New beginnings for a new year

As 2007 winds to a close, I’m looking ahead. This past year was a busy one for me. I started it off with a bowel obstruction that almost missed getting diagnosed, leading to emergency abdominal surgery and a long, arduous recovery. My husband and I separated in June; a very dear childhood friend and her unborn daughter were killed in July; I switched careers in September; and I moved 75 miles southeast of Tracy in October to be closer to my new job.

There is not one event that has occurred over the past year that I would change if given the chance, not even the death of my friend. After all, it was her death that led me reexamine my priorities in life and make the changes required to be where I’m at now.

However, during the course of it all, I’ve succumbed to some old habits that I need to relinquish yet again. In times of stress, I think it’s normal to revert back to old coping mechanisms. My most comfortable coping mechanism has always been eating. More accurately, it’s been the abuse of food or using food to feed my emotions rather than hunger. Feeding has always been easier than feeling for me.

Luckily for me, weight gain hasn’t been an issue. I dropped enough weight while sick from January through March that the weight I’ve put on makes me look healthy not out of control. But for a food addict, “out of control” can be just one bite away. And that’s not a place I want to visit, much less stay. So I will take advantage of the new beginnings associated with a new year and get myself back on track before I veer too far off my desired path.

Getting back on track won’t be easy, but the gift of gastric-bypass surgery and the tool it provides still make it easier for me to adopt healthy habits once again than if I didn’t have surgery at all. The key for me will be to draw some very deep lines in the sand and not let anyone or anything cross them.

Here are my top 5 rules for 2008 that will help me make sure my health goes back to being my top priority:

My house is a junk-free zone
No, I will not become a better housekeeper. Ha! That’ll have to wait until 2010 to make the resolution list, if ever. Instead, I’m referring to junk food. “Junk food” is different for everyone. For a gastric-bypass patient, simple carbohydrates and sugar are our main enemies but junk food can be any trigger food, even ones considered “healthy” (like sugar-free desserts).
I used to believe I had to have these things for those who didn’t have the dietary restrictions I did. Now I realize that as a single woman, there is no reason to have stuff in the house that I should not be eating. I've tossed out all the crackers, rice, pasta and chips that have wormed their way into my pantry, in addition to the sugar and baking ingredients I collected to make holiday treats. I don’t need the temptation. I’ve baked a few things for my end-of-the-year church potluck, and the rest will go out with the trash. Better that it fill the trash bin than my backside.

I will respect my pouch
One of the greatest gifts bariatric surgery offers is the ability to control the amount of food one needs to eat to feel full and/or satisfied. That gift can be abused by non-compliance. Non-compliance comes in a variety of forms but the most common are overfilling the pouch at meal times, grazing throughout the day and consuming liquids with meals. Rather than eat until I’m full, I will focus on eating until I’m no longer hungry. Though it sounds like a minor difference, the difference can add up to quite a few hundred calories by the end of a day. Hypoglycemia requires that I eat more often than most bariatric patients, but I don’t have to eat huge amounts at each sitting.

I will not drink my calories
This one will be tough. I really love mochas and caramel macchiatos from Starbucks and the Acai Super-Antioxidant from Jamba Juice. Even with two scoops of protein powder, Jamba Juice smoothies aren’t good choices for bariatric patients. The sugar content in them outweighs any benefits of the protein. Alcohol also fits into this category. I love a good vodka martini, but calories add up. I spent my first two post-op years drinking nothing more than water and unsweetened tea. I was quite content and am confident I can be equally content doing so yet again.

I will exercise five times a week
I have to stop kidding myself. Parking a half-mile from the office is a nice way to incorporate more movement into my daily routine, but it does not replace the need for honest exercise. Like all gastric-bypass patients, I have the metabolism of a sea cow. Our drastically reduced intake, coupled with nutritional malabsorption, puts our bodies into starvation mode. The only way to kick start the metabolic standstill is by incorporating vigorous exercise each day.

I will say no to sabotage
This one is easier said than done, but it’s high time I put my foot down. I’m tired of well-meaning people encouraging me to “treat” myself and assuring me that “a little bite” or “sip” won’t hurt, as if they had any clue what it’s like to walk in my shoes. The fact is that for some of us, there is really no such thing as “just one bite,” and I’m tired of pretending it’s not an issue. So rather than give in to temptation in a misguided attempt at politeness, I will offer a firm rejection and not lose sleep over potential hurt feelings. After all, I’m the only one who has to live with the consequences of eating foods my body doesn’t tolerate well.

Merry Christmas

I'm not sure I'll ever stop being amazed at how much more I enjoy holidays now that I'm no longer a slave to food.

Today was such a great day. Woke up early, had some chicken and veggies for breakfast, a couple of homemade mochas and gallons of iced tea. Lunch was turkey, a bit of ham, cranberry sauce, some potato and corn. Dinner will likely just be turkey, cranberry and veggies. Oh, I did splurge on a slice of cherry pie, but just a slice -- not the whole pie, nor a slice of every pie and cake available.

We watched a movie, we hung out, we relaxed. It was amazing. No uncomfortable over-stuffed feeling, no wanting to puke, no food coma. Who would have thought a holiday could be so pleasant?

Dinner of Champions

I'm back to my old tricks of cooking up a storm. Here's what I made for dinner: Chicken Stew Recipe courtesy Giada De Laurentiis Show: Everyday Italian Episode: One Pot Meals

2 tablespoons olive oil 2 stalks celery, cut into bite-size pieces 1 carrot, peeled, cut into bite-size pieces 1 small onion, chopped Salt and freshly ground black pepper 1 (14 1/2-ounce) can chopped tomatoes 1 (14-ounce) can low-salt chicken broth 1/2 cup fresh basil leaves, torn into pieces 1 tablespoon tomato paste 1 bay leaf 1/2 teaspoon dried thyme leaves 2 chicken breast with ribs (about 1 1/2 pounds total) 1 (15-ounce) can organic kidney beans, drained (rinsed if not organic) Serving suggestion: crusty bread Heat the oil in a heavy 5 1/2-quart saucepan over medium heat. Add the celery, carrot, and onion. Saute the vegetables until the onion is translucent, about 5 minutes. Season with salt and pepper, to taste. Stir in the tomatoes with their juices, chicken broth, basil, tomato paste, bay leaf, and thyme. Add the chicken breasts; press to submerge. Bring the cooking liquid to a simmer. Reduce the heat to medium-low and simmer gently uncovered until the chicken is almost cooked through, turning the chicken breasts over and stirring the mixture occasionally, about 25 minutes. Using tongs, transfer the chicken breasts to a work surface and cool for 5 minutes. Discard the bay leaf. Add the kidney beans to the pot and simmer until the liquid has reduced into a stew consistency, about 10 minutes. Discard the skin and bones from the chicken breasts. Shred or cut the chicken into bite- size pieces. Return the chicken meat to the stew. Bring the stew just to a simmer. Season with salt and pepper, to taste. Ladle the stew into serving bowls and serve with the bread.

I've Said it Before ...

... But the following bear repeating:

• I love AchievOne Cappuccino RTD protein supps.
• Using RTD protein supps (like Micellar Milk) as creamer in your coffee is a great way to get your protein and caffeine boost in one convenient dose.
• Sugar-free syrups and flavorings are a great, low-cal way to add variety to your protein shakes and beverages. They also help you get through a huge tub of protein powder without wanting to yak from boredom.
  
• Some of my faves: Add peppermint syrup to a chocolate protein supp with a little coffee for your own peppermint protein mocha; add caramel and hazelnut syrups to a vanilla shake for a little decadence; fruit-flavored syrups are great additions to vanilla shakes in the summertime.
  
• You can use Micellar Milk in lieu of fluid milk in recipes. Just be sure to adjust the amount of sweetener added. I love using vanilla MM in custard recipes.
• You are worth every dime you spend on protein supps, vitamins, gym memberships, personal training, etc. Remember, these are not luxuries; they are investments in your health.
  

The Ugly Side of the Holiday Season

Now is the time of year when people are decking the halls and spreading holiday cheer to everyone and their brother. But there is an ugly side to holiday cheer. It's also the time of year when decadent treats and desserts seem to multiply like caged rabbits. For those of us who struggle or have struggled with controlling our body weight, the holiday season can feel a lot like a Cambodian minefield. It feels like everyone we turn, there are cookies, cakes, pies, candies -- and a million and one reasons why it's OK to indulge.

But the worst part of the holiday season are the food pushers. The name is self-explanatory. Food pushers are those who push food at you. They tell you that you deserve to treat yourself, that just one bite won't hurt, that we all need to splurge now and then. Food pushers are a year-round hazard, but the holiday season seems to be when they are in rare form.

I try to see the good in people, to assume that they mean well and don't understand the ramifications of their actions. After all, that's a much more pleasing thought than to believe they are intentionally trying to sabotage your efforts to maintain a healthy way of eating.

Shock and Awe

When I accepted this new job, I was excited at the prospect of a new start in a new town where I had no expectation to live up to. Following a dear friend's advice, I considered not sharing my past with my new coworkers and acquaintances.

My friend suggested I keep mum about my past because he felt I deserved to make impressions based on who I am now, not on who I used to be. He's always thought my column, blog and transparency on my history with obesity was unfair to me. I understand where he's coming from. He's seen firsthand how people treat me differently once they find out I used to be morbidly obese or that I had weight-loss surgery. They scrutinize my body to gauge whether I've had cosmetic surgery or if I was ever big enough to "truly need it." They talk to me differently; the watch everything I eat. It's like living in a fishbowl, and it loses its charm quickly.

