I recently had my 5-year post-op follow-up.  I haven't seen my actual surgeon in years; my follow-ups after year 2 have just been with his nurse.  Before this appointment, I considered myself a WLS success story.  I lost about 200 pounds from my highest weight and have maintained a healthy weight for years.  I have completely overhauled my diet and developed healthy eating habits.  All of my health markers like blood pressure, glucose, lipids, etc. are excellent, and I have gotten in great shape with both cardio and weight training.

I weighed in at this appointment, fully clothed, at 144 pounds, which puts me at a BMI of 25.5, 4 pounds into the overweight range.  I'm not that concerned about BMI because I believe that actual health metrics are more meaningful, especially considering that I have several pounds of loose skin after massive weight loss.  DEXA scans show my body fat percentage around 21%.

When the nurse came into the exam room, the first thing she said was, "You've gained some weight.  How do you feel about that?"  I was taken by surprise and said that obviously, I want to maintain my weight loss, but I'm also trying to build muscle.  She asked how many carbs I'm eating and I said it varies, and I mainly focus on calories and protein.  She said, "You need to keep your total carbs under 60 grams per day."  I said, "That seems pretty low."  She replied (in a condescending tone), "Well, that's what you have to do to maintain your weight loss.  It's in the manual.  Carbs are the foods that sneak back into your diet and cause weight gain."

I was pretty shocked and offended by what she said.  First of all, I find it hard to believe that they expect WLS patients to stick to a carb limit of 60 grams/day for life.  I think that's unsustainable for most people, especially for someone like me who works out for 2-3 hours per day (not that she asked how much I exercise).  And I'm shocked that someone who works with bariatric patients speaks in such judgmental and insulting terms about food.  Saying that carbs "sneak back into your diet" implies that I'm stupid and/or dishonest for eating more than an absurdly low level of carbs.

And then she told me to schedule the next follow-up in a year, but if I gain any more weight, I should come back sooner because I might need to consider GLP-1 medications (which she noted wouldn't be covered by insurance at a BMI of 26).

I went in thinking that I was a model patient, and left feeling like a complete failure.  I thought I was a success story, and now I'm doubting myself entirely, wondering if I'm deluding myself and really on the road back to morbid obesity.  I haven't felt this demoralized in a long time, and it makes me never want to talk to that nurse again.  But I also know that long-term success with WLS is strongly associated with continuing follow-up, and I'm afraid it's a red flag that I'd give up just because a nurse shamed me about 4 pounds.

I'd really like some outside perspective on this, especially from other WLS veterans 5+ years out.  Do you still stick to a strict carb limit?  Am I overreacting, or was this nurse out of line?

P.S. My weight often fluctuates by up to 5 pounds in the same day.  This morning, I weighed in at 139 pounds.  And here is a picture of WLS failure.

OMG how rude. Can you report her? Can you request she doesn’t meet with you again! An important component of her role is to be supportive yet she tore you down and made you doubt yourself. Did she even actually read your file and review your progress? Seems like she just looked at the number on the scales and made judgement. I mean how many times do we tell each other not to focus on just the number on the scale.

I have admired your progress and successful maintenance over the years @BigSue. You have been a great mentor & role model here & I am so angry that this person has damaged your confidence.

My follow ups are 6 monthly and I see a doctor. (I’ll be seeing her again in a couple of weeks.) She reviews my bloods, has a chat with me about any things I’ve noticed, have concerns about, happy about, etc. Yes, she does weigh me but generally makes no comment excepted to maybe to say about the same as last time. When I saw her 6 months ago, I was having issues of weight gain (which was strongly hormonally driven) and we discussed that but she never once spoke to me about what I ate. I know if the gain had continued I know I could have rung her and asked for further support and advice.

As you may recall, I was never a food tracker. I still do random checks of calories, protein and fluids though. And I like to ensure I’m getting in a balance of nutrient sources so ensure I have fruit, vegetables, complex grains, dairy, seeds & nuts & meat every day and occasionally legumes. I have no idea how many carbs I eat or fat for that matter. I just know I have 2 - 3 serves of carbs a day.

