Cervidae

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

@@baylyy the whole point is that whether you're a fat person who is working out and eating healthy and trying to lose weight or a fat person who likes pizza and eats it every daya nd is slowly killing yourself, you deserve to be treated like a human being.
And as a general comment about medical professionals and the fat acceptance movement: the connection between the movement and medicine/doctors is that there's no denying that doctors often sort of just brush aside other possible health issues when someone is overweight. It's common for a doctor to take one look at the number on the scale and automatically chalk up all symptoms to obesity. The movement is trying to say "hey, yes, weight can and does cause health issues, but assuming a fat person is automatically unhealthy is utter idiocy, and it needs to change." The fact is even medical professionals can be discriminatory towards obese people. And that's a big, big problem.

The fat acceptance movement is a lot like the feminism movement in that a lot of people have utter misconceptions about what the movement is actually about and why it exists. Much like the crazy people who call themselves feminists while attacking men, saying we should just kill off all the men, saying the men are inferior, etc are not ACTUALLY feminists, people who truly believe that being fat is healthy and that all doctors are just being hateful and discriminatory are not actually fat activists.
The point of the fat acceptance movement is the same point as the broader body positivity movement: it doesn't matter if you weigh 800 pounds and literally can't move off your bed, it doesn't matter if you have made yourself unhealthy with poor choices or if you are making no move whatsoever to lose weight. Every person deserves to be treated like a human being, with dignity and respect, end of story. Fat acceptance is all about treating fat people like they are humans instead of the often appalling way we are often treated, ways that are still socially acceptable and that need to change, NOW. The point is, no one has a right to judge you or treat you poorly because of your body because it's your body, not theirs, and no one gets a say unless you want them to. These misguided people who stubbornly tell themselves that fat acceptance is about pretending to be healthy and thinking fat is better are just that, misguided. I can't really blame them, in some ways. Being treated like less of a person because of how you look is just absolutely wrong and ridiculous, and doesn't serve to actually help people.
No true body positivist would ever ignore medical advise just because they are hurt and offended by the truth, just like no actual feminist would say that men are inferior. There are idiot radicals in every movement, but what's important to take away from it is the core message.

I'm getting my one year post op labs done tomorrow! And one of the things I love so much about my bariatric center is they encourage and expect you to be patients there for life. They schedule annual follow-ups every year following surgery for as long as the patient will show up. The surgery and lifestyle change is for life, so the checkups should be too!

I'm getting my one year post op labs done tomorrow! And one of the things I love so much about my bariatric center is they encourage and expect you to be patients there for life. They schedule annual follow-ups every year following surgery for as long as the patient will show up. The surgery and lifestyle change is for life, so the checkups should be too!

I'm getting my one year post op labs done tomorrow! And one of the things I love so much about my bariatric center is they encourage and expect you to be patients there for life. They schedule annual follow-ups every year following surgery for as long as the patient will show up. The surgery and lifestyle change is for life, so the checkups should be too!

If you'd rather vacation in a desert greenhouse this summer than get your bloodwork done, you're obviously not a fan of WLS labs. Are all those labs really necessary? Bariatric Dietitian Elizabeth Anderson helps you decide if it's time to fast or pack the sunscreen.


