Food amounts

Question
Hi Karla, firstly, I've found your advice to others most helpful to my own weight loss journey.

I would really like to know though, I am a 13months out from surgery,
Highest weight - 164kgs - [361 lbs]
Weight pre-op 142kgs -  [313 lbs]
Discharge weight (my ugly weight gain, due to fluids apparently?) 147kgs - [324 lbs]
3 week post op 134kgs - [294 lbs]
Current weight 105kgs - [231 lbs]
Total loss since surgery 59kgs - [129.8 lbs]

But im so scared that my stomach has stretched to its previous size, because i am able to take in so much more than i hear others can.  I mean I still for the most part am sensible and consciously aware of where i started from, and i have learned so many valuable lessons during this 2 yr process (including waiting time for surgery) but im terrified of going backwards, and am contemplating starving myself, rather than continuing to just eat making smarter choices,because i am also stabilising at my present weight, and i should be down to 165lb as a goal, and most said i shouldve acheived this by now.

:( feeling somewhat discouraged/disheartened, and helpless.

many thanks for your time and consideration

kelli

Answer
Hi Kelli:

I'm so sorry it took me a few days to get back to you.  I honestly thought I had already replied...but I probably  just thought about what I was going to say and didn't actually type it in.  Sorry!

You've done really really well and should be proud of yourself!  Have you taken the time to realize just how much weight you've lost since you're highest weight?? 59 kgs is absolutely nothing to dismiss. 130 pounds! It's amazing.  It's more than what a model weighs. ;)  It's more than a typical Hollywood actress. ;)  Next time you're at the store, lift up a giant bag of dog food (or something similar) and try and envision just how much weight you've lost.  Celebrate that.  The fact that you were able to lose 22 kgs pre-surgery on your own is amazing too.  Many many people can't lose any weight until the surgery--so knowing that you did that... and now that you have this amazing tool (and trust me, no matter how much you worry about it stretching back, your stomach is no where near the size it was pre-op), should make you pretty hopeful.

Who says that you should be at 165 lbs? Is it you? Is it fellow weight loss buddies? Is it your Mom? Is it your surgeon? I'm going to assume that 165 lb is around where a "normal" BMI would be for you--so around 25.  It may be a few points more.  For me, I think it's really useful in determining a goal weight to look at the lowest weight one maintained as an adult for any length of time (understanding that it still might be "overweight" or "obese")...as well as how long you were morbidly obese for.  You also need to look at where your surgery will take you.  For most bariatric surgeries, you're looking at a 50-65% excess weight loss.  If you had a duodenal switch, you can up it a bit... but NO surgery promises 100% excess weight loss...and in truth, very very few people achieve that and maintain that.  The thing is, that really doesn't matter as even if you only lose 30% of your excess weight (and I know you've lost more), you're 100% healthier than you were before.  You've exceeded what any diet or medication will achieve for most people.  You're still a lot better off.

It's absolutely, completely normal for your stomach to stretch a bit after surgery... heck, even more than a bit.  Yet, the radiological studies they've done on VSG and RNY stomachs (I'm assuming you've had one of these) show that they do not stretch back to a pre-op size.  Just because your 13 months post-op does not mean that your weight loss has come to an end, but you're
right in wanting to make sure that you can keep this off and not go backwards.  Honestly, one of my favorite recommendations is to tell people to join Weight Watchers (in person).  Do it for the accountability.  While you might not reach what they consider your goal, you can have your family doctor write you a note saying that XYZ is a healthy weight for you (and given where you've come, your current weight could even qualify).  Usually you need to lose at least 10-15 pounds with them, but after that, you can be on maintenance.  You can also try Overeaters Anonymous or see if your surgeon has a group.  Or try an online place like Sparkpeople, ObesityHelp, 3 Fat Chicks on a Diet, etc. They all have bariatric surgery "grads" (graduates==you're no longer a newbie) support/accountability groups.

One thing to do is to track what you're eating.  A lot of people think they're eating huge amounts, but when they actually measure it out, they're not.  (It's also useful to compare it to what you ate before!) Sparkpeople is a free website that can help you figure out calorie counts, etc.  

I also think it's a good time to sort of figure out (if you haven't) the meals that work for you.  Write out 3-5 favorite breakfasts that you know are healthful, tasty, and satisfying for you.  Do the same for snacks, lunches, and dinners.  If you can, plan most of your meals around those--and you'll do well.  I know some people who at this stage focus on certain things...like eating so many fruits or veggies, or getting so much protein in.  Others just want to make sure they stay away from soda pop.  Still others, move away from focusing on diet and focus on exercise.  Choose one thing to really concentrate on for the next 2-3 months and see how it goes.

Oh! And don't forget to have your yearly bloodwork if you haven't already!

I hope this helps a little. Kelli, you've done great.  There's no reason why you can't keep off what you've already lost, and perhaps lose even a bit more.  Celebrate how far you've come and ignore the nay sayers and those who say you haven't lost enough.  In just this past week there was an article in the news about how difficult it is for people to maintain weight loss due to various hunger hormones.  Your body does everything it can to make you gain the weight back.  Yet, you're not doing that.  You're succeeding.  Celebrate that!

Kind Regards,
Karla

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