Alex Brecher

There’s no doubt weight loss surgery helps you eat less. Whichever type you get replaces your regular stomach with a smaller pouch (or stoma or sleeve). But your struggle with food isn’t automatically over the minute you get out of surgery. The sooner you accept and confront this, the more weight you can lose, and the easier your weight loss journey is likely to be. Whether you get the adjustable gastric band, gastric sleeve, gastric bypass, or another type of Weight Loss Surgery, your Weight Loss Surgery is a restrictive procedure. It helps you fill up sooner, stay full longer, or be unable to tolerate certain foods. (And yes, some procedures such as the gastric bypass are malabsorptive – they reduce nutrient absorption – but all of them restrict food intake). The Struggle Often Continues For some patients, Weight Loss Surgery can lower your interest in food, so you are not constantly thinking about it. There’s no question Weight Loss Surgery can help you gain control of your eating, but it’s unlikely to eliminate your struggles with food disappear. A few lucky Weight Loss Surgery patients really do stop being tempted by food. The rest, who make up the vast majority of Weight Loss Surgery patients, continue to struggle. You still may be hungry, enjoy salt, fat, starch, or sugar, or be tempted to use food as an emotional crutch. Your family members may continue to insist on keeping high-calorie foods in the house, or pressure you to eat things you shouldn’t. Your friends may still be going out to eat and inviting you to join them in ordering high-fat, high-sugar items. “Why Me?” Isn’t Appropriate It’s easy, even natural, to think of yourself as unlucky. Why should you have to struggle with food? Why should you have to monitor every bite you take, while some people don’t? The fact is, almost everyone does. Ask almost any skinny person how they stay skinny, and you’ll get some variation of the same answer: “I work hard for it.” Just like you, they are aware of what goes into their bodies. They sometimes may be hungry; they sometimes may want to eat more than they should. But they, like you now, take responsibility for their decisions. They may: Skimp on portions if they over ate at the previous meal. Choose healthy foods first. Have a strategy for dealing with emotions and boredom that doesn’t involve eating. Have a support system that promotes healthy behaviors. Accept It and Manage It If you find you still have a rocky relationship with food after weight loss surgery, don’t conclude that WLS didn’t work for you. Instead, accept that you will need to fight the cravings and urges for months, years, or life, and start making a plan. Don’t be afraid to ask for help in developing strategies – whether you ask other BariatricPal members or an always-thin person you admire! Persist in Order to Get the Answers You Need We all want to be able to trust our doctors. You want to believe your surgeon takes care of all aspects of your Weight Loss Surgery, including your post-op, long-term nutrition. But it doesn’t always happen like that. Nutritional counseling may not be part of your surgery package, or you may only get a limited amount of generic information. Or, your surgeon may simply not know how to help you nutritionally. Remember that many doctors have no more than an hour of nutrition education in medical school. To become a weight loss surgeon, doctors need to learn surgery. There is no dietary education requirement. If you need help finding strategies to satisfy hunger – physical or head hunger – and your surgeon and primary care doctor are not able to help, keep looking. A session with a nutritionist may be more affordable than you think, and worth every penny. Your Emotional Support System and Your Relationship with Food The support system you built so carefully can come in handy right about now. Take advantage of your ability to talk to a therapist or psychologist if you have one to bring up your concerns. Discussing your ongoing struggles with portion sizes, food choices, and over-frequent nibbling with a mental health professional can help you come up with some strategies that work for you. Group sessions are also appropriate forums to talk about food struggles and strategies. Though it may feel embarrassing at first to admit you’re still thinking about food a lot, you will find nearly everyone in that room did or does have that same experience. Most Weight Loss Surgery patients do not find their surgery instantly eliminates their food struggles. You can take months or years to come to terms with a food addiction, and it may be something you need to learn to live with for life, but in a healthier manner than before Weight Loss Surgery. Be honest with yourself and those around you, and be open to suggestions, and you can figure out strategies that work for you. Do not assume WLS did not work for you!

Sheesh! Not very impressive. What are your thoughts on the ORBERA™ Intragastric Balloon US Pivotal Trial Results ? http://www.reuters.com/article/2015/05/18/tx-apollo-endosurgery-idUSnBw185339a+100+BSW20150518

The Orbera Gastric balloon has just been approved by the FDA: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm457416.htm

These are such great tips, and so necessary! It’s really important to be positive, since that’s motivating, and not be negative, since that can be a barrier. I try to think about making good diet and exercise choices in terms of positives. I try to think, “I’m lifting weights because I love way it makes my arms look,” and not, “I’m lifting weights to try to get rid of my flabbiness.” Thanks for telling us why we need to feel good about ourselves, and how we can!

