So this is for all the successful veterans out there....for those that lost what you wanted to lose, have made all the necessary lifestyle changes to be successful and continue to maintain your weight loss.....

Why couldn't we do this without surgery?! The surgery was on our stomachs, not our brains. So how are we able to stick to whatever changes we've made and continue to be successful? For me, I haven't made as big of changes as a lot of others. I simply eat healthy, eat smaller portions and drink way less alcohol. I don't track, I don't measure, I don't exercise, I don't see a therapist. So why can I do this now and not the dozen times I've tried in the past?

I've had some horrible emotional hits since surgery...I had to put both of my dogs to sleep, my best friend committed suicide and another good friend was just diagnosed with cancer. I exist in a fog of grief and anger and confusion over my best friend. I am overwhelmed with emotions and some days wish I could join him. I should be stuffing my face and getting drunk every night. That's how I've always coped in the past. Why aren't I doing that now?

How about those of you who count calories and carbs and track everything in MFP and go to the gym and run C25K, etc.? Those are huge changes and yet you've made them. Why couldn't you simply do that before surgery? Why are you so good at the healthy lifestyle now? I'm asking because I have no answers to explain my changes. What about you?

The surgery gives you the boost you need. It helps.

There are tons of reasons why this works for 80% of those who do it and why behavior modification alone works for less than 8%...Two big ones

Biological reason:

Long term obesity changes the body. It creates systems to support the fat that end up killing you. Insulin spikes, extra coritisol, creating less testosterone. All these cascade into a nearly unwinnable war against weight.

Behavioral habits:

We all have them. food is soothing. It was a way of dealing with stress. It is in our memories of good times.

The surgery changes the hormones, allowing weight loss to happen. It is a tool to help us break behavioral habits. It is only a tool. You still have to eat the right stuff and move. But it is a great tool.

You ask a complex question but clearly the "reason" is rooted in the physical changes.

I've been at goal for about 8 months and holding steady. However, I'm snacking more and taking in more carbs yet I'm not gaining.

I work out 6 days/week and log all food. At 2200/2300 calories I'm still not gaining. Don't want to push my luck on this but it seems like my metabolism has changed since the surgery, in addition to the much-needed restriction.

Edited June 11, 201511 yr by Andrew0929

@@Kindle, you ask a GREAT question! I am so much a "WHY?" person too. But as so many mental health professionals have suggested to me, sometimes there just are no answers some questions and we serve ourselves best by being at peace with "what is."

Sorry for all the pain you are experiencing in your life, but hope you are being extra kind to yourself in acknowledging how awesome your are for your strength in the midst of all this adversity! For so many of WLSers who suffer major emotional life changing events (deaths, divorce, job loss, etc) that is a huge trigger for major weight gain. Having the knowledge that this DOES happen when we experience major life events, and being able to keep in the back of our minds that we will need a lot of support at these times helps so much. Somehow, you have been able to maintain your weight during all this and wow that is amazing.

At four years out, I can relate to a lot of what you have said (except the therapist part--definitely working on head). I feel pleased with my WLS success. I attribute that to FINALLY in my life being READY TO CHANGE, and being totally HONEST with myself. No more excuses. That meant letting go of a lifetime of old unhealthy eating habits forever and working REALLY HARD that first year to figure out what new, healthy eating habits and lifestyle even were (I really didn't even know.).

For me, without question, the difference from all the other times in my life that I tried to lose weight is that the sleeve provides the restriction that was never there before. Why can I keep the weight off when we see other WLSers regain? That's where the work that we do in that first year to change our habits is so important. Also, I often repeat to myself a mental affirmation: (Your disease of obesity was so severe that you had the majority of your stomach surgically removed--behave accordingly!)

I know what healthy eating is now. I don't count calories any more. I know what 1200 quality calories a day is. Fake, processed junk foods do not live in my house. I eat whole, clean meals/snacks prepared at home. I really think it just all boils down to CHOOSING TO CHANGE, forever. It is not about willpower. It is about choosing to live your best life and restoring your body to health. Sure, the number on the scale, and the fun clothes etc are nice, but if those are made the priority in the WLS adventure, my opinion is that the long-term success might be in question.

Give yourself an extra pat on the back today--because you deserve it!

Edited June 12, 201511 yr by LivingFree!

Research tell us that most weight gain happens after 3 years. I think there are both mental and physical reasons for this. Some of the reasons are unknown by medicine....they are looking into it more than ever. Lots of new research thinks that changes in the biom have something to do with why we lose, and if we start back into eating those refined foods we used to eat, the biom slowly changes back to how it was before surgery. (Some research suggests that when you eat lots of refined food, you grow more bacteria in the gut that processe that kind of food, and the bacteria has an imperative to get you to eat even more of that food FOR THEM. Creepy hugh? Our gut floura tells us what to eat. So if you stick with the right foods long enough, the gut will want you to keep eating them. Slip up for long enough and the gut will trigger chemicles that scream EAT CAKE! Not kidding. That is only part of the story, but those primitive voices that call us to eat cake are real and hard to ignore. There is thought that the surgery sets the gut biom in a new direction and gives us a boost towards a healthy reset... that combined with a smaller stomach helps the initial weight loss. I am at 41/2 years, have struggled with my goal... took 3 years to get to goal, and have bounced around a bit there... I am about 14 pounds above goal right now... and holding... always going back to maintaining consciousness about what i eat and how I move when I slip up... lots of good habits I keep up all the time...I consider myself a success (and so do my docs)... of course I would rather be at goal... but its still a work in progress.

