Welcome to the Bariatric Weight Loss Surgery Blog!

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This blog features information, articles, news, studies, tips and more about Bariatric weight loss surgery, both pre-op and post-op.  Making the decision to have any kind of weight loss surgery is not an easy one and usually comes after years of trying to lose weight without success.  We want to help and support you! 

Obesity is a disease that you must commit to fight against for your health and well-being, not to mention survival.  This blog provides helpful information to help in your weight loss journey to a healthier, slimmer you.

Welcome!

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Where Do I Fit In? Average and That's OK!

I think that I'll always consider myself the "fat girl."  Even at 165 lbs and 5'7", I still define myself that way. After a lifetime of others defining me that way, it's hard to shake that definition, that mindset. Six years out, I still have to work every day at treating myself better, and it's not always an easy task.  

mirror

When I look in the mirror, I see the remnants of a former me:  rolls of extra skin around my waistline that will never go away without plastic surgery (which I cannot get covered, nor can I afford out of pocket.) I see the cellulite on my 42 year old thighs, and the loose skin under my arms.  Shapewear helps a great with that, and once I'm dressed, I can often forget about those parts of my body that I dislike.

Read Also:  The Shape of Things to Come

What Size Do I Wear?

Still, I don't know how to define my body "type" anymore.  I wear a size 10 in pants, a size L or XL in a top to cover my poochy midsection.  (Note:  if that extra skin weren't there, I'd likely be a size medium).  In dresses, I can wear a size L if it is stretchy or knit material, but if it's fitted in any way, I wear a size XL or 14. I'm not thin, but I'm also not what's considered to be a true plus size.  So where does that leave me? 

Where Do I Shop?

It's leaves me smack dab in the middle of two sections of clothing in any store.  The good news is that I can shop almost anywhere now and find something that will look cute on me.  Still, I find myself always gravitating towards the plus size clothing.  I take things from the rack and try it on, knowing that it's too big for me, but also feeling comfort in being covered up by loose, hanging clothes.  It's the part of the "former" me that I can't let go of, even six years later.

What Type of Clothes Can I Wear?

There are things that I'll never be able to wear:  crop tops, blouses or tops tucked into my pants, short-shorts (although at 42, I probably shouldn't be wearing those anyhow).  But there's things that I can wear now that I never could (or would let myself) before:  spaghetti strap tops, dresses, high heels, lingerie.  

"Average is OK!"

I've worked pretty diligently on being positive about my body, and treating myself well despite the battle scars of a former morbidly-obese me.  I love fashion, but I also hate it - because it often reminds me of the shame I felt and still feel with a body that's not "perfect."  I'm not obese, but I'm not thin.  I guess that means that I am average.  And average is ok. Average is good.  Average is healthy.  Average is me.

Guest post by Diva Taunia, a professional musician and music educator located in the greater Los Angeles area."  

Also by Taunia:

Additions and Subtractions to Your Diet After Weight Loss Surgery

The "Unsolicited Advice" Syndrome - Thanks but NO Thanks!

What Would I Have Done Differently with My Bariatric Weight Loss Surgery?

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The Shape of Things to Come

I had weight loss surgery six years ago, and I've done incredibly well with it.  I've maintained a loss of 150 lbs on my 5'7" frame, became a much healthier eater, have more options for clothes, and many other wonderful things that going along with losing the equivalent of a whole other person.  BUT, I've also never had plastic surgery.  I've never been covered by insurance either on the east coast in Boston (where I had my surgery) or here on the west coast at Kaiser.  When you lose a ton of weight, some of it just "evaporates" but most of it stays there, in a different form, as a constant reminder.

excess skin after weight loss surgery

I've been extremely fortunate because I didn't have a lot of extra skin on my legs and arms.  Even at 311 lbs, I was pretty active swing and latin dancing, so those parts of my body (that were smaller to begin with) stayed pretty toned throughout the whole process.  But my stomach?  Not so much.  I look like I've had the equivalent of a small children's choir living in my gut.  It's ridiculous.  And the (innocent, but uninformed) answer from people is usually, "Why don't you try exercise?"  "OMG!  Exercise?  Geesh, I hadn't thought of that!"  There are no numbers of crunches of push ups, of sits ups, of cross-training, kickboxing, zumba ANYTHING that will get rid of this gut.  For those of you who have had several children, you may be able to relate.  The only way this is going away is with some serious plastic surgery, which we have already discovered is not an option for me without insurance coverage.

If one of more person asks me "when I'm due," I may lose it and just start shopping strictly in the maternity department and start lying about when my beautiful, talented, genius of a children will be brought forth unto this world.

"But I've found options other than straight up insanity.  It's called shapewear."

Shapewear is daunting if you've never worn it before.  There are so many pieces to choose from, each helping with a different problem area, some working with all problem areas.  So what I've decided to do is give you the solutions and shapewear that I've found works best for me, with different types of outfits.  All are very affordable, but I consider shapewear an investment in my sanity. :)  It does take some getting used to - being stuffed into something like a sausage you can't eat anymore, but you'll become used to that too, and a lot of the restriction loosens up after a wash or two.  Here are my favorites:

DRESSES:  I live in dresses in the summer.  Because of this, I need a great shaper that works all-over, so I opt for the bodysuit shaper, which is almost like a bathing suit.  My absolute favorite is "Beauty by Bali" Smoothing Lace Shaping Bodysuit.  Not only is it an amazing piece of shapewear, but it is sexy as hell.  My husband LOVES these and thinks they look like amazing lingerie. You can also find these in most department store lingerie departments.  It's the ONLY piece of shape wear I wear with dresses.  It provides great midsection coverage and the girls look pretty damn good in it!

TOPS:  For tops of any kind, I always use the Self Expressions Cami Shaper from Maidenform. It comes in a range of sizes and colors, and could really be worn all on it's own as a top.  What I like about them is the the most shaping coverage is in the midsection (where I need it most) and it doesn't smoosh the girls.  Also, another bonus for tall upper torso girls like me is that it has adjustable straps and enough length to cover the pouchy midsection below the belly button.  I also really like Slimpressions Tanks A Little because it provides coverage for the mid section, but you can wear your own bra with it.  Plus, the material is SUPER comfortable.

BOTTOMS:  When it comes to bottoms, I'm fortunate enough that I don't need any coverage around the thigh or knee area.  I know lots of folks that do, though, so I thought I'd direct you to a few great companies for that:  Slimpressions, Spanx (which I find very expensive and very uncomfortable, but lots of ladies love them), and HERROOM has tons of great selections.  You can also do some searches on Ebay, Google Shopping, and Amazon.com for more items to choose from.

PANTIES:  I tend to wear lightweight shape wear panties or else I feel like I'm wearing a chastity belt.  I just need enough coverage to make sure the pooch doesn't get out of control.  I tend to like boy short cuts, and I can find a ton of different options at Bare Necessities.  If you sign up for their email you get access to a ton of discounts too, so I would definitely try that route.  I also love Slimpressions Full Cut Panty.  Really great coverage without sucking every ounce of air out of my body.  Seriously, though, they're very comfortable.

SUMMER TIPS:  As summer starts to roll around, we all start to freak out about SWIMSUITS.  Have no fear!  I have some helpful hints for that as well.  There is a great company called MiracleSuit that has some seriously rocking styles, but all have really great shaping coverage.  There's a reason "Miracle" is  in the name.  Here's the one I'm coveting for this summer: Tile Style Suit and Sarong.Diva Taunia with Tim Gunn

QUICK TIP:   Remember the Bali Bodysuit Shaper I mentioned at the top?  You can wear those under nearly any bathing suit to help you feel more shapely and confident.  I did that all last summer and it made me extremely comfortable to walk around in my suit.

Another tip?  Self-tanner.  I don't advocate tanning in the sun - it's bad for you!  But self-tanner can darken your skin a few shades and hide some of the extra cellulite and icky parts that we don't love so much.

Hopefully, you found this helpful.  Have any questions about where to shop or what types of shape wear to get?  Feel free to email me at info@divataunia.com.

Guest post by Diva Taunia, a professional musician and music educator located in the greater Los Angeles area." 

More Great Articles by Diva Taunia:

Additions and Subtractions to Your Diet After Weight Loss Surgery

Pizza on the Brain - Can I Ever Eat It Again?

The "Unsolicited Advice" Syndrome - Thanks but NO Thanks!

