“Normative discontent” is the term coined by eating disorder researchers to describe the tendency for women in our society (and increasingly more men) to be dissatisfied with their bodies, regardless of shape or weight. It is unfortunate that it is now considered normal for us to dislike our bodies. For those of you who have battled obesity, this so-called normative level of body discontent is further compounded by the additional weight-related teasing, criticism, bias and discrimination you have likely endured. Studies show that negative body image is more common and severe among those who are or have been obese.
When body image is impaired, it can dramatically interfere with your ability to lead a full, satisfying, healthy life. Thoughts affect feelings and feelings affect behavior. When your thoughts about your body are consistently poor, this negative body talk becomes inextricably linked with feelings of low self-esteem, depressed mood and anxiety. These negative thoughts and feelings leave you vulnerable to emotional eating and can interfere with engaging in activities that promote your psychological, social and physical well-being....click here to read more.
Most people have experienced “body issues”—that nagging dissatisfaction with a physical feature, whether it’s about skin, shape or size. Many of us complain to our friends; others just cover up; but some resolve to make a change.
Body issues can be particularly severe for people who have lost a substantial amount of weight or undergone weight reduction surgery. Eager to enjoy the benefits of their weight loss, they may find that their skin has lost elasticity and no longer conforms to their newly reduced body size.
Post-bariatric body contouring is an increasingly popular solution to excess sagging skin. This series of plastic surgery procedures may include a lower body lift to correct sagging of the abdomen, buttocks, groin and outer thighs, as well as lifts for the breasts, arms or inner thighs. These procedures remove excess skin and can improve the shape and tone of the underlying tissue that supports fat and skin.
The results of a body contouring procedure following aggressive weight loss are visible almost immediately, but it can take a year or more to see the final results. Aside from the natural effects of aging, the overall results are long-lasting for patients who maintain their general fitness and a stable weight....click here to read more.
Members like you asked, and OH’s network of professionals answered!
Do you have a question you would like to ask of a plastic surgeon, bariatric surgeon, fitness expert, dietician, psychologist or other bariatric professional? Send your questions to AskOH@obesityhelp.com.
I had RNY in mid-February of this year, so I am four months post-op. I have done pretty well so far: never eating anything with sugar or fried. I have lost 100 pounds so far and am much more active and healthier. I started out at 402 pounds and am now 302 pounds. My goal is 150 pounds. My question is this: pills are still very difficult for me to swallow. In the morning I take my blood pressure med, Prevacid, my two antidepressants and B12 liquid (no one to give me a shot). In the evening I take my blood pressure med (again), another antidepressant, calcium citrate and more B12. Unfortunately, I did not take my B12 in months three and four. I just recently started it again. I have this problem now where my hands spasm and my legs feel numb on the surfaces of my skin. Could this have something to do with the lack of B12 in the beginning or the fact that I have saggy skin? My legs always feel like I freshly shaved them with no feeling on the first layer of skin. It is worrying me. Any ideas? - Barb
Dear Barb,
Let me begin by urging you to see your bariatric team as soon as possible. It is difficult to know from an email exactly what is going on, but it does sound like you may be suffering from a neurological disorder. Your bariatric team will probably need to do some testing. They will probably ask for a consult with a neurologist.
For patients with gastric bypass, liquid B12 will not be absorbed—it will be destroyed in the small intestine. The patients must receive B12 as an injection or take it as a dissolvable tablet under the tongue. You should also be taking a multivitamin specifically for bariatric patients so that you get all of the micronutrients you need. Many of the other B vitamins could be contributing factors to your symptoms. If you are doing any vomiting, you could be low on thiamine (B1).
You don’t mention how much calcium citrate you are taking. The literature shows that after gastric bypass, there is more difficulty absorbing calcium, so you should be getting 1500 to 2000 mg of calcium citrate per day. If your calcium is low, it could cause some of these symptoms. Gastric bypass patients can also have problems with low potassium, which might also be a factor. While it probably won’t affect your symptoms, you should also be taking an iron supplement.
In short, please follow up with your bariatric team! They can help you get the treatment you need.
