Need Dietitians' advise

My name is Rana and I will be 45 years old next month. I have a 30 year history with yo-yo dieting. Every 2-3 years I lose all excess weight, and gain it back (with a little more) within 6 months to a year.  I am 5'6 and weigh 226.  I had decided to have gastric bypass in Oct., so I started the 6 month Dr deal/dietitian deal.  Neither really know too much about surgical weight loss/all that wls clients need to know.  I've been reading the wls forum and found a site that is totally against wls.  Now I'm a little conflicted.  My question is:  Since I haven't had wls, is it better for me to just make my eating habits lifelong and forego the wls?  Have you seen long term effects of osteoporosis with most people who have wls?  If I've yo-yo'd for years, do you think I'll ever keep it off, or should I just go ahead with RNY?  If so, how many proteins/carbs/etc. should I be eating right now (my surgery would be around the 1st of June).  If not, what type eating plan should I use.  The nutritionalist that I'm seeing gave me a food pyramid chart and told me to eat 6-7 starches, 3 fruits, 2 milk, 7 oz. meat, 3 fats, and 3 free foods.  That is just too much for me to eat and/or count each day.  I do much better by something like I'm doing, which is 1 banana or 1 protein bar (1 g. sugar) for breakfast with 1/2 c. decaf coffee; 1 can Progresso soup (120 cal) for lunch; and a meat (grilled) and green veggie for dinner.  I seem to do fine with this amount of food, and it's easy to keep up with.  I cut sweets/caffeine/carbonated drinks from my diet in preparation for wls.  I also began taking a multi-vitamin and  calcium daily.  The bariatric dr. I saw said I had 2 co-morbidities - my knees were starting to hurt and I have some incontinency  (but that may mostly be due to the 10+lb babies I had). Anyway, I know if I lose 6 more lbs then my bmi will be too low for surgery.   Please help me to get on an appropriate eating plan and give me your take on what you think might be best for me.  Am I fooling myself to think that after 30 years of yo-yo dieting that I could take the 70 or so lbs off and keep it off long term without wls? I still have the option of wls if you think it's a viable alternative for me.   Thanks so much for taking the time out to help guide me.  I really do appreciate it. Rana Burt

I'm not a dietician, but I'll chime in with my thoughts and hopefully give you some food for thought, so to speak.   I made some changes in connection with my WLS and have sometimes wondered whether I could have lost the weight without surgery if I could have made those changes anyway.   First, I educated myself about nutrition and learned about what was healthy to eat and why.  I also learned why so many of the things I had been eating were really not good for my health.   Second, I started tracking everything I eat, and I still do this 27+ months post-op.  Before surgery, I had no idea how many calories I was taking in every day; it was probably 3750-5000 calories per day.  I also track my weight every day.  This has helped me create a relationship in my head between how many calories I take in every day and what I weigh.   Third, I exercise regularly - 6-8 times per week.  I did some exercise before surgery, but not with this regularity because it was a lot harder because of my excess weight.  After surgery, I stuck it out when before surgery I would have given up after a few weeks or a few months.  I've been exercising 4-8 times per week for over 2 years now, and I actually look forward to exercise.   Fourth, I finally had the courage to face the reasons for my weight problems.  I used food for the wrong reasons - stress, boredom, anger, celebration, etc. - and I had to figure out how I was going to handle those things that did not involve eating.  For me, this was the most challenging part of the process because it forced me to confront some things about myself that frankly I would have prefered to leave hiding in a very dark closet.  But I think I'm a better person today for having taken this journey... Honestly, I'm not sure I could have made these changes without WLS.  The other thing is that when I "dieted" before surgery, I was always hungry.  Now, I get hungry, but I'm satisified with a lot less food.  So the surgery helped eliminate something that was a problem for me -- feeling hungry a lot of the time when I "dieted."   Anyway, I hope some of my ramblings resonate with you, and I wish you luck with whatever choice you make -  Kellie

