Tuesday, May 31

Introducing “Today’s Topic”

Living After WLS is pleased to announce a new page in our community: Today’s Topic. Each day we will post a topic of interest to people Living After WLS. It is our hope to have readers respond to the topic with their insight and experience so we can learn from one another.

At present, this is in a blog format and comments will be accepted by anonymous posters as well as those who chose to log-in with their Blogger profile. Our long-term plan is to establish a community with forums and bulletin boards for a more user-friendly exchange.

We are looking forward to your comments as we launch this new page. If you have a topic you’d like to see discussed click on the “Future Topics” post and enter a comment, or write to Today's Topic

Even WLS Patients Occasionally
Suffer From The “Stuck Scale”

Sometime, during the phase of rapid weight loss after gastric bypass surgery, many patients may find their weight loss is stalled. Talk about discouraging. The daily ritual of weighing and celebrating another pound gone has turned into depressing torture because the scale just won’t move- the dreaded plateau has arrived.

One reason for the plateau is physiological – the body reacting to the restrictive caloric intake sends out a signal to start burning less stored fuel. In other words, the metabolic rate – the rate at which the body burns fuel – is reduced as the body attempts to conserve fuel in reaction to a state of famine. Your body is hanging on for dear life to it’s beloved fat.

Face Down The Dreaded Plateau
There are things we can do to face down the dreaded plateau – and the first is to avoid beating up on ourselves or regretting the decision for WLS. Simply accept that a plateau is part of the natural course of weight loss and this too shall pass. Plateaus can last two to four weeks. Try to be patient and consider your body is simply taking a rest from the hard work of losing weight.

Avoid snacking during the plateau. Our old eating habits may resurface as we comfort our disappointment with extra snacks or make unhealthy food choices. Try to avoid this type of self-sabotage. I know this is a difficult time, I can recall feeling, “I really didn’t deserve to lose all this weight anyway, so I may as well eat this or that.” Avoid the self-pity trap.

Re-examine your commitment to healthy eating and exercise. Sometimes a plateau can be busted simply by returning the very basic principles of Living After WLS. One nurse-dietician suggests a return to pure protein for 48-hours: that means eggs, low-fat cheese, chicken, tuna, turkey, etc. - nothing processed. The science behind that is the intake of pure amino acids (protein) will boost your metabolism and force your body to burn stored fat. She said sometimes on the processed proteins, such as protein drinks, the body will adapt to store it as fat rather than burn it for fuel.

Another way to feel proactive in plateau busting is to kick-up your exercise program. Add an extra half-mile to your walk or an extra set of repetitions to your strength training program. Any little change will catch your body off guard and it just may respond by dropping a pound or two.

And of course, you wouldn’t expect me to get this far without mentioning it , Remember to drink your water! Lots of water to flush your body.

Counterfeit Plateaus
Now, What about the plateau that lasts longer than four weeks while you still have lots of weight to lose? These are referred to as “Counterfeit Plateaus” in the health community. Most counterfeit plateaus result from miscalculations or forgetfulness on the part of the dieter. For example, maybe we are forgetting to avoid starchy carbs or processed snacks. Maybe we are eating a tiny dinner and an hour later eating another tiny dinner? Perhaps we’ve fallen out of the habit of exercise. Little slip-ups or forgetfulness can become quite costly if we let it go too long without correcting the behaviors. Take a hard look and find ways to improve habits and boost weight loss.

Water/Fluid Retention Plateaus:
Too much salt in the diet will cause a water retention plateau – avoid prepared soups or other foods that have excessive salt. A fluid retention plateau is the result of insufficient water consumption so the body retains fluid to compensate. Remember, drink the water.


Plateaus are Temporary:
Remember, plateaus are temporary. I called mine “The Humbler” because maybe I was getting just a little too prideful over my weight loss and it effectively humbled me and made me work for the remaining weight loss!

Have you found a trick for facing down the dreaded plateau? Why not click on our “Today’s Topic” page and post your hint or idea for getting past the dreaded plateau after WLS.

Monday, May 30

So, You’ve Lost All That Weight -
But Now Your Neck is a Turkey Waddle!

A friend of mine who recently lost nearly 150 pounds after gastric bypass was sharing her excitement with an acquaintance. She was excited because all symptoms of her Type II Diabetes were gone and she no longer takes any medication – she feels healthier than ever in her life.

Then the acquaintance, a life-long skinny-minny, burst her bubble, “But doesn’t having that turkey neck bother you? You know, all that wrinkly skin just hanging there?”

What a cruel world. My friend was crushed. It is true, she has a turkey neck. Most people who lose massive weight will have a saggy wrinkly neck so kindly referred to in the medical profession as “turkey waddle”. A saggy neck is a small price to pay for better health and wellness. Even so, we want to look our best after WLS and having someone draw attention to this residue of our obesity is disheartening.

There are some surgical options to tighten then neck skin: A neck lift is actually a set of procedures used to enhance the appearance of your neck:

  • Cervicoplasty is the procedure used to remove excess skin
  • Platysmaplasty removes or alters neck muscles

Your surgeon also can perform neck liposuction, which removes excess fat. In some cases, Botox injections may be the answer to your problems if you have fullness or "bands." For a complete overview of neck lift procedures link to MedicineNet.

A neck lift was out of the question for my friend, so we did some research and found a more holistic approach that yielded some improvement. From Bharti Vyas’ book, “Beauty Wisdom” we found the following advice:

  • Give your neck a weekly massage
  • Hold your head in proper alignment – imagine that your head is being pulled upwards by a piece of string attached to the crown
  • Cleanse your neck night and morning the same as you do your face, starting at the collarbones and working up to the jawline.
  • Apply a rich-moisturizing cream at night and moisturize with sunscreen during the day. Cover front and sides of neck and the area around the collarbones.
  • Exfoliate your neck weekly.
  • For crepey neck, apply almond oil as a nourishing moisturizer.

Ms. Vyas also recommends some simple exercise to tone neck muscles (and *Bonus* these are wonderfully relaxing):

  • Hold your head in a central position, then lean it as far over as you can towards one shoulder and hold for a count of 10. Your neck may feel rather stiff to begin with. Repeat on the other side, making sure that your shoulders remain still and relaxed throughout. Do five repetitions.
  • Keeping your chin level, turn your head to one side so that the chin is over your shoulder. Incline the head backward in a “come hither” movement. Repeat on the other side. Repeat the sequence five times.

My friend follows these practices faithfully. Her neck is not flawless, but to me it’s beautiful. She has collarbones and a chin and a beaming smile on her healthy face.

Thursday, May 26

Announcing “You Have Arrived”

I am pleased to announce the creation of the Living After WLS monthly newsletter: You Have Arrived. The premier edition will be delivered to subscriber inboxes on June 1. We hope you will find it inspiring and useful as you are Living After WLS.

To subscribe, enter your email address in the “subscribe” box to the left or click over to the LivingAfterWLS website and complete the entry form there (you will have a chance to leave comments). If you are already a subscriber watch your inbox on June 1.

Thanks for your continued support of the Living After WLS project.
Best Wishes,
Kaye

After WLS What is the Best Multi-Vitamin?

The multi-vitamin market is rich with choice. It’s also very confusing. There are mega’s, potents, super all-day’s, vegetarian formulas, geriatric formulas, athlete’s formulas, recipes for men and women and teens! There are some things to consider when selecting a multi-vitamin supplement.

For the bariatric patient, first ask, “Can I swallow this and will it absorb quickly enough for my short circuited system?” Adult chewable tablets are available, but the taste is often unpleasant. However, these may be used during the first few months after surgery. Capsules and gels are a good choice because they are more likely to absorb quickly. Time released tablets should be avoided, they dissolve slowly, that’s what makes them timed release. There is no right or wrong form of supplement, just make sure to select a form you will take routinely.

Choose a gender and age specific formula. The more that is learned about nutrition, the more obvious are men and women’s different dietary needs. For example women need more calcium and iron in their diets. Geriatric vitamins often included chelated minerals for better absorption in addition to glucosamine to help with bones and joints and herbs to improve memory and wellness.

Finally, look for a supplement that contains most of the vitamins and minerals essential for good health – but does not exceed the U.S. RDA by more than 150 percent. (Most multi-vitamin supplements do not contain vitamin K – it is naturally synthesized by the body.) The label on the supplement bottle lists the weight in milligrams of the vitamin and minerals contained in the supplement.

The label also shows the percent of the U.S. RDA the supplement supplies. Natural and synthetic vitamins are virtually identical and most supplements are synthetic. It would require heaps of natural foods to extract enough vitamins for supplements and the cost would be prohibitive. One exception is vitamin E: the natural form is actually biologically more active and better absorbed and utilized by the body.

In addition to the multi-vitamin, it is important to supplement Iron, Calcium and B-Complex. For detailed information on these read some previous posts:

Iron Deficiency

Got Calcium?
B-Complex Vitamins
Organizing Your Vitamin Cocktail

Tuesday, May 24

Protecting Your Spine During Weight Loss

In the phase of rapid weight loss many of us introduce exercise and increased activity into our lifestyles. Of course we do! It feels great to move and move with less weight. Especially during this time we must protect our backs from injury that may disable or discourage us. Read advice from Lawrence Cole:

Protecting Your Spine and Lower Back While You Lose Weight


By Lawrence Cole

When most people begin a Weight Loss program or diet plan so that they can tone up and/or lose weight, the often forget about THE most important aspect of any exercise and diet program: Safety.

Although there are numerous ways in which exercising safely is beneficial to you, one of the most important and the least observed is concerning the spine and lower back.

There is nothing inherently wrong with spinal movement. However, problems tend to arise over time as a result of holding static positions such as sitting or standing with bad posture or not using proper body mechanics for lifting objects over a period of months and/or years.

