To Carb, or Not To Carb?

Into every post-surgery life, a little rain must fall. Apparently, it is my turn again, as my latest weigh-in has me up by 1.2 pounds. This would not be terribly significant if it were not for the fact that I am within spitting distance of my goal weight of 185. It seems a cruel joke by my metabolism, setting me back when I am under 5 pounds away.

What Do The Numbers Really Mean?

Now, first things first: gaining a pound when you weigh 188 (189, now) pounds is no reason to sound the alarms. So many different things can contribute to weight fluctuation. There is no way to determine if this is water weight, or “OMG I ate a cheesecake” weight gain.

For the record, I did not eat a cheesecake.

What I did do, though, is change a couple things in my workout habits. I have been hitting the workouts really hard. At the advice of our shared personal trainer, I have reversed my normal exercise routine. I am now doing weights first, then cardio-vascular exercise. This meant instant increases in all my weight levels for resistance exercise. It also means I am leaving the gym a heck of a lot more blown out than I was previously.

My trainer, Ian, also suggested that I look into HIIT exercise. High-Intensity Interval Training involves blasting out reps as hard as you can for a short time period (usually 30 or 60 seconds), then resting for a minute or two. It sounded interesting until I mentioned how low my current carb load is.

“Carbs are what your body uses for fuel,” Ian told me. “At your carb level, you are going to have nothing in the tank.”

Torn Between Two Experts

So, we have my Certified Personal Trainer, Ian, suggesting that my exercise level needs to be supported by increasing the carbs in my diet.

And we have my Certified Nutritionist, Patti, who insists that, for bariatric patients, carbs are the devil.

So, umm…yeah. Confused much?

Last week I made the judicious decision to increase my carb content by about 50% (to 90 grams a day.) I slept better, had more energy,  and got all the way through all my workouts.

And I gained 1.2 pounds.

Now, other factors have to be taken into consideration. Development of lean muscle mass means that, initially, weight will go up. This, in turn, will raise the Base Metabolic Rate, meaning that the body will burn more energy while resting. Which should, in theory, lead to overall weight loss.

Now, do I really think I added 1.2 pounds of muscle in a week?

Kinda doubt it.

Peering Into The Future

So, I am going to have to settle for looking down the road and deciding what my focus will be.

The fact of the matter is, I am not training for weight loss per se. I am training for functional muscle and endurance. Starting this weekend, I have some energy-burning activities on the radar.

On Sunday we will be participating in our first 5K.

Later this month we will be hauling ourselves up a 45-foot wall at Stone Age Climbing Gym.

We’ll be heading out every week on a different day hike into the Sandias.

And this will all culminate in the assault on the La Luz Trail, probably in August.

The theme here seems to be “energy-burning activities.” I am going to have to plan (and train) accordingly. This is going to mean enhanced carbohydrate intake. So I am going to have to be careful. Complex carbs, ancient grains, and regular food logging will be the order of the day. And, once the increased workout load stops, I will need to drop the carbs back to 60 grams or less a day.

Every time I start to panic, I can just reach into my closet and try on my beloved 501s. As long as the 36-inch waistline is comfortable, I won’t panic too much.

As of this morning, they are actually a little loose.

Now there’s some food for thought.

Are 34s On The Horizon?

Jeremy

 

Bariatric Surgery Misconceptions 3: This Is Never Going To Work

Wile E. Coyote property of Warner Bros. Inc.

The diet cycle experienced by those of us who are obese is a familiar one. We look in the mirror and sigh and/or cry. We read books, check out magazines, surf the internet. We find some new diet that looks like it might work. We try the diet. It works: for a while. Then, something happens. Maybe Real Life interferes. Perhaps we decide we can’t live on grapefruit and quinoa. It is even possible that we recognize the fact that obese bodies can not manage high-intensity interval training every day. But something interferes, the diet stops, and we gain all our weight back.

So, why would we expect bariatric surgery to be any different? And, let’s face some facts here: bariatric surgery is a heck of a lot more invasive and expensive than our usual diets.

Do we really want to invest so much if we are only going to gain the weight back anyway?

The Cold Equations

Here’s the truth: about 20% of bariatric patients eventually suffer some sort of regain.

Don’t get me wrong: that is a big number. For one in five people that go through bariatric surgery, the lowest weight they achieve after surgery will not be their stopping point. They will eventually creep back up to some other weight.

But notice what is not being said here: 20% of patients do not regain all their weight. They hit a low weight, then eventually add some weight back to that. The number of patients who end up regaining all their weight is so low that I can’t even find reliable numbers on the phenomenon.

Let’s say my desire for beer and Oreos finally takes me out back and roughs me up. As a consequence, I gain 50 pounds from my current 192. This leaves me, bruised and depressed, at 242 pounds.

In other words, I would still be 50 pounds lighter than where I started this process. And no doctor is ever going to tell you that a permanent weight loss of 50 pounds is bad for an obese person.

Heck, when I started this process, I was hoping to lose around 50 pounds.

