Dear Barbara
I had my surgery in 2001. I started at 286 lbs and lost 146 lbs. I kept it all off until 2005 when I gained 20 lbs.  I just had a baby in January and I gained another 30 lbs. I don’t know what my calorie intake should be to lose my weight. Can you please help?
Melanie

Dear Melanie,
What an excellent question. We tend to get so wrapped up in how many grams of protein and ounces of water we should be consuming that often we totally forget that even after gastric bypass surgery, we are still the product of calories in versus calories used. And if we don’t watch calories, then the pounds will return.

There are a few ways to determine how many calories you should be eating. Many weight loss surgery practices or gyms have devices that fairly accurately determine how many calories you use each day. You breathe into a tube for these devices and after about 15 minutes you are given the total number of calories you consume daily.

There are also consumer devices that you wear on your arm that determine your daily caloric expenditure. Body Bugg and SenseWear are two such devices. They run about $400.

However if you don’t have access to devices, there is a reasonably accurate formula that you can use called the Harris-Benedict formula which will give you something called your basal metabolic rate (BMR) to determine how many calories you use.

To figure out your calorie expenditure using this formula
For women the formula is:
655 + (4.3 x weight in pounds) + (4.7 x height in inches) – (4.7 x age in years) = BMR (Women)

For men the formula is:
66 + (6.3 x weight in pounds) + (12.9 x height in inches) – (6.8 x age in years) = BMR (Men)

Then you have to determine your Activity Level.  This is where it gets tricky.

If you are sedentary: BMR x 20 %

If you are lightly active: BMR x 30 %

If you are moderately active (You exercise 3 to 4 times per week): BMR x 40 %

If you are very active (You exercise intensely 5 or more days per week): BMR x 50 %

If you are extra active (You do hard labor or are in athletic training, or exercise intensely 5 or more days per week for 3 or more hours per day): BMR x 60 %

Add your Activity Level number to your BMR = Daily Calorie Expenditure

As an example if Melanie now weighs 190 lbs., is 5’6” tall, is 32 years old and is lightly active (I am just making up her height, age and activity level), this is how many calories she uses:

655 + (4.3 x 190) + (4.7 x 66) – (4.7 x 32)   OR
655 + 817 + 310.2 – 150.4 = 1631.8. This would be Melanie's BMR

Since she is lightly active:

1631.8 x .3 = 489.54 (Activity Level)

1631.8 + 489.54 = 2121.34 calories used in a day.

To lose 1 pound of weight, you have to consume 3500 calories less than what you eat. If you want to lose 1 pound per week, you have to eat 500 less calories per day than what you eat. If you are not losing weight then you have miscalculated your activity level or you are not correctly calculating the calories of the food you are eating. This is particularly true if you aren’t weighing and measuring your food.

Therefore Melanie should consume 2121.34-500 = 1621.34 calories per day to lose a pound per week.

I hope this makes sense to you and thank you, Melanie, for the question.

Hi Barbara,
I am almost 2 1/2 yrs post-op gastric bypass patient. I have recently been diagnosed with h pylori, a bacterial ulcer. I am interested in hearing if you might have information on this and also see if you might have links to help me better understand why this has happened.

I appreciate your website and all the wonderful information you have shared before and post op for me. I am happy to report that I have lost over 160 lbs and am holding steady.

Thank you for your support today and always.

Sincerely,
Connie

Dear Connie,
Prior to 1982, doctors believed that ulcers were caused by too much acid in the stomach as a result of stress. Consequently, doctors treated ulcers for the most part with antacids which treated the effects of the ulcer but not the cause.

However it was discovered that ulcers are in fact caused by bacteria called h. pylori which exists in the stomachs of about 20 percent of people under 40 years old and half of those over 60 years of age. It is not known why some people with the bacteria develop ulcers and others do not. Ulcers now are treated with antibiotics rather than with antacids.

It is thought that people contract the h. pylori bacteria through food or water. And the bacteria have been found in saliva so it can be spread through kissing. The bacteria are able to live in the harsh acidic environment of our stomachs because the bacteria secrete an enzyme that protects it. Then the bacteria the burrow into the lining of the stomach causing ulcers.

Symptoms include a stomach ache that is especially bad 2 or 3 hours after eating or in the middle of the night when the stomach is empty. Eating helps to relieve the symptoms as do antacids.

Ulcers are treated with a combination of antibacterial drugs and acid reducing drugs. The therapy may have patients taking as many as 20 pills per day for 2 weeks. It is effective 90% of the time.

A good website to check is http://www.digestive.niddk.nih.gov , the National Digestive Diseases Information Clearinghouse.

I want to offer a special thanks to Julie Akyol for sharing her story.   

After a whole lifetime of being overweight, I underwent gastric bypass surgery on June 25, 2003.  It took me 10 months to go from being 255 lbs (at 5’5”) to 145 lbs.  I went from wearing a size 26-28 to a 6-8.

My journey that led me to the decision to have gastric bypass surgery was, probably, like that of many others; I was always on one diet or another, starting at a very young age. I’d lost hundreds of pounds, only to gain hundreds back.  I thought I was destined to always be overweight. 

Through the years, I saw myself becoming more reclusive. I’d avoid social situations because I was embarrassed by my size. My family, rather than participating in activities without me (because I’d refused to or couldn’t do something) missed out on many things.  It got to a point where I was just so saddened by the fact that I was overwhelmed by my excess weight. I had tried every diet. I had tried medications to lose weight. I had success and than failure at every attempt to lose the weight.  I knew in my heart that gastric bypass surgery was my last chance. When my own family practitioner wasn’t supportive, I found another one that was.

I read everything I could online, about the different procedures, as well as the experiences (good and bad) of others who had gone through these procedures.  I did this for about a year before I found a surgeon in my area and made an appointment for a consult. It was only after I had this appointment that I “shared” my plans with my husband.  He was afraid for my safety, but trusted my decision and supported me every step of the way.  My consultation was in January, 2003 and I finally had my surgery 6 months later.

Life since then has been much different than the life I had before surgery.  I have a very positive attitude, I feel courageous, I’m no longer invisible to the world around me and I am no longer “afraid” of social situations.  I even have a new career.  Life is so much easier without the burden of all of that excess weight, and the self-loathing and blame I punished myself with.  I work hard to maintain my weight, by eating according to pouch rules and exercising, but it is a breeze compared to my years on Weight Watchers and being starved and miserable!  Having gastric bypass surgery was the best and bravest decision I’d ever made.

Julie Akyol
julieakyol@yahoo.com

Congratulations Julie

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