June 6, 2017 – The Appetite Regulation System – Simplified
Facilitator: Dr. Hassan Saradih, Bariatrician
Dr. Saradih began by showing that the body’s organs “talk” to each other through a signaling system. The organs, like the stomach, liver, intestines, pancreas, etc. send signals by secreting hormones that then send signals to the brain. These signals either tell a person they are hungry or they are full, which is called satiety. These two signaling pathways – the hunger pathway and the satiety pathway – counter balance each other, and they cannot both be active at the same time. When the two pathways are pulling against each other, the strongest one wins.
When you gain weight, and have an increase in the amount of fatty tissue, you develop leptin and insulin resistance. This means they are no longer pulling for the satiety side, but move to the hunger side which makes Ghrelin even stronger.
When we do bariatric surgery, this signaling system is reset back to normal. Now the hormones can work normally. You begin to feel satisfied more easily, and the hunger is knocked out. (If you feel hungry right after surgery, it is not physical hunger. It is more likely emotional hunger, and that can be managed with treatment.)
The one piece missing in the above is the “organ” that affects metabolism – muscles. Following weight loss after surgery, your goal is to maintain that weight. The surgery helps you to lose weight and your muscles help you to keep it off. While still in the early stages of research, we have discovered that your muscles send out myokines, which is their signal to the brain to adapt your metabolism to assist the body in reaching “equilibrium,” or that state where the energy you take in equals the energy you put out. If you take care of your muscles, your muscles will take care of your weight. By feeding your muscles protein and exercising them every day, you keep your muscles strong. And when they are strong, they will keep burning fat. The type of exercise that helps muscles burn the most fat is called High Intensity Interval Training, where you are constantly changing up the muscles used. This allows them to continue to burn fat for many hours after you stop exercising.
Bariatric Health: Shop Fresh at Your Local Farmer’s Market!
June is National Fruit and Vegetable Month, which fits nicely with our discussions about bariatric health. What better way to celebrate than to shop at your local farmer’s markets for fresh produce? Other than the benefit to your bariatric health, there are many benefits to buying fresh produce from our local farmers. Here are our top reasons for shopping local:
Buying local produce contributes to your community and its economy. Every dollar spent on local foods generates twice as much income to provide for the local economy.
When you’re buying local produce, you’re getting in touch with the current season. Seasonal fruits and vegetables are most abundant, and are typically the least expensive.
Local produce is guaranteed to be fresh and ripe. Produce is allowed a longer time to ripen on their vines because they don’t have to travel long distances, and they are typically sold within 24 hours of harvesting. You get a tastier, vine-ripened product.
Because the produce isn’t traveling far, your carbon footprint is reduced, which is promoting better air quality and reducing pollution. The foods are also less likely to be contaminated and tampered with.
Supporting your local farmers is supporting responsible land development. The farmers are able to keep their land to continue growing produce to supply to their communities, giving their land good reason to stay undeveloped. The sustainability of their land then allows for production of a wider variety of fruits and vegetables.
Shopping at farmer’s markets allows you to build relationships with the farmers who grow your produce. Knowing where and how your food is grown can be empowering and reassuring that your food is healthier and cultivated in an environmentally friendly atmosphere.
Buying local is inspiring. With a variety of fruits and vegetables to choose from, you are more likely to incorporate this same variety into your own meals. The farmers typically have ideas for cooking, and sometimes even have recipe cards to hand out.
Bariatric health is a constant consideration for those post surgery. Here are a few special tips for smaller stomachs:
Buy small amounts. Markets usually carry produce in a variety of sizes so you can pick the amount you’ll be able to eat. You can choose as little as 10 cherries, 1 pear, and 2 tomatoes. Local markets will help you manage your portions and budget!
Buy produce with a longer shelf life. Carrots, onions, sweet potatoes, winter squash, and beets are among many of the vegetables that stay fresh for a week or more, so they don’t go bad faster than you can eat them.
Aim for a rainbow of colors. Brighter vegetables are often packed with the most nutrients. For fun, look for unique colors like orange cauliflower, purple beans, or rainbow carrots. Bonus tip: eat the peels if they’re edible – that’s where most of the vitamins are!
Hydrate while shopping. Markets are usually outdoors. Prepare for weather conditions and hydrate as often as you need to prevent dehydration.
Eating protein first is always important, but even a bite or two of fruits and vegetables can add nutrients and flavor! Here are some tips for adding that local produce to your high protein meals:
Add fresh berries to Greek yogurt
Use butter lettuce to make tacos or tuna salad wraps
Toss chopped spinach or arugula and goat cheese into your scrambled eggs
Serve cheddar cheese with a few apple slices – try Honeycrisp, Braeburn or Ambrosia!
