help me with this...

hi all, I am little over 2 years out had my Open Gastric Bypass August 28,2003 I need help do you measure your food? how much and all. i have never mesaured my food. i wish i had local support but i havent found any help yet.I have no car so i cant get to the support meetings. i have no one . in my picture i was about 173 now i am about 199 pounds. i do have PCOS not sure if that is the reason why i have gained. any help would be so greatful.I want to start the new year with measure all my food. i guess i do have to quit the diet pepsi and drinking with meals.Anita ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ someone told me she uses a 4 oz. container and she only eats whats in that one 4 oz. container. is that a good idea? or do you eat like 1/4 cup of this and 1/4 cup of that and some meat? how much do you measure? my problem is i love to snack like, lately it is white chedder popcorn, nuts, twizzlers , sugar stuff, sugar free pudding too.. what are good snacks? i could eat. i can almost eat a whole reg. plate of food. this 4 oz. container will be very new for me and i really want to do this. it will also be hard for me to not eat with my meals. and i have to try and stay away from the diet pepsi. thanks for listening and helping. you all are friends to me on here. tonight i just bought some yellow and green squash, fresh mushrooms . i think i will make a nice foil dinner and include other stuff also. also my dietian never told me to use protein powder and i do have some akins chocolote that was giving to me . should i start using that . if so how much and all.anita

Hi Anita, I see you had Dr. Cole as your surgeon, he was mine as well. I would suggest that you call the Dr. office and contact Colleen Bucher the nutritionist she would be very glad to help you. I think from what I have learned from her is to stay away from the sugar and snacks, if you are going to have a snack make sure it has some kind of protein in it, such as 4 or 5 crackers with peanut butter or cheese on them, or tuna salad, she even suggested that we can have (sparingly, not too often) refried beans with cheese and salsa and BAKED tortilla chips only a few chips, the rest is good for you. Stay away from those thing with all the preservatives in them and yes stay away from the soda, she said the soda bubbles can swell the pouch. Also she said to make sure you have variety in your meals, but concentrate on your protein first, I am only a month out and can eat about 1/2 cup at a time. I try to have like 2oz of protein , and the rest some vegies. Try serving yourself on a salad plate, don't use the regular size plate. Hope this helped you in some way. Good luck. I sure hope you can find a way to the meetings, you are really missing out on tons of information. I go to the meetings at East High School in Corning. I will ask the lady who runs it to see if there is anyway they can help you get to them. The next time I go will be Jan. 9th. Shannon Arnold 257/229/130???

hi Shannon, I did buy the 4 oz. containers today. that is only a half cup. i bought them in the baby section of the dollar store.i am going to try and just eat one but what if it is not enough. how can i break a meal down into 4's with a 4 oz. container? I did talk to colleen on the phone the other day and she said to try and cut my intake in half. and of couse the diet pepsi and do water which i dont do much. and also to try and walk more. i did buy the lemon powder stuff today to add to my water.its new out. i plan on starting out new. also how about snacks? lately i love white chedder popcorn. isnt popcorn good either? if you want i can give you my # if you find someone that can help me. just email me and i will send. anita

Anita, Hun I used to measure my food in the beginning and I am starting to get back to that now since I can eat more so I need to watch that. I also try to track my food intake at fitday.com, that sure helps see what you are eating every day! Give it a try, it might just help. I know when I add Diet soda to my meal plan it seems to slow down my weight loss as well. try to stay with the light colored, caffeine-free diet coke like 7up or sprite. I try and do that only as a treat now, since I do not like it slowing me down. Just be careful with the protein powder, make sure you are not getting to much protein since you can eat more now because you will not lose if you take in to much. I think some Dr's don't want you to use it after you can eat enough without it. They rather you get your protein with the food, I do take in some protein powder from time to time. Well take care hun and I wish you all the best.... ~hugs~ Happy New Year! Debra P