Thanks for the article! These are great tips. It’s always important to remember that the customer is always right, and YOU’RE the customer! You can get what you want/need either by ordering it from the menu, or by asking for it.

I wouldn't get a Balloon in Mexico if you can't get there in a jiffy. You should use a local doc for this procedure. There are a few awesome Mexican docs that actually proctor and are teaching US surgeons and have been doing balloons for quite a long time.

Not sure about cost but I think they're anywhere from $5,000-$7,500. Don't quote me on the price because I'm not certain. The only issue is long term weight loss viability. Most people take off a very decent amount of excess weight with the Balloons, but we're going to need to see how long they'll be able to keep it off.

The gastric balloon is a newer approach to weight loss. It is an alternative to Weight Loss Surgery for obese patients whose BMI’s may be too low to qualify them for Weight Loss Surgery. It can also be an option for you if you do not want surgery because of its risks or because you want a completely irreversible treatment. How It Works The gastric balloon is placed in your stomach to partially fill it. This helps make you feel full so you are inclined to eat less and lose weight. The program depends on your readiness to make changes in your eating behaviors, and you are likely to be more successful if your doctor works closely with you during the time you have the balloon inflated to establish healthier nutritional habits. Like weight loss surgery, the gastric balloon is a tool for weight loss that depends on behavior change. Patients are supposed to have nutritional counseling and learn new eating habits during the months they have the balloon in place. Orbera also promotes establishing a sustainable exercise routine, managing your appetite, and learning how to keep yourself motivated. The Procedures for Implanting and Removing the Balloon It usually takes less than 30 minutes to get a gastric balloon implanted. The procedure is endoscopic, not surgical. You receive an anesthetic for your throat, and then swallow a deflated balloon attached to a catheter or small tube. The surgeon places the balloon using endoscopic instruments, such as a probe with a camera, and then inflates the catheter with saline solution or air. You can go home within hours after your balloon is filled. For 1 to 3 days, you follow a liquid or soft foods diet. You may have multiple balloons inserted over the course of your treatment. For example, Obalon’s 12-week program includes up to three balloons, each with a size of 250 cc (about 1 cup), for a possible total of 750 cc. Other company’s balloons may be larger, such as 400 cc. To remove the balloon, the surgeon gives you a sedative. The process takes only a few minutes, and you will be sedated for only about 30 minutes. Differences from Weight Loss Surgery In general, the gastric balloon is an obesity treatment designed for lower-BMI patients than weight loss surgery. In general, you are eligible for the gastric balloon starting at a BMI of 27. In contrast, health insurance plans that include weight loss surgery set eligibility for reimbursement at a BMI of 40, or a BMI of 35 with an obesity-related comorbidity, such as type 2 diabetes or hypertension. A BMI of 27 is not even considered “obese,” but rather categorizes you as “overweight.” Unlike Weight Loss Surgery, the gastric balloon is not intended to be permanent. The Orbera and ReShape Duo intragastric balloons can be used for up to 6 months. Manufacturers of the gastric balloon claim it can help you lose about 10 to 15 kg (20 to 35 lbs), at the rate of about 1 kg (2 lbs) per week. In comparison, Weight Loss Surgery patients may lose about 80 to 100 lbs. (35 to 45 kg) in their first year after surgery, which is also a rate of about 1 kg/week. They have continued effects of the surgery (e.g., restriction from a smaller pouch/sleeve) after that time, since surgery is permanent. Effectiveness and Safety The gastric balloon can help you lose weight at a steady rate for the months or year you have it in place. It can also help encourage you to establish healthy eating patterns. Some research studies have also found reductions in visceral (or abdominal or belly) fat (that’s the unhealthiest kind of body fat). Patients who are most compliant and lose the most weight are also likely to see improvements in type 2 diabetes, hypertension, and fatty liver. The gastric balloon has fewer risks than surgery. It can lead to gastroesophageal reflux disease (GERD). Nausea and vomiting are among the more common side effects. Pregnant women, individuals with psychological disorders, and individuals who are misusing drugs should not get a gastric balloon. A Few Different Versions Multiple companies make versions of the gastric balloon. For example, Apollo Endosurgery, makers of the lap-band, make the Orbera gastric balloon. Obalon sells its gastric balloon in Europe and Mexico. A smaller medical device manufacturing company, ReShape Medical, makes the Reshape Duo balloon, which was approved by the FDA yesterday!

