Alex Brecher

Jean, Thanks for yet another bit of your wisdom. Yes, weight loss surgery helped me lose almost a whole person, both in weight and in personality, as in eating too much and sitting on the couch instead of being active and really living. And you are right that “person” is not necessarily entirely lost all the time. Now, well over 10 years post-op, the healthy behaviors are pretty much habitual, but the old devils are still calling. Sometimes they call louder than other times. Hearing them, and occasionally giving in to them, reminds me where I came from and why I don’t want to go back.

Thanks for this next ingredient in the recipe for success in the Journey to Recovery! Attitude is so important. You provide such great examples of how it can affect our own journeys and the people around us. I think it’s also important to recognize each situation can have more than one “best” attitude. Or example, you could also be “GENEROUS” to your sister-in-law by waiting until the two of you are alone, and then offering any help she might want in getting healthy. One thing that’s great about attitude is the control we each have over our own. We cannot control other people and things but we can control our own attitudes and reactions, and that in turn affects what happens next. When confronted by an unexpected or new situation, it never hurts to take a few seconds to think about the best way to respond to get the best results. Having a good attitude and healthy reactions to different situations become habit when we practice it. Thanks for this help!

Dr. Huberman, Thank you for this fabulous article! Every part of it is spot on! I really appreciate how you classify emotional eating as a habit, just like eating in other situations when we’re not hungry is a habit. Each of your suggestions for preventing emotional eating is so helpful. It is unbelievable how effective it can be to simply train yourself to delay eating for 30 seconds. If you can delay 30 seconds, you may be able to delay for a minute, and then 5, and then 30, until the urge passes or it really is time to eat. Or in those 30 seconds, you might be able to talk yourself out of it, or find something more productive to do, like prepare for that meeting! It is also amazing how little we actually do allow ourselves to feel emotions sometimes, often without even realizing we’re suppressing or avoiding our feelings. Getting to know what they feel like can be scary at first, but so worthwhile because we can become accustomed to feeling them and dealing with them instead of hiding with food (even if it is subconscious, not deliberate, suppression). Thank you again for these great explanations and suggestions.

Great article(s)! Almost fell off my chair when I got to #10!

Many weight loss surgery patients find they turn to salads…a lot! Salads can be low-calorie, high-protein, quick to make, and easy to make for one person or a family – all important factors for a lot of BariatricPal members! With spring greens hitting stores, farmers’ markets, and maybe even your own garden, it only makes sense that May is National Salad Month! Not all salads are created equal, though. Make or buy a salad without thinking about its nutrient content, and you could get in 1000 calories while thinking you’re making a healthy choice! A pecan-crusted chicken salad from TGI Fridays has 1080 calories, and a Carolina chicken salad from Ruby Tuesday has 1117 calories. We thought we’d take a little time to think about salads so you can keep yours healthy and anything but boring. The Basic Salad – Green and Lean Your surgeon or nutritionist may have talked to you about building salads. They’re great for main courses if you keep them low-calorie and eat them slowly. The key is to use a foundation of greens since they’re so low in calories. Choose your favorite kind of lettuce, whether Romaine, red leaf, or another kind, or use spinach, baby greens, or spring greens. Be generous! Then, add the protein. You can keep it as simple as a scoop of canned tuna or a couple ounces of turkey breast. Leftovers are great in salads – when cooking, make an extra chicken breast or turkey burger to add to tomorrow’s salad. Egg whites, beans, low-fat feta or other cheese, and tofu are other easy protein additions. Next, it’s time to get fun with your salad. Add in whatever vegetables you like, whether it’s traditional tomatoes, cucumbers, mushrooms, and onions or snow peas, bell pepper strips, and carrot slices. A bit of fruit can liven up your salad, so think about berries, diced apple or pear, and mandarin orange segments. Don’t be afraid to experiment with herbs, whether it’s basil, cilantro or even mint. The salad will be a masterpiece, and the variations are unlimited! Side Salads – Greens and Beyond A salad doesn’t have to be the centerpiece of your meal. Side salads can be just what the doctor ordered. Have a simple green salad to your protein entrée, and your meal will be bigger with hardly any extra calories. You can have plain lettuce or spinach, or add cucumbers, tomatoes, or onions. As always, watch out for dressings and croutons. Salads go way beyond greens. You can substitute salads for sides to keep your meal low-calorie but filling. Serve one or two salads next to your grilled chicken, broiled fish, or turkey meatloaf. Instead of mashed potatoes, rice, or pasta, serve three-bean salad, egg salad made with egg whites and Greek yogurt, coleslaw made with light Asian dressing, grilled pepper salad with rosemary, or sugar snap pea with barley and balsamic vinegar. Here are a few tips. Except for greens and other raw veggies, keep your portions small. Watch for oils in prepared salads like marinated artichoke hearts and marinated mushrooms. Stay away from calorie disasters, like pasta salad and tuna salad with mayonnaise. Your “side salads” are sides…unless they take the place of main courses. If you’re having tabbouleh with bulgur, three-bean salad, and caprese salad with mozzarella and tomatoes, you’re eating protein, and you’re eating healthy. You’re also eating enough! You don’t need a main course in addition to those nutritious but hefty salads. Fruit Salad – Something Sweet and Healthy While we’re on the subject, what about fruit salads? We say…go for it! Better a fruit salad for dessert than an ice cream sundae or a piece of cake. Make your own ambrosia salad with fresh fruit and no sugar added vanilla Greek yogurt, or top your oatmeal with fruit salad instead of brown sugar. You can also get creative and make a side dish such as strawberry, tomato, and cilantro salad. Warning: you may not be able to handle much fruit if you have gastric bypass or gastric sleeve. Fruit contains sugar, and it can give you dumping syndrome. Ask your doctor, and see what your body can tolerate. Know the Pitfalls What are the differences between a 1,000-calorie salad disaster, and a reasonable weight loss surgery-friendly salad? You can learn to recognize and avoid the ingredients that can wreck your good intentions. Too much dressing – a quarter-cup can have 300 calories. Fatty meats, such as bacon, salami, pepperoni, and bologna. Too much cheese. Fatty carbs, such as croutons (they’re essentially buttered toast!), chow mein noodles, and crunchy onion rings. Mayonnaise – avoid traditional pasta, egg, seafood (and crab), and tuna salad, and coleslaw. Too much dried fruit – it’s healthy but high-calorie and high-sugar. A half-cup of raisins or dried cherries has 260 calories and more sugar than a can of soda. Dumping syndrome, anyone? Learning how to keep those salads nutritious and low-calorie can be a key to your long-lasting weight loss after weight loss surgery. Why not use National Salad Month as an excuse to practice? Buy fresh and interesting greens, and see how you can mix up the add-ons to create delicious salads. You may not even miss the junk food they’re replacing!

