Elizabeth Anderson RD

Folks who've had weight loss surgery are usually dieting experts. After years of following various diets, programs and plans, they know the rules inside and out. Now some of these old rules or diet tricks might work temporarily for dieters but they're downright dangerous for WLS patients. Bariatric Dietitian Elizabeth Anderson explains why the gold standard of many diets needs to be titrated after surgery. Remember this old diet trick? 'Drink a BIG glass of water or a diet drink before a meal; you won’t be hungry and you’ll eat less.’ Clearly this isn’t the most delicious diet tip but nevertheless, it’s one that many dieters still follow. WLS patients should not try this for three reasons: 1. Filling your pouch or sleeve with a large amount of fluid at one time will cause great discomfort. 2. Emptying your stomach quickly after a meal counteracts the satiety benefit of your surgery. Meaning, the faster your stomach empties—the sooner you’ll be hungry again. 3. Using fluids or drinks to replace food could lead to less total weight loss. Wait, less weight loss?? How’s that possible? Fluid pushes food through the pouch/sleeve more quickly. Food moving through your ‘stomach’ faster means important vitamin, mineral and nutrient digestion might not happen. Without these important nutrients and micronutrients, your metabolism will not run efficiently. A sluggish metabolism leads to less weight loss, if any at all—despite reduced caloric intake. Tomorrow dangerous diet tip #4: Salads: Your Weight Loss Staple.

Imagine me, 16 years old at the neighbor’s pool, feeling pretty sassy in my new one piece bathing suit with the buttons down each side. My grandmother’s friend edges up to the side of the pool and motions me over conspiratorially. “Elizabeth, I see you’ve lost some weight, tell me, what’s your secret?” “It’s easy, just eat 1000 calories a day. You can eat whatever you want just don't go over 1000." Ladies and gentlemen, why did I ever pay for a nutrition degree when I clearly had all the information at age 16???? Clearly, I jest. 1000 calories of hot dogs, English muffins, fat free cookies and pancakes does not a diet make—let alone a healthy weight loss plan. But it’s soooo tempting to follow this advice. It’s simple, clear cut and junk food is totally fine--as long as you keep the total consumption under the specified number of calories. Some WLS patients have taken the bait—especially after they stop losing weight. Not surprisingly, there are some problems with this type of plan. 1. 1000 calories of potato chips isn’t nutritious but it fits the criteria. 2. If you don’t have enough protein you’ll be compromising your weight loss—regardless of calories. 3. Individual calorie needs depend on sex, age and activity level to name a few. One size does not fit all. There’s a better way. Stop counting calories. Don’t let a number determine how much you’re going to eat today. Rely instead on your surgical tool and natural hunger. This can be scary—flying without a net. The temptation to use total calories as a guide is real. But ignore it. You are ready for something else, something more effective and natural. Here’s how to start: 1. Eat three bariatric-sized meals and two portioned snacks each day. 2. Sit down to eat, eliminate distractions: TV, computer, magazines or books. 3. Pay attention to the deliciousness of the food. Savor it. 4. Try to take at least 15 minutes to finish a meal, 30 is better. 5. When you are full, stop eating. Notice if there is still food on the plate. If there is, does that make you uneasy? There are a lot of members in the Clean Plate Club. Cancelling your membership IS possible, but first you have to realize you are a member. It isn’t easy shaking old diet thinking and behaviors—the first step is realizing you are following them. With some self-compassion and support, you can find your way back to healthy and sustainable weight management.

I tell my clients to work up to that gradually after surgery. I recommend the bariatric serving sized plate as a meal guideline and lean Protein based snacks in the 100 calorie range.

