Gastric Sleeve, Gastric Bypass and Gastric Band

General Comments

1. All bariatric operations are complex. The surgeon needs to perform the operation in a way that results, in the end, in very specific anatomy. In other words, if the anatomy of the stomach and intestine is not correct at the end of the operation, the operation will not work. This is not always easy to do since every person is shaped differently inside (just like we all are shaped differently on the outside). The surgeon must be focused on performing the operation correctly in order to give his or her patients the best chance for success.
2. If you eat high-calorie soft foods, or high-calorie liquids, you will be able to take in a lot of calories without feeling full. This is a way to minimize the beneficial effects of the Gastric Sleeve, the Gastric Band and the Gastric Bypass. I call this “SABOTAGE” because it means that you’ve chosen to undergo an operation to help you eat slowly and modify your eating pattern, and then you’ve figured out how to “get around” the operation. Most patients do not sabotage themselves, and as a result, they succeed in modifying their diet and losing a substantial amount of weight.
3. The speed of the operation is not a main goal; although novice surgeons may think that speed makes them “better” this is NOT TRUE. The important goal with these operations (and all surgery) is to get the operation done correctly, and to have a low complication rate. Nothing else is important. Bariatric surgeons must focus on getting the operation done correctly, and in the safest way possible.

One woman tried to lose weight with her boyfriend—and just about lost her mind. Here, experts explain why men lose weight so much faster than women, plus the best ways to try to slim down with your S.O.

After a year spent flirting over candlelit dinners and skipping the gym for between-the-sheets sweat sessions, my boyfriend and I decided we really needed to lose the 15-plus pounds we had each packed on since our first date.

He cut his soda habit to just one bottle a day. I sipped water and green tea like it was my job. He ate takeout every day for lunch. I made all of my meals from scratch. On road trips, I noshed on almonds and carrots. He bought beef jerky, a bag of doughnuts, and an energy drink from a gas station. I ran about 20 miles a week; he said he’d get around to it. And he’s still losing weight faster than I am.

Yes, it’s infuriating. But it’s also biology. Between their higher levels of testosterone and increased muscle mass, guys are designed to make weight loss look easy. “Women will lose less weight, compared to men, even if they cut the same number of calories,” says Brian Quebbemann, MD, a bariatric surgeon with the Chapman Medical Center in California and president of The N.E.W. Program. “Men need more calories to supply energy to their muscles and other organs, which are larger, on average, than those of women.” Even if you and your BF are the same height, he’ll have more lean muscle mass, requiring the consumption of more calories, says Quebbemann. “What’s more, men have seven times the testosterone as women, which increases their metabolism independently from the muscle mass factor.” And women? We’re bathing in estrogen, which causes our bodies to glob on fat, especially around the hips, thighs, and butt.

But if you’re like me and trying to lose weight with your S.O., getting hung up on how much easier weight loss is for him won’t do you any favors. Follow these five strategies to lose weight with your boyfriend, without giving up in the name of genetics.

1. Lift more weights.

If there’s any weight-loss lesson women should take from men, it’s that muscle revs your metabolism, says Wayne Andersen, MD, co-founder and medical director of the Take Shape For Life online health community. Plus, regular resistance training can actually increase women’s levels of testosterone and influence how the body hangs on to fat, says research published in the International Journal of Sport Nutrition and Exercise Metabolism. (Don’t worry, you won’t sprout a mustache!)

2. Don’t try to match his eating.

If your plate is as big as his, you might actually gain weight. After all, even if they’re the same height, weight, and age, women typically need fewer calories per day than do their male counterparts, says dietitian Tori Holthaus, RDN, LD, founder of YES! Nutrition. Listen to your own body to guide how much you need. Likewise, what foods he decides to eat shouldn’t determine your menu, she says. Even if you’re trying to lose weight together, it’s important to do it in a way that fits your tastes and preferences. That’s the only way it’s sustainable.

3. Make it a team effort.

When his weight drops off faster than yours, it’s easy things to get competitive. Instead, consider his success your success, Holthaus says. In the end, the healthier he is, the longer he’ll be around (and the sexier he’ll look when he crawls in bed with you every night). “Cheer each other on for the small daily wins in your efforts to be healthier, and encourage each other if things get a little off-track,” she says.

4. Give it time.

When it comes to weight loss, fast isn’t always a good thing. Remember that the faster you lose weight, the greater the chances that you’re burning not only fat but calorie-torching muscle as well. So instead of trying to catch up to your guy’s weight-loss totals, aim to lose a maximum of about one to two pounds per week. That will guarantee that your weight loss is both healthy and sustainable. Do that, and after about six months, most women will find that they’ve actually lost a similar amount of weight to most guys, Andersen says.

5. Reassess your goals.

You don’t need to be—and shouldn’t be—as lean as a guy! For optimum health, 12 to 18 percent of a man’s weight should come from fat. For women, that target balloons to 18 to 24 percent, Quebbemann says. Try to achieve the same body fat percentage as your boyfriend, and your health will suffer. “Women with less than 12 to 14 percent body fat content will often have irregular menstrual cycles,” he says. “Plus, body fat seems to have a substantial effect on emotional health, with women often suffering from depression when they ‘achieve’ extremely low body fat percentages.” You do you, ladies.

