Ask OH!
Members like you asked, and OH’s network of professionals answered!
Do you have a question you would like to ask of a plastic surgeon, bariatric surgeon, fitness expert, dietitian, psychologist or other bariatric professional? Send your questions to AskOH@obesityhelp.com, and we will print answers to select questions in future issues.
Q: I am post-op and approximately 230 pounds. What body weight should I get down to before I start running, and should I begin running on a treadmill rather than the street?
James
A: There is no standard in regards to what body weight you must achieve prior to initiating a running program. That said, there are several points you should consider prior to running:
• Running is a fairly high-impact activity that may further complicate any orthopedic issues you may have. This may further be exaggerated if you are still obese or overweight. Please seek medical clearance for general exercise participation and, more specifically, discuss any orthopedic problems that may limit your exercise participation.
• Using a treadmill will reduce the amount of impact associated with running or walking, so you may want to consider starting with a treadmill rather than the street, sidewalk or track.
• One of the factors most frequently overlooked by recreational exercisers is proper shoes. You MUST get the proper shoes for the type of feet you have and the activity you will be participating in. Runnersworld.com has great information about fitting and finding the proper footwear.
• Take your time! If you are new to running or have not done it for years, begin slowly and at a low intensity.
The fitness question above was answered by Jeremy Gentles, CSCS, OH’s own exercise and fitness expert. Please visit www.obesityhelp.com/forums/fitness for more information.
Q: I had breast augmentation and a tummy tuck one week ago. How long should I wear the abdominal binder? It causes me discomfort around the drainage sites. Maybe I could just wait until the drains are pulled and then wear it? Or am I going to be horribly lumpy from omitting it? That said, I only had a small amount of skin removed and minimal liposuction.
Shannon
A: Well, I am going to be very careful with this one. First and foremost, you should consult directly with your plastic surgeon. I will tell you that, in our practice, we have our patients wear their abdominal binders around the clock (except when showering or doing their wound care). The abdominal binder is important for several reasons. The binder will keep your swelling down. It will decrease the risk of bleeding and/or fluid accumulation within the fairly large surgical site underneath your skin. The binder also provides reinforcement and support for your newly tightened abdominal wall muscles. In our practice, the abdominal binder is an essential and important part of the recovery from abdominoplasty.
This question was answered by board certified plastic surgeon Steven Gitt, MD, FACS. For more information about Dr. Gitt and his practice please visit his ObesityHelp profile or visit his website at www.NVPSAZ.com.
Q: I have faith in my surgeon but I question the Medifast pre-op diet. I have been on Medifast—the program with bars, shakes, soups—and lost pretty quickly, but I found it hard to stay with. I am five weeks pre-op and have been put on Medifast shakes only. I asked if I could have just one lean and green, which others get, and they said no. Isn’t it unhealthy to be on just 500 calories per day? I know I need to lose 25-30 pounds before LAP-BAND surgery, but can’t I do that with a few more calories and a protein meat and veggie?
Nancy
A: You could and should most certainly be on more than a 500-calorie liquid diet, especially if you have five weeks to go before surgery. The very low calorie diet (VLCD) has been shown in the literature to have some success in the short term, but it should not be followed for long periods of time. Patients find them very difficult to stick to. I, at least in this practice, have never had a patient have successful pre-op weight loss on less than 1000 calories. Within the past few months, nine patients have called struggling with pre-op weight loss, and upon review of their food intake records, all nine patients were consuming between 700 to 1000 calories. I had them increase their calories to 1200 to1400 per day, and all nine patients met their pre-op weight loss goals and had surgery. I find that it is a common misunderstanding that consuming less means more weight loss. I would recommend four to five small meals per day. Two meals should consist of a liquid meal replacement drink or frozen meal replacement (healthy choice, lean cuisine). One meal should be a small snack at the time the patient feels most hungry (morning, afternoon or evening). The last meal should be a balanced home-cooked meal consisting of all food groups: 3 oz. of lean protein, 1/4 cup vegetables or fruit, 4 to 8 oz. of low-fat dairy and a small complex carbohydrate.
This question was answered by Gina Comer, RD, a registered dietitian specializing in bariatrics at the office of bariatric surgeon Michael W. Johnell, MD, FACS. To learn more about Dr. Johnell, visit his ObesityHelp profile.
Q: I lost 107 pounds and have gained all but 20 pounds back. My pouch stretched fast—within eight months. I considered myself very lucky since I never suffered any dumping, no throwing-up early or later. One strange thing is I never got the connection from stomach to brain, I was always hungry and upset about not grazing. I now realize I must have more mental problems which did not allow me to have lasting results from such a procedure. I feel like such a failure! I have many major health issues which demand reduction in body weight. I have not helped myself, only put this “stressed out” body and mind through trauma for nothing. I also suffer from Bipolar Disorder. This has been hell on my self-esteem.
Ruby
A: Ruby, I am sorry to see you struggling so, yet I am glad you had the courage to seek support. You raise a number of important concerns with your comments. First, while you have regained all but twenty pounds, that does not mean you failed the surgery. Rather, I suspect that your pouch remains plenty small enough that you have the opportunity to be more successful now than when you started with your surgery. Your awareness of your issues and desire for help are tremendous assets.
You are right to suspect that psychological and emotional factors play such a significant role in influencing the success of post-surgery weight loss maintenance. It’s unfortunate that meaningful psychotherapy wasn’t required before surgery, as it might have saved you much hardship and discouragement. I am curious about your mentioning that you suffer with Bipolar Disorder. Are you under the care of a mental health professional? In any event, I would encourage you to seek assistance from a bariatric surgery supportive and qualified mental health professional in your neck of the woods. I would expect that they would be able to accurately assess your circumstances and tailor your treatment with an eye towards helping you to get back on track.
This question was answered by Stephen J. Ritz, PhD, who is a Licensed Psychologist in Georgia, and a member of ObesityHelp’s Mental Health Board.
Q: I had my gastric bypass surgery in 1998 and I lost 15 pounds total. Why do you think I have not lost weight? I eat only 4 oz. at a time and don’t drink while I eat. I don’t eat much during the day. The doctor that performed the surgery left his practice in 1999 and I have not had a follow-up with anyone. I have several hernia repairs where the incision is and the hernias keep coming back. Any suggestions? My morale is down, and every time I see the big scar in my stomach and my weight, it depresses me.
Gladys
A: I recommend that you visit with your primary care provider for a full check-up. Lack of expected weight loss and recurrent incisional hernias are depressing medical problems indeed. You need a complete nutritional work-up. Our experience has been that patients who have undergone gastric bypass can have serious nutritional deficiencies—especially if they do not take the recommended amount of protein, multivitamins, iron, calcium citrate and B-12. It is not uncommon for patients to become severely iron deficient and anemic—especially if they are menstruating females. If you and your PCP feel that there may be a problem with the underlying surgery (problems such as ulcer, fistula, stricture and others), your PCP can refer you to a bariatric surgeon, preferably one that is a regular member of the American Society for Metabolic and Bariatric Surgery (ASMBS). Gastric bypass patients need yearly check-ups due to malabsorption of nutrients. A baseline DEXA scan (bone density scan) would be prudent as well.
This question was answered by board certified bariatric surgeon Michael W. Johnell, MD, FACS, who is the Medical Director of Bariatric Surgery at the North Colorado Medical Center in Greeley, Colorado. To learn more about Dr. Johnell, visit his ObesityHelp profile.
Remember, while the professionals contributing to Ask OH are highly skilled and well-qualified in their fields, they don’t know all of the details of your personal situation. Discuss the answers you receive, and any further questions you may have, with your personal healthcare team.
