Alex Brecher

Personally, about two years ago I went from 8 cups and a Keurig on my office desk to 0 cups and a poland spring water fountain instead :-)

Caffeine is a part of daily life for millions of Americans. Some people limit themselves to a single mug of half-calf to help them wake up in the morning, while others depend on the drug at all times of the day. There’s the morning cup of coffee to wake you up, the travel mug on your morning commute as you fight traffic, the morning coffee break to help you focus, and the afternoon pick-me-up soda. For most people, this drug is about as harmless as a drug can be. It wakes you up, keeps you mentally sharp, and even helps you burn a little extra fat. There aren’t many serious health risks, as long as you don’t have too much. For weight loss surgery patients, though, caffeine is a bit of a bigger deal. Find out what it can do to your body, how much is safe to have after surgery, and where to find it. Caffeine and Your Digestive Tract Caffeine is an acid, and it can irritate the lining of your stomach pouch or sleeve. This is true whether you have the lap-band, vertical sleeve gastrectomy, or gastric bypass. One way to prevent symptoms is to make sure you don’t have your caffeine on an empty stomach. However, that’s not really possible when your weight loss surgery diet doesn’t allow you to have beverages at the same time as solid food! Limiting your consumption is the best way to avoid trouble. Caffeine and Acid Reflux Acid reflux occurs when acid from your stomach comes up into your esophagus or throat, causing symptoms like heartburn or an acid taste in your mouth. Acid reflux is considered gastro esophageal reflux disease (GERD) if it persists. Weight loss surgery often helps with GERD, since obesity is one of the main factors. However, you can still get GERD after weight loss surgery, especially if you have the lap-band. What does all this have to do with caffeine? Coffee and other source of caffeine are among the foods beverages that make acid reflux worse. There are plenty of other risky foods, such as citrus fruits, spicy foods, fried foods, and garlic. If you do choose to have caffeine, just be watchful for signs of acid reflux and ask your doctor if you think there may be a connection between caffeine and your symptoms. Does Caffeine Dehydrate You? Staying hydrated is a big deal after weight loss surgery because it’s so important and so tough. It helps keep you full and healthy, and you can only do it if you plan carefully and pay attention to your fluid intake. Coffee and caffeinated diet iced teas and other drinks may seem like a great alternative to water, which can get pretty boring. Unfortunately, caffeine is a diuretic. That means it increases the amount of water your body loses. That means it helps dehydrate you. It’s not a serious problem if you don’t have too much caffeine and if you’re drinking plenty of other liquids, especially water. If you’re already struggling to hit your 8 to 10 cups of water a day, though, you might want to think seriously about skipping the caffeine so you don’t get dehydrated. Caffeine and Your Nutrient Status One of the most serious problems with too much caffeine for bariatric surgery patients is that it interferes with nutrient consumption. This comes at a time when you’re fighting hard to give your body the nutrients it needs through healthy eating and supplements. Caffeine reduces your body’s absorption of two key nutrients: calcium and iron. Miss out on your calcium, and you’re at risk for developing osteoporosis and a high risk for bone fractures later on. Skip the iron, and you could get anemia, making yourself tired and weak. If you do choose to have caffeine, make sure it’s not at the same time you’re taking your nutritional supplements. How Much Caffeine Is Safe? There’s no single recommended amount of caffeine that’s best for everyone. The right amount for you depends on a variety of factors. How it affects you. The type of surgery you have. Your surgeon’s recommendations. A good amount for many bariatric surgery patients who can’t face the thought of quitting might be a cup in the morning to get you awake. Cutting Back on Caffeine If you’re addicted, cutting back on caffeine can be challenging. You can get some headaches, feel groggy and cranky, and get constipated. These symptoms only last a few days, though, and you can use them as motivation to take good care of yourself. That’s because healthy behaviors like getting enough sleep, exercising, and drinking enough water can help reduce withdrawal symptoms. If you’re trying to have less caffeine, it’s helpful to know the sources. Everyone knows about coffee, but there are plenty of other places where you might find caffeine. Hot and iced coffee and coffee drinks. Hot and iced tea. Diet and non-diet energy drinks, including 5-Hour Energy. Some over-the-counter migraine, pain, and cold and flu medications. Caffeine has a lot of uses in everyday life, and it’s not necessarily a bad drug. But, after weight loss surgery, it can be a problem if you have too much. If you love your coffee, ask your surgeon how much you can have to make sure you don’t harm yourself while you’re working so hard to get healthy and fit.

After weight loss surgery, eating right involves fighting a lot of temptations. You pay constant attention to make sure you choose nutritious, low-calorie foods and don’t eat too much. You probably manage to eat right most days, but for many weight loss surgery patients, you slip up occasionally. Often, it’s for an unnecessary reason, such as letting your guard down and forgetting to monitor your portion size, or feeling pressure from someone else to overeat. Following are some of the common reasons why people overeat. Each is a bad reason to overeat, yet you might catch yourself using it as an excuse. Thinking about these reasons can help you recognize when you’re about to use them as an excuse to overeat, and hopefully help you resist. “Children are starving in Africa.” Yes, they are. There are also starving children in Asia, and in South America. It is extremely sad that hundreds of millions of children are starving. Do you know how many of them you will help if you clean your plate instead of throwing the extra food away? Zero. When you serve yourself extra food, you have three choices for the extras. Throw them away. Use your body as a trash can, and eat them. Store them in the fridge and eat them later. None of these options helps to feed starving kids, and you hurt yourself if you choose the option to use your body as a trash can. What’s the point? If you’re really so eager to be in the “Clean Plate Club,” serve yourself less to begin with. And if you want to help starving children in Africa, make a donation using the money you save by not eating as much. “I only get to eat this once a year.” Everyone has a few annual favorites. Maybe your aunt makes a Thanksgiving pecan pie from your great-grandmother’s secret recipe, your mom has baked you the same triple chocolate fudge cake for your birthday since you were five years old, or your annual trip to the coast wouldn’t be complete without a crab sandwich from a family restaurant that’s been in business for decades. That’s great! There’s no reason not to enjoy your special treat unless, of course, it gives you dumping syndrome or threatens to stick in your band. But you don’t need 10 servings. One serving is enough. Even if you only get the chance to eat the dish once a year, you’re not going to make it last any longer by cramming in more servings. Plus, the guilt from eating too much just isn’t worth it. Serve yourself one small portion, and savor every bite. Think about the taste of the food, how it feels in your mouth, and what memories it brings to mind. Then think about how good it feels to be in control of yourself and able to enjoy the single serving instead of planning how soon you can go and serve yourself more without people noticing. “I made it just for you!” You invite your parents over for dinner, and your mother-in-law brings a container of freshly baked red velvet cupcakes with cream cheese frosting. You loved it when she brought these cupcakes over, until you got weight loss surgery a few months ago and told everyone that you just can’t eat these kinds of desserts anymore. Everyone has situations like this, whether it’s a loving parent who shows his love by feeding you, or a friend who brings you a box of gourmet chocolates from a vacation in Belgium. You can tell them a million times that you don’t eat that way, but they just don’t seem to get it. You can feel trapped when you’re faced with your old, high-calorie favorite foods. What can you say and do without offending anyone and without letting yourself down? These are a few options. “Thanks, but I can’t eat that anymore. The sugar could make me sick, and I’d rather stay healthy and get to spend the afternoon with you instead of in bed.” “Thanks, but I can’t eat that. My doctor told me I can’t have doughy foods because they can cause problems with my lap-band.” “That was so kind of you to bring me this candy from your trip! You know how much I love this kind, but I can’t eat it right now. It’s so sugary that I could end up feeling sick. Thank you, though!” “Thanks, but I’m not hungry right now. It sure looks good, though. You really put a lot of effort into making it!” If you’ve tried your best to make people understand that you don’t want their high-calorie treats but they keep pressuring you to indulge, you can tell a little white lie. You can tell them that maybe you’ll have some later even if you don’t intend to. Sticking to your diet takes a lot of thought and caution. As soon as you stop being so careful, you’re likely to overeat. If you’ve been using these absurd excuses as a reason to eat food you know you shouldn’t, it’s time to admit it and figure out how to overcome temptation.

