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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.

Is your weight loss history standing between you and your current success after weight loss surgery? If you’re not getting the results you want, there’s a good chance it is. In Part 1 of the series, we brought up the idea of learning from your past, not running from it. Now, we take a look at a few more ways your past might have brought you down, and what you might be able to about it. Problem: Depending on Others This one’s not always so obvious, but it may be keeping you from reaching your full potential in weight loss and, frankly, in life. Of course, it’s normal and healthy to depend on others for some things. Maybe you rely on your spouse to pick up the kids from school, and you depend on your parents to parents to take care of your house when you’re on vacation. But what about the important things? What about your health? Do you take full responsibility for it? Or do you do what you did as a kid – depend on someone to make sure you had the food you needed and expect your parents or the doctor would make you better if you got sick or hurt? You’re still living in the past if you have not taken control of your health. You are the one who needs to purchase and prepare healthy food; set aside time to work out; eat the right foods to avoid complications from surgery. Others can help, but you need to be in charge. Problem: Looking for the Quick Fix If you look for a quick fix, you’ll probably find one. You can lose weight quickly using any number of strategies, and you’ve probably used them all from juicing to low-carb to low-fat. The problem with quick fixes is they’re quick to break, as you’ve found out when you went off the diets and gained the weight back. After WLS, don’t look for the quick fix. Be patient, and know you’re in it for the long haul. Looking for the quick fix can be something obvious that you recognize in yourself, but it is not always. Looking for the quick fix can be as subtle as subconsciously thinking of what and how much you eat as a temporary diet or thinking of your exercise program as something with a start and finish. You may be subconsciously looking for the quick fix if you’re unwilling to sign up for a long-term gym membership, or to invest in a kitchen scale or bariatric surgery recipe book. If you feel these things aren’t worthwhile, think about why. Is it because you don’t honestly see yourself needing them for long because you’re not really invested long-term into weight loss surgery success? Problem: Not Building Your Support System Many obese people struggle with late-night eating. Even if they are able to make it through the rest of the day eating reasonably healthy, night-time binges can strike furiously. If you weren’t able to overcome them previously, it may have been because you did not build enough of a support system. This time, don’t underestimate the power of your support system. Include people, such as friends and family, as well as alternate plans. You can set up many layers of protection against late-night overeating. Don’t store junk food at home, and don’t drive home past trigger spots like drive-through burger joints. Have two or three friends or family members whom you can call or talk to if you’re about to make a bad choice, and choose a pre-determined activity to do before eating, whether you decide to blog, sew, or take a walk. Also, have plenty of ready-to-eat healthy food around so it’s easier to grab than any junk. Problem: Lack of Self-Confidence Have you ever heard of a self-fulfilling prophecy? You think something will happen a certain way, so you act as though it will happen that way, and then it does. For weight loss, that can be a bad thing if you let it. “I know my diet’s going to fail, so I’m not going to bother weighing my food.” Then, guess what – you don’t lose weight! “I knew I wouldn’t lose weight.” But self-fulfilling prophecies can be just as positive as they can negative, especially if you have self-confidence. “I know WLS will work for me, so I’m going to hit my protein goals and weigh my portions every meal.” When you don’t even let doubt creep in, you can be more empowered to follow the behaviors that lead to success. Weight loss surgery can be a fantastic tool for weight loss, but it’s only as good as you make it. To make it more powerful, don’t run from your personal history. Recognize your past, identify what went wrong, and fix it. Make sure this time really is different.

Gift Card to The BariatricPal Store Gift cards are all the rage. They avoid the possibility of giving an unwanted gift and forcing the recipient to go through the hassle of the returns process. You could opt for a generic gift card to one of the mass merchandisers, but why not get one that’s a little more personal? A gift card to The BariatricPal Store may be the answer. It’s good on any product in the BariatricPal store, from high-protein pretzels to single-serve packets of low-carb oatmeal and pasta to bariatric vitamins. Weight loss surgery patients can stay nourished and save time using The BariatricPal Store. Oh, and by the way…it’s a great last-minute gift. It’s delivered electronically so the recipient gets it instantly. A Comfort Basket Everyone can use a little extra comfort after weight loss surgery. A comfort basket can be a great gift, and it’s even better because you can customize it with special treats for the recipient. Here are a few ideas. A cute blanket because some weight loss surgery patients get cold as they lose weight. Some gourmet protein soup, broth, or bouillon to stay hydrated and get warm. Some recipe cards with high-protein, low-carb healthy recipes…and maybe some of the ingredients that go into those recipes. A nice bath soap to encourage the recipient to just…relax. Some bariatric treats like sugar-free cheesecake