Blend a handful of raw kale and blueberries into a protein smoothie
Make a salad with sliced tomatoes, fresh mozzarella, basil, and balsamic vinegar
Serve a side of roasted asparagus with grilled salmon
Munch on cherry tomatoes and cucumbers dipped in hummus or tzatziki (yogurt dip)
Dustin is Dr. Hamilton’s Physician Assistant, and assists Dr. Hamilton in all surgeries. He has worked with Dr. Hamilton for 4 years, and sees Dr. Hamilton’s patients post operatively. He graciously agreed to come to support group and answer any questions our support group members had. Below are the questions and answers.
Is it normal to not have a normal menstrual cycle after surgery? Yes, there are a lot of changes that can occur after surgery due to the disruption in hormones after surgery. Some people have another cycle, some have a much heavier cycle due to the Lovenox, and some will have a delay. Your fatty tissue holds estrogen, so as you begin to lose weight, that estrogen is released and can cause a lot of changes over the next few months. That is normal, and we only worry if someone is having very heavy bleeding while still on Lovenox. They need to know about that, and may stop the Lovenox if someone is bleeding too heavily.
How long do you need to be off estrogen/birth control before/after surgery? Generally, they like people off birth control pills 2 weeks before surgery and 30 days after surgery due to an increased risk of blood clots. For women who are taking estrogen (estradiol) for menopause, we would like to have patients off for the same time, but also do not want patients feeling too anxious if they become too symptomatic. In that case, you may restart your medication and just make sure you remain very hydrated and increase your mobility to prevent clots.
Does pregnancy cause problems right after surgery? The first thing you need to do is have a meeting with the dietitian to ensure you are getting enough calories a day to feed both yourself and the baby. Then follow your weight with your OBGYN physician.
When should I call the physician if I’m having trouble eating? If something is causing you to not be able to eat, you need to call the physician and be seen. It is always difficult to eat right after surgery, but once you get through the first month, if you find you cannot eat, do not just stay on liquids – call and be seen.
Why do I have hiccups or pain after sleeve surgery? Both of those can be caused by eating too fast and eating a few bites too much. Food does not move down the esophagus into the stomach by gravity. It moves down through muscle contractions that push food on into the stomach. If you are eating too quickly, it gets backed up and can cause pain or painful hiccups. If you slow down your eating or stop eating a bit or two earlier, that should resolve.
If you have had a bypass, it could also be an ulcer – when we do a bypass, the 2nd part of the small intestine, the jejunum, is brought up to the pouch. This part of the small intestine is not used to having any stomach/digestive acids on it. If you eat too fast or too much, the acid in the stomach can get on that jejunum and cause burning and eventually an ulcer where it meets the stomach. You need to eat slowly and stop before you are too full.
How much food should I be able to eat at once after healing? Your stomach should be completely healed at 8 weeks after surgery. You should be able to eat about ½ cup of food, or 4 oz., of protein at a time.
Why do I have reflux after stopping my omeprazole after 8 weeks? It could be too much intra-abdominal pressure, which should resolve as you lose more weight. It is best to wean off the omeprazole rather than stopped it suddenly.
Why do alcohol cause effects so quickly after surgery? Alcohol is the only thing we take in that is absorbed in the stomach. Food gets absorbed in the intestines. Since you are not drinking with eating, you are drinking on an empty stomach, and get immediate absorption.
How can you tell the difference between and ulcer and stricture? Both will have about the same symptoms – they will hurt and you will feel a “stuck” feeling every time you eat. We treat an ulcer with medication. We treat a stricture with dilation during an EGD. Because we always want to do the least invasive procedure, we will treat the symptoms medically for 2 weeks. If that doesn’t resolve it, then we will do an EGD to see if it is a stricture and dilate it. Frequently we have to do at least 2 dilations to completely resolve a stricture.
When can I take ibuprofen (Advil) after surgery? We don’t want you to take ANY for at least 8 weeks after surgery. Then you can take an occasional one with food. If, however, you need to take them routinely, you will need to take omeprazole twice a day. You take omeprazole for 8 weeks after surgery to keep acid off the staple lines. Once they are healed, you still need to protect the stomach by not taking large amounts of non-steroidal anti-inflammatory medications, such as ibuprofen.
Why is there so much swelling after surgery? You will feel a pressure in the center of your chest, which is normal reaction to the surgery. When we do the sleeve surgery, we place a long, snake-like rubber tube down through your mouth into the stomach, and we use that to know how big to make your sleeve. We always use a size 34Fr. Because the research shows that a 32 is too small for patients to eat enough, and a 36 is too big to get the best weight loss. We use a small balloon that is the size of a large egg to show us how big to make the pouch for bypass surgery. Because we are placing these into the stomach, there can be swelling which will get better every week.
