Alex Brecher

Mounjaro (semaglutide) is a medication that is approved for the treatment of type 2 diabetes, and it is currently being studied for its potential use as a weight loss medication. The medication is a glucagon-like peptide-1 (GLP-1) receptor agonist, which means that it mimics the effects of a hormone that helps to regulate blood sugar levels. It is not yet approved by FDA as a weight loss medication and its use in weight loss is still under research. The studies that have been done on semaglutide for weight loss have shown promising results, with people losing a significant amount of weight and reducing their risk of obesity-related health problems. However, it's important to note that everyone's experience with weight loss surgery and medications is different and it's important to work closely with your healthcare provider to determine the best treatment plan for you. It's also important to note that weight loss surgery is not a magic solution, it's a tool and it's important to follow the recommendations of your surgeon and dietitian, to maintain a healthy diet, adequate protein intake, and regular physical activity. It's also important to keep in mind that weight loss is not linear, sometimes we may experience Plateau, and even weight regain, it's important to work with your healthcare provider to evaluate the reasons and address them.

It's not uncommon for people to experience changes in their relationship with food and their emotional responses to eating after bariatric surgery. Some people may find that they no longer crave certain foods or that their emotional association with food changes. Reverse behavioral conditioning, as you've described it, is a phenomenon where the physical discomfort associated with eating too much or eating certain foods can change the way a person feels about those foods and their overall relationship with food. This can help to reduce cravings and change the way a person thinks about food, making it easier to maintain a healthy diet and weight in the long-term. It's also common for people to experience a change in the way they feel about their body and their self-esteem. The weight loss and the change in the way they look, can help them to feel more confident and comfortable in their own skin. It's important to note that this process is unique to everyone and some people may not experience a change in their emotional relationship with food. It's important to continue to work with a therapist or a dietitian to help you manage and understand your feelings about food and your relationship with it.

It's generally safe to eat raw fish, such as sashimi, 5.5 weeks after gastric sleeve surgery, as long as you are tolerating regular foods well and do not have any complications or sensitivities. However, it's always important to check with your surgeon or dietitian before consuming raw fish, as they may have specific recommendations for you. It's also important to note that while you may have been able to tolerate rare seared tuna over the weekend, it's important to listen to your body and stop eating if you experience any discomfort or difficulty swallowing. Also, it's important to keep in mind that it's recommended to eat small and frequent meals after bariatric surgery and avoid overeating, and raw fish like sashimi, tend to be low in calories, so it's important to not overdo it, also consume it with other nutrient-dense foods such as vegetables. Finally, it's also important to make sure that the fish you're consuming is properly handled, stored and cooked to avoid any foodborne illness.

Thanks for the update. We appreciate your feedback and will take it into account. Here's a photo from the side of our newest boxes. The BariatricPal logo isn't very noticeable.

It's not uncommon for weight loss to slow down or plateau after initial rapid weight loss. There could be a variety of reasons for this, including physiological changes in the body, changes in activity levels or physical activity, changes in diet, or even certain medications or medical conditions. It's important to remember that weight loss after surgery is a journey, and it's not uncommon to have ups and downs along the way. It's important to focus on making healthy lifestyle changes that are sustainable over the long term, rather than trying to achieve rapid weight loss. If you're concerned about your weight loss progress, it's a good idea to talk to your surgeon or another healthcare professional for guidance. They can help you identify any potential issues and work with you to develop a plan to help you reach your goals.

I understand that you are feeling frustrated and regretful about your decision to have surgery. It's normal to have ups and downs after any major procedure, and it can be especially difficult to adjust to the changes in your body and lifestyle that come with bariatric surgery. It's important to remember that everyone's journey is different, and what works for one person may not work for another. It's also worth keeping in mind that while surgery can be a helpful tool for some people, it's not a magic solution and it requires a lot of hard work and commitment to make lasting changes. It's important to communicate your concerns and feelings with your healthcare team, as they can offer support and guidance as you navigate your recovery. It can also be helpful to seek out support from other people who have had bariatric surgery, as they may be able to offer insight and encouragement. Finally, try to be patient with yourself and remember that it takes time to adjust to the changes that come with surgery. It's okay to have difficult days, but try to focus on the progress you have made and the improvements in your health that you have experienced as a result of the surgery.

