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

Hello All, I have been considering lap band surgery since Nov. 2011. I met with a the surgeon's nurse practitioner and she was great! Answered many of my questions and was not pushy in my process. I attempted to lose weight on my own (again), but just seem to gain. I have insulin resistance and high cholesterol. I am 23, work full time as a paramedic and on call firefighter. I have become so discouraged, it seems I just keep gaining. I figure I now need to lose about 105lbs to be at a healthy weight ( I can't remember when I was at a healthy weight, but I have never been this big before) I am glad I found this forum, as I have read quite a few threads and I feel like I can get answers from people who have had the surgery. A few of my questions that I forgot to ask the nurse practitioner: Is 23 too young for this surgery? I have not had any children. Has anyone here had the surgery and then become pregnant? Does it increase any complications with pregnancy with having the surgery? I know the lap band won't take away emotional eating (something I have a problem with), but does it help to stop thinking about food? While I don't think I drink excessively for someone my age, I do enjoy going out and having drinks every now and then. How does the surgery affect consuming alcohol? Not that I would be embarrassed about having the surgery, I would like to keep it quiet. Is this the wrong attitude to have going into it? I am not sure how having the surgery and getting back to full time work as I do alot of heavy lifting and strenuous activity. I hope this isn't too many questions! I just want to feel confident and pretty again, I guess I just worry that this surgery won't work as I have decreased my calorie intake and I still seem to be gaining. Thanks so much for answers and advice!!! Kaylee

I agree with all that has been said, and would like to add.... like someone said, the sleeve will not "fix" the depression, anxiety, and the many other things that might had started the whole rollercoaster of unhealthy eating, so is super important that whatever that might had been for you, you figure it out and find other healthier ways to deal with it. After talking to many doctors and nutritionists, I have heard many times that if we do not work on that, we will just find a different unhealthy way of coping (such as alcohol). So keep in mind that the worst thing that can happen is not gaining the weight back (I know none of us want that). This is a journey in which we need to do more than just eat healthy and exercise, we need to find ways of dealing with our emotions and other things which do not include food. The sleeve allows us to concentrate in those things since we don't have to worry about all the bad food we are eating and the stress of being fat and doing the many unsuccessful diets we have all done. I go to keep reminding myself of this. Good luck!

There was an interesting article in the New York Times about a young woman who had a Lap-Band weight loss surgery after years of suffering the emotional journey of an overweight kid. The story was very honest about what to expect with this type of surgery, and it also tracked the journey of the young woman. The story is of interest to many as more and more teens and adults are turning toward the option of weight loss surgery. The latest number of weight loss surgeries performed in the United States is 220,000 per year. That is a seven-fold increase over the past 10 years according to the New York Times article. Weight loss surgeries do save lives and also improve quality of lives for sure, but they aren’t for everyone. The surgeons do the surgery and are skilled at centers of excellence, but unless the patients come back, join support groups and stay in contact with dieticians, falling off track is way too easy and, unfortunately, many of them do, including the young woman in the NYT story. I run several food addiction groups in Houston, and was featured as the psychotherapist for TLC’s show “Big Medicine.” On the show, I worked closely with Drs. Robert and Garth Davis. We tried to give the viewer an honest look at what happened with the weight loss surgery and the journey after. My work now is primarily with revisions. Revisions are the surgery done when the first weight loss surgery failed. My office is full, as are my support groups. What happened to the patients that so eagerly came into our offices feeling empowered and ready to give up their morbid obesity forever? They are replaced with patients who hang their head feeling like they failed. Even though they feel defeated, the ones I see are the fortunate ones who were able to step out of their shame cycle, call their insurance company and ask for a second chance. They need a second chance because neither they nor we (the health team) had a full picture of what was underneath their weight. They couldn’t see it prior to surgery, and since they are their own historians telling us their story, we are blinded also. I believe in weight loss surgery, but I believe more in the knowledge we impart to the patient prior to and after the surgery. Performing an alteration, such as a weight loss surgery, is a huge decision, but in the case of a minor I think the whole bariatric medicine team must be on board. There has to be a built-in safety net to handle the transformation of the child as well as their family. Everyone who loves the patient must change when someone they love has weight loss surgery. The counselor, dietician, and surgeon must know all of the family members. We must know who is sabotaging and enabling that patient on an emotional level. Enablers are the people still giving the patient food as a source of love. Our bariatric treatment teams must also understand if simply making better food and lifestyle choices worked, it would have worked 20 diets ago. It did not. Obesity has an addictive component, and addictions are kept in place by denial. Most patients will tell you they are not addicted to food exactly the same as an alcoholic will tell you they aren’t addicted to alcohol. The question is: “Do you use food to comfort yourself?” If the patient says “YES,” then treat them for a food addiction. Do this because they are telling you they have a relationship with food that is emotionally based and most likely they are choosing food with high fat or high carbohydrates (not one of my patients has ever had an addiction/emotional relationship to steamed or raw vegetables). Whenever a patient feels like a failure after going through the process of weight loss surgery and everything it entails, it is heart wrenching not only to them, but to me and anyone working in this field. If insurance companies won’t cover patient care for years to come after the surgery, then we in the field are going to have to put these measures in place and make them affordable to the patients. We cannot tell a patient they need to continue in groups and follow-ups if they can no longer afford the cost. Whoever said, “Weight loss surgery is a quick fix” truly never had weight loss surgery or worked with my patients. There is nothing quick about it. Obesity is a disease and once you have it, losing the weight is the easy part, managing that loss is a life long journey.