or all-natural turkey jerky. Product Subscriptions from The BariatricPal Store Once you become a bariatric surgery patient, you’re no longer a great candidate to be a member of a Wine of the Month, Chocolate of the Month, or Cookie of the Month Clubs. So how can your friends and family give you a gift that you’ll remember all year long? Try a subscription at The BariatricPal Store! When you sign someone up for Subscribe and Save, the order automatically ships to their door every 1, 2, or 3 months. You can have The BariatricPal Store bill your credit card. It’ll keep going until you cancel it, so there’s no need to remember to pay a bill or order the next delivery. The recipient will think of you every time they receive a great-tasting batch of bariatric chocolate cake, or a time-saving variety pack of hot and cold breakfasts. Gym Membership for Two This kills so many birds with one stone. It is a gift that says, “I love you so much that I’m willing to go to the gym so we can be healthy together.” It gives you the chance to get fit, and it comes with a built-in motivator: a workout buddy. Say goodbye to excuses when both of you have a gym membership. You can’t let that money go to waste. And when you work out together, you can push each other, encourage each other, gain a little more respect for each other, and, yes, even have fun together. That’s a great gift! The BariatricPal Big Book Pre-op or post-op, and band, bypass, or sleeve, there’s a Big Book on Weight Loss Surgery that’s right for you. The big books have tips, hacks, and recipes for every stage of the weight loss surgery journey, from choosing a surgeon to moving into maintenance. Order a hard copy for curling up near the fireplace on a cool evening, or get an electronic version so you can read the Big Book whenever you want. I.O.U’s Remember back in grade school when you’d make a coupon book for Father’s Day? You might have included things like washing the car, mowing the lawn, or making lunch. Those things may not seem too special, but here’s a hint that they were: your dad may have kept those coupons around for decades. Well, you can create something just as special now. What about some of these coupons? A workout together at the gym, in a group fitness class, or outdoors. A meal that you cook together, so both of you can understand what it’s like to count protein, measure every bite, and put together healthy meals. An afternoon shopping for clothes…which is so much more fun when you can fit into them after losing weight. (For a pre-op patient) Help cleaning out the unhealthy foods from the kitchen, and restocking it with healthy foods. Each of these coupons says, “I like spending time with you. I want to share my world with you, and I am so thankful for your interest.” We hope these ideas are helpful and make your holiday season easier. If you have any gift ideas, please share them in the comments section!

Of course! I actually have a page for adolescent teens (really anyone who is looking for advice!) who have had or are looking into bariatric surgery. You can add Bariatric Teens on Facebook or you're welcome to email me at barihealthyteens@ymail.com and I will do my best to help in any way I can!

Hello New Friends! I need some support and hope to make some new friends here. I had a Lapband down in Mexico in 2004 by Dr Kuri and lost 150 lbs then maintained that for about a decade. I started at 536lbs and got down to just under 400lbs which my surgeon said was a success. I never hit my goal weight of 300lbs but I was happy. After several gallstones and trips to the ER my doctor in Portland said I needed to have my gallbladder removed. The gallbladder surgeon in Portland offered to remove the 10 year old Lapband which was causing me trouble so I did it without even considering other options. At that point it was taking me 1.5 hours to eat half of a small meal and I had zero restriction. So his offer was a welcome relief. I thought I was doing fine. I knew I had gained a little but not 80 pounds. That scared me because it had only been a few months. I was getting to the point of having a hard time walking, and I had developed neuropathy in my feet. I also had a couple weight related injuries and then my knee got real bad. This was a real low point in my life. I visited a friend in Texas who had the sleeve and I didnt even recognize him! I was shocked at how much he had lost. So that was the start of my sleeve journey. When I got back to Portland I started off talking to Puget Sound Bariatrics in Washington and Legacy Emanual in Portland but both surgeons needed me to lose 30-40 pounds before they said they could operate on me for the sleeve. They said I had to be under 500lbs. One surgeon suggested I try a low carb diet. I didnt know what he was talking about! Thus I began learning about low carb eating. During the last 2 years I have been learning about the weight loss industry. Ive read The Obesity Code by Dr Jason Fung who is a doctor that helps cure diabetes, a supposedly incurable disease. Reading his book educated me on all the "great advice" weve been getting all these years about how to lose weight, advice that was pretty much worthless to people with obesity. Dr Jung examines all the recommendations passed down thru the years and then explains why they dont work, its a real education that answers a lot of questions. He also explains how foods we eat turn to glucose that is stored in our liver for the first few hours after we eat a meal. Then as our bodies use up the glucose and our insulin levels drop our bodies are able to access the stored body fat for the energy our bodies need. This is what causes weigh loss. Thats why intermittent fasting works so well. I learned about intermittent fasting and have found that to be fairly easy to implement into my lifestyle. I hired a personal trainer and spent a year in the gym