, he covers the topic extensively on his podcast and has additional info on his website. https://youtu.be/eu6Zt0LTg14?si=_rPWlf8DlrhGh3u6 https://www.poundofcureweightloss.com/glp1-medications/ Please connect with a Bariatric/weight management team that supports this. Unless you are T2D, you’ll likely be prescribed Zepbound. Make sure to check your insurance coverage and download the coupons. https://zepbound.lilly.com/coverage-savings

Try the Bariatric Fusion soft chews. They come in multi, iron, and calcium. They are all the texture of a Starburst candy. I was given samples by my dietician and they were wonderful. I would have opted for them if they weren't the most expensive option. I went for just the calcium as a soft chew and did the chewable, chalky type instead for the multi and the iron to save money, but if you need a really palatable option, these are the way to go.

Hey Bariatric family!! I’m four weeks post op and the thought of food makes me sick. Protein and water are my best friend. I have had some puréed stuff and a tiny piece of white fish. Once I eat something and put it up for “later” the thought of it disgust me. Will this go away?? Any food ideals?? Besides chili and fish?? The thought of chicken makes me want to pass out. I’m feeling good and everything is going well , just scared that this will not go away. Thanks in advance for all replies . These forums have gotten me through some of the hardest times of my life after vsg surgery.

this is the first time I've heard of a case like this, and I've been on this site for nine years. I malabsorb protein so from the get-go I've had to be sure to get at least 100 grams in every day, but it sounds like your mother's case is more extreme. I still have a protein shake every morning so I can be sure my intake ends up at least 100 grams by the end of the day, but it sounds like your mother may need even more than. that. Maybe her liver issues are a factor in this, too. I've taken OTC vitamins all along and have never had deficiencies - and that's true of many of us. Usually, OTC versions are fine (although you usually have to take two regular multis a day, rather than one (which is true of many of the bariatric-specific multis). She may have to get prescription-strength vitamins (I know they have prescription-strength vitamin D, for example - not sure about other vitamins). hmmm...not sure what to tell you. This sounds like a pretty rare condition, so I hope someone can help her!

Hi I don't know of many people with the protein problem but my daughter is in the same position as your mother her blood level for protein is almost non exciting her bariatric surgeon has told it is because she hS malabsorption but at the same time she is allergic to protein where as I hD the bypass and have fat malabsorption I am also 69yrs lost 70kg my daughter had the sleeve In Australia we have a group on Facebook for the over 50 people maybe she should look at and even join it hope this helps abit

I don’t personal buy it on bariatric pal, but might look into it. Before my surgery I bought some protein soup and protein pudding on Amazon. I picked the one that is bariatric friendly like low in carb, and low in sugar. The protein pudding I tried the variety pack first, but the 0 sugar one didn’t taste to my liking and I bought the one I like that have 2garm of sugar in it. The soup and pudding have extra 12-15 gram of protein. I only use it when my meals does not meet my protein requirements and it can give me a boost, or I use it when I am craving dessert. It does help a lot for me. But I had only used 2 time after surgery. I used it more when I was in my pre ob liquid diet.

My mom had gastric bypass a few months ago. Her doctor wanted her to have it because she was Type 2 diabetic and in danger of a lot of other health issues that would be solved by losing weight. She is 69 years old. Things were going well at first - she felt well, she was able to eat as needed, and was losing the weight. She is about 5'5" and I'm not sure about her current weight, but she's lost quite a bit and can now fit into like size large in women's (she was at a 2XL or 3XL before). But recently she has become very weak and has fallen several times (which is dangerous at her age). She went in to the doctor and they were initially convinced based on scans and blood work that she she had fatty liver that had advanced to cirrhosis, and they said it was Stage 3 cirrhosis (and that her only hope for survival would be a liver transplant). The doctor also told her that she was severely malnourished, comparing her to starving kids in other countries. He said that was the cause of her weakness, along with the liver issues. A biopsy was done on her liver and she's Stage 1 of fatty liver, which means she can turn it around with diet and exercise, and we're all very happy about that. However, she is still extremely malnourished. The doctor's solution was that she eat more protein. She has been focused on doing so ever since her surgery; now she is trying to up her intake even further. And despite trying to get as much protein as she can, her last blood work showed that her protein is at a 2, which is apparently really bad. So a couple of questions for you - Have you heard of anyone going through something similar to this? What did they do to improve their nutrition and overall health? (Because at this point the doctor is now recommending undoing the surgery so that she can absorb protein better, but I don't want my elderly mother to undergo surgery again.) How can she up her protein? She is already eating large amounts of protein at every meal and snacking on it throughout the day. She is also eating plenty of vegetables. I know you're not supposed to get your protein from drinking, but would that be helpful here? Just to make sure that she's getting enough? And how many grams of protein should she be eating a day? What kind of vitamins should she be taking, and at what dosage? She is very low on like Vitamin D and B, and assures me that she's taking OTC vitamins that her doctor recommended. I know that's not good enough if you have absorption issues and gastric bypass, and I also know that doctors' recommendations (especially those who don't focus on bariatrics) often recommend way below what is needed. (Her vitamin levels are bad enough that the doctor wrote her a prescription for vitamins to take once a week.) She told me she takes the Fusion brand Multivitamin every day (designed for bariatric patients) and a calcium/Vitamin D that is 1000iu twice a day. Looking at the label for the multivitamin, it seems low to me. Any and all advice/help/suggestions would be most welcome. Thank you!

