Hi all,

My surgeon has said my weight loss is too fast & I should increase my calories or decrease my activity. My nutritionist disagrees & says i shouldn't be forcing calories if its making me uncomfortable (it is)!

I was 128kg when I started the LRD on 12th oct, 125kg on surgery day on19th oct & I'm now 114kg. So 14 kg in 26 days. Height 175cm. Does this seem familiar/ok to anyone else. I'm managing my protein & water quantities most days but do feel a little weak & tired still. Any advice/opinions would be welcome

It’s not unusual to feel weak & tired in the first couple of months. You’ve had surgery, altered your body & are on a restrictive, reduced calorie diet.

While your dietician is right in advising you not to overeat, your surgeon would be concerned about the possible health impacts of rapid weight loss.

How many calories are you consuming? It can be hard to get in a realistic amount that allows you to lose weight without stressing your body or leaving you open to health complications especially at the beginning when your appetite is very low & your restriction is in full force.

Instead of pushing you to eat more, what about enriching what you are eating - quality vs quantity. Your dietician should recommend some options to enrich your diet or other food choices you could try. I struggle to maintain & I did not enjoy protein powders. So my dietician had me add milk powder to my rolled oats, which I already made on milk, every morning so I’d up my calories & protein. I found it too sweet so I add it to my chia pudding which I eat 4 times a week. If you can tolerate it, add extra protein powder to your smoothies or yoghurt. You can sip on the smoothie all day as it counts towards your fluid intake.

Thanks for replying. I'm averaging around 800 calories a day which i thought was quite good so early (only 3 weeks out of surgery & on the puree food stage). I could increase my milk intake as a quick calorie boost but it makes me feel a little sick. I don't want to add protein powder to anything as I'm hitting at least 70g of it a day via lean meat, protein water & protein yogurts (i hate the shakes too?)

Thanks for the reminder that this is very early still & the tiredness is normal for now. I'm seeing my nutritionist next week so will discuss & show her my food diary. If I get any useful advice I'll post back for others!

800 kcal per day is a very typical number and consistent with good weight loss. Our loss tends to be heavily forward loaded with a lot of water weight loss early on - your loss rate should be slowing right about now (do a search for the "three week stall") as your body pauses to catch up. As a reference, I lost 32lb the first month, and then 15 each of the next two months, so things do slow down.

(What is happening is that your body, when it goes into a big caloric deficit as it does immediately after your WLS, starts drawing of your body's glycogen reserves - basically stored carbohydrate - which takes a lot of water to stay in solution. So your body is throwing off a lot of water as it burns the glycogen. Then, when that runs out (after 2-3 weeks typically) the body has to start drawing on its stored fat (which is what we want!) but it can take a few days (or weeks for some) for the body to shift gears to do that, so don't panic if your loss suddenly stops for a while. Also, your loss rate will be lower once you start burning your fat reserves, as the fat burns more slowly than the glycogen.

The glycogen burn may also be why you are feeling a bit weak and tired, as that is your quick response energy store, and you are running low. Try working in a little more carbohydrate - oat meal, cream of wheat, unsweetened apple sauce are common - to help keep those levels up a bit more. In theory, our body is supposed to burn our excess fat to make glycogen, but that doesn't always happen as quickly as we need it (this is why marathoners will "carb load" with a lot of bread and pasta the day before an event - to make sure their glycogen levels are as high as possible before they go burning it all off the next day - we don't need to go that far, but the same principle applies.)

Overall, it looks like your are doing great, and I wouldn't worry about losing too fast until you are within maybe five kilos of your goal weight - if you get there withing six months, then you may need to slow things down so that you don't overshoot the mark too far; otherwise, I wouldn't worry about it. (And yes, my doc's RN also told me to cut back the exercise because I was losing too fast - but that was at six months, and about 10 lb from goal weight, and while I wasn't inclined to cut back on what is my normal maintenance level of exercise, I did start ramping up the calories to start slowing things down.)

Thats super informative Rick, thank you. I'm in the UK and paid privately so didn't get any support/advice beforehand except for an initial consultation! I think I had a mini stall of around 3 days. Decided to only weigh every 3 days now & measurements every 2 weeks. To stay sane!

That's twice as many calories as I was getting during that same time frame. I lost weight quickly, as well, but I was listening to my body as far as how much I could eat. I figured as long as I was getting my fluids and protein requirements in, the food would come at it's own pace..... and it did. You can't force feed yourself if your body isn't ready. And extra protein shake would be the way to go.