~*~Rose Y.
I'm 45 years old, married with three wonderful children and three gorgeous grandchildren.
I've been struggling with my weight for 20 years now, trying every diet under the sun in the process, only to lose a little and gain more with each one.
I currently weigh around 240, down from my all time high of 256.
I have high blood pressure, PCOS, diabetes, high lipid levels, arthritis in my right hip, left knee, and hands. I have lower back problems that my doctor associates with my obesity. My back & feet are in constant pain now.
Not to mention having incontinence issues that are very embarrassing.
It's my hope that WLS will give me back my health and my life.
I want so much to be the active and vibrant person that I used to be.
This hasn't been a snap decision, either. I've been thinking about WLS for over a year now. I've researched the pro's and con's and I feel in my heart, this is the right thing for me to do.
I started out with Blue Cross, then a change of employment for my husband meant a change in insurance companies.
I'm now with Health Net PPO and am starting the process over.
Here's some great information!!!
Pouch Rules
INTRODUCTION:
A common misunderstanding of gastric bypass surgery is that
the pouch causes weight loss because it is so small, the patient eats less.
Although that is true for the first six months, that is not how it works.
Some doctors have assumed that poor weight loss in some patients is because
they aren't really trying to lose weight. The truth is it may be because they
haven't learned how to get the "satisfied" feeling of being full to last
long enough.
HYPOTHESIS OF POUCH FUNCTION:
We have four educated guesses as to how the pouch works:
1) Weight loss occurs by actually "slightly stretching" the pouch with food
at each meal or;
2) Weight loss occurs by keeping the pouch tiny through never ever
overstuffing or;
3) Weight loss occurs until the pouch gets worn out and regular eating
begins or;
4) Weight loss occurs with education on the use of the pouch.
PUBLISHED DATA:
How does the pouch make you feel full?
The nerves tell the brain the pouch is distended and that cuts off hunger
with a feeling of fullness.
What is the fate of the pouch? Does it enlarge? If it does, is it because
the operation was bad, or the patient is overstuffing themselves, or does the
pouch actually re-grow in a healing attempt to get back to normal?
For ten years, I had patients eat until full with cottage cheese every three
months, and report the amount of cottage cheese they were able to eat before
feeling full. This gave me an idea of the size of their pouch at three month
intervals. I found there was a regular growth in the amount of intake of
every single pouch. The average date the pouch stopped growing was two
years. After the second year, all pouches stopped growing. Most pouches ended at 6
oz., with some as large at 9-10 ozs.
We then compared the weight loss of people with the known pouch size of each
person, to see if the pouch size made a difference. In comparing the large
pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF
WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is
NOT the size of the pouch but how it is used that makes weight loss maintenance
possible.
OBSERVATIONAL BASED MEDICINE:
The information here is taken from surgeon's "observations" as opposed to
"blind" or "double blind" studies, but it IS based on 33 years of physician
observation.
Due to lack of insurance coverage for WLS, what originally seemed like a
serious lack of patients to observe, turned into an advantage as I was able
to follow my patients closely. The following are what I found to effect how
the pouch works:
1. Getting a sense of fullness is the basis of successful WLS.
2. Success requires that a small pouch is created with a small outlet.
3. Regular meals larger than 1 ½ cups will result in eventual weight gain.
4. Using the thick, hard to stretch part of the stomach in making the pouch
is important.
5. By lightly stretching the pouch with each meal, the pouch send signals to
the brain that you need no more food.
6. Maintaining that feeling of fullness requires keeping the pouch stretched
for a while.
7. Almost all patients always feel full 24/7 for the first months, then that
feeling disappears.
8. Incredible hunger will develop if there is no food or drink for eight
hours.
9. After 1 year, heavier food makes the feeling of fullness last longer.
10. By drinking water as much as possible as fast as possible ("water
loading"), the patient will get a feeling of fullness that lasts 15-25
minutes.
