Alex Brecher

Why Does It Matter?
There is an expression that goes, “Shoot for the stars and you’ll hit the moon.” The idea is that if you set your sights high but fall short, you will still achieve something great. The theory may sound good, but it may neglect to consider reality.
The truth is that for many of us, another saying is truer: “Success breeds success.” That is, when you hit one goal, you are motivated to keep working towards your next one. You build momentum as you hit goal after goal, and those goals then act like stepping stones to those proverbial stars.
The Trap of “Too Much, Too Fast”
There is a common tendency overshoot when it comes to weight loss goals. These are some reasons why.
We want to lose weight so badly that we think only of the dream goal.
Most of us tend to think of ourselves as above average – so we set our weight loss goals at higher than average.
We set deadlines that are too short because we are so focused on getting there that we forget to recognize how wonderful the journey is.
We set our goals based on what someone else lost.
Classic Failure: “All or Nothing”
One of the surest ways to set yourself up for failure is to set your weight loss goal to be too many pounds within too little time. It is comparable to the “all-or-nothing” mentality that so often comes with dieting: you are doing fine until you eat a cookie, and then you figure that the day is wasted, so you might as well finish the bag of cookies, skip your workout, and order pizza and breadsticks for dinner.
The same mentality after weight loss surgery can get you into the same trouble. If you aim for an unrealistic 20 or 30 lb. in your first month and instead hit a respectable 5 to 10 lb., the “disappointment” can discourage you so you do not try as hard.
Realistic Weight Loss
The amount of weight you can realistically expect to lose depends on your procedure, how much you have to lose, and your own drive and other individual characteristics. An average gastric bypass or sleeve patient might lose about 50% of excess weight. For example, Someone who is 5’4” tall and weighs 245 lb. has about 100 lb. of “excess” body weight and might set a goal to lose about 50 lb.
Another way to look at it is to take a rough estimate of average weight loss with your procedure for your surgeon’s patients. You might use that number as the basis for your own weight loss goal. You could also look at your final goal – say, 100 lb. down – and divide that by 1 to 2 years – in this case, a seemingly modest 1 to 2 lb. per week.
Setting Realistic Goals
For weight loss or any other goal, you can follow certain guidelines for realistic goal-setting. Set your goal to:
Include a realistic amount of weight loss.
Leave yourself enough time to achieve that amount.
Include interim goals that you can celebrate and use as motivation.
Provide for rewards as you progress, so you stay motivated.
Allow enough time for plateaus and setbacks. They will come.
Keep It in Perspective
Strange but true…weight loss is only one of many reasons to get weight loss surgery and follow a healthier lifestyle. What about…?
Gaining energy?
Getting healthier?
Feeling more confident?
Participating in more of life?
Along with setting weight loss goals, you can set other goals for healthy eating, working out, and trying new things. You will always have something to chase after and you will be able to see more progress every day.

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!

Who cares what obesity is?
You might wonder whether it matters whether obesity is a “disease” or not, especially if doctors have not managed to help you lose weight, except, possibly, your bariatric surgeon. But, the name actually does make a difference.
It gives obesity and obesity treatment more attention. It can help remove the stigma surrounding obesity. It gives doctors a mandate to treat you. It could lead to increased medical insurance coverage for obesity treatment, from diet programs to bariatric surgery. Here is why obesity is a “disease.”
Obesity meets a definition of disease comprising three criteria:
"an impairment of the normal functioning of some aspect of the body;" (changes in organ function, for example) "characteristic signs and symptoms" (excess body weight, for example) "harm or morbidity” (obesity-related complications, such as diabetes and arthritis, for example) The American Medical Association, the American Heart Association, the American College of Cardiology, and The Obesity Society are among the respected organizations who agree that obesity is a disease.
Obesity is not only a disease but an epidemic based on the number of people it affects. It affects 35% of American adults, not including the other 30% who are overweight and at risk for obesity. Nearly one out of five children are obese.
Healthcare providers can take charge.
One point of calling obesity a disease is to allow and even require, healthcare providers to treat it. No longer should they simply tell you to lose weight, or, worse, ignore the “condition” in the first place. Instead, they should provide care for obesity, including developing treatment plans and following up with you to discuss progress.
Now there is a roadmap.
Now that obesity treatment is in the realm of medical professionals, there needs to be a standard approach to treating it. The American Heart Association, along with the American College of Cardiology and The Obesity Society, have published clear guidelines for treating obesity.
Identify at-risk patients and patients with obesity using BMI, and monitor them at each appointment. Enroll patients with BMI of 30 or over in a medically-supervised weight loss program (note: this is not the same as your doctor telling you to eat less and lose weight on your own!) Keep weight loss surgery in mind for patients with extreme obesity and an obesity-related condition). Weight loss surgery is a recognized treatment for obesity.
The third prong of the roadmap is especially important if you are considering weight loss surgery. The recommendation to consider it when treating high-risk patients has a few effects.
It reduces stigma, from primary care physicians and your other regular doctors, surrounding WLS. It increases the number of patients who may have WLS covered by insurance. It encourages patients and professionals alike to learn about WLS. No longer is weight loss surgery considered to be an extreme or fringe approach. The ASMBS states that experts who agree that bariatric surgery has a role in obesity treatment also include the American Association of Clinical Endocrinologists, the American Diabetes Association, Centers for Medicare & Medicaid Services (CMS), and the National Institutes of Health (NIH).
Further progress is needed.
There is still much to be done in the medical arena. Healthcare professionals aside from bariatric specialists are often still in the dark about recognizing obesity and treating it. Worse, many still have stigma or bias against overweight patients, and still, engage in patient-blaming.
Obesity almost certainly has genetic components along with lifestyle factors. While it may be a disease, it is also a disease that you can work to treat. Now that it has officially been recognized as a disease, let us hope that patients and healthcare professionals can work hand-in-hand, each doing their part to fight obesity.

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!

Take note of the research.
Studies have already shown the potential for people to give in to obesity due to its classification as a disease. In one study, overweight individuals who read a story about obesity being genetic ate more cookies than a group of individuals who read a different story. In another study, overweight individuals who read an article explaining that obesity is a disease ordered and ate more calories from a menu at lunch than a control group.
Distinguish “disease” from “doom.”
A drawback of labeling obesity as a disease is the tendency to feel doomed or to feel like a victim. That could lead you to stop trying to be healthy, but that mindset is ridiculous. That would be like giving up using sunscreen simply because skin cancer is technically a “disease,” or skipping the measles vaccine because measles is a “disease.”
Genes and the environment interact to affect your health.
You do not need to succumb to obesity simply because it is a “disease.” A disease means that something it wrong; it does not mean that you cannot do anything about it. Even if you suspect that you do have obesity gene or two, your own choices still affect your weight.
Consider identical twins with a genetic predisposition to obesity. If one twin eats 3,000 calories a day from pizza, ice cream, and beer, she will end up weighing more and being less healthy than the other twin, if she eats 1,500 calories a day from vegetables, whole grains, and lean proteins.
Rather than feeling sorry for yourself because of your genes, make the most of what you have. Any effort you put in will yield benefits.
Pull your weight (so to speak) in the doctor’s office.
Doctors may have general guidelines for treating obesity patients, but that does not make them experts. You have the right to the best possible treatment, which means you have the responsibility of helping your doctor along as needed. Let her know if the plan she suggests is not going to work for you, and tell her what you really need. She should be grateful to hear from you, since the concept and practice of treating obesity rather than ignoring may be new to her.
In addition, demand the compassionate and respectful care you deserve. If your doctor or anyone in the office is rude to you or treats you without respect, speak up. You might consider being polite the first time; they may not even know they are demeaning.
Obesity is a disease, but it is one you can influence with your healthy behaviors and your decision about weight loss surgery. Let yourself feel better knowing that it is a disease, but do not let that be an excuse to play the victim. You can fight obesity successfully!

