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For someone trying to lose a substantial amount of weight, the idea of building muscle may sound counterproductive. You may fear that it will make you larger and bulkier. Don’t worry: Muscle is a very dense fiber that actually takes up far less space than fat! Let’s start by defining what is meant by “strength training”. This term loosely refers to the use of resistance -- in the form of machines, free weights, bands, or even one’s own bodyweight -- to increase the strength and size of muscles. (We’ll get into more specifics later.) For someone trying to lose a substantial amount of weight, the idea of building muscle may sound counterproductive. You may fear that it will make you larger and bulkier. Don’t worry: Muscle is a very dense fiber that actually takes up far less space than fat! In fact, you should worry more about losing muscle. Muscle is increasingly hard to develop as we age, yet it’s incredibly important to maintain for a variety of reasons. Sarcopenia -- essentially the wasting of muscle -- is a condition that contributes to a significant number of health problems. In his 2006 study, “The underappreciated role of muscle in health and disease”, Robert R. Wolfe found that: “Both cardiac failure and cancer are often associated with rapid and extensive loss of muscle mass, strength, and metabolic function (cachexia)” (American Society for Clinical Nutrition, 2006). The fact that muscle plays a tremendous role in metabolic function explains its significant impact on overall health. In addition to burning significantly more calories per day than fat tissue, muscle tissue also helps to stabilize blood sugar and hormones. A study conducted by researchers in the Life Sciences Institute at the University of Michigan found that white muscle, the type formed through resistance training, utilized glycogen and controlled blood glucose more efficiently than red muscle, the muscle associated with cardiovascular training (Williams, 2013). This is not to say that cardiovascular exercise is not important, only that strength training is also highly beneficial. In addition to building new muscle, resistance training can prevent the catabolization (breakdown) of the muscle you already have. According to the National Council on Strength & Fitness, “Losses of lean mass during the ‘dieting’ process reduce the caloric contribution of muscle and just 10 kcals/day equates to the metabolic equivalent of one pound of fat in a year” (“A Pound of Muscle Burns 30-50 Kcal/Day, Really…”, n.d.). Therefore, in order to properly recover from training and preserve muscle, you may need to increase your protein intake. Speak with your nutritionist about how much you need! Not only does building strength affect you physically, it can also greatly benefit your mental health by boosting confidence and self-esteem. You will stand taller and feel more grounded in your own body. You will feel more powerful and competent in all areas of life. And, as a bonus,, building muscle can help improve the appearance of loose skin caused by losing large amounts of weight. There are a few things to consider before beginning a strength training program. Most importantly, as with any workout program, always consult with your physician first. Those with high blood pressure may be discouraged from lifting particularly heavy weights until the blood pressure is controlled. You then need to consider the safest and most efficient exercise equipment. For example, machines are rarely a “perfect fit”, and they also dictate a single pattern of movement that may not be ideal for the mechanics of your body. However, most machines are used while seated, so they might be a good option if you have difficulty standing. Using free weights, cables, and bands allows you to move more naturally and in a space that feels more comfortable. In addition, training with these tools (as opposed to machines) will force you to use your own body to do much of the stabilization. In other words, you do more work, and, as a result, burn more calories. When you start an exercise program, start with low weights and high repetitions (around 12-15), as performing repetitive actions many times creates the neurological pathways for new movement patterns. This initial phase of training is known as the muscular endurance stage. As form and endurance improve, gradually lower the repetitions and increase the weight, in order to build muscular strength, or “a muscle’s capacity to exert force against resistance” (Cespedes, 2013). A repetition range of 8-12 will cause hypertrophy, the point at which you begin to see an increase in the muscle size, while six or fewer reps results in the greatest improvement in actual strength and power. With resistance training, you will need to rest between exercise sets in order to give your muscles a chance to recover. As a beginner, stick with one exercise at a time to allow your body to acclimate and adapt to the new stressors you’re placing on it. Once you’re ready for a little more of a challenge, you can try supersets, or circuits. These terms refer to combining two or more exercises in sequence, generally for different muscle groups, so that one muscle group gets to rest while another is working. This also keeps the calories burning! For example, a simple circuit could include bodyweight squats, seated rows, and planks. Another way to “up the ante” on your calorie burn is to choose triple-joint or compound movements, as opposed to single-joint or isolation movements. Examples of triple-joint exercises include squats and bench presses, as opposed to single-joint leg-extensions or bicep curls. Movements that require you to move more joints engage more muscle fiber, because they use larger, more calorie-consuming muscles. So, in addition to burning more calories, these movements can increase the efficiency of your workouts and save you time. Speaking of joints, strong muscles stabilize joints and can help you avoid injuries. However, performing an exercise in bad form can actually harm your joints. Muscle soreness is fine, but do not push through sharp pain in a joint, as pain might a red flag that you are not doing something correctly, or that your body is not ready to move in a certain way. Ask a personal trainer or physical therapist about modifications or corrective exercises. It can be tempting to want to show off, but always prioritize form over weight! As long as you have medical clearance, try adding some resistance training to your workout regime. It can boost your weight loss and be a fun break from the monotony of cardio! References A Pound of Muscle Burns 30-50 Kcal/Day, Really… (n.d.) [retrieved from https://www.ncsf.org/enew/articles/articles-poundofmuscle.aspx] Cespedes, Andrea. 2013. The Difference Between Muscular Strength & Muscular Endurance. Retrieved ___________ (http://www.livestrong.com/article/154326-the-difference-between-muscular-strength-muscular-endurance/). Williams, Laura J. 2013. Lift weights to lower blood sugar? White muscle helps keep blood glucose levels under control. University of Michigan News. Retrieved from http://ns.umich.edu/new/releases/21363-lift-weights-to-lower-blood-sugar-white-muscle-helps-keep-blood-glucose-levels-under-control Wolfe, Robert R. 2006. “The underappreciated role of muscle in health and disease”. American Society for Clinical Nutrition.

