Alex Brecher

Stand up to weight bias by asking the ABC television network to remove fat-shaming content from its new series, “Dr. Ken.” The conversation featured in the promotional trailer between Dr. Ken and one of his patients, who is affected by excess weight, furthers the misconception that healthcare providers do not want to help patients with obesity. We’re asking for the ABC television network to remove this and any other fat-shaming content from the television series before it goes to air. Visit the following link to stand with us and contact ABC to ask for the removal of fat-shaming content from the “Dr. Ken” television series: bit.ly/OACBias3

Djmohr, Those stalls are frustrating, but as you get closer to goal weight, stalls are more frequent and last longer. All you can do now is to keep doing what you’ve done to get to this point: eat right, and be patient. I know it’s hard! Sometimes stress plays a large role in plateaus. Try to relax! Get enough sleep, and find fun things to do. Also, you might be able to mix up your exercise with an exercise bike…maybe that can help reduce stress – or take a spinning class to make it more fun. It sounds like you’re eating right, so the stall MUST end sometime! Let’s see what the others have to say. How have you gotten over stalls? Did you experience more stalls when you got closer to maintenance? How long did it take you to lose the last, say, 20-40 lbs?

Happy Labor Day from BariatricPal!#subject#> body,div,dl,dt,dd,ul,ol,li,h1,h2,h3,h4,h5,h6,pre,form,fieldset,input,textarea,p,blockquote,th,td { margin:0; padding:0; } table { border-collapse:collapse; border-spacing:0; } fieldset,img { border:0; } address,caption,cite,code,dfn,th,var { font-style:normal; font-weight:normal; } caption,th { text-align:left; } h1,h2,h3,h4,h5,h6 { font-size:100%; font-weight:normal; } q:before,q:after { content:''; } abbr,acronym { border:0; } address{ display: inline; } html, body { background-color: #d8dde8; color: #5a5a5a; } body { font: normal 13px helvetica, arial, sans-serif; position: relative; } h3, strong { font-weight: bold; } em { font-style: italic; } img, .input_check, .input_radio { vertical-align: middle; } legend { display: none; } table { width: 100%; } td { padding: 3px; } a { color: #225985; text-decoration: none; } a:hover { color: #328586; } div.outer { margin: 0 auto; padding: 14px; } table.wrap { max-width: 800px; margin: 0 auto; } td.logo { background-color: #0f3854; padding: 8px; } td.content { background-color: #fff; font-size: 14px !important; color: black !important; line-height: 150% !important; padding: 8px; } ul { margin-left: 25px; } Hey BariatricPal Members, Happy Labor Day! It’s the last official chance to throw a summer party, go to a parade, and if you’re lucky, see a few fireworks. It’s a good chance to make sure you give summer a healthy send-off and you greet autumn with healthy intentions…and that’s what we hope this newsletter does. Here’s what you’ll find. Packing Your Labor Day Picnic Basket Getting Back into the Groove Enjoying the New You – A Reminder Have a great time going through the newsletter, and also have a great and healthy holiday. Happy Labor Day from BariatricPal! Sincerely, Alex Brecher Founder, BariatricPal Packing Your Labor Day Picnic Basket Going on a picnic this Labor Day? It’s a nice idea if you’re going to watch a parade, take the family to the park, or watch fireworks later on. Here’s how you can get in a good meal without going off your WLS diet. Picnic Favs You Can Eat Picnics tend to have a lot of food you can’t eat, at least, not if you’re serious about losing weight. Fried chicken, tuna salad subs, and potato chips just aren’t on the diet. But there’s no reason you can’t make your own picnic favs! Have grilled chicken or baked “fried” chicken coated with high-fiber cereal instead of breadcrumbs, or make tuna lettuce wraps instead of tuna salad sandwiches. Instead of potato chips? Try baked kale chips. You can round out your basket with proteins and veggies like hard-boiled eggs, fat-free refried bean dip, salad, and cut raw carrots, cucumbers, and celery sticks. Prepared Salads…The Healthy Way It’s not a picnic unless it has pasta salad. Just skip the pasta! Take your favorite pasta salad recipe and make a few small changes. Use cooked zucchini noodles or spaghetti squash