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600 kcal a day at five years out is REALLY low. Maintenance for most people is somewhere in the 1200-1500 range (fortunately, for me it's more like 1700). Have you been eating 600 calories all along? Most of us just eat at that level the first year post-op. I can lose if my intake is 1500 or fewer calories - but of course that's going to be different for everyone. Weight loss is supposedly 80% diet and 20% exercise, so losing is going to be more impacted by food choices than exercise (although exercise helps somewhat - and it's GREAT for general health). I wouldn't necessarily cut back on strength training. It doesn't burn many calories, and some people gain a few lbs when they first start (usually less than five lbs - and that's usually temporary), but in the long term it does increase your metabolism. When I want to lose, I try to go back to the basics - protein first, then vegetables, and then if I have room, maybe a small serving of fruit or whole-grain carb. I also figure out how many calories I'm averaging a day (and you can do this by tracking your intake for a few days, if you're not already doing that), and then cut back about 100 calories. If after a couple weeks nothing happens, then cut another 100. Rinse and repeat. But if you're truly only eating 600 kcal a day, I would NOT cut back from that. That's too low as it is. are you getting enough protein? Drinking enough fluids? also, keep in mind that if you're at or near a normal BMI, that last 20 lbs can be a BEAR to lose. I've been on a mission to lose 10 these last couple of months, and I can only manage to eke out about 2 lbs a month. That may be what you're dealing with as well..

Thank you for replying. I am 5’2. I weighed 254 October 8 2019 on the day of my surgery. My health issues are PTSD and COPD. I don’t have pictures but my pant size has gone from a 20 to a 12. I do a little exercise with bands. I also bought a Cubii elliptical this past week. I track my food on the app Baritastic. I also track my steps.

I had my surgery on 1/29/19 and was told just to take the capsule. I didn't have any issues or side effects from it. I hope whatever you decide to do, that you feel and heal well.

My doctors said the surgery & sudden reduced food intake is a shock to our system and one of the side effects is that our normal hair loss cycle accelerates. My dietician advised there was nothing much that could be done except keep up my multivitamins & ensure I meet my protein requirements. Biotin, silica, collagen, & other supplements to benefit your hair will only make your new growth stronger & not reduce the hair loss. Your hair itself is dead and regularly sheds like our skin cells. It’s just happening faster. My loss began at about month 3 and started to slow at about month 10. It’s pretty well back to normal now & I can feel it’s thickening again. I lost a good 50% of my hair. Thank gracious I had a lot of it to begin with.

Give me your update. Was sleeved 7/15 2019 I have gained 10 pounds feeling disappointed Sent from my SM-G950U using BariatricPal mobile app

I called them once - I was confused by that process. If the procedure isn’t covered then it would be cheaper for me to go to local and pay 10,000 versus 15,500. There are at least three good surgeons in Florida that are in the $10-$11,000 range!

1) hair loss is pretty common, but temporary. Mine started in month 5 and went on for about three months. It'll grow back. 2) weight loss slows down quite a bit after the first month. I lost 10-12 lbs per month during months 2-6. At about the six-month mark, it dropped down to about 5-8 lbs a month. So that is normal. I started out at 373 lbs and lost over 200 lbs, so a decrease in weight loss the further out you get doesn't mean you won't ultimately get to your goal. Just stick to your plan since your level of commitment will have the greatest impact on your final results.

1) hair loss is pretty common, but temporary. Mine started in month 5 and went on for about three months. It'll grow back. 2) weight loss slows down quite a bit after the first month. I lost 10-12 lbs per month during months 2-6. At about the six-month mark, it dropped down to about 5-8 lbs a month. So that is normal. I started out at 373 lbs and lost over 200 lbs, so a decrease in weight loss the further out you get doesn't mean you won't ultimately get to your goal. Just stick to your plan since your level of commitment will have the greatest impact on your final results.

