# Liquid Diet vs Surgery



## tn_junk (Nov 28, 2006)

Dr. wants me to have gastric bypass surgery. Says that I've got to lose weight *NOW.* The 3-4 pounds a month I am losing ain't fast enough. (This guy is a diabetic/internal medicine specialist). Says that my life depends on it. 
Anybody out there doing a Liquid Diet? Anybody had the surgery?

thanks

galump


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## susieM (Apr 23, 2006)

I recently read that people with this b-pass who also suffer from diabetes, have been found to have the diabetes symptoms back off, with some even being able to get off the meds. This was on GoogleNews and camefrom Australia.

It seems that it is maybe not so much the diet, altough losing weight is a big factor, but also the fact that with these by-pass things people tend to eat tiny meals often instead of big ones that seems to do the trick.

So forget the liquids and go for the by-pass.


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## mammabooh (Sep 1, 2004)

Why not just start eating like you would after you had the surgery? I'd think that would have a dramatic effect. Sorry...that sounded sort of mean and simplistic. I know it's not as easy as that.


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## tn_junk (Nov 28, 2006)

mammabooh said:


> Why not just start eating like you would after you had the surgery? I'd think that would have a dramatic effect. Sorry...that sounded sort of mean and simplistic. I know it's not as easy as that.


I know that you are not trying to be mean. But I am fifty years old and have been yo-yo dieting for 40 of those years. I weighed 160 pounds when I was 10 years old. I weighed 185 pounds three years ago. Have weighed as much as 425 before. Now am at about 300.
If you look at the world around you, there are a whole bunch of us that just can't seem to "get it". Can't seem to eat right and maintain a healthy weight. 
I have already lost my mother and two uncles to obesity related issues, all under 60 years old. And I can't blame my problems on the way I was raised, because they didn't raise me. I was raised by my fathers family, and they are all slim skinny people. 
Not making excuses, just stating fact. If I could just eat a little, lose weight and keep it off, I would have done so 40 years ago.

galump


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## MaineFarmMom (Dec 29, 2002)

I have a friend who asked her doctor about gastric bypass and Lap-Band. Her doctor had two questions for her. First, is your stomach broken? No. Second, then why do you want to alter it? The problem isn't her stomach. Until she deals with the problems that cause her to overeat she'd be miserable not being able to eat. Her doctor said people who don't fix the head before tampering with the stomach too often are not successful with the surgery. They either find a way to continue eating, start eating again soon after and regain the weight, or replace food with another crutch.

It makes a lot of sense to me. I've been paying attention to what her doctor is having her do and some of it's applicable to me. I've lost four pounds since she started paying attention to what she eats. =) The only thing I'm doing is writing down every single thing I eat along with the emotions and goings on at the time. I realized last week that I'm an emotional eater. I'd have said I like comfort food now and then but I don't typically drown my sorrows in chocolate. I've realized I do in fact eat when I'm stressed and sometimes do it mindlessly. I was stressed over a phone call, hung up, immediately went to the kitchen, ate an apple muffin, and 20 minutes later realized what I'd done.

I think before I'd considering damaging a perfectly good stomach I'd have to get some professional help to figure out why I eat the way I do. So far so good with my friend. It's been only a few weeks but she's figured out some important patterns. I don't know if there's anything you want from this but it's something to think seriously about. People do die on the table from this surgery.


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## RockyGlen (Jan 19, 2007)

Because diabetics don't heal as well, I would try the liquid diet first. I have an aunt who was 100 pounds overweight and diabetic. Here is how she lost the 100 pounds in just under a year:

all the water, black coffee, and celery she wanted, plus

breakfast: slim fast shake

mid-morning snack - a 100 calorie pack (whatever she felt like, as long as it was a premeasured 100 calories)

lunch - lean cuisine meal and diet coke

mid afternoon snack - a 100 calorie pack

dinner - slim fast shake

bedtime snack - a 100 calorie pack

I tried doing this diet, and lost weight....but still cooking huge meals for my family I was not able to stay on it long.


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## seedspreader (Oct 18, 2004)

Just listen to your doctor and get the surgery.

My mom, dad, and sister have had the surgery and all came through it wonderfully.

It's hard, but it's worthwhile.

Myself... I am in good health so I am going at it the hard way. I've lost around 40 lbs so far... But I've changed my eating habits totally too.


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## Shazza (Nov 20, 2004)

I think the surgery is too drastic a step to take...thinking of afterwards...you will still weigh the same but only able to eat a cup of food at a time. The weight will drop off you not because you have changed your lifestyle but because you are starving. My good friend who lives in the top end of Aus had this surgery done. She only weighed 100 kgs but has Diabetics in her family....she must have done some sweet talking for him to do the op. She now of course only weighs 60kgs 7 mths later. I fear she will fade away and become unhealthy on the other end of the scales.
Remember that when they downsize your stomach they take away the "chemical indicator" to your brain that tells you you are hungry. 
I agree with mammhboo, practice eating tiny tiny bits of food, reward hunger pains with a glass of water.
But it all comes down to what you want to do...good luck.


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## Jaclynne (May 14, 2002)

Everyone keeps saying just eat as if you had the surgery. 

Well, how is that?

No more than 1 cup of food at a time. How often?

Does it matter what it is? Is it liquid, bland, no fat, sensible diet, or just anything you want?

