Many new patients often ask, “What do your most successful patients do?”. As a seasoned, experienced Bariatric surgeon who has performed over 1000 laparoscopic, Bariatric surgeries I have had the privilege of treating and caring for patients of every age, size, shape, religion, ethnicity and education level. Like every bariatric surgeon I have my own group of “superstars” or “high achievers” who exceed the average weight loss for their operation and lose 75%, 85% or even 100% of their excess body weight. I have certainly seen trends or a common group of practices in these highly successful patients.
First, they don’t skip meals. They make it a point to eat at least 3 meals a day. They know that skipping meals slows metabolism and leads to hunger motivated grazing. These patients tend to eat breakfast, lunch and dinner or breakfast, lunch, snack and then dinner. This routine involves eating every 4 hours during the course of the day which better controls hunger and keeps the metabolism elevated for more efficient calorie burning.
Second, these patients know that solid foods, especially proteins, fill them up faster and control their hunger better. Too soft, mushy or liquid calories allow them to eat too much and these foods empty through their sleeve or band too fast not controlling their hunger as well. This can lead to grazing in between meals. They always try to include a solid protein source such as chicken, fish, ground beef, ground turkey, scrambled eggs, deli shaved meats, seafood, tofu or beans with their 3 main meals of the day. By eating solid foods they fill up faster, eat less and don’t get hungry until it’s time for the next meal. Remember, you didn’t just eat liquid and mushy foods all the time before surgery, we don’t want you to after surgery either.
Third, the most successful weight loss surgery patients know to stay active. The most common form of exercise among these patients is good, old-fashioned walking. Sure, some patients join a gym, get a trainer, jog, run or even ultimately do hard-core circuit training. However, a good amount of my most successful patients simply walk regularly during the week. “I park far away” or “I take the stairs at work” or “I walk a lot at work” isn’t what I’m talking about. Regular, sustained walking or other activity for 30-50 minutes a day, 4-5 days a week minimum is the goal.
Lastly, they avoid high calorie, unhealthy snacks. Even the most successful patients will treat themselves to a cookie, piece of candy or even a little ice cream every once in a while but know that eating these things on a regular basis will fight against their success. These patients have said “keep it out of the house and it won’t be there calling your name every day”. Alcohol, fried foods, ice cream and sugary snacks should be limited as much as possible. Any weight loss surgery patient who eats these things on a daily basis will never be successful.
By realizing that any weight loss operation is a tool and not a “quick fix” or “magic bullet” you start off with the correct “mindset”. The next step is to make a commitment to make the necessary lifestyle and eating changes to get the best results. These two things coupled with the knowledge gained from the most successful patients will allow you to most certainly change your life and achieve your weight loss goals.
With all my respect,
Beware of hidden calories. They’re everywhere! Simple substitutions and eliminations can cut thousands of calories per month. To understand how your body loses weight let’s oversimplify things. Of course, there are many genetic, metabolic and even psychological factors that influence the speed and amount of weight loss or gain that a person experiences with any diet they may be on. However, to make things as easy to understand as possible think about it this way. You expend a certain number of calories just to exist every day. Basic movement, flexing of your postural muscles to keep you upright, the beating of your heart, breathing and digestion of your food all requires energy and burns a set amount of calories per day. Let’s call this your baseline calorie expenditure. Any additional physical activity from exercise or heavy physical activity at your job will require more energy and thus will burn more calories. Let’s call this additional calorie expenditure. With this simplified explanation if we add your baseline calorie expenditure to your additional calorie expenditure we get your total calorie expenditure.
BASELINE CALORIE EXP + ADDITIONAL CALORIE EXP = TOTAL CALORIE EXP
Now, the amount of calories you take in from solid food, liquids, snacks, and pieces of candy for example (yes, you have to count EVERYTHING) is your total calorie intake. Your weight loss then over any given period of time is directly linked to how your total calorie expenditure relates to your total calorie intake. We need to think of the total calorie expenditure as a minus or negative number and the total calorie intake as a plus or positive number. If we then add the total calorie intake to the total calorie expenditure we get the total calories burned. If this resulting number is a positive number you wont lose weight. If it’s a negative number you lose weight.
