On March 1, it will be eleven months since my surgery. I've lost 92 pounds and I'm happy about it, but I'm forty pounds off of my goal weight of 155.

I have not, since my surgery, ever succumbed to a real diet. I did not count carbs or calories except for getting a general number of calories I was staying under, just to make sure i wasn't really going crazy. The reasons for this are pretty complex -- mostly as a lifelong, seriously obsessive compulsive dieter I decided I really could not manage another diet emotionally. I know this sounds odd to some of you, who've been enthusiastically tracking your calories and carbs and weight loss and staying meticulously under a thousand calories per day, but for me that was just not possible and I will tell you why:

1. I have been able to stay under 900 calories a day for months and lose all kinds of fat only to gain it back. I was on a major roller coaster ride with my weight for most of my adult life and I saw this as an opportunity to lose weight *slowly* and non-obsessively without freaking out because I knew that the smaller calorie deficit over time would make the scale go down, not up, over time. That was a big luxury for me because before if I was not *dieting* I was gaining weight. Up and down. Up and down. The frustration and misery in all that is just indescribeable and it's also really bad for your metabolism. Mine was shredded.

2. Whatever I lost, I planned to never gain back. That meant learning to eat like a normal person. I don't think living on dollops of cottage cheese and Protein shakes comprise eating like a normal person. Eating like a normal person means eating everything and whatever you want in moderation, allowing your body and appetite to dictate your food intake and letting that entire feedback loop settle into a stable pattern over time. That's how you get to a stable weight comfortably. I knew that, or learned it, over the past twenty years of undereating severely, getting down to some satisfactory weight for fifteen seconds and then watching myself pack those pounds back on over time because the feedback loop never reached a stable place.

I'm convinced this pattern is bad for everything. It's bad for your hormones, your sleep, your energy, your nutrition but most *especially* your mental health. I'm convinced that severely overweight people start off with a tiny problem that turns into a massively vicious circle as the rounds of dieting lead to bad health and low mood; lack of exercise leads to even worse lack of exercise due to partially physical and partially emotional factors; exhaustion and low self-esteem lead to addictive eating ( and drinking ) patterns and it's eventually almost unbeatable.

3. I don't want to live by the scale. I know I am overweight and do not want to be, but I have a tendency to overwatch, when I am watching. Dieting and weight loss for compulsive people adds up to a lifetime of terror of gaining weight back because of this cookie or that glass of wine. We become these horrendously abusive scientists who will start to experiment with all kinds of odd protocols and weigh and measure ourselves fanatically, hiding in the practice of weight loss instead of taking an overall view of what we're really doing. I knew I would do that if I started a diet; I knew I would probably get to goal in some amazing amount of time and be sitting here, right now possibly, worrying about whether that last cracker I ate was going to burst the golden bubble of my life at 155.

4. I don't care what the bariatricians say, I believe that if you go too low in your calories you set yourself up for a lifelong struggle. I've done this so many times and I don't believe it's possible to live on 900 calories a day, especially not for years; and if it was what you would get would be a body that learned that its stable metabolism was meant to stay at 900 calories a day, meaning basically you could never eat a single calorie more without rebounding. I've watched myself do it so many times. So I never, except for the first month maybe, was under a thousand calories the entire time since my surgery and most of the time I've been between 1300-1500 *or more*. As I've been paying attention, I know my metabolism might be a little slow BUT it seems to track pretty well with any online calorie calculator. 1700 calories a day is *still* a deficit. It's a slow one, but it's still there.

But eating a thousand calories, walking an hour a day and weight training five times a week just to stay at a certain pants size? I could not, could not, ever live that way again.

However.

I still do have 40 pounds to go. I could go low carb and get under a thousand for a month or two and be done. The problem is adjusting to the monstrous deficit, managing my life in the meantime, and then the scary obsession afterwards as I watch the ten pound to twenty pound spike when I go back to eating my normal 15-1700 calories per day. I'm tempted and I'm tired of waiting. When I got the surgery last April I was 46 years old -- when it's all finished at the rate I'm going I'll be almost 48.

I'm under 200, have 40 pounds to go and I'm tempted. For some reason I feel like I have to decide what to do now. I wake up every morning, look at my much thinner self and think...should I start a diet ? I could be a size six by summertime....

