Category Archives: Weight Loss Surgery

Mentally Preparing for Weight Loss Surgery

Posted on March 02, 2020 by CFWLS

Getting your mind in the right place before undertaking any weight loss plan is a good idea but it is especially important when considering a surgical weight loss procedure. Awhile ago, I interviewed Dr. Dawn Reese for one of my podcasts. We’ve transcribed the recording to post for you today.

Dr. Clark: “Dr. Reese, tell us a little bit about your background and how you got involved with me.”

Dr. Reese: “Thanks for having me back. I love being here. I love talking with you. We’ve been together now about 10 years. I met you in the hospital and we talked about doing this. I have a PhD in clinical psychology. My specialty is behavioral health (health psychology). I try to help people live healthier lives and do more with their lives then what they want. When you and I first met we talked about what you wanted to do with these surgeries and medical weight loss program. That was right up my alley. We can help people live healthier and take better care of themselves. This is what we need to talk about today when getting ready for surgery or a medical program.”

Dr. Clark: “We have to change our mindset. What do we need to work most on when we start contemplating a weight loss plan or having surgery?”

Dr. Reese: “People have to take care of themselves first. That’s the biggest thing with all of this. That’s the umbrella that we’re going to put everything else under. You have to start taking care of yourself first and start thinking about yourself first. One of your goals for weight loss is to change your mindset. How are you going to view yourself differently? How are you going to view yourself as a priority?”

Dr. Clark: “That priority and that mindset are very important. Eighty five percent of my surgical clients are women. They’re often worried about taking care of everyone else first. They put themselves on the backburner. We need to start planning for shifting that mindset before surgery. Make yourself a priority.”

Dr. Reese: “We start people having a mind shift (fake it til you make it). For example, you start using the smaller plate. Join the gym. I had a patient come in to my office and tell me he was going to join the gym after surgery. I told him we were going to start tomorrow. You start doing these things now and behaving as if you’ve started your medical or surgical weight loss. Think about how you’re going to plan and cook differently. Get mentally and behaviorally prepared.”

Dr. Clark: “A huge part of this is planning. You alluded to this when talking about the person going to the gym. You need to start implementing that plan even if you’re not able to do much at the gym. Get comfortable with walking in the gym and walking by the class you would like to do. Watch it for a couple minutes. Setting that time aside makes it much more likely that it’s going to happen afterwards. We want to develop skillsets before and after surgery. It could be eating skills or activity skills.”

Dr. Reese: “Planning is going to be key. How are you going to live your life differently? What are you going to change every day in your life so that you make yourself a priority? Make a list of what your goals are for that day. Preparing people around you is important. If you’re the cook of the family, how is that going to change? Mentally prepare on how this is going to impact other people and how that will make you feel. We have a joke in psychology: it doesn’t take 20 days to create a habit. It takes a little longer than that. Getting mentally prepared and behaviorally implementing it is so very important. For anything, planning is the key.”

Dr. Clark: “If my norm is getting together with my best friend on Friday nights and going to a movie, that might also include getting a big bucket of popcorn or other snacks. That’s a great part of life. We want to keep doing it, but we have to change some of the aspects. It isn’t that simple to make that change.”

Dr. Reese: “What you’re talking about is really important in terms of mentally rehearsing. You can imagine yourself at the movies but not having that popcorn. How is that going to look? How is that going to feel? When we are preparing athletes for an event, we have them imagine themselves in their role. If you’re an offensive lineman in football we have you imagine doing what you’ll be doing on the field before you even go on the field. That’s a great thing we can do here. How is it going to be Friday night at the movies? What is that going to look like? Mentally rehearsing is wonderful.”

Dr. Clark: “You have to mentally walk yourself through daily situations. Most of us have a routine we go through. I have a routine. I get up in the morning and shower and shave. I can literally write it out. What I find is that if my routine gets thrown off, my whole day starts to fall apart. I might have just told a patient who just had surgery to change their routine. You then have to think about how that will change everything else in your day. A lot of times people don’t think about a disruption or change in schedule. Then, when their routine changes (which causes stress) they revert back to old comfort levels. What does a person do?”

