summerset

If there are many, there isn't obviously a best one because if there would be a best one, there wouldn't be many. Guidelines differ, evidence-based or not, depending on what studies are included or not. If one wants to cherrypick studies in one direction it's always possible. There are also too many unpublished studies rotting away in desks because the results were not the desired ones (that might be more of a problem when it comes to drug therapy though). Crappy study designs. Sky-high drop-out rates and having to rely on self-reporting (that seems to be a big problem in the weight loss field). Thats why I lost quite a bit of trust and belief in EBM over the years. There's also always the question of "Cui bono?" hovering and the principle of "publish or vanish". Bonus icing on the cake: whenever I read a study about nutrition, behavior, psychological or environmental factors that might have impact on losing and maintaining weight (or not for that matter) one term at the end of the discussion almost always seems to catch my eyes: "needs further evaluation". What's a clinician supposed to do with that? Wait and see or change treatment protocol? What I said. And that's where this whole guideline and rules thing seems to go out the window. In the end it boils down to trial and error for the patient and I wish treatment teams would admit to this and therefore being more flexible in their approaches instead of practicing a one-fits-them-all approach. The clinicians I know usually want to have trustworthy diagnostic tools and effective treatments they can offer their patients. Nothing more frustrating than not coming to a proper diagnosis and being able to offer effective treatment. Most likely they do and that's why there is so much eminence-based treatment out there, hence the difference between recommended diet protocols after WLS.

While I agree with this in general I also hold the opinion that there don't seem to be really that much evidence-based treatment guidelines around. Most of the stuff seem to be more eminence-based instead. If there would be really evidence-based guidelines out there about what treatment protocol provides the best outcome possible then why do e. g. days of planned hospital stay, peri-operative eating guidelines and longterm diet protocols vary that much, not only from country to country but also from treatment center to treatment center? The only reason I can think of is that there is no evidence-based best protocol out there yet (and honestly, I doubt there will ever be).

Oh, don't be fooled! ? It doesn't taste anything like Lebkuchen/Spekulatius at all. It's too heavy on the aniseed for that - some people reviewing it compare it more to "Pfeffernüsse" and I agree. I personally think it's absolutely undrinkable on it's own but it adds a really nice flavor to a chocolate protein shake when used sparingly. I'm thinking of trying the Pumpkin Spice one next time. I already had this idea a while ago. Unfortunately only the same limited selection of products one can get in Germany. Oh, well...

True. There will always be a-holes and batshit crazy zealots around. I absolutely hate what the above mentioned idiots have done to both the fat acceptance and HAES movement.

Meh, I'm really craving Gulasch these days. Have to find a recipe for it that's vegan.

I had some fake chicken that had to go but was more in the mood for bean pasta with something-tomato. So there it is: tomato sauce, fennel, red bell pepper, the chicken and cashewsan on bean fettuccine.

Honestly I'm on the fence with this one. I've seen unhealthy eating and/or exercise behavior promoted often enough on WLS boards or weight loss boards in general. Support groups, be it one IRL or an online one can be very helpful. However, they can also be highly toxic environments. People seeking support should be aware of their own inner reactions and act accordingly. I for sure do. Ever seen how the reactions to these posts are? Way too often plain smug, arrogant and downright insensitive. Who would want to talk about struggling and regain in such an environment? Not me.

I'm also still frustrated with my body and I can't think of a person I know (be it a woman or a man) who isn't to some degree. It runs rampant in our society. One has to learn to live with imperfections and limitations.

Hm, I had my first surgery in 2001. I don't know though if my weight would be different if I didn't have these intolerances and complications. If you maintained for 10 years - do you have any idea what caused the weight gain? Like having a new job and being less active or entering retirement or something like this?

It's not frozen wakame, it's frozen wakame salad with sesame seasoning and all. I won't even attempt to copy it, lol. I use dried and re-hydrated seaweed in soups though.

Yes, it's way different than the first surgery. Especially if you feel "forced" to do it because of e. g. reflux. The excitement of weight loss is completely missing when you're having surgery out of other reasons. You just feel like like crap for a while and have to deal with the anxiety that the "new surgery" isn't as good as the one you had before. I'm still not convinced that the RNY is as good as the MGB when it comes to maintenance. So far I don't have any real reason to think so but there definitely is this nagging anxiety in some part of my brain I can't get rid of and that maybe will be present for some years. If it will ever go away, who knows.

This combo is a keeper. I'm going to add more wakame salad next time though (also a keeper, got it frozen from the asian supermarket I regularly shop at for specialties). Next time I'm going to try with a vegan mock salmon filet. If that's good it'll substitute the fish.

OMG, the pictures look awesome, LOL. ?

I don't mind protein powders. I use them regularly in e. g. oatmeal anyway. I like this creamy texture they provide. I also like protein mug cakes once in a while. I found some recipes on the Alphafoods, Nutri+ or Vega website I'd like to try plus of course several on the web or in fitness magazines I browse on Readly (the peanut protein balls were awesome, I posted them on this thread a while ago). When using a protein powder I usually doesn't have to use any additional sweetener. The powders are sweet enough. What powders do you use? I use Alphafoods, Nutri+ and ProFuel - Vega is very hard to get your hands on in Europe as it seems.

Lunch for today: rice with furikake, edamame, wakame salad, smoked trout eaten cold. Not pictured: apricots and plums in soy skyr.

Tomato soup. Later on spelt cooked in the microwave with almond milk, vanilla protein powder, cocoa powder, dark almond butter and a bit of sea salt. Banana on top and a little bit of chocolate sauce for decoration purposes.

This is the Like Meat brand. However, I prefer the Ruegenwalder Muehle one. Better taste and consistency IMO.

Daily weighing drives me crazy, so no.

Hokkien noodles, fake chicken, zucchini, red onions, some mixed frozen vegetables in a lemony sate sauce.

A flat peach.

A flat peach is a peach that is not round but looks more like some kind of disk.

Food for tomorrow: soy skyr with banana (yellow bottom), flat peach, apricot and plum (top). Maybe I will add some muesli to-go I have sitting in my desk, depending on appetite. Rice with wasabi furikake, frozen wakame salad and soy beans.

Hospitals usually don't allow smoking within the building of course but there are usually designated areas for smoking outside.

Really? Never heard of this...wow. Of course surgeons will recommend that patients stop smoking before surgery. They also recommend it before hip or knee replacement etc. However, while in the hospital I saw a lot of patients smoking before and after surgery. People getting the surgery are usually grown-ups. In the end the patient has to make the decision and you know what? Most doctors give a damn in the end if the patient stops smoking or not. You just have to be in the game long enough, lol.

True. In the end it's always a question of "how big is the price one has to pay for it". If you can maintain a BMI in the normal range or maybe even in the being-slightly-overweight range rather effortlessly what's the point of trying to white knuckle your way to a BMI of e. g. 21? If we're being honest we're no longer talking about "health" then. We're talking about "vanity". Don't get me wrong, there's nothing wrong with wanting to lose more weight because of a little vanity but be honest and stop hiding behind the word "health" once a normal weight is reached and it doesn't hurt to be aware of the price one might have to pay for it either. For many patients the decision to lose some more "vanity weight" might boil down to "Do I want a life or a diet and an exercise plan?" I'm dropping again the term "best weight possible". For some, that might indeed be that BMI of 20. For others it might be the BMI of 27 or 28 or higher, depending on starting BMI and life circumstances. Usually surgeons and dietitians are more realistic when it comes to goal weight than the patients, e. g. https://pubmed.ncbi.nlm.nih.gov/18201668/