Okay, I don't know whether this topic has been covered before. If it has, my sincere apologies. However, there is something I have found on my explorations of all things 'sleeve', that has somewhat resonated with me. And not always in a good way.

If you're a bit like me, you've devoured everything available on the big ol' t'internet about the wondrous vertical sleeve gastrectomy. From doctors, to insurance, location, cost, life impact, health implications, surgery competence, surgery complications, long-term outlook, short-term discomforts, scale victories, non-scale victories, psychological wellbeing, psychological hurdles, physiological impediments, familial responsibilities, the Quest for Protein, the quest for Fluid, Protein Bars, protein shakes; which brand is the best, which brand is the worst.

The areas for consideration in this matter are endless and, if you're like me, you keep stumbling across extra information which every so often makes you say 'oh no, not another thing to consider'..

Getting to the point, I don't think there is a person amongst us that hasn't trawled the endless YouTube videos and the photos on this website of the dramatic transformations people have achieved. It is almost a voyeuristic pleasure which provides instant gratification and codification as to why you're taking this road. You see people and think 'wow, that could be me'.

Whilst clearly, dramatic weight loss will have significantly improved people's health and general wellbeing; reducing or eliminating comorbidities and making their prognosis much better than when they were significantly overweight. There is something that just won't leave me.

Have any of you seen photos and videos (and please don't quote specifics) where you've thought either a) you looked better when you were heavier or your weight loss has gone too far, stop, you're looking ill.

I don't want to be one of those people that everyone silently thinks 'you looked better before'. However, one only ever knows whether this is the case until you get there and or generally, after the event in question.

I guess, fundamentally, I'm questioning whether, in line with some medical publications, some of us are pre-programmed to be portly and we look 'better' portly as a consequence?

I know I shouldn't be concerned about this, because health comes first, right? However, when I see people with thinning hair/ no hair, degraded teeth, grey complexions, sunken cheeks, sunken eyes, I sometimes question whether this is the right thing to do, or are people, behind my back (and knowing some of the people I know), to my face, going to be thinking 'crikey, she looks awful'...

I have seen, particularly with some photos and videos over a lengthy period of time, people achieve a 'sweet spot' for looking 'well'. However and more often than not, they don't appear to stay at this. Is there a middle ground between meaty and malnourished? Can it realistically be reached and maintained?

What are your thoughts, people? Would be good to hear them x

You're right on that one; one mans Water is another mans champagne. But no' date=' the 'mis-proportioned' thing is not really what I'm talking about. It's the gaunt, drawn, malnourished look. Generally looking like walking death. Then, the question - when is enough, simply, enough?[/quote']

I'm trying to figure out the "simply enough" right now.. So I don't have the answers.

But I will say if you don't take care of yourself, the sickly look will be part of your life,

We eat so little now, and some chose to eat crap still. you will still lose weight but you are not feeding your body what it needs.

And unlike before there is not much room for error.

I eat lean Proteins and veg. That does not mean everyone does though. If you have read these forums some people go right back to fast food.

That is not feeding your body, plain and simple.

Not to say I don't eat a treat here and there,

I do, but not on a daily basis.

I think most people look better after the surgery, but when I have watched You Tube videos I have noticed that many people seem drained and tired all the time, like they barely have energy to talk into the camera. Their voice even seems quieter than the "before" videos. I see it in women more than men, the men seem energetic and excited and the women seem to be lethargic and pale. That concerns me!

I think about it like my pico coral tank, it's 2 gallons of saltwater coral, because of its size, the perimeters are thrown off so easily.. It takes daily checks and tweaks to keep it running smoothly.

Our new stomachs are like that now, good nutrition and vitamins for the rest of your life are important, as is the periodic blood tests to monitor your levels.

