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Hello maintenance or the no-stress apathetic no-diet plan for long term WLS patients.

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I suppose this is maintenance.
I’ll take it.  I apparently maintain at this caloric intake at this activity level.
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It’s magic. 


I have also been extraordinarily “lazy”  (in Beth terms) in the last 30 days — with very little gym time. Calorie Control.org doesn’t have a setting for extraordinarily lazy – but if they did – or a setting for extraordinarily lazy post bariatric patient who eats 1200-1400 calories per day, that would be me.
PS.  I’m not really that lazy, but, I am not about to own running half-marathons up in this bitch, because, no.
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I suspect that as soon as I get back into a routine at the gym (… school is out and it’s hot and we are whiny)  that one or two things will happen:
I will see a bounce up because “YAY! MUSCLE!”  Or my trend down will start again – although as it has been – very slowly.  I still have body-fat to lose while I grow/gain muscle which I desperately need.   Either option is fine with me.  I have no goal, other than health with no stress in doing so.
Welcome to the apathetic non-diet plan for WLS’ers.  
It works.  
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Regain After Weight Loss Surgery.

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Left –  Fitbloggin' 2012  Right – This Week – Lost the regain  - Also, 3 pounds to my lowest weight.

Several years ago, a woman messaged on a weight loss surgery forum and told me that my weight chart resembled a roller-coaster and that she wanted to "help me get control."  After a quick Google search — I noted she was seeking a new client for her weight loss surgery coaching business and dumped her "friendship."

Thumbs_Up!

Friends do not pay friends to help them lose weight, maintain weight loss or to help them lose regained weight after weight loss surgery.  If you are paying someone for your friendship, it might be time to redefine that friendship — just saying.  I suppose this changes if your friend happens to be a weight loss professional?  But how often does that happen — and how many weight loss professionals would potentially destroy a friendship with aligning with your weight loss journey?
Um.  No.  A professional would NOT.
  • Weight loss is personal.
  • It is something you choose for yourself when you are ready.
  • Weight loss is not something you can be talked into – nor shamed into.  

Regain after weight loss surgery is also a very touchy subject.  Countless bariatric patients go through it — and less want to talk about it.  But it seems like everyone wants to sell "us" something to fix it.  

Let me repeat –

  • Weight loss is personal.
  • It is something you choose for yourself when you are ready.
  • Weight loss is not something you can be talked into – nor shamed into.  

Yet it seems like the larger community wants "us"  (the regainers) to feel shamed for regaining and wants to sell us another quick-fix.

Let us discuss:  Regain is common.  How much?  Some is very typical.  Sometimes even a lot of regain is normal.  You do not have to be sold into another diet, quick-fix, or scam.  You need to remind yourself why you had weight loss surgery to begin with —

…for your HEALTH.  

Some good links on regain –

 

 

 

 


What does 2000 calories look like!?

I might be slightly disturbed by this, and it is blatantly obvious why I was 320 lbs, and even more clear How Easy It Is To Regain Weight After Bariatric Surgery.

Just a few calories a day – it adds up so damned fast.

My before-WLS diet would easily dwarf this 2000-calorie business.  

Related articles

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Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update

The Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient has been updated for the first time since 2008.   There are changes and updates and suggestions for your clinicians – the entire text is available online below –

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Download here –

Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient – 2013 Update


Abstract: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of

clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the
evidence and subjective factors per protocol.

Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery forpatients with mild obesity, copper deficiency, informed consent, and behavioral issues.


A lifetime history of substance abuse disorder is more likely in bariatric surgery candidates compared with the general population (211 [EL 3, SS]). In contrast, current alcohol and substance abuse in bariatric surgery candidates is low compared with the general population (211 [EL 3, SS]). The LABS study demonstrated that certain groups including those with regular preoperative alcohol consumption, alcohol use disorder, recreational drug use, smokers, and those undergoing RYGB had a higher risk of postoperative alcohol use disorder (212 [EL 2, PCS]). A web-based questionnaire study indicated that 83% of respondents continued to consume alcohol after RYGB, with 28.4% indicating a problem controlling alcohol (213 [EL 3, SS]). In a prospective study with 13- to 15-year follow-up after RYGB, there was an increase in alcohol abuse (2.6% presurgery to 5.1% postsurgery) but a decrease in alcohol dependence (10.3% presurgery versus 2.6% postsurgery) (214 [EL 2, PCS]).  In a survey 6-10 years after RYGB, 7.1% of patients had alcohol abuse or dependence before surgery, which was unchanged postoperatively, whereas 2.9% admitted to alcohol dependence after surgery but not before surgery (215 [EL 3, SS]). Finally, in a retrospective review of a large electronic database, 2%-6% of bariatric surgery admissions were positive for a substance abuse history (216 [EL 3, SS]). Interestingly, 2 studies have demonstrated better weight loss outcomes among patients with a past substance abuse history compared with those without past alcohol abuse.

