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The biggest lifestyle change for me is exercise and alcohol. If you drink a lot you may have difficulty losing. Likewise with exercise. The more you exercise the greater the results. The food issues too. Some foods go down really easy. It will be very important for you to eat good healthy solid proteins and less junk. If you are ready to do those 3 things then you can be banded. Good luck on your journey.

Hi girlies! You look like you had a blast Cindy!!! I am glad you got to spend special time in a special place with special people. We never seem to get enough of those times! Dianne-what a perfect job for you! You always have such an upbeat attitude towards your banding, and you have done such a great job working yours! Congratulations!!!! My SIL that was banded the same time I was told me today that her oldest and youngest DD's are going to be banded in August, and will be going together. How lucky for them to be getting the help at the youger ages. One is 33 the other 29 or so.... I never really had a problem with my weight until in my 30's----I would have loved to have the 15 years back, to live at a normal weight, without the years of obesity. Lots of you are younger, and I think it was a great move getting it done then, not waiting! Anyway.....I have no doubt you will prove to be excellent at your new job an a real asset to the medical group! WTG!!! Mandy---you too would do good at something like that---but girl you know those kiddos need you!!! I am exhausted! I cleaned the garage today!!! I also got the flowers done. My SIL come and helped me, with the flowers thank goodness. Rick built my picture things tonight, so I will finish them tomorrow. I have these vinyl cling like things of the Surf Guy, with the ripped muscles, and the Hula Girl, with all the perfect curves. They are like 5- 5 1/2 feet tall. So we are mounting them on sheets of board, and we cut out the faces, and made holes in the board. So you stand behind them, and put your face through. They are going to turn out pretty cute I think---I'll try to post a "new" after pic!!!! He also used our old desk and built a Tiki Bar. I am going to have several of the sun tea jars with tea, some flavored tea, and lemonade in them, as well as one of the big pails with iced soda's. My inlaws are VERY anti alcohol, so there will be none! I have a full day of shopping, and lawn work tomorrow, and then the next will be split between cooking and cleaning. Then it will be over soon!!!! I have horrible "farmers" tan on my arms after this last weekend on the bike, and my dress is sleeveless....not gonna be pretty! I never buy sleeveless, because I have some pretty scary scars on my arm....but went for it anyway, and now the tan only highlights them! Oh well, they won't be looking at me anyway---and hopefully if they do, they will notice the weight loss, and not the arms!! Cindy---ask Sherry for some help with the avatar, she helped me. I need to make a new picture.....but even though I know that one was taken over 40 pounds ago, I don't feel like I have changed much. Betty---been getting in any riding? I know everytime I see the weather it shows y'all getting more storms. I bet it is so green there!!! Gotta show us your yard! I keep trying not to stress over our weather for these parties---but it is hard not to! So what's everyone got on the agenda for the 4th of July? I can tell you what I am NOT doing!!!! There will be NO parties here at our place for the 4th!!!! Be willing to bet they expect there to be though!! Well, I am off to cruise the site a bit, and then head off to bed. We had dinner late, so letting it settle before laying down, or I reflux----ewwwwww! Talk to y'all soon!!! Kat

They say that the alcohol is empty calories, it can stall weight loss and promote weight gain. I am not a drinker anyway, so I will not miss that one bit, lol.

