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I got my surgery there two years ago. Dr. Hahn. When I had my surgery you had to have a BMI of 40 or higher to get referred to the program. They have their booklet online: http://mydoctor.kaiserpermanente.org/ncal/facilities/region/gsaa/area_master/departments/Bariatrics/binder.jsp Lynda

Congratulations! Dr. Rodriguez was my bariatric surgeon too (April 30th at Star Medica). You've made a wise choice.

That's awesome. I have BCBSIL PPO and the surgery is covered under my employers contract. It has to be deemed medically necessary! Well, I fall within the guidelines of what BCBSIL require >40 and I can see a Master's Degree or higher NUT to say I'm mentally stable and understand what's expected before, during and after surgery. But ... My surgeon, through Cadence Health Bariatric Treatment Program, @ Central Dupage Hospital is having me to meet with my PCP for bloodwork and a letter stating there are no medical contraindications to surgery and a release to exercise, NUT, Pulmonologist, consult with an Exercise Specialist prior to surgery, Gastroenterologist eval or blood test to screen for H.pylori, an ECD and attend at least 1 support group. This along can take months. Is all this needed to help with the approval from the insurance company? These are all things your surgeon requires to ensure a successful outcome. This is major surgery and lifestyle change. You have a surgeon who wants to ensure success.

That's kind of a privilege of being a male. Overweight women are pariahs--we are assumed to be lazy, have weak character, etc. I'm not telling anyone (not a single person) because people are nasty, judgmental, rude... I don't need anyone telling me how to eat, or what I should or shouldn't do about my body. For some reason though it happens all the time. "Are you sure you want to eat that?" "Have you ever bought a slow cooker? You can just fill it up with lean Proteins and vegetables in the morning and have a healthy meal at the end of the day!" "I can show you some easy workout routines." These things are always UNSOLICITED. Most recently, a blonde haired plastic Barbie approached me at target to give me her husband's business card. It was very strange but I took it and gave an awkward "thanks..." And as she walked away, I looked down to see that her husband is a Bariatric surgeon. It was this moment that did in fact inspire me to look into WLS, but not because of her recommendation (I am certainly not seeing that surgeon). But because I'm so tired of being judged by other women. I'm only 90 lbs overweight. I can't imagine how other heavier women manage. I don't want my identity to be defined by my WLS or my weight period. It is for this reason that I refuse to tell anyone.

Found this online... One nutritional ramification of bariatric surgery can be Lactose Intolerance. After bariatric surgery, dairy products can move too quickly from the stomach to the small intestine potentially resulting in gas, bloating and/or cramps. Makes sense!

I am in Chicago, getting my surgery at Little Company of Mary Hospital - the Midwestern Bariatric Institute which is a " Center of Excellence".

The only one I had trouble with was the Bariatric AE Multi-Vitamin which would choke a horse. I cut them in fours and tried to mash it up in cinnamon applesauce, but the bitter taste made me puke. So, I ended up switching to a Walgreen's Women's Over 50 multi and take two instead of one. Some folks have even taken Flintstones Chewables until they got past this hurdle.

I think that you are reaching for Snacks because you're stressed---just like the good ol' days, before WLS. Usually when some one is constipated there's no room for more food. I'm think'n your hunger is the dreaded head hunger. That doesn't make it any easier to live with, but maybe just a wee bit more understandable.--and when something is understandable, it is manageable. I think a call your bariatric team is warranted. If it concerns you enough to stress about then it's worth a call. They will be able to guide you because the "know" you. Please keep us posted. We care about you. You know that.

I had my surgery on 03/17/2015 and I thought, this is it!!!! I had read stories of people that gained back all the weight and sometimes more and I thought why would you do that and how could you if your stomach was removed. I had the Sleeve and I said not me no way no how. WELL here we are in 10/28/16 and I have not gotten to goal and have been fighting the same 8lbs for the last 8 month. food is a whole lot easier to eat and eat I have been and then I realize I am up the same eight and get back on track and lose a few and that VICIOUS VICIOUS cycle will start again. I am in other Bariatric sites and even buy their expensive Protein powder saying this will get me back on track but my MIND JUST WONT HELP ME. How do you make your mind understand to let the sweets and carbs go and not want them. I am like some sick addict that at night says I will not touch it, I will get clean and then morning comes and I fall right into the addiction of bad food. I get super jealous (the good kind) when I see others who have succeeded and look at the before and after photos and am like COME ON WOMAN this could be you and for a fleeting instant I can tackle it but then the addict comes back out and I get my fix of something or anything--even if it doesn't taste good. A sick addict does that. I want to reach my goal by my birthday in Feb 2017--a little over 30lbs to get there and I hope that I can reign in this addict that lives within me to get there.

I'll be starting my two week liquid diet on May 29 also. The dietician I saw at the bariatric center gave me some recipes for some shakes that don't sound half bad....some of them even have strawberries or banana in them, and I'm also allowed to have a salad or steamed veggies if I get too hungry so I think I can manage that. My aunt did the same identical diet and lost 15lbs. in the two weeks before surgery, so I'm hoping that I can also. I know I can do it, but it won't be easy so I'll definitely be leaning on you guys for some support!!! Good luck!!!