Hi Debra, thank you for your advise also. maybe i should start writing down all that i eat . i will look at fitday. that should help also. i have been drinking diet pepsi for awhile now so i guess i am addicted to it. but i do have other stuff to drink and i will leave the diet pepsi for my husband. my dietcian from my surgeon said before to eat the pretein instead of the powder. how do you mix it. i did try it once and it was very very thick and it is chocolate . happy new year to you too.... anita

Anita: (*WARNING I TEND TO RAMBLE AND MAKE THINGS LONG SO TAKE A DEEP BREATH PULL UP A CHAIR AND STAY A WHILE ) lol BELOW IS MY OPINION ONLY based on my education/research &personal experience. I run a in person support group and various online groups! Hi I am 3+ yrs out of Lap RNY proximal 100cm bypassed. The honeymoon is over for many of us at 6, 8, 12 months or so. WE get that GOLDEN time to learn new habits and lose as much as we can (what the tool will do regardless of what we do). Even if we did not take optimal advantage of that time, it is never too late to learn/change/grow/progress to the life we need to be happy, healthy and successful! I am here to say REGAIN CAN & DOES HAPPEN COMMONLY!!!!!!! SO any newbies out there read & PLEASE change now or it is just like before HARD, HARD WORK! Over time the ability to eat larger quantities and larger varieties of food happens for most of us, we lose that HIGH of losing wt rapidly/almost effortlessly, it is a challenge later on...The pouch matures, it is a muscle after all and can stretch if we continue to overfill it... WHAT we put into it matters a lot PROTEIN FIRST! WHY? It sits heaviest, fills us up (crackers, pretzels etc do not!) Do an experiment; fill a 1-cup measure with a piece of chicken, then with crackers (Crushed up!) What weighs more? How many calories are in that cup of chicken? How many in the crackers? Our malabsorbtion of calories slows over time (not of vits/minerals though!) as the body adapts (life saving mechanism) so we don't lose to nothing and die!....WE NEVER MALABSORBED SUGAR EVER...sugar (in the way of carbs crackers etc) is absorbing the MOMENT you put it in your mouth with saliva! A cracker does go to nothing in your mouth, but does that piece of chicken? NOPE..Carbs also for many (self included) leave us UNFULL, Hungry in a few hrs due to insulin rising/falling (read south beach for the science behind this if desired).. So we GRAZE all day, ONE OF THE BIGGEST Ways TO DEFEAT THE TOOL! Calories still matter. I suggest going to www.fitday.com LOG EVERY morsel u put in your mouth! POST A TYPICAL DAY FOR US OK! No denying when u see it in Black/White! It will give u a way to see the changes needed also. Make one at a time as not to be overwhelmed. I think u r drinking/eating together..Ok #2 way to defeat the tool is to eat/drink together.. u will make a slush that will pass the pouch and u wont feel full and in essence could eat like a NORMIE! LOTS & LOTS. The pouch is a slow leaky drain w/o a plug if u put soup in it no fullness, but protein *(yeah back to that piece of chicken!) it sticks a while.. long enough for those stretch receptors to go to brain to say stop I am FULL! Many feel soda (even diet) causes wt regain, (one lady in the offtrack group I co-own/moderate lost 50# giving up diet soda alone!?) http://health.groups.yahoo.com/group/OSSG_Off_track/ feel free to join it is a group for those 1 yr out+ (newbies may lurk and I recommend that to see what can/does happen and how to avoid it! But newbies can't post until 1 yr anniversary) stretching the pouch perhaps, the caffeine is as the bubbles a gastric irritant, risking possible ulcers, stretching the pouch or stoma worse yet! OR adding the phosphorus in it helping leach calcium out of your bones and we are already malabsorbing calcium and at risk for osteoporosis! Caffeine also interferes with much vit/mineral absorption! (We have enough trouble after RNY as it is!)