doing water aerobics - inbetween injuries and weightloss restarts. I bought a few weeks worth of Adkins meals and then figured out how to use those concepts with regular food and even some fast foods. Ive learned about portion control and how important that is. Ive learned about carbs in food including veggies. I had no idea there were carbs in lettuce! Or that a banana contains 55 grams of carbs! I spent 2 weeks getting my body into ketosis which required frequent emergency trips to the bathroom for explosive diareah....no fun. Ive tracked all my meals and had to get honest with myself about late night snacking, the scale doesnt lie. But overall I havent maintained much weight loss. I admit Ive had some depression these last few months since my dad died, but Im moving forward now... A few months ago I was surfing the web and started hearing about guys bigger, older, and taller than me having the sleeve surgery with great success. Yet the 3 surgeons I dealt with in the Pacific Northwest all said I had to be under 500 lbs...BUT WHY??? I soon discovered it was because they dont have the equipment to handle patients over 500 pounds and they didnt want to lose me as a patient so they told me to lose weight instead. Seems crooked to me. Ive needlessly suffered for years now. If I had known better I could have had this surgery 3 years ago. Im now scheduled for January 26 with Dr Rodriguez down in Juarez. Im a snowbird this year so Im moving down to El Paso for the winter, surgery and recovery. The one mistake I made when I first got my lapband was I didnt make it the sole priortiy of my life. This time around my sole focus for the next two years will be losing weight and getting my health back. Im now looking forward to leaving Oregon for a few months and getting really focused on my health. Being in a sunny location will help me feel better and keep me motivated as I begin losing weight again. Today I discovered this forum and read some good stuff. I need your support and hope I can provide you some too! Thanks for reading, Free Stanley

Protein is IMPERATIVE to bariatric patients. And the great thing is we have so many options! Once upon a time it was nearly impossible for a bariatric patient to keep their protein counts up. We were taught to only eat certain foods and to avoid others. Chicken breast, lean beef, and fish was the rule of thumb. The problem with these foods was that several people had problems eating, swallowing, and digesting them. And we were told that once we hit a certain point, to avoid protein drinks as we needed to be eating our protein rather than drinking it. Isn't it nice to know that times have changed? New research and information has given the bariatric patient so many more options on foods we can eat now to keep our protein levels where they should be. We are no longer restricted to the leanest cuts of meat, but are encouraged to try other cuts such as dark meat chicken, 80/20 or 90/10 ground beef, and (a personal favorite) BACON. Additionally, we are encouraged to eat eggs and shrimp, salmon and pork. And protein drinks (when done RIGHT) are no longer a no-no! How Much Protein Do We REALLY Need and Why Is It So Important? According to most surgeons and nutritionists, we need about 65-70 grams of protein daily. That goes up a little bit if you're recovering from surgery or are sick or pregnant (to about 85-90 grams). Protein is an essential building block of our bodies. When we're losing weight, especially, protein is one of the hardest working macronutrients on the planet. Beyond muscle building, it also helps strengthen our immune system, rebuilds tissue, and can even improve brain function. Additionally, when we lose weight, our bodies burn protein. When we're not getting enough protein, our body takes it from wherever it can get it - typically our body muscle. What's more, it can actually take muscle from our cardiac system! How Can I Get My Protein? Focusing on protein is the #1 concern of many bariatric patients. Of course, eating your protein is the very best bet. Focusing on protein foods with a high protein to fat ratio is the very best bet. Some of the best protein foods are egg whites, chicken breast, and shrimp. Although other meats, poultry, and seafood are also good options. Cheese is another great choice as are nuts and seeds. Beans do give some protein, but many bariatric patients have issues with digesting them. Another good option is the protein drink. Once only encouraged in the early phases after surgery, now many nutritionists and dietitians are encouraging the bariatric patient to include protein supplements in their daily diets. Most contain high (35+ g) amounts of protein, and leave you free to consume other healthy (and needed) foods later on such as vital fruits and vegetables. The #1 suggested protein drink that nutritionists suggest is whey protein. It is, by far, the most digestible and assimilated protein on the market (that means your body can use it a lot easier than other kinds). Sadly, many people can't tolerate whey or stomach it. If this is the case, there are other options available that are almost as easily digested such as egg white protein or vegan (brown rice, pea, and hemp) proteins. If I'm Focusing On Protein, I Don't Have Room For Other Foods, HELP! VITAMINS! You remember those vitamins and fiber supplements the doctor sent you home with? TAKE THEM. It's true that we often have to forgo fruits, vegetables, and whole grains when we're focusing on protein. That's why these supplements are so important to our lifestyle. Remember The Basics! The basics of our lifestyle don't change with time. We still need to remain focused on protein, water, and our vitamin supplements. Keeping these three things at the forefront of your mind will help ensure you successful weight loss, successful maintenance, and a successful lifestyle overall!

