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Wow. I am so sorry you experienced such unprofessionalism. They must not have many bariatric patients. One of the reason's I chose my hospital/program was because they had a very well-regarded bariatric program. Everyone I encountered was kind, encouraging, helpful, and very professional. I would definitely make your surgeon's office aware of how you were treated.

how awful! I can't believe a bariatric professional would say 'this surgery is like being on a diet and they fail.' How ignorant. I hope if you need any more followups you can find an office that has more knowledge and experience in this area. If the surgeon employed a hospital I'd write a letter to the chief medical officer to relay how you were treated. If they aren't hospial affiliated, I'd write to the medical director of that office if they have one, if not the surgeon you intended to see. At the very least it may help them realize they need to educate their staff better.

Thought I'd give a little update after my first set of appointments at the bariatric center. During my first set of appointments I had an EKG and a ton of blood work - 9 vials worth. I also took home an ApneaLink to capture one night's breathing and oxygen levels. I didn't have any reason to believe I have sleep apnea, but lo and behold, I got a call after they reviewed the ApneaLink data and now I need to have a full sleep study. About 25 years ago I was diagnosed with colitis. I would have occasional flair ups that would send me to the emergency room, but I haven't had an episode in about 17 years. However, my bariatrician was concerned about it, especially since I am opting for the gastric bypass. He said if they did the bypass and then ended up with Chron's Disease or ulcerative colitis, it would be catastrophic. Hearing the doctor say catastrophic kind of freaked me out a bit. Anyway, it looks like I will also end up having to have a colonoscopy and likely an upper GI series. If they do find something, it sounds like they would still be able to do the sleeve so I'm thankful that. Next set of appointments are 7/24, wonder what they'll come up with this time?

The closer you are to goal, the more slowly you lose but in saying that you may have reached your balance & are in maintenance. That is the calories you are consuming are equal to the calories you are burning. To lose more you either have to consume less or increase your activity. Whatever weight you end up at has to be sustainable. Many bariatric patients end up at a weight that is higher than what they may have initially wanted. But they’re at a weight they can maintain while still enjoying & living the healthy & happy life they want. It’s fine to eat several smaller meals across a day or graze on three meals as long as caloric intake is constant. It just has to work for you. I eat three meals and about 4 nutritious snacks every day because I can’t physically consume enough in three meals to maintain - my restriction kicks in & I can’t eat any more. My total caloric intake sits at about 1200 calories a day. Another path you could look at is Dr Matt Weiner’s videos & books about resetting your basal metabolic rate which could enable you to lose more if you are interested. The intent is to reset your metabolism to run faster so your body burns more calories just to function. I guess the big questions are do you want to have to take appetite suppressants for the rest of your life to maintain at a lower weight? Do you want to live your life consuming fewer calories &/or maintaining a higher activity level to stay at a lower weight? You may say yes to either of these questions & that’s fine. It’s your decision. Congrats on your weight loss & good luck whatever you decide.