Pregnancy after Weight Loss Surgery

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Additions and Subtractions to Your Diet After Weight Loss Surgery

"What can you eat now?"  It's one of the first questions that I get asked by people.  

chinese food

At six years out from gastric bypass surgery, my answer is "almost anything."  It wasn't always that way, of course. The first few years, I couldn't eat things like ice cream, french fries, and other former staples in my diet. There would be immediate mutiny in my stomach if I even looked at those foods. So out of necessity, I just started eating a lot healthier and it soon became my "normal" way of eating. There are some things that I still cannot eat, but mostly there are things that I choose not to eat.

"Actually, the way lots of foods tasted was dramatically different."

I know many other weight loss surgery patients have said the same thing:  many of the foods in our former pre-op lives just taste awful now.  (There is actual scientific fact to back this up, such as this great article found here on Bariatric Times.) So I thought I'd create an addiction and subtraction list to get a glimpse into my post-op life eating.  Some of these foods are healthy, some are not.  Some of these foods I eat because I have to, some are because I want to.  Some of them are subtracted from my life for good for medical reasons. In all of these cases, it may be helpful to first get a glimpse at what I used to eat regularly first.

Before Weight Loss Surgery

Pre-op:  I lived alone in a large house and I taught music out of my home.  I barely left home, as a matter of fact.  My life consisted of take out food, ice cream, and ice cold glasses of Coke (which was my absolute favorite beverage in the world: several cubes in a nice glass - ahhh, heaven!).  My take out meals were almost always either pizza (of which I would eat approx 80% of the entire large pie) or chinese food takeout - enough for at least two large meals, which I would eat as one.)

When I had to go on the liquid diet for two weeks before surgery, I thought I.  was.  going.  to.  die. I literally thought I was going insane and that maybe I was making some horrible, horrible mistake.  I had 2-3 shakes a day and allowed myself two slices of low calorie toast with butter for the last meal of the evening.  I lost 14 lbs in two weeks, enough for the go-ahead for surgery.

I think I can probably skip the portion size and shakes description for the first few months after surgery. Most of you already know that. So, I'll jump straight to me six-years-out addition and subtraction lists with notes:

Six Years After Surgery

SUBTRACTIONS:

Soda:  any soda.  I cannot STAND the taste of it - whether it's diet or regular.  It all just tastes like a giant fuzzy glass of sugar and turns my stomach.  The only exception to this is ginger ale and I have the diet version ONLY when I have an upset stomach.

Chinese Food:  I never touch it any more, and if someone suggests we go to a chinese restaurant, I begrudgingly oblige.  The oily taste just completely turns my stomach.  (You might be happy to know, though, that pizza still remains a staple in my diet. More below.)

Also Read:  Pizza on the Brain - Can I Ever Eat It Again?

Ice Cream:  In my post-op days, I have become lactose intolerant.  I can have a couple bites, but that's it. Any more than that and World War III breaks out in my gut.

Rice and Pasta:  I can't have it - of any kind.  Once it's inside my pouch, it expands and the pain is excruciating.  I love both, but I love being NOT in pain even more. Foods that are high in calcium oxalate stones can wreak havoc on a post-op who is susceptible to kidney stones. Other healthy but hurtful foods include spinach, beets, rhubarb, nuts, and wheat.  It's the spinach one that kills me. I love me some spinach.  *Note:  have questions about this?  Be sure to check with your surgeon or nutritionist!

ADDITIONS:

Cottage Cheese:  I know.  Some of you are rolling your eyes right now, but honestly, it's good stuff!  Knudsen offers cottage cheese doubles with amazing flavors like pineapple, peach, mango, and strawberry, and they're only 100 calories and completely fill me up in the morning with a cup of coffee.  Never in my life did I think cottage cheese would be a favorite of mine, but it is.  And speaking of cheese…

Cheese:  of all kinds, all varieties, I love, love, love it.  One of my absolute favorites is from Trader Joe's and it's called Unexpected Cheddar.  It's like cheese sent from the Gods.  It's a small square wrapped in cheese paper in the cheese section.  Buy it. You will thank me for it later.

Fruit:  my new sugar rush.  I love, love, love fruit.  In particular, I love pineapple, mango, red grapes, and bananas.  Any time I start getting a sweet tooth, I grab some good stuff.

Lean Cuisine:  I know it's a bit of a cop-out, but when I'm working at the school and need something quick to eat, this does the job. Usually the calorie count is pretty decent, and they have some great flavors like Turkey Dinner, Sesame Chicken (my favorite), steamed Asian dumplings, and even a great BBQ pizza.

Pizza:  This has never left my diet, I've only gotten more adventurous with the vegetable portions.  I love pretty much any veggie but a mushroom on my pizza.  And if it's well hidden, I'll even eat that.  I can only handle one piece of pizza on a good day, but believe me, I savor each bite.

Salad: Ok, so no dark greens like spinach, but I can create a pretty kick-ass salad with butter lettuce, romaine, or even regular iceberg.I think every salad should have veggies, cheese, egg, and some kind of small chopped meat.   And I usually add some tortilla strips for crunch.  And salad dressing?  I either make my own (lite vinaigrette) OR, I usually use a regular honey mustard as a dressing.  Trader Joe's make the BEST sweet and spicy honey mustard in the world.  Go buy it in vats.  You'll thank me later.

Vitamins and Supplements: It goes without saying that I'm a huge fan of Wellesse Liquid Supplements.  As someone who is Vitamin D deficient and also anemic, going without vitamins in my diet is NOT an options.  Check with your surgeon and dietician and make sure that you are including your vitamins as part of your new post-op world diet.

So that's about it.  I eat pretty normally now with a few exceptions.  I am by no means a nutritionist or dietician, I just go by the info they've given me and the research I've done.  Hope this helps you know what to expect.  At six years out I'm living and eating great!

Guest post by Diva Taunia, a professional musician and music educator located in the greater Los Angeles area."

Read More!

Importance of Working With Your Dietitian Before and After Weight Loss Surgery

After Weight Loss Surgery Success Tip - Check Your Dishwasher!

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Pizza on the Brain - Can I Ever Eat It Again?

Ah yes, the old "will I still be able to eat pizza???"  It's the most often-asked question, and I totally get it.

Veggie Pizza - see www.budgetbytes.com

Photo & recipe - www.budgetbytes.com 

This coping mechanism that you've been using for years - if not decades - is suddenly and quite dramatically being taken away from you.    Again, this is from my  own personal experience - others may have had different experiences, so always do your research!  


My first two years post-surgery were tough eating-wise. I was simultaneously battling a life-threatening kidney problem, so I was barely hungry, ever.  I drank a ton of shakes (some that I still really love and can suggest below**). But at about a year out, I was able to have three of the most delicious bites of pizza I have ever tasted. A lot of the things that I used to love tasted AWFUL to me now - like Coke, Chinese food, any sweet type of drink, bleck!  But pizza? To this day it remains a favorite (although it's harder to find good NY style pizza out here in SoCal!).  And I can eat exactly one slice with a small glass of wine.  That's it, but it makes me feel full and satisfied.  It's a usual Friday night staple for my husband and I:  veggie pizza, wine, and a Redbox movie.

"I don't diet, and I never will."

I'm kind of perplexed by the questions about what diets I am on.  I don't diet, and I never will.  For me, I rely solely on how I feel.  If my pants start feeling a snug around the waist, I change what I'm eating.  If I feel sluggish, I know I am not eating enough nutritious foods and probably eating things that are fast, but lack in nutritional value.  What I consider myself now is a "normal" person.  I still love food.  I love, love, love to cook.  But I absolutely refuse to be a slave to food, my weight , or the scale anymore.  It makes me crazy (crazier than before, lol).  

When my husband and I moved in together, he refused to let me have a scale in the house.  And this week after visiting my doctor and seeing a 3 lb gain, he wouldn't even listen to me talk about it.  "3 pounds?  Are you nuts?   You look exactly the same to me.  We're not talking about it."  That was the first time I gained in about a year and it also coincided with my time of the month (oh yeah, don't think you get out of that when you get into perimenopause - oh joy!).  I backed away and looked at it rationally.  

What I try to do now is just try to make reasonably healthy choices, move more, and enjoy this new life that I've been given.  That's the "diet" I am on now.  Maybe I'll go order a veggie pizza for dinner.  :)

Read More:  Eating More Fresh Produce – Why You Need It and How to Get It!

Guest post by Diva Taunia, a professional musician and music educator located in the greater Los Angeles area.  More information can be found at www.divataunia.com.  Read also by Taunia : The "Unsolicited Advice" Syndrome - Thanks but NO Thanks!

**Some of my favorite and tasty shakes:

•    Smoothies with my with Wellesse Liquid Supplements
•    Lean Dessert Chocolate Fudge Pudding
•    Big Train's Blended Ice Coffees

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The "Unsolicited Advice" Syndrome - Thanks but NO Thanks!