Remember you know your body best. Your fluctuations, your general health and well being, what you need to support your activity routines & for your body to function, etc. You know if you’re retaining fluid, constipated, been unwell, where you carry loose skin, your muscle development & if there have been any changes in your usual routines lately (like a bit more socialising, been on holidays, work been more stressful,…). Are your clothes tighter? Is your general doctor happy?

I’d give her a big F you & stick to what you’ve been doing.

PS - You look great in that pxt.

Edited October 15, 2025Oct 15 by Arabesque

@BigSue I am feeling so angry and upset for you, how damn dare she. You are a success, you look amazing. You did this really difficut surgery. You changed your life. You lost the weight. You work your butt off to keep it off.

No a measure of carbs has never been in my diet plan. My main instructions were at least 60 -80 grams of protein a day and drink plenty of water.

I am with @Arabesque here, the nurse needs to give her head a wobble, if they have changed the diet for you then they should have alerted you beforehand.

I am a great believer of a complaining email. They work for you and with you. Maybe this lady forgot

I am so sorry and upset that she treated you this way!

Her job is to be supportive, not to diminish your amazing achievements for a minor (and very normal) fluctuation in your weight.

I would put your feelings in writing to the clinic.

Don't let her or anyone steal your light! You're doing a amazing job! 🤗

2 hours ago, DaisyChainOz said:

steal your light!

What a great saying, so apt

On 10/14/2025 at 11:38 PM, Arabesque said:

OMG how rude. Can you report her? Can you request she doesn’t meet with you again! An important component of her role is to be supportive yet she tore you down and made you doubt yourself. Did she even actually read your file and review your progress? Seems like she just looked at the number on the scales and made judgement. I mean how many times do we tell each other not to focus on just the number on the scale.

I have admired your progress and successful maintenance over the years @BigSue. You have been a great mentor & role model here & I am so angry that this person has damaged your confidence.

My follow ups are 6 monthly and I see a doctor. (I’ll be seeing her again in a couple of weeks.) She reviews my bloods, has a chat with me about any things I’ve noticed, have concerns about, happy about, etc. Yes, she does weigh me but generally makes no comment excepted to maybe to say about the same as last time. When I saw her 6 months ago, I was having issues of weight gain (which was strongly hormonally driven) and we discussed that but she never once spoke to me about what I ate. I know if the gain had continued I know I could have rung her and asked for further support and advice.

As you may recall, I was never a food tracker. I still do random checks of calories, protein and fluids though. And I like to ensure I’m getting in a balance of nutrient sources so ensure I have fruit, vegetables, complex grains, dairy, seeds & nuts & meat every day and occasionally legumes. I have no idea how many carbs I eat or fat for that matter. I just know I have 2 - 3 serves of carbs a day.

Remember you know your body best. Your fluctuations, your general health and well being, what you need to support your activity routines & for your body to function, etc. You know if you’re retaining fluid, constipated, been unwell, where you carry loose skin, your muscle development & if there have been any changes in your usual routines lately (like a bit more socialising, been on holidays, work been more stressful,…). Are your clothes tighter? Is your general doctor happy?

I’d give her a big F you & stick to what you’ve been doing.

PS - You look great in that pxt.

Thank you for this! I see several doctors in this hospital system, and they almost always send me a survey after each visit, but go figure, this time, they didn't. I hate to lodge complaints because I don't like the idea of getting someone in trouble, and I don't want to look like an entitled brat, but this encounter seriously bothered me to the point of making me lose sleep. I thought she was going to congratulate me on maintaining a weight loss of over half of my starting weight, 5 whole years out from surgery, but no, my BMI is a hair over 25 and suddenly I'm a failure and all I get is, "You've gained weight" and a lecture about carbs.