'If I'm not really hungry for lunch, what's the big deal about skipping it?' Bariatric Dietitian Elizabeth Anderson sheds light on the classic diet technique of skipping meals to save calories. After decades of dieting—books, programs and classes—the ‘rules’ of dieting can become second nature, perhaps even subconscious. Following these practices can reap temporary results for dieters, but for weight loss surgery patients, these rules can be unhealthy and even dangerous. In our hustle-bustle, productivity-obsessed work world, taking time for lunch can seem like a time suck. It’s almost virtuous in this country to skip meals because you’re ‘just too busy to eat.’ Hey, it’s a win-win, right? Your work dedication impresses the boss and, extra bonus--you didn’t consume any of those lunch-time calories! Great for the diet, right? Wrong. Missing meals isn’t smart for the dieter or the bariatric patient. Skipping meals throws off metabolism and triggers a biological effect in our brains making it almost impossible not to overeat at the next meal. But before that, a skipped lunch sabotages those ‘saved’ calories if we start justifying grazing with the thought, ‘It’s okay, I didn’t eat lunch, I can have this.’ For bariatric patients, eating three meals and two portioned snacks each day is essential to: · reach your ideal weight loss · maintain weight loss · keep blood sugar balanced · manage hunger by keeping your pouch or sleeve comfortably full · fuel your body during the most active part of your day Bottom line, a missed meal compromises your weight loss and weight management efforts. I tell my clients to think of skipped meals like missed sleep; your body doesn’t dig it and will let you know! You’ll slog through the day without sleep and you’ll be a starving beast at dinner if you miss lunch. Tomorrow, dangerous diet tip #2: Low calorie, high volume foods are your best friend.

Salad. The food most synonymous with the word ’diet.’ Many people LOVE salad. Others eat it because they feel like they should if they’re on a diet. Nutritionally, the darker the greens, the more brightly colored the vegetables—the healthier the salad. High volume, low calorie salads make a lot of sense for the average dieter. You feel full on very few calories, provided you skip the high calorie dressing. But there’s one ingredient many people forget that prevents salad from being a balanced meal---the protein. I tell my weight management clients if they really enjoy salad, it’s a great meal AS LONG AS there is at least 3 ounces of a lean protein included in, on or with the salad. The protein piece is vital because it helps the meal digest more slowly. This leads to less hunger between meals. The protein is also important to protect lean muscle from being used for fuel when calories are cut. I tell my weight loss surgery clients, the need for protein is more than just a recommendation, it’s an absolute must. At least 3 ounces of lean protein (about 15-20 grams of protein) with your salad. I urge you to actually measure out the chicken, cottage cheese, beans....to ensure you are hitting the mark. A bariatric salad ‘meal’ should look like protein with a little salad on the side rather than a huge bowl of greens with a sprinkle of cheese or half an egg. As we’ve seen with the other diet myths, standard operating procedures for dieting do not translate after WLS. Tomorrow, dangerous diet tip #5: It’s all about the calories.

Are you unknowingly following some of your old dieting habits? After decades of dieting it can be hard to let go of old beliefs and behaviors. But be careful, some of those old rules and tricks are downright dangerous after WLS. Bariatric Dietitian Elizabeth Anderson unveils 5 common but Dangerous Diet Myths. Today, myth #2--low calorie food don't count. Let’s start with pure, innocent popcorn. Popcorn is a great, high volume, low calorie, whole grain snack-- if prepared in a healthful way. Dieters love air-popped popcorn! It provides a BIG feeling of fullness for very few calories. It can be a great tool for managing late night snacking when you’re watching your weight … if you aren’t a bariatric surgery patient. For weight loss surgery patients, it’s that feeling of fullness that’s the concern. After WLS, you’ve got to be very careful about high volume foods—even if they’re ‘healthy’ or low calorie. Those neat little bags of baby carrots are a classic example. In many diet plans, these low calorie veggies are the perfect ‘free food’ because they’re high in nutrition. I’ve had many clients tell me this is their go-to snack because ‘they really don’t count.’ Don’t get me wrong, we all need vegetables and carrots ARE super healthy. But WLS surgery intentionally left you with precious little capacity in your pouch or sleeve. For the very best and most healthy weight loss/maintenance, you need to fill that tiny space very strategically. Protein, vegetables, whole grains—in that order. Be careful not to override your surgical tool with very low calorie vegetables or…popcorn. Yes, they’re healthy but standard dieting advice is just one more of things that don’t fit after WLS. Tomorrow dangerous diet tip #3: Fooling Your Stomach with Fluid.

How much hummus can you load onto a chip, cracker or pita wedge? If hummus is healthy, is it a freebie food after surgery? Bariatric Dietitian Elizabeth Anderson helps clear the air. “But Elizabeth, hummus is supposed to be good for you.” My post gastric sleeve client sat across from me in the office, confused and frustrated. “Are you telling me I can’t eat hummus?” As a bariatric dietitian, I’ll tell you what I told him, “You can eat hummus…. cautiously.” Here’s the deal with hummus. Hummus is a savory and delicious, bean-based condiment or dip. Yes, it’s full of good-for-you monounsaturated fat but at 50 calories per 2 tablespoons—the good times add up FAST. Every two bites mean 50 calories. 4 bites = 100 calories. You get the idea. If you’re not paying a whole lot of attention to your snacking --you can easily be in pain and overloaded with calories in no time. The hummus example is just one in a long line of misconceptions that set dieters back but can be downright dangerous for weight loss surgery patients. I’ve picked 5 of these misunderstood dieting tricks and in the next five days I’ll clear the air. Tomorrow check out the first myth: missed meals = missed calories.