“Do you think I should keep taking my sublingual B12, Elizabeth?” Roxanne* is 3 years post op from her gastric sleeve and is wondering if the expense of the meltable supplement is worth it.
“I’m not sure, what does your latest B12 lab show?” I respond.
“Uh…..I haven’t had labs done in, well...years,” Roxanne admits.
And she’s not alone. Scores and scores of WLS clients intend to keep up with the required post op labs but life gets in the way.
People, I am here to tell you, if it has been a long, LONG since you’ve had your specific bariatric lab work done, run, don’t walk, to your nearest phlebotomist.
Every few years, the Obesity Society (TOS), the American Society of Metabolic and Bariatric Surgery (ASMBS) and the American Association of Clinical Endocrinologists (AACE) update medical guidelines for bariatric surgery patients. They have a list of labs that need to be done at 3 and 6 months and those that need to be done annually. Yes, every-single-year, after surgery.
Why? Believe it or not, vitamin and mineral deficiencies increase over time—regardless of your WLS procedure.
I know many PCPs push back against ordering these regular labs--whether it’s the cost to their practice, the patient or both, many providers don’t understand the necessity for the work-up.
What concerns me the most is that the damage from some vitamin and mineral deficiencies cannot be undone or corrected. The damage is permanent.
A psychiatrist speaker at a recent convention I attended, talked about patients he’s seen that were 6-10 years post op that were suffering from mental health issues--sometimes incapacitating problems.
When he looked at their lab work, he was shocked to see that for some patients, vitamin and mineral deficiencies were the sole cause.
If your provider pushes back against these labs, I’m happy to provide you with the link to the scientific paper citing which labs need to be done and when. You can share this with your provider and insurer.
Roxanne is off having her B12 checked as we speak. Armed with those results, we’ll be able to determine the most affordable and healthful path forward, specifically for her.
You deserve the same so make that appointment today. I thank you.
*names of clients have been changed

Ahhh…goal weight! It’s something you’ve wanted for years. You went through the pre-op diet, weight loss surgery, and the recovery period. You’ve worked harder than most people can imagine in order to get to goal weight. Now, all you have to do it keep the weight off.
Well, you know that’s easier said than done, but this two-part series offers a little help. Part 1 talked about what you can do if you hate counting calories, and how to develop a diet pattern that can work for you for life. Part 2 will cover making up for lower calorie burn and staying motivated even when the scale is not going down. Here goes!


I Don’t Burn as Many Calories.
The more you lose, the less you can eat if you want to keep losing or keep the weight off. There are a couple of reasons for this unfortunate fact. First, your metabolism slows as you lose weight as a response to the dieting. Your body compensates for your low-calorie consumption by conserving energy – which translates to burning fewer calories.
A bigger factor is your lower body weight. The less you weigh, the less you burn at rest and while exercising. Take a 30-year-old 250-lb woman with a height of 5’4”, for example. She burns about 1900 calories per day at rest. She burns about another 450 calories for every hour she walks. So, she can lose about a pound a week if she eats about 1,800 calories per day.
Take this same woman at 140 pounds. She might need only 1,500 calories per day at rest, and burn 250 calories while walking for an hour. If she walks for an hour a day, she might even gain weight eating 1,800 calories per day.
So what can you do to combat this? Being aware is a big step. Know that you may not need as many calories as you used to need. You can cut out calories the way you have been: by taking smaller portions, and by choosing healthy foods and lower-calorie versions of normally high-calorie foods: think of a plate of zucchini noodles (“zoodles”) instead of a plate of pasta, for example.
You can also be more active to burn more calories. While an hour’s walk may have been a good workout for you while you were at your high weight, you might be in better shape now, and able to work a little harder. You might be able to throw in a little jogging, or try aerobics or kickboxing or Zumba, to burn more calories in that same hour. Build a little muscle with some strength training, and your calorie burn will be boosted round the clock.
I’m Not Motivated.
Lack of motivation is one of the biggest barriers to keeping the weight off. Preventing regain takes a lot of work, so you need to be motivated. But how can you stay motivated when one of the strongest motivators – the dropping number on the scale – isn’t there anymore?
The first thing you can do is change your attitude. From the time you had WLS to the time you hit goal weight, your job was to lose weight. You had a victory every time your weight dropped, and that was exciting.
Now, your job is to maintain your weight. You have a victory every time you step on the scale and your weight is the same. That is exciting, too – hopefully, exciting enough to keep you motivated to do the right thing as you make your eating and exercise choices throughout the day.
Most of the motivators that you used when losing weight are probably still there. You may just have to search a little harder to remember them. You want to be healthy. You want to be proud of yourself. You want to be around to support your family and to watch them grow. You want to be healthy. You want to shop in regular stores. Remind yourself of your reasons for wanting WLS, and remind yourself how hard you worked to get here. It’s something not everyone can do, but you did it!
I Got off Track.
So does everyone. Let it get you down, and you can regain a lot of weight very fast. Take care of it and use it as a learning experience, and it can only make you stronger. Figure out what got you off track, and do your best to fix the habit. Maybe it’s drinking your calories, choosing slider foods, munching throughout the day, or using food instead of the gym as your emotional outlet. Whatever it is, fix it, forgive yourself, and keep going! If you’re really not sure what went wrong, go back to the basics of your post-op solid foods diet.
Figuring out your strategies can help you keep the weight off for good. Preventing regain is a lifelong endeavor. You may need to work on it daily, but the payoff can be worthwhile. You worked awfully hard to get WLS and lose the weight – don’t you want to keep it off?

