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Food will not rule your life Once obesity sets in, life is about food, first and foremost. But after bariatric surgery, you’ll see that food isn’t really your ‘best friend’ anymore; it just keeps you alive, nothing more. Get ready to say goodbye to the constant worry about your next snack, next meal or which drive-through you’re going to visit. Going forward, you will learn that food gives your mind and body fuel to perform at its highest level possible. Food is not a crutch or a protector from the challenges of daily life. You’re going to feel so much better Preparation is the number one key to weight loss success. Before surgery, you’ll work with our Bariatric Navigator to start the process of changing what you eat. Go ahead and dump the junk food, the sugar products and empty carbs now. Your body doesn’t need artificially processed foods (nor does your family). After about a week or two of excluding these foods from your diet, you’re going to feel the difference. Read articles, blogs, magazines and books about healthy living. Prepare your body and your mind to make changes toward living a healthier lifestyle. By utilizing all of the resources from our comprehensive bariatric weight loss program, you will have many levels of support and education available to you. You are not alone in this journey Through your surgeon or hospital's bariatric program, you are going to meet people at all stages of the bariatric process. You will garner the tools to live a healthier life and learn how to meet and overcome obstacles. There is strength in numbers so seek out both live and online support groups. Sign up for a few and build relationships with people. You will be as big a help to them as they will be for yo u! Only you can change your mindset about food, exercise and weight The struggle against obesity is not just physical. It’s also mental and emotional. Having the courage and dedication to have weight loss surgery is a strong statement about your regard for your value and self-worth. The battle against obesity is complicated; if you feel you need psychological counseling services, we’ll be happy to provide you with recommendations based upon our patients’ feedback. You will be amazed that you actually like to exercise Once you are eating solid foods again, you can incorporate exercise into your routine, in most cases. Many patients enthusiastically report that weight loss surgery gave them a new chance to reap the benefits from working out. After weight loss surgery, you call the shots about what happens next. How will you reclaim your body, redeem your health, and start a journey toward a healthier quality of life? Discover or re-discover activities that you enjoy—start with walking around the neighborhood; jog/walk on a treadmill while you watch your favorite TV show or play ball with your kids (they will be elated, I assure you). Have you always wanted to hike? Take a water aerobics class? Try Yoga or Zumba? Embrace the new life you are creating for yourself. Dive in, try everything! The battle against the disease of obesity is often in the mind. When you see the physical changes happening, your mental outlook will improve as well. Seize that momentum and go after your goals with everything you’ve got. It’s well worth the effort.

Choose the right surgeon. If weight loss surgery is the tool, your bariatric surgeon is the one who makes the tool and gives it to you. You want a tool that is made precisely, ready to do the job, and built to last. Your surgeon needs to make the right cuts and place the band properly or make a tight, solid sleeve or pouch. So, look for a surgeon who is experienced and has a good track record of successful patients and low complication rates – don’t be afraid to ask! There’s more to choosing a surgeon than technical skills. Also, consider what else the surgeon will do for you. The right surgeon for you is willing to discuss your options and the procedure with you in a way that you can understand. You’re setting yourself up for extra challenges if you’re afraid to talk to your surgeon or your surgeon is unavailable. Get the scoop on the diet. Your diet is central to every part of the weight loss surgery journey. You may be told to lose some weight before surgery as a test to make sure you’ll follow the rules post-op. Then there’s the pre-op liquid diet to shrink your liver for a safer surgery. Next, for faster healing and fewer side effects, you need to follow the post-op progression from liquids to pureed foods to solid foods. Finally, there’s the nutrient-dense, low-calorie diet to help you hit goal weight and stay there. At best, you will have a surgeon or a nutritionist who gives you plenty of information. Since that’s not always the case, you may need to take steps to figure out the diet for yourself. You can look online, and may need to shell out the money for a few appointments with a nutritionist. Not knowing the right foods to eat can set you up for surgery complications and disappointing weight loss. Take responsibility. It’s nice to depend on a stellar surgeon and complete healthcare team to walk you through surgery and beyond step by step. Ideally, your trusted surgeon would explain your options to you and recommend the best surgery for you, whether it’s the sleeve, band, bypass, or another choice. You’d go back for follow-up appointments and ongoing nutritional and psychological counseling. That doesn’t always happen in the real world, but that’s no excuse to give up. You can take responsibility for finding out the information you need to know about what to expect, how to prepare, and what comes next. Be persistent and do your research in all kinds of places, and you’re more likely to succeed. Face the facts. Weight loss surgery isn’t all fun and games. You don’t leave the operating room skinny. Weight loss isn’t steady. It may take you longer to get to goal weight than you hoped. Recognize the real possibilities to avoid being disappointed and possibly even giving up. These are some other possibilities to consider, so you can be prepared if they happen to you. You may still love sugar, salt, fat, and/or starch. You may still be hungry. Others may not notice your weight loss, or may not be impressed. Others may be jealous of your weight loss or say you didn’t earn it. You may have loose skin when you are finished losing weight. Weight loss surgery doesn’t solve psychological problems. Be Open-Minded If you want to lose weight and get healthy, you’ve got to change your diet. Whatever eating habits got you to this point are not going to get you to goal weight! That may mean you need to be open-minded. Maybe you hated vegetables, or can’t stand the thought of downing protein shakes for 2 weeks on the pre-op liquid diet and up to 4 weeks on the post-op liquid and mushies diets. It’s time to re-evaluate. Can you sneak some veggies into your diet? Can you retrain your brain to love them? Can you force down those protein shakes for a few weeks in exchange for a lifetime’s worth of better health? Learn to see the good. There will be disappointments - guaranteed. The scale may not cooperate, or you may make a poor eating choice, or you might skip your morning workout because you didn’t make sleep a priority the night before. Focus on the negative, and you just may talk yourself out of continuing the hard work and good progress. Instead, learn to appreciate yourself and see the positive sides of things. Maybe you didn’t lose weight this week, but did you eat right? Maybe you downed a piece of pepperoni pizza without thinking about it, but did you pass up the breadsticks and soda that you would have had before surgery? Maybe you didn’t work out this morning, but did you make it to the gym more this month than you did last month? See yourself as a strong, powerful person, and you will act like one. You can build on the positive behaviors you see in yourself so they eventually overshadow the mistakes. You have control over your own destiny. Success with weight loss surgery depends on planning and hard work. The more you are involved and the more responsibility you take throughout the process, the better you can do.