Dr. Reese: “You’re absolutely right. It’s stressful when we don’t have a normal routine. When people get stressed, we’re going to fall back into old patterns. We go back to things that are comfortable to us. We have to start planning. We need to think about what it is that we’re going to do even if we get stressed. How can I not fall back into that pattern and admit to ourselves that it happens? It’s not bad. It’s not good. It’s not anything. It’s just what happens. It’s not a failure. If you plan for it, you’re less likely to fall back into old patterns. You’re more likely to be able to get a new routine going.”

Dr. Clark: “You want to practice these things ahead of time so you’re ready for surgery. It sounds good and you have your plan in place. However, sometimes things don’t work out quite like we want them to. What you do is discuss how to handle things at this point. A major part of what you do is help people figure some of this out. What do we do? How do we change? It really still goes back to the mindset. This is a lot of what you do, right?”

Dr. Reese: “Absolutely! We want you to be successful. If you’re going to start a behavior change, especially weight loss, we don’t want you to be a failure.”

Dr. Clark: “The big message here is changing that mindset. We want to plan for it and practice it ahead of time. It doesn’t matter whether we’re talking about having surgery or starting on your weight loss plan. Things have to change. Change will never occur if you don’t actually change. You can’t wait for change to happen to you. You’ve got to be an active part of all this. Typically the change that happens to us is usually not a good change. We would like to be an active participant. We really want you to think about that message.”

What You Need to Know About the Gastric Sleeve

Posted on November 20, 2019 by CFWLS

The gastric sleeve, or sleeve gastrectomy, is the new kid on the block so to speak. It’s not a new operation. We used to do the surgeries for other reasons not including weight loss. About 15 years ago a hormone was discovered called ghrelin. It’s a hormone made by part of the stomach that makes you feel hungry. We thought if we took that part of the stomach out, we’ve actually done two things. First we’ve made you a smaller stomach so you can’t eat very much. Secondly, when you take that part of the stomach out, ghrelin levels go way down. Since ghrelin makes you feel hungry, hunger levels go way down in its absence. If you think about it, one of the potential downfalls of every single weight loss plan in the world is hunger. If we can control hunger it’s a lot easier to lose weight and keep the weight off. Sleeve gastrectomy is the fastest growing option out there. It is the most common operation for weight loss right now. Last year about 2/3 of all operations done for weight loss were sleeve gastrectomy in the US. It’s close to 95% of what I do these days because it works so well and we see a quick recovery with very low risk. It keeps your anatomy normal.

In the sleeve gastrectomy, we remove the greater curve of the stomach (stretchy part). If you eat a large meal the stomach fills and stretches way out as you eat. That’s how it can hold so much. When we remove the stretchy part it leaves you with a tubular part (or sleeve). Sometimes when people hear the term sleeve gastrectomy they mistakenly think we’re placing something around the stomach. We’re not placing anything around the stomach. It’s referred to as a sleeve gastrectomy because we’re changing the shape. Like the sleeve on a shirt, it’s tubular shaped. We’re making it into a tubular shape. Nothing is bypassed so there is no malabsorption. Your anatomy remains normal. Food is going to enter the stomach and empty into the small intestine the same way it did before. The size of the stomach is about the size and shape of a medium banana. The part of the stomach that’s removed is the part that makes the hormone ghrelin. Ghrelin is decreased so hunger decreases. This doesn’t mean that you won’t get hungry. There are still good reasons to get hungry. Your hunger is just much easier to control. This surgery is increasingly popular and the fastest growing option out there. It’s literally close to 95% of what I do nowadays.

