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Mine was also hiatal hernia and went in 12/19 and release 12/20. Have any of you had any complications? I don’t know if it’s from the hernia or not. But I feel like heartburn or acid reflux , something I’ve NEVER had before. [emoji30] hw: 246 sw: 235 cw: 215 gw: ? Sleeved :Dec 19, 2017

Not sure if this makes a difference but the whole day before I went for my first fill I was on liquids only, then liquids two days after. Soft musies for two more days and on the 5th day I went back to solids. Never had a burping or sliming problem. With the second fill, I ate normally all day on the day of the fill. After the fill I was on 1 day of liquids instead of two and went to solids on day two instead of day five. The difference in the two fills was huge. The first fill, no complications. The second fill, I've had burping problems and haven't felt that great. I'm still not restricted so when I go for the next fill I'm going to do liquids only before and after and follow my surgeon's instructions to a T. It makes all the difference for me. Hope this helps. :thumbup:

Best decision of my life. I am 3 weeks post op, no complications and minus 15-17 pounds. My asthma, high blood pressure and pre diabetes...all gone. I tried everything prior to the sleeve, lost only so much and gained all back plus. I am now down from 272 from the Fall to 225 and feel 20 years younger.

They always have to be prepared for complications. I went in as a 23 hour out patient and ended up there three days with dry heaves. Basically it is an outpatient procedure but if you are high risk or they feel that there may be a need to keep you it has to be submitted or your insuance will not pay if he decides later on that you need to stay.

The hospital said that I could have it done outpatient there. My insurance says if there are any complications and I need to stay longer, I will be able to.

I've never had a band, but know 3 individuals who have. They've not met goal in the 3+ years of having the band. Most importantly, they have had complications - swollen esophogus, throwing up, unable to eat certain foods, etc. Knowing that, I looked into other options and found the Sleeve. It appealed to me due to most of the reasons DeeDee mentioned. For experiences of ex-banders, look up posts/blogs by Tiffykins, youknowit, and FabBy50. Best of luck on making your decision.

Hello all my name is heather and i am from Dallas TX. I joined because i am meeting with a Dr. in a couple days about getting the Lap Band. I am 5'6 310 with a BMI of 48. I meet the requirements to get the band with my insurance as long as i do a DR. directed diet plan, my insurance is aetna EPO. I have alot of worries with getting this surgry but my first one is with my insureance. this is the 1st time in over five years i've even had health insurance. I do not have a PCP and I have not gone to the doctor in at least 5 years with one exception. (emergency tooth surgery) i"m worried that even with my weight having been very high all my life i have no recent documation to prove it. Has any one had the surgy that has my similar problem? Any adivce from any one who has aetna would be great. I've read alot about both gastric bypass, which my mom and sister had with little complications, and the Lap Band, which my boyfriends father had with few complications. I have decided on the Lap band for many reasons man one being i'm less likey to die from it. Another is i want it help me loose weight not make me dump all my wieght in less than a year like my mom and sister did with the bypass. I was wondering though, since u loose so much slower how much do you loose in say a month? I know its differnt person to person i just want to get a general idea. Well i'll go read threw some threads see if i can get answers to the rest of my questions that way, thanks for anyone who reads this time. :tongue_smilie: Sincerly hopeful and worried Ps. please excuse my spelling