My attempt to follow his advice didn't last long, though. After all, I can't change that fact that I used to be morbidly obese and how it has shaped my character. I can't change my dietary restrictions, and I refuse to let people assume I'm one of those healthy-looking women who hates herself and is perpetually on a diet.

I don't broadcast my past or my surgery, but I don't shy away from the subject when it comes up. I've showed my before pictures to a couple of people and the reaction is always the same: shock and awe. I'm told I look like a different person, that they never would have guessed I had a history of obesity. I know I should be flattered, but it's hard. It's been 2.5 years since I had WLS; I'm at home in this new body. At the same time, I can't blame people for how they react -- especially if I'm openly sharing my history.

Happy Trails

The Livermore Walk From Obesity was Oct. 6 at LifeStyleRx in Livermore. The walk was a fundraiser for the American Society of Bariatric Surgery Foundation and Obesity Action Coalition. The ASBS Foundation raises money for the study and treatment of morbid obesity. OAC is an activism group dedicated to fighting discrimination against the obese and encouraging insurance companies to cover medical treatments for the disease.

I won't deny that I was a bit disappointed by the walk's turnout. I had lofty goals when I signed on as a team leader for the walk. I thought I could amass a Tracy team of at least 20 people who would raise $5,000. After all, I know how much this town raises in the American Cancer Society's annual Relay For Life. So I knew it could be done. But it just didn't happen for us.

Instead of 20 people, my team -- One Step at a Time -- had four members who raised less than $1,000. But as walk organizer Julie Rooney of LifeStyleRx said, "every little bit counts." And other walkers raised similar amounts of money, which added up to a decent sum of money for the charities involved.

Personally, I want to thank my generous sponsors: Dagny of Sassy Ladies of WLS; Kenny Luiz (my uncle); Lorraine Cardoza (my aunt); and Ben van der Meer (former colleague). Their support has meant more to me than words could ever articulate.

Those who didn't participate missed out on a fun day and a leisurely three-mile stroll down the Arroyo Mocho Trail. Walkers enjoyed a goodie bag and free breakfast, courtesy of ValleyCare Health Systems, and AchievOne protein lattes (a personal fave).

More than one person questioned why there wasn't more participation. Each of us talked about how we had difficulty getting people to join our team and the challenge of fundraising. The conversation reminded me of a friend of mine, Heather Maes. Heather is a 30-year-old single mom battling colon cancer. She's documented her fight on MySpace, in a blog she calls My Cancer Chronicles. The Tracy Press occasionally prints entries from her blog, which is how we first met.

Heather is a calendar model. Well, to be precise, she's actually Miss December on this year's Colondar. The Colondar is a fundraiser for the Colon Club, which is an organization that raises awareness of colon cancer among those younger than the stereotypical over-50 crowd. In September, Heather blogged about online encounters with people who did not agree with Colondar concept. Some called it disgusting; others lamented what they considered preferential treatment of cancer patients. One person even said that the limelight on cancer made others suffering from chronic illness feel "left out of the fun." I'm sure Heather can tell you all about the fun she's having as she undergoes her second round of aggressive chemotherapy.

But I digress. My reason for mentioning Heather and her Colondar (BTW: they are on sale for $15; you should buy one) is that I found myself walking three miles on an early October morning wondering why thousands of people get so passionate each year about fundraisers benefiting cancer societies, Special Olympics, and even the American Heart Association, but it was like pulling teeth to drum up any interest in a Walk From Obesity. I don't want to sound like the ignorant idiots who told Heather and other cancer patients that they didn't deserve to raise money for their causes. At the same time, I'm curious at why obesity doesn't get the same attention as other diseases.

Cancer, special needs and heart disease are relatively random afflictions caused by a combination of family history, lifestyle and luck -- or more correctly, a lack thereof. Obesity, on the other hand, affects a majority of our society. About 60 percent of our nation suffers from obesity (BMI of 35 or more); morbid obesity (BMI of 40 or more) affects about 35 percent of all Americans. Obesity is preventable, treatable and deadly. We all know how the disease comes about; and assuming you subscribe to the "calories in vs. calories out" theory of nutrition, we all know how to overcome it.

So why is it so hard to get support for a Walk From Obesity? I think because obesity is preventable and curable, people don't view it as a disease. And that includes those who suffer from it. If I had a nickel for every time I heard an obese or morbidly obese person say, "I know what I need to do; I just have to do it," I'd be a very rich woman. If the obese don't realize they are diseased, why should anyone else?

When I participate in Relay For Life each year, I am surrounded by those who are fighting cancer, have beaten cancer, have loved ones who fit into the previous categories or have been touched by cancer in other ways. At the Livermore Walk From Obesity, I was surrounded by bariatric medical professionals, post-ops and their loved ones. I even tried to drum up interest among my non-op friends, regardless of size. To me, this walk was about silencing a killer (just like any other fundraiser walk); nothing else.

But I realized that it's impossible to silence a killer when its victims refuse to come forward and defend themselves. I haven't given up, though. I hope the Dr. Mary Estakhri, the bariatric surgeon who has sponsored the Livermore Walk From Obesity for the past two years, will continue to support this event; and I also hope that, in time, the walk will gain steam as more and more people realize the how tight of a grip obesity has on this nation.

Crawling Out From Under My Rock

Just a quick post to let you all know that I have not fallen from the face of the Earth. I've been juggling lots of changes, and this blog has fallen through the cracks for a short time. I'm newly single, have taken a new job in a new town, which has prompted me to move away from Tracy but also enabled me to adopt a new focus on serenity in my life.

I'm having lots of fun and can't wait to share it all with the rest of you. As planned, I took part in the Livermore Walk From Obesity earlier this month. Once I get photos from the event, I'll post an entry on the event. It didn't have the huge turnout I anticipated, but those of us who were there enjoyed ourselves. I think I've finally gotten a handle on my blood-sugar issues. Hypoglycemia is a lot easier to manage when you cut out carbs. It's not a perfect science, but it's getting easier to manage.

And we wonder why we're fat

Calories underestimated in "healthy" restaurants

By Anne Harding
Fri Sep 14, 3:24 PM ET

People who opt for a meal at a "healthy" restaurant often consume more calories than they would dining at fast food joints that make no health claims, a new study shows.
The researchers found that individuals underestimate the calorie content of foods served at restaurants they see as healthier, to a degree that could easily lead to weight gain.
For example, "People think that the same 1,000-calorie meal has 159 fewer calories if it comes from Subway than if it comes from McDonalds," Dr. Pierre Chandon, at INSEAD in Fontainebleau, France, told Reuters Health. "If they choose to consume this fictitious 'calorie credit' on other food, and it they eat at Subway twice a week, they could gain an extra 4.9 pounds a year."
While restaurants presenting themselves as healthy have grown at a much faster rate over the past five years than traditional fast food restaurants, Americans' waistlines have not been shrinking; in fact, the nation's population is fatter than ever, note Chandon and his colleague Dr. Brian Wansink of Cornell University in Ithaca in their report in the Journal of Consumer Research.
The researchers theorized that people might take in more calories when they eat in "healthy" restaurants, and conducted a series of studies to test this notion.
In the first, they asked people who had just finished eating at Subway or McDonalds to estimate how many calories they had just consumed. On average, Subway patrons rated their meals as having 151 fewer calories than did McDonalds patrons. In fact, for a meal at either restaurant containing 1,000 calories, people would estimate it to contain 744 calories if they'd eaten at McDonalds and 585 calories if they'd dined at Subway.
In the second experiment, they asked people to estimate the calorie content of four different sandwiches: a six-inch ham and cheese sandwich (330 calories) and a 12-inch turkey sandwich (600 calories) from Subway; and a McDonalds cheeseburger (330 calories) and a Big Mac (600 calories). Study participants consistently rated the Subway sandwich as having fewer calories than the McDonalds sandwich with the same calorie content.
Next, the researchers offered people a coupon for a Big Mac (600 calories) or a Subway 12-inch Italian BMT sandwich (900 calories), and asked them whether they would like to order a drink or cookies with their sandwich. People eating the Subway sandwich were more likely to choose a large drink, less likely to opt for diet soda, and more likely to get cookies. This meant that, on average, they wound up consuming 1,011 calories, compared to 648 calories for the people given a McDonalds coupon.
People who want to control their weight or trim down need to think objectively about calorie content, and not let their perceptions be clouded by whether a food is supposed to be good or bad for them, Chandon said. "We have to move away from thinking of food in 'good food / bad food' (terms) and think also about 'how much food.' In France, for example, people enjoy relatively fat diets but are less overweight simply because portion sizes in restaurants and at home are smaller."
Chandon suggested one technique to help people judge calorie counts more accurately: "Instead of estimating the number of calories of the whole meal (which leads to undercounting) look at the sandwich, the side, the beverages, and the drink and add that up. Our research showed that this 'piecemeal' method is very effective."
SOURCE: Journal of Consumer Research, October 2007.