I've heard people with prior gastric problems are not candidates for the surgery or lapband. What is considered gastric problems? Gerd, I know but what else? 

Are lapband or surgery patients required to take some medications? 

Halo


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## Guest (May 29, 2007)

Have you tried weight watchers? What about therapy? Seriously, the first place you need to work on is your head. I'm 120 pounds overweight and I'm just now getting it. I've lost 20 pounds so far, but I need to be serious and quit looking for ways to "cheat".


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## Shazza (Nov 20, 2004)

I said one cup cos that is all you can fit in after the op...anymore than that and you will have EXTREME gut ache cos you will be over full...stuffed...so one would make sure that that one cup is low GI food...something very healthy. Or one of the SUPER veges...carrots, corn, broccoli, peas, beans....they have the most mins/vits and anti-oxidants.


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## ArmyDoc (May 13, 2007)

Disclamer: The following is only general information. It is not to be construed as medical advice. You should talk to your doctor about all medical decisions. I am not your doctor. 

That said, I am a bariatric surgeon, and I would be happy to provide you with general answers about bariatric surgery. Iâll give an overview here, and answer more specifically if you ask. But seriously, if you decide to pursue this, you need to find your own surgeon and talk to him/her about your specific situation. 

First off, who is eligible for weight-loss surgery? Answer: Patients who are morbidly obese. The term implies patients whose obesity is causing them medical problems, or who can be relatively certain that it will eventually cause them medical problems. The standard is a BMI over 40 or a BMI over 35 with some obesity related condition. BMI is calculated by taking your weight in kilograms and dividing it by your height in meters squared. (itâs easier to use one of the on-line BMI calculators)

The problem is, that it is actually more complicated than that. There are plenty of patients who are morbidly obese who are poor candidates. They maybe too sick for surgery (this is major surgery â donât let anyone tell you otherwise.) They may not be mentally ready for the major lifestyle changes that this surgery will entail. They may not be willing to stick to the diet post-operatively, to name a few.

Concerning Bariatric surgery, there are currently 2 main surgeries being performed in the US right now. The Gastric Bypass and the laparoband. There are a few other variations, but I won't go into those right now. 

The most common, and most successful is generally the Gastric Bypass. It does two things: 1) it decreases the amount you can eat and 2) it decreases the efficiency of your bodies absorption. It can be done open (through and incision) or laparoscopically. Most patients lose about 65% of your excess body weight. (for example, if your ideal weight is 145#, but you actually weigh 295#, then you are 150# over weight. The average patient would lose about 65% of the excess weight, or 100#)

The laparoband is a laparoscopic surgery that effectively makes your stomach smaller by putting a band around the upper part. This decreases the amount you can eat at one time. In most studies, it doesn't reslult in as much weight loss as gastric bypass - averaging 40 to 50% of excess weight. Also, it can have a revision rate of up to 40 percent, and in some studies does it does not provide as good results over the long term (several years). That said it can be beneficial for some patients.

As for diet vs surgery, that is a hard decision. Though I do the surgery, I am not a fan of surgery. It is not a quick fix, it is a court of last resourt. Anyone who views it as a quick fix is likely to regain a significant amount of weight inspite of having surgery. 

That said, I am also not a fan of any type of diet that you can not stick to for the rest of your life. So I guess you could say I donât believe in any type of âdietâ because the common concept of a diet is a short term change in what you eat. The problem with diets is, when you stop your diet you go back to eating the way you did before you went on your diet. In other words, you eat the way that made you obese in the first place. 

In order for any weight loss program to work, diet and exercise based or surgery based, you are going to have to make a *permanent* change in your lifestyle / eating habits. Surgery is very effective at causing the type of permanent changes that are necessary, and I believe in general for the morbidly obese patient is more effective than diet and exercise programs.

Even so, diet and exercise should be the first line of treatment. Concerning diets, studies have shown that in general, losing weight at 1-2 pounds a week is generally as much as is sustainable on a diet program. More than that, and you have an increased rate of rebound. Weight loss of more than 10% of your body weight is also associated with a high rate of rebound. Does this mean you canât lose weight and keep it off without surgery? *NO!* It means it isnât easy. But I think you already know that, right?

Your doctorâs urgency may be more related to your age, than your health â but again, never having met you, I can not say for certain this is true. Your doctor may be concerned that if you continue to yo-yo back and forth with your weight, you may be too old for surgery by the time you decide to have it. You see, many Bariatric surgeons will not operate on older patients. Itâs not that the risk of surgery is any higher in the older patient. The complication rate is the same in older patients as it is in younger patients. But in older patients, the patientâs ability to tolerate a complication is decreased. Iâm sure anyone whoâs over 40 recognizes that we donât bounce back as well as we did when we were 20. Our bodies reserves just arenât what they used to be. 

I hope this helps. A good resource is www.obesityhelp.com There are many other good sites, but this one should at least get you started.


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## ArmyDoc (May 13, 2007)

HaloHead said:


> Everyone keeps saying just eat as if you had the surgery.
> 
> Well, how is that?
> 
> Halo



Excellent question. Because mammabooh's suggestion is actually a very good one. Bariatric surgery isn't magic. If you can stick to a post-bariatric diet you would definitely lose weight.