I'm working on getting banded. Having been very heavy in my youth, losing much if not all of the weight I needed to lose and now, having gained most if not all of it back, I can give you a few points of view that your Mother is going through. First, the comment you make about "trying to be supportive". In that kind of language, this says to me that you are only being supportive, because you have to, not because you want to. Being genuinely concerned and being OVERLY PROTECTIVE, are two entirely different things. You need to focus your mind differently on approaching your mother and how you deal with things. Statements like "I've tried to be supportive" indicate that you don't trust the person inherently and this can create an emotional chasm between you and the other person that can have ill effects later on. My second insight to you is that having been an EXTREMELY obese person, migrating to the EXTREMELY FIT and healthy thin person, I never truly saw how wonderful I looked. I always thought I was still fat. I look at pictures now and wince, knowing that the person in that picture was thinking that he was still disgustingly fat, even though he looked AMAZING in the picture. The problem is called Body Dysmorphic Disorder. Body Dysmorphic Disorder is a psychiatric disorder in which the affected person is excessively concerned about and preoccupied by an imagined or minor defect in his or her physical features. This is especially common with people who have lost a tremendous amount of weight, or have eating disorders. The only suggestion I can give you is that perhaps you gently encourage your Mother to speak to her physician and/or you possibly speak to her physician on the side asking if he/she could recommend that your Mother see a psychotherapist. Perhaps the one that did the Bariatric Surgical Evaluation to go over these issues. Please just be careful when approaching your Mother. Be patient and understanding, because the last thing you want to do is to alienate her and her feelings by trying too hard to "Dr. Phil" her into seeing that this is a problem. Your mother needs to come to this conclusion on her own, with some really great, nurturing psychotherapy. Now that I'm on the other side again, anxiously trying to get back, I have overcome this issue and know that when I get where I need to be, I will be the most thankful person in the world. Best of luck to you and remember to be really proud of your mother and her accomplishments. A 74 year old lady who lost that much weight deserves to kick up her heels and live a little! Enjoy this time with her!

It kind of depends on your surgeon. Some people get the advice that as long as it is about the size of an m&m you can swallow it no prob. My surgeon likes people to crush until 3 months, but I couldn't pull it off and finally called and they cleared me at 1 month. I take chewable (bariatric advantage) multis, I know lortab comes in a liquid, I used to take melatonin and you should be okay with that size pill, but like I said, I would check with your surgeon/pharmacist. Good luck!

I personally like both Matrix and Nectars. My surgeon's office sells both so I would take that as an endorsement by them. I have read that the human body cannot digest more than a certain amount of Protein at a time. The numbers I have seen vary from 20-30 grams. What I recall is that most of the studies regarding the high protein at one meal was done for body builders. That having higher amounts of protein per meal did not result in better building om muscle mass. It seems to me that this has then been twisted into the thought that we cannot absorb/digest more than X grams of protein per meal. I have not been able to find legit research that has been done to document how much protein is too much protein per meal as it applies to normal everyday people not body builders and their goals. I certainly have not been able to find how it relates to bariatric patients. Disclaimer: I am not a medical professional and may be way off base with what I am reading. If somebody has a link to research on how much protein is too much protein from a legit source I would love to read it.

We all know exactly what weight gain is; the scale goes up in numbers, our clothes start to get tight, it takes more effort to get out of a chair, the seat belt is tighter and we just don’t feel as well. We all know what weight loss is; the scale shows us a lower number, our clothes hang funny and fall off of us, people start complimenting us about the way we look, we feel better, and we need less medicine. But weight maintenance is something that we all have failed to understand. We have gone up and down in our weight our entire lives, struggling to keep the weight off, gaining weight over and over again. Gaining it has always been easy, I just look at brownies and I would gain two pounds. I never understood my neighbor who was always a perfect size 8 and ate everything in sight. We all know people like that. What has always been missing, is weight maintenance – it was something that I had never achieved. It was elusive to me. I was a constant yo yo. I would lose the weight and thought I could maintain my weight loss but those old habits would sneak back in and sabotage me one more time. The frustration grew every time that I would go down and then back up again and many times with a bonus extra pounds. Each time getting more and more frustrated. When you buy a new car you shop around to get the best deal and then you pick the one that best suits you and your lifestyle. When you pick it up, it comes with a manual, a set instructions and guidelines. You need to put gas into the gas tank to make the car move and every 3, 0000 mile change the oil. Then every once in a while you need to take it in to the dealer who opens it up and looks inside. They make some adjustments and then they give you a bill. You pay the bill and then you are on your way. You need to wash and wax your car so it always looks good. Well, if you think about this is the same as having Bariatric Surgery. The new car is the same as your new pouch. You decide what kind of surgery that is best for you and your lifestyle. You shop around for the best surgeon. You are given a set of instructions from your surgeon, just like you received with your car. You need to feed yourself protein and water to keep you going. Every few months you need to see the surgeon, to check under your hood to take sure your blood levels are good to keep you going in the best condition. You doctor will give you some suggestions to keep you running well and keep you on the right road to weight loss. You exercise and continually add more fuel. But then one day you stop checking the oil and washing the car. A rattle appears out of nowhere and you get used to the new noise coming from the right front of the car. A door ding shows up and you do not even notice the second or third one. You forget to check under the hood. For the bariatric patient this is the time that they start to stray from their doctors program, they start to gain a little weight, we go back to some of our old habits without even thinking about it. This is where we all start to get into trouble. We think we do not need support group anymore, after all we have lost a lot of weight and we think that we are doing just fine. Then all of a sudden we have a wreck, we got on the scale and it is up by 20 or 25 pounds. It is time to call the Auto club tow truck. We need to get towed back to the right road. The Maintenance Road. We all have heard the new Weight Watchers ad campaign, that diets do not work, every one of us know that diets do not work. We have tried them all and look where we ended up; heavier and more frustrated. The only thing that will have lasting effects on us is when we are ready to make lifestyle changes. These changes will make us not only lose the weight but to keep it off for life. To lose weight and keep it off, the best approach is to focus on lifestyle changes and develop an eating plan that's enjoyable, yet healthy and low in calories. This approach will result in weight loss that you can live with - that is, that you can maintain over a long period of time. We need to attend support groups and get a constant stream of positive motivation to keep us on the Maintenance Road. It is easy to get lost and to end up in a dead end; your support group can direct you back at anytime. We are here to help you achieve the goals that are important to you. We each need to learn to make it a Lifestyle that you can live with and enjoy day in and day out to continue to maintain your weight loss. Successful Make it a Lifestyle weight-maintenance strategies Now that you have lost the weight, you can't stop your hard work. Weight maintenance requires daily exercise, healthy eating, a long-term commitment and constant attention. The following habits are essential for you to develop to achieve long term weight maintenance: Healthy snacks and meals - Focus on low-calorie, nutrient-dense foods, such as fruits, vegetables and whole grains. Keep saturated fat low and limit sweets and alcohol. Remember that no one food offers all the nutrients you need. Choose a variety of foods throughout the day. Remember to eat two bites of dense protein to one bite of anything else. Exercise program - One of the most important things you can do for weight maintenance is to continue a aggressive exercise program. Studies suggest that it only takes 30 to 60 minutes of moderately intense physical activity daily to maintain weight loss. Moderately intense physical activities include swimming, fast walking, biking, and hiking. Know and avoid your food traps - Know which situations can trigger you’re out-of-control eating. The best way to identify these food traps and emotional eating is to keep a food journal. For as long as you find it helpful, write down what you eat, how much you eat, when you eat, how you're feeling and how hungry you are. This will help you understand and stay in control of your eating behaviors. Regularly monitor your weight - People who weigh themselves at least once a week are more successful in keeping off the pounds. Monitoring your weight can tell you whether your efforts are working and can help you become aware of small weight gains before they become larger. Be consistent - Sticking to your new lifestyle plan during the week, on the weekends, and amidst vacation and holidays increases your chances of long-term maintenance. Attend Support Group - Getting support is critical, whether through a friend, family member, trained professional or support group, can ultimately mean the difference between your success and failure.

