Super morbidly obese. Where do I start?

[Anonymous]

Anonymous wrote:Find a doctor that specializes in obesity to talk about your options. Good meds are available now (semaglutide) but I think weight loss surgery would be the best option for you, likely duodenal switch or roux en y instead of gastric sleeve.

It is a great option and doctors should discuss it more often, but may not be the best initial option if the underlying issues that are leading to overeating are not addressed first. To increase the chance of long term success a person needs to work on mental health, commit to dietary changes and incorporate physical activity. It's less severe with the sleeve than with roux en y or duodenal switch, but if you eat a carb-heavy diet post-op you can develop dumping syndrome and/or reactive hypoglycemia - the first line treatment is adhering to a low carb diet. Unfortunately, although the surgery is life changing and often leads to diabetes remission, its possible to eventually put the weight back on if a person continues a non-optimal diet and increases the amount eaten over time.

Most endocrinologists are able to discuss obesity treatment options in detail, or look for a doc who has a certification in obesity medicine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You need to start with a doctor and a full blood workup. It's possible, even likely, based on what you describe that you may have Type 2 diabetes or are at least pre-diabetes. You almost certainly have metabolic syndrome and a fatty liver.

Once you have the blood work you can create targets. You'll want to get your sugar and A1C down if you have diabetes. You can do this through a combination of eating better, moving more and maybe medications like insulin or a GLP-1 like Ozempic.

I have lost 45 pounds since February since getting the diabetes diagnosis doing the above. What works for me:

-- Writing down everything I eat in an app. Every meal. No heating.
-- Aiming for under 125 carbs a day total. This isn't keto -- it's more reasonable than that. But forces you to be more mindful of what you're eating.
-- Along those lines, eating at least 30 grams of fiber.
-- More vegetables. Some fruits, although you have to be a little careful with fruit because it can spike your blood sugar. Like, don't eat a banana.
-- Keeping calories to between 1,500 and 1,800 a day.
-- No alcohol or sugar at all. At ALL.
-- Walking 4-6 miles per day. I usually do at least one 45-minute brisk walk.

You didn't get this way overnight. It will take months, if not years, to correct. Be good to yourself. But having reachable goals will help. Mine was to get my A1C down from 9. I did that -- it was 6 at my last appointment. My fasting glucose now most days is about 95-100. It's how I know I am maintaining.

I just started on Ozempic. The doc is taking me off the insulin. She says once that happens, the weight loss will accelerate.

BTW I started out at 285. My goal is 185.

This seems like extremely fast weight loss.

It was rapid at first and has slowed down. About a pound and half a week or so. In the beginning it was closer to 2-3 pounds a week. So maybe 15 in Feb and 12-15 in March and the rest since April.

The exercise generated a calorie deficit of around 1200-1,500 a day.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You need to start with a doctor and a full blood workup. It's possible, even likely, based on what you describe that you may have Type 2 diabetes or are at least pre-diabetes. You almost certainly have metabolic syndrome and a fatty liver.

Once you have the blood work you can create targets. You'll want to get your sugar and A1C down if you have diabetes. You can do this through a combination of eating better, moving more and maybe medications like insulin or a GLP-1 like Ozempic.

I have lost 45 pounds since February since getting the diabetes diagnosis doing the above. What works for me:

-- Writing down everything I eat in an app. Every meal. No heating.
-- Aiming for under 125 carbs a day total. This isn't keto -- it's more reasonable than that. But forces you to be more mindful of what you're eating.
-- Along those lines, eating at least 30 grams of fiber.
-- More vegetables. Some fruits, although you have to be a little careful with fruit because it can spike your blood sugar. Like, don't eat a banana.
-- Keeping calories to between 1,500 and 1,800 a day.
-- No alcohol or sugar at all. At ALL.
-- Walking 4-6 miles per day. I usually do at least one 45-minute brisk walk.

You didn't get this way overnight. It will take months, if not years, to correct. Be good to yourself. But having reachable goals will help. Mine was to get my A1C down from 9. I did that -- it was 6 at my last appointment. My fasting glucose now most days is about 95-100. It's how I know I am maintaining.

I just started on Ozempic. The doc is taking me off the insulin. She says once that happens, the weight loss will accelerate.

BTW I started out at 285. My goal is 185.