Yesterday was my 6th month anniversary of being banded (was banded November 30th). My starting weight was 257. My weight was 247 the day of surgery. I currently have 4.5 cc in a 14 cc band. My current weight is around 217! I AM 40 POUNDS THINNER THAN I WAS AROUND THANKSGIVING. In fact, I've lost about two turkeys myself or 8 pounds of sugar or however you wanna look at it. TO ME, THAT'S GREAT! Sure it's not the big numbers some people are pulling, but it's amazing for me. To show you how amazing I'm including an old journal entry.......... THE OLD ME TALKING: ".... During the weekend it was really difficult to count calories when it feels like every calorie is a big mistake. So the good thing was that I started counting again, the bad thing is that I ate over 2,500 calories today, and I know that's not conducisve to weight lost..... After my appointment I was sooooo drained, I didn't go to the gym. I just couldn't get in the right mindset. I have to be in the right mind set and do things in a certain way when it comes to working out. Then I felt bad because I shoulda, coulda, woulda went. This is the type of thing I was talkin about. I feel like if I was a better, different, person I would have pulled things together and went. "..... THE NEW ME TALKING: I used to be a size 22. NOW I AM A SIZE 16. I used to hate going to the gym. NOW (althought I dont love it, love it) I ENJOY THE GYM AND RARELY SKIP EXERCISING. I used to have trouble doing 15 mintues on the elliptical. NOW I CAN DO 60 MINUTES ON THE ELLIPTICAL, BUT WHAT I REALLY LOVE IS SPIN CLASSES!!! I used to be out of breath, and have back and knee pain from walking. NOW I CAN WALK FOR AN HOUR PLUS OUTSIDE! I used to be so fat that people thought i was pregnant. :ph34r: NOW PEOPLE TELL ME I LOOK NICE, CAUSE I DO! Although every day is not perfect with the band. Things are so much better than they were! I still struggle with my food addiction everyday. The band does not cure the addiction just like locking the liquor cabinet doesn't cure alcoholism. Food addiction is a real thing and mine isn't going anywhere. I still have to fight myself to make the right choices. AND I DO MAKE MISTAKES, OFTEN, TOO OFTEN. But I've learn to pick myself up and start again the next day! And I you can see I used to eat upwards of 3,000 calories a day. Now I eat about half that (it should be less) but i'm wortking on it! The band isn't for everyone, but it's working for me. GOOD LUCK TO EVERYONE OUT THERE! :wub:

Average rate of loss is 10% of your total body weight at the six month mark. Most of you are on target. I have had moments of struggling too since being banded. It was in my case completely due to my own poor choices. Are you drinking alcohol? Tracking what you eat? Cutting out refined foods? Exercising? If you can't honestly answer the above questions as they ought to be answered, then you have some work to do still. There ARE, however, people for whom the band is not effective. Everyone who feels discouraged by lack of loss needs to be talking to their surgeon.

@@2goldengirl lol! I'm boring! My kids suck the life right out of me! I'm only 35 but each kid aged me 10 years + 10 more for the husband so I'm really 75! Yep that sounds about right. No more waking up smelling like alcohol and bad decisions lol!!!

I had the sleeve over two years ago, and even before surgery I didn't get a lot of hunger pains. But what surgery doesn't fix for me is the head hunger. I get cravings for Snacks -- especially salty snacks like popcorn, chips and nuts. I still get these after the sleeve even though I am not hungry. Sometimes I go to bed early just to avoid eating late at night. I think this would be true regardless of the surgery type. I haven't had any complications since being sleeved. I have not vomited at all. I can feel very uncomfortable if I eat too much too fast, but I've adjusted how I eat to accommodate this. I tend to stop eating after a few bites and give my body a chance to send me signals about fullness before continuing. Before my sleeve, I loved my carbs especially breads and potatoes. Since being sleeved, these are the foods I am least likely to eat because I don't like the way they fill me up. I can eat more of these than I could during my first year after surgery, but they tend to be crunchier versions, and I don't eat as much (especially potatoes). That said, I can still eat them. I just don't like the way they make me feel bloated, so I don't eat them. I love that I am satisfied with less. It sometimes takes me longer to eat if it is really protein-rich food. Alcohol hits me harder and faster on way less. I do drink when eating. I take NSAIDS fairly frequently. I should drink more Water on a regular basis. Lately, I have been neglecting to take my Vitamins, and I should at least be taking Iron because I tended to have iron-poor blood before surgery. When my blood work has been done, my results have all been very good although my B Vitamin levels were higher than normal, so I stopped taking Biotin. When I am taking my vitamins normally, I take one Multivitamin and 1 iron Vitamin A day. When I was taking Biotin, I also took one of those a day. I do not take Calcium supplements since I tend to have a lot of calcium in my diet. I love cheese. My stomach was very noisy right after surgery. For a while, it quieted down. In the last month or so, my stomach has gotten noisy again. I'm not sure why, but it may be because I've cut back down on my calories again. Growl, roll, growl. It can get pretty loud. This is something that didn't happen before my WLS. When I eat in public, someone who doesn't know that I had WLS won't comment about my eating habits. Those who know, especially if they haven't been with me when eating before, will comment about how little I eat. I would agree with someone earlier and say that what I eat is on the low side of normal portions.