Rene, Thanks for bring attention to this important topic! As you found, the links between sleep and weight control are pretty definitive. There is the effect of sleep deprivation raising ghrelin (hunger hormone) levels, and it also interferes with related hormones like leptin. And it’s not just hormonal! Research studies have shown people make bad choices when they’re sleep deprived. They’re more likely to crave sugary and starchy foods – and give in to these carb cravings. And they’re more likely to take larger portion sizes when they’re sleep deprived. The effects aren’t just limited to hunger. Lack of sleep also raises your risk for diabetes, hypertension, and heart disease – some of the very diseases we’re trying to fight with weight loss surgery! So it’s definitely time to think of adequate sleep as part of an overall healthy post-op life. It takes discipline to get enough sleep, but if you’re going to go through the trouble of weight loss surgery and changing your entire lifestyle to get healthy, it makes a lot of sense to get enough sleep, too.

Wow, what an inspirational story! Congratulations to George! An Ironman is something most people cannot even imagine completing! You are an inspiration for your weight loss and athleticism! Thanks, Dr. Adeyeri, for sharing this story.

Awesome! Sounds like tons of fun!! I've only been to Colorado in the winter. I'm told it's stunning without the snow as well. How old are your kiddos? Are you driving straight or stopping midway?

The thought of summer is always nice. The pace is usually slower at this time of year, and you may be lucky enough to get away for a vacation or enjoy a bit of a staycation. If you’ve had weight loss surgery fairly recently, this may be the first summer in years that you’re itching to be healthy and active! But the summer heat can challenge for WLS patients. How can you lose weight and get fit safely during the summer? Hydration Hydration is a big one. WLS patients are at double risk for dehydration during the summer. First, there’s the heat. Second, there’s the difficulty of meeting your fluid needs already, since you can’t drink with meals. Under normal conditions, you need at least 64 ounces of fluid per day. That’s 8 cups or 4 half-liter water bottles. Here’s one way to get in your fluid. Start with 1-2 glasses as soon as you wake up. Have a cup 30 minutes after breakfast, and an hour after that (or 30 minutes after your mid-morning snack if you have one). Have a cup or 2 30 minutes after lunch, and an hour after that (or 30 minutes after your mid-afternoon snack). Have 1-2 cups at least 30 minutes before and after dinner. Don’t forget to go calorie-free and non-carbonated with your beverages! You need more liquid when it’s hot, and a little extra when you sweat heavily during exercise. Remember, water is fine. You don’t need sports drinks unless you are exercising intensely for more than 90 minutes. Drink extra an hour before your workout, every 15 to 20 minutes during it, and when you’re done. Stay Motivated Don’t let the long, lazy days of summer lull you into being lazy! It may be hot, but there are better things to do – like exercise! - than sit on the couch (and by the way, cranking up the a/c while you watch TV is expensive). Here are a few ways to get yourself moving. Walk somewhere cool and inviting, such as in the mall or along the beach. Get a friend, or a group of friends, to get moving with you. The more the merrier, whether you break up into walking groups of twos and threes, or you play a big game of volleyball or tag. Set a goal to finish a 5k by the end of summer, and train for it. Let the gym pay for the air-conditioning. Take advantage by trying new classes, using each of the cardio and weight machines, and playing with equipment like free weights, kettlebells, weighted medicine balls, and Bosu balls. The gym has more equipment than you’ll ever have at home, so use it and have fun with it. Safety Precautions Safety comes first. Avoid activities that are very hot and can put you at risk for heat stroke. Instead, go indoors to an air-conditioned gym, or choose cooler options like swimming, or walking in a shaded park. Most of the time, you can beat the heat by exercising very early in the day, which is the coolest time, or later in the evening, after the sun goes down. If you’re exercising outdoors, tell someone where you’re going, your route, and when you’ll be back. Better yet, get that someone to go with you! Don’t exercise in severe weather warnings, such as extreme heat, tornado watches, or electrical storms. Never go near water during a thunderstorm. Count Calories Okay, this one applies year-round, but it’s worth a reminder now. That’s because, in the heat of the moment, you might forget about your WLS rules. What will you order when you and the kids flag down the ice cream truck? (Nothing). What do you say when you’re offered a cold beer at your neighbor’s backyard barbecue (“No, thanks – got my water right here!”). How do you avoid the baseball game peanuts (suck on ice cubes), hot dogs from beach vendors (PYOP - pack your own protein), and freshly baked blueberry pie (enjoy your own fresh blueberries)? These are some tips for losing weight, staying hydrated, and getting in your exercise without putting yourself at serious risk. What are your summer tricks?

We've updated the YouTube video that was initially included in this article.