Thanks for bringing to my attention. I had them update to B.P Store.

According to previous ASMBS guidelines from the ASMBS website, "Q: Do I need to avoid caffeine after bariatric surgery? A: Caffeine fluids have been shown to be as good as any others for keeping you hydrated. Still, it is a good idea to avoid caffeine for at least the first thirty days after surgery while your stomach is extra sensitive. After that point, you can ask your surgeon or dietitian about resuming caffeine. Remember that caffeine often comes paired with sugary, high-calorie drinks, so be sure you’re making wise beverage choices." The BariatricPal Store carries a large selection of bariatric friendly coffee options at https://store.bariatricpal.com/collections/coffee .

The BariatricPal Store carries a huge selection of Bariatric-friendly Protein drinks at https://store.bariatricpal.com/collections/protein-powders. Here are some popular options: BariatricPal Protein ONE: MultiVitamin, Calcium, Iron, Fiber & Meal Replacement from https://store.bariatricpal.com/collections/protein-powders/brand_bariatricpal Syntrax Nectar Protein Powder Sampler Variety Bag - All 17 Flavors! from https://store.bariatricpal.com/collections/protein-powders/products/syntrax-nectar-protein-powder-sampler-variety-bag-all-17-flavors GENEPRO Medical Grade Unflavored Protein Powder - 3rd Generation! from https://store.bariatricpal.com/collections/genepro/products/genepro-medical-grade-unflavored-protein-powder-3rd-generation Bariatric Advantage HPMR High Protein Meal Replacement - Available in 8 Flavors! from https://store.bariatricpal.com/collections/protein-powders/products/bariatric-advantage-high-protein-meal-replacement Protein tubs from https://store.bariatricpal.com/collections/protein-powder-tubs Protein Smoothies from https://store.bariatricpal.com/collections/smoothies Hot Protein Drinks & Soups are great alternatives to protein shakes: Hot Protein Drinks: https://store.bariatricpal.com/collections/hot-protein-drinks Hot Protein Soups: https://store.bariatricpal.com/collections/soups-bouillons-broths

I use BariatricPal Multivitamin ONE “1 per Day!” flavorless capsules from https://store.bariatricpal.com/collections/bariatricpal-multivitamin-one! BariatricPal has a special offer where it’ll cost you only $99 for an entire year's supply! Check it out at https://store.bariatricpal.com/99 With just ONE convenient & affordable BariatricPal Multivitamin ONE each day, you can get the bariatric vitamins and minerals you need to stay healthy! BariatricPal Multivitamin ONE was designed and developed by a team of the world’s leading Bariatric medical professionals. Please take a calcium supplement separately to prevent interference with the absorption of iron. You can view a large selection of bariatric-friendly Calcium supplements at https://store.bariatricpal.com/collections/calcium. You can also find MANY other brands of bariatric multivitamins at https://store.bariatricpal.com/collections/multivitamins. The BariatricPal Store carries a huge selection of Bariatric friendly Calcium at https://store.bariatricpal.com/collections/calcium. Check out the newly released BariatricPal Sugar-Free Calcium Citrate Soft Chews 500mg with Probiotics at https://store.bariatricpal.com/collections/calcium/brand_bariatricpal+vitamin-form_soft-chews . They come in 8 AMAZING flavors: French Vanilla Caramel, Chocolate Mint, Belgian Chocolate Caramel, Orange Creamsicle, Strawberry Watermelon Twist, and Wild Grape. You can get Calcium in many different forms: Soft Chews: https://store.bariatricpal.com/collections/calcium/vitamin-form_soft-chews Chewable: https://store.bariatricpal.com/collections/calcium/vitamin-form_chewable Powder: https://store.bariatricpal.com/collections/calcium/vitamin-form_powder Liquid: https://store.bariatricpal.com/collections/calcium/vitamin-form_liquid Tablets: https://store.bariatricpal.com/collections/calcium/vitamin-form_tablets Patches: https://store.bariatricpal.com/collections/calcium/vitamin-form_vitamin-patch

