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!

:)

I appreciate the information you have posted. I am close to 7 months post-op and was pretty discouraged by the info posted by rogofulm. I plan to print out your post too. I think it will help when I reach maintenance. Thanks for thinking of us and sharing what you learned.

@@VSGAnn2014 - Thank you for sharing your questions to and answers from your PA. It is very encouraging and will be very helpful in multiple ways. I appreciate your forthrightness and wisdom of your posts. My daily jaunts on BP always provide me with a lot of information to ponder. Your posts are some that I always look forward to. Thank you for being an inspiring VSGer

I appreciate the information you have posted. I am close to 7 months post-op and was pretty discouraged by the info posted by rogofulm. I plan to print out your post too. I think it will help when I reach maintenance. Thanks for thinking of us and sharing what you learned.

Hey Borg, I'm so sorry that my post discouraged you! I knew that was a risk when I wrote it, but sometimes we need to understand the hard truths in order to stay completely focused and not take our foot off the throttle. Just like before surgery when they tell us that the risks include *death*, we need to know what our risk factors are so we can make daily choices fully armed with the necessary information. Please try to use it as motivation, not as an impossible hill to climb. As you've read from this thread and others, long-term maintenance is definitely achievable. And the people who remain fully engaged in their programs, including facing the daily challenges, are the ones most likely to succeed!

At my 18 month follow-up in June, I was told to knock it off with the Protein drinks and get my protein from real food. I have a tendency to add fruit to my shakes to make them palatable. My instructions were to quit drinking my fruit, too. It is for sure important to keep in touch with your team. As long as I stay honest with them, they can continue to help keep me on course. I was also told to keep weighing, measuring, and logging since I have a bad case of portion distortion. It only takes me three days of going rogue to start gaining back. My sleeve has definitely forced me to be more aware of what I eat, when I eat, and how I eat.

@@VSGAnn2014 - Congratulations on your personal success and thank you for the support and inspiration you provide to this group. That is some great info from your PA. I ran across this study when it came to leptin and ghrelin and WLS: http://www.ncbi.nlm....les/PMC4284080/. I was interested in this because of the research on weight set point that seems from leptin which is explored in depth here: http://theweightofth...-of-weight-loss

Leptin, ghrelin, both affect the bodies set point and our weight loss...and keeping it off, but some people's "set point" seems to get reset and others do not. Why? Who knows. But it is an ongoing struggle. We have to find our max calorie level, exersise level etc. Dang we are complicated critters. But I am going to look hard at upping my calories about 10% at this point. Thanks.

Edited August 28, 201510 yr by OKCPirate

You have done so well - a true inspiration to all!

I have to say though, I am not sure I completely agree with all the points, but my personal experience definately matches much of what was said.

I will be 4 years in December (Dec 2011). What I can say is this year has been different then the previous ones for a variety of reasons. I hit goal in Feb 2013. Lost 150# in 14 months and have been maintaining pretty well.

I have mixed feelings about the honeymoon period arguement. I lost significant amount of additional weight in 2014 and got 20 under goal, when I had been in maintenance over a year but it was due to problems that caused me to not be able to eat. (not really sleeve related). I do think there is a honeymoon period even if it is partially "in your head". It is my opinion that they don't actually KNOW all the reasons for how the sleeve works. For example, nobody has ever been able to tell me why Water tasted metallic to me the first year or so post op. I still don't love plain water like I used to. Why would that happen from a partial stomach removal?

Anyway, I do think the main point is spot on - you have to keep doing what you did to keep having success. There is nothing really magical about maintenance in truth... it is just more of the same forever.

@@OKCPirate That video to which you posted the link was extremely educational! Thank you for posting it.

@@Rogofulm

Sorry if I sounded like I wanted to kill the messenger. Forewarned is forearmed I do believe, however sometimes my emotions come into play and I just don't want to hear about the hard stuff. I can do hard stuff! Your information just reminded me that I must do the hard stuff if I intend to be successful long term.

@@Rogofulm

Sorry if I sounded like I wanted to kill the messenger. Forewarned is forearmed I do believe, however sometimes my emotions come into play and I just don't want to hear about the hard stuff. I can do hard stuff! Your information just reminded me that I must do the hard stuff if I intend to be successful long term.

Yup, it kinda sucks. But it sure tells us what we need to do (and not do), doesn't it?

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.

Could you say a little more about this metabolic honeymoon? I've not heard of it and I tried googling but couldn't find much. Also, congrats on a successful first year! Hope I'm joining you this time next year.

@@VSGAnn2014

Loved your post! It makes so much sense that our bodies would get used to a set point, and if that set point is 1000 calories, eventually we could gain weight even on that.

Would you mind sharing what a typical day's meals look like? I'm just 23 days out and having a hard time visualizing how I'll ever be able to eat 100 grams of Protein, 5 servings of fruit and veggies, and 21 grams of Fiber. I'm struggling to get my 60-80 grams of protein (hitting it, but have to work hard at it) and I am WAY under on fiber. My only veggies right now are in V8. Which I can drink a 5.5 oz can of!!!

More worrisome, I can eat 5 ounces of mushies/puree no problem. And if my stomach is empty, I get nauseated. I'm finding I eat a small something every couple of hours just to keep from feeling nauseous and having a feeling that my tummy is gnawing itself away. As a result, I'm eating about 800 calories a day. I'm worried that's too much this early. I'm starting soft foods tomorrow (which my Nut distinguishes from pureed, although I'm not exactly sure that the difference is!)

@@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?

I don't think it's that uncommon. I mean I know I hear people on the board say they can't maintain on more than 800/1000/1200 calories and I'm sure that's true for some. But I "wrecked" my metabolism plenty yo yo'ing most of my life and yeah I exercise a lot, but I maintain my 135lbs on 1800+ calories (more on days I run) and during my six weeks of no exercise post plastics I still ate 1600 calories or so and maintained fine.

I think those stats are as typical as the others. We are all different for sure, but I think there are many of us who can maintain at that calorie level.

@@jess9395

How many calories were you losing on?

@@VSGAnn2014 congratulations on your new life! It is clear you are enjoying it

Oh, I want all that your dietician said to be true!! I'm not sure my experience could corroborate it, though. In particular, #2. I don't know if it's ghrelin or something else, but I do believe that hunger returns, and it's not head hunger. At nearly three years post op, I know the difference. It's not nearly as intense as before, but it most certainly different than it was at 6 months or even 2 years post op.

- 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?

Mostly, I just walk 8,000-10,000 steps a day. I do a yoga class once a week (should be twice, but our schedule is craaaazy right now) and strength training (machines) two times a week (should be three times) and (rarely) another gym classes (BodyPump, etc.), but, as I said, our schedule is nuts right now.

A sad aspect of life is that we currently have two parents in the last days of their lives (Alzheimers and lung cancer), and their needs are absorbing a lot of our non-working daylight hours. I'm sure many of you understand this well. But we're both doing a lot better about caring for ourselves (reserving enough energy for us, rather than giving it all to others). Doesn't take a lot. But you really can't give everything away and expect to do well health-wise yourself. This has been a lifelong and very hard lesson to learn.