Jean McMillan

My nutritionist is a skinny minny also, but that doesn't mean she's not qualified to teach me about nutrition. And what you eat is directly related to your weight, so sending you to see her was actually a good idea. What's wrong with tuna on cucumber slices? Do you not like tuna or cucumber? What else did you expect her to say? She's not a doctor and isn't qualified to advise you on medical or surgical issues. There are far too many factors that could be affecting your disappointing weight loss to address in a single forum thread. I just want to reiterate that giving up on yourself and your band now is literally throwing away that $16,000. Don't you believe that you and your health are worth some extra effort? Finally, I think it's extremely rude of people to play with their cell phone when they're supposed to be giving another person their attention. I suggest that you call her on that should you ever cross her door again. I can give you suggestions for ways to say it that will solicit her sympathy instead of turning her off. Just let me know if you need help with that or anything else related to your WLS journey.

I'm sorry to hear your band experience has been disappointing. It sounds like you've given up on yourself. Why? If I spent $16,000 for WLS, I'd be determined to stick it out come hell or high water. But like many Scotsmen,I'm extremely stubborn. Have you considered getting a 2nd opinion from a different bariatric surgeon, perhaps one that has a better post-op education and support program?

So, have you lost any weight in the past 4 weeks? Weight loss isn't actually the result of a fill. It's the result of consuming fewer calories than you burn (or burning more calories than you consume). Getting fills will make that easier for you because you will experience early and prolonged satiety (the sensation of having eaten enough food, which is not the same as feeling "full"). Also, keep in mind that just because you feel like your band isn't working yet (if that's the case), that doesn't mean it isn't working. I lost weight before my first fill because I was following my dietitian's eating plan to the very best of my ability.

I'm with Carolina Girl. That was a big, big stumble but it's history now. Stumbles like that are probably part of what made you obese enough to qualify for WLS. It's good that you recognized it as a stumble instead of saying, "So what?" Learn from this mistake and move on. You can do it!

I can sympathize because I know from personal experience that it can be hard to concentrate on good band eating skills when you're in a restaurant or other social situation that involves food and conversation. Eventually you're going to have to master that, but in the meantime you can play it safe with soup or the softer foods mentioned by the other people who've responded to your question. My personal favorite is to order crab cakes (usually found on the appetizer menu). I love them anyway, they're easier to eat, but more satisfying than soup.

You're very welcome. You've probably noticed by now that humor makes my world go 'round!

