PATCHELTON

Besides the Biotin, if you don't think you are getting enough Protein, you could try adding a Protein shake to your daily intake. I still drink one at least 5 days a week. I use Worldwide Protein shakes. They are available various places. Cheapest is Trader Joe's. They only carry vanilla and chocolate in 21g and 35g ready to drink shakes. Low in fat/sugar/carbs. The 21g run about $1.69 each and the 35g about $2.29. Price could vary a bit in different areas. I noticed Target is now carrying the 21g for either $5.99 or 6.99 for a 4 pack. They carry Vanilla, Chocolate and Cookies n' Cream flavors. The Vitamin Shoppe carries the 35g shake in Vanilla, Chocolate, strawberry, banana Cream and Cookies n' Cream (my favorite--tastes like Oreos). Individually they cost $2.79 each but if you buy a 12 pack for $27.99 that works out to about $2.33 each, close to Trader Joe's price. Vitaminshoppe.com also carries them and for orders $99 or more shipping is free. If you join their Reward Points, they have coupons or offers via email that can save you even more money. I got a coupon for $20 off $100 order, so I ordered enough that after I took off the coupon the order was still over $99 and I got free shipping too. It was like getting a 12 pack free. I like free stuff! Worldwide is a milk based shake, in case you are lactose intolerent. nectar is another brand that is a powder and you mix it in Water or milk depending on the flavor. Comes in 2 lb tubs. Also unjury.com carries Vanilla, Chocolate, Strawberry, Unflavored (to mix in other stuff to bump up the protein content) and chicken Soup flavors (like broth). They come in powder that you mix. Comes in large tubs or individual packs that you can use at work maybe. I hope this helps, and good luck on your journey. BTW I haven't had a problem with my hair falling out. Maybe it is a tad thinner than before surgery but I don't look like I am balding. I recently switched chewable Vitamins, and Bariatric Advantage has more biotin than some of the others. You can check that out at bariatricadvantage.com. I was looking for an Iron free formula. Interestingly their gastric band formula has iron, but the RNY/Sleeve formula doesn't, so that is the one I am using. It has about 600mcg biotin if I remember correctly.

Prior to surgery (3/25/08) I had enough co-morbidities for 2 or 3 people. High blood pressure, reflux, sleep apnea, joint arthritis, high cholesterol, everything but diabetes. I took 2 meds for BP, 2 for cholesterol, 1 for reflux, 1 for arthritis. I have been able to stop all the cholesterol meds, the reflux med and one of the BP meds. We tried stopping the second BP med but my BP crept up some (not horrible, like 130/85) AND my weight crept up a few pounds too, so I talked to my doctor and we left it at one BP med. At least it is the generic type that I can get at Walmart for $10 for 90 days. Just the copays on all that stuff is enough to kill you. I also take Meloxicam for my arthritis but getting the weight off has made a huge difference in how much pain I get. Not nearly as bad as before. There is HBP in my family too, so I may be dealing with a genetic component also. I can't complain, though. Compared to before, I am doing great. And from a size 22womens to 10misses ain't bad either!

For those craving snack foods, I have found Kay's Naturals Protein chips help. For the salty craving, my favorite flavor is Lemon Herb (they also have Crispy Parmesan, and Chili Nacho, and pretzels). There is also Krucheese chips, kind of a cheesy flavor. They are high protein, gluten free. The nut label is for 1oz but the bag is 1.5 oz so I do the math, because I eat the whole bag. They come in larger boxes, but I do better with the small bags, because I will stop when the bag is done. I can't always guage in a bigger bag or box and I eat too much. For the sweet cravers, they have Almond Delight and Hazelnut Delight (chips) and sweet/salty Sweet BBQ(pretzel and chip combo). They also have a new Cinnamon pretzel, and if you like wasabe there is a wasabe pretzel(I didn't care for that flavor). They also make Cereal in 1oz 100 cal bags in three flavors (Apple Cinnamond, French vanilla, and Honey Almond). I am a grab and go type person, so during the week they work for Breakfast because I keep them at work so I don't have to pack one each day. I drink a Protein shake first, wait an hour or so and then have cereal (I don't even bother with milk, I eat it like a snack) sometimes by itself, sometimes with my yogurt. I get Greek yogurt from Trader Joe's. They have a plain fat free there that has 22g protein per cup! Comes in a 2 cup container, and at home I split it into half cup servings (11g protein and only 3g sugar each) and stir in sugar free Smuckers preserves for flavoring (plus some cinnamon). I can't say every day is perfect, but I have probably eaten no more than 5 potato chips and a handful of regular pretzels since my sugery over a year ago. Kay's has a sampler you can order to try different flavors. They sell the bags in a carton of 12, and they frequently have sales. Find them at kaysnaturals.com. I don't know if this solves the snacking problem for anyone, but I hope it helps. Good luck on your respective journeys.

