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Realistic Goals and Personal Responsibility

Discussion in 'Duodenal Switch' started by DianaCox, Mar 16, 2014.

  1.  
    DianaCox

    DianaCox Bad Cop

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    This is a repost of something I wrote nearly 5 years ago. Apparently, people appreciated it, so I'm reposting it here. (And if you see something like it elsewhere, it is there without my permission; if you see it rewritten and not credited, I consider it plagiarism.)

    Post Date: 5/9/09 9:09 am

    Someone asked me a very thoughtful question via PM, and I thought I would generalize the answer and post it here. It related to several recent posts complaining about sub-optimal weight loss being experienced by some post-ops.

    1) The AVERAGE long-term weight loss for the DS is 75%. That means a (somewhat skewed) bell curve centered on 75% -- some people lose 100% (or a tad more), some people (fewer than 10%) lose less than 50%. Expecting 100% is unreasonable. It is POSSIBLE, but expecting it is unreasonable.

    2) The heavier you are, the less likely you are going to lose all your weight anyway. 50% EWL of a 350 lb person with a goal of 150 leaves them weighing 250 lbs -- 50% EWL of a 250 lb person with a goal of 150 leaves them weighing 200. Both are considered a successful result.

    3) Some people can't or won't change their eating habits long-term. I myself was so pleased to NOT be dieting and losing weight that my weight loss stopped when I got to 205 at one year out, down from over 290. That was a healthy 205, in normal sized clothes, so I tried not to care. My cravings have changed over time, so now I'm not having as hard a time resisting that which I should not eat, so I have lost another 35 lbs in the last 2.5 years. I could have lost more if I was stricter with myself, but I am happier not dieting than I am at the idea of being under 170. 171-173 is pretty steady right now eating whateverthehell I please. I'm not saying one or the other mind-set is right or wrong, but it is a trade-off that I am responsible for choosing.

    4) (In answer to a question about a specific person who had posted about stalling at a pretty high weight, and who was eating a lot of carbs, which concerned the person who asked me the question.) The person you mentioned started out over 400 lbs., and pre-op said that she had no intention of getting below 250, that she was only doing this because of her health, and was happy being a person of size. Then, as she started losing weight effortlessly in the immediate post-op period, it seems her goals changed to be more optimistic, possibly because she started thinking and believing she really COULD lose to lower than 250 (which I think she didn't really believe pre-op, and had geared herself to believing was OK, so long as she was healthy -- a NOT unreasonable goal), but -- it appears sh didn't control her carb intake sufficiently during the effortless part, and now the results are coming to bear. 150-200 g/day of carbs is way over the top for someone who is SSMO and supposed to be trying to maximize her weight loss in the "window," despite the fact that the weight loss was impressive for the first few months no matter what she ate. Starting out SSMO and not controlling carbs sufficiently during the weight loss phase is more likely than not going to lead to sub-optimal weight loss overall, even if it didn't seem to matter at first.

    5) Some surgeons do not do adequate operations. That's just fact. Drs. X, Y and Z (I'm not going to name names here, but I will give my opinions privately) seem to have more patients with worse results on average than others. And I'm wary of the surgeons who are giving people REALLY small stomachs and longer common channels -- some surprisingly long (150-200 cm). I have my doubts about them. My opinion, of course, and not a fact, and all based on anecdotal evidence. Personally, I would never accept a common channel longer than 125 cm, but that is my OPINION, not fact. The smaller stomach (3 oz vs. 5 or more, but no smaller) I think is a good idea, depending on the person.

    6) Some people are just biologically resistant to weight loss. People of black and Hispanic ancestry in particular. Short women tend to lose less well. Tall men do better. People who have failed previous WLS do less well, as do people who have dieted severely several times previously. Age often matters, though I'm not sure if that is because older people are more sedentary or are more likely to have wreaked their metabolism worse with multiple starvation diets. There needs to be more study on optimizing common channel and alimentary tract lengths, as well as stomach size, with people's metabolisms. I'm NOT OK with surgeons who do a cookie-cutter surgery without measuring the small intestine (which can vary from something like 7 feet to 23 feet in length) and doing a proportional DS, or who don't vary the procedure based on age, BMI, health issues, etc. -- it has to be personalized.

