Observations About Weight Regain in the Absence of Easy Cues

I last wrote about my small but significant weight re-gain, and returning to tracking my eating. Although in March I wrote "see you in a month," it's been several months, so there's a decent amount of data on how things are going.

Tracking my eating has been very helpful. But despite that, I noticed I was eating more. I was increasingly concerned that I my little stomach may have stretched irrevocably: I was able to eat larger portions without experiencing the sensations that would cause me to immediately stop eating. 

For more than a year after the surgery, when I ate, I would very quickly feel full. If I ate one bite past that feeling, I was uncomfortable. Two bites, I would be overwhelmingly uncomfortable. Three bites was impossible, or I would run to the bathroom gagging. Thus I learned to be satisfied eating less!

I gradually lost this instant feedback, slowly enough that I didn't notice it on a daily basis. And then one day, I realized I was eating larger portions. In the summer we grill burgers on the deck. Last summer I would cut my burger on a bun in half, eat one half, and save the other half. This summer, I ate a whole burger with no discomfort. This worried and scared me. 

Then something interesting happened. I tried eating the post-surgery portion sizes and stopping, even though I wasn't getting that stop eating now! feeling. And I found I could stop, and was no longer hungry.

This may sound ridiculous or obvious, depending on your experience. But in my past experience, pre-surgery, I was almost always hungry. If I ate a smaller portion, I needed to cope with the feeling of still being hungry. That is very difficult to do on a consistent basis. 

The half-burger is one example. Another example is my mid-morning snack, between breakfast and lunch. I could eat x amount and not feel uncomfortable. Or I could eat half-x amount and also feel like I'd eaten enough.

So it turns out I can eat more -- but I can also eat less.

This causes me to wonder whether the disappearance of the immediate and non-negotiable feedback cues are the reason for some people's long-term weight regain after bariatric surgery. Because the big difference post-surgery is that immediate stop eating now sensation. Without those non-negotiable cues, I must be much more mindful of portion size and quantity. I must make very conscious choices of when to stop. This is a whole different post-surgery outlook. 

If you've never been overweight, or you're not someone with a big appetite who enjoys food, this may sound easy. I can tell you it is not easy. It is challenging. However, I can now do it -- where in the past, I could not.

So now in addition to tracking my food, I have to negotiate my portion size in advance of every meal. This means I can never let myself get too hungry. That's always been important for me, but now it's crucial, if I'm going to avoid re-gaining weight. 

Right now my weight is -37 from my pre-surgery weight, same as it was one year ago, and three pounds less than it was in March of this year. I'd like to lose a little more, but most importantly, I don't want to gain any more. 

Some Clarity: I Want to Lose the Pounds I've Regained (Updated)

It's now just shy of two and one-half years since my surgery. 

Recap: I lost 50 pounds, gained three or four (which I expected, based on everything I had read), and stayed at that approximately -45 weight for about a year. I was happy at that weight. 

Now I've gained 5-7 pounds over that, and I'm concerned that my tiny stomach may be stretching, my weight may be creeping upwards, and everything I've been through since the day I travelled down to Mexico -- by myself -- during covid -- will be undone.

I don't know if this fear is valid or not, but it's nagging at me. 

So I've decided I will try to get back to the -45 weight.

Today I reloaded the food-tracker app, which I have not used in more than a year, and started logging my eating again. I'm committing to tracking, eating less, and making better food choices for one month, then seeing where I am. If I lose weight in the one-month period, I'll continue. 

In this context, eating less means being very conscious about snacks -- how frequently I eat and how much. I must eat between meals, but I have to eat the least amount possible to not feel hungry. The differences are very slight.

I've been weighing myself daily, which must stop! The scale addiction is returning. I'm going to give the scale to my partner to hide, something that has worked in the past. Having to ask for the scale usually gives me enough pause to stop myself. 

See you in a month!

Update

After only two days of food tracking, I am feeling better. I am still concerned, but feeling calmer and more in control. 

Two Years Post-Surgery and I'm a Bit Confused

I'm coming up on two years since my gastric sleeve surgery, and taking stock of where I am, and where I want to go. Right now I lack clarity.

At the one-year mark, I had lost 48-50 pounds. I was thrilled and felt great.

Earlier this year, at 17 months post-surgery, I had re-gained 7 pounds, meaning that I've lost 41 pounds.

I experimented with some tweaks to my eating habits -- places where I had become less disciplined. I did lose a bit, felt encouraged... but didn't stick with it.

Earlier this year, I wrote this:

But it's frustrating that maintaining minus-50 or minus-45 should require so much effort. I didn't expect that. Minus-50 was self-sustaining for about a year, and I thought it would remain so. But it has not. 