1. What was the best part of surgery for you? The jumpstart to weight loss was obviously amazing, but I was surprised how quickly my usual body pain & aches stopped bothering me. My knee problems have basically vanished, and the lower back pain I had gotten so used to living with has gotten so much better. I can breath easier when doing things that used to have me out of breath -- going up 2 flights of stairs, for example. 2. What was the worst part of surgery for you? The pre-OP shakes -- I'm lactose intolerant and have trouble with stevia, and there were no shakes my care team could find for me that didn't have one-or-both things, so I spent a good 8-9 days barely keeping anything down. The surgery itself went off without a problem, and the pain wasn't as bad as I thought -- other than the car ride home! If you get WLS, bring a pillow to clutch to you afterwards!! 3. Did you have any complications (minor or major) during or after your surgery? Nothing during, nor after -- but I'm only 10wks post-OP tomorrow. 4. How has adjusting to your new life been for you? I too am on SSRIs for long-time depression & anxiety. Most days have been awesome and cheery. Even during the initial aches and pains of recovery, just knowing that things were going to start changing for the better improved my mental state. I still have bad moments / days but once I started seeing all the improvements to my life it makes it easier to push through. It certainly helps to have a good support system -- people in my life, but also honestly this forum. TBH I was in a #$%& mood all day and feeling lethargic, but logging in here I know that everyone here understands and it just makes me feel more settled. 5. How long did it take you to feel comfortable eating food? I am currently having a ton of problems with chicken breast. I hate 'dark meat' poultry, but tried chicken thighs recently and it's not too bad but still leaves me with a heavy feeling in my stomach -- still better than the stuck feeling in my chest that the white meat gave. I feel like no matter what I put on it or how I cook it, it's just clearly a No for now. That said, for the most part everything else has gone down well as long as I eat slowly, and make choices consistent with my care team's plan / schedule. Going from puree to soft foods was probably the hardest for me physically, because it felt so different in my stomach. 6. Is there anything you can’t eat anymore that you used to enjoy? It's early on for me, but the changes in my body's hormones seems to have stopped most of my cravings. When I'm having a rough time emotionally, I still have momentary yearnings for old 'comfort foods' but honestly just the thought of some of them will turn me off within a few minutes. (For some reason if I think about fatty oils too long, I just get nauseated). And many of my old comfort foods have just updated into healthier things I can eat. Instead of my mum's Dutch mashed potatoes, I have a smaller bowl of healthier mashed potatoes (or cauliflower, or heart of palm) with a scoop of bone broth powder to up the protein. Instead of spaghetti and meatballs, I have homemade meatballs and extra sauce -- or a ricotta bake instead of lasagna. 7. What was your recovery like? Any vomiting or dumping syndrome? I've had one instance of dumping syndrome so far, and it was 100% my own fault. I knew what the culprit was immediately (white-flour leftover tortilla and more difficult chicken breast). I won't lie, I seriously wanted to die for probably an hour, and then slept the rest of the day away. It's horrid. I'm hoping that I've learned enough to take better care / caution and avoid any more instances. Other than that, recovery has been pretty smooth. All my incisions healed up without issue, the gas pain only lasted a few weeks and then there was just a strange tightness / mild soreness on one side of my body for the first 5-6 weeks. 8. How long did it take you to feel semi-normal after surgery? I want to say 2-3 weeks. Around the time I started eating puree (week 3), my energy levels started bouncing back much more rapidly -- which let me walk more easily. 9. Did you experience higher energy level post surgery? 100% yes. NGL, sometimes I feel like skipping even though it's not suitable for someone my age, LOL. I feel like I've been more efficient at work post-OP just because of the energy improvement, and physically I notice the increased stamina every time I go on an errand or for a walk with my dog. (I tire her out now!) 10. Did surgery affect your mental health? For the better. Some of it is because the energy and the physical improvements make me feel better about myself in general, but part of it is kind of a trickle-down effect. I spend more time making good, healthy choices for myself, spend more time being mindful whether it's while I'm eating, or making a grocery list, cooking, etc. It's so much time spent on self-improvement and self-care. So I have less time to worry about what other people's secret thoughts or judgments might be and take people more at face value. I have less time to waste on people that bring toxicity to my life or can't respect my boundaries. It's like this microcosm of self-care made by investing my energy in my current journey has expanded it's hooks into the rest of my life. I feel like for the first time in my life, I am actually one of my top priorities. 11. Do you regret it? Would you recommend it? I had moments of regret during dumping syndrome, for sure. But as soon as I recovered from that one bout, I was still happy I'd done the surgery. I think it definitely forces us to take ownership of our own health and making the best decisions we can towards that. I would recommend it to anyone who has struggled with weight loss and can honestly look at their life and see themselves living in this framework for the rest of their lives. By all accounts it seems to be incredibly important to keep it all up -- the vitamins and supplements, the healthy choices and portion sizes, etc. I would NOT recommend it for anyone looking for a magic pill. This takes work, will continue to take work.