I can appreciate your irritation, although...a $7 burger isn't really a fancy place to eat. If your total bill for a burger, presumably two non-alcoholic drinks, and a $3 split fee was $17, I feel like they're holding themselves a bit high as a "nice" establishment. Given the way you were treated, I tend to think their behavior supports the point that they aren't the fine dining they seem to consider themselves to be. That being said, I haven't ever been charged a split fee because I don't really split things. I eat what I want to, then take it home or let someone else at my table eat it. Margins on actual fine dining are slim, and you aren't being charged a $3 fee to actually cut the burger, just like a corkage fee has nothing to do with the manual act of removing a cork, but rather the right to split a meal or to bring your own bottle of wine, when to do so without any minor fee is really not customary practice. It certainly would have been nice though if they had put somewhere on the menu that the fee existed. At a nice place, I can see economically the purpose of a split fee and most people paying to eat at a nice place, first don't care about the $3 and probably don't notice it on their bill, and second at an actual nice place, there would not have been any attitude from a manager, the fee would have been removed. The difference in my experience between a classy place to eat and a place that likes to think its classy is that there is an understanding that you sometimes lose a few dollars, but you make up for it in customer loyalty. A truly nice establishment handles the customer in a way that leaves them feeling happy...sure they complain about you when you leave and they roll their eyes when you aren't looking, but they are never, ever rude to your face or in front of any other customer. They certainly don't have their family members replying to your Yelp comments- that would make them look incredibly stupid and any person who was accustomed to eating in nice places would absolutely avoid going somewhere that responded that way on social media if only because it clearly demonstrates a total lack of class. So...sure, a split fee is normal sometimes, and I understand that you were surprised by it, but I find the behavior of the business to be unacceptable if they are going to cast themselves as being a better than average place to dine. I wouldn't go there after seeing that exchange on social media because it reeks of a scene- something that you will rarely if ever see in a nice place, and certainly not in a way that is exacerbated by management. I'm sorry you were treated poorly, but if it makes you feel better, places like that rarely last very long for all of the reasons I've mentioned above. They will be sad soon enough, lol.

Walter. You've been so honest with us. Thank you for sharing your struggle and triumph. YOU have great power inside you to figure this stuff out and not be a victim to your addictive nature/genetics or whatever it is that predisposed you towards these substances! Please, please, please work on getting to the point where you are just sick of continuing sliding down the slippery slope and regaining all your hard lost weight? PLEASE? I know this is the last area that you get to control. And there must be some part of you that is wanting the high that comes from medicating with food (dopamine/seratonin rush). Why not talk to your surgeon or PCP about prescribing I think it's something like Contrave? Or naltrexone? They give it for food addictions but also to help curb alcohol and drug cravings. Then start working your OA program, just as you work your AA program. Don't let having 3 kids give you the excuse to cave to the craving. You don't want to be obese. I think you don't. Right? It's hard, but you can do it. Someone mentioned a book that is really helpful and free on Amazon for Kindle called Never Binge Again. A dude wrote it and you might relate to it. It really is a helpful book. I have used it for years to help with my BE behaviors. You got this bro. Just take that 2nd step now that you've taken the 1st step!!!