11. By eating "soft foods" patients will get hungry too soon and be hungry
before their next meal, which can cause snacking, thus poor weight loss or
weight gain.
12. The patients that follow "the rules of the pouch" lose their extra
weight and keep it off.
13. The patients that lose too much weight can maintain their weight by
doing
the reverse of the "rules of the pouch."
HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE:
By following the "rules of the pouch," it doesn't matter what size the pouch
ends up. The feeling of fullness with 1 ½ cups of food can be achieved.
OUTLET SIZE:
Regardless of the outlet size, liquidity foods empty faster than solid foods.
High calorie liquids will create weight gain.
EARLY PROFOUND SATIETY:
Before six months, patients much sip water constantly to get in enough water
each day, which causes them to always feel full.
After six months, about 2/3 of the pouch has grown larger due to the natural
healing process. At this time, the patient can drink 1 cup of water at a
time.
OPTIMUM MATURE POUCH:
The pouch works best when the outlet is not too small or too large and the
pouch itself holds about 1 ½ cups at a time.
IDEAL MEAL PROCESS (rules of the pouch):
1. The patient must time meals five hours apart or the patient will get too
hungry in between.
2. The patient needs to eat finely cut meat and raw or slightly cooked
veggies with each meal.
3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal
will cause failure.
4. No liquids for 1 ½ hours to 2 hours after each meal.
5. After 1 ½ to 2 hours, begin sipping water and over the next three hours
slowly increase water intake.
6. 3 hours after last meal, begin drinking LOTS of water/fluids.
7. 15 minutes before the next meal, drink as much as possible as fast as
possible. This is called "water loading," IF YOU HAVEN'T BEEN DRINKING OVER
THE LAST FEW HOURS, THIS 'WATER LOADING' WILL NOT WORK.
8. You can water load at any time 2-3 hours before your next meal if you get
hungry, which will cause a strong feeling of fullness.
THE MANAGEMENT OF PATIENT TEACHING AND TRAINING:
You must provide information to the patient preoperatively regarding the
fact that the pouch is only a tool: a tool is something that is used to perform a
task but is useless if left on a shelf unused. Practice working with a tool
makes the tool more effective.
NECESSITY FOR LONG TERM FOLLOW-UP:
Trying to practice the "rules of the pouch" before six to 12 months is a
waste. Learning how to delay hunger if the patient is never hungry just
doesn't work. The real work of learning the "rules of the pouch" begins
after healing has caused hunger to return.
PREVENTION OF VOMITING:
Vomiting should be prevented as much as possible. Right after surgery, the
patient should sip out of 1 oz cups and only 1/3 of that cup at a time until
the patient learns the size of his/her pouch to avoid being sick.
It is extremely difficult to learn to deal with a small pouch. For the first
6 months, the patient's mouth will literally be bigger than his/her stomach,
which does not exist in any living animal on earth.
In the first six weeks the patient should slowly transfer from a liquid diet
to a blenderized or soft food diet only, to reduce the chance of vomiting.
Vomiting will occur only after eating of solid foods begins. Rice, pasta,
granola, etc., will swell in time and overload the pouch, which will cause
vomiting. If the patient is having trouble with vomiting, he/she needs to
get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes
before eating another 1 oz of food. Stop when "comfortably satisfied," until
the patient learns the size of his/her pouch.
SIX WEEKS:
After six weeks, the patient can move from soft foods to heavy solids. At
this time, they should use three or more different types of foods at each
sitting. Each bite should be no larger than the size of a pinkie fingernail
bed. The patient should choose a different food with each bite to prevent
the same solids from lumping together. No liquids 15 minutes before or 1 ½ hours
after meals.
REASSURANCE OF ADEQUATE NUTRITION:
By taking vitamins everyday, the patient has no reason to worry about
getting enough nutrition. Focus should be on proteins and vegetables at each meal.
MEAL SKIPPING:
Regardless of lack of hunger, patient should eat three meals a day. In the
beginning, one half or more of each meal should be protein, until the
patient can eat at least two oz of protein at each meal.