....What people can eat is individual (and lose etc) (or maintain)...They say up to 9oz may not effect wt.. I know I can eat a lot of some things and less of others. Density is key for me! Mostly I can eat 1 cup of food. (8 oz). I do a protein shake for am, (5am before I go to gym), at 9am a lo carb yogurt (bluebunny http://www.bluebunny.com/ProductList.aspx?productcategoryid=63 at Wal-Mart of dannon light n' fit carb control (I don't like these as well they do in a pinch!) http://www.dannon.com/dn/dnstore/cgi-bin/ProdSubEV_Cat_240859_SubCat_262218_NavRoot_200.htm with lean protein bites http://www17.netrition.com/breakthrough_lean_protein_bites_page.html (lemon or peanut butter flavor), lunch at 12 noon is 99% of the time a NICE beautifully made salad of: ~2cuips mesculin/spinach/romaine greens, broccosprouts, few pieces of shredded carrot, 1 radish, ¼ avocado sliced, 2-3 slices of cuke, few broccoli florets, slices 4-5 of celery, 3-4 oz tuna/shrimp/salmon/chicken/turkey etc on it, ½ Hardboiled egg also, 2T sunflower seeds or sliced almonds, 1T ground flaxseed (fiber for my constipation and good omega fatty acids to boot! Nutty flavor!) and 2T salad dressing, usually lighthouse brand jalapeno ranch or blue cheese (full fat as we malabsorb some fat and ff or lowfat are usually loaded with sugar!) or my own vinaigrette! (walnut or canola oil, varied vinegars, good seasons packet herbs etc/water). A typical dinner is 3-4 oz meat (chicken/lamb/fish/turkey etc) 1/4 cup sweet tater or mashed cauliflower (or 2nd veggie) and 1/4 cup green beans. I haven't touched pasta/rice since surgery, too many carbs it swells they say and best for me to avoid! I used to eat potatoes, I try and avoid now due to higher GI http://www.glycemicindex.com/ than sweet taters. I haven't touched sugar in the raw form, or in cakes/cookies/candy etc I fear dumping but ya know what I fear more? NOT DUMPING & being able to eat that stuff that made me fat pre-wls.. (I see so many go down this road! L )1 cookie won't fill u up, I bet it never did, even after surgery, again each calorie of that cookie is absorbed , it doesn't add to my nutritional health and I try and eat to live vs. live to eat. It takes great effort to restructure my thinking on food...Really for me one cookie would hurt I believe, it may fill u at 2,4,6 months out I am here to say it is such a slippery slope for many those 1 or 2 cookies turn to a dozen of 1-2 every few hrs... YUP they operate on out tummy not brain, again that operation is up to us! (LOL) it is a journey an awesome one but I feel if we are not diligent it can slip away FAST! (not to be gloom and doom just reality!). I also drink at least 8 cups PURE water a day and usually another 8 cups diet Kool-Aid or crystal lite or decaf tea/herbal tea. I use soyslender plain or vanilla milk in my tea of hood carb countdown (green box) dairy beverage.. (lower in sugars). http://www.westsoy.biz/products/slender.php or http://www.hphood.com/products/products.list.Cb.asp Many times we feel hungry we are thirsty, a trick I employ is drink 8 oZ water/decaf tea or crystal lite and wait 10 min see if I am still full! I prepare my food/fluid each day, I take it with me so I am prepared! I also plan dinner each night so no bad choices at rush when I am home! It is what I find I HAVE TO DO to make my life work.. It takes time but saves so much more! I feel if we cant find time for ourselves something has to give somewhere or we are back to where we were preop overweight and serving everyone's needs but our own, angry/depressed etc! Snacks, in eve usually a shake, or 2T peanuts (if I am strong and can ration) or small apple w/ skin and 2 oz cheese, or porkpuffs (cinn flavored pork rinds! YUM!) http://www17.netrition.com/lcs_pork_puffs_page.html http://www.lowcarbcare.com/ If u are going to have a carb (such as apple) mix w/ protein (such as PB or cheese!) so it lowers overall glycemic load! I exercise EVERY SINGLE DAY! I have to for my emotional and physical health. I love it and I feel better doing it! It revs my metabolism and destresses me and I can eat more, I STILL have food issues and yeah love to eat! BUT balance is the key. I do 45-60 min cardio a day and 4x week I do wt lifting/strength training. I stretch 10 min also daily at end of my routine. START SOMEWHERE with exercise 3x week 30 min walk, curves, Leslie Sansone