2007 Livermore Walk From Obesity nears

The 2007 Livermore Walk From Obesity needs your help. Please do what you can to volunteer, join a team or donate to the cause. If you want to join my team or donate to it, visit my page here. Registration is $25 and includes a shirt, all-day pass to LifeStyleRx in Livermore (where the walk starts) and other goodies. The walk is from 8:30 to 10:30 a.m. Saturday, Oct. 6, at LifeStyleRx, 1119 Stanley Blvd., in Livermore. You can walk anywhere from a quarter-mile to three miles.

A family affair

http://www.sacbee.com/101/story/339981.html

Cooled off...sorta

It's taken a couple of days but I think I can finally address the topic of the 12-year-old who had Lap-Band surgery in Mexico with some measure of civility. At least, I hope I can.

What disturbs me most about the case is this girl's mom and the apparent lack of accountability on the part of both of them. Mom has a fat kid, so her first step is cosmetic surgery (tummy tuck and lipo). When that fails, Mom takes daughter (now 12) to Mexico for bariatric surgery.

Now everyone is happy. Mom says daughter is a compulsive eater and she likes the band because whenever she overeats, she throws up (nice way to train for bulimia, I suupose). Mom likes that her daughter is finally thin and fashionable.

My personal favorite of all the comments Mom made were those related to why she didn't have her daughter go through the process in the states: Money. Nutritional and psychological counseling were too expensive. Really? Compared to a tummy tuck ($3K-$6K), lipo ($1K) and Lap-Band ($9K in Mexico)? Why do I have a hard time buying that story?

I was a fat kid -- not a chubby kid, a FAT kid. I understand how cruel children and adults can be to obese children. It's not a fun life, but is cosmetic and bariatric surgery the answer? I don't think so. A 12-year-old is not mature enough to understand the dangers/consequences of such decisions. The key to long-term weight-loss success is developing a healthy relationship with food and learning to balance consumption with exercise. What has this little girl learned about that? And how is she supposed to learn when Mom's answer to everything is surgery?

12-year-old gets Lap-Band in Mexico

I need a moment to gain my composure on this one...but until then, watch the clip and leave your opinion:

http://www.cnn.com/video/#/video/us/2007/08/07/ochoa.tx.lap.band.kvue

The skinny on Star Jones

Star Jones has finally admitted to having bariatric surgery.

Click here to read more.

Changes are a comin'

I am in the process of negotiating with the Tracy Press to take over sole ownership of Inside Out, both in print and online. My work in the field of bariatrics and as the writer of this column/blog has begun to overshadow my actual full-time job as managing editor of the Tracy Press in the eyes of some.

What the general public has not realized is that I have never been paid by the Press for my work on Inside Out. I write all postings and attend all bariatric- and obesity-related events on my own time, either using paid or unpaid time off, depending on the situation. This has worked just fine for the last 2.5 years. However, demands on my time have increased exponentially this year, leading me to request more time off work and leading the public to think that Inside Out is my full-time job.

The Tracy Press and I have agreed that it would be best for everyone involved if I were to formally make Inside Out a personal endeavor. This is exciting news for me, because it means from this point on, I truly own my own words. Even with free columnists, the Press assumes the rights over everything it prints. It also means I get more freedom over my postings. The Press has never told me what I can and cannot write, but since I know that many readers consider this blog the property of the Press, I have stayed away from certain topics.

The only downside to this arrangement is that I no longer get media clearance into events as a representative of the Tracy Press. If an organization extends media credentials to bloggers and freelance writers, I will be able to obtain press passes under that umbrella but I can no longer use the Tracy Press' name or resources to gain entrance. Truthfully, though, I don't foresee that being a problem. It's not a privilege I took advantage of much anyway.

To better facilitate this division, I have created a consulting company with a business associate for my work in the field of bariatrics. We call our company Bariatric Network Associates, and we specialize in the education and support of those interested in surgical weight loss and the medical professionals who serve them.

We have our first Introduction to Weight Loss Surgery seminar tomorrow (Monday, July 30) at Sutter Tracy Community Hospital. Thanks to the generosity of the hospital, we are able to offer the seminar at no charge but we do request that those interested let us know they will attend ahead of time. The company's contact information is on the Web site.

Living and eating well after all these years

Originally published Saturday, July 30, in Our Town for the Tracy Press.

This week marked the launch of the revised edition of “Before & After: Living and Eating Well After Weight-Loss Surgery” by Susan Maria Leach.

Leach’s first edition, affectionately known by many in bariatric circles as “the pink book,” has gotten a lot of coverage in this column as I’ve traveled on my journey toward a healthy weight.
I first discovered Leach through her Web site, www.bariatriceating.com, an online superstore of all things a bariatric patient could want or need. It didn’t take me long to find out that her promise of “great taste and good nutrition” was more than just mere words.

The pink book was waiting for me, along with a shipment of protein supplements from her company, when I got home from the hospital after having Roux-en-Y gastric-bypass surgery in 2005.

To this day, I credit Leach’s book and products for helping me to achieve my weight-loss goals without sacrificing my health, appearance or energy.

The revised edition, packaged in a light-blue paperback for convenience, is everything its predecessor was and so much more.

The hybrid of diary, no-nonsense advice and cookbook features 35 more recipes and updated information based on research and discoveries in the bariatric field since the original printing in 2004.

“I have a better perspective as a six-year post-op,” Leach said in an interview this week. “I now understand that people don’t do the right thing automatically. I see so many who give it all up for fast food and sugar, and begin a downward spiral again.”

Leach said she’s realized that many people who have suffered from morbid obesity have a difficult time figuring out how to deal with food. She hopes the new edition’s inclusion of meal plans for every stage of post-op eating will help those people adopt healthier eating habits.

“I offer different good food choices for each meal and simple recipes to combine their grocery list items,” Leach said. “My meal plans train people to create new food patterns that they will enjoy eating and will stick to long term.”

The book’s new recipes reflect Leach’s travels and constant quest for food that is fabulous and healthy. One of her favorite additions is the creamy Tuscan white bean soup, featured on Page 132. She said it’s a replica of a soup she enjoyed with her aunt in Tuscany last year.

“It’s a wonderful reminder of a fantastic trip,” she said. “Plus, it’s a 15-minute recipe that can be used in the earliest stages after surgery but will be a family favorite for years!”
In addition to new recipes, the book also features updated versions of previous favorites, like Leach’s light banana bread.

The new banana bread recipe is a perfect example of what is possible when the marketplace broadens its offerings. She replaces the Splenda (sucralose) and protein powder used in her original recipe with Nature Sweet Crystals (maltitol) and California almond flour.

“This superb sugar replacer makes a delicious, healthy loaf that is indistinguishable from a full-sugar, full-fat version,” Leach writes in the recipe’s introduction on Page 263.

Though the original edition of “Before & After” was a financial success for Leach, she hopes readers feel they get something for their money with the second edition.

“Weight loss surgery was not my first choice; it was my last choice,” she said. “It is so important that people understand it is not a diet that ends at a goal weight; it is a new way of life.”

Product Review: Better Balance Protein Cereal

The folks at Kay's Naturals sure do know their stuff when it comes to protein snacks. I was lucky enough during ASBS to sample a variety of their products, but the Better Balance Protein Cereal exceeds expectation. During the conference, I snacked on the Honey Almond and French Vanilla flavors right out of the bag. This morning for breakfast, I enjoyed the Apple Cinnamon variety mixed with my Fage 0% greek-style yogurt.

Though I like all of the varieties, Honey Almond is my favorite. It reminds me a bit of Smart Start, which was a cereal I regularly enjoyed as a pre-op. Apple Cinnamon tastes like Apple Jacks, and French Vanilla has a great vanilla flavor.

The O-shaped cereal comes in 1 oz. packages, providing 9 grams of soy protein in 100 calories with 1.5 grams of fat and 15 grams of carbohydrate (3g dietary fiber; 3g sugar). The cereal is sweetened with inulin.

Hit or Miss? A definite hit. The Kazemzadehs, who own the company, were nice enough to let me try almost all of their products at the convention tradeshow. Awesome product!

From the "duh" files...

SAN DIEGO -- Though I appreciate the time and effort taken in researching obesity and bariatric procedures and outcomes, some studies make me shake my head in wonder.

For instance, comparing the success rate of bariatric surgery to commercial weight loss programs seems ridiculous. After all, does anybody really think counting POINTS! can hold a candle to rerouting one's digestive tract to reduce capacity and nutrient absorption? That doesn't even seem logical to me, much less a wise use of funding.

Here are two of what I'd call "duh" studies that were presented at the convention this week:

* Bariatric surgery makes people more sensitive to alcohol -- I don't think any of us with gastric bypass needed Stanford researchers to tell us that our rerouted intestinal tract makes us cheap dates when it comes to running a bar tab.
Dr. John Morton, assistant professor of surgery and senior author of the study, was quoted in today's Science Daily as saying, "I've heard the anecdotes of a patient who will drink one glass of wine and get a DUI, but I wanted to know if there is really a difference before and after the surgery."
Dr. Morton later says in the article that most patients aren't aware of this and that Oprah has done the field a favor by pointing it out on her show about the dangers of cross-addiction. I don't know about the rest of the post-ops in the world, but I discovered that fact the first time I tried wine after surgery. I didn't need Oprah or a study to enlighten me. Furthermore, I had been warned by other post-ops about the phenomena long before I ever had surgery, so I don't think it's as big of a mystery as Dr. Morton professes.