At one point or another in your life, you've probably experienced some friendly "unsolicited advice." Something charming like, "You have such a pretty face, if only you'd lose weight."  
 

someecards.com - “Unsolicited advice is like someone singing out of tune. Nobody wants to hear it.”

 
I always loved when people would point out to me that cutting calories and exercising "would help me lose weight."   OMG!  Thank you!  I have never in my 40+ years even CONSIDERED that!  (Yes, that was sarcasm.)  I would get comments like that ALL. THE. TIME. And despite it being so constantly rude, I was always very polite in responding.
 
Now here I am - six years and 150 lbs older and lighter - and ANY time I see someone morbidly obese, I want to walk over to them and tell them there's a solution, there's help.  I'm a walking success story, and a complete asshat.  What kind of pompous person would EVER do that? Certainly not the same one that dealt with that my entire life, right?  Well, the good news is that I have never ACTUALLY said something like that to anyone.  I put my story up on YouTube and my blog and figured if people were interested in my story, they'd ask.  And I was right.  Lots of folks would send me messages and emails (and sometimes even little thank you packages!), and if someone took the time to ask for my input, I would certainly make time to answer them.  
 
When I did reply, I was always cautious to be very clear that this was MY story, MY experience, and that there were many other folks with differing experiences and they should talk to them as well.  I felt like I was pretty good at balancing my own personal success with the importance of researching what the risks might be.  Still, whenever I was out and saw someone morbidly obese, and saw them suffering, I wanted to run over and give them a sermon on the blessings of weight loss surgery.  Can I get an AMEN?  (Please don't.)
 
 
Now, there will be people who disagree with me on this.  I know a few people who were approached in a similar manner and it was that which led them to get the surgery, and they are outwardly thankful about that.  And I really do support their story, but I also support and understand that's not always the norm.  I can't even count on both hands the number of times that people suggested it to me.  It infuriated me to think that others just thought that I should jump on the operating table and just get it done.  It infuriated me mostly because I knew that 90% of the people that said things like that were really just thinking "you'd be so much prettier if you lost weight."  It was never really about the health.  And I'd be lying if I didn't admit that there was a small part of me that wanted to look better, but mostly I just wanted to FEEL better - healthier.

But my promise to myself is this:  I will never, ever offer unsolicited advice to someone overweight.  

I know what that kind of shame feels like.  I know what it feels like to have someone make judgements about you based solely on the space you occupy.  I also know that sometimes insurance just won't cover it and they don't have the means.  It's not MY place to give them the ol' pep talk and get them to open up, and it's not yours either.  I see a lot of folks in the weight loss surgery community boards talk openly about this, and I get that you all just live by example, answer questions about your own personal journey and point folks in the right direct for resources.  Unless you're a medical doctor, it's not your place to suggest it.  It's certainly not mine.  I can't help the dialogue that happens in my head sometimes, but I know when to filter, and that's the key.  Just be a good version of me.  That's all I can do.
 
Guest post by Diva Taunia, a professional musician and music educator located in the greater Los Angeles area.  More information can be found at www.divataunia.com.
 
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Pregnancy after Weight Loss Surgery

Guest Post by Diva Taunia, a professional musician and music educator located in the greater Los Angeles area.  More information can be found at www.divataunia.com.
 
 
In my last blog What Would I Have Done Differently with My Bariatric Weight Loss Surgery? , I gave you a bit of a teaser in hopes that you'd come back and read my next entry.  If you're reading this, my sneaky plan has worked!  (Thanks for coming back, I appreciate it.)
 
I had mentioned that if I could change something about my surgery, it would have been when I had the surgery. I was 36 when I had the surgery and 38 by the time I had lost all the weight.  Besides being able to be much more physically active and really participate (fully) in things that I loved like swing and latin dancing, there was one major problem that I never anticipated ever being an issue for me:  fertility.
 
fertility after bariatric weight loss surgery
 
Anyone who knows me, has known that I was childless by choice.  I was a step parent in my previous marriage, which was one of the most difficult things I ever had to do.  The kids were great and I loved them, but when the marriage didn't work, I was happy to go back to being single and childless.  People thought I was crazy, and almost everyone I ran into said, "Oh, that's just how you feel now. You'll change your mind someday."    That comment always infuriated me, because I was completely happy being a non-parental unit.  Until...
 
Rewind to two years ago, when I got a random email from my college sweetheart, who I hadn't seen or heard from in 17 years.  He found out I was divorced and asked if I'd like to get together and catch up.  He lived in Southern California, so I didn't think anything of it.  I bet you can guess where this is going (if you don't already know).
 
We began seeing each other again, and eventually I decided that because I didn't have children I was looking forward to an exciting adventure and would move from Boston to the Los  Angeles area to be with him.  Months later, he proposed and we got married last April.  Neither of us had children.  Neither of us ever WANTED children.  Until...
 
Until we got married.  We were both back with the love of our lives and realized that the reason we never wanted children before was because we weren't with people we could even imagine  being a parent with.  We got married older:  I was 41 and he was 43.  We knew it would be tough, but decided that we needed to find out where we stood with fertility.  We also decided that we wouldn't take any extraordinary measures to get pregnant.  We just wanted to know what our chances were at this age.
 
I scheduled an appointment with my doctor to discuss my options.  She  told me to immediately start taking multivitamins, folic acid, and other supplemental nutrients to help prepare my body for possibly becoming pregnant. As a gastric bypass patient, she was very concerned that I began those things early to ensure that if I were to get pregnant I would be nutritionally sound.  She and several other doctors immediately said the same thing:  take pre-natal and multivitamins even when the thought of pregnancy was just that, a thought  They stressed the importance of that over and over again, I did what I was told. 
 
I went and had a fertility test done and found out that I was in the beginning of peri-menopause.  My chances of getting pregnant are 1%.  It's very unlikely and makes me incredibly sad that we had not found each other earlier.  I am sad that I spent so many years being morbidly obese with PCOS (Polycystic Ovarian Syndrome) and fertility issues.  I am sad that I had not decided to get the surgery when I was a bit younger so that I'd still have a chance.  I can't help but think if I had done this in my late twenties, that I may have been able to get pregnant.  But I also know I wasn't ready for that, and didn't want it then.
 
This is the first time I have ever spoken about this publicly, as it's still very difficult to wrap my head around.  But I feel like it's an important cautionary tale for anyone suffering from PCOS and morbid obesity who may want to someday become pregnant.   My life is incredible now.  I can do just about anything I want - except conceive.  It's a bitter pill to swallow, but one that we're learning to cope with. (Please note:  we know that there are other options that would help us conceive, but have decided those are not options that we want to explore.  We just want to be as healthy and joyful as we can with the life we've been given.)
 
Thankfully, my husband and I have an incredible relationship.  Children may not be in the cards for us, but it may be for someone else.   I hope that my experience may help someone struggling with a decision like this.
 
 

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What Would I Have Done Differently with My Bariatric Weight Loss Surgery?

Guest Post by Diva Taunia, a professional musician and music educator located in the greater Los Angeles area.  More information can be found at www.divataunia.com.

For those of you who may not be familiar with me or my story, I had Laproscopic RNY Gastric Bypass Surgery almost six years ago at Boston Medical Center with Dr. Donald Hess.  

At my highest weight, I was 311 lbs (at 5'7").  Six years later, I'm maintaining my weight at a very comfortable 165 lbs.  Weight loss surgery was one of the best decisions of my life.  I happily share my story with anyone interested, and always try to answer emails and questions from folks when I can.  I try to still maintain my YouTube channel and give updates about my post-op life and (much of that will now be chronicled here on this blog as well) and all of my pre-surgery videos until now are available for anyone looking to research life after weight loss surgery.

Diva Taunia Bariatric Weight Loss Surgery

 

I thought that for my first blog here, I'd answer the most common question I get, which is "would you do it all over again if you had the choice?"  The answer is a resounding YES.  However, there are definitely things that I would change now that I have the hindsight of six years experience.  

First, I would have researched my vitamin options a LOT more.

Truth be told, I didn't even know about Wellesse Liquid Supplements until I was well-into the stage where I could take actual pills again.  But as much as I tried in those first few years, I had lots of problems getting my vitamins because only a handful of them were offered in a chewable form - the rest were caplets and pills.  I know that I wasn't good at taking my vitamins, despite my liking the companies I used and the flavors that were offered.  It was just too difficult. If I had known a great-tasting liquid option was available, it would have been a huge boost in my nutrition and health, because I would have been much more dedicated to taking them. And the thing is, even now - at six years out where I can take any form of medication/vitamins/supplements I can - I still use Wellesse because it's the easiest, fastest, and tastiest way to get in my vitamins.  Granted, that's a full-on promo plug for Wellesse for sure, but it also happens to be the truth.

