Mom Takes Too Long to Order Food After WLS

Dear Kaye,

Why does my Mom, who had gastric-bypass surgery, take so long to order food in a restaurant? She’s driving me crazy with her indecisiveness.
Thanks,
Rose

Thanks for the great question, Rose. For our readers, Rose is a frequent visitor at Living After WLS. She has not had surgery but is trying to better help and understand her mom who had surgery about 8 months ago.

Rose, there are a number of reasons your Mom could be indecisive when ordering a meal at a restaurant. Perhaps she’s worried about getting sick – dumping or vomiting. All WLS patients worry about getting sick in public.

Perhaps she has some unresolved emotional issues about leaving too much food on her plate. (Remember the “clean up your plate” threat of childhood and habit of adulthood.)

She may fear she won’t like what she orders: to a bariatric patient taste takes priority over quantity.

Maybe nothing sounds good to her, in the early stage after WLS food can seem unappealing and even nauseating.

She may not be hungry, but doesn’t want to offend you by rejecting your invitation to dine out.

Some patients in this stage of the bariatric journey feel grief or loss for the foods we once loved gluttonously. She may be feeling loss seeing a menu of many things that she can no longer enjoy.

These things considered, is it possible to ask your mom if there is a specific reason she’s struggling to order her meal? That may be touchy and her feelings are probably raw in this early phase of weight-loss, so be cautious.

Some bariatric patients I know look at on-line menus before dining out. They make a plan ahead of time of what they will order and enjoy based on the very specific needs of the low-volume, high-protein WLS diet.

Rose, I believe you mom’s confidence in eating out and ordering skillfully for her needs will improve with time. Be patient with her, she is busting a lifetime of bad habits and finding her way to health and living after WLS.

Best wishes, please let us know how your mom is doing.

Kaye

Journaling

We’ve heard it all our dieting life – “keep a food journal, it will keep you accountable for what you eat.” That advice always failed me, the best I could ever keep a food journal was through breakfast – I didn’t want to leave written evidence of my eating behavior.

But there is one time in my life I kept a journal, words and feelings scribed on the page. That journal chronicled the first year following my weight loss surgery. The weight loss surgery experience is profound. It is a physical and emotional Mt. Everest. I dare say there is no other change a morbidly obese person will ever undertake that is as emotionally significant as weight loss surgery.

There are two reasons for keeping a journal: first to have a release for your thoughts and feelings; second, to have a record of your experience. For many people it is less painful to be honest about our feelings when writing them down rather than speaking them. If we write them down we don’t have to hear them aloud. If we write them down we are not vulnerable to sharing with someone else. For me, writing my feelings on paper was like sweeping the floor – I could gather the debris and toss it out – I didn’t have it cluttering my mind.

Secondly, as a record, your journal will become priceless. Perhaps on a daily basis we cannot measure our growth, our strengths and courage as we experience the weight loss transformation. But if we have a reference we can deliberately and honestly measure our progress. We can turn to the journal when we are feeling defeated and relive milestone moments we’ve recorded. One of my greatest moments during the weight loss was fitting in size 12 jeans. Imagine it – size 12! I don’t ever want to forget that moment, and I won’t. It’s in my journal and it’s a success I visit often. Record those magical moments to relive later, its worth the time and trouble.

A journal can be a lovely bound writing book, a simple steno tablet, a computer document or even a blog. You can commit to daily entries, or write when the mood strikes. You can share your travel log or keep it tucked away and private.

Some patients elect to keep a weight loss scrapbook and they document their transformation with pictures and captions. What an excellent pastime and celebration of the weight loss, to record in pictures and words the transformation. Others use log sheets to mark progress, specifically fitness log sheets. They begin day one recording walking distance and speed. Looking at a log sheet is an excellent measure of progress. It can be used to identify trends and spot problems. It most certainly is a place to record accomplishments and highlight new records.

Do what is right for you. This is your experience – please, do yourself the favor of recording your journey.

My Secret Chocolate Fix

Here's my dark little secret: I still love chocolate.

Five years after WLS I sometimes crave chocolate and and occasionally I indulge. I would never punish my body with a king-sized candy bar or a hunk of chocolate cake, I know better than that. These days I keep a bag of Andes Thin Mint Parfaits in the freezer. About once a week for "dessert" I have two pieces and it is completely satisfying. Two pieces contain 5 grams of sugar and just over 50 calories. I break each piece in two so I have four bites and it does the trick without causing me to be sick or worse - regain the weight.

What is your dark secret for attacking those chocolate cravings?

How to eat and not get sick

Here is a great how-to article for eating after gastric-bypass surgery. I found this at stronghealth. I know for me a frequent review of the best way to use my "tool" is always useful and refreshing.

Here are the guidelines for your new way of eating.

Eat slowly and chew foods until they are mushy.

* Allow 30 - 60 minutes for each meal
* Aim for 30 chews for each bite, chewing thoroughly to mush
* Explain to people why you must eat slowly
* Take small bites. Try a baby spoon. Cut food in the size of a "pea" to make it easier to chew
* Savor each bite, noting its taste, flavor, and texture
* Sit down and be focused on eating, not other activities where you can become distracted

Stop eating as soon as you feel full.

If you eat too much you'll get sick. Because the amount of space in your stomach is so small, do not eat and drink at the same time.

At first, you'll only be able to eat 1/4 cup of solid food (2 to 3 tablespoons of each item on your plate). Over time, the amount of food your stomach can hold will increase from 1/2 to 1 cup per meal. Your new, tiny stomach will not hold more than 1 cup of food at a time.

How to tell when you've had enough?

* Pressure or fullness in the center below your rib cage
* Nausea
* Pain in your shoulder or upper chest

When you get the feeling of fullness, stop eating, even if you have not finished your meal.
Set aside three meals a day when you only eat solid foods.

This will help you eat nutritious meals rather than endless snacking. Snacking could prevent you from losing weight. It could even cause you to gain weight.
Sip slowly in between meals all day.

* We all need liquids to stay hydrated. We suggest you drink water, skim, low fat or soy milk (up to 24 ounces per day), low calorie beverages, or tea.

* Don't drink anything for 30 minutes before or after each meal. Your stomach isn't big enough for both food and liquids!

* Sip beverages slowly. Carry a bottle of water at all times.

* Avoid high calorie drinks like milkshakes, soda, fruit juices/fruit drinks, beer, alcohol, meal substitutes. They can sabotage your weight loss efforts by adding calories without making you feel full.

* Avoid carbonated beverages. They can cause bloating.

Some Lovely WLS Friends

I happened upon this site today, some wonderful inspiring stories of fellow WLS patients. I don't know anything about the New York Bariatric Center, nor do I know these patients. However, I was touched by these wonderful testiments of the center, and of their own personal stalwartness in the struggle against obesity. I'm pleased, after all this time, to still be inspired by others who have the courage and gumption to succeed at Living After WLS. Take a look, and celebrate your own "LivingAfterWLS!"

Best wishes,
Kaye

What's for Dinner?

Be sure to see tonight's dinner recipe: Lemon-Thyme Oven Roasted Chicken with steamed zucchini & rice. Outstanding!

Appreciation & Incentive

Dear Readers:

Thanks for reading and subscribing to Living After WLS. Your feedback and returning visits have validated my belief that there is a need for long-term dialog among gastric bypass patients.

As always, your questions and feedback are welcome. You can post comments or click my email link.

As an incentive to new subscribers, I’m offering two files: the first is RDI’s Defined, a handy chart of nutrients, the daily value, why it’s necessary for health and where to find it. The other chart is a tool to assess your present nutritional intake and compare it against the RDI’s. Both charts will be sent to you without charge upon your subscription to Living After WLS.


Existing subscribers: Watch your inbox for an email titled “WLS Nutrition Charts”.


Best Wishes & Happy Living After WLS!

Kaye Bailey

WLS Myth Busting: After surgery you have to take all those vitamins

MYTH: After gastric bypass you can never be nutritionally healthy and you have to take all those vitamins for the rest of your life.

THE FACTS: It is a mistaken notion that weight loss surgery patients cannot lead a nutritionally sound life. The assumption is due to the restrictive and malabsorptive nature of the surgery it is impossible to eat a nutritionally sound diet. When good food choices are combined with a solid vitamin and mineral supplement program weight loss patients will enjoy good nutritional health. In fact, after surgery, most weight loss patients are more nutritionally balanced than before surgery.

Furthermore, evidence now suggests most Americans should take vitamin and mineral supplements to balance their nutritional wellness. In the 2005 Dietary Guidelines published jointly by the United States Department of Agriculture and the United States Department of Health & Human Services the government concedes that dietary supplements are a useful source of nutrients when nutritional needs are not being met through diet. Here’s the quote:

A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other compounds that may have beneficial effects on health. In certain cases, fortified foods and dietary supplements may be useful sources of one or more nutrients that otherwise might be consumed in less than recommended amounts. However, dietary supplements, while recommended in some cases, cannot replace a healthful diet.

Check out the person who badgers you about your vitamin habit – I’d bet my bariatric butt they don’t meet their RDI of vitamins, and in fact, in most cases I bet they don’t have a clue what the guidelines are for vitamin and mineral intake. In addition, WLS patients who return annually to their bariatric centers (and remember, that’s part of the long-term commitment we made, right?) have our blood tested and our nutritional health analyzed. We have the opportunity to meet with a nutritionist to assess our vitamin and mineral needs and make adjustments for better health. We are on top of the nutritional game when we follow the program.

Now the Lecture: Bariatric patients who desire optimum health and nutrition will take dietary supplements every day. Taking vitamins is a good thing. Before surgery I did not meet my body’s nutritional needs with my poor eating behavior, I did not take supplements and I did not feel well. Now, dietary supplementation is a habit and I feel great. I do not suffer from colds, anemia or brittle bones. My vascular and respiratory systems are healthy. My skin glows and my hair is lush and healthy. I don’t miss a day taking my vitamin cocktail because I love the way being nutritionally healthy makes me feel. (For easy to use reference charts, see the subscriber incentive.)

