Questions…??

[bahuber5477 96]

Question for you all with experience with going on GLP-1s after surgery. First of all I started out at 325 before I started my pre op diet, Day of surgery i was 315 (Oct 2), Tomorrow I am 4 months post op gastric bypass and I am down to 259.8 (55 since surgery and 65 since the pre op diet)Anyways, I also have a failed attempt with the gastric band back in 2013. Lost 100 lbs only to have complications and gain it back so thats part of my side story. My Dr. recommends GLP-1 starting now because of my high BMI and how much I want to lose after surgery. Personally i would prefer to start this after I’ve lost all the weight I can with diet and exercise and have plateaued. What is your experience with this. I am always wondering if im on track. I would ultimately like to see 160-175 but I guess I wont know until I get there. Any feedback or experiences would be great! Thanks

[SpartanMaker 1,307]

I think you have to first understand what these medicines do.

• They stimulate insulin production. This may or may not be important to you depending on if you are diabetic.
• They slow gastric emptying, meaning you'll feel full longer
• They may suppress hunger signals.

Interestingly, researchers don't fully understand why all of this occurs.

My personal take in your case is that if you are still steadily losing and are not feeling overly hungry yet (most people don't feel a lot of hunger 4 months post op), then I personally don't see the need to use this medication. I doubt it will do a ton, and might even make it hard to get adequate Protein intake. If on the other hand, you are already feeling a lot of hunger and are struggling, then these might help.

A few other things to think about:

• For most people in the US, these medicines can be VERY expensive, even if you have good insurance. If you don't have good insurance, then I hope you're independently wealthy because they can be several thousand dollars a month.
• Most of the pharmaceutical companies that sell these drugs do have some sort of savings card to make them SIGNIFICANTLY more affordable. Keep in mind that most of those are only good for up to one year. That means you could be back to looking at thousands of dollars a month to continue the medication after the savings card runs out.
• There are companies that are selling compounded versions of many of the GLP-1 agonists and they sell these for a lot less (typically hundreds of dollars a month rather than thousands). Bariatric Pal is even doing this. These companies can do this because the FDA has special rules for drugs in short supply that allows companies to make them to help fill demand. The issue is that you may or may not be getting what you think. See this link for more info: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss While some companies are certainly reputable and selling you what they say they are, others just are not. It's a little like the wild west right now when it comes to compounded GLP-1 agonists.
• There is a percentage of people that don't seem to respond to these medications. It's about 15% for semaglutide and a bit less for some of the others. I mention this since some people get really disappointed when this happens, so it would be good to be aware of this possibility ahead of time.
• These drugs (like most any drug), can have side effects that make then not worth taking for some people. There's really no way to know ahead of time if you will have this sort of problem.
• Generally speaking, most people that stop using these medicines tend to gain weight back pretty quickly, since the hunger will kick back in. As such, most doctors and pharmacists recommend staying on these for life. It's best to be prepared for this now, vs. thinking you're going to get away with just taking it temporarily.

[SpartanMaker 1,307]

1 hour ago, bahuber5477 said:

Personally i would prefer to start this after I’ve lost all the weight I can with diet and exercise and have plateaued.

Sorry, wanted to make one other comment here. Please don't approach your weight loss as something that will inevitably stall short of your goals. Plenty of us make it to goal and below, and have maintained this lower weight successfully.

There are two things that will really up your chances here: You need to eat better and move more.

• If you slowly start making better food choices, you'll find you'll lose weight more steadily and be a lot less likely to regain. By making better food choices, I mean eating less ultra-processed foods and focusing instead on:
  • Protein:
    • High quality legumes
    • Lean dairy
    • Lean meats
  • Carbs:
    • Mostly veggies
    • Some whole grains
    • Some fruit
  • Fats: Try to make this primarily monounsaturated fats
• This is not to say you can never have a treat, or have to eat only the above, but the more you focus on less processed foods, the better off you'll be. I also recognize that you can't make changes like this overnight. Take your time by just making small changes here and there until they become your new normal. Once those small changes are the new norm for you, it's time to make another small change. Keep at this process of making just small changes and eventually, your diet will be a lot better.
• In terms of movement, we now have lots of data to show that people that are successful in maintaining after weight loss tend to be very active. Once again, I know you're not going to be running any marathons tomorrow, but you absolutely can start small and focus on doing more and more over time.
• The CDC recommends at least 150 minutes of moderate intensity physical activity per week, which works out to 30 minutes per day for 5 days. They also recommend 2 days of strength training per week. Some data suggests that formerly overweight and obese people need to do even more than this, so my personal recommendation would be to shoot for at least 300 hours of moderate-intensity physical activity or 150 hours of intense physical activity, or some combination of the two per week.
• If you are over 65, the CDC also recommends you do some sort of regular training to improve balance since this can have a dramatic impact on fall risk.
• I know that sounds like a lot, but again, if you start slow (even 5 minutes a day 3 days a week), you definitely can get there.
• For reference, moderate intensity physical activity is walking a brisk pace, or similar activities such as a slow bike ride. Intense physical activity is more like jogging or riding a bike up a hill. If you didn't work up a sweat, it definitely does not count as intense.

[bahuber5477 96]

Spartan Maker thanks for the feedback. I am doing my best to increase my physical activity every day. I am weight training with the a trainer 2x a week and I’ve been trying to get in 30-45 minutes of cardio 2-3 times a week to. I do agree I probably need to do my best to up the intensity. I think I’ll start couch to 5k and start jogging.

Lately my Protein has been variable. I always get 70-80 but I know I would like to get more like 150. On a good day I get 110. My calories have been anywhere from 900-1300 depending on the day and if I work long hours. My hunger is generally fair. I do get hunger cues and what not but it’s not terribly overwhelming. I have been feeling great overall.

I would say as far as processed foods the main thing I eat processed is the shakes otherwise I have been trying to eat Whole Foods. I am a nurse and work 12 hour shifts and I do need To do better about getting a little additional physical activity after my shifts. This is a journey but have been blessed with feeling good and generally have good energy.

[SpartanMaker 1,307]

@bahuber5477 Great job, it sounds like your doing all the right things! I too make an exception for Protein Shakes. The nutrient profile for most of them is fantastic and for many of us, it would be next to impossible to reach our Protein goals eating just whole foods. I know I can't eat that much and I'm over 2 years out.

As an aside, I just wanted to say thank you for what you do. Nurses are the unsung heroes of the healthcare system and I for one really appreciate what you all do.