Leaderboard

We all have an inherent need to help others before we help ourselves, particularly as adults when we take on the roles of spouse, partner or parent. But taking on the goal of losing a large amount of weight requires that you dedicate yourself 100 percent to the task at hand. Make time--no matter what obstacles try to block your path--to accomplish these tasks every day 24/7/365 (yes, even Christmas): · Shopping for fresh and healthy food · Preparing meals · Exercising daily · Relaxing · Planning for the next day These responsibilities can be challenging when you are so accustomed to helping everybody else before finally seeing to your own needs (if you are not too exhausted to do so). It’s all-too-easy for self-care activities to slide off the to-do list (I’ll start again tomorrow…) Undertaking the Herculean challenge of losing a large amount of weight and changing unhealthy lifestyle patterns in your life may be the battle of a lifetime for many of you. And you are worth it. But to accomplish this goal as quickly and effectively as possible, you have to prioritize “self-care.” Five ways to prioritize your needs during weight loss 1. Prepare and enjoy your meal before you cook for the family. 2. Set-up a kids’ activities car pool to lessen wasted time sitting idly in the car. 3. Set a daily reminder to take a 15-minute break every day to do something that you enjoy, even if you just sit with your eyes closed. 4. Feel free to say to detractors, “I have to devote a concerted effort toward my weight loss, which will make me healthier and happier.” 5. If you are put into a situation where you may eat for the wrong reasons, change plans or politely excuse yourself. (You are in a special situation, you are allowed). Like getting regular oil changes for your car, prioritizing your own needs is what allows you to run optimally and put your best foot forward toward achieving your weight loss goals. And you are very much worth it.

When new bariatric patients come to my practice, one of the first things we discuss is how unimportant the operation will be for them, in the big picture. Once they recover from the shock of that news, we explain that their mindset contributed to their weight problem, and their mindset will be the secret weapon to ultimately get the weight off. Here’s the thing--we don't operate on your brain. Bariatric surgery will only take you so far. Long-term weight-loss success requires a firm commitment to living a healthy lifestyle—eating the right foods--and ignoring the others that made you feel bloated and too tired to do anything. You need to stay very well hydrated and discover an exercise (or two or three) that you perform about 4-5 times a week for about 30-40 minutes. Take this stress and… Then there’s the stress of everyday life—we all have it. The trick is to find ways to offset these unavoidable pressure points, so that you aren’t on a one-way road to the kitchen. Food is not the answer to your problems, it never was. While you are improving your health, feed your brain with positive feelings by improving the quality of your life. Make the effort to become more social: Join a gym, catch a movie with a long-lost friend, invite the nice parents of your child’s best friend over for coffee. Give a little, get a lot One of the activities I recommend to every bariatric patient is to give back to their community. Want to feel better than any junk food could make you feel? Volunteer. If you look around, you’ll see that you’re far more fortunate than you may realize. Help out, make life better for someone else, even in a small way. Give your time, give your heart. Everyone needs a little help If you think you can’t go it alone, reach out to your bariatric or family doctor to ask for resources who can offer mental health support specifically for people with food/weight issues. You are never in this battle alone, always remember that.

“Do you think I should keep taking my sublingual B12, Elizabeth?” Roxanne* is 3 years post op from her gastric sleeve and is wondering if the expense of the meltable supplement is worth it. “I’m not sure, what does your latest B12 lab show?” I respond. “Uh…..I haven’t had labs done in, well...years,” Roxanne admits. And she’s not alone. Scores and scores of WLS clients intend to keep up with the required post op labs but life gets in the way. People, I am here to tell you, if it has been a long, LONG since you’ve had your specific bariatric lab work done, run, don’t walk, to your nearest phlebotomist. Every few years, the Obesity Society (TOS), the American Society of Metabolic and Bariatric Surgery (ASMBS) and the American Association of Clinical Endocrinologists (AACE) update medical guidelines for bariatric surgery patients. They have a list of labs that need to be done at 3 and 6 months and those that need to be done annually. Yes, every-single-year, after surgery. Why? Believe it or not, vitamin and mineral deficiencies increase over time—regardless of your WLS procedure. I know many PCPs push back against ordering these regular labs--whether it’s the cost to their practice, the patient or both, many providers don’t understand the necessity for the work-up. What concerns me the most is that the damage from some vitamin and mineral deficiencies cannot be undone or corrected. The damage is permanent. A psychiatrist speaker at a recent convention I attended, talked about patients he’s seen that were 6-10 years post op that were suffering from mental health issues--sometimes incapacitating problems. When he looked at their lab work, he was shocked to see that for some patients, vitamin and mineral deficiencies were the sole cause. If your provider pushes back against these labs, I’m happy to provide you with the link to the scientific paper citing which labs need to be done and when. You can share this with your provider and insurer. Roxanne is off having her B12 checked as we speak. Armed with those results, we’ll be able to determine the most affordable and healthful path forward, specifically for her. You deserve the same so make that appointment today. I thank you. *names of clients have been changed