The BariatricPal Store carries a huge selection of Bariatric friendly Protein Snacks & Desserts at https://store.bariatricpal.com/collections/bariatric-high-protein-low-calorie-snacks-and-desserts Here are some other bariatric friendly ideas as well: Chips and Crunchy Snacks: https://store.bariatricpal.com/collections/protein-chips-and-crunchy-protein-snacks Chocolate Bars & Candies: https://store.bariatricpal.com/collections/bariatric-friendly-chocolate-bars-chocolate-candies Cakes, Cookies & Wafers: https://store.bariatricpal.com/collections/cookies-wafers Sugar-Free Candy: https://store.bariatricpal.com/collections/sugar-free-candy Cheese Snacks: https://store.bariatricpal.com/collections/cheese-snacks Meat & Jerky Snacks: https://store.bariatricpal.com/collections/meat-snacks Fish Snacks: https://store.bariatricpal.com/collections/fish-snacks Protein Bars: https://store.bariatricpal.com/collections/protein-bars Pretzels: https://store.bariatricpal.com/collections/pretzels Nuts: https://store.bariatricpal.com/collections/nut-snacks

Medical Groups Replace Outdated Consensus Statement that Overly Restricts Access to Modern-Day Weight-Loss Surgery NEWBERRY, FL – Oct. 21, 2022 – Two of the world’s leading authorities on bariatric and metabolic surgery have issued new evidence-based clinical guidelines that among a slew of recommendations expand patient eligibility for weight-loss surgery and endorse metabolic surgery for patients with type 2 diabetes beginning at a body mass index (BMI) of 30, a measure of body fat based on a person’s height and weight and one of several important screening criteria for surgery. The ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery – 2022, published online today in the journals, Surgery for Obesity and Related Diseases (SOARD) and Obesity Surgery, are meant to replace a consensus statement developed by National Institutes of Health (NIH) more than 30 years ago that set standards most insurers and doctors still rely upon to make decisions about who should get weight-loss surgery, what kind they should get, and when they should get it. The American Society for Metabolic and Bariatric Surgery (ASMBS) is the largest group of bariatric surgeons and integrated health professionals in the United States and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) represents 72 national associations and societies throughout the world. "The 1991 NIH Consensus Statement on Bariatric Surgery served a valuable purpose for a time, but after more than three decades and hundreds of high-quality studies, including randomized clinical trials, it no longer reflects best practices and lacks relevance to today’s modern-day procedures and population of patients," said Teresa LaMasters, MD, President, ASMBS. “It’s time for a change in thinking and in practice for the sake of patients. It is long overdue.” In the 1991 consensus statement, bariatric surgery was confined to patients with a BMI of at least 40 or a BMI of 35 or more and at least one obesity-related condition such as hypertension or heart disease. There were no references to metabolic surgery for diabetes or references to the emerging laparoscopic techniques and procedures that would become mainstay and make weight-loss surgery as safe or safer than common operations including gallbladder surgery, appendectomy, and knee replacement. The statement also recommended against surgery in children and adolescents even with BMIs over 40 because it had not been sufficiently studied. New Patient Selection Standards — Times Have Changed The ASMBS/IFSO Guidelines now recommend metabolic and bariatric surgery for individuals with a BMI of 35 or more “regardless of presence, absence, or severity of obesity-related conditions” and that it be considered for people with a BMI 30-34.9 and metabolic disease and in “appropriately selected children and adolescents.” But even without metabolic disease, the guidelines say weight-loss surgery should be considered starting at BMI 30 for people who do not achieve substantial or durable weight loss or obesity disease-related improvement using nonsurgical methods. It was also recommended that obesity definitions using standard BMI thresholds be adjusted by population and that Asian individuals consider weight-loss surgery beginning at BMI 27.5. Higher Levels of Safety and Effectiveness for Modern-Day Weight-Loss Surgery The new guidelines further state “metabolic and bariatric surgery is currently the most effective evidence-based treatment for obesity across all BMI classes” and that “studies with long-term follow up, published in the decades following the 1991 NIH Consensus Statement, have consistently demonstrated that metabolic and bariatric surgery produces superior weight loss outcomes compared with non-operative treatments.” It is also noted that multiple studies have shown significant improvement of metabolic disease and a decrease in overall mortality after surgery and that “older surgical operations have been replaced with safer and more effective operations.” Two laparoscopic procedures, sleeve gastrectomy and Roux-en-Y Gastric Bypass (RYGB), now account for about 90% of all operations performed worldwide. Roughly 1 to 2% of the world’s eligible patient population get weight-loss surgery in any given year. Experts say the overly restrictive consensus statement from 1991 has contributed to the limited use of such a proven safe and effective treatment. Globally, more than 650 million adults had obesity in 2016, which is about 13% of the world’s adult population. CDC reports over 42% of Americans have obesity, the highest rate ever in the U.S. “The ASMBS/IFSO Guidelines provide an important reset when it comes to the treatment of obesity,” said Scott Shikora, MD, President, IFSO. “Insurers, policy makers, healthcare providers, and patients should pay close attention and work to remove the barriers and outdated thinking that prevent access to one of the safest, effective and most studied operations in medicine.” The ASMBS/IFSO Guidelines are just the latest in a series of new recommendations from medical groups calling for expanded use of metabolic surgery. In 2016, 45 professional societies, including the American Diabetes Association (ADA), issued a joint statement that metabolic surgery should be considered for patients with type 2 diabetes and a BMI 30.0–34.9 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. This recommendation is also included in the ADA’s “Standards of Medical Care in Diabetes – 2022.” About IFSO The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) is a Federation composed of national associations of bariatric surgeons and Integrated Health professionals. Currently, there are 72 official member societies of IFSO, as well as individual members from countries that thus far have not formed a national association. IFSO is a scientific organization that brings together surgeons and integrated health professionals, such as nurse, practitioners, dieticians, nutritionists, psychologists, internists and anesthesiologists, involved in the treatment of patients with obesity. About ASMBS The ASMBS is the largest organization for bariatric surgeons in the United States. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.

