SpartanMaker

It might be challenging to find someone from the message boards. The thing is, just like most medical professionals, a therapist needs to be licensed in your state of residence. In other words, you'd have to find a therapist that's licensed in Texas, or they can't legally treat you.

Typically, the purpose of the Psyc visit is not to provide you therapy, it's to assess your readiness to undergo the procedure. Think of it much like any other doctor they might want you to visit to receive clearance prior to surgery. For what it's worth, the reason the insurance carriers require it is because it's considered best practice by the ASMBS. The psychologist or psychiatrist will evaluate several things, such as if they believe you are a suicide risk, if you are capable of mentally understanding the lifestyle change you will be undergoing, if they believe you are in an abusive relationship, if they believe you have any mental disorders that would disqualify you from surgery, etc.

One of the best ways would be to think back and remember if there was a point as an adult that you felt healthy and happy with your weight? If so, that's where I'd start. If not, better to err on the high side. You can always adjust down if you get to your goal and are still not where you want to be. For example, right now, you're lean mass is ~144 pounds. That means any BMI based calculations would be too low. Yes, you'll lose some lean mass as your weight goes down, but not enough that you'd be at a healthy weight in that 104 to 140 range. My gut tells me maybe 175-180 would be a good target for you at this point. Depending on how much lean mass you lose, that would put you in the 25 - 30% range for body fat, a healthy amount for a woman.

If you have not tried "Fairlife Nutrition Plan", esp the chocolate, it's one of the best tasting shakes I've ever had. It's a lot like drinking chocolate milk. I've heard their other flavors are good as well, but I've not tried them yet.

Ah, you must be using a mobile device. I assumed incorrectly you were on a PC. Glad you figured it out!

Below a post, there's a quote button. press that and it will do what you're looking for. Also, if you only want to copy a part of their response, you can edit the part in the quote box.

Yes, any milk protein will have both. The problem is they generally don't give the percentage of each. There is research out there that different percentages of casein vs. whey can have different effects, but at this point, we're probably only talking about differences to elite athletes.

Everyone reacts differently, so I don't think I'd be too concerned at this point. For bypass patients, liquids tend to flow right through your new pouch (there's nothing to stop them any more). I suspect when you hit solids, you'll realise just how quickly you get full. If you're really concerned, it's best to talk to your surgeon.

Ouch, I hope not! Ten years ago, the accepted opinion was the whey protein was superior for supporting weight loss and preventing muscle catabolism. More recent research supports that a combination of both whey and casein is superior. I specifically picked the 2 brands I did (Premier Protein and Fairlife), because they were both milk protein instead of just whey. I don't know if this will work, but I'm going to try and post some links to research that supports this view: https://www.pnas.org/doi/abs/10.1073/pnas.94.26.14930 https://link.springer.com/article/10.1186/1743-7075-10-46 https://pubs.rsc.org/en/content/articlelanding/2021/FO/D0FO01960G https://journals.physiology.org/doi/full/10.1152/ajpendo.00106.2012 https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/effects-of-hydrolysed-casein-intact-casein-and-intact-whey-protein-on-energy-expenditure-and-appetite-regulation-a-randomised-controlled-crossover-study/C90335661B4E43ACA05E7C80032D951F

Well at the end of the day, you have to follow their recommendations I guess. It's a shame, as I think they have some unsupported beliefs about certain types of protein. I'd love to see the research they are basing this on, as I'm not really finding anything other than internet lore.

Oh no, sorry about that! Just remember it's for your safety in the surgery. We all just have to grin and bear it I guess. I definitely don't want to be one of those people that my surgeon starts working on, only to be told they couldn't do the surgery because my liver was too big!

I find this really odd? Premier Protein is Milk Protein, meaning it contains both Whey Protein, and Casein. Both are considered complete proteins, so I'm not following the comment about it being blended or unable to be fully absorbed. Both are present in all mammalian milk, including human, though the amounts can vary from animal to animal. In cows milk, Casein makes up ~80% of the protein content. Milk Protein actually replicates that. Typically Casein is slower to metabolize, meaning it should help tide over the hunger longer. Whey Isolate is quicker to metabolize, so would be great as a recovery drink after a hard workout, but may leave you feeling hungry sooner.

Agreed. The study I referenced above is older, but even that one suggested this: Healthy Body Fat Guidelines*: Age Women Men 20 - 39 21% - 32% 8% - 19% 40 - 59 23% - 33% 11% - 21% 60 - 79 24% - 35% 13% - 24% Those BMI based calculators also don't take age into account.