instead of pasta. Substitute fat-free Italian dressing for full-fat dressing, or use Dijon or spicy brown mustard as your main flavor. Add plenty of veggies, such as cherry tomatoes, green onions, and broccoli florets. Add some sliced olives for a little healthy fat and a lot of flavor. Add low-fat feta or diced lean pastrami for some flavorful protein. You can always healthify other traditional prepared salads, too. Use cooked cauliflower instead of potatoes in potato salad. Toss shredded cabbage with low-fat Asian dressing instead of mayo for coleslaw. Use Greek yogurt or fat-free mayo instead of full-fat mayo when making tuna or other salads. The “Extras” Can Fit into Your WLS Diet The “extras” at a picnic can be high-sugar, high-calorie, and devastating to your weight loss efforts. Drinks like soft drinks and sweet tea, and desserts like brownies and chocolate chip cookies, can set you back by days, not to mention make you feel sick. Be sure to pack plenty of cold water to drink. Also, bring some appetizing fresh fruit to eat instead of sugary, fatty desserts. Apples and oranges are about as easy as it gets, but you could also make a red, white, and blue fruit salad with strawberries, white peaches, and blueberries. Getting Back into the Groove Summer is a little more relaxed than the rest of the year. Even if you’re not a student or teacher who gets an extended summer break, the season is a little slower moving. It’s easy to lose focus. Your diet may get a little less strict, or you might have trouble getting out the door for a workout in the summer heat, or you may be a little less aggressive about being on the phone with the insurance company or finding the right surgeon for your WLS. After Labor Day, that all changes. Now that kids are back in school and people are back from vacation and going back to their regular schedules, it’s time to take a look at your own schedule. Did you hit your summer goals? Are you following your WLS diet to a “T?” If you haven’t had surgery yet, are you doing everything you can to get it scheduled and paid for? Think Back and Ahead Think back over the past couple of months. Were there some times when you knew you weren’t making the best choice for your health, like when you went out for ice cream and got your own scoop instead of bringing an apple to munch on? Did you skip a few workouts? Did you get out of the habit of measuring your food? Did you stop making phone calls to the insurance company because you just couldn’t face being on the phone anymore? Plan Your Schedule With everything starting up all at once, things can get pretty hectic. That gives you the opportunity to create a new schedule for yourself. You can be sure to include the things that are important to your new healthy lifestyle, such as time for cooking at least once a week, and going to the gym a few times a week. Sometimes it seems hard, but success is largely a question of building a habit. The sooner you get started, the sooner your healthy behaviors will be habit. You won’t have to think about making the “right” decisions, and it’ll be easier for the weight to come off! Enjoying the New You – A Reminder The WLS journey is hard, no question. You form new eating habits, give up some favorite foods, develop new relationships with food and sometimes with people. You may spend a lot more time thinking about your health and acting on those thoughts. With all that hard work, we thought we should take a second to remind you to enjoy the rewards! There are probably some victories you can’t help but notice and celebrate, like hitting milestones on the scale. But don’t bury yourself so deep in the daily choices that you forget to enjoy the journey. Notice how much better you feel when you’re sitting in the car, or how much easier it is to push the shopping cart around the grocery store. Notice how much easier it is to spend time with your kids, friends, and other people. You can even appreciate your changes in mentality, from “I can’t,” “I’m not worth it,” and “Maybe I shouldn’t be eating this pizza,” to “I can,” “I deserve it just as much as everyone else,” and “I’m so proud of myself for enjoying these carrot sticks!” Thanks for reading the newsletter and making BariatricPal part of your Labor Day weekend. Have a healthy, happy, and safe holiday, and thanks for your support!

Other people can put a lot of pressure on us to eat. Consciously or not, they can make us feel bad or guilty for passing up food that we know we shouldn’t eat. It can be innocent, such as kindly (they think!) offering some specially baked goods. Or our friends or family might tell us while at a restaurant, “It’s just one meal…it doesn’t matter.” You know it DOES matter, but how do you handle the situation? How can you stand your ground (“No, thank you!”) when you risk making them feel bad for your refusal? I’ve found that I can use my surgery as an excuse to say NO to something I don’t want to eat when people pressure me to eat it. If I simply say that I don’t want to eat the ice cream, they’ll say just a little won’t hurt me. If I say it’s not part of my lap-band diet, they’ll accept that I “can’t” have it, and won’t pressure me. Sure, it’s a little white lie, since I could have a little ice cream by now. But they don’t need to know that. So I guess you could say I’m using my WLS as an excuse. Do you ever use your surgery as an excuse? How? Do you think it’s helpful?

Lunchtime can be a problem, especially if you work, are a student, or are extremely busy…and that’s most of us! We’re rushing around the home or out the door in the morning, and have temptations to just opt for fast food at lunch. But that’s not healthy, and I know you’re not doing that! So I’m curious…what’s in your healthy lunch? Do you keep it the same, or do you vary it? What do you normally pack or make? What do you always have in your house for lunchtimes? Can you share any tips for quick and easy lunches, or recipes to make lunch more fun while on the WLS diet?

ktscott, Welcome to the forums! Those are great questions. It’s good to get information from as many sources as you can, doctors and patients, so you can get a variety of facts and experiences. Then filter the info and make the best decision for yourself. I got the band because it helps me with portion control but does not interfere with nutrient absorption – so I’m less likely to get nutrient deficiencies. I also like that it is adjustable because it’s a bit of a safety net. If I ever get sick and need it loosened, I can. The sleeve is so permanent! The band is, however, getting less popular, and the sleeve is getting more popular. We don’t know yet how the sleeve does in the long-term, although it’s looking good in the short-term. Do you need medications for your RA? Would the sleeve affect absorption? That may be a consideration. I think every WLS patient is worried about “rewarding themselves” later. That’s why our first several diets didn’t work and we needed to get WLS! I think whether you go for the sleeve or band, you’ll need to make the commitment for life if you want to hit and maintain goal weight. Anyone can eat around the band OR the sleeve and gain the weight back. Good luck with your decision!

Lots of great ideas here! You can do a lot of things with eggs on the soft diet. Scramble them using cooking spray (not butter) and non-fat milk (or soy milk or almond milk). You can make it higher in Protein with shredded non-fat or low-fat mozzarella or cheddar or another kind of cheese. You can also add protein with soy crumbles or ground turkey or chicken breast. Serve it with a cooked veggie, like cauliflower or zucchini. Of course, hard-boiled eggs are pretty much a staple for Snacks on this part of the diet! You can scoop out the yolks and eat them with tuna.

Bellaboom, congrats!

Just responded to your other post. There are very few surgeons or Gastroenterologists that have fully completed training. There are many that are in midst of training and over the next 6-12 months you'll see Balloons popping up all over the place. Realy happy that you're part of our community. Thanks for your updates and keep em coming, please!

Very exciting!! Dr. Garber is putting it in for you? How much is he charging? Are you going with the Orbera or Duo? Send him my regards and please keep us updated on your progress.

She's most likey referring to the Endobarrier. It hasn't been approved by the FDA as of yet and won't be for another year or two at a minimum.

Alex, any timeframe on whether BariatricPal will partner with plastic surgeons in Mexico? I'll be needing plastics next summer. We're working on something interesting as I type this....I hope to have some news for you in a week or two.

Seems like we have a bug! I'll let you know once it's resolved.

No need to as me to start ANY Topic! Please, go right ahead and post away.

Rogofulm, Thanks for posting this. Even if it has been posted before, this is a good reminder, as you said. The only way any weight loss technique, and any type of weight loss surgery, will work long-term is if you follow the diet long-term. There is still not that much information on long-term effectiveness of the sleeve. What little research there is isn’t necessarily what I’d call “long-term:” like the article you posted, a lot of the studies only follow patients for 5 years. What about the next 30 or 40 or 50 years? And some of the studies show positive results: for example, the study talked about here found 57% excess weight lost after 5 years – pretty good! But I bet those patients put in a lot of hard work in addition to just getting the sleeve. http://www.medpagetoday.com/Endocrinology/Obesity/40490 And also that above study says one-third of patients still had BMI over 35 after 5 years. On another positive note, the study you posted says blood pressure stayed lower! Anyway, I guess we’ll find out over time how well the sleeve does on average. For all of us who are WLS patients, it’s up to each of us to do our best to meet or beat the average with our healthy lifestyles and hard work.

