Losing too much weight...

[Highly_Undermedicated 55]

I am 21 months post RNY and I am still losing weight. My HW 325 (2/20/20), SW 311 (3/9/20), CW 133. I had an abdominoplasty on 10/27/21 (weighed 145, no Lipo due to little to no body fat, and I don't know what amount was removed). I saw my NP today for pist abdominoplasty and then an emergency illness x2 following abdominoplasty stay in hospital same week for bowel obstruction.

My labs are normal, my NP says I am healthy BUT, I am on the low weight end and just a few pounds from being underweight according to their standards. She advised me to add in healthy fats (nuts, nut butters, avocado daily), 2 Protein Shakes, 3 meals, 3 Snacks. I just can't eat all of that. And little to no cardio and focus on strength training with weights. They are giving me 3 months to gain more muscle mass and gain weight and fill out more. And then return for re-evaluation. IF my weight continues to drop, they are talking about reversing my RNY! I literally cried in the office, on the way home, in the pharmacy (when the girls asked me how my weight and post abdominoplasty were going....they've known us many years) and then I cried several times on and off at home. I keep thinking about the old me, the 325 lb me, the old capacity, no restriction stomach and its ability to hold more, leading to weight gain and then it getting out of control, leading me back down the hole I just struggled to dig myself out of. This scares me so bad. I mean, it's ultimately up to me, right? As in, if they ended up scheduling that procedure months down the road, it's my decision if I go or not, it's my body. I'm thinking of seeking out a different opinion on this because this just doesn't seem like it should be the conclusive answer to this issue. Does it?

[Arabesque 6,420]

It can be a challenge to increase your calories to stop losing & maintain. It took me about 11 months after I reached goal to stop losing. I understand just not being able to eat any more. I slowly added more Snacks as I was able. I also noticed over the months my portion sizes for meals started getting larger. By the time I stabilised I was eating 4 or 5 snacks a day plus 3 about recommended portion sized meals. My snacks were combinations of whole & multi grain crackers, hummus, fruit, liverwurst, string cheese, nuts, Protein Bar, chia pudding & yoghurt. I used full fat salad dressings & added a seed mix to my rolled oats. So I upped carbs (no over processed carbs) & fats but still ensured everything I ate was nutritious (liverwurst & Salad Dressing aren’t good but yummy) & included 5-10g Protein (except no protein in fruit). My dietician suggested I add powdered milk to my milk to make it richer but I found it too sweet. Honestly, I did feel like I was eating all day long.

My lowest weight was 48.2kg & I’ve been maintaining at 49 (48.5-49.5) for 14 months now. My BMI is around 18.7 so on the low end too but I’ve got a smaller frame so it’s ok. Initially my surgeon & doctor wanted me to put on a couple of kg too. I said I didn’t want too because of the possibility of 5kg bounce back in the future. Now they’re fine with my weight & tell me I look great & have done well (& I’m actually a couple of kgs less then when they wanted me to gain).

I eat about 1300 calories a day & only 3 or 4 snacks to maintain my weight. I’m not very active. I still have days or times when I don’t feel hungry but I always try to meet or be close to my protein goal. So if I don’t feel hungry say for lunch or dinner I’ll graze on a high protein yoghurt.

I was a little worried I wouldn’t stop losing &/or I’d get too thin & I had some ‘well intentioned’ family & friends saying it too. But I really like how I look now. Yep, I still get surprIsed when I see my skinny legs & thigh gap or buy size 4 (US 0) clothing but it’s a good feeling. It does take a while for your body to resettle too. I initially thought I’d got so slim I’d lost my hourglass shape but it came back (still don’t have much of a butt though 😉). I should mention I haven’t had any plastic surgery.

Have a chat with your surgeon & medical team & tell them honestly about how you feel about your current weight, the possibility of a reversal, etc. Do you still have access to a therapist to talk through how you’re feeling. I hope you can reach a point soon that your weight settles so you can fully embrace what you’ve achieved. All the best.

