This is an honest question. Most of the people I know who have had this surgery eat whatever they want just smaller portions and of course they may not be able to tolerate everything they had before.

By my understanding this is not how this surgery is supposed to work for you by just causing you to eat smaller portions and BAM your weight drops. A big part of it what you put in your mouth no matter how much or little it is.

Ive been going to the NUT visits and being taught that the pre and post diet is pretty much the way I should be eating the rest of my life, a lifestyle change. That's really what I'm trying to prepare myself for because i know if I ever went back to my old habits..my weight would increase FAST.

Is it that they begin eating other foods when they've gotten to their ideal weight and they want to maintain or even gain a little?

I am not persuaded that the comments we see here about "When can I eat pizza again?" are really due to lack of education or knowledge. Consider this ....

This morning I spent several hours in hospital waiting rooms with a family member who's undergoing medical tests. We were there during the morning shift change, and the halls were full of nurses, doctors, and other medicos, arriving and leaving.

I started categorizing them as "normal weight" vs. "obviously overweight or obese." An hour of this impromptu survey returned these results: The ratio of "overweight or obese" to "normal weight" medical personnel was (wait for it) ... 2 to 1. That's 67% overweight or obese folks -- the exact proportion of US adults who are overweight or obese.

But if anyone should know how to eat / exercise for good health we'd expect medical professionals to be well educated on this front. And they probably are. But their education and knowledge hasn't fixed their weight problems any better than it fixed mine prior to WLS.

I don't assume that many WLS practices leave their patients totally ignorant of what to do post-op or long-term. Even most low-cost tourism WLS practices that offer no or minimal after-care provide their patients with post-op handouts and some general counseling about what to eat long-term. The knowledge is there for the reading.

Yet many WLS patients (no matter where they had surgery or how much they spent for it) seem helpless or unwilling to change the lifestyles that made them obese.

Contemporary US culture is greatly to blame, thanks to the influence of fast food, sedentary lifestyles, a lifetime of terrible habits, and the influence of friends, work colleagues, and family members who are twice as likely to be fat as slim. The pressure from peers and the environmental is horrific, and food that's terrible for us is offered daily as "treats."

In the face of so much temptation it's easy to backslide. Sometimes we feel fury at the food gauntlet we have to run. But what's really hard to create is a serene mental space where we feel safe to make on a regular basis the healthy decisions we want to make.

WLS procedures provides us with significant metabolic benefits: restriction of a smaller stomach or pouch; the cessation of ghrelin-induced hunger urges (with the sleeve); malabsorption (of the bypass and some other WLS procedures); and a 12-18 month window when our WLS surgeries make it easy for us to eat less, eat healthier, and build healthy new habits. Every WLS patient is given these early advantages to reset their lives, whether they take advantage of them or not.

But then weight loss ends and maintenance arrives -- along with diet boredom, holidays, stresses of daily living, health problems (some obesity-related, some not), inclement weather, career setbacks, exercise injuries, the illness and loss of loved ones, etc. In response, some WLS patients return to bad habits and food for comfort. But some don't.

Some stay the same weight or perhaps in a small "bounce zone." Some regain 10-15 pounds. Some folks knuckle down and re-lose the regain -- multiple times. Some just keep gaining. Of those, some stop halfway to where they started out pre-op. But some (50% of all WLS patients) regain more than 50% of the weight they lost -- some even regain all the weight they lost.

Understandably, I'm curious about why people revert to old behaviors and/or can't sustain what started them on their WLS path and, for some, got them to their goals. But I'm most curious about what distinguishes those who stay at or near their new healthy weights for the long term.

Your thoughts?

So many excellent points, @@VSGAnn2014! (As always.) Just to close out my last post... I don't disagree that it's the responsibility of the one going under the knife to learn everything they can about the surgery and the long road ahead. But the "When can I have pizza?" question from those who are only a few weeks or months out indicate that the education portion of their program has not been effective. Maybe that's a better way to say it.

Now, on to your question...

nderstandably, I'm curious about why people revert to old behaviors and/or can't sustain what started them on their WLS path and, for some, got them to their goals. But I'm most curious about what distinguishes those who stay at or near their new healthy weights for the long term.

Your thoughts?