Think you don’t have time to commit to losing weight and getting healthy? Think nobody has a less healthy relationship with food than you do? Then you haven’t met Robanne Robin. She’s a mother of 3, a motivational speaker, a diabetes prevention educator, and a weight loss and fitness coach for kids and adults. She’s also a Roux-en-Y gastric bypass patient. A Lifelong Struggle with Food Some weight loss surgery patients have nothing but memories of being obese. Robanne did struggle with food her entire life, but her ordeals included battles with anorexia and bulimia as well as childhood obesity and morbid obesity as an adult. By the time she was 37, she had high blood pressure and diabetes, and had two trips to the ER. She was close to giving up. That was at a weight of 300 pounds. The Decision and Her Surgery Robanne knew her health was the result of her weight. She researched the various WLS possibilities and felt Roux-en-Y was the best option for her because of the long-term success rate. Also, she had a friend that had lost 100 lb. after RNY. She got her surgery in 2009 with Dr. Brenda Cacucci at the St. Vincent Bariatric Center of Excellence, in Carmel, Indiana. A Personal Decision with Family Support The decision for Robanne was personal. She explains she had enough on her mind at the time of her surgery, and was not in a place to be able to justify her decision to friends and family. So, she only told them about the surgery after she got it done. She also did not want to deal with judgmental people, since she was scared and uncertain at the time. Her friends and family were supportive when she told them. She says her children “were particularly excited that ‘mommy would be able to jump on the trampoline with them some day.’” Now she says she is “strong enough to believe in my path,” and her results show it. She lost 150 lbs. and now weighs 150. Overcoming the Challenges and Becoming a Dancer Robanne faced the same challenges many WLS patients can relate to. It was tough to get in her dietary supplements and drink her protein shakes. In the beginning, exercise was a serious challenge – so much so that she tried to convince herself she didn’t need to exercise. Luckily, she went to a group exercise cardio class, which happened to be a hip-hop dance class. She was too embarrassed to quit, so she stayed in class…and says it was the best thing that could have happened! That class changed her life. She loved it, and learned that exercise could be fun and not dreadful. But she took it much further. Robanne worked at it, and now teaches seven hip-hop classes a week. She leads group exercise classes for the Obesity Action Coalition's national conference. Look for her at their next conference in San Antonio in August! Robanne’s also been selected as a national national spokesperson for the Y.. She’s appearing in a national commercial rolling out this year. It is currently on the air in Seattle, WA and starting to pop up across the country, and you can take a look on . Tips from the Top Anyone who’s lost and been able to keep off half her body weight probably has a lot of good advice, and Robanne is very willing to share it. First, she says to try new things. If you’ve been sedentary and overweight for years, she says, how do you know what you like? So try everything! Also, “keep it real.” You’re not in the best possible shape right after surgery, so just work up to the tougher workouts instead of jumping right in. You don’t want to get hurt, burned out, or discouraged. Fitness is about being strong and pursuing health, not about a single number on the scale. Another piece of advice comes in the form of one of her favorite quotes. "Start by doing what is necessary, then do what is possible, and suddenly you are doing the impossible"--St. Francis of Assisi. And finally, stay focused. Robanne says, “Every day, I recommit to do what it takes to stay successful.” A Day in the Life What does a typical day look like for 6-year WLS veteran who’s lost half her body weight? Something like this, at least for Robanne. Coffee...with cream. Breakfast: 1-2 packets of plain, heart healthy instant oatmeal sweetened with Splenda. First morning snack: Greek yogurt. Late morning snack: 1-2 hard-boiled eggs Lunch: some kind of chicken (usually grilled), on a bed of mixed vegetables (usually salad). She uses salsa for dressing. First afternoon snack: something crunchy like Skinny Pop popcorn. Second afternoon snack: a slice of cheese, and handful of turkey, or some kind of lean protein. Dinner: lean protein, 1/3 cup brown rice and broccoli or a small salad. Every other day: a protein shake. Plenty of water. Robanne says she’s a creature of habit and keeps eating what she likes. The key for her is snacking on protein instead of carbs for the most part. She splurges on occasion on something like a cookie or something chocolate. But, she says, eating too much sugar and refined carbs makes her feel less bad. She sticks to whole grain carbs instead of white. And exercise? This hip hop instructor is no slouch! She teaches 6-7 classes a week, including 2 days with 2 classes each. She also does weight training to keep up her muscle mass. She has 2 days off each week. More from Robanne If you want to learn more about Robanne, take a look at her Get Your Strong On site. It details her work in motivational speaking, weight loss coaching, and promoting corporate and kids fitness. You can also check out her inspirational video called “ .”Robanne wrote her story in a book, “Half My Size,” which she’s offering at a discount for BariatricPal members. You can order yours for $10 each with free shipping! The book is her story along with the lessons she learned for overcoming obstacles. And for more ways to connect with Robanne…check out her bariatric motivation page on Facebook and give her hip-hop workouts a try!

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

Can you post a link or two, please?

