Quick note:  The following is informational only.  Always follow your surgeon’s advice first and foremost!  Also, remember that our medical histories are different as are our pouches.  What works for one person might not for another.  Please consider these Guidelines as suggestions and follow the program and the protocol best for you.

BACK ON TRACK TOGETHER - BACK TO THE BASICS

Planning/Preparing
Remember when we were preparing for surgery?  How many meetings, classes and such did we attend?  We were told the more prepared we were the better our chances were for success.  And they were right.
Go through the house, car and work place and get rid of trigger foods.  Stock up on foods that will keep you on track.

Journaling
Get back to journaling.  This will help you identify when you feel like eating, stress factors and any triggers in your life.  Once you identify these factors, this will help you put tools in place to keep you from eating.  For example, if you find you are eating more at night, then sign up for a dance class or something fun you like to do.  Go for a walk, bike, and swim or come to OH and reach out to your friends in the Back On Track Together Group.
·    Go back to your old blogs and read them, make notes of what worked for you and what didn’t.
·    Journaling can be a powerful tool in recognizing your successes and emotional red flags. 
·    Track all your food.  Write it all down.  Even condiments contain calories and all the bites that you take have calories in them.  They add up fast.
·    Note how you are feeling during the day.  This will help you find out if a certain time of the day or event is a trigger making you eat.
Here is a list of some websites that will help you track your food, exercise and water;

ObesityHelp Health Tracker
iphone apps - Lose It, iFitness, ALowGIDiet and Tap & Track
www.thedailyplate.com
www.myfooddairy.com
www.sparkpeople.com
www.my-calorie-counter.com
www.myfitnesspal.com
www.fitday.com

Goals/Rewards
Make a list of goals for yourself.  Make them realistic and small.  As Cathy pointed out, small steps are easier to reach than unrealistic ones.  For example, set your goals like being able to take in your belt one notch and then reward yourself with something non-food. This is realistic and you can make it happen, instead of a goal of losing 5 pounds in one week.  You are just setting yourself up for that Merry Go Round we don’t want to get on again.  Unrealistic goals, beating yourself up and saying the hell with it leads to emotional eating.  Let our rebel yell be NEVER AGAIN!

Food
In general, a long term post-weight loss surgery eating plan includes foods that are high in protein, and low in fat, fiber, calories, and sugar. Important vitamins and minerals are provided as supplements.
General Dietary Rules
·    While this food plan includes all 5 food groups, it is best to start each meal with high-protein foods, like lean meats or LF milk.
·    Eat small, frequent meals throughout the day. This is essential as your stomach pouch is small.
·    Each meal or snack should be small.
·    Eat and drink slowly. Allow up to 20 to 30 minutes to finish your meals and snacks.
·    Take small bites and chew all food thoroughly.
·    Avoid extra liquids during meals.
·    Learn to read labels on food for fat content. Aim for no more than 35 grams of (good) fat per day.
·    Foods which are best avoided include:
- High-sugar carbs, including carbonated or regular beverages or sodas.
- Fried foods
- High-fat fast foods, including snack chips, candy, junk food, chocolate or cookies.
- Sugar foods like white/brown sugar, syrup, molasses, jelly, desserts, and jams.
- Alcohol.

Fat in Weight Loss Surgery Food Plan
To help with weight loss and to maintain your weight loss, limit your fat intake to no more than about 35 grams of fat/day and avoid the following high fat foods and beverages except in small amounts:
Olives, nuts, avocados, regular mayonnaise, sour cream, cream cheese, pie crust, whole milk, butter, margarine, peanut butter, granola, muffins, cole slaw, potato salad, whole milk cheese, snack crackers, ice cream, shortening, lard, regular salad dressings, sauces, fried foods, bacon, sausage, bologna, potato chips, doughnuts, all oils, gravy, regular sodas, Kool-Aid, etc.

Sugary Foods and Refined Carbohydrates in Weight Loss Surgery Food Plan
By sugary foods, we mean food like: candy, cookies, ice cream, milkshakes or slushes, soda pop, sweetened juices or gelatin, and most desserts. The weight loss surgery food plan is low in these sweet and sugary foods for a number of reasons. First, these foods are high in calories and fat. Even in small amounts, they can make weight loss difficult.   Finally, most sweet and sugary food options are "empty-calorie" foods - meaning, they provide calories but no nutrition. And since calories are so restricted on a long term weight loss surgery food plan, it is important that nutrient-dense foods become an eating priority.  (AS A GENERAL GUIDE, BE CAUTIOUS IN EATING AN ITEM THAT CONTAINS MORE THAN 15 GRAMS OF SUGAR.) 