The surgery doesn’t take that long. It generally lasts about 45 minutes. 95% of the surgeries we do are outpatient. It’s pretty rare that someone needs to spend the night. Full recovery isn’t as fast as the adjustable bands but it’s a lot faster than gastric bypass. Most people are comfortable driving about 3-4 days after surgery. Generally in 2 weeks people can do most things. In a month you can do anything you want. Recovery tends to be really quick.

What are the risks? The first 30 days is the same as the other surgeries. It’s just slightly different numbers. In theory the death rate and leak rate should be the same as gastric bypass. But we’re not seeing that. What we’re seeing is about 1:1000 for deaths and less than half a percent for leaks. Wound infections, DVT’s, PE’s and dehydration have fewer risks than gastric bypass because the surgery doesn’t last as long. But it’s not impossible for any of those things. One of the things I really like about this operation is that we’ve gotten rid a lot of the long term risks. You’ve got normal anatomy so once you’re healed, you’re healed. The thing we have to keep in mind is stenosis. Stenosis means narrowing. Anywhere along the tubular stomach could get scarring and become too narrow. If that happened you would go see a gastroenterologist. They can look in there and take care of it. It would be very rare to need another surgery after the sleeve. In theory stenosis should be about 1%. I’ve done over 1600 of these surgeries. I’ve only seen 1 case of stenosis.

We basically see the same weight loss as we did with the gastric bypass. Average weight loss is 70% of what you were overweight. If you are 100 pounds overweight, your average weight loss will be 70 pounds. If you are 200 pounds overweight, your average weight loss will be 140 pounds. That’s average. Some will lose more and some will lose less. That is very good weight loss. Long-term we see about 10-20% regain most of their weight. With any of these operations you can gain your weight back. Your stomach is a little bigger than with the gastric bypass. So why do we see a similar result? It’s because ghrelin levels go down. In the other operations, that part of the stomach is still there. We can control the hunger somewhat with appetite suppressants. But they’re not necessarily ideal. With the sleeve gastrectomy ghrelin levels go down and hunger is easier to control.

Overall, for most people considering weight loss surgery, the sleeve gastrectomy is the better option. One of the reasons is we keep the anatomy normal. There’s a lower risk with the procedure, a fairly quick recovery and very good weight loss. We also get rid of any concerns about having anatomic abnormalities or nutritional abnormalities (malabsorption). There’s no mechanical device. Finally, you haven’t burned a bridge. That means if you don’t get out of it what you wanted out of it your anatomy is at least still normal. If your anatomy is still normal you could still have any of the other surgeries done. You could have a band placed on it or converted to a bypass. This is much more difficult after any other the other weight loss surgeries. We haven’t revised these things. We’ve seen really good results with them.

How does CFWLS compare to the national average? Obviously we’re doing this for weight loss to improve medical problems and improve your life. We’re doing the same thing as everyone else in the world but we’re seeing better weight loss. We have a 15.8% better average weight loss at 2 years. We have good education and weight loss. We give you a full year afterward. And with that better weight loss we also see better reduction in medical problems: Diabetes 78.6% vs 62.3%, HTN 62.5% vs 46.9%, lipids 70.7% vs 45.3%, sleep apnea 69.4% vs 56.6%, and GERD 74.3% vs 16.6%. Some people think weight loss surgery shouldn’t be done on patients with GERD. But we’ve seen it get much better, not worse. Again, it’s not the operation. It’s what you do with the operation. If you do the right things it can fix these medical problems.

Why is the education and support so important? We have Weight Management University for Weight Loss Surgery™. It’s a 12-month post-op program. It includes all kinds of thing including the following: pre-op and post-op text books, monthly support group, 12 Weight Management University courses, access to Members Only portal, fitness classes, personal training and more.

View the online surgical webinar and then schedule a call with Cat Williamson to go over any further questions you may have. You’ll get a copy of my best-selling book, Less Weight…More Life!

