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Thursday, December 28, 2006

Essay contest entry

This is the essay I submitted to Quick & Simple Magazine that won me the beautiful sapphire-and-diamond bracelet you see here:
"I'm less than half the woman I used to be, yet in so many ways, I'm twice the woman, wife, friend and employee I ever was.
"I've lost close to 190 pounds in the last 18 months with the help of gastric-bypass surgery. Though many consider it to be a coward's method of weight loss, I've never worked so hard in my life. Surgery has required me to focus on myself and my health for the first time in my life.
"I used to consider exercise a luxury I couldn't afford and used that excuse to remain sedentary. I convinced myself that my job was too demanding to allow for planning and cooking my meals, and I often ate fast food daily. I spent many years hiding behind my job, saying that if only it were less stressful, I would have the time needed to lose weight. Then I was diagnosed with obesity-related infertility after a year of trying to conceive. My weight problem was no longer something I could put off to deal with later when life was less hectic.
"It was then that I realized something had to change. I knew bariatric surgery would force me to rethink my priorities. Rerouting one's innards leads to an altered perspective. Suddenly, exercise was a necessity instead of a luxury. Planning my meals was as important as breathing, because protein deficiency would lead to serious complications. Rest became something upon which I depended. Before surgery, I would sleep two to four hours a night, figuring the time most people spent in bed was better spent at the office or trying to catch up around the house.
"Surprisingly, focusing on me and my needs didn't make me lazy or put my job in jeopardy (my biggest fear). These changes have made me more productive. It's amazing how much you can accomplish in a standard day when you're operating on eight hours of sleep and are appropriately nourished and hydrated. I've gone from working 18-hour days to 10-hour days, and my husband loves the fact that he finally has a wife who comes home at night and has energy left over to devote to him. And most importantly, my weight loss and change in perspective have prepared me for the challenges of motherhood -- something I hope to experience in the near future.

"Almost" Famous

I won an essay contest from Quick & Simple Magazine last fall by submitting a piece on how bariatric surgery changed my life. A brief article quoting from my essay (see above) is in this week's issue of the magazine, available at most grocery store and Wal-Mart check stands (in Tracy, you can find it at Wal-Mart and Albertsons). The Jan. 2 issue, which costs $1.59, will be available for sale at least through Saturday.

I'll post the essay I entered in its entirety later today.

Friday, September 01, 2006

Does being fat make kids stupid?

A recent study out of the University of Florida links extreme obesity in children with low IQ scores.
According to an article on WebMD, the study found children who were 150% above their ideal body weight by age 4 tended to have lower IQ scores and mysterious spots on their brains later in life.
Click here to read the full article.

Wednesday, August 30, 2006

Recipe: Caramel-Hazelnut Shake

Caramel-Hazelnut shake
2 scoops vanilla Zero-Carb Isopure
1 c. ff Lactaid Milk
3 T. Coffee Mate sf Hazelnut non-dairy creamer
1 oz. sf Torani Caramel syrup
Ice (I use an entire tray)

Add everything in blender but ice and blend together to combine. Add ice cubes one by one to create consistency you desire.

Calories: 335
Protein: 59
Carbs: 16
Fat: 3

Notes: I like using the sugar-free and fat-free Coffee Mate creamers, but I often have a problem in which the amount needed to solicit the flavor I want is too rich for my tummy.

Monday, August 28, 2006

Overweight? Asthmatic? Australia's army wants you

Click here to read an interesting story on Australia's army lowering its standards to bolster recruitment numbers.
What do you think about this idea? Post your thoughts in the comments section.

Sunday, August 27, 2006

Recipe: Chocolate-caramel-brownie shake

Chocolate-caramel-brownie shake
2 scoops PD Alpine Chocolate
1 cup ff Lactaid milk
1 shot Torani sf caramel syrup
4 Joseph's sf brownie bites
Ice cubes

Blend liquid ingredients until smooth, add brownies with ice cubes and pulse until same thickness as a Dairy Queen Blizzard (I use an entire tray of ice cubes).

It's important to note that this is not a low-calorie meal. This was yummy, but I would not add the brownie bites in the future -- they add 100 calories and 14g of carbs, which isn't worth it for the minimal flavor boost. Also, I typically use ff Lactaid milk, but dh brought home reduced fat and I didn't realize it. So, the reduced fat milk has 130 calories per cup, versus only 80 for the ff version. The caramel syrup has no nutritional value for a 1-oz. serving.

So, here's the stats for what I actually drank this morning, though you could easily cut 150 calories by making the substitutions mentioned above:

Calories: 420
Protein: 49
Carbs: 38
Fat: 10

Saturday, August 26, 2006

Great finds at Cost Plus World Market

I took an impromptu trip into Cost Plus World Market today, because I had heard the store carried a variety of Torani syrups sweetened with Splenda. I've discovered that such flavored syrups are a great way to add variety to my protein shakes without having to invest in myriad flavored powders. It's amazing how much you can do with basic chocolate and vanilla when you have various flavorings to add to them.

However, World Market had more to offer me than just the Torani syrups. En route to the flavoring aisle, I stumbled upon the store's sugar-free section. Tucked away at the end of an aisle by the candy, I found various sugar-free treats that I had thought were only available on the Internet.

Just about every flavor of Joseph's sugar-free cookies were there. The crunchy, bite-size cookies aren't only great for snacking but also make an incredible low-carb crust for sugar-free pies and cheesecakes. I like snacking on the pecan shortbread, which I also use for my cheesecake crusts. The chocolate-walnut cookies are great as a crust for chocolate pies, and I use the lemon cookies in the crust for my sugar-free key lime pies. The only variety I found today that I hadn't previously tried was the soft brownie bites. I can wait to try them and tell you what I think of them.

Enchantments soft-baked cookies were also available. The store had frosted lemon, chocolate-walnut chunk and snickerdoodle varieties in stock. I picked up the snickerdoodles and will report on them later.

Also available was sugar-free black licorice (no red), gummi bears, Jelly Belly jelly beans and Guylian belgian chocolate. I've heard from other bariatric gourmets that Guylian is the best brand of sugar-free chocolate on the market so I picked up a bar in each flavor to try and use in cooking.

I was so excited by these finds that I almost forgot my Torani syrups. Good thing my husband was there to keep me on track. Though the full-size bottles of Torani are on sale right now for $5 each (regular $5.99), I decided to buy the smaller 5-ounce bottles to try out. Sadly, there was not as much variety in the smaller bottles but I managed to pick up raspberry and caramel. I can't wait to make a chocolate-caramel protein shake. I already know it'll be tasty. For those braver than me, the store had full-size bottles in Irish cream, toffee, vanilla, caramel, raspberry, peach and others -- all sugar-free. There was even sugar-free white chocolate and chocolate syrup.

It was an exciting trip, to say the least. I've spent so much time over the past two years investing time and money buying these types of products on the Internet. Not only is it risky to buy stuff sight unseen for the most part, but it gets expensive to ship glass bottles and heavy packaging.

Knowing I can buy such stuff in Tracy makes life so much easier for me. And it guarantees I'll make numerous stops at World Market in the future.

Thursday, August 24, 2006

Product Review: Better Balance Pretzel Snacks

Kay's Naturals Better Balance Cinnamon Toast Pretzel Snacks
• $2 for a single-serving bag

These thin soy-based snack sticks resemble cereal twigs, but they don't taste nearly as good. According to the package, a bag of these snack sticks offers 120 calories, 9 grams of carbs, 6 grams of fat and 10 grams of soy protein.

At first taste, the crunchy sticks offer a good cinnamon-sugar flavor but the heavy soy aftertaste and sandy texture ensure they won't be something I eat again.

Hit or miss? Definitely a miss.

Wednesday, August 23, 2006

Product Review: Water Sensations Liqui-Packs

Water Sensations Clear Liquid Flavor Enhancer for Water
• About $4 for a box of 16 Liqui-Packs
• Comes in the following flavors: Mixed Berry, Natural Peach, Natural Kiwi-Strawberry, Natural Grape, Natural Lemon and Natural Orange

Each Liqui-Pack is meant to flavor a standard 16.9-oz. bottle of water. The flavoring packets have no calories and are sweetened with Splenda. In fact, the ingredient list is pretty minimal: filtered water, natural flavor, citric acid, ptassium citrate and sucralose (the official name for Splenda). The idea behind the enhancers is that you can take them with you to use anywhere. Instead of hunting down a vending machine with Propel or Fruit2O, you can just order a glass of water or buy a bottle somewhere and flavor it yourself.

I've tried the mixed berry and natural peach Water Sensations, both in about 20 oz. of water, because I'm not one for super-sweet drinks. The natural peach flavor tasted as if I had sliced a peach into my water. I didn't find it overly sweet, and I will admit that I slurped down my 20 oz. of water faster than usual.

I didn't like the mixed berry nearly as much, but I've never been one to enjoy berry-flavored water. I don't know why, but berry seems like an odd flavor for water to me. I actually ended up dumping it out because it was just too weird for my liking.

If you check out the Water Sensations Web site,, you'll find that the flavor packets aren't just for water. There are suggestions for using Water Sensations to flavor iced tea, yogurt, warm beverages and sparkling water. And I'm sure as these little packets gain popularity, the site will offer even more ideas.

Hit or miss? Definitely a hit. I've already bought a box of the peach flavor and look forward to trying the lemon and orange ones as well.

Tuesday, August 22, 2006

Fat Clock's ticking

Diet Detective, a Web site devoted to fitness a nutrition, has now posted the Fat Clock. The clock, in the upper right corner of the site's home page, shows the escalating weight off all Americans combined.

"It's tied to population and changes about 8 pounds a second," says Charles Stuart Platkin, founder of Diet Detective and a syndicated health-fitness-nutrition columnist, in a recent Sacramento Bee article.

