Sep 21

How Many Calories Should I Eat Pre-Weight-Loss Surgery

BMR

Your Basal Metabolic Rate (BMR) is the foundation of your pre-surgery weight-loss plan.

When my dietitian said, “You’re eating about 1,700 calories (my BMR) a day to maintain your (heavy) weight. We need to reduce that by 500 calories daily so you’re able to lose weight during the six-month, pre-op program,” I groaned. Wow, 1,200 calories?

I didn’t want to diet.

Been there, done that.

But, I had to lose weight so I could have my gastric bypass surgery.

So, I counted calories every day** and lost about a pound a week during the six-month period.

How Many Calories Should You Eat Pre-Surgery?

As you and your medical team plan your pre-weight-loss-surgery program, your dietitian probably will calculate your basal metabolic rate (BMR) too and use it as the foundation for your eating plan.

If you don’t want to wait on the dietitian, determine your BMR now by using the calculator below.

What is BMR

The rate at which energy (calories) is used for the essential life functions is called Basal Metabolic Rate (BMR). Basal metabolism includes most of the involuntary things the human body does to support life – such as breathing, blood circulation, body temperature regulation, nervous system operations, etc., but not the extra energy needed for any additional physical activity such as gym exercise.

In other words, if you laid in bed all day doing nothing else, then you would need to eat at least the number of calories roughly equal to your BMR in order to maintain your normal body functions.

Basal metabolism consumes from 60- to 70-percent of body’s total daily calorie expenditure.

Calculate Your Basal Metabolism Rate

BMR calculation is based on age, weight, sex and activity level.

Fill out the information and click select. Your results will show in a pop-up window.

 

 

 

 

 

** The key was not just cutting calories but also eliminating specific food types from my diet, such as fats, sugars and carbs.

Apr 06

Calorie Calculator to Help Maintain, Lose or Gain Weight After Weight-Loss Surgery

calorie calculator, couple, happy

Maintaining weight loss requires effort. Know what normal weight gain is after weight-loss surgery, and how much weight gain or loss is too much. Talk to your dietitian.

The calorie calculators shown below will help you determine a baseline for how many calories you need daily to:

  1. maintain current weight
  2. lose weight
  3. gain weight

Visit with your dietitian/nutritionist before attempting to lose or gain weight. Other issues, beyond food/calorie intake may exist. If you don’t have a nutritionist/dietitian, your surgeon or hospital can certainly make recommendations/referrals. Check out data on how much weight gain is normal and what is not.

In addition, don’t forget that you need to take in high levels of protein. If you attempt to lose weight, make sure to find low calorie foods with high levels of protein. Also make sure you take all of your supplements daily.

 

 

 

Click either image to go to the selected calorie calculator
and see your personal results.

Consider using both calculators and comparing the results to confirm your caloric intake number.

NOTE: (The numbers shown below are are for the author. When you click to the calculator, you will enter your personal information)

 

Calorie Calculator #1

calorie calculator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Calorie Calculator #2

calorie calculator

 

 

 

Apr 02

Lying to Yourself is Living Dangerously – After Weight-Loss Surgery

jeans isolated on background

Liar, liar, pants of fire. Are you feeling the burn? I have been.

Liar, liar, pants on fire . . .

. . . Mine are burning up.

When we fall off the wagon or sneak a little snack and fail to acknowledge our action, we’re basically lying to ourselves. And, we put ourselves right back into the danger zone that we lived pre surgery.

What’s making me write this post? I’ve been slipping and sneaking, and I’m afraid to stand on the scale, even though my size-four pants still fit.

Highway to the Danger Zone. Can you hear the chorus to the song?

I’m a food addict, and I need to admit it every day. I find myself, however, making the familiar excuses, self-medicating statements, and falling into old patterns.

I’m further prompted to travel down this discussionary patch because of questions I receive on our Gastric Bypass Support and Journals Facebook page.

Questions We Ask About Weight Gain After Weight-Loss Surgery

  • Why am I gaining weight?
  • Is it normal to gain some weight?
  • I’m hungry all the time, why?
  • I’m falling back into old patterns?
  • I’m six years out and gaining back lots of weight, what should I do?

These are complex questions, which require knowledge and attention.

Post Weight-Loss Surgery Weight Regain – By the Numbers

Numerous medical studies indicate some (re)weight gain after surgery is normal. It’s normal, however, only after you’ve hit your low-weight point (nadir).

The data and formulas cited regarding regain are simple to understand.

  • The average excess weight loss after surgery is approximately 70 percent
  • About 80 percent of patients experience some weight regain
  • The average amount of gain hovers at about eight percent of the patient’s original excess weight

For easy calculation purposes, let’s say:

  1. You were 100 pounds overweight pre surgery.  Calculate: 100 excess pounds x 70 percent loss = 70 pounds lost (at low point)
  2. You’re one of the 80 percent who gain weight back. Calculate: 100 original excess pounds x 8 percent gain = 8 pounds gained
  3. Your net loss would be 62 pounds. Calculate 70 pounds lost – 8 pounds regained = 62 pounds lost

On the positive side, between 65 and 80 percent of patients keep at least 50 percent of their excess weight off after 10 years.