Please help, I just got a denial letter from my surgeons office saying that I didn't have 2 comorbids that have not responded to maximum medical management that are generally expected to be reversed or improved by bariatric treatment!!!! My BMI is 35.6 my comorbids are a high cholesterol of 254 and sleep apnea. I have had high cholesterol for years with no medication and I have had a sleep study done years ago but I dont use a cpap. Any ideas on how to appeal this decision?? My surgeon's office submitted all other requirements. I have tried other weight loss methods like weight watchers, used phen phen, atkins diet, dexatrim, slim fast, scarsdale medical diet, grapefruit diet, etc..Any info would help... I am desperate !!! I am scheduled for surgery on November 4th supposedly. Very upset and can't stop crying here..

Hello everyone! I was just sleeved on 10/16 and my doctor doesnt have me starting my Vitamins until I'm in stage 2 of my diet which won't start until after I see him again on 11/1. There's not a whole lot out there by way of bariatric Multivitamins but the main ones I've seen are Opurity and Optisource. I do see that OptiSource is available at Walgreens, which I love that I could just go pick it up but it requires you to take 4 pills a day! Opurity only requires one and all the reviews of it on their website are great, but a quick jump to Amazon shows people saying it's DISGUSTING! My bariatric coordinator mentioned it tasted liked sweettarts, and OptiSource like tang but wanted to get some more thoughts. Thanks =o)

I got alot of celebrate samples and it is what my doctor recommends. My bariatric coordinator at the hosptial also told me it's best to stick with the ones designed for bariatric patients because they are made to work and dissolve better with our bodies.. They dont seem to be terribly expensive either and from what I see they are jam packed.. What's your favorite flavor?

I was banded by Dr. Kurt Roberts with Yale Bariatric group in New Haven, CT. Was banded on December 18th, 2008. Have had one fill of 1 1/2 cc's. I really don't have any restriction. I eat about a cup to a cup and a half of food and would love to eat less. I have lost 18lbs, but that was in the first two weeks. NOTHING since. Can anyone tell me what the 'norm' is? I feel like such a loser that I can't even lose a single pound!! I'm beginning to regret this surgery and thinking of gastric bypass. Please help! I will take any type of feedback you are willing to give. Thanks bunches! Brandy

hi theekimmy my bmi was too low for anyone i contacted in the u.s. to do surgery on me. I found dr arturo rodriguez in monterrey, Mexico who did band surgery on me 9/24. about a week afterwards i went to nyu's bariatric center and had dr. george fielding check arturo's work. fielding said Rodriquez did an excellent job. rodriguez' fee wasd $7900, a third of what i would have had to pay at nyu. dr. fielding also said that he would band patients whose bmi's are too low (according to most docs) but who have good cause to get the band. (i had the band put in mostly as a prophylactic measure because of side effects from drugs i will have to take for the rest of my life from newly diagnosed lupus). here is the contact info for both docs: dr. arturo rodriguez: md@thebariatric.com dr. george fielding: (212)263-3166 good luck anya

This is going to sound really weird, but my bariatric nurse told me that those of us who have been carrying around all this extra weight for so long actually have heavier bones. Our bodies have adapted to be able to handle the stress. I'm not sure if I believe her yet, but I guess time will tell.