You’re considering weight loss surgery, you’ve scheduled it, or you’ve already gotten it. Are you going to be successful with it? Historically speaking, the answer is “No.” Maybe that’s not what you wanted to hear, but it’s true. Just take a look at your past. You haven´t been able to lose weight and keep it off. It you had, you wouldn’t be looking at Weight Loss Surgery. But that’s no matter. Your past does not need to determine your future. Replace old habits and attitudes and look forward instead of back. That’s how you will be able to get the results you want instead of the disappointments you used to get. In this first article of the two-part series, we’ll take a look at some of the problems from the past that could stand in your way. Part 2 of the series will have a few more. Problem: Childhood Habits No joke. It’s hard to shake off the behaviors you learned while growing up. Maybe your family traditions were something like making pancakes and sausage on Saturday mornings, ordering pizza on Wednesday nights, and watching Sunday afternoon football while eating the usual unhealthy snacks. Maybe your “habits” were actually lack of habits – maybe you didn’t grow up walking to school or playing outdoors every day. Do you see yourself clinging to the old traditions, whether or not purposefully? Give yourself permission to let go of the old ones, and maybe even create some new ones. You don’t need to plop down in front of the TV after dinner just because you always have. Maybe you could take a walk. You don’t need to meet your parents at a favorite Italian restaurant every week. Maybe you could meet for coffee. Or, you could meet at the Italian restaurant, but change your usual order of spaghetti and meatballs to a salad. It’s time to stop letting your childhood dominate your current life and health. And here’s food for thought: if you’re old enough to get weight loss surgery, you’re old enough to make your own traditions. Problem: Mistaking “Food” for “Love” This can be one of the biggest obstacles for weight loss surgery patients because it can lead to conflict between them and their families. Maybe it’s the Jewish or Italian mother who guilts you into eating, the Asian culture that requires you to clean your plate, the Latin American family that solves problems at the dinner table, or the African American community known for soul food. Which of these or other food-centric cultures you were raised in doesn’t matter; the point is somehow food got confused with showing love. Somehow, eating for reasons other than hunger – for celebration, comfort, courtesy, expression of love – became cultural norms. Your personal history may be weighing you down if you are eating to make other people happy. This won’t work for you. It can stall weight loss and continue to make you feel dependent on others. Instead, make the decision now to eat for yourself – to nourish yourself, to fuel yourself, to be able to enjoy life. There are many ways to give and receive love besides eating food that is literally killing you slowly. Problem: Devaluing Yourself You wake up before dawn to clean the house. Then you get the rest of the family up and ready, and make, serve, and clean up from breakfast. You drop the kids off at school on the way to work, then pick them up on your way home. You help them with homework, make and eat dinner, and put the kids to bed. After a few minutes with your spouse, you hit the sack yourself. The day is over, and you haven’t had one second to yourself. Sound familiar? If this – or something like it – has been your life for years, you’re setting yourself up for weight loss underachievement because you’re undervaluing yourself. Where’s the you time in this day? You deserve it, and it's up’to you to take it. It’s not something you should feel guilty about, but if you do, consider this: doing your best for yourself puts you in the position to do your best for others, too. Problem: Hanging with the Wrong People It’s true. The people you hang out with affect your weight just as much as your genes do. If your friends are obese, they may be setting you up for much bigger struggle than necessary against obesity. That’s because you are likely to make the same choices they make. You sit on the couch with them and order unhealthy dishes with them. In contrast, skinny friends may influence you to eat healthier and be more active. If you notice your friends dragging you down, feel free to say something. You can politely ask to get together to shoot hoops instead of drink beer. Catch up at the park or over coffee, not over nachos. Collect and test healthy recipes instead of decadent desserts. Changing those age-old habits may not be that hard. If your friends refuse to change their activities and you still want to spend time with them, you can. Just be aware of how their choices can affect yours, and make sure it doesn’t happen. Do any of the above sound familiar? If they do, think about how you can avoid making the same mistakes this time around. Some of the smallest changes in attitudes can lead to big changes in results. Stay tuned for Part 2 of the series for more!

Thanks for the article! These are great ideas – it’s always good to have easy, healthy, seasonal recipes on hand. Gazpacho is another cold soup you can make. It’s great when the cucumbers at the farmers’ market are too irresistible to pass up, so you buy too many. You can throw some cooked Protein in there, too – maybe chicken, Beans, or tofu. Or you can even put Greek yogurt in to make it creamy and add protein.

