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This is my current concern and project. I noticed when I got to goal that weight had stop coming off my waist quite a while ago. And my pear/hourglass shape was gone. Way to much weight was still around my waist and my backside was a unsightly, malformed, and mostly gone mess. My theory is this is due to lower female hormones due to my age, 47. I wanted to lose a few more pounds but was afraid my body would continue it's current distribution of loss and I would look even worse. I'm now doing keto, upped the cardio, taking certain supplements, and added bioidentical estriol, and progesterone in over the counter cream form. I'm also doing more exercises to build muscle and increase my backside. It's early yet I think it's working . I've only lost a couple of more pounds but some has come off my waist. I haven't had any problems with clothing and look pretty good fully clothed. You probably just need to spend time shopping and trying on clothes to see what looks good on you now.

Impossible to predict. We're all so different and each of us have a different relationship and level of attachment to the food. Each of us have different mental preparations for this surgery. You really need to just start looking at how you view food. Start down-regulating its importance in your life. Start eating whole foods--lose the CRAP, detox off caffeine, get off sugar and all white stuff. Go low carb or keto now if you can. What you do now, will ultimately make life in the 2 week pre-op liquid diet and life in the 2-6 weeks post surgery so much easier for you. I was personally so ready for this surgery, mentally, emotionally, and I welcomed the changes with a hopeful and positive attitude. I have had very little grieving. I did have periodic episodes of unexplainable sadness and depression that would last anywhere from 1 hour to a day or two. These are a normal part of gut surgery, anesthesia, and liberation of hormones from fat burning. You learn to deep breath, exercise and get moving, get out in the sun, watch comedies, commune with your family and friends and to talk it through. Honestly, you will eventually be able to eat all the things post surgery that you eat now. The bigger question is, why would you want to keep doing the same things post surgery that got you the lifetime invitation to the Obesity Ball in the first place? That's lunacy. Albert Einstein said, "Doing the same things and expecting a different outcome is the definition of insanity." All things in small portions is a big fat forking lie invented and perpetrated by skinny doctors and nutritionists who have NEVER been obese. Once you are overweight or obese, a totally different set of rules apply--for life.

You might consider a version of these: https://www.wholesomeyum.com/keto-banana-muffins-recipe/ They are keto, so they are low in carbs, but you could always add some blueberries and skip the banana bakery emulsion, swapping in vanilla. They keep well in the fridge. I used real dark chocolate in mine and a combo of Splenda and allulose, they still came out to only about 10 total carbs and 8 grams of protein. That would change a bit if you add blueberries though.

So i go for the seminar next week and i cant wait to get things started. Something that is so frustrating to me right now is the amount of food i eat to get full. I was so envious of other people eating and get full so quick i have never ever ever been like that. I wish i was I feel like a bottomless pit and it is beyond frustrating. even when eating clean or keto or whatever Portion Control is what destroys everything i work so hard for would go down the drain. I need this tool to help me so bad. I have medicaid and im hoping the pre stuff will go smooth for approval i work in healthcare and insurance companies can be butts! I just cant wait to start my journey.