IN & OUT OF THE WLS CLOSET I was happy about my decision to have WLS and thrilled when my insurance company finally approved it. I shared this happy news with many friends, acquaintances, family members, and coworkers. I don’t know but I assume that they discussed it amongst themselves to some extent, expressed opinions or concerns, and perhaps worried about my decision, but none of them gave me frankly negative feedback. They might have been thinking it, but they didn’t say it. I very much doubt I would have reversed my decision if someone had said, “That’s too risky/it’s a bad idea/I don’t want you to/you’re crazy/or whatever.” I’m going to assume that you, the reader of this article, are an adult over the age of 18, with the right to vote, the obligation to serve in the military, and (at some point, depending on your location) the right to purchase and use tobacco and liquor. Unless a judge has declared you mentally incompetent (and that’s harder to accomplish than you’d think), you are the one who’s responsible for your body – for its care and nourishment and any medical treatments or procedures that affect it. So if you’re in the early stages of considering WLS, whose input are you going to trust to inform your final decision? A bariatric surgeon, or your dad? Your primary care physician, or your sister? Your therapist, or your hairdresser? And hey, I’m not slamming hairdressers. Mine could do very well indeed as a therapist, but she has a cosmetology license, not a mental health practitioner license. Last summer I was startled to hear a 50-something bandster state that she had gotten her husband’s permission to have plastic surgery. His permission? Huh? Does that mean he’s the only adult in that relationship, or what? I’m not against asking permission, mind you. I ask my boss’s permission to undertake certain tasks or projects at work; I ask the State of Tennessee for permission (i.e., a driving license) to drive a car; if I still lived in a suburban development, I might ask the zoning board for permission to add a room to my house; I ask the government of China for permission (i.e., a visa) to travel in that country. I’m an extremely independent person in many ways, so I have to stop and think carefully about what I might ask my husband permission to do. We have our own separate checking accounts as well as a joint account, so I might ask him for “permission” to spend a chunk of that joint account on a big purchase like a computer or a car. Everything else gets negotiated. I have a lot of experience in negotiation because of my business career. I negotiated things with everyone from my coworkers to my suppliers. But people who do that kind of thing for a living aren’t the only ones who negotiate, and negotiators aren’t necessarily politicians or manipulators trying to advance some evil cause. My own career as a negotiator probably started when I was a child who realized that good behavior often yielded a treat. My negotiations with my mother went something like this: It’s 7:00 o’clock on Thursday morning. Mom is brushing the tangled cobweb of my hair in preparation for braiding it. I am sniveling because the untangling hurts. The negotiation begins. Mom says: “Jeannie, if you stop whining right this minute, you can have Cocoa Puffs for breakfast.” Jeannie sees an opportunity and negotiates this agreement by asking, “Can I have chocolate milk on my Cocoa Puffs?” Mom sighs and yanks at a hank of hair. Jeannie snivels a little bit more. Finally Mom says, “Yes, you can have chocolate milk on your Cocoa Puffs.” Jeannie instantly shuts up. Negotiation over. It’s a win-win situation. Everybody’s happy… for maybe 15 minutes. In 15 minutes, Jeannie’s hair is finally tamed into two narrow braids and it’s time to choose an outfit for school. This time Jeannie begins the negotiation. “Can I wear my pink dress to school?” Mom says: “That dress is brand new. We’re going to save it for church.” Jeannie says: “I promise not to get it dirty.” And so on and so forth. Well, that’s enough time spent traipsing along Memory Lane. My point (and, like Ellen Degeneres, I do have one) is that the “yes or no” WLS decision is yours. Everything else (how to make it work best; what your family can do to help you; how much to tell your nosy coworker) needs to be negotiated with (or modulated by) the people who will be involved in your WLS journey on a daily basis and possibly renegotiated as time goes on and your needs change. The negotiation may be simple (“Will you take the kids to McDonald’s for lunch if I pick up your dry cleaning?”) or complex (“Let’s talk about how we’ll handle Thanksgiving Dinner this year”) or downright messy (“I feel like you’re trying to sabotage my weight loss.”). That’s life, isn’t it? BE CAREFUL WHAT YOU ASK FOR Getting feedback from others is usually a mixed bag experience. It’s wonderful to get the positive stuff and uncomfortable to get the negative stuff. It’s also very frustrating when your announcement elicits no response at all. What if you tell your sister, “I’ve decided to have weight loss surgery,” and all she says is “Oh.” What’s that all about? She’s shared her thoughts about your hairstyle, your boss, your kid’s struggles with math, your parents’ new car, your high blood pressure and now she has nothing to say about something as momentous as weight loss surgery? If you’re like me, your mind gets busy filling in all the empty spaces with scenarios and speculation. My own little mind is always full of running commentary (most of it – well, some of it – never uttered aloud). When