determinedtolive

Well, the prescribed 2-4 oz of meat is hardly an obsession when the average American is probably eating 8 oz of animal Protein at a meal.
I am 13-years out from gastric bypass and have not eaten red meat for so many years that I have lost count at this point. But the validity of bariatric surgeons telling us to eat animal protein is apparent to me, based on my personal experience. And my experience has been that, I eat wild caught fish and organic raised on pasture eggs and supplement with vegan Protein powder (of which most brands are crap) and collagen. Sometimes I will eat organic free range poultry. I also take lots of supplements including a heavy dose of Iron. All this personal history is given just so that I can tell you that given these high dietary standards, I still struggle with iron deficiency and anemia from time to time. So, I will say that there is legitimacy to the prescribed "up your animal (red meat) protein intake."
Dr. E. E. Mason wrote these gold standards several decades ago and there is a lot of value in them. They are not nutritional guidelines per se and so they don't include things like phytonutrients -- that's my take on it anyway. That said, given what we are now seeing as far as nutritional deficiencies and digestive disorders in long-term bariatric patients, perhaps the ASMBS will publish more comprehensive nutritional guidelines for micronutrients and (one could only hope) phytonutrients. There is some detailed information on the ASMBS website regarding micronutrients, and a European bariatric surgeon that I spoke with recently said this was a big area of discussion at their annual meeting.
When I had my gastric bypass surgery in 2003, I was told that I needed to take one Multivitamin, one Calcium, and one iron tablet a day. That turned out to be a complete fallacy. The quantity of supplements that I take is extreme.
GSleeve822, rather than try to degrade ops with name calling -- ops, who I might add, take precious time out of their busy lives to write articles such as this purely to help bariatric patients -- why not add to the conversation with information from authoritative sources that support your point of view rather than issue complaints that show your lack of gratitude and decorum in a public forum?
As always, my information is cited from the authoritative sources from which they are taken, and shared here for informational purposes. You should always check with your healthcare provider, as well as trust your gut instinct... if something doesn't feel right to you then by all means exercise your right to not believe it.

If you don't eat animal Protein, then substitute the protein of your choice. If you are vegan or vegetarian you are should already be used to this.

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.

I have never ate lettuce based salads because lettuce has zero nutritional value.
I like baby spinach salads. Spinach totally breaks down. I can eat a lot of spinach and I find it makes a great afternoon snack. 3 ounces of spinach is 1/3 of a bag of a spinach, and 20 calories.

Success after weight loss surgery is no accident. It is the result of a lot of hard work and careful planning on your part. While of course it depends on a skillful surgeon, your post-op success depends most heavily on you.
You can begin to set yourself up for satisfying weight loss and preventing regain long before your surgery date. Here are some ideas for building that solid foundation that will make your weight loss surgery journey smoother and more satisfying.


Choose the right surgeon.
If weight loss surgery is the tool, your bariatric surgeon is the one who makes the tool and gives it to you. You want a tool that is made precisely, ready to do the job, and built to last. Your surgeon needs to make the right cuts and place the band properly or make a tight, solid sleeve or pouch. So, look for a surgeon who is experienced and has a good track record of successful patients and low complication rates – don’t be afraid to ask!
There’s more to choosing a surgeon than technical skills. Also, consider what else the surgeon will do for you. The right surgeon for you is willing to discuss your options and the procedure with you in a way that you can understand. You’re setting yourself up for extra challenges if you’re afraid to talk to your surgeon or your surgeon is unavailable.
Get the scoop on the diet.
Your diet is central to every part of the weight loss surgery journey. You may be told to lose some weight before surgery as a test to make sure you’ll follow the rules post-op. Then there’s the pre-op liquid diet to shrink your liver for a safer surgery. Next, for faster healing and fewer side effects, you need to follow the post-op progression from liquids to pureed foods to solid foods. Finally, there’s the nutrient-dense, low-calorie diet to help you hit goal weight and stay there.
At best, you will have a surgeon or a nutritionist who gives you plenty of information. Since that’s not always the case, you may need to take steps to figure out the diet for yourself. You can look online, and may need to shell out the money for a few appointments with a nutritionist. Not knowing the right foods to eat can set you up for surgery complications and disappointing weight loss.
Take responsibility.
It’s nice to depend on a stellar surgeon and complete healthcare team to walk you through surgery and beyond step by step. Ideally, your trusted surgeon would explain your options to you and recommend the best surgery for you, whether it’s the sleeve, band, bypass, or another choice. You’d go back for follow-up appointments and ongoing nutritional and psychological counseling.
That doesn’t always happen in the real world, but that’s no excuse to give up. You can take responsibility for finding out the information you need to know about what to expect, how to prepare, and what comes next. Be persistent and do your research in all kinds of places, and you’re more likely to succeed.
Face the facts.
Weight loss surgery isn’t all fun and games. You don’t leave the operating room skinny. Weight loss isn’t steady. It may take you longer to get to goal weight than you hoped. Recognize the real possibilities to avoid being disappointed and possibly even giving up.
These are some other possibilities to consider, so you can be prepared if they happen to you.
You may still love sugar, salt, fat, and/or starch.
You may still be hungry.
Others may not notice your weight loss, or may not be impressed.
Others may be jealous of your weight loss or say you didn’t earn it.
You may have loose skin when you are finished losing weight.
Weight loss surgery doesn’t solve psychological problems.

