Awkward customer

Last time I lost a lot on a diet was when I was 30. I lost more than 100lbs in six months, and I had no problems with excess skin. This time round, I have just been banded, and I am 40, and a little concerned my skin elasticity won't be the same. Am I right in saying that by eating high protein foods (eg tuna) it will help my skin adjust and obviate any needs for skin adjustment surgery? I was thinking about eating a pound of tuna chunks a day...

Btrieger, we have reached the stage where all children are being weighed at school (an invasion of privacy and abuse of human rights, for sure). See this slim 5-year-old who was told she was fat at Mother's fury as nanny state brands her healthy daughter, 5, 'fat and at risk of heart disease' | Mail Online

ElfiePoo, I think a measure of scepticism about claims that rapid weight loss is dangerous is more than justified. Every claim made by any study is instantly reported as fact by the media, and much of science itself has turned into some kind of policy advocacy where self-righteous campaign groups make themselves feel better by calling for various kinds of action. Think of global warming and the "science" behind that. Think of "passive smoking" - actually disproven by countless studies, but a great source of self-righteousness to those campaigning around it. Obesity itself is yet another one of these campaigns - constant programmes on obesity on the TV strike me as "pornography for the middle class". It has been demonstrated time and again that carrying a little extra weight over the 25 BMI level (and am not talking about morbid obesity) is not dangerous to health, but many health professionals get a self-righteous kick out of the campaign around obesity and continue to assert interpretations that are not backed up by science. An awful lot of false claims are made. There is a fascinating article at Four fat myths about obesity and cancer | spiked about how the links between obesity and cancer have been completely misrepresented by health professionals, particularly so in the case of those with BMI below 40. Then when we do try to lose weight, the self-righteous intone, "you shouldn't be doing that. You shouldn't have lost 4lbs in a week". It is the way in which these studies are reported that is problematic. Eg a study showing-- and this is the type of thing reported in countless studies-- that "20% of people who are 30% overweight are more likely to develop condition X" would be breathlessly reported by the media as "having proved a link" between obesity and condition X. You only have to open the newspaper or turn on the TV to be subject to numerous examples of this sort of thing. "10% of children whose parents are at least 20% overweight are 15% times more likely to develop condition X on 5% of Tuesday mornings". The key weasel word is "linked". Something is "linked" to such-and-such a result. But "linked" is not a scientific word. A weak statistical link - which is what we are talking about in nearly all these studies - does not prove anything. In the case of weight loss and gallstones - yes, one can see that without the right mineral balance weight loss "can" lead to gallstones. So, are we saying that 90% of very large people who lose 4lbs a week in the first three months of a diet, before the weight loss slows down as they themselves become smaller, will lose their gallbladders? By posing the question that way you expose the "advocacy" at the heart of these health campaigns: they could not answer yes to a question posed in that way. Loss of the gallbladder is statistically not the most likely outcome from rapid weight loss. Rapid weight loss is just a heightened risk factor - and a fatty diet that many obese people consume is itself a heightened risk factor for gallstones. There seems no sense of proportion or perspective in most of these claims. Crossing the road is "a heightened risk factor" for a collision with a car. In the end overweight people - people whose BMI is in the 40s, not people whose BMI is 25.1 - need to lose weight, and for them to lose 3-4lbs a week for a while, slowing down eventually to 2lbs a week, and then taking steps to keep it off for life -- that's healthy. That's what they need to do. Who knows if by losing 15 lbs in the first month the dieter has not warded off what would have been a massive heart attack or stroke that was coming? These people who talk of "links" and "risk factors" are probably mainly trying to raise money for their organisations--they are forgetting that morbidly obese people are "at risk" of strokes and heart attacks, and a small statistical possibility of gallstones by losing weight fast is not the only thing they have to consider. Much of this "science" shades off into charlatanry.

