advice appreciated: surgery, exercise, and weight loss maintenance?

[MaineDoc 31]

Hi all,

I have been participating in a medically supervised weight loss program for the past 5 months and I've nearly completed all the pre-op requirements to qualify for bariatric surgery. I've been really lucky and have already officially lost about 50 lbs (at my last weigh in a few weeks ago, it's probably closer to 60 now). My BMI is now probably 31ish. I have adhered to their guidance fastidiously and have made major changes to how and what I eat.

I've learned a lot from these boards and I'm leaning towards going the surgery route. Far and away, my primary concern is my ability to be physically active short- and long-term after the surgery. Exercise is extremely important to me and has been for most of my life. Even at my heaviest and unhealthiest, I've still maintained some degree of regular physical activity. And for a lot of the time, I've been able to engage in quite vigorous exercise regimens (running half marathons, weight lifting, vigorous cardio 5-6 times per week). My weight gain has been almost entirely due to poor eating habits as opposed to anything else. Given the considerable calorie restriction post-op, should I expect to have enough energy to exercise vigorously? I understand if it may take some time after surgery to build up my conditioning to where it's at now given that I'll have to take time off and given how little I'll be eating, but say a couple months after should I expect that I'll have enough energy to work out intensely?

My other question is how useful/effective is bariatric surgery for those who have been able to lose (considerable) weight historically, but haven't been able to keep it off. As part of doing my homework in preparing for the surgery, I actually obtained all of my medical records for the past 10 years. I charted my BMIs and weights (attached here). It was really eye opening for me to see the true "yo yo" that I've lived. I've definitely been able to have success losing weight, the issue always has been maintaining whatever changes I've made to keep it off. From what I can tell, the surgery seems immensely helpful for initial weight loss but it isn't as clear to me from what I've seen how helpful it is for those who've lost weight as part of the medical supervised plan (and who've been able to lose it historically) to help keep that weight off.

I greatly appreciate any insight, advice, or guidance you can offer. Thank you!

[AZhiker 2,251]

As far as exercise goes, my doc said to work toward 10,000 steps a day with a step tracker. I started walking within hours of surgery and was up to 10,000 steps by day 7 post op. I gradually added stair climbing and wall pushups. Then some leg exercises and very light weights for upper body. I worked up to walking 5K at least 3 times a week, and then got a bicycle. I finished a sprint triathlon (400 meter swim, 14 mile bike, 5K run/walk) 8 months after my surgery. Then I finished a 50 mile bike race a month later. I am currently training for another tri in March and the ultimate of ultimates - a one day rim-to-rim Grand Canyon hike, which will be 24 miles of all down and then all up.

I currently ride my bike twice a week (30 and 16 miles), do 5 mile hill hikes twice a week, Elliptical machine twice a week. Daily routine includes pushups/arms/upper body weights, leg routine, 30 flights of stairs, stretches, and of course at least 10,000 steps. (At this writing I actually have over 19,000 steps today so far.) All of these numbers will greatly increase as the year progresses. I want to do a 100 mile bike race in November and will be gradually working up to at least 80 mile rides before then. The GC hike will be in October and by then I should be doing 70 flights of stairs/day, and working up to 20 mile day hikes.

I am focused more on endurance events, but do the weights to keep muscle strength and tone. I am amazed at how fun and enjoyable it has been to see my body changing, becoming more fit, and able to meet all new challenges. My resting heart rate is now in the low 40's. I have no pain, stiffness, or soreness, even after long workouts. Once you are healed - GO FOR IT! There is no stopping you!!!! Be very careful to follow all recommendations for weight lifting. Do not cheat on this. You do NOT want to go back for hernia surgery, which will lay you up even longer and has its own set of complications.

To your second question - bariatric surgery is the perfect answer for us who have yo-yo dieted for much of our lives. Doing so has wrecked our metabolisms and short circuited to stomach-hormone-brain connections that tell us when we are hungry and when we are full. Remember the contestants on "The BIggest Loser?" Most of them gained all their weight back, and with slower metabolisms as a result of the weight loss. They could not sustain, because they had to eat so much less. What is really neat about bariatric surgery is that the metabolism gets a change to reset. Your body gets a chance for a complete "do-over." You will lose the weight and finally have the best chance possible at keeping it off for good. WLS is only a tool - and the lifestyle modification is up to you, but it is a powerful new start to a new life for many of us. Personally, I feel better now than I did 30 years ago! I am more active, have less pain, and have eliminated every co-morbidity. I am determined that I WILL NEVER GO BACK. This is my chance for a new life, and I am grabbing it by the horns and not letting go.

