2 replies to this topic

[goingtobethinin2010]

I have a question about this surgery. I am 9 months out and have had quite an easy time of things. I eat when I feel empty I really do not have a real hunger feeling any more I here so many people say this is not easy but so far for me it could not have been easier. I have no cravings and do not feel hungry or have any desire for sweets I do not even like to smell them. I also can not eat but maybe 2 or 3 ozs of food at each meal. Example 1 normal chicken strip would be a full meal for me. So for now I do not have to worry much about what I eat as long as I get my protein in I still lose weight. I have lost 113 pounds in 9 months and it has been almost to easy. I follow all the rules of drinking and I stay away from sweets but I do eat foods sometimes with fat and carbs and have still lost very easy. I wonder if I will wake up one day and suddenly have to start working really had at keeping my weight off? I just can not see at this point that I will have that problem because things seem so easy right now. What is your opinion on this. Thanks

[Dr. Callery]

There is a wide variation as to how people react to gastric bypass in the long run. Almost everyone has a dramatic decrease in appetite early on. This is called the "honeymoon period" by the old timers. Often appetite and the ability to eat more at one time slowly comes back between year one and year two. Now there are maybe 10 or 20% of patients where this is not the case and the lack of appetite is ongoing. The degree to which appetite comes back is variable.

Why does the appetite go and return? No one knows for sure. Some researchers attribute the change to changes in the amounts of a hormone called ghrelin. It's probably much more complicated than a single hormone, but rather an interplay of various hormones. As you may know, there are redundant and overlapping systems in the body. When disease, or injury, or surgery for that matter, changes the intestinal tract the body compensates.

When you think about it, we are doing gastric bypass on a wide range of people who may have many different reasons for becoming large. It doesn't surprise me from a biological point of view to have a range of responses to the surgery. Groups doing genetic research around the world are trying to isolate gene patterns that may govern the response of obese people to various gastric surgeries.

Since long term appetite levels are not predictable, it seems to me that the best approach is to establish firmly good eating, exercise, and mental health habits during the honeymoon period.

Most people find that their pouch becomes less restrictive over time. If patients rely on pouch restriction to guide their eating, then they find that they gain weight when they can eat more. On the other hand, if they have developed good habits, there is less of a tendency to regain.

I'm happy for you that you've done so well and wish you the best of luck in the months and years ahead.

Edited by Dr. Callery, 31 January 2011 - 08:43 PM.

[maxxy]

I am 2 years out and my honeymoon period is well over.  But, I have done well.  I continue to watch my intake with portion control with emphasis on protein intake.

I exercise 30 minutes, 5 days a week.

That is my long term strategy.  I only have 10 more pounds to lose until I am in a normal BMI!  Even after reaching a normal BMI, I will have to put effort, attention and monitor my maintenance strategy for weight control.