If you struggle with obesity, you probably already face or are worried about getting a variety of health conditions, such as heart disease, high blood pressure, arthritis, and asthma. Type 2 diabetes is another obesity-related condition that can affect you and lead to scary complications if you’re unable to control your blood sugar. You can use diabetes medications to help control your blood sugar levels, but often, weight loss surgery and the right diet can be even better. Reminder: the Importance of Diabetes If you don’t have diabetes, someone in your family might if obesity runs in your family. You may remember a parent, aunt or uncle, or grandparent who had diabetes and suffered from complications. 29 million Americans, or 9.3 percent of the population, have diabetes, or high blood sugar, and most cases are linked to obesity. Type 2 diabetes is the seventh-leading cause of death in the U.S., but it gets worse. It’s a risk factor for heart disease and high blood pressure, stroke, and high cholesterol. Uncontrolled blood sugar can lead to kidney failure, blindness, infections, and amputations. In total, the U.S. spends about $245 billion per year on diabetes. Medications for Diabetes Diabetes medications can help keep your blood sugar in check in various ways. The following are some common types of diabetes medications. Increase insulin sensitivity. Reduce the amount of sugar your liver releases to the bloodstream. Increase insulin production. Prevent the kidney from reabsorbing sugars. Slow down metabolism of sugars and starches. Diabetes medications help, but each type has drawbacks. They can cause weight gain, increase your risk of infections, harm your heart, and lead to nausea and vomiting. Unless you’re on a good health plan, these medications can also be expensive. The Effects of Weight Loss Surgery on Diabetes When considering weight loss surgery, you probably think about the number on the scale, how nice it will be to shop at regular clothes stores, having more energy, and improving your heart health. It turns out that weight loss surgery has a big effect on diabetes, too. People who get weight loss surgery often see their blood sugar levels drop and are able to decrease their medication doses or get off of medications entirely. You’d expect to have improvements in diabetes if you lose a lot of weight after weight loss surgery. After all, your diabetes was probably caused by obesity. Whether or not you get surgery, you’re likely to have better control over your blood sugar levels if you lose a lot of weight. However, it turns out that weight loss surgery has a bigger impact on diabetes than what you’d expect just from losing weight alone. In some studies, patients have had their blood sugars lowered as soon as a few days after surgery! In just a few days, you can’t lose enough weight to explain the drop is blood sugar. There must be another explanation. As it turns out, researchers do have a lot of theories about what causes the health improvements so quickly. It may have something to do with the way your body processes carbohydrates. There could be increases in insulin sensitivity. Multiple hormones are probably involved. Researchers don’t know all of the reasons for sure, but these results are pretty consistent. The gastric bypass is most likely best at resolving diabetes quickly, following be the vertical sleeve gastrectomy. The lap-band isn’t as effective, but lap-band patients do tend to see at least some improvements. Each type of weight loss surgery has its own advantages and disadvantages, so be sure to ask your surgeon for advice. The Weight Loss Surgery Diet and Diabetes Surgery is only part of the solution to controlling diabetes or preventing pre-diabetes from developing into diabetes. If you want maximum benefits and lasting effects, you also need to take a look at your nutrition. For weeks, months, and years after weight loss surgery, your diet will largely determine your weight loss and blood sugar levels. Fortunately, the weight loss surgery diet is also a diet that can lower your blood sugar levels. First, stick to your low-calorie diet. If you’re not counting calories, serve yourself only the portions and types of foods that your surgeon allows. The low-calorie diet lets you lose weight and as you do, you’ll find that your blood sugar is in a healthier range. Next, there’s the protein content. You already know that you need to focus on protein on your weight loss surgery diet. It keeps you full to help you lose weight, and prevents symptoms of protein deficiency. Another benefit is that it doesn’t spike your blood sugar and insulin levels like carbohydrates do. When you eat fewer carbs and more protein, your blood sugar levels will be more stable. There are a few other ways you can plan your weight loss surgery diet to also be healthy for your blood sugar. Better yet, these tips will also make your diet higher in nutrients. Instead of refined grains, select whole grains, such as oatmeal and whole wheat bread and pasta, whenever possible. Eat plenty of vegetables, since they’re filling, low-calorie, and unlikely to spike your blood sugar. Choose unsaturated fats, such as olive oil, instead of saturated fats, such as butter, to promote heart health and better control your blood sugar. Eat high-fiber foods, such as whole grains, vegetables, beans, and fruit, to feel less hungry and to prevent blood sugar spikes. Type 2 diabetes can be an inconvenient disease to manage, and it can cause all kinds of devastating complications. If you have diabetes or prediabetes and are thinking about weight loss surgery, it’s important to know the facts. Weight loss surgery can help resolve your diabetes and get you off medication, but it’s not likely to be too effective without a good diet, too. Just like with weight loss, weight loss surgery is a tool for diabetes management, and you need to follow a healthy nutrition plan to get the maximum results.

Since you first started looking into weight loss surgery, you’ve probably been hearing a lot about the importance of protein. You need at least 60 to 80 grams a day for the following reasons: It’s a filling nutrient that helps you lose weight by decreasing hunger. It’s an essential nutrient for healthy skin, hair, nails, hormones, and enzymes. It helps stop you from losing too much muscle while you lose body fat. Almost everyone needs protein supplements right after weight loss surgery. Protein shakes and powders give you the protein you need when you’re not allowed to eat solid foods. But which types should you choose? And should you keep using them when you’re eating solid foods and surgery is long behind you? Protein for the Liquid Phase of the Post Weight Loss Surgery Diet Progression After a day or two of sticking to clear liquids, you progress to a full liquid diet. You can be on this diet for a few days, if you’re a lap-band patient, or a couple of weeks, if you have the gastric sleeve or gastric bypass. Protein sources include the following. Non-fat milk, with 90 calories and 8 grams of protein per 8 ounces. Non-fat milk powder, with 100 calories and 10 grams of protein per ounce. Low-sugar protein powder, with 110 calories and 25 grams of protein per ounce. Low-sugar protein shakes, with 100 or more calories and 15 or more grams of protein per 8 ounces. Without supplementing your diet with protein shakes and powders, you’re not going to be able to hit your 60 to 80 grams of protein. Protein Powders and Shakes in the Pureed Foods Phase This phase is really a transition phase. You’re adding foods back into your diet, but aren’t yet ready to eat chewy, sticky, crunchy, or other solid foods. Protein foods include the following. Non-fat cottage cheese, with 12 grams of protein per half-cup. Non-fat ricotta cheese, with 5 grams of protein per half-cup. Egg whites, with 4 grams of protein per extra-large white. Non-fat Greek or regular yogurt, with 8 to 14 grams of protein per container. During this phase, your surgeon will probably have you start to decrease your use of protein shakes and powders, but will probably recommend keeping them in your diet to help you get to 60 to 80 grams of protein per day. You might need one or two shakes a day, plus powder in foods such as oatmeal, yogurt, or pureed potatoes. Be Wary of Protein Supplements in the Long-Term Protein shakes and powders can be convenient, but they’re not your best bet for long-term weight loss. As you progress from pureed foods to semi-solid and then solid foods, your surgeon will probably recommend that you stop drinking shakes and focus instead on solid sources of protein. They’re more substantial and satisfying than liquid shakes. They take longer to eat than drinking shakes. They’re easier to fit into a real-life eating plan. You won’t be “drinking your calories.” They have more natural nutrients than processed shakes and powders. Most weight loss surgery patients can get enough protein just by choosing one or two high-protein foods for each meal. You’ll get 60 to 80 grams with the following foods. Breakfast: 2 scrambled egg whites with ½ light English muffin and some fruit. Lunch: ½ cup fat-free cottage cheese and a green salad with 3 ounces of canned light tuna. Dinner: 3 ounces of chicken breast and steamed spinach. Snack 1: 1 low-fat cheese stick. Snack 2: 1 6-ounce container of plain low-fat yogurt and ½ cup carrot sticks. When Protein Supplements Are Okay Still, some weight loss surgery patients may still need protein shakes and powders in the long term. That’s often the case for vertical sleeve patients if your sleeve fills up too quickly to allow you to eat enough solid protein throughout the day. Talk to your surgeon to find out whether you should still use shakes and powders. Your surgeon might suggest that you include one or two protein shakes a day as snacks or mix protein powder into your yogurt, cereal or other foods. Protein supplements can still come in handy even if you’re able to meet your protein requirements on your daily weight loss surgery diet. If your routine gets interrupted, you might come up short. Consider the protein you can miss if you need to change your regular plans for a meal or snack. 10 grams of protein if you run out the door without grabbing your yogurt in the morning. 22 grams of protein if you forget to pack your tuna for lunch. 26 grams of protein if you’re stuck in a meeting instead of cooking your chicken dinner at home. When you’re stuck in the car or too busy to plan ahead, protein shakes can be lifesavers. On vacation, you can take protein powder with you so you’re always sure to have a source when you need it. You could also try Unjury Protein’d Cheese Sauce on steamed vegetables for an extra 21 grams of protein. Read the Nutrition Facts Panel to Find Protein Content The Food and Drug Administration lets food manufacturers call a food “a good source of” protein if it has at least 5 grams of protein. If a serving has at least 10 grams of protein, a food can be labeled “high,” “rich in,” or “an excellent source of” protein. That doesn’t do you much good if you’re trying to find a shake or powder with at least 15 to 20 grams of protein per serving. Don’t rely on a claim on the front of the label when you’re looking for a protein supplement. You could end up with a “high-protein” shake with only 10 grams of protein! Instead, check the nutrition facts panel to see how many grams of protein the food or shake has per serving. Check the Label for Calories and Sugar Protein shakes and powders can be high in calories and sugar. A bottle of Special K Protein has only 10 grams of protein, but 190 calories and 18 grams of sugar. A Pure Protein Frosty Chocolate Shake has 15 grams of protein, but 190 calories and 25 grams of sugar. A can of Boost High Protein drink has 15 grams of protein, 240 calories and 27 grams of sugars. No matter which stage of your weight loss surgery diet you’re on, you can’t afford to eat too many calories or too much sugar. The only way to protect yourself is to read the labels. Protein supplements can be great choices for boosting your intake to 60 to 80 grams a day. Shakes and powders can get you through the liquid and pureed foods stages of the post-surgery diet progression, and they can have a place in your diet even when you reach your long-term weight loss surgery diet plan. Just make sure not to overuse them if your surgeon is concerned, and to choose low-sugar options.

