I have no fixed opinion about this issue - I'm just interested to hear other people's views and approaches.

I've got to the point where my BMI is about 27/28ish and I've lost oodles of weight. I've only lost a pound in the last 7 weeks or so, but I have lost inches, so I'm not too worried. However, I think my weight loss is beginning to 'bottom out'.

Ideally, I should lose another 14-20lbs, and to this end, I was thinking of using a ketogenic diet for a few weeks. However, I've had some conversations with medical types about it recently (a retired doctor who's a friend, a bariatric nurse and the nurse at the local GP's surgery). They all said slightly different things, but the common threads of what they said were:

• If reaching the BMI-25-target is important to you, then by all means try!
• The final pounds of weight loss are difficult and - because of the type of severe restrictions needed to get there - are not often sustainable.
• The differences in health benefits between a BMI of 27ish and 25 are negligible.
• Ketogenic diets are not really recommended long-term for bariatric patients.
• I might still lose more weight using a balanced diet (with small portions) and although it would take longer, it would be more sustainable.

From my own point of view, I had stopped thinking about food so often and I felt that this diminished importance of food in my mind was good for my mental health. There's a risk that if I go back to a diet with 'forbidden foods', I may start thinking about it too much again (which - for me - would be counter-productive).

However, I know that some of you guys have achieved (and surpassed) that magical BMI of 25. How did you do it? Did you have to adopt a different strategy for the last few pounds, or did you just keep on plugging with the good habits you had learnt?

As I said, I'm not here to pre-judge; different things work for different people...I'm just interested in hearing about a range of strategies that work.

i am in the last 25 or so.. i plan on sticking on plan and doing what i am doing. i would rather eat how i eat now than force lose it only for it to come back once you revert back to carbs.. slower the more long term.. but that is just my opinion.

57 minutes ago, looly said:

I have no fixed opinion about this issue - I'm just interested to hear other people's views and approaches.

I've got to the point where my BMI is about 27/28ish and I've lost oodles of weight. I've only lost a pound in the last 7 weeks or so, but I have lost inches, so I'm not too worried. However, I think my weight loss is beginning to 'bottom out'.

Ideally, I should lose another 14-20lbs, and to this end, I was thinking of using a ketogenic diet for a few weeks. However, I've had some conversations with medical types about it recently (a retired doctor who's a friend, a bariatric nurse and the nurse at the local GP's surgery). They all said slightly different things, but the common threads of what they said were:

• If reaching the BMI-25-target is important to you, then by all means try!
• The final pounds of weight loss are difficult and - because of the type of severe restrictions needed to get there - are not often sustainable.
• The differences in health benefits between a BMI of 27ish and 25 are negligible.
• Ketogenic diets are not really recommended long-term for bariatric patients.
• I might still lose more weight using a balanced diet (with small portions) and although it would take longer, it would be more sustainable.

From my own point of view, I had stopped thinking about food so often and I felt that this diminished importance of food in my mind was good for my mental health. There's a risk that if I go back to a diet with 'forbidden foods', I may start thinking about it too much again (which - for me - would be counter-productive).

However, I know that some of you guys have achieved (and surpassed) that magical BMI of 25.s, or did you just keep on plugging with the good habits you had learnt?

As I said, I'm not here to pre-judge; different things work for different people...I'm just interested in hearing about a range of strategies that work.

115 pounds lost is phenomenal.

How did you do it? Did you have to adopt a different strategy for the last few pound

The last pounds can be painfully slow. We have less body fat to burn. No different diet or strategy . Reaching a lower BMI was not important to me. Its just where I ended up. I wish there was less emphasis on BMI. The goal to me is healthy.

You said “The final pounds of weight loss are difficult and - because of the type severe restriction to get there - are not often sustainable”

I agree that severe restriction is not sustainable. I did not use severe restriction to get to my BMI. I used bariatic basics and the calories/macros that kept my body in weight loss mode. Many do Bariatric basics, Keto, intermittent fasting, whole 30. Vegan paleo Etc. These are weight loss phase diets.