Five weeks ago, banded and hopeful. Today, I'm down 23 lbs and so happy about that! Not a super fast loss, but I'll take slow and stead and PERMANENT any day over fast and yo-yo! I'm finding that summer time is the most challenging time for me - although there are many fresh fruits, veggies and healthy options out there at this time of year, for me and my husband, there are many social engagements including barbecues, outdoor concerts, farmer's markets, weddings, and other really wonderful events. The events for me are not a challenge, and I'm finding that the food at the events is not the problem, but I am one to enjoy a glass or two of wine or a cocktail with friends at these events. While I'm still losing, I'm thinking that I'd do myself a bigger favor if I stuck to non-alcoholic beverages and watch the weight come down faster. But like I said above, it's not all about losing it fast - I am learning a new way of living right now, and if that life involves an occasional cocktail or glass of wine, so be it. This week has been full of festivities related to a dear friend getting married tonight. I haven't exercised as much because work has been insane busy and we've had engagements every night this week. But isn't that what life is all about? Some weeks are busier than others, it's all about having balance and taking care of myself. I feel like I've been doing a pretty good job in that area. Will I have a glass of wine tonight at the reception? YEP! My daughter turned 18 on Thursday and headed out to Denver (about 4 hours away) for the weekend. As life would have it, she ended up in a fender bender, wanting to come home, not sure about her future move to Denver for school, and so upset (poor baby!) My old mode would have been to hit the pantry since I couldn't be right there to help her. But this time, (luckily her dad is over there), I was able to deal with the problem, feel the emotions I was having, and not stuff them down with a bag of chips. I just talked them out, and I felt better than the food would have made me feel. Again, life happens. So the ups and downs can still happen without dousing them in food - I am learning a whole new way of being, a new way of dealing, and I feel good that so far I've been able to take on stress (good and bad stress) in a healthy way. Hope all of you out there are doing well, remember it really is a JOURNEY and our bands are helping us physically manage hunger while we learn to deal with the other habits and head issues that have made us obese. It is so much easier to understand old patterns, look at them for what they were and change them when I'm not constantly starving. I LOVE MY BAND!!! My best - D

Hi All I am needing a little help here I am not losing weight only inches. I am two months post op and I have lost over 10" total and 14-15lbs. I am making sure I stick between 1200-1500 calories granted some weekend I have had some alcoholic beverages. I am exercising at least 4days/wk cardio for one hour and some weight training. This week I have started a food journal but I need some encouragement? how did you get past plateaus?. Also I have 4cc in my band got a second fill last week Thank you

As someone who's been at goal for over a year, I can say it continues to be easy and I'm loving life now. Even if I splurge and eat sweets, sodas, alcohol, etc. I don't gain weight since I keep the portions small. And also as a former lap-band patient, the sleeve is a MILLION times easier than that ever was! Love it!!

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.

Hi Camilla! Doing great so far, it definitely gets easier. I am on day eight and it feels pretty normal now. Going to a party later, that will be hard cuz there's going to be candy and alcohol everywhere. Wish me luck! Oh and I'm down 7 pounds.

I can't find an answer on how long to wait after a Gastric Sleeve to have a drink. I've seen answers from one month to six months to never. I will speak to my nutritionist tomorrow, but I was looking for a quicker answer because of a work event this evening.

You're right... actually i was hoping i could get him to do something too, he's overweight as well. His dad had a quadruple bypass in his 30s i believe, my mothers 1st heart attack was at 34, both my maternal and paternal grandmothers died at 57 due to heart conditions, diabetes and prescription drug abuse, and one of them was an alcoholic as well. Sent from my LG-E980 using the BariatricPal App

Hi Tlmiller2971. The death of somebody close is bound to bring up a variety of emotions. You recognised that drinking so early after your surgery was not wise, so just forget what happened and think forward. Don't be too hard on yourself. Give yourself time to grieve for your friend. My only advice is for you to try and separate the feelings of loss due to your friend's death and the feelings linked with the lack of food and alcoholic drinks that would have been your crutch pre-surgery. You will have to find a way to cope differently from now on. Sorry for not being more helpful. I send you a big hug.