I like Worldwide Protein Shakes, available at Vitamin Shoppe and vitaminshoppe.com. Individually they are $2.79 each but if you buy a 12 pack for $27.99 they are about $2.33 each. They come in Vanilla, Chocolate, Strawberry, Banana Cream, and Cookies n' Cream (my favorite--tastes like a minty chocolate Oreo) I have powders at home to make smoothies, but for grab and go I like the WW. 35g protein, low in fat/carbs/sugar.

Congratulations on your success. I have had similar success, and you are right. You resolve one issue and another rears it's ugly head. I am delighted with my progress (I have similar starting weight, and 150 was my original goal--I was able to do a little below goal, so I am thrilled about that) Now to stay there. Also if I hit the lottery I will be making some plastic surgeon a VERY happy man or woman :thumbdown:

For those having problems with the Protein powders, I would suggest trying a ready to drink Protein shake. I drink Worldwide Protein shakes (available at Vitamin Shoppe and online). They come in vanilla, chocolate, Strawbery, banana Cream and Cookies n' Cream. The Cookies n' Cream tastes like Oreos (they even use an Oreo type cookie being dipped in mild on the can). It is a lightly minty chocolate and my favorite. It provides 35g protein per shake. Also there are fruit flavored powders, like nectar brand, also available at Vitamin Shoppe. Most of the flavors can be mixed in Water (some in milk), and give about 23g protein. Nectar has a wide variety of flavors, including coffee type, and iced tea, lemonade, and a host of others. unjury powder comes in the usual Vanilla, Chocolate and strawberry, but also in unflavored (you can add a scoop to fat free/sugar free instant pudding to bump up the protein content), and chicken Soup flavor (like a chicken broth). Go to unjury.com to check that out. There is also a liquid called Profect. It comes in what looks like a large test tube with a lid, in fruit flavors and gives about 25g protein. A couple swallows and it is gone. Haven't seen their ads lately, but I would guess profect.com would get you to them. I hope this helps, and good luck on your journey.

I was reading the posts, and I thought I might throw in my congratulations to those who have gotten to goal, as I have, and to encourage those starting out. Interestingly, those of use at goal started out in similar weight ranges (280, 252, 250). I don't know if that is scientifically significant, just an observation from those posting, and from myself. Some days are harder than others for sure. Yesterday the humidity was unreal here, and only dedication got me through my walk. I walk on a nature trail in a local park, carrying peanuts for the squirrels and ducks. Even the squirrels were too hot to show up, except for a few. But once you taste success, sometimes the dedication will kick in without much thought, because you know what it has contributed to your success. To the newbies: Take advantage of all the bariatric team has to offer. Use the dietician to help you design your eating plan. Use the support groups to air issues that you think are unique to you (you will find they probably aren't). Use this site to learn (I started reading and later posting in Nov 2007-my surger was 3/25/08). There are some wonderful books available (amazon.com) and magazines (such as OH on obesityhelp.com, and WLS Lifestyles available at some of the bariatric food sites). The more you know about what you are getting into, the better your experience will be. Even if something is not going as planned, you will be better prepared to handle it. Good luck on your journey.