Paula Shellenbarger, MSN, FNP-C
Family Nurse Practitioner—Bariatrics
North Colorado Medical Center Bariatric Center
I had gastric bypass seven, almost eight, years ago and lost 155 pounds. Over the last year, I have quit smoking, which was a necessity since I have emphysema. Unfortunately, I have gained about 40 pounds and about 60 overall through the years since surgery. Can a person have laparoscopic revisional surgery after having gastric bypass? What does it entail? - Steven
Dear Steven,
Weight regain is a complicated issue and can be related to several factors. If it is determined by your surgeon that your stomach or stoma size is larger than desired, it is possible that you could qualify for revisional bariatric surgery where the stomach pouch and connection point (stoma) are revised. This revision is higher-risk for several complications due to the amount of scar tissue present, such as leakage, bleeding, obstructions, etc. Scarring is more likely to be an issue if your original surgery was performed “open” with a large scar from your ribs to your belly button, or laparoscopic with several, much smaller incisions. Thus, the likelihood of performing revisional bariatric surgery laparoscopically is higher if you originally had laparoscopic gastric bypass, and lower if you had open gastric bypass. With less scarring, there is less blocking the view of your organs. With more scar tissue, which is especially seen with open surgery, there can be so much scarring that it is not safe to proceed with laparoscopic surgery, and you would then have another open surgery.
Preparing for revisional bariatric surgery is much like preparing for your first gastric bypass, with evaluation by the surgeon, your doctor, a nutritionist and a psychologist and any testing necessary to maximize the likelihood of tolerating the stress of surgery and/or complications. I am concerned about your emphysema caused by your smoking, which has now permanently affected your lung function; that alone increases the risk of surgery. You may require evaluation by a lung specialist with additional testing to see if you would be able to handle surgery. Hope that helps.
Remember, while the professionals contributing to Ask OH are highly skilled and well-qualified in their fields, they don’t know all of the details of your personal situation. OH Magazine and the professionals contributing to Ask OH make no promises, guarantees, representations or warranties, expressed or implied, and assume no duty or liability with regard to the information contained herein. Discuss the answers you receive and any further questions you may have with your personal healthcare team.
Plastic surgery is not inevitable for those who have had weight loss surgery, nor is it inevitable for those who have made it to their weight loss goal. Plastic surgery is something that a group of people choose to do for themselves.
Our goal is to get you to the place where you have the option. You don’t have the option when you are still losing weight.
When we looked at patients who went to get plastic surgery—and had a BMI less than 24—here were some of their characteristics:
Over 80 percent of them weighed themselves on a weekly basis. This meant that they were using their weight as a marker for what they were doing. It was the warning signal about the things they ate.
Over 75 percent of them engaged in some form of exercise at least three times per week. This involved at least 30 minutes of doing something beyond “work.” For the majority of these folks it was walking, and for some who had joint issues it was water aerobics or even an elliptical trainer.
All of them thought about food and were always making choices. Some described their association with food as different, while others described it as a meal-by-meal decision, which was not a burden.
Over 85 percent of them portioned their food carefully and could tell you how much they ate at any given meal. They would eat a portion, not go beyond that portion, and walk away from the table. The remaining patients said that they portioned their food, and described it as much less than they ate before, but they could not say for certain how much they ate.
None of them ever ate until they felt full. Feeling full was not a marker for any of these folks to stop eating. They all, however, described feeling “satisfied” after a meal. I think this is one of the more interesting markers. Feeling “full” is subjective, but knowing portion size and then walking away is more objective. It is no surprise that those who practiced portion control and used their weight loss tool achieved success.
So, take a lesson from those who have made it to plastic surgery, and work on incorporating those changes into your life. Then make the decision as to what further steps are right for you.
Do you sometimes confuse Head Hunger with Body Hunger? If you're sensitive to food cues, weight management becomes much easier when you're able to recognize the triggers in your environment and break the associations that lead you to overeat simply out of habit.
Let's take a look at just a few of the common triggers for overeating and strategies for coping more effectively.
By the Clock:
Society programs us to follow a schedule, so like Pavlov's dog, we've learned to salivate when the bell rings. The reality is that it's more convenient to eat at certain times than others, so it takes effort to listen to your hunger cues.
Strategy:
Though it's challenging to change this routine, you can adapt it to fit your own needs. Learn to pace yourself by observing your natural hunger rhythms. You'll probably notice that you get hungry every three to six hours, depending on what and how much you ate at your last meal and how active you have been. Keep a healthy snack handy to satisfy hunger that doesn't conform to mealtimes. If you're consistently tempted to snack right before a meal, consider moving the mealtime up or adding more protein to your previous snack....click here to read more.
After bariatric surgery, if you’ve kept the weight off successfully, you may opt for plastic or reconstructive surgery to remove excess or sagging skin. How much do you know about the different plastic procedures? Take our quick quiz to find out.
True or False?
