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    California62 posted:
    I had my gastric sleeve done last July 16, 2012. I lost 20 pounds and got stuck at 189 lbs and I exercise everyday for an hour. I also feel hungry every two hours ( could feel the hunger spasm) so I graze with snacks. Instead of losing appetite, it has somehow increased. I am bloated most of the time and feel fatigued although I take all the vitamins needed. I wanted to know if these are expected of with the sleeve surgery. I am getting frustrated as I am not losing any weight anymore. Is there somebody who can relate with me?

    Pamela Peeke, MD, MPH, FACP responded:
    HI and thanks so much for your posting. First, every bariatric practice has associated with it team of nutrition, fitness and psychological professionals to help you pre and postop, no matter how many months post op. As soon as you experience any problems, you need to check in with them immediately. Typically the sleeve is a very effective procedure because it interferes with the secretion of the appetite stimulating hormone ghrelin, which is located in the curvature of the stomach.

    Get in touch with the registered dietitian associated with your bariatric team, or find one that specializes in bariatric patients (you can find such a person easily online through the American Dietetics Assn or your local ADA affiliate).

    You need to have the RD look closely at your daily food intake including the types of foods you're grazing on.

    A word of caution about exercise. Keep it moderate. Sustained longterm exercise (running 6 miles at a good clip) stimulates appetite. In my book, The Hunger Fix, i note the new science that states pretty clearly that moderate exercise will keep the fat burn going and control your appetite as well.

    Good luck and let us know how you're doing,

    Dr. Peeke

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