Second, I would have had surgery at a younger age.

The other thing that I would have changed is when I had the surgery.  I was 35 when I started researching it, and 36 when I had surgery.  It took another two years for me to get to my settled weight, and another two years after that to figure out how to get myself and my body nutritionally sound as I started to get older.  The only thing I regret is that I would have made that decision sooner, so that I could have been living my life the way I am now at (almost) 42.  My life was affected by my weight in such dramatic ways - some that I didn't even know about until I had lost the weight and saw how different things were.  

And finally, there was one very monumental thing that was affected by the date/time/age that I decided to have the surgery.  My next blog will go into detail about that.  (Teaser, I know…but it's an important topic - especially for women, so I hope you'll bookmark this blog and come back to read it.)

Despite those things, weight loss surgery remains one of the best and most positive decisions I ever made for my life and my health.  Yes, I'd do it all over again in a heartbeat.

Related Articles:

Weight Loss Surgery is a Major Life Decision - Setting Yourself Up for Success

My Journey to Health With Weight Loss Surgery

"Liquid Supplements are Easier to Swallow and Faster Absorbing"

 

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Evening Eating: Are Your Actually Hungry or Do You Just Want to Eat?

You've had dinner, the kitchen is cleaned up, and it's time to relax and watch TV or a movie. You plop yourself into the chair and put your feet up. You're enjoying your show and before you know it, your head is telling you it's snack time.
 

But are you hungry or do you just want to eat?

 
More than likely, you're not hungry and just want to eat. Even if you've had bariatric surgery, you are not immune from the evening eating demons. It's important to look at the reasons why you want to eat even though you've just had dinner. 
 
You have trained yourself to eat in front of the TV and it's become a learned behavior. When you sit down your brain says, "Time to eat." It's not just the TV that can be a problem. You can train yourself to eat in front of the computer and that may be your evening relaxation.
 
Is this emotional eating? Are your looking for relaxation, are you bored, or are you looking for a distraction from what is going on in your life? 
 
Wellesse Health Fact Eating in front of the tv
 

How do you determine if you're hungry or just want to eat?

I teach this simple, but very effective strategy, to my patients. Think of a food that when you eat it, it's OK, you enjoy it, but you don't want another portion when you're finished. When you're done, you're done. What food comes to your mind? Some common examples are apples, cottage cheese, yogurt, eggs, chicken, broccoli, or tuna. The food you have selected is what I call your anchor food. That is the food that is "safe" for you. It's not a trigger food leading you to overeating, and it's satisfying enough so you don't go looking for something better to eat.
 
When you have determined your anchor food, use this strategy. When your head tells you it wants something to eat, ask yourself this question. "Do I want to eat (anchor food)? If the answer is, "No, I don't want (anchor food).  I want chips, cookies, or ice cream," you are not hungry. So if you are not hungry, what else is going on? More than likely it is emotional eating. If the answer is yes and you are willing to eat your anchor food, you probably are hungry and it's OK to eat that food since it doesn't lead to overeating for you. It's a good idea to keep your anchor food available for the times you determine you really are hungry. 
 
The most common emotion I hear leading to evening eating is boredom.
 
I give my patients a homework assignment to deal with this evening eating and grazing problem. Make a list of things to do to keep yourself busy that don't involve food and that will get you away from the TV or computer. If you decide to watch TV, keep your hands busy with craft work, riding a stationary bike, walking on your treadmill, using an exercise ball, marching in place. Just do something else while you sit there. 
 
Something to keep in mind before you eat that evening snack when you are not hungry is that you can undo an entire day of healthy eating in 10 to 15 minutes. Think before you eat.
 
Eat Smart...
Vicki Bovee, MS, RDN, LD
 
Read more:
 
 
 
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4 Key Ways to Keep Your Weight On Track During the Holidays

The holiday season is underway with parties, dinners, potlucks, and baking which translates into food, more food, and too much food. How does one stay on track and still enjoy the food and festivities?
 
Holiday Treats
 
Years ago in my career, I worked for the University of Nevada School of Medicine as a research dietitian. One of the research studies, funded by a liquid meal replacement company,  with which I was involved studied the prevention of weight gain over the holiday season. We conducted the study for three years over the weeks from Thanksgiving through New Year's Day. We developed holiday eating messages which were tested and refined each year. At the end of the third year we knew what worked and what didn't work. Since that time I have focused my career on weight loss surgery with Western Bariatric Institute. But I have continued to use these messages for myself and I have continued to teach them to my patients because I know they work to prevent weight gain and allow you to still enjoy some of holiday foods.    Holiday Weight Gain - Fact or Fiction?
 

Key messages for holiday weight management

1. Eat only one small treat a day.

Often times, especially at work, we have access to candies, cookies, and other treats. They are brought into the office by coworkers, clients, vendors, or business partners. Sometimes these treats find their way into your home. Telling yourself for 8 to 12 hours a day that you can't have it may lead to feelings of deprivation. Then if you decide to indulge, it's more likely you will overeat and then there feeling of guilt afterwards. Allow yourself one small piece of candy, one small cookie, or one other small treat per day. Be choosey because once you've eaten it, you're done for the day. If you choose to eat a cookie at your morning break, know that the next treat comes tomorrow.

2. Eat only three small appetizers at a party. 

These foods may be small but they pack a lot of calories. Check out these bites: 1 mini-quiche = about 90 calories each, 1 cream cheese stuffed jalapeno pepper= about 75 calories, 2 small smoked sausages in barbeque sauce = about 85 calories, 1 bacon wrapped scallop = about 80 calories and 2 tablespoons spinach dip = about 90 calories (without crackers). If you ate the above appetizers you would have consumed about 330 calories, 21 grams of fat (58% of the total calories) and 930 mg sodium. Again, be choosey and select the three most appealing to you. This probably won't fill you up, but this type of event is not a meal. Fill up on the lower calorie items available.

Sneaky Calories - Identifying them is half the battle!

3. Include fruits and/or veggies at all meals and snacks.

Foods that are high in fiber and water content will help fill you up and keep you feeling satiated more than dry foods since they stay in the pouch or stomach longer.

4. Use a meal replacement shake for the meal before and after a holiday meal or party.

Since you may be eating more calories at this meal than normal, you will need to balance out your intake. Using a portion-controlled meal replacement is an effective way to make that balance happen. In our study we found that the shake produced better results than using a packaged portion controlled food, such as a frozen dinner. So if your event is in the evening, have a shake for lunch and then again for breakfast the next day. 

The holidays don't have to mean weight gain. If you have many challenges, focus on maintaining your weight. Your stomach or pouch doesn't know it's the holiday season. Your head needs to get in step with your goals. Stay focused and eat smart.  Be sure to remember to take your vitamins and supplements each day too! 
 
Healthy Holidays!
Guest post by Vicki Bovee, MS, RDN, LD 
 
 

photo credit: PetitPlat - Stephanie Kilgast via photopin cc

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8 Tips to Break a Weight Loss Plateau

You've been faithful with your diet and exercise program but the scale is stuck. It can be frustrating to work hard and not see positive results. It may be tempting to throw your hands in the air and say, "What's the use of continuing with this? I'm doing everything right, and the scale isn't moving."

Hitting a weight loss plateau is normal, even with bariatric surgery. Your body is not programmed to lose a certain amount of weight every week. There are numerous factors that affect your rate of weight loss.

A person with a higher BMI will generally lose more weight in the first few months than a person with a lower BMI. I have also seen people who lose a significant amount of weight before surgery, have a slower weight loss after surgery, and hit a plateau sooner than someone who has minimal weight loss preoperatively.

As you lose weight, the amount of calories you need to run your body decreases since you have less pounds to support. So if you were eating 1500 calories a day and losing weight, eventually that 1500 calories will need to be reduced to continue with weight loss. If the scale has been stuck for a couple of weeks, either you need to cut calories from your intake or increase your activity and burn more calories.

Check out my favorite plateau busting tips.

  • Keep a food record of everything you eat and drink. It is easy to forget about the calories from beverages, or the calories consumed while grazing. Grazing can stop weight loss in its tracks and is one of the major causes of weight regain.  Keep Losing the Pounds with a Food Diary
     
  • Drink a protein shake for at least one meal a day. If your surgical practice required you to follow a liquid diet before surgery, you can use that plan.
     
  • Eat your protein first and watch the carbs from starchy foods. Eating a diet higher in lean protein is more satiating than eating a lot of carbs. All calories are not created equal.
     