so i asked my dr where he learned to do the sleeve. he said he taught himself after watching his partner do them and by also watching videos of other dr's who had done them. i guess he really learned while being in the operating room with his partner (who is the head of the bariatrics unit). my dr has done over 300 rny's, 100's of lapbands and 6 sleeves. he says he only had 1 leak ever, and that was in an rny patient. i also asked him if there were any deaths and he said 1, but that was a person who was getting a revision of a revision. he seems very honest and straightforward in all his answers. his 6 sleeve patients are all doing well. my dr works on one of the best bariatric teams in new york, which is the st lukes hospital bariatric unit, which is also a bariatrics center of excellence and a leading research center for bariatric surgery. their team is headed by dr julio teixeira, who has done thousands of wls and teaches other dr's. dr teixeira is also well known to do surgeries that many other dr's wont touch because theyre being done on patients at high risk and/or with complications. apparently hes that good. i dont know how many sleeves he has done. my dr is the no. 2 on his team and his name is dr james mcginty. my insurance has dr mcginty on my plan, but no other dr from that hospital is on my insurance as different dr's there take different insurance companies. im confident in my dr and he was the best and most experienced from all the dr's that were accepted by my insurance. what do you think about him saying he was self taught? im not really worried about him only having done 6 sleeves (this was discussed in a prior thread), im just concerned about what is considered the normal way for a dr to learn how to do the sleeve? any replies would be appreciated. ps - i did ask my dr a ton of questions about the sleeve and his procedure, including bougie size, how far from the pyloric valve does he start, leak testing and so on, and he answered them all to my satisfaction. and ive researched the sleeve so throughly that i knew what answers i should of gotten. he really seems to know what he is doing and i am very confident in using him, but i guess him saying he was self taught is making me think. ps - i edited this ps in later. i just found out my dr operated on james gandolfini (tony soprano) back in 2008 (see link below). so if hes good enough for tony soprano, hes good enough for me http://showhype.com/story/news_james_gandolfini_hospitalized /

It's funny, I hear all sorts of things about do's and don'ts after surgery that sound so severe, but every one of them, my surgeon has dismissed. He asked if I planned to have more kids, and I said yes, but I know I need to wait 18 months. He shrugged his shoulders and told me you can't always control life, and if I get pregnant before that, everything will be safe and fine (I'm still not planning on it, but it's nice to know). He told me that he had one woman come in for her 6 week checkup pregnant, she found out at the appointment, and she had twins! He said that was ten years ago, the pregnancy was normal, babies delivered healthy, and she's still doing well after ten years with no complications. Sent from my iPhone using the BariatricPal App

Hi Im from NJ, I finally gave up fighting my insurance company and am flying out to Colorado to get banded by Dr. Kirschenbaum on 12/17/08. I have read good things about him. The only bad thing I read about him was that he wouldnt accept some type of insurance, and that there was 1 complication where the lapband was defective. I would have had to pay $20,0000 here in NJ. Dr. K. is just under $10,000. And he is in the U.S. of A! I think the trip out to Colorado will be quite a savings in my pocket.