When they can fix an abdominal wall hernia? Abdominal wall hernias are where there is weakness in the abdominal muscle that allows some of the intestine to poke through, which is why you see a lump. The larger the hernia is, the less likely it is to kink off and cause a bowel obstruction. We want to wait until you have lost some weight in order to make the surgery easier. A hiatal hernia is where there is small hole in the diaphragm which allows a portion of the stomach to poke up into the chest. We always repair those type of hernias during surgery, as the surgery will not work well if you have a hiatal hernia.
How will I take all the medications I’m on after surgery? You won’t be going home on nearly as many medications, and you won’t take them all at once.
What should I do if my PCP doesn’t support my surgery? Call Dr. Saradih – he is also a PCP and takes care of a lot of our patients.
When I can I go back to work after surgery? You should be off at least 1 week. You will be tired for a few weeks.
Who should I have remove excess skin? Our surgeons will do an abdominoplasty (tummy tuck) for our patients once you have gotten down to your lowest weight. For other body parts, you need to go to a plastic surgeon.
How long does it take to heal after tummy tuck? You will have 2 drains in place after a tummy tuck. We will remove 1 drain and half the staples after 1 week. We will remove the 2nd drain and the rest of the staples after 2 weeks. Then you can go back to work. The surgery takes about 1 ½ hours, and there are always 2 surgeons in the room, plus the PA.
I have constipation – how often should I have a bowel movement? You probably won’t have a BM for the first week after surgery. Once you begin eating more, then if you feel constipated you can take Miralax every day until you have one. Once you begin eating more high fiber foods, which you don’t for 8 weeks, then you should eat more fiber. You must also get your water in every day. But Miralax is fine. If you are having very hard stool, use a suppository to get things started.
I am moving to Texas – how do I find a doctor who understands the surgery down there? Call or email Chris, our coordinator, and she will find you one. (email@example.com) or call 913-676-8491,
IS THERE A CURE FOR TYPE 2 DIABETES?
Is There a Cure for Type 2 Diabetes?
I was amazed when I heard the word cure used in the same sentence with Type 2 Diabetes (T2D) by a friend of mine. She’d been in the hospital three times in the last few months with out-of-control blood sugar issues. Always a model patient, insulin and the explicitly followed strict diabetes protocol was no longer working for her. The same surgery I’d had a year ago for the wildly fluctuating weight challenges I’d endured over the past twenty years couldn’t possibly be her cure too.
My friend was searching on the web when she found a June 2016 article, Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes 1. The article stated that countries like Japan and Brazil had been routinely using surgery in the treatment of T2D for some time. It went on to say that with minimally invasive metabolic surgery it might be possible to eliminate all medications and injections, instead of suffering through life with a Band-Aid on her disease.
The first bariatric surgery was done in 1954 and became more widely used for obesity when laparoscopy or minimally invasive surgery became routine in the 1980s. Metabolic surgery became a more appropriate name for bariatric surgery about ten years ago when medical studies showed the myriad of conditions, diseases, and comorbidities that were helped, reversed, or cured with the simple procedure. The most common include:
T2D (even Type 1 Diabetes to a degree),
high blood pressure,
venous stasis (blood clots),
gastric reflux disease,
polycystic ovarian syndrome,
pregnancy and fertility problems,
sleep apnea, and
stress urinary incontinence.
Dr. Robert Aragon, one of four highly trained surgeons with The Bariatric Center of Kansas City in Lenexa, Kansas2 says that most patients with T2D can see a marked reduction in the need for insulin within a few days after surgery and may be able to quit their doses completely within a few weeks or months. If the individual suffers from T2D and obesity, this occurs even before the patient has lost significant weight. Of course, one solution is not optimal for every patient.
Why surgery works so fast on T2D symptoms
“Most people considering bariatric/metabolic surgery, for whatever reason, initially have a very simplistic view of the process,” says Dr. Aragon. “They believe the surgery, which will either reduce the size of their stomach or bypass it completely depending on the procedure3, will ultimately cause them to eat less and the result will be to lose weight. The reality is that the smaller stomach is the least of the factors that cause the weight loss. The surgery causes a massive metabolic and hormonal change. It’s no different from when a woman has her ovaries removed. Without ovaries, she is likely to have hot flashes, night sweats, mood swings, sleeplessness, fatigue, anxiety, and even loss of sex drive. Our stomachs and intestines are not just reservoirs for food. Like ovaries, they secrete substances that influence our appetite, sense of fullness, the way our bodies manage sugar, store fat, and more. The surgery removes or bypasses the source of these hormones. That is why we see almost immediate results for diabetics, whether weight has been part of the equation or not; their blood sugar comes under control without insulin. … An overweight patient does lose weight, but what’s interesting is that patients who are not obese do not seem to lose weight. They maintain their current weight and just enjoy the metabolic results of the surgery.”