Immediately after surgery, you are on a liquid diet only. The connections made between the intestines and stomach need time to heal. After a few days patients are advanced to a purre (baby food consistency) diet. The time for this phase depends on the surgeon. I recommend 4 weeks. After this, firmer foods are added slowly.

The key is in portion sizes. Most surgeons create a pouch that is about 30cc or about 1 oz in size. You can't eat much at a time. This means frequent small meals consisting of 3-6 bites at a time. The type of food is also important. Because you can't eat much, you have to make it count. This means high protien, low fat and low carbohydrate meals. Also, after bypass surgery foods that are high in carbohydrates and fats are likely to make you nauseous or give you diarrhea. This is a side effect of the surgery.

Gastric bypass forces you to eat differently from the way most people eat. It forces (at least initially) you to eat in a pattern that is healthy. But if you can eat that way without surgery, and not just for a few months or years, but for the rest of your life, you may not need surgery at all. What is that healthy pattern? 

Basically:

1) Don't eat when you aren't hungry
- most people don't eat when they are hungry. They eat when they are bored, want a certain taste, are cellebrating, are happy, are sad, or any number of other reasons that have little to do with being physically hungry. Also, the phyical feelings of thirst are almost identical to hunger, so many times people eat when they are really just thirsty. Try drinking a cup of water and waiting 10 minutes. A lot of the time you'll find you won't be hungre after wards.

2) Don't continue to eat after you no longer feel hungry
- notice I didn't say don't eat after you are full. I said don't continue to eat when you no longer feel hungry. If you feel full, you ate too much, and probably too fast. Eat slowly, a few bites then wait for 5 or 10 minutes to allow your body to recognize that it's not hungry any more. It should take you a half hour to eat 4 ounces of food.

3) Eat healthy. Avoid fats and carbohydrates, and increase protiene. You don't have to go to extreams, but recognize that fats give you twice as many calories per gram as protiens, and carbohydrates will be burned faster (resulting in your feeling hungry sooner) than protiens.

4) Drink lots of water through out the day, and BEFORE your meals. This will ensure you are not eating because you are thirsty.

Those 4 things are the foundation of a healthy eating lifestyle. 

A lot of weight loss has to do with mental programing. To be successful, you have to reprogram yourself, break old habits and form new ones. With that in mind, here are two other things to remember:

1) Hunger is your body's way of telling you: "unless you feed me, I'm going to start losing weight." 
-If your goal is to lose weight, when you feel hungry don't be upset, rejoice! You are accomplishing your goal. Have a drink of water. Then wait for a half hour or so before you eat. You might be surprised - your hunger pains might go away. Don't push it longer than this though - or you won't stop eating after those first few bites. You need to stop after 3-4 bites to give your stomach a chance to change signals from hungy to not hungry.

2) The sensation of being full is your bodies way of telling you: "You ate too much, and now I'm going to have to convert this to fat."
- Feeling full is a bad thing. It means you over did it.


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## Jaclynne (May 14, 2002)

Thank you ArmyDoc. Good information.

Halo


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## tn_junk (Nov 28, 2006)

Thank ArmyDoc, good info.

Even at 325 pounds I have low cholesterol (165), good blood pressure (118/72) and decent triglycerides (205). Only health problem is an extended q-t interval, and arthritis. Dr. is concerned that I will get type II diabetes, and wants me thin *NOW.* Have tried OA, WeightWatchers, individual therapy, you name it. Have not had long term (over 5 years) success.
Will talk to a surgeon next week.

Thanks

galump


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## ArmyDoc (May 13, 2007)

galump said:


> Thank ArmyDoc, good info.
> 
> Even at 325 pounds I have low cholesterol (165), good blood pressure (118/72) and decent triglycerides (205). Only health problem is an extended q-t interval, and arthritis. Dr. is concerned that I will get type II diabetes, and wants me thin *NOW.* Have tried OA, WeightWatchers, individual therapy, you name it. Have not had long term (over 5 years) success.
> Will talk to a surgeon next week.
> ...


I wish you every success. I'm sure you will do well. The key will be to remember that the surgery won't do the work for you. But if you work with the surgery, it will help you to lose the weight. After you lose the weight, it will remind you when you are eating to much - it's still up to you to listen to that reminder. Use the first two years after surgery to learn new eating habbits. Once you've learned those new habbits, stick to them!

Good luck and god bless.


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## Jaclynne (May 14, 2002)

I am recently diagnosed with type 2 diabetes, but have no problems with bloodpressure (120/70), cholesteral (149), etc. I do have a real problem with water retention, though heart/circulation tests show no reason for it. My doc says its the extra weight.
The diabetes is controlled with diet - small, frequent meals. So I think trying the eating style for a GB surgery patient is the way to go for me. 

Halo


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## suburbanite (Jul 27, 2006)

That seems to me to be a bit low threshold for getting the surgery. I thought the guideline was two co-morbidities, not an isolated co-morbidity (diabetes in this case). ArmyDoc may have some enlightening comment on that?

Ask your doc what the post-op diet would be and then try that for awhile. You'll be ravenously hungry but it will give you a trial run of post-surgical life.

I disagree with ArmyDoc in that I think for the purpose of losing weight, a 'diet' is a useful tool. But understand, the point of the weight-loss diet is to get you down to a weight where you can safely increase your physical activity level. You will not be able to maintain the restrictive diet forever, and it is the exercise that can re-set your metabolism and allow you to shift over to a more sustainable long-term diet plan.

