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. 

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.

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!

June 1 Weigh-In: Reaching a Milestone, Working on Not Being Obsessed

Pounds lost since last weigh-in: 1

Total pounds lost so far: 50

I did it! I lost 50 pounds! I don't know why the difference between 49 pounds and 50 feels so good... but it does!

* * * *

As I inched towards the 50-pound mark, I started weighing myself more frequently and was beginning to obsess again. 

I went back and read this post: What Is My Ideal Weight? Why I Don't Have a Weight Goal. I need to read this frequently. I don't want this experience to turn into a diet trap, the "trying to lose that last 10 pounds" scenario that I struggled with for so many years. 

Here's what I need to do.
1. Buy a few more clothes that fit at the size I am right now.
2. Continue eating and exercising the way I have been.
3. Weigh myself monthly.
4. Stop writing this blog for a while, unless there is a significant change. 

My weight-loss may end at 50 pounds, or it may continue moving slowly but downward. Either way, I want to focus on the positive, and not on losing more weight.

Thank you for reading and for all your support. 

May 1 Weigh-In

Pounds lost since last weigh-in: 2

Total pounds lost so far: 49

I've lost another two pounds and I'm very pleased!

I'm especially pleased because (a) I was mentally preparing myself for a plateau, and (b) we were away for a few days this month, and I ate differently. I didn't overeat -- I can't -- but I did let myself loosen the reins a bit on food choices. I was prepared to declare this worth it, even if it slowed down my weight loss for one month. 85% thinking, right? But I despite this, I lost two more pounds. Yay!

I am now 11 pounds away from my "soft goal" weight.

That weight, by the way, is still 20 pounds more than my supposedly ideal weight. But that weight -- 70 pounds lost -- does not seem possible or sustainable. So I'm sticking with current weight minus 10 as my "soft goal". 

But if I don't lose another 11 pounds, I'm fine with that. I promise. I'm feeling so good, and losing (almost) 50 pounds permanently is reward enough.

The Average: My New Best Friend

This week I again started to worry that I'm eating too much. I'm eating only when I'm hungry, and tiny portions. On the other hand, I'm often hungry, and many days I eat slightly more than my goal calorie intake. 

I'm speaking with WRD monthly now, so I spoke with her about this. She reminded me:

* My goal is made up! There is no set amount of recommended calories per day that I'm supposed to be eating. I arrived at my calorie goal through guidelines and self-awareness.

* Calorie content is all approximate. The numbers on the packages -- or in my app -- are not exact. Obsessing over small differences in daily intake is pointless.

* Calorie tracking is a tool. It's meant to help me stay on track, not to control my eating. I should be controlling my eating based on feelings of satiety, and I'm doing that.

* I'm exercising 60 minutes/day, six days/week. Maybe I need a bit more more fuel.

* I'm still losing weight.

* I'm still eating about one-third of what I ate before surgery.

This all made me feel better, for a while. Then the nagging worry returned. 

I jumped on the scale -- thank you to R, who encouraged me to give myself permission to do this sometimes! -- and saw I had lost a few pounds since my last weigh-in. 

Then I searched online several times for something that would make me feel better. And I found it: the average.

Some days I eat more. Some days I eat less. What's my average calorie intake over one week or two weeks? 

I went back through the tracking app and chose random periods of time. And guess what? It's all fine. 

I did a weekly average for several different weeks, plus two-week averages, and a couple of monthly averages. Fine, fine, fine. In fact, my average daily caloric intake is remarkably consistent. 

This is a big relief. I'll try to remember it next time I start to worry.

What Is My Ideal Weight? Why I Don't Have a Goal Weight

Motivational advice has become a cottage industry during the pandemic. Advice on how to set goals, how to reach goals, how to adjust your attitude, how to stay motivated, how not to sabotage yourself, how this and how that, have proliferated online like mushrooms after a rainstorm. 

Many people are experiencing "motivation fatigue". On social media, you see a lot of  "stop telling me how to meet my goals... I just want to get through the day".

85% goal-setting: it's not SMART

Most motivational advice involves goal-setting -- especially so-called SMART goals. If somehow you've managed to escape this over-used acronym, it stands for Specific, Measurable, Achievable, Relevant, and Timely. The company I work for is obsessed with SMART goals. We're always writing them, planning for them, evaluating them, re-assessing them. 

