Getting enough calories

[bellabloom 2,469]

I'm not having issues with the stricture any more

Edited January 11, 2016 by bellabloom

[Healthy_life2 8,330]

Wow, Here I go.

I would like the issue of eating disorders after bariatric surgery to be addressed some how. I am very much supportive of bariatrics. This issue is not intended to scare people away from surgery. I appreciate @@bellabloom honesty.

I found this info on the web. I'm trying to find statistics and more recent studies. @@Alex Brecher do you have any info on this?

• By COURTNEY HUTCHISON ABC NEWS MEDICAL UNITJune 13, 2011

Weight-loss surgery was supposed to be Chevese Turner's salvation -- a last resort in her battle against obesity and binge eating. Instead, her 2007 lap band procedure catapulted her into full-blown bulimia.

"I had always struggled with binge eating, and my relationships with food didn't change just because of the lap band. Even though binging is really painful when your stomach is restricted like that, I would still binge knowing that I would throw it up. I felt like finally I could be bulimic, like this was what I wanted all along," says Turner, 43, of Soverna Park, Md.

Turner knew she had a binge eating disorder going into surgery, but after experiencing cardiac complications attributed to a lifetime of yo-yo dieting, she was desperate to lose weight. Instead of solving her overeating problem, however, the surgery only changed its form: for 18 months following the surgery Turner regularly binged and purged.

Only after going into intensive therapy to cope with the binging behavior she had experienced since age 5 did Turner, who now runs the Binge Eating Disorder Association, build a healthy relationship with food and her body.

When multiple traditional diet methods fail, weight-loss procedures such as the band are seen as a last hope for getting obese patients to eat more healthfully and lose weight. For an underrecognized minority of patients, however, the surgery only triggers a different kind of disordered eating. For Turner, it was bulimia, for others, it's anorexia. For one fellow patient in Turner's community, the anorexia was so severe that it ultimately took his life.

Sixty percent of individuals seeking treatment for obesity have some kind of eating disorder, usually binge eating, according to a 2007 Harvard study. It is these individuals, who already have an unhealthy relationship with food and their bodies, who are at most risk of developing further eating disorders post-surgery, says Lisa Lilenfeld, a psychologist and president of the Eating Disorders Coalition at Argosy University in Washington, D.C.

Lap band or gastric bypass surgery is not likely to create an eating disorder where there wasn't one, she explains, but "the most likely thing is that people had untreated or unsuccessfully treated binge eating disorders before surgery will continue to have problems after surgery. The problem is, it becomes physically challenging and potentially dangerous to binge like this because of the structural changes in the stomach," she says.

On the other end of the spectrum, patients who used to overeat now overshoot with their weight loss, severely limiting their caloric intake to the point of malnutrition and anorexia.

"I've had a number of patients go from very obese to very underweight, so much so that they need to be rehabilitated with intravenous nutrition," says Dr. Donald Kirby, a gastroenterologist at the Cleveland Clinic who treats patients undergoing bariatric weight-loss surgery.

Because there are so no statistics on how many of these patients experience eating disorders post-op, it's difficult to gauge the scope of this issue and there is much debate over its prevalence between the surgeons who perform the procedures and the therapists who treat eating disorders down the line. Dr. Mitch Roslin, a bariatric surgeon at Lenox Hill Hospital in New York, has performed thousands of bariatric surgeries and he says he only sees one or two cases a year of eating disorders, but psychologist Lilenfeld believes it's much more common than that.

Binge Eating: Hiding an Eating Disorder

Technically, those with diagnosable eating disorders are not advised to undergo weight-loss procedures, but because each hospital and insurance company has different psychological screening requirements, many patients with mental health problems slip through the cracks.

In some cases, psychological screenings consist of asking only a couple of basic questions that don't even address eating disorders or mental health concerns, says Dr. Leslie Seppinni, a therapist who specializes in treating obesity. "Then after the surgery, most doctors fail their patients in terms of follow-up. There are some group sessions with other patients, but that's about it."

