Ozempic Update: Two Doses In

I won't post weekly updates about my experience using Ozempic, but I will update from time to time.

So far, all is well. Self-administering is painless, but a bit more complicated than I imagined. There are several steps and it's not necessarily intuitive. I've used two weekly doses so far, and both times followed along with a video. Easy enough.

The information said you usually start to feel a difference after three to four days, and that is exactly what happened. I had my first dose on a Friday, and when eating on Monday, felt fuller sooner. I simply lost my appetite and wanted to stop eating. Also, my nighttime carb cravings were more manageable. I found that eating a small amount of fruit took care of it. Both these things are quite different.

I have lost a little weight, which already makes me feel better. I have had some mild side effects, just some GI stuff. Nothing that an over-the-counter remedy can't fix. Side effects are supposed to taper off within a few weeks or less.

The plan starts you off on a very low dose - 0.25 milligram - to allow your body time to adjust, and to minimize potential side effects. There are cautions everywhere, telling you not to bump up to the next dosage - 0.5 milligram - until your practitioner tells you to. It is very tempting! But I will restrain myself.

Almost Five Years Post-Surgery: Weight Re-gain and Decision to Use Ozempic

I'm five years (minus four months) post-surgery. I'm not happy with my weight, or with my eating. 

Satiety cues have greatly diminished. I can eat more at any given meal, and have to be super careful to find an artificial stopping point. Worst of all, cravings are back -- intense feelings of needing to eat something carbohydrate, especially at night. I've learned a lot about these cravings over the years. It's not hunger, but it's also not emotional eating or stress eating. It's an addiction, and it takes more than willpower to shut down.

So, to recap.

Shortly after hitting the 50-pound weight loss, I re-gained five pounds. That's fine. I knew that minus-50 was not sustainable. 

About a year after that, I re-gained five more pounds. I wasn't thrilled about that, but I accepted it, and I could live with that weight.

I maintained that minus-40 weight for three years. 

And since then, I've re-gained 10 more pounds. Now I'm seriously unhappy with my weight again, and I don't want to let this go any further.

I want to note that I never got thin. Minus-fifty wasn't even thin. I look and feel significantly better than I did pre-surgery. My bloodwork is in the normal range again. But I am still my chunky, shapeless self. Meaning, the weight re-gain is significant.

For a while, I was really beating myself up, blaming myself for letting the tiny stomach expand. But I gave that up. No one knows how permanent weight-loss surgery is. It was originally thought that lap-band surgery was the fix. Now that is no longer used, because most people re-gain everything. The data on the "permanence" of gastric sleeve surgery looks at five years: if a patient retains the weight loss after five years, it's considered permanent.

Even that data is incomplete. Most people who have the surgery aren't tracked. Most people aren't part of a study, and many study participants drop out because they've re-gained weight. So the long-term prognosis is unknown. What's the point of beating myself up?

I've tried repeatedly to lose the weight I've re-gained. It starts out well: I lose a half-pound per week. Then, after three or four weeks, weight loss stops, and eventually those few pounds return. I do not want to return to the diet yo-yo! But I also don't want to be this weight.

I did a lot of research and decided to try Ozempic. Our provincial health care and our extended insurance doesn't cover it, because I don't have diabetes, and because my BMI is under their threshold. It's a sizeable expense, so it was a big decision. 

It's also impossible for me to tell if this is a rationale decision based on health, or if I'm back to obsessing on the number on the scale, if I'm having disordered thinking again. I can't sort it. I don't have the perspective. 

My hope is that a few months on Ozempic will lead to 15 to 20 pound weight loss, and I'll return to the state where it was easy to maintain that, and transition off Ozempic. I honestly don't know how realistic this is, but I'm trying it.

I had my first dose this morning. Stay tuned.

A Decision to Try Again, Four Years After Surgery

Last year I wrote about my weight re-gain, and realized I was no longer getting the immediate cues of satiety that force you to eat less after bariatric surgery. I had re-gained 10 or 12 pounds (depending on the day). I found it very easy to maintain that weight, and was feeling all right about where I had landed. After all, I'm healthier, I went down two clothing sizes, and I'm still enjoying eating. I maintained that weight for more than two years. So, I told myself, accept it. And for the most part, I did.

Then I gained a few more pounds. I've been having some issues with my feet which cause severe pain; as a consequence, I've been less active. I don't know if that caused me to gain these extra pounds, or if I was just plain eating too much, but I did not feel happy at this new weight. It was past my comfort threshold.

Having flirted with the idea of more weight loss for the past two years, I already had identified a few things I changes I could make. I decided to:

• return to tracking my eating, which seems to go hand-in-hand with not gaining weight,


• be very mindful of portion size,


• eat a more substantial dinner, then stop eating for the day -- which will also help reduce incidents of acid reflux, 


• and drink more! which is surprisingly difficult for me, but worth trying.

So I did all these things, and very quickly lost the additional 2-3 pounds. Now I'm using this as incentive to try to lose more of the weight re-gain. My goal is another 7 pounds. This may not be possible, but I'm willing to try.

The challenge, of course, is doing this without becoming obsessed. My compulsive behaviour -- mild by diagnosable OCD standards, but present in my life -- has gotten worse with age, so I'm not sure where this is going. But I'm feeling good about trying.

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.