Great timing, as usual, Alex! Thanks for the post. I'm right at the point where my hunger is coming back and I'm transitioning into maintenance. Tricky time! D:

Great timing, as usual, Alex! Thanks for the post. I'm right at the point where my hunger is coming back and I'm transitioning into maintenance. Tricky time! D:

Great timing, as usual, Alex! Thanks for the post. I'm right at the point where my hunger is coming back and I'm transitioning into maintenance. Tricky time! D:

Great timing, as usual, Alex! Thanks for the post. I'm right at the point where my hunger is coming back and I'm transitioning into maintenance. Tricky time! D:

Beautifully and eloquently written, thank you. <3

Looking at my journey over the past decade-plus, I can see the fallout from my terrible mentality of weight loss at any cost. But, really, at what cost? At the cost of my sanity? At the cost of my self-esteem? At the cost of my health?

People say you have nothing if you don’t have your health, and as I get older, that truth can no longer be ignored.


When I had my roux-n-y gastric bypass surgery in 2005, my goal was to lose weight. Specifically, I wanted to lose 225 pounds.

At just over five feet tall and 343 pounds, I was super morbidly obese. Those are the facts, but what is also true is that my weight has been the bane of my existence for my entire life. Or, at least, since I was about three years old, when I first realized that my weight fell on the less socially “acceptable” end of the spectrum.

So, yes, weight loss was the goal I set for myself, but what I see now is that all I really wanted was to slip into the spectrum of acceptability enjoyed by women who wear single digit jeans. It was about fitting in. It was about not standing out. It was about being “normal.”

At no point was it ever really about being healthy.

In the two years after my surgery, I dedicated my days to working out and eating as little as possible. Ultimately, I lost 201 pounds. It wasn’t the hoped for 225, but I was a size eight - victory, right?

Not exactly. Even at a size eight, I struggled with body acceptance. I still felt like a fish out of water and worse, I couldn’t seem to sync up with the woman in the mirror. I had a new body, but I didn’t feel like “me” anymore.

And worse still, I didn’t feel healthy. Sure, I’d lost 200 pounds. By all the usual measures (and certainly by societal expectations), I was “cured,” but I felt sick. My energy was low, my sleep was all over the place, and I was incredibly frustrated by a diet that seemed barely sustainable for any length of time.

That diet piece was my fault, of course. So determined to lose the weight, I worked hard to hit my daily protein goal, even if that meant I consumed hard boiled eggs three times a day and literally nothing else. For much of the past 11 years since my surgery, I’ve been riding a roller coaster. I’ve lost and gained weight over and over, the pendulum swinging back and forth and my emotions following. I have suffered serious vitamin deficiencies and still struggle to disconnect guilt from the simple act of eating. In this state of mind, it’s been easy for me to sacrifice overall well being for short-term gain, or in my case, loss.

Despite the fact that I didn’t really feel that great, it still took a while to realize why. When weight loss was the goal, I needed only to focus on the aspects of my new life that supported it: protein, calorie counting, and obsessive exercise.

Health has been the missing piece all along.

Focusing on my health has required a total turnabout. It means that I’ve had to reevaluate my goals. I’d lived so much of my life with oversimplified ideals: thin equals good, fat equals bad. The reality is more complex, as it so often is.

Looking at my journey over the past decade-plus, I can see the fallout from my terrible mentality of weight loss at any cost. But, at what cost really? At the cost of my sanity? At the cost of my self-esteem? At the cost of my health?

People say you have nothing if you don’t have your health, and as I get older, that truth can no longer be ignored.

