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I have the same fears! I had really good results from HCG, but the moment you stopped it (it was super expensive) I started gaining 1lb a day. Now I at my largest in my whole life. After the HCG it seem to be stubborn fat that wouldn't budge, when in the past I used to lose and gain super fast. I have been on the 7day liquid diet and have lost 8lbs on day 6... So i have renewed hope!

It sounds like a reflux of bile is what is causing the ulcer, not common but it does happen. I had my gallbladder removed during my gastric bypass surgery due to chronic inflammation. But I also had frequent ulcers in my stomach and small intestine. it is extremely common for bariatric patients to need a cholecystectomy after dramatic weight loss. you might want to consider adding digestive enzymes with meals afterward. Some doctors also recommend bile salts.

these guidelines from the American Society of Metabolic and Bariatric Surgery are from 2016, but still current. Scroll down a few pages to see the vitamin requirements for each type of surgery (including DS). Just make sure your vitamins of choice meet the requirements: https://asmbs.org/app/uploads/2017/06/ASMBS-Nutritional-Guidelines-2016-Update.pdf

Yes I also went through that stage. Idk what eating plan ur currently in or on lol but I looked up Bariatric meals in line. My favorite one during soft food or even purée was the shellys ricotta bake!!! It is so delicious!! I freeze little portions and take them with me for lunches. But there are tons of ideas! I also did like zucchini boats. Stuffed eggplant. Stuffed mushrooms. Turkey bacon wrapped Brussels sprouts. Grilled or baked asparagus. Salads. Cucumber tomato and avocado salsa. Chickpea salad. There are tons of options.

Thanks for the advice, everyone! My insurance requires my medically supervised diet to be outside of the bariatric group. I do have to meet with a nutritionist in the bariatric group, but that's a few weeks from now and I get the impression that it's a one-time thing. I also have to take an online nutrition class and a pre-op surgery prep class. I switched from regular soda to diet several years ago, and I was kind of proud of that because it was hard (I loved regular soda and hated the taste of diet, but I gradually made myself switch and now I prefer the taste of diet, and even unsweetened flavored seltzer). I have a personal rule of no snacking at work, but that's not so easy at home, although the intermittent fasting has helped. I've been entering my food in MyFitnessPal, which is required in my bariatric program for the week before meeting with the nutritionist, but I went ahead and started early, so that is helping me to choose lower-calorie foods, but I am having scary flashbacks to my years of yo-yo dieting because I always do well at the beginning but I can never keep it up for the long term.

I am wondering if there could be a market for before and after portraits of bariatric patients. I know overweight people generally do not like their photos taken. However, having been a former patient, I might be able to find a niche market for my area as future patients might be more comfortable with a former patient who could definitely see their future selves I would take photographs at local "outdoor scenes" so that they can be followed up at the same place in the future by anyone. Photography is more of a professional hobby for me, but I have never got into the "portrait" arena. This might be a fun venture. I have never seen a good before, or even good after pictures. I think the before pictures are all just horrible. Even in doctors offices, they are so bad, my center stopped taking posting them on walls. I would even hang out with them for some activities for candids, because many patients change what and how they do things afterwards. So instead of having horrible pictures to show people, they'll have something; nice. Sent from my ONEPLUS A6013 using BariatricPal mobile app

Hey All! I'm a newbie here, but I've finally decided to start the process and get information about VSG. I feel mentally ready for it and that it's time, as I've been going round and round with the decision for years. I go back to my new PCP on 3/10 of this month to discuss it more and get bloodwork. I gave her a head's up at my initial consult that this was something I wanted, and she said let's see if you are a candidate at your next appointment. I already made my appointment with the weight loss center for the information center on 3/25. They advised they do not need a referral from my PCP, but to have my most recent labs sent over. When I called the weight loss center, I was advised that after the information session, you will be contacted within a week for the actual consult with the surgeon. I've been doing a ton of research so far, and I see a lot of folks have a 6-12 month supervised diet mandate with the insurance. After contacting my insurance company, they sent me the policy and advised that they have lifted their 6 month restriction. My policy states the following is needed for approval. BMI 40 and over or BMI of 35-39 with co-morbidity. Individuals should have documented to respond to conservative measures for weight reduction prior to the consideration of bariatric surgery and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. HOWEVER, following that statement, it says "As a Result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. However there is a lack of evidence on the optimal timing, intensity and duration of non-surgical attempts at weight loss, and whether a medical weight loss program immediately preceding surgery improves outcomes." HELP- what does this mean? Psych consult I'm pretty clear on the other first and last requirement, but the 2nd one has me spinning my wheels slightly. When I called my insurance to ask for clarification, I was advised that a letter of support from my PCP would likely suffice. My only hesitancy is that I just started with a new PCP, and I'm wondering if she will approve me off my BMI alone, or want to try conservative measures first since I am new patient there. If she doesn't provide letter of support, will the nutrition classes that the surgeon will inevitable require satisfy the letter requirement, can he be the one that writes it or does this text indicate that it needs to come from my PCP? I plan on calling the center during their business hours to ask if they've encountered this insurance wise tomorrow, as they were closed today. Any one run into this issue with their insurance policy? Any insight or perspective offered would be awesome.