Due to the above factors, a very large portion of the population eventually develops one form or another of complications with their lower spine and back.

Here are some ways that you can protect your lower back and spine area from injury and strain while exercising to tone up and lose weight:


Avoid bending over and lifting objects with your back muscles This is a common habit that wears down on the spine and lower back area by placing more tension on the area than it should be handling. As an alternative, bend fully at the kness when picking up objects of any significant weight and use the power of your larger, much stronger leg muscles to carry the majority of the weight load and give your lower back and spine a break.

Strengthen your abdominal muscles for additional back support The abdominal muscles are antagonist to the lower back, meaning that they stabilize movement at the back by providing a force in the opposite direction. They also have the potential to significantly reduce or even stop a force made on the back if they are strong enough.

Either way you slice it watching out for your spine is a crucial part of your weight loss program in that it keeps your body in good enough condition to continue your plan to help you tone and lose weight effectively.

Your Lifestyle and Fitness Coach,

Lawrence Cole

YourbestbodyNOW.com

See this article on YourBestBodyNOW.com

Lawrence Cole is a Lifestyle and Fitness Consultant based out of Pasadena,
CA. He has over 10 years of health and fitness experience and designing simple,
effective nutritional strategies to help individuals achieve their personal best
internal health and physical conditioning.

Article Source: http://EzineArticles.com/

Monday, May 23

Children of WLS at Risk of Eating Disorders

Here at LivingAfterWLS we’ve been speaking about our children, obesity and weight loss surgery. A reader pointed out yet another problem we face as parents who’ve had WLS: A child with an eating disorder. Turns out, as our children observe us diet and fail (repeatedly) before having gastric bypass, then they watch us lose weight in an almost obsessive excitement after WLS, some panic and vow “this will not happen to me.” A descent into an eating disorder may follow.

According to AnorexiaBulimaHelp “Dieting or restriction of certain foods, or excessive dieting from parents” is a contributing factor in teen and pre-teen eating disorders. In addition “The appearance obsessed society most people live in can contribute to eating disorders . . . When combined with a low self-esteem, feelings of depression or anxiety or isolation, the effects can be devastating. Eating disorders commonly erupt as a coping mechanism, as a way for people to feel more “normal” and in control in a society that isn’t really normal to begin with.”

Wow. Are you worried? Growing up I watched my mother work her way up and down the scale many times. No need to name the diets she tried: we all tried them. I believe I learned from her that diet equals failure. It seems like every time she’d get to the benchmark, “this is the lowest weight I’ve been since having my first child” suddenly her weight loss would stop and back up the scale she’d climb at a rapid rate. She is morbidly obese today and no longer attempts dieting. Who can blame her?

Did she know that was the lesson she was teaching me? That eventually I’d "diet" myself into morbid obesity? I don’t think so, and I don’t blame her. She didn’t know any better.

We know better today. It is our stewardship to our children to do the best we can to protect them, raise them healthy, and teach them healthy habits of nutrition and exercise. We owe it to our children to keep them off the operating table and out of eating disorder treatment centers.

But how to do that? By example and by being informed.

AnorexiaBulimaHelp is a comprehensive resource on eating disorders – if you fear someone in your family is suffering from an eating disorder please visit this site. There are links to several other resources. For an informative overview read Anorexia Nervosa Alert - is Your Daughter Dying To Be Thin? In addition, take a look at this article, Family Meals Help Prevent Eating Disorders. It suggests regular family mealtime will reduce incidence of eating disorders in children and teens.

Anorexia Nervosa Alert - is Your Daughter Dying To Be Thin?

By S.A. Smith

Anorexia nervosa is a serious medical disorder that is statistically most prevalent in the adolescent teenage years of young women. It is estimated that 7% of the population suffers from eating disorders and if left untreated over 20% of them will die from it. Anorexia takes the lives of children everyday in this world and there are things you can do as a parent to identify anorexic behaviors and intervene to protect your children.

Anorexia nervosa is a condition where one becomes obsessed with losing weight and practices self-starvation in an attempt to achieve significant weight loss or to maintain extremely unhealthy level of body weight. Anorexics are terrified of gaining weight, and often believe they are very fat even though they are already very thin.

Anorexia is not just a condition related to food and eating, but takes its roots from a deeper psychological level. Food and eating becomes a destructive tool that one uses to deal and cope with other emotional problems. Anorexics will often reach out to other anorexics on the internet in “pro-ana” sites whereby they encourage each other to continue their weight loss journey. Pro-ana sites argue that anorexia is a lifestyle choice and not an actual disorder, and offer dysfunctional support to other victims of the disease. The risk to our youth from eating disorders is significant and there are things you can do as a parent to intervene:

WATCH FOR WARNING SIGNS

Excessive weight loss: A person suffering from anorexia is skinny and may end up losing more that 15% of their ideal body.

Diet restrictions: a person with anorexia continues to restrict foods and diet even when they are not overweight.

Food Obsession: an excessive preoccupation with food, calories, nutrition, or cooking methods is also a sign of anorexic behavior.

Distorted body image: complaints of feeling bloated, nauseated, or fat even when the person is thin or underweight, and also denying feelings of hunger.

Excessive exercising: Anorexia may cause a person to complain about feeling bloated or nauseated even when she eats normal—or less than normal—amounts of food.

Cold Sensitivity: A person suffering from anorexia may feel cold even though the temperature is normal or only slightly cool.

Fatigue: a person suffering with anorexia will often show signs of fatigue and inability to concentrate on most tasks (except food and related weight topics).

Lack of social interaction: living with anorexia nervosa can become complicated when trying to hide it in social settings involving food and eating. Avoidance of social activities that include food is a common sign.

Depressed immunity: a person suffering with anorexia may have a weakened immune system and have frequent colds, illnesses and a general feeling of not feeling well.

Depression: anorexics will often exhibit signs of depression, anxiety, guilt and sadness while struggling with their disorder.

Physical changes: a person with anorexia over time may exhibit tell-tall physical characteristics such as; downy hair growth on the face, loss of menstruation cycles, dry nails, dry hair, constipation, headaches and possible hair loss.

Internet behaviors: a person with anorexia may be visiting pro-anorexic sites on the internet that offers encouragement and support of this disorder. Check your computers browser cache to review the history of websites it has visited.

If you suspect that one of your family members is suffering from anorexia nervosa it is important to take action now to arm yourself with information about the disorder and steps you can work towards to provide help and assistance. For more information on the types of treatment methods available you can visit: http://www.anorexiabulimiahelp.com/eating-disorders-treatment.htm

S.A. Smith is a freelance writer, correspondent, and contributing editor of the Anorexia Bulimia Help resource site and can be reached at http://www.anorexiabulimiahelp.com

Article Source: http://EzineArticles.com/

Family Meals Help Prevent Eating Disorders

By Kelli Miller
WebMD Medical News Reviewed By Michael Smith, MD
on Friday, November 12, 2004

Nov. 12, 2004 -- In today's on-the-run society, the traditional sit-down family meal has pretty much gone by the wayside. But researchers say restoring regular family meals can help teenage girls avoid dangerous eating disorders.

"It doesn't have to be a home-cooked meal. The idea is to bring people together," University of Minnesota researcher Dianne Neumark-Sztainer, PhD, MPH, RD, says in a news release.

Armed with data from more than 4,700 ethnically diverse adolescent girls and boys, Neumark-Sztainer and colleagues examined family meal patterns and eating behaviors.

They found that those who regularly ate meals in a structured, positive atmosphere were less likely to show signs of eating disorders, such as vomiting, chronic dieting, and using diet pills.

Nearly 18% of girls who ate one to two family meals each week showed signs of eating disorder behaviors. This number fell to 9% of girls who had family meals three to four times a week. Girls who ate five family meals weekly had an even lower risk of eating disorder behaviors. While boys also benefited from the family meals, the association between eating disorder tendencies and family meals was not as strong.

"Making family meals a priority, in spite of scheduling difficulties, emerged as the most consistent protective factor for disordered eating," the authors write in the November issue of the Journal of Adolescent Health.

Researchers suggest that parents keep conversation light and positive at the dinner table, especially if their children have issues surrounding food.

SOURCES: Neumark-Sztainer, D. Journal of Adolescent Health, November 2004; vol 35: pp 350-359. News release, University of Minnesota.

Sunday, May 22

Sunday Picnic!
Fried Chicken & Fresh Melon

Thinking about enjoying a Sunday picnic today? How about giving Kim Beardsmore’s Oven Fried Chicken a try. Easy, tasty and picnic portable. (And, oh yes, WLS Friendly, Family Friendly!) Pair it with some melon chunks and you’ll enjoy a wonderful healthy meal!

Enjoy!

Raising Children After We've Had WLS

We have spoken before about the dilemma for parents having gastric bypass and raising children. One of the concerns always expressed, “What can I do to keep my child from eventually having to undergo weight loss surgery? How can I raise a healthy child in the Living After WLS lifestyle?

Here's a shout-out to Katherine Prouty over at LowCarbFreedom. Click the link for her index to LowCarbKids. Essentially, the gastric bypass diet is low carb, and Katherine is proving that healthy children can be raised in a low carb lifestyle. I particularly like this quote from the mom who has lost 50 pounds following a low-carb lifestyle: “I am doing a MUCH better job with my daughter than with my son. My daughter wants to listen and my son lives for white bread and everything that is unhealthy, and I give in too much.”

Katherine is a real person living in the real world. Her content reflects just that.

In The News:

Obese children turning to surgery
Andrea Mayes
13may05

CHILDREN as young as 12 are undergoing radical surgery to cure what doctors are calling Australia's obesity plague.

An estimated 50 to 60 children have already had lap-band surgery in Australia, and surgeons are struggling to cope with increasing demand for the operation.