1. Breast reduction patients report a high rate of symptom relief (70-100 percent).
2. The most time-consuming of common post-WLS cosmetic surgeries, in which the patient spends the most time under anesthesia, is abdominoplasty, or tummy tuck.
3. Breast augmentation is the most performed type of cosmetic surgery.
4. Silicone breast implants are more expensive than saline implants.
5. If you think your earlobes are too big, you can have an earlobe reduction.
6. The physician’s or surgeon’s fees quoted for the price of a cosmetic surgery are about what you can expect to pay out of pocket.
7. A thigh lift requires you to miss about a week of work in order to recover.
8. Surgical treatment of gynecomastia, or enlarged breasts in males, is permanent.
9. Results of a buttock lift are permanent.
10. Surgeons can now fully eradicate the appearance of cellulite.
Abdominal training is nothing new, but if you spend any time watching TV or flipping through magazines, you are well aware of the numerous abdominal exercise devices that are touted as the latest and greatest. Despite all the advertising and fads, the best abdominal exercises require little or no equipment. While this list is not comprehensive, these exercises are great for developing abdominal strength, and they won’t cost you a dime!
PRIMARY MUSCLES INVOLVED: Rectus Abdominis
Beginner Level: The Crunch (unweighted and weighted)
Preparation/Setup: Lying supine on the floor/mat, cross your arms across your chest and flex your knees, placing your feet flat on the floor. If performing a weighted...click here to read more.
I had been talking passionately about the obesity “Walk on the Capitol” for months at my support groups. It was scheduled for my 36th wedding anniversary, but my husband, Bob, didn’t mind me going because he knew it was something I cared deeply about. However, when Bob became terminally ill with cancer and had to enter hospice care, the walk was the last thing on my mind.
The night before the walk, I got a call from Heather O’Connor, an OH Support Group Leader in training. Heather and I had been working with Jen Rosen, another leader in training, on support groups in Delaware. Heather was calling to offer me an OH T-shirt to wear at the event. I explained why I couldn’t attend, but Heather encouraged me to go and told me she would rearrange her schedule to go with me. Bob overheard the conversation and also urged me to go. My daughter Debbie, a RNY patient and support group member, told me she would stay with her dad so I could participate. How could I say no? I called Heather back, and we made our plans.
The day of the walk was busy, and Heather and I were on our way to DC when I realized I had forgotten my bag with the directions. We decided to wing it. We at least knew how to find the Capitol!
It was about 6 p.m. when we arrived in the area. After a chat with a DC policewoman and about 16 blocks of walking, we found the right spot. We handed out support group cards, and Heather even took the OH shirt off her back and gave it to someone who had never heard of ObesityHelp. About 45 minutes later, the buses started coming. People streamed in from everywhere. I had never seen so many people in one place. It was amazing!
After the speakers gave their addresses, everyone just walked and talked. There were thousands of people from support groups of all kinds, all there for one cause. As we progressed, walkers at the end met those at the beginning and formed a two-mile circle.
It was an event to remember. Best of all, Heather and I forged a bond that day in DC. We are now not just Obesity Help Support Group Leaders, but friends, and we’re part of something wonderful: an unbroken circle of support.
At the end of May, OH held a one-day event at the Crowne Plaza Detroit Metro Airport in Michigan. Co-sponsored by Dr. Ayoub Sayeg and Dr. Michael Pleatman, the event featured WLS post-op and motivational speaker Laura Preston, addiction counselor Jason Wilkinson, fashion consultant Indigo Zuri and Lifetime Fitness. Hosting the day’s festivities was local celebrity and WLS post-op William “Big Will” Elijah, and vendors (including Astute Artistry, Progressive Counseling, P2Styles Fashion Consulting, Lifetime Fitness, Sayeg Plastic Surgery and AchievOne) offered everything from complimentary eyebrow tweezing and dermabrasion to discount Lifetime Fitness memberships. Free samples were provided by Kay’s Naturals, Profect and AchievOne.
The best part of any OH event is the wonderful people in attendance. OH member Jenn said, “We had a great day learning and mingling.”
In late July, OH partnered with Pittsburgh’s Magee Women’s Hospital for a fantastic one-day event featuring sponsor Dr. Dennis Hurwitz of Hurwitz Center for Plastic Surgery. Also presenting was Dr. Anita Courcoulas, who shared the bariatric surgery outcomes research she is conducting with the National Institute of Health. Other presenters included Certified Professional Coach Lynn Meinke, WLS post-op Laura Preston, Fashion Fit Formula and OH’s fitness expert Jeremy Gentles. The day concluded with our first ever $1000 gift card door prize, which went to attendee Megan Hill.