http://www.lesliesansone.com/ walk off the pounds videos, go to library and take out exercise videos, rent them, something.....Add slowly as u are able to daily or as close as u can 60 min probably....IT FOR ME HAS TO HAPPEN no ifs, ands or buts. I had this surgery to change my life, the tool is there but the lifestyle and choices are up to me. Choices are ours, and there are consequences to our actions/inactions....You can do this...IT is never too late, your not a failure, you have just slipped a little.. but before u find that regain creeping higher and higher, look at what u r REALLY doing, Make a goal for change and plan.. I say it is about progress not perfection, what u do 90% of the time matters! and if u fail to plan u plan to fail.. some mottos that help me. I regained also at 1 yr out (10# yikes I thought!) my honeymoon stopped at 7 mo, hunger returned and I got ****y, eating too many carbs (bread/crackers/chips etc). THEY had to go.....I developed the south beach philosophy (a good fit for wlsers) and with my shakes I 'detoxed off those nasty buggers!' It was 2-3 days of missing it, headaches etc but after that I was not hungry it is AMAZING the power of protein!!! I don't count carbs, I keep calories for me around 1,500 most days... that magic calorie # is individual for us all.. I bounce up & down 5# (10# IS MY DANGRER SIGNAL TO CUT THINGS OUT AND BE BETTER AT BASICS AND REEVALUATE PAST FEW WEEKS)...or so depending on things, I weigh monthly (no more as I know what I am due to what I am doing/eating etc) and I don't recommend more than weekly, gives scale too much power, it lies anyways due to water wt, constipation time of day etc! It is one age to success is all! Measurements, how u feel/clothes fit are good also! It IS MORE ABOUT A NUMBER ON A SCALE IT IS ON THE lifestyle WE NEED TO LIVE TO BE HEALTHY! PCOS is usually helped after WLS, ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ http://www.medscape.com/viewarticle/519935?src=search PCOS in Morbidly Obese May Be Reversible With Bariatric Surgery Dec. 16, 2005 -- Weight loss following bariatric surgery in morbidly obese women with polycystic ovary syndrome (PCOS) can normalize the metabolic, hyperandrogenic and reproductive abnormalities that accompany this syndrome, Spanish investigators report."Our findings indicate reversibility of PCOS in morbidly obese women in response to normalization of insulin sensitivity after sustained weight loss," lead investigator Dr. Hector F. Escobar-Morreale told Reuters Health. "This suggests that the mechanism underlying PCOS in obese women is possibly quite different compared to those of lean individuals, in whom insulin resistance may be a much less important factor."Dr. Escobar-Morreale and colleagues at Hospital Ramon Y Cajal in Madrid performed bariatric surgery on 36 premenopausal women for whom noninvasive weight loss strategies had failed. Seventeen were diagnosed with PCOS, a frequent finding in morbidly obese women.After excluding seven patients who had been previously diagnosed with PCOS, the researchers estimate that 35% of the patients had undiagnosed PCOS, a nearly seven-fold increased prevalence compared with that in unselected female blood donors from Madrid.They report the patients' outcomes in the December issue of the Journal of Clinical Endocrinology and Metabolism.Among the 12 women with PCOS who were available for follow-up, the syndrome resolved after the marked weight loss achieved after surgery (mean, 41 kg after a mean of 12 months). Regular menstrual cycles were restored in all 12, and luteal phase serum progesterone concentrations of 4 ng/mL or higher confirmed that they were ovulating.Elevated fasting insulin levels, observed only in those with PCOS preoperatively, returned to the reference range after weight loss, as did hormone levels.Dr. Escobar-Morreale recommends that all morbidly obese women be screened for PCOS, thereby preventing "reproductive complications of PCOS (infertility, endometrial hyperplasia/carcinoma) and permitting treatment of cutaneous symptoms."He advises that screening include "clinical history, physical examination including hirsutism score, serum total testosterone and sex hormone binding globulin (SHGB) levels to calculate free testosterone concentration, and evaluation of ovulatory dysfunction by using luteal phase progesterone levels or basal body temperature charts.""Based on the excellent response in our series, follow-up without specific treatment would be enough," he added. "Pharmacologic treatment (antiandrogens and/or insulin sensitizers) should only be considered if symptoms of PCOS persist after sustained weight loss." J Clin Endocrinol Metab. 