  • Change up your exercise program. If you are a walker, walker faster, change the route, or include some hills in your walk. If you are at the gym, work with a trainer to keep your routines changing. Bariatric Surgery Patients Continue to Lose Weight with Rigorous Exercise
     
  • Look for ways to increase movement in your daily activities. If you are picking something up off the floor, squat down and use your legs instead of your back. Get up and move from your desk or the sofa every 45 minutes.  Want to Help Rev Up Your Metabolism?
     
  • Wear a pedometer. The goal for Americans is 10,000 steps a day. This is equal to approximately 5 miles and burns about 500 calories.
     
  • Weigh yourself no more than once or twice a week. It is only more stressful to be on the scale every day.
     
  • Sometimes you just might need a booster. Check in with your program dietitian to help you set some goals and hold you accountable.  Make sure you are taking your daily vitamins and supplements to help your energy levels!

Relax. Weight loss is a process and it takes time. If your head is on straight, the numbers will follow.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Expert

 

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What to Eat for Breakfast After Weight Loss Surgery

Breakfast..To eat or not to eat?

Healthy Breakfast

For years we've been told that breakfast is an important meal. It recharges your brain and your body and makes you more productive. Numerous studies have found that people who eat breakfast do a better job of managing their weight and they tend to have less cravings for carbs later in the day.

You may have heard or read in recent news that a study published in August in the Journal of Obesity that a group of 1,600 overweight, middle-aged and diabetic women were asked to distribute their 1,400 calories in different proportions during the day. The group that ate half their calories at breakfast lost more weight than those that ate most of their calories at dinner. The problem with this that I see, is how many of us can eat 700 calories at breakfast without loading up on high fat foods?

Other studies have found that people who skipped breakfast really didn't eat more calories later in the day as we would expect. Theoretically, you save calories during the day by skipping any meal. But should you?

If you've had any type of weight loss surgery the recommendations are clear to eat 3 small meals a day. We know that obese people are more likely to be breakfast skippers than normal weight people so eating breakfast is one of those lifestyle changes for long-term success. Generally, breakfast is eaten within 60 to 90 minutes after getting up. For some people with an adjustable gastric band, breakfast may be difficult due to band tightness in the morning.

Post-operatively, the question is not whether to eat or skip breakfast, but what to eat for breakfast. The best breakfasts are low in carbs and fat and high in protein and fiber. Skip the sugary breakfast cereals, pastries, baked goods and coffee drinks. For my patients who are not breakfast eaters, I recommend a shake made with a high quality meal replacement, protein supplement, or make your shake with cow's or soy milk and yogurt. Other good choices for breakfast are Greek yogurt with some fresh fruit, egg white omelet and whole grain toast, or oatmeal made with milk and sprinkled with some nuts. No one says you have to eat breakfast foods for breakfast. You can make a wrap with a whole wheat tortilla and some deli meat or have last night's leftovers.

Other suggestions:

  • Hard boiled egg
  • Fish - smoked salmon or tuna
  • Turkey slices
  • Chicken pieces
  • Tomato
  • Other veggies
  • Mushrooms
  • Turkey bacon
  • Cottage cheese
  • Cheese stick
  • Banana with peanut butter
  • Protein coffee - Chike has some really good ones! http://www.chikenutrition.com/buy-chike-coffee.html

Check bariatric food blogs for other great ideas such as www.worldaccordingtoeggface.blogspot.com 

Breakfast is an important meal for you. Your pouch has limited capacity and you don't want to risk overfilling it at lunch because you let yourself get too hungry. This meal also helps keeps your blood sugars more stable and you'll have a better more energetic morning.  Breakfast is also a great time to take your supplements for the day.  If you take a liquid supplement, you can easily add it to your protein shake or smoothie.

Are you skipping breakfast? You may want to reconsider....

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Expert

 

photo credit: Denna Jones via photopin cc

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Weight Loss Surgery is a Major Life Decision - Setting Yourself Up for Success

"Every patient has the intention of being successful long-term."

I have been specializing in bariatric nutrition for 10 years and have seen thousands of patients proceed with gastric bypass, gastric sleeve, or gastric banding surgery for weight loss. I believe every single pre-operative patient who has sat in my office or my preop nutrition class, has every intention of being successful long-term. I don't recall ever hearing someone say, "I'm going to have surgery and regain my weight." Yet, some do. Not everyone is successful in keeping off significant weight for the long haul.

Weight Loss Surgery Decision

Setting yourself up for success starts long before your surgeon meets you in the operating room. The decision to have weight loss surgery is not to be entered into lightly, but requires a great deal of soul-searching and homework on your part. Whether you are investigating the very idea of weight loss surgery or  investigating your surgical options, please allow me to offer some experienced guidance.

If you are contemplating having bariatric surgery:

·         Do you meet the BMI criteria for surgery? You must have a BMI >40 or be more than 100 pounds overweight without comorbidities or a BMI >35 with comorbidities. Typically, the insurance companies are looking for comorbidities of diabetes, hypertension, and/or sleep apnea. If you are pursuing an adjustable band, check with your surgeon if your BMI is >30 with comorbidities.

·         Have you made numerous attempts, beyond over-the-counter weight loss drugs, to lose weight? Have all these attempts failed and you've regained the weight?

·         Does your insurance coverage provide bariatric benefits? This alone can stop you from proceeding further. Some insurances cover only certain procedures, have limited coverage for surgery, and/or have lifetime limitations on benefits. You may be able to have surgery, but they will not cover follow-up visits. If you are a self-pay, are you able to pay the costs of unforeseen complications?

If you have met the above criteria, now is some time for soul-searching.

·         This is a life-changing surgery. Are you ready to make changes in your life that affect every aspect of it besides the number on the scale and your health problems? This surgery changes relationships with spouses, significant others, partners, family, friends, and co-workers.

·         Are you committed to change your eating and exercise habits for the rest of your life? This is not the easy way out. I have never had a post op patient, successful or not, tell me that this was the easy way out. Weight loss surgery is a tool, and it's a wonderful tool when you work with it, but you have to be 100% committed.

·         If you are having second thoughts or reservations about proceeding, it's OK to stop the process. You need to be ready. I've had patients stop and some return in a year or so. Some never return and I think that is a wise decision on their part. If you are not ready or proceeding for the wrong reasons (someone else is pushing you), success is not in your favor.

If you are certain this is for you and you are committed to make the lifestyle changes, how do you decide which procedure is best suited to you? This is a decision you will make with your surgeon, and here are some things to think about.

·         What are your current health problems or comorbidities? Your surgeon will look at your medical history, and based on his/her experience, will direct you to the best procedure.

·         What medications are you currently taking? Both gastric bypass and gastric sleeve and medication implications. Again, consult with your surgeon.

·         What procedures does your surgeon routinely perform? Ask them how many of each of the procedures they have performed and their complication rates for each.

·         Are you willing to take vitamin/mineral supplementation daily for a lifetime? There is malabsorption with gastric bypass and gastric sleeve surgery. You will need to take supplements daily to prevent vitamin or mineral deficiencies. You may get rid of medications, but you trade them for supplements.

Read  Vitamin and Nutrition Management Vital After Bariatric Weight Loss Surgery

I sometimes hear someone say to a preop patient, "Good luck with your surgery." I don't believe success is a matter of luck. It is based on the skill of your surgeon and, most important, your commitment to making those lifestyle changes, not just for a few months but for a lifetime.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Expert

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Want to Help Rev Up Your Metabolism?

Over the years, the tools we use for anthropometric assessments for weight management have improved tremendously. These tools provide us with much more accurate information than using predictive equations or estimations.  

The term anthropometric refers to comparative measurements of the body. Anthropometric measurements are used in nutritional assessments. Anthropometric measurements used for adults usually include height, weight, body mass index (BMI), waist-to-hip ratio, and percentage of body fat. These measures are then compared to reference standards to assess weight status and the risk for various diseases. Anthropometric measurements require precise measuring techniques to be valid.

How to boost metabolism

I have been using an indirect calorimeter for about 10 years to measure resting energy expenditure (REE), or resting metabolism. The device measures CO2 production and O2 consumption and converts that measurement into calories. As I explain to my patients, it is the amount of calories your body burns in a day just to run your body at rest. Or as one of my patients said, "The calories just to be."

At the baseline REE, I often have patients tell me they believe a large part of their weight problem is due to a slow metabolism, and for some, this is the case. For those people with extremely low metabolic rates, I refer them to their PCP for thyroid testing. But for most, I discuss the factors that influence metabolic rate and how they can improve it.