My surgeon said no alcohol for 6 months. There's a 4th of July party, I really want a glass of wine, I'm 3 months out then, I'm toying with it but I'll probably behave. I was warned by other veteran WLS people that IF you decide to drink in public, try one at home first, you never know how it will effect you.

no info given on pre-op or post-op. but there is a paper given at the seminar the DON'TS are smoking, NSAIDs, carbonation, fluids with meals, fresh coconut, snacking and caffeine. AVOID FOR THE FIRST YEAR arepregnancy, alcohol, read meat, orange and apple juice, corn, raisins and gum. and the DOs are positive mindset, take responsibility, exercise, water/water, quality Protein, multi-Vitamins with minerals, Iron, b12, Calcium with magnesium & zinc, support group and follow up. the seminar lasted 1 1/2 hours. it began at 550pm. open questions started about 645, but you don't have to stay for that; your choice. the doctor did have a open floor to those who wanted to stay longer and speak with him. i thought that was awesome. i drink Pure Protein already made in a can. i tried buying from their website, but you can only buy at health food stores. i buy minds at trader joe's. with that said, the surgeon will most likely give you your diet info. remember everyone is different. ohhhhh, the doctor mentioned also that they try not to use banding too much and they prefer to use gastric bypass, but the decision is yours. the majority of the class raised their hand for the sleeve. also if there are teachers out there, get that paper work in because you are definitely first in line.

Three months ago I sat in a small sandwich shop and ate a huge turkey sub. Turkey, cheese, and a mountain of veggies covered with mayonnaise, that was delicious. It is also just a memory. I can no longer handle meat. My first experience was 45 days post op. My wife and I went to a steak house. I ordered a small steak and planned to take a few small bites to Celebrate liberation from the rigorous post-op diet my surgeon put me on. The steak was so juicy and tender. I chewed slowly in appreciation of solid food and swallowed the small fillet of heaven. I threw up the moment the steak hit my stomach. Not the best start to my new lifestyle. I was in plenty of pain for the next half hour. The next day I reported back to my surgeon for my first fill. He told me that some people just can't handle some things and to say goodbye to my old friend. A few weeks ago, I sat down with a small hump of cottage cheese and spinach with blu cheese. I sprinkled my salad lightly with tiny shreds of bacon. Again, the moment the bacon hit my belly I was in trouble. What a stomachache! I can eat all sorts of things: sticky rice, white bread, and any vegetable, but any type of meat just gives me trouble. The long and short of this story is that I am now a vegetarian. A couple days ago, my wife had some friends over - a gakle of 20 something grad students. As they giggled and gossiped in the living room, I rummaged about the fridge in search of cheese or some other lap band friendly meal. Sadly the fridge contained only party foods: soda, alcohol, juice (did I say food?), and fried chicken. I poked my head around the corner and asked my wife if we had anything other than meat. This caused a little commotion among the ladies in the living room. "What, he doesn't like chicken?" I heard one of them chide. My wife explained that I am a vegetarian. This pronouncement was met with a moment of angst as the room fell silent and all eyes turned to me, a 5' 10'' 25 year-old weighing almost 300 lbs even. I broke the silence with my own awkward chuckle. I guess you had to be there. -Chunk

The main purpose of losing weight before surgery is to shrink the liver. When you are overweight, the liver is overweight and we lift the liver to put the band in. If the liver is large it makes the surgery more difficult, harder to see high up on the stomach where we're working. The first weight you lose comes right out of the liver. It is easier for the body to mobilize liver fat than the kind that makes our clothes tight. You wouldn't believe the difference it makes in the ease of surgery when patients lose even 10 pounds before surgery. The biggest livers are in men, diabetics and BMI>50. I tell patients to lose 10 pounds for each of these. So for example, a female, non-diabetic, BMI<50 is an easier case as far as the liver is concerned. There have been instances of surgeons not being able to put the band in due to the size of the liver. Leaving a "fatty liver" for many years can actually cause cirrhosis - the same liver disease that alcoholics get. Fatty liver can cause elevations in liver enzymes on blood tests. Losing weight is amazingly great for your health for many reasons. It also is great for your liver.

