Anyone who has read my posts knows that I'm pretty upbeat and positive about weight loss surgery in general, and the sleeve in particular. That's why it pains me to share the results of a new study that is not terribly optimistic (links below). With that being said, I think what this means is that we need to be put even more energy into getting all the way to goal weight, and then be even more diligent about maintaining it for the rest of our life. Otherwise, some of the weight will come back and bring co-morbidities along for the ride – especially diabetes. So hard as it may be, my suggestion to myself and everyone else is to remember that there is no finish line! We have to stay ultra-focused on our healthy eating programs forever. Of course we already knew that, but this study really brings it home. So let's use that as extra motivation to succeed!!!

Washington Post Synopsis

JAMA abstract of the study results

You know who says that? People who don't know what "extrapolatability" means....

I've been thinking a lot about this lately. Some days I almost have a defeatist attitude about it, thinking "I'm going to enjoy being thin while I can". But then I get my determination face on and think I just CAN'T go back. I'm just going to have to take it one day at a time, almost like an addict--no, JUST like an addict has to approach their sobriety. I can't worry about the 'what ifs' and worry about the right now. And right now, as of today, I've excerised and eaten right. And that's the plan for tomorrow, too, but I'll take that on when tomorrow comes. I just won't live in constant fear of regain. I can't. I won't.

Two pounds from goal and you're feeling defeated? Grab that goal by the throat and kick its a$$! You can do this!!! As you say, one foot in from of the other today, and then tomorrow.... At support group last night our surgical coordinator/nurse was talking about how after 18 months we lose the metabolic advantage. Meaning that we have roughly that long to get our heads straight and inculcate the "good" habits. If we don't, it will be a much harder road. (See what I did there @@VSGAnn2014? Used "a$$" and "inculcate" in the same paragraph.)

@@Rogofulm ... that's how I talk all the time. Love it!

BTW, would you expound a bit on this: "At support group last night our surgical coordinator/nurse was talking about how after 18 months we lose the metabolic advantage."

What is the "metabolic advantage" she/he was referring to?

Did she/he mean that 18 months is how long it takes for the body to figure out how and where to produce and release ghrelin elsewhere in our bodies (other than in the stomach fundus that was removed during VSG)?

A.

@@Rogofulm ... that's how I talk all the time. Love it!

BTW, would you expound a bit on this: "At support group last night our surgical coordinator/nurse was talking about how after 18 months we lose the metabolic advantage."

What is the "metabolic advantage" she/he was referring to?

Did she/he mean that 18 months is how long it takes for the body to figure out how and where to produce and release ghrelin elsewhere in our bodies (other than in the stomach fundus that was removed during VSG)?

A.

My understanding is that it's somehow hormonal (and I'm assuming ghrelin is the hormone). At least that's what my favorite Dr Weiner says. He says while everybody assumes pouches and sleeves get stretched out and cause weight gain, studies show after the honeymoon period at around 18 months and then a year or two out, hormonal changes that happen naturally over time cause us to become hungrier and somehow allow a little more volume to be eaten. Though he didn't say WHY it happens. Anyway, he said there have been studies proving those are the causes of weight regain, not stretching (and obviously diet). I'll have to see how good my Google - fu is and see if I can find some of those studies to answer why it may happen.

This has been out, well I put it out I should say. There was a fair amount of comment on it. Not a lot people can do. Its sort of known that this is restriction only and you can get by things like that (band).

Vic

This article is about the sleeve, not the lap band. Yes, they are both "restrictive" in a sense, but very different procedures. It is important to realize that the sleeve is not a cure for obesity. Instead, we all should focus on utilizing it as a tool for weight loss and improved general health.

@@Rogofulm ... that's how I talk all the time. Love it!

BTW, would you expound a bit on this: "At support group last night our surgical coordinator/nurse was talking about how after 18 months we lose the metabolic advantage."

What is the "metabolic advantage" she/he was referring to?

Did she/he mean that 18 months is how long it takes for the body to figure out how and where to produce and release ghrelin elsewhere in our bodies (other than in the stomach fundus that was removed during VSG)?

A.

He didn't specifically mention the return of the ghrelin gremlin, although he did impress upon us that hunger returns in spite of the restriction, and our healthy eating habits need to be well-established so as to avoid falling into old patterns. I think the point he was making is that our metabolism stays "confused", for want of a better word, for about 18 months. After which, it recognizes that this is the new "normal" and settles-in for the long haul. I'm extrapolating now , but it may be that whether our metabolism settles-in at a faster or slower rate may depend on our nutritional and exercise patterns. I could expand that to include our muscle mass as well, since that contributes to our metabolic rate, right? So in my case, at 14 months out, I have about 4 months to build up additional muscle mass to support a faster metabolism. I doubt that it's quite so cut-and-dried, but it may be worth using 18 months as a target time-frame to have all our ducks lined up, whether they be eating/drinking habits, exercise routines, or muscle mass development. That last piece is an "aha moment" I'm having even as I write this. Thanks for the question, @@VSGAnn2014, it caused me to think more deeply about the topic, and may encourage some needed changes; specifically, the urgency to add strength training to my routine. Okay, I'm tired now....

I was using the band as an example of a restrictive only process. Yes they are very different procedures. I'm aware of them.

