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Overwhelmed by length of pre-op diet



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I'm at the beginning of this process. I had my first appointment with the doctor on Friday, and he outlined the pre-op diet he wants me to start immediately. In this clinic, they require people to lose 10% of their overall weight before surgery, and he said he expects it to take about 2 months. I was prepared for a few weeks of a really restrictive diet, but not 2+ months.

Anyone else started their journey this way?

Here's what he wants me to eat:

2 Protein Shakes (1/2 scoop, made with 8 oz almond milk)

2 Protein Bars

dinner of 10 forkfuls of Protein, 10 forkfuls of veggies

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10% in two months is a lot, do you mind if I has how much you weigh and how tall you are? After two months (and expected weight loss) do you immediately qualify for surgery or do you have insurance requirements to meet as well?

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I'm 5'1" and 220 lbs... There are no other insurance requirements for me, just the policy of his clinic. He'd like me to lose 20-25 lbs before surgery.

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That's a fairly lowish weight and to lose 10% in two months is doable but you will have to be tight with your eating and exercise. In the first week or two you will lose a lot water/bloat weight so that will give you a kick start. If by the last two weeks you need a weight loss boost you could cut out one of the Protein bars and the other if needed by the last week.

Is this your preferred surgeon or do you have other options?

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Just to give you something for comparison, my program's requirement was that I lose 5%. Of course, as soon as I started the program I panicked and gained 4 pounds (blessing in disguise, it made me confront some emotional eating habits I was in denial about) and then had a really hard time losing. I ended up being a few pounds shy of the 5% goal, but did well everywhere else and was still approved.

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2 months of that does seem tough!

Every surgeon is different and it's important to follow the recommendations of yours as they will be the ones doing the surgery and know what they need to be successful. But if the surgeons plans don't seem like something you can successfully do, I would say something. Is there a nutritionist in the clinic you could speak to to come up with a more realistic plan? I would hate for you to be discouraged from the start.

For reference, my doctor told me I did not need to lose any weight before surgery. I was told to increase my Protein intake and Water intake but I was allowed to eat normally. I was put on a liquid only diet a week before my surgery, Clear Liquids the day before. I didn't have any complications. I'm 5'5 and my starting weight was 267.

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I'd research other surgeons, just to get a feel for the different approachs....then make your decision.

There is emerging evidence that prolonged super low calorie diets before and after surgery could reset your metabolism to unrealistically low levels that set you up for weight gain later. (not saying this always happens, not saying this is gosple....bariatrics are an emerging science....just sharing that there are a lot of different ideas at play)

My group did a very carb restricted diet for two weeks before surgery. We were allowed to drink 5 shakes a day plus one food item from a list.....but this was just to shrink the liver for an easier procedure.

My group wanted 10% weight loss, but expected it to take months. We were required to work with a nutritionist, attend fitness classes, healthy cooking classes, support groups. Our whole process took 4-6 months...just to lay the nutrition groundwork and weight loss work before the surgery.

After surgery, we were pushed to eat 1200 calories a day as soon as we could tolerate it...in hopes that this would give us a robust metabolic reset. (to be clear, we went through the gradual restoration of diet after surgery for safety....liquid, puree, soft, etc....but our caloric goals were advanced as tolerated)

I lost weight slower than most people....but I made goal, and I'm doing really well maintaining. My preferences and nutrition choices are much healthier. I've got good support for the mental side of this process.

I feel like I was better prepared by my group for the work of making the permenant changes necessary and dealing with the lifetime challenges.

Be a little careful of clinics that push unrealistically brutal calorie restriction. Eating 600 calories a day will make you lose a crap-ton of weight and will make your clinic look like they offer "The Magic Cure"....but you don't need to be their walking bulletin board for a year and then be abandoned by them when you regain. You need a comprehensive program that supports your needs for a lifetime and teaches healthy nutrition and fitness and supports the mental challenges of breaking the addiction.

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That's pretty extreme. Different surgeons have different pre-op diets (some don't require any pre-op diet at all until the day before surgery), but this might be the most extreme one I've seen. If this type of diet were sustainable without surgery, you already would have lost the weight!

Honestly, I would look at this as a red flag for this surgeon and get a consultation with another surgeon. At 5'1" and 220 pounds, your BMI is 41.6, which is relatively low for WLS patients. You shouldn't need to lose a lot of weight just to get the surgery. My BMI was over 60 when I went to my initial consultation and my surgeon only asked me to lose 20 pounds. There is a legitimate reason for the pre-op diet, which is to shrink your liver and give the surgeon more room to work for a safer surgery, but it's usually no more than 2 weeks. This diet, for 2 months, is pretty unrealistic and it's setting you up to fail, just like all the diets you've probably tried in the past. It makes me wonder what his post-op diet is going to look like.

Just out of curiosity, are you allowed to use any Protein Shakes and bars you want, or is he requiring a specific brand? Like one that you're supposed to buy from his office?

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^^^^^^^ Agree with Sue completely!!

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I *really* appreciate everyone's thoughts! It is really affirming a lot of the feelings I have been having the past few days. One of the reasons I think I was feeling so emotional about it is connected to it being winter in the middle of the pandemic. I really enjoy cooking, and with all the isolation and every day feeling like the next, I'm realizing that planning meals has been a big part of my day. I also really like cooking for my family (definitely a "love language" for me!!!). When I first talked to my primary care doc about the possibility of surgery, she said that she thinks that loving to cook will ultimately be an asset to me. I think I need a plan for the next few months that is more real food. I enjoy cooking healthy meals with fresh ingredients. And I have had success losing weight with WW in the past this way (trouble is always keeping it off!).

You have all made me feel stronger about advocating for this with the doctor. Even if it takes 3-4 months instead of 2, I need to do it in a way that I feel good about.

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