I added the actual video clip of Rosie on The View to my original post.

You can join in on my convo with Rosie at https://twitter.com/Rosie/status/515475737269510144

I strongly believe that all procedures are safe and effective and that the choice of weight loss procedure is between the patient and their surgeon. Here are key data points for the Safety and Efficacy of the LAP-BAND: 1. The LAP-BAND is the only FDA-Approved device for patients with a BMI of >30 with a comorbidity or BMI>40 LAP-BAND for Lower BMI: 2-Year Results from the Multicenter Pivotal Study Obesity (2013) 21:1148–1158. doi:10.1002/oby.20477, Robert Michaelson, et al. · 149 Patients · BMI of 30 -39.9 w/ Comorbidities · Primary Endpoint - >40% of subjects achieved >30% EWL at 1 year · Results: o 84.6% achieved >30% EWL at 1 year o 65% Mean EWL at 1 year · Conclusion - LAGB is safe and effective for people with 30-30.9 BMI, with weight loss and co-morbidity improvement through at least 2 years. 2. The LAP-BAND has shown Long-Term success when patients are managed with appropriate aftercare Long-Term Outcomes After Bariatric Surgery: Fifteen-Year Follow-Up of Adjustable Gastric Banding and a Systematic Review of the Bariatric Surgical Literature Annals of Surgery , Volume 257, Number 1, January 2013, Paul E. O’Brien, et al. · 50.5% EWL at 3 Years · 49.6% EWL at 5 Years · 47% EWL at 10 Years · 47.2% EWL at 15 years · 3227 patients, 714 with 10+ years follow-up only 5.6% removal rate for the entire group 3. The LAP-BAND has been shown as safe or safer than any other bariatric procedure There are a number of databases that healthcare organizations and professionals use to monitor bariatric procedures after surgery. A recent review of data from the American Society for Metabolic and Bariatric Surgery and the American College of Surgeons databases showed the following: LAGB Sleeve RYGB Total Complications 6% 18% 24% Reoperation Rate 1% 3% 5% Hospital Stay After Procedure Less than 1 day Approximately 3 days Approximately 3 days Illness After 30 Days 1% 6% 6% · 75% lower 30-day morbidity compared to sleeve (ACS – Hutter 2011) · 1/3 the complications compared to sleeve through 1 year (BOLD – DeMaria 2010) · 68% lower readmission rate than sleeve (ACS – Hutter 2011) · 1/3 the reoperation rate compared to sleeve (ACS – Hutter 2011) · Shorter length of stay than sleeve and bypass (ACS – Hutter 2011)

On Wednesday, ABC’s “The View” included a tactless segment for weight loss surgery patients. In it, Rosie O’Donnell said that she disagreed with New Jersey Governor Chris Christie’s choice to get the laparoscopic adjustable gastric band (lap-band), calling it an “inefficient” way to lose weight. Ms. O’Donnell herself is a gastric sleeve patient who had struggled with her weight throughout her professional life. She got the procedure done in July of 2013, and has since lost about 50 pounds. Upsetting Effects of Ms. O’Donnell’s Words Ms. O’Donnell not only insulted Governor Christie, but also every lap-band patient. She stated outright that the lap-band has a 50 percent rate of removal, and is an inefficient way to lose weight. She strongly implied that anyone who gets the lap-band chooses to do so because they haven’t done enough research. This kind of divisiveness between weight loss surgery patients is harmful to everyone who is affected by obesity. Weight loss surgery can literally save lives and give people back their quality of life. It can be the only way to lose weight for many people. The only way to improve weight loss surgery outcomes and acceptance is to provide a unified front. When someone like Ms. O’Donnell bashes lap-band surgery, it only adds to the public’s general misconception of weight loss surgery as a foolish choice. The Lap-Band Is a Good Choice for Many The gastric sleeve is the right choice for some weight loss surgery patients, and it may have been the right choice for Ms. O’Donnell. For other patients, the lap-band is the right choice – and, in contrast to Ms. O’Donnell’s accusations, they can arrive at that decision after careful research. They may be hesitant to permanently remove most of the stomach, as in the gastric sleeve, and may value the ability to adjust their bands. There’s no shortage of evidence that the lap-band can work. In fact, it may even be working for Governor Christie! He will not publicly discuss specific numbers, but he’s clearly lost weight since getting the lap-band in February of 2013. Rumor has it he’s down 85 pounds, but he hasn’t confirmed this amount. A Better Choice of Words Ms. O’Donnell is certainly entitled to her opinion, but it doesn’t seem necessary for an influential celebrity to insult all lap-band patients in front of millions of viewers on national television. She could easily have praised the gastric sleeve and all that it has done for her without bashing the lap-band. She could have discussed why she chose the sleeve over the lap-band and gastric bypass. She could have praised Governor Christie for his weight loss without insulting his choice of weight loss surgery. How Can “The View” Make Amends? “The View” could have handled the situation a little differently. The show could have done something as simple as asking Ms. O’Donnell for evidence for her claims. For example, where did she learn that half of all lap-bands are removed? That flies in the face of what patients learn from their surgeons, who spend years studying the lap-band and other types of weight loss surgery. There’s still time to make amends and show weight loss surgery patients some respect. “The View” could dedicate a segment of a future show to discussing weight loss surgery more accurately. Any number of bariatric surgeons and allied health professionals could serve as credible guests in an informative interview. Make Your Voice Heard! What you think matters to Hollywood celebrities and TV shows. Their success depends on your approval and continued support. If you want to weigh in on how you feel about Ms. O’Donnell’s insensitive comment about the lap-band, why not tell her and “The View” what you’re thinking? You can tweet them at @Rosie and @theviewTV to explain how hurtful her words were. They’re on Facebook at https://www.facebook.com/RosieODonnellOfficial and https://www.facebook.com/TheView. Ms. O’Donnell may benefit from learning that the lap-band is a good choice for some weight loss surgery patients, and “The View” may learn that the show needs to take responsibility for presenting a more accurate picture of this – and any other – sensitive topic.

