You’ve been watching the scale for months—or even years—waiting for it to hit that magic number: your VSG goal weight. Next stop? Maintenance city. This might seem like the easy part of the journey, but many patients find it to be confusing. Weight loss the Endobariatric way is pretty foolproof for our vertical sleeve gastrectomy patients, but maintenance isn’t quite as one-size-fits-all. With a little trial and error, though, you can live happily ever after in maintenance mode.

Maintenance Issue #1: “I’m tempted to try eating more carbs.”
The idea of not needing to lose weight can seem downright odd for many VSG patients who’ve hit their goal. For some, it’s like the gates to heaven have been thrown open and all they see are carbs. If they’re not trying to lose weight, they reason, why can’t they eat all the foods they’ve been denying themselves since bariatric surgery in Mexico? Bad idea. It’s kind of like being an alcoholic: If moderation were possible for you, you wouldn’t have had a problem in the first place. There are exceptions like my patient, Peggy, who has decided on a moderation route during maintenance, commenting, “I didn’t have sleeve surgery so that I could continue to diet, count calories, and restrict myself for the rest of my life.” But most sleevers who’ve had long-term success in maintaining their weight have found that “everything in moderation” leads to weight gain. Kori says, “Twenty-five pounds of regain later and I’m back on keto and down 16. I won’t do that again.” I would argue that maintenance isn’t about dieting and depriving yourself for the rest of your life; it’s about sticking to a lifestyle that has proven to work for your health goals.

Maintenance Issue #2: “I have no idea how many calories to eat now.”
If you keep eating the same number of calories as you did when you were losing, well, you’ll probably keep losing. So it needs to be more than that. But if you eat too many, you’ll regain. And therein lies the conundrum for many bariatric patients. I wish there were a failsafe formula that I can promise will keep you square in the maintenance phase for the rest of your life, but the truth is that there are a number of variables that will impact your calorie count. One of the most important factors is how active you are. I encourage all of my patients (who are able) to make exercise a lifelong habit. But there’s a pretty big difference between, say, walking leisurely half an hour a day and training for a marathon. And the more muscle you have, the more calories you’ll burn while at rest and while working. A very general rule of thumb is to amp up your daily calories by 300 when you transition to maintenance mode. If you’re still losing, gradually increase that by 100 calories every week or so until you hit the sweet spot. If you begin to gain, on the other hand, decrease your calories by about 100 every week and/or increase the intensity of your exercise program. And whether you’re wanting to lose or maintain, the quality of your calories always matters. Protein plus produce is still the magic combination.

Maintenance Issue #3: “I have fears that I never did before.”
Weight loss is usually seen as physical, but as we all know, the mental aspect is huge. That doesn’t necessarily change when you hit maintenance. In fact, things like anxiety and even phobias might get stronger in this stage because your mind isn’t laser-focused on weight loss like it has been for years. The anxiety/fear thing doesn’t affect everyone, of course, but when it hits, it can really rock your world. One of the most common is a fear of certain foods, either because you believe it will completely sabotage your results (ie: bread) or because you had a bad reaction the last time you ate it. Onardo confessed to be newly afraid of heights, while Regina says the thought of carnival rides freak her out now. Then there’s the more human anxiety, like how weight loss will ultimately affect relationships. If fear or anxiety is affecting your life, it’s crucial to address them with a counselor. Unchecked, they could impact your ability (and desire) to maintain your weight over the long haul.

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