1. Eat Chewable Food—Not “Mush”

-Chewing food provides more satisfaction when eating. Eating soft mushy foods that don’t require chewing will decrease your satisfaction after a meal and result in less satiety.

2. Eat 2-3 meals per day and 2-3 snacks per day. (eat 5-6 times/day)

-Eating regularly during the day will maintain a higher metabolism. Skipping meals will also result in fluctuations of your blood sugar and energy level and may cause cravings and headaches. Always eat breakfast!

3. At least three of the meals should be high protein meals.

-Remember, “protein first.” Protein causes more satiety than carbohydrates. When eating smaller portions, following a pattern of starting with protein-based foods (meat, fish, eggs, etc…) will also ensure better nutrition.

4. Drink at least 2 quarts of calorie-free beverage per day, and drink 1 glass (8oz) of water, 30 minutes prior to regular meals. Do not drink during meals.

-Dehydration will often be mistaken as hunger, resulting in a need to eat more. Drinking a thirst-quenching liquid prior to meals will also eliminate the feeling of a need to drink during the meal.

5. Eat good tasting, flavorful food; chew well and eat slowly.

-This is very important. You will be eating slowly and chewing for a longer time, and therefore you need to make sure that you have good tasting food that you enjoy. This is an important part of feeling satisfied after a meal.

Dr. Quebbemann is a renown weight loss expert and he often receives interview requests and invitations to speak on a variety of topics related to weight loss. One topic that is often addressed by Dr. Quebbemann is metabolism. He recently spent some time responding to some questions about it. Here are some of his responses:

1. Medically speaking, what is “metabolism”? What role does it play in weight loss?

Metabolism is the way our body takes in, modifies and uses the calories we eat and drink. Our bodies carefully regulate our metabolism through hormones and other mechanisms to ensure that we have enough energy to survive and to be physically active.

Experts in metabolism distinguish two general types of metabolism, resting metabolism, also called resting metabolic rate, or RMR, and active metabolic rate. Your resting metabolic rate represents the calories your body burns when you’re at rest during the day, where your active metabolic rate, AMR, includes the calories you burn while active, whether brushing your teeth, doing housework or weight lifting.

Since your weight depends on the balance between calories taken in by eating and drinking, and calories burned throughout the day, your active and resting metabolic rate will affect your weight.

If your overall metabolism is higher, you will burn more calories throughout the day, and tend to accumulate less body fat. If your total daily energy expenditure is greater than the calories in the food you eat, then you will lose weight.

2. What are some of the things that people/patients often don’t know about metabolism?

A common misconception is that many people are overweight due to a low metabolism; this just isn’t true. Experts in weight loss know that excess weight and obesity is caused mainly by eating too many calories and getting too little physical exercise.

However, metabolism is affected by muscle tone and by the amount of excess body fat a person has. People with excess body fat generally have hormone imbalances that affect their metabolism, slowing it down, and making it more likely that they will gain even more weight.

3. What can cause metabolism to slow down?

The most common cause of a slower metabolism in America today is lack of exercise.

4. How does aging affect metabolism?

Age tends to result in a decrease in growth hormones as well as a change in your sex hormones, all of which will decrease your metabolism. The effect of aging on your metabolism varies from person to person and is determined to a large extent by your genetics. However, remaining active, and maintaining your muscle tone and aerobic conditioning will do a lot to decrease the effects of aging on your metabolism, allowing you to keep your metabolism high well into your older years.

5. What are some medical conditions that can cause metabolism to slow or speed up?

The most commonly recognized disease that causes your metabolism to slow down is hypothyroidism. However, many other conditions will cause your metabolism to slow, including decreased testosterone or “low-T”, menopause, poly-cystic ovarian syndrome and even stress.

6. What are some foods that can affect metabolism?

The type of food you eat has only a small effect on your metabolism, but some food requires a lot more energy to digest and absorb into your system. Food that takes more calories to digest results in less calories being available for your muscles to use, but also less calories that cause weight gain.

Foods that digest easily, such as high glycemic index foods like sugar and processed carbs, cause a sudden spike in blood sugar and a subsequent spike in production of insulin. If you’re burning off these calories at a rapid pace, such as during a triathlon, your body will rapidly metabolize sugar in your muscles and liver, generating energy. If you’re not actively burning up these calories, the increase in the hormone insulin in your body will result in accumulation of calories in the form of fat, even within your muscles

A “double whammy” occurs when you eat high glycemic index food, like frosted corn flakes, when you’re sitting around, resting, because high blood sugar levels cause a decrease in growth hormone. Decreased growth hormone further drives down your metabolism, limits your “energy level” and decreases your ability to maintain lean muscle mass.

7. Can the manner in which you eat affect your metabolism (eating regularly throughout the day vs. starving and gorging, for example)?