In Turner's case, however, her health insurance had relatively rigorous requirements for surgery approval, including an eating disorder screening and a letter from her therapist. But for those who are desperate to get the surgery at all costs, she says it's relatively easy to get around these requirements by answering the questions "right," as she did.

Because of insufficient screening or deception, Lilenfeld says about a third of all patients who undergo weight-loss procedures are believed to have "severe binge eating disorder" going into surgery, though not all of these patients will go on to develop other eating disorders post-op.

Anorexia/Bulimia After Surgery: Medical or Emotional?

One of the reasons that true anorexia and bulimia may not be recognized after bariatric surgery is that the symptoms of these eating disorders can mimic some of the expected adverse affects of the surgery.

In the months following surgery, the stomach has to heal and slowly expand, which makes eating difficult and sometimes painful. Patients who eat too much will sometimes throw up because it's the only way to relieve the pain in their stomach, not because they are compulsively trying to get rid of calories. Similarly, the indigestion, diarrhea and acid reflux that can occur post-op leads some patients to avoid eating altogether just because eating becomes an unpleasant experience. These patients will become malnourished and resemble anorexics, but the psychological aspect of the disorder is not there.

It is important to distinguish between these medical reasons for anorexic/bulimic behavior and true, psychological cases of eating disorders, says Seppinni, who has traveled the country interviewing people about their experience with obesity, weight loss and bariatric surgery. In true cases of eating disorders, it's about the addiction to overeating getting transmuted into another addiction. For some, they become compulsive exercisers, for others, alcoholics, for still others, anorexics. "You take away the coping strategy they've been using all their lives, and the addiction has to go somewhere else," she says.

The "loss" of binging as a coping strategy was palpable for Turner following her surgery. "I lay in bed and cried for a week because I couldn't eat. Eating was the way I soothed myself my whole life. As soon as I could binge again, even though it was extremely painful, I did," she says.

[jess9395 5,450]

I'm not having issues with the stricture any more

Has your doctor identified any other physical issues? The amount and variety of foods that cause you to dump seem really high especially for a sleeve patient, I just assumed it was the structure issue. Is he attributing it to your conversion from bypass to sleeve? Any predictions on when it will end?

Seems like a cant win situation that may need medical intervention.

[foodfighter78 258]

@@bellabloom I have same problem only worse I can't get no more then 1200 cal a day. 10 months from surgery. Now I'm at 119 for 5,6 I try to eat and push food but I can't it hurts, I been dealing with strictures, I went to a different Bariatric center and they said everything is ok mechanically. So they thing is the strictures that cause so much restriction. Last baloonplasty in December. But I still can't eat a complete meal. Bellabloom if you eat 1800 cal a day you should be staring getting. Also my doctor told me it will take time to gain weight , is not like a magic switch.

Edited January 12, 2016 by foodfighter78

[bellabloom 2,469]

Wow, Here I go.

I would like the issue of eating disorders after bariatric surgery to be addressed some how. I am very much supportive of bariatrics. This issue is not intended to scare people away from surgery. I appreciate @@bellabloom honesty.

I found this info on the web. I'm trying to find statistics and more recent studies. @@Alex Brecher do you have any info on this?

• By COURTNEY HUTCHISON ABC NEWS MEDICAL UNITJune 13, 2011

Weight-loss surgery was supposed to be Chevese Turner's salvation -- a last resort in her battle against obesity and binge eating. Instead, her 2007 lap band procedure catapulted her into full-blown bulimia.

"I had always struggled with binge eating, and my relationships with food didn't change just because of the lap band. Even though binging is really painful when your stomach is restricted like that, I would still binge knowing that I would throw it up. I felt like finally I could be bulimic, like this was what I wanted all along," says Turner, 43, of Soverna Park, Md.

Turner knew she had a binge eating disorder going into surgery, but after experiencing cardiac complications attributed to a lifetime of yo-yo dieting, she was desperate to lose weight. Instead of solving her overeating problem, however, the surgery only changed its form: for 18 months following the surgery Turner regularly binged and purged.