ARTIFICIAL SWEETENERS:
In our study, we noticed some patients had intense hunger cravings which
stopped when they eliminated artificial sweeteners from their diets.
AVOIDING ABSOLUTES:
Rules are made to be broken. No biggie if the patient drinks with one meal -
as long as the patient knows he/she is breaking a rule and will get hungry
early. Also if the patient pigs out at a party - that's OK because before
surgery, the patient would have pigged on 3000 to 5000 calories and with the
pouch, the patient can only pig on 600-1000 calories max. The patient needs
to just get back to the rules and not beat him/herself up.
THREE MONTHS:
At three months, the patient needs to become aware of the
calories per gram of different foods to be aware of "the cost" of each gram.
(cheddar cheese is 16 cal/gram; peanut butter is 24 cals/gram). As soon as
hunger returns between three to six months, begin water loading procedures.
THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY:
1. Fill pouch full quickly at each meal
2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids
15
minutes before and none until 1 ½ hours after the meal). A scientific test
showed that a meal of egg/toast/milk had almost all emptied out of the pouch
after 45 minutes. Without milk, just egg and toast, more than ½ of the meal
still remained in the pouch after 1 ½ hours.
3. Protein, protein, protein. Three meals a day. No high calorie liquids.
FLUID LOADING:
Fluid loading is drinking water/liquids as quickly as possible to fill the
pouch which provides the feeling of fullness for about 15 to 25 minutes. The
patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to
30 SECONDS. Then just take swallows until fullness is reached. The patient
will quickly learn his/her maximum tolerance, which is usually between 8-12
oz.
Fluid loading works because the roux limb of the intestine swells up,
contracting and backing up any future food to come into the pouch. The pouch
is very sensitive to this and the feeling of fullness will last much longer
than the reality of how long the pouch was actually full. Fluid load before
each meal to prevent thirst after the meal as well as to create that feeling
of fullness whenever suddenly hungry before meal time.
POST PRANDIAL THIRST:
It is important that the patient be filled with water before his/her next
meal as the meal will come with salt and will cause thirst afterwards. Being
too thirsty, just like being too hungry will make a patient nauseous. While
the pouch is still real small, it won't make sense to the patient to do this
because salt intake will be low, but it is a good habit to get into because
it will make all the difference once the pouch begins to regrow.
URGENCY:
The first six months is the fastest, easiest time to lose weight. By the end
of the six months, 2/3 of the regrowth of the pouch will have been done.
That means that each present day, after surgery you will be satisfied with less
calories than you will the very next day. Another way to put it is that
every day that you are healing, you will be able to eat more. So exercise as much
as you can during that first six months as you will never be able to lose
weight as fast as you can during this time.
SIX MONTHS:
Around this time, our patients begin to get hungry between meals. THEY NEED
TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO
THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered
before they do the last gulping of water as fast as possible to fill the
pouch 15 minutes before they eat.
INTAKE INFORMATION SHEET AS A TEACHING TOOL:
I have found that having the patients fill out a quiz every time they visit
reminds them of the rules of the pouch and helps to get them "back on
track." Most patients have no problems with the rules, some patients really
struggle to follow them and need a lot of support to "get it", and a small
percentage never quite understand these rules, even though they are quite
intelligent people.
HONEYMOON SYNDROME:
The lack of hunger and quick weight loss patients have in the first six
months sometimes leads them to think they don't need to exercise as much and
can eat treats and extra calories as they still lose weight anyway. We call
this the "honeymoon syndrome" and they need to be counseled that this is the
only time they will lose this much weight this fast and this easy and not to
waste it by losing less than they actually could. If the patient's weight
loss slows in the first six months, remind them of the rules of water intake
and encourage them to increase their exercise and drink more water. You can
compare their weight loss to a graph showing the average drop of weight if
it will help them to get back on track.
