I tell my patients that the surgery is only successful with your commitment.

In truth, with weight-loss surgery and so many other facets of life we choose whether to commit to it and are successful at it, or we choose to do something less than this.

Committing to success starts well before surgery.  It starts sometime after the information-gathering phase, sometime after the initial visits with support groups and with the bariatric surgeon and some of the preoperative educational work.  But at some point in that process it is time to fully commit, mind, body and soul.

Once you have committed, then it is time to fully and completely put your heart into making your weight-loss journey a success.  Then, practically speaking, the commitment begins with a preoperative weight loss program, usually consisting of any protein based meal replacement diet.  iMetabolic has worked hard to create several great tasting meal replacement options to help make it easier to stay on track. During the weeks of this rigorous diet, most of my patients will lose 20, 30, 40 or more pounds.  Fully and completely committing to this preoperative program has a huge positive effect on initiating weight loss, but also making the surgery itself more safe for you and more technically successful for the surgeon.  If you put your heart into this preoperative diet and weight loss program, then you can already begin to have amazing results even before the surgery takes place.

And then the successful journey really begins, and the weight loss really takes off! And your commitment will last a lifetime.

Increasingly, I encounter people who describe that they feel a terrible sense of fatigue and a loss of energy.  Many people lose their zest for fun things in life because of lack of energy. At our weight loss centers, a lack of energy impairs people’s efforts to exercise and lose weight.  It interferes with many aspects of life and with enjoyment of life.  Certainly, it interferes with a person’s motivation level to try to successfully work on any weight loss program.

With fatigue being so common, are there causes of it that can be fixed?

Indeed there are.  Finding the cause is important to a weight loss physician as part of a medical supervised weight loss plan.  Without investigating some of these potential root causes of fatigue, it may be difficult to get out of the starting blocks and begin losing weight.

Here just a few of the treatable causes for fatigue that a doctor might help you to diagnose and treat:

Hypothyroidism (low level of circulating thyroid hormone treated with a common medication: thyroid replacement hormone).
Anemia (low circulating red blood cells, often as a result of iron deficiency).
Depression (often markedly improved with medication and psychological counseling).
Viral illness (one example is mononucleosis).
Diabetes.
Heart condition.
Liver dysfunction.

and
Vitamin deficiencies.

Here are some common vitamin and mineral deficiencies that can cause fatigue, sometimes, profound fatigue:

• Vitamin B6.
• Vitamin B12.
• Iron deficiency.
• Vitamin D

In future discussions, I will explore how some of these causes can be identified and corrected in many cases. Some times, people experience dramatic improvement in their energy level after identifying these problems.

A recent study finished in March of 2009 in surgical endoscopy described the outcomes with surgery in people with a lower Body Mass Index than the current standard widely accepted criteria (normally a Body Mass Index of 35 or greater qualifies people for weight loss surgery at most U.S. centers).

In this study, 53 patients with a Body Mass Index ranging from 28 to 35 underwent laparoscopic adjustable gastric banding surgery.  In the study, the patients lost 69% of excess body weight at six months. This rose to 77% at 12 months and 81% of excess body weight was lost at the two-year mark.  The mean Body Mass Index was 33 at the beginning of the study and then fell to 25.8 at the two-year mark.

Even more importantly, 50% of the patients with diabetes mellitus experienced complete resolution of their diabetes.  (Fifteen patients total started with type II diabetes.)  45% of patients with hypertension experienced resolution of this condition. Similar results were seen with asthma and obstructive sleep apnea.

Over the two-year course of the study, 13% of patients experienced some type of problem or complication including one patient with a band slip, two with fluid causing band obstruction, two with esophagitis and two with port leaks.

This most recent study adds further evidence that weight loss surgery is safe and effective for people with a lower Body Mass Index than is widely accepted.  The implications of this sort of research finding are quite profound.  Many additional tens of millions of Americans and hundreds of millions worldwide would qualify under an expanded BMI criterion.