I believe that there is a disconnect between what doctors do in terms of getting patients to realize that this is a tool vs. true belief in that this will be a struggle after the "honeymoon" period referred to above. That would include insurances paying for such things. It would encourage also addressing the problems in not having access to care if you want to move to another group that has better aftercare. The money is in the surgery.

This has been out, well I put it out I should say. There was a fair amount of comment on it. Not a lot people can do. Its sort of known that this is restriction only and you can get by things like that (band).

Vic

This article is about the sleeve, not the lap band. Yes, they are both "restrictive" in a sense, but very different procedures. It is important to realize that the sleeve is not a cure for obesity. Instead, we all should focus on utilizing it as a tool for weight loss and improved general health.

He didn't mention the return of the ghrelin gremlin, although he did impress upon us that hunger returns in spite of the restriction, and our healthy eating habits need to be well-established so as to avoid falling into old patterns. I think the point he was making is that our metabolism stays "confused", for want of a better word, for about 18 months. After which, it recognizes that this is the new "normal" and settles-in for the long haul. I'm extrapolating now , but it may be that whether our metabolism settles-in at a faster or slower rate may depend on our nutritional and exercise patterns. I could extrapolate that to include our muscle mass as well, since that contributes to our metabolic rate, right? So in my case, at 14 months out, I have about 4 months to build up additional muscle mass to support a faster metabolism. I doubt that it's quite so cut-and-dried, but it may be worth using 18 months as a target time-frame to have all our ducks lined up, whether they be eating/drinking habits, exercise routines, or muscle mass development. That last piece is an "aha moment" I'm having even as I write this. Thanks for the question, @@VSGAnn2014, it caused me to think more deeply about the topic, and may encourage some needed changes; specifically, the urgency to add strength training to my routine. Okay, I'm tired now....

@@Rogofulm ... that's how I talk all the time. Love it!

BTW, would you expound a bit on this: "At support group last night our surgical coordinator/nurse was talking about how after 18 months we lose the metabolic advantage."

What is the "metabolic advantage" she/he was referring to?

Did she/he mean that 18 months is how long it takes for the body to figure out how and where to produce and release ghrelin elsewhere in our bodies (other than in the stomach fundus that was removed during VSG)?

A.

Also.... I don't mean to imply that after 18 months all hope for change is lost. It most certainly is not! But we all know that the "honeymoon period" is our best opportunity to make profound lifestyle changes that can carry us down the road. After that, it just takes more effort.

@@Rogofulm @@VSGAnn2014 @Babbs - all I am going to say is I HOPE the internet and BP are still available because we will be slapping each other on the heads here for the next 40 years or so...I am 52

takes more effort

@@Rogofulm

no truer words have been spoken

i'm going to reply only to that comment

i am 2.8 years maintenance

i know i can eat more than i should

I do eat junk "sometimes" that i know i shouldn't

recently my weight went up by almost 10 lbs!!

i got back on plan better, and so far i have lost 5 lbs

the other 5 lbs will come off in its own time

it's harder to loose weight after maintenance (for me)

ahhhhh, confession is good for the soul

but with that effort that @@Rogofulm ( me too)speak of - you/me/us can continue to be a success story

hard work/effort/determination

new lifestyle - we can do this

good luck to ALL of us

kathy

@@proudgrammy

Do you find you are hungrier, also? And is your volume of food you can consume considerably more? Do you still feel restriction?

Sorry for all the questions, but you're a real life success story who is currently in maintenance for a couple years, too! You can be my guinea pig!

Anyways, love ya

I sooooo appreciate you all!!! And all the information you put out here.

There's always so much great information on this site and I look to many of you for your tidbits of wisdom, advice, slap up side the head, whatever's needed on various topic posts. Of course, my first source for information will always be my surgeon/ NUT/exercise guru's office, but you all add so much more - LIFE EXPERIENCE - from which we all can learn something.

THANK YOU!!! for being YOU!

OK, I have new and IMHO dependable, reliable information about all this. I'm going to start another thread here called: What to Expect During Year Two Post-Op After the Sleeve.

(Saw my bariatric P.A. today who had lots to tell me.)

P.S. New thread started is at http://www.bariatricpal.com/topic/349302-what-to-expect-during-year-two-after-the-sleeve/

duplicate post

So, my sleeve was December 2011.

I had LOTS to lose and knew that nobody expected me to get/maintain much below 200# so i just kept my shoulder to the grindstone until i got to my personal goal. Took me 14 months. I feel that I worked it pretty hard the whole time, but it took MORE effort after about 8 months post op.

After about a year, a few pounds came back on, but they were super easy to get rid of.

I am now about 10# over goal and 20# over where i want to be. OMG... it is like hand to hand combat (again!!!) with each pound. For me, there has been a huge huge shift this year versus previous years. It isn't just about hunger, it isn't just about old habits, it isn't just about less restriction. Seriously, i think i need fewer calories now! Also, due to some physical problems i don't do the higher intensity workouts anymore.

So, hard cold truth is I completely understand why we have so many people that come back to this forum 3-5 years post op having regained a good portion of your loss. I feel the need for ongoing vigilance which you would think gets easier, but it doesn't.

Even so - sleeve HAS BEEN a miracle for me. It has done it's job and now the maintenance is up to me.

I am STILL a normal sized person, after a lifetime of morbid obesity, it is a miracle. I still say that I worked harder to stay under 300# then I do now to stay "normal".

@@CowgirlJane

I have heard that before. Why do you suppose the body gets so resistant to losing after a few years? Any ideas?