After decades of dieting—books, programs and classes—the ‘rules’ of dieting can become second nature, perhaps even subconscious. Following these practices can reap temporary results for dieters, but for weight loss surgery patients, these rules can be unhealthy and even dangerous. In our hustle-bustle, productivity-obsessed work world, taking time for lunch can seem like a time suck. It’s almost virtuous in this country to skip meals because you’re ‘just too busy to eat.’ Hey, it’s a win-win, right? Your work dedication impresses the boss and, extra bonus--you didn’t consume any of those lunch-time calories! Great for the diet, right? Wrong. Missing meals isn’t smart for the dieter or the bariatric patient. Skipping meals throws off metabolism and triggers a biological effect in our brains making it almost impossible not to overeat at the next meal. But before that, a skipped lunch sabotages those ‘saved’ calories if we start justifying grazing with the thought, ‘It’s okay, I didn’t eat lunch, I can have this.’ For bariatric patients, eating three meals and two portioned snacks each day is essential to: · reach your ideal weight loss · maintain weight loss · keep blood sugar balanced · manage hunger by keeping your pouch or sleeve comfortably full · fuel your body during the most active part of your day Bottom line, a missed meal compromises your weight loss and weight management efforts. I tell my clients to think of skipped meals like missed sleep; your body doesn’t dig it and will let you know! You’ll slog through the day without sleep and you’ll be a starving beast at dinner if you miss lunch. Tomorrow, dangerous diet tip #2: Low calorie, high volume foods are your best friend.

I just saw the Talking Heads with Hummus thing too! Funny what our brains do to us!

“But Elizabeth, hummus is supposed to be good for you.” My post gastric sleeve client sat across from me in the office, confused and frustrated. “Are you telling me I can’t eat hummus?” As a bariatric dietitian, I’ll tell you what I told him, “You can eat hummus…. cautiously.” Here’s the deal with hummus. Hummus is a savory and delicious, bean-based condiment or dip. Yes, it’s full of good-for-you monounsaturated fat but at 50 calories per 2 tablespoons—the good times add up FAST. Every two bites mean 50 calories. 4 bites = 100 calories. You get the idea. If you’re not paying a whole lot of attention to your snacking --you can easily be in pain and overloaded with calories in no time. The hummus example is just one in a long line of misconceptions that set dieters back but can be downright dangerous for weight loss surgery patients. I’ve picked 5 of these misunderstood dieting tricks and in the next five days I’ll clear the air. Tomorrow check out the first myth: missed meals = missed calories.

Excellent point! Thanks for adding that!

Carbonate, Citrate, Tricalcium phosphate oh my! Bariatric Dietitian Elizabeth Anderson has the sly on what to buy. It isn't easy to find calcium citrate in the store. It also isn't cheap. But oh how we bariatric dietitians urge you to go with calcium citrate versus the more affordable and freakishly easy to find--carbonate form. Optimistic me hopes that one day that will change. So I'm always on the look-out for calcium citrate on store shelves. Imagine my delight when I was at a national surplus store and I saw a box of Citracal chewies for sale! As per my geekish habit, I flipped the box over to double check the form of calcium. To my shock and horror it was calcium carbonate!!! I wondered if others had picked up the package and thought, "Citra-cal sounds sort of like 'citrate'-- must be what I need!" Maybe the rest of you are more eagle-eyed than me. Maybe you are never fooled by food packages. But if you are sometimes just in a big blessed hurry and just throw things in the cart--slow down when it comes to the calcium. "But Elizabeth, do I really need to trouble myself with citrate anyway? Why not just get the yummy chews in the brown little tub?" There is a reason to go citrate instead of carbonate, and here it is. Weight loss surgery patients need calcium because bone loss is almost always greater than new bone formation, after surgery. Even with supplements! Since the stomach is smaller after all weight loss surgeries/procedures--it also has fewer cells producing acid. Calcium needs acid to be absorbed. Registered Dietitians recommend the citrate form of calcium because research shows it's better absorbed (about 25% more absorption) than other forms in a low acid stomach. But it's not as simple as that. (You knew that was coming, didn't you?) If you cannot STAND the taste of the citrate form, if you will NOT spend that amount of money on a supplement, then by all means, please take the carbonate form. Any form of calcium is better than none! Remember, most patients need about 1500 milligrams a day-- spread out in doses of no more than 500 milligrams each. Here's to your savvy shopping, your strong bones and your continued journey to health!