This seems like extremely fast weight loss.

It was rapid at first and has slowed down. About a pound and half a week or so. In the beginning it was closer to 2-3 pounds a week. So maybe 15 in Feb and 12-15 in March and the rest since April.

The exercise generated a calorie deficit of around 1200-1,500 a day.

Do you consider that to be sustainable? It does not feel sustainable to me, but I’d like to hear what you think about it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You need to start with a doctor and a full blood workup. It's possible, even likely, based on what you describe that you may have Type 2 diabetes or are at least pre-diabetes. You almost certainly have metabolic syndrome and a fatty liver.

Once you have the blood work you can create targets. You'll want to get your sugar and A1C down if you have diabetes. You can do this through a combination of eating better, moving more and maybe medications like insulin or a GLP-1 like Ozempic.

I have lost 45 pounds since February since getting the diabetes diagnosis doing the above. What works for me:

-- Writing down everything I eat in an app. Every meal. No heating.
-- Aiming for under 125 carbs a day total. This isn't keto -- it's more reasonable than that. But forces you to be more mindful of what you're eating.
-- Along those lines, eating at least 30 grams of fiber.
-- More vegetables. Some fruits, although you have to be a little careful with fruit because it can spike your blood sugar. Like, don't eat a banana.
-- Keeping calories to between 1,500 and 1,800 a day.
-- No alcohol or sugar at all. At ALL.
-- Walking 4-6 miles per day. I usually do at least one 45-minute brisk walk.

You didn't get this way overnight. It will take months, if not years, to correct. Be good to yourself. But having reachable goals will help. Mine was to get my A1C down from 9. I did that -- it was 6 at my last appointment. My fasting glucose now most days is about 95-100. It's how I know I am maintaining.

I just started on Ozempic. The doc is taking me off the insulin. She says once that happens, the weight loss will accelerate.

BTW I started out at 285. My goal is 185.

This seems like extremely fast weight loss.

It was rapid at first and has slowed down. About a pound and half a week or so. In the beginning it was closer to 2-3 pounds a week. So maybe 15 in Feb and 12-15 in March and the rest since April.

The exercise generated a calorie deficit of around 1200-1,500 a day.

Do you consider that to be sustainable? It does not feel sustainable to me, but I’d like to hear what you think about it.

Yes, it is sustainable. I have diabetes now — it HAS to be sustainable. It isn’t anything particularly radical. It’s a combination of being more mindful of what I eat and getting more exercise. The Ozempic also reduces appetite but I lost 40 before I started it. We will see what that does — only been on it three weeks but it very clearly send a signal to brain that you are full quickly. So you don’t overeat.

It takes some willpower to give up alcohol and sugar for sure. But I like seltzer and do fun things with tea. I was never a big sweets person so that isn’t a big deal.

Otherwise it is avoiding foods like pizza and pasta or finding alternatives (ie I use a low-carb lavash bread for a pizza crust and make my own at home and maybe twice a month… I just don’t eat pasta anymore). The key word here is being mindful about what you are eating.

In general I eat nearly everything at home. Travel is harder. When eating out substitute vegetables for potatoes, avoiding breads or just knowing the carb count and what is low-glycemic.

So, yes, it’s sustainable. It has to be.

[Anonymous]

All this advice is great, but I’m telling you talk to your doctor about Wegovy. Life changing. I’m maintaining a 100lb weight loss. I’ve posted about it.

[Anonymous]

Anonymous wrote:Talk to your doctor and google Wegovy.

+1 and go to the Facebook support group for Wegovy/Ozempic users - lots of good info there.

https://www.facebook.com/groups/ozempicweightlosssupportowls

[Anonymous]

Start a YouTube channel.
Even if you are the only one to watch, you have documentation and self accountability.
I think all you really need is your phone and a computer.
Do a weekly or monthly numbers update...maybe a weigh in, maybe a number of minute walked, maybe some measurements, maybe total minutes active...something you are excited to measure.
Talk about food planning, self care, exercise.
Document all that you want.
There are many exams on YouTube, many are really fun and inspirational but I don't recommend you wasting Tim watching YouTube, you should be filming.

[Anonymous]

Anonymous wrote:All this advice is great, but I’m telling you talk to your doctor about Wegovy. Life changing. I’m maintaining a 100lb weight loss. I’ve posted about it.