Dr. Aragon also indicated that individuals with Type 1 Diabetes that opt for surgery have much better control of blood sugars. They can reduce the amount of injected insulin, but not eliminate it.
From someone who has had bariatric surgery for weight loss, having the simple procedure done so that I did not have to stick myself with a needle several times a day and have to live with a very restrictive diet seems elementary.
Insurance companies are willing to pay
In 2015, the 2nd Diabetes Surgery Summit (DSS-II)1 stated as part of their conclusions, “Health care regulators should introduce appropriate reimbursement policies [for individuals suffering from metabolic imbalances].”
Currently, most insurance carriers are more than willing to pay for surgeries for obese patients that meet certain criteria3. “From a financial point of view, bariatric surgery makes overwhelming sense,” says Dr. Aragon. “The money that is saved years down the line by an insurance company is astronomical. We tell patients that on a yearly basis they can save $10,000-$12,000 in prescription drug costs, doctor’s visits, diet programs, and food costs. So for an insurance company to not have to pay for twenty years of diabetic care or other commodities of obesity, it just makes sense. The government is well aware of this, so for individuals that qualify, Medicare doesn’t set up a lot of roadblocks either.”
Dr. Aragon says that if an insurance policy does not cover the surgery, it isn’t the insurance company that is the problem, but the employer that did not negotiate the surgery into their program because rates would be higher. “We’ve had patients band together and change corporate policy,” he says.
So, why hadn’t my friend heard about the surgery before?
“In the 60s, 70s and even 80s before minimally invasive surgery was common there were stories of patients who had bariatric surgery and required weeks in the hospital, had postsurgical problems, did not reach desired outcomes, or developed nutritional deficiencies. This caused most of the stigma and bias that we still see today,” said Dr. Aragon. “Now, with laparoscopic, the surgery takes less than two hours (KC Bariatric does most in less than 45 minutes), there’s minimal downtime, patients lose weight, get off medications, off insulin, become more mobile, and complications are rare.
“In 2005 there were around 140,000 bariatric surgeries in the US. That [number] has grown but at a marginal rate. An impressive or actually unimpressive statistic from the American Society for Bariatric Surgery who sets the standard is that of the patients that would qualify for the surgery based on weight and medical problems, only 2%-3% actually have the surgery. There’s a huge discrepancy between those who need it and those who get it. Even with that today I would say there are over 200,000 surgeries every year in the US. Here at The Bariatric Center of Kansas City, we’ve done about 8000 since we opened in 2002, and around 1600 in 2016 alone.”
Why do I care?
Twenty-one years ago my husband was diagnosed with a rare form of leukemia. A seemingly perfectly healthy man was given three months to live if he did not undergo chemotherapy; with the chemo, he was told he should go into remission and live at least another four or five years. Doctors wouldn’t predict after that. Like my friend with T2D, he was a model patient and followed their the protocol, but somehow was overdosed on the chemo and lived three months eight days. It wasn’t until his death that I researched alternatives to his treatment. I believe that one of those alternatives would have given us a totally different outcome.
If you have a medical condition and aren’t completely satisfied with the treatment suggested, or the treatment you are undergoing isn’t working, do your research. We are led to believe that we have the finest health care in the world, but numerous countries treat medical conditions successfully in different ways than what is common here in the US. Take charge of your health. My friend is determined to have the metabolic surgery and is working to convince her physician and insurance company that in her case, it is the best solution.
Diabetes Care Volume 39, June 2016 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.
The Bariatric Center of Kansas City (http://kcbariatric.com).
Surgical Procedures – Wikipedia – The two most common procedures today are the gastric sleeve, in which the stomach is reduced to about 15% of its original size by surgically removing a large portion and leaving a tube, sleeve, or banana shape. Gastric bypass surgery is where the stomach is divided into a small upper pouch and a much larger lower “remnant” pouch, and then the small intestine is rearranged to connect to both.
May 2, 2017 – Clinical Pearls to Prevent Weight Regain
Facilitator: Chris Bovos, RN, CBN
Taken from The Bariatric Times, November 2016
There is a lifelong threat of weight regain after surgery. A small amount of weight regain (3 – 5%) is expected after a patient reaches their lowest weight; but maintaining that weight loss is a challenge for most patients.
Some of the areas we looked at include:
Risk factors for weight regain include:
Preoperative binge eating, which can become loss of control eating after surgery;
Depression – many of the drugs used can increase weight Need to get depression under control prior to surgery and monitor after surgery;
Night eating or grazing – early, brief intervention can improve this.
