This question is more targeted towards you long term vets - 2+ years out. Sorry in advance for its length.

I have read from a few vet posts ( ok, more then a few) that eating is much harder to control post 2+ years then, say, post 1 year. Why is that? Is it a relaxation of new post op lifestyle issue or something else deeper then that? I am looking more for an anatomical response rather then an emotional one because we all know about stress eating. Let us assume stress eating due to life circumstances or head issues are off the table for this discussion.

My hunger woke up around post op month 5 and it required me to figure out a way to eat in balance with fitness. Lots of trial and error, research, reading, etc. you can probably identify when this happened by looking back through my post history. Not saying you should or need to do this. Just take my word for it.

Today at post op 1 year I can honestly say my nutritional plan is working for me. And I am not struggling with eating or hunger at all. Sometimes i slime because i eat to fast, but that is my own fault.

Essentially, I eat a very high Protein diet with some fruits and veggies. I have at most 1/2 apple or 1/2 banana a day with nut butter that also includes 3-4 ounces of some protein. Usually this is for my morning 9ish am meal. I eat 1-2 ounces of some veggie for lunch meal and for dinner meal along with 4-5 ounces of some protein. the rest of the meals are Protein shakes of various kinds. Most of my nutritional needs come from daily Vitamins, protein shakes and other supplementation and not from real veggies and fruits. I have a green drink that i take every other day. it is very nutritionally sound, but is loaded with too many vitamins to take daily with my Multivitamin. No reason in particular to do it his way; it just works out well for me. I do mind taking supplementation every day; it is just part of the day and is second nature. I really like the way I am eating and have energy to complete my activities for the day.

I chose not to eat snack or junk foods after surgery. It was a little hard at first, but now it seems fairly normal to not eat or think about them. There is no desire to go have cake, donuts, Cookies, chips, etc. that is from another time in my life, in which the door has closed. A nice quality about abstaining and retraining the brain to be rewarded with healthy food, is nothing becomes a temptation any more (well, except low carb protein bars). No problems arise from sharing a conversation or dinner table with others who eat the way they want to eat. No desire to go hunt out carbs in the house. It is freedom and peace of mind to not be controlled by food. For this reason, I deeply thank VSG for giving me the time as a post op to turn my lifestyle around 180 degrees. There is no better way to describe it.

Calories tend to be around 1700-1900 as I eat 7 small meals a day and each meal is about 200-300 calories. I eat about 170 G protein a day, sometimes more. Never hungry and weight is very stable (leaning out though) at my goal weight of 180. I have been maintaining this weight for 5 months now if you look at the starting and ending dates of the time period. In reality, i have gone up about 15 lb and then back down, swapping fat for lean muscle, as I experimented with different approaches since hitting goal.

In so many words, I am asking if the way i am currently eating not going to require a change or adaptation in 1, 2, 5 years from now? Or am I somehow still in a honeymoon period where eating requirements will drastically change once I am out of it?

Appreciate your thoughts. You are all good role models.

I only gained weight in my time after achieving goal because I chose to get pregnant. Now, it took me 17 months to achieve goal. But the way I ate roughly 18 months out is the way I eat right now.

Had I not chosen to have a child I have no doubt that I would still be happily within my maintenance window, adhering to something much like 6:1 or 5:2, though I admit I was less careful tracking calories in actual maintenance. I used my clothes and scale as the real indicators of how I was doing, and only tracked a few days each month to be sure I was on track.

I think that if you do that work to find a way to eat and live prior to goal there's no need to shift anything in maintenance, except perhaps adding in a few more calories each day so you don't continue to lose.

My opinion, controversial though it may be, is that the real problems occur more for people that "diet" their way to goal. Meaning they restrict everything to ridiculously low levels and work out like maniacs during loss but their lifestyle isn't practical for the long haul. And so they have real problems transitioning to maintenance and a more moderate lifestyle.

It's sort of that all-or-nothing approach, and once they hit goal a number of people have issues because they feel like it's over, they're done and now that they completed their diet they can do what they want.

Not so.

Just my opinion, of course. I'm plugging along at three years out (in just eight more days!) and only have six pounds to lose before I'm back where I was prior to having a baby. Maintenance is about a thousand times easier if you do the head work beforehand. And truly, the only issues with food/hunger that I have at this point are purely emotional and not physiological at all.

~Cheri

So far, so good for me in maintenance. I hope Oregon Daisy chimes in. I believe she is one who did well till after three years out. I do think a relaxation in attitude contributes to long term weight regain.

For me, I'm hyper-vigilant. I weigh daily and changed my bounce range to 2 lbs. I still track my food. I do eat junk, but I limit it. We'll see how this pans out in year 3.

Lynda

I will be 2 years post op October 4. So I am totally interested in this post. A bariatric surgeon did tell me that the sleeve will not stretch if a bougie under 40 was used in which I had a 34 bougie. So I would like to see the results. I do know that we or I have to be hyper-vigilant and eat a healthy diet and that we can gain weight if grazing all day and eating crap.