In 2001, Yvonne McCarthy from Dallas, Texas, decided to get healthy. She hit the ground running and never looked back as she committed to weight loss surgery and learned to manage her food addiction. Her Open Roux-en-Y gastric bypass surgery 13 years ago helped Yvonne lose half of her body weight and keep it off for over a decade. Yvonne has used her weight loss surgery experience to help others. She spends over 80 hours a week advocating for bariatric surgery patients as “Bariatric Girl.” She answers emails and posts on Facebook and from her blog to advocate for weight loss surgery and support people who are fighting obesity just like she did. That’s like working two full-time jobs – for free! Being a great role model and giving back to the weight loss surgery community are what make Yvonne a true weight loss surgery hero. Don’t miss seeing Yvonne’s website or Bariatric Girl Facebook page, You Tube Channel and follow @BariatricGirl on Twitter! She’ll share her experience on bariatric surgery, and you’ll get to learn more about this talented woman’s photography and music! First, read Yvonne McCarthy’s story and our interview with her here. Finding Out How Heavy People Get Treated Yvonne was a strong and athletic girl. That worked out well when it came time to pick teams at school, but her athletic abilities weren’t needed or appreciated elsewhere. Instead, she quickly learned that bigger girls aren’t welcomed. She says, “I figured out pretty young how being different made people treat you badly.” Puberty hit hard, and the dieting started in fourth grade. Yvonne’s struggles got worse through college and beyond. She nearly turned anorexic during her college years, but “couldn’t keep it up.” After college, she “did every diet known to man” and each time, she gained back all the weight she’d lost plus a few pounds. Her highest recorded weight was 260 pounds. Didn’t Listen When They Said Not to Have “Unrealistic Expectations” Yvonne got gastric bypass in 2001. At that time, the bypass was only offered as an open surgery, not as a laparoscopic procedure. She went into surgery with the intention of hitting a “normal” body weight (BMI under 25), and didn’t listen when surgeons warned her not to have “unrealistic expectations.” She followed the prescribed diet and lost 130 pounds in the first 13 months! Yvonne now weighs exactly what she weighed in college over 40 years ago. Never Going Back to “Prison” Yvonne says she has a “really healthy memory of 30 years of obesity” and refuses “to return to that prison [that she] couldn’t break out from.” Post-op care wasn’t a standard part of care in 2001, and she didn’t see another post-op until three years later! She just stuck to the diet because she thought she had to, and she hasn’t strayed more than five pounds from her goal weight! “I assumed that you lost the weight and “IF” you regained that you should fix it while it’s small. When I attended my first weight loss surgery event everyone asked me how I kept it off. I literally didn’t know any better.” By that time, she’d developed the good habits that she maintains today. Learning to Manage an Addiction to Food Some people eat to fill a void. Some eat out of boredom. Others eat for comfort, or to manage stress. Yvonne discovered that she ate to cope with feelings she didn’t want to have. She had a food addiction. She says, “I was fortunate that I chose to work on my head just as much. I am passionate about the acknowledgement of the existence of food addiction and when I admitted I was an addict, I was able to take steps to work on the root problems that fueled my addiction. I don’t know how many years ago I started doing this but today I eat very boring things and practically the same food every day. I can no longer have “sex in a plate” so my food has to be just like the fuel you put in your car.” No More Junk Food The days of eating junk food are over for Yvonne. She’s not comfortable eating it for fear that she’ll fuel her addiction and regain the weight. “ I can’t eat just one so I quit craving sugar and junk food because I quit eating it completely. I haven’t had cake, pie, cookies, candy etc. in 13 years and I don’t even remember what it tastes like. I feel very strongly that if you wish to lose a craving that you need to quit eating it. “You wouldn’t give an alcoholic a sip of beer to get past the craving….why do we think that works with food? There are some people that can eat that stuff and maintain and I’m happy for them but I don’t know very many that can.” The Need to Support Others Yvonne didn’t just go against the grain by setting, achieving, and maintaining a goal of 130 pounds. She also didn’t know that the “only” way to lose weight and keep it off is to have a strong support system. So, she managed to succeed without the standard support system only because there were none and she was forced to figure out her “head” on her own. Yvonne turned to the Obesity Help forums and her profile there transitioned into her blog. Over the years, she “saw the exact same patterns over and over and I felt a passion to help warn others of what was coming down the road.” A Life Dedicated to Helping Others She felt obligated to help others because her own “unique situation of not seeing another post-op for 3 years in the beginning saved me because if I had seen even one other person regain I would have thought, ‘I’m nobody special and if they can’t keep it off, I can’t either.’” Bariatric Girl to the Rescue! Yvonne has done the majority of her advocacy as “Bariatric Girl.” She maintains a website and blog, You Tube channel, and stays active on her Bariatric Girl Facebook page and Twitter. She answers emails and Facebook messages, and even takes phone calls to help others with their struggles and questions. Yvonne now spends over 80 hours a week as a volunteer with the goal of supporting others who are considering weight loss surgery or who are already weight loss surgery patients. “Since the sun and the moon and the stars lined up for me I felt like I didn’t have the right to not help others by sharing the experiences of the thousands of people I’ve communicated with over the years.” In addition, Yvonne has spoken at many events and volunteered for many organizations by taking photographs and videos at events. Her other advocacy work includes: Former faculty with the Weight Loss Surgery Channel. Host of the channel’s Weight Loss Surgery Journeys, a program that included interviews with recent bariatric surgery patients. Member of Apollo Endosurgery Patient Executive Council. Three-year service on the Board of Directors of Weight Loss Surgery Foundation of America, which advocates for bariatric surgery patients and provides grants to deserving patients who can’t afford weight loss surgery on their own. Every weight loss surgery patient and candidate wants to hear success stories. These stories are sources of hope because they’re about people who used to feel hopeless and out of control, but who found weight loss surgery as a solution. Yvonne was able to use the gastric bypass surgery as a tool to learn to manage her food addiction and turn over a new leaf. Yvonne is more than just a story, though. She gives her knowledge, love, and support to others who are struggling with their weight and who are weight loss surgery patients. It’s rare to find someone as giving and dedicated as Yvonne is, and everyone whose lives she has touched is grateful.

Nutritional deficiencies are among the common risks of weight loss surgery. Calcium deficiency in particular can be a serious problem because it may not show up until years or even decades have passed and you are diagnosed with osteoporosis, or weak bones. Osteoporosis can cause: Broken ribs from something as innocent as coughing or sneezing. Broken hips and wrists from falling. Broken ankles from stepping off a curb. Loss of height and back pain from vertebral compression in your spine. You can take charge of your bone health. Learn why calcium can help, and how you can get enough calcium after weight loss surgery. Bone Loss Is Irreversible Obesity is a serious disease that’s tough to overcome, but there is at least one positive thing about obesity: it is reversible. Hard as it may be, you can lose weight and get your health back. After losing weight, you may have lower blood pressure, sugar, and cholesterol levels, less joint pain, and more energy than you’ve had in years. That’s not true with your bones. Your bone density increases from birth until your mid or late 20s. After your skeleton is mature and you reach peak bone mass, your bone density decreases for the rest of your life. Your job is to keep the decreases as slow as possible to preserve your bone mass. Bone Health is for Everyone A lot of people think that osteoporosis is something that only frail, older women need to worry about. That’s just not true. Men and women of all ages need to think about bone health after weight loss surgery. Younger weight loss surgery patients are still building bone mass. If you get weight loss surgery before your late 20s, you may never reach your highest possible peak bone mass. Middle aged adults need to protect bone mass so you’re not at high risk for fractures when you get older. Women around menopause are already losing bone density quickly. If you don’t protect yourself after weight loss surgery, you could quickly develop osteoporosis even if you had healthy bones a few years ago. Men have higher bone density than women, but you can still get osteoporosis. Your risk increases as you get older, and you don’t want weight loss surgery to increase your risk. Calcium in Your Body Most of the calcium in your body is in your bones, but 1 percent of the calcium is in your blood and other tissues. Calcium is necessary for vital processes, like muscle contraction, hormone secretion, blood pressure regulation, and sending nerve impulses. Calcium levels in your blood are very tightly monitored. If blood levels of calcium drop, you need more calcium in your blood. Ideally, your body uses calcium from your diet to bring calcium levels back to normal. This works well when you get enough calcium in your diet. If you don’t, your bones suffer. That’s because your body pulls calcium from your bones to put in your blood when there’s no dietary calcium available. Your bones slowly get weaker every time this happens. Why Bone Loss Is a Problem After Weight Loss Surgery It’s harder to get enough calcium from your diet when you lose weight fast. That’s why you're at high risk for osteoporosis after weight loss surgery. You’re eating less food overall. You’re cutting out liquid calories, such as from milk. You’re cutting way back on junk foods that have calcium, such as pizza, fortified but sugary breakfast cereal, and ice cream. You may also be absorbing less calcium from your diet after weight loss surgery. Calcium absorption drops after gastric bypass. Vitamin D absorption, which is necessary for calcium absorption, drops after gastric bypass. Vitamin D absorption drops if you eat a very low-fat diet, which is likely after weight loss surgery. Get Three Servings of High-Calcium Foods Each Day The following foods are good sources of calcium. They also have protein, making them great choices for your weight loss surgery diet. 1 cup of non-fat yogurt or Greek yogurt. ½ cup of non-fat cottage cheese. 1 ounce of reduced-fat cheese. 3 ounces of canned salmon. 3 ounces of canned mackerel. ½ cup of tofu. Calcium at Breakfast, Lunch, and Dinner Aim for one serving of a high-calcium food at breakfast, lunch, and dinner. These are some ideas for dishes with a good amount of calcium. Oatmeal cottage cheese pancakes. Baked tomatoes with low-fat feta cheese. Broccoli with melted low-fat cheddar cheese and crushed cashews. Salmon salad made with Greek yogurt instead of mayo and wrapped in a lettuce leaf. Chili made with tofu instead of beef. A fish wrap with canned mackerel, basil, tomato slices, and spinach or arugula on a small, high-fiber tortilla. Other Ways to Protect Your Bone Health Take the dietary supplements that your surgical center recommends. Those will probably include a daily multivitamin supplement and one or two daily doses of calcium. You may also be told to take vitamin D. Other nutrients affect your bone health, so make sure to eat the healthy foods on your meal plan. Regular exercise is another great way to keep your bones strong. Osteoporosis puts you at risk for devastating fractures, and you may not even know you have it until you break a bone. You can lose bone mass after weight loss surgery, but you can protect yourself with a healthy diet and exercise plan. In particular, getting enough calcium on a daily basis can keep you healthy.