TOT CAL EXPENDITURE (-) + TOT CAL INTAKE (+) = TOTAL CALORIES BURNED
As you would imagine then if you keep your total calorie intake down with smarter eating habits and increase your total calorie expenditure by increasing your activity, you will experience better weight loss. To decrease your total calorie intake, eat 4 small meals a day of REGULAR food and include as much solid protein as possible. Avoid grazing and snacking between meals. Avoid too many liquid calories. Getting back to those “hidden calories” I mentioned before, using light margarine and cream cheese, light salad dressing and pasta sauce and cooking with a cooking spray rather than a cup of oil in the pan are simple ways of eliminating thousands of calories per month. Choosing the lean ground beef or turkey, avoiding fast food and picking healthier soups (not cream-based) are other ways.
To increase your total calorie expenditure just STAY ACTIVE. If you have a treadmill – USE IT. Simply getting out and walking 4 or 5 times a week will dramatically increase your total calorie expenditure every week. Take the stairs instead of the elevator, walk at Wal-Mart as much as you can instead of taking the electric cart. Even a patient who just marches in place 15 minutes a day will have a higher total calorie expenditure than the sedentary patient. Remember, I don’t want any of my patients “dieting” after surgery. Patients who eat regular food four times a day, don’t snack or graze and stay active ALWAYS LOSE WEIGHT. I wish you all success!
As you already know, there are choices that have to be made when you’re considering weight loss surgery. You need to choose a surgeon, a program and of course, the operation you will have. The final decision as to what operation you undergo should be a decision YOU make. It’s your body and your life. You are the one that will need to follow the recommended lifestyle changes and restrictions. You are the one that needs to be comfortable with the possible complication profile, follow up regimen afterwards and reversibility/adjustability of the procedure if applicable. In my opinion, the main role of the surgeon in this respect is to educate potential patients as to exactly how the different procedures change their body, how they work to help them lose weight and the possible, associated risks and complications. The other important role of the surgeon on the initial consultation with the patient is to obtain a thorough medical and surgical history. This allows the surgeon to determine whether or not a particular weight loss procedure is contraindicated for that patient, or shouldn’t be performed for them. For example, a patient who has gastroparesis, a condition affecting their stomach function usually associated with long-standing diabetes, should not have a Lap-Band operation. They can however have a sleeve gastrectomy or gastric bypass, and in addition to helping them lose weight, these operations will also diminish or completely alleviate their gastroparesis symptoms. Patients who come to me with a history of Crohn’s disease or Lupus will undergo specific testing to ensure they are a candidate for surgery. If they ‘pass’ these pre-op tests I will perform a Lap-Band surgery for them, but will not recommend a gastric bypass or sleeve gastrectomy. In these patients I prefer a lesser invasive, reversible operation. In the future event that they develop problems with their esophagus or stomach from these chronic diseases, I know that I can go back in laparoscopically and simply remove their Lap-Band device and they will be right back where they were before surgery, and can have any medical treatment needed without any additional fears or concerns. If they never have any of these complications from their Lupus or Crohn’s, their band stays in forever.
The take-away message is as follows : whatever surgeon you choose should educate you completely, answer all of your questions, give you the pros and cons of each of the operations and act as a guide to help you choose your operation. He or she should not choose the operation for you. Most patients make their decision at the initial office visit but I have had several patients come back to discuss things and ask questions on one or two additional office visits. Remember, there is no rush. I want my patients to be comfortable, educated and ready before we go to the operating room.
Several studies have been completed for the purpose of identifying those patient populations that really require, or will benefit from vitamin supplementation. One such population is patients who have undergone bariatric surgery. Weight loss surgical procedures are fundamentally classified as either restrictive or malabsorptive. Restrictive operations for weight loss restrict the amount of food that a patient can eat at any given time allowing for portion control and hunger control. Examples of these procedures include the Lap-Band and Laparoscopic Sleeve Gastrectomy operations. Malabsorptive operations such as the Gastric Bypass or Jejuno-ileal Bypass decrease the amount of calories, nutrients, etc. that the patient will absorb from each meal. It is very important for all bariatric surgery patients to take vitamins but there are some differences between patients who have had these different operations.
When a bariatric patient first goes home after surgery there is always that 4 or 5 week period where pills have to be crushed. In this instance, it’s typically easier to take chewable or “gummy” style vitamins. These are usually available everywhere however unless labeled ‘adult’ they are often for children and the dose must be doubled. For example with the “Flintstone” vitamins adult patients need to chew two daily.