From the story of your family it sounds to me like you have a genetic/hormonal predisposition to be fat. However, since there aren't really any good tools for treating such a condition, even though it makes your weight 'not your fault', you are still left with having to use the old 'diet and exercise' routine to address it.

There are a few emerging elements which might be helpful to experiment with. First, corn syrup is getting to look more and more disadvantageous to losing weight, having to do with what sugar metabolism pathways are activated to deal with the fructose. Second, the sodium benzoate used as a preservative in most diet soft drinks is now found to be toxic to mitochondria, independent of its potential to become carcinogenic benzine if improperly stored. 

Mitochondria are what convert sugar in your cells into ATP, the energy currency of the cell, and so although no studies are yet out to explore what role this toxicity might have in obesity, it seems a reasonable leap of logic that a mitochondrial toxin could have a role in the development or maintenance of a weight problem. Until there's data to see whether this has any effect, and given that there's already some question about the benzene, it seems reasonable to me to cut out anything containing sodium benzoate and see if that helps or not.


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## suburbanite (Jul 27, 2006)

Sometimes if you have a lot of body fat in your abdomen it can press on the vena cava (which returns blood to the heart) and cause water build up in the extremities. This is part of why some women get puffy ankles when pregnant (its not all just hormonal).


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## suburbanite (Jul 27, 2006)

When I was in college I weighed 140 lbs and was doing sprint-length triathlons--1/2 mile swim, 12 miles bike, 3 miles run.

To train for this level of competition I swam 6 miles a week, ran 15 miles a week, and biked 40-60 miles per week. Since I was comparing myself to other triathletes, I considered this to NOT be much exercise.

Part of what you'll need to do is re-adjust your concept of what constitutes 'active'. Since your genetic cards seem loaded against you, my college level of activity is probably something like what you'll need to shoot for to keep weight off, eventually. 

This probably seems to you like an impossible level of activity to maintain. I had to quit this level when I left college primarily because I could not find a suitable local swimming venue. I gained about 20 lbs (partly also due to a serious bout of pneumonia that left me with diminished reserve for about 6 months). Then after becoming disabled after an accident (RSD/CRPS) I gained weight and am now about 90 lbs overweight myself. 

But back in the day it wasn't as hard as one might think. Swimming can be done daily, and the lower body intensive exercise was alternated with one day off in between. So I'd swim Monday through Saturday for an hour each morning, and then at the end of the day either run or bicycle for about 30 minutes, alternating days. Saturday and Sunday I'd go on a longer bike ride or run to hit my mileage target for the week, or I could take Sunday off entirely. Also on weekends I could substitute another physical activity, such as hiking or skiing or some other social sport.

My suggestion to you is the plan I keep wanting to implement--loose weight via dieting (in my case, Atkins is the only one I can stick with) until I get low enough to sit comfortably on my bike again (which is on a wind trainer so if my disability acts up I won't be stranded miles from home), or in your case perhaps to go on long walks. I figure this for me will be a loss of about 30 lbs, which is not that difficult with diet alone. Then I hope to increase my activity level on the stationary bike such that I can slowly liberalize my diet while still losing weight at a 2-3 lb/week rate.

Now, swimming will not cause a person to lose weight. But what it will do, is strengthen muscles around joints and increase your cardiac fitness. This in turn can reduce your risk of injury and increase your endurance for when you begin adopting other forms of exercise (such as bike riding or walking) which *do* help you lose weight. 

So if you have access to a swimming pool--not a backyard puddle but a real pool of minimum 20 yards length--then you should start swimming laps. You can do this even at 300 lbs. If you have poor form swimming, take lessons--with summer coming up there should be a lot of classes offered. You need to become proficient enough that you feel comfortable swimming laps, not like you're just flailing in the water. Start off with about 500 yards three times a week, keep that up until it is not exhausting, then add days one per week until you're up to 6 days a week, then you can add 100 yards at a time, as rapidly as weekly. You'll want to work up to about 2000 yards a day, 6 days a week. The most common way to fit this into a schedule is to do it first thing in the morning. If you do it at the end of the day you're more likely to get tired and blow it off. You can do this now so that when you get your weight down to a level where walking doesn't whack your joints badly, you're heart will be up to the walk and your joints will have good muscle strength to protect them.

You want to be going slowly and consistently--what athletes call 'long slow distance'. Don't worry about speed or strength at this point. Since you're going for fitness not competition, those are secondary considerations and will come with time. (If you want to improve them after you've been exercising awhile, you can add weight training, but that is a whole other topic).

There used to be a book 20 years ago called the 'run easy method' or something like that. If you can find it then you can use that to guide your walking program (it works for walking or for running). It uses something called 'the target heart rate' to adjust your exercise intensity to match your current fitness level. The basic principal using the heart rate is very good to use across all the various cardiac exercises that you do.

Sports books for competitors will talk about sprint training and hills and such. Ignore all such tactics until you've been at a sport for over a year. Right now you just need to focus on the basics of getting your fitness level up.

The exercise will change the way your muscle cells handle sugar and this will help you lose weight faster. It will also increase your baseline metabolism so that you are burning energy faster when at rest. In this way you will eventually be able to go on a less restrictive diet, although your diet will probably never be able to be as free as that of someone without a history of weight problems.