I’m exercising, I’m planning what to wear to work that day. When I’m driving to work, I’m considering the best way to write the first or fifth or fifteenth sentence of my next article. When I’m driving home at the end of that day, I’m replaying a conversation I had with a coworker and fiddling with what I could have said better. So when I encounter my complete opposite (someone who has nothing to say on a matter that’s important to me), I cast my fishing net into my teeming mental pond, scoop up a dozen squirming fish, and off I go into Wonderland. “Wonderland” as in the land where I wonder, and wander, on an endless circular track. Around and around Jean goes, and where she stops, nobody knows, least of all Jean. The official term for that is “projection”. You project your own internal drama onto someone else’s blank white movie screen without having the first clue about what’s really going on behind that blank screen. You’ve known your sister all her life, ever since she supplanted you as the baby of the family. That’s what, 35 long years? After 35 years together, you might think you could predict her reaction to almost anything, but it’s also quite possible that you cannot correctly read her mind. Your suspicions about her reaction to your weight loss surgery announcement may be accurate, but you’ll never know that unless you specifically ask her. That’s more or less what happened to me when I first began discussing weight loss surgery with my husband. We had been married for 20 years, so he had two long decades of experience with his wife launching herself into risky situations (be it a new job, an overseas trip, adopting a pet, redecorating a house, taking fen-phen). He had been amazingly patient through all of that, not just because he loves and supports me but also because he knows that hell hath no fury like Jean with an obstacle in her path. So when I said, “Today I made an appointment to go to a bariatric surgery seminar,” and he said nothing in response, a dozen things ran through my mind. He thinks I should be able to lose weight by dieting. He doesn’t want me to lose weight because he likes fat girls. He thinks this is another of Jean’s wild goose chases and if he leaves it alone, she’ll get over it and move on to some other project…and so on and so forth. What was actually going on in his head was probably more like, “I wonder if there’s more rice in that saucepan, but if Jean forgot to buy soy sauce again, I won’t have another helping because I can’t eat rice without soy sauce. If Jean has weight loss surgery, will we ever get to eat rice with soy sauce again? Will we be living on warm water and melba toast? Did I remember to fill the cat’s water dish before I came in the house? We really need to get the cat fixed but I don’t want another argument about whose turn it is to take a critter to the vet. Oh no, Georgie’s puking in the living room again. If I ignore it, can I get Jean to clean it up? I’m going to write SOY SAUCE on the grocery list in big letters so Jean won’t forget to buy it. Maybe if I ignore the weight loss surgery thing, it’ll disappear, like Georgie’s puke”…and so on and so forth. I’m not trying to make my husband’s thought processes sound asinine (for a taste of truly asinine thinking, you really need to listen to a few minutes of my own stream of consciousness). I’m just making the point that our minds are full of stuff that may be worthwhile or interesting to us but doesn’t necessarily have to be shared in detail with everyone around us, and that nobody but the Amazing Kreskin can hear someone else’s thoughts. When my husband finished his dinner (without a second helping of rice) that night without making any response to my bariatric ambitions, I asked him, “So what do you think of the idea of me having weight loss surgery?” And he said, “I’m not crazy about it, but if you really believe it will help you, I’ll do my best to support you.” And what did I say to that? All I said was, “Thank you.” I could have said a lot of other things. I could have said, “Why aren’t you crazy about the idea?” I could have quizzed his knowledge about weight loss and weight loss surgery. I could have asked him if he would still love me and desire me when I was thin. I could have gone on and on for hours, while adding to my own anxiety and creating a host of brand new anxieties in his poor head. But instead I said, “Thank you,” because his promise of support was all I needed to hear at that time, and we had a lifetime of conversations ahead of us. And I said “Thank you” because when I’m in the planning stages of something big that will require a group effort, I try not to invite discussion that will derail the whole project even before its engine starts. You may have a different style, and you may think I was postponing a discussion that should be tackled immediately, but my approach is: one step at a time. I don’t try to build Rome in one day. I pick up one brick, walk it over to where I want the wall, put it down, and go back for another brick. Eventually the wall (or Rome) gets built. IN & OUT OF THE BAND CLOSET My feelings about sharing my WLS journey with other people have changed as time has gone on. For three months before and about 18 months after my band surgery, bariatrics was the #1 subject in my mind at least 75% of the time. I had to exert effort to not talk about it constantly. If I hadn’t discovered online WLS forums, where I could talk about it constantly with other people who talked about it constantly, I think my head may have exploded. I didn’t talk about WLS with