I'm 4 months post op today from my SIPS procedure. I have lost 83lbs in total since the start in early June, and 68 lbs since surgery, however I was hoping to be further along and even at my last Dr appointment they indicated I could have lost more and were surprised I hadn't. I seem to be averaging 11 lbs a month over the last 3 months, but what keeps happening is that I lose 11lbs in one week, then NOTHING for 3 weeks!! Is this normal? At first I thought it was just a stall, but the last 3 months in a row have had exactly the same pattern. Don't get me wrong, I'm really happy to have lost the weight I have, but I was kind of hoping for it to go a bit quicker, because I have a total of 200lbs to lose and everyone tells me (including my Doctor!) that after the first 6 months it will slow right down. I took on board what they said and have been sticking to the food plan and going to the gym, because I was terrified if I didn't lose 100-150lbs in the first 6 months, I wouldn't get to my goal. But seems like my body had different plans. I also don't understand how I can have a daily calorie deficit of approx 1000 cals, but for 3 weeks out of each month, not lose anything? How is my body actually powering itself during that time? My hair is falling out in clumps and my skin isn't great, so I'm guessing thats what's happening instead, but seriously....how can I be running on negative?? My average daily food intake looks like this: Breakfast: either 1 boiled egg with a little mayo, or 1 protein shake (premier protein). Once a week I will have 1/2 a cup of rice cereal. Lunch: I batch cook chilli or soup with added protein at home to take to work. Usually have it with 1oz of pecans or macadamias (trying to follow keto) Mid-afternoon snack: cheese stick or protein shake (depending on whether I had one for breakfast or not) Dinner: Varies, but generally I go for pressure cooker chicken (between 3 and 5 oz) and green veg, or tuna salad, or 3-5oz of pork chop. 2-3 times a week I will have 3oz of sweet potato, but thats not every day and depends on how hungry I am. My average calorie intake is 99% of the time between 800 and 1150 and I hit at least 80g of protein every day. I try to keep carbs under 30g, but often average about 50g (gross) I count my water and get at least 64oz every day. I go to the gym 2-3 times a week, and on average I do 45 mins of cardio (cross trainer/eliptical and bike) and then 10-15 mins of weight training. Outside of this i try to be as active as I can, and I average round 6000-7500 steps daily (I have an office job so can be tricky) Does anyone have any advice or thoughts on what else I can do to try and speed this up? Should I do different things at the gym, or just try to go more often? Or should I mix up my food a bit more? I'd really appreciate any ideas.

There are a lot of Facebook groups out there dedicated to Keto after bariatric surgery. I've done Keto before as a regular avenue for weight loss and it does work, but like anything else it requires strict adherence. Due to it's focus on high fat, you can't "cheat" and add in a few carbs because that just makes it the standard american diet and likely the diet that put so many of us here in the first place. I haven't dug into how people do Keto after surgery, but with the need for protein to be so high it doesn't make sense to me that Keto would work. Bariatric focus is supposed to be High Protein, Low Carb and that is different than High Fat, Moderate Protein (Keto).

@southernbellair79 I heard keto is tough for bariatric patients being that protein has to be our main priority and to try our best to limit fat. I think early on we are all in ketosis just in nature with our low calorie and no carb intake. I could be wrong, don't know much on it. My wife is running a keto diet and said that too much protein can even turn into carbs if your macros aren't inline. Long story short. Parm crisps are amazing.

I'm on day 5 too, (only one more day as Friday I start my Clear Liquids for my 3-day final prep for surgery on Monday). I've been drinking the Premier Protein shakes for Breakfast, lunch, and a mid-day snack. I'm lucky in that I get to have a lean meat with a salad for dinner each night though, but that doesn't really help much during the day, haha. I've drank an extra shake on the days it's tough, as well as trying to make sure I get lots of Water in. The only downside I've experienced is that I may be getting "keto breath", though I thought that took longer than just 5 days. Nasty yucky after-taste and odor than I can 'feel' on my breath. Semi-related - Post-Op, do you keep the 'keto breath', since you're still pretty much still on an all protein diet? If so, I foresee needing to buy some mouthwash to carry around with me.

I'm 4 years out also. In complete transparency, I fell off the wagon bad about 16 months out. I went through major life changes (moved, changed job, lost a parent, went back to grad school, graduated and went back AGAIN for a PhD, hubs changed jobs, etc.). Yes, major changes. When I fell off, it was very gradual and I hardly noticed it until I had regained almost 40 lbs and got some seriously sobering health news last fall. It kicked my butt into gear and I went strict Keto and have lost all of my regain and continue to lose even more. While I never even reached goal the first time around (I think that I had so much change during my honeymoon phase that I lost focus) I know that at this point I WILL get there and I plan to have my plastics done next year after I graduate for the FINAL time!!! For me, I don't count macros too closely, I just focus on protein, water intake, moving every day, good sleep hygiene, supplements and I TRY to manage my stress so cortisol doesn't go sky high (I get serious belly gain when my cortisol goes up, and I have it clinically monitored every few months). Yes I fell away, yes I regained, but YES I have figured it out and am making it happen. Even if I'm 4 years post op, I'm proof that it's never too late for anyone!!!