There are pros and cons to being first and being up there in the numbers. I was roughly patient numbre 50-60 that Joffe and Yau banded. I know patient numbr 2-3 and they never had problems and that is 2-3 in the country not just with that surgeon. They say you should wait until after patient 50 because by patient 50 most docs have seen all different types of stomachs, and insides etc and they have placed enough bands to eliminate the possibility of most complications. But someone has to be the first 50 patients.. My advice as someone who has had complications is ask questions, like your doctor, seriously like your doctor you are going to have a lifetime relationship with them and make sure you are comfy with their staff. I would ask him if you are a complication who fixes it, who pays, etc. I would also ask what post op support he is offering, it is so important to have a good post op experience because that will help make or break some people. Good luck and argon is right for peace of mind 4 hours is nothing to drive for fills and support. Most of all make sure you are comfy with what you decide.

I would try to keep your questions open ended. I'm interested in hearing how your previous SADI patients have progressed and where they have ended up. Have they had complications or have any of them regretted having SADI? If so, why? Would it be possible to give me a ballpark, numbers wise, of the spilt between your sleeve, bypass, and SADI procedures? Do you have to undertake special training in SADI, given that it's not a routine WLS? Please can you explain...(whatever specific Qs you have about the procedure or life after the procedure, or whatever) It would help me with my decision to know how many of your previous SADI patients were second surgeries and how many first. If you were advising a relative of yours who was considering SADI, what would you tell them? If you were in my position would you have this particular procedure? How do immediate and long term complications tend to manifest?

For me it was an easy decision. #1 I did not want my insides rerouted. No way. #2 Too many complications!!! #3 Death rate from GB is too high

For me, it was the only surgical option I would even consider. I was able to lose weight when I set my mind to it but never able to keep it off. The mere thought of having weight loss surgery seemed drastic to me, but the lap band was the only procedure I was even willing to consider for myself. It truly is a personal decision. I needed a bit of help and it seemed like the right answer. I don't regret getting the band for 1 minute, but it's only been 3 months, so I'm just trying to make good choices to keep from developing any complications or adverse effects. You can research all the different types or surgery and there are risks to each and every one. You have to pick which one is right for you, knowing your lifestyle, your medical conditions (if any), the type of food choices you may have to make, the amount of weight you have to lose, and your goals along with what complications/adverse effects that may arise among other things. I think it is important to not let anyone "talk you into" a specific type of surgery. You really have to figure it out for yourself. :wub:

So, just out of curiosity, is there anyone else out there who's relationship nosedived after losing a lot? I was already in a rocky - but long lasting - relationship before banding. but as the weight came off, it just got worse and worse. Relationships are complicated. I don't know or understand all the factors that pitched into the issues. I never had any band fills, I used it more as a security blanket I guess. knowing I couldn't fall off (too hard) made it much easier for me to jump in and work it off. At first she was supportive - though a little inquisitive - about the change in lifestyle. Without going into any details, the things I thought she would appreciate - better body, more energy, 10 times the sex drive, healthier and happier, etc - she came to resent. Eating healthy turned into "thinking I'm better than her because I don't want any ice cream." Working out turned into "my daily excuse to get away from her." Buying new clothes, which is necessary when one looses 125 lbs, was of course done to impress "______". Blank being a different woman of her whim every day. The sex - which you would think got better, didn't. I'll spare the embarassing details, but my raging "affections" and strong will to do more things, more often, etc - were not because I was actually in good shape, but because it was what "my girlfriend" did with me. There of course never was a girlfriend. And hours of reassurance wouldn't convince her of any different. On top of that, the more weight I lost, the more she seemed to gain - though I denied it heavily when she mentioned it. And it made it that much worse, she resented me for it all. Has anyone else had anything similiar happen?

My mom is an ICU nurse there in Vegas too at St. Rose in Henderson... she too will be accompanying me at my consult and surgery... so far the staff has been great and very accommodating... I'm sure things will be fine, and the positives definitely outweigh the negatives, but it's hard not to imagine worst case scenario on things like these... My mother in law was banded in Mexico a few years ago and has no complications, and I know several other people throughout my travels that have been just fine too.... It's exciting and nerve racking both at the same time... MINI-Me.. what was the pre-op diet like? My surgeon here was going to have me do liquid diet four days before surgery.. since I won't actually get to meet Dr. Umbach until the day before the surgery, I wanna make sure I'm doing everything I need to do, especially if it will assist in the surgery going off with less complications. Also, I'll be coming back to Tulsa after the surgery (leaving 4 days later) - what type of follow up should I schedule? Should I set up a scope 6 weeks after to check the healing? or should I only worry about it if I have complications?