But while I'm forced to use SMART goals in my professional life, I consciously don't use them in my personal life. My problem with SMART goals are the S and the T. For me, specific goals with deadlines are exactly what I don't need. 

Since recognizing that my biggest obstacle was all-or-nothing thinking -- since understanding that 85% thinking would be a healthier way to live -- I have chosen not to create specific goals and never to give myself a deadline. (There are some exceptions to this... because even 85% thinking is subject to 85% thinking!)

Instead, my life goals are all about process. 

Here are two examples of process goals from my life. 

• Rather than say, I will read x number of books this year, I say, I want to devote more time to reading, and come up with strategies to help me do that.


• For the past year, I have been re-learning how to play piano. My goal is simply to continue to learn how to play. The process of learning is the goal.

For me, as soon as I attach a specific -- I will read 30 books this year, I will learn how to play Summertime -- the experience is ruined, or at least diminished. If I can play Summertime but I still make mistakes, have I failed? What about a more complicated version of the song -- does my simple version "count"? What if I start a book and don't finish it, does that count? What if I read only 28 books -- what happens? 

I do use habit-tracking. I track various healthy habits that I want to incorporate into my life, and I like to see as many x's in as many boxes as possible. But not every box is checked every day. Some days, all the boxes are empty! And some days they are extra full. I find the act of tracking habits to be motivating, so I use it. But my goal-setting is general, rather than specific, and has no timeline attached.

If you know that staying motivated is difficult for you, and your habits run more to procrastination, then goal-setting and SMART goals could give you structure and direction. But if, like me, you are too disciplined, and your habits run more towards obsession and perfectionism, then SMART goals can become straightjackets.

So where does this leave me in terms of weight loss?

No one can tell you how much weight you'll lose from bariatric surgery. Post-surgical weight loss is measured as percent of excess weight loss (%EW). Estimates run from 40%EW to 80%EW. That's wide range! Plus, your ideal weight is also expressed as a range, usually plus or minus 20 pounds. So I can't say with any certainty how many pounds of excess weight I have, and I can't predict how many of those pounds I'll lose!

And the lowest weight you reach after surgery is likely not your final destination; most people re-gain around 10% of the weight they lost.

So what's a realistic goal? Who knows!

I probably have 70-ish pounds of excess weight. But is losing 70 pounds a realistic goal? Who knows!

In the back of my mind, I did think it would be good to lose at least 50 pounds, and right now that seems likely to happen. But if ultimately I lost 45 pounds, and my health outcomes improved greatly, is that a failure, and should I obsess on losing five pounds more? No and no. 

TL;DR: I'm trying really hard to not obsess on the number on the scale, but to focus on health and how I feel. That's why I've chosen not to have a weight goal. I'm going to continue doing what I'm doing and we'll see where it takes me.

Feeling Really Well: Increasing Daily Calorie Target Range and Allowing Myself a Mid-Month Weigh-In if I Want One

I am feeling really well! 

You may recall, I had a little freak out a couple of weeks ago (here, here, and here), and with the help of friends and readers of this blog, and a meaningful session with WRD, I was able to get back under control. 

Now it feels like that little earthquake threw me into a new place. 

I'm ticking off all the boxes on my healthy habits checklist almost every day, and days when I can't or don't, I can accept it: 85% thinking.

I increased my daily caloric range by 100 calories: from 1000-1300 to 1100-1400. This slight adjustment makes it much easier to stay within the range every day, which means it's probably what I need. 

WRD suggested I de-emphasize the calorie target in favour of mindful eating, but I don't feel ready for that. I still feel the need to track my food daily, and that means checking portion sizes, grams of protein, and calories. It's like wearing a seat belt -- a simple act that takes very little time and keeps you safer. I'm still working on mindful eating (driving under the speed limit?) (enough of this metaphor), but tracking my eating decreases my anxiety, increases my peace of mind.

After excellent advice I received from you all, I'm also letting myself hop on the scale an extra time or two, if I feel the urge. Once my weight hits a plateau, weekly weigh-ins are a good idea, and I'd like to be able to do that without going back to daily or more-than-daily weight checks. We'll see. I'm willing to experiment with this one.

The Challenge of Obsessive Thinking (the Eating Disorder Spectrum)

Obsessive thinking is back. 