EXERCISE:
In addition to exercise helping to increase the weight loss, it is important
for the patient to understand that exercise is a natural antidepressant and
will help them from falling into a depression cycle. In addition, exercise
jacks up their metabolic rate during a time when their metabolism after the
shock of surgery tends to want to slow down.
THE IDEAL MEAL FOR WEIGHT LOSS:
The ideal meal is one that is made up of the following: ½ of your meal to be
low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal
solid fruits. This type of meal will stay in your pouch a long time and is
good for your health.
VOLUME VS. CALORIES:
The gastric bypass patient needs to be aware of the length of time it takes
to digest different foods and to focus on those that take up the most space
and take time to digest so as to stay in the pouch the longest, don't worry
about calories. This is the easiest way to "count your calories." For
example, a regular stomach person could gag down two whole sticks of butter
at one sitting and be starved all day long, although they more than have
enough calories for the day. But you take the same amount of calories in
vegetables, and that same person simply would not be able to eat that much
food at three sittings - it would stuff them way too much.
ISSUES FOR LONG TERM WEIGHT MAINTENANCE:
Although everything stated in this report deals with the first year after
surgery, it should be a lifestyle that will benefit the gastric bypass
patient for years to come, and help keep the extra weight off.
COUNTER-INTUITIVENESS OF FLUID MANAGEMENT:
I admit that avoiding fluids at meal time and then pushing hard to drink
fluids between meals is against everything normal in nature and not a
natural thing to be doing. Regardless of that fact, it is the best way to stay full
the longest between meals and not accidentally create a "soup" in the
stomach that is easily digested.
SUPPORT GROUPS:
It is natural for quite a few people to use the rules of the pouch and then
to tire of it and stop going by the rules. Others "get it" and adhere to the
rules as a way of life to avoid ever regaining extra weight. Having a support group makes
all the difference to help those that go astray to be reminded of the importance of the rules of
the pouch and to get back on track and keep that extra weight off. Support groups create a
"peer pressure" to stick to the rules that the staff at the physician's office simply can't
create.
TEETER TOTTER EFFECT:
Think of a teeter totter suspended in mid air in front of you. Now on the
left end is exercise that you do and the right end is the foods that you
eat. The more exercise you do on the left, the less you need to worry
about the amount of foods you eat on the right. In exact reverse, the
more you worry about the foods you eat and keep it healthy
on the right, the less exercise you need on the left. Now if you don't
concern yourself with either side, the higher the teeter totter goes, which
is your weight. The more you focus on one side or the other, or even both
sides of the teeter totter, the lower it goes, and the less you weigh.
TOO MUCH WEIGHT LOSS:
I have found that about 15% of the patients which exercise well and had
between 100 to 150 lbs to lose, begin to lose way too much weight. I
encourage them to keep up the exercise (which is great for their health) and
to essentially "break the rules" of the pouch. Drink with meals so they can
eat snacks between without feeling full and increase their fat content as
well take a longer time to eat at meals, thus taking in more calories. A
small but significant amount of gastric bypass patients actually go
underweight because they have experienced (as all of our patients have
experienced) the ravenous hunger after being on a diet with an out of
control appetite once the diet is broken. They are afraid of eating again. They
don't "get" that this situation is literally, physically different and that they
can control their appetite this time by using the rules of the pouch to
eliminate hunger.
BARIATRIC MEDICINE:
A much more common problem is patients who after a year or two plateau at a
level above their goal weight and don't lose as much weight as they want. Be
careful that they are not given the "regular" advice given to any average
overweight individual. Several small meals or skipping a meal with a liquid
protein substitute is not the way to go for gastric bypass patients. They
must follow the rules, fill themselves quickly with hard to digest foods,
water load between, increase their exercise and the weight should come off
much easier than with regular people diets.
SUMMARY:
1. The patient needs to understand how the new pouch physically works.
2. The patient needs to be able to evaluate their use of the tool, compare
it
to the ideal and see where they need to make changes.