This was also a big fear of mine. I've been taking a biotin supplememt daily since surgery 1/31 and haven't noticed hair loss (yet). I also only wash my hair once a week since I'm working from home. https://www.iherb.com/pr/sports-research-biotin-with-organic-coconut-oil-10-000-mcg-120-veggie-softgels/71104

I know! People have been warning me not to get discouraged with stalls. I mean I suppose the last 10 years have been on big ass stall lol! It helps to talk to people like you and know that this is a normal part of the journey. Besides, I suppose it’s better to have a slow steady constant loss then no loss at all:)

Hey. I’m 33. I didn’t have the sleeve but had the bypass and can give you what I know so far from it. I had surgery on 2/19/20. They went in and found some kind of rare hernia that they said could be very fatal if it had not been found so they had to do a lot work to that area. My doctor said that my recovery would be a little worse than normal because of it. I don’t take to anesthesia very well. As soon as I woke up, I was definitely in pain and let them know. I guess they fixed it cause I passed back out right away. This happened pretty much the rest of that first day of surgery. I would wake up in pain, they would give me more meds in my IV, and I would go right back out. I didn’t get up to walk until the next day. I wasn’t able to do much at a time but I did what I could. I had to stay 3 nights in the hospital. I had a very hard time getting my liquids in and I still do to this day. Once I got home, I stopped taking pain meds and felt decent. I was definitely sore but it was very doable. I was not able to start eating soft foods until week 4. Until then, I was having a really hard time getting in my protein and I felt really tired and week most of the day. By week 6, I was doing much better. Today, I feel great! I’ve lost 55 pounds and I am feeling it! I can’t answer your questions on the loose skin as I’m not to that point yet but I honestly don’t care. I do plan on getting a tummy tuck done and maybe a couple other things once I get to where I need to be but I really think I would rather deal with the loose skin than being morbidly obese and at a BMI of 50!!! I’m able to play more with my children and actually keep up with them! My husband and I are able to do “more” if you can get my meaning. Life is just so much better and I still have a significant amount of weight to lose! Good luck with your surgery.

My hospital requiring Covid-19 testing 48 hours before surgery. OK with me. I can feel confident that there are no infected patients roaming hall.

Ditto on both counts for me as well, even though I am about to run out of TP and still can't find any in my city. Since you work in the healthcare profession, I expect that either directly or indirectly, you've been deeply affected by covid-19. I'm a biologist with a secure job and career, but also a long-time volunteer in the field of end of life care. The nature of my volunteer work hasn't changed lately, but the volume of patients we’re seeing and the environment in which we’re caring for them has been meaningfully altered. The pandemic does not allow the luxury of time with my patients and their relatives. News is broken quickly, visitors and families are largely absent, faces are obscured by masks and visors, and more people are dying alone. The atmosphere in hospitals and hospices is taking an emotional toll on us all. Perhaps you’re experiencing something similar at work, as well. I'm grateful that my WLS surgery is in the rear-view mirror (or I’d be worrying about access to enough fresh foods, since pre-op I ate 3lbs of raw veg and fruit daily), but still not too far away, as I remain relatively uninterested in food (cooking and food science used to take up a lot of my free time and without a doubt I'd be doing way too much cooking and eating right now if I hadn't had surgery). I still have to work hard to adhere to a strict eating and exercise schedule, but I'm at ease with that and view this is a beneficial intensive training period that will serve me well over the long-term. Like you, I embrace this as an opportunity to learn more about myself and others. One of the few consolations of the coronavirus is the possibility that it could (eventually) lead to some progressive economic and political changes. I find it (somewhat) helpful to frequently remind myself that none of what we are experiencing right now is permanent. Please take care, and stay as safe as you possibly can.

Thank you all, I feel much better reading these responses; I was right to share this concern. I am not sure if I am technically on track, but will make an effort to find out. I am pulling out all the stops for the first week of May with water, protein, carb and calorie counting, etc, that will make it easier to recalculate. I use Silk protein milk with protein powder for breakfast, 8 oz of that stuff adds 10 grams of protein! The covid freak out has made me a little lax, but it also made me realize how I use food as a crutch, and I don't like it and don't want to be there again. I was slow loosing, and then it did come to a grinding halt for several weeks, and that is when the frustration mounted. I had not taken my height into account for the creation of a calorie deficit, I will look into that. I like to watch "My 600 lb Life" to keep things in perspective- those folks are facing the same issues as I am and they would probably be overjoyed to "only" need to drop 50-60 pounds. So right to try to focus on the victory so far. I can't speak for anyone else, but I was always subjected to negative conduct, so learning to keep my head up is something new. My job is a foolish place- and I work for a health care company! Thank you, thank you! 😘