Here's the full story.
Fat Clock says it's time to watch our weight
Sacramento Bee
Actress Kirstie Alley, one-time star of the Showtime comedy series "Fat Actress," may have lost 65 pounds thanks to Jenny Craig, but thanks to the rest of America, the Fat Clock is piling up poundage.
Diet Detective's Web site has posted the Fat Clock, real-time calculations of the aggregate amount of weight gained by American adults ages 20 and older.
"It's tied to population and changes about 8 pounds a second," says Charles Stuart Platkin, founder of Diet Detective and a syndicated health-fitness-nutrition columnist.
Remember the National Debt Clock that was in New York's Times Square? The Fat Clock is similar. Putting on pounds in a blur of numbers, the Fat Clock had a starting weight of more than 39 billion pounds _ impressive but not enough adipose deposits to alter Earth's orbit.
Crunching numbers from the U.S. Census Bureau and the federal Centers for Disease Control and Prevention, Platkin hatched a formula to confound Einstein. He spent six weeks perfecting his formulation to determine escalating weight gain.
"There's a lot of research behind it," he says. "It can be seen as a public health awareness tool to see how rapidly we're gaining weight."
But do we really want to know?
"I do," says Delores Bartella, sipping coffee at a Starbucks in Carmichael, Calif. "I truly think American children and adults are eating too much junk food and not getting enough exercise. It's a good thing to remind people."
Peggy Howell, spokeswoman for the National Association to Advance Fat Acceptance, vehemently disagrees.
"It's utterly absurd," she says by telephone from her Las Vegas home. "There was a recent study that said focusing on diets and weight loss is actually counter-productive."
Howell said she believes people shouldn't focus on "how much weight they're gaining every second of the day," but on a healthy diet and allowing the body to "take care of itself."
Statistically speaking, two out of three adults in the United States now are considered overweight, according to the CDC. The number of overweight people ages 6 to 19 has tripled since 1980.
"I hope people won't feel overwhelmed by the numbers," says Platkin. "But policymakers, politicians and health-awareness campaigns out there should take note."
The news that the world is populated by 1 billion overweight people _ more fat folks than the 850 million undernourished people _ certainly is food for thought.
"Obesity is the norm globally, and undernutrition, while still important in a few countries and in targeted populations in many others, is no longer the dominant disease," professor Barry Popkin of the University of North Carolina told a conference in Australia recently.
Fat Clock founder Platkin knows obesity firsthand. He once carried 220 pounds on his 5-foot-9 frame and says he was obese all his life until he took charge. Twelve years ago he lost 50 pounds and has kept it off.
"I'm tipping the scales at 165 pounds now," he says. "The quality of life can be horrific when you're obese."
(Dan Vierria can be reached at dvierria(at) Distributed by Scripps Howard News Service,

Monday, August 21, 2006

Poll: Widespread delusion among parents about kids' health

A poll of Canadian parents show they drastically discount the size of their children, a Scripps Howard News Service story reports.

"Parents seem to be looking at the health of their own children through rose-colored glasses," said Dr. Ruth Collins-Nakai, president of the Canadian Medical Association, which commissioned the survey.

The poll found that only 9 percent of parents believe their children are overweight. Researchers found that 26 percent of the children of the parents polled were actually overweight or obese.

Here is the full article:
Poll: Widespread delusion among parents about kids' health
Toronto Globe and Mail

A new poll shows that only 9 percent of Canadian parents believe their children are overweight or obese. That is markedly less than the 26 percent who are, in fact, overweight or obese, according to data collected by a federal agency, Statistics Canada.
"Parents seem to be looking at the health of their own children through rose-colored glasses," said Dr. Ruth Collins-Nakai, president of the Canadian Medical Association, which commissioned the survey.
Over all, Canadian children rated poorly in the eyes of adults, with only 6 percent garnering an "A" for overall health among respondents.
But, again, those surveyed had a much higher opinion about the behavior of their offspring, with 40 percent of them earning top marks.
Collins-Nakai, a pediatric cardiologist, said she worries that the self-delusion of parents is cushioning kids from reality and will lead to poor health outcomes.
"I have a very real fear we are killing our children with kindness by setting them up for a lifetime of inactivity and poor health," she said.
The CMA, which represents the country's 62,000 physicians, releases an annual report card to measure public feelings about the health system.
The overall grades vary little from year to year, with two-thirds of Canadians giving the system high marks (A or B).
What is new this year is the report card's focus on child health, a central issue at the CMA's policy convention this week in Charlottetown, Prince Edward Island.
The group is expected, among other things, to call on Ottawa and the provinces to adopt specific targets for improving child health, and to support the adoption of a Charter of Children's Health.
The survey asked what immediate initiatives should be taken to improve the health of children.
Respondents showed broad support for mandatory physical education from kindergarten to grade 12 (92 percent), a mandatory school curriculum on the benefits of physical activity and healthy diet (87 percent), and removing all junk foods from schools (81 percent).
In the poll, parents showed a desire for better nutritional information and warning labels on food, tax breaks on health foods and tax deductions for the fees paid by children participating in sports. The survey also found lukewarm support for a ban on junk-food advertising and opposition to junk-food taxes.
Guido Van Rosendaal, chair of the council on health care and promotion of the CMA, told the conference that Canada has to begin by setting specific and aggressive public-health goals related to child health.
Delegates were also presented with sobering statistics showing that Canada has an infant mortality rate of 5.3 per 1,000 live births, a perinatal mortality rate of 6.3 per 1,000, and a maternal mortality rate of 4.6 per 100,000 live births. These data place Canada in the middle of the pack among developed countries.
Landon Pearson, a former senator and longtime activist now associated with The Landon Pearson Center for the Study of Childhood and Children's Rights at Carleton University in Ottawa, told delegates that Canada has to move beyond the "vague splendid goal of healthy, happy children" and set real targets to improve childhood health.
(Distributed by Scripps Howard News Service,

Thursday, August 17, 2006

Product Review: Herbalife Products

At the recent ObesityHelp conference in Visalia, I received a sampler pack of numerous Herbalife products from one of the convention attendees.

For those unfamiliar with Herbalife, it's a line of nutrition products available for purchase through independent distributors. The company offers various lines, from weight management to general wellness products.

I haven't yet had the opportunity to try all of the products I received in my sampler pack, but I've tried enough to offer an opinion on them.

Protein Bars ($16.95 for a box of 14 bars)
These bars are fairly standard as far as protein bars go. They have a clay-like texture and are coated in either a chocolate or white candy-like coating. Though calorie count varies according to flavor, each bar offers 12 grams of protein, about 6 grams of fat and about 15 grams of carbohydrate. The bars are sweetened with sugar alcohols, so they are safe for sugar-sensitive post-ops.

I've tried each flavor -- peanut butter, chocolate fudge, lemon and chocolate coconut -- and consider them to be decent. Peanut butter was my favorite. Of all the flavors, I think it had the least protein aftertaste. Lemon was my least favorite. The other two flavors were middle of the road to me.

Personally, I wouldn't consider buying these for myself. They are so dense that I can't eat more than half of a bar, which only gives me about 6 grams of protein -- not nearly enough to make it pouch worthy.

Roasted Soynuts ($10.95 for a box of 14 packets)
These are no different than the average roasted soynut, except they are seasoned with Cardia salt, a low-sodium seasoning. I thought the Cardia salt had a strange taste so I emptied about half a packet of Splenda into my packet and shook it up to give the nuts a salty-sweet taste similar to kettle korn.

I don't think these soynuts are any different or better than the varieties available at the grocery story, but the single-serving packets are handy -- especially if you have a tough time regulating your portions when it comes to snack foods. Each packet provides about 130 calories, 5 grams of fat, 5 grams of fiber and 11 grams of protein -- a very nutritious snack for anybody but especially good for a post-op. And they definitely satisfy any craving for crunch.

Peach Mango Beverage Mix ($10.95 for 7 packets)
This is an instant beverage mix that offers about 70 calories, less than a gram of fat, 2 grams of carbs and 15 grams of protein. I was really excited to try this, and it seemed like it would be good. the powder mixed well in water with a few stirs of a spoon. The finished product was a little cloudy, but it didn't seem too bad. Then I took a sip, which I promptly spit out into the sink. I can't offer any specifics on what I didn't like, apart from everything. The initial taste wasn't good, and the aftertaste was terrible. There was an overbearing protein taste to the beverage, and I couldn't think of anything to improve it. In hindsight, mixing it in a blender with ice and fruit may have made it drinkable, but that would have defeated the purpose of having a convenient drink mix that can be made anywhere.

Herbalife herbal concentrate ($19.95 for 1.8 ounces)
I first tried this product, a thermogenic drink mix that contains green tea, about seven years ago. To this day, it's still my favorite product and it makes a tasty sugar-free drink. I favor the original flavor. The single serving packets are great when you're on the go. Just dump it into a standard bottle of water with a few packets of Splenda mixed in.

Tuesday, August 15, 2006

Product Review: Tropical Oasis Liquid B-Complex

Tropical Oasis Liquid B-Complex Supplement-$23 for about 32 ounces

I was excited to try this vitamin b-complex supplement. I use Tropical Oasis' liquid calcium supplement, and I love it. It's tasty and provides a large amount of calcium in a small dose.
I wish I had similar praise for the B-Complex supplement. Unfortunately, the liquid vitamin B supplement is icky. It contains all B vitamins, so I hold each dose under my tongue for a minute to allow my body to absorb the B-12 before swallowing it. That may be why I think it tastes so terrible. Most liquid vitamins are only in your mouth for a moment, but when you're letting a dose sit in your mouth for a minute, the nasty flavors are more noticeable.

In talking with some fellow post-ops, I've discovered that all liquid B-complex supplements are gross. The consensus among my friends is that one of the B vitamins (everyone's assumption was that it's B1, or thiamine.) has a disgusting flavor that cannot be masked.