It isn't easy to find calcium citrate in the store. It also isn't cheap. But oh how we bariatric dietitians urge you to go with calcium citrate versus the more affordable and freakishly easy to find--carbonate form. Optimistic me hopes that one day that will change. So I'm always on the look-out for calcium citrate on store shelves. Imagine my delight when I was at a national surplus store and I saw a box of Citracal chewies for sale! As per my geekish habit, I flipped the box over to double check the form of calcium. To my shock and horror it was calcium carbonate!!! I wondered if others had picked up the package and thought, "Citra-cal sounds sort of like 'citrate'-- must be what I need!" Maybe the rest of you are more eagle-eyed than me. Maybe you are never fooled by food packages. But if you are sometimes just in a big blessed hurry and just throw things in the cart--slow down when it comes to the calcium. "But Elizabeth, do I really need to trouble myself with citrate anyway? Why not just get the yummy chews in the brown little tub?" There is a reason to go citrate instead of carbonate, and here it is. Weight loss surgery patients need calcium because bone loss is almost always greater than new bone formation, after surgery. Even with supplements! Since the stomach is smaller after all weight loss surgeries/procedures--it also has fewer cells producing acid. Calcium needs acid to be absorbed. Registered Dietitians recommend the citrate form of calcium because research shows it's better absorbed (about 25% more absorption) than other forms in a low acid stomach. But it's not as simple as that. (You knew that was coming, didn't you?) If you cannot STAND the taste of the citrate form, if you will NOT spend that amount of money on a supplement, then by all means, please take the carbonate form. Any form of calcium is better than none! Remember, most patients need about 1500 milligrams a day-- spread out in doses of no more than 500 milligrams each. Here's to your savvy shopping, your strong bones and your continued journey to health!

Old habits can be hard to break. Throw in a sale and the temptation is fierce. Bariatric dietitian Elizabeth Anderson gives you some tips to stay strong. Perhaps you're not like me. Perhaps you're not a bargain diva or czar. Perhaps you don't have a sweet tooth, never have. Maybe you never went into a drug store to buy a greeting card and came out with 3 for 1 bags of candy? Perhaps you always share big bags of treats with others, never squandering it all for yourself... on the drive home! However, if ANY of this sounds a little like you. Read on. You're in good company. Easter is over but the candy is not. Are there marquees or sale flyers in your world advertising deep discounts on the leftover candy? It's tough to resist, especially if you have a history of overdoing it during the holidays. If the Peeps are literally calling your name consider the following: 1. There are No Peeps left! They were sold out a week before Easter. The only thing left is candy so icky, they're selling it for 70% off. (No doubt those licorice jelly beans.) 2. This isn't Christmas wrapping paper people. If you stash away these deeply discounted items, you might have lots of chubby vermin in your attic making making nests out of that holiday wrap 3. Splurge your bargain urge this weekend at one of the first yard sales of the year. Be honest with yourself. Is your weight up a little after the holiday? Maybe in a downward spiral of negative thought you've said to yourself, 'Buy the damn candy. What difference does it make? You're fat anyway?' I'm here to tell you it does make a difference because YOU matter!! There is no lasting love, lasting relaxation, lasting peace in the discounted candy. Yes, it soothes momentarily but at a very, very high price to your peace of mind, your confidence, your well-being. And those are the things I'm most interested in protecting. No two WLS clients are the same, but I'll bet most would agree that having bulk candy around the house or office is an invitation for stress. Save yourself the grief, drive on by the candy sales and aisles and discount bins. Focus on the fun springtime clothes, bike rides and outdoor walks you're now enjoying. Now that is something to PEEP about!