Hello Rana, i am not a professional.  i am just an over obsessive-compulsive researcher ... LOL  haha...  i'd like to reseach a lot. this post is going to be VERY LONG.... i am sorry about that ...lol i love to read in detail :-) alrighty here we go :-) take your time reading it ... lol or take breaks ...which ever is best for you ! lol my research ...actually helps me with my weight loss surgery. i research a lot of vitamins , what to take and add to my diet....etc.. also what foods can help me with my weight loss. what kind of snacks are healthier then other foods... foods that will not effect my blood sugar levels..... you know , just the basic stuff. :-) anyways ... I have to be honest with you ..... if you do have the weight loss surgery. you have to be dedicated and follow through with staying on a very healthy diet plan. a diet plan can be something like .. W W diet plan Having the weight loss surgery will change your whole entire life style. A decision to have obesity surgery is not to be taken lightly. Use the internet and do your research! the internet is to provide you with information that can help you decide whether obesity surgery is right for you and if you are a candidate for the weight loss surgery. i am guessing since you mentioned that you spoke with the surgeon and the nutritionist. you probably then know all the rules of the weight loss surgery.

There are eight rules that we have found helpful for weight loss success.  All successful patients have these things in common. 

Consumption of an adequate amount of liquid, preferably water, is crucial. You should consume a minimum of 64 oz. of liquid each day. This can only be done slowly, sipping fluids throughout the day. Gastric bypass patients should never drink more than 2 ounces of liquid quickly. On very hot or humid days, or when exercising, you should drink additional water.  This is necessary in order to prevent dehydration.  weight loss patients tend to get very dehydrated , so we must sip on water throughout the day , when we are not eating anything. drink while you exercise, drink water while you are talking on the phone, drink while you are walking the dog, drink while you are here reading the boards........etc. you got the idea....keep on sipping water.