My problem is, I’m terrified of gaining weight. And, because my behavior is slipping and I’m not adequately addressing the problem, I need to open my eyes and take action. Do you?

Three Critical Steps to Take to Combat Weight Regain

My three go-to tips are ones I have to implement today.

  1. Attack food urges or feelings of depression or a lack of well being. Talk with your medical team, immediately. Don’t put it off. Success if built on team work.
  2. Meet with your dietitian/nutritionist face to face. A good medical team includes a dietitian. Your doctor already may have connected you with one. If not, ask for one. Plan to never stop seeing the nutritionist. Because I moved from Pa. to Ga. I’ve been disconnected. I can’t do this alone. Neither can you.
  3. Actively Participate in a Support Group: Patients who are actively involved in a support group have better success than those who do not. In general, their BMI is lower.

Also Consider Additional Counseling

Because I’m a food addict, I also believe psychological counseling can be helpful. So, don’t be fearful to reach out. You made the big step by deciding on Get yourself whatever level of help you need to remain successful.

 

Study from the National Center on Biotechnology Information: Weight Gain After Short- and Long-Limb Gastric Bypass in Patients Followed for Longer Than 10 Years

 

 

 

Mar 23

11 Smart, Basic, Bariatric-Eating Tips

 

Argh, my tummy hurts. Why did I eat (enter your bad habit here).

Are you prone to falling into pre-surgery eating habits? Eat too fast, skip meals, inhale rather than chew. If I’m honest, I have to admit I sure do. That means a a back-to-basics reminder is in order.

11 Commonly Forgotten or Ignored Post-Weight-Loss Surgery Eating Tips

Here are some tips you may have forgotten that make the eating process more comfortable and enjoyable. They also promote success:

Oh the details of eating, enjoying eating and being successful as a bariatric patient. (c) svariophoto Fotolia.com

Oh the details of eating, enjoying eating and being successful as a bariatric patient. (c) svariophoto Fotolia.com

 

  1. Eat Breakfast: Whether a shake or protein bar, yogurt or some scrambled eggs with cheese, eat soon after awakening daily. Skipping breakfast puts the body in starvation mode. Not good. Studies also show that eating breakfast helps with weight loss.  In addition, people who eat breakfast are better able to make it to lunch without snacking and don’t overeat at lunch to make up for no breakfast. Of course we all know how a good breakfast helps concentration, productivity, a good attitude and more.
  2. Schedule and Consume All Meals: For the same reasons listed about breakfast, but also to keep from snacking, ensure you’re getting proper nutrients throughout the day and hone in on a good eating routine. Eating on a regular schedule also helps to stave off hunger pangs or the desire to overeat after skipping meals.
  3. Sit Down at a Table to Eat: No phone, TV, tablet. Just you, your food and perhaps some good company. Concentrate on your meal and enjoying it. You’ll gain more from the experience, for both body and mind, than is possible when mindlessly eating in front of the tube.
  4. Eat Protein First: Protein is number one for all of us, so eat it first always. If you consume all your protein (about 3 ounces each meal) and can still handle a little more then turn to your veggies and fruits. Remember you need 60 to 80 grams of protein daily.
  5. Take Small Bites: Oh gosh, this still gets me all the time. I start to eat like I’m a football player revving up for a game. I take that wonderful huge bite and then I have to sit for what seems forever to chew it up. Toddler utensils help. In addition, don’t eat anything with your hands — not even that yummy chicken. It’s just too easy to shove the food in your mouth. Cut up my wraps, pull chicken from the bones, and cut meats into tiny pieces before starting to eat.
  6. Slow Down: I was a food shoveler before my bypass. I ate huge bites and ate rapidly. I still have a tendency toward this behavior. So, I force myself to put my utensil down after each bite. I also make a comment to someone else at the table before taking another bite. The practice keeps me from getting over full before I get what I need in terms of nutrition. It also eliminates the too-fast tummy ache. Chewing and savoring every bite is fun and makes meals more enjoyable. Kathleen M. Zelman, MPH, RD, LD, director of nutrition for WebMD reports, “It’s (eating slowly) especially important for people who have had gastric bypass operations to heed advice to eat slowly. A study of gastric bypass patients showed that those who ate too fast and failed to recognize the signs of satiety were less successful at losing weight than other patients.”
  7. Put Food on Small Plates: Psychologically, I love this trick. When I sit down to eat, I see a lovely full plate, not a measly meal. I feel normal and find I eat more slowly. You might even consider getting or making your own bariatric portion plate, which really keeps you on track with portion size.

    portion plate

    Portion plates are available online at retailers like Amazon.com. You can also easily make your own.

