Resting Metabolism after Surgery

[Still Waters]

In prep for DS, the nurse gave me a test that indicated my daily calories, to maintain my weight, to be 2200 calories. After 4 years, since the sleeve, on 1100 cals daily, I also exercise 2-3 hrs a day. She seemed confident that I was misrepresenting the amount I eat. Is this test anywhere close to being accurate after so much metabolic compromise?

 

[DianaCox]

I am afraid I join her in doubting that you are reporting your intake accurately as 1100 cal. Even the most metabolically compromised MO person who is exercising 2-3 hours a week cannot burn less than 1500 cal/day.

 

[Munchkin]

I know that machine has never measured my BMR even close to correctly.

 

[DianaCox]

Pat - where do you think the error in measurement of your BMR comes from? http://en.wikipedia.org/wiki/Basal_metabolic_rate

"BMR and RMR are measured by gas analysis through either direct or indirectcalorimetry, though a rough estimation can be acquired through an equation using age, sex, height, and weight. Studies of energy metabolism using both methods provide convincing evidence for the validity of the respiratory quotient(R.Q.), which measures the inherent composition and utilization ofcarbohydrates, fats and proteins as they are converted to energy substrate units that can be used by the body as energy."

It seems to me if they are actually measuring exhaled CO2, that would be a fairly accurate measure of what you are expending. If it is just an estimate from age, sex, height and weight, that would be a different issue - that would be very variable, and I'll bet people who are or have been MO have BMRs on the low (efficient) end - we don't burn calories like normies. But I still find it hard to believe that a morbidly obese man exercising 2-3 hours a day is expending less than 1100 calories/day (BMR + exercise). I'd be willing to bet he is not cataloging ALL of his caloric intake.

Obes Surg. 2012 Aug;22(8):1257-62. doi: 10.1007/s11695-012-0651-y.
Metabolic profile of clinically severe obese patients.
Faria SL1, Faria OP, Menezes CS, de Gouvêa HR, de Almeida Cardeal M.
Author information

Abstract
BACKGROUND:
Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition.

METHODS:
We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables.

RESULTS:
Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p < 0.0001). A positive correlation between fat-free mass and a negative correlation between body fat percentage and BMR were found in both groups. Among the clinically severe obesepatients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC.

CONCLUSIONS:
The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

 

[Still Waters]

I am afraid I join her in doubting that you are reporting your intake accurately as 1100 cal. Even the most metabolically compromised MO person who is exercising 2-3 hours a week cannot burn less than 1500 cal/day.

Thanks. I can agree that one day or another might be off, but for years, on lean and green diet, I had to get down to 900 cals to lose, and that only lasted a few days. I wish I was not eating the level I report on average. Also taking Metformin and Victoza. Exercise is not strenuous, involving walking, in place cycling, aerobic weight lifting (low weights, high reps). I eat virtually the same thing each day. No rice, pasta, bread of any kind. Low carb vegs, protein from meat, and shakes, measured the same each day. My metabolism was very resistant even before surgery. My GP concurs, and states revision is the only way to get the regain off, lose the rest of the weight and maintain.

 

[DianaCox]

There is so much variability in people's metabolisms - but you sound like an outlier to the extreme! I agree, malabsorption is the way to go in that situation.

 

[bearmom]

A lot of your history sounds similar to mine, and I'm wondering if you have had eating disorder issues, like fasts and purging. I too had a very efficient metabolism, but my doctor now says I honed that efficiancy to a point with my decades of bad habits.

For years pre-surgery I had doctors convinced I was misrepresenting my intake and exercise, so I went to great lengths to measure every bite and calaorie burned, and at least knew for myself, whether my doc wanted to believe me or not. Even now with the DS, I still don't think I eat the daily calories that many post about.

Did they also check your DHEA and cortisol?

 

[Still Waters]

A lot of your history sounds similar to mine, and I'm wondering if you have had eating disorder issues, like fasts and purging. I too had a very efficient metabolism, but my doctor now says I honed that efficiancy to a point with my decades of bad habits.

For years pre-surgery I had doctors convinced I was misrepresenting my intake and exercise, so I went to great lengths to measure every bite and calaorie burned, and at least knew for myself, whether my doc wanted to believe me or not. Even now with the DS, I still don't think I eat the daily calories that many post about.

Did they also check your DHEA and cortisol?

***************************
Yes they did. I have had every test possible. I am tested regularly q3mos full panel of maintenance related levels. Metabolic syndrome and insulin resistance seem to be the culprits. I was in a special endocrinological study two years before 2010 Sleeve. Hopefully DS will do the trick...

 

[Still Waters]

So to update... I have written down everything I have eaten, with all the nutritional values, and the activity, and there is NO way I should not be losing at a net calorie intake of 800c. Values are good. So, I gained and lost the same three lbs in a cycle! WTF? Endocrist had no answers. It occurred to me that the difference may be due to meds. I have an appt on the 26th and am going to hand them the minutiae filled meal plan data and let them figure it ouy...

 

[bearmom]

So to update... I have written down everything I have eaten, with all the nutritional values, and the activity, and there is NO way I should not be losing at a net calorie intake of 800c. Values are good. So, I gained and lost the same three lbs in a cycle! WTF? Endocrist had no answers. It occurred to me that the difference may be due to meds. I have an appt on the 26th and am going to hand them the minutiae filled meal plan data and let them figure it ouy...

There certainly are some meds that can contribute, or need for meds like thyroid. Hopefully they have checked that level already, but make sure the endo has the full list of meds you take as well. I would print the list and bring it, even though they may already have it in the chart.

 

[Munchkin]

Pat - where do you think the error in measurement of your BMR comes from? http://en.wikipedia.org/wiki/Basal_metabolic_rate

"BMR and RMR are measured by gas analysis through either direct or indirectcalorimetry, though a rough estimation can be acquired through an equation using age, sex, height, and weight. Studies of energy metabolism using both methods provide convincing evidence for the validity of the respiratory quotient(R.Q.), which measures the inherent composition and utilization ofcarbohydrates, fats and proteins as they are converted to energy substrate units that can be used by the body as energy."

It seems to me if they are actually measuring exhaled CO2, that would be a fairly accurate measure of what you are expending. If it is just an estimate from age, sex, height and weight, that would be a different issue - that would be very variable, and I'll bet people who are or have been MO have BMRs on the low (efficient) end - we don't burn calories like normies. But I still find it hard to believe that a morbidly obese man exercising 2-3 hours a day is expending less than 1100 calories/day (BMR + exercise). I'd be willing to bet he is not cataloging ALL of his caloric intake.

Obes Surg. 2012 Aug;22(8):1257-62. doi: 10.1007/s11695-012-0651-y.
Metabolic profile of clinically severe obese patients.
Faria SL1, Faria OP, Menezes CS, de Gouvêa HR, de Almeida Cardeal M.
Author information

Abstract
BACKGROUND:
Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition.

METHODS:
We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables.

RESULTS:
Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p < 0.0001). A positive correlation between fat-free mass and a negative correlation between body fat percentage and BMR were found in both groups. Among the clinically severe obesepatients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC.

CONCLUSIONS:
The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

Back in 2006 a postgrad at the U of M asked me to do a study. It was interesting so I agreed. First was the water displacement weighing/body composition. Then the RMR...pretty much consisted of breathing through a mask in a dark, quiet room. Then I had to wear a pulse rate monitor for 2 weeks. And keep track of what I ate. They were trying to prove or disprove continued metabolic dysfunction post ds. I asked for a copy or notification of publication but I never got anything. They told me I should be eating much more than I was reporting but the pulse monitor did confirm my exercise.