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Questioning Nutritionist Advice



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After reading threads on stalls, I'm questioning my nutrionists advice at my 6.5 month post surgery appointment on 1/12/21. Background info = surgery July 9, SW 205, CW 163 5'5" on a good day. I've been in a maintenance phase (not deliberately) for 2 months. According to my surgeon's PA and nutritionist, I wasn't getting enough Protein at 60-65g per day. I've since corrected that. But after a body composition test (reads lean body fat, resting BMR, Water weight, muscle mass) the nutritionist he told me 1300 calories a day to continue losing. 25 to 30% protein (81g-98), 40% carbs (130g) and 30% fat (43g). He said no less than 1200 a day. Thid seems like a lot compared to what others have said here about their daily intake. I realize that what he told me will result in slow weight loss which isn't bad but... My surgeon's PA was happy with my weight loss so far since this is for life, not a race. But no loss in 2.5 months is disappointing to me. Maybe my surgeon (best in my city and I paid more for him specifically) has a different philosophy than most? How would you take this recommendation from your nutritionist?

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My daily intake is 1200, based on advice from the dietitican and doctor. I would follow it.

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I just had my 7 month post op with my nutritionist and was told pretty much that exact same thing as you. She said at this point I should work at slowing my weight loss to just 1 pound a week. She recommended increasing calories by eating "good" carbs such as whole grains, Beans, fresh fruit, etc. She also said there is no need to be afraid of good carbs but to avoid refined sugar and processed grains. And to limit my good carbs to 1 serving size at a setting. She gave the example of 1/4 bagel is 1 serving - not the entire bagel! She also stressed that by incorporating more carbs into my diet I will have greater variety and my diet will be easier to maintain over time.

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Also, my surgeon said from the very beginning that after the first two weeks if I was losing more than 8 to 10 pounds a MONTH than I was not eating enough!!

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36 minutes ago, km13118 said:

I just had my 7 month post op with my nutritionist and was told pretty much that exact same thing as you. She said at this point I should work at slowing my weight loss to just 1 pound a week. She recommended increasing calories by eating "good" carbs such as whole grains, Beans, fresh fruit, etc. She also said there is no need to be afraid of good carbs but to avoid refined sugar and processed grains. And to limit my good carbs to 1 serving size at a setting. She gave the example of 1/4 bagel is 1 serving - not the entire bagel! She also stressed that by incorporating more carbs into my diet I will have greater variety and my diet will be easier to maintain over time.

Thanks for both of your posts! It makes me feel better. My surgeon's PA (who is also his wife lol) also said the same thing about the 8 pounds a month. I love this board, so many helpful suggestions and people but I get anxious reading about people that stay below x amount of calories until a year out from surgery. Or those that have met goal (although a similar SW to myself) by 6 or 7 months. I definitely get the low carb thing but I paid for surgery with the hope that Keto wouldn't be any part of my future. I've tried it and it's just so expensive and unrealistic for me personally. I wanted the switch and my surgeon said he thought I'd do fine with the less severe sleeve and promised no keto required. Lol. I'm hoping that slow and somewhat steady will win the race. Thanks again!!

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You certainly don't have to do Keto if you don't want to (I never did) as people have been successfully negotiating their WLS for years, decades, before keto was ever dreamed of, and will continue to do so once that fad has faded, lol.

What type of test(s) did they do for your body composition and BMR? Some work better than others, and they all have some flakiness when it comes to measuring obese, or formerly obese, people, but they can give a ballpark estimate of things.

I am a bit skeptical of the 1200 calorie minimum for a woman of your size (height mostly) as there can be quite a variation in metabolic rates (which the test may or may not pick up) and it's not unusual to see women of your height maintaining in the 1200 range (and some may do so at 1600 or so.) I do understand that there are differing hypotheses and philosophies regarding metabolic set points and going too low means you stay low, etc., but there is also not a real strong consensus on this issue, either. My inclination would be to keep the calories on the lower side of their range, if not a bit lower, and see how that goes.

I did fine at a consistent 1100 per day, but I have a decent guy's metabolism, and was losing at a consistent 10 lb per month after the initial quicker loss of the first three months. I am also maintaining in the 2000-2200 calorie range, so I had a fairly large caloric deficit to work from, which I doubt that you have given your height and gender.

There is a general tendency for our loss to decline as we lose weight over the months, simply because we aren't moving alll of that excess weight around 24/7, so a slowdown should be expected, but it also means that there is a danger of going into maintenance early if our calories are too high, or worse, increase them over time as some programs suggest.

Good luck!

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What I’ve noticed from reading posts on this board is that nutritionalists offer a lot of conflicting advice. It can be confusing. I would tell my dietician if I disagreed with her advice or if it wasn’t something I could follow in my life & I’d ask for alternatives.

What is your goal weight? Does your nutritionalist know what it is? What do they say to explain your lack of loss on the higher calorie diet? Sure, as you get closer to your goal your weight loss does slow but not losing any weight over 2.5 months at your weight sounds like maintenance to me. How active are you?

Keto was my recommended 2.5 week pre surgery diet. My personal view is Keto is good for kickstarting your weight loss but not as a long term diet. There’s research about the risks from the high fat component of the diet & also that it can cause issues for diabetics with erratic insulin levels because of the low carb aspect. Just something to consider.

I’m all for a balanced diet. I eat about 2 serves of carbs a day (rolled oats & multi grain crackers only not including naturally occurring carbs in other foods), 4 serves of fruit/vegetables, 2-3 serves of dairy, 60g Protein & am low fat. I avoid added sugar & artificial sweeteners wherever I can & have a glass of alcohol about once a month. I will have a Protein Bar if my protein is a little low. My portion sizes are about 3/4 of the recommended serving size or I have fewer serves in a day (like 4 serves fruit/vegetables not the recommended 5). I was told my maintenance protein level was 1.2g per kg of body weight because of being a women in her 50s. I don’t take Multi Vitamins.

This is working for me. It took me a while to discover out how much I could eat in maintenance & I kept slowly losing for 12 months. You will need to work out what works for you in relation to the point at which you can lose & the point at which you can maintain. It will be different to other people’s diets. You may be able to eat more carbs or may choose to go down the plant based protein route. You may need more or fewer calories. You also need to work out what food choices allow you to live your life - dining out, having a glass of wine, travelling (whatever that will be like), work, etc.

It may be time for some straight talking with your nutritionalist about your goals & what is achievable for you & your lifestyle.

Good luck.

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