Lite & Smart DIMENSIONS™ Patient Blog

Over the past few weeks, I’ve seen article after article condemning Paula Deen for her recent revelation that she has diabetes, and her subsequent endorsement of a major pharmaceutical company that manufactures the medication she takes to manage her condition. As a physician, what celebrities do with their lives is of much less significance to me than what my patients do with theirs. And truth be told, most of my patients know, deep down, that eating meals high in saturated fats and laced with refined sugars is not the way to weight-loss success or the key to optimal health. So, what is?

First and foremost, it’s responsibility. I often tell my patients the best way to overcome a diet and lifestyle that has spiraled out of control is to take that control back. I know, I know. It sounds so easy, right? In theory, it is. In practice, I know it can be a struggle. But when it comes to your best weight and health, you have the most important tool you need to get you there. It’s called “choice.” Just as Paula chooses to use a whole stick of butter in some dishes, you can opt to cut that amount in half or substitute olive oil. In making this conscious effort, you’ve chosen the healthier path, for you.

So what stands in the way of us choosing the healthier path? The best term I’ve found is “noise.” Perhaps it’s echoes from your childhood, pushing you to clear your plate at every meal. Maybe it’s your own internal voice that defeats you by telling you you’ll never reach your goals. Whatever your source of noise may be, figure out where it’s coming from before it drowns out that other, better, but not yet powerful enough voice that’s telling you the right things to do for yourself.

It’s easy to point fingers. Especially at celebrities who we hope will be shining examples of what we “should” want for ourselves. Yet, we’re often so disappointed and shocked when they often turn out to be just like the rest of us. So instead, I say put yourself up on that pedestal. Make choices you know are good for you. Take a mental inventory of the noise that keeps you from your goal and start drowning it out with a positive voice that encourages you. If you begin to make a habit out of those exercises, there will be no need to look to someone else for the answers. You’ll already have them. The power will be yours. Then, you won’t waste your time playing the blame game. Because you’ll already know that it has no winners and really, is just another road block to your own personal success.

It seems these days that there’s a national observance for just about everything. Some are critically important like breast cancer awareness and diabetes education. Yet others, like National Hamburger Month (yes, it’s apparently real and observed in May) don’t seem that important at all. I recently came across an article that said this week (January 15-21) is dedicated to achieving and maintaining a healthy weight. Now, there’s an observance I can stand behind.

The title of the week also got me thinking. Its creators didn’t call it National Weight Loss Week or National Cabbage Soup Diet Week. No, the message is much clearer and simpler–that it’s important to maintain a healthy weight by doing what works for YOU! I like this concept for many reasons. First, January is a tough month for many people who struggle with their weight. It’s a month that’s filled with the pressure, expectations and guilt we place on ourselves to achieve that big New Year’s Weight-Loss Resolution as quickly as possible. (More on managing that New Year’s Resolution here).

The end of January is even tougher and is usually the time when the realization sets in that maintaining a strict diet of cabbage soup (for example) really isn’t sustainable. This leads to frustration and often, causes people to give up on their goals all-together. I understand and I see it often in my practice. You know, the public frequently sees obesity as a “lazy person’s disease.” Yet, judging from the patients I’ve cared for, nothing can be further from the truth. These are some of the most determined people I know. It’s just that so many other factors are standing in the way of their success including genetics, metabolism, relationships, self-esteem, and the list goes on.

So during this Healthy Weight Week, I offer you some do’s and don’ts that I hope will be simple motivation to stick to those New Year’s Weight Loss Resolutions, especially when the going gets tough:

DO: Ditch that cabbage soup diet, or any diet that limits you to one food group. It isn’t healthy and it isn’t sustainable. Balance is key.

DON’T: Put so much pressure on yourself to lose all that weight in one month. The best success stories are achieved by those who live by the notion “slow and steady wins the race.”

DO: Move. In the beginning it really doesn’t matter how much or how often. Committing to some form of exercise a few times a week can create the beginnings of a great habit.

DON’T: Give up. Just because one approach didn’t work doesn’t mean there aren’t others that will. Experiment and find out what works best FOR YOU!

I hope the observance of this as Healthy Weight Week and this post provide at least some motivation to “keep your eye on the prize.” Significant weight loss is definitely a marathon, not a sprint. Seeking out motivation along the way is essential to staying on track and eventually winning the race. I’m certain your effort will be well worth it when you cross the finish line.

