Realistic Goals and Personal Responsibility

[Charris]

Glad to see this post again as I am being a worry wart about the 50 pounds I gained being sick. I don't feel good enough to get in the gym but I'm not doing all I can do to make sure I get back to goal. Personal responsibility. Don't carry a raw egg with one finger then be surprised when you drop it and break it.

 

[robs477]

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.

Hi @Will2014...Congratulations on your WL! I'm at my 6 week post op stage and have all those same "non-desires" for food. nothing sounds good...lol And its weird, I dont miss the foods I use to like because I dont want them. So, yeah, at only 6 weeks out, Im hoping that changes some for sure too, but, I can relate to what you are describing, exactly. As far as WL....for me, I dont want to get under 220 or so, but thats just me. In the mid 90's I was under the strict care of a trainer and a REAL nutritionist for about a year and got down to 230 lbs but was at 17% body fat, so...going by the scale sometimes is not always giving the real picture. BTW, My Wife does the same thing...lol Best luck to you!

 

[Will2014]

@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 ...)

Thanks Diane! Really appreciate your taking the time to respond. I'm happy to hear about the fat rearrangement stuff, and the face filling out again. My face and neck look so skinny! Still have 13 lbs to go to get to my original target weight, and 23 lbs for the one I changed to. But I was wondering if I could afford to lose 23 more recently. I suspect the answer is yes, because I still have fat inside my loose stomach skin, and a tad more on me thighs. I found a delicious protein drink brand called Bolthouse...love it! They have 3 kinds of chocolate, vanilla, and strawberry. Sold at my local supermarket and at Walmart. Thanks again for the uplifting response.

 

[Will2014]

Hi @Will2014...Congratulations on your WL! I'm at my 6 week post op stage and have all those same "non-desires" for food. nothing sounds good...lol And its weird, I dont miss the foods I use to like because I dont want them. So, yeah, at only 6 weeks out, Im hoping that changes some for sure too, but, I can relate to what you are describing, exactly. As far as WL....for me, I dont want to get under 220 or so, but thats just me. In the mid 90's I was under the strict care of a trainer and a REAL nutritionist for about a year and got down to 230 lbs but was at 17% body fat, so...going by the scale sometimes is not always giving the real picture. BTW, My Wife does the same thing...lol Best luck to you!

Thanks Robs477! Where would we be without these magical angels God gave us as our wives eh? We're lucky guys both! Gratz on your decision and best of luck to you in your recovery phases. What you drinking for protein shakes? I found great one, Bolthouse is the brand and it's sold in Walmart and my grocer. GREAT! Most taste like cat turds....so I tell everyone I can how good this tastes to me. My biggest recovery problem at 6 weeks out was still fluid intake. I was DEHYDRATED! A poster here told me about Lemonade-the Fresh squeezed stuff. It may well have saved my life, and I'm honestly not joking. I was peeing dark brown urine, and not a lot of it. The lemonade helped me a lot, because I would get sick drinking water. Something about the acid that helped me hold it in....and actually enjoy drinking it. Keep us posted here on your progress! Any help I can offer is yours, as so many here have done for me.

 

[lavie12]

Thanks for this post @DianaCox. Gives me so much to consider since I am now researching the possibility of revision from RNY to DS. I was one of those people who did reach goal within a year lost all of my excess weight to a BMI of 24. Sometimes all I can think about is getting back to that and how good I felt when all my co-morbs were resolved, but it's good to keep things in perspective that it may be tougher to do that this time around. I'll keep my expectations in check.

 

[SJB41976]

This post is especially helpful for anyone considering WLS. Very helpful!!! Since I am a revision (twice over) I know if I do this, it's on. I have a window, I want to take full advantage of it. I'm so glad I have had therapy the past two years specifically dealing with my food issues. I cannot say enough about how hindsight is 20/20. This mistakes I made. Well, today is a new day. No sense in wallowing in the failures of the past especially when you learn from them.

Thanks, again!

 

[Debbie]

Thanks - you are a plethora of information. If your were a surgeon I would choose you - you are a straight shooter and thats really what most of us need! I am gonna join the losers bench on July 22 and am looking forward to getting information from you and everyone else.

Thanks!

 

[DianaCox]

Your happiness and satisfaction with your life is also your personal responsibility - and that includes deciding that "perfect" is not a reasonable goal.

 

[JackieOnLine]

very well put!

 

[Denis Korb]

My Goal is still 250 by Christmas...<winks @ Diana>

 

[newwomanin2015]

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

Hi, Diana,

Thanks for the time you take writing all of your informative articles and for encouraging intelligent research on a variety of topics. When making this decision, I read much of what you had to write both here and on another forum.

I have some questions for you about some of what you wrote here and also want to send you a private message to get your opinion on number 5.

I, too, thought that carbs would be a pretty significant factor in how much would be lost and since already have been doing low carb for last 5 years (30 or less per day and only those in green vegetables, eggs or cheese) figured it would be best to keep to that after DS. Also, hoped it would help balance the negative side of the equation, which is: being 50, starting out at 430, and 5 to 6 briefly successful attempts at weight loss throughout life. On average, lost approximately 100 pounds with each attempt and generally, weight was lost over a year and a half time period.