  8. Chew, Chew, Chew: If you’re not chewing until you think you can’t chew anymore, you’re doing yourself a huge disservice. Swallowing large chunks of food will cause discomfort. Chewing is also critical to digestive health. I’ve been counting how many times I chew my food for so long now, I automatically chew to 25 or longer. U.S. News and World Report even published an article on why we must chew our food.
  9. Stop Drinking:  Many bariatric patients say they don’t understand why they can drink near or during meals. Some even say they can’t. The reasons to avoid drinking, especially during and after meals are simple. Your pouch is small and its important you eat your meals. If you’re full of liquid, you may not eat well. The more important reason is liquids flush food through your stomach quickly, which can affect digestion. Furthermore, if you drink during or after your meal, you might find yourself still feeling hungry, which could lead to weight gain.
  10. Learn Restaurant Management: Ask for a box when you order your meal — not after you eat. When the meal comes, put all foods you know you should not eat or will not be able to eat in the box and close it. Leave only a meal you should be eating on the plate. Push all foods others order, especially breads and appetizers away from your place at the table, to reduce temptation.
  11. Track Your Intake: For purposes of counting calories and tracking sugar, fat and nutrition, consider journaling your food and drink intake via an app. I prefer MyFitnessPal. I used it during my pre-surgery program and continue now. My food addiction is so strong, even though I can’t eat a lot at once, I need it to keep me on the straight and narrow and keep me accountable.

 

Do you have additional tips? If so, please share them in the comments section below. We want to hear from you.

 

Mar 13

You Have to Stop Losing Weight, NOW

“You have to stop losing weight,” my nurse said. “If you lose any more your insurance may not approve your surgery.”

The date was my four-month visit, of my six-month pre-gastric-bypass-surgery program. The problem was my BMI (body mass index) and the success I was having with my supervised pre-op program.

I’d lost weight, which was necessary for surgery insurance approval. However, suddenly my hard work was my enemy. My BMI had dropped dangerously close to the line that could deem my surgery not coverable.

How screwed up is this whole weight-loss surgery and insurance approval process? I was doing what the insurance demanded. I was still obese. I still needed the surgery. But a few more pounds eliminated and my surgery ship might sink.

Not Obese Enough for Weight-Loss Surgery But Obese Enough to Die

About a year before, when I weighed 215 pounds (at 5-foot 3-inches), had high blood pressure, couldn’t breath or do normal activities, and was threatened with diabetes, I wasn’t fat enough (didn’t have a high enough BMI) to get into the program. I could still join the program and have surgery. I would just have to self-pay the $24,000, which I didn’t have on hand. So, I just kept on living — sort of.

obesity grim reaper

Obesity and heart disease paint a frightening picture.

A few months later, I found myself in a hospital in northern Mississippi, alone and 1,500 miles from home. I was having a heart cath and subsequently a stent placed in my LAD artery, the widow maker artery. I was also over 230 pounds.

The Catch 22 for Borderline Obese People

The good news, which also helped cause the heart problem, was my BMI was now high enough to get into the fabulous weight-management program at my home hospital, Conemaugh Memorial Medical Center. I:

  1. Had to wait a few months to get into the program
  2. Worked hard once in the program
  3. Learned from my medical team and studied how to succeed
  4. Was so excited about changing my life

Then BAM, everything I worked for, and my new healthy life, was in jeopardy. I had to stop losing.

After four months of learning how to live healthy and lose weight — I had to do a 180, jump ship. Insanity.

Insurance Insanity and Walking the Obesity Tight Rope

For two months I had to:

  1. Walk a tight rope
  2. Live with the fear of losing weight and not getting approved
  3. Face the terror of regaining weight and reversing my new lifestyle and way of thinking

I managed to find a middle ground where I could still eat healthy but quit losing, but I was depressed. I didn’t want to quit. I wanted to keep conquering my decades-old life of obesity. Thus, another health issue (depression) forced on be by the insurance industry.

Thank God for my amazing medical team. They kept me focused. But, I worry about folks who might not have the support system I had.

Slowing the Weight Loss Train

  • Check with your insurance program. Some say if you start with your BMI at a certain point they’ll cover you no matter how much you lose, and encourage you to lose
  • Talk with your nutritionist about how to handle the situation, and
  • Keep a positive frame of mind and
  • Stay focused on healthy eating and living

Medical Opposition to the Reqirement by Insurance to Lose Weight Pre-Op

The American Society of Metabolic and Bariatric Surgeons (asmbs.org) has taken a stance against prolonged dieting before surgery. Don’t, however, misconstrue the organization’s stance with opposition for following a pre-op program of education and involvement with your medical team.

“It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery services is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and circumstances of the patient.”

Read more about the organization’s reasoning, Preoperative Supervised Weight Loss Requirements

 

 

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