Naked, I actually looked better before.. Granted I was 360 pounds. But my fat was distributed from head to toe and I filled out all my skin. I was never uncomfortable with the appearance of my fat body.. Now 100 or so pounds in, I'm already REALLY saggy and wrinkly and I don't love it. I'm already saving for plastics in Mexico

My face looks better now. I still have a plump youthful face.. What will it look like in 100 more pounds? I don't know.. I'm hoping to keep some of the chub in the face though... and if I don't.. I'll have some work done to the face while I'm in Mexico as well!

Hehe, like your style! Self body-image is such a big thing, isn't it? I, too, am proportioned. I, too, don't want to lose my healthy facial coverage either. Has anyone got any answers for this one?! How do we prevent looking gaunt?!

Madame Reverie, I've enjoyed all of your posts so far and this one is great too. I know exactly what you're talking about. Right now, losing too much is the farthest thing from my mind though. I spend too much time whining that I'm not losing enough/ fast enough lol. Lord I hope I have to worry about that some day!

I have seen people after losing all of their excess weight that looked terrible, in a sickly kind of way. I have always felt that comes along with loss that is too fast and done without constant attention to Vitamins and Water. Although we all know there are people that are attracted to people that are morbidly obese I think it's safe to say most do not prefer that look on anyone, including themselves. As for me I'll strive for perfection and hope I recognize it when I see it.

I think most people look better after the surgery, but when I have watched You Tube videos I have noticed that many people seem drained and tired all the time, like they barely have energy to talk into the camera. Their voice even seems quieter than the "before" videos. I see it in women more than men, the men seem energetic and excited and the women seem to be lethargic and pale. That concerns me!

TOTALLY! People also seem to gasp for breath while they're talking for what appears the first 6 months, along with the burp-stifling! Oh, and mental confusion seems apparent, too. It is concerning. In addition to these things, what I have also observed, is that there is a bit of a change in personality,too, as the videos go on. People start out fairly balanced, contemplative, reserved, grateful for small milestones, to then changing in line with their weight, to on occasion, becoming quite arrogant and demanding. Why is this? Maybe that's another question for another forum topic

That's a healthy attitude. Do you think you'll know when 'enough is enough' though? How will you gauge it? By clothes? Comments? Looks? It's a great achievement so far, I wish you all the best in finding your sweet spot

I've never cared about other people's opinion of me and clothing size means nothing. When *I* love the way I look, when I can do all the things I want to do without feeling unhealthy, when I can shop in any store I walk into and when I don't look fat on film next to my friends who are of similar height and have what I now see as a great body size, I will be happy.

Madame Reverie, I've enjoyed all of your posts so far and this one is great too. I know exactly what you're talking about. Right now, losing too much is the farthest thing from my mind though. I spend too much time whining that I'm not losing enough/ fast enough lol. Lord I hope I have to worry about that some day!

I have seen people after losing all of their excess weight that looked terrible, in a sickly kind of way. I have always felt that comes along with loss that is too fast and done without constant attention to Vitamins and Water. Although we all know there are people that are attracted to people that are morbidly obese I think it's safe to say most do not prefer that look on anyone, including themselves. As for me I'll strive for perfection and hope I recognize it when I see it.

Thank you so much, that's truly very kind of you.

You've hit in on the head - the sickly look. With so many different opinions on what is right and what is insufficient across the board, it is easy to get very confused. I guess we can blame the lack of long-term medical research on this issue being as to why it's so difficult to get a cohesive and collective response from all those in the business of providing this surgery. Consequently, people are left trying to find their own answers and through trial and error, finding what's right for them. I'm wondering whether there will ever be a definitive stance on the issue? Or, we all make a 'best guess'. I love your statement about hoping to recognise perfection. I'm hoping to recognise when I'm losing too much because I do not want to look ill. If I do, be assured, I shall be promptly heading for my favourite restaurant for a creme brulee (or three)!