Thanks for the great article. It is so true that acceptance is a critical part of living a healthier and happier and higher-quality life, which, as you point out, is the point of WLS. We have to accept that life will not be perfect, but it can sure be better if we do our best to acknowledge our struggles and figure out how to manage them. I also appreciate your reminder that others may or may not accept our struggles because so often, we act based on what other people think, and not always based on what is healthiest for us. Also, we need to face our struggles and our need to deal with food, not deny it. One thing that helps me with acceptance of as part of the process of recovering from obesity is remembering that life isn’t perfect for anyone. I may have – and dislike – my struggles with obesity, but other people have other struggles that maybe I don’t have and maybe they dislike just as much. None of us have the perfect life, and we all have to accept that the best we can hope for and work towards is the best possible situation for us.

Wow, what an inspiring and meaningful article!! Thanks, Kendra!!!

Here’s the scenario. You’re obese or morbidly obese, maybe 100 or 200 or 300 pounds overweight. You haven’t been able to lose weight on your own with diet and exercise. You don’t respect yourself. You’re looking at a future with joint pain, heart disease, diabetes, and sleep apnea, or maybe you already have some obesity-related health conditions. What do you do? Weight loss surgery? Or going “Biggest Loser” style? In the first part of the series, we looked at a recent study comparing results of weight loss with NBC’s “Biggest Loser” to weight loss with weight loss surgery. At least in the short term, weight loss was similar, with Biggest Loser contestants coming out ahead at 7 months with the gap narrowing by 12 months. Some articles and research are available, but wouldn’t it be nice if there were a way to compare Biggest Loser and bariatric surgery side by side? Here’s our summary of how the groups lost weight and what the results were. Methods In case you’re not aware, the “Biggest Loser” is a reality television show that is a weight loss competition. Morbidly obese contestant compete on the Biggest Loser ranch to lose the most weight. Every 7 to 10 days for 13 weeks, a contestant is voted off and eliminated from the competition. From week 13 to 30, the remaining contestants go home and return for the finale, where the contestant who has lost the most weight is crowned the Biggest Loser winner. They lose weight with intense exercise and a restricted diet. This study compared roux-en-Y gastric bypass (RYGB) patients. They lose weight because their smaller stomach forces them to eat smaller meals. In addition, they need to limit sweets and fatty foods to avoid gastrointestinal symptoms. Diet Biggest Loser contestants ate similar amounts of to RYGB patients. In the Biggest Loser, contestants ate at least 70 percent of their baseline needs, calculated by a formula based on their fat-free mass. A contestant who weighs 220 pounds and has 50 percent body fat would be asked to eat at least 1,000 calories per day. The diet includes lean protein, fruits, and vegetables, and restricts processed foods. In comparison, RYGB patients often eat a similar number of calories. They too focus on protein, followed by vegetables and fruits. Also, they limit sugary and fatty processed foods. Exercise Here’s the big difference. Four hours of exercise a day, anyone? Biggest Loser contestants exercise 90 minutes per day six days a week with the trainers, plus up to 3 hours daily on their own. That adds up to up to 31.5 hours a week – basically a job! Weight loss surgery patients are asked to exercise, but to work up to it. They may have goals such as working up to 20 or 30 minutes daily, and getting up to 60 to 90 minutes most days over the long run. The Logistics: Support and Cost Biggest Loser contestants have a lot of support. On the show, they see a trainer six days a week. They have a doctor – Dr. Huizenga – to monitor their health and progress. In contrast, most RYGB are on their own – they don’t have the luxury of a trainer each day. They tend to follow-up with their surgeon once or a few times over the months following surgery. They may have support groups to help. Bariatric surgery is expensive, no question. The procedure, plus pre-op workups and post-op appointments, can be thousands or tens of thousands of dollars. Biggest Loser? Diet and exercise sound inexpensive, but can you afford to exercise for 31.5 hours a week? Can you afford to see a doctor whenever you want? What about the cost of benefits provided to contestants, such as having room and board at a weight loss resort for several weeks? The list price for a guest at a Biggest Loser Resort is about $2,500 weekly. For 13 weeks, as on the Biggest Loser, that’s a cost of $32,500. Makes RYGB seem cheap! Weight Loss What about the important thing – weight loss? Turns out the results are pretty similar…at least in the beginning. After 7 months, the Biggest Loser group lost an average of 108 pounds, while RYGB patients were at an average of 78 pounds down. By 12 months, RYGB patients were down by 89 lb. on average. And Biggest Loser patients? They were no longer being followed – who knows what happened after their season of the show ended? It stays a little cloudy later on, too. Biggest Loser hasn’t published statistics on the long-term success of its contestants. In contrast, RYGB has been shown to be successful in studies that have tracked patients for 5 or even 10 years. Health Effects Both groups had improvements in some measurements of health. Blood pressure, blood sugar, chronic inflammation, and “good” HDL cholesterol improved. Strangely enough, Biggest Loser contestants had an average increase of total cholesterol from 168 to 192, and of “bad” LDL cholesterol from 105 to 126. Also curious was the decrease in metabolic rate – or the number of calories burned at rest. Biggest Loser contestants’ metabolisms dropped more the RYGB patients’, even though Biggest Loser contestants maintained more of their lean tissue while dropping more fat. Okay, so what’s the take-home message? One might be that the way that is best for you to lose weight depends on your individual situation. If you have the time and money to train Biggest Loser-style, maybe you would prefer that to going under the knife. If you need a permanent tool for long-term assistance with losing weight, and maybe even if your health insurance will chip in, weight loss surgery may be for you. What do you think?

Thanks for this article and for linking to and explaining the research behind the recommendations for amount of Protein intake. If I’m understanding correctly, it looks like it’s very possible to achieve the recommended ranges for protein intake within each window of meal plus snack as long as you’re a little careful with what you choose. That’s right in line with what I’ve been taught – choose protein first at meals and Snacks, then go for veggies since they’re nutritious, filling, and low-calorie. Then go for fruit and healthy starches. It looks like as long as you try to include high-protein options at each eating occasion, the numbers should work themselves out – even if you don’t want to eat meat 6 times a day. Thanks for going over the numbers so carefully and providing meal and snack suggestions! Very useful information.

Thanks for your article and advice – right on point! It is always great to have delicious and healthy recipes that you can re-use in different ways! It’s also easy to add spinach to bolognaise sauce. You can layer it with eggplant and/or zucchini slices. I also like to use it as a dressing for salad sometimes. For the Mexican style mince – sounds great! Another Pasta substitute is spaghetti squash or even shirataki noodles. Great ideas here – it’s always easier to motivate yourself to cook if you know it’ll be easy, healthy, and reusable. Thanks for your article!