If you're counting carbs, a carb is a carb. I wouldn't eat anything on your list. If you just had to have something, look on Pinterest for keto bread, keto pizza, meatza. Find low carb marinara on Amazon as well as almond flour and xantham or guar gum for thickening, etc.

I did keto as the 2week pre surgical diet but my dietician said keto is a short term diet, best for kickstarting weight loss. It shouldn’t be followed long term. (Check research on effects on diabetes & insulin levels, cholesterol, etc.). Most post surgery diets are high protein, low fat, low carbs so probably closer to Aitken’s if you’re looking for a more formal recognised diet. One of the most important learnings I’ve had is that there is no one diet/way of eating that works for everyone. If there was the dieting wouldn’t be a billion dollar industry. Speak with your dietician, do your own research, & listen to your body & needs & the work out a way of eating that works & is best for you. As to your weight loss so far, you’re doing fine. The only people who lose very large amounts pre & immediately post surgery are those who began at a very high weight. There is really no right or wrong rate of loss. There are averages which only give you an idea of what you might lose. We all lose at our own rate. How many stalls you experience,how often & how long they last are individual too. And everyone’s’ rate of loss slows as they get closer to their final weight. I decided I would only worry about how much I was losing if my surgeon was upset but he wasn’t ever. All the best.

Is it Keto-breath?

@SuziDavisI basically had the same problem before surgery. I would loose maybe 4-5 pounds a month. I was doing keto and basically working out 5-6 days a week. I know I shouldn’t worry so much about the scale but it’s hard.

Hi all, I'm just starting the journey so I've been reading and researching a lot! I attended a seminar and I have my first individual consultation later this week. My concern right now is with my husband. He's technically overweight on the charts, but has never been obese and hasn't gone through that experience--he can shop in regular stores, sits in middle seats at concerts, and actually prefers booths at restaurants. My experience is pretty opposite, as I've been big since I was 15 (25 years ago lol!), and have ballooned up to a BMI of 51, the highest ever. When I first brought up the idea of WLS, I positioned it as a tool to give me a head start on the weight loss and to give me some time to develop healthy eating habits without starting so far behind. I think he's really nervous about surgery in general because he started tearing up and said that he's really scared, so we talked about the risks of surgery vs the risks of staying this obese, and so on. I thought he was coming around to the idea since he said he supports it, and when I talk about going to the "fat people clinic," he corrects me and says that it's just a tool. It's super sweet actually! Now he's started offering new diet suggestions instead. He's seen me go through a number of diets in the last eight years, though I'll admit I've given up a little in the past couple of years, but he hasn't seen the whole history. He thinks that because I do really well with losing weight when I stick to a diet, I just need to do a better job of sticking to one, but I keep telling him that if it were that easy for me, I would have done it already! Just today, he suggested "what if you do the keto diet but this time cut out all artificial sweeteners? I really think that's why you had trouble before." I understand that he's scared, but it's making me question myself a little. Do I really need to try every different variation of all the diets out there? I've also never really tried any of the prescription weight loss drugs (outside of some bronkaid/coffee stacking experimentation that was super unhealthy in a number of ways). Is there more due diligence before I give surgery such heavy thought? The other part of this is that he thinks that the doctors are only interested in their profit and won't give me accurate information, and while I believe that they deserve to earn a living, I have some trust in the hippocratic oath. I do understand that when you have a hammer (or scalpel?), every problem becomes a nail (or surgery lol). Anyway, I know this isn't a relationship advice site but I thought others may have encountered a similar situation! I'm venting a little but would appreciate your thoughts!

Mine is not related to ketosis, as i had done keto many times before and never had this funny smell lol im going with hormones being out of whack.