I wouldn't worry about it. I've looked for, but have not found a "definitive" guide as published by the ASMBS. To some extent I think these guidelines develop over time as the doctors adjust to their own preconceived ideas, as well as what their patients are telling them about their experiences. Some doctors (like mine), are very conservative in this regard, and others have looser standards based on what they've seen in their practice. In the end, I think they all work to accomplish the goal of shrinking your liver for surgery. Post-op is the same. Some plans are much more conservative than others, but long term loss shouldn't really be impacted by how soon you eat solids, for example. .

I'm not even allowed the yogurt preop! The one thing they said I could have is one cucumber or pickle per day if I needed something to crunch. I bought a huge jar of pickles this week. 😁

I understand, but the problem is that for most obese people, the number these simplistic calculators spit out is way too low. None of them take into consideration that obese people have things like enlarged hearts, denser bones, more blood volume, extra skin, etc. in addition to the fat. While some of those things will eventually change over time, it's not nearly as quick as the fat loss, especially for bariatric surgery patients. I've seen way too many people shoot for weights that are unrealistic and frankly would be unhealthy for them. That's why I said pick a higher number and reassess there.

To put it simply, Ideal Bodyweight is a crock. These are all based on one of 3 things: BMI, population studies like the NHANES survey, or body fat %. None of these can tell you what YOUR ideal bodyweight should be, only what an average range of weights might be. Why? Let's look at these individually: BMI: Frankly the fact that this psuedo-science is so widely used is downright scary. This is all based on a formula created almost 200 years ago by a mathematician (not a physician), trying to determine what an "average" man would look like. It does not take into consideration muscle mass, frame size, or any thing other than height and weight. As an example of just how messed up this is, consider that some professional bodybuilders fit into the morbidly obese category even though they may only have 5-8% body fat. Population Studies: Studies that look at large populations have the same flaws in that they only look at averages. They are good for understanding population groups, but are not instructive to know what YOU should weigh. Body fat: In general, these formulas are going to be better than the above (as an example, see Gallagher et al., "Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index." American Journal of Clinical Nutrition, 72 (3): 694.), because they are at least based on your stats (% Body Fat), but they have 2 fatal flaws: First, they rely on BIA (Bioelectrical impedance analysis), but BIA is not that accurate overall. Second, Lean mass is also is lost as someone loses weight, but if the estimate is based on body fat alone, it will be wrong. My point is the best way to know what your ideal weight should be is based on how you feel and look once you get there. If you need a goal to shoot for, aim high when looking at ideal weight charts. If you're not happy once you get to that weight, you can always adjust downward.

You might like "This American Life". If you asked, I'm not sure I could explain what it's about, but based on your likes, I'm guessing you might enjoy it.

Same here. Sleeves can often make this condition worse.

I think it came back from insurance in a couple of weeks, but due to the backlog at the clinic, it took them about a few weeks to submit it. The biggest delay was just getting on the surgical schedule. I think they are still running at a reduced schedule due to COVID, so the delay to even get on the schedule can be a month or two. Also, based on previous experience in this area, most facilities only schedule out a couple of months at a time, so like clockwork, I got my date exactly 2 months prior. I trust the surgeon, she is very experienced, but I think the hospital and staff are just swamped with a huge backlog.

Hopefully it doesn't take you as long as me! I had all the pre-work done by May and it took 4 more months to get insurance approval and get on the surgery schedule. Now some of that I suspect is because I'm going to a large teaching hospital and their schedule is still massively delayed due to COVID.

Ah, got ya. Not sure about how your procedure differs from other sleevers, but they may be better able to advise on how they are on sugar. I wanted to suggest you try the monk fruit sweetener (with erythritol), and see how you tolerate that. I find it's a little better for me in terms of taste and side effects compared to many other sugar substitutes.

I sincerely mean no disrespect, but I'm honestly a little confused? You said you did the surgery to change your relationship with food, but here you are a few days post-op and already asking if you can deviate from your prescribed plan? This seems incongruent to me. If you're really serious about changing your relationship with food, why deviate so early?

I took the first thing they offered, but was given the opportunity to reschedule if that didn't work. I took it because there's never a "good time for it", and I wanted to have it done as soon as I could.

May depend on the insurance. Some may want to see the person you spoke with have a US credential like RD, or RDN.