2005;90:6364-6369 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ but even if not it is a good reason to eat a higher protein, lower (better carb diet!) with good fats. I don't believe in diets, I believe in lifestyle changes..! The problem u have id, the non-nutritive snacks: sugar! IT is keeping u hungry, adding to wt gain. YOU can control it! By using protein and good carbs/good fats! It is not so much about portions (it is a piece) but I will bet if u cut these nasty carbs out and such u will be eating many less calories, feel full sooner and be eating less overall! Problem with SF?FF pudding is again a slider food (no fullness) and made with milk , so not sugar free, again can add to carb cravings if u r insulin sensitive (with PCOS u r!) I wonder when your last set of full labs were??? I have included common clinical nutrition req on labs postop!!! Below....Do u take a multivit? Calcium (citrate form, no tums of carbonate for WE CANNOT USE THAT we do not have acid in our pouches!), B12?....... Bariatric programs differ in postop F/UP and nutrition info, some say protein shakes, others say no.. With the lower stomach and duodenum/1st part of jejunum bypassed we can be at risk for protein deficiencies! (even if eating enough protein, we may not absorb it all off the food! So shakes that are 100% Bioavail and predigested work to feel our cells, fuel our metabolism and decrease our hunger!)It is up to you to see what u need! (Educate self on benefits of whey protein and choose, I cannot tell u what is best, but work with a knowledgeable health care provider one who knows us well! a clinical nutrition DOCTOR or Bariatrician!) http://www.wheyoflife.org/ or http://www.wheyprotein.com/sec_intro.html *Not those nasty Atkins shakes which are not all whey they are milk protein I believe (calcium caseinate) Whey is 100%predigested and bioavailable....W/O the sugars in milk (1 cup milk skin 90 cal is 8 g protein, 13g carbs (as milk sugar)!!!! Although natural still sugar!) My shakes are 23g protein 120 cal, 0g fat 2-3g carbs! The ones I use are: I like PVL whey gourmet flavors the best, White chocolate, vanilla, raspberry, caramel dip, milk chocolate, PB chocolate, blueberry, orange cremescicle.... This is where I order it online: (2# tub $21.95) http://www.a1nutritionproducts.com/buy/pvl/whey_gourmet Most 120 cal 23g protein a scoop 2.6 g carbs 2 g fat.... 15 Flavors to choose from and more to come! NEW Arctic Cappuccino FrappeNEW Creamy Dreamy Milk ChocolateNEW Radical Raspberry SmoothiePiña Colada BreezeCreamy Orangesicle SwirlCreamy Caramel DipDark Chocolate MousseMocha Java MadnessSmooth Peanut Butter ChocolateStrawberry Banana SmoothyBlueberry BurstChocolate Chip Mint ExtremeVanilla Ice Cream RoyaleSilky Smooth White ChocolateRootbeer FloatCookies & Crème SupremeSAMPLES AT: http://tinyurl.com/9prnh$1.99/ea.Here is PVL's website so u can print it off and take to GNC or Vitamin World when u ask them to supply it! It is out of Canada.http://www.pvldirect.com/http://www.wheygourmet.com/~~~~~~~~~~~~~~LABS: COMPREHENSIVE METABOLIC PROFILE LIPID PROFILE GGT, LDH, Prealbumin PHOSPHORUS - INORGANIC, URIC ACID CBC w/ diff B-12 & FOLATE, B-6 & Thiamine (B-1) IRON, TIBC, % SAT, FERRITIN VITAMIN A, E & D (25-hydroxy) THYROID PANEL (T3, T4, TSH)*only initially unless suspect. ZINC, MAGNESIUM, Selenium SERUM INTACT PTH Homocystine, MMA HGB A1C (only if diabetic or suspected) DEXA SCAN Diagnosis: 579.3 post-surgical malabsorption 268 vitamin D deficiency 269.2 hypovitaminosis 268.2 metabolic bone disease 244.9 hypothyroidism 401.9 hypertension IF you desire my document on south beach let me know..I can post that but I have gone on and on too long! I hope u join us on off-track & with u the best! What we can eat and what we CHOSE to eat are 2 entirely different things! Take Care, Jamie Ellis RN, MS, NPP Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!" ***disclaimer, I am a medical professional, but nothing in this email should be considered medical advice, please consult with your health care providers for your best treatment! (I hate putting this but past experiences force me!) J also forgive any typos! I make many typing too fast for my long acrylics! LOL