Take note of the research.
Studies have already shown the potential for people to give in to obesity due to its classification as a disease. In one study, overweight individuals who read a story about obesity being genetic ate more cookies than a group of individuals who read a different story. In another study, overweight individuals who read an article explaining that obesity is a disease ordered and ate more calories from a menu at lunch than a control group.
Distinguish “disease” from “doom.”
A drawback of labeling obesity as a disease is the tendency to feel doomed or to feel like a victim. That could lead you to stop trying to be healthy, but that mindset is ridiculous. That would be like giving up using sunscreen simply because skin cancer is technically a “disease,” or skipping the measles vaccine because measles is a “disease.”
Genes and the environment interact to affect your health.
You do not need to succumb to obesity simply because it is a “disease.” A disease means that something it wrong; it does not mean that you cannot do anything about it. Even if you suspect that you do have obesity gene or two, your own choices still affect your weight.
Consider identical twins with a genetic predisposition to obesity. If one twin eats 3,000 calories a day from pizza, ice cream, and beer, she will end up weighing more and being less healthy than the other twin, if she eats 1,500 calories a day from vegetables, whole grains, and lean proteins.
Rather than feeling sorry for yourself because of your genes, make the most of what you have. Any effort you put in will yield benefits.
Pull your weight (so to speak) in the doctor’s office.
Doctors may have general guidelines for treating obesity patients, but that does not make them experts. You have the right to the best possible treatment, which means you have the responsibility of helping your doctor along as needed. Let her know if the plan she suggests is not going to work for you, and tell her what you really need. She should be grateful to hear from you, since the concept and practice of treating obesity rather than ignoring may be new to her.
In addition, demand the compassionate and respectful care you deserve. If your doctor or anyone in the office is rude to you or treats you without respect, speak up. You might consider being polite the first time; they may not even know they are demeaning.
Obesity is a disease, but it is one you can influence with your healthy behaviors and your decision about weight loss surgery. Let yourself feel better knowing that it is a disease, but do not let that be an excuse to play the victim. You can fight obesity successfully!

Cooking methods. If you tolerated a saucy chicken pot-pie, it doesn’t mean roast chicken will go down just as comfortably. Dryer methods of cooking (like broiling, roasting, grilling, and pan-frying) tend to be more difficult to tolerate. Moist cooking methods on the other hand (like steaming, braising, stewing, simmering, poaching) that involve liquids or a sauce are typically better tolerated. Also, be careful when microwaving, as the process of reheating foods can dry them out. A good way to keep the moisture in is by resting the lid on the container (not sealed) and stir after each minute until ready. If you’re reheating dry foods remember to sprinkle in some water, broth, tomato juice, milk, or low-fat gravy to add additional moisture. Mechanical reasons like not chewing well enough and taking large bites. You should always be sure to cut your food into small pieces—as small as your pinky fingernail to start—and chew your food until it’s puree in your mouth before swallowing. Remember that digestion starts in the mouth! Emotional stress and anxiety can tighten the upper digestive system which makes food more difficult to tolerate. Do you find you eat more comfortably at home or on the weekends compared to at work? If so, your tolerance issues could be related to stress or anxiety. Always be sure to eat in a calm environment and start your meals by taking a few deep breaths to relax and decompress. Some patients feel more comfortable eating alone at first (i.e. in their office instead of in the cafeteria). Eating while multitasking! When you are eating, you should only be eating. We know that this is a tough one to practice, but eating while driving, watching TV, cleaning, working through lunch, etc. can distract you from taking small bites and chewing well. Do your best to put away distractions during meal times. If you choose to eat lunch in your office, mute the volume on your computer and turn off the monitor so you’re not tempted to check your email in between bites. Posture. It sounds silly to discuss, but it’s true, poor posture can negatively affect digestion. If you are eating while slouched or reclined on the couch or awkwardly propped up on pillows in bed, chances are that you will experience some tolerance issues. When you are eating, you should ideally be sitting in a chair pulled close to the table with your bum as far back as possible and with your back nice and straight. Eating at the table in your kitchen or dining room will also give your meals and snacks more structure. Generally speaking, it’s a good habit to limit food and eating to only the kitchen and dining room. Excerpt from "The Complete Guide to Weight Loss Surgery: Your questions finally answered".
Available on Amazon.com, Amazon.ca, or our website (PDF download).

Who cares what obesity is?
You might wonder whether it matters whether obesity is a “disease” or not, especially if doctors have not managed to help you lose weight, except, possibly, your bariatric surgeon. But, the name actually does make a difference.
It gives obesity and obesity treatment more attention. It can help remove the stigma surrounding obesity. It gives doctors a mandate to treat you. It could lead to increased medical insurance coverage for obesity treatment, from diet programs to bariatric surgery. Here is why obesity is a “disease.”
Obesity meets a definition of disease comprising three criteria:
"an impairment of the normal functioning of some aspect of the body;" (changes in organ function, for example) "characteristic signs and symptoms" (excess body weight, for example) "harm or morbidity” (obesity-related complications, such as diabetes and arthritis, for example) The American Medical Association, the American Heart Association, the American College of Cardiology, and The Obesity Society are among the respected organizations who agree that obesity is a disease.
Obesity is not only a disease but an epidemic based on the number of people it affects. It affects 35% of American adults, not including the other 30% who are overweight and at risk for obesity. Nearly one out of five children are obese.
Healthcare providers can take charge.
One point of calling obesity a disease is to allow and even require, healthcare providers to treat it. No longer should they simply tell you to lose weight, or, worse, ignore the “condition” in the first place. Instead, they should provide care for obesity, including developing treatment plans and following up with you to discuss progress.
Now there is a roadmap.
Now that obesity treatment is in the realm of medical professionals, there needs to be a standard approach to treating it. The American Heart Association, along with the American College of Cardiology and The Obesity Society, have published clear guidelines for treating obesity.
Identify at-risk patients and patients with obesity using BMI, and monitor them at each appointment. Enroll patients with BMI of 30 or over in a medically-supervised weight loss program (note: this is not the same as your doctor telling you to eat less and lose weight on your own!) Keep weight loss surgery in mind for patients with extreme obesity and an obesity-related condition). Weight loss surgery is a recognized treatment for obesity.
The third prong of the roadmap is especially important if you are considering weight loss surgery. The recommendation to consider it when treating high-risk patients has a few effects.
It reduces stigma, from primary care physicians and your other regular doctors, surrounding WLS. It increases the number of patients who may have WLS covered by insurance. It encourages patients and professionals alike to learn about WLS. No longer is weight loss surgery considered to be an extreme or fringe approach. The ASMBS states that experts who agree that bariatric surgery has a role in obesity treatment also include the American Association of Clinical Endocrinologists, the American Diabetes Association, Centers for Medicare & Medicaid Services (CMS), and the National Institutes of Health (NIH).
Further progress is needed.
There is still much to be done in the medical arena. Healthcare professionals aside from bariatric specialists are often still in the dark about recognizing obesity and treating it. Worse, many still have stigma or bias against overweight patients, and still, engage in patient-blaming.
Obesity almost certainly has genetic components along with lifestyle factors. While it may be a disease, it is also a disease that you can work to treat. Now that it has officially been recognized as a disease, let us hope that patients and healthcare professionals can work hand-in-hand, each doing their part to fight obesity.