I like to think that I've learned a lot about maintaining a healthy lifestyle and mindset about food and eating. I've had a lot of time to think about how I gained so much weight and why I was unable to lose it for so long, and I've come to believe that this type of judgment has been a huge part of it. I'm 5 years out and I know better, but this visit really shook my confidence, and I hate to think what it could do to a patient who is struggling pre-op or still trying to adjust in the early post-op phase. I already have an appointment with her for next year, and I hate the thought of subjecting myself to this again. I almost wonder if I should consider myself to have "graduated" from the WLS program -- not that I know everything and can stop working to maintain my weight loss, but maybe move on to a more advanced program or trainer with expertise in healthy, fit people. In the last couple of years, I've worked really hard to improve my fitness rather than just being "not fat," and I'm not sure the bariatric surgery nurse is equipped to support my changing needs. But I felt that her comments went beyond ill-informed and ventured into harmful.

I can only pray to be as "unsuccessfull" as you are!! Lol...She is out of her mind, and I'm not a veteran yet, but I would report her. Tell the doctor. She needs to have an appropriate bedside manner that she lacks. You deserve better!

I think that is a concern and maybe why you should lodge a complaint @BigSue: if her comments made you feel like this what is she saying to those staring out or early on the journey. Have to admit I did think I bet she’s never had to battle with her weight at any point in her life.

May be in your complaint suggest the need for a program to support those like you who are more advanced, informed and been maintaining successfully for a number of years. I think that’s a great idea & there would be others like you at the clinic. It would be an incentive for everyone to keep up with check ins and to check they’re still on the best path for them.

ugh.

i learned early in my WLS experience to take the things my "team" advised me with a grain of salt (i'm looking at you nurses, NUTs and dieticians in MY program, YMMV). It was obvious even in my pre-surgery appointments that they were reading from a script and dispensing a one-size-fits-all solution. um, i am not the same size as the lovely lady next to me, nor are we the same age, have the same metabolic makeup, genetics, weight history, mental state, etc, etc.

i basically discovered what worked for me via trial and error - always letting them know what i was doing, and always being low-key scolded for doing so. ASIDE: On top of that they would also marvel at my weight loss as i progressed, so wtf, really. but i get it, they see hundreds of us a week, in 15 min increments, its difficult to give personalized attention. if i wanted personalized attention, i'd been better off hiring private assistance. but i didn't, so i went to my mandatory appts and just smiled and nodded.

sorry you left that appt feeling sh*tty. she was looking at a number not at you.

from what i have seen of you on here over the years, you are doing/have done marvellously. you've lost 200 lbs and maintaining. you've navigated up to now with no saltiness, you've displayed patience are not a huge stresser nor display huge anxiety, you provide helpful and encouraging advice to others kindly and funny ways, plus you look HAWT in that pink dress.

was she out of line? maybe. do her words make you any less marvellous? hecks, no.

this is ridiculous! Can you switch over to your regular PCP, maybe? (we were encouraged to have our annual check-ins with our regular PCP once we were 5+ years out and had had no issues). I wouldn't want to see a nurse like that again. And no, I don't eat an obscenely low level of carbs (my surgeon's program wasn't ultra-low carb to begin with - they stressed balance - protein, healthy carbs, and healthy fats). And you have been amazingly successful. Most successful bariatric patients make it down to "overweight" or "class I obese" (which is not very obese - we're talking like 30 lbs overweight). You're only barely in the "overweight" category - and like you said, you've got loose skin, which probably counts for a good 4 or 5 lbs. Sheesh. That nurse needs a new profession.

(P.S. I'm 10 years out)

Well, I am not five years out from my revision, but I think I have a pretty good understanding of what works and what did not for me and that we are all different. This time, I have a nutritionist who actually looks at my logs from the Baritastic app as well as my fitness stuff on my Apple Watch and she told me to add in more carbs because of my exercise!

The fact that your nurse didn’t even bother to ask you about your nutrition, activity or medication changes, etc means she has no clue what she’s talking about and I would’ve checked out right there.

Honestly, the fact that she is working for a weight loss clinic with that level of ignorance and attitude is just baffling. Whether you decide to report her or not is entirely up to you, but at the very least, I would ask for any follow ups to be with a different practitioner at that office or just go to another one. What you were doing is clearly working for you. I mean you don’t fit into her little mold but that’s because there is no one size fits all mold. You are doing great and certainly don’t need her reckless advice to break what isn’t broken. 😡

Girl, just take a look at those arms! Man they're impressive! Totally fangirling right now.

