Maybe the regain has nothing to do with emotional eating or bad food choices?

[catwoman7 10,875]

I know the stats aren't encouraging, but on the other hand, there seem to be a lot of us around on these forums (this one and others I'm on).

[Creekimp13 5,838]

Actually, if you look closely...I think you'll find that about 2 in every one hundred posters here....have the results you do. That's not even counting the thousands of people who read and don't post, and the other thousands who post once or twice and lose interest.

Just sayin...

[Xerox 14]

The OP was about why people regain, not how many people statistically regain and to what extent.
The focus on regain is kind of silly. Wouldnt it make more sense to say that statistically people post op do not adopt the kind of eating habits and lifestyle that would result in weight loss and maintenense long term? Because that is what we are talking about.
Energy doesnt come from nowhere and you cant live without expending energy.
The reason people regain is because they are consuming more energy than their body is expending on average.
If you want your body to burn more calories then you will need to exercise and build lean muscle.
If you dont want to exercise then you will have to eat low calorie foods like lean meats and non-starchy vegetables.
Statistically people probably arent willing (or dont have the means) to make that kind of change to their lifestyle and that is why they regain.

Edited December 30, 2017 by Xerox

[summerset 5,261]

18 minutes ago, Xerox said:

Statistically people probably arent willing (or dont have the means) to make that kind of change to their lifestyle and that is why they regain.

In the end that's no surprise. Before WLS we couldn't adopt these new and oh-so-healthy habits - why should the whole bunch of WLS patients be able to do that after surgery?

What tremendously helped me changing behaviors (though I have enough "bad" ones I guess, lol) was reading books about normal eating and it was also the fact that it's easier to maintain the weight when you're close to your goal. When I look into the mirror, being fully clothed I can say to myself "Well, that's not bad - don't mess it up!" - I think I should really look into plastics even though I dread the whole procedure (I fear I will have to shell out the money because I don't have any inflammation or what not in the skin folds) but it seems to be a fact that patients who had plastics do better at maintaining a low weight. Might be because of "Well, that's not bad - don't mess it up!" but also be because empty fat cells are removed that don't scream to be filled or most likely both.

[Xerox 14]

I wouldnt say we couldnt do it. Ive been down from my highest weight for years and im up from my lowest weight in my adult life which I initially acheived through diet and exercise.
My problem was binge eating, but now my problem is lazyness, its a shame because the food ive been eating recently doesnt satisfy me in any way other than making me not hungry, while eating a healthy whole foods diet was enjoyable, but my problem is I have developed new bad habits of being too uninterested to cook and resorting to quick fixes in the form of high carb foods like bread, rice and potatoes.
If I continue this post op then I will not shift the weight, my hope is I will become a more mindful eater over the next year or so because I dont remember a single meal ive had since Christmas, probably just a whole lot of sandwiches and left over christmas Cookies.< br />

[summerset 5,261]

2 hours ago, Xerox said:

I wouldnt say we couldnt do it.

Me neither, but just as every other medical therapy on this planet doesn't work in 100% of the cases with 100% success it's not realistic to expect 100% of WLS patients being 100% successful.

I think most surgeons have a way more distant and neutral view of this treatment method than most patients. The patient's view seems to be loaded with emotions (no surprise here) and that is reflected on this board as well. It's never the treatment method that fails, it's always the patient who isn't strong enough, disciplined enough, motivated enough if goal weight isn't 100% or 100% maintained for the rest of life.

This is very interesting because we used to be the same with diets. Then came the "diets don't work" movement along, backed up scientifically. And then as a last resort there is WLS - it's kind of depressing to accept that this last resort treatment isn't 100% fool proof either. It's easier to blame the fellow patients because it's quite frightening to think about the fact that you yourself might be one of the patients where it doesn't work 100%.

And this sword of doom looms above your head for a very long time, if not forever. You always worry and if it's only in that little chamber in the back of your brain: "Will I be able to get down to a normal BMI?", "Will I be able to maintain my weight loss?", "Will I regain everything I lost or most of it?", "I simply can't accept even a slight gain or I'm a failure", "Will I be able to function on this high level of discipline and vigilance for the rest of my life?", "What about my 15 h per week exercise program when I suffer a serious injury and have to pause for several months?", "Am I really doomed to always follow a rigid diet for the rest of my life?"