Love at First Sight
I was enthusiastic about the promise of the lap-band from the moment I first heard about you. Could you be the tool that could end my struggles with weight? Could it be possible that there could be an end to my unhealthy relationship with food? Could I say goodbye to the liquid diets, the low-carb diets, the fat-free diets, and all the other fad diets I had tried?
You had worked for my friend; could you work magic for me, too? I dared to hope. I got surgery in July of 2003.
Honeymoon and Beyond
Surgery went as expected, and you lived up to your promise. I lost weight – nearly 100 lbs. – and hit a healthy BMI. I felt better than I ever had. Sure, you made me work hard for every pound, but each victory was so sweet that there was no question that I would not follow your guidance.
In so many ways, the honeymoon period did not seem to end. Life has gotten better and better as I have gained confidence that I can maintain goal weight and prevent regain. Not once did I look back with regret.
A Helping Hand for a New Lease on Life
With the lap-band, I was able to gain control of myself and my life. I enjoy life’s events for themselves, and not for the food that comes with or after them. I am able to keep up with my children, who are my greatest joys. I have energy and confidence.
You have made my relationship with food better, and that is liberating. I eat when I am hungry and stop when I am full. I give in to my cravings and become satisfied with only a reasonable amount of the food I craved. There have been bumps along the way, but you have been my dependable gauge and silent cheerleader throughout.
My Life and My Livelihood
Along with my health, you also gave me my career. Out of necessity, I started LapBandTalk.com as soon as I came home from the hospital after surgery because I needed the help of other patients. Not in my wildest dreams did I think that impromptu discussion forum would become my career.
To LapBandTalk, I added other boards for the other weight loss surgery types, and they eventually became BariatricPal to recognize that we are all in this together. I am now honored and grateful to be able to call my life’s work my true passion – helping people through weight loss surgery. Nearly 15 years after I started a discussion board to help myself, BariatricPal now includes the forums, the store with protein products and bariatric vitamins, and even a full-service program for weight loss surgery in Mexico – at BariatricPal’s own hospital. I have gotten to meet and work with all kinds of wonderful patients, surgeons, and others in the weight loss surgery community.
Time to Part Ways
It is on a bittersweet note that I bid you, my lap-band, farewell. I have no real choice; multiple medical professionals agree that the safest decision is for us to part ways. I have been struggling with acid reflux (GERD) for a few years, and symptoms are getting worse, especially after my Lap-Band slipped. I also have been diagnosed with pre-Barrett’s esophagus and severe erosive gastritis, most likely caused by my lap-band. I will get my lap-band removed and opt for gastric bypass to help me maintain my goal weight.
The lap-band may not last forever, as it was meant to. I know the I will succeed with the Gastric Bypass because I already have the skills I need to eat right. Of course, I am a little worried. How could I not be, after having been so successful with you as my partner for 15 years?
But as is necessary with anything in life, I will do my best. I will take what I have gained from you, my lap-band, and carry it forward. Thank you, and farewell.

If you are on the fence about it, take your time coming to a decision. Even if you are theoretically eligible for it, you might have a funny feeling about it still. Here are five signs that might be saying that you are not yet ready for WLS.
1. You want to know how soon you can have …
Whatever “…” may be, if you are counting down the days until you can have it after your surgery, you might be missing the point. This is a lifetime commitment. It is not a 30-day period of abstinence from alcohol or from pizza. If your mindset is that this is a short-term race to goal weight, bariatric surgery might land you where other diets have: at goal weight and then back to starting weight, plus a few pounds.
2. You’re looking for any excuse to be found ineligible.
You may technically qualify for weight loss surgery based on your BMI and any obesity-related health conditions you may have, but are you ready? You might not be if you are grasping at straws to come with reasons you that you “should not” have surgery. For example, you practically ask a doctor to disqualify you because your great-grandfather (who was a smoker) died of a heart attack at age 92 and therefore you worry your heart is not strong enough to withstand surgery.
(Note: it is absolutely the right thing to do to explore all of your health history to be sure that the surgery is a relatively safe option for you. Just distinguish between real and imaginary reasons).
3. You are seeking fourth, fifth, and sixth-second opinions.
Let’s say your primary care doctor recommends that you have the surgery, and you found a surgeon who gave you the go-ahead. It’s one thing to ask another expert for a second opinion, just to be sure that you are making the right choice. It is quite another to ask several more experts for their opinions, hoping that one of them will advise against surgery. If that is the case, it might be a sign that you are not ready to commit to weight loss surgery and the lifestyle changes that are part of that commitment.
4. You are not sure how it would be different than dieting.
Bariatric surgery is worlds away from dieting. If you are thinking of bariatric surgery as a new diet that you will follow until you reach goal weight, you probably will not be prepared to sustain your new eating habits for life, and the weight will come back, just like it may have after countless diets. If you cannot explain to yourself why this is different than previous diet attempts, you might end up with the same results.
5. Your SO is doing more research than you.
It seems like every day, your significant other or your mom or your sister is telling you factoids about surgery that they discovered while researching online or talking to people. In the meantime, you have not seemed to be able to find the time to look things up. The fact may be that you are just not that engaged, which may be a sign that, deep down, you are not ready to take the plunge.

Love at First Sight
I was enthusiastic about the promise of the lap-band from the moment I first heard about you. Could you be the tool that could end my struggles with weight? Could it be possible that there could be an end to my unhealthy relationship with food? Could I say goodbye to the liquid diets, the low-carb diets, the fat-free diets, and all the other fad diets I had tried?
You had worked for my friend; could you work magic for me, too? I dared to hope. I got surgery in July of 2003.
Honeymoon and Beyond
Surgery went as expected, and you lived up to your promise. I lost weight – nearly 100 lbs. – and hit a healthy BMI. I felt better than I ever had. Sure, you made me work hard for every pound, but each victory was so sweet that there was no question that I would not follow your guidance.
In so many ways, the honeymoon period did not seem to end. Life has gotten better and better as I have gained confidence that I can maintain goal weight and prevent regain. Not once did I look back with regret.
A Helping Hand for a New Lease on Life
With the lap-band, I was able to gain control of myself and my life. I enjoy life’s events for themselves, and not for the food that comes with or after them. I am able to keep up with my children, who are my greatest joys. I have energy and confidence.
You have made my relationship with food better, and that is liberating. I eat when I am hungry and stop when I am full. I give in to my cravings and become satisfied with only a reasonable amount of the food I craved. There have been bumps along the way, but you have been my dependable gauge and silent cheerleader throughout.
My Life and My Livelihood
Along with my health, you also gave me my career. Out of necessity, I started LapBandTalk.com as soon as I came home from the hospital after surgery because I needed the help of other patients. Not in my wildest dreams did I think that impromptu discussion forum would become my career.
To LapBandTalk, I added other boards for the other weight loss surgery types, and they eventually became BariatricPal to recognize that we are all in this together. I am now honored and grateful to be able to call my life’s work my true passion – helping people through weight loss surgery. Nearly 15 years after I started a discussion board to help myself, BariatricPal now includes the forums, the store with protein products and bariatric vitamins, and even a full-service program for weight loss surgery in Mexico – at BariatricPal’s own hospital. I have gotten to meet and work with all kinds of wonderful patients, surgeons, and others in the weight loss surgery community.
Time to Part Ways
It is on a bittersweet note that I bid you, my lap-band, farewell. I have no real choice; multiple medical professionals agree that the safest decision is for us to part ways. I have been struggling with acid reflux (GERD) for a few years, and symptoms are getting worse, especially after my Lap-Band slipped. I also have been diagnosed with pre-Barrett’s esophagus and severe erosive gastritis, most likely caused by my lap-band. I will get my lap-band removed and opt for gastric bypass to help me maintain my goal weight.
The lap-band may not last forever, as it was meant to. I know the I will succeed with the Gastric Bypass because I already have the skills I need to eat right. Of course, I am a little worried. How could I not be, after having been so successful with you as my partner for 15 years?
But as is necessary with anything in life, I will do my best. I will take what I have gained from you, my lap-band, and carry it forward. Thank you, and farewell.