Thanks for the honesty ! Theresa lot to be said for tracking then food, the calories and the type of food you eat! I can stay below 1000 calories a day, but if those calories have any sugar or bread in them, I stall out for a week or two. I'm about 2 months out of the surgery. Sometimes I think, maybe it isn't working on me like everyone else. I'm certainly not in the "I can eat whatever I want and still lose weight." I know I do best on keto diets, but that's so hard to stick to! If I think I will still lose by eating only 1/2 of a sandwich and still sticking to under1000 calories a day, it doesn't work that way for me. The bread stops the weight lost. Not being able to eat salads right now (my surgeon says no raw vegs for 6 months) its really challenging eating out and staying away from any carbs. I admire people who can do it. I've noticed, the further away from the surgery, the more my hunger comes back. I'm only 2months out! Is anyone else dealing with this? At the same time, if I'm not hungry, at least a little bit, I'm not losing weight!

I was exactly in your shoes two and a half years ago. I researched both surgeries and I had decided on the bypass because I read that bypass patients tend to lose more of their excess weight. But the bypass turned out to be medically contraindicated for me and I had to have the sleeve. Like you, I was never one to eat large volumes of food, so I wasn't sure the sleeve would be effective. But it was. I was one of the lucky ones who completely lost my appetite for the first year so it was possible for me to eat 600-800 calories a day for months. As my appetite slowly returned in year 2, my calories increased to 800-900. My weight loss slowed down but it continued and almost two years from my surgery date, I hit my goal of 130 pounds for a normal BMI. I continued losing and at this point my weight stays between 120 and 125. When I see it creep up to 127, I find myself immediately cutting back until I get it back down to under 122. It wasn't just the restriction of the sleeve that helped me lose. The surgery changed my relationship with food (I'm guessing due to the hormonal changes from having most of your stomach removed). Even today, my appetite is about 65% of what it was presurgery and I don't have unmanageable cravings. I still like sweets but I eat mostly sugar-free things like popsicles and pudding, yogurt, etc. Once in a while I'll have a treat of some kind, like cake or pie or Bailey's Irish Cream, but it's rare and it's always one treat and then back on plan. I feel like I still have the capacity to be a sugar/carb addict, so I'm careful with those foods. I also keep my carbs relatively low (although not keto-low) because that helps me maintain. So, statistically, bypassers do lose more on average. But your individual results can vary a lot.

I'm not the guy to ask lol. I have never watch the amount of fat I eat. I figured if my Protein, carbs, Fiber and daily calories where met, combined with how little I was eating, that the amount of fat would be at an acceptable level. I have been on somewhat of a keto diet for the last couple months. I figured with so much carb restriction its ok to up the fats a little. I would estimate my fat intake to be below 30g per day which is still more than half whats recommended on a regular diet for a guy. I can't stand the taste of fat free or low fat items. I choose top sirloin and chicken breast, both pretty lean, as my main protein choice along with whey isolate. I eat at least 1 big bowl of salad a day and add 2 table spoons of dressing. A decent amount of my daily fat intake comes from the salad dressings I use. They are not low carb or fat free but they do have relatively low calories compared to most. A whopping 8g of fat though per tablespoon. I use anywhere from 2-4 daily depending on how much salad I eat. I use a powdered creamer for my coffee. It has only 1g of fat per heaping tablespoon. I also have a small collection of torani syrups I use to change the flavor in my coffee up a little... also add it to greek yogurt. If your staying below your daily macro requirements I dont see any harm in adding a fresh full fat creamer, although I assume that's a lot of added calories for just a little fresh cream that can easily be substituted with some powdered creamer. If you can stand the taste of the low fat products by all means... I stay away because I hate the aftertaste and can still maintain my macros while eating full fat foods. A paleo diet sounds awesome, although I dont like the no grains or dairy most paleo diets restrict. I think the less processed the better. I eat regular meat but my chicken breast and all veggies are organic.