Bariatric surgery remains a safe and
effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.


Obesity continues to be a major public health problem in the United States, with more than one third of adults considered obese in 2009- 2010, as defined by a body mass index (BMI) 30 kg/m2 (1 [EL 3,

SS]). Obesity has been associated with an increased hazard ratio for all-cause mortality (2 [EL 3, SS]), as well as significant medical and psychological co-morbidity. Indeed, obesity is not only a chronic
medical condition but should be regarded as a bona fide disease state (3 [EL 4, NE]). Nonsurgical management can effectively induce 5%-10% weight loss and improve health in severely obese
individuals (4 [EL 1, RCT]) resulting in cardiometabolic benefit. Bariatric surgery procedures are indicated for patients with clinically severe obesity. Currently, these procedures are the most successful and durable treatment for obesity. Furthermore, although overall obesity rates and bariatric surgery procedures have plateaued in the United States, rates of severe obesity are still increasing and now
there are approximately 15 million people in the United States with a BMI 40 kg/m2 (1 [EL 3, SS]; 5 [EL 3, SS]). Only 1% of the clinically eligible population receives surgical treatment for obesity
(6 [EL 3, SS]). Given the potentially increased need for bariatric surgery as a treatment for obesity, it is apparent that clinical practice guidelines (CPG) on the subject keep pace and are kept current.

Since the 2008 TOS/ASMBS/AACE CPG for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient (7 [EL 4; CPG]), significant data have emerged regarding a broader range of available surgeries for the treatment of obesity. A PubMed computerized literature search (performed on December 15, 2012) using the search term ‘‘bariatric surgery’’ reveals a total of 14,287 publications with approximately 6800 citations from 2008 to 2012. Updated CPG are therefore needed to guide clinicians in the care of the bariatric surgery patient.

What are the salient advances in bariatric surgery since 2008?

  • The sleeve gastrectomy (SG; laparoscopic SG [LSG]) has demonstrated benefits comparable to other bariatric procedures and is no longer considered investigational (8 [EL 4, NE]).  
  • A national risk-adjusted database positions SG between the laparoscopic adjustable gastric band (LAGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) in terms of weight loss, co-morbidity resolution, and complications (9 [EL 2, PCS]). 
  • The number of SG procedures has increased with greater third-party pay or coverage (9 [EL 2, PCS]). 
  • Other unique procedures are gaining attention, such as gastric plication, electrical neuromodulation, and endoscopic sleeves, but these procedures lack sufficient outcome evidence and therefore remain investigational and outside the scope of this CPG update.
  • There is also emerging data on bariatric surgery in specific patient populations, including those with mild to moderate obesity, type 2 diabetes (T2D) with class I obesity (BMI 30-34.9 kg/m2), and patients at the extremes of age. Clinical studies have demonstrated short-term efficacy of LAGB in mild to moderate obesity (10 [EL 1, RCT]; 11 [EL 2, PCS]; 12 [EL 2, PCSA]; 13 [EL 3, SS]), leading the Food and Drug Administration (FDA) to approve the use of LAGB for patients with a BMI of 30 to 35 kg/m2 with T2D or other obesity-related co-morbidities (14 [EL 4, NE]). Although controversial, this position was incorporated by the International Diabetes Federation, which proposed eligibility for bariatric procedures in a subset of patients with T2D and a BMI of 30 kg/m2 with suboptimal glycemic control despite optimal medical management (15 [EL 4, NE]). Thus, the term metabolic surgery has emerged to describe procedures intended to treat T2D as well as reduce cardiometabolic risk factors. In 1 study, metabolic surgery was shown to induce T2D remission in up to 72% of subjects at 2 years; however, this number was reduced to 36% at 10 years (16 [EL 2, PCS]). In a more recent study, patients who underwent RYGB sustained diabetes remission rates of 62% at 6 years (17 [EL 2, PCS]). The overall long-term effect of bariatric surgery on T2D remission rates is currently not well studied. Additionally, for patients who have T2D recurrence several years after surgery, the legacy effects of a remission period on their long-term cardiovascular risk is not known. The mechanism of T2D remission has not been completely elucidated but appears to include an incretin effect (SG and RYGB procedures) in addition to caloric restriction and weight loss. These findings potentially expand the eligible population for bariatric and metabolic surgery.

