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After reading you post I do not feel so alone because I went through the same thing with my primary care physican after all he was always the one to suggest to me I needed to loose the weight to control my sugar levels but yet the meds you prescribed after weight gained meds, he will say just excercise cut back on your foods did that done that how stressful nothing worked I did loose 85 pds and had a follow up blood sugar was 455. Now with the insurance I have i did not need a referral. i am suppose to be having my surgery on the 2nd of March I have to see a therapist to make sure I am not bipolar and a cardiologist my ekg was not normal. I wish you well on your journey keep me posted ok.

LAPAROSCOPIC GASTRIC SLEEVE DIET Introduction The following information provides guidelines for you to follow before and after Gastric Sleeve Surgery and for the rest of your life. Gastric Sleeve Surgery is a weight loss tool. After surgery, you will be required to make lifelong changes in your eating habits and to exercise on a regular basis in order to achieve and maintain your weight loss goals. Gastric Sleeve Surgery reduces the size of the stomach which restricts the volume of food that you can consume at one time. This means that you will feel full after eating a small amount. The surgery also induces hormonal changes which help prevent you from feeling excessively hungry. You should avoid drinking liquids with meals. This is to prevent overfilling of the stomach. Frequent snacking or grazing must also be avoided as this contributes to excess calorie intake and can slow weight loss or cause you to gain weight. Exercise is an important component of weight loss success. Exercise is recommended before and after surgery in order to maximize the amount of weight that you lose and keep off. If you have not been an active exerciser, always consult with your physician for clearance and recommendations before beginning any exercise program. It is important to follow the lifetime Gastric Sleeve diet rules, supplement guidelines, and exercise recommendations in order to achieve and maintain optimum weight loss success. In order to begin preparing for surgery, start implementing the pre-surgery diet goals listed on the next page. 4 Pre-Surgery Diet Practice Tips 1. Choose low-fat foods, and avoid fried foods. 2. Stop using sugar. Use sugar substitutes such as Sweet & low, Equal, or Splenda. 3. Decrease intake of Desserts and candy. 4. Stop drinking sugar-sweetened beverages such as regular soda and sweetened Kool-Aid. 5. Start weaning off of caffeine and carbonated beverages. 6. Start cutting back on fast food and eating out. Begin making healthy meal choices when eating out and at home. 7. Eat 3 meals a day. Do not skip Breakfast. 8. Start decreasing portion sizes. 9. Eat more fruits and vegetables. 10. Practice drinking water and other fluids between meals, not with meals. 11. Drink 64 ounces Water a day. 12. Practice sipping liquids. 13. Avoid alcohol. 14. Begin some form of exercise. 15. Review the following information on the gastric sleeve diet. 16. Practice chewing foods thoroughly, 20 - 40 times or to paste consistency. 17. Purchase your protein drinks or supplements. 18. Purchase your vitamin and mineral supplements. 19. Begin planning a schedule for mealtime, fluids and Vitamin and mineral supplements. 5 Post Gastric Sleeve Surgery Diet Important Diet Guidelines: 1. Eat 3 meals per day. Avoid snacking and grazing. 2. Eat small amounts. Initial portion size should be no more than 1 - 2 ounces - approximately 2 - 4 Tablespoons - of food per meal for the first month. At first you may not be able to tolerate this amount. Over time, you will slowly tolerate more volume at each meal. Long term, the stomach will eventually hold about 4 - 8 ounces (1/2 - 1 cup) of food per meal. 3. Eat Protein foods first. 4. Do not try to eat food and drink liquid together. • Consume liquid 30 to 60 minutes before and/or 30 to 60 minutes after eating meals but not during meals. 5. You are required to take a multi-vitamin with minerals for the rest of your life. 6. Eat slowly! • Each meal should last 30minutes or longer. • Avoid gulping foods and drinks. • All foods must be well-chewed to a paste consistency. • Using a small fork or spoon (i.e. baby utensils) can help control portion sizes. • Have one place to eat (such as at the table) and avoid reading or watching TV while you eat. This helps you to enjoy your food, concentrate on eating slower and to realize when your stomach is full. 7. Drink plenty of calorie-free, non-carbonated, caffeine- free fluids between meals . • Drink slowly-sip fluids, never gulp. • Calorie-containing beverages should be limited to skim milk and Protein Drinks. • Limit juice to no more than 4oz. per day. • Consume zero-calorie beverages throughout the day. 6 Diet Progression After Surgery The diet after gastric sleeve surgery progresses through several stages. Your surgeon will let you know when it is okay to progress to the next stage. Day 1 - 2 after surgery: Clear Liquid Diet The clear liquid diet means fluids or foods that are liquid at body temperature and can almost be seen through. You will be on a clear liquid diet while you’re in the hospital. Examples of Clear Liquid Diet (No Added Sugar/ Sugar Free): • Clear (diluted) fruit juices without added sugar: apple, grape or white grape or diet cranberry • Sugar-free Crystal Light drink mix or popsicles, sugar-free Kool-Aid • Herbal tea, caffeine-free tea • flat soda • Sugar-free Popsicles • Sugar-free gelatin • Clear broth • Water ???? It is best to dilute juices by 50% with water. ???? Avoid citrus juices (orange/grapefruit) and tomato juice for the first three weeks. ???? Coffee and de-caffeinated coffee contain acids which are irritating to the stomach lining and should be avoided for the first few weeks for healing. Day 3 through Week 2: Full Liquid Diet The next stage is the full liquid diet which consists of sugar-free, low-fat milk products and the Clear Liquids listed above. You will need to supplement with protein (drinks or powder) after surgery. Remember to sip liquids, do not gulp. Examples of Full Liquid Diet (No Added Sugar/Sugar-Free, Low Fat): • Skim Milk or Lactaid milk • Soy Milk (non-fat) • Low fat, thin, strained cream Soup (smooth, no pieces of food) • Sugar-free instant breakfast • Protein drinks – Start daily when you get home from the hospital. (See section on protein and protein drinks) • Plain or “light” (no sugar added) yogurt with no fruit pieces • Sugar-free pudding or custard • Thinned cream of wheat or rice cereal 7 Week 3 through Week 8: Pureed Diet You may now begin a pureed diet. This includes all items listed for clear and full liquids, and the items listed for the pureed (blenderized) diet. • Eat PROTEIN foods first • Make sure foods are well blended. • Start slowly. If you do not tolerate pureed foods go back to the liquid diet and try again in a few days. • Remember to drink liquids between meals, not with meals. • Continue protein drinks or protein supplements every day. Examples for the Pureed Diet (Sugar-Free/No Sugar Added, Low Fat): Eggs Cheese Pureed or blenderized scrambled eggs or egg substitute or cheese omelet; melted low-fat cheese, low-fat or non-fat cream cheese, ricotta cheese, very smooth/mashed soft cheese such as mozzarella, string cheese, low-fat or non-fat smooth or small curd cottage cheese Meat, Fish, Poultry, Baby food meat or pureed meat or poultry moistened with broth or low-fat gravy Blenderized shrimp, scallops or fish Pureed tuna or salmon (canned in water) or pureed egg salad with low-fat or non-fat mayonnaise Potted meats thinned with broth; smooth deviled ham Starches Unsweetened instant oatmeal (strained), cream of wheat or rice cereal, mashed potatoes or sweet potatoes, smooth polenta, hummus, refried beans; low-fat or baked crackers or chips Vegetables Baby food vegetables or pureed cooked vegetables (no corn or peas) Mashed winter squash, tomato juice or sauce, pureed salsa, marinara Soup Strained, low-fat cream soup made with skim milk; fat-free broth Blenderized lentil or split pea soup or chili Fruit Baby food fruits (bananas, pears, applesauce, peaches, mango, etc) Unsweetened applesauce (smooth) Unsweetened canned fruit – blenderized Unsweetened fruit juice (diluted, no sugar added) Remember: IF YOU CAN CHEW IT, DON’T DO IT! 8 Tips to Get Started Everything that you eat on the pureed diet should be sugar-free or no sugar added, low fat and blended to the consistency of baby food or smooth applesauce. • You will need a blender or food processor or you can purchase baby food. • Start with 1 ounce (2 Tablespoon) portions - no more than 4 Tablespoons at the most. Listen to your body and stop eating as soon as you feel full. • Eat protein foods first. Then if you are not too full, try vegetables or fruits. • Continue protein supplements (80 g protein per day from supplement). Helpful Hints for Blenderizing • Cut foods into small pieces before putting into the blender or food processor. • Remove seeds, skins and fat. • Add liquid for ease of blending. Add enough liquid to cover the blades. Options include skim milk, broth, strained low-fat cream soup, low-fat gravy, low-fat or non-fat sour cream or fat-free half & half. • Blend the item to a smooth, applesauce consistency. • Make sure there are no particles, seeds or lumps remaining. If so put through a sieve or strainer. • If you have leftover blenderized foods, try freezing in single serving portions in ice cube trays and put the frozen cubes into plastic freezer bags. Meats – Very lean and dry meats puree better by adding a small amount of fat (margarine, oil, light mayonnaise, gravy, etc.) Fish also tends to be dry. Improve the texture by adding small amount of lemon juice, light mayonnaise or strained low-fat tartar sauce. Starches – Try pureed peas, canned Beans, sweet potatoes. Starches puree better when hot. Rice and potatoes tend to puree into a gummy paste and are not recommended. Substitute cream of rice Cereal prepared with a flavorful broth and seasoned with margarine. Pasta or noodles are not recommended as they are not well-tolerated. Vegetables – Cook vegetables until soft. If using canned vegetables, drain first. Add melted margarine and puree. Add a small amount of liquid until it reaches the smooth applesauce consistency. Fruit – If using canned fruit, drain first. Add a few drops of lemon juice to help prevent them from discoloring. Begin to take advantage of your favorite leftovers before surgery. Process these foods, and freeze them in an ice cube tray. (Each cube is approximately 1/2 to 1 ounce). When frozen, pop out into Zip-lock bag; label and date, and freeze cubes until needed. 9 Meal Guidelines for the Pureed Diet (See Sample Pureed Meals listed in the Appendix) Once you begin to eat pureed foods (which are considered solids) you will want to start differentiating between liquids and solids – meals should include pureed foods, and so liquids (including protein drinks) should be taken separately from your meals. • You should eat 3 meals a day with protein drinks between meals. • Protein drinks containing at least 20 grams of protein per serving should be consumed as needed to meet 80 g/day goal. • Start with a portion size of 1 to 2 tablespoons of pureed food for the first month. At first you may not be able to tolerate this amount. Eat your protein source first, and then if you have room a small amount of fruit, vegetables or other foods may be consumed. Hints for Measuring Foods: Liquids or soft/pureed foods are best measured in measuring cups or spoons; they can be measured in ounces, Tablespoons or mls. 1 cup 8 Fluid ounces 240 ml 16 tablespoons 3/4 cup 6 fluid ounces 180 ml 12 tablespoons 1/2 cup 4 fluid ounces 120 ml 8 tablespoons 1/4 cup 2 fluid ounces 60 ml 4 tablespoons 1/8 cup 1 fluid ounce 30 ml 2 tablespoons 1 Tablespoon = 3 teaspoons 1/2 Tablespoon = 1-1/2 teaspoons Week 9-12 After Surgery: Soft solid food Diet If you have been tolerating pureed foods, you may now begin a soft diet. This includes all items listed for clear and full liquids and pureed diets plus items listed for the soft diet. Try 1 to 2 new foods a day. This will help you to learn what foods you tolerate. • Remember your stomach pouch empties more slowly with more solid or dense foods than with liquids, so you will be able to tolerate a smaller quantity of food than you could with liquids . • Go slowly. If you do not tolerate the trial of soft foods, resume pureed foods and try again in a week. • Eat protein foods first • Avoid foods high in sugar and fat. • Space meals 4-5 hours apart • Continue your protein drinks between meals • Drink other fluids constantly between meals 10 Examples of Soft Diet (No Added Sugar/Sugar-Free, Low Fat): • Baked fish (no bones) • Imitation crab meat, baby shrimp • Bananas • Canned peaches or pears in water or juice • Well-cooked vegetables without seeds or skin (no corn or peas) • Scrambled, poached or hard boiled eggs • Tuna or egg salad (no onions, celery, pimientos, etc.) • Finely shaved deli meat • Baked, grilled or rotisserie chicken o Moist foods will be better tolerated. Moisten meats with broth, low fat mayonnaise, or low-fat gravy or sauce. o Fish and seafood Proteins are softer and easier to break down than poultry or red meat proteins. o Reheating foods tends to make them dry out and hard to tolerate. Common Problem Foods (Avoid for 3 months after surgery) • Red meat such as steak, roast beef, pork. Red meat is high in muscle Fiber, which is difficult to separate even with a great deal of chewing. Avoid hamburger for one month after surgery. • Un-toasted bread; rolls, biscuits. (Toasted bread may be better-tolerated.) • Pasta • Rice • Membrane of citrus fruits • Dried fruits, nuts, popcorn, coconut • Salads, fresh fruits (except banana) and fresh uncooked vegetables, potato skins. Month 4 After Surgery: Regular Diet • Problem foods as listed above can now be tried. • Rice, pasta and doughy bread may not be tolerated for 6 months or more. • Try fresh fruits without the skin first. If tolerated, the skin can be tried the next time. Salads are generally well-tolerated if chewed well. • Go slowly. Try a small amount to see how you feel. • Avoid high sugar and high fat foods to avoid a high calorie intake. 