SpartanMaker

You are WAY, WAY smaller, but you know what I like even more? The big smile on your face now! Great job!

So re-reading my post above, I think my tone came across as a bit harsh. That was not my intention, so I apologize if that's how it's interpreted. What I was trying to convey is that you can drive yourself crazy worrying about stuff like this. What really matters is (aside from your abdominal panniculus), are you are happy with your health and body composition right now? if so, then whether it's fat or skin is meaningless, just like a number on a scale is meaningless. On the other hand, if you're not happy with where you're at right now, then put together a plan to address it. For example, are you good with your overall amount of body fat, your muscle mass, your athletic ability, etc.? In short, focus on the things you can change.

This will be my 15th surgery I think? (Obviously not weight loss surgery, but lots and lots of other body parts have needed repair. 😁) It's super normal to be feeling anxious right now. I was worried about every one, and I'm not a worrier. Heck, I'm worried right now about my bypass and I still have 3 and a half weeks to go!

Going through same stuff. Presurgery stuff on the first and second, followed by the COVID test on the 18th. I have to self isolate from then, through to the surgery on the 20th. My wife is none too happy since the 18th is our anniversary. I'll just have to yell happy anniversary from the other room!

Does it matter? The truth is, it's likely both. Fat doesn't float around in our bodies (if it did, it would all eventually end up in our feet!), instead, it's attached to other things. As the largest organ in our bodies, skin is a great attachment point for fat, especially in the belly region. Here are two other hard truths: One, a certain amount of body fat is healthy. In fact, without essential levels of fat, you would likely die when certain cellular functions stopped. Two, contrary to what some people think, it's impossible to target fat loss in specific areas. Where you store body fat is mostly genetic. My point in all that is to explain that you really don't have much control over whether or not that "saggy tummy" is fat and skin, or just skin. If you're otherwise healthy and happy with your both composition, you can think about plastic surgery to address the issue.

Yep, this sounds to me like a vitamin deficiency, most likely biotin. In other words, this is most likely related to what you're eating, not how you style or treat your hair.

I know, right! Oh wait... Checks profile, hmm, maybe I'll stay out of this one... 🤣 Seriously though, sorry you're dealing with this. We're not all bad, I promise!

Eat lots of salty foods? 😁 I say that only half in jest. Since you just have to maintain a certain overall weight and not actual body fat, water weight will work just fine for you to "maintain".

Great job, HUUUUGE difference! Hope you're feeling better as well?

I'm still pre-surgery, but that sounds a lot like a problem I sometimes have that's attributed to a hiatal hernia. I think you need to call your surgeon. My guess is they'll have to do some imaging, starting with a barium swallow, and maybe an endo.

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. 😁