George Fielding, a former Brisbane surgeon who now teaches obesity surgery at the New York University Medical School, told a conference in Perth that at least 3 per cent of Australian schoolchildren were so obese they needed surgery.

While acknowledging the solution was extreme, he said the problem had gone beyond an epidemic and was more accurately described as a plague. "I think epidemic's almost too polite a word - plague has connotations of something truly terrible," Professor Fielding told the Royal Australasian College of Surgeons conference.

"There are terrible consequences for children with this obesity ... They're all getting the diseases their grandparents have, and they're getting them when they're 12, 13, 14.

"They're getting diabetes, high blood pressure, sleep apnoea, heart disease at rates that would be unbelievable 10 years ago."

Paediatrician Louise Baur, a childhood obesity expert from Sydney's Children's Hospital at Westmead, cautioned that there was no strong evidence to support the benefits of lap-band surgery in adolescents, although it had been proved to be beneficial for adults. She said teenagers should be severely obese before surgery was considered, and should have failed to lose weight using conventional methods. "I would argue that most severely obese adolescents don't receive anything like adequate conventional therapy as yet," Professor Baur said. Intensive long-term support would be required for teenagers undergoing such surgery, she said.

Professor Fielding said for those teenagers already grossly overweight, diet and exercise did not work and surgery was often the only effective answer.

"Unfortunately these kids aren't just chubby little kids - they're humungously fat, sick kids," he said. "Diet and exercise do not work when you're morbidly obese."

The surgery involves inserting a band around the top of the stomach and tightening it to limit the amount of food that can be eaten.

Professor Fielding said the risks associated with the procedure were very small and the same as those for any operation involving general anaesthetic. He said it was too simplistic to blame parents when teenagers faced severe social pressures. Food was plentiful and easily available, especially junk food, and children led much more sedentary lives than previous generations, Professor Fielding said.

The solution was to tackle the root causes of the problem by banning junk food at school and encouraging children to be more physically active, he said.

Obesity Surgery Society president Harry Frydenberg said lap-band surgery had increased ten-fold in the past 10 years, and Australia would need another 100 specialist surgeons to cope with demand over the next 20 years.

"In the public hospitals there is two to three year waiting lists, and in a morbidly obese person, this can be life-threatening in lots of ways," Mr Frydenberg said.

Saturday, May 21

Melons: Gastric Bypass Friendly Fruit

Cantaloupe and Melons


Many gastric bypass patients report melon to be one of the easiest of fruits to enjoy after surgery. Melons are generally low in natural sugar, ripe on flavor and easily digestible. They are rich in Vitamin C, Vitamin A, Potassium, Vitamin B6, folate and dietary fiber.

How to Select and Store


The key to purchasing a quality melon is to find one that is ripe. If you tap the melon with the palm of your hand and hear a hollow sound, the melon has passed is ripe. Choose a melon that seems heavy for its size, and one that does not have bruises or overly soft spots.

Melons & Food Borne Illness


Because of heightened sensitivity to foods and food borne illness gastric bypass patients must exercise extreme food safety precautions. Follow these simple guidelines to help keep your fruit fresh as well as safe.

When you buy cut melons, be sure they have been buried in ice or displayed in a refrigerated case, not just displayed on top of ice. Uncut melon does not need to be refrigerated.

Before cutting, the outer surface of the melon should be washed with drinking water to remove surface dirt.

Hands and all equipment and utensils (cutting boards, knives, etc.) need to be washed thoroughly with hot soapy water, and rinsed.

Cut melons must be refrigerated at 41º F or below.

Cut melons may be served without refrigeration for a maximum of 4 hours (such as at a brunch, picnic, or buffet). At the end of that time, any leftover melon must be thrown away.

A Few Quick Serving Ideas:

Add some sparkling water to fresh squeezed cantaloupe juice for a delightfully refreshing drink in the warm months of the year.

In a blender or food processor, purée cantaloupe and peeled soft peaches to make delicious cold soup. Add lemon juice and sweetener (sparingly) to taste.

Top cantaloupe slices with yogurt, and chopped mint.

Slice melons in half horizontally, scoop out seeds and use each half as a basket in which to serve fruit salad.

Friday, May 20

The Tummy Tuck:
I Relented & Went Under The Knife (again)

We talked earlier this week about my reconstructive breast surgery. It was painful and emotional. After that considering another elective surgery was out of the question.

It took me a long time, 3 years, about 1-million ab-crunches and a few thousand miles on the treadmill before I gave in and decided to have a tummy tuck. It was my last hope to get rid of the awful belly flap left behind from my obesity.

No matter how thin I appeared, how many compliments I received, I always believed the belly bulge was the equivalent of a wart on the tip of the nose. I was certain it entered the room before me and people stared at it. I loathed how I looked naked.

A tummy tuck, abdominoplasty, is a procedure that flattens your abdomen by removing extra fat and skin, and tightens muscles in your abdominal wall. But be cautioned: This is a major surgery, it is not the easy way out. (Have you ever hear that before - "easy way out?)

I had the tummy tuck last fall. The surgeon cut me hip to hip: I have a 20” scar to prove it. He removed the flap of skin, gave me a new belly button and did some body sculpting with liposuction on my hips and waist. Like the breast surgery, it was done in his surgical suite and I went home that evening heavily medicated. I rested in a reclining chair for several days. Everything was painful and exhausting: sitting, standing, showering, eating. I slept a lot for two weeks. I wore a surgical girdle to keep everything in place.

The surgeon closed the wound with tape and I wore a surgical drain for 10 days (sound familiar?) My body was quite swollen and this messed with my head - - I expected to wake from surgery swimsuit model perfect. Not so. In fact, my measurements after surgery were actually greater than prior to surgery. The swelling lasted, to a lesser degree, for about a month. The good news, within 3 weeks I was back to my walking program on the treadmill.

Now, six months post-op I’m happy to report a firm flat tummy (Who me? The Little Fat Girl? YES!) The incision is still ugly wicked red and tender: wearing jeans is uncomfortable. Still, I’m happy I had the surgery, but don’t even consider asking me if I want any more surgery. I hope I’m done with that forever!

Who Are the Best Candidates For a Tummy Tuck?
A tummy tuck is suitable for both men and women who are in good general health overall.

It should not be confused with a liposuction (the cosmetic surgery used to remove fat deposits), although your surgeon may elect to perform liposuction as part of a tummy tuck.

Women who have muscles and skin stretched by multiple pregnancies may find the procedure useful to tighten those muscles and reduce that skin. A tummy tuck is also an alternative for men or women who were obese at one point in their lives and still have excessive fat deposits or loose skin in the abdominal area.

How a Tummy Tuck is Done

Depending on your desired results, this surgery can take anywhere from one to five hours. The complexity of your particular situation also will determine whether you have it completed as an in-patient or outpatient procedure.
You will receive general anesthesia, which will put you to sleep during the operation. It's important to have someone with you who can drive you home. If you live alone, you also will need someone to stay with you at least the first night after the surgery.

There are two options for a tummy tuck. You and your surgeon will discuss your desired results, and he or she will determine the appropriate procedure during your consultation.

Complete abdominoplasty. Your abdomen will be cut from hipbone to hipbone in this procedure, the option for those patients who require the most correction. The incision will be made low, at about the same level as your pubic hair.

Your surgeon will then manipulate and contour the skin, tissue and muscle as needed. Your belly button will have a new opening if you undergo this procedure, because it's necessary to free your navel from surrounding tissue. Drainage tubes may be placed under your skin and these will be removed in a few days as your surgeon sees fit.

Partial or mini abdominoplasty. Mini-abdominoplasties are often performed on patients whose fat deposits are located below the navel and require shorter incisions.
During this procedure, your belly button most likely will not be moved. Your skin will be separated between the line of incision and your belly button. This type of surgery may also be performed with an endoscope (small camera on the end of a tube). The procedure may only take up to two hours, again, depending on your own personal situation and the complexity of your needs.

In our next plastic surgery installment we’ll talk about the “Full Body Lift” and Brachioplasty (removes batwings under arms).
Best wishes!
Kaye

Thursday, May 19

Reader Recipes: Kerri's Dinner Dishes

One of our Living After WLS loyal readers is Kerri. She had her surgery in February and has already lost 60 pounds. Way To Go, Kerri! I really enjoy receiving her letters, she is working very hard on her weight loss and healthy lifestyle. Here are family friendly recipes she used prior to gastric bypass. With a few clever changes since having surgery her family is now enjoying a more healthful version of old favorites.

Thanks Kerri, for sharing with us – I’m fixing Kerri’s Beef Stroganoff tonight!

  • Kerri's Beef Stroganoff


  • Kerri's Chicken With Broccoli & Mushrooms
  • Wednesday, May 18

    WLS Friendly Recipes Wanted!

    LivingAfterWLS is seeking your best gastric bypass friendly recipe. What are you enjoying that’s high protein, low-carb healthful & nutritious & delicious? Please click the "Share Your Recipe" link on the recipe page and send us your best recipe to share with others who are LivingAfterWLS!

    Thanks & Happy Eating!
    Kaye

    Daily Motivation Needed for Success After WLS

    One of the things we often overlook while living after WLS is that even with this great “tool” of gastric bypass – we still need daily motivation to succeed. Weight loss and weight maintenance are not guaranteed with the surgery. We need motivation to eat the right things, to follow the rules, to engage in exercise. We need motivation to protect and defend our health.

    Hopefully the LivingAfterWLS Blog and Website are sources of fresh daily inspiration and motivation. In addition, we can turn to our families or friends or join a WLS support group, online or at our bariatric centers. Ben Sather, from A2-WeightLoss has a great article about weight loss motivation:

    Daily Weight Loss Motivation
    By Ben Sather

    When you are faced with the daily challenge of trying to lose weight, you will need to find ways to stay motivated every day. The factors that keep weight loss motivation high include your specific goals, your ability to envision what you want to achieve, and the degree of success you have in the beginning.