People frequently have trigger foods that trigger the dopamine or reward response.
Need to identify what your triggers are and avoid them;
Keep a food journal. Most people begin to have more liberal meals once they have lost their weight, and need to become aware when they are eating high glycemic, high-fat and carbohydrate-rich foods by journaling every day;
To “reset” things, cut to 1000 – 1200 calories a day for women; 1200 – 1600 for men;
Follow the physician orders and nutritional guidelines:
Meet daily fluid goals of 64 ounces a day at least;
Wear CPAP – poor sleep can increase cortisol and slow your weight loss;
Eat 3 meals a day – skipping meals slows your metabolism.
Get at least 1200 mg Calcium with Vitamin D each day to improve body’s ability to burn fat;
May need to take a metabolic boosting medication.
Meal composition and portion control are critical:
50% of your plate should be lean protein;
30% of your plate should be vegetables (non-starchy);
20% or less should be complex carbohydrates – not processed foods;
Eat slowly and take 2 bites of protein to 1 bite of something else – helps keep protein a priority, and wait 5 seconds between bites.
Focus on making your muscles healthy in addition to losing weight
Muscle has a higher metabolism and increasing lean body mass increases metabolism;
Begin with 150 minutes/week and work up to 200 – 300 minutes a week;
Once you lose weight, your body is so much more efficient at using energy that you have to work harder than you did in the beginning;
Any kind of activity can be modified – don’t say “I can’t”.
The most vulnerable time for people to start regaining is at 2 years’ post op. Usually will see one of the following start:
Going from 3 meals a day to grazing;
Intake has switched from protein, fruits and vegetables to carbohydrates, sugars and fats;
Decreased physical activity;
Loss of Control eating.
Eat real foods, not packaged foods (eat food that will rot over time);
Make protein a priority and omit all processed food, sugar and simple carbs;
No snacking or grazing. Be aware of mindless eating (eating from boredom);
8 glasses of water daily, and don’t drink with meals or 30 minutes after meals;
Walk as alternative to driving. Take the stairs;
Follow up with physician and support groups;
You can regain control!
April 20, 2017 – Meal Planning
Facilitator: Stephanie Wagner, MS, RDN
Stephanie Wagner is a dietitian who has spent the last 8 years working with bariatric surgery patients, and has developed a support website and recipe book specific for patients who have had weight loss surgery.
Steph began by discussing how we frequently manage many areas of our lives well, but don’t do a good job managing our “food life” well. She gave us some tips on grocery shopping, such as Wednesdays being the best shopping day. There are more deals, double coupons, and stores will be out of less food, since grocery stores do their restocking on Tuesday nights. She told us that she does her shopping for large bulk items once a month at Sam’s or Costco. Then once a week, she uses Walmart’s Pick up Service, where she can order the week’s food online and pick it up Wednesday morning. As a busy mom, this saves her time trying to shop with children. It doesn’t make any difference what your system for shopping is – she just recommends you find one that works for you and stick to it.
She spoke about making small portions for after surgery and cooking for one.
She uses a silicone muffin pan to make individual mini meatloaves, egg & ham breakfast muffins. Even chili is something she puts into the muffin pan and freezes them. Once they are frozen, she can easily remove them and put them in a gallon freezer bag and they are good for 6 months.
She uses a cookie scoop to make small meatballs
She uses kitchen shears to cut up meat into bit size pieces – it cooks faster and is ready for small portions
She uses ¾ cup size food storage containers made by Elacra to prepare food for the day,
And she uses a covered baker to make crock pot meals only much more quickly in the microwave.
She uses rotisserie chicken to make a lot of meals using chicken
Some suggestions for converting old family recipes into healthier versions:
Use fat free Parmesan cheese in place of breadcrumbs when making meatloaf or meatballs – 1 cup of grated cheese equals 1 cup of breadcrumbs
Use fat free yogurt in place of sour cream
There are many ways to convert recipes you love without tasting the difference
Stephanie also has written a cookbook that is available on her website or on Amazon called “Best Fork Forward.”
Her website, which includes a blog, recipes, meal planning and coaching is www.foodcoach.me. You can try the website free for 2 weeks, or join for $10 a month. With the membership, there is a series of educational courses, including a Back on Track course with videos to assist you getting back on track if you are struggling with any weight regain. Some of the other courses available are:
Reading nutritional labels
Gastric Sleeve 101
Gastric Bypass 101
Lap Band 101
Pantry clean out challenge
Top 10 reasons for weight regain
The Dos and Don’ts of Protein
6 ways to overcome feeling hungry
Stephanie will be coming back for our August 1 meeting at 5:30 pm, so if you missed her this time around, mark it on your calendar and don’t miss this one!