How To: Get Back on Track and Stay There Are you finding yourself at over a year out and now you find yourself struggling? Do you miss the excitement that you first had when you had post op surgery while the weight seemed to melt away? If this is describing you, then I want you to listen up… you are not alone. In fact, I’d say that probably all of us post-operative surgeries have felt this way at one time or another. The difference between all of us is how we respond and how quickly we can hit the ground running again after a setback. So then, what are those who are successful doing differently compared to those who are struggling more? I have been doing extensive research in the last 6 months and I’m going to share with you what I have discovered. I’m hopeful that it will help everyone out there, because none of us are failures. If we have a setback, we MUST forgive ourselves and fight to get back up. The only time one can be determined as a failure is if they simply give up. As long as you don’t give up, you still have a chance. Weighing In: I’ll be the first to tell you that your self-worth has nothing to do with the number on the scale. That said, the scale never lies, but you just have to determine what it is telling you. It will let you know when you have not been on track, that’s for sure. During my weight loss phase post op, I never went more than 10 days on a stall. I’d sometimes fluctuate up a Lb. or two due to hormones and water retention but it was the scale telling me I needed to do two things, drink more water which is a natural diuretic and second reduce my sodium intake. I tend to crave saltier foods at that time and no, the scale did not lie one time. Sodium is a major culprit in water retention, not only that if you have high blood pressure you will always want to be mindful of how much you are getting in. Someone with HBP should keep their daily total to 1,800mg or less per day. A normal person should be around 2,400mg per day or less. Back to weighing in however, doing so at the same time of day daily, weekly or monthly (whichever you personally prefer) is really the best way to measure the difference between your last weigh in. Again, do not allow the scale to crash your mood. It is a measure of success or changes that might need to be made. But it won’t lie to you! If you are up 5 Lbs. then likely you need to put on the brakes somewhere and get back to basics. Put a limit on how much you will allow yourself to weigh on your scale. You decide what that number is, as long as it’s a healthy number for you. The WORST thing you can do regarding staying on track is ignoring your scale altogether. It has to be a part of your regimen because take it from me, it is much easier to lose a 5 Lb. gain than to realize you have gained 40 and desperately need to stop the gaining in its tracks. If you have been ignoring the scale then it’s far beyond time to stop lying to yourself and check the damage. In the smaller sizes it only takes 7-10 Lbs to go up a size. Do not wait until your clothes feel too tight, because by then you probably have already gained that much. Diet: Diet: di·et1 noun noun: diet; plural noun: diets 1. the kinds of food that a person, animal, or community habitually eats. (Google Definition) What does your Surgeon and/or Medical staffs say about this? Did they leave you with any kind of eating plan before you left from your hospital stay? The majorities of all of the journals I’ve ever read regarding post op diet plans are extremely similar to one another, give or take a few variations on when to move to the next step in foods. I’m talking about long term eating however, not the liquids or soft foods phases, but more what and how to eat as a Weight Loss Surgery patient once your stomach has healed. Back in 2011 when I was being asked by numerous members on the website how I was able to maintain my weight so well I decided to create a thread called the Basics Bootcamp. It was a regimen I held close to me if I felt I was falling off track and it helped me to stay at goal for nearly 3 years. I recently have made a bit of a revision to it knowing what I know now regarding nutrition and health sciences. I’ve been studying Nutrition and Health for a while now as well as speaking to many Bariatric Registered Dieticians and Nutritionists. But it still has the basic concepts which are: We do not need to eat so much sugar, we do not need to eat so much salt, we need to focus on protein first and we need to eat our fruits and vegetables. We especially need to be sure we are getting in our minimum of water every day. Sound simple enough? It should be but we have to deal with head hunger too. Indulging in sugar can become a slippery slope. Some people can do much better at moderation of these types of foods than others. I am not one of them. I find that if I abstain from junk food all together I do not think about eating it as much. But once I eat that first bite it feels almost uncontrollable to stop when I should. I continue to crave it for a week or more but then as time goes on the cravings do diminish once again. It all comes down to knowing how YOU react to them and recognizing these behaviors. Getting in tune with your personal triggers and avoiding them is one of the best ways to both get back on track and to stay there. When you hear that sound in your head that says “It’s okay, other people do it and they are okay. Go ahead, you’ve been good, you deserve it.” Realize this voice is a liar and if you listen you will likely find yourself back in square one. Anyhow, here is the thread if you’re looking to kick start getting back on track: http://www.bariatricpal.com/topic/306411-basics-bootcamp-v2-getting-back-on-track/#entry3459464 Exercise: Working out... Does everyone really need to do this? Even if you’ve lost weight really great in the beginning? The answer is definitely YES. Everyone should have some kind of exercise regimen tailored to them, but no matter what everyone should be doing something. Maybe all you can do is sit on the couch and do leg lifts. Then do that. Maybe you’re very advanced and you can run marathons… good for you! But do it and don’t stop. It takes a long time to become conditioned enough to be advanced but only a matter of weeks to fall all the way back to level 1. According to the Mayo Clinic standard adults should get 150 minutes of moderate aerobic exercise every week, or 75 minutes of vigorous aerobic exercise weekly. Break that up into 21 minutes per day if you have to, but just be sure to do it. This is a general guide and a good one to follow, especially if you are just starting up or starting again. The secret is figuring out how to stay there is to find something you like to do. You don’t have to train to run a marathon if you hate running. All that will do is burn you out and likely you will want to give up because it does not meet your fancy. Keep searching and doing new activities. Even brisk outside walking is considered moderate aerobic activity. I personally love it; I can treat it as my getaway at work. I put on my head phones to my favorite tracks and just let my mind wander to another place and relax. Yes, I love it so much I find it more relaxing than tiring. I breathe the fresh air and let the sun soak in. Believe me there are so many choices out there, you only need to find your favorites to keep you coming back. If you are doing this for reasons such as health, you will want to add in your workout. That’s