From the Port Huron Times Herald: St. Joseph Mercy Port Huron hospital is branching out into bariatric surgery by teaming with the Michigan Bariatric Institute. Two local surgeons who had worked at Port Huron Hospital are the first onboard. Dr. Zubin Bhesania and Dr. Anthony Boutt will be moving the bulk of their bariatric practice from Port Huron Hospital to St. Joseph Mercy this month, although both will do surgeries at Port Huron Hospital when necessary. "It's a huge thing for the community," Bhesania said. "At St. Joseph Mercy, we will be able to network with fellow Michigan Bariatric Institute surgeons. It is a good synergistic move for us. We are bringing a lot of bariatric experience with us." The Michigan Bariatic Institute is part of the St. Joseph Mercy Health System, the parent of St. Joseph Mercy Port Huron. Bhesania founded Port Huron Hospital's Lap-Band Center of Michigan and has been serving as its director since it opened in 2002. Boutt also has been on staff since the center opened. Patients will be able to have both surgical and medical bariatric treatment at the new center, which Bhesania said is a big improvement. Port Huron Hospital's bariatric center only offered surgical treatment, which excluded some patients from care. "Not everyone qualifies for surgical bariatric weight loss," he said. "If your (body mass index) is 29 and you have high blood pressure, you wouldn't qualify, even though you would definitely benefit from being able to lose weight." Medical weight loss combines dietary changes, medications and exercise to achieve weight loss, Bhesania said. The bariatric center at St. Joseph Mercy Port Huron will be on the main floor, near the emergency department. It will open Jan. 23, and the first patient education seminar will be 5:30 to 6:30 p.m. Jan. 26. Registered nurse Tammy Kwarciak has been named director of bariatric services for the new center. Officials with St. Joseph Mercy Port Huron said they are excited about the chance to start a bariatric program with Bhesania and Boutt. "We are very fortunate that this important service will be provided by two highly experienced and professional surgeons who have completed more than 3,000 bariatric cases over their extensive careers," Peter Karadjoff, president and chief executive officer of St. Joseph Mercy Port Huron, said in a news release. "Alignment through the Michigan Bariatric Institute will provide Dr. Boutt and Dr. Bhesania access to health system resources not available before, offering the ability to more readily expand their scope while improving service to the entire southeastern Michigan community." The surgeons aren't the only ones moving to St. Joseph Mercy Port Huron. Bhesania said most of the staff at Port Huron Hospital's Lap-Band Center will be following the surgeons to the new center at St. Joseph Mercy Port Huron, and he expects patients will do the same. "We are intimately involved with the care of our patients," Bhesania said. "I expect that they will follow us." "We'll be the same people with a different roof over our heads." The news comes one month after Port Huron Hospital announced an expansion of its Lap-Band Center of Michigan. In December, the hospital said surgeons would do gastric sleeve and gastric bypass surgeries in addition to Lap-Band. The hospital also said it would add surgeons to the center. Officials with Port Huron Hospital said the center has earned accolades as a Bariatric Center of Excellence by the American Society of Metabolic and Bariatric Surgery during its 10-year center. "Port Huron Hospital's Lap-Band Center of Michigan is considered one of the most experienced programs in the state," Dave McEwen, vice president of operations, said in a statement. "In the next few months, the center will expand to include additional surgical procedures and welcome two additional bariatric surgeons to the program."

Florida Pete is right; Let me play the "devil's advocate" here. I've been going to a psychologist/therapist since puberty. I have bipolar disease with some lovely childhood trauma thrown in, suicidal tendencies, body dysmorphic disorder, agoraphobia because of humiliation of my weight. Based on this assortment of "stuff" - I am NOT a candidate for bariatric surgery. Reason is that the weight loss is not going to make it all go away and quite probably based on my behavioral history - the potential failure of weight loss will likely put me over just one more edge. However - I'm BLESSED with Diabetes II, sleep apnea, high blood pressure, fatty liver, peripheral neuropathy, arthritic knees and some other delightful gifts from my severe obesity. Based on HEALTH issues first and foremost - I'm a wonderful candidate - now. So I can understand the theory behind weight loss surgery as a treatment for depression is NOT a good recommendation by a good psychiatrist - a focus on the health issues should be the legitimate "arguing point" And further counselling is an important step to achieve both mental and physical health. Good luck- My own psych evaluation is Sept 11.