Twitter Are your friends and family helping you lose weight or standing in your way? Don’t let your social network hold you back! Facebook Your friends and family can affect whether you lose weight as quickly as you’d like. You are more likely to become obese if your sibling, spouse, or friend is obese, and more likely to want to lose weight if your friends want to. Ask your friends to join you in eating well and exercising so that you can all get healthy and enjoy life more together! If You Want to Lose Weight, Keep an Eye on Your Social Network One of the first things you learn about weight loss surgery is that you need a support system. The more friends and family you have around, the more likely you are to lose weight. At least, that’s what you’re told. It’s mostly true but it’s not completely right. The truth is that your friends and family don’t always help you lose weight. If you have anyone sabotaging your efforts, you already know that. But your friends and family may be dragging you down without trying to. You may not even realize it’s happening. Once you do, though, you can resist the bad influence. Effect of Friends and Family on Weight Take a look at your friends and family. Are they overweight? If they are, they may be getting in the way of your own weight loss. Part of it may be genetic. If one sibling gains weight, the other is 40 percent more likely to also gain weight, according to research described in the December 2011 edition of the Harvard Men’s Health Watch. You might point to genes to explain why you can predict people’s weight gain based on their siblings’ weight gain. That may be partly true, but consider this. Spouses are 37 percent more likely to become obese if their spouse does. Okay, live together, eat together, gain or lose weight together. That makes sense, right? But do you know whose weight is most closely related to yours? It’s not the weight of your siblings or spouse. It’s your friends’ weights! If you have a close friend who becomes obese, your risk of becoming obese increases by a scary 57 percent! And, if your friends want to lose weight, you’re more likely to want to lose weight. How Your Friends Affect Your Weight You don’t live with your friends, and you don’t share their genes. So why should their weight affect yours? Part of it is just from trying to be a good friend. Your friend’s job is to cheer you up and accept you for who you are. That’s great in most cases because we all need someone on our side. Unfortunately, it works against you when you tell your friend that you just ate a half a pizza because you had a bad day at work, your friend may just tell you that you deserved that pizza. Worse, she might invite you out so that the two of you can split another pizza. Also, your perception of what is normal and acceptable might shift towards what your friends do and think. If they are overweight or obese, you may not see yourself as unhealthily overweight even if you are. If they share a few boxes of doughnuts every Sunday, you might not see any problem with those extra hundreds of calories. But continuing to do what they do can get in the way of hitting your weight loss goals. Make New Friends… When you’re getting started on your weight loss journey, think about making a few new friends who are going to support your new commitment to health. Other weight loss surgery patients: they’re going through exactly the same things that you are. Exercise buddies: find them at the gym, in the park, or through craiglist.com or meetup.com. Don’t be shy about asking if you can join them for a workout or two. If they say no, ask someone else. You might end up making a few new friends that you can hang out at other times during the day. …And Keep the Old You don’t have to ditch your old friends and stay away from your siblings and parents if they’re overweight. Ideally, you can be open with them. Explain how hard you are working to get healthy, and let them know how they can help. If you’re lucky, they’ll be willing to change some of their behaviors to support your goals and get healthier themselves. Meet to go shopping or take a walk in the park instead of to eat at a restaurant. Order an egg white omelet instead of pancakes with butter, syrup, and sausage when you go out for breakfast. Meet your friends to do crafts or pack lunches for a homeless shelter instead of baking and eating cookies. If your old friends and your family are unwilling to change, you don’t need to avoid them. Even being aware of how friends and family can affect you can protect you from following their leadwhile you’re hanging out with them. Be on the lookout for unhealthy behaviors, and make your own healthy decisions. Skip the table’s appetizers and enjoy your glass of ice water. Order what you know is right, like chicken breast or fish and vegetables, while everyone else is ordering pasta or steak, mashed potatoes, and gravy. Savor coffee while everyone else is digging into dessert. Lean on them for sympathy when you’re struggling, but don’t use them as eating buddies anymore. Eventually, they may see how happy and successful you are, and they may be ready to ask you for help losing weight. Your friends and family are there to support you, but sometimes their love for you isn’t good for your weight loss journey. Ask them to help you out by setting a good example, and keep yourself from following their lead if you know they’re eating badly.

Click here to view the recipe.

A lot of us have slightly different habits during the summer compared to the rest of the year. We often have a little bit more time in the summer, and the extra time, sunny days, and long evenings give us the chance to do things we can't always do year-round. Some of your healthy summer habits might be swimming, walking around town with your friends, or playing with your children at the park. Unfortunately, not all summer traditions are healthy. Before weight loss surgery, you may have depended on frozen treats to help beat the heat and have fun. Ice cream cones, bars, and sandwiches, popsicles, smoothies, and slushies are cold choices, but they do not belong on your weight loss surgery diet. They can be high in calories, so your weight loss can stall. They can be high in sugar, so you can get dumping syndrome, especially if you are a gastric bypass patient. They can be low in nutrients, so you are less likely to meet your daily needs. They can be high in saturated fat, which is bad for your heart. They’re low in protein. So what can you do when you want something cold and refreshing but don’t want to throw your weight loss off track? There are plenty of options for cold summer treats to buy or make while sticking to your diet. Avoid the Bad Choices There’s no doubt that ice cream tastes good, so you may need a little extra help gathering the willpower to resist it. The following scary statistics should be enough to make you think twice before indulging. An ice cream sandwich can have 360 calories and 10 grams of saturated fat (more than half the maximum you should have in a day). A cup of Ben and Jerry’s Chunky Monkey ice cream (half of a pint) has 600 calories and 20 grams of saturated fat. That’s like having two meals and only getting 8 grams of protein! A brownie sundae from Baskin Robbins has 920 calories and 97 grams of sugars. Eat one of those, and you’ll be near your calorie limit for the day. A fruit smoothie can seem innocent, but an original Mega Mango smoothie from Jamba Juice has 340 calories and 78 grams of sugars. You’re likely to feel pretty sick from all that sugar and hardly any protein. The best way to arm yourself against these diet disasters is to have your own alternatives at the ready. Try These Healthy Options Fruit is high in fiber and low in calories, and is a great choice for frozen snacks. Add protein to your treat by using Greek yogurt or a small portion of nuts or peanuts. Try these ideas, or create your own variations. Roll a banana in chopped peanuts and freeze it. Mix the peanuts with cinnamon before rolling, if you want. Freeze melon or watermelon balls or grapes. Make raspberry lemonade pops by blending raspberries – or your choice of berries – and light lemonade. Pour into paper cups, stick popsicle sticks in the centers, and freeze them. Blend mango, peach, or another soft fruit with Greek yogurt, keeping it chunky. Freeze. Dip strawberries, peach slices, or cherries into light Greek vanilla yogurt. Put the fruit on wax paper on a cookie sheet, and freeze your treats. Check the Ice Cream Aisle The ice cream aisle has some options that are good for occasional treats. Sugar-free popsicles have 15 calories each. No sugar added fudge pops have 40 calories each. A small no sugar added ice cream sandwich has 100 calories. A half-cup of no sugar added vanilla frozen yogurt or ice cream has 90 calories. Don't Get Tricked! Never assume anything is healthy or low-calorie. Always read the nutrition facts panel and list of ingredients. Then make your own decision about whether the food belongs on your weight loss surgery diet. Low-fat and fat-free products can be high in sugar and calories. “Light” can mean light in color, light in calories, or light in something else. Low-carb and low-sugar products can be high-calorie and high-fat. Fat-free toppings, such as caramel or chocolate topping, can be high in sugar and contain 50 calories per tablespoon (that’s not a big serving size!). Frozen Treats and Your Weight Loss Surgery Diet Rules: Solids and Liquids After weight loss surgery, you are supposed to drink liquids separately from when you eat solid foods. This is true whether you have the gastric sleeve, gastric bypass, lap-band, sleeve plication, or another kind of surgery. The reason is that solid foods stay in your stomach, pouch, or sleeve for a while, while liquids flow through more quickly and leave your stomach empty. When you eat ice cream or ice pops, they melt in your stomach, sleeve, or pouch. This means that you do not stay full for as long as you would if you ate the same number of calories in solid foods. This does not mean that you can never have frozen treats, but it does mean that you should be aware of the extra calories you are taking in when you eat them. If possible, eat them with solid foods, such as fruit or nuts, to stay full. Frozen Treats and Your Weight Loss Surgery Diet Rules: Portion Control Another weight loss surgery diet rule is to use portion control. An innocent 90-calorie half-cup serving of non-fat frozen yogurt becomes a 360-calorie mistake if you sit down with the pint or fill up a regular-sized bowl with frozen yogurt. Always measure your portions. Treats for the Liquid and Pureed Foods Stages Ice cream and fresh fruit are off limits during the liquid post-op stage, and you can only eat selected fresh fruit on the pureed foods diet. You can still enjoy healthy, refreshing treats this summer. For example, you can enjoy frozen juice pops or make a fruit slushie without the added sugars. Freeze one or more kinds of juice in ice cube trays. Mix and match flavor combinations, such as apple and grape, a citrus blend with grapefruit, tangerine, and orange juices, or a tropical mixture using pineapple and raspberry lemonade juices. Be sure to choose 100 percent juice instead sugar-sweetened juice drinks. When you are ready for your treat, grind the cubes in the blender until they are more like chips. If your surgeon has suggested that you avoid orange juice because of its acidity, look for a low-acid brand in your supermarket.