Yo, crosswind -- what's ya goddamn hurry?? You're doing great and are on the right track for you (and for me, honestly -- we are following a very same approach and I've also lost 90 lb in a year, and I also eat 1500+ cals per day), so why suddenly get antsy and dip your toe back in the waters of diet OBSESSION? Not. worth. it. Stick with what you're doing, be patient FFS, and you'll get there!! :-) Don't go mental on yourself, don't mess with the success you are having and will continue to have just for the sake of being impatient. Bad trade-off IMO.

Yo, crosswind -- what's ya goddamn hurry?? You're doing great and are on the right track for you (and for me, honestly -- we are following a very same approach and I've also lost 90 lb in a year, and I also eat 1500+ cals per day), so why suddenly get antsy and dip your toe back in the waters of diet OBSESSION?

I don't know. I look a lot better. People comment on it occasionally. But I'm in a weird place with my clothes. This pair of jeans I bought a long time ago as my "under 200" jeans in a size 12 button and zip but it's still a serious muffin top proposition. I have a ton of stuff in my closet I can't wear yet. I'm thinking about summer, three months away. In roughly a month it will be a year since my surgery.

When I started this I wasn't really even that fixated on "getting to goal". it was just too far away. I mostly just wanted to relax about my weight instead of being miserable either "eating what I wanted" OR going on some diet where I watched the scale for changes every six hours. I knew when I started there was a *lot* of metabolic benefit in losing slowly over time but that there was no *way* I could go the "slow" route without surgical assistance. I only have two modes: strict dieting and being a crazed foodaholic. Something like Weight Watchers used to drive me crazy with the point counting and the box-checking but I saw the major benefit in being able to eat an extremely varied diet. The major benefit being: no crash. Ever, or ever again.

But boy oh boy do I want to be a size eight. In this lifetime.

Ok I am going to agree with you on some points. Healthy carbs are good for you but still has to be in tight control. But to get your body to Burn the fat is by going into a ketosis state.

Theoretically your right. But in the real world therorys are theorys. I can just attest to what I noticed on my diet pre op. once I started controlling the carbs the weight started dropping even eating up to 2000cal/day.

Everyones different but as fat people we have a genetic advantage of our abilities to convert carbs over to stored energy. I dont have any background in nutrician but I know I used to eat the same thing as my father everyday. He stays at 150lbs and I stayed at 325lbs. We worked together, ate together, lived together. We both did house framing which burned tons of calories daily. Theres no explaination other than carb conversion.

For the Majority of people here. The High protein/low carb is the bible. In Professional Bodybuilding carbs are only used for insulin spiking pre/post workouts because insulin has one of the greatest growth factors. Nutrient timing is key.

On another note. What if someone ate 1000 calories a day of straight carbs. Would they lose weight? Sure would. And they would also be causing skeletal muscle damage, eventually death from cardiac arrest. On the flipside if you eat no carbs you will never die. It will however have an effect on the brain. Thats why you need a small amount of healthy carbs. The healthy carbs feed the brain promoting memory, sleep, and so on but in excess goes straight back to storage. You have to find a happy median.

My name should be Capt realworld logic. Its just since I was 14 I have been trying to find away to lose weight. I have had so many people try and tell me how, even doctors. They even gave me meal plans. The problem was it was 45%protein/45% carbs/10% fats and the caloric range was 1600-2200 per day. You know what happened? I still gained slowly. But keep in mind slowly. As soon as I got carbs under 60grams per day i started melting. The only reason why I did my surgery is to prevent bounce back. Now once you get to where u WANT to be thats when u find your happy median to keep your body stabilized.

I know that I speak in circles but I have a form of autism. I just hope you understand where I am coming from and have an understanding that textbook entries can be wrong and rewritten.

Yep, Derek, strict lowcarbing is a fantastic dietary intervention and there are some real advantages to it if you're severely overweight. Mostly: if you are severely overweight and somebody put you on a thousand calories a day of pure carbohydrate you would not lose weight because you wouldn't be able to stand it for longer than a half an hour. Initially lowcarb shuts down a totally out of control insulin feedback loop so it can return to baseline -- and if you're severely overweight that -- or surgery -- or both -- are basically the only options we've got right now.