Eat every 2 - 3 hours of meals that are small portion size meals. example - eat a 3 oz can of tune fish with a piece of fruit  ( melons and berries are the best fruits to eat ) Only eat at mealtimes. Between-meal snacking or “grazing” on small amounts of food throughout the day will sabotage your weight loss and result in the inability to lose an adequate amount of weight.  The primary source of nutrition should be protein. 70 to 75% of all calories consumed should be protein-based (eggs, fish, meat, etc.) Carbohydrates (bread, potatoes, etc.) should make up only 10 to 20%, and fats (butter, cheese, etc.) only 5 to 15% of the calories that you eat. A diet consisting of 600 to 800 calories and 75 grams of protein should be the goal for the first 6 months. Never drink liquids when eating solid foods. Liquids should be avoided for a period of 30 minutes before and 30 minutes after eating meals.  Avoid foods and liquids which contain sugar or high fructose corn syrup. Not only will they slow down your weight loss, but they may make you VERY sick! Sugar may cause “dumping syndrome” in patients who have had the gastric bypass procedure. "Dumping", in short, is when sugars go directly from your stomach pouch into the small intestine causing heart palpitations, nausea, abdominal pain and diarrhea.  Stop eating and drinking when you begin to feel full. Listen to your body's signals. Do not think about the food that is left on your plate. Overeating and overfilling your stomach pouch will cause your pouch to stretch and may prevent weight loss success - or worse - cause long term problems and complications. try to eat a lone at first ...turn off the TV and get away from the computer while you eat because it will distract you while you are eating. It is very important to listen to your body and feel out the body's signals when it is getting full. always eat solid foods because it will keep you satisfied and full longer. eating ....pretzels , popcorn , crackers  and protein bars ( yes , even protein bars ) as a snack ........... will NEVER hold your appetite long enough. as soon as you are all done with those kind of foods and snacks you'll only end up back in the kitchen again , looking for something yet to eat. eat foods that will keep you full. eat protein! all meats fish shrimp turkey ham meatballs hard boil egg yogurt .... fat free cheese cottage cheese portion out a small size and eat them every 2 - 3 hours. you want to be satisfied and feel full. so i suggest stop eating the protein bar and start eating real foods that will HELP you with weight loss and stop your food cravings. It is essential that, within the first 6 weeks after surgery, you begin a regular exercise program, like walking,etc. Research indicates that this will increase your overall weight loss by 12% in 6 months.  Attend support group meetings and workshops. They will help you stay focused and motivated and help you work through the changes that weight loss brings. Plus, you might just make a few new friends!  Support and motivation are the KEYS to losing weight. with or without surgery. you need support ! if you decide not to have surgery ...  i recommend and suggest a diet program like WW WW is the best and healthy diet plan out there. if you get the support system and motivation that you need. you will go far and lose weight and then maintaining your weight  years after you lost weight. having support system MOTIVATES YOU so much in many ways! it effects how you THINK about yourself.  By the way ....exercising also does this too :-) Having a good healthy support system is a must in weight loss. having all your friends and family supporting you...is a wonderful thing they all will say positive things to you everyday. and that will keep you motivated..... and PUSH you when you do not want to execrise! IF you start your diet today , try to go walking for at least 30 minutes as you get better at walking.......  increase the time... and walk 45 minutes......  then increase that to 1 hour. you can also split up your execrising.......  if you want to walk a little extra go for it.  don't be afraid of increasing your time while walking walking is the best exercise! walk 30 - 40 minutes in the mornings. then after lunch walk for 15 - 20 minutes after dinner  ...walk  30 minutes with a friend or family member. walk in the mall , walk around a school track. just keep your self moving and busy. and don't stress over the scale if you don't see it moving. go by measuring your waist ..... get a measuring tape....and measure it today keep a weight loss journal book. write down the number. also write down and keep track of what you eat during the day. and how much exercising you do as well. this also keeps you focus and keeps your mind going on your weight loss journey. with or without surgery....... you must have the dedication to lose your weight and get down to the size that you desire so badly. read health and fitness magazines. keep focus...... once a week try to increase your intensity to shake up your walking routine. sometimes when the body gets use to a certain exercise.... the body holds on to the weight and does NOT let go of the weight. that is what a plateau does... so try to aviod plateaus and PUSH yourself more , ONLY ONCE A WEEK and increase your miles and speed while you walk. you can also buy the DVD Walk away the pounds by Leisle Sansone. google.com research - here again walking is one of the best exercising that we can do without overly killing ourselves exercisng. its low inpact on our knees and body. also you should get Leisle Sansone other DVD's too. you want to break through the layers on your Abs. if you have great abs , your back and body will be in good health. do this DVD video below 2- 3 times a week.... to build up your abd core area. These DVD's workouts for the abs are  ...very nice and easy for the abs. the Ab workout with the stable ball. CLICK HERE also this DVD here , is a great DVD video for the Abs. i believe on the same DVD video there is a workout for your arms. you want to weight lift 2- 3 times a week to keep your arms firm and help you build muscle. get a 2 pound weight to start off with and slowly increase  the weight as the weights get easier for you to hold and use. always start off with light weights and while you do the workouts , go slow do over extend your arm movements. and when you get really good at walking.... you can do THIS DVD video!   CLICK HERE the 5 mile walk ! I love this DVD ,  i do this every morning and then go walking with my mother at the mall  ( for 1 hour ) okay , well , i gave you all the advice and suggestions that i have. Ultimately , in the end , the choice is yours whether you want to go through with the weight  loss surgery or not. i say , if you have a very hard time with dieting THIS time around. if I were you , i would start researching more into this surgery again. and do not go back to that surgeon and nutritionist... because , like you said ...... Neither really know too much about surgical weight loss/all that wls clients need to know you want to find a surgeon that is in the ASBS Center of Excellence Program you can read about this HERE ! you also want to ask the surgeon about their AFTER CARE PROGRAM group support meetings .... are VERY important after having the weight loss surgery. Ask the surgeon if they are part of the American Society for Bariatric Surgery Ask the surgeon if they are part of The Society of American Gastrointestinal and Endoscopic Surgeons those questins are very important to ask. if the surgeon is part of these things , then he is one of the best surgeons around in your area where you live who does the weight loss surgery. you want the BEST surgeon in your area who does this kind of surgery VERY well ! i changed surgeons because i actually did not LIKE WHAT i heard after speaking to the surgeon's nurse who works at the front desk. i asked how many surgeries did the surgeon do. she pulled the phone away from her ear and asked - yelled kind of across the room to her co - worker , and they yelled back to her.... i don't know ... WHAT ???????? you don't know ? THAT there troubled me a lot so i canceled with him  AFTER i got approved :-) and went with Dr Vohra who is EXECELLENT in my area where i live! so you can still do this. you got to RESEARCH A LOT before you decide on which surgeon you want to go with! ask TONS of questions about the surgeon's background. you can also get reports online , you may have to pay for it. although it is worth every single penny! you want to make sure the surgeon who does the surgery is the BEST and did more then 1,000 surgeries ! the surgeron i first picked , didn't even have 300 surgeries under his belt and i do not want to chance my life with that surgeon. he was not part of all those very important questions UP ABOVE in bold ! so i left him and went with Dr Vohra who is part of the ASBS Center of Excellence Program HAS an great aftercare program and is part of the American Society for Bariatric Surgery my surgeon is the Chief of Bariatric Surgery. he is also part of The Society of American Gastrointestinal and Endoscopic Surgeons he was one of the pioneer in the field of laparoscopic and bariatric surgery and performs laparoscopic gastric bypass, lap-band and advanced laparoscopic procedures including colon resection, surgery for reflux, solid organ removal (spleen, adrenal, pancreas), inguinal and ventral hernias and biliary surgery. ask the surgeon TONS of questions! how many surgeries did you do ? how many surgeries patients have you lost ? i have other questions for you, although it is too long to put it all here. so i will email you the list of questions. you can also go to THIS website HERE and print it out as well. sit down with your surgeon that you picked and GO OVER these questions with them! print it out , when you are ready to go visit your NEW surgeon , alright ? you have so much to think about , so don't stress over it now you have time to think about it.....whether or not you want to go through with surgery just take your time and think it all through.... keep on visiting these message boards..... ask tons of questions.. and don't be shy about asking. you can always email a person privately too and ask questions. don't be shy at all. ask .... tons of questions..... alright ? again, at the end , you will know what you want to do , but remember you must be dedicated to you  and getting yourself on the right track so you can feel and look so much better. best wishes to you and please come back and give me some updates or you can email me.... JUST DO IT and MAKE IT HAPPEN! DO NOT STESS OVER Weight loss .... you will lose your weight and it will eventually all disappear... and you'll look gorgeous :-) STAY FOCUS and MOTIVATED! BE determine and STAY dedicated. you'll get the results that you want and desire !! hugss Lizzy