Hundreds of thousands of weight loss surgery patients are writing their stories each day. Each story has its own unique twists and turns, and each is filled with battles, triumphs, and setbacks. Some stories are so remarkable that they need to be told, and Jim Blackburn’s story is one of those. Like so many others, Jim was morbidly obese and faced the health problems and daily struggles that are so familiar to overweight people. He got the roux-en-y gastric bypass surgery, and lost over 200 pounds. That is already quite an accomplishment in itself, but Jim did not stop there. He continually gives back to the weight loss surgery community by volunteering and sharing his story with thousands of people. Jim was generous enough to share his story with BariatricPal. Following are his story and interview answers. From a Husky Child to a Seriously Overweight Man Like so many weight loss surgery patients, Jim remembers himself as being “husky” as a child in Georgia. His peers picked on him, the “fat kid,” as he grew up on generous and fattening Southern cooking. As a high school football player, his body became more athletic and the teasing stopped. When he went into IT in 1984, though, Jim was not only starting a new life that grew to include a successful career and wonderful family. He was setting off on a path to morbid obesity. These are Jim’s weights and life events through the years. 17 to 19 years old: 275-280 pounds as an offensive lineman in high school. 20 to 21 years old: 205 pounds: in college. 23 to 24 years old: 250-260 pounds during his first marriage. Late 20’s through 40 years old: weight cycling, with each cycle adding more weight, as he worked hard, enjoyed his new marriage, and raised his children. By age 35, Jim hit 300 pounds, and it didn’t stop there. The yo-yo dieting continued for years, and he topped out at 420 pounds. BariatricPal (BP): Why do you think you became obese? Are others in your family overweight? Did you learn poor habits as a child? Did you gain weight later in life as the result of some life event? Jim Blackburn (JB): At a very early age I was tagged with the label "husky" and from that point I endured a lot of bullying in elementary and high school because I was the fat kid that everyone seemed to enjoy picking on. My father was tall and slim and my mother was short and considerably overweight. My family – sister, brother-in-law, cousins, aunts, uncles – were for the most part big and the one common thread among everyone was the joy of eating - and eating in massive quantities. I was part of the clean-your-plate generation and butter, Crisco, grease, and fat all went into making the food taste delicious - delicious to the point where you just could not eat enough. A typical southern breakfast for me was eggs, biscuits, sausage, gravy, streak-o-lean, and milk. I can remember eating four to six biscuits and gravy in one sitting as a child - keeping up with my parents and meeting their demands to clean my plate and eat good - because eating made everyone feel good. As I grew older I became more active. My mother owned a southern cooking restaurant that she used as a means to pay for my private school. She worked hard and fed me well. Since I was a lot bigger and a lot stronger the bullying stopped and I became a football player where the activity helped me to slim down but the eating - and push to eat a lot - was even more prevalent. Through high school and into college I ate huge amounts of food, but fortunately the activity - football - helped me to maintain. And then football ended and my life started. I began to work in a field that required a lot of chair time (and screen time) and little did I know that in 1984 I was getting ready to ride, for the next 30 years, the information technology revolution. This, along with marriage, raising a family, and the ups and downs of relationships and finances all contributed to my lack of activity and binge type eating habits. The Decision to Get Weight Loss Surgery Jim’s wake-up call came when he had to go to the doctor for an ECG. Ironically, doctors were concerned about his heart because of the diet pills he had been taking. He also had hypertension, sleep apnea, a fatty liver, the beginning stages of diabetes, and chronic joint pain. He carefully researched weight loss surgery and thought about whether he would be able to use it as an effective tool for weight loss. Then, he settled on the Roux-en-Y gastric bypass at Emory Bariatric Center. BP: Did you consider other types of surgery? Why did you choose the roux-en-Y? JB: I was the last of four family members to have gastric bypass over the course of two years - same bariatric center, same doctor and surgical team. Collectively we did our research and after seeing the results from those who went before me and close consultation with my surgeon and primary care physician, I decided the roux-en-Y was the best option for me. There was some consideration for Lap-Band but again, seeing the results from my other family members made me want to go with roux-en-Y. I felt I was going to only get one shot at success so I took it. The First Year Post-Surgery Jim stayed focused and lost an admirable 174 pounds in the first year after his surgery on April 5, 2010. He did it by following his weight loss surgery diet very carefully. He also used the support of his wife and two children to stay on track. BP: You have named your wife and children as being supportive during your weight loss journey. What were their roles? JB: My wife was my toughest supporter. She took no crap from me and had studied, over and over, the pre-op and post-op program and knew exactly when, what, and how much I was supposed to be putting in my mouth. If I regressed or lost focus she was there to correct me and together we did it. Along with my loss, she lost amost 80 pounds which was weight she had gained since we were married by adopting my eating habits. My wife was is Brazilian and the eating culture there during her childhood was much different. She recalls coming to the U.S. to live and being amazed at how we ate and how much we ate. Along with my wife, my son and daughter were with me every step of the way and as a family we endured good and bad times during my first year post-op but in the end we all have become a lot closer and my family has been with me at every major milestone (and finish line) showing their love and support. I consider myself very fortunate to have had this support and my success is directly attributed to my wife, son, and daughter’s love and support. BP: Did you face people who thought your surgery was the wrong decision or who tried to sabotage you? How did you (and do you) handle it? JB: Yes. Yes. Yes. The proverbial "eye-roll" from people who wanted to pre-judge my decision to have weight loss surgery. Fortunately I made my decision to have the surgery privately and once committed I was very open with everyone many months before - I did not try to hide the fact I was having surgery and was quick to politely "shutdown" the naysayers and critics many of which instantly became experts on the topic of weight loss and my history, co-morbidities, and my level of will power to be able to lose weight without such drastic intervention. I put my trust in my medical team, my Lord & Savior Jesus Christ, and my deep-rooted desire to live a healthier and longer life. Transformation to an Athlete Jim began lifting light weights and walking on the treadmill towards the end of his first year after surgery. He eventually began to run, and a new world opened up to him. Running helped him relieve stress and control his eating. Now, he describes himself as a passionate runner, and he has lost over 200 pounds. Jim’s list of completed road races is growing. He has run the prestigious Atlantic Journal Constitution Peachtree 10K (6.2 miles) three years in a row. This year, he finished in 53 minutes and 50 seconds over the 10K (6.2-mile) course. That’s less than 9 minutes for each mile, or nearly 7 mph if you’re a treadmill runner. He participated in his first marathon this February, completing the 26.2-mile course in 5 hours 7 minutes. Jim is now planning to run the 2014 Marine Corps marathon as part of the Push America challenge this autumn in Washington DC to raise money for athletes with disabilities. BP: You have become a respected athlete in some circles and are now training for another marathon. How do you keep yourself motivated to get out the door and work out each day? JB: The accountability that comes with setting goals and staying on track with my fitness is the motivation I need to get me out the door. Some days are harder than others and I have not been perfect, especially when factoring in injury, soreness, or the day-to-day stresses that come with life. I remain focused and use my success to be an example to others and to try an help others to find their way on this very complex journey. We are all entitled to freedom of speech, but whoever said that weight loss surgery is the easy way out needs to really take the time to become educated with the hundreds of thousands of people who struggle with their weight daily and who are at the end of their life, at a young age, because they have tried every possible avenue to lose weight and failed for one reason or another. Obesity is a disease and surgical intervention is a viable solution that works if the recipient is willing to make the necessary changes and take personal responsibility. Surgery as a Tool for Weight Loss From the start, Jim looked at weight loss surgery as a tool, not as a cure. The surgery, and maybe his new eating habits, helped him lose his taste for fattening foods, and gain a taste for vegetables. Still, it is up to him to eat right and plan his time. He makes exercise a priority, getting up for 5:00 a.m. workouts and checking out the hotel gyms as soon as he arrives. BP: You have said that you lost your taste for some of the high-calorie junk foods that you used to eat before surgery, but are you ever tempted to go off of your diet? How do you handle cravings and other temptations? If you give in sometimes, how do you get back on track? JB: Honestly, at this point in my post-op life I do not diet and yes, I do eat the occasional donut or candy bar. I am limited in quantity of intake but I am blessed with being able to tolerate 95% of all foods. My tastes do continue to change so some things are totally off the table. I believe the tool given to me with the roux-en-Y and my commitment to daily exercise has paved a path for me to maintain my weight while staying within the quantity limits of my stomach pouch. Currently I am training for a marathon and my training week consisted of 30 miles of running, 80 miles of biking, and 7,600 yards of swimming. The calories burned during these daily workouts put me off the charts when it comes to maintaining a 1,200 to 1,500 daily calorie diet and my intake far exceeds this in order for me to keep my energy levels up. Helping Others Among the most admirable parts of Jim’s story is his desire to give back to the weight loss surgery community. He gives public speeches, maintains a podcast, and is happy to answer questions via email or Twitter. He is a board member of the non-profit organization WLSFA (Weight Loss Surgery Foundation of America). WLSFA advocates for weight loss surgery and helps provide funds to those who cannot afford it. Jim was named the Bariathlete of the Year at the 2014 WLSFA Meet and Greet in Tampa, FL. Jim is a class act, and BariatricPal is very grateful for the interview and for all that he does for the weight loss surgery community.