    Daily motivation requires a special, concerted effort, and it is not always easy. One great way to keep weight loss motivation high is to find an Internet support group to check in with every day. There are many such chat groups and forums on the web.

    Another idea is to keep a daily journal of your progress, struggles and success. You can keep a record of your daily diet or write in your journal about the journey and challenge of losing weight and the emotions connected to it.

    Weight loss motivation will stay fresh with something tangible that you can look at to remind you of your goals. For example, you can tape a picture of yourself when you were at a more ideal weight to your refrigerator door. You can buy an outfit in your ideal size and hang it in your closet where you will see it every day. There are many books filled with affirmations and inspiration for dieters. Buy one, and read a bit of it every day.

    The motivation to lose weight may not come from the same place every day. If you can develop some strategies for keeping your daily motivation high, you are much more likely to be successful and bounce back quickly if you have any setbacks. Whatever you ultimately see as your motivation for losing weight, you do not have to face the challenge alone.

    There are resources and people available for anyone who takes the time to seek them. Make a daily commitment to do at least one thing in support of your goal, and you may soon find that the behaviors that support weight loss have become second nature to you!

    Ben Sather is the publisher of http://www.a2-weight-loss.com. You can publish this article if the author's byline is included and all links are hyperlinked.

    Article Source: http://EzineArticles.com/

    Tuesday, May 17

    Quick Supper: Guacamole and Turkey Sandwiches

    Tonight's quick supper makes good use of the LivingAfterWLS staple: Deli Turkey. It includes fresh vegetables for their flavor an nutrients. Give Guacamole and Turkey Sandwiches a try, I think you'll enjoy them!

    Cosmetic Surgery After Massive Weight Loss
    Breasts? Where'd they go?

    Many readers are asking about plastic or cosmetic reconstructive surgery after losing weight with gastric bypass surgery. Over the next few days I’ll share my experience with cosmetic surgery and direct you to some informative sites about procedures to clean-up the excess skin resulting from weight loss after morbid obesity. The first topic is breasts.

    Breasts? Where’d they go?


    In my pre-surgical consultation I remember one of the questions I asked my surgeon was “will I lose my breasts?” He assured me, yes indeed, I would lose my breasts. Nine months and 100 pounds later they were gone. I was embarrassed by after WLS breasts, now deflated skin balloons hanging from my chest. My breasts – my sexual pride and joy for so many years - were now ugly sloppy flaps of skin. I loathed my trimmed down naked boy-body. Something had to be done.

    First effort: I increased my exercise: bench presses and butterflies. That didn’t help. Any exercise that works the pectoral muscles will help tone the chest, but not the breasts. Breasts are not muscle tissue, they are fatty tissue, and therefore do not respond to weightlifting or resistance exercise of any type.

    Second effort: I tried some rub-in creams ordered from the back of a fashion magazine. They promised to grow my breasts by two cup sizes. The promise was a lie; don’t waste your money.

    Last step: Consult with the plastic surgeon. He congratulated my weight loss, complimented my muscle tone (I really did do a lot of resistance exercise) and then he suggested mammoplasty & augmentation. He would take my deflated skin balloons, put them back front and center where they belonged and inflate them with implants. I was about 18 months out of surgery and had maintained my weight loss for two or three months. I felt confident the time was right to get on with the “finishing touches.”

    The surgery was done under general anesthesia in surgical suite at the plastic surgeon’s office. He removed excess skin, lifted my nipples and repositioned them and inserted implants beneath the pectoral muscles. He closed the area with surgical tape and bound me in a surgical support bra. After I was awake from the anesthesia my husband took me home to rest and recover.

    There was a great deal of pain from the muscles being lifted and moved in surgery. Also, the weight of the implants seemed great on my chest. Sitting was the most comfortable position. Lying down or standing caused discomfort. I took prescription pain medication for six days and then over-the-counter pain medicine for another two weeks. At first the breasts didn’t look normal (what’s normal about implants?) and I had the equivalent of breast postpartum sadness asking repeatedly “What have I done to my body?”

    However, as the pain subsided so did my sadness or regret. My new breasts settled nicely onto my new small body and to this day I do not regret the procedure. I feel like a sexy, curvaceous woman – the woman I never thought I’d become.

    For a detailed explanation of breast augmentation I recommend this article by Kimberly A. Henry, MD and Penny S. Heckaman WebMD Medical Reference from “The Plastic Surgery Sourcebook.”

    Breast augmentation, or augmentation mammoplasty, has become one of the most frequently requested plastic surgery procedures by women of all ages. It is most commonly performed to increase the size of small breasts, correct a difference in size between the breasts, and for breast reconstruction following mastectomy for breast cancer. A breast implant is inserted either behind the breast tissue of each breast or behind the pectoralis major muscle, the major muscle of the chest wall, thereby increasing the size of the breast. Link to the full article.

    Monday, May 16

    It’s Grilling Season!

    The spring & summer seasons are for many of us one season: Grilling Season. The best part about grilling is how compatible grilled foods are with the gastric bypass system. For some great grilling recipes hop over to the Weber Grill recipe page. They’ve got healthy and inspiring ideas for outdoor grilling. Today’s Shrimp Kabob recipe comes from Weber. Give it a try!

    SHRIMP: It’s What’s For Dinner Tonight

    While shrimp may be small, they are huge in their appeal as these deliciously clean and crisp tasting crustaceans can be served hot or cold and are the most popular seafood in the United States, next to canned tuna. Fortunately, for us living after WLS, we able to enjoy fresh and frozen shrimp throughout the year.

    Shrimp are anything but small in their nutrient density. Our food ranking system qualified shrimp as an excellent source of selenium and unusually low-fat, low-calorie protein--a four ounce serving of shrimp supplies 23.7 grams of protein (that's 47.4% of the daily value for protein) for a mere 112 calories and less than a gram of fat. Shrimp also emerged as a very good source of vitamin D and vitamin B12.

    Tonight's high-protein gastric bypass friendly dinner is Shrimp Kabobs in Ginger Marinade. This is one dish you'll make time and time again. Enjoy!

    Sunday, May 15

    Antioxidants & Free Radicals

    I want to revisit the topic of good nutrition - eating healthy to nourish our bodies. It is so important to pay attention to nutrition after gastric bypass; first to ensure our diet is healthy and balanced (using supplements) and second to make the most of this new chance at living. We sacrificed greatly to become healthy - we owe it to ourselves to be vigilant about nutrition.

    Antioxidants & Free Radicals


    One reason to keep your body nutritionally well is to aid in the defense against free radicals by building an army of antioxidants. The body’s normal metabolic process produces free radicals – unstable rebellious compounds that are intent on destroying the genetic structure of the body. They seize other elements in the body and make them unstable – free radicals are blamed for causing cancer, heart disease, cataracts, arthritis and neurological diseases. They recruit from the environment too, gathering toxins from heat, radiation, environmental pollutants including cigarette smoke and excessive alcohol consumption. Together the free radicals and environmental toxins attempt to catastrophically damage the body.

    The body has mechanisms to fight the free radicals and the intake of antioxidants can help in the battle. Antioxidant nutrients include Vitamin C, Vitamin E and Beta Carotene. The antioxidants are powerful: they can repair the damage caused by free radicals and deactivate their chain reaction of destruction.

    The antioxidant repair process is exciting for the bariatric patient: you had surgery because you suffered co-morbidities associated with obesity: arthritis, diabetes, heart disease, weakened immune system, asthma and others.

    After you have surgery and you intentionally incorporate antioxidants in your diet you give your body a fighting chance against the free radicals that were literally destroying your basic genetic material – your DNA. Feed your body antioxidants: take your Vitamin C and Vitamin E. Bite-by-tiny-bite incorporate beta carotene in your diet; it’s found in orange fruits and vegetables (carrots, cantaloupe, yellow bell peppers, pumpkin and winter squash). When you do these things your body will be armed with a known disease fighter and your immune system will be strengthened. You will feel well.

    Make certain your supplements include the RDI of Vitamins A and C, also.

    Here are some quick links to some of our previous conversations about nutrition and supplementation:


    B-Complex Vitamin

    More Thoughts on Supplementation

    WLS Myth Busting: After Sugery You have to Take All Those Vitamins

    Iron Deficiency

    Harsh Reminder

    Saturday, May 14

    Running from Fat Monster

    We recently talked about the fear of success. Today we will address fear of the Fat Monster.

    I thought the fear of success was scary – that is until I met the Fat Monster. The Fat Monster came into my life one night shortly after I achieved my weight loss goal. The Fat Monster terrified me with illusion – in the darkness of night he convinced me that the weight loss was just a dream, that by morning the Little Fat Girl would be back. He convinced me that being thin was too good to be true. I was terrified.

    The Fat Monster scared the hell out of me and I believed his frightening stories. Even on days when my behavior was stellar – I followed the four rules – I was convinced he could catch me Many restless nights I woke frequently to run my hands over my body confirming he hadn’t caught me that night. I needed to know that I was still thin. Many patients are acquainted with the Fat Monster – after years of dieting failure it is common to believe this weight loss is too good to be true.

    To this day the Fat Monster keeps me honest. Aloud I can say that looking and feeling great is my motivation to follow the rules, to exercise and maintain my weight. But deep down inside I’m on a dead run trying to get away from the Fat Monster. I don’t ever want to return to being morbidly obese, I hated that life. So when I get on the treadmill I am literally running from the Fat Monster. When I eat my protein and take my supplements I’m building my strength to battle the Fat Monster. I am at war with the Fat Monster and I will never surrender; I am winning!

