CindyZee

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

The bariatric operation will only take you so far. For many people battling weight issues, the biggest caveat in achieving sustained weight loss is the way you think about food. It's not easy to break habits that have been comfortably in place for years, even decades.
It's time to take your "old frame of mind" out of its comfort zone. Here's how to do it:

When new bariatric patients come to my practice, one of the first things we discuss is how unimportant the operation will be for them, in the big picture. Once they recover from the shock of that news, we explain that their mindset contributed to their weight problem, and their mindset will be the secret weapon to ultimately get the weight off.
Here’s the thing--we don't operate on your brain. Bariatric surgery will only take you so far. Long-term weight-loss success requires a firm commitment to living a healthy lifestyle—eating the right foods--and ignoring the others that made you feel bloated and too tired to do anything. You need to stay very well hydrated and discover an exercise (or two or three) that you perform about 4-5 times a week for about 30-40 minutes.
Take this stress and…
Then there’s the stress of everyday life—we all have it. The trick is to find ways to offset these unavoidable pressure points, so that you aren’t on a one-way road to the kitchen. Food is not the answer to your problems, it never was.
While you are improving your health, feed your brain with positive feelings by improving the quality of your life. Make the effort to become more social: Join a gym, catch a movie with a long-lost friend, invite the nice parents of your child’s best friend over for coffee.
Give a little, get a lot
One of the activities I recommend to every bariatric patient is to give back to their community. Want to feel better than any junk food could make you feel? Volunteer. If you look around, you’ll see that you’re far more fortunate than you may realize. Help out, make life better for someone else, even in a small way. Give your time, give your heart.
Everyone needs a little help
If you think you can’t go it alone, reach out to your bariatric or family doctor to ask for resources who can offer mental health support specifically for people with food/weight issues.
You are never in this battle alone, always remember that.

During weight loss, and eventually weight management, your long-term success will be contingent upon prioritizing time and effort to take care of your business of weight loss.


We all have an inherent need to help others before we help ourselves, particularly as adults when we take on the roles of spouse, partner or parent.
But taking on the goal of losing a large amount of weight requires that you dedicate yourself 100 percent to the task at hand. Make time--no matter what obstacles try to block your path--to accomplish these tasks every day 24/7/365 (yes, even Christmas):
· Shopping for fresh and healthy food
· Preparing meals
· Exercising daily
· Relaxing
· Planning for the next day
These responsibilities can be challenging when you are so accustomed to helping everybody else before finally seeing to your own needs (if you are not too exhausted to do so). It’s all-too-easy for self-care activities to slide off the to-do list (I’ll start again tomorrow…)
Undertaking the Herculean challenge of losing a large amount of weight and changing unhealthy lifestyle patterns in your life may be the battle of a lifetime for many of you.
And you are worth it.
But to accomplish this goal as quickly and effectively as possible, you have to prioritize “self-care.”
Five ways to prioritize your needs during weight loss
1. Prepare and enjoy your meal before you cook for the family.
2. Set-up a kids’ activities car pool to lessen wasted time sitting idly in the car.
3. Set a daily reminder to take a 15-minute break every day to do something that you enjoy, even if you just sit with your eyes closed.
4. Feel free to say to detractors, “I have to devote a concerted effort toward my weight loss, which will make me healthier and happier.”
5. If you are put into a situation where you may eat for the wrong reasons, change plans or politely excuse yourself. (You are in a special situation, you are allowed).
Like getting regular oil changes for your car, prioritizing your own needs is what allows you to run optimally and put your best foot forward toward achieving your weight loss goals.
And you are very much worth it.

Hi Zephra. I was sleeved by Dr. Nick Nicholson on 07/27/10. He is absolutely great. Forgot to mention: my incisions are healing super well, I haven't thrown up even once, etc. so everything else is great. I was just worried that it was too much pain. I keep forgetting that it's only been two weeks and "DUH", it is major surgery!

Good observations.
One thing I have been thinking about lately, especially with many of the issues that are being brought to the surface because of the US political campaign is sexual abuse.
I know a large part of my obesity is the result of me building a literal wall against unwanted attention/pain.
Even though I never experienced overt sexual abuse, the memories of bullying, ostracism, ridicule, unwanted comments, catcalls, rejection, harassment, and discrimination are very vivid. Much of it because I am female, but more so because I am a fat female.