Today, I am 89 pounds heavier than my lowest post-op weight. Typing those words makes the old me cringe… I feel waves of embarrassment, shame, anger, frustration, and the ever useless guilt.

The new part of me, the one I am working to healthfully feed mind, body, and soul, feels hope. I feel hope because I remember the young woman that weighed 138 pounds, and I know that I was less healthy standing on that scale back then than I am today in my double digit jeans. This new woman I see in the mirror still wants to lose weight, but as a byproduct of a healthy life.

Health has become my personal mission. I wasted a lot of time hating myself to obesity and then hating myself thin. My plan now is to love myself healthy. To do all that I do in the pursuit of weight loss and health with kindness to the woman in the mirror, no matter how she looks.

If any of what I’ve written resonates, I hope you too can break free. My wish for you is that as you walk your own path, you keep your eyes trained on your health goals and not simply on the scale.

Bariatric surgery may not typically be considered when discussing planning pregnancy, but in severely obese women, bariatric surgery can greatly improve the odds of conceiving, either naturally or assisted. Weight loss can help restore a healthy hormonal balance in both overweight and obese men and women. It can create an environment where the odds of becoming pregnant naturally, as well as the success of infertility treatments, are optimized.


Physicians understand the negative health consequences of being overweight, including a higher incidence of heart disease, diabetes, cancer and back pain, to name a few. Another consequence is the effect of weight on fertility, fertility treatment and pregnancy, as well as the ongoing health of mother and child.
Infertility, for example, is significantly higher in women who are overweight, and it increases as their BMI rises.1,2 Attempts to become pregnant through escalating interventions become ever more physically, financially and emotionally costly. These costs become statistically significant, and they are more pronounced at higher BMIs, especially if there is central obesity.2
Obesity brings multiple physiologic changes that affect fertility and pregnancy, including changes in estrogen, testosterone and LH/FSH ratios. Leptin, insulin and multiple inflammatory cytokines are also affected. These contribute to abnormalities of ovulation; abnormal egg, embryo and endometrial development; unsuccessful implantation; and failure to maintain a viable pregnancy.
Male fertility is also negatively affected by obesity. The prevalence of male infertility is increasing, as evidenced by decreasing sperm counts throughout the world. It has been estimated that sperm counts have fallen by as much as 1.5% each year in the United States, a finding also noted in other Western nations.3 Health, volume and motility of sperm are all affected. Although the cause is uncertain, proposed explanations include increasing obesity and exposure to environmental toxins.
Women who are underweight (BMI <19) often have difficulty conceiving as well. After ruling out underlying illness or eating disorders, it is generally easier for this population to reach an ideal weight and improve their odds for conception. For all groups, an ideal body weight results in the best outcome for fertility and fertility therapy, as well as maternal and fetal health.
Other potential complications that overweight and obese women face around pregnancy and birth include:4,5
Irregular periods
Difficulty or inability to conceive
More complicated IVF cycles
Lower IVF success and greater complications of pregnancy for those who do conceive
Higher frequency of early pregnancy loss
Greater anesthesia and surgical complications if surgery is required
Greater frequency of hypertension, gestational diabetes, preeclampsia, stillbirth and other complications of pregnancy. Rates of stillbirth are twice as high in obese patients as in normal weight patients.
Increased risk of cesarean section delivery. The C-section rate is almost 50% in obese women, and the postoperative complications following C-section are significantly higher as well.
Due to larger babies, greater delivery complication rate for women delivering vaginally.
Lower prolactin leading to decreased nursing
Higher risk of maternal diabetes

