Beginning in January, 2012 our monthly support group will take on a new look and feel. RMAP will begin offering Group Therapy from Leslee Miller, a licensed clinical social worker who had weight loss surgery six years ago. Leslee has been working closely with RMAP for the past several years to provide both individual and group therapy for our patients in her own private practice. We believe it will be very beneficial to our patients to begin providing group therapy for all patients who wish to be supported in this way. This service is included as part of each patient’s Education Program.

We have teamed up to offer three different support groups to fit the individual needs of our patients. Each patient desiring to participate will be assigned to one of the three groups based on where they are in their weight loss journey. We will meet in these groups every month, except March, July and November where we will combine for a big event!

One important change this year to Support Groups is that they are limited to RMAP patients ONLY, patient supporters will not be eligible to attend group, aside from the Support Group Events held in March, July and November.

Stage I – Early Weight Loss Group. This group will be for patients who have had surgery but are less than six months out from their surgery date. This group will focus intently on supporting and helping new patients as they adjust to the many changes they face after surgery. Questions and concerns about the early stage of weight loss will be answered.
This group will be held on the second Wednesday of each month from 7:00 until 8:30 p.m., starting January 11th, 2012

Stage II – Weight Loss Group. This group will be for patients who are six months out from their surgery date and still in the weight loss phase. This group will focus on identifying habits, thinking errors, self-defeating beliefs, and unresolved emotional issues which, if left untreated, are likely to sabotage the patient’s long-term success. Patient’s will be encouraged to meet their weight loss goal and will be carefully directed in how to approach the maintenance phase successfully.
This group will be held on the third Wednesday of each month from 7:00 until 8:30 p.m., starting January 18th, 2012

Stage III – Maintenance Group. This group will be for patients who are finished with the weight loss phase and are in the maintenance phase. This group will focus intently on helping patients adjust to maintenance without excessive weight gain. Questions and concerns about the lifetime commitment to weight loss maintenance will be the focus.
This group will be held on the fourth Wednesday of each month from 7:00 until 8:30 p.m., starting January 25th, 2012

All group therapy meetings will be held at the office of RMAP, in Suite 4200 and are included in your Education Program, paid with your bariatric program fee at the time of surgery.

Pre-registration is necessary prior to attending group. Please fill out the registration form, found here, and send it back to our office,
1. E-mail your form to Carley.Mills@rmapinc.com
2. Fax your form to (801) 268-3997 Attn: Carley
3. Mail or bring your form to Rocky Mountain Associated Physicians
Attn: Carley
1160 East 3900 South, Suite 4100
Salt Lake City, UT 84124
We must receive this form before attendance

We look forward to an exciting, life changing year!

Before I post the handout that was available Wednesday night, I want to post about the next combined event. This is scheduled for March and will be the Makeover Event, A New, A New You. We are excited for this event, as it was a fun event last year. I will keep everyone updated with more details on our website homepage and our facebook page .

“Lessons Learned”

Aimme learned…

Build a support system. This should include people who are apart of your daily life; such as family, friends and co-workers.

Don’t get stuck in a rut. It may become easy to stick with a few choice foods that you tolerate well. Learn to expand and try new (on plan) items. Change it up! You’ll start dreading meals or your exercise routine if it’s the same thing you’ve been doing.

Aimme Waters
Duodenal Switch 2011
Blog: www.watersweight.blogspot.com
E-Mail: waterswife@gmail.com
Phone: 801-792-1092
                                                                                                                                                                                                                                                                      Sean learned…

Break old habits. The magical 18-24 month weight loss journey is the perfect time to break old habits and form new ones. Stop looking to replace popcorn, fudgesicles or other foods that you loved pre-surgery. Those were the foods that got you here, now is the time to learn to eat different, better foods.

Learn how to deal with stress differently. Habits are cycles of behavior that only go away when you replace them with something else. Finding a hobby (such as exercise), other than eating, that allows you to effectively deal with your stress is important.

Sean Joyce
Gastric Bypass 2007
Blog: www.seanstransformation.blogspot.com
E-Mail: sean_joyc@yahoo.com

Joe learned…

Follow the program. Don’t rationalize, don’t cheat (you’ve been doing that your whole life)!  Be psychologically committed.  Your change is not temporary.

Find new ways to enjoy food, research new recipes. I can still enjoy food, I just do it differently now, and in smaller portions, but food is still allowed to be yummy.

Joe Christensen
Gastric Band 2010
Blog: www.thevoiceofjoe.blogspot.com 

Tyson learned…

Build an environment where you can succeed. Talk to everyone who plays a significant role in your life. Make sure they are prepared to make a change with you. No matter what, you’re going to experience some frustration about food that you’ll have to own and deal with, but, if you can get your friends and family aligned with you and your lifestyle change, that frustration will be so much more manageable.

Commit to changing your relationship with food forever. You have to be mentally prepared to continue your diet when cravings return. If you start cheating, it will only trigger more cravings, which is a slippery slope.  To help prevent this, try to find new low-carb, high protein recipes and foods that will help you keep your meals interesting.

