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printer-friendly version| Those Darn Plateaus by Terry Simpson M.D., F.A.C.S. What is a plateau? Every patient stops losing weight after weight loss surgery and wonders why. They may think their stomach has stretched. Often they just don?t know why they stop losing. But first let us define a true plateau. A plateau is when you have maintained your weight and your measurements for four weeks. If you are still losing inches, you are not on a plateau; you are simply redistributing the weight. The first six weeks after surgery You will reach the plateau during the first few weeks after surgery. Some people come back from the hospital and find they weigh more than when they went in. This is generally because a lot of the fluid we pumped in you is still in your tissues, so the first few pounds you lose is typically water weight. The first six weeks after surgery is a fun time, and it is common for patients to lose 10 percent of their weight during this time. This means that if you weigh 300 pounds you will be down 30 pounds or more. More isn?t bad. Some patients don?t have a scale, or they are looking forward to the time when their scale can weigh them. That is why you should take your measurements?as well as your photograph?prior to going to the hospital. So, measure your neck, chest,waist, thighs, and arms before going to surgery, and keep watching those at least once a month. You will lose inches, sometimes before you lose weight, and as your body is changing where it is putting things, it is important to know where you are losing. One of my patients didn?t have a lot of spending money and didn?t want to buy too many clothes until she had a more stable weight. She changed her mind after her underwear fell off as she was purchasing food at the checkout counter in the grocery store. Taking measurements not only helps you chart your progress, it can prevent an embarrassing moment.  Sometime in this first six weeks, the weight loss will stop for a while. That is just your body readjusting?that is all. If your surgeon has placed you on a liquid diet, you will also notice that you can drink a lot more than you thought?nope, you didn?t stretch it. It is just that liquids are able to go passively through the stoma, or the pylorus (if you had a duodenal switch). Sometimes you are left with a lot of hunger. Early on, fluids will fill your pouch or stomach, and you will not have much of an appetite, but as you move forward you will re-discover your appetite?not a bad thing, just one sign that it is time to move to more solid foods. A readjustment period for the body is necessary. During the postoperative time, you not only lose weight from fat cells, but also from what we call ?lean body mass.? That is, you lose weight also from muscles.You need this muscle mass for walking, moving around, breathing, and assorted other body functions. That muscle mass needs to be rebuilt, therefore we want you to start a walking program. The more you walk, the more you will keep the lean body mass?if you don?t use muscle you will lose it?so start walking.  After the first six weeks:If you have reached a plateau, you should check several things. Certain foods will slow down and even STOP weight loss. Foods with sugar (high glycemic), including things you may not think about like:fruits, fruit juices, condiments, potatoes,soft drinks, breads and past as. Check the label and see how many carbohydrates and how much sugar they contain. Snacking will slow down weight loss. A few extra bites of some things are a few calories you do not need.If you need a snack, make certain the snack is high in protein and not in carbohydrates or sugars. Do not skip meals. Meals are planned for, so it is easy to have nutritious food that has fewer calories (or lower in those high glycemic carbohydrates). If you skip meals you will feel more like eating snacks?snacks are filled with lots of dense calories. Skipping meals does not help to lose weight?in fact, the more patients skip meals, the longer it takes to get to your goal weight (a BMI of 22). Grazing is OUT. Remember to eat three meals a day, not three hundred. You can slowly consume a lot of calories by grazing. If a meal is taking you longer than 30 minutes to finish, you are grazing. The first few weeks you will need to eat a little bit at a time, but then you need to transition into three meals a day. This transition is difficult because you cannot believe that a two-inch square of salmon will fill you. Exercise. If you are not walking, the world is passing you by. Walk, walk, walk and walk. When you are tired of walking, walk again. There is no excuse. If you need a new hip, knee, back, or other joint, then get involved in water aerobics. My favorite excuse is, ?I walk a lot at work.? Essentially, if you are not dedicating some time to exercise, you are missing the boat. My suggestion?purchase a recumbent bike. Count carbohydrates. The more carbohydrates you consume, the harder it is to lose weight. Sixty grams a day should be MORE than enough. If you are eating carbohydrates, check the ones you are eating and see where they fit on the glycemic index scale. We also have a list of common glycemic index carbohydrates on my website www.drsimpson.com. (More about the glycemic index below.) Natural sugar and honey are still sugar and natural fruits contain sugar. Your body really doesn?t care if little elves, an organic mistress, or mom made the cake you eat. Just because it is natural does not mean your body won?t grab the calories. Believe me, your body loves sugar and it will grab onto every molecule and hang onto it for dear life. For women, your cycle will affect your weight. During certain times of the month you will retain more fluid and weigh more. There is a natural urge to snack more during these times?that is why you should have a supply of sugar-free fudge-sickles! Alcohol contains calories. Wine and beer have a lot of carbohydrates, but alcohol has a lot of