RNY bariatric surgery

Question
I had RNY on 2/2/09.  I was 324 the morning of surgery.  I lost 35 pounds within the first week of being out of the hospital then in the weeks to come I lost 15 more pounds and finally stopped losing at 241, it just unexplainably stalled for weeks.  I'm now 2 years out I've lost 88 pounds in 2  years.  I still havent lost a 100 pounds, that most people lose when they have the surgery.  I have been going to see my doctor on a regular basis and as always I am on a yo-yo string with my weight 236 to 244.  I've haven't lost very much weight in the past eight weeks or so If I do It comes right back. What can I do???? I'm at my wits end.

I've tried shocking my body by eating even less than I already am.  That works for a few days, but as soon as I add any more food, I'm back up to my "yo-yo" point of 236-244.  I just dont understand why this has got HARDER after surgery and not EASIER??!  It all made sense and weight loss was like clock work beforehand -- eat a certain amount of calories, drop pounds, drop inches.  It was like ABC.  But now it's like your body no longer goes by the rules even though YOU do!  It would be one thing to continue doing what you're doing because the incentive is the results you see.  But it's quite another to keep doing something and get absolutely nothing in return.

I really need some help here.  I'm nearly tired of trying, and I'm scared to death that this is all I'm going to lose with this surgery, and that I've just wasted a whole lot of time.  My mind is all consumed with weight loss every day.

Answer
Sandra,
I can see that you are frustrated and concerned to have lost about 85 pounds after gastric bypass, and to be stuck now at a bit more than two years out from surgery.

In my opinion, you need an assessment from scratch, then interventions depending on where the problem is located.  I get the sense from your question that you are trying to do this on your own, and the type of assessment/intervention/reassessment process that you need is not practical for an individual to take on alone, so my main advice is going to be to find long term medical help in your area.  I believe the assessment should start with two things:
1) how many calories are you taking in, and what type of foods are those calories coming from!
2) how many calories are you burning?

If you are taking in too many calories or the wrong type of calories, there may be a number of interventions such as:
-eliminate meds that create hunger
-reduce/eliminate foods that create hunger (starches, soft foods)
-reduce/eliminate empty calories (sugar, alcohol)
-check your surgical anatomy
-appetite suppressing meds

If you are not burning enough calories, the following interventions might be useful:
-increase activity
-build muscle
-modify exercise pattern
-add protein to food intake

If your surgeon and his/her team are not able to give you this type of evaluation/support, you might benefit from seeing a bariatrician in your area.  You can google "bariatrician."

Best of luck,
Dr JP

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