Protein
The first rule for living after Weight Loss Surgery (WLS) is Protein First – that means eating protein for three daily meals and (PLANNED) snacks.  The overall guide is you take what you weigh and divide it in half for your general protein requirements up to 125-150 grams per day maximum.  Of course, your activity level can cause that to be higher if you have a physical job or do considerable weight training.  Animal products are the most nutrient rich source of protein and include fish, poultry and meat. Dairy protein, including eggs, is another excellent source of protein. Nuts and legumes are also good sources of protein, but sometimes difficult for bariatric people to consume. 

Weight loss surgery people don’t have a choice, they must eat lean protein or they will get sick, anemic, and weary. Weight loss will cease or increase if they eat processed carbohydrates instead of lean protein.
The distinction must be made between high fat proteins and lean proteins. A weight loss surgery person should not eat high fat proteins such as bacon, fatty beef or sausage products or greasy fried chicken.  In addition, these high fat protein rich items are contributors to obesity and should be avoided by anyone wishing to control their weight.

The average, Non-Weight loss surgery person in general has a 50% to 80% of malabsorption.  There are a few that may be at 50% but the rate for most of us is higher than that. 
·    To maintain nutrition eat more protein foods like:
·    - Skim or 1% milk (if tolerable for your pouch)
- Low-fat cottage cheese
- Low-fat or non-fat yogurt with artificial sweeteners
- Egg whites
- Low-fat cheese
- Oatmeal and cream of wheat made with skim milk
- Fish
- Chicken and turkey (poultry)
- Other lean meats (pork tenderloin, extra lean ground beef)
- Non-fat dry milk powder (added to casseroles, soups, hot cereals, etc.)

Water
Water is our Best Friend.  We need to drink water. Drink a minimum of 64 ounces a day – eight glasses a day. Weight loss surgery people don’t have a choice: they must drink lots water. Other beverages including coffee, tea, LF milk, crystal light should be consumed after you have met your water requirements.  Soft drinks and alcohol are forbidden (yea, I know what you are saying on the alcohol one).  Water is the essential fluid for living. Water is one of the most important nutrients the body needs to stay healthy, vibrant and energetic. A tell-tell sign of a weight loss surgery person is the ever-present water bottle.

The human body is a magnificent vessel full of water. The brain is more than 75 percent water and 80 percent of blood is water. In fact, water plays a critical role in every system of the human body. Water regulates body temperature, removes wastes, carries nutrients and oxygen to the cells, cushions the joints, prevents constipation, flushes toxins from the kidneys and liver and dissolves vitamins, minerals and other nutrients for the body’s use. 

Nutritionists say a precise measure of the body’s need for water is to divide body weight (pounds) in half and drink that many ounces every day. That number could well exceed 200 ounces a day for morbidly obese people actively engaged in weight loss.

The body will panic if actual water intake is significantly less than required. Blood cannot flow, waste processes are disrupted and the electrolytes become imbalanced. Proper hydration prevents inflammation, promotes osmosis and moistens lung surfaces for gas diffusion. It helps the body regulate temperature, irrigate the cells and organs and promotes all functions of elimination. Certainly by drinking plenty of water many people could resolve inflammation and elimination problems that result from insufficient water intake. Adequate water facilitates weight loss.

Snacking
Weight loss surgery people are instructed to avoid grazing. No exceptions.

Grazing is the worst possible thing a WLS person can do. If we graze we cease to lose weight and regain weight. In addition weight loss surgery grazers risk severe swings in blood sugar levels and glucose overdose, they fail to move forward to the healthy life that surgery makes possible.

The nature of weight loss surgery gives people an edge on beating the grazing habit. When a person eats 6 small protein-rich meals a day or 3 meals with planned snacks in between, the body’s fuel requirements are met with no bad grazing. Hunger does not occur if water is sipped throughout the day. If a person is taking vitamins they will not be nutritionally wanting. Given that, people who graze are doing so out of the very habit that contributed to obesity.

Successful WLS people understand that grazing is bariatric purgatory. When they begin to graze weight loss will cease and weight gain will certainly result. Successful weight loss people – those who maintain their weight loss years after surgery – do not graze.  The same is true for all successful weight losers regardless of the means by which they initially lost weight.  In our experience, we find that grazing is the number one cause for weight regain.
 
Last But Not Least – Exercise
Nothing is more disappointing than hearing a weight loss surgery person brag that they didn’t have to exercise to lose weight. It’s true; people will lose weight without lifting a finger. But people who do not use the time of rapid weight loss to incorporate exercise into their lifestyle are doing themselves a grave disservice.

Obesity cripples the body. Bone tissues are compromised, joints are swollen, the vascular system is inadequate and the skeleton overburdened. As weight is lost, the burden on the bones, joints and vascular system is decreased. However, the body is a magnificent machine. Given proper nutrition and physical motion it will rebuild its broken framework. The systems can become strong and vital.

The most effective way to heal the body from the ravages of obesity is to exercise. Exercise means moving the body: walking, stretching, bending, inhaling and exhaling. Exercise is the most effective, enjoyable, beneficial gift one can bestow on themselves in the recovery from life threatening, crippling morbid obesity.