Coping with Stress During COVID-19: What Bariatric Patients Need to Know May 1, 2020 by Harold Bays, MD, FOMA, and Lydia C. Alexander, MD, FOMA Dr. Bays is Medical Director and President of the Louisville Metabolic and Atherosclerosis Research Center in Louisville, Kentucky. Dr. Alexander practices obesity medicine at Kaiser Permanente Medical Weight Management Group in San Francisco, California. Funding: No funding was provided. Disclosures: Harold Bays, MD, FOMA is Trustee, Chief Science Officer, and Lydia C. Alexander, MD, FOMA, is Secretary/Treasurer for the Obesity Medicine Association. During this most unique of times, as frontline healthcare workers and hospital staff, we frequently face difficulties when treating patients threatened by a rapidly increasing pandemic. This is made even more difficult with the stress of limited essential medical supplies. Among all the turmoil and disruption, the emergence of COVID-19 has created special challenges for patients with obesity. Many patients with obesity have impaired immunity, impaired lung function, sleep apnea, and hypoxia, making a virulent upper respiratory tract infection especially perilous. Added to this are obesity-related debilitation, immobility, orthopedic changes, polypharmacy, more limited access to medical/preventive care, and adiposopathic complications of diabetes mellitus, and cardiovascular disease.1 Collectively, patients with obesity are more susceptible to COVID-19 disease and have worse outcomes once infection occurs. For many bariatric patients, the rise of the novel coronavirus has created additional challenges, such as the effect of mental stress on their lives. Increased mental stress can worsen complications from obesity, such as hyperglycemia, high blood pressure, dyslipidemia, and might also worsen obesity itself. The good news is that if clinicians are attuned to the physical impacts of mental stress, then proactive measures can be taken to mitigate the potential adverse consequences of mental stress. Acute Stress, Chronic Stress and COVID-19 Acute, or short-term, stress is a function of the natural “fight or flight” response. One of the systems activated by the stress response is the sympathetic nervous system, which increases production of hormones epinephrine and norepinephrine. The acute stress response can be beneficial—it can increase visual acuity, decrease pain, increase blood flow, and boost the immune system. This complex sequence of hormonal changes and physiological responses helps people when they need to fight or flee to safety. Conversely, chronic, or long-term “submit and stay” stress has the potential to worsen health outcomes. Chronic stress can increase cortisol production, which might promote visceral fat accumulation.2,3 Symptomatically, chronic stress can cause decreased cognitive ability, diminished healthful decision-making, and more pronounced pain. Physiologically, chronic stress can impair immune function, impair sleep patterns and increase blood sugar, high blood pressure, and body weight.4 The Toll of Chronic Stress on Patients with Obesity During COVID-19 Stress and anxiety are understandable during the COVID-19 situation. We are living in a time of an unprecedented global pandemic crisis. Doom and gloom are everywhere. Good news is rarely reported. Stress is to be expected. However, clinicians can assist patients with proactive stress management techniques, especially for people living with obesity. Many patients are staying home to keep themselves and others safe and limit the spread of the novel coronavirus. Other patients are staying home because of governmental mandates. But while “distancing” from others could have potential benefits in preventing viral spread, staying home might result in less healthful nutrition and reduced physical activity. As we navigate the unparalleled COVID-19 crisis, it is critical that clinicians, including bariatric surgeons, counsel patients to recognize the signs of mental stress, as well as its potential negative impact to health. This would include increased blood sugar, high blood pressure, increased body weight, and challenges fighting viral respiratory infections. Bariatric patients should receive specific and actionable guidance on safely optimizing nutrition and physical activity during periods of shelter-in-place orders.5 Coping with Stress During COVID-19 As we await a cure or vaccine for the novel coronavirus, one of the most important measures clinicians can take in the interim is to address potential mental stress head-on, as one of the first topics of discussion during patient encounters (e.g., via telemedicine or otherwise). When appropriate, clinicians can then recommend patient-centered stress management techniques that might prove helpful. Here are some ways to get started: Feel your feelings. While it might seem intuitively obvious, many patients might not truly recognize the degree by which mental stress is altering their behavior, lives, and overall health or might be avoiding addressing feelings of sadness or loss of previous routines and lifestyle. This should be a prime topic to discuss during any patient encounter. Patients should be educated to become in touch with their feelings and recognize how those feelings might be affecting their behavior. Negative or unproductive feelings and the potential adverse effect on behavior cannot be resolved until it is first acknowledged. Take it one moment at a time. At this time, no one knows how or when the COVID-19 crisis will end. It is likely nothing will ever go back to “normal.” This