I think driving through to goal weight and having some degree of success in maintenance requires a single-minded focus on the prize. We didn't get heavy through self-discipline, but that's what it takes to get thin. Other factors:

• Not merely fear of failure, we all have that going into surgery, but some degree of terror of the "slippery slope" that certain foods might put us on.
• Accept that the 12-18 month window for optimizing our weight loss is real and must be used to its full advantage. I was told by my doc that it takes the 12-18 months to inculcate the good eating habits.
• Learn quickly from our missteps. If we eat just two bites of cake, but then eat a whole slice the next day, then we know that the two bites were a bad idea and we shouldn't do that again.
• Certain foods are never going to be a good idea for us, and the list is different for everyone. But my doc told us that ice cream and fruit juices should always be avoided as pure empty sugar calories -- the ultimate slider foods.
• Realize that alcohol is not only empty calories, but can also lead to poor eating choices. I've done an informal poll of everyone I know (including myself) who quit smoking and then started again. 95% to 100% had an alcoholic beverage in their hand when they took that first puff. I finally quit smoking permanently 20 years ago when I became terrified to have even one puff. It's the same with food!
• Stress and boredom eating are real. Stress and loss don't cause me to eat, but watching TV does. Many of my friends go for the comfort of food when stressed. We're always going to have a certain amount of stress in our lives, so finding non-food coping mechanisms is crucial to our weight loss success.
• The ability to embrace our well-deserved success, look forward to the new slimmer/healthier self, believe what we see in the mirror, and don't look over our shoulders waiting for our former selves to pull us back.

There are many more reasons, but that will suffice for now.

Roger, thank you, thank you! So many good thoughts there.

Now I gotta think more about all this.

Well, now I feel like I need to make a distinction between "can" and "should". It sounded to me like the OP was asking if WLS patients are physically capable of eating any type of food eventually. And the answer to that question is "yes", with the few potential exceptions already mentioned.

If we want to get into a discussion about what a WLS patient SHOULD eat long-term, that's a whole other topic.

They should pin this somewhere.

I can think of a few members of this forum who should have this pinned to their foreheads.

LOL ...

I found the BEST internet meme to post on another thread today. But the link keeps getting rejected.

SUCH a shame!

Can vs. Should

They should pin this somewhere.

I can think of a few members of this forum who should have this pinned to their foreheads.

Done. I've added it to my signature.

That's pretty much exactly how the sleeve works for me. I eat what I like in small portions. I enjoy treats, but no longer to excess. And yes, there are things I tolerate less well now than I used to. Too much fat or sugar over the course of a day, (not typically one meal) will send me to a place I don't enjoy, (food trying to leave my body violently either the way it went in or by dumping), so I have to pay attention. But I do enjoy all things including carbs, deserts, and even a drink now and then in moderation.

Has it been a major change, yes, absolutely! I went from being a couch potato who ordered a lot of pizza to a person who exercises 5x per week and tends to eat a lot more high Protein, home made meals. I've come to prefer it most of the time, (probably out of self preservation . For example, I had a single fried chicken leg for lunch with a Starbucks latte (unusual for me to do that much sugar in a drink but I do occasionally). I have skinless chicken thighs, potatoes and carrots in the crock pot when I get home and will eat on that for the next several days. When I'm done for today, I'll have had about 1200-1300 calories and 75g of protein which, I've learned is about what I need to maintain while exercising off about 500 calories per day. I've maintained my 90ish pound loss for 2 years so far.

@@bikrchk, I admire that you can handle small amounts of everything, but I'm still nervous. Lately I've started taking a tiny bite of special foods my wife or daughter make just so I can ooh and ahh over them. But just a taste, not enough to go, "Wow, I want more of that!" But I'm still 3 months shy of one year since making goal weight. We'll see where I am in another year or more. I've heard/read a number of times that years 2 and 3 are critical to long-term success. Which is what I wish for you and for us all.

One of my biggest issues before surgery was eating cake tops

and icing from cakes I would bake. I haven't scheduled many cakes post surgery because I wasn't sure how I would handle the temptation.

I've made 3 cakes since surgery (4 weeks today) and I have no desire to taste even the icing. Luckily I have my recipes down to a science. This is a big step. I think for me the desire to be heathy and present is stronger than my desire to eat whatever I want.

