Forwarding Some Information

I'm really struggling, so depressed and upset. Have gained significantly over the last few days and feeling just terrible physically and emotionally. Just don't think I can do this anymore. For the first time in my journey, I've had to go up a size or two from my lowest. Just don't think I have it in me anymore. Anyway, I get some information periodically from another support group in CT and so am passing this along. Hope it helps someone. Take care, friends. Maureen Success Habits of Long-Term Gastric Bypass Patients Colleen M. Cook; Charles Edwards, MD, FACS St. Mark's Center for the Surgical Treatment of Obesity, Salt Lake City, Utah, USA Background: By identifying common habits of the most successful long-term gastric bypass patients, one is able to establish more specific guidelines for new patients to follow. The first postoperative year is a critical time that must be dedicated to changing old behavior and forming new, lifelong habits. Methods: 100 gastric bypass patients from 1979 to 1995 participated in a comprehensive survey. Surveys were completed in person, by phone, or in writing. Participants were asked to answer questions regarding their eating, drinking, sleeping, exercise, and personal habits. Results: The survey revealed that specific habits are common in gastric bypass patients who have maintained their weight loss for many years. Conclusion: Identifying and defining the common habits of patients who are successful with long-term weight loss enabled specific guidelines to be established for new patients to implement during the initial weight loss phase, which will contribute to life-long success. Key words: Behavior, exercise, gastric bypass, habits, morbid obesity, surgery. Since 1979, the surgeons* at the Rocky Mountain Associated Physicians office in Salt Lake City, Utah, have collectively performed over 8000 Roux-en- Y gastric bypass procedures. In those nearly 20 years, much has been learned about the habits and behaviors that contribute to or are detrimental to the long- term success of gastric bypass patients. The success of weight loss surgical procedures is most commonly defined by the total weight loss during the initial weight loss phase. However, fore- most in the minds of weight loss surgery patients are the questions "Will this be a long-term permanent solution?" and "What can I do to insure my life- long success?" Methods We conducted a random survey of 100 gastric bypass patients who had undergone surgery from the years 1979 to 1995. They were asked questions regarding their eating, sleeping, drinking, exercising, and personal habits. From our research, we identified six key habits that are common among our most successful long-term gastric bypass patients. Surveys were completed in person, by phone, or in writing. Our research details are as follows: Success was defined as maintenance of at least 74% of the initial weight loss. Patient demographics are shown in Table 1. Survey data are shown in Table 2. The habits surveyed were eating, drinking, sleeping, exercise, and personal habits. Table 1. Patient demographics Demographic Value Gender (female/male) 95/5 Average postoperative time (years) 7 Average initial weight loss (kg) 47.7 Average weight gain (kg) 5.5 Results Successful gastric bypass patients had each implemented several life-long habits that contributed to their ability to maintain a significant weight loss for many years. We identified six common habits among the patients surveyed, and established guidelines for those habits that will provide needed direction for new weight loss surgery patients. Eating Successful patients ate three well-balanced meals and two snacks per day. Daily servings for each of the food groups were as follows: three servings of protein, three servings of vegetables, one serving of fruit, two servings of bread/ starches, and two servings of sweets. Drinking Successful patients drank water and did not drink carbonated beverages. On the average, patients drank 40-64 oz of water per day: 58% of patients do not drink carbonated beverages of any kind; 55% do not drink juices or sweetened beverages; 53% do not drink caffeinated beverages; and 74% do not drink alcoholic beverages. Vitamins and Supplements Successful patients took daily multiple vitamins, calcium, and iron if needed; 92% of patients took a daily multiple vitamin, 68% took supplemental calcium, primarily in the form of tums{****JAMIES NOTE CALICUM CITRATE IS THE BEST FORM OF CALCIUM FOR US TUMS IS CALCIUM CARBONATE NEED STOMACH ACID FOR ABSORPTION WHICH WE HAVE LITTE/NONE OF IN OUR POUCHES!}, and 39% continued to take supplemental iron, such as Trinsicon or Chromagen. Table 2. Survey data Successful group (kg) Unsuccessful group (kg) Beginning weight range 88-163 88-168 Average beginning weight 112 120 Weight loss range 28-92 22-87 Average weight loss 48 52 Weight gain range 0-13.5 14-61 Average weight gain 5.5 25.5 Sleeping Successful patients slept 7 hours per night on the average, and 76% of patients rated their personal energy as being average or high. Exercising Successful patients exercised regularly to maintain their weight; 77% of patients exercised. The average was four times per week for at least 40 min. Patients reported exercise as a key factor in their ability to maintain their weight. Comments such as "helps me keep my weight in check" and "keeps me in control" were noted. Personal Responsibility Successful patients took personal responsibility for staying in control. Of the patients, 69% weighed themselves at least weekly. They were found to have a general feeling that maintaining their weight was indeed their own responsibility and that the surgery was a tool that they used to reach and maintain a healthy weight. By weighing often and allowing themselves only a few kilograms of leeway, patients stayed in control. In those patients surveyed who were not classified as successful, an absence of at least one or more of the six success habits was found. The most common were lack of exercise, poorly balanced meals, constant grazing and snacking, and drinking carbonated beverages. In the entire number of patients surveyed, including those who have gained back part of their weight, 97% of patients viewed their gastric bypass as a success. Discussion Successful patients ate three well-balanced meals and two snacks daily; drank water and avoided carbonated beverages of any kind; took multiple vitamins, iron, and calcium; slept 7 hours per night; exercised regularly; and took personal responsibility for weight control. Carbonated beverages may be detrimental to the long-term success of gastric bypass for the following reasons: Carbonation: When the cold beverage is consumed, it warms and releases gases, distending the stomach pouch. The stretching of the stomach then creates undue stress and subsequently causes stretching of the anastomosis, Caloric intake: Many carbonated beverages are high in calories, are low in nutritional value, and contain simple sugars. Not only do they add additional calories with low nutritional value, but they are absorbed quickly into the blood stream, causing a rapid rise in blood sugar, elevated insulin levels and increased hunger. Caffeine: Many carbonated beverages contain caffeine, an appetite stimulant, which is detrimental to initial weight loss and long-term weight control. The first postoperative year is a critical time that must be dedicated to changing old behavior and forming new, lifelong habits. By identifying these six common habits of our most successful long-term gastric bypass patients, we have established more specific guidelines for new patients to implement. Guidelines formulated from the results of this survey have provided needed direction. Acknowledgments The authors acknowledge the assistance of Dawn L. Armstrong, St. Mark's Center for the Surgical Treatment of Obesity; Mary Ann Christiansen, Rocky Mountain Associated Physicians; and Anita Hansen, Rocky Mountain Associated Physicians. (Received July 2, 1998, accepted September 18, 1998) Presented at Allied Health Session, 15th Annual Meeting of ASBS, Orlando, June 29, 1998. Reprint requests to: Colleen M. Cook, Vice President and Founder, Bariatric Support Centers International, 1160 East 3900 South, Suite 4200, Salt Lake City, Utah 84124, USA. Tel: 801-268-6262; Fax: 801-281-6248.