Here is a screenshot of a conversation I had with Dr. Ramos Kelly from Tijuana moments ago.

Sounds like a bait and switch to me! I know Dr. Verboonen but have never heard of this other surgeon.

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The BariatricPal Store has just added over 400 bariatric-friendly brands to its store! Check them out at https://Store.BariatricPal.com or click on the STORE button at the top of this page. So many new brands.mp4

I use BariatricPal Multivitamin ONE “1 per Day!” flavorless capsules from https://store.bariatricpal.com/collections/bariatricpal-multivitamin-one! BariatricPal has a special offer where it’ll cost you only $99 for an entire year's supply! Check it out at https://store.bariatricpal.com/99 With just ONE convenient & affordable BariatricPal Multivitamin ONE each day, you can get the bariatric vitamins and minerals you need to stay healthy! BariatricPal Multivitamin ONE was designed and developed by a team of the world’s leading Bariatric medical professionals. Please take a calcium supplement separately to prevent interference with the absorption of iron. You can view a large selection of bariatric-friendly Calcium supplements at https://store.bariatricpal.com/collections/calcium. You can also find MANY other brands of bariatric multivitamins at https://store.bariatricpal.com/collections/multivitamins.

The BariatricPal Store carries a huge selection of Bariatric-friendly Protein drinks at https://store.bariatricpal.com/collections/protein-powders. Here are some popular options: BariatricPal Protein ONE: MultiVitamin, Calcium, Iron, Fiber & Meal Replacement from https://store.bariatricpal.com/collections/protein-powders/brand_bariatricpal Syntrax Nectar Protein Powder Sampler Variety Bag - All 17 Flavors! from https://store.bariatricpal.com/collections/protein-powders/products/syntrax-nectar-protein-powder-sampler-variety-bag-all-17-flavors GENEPRO Medical Grade Unflavored Protein Powder - 3rd Generation! from https://store.bariatricpal.com/collections/genepro/products/genepro-medical-grade-unflavored-protein-powder-3rd-generation Bariatric Advantage HPMR High Protein Meal Replacement - Available in 8 Flavors! from https://store.bariatricpal.com/collections/protein-powders/products/bariatric-advantage-high-protein-meal-replacement Protein tubs from https://store.bariatricpal.com/collections/protein-powder-tubs Protein Smoothies from https://store.bariatricpal.com/collections/smoothies Hot Protein Drinks & Soups are great alternatives to protein shakes: Hot Protein Drinks: https://store.bariatricpal.com/collections/hot-protein-drinks Hot Protein Soups: https://store.bariatricpal.com/collections/soups-bouillons-broths