This study and other like it show that people who are moderately obese stand to improve their health and resolve very serious conditions such as type II diabetes, obstructive sleep apnea, hypertension and asthma with the help of weight loss surgery.  Should the criteria be expanded?  Should health insurance plans pay for this surgery for this vast number of people who would qualify under expanded criteria?

Perhaps it is better to offer the weight loss surgery to people at a lower BMI and take a more proactive or preventive approach to the serious diseases they will soon develop.  One might argue that they might also be expected to have lower risk for surgery at this earlier stage of the obesity disease rather than waiting until they have full-blown obesity with many complications like severe heart and lung disease (which make them higher risk for surgery and anesthesia).

In the future, we will see a debate over whether the current criteria for weight loss surgery need to be expanded and then who would pay for the procedures and programs.

For many years, the kind of protein powder shake mix that one could find was meant for muscle building in the gyms.  These shake mixes often had names that implied bulk and strength and growth and they were not only high in protein but were also very high in calories generally. So for a body builder or a young football player or wrestler aiming to bulk up, these shake mixes were just the ticket.

Today, more and more people are going to gyms for different reasons.  Yes, they  need to increase muscle, almost all of us do.  But increasingly, most people are also needing to burn fat and lose weight.

So the protein shake mixes must be different.  Instead of something aimed at helping a young person build muscle and build weight, this more modern shake mix must help a person build muscle while reducing weight.  So how does one do this?

The key is in the ingredients of the shake mix, as well as in the exercise performed by the person using it.  Sometimes young athletes are able to devote several hours a day toward pumping iron and building muscle. Very few adults can do that, simply because of time.  In addition, a  young athlete has typically a much higher basal metabolic rate than does the average person who needs to lose some pounds.  So the ingredients much match the person.

The ideal shake mix has now changed and takes into consideration all these factors.  One that now consists predominantly of proteins with the right amino acid mix, adds vitamins that are helpful both for muscle building and weight loss, and lastly contains low total amount of calories, serves to accomplish all the goals.  In this way, a person can benefit greatly from both the protein shakes and from their exercise regimen.  I highly recommend the protein shake mix from iMetabolic that accomplishes all of these goals with some great flavors.  Please let the creators of iMetabolic know what flavors you  might prefer or what tastes you do and don’t like about their shake mix.

We all know how tough it is to stick with a weight loss program.  What makes it so tough?  If you think about it, one of the answers you come up with is that social events and friends tempt us with treats and fun times but also center around food and drink.  And remember, it is not just regular food and drink, it’s often high calorie food that happens around parties. Think of fried hors d’ourves and plenty of tortilla chips. Then the drinks count for a lot of calories as well because of the high calorie content of alcohol.  So how do we still enjoy our friends and social events and yet still manage to stay on track.

One way is to enlist your friends to help you.  Many times well-intentioned friends just do not realize how serious your commitment to losing weight is.  But they do probably understand that if they’re inviting you to go have drinks and desserts that it’s going to make it difficult for you to lose weight.  You shouldn’t have to choose between your friends and your weight loss goals.  But if you don’t ask them for their help, then it might seem that way sometimes.

I recommend you speak to your friends one on one and tell them about your commitment to losing weight and becoming healthier.  Let them know why it’s so important to you and the kind of things that you are suffering with due to weight.

What else can you do?  Well, here are a few of the grim realities.

• Remember that your weight loss goal is more important than any social outing with food, cake, cookies, drinks, snacks, etc.  (Well, okay, maybe if it’s your child’s wedding, we’ll make an exception but you can still stick to your game plan even if you have to attend).
• You may have to decline some invitations.
• Enlist your friends to help you with your weight loss goals.
• Use willpower and think of the big picture here.  Remind yourself of your overriding goals. Don’t order foods and drinks and desserts that will throw you off your plan.
• Plan ahead.  Know what you are going to order and how to manage the evening.  You may need to leave early.
• Don’t drink if drinking for you leads to a total loss of willpower and even more drinking and eating.
• Work on finding ways to have fun in these social settings without eating and drinking excessive calories. Start with a mineral water and some good conversation.