Nutritional deficiencies are a major concern after weight loss surgery. You eat less food, so you eat fewer nutrients. Sleeve and bypass patients absorb fewer nutrients. You eat less fat, which makes it harder to absorb fat-soluble nutrients like vitamin A. Some bariatric surgery patients take one or two multivitamins, plus an entire barrage of high-dose vitamin and mineral supplements. Others barely take any supplements. Which should you be taking? How do you even know whether you need a supplement? Can you prevent deficiencies just by eating a better diet? VITAMIN A – Vision, immunity, and healthy red blood cells Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS Very low-fat diet Food Sources Orange fruits (mango, cantaloupe) Orange vegetables (carrots, sweet potatoes, Green vegetables (kale, spinach) Liver Deficiency Information Blood test: serum retinol (vitamin A) Consequences of deficiency: impaired vision; changes in iron metabolism Supplement Notes High doses can be toxic – take only if your doctor prescribes them. VITAMIN D – Calcium metabolism and bone health, affects immune function and heart health Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS Very low-fat diet Little skin exposure to sun, live in northern climate, or older age Food Sources Fatty fish (salmon, herring, mackerel) Fortified milk Egg yolks (if you are a bariatric surgery patient, you might mostly be eating egg whites) Some fortified cereals Deficiency Information Blood test: 25-hydroxyvitamin D Consequences of deficiency: osteoporosis (low bone mineral density and higher risk for fractures); possible higher risk for heart disease Supplement Notes High doses can be toxic – take only if your doctor prescribes them. Need for supplementation is very common. VITAMIN B12 – Healthy red blood cells, homocysteine metabolism (important in heart health) Risk for Deficiency WLS that reduces nutrient absorption: gastric bypass, gastric sleeve, BPD-DS. Plant-based diet. Heavy bleeding: e.g., complication after WLS) Older age Food Sources Animal-based foods: meat, fish, poultry, dairy products, eggs Some fortified cereals Deficiency Information Blood test: vitamin B12 Blood test: CBC (complete blood count) Consequences of deficiency: risk of heart disease; megaloblastic anemia; permanent neurological damage; osteoporosis; depression Supplement Notes High doses not likely to be toxic. Supplements may be necessary if you are on antacids such as proton pump inhibitors FOLIC ACID – Healthy red blood cells, homocysteine metabolism (important in heart health), prevention of neural tube defects (for pregnant women) Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS Low dietary intake – especially when grain intake is low after weight loss surgery Food Sources Fortified grains (most grains in the U.S.): including spaghetti, bread, cereal Lentils Asparagus Orange juice Spinach Lima beans Deficiency Information Blood test: serum folate Blood test: homocysteine Consequences of deficiency: cognitive dysfunction; neural tube defects; megaloblastic anemia Supplement Notes High doses can hide vitamin B12 deficiencies. CALCIUM – Bone health, muscle function Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y, gastric bypass, BPD-DS Diet low in dairy products – either because of lactose intolerance or other reasons (such as avoiding milk because of the calories). Food Sources Dairy products: milk, cheese, yogurt (choose fat-free) Fortified milk substitutes (almond milk, soy milk) Fortified orange juice Canned bony fish (salmon, sardines) Green leafy vegetables (absorption is poor) Some fortified cereals Tofu Deficiency Information Blood test: calcium levels – note: this is not a good test for adequate calcium! You can have normal test results and still not have enough calcium in your diet! Dietary intake analysis: see if you get at least 1,200 to 1,500 milligrams per day from your diet. Rough estimate of dietary intake: at least 4 servings of high-calcium foods each day Consequences of deficiency: decreased bone mineral density (osteoporosis and higher risk for bone fractures) Supplement Notes Taking too much calcium can cause kidney stones and be bad for the heart. Ask your doctor how much calcium you should take in a multivitamin and as a calcium (or calcium and vitamin D or calcium and magnesium) supplement. Don’t take your calcium supplement at the same time as iron because you will interfere with absorption IRON – Healthy red blood cells, energy and other metabolism Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y, gastric bypass, BPD-DS Vegetarian or vegan (plant-based) diet Adolescents and women of child-bearing age. Individuals with excessive bleeding (such as with a post-op complication) Food Sources Fortified grains (most grains in the U.S.): including spaghetti, bread, cereal Meat, seafood, and poultry (animal-based sources have a more absorbable form of iron) Beans and lentils Green vegetables, such as spinach, kale, broccoli Potatoes Raisins Deficiency Information Blood test: serum iron/Fe Blood test: ferritin Blood test: total iron binding capacity (TIBC) (high value means low iron status) Blood test: hemoglobin and hematocrit Supplement Notes Iron supplements can be toxic even if your dose is not that high. Don’t take them unless your doctor prescribes them. That includes iron in multivitamins. Don’t take iron supplements at the together with calcium supplements. Try to take supplements with vitamin C (in food or as a supplement) to increase absorption. THE OTHERS The above deficiencies are most common among weight loss surgery patients, but other deficiencies are possible. You are at risk because of your low food intake as you restrict calories. Malabsorptive procedures, such as gastric bypass and gastric sleeve, also put you at risk. Ask your doctor if you are concerned about any of the following vitamins and minerals. Often, a simple blood test or even a run-through of your daily diet can help you figure out if you need an additional supplement over your daily multivitamin and mineral supplement. B vitamins: B1 (thiamin), B2 (riboflavin), B3 (niacin) Vitamin C Vitamin K Magnesium Zinc The Bottom Line Nutritional deficiencies are a big risk after weight loss surgery, but they depend on a few different factors. Type of weight loss surgery – sleeve and bypass patients are more prone to nutrient deficiencies than lap-band patients. Your diet – eat protein first and choose nutritious foods to lower your risk of deficiencies. Genetics and other uncontrollable factors – women are more likely to need iron supplements, for example, than men. Megadoses of vitamin and minerals can be toxic, so don’t prescribe them for yourself. Instead, contact your surgeon or regular doctor. Simple tests can often let you know your nutrient status so you can know which nutrients to supplement.