The Wikipedia article says on the Harris-Benedict equation "The equation does not take into account calories burned by existing large amounts of muscle mass, nor does it account for the additional calories provided by excess body fat—so the equation is more effective for individuals at an ideal body weight or close to it". That means the equation overestimates the amount of calories burned by very overweight people, and underestimates the amount of calories burned by very muscular people. So it is only a guide.

Oxtail soup and cream of tomato soup are both wonderful

There is a US handheld calorie calculator with a database of 5000 foods at Electronic Mini Handheld Calorie counter Fitness Planner by Vivonic NEW in Box, but I don't think all US foods are available in the UK. Is there a UK equivalent? I know Weightwatchers do handheld calculators, but they are "points" rather than calories. Can anyone suggest anythign?

The nearest thing I could find is this: Weight Loss Resources Food Diary Calculator

It is explained a little more neatly on one page at Harris-Benedict equation - Wikipedia, the free encyclopedia

The question of whether you can lose 4lbs a week - I know a large man can maintain that pace for months on Weightwatchers - depends on how big you are. Let's use the Harris Benedict Equation (Harris Benedict Equation) A man like me of 340 lbs, 6 foot, 40 years old, little exercise would require 3392 calories to maintain his weight. By reducing that to 1392 calories a day, he would lose 4 lbs a week (as 1 lb =3500 calories). Clearly that pace of weight loss could not be sustained by everyone. Using the same formula: A woman (like my sister) of 224 lbs, 5 foot 7 inches, 39 years old, little exercise would require 2102 calories to maintain her weight. Even a 1000 calorie a day diet would only save her 7700 calories a week, equivalent to 2 lb. It would not be possible for such a woman to lose 4lbs a week for a long period. To experiment with these figures: work out your BMR (basal metabolic rate) using BMR Calculator, and then multiply by your activity factor (Harris Benedict Equation). That gives you the daily calorie intake needed to maintain weight. Anything below that will lose weight, but 3500 calories are required to be lost to lose one lb.

Thanks. I'll try that book.

Let me clarify. I have previously done well on the Weightwatchers diet, but have this time round found it hard to get into. I asked the hospital whether I should follow the Weightwatchers diet after banding. They said no - I could cancel my WW membership, as no specific slimming club memberships were required. The band would help me on its own. Actually I am not sure this was good advice. The weightwatchers principle starts you off eating quite a lot and reduces your allowance as you lose weight, with the result the weight still comes off. I think the general principle is 70 calories is one WW point and 4 grams of saturated fat are one WW point. So if you have something with 140 calories and 8 grams of SF, then that would be 4 points. I would start off on about 39 points and then gradually be allowed less as I lost weight. But I am not sure when I start eating real food that I would be able to eat the 39 points - that is actually quite a lot o food. Should I target calories? or calories and SF (as with WW)? or what? Or just forget calories and SF and let the band control my portion size?

Hi, Dr Watkins. I wonder if there is a book specifically about how to lose weight with a gastric band. Can anyone recommend any book?

You are doing brilliantly. I am sure you will be a great success on the band too. I wish you every success with it!

I am male and my doctor told me men do better on the band. Why should that be? Because they often don't have to prepare food for others?

Well, let's wait and see how much I lose first. I could lose 40 lbs in 3 months with Weightwatchers when I could be bothered to stick to it, and my main problem has always been overeating. I could buy food and put it in the cupboard, thinking "I'll have one packet of crisps (potato chips) out of that 6-pack per day", and then find myself having all six packets in one go in the form of crisp sandwiches. Or I would stick to a diet all day, and then suddenly in the evening decide to order a half-pound cheeseburger, a portion of chips (french fries) and a kebab. I think the band will be great for someone who likes to eat in bulk. Obviously, the exact amount you lose depends on what you are eating, and also how much exercise you do. The band does not come with a babysitting service in tow. The people here who are convinced I will lose just 1-2 lbs a week may be right, but if I want to do better than that, it is all up to me to make it happen too. Another thing is the 3 meals a day advice. I often used to skip breakfast and lunch and just eat one meal a day at 7pm or 8pm. I know people advise against that. But I found that when I started the day by eating breakfast, I would then progress on to lunch and then eat just as much as I would have at 7pm or 8pm later on in the day. But portion control may help me have three non-excessive meals a day. I agree with people that if you are losing 1-2lbs regularly, then it is coming off, and that is something to celebrate, especially if it is coming off for the long term.