What You Need to Know About a Gastric Bypass

Posted on November 11, 2019 by CFWLS

Let’s start with a few facts about the gastric bypass. It’s been around the longest period of time. If you know anyone who’s had gastric bypass, they lose weight fairly quickly. People are often very concerned about the speed of the weight loss. Speed of weight loss doesn’t matter. It’s all tied to body composition.. If you’re losing weight quickly and it’s all fatty tissue, than the faster the better. On the other hand, if you’re losing weight quickly but it’s lean body mass, that’s not so great. You’re going to get more and more tired and weaker and weaker. You’re slowing your metabolism down which will make it much harder to lose weight and easier to gain weight. No matter what, if you have gastric bypass, you’re going to lose weight fast. We refer to gastric bypass as being restrictive and malabsorptive. Restrictive means we’re making your stomach smaller. If we make you a smaller stomach, you can’t eat very much. You’re going to lose weight. The concept is simple. We make your stomach about the size of an egg. People often wonder if their stomach is going to stretch out. The answer is yes. We know it’s going to stretch out and we want it too. We don’t want your stomach the size of an egg. What we’re shooting for long term with all these operations is meal size, that being a small plate. That’s where we want to go. But, we’re working with stretchy material just like your skin is stretchy. If we make your stomach meal size small plate it would stretch way out. A normal size stomach can hold about 2-3 liters. We have to make your stomach tiny to begin with knowing that it’s going to stretch out.

The second part is the malabsorptive part. That’s where the bypass comes in. We’re going to bypass the part of the stomach called the excluded portion. We go to the very beginning of the small intestine and divide it and pull it up and hook it into that tiny stomach so that we bypass the rest of the stomach. Whenever we bypass any portion of the intestinal tract, you’re not going to absorb things perfectly. You don’t absorb all the calories that you eat. But, you also don’t absorb some of the vitamins, minerals, and micronutrients quite as well either, which can be problematic. The surgery itself doesn’t take that long. It’s about 1 hour and 40 minutes. It can be done laparoscopically now. What we do is use long instruments and cameras and make little incisions on you. Recovery is pretty quick. Hospital stay is pretty quick. Recovery can take a while because this is a big operation. Whenever we start rearranging your anatomy, that’s a big operation. Recovery can take a good 4-6 weeks. Sometimes it can take up to 8 weeks to feel back to normal.

There are risks with every operation in the world. This is a bigger operation so the risks are bigger. When I talk about risk, I divide it into two time-frames. This is not something I made up. This is a medical standard which is basically right around surgery (peri-operative). By medical definition this means the first 30 days. The second time-frame is long-term which, by medical definition, means longer than 30 days. What’s the worst thing that could happen in that first 30 days? Could you die? The answer is yes it could happen. The risk of death is real when we start dividing your intestinal tract. It wouldn’t matter if I was talking about taking your appendix out or taking your colon out. When you look at national statistics, the risk is about 1: 200. What we see is about 1:500. Bottom line is that it may be rare, but not impossible. The things we worry about the most are infections. Some things are easy to treat such as urinary tract infections. Other infections aren’t so easy to treat such as pneumonia. They occur about 2% of the time after any surgery where you have to go to sleep for. You have to go to sleep for all these surgeries. It’s somewhat related to how long did the surgery take? The biggest fear as far as infections go is a leak on the inside. What if the pieces we took apart during surgery and put back together leaked? There are literally trillions of bacteria that live in the intestinal tract. When we start dividing the intestinal tract some of those bacteria could potentially get out. If they set up a rip-roaring infection, potentially you’d have to have another surgery to fix that. Wound infection means on the skin. They’re more of a nuisance than dangerous. They have to be treated with antibiotics. DVT is a deep venous thrombosis. PE is a pulmonary embolism. These are blood clots. You can get a blood clot without having surgery. You can get it from being dehydrated. One of the most common ways to get a blood clot is traveling on a long plane ride. You can also get it from having a general anesthetic. Again, it’s somewhat related to how long the surgery takes. The longer the surgery takes, the higher the risk is. We do all kinds of things to prevent that during surgery. The blood clot risk is 1-2%. If you got a blood clot you have to be on a blood thinner to dissolve that blood clot. The first thing that happens to that tiny stomach is the tissue swells up. Just like if you sprained your ankle. Your ankle would swell up. Stuff just trickles through the stomach initially. If you’re not able to stay hydrated you have to come back to the hospital to get IV fluids. You have to rest for a few days.