Love it, hate it or ignore it completely, the “Biggest Loser” on NBC is one of America’s favorite shows. Millions of viewers tune in each week to watch contestants weigh in as they shed pounds during this inspirational weight loss competition. If you are a bariatric surgery patient or candidate, however, this inspirational show can be bittersweet. You root for each contestant because you understand their fight against obesity. But if you have been a long-time viewer, you may also cringe regularly. That’s because of the show’s history of devaluing weight loss surgery as a legitimate weight loss aid. More than once, Biggest Loser trainers and the head doctor, Dr. Robert Huizenga, have stated Biggest Loser methods is a better way to lose weight than surgery, which they imply is dangerous and an inappropriate solution in all cases. New Study: Biggest Loser versus Bariatric Surgery Are these obesity experts right to discourage weight loss surgery in the national spotlight? Or should they acknowledge bariatric surgery as a possibly beneficial weight loss approach? A lot of us would love to know more about the weight loss program on the Biggest Loser competition and how its results are compared to weight loss surgery. Now, we can. Dr. Huizenga has published a study comparing Biggest Loser to weight loss surgery – in particular, gastric bypass. It answers a lot of questions…and raises a lot, too! Here are the basics of the study. The Study Groups The study compared 13 contestants on the Biggest Loser to 13 roux-en-Y gastric bypass patients. The weight loss surgery patients followed their surgeon’s standard program, including the weight loss surgery diet and any required post-surgery follow-up care and support. Biggest Loser contestants were on the Biggest Loser Ranch until week 13 or until they got voted off and were at home until the finale. While on the ranch, they exercised for 90 minutes 6 days a week under supervision and were encouraged to exercise up to three additional hours each day on their own. Their diet included lean protein, fruits, and vegetables, and limited sugars, fats, and processed grains. The Results By seven months, or the time between the start of the Biggest Loser season and the show’s finale, Biggest Loser contestants were ahead of bariatric surgery patients. The average Biggest Loser weight loss was 108 pounds while weight loss surgery patients averaged a loss of 78 pounds. By the end of the year, weight loss surgery patients got to an average loss of 89 pounds. In addition, Biggest Loser contestants lost less muscle and more body fat. However, they also had a lower resting metabolism – that is, they burned fewer calories per day than the weight loss surgery patients. That means they are more likely to put the weight back on. These are the key findings. Biggest Loser contestants lost more weight at 7 months, but the gap narrowed by 12 months. Biggest Loser contestants lost more body fat. Weight loss surgery patients had a higher metabolism. Weight loss surgery patients had lower levels of leptin, a hormone related to hunger. Dr. Huizenga’s Conclusions…Leading to More Unanswered Questions? Dr. Huizenga believes this study is a compelling argument against bariatric surgery. He refers to the risk of death (1 in 1,000) from bariatric surgery, as well as the high cost of surgery. He acknowledges the high injury rates of contestants but believes these can be treated with orthopedic techniques and surgery. Hopefully, you know a good orthopedic surgeon and have good medical insurance! Do You Watch TV for Four to Six Hours a Day? The Biggest Loser includes 90 minutes per day of exercise under the watch of Biggest Loser trainers, plus contestants are encouraged to exercise up to another three hours a day on their own. Do you have a spare four and a half hours each day? Dr. Huizenga has a solution. He says most people spend 4 to 6 hours per day watching television. He suggests you could spend that time exercising instead. Indeed, a Nielsen survey backs him up. However, while the numbers may sound reasonable, can that be true in real life? Do you really watch TV for that many hours each day? When you “watch” TV, are you just watching TV (and are, therefore, available to do exercise instead), or are you already doing something else, like folding laundry or cooking dinner? Are you willing to exercise that long each day? Are you physically able to exercise that long each day? To sum it up, this is an interesting study. Certainly nobody actually wants bariatric surgery – but is there an alternative? Can you follow a Biggest Loser lifestyle and get the results you want? Dr. Huizenga thinks so, but we have our doubts. Coming up, we’ll have an easy-to-read comparison of Biggest Loser and bariatric surgery. Then, we have a few final questions to raise about the study. Stay tuned! If you’re interested in reading the original research article by Dr. Huizenga and his colleagues at the National Institutes of Health, Vanderbilt University, and Pennington Biomedical Research Center, you can go here.