A Lifelong Struggle with Food Some weight loss surgery patients have nothing but memories of being obese. Robanne did struggle with food her entire life, but her ordeals included battles with anorexia and bulimia as well as childhood obesity and morbid obesity as an adult. By the time she was 37, she had high blood pressure and diabetes, and had two trips to the ER. She was close to giving up. That was at a weight of 300 pounds. The Decision and Her Surgery Robanne knew her health was the result of her weight. She researched the various WLS possibilities and felt Roux-en-Y was the best option for her because of the long-term success rate. Also, she had a friend that had lost 100 lb. after RNY. She got her surgery in 2009 with Dr. Brenda Cacucci at the St. Vincent Bariatric Center of Excellence, in Carmel, Indiana. A Personal Decision with Family Support The decision for Robanne was personal. She explains she had enough on her mind at the time of her surgery, and was not in a place to be able to justify her decision to friends and family. So, she only told them about the surgery after she got it done. She also did not want to deal with judgmental people, since she was scared and uncertain at the time. Her friends and family were supportive when she told them. She says her children “were particularly excited that ‘mommy would be able to jump on the trampoline with them some day.’” Now she says she is “strong enough to believe in my path,” and her results show it. She lost 150 lbs. and now weighs 150. Overcoming the Challenges and Becoming a Dancer Robanne faced the same challenges many WLS patients can relate to. It was tough to get in her dietary supplements and drink her protein shakes. In the beginning, exercise was a serious challenge – so much so that she tried to convince herself she didn’t need to exercise. Luckily, she went to a group exercise cardio class, which happened to be a hip-hop dance class. She was too embarrassed to quit, so she stayed in class…and says it was the best thing that could have happened! That class changed her life. She loved it, and learned that exercise could be fun and not dreadful. But she took it much further. Robanne worked at it, and now teaches seven hip-hop classes a week. She leads group exercise classes for the Obesity Action Coalition's national conference. Look for her at their next conference in San Antonio in August! Robanne’s also been selected as a national national spokesperson for the Y.. She’s appearing in a national commercial rolling out this year. It is currently on the air in Seattle, WA and starting to pop up across the country, and you can take a look on . Tips from the Top Anyone who’s lost and been able to keep off half her body weight probably has a lot of good advice, and Robanne is very willing to share it. First, she says to try new things. If you’ve been sedentary and overweight for years, she says, how do you know what you like? So try everything! Also, “keep it real.” You’re not in the best possible shape right after surgery, so just work up to the tougher workouts instead of jumping right in. You don’t want to get hurt, burned out, or discouraged. Fitness is about being strong and pursuing health, not about a single number on the scale. Another piece of advice comes in the form of one of her favorite quotes. "Start by doing what is necessary, then do what is possible, and suddenly you are doing the impossible"--St. Francis of Assisi. And finally, stay focused. Robanne says, “Every day, I recommit to do what it takes to stay successful.” A Day in the Life What does a typical day look like for 6-year WLS veteran who’s lost half her body weight? Something like this, at least for Robanne. Coffee...with cream. Breakfast: 1-2 packets of plain, heart healthy instant oatmeal sweetened with Splenda. First morning snack: Greek yogurt. Late morning snack: 1-2 hard-boiled eggs Lunch: some kind of chicken (usually grilled), on a bed of mixed vegetables (usually salad). She uses salsa for dressing. First afternoon snack: something crunchy like Skinny Pop popcorn. Second afternoon snack: a slice of cheese, and handful of turkey, or some kind of lean protein. Dinner: lean protein, 1/3 cup brown rice and broccoli or a small salad. Every other day: a protein shake. Plenty of water. Robanne says she’s a creature of habit and keeps eating what she likes. The key for her is snacking on protein instead of carbs for the most part. She splurges on occasion on something like a cookie or something chocolate. But, she says, eating too much sugar and refined carbs makes her feel less bad. She sticks to whole grain carbs instead of white. And exercise? This hip hop instructor is no slouch! She teaches 6-7 classes a week, including 2 days with 2 classes each. She also does weight training to keep up her muscle mass. She has 2 days off each week. More from Robanne If you want to learn more about Robanne, take a look at her Get Your Strong On site. It details her work in motivational speaking, weight loss coaching, and promoting corporate and kids fitness. You can also check out her inspirational video called “ .”Robanne wrote her story in a book, “Half My Size,” which she’s offering at a discount for BariatricPal members. You can order yours for $10 each with free shipping! The book is her story along with the lessons she learned for overcoming obstacles. And for more ways to connect with Robanne…check out her bariatric motivation page on Facebook and give her hip-hop workouts a try!