Congrats to all the newbies! I couldn't resist posting after the mention of kitties (I have 5). But aside from that I wanted to offer encouragement. You have the right idea about your "assistant" (never thought of naming mine--great idea). Do it all, stay in touch with your surgeon and dietician, go to group support, come here and post, and exercise. You don't have to do anything fancy. I mostly just walk, but I do something at least 6 out of 7 days a week. I have Curves, Water aerobics, and the rec center gym as backups for bad weather or when I lose daylight in the winter. With lots of daylight I walk in a park on the nature trail and feed peanuts to the squirrels. For the poster who ate pizza and had problems, try this. I love pizza (used to work out at Curves, then pick up a 12-15 inch pizza with pepperoni, green peppers, onions and extra cheese, take it home and eat the whole thing) so I thought about it and devised a crustless pizza you can heat in the microwave. Take a meal size microwavable dish, pour in about 1/3 jar of Ragu Homestyle sauce, cover with Hormel Turkey Pepperoni, and next with peppers and onions (I keep Birdseye Pepper Stir Fry in the freezer just for this--it is 3 colors of peppers and onion chunks) and top with Kraft fat free Mozarella or Cheddar cheese. Nuke for about 2 minutes to melt cheese and warm the other stuff. Now you have all the toppings and none of the crust and close to fat free (the Hormel is 70% less fat). You have the pepperoni and cheese for your Protein source, and sauce and veggies. What more could you want LOL? Anyway, good luck all of you on your journey.

I am as surprised as the other posters about the number of fills you have had. I was banded 3/25/08, had one fill of 3ccs 6 weeks later, discovered I was VERY sensitive to fill restriction and had 2 unfills, one the following day (I met my surgeon at the hospital--water was even giving me indigestion) and another small one 2 weeks later in the office (I was getting liquids and mushies down, but solids were giving me trouble). After that, I was good, losing steadily until 8/08 when I had a small fill of about 1cc. That actually kept me going until about March or April this year, and in May I had another fill of 0.5cc (the doc even let me pick how much). Man, that half cc was plenty! I had to reduce my portion size and everything. I do have a problem with bread so I rarely eat it. Pasta is another (I think I am not chewing it thoroughly). If you can eat bread it should be whole grain well toasted so as not to be chewy. White bread is about the worst kind you can eat. Might as well eat ice cream! The plan is to become healthier as you lose weight. You might want to talk to the dietician as well as the surgeon. If you have had that many fills and can eat stuff like white bread, there is definitely something wrong. You do need to find out how much is going into your band, too, and how much is actually in there.

You made me remember a comment I received at a group support meeting I went to as a pre-op. It came from a lapband post-op. Now I am 5'7" but my 252 lbs and size 2x scrubwear told me I needed to do something. She looked at me and told me I didn't look heavy enough to need surgery. She was shorter than I am so I could understand that up to a point. But now, 110 pounds later I might agree that I don't need surgery. But surgery is the REASON I am 110 pounds lighter! And I got an occasional "you are doing this for your health, right?" (Nah, I thought I would pursue becoming the world's oldest Barbie--duh!) I think people mean well, but often fail to engage their brain before putting their mouth in gear. I am also single, and thank God I am finally old enough (at 64) that people have stopped asking me when I am getting married! Sometimes people actually think they are being helpful. They really are clueless. And hon, if you want a belly ring, you go for it! I might just get a tattoo one of these days (tummy tuck first, though).:wink2:

The group support at St Agnes is free and open to the public. The fees paid for surgery do not pay for group. I went to group support for 6 months PRIOR to surgery (learned a lot) while I completed the 6 month diet my insurance required. I am still going to group now. People thinking about surgery, getting ready for surgery, recent post-ops and those a year or more out are all welcome. Unless Dr. Von Rueden has his own group, I think we are talking about the same one. Lapband group is the 3rd Monday of the month at 6pm in the Alagia Auditorium. The RNY and sleeve group meets the first Monday (I sometimes attend that one too if the topic interests me).

Congratulations on your decision. With 7 kids it's no wonder your knees hurt! And BTW, 52 isn't old. I was 63 when I was banded.

Only one time did I let my surgeon talk me out of a fill. I was losing but felt I was getting hungry too soon. Next time I saw him I had still lost, but this time I pushed, saying I was hungry after 2 hours, and I could see the volume at each meal rising. So he gave me the fill. That lasted me from 8/08 to 5/09, believe it or not! In the 5/09 visit I was actually on the fence about a fill but I knew my weight was up just a bit. Well, they weighed me and said "Your weight is up a little, do you want a fill?" They usually require a 3 day food diary, but the 8/08 fill they didn't even look at it, so I didn't do one this time and thought they wouldn't do the fill because of that. No. The surgeon even asked me how much I wanted .5 or 1. I opted for .5 (I am pretty sensitive to fill restriction) telling him I call always come back for more. That was actually plenty. I lost the weight I had gained and even a few pounds more. I had to lower my portion sizes even. I think you need a different doctor, one who can give you credit for knowing your own body and be able to work with you. I am fortunate to have a doc who trusts my judgment.