I understand that weight gain and loss (beyond the usual 10-15 pound swings most people experience) is based on insulin resistance rather than total calorie consumption. However, even with diets that are not based entirely on cutting calories--like Keto and Atkins--still place limits on total consumption and advocate weight food so you can track your macros. Ultimately, the idea is that the fat and protein that makes up 90% of your consumption on these diets will be more satiating, so you end up eating less because you have less cravings and hunger. Regardless of how the goal is achieved, one of the goals is a reduction or moderation in total caloric intake for someone that has weight they need to lose. Keto, in particular, focuses on insulin control, but by adding in intermittent fasting (which most strict keto people incorporate at some point), you're definitely cutting calories by limiting the window for eating. You're not strictly counting calories like you would on a diet like weight watchers (probably one of the worst diets out there IMO), but the calories are cut anyway (it's just a less painful process in my experience). Anyway, I am happy with following a keto style diet (constipation notwithstanding). It's something I can do long term, but I can't follow a therapeutic style keto with a 4:1 fat to protein ration or anything close that as a new sleever (6 weeks post-op). Based on my workout regimen, I need to get around 125-150g or protein in a day (even with the protein/muscle sparing qualities of Keto) and there's a limit to how much else I can eat (even with calorie dense fats like avocado). I also don't want to deviate too far from my doctor's prescribed diet at this point, so I doing a 1:1 fat to protein diet (sticking to clean, high quality fats and proteins) and I cut carbs to less than 20g net carbs. I pretty happy with this and it sets enough ground rules that I can easily decide what I can eat and how much of it---even when I am out a restaurant.

Real, serious for realsies keto you can't have yogurt (or pretty much any dairy except heavy cream and cheese). BUT, it's *really* only about the carbs at the end of the day. So if you can eat the yogurt and still be within the carb restriction, you should still see results. Just make sure the yogurt isn't too sugary because that will kick you out of ketosis.

Ketosis by definition is pretty much HIGH fat, MOD protein and VERY LOW carbs. It goes against much what we are told as bariatric patients. That said... YES I LOVE KETO!!! I have been strict keto for over a year and maintain these daily macros: 85% fat, 5% carb and protein takes care of itself. Keto can be a little tricky if you 'dump' from fat- it takes a little while for your system to adjust- but once you're there, it's great. I had a 40 lb regain from my lowest and used Keto to lose the regain successfully in about 6 months time. I am 4.5 years post VSG and did the whole 'bariatric' type low carb, low fat thing for the first year. I have found that for the regain, Keto worked really awesome and my body LOVES being in ketosis. I have boundless energy, seriously clear brain function, etc. There are SO MANY metabolic benefits that can be researched in the NIH database. You will get mixed reviews, but for someone who is longterm post op, it is a great option. I'm all about following your surgeon's guidelines during loss phase, but after a couple years most of us are 'done' with our surgeons. Keto is such an awesome tool to use along with bariatric surgery. Feel free to PM if you have questions!

I’ve been doing keto for three months and lost 25 pounds scheduled for the sleeve in February not sure if I’m gonna go through with it if I can just stay keto it seems to work well also I have a lap band for 11 years and had it removed October 1 so I have lost this weight right after removal of the lap band

I feel pretty lucky because I found a keto diet very easy to stick to. So, even long-term, I feel like I will be successful. I find my current bland puree easy to stick to, even. I just need to make sure I continue to keep my cravings themselves in check, which has been great thus far. But, as far as getting hungrier, I am down for eating meat meat meat! Lean meat, that is.

All I know is that when I did keto I was so thirsty all the time I just couldn’t drink enough water. I wouldn’t do it again just because of the extreme thirst. That, and I don’t ever want to have to restrict the amount of vegetables that I eat.

If I could go back and edit my comment to clarify, I would. I was explaining what I currently follow (pre-op) and how I handle calories. I did mention at the end that I don't know how pre-op keto translates to post-op since most people follow low-fat post-op. But I understand...I'll be more careful.