[huskymama 149]

Just curious how tall are you? I’m 5’7” and I am getting the sleeve this month. I am hoping to get back to my high school weight of 125. My surgeon never gave me a goal weight

[catwoman7 10,843]

it's very common to have a 10-20 lb regain in year 3 without much effort. I was convinced it would never happen to me - BUT...it did. That said, since you're dealing with too much muscle loss, then yes -it'd be good to stop the weight loss since you need to maintain your health. I started gradually adding calories when I got down into the 130s (too low for me) ("gradually adding" since it would have been too hard to suddenly add 500 or so calories a day to my diet - it took a few weeks to get up there).

[WildWill 22]

3 hours ago, catwoman7 said:

it's very common to have a 10-20 lb regain in year 3 without much effort. I was convinced it would never happen to me - BUT...it did. That said, since you're dealing with too much muscle loss, then yes -it'd be good to stop the weight loss since you need to maintain your health. I started gradually adding calories when I got down into the 130s (too low for me) ("gradually adding" since it would have been too hard to suddenly add 500 or so calories a day to my diet - it took a few weeks to get up there).

OMG on your weight loss... AMAZING!

Highly_Undermedicated, no one can force you to undergo a procedure - however, they can use those terms to get you to understand the risks of being underweight. As Arabesque suggested, continue conversation with your team and also acknowledge that "I just can't eat all that" is suggestive of an opportunity to look at what you are eating and compliment or replace the volume of what you are eating with something that would compliment both your body AND the doctors.

Best Wishes, Will

[Highly_Undermedicated 55]

15 hours ago, Arabesque said:

It can be a challenge to increase your calories to stop losing & maintain. It took me about 11 months after I reached goal to stop losing. I understand just not being able to eat any more. I slowly added more Snacks as I was able. I also noticed over the months my portion sizes for meals started getting larger. By the time I stabilised I was eating 4 or 5 Snacks a day plus 3 about recommended portion sized meals. My snacks were combinations of whole & multi grain crackers, hummus, fruit, liverwurst, string cheese, nuts, Protein Bar, chia pudding & yoghurt. I used full fat salad dressings & added a seed mix to my rolled oats. So I upped carbs (no over processed carbs) & fats but still ensured everything I ate was nutritious (liverwurst & Salad Dressing aren’t good but yummy) & included 5-10g Protein (except no Protein in fruit). My dietician suggested I add powdered milk to my milk to make it richer but I found it too sweet. Honestly, I did feel like I was eating all day long.

My lowest weight was 48.2kg & I’ve been maintaining at 49 (48.5-49.5) for 14 months now. My BMI is around 18.7 so on the low end too but I’ve got a smaller frame so it’s ok. Initially my surgeon & doctor wanted me to put on a couple of kg too. I said I didn’t want too because of the possibility of 5kg bounce back in the future. Now they’re fine with my weight & tell me I look great & have done well (& I’m actually a couple of kgs less then when they wanted me to gain).

I eat about 1300 calories a day & only 3 or 4 snacks to maintain my weight. I’m not very active. I still have days or times when I don’t feel hungry but I always try to meet or be close to my protein goal. So if I don’t feel hungry say for lunch or dinner I’ll graze on a high protein yoghurt.

I was a little worried I wouldn’t stop losing &/or I’d get too thin & I had some ‘well intentioned’ family & friends saying it too. But I really like how I look now. Yep, I still get surprIsed when I see my skinny legs & thigh gap or buy size 4 (US 0) clothing but it’s a good feeling. It does take a while for your body to resettle too. I initially thought I’d got so slim I’d lost my hourglass shape but it came back (still don’t have much of a butt though 😉). I should mention I haven’t had any plastic surgery.

Have a chat with your surgeon & medical team & tell them honestly about how you feel about your current weight, the possibility of a reversal, etc. Do you still have access to a therapist to talk through how you’re feeling. I hope you can reach a point soon that your weight settles so you can fully embrace what you’ve achieved. All the best.

I don't have access to a therapist any longer. Nor a dietician..I saw the dietician once, during month 1 pre surgery and the therapist like 3x pre surgery. It's like it's been a DIY on your own type situation. At one point, around 8 months pist surgery, my team was like "you're eating too much" or "you're not losing enough" and now I'm losing too much but yet they say in the same breath "it's not your fault, it just happens ". I'm waiting for my plastic surgeon to contact me back with details on how much was removed so I can report that back to my team as they want to see how it correlates with the weightloss. Also, the abdominal tightness pist abdominoplasty and having to wear a binder for 24/7 for 2 months due to swelling makes you feel like you can barely eat..even when you take it off to eat...they say this feeling will go away in a few months. But it makes you feel like you did coming out of bariatric surgery...no room to eat 2 oz. So, we shall see what happens. I can only do what I can do and hope for the best. Right?