I'm remembering how awful this feels, how it sucks up energy, how it clouds the mind, making rational decision-making a monumental task.

Obsessive thinking about diet and weight is one reason I gained so much weight. I had been so trapped in the dieting cycle, so unhappy with my own unrelenting focus on my weight, that once I liberated myself from it, I was afraid to take one step towards it again. That wasn't the only reason for my weight gain, but it was definitely in the mix.

Now I have to monitor my eating and weight very carefully. That's what I agreed to when I decided to have the surgery. Most days it's all right. But sometimes I feel the obsession creeping back. 

About one day each week, I feel noticeably hungrier, and I eat a little more. I tell myself that this shouldn't matter. I tell myself: 

• It's one day a week. Most days I am well within the low end of the preferred calorie range.
• It's only about 300 calories.
• It's only because I'm hungry. I'm not eating out of boredom or from stress.
• Even with this few hundred extra calories, I'm eating way less than I did before the surgery.
• I'm getting a lot of physical exercise, so a few extra calories once a week is not going to hurt my weight loss.
• This is a lifelong process. It's not going to be perfect every day.

I run down this checklist of rational thought, but the truth bounces off the wall of obsessive thoughts, and I can't convince myself. I think about these extra calories... and think, and think, and think. The thoughts run around a hamster wheel in my mind.

The next step down this slippery slope is weighing myself. 

This week I searched for -- and found -- where my partner has hidden the scale, and jumped on. It's my form of bulimia. My obsessive thoughts are triggered and I reach for the scale.

This is what I was afraid of, and I do not want to do this.

Last night I told P a bit of this, and he suggested I ask someone about it, like WRD. I said I knew exactly what WRD would say. She'd say exactly what I'm telling myself. But I should tell her anyway. She always has good ideas, maybe she knows some tricks that I haven't tried. 

I do not want to do this!

Eating and Enjoying Real Food; Sustainable Self-Discipline

One of the things that concerned me most about weight-loss surgery was the idea of losing the enjoyment of eating and food. I heard and read that this would not happen, but there's a difference between knowing something in your mind and seeing it in practice in your life. 

Now I am eating. And enjoying. And this is a great relief! For the last 10 days, my partner and I have eaten the same food for dinner almost every night. If we didn't, it was because we got takeout and ordered different things.

"Eat protein first"... not really

Some of this concern was about cooking. All the info on bariatric diets advise you to eat protein first, then vegetables, then if you are able to eat more, a small portion of whole grain or complex carbohydrates. I cook mainly one-pot dishes. Whether soup, stew, stir-fry, sheet-pan, or casserole, the protein, vegetables, and grains are all cooked together. The one exception to this is grilling in the summer. Other than that, I'm combining simple ingredients in various ways. How was that going to work with "eat your protein first"? 

WRD explained that this "rule" really means to make protein the focus of your meal. You want to make sure you are meeting your protein requirements, and if you fill up on carbs, you won't be able to do that. Then why don't they say so?

For a one-pot cook, this means adjusting the ratio -- bumping up the protein, reducing the carbs. That's easily done. I might change the ratio when I'm cooking, or I might do it only when I serve myself. Either way, it's not difficult.

Sustainable self-discipline

Despite the tiny stomach, the bariatric diet still requires discipline and self-control. Although I can't eat a lot at once, I could eat small amounts that would add up to too much. If we're binge-watching something on Netflix, I could easily have a small snack every half-hour, and/or I could snack on the wrong food, filling up on empty calories. It's possible to do.

The difference is that the tiny stomach makes the discipline sustainable, because I'm not hungry all the time, or if I am hungry, a small amount of food is all I need.

When I was doing the pre-op fast, someone mentioned that I was proving that I could modify my eating behaviour. But behaviour modification was never my issue; my long history of dieting demonstrates that! I was overweight because I had consciously given up on dieting, and I was always hungry. Now, because of the surgery, I can eat a very calorie-restricted diet, without being hungry. Sustainable self-discipline.

85% thinking

Using an app to track diet and exercise can really run counter to 85% thinking. Calories eaten, calories burned, calories left to eat for the day... it has the potential to cultivate some very unhealthy thinking. But tracking my intake is really important right now. So I have to do it, and stick to it, but at the same time I have to give myself leeway and not give in to all-or-nothing thinking. It's a challenge!