You weigh and measure yourself, don’t you? It can be such a gratifying way to see your progress towards your weight goal. But do you weigh and measure your food as well? No? Despite the potential for that practice to help you lose weight? Tell me why you don’t weigh and measure you food before putting it on your plate. Is it painful? Surely not. Is it impossibly difficult? No, I can’t believe that either. Or do your cups, spoons, and scale gather dust simply because they remind you too much of…gasp!!...dieting? Dieting…one of the most hated words in the vocabulary of every obese person who hated dieting, and failed at it so often, that she or he finally got fat enough to qualify for weight loss surgery. I completely understand. I’ve been there, done that, and got the size 3X tee-shirt. Yet still I’m going to insist that you give the practice of weighing and measuring food a try, because it’s one of the things that has made me a WLS success and because I can think of 9 (count 'em - NINE) excellent reasons for you to do it too. 1. It will prevent you from consuming more calories than you can burn each day, thereby helping you lose weight. Me, I’m terrible at eye-balling food amounts, even after years of practice. I cut myself a piece of chicken that I think weighs 2 ounces, and find to my surprise that it weighs 4 ounces. I spoon myself a modest mound of veggies that I think measures ¼ cup, and discover that it actually measures ½ cup. 2. It will make the data you enter in your food log more accurate so you’ll know how much you’re really consuming and whether you’re eating appropriate amounts of proteins, carbs, and fats each day, not just for weight loss but for good nutrition. You do keep a food log, don’t you? Did you know that scientific studies have shown that people who keep a food log lose more weight than people who don’t? 3. It will help give you a sense of control and mastery over food and eating, which will be very welcome and empowering after years of feeling that food and eating controlled you. 4. Weighing, measuring, or counting out 10 potato chips or 14 M&M’s will give you a chance to think one last time about whether that stuff will meet your nutritional and health goals as well as temporarily scratching the itch of a food craving. 5. It will slow your progress from stove to table, thereby reducing your risk of inhaling your food without even tasting it. You do sit at the table to eat, don’t you? It’s not true that calories eaten while standing up at the counter (or in your car or at your desk) don’t count! 6. The ceremony of weighing and measuring will help you appreciate the sensual delight of food, and that will increase your satiety (the sensation of having eaten enough food, which by the way is quite different from feeling “full”). 7. Until you learn what your satiety or “stop eating” signals are, you’ll have no way of knowing if you’ve eaten too much until it’s too late. And stopping eating too late can translate not only into disappointing weight loss but into unpleasant side effects like PB’s (regurgitation), sliming, foaming, and stuck episodes. 8. It will prevent you from consistently overeating, thereby preventing you from experiencing not just the side effects mentioned above but also some unwanted and potentially irreversible medical complications, like a band slip, a dilated esophagus, and/or a dilated stomach pouch. 9. If you give it an honest try for at least one week – just 7 days – and it doesn’t help, you’ll have the pleasure of saying that you proved me wrong. That’s highly unlikely, but hey, give it a shot! Oh, one last thing (for now). I know some highly successful bandsters who never weighed and measured a single morsel of food. They ate small amounts of foods they liked, lost weight, and maintained that weight loss. But they’re in the minority. And I, the World’s Greatest Living Expert on Everything, who slacked off on food vigilance after I reached my goal weight, have found that one of the quickest and easiest ways to get my eating back on track and nip weight regain in the bud is to go back to weighing and measuring. At the same time, I’m able to eat small amounts of foods that I like – just like the ones who don’t weigh and measure. The fact that my food has been weighed and measured doesn't make it any less delicious! If it makes the practice easier for you to bend your stubborn mind around, tell yourself you’ll just do it just for this one week, or one day, or one meal. Sometimes the WLS journey has to be taken one tiny baby step at a time. And that’s perfectly okay, because hundreds of baby steps can add up to hundreds of pounds and inches lost, and a lifetime of weight maintenance. Isn’t that what you want, in the end? Yeah, me too.

This is Memorial Day weekend – a time of picnics, cookouts, and other food-centered fun – and a time to remember the past sacrifices of fellow Americans who serve(d) in the military, and to thank them for their service to our country. It’s also a good time to remember the fat girl or guy we once were. I used to cringe when I saw photos of Fat Jean, but now I want to hug that unhappy girl and tell her that life is good. When I look in the mirror now, I see a "normal" sized woman who strangers would never guess had once been morbidly obese. I think we all need to remember where we came from, and to forgive ourselves for our pre-op weight loss failures. But halfway through the first sentence of this article, I thought of an equally important aspect of Memorial Day that turned this article's theme upside down. The meaning of "lest we forget" is more complicated than you might think. It represents more than three sappy words and planting a flag and a geranium on your grandfather's grave. It expresses an important message for a bariatric patient like me and you. The phrase "lest we forget" forms the refrain of "Recessional," a poem by Rudyard Kipling (1865-1936). It warns about the perils of hubris and the inevitable decline of British imperial power. After World War l, "lest we forget" passed into common usage as a plea not to forget past sacrifices and was often used on war memorials and as an epitaph on tombstones. So it’s an appropriate title for a Memorial Day article. Hubris is the extreme haughtiness, pride and arrogance that makes us think we're as invincible and all-powerful as Great Britain thought it was back in the days when it was taking charge of big countries (India) and small (Singapore) all over the world. One of my jobs in life is to resist the urge to be conceited about my weight loss success and to remember that I’m not invincible. I don’t ever want to lose sight of the fat girl deep inside me who's just waiting to get out again. Losing 100 pounds is such an enormous accomplishment that at times it seems like the most magnificent and significant achievement of my entire life. I'm justifiably proud of that achievement, but having weight loss surgery is not a guarantee of continued weight loss and weight maintenance success. As a boss once told me on the occasion of my promotion to management, "Remember, you're only as good as your last act." In other words, my great performance won me a place on the stage, but I'm going to have to repeat that performance over and over again in order to stay on the stage. WLS is a wonderful tool that will improve my ability to manage my weight for another 30 or 40 years, but it doesn't make me bullet-proof. Weight loss is no longer the centerpiece of my life, and I think that's a healthy thing. Some days I even ask myself why I'm still writing about eating, obesity and weight management. Why can't I let go of it? What will happen to me if I run out of things to say about it? But while I'd like to know the future, or at least know it will be a happy one, a long, straight road with the same scenery for mile after mile sounds boring to me. I'll stay on this road, with its twists and turns and steep hills, and trust God to keep me from getting too far off course. Writing about obesity is one of the things that keeps me going in the right direction. When other bariatric patients ask me questions about how to live and succeed with the adjustable gastric band, it forces me to think, and being forced to think is much healthier, and more interesting, than switching on the cruise control for the rest of my life. Along the road to your weight goal, I hope that you, too, will be able to acquire new interests and activities that you can take with you into your new life as a "normal" weight person, but don't forget to look backward every now and then. Don't throw out all the fat photos and fat clothes. They're memorials to your past obesity.