Tyson Waters
Duodenal Switch 2011
E-Mail: Tyson@myheck.net
RMAP Forum: TysonDUB
Phone: 801-234-0447                                                                                                                                          

Chris Learned…

Get into a routine of daily exercise. Appreciate what you can do now, don’t overwhelm yourself with what others are doing. Set goals for yourself and enjoy what your body can do for you.

Weight-loss surgery is just a tool. You hear RMAP say that, but it really is just a tool in weight control, not a cure. Listen to your surgeon and staff, they can be a huge part of your support system, where you can ask questions or find advice.

Chris Stevenson
Gastric Bypass 2011
E-Mail: benevations@gmail.com
Phone: 801-791-9933                                                                                                                                   

Jeanette learned…

Enjoy the compliments. They will come and practice receiving them with grateful acknowledgement – don’t make light of your accomplishment. You’ve worked hard to get where you are today.

This is my journey. No matter how many people are supporting you, you are the one taking each step of your journey. Keep a journal about your journey. I found inspirational books and quotes really helpful, they helped me stay focused and committed.

Jeanette Marsh
Gastric Bypass 2011
RMAP Forums: Dollygrandma
Blog: www.dollygrandma-weightlossjourney.blogspot.com
E-Mail:dollygrandma6@hotmail.com
Phone: 801-875-3137      

Thank you to our panel who made this support group a great learning and inspiring event, along with those in attendance who shared their story. If you are interested in sharing your story please contact Carley at Carley.Mills@rmapinc.com

A: Increased absorption years out from weight loss surgery….
 False.

Same absorption as when you first had surgery…. True.

Your stomach gets more efficient at emptying food into the small intestine years out from weight loss surgery…. True. (This is why you are able to eat more food at each sitting, but never more than 6-8 ounces/meal).

For December’s support group, attendance was not as desirable. Was it the busy holidays interfering with the schedule? Was it the weather? Was it the topic (Clothing Exchange)? Or was it all of the above? As we look to 2010 and new changes that can be made, your input is vital.

However, one idea was further solidified during support group this month: Support from peers is vital. Whether it’s 5, 20, or 40 patients in attendance, knowing that you can interact with others who know exactly what you are going through is of great importance. We so value the efforts made by our patients this month to come and feel the support of others and RMAP. We strongly encourage you to make a new resolution to make support group a constant in your life!

E-mail your responses to Meredith@rmapinc.com

A. Thanks to Susan, again, one of our patients, here is the answer: 

“Open your “Paint” program. Usually, that is found in the “Accessories” folder on the Start Menu (lower left corner of your screen).
Open your photo in the program.
On the top bar, click on the “Image” button.
Then select “Stretch/Skew”.
Change the horizontal AND vertical numbers to 50%. This will make your photo half as large as it was.
Then click on File and “SAVE AS”. Save your resized photo with a new name. Do NOT do a “Save” as this will permanently change your original photo.
Then try uploading your new, smaller photo. If it is still too big, repeat the above process, starting with your ORIGINAL photo, and try smaller percentages (maybe 40% or 30%) until you have a size that will upload. It all depends on how large your original photo is as to what percentage change is required to make it small enough for the website.”

Success can be defined in many ways, and to different degrees, but the ultimate definition stems from HAPPINESS received. And the support groups in Orem, Ogden, and Salt Lake City all offered their HAPPINESS from personal success stories.

Our patients’ success:

• Fitting into clothes that haven’t seen the light of day since college. Or even fitting into size 14 of the little girl’s department!
• Running and playing with children, nephews, and nieces.
• Coming off of all diabetic, blood pressure, cholesterol, and sleep apnea (etc) medications/devices
• Flying on an airplane for the family’s annual vacation.
• Motivation to go to nursing school (Hooray for nurses! I am not biased or anything…)
• Seeing a 100 pound bag of potatoes during Idaho’s harvest and realizing that “bag” has been lost from the body.
• Being able to cross the legs when sitting, and not even think twice.
• Changing their family’s health: Teenage daughter losing 14 pounds simultaneously from healthier habits being established
• Has learned to love exercise. Yes, physical activity is now fun!

I cannot speak for all in attendance, but I certainly walked away from support group this month feeling buoyed and grateful for the opportunity to work with people who are changing their lives. Thank you for those who attended, for sharing a piece of yourself. It was rewarding and inspiring.

Many of you have come so far. And I look forward to seeing those same changes in patients to come. Enjoy this journey!

Meredith Mangum, RN

Top Ten Holiday Survival Tips: 

1. Focus on the people, and not the food/drink when at a holiday function.

“I actually enjoy these events more now, as the focus is on spending time with people I like and focusing on them instead of the food.” – Amy

2. Bring food you can eat and enjoy.

“If you are going to a potluck type event bring something you can eat. Meat and cheese trays are popular and WLS friendly.” – Amy

3. Healthy stocking stuffers.

 Instead of filling your children’s Christmas stockings with sugary goodies, add oranges and their favorite sugar free chewing gum.

