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It's 14 pages but they are filled with goodness. Makes a very interesting read and shows us the role of policy and politics in decision making. meat and dairy products -- was the primary nutritional evil in the American diet. Atkins managed to sell millions of copies of a book promising that we would lose weight eating steak, eggs and butter to our heart's desire, because it was the carbohydrates, the Pasta, rice, bagels and sugar, that caused obesity and even heart disease. Fat, he said, was harmless. Atkins allowed his readers to eat ''truly luxurious foods without limit,'' as he put it, ''lobster with butter sauce, steak with béarnaise sauce . . . bacon cheeseburgers,'' but allowed no starches or refined carbohydrates, which means no sugars or anything made from flour. Atkins banned even fruit juices, and permitted only a modicum of vegetables, although the latter were negotiable as the diet progressed. Atkins was by no means the first to get rich pushing a high-fat diet that restricted carbohydrates, but he popularized it to an extent that the American Medical Association considered it a potential threat to our health. The A.M.A. attacked Atkins's diet as a ''bizarre regimen'' that advocated ''an unlimited intake of saturated fats and cholesterol-rich foods,'' and Atkins even had to defend his diet in Congressional hearings. Thirty years later, America has become weirdly polarized on the subject of weight. On the one hand, we've been told with almost religious certainty by everyone from the surgeon general on down, and we have come to believe with almost religious certainty, that obesity is caused by the excessive consumption of fat, and that if we eat less fat we will lose weight and live longer. On the other, we have the ever-resilient message of Atkins and decades' worth of best-selling diet books, including ''The Zone,'' ''Sugar Busters'' and ''Protein Power'' to name a few. All push some variation of what scientists would call the alternative hypothesis: it's not the fat that makes us fat, but the carbohydrates, and if we eat less carbohydrates we will lose weight and live longer. The perversity of this alternative hypothesis is that it identifies the cause of obesity as precisely those refined carbohydrates at the base of the famous food Guide Pyramid -- the pasta, rice and bread -- that we are told should be the staple of our healthy low-fat diet, and then on the sugar or corn syrup in the soft drinks, fruit juices and sports drinks that we have taken to consuming in quantity if for no other reason than that they are fat free and so appear intrinsically healthy. While the low-fat-is-good-health dogma represents reality as we have come to know it, and the government has spent hundreds of millions of dollars in research trying to prove its worth, the low-carbohydrate message has been relegated to the realm of unscientific fantasy. Over the past five years, however, there has been a subtle shift in the scientific consensus. It used to be that even considering the possibility of the alternative hypothesis, let alone researching it, was tantamount to quackery by association. Now a small but growing minority of establishment researchers have come to take seriously what the low-carb-diet doctors have been saying all along. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, may be the most visible proponent of testing this heretic hypothesis. Willett is the de facto spokesman of the longest-running, most comprehensive diet and health studies ever performed, which have already cost upward of $100 million and include data on nearly 300,000 individuals. Those data, says Willett, clearly contradict the low-fat-is-good-health message ''and the idea that all fat is bad for you; the exclusive focus on adverse effects of fat may have contributed to the obesity epidemic.'' These researchers point out that there are plenty of reasons to suggest that the low-fat-is-good-health hypothesis has now effectively failed the test of time. In particular, that we are in the midst of an obesity epidemic that started around the early 1980's, and that this was coincident with the rise of the low-fat dogma. (Type 2 diabetes, the most common form of the disease, also rose significantly through this period.) They say that low-fat weight-loss diets have proved in clinical trials and real life to be dismal failures, and that on top of it all, the percentage of fat in the American diet has been decreasing for two decades. Our cholesterol levels have been declining, and we have been smoking less, and yet the incidence of heart disease has not declined as would be expected. ''That is very disconcerting,'' Willett says. ''It suggests that something else bad is happening.'' The science behind the alternative hypothesis can be called Endocrinology 101, which is how it's referred to by David Ludwig, a researcher at Harvard Medical School who runs the pediatric obesity clinic at Children's Hospital Boston, and who prescribes his own version of a carbohydrate-restricted diet to his patients. Endocrinology 101 requires an understanding of how carbohydrates affect insulin and blood sugar and in turn fat metabolism and appetite. This is basic endocrinology, Ludwig says, which is the study of hormones, and it is still considered radical because the low-fat dietary wisdom emerged in the 1960's from researchers almost exclusively concerned with the effect of fat on cholesterol and heart disease. At the time, Endocrinology 101 was still underdeveloped, and so it was ignored. Now that this science is becoming clear, it has to fight a quarter century of anti-fat prejudice. The alternative hypothesis also comes with an implication that is worth considering for a moment, because it's a whopper, and it may indeed be an obstacle to its acceptance. If the alternative hypothesis is right -- still a big ''if'' -- then it strongly suggests that the ongoing epidemic of obesity in America and elsewhere is not, as we are constantly told, due simply to a collective lack of will power and a failure to exercise. Rather it occurred, as Atkins has been saying (along with Barry Sears, author of ''The Zone''), because the public health authorities told us unwittingly, but with the best of intentions, to eat precisely those foods that would make us fat, and we did. We ate more fat-free carbohydrates, which, in turn, made us hungrier and then heavier. Put simply, if the alternative hypothesis is right, then a low-fat diet is not by definition a healthy diet. In practice, such a diet cannot help being high in carbohydrates, and that can lead to obesity, and perhaps even heart disease. ''For a large percentage of the population, perhaps 30 to 40 percent, low-fat diets are counterproductive,'' says Eleftheria Maratos-Flier, director of obesity research at Harvard's prestigious Joslin Diabetes Center. ''They have the paradoxical effect of making people gain weight.'' Scientists are still arguing about fat, despite a century of research, because the regulation of appetite and weight in the human body happens to be almost inconceivably complex, and the experimental tools we have to study it are still remarkably inadequate. This combination leaves researchers in an awkward position. To study the entire physiological system involves feeding real food to real human subjects for months or years on end, which is prohibitively expensive, ethically questionable (if you're trying to measure the effects of foods that might cause heart disease) and virtually impossible to do in any kind of rigorously controlled scientific manner. But if researchers seek to study something less costly and more controllable, they end up studying experimental situations so oversimplified that their results may have nothing to do with reality. This then leads to a research literature so vast that it's possible to find at least some published research to support virtually any theory. The result is a balkanized community -- ''splintered, very opinionated and in many instances, intransigent,'' says Kurt Isselbacher, a former chairman of the Food and Nutrition Board of the National Academy of Science -- in which researchers seem easily convinced that their preconceived notions are correct and thoroughly uninterested in testing any other hypotheses but their own. What's more, the number of misconceptions propagated about the most basic research can be staggering. Researchers will be suitably scientific describing the limitations of their own experiments, and then will cite something as gospel truth because they read it in a magazine. The classic example is the statement heard repeatedly that 95 percent of all dieters never lose weight, and 95 percent of those who do will not keep it off. This will be correctly attributed to the University of Pennsylvania psychiatrist Albert Stunkard, but it will go unmentioned that this statement is based on 100 patients who passed through Stunkard's obesity clinic during the Eisenhower administration. With these caveats, one of the few reasonably reliable facts about the obesity epidemic is that it started around the early 1980's. According to Katherine Flegal, an epidemiologist at the National Center for Health Statistics, the percentage of obese Americans stayed relatively constant through the 1960's and 1970's at 13 percent to 14 percent and then shot up by 8 percentage points in the 1980's. By the end of that decade, nearly one in four Americans was obese. That steep rise, which is consistent through all segments of American society and which continued unabated through the 1990's, is the singular feature of the epidemic. Any theory that tries to explain obesity in America has to account for that. Meanwhile, overweight children nearly tripled in number. And for the first time, physicians began diagnosing Type 2 diabetes in adolescents. Type 2 diabetes often accompanies obesity. It used to be called adult-onset diabetes and now, for the obvious reason, is not. So how did this happen? The orthodox and ubiquitous explanation is that we live in what Kelly Brownell, a Yale psychologist, has called a ''toxic food environment'' of cheap fatty food, large portions, pervasive food advertising and sedentary lives. By this theory, we are at the Pavlovian mercy of the food industry, which spends nearly $10 billion a year advertising unwholesome junk food and fast food. And because these foods, especially fast food, are so filled with fat, they are both irresistible and uniquely fattening. On top of this, so the theory goes, our modern society has successfully eliminated physical activity from our daily lives. We no longer exercise or walk up stairs, nor do our children bike to school or play outside, because they would prefer to play video games and watch television. And because some of us are obviously predisposed to gain weight while others are not, this explanation also has a genetic component -- the thrifty gene. It suggests that storing extra calories as fat was an evolutionary advantage to our Paleolithic ancestors, who had to survive frequent famine. We then inherited these ''thrifty'' genes, despite their liability in today's toxic environment. This theory makes perfect sense and plays to our puritanical prejudice that fat, fast food and television are innately damaging to our humanity. But there are two catches. First, to buy this logic is to accept that the copious negative reinforcement that accompanies obesity -- both socially and physically -- is easily overcome by the constant bombardment of food advertising and the lure of a supersize bargain meal. And second, as Flegal points