Enough is Enough: Mastering Your Body Signals
It is well known that hunger is a common complaint after weight loss surgery. Bariatric surgery induces changes in various metabolic hormones such as Gherlin, Leptin, Gastrin, and Insulin. These hormonal changes have a long-term effect on energy expenditure and the sense of hunger and satiety. Still, as human beings, life and survival depend on the ability to find food for immediate metabolic needs and to store excess energy in the form of fat to meet metabolic demands during fasting. Hunger and satiety continues to be a fundamental body mechanism after surgery and is critically guided by the brain reward system.
Yes! There is still a gut-brain interplay controlling your eating behavior. Stomach hunger, or physical hunger, involves a complex interaction between the digestive system, endocrine system and the brain. The brain detects alterations in energy stores and triggers metabolic and behavioral responses designed to maintain energy balance.
After bariatric surgery, is important to understand your body, the foods you like, the ones that you have control over, and your triggers. It is also important to understand your physical feelings of hunger and satiety. Listen to your body and respond to it. Remember that the pleasure and rewarding feelings from eating affect the ultimate deciding factor of what kind of foods and how frequently you eat.
The stomach starts to ache and rumble in early signs of hunger. You start feeling tired and weak, while finding it harder to concentrate and work. When you begin eating in response, you really enjoy the food and start feeling better, because a bodily need is being met.
If you don’t feed your body when it needs food, the physical symptoms intensify. The stomach starts to really hurt. You find it more difficult to concentrate and may experience lightheadedness. You may also get irritable and short-tempered. In addition, some people get shaky and nervous, while others get a headache. Because you are so ravenous at this point, once you do start to eat, you’re very vulnerable to uncontrolled eating.
While eating, learn to stop when the stomach feels comfortable, and satisfied–not stuffed. You soon begin to feel calmer, more alert and energized. It takes approximately 20 minutes for fullness signals to transmit from the stomach back to the brain. You may experience a runny nose, watery eyes, hick-ups, sneeze, or a deep sigh.
If overeating occurs, you are mechanically taking bites and swallowing, but you aren’t really enjoying the food anymore. You are feeling pressure and discomfort in your stomach. If filled further, it starts to hurt. You may even feel queasy and after a while you start to feel sluggish. You may also experience heartburn, nausea, or vomiting. Avoid overeating.
Food tastes different
Taste adjusts while you eat just like hunger and thirst. It takes only a few bites for your taste buds to adapt. If you take two, three, or four bites of food and pay attention, you’ll notice that it rapidly gets less tasty, less satisfying, and less crave-worthy. Your taste buds are usually the first part of your body to start sending the “had enough” signal.
Pay attention on how your stomach feels
The stomach isn’t by your belly button. It’s higher behind your ribcage. For most people, the feeling of fullness is more like a pressure or tight feeling and happens just behind the bottom of the sternum, behind the little indentation between your belly and your chest. In the first few weeks after surgery, you may feel the pressure up in your chest area.
Do Not Skip Meals
Eat 3 times/day within your waking hours. Long periods of fasting when skipping a meal can trigger hunger.
Follow Your Eating and Drinking Routine
Remember to stop drinking 30 minutes before your meal, do not drink while eating, and wait 30 minutes after you are done eating to drink fluids again.
Drinking fluids while eating or right after your meal will empty your stomach quickly. This means you will feel hungry sooner. This in turn will lead to snacking/grazing affecting your weight loss success.
Helpful Tool: Download the Baritastic App. It has reminders, a 30 min timer, and many other tools to help you succeed. The Bariatric Center of Kansas City has downloaded additional resources and helpful links on the app as well. Add code: 76319. Yes, it is free!
Focus on Eating Solid Foods
Solid foods will remain in your stomach longer. This will make you feel full and satisfied for a longer period of time. Avoid drinking your calories.
Other Body Signs Unrelated to Physical Hunger
Sometimes, especially if we’re feeling irritated or stressed, you want to chew frustrations away. Your body is not calling for food, but you eat in an attempt to relieve anxiety.
You see or smell something that looks so delicious that your mouth starts to water. Sometimes just thinking about a food brings on a craving for it. You desire to taste the food, but really aren’t physically hungry.
You look at the clock and think you have to eat a certain amount of food because “it’s time”, even if you don’t feel like eating.
Sometimes the sluggishness of dehydration can be confused with actual hunger. The body is calling for fluids, not food.
When you sense low energy levels you automatically think that if you eat something you will feel better. However, if you’ve been working extra hard and/or haven’t been getting enough sleep, your body is calling for rest, not food.