11 Foods to Avoid : Hard/crunchy foods may always be poorly tolerated. Nuts and seeds are difficult to break down. Fried foods/greasy foods are hard to digest and are very high in calories. • Corn chips, potato chips, tortilla chips, hard taco shells • Nuts and seeds • Fried foods and greasy foods Points to Remember: • Solid foods will fill your stomach pouch more than liquids so you will be eating smaller quantities of foods versus liquids. • If you don’t tolerate a food the first time, wait a week and try again. • You may find that you tolerate a certain food one day and not the next. It is normal for this to happen. • If you don’t tolerate certain foods or notice nausea, vomiting or diarrhea during or after eating, ask yourself the following questions: o Did I chew to a paste consistency? o Did I eat too fast? o Did I eat too much volume? o Did I drink fluid with my real meal or too close to my meal? o Did I eat something high in sugar or fat? o Was the food moist or was it too dry? Steps for adding solid foods: • Try only 1 small bite of the new food and chew well. Wait awhile and if there are no problems, take another bite. • If at any time you feel too full, nauseated or vomit, stop eating and rest. Take only clear liquids at the next meal and add blended foods and liquids at the following meal. Try one solid food again the next day. 12 PROTEIN Protein is the most important nutrient to concentrate on when resuming your diet. Because the volume of your meals will be limited, you should aim for a minimum of 80 grams of protein per day – this needs to come from your protein supplement . Why is protein important? • Wound healing • Sparing loss of muscle • Minimizing hair loss • Preventing protein malnutrition Remember to eat protein foods first at each meal, followed by vegetables and fruit. These are some good sources of protein: Protein Sources Serving size Protein (g) Skim or 1% milk 1 cup 8 Evaporated skim milk (canned) 1 cup 19 Soy milk beverage 1 cup (8 ounces) 7 Non fat dry milk powder 1/3 cup powder 8 Nonfat, sugar free yogurt 1 cup (8 ounces) 8 Nonfat or low fat cottage cheese ½ cup (4 ounces) 14 Nonfat or low fat cheese slices String cheese *1 ounce/ 1 slice 6 LEAN meats – skinless chicken or turkey breast, fish, beef, ham, Deli meats *1 ounce 7 Egg or Egg substitute 1 egg or ¼ cup subst. 7 Peanut Butter (creamy) 1 Tablespoon 5 Tofu ¼ cup 5 Legumes; dried beans peas or lentils Chili, bean soup ½ cup cooked ½ cup 7-9 6-7 Soy/vegetable patty (like Gardenburger) 1 patty 8 - 10 Hummus ½ cup 6 Measuring Hints: *1 ounce of meat is equal to about 3 – 4 Tablespoons of chopped or ground meat. 1 ounce of grated or cottage cheese, tuna or egg salad is ~ 1/4 th cup (4 Tablespoons). A 3-ounce portion size of chicken or meat is about the size of a deck of cards. 13 High Protein Ideas Chicken or Turkey Pureed – Use baby food or make your own. Try mixing it into strained low-fat cream soup. Breast – baked or grilled Thin-sliced/shaved deli slices Ground – meatballs, meatloaf Canned – works great for chicken salad Strained out of canned soup – tends to be very moist Fish (avoid bones) Baked, broiled, poached, or grilled fish Shrimp Imitation or regular crab meat Fresh or canned salmon in water Canned tuna in water Sushi Beef or Veal (Extra Lean) Ground – meatballs, meatloaf Pork Shaved deli ham Eggs or Egg substitute Scrambled eggs or omelet Homemade eggnog made with skim milk, sugar-substitute Diet custard Egg salad Quiche or frittata Deviled eggs Low-fat Dairy Products Milk (skim or 1%) Yogurt (plain or no-sugar added) Low-fat cheeses including cottage cheese, string cheese, ricotta, or any other cheeses which are reduced-fat or non-fat. Legumes Peanut Butter – smooth Dried beans or lentils – or Soups, stews or chili made from these Hummus Vegetarian or fat-free refried beans Tofu 14 Protein Supplements ???? Because of the limited volume capacity of the stomach, it will be nearly impossible to meet your protein needs from food sources for up to a year after surgery. ???? You will need to consume a protein drinks to get a total of 80 g protein per day – This would be 2 protein drinks with 40 or more grams per serving, or 4 servings of a protein drink with 20 grams of protein per serving. ???? Once off of the liquid diet, it is best to consume your protein drinks between meals, rather than as a meal. How to choose a protein supplement: • Review the label to find a product that is high in protein, low in carbohydrate or sugar and low in fat. • Choose a product with at least 20 grams or more of protein per serving. • Whey protein is preferable, especially whey protein isolate. • Choose a product that is low-sugar or sugar-free and sweetened with sugarsubstitutes such as Nutrasweet (Aspartame) or Splenda (Sucralose) or Acesulfame K. The sugar content listed on the label should be no more than 6 grams per serving. • Avoid drinks such as Ensure, Boost, or Slim Fast. They tend to have a lot of carbohydrate and fat compared to pure Protein Powder mixed with skim milk or water. • Choose a product that is low fat: no more than 3 grams of fat per 100 calories. (For example, Atkins shakes tend to be too high in fat and are not recommended). Where to purchase protein drinks: • GNC • Super Supplements • Trader Joe’s • Fred Meyer • Wal-Mart • Rite-Aid • Walgreen’s • Grocery store pharmacies • On-line (www.Bariatriceating.com) 15 Commercial Protein Supplements Unjury (Flavored or Unflavored powder). 20 grams of protein per scoop. Mix with 6-8oz. skim milk, water, or yogurt Order at www.UNJURY.com or (800) 517-5111 or (703) 925-9390 Check the websites for recipes using Unflavored unjury protein powder. Optimum 100% Whey Protein 1 scoop powder = 24 grams protein Zero Carb Isopure 2 scoops powder = 50 grams protein Available at GNC Met-Rx Protein Plus Whey 2 scoops powder = 46 grams protein Designer Whey Protein Supplement 1 scoop powder = 17.5 grams protein Available at Rite-Aid, Super Supplements EAS 100% Whey Protein 2 scoops powder = 23 grams protein Zero Carb Isopure Ready to Drink 40 grams protein per 20 ounces serving Fruit flavors (clear liquid) EAS Myoplex Carb Sense Ready to Drink Liquid product 25 grams protein per serving MetRxUltra Pure Protein Shake (Ready to Drink) Liquid product 35 grams protein per 11 oz. Worldwide Pure Protein (Ready to Drink) Liquid product 35 g protein per 11 ounces (Available at Trader Joe’s, most large drugstore/pharmacies) Cytosport Protein Pure Performance Drink 40 g protein per 20 ounce bottle Tangerine and Watermelon flavors, clear liquid Available at NW Prescriptions 16 These products are available from Bariatriceating.com: (This website has a large selection of protein powders and ready to drink products. Check the website frequently for availability.) Micellar Milk Ready to Drink 40 g. protein in a 17 ounce serving New Whey Liquid Protein “Bullets” 3 ounce plastic container – 42 g protein, 2 g carbs Orange, Grape or Fruit Punch flavors AchievOne – Ready to drink (contains coffee) 20 g protein per 9 ounce serving Whey Gourmet 23 grams protein per scoop Comes in 12 flavors Nectar 23 grams protein per scoop Also available in single scoop packets Any Whey Tasteless Protein 17 grams protein per small scoop Add to soups, chili, eggs, etc. IsoFruit Delite Protein Cocktail Refreshing Cantaloupe or pineapple flavored 21 grams protein per scoop Matrix Protein 23 grams protein per scoop Elite 22 grams protein per scoop IDS 23 grams protein per scoop Protein Delite on the Go (plastic bottle with pre-filled powder) (contains dried fruit or chocolate bits) 25 grams protein in 8 ounces Additional ideas for adding protein to foods: 17 • Non-fat dry milk powder can be added to milk, hot cereal, cream soups, mashed potatoes, or casseroles – 1/3 cup powder = 8 g protein. • Egg white powder – can also be added to foods as listed above. Adds approximately 6 grams protein per 2 Tbsp. (check label protein content may vary by brand.) Sold at the grocery store (in the baking section). Hints to add variety to your protein drinks: • Flavor extracts or spices that do not contain sugar can be added to protein drinks for flavor. Examples: vanilla or almond extract, cinnamon or nutmeg. • Sugar-free cocoa powder can be added to provide a chocolate flavor. • Instant decaffeinated coffee can be added to drinks or yogurt for a flavor change. • Sugar-free Tang can be added to vanilla drinks to create an orange creamsicle flavor or try adding to an unflavored Protein Drink. • Sugar Free Kool-Aid or Crystal Light powder can be used to flavor protein drinks • Sugar-free syrups can be added to flavor protein drinks • If a drink tastes too thick or too sweet try adding more milk or water. • Mixing with milk provides additional protein and Calcium. • Try freezing your protein drinking after preparing. This can be consumed with a spoon as a frozen treat. Also can be made into “popsicles”. • Try adding ice to the prepared protein drink and blenderize to make a slushy. • Try mixing your protein powder with plain or sugar-free vanilla yogurt. • Try mixing protein powder into sugar-free Gelatin (before it is set). 18 Daily Vitamins and Minerals You are required to take the following vitamin and mineral supplements every day for the rest of your life. Taking a vitamin and mineral supplement is vital to maintain your nutritional health and prevent vitamin and mineral deficiencies. You are now at greater risk for decreased absorption of vitamins and minerals because you are eating a significantly smaller amount of food in a day. o All pills must be crushed, chewed or liquid for the first month after surgery or as directed by your physician. Multivitamin with Minerals (Start the first day that you get home from the hospital). First 6 weeks following surgery • 2 children’s complete chewable Multivitamins with minerals or 2 adult chewable multivitamin/mineral supplements to provide twice the adult RDA. • Take with meals, one in the morning and one in the evening. • Examples: One A Day Children’s Complete, Flintstones Complete. Centrum Children’s Complete, or Centrum Chewable for adults, Kirkland (Costco brand) chewable multivitamin Week 6 after surgery • Decrease to 1 multivitamin with minerals tablet daily for the rest of your life. • Take with a meal. • If the multi-vitamin/mineral supplement makes you nauseous, do not take it on an empty stomach—take it with food or at night. 