Sorry for hijacking your thread, tflemon67. That wasn't my intention! Thanks for your, ah...extensive reply, Carole! I'm going to try to provide an adequate response: Whey isolate is 99% lactose-free, but for many people with sensitivity this is not enough. I am allergic to cashews and hazelnuts, and my mother is allergic to peanuts; in most cases we aren't able to eat foods that are processed on the same equipment as those containing nuts. If you don't have any food allergies, count your lucky stars! I've been a vegetarian for almost 15 years, and I'm (finally!) in excellent health; the vast majority of my Protein is from soy, much like many others in the vegetarian/vegan community. Does soy have these effects on some people? Most assuredly. But that is far from damning. Depending on the source (rBGH anyone?), dairy products have been shown to cause hormone issues as well. But similarly, it would be unfair to demonize dairy and suggest that it is not a useful source of protein. I think there is room for many sources of protein, and research suggests that variety is a good thing. I am not badmouthing whey. I think you felt that I was, and then assumed that I did so to promote Herbalife products. Incidentally, Herbalife has some products that use whey. I was simply objecting to the suggestion that whey is the be-all, end-all. I know you said you didn't want to get into it, but since you asked: Amino acids are not derived; they are what Proteins are built from. A 'complete protein' is a protein that breaks down into the amino acids that are necessary for human nutrition (i.e. the body is unable to synthesize them itself, so we must come from our diet): histidine, isoleucine, leucine, lysine, methionine (and/or cysteine), phenylalanine (and/or tyrosine), threonine, tryptophan, and valine. Since these are present in soy protein, many in the scientific community consider it to be 'complete'. I tend to agree. The rest of the amino acids can be synthesized in the body from other precursors. Scientific knowledge itself, of course, is never 'complete', so it may be that future research will augment or obviate some of what we know now. I am not familiar with this 'Center of Excellence'. What I do know is that peer-reviewed studies both around the world and the at the Center for Human Nutrition at UCLA (which has staff who advise Herbalife on nutrition) have found soy to be very nutritious. I also find it to be very tasty. All good questions, and many good points. You are correct, Carole: I have not been a bariatric patient. I had only heard of LapBand in passing and really didn't know much about it before joining this community. I also did not discover Herbalife until I had achieved my initial goals, but it has helped me achieve new milestones I wouldn't have dreamt of before. Regarding my reason for being here: First and foremost, I have struggled with obesity since childhood, and I was drawn to this community of people who share many of the same struggles and passions that I do. I have, at two points in my life (14 years ago and 4 years ago), weighed twice what I do now. The first time I lost the weight, I basically starved myself. Suffice to say, I gained it all back over time, as I was neither physically healthy, nor had I developed the healthy habits necessary to make the transformation sustainable. Before my now-wife joined me on this journey, I was alone in my struggle with eating and weight-management. I know what it has meant to us to share our disappoinments and triumphs, and just support and encourage each other. That's what I really love about this community. And if my successes, failures, and other knowledge and experience can help inspire someone else to achieve their goals, that is something I want to be a part of. I am sorry if I have done something to offend you personally. It wasn't my intention. I see a lot of people here who are excited about the individuals, products, and tools that they are utilizing to reach their goals, and I have been thrilled to participate. Regarding professionalism: I am primarily an IT professional. Herbalife is my hobby. It is something I am passionate about because of my personal journey with weight loss, health, and nutrition -- and it's a nice break from the screen. Since you have scrutinized me a bit, I'm sure you've noticed that I don't link to products or give out my number or website here. It would be easy enough to do so, but I have been on my share of forums plagued by spammers and shameless self-promoters. I can't stand that either, so I don't do it. That isn't why I am here, and frankly I am more than happy to stick to my principles and keep my dignity. I got into Herbalife as a distributor initially because my wife and I get a discount. My focus with customers, however, is on building relationships and helping them achieve their goals, and if feels like that is really only feasible locally, where I can work with them one-on-one. And at the end of the day, Herbalife doesn't pay me; my customers do. So don't worry: I'm not trying to recruit you, Carole! But thanks for your interest in my background. Question everything; the truth can withstand scrutiny.

Are you getting your protein in? Lack of enough protein can cause hair loss. I haven't had this problem, but all my reading says that protein is essential to maintain muscle and hair. I use Unjury protein, which is vey high quality and tastes the best of all the bariatric protein powders I've tried.