out, little data exist to support any of this. Certainly none of it explains what changed so significantly to start the epidemic. Fast-food consumption, for example, continued to grow steadily through the 70's and 80's, but it did not take a sudden leap, as obesity did. As far as exercise and physical activity go, there are no reliable data before the mid-80's, according to William Dietz, who runs the division of nutrition and physical activity at the Centers for Disease Control; the 1990's data show obesity rates continuing to climb, while exercise activity remained unchanged. This suggests the two have little in common. Dietz also acknowledged that a culture of physical exercise began in the United States in the 70's -- the ''leisure exercise mania,'' as Robert Levy, director of the National Heart, Lung and Blood Institute, described it in 1981 -- and has continued through the present day. As for the thrifty gene, it provides the kind of evolutionary rationale for human behavior that scientists find comforting but that simply cannot be tested. In other words, if we were living through an anorexia epidemic, the experts would be discussing the equally untestable ''spendthrift gene'' theory, touting evolutionary advantages of losing weight effortlessly. An overweight homo erectus, they'd say, would have been easy prey for predators. It is also undeniable, note students of Endocrinology 101, that mankind never evolved to eat a diet high in starches or sugars. ''Grain products and concentrated sugars were essentially absent from human nutrition until the invention of agriculture,'' Ludwig says, ''which was only 10,000 years ago.'' This is discussed frequently in the anthropology texts but is mostly absent from the obesity literature, with the prominent exception of the low-carbohydrate-diet books. What's forgotten in the current controversy is that the low-fat dogma itself is only about 25 years old. Until the late 70's, the accepted wisdom was that fat and protein protected against overeating by making you sated, and that carbohydrates made you fat. In ''The Physiology of Taste,'' for instance, an 1825 discourse considered among the most famous books ever written about food, the French gastronome Jean Anthelme Brillat-Savarin says that he could easily identify the causes of obesity after 30 years of listening to one ''stout party'' after another proclaiming the joys of bread, rice and (from a ''particularly stout party'') potatoes. Brillat-Savarin described the roots of obesity as a natural predisposition conjuncted with the ''floury and feculent substances which man makes the prime ingredients of his daily nourishment.'' He added that the effects of this fecula -- i.e., ''potatoes, grain or any kind of flour'' -- were seen sooner when sugar was added to the diet. This is what my mother taught me 40 years ago, backed up by the vague observation that Italians tended toward corpulence because they ate so much pasta. This observation was actually documented by Ancel Keys, a University of Minnesota physician who noted that fats ''have good staying power,'' by which he meant they are slow to be digested and so lead to satiation, and that Italians were among the heaviest populations he had studied. According to Keys, the Neapolitans, for instance, ate only a little lean meat once or twice a week, but ate bread and pasta every day for lunch and dinner. ''There was no evidence of nutritional deficiency,'' he wrote, ''but the working-class women were fat.'' By the 70's, you could still find articles in the journals describing high rates of obesity in Africa and the Caribbean where diets contained almost exclusively carbohydrates. The common thinking, wrote a former director of the Nutrition Division of the United Nations, was that the ideal diet, one that prevented obesity, snacking and excessive sugar consumption, was a diet ''with plenty of eggs, beef, mutton, chicken, butter and well-cooked vegetables.'' This was the identical prescription Brillat-Savarin put forth in 1825. It was Ancel Keys, paradoxically, who introduced the low-fat-is-good-health dogma in the 50's with his theory that dietary fat raises cholesterol levels and gives you heart disease. Over the next two decades, however, the scientific evidence supporting this theory remained stubbornly ambiguous. The case was eventually settled not by new science but by politics. It began in January 1977, when a Senate committee led by George McGovern published its ''Dietary Goals for the United States,'' advising that Americans significantly curb their fat intake to abate an epidemic of ''killer diseases'' supposedly sweeping the country. It peaked in late 1984, when the National Institutes of Health officially recommended that all Americans over the age of 2 eat less fat. By that time, fat had become ''this greasy killer'' in the memorable words of the Center for Science in the Public Interest, and the model American breakfast of eggs and bacon was well on its way to becoming a bowl of Special K with low-fat milk, a glass of orange juice and toast, hold the butter -- a dubious feast of refined carbohydrates. In the intervening years, the N.I.H. spent several hundred million dollars trying to demonstrate a connection between eating fat and getting heart disease and, despite what we might think, it failed. Five major studies revealed no such link. A sixth, however, costing well over $100 million alone, concluded that reducing cholesterol by drug therapy could prevent heart disease. The N.I.H. administrators then made a leap of faith. Basil Rifkind, who oversaw the relevant trials for the N.I.H., described their logic this way: they had failed to demonstrate at great expense that eating less fat had any health benefits. But if a cholesterol-lowering drug could prevent heart attacks, then a low-fat, cholesterol-lowering diet should do the same. ''It's an imperfect world,'' Rifkind told me. ''The data that would be definitive is ungettable, so you do your best with what is available.'' Some of the best scientists disagreed with this low-fat logic, suggesting that good science was incompatible with such leaps of faith, but they were effectively ignored. Pete Ahrens, whose Rockefeller University laboratory had done the seminal research on cholesterol metabolism, testified to McGovern's committee that everyone responds differently to low-fat diets. It was not a scientific matter who might benefit and who might be harmed, he said, but ''a betting matter.'' Phil Handler, then president of the National Academy of Sciences, testified in Congress to the same effect in 1980. ''What right,'' Handler asked, ''has the federal government to propose that the American people conduct a vast nutritional experiment, with themselves as subjects, on the strength of so very little evidence that it will do them any good?'' Nonetheless, once the N.I.H. signed off on the low-fat doctrine, societal forces took over. The food industry quickly began producing thousands of reduced-fat food products to meet the new recommendations. Fat was removed from foods like Cookies, chips and yogurt. The problem was, it had to be replaced with something as tasty and pleasurable to the palate, which meant some form of sugar, often high-fructose corn syrup. Meanwhile, an entire industry emerged to create fat substitutes, of which Procter & Gamble's olestra was first. And because these reduced-fat meats, cheeses, Snacks and cookies had to compete with a few hundred thousand other food products marketed in America, the industry dedicated considerable advertising effort to reinforcing the less-fat-is-good-health message. Helping the cause was what Walter Willett calls the ''huge forces'' of dietitians, health organizations, consumer groups, health reporters and even cookbook writers, all well-intended missionaries of healthful eating. Few experts now deny that the low-fat message is radically oversimplified. If nothing else, it effectively ignores the fact that unsaturated fats, like olive oil, are relatively good for you: they tend to elevate your good cholesterol, high-density lipoprotein (H.D.L.), and lower your bad cholesterol, low-density lipoprotein (L.D.L.), at least in comparison to the effect of carbohydrates. While higher L.D.L. raises your heart-disease risk, higher H.D.L. reduces it. What this means is that even saturated fats -- a k a, the bad fats -- are not nearly as deleterious as you would think. True, they will elevate your bad cholesterol, but they will also elevate your good cholesterol. In other words, it's a virtual wash. As Willett explained to me, you will gain little to no health benefit by giving up milk, butter and cheese and eating bagels instead. But it gets even weirder than that. Foods considered more or less deadly under the low-fat dogma turn out to be comparatively benign if you actually look at their fat content. More than two-thirds of the fat in a porterhouse steak, for instance, will definitively improve your cholesterol profile (at least in comparison with the baked potato next to it); it's true that the remainder will raise your L.D.L., the bad stuff, but it will also boost your H.D.L. The same is true for lard. If you work out the numbers, you come to the surreal conclusion that you can eat lard straight from the can and conceivably reduce your risk of heart disease. The crucial example of how the low-fat recommendations were oversimplified is shown by the impact -- potentially lethal, in fact -- of low-fat diets on triglycerides, which are the component molecules of fat. By the late 60's, researchers had shown that high triglyceride levels were at least as common in heart-disease patients as high L.D.L. cholesterol, and that eating a low-fat, high-carbohydrate diet would, for many people, raise their triglyceride levels, lower their H.D.L. levels and accentuate what Gerry Reaven, an endocrinologist at Stanford University, called Syndrome X. This is a cluster of conditions that can lead to heart disease and Type 2 diabetes. It took Reaven a decade to convince his peers that Syndrome X was a legitimate health concern, in part because to accept its reality is to accept that low-fat diets will increase the risk of heart disease in a third of the population. ''Sometimes we wish it would go away because nobody knows how to deal with it,'' said Robert Silverman, an N.I.H. researcher, at a 1987 N.I.H. conference. ''High protein levels can be bad for the kidneys. High fat is bad for your heart. Now Reaven is saying not to eat high carbohydrates. We have to eat something.'' Surely, everyone involved in drafting the various dietary guidelines wanted Americans simply to eat less junk food, however you define it, and eat more the way they do in Berkeley, Calif. But we didn't go along. Instead we ate more starches and refined carbohydrates, because calorie for calorie, these are the cheapest nutrients for the food industry to produce, and they can be sold at the highest profit. It's also what we like to eat. Rare is the person under the age of 50 who doesn't prefer a cookie or heavily sweetened yogurt to a head of broccoli. ''All reformers would do well to be conscious of the law of unintended consequences,'' says Alan Stone, who was staff director for McGovern's Senate committee. Stone told me he had an inkling about how the food industry would respond to the new dietary goals back when the hearings were first held. An economist pulled him aside, he said, and gave him a lesson on market disincentives to healthy eating: ''He said if you create a new market with a brand-new manufactured food, give it a brand-new fancy name, put a big advertising