Are you afraid of an unhappy outcome of your weight loss surgery? You're not alone. Use your fear to conquer obstacles rather than letting it conquer you For most of us starting a WLS journey, bariatric surgery is vast, uncharted territory, full of unknowns. We long for a happy outcome – maximum weight loss with minimum problems. We listen to stories told by other patients with a combination of hope (to be as successful as they’ve been) and fear (that we won’t experience the side effects or complications they talk about). No one wants to be haunted by the specter of anxiety and dread, but I think a little bit of fear is a good thing. I don’t want fear to dominate my life, but without it, I’m likely to become complacent about my weight loss success and/or revert to the old, all-too-comfortable ways that made me obese in the first place. In small doses, fear keeps me on my toes. Like pain tolerance, fear tolerance varies from one person to the next. Perhaps I’m able to tolerate and use fear because my childhood and adolescence were so full of fear-provoking experiences. By the time I was in my late 20’s, I actually got a little thrill out of fear, possibly because it stimulates adrenalin production. There’s nothing quite like a knife coming at you to activate your fight-or-flight system, causing a perverse fear “rush”. At the same time, prolonged exposure to fear has also taught me to respect it. I don’t play with fear the way daredevils like Evel Knievel did, risking life and limb for the brief thrill of jumping 14 buses at a time with his motorcycle. But I do like the way fear can clear my mental field, forcing me to draw a line between important and unimportant. When the choice is survival or surrender, I’d rather choose survival. I’m not a quitter. When challenged, I’m going to fight back, especially if something precious like my health is at stake. If fear tends to paralyze rather than mobilize you, you may have to use your own compass to navigate a problem, or play follow-the-leader (provided you have a trustworthy leader) instead. Whatever you do, don’t give in. Giving in turns you into a victim (click here to read an article about victim mentality: http://www.lapbandta...-of-obesity-r79), which is not a position of strength in any battle worth fighting. And your health is worth fighting for, isn’t it? So, how can you make fear a working partner in your WLS journey? Let’s take a closer look at two of the more common faces of fear. FEAR OF FAILURE Somewhere between my first, mandatory pre-op educational seminar and my pre-op liver shrink diet, I became uncomfortably aware of a shadow that followed me everywhere. It was dark and scary, and even bigger than I was. It was my fear of failure. After decades of struggle – diets, weight loss, weight gain – I felt that WLS was my absolute last chance to be healthy. And after slogging through all those pre-op tests, evaluations, consults and procedures, I danged well was not going to fail this time. Since I had to admit that my weight management skills were sadly lacking back then (as amply proven by the number on the scale and the numbers in my medical files), the only option available to me was to become the most compliant patient my surgeon ever had (click here to read an article about patient compliance: http://www.lapbandta...g-deal-abo-r112). I had to believe that he and his staff knew what they were doing and would guide me well. I’m a very curious and often mouthy person, so I asked a lot of questions and did my best to understand what was going on in me and around me, but I spent very little time trying to second-guess the instructions I was given. That approach freed up a lot of time and energy that I was then able to devote to changing my eating and other behaviors in ways that helped my weight loss. FEAR OF COMPLICATIONS Compliance served me well I this area also. I can’t claim that I was never tempted to cheat on my pre or post-op diets or to test my band’s limits. I can’t claim that I believed I’d be forever exempt from the side effects and complications I heard about from other WLS patients. But when my dietitian told me (for example) that I’d be mighty sorry if I accidentally swallowed a wad of chewing gum and had to have it scraped out of my stoma, I quickly lost my interest in chewing gum. When I observed that many bandsters experienced certain types of side effects and complications after engaging in certain types of risky behaviors, I resolved not to follow them down the road of no return. Eventually I discovered that life after WLS can deliver some unpleasant surprises, just as in every other aspect of life. I had to learn some things the hard way, like: If you swallow a large antibiotic capsule that can’t pass through your stoma and slowly dissolves into a corrosive mess, you will end up in the ER thinking you’re having a heart attack (and end up with a big unfill). And no, liquid antibiotics don’t taste good, but they taste a lot better than the weight I regained after that unfill. Most of the mistakes I made were the result of impatience or carelessness, but I did my best to learn from those mistakes and keep moving on. A handful of mistakes was about all it took for me to decide not to challenge the validity of my surgeon’s and dietitian’s instructions, and that kept me trudging along the bandwagon trail, getting ever closer to my weight goal. And once I reached that wonderful place, I was determined to stay there!