Definitions: The Food and Drug Administration considers vitamins, minerals, herbals and botanicals, animal extracts, amino acids, proteins, concentrates, and teas dietary supplements. The FDA governs the labeling and intake recommendations for dietary supplements. The following are FDA terms for describing dietary and nutritional needs:

DVs: Daily Values – Daily values are two sets of references: DRV’s and RDIs.

DRVs: Daily Reference Values - a set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium

RDIs: Reference Daily Intakes - a set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. RDI’s are essential to our health.

RDAs: Recommended Dietary Allowances – a set of estimated nutrient allowances required daily to maintain good health - established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. RDA’s set the minimum intakes of vitamins and minerals and protein needed for the average person to stay healthy – these intakes vary by age and gender.

WLS Patients have lower diabetes risk

As reported in FIRST 5/2/05

“Overweight individuals who undergo weight loss surgery have lower diabetes risk, we hear from Claude Bouchard, Ph. D., of Louisiana State University in Baton Rouge. He compared WLS patients to similar-size dieters receiving nutrition an exercise advice. Only 7 percent of the surgery group developed diabetes after 10 years, compared with 24 percent of the dieters. Lasting weight loss explains the benefit: Gastric bypass patients weighed 16.1 percent less, even 10 years after their procedures.”

Sandwich Ideas

I’ve always loved sandwiches, but after gastric bypass the traditional breads or wraps are difficult to eat and take up valuable tummy space. These days I prefer to make the fillings and skip the bread. I’ve compiled some of my favorite sandwich recipes in the WLS Recipes section – take a look.

I’ve included the bread or wrap ingredients for your information, particularly if you are cooking for the non-WLS members of our families. Enjoy!

Happy Healthy Eating!
Kaye

WLS Myth Busting: All patients re-gain weight because they stretch their stomachs

Dear Readers:

Recently I’ve been annoyed at the number of myths floating around about weight loss surgery. Today I introduce for your information and amusement a new column: WLS Myth-Busting. I will address for you the things people say about WLS that are false and misleading and hopefully offer some intelligent feedback for these comments. Please drop me an email if there’s a WLS Myth bugging you.


MYTH: All WLS patients re-gain weight because they stretch their stomachs.

FALSE: WLS stomachs can never stretch to pre-surgical size. At best, a post gastric-bypass stomach will expand from a capacity of 2 Tablespoons to one-cup capacity. Eat more than 1-cup volume at one sitting and it’s vomit-city, sweetheart!

TRUTH: WLS patients will regain weight (here’s the secret) by snacking or grazing. Eating little quantities of the wrong foods all day long causes WLS patients to stop losing weight, or worse, this behavior results in weight gain.

Snacking is the downfall of the WLS patient who regains weight, not stretching the stomach. For an example, 5+ years out of surgery, I can eat one piece of pizza at dinner. If I eat a second piece at dinner I WILL get sick: guaranteed. However, If I nibble on the leftovers an hour later, I can add another piece, and an hour later, another piece, and so-on. See the pattern? Snacking is the problem, not stretching the stomach.

The fact is, patients who live by the four rules do not regain their weight. Just as a reminder, here are the four easy rules:

• Protein First
• No Snacking
• Exercise
• Drink LOTS of water

The best way to bust this myth and prove the nay-sayers wrong (and don't we all want to do that!) is to live the four rules and never re-gain your weight.

Best Wishes,
Kaye Bailey

WLS Clothing Exchange

Here's an interesting article on clothing swaps in Iowa for rapidly diminishing WLS patients. Click the link above for the full article. Check with your local area bariatric center for a similar program.

Trinity Medical Center-West Campus, Rock Island, opened its doors Saturday for the swap. Members of the support group donated articles of clothing and were able to swap those clothes for clothes that fit.
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“This is a clothing swap for bariatric patients sponsored by bariatric patients. There is no money exchanged,” said Billie Terrill, office liaison for the institute, who also was a gastric bypass patient. “This is a great way for people to get nice clothes when they’re transitioning so quickly.”
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Terrill said an average patient will drop a size every six weeks. With clothing costs high, many of the patients shop at the Goodwill Store. But the monthly support group came up with the idea to swap clothing among themselves. Members volunteered to sort and arrange the clothes, and orchestrate the morning’s swap.

Got Calcium?

Calcium: Calcium is the most abundant mineral in the body – we have two or three pounds of it, most of which is located in the bones and teeth. In addition to building bones and teeth, calcium is an electrolyte required for transmitting nerve signals, water balance, acid/alkaline balance and maintaining osmotic pressure. It helps the blood to clot and is necessary for the heart muscle function. It’s long been known that calcium will aid in the prevention of osteoporosis, but new studies are identifying calcium for it’s anticancer actions within the colon.

Most dietary calcium comes from dairy products but can also be found in sardines, canned salmon, green leafy vegetables and tofu. The National Academy of Sciences has raised the calcium guideline to 1,000 milligrams a day for people under 51, and to 1,200-1,500 milligrams a day for people over 51. Most Americans do not get enough calcium in their diets; the average daily amount is about 500-1,000 milligrams. Bariatric patients are unlikely to intake that much dietary calcium therefore supplementation is necessary. Not only are bariatric patients limited by the amount of dietary calcium they may consume, the malabsorption issue presents another problem. Since the bowel does not readily absorb calcium there is limited opportunity for the calcium to be absorbed in the body.

Bariatric patients can do three things to better assimilate calcium in the body:

First: take a chewable calcium supplement twice daily – and good news, these taste really good!

Second: exercise consistently.

Third: enjoy sunshine every day.

Chewable supplements taken twice daily will more rapidly dissolve and assimilate into the body. They should be 500 milligrams each; the body cannot absorb more than 500 milligrams at a time. The best supplements are calcium citrate, calcium carbonate and calcium lactate. Next, studies show that exercisers better assimilate calcium into the body than sedentary individuals. Even though US Astronauts take calcium supplements in orbit, they return to Earth calcium deficient; NASA believes lack of physical activity prevents their bodies from assimilating the calcium. Finally, get some sunshine. Twenty minutes a day of direct or indirect sunlight will give the body plenty of natural vitamin D, the “sunshine vitamin”, which is necessary for calcium assimilation.

Doing these three things will make you feel great today and will contribute to healthier living down the road. Osteoporosis is an epidemic in this country and is directly attributed to calcium deficiency. We all know that when an elderly person falls and breaks a hip death is imminent. Osteoporosis is nearly always the reason why hipbones break when older people fall. In the case of osteoporosis there is nothing the body can do to defend itself from the loss of calcium associated with aging. Supplementation is necessary throughout adulthood to prevent chronic loss of calcium. You have gone to the trouble to avoid an obesity related death: now you can do these three easy things to help your body avoid osteoporosis in old age. You deserve the gift of strong bones and healthy electrolyte process: give yourself some calcium everyday!

Mini Muffins- OCCASIONAL Indulgence

As a general rule, WLS patients should avoid baked goods for several reasons: ingredients that may cause dumping (sugar, wheat), lack of nutritional value, and the “soft foods phenomena” or foods that dissolve to quickly in the pouch and pass allowing too much consumption. And really, if we are truthful, excessive consumption of baked goods caused, in part, our obesity.

That said, I confess to enjoying a baked treat now and again. Here’s a little portion control trick I’ve learned: Mini Muffins. For about $10 you can get a 24-cup mini muffin tin and bake your favorite recipe. Mini Muffins freeze well, and one muffin is taste satisfying portion control. The argument could be made- just cut a regular muffin in half. I’m not to good at cutting it in half and then only eating one half. One mini muffin feels like a whole treat. I know, it’s mind games, but winning those is half the battle against obesity.

I don’t recommend any baked goods for patients in the phase of rapid weight loss. But for maintainers this is an acceptable occasional indulgence. Check out the recipe section for a few of my favorite tiny treats.

I've stopped losing weight. Now what?

Ask Kaye: Why has my weight loss stopped when I still have weight to lose?

This question typically comes up when a patient has achieved about 60 percent of their targeted weight loss. Occasionally at this point, usually nine to twelve months post-op, a patient’s weight loss may stop, and perhaps even a few pounds will creep back.

If you are asking this question then it is imperative you take some very private time and be brutally honest with yourself. Are you following the four rules; eating protein, drinking water, exercising and not snacking? Review the rules to help pinpoint a defeating behavior. Chances are you will be able to identify the behavior that may be the cause of your weight loss plateau.

One woman I know said she hit a plateau when she reached 205 pounds (down 95 pounds). She told me she had dieted successfully before, but had never been able to break the 200-pound barrier. But as she did some critical self-searching, she learned she was derailing her efforts by snacking throughout the day. After her hard cooked egg for breakfast she was eating as many as six full graham crackers mid-morning, her protein for lunch, a bag of air-popped popcorn in the afternoon, a piece of toast when she got home from work, dinner, then a late night snack of sugar free frozen yogurt. When she was brutally honest with herself, she realized she was afraid of succeeding and reaching her goal weight of 150 pounds, but she was also afraid of not reaching that goal! She was allowing fearful emotions to control her eating behavior.

If you find yourself in a similar situation, please disconcertingly evaluate your behavior. If you identify behaviors that could be derailing your weight loss then use some of that self-discipline you have already proven so powerful and go back to the basics. You still have your tiny tummy; use it as the tool it is intended to be to control and limit your caloric intake. Try this for a week – I bet you break away from the plateau and begin losing again.

I am happy to report that this woman conquered her emotional eating and has maintained a healthy 145 pounds for over two years!

If your weight loss remains stalled after an honest self-evaluation and a return to stellar behavior then perhaps its time to re-evaluate your goal weight. Maybe your body has reached an appropriate weight. If however, you have a long way to go before reaching your goal weight, and you have taken the steps described above yet still experience a plateau, then it is appropriate to call your bariatric professional for guidance.