Okay, it sounds cute, but it’s a serious question. If you want to lose weight or keep it off and get healthy, you need a plan. The old saying, “Fail to plan, and you plan to fail” could have been intended specifically for weight loss surgery patients. Fail to plan after Weight Loss Surgery (WLS), and you’re planning for plateaus or regains and possible complications. What should you be planning? You don’t want to become fixated on planning, but there are a few key areas to be aware of. These are some of the questions you might ask yourself to make sure you’re planning enough. Each question is followed by the pitfall you might fall into if you don’t think ahead. Where are you shopping, and what are you buying? Possible pitfall: Finding an empty fridge and opting for McDonald’s or pizza delivery, or going to the supermarket without a list and buying whatever looks good – which usually doesn’t include lettuce and chicken breast. A solid answer identifies when you’ll shop, and it includes a list of proteins and other essentials, such as vegetables, fruit, healthy starches, and healthy fats. Check the list to make sure it has enough healthy foods for the meals and snacks that will get you through to the next shopping trip. What are you having for breakfast tomorrow? Possible pitfall: Being so rushed you grab a pair of Pop-Tarts on your way out, get a bagel at the coffee place, or get to work so hungry you sneak in a doughnut from the reception area. A solid answer is realistic, so if you know you’ll be in a rush, it doesn’t involve a lot of preparation. You may want to get your breakfast ready the night before, even if it’s as simple as putting some cottage cheese and a few slices of turkey in a portable container with a tight-fitting lid. What are you ordering for lunch? Possible pitfall: Going out with the gang and ordering what they do…anything from a burger and fries to pasta primavera. A solid answer considers where you’re likely to find yourself at lunch and what’s on the menu. Identify your source of protein and a vegetable beforehand and stick to your pre-made decision when you order. If you end up going out unexpectedly, look for salads, grilled chicken and fish, and sides of vegetables and fruit. What are you making for dinner? Possible pitfall: Ordering in or getting take-out, or falling back on a high-calorie, low-nutrition quick fix such as macaroni and cheese or taco kits. A solid answer identifies your source of protein and vegetables so you can figure out what you need to buy and how much preparation is necessary. When, where, and what is today’s workout? Possible pitfall: Running out of time if you haven’t scheduled it into your day, or chickening out of the workout if you haven’t quite made the commitment to a specific exercise. A solid answer says when you’ll work out, whether you’ll do it at home, at the gym, or somewhere else, and what clothes, shoes, and other equipment you need to bring with you, if any. Your answer should also include what you’ll be doing, whether it’s 30 minutes of walking on the treadmill plus 15 minutes of lifting weights, going to a Zumba class, or pulling weeds and sweeping the driveway. What will you snack on at the party? Possible pitfall: Eating whatever happens to look good, and ending up with not enough protein, too many calories, too much fat and sugar, and possibly nausea or dumping syndrome. A solid answer doesn’t depend on what the host may serve. Your plan may be to bring some hard-boiled eggs or beef jerky for yourself, plus a large green salad, vegetable skewers, or fruit salad for you and the rest of the guests to enjoy. How will you answer your mother when she offers you a freshly baked chocolate chip cookie (your favorite) or the entire batch? Possible pitfall: Feeling guilty for refusing or being caught off guard, and accepting the cookie or batch. A solid answer includes a polite refusal, possibly with an explanation, such as, “No, thank you. My doctor has advised me not to eat cookies.” If you can’t avoid taking the batch home as a “gift,” don’t be afraid to throw it out. Nobody likes to throw away food, but if you’re going to, better to throw it away in the trash can than in your body. How are you going to feel at the end of the day? Possible pitfall: Let doubt creep in, and you may be setting yourself up for bad decisions with eating and exercise. A solid answer is positive and confident with no room for self-doubt. At the end of a day of good eating and a bit of exercise, you may be tired, but satisfied, proud, and a little lower in weight. Staying positive and optimistic sets you up for good decision making without even thinking about it. You always hear about the importance of planning for weight loss surgery success, but that advice may seem confusing if you’re not a natural planner, or even if you’re just not used to thinking so much about your WLS-related habits. Know the answers to these questions, and your planning skills can help you lose more weight and stay healthy.

Thanks for this article! Yes, thinking of yourself as being “all in” is necessary! You have to identify yourself as being the person who eats healthy and lives healthy, not just someone who is currently going through those actions. It’s something that helps you stay on track, and it’s something that helps you get back on track if you get off briefly. I think you can eventually have the occasional treat, but I agree with you it’s not healthy to think things like, “I can be bad now because I’ve been good for so long.” I like to think of it more as a part of my normal life, as in, “I really want to eat ice cream. How can I fit this into my diet? I can have a couple of spoonfuls tomorrow night as long as I make sure not to have any other sugary foods during the day.”

Thanks for your article. It is so true that we can’t lose weight just by telling ourselves to eat right or by depending on the WLS procedure itself. We need to explore our own reasons for not having been able to lose weight in the past, and figure out how we can free ourselves to succeed now. Thanks for this article.

The 100lb figure is an average I've seen from our members, but I think of 90-100 as sort of the common number that's given frequently. E.g., here's 90 lbs. http://www.nih.gov/researchmatters/november2013/11182013bariatric.htm and I think this works out similarly: http://www.ncbi.nlm.nih.gov/pubmed/23265120 .