Most gastric-bypass patients don't need a B-complex supplement. Those who are diligent will get all needed vitamins and minerals by taking a specialized multivitamin, about 2,000 mg of calcium, iron and a weekly B-12 supplement (monthly if injected). However, there are increasing numbers of post-ops who have become deficient in thiamine. And supplements such as this one are an unfortunate necessity for those people.

The smartest thing any post-op can do is take all required vitamins daily to avoid ever getting deficient so yucky supplemetns are a requirement.

Hit or Miss? Miss this one, unless you truly are deficient in one of the B vitamins.

Sunday, August 13, 2006

Something for almost nothing

I've already blogged about how the small turnout at the OH conference in Visalia was a boon for its attendees, but I didn't realize how much of a perk it was until returning home and unpacking.
As I unpacked all the samples and full-size products I received at the conference, I realized what I walked away with was worth a pretty penny. And I'm not the only one who went home with loads of stuff; just about every other participant did as well.

Here's what I received at the conference -- and each product's estimated sales price -- in giveaway prizes, as part of the registration packet and as snacks throughout the conference weekend:

Nectar Fuzzy Navel protein powder (2lb. canister) — $24.95
Profect Protein Beverage (five 2.7-oz vials)– $15
Tropical Oasis Liquid B-Complex Supplement — $23
PowerCrunch protein bars (4)— $8
AchievOne coffee-flavored protein drinks (4) - $8
Bariatric Advantage Vitamins (three days' worth)-$3
Herbalife Protein Bars (2) — $2.50
Herbalife Roasted Soynuts (1 packet)- 75 cents
Herbalife protein drink1 packet)- $1.50Herbalife protein shake (1 packet)- $2
Herbalife take control (2 days) - $2
Herbalife herbal concentrate (2 packets) — 50 cents
Water Sensations Liqui-Packs (1 box) -$4
Better Balance Pretzel Snacks (1 full serving) -$2

I'm not the queen of math, but by my quick survey, these products have a market value of about $95. This happens to be exactly how much a three-day pass to the conference cost those who registered early. Talk about breaking even. Not only does this help make attending the conference financially worthwhile, it also helps bariatric patients by allowing them sample a variety of products geared toward them without shelling out a wad of cash on an uncertainty.
Keep reading over the next few days as I post reviews of each of these products as I try them. I imagine some will be good, while others will leave much to be desired. But at least I can say I will have tried them.

Learning to think thin

Presented by Dr. Monica Ganz,director of events and support groups for OH

The difference between thinking as a thin person vs. a fat person is when you need to get somewhere, a thin person will give you street names when they deliver directions. An overweight person gives you eateries as landmarks.

Portion sizes
Eating off standard American dinner plates can lead you to feeling deprived. Using small plates and utensils teach us to relearn to eat – to eat smaller bites and smaller amounts. Monica used a timer to limit herself to one bite every three minutes to teach herself to take a full 30 minutes to eat her meals. She even used miniature pots and pans to cook her meals. Buy smaller leftover containers to portion out your meals.

Taking pictures
You may not want to look at them right away, but you need to have photos to document your pre-op size and your loss along the way. Many post-ops suffer from body dysmorphia, which means that they do not see themselves as the size they truly are. Pictures will help train yourself to see your true size.The amount of time body dysmorphia lasts depends on how long you were obese and how long it’s been since you’ve lost weight. Remember, it takes time for the mind to catch up to the body. And for some, it takes five years to get their brain in line with their appearance.

Taking measurements
Measurements are important because you will lose inches even when you’re not losing weight on the scale. And the record of your measurements will also help drive home the impact of your weight loss.

Drinking water
Be prepared to make sure you get enough fluid. Line up eight 8 oz. bottles in the fridge and make sure you drink all of them before going to bed each night. Or take two 1 liter bottles of water to work with you and drink them before going home. Do whatever it takes to ensure you reach your water goals.

Learn to stop eating
You need to convert to controlling your food instead of letting it control you. Change the way you think about eating. Eat to live; don’t live to eat. Learn to walk away from your plate when you’re satisfied. You don’t have to clean your plate.

Figure out what works for you
If vegetables or beans give you gas, take Beano. Gas is no fun after gastric bypass. Passing it is difficult; it’s best to help your body not make it. Carry Lactaid with you if you’re going to eat dairy products because many post-ops become lactose-intolerance. Keep other condiments with you such as Splenda, Molly McButter, low-carb dressings and even sugar-free mints so that you’re never caught unprepared.

Support groups are so important because the success rate for post-ops is higher among those who attend such groups. It helps keep you accountable. Having trouble staying motivated? Start your own group. Nothing will motivate you more than having to set an example for others.

Fat clothes
Get rid of your clothes as you shrink out of them. You’ll never need them again. Accept that. If they are in your closet, regaining your weight will be an option in the back of your mind. That’s not an option.

Get a full-length mirror
Obese people only look from the neck up. Look at your entire body. Get in touch with how you look. You need to keep looking in the mirror to see yourself as you really look.
Surgery is a toolThis is not a magic pill. America is still looking for that. This is merely a tool, but it’s an amazing tool that will help you reach your ultimate goal.

Dare to dream
Set goals and achieve them and reward yourself for that. Each of us is capable of incredible things if we allow ourselves to do so. Give yourself permission to dream, believe your ability to achieve those dreams and allow yourself to accomplish them.

Getting on the ball

Presented by Karen Donaldson of Excel Weight Loss Solutions

Karen Donaldson is a fitness and nutrition professional who lives in Idaho. She has presented numerous sessions this weekend on fitness, massage and aromatherapy. I had the opportunity today to sit in one of her fitness sessions using exercise balls.

Inflated exercise balls – also called Balance Balls – are commonly used in Pilates and yoga classes, but their usefulness doesn’t end there. I’ve exercised with them regularly for about five years, but mainly just to work my ab muscles. That’s the greatest thing about the balls – because they provide an unbalanced exercise surface, everything you do on them works out your core muscles. A word of warning, though: Sometimes you don’t realize how good of a workout you got until you try to get out of bed the next morning.

Today’s class was popular, with a few participants taking it for a second time. We started by getting a feel for the ball by doing hip rotations and figure-eights. This enabled everyone to get their balance and learn how they moved. Then we walked our feet our in front of us until our lower backs rested on the ball to do sit-ups. We laid across the ball to do push-ups. We laid on the ground and rested our legs on the ball to do pelvic raises. We even did leg raises and played catch using the ball – only we had to catch the ball with our legs.

The class was the fastest hour of my life. Everyone had a great time. The versatility of the ball meant that everyone – regardless of size or fitness level – was able to exercise with it. One man marveled that it was the first time in decades that he was able to do push-ups. Another woman was surprised that she could exercise her abs without having to lie on the floor and struggle with getting up. Others couldn’t believe how much fun it made exercise. As a testament to that, more time was spent laughing than talking, but we each broke a sweat and left feeling the effects of the exercises.

Emotional Eating

Presented by Dr. Monica Ganz, director of events and support groups for OH

I decided to sit in on today’s emotional eating workshop, because it’s heavy on audience participation and I thought it would be useful to see if any new information would be presented today. If you want to read about the full, prepared presentation, check out Saturday’s post.

This is more of a compilation of notes and tidbits extrapolated from today’s session.

The basic theme of the session is that everyone struggles with emotional eating in some form or another, but the key is how you handle it that determines whether it will derail your success.
Monica is big proponent of finding out your emotional eating triggers and using that knowledge to substitute other behaviors for eating. If you eat because you’re stressed out, find ways to relax yourself (bubble baths, aromatherapy, exercise, etc.). Monica uses a sound machine that lets her feel like she’s near the ocean to have alone time, because she believes we each need time for solace. One participant said she finds crafting (scrapbooking, needlecrafts, etc.) to be relaxing. An added bonus is that it keeps her hands busy, and that means she doesn’t graze or snack. Other ways participants mentioned they relax included drinking a cup of tea, doing crossword puzzles, online chatting, swimming and sunbathing and playing cards.

Another woman brought up a recent “A-ha Moment”: She’s 18 months post-op and has found herself grazing at night. One evening, she got involved cleaning her bedroom and found that it was 11 p.m. and she hadn’t eaten since dinner. It was at that point that she realized that she needed to keep herself busy in the evening to stave off her urge to snack. She said it’s frustrating to have these thinks pop up just when she thinks she has everything figured out, but Monica points out that this is a lifelong process. We’ll always learn new things about ourselves, our triggers and our needs.

For me, I’ve recently discovered that working at home has triggered me to graze at night. I’ve always been the type of person to eat at my desk, and I’m a workaholic – the two habits don’t mesh. What I didn’t realize is that when I started working from home in the evenings a few months ago, my couch became my desk. And when that happened, the urge to snack went from being something that only happened at the office to something that I had almost around the clock – because I no longer felt like I was leaving the office. Monica, who has worked from home for the last 20-plus years, said setting boundaries is the key. She’s had similar issues, which is why she has a dedicated workspace in her home and sets specific work hours so that she officially leaves the office each day. Not a bad idea.

The lone man in the group is considering surgery. He said he has a habit of unwinding in front of the computer and often eats while chatting or playing games. After asking him a few questions, Monica drew from him a big picture of his basic day. He works 5 a.m. to 5 p.m. He said he typically eats breakfast at 10 a.m., lunch at noon, a snack (like a full sandwich) at 5 p.m., dinner at 7 p.m. and then grazes until 3 a.m. some nights.

Monica explained to him that by grouping some meals so close together and then having a huge gap between others leads him to severe highs and lows in his blood sugar. Planning his eating episodes to be equally spaced apart will enable him to keep his blood sugar level and also control his portions.