Consequences for the newborn into adulthood include fetal macrosomia, pneumonia, lifelong risk of obesity and its consequences, behavioral problems, and risk of asthma.6
In the face of all these potential complications and adverse effects, reduction in BMI through weight loss has been demonstrated to improve fertility and fertility therapy success and to lower complications of therapy and pregnancy.
Women often ask for help with weight loss when they are considering pregnancy. Many of them understand that pregnancy will be easier if they don’t carry extra weight.
Recently I helped care for a patient who had tried unsuccessfully to become pregnant during the past year. I chose her as an example because she might not be considered a typical candidate for weight-loss therapy, yet the intervention in her case turned out to be simple and effective.
She had already been to an infertility specialist and was told she had a fibroid uterus. She had a long history of irregular or missed periods and a diagnosis of polycystic ovary syndrome. Her initial BMI was only 26.5, but her waist circumference was 36 inches. (Central obesity is often characteristic of women with impaired fertility.) The patient also had a high-stress job, many hours of driving and little physical activity.
She started on a 1,200 calorie low-fat diet, avoiding refined carbohydrates (the whites: white sugar, white flour, white rice, and white potatoes because of all the toppings). I advised her to eat small, frequent servings of protein throughout the day. She also began phentermine at one-half of a 37.5 mg tab daily. She delayed pregnancy for several months during the active weight-loss phase. She resumed regular physical activity and started yoga. She was seen every two to four weeks for monitoring, and I adjusted her program as needed.
At her six-month follow-up exam, she had lost 12 pounds, her menses had returned to normal, and she was feeling better than she had in a long time. Her husband also lost 25 pounds. (When women take better care of themselves, it is common for the entire family to benefit.) Medications were stopped, and she continued to lose weight following a program of reduced calories, optimal protein, regular physical activity, and yoga for stress management. Six months later she happily reported she was eight weeks pregnant. After five months of pregnancy, she was 10 pounds lighter than at her initial visit.
This case illustrates the tremendous opportunity physicians have to influence weight loss in women before and during pregnancy. The U.S. Preventive Services Task Force recommends making height and weight measurements part of vital signs.7 They also recommend recording waist circumference for people with a BMI over 25. These actions go a long way toward letting patients know the importance of achieving and maintaining a healthy weight; they also alert patients to potential risks. People are often surprised to learn what weights are medically considered overweight, obese and extremely obese.
Beginning weight counseling early, long before pregnancy is contemplated, makes a big difference. It’s easier to lose 10 to 30 pounds when a patient is younger, and changes made at this time of life can have a positive effect far into the future. Eating more protein, much less sugar and avoiding refined carbohydrates can result in significant weight loss. Even weight loss of 5–10 pounds can improve health and metabolic parameters.
Anti-obesity medications can be a helpful tool when used with a comprehensive program. Patients who have a significant amount of weight to lose often do better with medications. All weight-loss medications are contraindicated during pregnancy, but they can offer a significant advantage when used selectively and carefully monitored with patients who are considering a pregnancy that might otherwise be impossible.
Several weight-loss medications have recently been approved by the FDA, making it easier for primary care physicians and OB-GYNs to prescribe them. The medications include phentermine-topiramate (Qsymia), lorcaserin (Belviq), wellbutrin-naltrexone (Contrave) and liraglutide (Victoza). Each offers a different approach to a complex problem. Some older medications, such as phentermine, diethylpropion and phendimetrazine, have a long history of safety and effectiveness. Patients must use appropriate contraception during this active weight-loss phase.
For pregnancy itself, clomiphene has long been considered first-line therapy to induce ovulation. Metformin plays a role in managing infertility caused by polycystic ovary syndrome (PCOS), an endocrine abnormality that, through numerous proposed mechanisms, leads to anovulation.8 Although the comparative results of clomiphene vs. metformin have differed, a 2009 meta-analysis showed no difference between the two treatments in terms of ovulation rate, pregnancy rate, or live birth rate.9 When clomiphene plus metformin was compared with monotherapy with each agent, combination therapy was no more successful than monotherapy.
Patients who are candidates for metformin therapy must be made aware that it induces ovulation indirectly, taking up to six months to improve ovulation.9 Clomiphene, in contrast, acts directly by producing a surge of luteinizing hormone and could cause ovulation within days.9