every single person in my everyday circle of friends and acquaintances (for example, I decided not to tell my church friends about it, mostly out of laziness), but most of the people who knew me as obese also knew about my surgery. When I had lost my excess weight, the focus of my life began to shift to other things. Yes, bariatric surgery was still important to me, and so fascinating that I wrote a 500+ page book about it, but as my interests and activities grew and changed, I acquired a whole new set of friends, acquaintances, and coworkers who had never known Fat Jean. It didn’t occur to me to tell them I’d had WLS any more that it occurred to me to tell them I’d had a hysterectomy or hemorrhoids. If the subject of weight loss or dieting or exercise came up, I was willing to talk about those topics, but not necessarily in the context of weight loss surgery. I guess you could say I was in the band closet then, though I won’t admit to hiding in there. I still wanted to talk about bariatric topics, but not with the general public. I made two new friends during that time who know about my band surgery. One of them had heard about it from her mother (a former coworker of mine) and the other heard about it from me. Otherwise I was kind of enjoying being perceived as a “normal” woman by people who couldn’t even imagine me as a fat woman. But one day my feelings changed. I opened the door of my band closet and peered out. It was time to get out of there. Here’s what happened. During an exercise class at my fitness studio, another (naturally slender) student began making fun of fat people, and a few more people there chimed in. They just couldn’t imagine how someone could “let themselves go” like that. It sounded to me like these well-meaning people were saying that obesity is a choice – that the fat people had made a conscious decision to overeat, under-exercise, and gain an unhealthy amount of weight. It sounded to me like these well-meaning people were saying that fat people don’t have the willpower or intelligence to maintain a healthy weight. And suddenly I heard myself say out loud, “Those people aren’t proud of their fat. Don’t be making fun of them.” After a minute or two of mumbled objections, those well-meaning people fell silent, and soon the conversation took a new direction. Months later, when I was about to publish Bandwagon Cookery, my friend, instructor and personal trainer, Caroline, suggested holding a book-signing event at the fitness studio. At first I was wary of the idea. It would require me to step out of the band closet and expose my bariatric secret to a community of people who had never known Fat Jean. It would require me to step out of my comfort zone and into the limelight. I’m not afraid of public speaking – I actually enjoy it in most circumstances – and I’ve told my WLS journey story plenty of times, but mostly to bariatric patients and professionals. At Caroline’s loving insistence, we hosted the book signing, which was well-attended by women for whom weight management was an interest but for whom obesity was not an issue. One of them had a sister who was banded, but the rest of the guests were blank slates when it came to bariatrics. I want to share with you what I told this audience after announcing that I had weight loss surgery, something that I felt they needed to hear before I could tell my nitty-gritty obesity story: “I need to talk about the elephants in the room. The elephants are the beliefs that many people have, that obesity is a moral failing and that weight loss surgery is taking the easy way out. Obesity is not a choice, nor is it evidence of inadequate willpower. It’s a chronic and incurable disease caused by a combination of genetics, environment, and behavior. Weight loss surgery is the only effective long term treatment for obesity available in the United States today. And weight loss surgery is by no means the easy way out. Weight loss is hard work with or without the help of surgery. Has my weight loss been easier because I had bariatric surgery? Of course it has. That’s one of the reasons I chose surgery – because without it, my previous weight loss attempts had been so difficult and so ineffective. “I’m glad to have my Lap-Band, but it’s just a little piece of plastic, a tool that reduces my appetite. When I stick my hand in a bag of potato chips, my band doesn’t yank it out again. When my alarm goes off in the morning and I want to roll over and go back to sleep, my band isn’t what gets me out of bed, into workout clothes, and into this fitness studio. When I’m thinking that I need a 2nd helping of mashed potatoes, my band doesn’t shout, “Don’t do it, Jean!” When I’m sad and thinking that buying and eating a gallon of ice cream would make me feel so much better, my band doesn’t hide my car keys on me. “I am the one who makes decisions about what I eat and how I exercise. I am the one who’s responsible for making good food choices and changing my eating and exercise behavior. So I get the credit for my weight loss, and I’m the one who has committed to maintaining that weight loss for the rest of my life.” Looking back, I’m not sure how much of an impact that speech had on any of my listeners, but it had an impact on me. Hearing myself say those words affirmed my important and life-changing decision to have bariatric surgery. Whatever you do as you go forward on your weight loss journey, be proud of what you’re doing. It’s a courageous thing. If no one else congratulates you for the undertaking, you should still pat yourself on the back for it.