Factors that affect metabolic rate and are out of your control.

·         Age. Your metabolic rate declines as you age due to the natural loss of muscle mass that comes with aging.

·         Gender. Women have lower metabolic rates than men because women genetically carry more fat than men. Men have more muscle mass and therefore burn more calories. So ladies, do not compete with men when it comes to weight loss.

Things you can do to help maintain or increase your metabolic rate.

·         Hands down, the best thing you can do is exercise. Cardio activity will raise your metabolic rate while you are exercising and for several hours after. But, it is the muscle building, or strengthening activities, that will keep your rate higher for 24 hours. Muscle burns more calories than fat, so more muscle mass means a higher metabolic rate. The muscle building activities help prevent the natural loss from aging. In addition, when you lose weight, especially rapid weight loss that comes from weight loss surgery, you don't lose just fat. Part of that weight loss includes muscle mass. Faithfully doing strength training can help preserve lean body mass during weight loss.

·         Get enough sleep. If you consistently burn the candle on both ends, it will slow down your metabolism.

·         Eat often enough. This is not grazing! This is eating every 2 to 3 hours. At eating times, choose healthy foods that include protein since protein requires your body to burn more calories to utilize than carbs or fat.  Avoid eating one, large meal a day as this can slow down your metabolic rate.

Making Sense of Protein Recommendations and Requirements

There are some foods that may help you increase your metabolism. There is a compound in green tea, ECGC, and a compound in peppers, capsaisin, that can produce rather small increase but at this time the research shows they do not significantly affect weight loss. Caffeine does increase metabolism, but again, there is not enough research to support its benefits for weight loss.

At repeat REE measurements I have seen patients significantly increase their metabolic rate with large weight losses after bariatric surgery. How do they do it? EXERCISE! The best way to maintain or increase your metabolism is through exercise, both cardio and strength training.

Bariatric Surgery Patients Continue to Lose Weight with Rigorous Exercise

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Expert

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Is it Possible to Eat Healthy Fast Food?

We’ve all done it. We run to drive thru to pick up a quick meal. What else can you do that requires so little calorie expenditure in return for high calorie consumption? It’s no mystery to me why people use the drive thru. All that is needed is to push a button to lower the window, hand over a couple of dollars for a value meal, and in return you get a tasty meal to fill you up and it requires no preparation or clean up.

subway

According to a CDC report during 2007 - 2010 American adults consumed 11.3% of their total daily calories from fast food. Overall, no difference was observed by income but food fast food meals decreased with age. The report also noted that as weight increased, the calories from fast food increased.

Why Fast Food?

Why are so many of us eating fast food even though most of us know that the meals are high in calories, fat and sodium? Researchers at the University of Minnesota interviewed nearly 600 people who ate regularly at fast food restaurants. The results will come as no surprise with speed and convenience the top two responses. Of those interviewed, 92 percent stated eating fast food because they’re quick. More than 80 percent said they are easy to get to. You can find a fast food restaurant with no problem since they are just about on every corner. Only 20 percent felt there were many nutritious foods to choose from.

Bottom line, we know we’re not making healthy food choices, but time and convenience are more important to us.

Menu Labeling

Several U.S. states and cities have passed menu labeling policies that require nutrition information to be provided to consumers that is easy to find and easy to read. When calorie content is posted on the menu rather than in a nutrition pamphlet that may not be easily accessible, consumers may make lower calorie choices. Even though the calories are posted on the menu and customers may choose them, the restaurants are not providing more healthy options.

Tips for Eating Healthier at Fast Food Restaurants

*Note: All nutrition information was obtained from the various companies’ web site nutrition facts.

Read the menu carefully before ordering. Avoid deep fried or breaded items. Crispy means extra fat so look for grilled items.

McDonald's®

 

Calories

Fat (g)

Protein (g)

Carbohydrate (g)

Sodium

( mg)

Premium Crispy Chicken Classic Sandwich

 

Premium Grilled Chicken Classic Sandwich

 

Premium McWrap Sweet Chili Chicken (Grilled)

510

 

 

350

 

 

 

360

 

22

 

 

9

 

 

 

9

 

24

 

 

28

 

 

 

26

55

 

 

42

 

 

 

43

990

 

 

820

 

 

 

1030

 

Choose a Smaller Size Portion

No more super sizing! Even though it may cost less for foods on the dollar menu or the value meal, they come with a higher calorie price tag. Even restaurant chains that advertise healthier foods still offer portions that are large enough to provide 600 to 800 calories per item.

 

Calories

Fat (g)

Protein (g)

Carbohydrate (g)

Sodium

( mg)

Burger King

Double Whopper®

 

Whopper Junior®

 

Hamburger

 

 

830

 

 

340

 

240

 

 

50

 

 

19

 

9

 

 

42

 

 

14

 

12

 

 

57

 

 

28

 

28

 

 

1040

 

 

510

 

490

Jack in the Box

Large French Fry

 

Small French Fry

 

 

557

 

 

330

 

 

26

 

 

15

 

 

6

 

 

4

 

 

75

 

 

45

 

 

1017

 

 

609

Taco Bell

Double Decker® Taco

 

Fresco Ranchero Chicken Soft Taco

 

320

 

 

 

140

 

14

 

 

 

4

 

 

14

 

 

 

10

 

36

 

 

 

16

 

 

710

 

 

 

470

 

 

Eliminate the High Calorie Add-ons

Cheese, bacon, mayo, regular fat salad dressings and dipping sauces add a lot of extra calories because they are high fat. Ask for sandwiches without the mayo or sauce and add catsup or mustard to replace it. Salads with grilled meats are usually a good choice but make sure to ask for reduced fat or light dressing.

Wendy's

Calories

Fat (g)

Protein (g)

Carbohydrate (g)

Sodium

( mg)

Spicy Chicken Caesar Salad Half Size with Crispy Chicken with Avocado Ranch Dressing

 

 

 

 

 

430

 

 

 

 

 

27

 

 

 

 

 

21

 

 

 

 

 

28

 

 

 

 

 

930

Spicy Chicken Caesar Salad Half Size with Grilled Chicken with Light  Ranch Dressing (no croutons or cheese)

 

 

 

 

 

230

 

 

 

 

 

13

 

 

 

 

 

22

 

 

 

 

 

9

 

 

 

 

 

530

 

Choose Healthier Side Dishes

Most fast food restaurants offer side salads, fruit or yogurt. Pick these instead of the high fat fried sides.

McDonald's®

 

Calories

Fat (g)

Protein (g)

Carbohydrate (g)

Sodium

( mg)

Medium French Fries

380

19

4

48

270

Fruit 'n Yogurt Parfait

 

150

 

2

 

4

 

30

 

70

 

Choose Low Calorie Beverages

Avoid the shakes, blended drinks, soda, or designer coffee drinks. All are high in calories from added fat and/or sugar. Choose water, low fat milk, iced tea or diet soda instead.

 

Calories

Fat (g)

Protein (g)

Carbohydrate (g)

Sodium

( mg)

1 cup 1% Milk

100

2.5

8

12

125

Small Vanilla Shake

 

420

 

10

 

13

 

72

 

140

Medium Cola

200

0

0

56

5

Small Lemonade

200

0

0

54

21

 

Pay Attention to What You are Eating

You may be in a hurry, but resist the temptation to eat in your car. For one, it's not safe to be eating and driving with one hand. Take your meal back home, to the office, or make it a picnic. Slow down your eating and taste your food.

 

Limit Your Fast Food Meals

These are not places for frequent dining. The average amount of calories for a fast food meal ranges from 1500 to 1800 calories. This amount of calories is more than half of most people's caloric needs for the entire day, not to mention the excessive sodium found in these foods. Do some planning ahead. This may mean packing your lunch or taking a snack with you. If you are able to do so, look up the nutrition information on the company's web site. Some of them are easier to read and navigate than others but the information is available. Some of them give you the option to personalize your menu item or build your meal.

Use the internet to help you find healthier dining choices.  Healthydiningfinder.com allows you to select restaurants in your area displaying their suggested menu items, with or without special requests. You can make healthier choices and enjoy your occasional fast food meal.

Sneaky Calories - Identifying them is half the battle!

Summer Road Trip? Tips for Healthy Eating on the Go

 

Eat Smart…

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Expert

 

References:

Fryar CD, Ervin BE. Caloric Intake From Fast Food Among Adults: United States, 2007-2010. NCHS

Data Brief 2013;114. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db114.htm

Namba A, Auchincloss A, Leonberg BL, Wootan MG. Exploratory Analysis of Fast-Food Chain Restaurant Menus Before and After Implementation of Local Calorie-Labeling Policies, 2005–2011. Prev Chronic Dis 2013;10:120224. DOI: http://dx.doi.org/10.5888/pcd10.120224 .