3. Instruct your patient in all ways (through their eyes with visual aids,
ears with lectures and emotions with stories and feelings) not only on how
but why they need to learn to use their pouch. The goal is for the patient
to become an expert on how to use the pouch.
EVALUATION FOR WEIGHT LOSS FAILURE:
The first thing that needs to be ruled out in patients who regain their
weight is how the pouch is set up.
1) the staple line needs to be intact;
2) same with the outlet and;
3) the pouch is reasonably small.
1) Use thick barium to confirm the staple line is intact. If it isn't, then
the food will go into the large stomach, from there into the intestines and
the patient will be hungry all the time. Check for a little ulcer at the
staple line. A tiny ulcer may occur with no real opening at the line, which
can be dealt with as you would any ulcer. Sometimes, though, the ulcer is
there because of a break in the staple line. This will cause pain for the
patient after the patient has eaten because the food rubs the little opening
of the ulcer. If there is a tiny opening at the staple line, then a
reoperation must be done to actually separate the pouch and the stomach
completely and seal each shut.
2) If the outlet is smaller than 7-8 mill, the patient will have problems
eating solid foods and will little by little begin eating only
easy-to-digest
foods, which we call "soft calorie syndrome." This
causes frequent hunger and grazing, which leads to weight regain.
3) To assess pouch volume, an upper GI doesn't work as it is a liquid. The
cottage cheese test is useful - eating as much cottage cheese as possible in
five to 15 minutes to find out how much food the pouch will hold. It
shouldn't be able to hold more than 1 ½ cups in 5 - 15 minutes of quick
eating.
If everything is intact then there are four problems that it may be:
1) The patient has never been taught the rules;
2) The patient is depressed;
3) The patient has a loss of peer support and eventual forgetting of rules,
or
4) The patient simply refuses to follow the rules.
1) LACK OF TEACHING:
An excellent example is a female patient who is 62 years old. She had the
operation when she was 47 years old. She had a total regain of her weight.
She stated that she had not seen her surgeon after the six week follow up 15
years ago. She never knew of the rules of the pouch. She had initially lost
50 lbs and then with a commercial weight program lost another 40 lbs. After
that, she yo-yoed up and down, each time gaining a little more back. She
then developed a disease (with no connection to bariatric surgery) which weakened
her muscles, at which time she gained all of her weight back. At the time
she came to me, she was treated for her disease, which helped her to begin
walking one mile per day. I checked her pouch with barium and the cottage
cheese test which showed the pouch to be a small size and that there was no
leakage. She was then given the rules of the pouch. She has begun an
impressive and continuing weight loss, and is not focused on food as she
was, and feeling the best she has felt since the first months after her operation
15 years ago.
2) DEPRESSION:
Depression is a strong force for stopping weight loss or causing weight
gain.
A small number of patients, who do well at the beginning, disappear for a
while only to return having gained a lot of
weight. It seems that they almost on purpose do exactly opposite of
everything they have learned about their pouch: they graze during the day,
drink high calorie beverages, drink with meals and stop exercising, even
though they know exercise helps stop depression. A 46 year-old woman, one
year out of her surgery had been doing fine when her life was turned upside
down with divorce and severe teenager behavior problems. Her weight
skyrocketed. Once she got her depression under control and began refocusing
on the rules of the pouch, added a little exercise, the weight came off
quickly. If your patient begins weight gain due to depression, get him/her
into counseling quickly. Encourage your patient to refocus on the pouch
rules and try to add a little exercise every day. Reassure your patient that
he/she did not ruin the pouch, that it is still there, waiting to be used to help
with weight control. When they are ready the pouch can be used once again to
lose weight without being hungry.