Bariatric Realities I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress. I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored. Not to me, they aren’t. And these will be addressed in this series. In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…) I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real. Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series. Alcohol Use After WLS This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment. Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders. And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot. Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA? No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality. Food Addiction Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction. “Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real. Ask your patients. They believe food addiction is real. So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives? I’m frustrated. Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS! The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for? Connie Stapleton, PhD connie@conniestapletonphd.com Facebook: Connie Stapleton Twitter: @cstapletonphd LinkedIn: Connie Stapleton, PhD

The American Society for Metabolic and Bariatric Surgery (ASMBS) emails each new edition of “connect,” their official news magazine to its members upon publication. In it, they provide a synopsis of recent articles of interest related to WLS. One noted article this week is titled, “What Matters: What’s the magic behind successful bariatric patients?” and is written by Dr. Jon O. Ebbert, an internist at Mayo Clinic. In the article, Dr. Ebbert states, “I was left wondering how I can best help my patients using this information.” Let’s help him help his patients! I’ll share the short article, give my editorial (what I didn’t share with Dr. Ebbert) and then write the response I did share with him. Finally, I’ll provide the link where you, too, can share feedback directly about the article, or send it to me and I will be happy to forward it! The article: “MARCH 3, 2016 A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss. When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again. Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm. So, what predicts success – and can we facilitate it? Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss. In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery. The voice of the successful bariatric patient is an interesting and important one. Several themes were identified: 1) taking life back (“I did it for myself”); 2) a new lease on life (“There are things I can do now that I am not exhausted”); 3) the importance of social support; 4) avoiding the negative (terminating unhealthy relationships in which “food is love”); 5) the void (food addiction and sense of loss); 6) fighting food demons; 7) finding the happy weight; and 8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either). I was left wondering how I can best help my patients using this information. First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support. Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.” My Editorial I’m grateful that an internist is addressing the topic of WLS. I love that he is thinking about ways to use the information gleaned from the research he notes related to the behaviors of those who have “successful weight maintenance” following weight loss surgery. Pardon my sarcasm, but, WOW! Getting information about the behaviors that led to weight loss from patients who have 50% or more of excessive weight loss 24 months after bariatric surgery? Does that really tell us anything? I’d venture to say that the majority of professionals in the field would note the surgery itself as being primarily responsible for the “success” of the weight loss at 24 months out. I’m NOT saying that many patients fail to put forth a great deal of effort at that point, because I know many do work very hard during those first 24 months. But come on… let’s talk to successful weight maintainers at 5 years after surgery to get a better indication of what they are doing to manage a healthy weight. I’d also be curious to know at what point in time after surgery the statistic was obtained noting “Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.” How much weight regain? After how much time? If you look closely at research in many fields, you can find numbers that vary widely on a particular topic. Dr. Ebbert states, “Psychological burden and motivation have not been associated with weight loss.” I wasn’t at all sure what this meant. Questioning my comprehension skills, I asked some other people how they interpreted that statement, and they couldn’t tell, either. If the implication is that psychological issues have no impact on weight loss or lack thereof, I have to disagree. But then, I have no research to back up my hypothesis. I do have 11 years working in this field and the anecdotal evidence of hundreds of patients that says otherwise. I’d say depression interferes with the desire/ability to follow through with certain behaviors that require significant energy. I’d say that intense shame interferes with the perceived efficacy to follow through for the long haul with behaviors necessary to sustain weight loss – well past two years of having WLS. I don’t know… I believe poor self-esteem, a history of “failing” with “diets,” unresolved grief, loss, and abuse issues sometimes affect a person’s perceived ability to succeed. I also believe treating these psychological issues in conjunction with treating one’s physiology and teaching important skills such as healthy coping mechanisms, positive self-talk, and efficacy-enhancing skills is a recipe for better outcomes. My Response to Dr. Ebbert (in an attempt to be brief): “Dr. Ebbert - With all due respect, the medical field is, in my opinion, missing several very large pieces of the puzzle with the surgical weight loss population in terms of treating them. I am a licensed clinical psychologist. I work in a surgical weight loss clinic and have spoken with literally thousands of patients who have had weight loss surgery. Obesity is a complicated disease that is more than just physiological. I treat the underlying and associated psychological co-morbidities, which the medical community largely ignores, except under the broad category of "Behavior Modification." I assure you that there is a lot more than changing behaviors that needs to be addressed with this population. A vast majority of this population suffers with deep shame and low self-esteem, both rendering them inefficient at maintaining motivation to follow through on a long-term basis with "behavior modification." I am working tirelessly to try to address the elephants in the OR, but surgeons don't really want to listen to myself - or the patients - who are clamoring for additional mental health care (MORE than behavior modification) following WLS when their "issues" interfere with healthy behaviors - just like before surgery. More suicides? Maybe because in a sense, we take away the patients’ coping skill (food) and throw them to the wolves. I've created a video series that I require all of my patients to watch before surgery to help them understand the deeper issues they may face and to urge them to seek counseling. I could use help in the medical community. You in?” I do believe, and I thank Dr. Ebbert for noting, “this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure.” Let’s all pitch in and share with Dr. Ebbert and other interested physicians what you need to be successful, on and off the scale, for years and years following WLS. Please share your comments at: http://www.clinicalendocrinologynews.com/comments/what-matters-whats-the-magic-behind-successful-bariatric-patients/016f71fe2abdc0198ac42d75d039d712.html?comments_link=1 Or, post your comments here or contact me via my web page: www.conniestapletonphd.com Let’s pitch in and help! Connie Stapleton, Ph.D.