* Binge eating and a sweet tooth lead to gastric-band failures -- Just to make sure we're all on the same page here, a team of Swiss researchers reported that those post-ops who binged on food or indulged in sweets experienced a higher incidence of band failure than those who did not. The conclusion? The best candidates for banding are highly motivated patients who don't binge or eat sweets. Wouldn't you say the same thing for any type of bariatric procedure?

Candelas San Diego

SAN DIEGO -- Words cannot describe the dinner I experienced this evening. We visited Candelas on Third Avenue. And I say visited, because it was so much more than just a place to eat; it was an all-encompassing environment with an amazing atmosphere, above-par staff and cuisine that was out of this world.

Our party decided on a collection of appetizers and one entree to share, because making a decision was so difficult. We all giggled a bit when our server, Tony, went over his recommendations on the menu. He said everything was "amazing" but suggested the duck, poblano soup and the avocado salad. We thought he was just angling for a good tip -- until we were presented with the incredible dishes we ordered.

The Carpaccio Franco ($12) had fan of paper-thin raw ahi drizzled with a lemon-cilantro mustard sauce served around a salad of marinated bell peppers, baby greens and tequila-marinated pear. The ahi was so tender that it melted on my tongue, but I would have liked a little more of the sauce to enhance its flavor.

Taking Tony's suggestions to heart, we ordered the Estructura de Aguacate ($11.50), which was a stacked salad of avocado, scallops, crap, shrimp, parsely and mild jalapeno with a light drizzle of mango-basil vinaigrette. The presentation was awe-inspiring. The salad was molded into a cylinder in the center of the plate with ribbons of dressing poured around the edges. It had a delicate flavor, with each ingredient complementing one another instead of competing for attention.

The Crema Fabiola ($14.50) is a stellar puree of poblano chile and cream with a half of a lobster tail poised in the center. The color contrast between the pink and white lobster and the sage-green soup was eye-catching but nothing prepared me for the taste of the soup. It was an explosion of flavor that led a few of us to consider licking the bowl when we were finished.

The only entree we ordered, the Pechuga de Pato Lucrecia ($25.50) was another sight to behold. The duck breast was cooked in its own juices until medium rare and then fanned around vegetables and mashed potato with a light passionfruit sauce. The duck barely required a knife to cut and its buttery texture dissolved easily on the tongue. Our only regret was that our pouches forced us to leave one succulent piece on the plate along with the potato. Even Tony remarked it was a crime.

We had planned to pass on dessert until Tony mentioned crepes covered in a goats milk caramel that sounded heavenly. The presentation was simple, two crepes swimming in thick, rich caramel with pecans sprinkled over the top. We each took only one bite, knowing that a second would leave us sick all night. But that one bite was all that was needed for an instant trip to nirvana. It was the type of dessert that makes you not want to put anything else in your mouth so you can savor the flavor as long as humanly possible and then burst into tears once it diminishes.

I could not even imagine a better way to end the most hectic day of the convention.

A whirlwind of a day

SAN DIEGO -- Thursday was such a crazy day that it took me until Friday to realize that I didn't publish this post. I'm back-dating it so it's chronological:

I sat in today on an interesting session for primary clinicians. The opening speaker was Dr. Sasha Stiles of Kaiser South San Francisco, where I had my bariatric surgery two years ago. Dr. Stiles is the program's medical director, creating Kaiser's Northern California program with Dr. Prithvi Legha (my surgeon). During my time with Kaiser, I grew to know Dr. Stiles more than Dr. Legha because she is the one who handled my pre-operative screenings and post-operative follow-up. I was very sad when my employer switched from Kaiser coverage, because she is such an amazing doctor. At least I'm still able to be in Dr. Legha's capable hands.

Dr. Stiles provided a brief introduction to the Primary Clinicians Tract that was an overview of the advancements made in the treatment of obesity. For a rail-thin woman, she knows a lot about obesity. She sees 6,000 patients a year through Kaiser's bariatric program, and the South San Francisco facility treats about 200 patients a month.

She didn't report anything that was new or earth-shattering but did pose some interesting questions for the audience to ponder. Her over-arching theme regarding the success of bariatric surgery was that it provides hope for the morbidly obese. Hope, she said, is what motivates patients to make the lifestyle changes required for long-term success.

She called the physicians collectively on the carpet for not doing a good enough job in following up with their patients to ensure long-term success. Studies show that dieting is stressful and that even the most successful weight loss programs have followers who fall off the wagon and start over. Dr. Stiles said anticipating this aspect of human nature can make bariatric programs more successfull, too. After all, if you anticipate that after two years, post-ops will stop attending after-care programs and possibly begin to gain back weight, doctors could then build services into their programs to bring those patients back to the fold in a supportive manner.

Makes sense to me. What do the rest of you think?

Food, fabulous food

SAN DIEGO -- It occurred to me last night after signing off that I've yet to post about food. One of the reasons I promote Susan Maria Leach's book, "Before and After: Living and Eating Well After Weight Loss Surgery," (revised edition goes on sale in two weeks) is because it proves that enjoying great food does not end when you go under the knife.

A lot of non- and pre-ops I meet fear gastric-bypass surgery means a life without taste, texture and gastronomical pleasure, but nothing could be further from the truth. If anything, most of us become food snobs after weight loss surgery. I ate fast food at least twice a week as a pre-op. Now, I could hardly be paid to eat at McDonalds or Carl's Jr. -- the food doesn't even taste good enough to be pouch-worthy. I can find something to eat just about anywhere, but I'd rather not waste valuable space in my gastric pouch on mediocre food.

So, what does the American Society of Bariatric Surgery have served at its annual conference? Last year, I made the mistake of thinking that because it was an event about bariatrics, the catering would reflect the needs of bariatric patients. Wrong. What I forgot in my naivete is that the conference is geared toward bariatric health care providers -- not patients -- so the food did not match what my pouch could tolerate. If it hadn't been for the BariatricEating.com booth last year, I would have surgery fainted for lack of protein. That's part of the reason I agreed to help Susan at her booth this year -- I owe her a debt of gratitude for saving my pouch last year.

So far this year, I've been pleasantly surprised. Yesterday's breakfast was the obligatory continental convention fare: pastries, muffins, bagels, fruit, juice and coffee. The BE.com gang picked up coffees and went to the booth to make protein lattes and cappuchinos. I enjoyed a delicious latte made up of Nectar Cappuccino, Matrix Chocolate, Micellar Milk and hot water (12 oz offers about 25 grams of protein). For my mid-morning snack, I sipped coffee mixed with vanilla Micellar Milk and a shot of Davinci sugar-free Englis Toffee syrup and Cinnamon Bliss (a sugar-free caramel replacement that tastes just like a spicy cinnamon roll). OK, I'll be honest: I had two of those for about 20 grams of protein combined.

Lunch, however, offered something for everyone. The buffet featured a selection of salads and build your own sandwiches. I enjoyed a small green salad with tomato-basil vinaigrette and swiss cheese rolled up with deli ham and grainy mustard -- fast, filling and delicious. I was wise and steered clear of the decadent desserts.

Back at the booth, we were serving Revial soy chips (I'll have to review those at a later time), parmesan cheese crisps, AchievOne, Nectar Twisted Cherry mixed with Cherry-Pomegranate Crystal Light, ThinkThin bars and New Whey protein bullets in addition to the Micellar Milk lattes. Again, my body has never been so happy. My blood sugar only dipped once all day.

For dinner, we attended the conference's welcome reception. Again, I didn't know what to expect. Imagine my delight when I spied appetizer tables overflowing with oysters on the half shell, succulent shrimp, snow crab claws, cheese trays, canapes and beef and turkey carving stations. I didn't even glance in the direction of the pasta and dessert areas, though I did spy a few people enjoying chocolate-covered strawberries and baklava. But personally, those are treats in which I could never eat just one. Instead, I helped myself to oysters with Tobasco and fresh lemon, shrimp and crab sans cocktail sauce, green olive tapenade eaten with a spoon, Jarlsberg cubes, and melon-wrapped proscuitto and brie with a dab of cream cheese and mandarin orange (it was easy to set aside the little squares of toast atop which the melon and brie canapes were served).

Heavenly food aside, the best part of the cocktail party was that you couldn't easily tell the post-ops from the non-ops. We were mostly all enjoying the same delicious cuisine combined with excellent conversation. And like I told a couple of very handsome Australian surgeons yesterday, that -- to me -- is what the gift of surgical weight loss is all about: looking, acting and living a normal life. I could have kissed just about every doctor there for that blessing.

New key studies on morbid obesity and bariatric surgery

SAN DIEGO -- The following studies will be released Wednesday at the American Society of Bariatric Surgery annual meeting in San Diego:

The Impact of Bariatric Surgery on Health Care Costs
Date/Time: 8:45 a.m. Wednesday
Lead Author: Anita P. Courcoulas, MD, University of Pittsburgh Medical Center
Key finding: Bariatric surgery reduces health care costs over time, especially those related to medication usage.

Bariatric Surgery in Adolescents: Analysis of 309 Cases
Date/Time: 9 a.m. Wednesday
Lead Author: Esteban Varela, MD, MPH, VA North Texas Health Care System and University of Texas Southwestern
Key finding: Bariatric surgery outcomes in adolescents appear to be as safe as for adults.