Why couldn't I just lose it and keep it off before surgery? I wonder why too, but seeing the stats about how many people can lose and keep off the weight withought surgery is reason enough for me to have gotten surgery. This is the very firt time I could get it all off or stay anywhere near goal this long in my entire life. I have achieved many things in my life, lots of travel, interesting jobs, notariety in my field.... really, the only thing that has been the bane of my life and health has been being fat and not finding success taking it off or keeping it off. Like most of us here, I spent at least half of my life trying without success. This surgery has been the tool I needed to have some success there as well.

I'm not long into this yet -- almost 10 months, and have already hit goal and lost 5 pounds below that now. Maintenance is new to me -- about 1-1/2 months now.

For me, the difference seems to be:

1. Less hunger -- the "lot less ghrelin" factor has been a big deal for me.

2. Restriction -- that's still a big deal for me, too. As we all know, the restriction is less than it used to be. But it's quite functional at this point.

3. New habits -- boy, do I have a lot of good, new habits: eating slower, chewing longer, planning my daily menus, recording my food intake, weighing daily. I'm even grooming myself better -- brushing teeth 2X daily, doing better skin care, getting dressed every day, wearing makeup, getting my hair done on schedule, etc.

4. I can move more now -- and, boy, do I move more! Weighing 90 pounds less has made me MUCH more energetic. I simply could not move much at all a year ago. And all that moving is burning calories. I'm cleaning house, walking, exercising, gardening, shopping more, and everything else you can imagine.

5. Elevated mood. I'm not nearly as depressed as I was a year ago when I weighed 90 pounds more, I was in physical pain, I was a functional agoraphobic (I could fly cross-country, but refused to go to the local Wal-Mart). And now I'm simply not pissed, embarrassed, afraid, etc. I am so much happier. Skinnier Me = Happier Me = Skinnier Me.

6. Seeing a shrink has helped. I've never seen a shrink before, but at my PCP's urging started doing so when I started my WLS journey. He's helped me stay quite focused on the right stuff. No big trauma in my past has been uncovered. But I've explored the factors associated with my past failures in caring for myself in the past and ways I can change those patterns. That's all been very helpful.

So far, for me, this has all been a dynamic dealio in that everything above seems to feed everything else. Put another way, when everything is working well, everything works well. When everything sucks, everything sucks. And according to my shrink, people who've reached goal risk regaining when they don't keep changing their goals, e.g., we lost weight -- now what? Get fitter? Leverage our new health to start our dreamed-for career? Human beings don't "stand still" very comfortably.

... anyway, those are some thoughts from my point of view.

Kindle, I hope you can find some peace in all this chaos thrust upon you. I'd love to "poof" you better, but I can't find my wand right now. ;(

Here's an interesting research report done by Kaiser Permanente following their WLS patients three years post-op.

http://asmbs.org/wp/uploads/2014/05/Coleman-Three-Year-Outcomes-May-June-2014-SOARD-1.pdf

The table on page 400 is where the interesting data is.

Thanks all for the replies. I know my question is too complicated for a "right" answer, but it's nice to get some theories to ponder. Being the scientific person I am, I definitely think the changes in our metabolism and GI biome do play a role. As a fecal transplant recipient, I can personally attest to the actual physical changes that occur when you all of a sudden have a different population of GI flora. And the instant (not weight-related) changes seen immediately postop in many diabetic patients is well documented.

Mentally, I think the "ready for a change" theory also plays a part. For those that don't succeed at this, maybe that's a big missing piece of the puzzle. But it was a significant factor for me. I really hit rock bottom as far as my weight-related and alcohol dependence mentality goes. I had no control at all. And like many other addicts maybe that's what it takes to finally get your shit together.

The positive feedback loop, self reinforcement and getting a handle on our mental health no doubt also plays a part. Even though I've lost a lot of weight in the past, (almost to surgeon's original goal) there was always something missing. For some reason I just lost the incentive to maintain those successes. Why it's different this time remains a mystery.

I think there are too many factors to really be able to explain my original question. And I'm sure it's different for everyone.....I guess success is just a matter of your personal "perfect storm".

Here's an interesting research report done by Kaiser Permanente following their WLS patients three years post-op.

http://asmbs.org/wp/uploads/2014/05/Coleman-Three-Year-Outcomes-May-June-2014-SOARD-1.pdf

The table on page 400 is where the interesting data is.

Very interesting data. Thanks for sharing. I see from the time of your post you don't sleep much, either

BTW, please let me know if you find that wand of yours!

Edited June 14, 201511 yr by Kindle

@@Kindle ... we usually go to bed with the chickens. I slept 7 hours last night, but was awake just before at 4:00 am this morning.

I do wish I could find my wand, too. I'd fedex it to you so you could whack yourself whenever you needed it.

I think it's amazing that you're dealing with this latest lost without self-medicating with alcohol or food. That's an awesome change.

If you ever want to talk, please PM me and I'll send you my phone number. I'm no kind of expert about suicide. But I'm a good listener. And I won't give you lots of advice. Promise.

Thanks for posting that link.

Here is a percent EWL calculator.... check it out. I am down 82.5% EWL at 4 1/2 years. According to the research paper... thats damn good. Funny, look at the numbers one way and feel like a failier, look at them another way and feel proud.

http://www.percentagecalculator.net/

I used the second calculator... I put the number of pounds I have lost at this time in the first slot, and the number of pounds I lost at goal in the second slot.