Bariatric surgery may not typically be considered when discussing planning pregnancy, but in the severely obese woman, bariatric surgery can greatly improve her odds of conceiving, either naturally or assisted. A positive outcome of pregnancy is also directly linked to the degree of weight loss.
A small cohort study reported at the 2011 meeting of the American Society of Metabolic and Bariatric Surgery showed that PCOS symptoms improved significantly after bariatric surgery, and previously infertile women successfully conceived. Almost all the patients had resolution of menstrual dysfunction, and fewer reported hirsutism. Every infertile woman in the study who wanted to conceive did so postoperatively, either naturally or by assisted reproduction. On the other hand, a 2009 practice bulletin from ACOG concluded that, “Bariatric surgery should not be considered a treatment for infertility.”10 I, personally, disagree with this statement. There is still significant prejudice against overweight people. Surgical options should be presented, as part of the spectrum of comprehensive care, to anyone whose weight is keeping them from a healthy, successful pregnancy.
For women who have been unable to become pregnant, weight loss may be all that’s needed. The closer women get to their ideal weight, the better their chance of success. There are many reasons for infertility, however, and weight loss and lifestyle changes will not address all of them. Nonetheless, weight loss is one of the most powerful and effective interventions. In my experience, just reducing insulin resistance with proper diet and physical activity can make the difference.
Weight loss can help restore a healthy hormonal balance in both overweight and obese men and women. It can create an environment where the odds of becoming pregnant naturally, as well as the success of infertility treatments, are optimized.
Here are some suggestions for making weight management part of a busy practice:
Ask permission to discuss weight. A few nonjudgmental questions can initiate a powerful partnership. “Would it be all right if we discussed your weight?” or “I’m concerned about your weight because I think it might cause health (or pregnancy) problems down the line” are a good place to start. Preferred words and phrases, such as unhealthy weight or excess weight, are better accepted by patients than words and phrases like obese, fat or large size.
Make your office welcoming to overweight patients. Use scales that read higher weights, large-size gowns, and chairs that are comfortable and fitting. Respect their privacy and remain sensitive to how you speak about their weight as it impacts their health. Make weight, BMI and waist circumference part of routine vital signs as appropriate.
Begin counseling early. Begin educating and counseling on the benefits of achieving and maintaining a healthy weight long before pregnancy is desired.
Provide monthly follow-up. Patients who are actively in a weight-loss phase need regular follow-up extending through maintenance.
Refer if necessary. Patients with complex weight-loss needs may need referral to a specialist.
When seeing an overweight or obese woman choosing to become pregnant, offer counseling and recommendations for appropriate calorie and nutritional intake, plus physical activity. Handouts work well at this stage. Patients who are in an active weight-loss process should be seen every two to four weeks for support and guidance. Often these visits can be done by a nurse or medical assistant; minimal extra training is required.
If these efforts are unsuccessful or the patient has significant weight to lose, refer them to a dietitian, community weight-loss program or specialist. In my experience, a physician’s interest in a patient’s weight loss frequently results in a positive response. ::
Dr. Altschuler, a family and bariatric physician, is medical director of the Altschuler Center for Weight Loss & Wellness in Greenbrae and Novato.
Email: drgail@marinweightloss.com
Phone: (415) 897-9800
References
1. Rich-Edwards JW, et al, “Adolescent body mass index and infertility caused by ovulatory disorder,” Am J Ob Gyn, 171:171–177 (1994).
2. Zaadstra BM, et al, “Fat and female fecundity,” BMJ, 306:484–487 (1993).
3. Ahmad HO, et al, “Obesity and male infertility,” Semin Reprod Med, 30:486-495 (2012).
4. Robinson, et al, “Maternal outcomes in pregnancies complicated by obesity,” Ob Gyn, 106:1357-64 (2005).
5. ACOG, “Obesity in pregnancy,” Committee opinion 549 (2013).
6. O’Reilly JR, Reynolds RM, “Risk of maternal obesity to the long-term health of the offspring,” Clin Endocrinol, 78:9-16 (2013).
7. USPSTF, “Obesity in adults: screening and management,” www.uspreventiveservicestaskforce.org (2014).
8. Morin-Papunen L, et al, “Metformin improves pregnancy and live-birth rates in women with PCOS,” J Clin Endocrin Metab, 97:1492-1500 (2012).
9. Palomba S, et al, “Clomiphene citrate, metformin or both as first-step approach in treating anovulatory infertility in patients with PCOS,” Clin Endocrin, 70:311-321 (2009).
10. ACOG, “Bariatric surgery and pregnancy,” Obstet Gynecol 113:1405-13 (2009).