not the only thing working out is good for however, it can help tighten your loose skin, toning can help fill it out. Also, being able to withstand longer periods of workout can help with simply being in a good mood. It’s a great stress reliever. It’s all mental: Yes, it really is. Your attitude will always be the driving force to whether you become a success and especially if you stay a success. How do you perceive yourself? Do you see yourself as worthy of being healthy, active, and happy and at a reasonable weight? Celebrate every pound you are down, no one pound deserves more praise than another. Lose the word “only” or “but” when describing how well you’re doing. It is okay to feel good about yourself and shout it out to the world! Take periodic progress photos so on days you’re feeling down, look at them and see how far you have come. Take as many photos as you like! It is not a bad thing. Another rule to hold dear is to ALWAYS forgive yourself, get back up and keep fighting. A baby never learned to walk after his first step. It took many try’s, stumbles and falls – but the baby keeps getting back up and builds those leg muscles until it can walk without effort. One last thing, NEVER compare yourself and your journey to anyone else!! You should only compete with who you were yesterday. Struggling has quite a bit to do with how you feel about yourself, and how you feel about yourself will have everything to do with how often you’re struggling. Stay positive, always. Every time! “If you think you are beaten, you are; If you think you dare not, you don't. If you'd like to win, but think you can't It's almost a cinch you won't. If you think you'll lose, you've lost, For out in the world we find Success being with a fellow's will; It's all in the state of mind. If you think you're outclassed, you are: You've got to think high to rise. You've got to be sure of yourself before You can ever win a prize. Life's battles don't always go To the stronger or faster man, But soon or late the man who wins Is the one who thinks he can.” ― Walter D. Wintle

To the general public, bariatric surgery may be a single procedure that ends as soon as you leave the clinic after surgery. Or, they may think of aftercare as periodic adjustments to make sure your surgery is “working.” As a weight loss surgery patient, you know that post-op care is crucial to your success. Most clinics have extensive mandatory programs to ensure your continued weight loss and pursuit of a healthy lifestyle. Shared Roles of Surgery and Post-Op Care Your care after bariatric surgery, or post-op care, is as important as the surgery itself. The surgery helps you eat less because you feel satisfied on a smaller volume of food, but it is up to you to follow a healthy diet. You can lose 100 pounds or more in the first year, but you may have more to go. The best way to lose weight and keep it off is to carefully follow the meal plan and exercise recommendations from your bariatric team. Consider these facts: A lap band does 30 to 40 percent of the total work; this means that you, the patient, are responsible for the remaining 60 to 70 percent of your weight loss journey’s success. Some banding or sleeve patients have procedures that do almost 100 percent of the work in the first year, and then the patient must adjust to continue that work. This means that aftercare is vital to your success. Components of Aftercare These are typical components of aftercare. They are critical for your success so that you know what to do and stay motivated. Dietitian appointments: You will take several weeks to work up from a liquid diet to pureed foods to your regular diet. The dietitian can work with you to provide meal plans and food choice ideas. Recovery period: You need to ease gradually into your regular activities and an exercise program to prevent poor healing of your surgical wounds. Surgeon follow-ups: Gastric bypass will require more follow-ups and blood tests than other forms of bariatric surgery, but these appointments are crucial for everyone. You want to be sure that you are healing properly and preventing nutritional deficiencies. Support groups: These groups are mandatory for many clinics. You can attend weekly or monthly meetings initially, and some clinics ask you to attend annual follow-ups for the rest of your life. These groups keep you motivated and informed. Adjustment Visits for the Lap Band Adjustment visits. These visits are periodic checkups that can lead to adjustments to make you more successful. Three different adjustments are possible. Your nutrition program: You may need to alter your calorie intake, frequency or volume of eating or type of foods that you choose to make sure that you are getting the nutrients you need. Your state of mind: A session with a psychologist or another member of your bariatric team can help you get motivated if you’re feeling discouraged, or make you more confident if you’re feeling lost. Your band. The Lap Band is the only weight loss surgery option that allows adjustment to improve the procedure’s efficiency. The band can be narrowed to make you feel full faster, or opened if you need to increase the volume of food you eat, such as what might happen if you get sick. Aftercare versus Maintenance Aftercare, or post-op care, is distinct from “maintenance.” “Maintenance implies that you have reached the end of a program, such as a diet program, and you are ready to go back to your old habits. “Aftercare” helps you continue the transition to a healthier lifestyle. People who think of you in maintenance might be waiting for you to regain the weight, as with another failed diet. So what can you do to change the negative perception of aftercare? Being a good role model is always a good start; follow through with all of your appointments, eat well and exercise as recommended. You can be more verbal about your continued efforts, and spread the word online through social media, such as Facebook and Twitter. What other ideas do you have for changing negative terminology disapproving assessments of post-op care for bariatric surgery?

My BMI was just under 35 on day or surgery; over 36 when I first saw the bariatric surgeon. I have v significant, multiple comorbidities. I don't know how old you are and I'm always a bit wary of younger people taking out bits of their body that they may find they need later on -especially if there are no health issues right now. But your family history is significant and it's not great that you can only walk a couple of blocks. IMO this surgery - any abdominal surgery - does pose significant risks and shouldn't be entered into lightly. I had a good run with surgery and recovery but I still didn't think it was a walk in the park. Now that I'm sleeved I also realise it is still very possible to not lose or to lose and then regain the weight... this is no magic bullet and you need to work at it long term, have no illusions about that. But having said all that, I am glad I did it and now have real hope for a healthy future and a longer life, after years of feeling completely opposite to that. I'm still adjusting but I don't feel I've 'lost' anything or am deprived. food tastes just the same and I enjoy as much as ever, just in v small quantities. So read up, decide if this is right for you, and if it is embrace it. I'd suggest you read the "complications" and "regrets" posts (along with the good news stories) to get a balanced view. Good luck with it all.