might be a daunting notion to patients with obesity, who might already have a sense of hopelessness. Thus, instead of focusing on the seemingly unending days of isolation ahead, patients should be encouraged to focus on manageable, demonstrable, and accountable healthful measures that can be accomplished today. Behavior changes that are doable, accountable, and sustainable represent the mainstays of a behavior modification plan. Perform a food inventory. It is common that patients with increased mental stress resort to “comfort food,” which is often energy dense and highly processed. Temptation to consume these foods is increased if these nutrition-deficient foods are in the location where people live. Thus, patients might best be advised to perform an inventory on the nutritional quality of food where they live. When ordering food or grocery delivery, patients should virtually shop when they are not hungry or exceptionally stressed. Having friends or family review the list might also be helpful for some to ensure healthy foods are chosen. Stay physically active. When shelter-in-place regulations prevent leaving the house, patients can be advised to look for novel ways to keep moving. Pacing while on the phone, putting the laundry away one item at a time, listening to music and dancing, and taking a lap around the house or backyard are all ways to remain physically active while sheltering in place. Passive stress relievers, such as surfing the internet, watching television, and playing video games might seem like an ideal way to pass the time. But these do not contribute much to energy expenditure and might worsen anxiety. Too much time spent with passive screen activities can have a negative impact on health. It is a good idea for clinicians to specifically talk to their patients with obesity about limiting screen time. Stick to routines and care plans. Now is not the time for patients to fall out of previous healthful routines and self-care that was either promoting health, or helping with health maintenance. Patients should be encouraged to think beyond COVID-19. They should avoid having these few months negate years of potential progress that were so hard to achieve. Patients should especially be advised to monitor their sleep patterns. Poor sleep can contribute to worsening metabolic disease, cardiovascular disease, and obesity. Closer clinician contact with bariatric patients at this time is critical to identifying early maladaptive behaviors and routines and ensure continued long-term success Practice active stress reduction. Patients should be encouraged to explore activities, such as walks (where permissible), puzzles, books, yoga, meditation, and other hobbies. Maintaining social connection via phone and video calls while physically distancing can be an important method of stress reduction. These pastimes can have a soothing effect during this stressful time. Look for the helpers. Fred Rogers said it best, “Look for the helpers. You will always find people who are helping.” During times of crisis, finding a way to join the helpers can be gratifying not just for the one being helped, but also the one doing the helping. Participating in community efforts to improve the lives of those affected by the COVID-19 crisis can have a relieving impact for everyone. Maintain social connectivity. While the recommended jargon of “social distancing” is prevalent, perhaps the implication of this approach is not what was intended. Perhaps a better term is “physical distancing.” Remaining socially distant is not always the best plan, especially for patients with obesity who are already stressed and who might already feel isolated. For many patients, it might be best to recommend to seek and maintain social connection via a simple phone call, or FaceTime, Zoom, Google Hangouts, or any of the myriad digital communication solutions available. As clinicians continue to look for ways to help their patients during these stressful and uncertain times, bariatric surgeons can empower patients via implementing simple techniques, such as the ones described here. The Obesity Medicine Association (OMA) offers a trove of resources for clinicians and health care professionals, including continuing medical education, American Board of Obesity Medicine (ABOM) exam preparation, Obesity Treatment Proficiency Badges™, and The Obesity Algorithm®, which offers comprehensive clinical guidance on the latest obesity management trends and evidence-based medical approaches to treatment.6–8 To become an OMA member, visit: https://obesitymedicine.org/join/. For more obesity medicine resources, visit: www.obesitymedicine.org. References Scott KA, Melhorn SJ, Sakai RR. Effects of chronic social stress on obesity. Curr Obes Rep. 2012;1(1):16–25. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression and type-2 diabetes mellitus. Ann N Y Acad Sci. 2017;1391(1):20–34. Kyrou I, Tsigos C. Chronic stress, obesity and gonadal function. Hormones (Athens). 2008;7(4):287–293. Yaribeygi H, Panahi Y, Sahraei H, et al. The impact of stress on body function: a review. EXCLI J. 2017;16:1057–1072. Bergmann N, Gyntelberg F, Faber J. The appraisal of chronic stress and the development of metabolic syndrome: a systematic review of cohort studies. Endocr Connect. 2014;3(2):R55–80 Obesity Medicine Association. https://obesitymedicine.org/badges/. Accessed March 24, 2020. Obesity Medicine Association. https://obesitymedicine.org/. Accessed March 24, 2020. Obesity Medicine Association. https://obesitymedicine.org/obesity-algorithm/. Accessed March 24, 2020