This is the most socially acceptable form of discrimination! It's hard to make people understand why losing weight isn't as easy as "eat less, move more." If that were the case we'd all be thin and there wouldn't be a multimillion dollar diet industry.

Fat shaming adds insult to injury when you are obese or you have had weight loss surgery. Life is already difficult enough without the extra challenges of fat shaming. You may have health conditions, trouble moving and low energy levels if you are overweight. After weight loss surgery, you need to watch every aspect of your diet and lifestyle.


Anyone who has struggled with weight can have low self-esteem and feel insecure at times. So why must you face “fat shaming,” too? Nobody should be forced to experience fat shaming, but unfortunately, it is a reality. It is a way of making people feel bad about their weight, often through subtle or less subtle passively aggressive words or actions. Here is some information about what it is and how you can fight it
Why It Hurts
Fat shaming hurts emotionally. It involved people judging you negatively for your appearance. Worse, they feel that you have no right to be at peace with who you are. Having others let you know day after day that you should feel inferior can drag you down, and that’s unfair.
Think about an experience so many of us have had, and often on a weekly or even daily basis. When you order in a restaurant or check out at the grocery store, have you ever suspected that the server is thinking, “Why is this lady ordering a salad? She clearly eats way more than that at home.”
Or do you see the skinny person in line behind you at the supermarket look at your cart and think, “She’d be better off skipping the Froot Loops and sticking to lettuce” (never mind that the cereal is for your kids). The fat shaming may be less subtle. “Excuse me, ma’am, but are you sure you should be buying that pasta? Should you stock up on celery sticks instead?” What nerve!
Fat shaming can even hurt in practical ways. Take jobs, for example. Have you ever walked into a job interview only to see the interviewer look at you with disdain, so you know you’re not going to get the job because of your weight?
How Bad It’s Gotten (Hint: There’s an App for That)
Fat shaming is pervasive in our society. People don’t even realize it’s there. It’s just accepted that fat people are somewhat subhuman. Even doctors often assume that your obesity is your fault. “Just stop eating,” people say. No matter what they see you do in public – order broiled fish and broccoli at lunch, hit the gym every day, and faithfully chug your 8 glasses of water – they assume you’re ordering a couple of value meals at the drive-through on the way home, and curling up with a box of doughnuts every night.
Fat shaming is so accepted in our society that there are even apps to promote it. They may show you what someone looks like when they’re a few pounds heavier (oh, the horror!), just to scare you away. The thing is, these shame campaigns don’t work.
In fact, they even lead people to eat more because they feel inadequate. People who experience fat shaming are more likely to gain weight. And, if their doctors are doing it – which happens with shocking frequency – they may not seek or receive the medical care they deserve and need. The Obesity Action Coalition (OAC) is calling for tech giants to remove these apps from the market.
What Leads to Fat Shaming?
Fat shaming comes from the assumption that overweight people are not people. Fat shamers believe overweight people do not deserve respect. They just eat too much because they’re too lazy to eat right and exercise. Fat shaming can also come up out of a sense of insecurity on the part of the fat shamer. It’s a lot easier to point out the flaws of someone who’s overweight than to acknowledge one’s own shortcomings. Fat shaming is hurtful, and it needs to stop now!
Pledge to Join the Fight
You can sign up to join the growing movement against fat shaming. The Weight Loss Surgery Foundation of America (WLSFA) is sponsoring a challenge to fight fat shaming. You can sign up to post videos, pledge to stand up against fat shaming, and join the growing movement. You can get more information and resources from WLSFA
Be the Change
You can also work every day on your own to fight fat shaming. The WLSFA suggests vowing to fight ignorance with education and speaking up for others who are facing fat shaming. You can also vow to treat all people with respect because you know what it is to be treated disrespectfully for no reason.
Fat shaming is deeply rooted in our society, and it hurts. You can fight this unfair practice by pledging with the WLSFA or taking your own steps to embrace your body, stand up for anyone who needs it, and love others, no matter who they are or what they look like.