The beef broth and protein shakes are for the pre-op diet and the 1st week post op. Some people continue to drink the protein shakes to get in the recommended daily protein. I rarely drink the shakes after the 2nd week post-op. I moved onto creamy soups and and a lot of chicken run through my food processor until very very finely chopped. I believe anyone that has 85% of their stomach removed will lose weight. You can't help but lose, if you are limited to 4oz of food every few hours. Now the big question is, where is your hunger coming from? Only you can figure that part out. Is it from emotional eating, boredome, stress, or is it because you have hunger pangs caused by the hormone ghrelin? From my own experience, I knew that my hunger was real (even though I had eaten 2 hours earlier, I'd be hungry again). It wasn't until I talked to my surgeon that he told me that I had an excess of the hormone ghrelin (produced by the stomach). The bigger the stomach, the more of the hormone produced. The surgery stopped my hunger pangs. I have not had that nagging sense of hunger (other than my stomach growling) since surgery 7 weeks ago. And 4 or 5 oz of food keeps me satisfied, whereas before, I could eat 1 lb of steak and know I'd be raiding the fridge in 2 hours. And I don't have any cravings anymore for certain flavors. Whereas before, I'd think about something that would taste good and I couldn't get the thought out of my head until I ate it. Don't get me wrong, you can sabotage yourself after surgery. There are foods, called slider foods, that are calorie dense (ice cream, peanut butter) that pass through the stomach quickly, so it's possible to eat more. And it is possible to just graze all day on snacks that are high in calories. The sleeve gave me the control over my eating that I needed. I really think of it as an addiction that you can't quit and never touch again. Other addictions can be quit and never touched again. But what if a heroine addict, smoker or alcoholic knew they had to take some every day or their body would die? What if they had 75 TV channels that ran commericals for cigarrets every 10 minutes during their favorite programs? Or had reality programs (like the best places to pig out or the food challenges) devoted to the best places to get their fix and showed people taking drugs and loving it? Could they just reduce the amount they took? Ok, rant over. :-)

With smoking, have you considered the prescription "Chantix"? I know it's a bit expensive, but I've met several patients (I am in dentistry) that have had great success. Talk to your MD about making sure that you are a good candidate for it. As far as the psychiatrist goes, from what I understand there are several kinds of tests given out there. I took a multiple choice 8-10 page test. Many of the questions seemed bogus to me. I think that they want to make sure that you aren't a complete psycho and have your priorities straight! I also had about a 20-30 minute interview with the psychiatrist. The only thing he said he was alarmed about me was that I was able to give up my huge Diet Coke addiction fairly easy and after two months did not miss it and was not tempted to indulge. He said he was concerned and likened me to an alcoholic that recently gave up alcohol and claimed to have no trouble staying sober. He said it was a red flag. Whatever! Good luck and keep in touch. ssdown

I've pretty much been drinking nonstop. (Sadly no alcohol.) My surgery is the 7th. I get into the office and have all my beverages lined up -- tea, crystal light, protein shake. If I'm in the bathroom every 5 minutes, I can't kill anyone. LOL Hang in there, Stitches! Sent from my SM-G970U using BariatricPal mobile app