READY TO BE WEDDED TO YOUR BAND? On a humid May morning 37 years ago, after a four year courtship, I married my first husband. We exchanged our wedding vows in front of a Catholic priest, a Presbyterian minister, and 40 guests consisting of family and friends. We walked out of the church and into our married life with “until death do us part” in our young minds. Six years later, we divorced. Eventually each of us married again, this time to the right partner, and we’re all still happily married today. As the saying goes, practice makes perfect. It’s practice that will make your “marriage” to your adjustable gastric band perfect, or as perfect as any human endeavor can be. It’s important to know that when you wake up in the recovery room after your surgery, you won’t be magically endowed with all the knowledge, experience, and habits you’ll need to succeed with your band. Even if you did tons of research, faithfully attended every pre-op educational class, and listened closely to and made detailed notes of everything your bariatric team told you, some things – important things – you’ll have to learn through the everyday experience of living and eating with your band. When you leave the hospital or surgery center after your surgery, you probably won’t be headed for your honeymoon quite yet. That will come later, when you’ve had enough fills to achieve optimal restriction and you begin to feel that your band is really working. The excess weight will start coming off and you’ll walk around in a dreamy pink haze, delighted with your new life partner. You might even give your band a silly private pet name, the way my husband calls me “Love Bug” (which always makes me think of my first car, a chubby little Volkswagen Beetle). Then one day, the reality of banded life will wake you up. You’ll think, “Who is this creature I’ve married?” And like Jenny, a former coworker of mine, you’ll realize that while the engagement, wedding and honeymoon were exciting and fun, the day-after-day business of marriage isn’t exciting or fun 24 hours a day. It’s hard work. It’s boring. It’s frustrating. It’s humdrum. Jenny divorced her new husband after only three months of marriage not because she didn’t love him, but because she didn’t love being married to him. For many of us, being a wife isn’t nearly as fun as being a bride. One day you’re a smiling princess dressed up in flowers and lace; the next day you’re a haus frau frowning at the skid marks in your prince’s underwear. I suspect that Jenny just wasn’t old enough or mature enough to be a wife. Neither was I when I married the first time. One of the reasons most bariatric surgeons and insurance companies require a patient to have a pre-op psychological consult is to evaluate the patient’s understanding of what they’ll have to do to succeed after surgery. Are they ready for a lifetime commitment? Do they have reasonable expectations? Can they follow instructions? Are they capable of learning the new behaviors they’ll need for a productive, peaceful partnership with their band? HABIT FORMING New bandsters need dozens of new habits – something like 60-70% of my book Bandwagon is devoted to explaining those habits, so I’m not going to try to cram them all into a single article. I’ll pick one at random. Hmmm…how about EAT SLOWLY? How are you going to turn that behavior into a habit that will serve you well for the rest of your life? So Dr. McMillan tells you, “Eat slowly,” and you nod your assent while thinking, “Get real! I’m too busy to do anything slowly. I have 3 kids and 2 dogs, I work 2 jobs, I take care of my elderly Aunt Bertha, I coach my daughter’s softball team, I have a house to run and a spouse who’s always on the road…” Well, you get the idea. Dr. McMillan has just told you to do something that’s very simple and yet impossibly difficult, you think Dr. McMillan needs to wake up and smell the coffee, and a door in your mind slams shut. Actually, Dr. McMillan is already awake, has had a cup of coffee, has tended to all 10 of her dogs and all 3 of her cats, is about to leave for the fitness studio, and when she returns she will deal with a home renovation project while running her home-based publishing business off the kitchen table; tomorrow the fun will start all over again, including a 5-1/2 hour shift at her retail job and a trip to the supermarket. She’ll get someone to come look at the leaking French doors, do the laundry, pick another batch off ticks off the new dog, and cook several meals. Dr. McMillan’s friend Nina calls her the “Tennessee Tsunami”, and despite all that, Dr. M. still manages to eat slowly every time she sits down to a meal. As a pre-op, it took her maybe 5 minutes to hoover her way through a meal that would feed a farmhand, and now it takes her 5 minutes to chew her way through the first bite. But that EAT SLOWLY habit (or any other habit) didn’t become a habit for me overnight. It takes many, many repetitions to turn a new behavior into a habit (a British study found that it takes anywhere from 18 to 254 days of daily repetition to make a new behavior “automatic”). I know it’s a big challenge, especially when you’re also trying to learn a few dozen other new behaviors and turn all of them into habits while somehow conquering the dozens of bad habits you already had, but I assure you, it’s worth the effort. MIND OVER MATTER? Sometimes the biggest stumbling block in changing my behavior isn’t the behavior itself – it’s me and my stubborn, willful mind. I rarely have a valid reason to refuse a new, healthier behavior, whether it’s a small thing like putting my fork down while I chew each bite, or a bigger thing like always wearing seat belts in the car. My brain stomps its feet and cries, “I don’t WANT to do it!” I have to ease into the new behavior gradually, so that I don’t become overwhelmed and end up crying, “See, I TOLD you it wouldn’t work!” So although part of me