What on earth are you doing back to work 1 week post-op? My bariatric team would not even consider anything less than 4 weeks out. The reason? Not only the physical healing (you have just had a MAJOR change to your internal structure) but also for the very reason you are now faced with--mental preparedness. Whatever you do, do not give in to the temptation of eating solid food. You will seriously endanger your health with a risk of leakage along the staple line, not to mention the discomfort caused by a tummy not yet ready to deal with the stresses of solid food. Is there any way for you to take another week or two off? Disability? FMLA? You really need more time to heal, mentally and physically.

Still undecided which one. thoughts please?

Hi BigSue and congrats on your journey! My insurance requires a 3 month program of supervised diet (but no set weight loss; I do hope to be close to 20 pounds down by surgery time). My bariatric center actually had a pre-op nutrition class and basically we were told to concentrate on getting your proteins in and lowering carbs. Just based on my experience so far, upping the protein and lowering the carbs is most successful, along with getting the water in. You should ask if your program includes meeting with a nutritionist to discuss specifics with you.

Momof3_angels pretty much broke it down, and I agree with all comments here. I did find a NHS study that discusses body reset points after bariatric surgery, but after reading many comments here, if you put in the post-op work, you will lose a lot of weight.

you do have to be disciplined. The first few months weren't too, too hard because my hunger disappeared for about five months, but it does eventually come back for most of us, and things get more challenging after that. I have to be very disciplined now in maintenance, too. I can maintain my weight by averaging about 1700 kcal/day. I can definitely go higher than that occasionally, but if I do it too often (like more than two or three times a month), it'll start showing up on the scale. I was in India for the month of October and although I wasn't making a pig of myself, I wasn't closely monitoring what I was eating. I was probably eating 2000 kcal a day. And then I came back a couple weeks before the holiday season started - more eating. I put on eight pounds from the beginning to October to New Year's. Still working on getting that off. So yea - it takes discipline for sure to keep the weight off. I can't answer your question about resetting metabolism, other than you'll see that claim pretty much everywhere. Also, the association of bariatric surgeons is called the American Society for Metabolic and Bariatric Surgery, so there does seem to be some metabolic aspect to this.

Request to see a bariatric nurtitionist. Mine gave me handouts that layed out exactly what my diet should be during each phase of my diet (both pre-op and post-op). I followed it almost all the time, and I had great success.