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## LilyFestre (Mar 20, 2006)

I disagree. My best friend had this surgery and sure she lost weight BUT she has had more complications and pain from the surgery than from being overweight and taking some time to properly diet. She went for the quick fix and is paying a HUGE price healthwise. The surery itself has not been researched for it's long term effects. Why cut open your body when there are other ways to do this.

I am a diabetic. I am overweight. I am also a member of Weight Watchers and am taking the weight off in a sensible, healthy manner. I"d suggest that route. Liquid diets do not teach you how to eat and they screw up your metabolism. They are not a healthy life choice.


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## LilyFestre (Mar 20, 2006)

If you decide on the gastric 
1. Rapid weight loss
2. Hair loss
3. Daily vomiting
4. Loss of the enamel of your teeth
5. Intense personality changes
6. Possible limitations to what you can actually eat (best friend can only keep down coffee...which by the way seems to be the norm with everyone I know who has had this surgery...tons of coffee, egg drop soup, refriend beans and onions. Another I know can only keep down mashed potatoes).
7. Complications. I know about 9 people who have had this surgery and only ONE has not had to return for more surgery. Most all of them have had an abcess that required home health care to come pack the wound 2 times a day (think long Q-tip shoving gauze into open surgery site and then UP the incision into the infection).
8. Taking vitamins for the rest of your life because you can't possibly get in and hold (or absorb) the vitamins that are essential to good health
9. Being able to only take liquid medications (sometimes very hard to get/lengthy wait and expensive) because your new pouch won't accept such anything that is the size of a pill.
10. Let's not forget the sagging skin. You will lose the weight. Yep. But your body will look like a freak show. My friend says that it's all an illusion, much like a drag queen. She looks great until she removes her clothes. Her body looks like a sagging theatre curtain. The fat is gone but the skin remains....like a balloon without 3/4 of it's air. Her belly hangs below her panty line. Her breasts are like shriveled up raisins (she's shown me and those are her words) that just hang there. Her upper arms? She calls those her bat wings. If you think they jiggle when you are fat, you haven't seen anything yet.

I know the purpose of this is to drive your blood glucose levels down but why subject yourself .to this when you CAN do it on your own (work, yes! Been there, done that, I DO KNOW!)

I have been as high as 312. I am diabetic. I understand where you are. If you were in the 400s and are down to 300s, what did you do? How did you lose that weight? 

Again, I will push Weight Watchers. You don't starve. You can eat whatever foods YOU like (as long as you count them so moderation is in place). It is a HEALTHY program that does work (nope, I do NOT work for WW). Also, if you get a prescription from your Dr. to join WW, the fees ($12.00 a week) are tax deductable. 

I also had a Dr. that was insistant the I lose the weight NOW. He'd never been overweight a day in his life and has NO idea what kind of struggle it is. In addition, many Dr.'s are weight phobic. They have NO idea how to deal with obesity. Find yourself a Dr. who does know. One who isn't all gung-ho on an invasive surgery with life altering results (death rate for this surgery is fairly high). There are other ways. I felt that my Dr. was bullying me into this surgery. I researched it, made and had a consultation appointment with the surgeon and found no reason in the world to do that to myself. 

Only you know your body. Only YOU know when you are ready to lose weight and to do the work it takes to get there. And only YOU know if you want to take the risks that this surgery involves. I wish you much success whatever road you choose.


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## Jaclynne (May 14, 2002)

LilyFestre - I agree with much of your post, but you _seem to imply _ that loosing the weight slowly will not result in the sagging extra skin at goal's end like loosing weight quickly will. 
This simply isn't true. The amount of extra skin a new skinny has to deal with is determined by :

a) the amount of 'overweight' they carried
b) how long they were overweight
c) genetics - some of us just have better skin than others

I've read most good surgeons insist you wait at least 6 months after weight loss to see what the skin will do on its own.

Halo


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## Jaclynne (May 14, 2002)

suburbanite said:


> Sometimes if you have a lot of body fat in your abdomen it can press on the vena cava (which returns blood to the heart) and cause water build up in the extremities. This is part of why some women get puffy ankles when pregnant (its not all just hormonal).


Thanks - this I will research.


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## ArmyDoc (May 13, 2007)

LilyFestre said:


> If you decide on the gastric
> 1. Rapid weight loss


True



> 2. Hair loss


Often true, but not universal. Some do not suffer this at all, but most patients will experience some degree of hair loss during the high stress first year. About 50% of those who suffer from hairloss will return to normal either on their own or with vitamin supplements. The remaining patients (about 1/3) will experience some degree of thinning ranging from minimal to severe.


> 3. Daily vomiting


In general, this is more related the patients eating habits than the surgery. If you eat more than your pouch will hold, you will vomit. That's what the surgery is designed to do. The vast majority of my patients don't suffer from daily vomiting. By the same token, the vast majority of my patients do suffere vomiting on more than one occasion. Usually, they attribute it to eating more than they should have. I have had only one patient in the past 5 years who had horrible nausea/vomiting unrelated to the amount she ate. She is the only patient I've had who required medication to control it. Her nausea spontaneousely resolved about 1 1/2 months out from surgery. 


> 4. Loss of the enamel of your teeth


I have never run into this problem as a result of surgery. It is a common problem with bulimia nervosa.