But what happens when you stop taking the mediciation?

[Anonymous]

One of the biggest problem people who lose a lot of weight have is that they adopt techniques designed to lose weight, but they don't focus on sustainable changes. Then when they reach a "goal weight" they change their behavior and put the weight back on.

The key to losing weight and keeping it off are to make changes to your lifestyle that are sustainable. To do that, you need to make small changes that you can continue. So, for example, like the people who say start by walking 20 min a day, that's something that you can continue. As you become acclimated to the exercise, then you can increase the amount, again at a sustainable level.

To change your eating habits, you have to do the same. Start with some basics, like eliminating some snacking and changing other snacking. When I lose weight, one of the things that is easiest for me to cut out is late night snacking. So, I set myself a limit, like 10:00pm or something like it and then I don't snack after that time. Typically when I snack late, it is usually stress eating or similar and I don't need to eat and don't get cravings by skipping that. You can also try switching one snack at a time. So I switched chips to celery with ranch dressing. Later I switched to celery with low cal Italian dressing. I've found that small changes and small steps are ones that are sustainable. Making large changes to my diet give me cravings and make me cheat or fall off the wagon. Small changes and steps are more sustainable.

Good luck.

[Anonymous]

Bariatric surgery. With your BMI your health insurance will probably cover it. Husband just went through it after years and years of getting nowhere with dieting and exercise. Sometimes your metabolism and stomach size is just broken. I’m planning on doing it myself this year after a lifetime of weight struggles. My health insurance will cover it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:All this advice is great, but I’m telling you talk to your doctor about Wegovy. Life changing. I’m maintaining a 100lb weight loss. I’ve posted about it.

But what happens when you stop taking the mediciation?

I’ve been off it for about 4 months, gained/lost about the same 15lbs. But while I was on it, I committed myself to the gym, I go 4-5 times a week focusing on strength training, that helps. Not gonna lie it’s hard, my insurance no longer covers it and I wish I was still on it. I’m doing IF and appealing my insurance. But I’ve learned a lot about my eating habits after losing over 100lbs. So it’s up to me know, but Wegovy was a hell of a kickstart! Gave me hope! Changed my life!

[Anonymous]

So it’s Up to me now….

[Anonymous]

A suggestion for exercise that I didn’t see yet - swimming/water fitness. The water supports your weight and allows you to work on flexibility and strength just with the resistance. I joined OneLife Fitness last year and love the variety of aqua classes, including aqua Zumba. I’ve never been motivated about exercise, but being in the water makes me happy and motivated to go.

[Anonymous]

Anonymous wrote:

Anonymous wrote:All this advice is great, but I’m telling you talk to your doctor about Wegovy. Life changing. I’m maintaining a 100lb weight loss. I’ve posted about it.

But what happens when you stop taking the mediciation?

Hunger comes back and you gain the weight back. Some may be able to keep the new habits and maintain despite hunger, but from what we know so far it is a lifelong medication at a maintenance dose not unlike cholesterol or blood pressure meds. However, using semaglutide for weight loss is new enough that we don’t know whether if you are on it and maintain a lower weight for long enough (as in several years) whether the body is willing to adjust to a new lower “set point” and stop fighting to get back to that higher weight even after discontinuing the medicine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:All this advice is great, but I’m telling you talk to your doctor about Wegovy. Life changing. I’m maintaining a 100lb weight loss. I’ve posted about it.

But what happens when you stop taking the mediciation?

Hunger comes back and you gain the weight back. Some may be able to keep the new habits and maintain despite hunger, but from what we know so far it is a lifelong medication at a maintenance dose not unlike cholesterol or blood pressure meds. However, using semaglutide for weight loss is new enough that we don’t know whether if you are on it and maintain a lower weight for long enough (as in several years) whether the body is willing to adjust to a new lower “set point” and stop fighting to get back to that higher weight even after discontinuing the medicine.

I’m the original poster suggesting Wegovy and I would agree with this. I’m doing okay, but it’s a daily struggle. My brain wants to to go back to my old habits and I mentally have to focus on fighting it. My gym family really helps me and I just don’t want to go back “there”. I have to keep reminding myself that I’m not hungry, it just my body wanting to be 300lbs again.