Your surgeon's comments are very interesting, and explain a bit more about the phenomenon of how microscopically different fills in the same size band in different patients can have such different effects on the patient. I have to say, for the sake of bandsters reading this thread whose surgeons do not routinely do fills under fluoroscopy, that while fluoro fills can help ensure a tolerable and effective fill level, they don't guarantee it. I have never had a fill under fluoro and don't feel that my band's effectiveness was compromised because of that. Fluoro gives the radiologist or surgeon a snapshot of your esophagus, band and stomach at one point in time. A few hours or days or weeks later, the effect of that fill can feel quite different because of perfectly ordinary physiological events and processes, including hydration, hormones, time of day, allergies, medications, etc. etc. Often bandsters get what seems to be a "perfect" fill under fluoro and a few weeks later feel as if they didn't get a fill at all. The stomach expands and contracts to aid digestion by breaking food down into pieces that can be absorbed properly by the intestines, and that necessary movement can affect the position of the band enough to affect the patient's experience of restriction. Also, as you lose weight, the visceral fat clinging to the stomach shrinks, so that your band feels looser and you need more fill. And finally, a new fill can feel extra tight in the first few days but feel less tight as the patient learns to adjust their eating skills to accommodate the new fill level. Also, bandsters can get what seems to be a perfect fill and hours or days later find themselves struggling even to drink liquids. That can be because the fill itself, and the newly increased pressure of the band against the stomach, can cause enough irritation to cause the patient discomfort. Eventually the band settles more comfortably against the stomach, everything calms down, and life goes on. Jean

Lauren, Have the fills and unfills been done to deal with side effects or complications? I've experienced long weight loss plateaus as well as weight regain during my 5+ year WLS journey. I do know how frustrating it is. Personally, I think it's too soon for you to give up on your band, and the potential for weight regain will be just as real after a revision as it is now. WLS does not cure obesity, it only treats it. From my perspective, the only advantage the sleeve has over the band is that it doesn't require fills. It is what is is the moment you're wheeled out of the OR...whether you like it or not. No possibility of fine-tuning or adjusting, and 75-80% of your stomach is gone forever. I wrote about my band-to-sleeve revision experience in a length blog post, here: htp://jean-onthebandwagon.blogspot.com/2013/03/a-lot-of-people-especially-those.html: Good luck! Jean

Can you remember doing anything unusual or that would put extra strain on your abs? Have you talked to your surgeon or fill person about this? My port flipped and I had no symptoms. I didn't know what was happening until my surgeon's NP had a harder and harder time accessing my port for fills. I wouldn't wish a port flip on anyone, but in the grand scheme of things, it's a relatively minor blip. My port flip was fixed with same-day surgery. Not fun, but totally worth it because when I was able to resume fills afterwards, my appetite and physical hunger nose-dived.