Week 5: Beginning Phase 4, the Return of Coffee, and General Check-In

Yesterday was five weeks since my surgery. 

I began the Phase 4 eating plan, which means gradually introducing soft foods to the pureed-food diet. Yesterday, for example, in addition to my pureed food, I had a few slices of canned pears, a banana, and a carrot that had been cooked in chicken broth. I tried to eat each one very slowly and chew it to death. 

This phase will require a lot of prep, since I still need to have pureed foods on hand, and also need to get some non-pureed foods every day. We bought some additional muffin tins, so I can make the pureed foods in larger batches and freeze several weeks' worth of small portions.

Meanwhile, my partner has come to the end of the food I cooked and froze for him, way back here, before my pre-surgery fast began. So I have a lot of meal-planning and cooking to do.

I've also started drinking coffee again, several months before I'm supposed to. I just missed it so much! (85% thinking!) I've made a half-decaf blend and I'm going to try to hold my caffeine intake to three small (8 ounce) cups of half-caff. This will definitely be a challenge!

I am itching to weigh myself but waiting for the December 1, which will be the first of my monthly weigh-ins. I had my hair cut and coloured yesterday, and the stylist immediately exclaimed how much thinner I looked. She is a beauty and a gym rat -- who used to weigh 250 pounds, and lost it all through diet and exercise. She thinks that's how I'm doing it, too -- a topic for another post (one that I have been trying to write for a while). 

The only thing I notice is that my face looks much thinner, which I really appreciate. I spend a lot of my day in Zoom meetings, and I hated looking at my fat face! My slimmer face makes me less self-conscious and less camera-shy -- a nice benefit.

In general I'm feeling very good. I'm walking almost every day, often on the treadmill, because it's winter, but often because it just feels easier, like less preparation is needed. My new habit has been treadmilling at lunch, which has a huge added benefit of forcing me to take a lunch break. I'm working at home and tend to work long hours without a break. Having a walk in the middle of the day really helps me recharge.

I was having some discomfort -- sometimes real pain -- after eating certain foods, but I couldn't tell if it was caused by the food itself or by eating too fast. I took a chance and ate the same foods later in the week, consciously eating much more slowly, and had no discomfort. There's my answer. It's not easy for me to eat a tiny portion of pureed fruit slowly, or to eat soup so slowly that it doesn't stay warm. But it's obviously essential, and the pain is a reminder.

In order to eat properly and avoid pain, it's also important to properly space out food and liquid intake. I've adopted a little trick of having a timer on my phone set for 15 minutes. When I finish eating or drinking anything, I turn it on, and can't take in anything else until it goes off.

I sometimes have a weird feeling that I'm eating too much. I'm trying for the recommended six tiny meals each day, or three meals and three snacks. Sometimes I can't finish even the tiny half-cup servings that I'm currently up to, so I eat more than six times in a day -- which makes me feel unsure. 

When that happens, I do a quick-and-dirty calorie check, and I'm always right on track. I'm amazed at how few calories I'm taking in. The target for this phase is 700-1000 calories per day, including 70-120 grams of protein. Yesterday I felt like I was eating all day, and came in under 800 calories. A very bizarre feeling! 

The Name of This Blog

Why is this blog called 85 percent thinking?

In my mid-30s, I was writing professionally, and had a run for a while writing about eating disorders. It was through that work that I first recognized my own disordered thinking about food and dieting. I reached out to one of the therapists I had spoken with, and worked with her for some time. It was difficult work and it had an enormous impact on my life.

One of my biggest pitfalls, something I've worked hard to recognize and reduce over years, is All Or Nothing thinking. All Or Nothing is a poisonous trap that prevents us from participating fully in our lives -- and it's often part of an eating disorder syndrome.

This therapist taught something she called 85 percent thinking. Whatever you're doing, whether it's eating healthfully, getting more physical exercise, or any other goal, if you're doing it 85 percent of the time, you're doing well. 

We're not machines that can be programmed to perfection. We're humans, with real lives, full of things we cannot control. That accounts for the other 15 percent.

To do anything well, especially to learn new habits, we need discipline and commitment and inner strength. But to be human, we also need compassion, and flexibility, and forgiveness -- and we must extend that to ourselves. For many people, especially women, it's much easier to be kind to others than it is to be kind to ourselves. That, too, is the other 15 percent.

That's 85 percent thinking.