Weight loss surgery can be a godsend. Getting the surgery could be the best decision you ever make. It can give you your life back and help you become healthier than you have been in years – or ever before. But what you need to do to stick to your new lifestyle isn’t so different from what other healthy people need to do. If you want to be thin and fit, you need to think and act like a thin and fit person. Bariatric Surgery: Necessary But Not Sufficient Weight loss surgery is a significant part of the solution to surgery. If you can’t lose weight without it, it’s necessary. But, on its own, it’s not sufficient for weight loss. As every weight loss surgery patient knows, weight loss surgery only works when you add other components, like a healthier lifestyle, to lose weight permanently. Don’t Give Up It’s easy to start feeling sorry for yourself when regular diets don’t work for you. You may feel that your doctor’s recommendation to get weight loss surgery is official recognition that your obesity is out of your control. After weight loss surgery, it can seem like you’re still working harder than the “skinny” people, and you may feel like giving up. There’s no point in feeling doomed to obesity. Don’t bother resenting your “bad luck” with obesity. The truth is that most fit and healthy people need to work hard at it, just like you do. Have a Plan Don’t leave things up to chance. Skinny people may not have as many dietary restrictions and requirements as you, but you can bet many of them think carefully about what they eat. They plan what they’ll order at a restaurant, and you should, too. They’ll also compensate for oversized meals by exercising a little extra or eating a little less at the next meal. Be Honest Are you really acting like a skinny person? Their behaviors are the same as many of the rules you’re supposed to be following on your weight loss diet. If you’re not losing weight like you think you should be, look carefully at your habits. Are you ending your meal when you’re barely full, or eating for another reason, such as eating to keep everyone else company while they eat? Are you driving straight home, or passing through the drive-thru? Are you drinking only water between planned meals and snacks, or are you getting in calories from juice and sweetened coffee drinks? Are you eating only at the table, or are you nibbling while standing? Watch your skinny coworkers and even housemates carefully, and you may start to notice some of their good habits. They may be lucky enough have those habits formed naturally while you need to work a little harder on them, but you can do it. Ask Away Yes, you’ll see a lot of skinny people doing a lot of things you wouldn’t dare try because you’d be afraid of gaining weight. They may pack away a hot dog, an ice cream sandwich, and a few beers at a baseball game, or munch their way through a bag of potato chips with dip while watching television. Ask them how they get away with it if it’s your friend or someone in your family and you feel comfortable enough. You may get a frustrating answer (“I eat whatever I want and don’t worry about it.”), but you may get something helpful (“I eat very carefully six days a week so I can veg out and eat chips on Sunday” or “I knew I wanted to relax and enjoy myself at the game, so I worked out for an extra hour this morning to burn a few extra calories”). These tips can reinforce the strategies you already know and add to your collection of strategies. They can also help you realize that everyone works hard at staying fit and thin – weight loss surgery or not. You may not be allowed to eat an ice cream sandwich and drink beer on your weight loss surgery diet, but you can exercise ahead of time as a strategy against If You Can’t Beat ‘Em, Join ‘Em Until you hit goal weight, you may be most self-conscious about your weight when you’re at the gym. You’re likely to be surrounded by fit people with strong-looking and lean bodies. Don’t just think of these people as another species. Instead, use them to your advantage. Strike up a conversation with them, being careful not to interrupt their workouts. Catch them while you’re both on the elliptical, bike, or treadmill, or when they’re done with their workout. Some people will let you know that they’re not interested in making friends at the gym. Don’t take it personally – it has nothing to do with your fitness level, weight, or personality. Some people just go to the gym because they want to feel alone. Other people will be delighted to talk to you. Most people love talking about themselves, including their workout schedule and goals. They’ll be happy to give you pointers. You can learn what they do to stay in shape, and how often they hit the gym. Possibly most inspirational of all is what you’ll learn about their dedication to their health. They had to get up just as early as you, they’re just as busy as you, and they worry about their diets just as much as you – and they make it a priority to get to the gym almost every day. It Comes Down to Attitude So much of your weight loss journey success depends on your attitude. When you feel like you’re working harder than everyone else, you may be tempted to stop trying. Once you realize that everyone needs to work hard to be fit and healthy, you’re more likely to stay committed. Act skinny, and you’ll hit your goal weight.

Pandora, Thanks for the article and the reminder that machines at the gym are notoriously generous with the calorie burn they claim! You’re absolutely right that these numbers can be very misleading and add up to big mistakes when you’re trying to lose weight by counting every calorie burned. I don’t know how true it is, but I’ve heard a good rule of thumb for ellipticals is to subtract about one-third of the calories they tell you (so if they say 300 calories, subtract 100 and you’ve probably burned 200). That’s about what you suggested – 20 to 40%. A lot of times, if it sounds too good to be true, it is.

Rene, Thanks for this article! You make a lot of good points. Breakfast is such an interesting topic. There is some research supporting your points, and breakfast is commonly believed to be crucial. But, there is research questioning a few things. For example, does breakfast eating cause those benefits, or does something else that influences people to eat breakfast also lead to the benefits you cite? And, is it better to eat breakfast and have lower hunger (but possibly higher caloric intake in the day) or be hungry but keep calories lower? And does And even, what is breakfast? Does the definition depend on when and how much you ate for dinner? So, it seems to me that it comes back to the same thing it often does…eat right in the best way possible for you. If that means eating breakfast to keep you on track, reduce cravings, and hit your nutrient goals, go for it! Either way, keep calories in check and get enough Protein. Thanks for the food suggestions for healthy breakfasts – quick and easy!