Sorry for the long reply. I wish you the best in whatever decision you make. For me, there was no yo-yo left. I just couldn't do it anymore. Maybe being a bit older (63) gives me a different perspective - I knew surgery was my last shot. Best decision I ever made.

One of the biggest challenges for me was to find a way to eat enough calories to sustain my exercise without losing any more weight. With a small pouch and volume restrictions, I've had to change some things. I found a hydration/nutrition system that works for me during long rides or hikes. I also have moved to a whole food plant based (WFPB) diet which provides more carbs and a lot more energy, without compromising Protein. I feel like Wonder Woman since starting on it! Watch "The Game Changers" on Netflix if you want to see how some world class athletes are dealing with nutrition.

[MaineDoc 31]

On 1/3/2020 at 12:11 AM, AZhiker said:

As far as exercise goes, my doc said to work toward 10,000 steps a day with a step tracker. I started walking within hours of surgery and was up to 10,000 steps by day 7 post op. I gradually added stair climbing and wall pushups. Then some leg exercises and very light weights for upper body. I worked up to walking 5K at least 3 times a week, and then got a bicycle. I finished a sprint triathlon (400 meter swim, 14 mile bike, 5K run/walk) 8 months after my surgery. Then I finished a 50 mile bike race a month later. I am currently training for another tri in March and the ultimate of ultimates - a one day rim-to-rim Grand Canyon hike, which will be 24 miles of all down and then all up.

I currently ride my bike twice a week (30 and 16 miles), do 5 mile hill hikes twice a week, Elliptical machine twice a week. Daily routine includes pushups/arms/upper body weights, leg routine, 30 flights of stairs, stretches, and of course at least 10,000 steps. (At this writing I actually have over 19,000 steps today so far.) All of these numbers will greatly increase as the year progresses. I want to do a 100 mile bike race in November and will be gradually working up to at least 80 mile rides before then. The GC hike will be in October and by then I should be doing 70 flights of stairs/day, and working up to 20 mile day hikes.

I am focused more on endurance events, but do the weights to keep muscle strength and tone. I am amazed at how fun and enjoyable it has been to see my body changing, becoming more fit, and able to meet all new challenges. My resting heart rate is now in the low 40's. I have no pain, stiffness, or soreness, even after long workouts. Once you are healed - GO FOR IT! There is no stopping you!!!! Be very careful to follow all recommendations for weight lifting. Do not cheat on this. You do NOT want to go back for hernia surgery, which will lay you up even longer and has its own set of complications.

To your second question - bariatric surgery is the perfect answer for us who have yo-yo dieted for much of our lives. Doing so has wrecked our metabolisms and short circuited to stomach-hormone-brain connections that tell us when we are hungry and when we are full. Remember the contestants on "The BIggest Loser?" Most of them gained all their weight back, and with slower metabolisms as a result of the weight loss. They could not sustain, because they had to eat so much less. What is really neat about bariatric surgery is that the metabolism gets a change to reset. Your body gets a chance for a complete "do-over." You will lose the weight and finally have the best chance possible at keeping it off for good. WLS is only a tool - and the lifestyle modification is up to you, but it is a powerful new start to a new life for many of us. Personally, I feel better now than I did 30 years ago! I am more active, have less pain, and have eliminated every co-morbidity. I am determined that I WILL NEVER GO BACK. This is my chance for a new life, and I am grabbing it by the horns and not letting go.

Sorry for the long reply. I wish you the best in whatever decision you make. For me, there was no yo-yo left. I just couldn't do it anymore. Maybe being a bit older (63) gives me a different perspective - I knew surgery was my last shot. Best decision I ever made.