Preoperative Weight Gain Does Not Predict Failure of Weight Loss or Co-morbidity Resolution of Gastric Bypass for Morbid Obesity
Date/Time: 10:30 a.m. Wednesday
Lead Author: Michael C. Harnisch, MD, Duke University
Key finding: Gastric bypass surgery can be performed safely with improvements in co-morbidity and extended weight loss regardless of preoperative weight gain or loss.

Presurgery Psychiatric Disorders are Associated with Smaller Reductions in BMI at 6 Months After Gastric Bypass
Date/Time: 10:45 a.m. Wednesday
Lead Author: Melissa A. Kalarchian, Ph.D., Assistant Professor of Psychiatry and Psychology, Western Psychiatric institute and Clinic University of Pittsburgh Medical Center
Key finding: Preliminary analyses suggest pre-surgery psychiatric disorders are related to poorer weight outcome at six months after gastric bypass. Results suggest that intervention to improve psychosocial functioning, especially anxiety and depression, may improve surgery outcomes.

Laparoscopic Adjustable Gastric Banding in Patients >65 Years of Age
Date/Time: 2 p.m. Wednesday
Lead Author: David A. Provost, MD, University of Texas Southwestern Medical Center, UT Southwestern Medical Center
Key finding: Laparoscopic gastric banding provides a safe and effective weight loss option in patients 65 years and older

Dinner at Henry's

SAN DIEGO -- We ate dinner tonight at Henry's, an Irish Pub near the intersection of Market and Fifth. Though Henry's definitely has a pub atmosphere, the food choices were superb. No bangers and mash on the menu at this place.

Eating among post-ops is such a refreshing change from what I'm used to. Five of us are post-ops -- from two to six years out from surgery -- and discussing what to have for dinner is a fun experience in itself. No mention of pizza or fried foods.

The biggest decision we had was whether to order our own entrees or share. We all decided that we hadn't eaten enough during the day so we opted not to share. Us post-ops were copy cats; we each ordered the salmon with dill cream sauce and a double portion of veggies instead of mashed potatoes. Being the "youngest" post-op in terms of when I had my surgery, I ate the smallest amount but I held my own with the veterans.

What I loved most was watching each of them following the rules even at their stage: No drinking with meals, protein first, eating slowly and chewing each bite thoroughly. We had incredible conversation on topics ranging from WLS issues to work topics to just life in general. It was like a night out with my best girlfriends, except that these girlfriends eat the same way as me.

Gringas like to party

SAN DIEGO -- Popping in for a second after helping to set up the BE.com booth at the ASBS convention center. I've learned many skills in my short time here. For instance, there is a lot of skill behind the building of a trade show booth, particularly when the shipping company crushes most of your boxes and leaves you to make do with damaged products. You'd never guess we had any trouble by looking at it, though.

Susan Maria Leach's new edition of "Before and After: Living and Eating Well after Weight Loss Surgery" hits bookstore shelves at the end of the month. The new version of the "pink book," as its known by many fans, is now a teal blue paperback that features updated information on the various types of surgeries, meal plans and even more recipes than its predecessor. Presale orders are now being taken at BE.com.

The best part of hanging out with the BE.com crew is that I never go hungry. We were all famished at light-headed while working on the booth, but that wasn't a problem because we had plenty of Revival soy chips, Power Crunch and Oh Yeah! bars and Protein DeLite Protein on the Go (chocolate coconut is soooo tasty!). My blood sugar hasn't been as level as it is today in weeks -- and I've been traveling -- not too bad, if you ask me.

Flying Southwest

Even after two years, the novelty of flying at a normal size has not worn off. Though I still feel like a world-class klutz when trying to negotiate my suitcase and carry-ons throughout the maze of airport lines and security checkpoints, I'm amazed at how effortless it is to move around -- even when loaded down with all my luggage.
This was my first time flying Southwest. I can see why people enjoy it. The lines weren't overly long, the staff was nice and the peanuts were yummy. I love that the seat belt fits me now, but the best part is still the tray table. Not only does it drop down completely, but I can also cross my legs beneath it!
Off to the convention center...more later

Look out, San Diego

I'm leaving tomorrow morning for the American Society of Bariatric Surgery annual conference in San Diego. My goal is to blog daily from the event but if this year is anything like last year, I'll be lucky to eek out a posting or two each day. The conference is jam-packed with educational sessions, events and an overwhelming trade show.

Open mouth; insert foot

I attended tonight's meeting of the Tracy Express Network (a local chapter of the American Businesswomen's Association).

During the networking portion of the evening, I was chatting with an engaging woman from New York Life. We were talking about all the illnesses that seemed to be going around this spring, which both of our husbands caught with gusto. I told her that I get very worried when my husband is ill, because he's such a thin guy, adding that I don't have the same concern for myself. She chuckled a bit and looked me up and down. I realized then that this woman had no idea I have ever looked contrary to the way I do today. I let the subject drop and we parted ways to mingle further.

We caught up again a few moments later when another member, a woman I know rather well, greeted me by calling me "Skinny." She made a comment to the New York Life agent about how great I looked. Finally, I let the agent in on the secret.

"You have no way of knowing this, but I used to be almost 200 pounds heavier than I am today. That's why calling me 'skinny' is humorous."

She was obviously shocked and after congratulating me, said she never would have guessed. I told her that I realized she had no idea based on her reaction to my earlier comment about my husband.

"Truly," I told her, "I have to be careful. I often forget I'm no longer a big girl and will make comments that come off as insensitive or rude."

It's not that I'm a narcisist who thinks the world revolves around her. It's just that I've chronicled my weight-loss experience for so long and so many people approach me in public about it that I forget it's not common knowledge. And then there are times like tonight that jolt me back into reality. I assume that the further out I get from surgery, the more common it will become to meet people who assume I've always been thin. I'm not sure I'll ever get used to it. I want to say that it'll become old had after a while, but that's hard for me to picture. I guess time will tell.

Too skinny?

I met a woman over the weekend who said something I consider interesting. Her husband had gastric bypass a handful of years ago. She said he's since gained about 40 pounds or so. I nodded, letting her know that's a common occurrence for veteran post-ops. Her response gave me pause for a moment.
"I think most people get too skinny after WLS," she said. "Your body has to put on an extra 20 to 40 pounds just to look normal."
I said nothing.
Then she added, "Then again, maybe it's just that the rest of us are used to seeing our loved ones be so big that we have trouble adjusting to their new size."
Hmmm...that was profound.
I get told I'm too thin all the time now. My favorite is when people inform me that it's time for me to stop losing weight -- as if I'm blind to my own size. I always let people know that I could lose another 20 pounds and still be within a normal weight range for my height, but I'm also clear that I'm happy at my present size. Though anything is better than carrying 335 pounds on a 5-foot, 3-inch frame, 138 pounds seems to be my body's preferred weight.
I don't understand why people feel obligated to tell me their opinion of my size. I assume it's because in our society, it's considered appropriate to tell someone when they are too skinny in your eyes even though you'd get a dirty look or backhanded if you pointed out an obese friend should lose a few pounds. I'm guessing that woman I met over the weekend has a clearer view into the average person's psyche than I do. If what she says is true, it's a matter of comfort. We know obesity is unhealthy but we're not comfortable with those close to us changing their appearance too much.
I wonder if this phenomenon will change down the line. Maybe in three years, people will be so accustomed to my size that they don't think twice about it. Then again, maybe well-meaning acquaintances and relatives will continue adding their two cents.

Who am I?

My husband and I just got back from a wedding on his side of the family. Though I feel at home at my present size, there are still many in his family -- and even a few in mine -- who haven't seen me in a year or more.

The funny thing is that few people assume I've lost a drastic amount of weight. Instead, they just figure I'm a different wife than the one my husband had the last time they saw him. Even better are those who think my husband is having an affair and dared to take his mistress to a family function.

I suppose this would offend some women, but I find it amusing. So long as they think I look fabulous, I won't complain about who they assume I am.

WLS not right for everyone

Melting Mama has a thought-provoking post on her blog about surgical weight loss. Instead of trying to restate what she says -- truly, she articulates the point way better than I ever could -- I suggest you click over to her site and read her words for yourself.

FYI

I'm noshing on a creamy peanut butter Think Thin protein bar, and it tastes a bazillion times better than the sugar-free peanut butter meltaway I blogged about yesterday. And a half-bar adds 10 grams of protein to my day.

When chocolate goes bad

There was a time in my life when I could say with confidence that I had never met chocolate I didn't like. That time was from about five seconds after I was born until about an hour ago.

To be honest, chocolate hasn't impressed me as much as it used to since I had WLS. I still love it, but a protein shake or bar can curb a chocolate craving better than a cookie. But every now and then, I still get a hankering for rich, delicious chocolate candy. Today was one of those days.

I was strolling around the mall this evening with my husband when the urge to have chocolate overwhelmed me outside of the Sweet Factory. I went inside to peruse the sugar-free section. I walked out with a bag of chocolate-covered pretzels, almonds, raisins, peanut clusters and something called a peanut butter meltaway. All together, I had about an eighth of a pound of candy in my bag.

Upon getting home, I couldn't wait to try some. I had a yummy dinner of Asian-style chicken and veggies and decided an hour later to treat myself to some of that sugar-free chocolate deliciousness I had purchased at the mall.