De nada!

I'm sorry to hear that you're having to deal with this. You're contemplating a big decision that could have a big consequence, and making the "right" WLS choice can be overwhelming. Sometimes I think that's aggravated by doing so much research online - you're overloaded with information and it all seems confusing. I've had both the band and the sleeve, so I'm uniquely qualified to respond to this thread. Because my response is so lengthy, I'm going to give you a link to a blog post I wrote about this a few months ago. http://jean-onthebandwagon.blogspot.com/2013/03/a-lot-of-people-especially-those.html I think the bottom line is this. When contemplating a medical decision, it's just not possible to accumulate and process every tiny piece of data that could influence that decision. We have to make the best decision we can based on the information available to us at the time. If the problem we're having isn't acute or life-threatening, we have more time to consider the best course of action, but that doesn't mean our choice is guaranteed to work out perfectly. If you have more questions that you don't feel comfortable posting on the forum, send me a private message and I'll do my best to answer or to send you in the right direction. Good luck! Jean

You're very welcome. I think that the eating skills we learn as a result of WLS can become ingrained in us to help us manage our weight for the rest of our lives. But I know from my own experience of having 2 complete unfills and then losing my band that I had been taking for granted all that my band had been doing for me.

If you’re once a fatty, are you always a fatty? THINK THIN, BE THIN I think I’m well qualified to speak on this subject, since once upon a time my schoolmates chanted, “Fatty, Fatty, two by four, can’t fit through the kitchen door!” when I walked into the gymnasium for a physical education class with a teacher who, after weighing and measuring each kid, announced to her captive audience that Jean was the shortest and heaviest girl in the class. After which I was the last kid (once again) to be chosen for a volleyball team. I believe that in order to become a thin person, we must learn to think like one. It’s a tall order, I know. You might as well ask my dogs to learn to think like cats (I’m pretty sure my cats can think like dogs, but it doesn’t seem to work the other way around, to the everlasting detriment of the dogs). At the same time, I believe that we must never forget our inner fat person. If we do forget, the fat folks may burst out of us and take over again. I know mine did last year, for six months and 30 pounds of regain. She was aided and abetted by the loss of my beloved Lap-Band®, but once she was out of her cage, she took charge so fast it made my dizzy blonde head spin. That’s not a pretty sight when that head is busy gobbling all the food in the western hemisphere and the body attached to it is rejoicing, “Starvation has ended at last! It’s party time!” (which is what my gastroenterologist said my metabolism was doing, although not in those exact words). I lost the weight I had regained, plus another 10 pounds. I know (or I hope) I don’t look like a fatty any more, but a fatty still lurks inside me somewhere. My fat demon is hidden from view, but she’s still my demon. Exactly what every girl needs, along with a good bra and a good hairdresser. Seriously, though, my fat potential lives on, mainly because obesity is an incurable, chronic disease that no surgery today can cure. As long as my inner fatty threatens to take over, it’s hard for me to think and act like a thin person. But I refuse to give up the quest for Thin Jean, and I strive every day to emulate her. I believe that practicing thin behavior will eventually teach me thin thinking, and I believe that practicing thin thinking will keep my body thin. FAKE IT UNTIL YOU MAKE IT We have now arrived at the bad-tasting course in this home-cooked meal of advice. In order to practice thin thinking, we need to do things that we’ve done over and over again in the past without long lasting results, like making good food choices, practicing portion control, and exercising. I know that this concept frustrates many of us and infuriates some of us. Some people scorn the practicing part of the WLS journey. They say, “It’s just another diet.” A friend of mine declared a week before her band surgery, “I refuse to diet.” Perhaps it’s a matter of semantics or personal preference, but I persist in believing in the importance of practice because thin thinking and thin acting don’t come naturally to me. I wasn’t born with piano-playing skills. I had to take lessons and practice every day just to be able to play “Chopsticks”. Even famous concert pianists must practice every day. The same is true of being thin. This reminds me of the “fake it until you make it” slogan repeated in 12-step groups. The 12-step tradition recognizes that sobriety or abstinence doesn’t come naturally to people with addictive tendencies. It doesn’t expect its members to leap from the first to the 12th step in one week, one month, or even one year. All it asks is that we practice desirable behaviors every day, day after day, while the struggle to do that gradually lessens and we gain some control over the undesirable behaviors. Eventually we discover that we don’t have to “white knuckle” it anymore because the desirable behaviors have become habits. Assuming that you had WLS because you don’t want to be a fatty any more, I’d like to suggest that you begin by not eating like a fatty any more. You don’t have to do it perfectly, because you’re just practicing, right? As far as I’m concerned, you can leave the perfection stuff to God. All you need to do is do your best, day by day, to work with your strengths and work around your weaknesses. Even if practice doesn’t always make perfect, it’s got to help you with the fake it part until you get to the make it part. Yes, it’s a lot of work, but you can do it!