3) EROSION OF THE USE OF PRINCIPLES:
Some patients who are compliant, who are not depressed and have intact
pouches, will begin to gain weight. These patients are struggling with their
weight, have usually stopped connecting with their support groups, and have
begun living their "new" life surrounded by those who have not had Bariatric
surgery. Everything around them encourages them to live life "normal" like
their new peers: they begin taking little sips with their meals, and eating
quick and easy-to-eat foods. The patient will not usually call their
physician's office because they KNOW what they are doing is wrong and KNOW
that they just need to get back on track. Even if you offer "refresher
courses" for your patients on a yearly basis, they may not attend because
they KNOW what the course is going to say, they know the rules and how they
are breaking them. You need to identify these patients and somehow get them
back into your office or back to interacting with their support group again.
Once these patients return to their support group, and keep in contact with
their WLS peers, it makes it much easier to return to the rules of the pouch
and get their weight under control once again.
4) TRUE NONCOMPLIANCE:
The most difficult problem is a patient who is truly noncompliant. This
patient usually leaves your care, complains that there is no 'connection'
between your staff and themselves and that they were not given the time and
attention they needed. Most of the time, it is depression underlying the
noncompliance that causes this attitude. A truly noncompliant patient will
usually end up with revisions and/or reversal of the surgery due to weight
gain or complications. This patient is usually quite resistant to
counseling. There is not a whole lot that can be done for these patients as they will
find a reason to be unhappy with their situation. It is easier to identify
these patients BEFORE surgery than to help them afterwards, although I
really haven't figured out how to do that yet. Besides having a psychological exam
done before surgery, there is no real way to find them before surgery and I
usually tend toward the side of offering patients the surgery with education
in hopes they can live a good and healthy life.
I saw this on my friend's blog (Tami) and love it:
The Ten Commandments of Weight Loss Surgery
1. THOU SHALL NOT DRINK with thy meals.
This means never! This is cheating...cheating yourself. It washes the food out of your pouch and allows you to eat more. This will slow and eventually stop your weight loss. PLUS you will not be getting all the benefits of the wise choices you have filled your little pouchy-poo with.
2. THOU SHALL EAT SLOWLY, very slowly.
This is not a rule for the first few months post op. This rule is for the rest of your life. If you eat too quickly, you will surely stretch your pouch. Eat too quickly and you will learn the hard way...the nausea is stifling. Oh and CHEW CHEW CHEW!! And when you think you are done, CHEW SOME MORE. Or your food will keep coming back to visit you.
3. THOU SHALL TAKE THY VITAMINS.
This surgery is a great tool for weight loss. But, as with all benefits, there are costs...and malnutrition is one of the potential prices of this surgery. Take a multivitamin supplement every day for the rest of your life and it is one you may never have to pay. You will also need to have your blood checked periodically for B-12 levels.
4. THOU SHALL EAT ADEQUATE PROTEIN.
What is adequate? I am not a physician, so I cannot say for sure. I have heard everything from 50-60 grams a day (which equals about 2 oz. Of protein) to a much higher number ...(to figure out the amount of grams of protein equals in ounces, multiply the # of grams by .0353. That will give you an ounce calculation. It may not sound like a lot, but when you get down to brass tacks, and really look at what you eat at a meal, are you getting in at least 2 oz of meat at a sitting? Then filling in with the rest? Meat is usually very heavy and it is hard to digest so it ends up being the last thing we work on at a meal. A lot (I did not say all) of post ops tend to take more of what rests comfortably in their pouch...all I am saying is to be aware and then adjust so you are meeting those requirements...above all be balanced in your diet (DON'T FREAK CAUSE I USED THE D WORD HERE....definition of diet-from Greek diaita, literally, manner of living, from diaitasthai to lead one's life-
a: food and drink regularly provided or consumed
b: habitual nourishment
-PLEASE NOTE-DIET does NOT translate to STARVATION or DEPRIVING ONESELF on ANY level...it merely suggests a habitual eating style...)
5. THOU SHALL EXERCISE.
Just do SOMETHING. Even if it means starting off simply...take the stairs instead of the escalator or elevator. Park at the furthest spot in the parking lot. Carry your shopping basket instead of pushing the cart (on small shopping days of course...LOL).