Thank you. I am proud that I am where I am. I've certainly worked hard, as do most Bariatric patients. Sent from my iPhone using the BariatricPal App

Hi Priscilla! I'd get a new doctor, too. "I'm not familiar with bariatrics" doesn't cut it. We're having an upper GI to look for a late leak or stricture and a radiologist reads the films and sends the PCP a report. As for the bloodwork, if she can't tell good values from bad ones, (the lab report will point out levels that are too high or too low) she probably isn't someone you want to go to anyway. I'd tell her why I was leaving, too, and also say that you will be spreading the word through these forums that the practice is not bariatric-friendly. It really makes me angry that we are treated poorly in this country when we take charge of our own medical care. My own PCP is a doll but the Kaiser bariatric center treated me like dirt since I had surgery out of the program.

In my opinion, the sleeve is the "cleanest". Nothing left behind, no major anatomical changes. Just less capacity. No limitation on what meds you can take later and your whole GI tract can be examined. No risk of scarring, slipping or port infection. And the sleeve is based on a surgical procedure, gastrectomy, that has been around and used for more than 50 years. (Maybe much longer, in fact). But all surgeries (even non-WLS ones) have risks. Weigh that with the fact that in the general population, people with problems are going to be the ones who are more vocal on the Internet and elsewhere. That's why you shouldn't only rely on personal anecdotes or stories about a friend of a friend, but actually read the research and the literature that is available from scientific and medical journals, read books, and talk to your surgeon. Even (especially?) on this website, there is a great amount of good info, along with a huge amount of rumor, speculation, and false misleading information, about each one of the surgeries. Alex, the founder of this site, has published informational books about the gastric sleeve, lap band, and RNY. Maybe more. They are available from amazon.com, as well as tons of other booms about bariatric surgery. I recommend reading them. Before you buy a book look at the publication date because books that are more than 5 years old will be less useful. And what matters the absolute most is the path you take after surgery, after the gradual reintroduction of food. At that point, our journeys become remarkably similar. We all need to eat high Protein, low carb healthy foods. We all need to drink enough Water. We all need to exercise. All of our procedures help us limit our intake. All procedures can he successful and all procedures can fail, because the procedure doesn't do all the work. You do. I think Alex combined the sites to show us all our similarities.

I just got home from yet another seminar and it was so fun hearing everyone's stories, it never gets old. I'm kinda in the same boat. Lol! I came into this not knowing what I wanted. Then I have been flopping back and forth between the band and RNY. I stopped at my sister in laws house who is an RN at Kaiser who works in bariatrics. We had a glass of wine and shot the breeze. Oh how I will miss wine....

Thanks guys. I will get a new PCP. The thing that frankly pisses me off is that I need a letter of medical necessity from her for my insurance to cover. So it looks like I will more likely be self pay. I will ask my surgeon to recommend a primary who is bariatric friendly. And I will getting gallbladder out instead of dealing with it. SMH!