Download here – via –

Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery* (pages S1–S27)

Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon and Stacy Brethauer

Article first published online: 26 MAR 2013 | DOI: 10.1002/oby.20461



 

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Cleveland Clinic study shows RNY bariatric surgery restores pancreatic function by targeting belly fat

Just to keep you on your toes, a couple days ago I shared the study that stated that WLS doesn't save you money in the long run.

Now, we hear once AGAIN that roux en y gastric bypass bariatric surgery fixes diabetes damn near immediately. This is just another study on THAT topic.

We already knew this.

Thanks, pancreas!  *thumbs up for working so well!*

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*Waves to all the post bariatric reactive non-diabetic hypoglycemics*

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Cleveland Clinic study shows bariatric surgery restores pancreatic function by targeting belly fat

2-year study indicates how gastric bypass reverses diabetes. In a substudy of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), Cleveland Clinic researchers have found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.

Fat mouse

Dieting can lead to food withdrawal and depression

I hate it when people abuse poor, poor mice.

Fat mouse
Dieting can lead to food withdrawal and depression

Over a six-week period, the team of experts fed one group of mice a low-fat diet, while feeding a second group of mice a high-fat diet, so that they could analyze how the different foods impacted the behavior of the animals.

Eleven percent of the calories in the low-fat diet consisted of fat, and 58% in the high-fat diet. This caused the high-fat group an 11% increase in their waist size, but they were not yet considered obese.

Fulton and her team then examined the association between rewarding mice with food and their behavioral and emotional outcomes by using a variety of methods that have been scientifically proven. The brains of the animals were also analyzed so that the experts could observe any changes that had occurred.

The researchers found that the high-fat group showed signs of anxiety, for example, they tried to avoid areas that were open. According to the authors, the animals' experiences physically changed their brains

Dopamine was one of the molecules in the brain that was observed. It allows the brain to reward people with good feelings, which in turn, motivates individuals to acquire particular behaviors.

Dopamine is a chemical which works the same in humans as it does in mice and other animals. CREB is a molecule which regulates the activation of genes that play a part in the functioning of human brains, including the ones that cause dopamine to be produced. It also contributes to the forming of memories.

Study –  Adaptations in brain reward circuitry underlie palatable food cravings and anxiety induced by high-fat diet withdrawal

Shocked Comic Face

Stress triggers eating problems – WHATSTRESS?!?!??!?!?!?


Shocked Comic Face
Huffington Post - 

While the holidays typically come with a great deal of celebration and joy, they can also bring up feelings of loss, regret or depression. And that's the problem: no matter the emotional response, an emotional eater will often turn back to food.

"Many people use eating as a way to cope with difficult emotions, not only bad ones, but also happiness, excitement and celebration, for example," says Alexis Cona, a clinical psychologist in private practice and a researcher at New York Obesity Research Center.

Researchers believe that many emotional eaters turn to food to numb emotions that are too painful or difficult to process. As Cona explains, it can be a mindless cycle in which an emotional eater suddenly finds himself in front of the fridge, not quite knowing how he got there.

Family time during the holidays can be a particular challenge, as many disordered eating habits begin with poor boundaries between family members, Cona says. Preparing oneself for difficult and triggering interactions might be an important aspect of getting ready for the holidays.

What's more, during this season, food is more plentiful. Many people have favorite, traditional treats that they only eat during this time of year.

"There are all sorts of memories associated with family favorites — these foods are imbued with expectations," says Ellen Shuman, president of the Binge Eating Disorder Association and an emotional and binge eating recovery coach. "That feeling of deprivation can make an emotional eater feel like they have to eat their fill in that moment. They become forbidden foods — and that brings out the rebel in many emotional eaters."

Instead, Shuman counsels patients not to have once-a-year foods. If they love a certain dish, they should make it occasionally all year long to avoid that panicked feeling of scarcity.

So what's someone with a history of stress-based eating to do as the holidays loom large?

First of all, work on mindfulness. Cona asks her patients to check in with themselves before they eat anything. Do you feel physiologically hungry? Rate your hunger on a scale. And if you aren't actually hungry, but you want to eat, think about what you might be feeling and what underlying desire is at the bottom of the impulse to eat.