Do you all buy any of bariatric pal foods? I’m about 3 days away from my 4 month post op. The bariatric foods hep me a lot to stick to my 60+ mg of protein a day still drink one shake a day because I get about 40mg protein in one shake. I usually drink around 4-6 pm so with my meals and snacks. I get the rest or more of protein through out. I too have sm stalls depending on if my right leg is swollen or I need to have a good bowel movement sorry TMI but I’m on pain management with chronic constipation. But I’m losing steady not as fast as first surgery but since I’m more sedentary then prior it’s expected but losing. Day of surgery was 304 now 272

This varies greatly by state, as each states' laws govern what is essential vs cosmetic medical procedures. For example, my work insurance is based in Tennessee, and all bariatric procedures are 100% cosmetic, so no coverage at all! To further complicate things, individual companies within these states can have varying coverage depending on how much business they get from your employer. Even if a company like Blue Cross or Aetna cover it for employees of one company, they won't for others. You will really need to look into the offerings you have available, and call them directly. You may have to get assertive with them to get a straight answer. I had one make me go through programs and jump through hoops to prepare for it, only to tell me they wouldn't cover anything when I went to schedule surgery. One even told me they would not cover any future medical procedures if I have it done anyway! I'm with another company and insurance plan now which didn't cover it either, but they didn't blacklist me for having a self-pay procedure. Good luck, hopefully you're more successful than I was with the insurance company.

There are things like miracle noodles, heart of palm noodles, and of course most of our "fullness" should come from veggies once we are a year out. Think high volume low carb veggies like lettuce, mixed greens, cabbage, cauliflower, broccoli, as well as colorful things like bell peppers, tomatoes, onions, green beans, etc... These paired with a little fat and a decent amount of protein should help you feel fuller longer. I think it is very well possible you could be experiencing true hunger. You are MUCH taller than the average woman (if you are not a woman I apologize for the assumption) and the dietary guidelines that surgeons and nutritionists hand out are usually useless if you fall outside their standard patient. If you are exercising enough to get your heart rate up for a consistent amount of time or doing weights/strength training, you could be burning a fair number of calories too. Both of these things would make me think you may have a higher caloric need, even though you are a sleeve patient, than the average sleever would. If your surgeon's nutritionist isn't interested in customizing your true caloric need given your frame, height, and activity level, you may need to have a few sessions with someone else who is trained in bariatrics and will actually help you work through this so you can stop feeling guilt when you eat more than your surgeon wants you to. Also, have you tried the Millie's sipping broths? You can get a sample pack of their flavors on Amazon for a pretty reasonable cost. They might help ease the hunger between meals until you find a dietician to talk to.

What’s the best insurance to have when you’re interested in having Bariatric surgery covered by insurance?

I was told by my bariatric team nurse that it's normally a two week wait, and they would call me at that point to set up my surgery date. BCBS approved me within a week. So, I was surprised when the hospital nurse called me with check in day instructions and found my surgeon had already scheduled my surgery in 10 days. So what normally would have been a 2 week wait for approval, then a 2 week pre-op diet turned into a Fastrack to surgery. My liver shrinking diet was shortened because of it which was OK with me and obviously OK by my doctor. Good luck!