Don't give up on your dream, 25 pounds can be done. 😊 Take it one day at a time. Years out, your surgery still works. Find your old discipline. Your weight loss may be slower but it still comes off. After the honey moon is over, what motivates you now? Dig deep to find your reasons to stay the course and be healthy. Work your program. Log food, hydrate and get exercise in. Join an online weight loss challenge. MyfitnessPal *JUST GIVE ME TEN DAYS WEIGHT LOSS CHALLENGE* https://community.myfitnesspal.com/en/discussion/10793433/just-give-me-10-days-round-112#latest

40 pounds is actually pretty good. My surgery was on 2/19 and I have lost only 25 pounds.I know it is discouraging but be patient. You are learning a better way to eat a slow weight is healthier. I concentrate how I am feeling rather the numbers.

I’m worried about the same thing. I’m scheduled for sgy next month and I find myself panicking sometimes about if I’m making the right decision or not. One reason being the loose skin factor. I’m 37, 5’3, 275 lbs and have been over 200 lbs for the past 10 years. Does anyone have similar stats who’s post op? How did you guys fair with loose skin? Do you regret the surgery? Did you see major improvements to your health long-term?

For those of you that didn’t reach your goal weight during the honeymoon phase (18-24 months after surgery), were any of you able to kickstart your weight loss later and drop the pounds? I lost lots of weight initially (100lbs.), but mostly maintained (or went up and down the same 5-10 lbs.) for the past year. I definitely haven’t been as strict with my diet and exercise during that time. I’m still about 25 pounds from my goal weight and don't want to give up on the dream. . Has anyone successfully met their goal later in the process? What made the difference for you to get it going again?

Yeah...i was soooooo cold ALL. THE. TIME. Some people report this as lasting quite long. For me, I stopped feeling I was unnaturally freezing to death around the 9-10 month mark (a couple months after my weight stabilized). At 1.5 years post op, i *think* I feel cold and hot like normal people now...

Thanks for the encouragement me. My wife created this account for me, and made my first post while I was in the hospital ( I am actually only 34). I was fine by day two, but they had convinced me that I was going to in surgery at 10:00 AM and out the door by 2:30 PM, and I would not have made it the first day without the IV. I had unfortunately only review this forum for peoples results at 6 months and 12 months, and didn't bother to look into the immediate after effects. I am 9 days into my diet and down 20 lbs (had a 5 lbs spike post surgery). Surely I can hit 40 lbs down by the end of May.

First of all congratulations on your 62 pound weight loss! I was a slow loser also. I had surgery 8/13/18. I was 204 when I had surgery and in February of 2019 I was 162 which was a loss of 42 pounds. (same time frame I believe). I was tracking everything I ate and averaged 700 calories a day. It was super frustrating and it felt like a turning point for me. I joined a gym through my hospital that provided me with a personal trainer and went to the gym 4-5 days a week. I tightened up my diet and ate more protein and fewer carbs . I made the decision that 40-50 pounds was not going to be good enough for me personally. Don’t get me wrong, I was pissed that I had to work “harder” than other people to get results, but that wasn’t going to change my situation. Once I let that go and just accepted that I wasn’t doing anything wrong and that my slow metabolism wasn’t a character flaw, I found it easier to dig deep and work hard to reach my goal weight. On the positive side: I had more time to adjust my lifestyle and eating habits and I never take a pound for granted. I maintain my weight on 1300 calories a day, so you can see why it took me longer, I just can’t eat a lot without gaining. I have tons of tricks and tips and I don’t feel deprived... ok, sometimes I do....But it’s ok, I’d rather grab an apple or a kind bar than be overweight again. You aren’t done losing weight, it might come off slower but you can do it. Track 100% of what you eat hydrate the best you can (your boss sounds like a gem) Move, walk, workout if you can as much as possible. Wear a Fitbit or device that monitors your steps, set a goal and meet it everyday. Best of luck and wtg with your loss so far!

