Res Ipsa

So I'm At My Goal Weight, Now What? Maintenance 101

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Almost all of the posting here at TTF focus on the weeks before weight loss surgery and the months of weight loss after this surgery.  These periods are of critical importance as they are the time of transition from being overweight and unhealthy to being at a healthy weight (the so called "goal weight").  But in the long term reaching one's goal weight is meaningless unless one can maintain this weight.   

At its core, I believe that success at maintaining weight once you reach your goal weight is about these things:

First, be sure that you set and then attain the right goal weight - not too high and not too low.  Weight charts and BMI calculators are almost useless in determining the right weight for a particular person.  The proper weight should just feel good and look good.  One person at TTF a few years ago referred to it as your weight "sweet spot."  The easiest way to find your proper goal weight is to keep losing weight until you are too skinny, and your goal weight is about 5 pounds more.  Try not to set a goal weight based on a vanity number or on what you may have weighed in high school or on a particular BMI.  While advice from your surgeon or NUT on a proper goal weight can be helpful, too often they will set a goal weight that is too high in order to make the goal attainable.  Remember, everyone can reach their ideal goal weight after weight loss surgery if they stick to a proper post-op diet; thus, there is no reason to accept a goal weight that is too high. Similarly, a goal weight that is too low can be unhealthy.  if you are all "skin and bones" then you probably need to gain a few pounds.

Next, remember that unlike the post op diet, your maintenance diet is for the rest of your life.  Forever.  So you need to make this diet varied, healthy, pleasant and effective.  Basically, it should be similar to your post op diet except with some more calories and/or carbs.  You will find what works best for you by trial and error.  Some people continue to avoid sweets and most carbs as they are trigger foods in that one bite leads to an unhealthy binge.  Other people can enjoy any food in moderation as part of a healthy balanced diet.  Obviously, avoid foods that make you dump.  Everyone's goal weight diet is a bit different.  Also, everyone's calorie intake on a maintenance diet differs.  I maintain at about 2,000 calories a day, while other people seem to maintain at about half that.  In general, at maintenance men can have more calories than women, and gastric bypass people can have more calories than sleeve people (indeed, a medical study showed that on average a RNY gastric bypass patient loses about 11% of their calories consumed through malabsorption as compared to people without a bypass and this malabsorption does not go away with time).  You also want your diet to reflect a healthy relationship with food, so try to continue to avoid viewing food as a source of pleasure or comfort.  Keep remembering how wonderful life is at goal weight, and how these joys far outweigh any "pleasure" from unhealthy food binges.  Also, I suggest that you think about foods that you like to eat that happen to be healthy, and try to build your diet around those foods.  

Next, remember that the basics of your post op lifestyle do not go away simple because you reach your goal weight.  You still need lots of lean protein (which may mean having a protein shake every day), you still need to drink lots of liquids, you still need to eat healthy foods, you still need to avoid liquids with meals, you still need to take your vitamins (and minerals) every day, you still need to see your doctor and have comprehensive blood tests on a regular basis, and you still need to exercise or lead an active lifestyle.

Next, maintain your weight support structure.  For me, this means coming on to TTF every day, even if just to read the latest postings and like a few of them.  Similarly, be sure that you continue whatever medicines and support that you need for your mental and physical health.  Also, be very very careful if you drink alcohol, as many people develop alcohol addictions in the years after weight loss surgery; and never drink and drive as the alcohol will hit you much faster and harder than before your surgery.  Smoking of any kind is out for the rest of your life, as the smoke will irritate your intestines (since the small stomach pouch cannot hold much smoke).

Perhaps most importantly, you need vigilance and a stubborn refusal to accept any weight gain over your goal weight.  TTF is full of postings from people who gained 10, 20, 30, 40, 50 or more pounds in the years after they reach their goal weight. DO NOT LET THIS BE YOU.  My mantra is that "failure is not an option."  I weight myself first thing every morning (unless I am traveling).  Even if you weighed yourself weekly when you were losing weight, so as to avoid the stress of stalls etc, I strongly suggest daily weight checks now.  For the rest of your life. Your goal should be to be at your goal weight or within five pounds below your goal weight every morning.  So my goal weight currently is 185 (it was 180, but after a couple of years my spouse quite correctly told me that I was too skinny), thus I want to be between 180 and 185 every morning.  If I go below 180, then I increase my food consumption to get back into the 180-185 range.  If I go above 185, then I immediately go "back to basics" on my diet, sharply drop my calories and carbs, increase my lean protein and liquids, and continue this until I am back into my proper weight range (usually a day or two).  In short, I do not accept any increase in my weight over my goal weight since I know that 1-2 pounds now will grow into 5-10 pounds and then.....  not good.  It is easy to lose 1-2 pounds of excess weight; it is not easy to lose 20 pounds of excess weight.  Also, if you have a vacation coming up, then try to be at the bottom of your weight range the day before you leave on vacation, as that will make things much easier when the vacation is over.