What did they told you at your bariatric clinic? Protein is something very important for us bariatric patients . You are not going to work out now because you just got sleeved but eventually you will start your own work out routine. Everybody that had surgery is been drinking protein shakes etc even before working out and I haven't hear about any problems. At least I haven't had any problems with my kidneys so I will say go by your surgeon instructions and forget about your friend lol You need that protein!!

That's perfectly fine to drink the shake in 30 minutes. The swelling in your stomach has gone down and allows the liquid to pass right through. However, you now have absolutely no excuse not to get your water in every day! You won't really start feeling restriction until you start eating soft foods That's also when you start being able to feel "full". One tip for the hunger: Sugar-free jello, DON'T CHEW IT WELL! It will be slippery enough to get into your stomach all right, but it will take your stomach a while to break it down, so you feel full for a while. The little ready-to-eat cup is the perfect size! Good luck! p.s. In my area, bariatric support meetings are open to everyone, even if you didn't have surgery at their facility. Maybe you can find one near you?

Marty, please go check out the Insurance forum. As I recall there are quite a few folks there who have had UHC. Also, just a word of caution, if YOUR policy does not cover Adjustable Gastric Banding because of an EXCLUSION, then you are sadly stuck. Just because you and I may both have United, my employer may have paid for a Bariatric surgery rider, but yours may not have. That is why you may not have coverage, but I may. Good LUCK! I hope this helps.

I have BCBS also. I had to have my surgery at Blue Center of Excellence also. The good thing is I had decided to use surgeons there to begin with and am not disappointed at all. We have a local doctor that does this surgery occasionally but the surgeons at the Blue Center (which was about 30 miles away) do approximately 300 of these a year. I appreciated the thoroughness. I am 63 and was checked by a cardiologist and pulmonary doctor, pre-op and post-op I've seen a psychiatrist, dietician, and a fitness/exercise specialist. My surgeon's office is in the same hospital as the surgery was performed. One whole floor is dedicated to bariatric patients and the nurses all know exactly how to handle any situation. It can be frustrating with all the hoops you have to jump through but hang in there. It is so worth it! Sent from my iPhone using the BariatricPal App

I don't think that's an indictment of the band or its safety. It's about poor medical and surgical practice, and I'm glad Allergan is refusing to sell bands to that program now. It's scary to think of general surgeons jumping on the bandwagon without fully understanding endoscopic and bariatric surgery and all the patient education and support it requires. I have banded acquaintances in California who are livid when they see huge billboards advertising clinics like that place who promise effortless weight loss.

The thrill is gone and its a fabulous place to be. Life goes on after the honeymoon. The NSV's , The shock from people around you and being driven by weight loss. Looking back I have to laugh. The high from the honeymoon was incredible..I even thought I had the answers to everything bariatric. The transformation is complete. Finding other adventures and things to overcome and conquer. I'm soooo over it!

I would go into your Dr. and ask him/her. I was at my Dr's for something else and asked if she could give me a referral to a Bariatric Center in the same medical system. Perhaps the Bariatric Dr. or the patient liaison in his staff can tell you if your insurance has approved the surgery for anyone else. I would think if the Bariatric surgeon thinks you have a case he might put in an appeal? I'm just guessing here... anyone out there from Louisiana?

Hi everyone, I wanted to introduce myself. I'm very excited to be on this board. You all are so very supportive of each other and I know that will help me as I begin this journey. I'm Jen, I've been married almost 10 years to a very wonderful and supportive husband. We have one son together. He'll be 6 in a couple of months. I've been overweight most of my life. It's just in the last 12 years though that I've become extremely overweight. I started at around 400lbs and I'm currently at 350lbs. It's taken alot of ups and downs over the last 5 years to get to this weight. I have already talked to my insurance company and I'll need 6 months of supervised diet. So I called yesterday and made an appt with Dr. Stiles to start that process. I am not using my regular PCP because he is very old fashioned and will barely give me medicine when I'm sick, much less help me get approved for surgery. So one of the bariatric surgeon's offices recommended Dr. Stiles. Well, I look forward to sharing in all your journeys.