However, you should be looking towards the future. You're going to keep melting but you're also going to have to slowly reintroduce carbohydrate as an energy source and I am not kidding when I say slowly.

No one really knows the reason that people become severely overweight. When hear someone say that "carb sensitivity" is genetic this is not true. There is no such thing in infants and at some point somethingorother gets turned on that changes the gut and rewires our hormonal feedback system. It could be any number of things and one thing researchers are finding out is that this kind of tendency is especially likely to develop in adolescence when hormonal changes in both genders can trip the switches for rapid gain. They're also finding out that there are three basic "types" of complex genetic traits that make up metabolism -- these are called "enterotypes" -- our genetic chemistry interacting with the environment.

Anyway you don't talk in circles at all. But keep in mind later that the carbs have to come back. *That's* the really tricky part.

again, shouldn't be a diet. should be a lifestyle.

I didn't see the MD after your name, pardon me for missing what isn't there.

Crosswind-

I have no good advice to offer you. It sounds like you know the right answer but just need to voice your frustrations with the time needed to get to goal doing things the way you know are best for your long term results.

I do want to thank you for the amount of knowledge I have gained reading your various posts concerning the drawbacks of going low carb. I will hit my one year anniversary next week and I'm a little bummed that I'm still 30 lbs. from goal and have been stuck here since November. Like you, I've contemplated giving up my balanced 1500 calorie diet in pursuit of fast results.

I'm not sure what your decision will be but you've helped me decide to maintain the course. I may try a five-day low carb run to flush out the bad carb cravings since I've been snacking unwisely but would then go back to eating a balanced diet. With your background, I'd be interested in your thoughts on the benefits/drawbacks of this.

Good luck to you in your decision.

Amanda

. Hi Amanda.

Let me tell you what I was thinking about doing. Actually two things:

I was going to give this until April 1 and then do one of two things, but I think I picked the one I'm going to do. One is the dreaded "sleeve reboot" for five days which starts out on clear Proteins and and then graduates you up the levels at a much faster pace. I can see the reasoning behind this because first of all, it's a fast drop and second of all, it *should* tighten up restriction just a little but and also shake up your metabolism just like any fast would.

Second -- and I think I'm going to do this -- Medifast for one month. When I was a month out I asked Dr. Aceves about this and at their office they said they highly recommended it because of all the "mushies" available. This brings cals down to under a thousand for a short period of time -- about the same time I was under a thousand when I was recovering from surgery. It's expensive but there is *no* hunger and one month will take off twenty pounds pretty fast.

It's also *not* lowcarb. There are fifteen carbs per serving in each of their meals -- times five meals plus your "lean and green" meal thing -- basically chicken and veggies -- you're still at about 100 carbs and Protein intake is spared.

I've been on Medifast before. One thing I noted about it is that the weight I lost stayed off for a reasonable period of time. I believe it's because that's because carbs aren't too low, or low enough to cause hyperinsulinemia when you go off of it. Also, if you're at 1500 and you go down to say 1000 or under for four weeks -- when you go back to your baseline calories you're still going to be in a deficit so there would be less of a "bounce", theoretically.

I'd say do this maybe even for two weeks. Then off for two weeks, then, back on. Then you're alternating between low and high but still staying at a deficit. Ancient bodybuilder secret.

That's what I'm thinking I'm going to do, anyway

Ok I am going to agree with you on some points. Healthy carbs are good for you but still has to be in tight control. But to get your body to Burn the fat is by going into a ketosis state.

If by ketosis state you mean going with one of the ultra low carb Atkins/ketogenic type diets, that clearly isn't the case; if you're talking about the biochemistry of fat metabolism that will have you excreting some ketones, then that's a function of chemistry and doesn't require an overly low carb intake - just enough caloric deficit to draw on your fat reserves. I have clearly burned a lot of fat without ever going near that magical 30-40g or below level - I was typically in the 80-120g range thru my loss phase but was not going to get into the nutritional deficiencies that go along with those atkins type diets - but if you look at my labs then, yeah, some ketones were detectable in there.

I swear, it's amazing that we get ostracized from the usual weight loss boards because we have surgery, but then people bring that same narrow-minded, "There's only one way to do this" mentality over here to these boards, too.