You said "Ketogenic diets are not really recommended long-term for bariatric patients"

Maintenance phase diet is a totally different long-term food plan.(ask your office for your plan) My instructions add calories, carbs, and fats to slow/stop weight loss. It’s been sustainable for me at five years out.

You said " There's a risk that if I go back to a diet with 'forbidden foods', I may start thinking about it too much again (which - for me - would be counter-productive).

You may want to work with a counselor to address this issue. Restricting and thinking about food too much is counter productive. I hope you find your own balance with all this. None of this is easy, right?

1 hour ago, looly said:

different things work for different people...

I agree 110%.

With that said, I got to 25 by plugging away at the same thing I was doing since Day 1: low cal, very low carb. This was coupled with slowly increasing exercise length and intensity as my health/strength/stamina improved over the months.

I consciously stopped weight loss mode when I was at 23.5. I increased calories and let go of the carb reigns to a certain extent. Now, a year out and almost 5 months into maintenance, I am at around 20-21. I still keep an eye on my carb intake: I don't eat bread nor rice; pasta I've only had during one vacation this year. However, I have been known to go to town on dessert once in a while. I exercise almost daily. This is sustainable...for me.

Edited to add: When all is said and done, BMI is just a number based on a very broad generalization of infinite body types. Your final weight should be the one you are most comfortable at and can maintain long term.

Edited October 29, 20196 yr by ms.sss

Thanks for that guys!

I'm glad that you all achieved success through the steady application of the healthy principles you've learnt. That's reassuring.

This rang true for me...

1 hour ago, ms.sss said:

When all is said and done, BMI is just a number based on a very broad generalization of infinite body types. Your final weight should be the one you are most comfortable at and can maintain long term.

I am think I'm probably too influenced by the idea of BMI 25 or less being the ideal.

I'm happier with my health and my relationship with food now. Perhaps I just need to develop patience and trust the balanced diet that's worked for me so far.

4 hours ago, looly said:

From my own point of view, I had stopped thinking about food so often and I felt that this diminished importance of food in my mind was good for my mental health. There's a risk that if I go back to a diet with 'forbidden foods',

Love this - I have 25 to go and feel for you, Going slowly even though i am less then 600 calories a day? Im done with food for life - I wrecked me and really dont miss it

Intermittent fasting knocked down the last 15 pounds for me. There are LOTS of threads on IF on this forum. Lots of us have used (or are using) one form or another. It is a powerful tool, not difficult, and actually very healthy for you.

I am not sure keto is the way to go, as the fat content is so high. With bypass, we already have fat absorption issues, and I know my intestines are not happy with too much fat. Also, your liver has worked very hard to process all the fat you have already lost. You might have had fatty liver disease, as I did, before surgery. From what I have read, adding more fat for the liver to work on is not a great idea.

IF gives you the benefit of ketones, but without the high fat diet.

Edited October 29, 20196 yr by AZhiker

i found that if i stick to my high protein no carbs or very low and exercise daily i can move the scale pretty easy if i really work out hard for a few weeks it moves really fast im comfortable at where i am at this point the last 15 pounds was slow to come off fore sure now that im there im just maintaining it

Looly, Great Question. I’m also dealing with those last 15 pounds and have been playing with the same one pound for a month or more. I’ve dropped my calories by 100 but not seeing a difference yet unless you count hair loss. Ughh I know patience is a virtue but man we get spoiled with the rapid loss in the beginning. Overall, I’m thrilled at this life changing choice I made. I’m staying with my original plan but I do appreciate your question and the great answers coming in.

On 10/29/2019 at 8:45 PM, AZhiker said:

Intermittent fasting knocked down the last 15 pounds for me. There are LOTS of threads on IF on this forum. Lots of us have used (or are using) one form or another. It is a powerful tool, not difficult, and actually very healthy for you.