Love at First Sight
I was enthusiastic about the promise of the lap-band from the moment I first heard about you. Could you be the tool that could end my struggles with weight? Could it be possible that there could be an end to my unhealthy relationship with food? Could I say goodbye to the liquid diets, the low-carb diets, the fat-free diets, and all the other fad diets I had tried?
You had worked for my friend; could you work magic for me, too? I dared to hope. I got surgery in July of 2003.
Honeymoon and Beyond
Surgery went as expected, and you lived up to your promise. I lost weight – nearly 100 lbs. – and hit a healthy BMI. I felt better than I ever had. Sure, you made me work hard for every pound, but each victory was so sweet that there was no question that I would not follow your guidance.
In so many ways, the honeymoon period did not seem to end. Life has gotten better and better as I have gained confidence that I can maintain goal weight and prevent regain. Not once did I look back with regret.
A Helping Hand for a New Lease on Life
With the lap-band, I was able to gain control of myself and my life. I enjoy life’s events for themselves, and not for the food that comes with or after them. I am able to keep up with my children, who are my greatest joys. I have energy and confidence.
You have made my relationship with food better, and that is liberating. I eat when I am hungry and stop when I am full. I give in to my cravings and become satisfied with only a reasonable amount of the food I craved. There have been bumps along the way, but you have been my dependable gauge and silent cheerleader throughout.
My Life and My Livelihood
Along with my health, you also gave me my career. Out of necessity, I started LapBandTalk.com as soon as I came home from the hospital after surgery because I needed the help of other patients. Not in my wildest dreams did I think that impromptu discussion forum would become my career.
To LapBandTalk, I added other boards for the other weight loss surgery types, and they eventually became BariatricPal to recognize that we are all in this together. I am now honored and grateful to be able to call my life’s work my true passion – helping people through weight loss surgery. Nearly 15 years after I started a discussion board to help myself, BariatricPal now includes the forums, the store with protein products and bariatric vitamins, and even a full-service program for weight loss surgery in Mexico – at BariatricPal’s own hospital. I have gotten to meet and work with all kinds of wonderful patients, surgeons, and others in the weight loss surgery community.
Time to Part Ways
It is on a bittersweet note that I bid you, my lap-band, farewell. I have no real choice; multiple medical professionals agree that the safest decision is for us to part ways. I have been struggling with acid reflux (GERD) for a few years, and symptoms are getting worse, especially after my Lap-Band slipped. I also have been diagnosed with pre-Barrett’s esophagus and severe erosive gastritis, most likely caused by my lap-band. I will get my lap-band removed and opt for gastric bypass to help me maintain my goal weight.
The lap-band may not last forever, as it was meant to. I know the I will succeed with the Gastric Bypass because I already have the skills I need to eat right. Of course, I am a little worried. How could I not be, after having been so successful with you as my partner for 15 years?
But as is necessary with anything in life, I will do my best. I will take what I have gained from you, my lap-band, and carry it forward. Thank you, and farewell.

Love at First Sight
I was enthusiastic about the promise of the lap-band from the moment I first heard about you. Could you be the tool that could end my struggles with weight? Could it be possible that there could be an end to my unhealthy relationship with food? Could I say goodbye to the liquid diets, the low-carb diets, the fat-free diets, and all the other fad diets I had tried?
You had worked for my friend; could you work magic for me, too? I dared to hope. I got surgery in July of 2003.
Honeymoon and Beyond
Surgery went as expected, and you lived up to your promise. I lost weight – nearly 100 lbs. – and hit a healthy BMI. I felt better than I ever had. Sure, you made me work hard for every pound, but each victory was so sweet that there was no question that I would not follow your guidance.
In so many ways, the honeymoon period did not seem to end. Life has gotten better and better as I have gained confidence that I can maintain goal weight and prevent regain. Not once did I look back with regret.
A Helping Hand for a New Lease on Life
With the lap-band, I was able to gain control of myself and my life. I enjoy life’s events for themselves, and not for the food that comes with or after them. I am able to keep up with my children, who are my greatest joys. I have energy and confidence.
You have made my relationship with food better, and that is liberating. I eat when I am hungry and stop when I am full. I give in to my cravings and become satisfied with only a reasonable amount of the food I craved. There have been bumps along the way, but you have been my dependable gauge and silent cheerleader throughout.
My Life and My Livelihood
Along with my health, you also gave me my career. Out of necessity, I started LapBandTalk.com as soon as I came home from the hospital after surgery because I needed the help of other patients. Not in my wildest dreams did I think that impromptu discussion forum would become my career.
To LapBandTalk, I added other boards for the other weight loss surgery types, and they eventually became BariatricPal to recognize that we are all in this together. I am now honored and grateful to be able to call my life’s work my true passion – helping people through weight loss surgery. Nearly 15 years after I started a discussion board to help myself, BariatricPal now includes the forums, the store with protein products and bariatric vitamins, and even a full-service program for weight loss surgery in Mexico – at BariatricPal’s own hospital. I have gotten to meet and work with all kinds of wonderful patients, surgeons, and others in the weight loss surgery community.
Time to Part Ways
It is on a bittersweet note that I bid you, my lap-band, farewell. I have no real choice; multiple medical professionals agree that the safest decision is for us to part ways. I have been struggling with acid reflux (GERD) for a few years, and symptoms are getting worse, especially after my Lap-Band slipped. I also have been diagnosed with pre-Barrett’s esophagus and severe erosive gastritis, most likely caused by my lap-band. I will get my lap-band removed and opt for gastric bypass to help me maintain my goal weight.
The lap-band may not last forever, as it was meant to. I know the I will succeed with the Gastric Bypass because I already have the skills I need to eat right. Of course, I am a little worried. How could I not be, after having been so successful with you as my partner for 15 years?
But as is necessary with anything in life, I will do my best. I will take what I have gained from you, my lap-band, and carry it forward. Thank you, and farewell.

Love at First Sight
I was enthusiastic about the promise of the lap-band from the moment I first heard about you. Could you be the tool that could end my struggles with weight? Could it be possible that there could be an end to my unhealthy relationship with food? Could I say goodbye to the liquid diets, the low-carb diets, the fat-free diets, and all the other fad diets I had tried?
You had worked for my friend; could you work magic for me, too? I dared to hope. I got surgery in July of 2003.
Honeymoon and Beyond
Surgery went as expected, and you lived up to your promise. I lost weight – nearly 100 lbs. – and hit a healthy BMI. I felt better than I ever had. Sure, you made me work hard for every pound, but each victory was so sweet that there was no question that I would not follow your guidance.
In so many ways, the honeymoon period did not seem to end. Life has gotten better and better as I have gained confidence that I can maintain goal weight and prevent regain. Not once did I look back with regret.
A Helping Hand for a New Lease on Life
With the lap-band, I was able to gain control of myself and my life. I enjoy life’s events for themselves, and not for the food that comes with or after them. I am able to keep up with my children, who are my greatest joys. I have energy and confidence.
You have made my relationship with food better, and that is liberating. I eat when I am hungry and stop when I am full. I give in to my cravings and become satisfied with only a reasonable amount of the food I craved. There have been bumps along the way, but you have been my dependable gauge and silent cheerleader throughout.
My Life and My Livelihood
Along with my health, you also gave me my career. Out of necessity, I started LapBandTalk.com as soon as I came home from the hospital after surgery because I needed the help of other patients. Not in my wildest dreams did I think that impromptu discussion forum would become my career.
To LapBandTalk, I added other boards for the other weight loss surgery types, and they eventually became BariatricPal to recognize that we are all in this together. I am now honored and grateful to be able to call my life’s work my true passion – helping people through weight loss surgery. Nearly 15 years after I started a discussion board to help myself, BariatricPal now includes the forums, the store with protein products and bariatric vitamins, and even a full-service program for weight loss surgery in Mexico – at BariatricPal’s own hospital. I have gotten to meet and work with all kinds of wonderful patients, surgeons, and others in the weight loss surgery community.
Time to Part Ways
It is on a bittersweet note that I bid you, my lap-band, farewell. I have no real choice; multiple medical professionals agree that the safest decision is for us to part ways. I have been struggling with acid reflux (GERD) for a few years, and symptoms are getting worse, especially after my Lap-Band slipped. I also have been diagnosed with pre-Barrett’s esophagus and severe erosive gastritis, most likely caused by my lap-band. I will get my lap-band removed and opt for gastric bypass to help me maintain my goal weight.
The lap-band may not last forever, as it was meant to. I know the I will succeed with the Gastric Bypass because I already have the skills I need to eat right. Of course, I am a little worried. How could I not be, after having been so successful with you as my partner for 15 years?
But as is necessary with anything in life, I will do my best. I will take what I have gained from you, my lap-band, and carry it forward. Thank you, and farewell.