Heart Hunger/Emotional Hunger
You feel an ache and emptiness in your hearts due to unmet emotional and/or spiritual needs. Rather than acknowledge your feelings and work through your issues, you try to fill the void with food. You may try to use food to “stuff” your feelings down. Although there can be physical discomfort in the gut when you’re upset, it is a distinctly different sensation from stomach hunger.
When you learn to be in synchrony with your body, understand your strengths and weaknesses, and make the most of them, you just might recognize that what you have eaten is simply enough.
Experience Life, April 2017. The Art of Enough by Elizabeth Millard.
April 4, 2017 – Optimizing Weight Loss
Facilitator: Dr. Saradih
Dr. Saradih shared a fishbone diagram (see below) that shows different things that affect our weight after surgery, and addressed what we need to do with each area in order to maximize weight loss in the first 6 – 9 months following surgery.
Dr. Saradih also pointed out that the first 3 things he addresses when someone stops losing weight is:
Stop protein shakes – need to be eating protein using whole foods
Make sure you are getting enough Calcium Citrate – it is essential for losing weight
Make sure you are eating at least 800 calories a day, because your metabolism will slow if you eat less than that each day.
The other areas he discussed were:
Barriers to weight loss – these need to be removed. 10% of excess weight can be attributed to medications that cause us to gain weight or prevent weight loss. These include:
Insulin and sulfonylureas for type 2 diabetes
We need to treat disease states that contribute to weight gain, such as:
Hypothyroidism – and we need to recheck the thyroid after every 30 – 40 lb weight loss after surgery and readjust thyroid medication
Testosterone deficiency in men
Vitamin D3 and Calcium levels need to be optimized; a deficiency in calcium can negatively impact weight loss
We need to address depression
Bariatric surgery is the best option for resolving type 2 diabetes, obstructive sleep apnea, hypertension, and high cholesterol
Dietary concerns include:
Eating 800 calories a day
Getting 60 – 80 grams of protein a day
Getting around 50 gm of carbohydrates a day
Eating 3 meals a day – don’t wait until you get hungry!
Use protein shakes only for the short term. Try to be off protein shakes within a couple of months, and then just use them occasionally! The number one reason people stop losing weight and plateau once they are more than 2 – 3 months out is they continue to have a daily protein shake, when they need to be eating their protein instead.
Eat real food – not processed food
Sleep is very important:
We need 6 – 8 hours of good quality sleep
We all have a certain circadian rhythm when hormones have peaks and valleys, and these can affect how our body rests, our metabolism, and how we deal with stress. If you don’t get enough good quality sleep, it causes your stress hormones to rise and increase weight.
Sleep apnea can significantly affect the quality of sleep – wearing your CPAP can improve weight loss
Certain sleep aid medications can cause you to gain weight, such as Benadryl
Activity should be used to keep muscles healthy. The healthier your muscles, the faster your metabolism, so think of activity as keeping your muscles healthy instead of exercising to lose weight. 150 minutes of activity a week will help maintain weight loss, but to optimize weight loss you need to increase to 300 minutes a week or increase the intensity of your activity, such as resistance or weight training.
Hunger is something most patients don’t deal with after surgery. However, 30 – 40 % of patients have Binge Eating Disorder, and after surgery can show up as Loss of Control Eating.
Do not fast – when you fast, your metabolism slows down in order to conserve energy, and your body is very efficient at storing energy.
Grazing and night time eating out of boredom can prevent weight loss – you need to find another activity to satisfy you at those times
Frequently hunger is really dehydration – try drinking when you feel hunger, especially in the early months.
There is no way you can be physically hungry after surgery, but you may feel mental hunger. That needs to be addressed
It takes an entire team to provide resources to assist patients for weight loss success. In addition to the surgeons our team includes:
Internal Medicine/Obesity Medicine Physician
Follow up after surgery is critical, as the earlier we are able to intervene when someone isn’t losing weight as expecting, the sooner we can help them get back on track to reach their goal. We need to see patients at 1 week post op, 2 months, 6 months and then annually. Our goal is that our patients reach their maximum weight loss within 18 months, regardless of which procedure they have done.
Relationships After Weight Loss Surgery: For Better or Worse
What To Do When Those Closest To You Are More Comfortable With “Worse”
We all know that change doesn’t happen in a vacuum; it’s dynamic. As you change, your relationships with those closest to you change too. Yet, most of us are caught by surprise when our dynamics with those closest to us begin to change in the aftermath of our weight loss surgery (WLS). Understanding why these changes occur, and how to address them, can make the difference between deepening the intimacy and connection we feel with those that matter most to us, or losing that intimate connection.