I'd like to get back to minus-45. But I don't know if that's possible, and if it's not, I won't take any drastic measures. But minus-40 does not feel as good as minus-50 did.

This is still true.

I'm of two minds.

I felt better, and felt that I looked better, at minus-48 than I do at minus-41. And part of me is afraid that this re-gain is a slippery slope, ending in a stretched stomach and a near-total re-gain.

Yet at the same time, if minus-41 is easily sustainable, maybe I should accept this as my new benchmark? 

Remember, we're not talking about a very thin person obsessing over a tiny weight gain. At neither weight am I considered thin. So the difference between minus-40 and minus-48 or minus-50 feels significant. 

But is it? 

Am I getting too hung up on the number, and losing sight of the more important picture?

Round and round I go. 

I'm re-reading this post to try and focus on the positive: One-Year Post Surgery.

Second Travel Experience Without Weight Gain

Last summer, I went on vacation, ate very well, and was thrilled to not re-gain any weight. In the past, travel almost always led to weight gain. Breaking that pattern was amazing. It re-confirmed that many of my fears about weight-loss surgery were unfounded. It also showed me that my new habits are becoming firmly rooted.

Now, 10 months later, I've recently returned from another trip, which included a lot of great food. I was so happy to discover my weight when I returned was exactly the same as when I left. 

I was worried, and now am greatly relieved.

This is a great incentive to also quickly return to my eating and exercise plan, post-travel. 

Recent Emailed Post Was From January 2021

If you subscribe to this blog by email, you recently received a post about obsessive thinking. I am happy to tell you that post was from January 2021! I don't know why it was emailed, but I'm happy to report that I am not being tortured by obsessive thinking right now. 

I have made some adjustments to my eating habits, and would like to lose 5-10 pounds. But I have a handle on how much emphasis I'm placing on this, and I'm weighing myself only weekly. 

Thank you very much for your concern! I appreciate it very much.

Small Weight Gain, Part 2 (Update)

Thank you to everyone who commented on my previous post, both in comments and by email. 

Confession: I was reluctant to write that update, because weight gain feels like failure. And thinking that weight gain feels like failure, is in itself a failure. This is how thoughts of my weight become obsessive. I'm fighting against it. I'm telling myself all the things I would tell any friend who was experiencing this.

Here is why I'm concerned with even a small re-gain: this is how I gained all the excess weight in the first place, a small increment at a time. 

Yes, I am getting lots of exercise, eating healthfully, and not overeating. But what if the amount I am eating causes me to continue to gain weight, a bit at a time, until all my hard work is undone?

I'm not saying this will happen. But it's what I'm afraid of. 

A few folks have suggested getting in touch with Wonderful Registered Dietitian who is available locally. That's a great idea: more support, and from an expert. I recall that the last time I felt panicked about eating, a session with her was very helpful. I will contact her this week.

Thank you as always for your support.

17 Months Post-Surgery: Small Weight Gain and Trying Not to Panic

In January, I decided to stop tracking my eating. My intake was so consistent over days and weeks and months that tracking felt useless. I had been planning to update this blog with that information... and now there's some new, less pleasant news. I've re-gained some weight. 

I'm concerned, and trying not to panic or obsess.

Since hitting my lowest weight of minus-50 pounds, my weight has fluctuated within 3 or 4 pounds of that weight. From everything I've read, that is normal. The lowest weight after bariatric surgery is not usually the final destination; most people re-gain about 10% of their total weight loss, and settle there. Since I lost 50 pounds, I thought gaining 3 or 4 was not a big deal. 

But now I've gained a few pounds over that. And this is really scaring me. 

Some people do re-gain weight after gastric sleeve surgery. How much weight, and the cause of the re-gain really varies.

Is this new, slightly higher weight my "true" new weight, and I need to accept that? Or have I been eating too much? Did the few times I was uncomfortably full after eating stretch my stomach pouch? That is possible to do -- but I imagine that everyone who has had bariatric surgery sometimes gets uncomfortably full, while they are still adjusting to their new capacity. How much repeated fullness would it take for the pouch to permanently expand?

These questions are spinning around in my head, and there are no clear answers.

I'm still getting a lot of exercise, and still eating well and healthfully. I have identified a few eating habits that I can tighten up, a few little eating habits that have gotten away from me. Those are easy enough to tweak. But my past experience with the effect of small diet tweaks have on my weight are not at all good.

I guess the only thing I can do is ensure my diet is meeting the post-surgery standards, and try not to obsess on the number. The former, easily done. The latter, a much greater challenge.

One Year Post-Surgery

It's coming on a full year since I had gastric sleeve surgery. It's been quite a momentous year for me.