My message to you today is short and sweet...


Slow down......
Take a Deep Breath......
and Enjoy the Journey.....
You are exactly where you need to be, doing exactly what you are meant to be doing in this very moment.. You are perfect right here, right now.......Be kind and be gentle with you.....

Weight loss surgery is hard work, and being in a time crunch can be another challenge. After weight loss surgery, you may need to spend extra time planning meals, preparing your food, and working out. That time can become a barrier to success
So how can you fit weight loss into your already-packed life? We have a few tips that can help you save precious minutes here and there.


Serve one meal per family.
Do you regularly make your family one meal and make yourself another? You’re doubling the time you spend cooking. You’re also showing your family that healthy eating is something that only YOU do, not something “normal.”
Save time and make the healthy eating bandwagon more welcoming by planning to serve one basic meal at each family dinner. You can always alter it to make it a little lower calorie for yourself, or to add some of the treats that your family loves but that are off-limits for you.
Take a spaghetti dinner, for example. You can skip the pasta but serve it to everyone else, while making lean ground turkey meatballs in tomato sauce with a side of veggies that you and everyone can enjoy. If you’re craving noodles, use some low-carb ones or make zucchini noodles. Then, if your family wants, offer extras such as parmesan cheese and garlic bread. It’s no extra work for you, and everyone gets what they want…while they get some good nutrients in them, too.
Use meal helpers – the healthy ones.
We’re not talking about boxes of rice or pasta helpers or family-sized frozen mac and cheese or pizza. We’re talking about healthy meal helpers, such as already-marinated chicken breast, pre-cut salad and veggies, and rotisserie chicken. They’re nutritious, and they save time.
You can also stockpile instant high-protein meals for anytime. BariatricPal has tons of hot and cold breakfasts and lunch and dinner choices that are ready in minutes and designed for weight loss surgery patients. Choose them for breakfast or lunch at work, for a quick dinner, or when you just feel like a great-tasting entrée without needing to cook.
Multi-task when appropriate.
We’re not fans of multi-tasking when it comes to focusing. In fact, multi-tasking can actually be one of the biggest time-wasters of your day since it takes so much time to switch your attention from one task to another. But in its place, multi-tasking can be a brilliant time-saving move.
Doubling up on family time and chores is one of the most sensible ways to multi-task. You’ll get to spend more time with your family, while making chores more pleasant and saving time. Take your children with you to the supermarket (bonus: they can learn to read food labels!), and work on household chores together. Cleaning the house is a lot more fun when it’s a family activity, and it’ll teach good habits and responsibility.
Multi-tasking can also be a great way to fit more exercise into your life, since one of the biggest excuses for not getting active is lack of time. Walk them to and from school while you chat about their days. Walk laps, doing jumping jacks and squats, or even help out the coach and run drills with the kids if you’re watching your children’s sports practice. Encourage your children to play outside, and make it fun for them by being right there with them. Walk on a treadmill, use an exercise bike, or march in place while watching TV or during commercial breaks.
Make movement part of life.
Did you know moving for even a minute at a time can give you tons of benefits? There are plenty of ways to add in activity without taking an extra second of your time. You can try different games with yourself to see which works for you. You might decide to stand up every time you send a text message or check your phone, or remind yourself to walk around your office whenever you’re on the phone.
Now, we’re not saying to quit your gym membership or give up on your regular workouts. Just know that every little bit counts, and getting in a few minutes here and there can keep your metabolism going and help you think more clearly…so you can make better food choices.
Plan ahead to save time.
Sometimes it’s hard to set aside a few minutes to plan the week’s meals, recipes, and grocery shopping, but it saves time overall. You’ll be able to zip through the grocery store and get meals on the table faster when you already know exactly what you’re making. Planning ahead can even let you plan for leftovers, so you don’t have to cook another meal just yet.
You already know that sustainability is the key to long-term weight loss surgery success. The more you can fit your healthy weight loss surgery habits into your regular life, the easier it’ll be to keep up those good habits. They don’t need to take up much time as long as you plan them carefully.