You really should have a long talk with a bariatric surgeon and nutritionist. But let me see if I can help. I will use gastric sleeve for explanations, since that is the surgery I have. This can also be applied to gastric bypass, but please know there is a lot more involved with a bypass than sleeve. I personally don't recommend lap band. Before you get weight loss surgery, you need to consult a physician and a nutritionist. You usually have a requirement of 6 months of nutrition counseling. During this time, the nutritionist prepares you for your post op diet. They start off giving you education on what you need to eat NOW. What you need to eat in your pre-surgery phase. And what to eat post op. A good program will have you continue nutrition counseling for AT LEAST a year post op, in which they will coach you through the stages of your post-op diet through until you reach maintenance stage where you are just maintaining your weight. During the pre-op period, you are also seeing specialists and getting testing for any problems that they may need to know about before your surgery. This includes a psych evaluation usually. And if you do have psych related issues driving you to eat too much, you should take this opportunity to deal with them. Many bariatric patients need counseling. Some need medications like anti-depressants or other psych medications. And some like me gained weight for other reasons (physical barriers). You will likely at least get an EKG if not a complete cardiac workup. You may need a sleep study to determine if you have sleep apnea like so many obese people do. If so, you will get treated for it. They will look for how you swallow, do you have a hernia in the stomach, and other issues affecting your surgery. Once you have jumped through the hoops and are treated for anything you need to be treated for... then you will be cleared for surgery (and no... ongoing counseling does not mean surgery will be delayed). With gastric sleeve, they remove 80% of your stomach, therefore for it immediately restricts how much food you eat. It also resets your metabolism and your hunger/full hormones. In the short term, yes your calories will be VERY restricted. But because you are seeing a nutritionist, they will help you know what to eat during each stage for optimal health. Water and protein first. Then healthy veggies. And you will learn to either not eat unhealthy carbs or eat very limited unhealthy carbs. It will be up to you to follow the recommended diet and stick with it. If you do follow directions, you will learn to eat frequent small but healthy meals every day. And over time, once you are closer to maintenance, you will start to eat larger portions, but sticking to healthy meals. Your nutritionist will guide you to ensure you do not go into starvation mode and that you eat a healthy amount of calories to maintain your weight. Most people do lose a little more than they need to early on... but then gain 20 pounds back and then maintain your weight there. The key is to stick to the recommended diet so that you don't KEEP gaining. You will also get blood work done every 3 months or so and have follow up appointments with your surgeon's office for at least a year. So, with the surgeon and nutritionist, you will be closely monitored. They will make sure you don't end up with vitamin deficiencies or other problems related to rapid weight loss. You will take daily vitamins and calcium as recommended. Your diet will be high in protein and low in carbs and fats. (So not really Keto... but many do keto post op). The carbs and fats you eat will be healthy carbs and fats if you stick to your diet. But this isn't a "diet" per-say... it is a lifestyle change. You are re-learning how to eat healthy. You are re-learning how to eat small to normal portions. And if you stick with it under nutritionist supervision, you will NOT go into starvation mode and you will not gain the weight back. Problem with all the fad diets is that there is no long term (psych) counseling, nutritional counseling, medical follow up. Most people eventually go back to their old ways. And gain everything back. If you are following the program with the bariatric team, they will help you prevent going back to your old ways. But seriously... only you can decide how successful you will be, based on your willingness to follow through. Again... if you need to, get counseling. See your surgeon and nutritionist regularly and follow their guidance. If you need CPAP for sleep apnea, wear it. If you need other medications, take them. Etc. I am 2 days shy of 6 months. I am at a NORMAL body weight. I am 6 pounds from my personal ideal body weight. I am following the recommendations of my team. And I can now eat double what I could 3 months post op and still maintain my weight and I am still losing a pound here and there. Again...talk to your bariatric team for better information, but bariatric surgery is a TOOL for weight loss. It is only successful if you follow your program. But it is also the best tool out there to reach your goals if you have dieted and failed in the past. But if you follow your program, they will give you additional tools to make you successful (nutrition and psych counseling are two of your best weapons... use them!)

I've been on bariatric internet forums for around 5+ years. SOME bariatric patients consume less than 1000 calories a day to maintain, but (and this is just based on postings I've read), this is the exception. I can maintain on 1700 calories a day. I've read of people maintaining on 2000 (I, unfortunately, would gain on that). I would say - and again just based on my own observation), that most women maintain on somewhere between 1200-1600 a day. A lot of that will depend on age, activity level, etc. and no, oddly, metabolism doesn't seem to be ruined (unlike that of people on the Biggest Loser). I do know that bariatric surgery "resets" metabolism, so that may have something to do with it (?)

I am 1 yr post OP from having my gallbladder removed and the severe sepsis that i endured and almost ended my life all because of the poison that happened from my gallbladder going rouge. My 51 year old brother's wife just died from sepsis! That is serious! If you do not feel well and have pain do not ignore it! I thought it was just a complication from my ByPass surgery but it was so much more. It has taken a year to feel better and I still have a lot of days that I do not feel very good, but much better than when I was admitted to UPMC hospital last year. Thank GOD for UPMC they saved my life twice. Once with my Bariatric operation which cured my kidney disease and then with curing my sepsis.