19 Fluids • Do not drink liquids ½ - 1 hour before, during, or ½ - 1 hour after meals. Drinking liquids with meals or too close to mealtime may cause bloating, nausea, or vomiting. It is best to drink a lot of liquids between your meals • Fluid intake is very important for prevention of dehydration and constipation; adequate water is essential to help rid the body of waste, maintain proper muscle tone and prevent sagging skin. • Sip on water all day between meals. A water bottle with a sport top is a good way to get small sips of water and to avoid gulping. Sucking on ice will also help with fluid intake. • Your initial fluid goal should be a minimum of 4 cups (32 oz. or one quart) of caffeine-free, sugar-free fluid per day. At least half of this should be from water. You should be able to consume this amount within a few days after surgery. Gradually, you want to increase your fluid intake to at least 8 cups (64 oz.) a day. • Do not use a straw. This can cause your stomach to fill with air, causing distention, gas and bloating. • Try varying the temperature of liquids for variety and tolerance. • Most fluids should be non-caloric such as water, Crystal Light, sugar-free Kool- Aid, decaf coffee, unsweetened or artificially sweetened tea, or broth. Avoid all sugar-sweetened beverages. • Fruit juice should be 100% fruit juice with no sugar added. Limit to no more than 4 oz. per day and dilute with 4 ounces of water. • Limit caffeine to no more than 4 ounces per day. • Avoid carbonated beverages and sodas. Flat (diet) soda may be better tolerated. • Avoid alcoholic beverages. They do not have any nutritional value and may cause weight gain and/or liver damage. 20 Sugar and Fat Foods high in sugar and foods high in fat should be avoided due to the high caloric content. Consuming high calorie foods can slow weight loss and even cause weight gain. Be careful to avoid soft calories. Soft calories are foods or liquids that are high in calories and easily tolerated (soft or liquid). This includes items such as chocolate, ice cream and high calorie liquids such as milkshakes, regular soda or soft drinks, sweetened drinks, and alcoholic beverages. Avoid sugar (this also means honey, syrup, molasses and other caloric sweeteners), and foods high in sugar or with sugar added, such as candy and sweets; baked goods such as cookies, brownies, doughnuts, cake, pastries, pie, cobbler; frozen desserts such as ice cream, sherbet, sorbet, frozen yogurt, milkshakes; sweetened cereals; fruit canned in syrup; regular jams, jellies and preserves. Fats High fat foods should be avoided because they are very high in calories. • Avoid fried foods. Remove all visible fat and skin from meats and poultry. • Avoid fast foods. • Choose low fat or fat free products. • Avoid high fat dairy products such as whole milk, full fat cream, cheese or sauce. • Avoid high fat pastries, donuts and desserts. • Avoid high fat meats such as bacon, sausage and hot dogs. • Limit added fats such as butter, margarine, lard, regular mayonnaise or spreads, and regular salad dressing. Try the fat free or low fat alternatives. • Avoid “snack foods” such as potato chips, tortilla chips, cheese curls. You need to eat some “healthy fats” daily (for example, vegetable oils such as olive, canola or soybean; nuts or nut butter, or avocado). However, since they are so high in calories, they need to be limited to no more than 2 – 3 teaspoons total per day. 21 Possible Complications Nausea/Vomiting This is often caused by eating too much – taking too big of a bite, eating too fast, not chewing well enough or drinking liquids with solid foods. It can also be caused by lying down after meals, or eating foods that may not agree with you. Be sure to eat in a slow, calm manner. • Call your doctor if you are having frequent or persistent vomiting. Hair Loss Hair loss is a side effect of weight loss surgery. You may not see hair loss initially due to the time it takes hair to grow from the root. You will see hair loss or breakage as the hair grows through the scalp. Often it takes several months after surgery for hair loss to show; and several more months for you to see the hair start growing back. Hair loss can occur from a low protein and zinc intake, and a severe decrease in overall nutrition intake. You must take in a minimum of 70 grams of protein per day. Adequate protein intake may help reduce (but not prevent) hair loss. If protein intake is meeting the minimum recommended guidelines and hair loss continues to be bothersome, you can try supplementing with zinc (no more than 50 mg per day.) Ongoing hair loss can also be a sign of iron-deficiency anemia. Constipation Constipation after surgery is common, but can be prevented. It is usually due to a decreased intake of fiber-containing foods; also, Iron in the Multivitamin supplements can be constipating. Tips to prevent constipation • Drink plenty of fluid -- a minimum of 8 cups (64 ounces) per day. • Exercise regularly. • Try baby food prunes or unsweetened diluted prune juice or oatmeal. When you are allowed to resume regular foods, you can start eating high fiber foods such as high fiber cereals (3 or more grams of fiber per serving), fresh fruits, fresh vegetables and legumes. • Add high-fiber foods gradually • Chew all fiber-containing foods very well. • Drink plenty of fluids when increasing fiber in the diet. If constipation persists, try a daily fiber supplement. Inulin-based soluble fiber supplements such as Fiber Sure are less prone to cause bloating. * If constipation continues, call your doctor; do not take laxatives without consulting your doctor first. 22 Key Points to remember 1. You may never be able to eat the portions you consumed prior to surgery. 2. For a safe weight loss, you need to eat a healthy, well balanced diet. 3. Be sure to make healthy food choices to obtain the most nutrition per serving. 4. Choose low-calorie, nutrient-dense foods. 5. Be patient. At first, you will fill up after just a few bites. This is normal. Stop eating when you feel full. 6. Initial meal size should be approximately 1 – 2 oz. (2 - 4 Tbsp) per meal, 3 meals per day. Volume tolerance will increase after healing (usually about 2 to 4 ounces). Continue to eat slowly, chew foods thoroughly and drink in-between meals. 7. When you try a new food, take one bite to see if it is comfortable for you. 8. You must take the recommended multivitamin/mineral supplement every day for the rest of your life. 9. You should consume protein drinks or supplement with protein powder until your protein intake from foods is adequate. 10. Following the recommended diet rules will help you to lose weight and keep it off. 11. Your dedication to diet, exercise and lifestyle changes will dictate your success after surgery. 12. You can defeat the surgery, resulting in weight gain. 13. Grazing, drinking fluid with meals, or consuming high calorie foods or liquids are examples of ways that the surgery can be defeated. 14. Keep a food and exercise diary. Record the time of meals, food consumed, portion size and preparation method. (You may be asked to bring a food and exercise diary to your surgeon and/or dietitian visits.) 15. Attend Bariatric Support Group meetings on a regular basis before and after surgery. 16. Exercise regularly and follow your doctor’s orders or restrictions when exercising. Continue to follow the guidelines provided throughout this education packet. You have been provided the tools necessary to achieve and maintain a healthy weight loss. 23 Checklist : The following tasks should be completed before surgery: ___ Purchase supplements: ___Protein Supplements – try to have a variety of ones you like ___Multivitamin/mineral supplement ___Any needed equipment (see Equipment Checklist in Appendix) ___Any other foods and beverages you will need during the liquid and blenderized phases of the diet (Review diet sections) ___ Prepare some pureed foods to be used after surgery ___ Complete Meal, Supplement, and Exercise Schedule (see example in Appendix) ___ Keep working on these behaviors to make them become habits: • Practice eating meals without liquids • Practice taking small bites and chewing thoroughly • Pay attention to what you are doing while you are eating • Try to make your meals last at least 30 minutes • Sip fluids slowly – do not gulp! • Begin to wean yourself from caffeine • Find alternatives to coffee and sodas • Do not chew gum • Do not use straws • Find ways to incorporate 30 minutes of activity into your daily routine. Resources: The following websites are highly recommended: www.bariatriceating.com www.obesityhelp.com These books may be helpful: Exodus from Obesity – The Guide to Long-Term Success After Weight Loss Surgery by Paula F. Peck, RN Eating Well after Weight Loss Surgery by Patt Levine and Michele Bontempo-Saray Websites for calculating calorie and protein intake: www.fitday.com www.sparkpeople.com 24 Appendix: Equipment Check List The following is a list of helpful items to consider. For your Dining Pleasure: ___ Baby Spoon, Cocktail Fork (Helps you to take small bites) ___ Small Decorative Plates (Helps control portions and increases the eye appeal of the meal) ___ Insulated dish or warming plate (Helps keep food warm while you slowly enjoy your meal) ___ Sippy Cup (For those that have difficulty with gulping liquids) ___ Water bottles with a sports top (Re-use to carry other sugar free, non-carbonated beverages with you Other ideas – candles, new placemats, and fresh flowers to create a pleasurable eating experience at the table… For Meal Preparation These are vital pieces of equipment: ____ Mini food processor/food chopper ____ Hand Blender or the “Magic Bullet” (available at Walgreen’s) ____ Measuring spoons and cups ____ Small kitchen scale These are very helpful: ____ Extra ice Cube Trays ____ Small Freezer bags ____ Permanent Marker or freezer labels ____ Small plastic containers OR ____ The Food Saver (to vacuum pack foods) (A $100 investment, available at Wal-Mart) For Medications: ____ Pill Crusher ____ Pill Splitter ____ Large pill case (1 week’s worth) 25 Appendix: Pureed Diet Sample Meals: The following are ideas for pureed meals. Each meal consists of about ¼ cup. Use your own creativity to add variety to your diet. Spices and seasonings are not limited after surgery. Remember to make each of your 3 daily meals protein-based and include the essential fats (i.e., margarine, mayonnaise, oil) in your food preparation. Example 1: 2 Tbsp of a pureed cheese omelet made with Eggbeaters 1 Tbsp hot cereal 1 Tbsp sugar-free or plain yogurt Example 2: 2 Tbsp blended low fat cottage cheese 2 Tbsp pureed fruit (i.e., applesauce, peaches, pears or baby food fruit) Example 3: 1 Tbsp smooth peanut butter 2 saltine crackers 1 Tbsp pureed fruit (banana) Example 4: 2 Tbsp grated cheese 1 Tbsp polenta 1 Tbsp pureed roasted vegetables or marinara sauce Example 5: 2 Tbsp fat-free refried beans or hummus 2 baked tortilla chips 1 Tbsp grated cheese; garnish with pureed salsa and low-fat sour cream Example 6: 2 Tbsp mashed tuna or salmon salad made with 1 tsp light mayo 2 low-fat crackers 1 Tbsp pureed fruit or baby food fruit Example 7: 2 Tbsp mashed/smooth egg or chicken salad made with 1 tsp light mayo 2 low-fat crackers 1 TBS pureed fruit or diet pudding Example 8: 3 Tbsp ricotta cheese 1 Tbsp marinara sauce 1 Tbsp pureed roasted vegetables Example 9: 2 Tbsp pureed turkey or chicken with 1 tsp gravy or broth 1 Tbsp mashed potatoes or sweet potatoes 1 Tbsp pureed vegetable or fruit Example 10: 2 Tbsp pureed crab or lobster with 1 tsp light mayonnaise Sprinkle with Old Bay Seasoning 1 Tbsp pureed acorn squash 1 Tbsp pureed fruit Example 11: 2 Tbsp pureed chili 2 Low fat crackers 1 Tbsp diet pudding 26 Appendix: Meal Schedule Example Sample: Your Schedule: Time Meal/Supplement Or Vitamin Time Meal/Supplement or Vitamin 7:00 – 7:30 Meal 1 Multivitamin 8:15 Start Fluids 9:00 Walk 15 minutes 10:00 Protein Supplement 11:15 Stop Fluids 12:00 – 12:30 Meal 2 1:15 Start Fluids 3:00 Protein Supplement 4:15 Stop Fluids 5:00 – 5:30 Meal 3 Multivitamin 6:15 Start Fluids 7:00 Walk 15 minutes 8:00 Protein Supplement Daily Goals: Drink a minimum of 64 ounces of fluid. Sip fluids between meals Walk for 30 minutes Eat 3 meals and Protein Shakes to meet protein needs Supplements: Multivitamin – 2 chewables daily with meals (after 6 weeks, may use 1 tablet per day, cut small) Reminders: Meals should be 4 to 5 hours apart Do not drink 30 – 60 minutes before, during or 30 – 60 minutes after a meal No alcohol No carbonated beverages No caffeine No acidy or citrus juices/foods/beverages for first month 27 BEHAVIOR MODIFICATION TECHNIQUES 1. Don’t eat in front of the TV. 2. Don’t read while eating. 3. Pre-portion your food and put the box or package away. 4. Keep tempting foods out of the house. 5. Don’t go to the grocery store hungry. 6. Make a shopping list. 7. Use smaller plates and bowls. 8. Keep healthy foods available. 9. Focus on activities other than eating. 10. Brush your teeth after meals or if feeling the desire to eat. 11. Don’t eat standing up at parties or buffets. 12. Don’t stand at the food table at the parties. 13. Offer to bring a healthy food item to a party. 14. Park your car far away from your destination. 15. Get up to change the TV channel instead of using the remote control. 16. Take the stairs instead of the elevator. 17. Keep a food and exercise diary.