Only after going into intensive therapy to cope with the binging behavior she had experienced since age 5 did Turner, who now runs the Binge Eating Disorder Association, build a healthy relationship with food and her body.

When multiple traditional diet methods fail, weight-loss procedures such as the band are seen as a last hope for getting obese patients to eat more healthfully and lose weight. For an underrecognized minority of patients, however, the surgery only triggers a different kind of disordered eating. For Turner, it was bulimia, for others, it's anorexia. For one fellow patient in Turner's community, the anorexia was so severe that it ultimately took his life.

Sixty percent of individuals seeking treatment for obesity have some kind of eating disorder, usually binge eating, according to a 2007 Harvard study. It is these individuals, who already have an unhealthy relationship with food and their bodies, who are at most risk of developing further eating disorders post-surgery, says Lisa Lilenfeld, a psychologist and president of the Eating Disorders Coalition at Argosy University in Washington, D.C.

Lap band or gastric bypass surgery is not likely to create an eating disorder where there wasn't one, she explains, but "the most likely thing is that people had untreated or unsuccessfully treated binge eating disorders before surgery will continue to have problems after surgery. The problem is, it becomes physically challenging and potentially dangerous to binge like this because of the structural changes in the stomach," she says.

On the other end of the spectrum, patients who used to overeat now overshoot with their weight loss, severely limiting their caloric intake to the point of malnutrition and anorexia.

"I've had a number of patients go from very obese to very underweight, so much so that they need to be rehabilitated with intravenous nutrition," says Dr. Donald Kirby, a gastroenterologist at the Cleveland Clinic who treats patients undergoing bariatric weight-loss surgery.

Because there are so no statistics on how many of these patients experience eating disorders post-op, it's difficult to gauge the scope of this issue and there is much debate over its prevalence between the surgeons who perform the procedures and the therapists who treat eating disorders down the line. Dr. Mitch Roslin, a bariatric surgeon at Lenox Hill Hospital in New York, has performed thousands of bariatric surgeries and he says he only sees one or two cases a year of eating disorders, but psychologist Lilenfeld believes it's much more common than that.

Binge Eating: Hiding an Eating Disorder

Technically, those with diagnosable eating disorders are not advised to undergo weight-loss procedures, but because each hospital and insurance company has different psychological screening requirements, many patients with mental health problems slip through the cracks.

In some cases, psychological screenings consist of asking only a couple of basic questions that don't even address eating disorders or mental health concerns, says Dr. Leslie Seppinni, a therapist who specializes in treating obesity. "Then after the surgery, most doctors fail their patients in terms of follow-up. There are some group sessions with other patients, but that's about it."

In Turner's case, however, her health insurance had relatively rigorous requirements for surgery approval, including an eating disorder screening and a letter from her therapist. But for those who are desperate to get the surgery at all costs, she says it's relatively easy to get around these requirements by answering the questions "right," as she did.

Because of insufficient screening or deception, Lilenfeld says about a third of all patients who undergo weight-loss procedures are believed to have "severe binge eating disorder" going into surgery, though not all of these patients will go on to develop other eating disorders post-op.

Anorexia/Bulimia After Surgery: Medical or Emotional?

One of the reasons that true anorexia and bulimia may not be recognized after bariatric surgery is that the symptoms of these eating disorders can mimic some of the expected adverse affects of the surgery.

In the months following surgery, the stomach has to heal and slowly expand, which makes eating difficult and sometimes painful. Patients who eat too much will sometimes throw up because it's the only way to relieve the pain in their stomach, not because they are compulsively trying to get rid of calories. Similarly, the indigestion, diarrhea and acid reflux that can occur post-op leads some patients to avoid eating altogether just because eating becomes an unpleasant experience. These patients will become malnourished and resemble anorexics, but the psychological aspect of the disorder is not there.

It is important to distinguish between these medical reasons for anorexic/bulimic behavior and true, psychological cases of eating disorders, says Seppinni, who has traveled the country interviewing people about their experience with obesity, weight loss and bariatric surgery. In true cases of eating disorders, it's about the addiction to overeating getting transmuted into another addiction. For some, they become compulsive exercisers, for others, alcoholics, for still others, anorexics. "You take away the coping strategy they've been using all their lives, and the addiction has to go somewhere else," she says.