Call your bariatric office. They are better qualified to answer your questions about metabolism Ask if they have an information seminar. It will help you decide on surgery. All I can offer is my experience five years out from sleeve surgery. (maintaining my weight in the 130's) Surgery is nothing like my other diet attempts. (I've done every diet and pill) I needed a long term solution. My weight loss/maintenance diet is very livable. I'm not deprived, My hunger is manageable. It's normal for your surgery restriction to relax after a year. My stomach is NOT back to full size. I still eat within my calorie range, Maintenance diet and calories are different for each of us. It depends on your surgeons/dietitians plan, activity level, metabolism, healthy issues, medications......The list goes on. I maintain my weight between 1200 and 1300. I do have days that are higher. I take vacations and indulge within reason. If I have a slight gain I eat weight loss calories (My weight loss calories are 1100) Take your time and research all of this. Do whats best for you and your health. Jenn

I appreciate your response and the link. It says right in this document... “ most post-op bariatric patients need to consume less than 1000 calories a day in order to maintain weight loss.” 1000 calories a day is a starvation diet Not a maintenance diet. This troubles me greatly. How can this be healthy long term? Meaning live to be 90 long term? Thank you for going to bat with me on this. I’m really having trouble with seeing how this is a forever option.

The restricted calorie intake is only for the first couple of months until your stomach has healed, and you are eventually able to eat a normal diet, just in smaller amounts of food “per sitting”. However just because your stomach is much smaller, you can still pack a hefty number of calories by the end of the day and eventually GAIN weight post-op. You must think of the surgery as a tool and not a “cure all” answer to lifelong weight management. Please review the information in the link below, I am sure the info will help answer many of the “what do I / can I eat” questions, it did for me. https://www.obesityaction.org/community/article-library/the-post-surgery-diet-for-bariatric-patients-what-to-expect/

I go in for bariatric sleeve Surgery on 3/3 in two days. I have been on all liquid diet for 11 days and counting. I am nervous and excited about this new journey.

I couldn't agree more. The confusion is terrible! Every surgeon and nutritionist is different. They need to be more organized. This is too life-altering a procedure for everyone to be all over the place. I would also like to add that they are in terrible need of educating hospitals and other medical professionals about bariatrics. There are certain medications and foods we can't have anymore and also no NG tubes (God forbid anyone never needs one of them). You'd be surprised at how many other healthcare professionals are totally unaware of all that. It's crazy.

I would request the information packet on Endobariatric.com. My coordinator was Brandi Carter (brandi@endobariatric.com). You can use my name as a referral. Brandi sends out a very informative pdf about Dr Alvarez’s entire process. Plus, she has had the sleeve procedure as well, so her advice comes from experience. Do not be skeptical about Endobariatric with regard to them being located in Mexico. It’s a state of the art, first class hospital, with hospital and hotel all in the same building. My friend had his procedure done their and referred me to him. I would have never even considered going to Mexico to have surgery unless my friend hadn’t praised him so highly. Needless to say, I was not disappointed. Dr A patients come to him, in Mexico, from all over the world. (Texas, Arkansas, New Jersey, and Wisconsin Folks were in my group). I was sleeve procedure # 16,848. That’s how many sleeves Dr A has performed. He is one of only 11 surgeons in the world with a certification of Master Surgeon in Bariatrics. It’s all done laparoscopically and robotically. I have 5 small 2” incisions, that’s it. Also, no surprises on fees and money. I sent a $1,000 deposit to book my surgery, then I brought a cashiers check for $6995. Done. Everything included. Drs, anthesthesia, recovery, lodging, post op medications, etc. turnkey. The only thing we paid for meals for my wife and the concierge delivered it right to our room. We never had to lift a finger. A clinic in San Antonio quoted me $15-$20k cash pay when they learned my insurance would not cover bariatrics. When I asked why the $5k gap, they couldn’t give me a straight answer. Every single thing that Brandi tells you is 100% accurate. I would at least look at the packet and watch the videos she sends before I made a decision. My reason was strictly cost In the beginning, but the more I learned and researched all the different Bariatric procedures, the more I realized how transparent Dr A is, and knows what he is talking about.

When can I reincorporate taking extra Vitamin C? I am taking my bariatric multi Vitamin however I would like to add extra vitamin C to help my immune system. Thanks.

When can I reincorporate taking extra vitamin C? I am taking my bariatric multi vitamin however I would like to add extra vitamin c to help my immune system. Thanks.

Great information Clint, thanks or sharing. I am still 6 weeks away from surgery, but I must admit I am beginning to get hints of cold feet again. I attended a local Bariatric support group meeting last Friday and someone in the group who recently had surgery is having similar issues with keeping their liquids down and another is experiencing a very nasty case of GURD. I would be very interested in seeing those videos your doctor gave you.