Menopause and weight gain after roux en y (distal)

Question
I had gastric bypass in 2000 at 430 pounds. I dropped to a weight of 245 pounds and maintained that for many years. Around 5 years ago, I gained to 270 and changed my diet by cutting carbs and adding protein, fruits and vegetables. That change allowed me to drop down to 250-255 and maintain for a few years. I am now almost 45 and find my weight back around 265, but I would love to get back to the 245 mark as I fear that menopause is going to make it harder to maintain.

When I had surgery, the surgeons did not follow up like they do now and I was never given a suggested food plan for maintenance. My question is what should a person 15 years out be looking for in a food plan? I have little restriction and can eat "normally". Right now, I average about 2200 calories a day, but think I should aim for 1800 until my weight is back to where I once maintained it.

Thank you for your suggestions!

Answer
Hello Betty,

First, let me say that you have actually done an excellent job at maintaining your weight.
The long-term studies of gastric bypass generally show that around a 20% weight regain is "normal" from the lowest weight people achieve - so you have done a very good job at weight maintenance.

It's very hard to say calorically what people should be at long term without knowing a lot of facts - how much lean body mass you have, what kind of foods you you eat, how much you exercise, etc. The truth is that to some degree, trial and error is just about as good. The target should be to be eating and exercising at  a level that allows you to maintain a weight you are comfortable without undue effort (meaning that you should feel pretty happy most days about how you get to eat, be eating a healthy range of foods, and not feel constantly hungry or deprived). If you are trying to lose a little you might have to drop some calories to get there and then find what level of calories lets you maintain the weight you are happy with.

That said, the ranges you are talking about above are about where we often suggest people start - 400-500 calories below where you are now is usually enough to produce steady, sustainable weight loss (say 1-2 pounds/week). Adding some regular exercise will give you an advantage but increasing your metabolism.

The only other advise I regularly give is to make sure you are getting at least 50-60 grams of protein daily as part of what you eat. If not, supplementing with some protein powder can be helpful. This is especially important while you are losing weight (you can even take in more) because you want to maintain as much muscle as you can and lose fat.

I hope this helps.

In health,
Dr Jacques

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