Congratulations all of you, for your decision. For the poster whose family is not supportive, explain to them that the band is simply a tool to restrict portions, and it is still up to you to choose to eat healthy and exercise. If you need motivation, consider my story: Top weight 252. My idea of working out was to go to Curves, then stop at the local pizza parlor, pick up a 12-15 inch pizza with pepperoni/green peppers/onions/extra cheese and then eat the ENTIRE pizza! I would tell myself that at least I was getting some veggies in with the peppers and onions. I would eat until stuffed. Did 6 month supervised diet for insurance (lost 10 lbs), was put on liquid diet before surgery (lost 25 lbs), had surgery 3/25/08, and this morning I weighed 139.8 which is roughly 112 lbs lost. I was wearing 22 womens, now misses size 10, and with work clothes I have gone from 2X to small-medium. I had every co-morbidity except diabetes (sleep apnea, high blood pressure, high cholesterol, reflux, and knee arthritis). I was on 2 meds for blood pressure, one for reflux, one for arthritis, and 2 for cholesterol. I now take only one for blood pressure, and the pain medicine for arthritis as needed. My cholesterol is normal, the reflux and apnea have resolved. What do I do? I don't hardly eat bread anymore (it gets chewy and can get stuck), and I designed a crustless pizza that I can make in the microwave when I have the urge (I still have peppers and onions, but I used Turkey Pepperoni which is 70% less fat, and fat free shredded cheese on top--so it satisfies the Protein first requirement, is almost completely fat free, and I can't eat NEAR what I used to). I read labels like a maniac (if you have a Trader Joe store near you, they have a Greek yogurt that you can get fat free with 22 grams protein per cup, and only 6g sugar, naturally occurring milk sugar--I divide it into four half cup servings, and add sugar free preserves for fruit flavoring, so I get 11g protein and only 3 sugar). I try to minimize fat, sugar, and salt. Some people do low carb, but some carbs are healthy so I don't. I look for cereals that are low in sugar, like original Cheerios (or Joe's O's at Trader Joe). I use light salad dressings and mayo (dietician told us they are lower in sugar than fat free), drink light Soy Milk (lower in sugar than skim milk). My stand by quick dinner is chicken caesar salad (grilled chicken breast with Pam or Olive Oil, fresh Romaine, hard boiled egg, Parmesan cheese, light caesar dressing, and fat free croutons. For exercise I don't do anything fancy. I still belong to Curves (just for women-sorry guys), but mostly I walk in a park near home. They have a nature trail that is about 1.5 miles or so, and I carry peanuts to feed the squirrels and ducks. I don't walk all that fast; I mainly go for distance. Curves is my backup for bad weather or darkness in winter. I also have a multi-class ticket for Water aerobics, and the county I live in has a nice fitness room at the local rec center that costs all of $2 a month. Mostly I walk, though. I hope this helps, and good luck on your journey.

I was banded the day after you, 3/25/08, also by Dr. Singh. If you attend the group support meetings, we have probably tripped over each other. I was the one at the June meeting that Cathy presented the 100 lb pin to, if you were there. Say hello at the next meeting. I have short brown hair and am usually wearing scrubs (except now instead of 2X they are size small--yes!) I chose Dr. Singh on the recommendation of my sister, whose RNY he performed. She loves him, and so do I. I told him on one visit he was responsible for my drinking and driving! I carry a Water bottle everywhere, even in the car. I live in Harford County, and I mostly walk for exercise. I go to Mariner Point Park in Joppatowne almost every day. The squirrels are really happy to see me (I carry peanuts) and I meet a lot of nice dogs, and people. I have gotten more fresh air since surgery than I ever had before. Good luck on your journey. See you at group.