When traveling on a puree diet, I also like to order thick, creamy soups like crab bisque. For breakfast you can usually find yogurt and cottage cheese, but I bring protein powder with me just in case. I buy milk at the hotel shop or a nearby convenience store, mix it with the powder, and I'm good to go. Just ignore the dessert menu with all the exotic ice cream or gelato flavors!

Did you know that full-service restaurants have at least one blender or food processor on hand and can puree your food if you ask nicely?

You are absolutely right that surgeons' protocols vary widely, but anesthetizing a patient in order to perform an expensive, risky, surgical "rescue" that could more easily and safely accomplished with an inexpensive, safe, non-surgical approach (upper GI study & complete unfill) sounds like bad medicine to me. Sometimes I hate the way the insurance industry manipulates the American medical system, but there's a lot to be said for their "choose the conservative option first" approach. If nothing else, it's more consistent with the Hippocratic Oath which bids doctors to "do no harm."

Eating like a fatty is your decision, one that your band can do nothing about. I don't recommend doing a liquid diet unless it gets you out of a sugar or carb addictive cycle. Nothing is going to shrink your stomach (with the possible exception of vertical sleeve gastrectomy surgery, in which about 80% of the stomach is permanently removed). Liquids just do not provide the satiety (the sense of having eaten enough food, which is quite different from feeling "full") that solid foods do, so on a liquid diet you'll be physically hungrier and (if you're anything like me) feeling very deprived. If you go ahead and do a liquid diet, you're going to need a sensible eating plan for when you're done with the liquids, because if you go back to eating like a fatty, your future band success doesn't look promising. I agree with Tom that a meeting with a dietitian is in order.