There was an interesting article in the New York Times about a young woman who had a Lap-Band weight loss surgery after years of suffering the emotional journey of an overweight kid. The story was very honest about what to expect with this type of surgery, and it also tracked the journey of the young woman. The story is of interest to many as more and more teens and adults are turning toward the option of weight loss surgery. The latest number of weight loss surgeries performed in the United States is 220,000 per year. That is a seven-fold increase over the past 10 years according to the New York Times article. Weight loss surgeries do save lives and also improve quality of lives for sure, but they aren’t for everyone. The surgeons do the surgery and are skilled at centers of excellence, but unless the patients come back, join support groups and stay in contact with dieticians, falling off track is way too easy and, unfortunately, many of them do, including the young woman in the NYT story. I run several food addiction groups in Houston, and was featured as the psychotherapist for TLC’s show “Big Medicine.” On the show, I worked closely with Drs. Robert and Garth Davis. We tried to give the viewer an honest look at what happened with the weight loss surgery and the journey after. My work now is primarily with revisions. Revisions are the surgery done when the first weight loss surgery failed. My office is full, as are my support groups. What happened to the patients that so eagerly came into our offices feeling empowered and ready to give up their morbid obesity forever? They are replaced with patients who hang their head feeling like they failed. Even though they feel defeated, the ones I see are the fortunate ones who were able to step out of their shame cycle, call their insurance company and ask for a second chance. They need a second chance because neither they nor we (the health team) had a full picture of what was underneath their weight. They couldn’t see it prior to surgery, and since they are their own historians telling us their story, we are blinded also. I believe in weight loss surgery, but I believe more in the knowledge we impart to the patient prior to and after the surgery. Performing an alteration, such as a weight loss surgery, is a huge decision, but in the case of a minor I think the whole bariatric medicine team must be on board. There has to be a built-in safety net to handle the transformation of the child as well as their family. Everyone who loves the patient must change when someone they love has weight loss surgery. The counselor, dietician, and surgeon must know all of the family members. We must know who is sabotaging and enabling that patient on an emotional level. Enablers are the people still giving the patient food as a source of love. Our bariatric treatment teams must also understand if simply making better food and lifestyle choices worked, it would have worked 20 diets ago. It did not. Obesity has an addictive component, and addictions are kept in place by denial. Most patients will tell you they are not addicted to food exactly the same as an alcoholic will tell you they aren’t addicted to alcohol. The question is: “Do you use food to comfort yourself?” If the patient says “YES,” then treat them for a food addiction. Do this because they are telling you they have a relationship with food that is emotionally based and most likely they are choosing food with high fat or high carbohydrates (not one of my patients has ever had an addiction/emotional relationship to steamed or raw vegetables). Whenever a patient feels like a failure after going through the process of weight loss surgery and everything it entails, it is heart wrenching not only to them, but to me and anyone working in this field. If insurance companies won’t cover patient care for years to come after the surgery, then we in the field are going to have to put these measures in place and make them affordable to the patients. We cannot tell a patient they need to continue in groups and follow-ups if they can no longer afford the cost. Whoever said, “Weight loss surgery is a quick fix” truly never had weight loss surgery or worked with my patients. There is nothing quick about it. Obesity is a disease and once you have it, losing the weight is the easy part, managing that loss is a life long journey.