All bariatric surgical patients, regardless of what procedure they’ve had done, should take an adult multivitamin daily. Centrum, Centrum Silver, Men’s or Women’s One-A-Day will usually suffice. It’s also recommended that all patients take a calcium supplement daily. I usually recommend Citracal. Calcium Citrate gives more bioavailable calcium per dose and doesn’t have carbonate which can produce more gas. A supplemental amount of 1000 mg daily is suggested. For Sleeve Gastrectomy and Gastric Bypass patients, a vitamin B12 supplement should be taken daily. Oral pill form B12 will not be optimally absorbed so in these patients B12 supplementation should be taken as the under the tongue drops daily or in shot form once monthly. A new prescription nasal spray called Nascobal is available and is taken as one spray in one nostril once weekly. Lap-Band patients can absorb B12 normally so the single, daily multivitamin usually provides enough. If extra B-supplementation is needed, these patients can take a B-complex pill daily.
Some patients have told me about www.vitapal.com. They have ordered various chewable and gummy forms of the adult vitamins and supplements and have been happy with the customer service. Bottom line : TAKE YOUR VITAMINS!
– Dr. Minkin
Although bariatric surgery is the most effective means for achieving weight loss for morbidly obese patients, there is no “magic bullet” for patients that requires no work on their part to achieve success.Any life-changing procedure requires a life-long change and commitment to do what is required to succeed. There are two main components to this commitment. First, following up with your surgeon as required, following his advice and taking advantage of any nutritional counseling or support is important. The second component is the patient’s adherence to the recommended practices that will insure success and the avoidance of certain practices and “pitfalls” that work against you. There are two main “pitfalls” or ways to “eat around” the procedures and these are discussed below.
Pitfall #1 – GRAZING. I recommend that my patients eat four times a day. My typical successful patient eats breakfast, lunch, a snack and then dinner. “Picking” and “snacking” throughout the day will allow you to eat much more than you should and each day, week and month adds up to sub-optimal weight loss on each office visit. I’ve even had patients come to the office and say, “My Lap-Band needs to be tighter! I can eat a whole plate of food! It takes me 2-3 hours but I can eat the whole thing!” With any of these operations I recommend you sit down with REGULAR food and eat and chew well, and when you’re full, stop, and that meal is over.
Pitfall #2 – TOO MANY LIQUID/MUSHY CALORIES. This is a very common pitfall. Solid proteins require that patients chew well and take their time or foods can get “stuck” or cause trouble. Instead of eating a turkey burger patty or a piece of cooked fish or chicken it’s so much easier to just eat a bowl of soup. Instead of a scrambled egg for breakfast or turkey sausage it’s easier to just eat a yogurt, or have a bowl of cereal. The Lap-Band patient for example that comes in wanting to be tighter because they can eat too much needs to be questioned as to what their eating. Same with the sleeve gastrectomy patient who can “eat too much”. Often these patients will say “Well I have a yogurt or cereal everyday for breakfast, soup for lunch, soup or mashed potatoes or chili for dinner”, you get the point. When I talk to these patients they say they can sit down and eat a huge bowl of soup but if they eat a burger patty, or piece of cooked fish or chicken they fill up fast with a small amount. Eating solid proteins first with as many meals a day as you can is the key.
Other important tips to keep you filling up fast and to prevent stretching of your pouch or sleeve include staying away from carbonated beverages, not drinking with meals and waiting an hour after eating before drinking again. In taking care of nearly 1000 bariatric patients so far I see the trends. The patients that follow up when they’re supposed to and stick to the above lifestyle and eating changes consistent lose weight, feel better and are happier and healthier! Good Luck!
The Sleeve Gastrectomy operation is now the most popular Bariatric surgical procedure in the United States.
The Sleeve Gastrectomy operation is the newest surgical procedure for weight loss being performed today. Visit here to learn more. This procedure is performed laparoscopically with a minimally-invasive surgical technique and involves removing approximately 80% of the stomach. This, in effect, creates a smaller, more tubular stomach or “sleeve” which allows for excellent hunger and portion control. We now have excellent, longer-term data from a recent 5 year study showing 60-80% weight loss, which is essentially the same as the results seen with the more invasive gastric bypass procedure. There is no bypass of the small intestine with this procedure making it essentially as safe as the Lap Band Procedure. There are no adjustments needed and the office follow-up regimen is not as intensive. Dr. Minkin has now performed over 3000 Sleeve Gastrectomy operations. Most major insurance carriers and Medicare now cover the laparoscopic Sleeve Gastrectomy procedure. provide coverage for the procedure and many expect that universal coverage may be available within the next year. If you interested in learning more about the procedure you may attend one of Dr. Minkin’s free educational seminars or call 314-965-8410 for an appointment.