Great article Jennifer!

You can find some great state by state resources here: http://asmbs.org/resources/ehb-access-toolkit

Innumerable consumers, lawmakers, and healthcare professionals alike celebrated at the passage of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, in 2010. The ACA expanded healthcare coverage to millions of Americans and promised to put this country’s broken healthcare system on the mend. The law came with an unprecedented focus on preventive medicine and wellness, and nationwide improvements in obesity treatment seemed to be coming. Many weight loss surgery candidates and healthcare professionals, however, have been disappointed. The ACA has plenty of shortcomings when it comes to bariatric surgery. More than half of states do not cover bariatric surgery. Among those that do, many put up barriers to getting the procedure that prevent some weight loss surgery candidates from being able to qualify for reimbursement. Advances in Obesity Coverage Under the ACA The ACA does have some provisions that help to reduce obesity on a national level. It includes $15 billion in funding for wellness and disease prevention programs, many of which will target obesity. Another preventive measure is that the ACA requires restaurant chains to post calorie counts on menus. The ACA requires Medicare providers to cover obesity screening and counseling when you go to the doctor, and many healthcare insurance providers are also providing these services. Another provision of the ACA is that employees in qualifying programs are reimbursed for their healthy behaviors. If they do not smoke, maintain a healthy weight, and have blood pressure and blood cholesterol levels within the normal range, employees can get up to $800 per year. Employees with obesity can get cash back if they lose at least 10 percent of their body weight, but will not receive the money until they reach a BMI under 30. The ACA also forbids health insurance providers to deny you coverage based on pre-existing conditions. Since obesity is now recognized as a disease, according to the American Medical Association (AMA), health insurance providers cannot refuse to accept you just because of your obesity. You also cannot be denied coverage just because you had weight loss surgery in the past. Measurable Benefits Expected With These ACA Provisions Each of the above provisions can lead to small amounts of weight loss. For example, counseling for weight loss can lead to a loss of about 5 percent of body weight on average. This modest weight loss can improve blood sugar, blood pressure, and other measures of health, and it can save you, your provider, and the government money. Limitations/More Is Needed However, if you are a weight loss surgery candidate, losing 5 percent of body weight will still leave you with a good amount of excess body weight. Obesity-related health conditions such as diabetes and arthritis are still a threat, and your obesity is likely to continue to interfere with your daily life. Bariatric surgery can be effective against obesity, and it can also fight diabetes and other conditions. With its potential to treat obesity, you might expect it to be covered under the ACA. Unfortunately, only some states cover it. State by State Differences in Healthcare Coverage – Benchmark Plans The ACA requires states to offer acceptable health insurance plans, but these plans may vary by state. The plans that states can offer to fulfill the requirements are known as benchmark plans. These plans set the minimum level of benefits that a state must provide, and the benefits are based on current plans within a state. So, states where competing private plans do not cover weight loss surgery are not likely to offer Obamacare plans that cover weight loss surgery. To make matters worse, the states that do not cover weight loss surgery tend to be the states with the highest rates of obesity. In effect, the more likely you are to have obesity, the less likely you are to live in a state that covers bariatric surgery. You can find out more about each state’s benchmark plan from the government’s The Center for Consumer Information & Insurance Oversight (CCIIO) within the Centers for Medicare and Medicaid Services (CMS) site. Which States Cover Weight Loss Surgery? So far, 22 states cover bariatric surgery. Arizona, California, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming Five states and cover weight loss programs, but do not necessarily cover weight loss surgery. California, District of Columbia, Massachusetts, Michigan, New Mexico Twenty-eight states do not cover bariatric surgery or other extensive obesity treatment. Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin Coverage Often Seems Reluctant Even if your health care coverage includes weight loss surgery, it can come with a lot of hoops. For example, you may need to wait a certain number of months or diet to lose a certain amount of weight before you can get the surgery. Your plan may not cover the type of weight loss surgery that you are hoping to get, especially in the case of newer surgery types such as the vertical sleeve gastrectomy (gastric sleeve). There can also be a lifetime limit of one surgery, which does you no good if your first surgery did not work. If surgery is a disease, shouldn't you be entitled to treatment that works? What Can You Do? You can advocate for making weight loss surgery a required service under Obamacare by reaching out to state and federal representatives. If you live in a state where bariatric surgery is already covered, contact your representatives in Congress. If you live in a state where bariatric surgery is not yet covered, contact your Congress people, and also contact your state representatives. In your letter, phone call, or email to your representative, explain what bariatric surgery means to you and to the thousands of others like you. Explain why you need it to lose weight, and how you feel that it could impact your life. Describe the obstacles and health problems that you face because of obesity. Your goal is to convince the representative that weight loss surgery needs to be covered. If weight loss surgery is the only effective treatment for obesity, it should be included in a healthcare plan. Otherwise, we will continue to struggle with these same problems because not everyone can afford the thousands of dollars it takes to get the surgery done.

Great article, Jill!!

Awesome article, Jane!!

Thanks!!