Hi all---I have two more appointments in first week of November and I think that I have met all of my presurgical requirements for insurance. Do you think I could get a surgery date during my appointment with the bariatric doc? I am a little nervous in the "not knowing stage" and wondering how long it took to actually get an appointment......I am in my fifth month of dietary waiting period---that is with documentation--I am planning my surgery at Allegheny General Hospital in Pittsburgh......anyone else????? also....how do i get one of those weight loss progression things to show my weight loss? I started at 42 bmi, currently at 40---presurgery

I just received my welcome/patient questionaire in the mail today I go for my very first appointment of Bariatric Orientation class on June 26th did some more research and now it's all becoming real for me and I've gotten a little scared and almost want to back out because of it!

That is for sure! Dr. Nowzaradan is a bariatric surgeon. WTF is he doing performing plastic surgery? I have never in my life, through all of my research of plastics and bariatric surgery heard of a surgeon that was doing both. They are both very highly specialized fields! I would never let a bariatric surgeon perform plastics on me or vice versa. It's insane! And the two younger doctors on the show... what is up with them doing tummy tucks with no muscle repair? That's pretty useless! No muscle repair, no lipo, everyone of their patients have a shelf and a terrible scar. Well, I'll cut them a little slack with the scar, because we aren't really seeing the patients a year or more out, when scars will really start to fade. But the no muscle repair or lipo makes it truly just "skin removal" surgery, which is not what most people think when they think of a tummy tuck. It will definitely require later revision with muscle repair for anyone to get the "flat stomach" they are hoping for.

Get back touch with your Bariatric team. They will be able to analyze what's going on with you and your journey. Please, give them a call, make an appointment and come back here and let us know their recommendations. We really care. We're just not familiar enough with your program to be of any real help. We can only generalize. You and your journey probably just need a little "tweaking". You can do this. You already are...

For a multitude of reasons, the weight loss surgery journey—mentally and physically-- is easier for some than others. The first month or so can be understandably challenging. I have treated hundreds of weight loss surgery patients here in New Jersey and can assure you of one fact: It’s probably not going to be smooth sailing from day one— like real life, there are going to be some obstacles thrown in your path. I’d like to help you overcome some post-op issues that may come up: Recover From Your Operation First, Then Focus on Weight Reduction You’ve prepared for weight loss surgery for a long time and you’re eager to start shedding those pounds--right now. But first, it’s far more important to heal properly after your operation. As a result, you'll very likely lose weight faster and avoid complications which could potentially set you back. “I’m Not Losing Enough Weight!” That’s a common concern and one that is certainly justified! Often patients think they will never be able to overcome obesity and metabolic disease since WLS was a last-ditch effort after years of dieting didn’t work. Keep your nutrition diary updated. Keep moving. Drink all that water every day. If you didn’t see the scale move this week, you’ll be happier next week. If not, call your bariatric doctor to take a closer look to determine what is causing this temporary setback. Doubting Your Decision I view the first few weeks or even months after weight loss surgery as a perfect storm for generating self-doubts about your choice to have the sleeve, gastric bypass or the lap band. You now realize that subscribing to a lifetime commitment of changing your eating habits and lifestyle is a pretty big deal. Additionally, you have not eaten solid foods for weeks, which can also be unnerving to some people. These feelings are completely normal—and temporary. You’ve undergone a big life change that’s going to take some time to get used to. Just make a little note to carry with you that says: 1) You are fighting back against obesity-related diseases. 2) You are lengthening your lifespan. 3) You are going to enjoy a significantly improved quality of life. 4) You will look better and feel great every day. Comparing Your Weight Loss to Others Everyone fighting obesity is completely unique. While Bob may lose 28 pounds in the first month, Linda may lose only 15. Months down the line, the weight loss figures even out, more often than not. Think about it. A general round number for great first-year weight loss after bariatric surgery is 100 pounds. That’s an average of 2 pounds a week, or 8 pounds a month. If you lost 20 pounds in your first month, you’re doing fantastic! To hit 100 pounds in your first year, you won’t even lose a pound every three days. Don’t worry if the scale doesn’t go down every single day. If you’re eating right, you’ll lose weight. Better yet, only weigh yourself about once a week. Take Weight Loss Surgery One Day at a Time No matter how frustrated you may feel at times, stay positive and focus on following your bariatric team’s instructions to the letter. Continue to eat a liquid diet and then pureed foods. Use this recovery time to plan a day-to-day system to help achieve your long-term success. Learn to measure your food. Schedule specific days/times for food prep, sleep and exercise. Should you have any pain or discomfort of any kind, call your doctor sooner rather than later. (Yes, it’s often gas, but it’s better to be safe than sorry!) We want to hear how you’re doing, I assure you. Weight loss surgery is a lifetime adventure. Your world is changing for the better. When you are temporarily frustrated or disappointed, move forward, look ahead. Because your future is going to be very bright (and healthy!) indeed. (Photo Credit: Courtesy Witthaya Phonsawat via freedigitalphotos.net)