When I explained that I am sensitive to sugar alcohols (all the SF crap), my peeps gave me the ok to consume sugar, so long as it was in responsible amounts. I am not a doctor, nor do I play one on tv. But I'm going to guess that if you need it, a bit of apple juice will do you no harm. Though I'd suggest you stay away from oj, just from a comfort perspective.

Thanks for the updates. Yeah I learned myself that the bandages aren't supposed to be pulled off OOPS!. I bought some surgical tape yesterday and attempted to clean off the "goo" and was going to replace the bandages, then I was like ummm this doesn't feel right. I tried using alcohol to get the goo off, it didn't really work. Today I almost scrubbed my skin off in the shower and most of it came off. Yesterday I met my friend at Panera and went to the mall. I feel regular and normal. I took today off because I thought I would need a week off, so I'm enjoying lounging around at home. It's weird, I'm having bowel movements, they are liquid but it's weird because I'm not eating anything. And also my whole digestive system is just very noisy. I'm doing well with water, Gatorade, and popsicles. I could actually do without the broth. I already decorated my April calendar with the days we can start protein shakes, and skim milk, then mushy foods. I've been good and not stepped on the scale. I'm going to commit to only weekly weigh-ins (on Wednesdays). Have you tried PowerAid? You might like it better, it tastes better to me but the Gatorade isn't bad so I'm sticking to it. I hope you have a safe journey home!

You will! Once you've had your fill, it'll be like a new lease for you. It was only this one fill that has put me straight. i tend to have actimel and green tea for breakfast (around 8.30) at my desk then have a side salad with boston lettuce, cherry toms, cucumber, spring onions, tuna or cheese and alfafa sprouts from about 11.30 which takes about an hour to eat whilst working, then a side plate of anything i want for tea at 5. I can't eat later coz it doesn't settle otherwise. And i still have one night a week out with alcohol, which i should probably cut out! Ofcourse, that doesn't apply right now coz i've been more restricted the last 2 days to liquids and omelette!

Have you seen 60 min? They have done studies that demonstrate the addictive properties in consuming sugar. Sugar is also consumed by cancer gulped also. I know that I am going to make more of an effort to stay away from processes foods. Fruit drinks are the worst. If u haven't seen 60 min maybe go to the website and see it. This is really scary and makes alot of sense.

an elevated level of ketone in the blood. Ketone is formed by ketogenesis when the liver glycogen stores are depleted and a process called lipolysis starts. Non medical terms = your body begins to use fat for energy and ketones are formed. Look up ketosis in google for some great in depth article. One way your body gets rid of ketones is through your lungs. It's like the alcohol smell, you can't get rid of it you just have to cover it up. Anyone who is loosing wt is making some and one way to test for them is the urin strips discussed above. Don't be worried its a good sign. It will go away when your wt stabilizes. My wife does not like the smell so I end up chewing a lot of gum.