The way a person eats does have some effect on metabolism, but it’s a small effect in general. Fasting for long periods will result in a decrease in a person’s basal metabolic rate, but this is not a common problem.

Short term fasting, on a daily basis, such as skipping meals, will also result in an intermittent decrease in resting metabolic rate.

8. Can exercise affect metabolism – for example, can your overall metabolism be elevated by exercising regularly?

Mild, easy activity, such as relaxed walking, has little effect on your hormones. More strenuous exercise, the kind that makes you sweat, causes an increase in the levels of many hormones in your body, including Growth Hormone and Testosterone, both in men and in women. This results in increased calories being burned, not only during exercise, but also afterwards as your muscles repair themselves and grow stronger and bigger. As a result, not only does your metabolism dramatically increase during strenuous exercise, but your basal metabolic rate increases, meaning you burn more calories in between workouts as well.

A little known, but very important fact, is that excess body fat causes your overall metabolism to decrease. Your muscles lose their normal ability to metabolize the calories that you eat, and instead your those calories get stored in your body as fat. So, as people lose muscle tone, and become more overweight, their tendency to accumulate fat increases.

9. Is gender a factor in metabolism?

Gender is a definite factor in metabolism, but not much of a factor in energy balance. Men have more testosterone which results in an increased energy level and helps to build muscle, resulting in increased basal metabolic rate, and increased calorie burning during exercise. This simply means that men need more energy intake to balance out calories burned. However, men are just as likely to consume more calories than they need, resulting in an imbalance that causes weight gain.

10. Can hormonal issues affect metabolism, and how?

Hormones are molecules produced by our body that control everything from when we sleep, to energy level, sex drive, hunger and also metabolism. Diseases such as hypothyroidism (too little thyroid hormone) and Cushing’s syndrome (too much cortisol) change your metabolism causing weight gain. But, more commonly, hormone levels are changed slightly by how we live; in other words our lifestyle and physical health significantly changes our hormones. Increase stress, lack of exercise, poor muscle tone and obesity will all cause an imbalance in testosterone, cortisol, insulin and growth hormone resulting in abnormal mood swings, decreased sex drive, low energy, and weight gain. Keeping fit, helps maintain a normal hormone balance, preventing many of these problems.

If you are having difficulty achieving permanent weight loss, The N.E.W. Program team is here to help! Our team of physicians are experts in weight loss and have experience working through all obstacles to help you lose weight. We have helped thousands of patients who thought they had lost their battle with weight, regain the upper-hand and conquer it! If you would like us to join your weight loss team, call us! 949-722-7662

U.S. News posted an article last month wherein our Dr. Quebbemann was asked to give some tips on what people can do before they start a weight loss plan. Just like most things in life, accomplishing weight loss goals gets a lot more effective when you have a plan to win. Identifying diet weaknesses and looking for preparation activities that will help you succeed are well worth your time as you begin you journey towards fitness. The U.S. News article gave these tips:

1. Raid the kitchen-Get rid of the junk food in the house

2. Fill the right fruit bowl-You are more likely to eat fruit if it is in a clear bowl

3. Gear up for your workouts-schedule your workouts in advance and pack your gym bag

4. Think through you food splurges-Dr. Quebbemann is quoted:

We all know that splurges are going to happen. And more than that, they should happen, Quebbemann says. Regular “cheats” can keep you from feeling deprived and make healthy eating more doable over the long term. But rather than make all of those splurges impromptu, plan small treats for yourself every day. It could be a square of chocolate, a slice of birthday cake or a glass of eggnog. But by planning them out, you make sure that you never feel deprived or, on the flip side, wind up having 10 splurges in one day.

5. Plan and prep your meals-Preparing your meals when the week starts can keep you diet healthy

6. Get to sleep early- A bad night’s sleep can make you over-eat

7. Store snacks everywhere-Dr. Quebbemann is quoted:

Wherever you are, protein-rich snacks should be there, too. “They’ll take care of your hunger and keep you from nibbling on junk, simply because you feel starved and have nothing healthy to eat,” Quebbemann says. Plus, protein sticks around longer in your stomach to keep you feeling fuller longer than any cereal bar will. Store protein bars, nuts or turkey jerky in your desk drawer, bag and car. Plus, if you have access to a fridge at work, cheese, Greek yogurt, lean meats and hardboiled eggs all make great mid-day snacks.

8. Buy smaller plates-Using a small plate can help control your portion sizes

9. Buy a refillable water bottle-Dr. Quebbemann is quoted:

That way, you’ll be able to drink up all day long. Staying hydrated is vital to keeping your body functioning properly, and the many of hallmarks of hunger – fatigue, stomach growls, moodiness – also occur when you’re thirsty, Quebbemann says. So by keeping yourself hydrated, you can make sure that you don’t reach for a second serving of mashed potatoes when all your body really wanted was a glass of water.

10. Download a food journaling app– Keeping a food journal can help you identify irregular food behaviors

The article is summed-up by this quote:

“The single most important thing for people to do if they want to succeed at weight loss over the long term is prepare,”- Brian Quebbemann