Hi Hayley. Well no doubt you will get a huge number of responses on this newly integrated site. And we'll have opinions that don't align tidily, so I bet you still are confused at the end! But it seems I get to go first... I have sleeve, which seems to be done very similarly in Australia to the US, although perhaps with slightly longer stays in hospital. We also have a very different private insurance scheme to the US, and insurance company approval is not an issue - it's entirely between you and your dr, and your health insurance either covers bariatric surgeries or it doesn't. Also, for me at least there was no difference in the cost - my dr offered all options and all were the same price. I understand that satisfying insurance requirements and cost is a big issue for many... And influences the decisions of some. But as I said, not me. Why not the band? I don't like the thought of a foreign object inside me (I'm a near-miss cancer survivor, which may be a factor in the absolute repulsion I have about that), and I'd also heard terrible stories of bands eroding through stomachs etc. I also didn't want to worry about bands slipping, regular visits to Dr to increase or decrease the band etc. Why not the gastric bypass or duodenal switch? My BMI was just over 36 so I was never really a candidate for those, although I had a lot of co-morbidities. I didn't feel I needed something that drastic and I didn't want malabsorption. I wasn't sure I could live with that long term. Why the gastric sleeve? I wanted something permanent - I've had problems with hunger and portion size all my life although my weight really only got out of control after the cancer, which took an enormous toll on my body. I wanted portion control and hunger reduction and sleeve does both of these. After the first 6 weeks, sleeve complication rates are lower than the band, and that appealed too. How long and how much? 6.5 months and 26kg. The amount is less than predicted but my thyroid packed up early in month 3, and is only just now recovering. Weight loss was 22kg by 9 weeks and 4 kg since... But I haven't exercised a great deal as I've felt so awful (from the thyroid). I'm just picking up again now. Problems? Reflux is sometimes better and sometimes worse than pre-sleeve. Would I do it again? Yes! I eat normally now though avoid carbs (by choice). Nothing I can't eat. Have a glass of wine occasionally. Feel very much in control of portion size, which is tremendous. People who don't know me think im a small portion size, slow eater - that's all. Slower weight loss means I've had no trouble with hair loss and my skin is in pretty good shape. What else you should know... 1. I'm 53. If I was a lot younger I may not be as keen on a permanent solution. Don't know, as my eating habits feel very natural now. 2. I had a very good surgery and recovery but not everyone is so lucky - go in with your eyes wide open! It's not a small surgery. 3. I had an easy adjustment to the sleeve - I was begging for restriction and never once regretted it. Again, not everyone is the same. But I really didn't feel physically better and able to eat and do a little more each day. I took on your new foods very slowly, so my stomach was well healed before I tried each one. 4. (So far) I've never vomited or had dumping syndrome. Good luck with your decision.

I'm am just starting a bariatric diet. I am 245 lb and hesitant about the surgery but need to lose weight.i am doing well with everything except that I cant get motivated to go for a walk and at night I get bad food cravings. Any help is appriciated. Sent from my LML713DL using BariatricPal mobile app

Ok... Found out tonight in support group if you have any type of bariatric surgery you must never have a NG tube, unles a gastroenteritis does it. It was advised to get a medical alert bracelet or I'd tag ::: No NG Tube. Bariatric patient. (procedure and year). Also make sure in your wallet with your I'd and insurance info you have a card with your surgeons info incase of an emergency.

NYU is supposed to have good bariatric doctors. It's a husband and wife team. I forgot their names. Also check the major hospitals in NYC.

yaborhoo I have attempted the 5 day pouch test and lost 3 lbs that was 10 lbs ago:(,Im not having any ill side affects from the medication I started today, the other medications that has weight gain warnings I cam off of 4 months ago,and the new medication for BED is the only one on the market as of now,I have also tried kundalini yoga, Miss Mac I haven't meet the bariatric Dr yet,More like the game Frogger ,me being the alligator trying to eat the frog,I only meet with a nut once or twice so I am so lacking in that department any advice would help, FrankiesGirl that is a great question my beloved husband does the food shopping I have been fired because I try to get more fresh fruit and veggies he dosn't like it retired cop needs his donuts,and he is constantly telling me I have to eat something I cant not eat.he also gained some weight ,Freshman 15 ha more like FL 30.but he has a 6'3"height advantage. BLERDgirl ED oh had to think about that for a moment ( I dont have those parts) eating disorder yes that I do have,I figured I would try here first.but that does sound like a good idea, thank you all so much

I’m now 13 months post successful gastric bypass surgery. What can I do to eliminate foul gas? Family are fed up and I’m nervous about dating (I’m divorced ) a,loud flatulence b, smelly & loud flatulence. I have been taking probiotics, 1st brand was unsuccessful and 2nd brand has made difference but not cured the problem. I know in the States you can buy Devrom,but it’s unavailable in England at the moment plus the cost is prohibitive! Any suggestions?