@@bikrchk, I admire that you can handle small amounts of everything, but I'm still nervous. Lately I've started taking a tiny bite of special foods my wife or daughter make just so I can ooh and ahh over them. But just a taste, not enough to go, "Wow, I want more of that!" But I'm still 3 months shy of one year since making goal weight. We'll see where I am in another year or more. I've heard/read a number of times that years 2 and 3 are critical to long-term success. Which is what I wish for you and for us all.

Everyone needs to do what works for them! I still monitor myself pretty closely and I do battle weight "creep". When it creeps outside my comfort zone, I journal and drop back to 1200 calories per day until the problem is managed. I also live alone and do all my own cooking so I don't have a lot of distractions, which helps!

The when can I have pizza question which I find annoying mainly because I have always thought pizza was really overrated, is more about head hunger and second thoughts post surgery than I think lack of education. People are miserable and want to know if there is a light at the end of the tunnel.

I wish more people know how to cook, really cook from scratch with real food. The is the first big problem with weight I'm America. Then people have surgery can't cook do you research recipes before surgery and feel like they can't have anything delicious. If you can cook, you can make a low carb version of basically anything.

As someone else said, things that are triggers for me, I can't have 2 bites. My only thing is French fries. I can't have 2 fries. I want a whole basket if I just have 2, so I can have zero. Everything else I can stop on but not fries. Rutabaga fries however don't cause this issue, they taste good but not too good. I learned and I adjusted.

@@VSGAnn2014 I remember reading results from the National Weight Control Registry years ago (they track people who have maintained a significant weight loss for over 5 years, I believe) and they found these behaviors highly correlated with successful weight loss maintenance:

• regular exercise - closer to an hour per day than something minor like walking for 30 minutes 3 times per week
• weighing yourself at least once per week
• watching much less tv than the average person
• not giving yourself permission to take "diet holidays" -- I'll eat whatever I want on Sundays, or on vacation, etc., and be "good" the rest of the time.

I've heard that its the diet/surgery that gets the weight off but the exercise that keeps it off. There is something to that as well in that maintaining more muscle mass keeps your metabolism revved. I haven't quite made it to my personal goal of 5 x per week, but I'm getting there.

Thx for the wealth of responses! My concern are the friends who are eating unhealthy foods from what I see, on a regular basis. It may not be my business but I certainly don't want to see them go backwards after so much progress and success. My hopes for myself and anyone who has wls is that its successful and long term. However I do realize that not all are mentally or educationally prepared for this. Although, shouldnt alot of it be common sense???? At the same time thats why changing eatting habits strictly during the first yr is so important...it will help to keep that craving horomone at bay...and teach you how to make better choices (Eat This, Not That!).

The fact that a high percentage of wls patients gain %50 of weight back, is quite scary.

"I didn't get WLS and then expect to be on a diet for the rest of my life!" are words I've seen posted numerous times on WLS forums.

The word "diet" doesn't freak me out like it does some folks. But I think what they are really saying is that they are hoping for a life where they can no longer overeat and will always be able to eat "regular foods" in moderation. In short, they want a surgical result that removes the risk of succumbing to old temptations.

The trouble is that long-term that's not how WLS usually pans out. Everyone I've read who's 3-4-5 or more years post-op (with a sleeve) agrees that being aware, consistent, disciplined and mindful is very important to their long-term success.

As @@Rogofulm said:

We didn't get heavy through self-discipline, but that's what it takes to get [and stay] thin.

For the last two years I've been in therapy, focusing in part on improving my abilities to care for my health consistently. What became apparent early on in therapy was that I have a tendency toward impulsiveness. As with all personal attributes, my impulsiveness isn't an all or nothing condition, but varies depending on the situation and environment. For instance, I seldom overeat when life hits me hard, but tend to eat more when I'm happy and celebrating and in the presence of others who are happy and celebrating.

After recognizing this tendency in myself, I've focused a lot on consistency in food planning to ensure my food is nutritious. Most days I track my food and liquids on MFP. I weigh daily and record my daily weight. I suppose some would think I'm on a "lifetime diet," since I try daily to eat 80-100 grams of Protein, 5 low-starch veggies/fruits, whole grains, and healthy oils. But I also have wine, dark chocolate, bread, even occasionally pizza. However, I eat those foods in smaller portions than the healthier foods I choose.

Thank goodness, I don't have to be perfect. But I can be successful long-term IF I remain disciplined and consistent in how I eat and exercise. And in the last 18 months I've finally learned what it takes for me to remain that disciplined and consistent.