However, other than the diet of cottage cheese mom put me on at 8, none were starvation diets. Usually, ate between 1500 to 1800 calories a day (when I counted such things) and focused on what was told by so many were healthy; low fat , high fiber, etc. foods. This was before educating myself through much desperate research to find answers, and learnin about fat not being the problem they said it was. The change to eating low carb and eating more fat and protein made a huge difference in how I felt and lost a lot of the constant hunger that had plagued me by giving up the oatmeal, wheat bread, fruit, etc. Also, discovered that butter is wonderful on broccoli!

It has been over a month since this stall started, and it's only been three months since DS. I am nervous because this body always seems to find a way to get weight lost back, plus some additional. Also, have heard about those poor souls in a research article I found who stopped losing after only 6 months and never lost another pound. At first, thought it must have been they were eating too many carbs, or not exercising, but, now, am not so sure. I know we're all different, but, it is disheartening to read about those who lose a lot during that all important honeymoon period while still eating carbs and I am stalled while eating barely any. I am comfortable with being strict with what I eat as overall feel better when eating this way.

Maybe a month is a short stall, and this is typical with this surgery? I have no way of knowing, but, back when losing weight in the past, (when it was still possible, at some point body just wouldn't any more, no matter what and I refused to do starvation diets) a stall was 2 weeks usually, at most.

Surgeon said that 220 was a realistic goal, but, hoping and working toward personal goal of 200 pounds. I understand what you are saying about averages above, but, am hoping with being strict and a little extra effort to increase the odds of a higher loss. I know this surgery is a tool and am willing to do my part to use it to my best advantage.

Do you know any other factors other than those listed by you above that could contribute to a stall?
Is it typical to stall for this long a time with the DS surgery due to all the changes brought on by the surgery? In other words, should I just relax because this is normal with DS and in another month, it will start coming off again?
Is there anything I can do to get out of the stall faster? For instance, am already walking at lunch daily, but, am going to start walking after work and doing body weight exercises in the hopes that this will help.

Thank you for any advice given.

 

[DianaCox]

I really don't know.

You have been low carbing forever - maybe your body is just getting used to low carbing WITH the benefits of the DS, and it really thinks it is STILL starving because it got used to hardly ANY carbs as it is, and now you're malabsorbing even more. But I really don't know.

 

[southernlady]

@newwomanin2015
I do advocate Dr. Bernstein BUT I never followed his advice to a T. But then I also have documented Reactive Hypoglycemia mixed into my diabetes. I STILL have RH. But one thing some of us have found is to NOT cut carbs to the bone. I lost all my excess staying between 70-100 carbs (total) not below 30. I maintain staying between 100-150. Most of my carbs are dairy or veggie. (tried looking for the thread but carbs are a very common subject around here). I did discover that an all protein/fat second breakfast sends me into RH whereas adding a slice of heavily buttered toast to that keeps me fine for many hours. All it takes is that ONE slice of bread (and thanks to jaw surgeries, I don't eat the crust any longer) to keep my blood sugars up enough to last much longer.

 

[KathrynK]

@newwomanin2015
I do advocate Dr. Bernstein BUT I never followed his advice to a T. But then I also have documented Reactive Hypoglycemia mixed into my diabetes. I STILL have RH. But one thing some of us have found is to NOT cut carbs to the bone. I lost all my excess staying between 70-100 carbs (total) not below 30. I maintain staying between 100-150. Most of my carbs are dairy or veggie. (tried looking for the thread but carbs are a very common subject around here). I did discover that an all protein/fat second breakfast sends me into RH whereas adding a slice of heavily buttered toast to that keeps me fine for many hours. All it takes is that ONE slice of bread (and thanks to jaw surgeries, I don't eat the crust any longer) to keep my blood sugars up enough to last much longer.

Southern Lady, I have long thought that I was the only DSer with reactive hypoglycemia. I have also learned that a combo of carbs and protein are best, I wore a 24-hr glucose monitors and it showed my lowest lows were at 2 am. I take one half of a peanut butter and jelly on whole whet to bed and usually et 2-3 bites at 2 am, but don't usually finish it. I eat every 2-3 hours doing the day, heavy protein, but always with some carbs. The best advice I got was to always mix protein with a little carbs and never eat carbs without protein,. Like you, I find fat with carbs are best. It has worked. I am at ideal, and maybe a bit below, ideal weight, This discussion reveals how individual we all are. I had diabetes pre-op and have a very strong family history of diabetes, and I believe my DS is not like none else's. there is no one size fits all in any area of medicine, and DS is no different.

 

[DSRIGGS]

Aside from reactive hypoglycemia which I'd a different animal.... I was told that our body/metabolism needs a certain amount of carbs to allow us to maximize protein absorption and fuel our furnace. It was a GI who actually started me on Creon who told me that. He said a lack of carbs can exacerbate protein malabsorption....

I still go back to our common sense moderation and think there has to be some merit to that thought process but I have no science to back it up.. Just my personal belief