The Hows And Whys

Regain is not an exact science. Some people decide they can’t live without certain elements of their old diet. There are those that determine they do not want to exercise. There are even a few people who lose too much (the mind boggles) and have to regain to be at a healthy weight.

The other thing to remember is that the process does not have to stop with regain. A person who regains still has the ability to identify the elements of their lifestyle that are not contributing to weight loss. You can always fight back.

Will it be at as easy as it was during the “honeymoon period” after surgery? Nope, not at all. But the fact is, the honeymoon ends for all of us. At some point, the “free” weight loss ends and the work of maintenance begins. That work is the same whether you have stayed at a stable weight or regained 20+ pounds.

Once again: bariatric surgery is a single tool to use in your fight against obesity. And any long-term weight loss is contributing to your overall health. If regain should happen, don’t give up. Just remind yourself that it could be (and has been) worse, and keep on fighting.

And put down the Oreos, for goodness sake.

Avoiding Oreo Alley and Beer Boulevard,

Jeremy

Bariatric Surgery Misconceptions 2: Goal Weight

Goal Weight

A great many of the issues I talk to people about make me genuinely empathetic. I can relate to something in their experience – if not the specific event, at least the way they feel about it. This is only enhanced with bariatric patients – after all, I’ve been through most of what they are going through.

However, there is one “bariatric subject” that I have no grasp of. Sadly, it is the one subject that just about everyone talks about:

Goal Weight

Your Doctor, Your Scale, And You

Go visit any bariatric forum, Facebook group, or message board. I guarantee, within the first 5 posts, you will see some version of the following message:

“Help! My goal weight is (X), and I am stuck at (Y)!!! What am I doing wrong???”

Goal weight, for the uninitiated, is the weight your doctor thinks you should settle in at after bariatric surgery. It tends to be the #1 fixation of bariatric patients. It is also, in my opinion, just about the most worthless of metrics.

Ever since the day I read an article that pointed out that the entire 2004 U.S. Women’s Volleyball Team were “obese” according to BMI, I have been suspicious of weight as a measurement of health. Need some more recent proof? Dwyane “The Rock” Johnson is, with a Body Mass Index of 34.1, obese.

Man, I would give a lot to be obese like The Rock. Just sayin’.

Weight is only one of several factors that determine health. But it tends to be the one thing that bariatric patients focus on. Why? Probably because we all have scales at home, and can check that number constantly. Seriously – I have more than one friend that feels compelled to weigh every day.

Functional Weight

We seriously need to stop with this obsession over numbers and start concerning ourselves with overall health.

Today, I can run 15 minutes straight. A year ago, I could walk about 10 minutes before collapsing on the couch and hyperventilating for half an hour. That, to me, is worth greater attention that the number on my scale.

My “goal weight” is officially 185 pounds. I may never get there, having slowed my weight loss way down by starting up again at the gym. I couldn’t care less. My clothes are still fitting differently every week. I am on my way to being able to run in a 5K in 2 months. By the end of the year, I hope to be able to bench-press my body weight.

In short, I am much more interested in what my body can do than what it weighs.

Body weight varies for all kinds of reasons. Water retention. Illness. Over- and under-eating. Any one of these things can cause that scale number to not move, or even move the wrong way!

But you have to ask yourself: what can I do now that I couldn’t do before weight loss surgery? How has my quality of life improved? More importantly, what can I do to continue improving it?

And the numbers of your BMI or on your scale will give you no help with that whatsoever. Find goals that actually mean something: participate in an event. Try on a new swimsuit. Take up a new hobby.

If you are healthy enough to do everything you want to do, weight is nothing but a number.

Just go ask The Rock. He’ll tell ya.

Though I Am Still Obsessed With The Number On The Treadmill,

Jeremy

 

Don’t Judge Me

Don't Judge MeOver this last weekend, I was left unsupervised for the first time since my surgery. Lor was attending a family reunion, so I was left to my own devices for four whole days. I cooked for myself, I wrote, and I played video games. Three days out of four I went to the gym, and I even did some work around the house.

Oh, and I gained 1.5 pounds.

The Shoe On The Other Foot

I must admit that I find it ironically amusing that I am now in the position I find so many other bariatric patients in: “Help! I’ve gained weight and I don’t know why!”

It is a common refrain at support groups and on message boards – something has gone wrong, please tell me how to fix it. Usually, though, there is another component to the plea for help. Something along the lines of “Oh, and don’t tell me anything I don’t want to hear while telling me how to correct this problem. Kthanksbye.”

I, of course, have a pretty good idea what happened to my diet. Hours normally filled with activity were, instead, taken over by sitting immobile in front of a monitor. I probably didn’t push myself as hard as I should have at the gym. I logged meals at the end of the day and discovered that, instead of a single snack during the course of a day, I had 2 or 3. (And this is why logging WHILE EATING is important.) These things all add up. In my case, they added up to a pound and a half.