Grit Determination

Last week I posted about a woman going public in her online diet community with her decision for gastric bypass surgery. She received a great deal of feedback, some positive, much negative and even hostile.

I was a bit taken back by the arrogance of some respondents: that if Lisa simply had the willpower she could lose the weight. Lisa has 170lbs to lose. In the last two months she has lost 7 pounds and a poster told her that was wonderful progress – she should just keep doing what she’s doing and lose the remaining 170 lbs. It would take Lisa, losing 3.5 lbs/month, 48 months to lose her weight. That is without setbacks or life’s little disruptions. That’s 48 months of maintaining a rigid diet/exercise program while seeing little progress. Few people can accomplish that. Take a look around, there are a lot of obese people struggling just to get by, yearning to be in any body besides their own fat one.

In the same forum another poster had the nerve to write Eat Less: Exercise More. Really? Thanks for the help with the math.

Another threw in the cheesy slogan: Grit Determination + No Excuses = Goals Reached and Dreams Becoming Reality.


Guess what folks? Catchy phrases and simple math don’t cut it when a person is morbidly obese.

I do not personally know Lisa, nor do I know her state of self-esteem.

I can tell you with heartfelt sincerity that when I had 150 pounds to lose I was in such a spiral of despair and hopelessness that nothing short of surgery worked for me. My acts of self-sabotage and self-destruction derailed every conventional attempt to lose weight. I did not have the self-esteem or courage to muster any grit determination. I was on the train to hell and getting there by way of Obesity.

I needed help.

Surgery opened a window for me: for once in my fat life I was succeeding at weight loss. My weight came off and I was empowered by the success of it. I sought fitness as a way of life, not evil torture. I embraced the art of cooking healthy balanced meals. I started taking care of myself.

AND I STARTED LOVING MYSELF.

Surgery and the occasional resulting discomforts is a small price to pay for self love and self acceptance, not to mention health and wellness.

Without weight loss surgery I can only shut my eyes in horror at the sad life I may have had. Low self-esteem and poor health never equal grit determination.

Best of luck Lisa; I am confident you will not regret your decision. The road is not easy, but neither is the alternative path.

Dr. Katz on WLS

You probably recognize the name Dr. David Katz, Oprah's diet doctor and author of The Way to Eat: A Six-Step Plan to Lifelong Weight Control. He is also an expert advisor for Men's Health Magazine. In the May 2005 issue on shelves now he responded to the question "What's Next in weight-loss surgery?" Here's what he had to say:

Gastric bypass is the chief option for the foreseeable future. It is increasingly done as a minimally invasive laparoscopic operation and may soon become an outpatient procedure. We'll probably see it combined with drug or hormone therapy in the near future. But it's better to prevent obesity in the first place - going under the knife is a last resort.

I'm a fan of Dr. Katz and refer to The Way to Eat often as a sound and healthy approach to living healthy and well after gastric bypass. He's the first medical professional (outside of the bariatric community) who has not made me feel inferior because I was obese - he explains the reason so many of us are/were obese and then lays a plan to sensibly control our weight.

An editorial review on Amazon:

From Publishers Weekly
Katz, a professor at Yale University School of Medicine and director of Yale's nutrition center, offers a comprehensive overview of food and diets. The book begins with a guide to nutritional basics and what people need to eat vs. what they may want to eat. Katz debunks common myths and offers specific suggestions such as how to eat less salt, what percentage of different foods should be consumed daily, how to limit foods, etc. The book contends that people can train themselves to eat certain foods and not eat other foods by eliminating less healthy choices. For example, by knowing something contains both excessive fat and salt, people can plan for a healthier substitute. Much of the book offers prescriptive steps designed to help people make these smarter food choices. The advice, while not completely original, is still worthwhile. For example, in a section on the right way to snack, Katz says, "For snacking to be beneficial, the snacks themselves must be well chosen, and used in substitution for, rather than in addition to, other items in the diet.... Good snacking should have a certain rhythm, with certain types of snacks eaten at certain times of day." While not offering a specific diet plan, the book provides practical tips, along with persuasive reasons, for changing eating habits. This title is a solid addition to the nutrition and diet shelves.
Copyright 2002 Reed Business Information, Inc.

New Recipe Section

Dear Readers:

By popular demand I'm introducing a recipe section for Living After WLS! All recipes will be geared to our very specific health and nutrition needs focusing on protein and fresh ingredients, not to mention ease of preparation so we can get out of the kitchen a LIVE after WLS. Click on the link to the left and see what's cooking.

Best wishes,
Kaye

Eating Well

I don’t know what my family ate in the months immediately following my surgery. I’m sure they ate something, they seemed to be healthy and well showing no signs of malnutrition or starvation. Whatever it was that they ate, they planned and prepared it on their own – I was too distracted to be of any help. It’s not that I didn’t care about them or their well being. But the immediate days and months after surgery are overwhelming. My single task was to take care of myself, heal my body, celebrate the weight loss, face the emotional issues and do the best I could taking each day at a time. It was an around the clock assignment: the most challenging task I have ever undertaken.

This was a time of great fear and realization for me as I started to comprehend just how dramatically weight loss surgery changed my lifestyle. I was a devout bread and pasta eater before; not after. A meat loving steak eater, not anymore. A skilled baker with a repertoire of cookies envied by Mrs. Fields, but never again. Eating breads and pasta, steaks and sweets was no longer a part of my life. It had been unequivocally excised from me without reprieve. All these beloved foods were history. Gone. Never again. No going back. Weight loss surgery is for life.

For the first few months I ate four foods: hard cooked eggs, tuna, shrimp and sugar-free gelatin. At first I tried mixing my morning egg with commercial mayonnaise to kill the taste of the egg, but that made me nauseous. I learned to eat the egg plain. The egg sustained me until lunch. Then slowly and deliberately I ate two ounces of canned tuna mixed with a little relish and mayo. Yum-yum. Then for dinner, a real extravaganza, six peeled and boiled shrimp. I’d have a spoonful of sugar-free gelatin as a special treat. That was all. That’s what I ate. I didn’t feel hungry and I was indifferent to eating.

I, the self-made gastronome, had lost her taste for food.

One reason for eating just these four things was a loss of appetite – I just wasn’t hungry for anything. Who would have thought that could be possible? The mention or sight of many foods made me sick. Can you imagine watching the late night television advertisement for a burger and getting ill at the site of the greasy drippy mess of heavenly fast food? Retching ill at the site of the very food I thought before I couldn’t live without. Before surgery an advertisement could be so powerful that I, wearing my super-sized sweats, would have loaded in the car and gone for that burger in the darkness of night. I was known to wolf it down on the drive home. Now just the sight of it on television was making me sick!

Worse than seeing food was smelling it – I couldn’t stand the smell of most foods cooking. Raw meat – ugh! Cookies baking – disgusting! Coffee brewing – putrid! It was as if the smells of food were exaggerated beyond tolerance putting me in a state of nausea at the first whiff. Other patients say this happened to them as well: food smells made them gag.

The other reason for my limited selection of high protein foods was fear. I was afraid to try anything except my safe foods. I was afraid of dumping, afraid of vomiting, afraid of breaking my stomach pouch, afraid of gaining weight. I didn’t know what to do with this new tool of mine, but I was certain I didn’t want to irreparably harm it because I was losing weight swiftly without hunger or dieting stress. The tool was working.

Time passed and I became acquainted with my bariatric infant tummy. With cautious hesitation I introduced new foods to my infant tummy: some deli turkey, bits of braised chicken. Cottage cheese, then hard cheeses like cheddar and mozzarella. And, glory be, I continued to lose weight and my energy soared.

It seems for some time we had two dinner menus at our house – the bariatric menu and the normal menu. The bariatric menu was little portions of lean protein. The normal menu included some protein sided with pasta, potatoes or bread, a salad, some vegetables and possibly a sweet treat for dessert. When I did return to the stove to resume the responsibilities of family chef I accepted that I would fix dual meals. And this I did for some time. It was a hassle, a lot of work, and I started to resent cooking things I could not eat. And I resented my family for “flaunting” normal tummies in my face.

But then the awakening moment arrived and I asked myself, isn’t this a golden opportunity for all of us to learn to eat more healthy, prepare better foods and start to practice some portion control? Can’t we all benefit from the things I’m learning about health and wellness by way of bariatric surgery? Is there a way to create one meal for the family that satisfies all of our health, nutrition and nurturing needs?

Eating well isn’t a diet. It’s a lifestyle choice. It should never be a choice of deprivation – it is the deliberate selection and preparation of food that leaves us nutritionally fit and emotionally fulfilled. Eating is one of life’s greatest pleasures: who knows this better than the bariatric patient? We lived to eat and that passion resulted in morbid obesity. Now we must eat to live. It is an astounding turn of events. Every bite, every flavor, every taste must be the best it possibly can be to satisfy and nurture contentment. Having bariatric surgery does not mean you’ve lost the right to have variety, flavor, and texture in your diet. It does not nullify your need to be emotionally fulfilled by the ceremony and tradition of eating well. It simply means redefining your lifestyle so your diet meets your nutritional and emotional needs – and respects the science of your medically altered digestive system. Bariatrics is truly a second chance to make good on feeding your body well. And for those patients with families, it is the golden opportunity to learn together that eating well is a pleasure with tangible benefits. And perhaps, you may save someone you love from needing bariatric surgery or worse, an early death from an obesity related illness.

I was unwilling to eat eggs, tuna, shrimp and jell-o for the rest of my life, I love food too much. I fully understood that not only couldn’t I return to my old eating habits – I shouldn’t return to them – they were killing me. I wanted a healthy, normal way of eating that met my bariatric needs, but also provided a healthy well-balanced menu for my family so they too could be nutritionally well. This was my chance to redefine our eating lifestyle.