One of the biggest challenges for me was to find a way to eat enough calories to sustain my exercise without losing any more weight. With a small pouch and volume restrictions, I've had to change some things. I found a hydration/nutrition system that works for me during long rides or hikes. I also have moved to a whole food plant based (WFPB) diet which provides more carbs and a lot more energy, without compromising Protein. I feel like Wonder Woman since starting on it! Watch "The Game Changers" on Netflix if you want to see how some world class athletes are dealing with nutrition.

First off, your personal experience is incredibly inspiring. Thank you so much for sharing the specifics of your exercise routine. What you describe is essentially where I'm at now, pre-surgery. I don't necessarily do the same exact types of activities, but I'd say overall my activity level is similar and I just want to maintain it. Knowing that you feel that you're able to keep up with this and have found a way to make it work in terms of getting adequate nutrition is really reassuring. Also, I like that you use the WFPB diet--I haven't actually heard that term before, but I don't eat meat (save for very occasional fish) and so my Protein sources now consist primarily of Beans, nuts, and soy products. Also, I feel similarly to you about the yo yo-ing. I'm just getting tired of it. I've probably gained and lost at least 500 lbs in my lifetime and I'm just tired of going back and forth. I guess my mentality has been that the surgery is my ace in the hole and will help finally push me over the top to help me maintain/lock-in the changes that I've made. I haven't disclosed my decision to pursue surgery with anyone other than my significant other. She has had some trepidation about it and just says, in so many words, "you obviously can lose the weight, you just have to maintain the changes that you make long-term so that you don't regain the weight." Over the years, I've said to her "that's the whole point! that's why this is so hard for me." And turning to this forum and answers like yours I think has been illuminating for both of us. She is now on board for me going forward with this, which is great. Anyway, sorry for the long somewhat rambling stream of consciousness reply--I'm just grateful for your insights!

[AZhiker 2,251]

2 hours ago, MaineDoc said:

First off, your personal experience is incredibly inspiring. Thank you so much for sharing the specifics of your exercise routine. What you describe is essentially where I'm at now, pre-surgery. I don't necessarily do the same exact types of activities, but I'd say overall my activity level is similar and I just want to maintain it. Knowing that you feel that you're able to keep up with this and have found a way to make it work in terms of getting adequate nutrition is really reassuring. Also, I like that you use the WFPB diet--I haven't actually heard that term before, but I don't eat meat (save for very occasional fish) and so my Protein sources now consist primarily of Beans, nuts, and soy products. Also, I feel similarly to you about the yo yo-ing. I'm just getting tired of it. I've probably gained and lost at least 500 lbs in my lifetime and I'm just tired of going back and forth. I guess my mentality has been that the surgery is my ace in the hole and will help finally push me over the top to help me maintain/lock-in the changes that I've made. I haven't disclosed my decision to pursue surgery with anyone other than my significant other. She has had some trepidation about it and just says, in so many words, "you obviously can lose the weight, you just have to maintain the changes that you make long-term so that you don't regain the weight." Over the years, I've said to her "that's the whole point! that's why this is so hard for me." And turning to this forum and answers like yours I think has been illuminating for both of us. She is now on board for me going forward with this, which is great. Anyway, sorry for the long somewhat rambling stream of consciousness reply--I'm just grateful for your insights!

I had to do 6 months of visits with my PCP for insurance approval. At one point I said to her, "Maybe I should just try it again on my own." Her reply, "If you COULD have done it, you WOULD have by now." She was so right, and her words inspired me to continue with the WLS. Yo-yo with weight loss and regain is just deadly - you damage your metabolism more and more each time you do it. That's why most of the Biggest Losers gained it all back. How sad is that? WLS resets everything, cuts off the ghrelin hormone that tells you to eat and eat and eat, and amazingly, does NOT result in a lower metabolism.

OK - promise to do two things: 1) Watch the "The Game Changers." It will truly inspire you in your athletic pursuits. Then watch "Forks over Knives." There is so much info out there on WFPB and I am in a wonderland of information and discovery now. I am convinced this is the healthiest way to eat, exercise, maintain weight, lower all the risk factors for cardio vascular disease, and live longer with quality of life to the end.

2) Please, please, please get a copy of "The Obesity Code" by Jason Fung. This will explain so much about what makes us fat. It will give you hope and a greater understanding.