    7) People need to take personal responsibility. The DS makes this journey much easier, but it rarely makes it effortless. You have to control your carbs, more or less depending on YOUR particular situation. If you are older, have starvation dieted several times previously or have a previous failed WLS, you are probably going to have to be stricter and work harder than a younger person who hasn't wreaked their metabolism as badly, in order to get the best results. If you don't exercise, you are making it less likely that you will have as good results -- the same weight of muscle burns more calories at a resting state than fat and occupies a smaller volume; exercise tones your body, strengthens your bones, makes you healthier overall. If you don't care about getting optimal results if it means working harder, by controlling your diet and/or exercising (and I count myself among those people until the last 18 months or so), that's fine, but qwitcherbitchin'!! You've made a choice -- take personal responsibility for the effects of that choice.

    TANSTAAFL.* It's the universal law. Some people get it easier than others, but who said life is fair? This is NOT a set-it-and-forget-it cure for morbid obesity. We have to be proactive about our health, and that includes setting realistic goals and taking personal responsibility.

    * en.wikipedia.org/wiki/TANSTAAFL
     
  2.  
    hilary1617

    hilary1617 First time at the rodeo.

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  3.  
    Joanne

    Joanne Member

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    Thanks for digging this up. This is a great post.

    I wish people in the first few years from surgery would better understand there are no guarantees. I read a post somewhere else from someone who is less than 6 months out who said he had the DS so he could eat whatever he wanted. That is so not true - well, not if you want to maintain your loss. The DS helps give us a normal metabolism, but even people with a normal metabolism don't have a free ticket to eat whatever they want. The honeymoon phase ends and regain is quite real.

    But I also think people can look at redefining "normal". "Normal" bodies come in different shapes and sizes. Look at people who were never obese. Not everyone is a size 4. There are size 8's, 12's, and 16's, etc out there - but all normal by any standard. The DS does the same for us. It's common that we'll see someone a year or two out, as the rapid weight loss phase is ending, and they'll be lamenting the extra 20, 30, 40 pounds they still have to lose. That's quite normal for most people, and we need to remember that 75-80% EWL is the average. Most people will lose in that range, and for everyone who makes it to a normal BMI there is someone who doesn't even achieve that 75-80% loss.

    But even though most people will not lose 100% excess weight, I dont think I have ever seen anyone remain morbidly obese. I encourage people who judge and measure by the scale and BMI to redefine what they consider success. Before my DS, I wrote down all the reasons I wanted it. The reasons were things like normal blood pressure, fitting into airline and theater seats, shopping in the Misses section, and being able to walk up flights of stairs without turning red and panting. I reached ALL those goals by the time I lost to at least 60-70 pounds OVER what I am right now. Everything else was just the icing on the cake. Or the butter on the veggies...to make it more DS appropriate :)
     
  4.  
    MyNewLife

    MyNewLife Roast Beef for dinner (shhhhh)

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    ok. So, when I first saw my surgeon, he set a goal for me of 170. I am 5'6.5" and a "normal" BMI would be 156 at the highest. My highest weight was around 340-350, SW 337 I think. Well, I went into this surgery hoping to live long enough to see my daughter get married and not become totally disabled, eliminate diabetes and my dependence on anti inflammatories for my knees. Well, too my daughter's too young to get married but I have a new career and am able to do what needs to be done to accomplish it. I never got to that magic 170 nor the internal goal I had of 150, one day I decided it was "good". That's the only way I can describe it, I was happy being healthy and being able to buy regular clothes. I fit in the tub, the car, movie seats and probably an airline seat if I flew. I had what I wanted and if i kept losing, I'd have to buy more clothes, what a waste of money.

    This morning I weighed 173, I quit trying at about 188. no longer diabetic and basically healthy. I eat what I want as long as it doesn't involve milk and I suffer when I over carb or over butter. Other than that, I eat what I want, salad, broccoli, breads and even sweets sometimes. When I get too many sugary carbs, the bathroom visits kick in and then I crave salt so I eat a lot of chips to get sodium in me. I'm floating down by about 1/2 to 1/4 lb a month without effort or even caring. I probably have 10-20lbs of excess skin.

    When calculating EWL, what goal do we decide on? I was happy around 188, the doc said 170, my twisted head at one time wanted 150, BMI charts say 156. What is my target goal in this scenario. I know it doesn't matter because with the exception of cheese, I have what I want but it's a geeky numbers thing :)
     
  5.  
    JackieOnLine

    JackieOnLine Moderator Staff Member

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    excellent post, Diana. :clap:
     
  6.  
    Lilyofthevalley

    Lilyofthevalley Revived & Revitalized

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    You should repeat this post every year just so more people will read it. Thanks
     
    marissamast likes this.
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    heyclementine

    heyclementine Member

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    Really enjoyed reading this, thank you for sharing.
     