I had to do a 6 month diet for my insurance, so I spent the time learning all I could to make sure I made an informed decision. I did the seminar and started going to support group probably also 6 months before surgery. I learned a lot there. You meet people at all stages pre and post-op. As for flip remarks, I had a coworker say "You are doing this for your health aren't you?" (Nah, I thought I would turn myself into the world's oldest living Barbie!). At the group support one night I had a lapband post-op look at me in my 2X scrubs and tell me I didn't look fat enough to need surgery (I was 252, BMI 37-38, 5'5"). My scrubs are now small to medium tops and small pants, my weight 141-143, BMI 22-23, and regular clothing is now a size 10-12 instead of womens 22. I only take one small generic BP med and have stopped one BP med, two cholesterol meds, reflux med and while I still have arthritis, I don't need pain med anywhere near what I used to. I walk mostly for exercise. You can do it. I am a reformed pizzaholic (I would consume an entire 12-15 inch pizz in one sitting with extra cheese, pepperoni, green peppers and onions (I deluded myself into thinking I was getting some veggies at least). I no longer do that. I devised a crustless pizza that can be heated in the microwave with fat free cheese and low fat turkey pepperoni (and of course green peppers and onion--gotta have my veggies!). I do have a problem with bread so I don't eat much at all, very little Pasta and rice, but I have all of them infrequently on occasion. I just have to eat carefully and chew thoroughly. Good luck on your journey.

If I may make another suggestion, since you have attended the seminar and "lived to talk about it". I was stuck waiting for 6 months due to a diet requirement by my insurance. I figured I might as well educate myself on what I was getting into. I started attending the support group (it wasn't required, but it was open to the public). I met people at all stages, thinking about having surgery, pre-ops, recent post-ops, people out a year or more. It was very educational, and by the time I had jumped through all the hoops and had surgery, I could practically do the procedure myself! Not really, but I had a really good handle on what I was getting into. The more you know . . . There are many books you can buy, most available on amazon.com (I bought The Lapband Solution and The Lapband Companion). Also on obesity help.com there is a magazine you can subscribe to called OH. Good articles, before and after pics, Wow moments (good stuff that happens after weight loss, also known as NSV or non-scale victories), nutritional articals, plus lots of ads geared just for bariatric patients, like Vitamins and Snacks. Many vendors have sample packs you can buy to try their product. The other thing: exercise. You will need to make a serious committment to exercise. It doesn't need to be anything fancy, like an expensive gym membership. Mostly what I do is walk in a park near home that has a nature trail about 1.5 or so miles long. I generally go around twice, carrying peanuts for the squirrels. For back up I belong to Curves, and the county rec center gym ($2.00 a month--that really is 2 dollars), and I have a multi-class ticket for Water aerobics, that I paid upfron but averages about $6.00 per class. Curves costs $29.00 a month. With the nice weather we have been having I have just about been living at the park. Curves called me up to tell me they missed me! Good luck on your journey. This site is also a great place to get info. Do your thing and don't let anyone tell you that you are taking the easy way out. The band only restricts the amount of food you put into your mouth. You still have to make the decision to eat healthy and exercise.

I was banded 3/25/08 and knee arthritis was one of my co-morbidities. My knees feel so much better now. A little discomfort now and then, but I no longer feel like I need to have knee replacements. It should only make your joints feel better. It won't rid you of the arthritis, but it will help a lot.

Hi. I am not in Delaware, but nearby in Harford County, MD. I was just up in New Castle on July 4th for a cat show (you'd never guess from my signature that I like cats--a lot). One of the best habits you can make is to carry food you can eat with you. That way you are not caught short somewhere trying to figure out what you can eat, or worse, eating the wrong stuff. I work in a cardiology office and we have luncheons all the time with the pharm reps. I still carry my lunch, in case it is something I don't want to eat, or can't. A lot of times it is pretty healthy (today there were turkey, ham, roast beef sandwiches, tossed salad, fruit salad--I tossed the bread and ate the meat for my Protein, a small scoop of tossed salad and some fruit salad). My lunch bag is still packed (will likely eat it for dinner). I also carry Kashi TLC bars in my purse in case I don't have food with me and I get hungry and can't eat for a while. Not as high in protein as some bars, but good for Fiber and fairly low in sugar and fat. They take the edge off without wrecking my diet. I also made a serious committment to exercise. Nothing fancy, mostly just walking (I walk in a park near home, carrying peanuts for the squirrels). I belong to Curves which I use more in the fall and winter when I don't have daylight to walk on the way home from work. I have Water aerobics and a rec center gym membership as further backups, but most of the time it's me and the squirrels. It seems to work for me. For Snacks (I was a salty snacker) I keep Kay's Naturals around at work and at home. They are sold online and you can get a sampler to try some of the different flavors. They have Cereal too. Go to kaysnaturals.com to check out. Good luck on your journey.