My weight holds steady at minus 50 pounds. It fluctuates within 2 pounds in either direction, but no more than that. I weigh myself sporadically, about twice each month. When I get concerned that I'm eating too much, I weigh myself and feel reassured.

According to the charts, I've lost 70-80% of my excess weight. This is in line with what all the medical literature says about this surgery. This means, of course, that I still have excess weight. I'd look better if I was 10 or 20 pounds thinner, but I don't worry about that. This is where my weight loss plateaued and stopped, so this is my weight. Even if I could lose more weight -- which I highly doubt -- I'd never be able to maintain it. I'm not going down that road.

I frequently feel hungry, just as I always did. But now when I am hungry, I have a very small healthy snack, and I immediately feel sated. The most important thing is to not let myself get too hungry. If I wait too long to eat, I end up eating too fast, and have a lot of discomfort. 

All my health indicators have greatly improved. My blood sugar levels are normal, and I've been able to drop one blood pressure medication. 

I'm more physically active than I've been in 30 years. I walk 5K either 5 or 6 days each week, and usually once a week walk about 7-8K. It feels great. 

And, although I didn't have the surgery to improve my appearance, the change in my appearance does feel good. 

I've gotten the hang of eating in restaurants. It's a bit frustrating, because I'd like to eat more! I wish I could save all my food for the day and have it all in one meal. But that is simply not possible. So I orderly lightly, bring most of it home, and get at least another meal out of it, often two meals. Drinking wine with dinner means eating even less... but dinner is better with wine! So these are things I have to constantly navigate. 

One fun little side benefit: I feel free to eat "fattening" foods when I want to, because the portion size is automatically controlled. In the past, if I decided to eat fries or chips, I would eat a lot, with seemingly no "off" switch. Because of that, I was always struggling to completely avoid those foods. Now if I want a few fries, it's no big deal. 

In general, I feel great. I'm super happy I had the surgery, and also very happy I had it done in Mexico rather than waiting yet more years to have it done in my province.

I haven't shared this story with anyone I work with. No one asks, as it's now considered impolite to comment on anyone's change in size in any direction. Only two people have mentioned my weight loss. One person wanted to know if I'm OK, or if I'm losing weight because of a health issue. The other person is a much older woman, who I think is probably not aware of this current norm. I'm very glad I decided to be more private about this locally. I would not enjoy the attention -- or being the subject of gossip.

Thank you to everyone who has supported me through this journey. It has meant so much to me!

Result: One Week Post-Travel

I did it.

I did it!

I went on vacation, and was more relaxed about food choices. Upon returning home, I immediately returned to pre-vacation habits. 

Result: I did not re-gain any weight.

I am beyond thrilled about this -- for the present, and also for the future. I feel like I've passed a major mental hurdle. It was not difficult to go back to proper eating and exercise. I made it a priority, really focused on it. I don't know why this was so difficult in the past, but it's not anymore.

I said I was going to wait two weeks to weigh myself, but I made it one week before asking my partner for the scale. I also returned it to him: no way I am keeping it in my bathroom at this point.

First Travel Experience Post-Surgery

I've just returned from our first vacation post surgery and since covid started.

In the past, travel has been a major obstacle to healthy eating and exercise for me. On vacation, I would eat whatever I wanted, gain weight, then have a very hard time losing it when we returned. It could take me a full year to lose the weight I gained on one trip. In addition, when travel interrupted my exercise routine, it would take me a very long time to get back to  the regimen. This was the pattern throughout my life.

So planning and taking this trip brought a certain amount of concern. I wasn't extremely anxious or worried. But it was always a concern in the back of my mind.

Obviously I don't want to re-gain any weight! But I also don't want to feel that I must be strict and disciplined every single day of my life. Vacations give us a break from our paid work, but they should also temporarily relieve us from our emotional work. While we were away, I tried to find a balance between these two needs. It was challenging.

First of all, I decided not to track my eating while we were away.

I also decided to loosen the reins on my food choices. I ate more cheese and more meat than I normally do, ate chips (in controlled quantities), more bread. 

I did both of these intentionally, which feels better than just mindlessly losing the discipline.

I can't overeat in a single meal. That's just not possible. But I could -- if I weren't careful -- eat the wrong foods every few hours, and in the course of the day, overeat. I did this while we were away, although not every day. Maybe one-third of the time.

Now I'm home. Here's what I've already done and my plan for the immediate future.

• I immediately resumed tracking my eating, and returned to all the healthy food choices. 


• I asked my partner to hide the scale. I don't want to weigh myself until I've been home for at least two full weeks.


• I plan to exercise today (our second full day home) and to put myself right back to my exercise routine. This will be the most challenging part. 

I'll report back.

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