> 5. Intense personality changes


Tough one. Personallity is closely tied with body image. Change your body image, and your behavior / personallity is likely to change also. Mostly, I've seen patients become confident after weight loss. This can be good or bad depending on the person, and how they express their new found confidence. 


> 6. Possible limitations to what you can actually eat


It is very common for certain foods to set off nausea after surgery. These effects can be short term or permanent. Usually, the worst offenders are foods that are not good for you - sweats and foods high in fat commonly cause dumping - sweats, diarrhea and nausea. Some people have problem with beef. It varies from patient to patient, but the majority eventually can eat a rather normal diet, but only in smaller portions.


> 7. Complications. I know about 9 people who have had this surgery and only ONE has not had to return for more surgery. Most all of them have had an abcess that required home health care to come pack the wound 2 times a day (think long Q-tip shoving gauze into open surgery site and then UP the incision into the infection).


Wound complications are the most common complication after bariatric surgery. But this is not related to having bariatric surgery. Rather, it is related to being obese and having a major surgery. Obese people do not heal well and are prone to wound complications regardless of what surgery they have. Luckily, these complications can be treated without surgery, using wound care such as you mentioned. More serious, obese patients are more prone to hernias, which can occure in 10-15% of patients. This would require surgery. More serious yet would be an anastamotic leak or a Pulmonary embolism - both of which can be fatal. Thankfully, both are rare with an incidence around 1% or less.


> 8. Taking vitamins for the rest of your life because you can't possibly get in and hold (or absorb) the vitamins that are essential to good health


Mostly true. Not all patients require vitamins based on lab values. However, I personnally recommend to everyone of my patients that they take vitamin supplements for the rest of their lives. The surgery decreases your ability to absorb nutrients (both calories and nutrients) and also decreases the amount you can eat. The cheapest insurance is to take a multivitamin supplement to cover any short fall in your diet. 

I don't consider this to be a significant problem, by the way. I recommend all women over the age of 30 to be on at least calcium and iron supplements if not a multivitamin regardless of their weight or surgical status. Women are prone to anemia and osteoporosis. Some doctors recommend such supplements starting during the first pregnancy and continuing for life.



> 9. Being able to only take liquid medications (sometimes very hard to get/lengthy wait and expensive) because your new pouch won't accept such anything that is the size of a pill.


Often true during the first year, and especially if the pill in question is a large one. Once patients are on a regular diet however, pills that are aspirin sized or smaller seem to go down fine. The oval "horse pills" are more problematic.


> 10. Let's not forget the sagging skin. You will lose the weight. Yep. But your body will look like a freak show. My friend says that it's all an illusion, much like a drag queen. She looks great until she removes her clothes. Her body looks like a sagging theatre curtain. The fat is gone but the skin remains....like a balloon without 3/4 of it's air. Her belly hangs below her panty line. Her breasts are like shriveled up raisins (she's shown me and those are her words) that just hang there. Her upper arms? She calls those her bat wings. If you think they jiggle when you are fat, you haven't seen anything yet.


Often is true, but it is very dependant on the patient - their age, amount of weight loss and genetics. I have a few patients who look great after a hundred pound weight loss. Most look like they are in a skin suit several sizes too big. The only treatment, unfortunately is plastic surgery. This is not an insignificant consideration either because insurance generally will not play for it, with the possible exception of a panniculectomy (like a tummy tuck) But this is true of any patient who undergoes massive weight loss regardless of the method.


This is not a decision to be undertaken lightly. You need to discuss this at length with your surgeon, your spouse / family, and ideally with other people who have had the surgery - preferably by the surgeon doing your surgery.

The simple fact is, even with intensive, medically supervised diet and exercise program, few people lose more than 20-30% of their body weight, and on average they only maintain a 10-15% weight loss one to two years later.

Does this mean that behavior modification is hopeless? Heck no! It's the best, most healthy option. Unfortunately, people who are 100# or more over weight often are not able to stick to it long term. More commonly obese people end up losing weight, gaining more weight, and yo-yo'ing back and forth. 

For people who can't lose weight with behavior modification alone, bariatric surgery can be a god send. For example. One of my patients was on home oxygen, 5 anti hypertensive drugs, Insulin and oral hypoglycemics, and required a medical scooter to get around becaus she couldn't walk more than 15 feet at a time. Since surgery, she's now off oxygen, walks everywhere, down to just 1 antihypertensive, and off insulin. She says her surgery was a miracle.

Bariatric surger can also be hell on earth. I had another patient who could not / would not follow the diet post-op. He called every day saying he couldn't eat enough to survive. No amount of reassureance would convince him that he wasn't starving, despite normal lab tests. He spent six months eating too much and throwing up before his pouch stretched enough that he could eat what he felt was reasonable. He lost a total of 50# at one year, dropping from 350 to 300#.

The bottom line is it is the head that has to be fixed, not the body. You have to learn how to eat in a way that keeps you at your proper weight. Bariatric surgery can help you do this, but you still have to work to learn thos habbits. Most patients who research the surgery, who are honest with themselves, their family and their doctors do very well. But if you expect the surgery to cause you to magically lose weight while letting you eat whatever and whenever you want, you are destined to be disappointed or worse.