PEOPLE WHO SUCCESSFULLY MAINTAIN THEIR WEIGHT EXERCISE DAILY!

Doc prepared by the BOTT Team, Cathy Wilson and Kathy S.

BACK ON TRACK TOGETHER - BACK TO BASICS CHECK LIST!

Plan and prepare as if you were Pre-Op

Go back and read your old journals. Note what worked and what didn’t work

Start journaling again, food, emotions, water, and exercise

Create a list of short term goals with rewards

Remove trigger foods from your home, car and workplace

Notify family and loved ones that you are Back On Track so they can support you

Go to the store and buy all your WLS friendly foods/tools

Protein, protein, protein, first and often

Water, water, water, and drink all your water before anything else

No grazing

Take all your vitamins and supplements

Exercise – Just Move

Weigh yourself if you want, don’t if it’s hurtful to you

Take your measurements

Take your favorite photo of you at goal and place it on the fridge and carry one with you to view often for motivation

Check in daily to your Back On Track Together group for accountability, support, suggestions, recipes and much more

Doc prepared by the BOTT Team, Cathy Wilson and Kathy S.

BACK ON TRACK TOGETHER - VITAMINS AND SUPPLEMENTS

The Weight Loss Surgery person can experience malabsorption.  The procedure restricts the amount of food eaten by creating a small stomach pouch and dependent on your surgical procedure, it can produce malabsorption of Vitamin B12, Iron, and Calcium.
 
If proper supplementation is not taken, this places you at a higher risk of developing anemia, osteoporosis and/or metabolic bone disease.  These nutrition deficiencies can be avoided with regular medical follow up, lab work and taking your prescribed vitamin and mineral supplements.

Multivitamin
A Prenatal Vitamin or Multivitamin/Mineral such as Centrum or One A-Day

Ingredient Amount % Daily Value** Vitamin A (29% as Beta Carotene) 3500IU 70 Vitamin C 120mg 200 Vitamin D 400IU 100 Vitamin E 60IU 200 Vitamin K 25mcg 31 Thiamin 4.5mg 300 Riboflavin 5.1mg 300 Niacin 40mg 200 Vitamin B6 6mg 300 Folic Acid 400mcg 100 Vitamin B12 18mcg 300 Biotin 50mcg 17 Pantothenic Acid 12mg 120 Calcium 100mg 10 Iron 18mg 100 Phosphorus 48mg 5 Iodine 150mcg 100 Magnesium 40mg 10 Zinc 11mg 73 Selenium 70mcg 100 Copper .9mg 45 Manganese 4mg 200 Chromium 120mcg 100 Molybdenum 75mcg 100 Chloride 72mg 2 Potassium 80mg 2 Ginseng Root (Panax ginseng) Standardized Extract 50mg † Ginkgo Biloba Leaf (Ginkgo biloba) Standardized Extract 60mg † Boron 60mcg † Nickel 5mcg † Silicon 4mg † Tin 10mcg † Vanadium 10mcg †   

Vitamin B-12 (sublingual)
·    Provides increased energy
·    Can help protect against cardiovascular disease
·    May help prevent or relieve depression
·    Necessary to properly regulate sleep and appetite
·    Sublingual delivery is convenient and inexpensive
·    Sublingual delivery gets into the blood stream more quickly

Calcium Citrate with Vitamin D
Calcium is needed for developing strong bones and teeth and to prevent degenerative diseases in old age. These diseases include osteoporosis, Alzheimer’s disease, Parkinson’s disease and colon cancer. Calcium is needed for developing strong bones and teeth and to prevent degenerative diseases in old age. These diseases include osteoporosis, Alzheimer’s disease, Parkinson’s disease and colon cancer.

Calcium citrate is a compound used in making calcium supplements. Taking calcium citrate with vitamin D is even more beneficial as vitamin D helps in the absorption of calcium.  Be sure and take Calcium Citrate, NOT Calcium Carbonate. As in Tums (This is carbonate). We do not absorb the carbonate!  Remember; do not take it with iron.

Iron
Iron is a mineral that the body needs to produce red blood cells. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. This condition is called iron deficiency (iron shortage) or iron deficiency anemia.

The best way to take iron is alone or with your multivitamin.  The vitamin C and copper contained in your multi will actually help enhance iron absorption. 

Vitamins A, D, E and zinc and C
If you add these additional supplements be sure and take uncoated pills only.  We do not absorb anything in capsules, oil type gel caps and anything coated.

B-12 injections
If your lab work indicates you need additional B-12 your doctor may recommend B-12 shots.  This can be done prescription only.

Biotin
Some people have found this helps for hair loss and brittle nails

Boron
Some have found this helps with problems absorbing Calcium

Cooper
This can be useful with problems absorbing Iron

Doc prepared by the BOTT Team, Cathy Wilson and Kathy S.