Here are 2 files from my offtrack group, my recioe fir success and back on track tips! HTH Jamie MY recipe for success: FIRST YOU IDENTIFY THE PROBLEM SECOND YOU FORMULATE A PLAN OF ACTION! THIRD you post it here so we can support you (Being accountable to someone outside of self helps!) ~~~~~~~~~~~~~~~~~~ NOW MY PLAN was it takes about 3 days to overcome the HORRID/VICIOUS carb addiction cycle for MOST (the physical aspect that is)... SO STEP ONE: I detoxed my house of all foreseeable triggers/carbs. (Join me on the pitch and ditch car) STEP TWO: I loaded my home with things allowable such as cheese sticks, pepperoni, jerky, eggs (hardboiled a few ahead), sandwich meats, stocked up on shakes so I had variety for the 3-5 a day I could use, low carb veggies etc..... STEP THREE: I was following the south beach phase 1 plan (adding shakes as above), so I had the book and there is a document explaining the reason it works/the plan in the files under http://health.groups.yahoo.com/group/OSSG_Off_track/files/ first folder back on track tips and plans.. Karen B's timer plan is there and many find that SO helpful! I KEPT IT HANDY TO READ/REREAD in times of crisis. STEP FOUR: Place motivational sayings all over, on computer on fridge (like nothing tastes as good as healthy & thin feels0, you can do this, its only a craving and will pass in a few minutes! STEP FIVE: List a bunch of things to do to pass time when a craving happens (it will happen and it will pass!) take a walk, drink a cup of water, have a shake, call a friend, email a friend, email the group, brush your teeth, listen to music, pet an animal (walk the dog), journal your feelings, give self a mani/pedicure, deep breathing/relaxation, go for a ride (bike or car) etc chew gum, have a sf hard candy. HAVE IT HANDY, as when we are impulsive it's hard to think so go to the list not everything will work all the time but it helps delay! STEP SIX: MUST PLAN, plan meal, prepare take fluid and food with you, if you fail to plan you plan to fail as we say here on off track. THIS is about progress, NOT perfection so don't beat self up, know that things improve with each passing day u get the refined carbs outta your body. It really gets easier cause if you don't put the junk in the hunger really decreases it is amazing!>>>>Again south beach worked for me...took me 1 mo to lose my 10# regain following this it was the hardest week 1, after that hunger was minimal and my willpower could handle the HEAD cravings (it couldn't handle the physically driven ones from how I was eating...bread=hunger kinda thing)... STEP SEVEN: WRITE IT DOWN if it goes in your mouth, at least week one...then tell us how u r doing, many use www.fitday.com and I also recommend exercise of some way shape or form for the body soul and mind! TOGETHER WE CAN DO THIS! IT is hard, but you just gotta do it....READY SET GO!!!!!!!!!!!!!!! Another saying we have is its WHAT U DO 90% of the time that matters, this strict carb reduction isn't forever, you can reintroduce things at a later date, for now it is no carbs like bread & crackers cause they aren't your friend, they give lots of calories and little nutritional value and well they make u hungry sooner with NO satiety (full feeling) I agree a burger or a pork chop sits with me for hours!!!!!!!!!!!!!!!! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Jamie's BACK ON TRACK TIPS Your surgery hasn't failed; you are just not using your tool to its potential that is all. It is there still; you need to get back to basics though. Remember it isn't the surgery alone that makes us lose weight it is the lifelong lifestyle & behavioral changes we make that enable us to lose weight and keep it off. Dumping isn't guaranteed after surgery and may decrease the farther we get post-op....with that said: You know the rules of the tool, (what you aren't doing)....So how to get back to basics? You have to just take one step at a time; it doesn't have to be all or nothing that is old thinking! What do you feel you can conquer first? Write down your goal for the week, then work on it, once you have one goal under your belt start on