Prior to having WLS, most of us had at least one person in our lives (a partner, parent, child, friend, etc.) that expressed concern about our health and longevity and supported our decision to have the WLS. That person had a stake in wanting us alive, well, and in their life for the long haul. So, we are understandably hurt and confused if the same person that initially supported and encouraged us begins to change their tune as we become healthier, thinner, more mobile, and more social.
Obesity is often a family disease. The family is the core unit of all social relationships across cultures. Even if we are not connected to our original families anymore, we tend to recreate the family systems we grew up in with those closest to us. When one person in the family goes through major changes (like WLS), the rest of the system experiences “aftershocks,” like in an earthquake. In the Earth’s case, the “aftershock” is a natural way to release the remaining tension and pressure so equilibrium can be reestablished. In our loved ones’ case, I would argue that the same holds true.
When we lose weight and become more available to work, run errands, and socialize with others, those closest to us may feel threatened and may (unconsciously) do or say things in an attempt to reestablish old roles, routines, and responses. They don’t do any of these things to consciously hurt us or make life harder for us. They are just trying to get back into equilibrium.
They just want life to feel “safe” again, on solid ground, like they did when we were overweight and our roles were clearly defined, predictable, and exclusive. It’s important to remember that our loved ones may be used to having us virtually all to themselves, so suddenly sharing us with a broader social network may be challenging and difficult for them to adjust to.
One of the biggest oversights in the WLS preparation process is the lack of education and communication about how our WLS will impact those around us. The focus of the preparation is generally on how the surgery will impact us, not on how our weight loss may affect those closest to us. This common (and often painful) oversight usually results in no one being adequately prepared to deal with the complicated range of feelings that arise (all around us) as a result of our WLS.
The bottom line is we all want to feel safe, loved, and know that we belong. Wanting safety, predictability, and reassurance during any transition is a normal, natural response. We aren’t the only ones that need support during our WLS transition. Those closest to us are going through their own tough transitions; it’s just not as obvious because there are no pounds and inches melting away before our very eyes.
So, if you’ve noticed that your loved ones are doing or saying things that feel like they are trying to sabotage your weight-loss progress, or blame you for not being as available, you are not alone. But, it may be helpful to understand that jealousy and sabotage (whether it’s self-sabotage or actions taken by another) can always be traced back to that deep desire to “protect” and preserve the equilibrium or status quo – even when that status quo made everyone miserable! Because, like it or not, even misery (that we are used to) is predictable, and change (even if it’s positive) is not.
It’s critical to understand that your family, close friends, and loved ones need their own source of support to adjust to “the new you” in order for the transition to work for everyone. If your partner or family members are willing to acknowledge that your WLS transition is difficult for them too, that’s half the battle. The other half is getting everyone the support they need to make the transition as productive, healthy, and sustainable as possible.
Talking to our loved ones about getting the support they need is key, so we don’t resort back to old behaviors (like overeating) in an effort to make them (and us) more comfortable in the moment. So, the next time you find yourself getting confused, angry, or reaching for food you didn’t intend to eat after a loved one says or does something that triggers or hurts you, ask yourself if they may be feeling scared or threatened and just looking for any way possible to get back to “normal” again.
If the people that matter most to you are willing to work together to explore, understand, and consider one another’s experiences and needs with respect and compassion, then you have a chance to make your relationships more meaningful and intimate than ever. With this sort of foundation, you can work through your collective transitions with a new appreciation and understanding of all that is possible for each of you now. To do that, I recommend that you and your partner (or family) either participate in:
1. Structured coaching, designed to help each person identify and implement practical strategies to move through his/her individual transition with more ease, understanding and, support; or,
2. Couples or family counseling (with a professional in your area) to help you work through more complicated, longer-term relationship issues.
Whatever you choose, understand that your WLS can be framed either as an opportunity to increase the satisfaction and depth you experience in your closest relationships or as something that shines a light on the growing divide between you and those closest to you. How you frame it and the actions you take based on that belief is up to you.
Jill Temkin, founder, Living Thin Within
Written for ObesityHelp
March 23, 2017 – Post Op Exercise Options
POST-OPERATION BEGINNER EXERCISE OPTIONS AND MODIFICATIONS
Katherine Caddell (Element Fitness) – March 2017
Getting started exercising is the hardest part, but once you begin, your body will love you for it!
Resistance Bands – Color matters (Check package to make sure they comply)
Yellow 4-6 lbs Green 8-10 lbs Red 12-14 lbs Blue 16-18 lbs
Ankle weights -Allows you to change the weight from 1-5 lbs based on ability level
Dumbbells -Light works well to begin with, and as strength builds, you can increase
*10 and 3 are beginners’ magic numbers – 10 repetitions of each exercise with 3 sets.
Exercises with chair – Sit on the edge of your seat with great posture to engage your core