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## ArmyDoc (May 13, 2007)

HaloHead said:


> LilyFestre -
> 
> I've read most good surgeons insist you wait at least 6 months after weight loss to see what the skin will do on its own.
> 
> Halo


Depends on the surgeon, but generally true. I did bariatrics for 3 years (and still do to a lesser extent) before subspecializing in plastic surgery. I recommend patients be at a stable weight for at least 3 months and preferably 6 months before considering plastic surgery to address excess skin. The reason is that patients often plateau for a month or more at one weight before losing some more.

In practice, this generally means waiting about 18 months after their surgery, because most patients don't stop losing weight for about 12 months. Some (those who are working with their surgery and exercising to attain the best weight loss possible) take 18 months to lose all their weight and have to weight a bit longer for their surgery. It's generally worth it, because they get much better results.


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## ArmyDoc (May 13, 2007)

suburbanite said:


> That seems to me to be a bit low threshold for getting the surgery. I thought the guideline was two co-morbidities, not an isolated co-morbidity (diabetes in this case). ArmyDoc may have some enlightening comment on that?


The published guidelines are a BMI of 40, even without morbidity. If the BMI is between 35 and 40, then they must have some type of obesity related co-morbidity, the number and severity of which seem to be surgeon dependant.



> Ask your doc what the post-op diet would be and then try that for awhile. You'll be ravenously hungry but it will give you a trial run of post-surgical life.


I disagree with the ravenously hungry part. If you eat frequent small meals that are high in protien and keep yourself well hydrated, I think you will find the hunger pains are tollerable. It will be hard (very hard) at first, but over time your bodies set point will adjust and it will get easier.



> I disagree with ArmyDoc in that I think for the purpose of losing weight, a 'diet' is a useful tool. But understand, the point of the weight-loss diet is to get you down to a weight where you can safely increase your physical activity level. You will not be able to maintain the restrictive diet forever, and it is the exercise that can re-set your metabolism and allow you to shift over to a more sustainable long-term diet plan.


I may have been unclear with my "diet" comments. Technically your diet consists of your dietary habits - what you eat. I am all for a change in dietary habits. 

I am against a "diet", as the term is commonly used when talking about weight loss. In that sense A diet, is by definition a short term change in dietary habits. When the change ends, and you go back to your old way of eating, you will regain the weight lost. This is the cause of the yo-yo pattern of weight loss and gain that happens so often.

I suggest a life long change in dietary habits - eat the way necessary for you to maintain your ideal weight, and eat that way for ever.


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## suburbanite (Jul 27, 2006)

Army Doc, I agree lifelong change is necessary, but I do think that a more restrictive diet short term can be useful, as in my goal to drop 30 lbs so that I can sit comfortably on my stationary bike and start exercising again (right now even with the wide seat I have, my butt hurts too much sitting on it to do 20 minutes of peddling). For me without changing activity level, atkins diet at 70 carbs/day give me about 2 lbs of weight loss per week, which is already almost a sustainable diet long term. I figure if I can get down to where I can resume regular non-weightbearing exercise then my 2 lb/week carb level will be somewhere around 90-100 carbs/day, which is pretty much a normal diet with no junk food and only slight cut-backs in rice and bread. So I think for me, that will prove to be a sustainable diet; I find diets that restrict fat leave me unbearably hungry, but on Atkins where you count carbs, my calorie intake spontaneously drops 200 cals/day because the fat content that comes with egg/meat/oily fish protein makes me feel full.

I suspect that 'fat' is the end state of a wide variety of different problems and that this is why no one solution works for all 'fat' people. I suspect that for me there's something wrong with carbohydrate handling; for others it may be a problem with dietary fat. I'm also in that 15% of folk who's cholesterol level stays rock solid no matter what I eat, just like my father. My total cholesterol is 170 +/-2.


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## ArmyDoc (May 13, 2007)

suburbanite,

Sounds like you have a reasonable plan. I think we are actually saying the same thing. Just because you start out a little lower in carbs intake than you end up with doesn't disqualify it as permanent change rather than a short term diet in my book. All I am trying to say is that in order to make a sustainable change in one's weight, you have to make a sustainable change in your eating habits and or lifestyle. If upon reaching your goal weight you go back to eating and living in the way that made you gain weight in the first place, chances are you're going to gain weight again.

Also, while I emphasized protein, I didn't mean to imply no fat or carbs. Just that the proportions need to be quite different from the typical american high carb, high fat, low protein diet. (or just as commonly high everything diet!) A no fat or even very low fat diet just isn't sustainable - at least for most people, myself included.

I also agree with you that every plan has to be individualized. What works for one person doesn't work for every one else. I think the key is to choose some thing that is reasonable and sustainable, and then stick to it.

I wish you luck. Sounds like you have a reasonable plan, and if you stick to it you should be able to reach your goal. Just remember, if for some reason you do get stuck along the way, don't give up. Just reassess, make a sustainable, incremental change and keep going.


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## suburbanite (Jul 27, 2006)

What do you think about target heart rate as a way to titrate exercise to effect without overdoing it?