The BariatricPal Store carries the Premium Abdominal Binder for Bariatric and Plastic Surgery by DeRoyal at https://store.bariatricpal.com/products/premium-abdominal-binder-for-bariatric-and-plastic-surgery-by-deroyal. I didn't use one after either of my weight loss surgeries. Still, patients tell me that it makes a HUGE difference.

I use BariatricPal Multivitamin ONE “1 per Day!” flavorless capsules from https://store.bariatricpal.com/collections/bariatricpal-multivitamin-one! BariatricPal has a special offer that will cost you only $99 for an entire year's supply! Check it out at https://store.bariatricpal.com/99 You can view a large selection of bariatric-friendly Calcium supplements at https://store.bariatricpal.com/collections/calcium.

I've had reactive hypoglycemia for the last 4-5 years. Definitely talk to an endocrinologist. I got a prescription for the Libre 2 wearable device that allows me to monitor my sugar levels in real-time. The Libre will notify you when your blood sugar is dropping or spiking. You'll learn which foods trigger low blood sugar soon enough. For me, it's sushi and alcohol or any high-carb food.

Your weight loss surgery decision is your own. So is your Weight Loss Surgery journey. Those facts, however, do not mean that others do not count. Having your loved ones on your side can pave the way for success, while their disapproval or outright sabotage can make your journey that much more difficult, from finding a ride to surgery to keeping trigger foods away from the home. Try to see their side. You are asking them to see it from your perspective, so it is only fair that you try to see it from theirs. What are the reasons they may be against your Weight Loss Surgery, and how can you address them? In many cases, their concerns are legitimately about your well-being, and things you should consider if you have not already. They may worry that: You will not hit your goal weight this time since they’ve seen disappointment before. You will suffer complications from surgery. You will regret having a permanent Sometimes, their concerns are selfish but still worth discussing. They may worry that: You’ll stop feeling attracted to them. You will pressure them to give up their own favorite foods while you eat healthily. They will feel left out. You will not want to spend time with them. Reassure them. Address their concerns directly. Explain why you feel the surgery is safe, and how much research you have done to learn about it as well as find a surgeon. Tell them why you think Weight Loss Surgery will work for you even if previous diets have not. Let them know that you need to do this for yourself, not for them and that this will not change the way you feel about them – you will still love your SO, and respect your parents, for example. Tell them how you see yourself spending time with them after surgery, so they can be comfortable. Write it down and practice. Starting the conversation can be the scariest part of telling them. Before you bring up the subject, write down what you plan to say. This is a good exercise for you to do anyway since it encourages you to think through all of the doubts around Weight Loss Surgery. Writing it down and practicing can make it easier for the words to come when you decide to bring it up. Include them in your plans. Often, your spouse and parents, and others who care about you, just want to help. They may be afraid if they do not how to help. When you talk to them, let them know how important they are to you, both in life in general and in this important period of your life. If you tell them specifically what they can do to support you, they may feel more at ease with your decision and more confident in their roles. You might ask them to: Pick up your children from school when you are recovering from surgery. Go with you to the store to pick out protein powders and measuring cups and spoons. Ask you each night how you are doing. Cook healthy meals with you. Prepare for anything. The conversation may be as difficult and unfulfilling as you feared. Or, your SO, parents or other loved ones may be surprisingly supportive once they realize that you have done your research and are serious about making the lifestyle changes needed for success. They may even be interested in getting healthy with you and ask for your help and support in exchange for theirs. Stay strong and independent. As much as you long for your SO and other loved ones to support you wholeheartedly, it may not happen. Try not to let it get you down, though. If you are sure about what you want, go for it, with or without them. They will come around sooner or later, and if not, you may be better off without their negative influence. Letting them know that you have made up your mind regardless of their support may actually convince them to help you since there is no point in standing in your way. Stay independent in the sense that you realize that you do not need them. Your success does not depend on their approval, and you are not doomed to fail if they stand in your way. Get the support you need from others as you move forward.