4. Don’t forget your water…But spice it up!

“Add a little variety to your party sipping options: lemon or lime slices, fresh mint, or crystal light. Tomato or vegetable juices are also reasonable options.” – Amy

5. Drink your Bloody Mary virgin.

“No one can tell by looking at your glass that it is [sans alcohol] and it’s tomato juice all spiced up and yummy. You usually get a celery stick to munch on too!” – Kristen  

6. Use fun party cups.

“If you are the host, put your water in a cocktail glass or other pretty glass. If you are at a party with a bar, ask for your drink in a cocktail glass instead of a plastic glass.” – Amy

7. Remember, you can eat Thanksgiving leftovers later.

Do not feel like gorging at Thanksgiving dinner will be the only time to enjoy the annual tasty meal. Leftover turkey is still yummy the next day!

8. Keep desserts out of view at work. “Out of sight, out of mind.”

“If you have coworkers who bring a lot of candy to work, see if it can be put in a place that is out of your way, but convenient for others.” – Amy  

9. Use closed containers to prevent munching mindlessly.

“Use a container with a lid so you don’t pick up a piece without thinking.” – Amy

10. Exercise.

This increases your output to defeat your input. And it motivates you to not sabotage your hard efforts by eating inappropriate foods. 

Happy Holidays!

A. Dr. Smith, one of our surgeons, responded:

“Human chorionic gonadotropin (HCG) is produced by the placenta signaling the hypothalamus to mobilize fat stores in the pregnant woman.  This helps bring appropriate energy to the developing fetus for growth and development.  There are some cancers from the reproductive cells in men and woman which also can secrete this hormone.

The recent resurgence of interest in this hormone has raised questions about the validity of relying on HCG to help people tolerate an extremely low caloric intake of 500 Kcal/day.  While the first attempts at using this approach date back to the 1950’s, strong surges of interest have resurfaced about every ten years.

In 1975 during a similar flurry of curiosity in this weight loss method, the FDA stated: “HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or ‘normal’ distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.”

Many individuals claim to have had success with this regimen; however, several scientific studies using a placebo control group in a prospective fashion have proven that there is no discernible difference in weight loss outcomes. Nor is there an improvement in the tolerance of such a restrictive diet with the help of HCG.

While we all hope for that magic pill or injection which will make weight loss successful and durable, there remains a paucity of proof that the HCG diet fulfills that hope.  Any diet which includes only 500 Kcal/day will lead to dramatic weight loss in the normal adult.  Eventually, returning to normal caloric intake is inevitable to survive, and weight regain is likely to occur. 

The good news in the world of treating severe clinical obesity is that certain surgical procedures do have proven value.  They have stood the test of time and the scrutiny of science. They include Roux-en-Y Gastric Bypass, Adjustable Gastric Band, Biliopancreatic Diversion (Duodenal Switch), and Vertical Sleeve Gastrectomy.  These procedures all help people to adapt to a lower caloric intake. These procedures are successful and durable.

Many comorbid conditions of obesity including sleep apnea, hypertension, high cholesterol, diabetes and heart failure, have all been shown to improve or even disappear following weight loss surgery.  We recommend these procedures for patients with a Body Mass Index (BMI) equal to or greater than 35.”

A. The following is a response from a patient, Susan, on our forums: 

“In the blue bar at the top of [the online forums], click on ‘User Control Panel’. Then choose ‘Profile’ from the list on the left side. There are several options to play with there. The ‘Avatar’ is where you upload a photo. The ‘Signature’ is where you put the cute little weight trackers and your name, or whatever else you want to announce.

To get the ticker, go to www.tickerfactory.com and click on ‘weight loss’ to get one of the weightloss themed tickers. Make your selections to create your ticker. After you are done, there’s a box at the bottom with code lines in it. Select and copy the code for ‘bulletin boards’ and then come back here to your profile and paste the code into the signature box. It won’t look like anything until you ‘preview’ your profile. Any changes you make to your profile will instantly change on every post you’ve previously made. Be sure to bookmark the tickerfactory site. You will need to go back there to make updates to your ticker.”

A. Our philosophy at RMAP is to eat for the lifetime; point being to utilize natural/real food for energy sources. We recommend eating 40-60 grams of protein/day, which equates to 160-240 calories/day. This is very achievable by eating more natural sources of protein- yogurt, cheese, beans, tofu, deli meats, chicken, ground beef, steak, and even vegetables. 

Protein shakes are very calorie dense for a small volume, and they will empty your pouch faster than regular food, leaving you hungry sooner. Protein shakes are also not always available wherever you may go in the world, and learning how to eat appropriately on food is the best route to making lifestyle changes. 

There are several patients who have been very successful at weight loss and maintenance by choosing to use protein supplements on a more regular basis. Who are we to argue success in that circumstance? Our philosophy simply stems from the success we have seen in the majority of our patients, and not the exception.