My son created something very similar for his 4th-grade science project: Makes me so proud!

She truly is! Ask her and please let us know.... http://www.bariatricpal.com/user/248078-pandora-williams/ .

Kelly, Thanks for your article. It is so true that we all have an inner beast. The first instinct is to give in to it, like we did before surgery, and we can’t really do that because the consequences are so severe and quick! The second instinct is to try to ignore the voice or pretend it doesn’t exist…but it does, and running from it will just lead to trouble. As you say, the best thing is to recognize it. I love how you name it (“the beast”) so you can face it head-on. What a great strategy! When you recognize, define, and face your enemy, you can defeat it. You can strategize how not to give in to the voice. Thanks for the valuable lesson!

Jaime “Pandora” Williams has not had anything handed to her. She has worked hard for everything she has, including every pound of her 250-lb weight loss. From weight loss surgery and overcoming food addiction to figuring out how to deal with her father’s death to paying for training for a new career, Pandora has kept moving forward and earned her spot as one of our weight loss surgery heroes. Jaime “Pandora” Williams has not had anything handed to her. She has worked hard for everything she has, including every pound of her 250-lb weight loss. From weight loss surgery and overcoming food addiction to figuring out how to deal with her father’s death to paying for training for a new career, Pandora has kept moving forward and earned her spot as one of our weight loss surgery heroes. Throughout it all, she has kept her determination to help others. She has shared every step of her journey on her Desperately Seeking Slender blog, and has made a career as a weight loss and wellness coach. Find out how Pandora Williams, who was “Desperately Seeking Slender,” turned her life around and is helping others do the same! Struggling with Weight from Childhood to Early Adulthood Pandora comes from a family that did not eat healthy. They ate fast food often, and home cooked meals were likely to be tacos, pot roast and potatoes, and other high-calorie foods. She remembers father loving his sweets, and her mother struggled with weight gain and obesity after quitting smoking. With a diet of cheeseburgers and chicken nuggets, not surprisingly, Pandora had been overweight since childhood. She hit the 400-lb. mark 4 years after graduating high school, and also had chronic depression, diabetes, and sleep apnea. Atkins and intense exercise helped her get down to 225 lbs. before getting married, but the weight came back after marriage. Weight Loss Surgery and a New Lifestyle Pandora wanted weight loss surgery, but put it off for a few years because she couldn’t afford it. She got serious when her health insurance began to cover it, and got the Roux-en-Y gastric bypass in 2010. She chronicled her entire weight loss journey on her blog. She lost 100 pounds by December of 2010, 200 pounds six months later in June of 2011, and entered “Onederland” (under 200 pounds) in October of 2011. Now, she maintains a weight of 165 lb. – quite a difference from her highest BMI of 69.9! Needless to say, she threw away the old habits of eating a half-gallon of ice cream or a dozen tacos. She worked hard to overcome her food addiction. Portion control and measuring were new behaviors she had to follow. Now, five years post-op, she is able to get away without writing down every bite when things are going right. Still, she keeps herself on track by food journaling and calorie counting the second she is unsure of herself, whether because of a jump on the scale or a high-sodium day. Pandora follows a carb cycling plan where she eats higher and lower amounts of carbs on alternating days. She’s an exercise addict, and that also helps her keep her weight in check. Body Image and Reconstructive Surgery Despite maintaining a healthy weight and feeling more confident in overcoming her food addiction, Pandora says her body image is a bit of a