Nepenthe44

Unfortunately, I live in a rural area outside of any major metropolitan areas. This practice is my only real option without restarting the process and driving several hours each way for appointments. And it's really not this practice that's the problem; I had the same problem with the previous practice I tried with. (That one allowed fiber during the pre-op but absolutely forbad cooking your vegetables, because everyone knows that if you steam the broccoli you eat, your surgery will fail and you won't lose weight as well as the people who are chowing down on raw florets pre-op.) I just have a fundamental problem complying with arbitrary and unjustified rules. I definitely don't trust my team, because I don't want to be denied again, so I'm not about to negotiate with them. (The surgeon in particular seems extremely rigid and unwilling to listen or negotiate.) I feel like the questions I've asked have already put me in serious jeopardy of being denied on the grounds that I won't comply. I plan on being a more forthright with the team after surgery, because what can they do then if I ask questions, hit me over the head and put my GI tract back together? But I'm never going to be able to trust a dietitian or anyone else that can't back up what they demand I do.

It's more like human growth media than bacterial growth media in intent. It's designed to be nutritionally complete; most of the ingredients are either essential nutrients (vitamins, minerals, protein, omega 3 fatty acids, etc.) or stuff to make it work as a powdered "drink" (anti caking agents and emulsifiers). But it's an entirely artificial reconstruction of food, not food. Add in artificial sweeteners, flavors, and coloring agents and you have the grossest stuff imaginable. I have to think that Nestlé gives kickbacks or other perks to doctors who use it.

Protein shakes in general are basically bacterial growth media with flavoring, so that's not unusual. (Once the growth really gets going, there's nothing I've found that gets the smell out. Buy extra bottles if you're forgetful and don't clean them out quickly every time.) 2 hours is a little fast though. And I don't remember anything liking Optifast.

Does anyone have experience getting cleared for surgery with a recent history of binge eating disorder? Or know what the official definition of remission is? My bariatric program reached out to my psychiatrist, who apparently said I'm not a candidate for WLS because of a history of BED that's in "partial remission". During our last meeting a few months ago, I was still having small binges about once a week. Since then, I binge less than once a week (a BED diagnosis requires binging at least once a week for at least 3 months) and my binges are getting smaller and smaller over time. I haven't received any notice from my bariatric program or my psychiatrist (I found this out by reading a chart note about the phone call between the two), so I'm not really sure what I should be doing. (Other than the obvious of not binging and continuing to work on my diet and exercise behaviors, like I was doing anyway.)

I appreciate the offer. I've been in therapy focused on BED for half a decade and think I have a good understanding of what's going on with me and I've gone from severe/extreme BED 15 years ago to moderate a decade ago to mild (as of my last meeting with this psychiatrist) to not meeting the diagnostic criteria at all now. I've lost a greater percentage of my body weight before surgery than research indicates a person with BED should expect to lose after surgery. It's more than a little irritating that having self-awareness of the disorder and thus being in active treatment is putting me at a disadvantage when it comes to getting WLS compared to the significant fraction of people who get surgery who have it and are unaware of it and thus have never been diagnosed or treated. Like, if my psych meds were prescribed by my PCP, I wouldn't even be having this problem. But now I have a black mark on my record with this program and I can't just go to another one.

I would look up advice for bariatric athletes online. There's a few dietitians out there who are working with post-surgery athletes and some of them write articles and blogs, but the field is very, very new. Most bariatric dietitians are not going to have the knowledge to guide you if you are exercising seriously and most sport dietitians don't have the knowledge to work around your restrictions and different macro needs during the active weight loss phase and beyond. (And even at the intersection, most of the writing I've seen focuses on athletes after the initial weight loss period.) And I don't fault them for that entirely. Bariatric dietitians are focused on patient populations assumed to be only begrudgingly if at all active and sport dietitians are focused on patients who have no history of morbid obesity so... what can you do. Don't worry about not getting enough carbs and losing muscle though. It's protein that you need to build muscle and it a lack of protein will cause your body to break down muscle. Carbs are for immediately accessible energy during workouts and Crossfit workouts are not long enough to require any additional carbs like a marathoner might need. You will be able to work from what your body has available, which it can convert from fat (from diet or from your excess weight). I would go relatively low-carb per your program's recommendation and notice how you feel during workouts. If you're hitting the wall much earlier than you have in the past (accounting for the fact that you've just gone through major surgery and probably taken significant time off), then maybe try adding a small amount of complex carbohydrate before your workout (something like berries or oatmeal, not something high in sugar natural or otherwise) or switch around the timing of when you eat your carbs and see whether that improves your workouts. Crossfit folks generally recommend a low-carb diet anyway. Disclaimer: I'm not a dietitian, I'm just a Crossfitter who was very concerned about this at the beginning of my surgery process and did a lot of research. I haven't had surgery yet, so I can't give my personal experience.