I am not sure Keto is the way to go, as the fat content is so high. With bypass, we already have fat absorption issues, and I know my intestines are not happy with too much fat. Also, your liver has worked very hard to process all the fat you have already lost. You might have had fatty liver disease, as I did, before surgery. From what I have read, adding more fat for the liver to work on is not a great idea.

IF gives you the benefit of ketones, but without the high fat diet.

Thank you for this reply, AZhiker. I didn't reply to it straight away, because I thought I'd research what you said a bit first. I had initial misgivings that I could fit enough healthy nutrition into an 8 hour window, given the restriction I feel. However, I'm looking into the 5:2 diet as a possibility and tried fasting for 16 hours out of the last 24. It wasn't too difficult. You've given me food for thought (which involves no calories - hurrah!).

2 hours ago, looly said:

Thank you for this reply, AZhiker. I didn't reply to it straight away, because I thought I'd research what you said a bit first. I had initial misgivings that I could fit enough healthy nutrition into an 8 hour window, given the restriction I feel. However, I'm looking into the 5:2 diet as a possibility and tried fasting for 16 hours out of the last 24. It wasn't too difficult. You've given me food for thought (which involves no calories - hurrah!).

The 5:2 is a great option. As is ADF (Alternate Day Fasting) which is doing the same thing but as 4:3 or simply every other day. The research shows that the body basically responds in the same way - it starts pulling from fat reserves and starts killing off the "zombie" cells (old cells that just don't want to die.) Personally, I love the 16:8 or even 14:10. I feel better in the mornings without food right away. When I DID have to go back to early breakfast on certain days, it didn't feel right and I was not as sharp mentally. On days when I train (like today - a long bike ride this morning) I have to eat a couple of hours before, but normally, I don't start eating til noon.

I totally agree that the restriction limits what one can eat in an 8 hour window, but you can stretch it to 10 hours, as well. And like you said, it has to be healthy nutrition - every bite has to matter.

I tried fasting for 2 days (16:8 pattern) and lost a pound. Promising so far! ?

Another strategy for optimal fat burn is to do your exercise during the fasting window, if you can. When I am doing IF, I do my stair climbing, arm and leg routines in the morning, before I start eating.

I'm trying to decide if I should continue trying to lose more weight or be satisfied with where I am. I will be asking my doctor in a few weeks, but curious what you folks think.

Had VSG surgery in Aug, 2018 and lost about 90# in the first 6 months; have lost another 5# during the next 10 months. Am 66 yrs old, 5' 2", BMI=26.2, currently weigh 143# but my goal has been 130# because I weighed that for 30 years before I got overweight. The "normal" BMI for me (24.9) is below 136#. I now wear a size 4-6, exercise every other day (1 hr of fast power walking & 1 hr of weight lifting) and eat about 800 kcal/day. My bad knees won't allow me to run. I have excess skin under my arms, thighs, butt and abdomen but I don't have any way to know how much it weighs...easily hidden by clothing. I'm pretty muscular but not sure how much that weighs either. It just seems crazy that I'm still in the "overweight" BMI category and I'm just not sure what more I can do to lose another 7-13#. Any thoughts from those more experienced than me?

Edited November 25, 20196 yr by Moa

First, you are actually more experienced than me (I was sleeved 3 months AFTER you )

With that said, I think, like alot of us, you may be focusing too much on the number on the scale? When you were 130 lbs before, were you bigger/smaller/the same size as you are now? I know that years ago, I when I weighed the amount I way now, I was actually bigger then than I am now. It may be because of the muscle vs. fat ratio...? Are you fitter now than then?

Chasing a number that worked for you before may not be as applicable now.

Edited November 25, 20196 yr by ms.sss

Keep in mind that it takes a deficit of ~3500 cals (some say that deficit has to be 7000) to lose a pound. Someone here cut their cals by 100 a day and hasn't lost anything in a month. Your body might have been at a new set point and cutting only 100 a day with no additional exercise means it WILL take over a month to lose that pound - assuming you were at a new set point.