    Other patients are battling their own Fat Monster. One woman believed the Fat Monster had occupied her bathroom scale – she began weighing compulsively around the clock. She had a before work weight, an after work weight, before work-out weight, after work-out weight and on and on. Any fluctuation from normal caused immediate panic and self loathing. Her husband locked away the scale and she nearly lost her mind! So, they came to a compromise. He would keep the scale - and the Fat Monster - locked away except for the once a week weigh-in. The physical act of locking-up the Fat Monster worked for her. She no longer weighed herself compulsively and her weekly weigh-ins showed she could very successfully maintain a healthy weight without round-the-clock vigilance to the bathroom scale.

    Identify your own Fat Monster and learn what behaviors – good or bad – the monster is affecting in your life. Do not surrender control to the Fat Monster but use terror as a source of motivation in your healthy life.

    What's for dinner?

    Baked Chicken Breast with Honey Mustard Sauce



    Try it tonight! YUMMY!

    Happy Cooking!
    Kaye

    Friday, May 13

    “I Want My Mind to Follow”

    Today I received a great email from one of our readers over at the livingafterwls.com website. She wrote,
    “I'm grateful to find your website. On January 19, 2005 I had lap Band surgery. I have been very successful to date with a loss of 25 pounds. Recently I've realized that my "affair" with food is attempting to regain my attention. I'm doing everything possible to give that "infant" tummy the same attention today that I did the first 10 weeks. Finding your story has reminded me of my intentions and has helped me come back to reality. I finally have my body on my side and I want my mind to follow!”


    Her words, “I finally have my body on my side and I want my mind to follow!” rang so honest and true with me I am inspired to share them with you. I was reminded of my own mental struggle during the growth process after gastric bypass. It was a woman at a support group whose gentle words helped me get my mind to follow.

    Speaking to our group she said, “There was a time when I, too, felt angry and punished by my weight loss surgery,” she began. “But one day I realized, weight loss surgery is part of a new lifestyle, not a regimen and not a punishment.” She explained that as a morbidly obese person – she had lost 130 pounds - she was a slave to the poor health, poor habits and low self-esteem that perpetuated her obesity. She said the day she realized she was no longer a slave to the shackles of obesity she was able to liberate herself. She embraced her new lifestyle, not as a regimen or punishment, but as a means to better everyday living. We were skeptical, and we didn’t applaud. But then she made her final pitch. “If we suffered from a life-threatening illness – and morbid obesity is life-threatening – and medical science said I will give you a tool to help you treat your life-threatening disease, but you are responsible to use that tool to achieve total success – would you settle for 50 percent as good enough?”

    To read the full post link: Rock Bottom: Was WLS a huge mistake?

    Thanks, Pam, for your inspiration today.

    Best wishes,
    Kaye

    Thursday, May 12

    Fear of Success? What if this time I REALLY lose weight?

    One of our regular LivingAfterWLS readers asked about emotional issues after gastric bypass that cause us to sabotage our own weight loss. One of those issues is the fear of success. Does this sound familiar?

    The fear of success arises in patients when they realize a genuine change is occurring and they are moving forward with their life. To have bariatric surgery is to pursue an allusive dream that is now being realized – many patients have dreamed all of their lives of successfully losing weight. This time the miracle is working and the pounds are melting away. This time there is no familiar failure, no relapse to bad behavior. This time we are eye-to-eye with success. Weight loss surgery guarantees successful weight loss, and increases the odds for long-term successful weight maintenance.

    The fear of success is very real because it’s about the unknown. We have not succeeded at dieting or weight loss, that’s why we are having surgery. It will take us into the unknown. The fear of success is real. It is also futile. Weight loss is going to occur in spite of our greatest fear of succeeding.

    The fear of success is an umbrella sheltering many other fears. Some patients say they fear loneliness, that successful weight loss will lead to isolation. Some women fear the empowerment of healthy self esteem will make them unlovable. Others fear success will make them vulnerable to people whose intentions are not genuine. Many women fear that successful weight loss will make them more attractive to others and could jeopardize their intimate relationships.

    For every fear there is a weight loss patient whose fear has come true. One trimmed down woman was lonely when her life-long friends “the Fat Pack” isolated her from the group. Another woman, so empowered by her weight loss and healthy self-esteem, became a career ladder climber with a single focus for reaching the top – she became unlovable. Slimmed down single gals report suspicion of their suitors saying, “he would have never loved me when I was fat – his intentions are not genuine.” And many other newly svelte women have found themselves divorced and alone. A jealous spouse simply could not manage the male attention his wife was attracting.

    Some fears of success are easy to dispel because they will probably never happen, such as the fear of waking up morbidly obese again. But some are real, and some do happen. When a person affects great change, the relationships around them are forced to change. Some friends will always cheer you on, but others are steeped in jealousy and will denigrate you for moving forward. Perhaps a suitor wouldn’t have loved you before weight loss, but truthfully, did you love yourself? If not, how could you expect someone else to love you? Some spouses will embrace the new you, others with tremble and run in the wake of fear your change has awakened in them.

    I believe the fear of success goes in hand with the social inferiority we felt as morbidly obese people. As we realize successful weight loss we start to think we don’t deserve to be thin, healthy and attractive – these are reserved for the beautiful, smart, successful people. If we become these things – healthy, beautiful, thin, attractive, successful – then we are frauds and hypocrites. We are undeserving.

    This is self-loathing and destructive behavior. It leads to self-sabotage. Patients report uncontrolled behavior changes such as snacking, eating sugary or high fat foods and not exercising. When a patient falls into the downward spiral of self-loathing and sabotage they show a complete disregard for the four rules. Patients know what they are doing is harmful to them. Many admit feeling unworthy of weight loss success. Some patients have become so destructive they have gained weight and compromised their health.

    The saddest part of self-sabotage is that it only hurts ourselves. The best thing about self-sabotage is that when we recognize it we can cease the harmful behavior.

    To manage the fear of success first acknowledge that you have the right to succeed and the right to enjoy your success. Nobody stood up to the plate for you and had surgery – it is you who made the sacrifice and paid the price to affect a healthy change in your life. Weight loss surgery will affect the way you conduct yourself every day for the rest of your life. It was not a simple one-shot solution. You pay the price for success with every bite you take, every swallow. The price is very steep – don’t ever minimize it. As obese people we are skilled at declining compliments and credit for the things we accomplished, we felt socially inferior for so long. But weight loss surgery is your sacrifice and your accomplishment: you are sole owner. You have a right, and an obligation to yourself, to celebrate the wonderful success it brings.

    Next understand that your success is about you, not anyone else. If others exclude you from their “fat pack” it’s not because you have succeeded, it’s because of how your success makes them feel. It has nothing to do with you. If a spouse is so insecure they would rather you be unhealthy and unattractive then it is their issue, not yours.

    Your weight loss is about you – you didn’t lose weight to show superiority over others – you lost weight because you had a debilitating illness that could be treated with surgery. The result of that surgery is weight loss. The result of weight loss is a longer, healthier life; and yes, a thinner, attractive beautiful person. While others may see it differently, the fact is, you have lost weight to save your life.

    You have succeeded.

    You have the right to celebrate your success.

    Best Wishes,
    Kaye

    Wednesday, May 11

    Soup: A Do or a Don’t after WLS?

    The school of thought is split when it comes to opinions about eating soup after gastric bypass surgery. One teams says no soup for you! Too much liquid, not enough solid food to satiate or provide nutrition. The other team says soup is a great palatable source of protein and nutrients.

    I am sitting between the two teams on the “Select Soups Wisely” fence. I happen to love soup, particularly in the winter. Broth soups with animal protein and soft-cooked vegetables and a little bit of rice or pasta are my favorites. Bisque, Chowders or cream soups are deadly to me and avoided at all cost. In fact, the worst dumping episode I ever suffered was following the best lobster bisque I’d ever had in my life. It was almost worth dying over, and believe me, I thought I was dying during that dumping episode.

    If you are in the soup eaters category here are a few points to consider when making a soup selection:

    • Clear broth soups are better than cream based soups after gastric bypass surgery.
    • Be suspicious of pureed soups, such as a puree of squash. Often heavy cream or sour cream are used to give the soup creaminess. Creams contain lactose, the predominant sugar in milk products that causes dumping for many WLS patients.
    • Animal protein should be the primary ingredient: fish, chicken, beef or pork.
    • Vegetable protein, particularly beans (think chili) is a healthy choice, but measured servings are best to avoid discomfort from over-eating the pouch.
    • Soups are a great way to include vegetables in the diet such as carrots, peas, onions, celery, tomatoes. Some vegetable soups that include cabbage, broccoli or cauliflower may cause uncomfortable gas and bloating. Beans or legume soups may also cause gas and bloating.
    • Grains and pasta can be included in soups sparingly.
    • When eating soup take the “good stuff” first, the protein and the vegetables. It’s perfectly fine to leave the broth in the bowl – little children may be starving in foreign countries, but your broth will not do them any good. You have permission to leave it in the bowl.
    • Crackers or bread may be enjoyed with soup – in moderation.
    I’ve updated the recipe section to include some of my favorite soup recipes.

    Tuesday, May 10

    Pregnancy After Weight Loss Surgery

    When a woman in the child bearing years undergoes gastric bypass surgery one of the first things she will hear from the nay-sayers is that after surgery she cannot have a healthy pregnancy. The contrary is true. Morbid obesity results in a high rate of complicated pregnancies and a high rate of miscarriage.

    In a study by Dr. Alan C. Wittgrove and nurse practitioner Leslie Jester from the Wittgrove Bariatric Center in San Diego patient follow-up indicates fewer risks during pregnancy after WLS than pregnancy in the morbidly obese.

    On a personal note, I know both Dr. Wittgrove and Leslie Jester. Dr. Wittgrove, famous for doing Carnie Wilson’s surgery, performed my gastric bypass surgery one month after Carnie’s surgery. Leslie Jester was my nurse and counselor in the first three years following surgery. Leslie had a successful, healthy full-term pregnancy following her gastric bypass, AND she got her figure back – she is cute as a bug! Here is an article on their 1998 study:

    Pregnancy following gastric bypass for morbid obesity.

