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).

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.”

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.

A. Artificial sweeteners like splenda, aspartame, and sucralose that are found in Crystal Light and Propel can be diluted and used sparingly to spice up your water. Do be aware that artificial sweeteners are known to be potent appetite stimulants. Another option is to use lemon or lime squeezes, as well as sliced cucumbers.

A. If vomiting is a consistent pattern, please call our office at (801)-268-3800. If the vomiting is a one time episode, do as follows: Put your fork down, do not take another bite, and do not drink water for 30 minutes. 

At that point, it is recommended to do a liquid diet for about 1-3 days, varying on the severity of the episode. Write the culprit food down in a journal and it is best to avoid that food for a couple of weeks. As you reintroduce yourself to a regular diet, remember to chew very thoroughly and make sure the prepared food is moist. 

Most common food culprits? Eggs and chicken breast. When eating these particular choices, take extra care: check moisture and chew each pea-sized bite 10-15 times.

A: Yes. Most commonly hair loss happens around months 3 or 4 postoperatively, but that can vary. It does stop and it does grow back. Rest assured, you will not go bald. The patient is the one who notices their own hair loss the most; we are our own worst critic.

No remedy is thoroughly scientifically proven, but some patients swear by biotin, niacin, or gelatin capsules to abate hair loss. As long as you are eating adequate amounts of protein (40-60g/day), the hair loss is stemming from the body’s way of shedding itself while maintaining the most vital organs (the ones inside you!).

A: If you are following the guidelines in your RMAP Binder, do not be discouraged! This is most likely a natural stall during your weight loss journey. To consider weight loss at a plateau, you usually stay at the same weight for about 6 weeks. Anything less than 6 weeks (if you are following the rules…) is the body’s own way of shedding itself. Weight loss does not maintain a consistent downhill pattern; weight loss ebbs and flows, vacillating between minor stalls and losses.

If you maintained a certain weight prior to WLS, it is not uncommon for the body to want to stay there on its way down, as well. As you should be exercising, you may be gaining muscle weight (which weighs more than fat) while losing fat. The number on the scale may be the same, but your clothes may be fitting more loosely.

Remember, you didn’t gain the weight overnight, so you are not going to lose it overnight either. Enjoy this journey!