Finally, enjoy the many and constant joys of being at a "normal" weight - such as being able to buy attractive clothes anywhere off the rack, being able to fit easily into coach airplane seats, being able to be active and not sweat much or easily lose your breath, being able to see your doctor and not dreading stepping on the scale and then getting the "lose weight" lecture, being judged by strangers by your actions and not by your weight, being able to stop taking many of the medications that you had to take when you were overweight, and being able to live (on average) decades longer and in more healthy manner.

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This is spot on!  I also have about a 5 pound range that I allow myself to fluctuate within but reaching the top of that fluctuation (like now) triggers the alarm to get back to basics and get back on track. 

Once the honeymoon phase was over my head hunger and cravings came back full force so it is a daily struggle to make the right decisions.  Coming off the holiday season where there are so many more opportunities for bad decisions, it is time to renew my commitment to this forever healthy life.  Thank you for the great reminder!!

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Thank you, @Res Ipsa. In a world full of choices, it's good to have a reminder that there are rules we shouldn't vary from. I appreciate your advice, and I think that coming here every day to check in, as you do, will be a great way to keep myself mentally in the game. Still working out what that GW will be, but staying within 5 pounds of it forever sounds great. 

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Thank you @Res Ipsa for the Keep Your Head in the Game post!  Good stuff!  It's a bit overwhelming to know that even years out, we need to not lose sight of the prize.  I think staying active on TTT is a great way to keep focus.  Thanks again for sharing :)

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Thanks for this @Res Ipsa! I agree with the others - spot on!

One thing I would like to add is if you do gain weight - don't let 5 become 10 become 25 become 40. If you lose focus (for whatever reason) as soon as you realize what you've done and where you are, take the necessary steps to correctly yourself immediately. As Res says, it is much easier to lose a couple of pounds than 10 or more. 

I am not as active here as I once was but I do try to check-in at least a couple of times a week. I recently learned one of the veterans that I admired when I was first losing has gained back a lot of weight. Learning about other's loses and gains is a regular reminder I need to keep my food addiction from taking back over and running amok.

 

 

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@Res Ipsa What a great way to ring in the new year. A reminder to stay on track and rely on the support of our peers couldn’t come at a better time. Tuesday will be my first weigh in since Dec 24. I’m hoping that some of my holiday treats haven’t impacted the scale. 

@Stephtay I love hearing from you. Seriously, your posts always make me smile.

The knowledge that someone you admired has gained weight scares me to death. That person is usually me. I hope that this time I break the cycle of gaining and losing. 

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I've said it before...here I go again!!! In the real world I know many people who've had WLS, and not one of them has managed to keep the weight off. Many are right back to where they started. I suspect the problem is a mix of complacency and no ongoing support. I know I added a couple of kgs over Christmas and I'm now half way back to getting it off. I'm not convinced that I found my goal weight yet, but I did have to purposely stop losing after orthopedic surgery. Now my bones are regenerating I hope to drop some more weight to find out for myself where I'll be happy maintaining. I'm not there yet, although possibly once cleared for more exercise I might actually be happy at my current weight having gained better muscle tone. Time will tell!!!!

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OK folks, time for true confessions...

I came off the holidays at the top of my "OK" range, which generally triggers me to get refocused and back on plan.  However this year I have let the carb thing slide too long and when I got on the scale this weekend I was 2 pounds OVER the top of my comfort range.  This scares me to death; not because it's two pounds over but because I have felt really out of control cravings.  Like I just can't stop craving, especially in the evenings.

So...Monday I started the 5 Day Pouch Test.  First day was so rough, reminded me of when I quit smoking decades ago.  My brain was screaming "I WANT" at me continuously.  Second day I started to feel more in control and today I am feeling confident that I can get back on track.  Whew!  This is the first time I've let myself reach that point and it really opened my eyes to the fact that I can never ever do that again.  Those 2 pounds are off already but it really wasn't as much about that as it was getting back in control.  Yikes!