Perhaps you're not like me. Perhaps you're not a bargain diva or czar. Perhaps you don't have a sweet tooth, never have. Maybe you never went into a drug store to buy a greeting card and came out with 3 for 1 bags of candy? Perhaps you always share big bags of treats with others, never squandering it all for yourself... on the drive home! However, if ANY of this sounds a little like you. Read on. You're in good company. Easter is over but the candy is not. Are there marquees or sale flyers in your world advertising deep discounts on the leftover candy? It's tough to resist, especially if you have a history of overdoing it during the holidays. If the Peeps are literally calling your name consider the following: 1. There are No Peeps left! They were sold out a week before Easter. The only thing left is candy so icky, they're selling it for 70% off. (No doubt those licorice jelly beans.) 2. This isn't Christmas wrapping paper people. If you stash away these deeply discounted items, you might have lots of chubby vermin in your attic making making nests out of that holiday wrap 3. Splurge your bargain urge this weekend at one of the first yard sales of the year. Be honest with yourself. Is your weight up a little after the holiday? Maybe in a downward spiral of negative thought you've said to yourself, 'Buy the damn candy. What difference does it make? You're fat anyway?' I'm here to tell you it does make a difference because YOU matter!! There is no lasting love, lasting relaxation, lasting peace in the discounted candy. Yes, it soothes momentarily but at a very, very high price to your peace of mind, your confidence, your well-being. And those are the things I'm most interested in protecting. No two WLS clients are the same, but I'll bet most would agree that having bulk candy around the house or office is an invitation for stress. Save yourself the grief, drive on by the candy sales and aisles and discount bins. Focus on the fun springtime clothes, bike rides and outdoor walks you're now enjoying. Now that is something to PEEP about!

Hi there! You might know me from some of my pieces in the magazine. I’m a registered dietitian in southern NH. Bariatric Pal’s CEO, Alex Brecher was kind enough to allow me the ‘reporter at large’ role for BariatricPal.com at this year’s Obesity Week. This is the second annual global convention for obesity experts & bariatric healthcare providers and vendors… This year we’re in Boston, MA. I am attending lectures, mixing, mingling and learning the latest in the science, treatment and prevention of obesity. I’ll share what I learn throughout the week on BariatricPal.com, CrackerJack Nutrition’s Facebook page and Twitter. This information is important for all of us. I’ll keep the medical gobbledy-goo to a minimum and simply give you the straight scoop. Stay tuned!

Alex Brecher has dubbed bariatric dietitian Elizabeth Anderson,BariatricPal.com's Reporter at Large for Obesity Week 2014. Elizabeth is attending nutrition lectures, seminars & meetings and she'll share news you can use throughout the week-- minus the scientific jargon. Just attended a lecture on food cues and impulsivity. MRI scans showing brain activity were done on obese-prone and obese-resistant rats. The results? After two days of being over-fed, obese-prone rats had continued motivation for food. The obese-resistant rats motivation levels were nearly zero—and the effect lasted for days. Researchers are hopeful this research translates to us humans AND that we can make positive changes. Promising changes to appetite hormones and specialized behavioral changes could be the key. Believe it or leave it, MRIs on obese-prone people showed that after just six months of exercise motivation centers in the brain are reduced!

CAUTION! MEDIA HEADLINES MEAN TO SHOCK! I was recently drawn into an online article with this tantalizing and provocative headline.. “Vitamin D Testing Not Recommended for Most People.” This was the headline from the Harvard Health Blog. I HAD to read more, this surely couldn't be correct. Could it? Is all this ’vitamin D saves the world’ merely hype? Not so fast. Remember, the media can’t sustain without an audience…even Harvard blog writers need readers. Flashy, conflict-building headlines do just that. My beef here is that in today’s hurry-up world, there’s a good chance many people won’t read past the headline. In fact, they may start thinking, “Hey, if Harvard says I don’t need vitamin D, I probably don’t” and stop taking the supplements their surgical team has recommended. Before anyone does that, here’s what I learned from reading the whole Harvard blog piece. 1. Many scientists don’t agree on what a ‘low’ level of vitamin D is. 20 ng? 30 ng? 50ng? 2. Vitamin D research is at a crossroads because its not certain if there’s a solid relationship between vitamin D levels and heart disease or cancer. And…… 3. Weight loss surgery patients are among the 3 groups of people that need to be tested for vitamin D levels because of changes in fat absorption after surgery. Will vitamin D prevent cancer, osteoporosis and heart disease? Not likely, on its own, but scientific research continues. In fact, a clinical trial is underway involving 26,000 people that will provide some solid information on vitamin D’s role in our health. Look for the accompanying tabloid-type headlines in 2017. Meantime, WLS patients, keep taking your prescribed supplements. You'll be glad you did.