I opened up the bag and took a whiff. Hmm...not the intoxicating aroma I had envisioned. Oh well. I shrugged my shoulders and dove in for one of those oh-so-dreamy sounding peanut butter meltaways. I took a bite, crinkled up my nose and promptly spit it out. It was bland and chalky and not worth the 10 calories I probably ingested during my brief taste.

Next I tried a pretzel. I was smarter this time, though, and just tried a tiny bit. The salty pretzel was stale and the cholate disapointing. It was waxy and again, lacking in flavor. It reminded me of a less-sweet version of Flicks, the "chocolate-flavored" candy wafers I abhorred as a child. Next I tried a peanut cluster. It was, by far, the best thing in the bag but that still didn't make it good.

Disappointed, I tossed the rest of the candy in the trash. Chocolate or not, the taste wasn't worth the effort it took to chew it. I never would have guessed that chocolate existed that was bad enough that I would throw it away, but I found it. Then again, maybe the chocolate wasn't that bad after all. Maybe chocolate just lost its hold over me. Or maybe, the change in my taste that makes fast food no longer palatable to me has crossed over into desserts. If it's not fabulous, it's just not worth my time.

Ghengis Khan

My husband and I tried out Ghengis Khan on Grant Line Road today (in the new shopping center by Costco). He loves Mongolian barbecue. Before I had surgery, we'd visit the Ghengis Khan in Stockton a few times a year. Since surgery, though, we've shied away from all buffets. It just doesn't make sense to shell out the money when I'm not going to eat much, nor does it seem smart to surround myself with the temptation of an all-you-can-eat event. But my husband really wanted to try it, and Ghengis Khan is affordable as far as buffet restaurants go.

The best thing about Ghengis Khan is its location. It's in a small strip mall along with Kinder's Meats, Kitchen Angel, a coupld of salons and a check-cashing store. It's remote location makes it the prime dinner spot on a weeknight. The manager said the place is packed on weekends but it's not a weekday destination yet.

If you're unfamiliar with Mongolian barbecue restaurants, they all work the same. You walk in, grab a bowl at the buffet that you stuff with thin slices of frozen raw meat (turkey, chicken, beef or pork), noodles, and a variety of vegetables and cooking sauces. At the end of a counter, you turn over your bowl to one of the cooks who dumps it out on a hot metal cooking surface. He uses two long sticks to move the food around the cooking surface until it's done. He puts your food into a clean bowl and then hands it back to you, piping hot.

While your food is cooking, a server is busy setting up your table. When you get to your table, there is soup, rice, an appetizer (fried wontons with sweet & sour sauce) and a sesame biscuit. You order your drinks and enjoy your food.

I had fun creating my bowl tonight. I added turkey, chicken, a heaping pile of spinach and cabbage, a little bit of corn, onions, mushrooms, broccoli, zucchini, cilantro, jalapenos and peanuts. I added one scoop of each sauce, three scoops of garlic sauce and a scoop of sesame oil.

My overflowing bowl cooked down into a scant bowlful, but it was so tasty that I didn't care I would leave most of it behind. After about 30 minutes of eating, I looked down to realize that I didn't even make a dent in the bowl. The server came by and asked if I wanted to box it up. That was shocking. Most all-you-can-eat places do not allow you to take food home with you. But the server said that anyone who only makes one trip gets to take home their leftovers.

That was exciting for me, because I now have at least two more yummy meals waiting for me in my fridge. And it's nice to know that there is a buffet in town I can visit without feeling like I'm the weirdo who doesn't make trip after trip.

I know many post-ops carry around a card that tells restaurateurs that they've had gastric-bypass surgery and asking that they be allowed to eat off the children's or seniors' menu. That's not something I've ever done because I don't find things on those menus to be that healthy. Besides that, I just don't think it's a restaurant's job to bend its rules for me because I decided to alter my body's biology. So, I would never ask for such things, but it's nice when a restaurant offers. And for that reason, I'll be back to Ghengis Khan.

Off Topic: Call Me Miss Green Thumb

I just have to share about my weekend endeavor. I planted a container garden on my patio. I'm now the proud owner of a tomato plant, Thai chile plant, basil, nasturtiums and marigolds. This could be as addictive as chocolate. I'm now eyeing a three-tiered plant stand to grow more herbs.

Can't wait till harvest time.

Things that make me go "hmm ..."

Took a quick trip to Kohl's today to check out the clearance ranks. I had fun trying stuff on, especially now that I'm a solid medium/size 8 almost everywhere. At JC Penney two weeks ago, I discovered that I fit 8 petites to a T.

I was excited today to see the awesome selection Kohl's had in its petite clearance section. Found a beautiful kimono-style blouse for $4 that I thought would be perfect for ASBS in San Diego. I took the medium into the dressing room, unzipped it and slipped it on. Looked great except for one teensy-weensy problem: I couldn't get it zipped up past my rib cage. Hmm ... OK, Plan B kicked in and I went in search of a large. I found one in a different color that I liked just the same as the first. Took that one in the dressing room, held my breath and tried it on. Again, no luck. No matter how much sucking in I did, I couldn't get the zipper past my ribs.

Before I had gastric bypass, this occurrence would have broken my heart. It would have ruined my day and I would have gone home mopey. But today, I just laughed. All I could think was, "Well, ribs are bones ... can't suck those in no matter what." My feelings weren't hurt; I didn't have any feeling of failure. I just figured that explained why such a cute blouse made it to the clearance rack in the first place.

And now, as I get ready for bed, I think of how far I've come in the last two years.

Product Review: Micellar Milk

Photo courtesy of BariatricEating.com

Nature's Best Micellar Milk is a relatively new addition to the ready-to-drink proteing supplement market. I had heard of it from other post-ops on the BariatricEating.com (which sells it) message board last year but hadn't gotten around to ordering any before getting sick in January.

While I was in the hospital, a member of my local support group, Tammy Coursey, smuggled a container of vanilla and chocolate into the hospital for me. She swears by it as helping her get in her required protein since having surgery last Thanksgiving. She enjoys the vanilla poured over ice, saying its thin milk-like texture is perfect for her pouch -- not too heavy like blended supplements can be.

Aside from being thin and easy to drink, Micellar Milk is also nutrient-rich. A 17-ounce container provides 40 grams of protein with 220 calories, 2 grams of fat and 4 grams of sugar.

My favorite flavor is vanilla, which reminds me of rice pudding in taste. My husband is in love with the newest flavor, strawberries & cream. He says it's just like Strawberry Quik. Micellar Milk also comes in chocolate.

Having the consistency of milk makes Micellar Milk a perfect protein-rich substitue for milk in many recipes. When I was recovering from my bowel obstruction and restricted to a full-liquid diet, I used it in lieu of milk to make Sans Sucre instant chocolate mousse. I also used it in vanilla custard (with a dash of sugar-free Torani syrup). It was a tasty way to make sure I met my protein needs without overtaxing my digestive system.

If you visit the BE.com message board's recipe thread, you'll find all sorts of recipes that incorporate what members affectionately call Mice Milk. One favorite is Mice Cream, a protein-rich version of ice cream.

Personally, I enjoy Mice Milk by itself or with a few variations. One of my favorite ways to serve it is to make ice cubes out of leftover coffee and pour either chocolate or vanilla Mice Milk over the cubes for a cool treat at the office. One weekends, I'll use vanilla Mice Milk as creamer in my coffee with a shot of Torani sugar-free Irish Cream syrup for an Irish Cream protein latte that puts Starbucks to shame.

Hit or Miss: Definitely a hit. I have two cases at home right now, but they are going fast.

Somerville supports kids

An entire town went on a diet for a year in an effort to help the children in the community adopt healthier habits, according to an Associated Press article.

Thanks to financial support from a couple of grants, educational programs emphasized the importance of increasing activity and making food choices that included more fruits and vegetables and less fat. School lunches featured more fruits and vegetables, and children were encouraged to eat as much of them as they desired. Restaurants even joined the effort by offering healthier options and smaller portions. At the end of the program, researchers say the town's children avoided gaining one pound of body weight, compared to children in neighboring communities -- making the program a success.

Read the article yourself and tell me what you think.

The difference that makes it

Katie Jay of the National Association of Weight Loss Surgery has just published an article by me on the free portion of her Web site.

The article is a basic retelling of my personal story, one that readers of this blog know all too well. However, I hope that having it published on the NAWLS site opens me up to a wider audience. Bookmark the site, because Katie has already asked me to write another article for NAWLS and to record an audio interview with her.

ASBS conference

The American Society of Bariatric Surgeons will hosts its annual meeting and conference next month in San Diego. The weeklong event will begin June 11 at the San Diego Convention Center.

ASBS is the only national governing body for bariatric surgeons. It's the group behind the Centers of Excellence distinction that surgical centers strive to achieve. The organization Web site offers a list of Centers of Excellence by state for patients to peruse.

The conference is a big deal. Not only does it allow medical professionals to congregate and network, it provides continuing education courses and panel discussions of interest to those who work with the obese. Surgeons and other bariatric health-care providers will learn the latest surgical techniques and discuss research data on topics such as how access to nutritional supplementation affects compliance in patients and whether preoperative weight loss makes a difference in surgical outcomes.

The conference also features an extensive trade show with vendors showcasing everything from super-size furniture that is comfortable for morbidly obese patients to compression garmets that hold in excess skin so post-ops can achieve a more normal appearance under clothes. There are also vitamin and supplement vendors galore, in addition to advocacy groups. Carnie Wilson was a featured guest at a vendor's booth last year. No word whether she'll attend again this year.