    Wittgrove AC, Jester L, Wittgrove P, Clark GW
    Department of Surgery, Alvarado Hospital and Medical Center, San Diego, CA, USA.

    BACKGROUND: Women who suffer from morbid obesity are often infertile. If these women are able to become pregnant, they are considered high risk because of the hypertension, diabetes and other associated risk factors. Following the pregnancy is difficult due to limitations of the physical examinations. More costly ultrasound examinations are needed at a higher frequency. Bariatric surgery reduces the woman's weight and the incidence of obesity related co-morbidities. The number of pregnancies and rate of complications during those pregnancies in our post-bariatirc surgical patients were evaluated.

    METHOD: Our group has been doing bariatric surgery since the early 1980s. We have over 2000 active patients on our current newsletter mailing list. The patients also have a series of networks through support groups. The patients are informed to contact us when they become pregnant so we may assist the obstetrician with their care. Through these various means, we have been able to identify 41 women in our patient population who have become pregnant. Using personal interview, questionnaire, and review of perinatal records, pregnancy-related risks and complications were studied.

    RESULTS: With over a 95% follow-up rate on the patients identified as having been pregnant following surgery, we found less risk of gestational diabetes, macrosomia, and cesarean section than associated with obesity. There were no patients with clinically significant anemia.

    CONCLUSION: Since the patients had an operation that restricts their food intake, some basic precautions should be taken when they become pregnant. With this in mind, our patients have done well with their pregnancies. The post-surgical group had fewer pregnancy-related complications than did an internally controlled group that were morbidly obese during their previous pregnancies.

    Obes Surg 1998 Aug;8(4):461-4; discussion 465-6

    Lactose Intolerance After WLS

    Lactose, the natural sugar found in milk products, is digested in the small bowel by means of the enzyme lactase. About 10% of adults in the United States are lactose intolerant. They do not have enough lactase to digest milk. When they eat milk or milk products, they develop crampy abdominal pain, bloating and diarrhea. Lactose intolerance can be acquired after gastric bypass or other gastric surgeries by as many as 10% of patients. When a person with a normal stomach drinks milk, it accumulates in the stomach and then is released slowly into the small intestine. There is enough lactase available to handle a small amount of milk at a time. After gastric bypass, milk passes directly through the gastric pouch into the small bowel at a much higher rate. The milk overwhelms the available enzyme and the lactose intolerance symptoms occur.

    The strategies to deal with lactose intolerance that develops after surgery are to take milk products more slowly, eat thicker products such as yogurt or cheese rather than liquids milk, avoid milk products all together, or take an enzyme substitute Lactaid with meals.
    The following information on the lactose-controlled diet and use of lactaid was provided by Marylyn Swift, RD from a hospital dietary manual.

    Monday, May 9

    Back-to-Basics – Long-term Tummy Maintenance

    I’ve talked to quite a few readers recently and we all have one thing in common: About the third year after gastric bypass we get hungry. And we eat more. And weight starts to creep back on. In the worst case a patient regains so much weight a revision surgery is required to again reduce the stomach and facilitate weight loss. In the best case, the patient catches the problem early and reverses the trend.

    In my third year out when this happened to me and I saw the scale jump ten pounds I called my counselor at my bariatric center. She told me “Get Back-to-Basics immediately.” She recommended that for ten days I eat like a post-op newbie. Jell-o, chicken broth, soft-cooked eggs. No solids. Lots of liquids. No snacking. Take my vitamins. Drink lots of water.

    I was so terrified of regaining the weight that I followed her directions exactly. She told me, “You have already done this once when you had surgery. You certainly can do it again, and this time you are much healthier.” She was right!

    The first day was hell. I was hungry and crabby. The second day was not as painful. By the third day Back-to-Basics was routine. By the tenth day my weight was down 7 pounds, my body felt lighter and happier. I felt unpolluted. Best of all, my tiny pouch seemed to be tighter and less tolerant of over-filling and that’s a very good thing! I was eating like a newbie again, recommitted to following the four rules and succeeding after weight loss surgery.

    Now, to be honest, I’ve had to employ this technique more than once to get myself back on track and avoid weight regain. Sometimes I’ll go Back-to-Basics for a long weekend, just to refresh and rejuvenate my body. I like the power the mindfulness of Back-to-Basics gives me, the complete awareness of my body and it’s needs. I like being able to remind my mind and body of this powerful bariatric tool. I like that when I do see a weight gain I can quickly get it under control by employing past practice that I know works.

    Are you in your third year and hungry? Give the Back-to-Basics a try.

    Say NO to Food Pushers After WLS

    Dear Readers – I came across this clever article with a helpful list of declinations when being pressured by a hostess to “Eat! Eat!”. After WLS this was one of my biggest peeves – the food pushers who didn’t like taking no for answer. I think for a time in my life I was a food pusher, and now I’m trying to be more respectful of my guests when they decline my food offers.

    Take a look at what Virginia Bola has to say:


    How To Cop An Attitude With An Overzealous Hostess
    By Virginia Bola, PsyD

    We all encounter those hosts and hostesses who feel it is their duty to make us eat whatever their specialty is and generate a sense of guilt if we do not flatter their creation by stuffing ourselves with it, regardless of our weight control plans and weight loss goals. Here are some nice ways to decline her offering.

    For example's sake, we will use her justly famous (but horrendously caloric) cheesecake.

    10 Nice Ways to Decline:

    1. Thanks, but I came to enjoy your company, not your cheesecake.

    2. I'll trade everything on that plate for a cup of your incomparable coffee.

    3. Before I eat anything, I'd love to see your new vacation pictures.

    4. This time I'm really losing weight so I can't break down, even though I know how delicious your cheesecake always is.

    5. Thanks, but no thanks.

    6. Thanks, but I'm on a mission - to thin-dom.

    7. It looks too good to eat . . . I'd hate to spoil it.

    8. I'm on a very strict diet that unfortunately bans your terrific cheesecake.

    9. I already filled up on your wonderful dinner, perhaps next time.

    10. Wow, that looks gorgeous but it just isn't something I'm allowed right now.

    When these don't work (and they won't), bring on the big guns - the declinations that ensure your hostess will not continue to press you further but may actually retreat to the other side of the room to bug someone else.

    The Big 15 (That Really Work):

    1. Sorry, but I'm allergic to cheesecake . . . my eyes swell shut.

    2. Thanks, but cheesecake always gives me flatulence.

    3. Thanks, but I'm already so full I'm having trouble keeping everything down . . . where's your bathroom?

    4. Thanks, but I see my personal trainer first thing in the morning and if I've slipped, he's a sadist!

    5. I spent the day at the dentist's office so I couldn't touch anything.

    6. My aunt almost died of food poisoning from eating cheesecake - I just can't face it anymore.

    7. Sorry, but I hate cheesecake.

    8. My grandmother was eating cheesecake when she died. I've never touched it since.

    9. I'd love to, but cheesecake always gives me immediate hives.

    10. Sorry, but I'm a cheesecake alcoholic. One bite and I'll eat the whole thing.

    11. Sorry, I don't do cheesecake - and you shouldn't either, honey.

    12. I'm fasting this week and it's time for my enema.

    13. I'd love some, but cheesecake always makes me throw up.

    14. Cheesecake always makes my crowns fall out.

    15. If I eat that, I'll be forced to lead all your guests in 50 sit ups immediately afterwards.

    Caution: you may not be invited back again for a while (but you're on your way to successful weight control).

    Virginia Bola is a licensed psychologist and an admitted diet fanatic. She specializes in therapeutic reframing and the effects of attitudes and motivation on individual goals. The author of The Wolf at the Door: An Unemployment Survival Manual, and a free ezine, The Worker's Edge, she is currently working on a psychologically-based weight control book: Diet with an Attitude. She can be reached at http://dietwithanattitude.blogspot.com

    Article Source: http://EzineArticles.com/

    Saturday, May 7

    How do you like me now?

    Dear Readers:

    WARNING! I’m about to take a leap off the “Politically Correct” high dive, so hold on to your tiny tummies and watch for the splash!

    I know the story we all tell: that we had gastric bypass surgery for our health, to prolong our lives, cure co-morbidities and to live better. It wasn’t about appearance; it was all about our health and wellness. I could talk about the health and wellness benefits of weight loss surgery for seven days and seven nights: “Blah, blah, blah – YAWN!”

    Sure health, wellness, fitness are all well and good (thank you Dr. Wittgrove). But the things I honestly thrill and chill about, the things I leap for joy over – the cherry on the bariatric sundae – are those “How do you like me now?” moments! Toby Keith sings the song:

    How do you like me now?
    How do you like me now,
    Now that I'm on my way?
    Do you still think I'm crazy
    Standin’ here today?
    I couldn’t make you love me
    But I always dreamed about living in your radio
    How do you like me now?

    This is my bariatric anthem because for too long, for too many years I felt belittled and demeaned because I was – horror of horror’s – fat! But then I made the ULTIMATE sacrifice – I gave up every comfort I’d ever known and had the good doctor whack my stomach down to the size of an egg. And I shrunk and was fat no more. And I avenged myself. These are a few of my “How do you like me now?” moments:

    The chance meeting with a former “love interest” from college who broke my heart and spirit when he said to me, “Sorry, I don’t date fat chicks.” Years later when our paths crossed again I was thin and he was fat. How do you like me now?

    The day the coffee shop manager handed me my coffee and said, “There’s no charge for a pretty lady.” How do you like me now?

    The day I went to Sears to purchase my second treadmill because I’d worn out the first one. The clerk looked me up and down, not with disgust implying it was about time I do something about my fat, but instead, he looked with appreciation and said, “I can tell you are serious about exercise.” How do you like me now?