Carbs are not evil. They do not instantly make you a fat person or an unhealthy one.

Oh yeah, acting like a carb Nazi is going to get you to goal, just like Atkins can get you to goal without surgery.

And then you get to live at goal and try to learn how to eat a normal, healthy diet in maintenance after restricting yourself to forty grams of carbs or less a day. Because the reality is it doesn't matter if you call it a "lifestyle change" while your aim is to lose 10 pounds a month - you can't live your entire life that way if you want to settle into maintenance and a steady weight for the rest of you life. Even some of the very strictest at controlling their carbs on these boards have had to learn this the hard way as they continue to lose beyond their goal weight - they end up having to eat a more normal diet to maintain. Since they waited until maintenance to start this they usually face challenges while they figure it out.

So if anyone here tries to tell me that I have to live on Atkins-level carb intake for the rest of my life or I'll be unhealthy or not lose, I'm going to call them on it, because that simply isn't the case.

On to the topic at hand, I do not believe Crosswind needs a strict diet to lose the rest of the weight. You're not even a year out, and you're in your final stretch. You are going to lose this weight if you continue on your current path, even if you don't lose as quickly as you'd like.

Medifast is wretched, in my opinion. I did a long stint on it myself prior to surgery. I question why you'd want to subject yourself to that when you have a perfectly healthy outlook on food and diet already. Why the rush? I think that simply scaling back your dietary intake (say, by dropping calories/carbs by 20% or so daily) will shock your body into losing again.

At 11 months out I was down about 90 pounds or so. I was very frustrated and thought I'd never get to goal. All of the little tricks I tried didn't make me lose any faster. The only thing I really needed was more time. The last forty pounds were very hard to lose and the last twenty took me six whole months.

If your impetus to try to shake things up so drastically is a fear of not reaching your goal within a year, I'd like to point out that a large number of people (most of us!) don't reach goal within one year. There isn't a honeymoon phase or a time limit. You sleeve is likely as big as it's getting, and if you think about it you'll realize that while having a capacity of 4 ounces over the 1 ounce you had a year ago is a lot more, it's still plenty small enough to lose weight using restriction alone.

At the very least, I think that if you insist on going with Medifast that doing it for short bursts is better than doing it full time to get to goal. But I still think that with regular old persistence and patience you can get there on your own.

~Cheri

Never said that you had to stay on the low carb atkins type diet. Please read the op first comment. They already have the sleeve and wants to go down more but they have plateued. Maintaining and shocking the system by the low carb diet is a majorly different ordeal. Ask me if I am going to stay low carb for the rest of my life and I would tell you you lost your mind. But I know this, it will never be high like it was before.

Read it ,somethings got to give. A resleeve isnt going to fix her problem. Its a nutritional change that has to happen to accomplish what she wants.

Lmfao how people jump when no one said to jump. You have to take in the full data before u just make an assumption thank you very much.

At 11 months out I was down about 90 pounds or so.

Oh yay, that's three of us now! I feel so normal and not-alone, knowing that others are right about at 90lb about a year out. Seriously. I have been a relative piggy by WLS patient standards, eating 1000+ since one month post-op and 1500+ for most of the past year, so everytime someone talks about their 800 cals at 8 months out, I'm like oh ****, I've screwed the pooch for sure. But I think we all lose in our own way and time, and mine was with the full support and guidance of nutritionists, doctors and my therapist.

I've said slow and steady all along, that's what I wanted, that's what I've gotten -- by WLS patient standards. By any normal dieter's standards, I've melted away over one year alone. Yeah, I still wouldn't mind to lose another 10lb, but I can see that it won't be easy or fast at all. Like my work colleague who has five kg to lose and she's really hoping to lose it by summer holidays in July. Nearly six months for those five kg. Made me remember the pre-WLS perspective anyhow.

This is not a passive-aggressive sideways message to you, crosswind LOL -- I'm just thinking out loud. I can totally understand the idea of wanting to GET THERE and get it over with. And THEN think about how to maintain, which you probably will not have a problem with I don't think.

I'd like to lose 10 more lb, which isn't going to go very fast based on how things have been the past few months. I really CAN'T do anything drastic in the WL arena because of my own history of obsessive behaviour...I consider myself a longterm recovering anorexic, not a grownup who fully has that stuff beat and behind me. So no, I step away from the brink when I am anywhere near it coz I don't think I will ever have full control once I get into that zone.