I also got moving more.  I'd been continuing to walk but was only doing about a 2 mile route instead of my former 4 mile one (I moved and haven't quite got the new neighborhood figured out yet).  My husband got our treadmill and TV set up in the office so in addition to my 2 mile route I've been walking on it while I watch the Olympics :)

Newbies, I'd like to be able to tell you that maintenance is as easy as losing but it is not, at least not for me.  I long for the honeymoon days when the "feed me demon" in my brain was silent.  For me it is a choice every single day.  Today I choose to be in control.  Today I choose to be healthy. 

 

 

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17 hours ago, msmarymac said:

For me it is a choice every single day.  Today I choose to be in control.  Today I choose to be healthy.

Thanks for your honesty! I'm glad you're feeling back in control :) 

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I don't know how I missed this Geoff - I'm truly sorry because I always enjoy reading your posts of support and advice to those following in your footsteps.

You've done an amazing job my friend and we're fortunate to have you as part of the T-T family.

Anyway - although my post is belated, it's never too late for a celebration!

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Thanks for this @Res Ipsa! Very keen insight to the wls journey. I think failure is everyone's greatest fear. I love how you talked about daily weight checks and using the rny as a tool to get/stay in the 5 pound range you speak of. I pray I'm able to stay in tune with my body and use the tool I've been given to maintain a healthy weight and enjoy life. I want to be harder for people to describe to someone else. I don't want them to be able to say "you know, that BIG guy" (or worse) when trying to describe me to someone else. Failure is not an option! Thanks again!

19 hours ago, msmarymac said:

OK folks, time for true confessions...

I came off the holidays at the top of my "OK" range, which generally triggers me to get refocused and back on plan.  However this year I have let the carb thing slide too long and when I got on the scale this weekend I was 2 pounds OVER the top of my comfort range.  This scares me to death; not because it's two pounds over but because I have felt really out of control cravings.  Like I just can't stop craving, especially in the evenings.

Thank you for your true confession @msmarymac! I'm glad it scared you and that you are getting control back. Fear can be a good thing. I think it's so important to hear this kind of truth. It's kind of like growing up as a kid. I could have saved myself a lot of heartache if I'd taken the time to really listen to what some of my elders had to say about their life lessons and apply them to mine. Definitely easier said than done, but something to strive for. I like to think I'm more teachable than I was in my youth. ;)

Edited by Chefman77

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I can't believe I missed your post!! I definetly needed it!!!  I have just a little over a month till my year anniversary but have completely fallen off healthy eating!!  I will continue to re read your post and get back on track!!!!  I will start weighing daily too! This I have never done, I weigh twice monthly!

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To know what your goal weight should be ay be difficult. I am almost 200lbs below my highest weight, but with all the extra skin it's hard to know what I should weigh by how I look... have a big frame (by wrist measurement) as well as scoliosis and a bit of a hunch back (likely from bad posture from carrying so much weight for so many years... So BMI by height really is meaningless for me. At one time I was almost 5 inches taller than I am now!!!

People tell me I am thin enough already but under the loose skin it feel like there is still significant fat to loose ... I have to wonder if people saying I am thin enough are just speaking relative to where I was. I am thinking of doing body contouring and from the research I have dome the lower the weight when it is dome the better as long as one is not unhealthy thin... Less complications etc... and at my age that is important if I do it.

I have been wracking my brain and searching the net to come up with an objective way of figure out what a good weight for me would be. The best I could come up with was that I need to determine body fat percentage and aim for weight which gives me a good value... But measuring that accurately is not easy.

Underwater weighing used to be the best way but it' hard to do and and find a place that does it. There is a more modern way that is supposed to be about as accurate.. It is a DEXA (or DXA) Scan. That is the same technology that is used to determine bone density. It is supposed to do a good job differentiation and measuring the amount of bone, muscle as fat you have as well as where the fat is...

There is a place in Boston that does it - though it's kind of pricey... $175 for a scan. Has anybody had any experience with this?

Is there a better way to objectively determine goal weight that anyone knows of?

Thanks,

Karen

 

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On 9/17/2019 at 1:24 PM, KarenBos said:

To know what your goal weight should be ay be difficult. ... I have been wracking my brain and searching the net to come up with an objective way of figure out what a good weight for me would be. The best I could come up with was that I need to determine body fat percentage and aim for weight which gives me a good value... But measuring that accurately is not easy.

Underwater weighing used to be the best way but it' hard to do and and find a place that does it. There is a more modern way that is supposed to be about as accurate.. It is a DEXA (or DXA) Scan. That is the same technology that is used to determine bone density. It is supposed to do a good job differentiation and measuring the amount of bone, muscle as fat you have as well as where the fat is...