If you’ve researched (or are in the process of researching) more than one program or surgeon who performs bariatric surgery, you know that a Center of Excellence designation is vitally important to the care you receive and the outcome you have. Having done your research, you also probably know that most programs now hold this designation. Now, that doesn’t make the seal any less meaningful. In fact, since the ASMBS began awarding it in 2004, the Center of Excellence designation has brought legitimacy to the idea that surgery can be a life-saving weight-loss option for the severely obese. But if most programs now have this designation, how does one decide which program is the best choice?

The answer lies with the surgeon you choose. I’m not talking about the surgeon’s qualifications or outcomes. Those are very important factors, but they’re covered in the Center of Excellence program requirements mentioned above. What I’m talking about has to do with how you feel about the surgeon you are considering. Can you talk to him openly and honestly? Does she listen attentively to your questions? Does he answer your questions thoroughly? Do you believe she cares about your well-being?

These may seem like questions that belong in the “Warm & Fuzzy” category, but they’re no less important than those you have about a surgeon’s skill and outcomes. Here’s why: Bariatric surgery is a serious, life-long commitment. It requires a lot from patients who choose to undergo it. Having a surgeon you can openly discuss issues with is extremely important in determining what your outcome will be. When you know you can talk to your doctor, you’re more likely to keep your appointments, follow his/her advice and implement suggestions for making adjustments that are right for you. These are important factors for taking the weight off and keeping it off, long-term.

If you or a loved one are considering bariatric surgery my advice is this: Make sure you choose a program with a Center of Excellence designation. Then, when it comes to the surgeon you choose, don’t discount your feelings. That old saying: “Go With Your Gut” is a popular one for a reason. And it’s particularly appropriate for this topic.

It’s that time of year again. Time for New Year’s resolution thoughts to begin swirling around in our minds. Before the clock strikes midnight on 1/1/2012, I thought I would issue a few tips and reminders for those with weight loss as their resolution for the coming year.

1. Set Realistic Goals!
Big goals are important. But goals you can’t realistically achieve are just a big downer. And when it comes to weight loss, arbitrary numbers and dates often don’t add up. For example, “I want to lose 20 pounds by January 31″ may not be an appropriate or healthy goal for some people. Make these decisions based on your body and what’s right and healthy for you. Consulting with your physician before beginning is always a great place to start.

2. Visualize Achievement.
Now that you’ve set a realistic goal for your weight loss, keep it top of mind with some mental-guided imagery. This really isn’t psycho-babble. Scientific studies have shown that when a person can visualize a goal, clearly and often, they are more likely to reach or exceed it. If some measure of weight loss is your goal, perhaps you might try visualizing yourself in that dress you haven’t fit into in ages. You can even pull it out of the closet and hang it somewhere that you’ll frequently see it. Tangible reminders of a goal are a great way to keep working hard at it, especially when the going gets tough.

3. Take it One Day at a Time.
Do you know why a huge percentage of people drop their weight-loss resolutions by mid-January? It’s largely because they tried to change too much, too quickly. Old habits are hard to break for a reason. Most who are able to stick to and eventually achieve their goals, take it one day at a time, or in some cases, one week at a time. Maybe this week you’ll commit to switching from low-fat to non-fat milk. Next week, it’s at least 30 minutes of heart-pumping exercise twice a week. These may seem like small changes, but I promise you they can add up to huge rewards over the long haul.

4. Get Support!
As humans, the last thing we want to feel is alone. Isolation is depressing and when it comes to body-weight, depression can often go hand-in-hand with an unhealthy relationship with food. Banish depression and isolation in achieving your goals by surrounding yourself with supportive, encouraging people who are working to achieve similar results. If you’re post-bariatric surgery or just beginning to consider it, attend a support group meeting at one of our several locations. There you’ll find people with similar struggles but the same “I can do this” attitude that you need to overcome the hurdles and obstacles that can present themselves when you’re trying to achieve your goals.

5. Reward Milestones.
Incentives don’t just work for kids. They can help motivate us adults too. Rewards are an important part of achieving long-term goals. With weight-loss goals, you might consider purchasing a new piece of clothing you’ve had your eye on when you reach a milestone–perhaps it’s the first 10 pounds lost of your 25 pound goal. Whatever your reward is, just be sure it isn’t tied to food. Rewarding yourself with a weekend food binge is really just making it tougher for you to achieve what you ultimately want.

Whether your goal is weight loss or something else entirely, I hope you’ve found value in these tips. For having the courage to make a New Year’s Resolution at all, I applaud you. Congratulations on taking that first step and best wishes for the achievement of your ultimate goal.

I wish you a happy and healthy 2012.