The subject then turned to cravings. One woman from the group talked about how sometimes her cravings for cake or sweets are so overpowering that she goes ahead and buys the cake, eats one bite and throws it away. She knows she’s spending hundreds of dollars on food that she tosses in the garbage, but it helps her stay on track. She also talked about occasionally getting something that she takes a bite of and then spits out without swallowing it. She enjoys the taste but doesn’t worry about the calories or after-effects of eating off-program foods.

Changing the Paradigm

Presented by Seth Margolies of Weigh2Win

Seth had surgery in 2003 and lost 188 pounds. From the beginning, he said, he understood that there was a high failure rate because people fall into old habits. For him, failure was not an option.

His belief is that unless you create a partnership, you will not have long-term success. You have to change the way you look at your lifestyle. Surgery alone will not keep you thin or in shape, but most surgical facilities don’t offer a fitness component so it falls to the post-op to become accountable for their own success.

Find ways to add activity to your life beyond your structured exercise time:
-Throw away the remote and get up to change the TV
-Get up and walk during commercials
-Take the stairs
-Walk the dog

The American College of Sports Medicine recommends 30 minutes of cardio per day and two days a week of strength-training. Yet only 15% of the U.S. population follows this guideline. The health benefits of three 10-minute spurts is just as effective as one 30-minute session.Seth is a firm believer in strength training because it improves the overall appearance post-ops and can reduce the need for cosmetic surgery. Women who do an hour twice a week of resistance training have less abdominal fat. Strength-training also increases your metabolism and keeps it elevated for longer periods of time.

If you’re inactive after surgery, your ability to eat more food kicks in. And if you fall in that, then you’ll start gaining weight back and be right where you started.

“Surgery is not the end of your battle with obesity," he said. "It’s the beginning of you starting to deal with it. And if you’re lucky, you’ll go into remission.”

Exercise improves mental health.
A Duke study took two groups of clinically depressed patients, gave one batch antidepressants and the other exercised 30 minutes a day. At the end of the study, both groups had 60% of its participants no longer depressed.

Workout tips:
-Start slowly
-Slowly increase the time spent and the intensity
-Set realistic goals that are measurable
-Visualize what you’re going to do
Track your progress
-Wear comfortable clothes

Don’t forget to mix up your routine to curb boredom and also to help your body break through its natural instinct to plateau. Think about variety. Think outside of the box when it comes to exercise. It doesn’t have to be just about going to the gym or following a fitness tape. Some like going to the gym because it’s a social experience. Others hate it because they are embarrassed or overwhelmed. Most people hate exercise because it’s boring, but it doesn’t have to be. You can make a fitness program out of cleaning house, if you do it to music and don’t take breaks. You can walk to run your errands instead of driving.

Losing weight and maintaining weight loss is as simple as calories in vs. calories out. Each of us burns calories at a different rate. Seth says it takes him three hours of exercise to maintain his weight when eating 2,000 calories. Start looking at food in relation to the amount of time required to burn it off.

It’s important to find something you love doing and do that as your exercise. If you like bike riding, make that your routine. If you like skating, then make time to skate regularly. Take dance classes. If you’re having fun, you’re more apt to keep it up.

We’re never going to be perfect, but we each have to do the best that we can and accept that’s our version of success. Changing the paradigm is amount loving yourself enough to put yourself first. Love yourself enough to give your body a break when you need one. Eat nutritious foods, because the better the food is going in, the better your body will run. Love yourself to invest in high-quality food.

Support is important. Surround yourself with loving, supportive people. Don’t waste your time with those who are negative.

Saturday, August 12, 2006

Emotional Eating

Presented by Dr. Monica Ganz

Normal eating consists of eating when you’re hungry, eating until you’re satisfied, eating a wide variety of foods, not avoiding foods out of fear and being flexible and varied.

Emotional eating consists of eating in response to feelings instead of hunger, such as:

Rewarding yourself
Other ways to deal with emotions and food cravings:
Take a walk
Listen to music
Take a bath
Call a friend
Drink water (dehydration causes hunger rather than thirst)

Avoid high-sugar, high-carb foods
Keep a journal of what you eat and when so you can figure out your triggers. This helps you to break the cycle of unconscious eating. Making a decision to eat also ensures you don’t feel guilty about what you eat.

Change is difficult, but it’s the only thing in life that is consistent. Adapting to change is necessary for success. Before surgery, we were eating ourselves into our graves. We have to change our behavior if we want to be successful. Monica says she still wants to eat everything in front of, but she chooses not to eat it. Surgery is a tool that enables her to stick with that commitment.

A lot of post-ops who don’t learn to cope with their emotions will turn to alcohol, sex or other destructive behaviors to replace their food addiction.

Emotional eating issues from attendees:
“Last Supper Syndrome”: Gorging as a pre-op in preparation for surgery. -This is common among pre-ops who fear they are never going to be able to eat their favorite foods again. The important thing is to recognize that it’s normal and just try to make the healthiest choices possible.

Fast food is taboo-Stay away from fast food. That’s a behavior that got us to a point that we’re morbidly obese. Surgery requires an entire lifestyle change, and part of that change requires staying away from the triggers from our pre-op life.

Anger associated with food intolerance-“Nobody warned me that I couldn’t have pasta or tolerate meat.”-“Nobody told me I’d have to eat tofu, but it’s all I can tolerate.”-It’ll take a period of mourning, but eventually you will accept your limitations

Interest from the opposite sex
“I’m the same person I was before but now that I’ve lost weight, everyone has a brother for me to meet. I’d rather just not date.”-You’ll start meeting people who didn’t know you when you were obese, and you’ll start off on different footing with them. Monica said she also doesn’t waste any time with people who didn’t have time for her when she was overweight.-Everyone has emotional baggage, but it’s up to us as individuals to decide whether we hang onto it.

Desire for food hasn’t gone away“I just wish I didn’t still want the food.”-Surgery is a tool that helps us walk away from the table without overeating.

Low-key lunch

One of my favorite things about the lunches offered at OH events is the fact that they are always bariatric friendly. Today's lunch was tuna salad, chicken salad, green salad, mixed fruit and fat-free Jell-O pudding snacks for dessert.

During lunch, I had the opportunity to meet Dean and Lori Banks, who are also from Tracy. Lori had RNY gastric bypass at Kaiser's Fremont facility three months ago. Since then, she's lost 47 pounds. She hasn't had any complications, and said she's pleased with her results so far. It was quite exciting to run into somebody from home who is on the same path as me.

How our weight loss affects our children

Presented by Dr. Monica Ganz and Nicki Ganz

Nicki was 17 when Monica had RNY gastric-bypass surgery in 2002. Since then, Monica has lost well over 300 pounds.But it wasn’t until a holiday trip a few years ago that Monica realized how her drastic weight loss affected her daughter.

“She walked into the house and hugged my sister, and she hugged her for a long time,” she remembered. “When she was done, she said, ‘Now that’s a mommy hug; I don’t get those anymore.”

Monica says she went to the bathroom and cried and then realized that she had been morbidly obese her daughter’s entire life. And Nicki had to adjust to losing the mother she always knew.

“It took me a really long time be OK with mom sharing clothes with me,” Nicki says.

Monica jumps in saying, “It was so exhilarating to be able to wear my daughter’s clothes that it never occurred to me how it would affect her. It took my husband to say, ‘That’s Nicki’s; you may not wear that,’ for me to realize what I was doing.”

Nicki admits that she still doesn’t like sharing clothes with her mother, especially if she thinks they look better on her mom.“

She’s always bigger than me in my eyes,” Nicki says. “Having her buy clothes the same size as me can be devastating.”

Other changes
Mealtime has also changed for Monica’s family. Though she still cooks for the family, she doesn’t eat everything she makes. She also will often need to leave the dinner table to avoid overeating.

“It’s rare that we have a full-length dinner with the whole family anymore,” Nicki said. “It’s usually just me and my dad left at the table.”

Monica says you have to be careful about the speed in which you make changes for the children. You can’t abruptly limit everyone’s portions just because you’re eating differently. Food changes need to be gradual, especially if the children are older. Younger children are more resilient and accepting of change. You can’t take an older child who you’ve let snack on chips and junk food without oversight and then take it all away from them and expect them not to resist the change.

The whole point, Monica says, is that this process doesn’t only involve us. Many of us think it’s all about us, because surgery is the first thing we’ve done for ourselves. But it involves and affects our children, spouses, siblings, parents and friends.

“Find out what works for your family and stick with it,” Monica said.

She also cautions against over-informing children. Only give them the information they need; otherwise, you may scare them.

“Older children have a harder time with the transition,” Monica said. “When they are in their teens and 20s, you’ll face jealousy and other emotions. It’s very scary from their perspective. The image they’ve always had of their mom doesn’t match what they now see.”

Nicki mentions her trouble with picking her mom out in stores anymore.

“Before, I just looked for the biggest person around, and that was usually Mom,” she said. “Now, I have a hard time finding her.”

Many pre-ops fear lost relationships, which Monica addressed by saying, “You have to remember why you’re doing this.”

Keeping the line of communication open is very important. Don’t just talk about your weight loss, Monica said. Make sure you talk about other stuff.

Nicki also talks about the difficulty adjusting to her mom’s increased activity.

“I wish she’d come back to the family,” she said. “She used to always be at home or around if I needed her. Now, she’s always on the phone or working or away from home. I feel like this new passion has now come first, almost.”

One Year+ Post-op: Now what?

Presented by Dr. Monica Ganz, director of events and support groups for OH

Losing weight after the weight loss stops
When you first have surgery, your pouch is about the size of your thumb – mainly because of swelling and irritation from the procedure. The pouch takes a year to 18 months to heal, and healing allows increased food intake.

Another cause of post-op weight gain is that some people start to be less diligent with exercise after a year. It’s typical to consume more a year after surgery. You have more foods available to you, because you’ve spent the first year experimenting with new foods and now know what you can and can’t tolerate. Some people think they are hungrier, which is unlikely if there is decreased activity. Also, many post-ops never experienced true hunger before surgery because they were eating all the time. Monica says they were never truly hungry yet never truly satisfied either. Eating more nutrient-dense foods also leads to eating more calories.