There is a place in Boston that does it - though it's kind of pricey... $175 for a scan. Has anybody had any experience with this?

Is there a better way to objectively determine goal weight that anyone knows of?

Thanks,

Karen

 

@KarenBos You have hit the nail on the head. You are quite right. DEXA scans are the way to go. The scales that calculate bio-impedence can give you relative measurements or relative changes over time are not that accurate. BIA uses a 2-compartment model - fat containing tissues, and non-fat tissues, which each conduct the tiny amount of current that the BIA devices run through you. DEXA scanning uses a 4-compartment model, and calculates your body volume and measures your skeletal mass too. 

@Rob_VSG recently posted on this... he lives in Texas ... he posted saying that a DEXA scan cost $150 where he lives, so the $175 you mention here (Boston area) may be reasonable. 

For what it is worth, my surgeon told me that the average person has about 6 pounds of excess skin after bariatric surgery. Am sure the actual amount varies by person and by how much they lost... others have posted that they have been told that their excess skin is 2 BMI points, which seems too much... for me that would be close to 15.5 pounds! and that number is not closely similar to the 6 lbs. my surgeon quoted. 

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17 minutes ago, BurgundyBoy said:

@KarenBos You have hit the nail on the head. You are quite right. DEXA scans are the way to go. The scales that calculate bio-impedence can give you relative measurements or relative changes over time are not that accurate. BIA uses a 2-compartment model - fat containing tissues, and non-fat tissues, which each conduct the tiny amount of current that the BIA devices run through you. DEXA scanning uses a 4-compartment model, and calculates your body volume and measures your skeletal mass too. 

@Rob_VSG recently posted on this... he lives in Texas ... he posted saying that a DEXA scan cost $150 where he lives, so the $175 you mention here (Boston area) may be reasonable. 

For what it is worth, my surgeon told me that the average person has about 6 pounds of excess skin after bariatric surgery. Am sure the actual amount varies by person and by how much they lost... others have posted that they have been told that their excess skin is 2 BMI points, which seems too much... for me that would be close to 15.5 pounds! and that number is not closely similar to the 6 lbs. my surgeon quoted. 

As usual, @BurgundyBoy has provided a very thoughtful and helpful response that I totally agree with.  

However, I am also of the opinion that there is no scientific way to exactly calculate what is a person's right goal weight.  We all have unique bodies and thus some of us find that our proper goal weights are somewhat higher or lower than the mathematically calculated goal weight based on height, gender, age, DEXA scans, etc.  Thus, I believe that it is a good idea to plan to adjust your final goal weight when you are near the end of your weight loss and can determine what weight looks and feels "right."  For example, my goal weight if I went by BMI would be much lower than the weight that I (as well as my spouse and my doctor) feel is healthiest for me.  On the other hand, other people here at TTF have found that their goal weight by BMI is too high and lose 10 pounds or so more in order to reach what they believe is a proper goal weight.

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6 hours ago, BurgundyBoy said:

@KarenBos You have hit the nail on the head. You are quite right. DEXA scans are the way to go. The scales that calculate bio-impedence can give you relative measurements or relative changes over time are not that accurate. BIA uses a 2-compartment model - fat containing tissues, and non-fat tissues, which each conduct the tiny amount of current that the BIA devices run through you. DEXA scanning uses a 4-compartment model, and calculates your body volume and measures your skeletal mass too. 

@Rob_VSG recently posted on this... he lives in Texas ... he posted saying that a DEXA scan cost $150 where he lives, so the $175 you mention here (Boston area) may be reasonable. 

For what it is worth, my surgeon told me that the average person has about 6 pounds of excess skin after bariatric surgery. Am sure the actual amount varies by person and by how much they lost... others have posted that they have been told that their excess skin is 2 BMI points, which seems too much... for me that would be close to 15.5 pounds! and that number is not closely similar to the 6 lbs. my surgeon quoted. 

It sounds like If I get the DEXA Scan, a bio impedance scale might be a cheaper way to track things afterwards as I would have defined starting point

I wonder how the extra skin would affect the results of either method as it's not something teh average person has to deal with.

As to how much extra skin I have, there is plenty in teh middle, thighs, arms and even calfs! I guess with over 190lbs lost so far, that is to be expected.

BTW as I said in my intro last year I lost the weight without surgery.  I joined here because some of the issues after massive weight loss are the same no matter how you lose it, and this looked like a nice friendly place with a lot of people who would have had to (or are)dealing with those issues.

 

Thanks,

- karen

 

Edited by KarenBos

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