Well, this is day 7 after my op, and I have lost 5 lbs, but I could have lost more had I not drunk so many shakes over the past 2 days. At first I hardly felt like drinking anything, but over the week I got more and more hungry - I was told to make the shakes with semi-skimmed milk, as I need the vitamins in my first 2 weeks, but I worked out that each Slimfast shake with semi-skimmed milk is only equivalent to 4 Weightwatchers points - so 3 shakes a day, at 12 points, is a very low intake for me; if I were on the Weightwatchers diet, I would be allowed 39 points a day. As I realised I could cope with drinking more, I started to have 5 shakes a day and a tin of soup. I now realise that liquids are going to be the real Achilles Heel with a gastric band - it would be so easy to drink a lot, I will have to make sure not to buy too much liquid stuff/shakes/ice creams etc. So I am back on 3 shakes a day for now, but I think all in all 5 lbs is not too bad for the first week.

I don't believe the nonsense about "safe" weight loss of only 2lbs a week. This is a PC bit of nonsense along with the multiple other "scares" we are subject to. Why is 2lbs safe than 5lbs? 5lbs could be much safer if you are in danger of a heart attack. See Fast Weightloss - the dangers of losing weight too quickly for a list of the "dangers" of rapid weight loss. They are: You might wonder where the "danger" is then. Er... you might put it back on? you will look gaunt? you might need vitamins? er... er... where is the "danger"? 2lbs a week would not be fast enough for me to justify weight loss surgery. Period. It is not "safer" than a faster weight loss. I want 3-4lbs a week at least. Just because I am overweight doesn't mean I swallow every detail of the "obesity panic" being promoted in the media.

It is now my sixth day since surgery and I took one of the dressings off - and I was surprised just how large the wound was. It is around 2 inches across. I immediately felt a sense of anger at myself that I would let my health get to the state where I needed such large incisions in my body. Does anyone know if the wound will heal better with exposure to the air now, or whether I should try to keep the dressing on for longer? Thanks.

I was told I could take the dressings off after 5 days and then I could shower, trying not to soak the wound, and when the wound was fully healed, after at least 2-3 weeks, I could have a bath. But you should check with your hospital.

I am slightly annoyed to see that I paid £6250 under a special offer, and that the same company is now advertising the gastric band at £5950. If I had just waited a couple of weeks, I would have saved £300.

Thanks, Ken. The dates are right now. Maybe I just needed to wait a while for the new data to register.

I forgot that US English puts the month first, and so I wanted to write 27 Jan 2010 for my first interview with the doctor, and then 11 Feb 2010 for the surgery, but I got: First Doctor Visit: 27 Jan 2010 Surgery Date: 2 Nov 2010 However many times I re-edit the profile, I can't seem to change those dates - especially the second one, which is just wrong.

Yes: that's where the notifications went - into the spam folder!

Thanks I'll look out for it!

I don't think there are staples or steri-strips. I was told my doctor uses some kind of "skin glue". You are right I should channel my annoyance with myself into changing my life. My family keep saying to me how exciting it is, and how I have a chance to change my life, but I suppose I will be more "excited" when the wounds have healed, and all the pain gone away! I suppose everyone doing this operation has a feeling of a little bit of excitement or hope tempered with regrets... If it all works over the next two years, I will never look back, though - and the doctor told me I would probably add 10 years to my lifespan by doing this operation - and I would like a nice long retirement!!