Hi All

I've searched the archives and medline on this topic but what I've found is too technical for me so would greatly appreciate any insight from those who enjoy this kind of question.

I am about 7.5 months out and have lost 99 lbs. Recently, my endocrinologist advised that my daily intake @ 650 calories and < 30 grams carbs are too low. Her concern is that metabolic adaptation will cause my body to function so efficiently at these reduced levels that any subsequent caloric increase - i.e., on maintenance once I've lost another 30 or so lbs - will result in significant rebound weight gain. She says I should increase my calorie levels now rather than waiting until I reach goal, and just be content with a slower rate of weight loss. This advice seems contrary to the received wisdom around here about maximizing weight loss during the post-surgical honeymoon.

The esteemed doc mentioned the Biggest Loser follow up study which is written up here. The authors state:

The magnitude of metabolic adaptation increased 6 years after "The Biggest Loser" competition. This was surprising given the relative stability of body weight before the follow-up measurements compared with the substantial negative energy balance at the end of the competition which is known to further suppress RMR. In contrast, a matched group of Roux-en-Y gastric bypass surgery patients who experienced significant metabolic adaptation 6 months after the surgery had no detectable metabolic adaptation after 1 year despite continued weight loss . It is intriguing to speculate that the lack of long-term metabolic adaptation following bariatric surgery may reflect a permanent resetting of the body weight set-point [citations omitted].

To my untutored mind this passage would seem to indicate that the risk of metabolic adaptation is lower for bariatic patients and that my set-point is no longer 250+ lbs, meaning that I can moderately increase calories in maintenance without significant regain. I should note that I am perfectly content on 650 calories a day, am meeting my protein and fluid goals and getting at least 10,000 steps a day. But I could probably choke down another 200 or so calories a day if I had to.

Thank you so much as always for all your wisdom and support!

HF

Biggest loser contestants didn't have surgery so don't think you can compare.

Everybody has their personal calorie range that works. During weight loss I started at 550, then 550 to 750, eventually 650-950... I never worried about having the exact same calorie count daily.

Why some people need to maintain on a low number of calories and others can increase is a mystery. I was able to increase to a usual range of 1600-1800 calories and an occasional higher day or lower day and not gain. I had metabolic testing gone 3x and according to that I should be able to eat 2500 calories every day. Nope. Wouldn't work on a regular basis.

I also find quality of calories matters- dense protein, veggies less bars and things

My 2 cents. Good Luck

I read that entire study, And as you've noted, the study explicitly stated that this sort of metabolic adaptation does NOT appear in patients who have lost significant weight as a result of bariatric surgery. This is the same result shown in studies about weight set points, and how bariatric surgery is the he only method shown to lower the weight set point. I worry about doctors advising bariatric patients about weight loss who have no idea about how surgery changes how our bodies work. In fact, most doctors have no idea what does and does not work for long term weight loss in general.

I have never in my life heard of "metabolic adaptation". I can't believe your doctor actually mentioned the BL study. Listen, if "metabolic adaptation" were a real thing, then people would never die of starvation. Also, please forget about the phrase "set point". Your body does not have a "set point". You have a comfort zone where you feel full and happy and that is what keeps your weight where it is. Not some magic "you shall not pass" Gandalf in your gut or bloodstream or whatever.

Years ago I had my basal metabolic rate tested. This is the rate I burn calories at if I were in a coma doing absolutely nothing other than breathing and existing. I burn 9 calories per pound which is on the lower end--the range for women is usually 9-11 calories per pound. I had surgery in 2013 and I'm pretty sure if I were to get the test again, I'd still be at 9 calories per pound. I have confirmed this with tracking my calories--my metabolism hasn't adapted to anything. I don't need as many calories now because I no longer weigh 350 lbs. The only adaptation I can make is building muscle since muscle takes slightly more calories to maintain. It would probably put me at around 10 calories per pound then.

I haven't experienced any rebound weight gain, so please don't be afraid of maintenance and think that you're automatically going to gain weight because as long as you're cognizant and aware of how much you're eating, you won't. Many, many vets here have had great success because they track their intake which is sounds like you are doing perfectly well. Don't let your doc scare you into eating more if you're not comfortable with it. If you feel great on 650--you're not tired, passing out or dizzy and you're keeping up on your supplements, you keep doing what you're doing. You sound like you're doing great and your endo sounds like a bit of a wingnut.

Jen

This all makes a lot of sense to me - thanks!

I believe that RNY is still an experimental procedure. we are the test subjects and the data is being gathered. The doc shave no idea what is going on and they can't predict who is going to lose and maintain and who is not, and why.

Some people gain the appetite back - some don't. in some cases diabetes goes away and does not come back.

I gain when I eat dairy and/or grains. but when I don't eat/ drink that, i can really eat a lot and not gain.

I'd suggest looking at the menu threads. There's plenty of folks "maintaining" at sub 1,000 cal-per-day diets. That's non-bariatric DIET LEVEL intake.

Bottom line is everybody is different and there doesn't seem to be any study with regards to metabolic levels in bariatric patients to reference.

Personally I would not dismiss the endocrinologists advice based on anything anybody says in here.

I would.

The advice of the baraiatric surgeon would be the best doctor to follow. It is his specialty after all.

My endocrinologist specializes in diabetes, PCOS, and reproductive problems (aka baby making). She doesn't know jack about vitamin levels or hand surgery.

Where the heck have YOU been? You don't write, you don't call....

I think ur doc doesn't know about bariatrics ppl. Maintenance cals for us are often 1000 cals or less. I am at 900 cals and more cals cause a gain.