1 yr follow-up, some unexpected advice?!

Hi.

I had my one-year follow-up with the WMC on Friday and was surprised by some of what the nurse and NUT had to say.   First of all, they don't want me to lose any more weight.  I'm about 142, 8 lbs below the top end of the normal BMI range.  I want to aim for 135 in order to have some wiggle room for regain and the dreaded looming menopausal weight gain.  I am seriously thinking of ignoring their advice and aiming for 135.  This would put me right in the middle of the normal BMI range for my height.  Normally, my next appt wouldn't be for another year but they want to see me in 3 months to make sure that I haven't lost any more weight.  This seems really strange to me, as I'm eating very well and don't see the harm in losing a bit more.  What do you think?

Also, the NUT told me to eat (get this)... 30-55 g of carbs PER MEAL! This seems really over the top to me, and I'm sure that I would gain weight if I were taking in this amount of carbs.  I double checked with her, thinking that she meant per DAY, and she said no, it's per meal.  That adds up to 90-165 g of carb daily.  Has anyone been given this advice?  Does anyone on maintenance actually eat that much carbs?  I'm on the WAYEDT thread and don't see this much carb intake on there...  Is my NUT losing it?

Other than that, it was good; I'm healthy and feeling terrific.  Love my RNY!

How do you feel, your body will tell you when its lost enough, I tend to agree with you on the wiggle room.....but you have to be cautious!


As for the carbs..... have either of them had WLS before..... my advise to the carbs is NO way...... you will be setting yourself up for a re gain.

Been there done that............ stay far away from that amount of carbs per meal.
 Everyone is different, you have to find the perfect number of carbs that will allow you to maintain and not lose or gain.  That is where you journaling will help you.

Karen I think you should aim for whatever you are comfortable with. It's your body not theirs.  As for the carbs, NUTs always follow the Canada Food Guide, whi*****ludes tons of grains, fruits and veggies.  You could probably eat more carbs than in losing mode but I could never eat all those carbs per meal any longer as my taste buds have changed so much.

The NUT at Barix told me that carbs should be roughly double your protein (in gms) intake.So for me,my maintanence protein was set at 70 gms/protein...so 140gm carbs. Sounds like a lot but when I track on fitday the carbs add up fast, and I'm not a bread or cracker eater. Veggies,fruits have alot of carbs, as does milk and yoghurt. What ever you do, go slow and find your sweet spot so to speak. Congratulations on you success!

I really think we have to start looking at carbs as things other than breads,  carbs are not always evil, but simple carbs can be such as bread.  That being said you need to find what works for you so long as you are getting enough nutrition in each day to keep the machine functioning.

Congrats on the work you have done in the year!!

I just checked my total carbs for today and it's 70 grams.  The only meal that had over 30 for me was dinner. My apple came close at 22 grams.

The Canada Food Guide uses that carb intake level for two things - improving our brain function, and providing long-burning fuel for activities.
Now, because we have been educating our bodies to use protein instead, I think the "fuel" argument is probably not as valid. But I do notice a definite difference in my alertness if I had few carbs on any given day. By 9 pm, I am incapable of making rational decisions or thinking quickly.

So I dunno. I too am one year out, and she hasn't recommended that I change very much.
On the other hand, I don't have the blood results back yet, so it's possible there is a deficit I am not aware of.

I tend to agree with the others - nutritionists and dieticians HAVE to follow the Canada Food Guide for purposes of certification/accreditation. If they don't can lose their credentials.
But WLS patients ARE different.

As a pre-op, I don't have any advice to offer, and wouldn't presume to do so!  But I was actually quite surprised, at my recent nutrition class last week, to see the nutritionist mention the Canada Food Guide.

There is strong criticism out there of the Canada Food Guide (and its American counterpart) because those critics claim that certain food lobbies have politicized it into a document that advises people to eat more of certain foods than they actually need to be healthy.

Criticism of the Food Guide by Dr. Yoni Freedhoff:

From the article (sorry, not sure how to use a quote function here):

"Dr. Yoni Freedhoff, an Ottawa specialist in obesity medicine, identifies a number of deficiencies in the proposed guide: inadequate recognition of the value of consuming more polyunsaturated fatty acids or more whole-grain products; a complicated and confusing array of recommended serving sizes; a total lack of guidance on recommended daily caloric intake; and insufficient warnings about the dire consequences of eating high calorie foods in the so-called „others" category. Canadians now consume about 600–800 calories worth of fried foods and sugary desserts in this category.

"„It's obesogenic," says Freedhoff. With help from a dietician, he calculated that the fewest calories anyone scrupulously following the new guide would consume daily is 1700 (females aged 19–50), assuming they only drank water, didn't use salad dressing or have dessert. In other demographic categories, the daily intake topped 3200 calories, again without extras.

"„What it means is that should anybody who is of average height and size follow Canada's Food Guide, there is a very, very good chance it will lead to weight gain."

"Both Freedhoff and Jeffery also chide Health Canada for failing to furnish the scientific rationale for the changes and allowing industry representatives to sit on its external Food Guide Advisory Committee. The 12-member committee includes representatives from Food and Consumer Product Manufacturers of Canada, the Vegetable Oil Industry Council and the BC Dairy Foundation.

"„It's obscene that industry is involved," Freedhoff says. „I would not have Exxon developing Canada's energy policy.""

 Hey Karen - I was told almost exactly the same thing when I went for my 9 month appt. I started maintenance and still lost another 10 lbs before my 1 year check-up (which turned out to be at 13 months) I also asked about the carbs and they said to only worry about the white carbs, carbs from veggies and fruit shouldn't worry us.  I am now maintaining my weight between 132 -135. At my 13 month check-up they told me that I was still in the healthy range but that if my weight dips below 130 that they wanted me to come back earlier than my 2 year check-up.

My original goal was 150 but then I lowered it to 140. I think that I'm still okay with 135 but I agree that any lower and I'm on the verge of unhealthy weight. I'm 5'5" and 50 years old so I think that is good for me. 

The APN in Ottawa said to remember that we are also probably carrying around 15-20 lbs of flabby excess skin so that our actual body weight is much lower than the scale shows and we need to be careful that we aren't trading one addiction for another. (Food vs anorexia)

Good luck finding the right mix to maintain your weight when the time comes. It's a lot harder than I expected. Plus I'm worried about hitting the wall when the "honeymoon" phase ends. 

All the best. Muriel

Hi Muriel

I hope you don"t mind me highjacking, but Wendy's issues and mine are the somewhat the same (concern about regain as we head into maintenance), and if you don't mind I'd love some input. 

I'm 5'4"; down 205 lbs to 143; and planning to still lose until I reach 135 to give me room for bounce back.  This will give me a BMI of 23. 

I have lost pretty steadily all along on a calorie intake of btwn 750 and 1000 calories per day, using roughly 40 - 45% in protein (80 - 110 gms /day), about 33% in carbs (no wheat), and the balance of 15 - 20% in fat. 

Do you mind telling what your daily calorie intake runs at, and how you breakdown your protein / carb / fat allocations?  Like Wendy, I too have found the NUT's not very helpful with this maintenance stage - I actually don't think they have much experience with this yet.

Thanks for any input you can give me.

Claire