Hi Rana, I think your feeling about WLS are normal. It's a tough decision to make. As you likely have found, WLS is not easy. It's not an easy answer and can be (at times) the most difficult diet you've ever had to do. At the same time, it works. It's the best way for people who are obese to lose weight to save their lives (that we know of right now). This needs to be a decision that comes from you - from how YOU feel about food and changing your lifestyle. Most people who choose to have WLS are at the end of their rope. There is no diet they have not tried & this is the last resort for weight loss. If you feel you can lose weight & keep it off without WLS, then you probably should NOT have WLS. You should try to work on changing your lifestyle with diet and exercise. That may mean seeking the advice of a registered dietitian and trainer. You want to see a dietitian that has experience in weight loss couseling - for general weight loss and weight loss surgery. Then, if you get to a point where dieting isn't working, you can explore WLS options. You may also seek a consultation with a surgeon to discuss with a doctor who knows WLS. Having a consultation does not mean you HAVE to have surgery. You can have a consultation just to ask questions & get more information. Or, if a surgeon is intimidating to you, look for a primary care doctor with the American Society of Bariatric Physicians (ASBP) (note: ASBS is for surgeons). Those doctors are trained in WLS - although not surgeons. In addition, you will always find people for and people against WLS. You have to decide what is best for YOU - I'm glad you are educating yourself on the pros & cons of WLS - it will help you make your decision & feel good about it. Good luck!