Defending WLS: Never Easy

Dear Readers:

We’ve talked before about the struggle to defend our WLS and be accepted by the “normal” people. This week an example of prejudice played out in a community of people struggling with weight issues: and online diet/weight loss community. A beautiful and courageous member of this community came forward with her plans for WLS. With her permission I’m posting her message and some of the feedback she received: much of it kind, compassionate and supportive, but also some arrogant judgmental and simply rude feedback. Take a look, this is a long post but there is much to learn:

Lisa’s Post: Having Gastric Bypass Surgery

After a lot of research and a very informative meeting with a bariatric surgeron, I have decided to pursue gastric bypass surgery. I applied to see this doctor over a year ago and I just got an appointment last week! So, even though I've been reading and researching for a while - I am still in the beginning stages.

The surgeon gave me a statistic that really got to me. She said that morbidly obese people (100 lbs over their ideal body weight and/or a BMI of 40 or higher) only have a 3-5% chance of losing weight by diet and exercise alone...and KEEPING it off for more than 5 years. That's not a very encouraging statistic. :-(

It makes sense considering I've been doing nothing but "dieting" since I was in junior high and I'm currently at the heaviest weight in my life.

With this surgery, I will have a 95% chance of keeping the weight off for the rest of my life. That's certainly more encouraging. But, don't forget about the risks!

Personally, I'm in a good position because the stats are on my side. I'm young, I don't have any other serious medical problems and I'm a woman. Women tend to fare slightly better than men do in gastric bypass. So, I can't help but feel that the benefits of this surgery far outweigh the risks.

I've been dealing with some negative people however. People who say, "why can't you just lose the weight on your own?" or "you're too young for that!". Well, those are actually the EXACT reasons why I'm having the surgery. I haven't been able to lose weight on my own and I am young enough to endure an operation to PREVENT all those weight related health problems. Let's face it, if I could lose the weight on my own...would I be in this position? It's not like I haven't tried for years.

Anyway, I have a re-visit appointment on May 18th...when we should be able to put me on the surgery schedule. In the meantime, I have to get some bloodwork done and get a psychological evaluation. I'm not worried about either of those, and neither is my surgeon. It's just something everybody has to get done.

I'm excited and nervous. It's going to be quite a challenge, but I'm up for it. Heck, in the long run...I can't afford not to.

Wish me luck! :-)

This is some of the feedback Lisa received:

-- It sounds like you've done your homework on this! If the traditional methods aren't working, and you have your physician's support, then all the best to you. Good luck

-- I had gastric by-pass on 3/13/03. I lost 190 lbs. I love to exercise now and still watch my diet. I am in the second phase of the process. I had a tummy tuck and skin removed from my arms in Dec. of 04. I would do it all again.

-- I guess I'm one of the "negative people" you talk about; what is it you've "tried for years"? Eating healthy food in reasonable portions and exercising consistently? Since you applied to the doctor over a year ago, how proactive have you been in making permanent changes to your lifestyle? Did you meet with your general practitioner and ask for assistance in a healthy eating program or a recommendation to a dietician? Did you start any kind of exercise program?

-- Have surgery if you want, it's your decision and yours alone regardless of what us "negative people" think.

-- I'm not sure how I feel about this. I know about 6 women who have had this done ( all about 10 to 15 yrs. ago) and every one of them have gained back what they lost and more. My best friend had it done before her wedding and today she weighs more than ever. I understand what you're saying when you say you've tried everything else and failed - I did the same thing, but, my Dr. wouldn't talk to me about surgery until I could document everything else had failed, that's when I started, but, first I had to make up my mind that I wanted to lose for ME, not my HB, not my kids, not everyone who ever passed judgment on me, ME. I've done pretty darn good with this and I'm proud of my hard work, granted there are times when I want to give up and have said "what's the use?"

-- I'm not trying to push anyone to see this side, I am just trying to open the door a little, so you can see the other side. I have held many people at this site in the highest regard for many years based on their will-power and success. I commend people who find their "it" and are successful, but sometimes (certainly not always!), maybe this really is the best option.

-- This is not a solution to weight loss; it is a tool. Those who view it that way are ultimately the ones who are successful. (signed Snick)

Lisa responded:

Snick, thank you for making that point - the surgery is a TOOL. I think a lot of people (even here on this board) have the misconception that surgery means you don't still have to diet and exercise. Believe me, I'm well aware of this.

I guess my point is, if my weight is hurting my health and life expectancy, the risk of surgery is worth it. The struggle to keep it off will still be there, of course! Anyone who thinks WLS will "cure" their weight problem is foolish. That's not what I'm saying at all!!! I know I will always have to battle with food, but I'd rather battle food at a healthy weight.

It's a controversial subject, but Snick is right. People who look at WLS as the ultimate CURE will never be successful in the long run. It is a TOOL, one I plan on taking very seriously.

Also, I know personally WLS patients from my support group in town that have had bypass of many variations (r-n-y, agb, etc...). I have learned from them that there will always be ups and downs. That's life! But every single one of them has kept the weight off (maybe a fluctuation of 5-10 pounds here and there), one woman for almost 8 years now.

I added my 2-cents

Dear website members:

First, I must commend you for being a wonderful, supportive and thoughtful community. Your posts in response to Lisa’s announcement have been thoughtful, compassionate and fair. Secondly, thanks for allowing a non-subscriber to post here.

Life after WLS is never easy. There are daily challenges. Some 6 years after my surgery I struggle with my weight; only now it is 10-15 lbs, not 50-80 pound fluctuations like before surgery. I get sick at least once a week: dumping or vomiting. I eat a boring menu of the same foods day after day after day after day.

However, I am fit and exercise 5 or more times a week. I sleep without complications of apnea. I do not suffer blood-sugar swings. My blood pressure, heart rate and insulin levels are stable. My BMI is textbook perfect. I feel better about myself than ever in my life.

Do I question myself, “Maybe I could have done it (lost all that weight) without surgery.” Absolutely – now it’s difficult to remember all the plans and programs I tried and failed. Do I regret it? Only when I get sick or can’t eat something that I know will make me sick. Would I recommend it to others? Only if they understand the whole story: that for good or bad, being a WLS patient will impact every day of the rest of your life.

To Lisa I wish you the best of luck and make myself available to offer encouragement or answer questions. I must say, I’m jealous of you – you are one step ahead of the game by having a supportive community online. Part of WLS success is an on-going supportive community.

Thanks and best wishes,
Kaye Bailey

To that someone immediately replied:

Wow, Kaye...getting sick once a week and eating the same foods day in and day out for 6 years and conceivably for the rest of your life? And you think it was worth it...wow, more power to you, you're a better person than I am, I'd consider that a worse death sentence than obesity.

Snick responded beautifully

testing123 said:
"I'd consider that a worse death sentence than obesity."

I respectfully beg to differ. Living in a family of people who love to be active and never participating because it is just too hard... always lagging behind everyone else because you simply cannot keep up... having your child hug you and not be able to give it his all because he is unable to reach his arms around your body... getting sick once a week maybe doesn't sound so bad.

I realize that due to the nature of this site, people have very strong opinions on this subject. I was once one of them! All I ask is that you all remember that there are two sides to any debate. Yes, there are bad surgeries. Yes, some people are successful losing weight through diet and exercise alone. There are also people who are (and this is scientifically proven!) genetically predisposed to weight problems - if all these folks ever do is work out and count calories, they may be fine, but that is not realistic. There are people who have this surgery and embrace every single inconvenience that comes along with it, just because it means they can ride a bike alongside their spouse on a Sunday afternoon.

I commend each and every person here who is working to make a difference in his or life - regardless of the method. The fact remains that everyone is striving for the same goal - to be able to maintain a healthy weight and live an active and enjoyable life.

Ask Kaye: I've blocked my stomach outlet

Is it possible to block the outlet from the stomach pouch to the intestine?

In a gastric bypass the connection between he stomach pouch and the small intestine is called the gastrojejunal anastomosis. It is roughly the diameter of a ladies little finger. This small opening slows food from leaving the stomach too quickly prolonging the satiated feeling. In extremely rare cases scar tissue may form at this connection resulting in a blocked outlet. Treatment to correct this is the insertion, endoscopically, of a special balloon. The balloon is inflated and expands the anastomosis returning it to the correct size.

If you have symptoms of blockage that is not the result of overfilling the stomach pouch seek the advice of your bariatric professional. The symptoms include chronic vomiting and food intolerance.

More commonly, a blockage of the anastomosis is caused by poorly chewed foods. Patients must be diligent in avoiding foods that may cause a blockage. This includes large pills, some types or too much bread, overcooked or chewy meats, starches and nuts. If a pill becomes lodged in the stomach outlet it will usually dissolve after a few hours. If food becomes impacted it will be painful. Food will eventually digest and dislodge itself in most cases. In extreme cases a patient may need to have an endoscopy to dislodge the offending food. Patients in the habit of chewing their food will rarely encounter a blockage or plugged outlet.

I caused a blockage with honey-roasted peanuts when I was six months post-op. It was the most painful experience in my bariatric life. And it happened before I realized the damage I was causing! While grocery shopping I purchased a 16-ounce can of honey-roasted peanuts, supposedly for my husband. Feeling particularly chipper, I put some great tunes on the stereo, opened the nuts and set them beside me and happily drove home. All the way I ate peanuts. Recklessly. Mindlessly. I ate just like I used to when I was obese, throwing another handful in my mouth before I’d finished the mouthful I was working on. Apparently it slipped my mind that I was a new person with improved eating habits and system to keep me honest. Literally sixteen ounces of peanuts were packed into my tinny tummy in 30 minutes.

I had enough time to put away the groceries before the pain began. For three days I was curled in the fetal position with a painful tight pressure in my chest. Keep in mind that the tiny tummy after bariatric surgery is high in the chest, right behind the sternum, not in the abdomen where we usually think it is. On the third day of suffering I called my surgeon and told him I had broken my pouch. He kindly recommended a dose of Pepto Bismol and that provided immediate relief. My tiny tummy was sore for another week and my food tolerance was very low for ten days. Fortunately I didn’t sustain permanent damage to my tiny tummy.