You’re probably thinking the answer’s easy: Don’t eat cookies! That’s a good start. But Cookie’s message can go much deeper, to an issue at the heart of the obesity epidemic in the United States.

I happened upon an episode of Sesame Street the other day and caught the tail end of a segment involving Cookie Monster. He’s the big, furry and blue guy who’s usually either talking about or eating a chocolate chip cookie. Well, in this segment, he was surrounded by fruits and vegetables. And his message was this: “Cookies are a SOMETIME food.” He said it more than once and referenced the apples, carrots and broccoli in his midst as members of the category: ANYTIME food. The message seemed clear and simple for impressionable young minds. And it got me thinking about how it might also apply to adults, specifically those who struggle with obesity and the “messages” they believe are true when it comes to food.

Research suggests that when a person considers any particular food bad or off-limits, the desire to want that food, and more of it, actually increases. Think about how this relates to you and imagine this scenario: There’s a birthday cake in front of you at a party. You repeatedly tell yourself you can’t have it, it’s bad for you, loaded with calories, fat and everything you shouldn’t want. The next thing you know, you’ve accepted two portions-worth of a slice and now there’s nothing more than crumbs on your plate. You feel terrible guilt for having “caved in.” An hour or so passes and before you know it, you’ve had a second two-portion slice of the same cake because you “already blew your diet anyway.” Your guilt spirals into orbit and you internally shame yourself for being so weak. Does this scenario sound at all familiar to you? Many people, whether they struggle with their body weight or not, can actually relate to it.

Now what if more of us accepted Cookie Monster’s message? What if we put some of these less nutritious, indulgent foods into the “SOMETIME” category in our brains instead of an “OFF-LIMITS” category? If we came from a place of sometimes, perhaps the above scenario would have resulted in accepting a smaller slice of cake, enjoying three-quarters of it, then taking a walk with friends after the party. This isn’t wishful thinking. It’s science and psychology-both of which are equally important in understanding and combating the rising incidence of obesity in this country.

I would like to leave you with this takeaway — unless a food is poisonous in a way that might threaten your life, delete the food file in your brain labeled: OFF-LIMITS. Replace it with a file called: SOMETIMES. Then set about surrounding yourself with lots of ANYTIME fruits, veggies, lean protein and whole grains. With practice, you might see some pretty significant results in the way you look AND the way you feel.

Don’t believe it? Ask Cookie Monster.

As a physician, it’s my job to care for patients using the knowledge I have gained in my education and experience. Part of that experience is staying up-to-date on the latest news, studies and facts surrounding the complicated issue of obesity. In performing some recent internet research in this regard, I came across this 1959 Telegraph Herald newspaper article. Now you might be asking: “why is he citing an article written more than 50 years ago? So much has changed!” You’re right. So much has changed. And this article is an interesting illustration of the great and the not-so-great ways.

What struck me first about this piece was the statistic in the second sentence. “About 20% of our adult population is overweight, yet only 7% is obese.” You can tell this article is from the late 50’s by that statement alone because today, according to the most recent data from the Centers for Disease Control, more than 33% of US adults are obese.

Something else I noticed in the article was the various “tests” used to determine whether or not an individual is overweight. The “pinch test” as explained by the author is not one you will find performed or recommended by your physician today. Because today we know that BMI (Body Mass Index) calculations are truer and more scientific ways to measure a person’s body weight as it relates to their overall health. BMI calculations also provide the opportunity to chart weight-gain over time and allow physicians and the public the opportunity to see negative trends and work to reverse them before they become life-threatening.

Perhaps the most telling “sign of the times” in this article, however, comes in its overall tone and the words and phrases used to convey its message. I must say that in no way do I believe the author’s intent was to insult his readers. But today, especially when it comes to obesity, we know that words and the emotions they elicit matter. With so much of the obesity epidemic tied to the emotional connection with food, we know that sensitivity in how the subject matter is conveyed is important in how it is received. I hear from many patients that the “F Word” isn’t allowed in their homes. And it isn’t the word you might be thinking of. It’s the word “fat.” Through the years we’ve learned that shaming people into weight-loss by the words we use and the tone we take isn’t ultimately effective. At least not long-term.

The Telegraph-Herald article is an interesting illustration of the gains and losses we’ve realized with regard to obesity in America. Today, we have more scientifically-valid and reliable ways to measure obesity. Today we know the obesity risk factors and have easier access to information on ways to reduce those risks. As a society, we’re more careful with our language and have empathy toward those who struggle with obesity. But, the fact that one-third of all adult Americans today are obese is also a somber reminder that while we’ve gained a lot, there is still so much to lose. Literally.