Right. All that said, Happy Medifasting, crosswind!! I do hope you'll keep posting and telling us how you're doing, I love hearing from you and hearing the thoughts of someone else who seems similar to me in some ways.

Oh, FWIW on the carb topic -- I've never counted carbs at all, except to keep them in balance with my overall eating -- which is what my nutritionist anyhow asks for. I used to get 'in trouble' all the time early out coz I wasn't eating enough carbs, so by now I'm doing much better at it. But I'm sure people would go nuts at my numbers, I don't think I've ever been below 40 for a single day. :-o

So now I'm going to google Medifast, as I have no idea what it is.

This is a pretty interesting discussion - maybe more so for me because I am just a few weeks from my one year as well.

There is one thing in this thread that I don't see folks talking about much and that's the mental aspects of all of this.

I was 250lbs and over 30 years old before anyone even mentioned PCOS to me. After being diagnosed I did the same thing any other obsessive person would do and educated myself about PCOS (or metabolic syndrome or syndrome X) to the point of absurdity. Every book, web posting, story about PCOS made me more and more angry.

I am a poster child for PCOS. Textbook symptoms and have been since puberty. But I was fat so surely the entirely of my life and my problem was the cupcakes I must have been forcing down my gaping maw.

Am I angry? You F'in bet I am. Was I underserved by our medical community? Horribly.

And the reality to this is that there is mental baggage as a result.

All of us here are on the road to gaining some understanding the delicate balance that represents our metabolism, our cravings, our hunger and our weight. Will we ever fully understand it? I hope so but what a daunting task when everyone's body chemistry is different.

What I hear in Crosswind's post (on top of a clear understanding of how her body works) is anger and pain. Why aren't we normal? Why can't we just eat without the cravings, and fat and obsessing etc.

It sounds like you have figured out where you want to go with regards to an action plan. I don't know anything about medifast so can't speak to it. I do however want to suggest that you find an outlet for the emotional weight you are carrying. Our body's work against us. I don't know why and the explanations seem interesting right up to the point where you realize that the explanation doesn't really help you lose those extra pounds.

I think its ok to be angry and sad and upset and worried and all those emotions we go through as a result of our weight and weight loss. I really hope its ok because I have a boat load of my own. And I really do believe that this is as important to treat or address as any other comorbidity related to obesity.

Do you really want to be a size 8 or are you really trying to get to the quality of life you think you'll have when you hit that milestone? If its the latter then its time to work with someone to figure out what you think that magic number will bring to your life.

First of all:

No argument whatsoever from me. Medifast is wretched. But it's not any worse in my opinion than under a thousand calories of cottage cheese, pot roast and Protein shakes plus Vitamins. The difference is I don't have to cook, shop, or really think about it. The drawback is more that I don't know if I can manage it at work. There all kinds of powdery substances you have to mix with Water and I'd have to pack a small laboratory I think just to get that whole thing going.

As to the emotional part -- actually that's what I've been writing about all along. I spent a year on the lowcarb boards about seven years ago having a lot of these celebratory discussions about jeans that fit and " finally getting control" and how great it felt to be thin. No doubt: it does feel great to be thin. But where I started was as an emotional dieter and recovering anorexic who spent at least one part of every hour of my life thinking about the appearance of my body.

What I believe about the emotional portion of being severely overweight -- especially if it's hormonally related -- is that there is a physical component to the obsession. In particular I remember this cycle: I would be ten pounds overweight. I would look in the mirror and see a bit of extra padding around my chin; I would see my arms were thicker, I would see this huge creature that looked like an ogre and I would begin to withdraw from the social world. I would stay home, stay in my room, and then later stay on the internet. Ten pounds would go to twenty and I would be exhausted and have insomnia at the same time. I would start to eat more because I was both comforting myself and thinking I better eat whatever I wanted now that I was about to embark on a "big diet." Then I would spend three months starving myself and waiting until I was down at least twenty pounds before I would allow myself to be seen or go outside.

Know when that started?

I was fifteen years old.