This is the premis of a particularly charming episode of Doctor Who! (Well, it's actually one of those sorts of things that's horrifying when you really think about it.) But the equivalent of the fat-taking blessed pixies are painfully cute.

Forreal, I think the biggest thing I want out of WLS is a lap for a cat to sit in. Currently, when I go to an animal shelter, the super snuggly cats will look at me and be like "okay, I guess I'll make do" and climb up on my shoulders/chest/upper stomach as a sort of last resort, but they always look up at me like "ok, seriously, this lap is not the correct shape human, let's work on this." But the cats that will sit in an available lap, but don't need it will just pass me up and that breaks my cat lady heart.

Re; being lighter. I especially love the extra motivation to lose weight that's goal oriented, not about aesthetics or some vague notion of health. Every pound of fat that I lose is a pound that goes up on the barbell, essentially for free. And that's something to cherish!

I still have a double+ chin, but I can flex my neck and see tendons now. I watched a video where a bariatric doctor said that not having fat around your neck/upper chest is a good proxy for loss of visceral fat, so I'm stoked. I keep flexing my neck in the mirror whenever I'm alone with one!

The only absolute in biology is that there are no absolutes, there's always an exception or a complication. (That's why I love it!)

I love it so, so much. I started about 4 months ago when my BMI was still north of 60 and I've gotten so much stronger since. We just did a workout to find our 5 rep max for back squats, a move that I could barely do with a PVC pipe on the first day. I could lift all the weight I've lost since starting + more, on a real barbell!, but I didn't have time to find my actual max. Never in a million years did I think that I would be an athlete, and yet...

I play so, so much Beat Saber, probably 5+ hours a week. To mix things up and increase intensity, I step in time to the the music. It takes a little finagling to set up on your machine, but there's a huge community of people who create mods and custom songs for the game. There's a style of song mapping called "fitbeat" that includes a lot more squats, dodging, and reaching to increase your effect, but I usually just play the sorts of music I listened to in high school and college. I use exercise as mood regulation as well as physical health, so sometimes I like to pick music that fits my mood. (I have a lot of very loud metal songs for when I'm angry, lol.) But usually I make a "playlist" by searching my library of 300+ songs with whatever the first 2 letters of that days' wordle answer was. If you're a numbers-focused person, on the Oculus there's a movement/calorie tracking app that I find very motivating. It's probably not super accurate because it only accounts for arm movement, but ... I like numbers.

I'm sure it'll be even better post surgery. I have my first appointment/consultation with the surgery program next week so I'm still at least 6 months out. Hopefully by my surgery date I'll be running up the stairs.

I just walked straight up the stairs, quickly, without getting out of breath, because I needed to get something from my bedroom. Didn't even think about it. I used to have to haul myself up with my arms, stopping on each step. Now I'm looking for excuses to take the stairs just to show off!

In my part of the US we call that angel food, not to be confused the with cake by the same name. Used to be my favorite Christmas treat.

Asking the specific why questions is bound to leave you extremely frustrated, because the truth is that these plans, even more than most of medical practice, aren't well-studied and are pretty arbitrary. A lot of guidelines seem to be trying to outwit the assumed devious and/or stupid fatties, the sort of person who if given permission to drink coffee will drink a venti Carmel Salted Caramel mocha. So they tell everyone not to drink coffee. I was previously seeking surgery from a program that disallowed steaming your vegetables in the pre-op diet---raw broccoli only!--presumably because then you might get the idea that you could have cooked vegetables in any form and cooked vegetables will probably be fried in oil or slathered with cheese sauce. Ergo, no steamed veggies for you, dumb fat person who thinks that cheese sauce doesn't contain any calories. There's no way to tell which guidelines are based in actually demonstrated science, which are at based on a plausible mechanism, and which are just the random things that seemed to work for that particular surgeon or nutritionists' past patients. You can ask, I suppose, but I'd guess that they're not going to appreciate it, because most people in the medical field do like to think that they're doing evidence based practices, even when they're just... not. And there's also no guarantee that the explanation is going to be the truth. The signpost I use to see whether a source is BSing is whether they claim that you need to drink only water because caffeinated beverages are dehydrating. 1) It's not even plausible, since caffeine is a very weak diuretic so the net fluid balance would be positive unless you're taking caffeine pills with just a sip of water. 2) It's actually been studied frequently since it's such a ubiquitous myth that's so easy to test, and found to be false, even with doses of caffeine much higher than typical consumption. The reason you need to drink only water is so that you don't have permission to consume liquid calories and you can't be trusted not to consume liquid calories if you're allowed no-calorie liquids other than water... that's it. Just jump through the hoops they want you to. Some of them are genuinely there to limit reflux or to keep you from ripping your internal stitches open and some of them are there because you can't be trusted and there's no telling which ones are which. It's just food. Signed, a medical researcher for whom giving up the tea habit will be the hardest part of the process.