Statistically, 50% of WLS patients will gain back more than 50% of the excess weight lost by five years. Twenty percent will gain back 20% of their weight loss immediately upon reaching their goal weight.

Calories in minus calories out equal a change in weight: When you take in the same number of calories you expend, your weight stays the same; when you eat more calories than you expend, you gain weight; and if you eat fewer calories than you expend, you lose weight.

Inadequate Weight Loss
Calorie intake too high/hunger: Are you planning your meals and spacing them apart appropriately? Are you making good food choices? The surgery doesn’t fail the patient; the patient fails the surgery.

Metabolism too low/hypoglycemia: Are you eating frequently enough? Are you making sure you eat protein-rich foods? You should have six planned eating events per day. That includes meals and protein supplements. Micronutrient deficiencies can also affect metabolism. Skin can be very sensitive to tape two years after surgery because of micronutrient deficiencies.

Why do we stop losing?
Again, it’s about calories in vs. calories out. Each of us has set weight that our body prefers. Not everyone is meant to be a size 4 after surgery. It can be done, but some post-ops find that the sacrifices required to keep body weight that low isn’t worth it in the long run.Eliminate excess or empty calories. Look for ways to cut out unnecessary fat and calories without compromising your nutrition. That means, cut out simple carbohydrates not protein. Don’t go crazy counting calories; realize that you need to improve your lifestyle, you are not on a diet. Pay attention to the glycemic index and pick foods that score lower.

All calories are NOT created equal
Energy density, water content, fiber content, absorption, processing and storage all contribute to the effects of calories on the body.Fruits and veggies are high in fiber and water and low in calories. Crackers, cheese and fatty meats contain a lot of calories relative to how heavy they are.
Foods that have a high water and/or fiber content add bulk to your meals, so you’ll feel satisfied without eating more calories. For example, a quarter-cup of raisins has the same calories as 1.75 cups of grapes, but the grapes will be more filling. 100 calories: 23 M&Ms, quarter-cup of raisins, 5 oz. Jell-O or 2.25 cups of strawberries. Obviously, the strawberries are the best option as a filling food. McDonalds large fries is 540 calories, which is equal to 22 cups of raw broccoli, 135 baby carrots, 17.5 oz. chicken breast or 4.5 whole sweet potatoes.

Soft carbohydrate syndrome
Soft carbs are the arch enemy of WLS patients and are the cause of weight gain or plateau in the majority of patients. If you can crush it, and it crumbles, stay away from it. That’s a sure sign of simple carbohydrates, which travel through the pouch easily and offer very little nutritional value or satisfaction.

Vendor fair

There are about a handful of vendors at today's session, peddling everything from fitness videos and equipment to nutritional supplements and vitamins.

I'll be spending a few minutes with the vendors -- many of whom are leading workshops this weekend -- today and tomorrow to get a little more information on the products they represent and what has led them to make a career out of serving the obese and morbidly obese population.

Bariatric Advantage
Seth Felix is the Bariatric Advantage sales rep attending this weekend’s event. The son of a bariatric surgeon, Seth says he grew up with knowledge and interest in both bariatrics and obesity-related issues. He’s been with Bariatric Advantage for a little less than a year, but is an avid proponent of the products and confesses to snacking on some of the food items at work.

I used Bariatric Advantage vitamins – all of which are chewable – from three months before surgery to about a year afterward. I only switched brands because I was tired of the flavors. I’m happy to see the company debuting new flavors of vitamins and branching out beyond just vitamin and mineral supplements.

Seth told me the company will introduce two new flavors of its already-popular 400mg calcium supplement lozenge. BA already has mint, cinnamon – the top seller – and chocolate. Within the next two months, lemon and sour cherry will also be for sale. Seth excitedly tells me that they taste like Sweet Tarts and will offer a nice change for those who are tired of the original flavors.

BA’s No. 1 selling product, according to Seth, is the orange-flavored multivitamin for gastric-bypass patients. Like me, this is the BA product most bariatric patients start with, because all surgeons recommend a good multivitamin.

Bariatric Advantage also offers a multivitamin for LapBand patients that is called VitaBand. Because Bandsters don’t have to worry about malabsorption, their vitamin and mineral needs are different than bypass patients. Seth says the main difference is that VitaBand has iron included, and it’s the only BA vitamin that comes in watermelon flavor.“

We’re starting to get a lot of complaints from people who want our other multivitamin to be offered in watermelon as well,” he said.

Seth also spent a little time telling me about the company’s new products, such as their food supplements. BA is now offering food items for early post-ops, such as protein supplements and cereal. Packaged for easy travel, the products come in smaller, bariatric-friendly portions. He says the chocolate cereal reminds him of Cocoa Crispies. The cereal comes in chocolate, vanilla and banana – which can be exciting for post-ops sick of just chocolate and vanilla.

Another new product is the Promend AGB, which Seth says can work for bariatric patients but is actually geared toward post-ops who have cosmetic surgery. It’s a drink powder that provides 10g of protein and various herbal supplements to promote healing after cosmetic surgery.“And it tastes just like lemonade,” he said.

Excel Weight Loss Solutions
Karen Donaldson of Pocatello, Idaho, has been in the fitness industry for more than 20 years. As the founder of Excel Weight Loss Solutions, she works with people on nutrition, exercise and weight management.Karen started in the fitness industry focused on the disabled and those of limited mobility, which led to her eventual exposure to the obese and morbidly obese population.

“I’ve never been interested in working with jocks,” Karen said. “Those people will work out no matter what. I’d rather serve the rest of the population. It’s about real life.”

Dr. Monica Ganz, director of events and support groups for ObesityHelp, is a strong supporter of Karen and her program. Monica invited Karen to attend an OH event about 2.5 years ago because she was impressed by the workout video she produced.

“The nice thing about it is that anybody can do it – regardless of their fitness level,” Monica said. “And the videos feature normal-size and overweight models, which is important to me.

That fact has not been lost on Karen.

“Nobody is motivated by seeing somebody prance around in a thong leotard,” Karen said. “But if you look at someone who looks normal or is close to your size, then you believe you can do it; and you’re much more motivated.”

The other reason Monica is a big fan of Karen’s is that her exercise programs use resistance bands and exercise balls.

“This is something that everyone can do,” Monica said. “When I had surgery, it never occurred to me that I could exercise while sitting down. At that time, I couldn’t even walk.”

Also, as someone who travels more than 100 days each year, Monica favors the portability of the resistance bands. They don’t take up much space in the suitcase and are easy to do in hotel rooms.

“This keeps me on track,” she said. “I would never use the hotel gym, but I can use these in the privacy of my own room on my own time.”

Karen, who is presenting workshops this weekend on insulin resistance and strength training and on using exercise balls, also has her own line of aromatherapy products.Monica favors the aromatherapy locket with a piece of felt anointed with Appetite Balance, which helps curb cravings.

OH Visalia Conference -- Day 2

I have a few minutes between getting ready and eating breakfast to jot down a few thoughts before heading out to today's session.

I learned something interesting about ObesityHelp during dinner last night. OH does not pay its speakers a dime, which explains why its conferences are so affordable. After all, how many 2.5-day conferences have you attended that only cost about $100? Dr. Monica Ganz, the organization's director of events and support groups, says it's important to her that every penny from events goes toward making the events rewarding for attendees -- not to line the pockets of speakers.

That also explains why some sessions can be a crap shoot. When I was at the Fairfield conference in June, I overheard some attendees complain that certain speakers delivered nothing more than an infomercial for their services or products. I would say that's a gross exaggeration, but I did notice bits of self-promotion here and there during sessions. Knowing that the speakers were not paid in any way explains that, however. You can't expect them to travel to a conference unpaid without hope of some sort of remuneration or exposure to their target market.

As I'm blogging from the sessions today, I'll try my best to make it clear who offers products or services for sale so readers can make the most informed decisions regarding whether to believe the opinions of the speakers.

Oh, and keep reading throughout the weekend for my review of the numerous samples given out throughout the conference. For example, attendees last night received full-size samples of AchievOne coffee-flavored protein drinks, Power Crunch protein bars, and various other bariatric-friendly snacks.

Friday, August 11, 2006

Changing places

Because of hacking issues associated with Movable Type (the program used for this blog), the Tracy Press will stop hosting blogs. Instead, the Press will link to external blogs.
The good news is that anyone within the Tracy Press circulation area may now ask to have their blog linked from our Web site (E-mail to make such a request).

The bad news is that my blog address will change this week. As far as I know, the plan is to keep all previously posted entries up as read-only files until I'm able to move all postings over to the new site. However, I'm not sure how long it'll take me to complete my transition. In the interest of serving readers best, I'll start uploading my oldest entries to the new site first. I won't publish new material until the transition is complete.

Click here to view and bookmark my new blog site. I'm hope that using Blogger will make this column more user-friendly to visitors. Please let me know what you think.

Movie Night -- "Super Size Me"

Tonight's session ends with a screening of "Super Size Me," the now famous documentary by Morgan Spurlock. Spurlock spent 30 days eating nothing but McDonalds food. During that time, he gained about 30 pounds and suffered serious health problems.
This is the third time I've seen the movie. The first time was a year before my gastric-bypass surgery, and it was then that I swore off McDonalds. I had it at home to watch the day I was released from the hospital. It helped strengthen my resolve as my mother and husband sat on either side of me eating Jack in the Box for dinner.
It's a film I highly recommend watching, if for no other reason than to understand why this country has more than 60% of its population who are considered obese.

Importance of Vitamins and Minerals after Gastric Bypass Surgery

Led by Dr. Monica Ganz
People who’ve had malabsorptive procedures (Roux En Y and duodenal switch) are in danger of vitamin and mineral deficiencies because certain vitamins and minerals cannot be absorbed by the new digestive tract through ingestion.

