Weight loss has stalled even on 800 calories

[Sylver75]

Quick synopsis: I'm 48, need urgent neck surgery or could end up paralysed. In Ireland, private hospital. I was told to get below BMI 50. Did it. Then told 47. Did it. Then told I had to lose 10% body weight compared to my last appointment.

I'm 7.5lbs away from that. My pre-op appointment when I'll be weighed is in less than 4 weeks. A dietitian from the hospital told me to increase protein when she got involved a couple of weeks ago so I went from 500/600 calories per day to 800. I lost 21lbs in 22 days.

I gained 3.5lbs last Saturday (I weigh daily), put it down to my period starting. Lost 3.1 by Tuesday. Lost 0.8 by Wednesday. Gained 0.8 this morning.

I'm only 1lb less now than I was a week ago. I will be turned down for surgery again if I don't lose 7lbs. Realistically, I need to lose more than that as I weigh first thing in morning in just my underwear. At the hospital, it will be in the afternoon/evening and wearing the lightest clothes I can find but still more than what I wear when on my own scales.

I am weighing and tracking and drinking lots of water. I spend the first few hours after going to bed getting up and down to the loo, it's exhausting.

Breakfast: 2 eggs, hard boiled or scrambled, tea
Snack: Fridge raiders or a cheese stick
Lunch: 100g cooked chicken, lettuce, tomato, onion
Snack: Easy peeler orange 🍊
Dinner: 100g cooked chicken, stir fry veg or salad
Two litres of water at work plus what I drink when I'm at home or on lunch break.

I have one slice of dry toast on a Sunday as a treat. Pretty much no carbs outside that. I tried protein yogurts but I don't like them. I add cottage cheese to scrambled eggs occasionally.

I really can't miss this surgery again. I will end up paralysed without it.

Has anyone any idea what I'm doing wrong? I was doing great but everything has ground to a halt.

Yes, because her metabolism has slowed down and her body is holding on to as much energy as possible and is no longer burning.
Up the calories by 200-300 and OP will see weight loss. Sorry it sounds hard to believe but it is a thing. And actually worked for me in the past.
I'm not saying stick on the higher calories- but yes to boost metabolism

'Starvation mode' is a thing but it's not what is often described here. It's also true that your body will try to compensate in anyway it can to prevent weightloss. This includes slowing down your digestion, heart rate, reducing the amount you move

However if OPs BMI is 45+ and she is genuinely eating only 800 calories a day then she will lose weight. That will be significantly below her BMR

Stick to what you're doing and make sure you are getting plenty of water.

On a different note why do the surgeons keep shifting the goal, you've hit the original and the second target they at for you.

I know that ultimately the lower your BmI the lower the risk but it seems incredibly unfair to keep putting more pressure on you and threatening to take away a necessary surgery.

Honestly OP, this is not mumsnet advice territory. I would stick to your dietician’s advice and see if you can get an appointment with your gp or if a telephone appointment with the dietician to discuss your concerns about your weight loss stalling. I do think it’s highly likely the number on the scales will start falling again if you stick to your dietician’s advice. You do have some time still to reach that target.
Your surgeon and anesthetist will also weigh up the risks of operating against the risks of not operating/postponing when you go in for your next scheduled appointment. If they can see that you have been losing weight and sticking to the very low calorie prep diet, and your weight is nearly at the target but not quite, that will factor into their decision too.

Careful your eyes dont roll out your head there.

You're wrong, there is no such thing as starvation mode

How do you think people starve to death?

have you looked at your salt intake?
too much salt makes our bodies hold on to excess water.
fluctuations around a kilo can be due to fluid retention and gut content.

Honestly, I think just keep doing what you’re doing. It will come off. I think because eating like that is such a monumental effort, it’s easy to lose patience every time you step on the scales. It will be working though, in 4 weeks your weight will be down.

The main thing is to work on your mindset, that you don’t go 3/4 days not seeing the numbers change and become disheartened that you reach out for a binge. I would suggest you not weigh for the next 3 days, and try not to focus on it at all. Do you have any hobbies like knitting or sudoku? Distract your mind from food, weight etc.

The hospital moving targets is something I've written to them to complain about. The surgeon fought to get me operated on even at the BMI of 50 as he feels the risk of my spinal cord getting damaged is higher than the risk of surgery at my weight but the anaesthesist wouldn't allow it. I get the reasons for that, I do but I'd have been happier had they told me a target in the beginning and let me work towards it, not keep changing it. They swear that this 10% figure is my final target.

You’re doing brilliantly really, I think it’s probably just one of those temporary blips . Really annoying I know, especially for you when you have such an important reason to keep going must be upsetting when the scales won’t shift. I agree with the others to just keep on following your dietician’s advice. You could try to get a phone appointment with her to chat it over? She can reassure you far better than us.
Meanwhile just try to not think about it too much, as someone said concentrate on a hobby you enjoy. I find knitting in front of the telly with sugar free chewing gum can help to not think about food. It’s doubly difficult when you can’t safely exercise, I can understand this a bit as I have spinal stenosis & walking is very difficult & painful so really feel for how bad this must be for you.

I weigh daily and sometimes I think it can be constipation. Then I unblock and can lose a bit more weight and poo a lot! You are doing well. Maybe try and replace the fridge raider with something to help digestion. Fruit.
Or can you swap some lunches for a lentil soup?

800 to way too low... your body has responded by sticking fast and protecting itself

I agree with pp- you have a dietician who is trained and qualified to help you lose the weight safely.

advice here may be well meaning but clearly not based on best practice.