I am skeptical about this subject. Mine was 38 and I have been maintaining 150# loss for a few years. I have never heard of them going under 32 BUT I am also not sure how important the bougie size vs technique. What you should investigate is long term, over 3 years incidence of bad reflux and if that is associated with sleeve size. I honestly don't know because when I was sleeved 4 years ago there was a "theory" that smaller sleeves might have higher incidence of this long term complication. Serious reflux upticks at about 3 years post op....knock on wood I am still okay no reflux.

You absolutely can not forget to take your vitamins. This is non negotiable. Set a reminder in your phone if needed. Do whatever it takes to make sure that you get your vitamins in. Otherwise you will have complications for sure. i had emergency c section 39 years ago. It was so bad that I never had another child. I was in pain immediately after sleeve surgery but the pain was not even close to my c section. You will get through it

Guys. You have to do this for you,not what your lunch buddies think. I told my wife and son and one else in my family. I told Most friends. Only 1 pushed back. She has since come around and supports me. she is coming to dinner Friday night. I am 4 weeks out and start " mush food" that night. I'll control the menu. It will be aewsome for them and compliant for me. The " eating out weirdness". Only lasts a very few weeks. I have danced around it successfully with my extended family. Due to complications I was hospitalized 6 days. No one knew. In terms of eating out. --- 99.9 % of people will understand and be helpful. I have explained my needs To waiters. Thay have in 100% of cases been helpful and have even gone out of their way to accommodate me. Sunday night we are going out with friends. They suggested a place. I looked up the menu on line and suggested some. Place else. I told them I had just had stomach surgery and thought the place I suggested would work better for me. They were very much on board. I am happy to chat 1 on 1 with anyone on the fence. It is all about YOU AND YOUR HEALTH.

I'm so happy for you, I have surgery on Friday and I hope my recovery goes that well! I'm a revision from a sleeve after complications and my sleeve recovery was great (beyond the major complications) so I'm hoping I'll get lucky again and have another easy recovery. Keep us updated, I'm hoping you stay feeling this good but we are here for you if you hit a speed bump

I had my surgery in Tijuana, MX with Dr. Garcia and I am feeling wonderful. This was proably one of the best decisions and actions I've done for myself. My insurance does NOT cover WLS, so I had to research my options. My research led me to the decision to go the Mexico route. I had not one complication or complaint by having my surgery there. For whatever it is worth... the choice is our, and it is our personal choice.

I just wanted to clarify something.. someone on here said that the DEATH RATE for VSG surgery was 1%. That is NOT true. Complications from leaks is about 1% Not DEATHS from leaks.. Complications from leaks. Mortality rates 30 days out from surgery date are around 2-3 per 1000 surgeries. Still Scary? Yes, but we can do a lot to reduce our personal risks. Also can't wait to go to Mexico for my surgery woo hoo. I definitely feel comfortable with my choice BUT for sure I gave it a LOT more research than I would have if my surgeon was in the US. Also, I feel much more comfortable going through a reputable US booking agency. They have a lot of requirements for their doctors and they make visits to the facilities, etc.

