Discussion: Maintainance

Hello Fellow Grads, I have been reading endless posts here recently about weight regain and food demon struggles.  I would like to have an active discussion on how we can maintain our weight loss.  I have been trying to analyze the reasons WLS patients regain, to come up with some common denominator to the problem.  I am not a psychologist or mental health worker, so my observations are purely  my own. First, did you ever reach your goal?  If not, why not?  Was the goal not realistic for your body, or did you stop following your doctors protocol?  Why? Second, when you started regaining, were you weighing yourself on a daily/weekly/monthly basis, or not at all?  I ask this because I wonder at what point do you say to yourself, "this weight regain has got to stop"?  I have set for myself a weight range, and give myself a 3 pound up or down fluctuation.  I have always weighed myself every day.  If I regain more than that 3 pounds, I would go back to only protein and low carb veggies until I am back down in my range.  When I see posts where people have regained 20-30 pounds, I wonder why that person didn't change their behaviours sooner. I sincerely don't want to give the impression here that I am being critical of the struggles that many of us are going through in regain.  I hope by having this discussion we could prevent regain in new WLS grads.  I have been thinking over this topic for weeks, trying to come up with the words that express my feelings about this subject.  I had been super morbidly obese my entire life, and had my surgery when I was 49.  I ask myself again and again why I have been able to get to my goal, and below, when so many others have not been able to.  I am not a "better" person, and sometimes eat foods that I probably shouldn't.  I want to be able to understand this so I can keep my weight off. Had I reached a lower rock bottom point than others when I had surgery?  I was losing my mobility, which is a pretty strong motivator.  I truly had reached the point where I was desperate to grasp for this last chance at health.  When I want to eat sugar and carbs, I try to remember what that felt like. I sometimes wonder if I am superstitious about my weight loss.  I drink a protein drink at least once a day, sometimes twice.  I don't want to give it up, thinking that it helps keep my weight off.  I have always been vigilant about my vitamins.  I exercise four times a week, even though I don't like it.  I drink my water, yet NEVER drink with meals, or an hour after I eat.  I used to be a perfectionist, but have learned to live with my imperfections.  I no longer have the "I screwed up my eating plan for today, so I have a free ticket to eat" thought process.  I believe if I give in to eating a cookie now, well, I ate a cookie and better watch what I eat the rest of the day. I am coming up to my two year anniversary, and am terrified when I read that this is the point when many start regaining.  Will it be inevitable for me, too?  How can I prevent this?  I talked to my surgeon about this last week.  He spoke of the surgery as being a "temporary tool".  He said the surgery allows you to retrain your eating and exercise habits.  If you don't learn this, it is simple, you will regain.  You can't stretch your pouch, but you can stretch your stoma.  If you do stretch your stoma, there currently aren't any therapies that will permantly reduce the size of your stoma.  Sclerotherapy or surgical suturing of the stoma have not proven to work for very long.  The only treatment is a revision surgery.  This is his medical opinion. Sorry this post has been so long and rambling, but I am trying to understand some things.  So, please, let us have a discussion about how to prevent regain, and for those who have already had a regain, how they can be helped. Debra M., far from perfect 351/135 5'5"

Hi Debra ~ Thought I would throw in my two cents...and don't worry, I don't think you are being judgemental of those like me who have regained - my reaction was one of helping you to NOT become like me! I am six years out from my surgery - have gained 65 lbs from my lowest weight - never reached my goal and just this week had to have the scleroherapy procedure done....again. 

I can remember coming to this site so often after surgery to post updates on my progress and being so happy to type statements like "50 pounds gone FOREVER"  oooohhhh if I only knew!  The only explanation that comes to mind is "Denial ain't just a river in Africa"  LOL  Denial is a big problem. 

We all know that it was our tummies not our brains that were changed.  And if we don't work to find out why we were fat in the first place - then the surgery is just a band aid.  The first year or so after surgery is a dream - a lot is being done for you...nothing has stretched yet, so the amount of food is taken care of....the dumping is still strong, so you are afraid to eat the wrong thing...and the pounds are flying off...geez you can sneeze and lose 10 pounds!  You are feeling great, looking great and forgetting what it was like to be fat... I have always weighed myself everyday...sometimes this worked for me, sometimes it worked against me.  At first, when I would be a pound or two up - it would motivate me to get back on the program - watch what I ate and exercise regularly.  Then it started working against me...when I thought I had been good, got on the scale and it hadn't changed or had gone up a pound...I would get so defeated - Gosh why am I killing myself!?! It didn't make a difference anyway....where are my twinkies? After two years is when it started to get away from me - the surgery started to fail, or more correct, I started to fail the surgery.  I got into the bad habit of drinking with my meals...actually taking a gulp of something after each bite.  So now I was eating way more than I should have.  This also dulls the dumping syndrome....all of a sudden a peice of chocolate cake isn't going to give you the shaky sweats when you washed it down with a diet coke!  And for me, what was further keeping my head in the sand... I kept saying to myself "Hey, I still look pretty good...better than 300lbs looked" Denial, denial, denial. So before this post turns into a novel....what I am doing to try and turn it around - the sclerotherapy is working ( yes it's only been 5 days) - I have decided to make the most of it and turn my diet back to what it was in the first weeks after surgery - liquid/puree diet and no drinking when I eat!  I have lost 7 pounds, so that feels great and I hope to build on that momentum.  Also, I have started seeing a therapist - and this I think is even more important in my "recovery" than the sclerotheapy - I am determined to find out what the hole in me is that I am trying to fill with food! I hope this helps - thanks for posting this question - I know it will cause all of us, no matter how many years from surgery and how many pounds gained/lost, to think about what we are doing! Take care!

