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.

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!

Update: One Month on the Minus-50 Plateau

It's been a month. Lots of good stuff has been happening.

• I'm still tracking my eating, and I feel like I'll be doing that for a long time to come. It gives me more peace of mind, and is very easy to do, so it's a very worthwhile habit. 

• I bought a whole bunch of new clothes! It feels wonderful to put them on. 


• I'm walking 5 kms 5-6 days/week, and usually once each week I walk a 7-km loop around our little town. It takes me past the bay, where there are eagles and herons, and snow-capped mountains in the distance. 


• I've discontinued one of two blood-pressure medications. I still take several other meds, and my goal has never been to discontinue any of them. But it's still a nice little perk.


• All my other bloodwork is normal -- blood sugar, liver enzymes, etc.

I'm weighing myself too often, but I'm trying hard not to obsess.

The last time I was the weight I am right now, I thought I was a fat oaf. I dieted obsessively, weighed myself constantly, hated my appearance, and was desperate to lose 25 pounds or more. 

Yet this is the weight at which my weight-loss settled. My post-surgery weight-loss gradually slowed and then stopped. So I feel that this must be my new normal weight, the weight that I can comfortably maintain.

However, the medical establishment and the weight-loss industry do not agree with me. According to BMI calculators, I am still obese. 

Now, I am not skinny. You might say I am "chubby" or "somewhat overweight" or similar expressions. But I could not rightly be called obese. 

Those same calculators say that my ideal weight is a minimum of 30 pounds less than I am now, giving a range of 30-50 pounds less! At current weight minus 30, I would be quite thin. Even if I could reach that weight (which is highly unlikely), I would never be able to maintain it. Current weight minus 50 is ridiculous. That would be my weight when I was 17 years old. 

From another perspective, the caloric intake per day needed to maintain my current weight is -- supposedly -- almost double what I am eating now. According to the information above, based on my size and what I am eating, I should be losing a pound per week. But I'm not. I'm maintaining my supposedly obese weight.

Something is seriously amiss.

I understand that being very overweight is not healthy. I get that. But the guidelines of what is supposedly healthy is conveniently aligned with the diet industry and all the other consumerism that feeds off people's unhappiness and insecurities.

When I say, above, The last time I was the weight I am right now, I thought I was a fat oaf, I can also say: today, at this weight and size, I feel great.

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.

April 1 Weigh-In

Pounds lost since last weigh-in: 2

Total pounds lost so far: 47

It seems my weight loss has now slowed to my "normal" rate, what I was capable of losing if I hadn't had surgery -- 0.5 pounds per week, or 2 pounds per month. The difference, however, is that in the past, those 2 pounds meant being hungry all the time -- literally all the time -- which would ultimately make the diet unsustainable.

I do feel disappointed that I didn't lose 5 pounds over the past month, as I had in previous months. But I have to move beyond that. I'm eating very healthfully, not overeating, getting more exercise than I ever have, and feeling really well. My fasting blood glucose level is back to normal. I must focus on the larger picture, and consciously not focus on the number on the scale.

Is this the beginning of the end, the signal that I will soon plateau at a new weight? Or will I continue losing 2 pounds per month? 

My secret goal weight, my "soft goal," is 13 pounds away. Most people who've had this surgery lose weight for 12-18 months, so it's possible. But I want to prepare myself mentally that it might not happen.

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.