I attended one day of last year's trade show in San Francisco. This year, I'm fortunate enough to spend most of the week at the event. I'll be blogging on the various workshops and educational sessions I attend.

Point to ponder: Childhood obesity

I was thumbing through a copy of Bariatric Times at a friend's house earlier today when an article on childhood obesity caught my eye. The article itself wasn't that earth-shattering but there was a profound quote from a source that hit home with me.

Loosely paraphrased, it read, "The key to treating childhood obesity is to understand that the afflicted come from homes where overeating and inactivity are allowed or encouraged."

Interesting perspective. I read those words and find them logical and succint. A lot of efforts toward reducing childhood obesity focus on educating and motivating the children but don't seem to target changing the environment at home. I wonder how effective it is to teach little Johnny the importance of making wise food choices and exercise if he goes home each day to a harried household where dinner is from the nearest drive-through and served in front of the Nintendo Xbox.

Any thoughts?

Recipes wanted

Summer is almost upon us, and that has me thinking of warm-weather meal options. Anybody have any recipes to share that include seasonal produce or are quick and easy and don't heat up the kitchen? Andrea, care to share some of your vegan favorites? Anyone else?

Vegetarian heaven

The downtown farmers market started today, and there was a vendor selling Afghan food who has stolen my heart. I'm serious -- we are new best friends. First off, he fed me lunch by giving me half a dozen different samples. I walked away with a low-carb pumpkin bolani, lentil curry, eggplant pesto, hummus, sweet-and-sour carrot chutney and whole wheat pita bread.

If you haven't tried Afghan food, I highly recommend it. To me, it tastes "cleaner" than Indian food but still has the complexity of flavor and spiciness that I love. All the stuff I bought today either was made with olive oil or had no added fat. Most of the breads offerred are made with lentil flour. That means no gluten and
lower carbs. The spinach bolani was super-yummy, too.

For those who don't know, bolani is almost like a cheeseless quesadilla. It's a folded piece of flatbread filled with spices and veggies. This vendor had low-carb pumpkin, low-carb spinach, then a veggie and potato version.

If you're in town next weekend, check it out. The farmers market will be open from 9 a.m. to 1 p.m. every Saturday until November. The market is on 10th Street, between Central Avenue and B Street.

If you don't live near the Tracy area, check out the company's Web site by clicking here.

The highs and lows of blood sugar

Melting Mama posted an article to her blog this week about the relationship between gastric bypass and low blood sugar. The article was of particular interest to me, because I was diagnosed with hypoglycemia a few weeks ago. Since then, life has been a constant balancing act as I figure out the best way to keep my blood sugar level throughout the day.

Before the diagnosis, I thought I was losing my mind. I was lethargic, spacey, dizzy, easily confused and could not focus on the simplest tasks. It would take every bit of willpower I had to stay awake at work and on the drive home. As soon as I'd walk in the door, I head straight to bed and crash. Often, I'd sleep for the entire night only to spend an hour the next morning willing myself out of bed.

After a month of dealing with this, just about any diagnosis would have been welcome. But once I heard the news, then reality set in. Not only is this most likely a permanent condition that will require constant diligence, I had trouble wrapping my brain around my body's new dietary needs.

Here I had spent two years following the gospel of three meals a day (no snacks), few to no carbs, protein drinks vs. protein bars (drinks are lower in calories), and absolutely no sugar. I had finally gotten the rules down pat and didn't have to think about them anymore.

But hypoglycemia carrries its own set of rules: Eating every three to four hours keeps blood sugar most level; protein elevates blood sugar but fiber helps level and maintain it so complex cars are a good thing; protein bars are better than protein drinks because they don't cause a rapid change in blood sugar; and in low moments, sugar can be the difference between maintaining consciousness and passing out.

I had a brief moment of bitterness upon hearing my surgeon's bariatric coordinator rattle off this advice to me. I felt like the rug had been pulled from beneath me. Eating four to five times a day worried me. What if I gained all my weight back? Carbs a good thing? What if eating them led me to feel hungrier or caused me to binge? Eat sugar? Seriously? What planet was this and what did the pod people do to my doctor?

After getting off the phone, I did a little Web research and talked to other post-ops who also had hypoglycemia. I made myself a shopping list and other notes based on their advice. Though my doctor wanted me to eat three full meals a day and two protein-rich snacks, most post-ops I talked to said their blood sugar levels were best maintained by eating four or five equal-sized mini-meals each day. All the post-ops I spoke to said cheese and peanut butter were their best friends. Some kept glucose pills handy; others didn't. All recommended I keep a stash of yucky-tasting crackers that I could grab when at a low point but that wouldn't be tempting to me otherwise.

Next, experimentation came into play. Cheese was definitely my best friend, but peanut butter wasn't as helpful. I keep a jar of it at the office just in case I get desperate, but I'm more apt to select a protein bar instead. My body feels best if I eat at least three whole-food meals each day.

For me, bars are definitely better than drinks. My favorite bars are Think Thin cruncy peanut butter (available at Trader Joe's) and Oh Yeah! chocolate-mint wafers (available online and at the Vitamin Shoppe). A half-serving is all I need to keep my blood sugar level. Both Think Thin and Oh Yeah! chew down very well so as not to overfill my pouch, but the Oh Yeah! bars are more convenient because they come with two wafers in each pack -- instant portion control.

Liquid protein is a toss-up for me. AchievOne sends my blood sugar soaring through the roof and then crashing down, but I can mitigate that if I eat an ounce of cheese after finishing my drink. Nectar-brand drinks don't cause any wackiness at all.

Carbs are a necessity for me, but I'm still learning how to effectively use them. My typical breakfast is high-fiber cereal mixed with flax seeds and Fage 0% Greek-style yogurt. Cheese and crackers is not as helpful and ends up being more of a trigger food. Salads are a good way to incorporate complex carbohydrates with my protein. I eat salad almost every day now.

As I said before, it's a balancing act. It's a challenge but it's not impossible. and if anything, at least it prevents me from getting bored.

Pre-op anxiety

I met with a pre-op today who is experiencing some last-minute anxiety over having surgery. A lot of what she confided in me today reminds me of my night-before-surgery meltdown in the Travelodge next to Kaiser SSF.

She's overwhelmed by her fears, and almost all of them are normal. She said she's overcome by what I call "last supper syndrome," which is the compulsion to make every meal your last as if you'll never eat again. I assured her that everyone goes through that. I spent six months before surgery saying goodbye to food that I thought I would never eat again. It took four times to truly bid farewell to the chocolate mousse cake at Fabio's, but I managed. The funny thing is, as I told this woman today, that many of the things I thought I couldn't live without are things that don't even tempt me now. My taste for them no longer exists.

She also fears failure. After all, she's failed at every diet she's tried before. Granted, this isn't a diet, but when you're a pre-op, surgery seems like a golden egg -- too good to be true. We all going into surgery worrying that we'll be the one person the surgery doesn't work for. But once we have surgery, we realize we have the power to make it a success. The patient fails the surgery; the surgery does not fail the patient.

I think the scariest thing of all when heading into surgery is the knowledge that your entire life is about to change but the inability to know exactly in what way. We can interview post-op after post-op, but everyone's mileage varies. We never know how we will react to surgery until we go under the knives ourselves.

Anybody out there care to share their fears in regard to weight loss -- surgical or otherwise?

Effects of preoperative exercise on complications and recovery

The December 2006 issue of Beyond Change, a newsletter focusing on obesity and obesity surgery, features an article proving what I've been touting for the last two years: Exercising before surgery vastly improves recovery time and decreases surgical complications.

If you want to read the article, click on the above link or here.

Before I had gastric-bypass surgery, I had heard rumors about the benefits of exercise when it came to recovery. I paid close attention to post-ops experiences and noticed that those who had a regular exercise program before surgery had fewer complaints about their surgical experience.

WLS was my first major surgery, and I was terrified about having my planned lap procedure being converted to open or suffering from wound infections. A doctor at the time told me that one thing obese people could do to prevent such occurrences is to increase bloodflow to the abdomen. Her opinion was that the more blood that flowed to the area, the faster wounds would heal. She also thought strong abdominal muscles healed from the trauma of surgery faster than undeveloped ones.

I had been exercising regularly for months before having WLS, but four weeks before my surgery date, I kicked things into high gear by hiring a personal trainer. We focused on building up my muscle mass (to mitigate the amount I would lose while recovering) and toning my core. At my first session, I did 25 crunches on a stability ball. By the time the month was up, I was doing 300 crunches a day on the floor -- and I weighed 310 pounds.

Surgery was a breeze for me. I'm not saying it was painless, but it wasn't as painful as I expected. I was walking laps in the ICU so well that I pushed for transfer because watching me made the other bariatric post-ops feel bad. I had no trouble adjusting myself in bed. And once I figured out how to negotiate the IV lines, I stopped needing assistance to get out of bed.

A week after my release, I was back in the gym. I wasn't insane. I started doing five minutes on the treadmill (the gym was across the street from my apartment) and worked my way up slowly to 30 minutes in two weeks.

A lot of post-ops I've met try to say my age is what made my recovery so easy. That's hogwash. One of my best post-op friends had a similar experience and she's 50. But she also hired a personal trainer before surgery, and she credits that investment for her easy recovery just as I do.