another, be patient and kind to yourself, no one said this was easy! It is hard and no one is perfect! But you can change. The negative habits didn't happen overnight so neither will positive ones! But they wont happen if you don't start somewhere! Asking for help and admitting the problem is a great first step! Get to a local support group at least monthly if available, this keeps you focused on what you are doing and accountable to yourself...Life will always be busy but you need to reprioritize health as a higher priority and taking care of yourself has to be more important than anything else! Here is how I'd break it down (not necessarily what to do first, just an example of the goals I'd set and work on one at a time!) some you may want to break into 2 parts also.... Goals: a.. #1: part 1:Fluid: resolve to drink 64 ounces ( This will keep you full longer and tension on the pouch) of NON-carbonated-NON-calorie fluid a day. (water, crystal lite, diet Kool-Aid, diet V8 splash, tea) In other words don't drink your calories! Part 2: DO NOT DRINK WITH MEALS and WAIT 1-2 HOURS AFTER MEALS TO START DRINKING....(OR U WILL JUST MAKE YOURSELF HUNGRY AGAIN...SOONER!) we can all wait a while and eat again esp. if we drink soon after or with a meal....It is called grazing, we have a leaky drain and after a little time we have more room in the sink to fill so we can all eat a while after we eat, I know at a restaurant I can eat more as the meal is spread over time, if I eat at home I cant eat 1/2 as much as I eat in 20 min and then I'm full and I'm done. b.. #2 Vitamins: resolve to take a multivitamin, and calcium 1,000mg a day. (just to give you some energy!)Maybe some B12 liquid/tablets sublingually to boost energy and metabolism! c.. #3 Protein: resolve to get in 65 grams a day either in the food you eat or by supplementing with shakes. EAT PROTEIN FIRST!!! IT fills the pouch!(less room for carbs) d.. #4 Meals: resolve part 1:to eat ONLY 3 meals a day over 5-20 minutes no longer, (and possibly one small nutritious snack of fruit or nuts etc...)....NO grazing. Part 2:Composition of meals: 50% protein leaving 25% of meal for veggies/fruit and 25% carbs (pasta/bread/rice/potatoes). This means most likely giving up McDonalds for a while or making better choices when you are there...It doesn't have to be 100% of the time but should be the way you eat more like 90% of the time!) e.. #5 Exercise: resolve to exercise 30 min 3x a week, then increase to 60 min 3x a week or 30 min 6x a wee****il you are exercising 30 min daily (or more)! It helps you cope with stress, so you don't turn to food, it will help the wt loss and also give you energy! You will feel better about yourself and be less apt to go for the carbs. f.. #6 resolve to either get involved in a local support group monthly (weekly would be better but at least 1x a month) and or get into therapy to deal with your food issues and look at why you are sabotaging your happiness. We all have food issues/demons and we all need to face them eventually the surgery is a great help but the brain is a hard organ to change and unfortunately they didn't operate it when they shrunk our tummy! g.. #7 if above are overwhelming many go back to postop and start liquids for a few days, then advance to soft/mushys such as yogurt and pudding and cottage cheese, then onto pureed then solids, many say this retrains the pouch and our brains to snap back into it...Again it is all hard but just my 2cents/suggestions! Good luck! Glad you are looking at the issues and wanting to deal with them! Be proud of yourself for that and you can do it, we are all here with you to help! Now is a great time to start, not everything but one thing....Do not put off to tomorrow what you can do today! Think this way if you wait you may have another 20# or so to work on after the holidays! Holidays and parties are always going to happen, we can always find an excuse to wait or a reason why we can't, search within yourself and find a reason why you can and do it (make this your gift for the holidays to yourself, nothing tastes as good as health and thin feel!)! Take care.... Jamie Ellis RN, MS, NPP Lap RNY 10/9/02 320/163 5'9'' (lost 45# before surgery) Dr. Singh, Albany, NY Plastics 6/9/2004 Dr. King Albany NY "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!" [email protected]