I realize some of these sound harsh and it may even feel like you’re having to change your whole social life in order to lose weight. But think about it, what could be more important than getting to a healthier weight, living longer and better quality years so that you can enjoy your friends for longer. There’s no rule that says that you have to have food and drink to enjoy your friends.

Recently I have had a series of patients ask a version that is more or less the same question:  “How much weight will I lose with this surgery?”

If you have read any of my books or other writings, then you probably know where this is heading. Because the question is now how much weight will I lose after surgery so much as, how can I do my very best to use the maximal amount of weight?  Or, what do I need to work on myself so that I can achieve the best weight loss results?

The problem with asking how much weight loss is the surgery going to create is that it places the responsibility on the surgery instead of where it belongs, which is on the person having surgery.  This can be a hard thing to accept, but weight loss surgery is only a tool in your hands. It does not do the work for you.

People who have achieved great weight loss and health improvement after weight loss surgery have done so with great effort and determination and a commitment to success. These are some of the essential ingredients to successful weight loss.  It’s true that large studies with thousands and thousands of patients report averages of expected weight loss at one year or five years or ten years.  But those kind of statistics fail to tell the stories of the individuals and the hard work it took for them to achieve those results. So just because one study shows that on average patients lost 75% of their excess body weight following gastric bypass does not mean that the next person who comes along will do the same.  In fact, if the next person coming along sets their mind to it and is very motivated, determined and persistent, he or she could lose 100% of excess body weight and keep it off for a lifetime.  On the other hand without those qualities, the next person could fail to lose any weight at all.

So, I think the best answer to that question is that it all depends on you. Averages would indicate that a very high percentage of people do successfully lose  a high percentage of their excess body weight, somewhere between 50 and 90%.  Where you will fall, how well you will do, how long you will keep the weight off and how much you improve your life will depend only on you and no one else. The surgery will help. There is no question that weight loss surgery is a highly effective tool, the best means of losing weight that has ever been developed.  But what you make of it is up to you.  Much of the information on this website is designed to help make every person’s weight loss effort as successful as possible.  Make use of every tool to make your journey a successful one to better health.

Some behaviors are repeated so often and they become so routine that they become an unconscious behavior.  We don’t really have to think about doing them, we just do them.  You probably have several habits in your day.  Do you commute to work?  Do you drive the same route every day?  Do you have to think about every turn you make or which lane to move over in to get off at the proper exit any more?  You may have had to when you first started on that but now you don’t.  You don’t even think about it.  In fact, you probably can listen to the radio, talk on your cell phone, even put on a little  makeup all while following the same commute route by habit.

Habits can be bad.  A lot of people have the bad habit of asking, “What’s for dessert?” after they’ve eaten a big meal.  It’s tradition.  It’s what they always did in their household.  It’s what there dad taught them.  It’s a habit.  Dinner doesn’t feel complete until someone has served up a big bowl or ice cream to top it all off. That’s a bad habit.

Habits can be good too.  Some people who are focused on health and fitness are in the habit of exercising every day.  In fact, they tell you they don’t even feel good, they don’t sleep well, or they don’t feel like their day is complete, unless they have gone for a run or gotten in an hour’s worth of exercise.

The real trick is to create habits that serve to help you achieve your goals of better health, longer life and better quality of life. That means you need to create habits that promote weight loss and maintenance of a healthy weight.

Sometimes creating a new habit is the hardest thing.  Think of the smoker who has to try seven or eight times before they finally quit smoking.  But then talk to them a few years later and almost all of them will tell you that it’s easier now.  They are in the habit of not smoking. They don’t even think about  it.  But getting there, that was another story. Creating the new habit was difficult.  It was a matter of fighting and shaking off the old habits of lighting up at umpteen different times during the day, and then creating new ones.  That was the hard part.  But after a year or two and hundreds and hundreds of repetitions, the new habit became an unconscious repeated behavior and a better, healthier one.