Congrats on the weightloss and the pregnancy! I have not taken them personally, but they do make prenatal bariatric vitamins. Procare Health which they carry here on bariatric pal. https://store.bariatricpal.com/products/procare-health-bariatric-multivitamin-capsule-prenatal?currency=USD&variant=5189958074405&utm_medium=cpc&utm_source=google&utm_campaign=Google Shopping&stkn=24a7de865f58&gad_source=1&gclid=CjwKCAiA29auBhBxEiwAnKcSqvHF7gegDH5JR7Hxartz8Q2592gZWW3ALpKpKmUJvttRygoWVzuq3xoCR5AQAvD_BwE

Hey all, I got VSG in August 2022. I've lost over 150lbs and just found out I'm 5 weeks pregnant (first time!). I've spoken to my surgeon, nutritionist and obgyn, but no one had a solid recommendation for prenatal. My surgeon said to take 2 prenatal vitamins which will give me what I need, while my obgyn said to compare my bariatric multivitamin to prenatal and if possible, stick with what I've been using. I do have a prescription for folic acid that I take daily which is why I assume the obgyn is not entirely worried about the prenatal itself. They also discussed making sure there's not too much iron which could lead to constipation. Anyways, could you guys share what you did or what was recommended to you? I currently take bariatric choice once daily multivitamin. Would also love to know what your daily regiment was (ex: prenatal, calcium chew, etc). Thanks so much!

Bowel movements the color you describe is usually do to fat malabsorption. That wouldn't be unusual since you had the Bypass and that causes some malabsorption. It is good they are doing a HIDA scan and ultrasound, as nausea with things like peanut butter could indicate you are having issues digesting fat. Some people get that when their gallbladder starts to misbehave. I have never had bloating that distends the belly like that, so I can't relate, but I have had about 6 colonoscopies for other things so if they go that route don't worry, you'll take a nap and it'll be all over. LOL The prep is definitely worse than the test. I hope they figure out what is going on! Some people develop SIBO after bariatric surgery and that can cause a lot of bloating, so if their tests don't show anything you may want to chat with a Gastro doc about that possibility!

Just wanted to say I'm starting Day 13 of my 2 week preop liquid diet and it's not so bad at this point. I mean, I wouldn't recommend it to friends, but my energy levels are good and the hunger isn't terrible. The first few days I was tired and cold all the time, but it is winter and I live near Boston, so cold comes with the territory. 4 weeks would be hard, but you can do it! I suggest getting any source of temptation out of sight, and keep yourself busy. Also, if you're like me, you will start thinking of the most random food-related things, like a food you like or a restaurant you went to one time 10 years ago, just totally out of the blue. Avoid cooking shows. I stupidly was halfway through an episode of Great British Baking Show before I realized what I was doing! OMG, why am I watching someone cook a tart right now?!? If you're allowed it, get the chicken soup flavored shakes (I know Bariatric Fusion, Unjury, and Celebrate have versions, if those brands are available to you). That has been such a life saver as I'm really tired of everything being sweet. Sugar free jello is lovely and only 5 calories, so it should be fine for you to have. It's almost like chewing, sort of. Good luck!

For life? Not true at all. Stage two of the post op return to eating is purée. It usually is weeks 3 & 4 so two weeks only in the first month. The staged return to eating (usually a two week cycle of liquids, purée, soft then solid foods) is to protect & support your healing tummy. It takes about 8 weeks to fully heal. Some surgeons recommend chewing well before swallowing to help during this time too to ensure nothing too coarse or fibrous is swallowed that could impact your healing. It also makes you stop & think about your eating. I wasn’t told to do that. A couple of weeks on the solid food stage (probably early start of month 3) I was eating chicken thighs, steak, lamb chops, pork loin, etc. Yes we are advised to eat slowly. It takes a good 20 odd minutes for the message to get through that you’re full. If you eat quickly you’ll easily eat too much & be over full. It’s about being mindful when eating too. Putting your cutlery down between bites & really thinking about if you need the next bite yet or just want it is a good habit to get into. It’s actually a good practice for everyone not just bariatric patients. So many people just shovel in spoonful after spoonful of food in their mouths & before they know it they’ve eaten copious amounts of food & are groaning & uncomfortable because they are overfull. Something to be aware of is eating too much, too fast or food that is too coarse or fibrous can result in the foamies. Thick foamy saliva rises to protect your oesophagus & to help you bring up the excess food or food that is causing a blockage. I still have the foamies at times. I think my oesophagus is more sensitive. Char grilled meats & vegetables & sometimes fibrous vegetables can cause me grief. But I feel fine once I’ve bought up the offending thing, I feel fine. Last time I had an episode it was because I hadn’t trimmed my sugar snap peas well & there was string left dangling & it irritated me. Most people rarely experience it & not in the long term. There’s lots of misinformation & scary horror stories online many not based on any truth or vey little or posted to drive likes (the scarier the story the more clicks). Go to reputable medical sites & forums like this one. Generally a good idea to avoid social media too. Highly recommend the you tube videos of Dr Matt Weiner (A pound of Cure) & Dr John Pilcher. Straight forward, practical information, clearly explained.