Bigger from Birth…And Then College Hit Michele was always big. She was at the top of her height and weight charts from the time she was an infant. She remembers times in her childhood when she couldn’t or wouldn’t participate because she was so big. She didn’t like physical education or sports, and the other children teased her. Food was a comfort. Michele describes the situation as a vicious cycle. The more kids teased her, the worse she felt. The worse she felt, the more she ate. The more she ate, the more she weighed. The more she weighed, the more she got teased. College was a disaster in terms of her weight. Forget about the freshman 15. What about the freshman 40? And the sophomore 40? Add to that the junior 40, the senior 40, and, for good measure, the super-senior (fifth-year) 67, and you now know how Michele Elbertson got to be 427 pounds at the age of 22 years. A Young Weight Loss Surgery Patient with New Relationships Michele made the decision to get the lap-band on her own. She needed a tool to help her control how much she ate, but understood that it was up to her to control what she ate. She only told her parents about her decision after she was sure about it. They were supportive, and have been since then. Michele has taken full advantage of and responsibility for the band. She has lost 260 pounds – 260 pounds! – in less than four years. As she says, she’s a determined person who will accomplish anything she sets her mind to. Michele began to “eat to live” rather than “live to eat.” As her relationships with food and exercise changed, so did her relationships with some friends. She lost some friends whose relationships centered only on food. She gained many more, though, through her new activities. She says the friends she’s gained through running and fitness far outweigh those she lost by changing her lifestyle. An Athlete Is Born Michele ran her first 5k after losing 100 pounds – when she was still 327 pounds. She was hooked. She loved the training, the atmosphere of the race, and the accomplishment. She has never looked back. Since then, she has run countless other races, including 38 half-marathons, 6 marathons, and a 50-miler ultra-marathon. She has also competed in triathlons. Now at an athletic 159 pounds, Michele has her sights on even greater challenges. In the near future, she wants to run a 100-miler and complete an Ironman. Both are feats that most people wouldn’t even dream of. Marathons, Ultras, and Ironmans Now, not everyone’s a distance runner or triathlete, so to understand Michele’s accomplishments, here are a few facts about these endurance sports. A marathon is 26.2 miles. All marathons are 26.2 miles. An ultra-marathon is anything over 26.2 miles. Michele’s recently completed ultra-marathon was 50 miles, and she is training for a 100-miler. A triathlon includes swimming, biking, and running. An Ironman triathlon consists of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile marathon. Fitting It All in Every Day Michele works out 6 days a week. Currently, she’s training for an ulta-marathon and is running 5 days a week and lifting weights 3 times. She also does Zumba classes. She takes a rest day once a week. Michele has built her life to be able to accommodate her training schedule. She recently quit her teaching career to focus instead on helping others achieve their fitness and health goals. She is a personal trainer and group fitness instructor. Working at a gym is pure genius – it leaves her with no excuse not to get her workout in! Eating Like a Bariathlete How do you have energy to train like an athlete and work full-time while losing over 200 pounds in 4 years? Ask Michele. Here’s how she eats and works out in a typical day. 7:00 a.m. breakfast: almonds and yogurt or eggs/romaine lettuce 9:00 a.m. snack: protein bar Workout, such as running, lifting, or group fitness class, such as Zumba or bokwa Noon. lunch: soup or salad, usually the largest meal of the day 2:00 p.m. snack: cheese and crackers or something small, equivalent to 200 calories (may include a fruit or vegetable) 4:00 p.m. snack: hot tea 6:00 p.m. dinner; lean protein, veggie, possibly a carb 7:30 p.m. snack: lemon water/hot tea. The number of calories Michele eats during a day is 1,800 (her resting metabolic rate) plus half of the calories she burns through exercise. So, if she runs 10 miles and burns 1,200 calories in exercise, she’ll eat 1,800 plus 600 calories, or 2,400 calories. She allows herself an occasional treat meal with junk food, but still counts those calories. The Accolades Michele is more than your typical bariatric patient, and she’s been getting the recognition she deserves for her extraordinary achievements. These are a few recent examples. Runner’s World magazine Cover Contest Finalist. Makeover on the Rachel Ray Show. Local feature on 6ABC Action News in Philadelphia. Dealing with Negativity – Don’t Worry About It One of the most striking things about Michele is her drive. She has worked very, very hard to get where she’s at today. She’s lost 60 percent of her body weight through being very disciplined every day. And, she has run marathons. Anyone who has run a marathon can tell you that it is was harder than they had ever imagined. Anyone who hasn’t run a marathon cannot imagine how difficult it is. But with all the publicity, Michele has receive a lot of nasty comments. How is she supposed to react when people slam her? They say she hasn’t accomplished anything, that the band has done it all. In fact, they basically say what a lot of weight loss surgery patients hear all the time from people who don’t know any better. So how does Michele react to negativity? She doesn’t want to respond directly and add “fuel to the fire.” She knows they don’t know anything about her, and she’s probably done more exercise and worked harder than they ever have. So, she just goes about her business. Leading by Example Michele says she hopes her successes and story will give others hope. She describes herself as a “real person” and “very down-to-earth,” and she hopes others will see that they can accomplish what she has. In the future, she would like to travel to seminars as a motivational speaker. In the meantime, we congratulate her on her amazing story and wish her well in her 100-miler this spring!