Rydell SA, Harnack LJ, Oakes JM, Story M, Jeffery RW, French SA. Why Eat at Fast-Food Restaurants: Reported Reasons among Frequent Consumers. J Am Diet Assoc. 2008;108:2066-2070.

Stewart H, Blisard N, Jolliffe D. Let’s Eat Out: Americans weigh taste, convenience, and nutrition. Washington, DC: United States Department of Agriculture Economic Research Service; 2006.

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Summer Road Trip? Tips for Healthy Eating on the Go

Ah, summer. Long, warm days of sunshine. A lot of us are hopping into the car and taking off for the beach, the mountains, Grandma's house, or just a weekend getaway. This can translate into hours of sitting in the car. This usually throws off our eating routine and for some, this means more junk food.

Road Trip Tips

If you start your trip off track, it will be difficult to get yourself back on track for the rest of your trip.

How do you enjoy your road trip without doing severe damage to your weight management efforts?  Just as you would plan out your route to drive, you need to make a plan for your eating. Before you even get in the car, draw up your game plan.

Eat protein first.

Plan to follow the rule of  including a good protein food at every meal and snack. You can carry powdered protein shake mix and a shaker cup and you only need some cold water for your meal or snack. It’s a good idea to plan on one shake day. That way you will be sure to have one meal or snack that helps keep you focused and on track.

Stay hydrated.

It can be easy to sit in the car and forget to drink your water. Put your water bottle in the cup holder for easy access and fill it up every time you stop. Sip, sip, sip.

Start the day with a healthy breakfast.

Whether you're taking off from home or a motel, eat something before you hit the road. It will be less tempting to start snacking or grazing when the car starts if you have food in your stomach. It also starts you off on the right foot for the day.

Get out of the car to eat.

You need to get and stretch and move around every couple of hours. Make it a rule to eat only outside of the car. Snacking or grazing in the car often leads to mindless eating which turns into overeating.

Bring your own.

The easiest way to monitor protein, calories and other nutrients is to pack your own food. Fruit, jerky, nuts, and protein bars don't require refrigeration. If you bring a cooler, you have lots of options. Cheese sticks, yogurt, bottled water, ready-to-serve protein shakes or meal replacements drinks, hard boiled eggs, sandwich fixings, and cut up veggies are all easy to tote. You may want to consider purchasing a small portable cooler that plugs into the cigarette lighter so you don't have to hassle with bags of ice.

Healthy Snacks for On The Go

Convenience marts are not for food!

The car needs to gas up here, but you don't. There are very few healthy, if any, choices at the gas station. Some may have fresh fruit but don't count on it. Pass on the food here since the aisles are filled with highly processed snack foods and the beverage cases have a large assortment of sugar-sweetened drinks. Personally, I am concerned about how long the hot food has been sitting under those lights. Food poisoning on the road is no picnic.

Truck stops - hunt or ask for fresh fruits and vegetables

You can usually find something healthy to eat at a major truck stop, but you may have to hunt for it and then choose to purchase it. Besides the ever present junk food, there is usually fresh fruit and a healthier selection of food in the refrigerated cases. Some truck stops have counters where you can order a salad  or a customized sandwich. If you decide to go into the restaurant, make wise choices. You are not going to burn the calories contained in the "Truckers Dinner Special" while sitting in the car.

Steer clear of fast food or know before you go.

The highway landscape is dotted with fast food places. The menus are pretty much the same everywhere. If you visit fast food places at home, you already know which items are your best bet. If you seldom eat fast food, read before you choose. Some of the restaurants have nutrition information posted. If you don't see it, ask for it or use your smartphone to look up the nutrition information posted on their website . You are fine with the salads with grilled chicken, just limit the dressing or ask for a low fat dressing on the side! You can also enjoy a grilled chicken sandwich or wrap. If you have to have a burger opt for the small size.

Tips for Eating Healthy when you Eat Out

A final thought

Where ever you decide to eat, beware of high calorie beverages. Sodas, designer coffee drinks, and commercial fruit smoothies can contain the same amount of calories as your meal.

Don't forget to take your supplements with you!

 

Eat smart and drive safely…

Vicki Bovee, MS, RDN, LD, Bariatric Expert

photo credit: Stuck in Customs via photopin cc

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Weight Loss Surgery and GERD - Gastroesophageal Reflux Disease

If you have had occasional heartburn, you know how uncomfortable it can be, and about 20% of Americans experience heartburn at least once a week.

People who experience chronic heartburn may have GERD, or gastroesophageal reflux disease, often called acid reflux. This reflux is caused by stomach acid that flows back into the esophagus. Over a period of time, complications from chronic reflux can lead to complications with swallowing and increase the risk for esophageal cancer.

what causes heartburn or acid reflux

Nearly all studies conducted have found a relationship between obesity and GERD. The increased incidence of GERD and excess weight is believed to be caused by excess belly fat putting pressure on the stomach, and the higher the weight, the more likely one is develop GERD. Treatment for GERD includes lifestyle changes, medication, and/or surgery.

An effective treatment for GERD is lifestyle modification includes:

·         Weight loss

·         Increased physical activity

·         Eliminating foods that typically cause reflux such as; alcohol, caffeine, chocolate, fried foods, spicy foods, cooked tomato sauces, mint, an carbonated beverages

·         Eat smaller meals

·         Don't lie down 3 hours after eating

Digestive Problems? Take These 10 Steps

Your doctor may also recommend medication, either by prescription or over-the counter. And if you are obese, your doctor may recommend you have bariatric surgery to resolve your problem.

Roux-en-Y gastric bypass surgery has been consistently shown to improve GERD symptoms. At this time it's not clear if the improvement is due to weight loss or related to the actual surgery itself which creates a pouch. Adjustable gastric banding may or may not improve GERD so many surgeons do not recommend this procedure because of conflicting data and outcomes. A more recent surgery, the gastric sleeve, has little long-term data on the improvement of GERD. The long, narrow pouch may actually worsen or cause reflux. For this reason, if someone has GERD a sleeve should be done with caution.

The best treatment for you is the one you discuss with your physician, and after weighing your options, you both agree to a remedy that meets your health needs and fits your lifestyle.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Bariatric Expert

Vitamin and Nutrition Management Vital After Bariatric Weight Loss Surgery

 

Resources:

Friendenberg, F., Xanthopoulous, M., Foster, G., & Richter, J. (2008). The association between gastroesophageal disease and obesity. Am Jour of Gastroenterology, 103, 2111-2122.

Kushner, N. & Kushner, R. (2012). Obesity & heartburn: What is the link?. Your Weight Matters: Obesity Action Coalition.

Prachand, V., & Alverdy, J. (2010). Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery?. World Jour of Gastroenterolgy, 16(30), 3757-3761.

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Weight Loss Surgery May End Family Obesity Cycle - New Study

The benefits of weight loss surgery have been well documented in recent years. But besides all the health improvements related to trimming your waistline, there may be one very powerful addition to the list. A new study suggests that bariatric procedures may actually break the genetic cycle of obesity.Weight Loss Surgery May End Family Cycle of Obesity

Canadian researchers found a number of differences between kids of obese mothers and those siblings who were born after the mother underwent bariatric surgery. The siblings born after the surgery were slimmer than their brothers or sisters and also had fewer risk factors for diabetes or heart disease.

But the most dramatic of the findings came on a genetic level. The genes linked to obesity-related health problems in siblings born after bariatric surgery worked differently than in their older brothers and sisters.

It’s important to reiterate that the offspring did not receive different genes, just that those inherited genes acted differently.

Whether or not an expecting mother is a candidate for weight loss surgery or actually has it performed, these findings still emphasize the importance of prenatal dietary choices and how they may have an impact on their newborns.

Women at a healthy weight at the beginning of pregnancy are expected to gain 25 to 35 pounds. If a woman is obese, they should not gain more than 20 pounds. Overweight women should figure on somewhere in between those figures.

Gaining excess weight during pregnancy is risky for both mother and child, increasing the risk of premature birth and cesarean sections. It also may increase the child's risk of developing obesity and diabetes later in life. It's always best to speak with your healthcare provider to find out what weight is healthiest for you and your child.

by guest blogger Jason Knapfel who writes for Northwest Weight Loss Surgery in Everett, WA.

Heart Health Benefits of Weight Loss Surgery

Vitamin and Nutrition Management Vital After Bariatric Weight Loss Surgery

Another Study Shows Weight Loss Surgery Works for Diabetes Treatment

 

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Finally Updated Guidelines for Weight Loss Surgery - Important Takeaways

Recently the updated clinical practice guidelines for bariatric surgery were released, cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery (ASMBS).  