budget behind it, you can have a market all to yourself and force your competitors to catch up. You can't do that with fruits and vegetables. It's harder to differentiate an apple from an apple.'' Nutrition researchers also played a role by trying to feed science into the idea that carbohydrates are the ideal nutrient. It had been known, for almost a century, and considered mostly irrelevant to the etiology of obesity, that fat has nine calories per gram compared with four for carbohydrates and protein. Now it became the fail-safe position of the low-fat recommendations: reduce the densest source of calories in the diet and you will lose weight. Then in 1982, J.P. Flatt, a University of Massachusetts biochemist, published his research demonstrating that, in any normal diet, it is extremely rare for the human body to convert carbohydrates into body fat. This was then misinterpreted by the media and quite a few scientists to mean that eating carbohydrates, even to excess, could not make you fat -- which is not the case, Flatt says. But the misinterpretation developed a vigorous life of its own because it resonated with the notion that fat makes you fat and carbohydrates are harmless. As a result, the major trends in American diets since the late 70's, according to the U.S.D.A. agricultural economist Judith Putnam, have been a decrease in the percentage of fat calories and a ''greatly increased consumption of carbohydrates.'' To be precise, annual grain consumption has increased almost 60 pounds per person, and caloric sweeteners (primarily high-fructose corn syrup) by 30 pounds. At the same time, we suddenly began consuming more total calories: now up to 400 more each day since the government started recommending low-fat diets. If these trends are correct, then the obesity epidemic can certainly be explained by Americans' eating more calories than ever -- excess calories, after all, are what causes us to gain weight -- and, specifically, more carbohydrates. The question is why? The answer provided by Endocrinology 101 is that we are simply hungrier than we were in the 70's, and the reason is physiological more than psychological. In this case, the salient factor -- ignored in the pursuit of fat and its effect on cholesterol -- is how carbohydrates affect blood sugar and insulin. In fact, these were obvious culprits all along, which is why Atkins and the low-carb-diet doctors pounced on them early. The primary role of insulin is to regulate blood-sugar levels. After you eat carbohydrates, they will be broken down into their component sugar molecules and transported into the bloodstream. Your pancreas then secretes insulin, which shunts the blood sugar into muscles and the liver as fuel for the next few hours. This is why carbohydrates have a significant impact on insulin and fat does not. And because juvenile diabetes is caused by a lack of insulin, physicians believed since the 20's that the only evil with insulin is not having enough. But insulin also regulates fat metabolism. We cannot store body fat without it. Think of insulin as a switch. When it's on, in the few hours after eating, you burn carbohydrates for energy and store excess calories as fat. When it's off, after the insulin has been depleted, you burn fat as fuel. So when insulin levels are low, you will burn your own fat, but not when they're high. This is where it gets unavoidably complicated. The fatter you are, the more insulin your pancreas will pump out per meal, and the more likely you'll develop what's called ''insulin resistance,'' which is the underlying cause of Syndrome X. In effect, your cells become insensitive to the action of insulin, and so you need ever greater amounts to keep your blood sugar in check. So as you gain weight, insulin makes it easier to store fat and harder to lose it. But the insulin resistance in turn may make it harder to store fat -- your weight is being kept in check, as it should be. But now the insulin resistance might prompt your pancreas to produce even more insulin, potentially starting a vicious cycle. Which comes first -- the obesity, the elevated insulin, known as hyperinsulinemia, or the insulin resistance -- is a chicken-and-egg problem that hasn't been resolved. One endocrinologist described this to me as ''the Nobel-prize winning question.'' Insulin also profoundly affects hunger, although to what end is another point of controversy. On the one hand, insulin can indirectly cause hunger by lowering your blood sugar, but how low does blood sugar have to drop before hunger kicks in? That's unresolved. Meanwhile, insulin works in the brain to suppress hunger. The theory, as explained to me by Michael Schwartz, an endocrinologist at the University of Washington, is that insulin's ability to inhibit appetite would normally counteract its propensity to generate body fat. In other words, as you gained weight, your body would generate more insulin after every meal, and that in turn would suppress your appetite; you'd eat less and lose the weight. Schwartz, however, can imagine a simple mechanism that would throw this ''homeostatic'' system off balance: if your brain were to lose its sensitivity to insulin, just as your fat and muscles do when they are flooded with it. Now the higher insulin production that comes with getting fatter would no longer compensate by suppressing your appetite, because your brain would no longer register the rise in insulin. The end result would be a physiologic state in which obesity is almost preordained, and one in which the carbohydrate-insulin connection could play a major role. Schwartz says he believes this could indeed be happening, but research hasn't progressed far enough to prove it. ''It is just a hypothesis,'' he says. ''It still needs to be sorted out.'' David Ludwig, the Harvard endocrinologist, says that it's the direct effect of insulin on blood sugar that does the trick. He notes that when diabetics get too much insulin, their blood sugar drops and they get ravenously hungry. They gain weight because they eat more, and the insulin promotes fat deposition. The same happens with lab animals. This, he says, is effectively what happens when we eat carbohydrates -- in particular sugar and starches like potatoes and rice, or anything made from flour, like a slice of white bread. These are known in the jargon as high-glycemic-index carbohydrates, which means they are absorbed quickly into the blood. As a result, they cause a spike of blood sugar and a surge of insulin within minutes. The resulting rush of insulin stores the blood sugar away and a few hours later, your blood sugar is lower than it was before you ate. As Ludwig explains, your body effectively thinks it has run out of fuel, but the insulin is still high enough to prevent you from burning your own fat. The result is hunger and a craving for more carbohydrates. It's another vicious circle, and another situation ripe for obesity. The glycemic-index concept and the idea that starches can be absorbed into the blood even faster than sugar emerged in the late 70's, but again had no influence on public health recommendations, because of the attendant controversies. To wit: if you bought the glycemic-index concept, then you had to accept that the starches we were supposed to be eating 6 to 11 times a day were, once swallowed, physiologically indistinguishable from sugars. This made them seem considerably less than wholesome. Rather than accept this possibility, the policy makers simply allowed sugar and corn syrup to elude the vilification that befell dietary fat. After all, they are fat-free. Sugar and corn syrup from soft drinks, juices and the copious teas and sports drinks now supply more than 10 percent of our total calories; the 80's saw the introduction of Big Gulps and 32-ounce cups of Coca-Cola, blasted through with sugar, but 100 percent fat free. When it comes to insulin and blood sugar, these soft drinks and fruit juices -- what the scientists call ''wet carbohydrates'' -- might indeed be worst of all. (Diet soda accounts for less than a quarter of the soda market.) The gist of the glycemic-index idea is that the longer it takes the carbohydrates to be digested, the lesser the impact on blood sugar and insulin and the healthier the food. Those foods with the highest rating on the glycemic index are some simple sugars, starches and anything made from flour. Green vegetables, Beans and whole grains cause a much slower rise in blood sugar because they have Fiber, a nondigestible carbohydrate, which slows down digestion and lowers the glycemic index. Protein and fat serve the same purpose, which implies that eating fat can be beneficial, a notion that is still unacceptable. And the glycemic-index concept implies that a primary cause of Syndrome X, heart disease, Type 2 diabetes and obesity is the long-term damage caused by the repeated surges of insulin that come from eating starches and refined carbohydrates. This suggests a kind of unified field theory for these chronic diseases, but not one that coexists easily with the low-fat doctrine. At Ludwig's pediatric obesity clinic, he has been prescribing low-glycemic-index diets to children and adolescents for five years now. He does not recommend the Atkins diet because he says he believes such a very low carbohydrate approach is unnecessarily restrictive; instead, he tells his patients to effectively replace refined carbohydrates and starches with vegetables, legumes and fruit. This makes a low-glycemic-index diet consistent with dietary common sense, albeit in a higher-fat kind of way. His clinic now has a nine-month waiting list. Only recently has Ludwig managed to convince the N.I.H. that such diets are worthy of study. His first three grant proposals were summarily rejected, which may explain why much of the relevant research has been done in Canada and in Australia. In April, however, Ludwig received $1.2 million from the N.I.H. to test his low-glycemic-index diet against a traditional low-fat-low-calorie regime. That might help resolve some of the controversy over the role of insulin in obesity, although the redoubtable Robert Atkins might get there first. The 71-year-old Atkins, a graduate of Cornell medical school, says he first tried a very low carbohydrate diet in 1963 after reading about one in the Journal of the American Medical Association. He lost weight effortlessly, had his epiphany and turned a fledgling Manhattan cardiology practice into a thriving obesity clinic. He then alienated the entire medical community by telling his readers to eat as much fat and protein as they wanted, as long as they ate little to no carbohydrates. They would lose weight, he said, because they would keep their insulin down; they wouldn't be hungry; and they would have less resistance to burning their own fat. Atkins also noted that starches and sugar were harmful in any event because they raised triglyceride levels and that this was a greater risk factor for heart disease than cholesterol. Atkins's diet is both the ultimate manifestation of the alternative hypothesis as well as the battleground on which the fat-versus-carbohydrates controversy is likely to be fought scientifically over the next few years. After insisting Atkins was a quack for three decades, obesity experts are now finding it difficult to ignore the copious anecdotal evidence that his diet does just what he has claimed. Take Albert Stunkard, for instance. Stunkard has been trying to treat obesity for half a century, but he told me he had his epiphany about Atkins and maybe about obesity as well just recently when he discovered that the chief of radiology