Be Open-Minded
If you want to lose weight and get healthy, you’ve got to change your diet. Whatever eating habits got you to this point are not going to get you to goal weight!
That may mean you need to be open-minded. Maybe you hated vegetables, or can’t stand the thought of downing protein shakes for 2 weeks on the pre-op liquid diet and up to 4 weeks on the post-op liquid and mushies diets.
It’s time to re-evaluate. Can you sneak some veggies into your diet? Can you retrain your brain to love them? Can you force down those protein shakes for a few weeks in exchange for a lifetime’s worth of better health?
Learn to see the good.
There will be disappointments - guaranteed. The scale may not cooperate, or you may make a poor eating choice, or you might skip your morning workout because you didn’t make sleep a priority the night before. Focus on the negative, and you just may talk yourself out of continuing the hard work and good progress.
Instead, learn to appreciate yourself and see the positive sides of things. Maybe you didn’t lose weight this week, but did you eat right? Maybe you downed a piece of pepperoni pizza without thinking about it, but did you pass up the breadsticks and soda that you would have had before surgery? Maybe you didn’t work out this morning, but did you make it to the gym more this month than you did last month?
See yourself as a strong, powerful person, and you will act like one. You can build on the positive behaviors you see in yourself so they eventually overshadow the mistakes.
You have control over your own destiny. Success with weight loss surgery depends on planning and hard work. The more you are involved and the more responsibility you take throughout the process, the better you can do.

My surgery isn't until June but my lunch today is 1 cup of spinach with a serving (2 oz) of sliced turkey breast, 1/2 an avocado and a serving of pumpkin seeds, no dressing.

Am I alone in my belief that surgeons are creations of God on a day when He had a migraine??
---AND---
There is a reason why surgeons exhibit their best patient to doctor skills when their patient is asleep.
Seriously, I really do believe that surgeons have a different mind set than general practitioners. Maybe it's the need for a more separation personally with the patient--the same theory of a PCP not treating or prescribing drugs for his/her own family. The connection is too close to be objective.
I feel that a highly successful "Bariatric Team" should not only include a surgeon, a nutritionist, a therapist and a well trained supporting staff, but should also include a general practitioner who would be primary provider for all aspects of the bariatric journey except the surgery itself. Release the surgeons to do what they do best--surgery-- while releasing them from the "best side manners", which most of them are just plain lousy at.
A monthly post op check with the PCP, the nutritionist, and the therapist should be part of the package with no added fees for six months, then every three months for the remainder of the first year and then twice a year thereafter--also with no added charge (other than routine co--pays).
I also believe that seeing a therapist just once for clearance falls way short of ensuring a solid mental foundation that is imperative for successful WLS journey. A monthly therapy session during the six month pre-op should be required--in my opinion.
After reading posts here and talking with other WLS patients, I believe that our minds take longer to get on track than our mouths ever will.
Great thought provoking posting. Thank you!

Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
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