I dunno - maybe after having had surgery almost 17 years ago now and having had one revision and adhesiolysis I tend to see things differently than I had 10 or 15 years ago. I went through quite a few things during these years, including some regain when I stopped smoking, being obsessed with clean eating, exercise addiction before several sports related ailments stopped me in my tracks and being just burnt out from all the above.

This is why I'm convinced that we should strive for a sustainable middle ground when it comes to eating and exercise and I can't see that much on the various WLS boards so I'm still searching for a place to settle down. Maybe it's because there aren't much people around whose surgery lies back so many years. Here you are a "veteran" after you're - what? - 18 months out IIRC.

I personally think this is not a very long time out. Also being 2 or 3 years out is not much. I'm not sure how I can bring my point across without sounding like a total ass. Think about long term relationships maybe. All the couples who're together for 5,10,15,20,25 years or longer will know what I'm talking about when I say "that's not a very long time".

[summerset 5,261]

2 hours ago, Xerox said:

My problem was binge eating, but now my problem is lazyness, its a shame because the food ive been eating recently doesnt satisfy me in any way other than making me not hungry, while eating a healthy whole foods diet was enjoyable, but my problem is I have developed new bad habits of being too uninterested to cook

If that's really the case I wonder why you don't go back to a diet that really satisfy you. I always went back to "eating not ideal foods" because this clean eating didn't satisfy me. Add on top of this that I don't like to cook and I knew I had to come up with creative solutions.

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high carb foods like bread, rice and potatoes.

IMO these are perfectly fine foods to eat. (Well, maybe not that kind of bread that has a gazillion chemicals as ingredients.)

[Xerox 14]

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Me neither, but just as every other medical therapy on this planet doesn't work in 100% of the cases with 100% success it's not realistic to expect 100% of WLS patients being 100% successful.

Indeed, its one of the reasons I have chosen to undergo surgery, although I could work at it myself, I cant garantee I wont regain at some point, and I am undergoing surgery in 2019 after which I will have to keep my weight down perminantly to avoid problems. So WLS for me is an added support to help me keep my weight as low as possible.

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If that's really the case I wonder why you don't go back to a diet that really satisfy you.

My disinterest in cooking is currently greater than my need to satisfy my pallet. In recent years I have avoided cooking and rather look to quicker alternatives. bread, rice and potatoes also store longer, and I dislike crowds and shopping, so keeping stocked with fresh vegetables is difficult for me.
I have become reluctant to push myself out of my comfort zone, when I do it life is better, but It gets the better of me at times.
Essentaily I have social disorders that make me more inclined to behaviours what would lead to weight gain. What I call lazyness is probably anxiety and avoidence.
my bmi is only 31, took me a while to climb to this weight again but here I am. If it wasnt for my future surgery |I probably wouldnt be going through with WLS.

Edited December 30, 2017 by Xerox

[Xerox 14]

Quote

I think most surgeons have a way more distant and neutral view of this treatment method than most patients. The patient's view seems to be loaded with emotions (no surprise here) and that is reflected on this board as well. It's never the treatment method that fails, it's always the patient who isn't strong enough, disciplined enough, motivated enough if goal weight isn't 100% or 100% maintained for the rest of life.

This is very interesting because we used to be the same with diets. Then came the "diets don't work" movement along, backed up scientifically. And then as a last resort there is WLS - it's kind of depressing to accept that this last resort treatment isn't 100% fool proof either. It's easier to blame the fellow patients because it's quite frightening to think about the fact that you yourself might be one of the patients where it doesn't work 100%.

The answer to long term weight loss and maintenence isnt dieting or WLS, its the adoption of long term improvement to your diet and lifestyle. (not debating you just making a statement)

Like you say, most people just arent going to make those changes and life hits you in such a way sometimes that pushes you towards unhelpful behaviours, but it is ultimately us as individuals who do it. We have agency over our lives and bodies.
I dont personally have an issue with accepting where I am going wrong, I can see exactly why I lost weight and why I gained. But we are flawed creatures and life is unpredictable.
I think we need to bear in mind that WLS is a tool and not a cure to be used in conjunction with developing better habits and improving mental health. Atleast that is how I look at it.
In my mind not reaching your goal 100% isnt a fail, its a success if you have lost a life improving amount of weight, if you lose a few pounds then I might consider it a fail.