in his hospital had lost 60 pounds on Atkins's diet. ''Well, apparently all the young guys in the hospital are doing it,'' he said. ''So we decided to do a study.'' When I asked Stunkard if he or any of his colleagues considered testing Atkins's diet 30 years ago, he said they hadn't because they thought Atkins was ''a jerk'' who was just out to make money: this ''turned people off, and so nobody took him seriously enough to do what we're finally doing.'' In fact, when the American Medical Association released its scathing critique of Atkins's diet in March 1973, it acknowledged that the diet probably worked, but expressed little interest in why. Through the 60's, this had been a subject of considerable research, with the conclusion that Atkins-like diets were low-calorie diets in disguise; that when you cut out pasta, bread and potatoes, you'll have a hard time eating enough meat, vegetables and cheese to replace the calories. That, however, raised the question of why such a low-calorie regimen would also suppress hunger, which Atkins insisted was the signature characteristic of the diet. One possibility was Endocrinology 101: that fat and protein make you sated and, lacking carbohydrates and the ensuing swings of blood sugar and insulin, you stay sated. The other possibility arose from the fact that Atkins's diet is ''ketogenic.'' This means that insulin falls so low that you enter a state called ketosis, which is what happens during fasting and starvation. Your muscles and tissues burn body fat for energy, as does your brain in the form of fat molecules produced by the liver called ketones. Atkins saw ketosis as the obvious way to kick-start weight loss. He also liked to say that ketosis was so energizing that it was better than sex, which set him up for some ridicule. An inevitable criticism of Atkins's diet has been that ketosis is dangerous and to be avoided at all costs. When I interviewed ketosis experts, however, they universally sided with Atkins, and suggested that maybe the medical community and the media confuse ketosis with ketoacidosis, a variant of ketosis that occurs in untreated diabetics and can be fatal. ''Doctors are scared of ketosis,'' says Richard Veech, an N.I.H. researcher who studied medicine at Harvard and then got his doctorate at Oxford University with the Nobel Laureate Hans Krebs. ''They're always worried about diabetic ketoacidosis. But ketosis is a normal physiologic state. I would argue it is the normal state of man. It's not normal to have McDonald's and a delicatessen around every corner. It's normal to starve.'' Simply put, ketosis is evolution's answer to the thrifty gene. We may have evolved to efficiently store fat for times of famine, says Veech, but we also evolved ketosis to efficiently live off that fat when necessary. Rather than being poison, which is how the press often refers to ketones, they make the body run more efficiently and provide a backup fuel source for the brain. Veech calls ketones ''magic'' and has shown that both the heart and brain run 25 percent more efficiently on ketones than on blood sugar. The bottom line is that for the better part of 30 years Atkins insisted his diet worked and was safe, Americans apparently tried it by the tens of millions, while nutritionists, physicians, public- health authorities and anyone concerned with heart disease insisted it could kill them, and expressed little or no desire to find out who was right. During that period, only two groups of U.S. researchers tested the diet, or at least published their results. In the early 70's, J.P. Flatt and Harvard's George Blackburn pioneered the ''protein-sparing modified fast'' to treat postsurgical patients, and they tested it on obese volunteers. Blackburn, who later became president of the American Society of Clinical Nutrition, describes his regime as ''an Atkins diet without excess fat'' and says he had to give it a fancy name or nobody would take him seriously. The diet was ''lean meat, fish and fowl'' supplemented by Vitamins and minerals. ''People loved it,'' Blackburn recalls. ''Great weight loss. We couldn't run them off with a baseball bat.'' Blackburn successfully treated hundreds of obese patients over the next decade and published a series of papers that were ignored. When obese New Englanders turned to appetite-control drugs in the mid-80's, he says, he let it drop. He then applied to the N.I.H. for a grant to do a clinical trial of popular diets but was rejected. The second trial, published in September 1980, was done at the George Washington University Medical Center. Two dozen obese volunteers agreed to follow Atkins's diet for eight weeks and lost an average of 17 pounds each, with no apparent ill effects, although their L.D.L. cholesterol did go up. The researchers, led by John LaRosa, now president of the State University of New York Downstate Medical Center in Brooklyn, concluded that the 17-pound weight loss in eight weeks would likely have happened with any diet under ''the novelty of trying something under experimental conditions'' and never pursued it further. Now researchers have finally decided that Atkins's diet and other low-carb diets have to be tested, and are doing so against traditional low-calorie-low-fat diets as recommended by the American Heart Association. To explain their motivation, they inevitably tell one of two stories: some, like Stunkard, told me that someone they knew -- a patient, a friend, a fellow physician -- lost considerable weight on Atkins's diet and, despite all their preconceptions to the contrary, kept it off. Others say they were frustrated with their inability to help their obese patients, looked into the low-carb diets and decided that Endocrinology 101 was compelling. ''As a trained physician, I was trained to mock anything like the Atkins diet,'' says Linda Stern, an internist at the Philadelphia Veterans Administration Hospital, ''but I put myself on the diet. I did great. And I thought maybe this is something I can offer my patients.'' None of these studies have been financed by the N.I.H., and none have yet been published. But the results have been reported at conferences -- by researchers at Schneider Children's Hospital on Long Island, Duke University and the University of Cincinnati, and by Stern's group at the Philadelphia V.A. Hospital. And then there's the study Stunkard had mentioned, led by Gary Foster at the University of Pennsylvania, Sam Klein, director of the Center for Human Nutrition at Washington University in St. Louis, and Jim Hill, who runs the University of Colorado Center for Human Nutrition in Denver. The results of all five of these studies are remarkably consistent. Subjects on some form of the Atkins diet -- whether overweight adolescents on the diet for 12 weeks as at Schneider, or obese adults averaging 295 pounds on the diet for six months, as at the Philadelphia V.A. -- lost twice the weight as the subjects on the low-fat, low-calorie diets. In all five studies, cholesterol levels improved similarly with both diets, but triglyceride levels were considerably lower with the Atkins diet. Though researchers are hesitant to agree with this, it does suggest that heart-disease risk could actually be reduced when fat is added back into the diet and starches and refined carbohydrates are removed. ''I think when this stuff gets to be recognized,'' Stunkard says, ''it's going to really shake up a lot of thinking about obesity and metabolism.'' All of this could be settled sooner rather than later, and with it, perhaps, we might have some long-awaited answers as to why we grow fat and whether it is indeed preordained by societal forces or by our choice of foods. For the first time, the N.I.H. is now actually financing comparative studies of popular diets. Foster, Klein and Hill, for instance, have now received more than $2.5 million from N.I.H. to do a five-year trial of the Atkins diet with 360 obese individuals. At Harvard, Willett, Blackburn and Penelope Greene have money, albeit from Atkins's nonprofit foundation, to do a comparative trial as well. Should these clinical trials also find for Atkins and his high-fat, low-carbohydrate diet, then the public-health authorities may indeed have a problem on their hands. Once they took their leap of faith and settled on the low-fat dietary dogma 25 years ago, they left little room for contradictory evidence or a change of opinion, should such a change be necessary to keep up with the science. In this light Sam Klein's experience is noteworthy. Klein is president-elect of the North American Association for the Study of Obesity, which suggests that he is a highly respected member of his community. And yet, he described his recent experience discussing the Atkins diet at medical conferences as a learning experience. ''I have been impressed,'' he said, ''with the anger of academicians in the audience. Their response is 'How dare you even present data on the Atkins diet!' '' This hostility stems primarily from their anxiety that Americans, given a glimmer of hope about their weight, will rush off en masse to try a diet that simply seems intuitively dangerous and on which there is still no long-term data on whether it works and whether it is safe. It's a justifiable fear. In the course of my research, I have spent my mornings at my local diner, staring down at a plate of scrambled eggs and sausage, convinced that somehow, some way, they must be working to clog my arteries and do me in. After 20 years steeped in a low-fat paradigm, I find it hard to see the nutritional world any other way. I have learned that low-fat diets fail in clinical trials and in real life, and they certainly have failed in my life. I have read the papers suggesting that 20 years of low-fat recommendations have not managed to lower the incidence of heart disease in this country, and may have led instead to the steep increase in obesity and Type 2 diabetes. I have interviewed researchers whose computer models have calculated that cutting back on the saturated fats in my diet to the levels recommended by the American Heart Association would not add more than a few months to my life, if that. I have even lost considerable weight with relative ease by giving up carbohydrates on my test diet, and yet I can look down at my eggs and sausage and still imagine the imminent onset of heart disease and obesity, the latter assuredly to be caused by some bizarre rebound phenomena the likes of which science has not yet begun to describe. The fact that Atkins himself has had heart trouble recently does not ease my anxiety, despite his assurance that it is not diet-related. This is the state of mind I imagine that mainstream nutritionists, researchers and physicians must inevitably take to the fat-versus-carbohydrate controversy. They may come around, but the evidence will have to be exceptionally compelling. Although this kind of conversion may be happening at the moment to John Farquhar, who is a professor of health research and policy at Stanford University and has worked in this field for more than 40 years. When I interviewed Farquhar in April, he explained why low-fat diets might lead to weight gain and low-carbohydrate diets might lead to weight loss, but he made me promise not to say he believed they did. He attributed the cause of the obesity epidemic to the ''force-feeding of a nation.'' Three weeks later, after reading an article on Endocrinology 101 by David Ludwig in the Journal of the American Medical Association, he sent me an e-mail message asking the not-entirely-rhetorical question, ''Can we get the low-fat proponents to apologize?''