Cona also recommends practicing kindness to oneself, especially in the aftermath of an overindulgence. "Trying to find acceptance can be challenging, especially in a society that condemns us for having eaten this way; especially if our bodies don't look the way society says they should. But it's important not beat ourselves up over it. If this happens, try to learn from it. Don't shame yourself."

But Shuman adds, you may not be the only person you need to forgive. Letting go of painful family history could help prevent the emotional eater's cycle. "Keep in mind that you don't have to spend the holidays with your history with Mom — just with Mom in that moment."

 

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Atkins Roast Turkey Tenders with Herb Pan Gravy

"Atkins, a US-based diet brand, has launched Atkins Frozen Meals that will be available across the nation from January 2013.  (They can be found in SOME WalMarts NOW…)

The new menu item includes Farmhouse-Style Sausage Scramble, Tex-Mex Scramble, Chicken & Broccoli Alfredo, Roast Turkey Tenders with Herb Pan Gravy, Beef Merlot, Crustless Chicken Pot Pie, Meatloaf with Portobello, Mushroom Gravy, Italian Sausage Primavera and Chile con Carne.

The items are prepared with whole food ingredients such as freshly-picked vegetables, real creams and sauces, and premium custom meats. They contain no added sugars or preservatives, offer 310-370 calories and also contain 7g of net carbs or less, said the company.


Atkins Nutritionals chief marketing officer Scott Parker said that the company's Frozen Meals line offers homemade food and fresh ingredients and provides a convenient solution to help facilitate weight loss.

The meals will have a MSRP of $4.49 for lunch and dinner variety. The breakfast variety will be available for $3.99."

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For lunch I heated up Atkins Roast Turkey Tenders With Herb Pan Gravy –  9 ounces

Turkey
Ingredients:  Turkey Tender Medallions (Turkey Tenders, Water, Less than 2% Autolyzed Yeast Extract, Maltodextrin, Salt, Turkey Stock, Flavor, Gum Arabic, Potato Starch, Canola Oil, Sodium Bicarbonate, Natural Flavorings, Paprika), Green Beans, Water, Turkey Fat, Red Bell Peppers, Cream Contains Less than 2% of the Following: Chicken Flavor Concentrate (Chicken Meat Including Chicken Juices, Chicken Fat, Yeast Extract, Potato Flour, Onion Powder, Sea Salt, Flavor, Carrot Powder), Canola Oil, Resistant Maltodextrin, Flavorings, Turkey Base (Turkey Meat Including Turkey Juices, Salt, Flavorings, Potato Starch, Carrot Powder), Modified Food Starch, Xanthan Gum, Caramel Color, Salt, Soy Lecithin, Disodium Inosinate and Disodium Guanylate.

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And now you have a heart attack thinking a about all that fat, just note the lack of carbs and how perfect this is for a low-carb diet or if a person ate a portion of it at one time.  If you were following an otherwise low carb diet this falls right into it.

Heated up  - the turkey is nice and tender.  The gravy has a nice creamy, almost buttery texture to it, and the green beans are fresh and crisp and go nicely with the turkey.  

As a nearly nine year gastric bypass post op, I was able to eat the entire dish and it was filling — 9 ounces for 360 calories/10 carbs/23 protein.   

I would suggest these dishes for someone following the Atkins plan COMPLETELY because they are very high in fat, and you shouldn't really over do it on them.    Two in one day would blow your fat grams through the roof.

  • Product – Atkins Roast Turkey Tenders with Herb Pan Gravy 
  • Via – WalMart
  • Price $3.49 at WalMart 
  • Coupon - https://www.facebook.com/AtkinsDiet/app_175238885954001
  • Pros – Low-carb, high protein, easy to prepare, great texture, good taste… fits into my "diet…" 
  • Cons – High fat, high sodium, could be too heavy for some… 
  • Rating – Pouchworthy, MM
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Atkins Frozen Meals in WalMart

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Hey, Atkins?  How did I not know about THESE?

Please to HAVE THEM IN MY WALMART, yesterday.  Or delivery?   Yes please?

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I. live. on. frozen. meals.  

I am entirely serious:  

I purchase 2-3 meals for consumption 5-7 days a week, I am for about a 1200-1400 calorie intake.  I am not supposed to cook, unsupervised. <—- the link explains.

I am your target customer.  I spend days looking for lower-carb options.

NOW.

Thanks!  *skips away*