Thank you all for your thoutful responses. I think this question really does start to shine the light in uncharted territory so I hope everyone can continue to offer their anecdotal experiences or research when it becomes available. This information will help future sleeve maintainers.

I would still say I have pretty great restriction. I can eat more now at over 2.5 years post op than I could at even a year, but I still cannot eat a lot. It all really depends on food choices that dictates how much I can eat, which I know we can all relate too. I also have about the same level of hunger as earlier out. I get hungry if I haven't eaten for a long period of time, but it is not the same gnawing hunger with a rumbling stomach that I got before surgery.

I agree with Cheri about the all or nothing approach and talked about it a little on another thread. Instead as looking at the sleeve as an opportunity to make lasting lifestyle changes, people, for lack of a better word, crash diet. Sure, it might get you to goal quickly, but it is not sustainable over the long haul, just like it was not sustainable before the sleeve. I never took that stance. I decided to make changes that I could live with for a lifetime (limiting processed carbs...white stuff, Protein first, no drinking with meals, etc). I believe in the 90/10 or 80/20 approach. Eating healthy most of the time, but allow yourself some wiggle room. Personally, I knew I could never go the rest of my life never having ice cream with my kids or having a piece of cake at a birthday. But I don't keep those types of food in my house because I do not need to be eating them everyday. And with this approach I was maintaining for almost a year before I started a new medication that caused me to gain 7 lbs in 3 weeks without any dietary changes. I stopped taking the medication and I stopped gaining, but the way I was eating has been enough to once again maintain but not lose. Thus why I have chosen to try the 5:2 method to shed the pounds to get back down to where I was.

I also have read that you can start to produce more Ghrelin several years after surgery which could account for more hunger. Whether that is true or not, I am not sure and since the sleeve is still really in its infancy, I think there is a lot more research to be done.

I cannot see that you would have a problem down the road if you maintain what you are doing. If you can look at yourself and you regiment and say that you are happy and you feel it is honestly something you can do for life, you will be rocking it 20 years from now! You have made it a new life and have chosen to make permanent changes you can be happy with and sustain.

In all honesty, our downfall is ourselves. Allowing old habits to creep back in, becoming more slack, and not making lasting changes is what results in weight gain for most people (of course, ruling out the medical), not a mechanical problem with the surgery itself.

I firmly believe gaining is just a "state of mind." Fiddleman, it's what you said "match your lifestyle with your eating habits. I can DEF eat more 3 years out but it is stuff I SHOULDN'T eat. If I stick to the guidelines, Protein first, veggies, no "whites", the restriction is still there in spades!

It comes down to former addicts recovering fully and understanding that for some it means stay away!!! Others can be more moderate and increase exercise. Our metabolisms don't "magically" change because we have the sleeve. Its like they say in the tech world, "garbage in, garbage out!" You eat junk, you will gain "junk" (maybe in the trunk!)

Love all my fellow Vets!!! So glad I have all of y'all! (Yes, I'm from the South!)

I will be two years out next month. I still eat mostly Protein, and if I stick to that I have great restriction. But, I do allow myself to eat other things. For instance, this summer I will eat an ice cream treat when my family does that. At home, I keep Greek Yogurt for my treat, but if we are out and about on a hot day, I won't skip the treat.

For me, I think the biggest difference is my tolerance for sweet stuff.

Right after surgery, I had absolutely no tolerance for anything even slightly sweet. The mildest flavor seemed very strong to me.

I believe this is because of the restrictive diet I had been on (pre-op diet, post-op diet). My surgeon's guidelines kept me on liquid with protein for something like 8 weeks in a row (two pre-op). My diet was so bland that when I finally did start eating regular food, it tasted horrible.

Almost two years later, my diet isn't as bland. The ice cream is appealing again.

So, I can eat things I wouldn't have right after surgery. However, I still have restriction.

I think the best thing about this whole experience is that I now eat more "normal" than I ever had in my life. My portions are sized right.

I also know that I don't have to eat everything I'm served. It has become normal for me to leave food on my plate.

I say this knowing that there are also "quirks" in my new diet that I never had before. The other day, I was eating out with my family and had limited options. I ordered chicken strips. When I was done eating, my daughter questioned me about why I had left the breading on my plate. She wanted to know if it was something I couldn't eat. I could eat it, but breading/bread/carbs make me feel full and bloated, so I tend to avoid them. I had peeled off the breading to get to the chicken underneath (protein!). I hadn't even realized what I'd done until my daughter commented on it.

I will be two years out next month. I still eat mostly protein' date=' and if I stick to that I have great restriction. But, I do allow myself to eat other things. For instance, this summer I will eat an ice cream treat when my family does that. At home, I keep Greek Yogurt for my treat, but if we are out and about on a hot day, I won't skip the treat.