I am not a foodie but have gained 100 pounds after being started on some meds known to cause weight gain. My Doctor recommended WLS after mutilple failed attempts at weight loss. Unlike others here who have lost and gained, I have never lost an ounce. I am scared I will do a drastic surgery and not lose the weight. Is there anyone out there who had surgery for the same reason, and did you succeed?

I had the Lap Band in 2011, lost about 50 lbs and had lots of the normal complications. food not going down, productive burps, vomiting, resorting to slider foods, weight gain, port site pain, etc. So after the birth of my son I decided to have my Lap Band removed in May (2014). I spoke to my doc about revision, he was ok with it but I had to do all the presurgery crap again due to staff not properly documenting. They were afraid my insurance would not cover revision if I didn't jump through the hoops again because ins wouldn't cover it for just having port pain. So I have one more family doc appt, my psych eval was good and she approved me for surgery, I got my date of Sept 16th last week, and I am finding myself going back and forth questioning whether or not I am ready for this. For me, it's now or never. I am 25 so am still under my mothers ins which pays 100% for surgery, however in Nov I will be 26 and I will carry insurance from the hospital I work at and the coverage sucks. My first thought is that I am terrified of complications. I am scared something will go wrong and I won't be here for my son(he's 4 months) and I get mad at myself thinking how selfish this is to want to risk all this just to be skinny? Am I crazy? I don't know if it's because its a more invasive surgery and it's permanent where as lap band wasn't, or if it's because I'm a mother now, but I am overcome by fear. Anyone else have this irrational fear almost stop you from going through with it? Any advice would be greatly appreciated.