There are many factors at play in banishing obesity. Whether post-bariatric surgery or just beginning the process, there are few influencers more important to helping patients stick to their goals than close family members. These are the people you love and trust. They’re often the people who’ve seen you through “thick and thin,” literally. They’re also the people who have a significant impact on your psychological and emotional well-being; two factors we know are critical in long-term weight loss.

So how can you help ensure your loved ones become your strongest cheerleaders or even better, commit themselves to the healthier lifestyle that you’ve adopted? I’ve compiled a few tips here to help put you on the road to success:

1. Communication is key- Whether you’re considering undergoing bariatric surgery, would like to lose 25 pounds by a certain date or want to regain control of your health habits post-surgery, communicating your goals early and often to family and close friends is important.

2. Change is difficult- Even when the people you’re communicating your weight-loss goals to aren’t the ones changing. This is the psychology of humans, really. Whether it’s in ourselves, in our environment, in our beliefs and yes, even in our loved ones, we generally don’t like change. Understanding this fact and communicating about it up front and honestly can prevent a lot of heartache down the road.

3. Fear is inevitable-But it isn’t unstoppable. Perhaps it’s your spouse who fears you won’t love his fluffier form after you lose 50 pounds. Maybe it’s your daughter who’s scared she won’t recognize you after you lose 100 pounds. Fear is a common factor in many a weight-loss journey. It’s also an emotion that can be banished early on with communication.

4. Involvement matters- Involving your loved ones in even the slightest of lifestyle changes can help you all reap great rewards physically, mentally and emotionally. In fact, recent studies have proven that family members of bariatric surgery patients often become healthier when they’re involved in the process of the patient’s journey. It’s called a “Halo Effect.” And whatever you decide to call it, it’s a great side-benefit for everyone involved.

Healthy families don’t just happen. They require effort, support, love and discipline. The great news? Most families have a great foundation to build from. So get started today. You’ll all be better for it.

Emotional Health is the single most talked-about topic for the patients at our support group meetings. And it makes sense. So much of what leads us to make unhealthy life choices is rooted in what we FEEL about ourselves, about the world, about the way we grew up and about what other people think about us. That’s a symphony of noise in our heads and sometimes, it drowns out that smaller, but much more POSITIVE voice telling us the right path to choose.

To give our patients some regular positivity and motivation, we embarked several weeks ago on a campaign to deliver a “daily dose” of emotional health tips via our Twitter and Facebook pages. The response was overwhelmingly positive. So, I’ve decided to put together the Top 10 tips into a blog post. Please bookmark it. That way, whenever you need an emotional pick-me-up, or wake-up-call, you’ll know right where to look.

Here we go:

1. Take Care of Yourself. Bariatric surgery can do a lot of great things. But it does not create more time in a day. That part is up to you. Make time for you.

2. Choose Positive over Negative. If pre-bariatric surgery friends don’t support your new healthy lifestyle, it may be time to let them go. After weight-loss surgery ask yourself: Which relationships are worth holding onto? When you feel bad, you have less energy to try harder at the good things in your life.

3. Be Respectful and Responsible. Doing what you know is right for your health is not always easy. But the choice is yours alone. Mom is no longer standing over us making us clean our plates. Habits are hard to break and the things we learn as kids are deep-seated. But with dedication, success in bariatric surgery is possible.

4. Take Credit for Your Successes and Accomplishments. In other words, you have permission to pat yourself on the back for even the smallest of victories. Doing this gives you fuel for doing what it takes to transform your health.

5. Be Yourself in Relationships. Developing at least one relationship wherein you can relax and be yourself is important to emotional health. Sharing excitement and disappointment is also vital to your mental and physical health.

6. Talk Positively to Yourself. Your inner voice is very powerful. If it isn’t positive, think about where it got its information from.

7. Have a Plan for the Future. Whether you are pre- or post-bariatric surgery, having a plan and set of goals for the future are musts. But be sure to work on them one day at a time.

Before I tell you what it is, let me tell you what it isn’t. It isn’t how much weight you lose after bariatric surgery.

The single biggest factor in determining your weight-loss surgery success is your commitment to a healthy lifestyle. This mostly means diet and exercise but also includes getting enough rest and surrounding yourself with supportive people.

When I speak with patients who are 5, 10, 15 or more years post-op and they’ve kept the weight off, I always ask them what strategy worked best for them. Across the board they tell me the same thing—they stayed committed. They promised themselves to never again go back to the severely obese weight that came with life-threatening medical conditions and brought them to the point of surgery. They choose to regularly exercise, eat healthy foods, get enough sleep and maybe even eliminated a toxic relationship that wasn’t going to benefit them in getting to a healthier place.