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    MyNewLife

    MyNewLife Roast Beef for dinner (shhhhh)

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    Lol. Thanks, heyclementine for bringing this to my alerts. I posted that in March of last year. I'm a bit over 3 years now. This morning I weighed 156, before Christmas I was down to 152. My clothes fit except for the ones I bought before March. I'm still happy and healthy and have no interest in losing more. Don't want to gain either LOL.

    How weird to see what I thought what seems like forever ago but was only 9 mos ago :)

    Thanks again!
     
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    heyclementine

    heyclementine Member

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    So you got down to what the BMI charts said afterall! That's amazing and inspiring. Congrats!
     
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    star0210

    star0210 Well-Known Member

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    Thanks...that's a really good post.

    I have a personal goal...but to me, it's more pie in the sky kind of a dream goal which I don't consider to be realistic.
    I know with my metabolic challenges I may never reach that goal...so I'm just along for the ride and what will be what will be. I know that whatever that is I will have done my best to maximize my chances (with the exception of exercise which maybe one day I'll be able to do some sort of exercise, who knows) and I'll accept wherever I end up.

    I track everything I eat, and think for being 7 weeks out from my conversion to DS with partial re-sleeve that I'm doing pretty good nutrition wise...except for getting enough fats. I average 80-100g of protein, and under 30g of total carbs per day. But I'm only averaging maybe 50-60g of fats. I'm working on upping that. I don't worry about calories but mfp tracks that so I've been averaging about 850 calories per day.

    Since the day of surgery I've lost 17 lbs which I think is pretty darn good for being such a lightweight to start. 195 day of surgery and 178 today.
     
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    star0210

    star0210 Well-Known Member

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    How cool is that? You were content where you were and ended up very near to your own personal goal which you thought wasn't ever going to happen! That's like CHRISTMAS! lol
     
    MyNewLife likes this.
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    MamaShelia

    MamaShelia Well-Known Member

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    Diana! You rock! You are the best "bad cop" ever and what a blessing! Thanks for digging up this post and for telling it like it T-I-S! All of it is is true, pertinent, and relevant....every 6 months a repost...or put it in the perma-post area, not sure what that is called! I am black and a revision, so I know I have my worked cut out for me, but am so ready and willing to put in the work and see the results paying off....unlike so much else I have done in the past 15 years!

    My New Life---what a story and a journey...thanks for sharing and for just being REAL! It means a lot!

    Joanne--yeah, "normal" and "normal weights" are so personal and individualized! I am not a numbers girl, so I don't get crazy over numbers....I am looking to be off of these meds, able to enjoy our empty nest right now, and prepare for grand babies in the next 10 years, I hope!
     
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    Honeybeeblue

    Honeybeeblue Well-Known Member

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    Will2014

    Will2014 Well-Known Member

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    I've lost 200 lbs now in about 10 months, down from my high of 412 to 212 lbs . I've lost a TON of muscle mass though, and I actually look like a concentration camp survivor with folds of loose skin at my gut, upper arms, and thighs. My arms and legs are really skinny now, when they were actually pretty muscular before my surgery. I'm happy about the weight loss, don't get me wrong. But if you all ever saw the movie "Thinner" by Steven King, you know how I am feeling of late. My question is this: have any of you lost TOO MUCH weight? I gotta confess, I still don't eat all that well since my surgery. My appetitie is just gone, and I only eat to stay alive and because my wife forces me to. I recently bought some weights to try to rebuild muscle mass, but I'm just kinda weak a lot and haven't been able to force myself to work out. Has anyone here gone through this? I'm posting this in the wrong spot I realize, as many here are struggling the other way. But I'd really give anything to be able to eat a whole cheeseburger again. I've never had steak since my surgery, and while I remember it longingly, the thought of trying to eat it now makes me sick. It's still too tough for me. At 10 months post op-is this normal? My labs were good last week except for my D3 and A which were low. I gotta work on those! In May I'm going to ask for a bone density test too. For those of you who are the praying sort, please pray for me.
     
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  15.  
    DianaCox

    DianaCox Bad Cop

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    @Will2014 - you aren't done yet. You will lose more, which i assume you want, BUT the weight loss will slow down, and the fat that you have will rearrange itself - your face will fill out again, and you won't look so skinny. BUT - if you are having that much trouble eating now, it might be time to go in for a check of your stomach and make sure you don't have a stricture or something like that. Most people are eating decent meals by now.

    If your weight loss doesn't slow down, you MIGHT need to consider whether you need some Creon to help slow things down.

    But yeah, you should start doing some weight training, as well as cardio. (Says the couch potato ...)
     
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