Vitamins are essential for the release of energy from carbohydrates, fats and proteins. B-12, for example, is a vitamin that can’t be replenished once a person has become truly deficient in it.

Minerals don’t furnish energy but are vital in many other physiologic functions. The body stores and reuses minerals so deficiencies aren’t easily detected.

Many post-ops become deficient in iron and calcium.

Iron deficiency occurs because the pouch empties too quickly for iron to be absorbed and because RNY and DDS patients have their duodenum – where 50% of iron absorption takes place – bypassed. Symptoms of iron deficiency include fatigue, feeling cold, pica (compulsive eating of non-food items), tongue fissuring and pagophagia (compulsive eating of ice).

Supplements should be in the form of 18mg of ferrous fumerate or amino-iron, which is most absorbable. Taking iron with vitamin C (such as diluted orange juice or even a chewable vitamin C) to help its absorption. Food sources of iron include liver, oysters, shellfish, organ meats, lean meats, poultry and fish (best meat sources), dried beans and vegetables (best plant sources), egg yolk, dried fruits, dark molasses, whole grains and enriched breads and cereals.

Calcium deficiency occurs because post-ops can’t eat enough of calcium-rich foods, and the mineral is absorbed in the duodenum. Symptoms of calcium deficiency include fragile bones and hypertension.Supplements should include 1200mg of calcium citrate (plus vitamin D) per day, four servings of dairy products per day. For each missed serving of dairy products, supplement with an additional 500mg of calcium citrate. This is why many post-ops are encouraged to take up to 2400mg per day.Another problem is that calcium deficiency is hard to detect because the body will leach the necessary calcium from the bones. Dexa bone-density tests are the best way to find out whether a post-op’s body is leaching calcium from the bones. Some people also notice teeth problems, such as a loss of enamel.

Vitamins most commonly found deficient in post-ops are vitamin B1 (Thiamin), vitamin B-12 and folic acid.

Thiamin is necessary for the breakdown of glucose for energy, nerve function, good digestion, normal appetite and good mental outlook. Deficiency is rare in the U.S., except in alcoholics. Symptoms include beri beri, fatigue, poor appetite, constipation, depression, etc. Supplementation is as easy as taking a chewable multivitamin (Bariatric Advantage, Optisource, etc.).

Vitamin B-12
Vitamin B-12 aids in the formation of mature red blood cells, synthesis of DNA, stimulates appetite, promotes growth and releases energy. Food sources include liver, kidney, dairy products, fish, clams, oysters, salmon and sardines.Gastric bypass post-ops MUST supplement with B-12 because the pouch doesn’t supply the intrinsic factor required for absorption. Signs of deficiency include pernicious anemia, tiredness and neurological disorders.Supplements can be by mouth, injection or nasal spray. Monthly injections are the safest best.

Folic acid
Folic acid is necessary for formation of red blood cells. Deficiency happens because of poor dietary intake, low iron and alcoholism. Symptoms of deficiency include rapid heartbeat, fatigue, anorexia, pale skin, paranoia, or sore, inflamed tongue. Food sources include soy, leafy greens, organ meats, mushrooms, oatmeal, red beans and wheat. Supplementation is usually as easy as taking a good multivitamin.

Dining among peers

We just got back from dinner. There are about 10 people at tonight’s session, which makes for a close, intimate experience. I’ve gotten the chance to truly get to know each woman here. Two women have come from out of state for the conference – one from as far as Minnesota. The rest are from up and down the state.Our introductory session was just that, an introduction to the weekend’s activities. We’ve had numerous opportunities to ask whatever we want and get in-depth answers from Dr. Monica Ganz, director of events and support groups for ObesityHelp.The best thing, though, for me has been the experience of eating with other bariatric post-ops. In my daily life, I tend to eat with non-ops and can forget myself when eating. Sitting around a dinner table with post-ops was amazing, because we had a lot of similar habits. Many of us ordered soup for dinner. There were lots of offers to share food. And everyone ate at a similar speed. I didn’t have to worry about being the slow poke who held everyone up or having anybody comment on how much I ate (or didn’t, for that matter).

In Central CA for OH Conference

I've arrived safe and sound for the ObesityHelp Regional Conference in Visalia.

The conference begins today and lasts through Sunday. According to the OH Web site, 70 tickets are still available for the weekend. Visalia is only about 2.5 hours from Tracy if you take I-5 down and cut through Los Banos. However, there is some construction along Highway 152 in Los Banos. If you decide to drive that way, pack plenty of patience.

I'm staying in Tulare, at the Charter Inn & Suites. About 15 minutes from the Presidian Hotel where the conference is held, the hotel I'm at offers me a nice break from all the excitement that is often found at convention sites. And I happen to really like the staff here.

Today's session begins at 3 p.m. with registration and a vendor fair until 4 p.m.

Dr. Monica Ganz will host a Q&A session from 3:30 to 5 p.m. Monica is a social psychologist who had gastric-bypass surgery in 2002. She has since lost more than 320 pounds and now works for ObesityHelp. Monica is someone whom I greatly admire. Her warmth and compassion are effusive in her discussions, yet she never sugar coats the situation either. Her honesty is appreciated and accepted because it's always tempered with the compassion that comes from someone who has been morbidly obese and changed her life.

Dinner is from 5 to 7 p.m., during which time I'll try to find some place yummy to eat and also take some time to update my blog.

After dinner, the evening sessions will begin and last until 9 p.m.

Check back later today for more updates.

Thursday, August 03, 2006

Perks of the flu

There's a line in "The Devil Wears Prada" where a characters says, "I'm just a stomach flu away from my goal weight." In my former life as a morbidly obese person, I would never have understood how true that could be.

But as a "normal-size" person, I smirk at the truth of such a comment. I'm just getting over my first nasty illness since having gastric-bypass surgery almost 18 months ago. After taking a week off work and spending almost two weeks subsisting just on liquids, I'm finally on the road to recovery from what had to be the most aggressive stomach virus known to man -- or at least to me.

The week before I came down with this bug, I weighed myself at home and found I was holding steady at 158 pounds as I had for the last few months. When I went to the doctor for my stomach ailment, I weighed 158 on his office scale. I thought that was odd. After all, doctor's office scales tend to weigh on the heavy side because they get jostled so much. But I figured the scale must have been recently calibrated. But after five days of struggling to get in 300 calories a day, I noticed my clothes were getting baggy. I hopped on the scale one morning and was surprised to see it register at 150. I didn't think much of it, figuring I'd put at least some of the weight back on when I started eating solid food again.

But here I am, a week into eating solids, and not only have I not put the weight back on, but I've managed to drop another couple of pounds. And believe me, at this size, 12 pounds is really noticeable. My size 10 pants are loose, and I've gotten tons of recent remarks about looking thinner. And to think, I have the stomach flu to thank for it all.

Tuesday, August 01, 2006

OH Conference in Visalia, CA

Obesity Help will have its last Northern Californai regional conference from Aug. 11 through 13 in Visalia.
I'm looking forward to attending and blogging from the event as I did at the Fairfield conference in June. The Visalia event promises to be even bigger and better. Tickets are still available and can be purchased by clicking the above link.
I hope to see you there.

Saturday, July 01, 2006

Risks of dying from obesity higher than that of bariatric surgery

Researchers from the Hospital of Saint Raphael in New Haven, Conn., report that the risk of dying from morbid obesity is 50 to 85 percent higher than the risk of dying from bariatric surgery.Scientists announced the study findings at the 23rd Annual Meeting of the American Society for Bariatric Surgery in San Francisco this past week.

“Morbid obesity is a killer disease that requires intervention,” said Dr. Randolph B. Reinhold, lead author and chairman of Saint Raphael’s surgery department, in a prepared statement. “This study puts into perspective that for some people, the risk of not having surgery is higher than having surgery.”

According to a press release from the society, the study evaluated 1,185 morbidly obese patients from 1997 to 2004. Of those people, 908 had bariatric surgery and 112 did not. The remainder were not available for the study. Over the course of the study, 2.9 percent of the surgery recipients died compared to 14.3 of those who did not have surgery.

“Bariatric surgery has been proven to be effective in achieving sustainable weight loss in people with morbid obesity and reducing or eliminating obesity-related diseases,” Reinhold said.

Friday, June 30, 2006

Peach Cobbler Recipe

I believe I have perfected my cobbler recipe. Beau says it's a keeper...we'll see what his parents say when I serve it for dessert tomorrow. I would rather use Nature's Sweet instead of Splenda, but since I didn't have any, this is what I went with:

Tonya' s version of Grandma's Peach Cobbler
1/4 cup butter (1/2 stick)
1/2 cup almond flour
1/2 cup flour
1-1/2 teaspoons baking powder
1/2 teaspoon salt
1 cup Splenda
3/4 cup milk
3 cups peeled and sliced fresh peaches, with their juices
Preheat oven to 350°F.
Put the butter in a 9x13-inch Pyrex baking dish and put the dish in the preheating oven. While the butter is melting, mix up the batter by combining the flour, baking powder, salt, sugar and milk.
When the butter is completely melted, remove the pan and pour the batter into the melted butter. Then, carefully spoon the peaches and juice evenly over the batter. Return dish to the oven and bake for 45 minutes to an hour.

Thursday, June 29, 2006

Settling in

Just got in from the American Society of Bariatric Surgeons' Annual Convention in San Francisco.
"Information Overload" are the two best words to describe how I feel right now, but I learned some amazing information. I learned about new procedures in the field of bariatrics, saw various vitamin and protein supplements.
I saw Carnie Wilson! She's absolutely beautiful. Celebrity Fit Club must have been a success for her, because she's now at her goal weight.
I'll report more over the next several days.