Have you ever caught yourself watching TV at night and feeling lonely, bored or sad? Your partner may be sitting next to you or in their favorite chair, but you get up anyway; making the routine trip to the freezer to fix a bowl of ice cream, which will provide the comfort you are craving. It may not be ice cream; your comfort food may be a bag of Doritos, a pizza delivery, or a can of coke and leftovers from dinner. You aren’t really hungry, you may feel miserable, but the effort it would require to hug your partner, or become intimate with them isn’t as easy or comforting as food. People who struggle with weight often times struggle with intimacy as well. This struggle extends beyond their family, and affects their personal friendships as well. Eating for comfort may lead to more isolation. The more weight people gain, the less they want to mingle and the more they worry about what others will think or say. Have we become a society of people medicating with food in order to feel better? Have we stopped turning to loved ones for support and comfort in lieu of food? Yes and no. Although overeating has always been a problem, the stress of technology speeding up our lives and forcing us to bring home more work, or never leaving work at work, we are all working more and more, and feeling less and less connected with those we love most. We return home feeling exhausted and overwhelmed. Rewarding ourselves with food is a lot easier than becoming vulnerable and open to criticism from our partner or friends. There are other reasons more people are turning to food for emotional comfort rather than a relationship. You don’t have to leave your home to get comfort. Food delivery is available within blocks of our homes. Food is easy; you don’t need to invest any effort or time. You don’t have to get dressed to enjoy comfort food. You don’t have to look handsome, desirable or pretty for food. Food doesn’t judge you, leave you, or criticize you. Eating a delicious dinner is longer and more enjoyable for many people than sex (the average length of lovemaking is less than ten minutes). Food doesn’t cheat on you. Food is available anywhere, anytime, and for any reason. Food may be tied to memories of love and childhood which makes you feel loved. Food doesn’t require a partner. So is it a bad thing if we prefer gourmet truffle macaroni and cheese along with a filet mignon and a fresh garden salad with gobs of ranch dressing? Is it bad to add chocolate mousse if you’ve had an especially rough day and need an additional reward? It’s not a judgment call of right or wrong, but it can be adding to your unhappiness and health. Intimacy with another is important. When you are intimate with someone they want you to be healthy; choosing food for comfort rather than reaching out to them would be hurtful or a sign of rejection. There are other reasons you need to find comfort in one another rather than food. Below are a few. Intimacy shared with another gives you a deeper connection. Intimacy doesn’t leave you with guilt, feeling disgusted, or body hate. Intimacy helps you lose weight, not gain. Intimacy lowers your heart rate. Intimacy lowers your blood pressure. Intimacy won’t cause diabetes. Intimacy is good for your heart. Intimacy improves your thinking. Intimacy is exercise and exercise is good. Intimacy won’t leave you feeling isolated. Intimacy doesn’t take your mobility away. Intimacy doesn’t cost anything. Intimacy doesn’t make your hips, knees or ankles hurt. Intimacy makes your brain work better. Everyone understands the feeling of working and having a bag of chips or a package of cookies nearby only to realize at the end of their task the bag or package is completely gone. They were eating them mindlessly. Eating to calm anxiety is more and more common. The primary reason for relationships growing apart is due to couples choosing other vices to fill the void they feel. Becoming aware of your behavior and what you are eating, as well as writing down what you eat (we forget) is a good way to begin eating less and becoming more in touch with the emotions you are repressing with food. A simple practice of not eating past 7 or 8 pm can help you lose weight, and communicate more with your partner, family or friends. Breaking the habit of turning to food is not easy, but with practice it does work. Intimacy and sex are better for you than food! –Mary Jo Rapini