I haven't had anything done yet, but from experience of gaining weight...Yes, your ring size will get smaller. It may only be a 1/4 size or a full size. It depends upon how much fat is in your fingers (some people's fingers are boney, mine are pretty padded like baby fingers, lol). My feet a little wider but not longer. However, I have flat feet and always have had flat feet. Some people experience their arches falling with weight gain. With weight loss their feet kind of spring back and they might be shorter. (Your feet actually flatten out a bit while running which is why they reccommend buying shoes with some room in the toes, the same principle applies with weight gain--more pressure on the foot means they flatten out). The sleeve is basically enforced anorexia. You will only be getting a few hundred calories during the first part of your post-operative period when your stomach is healing. Whenever you drop below 50% of your BMR in calories, you body will respond by burning excess fat and muscle. In obese people, the primary loss is in fat and very little muscle. Most obese people already have quite a bit of muscle from hauling their large bodies around (let's face it, our 100lbs backpacks do make us strong). This is how are bodies are supposed to work--we store energy as fat when we get extra food and we burn it off when we aren't getting any. That is how the sleeve works. There is no malabsorption of fat like alli, where the fat is blocked from being digested and comes out in your poops or uncontrollable farts.ick.

With my weight gain I went from a 36DD to a 40H/38I (depending on the brand). One reason I did the WLS was because the plastic surgeon I saw for breast reduction told me that if I did the reduction now, I'd be higher risk of complications (losing nipple, etc) and longer hospital stay. He actually referred me to my WLS doctor. He said, 'Lose the weight, let them deflate, them come back in a year or so and it will be SO MUCH EASIER!" I can't wait!! If I can be a B cup I would be SO HAPPY... they just get in the way with stuff I like to do. I haven't been able to "walk around without a bra" in 20 years. When I sleep at guest's homes, I even where one just to sleep in because I didn't want to risk getting up in the night and running into someone in the halls. I know they'll be ugly, but I'm ready for these things to GO AWAY!