[summerset 5,261]

53 minutes ago, Xerox said:

My disinterest in cooking is currently greater than my need to satisfy my pallet. In recent years I have avoided cooking and rather look to quicker alternatives. bread, rice and potatoes also store longer, and I dislike crowds and shopping, so keeping stocked with fresh vegetables is difficult for me.

I dislike shopping as well (do I really have to do this after I come home from work?) and I don't like cooking (do I really have to do this after I come home from work?) and cleaning up after (do I really have to do this after I come home from work?). I also dislike preparing food for the next day (do I really have to do this after I come home from work or before work in the next morning?).

My compromise is that I keep it as simple as possible. I buy ready made Soups that only have a few ingredients listed, even though they're relatively expensive. In general I think of warm food as more satisfying than cold food (e. g. warm oats are more satisfying IMO than cold oats) so I usually don't eat a sandwich/bread on its own but with Soup. Soup and sandwich is a go-to for me when time is scarce. I also use frozen vegetables a lot. Saves both shopping, preparing, cleaning up and cooking time. Rice I cook in batches with a microwave rice cooker and freeze it in batches.

After I started my new education my working times have changed (including 24 h shifts which are draining as hell) I'm struggling a bit as well, though it's more with regular exercise. I never got into the real groove again after my shoulder injury so far. Ok, I usually bike to work and I have been lucky with the roads not being icy so far but that's about it. Interestingly enough I haven't gained an ounce so far, even though I didn't feel I ate less food (though I must have anyway?). That's kind of a liberating observation.

Convenience food (like sandwiches from the cafeteria) or eating lunch at the cafeteria even though they have a salad bar makes for less than ideal choices too often. I don't notice it in terms of weight gain (even lost a bit since starting my education), but I feel tired and drained a lot which I think is only partly because of different working hours. So even though I don't might like it, I will see to preparing oatmeal in the evening to grab in the morning instead of simply buying a sandwich at the cafeteria. There's no way though that I'll be nibbling on a piece of cucumber at 2:30 AM when I want something sweet. Protein Bar for me then.

[Creekimp13 5,838]

It's actually quite accurate, statistically, to say sleeve surgery is 57-61% effective....since that is the amount of excess body weight most people lose long term. We all hope to lose and maintain a loss of closer to 100% of our excess body weight.... and a few of us will. Some of us won't make it to 50%. But most of us....the largest portion of people who have the surgery and try....will land on one side or the other of 60% and will maintain that weight loss at 5 years post-op according to available data.

I don't know why anyone would find this discouraging.

I think these data are astoundingly positive.

Dieting and exercize alone doesn't come anywhere near this degree of effectiveness. Nor are its results as long term.

We know that a 10% weight loss improves health outcomes drastically. SIX TIMES that number is an amazing victory.

[Creekimp13 5,838]

Quote

I think most surgeons have a way more distant and neutral view of this treatment method than most patients. The patient's view seems to be loaded with emotions (no surprise here) and that is reflected on this board as well. It's never the treatment method that fails, it's always the patient who isn't strong enough, disciplined enough, motivated enough if goal weight isn't 100% or 100% maintained for the rest of life.

I think most surgeons use empirical data from multiple studies as the basis of their views.

While I appreciate reading the stories of patient experiences, feelings are not fact.

"I didn't lose weight...so this surgery sucks and isn't worth is" is every bit as false as "I had 100% weight loss and anyone who really wants to can too, if they're disciplined enough."

Anecdotes are not predictive. Statistical data often is.

[summerset 5,261]

47 minutes ago, Xerox said:

The answer to long term weight loss and maintenence isnt dieting or WLS, its the adoption of long term improvement to your diet and lifestyle. (not debating you just making a statement)

I'm currently reading Karen Koenig's latest book "Helping Patients Outsmart Overeating". It's a book for both patients and health care providers. While no magic wand I think it's a little gem. It's definitely an interesting read on this subject.

Quote

Like you say, most people just arent going to make those changes and life hits you in such a way sometimes that pushes you towards unhelpful behaviours, but it is ultimately us as individuals who do it.

I think people make these changes to different extends. The more you change towards healthy behaviors, the better the outcome will be, both physically and psychologically. However, people are people with different personality traits and ailments and histories etc. - and a lot of people may simply not be in the position to make all the necessary changes to reach and maintain a normal weight or reach and maintain a normal weight without much hassle.