Why did I wait so long before calling the doctor?
Simple answer.
I was ashamed and embarrassed.

I felt I had let my surgeon – my healer - down by doing something so contrary to the rules he had given me to optimize my new system. I didn’t want to admit to him that I had lost control. Second, why didn’t my body warn me of the violation sooner? My body did warn me, but I ignored the feeling of fullness. By the time I acknowledged my body’s satiated feeling it was too late: my stomach pouch was impacted.

To this day when I mention “the peanut episode” my husband and I bow our heads in silent remembrance of this most painful event. I could have avoided this incident if I had respected my body and honored the bariatric rules. I was snacking. I wasn’t chewing my food. I ate too much. Since “the peanut episode” I have enjoyed nuts occasionally. I measure a scant one-tablespoon and include them with a meal. I chew thoroughly before swallowing. I no longer aimlessly eat in my car. Never. From this episode I learned the courtesy: I will respect my tiny tummy by not eating mindlessly.

Please respect your tiny tummy and honor the rules. It is entirely within your control to avoid this type of incident. If you do have a lapse of judgment and cause a pouch blockage give it a few hours and a dose of Pepto-Bismol to provide relief. If that doesn’t work then call your surgeon or primary care physician and follow their instructions.

Aquatic Exercise

Next to walking, aquatic exercise is the second favorite cardio workout most often cited by weight loss patients. Rapidly gaining favor in this age of “kinder, gentler exercise” water based exercise, when done correctly, provides a powerful workout that rivals many conventional fitness programs. In the water the body works against the water’s resistance and burns more calories. Aquatic exercise makes fitness fun, particularly for people with back and joint problems who avoid conventional exercise because of the pain.

Working out in the water is not only fun, it is hard work, say. The water has a 12-fold resistance over what’s in the air, yet at the same time cushions bones and joints from the impact of conventional exercise.

Some bariatric patients in the early post-op weeks and months may feel body-conscious about plunging into a pool of water with others for an aquatic fitness class. This is understandable – I certainly didn’t want to join a team of Olympic swimmers when my thighs were bigger than their little fish-like bodies! But the fitness industry realizes this too. Classes are now geared for different fitness levels. One class, called Deep-Water Walking, is a low impact class for those with arthritis or other joint problems. This class offers an excellent cardiovascular workout. Find a class in which you will be comfortable and you will likely return and advance your successful weight loss journey.

Aquatic exercisers are advised to participate in classes with certified trained instructors. Programs can be found at health clubs, YMCA’s and even some physical therapy providers. As with any exercise, be careful to advance into the program gradually and avoid injury. Drink adequate water before and after exercise to stay hydrated.

A word about insurance

Dear Readers -

I've received some questions about getting insurance providers to pay for gastric bypass. Since the focus of this site is on living after surgery, I respectfully refer you to ObesityHelp which is a comprehensive resource for pre-surgical patients. The site even has an Insurer Reportcard Database.

Thanks for the questions, and please, stop by often as we share this journey Living After WLS!

Best wishes,
Kaye

Physician's Guide to Pharmalogical (Drug) and Surgery for Obesity Patients

Katherine Prouty at Low Carb Freedom has presented this update from the Annals of Internal Medicine, take a look:

The Annals of Internal Medicine has come out with new guidelines, or, rather, codified guidelines, for the treatment of obesity. Diet and Exercise is the number one method, but it isn't covered extensively, at least in this paper. There are five recommendations:

Recommendation 1: Clinicians should counsel all obese patients (defined as those with a BMI 30 kg/m 2 ) on lifestyle and behavioral modifications such as appropriate diet and exercise, and the patient's goals for weight loss should be individually determined (these goals may encompass not only weight loss but also other parameters, such as decreasing blood pressure or fasting blood glucose levels).

Recommendation 2: Pharmacologic therapy can be offered to obese patients who have failed to achieve their weight loss goals through diet and exercise alone. However, there needs to be a doctor–patient discussion of the drugs' side effects, the lack of long-term safety data, and the temporary nature of the weight loss achieved with medications before initiating therapy.

Recommendation 3: For obese patients who choose to use adjunctive drug therapy, options include sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. The choice of agent will depend on the side effects profile of each drug and the patient's tolerance of those side effects.

Recommendation 4: Surgery should be considered as a treatment option for patients with a BMI of 40 kg/m 2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. A doctor–patient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gall bladder disease, and malabsorption.

Recommendation 5: Patients should be referred to high-volume centers with surgeons experienced in bariatric surgery.

Basically, there is a loop that always leads back to diet and exercise as you go down the choices. If, step 1, diet and exercise don't work, then, in step 2, offer weight loss drug therapy, but tell everyone the side effects and temporary nature of the weight loss. Step 3 talks about specific weight loss drugs.

If weight loss drugs don't work, then move to step 4, and offer them weight loss surgery, with all the precautions and potential problems. If weight loss surgery is the solution, then, in step 5, help them choose a high volume surgery center.

Seems like common sense. Further in the recommendation is this paragraph:

Lifestyle modification through diet and exercise should always be recommended for all obese patients. In addition, patients need to be continuously educated regarding diet and exercise, and it should be clear that after a surgical procedure patients cannot resume their previous eating habits. There is no evidence at present to answer the question of whether one procedure is better than another. In addition, weight loss through surgery has not been shown to reduce cardiovascular morbidity or mortality. (emphasis mine)

Basically, after weight loss surgery, you have to go on a low carb diet. So, for those who are thinking about weight loss surgery, why not try it out on a voluntary basis first before going through the surgery.

Re-Inventing Myself

Weight Loss Surgery was just part of the transformation I affected to become a healthier, happier person.

I wore braces to correct my crooked teeth and give me a Hollywood smile. I swapped my glasses for contact lenses and a ponytail scrunchy for a flattering haircut and highlights. I had a little cosmetic work done to put my boobs back where they belonged. I traded my sweats for skirts and tiny tops. Flat tennis shoes became the dog’s chew toys because I started wearing all those sexy sassy heels I used to only dream about.

In short, I reinvented myself into a lady.

I realized that as a chubby gal I was compelled to talk louder, be more assertive, and stand more aggressively. But as a re-invented svelte lady I became soft spoken and demur. I learned that charm and graciousness were not has-been attributes of the pre-feminism movement, but are good behaviors that a lady aspires to perfect. I became and kinder, happier person. I became a lady.

But still, a private lady, just without that comfy protective barrier of fat. Little did I know that my very wonderful, hard-earned, personal metamorphosis would become public fodder? The private girl was now very much in the spotlight in the tiny community we call the workplace. People I barely knew approached me wanting to know in legal measure exactly how much weight I had lost. Others, asking oh-so-sincerely, “How did you lose -all that weight so fast?” One day I was taken aback when a grossly overweight man actually told me I had lost too much weight. I told him, as a lady would, that I appreciated his concern, but I was at a healthy weight for my height and body type. But in my mind the sarcastic Chubby told him to worry about the number on his own damn scale.

Then there were the well-meaning life-long dieters with their sage advice, “Enjoy it while it lasts because nobody can keep it off forever.” Or how about this for encouraging feedback, “do you really think you should buy all those new clothes when you don’t know if you’ll be able to keep the weight off?” Wow! I had no idea my weight loss would matter to so many people, and often, my feelings were deeply hurt.

On one such day, with tears falling, I confided in a friend who simply said, “You losing weight is about you. It is about no one else but you.” At that moment it became very clear to me exactly how right she was. For the first time in my life I had successfully gained control of my body to become healthy and fit. I had done it for me, not anyone but me.

Over time I realized that negative feedback is some people’s method for dealing with things at which they feel they’ve failed. By belittling someone who has succeeded they lessen their sense of failure.

But then I learned one more extremely important thing about being a lady. I learned to hear all the good things people were saying, and to suck up those compliments like a sponge and fill my soul with them. Turns out there were more people cheerleading for me than there were killjoys. I started believing that I was a good and worthy person, not just on the outside, but on the inside too. You see, as a Little Fat Girl I never learned to hear, accept and relish compliments. There was too much counter information telling me I was unworthy of any compliment delivered.

Over time, with great courage I said goodbye to Little Fat Girl and all her defeating behaviors and I became a lady, inside and out.

During this time of weight loss you are at a magical moment in your life where you can reinvent yourself into anything you want to become! Play around and get to know the new you, I bet it turns out you just might really like yourself.

The Egg: Perfect Bariatric Food

Considering the protein needs of a bariatric patient, the egg may well be the perfect food.

An egg contains the highest quality of food protein known, each Grade A large egg contains 6 grams of protein. It is so nearly perfect that egg protein is the standard by which other protein is measured. The egg is second, only to mother’s milk, for human nutrition. On a scale of 100% efficiency the egg scores 93.7. Beef scores 74.3% and fish 76%.

If that isn’t enough to convince you the egg is the perfect bariatric food, consider this: an egg measures one ounce and is approximately the size of your new tiny tummy. How’s that for a perfect protein fit?

For many years eggs have been the forbidden food of the health conscious – fear of cholesterol content staved off many would-be scramblers who feared heart disease. But new research shows that dietary cholesterol intake does not necessarily affect blood cholesterol levels. People with a low fat diet can eat one or two eggs a day without causing a measurable change in their blood cholesterol level. By having weight loss surgery you have forced upon yourself a low fat diet which should include eggs. Your cholesterol levels will be monitored in the annual blood screening required by your bariatric professional. Speak with your center’s nutritionist for specific guidelines.

A large egg contains 4.5 grams of fat (1.5 of which is saturated fat) and 213 milligrams of cholesterol and it supplies 70 calories. By nature an egg is protein rich, low in sodium and contains vitamins and minerals. Eggs contain biotin, a B vitamin; calcium and cephalin. Egg yolk is one of the few foods that contain vitamin D, the sunshine vitamin. In addition, eggs are inexpensive, delicious and easy to prepare. I have enjoyed a hard-cooked egg almost every single day for breakfast since having surgery. By now I’m not sure if this is a habit or an addiction, but I just don’t feel right without my morning egg.