On a more serious note, BMI, the number on the scale ....etc. interpretations are nuanced and should never be taken at face value. You're 144 lbs but probably have a high muscle mass, skeletal muscle, lean body mass etc. which translates into a higher number on the scale, that is just a fact. Had this nurse known these nuances and cared to research (or just be kind and nonjudgmental for that matter) she would've commended you on the great work you've done.

Maintenance is not easy, I know many many WLS patients who never got to their goal weights, others who gained a ton back, and others who totally spiraled due to the lack of discipline and commitment to the after. From what I gather from your replies and posts, you are 100% a success story a million times over, never doubt that or let a sleazy nurse make you feel anything but.

As for tracking, I'm almost at the 2 year mark and I don't track nothing, I have done random checks here and there but I never track my carbs or even my calories, I eat a well balanced diet and focus on my protein, but I eat all the carbs (bread, rice, potatoes, chips, dessert) and I never want to live a life where I have to be carb counting everyday, it's just not for me.

Please be kind to yourself and celebrate what you've achieved, I certainly look up to you and people like you :)

Edited October 29, 2025Oct 29 by Lilia_90

On 10/15/2025 at 4:08 AM, summerseeker said:

@BigSue I am feeling so angry and upset for you, how damn dare she. You are a success, you look amazing. You did this really difficut surgery. You changed your life. You lost the weight. You work your butt off to keep it off.

No a measure of carbs has never been in my diet plan. My main instructions were at least 60 -80 grams of protein a day and drink plenty of water.

I am with @Arabesque here, the nurse needs to give her head a wobble, if they have changed the diet for you then they should have alerted you beforehand.

I am a great believer of a complaining email. They work for you and with you. Maybe this lady forgot

Thank you... I wouldn't say she changed the diet, but I don't think she's interpreting the manual the way it was intended. I haven't looked at it in years, but after her comment, I had to check, and this carb limit shows up in the section on diet progression after surgery. There's a page for each phase (clear liquids, full liquids, purees, soft foods, and regular solid foods).

The "Regular solid foods" page says "Week 7 - Lifelong," which I suppose implies that this is intended to be a lifelong diet. However, there's a whole separate section for "Lifelong Diet: Successful Eating Plan," and this has more general guidelines and lists of recommended foods, but no hard limits on carbs or anything else, and recommends using a calorie tracking app to understand calorie and protein needs. I think the "Regular solid foods" section is intended for patients who still have significant weight to lose after the first 6 weeks post-op, as I did, and continued to lose weight for over a year after surgery. The "Lifelong Diet" section seems directed more toward maintenance. It's alarming that this is so unclear, even to the nurse who is providing direction to the patients! It also makes me wonder if she is directing everyone to follow the same diet and same limits, whether it's a 5'3" woman or a 6'6" man?

On 10/23/2025 at 8:20 AM, ms.sss said:

ugh.

i learned early in my WLS experience to take the things my "team" advised me with a grain of salt (i'm looking at you nurses, NUTs and dieticians in MY program, YMMV). It was obvious even in my pre-surgery appointments that they were reading from a script and dispensing a one-size-fits-all solution. um, i am not the same size as the lovely lady next to me, nor are we the same age, have the same metabolic makeup, genetics, weight history, mental state, etc, etc.

i basically discovered what worked for me via trial and error - always letting them know what i was doing, and always being low-key scolded for doing so. ASIDE: On top of that they would also marvel at my weight loss as i progressed, so wtf, really. but i get it, they see hundreds of us a week, in 15 min increments, its difficult to give personalized attention. if i wanted personalized attention, i'd been better off hiring private assistance. but i didn't, so i went to my mandatory appts and just smiled and nodded.

sorry you left that appt feeling sh*tty. she was looking at a number not at you.

from what i have seen of you on here over the years, you are doing/have done marvellously. you've lost 200 lbs and maintaining. you've navigated up to now with no saltiness, you've displayed patience are not a huge stresser nor display huge anxiety, you provide helpful and encouraging advice to others kindly and funny ways, plus you look HAWT in that pink dress.

was she out of line? maybe. do her words make you any less marvellous? hecks, no.