I want to genuinely thank everybody who has responded............I am happy to report that the mere act of my taking the time to write my story and share it with all of you has begun sparking a bit of a change in me, I am feeling a little more hopeful again, feeling like maybe I can still make it work, I have even been eating better since my first post, it seems to have been a bit cathartic.....I also recently went to a 12 step AA meeting (although I am not an alcoholic) and found it very powerful too.......I simply substituted the word food everywhere they used the word alcohol...... In fairness to all here I think I owe it to admit that I just found out my un-supportive wife was doing things far worse than simply not caring about what foods I ate..............I don't care to go into details but any adult ought to understand what I am saying..... I must have been aware of this at some subconscious level and that caused my food addiction or compulsions to be extra hard to manage................... I plan to go ahead and get the study done to make sure the band has not slipped, and I am going to give it my all once again.... For those considering the band I just want to say that my experience shows that the lapband is not magic, it can and does fail if you are not ready for it.....Weight loss is an an all encompassing process of changing many things in your life...............The band will reduce your hunger and you will feel full quicker...............but if you are using food as a drug to make you feel better (as I was) you CAN and WILL find ways to defeat it........ The work is not over once the band is on, frankly it has only just begun...........all it does is gives you a little boost, head-start or helping hand in the process, but it does not run the race for you......... I think I will spend more time on this forum, I can see that the support, tips, tricks and experiences of others can be truly valuable in helping us succeed......... Thanks again, I'll keep you all posted, I need to go weigh in quick tonight before I start losing weight without knowing it!

Awww, thanks, Joni!! I don't drink a lot, but I do feel the alcohol VERY quickly these days. But, IMO, celebrating outliving the prediction calls for a drink...for me. I understand that some folks dont drink for various reasons, though. I'm still excited every day to see what new discoveries my sleeve has in store for me. My latest have been my collarbones and hip bones....

Its interesting that you had this happen to you and posted today because just this morning I was having a conversation with two Physician Assistats and one Medical doctor about it, I am a med student (PA to be exact)..... So it went like this, we were doing blood pressure, height, weight and BMI checks (as well as other stuff) at a health fair. Someone mentioned a patient that she recetly had who was 33 and had a BMI of 54, so one of my profesors said something to the effect that for those patients she really thought they just had to have surgery. Later another profesor came and she is bigger than me, and I asked her what she thought of the gastric sleeve, her answer was that she did not believe in those things because she saw too many patients with too many problems after having it (keep in mind that after more questions she admitted she knew little about the sleeve and she also has served mostly underrepresented populations who actually already lack health care), so I realized she would not be someone even willing to honestly talk about it so I left it at that. I later talked to the other PA and doctor (the one that had mentioned surgery earlier), they admited that they knew very little about the sleeve, but that there comes a time when people really needed surgery to succed at weight loss. After talking to them I realized what their apprehancion with it being done to someone with no immediate health problems, that they may not learn to eat (and or threat other underlying problems and take on alcohol or drugs when they cannot eat to deal with them) and might not be ready for a life change that it entails. Many doctors, PAs, NPs and other health care providers just don't kow the science behind it but see the patients who came to them because of gaining weight and other complications after the surgeries, not realizing that the majority of that was caused by the patient him/herself not the procedure (yes bypass has a lot of malnutrition but even that one is very successful with limited risk for patients who follow all directions). Has patients we need to keep in mind that this is a last resort surgery, I like many of you have a lower BMI (I actually lost a little weight recently I just found out and my current BMI is 35) but I have tried every diet in the book and those not in a book too! and nothing has done it! I confided in one of my teachers today and told her that I was having it done and why and after my explanation based on scientific evidence (I told her I have done a great deal of research and shared some with her before telling her I was doing it) she said she understood. Perhaps the best thing you can do is educate your doctor, and let him/her know that you have done your research (but back it up with information you have found) and let him/her know that you know it will take a great deal of effort from you to stay healthy (eat the Protein, Water, Vitamins, exercise and the like for the rest of our lives!) but that you just need help getting there. I believe if more clinitians knew more about it they would be more supportive. There are those (like I found out today) that don't believe in the surgery at all and will not listen even when research is presented to them, but your doctor does not appear to be one of them; just genuinely concerned. Make sure you are really ready for this change and if your answer is yes then you will know what to do! Good luck!

Lissa - You are awesome! Congratulations on all your success! You mentioned having a drink to celebrate and I had to smile. It reminded me of what the NUT said at our preop meeting - alcohol is frowned on, but we'd be "cheap dates" cuz it would take so much less to get a buzz. I quit drinking many years ago but found that interesting....