Now....what I think at this point is there was also something hormonal happening there. I can remember having no energy whatsoever, turning inward, becoming detached from the rest of the world. My periods were always heavy, nightmarish affairs. And the other day -- *just* the other day at 48 I had a bout of that same feeling and realized maybe for the first time in my life that it was connected to ovulation.

But there are other possibilities for other people. Women have cranky reproductive systems but there is more to them than estrogen and progesterone. Hormonally; there's more than the thyroid; there's the pituitary, the adrenals....and *every single one of these glandular functions* effects mood and appetite.

So what happens to you after twenty years of managing this?

You're utterly messed up physically and in the head.

However, in my nonmedical opinion I'm going with the old school on the diet and exercise thing. I think if you have an imbalance the answer is not to respond with more imbalance, but stability. I know that doesn't jibe with the new school, which recommends drastic reduction in carbohydrate or calories. The problem is that most of us with severe weight problems can't *manage* to stay at a minor deficit over a long period of time. Because we're compromised. Let me put it this way - -before this surgery there would have been no way I could have stayed at 1500 calories for one year because it was too easy for me to go nuts and eat 4000. Now I can't do that. it's close to impossible to overeat with a vsg. That's all, that's really the benefit to me.

Before I got the surgery I spent a couple years trying to do it the old way. Severe carb restriction. You start over on induction.

Then I gave up and decided at age 44 or so that I would just be fat. I decided to just eat what I wanted and give up and get old and be a fat middle aged person who made cakes and stuff. But after a year or two of that, I changed my mind again. I wanted to ride a horse and get on an airplane. I wanted to look good.

But i didn't want to get on the rollercoaster again and I didn't want to start thinking that my life would start when I got under 200 pounds. I had a lot of changes to face that I could not face and be meticulously obsessing over my calories and water intake and exercise every single day. But -- I also didn't want to be fat.

So this was my strategy, my decision, my investment.

I'm not angry, really, and the pain I felt over this was probably more when I was in high school or somesuch. The pain I really feel is the regret that I spent my life on this. Dieting and weight and body obsession have basically been my career. The real reason I got a vsg was because I was 46 years old and I wanted a different job.

I love reading intelligent dialouges and discussions. I don't have any input to this thread as I'm still learning and I have not been sleeved, but it has been a real eye opener. I'm struggling at this moment with my pre-op diet and have had some of the same questions floating in my head that you have addressed. Thank you for sharing Crosswind.

I'm sure you've heard the old adage, " The definition of insanity is doing the same thing over and over again and expecting different results."

I really really hesitate to give advice because here on the boards we really get such a small view into each others lives and few of us are experts at much beyond ourselves.

But it seems like you have acknowledge that the real issue (real being a horrid word... perhaps underlying would be better).... the real issue is something mental or at least a chemical issue that effects you mentally (and then indirectly, physically.)

My suggestion is to put a hold on any 'physical' solutions. You've already applied the best possible physical solution to the physical part of the issue - you got surgery and its working! You've dropped 90 lbs. That is amazing.

Medifast will be there for a while. I think you feel rushed because of this one year anniversary date looming. Its just a date. It doesn't mean anything. The generalization that once you hit one year your weight loss stabilizes is just a generalization. Its not a hard line.

You want something else to consume your life? Something positive? Something to be passionate about that doesn't involve obsessing about the mirror or scale? Medifast won't give that to you. Size 8 or twenty more pounds gone or what ever the magical number is doesn't give you peace or self worth or harmony with your body, mind and hormones.

And at 48, if you could have solved this problem on your own... you would have by now. I'm not trying to be harsh. Its obvious based on the history you've shared, the posts you've made and what we all know of this struggle that you are a strong, intelligent, capable person.

Now its time to ask for some help. Not the form of a diet but in the form of getting some of these mental issues addressed.

Like me, I truly feel you have been undeserved by the medical community, who for must of your life have likely not acknowledged the complexity of obesity. I don't mean to project here and I certainly don't mean to paint you as any kind of victim but be your own advocate now. Seek out the professionals that can help you. I'm talking Endo docs, and nutritionists and mental health folks that understand the bigger picture here where your hormones and weight and issues have banded together against you.

I think you are highlighting a serious issue here that a number of folks struggle with. And sadly, even here it doesn't get much spotlight.