Please tell me, what is scherotherapy?

Sclerotherapy is a treatment that reduces the size of the stoma through "scarring" the area.  It thickens the tissue, making the stoma smaller.   Since I am not an expert on this, perhaps someone else can explain it better.  I believe it can be done by applying a caustic agent to the area, such as a high level saline solution.  My surgeon said the effects were only temporary, however, sometimes only lasting for several months.  The body has an incredible desire to heal itself, and the thickened tissue can slough away over time, returning the stoma to its previous size. Debra M.

You have hit it right on the head!! I am almost 4 years post op and had my regain of 16# years 2.5 - 3.  Purely denial and feeling as if I had gotten a get out of jail free card. Getting it back off has been HELL!!  If only I had been smart in the first place!! Thanks for you post!

My surgery date was 3/11/05.  High weight 262 now weigh 130 5'1" (I guess this is goal--per doc.)  i certainly can not lose any more.  I weigh every day on a diginal scale and write it down on the calendar.  I slip up a pound or two ranging from 127 to 131.  At 131, I jump into action increasing protein and exercise.   I still drink protein drinks from one to three a day,  I take weight lifing and yoga/pilates classes at gym.  I walk from two to six miles most days.  i know I sound compulsive, but keeping this weight off is top priothy in my life.   I ,too, am far from perfect, but I am dedicated 

Thanks for the replies to my post.  This is exactly the type of discussion  I was hoping for in making my post.  How to maintain, and why some of us don't.  NIcole, I thought your comments on how the daily weighing sometimes working against you were interesting.  The concept of needing to be rewarded by the scale for our hard work is a valid one.  If the scale "doesn't give us what we want, i.e. a lower number"  then why continue to live without our comfort, food.  Something to think about.  Congratulations to you for seeking therapy, I wish you the best. Debra M.

I'm going to add my two cents (and it's worth just about that )! I had my surgery 8/18/04.  I weighed 278.  My surgeon's goal for me was 170 but my personal goal was 150 (and I was hoping to be one of the luck ones that loses w/o even trying and get to 135!  Fat chance of that!!  LOL)  I, at my lowest, was 147.  I always have, and still do, write down everything I eat and drink.  I weigh myself daily but only record it once a week on my "official" weigh in day.  I walk, and have done so since the beginning, 6 days a week. Starting back in late November to early December, my weight started to slowly creep up until I was 10 pounds over my goal.  I didn't panic but increased my exercising intensity and cut out one protein drink a day.  (They are 120 calories each and my husband suggested doing this.)  As of January, when I had hernia surgery, I had leveled off to 155-160 but still couldn't get back to the 147-150 that I prefer.  I called my nutritionist and got some suggestions from her but basically was told that it's normal to lose to under your body's setpoint and 2-2 1/2 years out, gain about 10 pounds and that's where your body wants to be.  I don't like that answer!!  But, having said that, no matter WHAT I do, my weight hangs at 155-160. I have no answers - just am DEEPLY concerned about regain and what else to do!  I really had hoped I was done w/weight obsession - but I think it's worse now than ever!!!!!

way below  your surgeons goal. Isnt that success? maybe your body's set point is just higher than you would like it to be. i think an unrealistic goal is the first step to long term failure ( or maybe more feeling like a failure when you are not)  I think self esteem is a real issue for most of us and especially the ones who cannot see that they are a success, or feel they are a failure for being a  "normal" wls patient who loses and rebounds a little.  It reminds me of the newlyweds who say we will always be this romantic etc (blech) then after 2 years they are crying because they are like every other couple who occasionally fights, or has money troubles or he leaveds his underpants all over the house.  we wls people also think we will not be like the others who dont go to a 22 BMI or rebound etc. then when we do it is a shocK that we are like the others.  Of course I have to throw in that BMI is not a great inidcator as to whether you are overweight or not.  I measured 23% body fat (low average for my age) but my BMI shows me as overweight.  also my personal training teacher has a BMI over 30 - and I can swear on a bible  he is not only NOT overweight he is very nicely built.  one of the surgeons in my practice told me we have heavier bones that we built to carr our heavier selves and we will always weigh a little more  because of that.  I like the dr who saidl goal should be blood pressure etc.  HUGS to you and good luck!

Thanks, Willow!  You brought up a lot of good points - and I'll be the first to admit that I'm my own worst critic!!  My self-esteem is still in the toilet - but I'm working on changing that!  That was interesting about our bones - I've never heard that!  Thanks for your response!!