OH’s Support Group Summit in Minneapolis was a jam-packed evening of fun at the Mall of America. Attendees heard from relationship expert Dr. Kathleen Nickerson and shared their “wow” moments during a support group session led by Liz Sorlie and Sandi Pulis. Members made new friends, hooked up with area support groups and enjoyed the thrills of the amusement park.
Don’t miss out on your chance to join us when OH next visits your region! It’s a great time for fun, friends and the opportunity to learn more about what it takes to succeed on your WLS journey!
You have laughed with Beth (MeltingMama) and salivated over the recipes of Michelle (Eggface). Come meet them in Philadelphia where they will be reviewing products and whipping up recipes in a way only they can do! This event also features Dr. Dennis Hurwitz, Motivational Speaker Bo McCoy, Certified Professional Coach Lynn Meinke, Fashion Fit Formula, WLS Post-Op Ramon Lopez, Fitness Expert Jeremy Gentles and more!
If you are coming to meet Eggface and MeltingMama in Philadelphia, use the following promo code and receive 50% off admission:
Featuring Dr. George Bitar, Psychotherapist Merle Cantor Goldberg, Relationship Expert Dr. Kathy Nickerson, Fashion Fit Formula and Fitness Expert Jeremy Gentles. Hosted by Support Group Leader Jackie Thodos.
Our 10-year anniversary celebration! We’re giving away two weight loss surgery procedures! Featuring Dr. Timothy J. Katzen, Dr. Dennis Hurwitz, Dr. Siamak Agha, Dr. Guillermo Alvarez, OH Members Eggface (Michelle Vicari) and Melting Mama (Beth L. Sheldon-Badore), Debbie Wong, Psychotherapist Lindsay Riccardi, Relationship Expert Dr. Kathy Nickerson, Motivational Speaker and Former Mrs. USA Dr. Tracy Kemble, Fashion Fit Formula and Psychotherapist Dr. Connie Stapleton. Weight Loss Surgery Giveaway sponsored by Dr. Alberto Aceves. Additional sponsorship by St. Mary’s Medical Center & Delano Regional Medical Center.
If you are coming to meet Eggface and MeltingMama in Los Angeles, use the following promo code and receive 50% off admission:
Featuring Dr. Bob Basu, UGH Bariatric Program and Dr. John LoMonaco, Dr. Guillermo Alvarez, Motivational Speaker and WLS Post-Op Yvonne McCarthy, Fashion Fit Formula, Psychotherapist Dr. Connie Stapleton and others.
Weight loss surgery is constantly changing as we learn more about the mechanisms of weight loss. Many of the changes are being driven by surgeons who aren’t afraid to innovate, such as Eldo Frezza, MD, MBA, FACS, a professor at Texas Tech University Health Science Center in Lubbock, Texas, and author of Slim the Italian Way—A Weight-Loss Surgeon’s Guide to Losing Weight. Dr. Frezza has put a relatively old procedure—vertical sleeve gastrectomy (VSG)— to a new and controversial use: gastric banding with stomach reduction (GBSR).
How exactly the VSG began is not certain, but it has a long history. According to Dr. Frezza, surgeons in Japan used a similar technique in the treatment of tumors in the 1980s. There is reference to a similar operation in France in 1993. Many people believe that VSG as we now know it was started in the 1990s by the internationally renowned bariatric surgeon Michel Gagner, MD, FACS, FRCS.
Dr. Frezza explains that the VSG operation differs from some of the other popular weight loss surgery methods because it involves the removal of a part of the stomach. Dr. Frezza says, “This is a very important concept. For instance, in the vertical banded gastroplasty, we staple parts of the stomach, but the stomach remains inside the abdomen. In the case of the sleeve gastrectomy, however...click here to read more!
At the end of May, OH held a one-day event at the Crowne Plaza Detroit Metro Airport in Michigan. Co-sponsored by Dr. Ayoub Sayeg and Dr. Michael Pleatman, the event featured WLS post-op and motivational speaker Laura Preston, addiction counselor Jason Wilkinson, fashion consultant Indigo Zuri and Lifetime Fitness. Hosting the day’s festivities was local celebrity and WLS post-op William “Big Will” Elijah, and vendors (including Astute Artistry, Progressive Counseling, P2Styles Fashion Consulting, Lifetime Fitness, Sayeg Plastic Surgery and AchievOne) offered everything from complimentary eyebrow tweezing and dermabrasion to discount Lifetime Fitness memberships. Free samples were provided by Kay’s Naturals, Profect and AchievOne.
