Almost 4yrs post-op

Question
I had gastric bypass surgery approx 4yrs ago this August and with having a full management career, 3 children 12,8,6, and full-time school schedule, I was unable to go to the bariatric doctor for regular check-ups because I had to travel out to Belvidere, Illinois from Bellwood, Illinois. I have gone to my regular family physician yearly for my regular lab work excluding last year. I would like to re-start a regular routine to see a weight-loss Dr. again somewhere closer to home.  I would like to see a Dr. soon since it is the beginning of the yr. I am 5"4.5 ft tall and my weight fluctuates between 155-160lbs,and I wear between a size 6 or 8 depending on the cut of the clothes. I know that my weight seems to still be a lot based upon my height, but people never believe that i weigh as much as I do by how I look. My highest weight was 234lbs. I have been at this weight for almost the entire 4yrs with the exception of my weight going down to 147 for about 2wks only it seemed, but I wore a larger size then. I would like to know how can I lose more weight (fat) w/o becoming unhealthy thin and or looking too thin. I do not eat any of the foods or prepare my food the way it was required after surgery, but I do limit my sweet intake, limit (to none)alcohol consumption, and I exercise occasionally. I have been taking a diet pill Slim Quick ( for about 6 months on and off) and its new product Slim Quick Hoodia (4 days) no weight loss has occurred. Is this something that i should be taking; and if i wanted to go the route of using a diet pill supplement, which product would be best.

Answer
Dear Moni,

For busy people like yourself, it is often hard to stick with the program required after weight loss surgery.  First, let me say that keeping off 80 pounds for 4 years is not a small accomplishment.  You should be congratulating yourself for this victory first and foremost.

To put this into another perspective your BMI started at 40.2 (making you morbidly obese), and you are now 26.6 (making you just barely overweight by the medical definition - overweight starts at a BMI of 25).  So a loss of 10-15 pounds from where you are right now puts you into a nice normal BMI and at a weight where most bariatric surgeons would be very happy.  

This said, what will make your doctor happy and what will make you happy may not be the same thing.  You have to know inside yourself both what you are going to be happy with and what you are willing and able to do to get there.  If you are maintaining this weight now with what you are doing, will you be able to eat 500 calories less per day and exercise 4 days a week to keep a lower weight (if that's what it takes)?

Here is what I would encourage you to do:

1) I think your idea of seeing a doctor is a great idea.  If you have not had your nutritional labs done in a while, get those done.
2) The most common cause of weight regain after gastric bypass is what I call calorie creep - where extra calories creep into your diet.  50 or 100 extra calories a day and add up to 5 pounds a year.  The more common culprits are caloric drinks - coffee drinks, sodas, etc, but any calories will do.  You mentioned that you stopped following the original dietary guidelines you were given.  One of the best things you could start doing now to get back on track would be to go back to how you originally ate - this was probably with a focus on protein, a minimal of carbohydrate and between 800 and 1000 calories per day.  If you don't know what you are eating, try joining a free service like FitDay (www.fitday.com) and keeping track for a week or so.  Remember to be honest with yourself. You can later print the pages out and bring them with you to the doctor.
3) You can consider a medical weight management program to get you started - since you don't have a lot of weight to get off, this might be an easy way for you to reach your goal.  Some doctors will use a medication like Meridia in post-op patients - but this should be determined on an individual basis.
4) Try to exercise more.  I know this is often the hardest thing especially with a busy family and career.  Even a little goes a long way - take the stairs at work, park farther away - do what you can to move more.  If you can't do more exercise, you will have to eat less to drop the extra pounds.  For some people, one is easier than the other - you sort of have to know yourself.
5) Join forces with others who are doing what you are doing.  There is nothing like community support.  Here are some resources that might be useful to you: Bariatric Support Centers International has a Back on Track program that they run as a phone-in class (http://www.bsciresourcecenter.com/index.php), Barbara Thompson has a Back on Track mentoring program (http://www.backontrackwithbarbara.com/), Katie Jay offers some wonderful resources (http://www.nawls.com/public/department58.cfm), MOnica Ganz at Make It a Lifestyle has some great resources and community message boards (http://www.makeitalifestyle.com/joomla/) - you are likely to feel a lot more supported in this process if you can connect with others who are doing the same thing.
6) I think you raise a good issue about becoming unhealthfully thin.  This is why it is good to have a goal in mind for where you want to be.  I think the bigger concern for many gastric bypass patients is losing more fat than muscle.  The best way to combat this is to keep your protein intake up and exercise as you lose weight.  

I hope this is helpful for you.  Please write back and let me know if you want or need more information.  

In Health,

Dr. Jacques

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