Subscriber note

Dear Readers:

My Bloglet subscription link has been down for a couple of days. If you tried to subscribe and received an error message, please try again. It should be working now.

Sorry for the inconvenience,
Kaye

Back to Basics: Protein

Yesterday I had a really sloppy eating day - a little nibble of this, a taste of that - - ALL DAY LONG!!! The worst behavior a bariatric patient can practice. Guilty! So, this morning I reviewed the Protein First rule.

Today I resolve to do better!

Here's the nitty-gritty of Protein First!
Best Wishes,
Kaye

Rule #1: Protein First: 50% of every meal

The first rule for living after weight loss surgery is Protein First – that means eating protein at all three daily meals, and protein must be 50 percent of food intake. Animal products are the most nutrient rich source of protein and include fish, poultry and meat. Dairy, including eggs, is another excellent source of animal protein. Nuts and legumes are also good sources of protein, but sometimes difficult for the bariatric patient to consume.

Protein is essential in the weeks immediately following surgery because it facilitates the body’s healing process. Surgery invades and injures to the body. Muscles and tissues are damaged by surgery, even the minimally invasive laparoscopic surgeries. When body tissues are damaged the body responds by increasing protein production from the dietary amino acids found in animal protein. To do so, the body requires an abundant supply of amino acids. One of the first foods allowed a post-operative patient is gelatin: it contains protein from the bone, skin and connective tissues of animals. Gelatin is a cool, smooth healing tonic for the injured body. Studies show that patients who eat adequate protein will heal better and faster than patients who are protein deficient.

Science is proving that a protein rich diet will prompt weight loss and increase energy. The body contains over fifty-thousand different active proteins all made out of the same building blocks: amino acids. Amino acids are made of carbon, hydrogen, oxygen and nitrogen as well as sulfur, phosphorus and iron. Many diseases – including obesity – indicate an amino acid deficiency.

In spite of the by-passed nature of the bariatric system, patients will metabolize proteins normally. Amino acids from food are not broken down in digestion or the small bowel. Instead they are absorbed directly through the bowel wall into the bloodstream. A diet rich in lean protein is the most efficient way for patients to heal their body, boost energy and avoid protein deficiency. A diet of lean protein guarantees weight loss.

The distinction must be made between high fat proteins and lean proteins. A bariatric system will not tolerate high fat proteins such as bacon, fatty beef or sausage products or greasy fried chicken skin. In fact, many patients report repulsion or nausea when presented high fat protein options. Meat with fat and poultry with skin contain a great deal of saturated fat and cholesterol, both of which increase the risks of cardiovascular disease. Milk and cheese are also significant sources of saturated fat. For many patients, intolerance of milk products prevents them from eating too much saturated dairy fat.

Before surgery, like most Americans, we ate too much high fat protein. In fact, protein deficiency is very rare in this country. Fortunately, there is an abundance of low-fat, high protein options. The advice varies from doctor to doctor, but generally patients should try to eat 20 to 50 grams of lean protein each day after their weight loss has stabilized. In the early weeks and months following surgery the protein intake will be much less, sometimes only 15 to 20 grams a day. See the specific guidelines from your surgical center to determine a timeline for protein intake.

Top 10 Bariatric Proteins:

1. Lean Beef with 10 grams/ounce
2. Turkey Breast with 8.6 grams/ounce
3. Chicken (any part) with 8.3 grams/ounce
4. Pork - lean with 8 grams/ounce
5. Tuna - canned with 7 grams/ounce
6. Salmon - fresh with 7 grams/ounce
7. Shrimp - with 6 grams/ounce
8. Eggs 1-soft cooked - 6 grams
9. Cottage cheese with 4.66 grams/ounce
10. Black Beans 1/2 cup - 7 grams/ounce
    

Body Dysmorphia

Yesterday we were discussing the Stranger in the Mirror. Continuing on those lines, let's talk about body dysmorphia.

Maybe you’ve heard about body dysmorphia – it’s a mental image many victims of anorexia nervosa have that tells them they look fat, even when they are emaciated. Bariatric patients can suffer from body dysmorphia as well. When we were morbidly obese our emotional coping mechanisms kicked in and many of us were able to convince ourselves we really weren’t that big. It is emotionally kinder to avoid body criticism, the whole issue seems hopeless. In fact, many morbidly obese patients will say they see themselves normal sized. That is until a rude moment reminds them they are not normal sized: a skinny chair, a turnstile, a bathroom stall, a flight of stairs, a photograph. This false perception is a subconscious coping strategy to protect us from the brutal truth, the truth about how big morbidly obese really is.

My sister and I were clothes shopping one day with our morbidly obese mother. She tried an outfit and complained to us, “but it makes me look fat.” And gently we told her, “Mom, you are fat.” Intellectually my mother knows she is morbidly obese, but the emotional issues run over reason and she doesn’t see herself fat. She is in serious denial that is preventing her from getting the help she needs – bariatric surgery – to save her life.

After surgery, there is a tendency for the body dysmorphia to reverse. Before surgery we denied how big we were, after surgery we judge ourselves critically – like the anorexic – and fail to see an honest reflection. One woman, down from size 24 to size 10 wrote, “I feel fat daily. I never felt this at 248 pounds – I saw a thinner person in the mirror than I see now. I look at my size 10 jeans and they look like tents. I don’t feel as attractive as I did when I was heavy. I don’t understand it,” she continued, “but I think it has to do with learning to accept yourself fat so you didn’t see all the fat. Now I just have to learn to accept myself as thinner.”

Many patients report hyper-judging their figures after weight loss. It seems the thinner you get the more judgmental of your body you become. To this day, the first thing I see in my reflection in my pudgy tummy – I think it’s enormous. I don’t see long slender legs or a tiny waist or trim arms. I see a Buddha belly. I’ve even apologized for my chubby tummy to others when they compliment my new figure. The apology usually goes, “Yes, but I can’t get rid of this stomach.” I say this while pointing to my "flaw".

That is wrong and brutally unfair to myself. I am working daily to keep this hyper-judgment in check, reminding myself the days of belittlement and self-loathing are over. Now is the time when I love myself.

Patients report universal success when they do one thing in the face of body dysmorphia: dress to impress! Get rid of the flowing camouflage clothes and wear a smart, well fitted outfit. Gentlemen, tuck in your shirts in. Ladies, wear a fitted skirt with a waistband. Small sized “fat clothes” do nothing for body image – dump that style and get something that flatters your new size. Enlist the help of friends you trust to find flattering clothes. Sometimes you have to force yourself to see your body as it is, a great fitting outfit will certainly do the trick.

We will talk more about reinventing our personal style later in this blog.

Have a great day, and Hey! Spend some time loving yourself.

Love,
Kaye

Who is the stranger in the mirror?

The massive weight loss achieved by patients affects the most profound physical and emotional transformation a morbidly obese person will ever experience.

The change is so rapid and so dramatic many patients report mid-way through the phase of rapid weight loss that they do not recognize the person looking back from the mirror. Prior to surgery when I first heard about this phenomena I thought people were being overly dramatic: how could you not know your own reflection and how could you so easily lose the person that you are? It didn’t seem possible.

But it is possible and it does happen. I had never seen my cheekbones, then suddenly, there they were in the mirror. My squinty puffy eyes suddenly became round and wide open. I had a collar bone. I looked pretty – surely this wasn’t the Little Fat Girl looking back at me? More than once I was startled when I’d catch a glimpse of this stranger reflected in shop windows or a random mirror. And others confirmed my suspicion – I was no longer me. People I’d known for years didn’t recognize me. It should have been rewarding, but I became tired of hearing, “I would have never known you if you hadn’t said something – you aren’t even the same person.” I’m sure they meant it as a compliment, but the words I heard in my head were “you were defined by your fat and now your fat is gone and I don’t know who you are.” They didn’t recognize this person and neither did I.

For many, this is the most unsettling period of the weight loss experience. We are torn between who we were and who we are becoming. In the early stages many of us will say I don’t want weight loss surgery to change me. But weight loss surgery does change us. It changes us profoundly. We are treated differently by others, and we treat others differently. We treat ourselves differently. We want to think we are above the superficial, that our body packaging doesn’t matter, but it does.

When I was morbidly obese I was a loud talker and a repeater. I wanted so badly to be acknowledged so I talked louder and repeated myself until someone responded. This I did at work, in business transactions, in interpersonal relationships. I just wanted somebody to validate the Little Fat Girl. After losing weight I found people more attentive to my softer spoken words. Merchants were more likely to help me with store purchases and answer my product questions. At work I was asked for my opinion; I did not have to speak loudly to force my peers to listen. People seemed attracted to me, they wanted to be with me.

If I’m honest with myself, I did not like the person I used to be – the body or the spirit. I was loud, pushy and defensive. While before surgery it was impossible for me to comprehend the physical, mental, emotional and spiritual changes that were to come, there is no doubt that I did view surgery as an opportunity for change, a rebirth if you will. Clearly, I wanted to change physically: to become healthy, fit and attractive. But I also wanted to become someone I liked, someone I wanted to be with.

As I became this person whose company I enjoy I did lose much of the old person, the pushy loud fat lady. It wasn’t a bad loss or one that I mourned, in fact, I don’t recall a defining moment when I became the “new me.” But I do know that in time, the stranger was no longer in the mirror – that person was my friend – someone I liked and I treated her well. The stranger was in old photographs and fleeting memories I did not often recall. One day, looking at our wedding pictures I wondered who that stranger was marrying my husband – could that have been me? I turned the pictures face down on the dresser, I wanted new pictures there instead that portrayed who I’d become.

It isn’t wrong to like the person we become as the result of this profound transformation. It means we are shedding the self-loathing, the poor health, the sadness that dominated our obese life. We won’t forget our former selves, we just won’t stay the same. The great philosophers have said we are the sum of our experience – that everything we have been is who we are now. If this is true, then I was using my collective experience as a fat person to make friends with a thin stranger.