I agree, it's probably just your body adjusting. Maybe you aren't eating enough calories. Also, how much sodium have you been taking in? It could be water weight gain and not actual poundage. Don't worry, it'll start coming off again. Good luck!

I feel the same way! I have already had 2 fills and am going for my third one tomorrow. I am afraid that I actually gained weight since my last fill (I am not certain because my doctor's scale is substantially different than mine). In all honesty, this past month I have been nothing but bad when it comes to eating the right foods and exercising, but I just feel so frustrated with the whole thing. I mean, I was banded on July 9th and, up until like three weeks ago, was eating right, controlling my portions, going to the gym 4 times a week, and I only have a total of 22 pounds gone to show for it. I am almost regretting my decision to get this surgery. At least before, when I dieted I lost some weight, but now I feel that I am at such a plateau and have even gained some of the weight back. I am afraid that my doctor will not give me another fill because of my weight gain which really kind of stinks since I am out of state at school and can't just go to her whenever I want to (she is two hours away). I am also super concerned that I have stretched out my pouch. I don't know if there is a way to check for that or not, but I know that it is possible. Anways, I'm glad that I'm not alone.

I think you summed it up right there. For me, I don't have a lot of the poor health conditions that come along with being over weight. My blood pressure is 95 over 59, I have a resting heart rate of 58 and a cholesterol of 139. I am healthy as can be. That is of course, until you look at the size of my ass-- it could replace Texas if need be! LOL. My little glitch is my thyroid, and it has reached levels of organ failure and cardiac arrest. The rapid weight gain associated with this prevents me from working out (causing blisters, joint pain, etc) and I am actually one of those weirdos thta LOVES working out. Throw on a recent pregnancy and it has been a recipe for failure. My doctor said that at my highest weight (227.5 at 5'5" and 28 yrs old) I would have a 75% chance of staying the same way or gaining more if I did not have the surgery. I have hypothroidism, and it is virtually a non-functioning thyroid. My endocrinologist has been workign hard at getting my numbers back in line and if all goes well, I should be back to normal in 3 weeks. Woo hoo! That being said, I was sick and tired of having my weight explode every single time my thyroid decided to change. I had the surgery on Thrusday 4/9 in an effort to couterbalance the thyroid issue. Part of it is also my own fault, I eat way too fast. The band helps with that. Most of all, I am a new mom and I have spent way too much time battling my weight. I have my whole life ahead of me and do not plan on wasting a single second. Being at this size and weight is a waste of my time and my life. By having the band, I am able to eat way less than the average person while getting a boost in the weight loss department. Thereby, beign able to work out sooner once I get to a slightly less painful weight for my frame. In this sense, the band is a tool, nothing more. I think you summed it up quite well yourself though--- You've "been miserable for far too long".... Life is short. I for one know I could not do this without the band. Best of luck to you!