Most bariatric surgery candidates fear the pureed stage. Many feel it it is like eating “baby food,” and associate it with being unappetizing. While some surgeons have done away with this stage, it continues to be used in a significant amount of bariatric surgery centers.
If you need to be on a pureed diet, take a look at the following strategies to help make this part of your journey easier.
Buy the Right Equipment
Having the right equipment will save you time in the kitchen and make your life easier. These kitchen tools include a high speed blender and ice cube trays. The high speed blender will help you prepare your food faster and give you a smoother consistency. The ice cube trays can be used to freeze your pureed food items in, so you can just “pop” them out and reheat for your meals later.
Prepare Ahead of Time
It may be helpful for you to prepare your food before you have surgery to reduce your anxiety. This will also give you more time to focus on your healing instead of worrying about what your next meal will be. As an extra bonus, this will develop your meal prepping skills which will be an important habit to develop as you embark on this new chapter in your lif.
Use Spices
Don’t be afraid to use spices to increase the flavor of your food. While “spicy” seasonings are usually not recommended initially after surgery, other more “cooling” spices ones such as basil, dill or oregano may be well tolerated. Plus, there are extra antioxidants stored in those spices. Add these seasoning during the cooking process to fully develop the flavors.
Garnish Your Food
Garnish? Really? This may seem like a silly step but it is helpful to make your food look attractive. If it appears unappetizing, then you likely will not enjoy the food. Try placing parsley on the side or garnish with basil flakes to add some color. It may also be helpful to serve your food in pretty dish-ware to feel more festive.
Make Your Own Food
Skip the baby food! Baby food usually doesn’t taste very good and may have added sugars or other ingredients that are not bariatric friendly. Food that you prepare from scratch usually tastes better and is healthier for you. Try modifying one of the dishes you already love. Instead of a traditional lasagna, prepare a lasagna that uses zucchini noodles and ground turkey. Blend it up in the blender and have a delicious meal on hand.
If all else fails, remember this is only temporary and you will soon be eating regular food again soon.
Have you already completed the pureed stage? What tips do you have? Please let me know in the comments below.

To be truly full from within means that our “tank” is mentally full. In other words, our self, although beaten up, bruised, and broken sometimes as a result of our journey down each of our unique life’s path - is repaired and felt as whole again. Like a patchwork quilt that only gets stronger as a result of its many tears and reparations.
How does one achieve this, you ask?
Borrowing from Aaron Beck’s cognitive triangle - we have three components of the mind that work to repair the self: THOUGHTS, FEELINGS, BEHAVIORS.


These are the different components that must be running on all four cylinders to ensure that we aren’t at risk of developing or perpetuating an unhealthy relationship with any of the topics mentioned above, for the purposes of this article, specifically - food.
Thoughts To Repair The Self
Mindfulness Based Cognitive Therapy is a 25 cent term to describe the process of looking at the old tapes we run in our minds day in and day out for years upon years, and stopping them in their tracks, and replacing them with new ones.
A hallmark approach in Byron Katie’s book “Loving What Is,” is to continuously challenge one’s thoughts by asking “is that really true?” 13 If we deem that we can’t say with absolute certainty that a thought is true, then we can replace it with a more constructive thought.
For instance, if we find ourselves with a running narrative that goes something like “you are just never going to be someone that stands out, it’s ok you have other good traits,” then what is the behavior and feelings that it produces? Perhaps the person goes on feeling invisible like many people who are overweight feel. Maybe the person gives up on trying to stand out in the way they look and participate in life.
Feelings To Repair The Self
For my clients suffering from depression, I will often assign them a task of doing one social event, one bout of exercise (if they have never been inclined to exercise), and one learning activity (lecture, take a CE, attend a webinar, go to a pottery class, painting class, attend a speaking event).
Many of them balk at the idea. Some of them have been doing things their way for years and there is an undercurrent of fear related to breaking their routine. It is almost as if the depression has a voice that says “don’t do it, you will only feel worse.”
We must realize that when we have depression, our mind is sick. It is no longer serving us, and the messages are coming from crossed wires. In order to uncross those wires, we must physically and literally put one foot in front of the other and re-engage in those activities that we know from the research lead to a sense of happiness or at least contentment.
Behaviors To Repair The Self
One of the biggest misconceptions about our mind is the idea that we must feel a certain way to engage in certain behaviors. In other words, we must first feel happy if we are going to go to a social event and relate to others in a positive way. However, the cognitive triangle mentioned above is tri-directional14, meaning our behaviors can influence our feelings and/or thoughts, and vice versa.
This is powerful information. This means that we don’t have to wait for happiness or joy to come around to engage in behaviors we know lead to more happiness. In fact, one of my first interventions with my patients who suffer from depression is the “just do it” approach, meaning they are given the task of doing three behaviors they don’t necessarily feel like doing in the six days in between their next therapy session.
To explain depression via a very simple analogy- it is like the flu for the mind. What do you typically do when you have the flu?
You cancel your appointments, stay in bed, drink lots of water, and get lots of rest. The reasoning is that if we minimize the number of life events for a brief bit of time, we will heal more quickly, and we do. BUT, this is not the case with depression.
The same intuition we use to combat the flu is the antithesis of what we must do to combat depression, yet somehow our instincts tell us to do the opposite. When we feel depressed, our inclination is to isolate, do less, and wait for the clouds to part. The problem with this is that this type of behavior is what feeds the depression.
Suggested Behaviors
Benevolence - reaching out to others and getting out of our own head, focusing on how to make someone else’s life or day better through connecting or giving.
Play- engaging in something that requires enough effort that we can’t run old unhelpful tapes (I’m not good enough, other people must be more disciplined than me, things will never change, etc), but provides us with enough fun that we leave the activity feeling light, like surfing, artistry, building, writing, playing an instrument, etc.
When we are kids, we spend about 95% of our day playing and even trying to find play in our responsibilities (have you ever watched a kid brush their teeth or get dressed? it is never a straightforward buttoned up process). Yet, as adults - we flip that on its head and spend 95% of our time being a human doing vs. a human being.
Learning- engaging in novelty is something our brain requires to feel happy and fed. It could be as simple as learning a new card game, all the way to enrolling in an MBA course. When we allow our minds to do what they are best at - our minds give back to us.
Connection- We are social creatures by nature. There is a physiological rewiring process that occurs as result of being in near proximity to other humans. It is how we survived so long ago, and our minds still provide the payoff.
We are not meant to live in isolation, yet so many of us drift in this direction when they are depressed. Even introverts require some social connection. While extroverts tend to thrive and recharge their batteries on social connection, it is true that introverts recharge in their solitude.
However, there is a difference between being alone vs. lonely. As introverted as you may think you are, none of us are immune to going from alone to lonely if we don’t make time for some social connection.
Exercise- There are about 99 reasons to exercise and happiness is one. I’m not going to waste space and wax poetic about the many benefits of exercise because I’m sure you’re well aware. But in addition to producing endorphins that have been proven to make us feel better, as far as weight loss goes- it also makes us less likely to put junk in our bodies. Ever do an intense sweat session and then make a beeline to the nearest McDonald’s? I didn’t think so.