For me, I think the biggest difference is my tolerance for sweet stuff.

Right after surgery, I had absolutely no tolerance for anything even slightly sweet. The mildest flavor seemed very strong to me.

I believe this is because of the restrictive diet I had been on (pre-op diet, post-op diet). My surgeon's guidelines kept me on liquid with Protein for something like 8 weeks in a row (two pre-op). My diet was so bland that when I finally did start eating regular food, it tasted horrible.

Almost two years later, my diet isn't as bland. The ice cream is appealing again.

So, I can eat things I wouldn't have right after surgery. However, I still have restriction.

I think the best thing about this whole experience is that I now eat more "normal" than I ever had in my life. My portions are sized right.

I also know that I don't have to eat everything I'm served. It has become normal for me to leave food on my plate.

I say this knowing that there are also "quirks" in my new diet that I never had before. The other day, I was eating out with my family and had limited options. I ordered chicken strips. When I was done eating, my daughter questioned me about why I had left the breading on my plate. She wanted to know if it was something I couldn't eat. I could eat it, but breading/bread/carbs make me feel full and bloated, so I tend to avoid them. I had peeled off the breading to get to the chicken underneath (protein!). I hadn't even realized what I'd done until my daughter commented on it.[/quote']

Awesome post! I agree about the sweets. For the first year or so, the very taste of milk chocolates for me sick ( and that was the rare bite). Then it all changed into 2nd year! Lol

It's very easy for me to eat mindlessly. That's what gets me. I think I'm eating right at meal time, but I forget about the container of pb filled pretzels on the counter at work, or the piece of candy at the bank, etc.

I do know that if I manage to keep all carbs out of my life, other than the ones in veggies, I have no hunger. My Ghrelin may have come back, but I can control it.

I am just now learning to count calories. I have always counted Protein grams and carb grams but now I know I need to count calories too. I can eat low carb and still be way over on my calories.

I think something that is often forgotten is the fact that as we age our metabolism changes. You can be in maintenance and stay eating the way you always have but you find your are starting to gain. Especially for women who are going through or have gone through menopause as that really does a number on our metabolism. How do I know this? Because that's how I gained my weight in the first place... I was always skinny until I went through chemo and menopause at age 31. Now, I'm back down to the weight I was before I became sick, 33 years later. My diet has changed and I feel like I know what I need to stay where I am - keep exercising, keep eating clean, and keep on top of any weight changes that last more than a couple of days. While once in a while I will have a treat, ice cream, or a bite of desert but for the most part I stay away. I feed my body fuel that it needs to work efficiently but no "additives".

To answer your original question Fiddleman, I think that you should eat what works for you. I don't think it matters if you spread your calories between 7 meals.

I am curious why you're eating so much Protein. I know protein keeps us full, but I worry about kidney stones. My dr. told me too much protein is bad for the kidneys. He told me to go online according to my height, and find out how much protein my body requires. I still have kidney stones, even after surgery. He blasted them, but I'm still passing pieces months later and it's not fun.

Oregon daisy - I eat the amount of protein I do to build lean muscle, lean out and eliminate hunger, in that order. I hear you on the kidney stones. However, I do try and drink water all day, every day to counter and negative consequences.

The biggest thing you said in your original post is that you do not snack. You do not graze. That's what gets everyone in trouble. Some of us eat correctly like our surgeons tell us to eat for a long time, but eventually, bad habits creep in. For some, it's soda, and others it's just little bits of junk food here and there.

There is a back on track thread at Obesity Help and the majority of people who need to get back on track say they stopped counting calories.

That is true - I never snack or graze, but where to draw the line between those two troublemakers and eating planned meals every 3 hours? Isn't that snacking? Occasionally, I might have an extra 1 ounce of chicken (skewer or meatball) an hour after I eat. If I get hungry and i need to eat something I make sure it is lean protein or it is an energy square. I try and only eat carbs in the morning from my energy squares. Rest of the day is protein in some form. I have been known to put food in my mouth 7x a day. 7x...That is a lot of eating, but it only helps my metabolism. My trainer commented today during our time together that I am leaning out too much ( never heard that before, never ever) and she is going to continue to increase my weight so I do not lose muscle because there is very little fat left for the body to use as energy. While I probably will not increase quantity, I might switch to higher calorie protein sources and shoot for 2500+ calories a day. OMG, that seems like a lot of calories as a sleever, but my trainer specifically said I leaned out a ton in the last few weeks and I would not want to lean out any more. Weight is still 178, but body shape is really changing. Big chest and back, slim waist, strong arms and legs. To follow up on some of the counting comments above, I never count. Never have from the start. I just made a lot of changes in food selections and had some vague idea of how many carbs or proteins, but do not track. Never will either. Just not my style. I would rather just follow a bunch of self imposed rules. And keep things simple.