I don’t think I wholly gave up my former self, I recognize much of her in the new me. New me still has strong opinions, but a different way of delivering them. New me still likes to bake bread, she just doesn’t eat it. New me still loves playing ball with the dogs, reading magazines and gardening. New me is still deeply compassionate toward the obese and sheds tears when she sees young girls suffering through adolescence as they battle their own Little Fat Girls. New me is the sum of my experience: and I like her. Isn’t that the most amazing gift this weight loss surgery can give a person?

Are you making friends with the new you?

Fondly,
Kaye

Ask Kaye: Is it possible I've blocked my stomach?

Is it possible to block the outlet from the stomach pouch to the intestine?

In a gastric bypass the connection between he stomach pouch and the small intestine is called the gastrojejunal anastomosis. It is roughly the diameter of a ladies little finger. This small opening slows food from leaving the stomach too quickly prolonging the satiated feeling. In extremely rare cases scar tissue may form at this connection resulting in a blocked outlet. Treatment to correct this is the insertion, endoscopically, of a special balloon. The balloon is inflated and expands the anastomosis returning it to the correct size.

If you have symptoms of blockage that is not the result of overfilling the stomach pouch seek the advice of your bariatric professional. The symptoms include chronic vomiting and food intolerance.

More commonly, a blockage of the anastomosis is caused by poorly chewed foods. Patients must be diligent in avoiding foods that may cause a blockage. This includes large pills, some types or too much bread, overcooked or chewy meats, starches and nuts. If a pill becomes lodged in the stomach outlet it will usually dissolve after a few hours. If food becomes impacted it will be painful. Food will eventually digest and dislodge itself in most cases. In extreme cases a patient may need to have an endoscopy to dislodge the offending food. Patients in the habit of chewing their food will rarely encounter a blockage or plugged outlet.

I caused a blockage with honey-roasted peanuts when I was six months post-op. It was the most painful experience in my bariatric life. And it happened before I realized the damage I was causing! While grocery shopping I purchased a 16-ounce can of honey-roasted peanuts, supposedly for my husband. Feeling particularly chipper, I put some great tunes on the stereo, opened the nuts and set them beside me and happily drove the 30 minutes home. All the way I ate peanuts. Recklessly. Mindlessly. I ate just like I used to when I was obese, throwing another handful in my mouth before I’d finished the mouthful I was working on. Apparently it slipped my mind that I was a new person with improved eating habits and system to keep me honest. Literally sixteen ounces of peanuts were packed into my tinny tummy in 30 minutes.

I had enough time to put away the groceries before the pain began. For three days I was curled in the fetal position with a painful tight pressure in my chest. Keep in mind that the tiny tummy after bariatric surgery is high in the chest, right behind the sternum, not in the abdomen where we usually think it is. On the third day of suffering I called my surgeon and told him I had broken my pouch. He kindly recommended a dose of Pepto Bismol and that provided immediate relief. My tiny tummy was sore for another week and my food tolerance was very low for ten days. Fortunately I didn’t sustain permanent damage to my tiny tummy.

Why did I wait so long before calling the doctor? Simple answer. I was ashamed and embarrassed. I felt I had let my surgeon – my healer - down by doing something so contrary to the rules he had given me to optimize my new system. I didn’t want to admit to him that I had lost control. Second, why didn’t my body warn me of the violation sooner? My body did warn me, but I ignored the feeling of fullness. By the time I acknowledged my body’s satiated feeling it was too late: my stomach pouch was impacted.

To this day when I mention “the peanut episode” my husband and I bow our heads in silent remembrance of this most painful event. I could have avoided this incident if I had respected my body and honored the bariatric rules. I was snacking. I wasn’t chewing my food. I ate too much. Since “the peanut episode” I have enjoyed nuts occasionally. I measure a scant one-tablespoon and include them with a meal. I chew thoroughly before swallowing. I no longer aimlessly eat in my car. Never. From this episode I learned the courtesy: I will respect my tiny tummy by not eating mindlessly.

Please respect your tiny tummy and honor the rules. It is entirely within your control to avoid this type of incident. If you do have a lapse of judgment and cause a pouch blockage give it a few hours and a dose of Pepto-Bismol to provide relief. If that doesn’t work then call your surgeon or primary care physician and follow their instructions.

Our Chubby Children

Dear Readers:

The news tells us every day that we have an obesity crisis in this country, that children are fatter than ever. Today I share with you an article I wrote a few years ago on the painful topic of overweight children. To this day I am still wounded by the pain of growing up fat, and my heart breaks for all of the chubby children out there. No matter how thin and healthy WLS makes me, I don't think I'll ever escape thinking of myself as "Little Fat Girl."

Thanks for joining me today,
Kaye

Our Chubby Children

We know that children are becoming obese at an alarming rate. We know fat kids become fat adults. We know that obesity is the second leading cause of preventable death in this county. We know that obese children will be faced with huge health risks that will compromise their quality of life as adults. We know that obese children are the target of hate and ridicule by other children. We know that fat children are shunned by their peers. And we know it is the parent’s responsibility to make sure their children do not become obese dooming them to lifetime of disease, heartache and suffering.

One of the most painful things about obesity is we seem to get it from our parents and pass it along to our children. I know a woman, Diane, who could not celebrate her bariatric success because she had a teenage daughter who came home from school day after day to hug a giant pillow and cry - her classmates called her “Fatty-Cathy”. Cathy is fat, or as her parents like to call her “stout.” Racked with guilt Diane asked “How in the world can I celebrate my weight loss when my own daughter is suffering? I feel pretty guilty about it. I’m her mother. I have fed her and taught her bad eating habits. I’ve actually written notes to excuse her from physical education classes. I gave her my genetic background, then I made the worst of it.”

As if “normal” teen-parent relationships aren’t difficult enough, imagine having a mother beside herself with guilt and a daughter angry and jealous over her mother’s weight loss. When I asked Cathy how she felt about her mother’s new figure and improved health she was angry. She said, “How do you think I feel? She is wearing the cute clothes my friends wear and I have to order fat lady clothes from a catalog. I wear my dad’s old raincoat because we couldn’t find a cute coat in my size. How do you think I feel?” she wept.

Even though she has pleaded earnestly to have surgery, Cathy’s parents are strongly opposed to the 16-year-old having bariatric surgery. They believe the family can learn from Diane’s life-long battle with obesity and make small steps to improve Cathy’s health, ultimately resulting in weight loss.

They are cooking healthy meals together and monitoring portion sizes. They are learning to read nutritional labels. There are no more late night pizza deliveries and “super-size” is off limits. Diane and Cathy have identified that they are emotional eaters. Now they are talking about their negative emotions rather than fostering them with high-calorie, high-fat out-of-control eating. They are working to improve physical fitness as well, walking together three nights a week. Diane doesn’t want bariatric surgery to be Cathy’s last and only hope. “I want to make things better for her, I don’t want her to suffer like I did all those years. I want to correct what I’ve done wrong by feeding her too much of the wrong things. I don’t want her to go through surgery. ”

Cathy has reluctantly made lifestyle changes along with her parents. After three months of improved eating habits and exercising she is down 10 pounds. Her BMI is 39, she started at 41, just at the cusp of qualifying for surgery. Dad has joined the fight against fat as well. He’s lost almost 20 pounds. “I’m proud of her,” said Diane, “and I tell her everyday. I think we are getting closer. I want so much to save her from feeling the pain.”

We know that children are copycats: they are more likely to do what their parents do, not what their parents tell them to do. Given that, Cathy’s parents are doing the right thing for her by adopting a new family lifestyle that will ultimately improve the quality of life for all of them. Bad eating habits are not impossible to break and exercise is not impossible to incorporate into our daily lives. Diane’s surgery was simply the catalyst this family needed to overhaul years of destructive habits.

Cathy’s parents have realized, by way of their own health crises, that eating is one of the most fundamental health-related behaviors that can be controlled. They are working together to improve the quality of life for the entire family.

As for the emotional issues: Diane’s guilt and Cathy’s jealousy; they are doing their best to work through those issues on their own. But Diane admits it is stressful at times and family counseling may be in order. “Years down the road I don’t want us to be a mother and daughter who never speak to each other because we didn’t resolve these issues. I think there is a chance here for us to become closer.”

Comments

Dear Readers,

I just wanted to mention you are welcome to post comments or questions directly to the blog. It's always nice to receive your emails too. It is my intent we use Living After WLS as a resource to learn together. Please let me know what improvements can be made or topics you wish to discuss.

Best wishes,
Kaye

(PS - If you're shy, I've enabled the option for you to post anonymously.)

Living Normal

It is common for new WLS patients to ask, “How soon after surgery will I get back to normal?” This is understandable. We’ve spent a lifetime dieting for the short-term – the 30-day diet, the six-week program, the lose-ten-pounds-over-the-weekend diet. Remember thinking, “If I can stick with this plan for just 10 days, then I can go back to normal.”

The diet industry has conditioned us to think long-term lifestyle changes are unnecessary to accomplish weight loss. We are impatient and demanding, we want a quick fix. Expectations are unrealistic and result in failure, disappointment and self-loathing.

But weight loss surgery is for life.
To that end, we must re-define normal.

Normal is living without co-morbidities: asthma, diabetes, high blood pressure, high cholesterol, sleep apnea, heartburn, and knee and back pain.

Normal is feeling your body in motion, walking up stairs briskly, and bending to tie your shoes.

Normal is playing children’s games on the floor and getting up without struggling.

Normal is hearing compliments about how great you look.

Normal is ACCEPTING compliments about how great you look.

Normal is fastening an airplane lap belt and pulling it tight.

Normal is enjoying clothes shopping.

Normal is the thrill of amusement park rides.

Normal is waking up early to jump on the scale – and thrilling at the number.

Normal is living without the incessant distraction of food and the relentless hunger.