The weight loss surgery journey is easier for some than for others. That’s true not only mentally, but physically as well. Some patients are confident as they get the surgery, follow their prescribed diets, and lose weight until they approach their goal weights. But most have doubts at some point. Those doubts can be strong especially in the first few weeks after surgery. I see this lack of confidence time and time again in the forums. Weeks or a month after surgery, gastric sleeve, gastric bypass, lap-band, and other Weight Loss Surgery (WLS) patients start to wonder whether Weight Loss Surgery was the right choice. Most often, they are disappointing in the number of pounds they have lost, and they wonder, “Am I going to be the Weight Loss Surgery patient who fails?” I can say this with confidence: If you follow the Weight Loss Surgery diet, you’ll lose weight. “I’m Not Losing Weight Fast Enough!” That’s a common post on BariatricPal. The poster is usually a week or a few weeks post-op, and worries their weight loss isn’t fast enough. They think their “slow” rate of weight loss means Weight Loss Surgery didn’t “work” for them. They think they will never be able to lose significant amounts of weight, since WLS was a last-ditch effort to lose weight and get healthy after years of dieting didn’t work. But in most cases, these fears just aren’t true. Don’t misunderstand me. I’m not saying these fears are unreasonable. I understand them perfectly. I, and probably every Weight Loss Surgery patient, wondered whether it would work for me. And the answer for me, and for everyone who followed their Weight Loss Surgery diet, was “YES!” The Perfect Storm for Frustration So why the panic? I like to think of the first few weeks or even months after weight loss surgery as a perfect storm for generating doubts. It’s a time when the following are true. You realize you have made a decision that led to a change to your body that is irreversible (in the case of sleeve gastrectomy) or meant to be permanent (in the case of the gastric bypass), or You realize a lifetime commitment to changing your eating habits and lifestyle is a pretty big deal. You have not eaten solid foods for weeks, or even more if you had a liquid diet for long before surgery, and it’s getting you down. You are struggling in your daily life as you try to make time for exercise or you find your family members continue to eat junk food in front of you. All that is enough to get anyone down before you even start thinking about the reason you got the surgery in the first place – to lose weight! If you doubt you’re losing weight “fast enough”, you might start wondering if you made the wrong decision when you got Weight Loss Surgery – and that’s a depressing thought. Crunching the Numbers Almost without fail, the BariatricPal member who posts about disappointing early weight loss is losing weight quite quickly. The only person who is disappointed in this number, typically, is the member him or herself. I’ve seen members post with concerns about losing “only” 20 pounds in the first month, or “only” 10 pounds in the first week. Guess what. That’s great! Think about it. A general round number for great first-year weight loss after Weight Loss Surgery is 100 pounds. That’s an average of 2 pounds a week, or 8 pounds a month. If you lost 20 lbs in your first month, you’re doing fantastic! To hit 100 pounds in your first year, you won’t even lose a pound every three days! So don’t worry if the scale doesn’t plummet every single day. If you’re eating right, you’ll lose weight. Try to keep yourself motivated by keeping it all in perspective. Another motivating thought is to consider how long it took you to gain the extra weight. 5 years? 10 years? Your whole life? And now you have a chance to lose it within 1 or 2 or 5 years? That’s a pretty good bargain, right? Recovery Now for Weight Loss Later Now, I know you’ve prepared for Weight Loss Surgery for a long time, and you’re eager to lose weight. But really, you’re not quite ready to focus on weight loss if you’re still recovering from surgery. It’s far more important to heal properly. That’ll help you lose weight faster later and avoid complications that’ll set you back, not to mention cause possibly serious health problems. So, no matter how frustrated you are, stay positive, and focus on following your surgeon and nutritionist’s instructions to the letter. Continue to eat a liquid diet and then pureed foods without cheating and sneaking in solid foods. Use this time to establish a pattern for your long-term success. Learn to measure your food, and to set aside time for food prep and for exercise. Weight loss surgery is a lifetime adventure, and that realization can really hit hard in the early days and weeks post-op. You can get through this tough period by focusing on one day at a time and not worrying about your rate of weight loss. Measure your success not by the scale number, but by how well you stick to your plan.

Dr. Adeyeri, Thanks for this article for those of us (myself included) who can find the scale creeping up. It’s a good reminder to take responsibility and face reality instead of denying the weight gain or acting like we’re not sure why the scale is going up. Thanks for the great advice. Going back to the beginning always works. Reaching out for help at support groups and anywhere else is good, too, because it helps us hold ourselves accountable. I’d also suggest troubleshooting – sitting down to try to figure out where we might be going wrong. Small changes can creep in without us noticing beforehand, and make us gain weight. Thanks for the article!