struggle. She has had 6 rounds of reconstructive surgery, and still has trouble accepting the mistakes she made in the past with her body and health. A Life-Changing Letter to Chris Powell! By August of 2012, Pandora’s weight was well under control, but she was not satisfied with that. She wanted to help others do the same. She knew she had the “the passion, desire to help, and love” for people who were struggling with their weight, because she knew exactly what they were struggling with. What she needed was help figuring out how to help them, and she just couldn’t get in touch with someone who could guide her. Then, in August of 2012, Pandora wrote a letter to Chris Powell, the celebrity trainer on “Extreme Makeover.” After some persistence, she managed to get her letter to him, and she received a reply! He posted an encouraging message on Facebook, and that was enough to keep her motivated. Since then, she has had a couple more interactions with him on social media – including an encouraging message when she was feeling down – and was able to meet him in Hollywood at the Extreme Makeover Finale. She considers him and his wife Heidi an inspiration. A Day in the Life Between taking care of herself and helping others be the best they can be, Pandora is very busy! Here is a typical day in her life. 8:00 a.m. Wake up, food prep, get ready for work. Coffee, coffee, coffee! 9:30 a.m. Arrive at the gym. May do a 4 to 5-mile run or take a group exercise class like yoga before work. 10:30 a.m. Breakfast: Quest protein bar. 11:00 a.m. Start work - working the front desk and doing either one-on-one training or weight loss/wellness coaching sessions. 12:30 p.m. Lunch: Veggies (cucumber slices, cherry tomatoes, baby carrots): about five of each and either some low-sodium turkey breast with low-fat Swiss cheese or some hard-boiled egg whites filled with chicken salad made with a Greek yogurt base and green onions. 2:30 p.m. Snack: Usually a container of Greek yogurt or some homemade steel cut oats from home. 3:00 p.m. Leads a weight loss boot camp group training session with light weights and cardio – usually works out with the group. 5:00 p.m. Snack: Usually a piece of fruit like an apple or an orange, or a banana on higher-mileage days. 7:00 p.m. Leads a weight loss boot camp group training session with light weights and cardio – usually works out with the group. 8:30 p.m. Finishes running for the day if she didn’t get in an early morning run or get more than 5 miles already that day. 10:00 p.m. Home/Shower/Dinner: usually a lean protein like baked chicken or turkey and steamed veggies. Uses spices and changes the vegetables a lot for variety. Includes a serving of brown rice, couscous, quinoa or whole wheat pasta on days she eats carbs. 11:00 p.m. Snack: Usually Greek yogurt, no sugar added ice cream sandwich, a frozen protein bar, or an extra-thick protein shake. 12:00 a.m. Bedtime Pandora tries to run longer distances after work if she doesn’t get to work out during her weight loss boot camp classes. Her days off on Sundays and some Thursdays may include an extra kickboxing class, a spin class, or a run over 10 miles. New Lifestyle, New Career, and Paying It Forward. As a morbidly obese high school graduate, Pandora had been limited in her career options. She made a living working from home at jobs such as customer support and data entry. Since losing weight and getting healthy, she has thrown herself into something she is passionate about – helping others get and stay healthy through lifestyle. Now, Pandora works as a weight loss and wellness coach at a ladies-only fitness facility gym, and has earned multiple certifications in the fitness and coaching industry. She also pays it forward as a weight loss surgery advocate. She has spoken at the Obesity Action Coalition and Weight Loss Surgery Foundation of America (WLSFA), as well as at other bariatric support clinics and groups. She publishes articles regularly, including here on BariatricPal! You can follow Pandora on Desperately Seeking Slender and on Facebook and Twitter @SeekingSlender.