Many times, though, we as patients don’t want to hear what we have done wrong. We want to know how to fix the problem immediately. A “make it didn’t happen” pill, maybe. The last thing a person wants to hear is “Don’t do what you just did.”

The Danger of Symptomology

We have an unfortunate tendency, in our culture, to focus on symptoms instead of root problems. Your head hurts? Take a pain med. Are you tired? Have some caffeine. Not sleeping well? Drink some Nyquil.

At no time do we stop to consider root causes. Maybe stress is causing headaches. Poor diet may be contributing to your lack of energy. An irregular schedule might be the cause of your sleep problems. But correcting each of those root causes requires work: a commitment of time and energy, usually over a period of days or weeks. And who has time for that? Just gimme something for the symptom, thanks.

I, myself, came very close to that exact “solution” after my unexpected weight gain. After I stepped off the scale I determined I would immediately go on a 3-day protein shake diet, to “reset” myself.

In other words, I wanted to be all better in three days.

Fortunately, I put some extra thought into it. An all protein shake diet is not a good long-term solution. A good long-term solution is to buckle down on gym work, continue to reduce carbs, and pay closer attention to what I am putting in my mouth. The symptom of weight loss is not the problem. The relaxation of dietary and exercise compliance is.

The Benefit of Judgement

See, mostly what I was lacking was accountability. I would love to say “Don’t judge me! I am human and I make mistakes!”

But, what I really needed was someone to smack the cookie out of my hand. (OK, in my case it was almonds, not a cookie. But you get the idea.)

If you are engaging in behavior that makes you want to say “Don’t judge me!”, you probably need to judge that behavior. Find yourself some accountability. Write things down. Tell someone your goals. Make a plan and stick to it.

Or, you know, be embarrassed that apparently you couldn’t be safely left unsupervised for a long weekend.

The choice is yours!

Two Steps Up And One Step Back,

Jeremy

 

Waving The Weight Loss Wand

Why bariatric surgery is not an easy solution

Most of the bariatric patients I know spent several months learning what they were getting into. Meetings with nutritionists, doctors appointments, and even psych evals were all required for Lor and I. Their purpose? To prepare us for the massive life changes that came along with bariatric surgery.

Apparently, not everyone gets the kind of preparation we did.

I Didn’t Sign Up For This

A few days ago, I discovered a very unhappy bariatric patient online. Her complaint (paraphrased by me) went something like this:

“I am sick of reading all this negativity! If I had wanted to sign up for calorie counting, food nazis, daily exercise, and never eating anything good, I would’ve just done THAT, and not had surgery!”

Yeah, sorry your surgical team didn’t make that a little clearer to you. Or that you weren’t really paying attention in the months before surgery. Because all that “negativity” is exactly what you signed up for by going through with bariatric surgery.

Let’s Be Honest

But, seriously: did you really think of having your innards rearranged or removed as a shortcut?

The vast majority of us that have gone through surgery have tried changing diets. We’ve tried going to the gym. We’ve tried buckling down and making major changes in our lives. And, every time, we have not only failed, but we’ve usually left ourselves worse off than where we began. Some try the latest crash diet, lose 10 or 20 pounds, and fall off the wagon. Their metabolic processes, undergoing starvation conditions, then pack the pounds back on as fat. This usually leaves a person heavier than where they started.

Or, they could take my route. I would try (and fail) to change my diet. So, instead, I would take up exercise. But I would inevitably be in a hurry to lose weight. So I would push the exercise a little too hard. Within a few days, I would injure myself, and wind up unable to do much of anything for a few weeks. During those weeks of physical inactivity, my weight would skyrocket.

In other words, we’ve tried all the things you said you would do instead of surgery. They didn’t work. So, we went forward with surgery: a combination of dietary restriction, negative reinforcement (in the form of dumping syndrome), and dramatic weight loss that freed us up to begin a sane exercise program. There was no magic wand that made us weigh less while maintaining the lifestyles that made us obese in the first place.

All This And More

And this is the thing that is misunderstood about bariatric surgery: it is not a shortcut. It is not a “get out of food-jail free” card. It is a dramatic solution to a chronic problem. First, we have surgery. Then, we get to go forward with all the solutions everyone thinks we should have done in the first place.

I will be on daily vitamins and supplements for the rest of my life. When I reach “maintenance mode” I will still be eating under 1,200 calories a day or so – normally enough to sustain a 120-pound person (roughly). I will not be eating carb-heavy foods like bread and french fries and pasta as part of my normal diet. Carbonated beverages like Coke and beer are gone forever.

Maybe this sounds negative to you. I have a different view on negativity. All I have to do is remember what it felt like to weigh over 300 pounds. Now THAT was truly negative.

If you truly were not prepared for what was coming with bariatric surgery, I am truly sorry for you.

But, I admit that I am puzzled by someone who wants to have surgery instead of making lifestyle changes. And, I kind of doubt that was your mindset when you signed up for the procedure that would change your life.

Just sayin’.

Sympathetic But Unconvinced,

Jeremy