Quick! Obesity is killing you! You need to drop weight and get your life back. What do you do? Do you exercise four hours a day? Or do you go for weight loss surgery? Dr. Huizenga of the Biggest Loser and colleagues asked exactly that question – and you can bet what they concluded. The first two articles in this series looked at their research. It compared Biggest Loser methods to bariatric surgery and reported findings on weight loss and other effects. As it turns out (spoiler alert if you haven’t read the previous articles in this series!), weight loss is faster among Biggest Loser contestants, at least for the first 7 months. And then? Who knows? The gastric bypass patients in the study continued to lose weight through 12 months, while the Biggest Loser contestants…weren’t even tracked. Who knows what they weighed at 12 months and beyond? The research raises a lot of other questions for me. Here are the ones I would like to ask Dr. Huizenga, with each question followed by an explanation of what I am curious about. Cost is obviously an important factor for almost everyone. Can you please explain your reasoning in saying a program like the Biggest Loser is more cost-effective than weight loss surgery? Exercise for four hours a day – cheap, right? In theory, sure. Just join a gym for $60 a month and work out as much as you want. But is it really that simple? Not really, if you’re an average human being. Take a look at the Biggest Loser contestants’ program. They didn’t just have access to a gym. They had trainers 6 days a week, a room away from real-world worries and temptations, and all the healthy foods they could dream of, not to mention medical care as needed. Value? Well, at a value of $2,500 per week (as listed on the Biggest Loser Resort website), contestants who were on the ranch for 13 weeks received a package valued at $32,500. That doesn’t include any additional support, like contact with trainers after the show was over. There’s no getting around the fact that weight loss surgery has a big price tag of $5,000 or $10,000 or $25,000. But that’s only if you’re paying out of pocket, and it’s still less than the first 13 weeks of a Biggest Loser style weight loss program. Get some insurance reimbursement, and you could get surgery for free or for a reduced cost. Plus, you don’t need to leave your job for a few months to live at the ranch – another cost in itself. Why do you believe slowed metabolism is more significant in weight loss surgery patients compared to Biggest Loser contestants? You found a slowed metabolism in Biggest Loser contestants compared to gastric bypass patients at 7 months. You attributed the slow to contestants losing weight for the show’s finale…but the weight loss surgery patients in your study were also still losing weight at that time? One of the reasons you promote intense exercise over weight loss surgery is because patients maintain more lean muscle mass and metabolism when they work out…but this didn’t seem to be a huge benefit in your study! Can you please provide a sample day that includes four hours of daily exercise and that individuals could follow on a long-term basis to lose weight? Okay, Dr. Huizenga says exercise can come out of television time, but I’m having trouble thinking of a daily schedule that includes four hours of exercise and still lets someone take care of the family and work. Here’s how I see it: wake up at 4:30, work out from 5:00 to 7:00 (thus missing your kids waking up), take kids to school, go to work by 8:30, walk on your lunch hour (that’s your hour 3 of exercise), get off work at 5, pick up kids, run errands, and get home by 6, have dinner at 6:30, work out from 7 to 8 (thus missing family time), put kids to bed, go to bed at 8:30 for a solid 8 hours of sleep. Fun life! (Not!). Maybe you can drop some of your duties for a few weeks, but for the months or years it takes to hit goal weight? That’s just not realistic. And how much exercise is necessary for maintenance? I guess the study didn’t say…because it didn’t follow the Biggest Loser contestants for more than 7 months. People aren’t supervised on a daily basis like they are on Biggest Loser. Is it safe to exercise for 4 hours a day, especially when we’re talking about people who may not have this kind of background? Most people don’t have access to trainers and medical support the way Biggest Loser contestants do. And, people who are 100 or 200 lb. overweight aren’t generally used to exercising for hours a day (let’s face it: except for athletes, most people aren’t). How do they know what to do? How can they prevent injuries? Are there any health risks associated with exercising to the extreme? How do you explain these health values? Most of the health values improved with weight loss, but some of the Biggest Loser contestants’ values got worse. Why do you think “bad” LDL cholesterol increased by about 20 percent, and total cholesterol also increased significantly? What are the long-term results in Biggest Loser contestants? The show has been airing since 2004, and it has just completed Season 16. You must be in touch with some of these contestants and have the ability to contact others. What are their long-term results? Have they kept the weight off? There are plenty of studies on long-term effectiveness of weight loss surgery. Most find that bariatric surgery is generally effective for weight control and improvements in health conditions such as diabetes, arthritic pain, and sleep apnea, for example. Many studies conclude that among people who are eligible for weight loss surgery, the ones who get surgery do better than the ones who don’t. Is it really justified to say exercise is better than weight loss surgery when there is no evidence supporting that?