I have spinal stenosis as well. This will be my third spinal surgery, two others were on my lower back. Fifteen years of pain put down now but this neck pain is a whole other level to anything I've had before. I wouldn't wish it on my worst enemy.

I'm no expert but I've lost 35% of my body weight in a year (yes, on that jab, but it's still not been easy). Very little exercise but 80% of the time I've been in extreme calorie deficit, <1000 kcal/day. Without the appetite suppressing effect of the jab this would have been hellish.
You must be exhausted. This is not easy but as a short term solution I feel this will be doable for you.
Just my two cents:
Bowel movements will make a difference, how are you getting on there?
12g protein for breakfast isn't a lot, could you add in some wafer thin turkey slices for example? 1/3 of the M&S pack is 52 kcal and 11.3g protein. It's the thermic effect you're after + feeling more sated. Upping the protein might be a bit of a fad but it actually works.
Cut more carbs, ie no more orange and toast. I know it sounds bonkers but it's just short term, you can do it. Because 1g carb will hold on to 3 g water. It adds upp and you are really chasing the numbers here. Think of your goal.
Re-feed days are controversial but have worked for me. 2 days month or so, when I feel I need them. Long term calorie deficit is physically and psychologically draining, and while I think starvation mode and slowing down of metabolism are debated, there's no doubt that re-feed days have helped me break plateaus. Leptin levels will be improved from it. I'm not saying go bonkers and eat everything you fancy, takeaways or stuff like that, but maybe going up to 1500 kcal on your refeed day. I've tended to go for some nice pasta dish, some nuts, some dark chocolate.
Very best of luck to you.

I just heard back from the hospital dietitian. She said not to panic, slowing down is normal and I can't be expected to go any lower in calories than I am already. It doesn't really help me get out of the slump but she is also gonna speak to the surgeon's team and see if I have to have those full 7lbs down by the 17th or if they have some leeway considering I've done my best. To be honest, I don't hold out much hope on that front as the head anesthesist came up with the 10% body weight loss which the surgery department nurse said they have never asked a patient to do before, it's always been a BMI target, which I've passed but that wasn't good enough for him.

I'd be asking for a different anesthetist, one who is confident enough in their own ability and their team to get you through the surgery. It really isn't fair of them to delay things like this when it is so badly needed.

Here’s hoping the new target was to keep you on track for your pre-op appt.

maybe the anaesthetist has seen people let loose once they get an op date and regain a lot of weight? Obviously the more you lose the safer it will be, so you need to keep going even if you get the go ahead.

good luck 👍

I am exhausted and it's making me an emotional wreck. Have been crying most of the day.

Bowels are ok, definitely not going as often as I used to, I'm also on oxycodone for pain which doesn't help that. Having so much protein and less fibre is taking an effect too. I have always had IBS so would go 3+ times per day, now it's once. I was having the orange to try to keep some kind of fibre in my diet. I do have Senokot in case I get bunged up but I rarely get to that point.

I sometimes have cottage cheese with my eggs in morning, couldn't find it in the shops this week for somereason. It's hard to add in more protein when I'm on such a low calorie amount as everything adds up but I will try.

Well done on losing 35%. My GP put me on the jab too when I told her about needing to lose weight for surgery but then I found out anaesthesists don't like patients to be on it as it can cause food aspiration issues under anesthetic so I never took it again after the first dose. I can't risk giving them another reason to turn me down.

Short term you could try calorie replacement shakes or soups, exante are good.
But you might just find that you don't lose much some weeks then other weeks quite a lot, sounds like nothing really wrong with your diet

Hi OP. I wanted to say how much I feel for you and I think you’re being treated terribly by the hospital, there is so much medical misogyny and also anti fat mindsets in health care, Aubrey Gordon’s book and podcast has shocked me on this. You are doing brilliantly and it’s ridiculous that they keep moving the goalposts, it must be so stressful.
If you want to keep posting on here for chats and motivation over the next 4 weeks then do, I’ll happily keep you company.
You’ve come so far already and done so well. You should be so proud of yourself 💕

Well done for getting back in touch with your dietitian. You’re doing really well, sticking to the plan and weight is coming off. It will continue to come off between now and your appointment date if you stick to your plan. The only thing I would suggest if you’re not doing it already is to consider weighing portions so you are sure you aren’t letting portion sizing creep up beyond what your dietitian has set for you. Not necessarily as a long term thing, but just for now to give you the best chance of hitting your weight target.
The anesthetist is just trying to make sure you’re as safe as possible when the surgery happens. Remember this is a target, on your appointment day they will think over the risk/benefit analysis of waiting or operating ASAP. Your dietitian is advocating for you. What you’re doing is a fairly extreme measure that’s not meant to be sustainable for months and years at a time. It’s a short term diet and your medical team know that. If you’re unhappy with the outcome of your appointment, you can then request a second opinion from a different anesthetist. But don’t panic yet. You’re doing everything you can to get your heath issue resolved. No one can ask more than that.

Mindy Peltz says when you hit a plateau to do a 36 hour water fast. Do that, add some fermented veg to your diet and keep at it - you’re doing so well good luck.

Mindy Pelz is a quack

I read your other thread op and I really don't think Mumsnet is the place for this. You need medically supervised weight loss support to get you life changing surgery and your hospital and doctors should be facilitating this as, in the kindest way possible, dramatically starving yourself at your size could be dangerous.

Seeing that this is short term, just eat 800 calories worth of protein until you have had the surgery