So remember that you can succeed in the battle to lose weight and maintain a healthy weight.  It’s more difficult in the beginning and for a long period of time until all those behaviors become habit.  But keep trying to make them habit because every single time that you exhibit a “good” behavior like skipping dessert, cutting back on treats and snacks, avoiding the chips, skipping food after dinner time, then the more those behaviors become unconscious habits.  And the more you replace bad habits with good ones like, say substituting a new habit of a nice long walk after dinner for an old habit of a bowl of ice cream, the more those become habits that feel good and that you can’t do without.

“You can’t fight obesity sitting down.”

Wow, what an amazing and motivated bunch of people.  31 dedicated souls including doctors, nurses, parents and weight loss surgery patients braved the uncharacteristic rain and competed in the Reno Rock-N-River Run to raise awareness of childhood obesity.

The Reno Rock-N-River marathon, half marathon and 10K begins in the old streets of downtown Reno and then takes a route that follows the Truckee River as it flows through this valley, around and over rocks on its way then east and to Pyramid Lake.

Our group proved to be the largest group running to raise awareness for a charitable program and we all completed the 10K.  Several of my past Roux-en-Y gastric bypass and laparoscopic adjustable gastric band patients completed in the run.  That even included one patient of mine who had undergone surgery only two weeks ago!  She kept up a brisk walking pace and completed the race handily.

Another former patient of mine told me that she maintained the weight that was even lower than what she weighed her last year of high school. She ran the entire 10K, something that she could never have done even back as a high school senior.  What a long way she’s come.

The race organizers have invited the Obesity Prevention Foundation to serve as the official race charitable organization partner, and we could not be more excited about it.  How many people can we enter in the race next year?  35?  50?  100?

Weight loss is such a personal goal that only one person can truly take responsibility for it:  you.  Unlike a lot of goals and projects that might require the work of several different people cooperating, losing weight has purely to do with your mind and your body.  Only you can make the weight loss effort successful.

Other people can help.  And there are a lot of good resources that you can utilize  in this battle.  There is a growing body of helpful literature, motivational audio products, excellent books, proven techniques, and coaches, counselors and weight loss physicians who can provide guidance and support.  Partners, buddies, walking groups, support meetings and therapists can help.  But in the end, all of these extra people, forces, information and tools are only resources that you must draw upon in order to succeed in your weight loss goals.

It is a surprisingly difficult battle to successfully lose weight and keep it off. But it boils down to determination, extremely hard work, altering behaviors, making commitments, creating good habits, enduring some pain, sacrifice and hardship, and making use of the best available tools.  And all of this just to reduce the weight of our bodies.

But you can’t succeed without taking total and complete responsibility for the outcome.  No one else forces you to eat too many calories or sit on the couch.  No one forces you to have dessert or accept snacks and treats that are offered.

The great thing is that accepting total responsibility for your weight is empowering and liberating.  It is empowering because it makes you realize that you are in fact in total control of your own destiny and your own body.  It may suddenly change the way you view some of the things you have been doing.  You realize that other people are tempting you with high calories foods and drinks just like advertisements and fast food restaurants are tempting you.  But you control what you do, and you may feel much less need or desire to give in to any of those temptations.

What works for you?

We have talked about methods that have worked in scientific studies and in the proven testing ground of our center at the International Metabolic Institute.  But let’s be clear:  there is no one single way to lose weight and keep it off that works for every single person. So you must find and follow what works for you.

For example, I was recently talking with a colleague of mine who keeps very fit and active.  And in her mind, the best way to stay healthy is to eat certain foods that have worked to provide some satiety and comfort to her. She has developed a routine that involves eating eggs and fruits, vegetables and lean meats and whole grains as the mainstay of her daily diet.  She is able to rigorously count calories in everything that she prepares and eats. She does not own a blender and she prefers the familiarity of foods she grew up with over the simplicity of prepared protein shakes or bars.  Her method involves a bit more research and a bit more dedication to looking up, knowing and following specific calorie guidelines and amounts of these foods, but it works for her.

You’ll have to find what works for you.

And stick with it.

But whatever the exact formula is that you employ, the principles of this blog will still fly.