If you suspect nerve pain you should check with your GP. I have nerve pain in low low back. I asked rheumatologist for Lyrica or Cymabalta and got samples first of Lyrica...worked well but common side effect is weight gain - 5 lbs the first week!...then Cymbalta...common side effect is loss of appetite but I think I will muddle through. It made a HUGE difference...still some pain but far less. As far as doctors are concerned you might see if the hospitals nearby have bariatric programs. I am near Houston and you can't spit without hitting a doctor who does banding. I can't believe there is no doctor there who won't take a transfer, especially if you might need a removal which would be more pennies in their pockets.

Losing weight and losing fat are two completely different things. It's nice to see the scale go down of course but usually quick weight gain or loss is simply the body ridding or absorbing fluids. It's nearly impossible to lose more than 1/2 lb of fat in one day unless you're a marathon runner or ride a century bike ride. Some types of food or sodium can cause the body to eliminate fluids or absorb fluids. Carbs and sodium can cause these wild weight fluctuations. If you're hyper-sensitive to seeing the scale jump around on a daily or weekly basis maybe you shouldn't look. But if you understand the reasons for these fluctuations and don't take them personally, weigh yourself daily like many of us do. I weigh morning and night. Just remember that you need to consume 3500 more calories than you burn to gain one lb/fat. Or, you need to burn 3500 calories more than you consume to lose one lb/fat. If you eat 1000 calories a day and burn 2000, you could be losing approximately 1/3 lb/fat a day. But, if it's your TOM or you consume a snickers bar or a bowl of cheerios or 2000mg of sodium, your body could retain 1-3 lbs of extra fluids. It's not fat weight but your scale can't tell the diff. Hope this wasn't too lengthy and helps?

This is so frustrating. I have been working on developing the habits neccesary after my surgery which includes no water 30 minutes before, during, and 30 minutes after a meal. I haven't been drinking 15 minutes before and during and I have been making it about 10- 15 minutes after before I have to drink something. This is a big accomplishment for me. I have also been working on chewing my food very well. I still have to not allow myself to get distracted and do better with it when I eat alone. I will work on that too. I noticed that some of my changes seem to have resulted in me gaining weight. For example, now that I am focused on being sure that I get breakfast, my metabolism is higher so I am hungrier much more often throughout the day. Also, I have noticed that when I don't drink water during a meal, I need to eat much more to get the same feeling. I don't know what to do! I am bigger than I have ever been in my life and it only seems to be getting worse when I combine these habits. Not sure how to work on this.

All of the paperwork provided to me from my provider says no coffee or caffeine. Not just at one stage, but all stages. I understand that during the initial weeks of healing (maybe) coffee might cause a problem. But it is expected that I an never have coffee again? I drink my coffee Black - no cream, no sugar. Granted, I used to drink a lot of it - but I've been sleeved on 8/23 and am craving for just a few sips of my delicious beverage. I'm curious as to the roles coffee and caffeine can play on the success of this surgery. So few questions: 1. Why no coffee? 2. Why no caffeine? 3. If allowed, when can I start having it again? *Again, all on the basis of black coffee - no cream, no sugar (additives that would result in weight gain)

it's not time to panic yet! That is probably mostly period water weight gain. Most women eat more on their periods or right before their periods. I agree that it is probably water weight. If the scale continues to go up steadily for the next few weeks then I think you need to re-evaluate what you're doing as far as calories. Are you still doing protein first? I hope you figure it out

Same boat here. This food addictions SUCKS with my weight gain I get down about it and all I want to do it eat. Vicious Cycle. I actually started a thread earlier this morning called Pre-Op Blues and this is what I wrote: So I am having pre-op blues. My weight keeps going up WTF?!?!?!?! My first appointment with the surgeon I was 254 and now I am 257. I am having my second appointment next wednesday (11/16) and I don't want to be heavier. Why can't I get it together? I know its all mental because I know I can do it. Is it that I am eating like its my last meal or that the I will only take it seriously when the doctor finally puts me on the pre-op? What a mental brain fart!!!! ARGHHHH!!!! I just hope that I am not doing this for anything. The Lapband better b*tch slap my a$$ into gear Off to change my ticker in the wrong direction. BTW a good point my best friend made...maybe I needed this weight gain to realize how much I do need the Lapband...talking about seeing the glass half full.

<TABLE class=ThmBgStandard cellSpacing=0 cellPadding=10 width="100%" border=0><TBODY><TR><TD>I was a healthy attractive athlete until my mid 40's. I developed Type 2 diabetes and things exploded after that in huge weight gains that I did not monitor. By the time I had Band surgery in 2005 I was 58. My brain remembered the good old days, so I started behaving like that again. The weight peeled off. I started by training and completing a half marathon. Now, after plastic surgery, my old self is coming back. I still have more surgeries and work to do, but I'm now on a positive roll that will not quit. My heart breaks over obese people who have NEVER been popular, had lots of dates, rode a horse, ran a marathon, etc. It's never too late to learn and go on. </TD></TR></TBODY></TABLE> Just i came across this i found it offencive, May be i read into it to much but to me i read that Obese people are unatractive cant or dont gets dates. dont have lifes and that the poster didnt have a lifetime battle with there weight so in my opinion WLS was very much a first rather than last option, Were as MOST of us who are big try every other available method of weight loss before resorting on surgery. The person who posted that didnt try anything just gained weight and had surgery to fix it. And while they claim to be heart broken for obese people they have some very derogotary opinions of obese people. Thats how i read it. I feel there is a huge difference between suffering a lifetime of true obesity and just gaineing a few lb's in later life. We all hear that years of yo yo dieting can mess up your matabolism. So may be the person who posted that found there banding jurney fairly easy because there matabolism had not been shot to peices like most of us who have tried basically everything else all our lifes.

hf2havefun, I live in Central Texas. I live in the Killeen / Harker Heights area and work in the Temple / Belton area. If anyone does have recommendations for a doctor, I'm all ears! My primary care physician of the last year hasn't listened to anything I've said. She recommended I try Weight Watchers (again). I'm only 23, but I also have been diagnosed with PCOS, one of the major symptoms of which is massive weight gain at a rapid pace. I had my son almost 3 years ago and since then have packed on the weight no matter what I do. I used to be very healthy, I worked at different local gyms for years before my pregnancy and loved working out and eating healthy, but at the weight I am now it's so frustrating to try and lose anything. I just don't have the will power to do it alone, yet I refuse to let it control my life like it has been. Sheesh, you gotta love the anonymity of the internet huh? I haven't said half this stuff to my closest friends! Thanks so much for the well wishes and advice!