Thanks... I did feel as though she was viewing me as a number on the scale and reading from a script or perhaps a flowchart. I imagine her looking at a flowchart that says, "Compare patient's current weight to previous weight," with one arrow for "higher" and another for "same or lower." She followed the arrow directly to the "REGAIN!!!" path and looked at me the same as if I had regained, say, 100 of the 200 pounds I lost.

I suppose I shouldn't be so shocked to encounter unhelpful weight management advice from a medical professional, considering that I've had a lifetime of hearing generic weight and nutrition counseling everywhere I went. Still, I expected a full-time bariatric clinic nurse to have a little more expertise and nuanced understanding of weight management, nutrition, and health metrics. My A1C was 4.8 and she's telling me I'm eating too many carbs?!

On 10/25/2025 at 4:47 PM, catwoman7 said:

this is ridiculous! Can you switch over to your regular PCP, maybe? (we were encouraged to have our annual check-ins with our regular PCP once we were 5+ years out and had had no issues). I wouldn't want to see a nurse like that again. And no, I don't eat an obscenely low level of carbs (my surgeon's program wasn't ultra-low carb to begin with - they stressed balance - protein, healthy carbs, and healthy fats). And you have been amazingly successful. Most successful bariatric patients make it down to "overweight" or "class I obese" (which is not very obese - we're talking like 30 lbs overweight). You're only barely in the "overweight" category - and like you said, you've got loose skin, which probably counts for a good 4 or 5 lbs. Sheesh. That nurse needs a new profession.

(P.S. I'm 10 years out)

Thanks... I actually have an appointment with my PCP this week, so I can ask her about this. My PCP is really good, but she's never claimed to have any expertise in weight loss or bariatric surgery patients, so I'm not sure if she would be comfortable with this. She's in the same hospital system as my bariatric surgeon, so she already has access to all of my records and knows what bloodwork the bariatric clinic wants. Even if this isn't her area of expertise, she's still more knowledgeable about it than this nurse.

3 hours ago, Lilia_90 said:

Girl, just take a look at those arms! Man they're impressive! Totally fangirling right now.

On a more serious note, BMI, the number on the scale ....etc. interpretations are nuanced and should never be taken at face value. You're 144 lbs but probably have a high muscle mass, skeletal muscle, lean body mass etc. which translates into a higher number on the scale, that is just a fact. Had this nurse known these nuances and cared to research (or just be kind and nonjudgmental for that matter) she would've commended you on the great work you've done.

Maintenance is not easy, I know many many WLS patients who never got to their goal weights, others who gained a ton back, and others who totally spiraled due to the lack of discipline and commitment to the after. From what I gather from your replies and posts, you are 100% a success story a million times over, never doubt that or let a sleazy nurse make you feel anything but.

As for tracking, I'm almost at the 2 year mark and I don't track nothing, I have done random checks here and there but I never track my carbs or even my calories, I eat a well balanced diet and focus on my protein, but I eat all the carbs (bread, rice, potatoes, chips, dessert) and I never want to live a life where I have to be carb counting everyday, it's just not for me.

Please be kind to yourself and celebrate what you've achieved, I certainly look up to you and people like you :)

Thanks! I hope this isn't too arrogant, but I like to think that I can give some encouragement to people who are so terrified of loose skin. I certainly have my share of it after a 200-pound weight loss, but if I dress strategically, no one would know. And strength training can actually make a difference in reducing arm flab. Then again, I wore a sleeveless top to this appointment and the nurse was clearly not impressed.

Based on a lifetime of personal experience, I'm not usually surprised when medical professionals use BMI as a health metric, but I guess I was caught off guard to hear this from a nurse who specializes in bariatric patients, and who knows that I used to have a BMI over 60.