Normal is feeling proud – not ashamed – of your body.

Normal is savoring food one bite at a time, not ravaging it.

Normal is having the power – the tiny tummy - to control eating behavior.

Normal is eating three meals a day and not snacking in between – and doing just fine.

Normal is feeling immediate discomfort when too much food, or the wrong food is consumed.

Normal is taking vitamins every day.

Normal is drinking water – lots of water.

Normal is enjoying exercising!

Normal is boundless energy.

Normal is a positive outlook, not fearing the doom of an early, miserable death for obesity related health complications.

Normal is eating lean protein at every meal.

Normal is declining doughnuts or pizza – and not feeling deprived!

Normal is making healthy eating and behavior modification a lifestyle for the whole family.

Normal is quality food, not gluttonous quantity.

Normal is taking responsibility for your own health and wellness.

Normal is respecting the science of your body, respecting the tiny tummy, and respecting yourself.

Normal is constant attention to weight maintenance.

Normal is feeling deep compassion for the obese.

Normal is being scared of the rapid transformation your body makes.

Normal is bouts of anger over years of self-loathing, discrimination, isolation and suffering.

Normal is the occasional departure from the rules that results in dumping or vomiting.

Normal is a rapid return to appropriate eating behavior.

Normal is seeing, for a time, a stranger in the mirror.

Normal is freeing yourself from obesity’s prison.

Normal is understanding that the pre-surgical behaviors and habits were unhealthy, destructive and abusive.

When a fellow patient asks, “When will I get back to normal?” the answer is Never-Ever-Never. Your tiny tummy is a one-way ticket to health, happiness and better living – the new normal!

Re-define your own normal! Chose your path into bariatric maturity. Embrace the new healthy, attractive you!

Welcome to your new life: You have arrived!

How much weight have you lost?

I had lost nearly fifty pounds before anyone mentioned my weight loss. Then, all of the sudden, everybody noticed! As soon as they noticed the rude and inappropriate questions began. The most offensive: “How much weight have you lost?” People who I barely knew asked me this question. I have not shared the answer with anyone but my husband and my doctor – it’s nobody’s business. I know many weight loss patients, who are proud of this number, but I’m embarrassed and won’t share it. When I’m asked this question, with a curious tilt of my head I ask back, “Why do you want to know that?” Never has anyone answered my question with a valid response.

This data, the number on a scale, means nothing to anyone but me. I don’t care to give someone an opportunity to marvel at just how fat I must have been that I could lose that much weight. Most of the time when I ask, “why do you want to know?” the busybody will retreat. In general, we know when we’ve asked a rude question – sometimes it just takes a gentle reminder. If, however, they persist, I say I prefer not to share that information. Only on one occasion has a nosy person continued, at which time I said I wouldn’t answer a rude question.

I admire the courageous patients who openly answer this question, perhaps many don’t consider this a discourteous inquiry. If you are comfortable sharing this number, then by all means include others in your celebration of the rapidly descending scale. You only have to answer to yourself – be true to yourself. Answer only what you are comfortable sharing.

Be True To Yourself.

Kaye

PS - Because we are a community of people in the same bariatric boat, I'll tell you I lost just over 150 lbs. But the statistic I'm most proud of: my waist is smaller now than my thigh measurement was before surgery. Hard to imagine!

Will my body temperature ever regulate?

Body temperature is the result of your body generating and radiating heat. The body is adept at keeping its temperature within a narrow range even though ambient air conditions vary. A normal body temperature is 98.6F. It is common during the period of rapid weight loss for bariatric patients to feel cold or chilled, even when their temperature reads normal.

People who experience the massive weight loss associated with weight loss surgery experience feeling cold for two reasons: loss of insulation and less energy generation.

Fat is a highly efficient insulator. Consider animals native to cold climates: for example sea lions and polar bears. They are loaded with insulation and thrive in cold climates. Because you are following the rules: eating your protein and exercising, the weight you are losing can only come from fat or stored energy. In effect you are losing your insulation. Less insulation increases the likelihood that you will feel cold.

The second reason for feeling chilled is that the metabolic cell processes are not working as hard as when you were heavier; it takes fewer calories and less energy to maintain and move a smaller body. Think about using an electric mixer: if you are whipping egg whites for a meringue the mixer will do this task effortlessly. But use that same mixer to knead bread dough and it will become warm to the touch, it is working harder because it is moving more mass. The same thing happens with your body; the more mass it must move, the harder it works. As a result more heat is generated.

The body has two well-tuned mechanisms for regulating body temperature: sweating and shivering. What overweight person hasn’t been embarrassed by a sticky bout of sweating at the most inappropriate time? Sweating is a mechanism for cooling your body when it becomes too hot inside. The body rids itself of excess heat by expanding the blood vessels in the skin so the heat may be carried to the surface. When this energy or heat in the form of sweat reaches the skin’s surface it evaporates and helps cool the body.

You will become more familiar with the second temperature regulator, shivering, as you lose weight. When you are too cold your blood vessels will contract reducing blood flow to the skin. The body responds by shivering which creates extra muscle activity to help generate more heat. If you allow your body to shiver it will begin to feel warmer. But this is also a good clue that it’s time to put on a sweater or turn up the heat. I think most weight loss patients will happily wear a sweater – a sweater is much easier to shed than that insulation we’ve worked so hard to lose!

Most weight loss patients report that their body temperature regulates after their weight is stabilized, usually eighteen to twenty-four months after surgery. In the meantime celebrate this change with your body because it is a clear measure that you are succeeding at your weight loss! Keep in mind your body is rapidly losing weight and the rest of your body’s functions are caught off guard when this weight loss begins. Your body’s thermostat needs time to catch up to the weight loss, and it will. Patients who incorporate exercise in their weight loss program experience less chilling than patients who do not – one more reason to follow the rules!

For many, the lower body temperature is a welcome relief. After years of embarrassing sweating and hot flashes it feels amazing to cool down! One svelte woman I know who used to be an arctic-ready 320 pounds told me of the summer her cold water pipe broke and she could only take very hot showers. When the building superintendent finally arrived to fix the pipe she told him she was too damn fat to be taking hot showers in the middle of the summer in Philadelphia! Now she laughs at that experience! But overheating is a very real problem for obese people. It is a problem that will resolve itself with weight loss surgery.

People in Southern climates are particularly tickled with the change. I know of one woman who exchanged the fan on her desktop for a space heater at her feet just to keep warm. She lives in Florida!

It seems like I was always cold during the infancy stage of my bariatric life. I’ve always enjoyed dressing up and going to swanky clubs. For years I dreamed about wearing the lovely little skimpy spaghetti strapped dresses that the skinny girls wore. Well, the pounds melted away and I felt fabulous about myself and bought some of those sexy little dresses. Dolled up in my new “never thought I’d wear that” dresses and stepping out in some seriously dangerous high heels I was ready to party. My husband took me to the finest clubs and hottest nightspots. Air-conditioned all of them! How I did freeze! I shivered my way through every outing and had the time of my life – Goosebumps and all!

Strawberries

This is a wonderful time of year for enjoying strawberries, and remarkably, this is one of the limited produce items I am able tolerate since having gastric bypass surgery. Have you tried them since your surgery?

Strawberry Facts:
-One-cup sliced berries has 50 calories, 3.8 grams protein, 157% the RDA of Vitamin C and 24% RDA of Manganese
-In the USDA’s assessment of the antioxidant power of various fruits, strawberries placed second, after blueberries
-Strawberries contain respectable amounts of folate – a heart-healthy B vitamin and potassium

At the Market:
-Look for strawberries that are plump, colorful and most important, sweetly fragrant
-The leafy caps should look fresh & green
-Check the packaging for signs of mold or rotting

To clean: place berries in a colander (Or leave in the plastic container if it has holes) and rinse under cold running water. Place on paper toweling to dry.


When I was a child, growing up in a fat household, I learned the only way to eat strawberries was the famous strawberry shortcake. The strawberries were cleaned & sliced, bathed in sugar (lots of sugar) then served atop a giant hunk of cake with a gravity-defying mound of whipped topping. Second helpings were encouraged. Hmmmm – now how is that all the members of the household were overweight?

Today I know better.

-Strawberries are wonderful without added sugar eaten right of the stem
-To sweeten under-ripe berries ½ teaspoon of sugar per cup of sliced berries works perfectly fine
-Strawberries soaked with a splash of balsamic vinegar and a pinch of sugar are outrageously good
-The cake and whipped topping a superfluous and counterintuitive to the healthy antioxidant benefits of fresh berries.

The following is a recipe from the Reader’s Digest cookbook: “Eat Well, Stay Well” page 338. It looks a little crazy at first glance, but we tried it last night and it was fabulous. I encourage you to give it a try. Remember that fresh greens are pretty hard on the gastric-bypass system, so measure a small quantity (1/4 cup) and cut the greens to small pieces, then chew chew chew! I think you’ll enjoy this taste of spring!

Strawberry Salad

¼ cup pecan halves (or walnuts)
4 cups cleaned, hulled strawberries
2 tablespoons balsamic vinegar
2 teaspoons olive oil
1 teaspoon light brown sugar
¼ teaspoon each salt & pepper
6 cups baby salad greens
4 ounces mild goat cheese (or cheese of your choice)

In a large salad bowl mash ½ cup of the strawberries. Thickly slice the remaining strawberries and set aside.
Whisk the vinegar, oil, brown sugar, salt & pepper into the mashed strawberries. Add the lettuce & toss to coat.
Measure ¼ - ½ cup lettuce and place on a salad plate. Top with sliced strawberries, a crumble of cheese and tablespoon of nuts. Enjoy!

If you are making this salad for one I suggest preparing the dressing, then topping the measured portion of lettuce with the dressing, strawberries, nuts and cheese. The dressing will store in the fridge for up to a week.

If you have problems tolerating greens, just skip them and top a serving of sliced berries with the dressing, nuts and cheese. This combination would be good served atop cottage cheese as well.