Do you need to obey this rule? If so, how can you reconcile yourself to life without fizz? Here is the information on carbonation and WLS from reasons to avoid it to what you can have instead.
Can Your Stomach Really Stretch?
The top reason given for avoiding carbonated beverages after weight loss surgery is to prevent your stomach, sleeve, or pouch from stretching. A major purpose of getting weight loss surgery is to make your stomach smaller, and stretching it would, as the fear goes, undermine your weight loss strategy. Is this a realistic fear?
Probably not. There are probably two parts to this idea. First, there will almost certainly be a small amount of stretching after surgery, naturally. There is no evidence that you can prevent this, or that drinking carbonated beverages affects it one way or the other.
Second, drinking carbonated beverages may lead to the effects of stretching, that is, overeating, for a slightly different reason. Carbonated beverages are very filling; they seem to take up a lot of room in your stomach. If you get used to the feeling you get when you drink them, you may start to have more trouble recognizing the subtle fullness signals you have when you stick to your small post-op meals. This lack of ability to feel full may be the “stretching” that people report.
Carbonation Is Uncomfortable
For most patients, the post-op recovery process is long and uncomfortable enough. Adding bubbly liquid into the mix can make it worse. The gas in carbonated beverages can cause bloating and stomach pain. The bloating and stomach distension can put stress on your surgical wounds and delay healing.
A Sign of Dedication
For many patients, and according to some health professionals, cutting out soda is a sign of your dedication to your new lifestyle. Some may see a soda habit as a sign of continued dependence on junk food, or an unwillingness to change. Another concern is that drinking soda can easily lead to eating whatever it is that you are used to eating with it: possibly chips or a burger or nachos. For WLS patients who want a “clean slate,” soft drinks and beer may not fit in.
P.S. Carbonated Beverages Are Unhealthy
Along with all of the above WLS-specific reasons for skipping soda is another reason: carbonated beverages are generally unhealthy. The sugary ones are obviously unhealthy - they add pounds and spike blood sugar – but there are other problems, too.
Artificial sweeteners in diet sodas can lead to excessive insulin responses, which can raise diabetes risk and also make you hungrier. Phosphoric acid in cola can erode your tooth enamel, leading to decay, and may lead to decreased bone mineral density and risk for osteoporosis. Cola can also decrease absorption of calcium. Refreshing Soda Swaps
If you are drinking soda for hydration and comfort, you can look to other cold drinks to fill the void. Look for non-carbonated, low-calorie, sugar-free choices.
Flavored water in a ready-to-drink bottle (be sure to choose low-calorie, noncarbonated versions) or that you make yourself with Flavor Enhancers. Infused water that you make by adding citrus fruit such as lemon, lime, or orange, strawberries, peaches, or mint leaves, to ice water. Decaffeinated iced tea ready-made from a bottle or that you make yourself with tea bags. Drink it unsweetened or use a low-calorie sugar substitute. You can try green, black, herbal, and fruit tea to find a variety that you enjoy. Iced green or black tea with a sugar substitute (if you need it sweet) plus a squeeze of lemon. Energizing Caffeine Jolts
Take heart if you are dependent on your soft drink for a caffeine boost, but you are not a fan of hot drinks or bitter taste of coffee. There are plenty of ways you can get your caffeine and burst of energy without sipping coffee, which has about 80 to 160 mg of caffeine per cup. For context, a can of cola has about 45-70 mg caffeine.
Energy drinks: 60-160 mg caffeine Water enhancer: 45 mg caffeine Iced tea: 5 to 40 mg caffeine Hot tea: 10-40 mg caffeine Caffeinated over-the-counter medications: 60-300 mg caffeine (be careful!) Do remember that you will probably need to abstain from caffeine for the first month after weight loss surgery to allow your surgery wounds to heal. Some surgeons will ask you to give up caffeine for life.

A certain amount of hair loss is expected after bariatric surgery due to the stress of surgery on your body and the effect of rapid weight loss. Hair loss usually peaks about 3-4 months after surgery and may last up to 6 months. If you continue to have hair loss after 6 months then it may be nutritionally related.
The three biggest nutrients that can affect hair loss are….drumroll please…
Iron Zinc Protein These three nutrients have been proven in multiple studies to be helpful in mitigating hair loss after bariatric surgery. So how can you make sure you are getting adequate amounts of these nutrients?
Check your vitamin and mineral levels before surgery
If you are obese then you are at higher risk for micronutrient deficiencies. It is important to check your nutrient levels before surgery. In fact, The American Society of Metabolic and Bariatric Surgery (ASMBS) recommends that all patients are prescreened for nutrient deficiencies before surgery. This helps correct deficiencies before surgery and give you the best outcome.
Start taking a multivitamin before surgery
Taking a multivitamin before surgery may help you in two ways. First, it may improve your nutritional status before surgery. And second, it will help you to develop the habit of taking a multivitamin daily since this will be crucial lifelong habit after surgery.
Take a quality multivitamin after surgery
There are so many multivitamins out there it can become dizzying. Follow your surgeon’s team advice for which multivitamin to use. Ideally, it should be chewable or liquid form during the first two months after surgery and then after that you can switch to capsule form. Higher quality vitamins tend to be more money than generic brands but the micronutrients in the higher quality vitamins, such as iron and zinc, are usually easier for your body to absorb.
Eat protein at every meal
This tip should come as no surprise. Since your stomach size is smaller after surgery it is important to include protein at each meal. Ideally, it should be a high quality protein such as eggs, fish, poultry, or dairy (if you can tolerate it!). Most bariatric programs recommend between 60-120 g protein daily but please follow your surgery center’s guidance. Depending on how far out you are from surgery you will likely need to supplement with protein drinks to meet your protein goals.
Check your vitamin and mineral levels after surgery
Every bariatric center is different but typically your doctor will monitor your labs multiple times during the first year after surgery and then yearly after that. It is much easier to correct a nutritional deficiency early on. It is important that you attend your follow-up appointments so your doctor can monitor your nutrient levels after surgery.
Eat your vitamins and minerals
Lastly, focus on getting your iron, zinc and protein from real food. Even though you can get these nutrients from your supplements, food sources are the best. Good sources of these nutrients include beans, chicken, turkey, or liver.
So what about biotin?
Despite its reputation, biotin has not been shown to be helpful in preventing hair loss unless you have a deficiency. However, I know lots of clients who swear by it!
Do you take biotin to prevent hair loss? Do you feel it works? Let me know in the comments below.

How many surgeries were done?
The data show that there were 215,666 total bariatric procedures done in 2016. That is a lot if you compare to 2011 – it is an increase of 36.5% over the course of 5 years, but it is not much if you compare it to the over 20 million Americans who are eligible for bariatric surgery based on criteria of a BMI over 40 or a BMI over 35 plus a related condition. In fact, only 1% of eligible Americans get weight loss surgery.
Why is the gastric sleeve taking over?
The gastric sleeve is gaining momentum, and quickly. It has leaped from 28,124 procedures in 2011 to 125,318 in 2016. It has jumped from making up 17.8% in 2011 of the total to 58.1% in 2016. Why has the gastric sleeve become so popular, so quickly?
There is a lower risk of nutrient deficiencies and dumping syndrome compared to gastric bypass. It helps fight hunger by lowering levels of the hormone ghrelin. It is relatively safe for higher-BMI patients. It has similar weight loss as gastric bypass, and lower reoperation and complication rates than gastric band. Why would anyone not choose the gastric sleeve?
The gastric sleeve may appear to be the choice du jour according to the numbers, but even so, not everyone chooses it. These are some hesitations with the gastric sleeve.
It is so new that there is no long-term research on it. We just do not know if it stays effective for years and decades. It is permanent. Done. There is no going back, even if the patient really, really begs. Some patients have trouble getting enough calories and protein and continue to depend on supplements for a long time post-op. What are the non-sleeve choices?
While 58.1% of patients opt for the sleeve, the other 39.9% do not. In fact, nearly 1 out of 5 patients opt for gastric bypass, and biliopancreatic diversion/duodenal switch (BPD-DS) has held steady at 0.6%. These are some reasons to consider other types.
The gastric bypass has a long history. It can be successful long-term with weight loss, and it is famous for its ability to resolve diabetes quickly. The lap-band is reversible. Even though the band has dropped 86.93% since 2011, there were still 7,310 new bands in 2016. The BPD-DS may still be the best for higher-BMI patients. What does the research say?
Good news – weight loss surgery works! At least, that is what the majority of the research studies conclude, whether they are looking at the sleeve, bypass, band, or another method. All surgery types have a risk of complications, and all have a risk of mortality of under 1%. BMI can drop 7 to 14 or more kg/m2, and diabetes, sleep apnea, hypertension, and other obesity-related conditions can get better.
Is the gastric balloon going to be a factor?
Time will tell whether the gastric balloon is going to be a factor in the overall bariatric surgery statistics. The FDA approved it only in 2015, and it jumped from 0 in 2011-2014 to 0.3% (700 procedures) in 2015 to 2.7% (5,744 procedures) in 2016. The balloon is not a true bariatric surgery; it is not permanent, it leads to less weight loss, and it is intended for lower-BMI patients. This means that it may not be in competition with the true bariatric surgery procedures, although it is likely to become more common as it becomes better known.
What is the deal with so many revision surgeries?
If weight loss surgery techniques are always advancing, why are revisions becoming so much more common? They comprised 6% (9,480) of the total in 2011, but 13.9% (30,077) in 2016. It could be because some of the previous (failed) surgeries were done using older techniques, and are now ready for serious help – a revised procedure.
Why are 99 out of 100 eligible Americans not getting Weight Loss Surgery?
There are a lot of reasons eligible Americans are not getting Weight Loss Surgery. They include:
Cost. Fear of complications or death. Not knowing where to start. Lack of support from family, friends, and healthcare providers. Fear of failure. Lack of long-term commitment to lifestyle changes. What can health professionals and patients do to help eligible patients get the Weight Loss Surgery they need?
Surgeons and other bariatric professionals can help by making sure they reach out to eligible patients. They can explain their options, and promise to provide the nutritional and psychological support patients need for success and to feel confident in their success. They can organize support groups and provide additional resources for patients to get advice and encouragement anytime.
What can health professionals and patients do to help eligible patients get the Weight Loss Surgery they need?
Patients can do their part by asking questions to learn about their best options. They can express their doubts and fears to surgeons to come up with strategies for success. They can reach out to friends, acquaintances, and online groups for support.