Fast food is a fact of life for so many of us, so is it really reasonable to expect it to disappear from the scene after bariatric surgery? Note: This isn’t an article on “How soon after surgery can I eat pepperoni pizza and wings?” This is an article on making the best choices you can given your situation. Consider Macros That is, “macronutrients,” or carbohydrates, fat, and protein. The news is bad on the surface since the average fast food meal has more carbs and less protein per calorie than the average home-cooked meal. You can work to turn this around, though. Carbohydrates: Cut back on carbohydrates by skipping the starchy sides: French fries, potato chips, and hash browns, steamed, fried, or Mexican rice, and breadsticks. Try to go “green” (lettuce wrap) or “naked” (no wrap) with your burger, tortilla, or sandwich; if the fast food joint cannot honor your request, just eat the filling with a knife and fork, and throw away the bread, bun, tortilla, or taco shell (if you are feeling guilty because of starving children in third-world countries, make a donation. You’ll do more good than you would by adding starch to your hips). Protein: How can you boost your protein intake at a fast food restaurant to be what you need? Skinless grilled or baked chicken, lean cold cuts, cheese, and beans can all up your totals, and yogurt is an increasingly common side option. Even a small burger patty can give you 10 to 15 grams of protein, although it comes with a few extra grams of fat. A good protein goal for a meal is about 20-30 grams. You can get that for 200-300 calories with any of the following. Burger King Double Cheeseburger, no bun; Grilled Chicken Garden Salad, no croutons; or Veggie Burger with cheese, no bun or mayo. McDonald’s Grilled Southwestern Chicken Salad, no cheese; or Grilled Chicken Sandwich, no bun or spread. Taco Bell 2 grilled or fresco steak soft tacos, no tortillas; chicken or steak Power Menu Bowl, no rice or cheese. KFC Grilled Chicken Drumstick plus green beans or side salad. Panda Express Grilled Teriyaki or Asian Chicken. Fats: Your first order of business is to avoid anything fried. You will be avoiding excess grease while also avoiding sneaky carbs in breading – did you know that the amounts of carbs in onion rings and fried chicken are comparable to the amounts in bread? Also, watch the fatty spreads – think mayonnaise – salad dressings, and dips. Find the Vegetables Protein and vegetables…does this sound familiar? It should, since your goals when eating at a fast food restaurant should be the same as when you eat at home. Vegetables help fill you up without filling you out, and it is best to eat as many of them as you can handle with your pouch or sleeve. It may take a little more digging to find vegetables at fast food restaurants than at home, but you can usually do it. Here are a few leads. Ask for extra lettuce, tomatoes, and any other available vegetables on burgers and sandwiches. Order a side salad or baby carrots with your meal. Check for salads with grilled chicken as an entrée. Pile salsa and diced vegetables onto your naked burrito. When “Value” Isn’t Besides the convenience, the deals are among the most tempting things about fast food. For pennies more, you can often add fries and a drink, or you could get a second burger or taco for half the price. Don’t do it! “Value” depends on what you want and need; why would you pay extra, even if it is “only pennies more,” for extra fat, sugar, starch, and calories? A healthier definition of “value” might be to pay the least you can for a meal that is convenient, delicious, and healthy. Why include “oversized” in your definition? For those times when fast food simply makes sense, go for it – just keep yourself on track by reading the menu carefully and staying focused. You can do it, no matter where you end up. You might as well enjoy it!

Collagen protein is great for you but is not counted towards the daily amount of protein you're required. Clean Whey by BariatricPal is a whey protein isolate, which is optimal for bariatric patients https://store.bariatricpal.com/collections/bariatricpal-clean-whey-protein . Protein ONE by BariatricPal has vitamins in them https://store.bariatricpal.com/collections/bariatricpal-protein-one-multivitamin-calcium-iron-fiber-meal-replacement .

I'm familiar with all available flavors and brands and there aren't any pure vanilla calcium citrate chews available on the market at the moment. As you said, there's French Vanilla Caramel but these taste very Caramel and not so much Vanilla.