In the first part of the series, we looked at a recent study comparing results of weight loss with NBC’s “Biggest Loser” to weight loss with weight loss surgery. At least in the short term, weight loss was similar, with Biggest Loser contestants coming out ahead at 7 months with the gap narrowing by 12 months. Some articles and research are available, but wouldn’t it be nice if there were a way to compare Biggest Loser and bariatric surgery side by side? Here’s our summary of how the groups lost weight and what the results were. Methods In case you’re not aware, the “Biggest Loser” is a reality television show that is a weight loss competition. Morbidly obese contestant compete on the Biggest Loser ranch to lose the most weight. Every 7 to 10 days for 13 weeks, a contestant is voted off and eliminated from the competition. From week 13 to 30, the remaining contestants go home and return for the finale, where the contestant who has lost the most weight is crowned the Biggest Loser winner. They lose weight with intense exercise and a restricted diet. This study compared roux-en-Y gastric bypass (RYGB) patients. They lose weight because their smaller stomach forces them to eat smaller meals. In addition, they need to limit sweets and fatty foods to avoid gastrointestinal symptoms. Diet Biggest Loser contestants ate similar amounts of to RYGB patients. In the Biggest Loser, contestants ate at least 70 percent of their baseline needs, calculated by a formula based on their fat-free mass. A contestant who weighs 220 pounds and has 50 percent body fat would be asked to eat at least 1,000 calories per day. The diet includes lean protein, fruits, and vegetables, and restricts processed foods. In comparison, RYGB patients often eat a similar number of calories. They too focus on protein, followed by vegetables and fruits. Also, they limit sugary and fatty processed foods. Exercise Here’s the big difference. Four hours of exercise a day, anyone? Biggest Loser contestants exercise 90 minutes per day six days a week with the trainers, plus up to 3 hours daily on their own. That adds up to up to 31.5 hours a week – basically a job! Weight loss surgery patients are asked to exercise, but to work up to it. They may have goals such as working up to 20 or 30 minutes daily, and getting up to 60 to 90 minutes most days over the long run. The Logistics: Support and Cost Biggest Loser contestants have a lot of support. On the show, they see a trainer six days a week. They have a doctor – Dr. Huizenga – to monitor their health and progress. In contrast, most RYGB are on their own – they don’t have the luxury of a trainer each day. They tend to follow-up with their surgeon once or a few times over the months following surgery. They may have support groups to help. Bariatric surgery is expensive, no question. The procedure, plus pre-op workups and post-op appointments, can be thousands or tens of thousands of dollars. Biggest Loser? Diet and exercise sound inexpensive, but can you afford to exercise for 31.5 hours a week? Can you afford to see a doctor whenever you want? What about the cost of benefits provided to contestants, such as having room and board at a weight loss resort for several weeks? The list price for a guest at a Biggest Loser Resort is about $2,500 weekly. For 13 weeks, as on the Biggest Loser, that’s a cost of $32,500. Makes RYGB seem cheap! Weight Loss What about the important thing – weight loss? Turns out the results are pretty similar…at least in the beginning. After 7 months, the Biggest Loser group lost an average of 108 pounds, while RYGB patients were at an average of 78 pounds down. By 12 months, RYGB patients were down by 89 lb. on average. And Biggest Loser patients? They were no longer being followed – who knows what happened after their season of the show ended? It stays a little cloudy later on, too. Biggest Loser hasn’t published statistics on the long-term success of its contestants. In contrast, RYGB has been shown to be successful in studies that have tracked patients for 5 or even 10 years. Health Effects Both groups had improvements in some measurements of health. Blood pressure, blood sugar, chronic inflammation, and “good” HDL cholesterol improved. Strangely enough, Biggest Loser contestants had an average increase of total cholesterol from 168 to 192, and of “bad” LDL cholesterol from 105 to 126. Also curious was the decrease in metabolic rate – or the number of calories burned at rest. Biggest Loser contestants’ metabolisms dropped more the RYGB patients’, even though Biggest Loser contestants maintained more of their lean tissue while dropping more fat. Okay, so what’s the take-home message? One might be that the way that is best for you to lose weight depends on your individual situation. If you have the time and money to train Biggest Loser-style, maybe you would prefer that to going under the knife. If you need a permanent tool for long-term assistance with losing weight, and maybe even if your health insurance will chip in, weight loss surgery may be for you. What do you think?