I have ADHD. I will most likely never be this organized, constantly calorie tracking accountant like person who follows plans to the last minuscule detail. So I have to operate within certain limitations and adapt to it. Don't get me wrong - I'm quite good at making plans and organizing stuff, but I absolutely suck at following through, so I'm glad I get to delegate certain things at work. (That said I'm proud of myself being able to function at work at high level without side-effect having medication but I have to be careful with energy levels so I simply won't prepare elaborate meals everyday.)

[setoo 2]

@Creekimp13
You make great points and I could not agree more!
I too see the danger in putting post-op folks on these rigidly low calorie and Protein dominant diets, which just don't seem like a good idea to me. Doctors have put obese people on exactly the same diets already(who had no surgery), there is tons of studies on that. While all of these obese people lost weight, they mostly regained it back and it did do no good things for their metabolism. (google for "very low calorie diets" or "vlcd", and you will find a lot of information, for anyone interested).
So why would one think it is a good idea to put people who had a gastric sleeve on that diet? They might do fine for some time, also lose weight at a fast pace. But really looking at it, this can't be healthy no? And I also do not think this is a "healthy, normal" diet, not at all.
Just to emphasize your point!

I also agree that people who lost 100% EWL are the minority. There seems to be no data that shows these people are in any way common or the norm.

@Introversion
Your post regarding people regaining weight after the "hooneymoon phase" because they did not adopt healthy habits does seem quite speculative. The parts with the genetics also. Could you provide some data or information on that? I'm curious!

Regarding the studies, like @Creekimp13 pointed out, they do not cluster everyone together. So yes, most people are actually at those numbers of regain or EWL for example.

@Xerox
I feel like you lean heavily towards people making "bad choices" or not forming "healthy habits" to be main reason for the weight regain. I do not think that's true. While I agree that healthy choices and awareness in general does help, it does not justify the regain in my opinion.
Let's apply your logic to some person that had no WLS surgery at all:
They are starting to eat "healthy" aka protein and veggies (this seems to be definition of healthy around WLS surgergies forums). They lose tons of weight, but say, after a year, they just can't do this anymore. They are not happy with this, their body is also fighting this. So they give up, because they simply do not feel good doing this.
So you could say these people have failed, because they have decided to go back to "bad choices". If that is the case, then everybody who does not maintain a great weight loss via eating a rigid diet (which is 99% of the population) is just making bad choices? That does not sound reasonable to me , at all and I think many of us can agree, by having experienced the said scenario.

@summerset
You speak my mind! Thank you for your wonderful posts on this topic, everything you said resonates with me and I also learned new things.

Like you said, one should strive for the sustainable middle ground. It often seems to me that people get kind of fanatic after these surgeries, because they HAVE to make them work. Meaning they will adhere to rigid restrictive diets and exercise, just to make it work. Guys, did we not go through all of this already via dieting, workouts and suffering because of these? This does not seem to be the way to a content life, nor to a happy and normal relationship with eating and exercise.

Awesome to have your insight on this, after 17 years (damn!), that's a long time and I really appreciate you chiming in on this topic.

______

What I'm proposing:
The gastric sleeve surgery does indeed work for weight loss, but with having the expectation to lose 100% of the excess weight, you will set yourself up for quite some disappointment. It's more realistic to have lost around 50 or 60% of excess weight. Pretty much every study confirms this. In my opinion this is still a wonderful thing.

Why not use this tool that was given to us and work with it, instead of trying to force some result which the body is not agreeing with?
Rather just have the surgery and eat the way your body signals you to. Think twice about labeling food as "bad". Rice is not bad, bread is not bad, potatoes are not bad either. These are staple foods of humanity, with which most people are doing wonderfully on. I would go as far as saying that just eating lean protein and veggies is actually unhealthy. I know, it's healthier than the food that is eaten when one is obese, but why go from one extreme to the other?

I just want to provoke some thought regarding all of this "I have to eat like that and exercise like this, eat that many calories and not more". Why should we do that? Why not actually LISTEN to what our body is telling us, accepting and working with that? Because everything else seems to be unsustainable in the long term.

Edited December 30, 2017 by setoo

[summerset 5,261]

7 minutes ago, Creekimp13 said:

I think most surgeons use empirical data from multiple studies as the basis of their views.

Partly. They also use their own experience. If you are into WLS since e. g. 15 years and have performed hundreds of surgeries and followed up hundreds of patients you will also have your own experience that tells you what's most likely and what's rare.

I don't know though if these experiences are very different from the numbers you can read in studies or if they in general match up.