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.

1. Oatmeal. Despite its high carb count, oatmeal is one of the healthiest foods, even for weight loss surgery patients. It is a whole grain (gluten-free, if you are wondering), and is a source of soluble fiber. People who eat whole grains instead of refined ones have a lower risk of heart disease, diabetes, and weight gain.
Have oatmeal with nuts or peanut butter for a little extra healthy fat and protein, and add cinnamon for a sweet flavor without sugar. No law says oatmeal needs to be sweet. Turn it into a savory bowl with a poached or hard-boiled egg, some feta cheese, and sliced cooked mushrooms.
2. Pear. Pears have a lower glycemic index and glycemic load than many other fruits, so they do not spike your blood sugar as much. They have soluble fiber, which helps lower cholesterol and blood sugar. They also provide lignans, which are heart-healthy.

You can do way more with a pear than use it as a dessert or a side for cottage cheese, although those work, too! Try serving it with all-natural ham, or tossing it with mixed greens, walnuts, bell peppers, and cooked chicken breast. You can also turn it into a salsa to top fish or chicken along with diced onion, tomato, and cucumber, plus chopped cilantro and lime juice.
3. Beans. Beans are a starch you can love since they pack in the fiber and protein along with vitamins and minerals. They are linked to lower risk for certain cancers, as well. If they bother your stomach, try having small portions or using an enzyme product such as Bean-o.
Kidney, pinto, garbanzo, and black beans – they’re all good! Make hummus with garbanzos and olive oil, or try vegetarian chili with beans, tomatoes, other vegetables, and seasoning. Or, make a taco salad or naked burrito with fat-free refried beans.
4. Pumpkin. Pumpkin has a medium glycemic index, but so few carbohydrates that your body will barely realize that it is there. Aside from the potassium and fiber in pumpkin, you will find amazing amounts of vitamin A in the form of beta-carotene – and that can only be a good thing after weight loss surgery. Butternut and acorn squash have a few more carbohydrates but are also excellent choices.
Stir pumpkin and cinnamon into your oatmeal, or mix them into non-fat cream cheese for a flavorful, protein-packed spread or dip for apples. Add chunks of butternut squash to stew, or blend pumpkin into a soup to make it creamy.
5. Peas. Peas may have a bad reputation, but it is undeserved. Choose snow peas or sugar snap peas in the pod for a dose of vitamin C and fiber. Use them raw or lightly cooked to preserve their antioxidants and keep their glycemic load down.
Use them in salads along with lettuce, chicken, and chopped vegetables, or dip them into Greek yogurt-based dips. You can also use snow and sugar snap peas in stir fry – just be sure to keep them crunchy.

A few years back, I was 1 of 6 people featured in a photo shoot of real people who have defeated their diabetes. And what an incredible day it was! I got to choose the location of my shoot -- the beach -- and was driven there by limousine. The photographer took shots of me doing planks, sprints, and meditation on the beach, as well as hanging out on the boardwalk. That experience was the closest I've come to being a model (a teenage dream of mine).
Across the decades I have been every size, from a junior size 7 to a women’s size 24. Getting a diagnosis of diabetes was a critical turning point in my life. It was a wake-up call that I answered, the impetus for me to have my gastric bypass surgery. Had I not gotten diabetes, then I likely would not have had the surgery and turned my health and my life around. My diabetes earned me a 3-night staycation in the hospital. I went home with 5 prescriptions for diabetes and hypertension. Within a year I had bariatric surgery and I credit it with saving my life.
But getting the surgery isn't a guarantee of success. It is vital, too, that we become skilled in Using Your Gastric Pouch for Weight Loss. Over the years I must have slipped back into old dysfunctional patterns of relating to food because I began to gain weight at 5-years post-op. And I ended up having a revision surgery.
Fast forward to 2013 after my plastic surgery, I became set upon living life larger than ever -- doing all the things that I wanted to do. One might say I am making up for lost time. I came to love planks and squats and HIIT and lifting weights and sprints with my dog Blue and BodyCombat class. I ran with my granddaughter in her first 3k, and we hiked for hours in the mountains of northern California. I learned to row, meditate, belly dance, and tai chi. I completed a strenuous all-day ropes course and overcame my fear of heights. I traveled the USA in an RV and lived in Belize and Mexico for 4-months. And so much more, more, more. I feel that the plastic surgery saved my soul.
I am so grateful for how my life has changed, now having defeated my obesity and diabetes for nearly 15 years. I lead a life well-lived. But when I was morbidly obese, I led a life half-lived. The biotech company behind the photo shoot shares my story with patients and healthcare professionals and with employees to encourage people that they can defeat diabetes, too. It is an honor to inspire people to better health.
Be thankful for who you are now, but keep fighting for what you want to be tomorrow. Strive for Daily Success.