I have been "thinking" about WLS for about 1 year. Last year I did a pretty restrictive diet and inbetween ate normally. I lost close to 40lbs without a whole lot of effort (gained the holiday 10, but that is almost officially off too). I am 35 and don't want to wait until I am 45. I went into my surgical consult last month convinced to get the band. However, they seemed real keen on the VSG and saying without saying not so much on the band. So I have been reading both. I am fat, but I have no health problems related to weight. My blood pressure is good (105-117/65-80 on average). My cholesterol is good, triglycerides are good, my HDL is good. My blood sugar is excellent and no diabetes in the family. I am able to stick to a diet for awhile, but when I go off, I go off and then have big motivation problems getting back on. I do best on a high Protein, low carb diet so this sounds like a good match. My tendency is to be very black and white in my eating patterns. If I am not on a diet, then I am being "bad" and if I am at a restaraunt, then I order what I want to eat. I am trying again to reroute my mind into middle ground that yes I can have Cookies, but that doesn't mean because I had cookies, I need to eat chips to round out the badness. I can just have the cookies and still be good. So I am *working* hard on changing my thought patterns. I was normal sized up until my early 20s when I was first put on birth control pills. I had a slight weight gain then. But then they changed my pills and I ballooned up. Combine rapid weight gain with a "damn I'm gross, eff it I'm eating Burger King morning, noon, and night!" attitude after I gained about 60lbs in about 6 months or so, I continued to pack on the pounds year after year. From my lowest weight of 118, my old "set point" of 125, to at my highest recorded of 252. OMG. So basically, there are many elements of this surgery that I like. I like that after time you can still eat all of your favorite stuff, just a few bites instead of a full serving or two. I like that there is no foreign body to have to work around or ports to get infected or the nearly 100% chance the band will have to come out within the next 5-10 years. What I don't like is the lack of long term data. What happens to me in 10, 20, 30 years? Will long term nutritional deficiences cause me problems? Is this surgery going to shorten my life? Because it can. There is absolutely no guarantee being fat will since we have some chunkers in my family who have lived to ripe old ages (although I would need to lose and keep off about another 30-40lbs in order to be where they were). I also don't like that it is permanant and that if anything goes wrong with the staple line, or my stomach explodes, I am stuck in some sort of bypass situation which is something I DO NOT want. In fact that is my biggest fear. The other part of the permanent thing is the lack of control. I can't get my stomach back but a band can be removed. So I am still in the driver's seat. I am also a bit scared of the rapid weight loss. I'd prefer to lose a steady 5-10lbs/month than huge 30lbs drops that I am seeing on the boards. Crazy, I know! But I am weird :tongue2: The VBG was popular and people who were a few years out raved about it. But it is now considered a very dangerous surgery by the AMA according to the wiki. Liver and kidney failure were common with that one. Bypass patients seem to end up with heart attacks. I know it may sound dramatic but it is very real to me trying to make this decision. Many of the people posting on this board had serious weight related health issues and mobility issues, so the choice is much easier to make, at least in my mind. Hands down, if I had diabetes, could barely walk, and/or was on a million pills a day to keep me alive, I would do it ini a heartbeat. But was anyone healthy but fat and made this choice? What brought you to the decision?