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 remember seeing brochures in my Dr.'s office about loans for surgery. There are companies out there that give loans for this type of surgery. I would go to a search engine and type in Bariatric loans and you should find some companies that you could apply to. Good luck!

Here is a link to an article on reactive hypoglycemia post–gastric bypass. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass The three most important things after surgery are fluids, Vitamins and Protein. Since you said that "when I drink Protein I throw instantly", have you tried MILK. 32 ounces of 1% milk fortified with 1 cup of powdered milk will give you 56 grams of protein. You cannot drink this all at once but spreading this out throughout the day will help you meet your daily protein requirement.

I am excited for you and I would love to be your buddy. I still havent heard anything yet. The way it was explained to me by a Coventry rep is that bariatric surgery is covered and that depends on your employer group whether they include it in your coverage. The bariatric coordinator had explained to me that I have a special situation, in which my insurance covers but the facility that I will have the surgery at has a contract with coventry at the delaware surgery center in dover but they may not include bariatric sx in that contract so she has to contact delaware sx center in dover and speak with the person who handles the insurance contracts and find out whether coventry covers procedures done there. Im biting my nails still. I need to do something about this weight. This is the largest I have ever been and its killing me. I am a RN so Im pretty much always on my feet, my feet and knee are killing me. Im just waiting (cant really say patiently) until I hear something back. I am glad you have gotten through this process. I cant wait to hear how everything goes for you.

I'm going to an information seminar next week at a Center that does Bariatric Surgeries. You are required to go to one of the seminar's to get the process started.. For those that have gone to similar, what should I expect?

Success after weight loss surgery is no accident. It is the result of a lot of hard work and careful planning on your part. While of course it depends on a skillful surgeon, your post-op success depends most heavily on you. You can begin to set yourself up for satisfying weight loss and preventing regain long before your surgery date. Here are some ideas for building that solid foundation that will make your weight loss surgery journey smoother and more satisfying. Choose the right surgeon. If weight loss surgery is the tool, your bariatric surgeon is the one who makes the tool and gives it to you. You want a tool that is made precisely, ready to do the job, and built to last. Your surgeon needs to make the right cuts and place the band properly or make a tight, solid sleeve or pouch. So, look for a surgeon who is experienced and has a good track record of successful patients and low complication rates – don’t be afraid to ask! There’s more to choosing a surgeon than technical skills. Also, consider what else the surgeon will do for you. The right surgeon for you is willing to discuss your options and the procedure with you in a way that you can understand. You’re setting yourself up for extra challenges if you’re afraid to talk to your surgeon or your surgeon is unavailable. Get the scoop on the diet. Your diet is central to every part of the weight loss surgery journey. You may be told to lose some weight before surgery as a test to make sure you’ll follow the rules post-op. Then there’s the pre-op liquid diet to shrink your liver for a safer surgery. Next, for faster healing and fewer side effects, you need to follow the post-op progression from liquids to pureed foods to solid foods. Finally, there’s the nutrient-dense, low-calorie diet to help you hit goal weight and stay there. At best, you will have a surgeon or a nutritionist who gives you plenty of information. Since that’s not always the case, you may need to take steps to figure out the diet for yourself. You can look online, and may need to shell out the money for a few appointments with a nutritionist. Not knowing the right foods to eat can set you up for surgery complications and disappointing weight loss. Take responsibility. It’s nice to depend on a stellar surgeon and complete healthcare team to walk you through surgery and beyond step by step. Ideally, your trusted surgeon would explain your options to you and recommend the best surgery for you, whether it’s the sleeve, band, bypass, or another choice. You’d go back for follow-up appointments and ongoing nutritional and psychological counseling. That doesn’t always happen in the real world, but that’s no excuse to give up. You can take responsibility for finding out the information you need to know about what to expect, how to prepare, and what comes next. Be persistent and do your research in all kinds of places, and you’re more likely to succeed. Face the facts. Weight loss surgery isn’t all fun and games. You don’t leave the operating room skinny. Weight loss isn’t steady. It may take you longer to get to goal weight than you hoped. Recognize the real possibilities to avoid being disappointed and possibly even giving up. These are some other possibilities to consider, so you can be prepared if they happen to you. You may still love sugar, salt, fat, and/or starch. You may still be hungry. Others may not notice your weight loss, or may not be impressed. Others may be jealous of your weight loss or say you didn’t earn it. You may have loose skin when you are finished losing weight. Weight loss surgery doesn’t solve psychological problems. Be Open-Minded If you want to lose weight and get healthy, you’ve got to change your diet. Whatever eating habits got you to this point are not going to get you to goal weight! That may mean you need to be open-minded. Maybe you hated vegetables, or can’t stand the thought of downing protein shakes for 2 weeks on the pre-op liquid diet and up to 4 weeks on the post-op liquid and mushies diets. It’s time to re-evaluate. Can you sneak some veggies into your diet? Can you retrain your brain to love them? Can you force down those protein shakes for a few weeks in exchange for a lifetime’s worth of better health? Learn to see the good. There will be disappointments - guaranteed. The scale may not cooperate, or you may make a poor eating choice, or you might skip your morning workout because you didn’t make sleep a priority the night before. Focus on the negative, and you just may talk yourself out of continuing the hard work and good progress. Instead, learn to appreciate yourself and see the positive sides of things. Maybe you didn’t lose weight this week, but did you eat right? Maybe you downed a piece of pepperoni pizza without thinking about it, but did you pass up the breadsticks and soda that you would have had before surgery? Maybe you didn’t work out this morning, but did you make it to the gym more this month than you did last month? See yourself as a strong, powerful person, and you will act like one. You can build on the positive behaviors you see in yourself so they eventually overshadow the mistakes. You have control over your own destiny. Success with weight loss surgery depends on planning and hard work. The more you are involved and the more responsibility you take throughout the process, the better you can do.