Hello, I am new here and don't know where or how to post things to ask the Dietician - but here is my story and I need help please. I had Laparoscopic Sleeve Gastrectomy August 6th, 2019. My surgeon and nutritionist said being almost 2 years out of surgery, my stomach should be able to hold 8 ounces in volume or 1 cup of food at a time (but obviously if I get full, don’t eat the whole thing) When I first started this journey, I had the Laparoscopic Sleeve Gastrectomy on August 6th, 2019, they said only eat 4 ounces of food for a meal three times a day. I did that and weighed my food at 4 ounces on my kitchen scale. Then a year and a half out they tell me no, I need to go by VOLUME and not by weight or else I will stretch my stomach! I feel like I am limited in what I can eat now because how do I make a sandwich fit in a measuring cup or a piece of pizza (which I no isn’t nutritious..) but just using those as an example for size. In addition to the whole volume thing, what about foods that expand like breads and crackers and pasta? How do I measure their volume? If I figure out the volume of something like that should I take away some of the food item that will expand, so I do not go over the volume? For example: If I make a sandwich that is a perfect half cup in volume, should I remove some of the bread because if it expands it will be more that that half of cup? I hope that makes sense. I have lost 230lbs since August 2019. Now I have to learn how to reeat again, because I don’t know how to measure volume without putting it into a measuring cup. I find conversion calculators online, but they give me different answers. I thought, well if my kitchen scale says 4oz in weight am I able to find the fl oz of that without smushing it? I don’t know what is accurate? Weighing was so much easier, but now I am told volume and that it has to fit into a measuring cup, but how do you put a meal in a measuring cup? Right now, I eat 3 meals a day at 1/3 cup volume measuring cup per meal and with 1 – 2 protein shakes for the day in between my meals. I eat a meal at around 6am, 12 – 1pm, and around 6 – 6:30pm. I get full on only a few bites of my 1/3 cup food or what I think fullness is so I don’t always finish even that. My hunger signals and fullness signals are all screwed up. And I don't know if it is all in my head? Thank you so much for your time. I truly appreciate it. I try asking my nutritionist and surgeon these things and they say they don’t know how to answer them – just make sure you don’t stretch your sleeve and go over the volume! I try to stay at 1/3cup volume per meal, because I am afraid of stretching my stomach out now. Maybe one day I can go up to 8 ounces in volume I hope because my meal choices have become really restricted because I can’t mush them into a measuring cup and what I can doesn’t seem worth it because If I wanted to enjoy a little something sweet, it barely fits in the 1/3cup – so why bother. Then that makes me sad. I originally weighed 352lbs and now I am 119lbs. I also spoke to someone who said that after I lose all of my weight that it doesn’t matter if I overeat and stretch my stomach back out any more just as long as I stay within 1,200 calories, 120 carbs, and 90g of protein? Is that true? My hunger and fullness signals are really difficult for me to tell apart and I have a severe anxiety over stretching my stomach (that I am trying to seek help for). But if the whole “It doesn’t matter if your stomach stretches back to normal” is fine and I watch my nutrition, is that ok? I feel like that would be giving up and taking the easy way out because I “like food more than blah, blah, blah, and just want to eat..” I am afraid of going back to old habits because I love bread and sweets. It scares me to gain any of my weight back because I don’t want to be one of those where people say, look at her – you can’t even tell she had weight loss surgery because she gained it all back! I made this big decision, this massive life change and accomplished a great weight loss, but now am I giving it all up? All because I miss food and want to eat in between meals. Right now I am so hungry or head hungry, but not physically hungry, but head hungry enough I think I want to eat something. I need help tp get on track and figure some things out please? I don’t know what else to do and I am so utterly lost. My surgeon tells me to ask my dietician these questions because he doesn’t know how to answer them – he just preforms the surgery. My dietician told me to go by weight, then volume and now she’s telling me not to weigh or measure at all just to go by how I am feeling? Well sometimes I feel I can eat a lot. I am not getting the support from them I need and I just need someone to have patience and understanding and who is kind to work with me please. I am sorry if this is a lot of information to take in. I don’t mean to go on a rant. I am just so confused. I am going to see a therapist, but the whole stretching my stomach thing is a real fear. I also had complications after surgery with bleeding that I am told may have given me PTDS..

BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence? (Part One of Three) I’m guessing most of us understand that the disease of obesity is a complicated one. There are a number of factors that contribute to obesity. Some of these factors you may be very aware of; others you may be surprised about. Some of the causes of obesity are things you cannot do anything about; other causes of obesity are things you can influence. It’s important to recognize the difference. Why? For starters, you can stop beating yourself up over the things you can’t do anything about. It’s also important that you focus on putting forth effort where it will get you the best results! It’s essential for both doctors and those suffering from obesity to have a mutual understanding of these causes of obesity and which people can influence, so that: 1) Doctors can develop or increase empathy for the struggles of those suffering with obesity. When doctors better understand that many people with obesity have struggles that go beyond fighting their biology which negatively impact their weight, the doctors can more compassionately and appropriately address these issues and refer patients to see other professionals, if need be. 2) People struggling with their weight can evaluate the numerous factors impacting obesity and work toward accepting those things they cannot influence. In addition, they can take responsibility for putting forth effort into those aspects of their struggles with weight that they can positively impact. All righty, then! Let’s look at three of the main contributing factors of obesity and then talk about each one, emphasizing what, if anything, each person can do to have a positive impact on their weight. Genetics Culture and Environment Metabolism Genetics Obesity definitely has some genetic determinants, as researchers have clearly discovered. If there are a lot of obese people in your extended family, you have a better chance of being obese than someone from a family without a history of weight problems. Although there are many more obese people in the current population than in previous generations, this cannot all be linked to genetics. The genetic composition of the population does not change rapidly. Therefore, the large increase in obesity reflects major changes in non-genetic factors. Listen to this… According to the Centers for Disease Control and Prevention (2002): “Since 1960, adult Americans have increased in height an average of 1 inch but have increased in weight by 25 pounds.” So in 50 years, the human species has grown taller by only an inch but heavier by 25 pounds. That tells us there is more than genetics influencing weight gain in this country. PATIENTS: Even if you have a genetic predisposition for obesity, there are other factors involved, including the food choices you make and whether or not you exercise on a regular basis. Some of these behavioral factors are habits learned in your family, so what appears to be a genetic predisposition may be a familial pattern of unhealthy habits that can be broken. DOCTORS: Remind yourself that patients cannot “eat less/move more” and have any effect on their current genetic makeup. Acknowledge to patients their genetic predisposition for obesity in a compassionate manner. Help to gently educate them about the factors affecting their weight that they can influence. Do so in a “firm and fair” way, providing encouragement rather than admonishment. Culture And Environment In addition to one’s genes, a person’s culture and environment play a large role in causing people to be overweight and obese. The environment and culture in which you were raised impacts how and what you eat. Some people were taught to eat everything on their plate and couldn’t get up from the table until they did so. Others never sat at a table for a meal but watched television while they ate. Some kids are fed well-balanced meals while others exist on fast food or microwaved mac and cheese with hot dogs. In some cultures, simple carbs make up a substantial part of every meal. In other cultures, fruits and vegetables are consumed regularly. When you are a child, you’re not in charge of buying the groceries or providing the meals. You did learn, however, about what and how to eat from those with whom you lived. And guess what that means? How you feed your children is what they will think of as “normal” and will most likely be how they eat as adults. (I’m always concerned when weight loss surgery patients tell me their kids are “just fine” even though they eat the same unhealthy foods as the obese parent. It’s only a matter of time before the kids start to gain weight and have health problems as a result of their unhealthy diet and learned eating behaviors.) PATIENTS: Although your genetic composition cannot be changed, the eating behaviors you learned in your family, from your culture, or developed on your own can be changed. You alone now determine what kind, and how much exercise you do and what and when you eat. Your behavior is completely within