Sounds great right? It is. But I would be lying if I didn’t tell you that I hear from plenty of other patients who may be two years post-op and utterly struggling to keep the weight off. In some cases, they’ve regained weight. I ask them the same question I ask the “success story” patients. Their answers are also largely the same, though they sometimes come packaged in different words–they haven’t stayed committed. Maybe it’s the lack of time they think they’re able to devote to exercise. Maybe it’s unhealthy food choices. Perhaps it’s a negative relationship in which they feel they need to retain some of the old, bad habits in order to remain “accepted.”

See, commitment is really just a big word for “hard work.” Now please don’t misunderstand me. If you’re struggling to keep the weight off, I am not saying that you’re not working hard enough. But maybe you need to take a look at the things you are working hard at, and channel some of that energy into the areas that need improvement. Are you eating healthier foods, but can’t seem to find the time to exercise? Try taking a walk on your lunch break. Carve out small blocks of time where you can find them. Do what you can, when you can. Before you know it, you may be walking the equivalent of a mile or more a day, without evening realizing it. What you are doing is staying committed.

When you chose this program for your weight-loss surgery procedure, we made a commitment to you. We promised we would be with you throughout your weight-loss journey. So, whether you’re two-weeks post-op or nearly a decade, we’re here to help you stay committed. Come and join patients who are experiencing the same things you are at one of our several support group locations throughout Southern California. Join us at our office in Fountain Valley for weekly strength-training exercise classes or monthly nutrition sessions. Get motivated by joining the growing community of fans on our Facebook page who share their stories of success on an ongoing basis. However you choose to go about it, we are committed to helping you stay committed.

Now get to work. Doctor’s orders.

After you undergo bariatric surgery, there are a number of factors you have to take into account regarding your diet. You can’t eat the same way that you did prior to surgery given the changes to your digestive tract, and in many cases you will need to watch out for certain foods and watch what you eat as well. We’ll be sure to discuss this with you at our Orange County weight loss surgery center both before and after you undergo surgery. This is a complex matter and it will take you a little time to get used to your new relationship to food after bariatric surgery.

Bariatric Surgery Means Changes to Your Lifestyle

Something that we cannot stress enough is that it’s important for patients to realize that bariatric surgery doesn’t mean immediate weight loss. The weight loss comes with a change in your whole lifestyle. You’re going to notice changes in your body shape as well as how your body reacts to different foods. It’s important that you keep our suggestions and guidelines for your diet in mind as you move forward in life after surgery.

Changes in Diet

Whether you undergo an Orange County LAP-BAND® surgery, a gastric bypass surgery, or a gastric sleeve surgery, you will transition into a new diet in steps. The first step will involve a room temperature liquid diet after surgery. This will consist mostly of:

• Broths
• Gelatin free from sugar
• Juices that are unsweetened

As you continue to heal, you will incorporate more types of foods into your diet. In the next phase, for instance, you will be able to have some ground up or pureed foods, such as yogurts, beans, egg whites, soft fruits, soft vegetables, and certain lean meats. Slowly you will transition into more solid foods, though you will need to chew them well and to eat your food slowly.

As you heal, you’ll be able to see which foods you can tolerate and which foods may be difficult to eat. You will want to be wary of granolas, nuts and seeds, bread and starches, and carbonated beverages. These foods can lead to discomfort when eating. The team at our bariatrics and weight loss surgery practice can provide a much more comprehensive list of eating do’s and don’ts.

Changes in Appetite and Food Consumption

One thing that patients notice after undergoing bariatric surgery is that their appetite is reduced. Part of this is due to the fact that bariatric surgery causes patients to change their eating habits and really pay attention to what they are eating. Not only are patients generally eating healthier, they consume food in several small helpings throughout the day rather than a few large, calorie-heavy meals.

Because certain foods are easier to digest and consume than others after bariatric surgery, patients may find certain foods less pleasant. These foods tend to be starchy, calorie rich, and not particularly healthy. While it may seem like not being able to eat bread and have soda is unpleasant, patients rarely miss these food items and prefer others.

Essentially the added awareness of what they’re eating combined with the calorie reduction effects of the bariatric surgery lead to healthier diets and better eating habits.

Other Factors to Keep in Mind

We’ll be sure to discuss more lifestyle changes at our in more detail. To discuss diet, exercise, and other important matters, be sure to contact our Orange County obesity and weight loss surgery center today.