If the many diets that you have tried over the years don't help you lose weight, weight loss surgery may turn out to be the only strategy that is able to get you to your goal weight. Still, weight loss surgery is just a tool, and your weight loss depends on your hard work over the years from when you first plan your surgery to when you are maintaining your goal weight. A healthy lifestyle includes eating right, exercising regularly, and silencing the doubtful voices in your head and of your family and friends. Measuring each bite of food, and getting up before dawn to take a walk, and passing up your aunt’s homemade peach pie can get tiresome. Motivating yourself and setting good goals can help you consistently make the right decisions for your health. These are a few tips to help you. Why Are You Losing Weight? It’s easy to remember why you want to lose weight when you are having trouble finding small-enough clothes or your weight is above the limit for a theme park ride. It’s harder to remember why you want to lose weight when you and a group of friends are at the dinner table with a large chocolate cake. Making a list of the reasons why you want to lose weight and looking at the list often can keep the reasons fresh in your mind and strengthen your resolve to resist temptation. These are some of the common reasons for getting weight loss surgery. Live longer. Be healthier – get off medications or manage your health conditions better. Participate in more activities with friends and family. Go shopping in regular stores with great clothes. Fit comfortably into car seats, restaurant booths, and movie theater and airplane seats. Feel better about yourself. Make It Personal Deepen your motivation even further and use it to help you stay on track if you think about some of the reasons why you are losing weight that have to do with people in your life. These might be some of your reasons. You want to be an active parent who is able to play with your children. You want to be alive and healthy when your children graduate from high school or give you grandchildren. Obesity is making you miss out on important moments like family hikes. You watched an overweight parent or aunt or uncle suffer from diabetes or heart disease at a young age, and know that you may be headed in the same direction. Your siblings also suffer from obesity and its consequences, and you want to break the pattern. Think About the Short, Medium, and Long Term The weight loss journey is a long and difficult process, to say the least. You need to spend months or years preparing for weight loss surgery by getting the payment sorted out, choosing a surgeon, and following the pre-surgery diet. Then there is the actual surgery, followed by months of recovery that can include pain, nausea, and complications. As you recover, you need to learn an entirely new way of eating and living, and may be hungry, cranky, and tired. Finally, there is the rest of your life, as you lose weight and stay on your new eating plan. Every day can be filled with challenges such as tempting but forbidden foods, the need to exercise, and how to deal with people who may not be supportive of your surgery. Goals give you something specific to work towards. The long-term goals are the big ones. They may be the ones that you have in mind when you get weight loss surgery or that you tell other people. Some long-term goals might be losing 100 pounds, or jogging five miles without stopping. Those long-term goals can take years to accomplish, and setting some short-term goals can keep you focused as you work toward the long-term goals. They can include losing 5 pounds this month or speed-walking for a mile. These are some other short-term goals that can keep you on track day-to-day. Lowering your blood pressure or cholesterol or blood sugar levels enough so that your doctor tells you to lower your dose of medications. Going for a month without going to a fast food restaurant. Hitting your protein and water goals every day for a week. Vary Your Goals Victories can be few and far between if your goals are too narrow, and this mistake can leave you feeling unmotivated. Consider what happens if the only goals that you have are to lost certain amounts of weight. What happens if you do not hit a certain weight loss goal? Does that mean that your hard work has been pointless? Of course not, but you might feel that way if that was the only goal that you were working towards. Learn to look for and recognize all kinds of progress by setting goals that go beyond your weight. When you achieve them, you have earned a non-scale victory (NSV). While a lower number on the scale is easy to see, NSVs are what make life worth living. They can include the following. Getting in good enough shape to be able to walk briskly with your husband. Making it through an entire dinner at your parents’ house without taking offense at any negative comments about your surgery. Going out with your friends and enjoying their company without giving in to the food. Celebrate! We’re all a work in progress. With weight loss surgery comes years of working on improving your health. The only way to keep up the effort, and the only way to make the effort worthwhile, is to celebrate! Celebrate the small victories to be sure that you realize how valuable your efforts are. Buy yourself a new kitchen scale, get your nails done, go out for coffee with a friend, or plan a hiking trip. You are worth working for, and your victories are worth celebrating. You can lose more weight and keep it off when you stay focused, but that can be challenged. Remind yourself of your motivations and celebrate all kinds of victories to keep yourself in the game.

I spend about $80-$100 per month on Poland Spring deliveries to my home. It's insane! Planning on installing water purifiers around the house shortly.

Millions of Americans will go away on vacation this year, and if you are lucky enough to be one of them, you need to know what to pack. Packing requires a little more thought than it did before weight loss surgery, when you did not have much to worry about besides your clothes and toiletries. After weight loss surgery, you need to be sure that you bring what you need to stay healthy and keep losing weight. That means adding a few extra items to your packing list. These are some essential additions to your suitcase when you are taking a trip after weight loss surgery. Keep reading even if you’re one of the nearly half of Americans who are not going to travel this year. These tips can be just as helpful for staycationers as for vacationers, since the goals are the same. On vacation, you need to stick to your weight loss surgery diet, keep exercising, and be prepared for unexpected complications that can come up. Water Bottle Before surgery, hydration was a lot easier. You grabbed a bottle of water, a soda, or whatever else was around. If nothing was available at the moment, you just waited until the next opportunity to drink something. That doesn’t fly after weight loss surgery! You need to stay hydrated to keep your energy levels up and your hunger down, and you cannot afford the calories of sodas, juices, or sports drinks. Another wrench is that you cannot drink beverages while you are eating solid food, so you need to be prepared to meet your fluid requirements within small windows of time. Take a reusable water bottle so that you can always have water available when you need it. A reusable water bottle is not necessary if you are certain that you will always be able to purchase a few bottles of water when you need one. Include a few packets of powdered sugar-free beverage mix if you do not like the taste of water. Protein Powder Getting enough protein was no problem before weight loss surgery. There was no way you couldn’t get enough each day. After weight loss surgery, though, your 60 to 85 grams of protein per day can be challenging. Being on the road can make the task much more difficult. You might not be able to check the nutritional information of a food before it is time to eat your meal, or you might find yourself at a restaurant that seems to have no high-protein options. If you are in a foreign country, a lot of the foods you eat may be unfamiliar, so you will not know the exact protein content. You can still enjoy these exotic foods on your vacation, though. Stash some protein powder in your suitcase so that you never need to risk being without enough protein. A 1-lb canister of protein powder can provide 300 grams of protein, which should be enough to help you meet your needs when you combine it with the healthy foods you choose during your trip. Healthy Snacks Snacks and meals were easy before weight loss surgery. There is always some sort of food around, and when your stomach growled, you could hit the nearest vending machine, convenience store, or restaurant. After weight loss surgery, you need to eat healthy foods. If hunger strikes and you are unprepared, you are out of luck. Bring a few healthy snacks to prevent diet disasters at the airport and throughout your trip, unless you are certain that you will be able to visit supermarkets with the healthy foods you need whenever necessary. These are some ideas. Protein bars. Nuts or peanuts. Peanut butter. Beef jerky. Microwave popcorn. Packets of instant oatmeal (use the coffee maker in your hotel room to heat water to make the oatmeal). Emergency Contacts Anything can happen at any time after weight loss surgery. Lap-band patients may get sick and need an unfill, and any weight loss surgery patient can need to see a surgeon for a variety of reasons. Be sure you know how to reach your surgeon, primary care doctor, your pharmacist, and a friend or family member who can act as your emergency contact. You likely already have their information in your cell phone, but write it down on paper, too. That way, you can easily make copies of the information. Include names, phone numbers, and email addresses. Anti-Nausea Medications You may have already been prone to motion sickness and nausea before weight loss surgery, but the risks associated with vomiting are more serious after weight loss surgery. Vomiting can displace the lap-band or rip the staples if you have the gastric bypass, sleeve plication, or sleeve gastrectomy. Pack an over-the-counter anti-nausea and anti-vomiting medication that your doctor approves of so that you can minimize vomiting as soon as possible if you happen to get food poisoning or fall ill on vacation. Running Shoes Take your running, walking, or other active shoes…because this year, you are going to participate instead of watching on the sidelines! Don’t forget other activewear, such as comfortable exercise clothes that are suitable for whatever you might encounter, whether that involves outdoor hikes or indoor group exercise classes on a cruise ship. Food Journal Calories and portion sizes count just as much on vacation as at home, and logging your food is just as important. Take a paper notebook so that you do not need to rely on having internet access to log your food. Or, if you are staying in the U.S. and are confident that you can keep logging your food on your mobile device like you always do, you can stick with your smartphone. Nutritional Supplements You don’t want to waste your vacation chasing down the assortment of vitamins and minerals that you are supposed to be taking. Some of the vitamins and minerals may not even be available over-the-counter in the doses you need if you are in a foreign country. Bring enough of each kind of supplement that you take to comfortably see you through your trip.

You mention only 2 cups of hot or iced tea. Why? I brew my own decaf iced tea and drink around 8-12 cups a day. I have told my doctor and he never said anything. I hate flavored drinks. Thank you Arlene Compounds in tea called tannins can act as chelators, binding to minerals and inhibiting the body’s ability to absorb them. This can reduce a person’s levels of iron. You're ok since you have approval! I personally drink quite a bit of caffeine free tea daily as well and my iron levels are great.