The "loss" of binging as a coping strategy was palpable for Turner following her surgery. "I lay in bed and cried for a week because I couldn't eat. Eating was the way I soothed myself my whole life. As soon as I could binge again, even though it was extremely painful, I did," she says.

Thank you for posting this.

[bellabloom 2,469]

@@bellabloom I have same problem only worse I can't get no more then 1200 cal a day. 10 months from surgery. Now I'm at 119 for 5,6 I try to eat and push food but I can't it hurts, I been dealing with strictures, I went to a different Bariatric center and they said everything is ok mechanically. So they thing is the strictures that cause so much restriction. Last baloonplasty in December. But I still can't eat a complete meal. Bellabloom if you eat 1800 cal a day you should be staring getting. Also my doctor told me it will take time to gain weight , is not like a magic switch.

I'm so sorry. I know what you are going through! Thank you for your post. I really hope things turn around for you.

[foodfighter78 258]

@@bellabloom I have same problem only worse I can't get no more then 1200 cal a day. 10 months from surgery. Now I'm at 119 for 5,6 I try to eat and push food but I can't it hurts, I been dealing with strictures, I went to a different Bariatric center and they said everything is ok mechanically. So they thing is the strictures that cause so much restriction. Last baloonplasty in December. But I still can't eat a complete meal. Bellabloom if you eat 1800 cal a day you should be staring getting. Also my doctor told me it will take time to gain weight , is not like a magic switch.

I'm so sorry. I know what you are going through! Thank you for your post. I really hope things turn around for you.

Why do we have this problem it doesn't look like a common thing. Most people don't loose enough or regain soon. I hope you can gain weight soon. I have no energy, I think I'm getting depress also. Was this surgery a total mistake?

[Alex Brecher 10,516]

Bellabloom,

It sounds like a struggle for you. The others have had some great points and ideas.

Focusing on some calorie-dense foods might help. What about nuts? cheese? Going back to the Protein shakes, as you may have used in the first stages post-op, could also help. Can you blend in, say, avocado and/or Peanut Butter to shakes to increase the calories? Could you cook foods with sneaky fats, like baking your Protein with olive oil, or tossing Pasta with olive oil?

Finding some slider foods seems like a great idea! Wheat Thins or other crackers, Cereal, macaroni and cheese (make it whole grain and real cheese, if you’re worried about junk food), or whatever may work for you.

I understand you don’t want to eat junk food, but if you’ve honestly tried every healthy food on the planet and you can’t get enough calories, junk food may be your best (and only) bet to make up the calories you need to stop losing weight. Maybe in a while, you’ll be able to eat more “healthy” foods and reduce the calories from “unhealthy” foods

I agree with some of the other members who suggest simply making it a priority – the same way after surgery when it’s really, really tough to get down those Protein Shakes to make 65 grams a day, and to get down that Water to make 64 ounces a day. Maybe eating will feel like a full-time job, but maybe it needs to be if the alternative is getting thinner than you want to be.

Experimenting until you find your own “slider” foods seems like a possibly great idea!

If you’re really and truly at a point where you cannot eat enough to subsist, that’s a serious problem! I hope you can find a nutritionist who addresses your particular problems and doesn’t just label you before listening to your story.

@@jenn1, I don’t have a ton of personal experience with eating disorders of the non-overeating type, but I know it’s definitely a big deal in our WLS community!

There’s a nice article here from the Obesity Action Coalition discussing obesity, eating disorders (binge eating disorder or BED, anorexia, and bulimia), and cross addictions. I’ve also heard them referred to as replacement addictions: after WLS, the addiction to food can be “replaced” by an addiction to something else.

The article makes a very interesting point that after WLS, the person may not realize they are developing a replacement addiction. They think they can handle the alcohol, or whatever it is they are turning to, and don’t realize when they get to a point that’s dangerous.