Want to know what no one else will tell you about life with the band? The NITTY GRITTY of WEIGHT LOSS SURGERY Nobody can predict the course or outcome of your weight loss surgery, but I’m going to try anyway, starting with a simile that most of us can understand. WLS is like a marriage, with your band as your lifetime partner. At times you’ll thank your lucky stars you found each other. At other times you’ll wish you’d never met, never mind married. You’ll never walk alone again, but you alone will be captain of your ship. You will lose weight and gain a new lifestyle, but some of your losses and gains will be bittersweet. You’ll wonder what on earth you got yourself into, as well as why on earth you didn’t do this a long time ago. Most of all, you’ll scratch your head and say, “Why didn’t anyone tell me how much work this would take?” I’m not telling you all this to scare you. A little fear is fine if it makes you a compliant patient, but I don’t want fear to rule you. I just want to remind you that like every other human endeavor, the WLS journey has ups and downs. I believe that my band surgery saved my life and I’ve never regretted my decision to do it, but I can’t claim that every moment of my journey has been sunny and carefree. If you don’t want to hear about the tough stuff, that’s fine. You have my permission to move on to another article (preferably one by me). But if you want to hear about some of the things I wish I’d known at the start of my journey, read on. Knowing these things in advance wouldn’t have changed my WLS decision, but it sure would have helped me stick it out more easily when my weight goal seemed a million miles away. 1. The band is not magic. There is nothing in it that – hey, presto! - will make you lose weight. Changing your eating behavior and lifestyle, plus dozens of other factors that vary from one person to the next, will make you lose weight. 2. Your band won’t do all of the work. If you don’t (metaphorically) grab hold of it and use it as a tool, it will be about as useful as a cordless drill without a battery. 3. For most people, the band doesn’t start working right away. As a new post-op, surgical swelling and/or a small “primer” fill may or may not kill your appetite (desire to eat) and physical hunger (physical need to eat), but most bandsters need several fills to get the weight loss going, and more fills after that to keep it going. 4. If you don’t eat carefully, will you will suffer temporary, extremely uncomfortable side effects that can, if ignored, turn into permanent, expensive, and unhappy complications. 5. Once you achieve an optimal fill and restriction level (which will last for 30 seconds, 30 minutes, 30 hours, but probably not for 30 years), your restriction is very likely going to vary, for reasons too numerous to explain here. In this area you must remember that the human body is alive and always changing, whereas the adjustable gastric band is inert and changes only with the addition or subtraction of fluid. One day you can hardly eat, the next day you can eat anything and everything, and the day after that, you can eat just the right amount (remember Goldilocks and the Three Bears?). 6. Restriction may also vary according to the time of day (or time of month, if you’re of the female persuasion). Morning “tightness” is very common, and it may limit your morning food choices. That is not, however, a good excuse for skipping breakfast and thereby depriving your body of the fuel it needs, and doing so can set you up for a monster binge when hunger suddenly hits you at 11:38 a.m. So you will have to be willing to stay flexible, try new foods, and practice patience (which is something I have to practice every day in every way anyway). 7. You will have to deal with restriction even when you wish you had none at all, when you’re at a party or on vacation or sitting down to Thanksgiving Dinner at Mom’s overloaded dining table. At times you will want to go on eating because the food tastes so good, but you’ll have to stop because you physically can’t eat more, and because eating more would cause uncomfortable and undesirable side effects (to say nothing of weight loss plateaus or regain). That experience of food “deprivation” has been very frustrating for me. Not every day, not at every meal, but often enough to remind me again and again that my upper GI tract is no longer the free and easy party girl it once was. That reminder is often a good thing, but sometimes it makes me want to put my fingers in my ears and chant, “I can’t hear you, Stomach!” 8. This next piece of WLS Nitty Gritty is such a big, important one that I left it for last so that it will (I hope) stay burned into your brain a good, long time. NO WEIGHT LOSS SURGERY OF ANY DESCRIPTION WILL KILL THE EATING DEMONS IN YOUR HEAD. Vanquishing, subduing or managing those demons is something you’ll have to do yourself, possibly with the help of a counselor or support group, with daily practice for the rest of your life. But that’s OK, because you are worth all that effort.

Hmm. Sounds familiar. I got a similar talking-to from my surgeon last fall! It's hard for me to recognize when I'm obsessing and over-thinking things, and I tend to anticipate disaster if I can't control every little detail or calorie.

That's awful. I'm not clear on how you had anything in your stomach to aspirate into your lungs? You were you allowed to (or able to) eat before your surgery and while recovering, despite the nausea, vomiting, and other symptoms? Where was your surgery done? Did they not give you anti-nausea meds?

Your a good aunt to worry about him, but as long as he can't see or admit that he's obese, there's not much anyone can do about it. Very sad.

I didn't delineate morbid obesity from obesity in this article for 2 reasons: (1) I don't think that's necessary when the essay's audience (LBT members) consists of people who are already intimately familiar with obesity criteria and are/were obese enough to qualify for WLS. In other words, I'd be preaching to the choir. And (2) The system currently used by insurance companies and the medical professional to identify obesity and morbid obesity is based on the BMI. The BMI calculation was developed by a statistician as a way to classify weight, wasn't intended to be used as a medical criteria, and doesn't take into account some important factors that skew the validity of a person's BMI - for example, that men have greater muscle mass and that Asians have lesser bone density. In my opinion, focusing on the BMI in evaluating a person's weight is a mistake.