I recently posted an article titled “The Biggest Loser:” Irresponsible Weight Loss Surgery Comments? . We received many fantastic comments from our concerned members. I've decided to follow up our article with an Open Letter to Dr. Robert Huizenga or Dr. H as he's known on the show. The letter will also be sent to the shows producers and staff members. Dear Dr. Huizenga, I am the founder of BariatricPal, the world’s largest online community for weight loss surgery patients and potential patients. I am writing to you today regarding your role as an expert on “The Biggest Loser.” I am asking you to please stop publicly portraying weight loss surgery in a negative light without any explanation. Most recently, during the Season 16 Finale, you stated that losing weight using methods used on the show were far healthier than turning to weight loss surgery. The implication was that bariatric surgery is under no circumstances the best choice for individuals struggling with obesity. I am asking you to stop making comments like this. You and “The Biggest Loser” have a significant amount of influence on America. The season finale attracted 5.4 million live viewers, with untold millions watching the show at a later time. Given that one-third of American adults are obese, it is almost certain that many viewers have obesity. “The Biggest Loser” reaches out to this audience throughout the show. Contestants, trainers, and health experts like yourself directly address viewers who need to lose weight, offering encouragement and tips. As you know, positive gestures like this can motivate people to change their lives. Unfortunately, the derogatory comments about bariatric surgery can have just as much impact, but in a negative way. Your statement at the Season 16 finale of “The Biggest Loser” and similar ones make weight loss surgery sound like a shameful, dangerous, and ineffective choice in all cases, with no further explanation. According to the Weight-Control Information Network (WIN), 4% of men and 8% of women in the U.S. have extreme obesity (BMI over 40). That translates to about 20 million American adults who are potentially eligible for weight loss surgery. This figure does not include the approximately 60 million Americans whose BMIs are between 30 and 40, and who might be eligible for surgery due to the existence of a co-morbidity. Not all of these individuals are eligible for and interested in weight loss surgery, but many are. BariatricPal alone, for example, has a quarter-million members who are weight loss surgery patients or who are considering surgery. For weight loss surgery patients, your comments can be hurtful. Weight loss surgery is not the “easy way out.” It is a tool to help control food intake. Eligibility criteria include a requirement that patients be committed to the strict dietary changes necessary to lose weight after bariatric surgery. I and millions of other weight loss surgery patients who have successfully used weight loss surgery as a tool against obesity worked hard to get where we are today. We do not deserve for you and your colleagues to suggest that we have cheated to lose weight. Comments that groundlessly condemn weight loss surgery can harm potential patients just as much if not more. Eligible candidates might decide not to get the surgery in part because of your position. First, your comments can lead to a feeling of shame for even considering bariatric surgery to fight obesity. This is unjust, since the post-surgery diet is strict and requires a lifetime of attention, just as “The Biggest Loser” contestants must modify their own diets for the rest of their lives to maintain weight loss. Secondly, your comments on the show seem to imply weight loss surgery does not work. While there are patients who do not respond to surgery, and complications are always a threat, the scientific literature overwhelmingly agrees that weight loss surgery is a viable option for the treatment of morbid obesity. Furthermore, the scientific community largely agrees that weight loss surgery can improve health and metabolic parameters. To varying degrees, methods such as gastric bypass, adjustable gastric band, and gastric sleeve have been linked to improvements in diabetes and other obesity-related conditions, such as hypertension, sleep apnea, and dyslipidemia. The UK’s healthcare system, known as the National Health System or NHS, is so convinced of bariatric surgery’s effectiveness, safety, and cost savings potential it covers bariatric surgery procedures. Unconditionally stating that weight loss surgery is the wrong choice is particularly unfair given that “The Biggest Loser” contestants do not always achieve or maintain their goal weights. An article on Today.com, which is owned by NBC, looked at initial, finale, and current weights of selected contestants from the first 11 seasons of the show. Of the 56 contestants they highlighted, 20 were within 10 pounds of their finale weights, and 8 had gained back at least 40 pounds since the finale. These results are impressive but not perfect. And, “The Biggest Loser” is not for everyone. So far, only hundreds of individuals have been lucky enough to have the opportunity to lose weight on the show. For a few others, losing weight at one of the Biggest Loser resorts is an option – but not a practical one for most people. At $3,000 per week, it could take $50,000 or $100,000 or more to reach goal weight, not including time out from work and life. Weight loss surgery may be the only practical choice for people who have work and family obligations, and who live within a budget. People struggling with obesity do not choose weight loss surgery because they think it will be easy. They choose it because they have no other choice. Nothing else has worked for them. For me and hundreds of thousands of other weight loss surgery patients, it worked. Because of this, I ask you again to please stop publicly attacking weight loss surgery without explanation. You and I and everyone else who is connected to obesity knows what a terrible disease it is. We should join forces in fighting it. Let’s work together to get the greatest possible number of people healthy, and not work against each other with derogatory and divisive comments. Thank you for all of your hard work and commitment to fighting obesity. You have established yourself as one of the most influential health experts in obesity, and I hope you will use your voice in a positive way. Thank you for considering this. Sincerely, Alex Brecher Founder, BariatricPal

I agree - well said, but I feel this paragraph could have been much stronger. Reason I say that is when you look at the evidence, bariatric patients as a population do a better job at maintaining their weight loss than other methods. This isn't just an "acceptable" approach, it statistically is the best approach. Second, your comments on the show seem to imply weight loss surgery does not work. While there are patients who do not respond to surgery, and complications are always a threat, the scientific literature overwhelmingly agrees that weight loss surgery is a viable option for the treatment of morbid obesity. I also think that a discussion about obesity as a "disease process" would be very fruitful. It really helps to understand how once you are obese it is just so hard to break free without help from a tool like the surgery.