I am 42 years old and been married for 8 years this feb.21, 2012. i have two 16 yr old girls and a 7 yr old girl. my wife had a D.S Switch in 2001 and has lost 200 pounds and has kept them off all these years with the ocasional 20-30 pounds of up and down. she kept telling me to have it but i did not want 2 and kept telling her i could do it myself. in 2003 we lost our daughter at 20 weeks and it was very hard on me to anything but sad and this went on for about 2 1/2 years. after losing the baby we decided to take the family on a vacation to yosemite and i decided this would be the time to make a change in my life so i started the atkins diet in august 1 week before our trip and did very well on it. after three weeks we came home i was sixteen pounds lighter but still had that cloud over my head but kept going and lost a total of 44lbs. by december 03. we also found out my wife was pregnant and was 5 weeks so they put her on complete bed rest for the rest of the duration so the diet came to a stop and the weight came back because i was more worried about her then the weight loss. after the birth of our daughter weight went up and down till she had her seventh birthday and one day said you know daddy your fat and well i smiled and thought i need a change so went for my physical and ask for a referal. i got a call in sept. 2011 and started my diet so when i started class i was 305.6 lbs. and i tell you after my first options class at downey kaiser i knew this was the right move. i came back every thursday and averaged 5-6 lbs a week, by week 8 i lost my 10% and after the final class was down 50 lbs. saw my bariatric surgeon DR. MUN on the 23 of jan. he was so impressed because by the day we talked i was 260.4 and was told that the ave. weight gain over the holidays was 3-5 lbs. so he set up my surgery for Feb. 1, 2011 and was weighed one last time and was 241 lbs.so he was really happy. was in my room by 6 p.m. and walking by 10 p.m. and felt so good. he let me know i was his new model as he should me the pictures of my sleeve and how good my liver looked. so if you ever go to the kaiser at harbor city and get DR. MUN for a surgeon he'll show you my surgery pictures. i am 9 days out lost a total of 70.5 pounds and just feel like my life just started over and well i love life again. ONE OF THE BEST CHOICES I MADE :biggrinjester:

Had my surgery on Jan 30 and it's been a success so far in that I never had vomiting or nausea, have been able to get in all fluids, Vitamins and Protein every day. I'm not losing as quickly as I'd hoped, but I'm putting some of that on being pre-menstrual (I hope). My worry right now is my brain. Ever since my surgery, I have nothing but horrific, mind-bending nightmares and even a few terrors where I wake up in a panic. A few mornings, I've woken up not sure where I was or what day it is. They are like nothing I've ever had before!! And believe me, I've had some nutty dreams in the past. They are the kind that stay with you all day and mess with my mind, I know I'm depressed. Usually going for walks and taking showers helps for a little bit, but I do not feel like my normal self at all. On top of that, I'm worried about my marriage. I'm wondering if anyone else had this problem? My husband is a fit, athletic, great guy with a kick-butt metabolism. He's never been over 165 his whole life. He can eat whatever he wants. A big part of my weight gain happened the year we moved in together. He's been nothing but sensitive, giving, loving and extrememly supportive about my surgery. Dotes on my every need and is my biggest cheerleader when I come home from walking or finish a shake. I love him like crazy. But since the surgery, we're not really talking much. Seems we used to do a lot of that over cooking great dinners, or going out to restaurants and talking about the amazing food. Now, we're in a slump of him making all his own dinners and I sit there next to him with my broth/protein. Plus, we can't be physically close because of how sore I am in so many places. It really feels like we're drifting apart. I miss him, I miss what we used to have and I'm worried we'll never get it back.

Ooh, Kelly, I'm with you in hoping you're not allergic to dairy! I'm a cheese girl, too, even more than ever now, since sleevie doesn't like most meats or eggs. Globe, I really think you should contact your doctor. Something's off, and it's not something you're doing, as far as I can read. Sounds like you're doing exactly what you should with your diet, and you exercise a LOT, in my opinion. Seems like you're burning more calories than you take in, so I'm really puzzled about the weight gain. So strange! But definitely check with your doc and keep us posted! So the last few days I've been kind of overdoing the carbs, even for me (I've never really restricted carbs because of the pickiness of my sleeve). I'm going to get back on a more "normal" diet for me--I'm thinking I'm going to up my salad veggies, lower my chips/crackers and cheese, and up my shrimp. I'm also going to try chicken again--maybe a bite or two with some salad, just to see. I tried turkey on Monday and it was rather emphatically rejected by my sleeve, but I really want to find a good animal Protein source that I can rely on besides shrimp. Need the Iron and protein!

Yes, extreme indeed. I couldn't keep my own saliva down. I think that was the worst. If it was just or even if it was just water maybe my night wouldn't have been soooo horrible. But OMG -- you can't stop your body from producting spit. LOL, I was getting creative to make it through the night. Trying to spit out any saliva before it escaped down my throat. Of course, saliva is not only produce in your mouth so my attempts for futile and the foam just kept coming. and coming ... Yes, I'm glad that I had an unfill. I'm not worried about weight gain ... That's the least of my worries. Just happy to be healthy, pain, and foam free. Honestly, after the horrible experience -- these 3 days of liquids only have been the equivalent of eating a steak dinner to me .. I'm happy as can be and hope I never have the experience of an overfill again ....