your control. Work toward accepting the fact that you are in charge of, and responsible for, your behavior and every food choice you make. For every choice, there is a consequence, positive or negative. And NO EXCUSES! It doesn’t matter how busy you are, whether you get a lunch break at the office or whether you have to cook for a family. Even if you have five kids in different activities and spend your life taxi-ing them from one place to another, you are the adult and you are responsible for how you eat and how you feed your children. It takes a very responsible person to acknowledge, “Although I have a genetic predisposition for obesity, I am responsible for making healthy choices about my eating and exercise. For me and for my children.” Focusing on what you do have control over rather than that over which you are powerless, leads to believing in your capabilities. So take charge and make positive changes happen! DOCTORS: Engage your patient in a discussion about the cultural and environmental factors that helped shape their current food choices and exercise behaviors. Empathize with them, noting they are going to have to put forth consistent effort to change years of bad habit formation. Encourage them to get support, whether it is from friends with a healthy lifestyle, a health coach, a personal trainer, or the use of free online exercise videos. Help them set a short-term, reasonable goal and set an appointment with you to follow up. Remember, docs: That which is reinforced is repeated. Reinforce even small steps forward you see in your patients. This can go a long way in encouraging them to continue making healthier choices. A step forward is a step forward. Notice and praise every single step forward your patient makes! Resting Metabolic Rate Resting Metabolic Rate (or RMR) is simply the energy needed to keep the body functioning when it’s at rest. In other words, RMR describes how many calories it takes to live if you’re just relaxing. Resting Metabolic Rate can vary quite a bit from one person to another, which may help explain why some people gain weight more quickly than others. And why some people seem to find it more difficult to lose weight than others. There are some factors related to metabolism that you can’t change, but there are actually some that you can influence and change. Things you cannot change about metabolic rate: Metabolic rate decreases with each passing decade, which means the older you are, the slower your metabolism gets, making weight loss more difficult. Sorry ladies - Men generally have a higher metabolism, meaning they burn calories more quickly than women. You can inherit your metabolic rate from previous generations - which can be a benefit… or not. An underactive or overactive thyroid gland can slow down or speed up metabolism. Some things you can do to influence your metabolism and burn more calories include: Eat small, frequent meals. Drink ice water. You can boost metabolism temporarily with aerobic exercise. You can boost metabolism in the long run with weight training. PATIENTS: I’ll bet you didn’t there was much of anything you could do that would increase your metabolism. I’m hoping you choose to implement the ways you can help your body burn more calories. And what do you know? They are completely consistent with healthy post-op behaviors that you’re supposed to do anyway: 1) Eat small, frequent meals. CHECK. 2) Drink water (so add ice and boost that RMR). CHECK. 3) Engage in exercise, both aerobic and weight bearing. CHECK. There’s no reason NOT to anymore! (That’s a slogan from a really old commercial…) The point is, your specific RMR is both something that is unique to you, and that will slow down with age, is gender-influenced, and can be affected by thyroid issues. Accept the things you cannot change and DO the things you can to get the most out of your own, unique RMR. You DO have choices! Opt not to make excuses and JUST DO THE THINGS YOU CAN! DOCTORS: I’m pretty sure that educating patients is in your job description. Even though you have an allotted set of minutes during which to accomplish all your goals with a patient, point out the ways they can boost their metabolism while you’re looking into their ears, or hitting them on the knee with that little hammer. Present it as a, “Hey! Guess what I was reminded of today?” sort of thing. It’ll probably be absorbed better than a mini-lecture. Leave yourself a sticky note in the patient’s folder to bring it up in your next session… and then a new educational point for the next meeting, along with the small goal you set with them so you can be sure to praise them for their efforts! Patients and Doctors and all Allied Health Professionals: We need to work together to do the following: 1) End Fat Shaming 2) End Blaming 3) End Lecturing 4) Encourage reciprocal AWARENESS and ACCOUNTABILTIY 5) Encourage reciprocal EDUCATION and DISCUSSION 6) Encourage reciprocal GOAL-SETTING and FOLLOW-UP Stay tuned for Part Two of BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence?