Dr. Adeyeri

Hitting a plateau or weight loss “stall” is common for just about everyone. While it’s certainly frustrating, it’s important to understand this is just temporary. The good news is weight loss plateaus usually happen after you have lost a significant amount of weight—so congratulations! During your post-op weight loss, the body will eventually need a ‘time out” to stabilize itself and adjust to your lower nutrition intake, smaller size and increased calorie burn due to exercise. It can happen at any time in your weight loss journey, but is particularly common 3-6 months after bariatric surgery. Generally, stalls can last anywhere from a few days to a few weeks, even though you’re staying on track. Expect from one to three plateaus in the first year following weight loss surgery. WHY DO WEIGHT LOSS STALLS HAPPEN? You can blame your body’s metabolism— When you lose weight rapidly, you are losing lean body mass (muscle) and fat. Muscle plays a big part in the burning of calories by keeping your metabolic rate high, so you want to hold onto muscle and strive to build more! (This is one of the reasons we ask you to take in so much protein). A weight-loss plateau usually occurs when your metabolism slows down. Now that you’re thinner, the activities you’re performing may not be resulting in as much caloric burning. An increased metabolic rate is not the only reason for keeping muscle. You want to keep muscle so you can use them to exercise and burn even more calories. Weak muscles make exercise more difficult, so build muscle with strength training and cardio workouts. EIGHT TIPS TO OVERCOME BARIATRIC WEIGHT LOSS PLATEAUS AND BOOST METABOLISM 1. Increase the intensity of your exercise. 2. Weigh yourself less often. 3. Keep food journaling to ensure there are no negative nutrition issues creeping in. 4. Eat all that protein to help retain muscle, even in shake form. 6. Drink 64 ounces every day. 7. Sleep eight hours nightly and keep a set schedule, even on weekends. 8. Talk to your bariatric team during the plateau for an added level of support and guidance. KEEP IN MIND… If you are weight training, consider that muscle weighs more than fat; while you are building muscle, you are still losing inches (girth) even though if it isn’t reflected in pounds lost. USE YOUR SUPPORT NETWORK Remember there are several layers of people supporting you during your road back to good health: Your doctor Bariatric dietitians and nutritionists Family Friends Colleagues Live and online support groups. (They understand more than anyone!) If a plateau lasts more than a few weeks and you haven't contacted your bariatric surgeon yet, make an appointment for an ASAP visit to rule out any issues. Meanwhile, stay positive and celebrate how far you have come in a short time. This is a very brief traffic jam on your highway to success.

We all have an inherent need to help others before we help ourselves, particularly as adults when we take on the roles of spouse, partner or parent. But taking on the goal of losing a large amount of weight requires that you dedicate yourself 100 percent to the task at hand. Make time--no matter what obstacles try to block your path--to accomplish these tasks every day 24/7/365 (yes, even Christmas): · Shopping for fresh and healthy food · Preparing meals · Exercising daily · Relaxing · Planning for the next day These responsibilities can be challenging when you are so accustomed to helping everybody else before finally seeing to your own needs (if you are not too exhausted to do so). It’s all-too-easy for self-care activities to slide off the to-do list (I’ll start again tomorrow…) Undertaking the Herculean challenge of losing a large amount of weight and changing unhealthy lifestyle patterns in your life may be the battle of a lifetime for many of you. And you are worth it. But to accomplish this goal as quickly and effectively as possible, you have to prioritize “self-care.” Five ways to prioritize your needs during weight loss 1. Prepare and enjoy your meal before you cook for the family. 2. Set-up a kids’ activities car pool to lessen wasted time sitting idly in the car. 3. Set a daily reminder to take a 15-minute break every day to do something that you enjoy, even if you just sit with your eyes closed. 4. Feel free to say to detractors, “I have to devote a concerted effort toward my weight loss, which will make me healthier and happier.” 5. If you are put into a situation where you may eat for the wrong reasons, change plans or politely excuse yourself. (You are in a special situation, you are allowed). Like getting regular oil changes for your car, prioritizing your own needs is what allows you to run optimally and put your best foot forward toward achieving your weight loss goals. And you are very much worth it.

The first time I met George Peters, I knew he would be a record holder, I just didn't realize to what extent! He had been sufficiently frightened by several chronic health issues he was living with as a result of his weight. And I knew he was ready to defeat the fear and fight back. While George didn't look like it outwardly, he weighed more than 400 pounds. With the full support of his family, his took his obesity challenge by the horns (and then some). George recently shared his personal weight loss journey on Facebook as a way to show where he had been--and where he is today. He kindly permitted us to share his remarkable story below: Why Weight Loss Surgery By George Peters (shared with permission) It's one month until my first Ironman in Mont-Tremblant, Quebec and I'm sharing my story of ‪#‎whyweightlosssurgery: In 2010, I weighed 425 pounds. I was visiting my primary care physician, and he stated that I would need surgery to have an insulin pump inserted into me to control my diabetes. My realization was that I would probably be dead by age 50, if I didn’t get my diabetes under control. Weight-related Health Issues My diabetes, high blood pressure, respiratory problems and circulatory problems were out of control. I had tried numerous diets to control my weight and health problems, and they always started off with success only to surrender any weight loss, to an eventual failure, and an additional weight gain. I decided that I would have bariatric surgery for weight loss in January 2011. I had gastric sleeve surgery performed by Dr. Ayotunde Adeyeri at Bayshore Community Hospital in Holmdel. Sleeve Gastrectomy Success I lost 125 pounds and started to control my health problems. My weight loss stalled in 2013 and my fear of my health problems returning scared me. I hadn’t reached my goal weight of 240 pounds. I started running in the fall of 2013 when my daughters convinced my wife and me to have our family run in a turkey trot (5K). A New Passion for Fitness, Strength and Endurance I started running and found the workouts to be rewarding. I started cycling again soon after. I hadn’t ridden a bicycle since I was a teenager because I was too big to ride a bike. Soon after my first 10 mile bike ride, I decided to sign up for my first sprint triathlon, in the spring 2014. During the 2014 year, my performance in three of my four triathlons was affected due to gall bladder problems that eventually led to my gall bladder being removed 5 days after the New Jersey State Triathlon. Losing Nearly 200 Pounds Sends George to His First Ironman Competition 2015 has been a year of setting goals and working to achieve them: My goal for this year is to finish an Ironman. I scheduled multiple smaller events to help me prepare for the Ironman. I finished the NYC half marathon in March. My training continued, and I finished the Raleigh Ironman 70.3 in 9 hours 3 minutes. In August, I will complete my first full Ironman triathlon in Mont Tremblant, Quebec, Canada. Ironman and Triathlon have given me a bright outlook for the future. I now have a goal of being in Kona by the age of fifty.

People who have undergone bariatric surgery know the weight loss battle does not end in the operating room. Months and even years after surgery, some weight can slowly creep back on. But this isn't a time to panic because now you have the tools to overcome a little setback and regain control of your weight. This time, you are in charge. One of the lessons you learn after weight loss surgery is that you are in charge of your health, diet and exercise program. The food no longer rules the roost--you do. The truth of the matter is no matter what the scale says, 110 or 310, everyone puts on a few pounds now and then. As a bariatric surgeon in New Jersey for more than 10 years, one of the biggest anxiety triggers for patients is weight gain. "That's it--it's over--I'm going to gain all the weight back." Of course that's not true. To get back on pace, I’ve listed a few essential steps to help get you back on track to dropping the pounds once again: • Go back to the beginning Post-surgery, you probably followed your healthcare team’s advice to the letter. But as time passed, and you looked and felt healthier, you may have started to deviate from those dietary and exercise guidelines. Pull out your notes and review the program guidelines that brought you this far. Get back on the scale once a week and fire up your food journal again. • Get thyself to the nearest support group ─ STAT Weight loss is a personal journey, but it doesn’t have to be a lonely one. Online support groups on BariatricPal.com are great secondary resources to live weekly or monthly groups with your bariatric doctor or hospital. There is support all-around you, reach out and take it. • Work it out Are you using the ‘too tired’ reason for missing a trip to the gym or 30 minute fast walk around the neighborhood? If you need energy, you know how to get it—get up, get out and get moving. “Too busy,” you say? Remember, only you can prioritize your health and wellness. You matter—make time for your health every single day. • Come to terms with the weight gain This doesn’t mean blaming yourself. Rather, be forthright about how and why it happened and pat yourself on the back that you’ve recognized it now—not later. There’s no need to beat yourself up. You have already done the hard part by recognizing some weight has crept back on. That in itself shows you are going to battle back. We encourage our patients at Sterling Surgicare to call us if they feel frustrated or defeated--everyone needs a pep talk now and then. Remember there are many people supporting you 24/7 in this effort. Life is filled with occasional side-steps and set-backs. It is part of making us who we are. Make a plan, regroup, recommit. You can do this.

You GO Maggie! Let me know how it goes! Dr. Adeyeri. Holmdel, NJ, USA

Studies have shown that obesity can result in a higher risk for dental problems. Issues with your teeth can affect your overall health and even open the door to serious chronic medical conditions including diabetes, heart disease and osteoporosis. Specifically, overweight people have higher tooth decay levels, more missing teeth and fewer required dental fillings. They also visit a dentist less frequently, have more difficulty accessing dental care on a regular basis and are likely to visit a dentist only when they have a problem. Dental issues after bariatric surgery Keep in mind, dental issues can continue even after obesity is defeated. Once bariatric weight-loss surgery has been completed and the weight begins to fall off, there are nutrition guidelines that patients need to follow. If this protocol is not adhered to, resulting gastrointestinal issues can cause damage to the teeth and mouth. Overeating causes stomach distension which frequently leads to regurgitation and reflux exposing the teeth to caustic gastric juices at pH levels high enough to dissolve tooth structure. This can lead to cavities, root degeneration and gum disease. Tooth erosion is a common condition that includes hypersensitivity to eating or drinking cold or hot items. This can be compounded by sugar ingestion which produces even more acid in the mouth. The combined acid attacks invites uncontrolled enamel demineralization that defeats daily oral hygiene efforts even in someone who has never experienced dental decay issues. Six ways to get back on the dental health track Proactive dental hygiene and early diagnosis of any problems will contribute to your overall health and wellness strategy. Here are steps to take to get rolling in the right direction: • Have a thorough dental cleaning and examination and take care of any problems before they become more serious. • Rinse with mouthwash for one minute twice a day prior to brushing and flossing. • Use one of the new toothpastes that helps to preserve and protect tooth enamel. • Add baking soda to your toothpaste to help neutralize acid levels in the mouth. • Drink water throughout the day to help offset the negative effects of dry mouth. • Eat more seeds, nuts, soy, seafood and spinach—this starves decay-producing bacteria and reduces acid levels in the mouth. The bariatric weight loss process is a way of regaining control over your health. During the journey, it is important to take care of your teeth, gums and mouth. Not only will your mouth be fresher and healthier, white teeth will serve as a terrific accessary to your new outlook and your new body. (Photo courtesy of FreeDigitalPhoto.net)

I’d like to share some of my tips, along with those of my dietitians, to help. Plan Your Strategy Beforehand Before you head out the door, decide how you will eat a small portion of the right kinds of food and drinks for you. If anyone comments about your smaller portions, feel free to say you like to eat "tapas" style where you try small portions of several foods. Stick to Proportions Divide your meal into three distinct sections—mostly veggies, a sampling of a few proteins topped off with a bite or two of carbs, if that's in your weight loss plan. Stick to these proportions and you’ll feel satisfied, full and enjoy a variety of foods in moderation. Take a Tour Insider tip: The most expensive (i.e. healthiest) are “hidden” at the end or up at the top of the buffet and the least expensive (carbohydrate-laden) selections are usually right at the beginning. Therefore, stroll around the buffet before making your final choices. Forego the typical foods you eat regularly (green salad, common cooked vegetables) and sample some new items or those that you might not normally eat. Dining should be fun and interesting. The game is to also make it healthy. Let Others Go First If you’re first in line for the buffet, you’ll also be the first one eating. By the time everyone has served themselves, you’ll be staring at an empty dinner plate, possibly considering a repeat performance. Try to time your meal so you are choosing your foods about midway through the meal. At that point, there will be ample servings of your favorite foods and you’ll finish eating with the other guests. Keep it Simple Chicken, fish and high quality, lean cuts of beef (steak) are both excellent sources of lean protein ─ but not when they’re drenched in creamy sauces, wrapped in bacon, or hidden under layers of cheese. Stick to foods simply seasoned with herbs and spices or lightly tossed in olive oil. With a strong emphasis on healthier eating, the buffet is no longer the enemy. It’s actually a rather fun game to fill your plate with delicious and nutritious food. You’ll be surprised how easy it is to make a delicious plate without feeling like you’re missing out! @sterlingsurgnj Follow Dr. Adeyeri for his tips and commentary about bariatric weight loss surgery. Image courtesy of Rosen Georgiev at freedigitalphotos.net.