    The day I saw another man shake my husband’s hand and say, “You have yourself a FINE woman there,” appreciating me for my outward appearance. How do you like me now?

    The day I had sex with my husband in broad daylight, naked! How do you like me now?

    The year we attended my family reunion and my cousin who excluded me from childhood games because I was a “fatty-fatty-two-by-four” noticed how thin I was and didn’t comment. She didn’t comment because it was her who now “couldn’t get through the kitchen door.” How do you like me now?

    The day I didn’t get fair raise for my job performance and I had the courage to speak up and say this won’t do. When I was fat I would have sulked silently, but now I stood up for myself and I was awarded a fair raise. How do you like me now?

    The day I went to the hotel pool in a two-piece swimsuit and didn’t feel like a beached whale and nobody stared or whispered behind there hands “look at the fat lady.” How do you like me now?

    The day I was stopped for speeding and the officer said, “No ticket for you, today. Just a friendly warning,” and he winked. How do you like me now?

    The day I boarded an amusement parks roller coaster and fit quite comfortably in the seat. How do you like me now?

    The day I ran into my former sisters-in-law, AKA, the “glamour girls” and they didn’t recognize me. Their brother divorced me because I was fat. I am fat no more. How do you like me now?

    The day I stopped on the sidewalk, bent at the waist to tie my shoelace and a guy whistled at me. How do you like me now?

    The day I walked into the “normal” sized clothing store at the mall, and nobody turned to stare and wonder what the hell the fat lady was doing in there. How do you like me now?

    And the list goes on . . . How do you like me now?


    So, tell me, What are your “How do you like me now?” moments?

    Friday, May 6

    My Hair is Falling Out!

    One of our readers mentioned hair loss - in case you missed the post here's a link to the topic of hair loss which occurs during the phase of rapid weight loss after gastric bypass.

    Walk This Way!

    Step for step, mile for mile, walking is the best cardiovascular activity you can include as part of your weight loss surgery success story. Walking is easy, accessible, inexpensive, individual and effective. It is the gold-star sport for real people with real lives! Formerly stigmatized as cheap transportation and a senior citizens’ sport it is now a credible and fashionable form of exercise! And it’s been around for a long time – anthropoids stood upright and put one foot in front of the other thousands of years ago and we haven’t looked back since!

    Now validated, as a vigorous fitness activity walking has become America’s most popular physical activity with over 20-million people stepping out regularly. Studies abound touting the benefits of walking: including weight loss, lowered risk of stroke or heart disease and improved mental well-being. While it may sound trite, 30-minutes of walking a day will keep the doctor away!

    Outlined below is the 12-week walking program that worked for me following gastric bypass surgery. By week four you will be meeting the Surgeon General’s recommended 30 minutes of moderate exercise a day, and more importantly, you will feel great about your progress!

    Be sure to record your walking activity beginning on the very first day. Find a notebook, a journal, or a computer program where you can record your time and distance each day! This may sound silly the first week when you are taking 5-minute walks, but by week 12 you will rejoice at your progress if you have a record of where you began.

    To achieve maximum benefit from this walking program, you will need a good pair of soft athletic walking shoes, preferably with ankle support. I suggest you get these prior to surgery so you don’t have the “no shoes” excuse to put-off your walking program. Give them to yourself as a gift acknowleding your bravery and courage to make this positive change in your life.

    Next, plan where you will walk. Raise your hand if you already own a treadmill! Mine was stored in a forgotten corner of the basement, bought with the best intention, but abandoned for a number of excuses. Get that old friend out and put it where you’ll use it. Most treadmills for home use are rated at a 250-pound weight limit. Fresh out of surgery, most of us exceed that limit. Fitness equipment manufacturers say that if the weight limit is exceeded, but at a slow pace for short duration, the treadmill should not be damaged. I say, take your chances and walk on the treadmill. It won’t take long before you drop below the weight limit and in the meantime you are becoming stronger and fitter by taking short walks on the machine.

    If your climate and neighborhood are equitable plan a walking route out-of-doors. Prior to surgery measure your route by the quarter mile. One determined patient I know walked one driveway further each day until she made it all the way around the block. Counting driveways is how she marked her progress. Good for her!

    Do you prefer to walk in the climate-controlled mall? Plan a walking route there – just be sure to swiftly step past the cinnabuns store! Many malls have early hours when people can gather and fitness walk without having to navigate around shoppers.

    For best success sip water throughout your walk. Wear comfortable clothing for easy movement. Avoid exercising in extreme weather – too hot or very cold.

    Now equipped with great shoes, comfortable clothes, a walking route and a journal to record your progress you are ready to take your first step! Here is my plan to walk your way into a healthier life!

    12-Week Post WLS Walking Plan

    Week 1: Take two 5-minute walks every day. Week one begins as soon as you are released from the hospital. Because of your recent major surgery and your past sedentary habits you may have poor endurance. By starting with 5-minute walks you will not become exhausted or discouraged, you will begin to build strength!

    Week 2: Take two 7-minute walks every day. Go at your own pace. If at the end of 7 minutes you feel like walking further continue, but no more than 10-minute intervals. You are getting stronger! Congratulations!

    Week 3: Take two 10-minute walks every day. Your abdomen will be healing now, concentrate on your posture! Good posture allows muscles to be used more efficiently! For more on good posture see Chapter 6.

    Week 4: Take two 15-minute walks every day at your own pace! Congratulations – you are meeting your 30 minutes of exercise each day! Doesn’t it feel great?

    Weeks 5-8: Gradually shift from two daily 15-minute walks to one walking session of 30 minutes each day! Make sure as you transition from two short walks to one long walk that your total walking time for the day equals 30 minutes. For example, one 20 minute walk and one ten minute walk. Walk proudly, swing those arms and applaud yourself! You are doing an excellent thing for your physical and mental health.

    Weeks 9-12: By now you have healed from your surgery, you are experiencing great success with your weight loss. It is time to pick up the pace and cover more distance in your 30 minutes of daily walking. Try each day to walk just a little bit further. Step proudly and get moving – you are going to love how good you feel!

    Excuse Busters: You CAN Walk After WLS

    Still not convinced walking is for you? Have some excuses you are using to deny your body and mind the pleasure of physical motion? Read on!

    Not enough time to walk? I don’t think so! Not when in the beginning you only need to walk 10 minutes a day – and by week twelve you are spending one-half hour a day walking! That’s a half-hour sitcom, surely you can squeeze that amount of time into your day to make your life healthier and more meaningful. One walking group claims time is all we have and walking for exercise will probably extend your time on earth! Bottom line: You don’t have time not to walk!

    Afraid you might injure yourself walking? Probably not. Walking is about the safest form of exercise around – in fact, walking injuries are slight such as blisters, mild cramping, or sore knees and joints. If you follow the program above and build up your endurance and strength you are at slim risk for injury. A cautionary word, pedestrians are killed by motor vehicles. Outdoor fitness walkers can avoid this fate by using walking trails or sidewalks. Walk facing traffic, wearing light colors and reflective clothing and double-check both ways before crossing streets.

    Too embarrassed by your size to be seen “exercising” in public? Admittedly, this is my personal favorite excuse, and I don’t think I’m alone. I’m lucky enough to have a treadmill in the basement, and even at a healthy weight, I prefer the privacy of my home to walk for fitness. If you don’t have a treadmill another option is a walking fitness video that will have you marching about in front of the TV building cardiovascular supremacy in the privacy of your own world. Try Leslie Sansone’s “Walk Away the Pounds” video.

    Exercise may be the most difficult change to incorporate into your lifestyle after weight loss surgery. Unlike the food restrictions necessary to affect weight loss, exercise does not come with surgically achieved tool to help you. Exercise is entirely up to you. Times have changed. Consistent moderate exercise has replaced the no-pain, no-gain torture of decades past. Exercise and fitness has become more pleasurable and less injurious. Daily exercise improves our physical appearance, our health and our overall sense of well being. We must not cheat ourselves the innumerable positive benefits exercise brings to living. Start slowly, set reasonable goals. Reach and surpass those goals. Your life now, after gastric bypass, is about health and wellness. This can only be achieved with a commitment to physical movement.

    Thursday, May 5

    Can We Have Our Gastric Bypass and Party To?

    Happy Cinco de Mayo day! If you are celebrating this holiday at home why not give my Shrimp Soup a try for a little south of the border flavor! ‘Ole!

    In many parts of the United States Cinco de Mayo is an important way to proudly honor Mexican heritage. Non-Mexican Americans also participate in the celebrations, much in the same manner that the non-Irish observe St. Patrick's Day, with holiday-themed parties marked by the consumption of Mexican food, tequila and Mexican beer.

    For a gastric bypass patient, any of the three: Mexican food, tequila and Mexican beer or the three combined can spell trouble. Rice and beans that are staples in Mexican food are dense and clog the system quickly. Tequila absorbs and intoxicates rapidly and beer bloats tiny tummies.

    So the question is, can we have our gastric bypass and party to?

    Here are my hints for making merry after weight loss surgery:

    If you are attending a party with a food buffet, first before dishing your plate, survey the food. Identify key protein sources and plan to eat protein for 50-percent of your intake. Consider splurge choices, such as a rice or tortilla items and partake cautiously. Identify one dessert and save it to taste last when you are almost full.

    Take little servings. We still have that “clean up your plate” habit, so don’t overfill your plate.

    Know your enemies – for example, if you know processed flour products make you sick avoid them. If you know you dump on sugar-dairy (ice cream) don’t have any. It’s just not worth it - a party is not fun if you get sick

    Be leery of hidden sugars, such as barbeque sauces or fruit dishes and avoid them.

    One of the classic dieting tips for the “regular” people is to eat a small meal before a party so you won’t be hungry and eat too much at the party. Sorry, folks. This is a bad plan for WLS people – all of our meals are small and it is ineffective to try and pre-eat before an event. Don’t bother.