Current Weight-Specific Legislation No federal laws exist to prohibit discrimination against obese individuals, and only Michigan’s civil rights legislation prohibits employment discrimination on the basis of weight at the state level (34) . The District of Columbia forbids discrimination on the basis of appearance including weight, and Santa Cruz, California includes weight in its definition of unlawful discrimination (129) . In the spring of 2000, San Francisco passed legislation to ban weight discrimination, adding weight and height to existing characteristics (such as gender, ethnicity, age, and sexual orientation) that are protected (130) . Advocates in San Francisco gained support for this legislation when a health club created a billboard with a space alien saying, "When they come, they’ll eat the fat ones first." Overall, few locations have weight-specific legislation, so most obese persons are forced to use existing human rights statutes for legal protection. In particular, overweight individuals have depended on the Rehabilitation Act (RA) of 1973 and the American Disabilities Act (ADA) of 1990 (131) . Employment discrimination cases encompass the vast majority of such actions. The RA was the first effort to prohibit federal employee discrimination against individuals with disabilities (32) . A person with a disability is one who has a physical or mental impairment that substantially limits at least one major life activity (activities such as walking, breathing, self-care, and working), has a record of such an impairment, or is perceived as having an impairment (34) (129) . The RA does not actually include obesity as a specific protected impairment (32) . The ADA expanded federal disability discrimination legislation by extending mandates to private employers, state and local employment agencies, and labor unions (23) (131) . Like the RA, the ADA protects disabled but qualified employees who can perform essential aspects of employment (131) . The Equal Employment Opportunity Commission (EEOC) implemented regulations for more flexible interpretation of ADA impairments, allowing obesity to be included in its broader definitions (129) (132) . The guidelines of the EEOC do not consider obesity alone to be an impairment. However, obesity can meet impairment definitions if one’s weight can be attributed to or results in a physiological disorder, or if a person’s weight is severe as in cases of morbid obesity (132) . Under the ADA two kinds of cases can be pursued: those involving actual disabilities, and those of perceived disabilities. An actual disability claim requires that an individual’s obesity be substantially limiting in at least one major life activity. A perceived disability occurs when one is regarded by others as having an impairment (131) . Here, the obese individual must demonstrate either an actual impairment that does not limit life activities but is perceived to be limiting by others or that there is no impairment at all but that the individual is perceived as having one. As many courts do not recognize obesity as an actual impairment, obese individuals must often use perceived impairment claims (131) . Inconsistent Rulings Although alleged discrimination is being met with lawsuits, the overall picture of cases pursued under these statutes is one of mixed results. The majority of courts have ruled that obesity, per se, is not a disability (32) . In Krein v. Marian Manor Nursing Home, for instance, an obese nurse’s aid was discharged because of her weight. The court held that her obesity was not a disability and, thus, was inadequate to qualify the plaintiff for discrimination protection (131) (133) . Similar court rulings were held for a flight attendant in Tudyman v. Southwest Airlines and for a labor worker in Civil Service Commission v. Pennsylvania Human Relations Commission, where both plaintiffs failed to show that their obesity caused, or was caused by, a condition that would qualify them for state protection (31) (37) . Later cases continue to follow this trend. In Cassista v. Community Foods Inc., an obese woman was denied a cashier/stocking position because of her weight (131) (134) . In the case of Philadelphia Electric Co. v. Pennsylvania Human Relations Commissions, an obese woman was refused employment in a customer service position due to her obesity, despite having passed pre-employment evaluation. The court ruled that her obesity did not impair her job performance and, thus, could not constitute a disability and receive protection (37) (135) . Although few cases have held that obesity on its own constitutes a disability, several court rulings have demonstrated circumstances in which obese plaintiffs have been successful. In the case of New York Division of Human Rights v. Xerox Corporation, an obese plaintiff was denied a computer programming position because her obesity made her medically unsuitable for the job, according to the company’s physician (32) (136) . The state court recognized broader definitions of disability under New York law and ruled that her obesity was an impairment as defined by Xerox’s medical staff, although she had no other medical conditions and could perform the duties of the position (32) (37) . In the case of King