This is a tough one, and I don’t use marijuana so I can’t speak from personal experience. Like the others, I would worry about two things. One would be the possibility of a replacement addiction – would you start to depend on marijuana more frequently for a high if you were not using food to get a high? My other concern would be if using marijuana made you eat more, whether from increased appetite or from decreased inhibition. If you are planning to continue to use it only once a week and you are aware of the risks of overeating, maybe you can take steps to prevent overeating, such as eating a salad that night. This definitely sounds like something you should ask your doctor, and also ask about the immediate post-surgery stage when you are recovering. Good luck!

Thanks for posting this. What an interesting study – it shows what a deep-rooted problem sugar consumption is among American children. Even parents who want the best for their children are giving them sugary beverages, which are linked to obesity, diabetes, and heart disease. It is so important to be aware of what we are giving our children. Sugary drinks are the top source of added sugars, ahead of the more “obvious” sources such as candy and Desserts. Children’s overall sugar consumption has decreased in recent years, but consumption of sugar-sweetened beverages is still rampant. Thanks for this article!

Thanks for this recipe. It’s a good one for any chilly day, not just St. Patrick’s Day! You can also give it a little twist and cut the carbs by switching half the potatoes for sweet potatoes and the other half of the potatoes for turnips. I love the suggestion to serve it with a salad!

Thanks for continuing your series here! I loved the way you looked at relationships as mirrors to your soul in Part 1. Here, I like your points about unconditional love and about actions coming from love and fear. At some point, we need to let go and trust in a relationship, and hopefully it will all work out.

Amanda, Thanks for this great visual. It always helps to see an image to help understand exactly how much sugar we are talking about. It is shocking how much sugar is in some of these beverages. Coffee beverages are another high-sugar beverage – for example, a latte can have 20 or more grams of sugar. Another way to help put these high-sugar beverages in perspective is to compare them to sweets – something like a cookie might have 20 grams of sugar – or less than the amount in a soda.

Thanks for these guidelines! Packing a lunch really can be the difference between a healthy diet and a “stall” because if you go for fast food or the vending machine, you can end up with hundreds of extra calories and tons of sugar. I love the recipe ideas you’ve suggested! Another kind of prepared salad you can make on the weekend is bean salad – it can give you the satisfaction of a grain salad, but it’s a little higher in Protein. It’s easy if you use regular or low-sodium canned Beans, such as garbanzo, pinto, or black. Also, throw in some green beans. Add vinegar and spices such as cumin and black pepper. You can add some sweetener. The night before you want to take it for lunch, or that morning, you can add fresh tomatoes and cilantro, or diced red peppers and onions. On your list of quick items to grab and snack items, I’d also add soy nuts and edamame. They’re high-protein and fun to eat.