CanyonBaby, Oh, my goodness! Congratulations, and thanks for letting us know! Best wishes for Tuesday’s appointment with the surgeon, and of course let us know any updates.

OutsideMatchInside, I definitely sympathize with you – it’s really frustrating for that to happen, and I agree that you should have been informed of that possibility before the process began. Before you give up on the clinic and just go to your primary care doctor, though, I would ask you whether you have any questions about the sleeve. If you’re just going for a check-up to make sure you’re okay, your own doctor can probably do that, as some of the other posters have said. If you have some questions, though, I’d still consider sticking it out and going out to the surgeon’s office to see a NP or PA. They may not have gone through medical school, but compared to a primary care doctor, they are more focused on a daily basis on sleeve patients. They may be better able to answer specialized questions. I’m glad everything seems to be going well with you, though! Keep us updated!

VSGAnn2014, first of all, congratulations on hitting your one-year surgiversary, and on getting there with flying colors! You are a model patient, and your doctor must love seeing and talking to you because you’re so successful and because she knows you’ll follow her advice! Wow, thanks for much for all of this insight! You got a lot of good news, which you deserve. Great news about the continued low ghrelin levels. I’ve seen some varied information from different studies – some with good news and some with predictions that it might rise again – but your doctor should know best! I’m not surprised, but I am glad, to hear that your metabolism should stay consistent. That makes sense, as long as your body and activity stay consistent. So it sounds like now, “all” you need to worry about is the rest of your life. Welcome to maintenance! As I am sure you already know, the biggest thing (at least for me and many others) is staying motivated and focused when the scale isn’t going down all the time. But you can do it!

Thanks for the answers! Yes, it’s definitely an issue that the others (bypass patients, sleevers) don’t have to think about…but also don’t get to think about. TheProfessor, good questions to raise about travel! Those airplanes can really hit people hard, and then there’s always the chance, although it’s a tiny chance, that you could get sick while abroad and need an unfill. Whether or not you get your band loosened for a trip, don’t forget it’s almost always possible to find healthy options, even if it means going to a supermarket instead of a restaurant. And it’s ALWAYS possible to eat smaller portions. For those who wouldn’t even think about unfilling…I get what you’re saying! We got the band for a reason, and I can completely understand wanting to stick with it. Lisacaron, lots of good points, and you are of course a great example. I had my band unfilled for a few years, but have recently filled it a bit to stop that creeping regain while it’s still under control. I love having the flexibility of how tight to make the band.

Thanks for all the answers! Looks like you’ve got quite a range of goals, including major long-term and minor short-term goals, and related to weight loss numbers and not! I remember setting a lot of number-related goals when I was losing weight. Now that I’m near goal weight, I think more about non-weight-related goals, like running a certain number of days each week. I know, though, how hard maintenance is, and I need to also be sure to keep the scale and scale-victories in my life! JustWatchMe, "day by day" is a nice, manageable approach...and it'll get you there, too! I go for day by day sometimes, and sometimes meal by meal.

Stacyg1, That’s totally out of line! Nobody should be rude enough to say things like that, and especially not a “gym friend,” since she obviously knows how hard you work since you’re both at the “gym,” and since apparently you two are supposed to be supporting each other as “friends!” Don’t even listen to her. She probably has no idea how hurtful she was. You could try telling her, but there’s a chance she won’t even remember the comment. People say things without thinking, and what they just say assuming is an off-hand comment can be something they don’t realize is a huge deal and hurtful comment for you. You have done wonderfully, and I have to congratulate you on what you are doing. You are trying to find the best nutritional diet for you, rather than trying to just go with what wasn’t working. You’ve done amazingly with your weight loss, and now you’re getting to the next stage where you’re going to find the meal plan that will work for you long-term. Don’t worry about her!

Bariatric Advantage, Bariatric fusion, Celebrate Vitamins and BariMelts.

Thank you for sharing Reeger's info. She's really awesome and it's a great resource. My interview got cut off midway due to technical difficulties. I'm gonna do another interview with her one of these days.

We don't assay products. Just passing on information we received.

I just received the following email from Unjury and I felt it was really important to share with our community! "We recently sent two bottles of a Vitamin product labeled "ProCare Health Bariatric Chewable Dietary Supplement" to one of the leading independent nutritional chemistry labs in the country. See footnote 1. We asked them to assay this bottle for a selected sample of nutrients. (Assays are costly.) We were curious for at least two reasons: One RDN, on the WM DPG Bariatric Subunit online board, posted a question: "We have been recommending Procare to our patients for quite some time now....Recently, we have started noticing that a significant number of our patients Folate levels are dropping" (see note about folate testing2) Upon visual comparison, the multi tablet appeared very small compared to other bariatric chewable multi's, and while the ProCare website, www.procarenow.com, states "lack of binders and fillers makes us smaller", we are not sure of the technical feasibility of using no binders and fillers. Note that this paper comments on the laboratory results for one bottle of the ProCare product, except for the folate retest on the second bottle. (The results of the folate test on the second bottle were consistent with the original result. See notes about purchase of bottles.3) The assay results from the single bottle,4 of ProCare Health Bariatric Chewable Dietary supplements for 6 of the 9 nutrients assayed (see chart below) shows less than 1% of the levels claimed on the label. Regarding the folic acid result: unless the source of folate was methylfolate, then the folic acid result is also less than 1% of the levels claimed on the label (see note5 below). The assay results for the remaining two nutrients are also below what is claimed on the label. 5 Results: Please note that when the lab result includes the "less than" symbol (<), the value reported is the lab's limit of detection - the lowest that the lab believes it can detect - and thus it was unable to find any of the nutrient within its limit of detection. PLEASE CLICK ON IMAGE FOR RESULTS! Note: The ProCare label did not mention the use of an expensive and rarely used form of folate called methylfolate. For this reason we did not test for it. If the company responds that it used methylfolate, we will test for methylfolate and publish the results for your review. We are not saying that ProCare Health Bariatric Chewable Dietary Supplements never contain the nutrients claimed, as we cannot test every bottle. We do believe however, that it is important and valuable to the bariatric community to provide the limited-scope assay results we have received. We have made initial contact with the...FDA...and are in the process of providing them the results. As some of you may already know, the FDA's ability to protect consumers-specifically in the dietary supplement market-is limited. Dietary supplement manufacturers are not required to get FDA approval before producing or selling supplements. All patients ultimately need your expert advice about which supplement brands they can trust. As responsible healthcare professionals, it is important to know the quality of supplement brands before recommending them. Footnotes 1 We originally sent one bottle, but the lab requested a second bottle to retest the folate level using that second bottle because the results from the first test were lower than expected. We did send the second bottle requested. 2 We mention the RDN's observation because it contributed to our curiosity. We cannot comment on the validity or accuracy of those patients' folate test results. 3 The lab confirmed that both bottles arrived still sealed. The bottles were ordered on the company website in late May 2015 and assayed in late July and early August 2015. 4 Note that this paper only comments on the laboratory results for one bottle of the ProCare product, except that a second bottle was requested by the lab to retest for folate when the initial results came in unexpectedly low. 5 We did not instruct the lab to test for methylfolate, which is an expensive and infrequently used form of folate. The ProCare label does not list methylfolate as the source of the folate in their Multivitamin on their label. 6 The lab indicated that various tests have expected error ranges, such as +/- 20% for example. However, the results show variances from label claims that are 99% or more, which is outside the lab's expected error ranges. 7 The lab assayed for both beta-carotene and Vitamin A acetate. For simplicity, we are showing the total result because the combined total is less than 1% of the Vitamin A claim. We welcome your feedback on this email. Please direct emails to RD@UNJURY.com The UNJURY® and OPURITY® Team"