Congratulations! and welcome to The Losers Bench! It is a great feeling. Glad to hear that you aren't having a lot of pain. If the Iso Pure is bothering you, try a diffferent kind. I like Unjury in the chocolate flavor. It tastes just like chocolate milk to me (I mix it with milk!). Take care of yourself. Get lots of rest. And don't be discouraged by the weight gain. The fluid will be gone soon and you will start to notice the weight loss! Again. Congratulations! Kathy D

After momths and momths of research, attending support groups, 3 seminars, etc, I told my best friend I decided to have lapband. She knew I was doing all this research and yet her response to me was " so you're going to take the easy way out". I was stu ned by her reaction. She has seen my weight gain, we work out hard everyday together and we are constantly supporting each other.....until that remark. I was very sad and hurt and decided then that I would not discuss my surgery with her anymore. My reply to her ignorance was to say: actually, this is the hardest decision in my life (im 57!). I will subject myself to surgery, have 5 holes drilled in my stomach, change my eating habits forever, give up bread, smash my meds everyday because they wont go down easy, commit to some meds for the rest of my life, possibly have temporary hair loss, awful stuck episodes, etc, in hope of weight loss to relieve my joint pain, ward off diabetes and feel human again... After all of that she admitted that she is jealous that I will be losing weight and she didnt want me thinner than her. OK, that I can understand. Just dont tell me Im taking the easy way out when you dont know a thing about it!

Alana, I am 8 months post op, and down 100 pounds. Everyday I struggle with the thought that I might gain it back. I am scared to death that I might gain. And somehow, my old friend--- food--- always pops up to comfort me. I struggle not to eat junk food when I am worried about weight gain. Doesn't make sense does it? I am trying so hard to break the habit of turning to food when I am stressed. It is a life long habit, and SO hard to break!!! I was 258 pounds at my highest. I am now 158 or 159 depending on the day. But some days I actually go up to 160 or 161. Those are the days it is hardest to stay away from the foods that have always comforted me. I tell myself over and over that I shouldn't eat ___________ (you fill in the blanks, it might be Twinkies, HO-HOs, mashed potatoes, ice cream, etc. But for sure it is a comfort food.) But somedays I just can't stop myself. It makes me worry about my long term success. Every one says how well I have done, but they don't know I am scared spitless that I might wreck it and eat my way back up to 250+ pounds. The main reason I continue to frequent this forum is that it helps me keep my determination to stay where I am and continue to lose. I am so thankful for the wonderful people here who encourage me to keep on this path I started in June. Best of luck on yur journey!

I was started on a new med that says it may cause weight gain. I've been on it 3 weeks. Anyway, I'm eating 1300 calories a day. 70 grams of Protein, 14-16 grams of Fiber and less than 100 carbs a day and I'm jogging 30 minutes 3 times per week and I've gained 2 pounds. I know that doesn't sound like much to some of you but I need to get a handle on it before it's 5 pounds, 7 pounds, 10 pounds. Ideas on what to change up? I'm 150 and I'm trying to get to 135.

BACK WHEN I WAS YOUR AGE, WE DIDN'T HAVE APPS FOR OUR CELL PHONES!!!! LOL I'm in a funny (ha ha funny mood today) which made me think about technology has helped me as a bandster, and I have to thank my dirty little secret... fat secret that is Not only is it a FREE app for your phone, but it also is online as well, and it links your accounts. Where my office is, I have no cell reception. But, being the sometimes good bandster that I am, the food that I'm eating is already recorded on my app, but for example if I don't eat something, I can go on my computer, log into my account on fatsecret.com and update the food for that day, then when I do have cell phone service and check the app it's updated. Sooo freaking cool! I swear this is not an advertisement they are def not paying me to promote the app. Let's see I weighed myself this morning, gained 4 lbs, but down 2 lbs since Monday so I'm blaming Aunt Flo for the 4lb weight gain she is such a pain! Went to the gym last night for only a half hour, but I have to say that usually when it is my TOM I don't want to go to the gym at all. Today I'll go for 35 minutes, Thursday 40 minutes and Friday 45 minutes. Also just received my Keurig brewer for my office in the mail yesterday, I'll bring it in Friday (I take the train to work and the train is least crowded on Friday). I usually need that ONE cup of coffee around 3pm to get through the rest of the day. I already brought in my mug, a teaspoon, and non dairy creamer. Tomorrow I'll bring in some K-cups. As a bandster I thought it would be good, because after every fill, I'm on liquids for one full day, so I can bring in some cup of soups and use the Keurig to heat up the water for it! I realized last night that changing jobs has helped me be a good bandster. My old job required me to have such a sporadic schedule that sometimes I would only have a few minutes (literally 5) to eat lunch. The job I have now I'm so independent, that at 9am, I stop whatever I'm doing have my breakfast and at 2pm stop everything again and have my lunch. Sometimes a life change will change your health too. Now I'm not recommending everyone leave their jobs for something else. I did it for the independence, the stable hours (M-F 8-4:30) and the flexibility for time off. And I love every minute of it! Well enough blabbing for today. To people that read this, I'm going to start asking you questions for input....when you work out and start to do weight training, how do you find what's best for you? Do you hire a trainer? Go online? Or just wing it?

The band is designed to work best with solid food. Things such as meat, chicken , fish, vegetables etc. These do not break down too easily and pass through the band slower therefore increasing the amount of time until you get hungry again. If you have too much Fluid in your band it becomes very difficult and uncomfortable to eat foods such as these so generally a person will start eating foods that go down easier.Foods that are liquid, smooth, dissolve in the mouth etc. These are termed sliders as they go down easily.Think chocolate, biscuits(cookies), crackers, nuts, custard, icecream, mushy foods etc. As well as going down easily they are generally high calorie and they do not satisfy you for very long. What happens is a vicious circle. The person thinks they are not tight enough so they go for fill after fill after fill. They are able to eat less solid foods and they eat more sliders. The person still feels hungry between meals and they are gaining or not losing weight so they think they need another fill and so the problem gets worse. Too tight leads to weight gain, reflux, slips, erosions and all sorts of problems. A lot of the reason that people get too tight is because they are chasing a mythical "sweet spot" or "restriction" . They have read about it many times and think that just 1 more fill will put them in that magical place where they can eat next to nothing and never be hungry and never want chocolate. That place doesn't exist. Each fill makes a difference. Some great, some slight. It is important to recognise and work with each one. HTH and that I haven't confused you too much

Being too tight will often lead people to eat more high calorie slider foods which is what is responsible for weight gains. It is often the high calorie foods that slip past a tight band.. and if u are too restricted u are hungry and often desperate to get some form of food inside you ... Plenty of threads on the forum about people unable to eat protein but can eat pizza and burgers and all the other junk food

@Elcee.....how does being too tight lead to weight gain? Thank you.

Most of the issues you are having with the band you would probably have had with the sleeve as well. Try going onto the sleeve board and reading some of the threads there - life isn't always greener on the other side. Would you have felt ashamed if you had needed a kidney transplant because your kidneys weren't working properly? No, then don't feel ashamed that you neede WLS because your hunger control mechanism wasn't working properly. You might feel that you could have lost 60lb without the band but I bet that you couldn't have lost that and kept it off. If you could have done then you would have done. Stop being so down on yourself. Instead of looking at the glass as being half empty see that it is half full. And most importantly make sure that YOU ARE WORKING THE BAND and not expecting it to do all the work. You should not have a band that is so tight that it restricts your diet. Ideally a well adjusted band should mean that you are able to eat most foods but less of them and not get hungry soon afterwards. Being too tight leads to weight gain, slips and other issues.

Like it's been stated, this is your decision. Don't forget that there are also negatives about the sleeve: higher complications, longer recovery time, possibility of weight gain after the body learns how to reabsorb things. Have you thought about the Iband? It's a procedure where they take the stomach and suture it into the shape of the sleeve without removing the stomach portion, and then a band is placed at the top. From what I've read, this lowers the risk of slippage with the band due to the stomach shape and also requires less maintenance/fills because the plication of the stomach only allows for so much to be held. The negatives of the lapband are easily found too: hard to eat breads/rice/pastas, fibrous veggies, some leaner meats. You must go in for regular visits with the Dr. to get fills and check ups. You may get a leak, a flipped port, an erosion, or a slip. Recovery time is a lot less than the other WLS because you are not getting anything cut or rerouted. I just look at it like this: if any of the above complications occur with the band and prove it to be a tool I cannot use, I can always petition to insurance to have a revisional procedure. But, if it does work as planned, I have my whole anatomy and I lose weight. And, maybe in the future they will have developed an even better way to lose/maintain weight and I can upgrade then. Just really analyze the pros/cons of both.