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## tn_junk (Nov 28, 2006)

Talked to the surgeon Friday. Says she would not recommend the surgery. My BMI is 36 point something, resting heart rate 75, and as I noted above low BP and Cholesterol with absolutely no sign of Diabetes (blood sugar is always 90-100). Had an arteriogram two years ago and I have no sign of any blockages. 
Surgeon says just keep doing what I am doing, walking every day and eating a reasonable diet. She sees the 1 lb a week (average) weight loss over the last three months as a good thing. When I dropped my weight to 185, I did it with the Paleolithic Diet. Basically no bread, dairy, no grains of any kind, no salt, sugar, processed meats (sausage, etc.). Only problem is I gained back 140 pounds in less than a year when I "fell off the wagon" and started eating "normally" again. 
What amazes me is that I have been posting on several Diet related boards, and have asked for someone with a long term, substantial (100 lbs) weight loss, to tell me how they did it. Not one response. Not one person has responded that they have lost a bunch and kept it off for over five years. 

No surgery. I will start going back to OA, working a program, and try and keep it real. 

Thanks to everybody for posting your support, and for putting up with my frustration.

galump


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## suburbanite (Jul 27, 2006)

Galump I think that you need to find a diet that you can lose weight on that has a logical way of liberalizing it to a maintenance program.

If you can find a way to add swimming to your walking it will help you avoid injury.

Do you know how to use target heart rate to adapt your exercise intensity to your current fitness level? http://www.americanheart.org/presenter.jhtml?identifier=4736

I'm glad your doc said not to get surgery at this point.


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## ArmyDoc (May 13, 2007)

Galump,

I know it can be frustrating, but try to look at this as a positive thing. She's basically telling you she thinks you can succeed without surgery. That's a good thing! 

I agree with her about the 1# per week - this is a sustainable weight loss rate. The key, as you discovered, is that when you reach your goal weight you pretty much have to keep eating the same way as how you got there, so pick a plan you can live with. You may be able to let up slightly, but generally you can't let up as much as you want to. One thing that seems to work is to set a goal range. When you hit your goal weight, continue to weigh yourself each day or every other day. Continue your established eating habits, but so long as you are within 5# of your goal weight, don't worry too much about small slips in the eating program. But if you hit 5# over goal, the "diet" has to tighten up again.

Suburbanite,
I think the target heart rate makes sense, and I haven't heard of any problems with it. It actually adjusts itself over time. The better shape you are in, the harder it will be for you to raise your heartrate because your heart is working more efficiently. So as your fitness level improves, you automatically have to work a little harder to get your heart rate up to the same level. Pretty cool.


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## Maura (Jun 6, 2004)

Galump, I wish you well. A friend of mine was put on a macrobiotic diet for two years. This consisted of a whole grain diet, little meat. She gained weight and felt awful for two years. She recently went on Eat Right For Your Blood Type diet for her blood type, 0 (very little grain, meat eaters diet) and has lost probably four dress sizes in a short time. Before deciding which diet to use, it might help you to tailor your diet to your blood type. Some people loose weight and stay healthy on a high fruit diet, others on a high protien diet.

I just got the books from my library and am shoring up to change my eating habits (again).

I wish you well


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## PonderosaQ (Jan 12, 2004)

Just wondering how you are doing a month later Galump. Don't know if it will help you at all but I lost the kind of weight you are talking about and kept it off well over five years. I gained it back and and am nowing trying to lose it again. I can tell you why I regained. I gave up/lost the ability to take care of myself. I put the energy that should have been mine into my husband. Sadly to lose and keep it of again I basically have remain detached from my husband. He eats fat filled high calorie garbage and refuses to eat decent healthy food.He doesn't like it and doesn't see why he should eat food he doesn't like. Obviously not to help his wife stay healthy!!!!! I allow him to manipulate me by his not eating and saying he'll be fine if I don't feed him.He then will go a day or more without food. He knows I believe in healthy regular eating. Obviously he's got me. wrapped around his little finger. I lost 50 lbs 2 yrs ago and have kept that off. Losing more is proving very hard. I'd be better off if I hadn't regained the weight but I can't change what is past. This time I WILL keep it off FOREVER even if being angry with my selfish husband is the only way. So let us know how you are doing.
PQ


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## Ruby (May 10, 2002)

Galump, try this forum.

http://www.southbeach-diet-plan.com/forum/index.php

This is a diet I feel like is very healthy and they say you will loose 1-1/2 lbs. a week. It's something you can follow all your life. The first two weeks is pretty restrictive but then after the first two weeks you start adding back food that you've cut out.

Be sure and read all the "sticky's" on the forum. They have a food list of good food and bad food.

They even have a 100 lb. thread of people who have lost a hundred lbs.

I belong to TOPS (Take Off Pounds Sensibaly) I just joined two weeks ago and will go to my second weigh-in Monday night. The first week I lost 3-3/4 lbs. I plan on starting the SB diet on Tuesday.

I know several people who have had the Lab-Band surgery, I don't think I want to put my body through that. My Dr. said my husband and I both are eligeable for it. But we are determined to do it on our own without the surgery.


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## tn_junk (Nov 28, 2006)

I really appreciate everyone's concern and am very thankful for your thoughts and opinions.
As of today I have lost 6 lbs, about 1.5 lbs per week average. And I am not on a very restrictive diet. If I could manage to drop my calorie intake to 2000 per day, things would work out well. It really frustrates me because from 2000-2004 I dropped my weight from 320 to 185 and maintained it at that for over a year and a half. Then gained it all back in a 7 month long binge. 
Just got to take it one day at a time.

galump


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