Tuesday, June 27, 2006

Monday, June 26, 2006


I've been busy trying all of the yummy samples I picked up at Saturday's OH seminar.

Some quick notes:

Body Choice Premium High Protein Pudding
I was not impressed by this protein pudding. First, I don't consider 14 grams of protein to be that high. I tried the chocolate flavor, and it was gelatinous and a bit grainy. There was a distinct protein aftertaste, and I didn't like the feeling on my tongue after eating it. Personally, I much prefer Snack & Slim pudding, which provides a creamy 20 grams of protein in a 5 oz. serving and has no icky aftertaste.

Bariatric Advantage Vitamins
BA has reformulated its vitamins, which means fewer are necessary each day. The taste of the chewables is just as good as before, except the flavor of the iron has improved dramatically (I love the new passion fruit flavor).

Achiev One
As I've said before, my pouch can't handle the coffee in these 20-gram protein mocha-style drinks. But my husband thoroughly enjoyed the hazelnut version I brought back with me. He said it's even better than Starbucks Frappucinos.

Sunday, June 25, 2006

ASBS Annual Convention

The American Society of Bariatric Surgeons is gathering in San Francisco this week for its national convention. The convention includes lots of classes for surgeons to learn new surgical techniques as well as other things related to bariatrics. But the highlight of the event is the exhibitors trade show that is from Wednesday through Friday. Day passes for the trade show can be purchased by the general public for $100. I can't wait to check it out myself. I'll be there Thursday.

Saturday, June 24, 2006

Live from Fairfield...

I attended today's ObesityHelp Regional Seminar in Fairfield. I can't even begin to describe how impressed I was by the all-day event. This seminar was small with a handful of vendors manning booths with lots of samples and a series of lectures delivered in the same room. There were about 200 people in attendance, some from as far away as Utah.

I apologize ahead of time for any typos; I blogged directly from the event and pushed each segment live without running spell check. If you find fewer than 10 typos, I think I did pretty well.

For those of you pressed for time or just not interested in wading through the details, let me sum up some of my favorite parts of the day:

For the most part, I enjoyed all of the speakers. However, I was surprised by new information a few of them provided. I learned about a new bariatric procedure called vertical sleeve gastrectomy. A less invasive version of bariatric surgery, the vertical sleeve gastrectomy can be done more safely on high-risk patients and features a faster recovery time (see notes on Dr. Cirangle for more information). Another surprise was learning that peanut butter isn't considered a high-protein food. This is terrible news for the woman who often licks peanut butter from a spoon in the name of lunch. Not only is the fat content in peanut butter so high that it outweighs the protein benefit, but the protein in peanut butter isn't easily absorbed. There goes my favorite convenience food. The final, most profound, news I heard was that a runny nose, sneezing and hiccups after a meal are signs of overeating.

The beauty of attending a bariatric seminar is that there is no anxiety when lunch time comes. I wasn’t worried that the menu wouldn’t be pouch-worthy. And boy, was I not disappointed.The only plates at the buffet were salad plates, which is important for me. I tend to be a member of the clean-your-plate club, and large-size dinner plates entice me to overeat. Salad plates ensure proper portion control. Lunch was a variety of salads: a curried chicken salad, tuna salad, a selection of cheeses, fruit and a mixed greens salad. Everything was tasty and perfect.

Interesting people
I talked to a few people who attended the seminar to get themselves back on track after regaining some of the weight they lost through surgery. One woman, four years after surgery, has put back on 45 pounds. Though she is still smaller than she was before surgery, she recognizes the fact that her previous size is just around the corner if she doesn’t gain control.

She says that her body tolerated junk food better than protein-rich foods, and she took to eating those more than good-quality foods. She stopped taking vitamins, stopped supplementing with protein, started drinking with her meals, etc.

She said one of her main mistakes was to start thinking of herself as “normal” and acting as if she was an average person. It’s taken her a long time to accept that she’s not normal and never will be. To get herself back on track, she’s started taking a doctor-prescribed appetite suppressant. She says it helps her use her tool the way it was created to be used.

“The big disappointment with weight loss surgery is that it doesn’t fix the daily struggle you fight each day.”

Another testament to it not being brain surgery.

Another interesting point that came up was how many of us blame so much of life’s challenges on being overweight and expect those challenges to disappear with weight loss. But that doesn’t happen. After surgery, your spouse may still belittle you, you’re still going to be insecure and you’re still going to face all of the same emotions you had before. The difference now is that you can’t eat to cope with those problems.

Vendor faire
The vendor faire, though small, offers some great information and features. has a sampling of products available at its online store. Everything from books to MedicAlert jewelry to hygiene helpers are showcased.Another booth offers a plethora of samples from Bariatric Advantage vitamins and Body Choice protein pudding (12g).

The Body by Katzen booth features numerous photo albums of work by Dr. J. Timothy Katzen, a Beverly Hills cosmetic surgeon who will also speak at today’s event. I even got the opportunity to see breast and buttock implants. The buttock implant is hard as a rock. Gives new meaning to the term “buns of steel.”

Dr. David Elliot of Healthy S.T.E.P.s Weight Loss Center, is a Santa Rosa bariatric surgeon who will also speak today. Dr. Elliot spent 20 years in the U.S. Army and was introduced to bariatrics while studying under another surgeon. He’s been performing gastric-bypass surgery on his own for the last six years.

Lauralyn Bellamy of Embody Success is a life coach who will also speak today. She’s a post-op who specializes in helping other post-ops adjust to life as thin people.

The most popular booth of the day is probably the one with Achiev One. Only available online, either through the company directly or through bariatric Web sites such as Account Exec. Fernando Vasquez had samples of almost every flavor. He was missing my favorite – cappucino. Of course, I shouldn’t complain. After all, my pouch doesn’t even like decaf coffee, and the Achiev Ones do have a small amount of caffeine from the real coffee used as flavoring in them. The drinks are similar to store bought Starbucks Frappucinos, except that they offer 20 grams of protein in each 9.5-oz. bottle. I think they are yummy and have given numerous ones to post-ops I know with daily coffee habits. However, they are not for everyone. A woman behind me complains that they smell of beef jerky but don’t taste nearly as good.

Lauralyn Bellamy – “The Key to Overcoming Self-Sabotage in Weight Loss and the Rest of Your Life
Lauralyn spent 51 years of her life on diets before having gastric-bypass surgery three years ago. According to her, “Sabotage is a misguided effort to protect yourself.” It may seem that there is nothing to protect oneself from, but the “reptilian brain” saves us from the unknown. Since many obese people cannot imagine themselves at a normal weight with a healthy, normal relationship with food, the brain considers that a danger zone and will sabotage efforts at weight loss.

Diets work for a short time, she says, because they distract us. Obsessing over food journals, counting calories or carbs or whatever, menu-planning, exercising, etc., keeps the brain from realizing what’s happening at first. Once the brain realizes what’s happened, it kicks in survival instincts and sabotages the weight loss.

Life coaching, Lauralyn’s specialty, is about making life-affirming changes. As she says, “This is not about using food as a reward, it’s about learning how to imagine the rest of your life.”

She goes on to say that it’s important to realize that your “sabotage voice loves you” and make it an ally in your efforts. The challenge is that nobody can dismantle his or her own defense mechanism, which is why therapists and life coaches are needed, she said. One example of a strong defense mechanism, she said, is forgetfulness. A third party can help to keep you conscious throughout the day and throughout your life. That's so important, she said, because surgery alone doesn't fix everything. It's not magic; it takes work.

Dr. J. Timothy Katzen – “Plastic Surgery After Weight Loss”
Dr. Katzen’s specialty has been post-weight loss plastic surgery for the past seven years. He’s certified by the American Board of Plastic Surgery and has offices in Beverly Hills, Santa Barbara and Hawaiian Gardens. Any surgeon can call him or herself a plastic surgeon, so it is very important to make sure surgeons are board certified.

Body contouring is the general term for the type of cosmetic surgery needed after drastic weight loss.

Why is it needed?
Weight loss leads to losing fat, shrinking muscles, buckling fascia (connective tissue). The skin attempts to recoil, but age, elasticity and overall health determines how well it can resume a normal shape.

Dr. Katzen explains what he calls the “Lamp Shade Analogy.” When a person gains weight, the body balloons out – body parts become spherical. When weight loss occurs, the body shrinks, leaving the appearance of a deflated balloon.Medically, reconstruction decreases and eliminates the occurrence of rashes, improves self-esteem, improves hygiene (a big issue when dealing with excessive folds of skin) and increases the ability to exercise.

Dr. Katzen suggests gastric-bypass patients consider cosmetic surgery once weight has stabilized, about 10 to 12 months after surgery and when you’re been at the same weight for about three months. Lap-Band patients, he said, should wait about 22 months after surgery.

He believes in doing reconstruction in a certain order: torso (abdomen and trunk), medial thighs, breasts and arms. Face work can be done at any time, he said. He recommends doing the torso first, because it’s the foundation of the body. He also does not believe in doing all of the needed reconstruction in one shot. He says it’s safer to do reconstruction in a series of procedures.

Another thing to remember, Dr. Katzen said, is that reconstructions are shape surgeries not weight surgeries. Patients should not expect to lose mass amounts of weight from cosmetic surgery, though having excess skin removed may give the appearance of major weight loss.

Cosmetic surgery is considered elective and is usually not covered by insurance companies. However, Dr. Katzen explains the necessity of documenting rashes, skin breakdown, back and neck pain and hernias, which help prove to some insurance companies that the reconstruction procedures are medically necessary.

Some terms to know
Panniculectomy: Removes apron of skin and the fat in it. No muscle tightening, no hernia correction. However, this surgery is the one most likely to be covered by insurance companies.

Abdominoplasty (tummy tuck): Removes skin and fat, tightens abdominal muscles, tightens fascia, allows for hernia repair. Incisions on women can vary from a high "french cut" to a low "hip-hugger" cut or anywhere in between. For men, the incision usually follows the underwear line.