I started my preop diet on 5 May 2019 and tend to think of this date as my anniversary, rather than my actual surgery date of 15 Oct 2019. Since May 2019 I've lost about 140lbs; 90lbs of this was after being sleeved. I lead a very busy, very active life and my goal weight is within sight, but it's more important to me to be fit, strong, and healthy, which I now am. Before becoming MO, I was a competitive athlete, and am again able to participate in sports and fitness the way I used to. There have been dozens of NSV's, and I'm grateful for every one of them. My focus continues to be on the psychological adjustments and actions required to permanently change my habits and behaviors. Since the coronavirus lockdown, I've continued to strictly follow an eating and exercise schedule so that I remain on track. With so much uncertainty at this time, what I put in my mouth and do with my body are one of the few things within my control right now. Congrats and well done to all my fellow Oct sleevers.

Hey there! I had gastric sleeve surgery on 1/31/2020 and here's my story. I attended the free 12 week orientation classes June 2019 thru Sept 2019 at Kaiser. My insurance paid for everything and I had no issues getting approved. My only out of pocket expense was a $100 co-pay for the hospital stay. Wonderful insurance, I know. Luckily, I had no medical issues making me very low risk for the surgery. My surgeon recommended that I get the Bypass and I changed my mind on procedure the day of surgery and switched to the Sleeve. My reasoning is simple...I didn't want to reroute my intestines and I didn't want to chance vitamin deficiencies or dumping syndrome. I fasted on clear liquids the day prior to surgery and it was hell. I had an interview on fasting day and wanted so badly to stuff my face, being an emotional eater (i did get the job!). I went to bed super early the night before surgery because I had a massive headache and mood swings from fasting. My surgery was at 1pm and because of the fasting... I wish I scheduled a morning surgery. The nurse that prepped me for surgery was an idiot. Why on earth would I be able to pee for a pregnancy test after having no fluids since the day before?! I could barely pee and what I did pee didn't make it in the cup lol I got 2 tiny drops of pee in the cup and guess what? It was enough for the pregnancy test. The nurse stuck me 7 times looking for a vein. 7 times. Not just a poke either, like she was really digging. She tried my forearm, the top of my arm, and both hands before calling for help. I woke up in recovery in extreme pain, nausea and was thirsty. I said "I'm thirsty and my stomach hurts really bad" and the nurse said yeah you just had stomach surgery. I wanted to sock her in the face. They made me wait 6 hours for pain medication and water. The night nurses sucked and the day nurses were great. I used the call button every 1-2 hours for more pain meds which they could only give me every two hours. I called after 45 mins and said "did you give me a full or half dose?" lmao but I was serious. The built up gas hurt and my throat was sore. I tried really hard to push the gas out and ended up sharting in my bed. I walked often because I badly wanted to go home. Coming home was nice and I wasn't hungry but still thought about food a lot. I followed the rules and sipped my water and protein shakes and jello. I only took a week off from work because I wanted my routine back. The doctor told me it was too soon because of brain function is usually low this early on. He said "do you want to go back because you're bored or because it's a money thing" and I said "I'm bored as hell" and he said "then no, you can't go back yet." I didn't listen and have no regrets. I started taking the pill form of multivitamin early on because the the ones you eat made me gag. I slowly introduce foods as instructed and my staples are yogurt, protein shakes, salmon, cottage cheese, and veggies. I keep my meals simple. I had my 3 month check up today and I'm on track. I've lost 50 lbs total since surgery. I'm aware that weight loss with the sleeve is slower but I'm okay with it. Each week I can physically feel and see my body changing for the better. I exercise daily by walking 1-2 miles, I feel great, and I have more energy. This is the one and only time that I've had surgery. It was rough at times but overall a good experience. I am happy that I did it and have a long road ahead

I know that every journey is different, but I feel very discouraged with my numbers. I was sleeved October 1, 2019 and my surgery weight was 229. I am now 178 and I feel that I have not lost enough and am in a stall. I have had problems with my water intake, partially due to my employer freaking out about additional bathroom breaks-I had to get an ADA accommodation, but it has expired, they want to hear from the doctor, who feels that it is ridiculous (he's not wrong). I am embarking on an effort to try to pick up the pace , 2 30 minute exercise periods per day ad diet modification. I am 4'11 and feel that i should lose a minimum of 50 more, nd it seems impossible. I know that part of it is mind set, but I just don't know what to do, other than discuss it with people who get it. Grrrrrr.😟