v. Frank, a postal worker alleged that he was fired because his supervisor perceived his obesity to be an impairment (137) . The commission ruled that because the employer perceived the worker to be substantially limited in work (one of the major life activities of the RA), he was granted protection under the RA (32) . Finally, the case of Gimello v. Agency Rent-a-Car Systems also accepted a disability claim in which the court concluded that the plaintiff’s obesity was a physical disability because he had sought medical treatment for his condition (36) . Unresolved Issues: Blame and Disability The legal issue of whether obesity is a disability has not been decided. Very obese persons or individuals whose obesity is attributed to an underlying medical condition may have the most success under the ADA (131) , but it is difficult to predict which cases will be successful. Court decisions of whether obesity is an impairment may be the result of many factors besides ADA guidelines, such as court beliefs, cultural perceptions, academic views, previous case rulings, and weight bias in judges. Inconsistent court decisions will likely continue until ambiguities in existing legislation are resolved. Under the ADA there is no standard for determining how obese a person must be for weight to be considered a disability (37) (132) . Being moderately fat will only be considered a disability if accompanied by an additional impairment, whereas obesity on its own does not meet ADA impairment definitions. Morbid obesity can meet disability requirements. Korn (138) notes that limiting the protection of the ADA to morbid obesity ignores the majority of the obese population and reinforces misperceptions that anything less than morbid obesity can be personally controlled. Courts have generally viewed overweight as voluntary and mutable and, therefore, have disqualified it as a disability (131) (138) . The ADA does not actually require a condition to be immutable or involuntary to be considered a disability (32) . The RA and ADA protect other mutable conditions like alcoholism, drug addiction, and acquired immune deficiency syndrome, all of which involve voluntary behavior (32) . Although the EEOC states that being voluntary is irrelevant in the definition of impairment, the fact that obesity is rarely considered an impairment without an underlying medical condition suggests that the EEOC sees obesity as controllable (138) . Another unsettled issue is the applicability of the perceived disability theory. Because courts are unlikely to accept obesity as an impairment, overweight persons can stand on this section of the law. Yet successfully applying this theory to obese individuals may be unlikely, because the plaintiff must prove that the employer perceived weight to be an impairment, not just that the employee was perceived to be overweight (131) . Legal pursuits are not necessarily easier for obese individuals proceeding under actual disability claims. Successfully proving that one’s condition substantially limits a major life activity does not necessarily satisfy legal requirements. Both the ADA and RA can deny protection even if one’s obesity does impair life activities (34) . The obese plaintiff must also prove that he or she can satisfy the essential functions of the position, and those who cannot perform job duties with or without reasonable accommodation will not be protected (34) . Whether it is advantageous for obesity to be considered a disability is a matter of debate. Despite the legal advantages of the disability label, considering obese persons disabled may have unwanted ramifications. For example, it may be undesirable for overweight children to consider themselves "disabled." Because weight is a disabling condition in only a minority of cases, it may be harmful to attach a disability label to a condition already severely stigmatized. A key problem is that existing statutes were not intended to protect against weight discrimination (129) . Categorizing discrimination claims under current disability definitions makes less sense than finding other strategies to fight weight discrimination. Several suggestions have proposed revising the ADA. One option may be to change definitions of disability in the ADA to explicitly include obesity (37) (138) . Doing this would allow individuals uniform protection for having limiting conditions due to obesity, although this option would also mean attaching a disability label (37) . Others have concluded that the EEOC should declare issues of voluntariness and mutability as irrelevant to decisions determining impairment and enforce that they be excluded (131) . An alternative is to create new legal options for obese employees other than the RA and ADA. Adamitis (129) suggests that the most appropriate alternatives are state and local laws for protection from weight discrimination. It may be more realistic to consider state statutes, which often provide broader coverage, than to focus on federal laws (129) . As mentioned earlier, legal cases prove only that discrimination based on weight is perceived and that legal justification for seeking relief is growing. One cannot infer that discrimination is widespread from such cases. Prevalence studies are necessary.