Anyway, it is definitely very common to have eating disorders (especially if you’ve struggled in the past) or other cross addictions post-op.

Thanks for that info, @@jenn1.

@@bellabloom, I would say to be super honest with yourself – can you physically eat more and do you want to? – and if the answer is that you’re in physical pain and you cannot get enough nutrients, then you need serious medical help. You’ve posted about this for several weeks (if not longer), and that’s way too long to live with bad pain.

You have worked so hard to get to where you are now, and you’re worth a trip to the doctor.

[Chrystee 838]

What about a higher calorie Protein Shake? You could have one weight gainer shake, which would help your calorie/protein and carbs..

[Chrystee 838]

This morning my weight dropped again, to 114. At 5'6 that basically makes me DISCUSTING.

It seems to be dropping faster now than I am eating!!!!!! I don't get this. I have to find a dietician here asap.

First off.. You aren't disgusting in any way, shape or form.. so stop telling yourself this. Secondly, you definitely need to up your calories, probably to 2000 or more, that is normal for most people to maintain, esp. women. At 1600, that is really a deficient caloric intake for you..

Can you post a normal meal schedule and what you usually eat? You could also go to GNC or another local health food place and get a weight gainer shake. Add 1 to your normal meal schedule.

[Inner Surfer Girl 12,015]

What about a higher calorie Protein Shake? You could have one weight gainer shake, which would help your calorie/protein and carbs..

That was what I was thinking since body builders drink higher carb shakes, but since she can't drink Boost then I would think she may have a similar reaction to higher carb shakes.

[Chrystee 838]

What about a higher calorie Protein shake? You could have one weight gainer shake, which would help your calorie/protein and carbs..

That was what I was thinking since body builders drink higher carb shakes, but since she can't drink Boost then I would think she may have a similar reaction to higher carb shakes.< /p>

True, but you can find some that have higher calories, and not so many carbs. Boost has a lot of sugar too i think.

Or maybe if its sipped all day.

I would say that there are lots of bodybuilders who are in prep mode that keep their calories higher but carbs are usually watched.

[JapGirl 229]

What about a higher calorie Protein shake? You could have one weight gainer shake, which would help your calorie/protein and carbs..

That was what I was thinking since body builders drink higher carb shakes, but since she can't drink Boost then I would think she may have a similar reaction to higher carb shakes.< /div>

True, but you can find some that have higher calories, and not so many carbs. Boost has a lot of sugar too i think.

Or maybe if its sipped all day.

I would say that there are lots of bodybuilders who are in prep mode that keep their calories higher but carbs are usually watched.

Isopure has an unflavored no carb protien powder. It has 25g of protien per scoop. And you can mix it with literally anything. I've mixed it into coffee, Soup, etc.

[Chrystee 838]

What about a higher calorie Protein shake? You could have one weight gainer shake, which would help your calorie/protein and carbs..

That was what I was thinking since body builders drink higher carb shakes, but since she can't drink Boost then I would think she may have a similar reaction to higher carb shakes.< /div>

True, but you can find some that have higher calories, and not so many carbs. Boost has a lot of sugar too i think.

Or maybe if its sipped all day.

I would say that there are lots of bodybuilders who are in prep mode that keep their calories higher but carbs are usually watched.Isopure has an unflavored no carb protien powder. It has 25g of protien per scoop. And you can mix it with literally anything. I've mixed it into coffee, Soup, etc.

Any idea on the calorie count? I think she needs a higher calorie count though.

[foodfighter78 258]

@@bellabloom I was thinking about you why don't your doctor gives you an IV I know they can put a feeding tube also. I mean if comes to that you have to take action to gain weight. Also I don't understand why you don't eat more. Are you in pain when you eat like me? Or you don't want to eat more? I unfortunately can't eat anymore then 1200 a day. I'm pretty desperate myself. But I'm actually hungry and want to eat, it hurts a lot to eat. I'm 118 this morning. I know doesn't look good at all. I'm giving myself 3 months if I keep dropping weight I'm going to ask to be admitted and get IV or something to help.