Lap-band weight loss surgery newsletter - September 2007

Accountability is the KEY to losing weight with Lap-band Surgery

The first key to weight loss is accountability.  Knowing that your calories come from you eating, not from a lack of exercise, not from a metabolic slow down, but from food.

Snacking -  why people don't lose weight with weight loss surgery

Every now and then we get a patient who we can observe in their native environment.  We have had a few patients who we have been able to watch and they were not losing the weight they thought they should be losing. Why? Because they were always snacking. Always had something in their mouth, at their desks, and nibbling in front of the computer, the television, or their work stations.  One of these nice folks tried to convince me that it was a lack of exercise, one tried to convince me they needed a band, one tried to tell me it was because of a slow metabolism.

Chocolate, chips, cookies, and nuts are not items that people serious about weight loss eat.

Exercise is good...but the food you eat determines weight loss

Often when going into a patient room and they have not lost the weight they desire tell me it is a lack of exercise. "I didn't have a chance to exercise this month."

For each one of these I relate a simple story.  In the 1960's when McDonald's first opened in Oregon the hamburger they sold was 230 calories less than the burger you get today. For me to exercise enough to make up for those calories I would have to be in the gym for 2 hours and 30 minutes doing serious weights for that entire time. That is just for ONE burger.  Don't know too many who do that. It is easier to eat less than to exercise for that amount of time.

Don't get me wrong-- we believe exercise is great. It is, however, a LONG TERM investment in yourself. It is something that will allow you to get the body you want. Exercise is NOT instant gratification.  You cannot exercise enough to make up for the sins of chips.

Those patients who do well have one simple attitude in common -- they know that they ate their calories. They know that the body is a perfect, and I mean perfect, calorie counter.

Accountability to your body - the perfect calorie counter

So, if you want to be serious about weight loss -- first be accountable to yourself. Your weight is from what you eat. Whether someone sees you (like your friendly surgeon) or you sneak to the break room for a quick junk food fix.

Here are a few simple things to help you:

IF you snack -- plan it. Plan it for a certain time of the day, when you get hungry. Plan what it will be, do not leave it to the random chance that when you look for a snack something healthy will appear and you will be instantly inspired to eat the fruit over the cookie.

DO NOT EAT in front of television. That is mindless eating. When you eat, sit down properly at a table and use real utensils.

We have one fellow who has done very well, and here is what he did -- when he came to us every day he would eat out at a Chinese restaurant for lunch. He would snack, he ordered dinner at fast food places, and snacks were the order of the day as he ran from one jobsite to another.  After surgery he changed where he ate, when he ate, and now is well on his way to his goal.  Most of my office staff have a crush on him at the moment.

Weight loss surgery is not brain surgery. Weight loss surgery is a tool. Like most tools you have to use it to your advantage. Start by being accountable. And remember, your body will reveal what you have done.

Do not be afraid to come into the surgeon's office. We are not there to offer repentence, but absolution. We will remind you that your weight loss is your journey, and our job is to help you with the journey.

Taking Vitamins with Lap-band surgery...Vitamin B and fat metabolism

Vitamins are more than a nasty tasting pill that you need to take, they are essential to fat metabolism. Many of our patients are deficient in these vitamins, and for this, and many reasons, we encourage our patients to take a good multiple vitamin daily.  There are a lot of different types, and many people selling them.  So they are available, abundant, and inexpensive.

Vitamin B1, Thiamin, allows proper use of carbohydrates.  Without it you end up storing carbohydrates. We store them as fat. So, while you may be eating less, if you are lacking in this vitamin you may notice some peripheral nerve problems as well as not metabolizing your energy sources.

Vitamin B2, Riboflavin, is also critical in fat metabolism. If you are a bit low with energy, this might be missing. Many patients after weight loss surgery are unable to take dairy products, and dairy is one of the better sources of B2. It is also available in some greens -- .

Vitamin B3, Niacin, can also help lower cholesterol, and many who have mildly elevated cholesterol are placed on Niacin as a simple way to reduce some cholesterol.

Vitamin B12 is especially important for those who have had duodenal switch or RNY gastric bypass. It can be readily measured, and many RNY patients need to take this forever. Deficiency of this can cause anemia.

So, if you want to lose weight, and join those who are getting to goal -- then take your vitamins. There are a lot of great formulations, and even companies who will monthly send you your vitamins by mail, or UPS, or FedEx -- so you have no reason to say you didn't get them.

One common feature of patients who get to goal and stay there is they learn nutrition.  While it is better to eat more vegetables, for safety we recommend all weight loss surgery patients take a daily vitamin, and if you are wondering if you are low-- your primary care doctor can always order a vitamin level.  Those are expensive tests, however, and can be avoided by simply taking the vitamins recommended.

Weight loss surgery...water and other fluids

How many times do patients come to us after surgery and think they need to be tested for potassium and calcium deficiency because of muscle aches after mild exercise.  It isn't the electrolytes, it is the water that is missing.

Or, patients come with issues of constipation -- or the eventual hemorrhoids that result from it.  Often the ingredient missing is water.

Many then tell me, "But I drink a lot of water, it couldn't be that."

It could be, and it is.

Most of the time when you are outdoors, you need to drink about 8 ounces every 12 minutes just to keep ahead.  Remember, your body processes water quickly.  If you have great kidneys it will get rid of it that way -- if you don't have great kidneys please talk to your renal doctor.  If we give you intravenous fluids, often they will be in the blood stream for about 28 minutes, then they will distribute elsewhere.  We call this third spacing after surgery, much like a bruise, that fluid goes to all sorts of spaces. So you can get a lot of water and still be dehydrated.

The message is simple: drink water throughout the day.

If you don't drink enough water here is what you will feel -- fatigue, constipation, fuzzy thinking, and muscle cramps.

Here is how most folks drink -- when they eat. Not a good idea for weight loss patients.  Instead, drink before you eat -- eat your food slowly, then two hours later begin drinking again. 

The average person uses 2 liters of water a day -- that is if they are in bed and not doing anything. If you are in the sun, working, or doing other things it will take even more.

This became very clear to me last year when my parents came to visit me.  My father, 82 years old at the time, went with us on a day trip to Sedona.  He had not had enough fluids while in the low humid desert -- and collapsed. He was taken by helicopter to a local hospital and rehydrated. Dad, by the way, will be 83 on the 6th, and my parents will celebrate their 59th wedding anniversary on the 5th.

Drink slowly and evenly throughout the day.

All fluids count.  The only fluid that takes more water from your body than you drink is alcohol. Another story -- whenever I play golf with someone who is drinking beer, I always wait to bet them until we get to the last few holes. Many of these folks are better golfers than I am, but when they tire and are dehydrated it is easy for them to make mistakes, and while I have been drinking water every hole, they are drinking beer.  I have never lost money doing that.

Second Edition of our weight loss diet book coming

Our second edition of "The Road-kill Diet" is coming out.  We are doing a major re-write to the book, so it should be fun.  Who contributed to this -- YOU DID.

So many of you have given of your recipes and we appreciate that.  Thank you.  We will keep you informed as soon as this edition is out.

Some of you received our first edition, which is long out of print (and only given to a few of our patients -- and of course mom, dad, cousins, uncles, and anyone else who would tell us what great writers we are). We didn't publish it widely as someone didn't like the name.

Well, a new day -- a new book.  Should be fun.  When it is ready to pre order we will let you know.

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