Hello all. I have never been so excited for and terrified of a date on the calendar as I am of June 18th. I cannot explain the number of emotions that I go through each and everyday. The anticipation of a healthier and more productive future and the gut wrenching fear of undergoing a surgery that will change every aspect of my life. Let me introduce myself. I am a 42 yo female who had become very comfortable on her obese life weighing in at 360 lbs. I have a great job, a loving boyfriend and a supportive family. From the outside looking in you would think she has it together except for the fact that she is thick. Thick is what I considered myself. I fortunately never was a victim of weight prejudice or fat shame, at least not to my face or where I could detect it. I have always carried myself with grace and class. I held my head high and moved through my life seemingly effortlessly. As I got more comfortable in life , I got bigger. I started to notice I was having pains that I never experienced before. I was having mobility issues. I thought it must be that I'm getting older. My world came tumbling down when I literally went tumbling down. I fell. Not doing anything out of the normal, I took a step and gravity was not my friend. I got up and was in excruciating pain and cannot walk. I as taken to the ER. This is when the story gets good. I find out that I need a complete hip replacement. The surgeon refuses to do the surgery until I lose 40-50lbs. Diagnosed me as morbid obese. Refers me to a bariatric surgeon. I see the bariatric surgeon, he's a really nice guy, I feel comfortable with him. Contact my insurance, they don't cover WLS. The insurance company covers it but my company excluded it no uncertain terms in our policies. I have to come up with $15k to cover surgery. I gather every financial resource I can come up with the fund needed for the surgery. So here I sit. I completed my psych and nutrition evaluations. I have appointments this week for EKG, chest X-ray, bloodwork and ultrasound of my gallbladder. I officially start my pre-op diet next week. I have been doing parts of the diet since I received it. I have lost 20lbs since I unofficially started the pre-op diet. I am hoping that by joining this community I will be able to get and be support for us folks going through this journey. Hope to hear from you soon.

Shianne Burns Gastric Bypass @ Boston Medical Center Referral date: 12/06/17 Bariatric program start date: 1/22/18 Program finish date: 5/30/18 Approval date: 6/12/18 Surgery date: 8/8/18

For those in the NYC area, I just received an email from NYU Bariatric Group. There will be a clothing exchange on September 7th. I've cut and pasted the info below. I'm bringing a bunch of things that no longer fit me and were very gently worn including my winter coat from last year. I hope everything gets taken. I also hope that others on this site stop by to drop off or pick up new things. Join us in midtown Manhattan Sunday * September 7, 2014 * 11 a.m.–2 p.m. qwetyuip[asdfghjkl;' Where: BOTTOMLESS CLOSET [in the Hotel Pennsylvania opposite Penn Station & Madison Square Garden] 401 Seventh Avenue, Level B, Suite 40 (bet. West 32nd and West 33rd Streets) *** Take Elevator #1 to Level B; follow signs *** Everything must be clean, intact and ready for wearing. Intimates (e.g., workout clothes, underwear, swimwear, sleepwear, socks, hosiery) must be new/unused/unworn. Accessories are great (belts, jewelry, scarves, neckties, purses, shoes, etc.). Dressing rooms are available. If you need nothing now, feel free to stop by with items you're no longer using and stay for the conversation. Bottomless Closet, our host, helps disadvantaged NYC women enter and succeed in the workforce and improve the quality of their lives. All items not adopted during our event are donated to BC. Documents will be available for tax purposes. Contact bandsterswap@yahoo.com if you have any questions about the exchange. If you'd like to help set up, please come at 10:00. If you're able to stay a little past 2:00 to straighten up, please do.

very very very bad idea. Lap bands have terrible complications and as of right now a 50% failure rate. the odds are extremely high you will do irreversible damage. there are Bariatric patients out there who have done band over RNY (never heard it for sleeve) and they can never have another revision because it could be fatal for them. my local center of excellence currently has an 80% removal rate...80%. there are countries that have banned the band. the conventional revision path from a sleeve for lack of weight loss is either RNY or DS (the sleeve is the first stage of the DS). Honestly, I"m shocked any doctor would recommend a band. my doctor says any doctor still putting them in should be sued for malpractice.