Discrimination and hatred of fat, obese, overweight (whatever you want to call it) is extremely rampant. I really wish they would add it as a criteria to the Disabilities Act. I was FIRED from my last job for being overweight. No I'm not being dramatic -- I have physical WRITTEN proof that my boss' boss did not think I "fit in with the look and feel" of the rest of the team. Granted, it was with an athletic-centered company. I used to be very athletic pre-accident/injury and weight gain, so a majory of my resume speaks to working in that industry. But since most people have known me for 10-15+ years, they knew who I used to be, who I am on the inside, and generally never bothered them. It was the best job I'd had in years, I was so happy. Then they hired this jack*** who had a real problem with not just weight but women in general who were of "childbearing years." It was a bloodbath how many good people he got fired. However, this story has a happy ending: His *** was FIRED for being a disappointment just a few weeks ago. He barely lasted 8 months with the company!! Also, I've had to unfriend a number of people on FB because they will make frequent posts poking fun at overweight people. Do not need that in my life!! I honestly feel really sad for them and feel like it's their own fears or worries to not love themselves if they ever got above 20BMI. I had a boyfriend about 10 years ago when I was 140lbs and our relationship started online. I NEVER lied about my weight, showed recent pics, etc. but he always talked about how he was concerned about a woman "gaining weight after marriage and having kids." Red flad #1. When we finally met, his face showed his disappointment. Mind you, I was very athletic and very large chested. A majority of that weight was in my legs (cyclist) and in my bra. Yet, he seemed to think I needed to be about 110lbs. That's what his former girlfriend was. Granted that relationship sunk faster than the Titanic and I have THE WORLD'S BEST HUSBAND now! Just like there are racists, sexists, etc. - there are these people. Just pray for them and hope they'll find a way to cope with being perpetually disappointed. I wish your fiance could let him know people can SUE and WIN for that type of discrimination, so he should watch his back!

I think you're right, I don't know why I weighed myself, I think it was to teach myself a lesson that I can't slack off no matter what. I really am attributing the weight gain (most of it) to the TOM, darnit! Thank you for your support as well

Here is a study that did something similar, Banded sleeve gastrectomy--initial experience. Alexander JW, Martin Hawver LR, Goodman HR. Source Center for Surgical Weight Loss, Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. jwesley.alexander@uc.edu Abstract BACKGROUND: Isolated sleeve gastrectomy is being used with increasing frequency for the treatment of morbid obesity. This study was done to determine the potential benefit of placing a band of processed human dermis around the upper portion of a sleeve gastrectomy to prevent late dilatation and weight gain. METHODS: Twenty-seven patients underwent a sleeve gastrectomy followed by placement of a band of biological tissue (AlloDerm) placed 6 cm from the gastroesophageal junction. The results were compared to 54 patients with a Roux-en-Y gastric bypass (GBP), matched for sex, age, and initial body mass index. RESULTS: All 27 patients had improvement or resolution of their diabetes, hypertension, hyperlipidemia, and sleep apnea after banded sleeve gastrectomy (BSG) similar to the control GBP group. There were no deaths, but one patient had a pulmonary embolus and another had a presumed leak. Symptoms of gastroesophageal reflux disease generally improved. Overall, results were almost identical to patients with GBP. CONCLUSIONS: BSG provides results comparable to GBP in the short-term follow-up, but avoids potential long-term complications including internal hernias, postoperative bowel obstructions, anastomotic complications of the jejunojejunostomy, hypoglycemia, bacterial overgrowth, and a spectrum of malabsorptive problems. While this study documents the feasibility and possible benefits of this modification, prospective controlled studies with long-term follow-up are needed to establish its place in procedures for surgical weight loss.

YES ... i still have this problem 6 months out ... nothing taste the same anymore... I just look at it this way- Food is Fuel for my body and so I eat what I need to keep it running properly. Don't get me wrong I do treat myself every now and then to foods that really taste good- I like to think of this as Premuim Fuel and I don't do it all the time just because Premuim usually comes at a higher price JUST LIKE GAS ... The higher priced Premuim usually equal to weight gain or more time at the gym... either way- I HATE THE COST... #STICKING2REG(most day LOL!!! )

I have heard many people on this board getting so upset about weight gain and lack of weight loss. And don't get me wrong, I completely understand. I have gotten on the scale myself and had that sinking feeling in my stomach when I saw the number. I have wanted to scream and cry when I saw the number go up. Trust me, I understand. But there is something that I was missing, and that was Godly love. I accepted Jesus into my heart when I was four years old. I don't remember if I even understood what that meant at the time, but it was what the grown-ups wanted from me, so I did it. I went to church with my mom until my pre-teen years. But then things started to fall apart in our family and we all lost our way. I don't want to get into it all right now, but there were many things that happened that were emotionally painful, and I felt like God had turned his back on me. I felt lost and abandoned. So I gave into the world's way of living, doing basically whatever I wanted, whenever I wanted. I still felt like I was a good person, and I believed in God, but felt like he didn't want much to do with me. After years of living this way, I noticed that He was showing up in my life more and more. Little things that would happen, little comments that people would make. I felt the need to go back to Him, but I didn't. I thought that after all of the bad things I had done, all the commandments I had broken, that there would never be a church that would accept me. After all, you can't be a Christian without going to church, right? But God kept insisting, kept calling me. Eventually I went out and bought myself a Bible and started to read. It took me a while, but it finally dawned on me that I didn't have to go to church to be a Christian again. I didn't need other people to accept me to be a Christian. I didn't have to be perfect. I didn't have to have a perfect past. Jesus did most of His work among the people who the church considered "undesirable," like prostitutes and tax collectors. If Jesus could accept them and love them, maybe He could love me too. Several months later, I was watching a television show on Daystar network, a Christian station. The woman who was speaking was talking about God's love. She said something that changed the way I looked at myself forever. "God loves you just the way you are," she said (paraphrasing.) "You don't have to lose ten pounds, you don't have to do anything different for him to love you." The woman was Joyce Meyer, and I have watched her regularly ever since. But that message really opened my eyes. It's really true. God loves you exactly the way you are right at this very moment. He loves you just as much as he loves anyone else. You are His child, and he made you knowing that you would be just who you are right now. He knew you would do everything you have ever done, good and bad, and he loved you just the same. When you feel the most unloveable, He still loves you just as much as He ever did. Even if you don't believe in Him, He still loves you! How wonderful! If you take anything at all from this blog, I want you to know that you are loved. You are loved more than you know, more than you could ever believe possible. And this love is not dependent on how much weight you lose, what kind of clothes you wear, or even how you act. You are loved simply because you exist, and you are important simply because you were born. God does not do things by mistake, and He would not waste time creating something that He was not proud of. It is important to take care of your body and make sure that you stay healthy, because our bodies are our home until we are done with our journey on the earth, but your weight is not everything. It is part of you, but not the thing that defines you. Even if you never reach your goal weight, God sees you for the beautiful creation that you are. And I hope that you do too.

I am feeling really good. I had a lot of second thoughts at first. I canceled my first appt. and everything. I am just so sick of being fat and tired. I have a gorgeous husband and two handsome sons and I just feel out of place. My husband is supportive but, says he loves me no matter what. I know that is sweet but, I need to do this for me. I have a really bad back and I take some serious pain meds which probably helped with the weight gain. I work full time and honestly I don't know how I do it sometimes. I am 207.5lbs but, on a 5'0 frame. I feel so terrible. I fell like a 4x4 (hahahaha). I want me back and I am willing to do this to get me back. I know it is scary and I am not telling many about this. If they notice I am losing weight, I am going to say thanks and go about my merry way. My work people do not need to know, I don't need any judgements. Most we tell are like you are not big enough or you will just gain it all back, or my favorite, I heard someone died of complications of that surgery.....I will just keep it to myself for now. Did I hear you say you were going to Mexico? Tell me about that and I would also like to hear more about you......nice to have a pal on here. Thanks for posting.......Heather