Thanks- as to my doc(s), my endo is one of the best (I am told that other doctors will only use him and he is on staff with 5 hospitals) so who he recommended for surgery has to be good. On the surgeons website he was voted 'best of (mycity) several times. One consistent thing I have read is use an EXPERIENCED surgeon, this guys sounds top notch (in fact in making an appt last week the first available was Dec 1 (one concern I have there, is reading that folks 'never see their surgeon again...). For me its all about the 'vibe'- if I like him- thats good enough for me. As to work- I work in a warehouse environment. I am the 'grunt' for my department and regularly life 75 lbs. (tho with the weight gain I have slowed down, and also realize if I get hurt...who cares (i.e. if i wrench my back out, who is that helping). Once a decision is made (about lapbanding) I will talk to management. They have been very understanding about the diabetes (well they have to but...). So I will do what I need to do. As to the pups, I was at the dog park and a lady literally abandoned the scottie in front of me, walked out, didn't look back. I think it was meant to be. He is a year and a half old and being diabetic really gets me up and at em. We go to the dog park at least 4-5 times a week (if if were just me and he older bassetish I would be much more sedentary... I have an appt with my primary care on Tuesday. I called my insurance company, lapband IS covered, 80% + deductable.

Hi everyone! I am new to the forums.. I could really use some advice before considering lap band surgery. I keep going back & forth, making consultation appts then not going. Its been awhile again and here I am considering it again. I have 3 family members that had it done & had great success. I am worried about qualifying mostly at this point... My bmi is 38 now.. I have Medicare as my primary insurance & I'm hoping I can qualify to have the procedure covered. Also, I am 32... 5'3, 212pds I have been struggling with my weight for years now though... lost & gained it back several times and I am just frustrated a permanent solution sounds so good to me at this point although I know it will still take some work on my part. I just hope it would be the right decision, I was never overweight until around age 24 ..after that and having my daughter the weight started adding on.. & medications I have to take just make it harder to lose the weight or cause weight gain. Anyways.. sorry for rambling..any advice is appreciated

I'm about 6 weeks post now, losing nothing. Had 1 fill so far and going for another next week (although I'm really not sure I need one, I don't have any type of hunger that I can't deal with). I'm watching Protein (at least 60g) and carbs (around 50g) each day, not snacking and definitely finding it hard to get more than 600-700 calder unless I'm eating junk between meals. I know this could be a problem but.. I also take lithium for bipolar disorder (which I'm having a hard time with right now but that's a different story). Lithium's main side effect is weight gain. I don't have the option of not taking it (trust me). I was wondering if anyone else took it and if they find it affects their weight loss much? I'm scared that it's playing a huge role in mine but like I said there's not much I can do. Does anyone still lose while being on lithium? Do you lose like normal or slower?

Hey fellow sleevers, I've just started thinking about the fact that I am on Estrodiol for hormone replacement (total hysterectomy at 33) and also Effexor for mild depression due to hormonal changes & to help with hot flashes. BOTH of these are known to have side effect of weight gain which is no doubt why I was able to put on over 100lbs in less than a year (that's way faster than normal). So just wondering from personal experience if weight loss has still been good if on either of these or has it not even been an issue. Also have Hypothyroidism which didn't happen till after Hyster also..... Thanks for any experience....

I'm about to have my final of six monthly nutritionist meetings and I've been worried because I've gained weight since the first meeting. Since I started six months ago my work hours have changed, I had a death in the family and I started taking Paxil for anxiety and depression. I'm not trying to make excuses, I have been trying, but it's been especially difficult to even maintain most months. How will gaining weight over the six months affect my chances of getting approved by insurance? I have BCBS. Anyone have any stories to relate? The reason I'm trying to get the band is because I obviously need help so im really hoping I don't get denied because of this!

Hate to be ignorant, but what does PB stand for? I have had the sliming thing a time or two. I agree, it's like aversion therapy but still much more tolerable than out of control weight gain!

POOP QUESTION ALERT So I've been clogged up. Had to go the fleet route to get things flowing but it was still bad. So I started taking colace 1x day and that did nothing. So now I'm tAking 2x day. I've noticed that I've GAINED 2 pounds since doing this. Is it making me retain Water? Why the weight gain?

I don't regret getting my band. Yes, the band works. You get full fast, there are times you simply can't eat. However, falling back to old habits comes too easy for many of us. I just always end up being the brutally honest one of the group that's not afraid to say that I've fallen back into my old habits to the tune of a 10 pound weight gain. It's all about choices. The Band originally restricts you from eating, and when it's new, you are scared to death to do anything wrong, so you follow the rules. Soon, the Band becomes a comfortable part of your life and you face all the same social settings, parties, work, leftovers, fast food joints, candy isles, etc. The Band restricts how your stomach feels, but it does nothing to take away the DEMONS. My demons are just meaner than others, so it takes more of a fight from me. But I'm tired. I have many enemies, but no regrets. I say it like it is, which really bothers or hurts a lot of people because girls aren't supposed to be mean. But to me, I want the hard, cold facts. I don't want to see a bunch of happy, smiling faces if there are underlying problems that need to be addressed. I need to get down and dirty and fix the problems. Could you imagine if a man tried to fix a car engine while keeping his hands clean? It's the same thing when it comes to our weight, our lives, our jobs, our relationships. If it's broken, it needs to be fixed, and you might get dirty fixing it. So I come here, post the problem, gnash it out, HATE a bunch of responses, LOVE a bunch of others, LOVE everyone for caring enough to put up with me, then hope for a better tomorrow. Meanwhile, I think Kare is me with another screen name. Don't be afraid to get the Band. Just get it knowing all the facts, and the fact is that statistics show "most" people lose 1/2 of the weight they need to lose with the band, and the rest has to come off through diet and exercise. Therefore, I'm a success. I'm still down a solid 60 pounds. I could not have done it without the Band. Rock on.

Hi all! I’m 18 months post op from my VSG and I’m still 24 pounds out from my goal weight. My highest weight was 313 and surgery day I was 289. I’m currently 204. I was able to get down to 197 a few months ago but I have gained some back. I’m battling constant hunger. I have been strength training a lot the past 6 months, which at first I attributed to my increase in hunger, but the past 2 months it’s gotten out of control. I eat anywhere between 100-130 grams of protein a day. Drink 120 ounces of water a day. Take my vitamins. I just can’t shake this hunger, which in turn makes me have bad food choices, usually later at night. Has anyone else struggled with this at this point in their journey? And what advice do you have? I’m terrified of weight gain and desperately want to reach my goal!

Make sure that for your supervised weight loss that you have them incorporate the mental health aspect of it as well, because if you go into surgery with a fixation that strong you can over do it! While I don't experience the same difficulties as you are facing getting a mental health plan established before and soon after support groups will really help. I am also 36 and had my share of bad things happen in my life that led me down the weight gain rabbit hole feel free to pm me anytime if need be you're welcome to my cell number!

I just wanted to note, for anyone that is stating that artificial sweeteners can cause weight gain and don’t drink diet because of them, I would absolutely not use this as a reason or to drink diet soda. There are artificial sweeteners in your protein shakes, protein bars, yoghurt, jello, pudding, Gatorade, mio/water flavorings, and many others items you consume. These are all foods and additions that are heavily relied upon on almost every single post op diet I’ve seen here.