What is it like the month after surgery? Arn't you put on an all liquid diet? Isn't that hell to get through??? Arn't you starving since liquids pass through easily????? I'm not big into crackers, candy, alcohol or juices/soda.... my issue is carbs.... I think I will do well, I just wonder how much the band will help me.... And thank you ladies for your thoughts and help!!!

I was full liquid for a couple of days post op then puréed adding solid foods each day and cleared for anything except carbonation and alcohol at 5 weeks.

I don't think it's about the calories or the stomach stretching as much as it is about the addiction. Diet or Regular I think it's a slippery slope for many of us (not all). I have known several people who went back to "just a sip or two", "I'll limit myself to one can a day" or whatever. It just gradually creeps back up. I was sleeved 5 months ago and still battle with this almost everyday. Especially if I'm eating something I used to always have a Pepsi with (pizza, Chinese). Pepsi was sooo my go to comfort item. Almost daily I have the desire for just one! But I know me-and it might be just one today but it wouldn't take long for that one to become two and so on. I also agree with the write above who said that even drinking diet soda was making her crave more sweets and carbs (that actually has been proven by MANY studies. Everyone has to chose for themselves and maybe it would never be a problem for some (just like not everyone who drinks alcohol becomes an alcoholic), but if it was a problem before surgery-It will most likely be a problem after surgery if you start up again.

Apparently post gastric bypass and less so with the sleeve alcohol hits quicker. Our coordinator stated that they tried shots At the support meeting and labeled it a17 sec drunk.

I was told no alcohol for a year, but I broke that at about 7 weeks and had a few glasses of wine with some girlfriends one night and I was perfectly fine. I had a pretty high tolerance for alcohol before though so those 4 glasses really did nothing for me except give me a headache the next morning.

when are you allowed to drink after being sleeved? I am 4 weeks out now.

Hi Lau! I am right there with you... I am now 21 but I had my surgery when I was 20. If you have any specific questions feel free to PM me. How to know you are emotionally ready? Honestly, you are the only one who can answer that. I have always been very emotionally mature for my age since I had to deal with both my mother and my grandfather being sick from a very young age. I knew that I could handle this emotionally. Emotions are pretty crazy during this process. You have your base problems, like why do we overeat in the first place. You have to deal with giving up food as a crutch. Find other ways to deal with those emotions. Some people turn to exercise, some people turn to alcohol. You have to make sure you have a strong support group (these boards, your parents, a therapist if you want, your friends, an in person support group) to make sure that you don't turn to the wrong things. After the surgery you have to deal with the extreme changes in your body. They might be good changes, but change can still be difficult. You will never eat the same way again, in public as well. You won't be able to drink the same way (you are a cheap date now lol, one drink has a lot of potency in your tiny tummy). You also have the pre-surgery emotions... the anxiety, the excitement, etc. It is a lot, but it is definitely do-able. You CAN handle it. BUT, the question is whether it is worth it or not. If you are seriously concerned, talk to a therapist a few times. They don't bite and they would be able to answer your question a lot more professionally then any of us

Hey, I have a question for the post op people here. I start my 8 day liquid diet on Sunday and my husband wants to have a couple drinks with me on Saturday night. I know I may never really be able to drink again, so would like to do this. I don't want to put my surgery at risk in any way, my understanding is that alcohol is out of your system in 24 hours. Did anyone else do this? Thoughts?

As of now I am totally addicted to Diet Pepsi. My medical team has told me that I must give it up, not have anything carbonated, and the caffeine at first is also a no-no. Initially, I thought it would be so wonderful if some day I could drink the pop again. BUT - after more thought, why? Isn't the point of this journey to be healthier and start a new path of taking care of myself? So, I have given up alcohol and cigarettes, and will give up the Diet Pepsi too. It's full of nothing good. And aspartame is being shown to have nasty long-term effects.. good bye my love...don't let the door hit in you in in the ----.

So add alcohol wipes to the list of things I cleaned my face with after