For us practitioners it was a welcomed document since the last guidelines were published in 2008. In those five years, we have learned a lot more through research and we are always looking for the best practices and recommendations to treat weight loss surgery patients. There has been a lack of standards as you may know since recommendations vary between surgeons and practices. If you talk to friends or family who have had weight loss surgery at a different location than yourself, you know what I mean.

Bariatric surgery food pyramid

The new guidelines are somewhat lengthy and technical. I would like to point out the postoperative items of interest that I have shared with my patients. Many of these are not new, but have new research to substantiate the recommendation. (My comments follow.)

  • Patients should adhere with principles of healthy eating, including 5 daily servings of fresh fruits and vegetables. (Eat your fruits and veggies before eating starchy carb foods.)
     
  • Minimum protein intake should be 60 grams/day and up to 1.5 grams/kilogram ideal body weight per day. (Your RD can individualize your protein needs based on your age, weight, and gender.)
     
  • Take your supplements daily. Your supplement needs depend on the type of surgery you had and your individual lab values. (Get your blood work done as ordered by your bariatric provider. Just because you feel good doesn't mean you don't have to take supplements. Supplements are not optional.)
     
  • Fluids should be consumed slowly, preferably 30 minutes after a meal to prevent gastrointestinal symptoms and in sufficient amounts to maintain adequate hydration, more than 48 fluid ounces. (Water is always a good choice. Flavor it with slices of lemon, lime, or cucumber.)
     
  • Exercise should include moderate aerobic activity of a minimum of 150 minutes per week and a goal of 300 minutes per week including strength training 2 to 3 times per week. (Do what you can, just get started. Any physical activity is better than no physical activity. You have got to do something and stick with it to maintain weight loss.) Read more on exercise after surgery
     
  • All patients should be encouraged to join and attend support groups. Patients who regularly attend support group have better weight loss.  (Better yet, be a support group leader. Then you have made a commitment to attend group.)
     
  • Regular postoperative dietary counseling with an RD means greater improvement in eating behaviors. (Your RD is important in your long-term success. Stay in contact with her/him.)
     
  • If you have an adjustable gastric band, adherence with follow up visits is associated with greater weight loss. (The band doesn't work by itself. In order to keep it properly adjusted and stay in the "green zone" you need to attend your follow up appointments for tune- ups.)
     
  • Out of control eating and grazing are associated with lower weight loss and weight regain. (Your pouch may not hold a lot of food at one time but if you eat every hour you can eat a lot of food over the course of a day. Ask yourself if you have physical signs of hunger or do you just want to eat.)
     
  • Drinking alcohol after gastric bypass and gastric sleeve surgery results in accelerated alcohol absorption, higher blood alcohol levels, and longer times to eliminate the alcohol from your body. (If you decide to drink alcohol, be very cautious. These two surgeries are not good mixers with alcohol. NEVER DRINK AND DRIVE.)

Please keep in mind that these are guidelines and recommendations, not absolutes. Follow the guidelines provided by your bariatric team since they know you and are best suited to meet your individual needs.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Vicki Bovee, MS, RD, Wellesse Bariatric Expertis a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.

*Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient- 2013 Update: Cosponsored by American Association of Clinical Endrocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.

 

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How Soon Can I Exercise After Gastric Bypass or Other Weight Loss Surgery?

Congratulations!  You've just had bariatric surgery and you're excited to get started with your new life (or you are researching for after your surgery).  Part of that new life includes exercise.  If you want to keep the weight off, you need to make physical activity a regular part of your life.  It may be one of the most important lifestyle changes you make for long-term success. Where do you start?

 

Walking exercise after gastric bypass surgery

 

Start with walking a little bit at a time...

  • While you are in the hospital, the nursing staff will have you up and walking as soon as possible to help with your recovery. When you get home, you may be fatigued and that is normal. You've just had surgery! While you are at home recovering, the goal is to walk every day and every day walk just a little bit further. Maybe you can only walk to the end of the driveway and that's OK. As time goes on you will be able to walk further and longer. Just keep working at it.

Download your free Beginner Walking Chart Here!

  • If you like to go to the gym or have exercise equipment at home, you will be fine on a treadmill or stationary bike right after surgery. You will want to avoid the cardio equipment that can put a strain on those recovering abdominal muscles, like a rowing machine and an elliptical if you use the arm attachments. You will want to get clearance from your surgeon for swimming or other pool exercise. Those incisions need to be healed and your surgeon will give you the go-ahead when he/she feels you are ready.
     
  • Strengthening exercise is crucial to maintain muscle mass but you need to allow those core muscles to heal.  General recommendations for abdominal surgery are not to lift over 10 pounds (about the same as a gallon of milk) for two weeks. In the practice where I work we also recommend no abdominal exercises (crunches) for a month. Always check with your surgeon for clearance with any activity that involves lifting or putting a strain on those abdominal muscles.
     
  • Just move!  Any exercise is better than no exercise. New recommendations from the American Society of Metabolic and Bariatric Surgery (ASMBS) include a minimum of 150 minutes a week of cardiovascular exercise with a goal of 300 minutes a week, plus strength training two to three times a week. Do what you can but do something. I have patients who are running half marathons a year out from surgery and would never have imagined that it was possible before their surgery. You may never run a half marathon but I am willing to bet you will be more active, walking further, and have more energy as you travel down the road of weight loss.

Be sure to take your supplements each and every day to help keep your energy levels up as well as getting enough protein.  B vitamins are especially helpful for energy and even help metabolism.  

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Liquid Supplements Bariatric Expert

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How Obesity Can Affect Your Immune System

Obesity can take a toll on the body, increasing a person’s risk for heart disease, certain types of cancer, fatty liver disease, osteoarthritis and many other diseases. And, to add insult to injury, obesity appears to launch an attack on the body’s defense network, the immune system. And, this attack appears to be multifaceted – there are several ways in which obesity may negatively affect the immune system, some of which haven’t been totally elucidated just yet.

Immune system

Vitamin D Deficiency Link

  • First, obesity is a contributing factor to vitamin D deficiency – a vitamin that has several effects on cells in the immune system. Vitamin D doesn’t just alter immune responses but a deficiency in this vitamin is associated with increased autoimmunity and an increased susceptibility to infection. Yet a recently published study found every 10% increase in BMI was associated with a 4.2% drop in vitamin D in the body. And therefore, monitoring vitamin D status in people who are overweight and obese may be critical for also maintaining a healthy immune system.
     
  • Obesity also decreases the body’s production of specific immune system cells while altering the functioning of others. Is this due to vitamin D deficiency? This part of the picture isn’t quite clear. And, factors that can contribute to obesity – including over consumption of fat, sugar and calories can increase both inflammation in the body and oxidative damage to cell membranes (healthy cell membranes are critical because they are like gate keepers regulating what molecules can pass into and out of cells and therefore).


Given the impact obesity has on the body’s defense network, it shouldn’t come as much of a surprise that research often shows obese hospitalized patients are more likely to develop secondary infections and complications.

If you have pounds to lose, don’t fret. Start by cutting down on sugary snacks, baked sweets and fried foods. Add vegetables to every lunch and dinner and fresh whole fruit to your breakfast. In addition, drink at least 8 glasses of calorie free fluid per day and get exercising. If you don’t exercise now, start by taking the steps instead of the elevator everywhere you go and take the long route when possible (park far from the store entrance for instance). Build up your exercise routine slowly (by 10% per week) to give your body time to adapt and minimize the likelihood of developing injuries.

If you have struggled with your weight for many years and still unable to lose the weight you need to for your health, consider weight loss surgery.  Talk with your healthcare professional about the options available to you.  Bariatric Weight Loss Surgery can be the needed tool for those who are obese and are unable to lose the necessary weight.  It can be a critical step towards a healthier, longer life.

Keep in mind that malnutrition and deficiencies can occur even if you are overweight, due to poor diet and/or inability to absorb enough nutrients from food.

For those that have already had bariatric surgery, be sure to always take your recommended bariatric vitamins and supplements for the rest of your life to protect against deficiencies such as vitamin D and calcium for immune and bone health.  Vitamin D is very important for the absorption of calcium for strong bones to prevent osteoporosis.  Make sure to get your blood levels tested regularly.  

 

References

PLOS Medicine 2013;10(2):1-13.

J Clin Invest 2003;112:1796-1808.

J Investig Med 2011;59:881-6.

Clin Exp Immunol 2006;146:39-46.

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