I had VSG surgery on August 18, 2014 -- one year and two weeks ago. Today I met with my bariatric P.A. for my one-year post-op review. She's extremely sharp and keeps up to date on bariatric surgery post-treatments, nutrition, behavioral issues and emerging news. She attends bariatric conferences often and reads all the new studies.

She was the one who encouraged me at four months post-op to move from 800 calories/day to 1,000 calories by Month Six and to 1,200 calories by Month Eight. She said that would help me to prevent my metabolism from accustoming itself to the very low calorie post-op menus we are restricted to with tiny, swollen stomachs.

Apparently, it worked: I am maintaining a 143 pound weight and eating 1,700 calories a day.

I've had an exceptional Year One. I've reached my weight loss goal and am 7 pounds lower than that. I feel great. My blood panel test results are 100% great. No shortages at all. In my opinion I've done everything right. I eat 3 meals and 2 Snacks. I don't graze. I eat nutritious food. Most days my Protein grams hit or exceed 100. I typically eat 5 healthy vegetables and fruits each day and eat at least 21 grams of Fiber (the daily requirement for women). My muscle mass is exceptional for my age (I'm almost 70). I no longer need knee replacement surgery. I walk most days, do yoga and strength training.

So today what I really wanted to know and what I asked her were these questions, along with her answers:

1. What should I expect during Year Two?

You've done really well with weight loss surgery. You've already been maintaining your weight for the last 4 months. In Year Two you can expect more of the very same challenges you've already been dealing with since you reached goal -- planning and eating nutritious meals, focusing on regular exercise, not overeating, and staying focused and motivated. It's important to stay connected to us if you have any questions or changes in how you feel or your health. Staying connected to us is one of the best things you can do. All the research shows that you're much more likely to be successful long-term if you don't "fade" away and try to deal with all the challenges you're having by yourself.

(That made me feel pretty good. )

2. During Year Two, will my body start to produce and release more ghrelin and will my pre-op hunger levels return?

No, the ghrelin doesn't come back. Yes, I know that myth is out there and considered to be true. But it's not true. Yes, you may experience "head hunger" or boredom that could lead you to start eating food full of empty calories that don't help you achieve satiety. And eating those empty "slider" calories will make you want more of them. That's the same "head hunger" challenge you've always had to contend with. Again, no, the ghrelin doesn't "grow back."

(Needless to say, her predictions about ghrelin not coming back just thrilled the hell out of me!)

3. Will my metabolism lower for any reasons, requiring me to eat less?

Not unless you stop exercising or your muscle mass goes down significantly. Also, you're already eating "good" foods, not high-sugar, high-carb foods. The nutritious foods you're eating (protein, veggies, fibrous fruits, whole grain foods) require your body to work harder to digest them. A diet high in slider foods (chips, Cookies, candy, ice cream, sugary drinks) wouldn't make those digestive and metabolic demands of your body. Just keep doing what you're doing now, and your metabolism should remain the same.

(Whew!)

I know that only time will tell how I do. But I now feel like I have a very good chance of keeping my weight down and remaining slim and healthy going forward. BTW, she told me about patients of hers who are 5 and 6 years out who are as slim now as they were when they first reached their weight goals.

So take that, b*****s!

:)

P.S. Oh, she also cleared up what the "18-month metabolic honeymoon" term means. She said that 18 months refers to gastric bypass and other malabsorptive weight loss surgeries that keep food from being fully absorbed for (approximately) that length of time post-op. She says that term and time frame doesn't apply to VSG surgery at all, since the sleeve isn't malabsorptive, but purely restrictive.

@@VSGAnn2014 - It sounds like you have had an amazing journey. To be in good health and no longer need surgery for your knees, and to be free to move and exercise is just beyond AMAZING. To reach your goal and maintain your weight is just a dream come true. I really appreciate you taking the time to share your follow up. Congratulations!

Good stuff! Thanks for sharing!

I do question #3. I've seen several veterans say that gaining weight a few years out is much easier and losing the weight gained is much harder. I don't believe all of these people are engaging in bad habits. How is that explained then?

PS: I'm printing your post and sticking it on my fridge for when I hit maintenence!

@@VSGAnn2014

You have done fantastic. Thanks for the great information. Staying connected is helping me so much. I know myself. It's far to easy to get back into old habits. I get a contact high from the people in the honeymoon phase. A BIG dose of reality from others further out from surgery. My fear of gaining is still with me. Still having days when I still think I'm obese....I hope that will change in year two.

Good luck to you in year two!

@@VSGAnn2014

Question...I talked with my surgeons office on the topic of weight gain after reaching goal. I was told they normally see a fifteen pound gain as your body adjusts. I have not seen anything out there that backs up that information. Anyone get this info from there surgeon's office????

Babbs,

We always wonder when someone comes on here and says, "Help!" ... what are they doing now that's different than they were doing when they were losing weight?

Of course, I don't know what's going on with those folks who are 3-4 years out and now gaining weight, because I don't have specific info about how they're eating / drinking / exercising.

However, I don't recall anyone coming on here saying, "I've gained!" and then offering a full list of what they're eating and drinking and exercising.

I do see some people say things like, "I know I'm eating more slider foods now than I used to." Or "I'm grazing now and can't seem to quit." Or "I don't exercise like I used to." Or "My life is so much more stressful now, and I can't focus on myself like I used to."

I have also seen people (on multiple boards) say they were able to buckle down and lose 20-30 pounds. I've also seen people on this and other boards who are 3, 4, even 5 years out who are still at goal. Not a lot, mind you. But there are some.

Remember -- I just asked the bariatric PA what happens in Year Two.

P.P.S. My bariatric PA also said she sees a lot of people during maintenance who start to drink a lot more of their daily calories -- specifically in the form of alcohol. She didn't reference this as a "transfer addiction" issue, but as an "empty calories" issue.

@@VSGAnn2014

Sorry, I'm going back and forth between Rog's thread and yours. I had coincidently asked Jane the question about why she felt it's easier to gain and harder to lose, and she pretty much backed up what your PA said in #3!

So there you go

P.P.S. My bariatric PA also said she sees a lot of people during maintenance who start to drink a lot more of their daily calories -- specifically in the form of alcohol. She didn't reference this as a "transfer addiction" issue, but as an "empty calories" issue.

Aww yes. Drinking your calories. The deadliest sin with WLS patients. I know by experience with my husband. Too many Starbucks coffees, beer and full sugar soda caused a 30 pound gain after he quit smoking.

Congratulations on your fantastic progress! How wonderful to not have to go through knee surgery now.

I hope that I am successful as you at year two. I always worry about maintenance.

The good news for me is I never ever drink anything besides Water and I was like that for 2 years before my surgery. I don't feel like liquid calories will ever get me.

I do worry about the crunch factor getting the best of me sometimes. I try hard to be very healthy with those Snacks.

@@Djmohr ... just to be clear, I am only one year and two weeks post-op. I'm just starting my second year, hence the title and the questions I asked my PA today.

Thank you so much for sharing the information! You are so inspiring!

Congratulations!! You're amazing. Thank you so much for posting this. It was very thoughtful of you. Although I'm just starting my journey, I took notes so I can refer to them down the line.

Thank you very much for the post and the information. Greatly appreciated.

@@VSGAnn2014 - so psyched to hear that you can maintain 143 lbs at 1700 calories a day. That is AMAZING! I'm sure that those stats are not typical but CONGRATULATIONS!!! What is your exercise program like?