Reenie! Get a grip! So you are up a size? Well, I guess you could throw in the towel and just resign yourself to gaining back all the weight you lost and going back to the the person you used to be. That is a choice, but certainly not one that you have to make. You do have choices and control. Take back the power that you are trying to give away. You call the shots in your life, no one else. You can continue to be the raving success that you are, and you can demonstrate the way to handle setbacks that inevitably hit all of us. I know your heart Girlfriend. You have the heart of a fighter, not a wimp. You can tough your way through this, and to it with style. Your value never was determined by the size of your jeans.... not 4 years ago, not a year ago, not now. Love you... Joy

Reenie, my Friend I agree with Joy DO NOT GIVE UP. Maybe change your thinking into choices instead of this being on a diet. diet's don't work never did when we were heavy, won't work now. So do today one thing that will amke you fell better. Get all your water in. Stay away from sugar, something like that. I have had to do it this is a fight we want to win. Weather has changed to cold 7 that does not help the depression, but, You are a important person to all of us & we all go through bad weeks. Last week was mine. So i am right there with you on that!! Hang in There & DO NOT GIVE UP no matter what your week was like. We are all fighting. Mike if you are reading this go kick Reenie's (little Butt) Yes, I said little. You are little & don't fret so much with a little gain. It WILL come back off. Maybe you go too low & your body is telling you that this weight is better for you. Go have a Great Day. You deserve it!! Marilyn, the Bearlady