[Highly_Undermedicated 55]

2 hours ago, WildWill said:

OMG on your weight loss... AMAZING!

Highly_Undermedicated, no one can force you to undergo a procedure - however, they can use those terms to get you to understand the risks of being underweight. As Arabesque suggested, continue conversation with your team and also acknowledge that "I just can't eat all that" is suggestive of an opportunity to look at what you are eating and compliment or replace the volume of what you are eating with something that would compliment both your body AND the doctors.

Best Wishes, Will

Thank you. It's been a struggle. I've had my pouch opening enlarged twice due to strictures, and a whole host of abdominal issues. And now this. It just scares me to think about the old stomach.

[Highly_Undermedicated 55]

14 hours ago, huskymama said:

Just curious how tall are you? I’m 5’7” and I am getting the sleeve this month. I am hoping to get back to my high school weight of 125. My surgeon never gave me a goal weight

I'm 5'6.5" According to the CDC, as my NP stated yesterday, I'm not underweight until my BMI falls under 18 or 19. But According to bariatric standards, I'm on the low weight side and my ideal weight should be 63kg and I'm 60.something kg.so, they said some people don't lose weight, some a little, some a lot and some they have to intervene to stop it. This, I'm now terrified of. I know where I've been, I don't want that and I know what it took to get me where I am now and it was hard.

Good luck with your surgery. When are you scheduled?

[lizonaplane 1,604]

9 minutes ago, Highly_Undermedicated said:

I'm 5'6.5" According to the CDC, as my NP stated yesterday, I'm not underweight until my BMI falls under 18 or 19. But According to bariatric standards, I'm on the low weight side and my ideal weight should be 63kg and I'm 60.something kg.so, they said some people don't lose weight, some a little, some a lot and some they have to intervene to stop it. This, I'm now terrified of. I know where I've been, I don't want that and I know what it took to get me where I am now and it was hard.

Good luck with your surgery. When are you scheduled?

Like another poster said, no one can force you to have a surgery.

My semi-ex-boyfriend has a BMI of 18 and he's extremely healthy, and eats healthy too. He's just naturally very thin.

I would consider getting a DEXA scan to see how much muscle mass you have. You don't have to go in for a "clinical" one, but there are some private DEXA scan centers that can give you a pretty good idea. I went in for one right after I started losing weight pre-surgery to get a baseline. It was about $100, but their usual price is $150.

Good luck!

Edited December 3, 2021 by lizonaplane

[Prestonandme 107]

I'm 30 months out. My dietitian got concerned when several months ago I had dropped down to 116 (I'm 5'4) and seemed like I was in an endless free fall since my surgery. But like you, I had some medical issues that seem to have caused the continuous weight drop. Since surgery, I've struggled with extreme nausea and g.i. problems which may have resulted from a damaged vagus nerve. Oddly enough, though, for the past month or so, after a course of antibiotics for a UTI, the constant nausea has stopped (at least for now) and I can eat at regular intervals.

I'm now hovering between 119 and 121. Even when I was precipitously losing, my surgeon never suggested reversing the surgery. My dietitian instead focused on increasing my caloric intake, having me eat healthy fats, etc., just like you, and she also had me drink Ensure on days when I couldn't eat at all.

You may be going through an adjustment period which will soon stabilize. Be easy on yourself -- you just endured an obstructed bowel and abdominoplasty. And as others have said, no one -- no one -- can force you to undertake an *elective* surgery such as reverse RNY. If you are still unsettled, definitely get a second opinion about your weight situation.

[Elaine77 15]

Just curious how tall are you? I’m 5’7” and I am getting the sleeve this month. I am hoping to get back to my high school weight of 125. My surgeon never gave me a goal weight

Im 5'7" and i look very thin at 160. 125 would be extremely thin for me and probably unhealthy. But everyone is different.

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[Flab-U-Less Forever 140]

I agree that everyone is different...my daughter is 5'-7" and ranges between 125-130 and does NOT look too thin. She has a small frame.