You're doing so great! It's nice you have your spouse to help you. I talked to the Bariatric Coordinator today at pre-op and she said sugar free gum is ok - Yay! She just said don't go crazy because it can make you salivate and may make you more hungry. It's encouraging you have not had any nausea. Has your family mentioned the tummy noises are loud enough for them to hear? I read that never goes away. Already cutting back on BP meds --- look at you GO! The emotional part if the best to hear and I can understand feeling down. Something has shifted in me in recent months from "no hope" to "I'm going to fight this obesity once and for all!"

I’m a year and a half out from surgery and my doctor and I are very happy with my weight loss. I am also very happily pregnant (in my first trimester) and so far have had great medical care. I spoke with my bariatric nutritionist today and she mentioned that I should absolutely not lose any more weight and should work on eating more, ideally seven eating moments per day, gaining 15-25 lbs over the course of my pregnancy. I’m running 5k 3-4 times per week and have been continually, slowly naturally losing weight. I told her this and she said to just eat more so I would gain more weight. In hindsight I feel a bit like I wasn’t totally done losing weight. The shift from being focused on weight loss to gaining weight is unexpectedly hard to make, but it course I follow my doctors instructions to a T. Anyone have similar experiences with struggling to gain weight during pregnancy?

I thought this post was appropriate for this thread too, to help clarify recent questions. I just received a copy of this thread from one of my clients. I want to clarify the differences between Dr. Valencia's own practice that that of Hospital Angeles and "BeLite Weight". Dr. Martin Salvador Valencia FACS has opened a practice in Tijuana and Ensenada, Mexico. Previously, Dr. Valencia finished his surgical residency in 1998. He was then appointed as Associate Professor of the Advanced Laparoscopy Fellowship at ABC Medical Center (One of the most prestigious medical schools in Mexico). He was then invited as a visiting professor of minimally invasive and bariatric surgery at UCLA in Los Angeles, CA. He was a full time professor there. When not doing surgeries as part of the UCLA bariatric team, he traveled all over the world proctoring other surgeons in minimally invasive bariatric surgical techniques. He continues to teach at UCLA part time while building his own practice in Tijuana and Ensenada, Mexico. All this information is not meant as a commercial, just an explanation in my attempt to clear up the confusion. Dr. Valencia was invited to be part of the staff at Hospital Angeles in Tijuana, one of the finest hospitals in Mexico. He began to perform Lap Band surgeries for the hospital. However, he additionally has his own patients. Dr. Lopez is also on the staff of Hospital Angeles. Belite Weight represents Hospital Angeles. Belite does NOT represent Dr. Valencia's in any way. I am Dr. Valencia's coordinator for his practice. Dr. Valencia is NOT part Dr. Lopez’s nor is he “partners” with Dr. Lopez. Dr. Valencia has his own team. I personally do not agree with the practices of Belite. I believe Belite is deliberately using Dr. Valencia's credentials and expertise in the forefront of all their advertising to further there own business rather than doing what they should be doing, selling the lap band services of Hospital Angeles. I believe them to be unethical in their business practices and I would not recommend using their services. I'm sure not every one would agree, but that is my opinion. For various reasons, Dr. Valencia very recently decided to stop doing surgeries for Hospital Angeles. He will concentrate on his own patients and building his practice in Tijuana and Ensenada. If anyone has any questions regarding Dr. Valencia's status, affiliations, etc., I would be happy to answer any and all questions. My best to everyone here and I wish all of you a healthy successful weight loss journey!

We are so lucky here in North Texas to have so many top bariatric surgeons. I was very happy with my surgeon and experience as well.

BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence? (Part One of Three) I’m guessing most of us understand that the disease of obesity is a complicated one. There are a number of factors that contribute to obesity. Some of these factors you may be very aware of; others you may be surprised about. Some of the causes of obesity are things you cannot do anything about; other causes of obesity are things you can influence. It’s important to recognize the difference. Why? For starters, you can stop beating yourself up over the things you can’t do anything about. It’s also important that you focus on putting forth effort where it will get you the best results! It’s essential for both doctors and those suffering from obesity to have a mutual understanding of these causes of obesity and which people can influence, so that: 1) Doctors can develop or increase empathy for the struggles of those suffering with obesity. When doctors better understand that many people with obesity have struggles that go beyond fighting their biology which negatively impact their weight, the doctors can more compassionately and appropriately address these issues and refer patients to see other professionals, if need be. 2) People struggling with their weight can evaluate the numerous factors impacting obesity and work toward accepting those things they cannot influence. In addition, they can take responsibility for putting forth effort into those aspects of their struggles with weight that they can positively impact. All righty, then! Let’s look at three of the main contributing factors of obesity and then talk about each one, emphasizing what, if anything, each person can do to have a positive impact on their weight. Genetics Culture and Environment Metabolism Genetics Obesity definitely has some genetic determinants, as researchers have clearly discovered. If there are a lot of obese people in your extended family, you have a better chance of being obese than someone from a family without a history of weight problems. Although there are many more obese people in the current population than in previous generations, this cannot all be linked to genetics. The genetic composition of the population does not change rapidly. Therefore, the large increase in obesity reflects major changes in non-genetic factors. Listen to this… According to the Centers for Disease Control and Prevention (2002): “Since 1960, adult Americans have increased in height an average of 1 inch but have increased in weight by 25 pounds.” So in 50 years, the human species has grown taller by only an inch but heavier by 25 pounds. That tells us there is more than genetics influencing weight gain in this country. PATIENTS: Even if you have a genetic predisposition for obesity, there are other factors involved, including the food choices you make and whether or not you exercise on a regular basis. Some of these behavioral factors are habits learned in your family, so what appears to be a genetic predisposition may be a familial pattern of unhealthy habits that can be broken. DOCTORS: Remind yourself that patients cannot “eat less/move more” and have any effect on their current genetic makeup. Acknowledge to patients their genetic predisposition for obesity in a compassionate manner. Help to gently educate them about the factors affecting their weight that they can influence. Do so in a “firm and fair” way, providing encouragement rather than admonishment. Culture And Environment In addition to one’s genes, a person’s culture and environment play a large role in causing people to be overweight and obese. The environment and culture in which you were raised impacts how and what you eat. Some people were taught to eat everything on their plate and couldn’t get up from the table until they did so. Others never sat at a table for a meal but watched television while they ate. Some kids are fed well-balanced meals while others exist on fast food or microwaved mac and cheese with hot dogs. In some cultures, simple carbs make up a substantial part of every meal. In other cultures, fruits and vegetables are consumed regularly. When you are a child, you’re not in charge of buying the groceries or providing the meals. You did learn, however, about what and how to eat from those with whom you lived. And guess what that means? How you feed your children is what they will think of as “normal” and will most likely be how they eat as adults. (I’m always concerned when weight loss surgery patients tell me their kids are “just fine” even though they eat the same unhealthy foods as the obese parent. It’s only a matter of time before the kids start to gain weight and have health problems as a result of their unhealthy diet and learned eating behaviors.) PATIENTS: Although your genetic composition cannot be changed, the eating behaviors you learned in your family, from your culture, or developed on your own can be changed. You alone now determine what kind, and how much exercise you do and what and when you eat. Your behavior is completely within your control. Work toward accepting the fact that you are in charge of, and responsible for, your behavior and every food choice you make. For every choice, there is a consequence, positive or negative. And NO EXCUSES! It doesn’t matter how busy you are, whether you get a lunch break at the office or whether you have to cook for a family. Even