Thanks so much! I am on a Vegan Shake and using some almond milk with no sugar added. I have slowed down on veggies and fruit. Apparently someone didn’t put on my chart that I suffer from IBS. Then nutritionist is calling me on Tuesday to help with a diet that’s is more manageable for me. I was told that My IBS could get better or worse. I read the Bariatric Bible they gave me and it is in there. I pray for the better scenario. They told me if I have any doubts then I shouldn't do it. It’s not that I have doubts, I’m scared of any surgery! I am nervous and I feel it would be favorable if one hear some positive. That’s why I am on here. I am hoping I hear the positive. I hate drama. I realize that it will be very difficult recovery. I don’t know how many days I will be in pain. They want me walking 20 min 3 times a day. I can do 10 minutes and I will work my way up. I think they do this liver cleanse for the purpose to make surgery easier but to show us this is your new way of life. When I look at phase 2 it’s not as much dairy, fruit and veggies they are requiring now. I am almost there I have today and tomorrow. Then clear liquids on Tuesday. My surgery Wednesday. I am giving it all to God! Thanks for all who reached out!

WOW. No offense, but I'm glad I'm not in the UK. There's absolutely no way I could do 4 weeks. 2 weeks pushed me to my very limits. By the time I couldn't do it anymore and was ready to just give up, it was the day before surgery! I give you all the credit in the world. Just hearing 4 weeks would have absolutely put me off from the surgery. The fact that you're doing it is extremely admirable and impressive. We'll all definitely be here to support you and cheer you on. If you can do 4 weeks of this, you can definitely stick to the bariatric diet after.

Sleeve in 2017 to revision Gastric Bypass Aug 2023 - Update Hi All! I can't believe how fast time has gone! I will be going to my 6 mth check up tomorrow 2/20/24. Everything is a lot better! As of today I am 173lbs, I'll update my ticker it's still at 183. I am able to eat more varieties that I cook at home. Can't tolerate beef to well but I was never a big red meat person. I am still on the fence with salads/raw vegs though I can tolerate raw onions and tomatoes. I CANNOT eat take out! Purchased chinese for my son as he was going back to college... tried a little and was bringing it back up the rest of the night! If I eat out it has to be at a place that actually cooks food like salmon, veggies, no added anything. Food prepared at home is MUCH beter because you know what's in it. I am not doing too well with my multi because I purchased capsules that I open to put in my protein smoothies (Unjury Vanilla) which I don't take every day anymore. I just purchase the multi-vitamin patch from the bariatric store, I'll update you on that later My food is mostly a diet consistency of pescatarian due to the low cal/high protein and the ease of my system digesting the food. I would occassionally eat chicken as well (ground, poached breast etc), turkey hardly ever because the meat is not as soft as chicken. My veggies are fine steamed, some legumes & beans (occasional), as far as grains or potatoes etc I try to not do carbs at all or keep them at a bare minimum (jasmine or basati brown rice) with an occasional meal...I've really gotten into sweet potatoes as I didn't eat them a lot before. Swelling is gone, skin is good, and I can visually see the difference in pounds and inches loss especially from a side view lol. I still have work to do (vitamins, eat more, move more) and I am working on it. BTW!!!! I am back in the health & wellness field as I start my new position next week. I took a pause last summer. Now as I am on my health journey I'll be helping my patients with weight loss and adopting healthier lifestyles. My goal is to lose 13 more lbs and as you all know after running so long and you can see the finish line in sight....your legs get weary and that last sprint is the hardest. It is good to move from "morbidly obese", to "obese", to now "overweight"...do you guys feel the same? Let me know how you all are doing!