I honestly don't think I'll have that problem. I'm studying the human body in school and have researched nutrition since I got the internet. I know eating under 1200 calories is unhealthy. I strived to get to 1200 as soon as I could. It took a good 6-7 months but I made it. Now I eat 1300-1500 calories a day and work out 5-6 days a week. I'm losing at a healthy rate usually 10 pounds a month sometimes less. Saturday I'll be 9 months out and I've lost 92 pounds.

It's important to fuel your body and give it the nutrition it needs. I only take a Multivitamin a day and my bloodwork is perfect. I have a few friends who've had the sleeve and only one is struggling with losing too much weight. She's always tired, doesn't work out, and still at two years post op only eats 800-1000 calories a day. My skin is the healthiest its ever been and my did fall out but was growing back at the same rate. It never got thin. Keep yourself healthy! Calorie restriction is only one factor of many to live a healthy lifestyle.

Hair*

I honestly don't think I'll have that problem. I'm studying the human body in school and have researched nutrition since I got the internet. I know eating under 1200 calories is unhealthy. I strived to get to 1200 as soon as I could. It took a good 6-7 months but I made it. Now I eat 1300-1500 calories a day and work out 5-6 days a week. I'm losing at a healthy rate usually 10 pounds a month sometimes less. Saturday I'll be 9 months out and I've lost 92 pounds.

It's important to fuel your body and give it the nutrition it needs. I only take a multivitamin a day and my bloodwork is perfect. I have a few friends who've had the sleeve and only one is struggling with losing too much weight. She's always tired, doesn't work out, and still at two years post op only eats 800-1000 calories a day. My skin is the healthiest its ever been and my did fall out but was growing back at the same rate. It never got thin. Keep yourself healthy! Calorie restriction is only one factor of many to live a healthy lifestyle.

That's excellent advice indeed. May I ask how you got those 1200 calories and above in, in the end and what prevented you from being able to do that for the first 6 months?

I'm able to eat more now. Before I was able to eat 2 oz of protein and maybe 3 bites of veggies. Now I can eat 3 oz plus maybe 1/4 cup of veggies. I try to eat every 3-4 hours since I'm working out pretty vigorously, my appetite has increased for needed nutrition. It took a while to figure it all out but I finally feel like I've found what works for me.

I was able to get to 1200 a day by 10 weeks out. and I try to stay around there. just 3 meals and about 3 snacks a day. it's pretty easy to get to 1200 it took a while to eat solid protein but I can do 3-4 oz now. ground meats and chilis and such are easier. I only do walking for exercise. nothing rigorous yet. I am 5-10 tall so that helps. so far I average 2 lbs a week and am happy with that. when I stall or slow down I will up the exercise program. I can't imagine losing too much! I have lost 70 and a normal BMI is 70 away. that's 9 more months. I would be happy with 50 more. I can't fathom having an issue with not being able to stop the loss. it takes concentration and mindful choices to keep it coming off!

I was able to get to 1200 a day by 10 weeks out. and I try to stay around there. just 3 meals and about 3 Snacks a day. it's pretty easy to get to 1200 it took a while to eat solid Protein but I can do 3-4 oz now. ground meats and chilis and such are easier. I only do walking for exercise. nothing rigorous yet. I am 5-10 tall so that helps. so far I average 2 lbs a week and am happy with that. when I stall or slow down I will up the exercise program. I can't imagine losing too much! I have lost 70 and a normal BMI is 70 away. that's 9 more months. I would be happy with 50 more. I can't fathom having an issue with not being able to stop the loss. it takes concentration and mindful choices to keep it coming off!

That's really good. Congratulations on your success. Have you any suggestions for upping the calorie intake in the first two months? I have visions of my being so worried about the calorie crash, that I'll be tempted to sip double cream or something?!

I know a few people who have lost too much weight and look bad. In at 165 now and i Think I look perfect! I would rather have a little meat left so my face stays looking good. I've had one person tell me how BAD my face looked now because of my weight lose but she is full of crap because I get told all the time how great I look. I do have saggy skin but seriously how many 38 year old women really look great naked?