Circumferential Body Lift: A continuation of the abdominoplasty incision that goes right around to the back. The procedure not only tightens the tummy but allows for lifting of the outer thighs, removing saddle bags, removing love handles and lifting buttocks. The incision is low in front, trails up over the hip and goes back down in the rear to help the scar be covered by insurance.

Buttock implants: Dr. Katzen says he’s a firm believer in implants to create a rounder back side. He doesn’t believe other procedures last. Saddle bag removal: Sometimes, body lifts don’t fully remove saddle bags and extra work is needed.

Thigh lift: Varying procedures that tighten and remove excess fat and skin from the legs. According to Dr. Katzen, Blue Cross of California no longer covers thigh procedures under any circumstances. He predicts this to be a trend with insurance companies. If you need a thigh lift, now is the time to try for one through your insurance company.

Breast surgeries: Includes augmentation, lift or a combo of both. Incisions can be in the shape of an anchor, T or lollipop. For women, augmentation is often needed. For men, the procedure is more about flattening the region and tightening the skin.

Arms: Minor problems an be treated with liposuction, medium problems can be treated with a lift that has a crescent-shape scar hidden in the armpit, severe problems require an incision from armpit to elbow.Dr. Katzen suggests people who want cosmetic surgery to quit smoking, exercise regularly and take vitamins as soon as possible before surgery.

Dr. David Elliot – “Protect Your Pouch: Maximizing Your ‘Window’ of Opportunity”
Dr. Elliot, a Santa Rosa bariatric surgeon, starts his session with an anatomy lesson of how Roux-En-Y gastric-bypass works. A one-ounce pouch (about the size of a golf ball) is created at the top of the football-sized stomach. The opening that connects the pouch to the intestine is about the size of a dime.

To protect the brand-new pouch, Dr. Elliot recommends the following the first month after surgery:
Slow progression of diet (food intolerances are common)
Hydration, between meals – not during
At mealtime, protein comes first!
Re-learning to eat (use a small plate, eat slowly)

The stoma (openings to and from the pouch) is swollen the first month, which means that dry foods will get stuck (inducing vomiting or gagging). Also, the divided stomach is hyper-sensitive to many foods, such as caffeine and dairy, among other things. He recommends protein supplements for the first three months in an effort to achieve 60 grams a day (my doctor recommends 80).

Common causes of vomiting:
Stomal stenosis or stricture – stoma closes, causing food and water to come up. Fixed by dilation

Eating too fast – most common reason; patient should spend 30 minutes eating

Excess mucus

Stomal ulcers
Bezoars – collections of undigested foodstuffs (think hairball) that have to be removed with an endoscope

One of Dr. Elliot’s key points is that surgery doesn’t equate to absolute success no matter what. Patients must exercise regularly, eat three meals a day (no snacking) that incorporate nutrient-rich foods to ensure their own long-term success.

Protein is the most important nutrient for the gastric-bypass patient. One point that surprised me, though, is that peanut butter is not considered a high-protein food. He said that the protein is too low in comparison to overall calories and fat. Fish and eggs, however, are excellent protein sources that are often well-tolerated by newer post-ops. For vegetarians, tofu, beans and legumes are good choices.

Hunger tends to return about six months after surgery. The pouch capacity increases (3/4 of a cup), the stoma size increases (pouch empties in two hours instead of four), and weight loss slows dramatically. For people who want to continue losing weight after six months, Dr. Elliot recommends avoiding carbs (they cause cravings and cramping that might be confused as hunger), not snacking (remove temptation from home and work), don’t drink with meals and “water loading.” Water loading is drinking a half-glass of water right before meals to dilute the ghrelin (hunger hormone) in the pouch. This helps some patients be satisfied longer and with less food.

One important thing to protect your pouch from is ulceration. Factors that can lead to ulcers include:
Nonsteroidal medicine (ibuprofen, naprosyn, aspirin)

Dr. Elliot recommends giving up alcohol for life because of the danger of ulceration, as well as the high number of calories. On special occasions, he recommends drinking no more than a half glass of wine after a full meal because post-ops are “cheap drunks” because of how fast alcohol is absorbed by the new digestive tract.

Some patients who think they are in menopause find that their menstrual cycles starts back after gastric bypass. This had to do with hormonal imbalances brought about by obesity. For those who want to conceive, he recommends waiting at least one year before getting pregnant.
Most common reasons for regaining weight:· Lack of exercise· Snacking or grazing· Stretching of pouch because of overeating

Long story short, Dr. Elliot says that falling back into old habits is the main reason that people regain the weight they lost during the honeymoon period. Taking advantage of the honeymoon period to learn and create new lifestyle habits is the key to making sure surgery is a successful tool to overcome obesity.

Dr. Paul Cirangle – Will discuss long-term issues that WLS patients need to be aware of forever and the insurance situation in California
Dr. Cirangle’s first topic of discussion was nutritional deficiencies after surgical weight loss.

Malabsorptive procedures (gastric bypass) lead to more long-term nutritional deficiencies than restrictive procedures (Lap-Band). There are varying degrees of malabsoptoion depending on bypass procedure. Duodenal Switch has the highest incidence of deficiencies. RNY is middle of the road.

Malabsorption is why vitamins are such a necessity for bypass patients. Part of the procedure that is gastric bypass actually bypasses the parts of the intestine that absorb vitamins. Dr. Cirangle cites research that shows that patients who didn’t take vitamins regularly in the first two years after surgery not only became deficient later on but also were less likely to be able to correct the deficiency once it occurred. He says the best vitamins are the ones that you’ll take forever.

“If you don’t like the taste, you won’t take it and that makes it a bad vitamin,” he said.

Other reasons patients develop deficiencies is because they had them before surgery and because of the drastically reduced nutrient intake. A scary point Dr. Cirangle made is that gastric-bypass surgery is a procedure that by its nature causes ulcers. He recommends post-ops take some form of acid-reducer daily for the rest of their lives.

Anemia is common and can be caused by anastomotic bleeding (very rare), marginal ulcers, B-12 deficiency and iron deficiency. A third of post-ops will develop it within two years. Supplementing with folate not only helps prevent anemia but also protects your heart, he said.

“Very occasionally, anemia becomes so profound that we have to reverse the procedure,” he said. “That occurs most commonly with the Duodenal Switch.”

Other possible complications that require reversal are protein deficiency and kidney stones. The good news is that he says anemia is 95 percent correctable with supplementation.

The normal human digestive system is so efficient at absorbing calcium that 90 percent of what most people eat is excreted through feces. But for gastric-bypass patients, calcium absorption is difficult because the part of the intestine that absorbs it is bypassed. Dr. Cirangle recommends taking 500 mg at a time (3x a day) with a protein source to improve absorption. He also said that he doesn’t believe that calcium citrate is the only way to go for gastric-bypass patients to absorb calcium.

“To me, the best calcium is the one you like,” he said. “If you like Viactiv, which is calcium carbonate, that’s fine by me.”

Dr. Cirangle mentioned a new procedure on the horizon called a vertical sleeve gastrectomy. It’s a restrictive procedure – no malabsorption – that uses no incisions and is safest for high-risk patients. His practice has done 500 of the procedures, and he said that for those who self-pay, it’s the most affordable option. The other perk is that it’s the safest option for high-risk patients.

Dr. Monica Ganz – “Learning to Think Thin”
Dr. Ganz, who has lost 320 pounds with the help of gastric-bypass surgery, understands the need for the formerly obese to figure out how to think thin. Thinking like a thin person is the key to long-term success, she says. She’s a high-energy speaker who jumps from topic to topic with rapid-fire speed.The first thing Dr. Ganz recommends is to get rid of too-large clothes. The advantage to doing that is that it’s a commitment to “never go back” to your previous size.

Old habits die hard, she says. Every single day is a battle with food demons, but it gets easier with time. The problem with time is that it’s also easier to lapse into old behaviors. Taking pictures each month is a necessary practice. Many post-ops develop body dysmorphic disorder, which means the brain perceives the body to look bigger than it really is. She says it takes the brain a lot longer to catch up with your appearance than it does to lose the weight. According to Dr. Ganz, it can take up to five years for the mind to adjust. Taking measurements regularly is another tool to help combat body dysmorphia.

Be wary of your relationship with the scale
The key to making this a success is it’s a lifestyle. People who use the scale to determine what they will eat that day (treats if they lost weight; depravation if they gained weight) are still on diets, and diets are proven not to work. A scale is only to be used as a tool to guide you; you can’t depend on it as a measure of your self worth.

Getting back to basics
It takes 21 days to form a new habit, but most people give up at 18 days. Get a food scale and measure your portions.· Read labels· Hydration – if you have trouble keeping it down, try Propel, or something similar· Chew your food down to baby-food consistency· Undigested carbohydrates or protein cause gas· Eat slowly – use a timer· Use smaller size items (mini pans, salad plates, baby spoons, etc.)· Sip water all day long until you get 64 ounces to 74 ounces a day· Stay away from fast food (too much of a trigger)

Dr. Ganz recommends eating about 100 grams of protein each day to account for malabsorption. Not all foods have protein that is easily absorbed. For example, she said that eggs have protein that is 99 percent available, where as peanuts are only 49 percent available. On top of that, gastric bypass patients have 25 percent of their nutrients bypassed, meaning they absorb even less. A good rule of thumb to determine whether you need more protein is if you’re tired or have noticed your weigh loss has stalled.

Some aids to help you on your journey· Lactaid or Lactaid milk· Molly McButter to replace butter· Beano to combat gas

After weight loss, many people don’t know how to dress for their new size and shape. Take advantage of personal shopping services at department stores, even if you don’t buy anything. Have your makeup professionally done; go to a salon and have a makeover. Look your best and you will feel your best.