I notice nothing posted since April, but thought I would leave one anyway. Hope to see many of you at the group support meeting on July 20. A friend of mine is scheduled for banding on the same day, so if she doesn't go home the same day, I plan to visit her after the meeting. I am sure we have tripped over each other, as I don't usually miss the meetings, and sometimes even go to the bypass group, depending on the speaker, etc. If you were at the June meeting, I am the one Cathy presented the 100lb pin to, and I talked about my sensitivity to fills (short hair, usually wearing scrubs). If you see this, give me a hello at the meeting.:smile2:

I have the same bathroom problem. I was taking stool sofeners twice a day before surgery. Since surgery I continued that but that is often not enough, and my PCP suggested something like Senokot on a daily basis. She was worried the straining would do something. She said cancer patients take it daily because of the effect of some of their meds. It has been better, though not perfect. I hate that bloated feeling.

Good luck with your surgery. Most docs won't do a fill for at least 6 weeks to give you healing time. My first fill had to be partially unfilled, but the fills are a bit of trial and error to get you to enough restriction but not too much. That is the nice thing about the band; it is adjustable. You will have ups and downs, and battles with head hunger (sometimes my lower stomach growls when my pouch is full--weird). If you make the committment to eat healthy and exercise (I mostly walk, almost every day though, about 3.5 miles or so) you will be successful.

I eat cereal, but I try to make it the healthiest I can. I buy cereal from kaysnaturals.com. They come in 1 oz packs, 100 cal and about 3g sugar. I don't even bother with milk; I eat it like a snack, maybe with some fat free yogurt (Trader Joe has Greek Yogurt with 22g protein per cup; I get plain and mix Smuckers sugar free preserves in for fruit at 10 cal a tbsp). Sometimes at home I will have cereal with soy milk, cut up fresh apple, maybe some craisins (100 cal pack). Because I tend to have low potassium I will sometimes have some dried fruit which is high in sugar but also potassium--don't have daily or frequently, just now and then). For commercial cereal, plain (not multigrain which has more sugar) Cheerios is really low, and Trader Joe has Joe's O's which is similar to Cheerios and is also very low. I don't add sugar, just some fruit and maybe some nuts (the kind you bake with, not salted).

I agree with the posters who said the kids' menu is not at all healthy. Choices like mac and cheese, chicken tenders, french fries are the norm. You are better off ordering what you want and taking most of it with you home, or ordering an appetizer and salad, or chicken caesar salad, chef's salad, stuff like that if you don't or can't take it home for another meal. As for the cards, many surgeons give the card mentioned to show to restaurants, explaining that you need to order smaller portions or from the children's menu. Apparently from the posts not all give them out. If I remember correctly, obesityhelp.com has a sample card that you can print out to use. They have revamped their website so you may have to look a bit, but I think it is there. Also if you have the Lapband AP by Allergan, they are offering a permanent ID card on their website. I got one and it is very nice, and has a paragraph addressed to restaurants. The print is a little small, but it is there. Online they ask for your temp ID number (7 digits). I didn't have a 7 digit number so I called their 800 number and they asked me a couple questions (doc name, date of surg, etc) and within a week I had it. Go to lapband.com for info. They also have special deals with Curves and I think Fitday and stuff. Realize may have something similar, but I am not familiar with their site since I have the AP. When I am in a restaurant, since you don't drink with meals and I had long been a Water drinker, I just ask for water like I have always done, then I leave it sit. I order an appetizer and salad mostly and still take some of that home. But you are out with friends and having a nice social time. I have not felt the need to use a card at restaurants.

As long as the weigh-ins are documented, most insurances will accept things like Weight Watchers. It is not the surgeon that will or won't accept the 6 month diet; he or she would probably skip that if they could. Many insurances require the diet, a documented 6 month supervised weight loss attempt. I had the dietician from the bariatric group supervise mine, which consisted of meeting her once and discussing food choices, a weigh-in, and the rest of the time on the honor system. I emailed her my weight every two weeks(I didn't fudge the numbers either). At the end she wrote a letter with all my reported weights and gave that to the surgeon. Some places have you meet with a dietician every month, others have you weigh in with your PCP every month. They are all a little different. But cancelled checks from Weight Watchers also sufficed in many cases. They just want evidence of an attempt to lose. (BTW my dietician even told me they didn't care if I didn't lose any weight; I just shouldn't gain any--I did lose 10 lbs). The surgeon wants to do the surgery. They will do what they can to help you get approved.