if you have five kids in different activities and spend your life taxi-ing them from one place to another, you are the adult and you are responsible for how you eat and how you feed your children. It takes a very responsible person to acknowledge, “Although I have a genetic predisposition for obesity, I am responsible for making healthy choices about my eating and exercise. For me and for my children.” Focusing on what you do have control over rather than that over which you are powerless, leads to believing in your capabilities. So take charge and make positive changes happen! DOCTORS: Engage your patient in a discussion about the cultural and environmental factors that helped shape their current food choices and exercise behaviors. Empathize with them, noting they are going to have to put forth consistent effort to change years of bad habit formation. Encourage them to get support, whether it is from friends with a healthy lifestyle, a health coach, a personal trainer, or the use of free online exercise videos. Help them set a short-term, reasonable goal and set an appointment with you to follow up. Remember, docs: That which is reinforced is repeated. Reinforce even small steps forward you see in your patients. This can go a long way in encouraging them to continue making healthier choices. A step forward is a step forward. Notice and praise every single step forward your patient makes! Resting Metabolic Rate Resting Metabolic Rate (or RMR) is simply the energy needed to keep the body functioning when it’s at rest. In other words, RMR describes how many calories it takes to live if you’re just relaxing. Resting Metabolic Rate can vary quite a bit from one person to another, which may help explain why some people gain weight more quickly than others. And why some people seem to find it more difficult to lose weight than others. There are some factors related to metabolism that you can’t change, but there are actually some that you can influence and change. Things you cannot change about metabolic rate: Metabolic rate decreases with each passing decade, which means the older you are, the slower your metabolism gets, making weight loss more difficult. Sorry ladies - Men generally have a higher metabolism, meaning they burn calories more quickly than women. You can inherit your metabolic rate from previous generations - which can be a benefit… or not. An underactive or overactive thyroid gland can slow down or speed up metabolism. Some things you can do to influence your metabolism and burn more calories include: Eat small, frequent meals. Drink ice water. You can boost metabolism temporarily with aerobic exercise. You can boost metabolism in the long run with weight training. PATIENTS: I’ll bet you didn’t there was much of anything you could do that would increase your metabolism. I’m hoping you choose to implement the ways you can help your body burn more calories. And what do you know? They are completely consistent with healthy post-op behaviors that you’re supposed to do anyway: 1) Eat small, frequent meals. CHECK. 2) Drink water (so add ice and boost that RMR). CHECK. 3) Engage in exercise, both aerobic and weight bearing. CHECK. There’s no reason NOT to anymore! (That’s a slogan from a really old commercial…) The point is, your specific RMR is both something that is unique to you, and that will slow down with age, is gender-influenced, and can be affected by thyroid issues. Accept the things you cannot change and DO the things you can to get the most out of your own, unique RMR. You DO have choices! Opt not to make excuses and JUST DO THE THINGS YOU CAN! DOCTORS: I’m pretty sure that educating patients is in your job description. Even though you have an allotted set of minutes during which to accomplish all your goals with a patient, point out the ways they can boost their metabolism while you’re looking into their ears, or hitting them on the knee with that little hammer. Present it as a, “Hey! Guess what I was reminded of today?” sort of thing. It’ll probably be absorbed better than a mini-lecture. Leave yourself a sticky note in the patient’s folder to bring it up in your next session… and then a new educational point for the next meeting, along with the small goal you set with them so you can be sure to praise them for their efforts! Patients and Doctors and all Allied Health Professionals: We need to work together to do the following: 1) End Fat Shaming 2) End Blaming 3) End Lecturing 4) Encourage reciprocal AWARENESS and ACCOUNTABILTIY 5) Encourage reciprocal EDUCATION and DISCUSSION 6) Encourage reciprocal GOAL-SETTING and FOLLOW-UP Stay tuned for Part Two of BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence?

I can't answer for that person but in my humble opinion, the need for such a high amount of protein isn't really needed. I think in the beginning, to follow through the best you can. But I just ordered Dr Garths book called a Proteinaholic today. He's a bariatric surgeon who went vegan and encourages his patients and everyone on a vegan diet. I'm currently doing vegetarian. I'm going to read it and see what he has to say. He dispels the myths about protein, protein, protein. Even though my doc wants me to do protein (min of 65g and that's where I keep it) he does promote more veggies and grains too, which is what I'm doing. So far so good. Still losing the weight too. 😊