knows that this is a huge, lifetime deal, I dole out the changes in small pieces, one day at a time, one hour at a time, one minute at a time. If I live as long as my mom did, I have another 32 years of eating ahead of me. I eat 6 times a day, 7 days a week, so if my arithmetic is correct (no guarantees there), I have another 69,888 meals to chew my way through. That is a truly mind-boggling number, so I’m tackling this task one meal at a time, and I suggest you do the same. I also suggest that you tackle one behavior at a time. Even simple things can become too complicated when you try to do them all at once. Last year, I bought a new cell phone. I hate the telephone and always have; as far as I’m concerned, cell phones are the work of the devil. I chose a phone with far more capabilities than my old one. It seemed like a dandy little gadget when the sales associate was demonstrating it, but when I’d had it a week, I had to return it because (as I told the puzzled 20 year-old who processed the return), I simply could not deal with a device that required me to hop on one foot while patting my head, rubbing my tummy, and singing the “Star Spangled Banner” in order to send an e-mail. So sitting down to each post-op meal trying to remember whether you’re supposed to hop, pat, rub, or sing is a set-up for failure. Better to pick out one new behavior as this week’s challenge. Next week, add another new behavior to your repertoire. The week after that, another one. During that time you’ll be repeating all the new behaviors as you slowly add new ones, and gradually the behaviors that were new become old…in other words, they become habit, and you won’t have to think about them much if at all. When I was a little girl, my mom had to remind me to brush my teeth every day, but eventually the tooth-brushing became an automatic part of my routine. If I were in a car accident (God forbid) and suffered a spine or brain injury that erased all my old habits (good and bad), I’d have to start it all over again. I’d probably festoon my house with reminder notes: BRUSH TEETH on the bathroom mirror; EAT SLOWLY on my placemat; FEED DOGS (well, maybe not – the dogs come complete with their own extremely reliable and audible meal reminder system). That’s a lot of work, I know, but the pay-off is enormous!

I was in the same situation. I work in the PACU and I hear nasty judgmental comments about the bariatric patients so I chose to keep my mouth shut. I only took one week off (vacation). I had sleeve surgery at a different hospital. I've lost 77 lbs and I am 5 away from goal. Best decision I made was to tell just my husband, kids, brother and one close friend. That's it. I have found people, especially coworkers, will be nice and supportive to your face yet talk nasty behind your back. Screw them all. Now I hear them talk about how jealous they are at my weight loss. They really have no clue. Jokes on them! LOL!

That's my concern also. .only hubby, sisters, mom knows. .I want to keep it private. Not sure how to go about requesting time off. Hope to have wls by early next month. Did I guys take FMLA? I already know I will be talked about by friends and coworkers. Especially working with a bunch of nurses and we get bariatric patients in our department post op all the time..I already know they will say or think I'm not big enough (I weight 240lbs)..mind u they are all almost skinny & they complain all the time how big they are and they need to lose weight. ..smdh

Hello, I'm new here. I'm getting new insurance starting in the new year. I'll have Medicare with Anthem Mediblue Access PPO (I am disabled with mental illness). I have some questions about insurance approval. These are the bariatric surgery requirements for my insurance: For Part A- I have a BMI of 42, so I meet that requirement. For Part B- I have not had a primary care doctor for about 3 years. I go to clinics and the ER when needed. I have tried various diets, and have been using a Fitbit for the past 2-3 years. I do not know if this is enough for my insurance requirement though. For Part C- The mental health requirement; I do not take medication for my illness because I have literally tried almost all of them and they do not help, I only experience the side effects. Doctors know psych medication isn't for me. One of the reasons I am overweight is from all the medications I have taken over the years. My mental illness is under control and I will be able to handle surgery and follow doctor's and nutritionist's advice. I am also getting a new primary care doctor in the new year. Has anyone else had these issues and had their insurance approve their surgery? Has anyone been denied because of similar problems? Thank you very much for your help. ~Anna

WATCH OUT! The Food Police are watching you, and if they catch you misbehaving, you’ll be dragged off to prison, where you’ll have to subsist on stale melba toast and lukewarm water. The Food Police are every dieter’s nemesis. They’re relentless and sometimes cruel, and they surround us. You know them. They're the friends, relatives, and coworkers who watch as you eat a meal and say things like, "Should you be eating that?" I actually enjoy dealing with that kind of comment. Depending on my mood and the circumstances, I might give a mind-your-own-business answer ("What's it to you?") or I might say, "So, where did you get your degree in nutrition science?" The existence of Food Police implies that there are some hard-and-fast Food Laws that the Food Police enforce as they prowl the weight loss community, maintaining order and detecting crime. Although I wouldn't want the job of a police officer, I know the police are necessary, and I believe that without them, chaos and anarchy would probably ensue. But in the world of weight loss, there are at least a thousand sets of Food Laws, and they change by the moment according to whatever new scientific discovery