“Vitamin D Testing Not Recommended for Most People.” This was the headline from the Harvard Health Blog. I HAD to read more, this surely couldn't be correct. Could it? Is all this ’vitamin D saves the world’ merely hype? Not so fast. Remember, the media can’t sustain without an audience…even Harvard blog writers need readers. Flashy, conflict-building headlines do just that. My beef here is that in today’s hurry-up world, there’s a good chance many people won’t read past the headline. In fact, they may start thinking, “Hey, if Harvard says I don’t need vitamin D, I probably don’t” and stop taking the supplements their surgical team has recommended. Before anyone does that, here’s what I learned from reading the whole Harvard blog piece. 1. Many scientists don’t agree on what a ‘low’ level of vitamin D is. 20 ng? 30 ng? 50ng? 2. Vitamin D research is at a crossroads because its not certain if there’s a solid relationship between vitamin D levels and heart disease or cancer. And…… 3. Weight loss surgery patients are among the 3 groups of people that need to be tested for vitamin D levels because of changes in fat absorption after surgery. Will vitamin D prevent cancer, osteoporosis and heart disease? Not likely, on its own, but scientific research continues. In fact, a clinical trial is underway involving 26,000 people that will provide some solid information on vitamin D’s role in our health. Look for the accompanying tabloid-type headlines in 2017. Meantime, WLS patients, keep taking your prescribed supplements. You'll be glad you did.

BariatricPal.com has Elizabeth Anderson, RD in Boston, MA this week as the reporter at large for Obesity Week 2014. Find out what Elizabeth discovered on Day 1. Here are some nuggets from just a smidge of the hundreds of lectures and presentations offered today. There are so many to choose from--it's tough to pick. What guides my selection? Information that could be useful, inspiring and life-changing for my bariatric patients. At a lecture on feeding cues we learned that our visual signals are the strongest cues for eating, not smell. Surprising! I think a certain cinnamon roll company might take objection to that. This got me thinking, what can I do to reduce my visual cues of tempting treats? Here's a quick list I came up with: avoid nighttime TV,(those commercials!) bypass the cracker and cookie aisle in the grocery store, use an alternate route home rather than the local fast food strip. Life is hard, don’t add stress with sugar plums dancing in your head. At a seminar on motivation, we learned that lasting motivation is built from a combination of importance + confidence. We have to truly value the change we want to make and we need to feel that we can actually do it, to get started. Weight stigma is unfortunately alive and well. At the ASMBS Integrated Health Update we were reminded that weight discrimination is still held as socially acceptable in many countries including the US. People with excess weight report skipping or cancelling healthcare appointments if they've been a victim of weight bias in their doctor's office. We know from history that stigma is a barrier to healthcare and disease prevention--think leprosy, AIDS, cholera, drug addiction. Let's get obesity off that list. Insults, sneers and bullying do not, have not and will never inspire weight loss. In fact, research shows they have the opposite effect. Looking forward to another jammed packed, informational day tomorrow. 'See' you then!--Elizabeth

I'll be sharing summaries from some of the 100s!!! of posters displayed at OWeek 2014. Stay tuned.

So sorry to hear you had to go through that. Glad you entrust your care to a more deserving, respectful and professional provider now.

An international throng of obesity researchers, providers and surgeons is in Boston this week sharing information, ideas and research. Here's your Thursday update from Bariatric Pal's reporter at large, Elizabeth Anderson, RD. Very interesting news from Obesity Week presentation in Boston. Research has shown after SG or GB (in rats...I know, I know!): 1. appetite decreases due to brain changes-- not just limited stomach size 2. the brain literally changes after repeated episodes of sickness after eating too much. Aversive conditioning makes the idea of some foods or overeating--disgusting 3. no one single hormone or nerve is solely responsible for decreased appetite 4. there's a strengthening in the executive control or restraint part of the brain 5. the very low cal diet prior to surgery mimics the appetite suppression seen after gastric bypass surgery. In other words, we're training the brain new ways to approach food, before surgery 6. there's a change in the reward system of the brain after WLS 7. formerly obese rats have less drive for concentrated sweets and fat than their lean pals Fascinating! We'll watch to see the implications for humans.