In the case of bariatric surgery and the questions patients ask about their post-op “diet,” most bariatric professionals speak in terms of the lifestyle and dietary changes that accompany post-op living. The majority of patients, both pre-op and post-op, understand that one of the goals of preparing for bariatric surgery is to begin making healthy, positive changes to one’s lifestyle. Which, of course, is code for changing behaviors (primarily eating and exercise). Hence, the popular phraseology that “bariatric surgery requires accompanying lifestyle changes” in order for one to maintain the weight loss they experience during “the honeymoon” stage.
For many (most?) people who have bariatric surgery, being on a “diet” of one sort of another has been a way of life prior to having a bariatric surgical procedure. Atkins, Paleo, low carb, low fat, vegan, gluten-free, DASH diet, ZONE diet, Jenny Craig, Whole 30, Weight Watcher’s, very low carb, Sugar Busters, etc. etc. etc. Sound familiar?
When I hear post-op patients talking about “going on a ‘diet,’” I really want to scream, “THIS ISN’T ABOUT A ‘DIET’! It’s about LIFESTYLE CHANGES!”
Don’t get defensive here if you have gone on a “diet” as a post-op. I understand that if you have regained weight, and are working with a bariatric professional, there may be a “diet” of sorts prescribed. That’s not what I’m referring to when I talk about my frustration. It’s when a post-op continues the diet-as-a-way-of-life mentality that I feel frustrated, and sad, actually.
Living life “on a diet” can be (and is, for some people), a way to: 1) avoid other things (feelings, relationships, etc.) by focusing all of their thoughts and attention on “the diet,” 2) remain obsessed with food (which may be an indication of a food addiction and/or my first point), 3) remain connected with others as “dieting” may have been the basis of their relationship with family members or friends, 4) attempting to have some area of control in life, and/or 5) lots of other things.
Regardless, dieting as a way of life is probably not a healthy way to live (for most people).
Sidenote: I add that “for most people” part because, sure as I’m sitting here, if I don’t say that, somebody is gonna get really ticked off and start thinking about how that isn’t the case for THEM and THEN they may miss the point of the whole article…
The POINT, by the way, is… choosing to have bariatric surgery is also choosing to make healthy, positive lifestyle changes. IF you want to sustain the weight you lose as a result of the surgery – and your efforts.
And YOU are in it to win it. SO… here’s how to change your thinking from making changes in your “DIET” to making changes in your lifestyle:
AWARENESS: Learn the difference between a “diet” and a “lifestyle change” if you don’t already know. Discuss this with your bariatric professionals, your support groups and your family members. Help those in your life understand the difference, as well. IF you fear not living on a “diet,” then perhaps consider getting some counseling to look into the reasons being “on a diet” is emotionally important to you. ACCEPTANCE: Realize that if you want to live the rest of your life at a healthier weight, then lifestyle changes in the way of “diet” (as in what you eat), as opposed to “A DIET,” such as the ones name above, are necessary. And the healthy dietary changes need to a lifestyle… meaning you continue them every day, one day at a time. In addition, the lifestyle changes necessary to life your healthiest life can include things such as increased physical activity, exercise, learning healthy coping skills, developing a healthy support system, etc. ACCOUNTABILITY: Find ways to be accountable for engaging in healthy lifestyle behaviors. Maintain food and exercise journals. Participate in support and/or accountability groups. Work out with others. Start a walking club. Start a support group. Take responsibility for your health. This day. Every day. ATTITUDE: Work to have a more positive attitude about the difficult parts of the journey. Read positive quotes. Maintain a gratitude journal. Encourage others. Talk to yourself when you’re grumpy and remind yourself that will not lead you in the direction you want to go! COMMITMENT: Make a list of the reasons you are working so hard to develop a healthier lifestyle and every day, SEVERAL times a day, state out loud your commitment to doing so. OUT LOUD! Your brain will hear you and respond in a positive way. EFFORT: Unless you do the doing, nothing much will happen in the way of results. So this EFFORT thing needs attention every day. Get help to get you going if you need to! Yep – that means: Ask. For. Help. You can do that! Your SELF matters. Be as loving toward yourself as you are to others. You are just important as every other person. Using these 4 ACES will get you to the place where a healthy diet is part of your healthy LIFESTYLE!

How many surgeries were done?
The data show that there were 215,666 total bariatric procedures done in 2016. That is a lot if you compare to 2011 – it is an increase of 36.5% over the course of 5 years, but it is not much if you compare it to the over 20 million Americans who are eligible for bariatric surgery based on criteria of a BMI over 40 or a BMI over 35 plus a related condition. In fact, only 1% of eligible Americans get weight loss surgery.
Why is the gastric sleeve taking over?
The gastric sleeve is gaining momentum, and quickly. It has leaped from 28,124 procedures in 2011 to 125,318 in 2016. It has jumped from making up 17.8% in 2011 of the total to 58.1% in 2016. Why has the gastric sleeve become so popular, so quickly?
There is a lower risk of nutrient deficiencies and dumping syndrome compared to gastric bypass. It helps fight hunger by lowering levels of the hormone ghrelin. It is relatively safe for higher-BMI patients. It has similar weight loss as gastric bypass, and lower reoperation and complication rates than gastric band. Why would anyone not choose the gastric sleeve?
The gastric sleeve may appear to be the choice du jour according to the numbers, but even so, not everyone chooses it. These are some hesitations with the gastric sleeve.
It is so new that there is no long-term research on it. We just do not know if it stays effective for years and decades. It is permanent. Done. There is no going back, even if the patient really, really begs. Some patients have trouble getting enough calories and protein and continue to depend on supplements for a long time post-op. What are the non-sleeve choices?
While 58.1% of patients opt for the sleeve, the other 39.9% do not. In fact, nearly 1 out of 5 patients opt for gastric bypass, and biliopancreatic diversion/duodenal switch (BPD-DS) has held steady at 0.6%. These are some reasons to consider other types.
The gastric bypass has a long history. It can be successful long-term with weight loss, and it is famous for its ability to resolve diabetes quickly. The lap-band is reversible. Even though the band has dropped 86.93% since 2011, there were still 7,310 new bands in 2016. The BPD-DS may still be the best for higher-BMI patients. What does the research say?
Good news – weight loss surgery works! At least, that is what the majority of the research studies conclude, whether they are looking at the sleeve, bypass, band, or another method. All surgery types have a risk of complications, and all have a risk of mortality of under 1%. BMI can drop 7 to 14 or more kg/m2, and diabetes, sleep apnea, hypertension, and other obesity-related conditions can get better.
Is the gastric balloon going to be a factor?
Time will tell whether the gastric balloon is going to be a factor in the overall bariatric surgery statistics. The FDA approved it only in 2015, and it jumped from 0 in 2011-2014 to 0.3% (700 procedures) in 2015 to 2.7% (5,744 procedures) in 2016. The balloon is not a true bariatric surgery; it is not permanent, it leads to less weight loss, and it is intended for lower-BMI patients. This means that it may not be in competition with the true bariatric surgery procedures, although it is likely to become more common as it becomes better known.
What is the deal with so many revision surgeries?
If weight loss surgery techniques are always advancing, why are revisions becoming so much more common? They comprised 6% (9,480) of the total in 2011, but 13.9% (30,077) in 2016. It could be because some of the previous (failed) surgeries were done using older techniques, and are now ready for serious help – a revised procedure.
Why are 99 out of 100 eligible Americans not getting Weight Loss Surgery?
There are a lot of reasons eligible Americans are not getting Weight Loss Surgery. They include:
Cost. Fear of complications or death. Not knowing where to start. Lack of support from family, friends, and healthcare providers. Fear of failure. Lack of long-term commitment to lifestyle changes. What can health professionals and patients do to help eligible patients get the Weight Loss Surgery they need?
Surgeons and other bariatric professionals can help by making sure they reach out to eligible patients. They can explain their options, and promise to provide the nutritional and psychological support patients need for success and to feel confident in their success. They can organize support groups and provide additional resources for patients to get advice and encouragement anytime.
What can health professionals and patients do to help eligible patients get the Weight Loss Surgery they need?
Patients can do their part by asking questions to learn about their best options. They can express their doubts and fears to surgeons to come up with strategies for success. They can reach out to friends, acquaintances, and online groups for support.

Fancy vinegars and quality olive oils. Aged balsamic vinegars and cold pressed or flavoured olive oils are incredibly trendy right now. They are a great addition to any kitchen pantry and with a simple drizzle can significantly enhance the taste of everyday dishes. These types of products can found at most grocery stores and all specialty food stores.
Gourmet coffee beans. Another trendy food item this year is specialty coffee beans. Whether you prefer fair-trade, certified organic or flavoured, there is something for everyone. Just be sure that the recipient actually has the proper coffee equipment to use them. In a world of Nespresso and Keurig fanatics you can never be too sure!
Homemade spice mixes. A quick internet search will bring up a never-ending list of DIY spice combinations. We love the idea of speeding up meal prep for friends and family. Some of our favourite examples include: taco seasonings, steak spices, chili seasonings, chai tea spice blends, salad dressing spice mixes, meat rubs, etc. Package the spice mixes in small mason jars or spice bottles and add a ribbon for a festive touch!
Potted herbs A small pot of rosemary or thyme this time of year makes a great gift for those who enjoy cooking. Both of these herbs are found in many fall and winter dishes such as turkeys, roasted chickens and stews. These plants can be tricky to find this time of year, but are most often found in select grocery and garden stores.
Specialty teas. You can never have too much tea! Around this time of year pretty much all tea shops offer gift sets of tea which make perfect host/hostess gifts. They also usually have several festive limited-time only seasonal blends that are perfect for winter.

What are your favourite go to host/hostess gifts? Let us know in the comments below!
– Monica & Lisa

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