Fun post

Check out the Crazy Salad Cravings post. I've added a few different salad ideas to it in the comments section. Look it over and then add your own.

2007 Walk From Obesity

Mark your calendars: The 2007 Livermore Walk From Obesity will be from 9 a.m. to 11 a.m. Saturday, Oct. 6.

Money raised from the three-mile walk will benefit the ASBS Foundation and the Obesity Action Coalition. The ASBS Foundation is the nonprofit arm of the American Society of Bariatric Surgeons, and it has done a lot in the way of advocacy on behalf of the morbidly obese. According to the foundation, it "is serious about improving the lives of the morbidly obese by focusing on ... Increased funding of research specifically in morbid obesity (and) increased public and professional education."

OAC is an advocacy group that fights on behalf of anyone who is obese or touched by obesity. The nonprofit's goals are as follows:

* Educate patients, family members and the general public on obesity and its effects on the healthcare community.
* Help patients gain access to medical treatment for obesity.
* Work to ensure that those obesity treatments are safe and effective.
* Strive to eliminate the negative stigma associated with obesity.
* Elevate and empower obese individuals to take action that makes a difference in their lives and the lives of others.

The walk is not exclusively for thin people or for obese people. It's not for bariatric patients or those on weight-loss programs. It's open to everyone who has a desire to help put an end to this debilitating disease. As one item I read said, "We walk on behalf of those who cannot because obesity has robbed them of their mobility or their lives."

As I've blogged about before, fighting the disease of obesity and advocating for those afflicted with it is very important to me. I don't think there is another cause that I can say incites such passion in me. And I am thankful that gastric-bypass surgery has given me the ability to fight this fight for those who cannot.

I am volunteering to help organize the event in addition to organizing a local team. If you are interested in participating in the team, want to organize one of your own, or want to volunteer to help plan it, let me know and I will get you the details. I don't have the details on fundraising requirements, but I believe each walker is expected to raise at least $100.

If you are outside of the East Bay Area, there may be a walk scheduled for your area. Visit the walk's site for further information. It's not yet updated with dates for all the walks, but that should happen by next week.

Vitamin Shoppe

I was shopping in Modesto on Saturday when I discovered a Vitamin Shoppe store on Pelandale in the same shopping center as Cost Plus World Market. I had heard from other bariatric patients that Vitamin Shoppe had a great selection of bariatric-friendly products and knowledgeable staff.

I had a little time to kill so I ducked in. It proved to be everything I heard of and more. When I walked into the spacious store, the selection of supplements was almost overwhelming. I was glancing over the events calendar, which features product tastings and events hosted with local gyms when the manager greeted me. I told her I was a gastric-bypass patient and that I was just looking to compare the store's prices with my favorite supplier. She handed me a flier the store has for bariatric patients that lists all the WLS-friendly products they have and a $5 off coupon.

Not only did the store have many of my favorites -- such as Micellar Milk, Zero-Carb Isopure and PowerCrunch bars -- but it also carried some of the products I've been wanting to try but haven't got around to ordering -- such as Oh Yeah! protein wafers and PowerCrunch's new cinnamon bun flavored bars. And to top it off, the store's products were priced about a $1 less than my favorite online supplier, and there's no shipping to worry about if you have a store nearby.

They didn't have all of my favorites, though. The manager said AchievOne RTDs aren't even offered as an option from her supplier. Revival soy chips and Snack & Slim pudding were also MIA. However, the store sells a sugar-free instant protein pudding that the manager mixed up for me to try. I was impressed; it was chocolately and tasty.

While looking over the various supplements, I found out one of the clerks had gastric bypass three years ago. She told me this was her first job since having surgery. She looked great, and she told me she feels great, too. We discussed our experiences with surgery while I looked over digestive supplements. The store carries a wide variety of vegan and vegetarian probiotics and digestive enzymes.

Probiotics can come in handy for people who've taken lots of antibiotics, because they replace the good bacteria in the digestive tract. Digestive enzymes work to break down undigested food in the intestinal tract. This is an important aid for WLS patients. Our new anatomical design means our food doesn't benefit from the chemical and mechanical digestion that typically takes place in the stomach. That's why we have to chew our food to baby-food consistency and stick with foods that chew down easily. Food that isn't chewed well enough can get stuck or irritate the intestines. Depending on the brand selected, digestive enzymes break down protein, fat, fiber and dairy and other foods.

Before I realized it, I had spent two hours at the Vitamin Shoppe and was late for my shopping date. I left in a rush, but I promise to be back.

Number of children hospitalized for Type 2 diabetes soars

My friend just sent me this link from Yahoo News that reports a 200% rise in the number of children hospitalized with complications from Type 2 diabetes.

Experts quoted in the article link the increase to the epidemic of childhood obesity, which seems to get worse each day. But a couple of people question the validity of the study's findings. One doc questioned whether the children were properly diagnosed. Another points out that the distinction between Type 1 diabetes and Type 2 diabetes has only been around since 1997, meaning the "soaring" numbers could just be from increased recognition rather than increased incidence.

Check out the link and tell your thoughts.

Shopping surprise

I've noticed over the last few weeks that my clothes don't fit like they used to. My shirts slide off my shoulders; my pants sag around my hips.

I decided today that I needed to remedy that problem with a jaunt to the mall. With my best friend in tow, I headed to JC Penney in Modesto. The store was having a fabulous sale, and we had coupons, too. Besides needing clothes that fit, I also needed career wear for a conference I'll be attending next month. I knew that meant this would be a heavy-duty shopping trip.

Upon entering the store, we headed to the career wear section and picked our way through the various separates. My best friend has an impeccable sense of style so I let her take control of picking stuff. We both had armfuls of clothes in sizes 8 and 10 when we entered the fitting room. Imagine my surprise when I found that every single size 8 was too big! I looked like I was wearing my big sister's clothes.

After looking at how some of the jackets fit me, my best friend suggested we head to the petite section. I protested, telling her all the reasons I've never been able to wear petites: crotch isn't long enough in pants; bust never fits in shirts. But it was obvious I couldn't wear anything we had already selected, and neither of us thought an average size 6 would fit.

First problem we found is that the selection in petites is lacking. The second problem I had is that the clothes looked outrageously small to me -- like they should be for children. We managed to find two suits, a skirt, a pair of those new long shorts that are trendy right now and a few blouses to try on. We grabbed 8s and 6s of everything we could, just in case. We now knew that 10s were out, no matter what.

In the fitting room, I held my breath as I tried on the first pair of slacks.

"Look, look!," my best friend exclaimed as I zipped them up. "They fit you!"

I surveyed my reflection in the mirror. They sure did, and they made my hips look so slim that I wasn't sure I knew the woman staring back at me. It turns out that everything fit, though we later decided the white-and-gray pinstripe suit was not practical enough to warrant its $100 price tag.

I walked out of JC Penney with a black suit, two blouses, long black shorts and a gray skirt for under $100 -- all in a petite size 8. Not a bad deal, if you ask me.

Blog Potato

Inside Out has been added to the Blog Potato blogroll. What's a Blog Potato? Just as couch potatoes sit on the couch all day; blog potatoes are people who blog all the time. Blog Potato has the ambitious goal of compiling the longest blogroll on the Internet. If you have a blog, visit the site and get yourself added.

Melting Mama

I've become hooked this week on reading other blogs related to surgical weight loss. There's an abundance of them out there, and each has its own merits. Take Melting Mama, for example.

The site's owner, Beth, is a Bostonian about my age who once topped the scales at more than 300 pounds. What I love most about her blog is its snarky tone. She's had a slew of complications since WLS, and she doesn't shy away from them. I appreciate that about her, because as I've said, this journey isn't all peaches and roses -- and I think more people need to be aware of the risks associated with it.

So, take a sec and check out Melting Mama, and then click back here and tell me what you think.

Chance meeting leads to friendship

I recently had the opportunity to meet Katie Jay, the director of the National Association for Weight Loss Surgery. Jay is a dynamic woman who self-published her memoir, "Dying to Change: My Really Heavy Life Story."

She refers to herself as an obesity survivor, and to her credit, she's maintained a 190-pound weight loss since she had bariatric surgery three years ago. Jay travels as a speaker, workshop leader and life coach, making a career out of supporting others in their efforts to overcome obesity.

We crossed paths by chance. She had connected with a Tracy woman who is starting up a bariatric life coaching business here in town. Jay was offering the woman some sage words of advice when the topic of Jay's recent bowel obstruction came up. The local woman briefly told Jay of my recent experience and decided that we had to meet, because our stories were similar.

After exchanging a few e-mails, Jay and I chatted on the phone for almost two hours. We talked about our histories, our bariatric journeys, our respective bowel obstructions (nothing like getting personal right out of the gate), and our goals. And I think it's safe to say we're well on our way to becoming friends, because we see eye-to-eye on so many levels.

Jay's Web site offers a wealth of information for those considering bariatric surgery. She offers numerous articles that discuss the various types of procedures available, common obstacles, insurance issues and the emotional challenges post-ops face. One article of hers that I particularly enjoyed is titled "My Body is a Wonderland." The article discusses Jay's journey toward self-acceptance through yoga. It's a profound and inspiring tale. Check it out, and come back here to post a comment on it. I'd love to hear your thoughts