6. THOU SHALL DRINK at least 64 ounces of water, everyday. It seems that some people have problems doing this. Use a water bottle and carry it with you everywhere. Sip all day long. Or refill a gallon jug and drain it every day. Do it in 2 pitchers. Do it with 2-32oz sport water bottles. Please note however, that if you are drinking coffee or tea with caffeine, you will have to compensate for the diuretic effects of the caffeine. Caffeine robs your body of water, therefore, you will not only be unable to count the coffee or tea, but you will have to drink an extra cups of fluid for every cup of regular coffee or caffeinated tea that you drink to compensate for the diuretic effects of the caffeine.
7. THOU SHALL EAT WELL BALANCED MEALS.
I think my doctor said it best: Protein first and foremost, then green/yellow vegetables, then fruit, then starches.
8. THOU SHALL NOT EAT SUGAR, in ANY form....no candy!!!
Treat yourself with some fresh fruit!!
9 THOU SHALL NOT modify these commandments to suit thy needs. It will not work. You will only defeat yourself physically.
10. THOU SHALL LOVE THYSELF and be happy with the body God gave thee. God did not intend for all of us to be supermodels, and this surgery will NOT make you one. Happiness comes from within. Be happy with who and what you are. Or you will defeat yourself mentally. Then the battle will be lost before it is ever even begun.
Author Unknown
Weight Loss Detail:
November 2005 256 lbs
February 2006 (Initial consutlation with PCP): 243 lbs / BMI 40.04
August 16, 2006 (Offical Weigh-In w/ Dr. Waldrep): 232 lbs / BMI 38.6
October 4, 2006 (One on one with Dr. Waldrep): 228.5 lbs / BMI 38
November 4, 2006 (!st Day of liquid diet): 233 lbs / BMI 38.8
Day of surgery: 233 lbs
Week 1: 219.5 (-13.5/ -13.5)
Week 2: 213 lbs (-6.5/-20 )
Week 3: 210.4 (-2.5/-22.5)
Week 4: 206.8 ( -4.2/-26.2)
Week 5: 200.2 (-6.6/-32.8)(BMI 33.3)
Week 6: 197 (-3.2/-36) (BMI 32.6)
Week 7: 196 (-1/-37)
Week 8: 191.6 (-4.4/41.4)
Week 9: 186.4 (-5.2/46.6)
Week 10: 185 (-1.4/48.0)
Week 11: 183 (-2/50)
Week 12: 179 (-4/54)
Week 13: 174 (-5/59)
Week 14: 172 (-2/61) BMI 27.8
Week 15: 172 (-0/61)
Week 16: 168(-4/65) BMI 27.1
Week 17: 163 (-5/70)
Week 18: 160 (-3/73)
Week 19: 157(-3/76)
Week 20: 157 (-0)
Week 21: 157 (-0)
Week 22: 157 (-0)
Week 23: 153 (-4/80 since surgery/103 total)
Pre-Surgery Measurements:
Neck: 15.5 inches
Chest: 47.5 inches
Waist: 47.5 inches
Hips: 49 inches
Right Thigh: 28.5 inches
Left Thigh: 27.5 inches
Under boobs: 39 inches
Left Calve: 15 inches
Right Calve: 15.25 inches
Right Bicep: 13 inches
Left Bicep: 13 inches
January 25, 2007 Measurements:
38.75 inches gone!
74 lbs down total.
Neck: 15.5 inches/15" (-.5")
Chest: 47.5 inches/43" (-4.5")
Waist: 47.5 inches/36" (-11.5")
Hips: 49 inches/42.5" (-6.5")
Right Thigh: 28.5 inches/24.25" (-4.25')
Left Thigh: 27.5 inches/24" (-3.5")
Under boobs: 39 inches/36" (-3")
Left Calve: 15 inches/14.25" (-.75")
Right Calve: 15.25 inches/14.5" (-.75")
Right Bicep: 13 inches/11.5" (-1.5")
Left Bicep: 13 inches/11" (-2")
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