Hello?? Is Reenie there? Obviously, someone logged into your name and wrote that message, because it's definately NOT you. You CAN do this. Yes, things are tough---I gained too. But I'm NOT giving up on this, there's just no way. I know what you're saying and I know what it feels like, but think of everything you went through to get to this size. You cannot give that up. Thank you for posting that study...it helps alot. I don't drink carbonated stuff but I DO drink a ton of caffeine....and now I know that has to be cut out. You are WAY stronger than the Reenie that posted this...and I know it. Check out this website: http://www.intuitiveeating.com/ It's a different approach to what we've been given, but hey, it's worth reading. I may not follow the entire idealogy behind this, but the main point is knowing when we're hungry and when we're eating emotionally...and I think that makes a big difference in what we're doing. I think there are times we SWEAR we're hungry when we're actually not. I still have a lot to learn about my body and my signals and I'm struggling. But I can't give up....and neither can you. It isn't an option. We love and need you! Hugs, Joanie

Listen missy, you only fail when you stop trying. Giving up is not an option. We are in this for the long haul and we´re in it together. Hell, I´m in it from half way around the world. Take a breath, step back and regroup. We can do this. Notice I didn´t say "you can do this." It takes a village to raise a skinny person and we´re your village. Lesson from the Casbah: When I was in Tangier, we visited the Casbah, which used to be royal territory and where the beautiful people hung out, but is now an urban neighborhood. In the Casbah, your business is everybody´s business. Everyone raises everyone else´s children and they are responsible for each other´s success in life. When one person´s family member gets married, everyone in the neighborhood pitches in with helping and putting up the out of town guests. Well, welcome to the wls Casbah. We´re all here to help with everone else´s success. Love ya! Connie

OH NO YOU DON"T!!......Write this down so that you don't forget: YOU CAN NOT AND WILL NOT QUIT!! I WILL ECHO CONNIE......QUITTING IS NOT AN OPTION!!! I KNOW WHERE YOU LIVE GIRL!!!!! Marilyn doesn't need to worry.....I will be there to administer the kicking of that little butt!!!! C'mon kiddo....things are rough, but think of everything you've gone through in the last 21 months. Yes, it's 21 months......how long did it take you to get to the size you were when I met you in Middlesex Hospital??!! Get this through your head once and for all, my friend...... It took years to develop all of the bad habits that got you here and it's going to take years to break them. If you refuse to keep on fighting for your own sake, think of everyone else who's depending on you: First and formost, there's your family.....that should be enough right there. Then there's all of the Marchers who need your wisdom, humor and support.....especially me dammit.....I can't do it alone and furthermore, I'm not going to let you quit without a fight. You had better get your skinny ass to that meeting Thursday. Yes you've hit a wall, but you can't get through it if you don't try. I'm here for you Maureen, and so is everyone else. HANG IN THERE!! Mike

Listen here maggot! What are you thinking! WHAT ARE YOU THINKING! OK, I'm stopping my impression of a drill intructor now, but really as Mike said, this is not an option of quitting. You don't have a choice in the matter. You will succeed. There is no alternative. Here is the deal. I know you are going through a rough patch. Things aren't great and this time of year can bring on additional feelings of depression. Hell, I saw a recipe for soft carmels today and had to change shirts because I salivated so much. Back in the day of fatdome, I would have cleared off a plate carmels in the blink of an eye. But all of that has changed. Do you think we all don't struggle? We all have our issues. Hell, I'm tired of being third string to my wife right now. But, we three kids, we are caring for her elderly mother, and then there is our relationship. My wife is a wonderful woman, and while the little dawg may get the idea that stepping out for some fun may be a good idea, it just is not an option. Why? Because I'm not going to give up 17 years of marriage for the physical pressure making a mistake would bring. Do you see where I going with this? Don't give up everything you have worked for to feed the limited amount physical pleasure derivived from quitting. Don't feel like you are weak. You are very brave. Anybody who stepped up and admitted to needing help, underwent a surgery that may have caused death, is very brave. You can do this, you will do this! Look at the help you have here! We care about you and will not let you fail. Hell, email me if you need my phone number to call, I'll talk with you if it will help. But I know that you will work through this. 1. Stop weighing in daily 2. Focus on what positives you have now and how you can do so much more then you could before. 3. Meditate,pray, go to your happy place. Do whatever it takes to get to reflect on just how lucky you are. 4. Be positive, you are going to come out ahead on this.