calories per serving. After surgery you will absorb alcohol quickly (you will become a cheap date). High Glycemic Index Carbs  Every morning when I go into the surgeon?s lounge at the hospital I am faced with a choice?I can have either a donut or I can have an apple. Both have 25 grams of carbohydrates?but there is a difference. If I eat the donut my blood sugar will quickly rise, which will cause me to produce more insulin, and in a couple of hours I will be hungry again. If I eat the apple, my blood sugar won?t rise as fast, my sense of ?satiety? or fullness will last longer, and I will have less of an insulin response. Glycemic Index is a measure of how fast blood sugar rises after eating carbohydrates. The donut will have a glycemic index of around 70, while the apple is about 28. The higher the glycemic index, the more that food is associated with obesity, diabetes, heart disease, and even cancer. Besides, the apple will have more fiber, more vitamins, more other good stuff?although the donut might appeal to me, the choice is that I can eat and be satisfied, or gain weight.Carbohydrates are complex molecules of sugar. Some are complexed in such a way that the body processes them differently?and they are not associated with as much obesity. Naturally anything you eat in excess can cause obesity (yes, even if you are on Atkins, you can eat enough fat to not fit in that high school outfit). Those carbohydrates that are less associated with obesity are vegetables, pulpy fruits (like grapefruit) and legumes. Those associated with more obesity are breads, rice, pasta, and candy. So, while counting carbohydrates is an easy way to lose weight ? remember, those which have a lower glycemic index are far better for you, and will keep you feeling full much longer than the higher glycemic index carbohydrates. How to get off the plateau?and back into the loss column?6 months and beyond You have two choices. Cut carbohydrates or start walking. I love it when patients tell me they are going to the gym. Going to the gym does not mean exercise. Years ago I went to a workout room at a hotel where I was staying. A woman came there dressed in appropriate workout clothes and walked around the room as if she was a priestess blessing the machines, and playing with them. There was no ?work? out. She maybe spent five minutes on an exercise bike. But?she could tell the world she went to the ?fitness center? at the hotel. Your body is a perfect calorie counter. It will measure what you take in and what goes out. You cannot fool it. Your body is not impressed that you took it to a gym. However, if you are stuck on a plateau,you need to work your way off of it. Just 45 minutes of sweating will do it. Watching a tape of some little ugly man swishing with old ladies does not cause you to lose weight. Before you start a walking program, however, check with your doctor, and with a physical therapist. Learn how to take your pulse, and learn what you should expect to find?do not start an exercise program without this.  Sometimes people refer to the first 18 months following surgery as the ?golden? period of weight loss. Most of the weight will come off during this time, and after this time, it is normal to regain a bit of weight. What is success with weight loss surgery? What do we really expect or want? That is something you and your surgeon should decide. Our expectation is that you will lose65 percent of your excess bodyweight and keep it off?that is our ?surgical? version of success.  Why not 100 percent? Simple. We don?t want to cut it too close (pun intended). If we make the stomach smaller, or make the bypass longer, patients can get into trouble?instead, our job in surgery is to give you a great tool that you can use to lose weight and to get you out of the ?morbid? category. You now have a tool that you never had before. Dieting is a lot more successful because of this tool. Dieting before surgery didn?t work well, but it will now. It will work for one simple reason?you cannot eat as much as you used to. If you had a 50 ounce stomach and now have a one ounce stomach you will be satisfied with a lot less, even after a year or two we see pouches get to ten ounces without a problem with regaining weight. So, before you had to eat a garden full of vegetables as well as half a cow, now it takes a few ounces of tuna fish to satisfy you. The smaller stomach allows you to feel full with less, so you don?t have the urge to consume large quantities of food. The way to lose again is not to stop eating, it is to make healthier choices. You now have a tool that you dreamed of?remember your skinny sister-inlaw who preaches about self-discipline?well, your body will now enjoy a discipline it couldn?t?so make the choices. Our goal is not just to get you to a BMI of 22, although that should be your goal and you can reach it. Those great before and after pictures you have seen? well?those are very dedicated patients. Their success was not the result of a specific surgery or surgeon; it was the result of a disciplined patient. Dieting may not have worked too well for you before the surgery, but after the surgery, dieting will work a lot better. So, limit the carbohydrates to those which have a lower glycemic index, and start walking. You will get off the plateau, you will lose weight and you will be surprised how well you can do this. Above all, weight loss surgery is not ever to make your life miserable, it is simply a tool. There is nothing wrong with having some dessert, but if you are on a plateau and have not reached your goal, you might consider putting it aside for a little bit, or walking it off later. Our goal is to help you get out of morbid obesity, and provide you with a tool that will make a diet work well for you. Your mantra: There are no bad foods; there are only bad quantities of foods. For more information about Dr. Terry Simpson or weight loss surgery, please go online to www.doctorsimpson.com. |
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