or not-so-scientific fad is being publicized. If you listened to every member of the Food Police, you'd probably end up feeling like a citizen of a Police State, where the police not only enforce the law but create it. That's truly a scary thought. I can snap out smart-aleck responses to Food Police interrogations all day long, but I'm not always so clever at dealing with the special squad of Food Police who live inside my brain, monitoring every bite of food, every minute of exercise, every food choice, every ounce on the scale. They've been there a long, long time. The summer I turned 14, when wearing a cute bikini was the most important goal in my mind, I kept a food log and graded every bite of food I took. I knew that a chocolate donut had 310 calories, and since that was one-fourth of the total calories I had allotted for each day, that donut got a low grade. I knew it was a "bad" food choice, so I decided to eat only a quarter of a donut (77.5 calories) for breakfast at 8:00 each morning, but since I'm a notorious Food Criminal, I'd end up eating another donut quarter at 8:30, and another at 8:45, and the last at 9:00, at which point I would view the empty donut box with deep regret and the three empty hours until lunch time with deep dread. That was not a happy summer for me and the cute bikini I sewed for myself would have caused the Fashion Police to arrest me if they'd been out cruising our neighborhood. FOOD CHOICES: GOOD, BAD & INDIFFERENT The Food Police can make us miserable, it's true, but can we live entirely without them? One of the lifestyle changes I committed to when I had bariatric surgery was to make a sincere effort at making good food choices from now on. Since I don't have a degree in nutrition science, I decided to follow my bariatric nutritionist's Food Laws. I think highly of Susan but as the months went by, I realized that succeeding with the band actually involved several types of "good" food choices. The two most important categories for me are: 1. Food that's nutritious. 2. Food with high satiety value. The pre- and post-op nutrition classes Susan conducted emphasized food choices and behaviors that would support good health ("nutritious") and prevent eating problems (like stuck episodes, PB's, sliming), but I don't recall any mention of eating for satiety. Susan is a smart lady but she's not a bariatric patient, and I learned gradually, through trial and error, that food consistency could turn a "good" food into a "bad" one in the satiety sense. For example: 1. An apple is "good" while applesauce is "bad". 2. Baked chicken is "good" while chicken salad is "bad". 3. A bowl of chickpeas is "good" while a bowl of hummus is "bad". 4. Hard cheese is "good" while cottage cheese is "bad". 5. A granola bar is "good" while a bowl of cooked oatmeal is "bad". Provided that all of the foods mentioned in the examples above are prepared in a low-fat, low-sugar manner, all ten of them are nutritious, but only five are good food choices in terms of satiety. How so? Solid food has the greatest chance of triggering the nerves in your upper stomach to register satiety and send a "had enough" message to your brain via the hormone called leptin. Soft and slippery foods, no matter how "healthy", can't be relied on to do that job. FOOD LAW AMENDMENTS I've also learned that appropriate enforcement of band food rules needs to be adjusted on almost a daily basis, because on Tuesday morning I can eat 2 cups of cottage cheese while on Wednesday afternoon I can eat only 2 tablespoons of it. As a result, I not only have to constantly monitor my body and my eating (which is not such a bad thing), I have to continually amend my Food Laws. The variability of restriction is one of the most perplexing things about living with the adjustable gastric band. It can be downright infuriating. But consider the alternative. The alternative is the way I ate and lived pre-op. I could and did eat anything I wanted, in any quantity, at any time of day. Three chocolate donuts every morning, three pounds of shrimp every afternoon, a gallon of ice cream every night. The price I paid for those food choices was obesity and all the painful, humiliating, and frustrating side effects and limitations caused by 90+ extra pounds on my short body. YOUR ASSIGNMENT, SHOULD YOU CHOOSE TO ACCEPT IT Do you have Food Police in your life? Who's wearing that uniform? A spouse, parent, coworker, friend or neighbor? Are they truly qualified to judge your food choices? How do you respond when they try to force a food law on you? And what about the Food Police inside you? What are they telling you every time you take a bite of food? Do they chastise you, or do they sometimes give you a good citizen award? Do you listen to them, heed them, ignore them, defy them? Make a list of 3-5 Food Laws that structure your post-op life. Are they serving your health and weight loss needs? Or do they need amending? Can you do that by yourself, or do you need the help of a professional, like a nutritionist or a counselor? At almost 5 years post-op, I still have my own in-house (so to speak) Food Police, but they're not as strict and punitive as they used to be. I keep them on the job because I'm so good at justifying the worst eating behavior and I sometimes need them to say, "Hey, hey, hey, little lady! What do you think you're doing? You know better than that!" The Food Laws that structure my life are: 1. Eat for good health. 2. Eat for good satiety. 3. Eat for pleasure. Did I really say "eat for pleasure"? I sure did. But that's a topic for another article!

There is a site called bariatricfoodie.com or also there's a free bariatric cookbook from Georgetown... You can just search it and it should come up. I use a lot of vegetarian recipes and then add in tofu or veggie crumble. I'm a big van of spaghetti squash... And I also I do each some legumes... Occasionally chick peas or whatnot.