    By the same token, avoid grazing for the duration of the party. Remember, grazing or snacking is the number one reason WLS patients regain weight. I like to floss and brush my teeth when I’m done with the meal – this helps me refrain from grazing. If this is possible give it a try, it may help you too.

    It’s important to drink plenty of water on the day of the party. It is especially important to have your cells well hydrated if you intend to splurge on wine or a mixed drink. (I know I nag about the water – it must be important!)

    If you splurge on wine or a mixed drink avoid the frozen tropical drinks such as Pina Colada, Daiquiri or Margarita. Consumption of these iced sugar-alcohol beverages takes you on a guaranteed short trip to dumpsville. Just don’t go there. It’s not worth it. Same thing with Tequila shooters – just don’t go there, you will get sick.

    A good mixed drink ratio is one-part liquor to three-parts mixer. Club soda or diet soda are good mixer choices. And the classic rule to drink a glass of water between drinks works well for WLS people – water, water, water.

    Red wine is a better choice than white wine because it has a lower sugar content. Sip slowly and be sure you have eaten some food. (I know the rule is no drinking liquids with solid food, but this is a party, not an everyday behavior. It’s ok to tweak the rules occasionally if you do it smartly.)

    Remember your water! (Did I mention that?)

    Have a great time at your celebrations! Remember you are Living After WLS! Send me your hints & ideas for safe celebrating.

    Happy Day!
    Kaye

    Wednesday, May 4

    Success Story: Judy H. Wright

    Dear Readers:

    I am pleased and honored to present Judy H. Wright's Living After WLS success story to you today. Here's an excerpt of her beautiful and inspiring story:

    For the first time in years, I feel normal and in control when making food choices. Now I am able to enjoy life to the fullest and have the energy and stamina required helping other families raise their standard of living through my books and workshops. Finally, my spirit and body are in sync and I am ready to go forward.


    Please click the link to read her complete story. Thank you, Judy, for sharing with us.

    Best wishes,
    Kaye

    Life Walking

    One of the best things to come of my WLS several years ago - I learned to love walking for the sake of walking. I used to loathe moving my body; walking was laborious, a real chore. Right after surgery I walked because I had to; it was a condition on my new lifestyle. Now I walk because I need to - my body needs the movement of walking and my mind needs the meditation time walking gives me.

    I found this wonderful article by Laxmi Krishna about Life Walking. I hope you enjoy.

    Life Walking: Don't Walk Just For Exercise - Change Your Life


    By Laxmi Krishna

    "Life walking" is more than walking for exercise and fitness objectives. It's the larger ideal of using walking to change your life.

    The objective for this New Year is simple: Get moving. Don’t wait. Time is running out on your sedentary lifestyle. What can you do to make this year count for your weight loss goals - and your life walking? Two simple things at least:

    One: If you’re the type who is doing absolutely nothing right now, please start to do some walking regularly. Any walking at all contributes to physical activity – and well-being. If you’re already modestly active, then do a little more every day and you’ll feel great. You will lose weight but gain something else - a life walking!

    Two: Walking is the numero uno activity you should focus on. Sure, there are millions of other choices for exercise, but we all know of people who are waiting till they find the "best exercise". How many of them are in fact wasting more time looking, rather than finding? That kind of ultra-perfectionism in choices leads nowhere.

    If you’re like the rest of us, the so-called "formal exercise" may not be part of your inclination or even your “must-do” agenda. But life walking can be. Remember, even if it’s just to and from the front door, you are already a walker. You have been a walker since you took your first steps as a baby. All you have to do is more of it.

    It's a strange fact that in 2005 we have to tell people to walk more. But humans have spent so many centuries reducing their need to walk, that it's now become necessary to tell people they have to "return to life walking".

    The industrial age, the automobiles we have, the tele-commuting we now do, the dial-a-life we now ring for everything - and the zillion other similar "conveniences" we have added to our lives ... these have all now become the collective cause for the greatest "inconvenience" we can have hoped to have - disease!

    Every passing year, technology encourages us in the life of a "Sit Where You Are And Be Served, Oh Master!" kind of existence we have built for ourselves.

    Fine. Let's look at the bright side. We no longer have to walk for the conduct of our lives. We have to now walk for life!

    I would like to stress that you should make walking a part of how you live every day, not make it an exercise project. It’s not a chore. It’s not an obligation either. It’s not even something to consciously think about. It's become an imperative!

    One year from now how actively would you be able to say you have lived life?

    Say, you’re downstairs … and need something from upstairs: Would you yell for someone to get it for you, or would you be sure to bound upstairs and get it yourself without a second thought? Not because you have to, but because it feels good to move again - a long-forgotten skill and thrill revived.

    When you actually start looking for chances to move, not ways to avoid it, you’ll know you have come full circle. By then, your body will surely reflect this weight loss and dynamism too. Importantly, your life will also feel lighter.

    "Movement is in your nature. Just put it in your routine." is what Mark Fenton says in his book "The Complete Guide to Walking".

    I'd add: Instead of pursuing mere weight loss, remember there's a bigger revival crying for your attention - today, decide instead to regenerate the life walking!

    Laxmi Krishna is a bestselling author on weight loss. She succeeded in losing weight superfast -- 30 kgs. in just 32 weeks, with no dieting -- through a unique walking program she has designed. She reveals her success secrets in her path-breaking guide.
    Visit Laxmi's site at http://www.walking-calories.com

    Article Source: http://EzineArticles.com/

    Tuesday, May 3

    After WLS: Successful Patients Embrace Four Stages of Growth

    Weight Loss Surgery is often viewed as a quick fix for morbid obesity. One day a person is fat, the next they are not. While it may appear to onlookers that a gastric bypass patient is losing the weight without personal struggle or effort, this really isn’t true. WLS patients must follow four rules for success and they experience four phases of growth following surgery.

    The four rules for successful weight loss and long-term weight maintenance are: Eat protein first; No snacking, Drink lots of water and get daily exercise. Adherence to these rules moves the patient smoothly through the four stages of bariatric growth which I define as: Conception, Infancy, Adolescence and Maturity.

    Conception begins when patients consider surgery as a treatment for morbid obesity. It could be prompted by a life threatening illness such as heart disease, diabetes, high blood pressure or high blood cholesterol, asthma, heartburn or sleep apnea. Or perhaps lifestyle prompts it – a person may lack the energy to play with their children or pursue the activities they love. Maybe self-esteem is so low because of obesity that a drastic measure – surgery – is needed to restore a sense of self-worth.

    Conception is followed by birth, an event left entirely to a carefully selected surgeon and staff of healthcare professionals. The surgeon partitions off most of the stomach creating a pocket or pouch that will hold one ounce of food. In most gastric bypass surgeries the digestive system is re-routed to bypass the intestine and shortcut to the bowel. This prevents too many calories from being absorbed and stored by the body in the form of fat. The patient wakes from the surgery a bariatric infant.

    Infancy. On the second day of my WLS infancy my surgeon stood at my hospital bedside and showed me a cup, the size in which sacramental communion is offered and he said “This is the size of your stomach now.”

    Just like bringing a newborn home from the hospital the bariatric patient brings home a tiny newborn tummy that has all kinds of requirements and restrictions. This new tiny tummy is completely foreign to the behaviors and habits that caused obesity. There is not one single thing an obese person has done in the past that they can continue doing. Patients who strictly follow the four rules quickly become acquainted with their new tiny tummy. This is the time of rapid weight loss. For the first time most morbidly obese patients are consistently losing lots of weight, something they have never experienced before. Infancy for most bariatric patients lasts from nine to 18 months.

    Similar to parents of a firstborn child who focus completely on their new baby, during bariatric infancy patients completely focus on their new tiny tummy. Then one day, without fanfare, they wake up and rediscover themselves. They enter adolescence.

    Adolescence. Adolescence is the stage when patients test the system. Many patients don’t dump, vomit, snack or eat the forbidden foods until they reach adolescence. But once they approach or reach target weight a mental bad boy shows up in a shiny black corvette saying take a ride on the wild side. So a patient jumps in the bad boy’s fast ride and speeds down a dangerous road. They break the rules! Perhaps they eat sugar which results in a blood sugar imbalance called “dumping” or they may stuff themselves with starchy carbs causing vomiting. In the worst case, a patient returns to snacking, a little treat of hard candy here and a handful of popcorn there. Mark my words, nothing stops-short weight loss or maintenance more quickly than a little bit of rule breaking. But like any teenager, we all have to learn it on our own

    The good news: the duration of adolescence is up to the patient! A patient only hurts themselves when they break the rules. Successful WLS patients commit to themselves early to be in control of their own gastric bypass growth cycle. However, some WLS patients get stuck in adolescence. I’ve heard many say, “Oh, I can eat anything I want, just not much of it.” Don’t believe it for a minute. They aren’t saying how often they vomit, or dump or how they never quite achieved their weight loss goal. Weight loss patients who eat anything they want are abusing their tool and stuck in perpetual adolescence.

    Maturity. At maturity a patient understands the gastric bypass system and is living the life they dreamed. They have achieved desired weight loss and are maintaining a healthy weight. A diligent patient can enjoy this phase for the rest of their life.

    I believe WLS maturity is reached when patients understand one word: respect. Respect for the tiny tummy, respect for the science of the body, and respect for oneself. Sure, we all experience an occasional lapse of judgment; that old lover of ours – food - is flaunting temptations every single day. But the gastric bypass patient is a brave and powerful person. Successful patients build on infant and teenage experiences and become an adult embracing all the good things gastric bypass has facilitated. The battle against obesity isn’t easy; patients will fight old habits for the rest of their life. Gastric bypass is a tool, a weapon in the battle against obesity, but it is the patient who wins the war.