Long-term means 30 days until forever. The most common long term physical problem is peptic ulcer. You can get an ulcer without having gastric bypass. But when you have the anatomy of gastric bypass, the risk of getting an ulcer goes up. The people who tend to get ulcers are smokers and people who take anti-inflammatory meds. Ulcers just need to be treated. Something that could require another surgery is a bowel obstruction. Adhesion means scar tissue. If you’ve had any surgery on your abdomen you’re going to have scar tissue, not only on the outside, but also on the inside. That scar tissue can potentially kink the intestine. Just like a kind in a hose, nothing is going through there. You then have to go back to the operating room. Hernias are another risk. You can get them without having surgery. Any place we make an incision there is potentially a weaker spot. Stenosis means narrowing. What we’re talking about is right where we take the stomach and hook the small intestine to it. A scar could potentially form and cause a narrowing. If this happened, stuff wouldn’t go through very well. We would send you to a gastroenterologist. They would take a look down there and can stretch it out. Typically it doesn’t need any surgery but it does need to be evaluated and treated. Vitamin and nutrient malnutrition is relatively common. You won’t be able to absorb things perfectly. You’re going to have to take some things long term in addition to taking a battery of tests every 6-12 months to make sure those things are staying where they should. That’s a forever thing. That doesn’t go away.

We see great results with gastric bypass. You’ll lose about 70% of what you were overweight. If you were 100 pounds overweight you’ll lose 70 pounds. If you’re 200 pounds overweight, you’ll lose about 140 pounds. That’s the average. Some people lose more, some people lose less. About 40% of people with gastric bypass regain most of their weight back. Overall the long term anatomical and nutritional problems, with relatively poor weight maintenance, make it difficult for me to recommend gastric bypass for most people.

What should you do? You need to decide what’s best for your unique situation. There is no right or wrong here. What I encourage you to do is give us a call and set up a 1:1 consultation to discuss the options. Let’s you and I sit down and go over your situation. Everybody’s situation is different. Give us a call at (757) 873-1880 or email us at success@cfwls.com.

I have some final thoughts for you. Weight loss is the most important step you can make to improve your health!! There are so many medical problems that are directly related to weight loss. If we can control weight, we can control medical problems. If we can control all these medical problems it gives you the best chance of living a long, healthy life.

Watch the online seminar and give us a call (757-873-1880) and set up your 1:1 appointment. If weight is contributing to your health problems let us help you. I hope to see you very shortly here in the office.

What Are the Options for Weight Loss Surgery?

Posted on November 04, 2019 by CFWLS

What are the options for weight loss surgery? The most common options done worldwide are: gastric bypass, Laparoscopic Adjustable Gastric Banding (LAGB), and sleeve gastrectomy. I’m going to give you the basics on all of these. You can also watch our complete online webinar on Weight Loss Surgery Options.

Gastric bypass has been around for a long period of time. The first gastric bypass was done in 1955. It’s been around for over 60 years. It’s a well-studied operation. We know what happens to people who have gastric bypass. We know the problems that arise and what to do about the problems. It’s a very well-studied operation.

Adjustable gastric bands have been around in the US since 2001. Worldwide they’ve been around since the early 1990’s. Why do you care how long an operation has been around? We talk about long-term problems and long term results. By medical definition, long-term means 10 years long. That wouldn’t matter if I was talking about brain surgery, heart surgery, or knee surgery. It doesn’t matter. With weight loss we’re going to be talking about things that literally can last 20, 30 or 40 years. If you’re fairly young it could be 50 or 60 years. Looking at the long-term issues is very important and how it impacts your health for your lifetime.

The sleeve gastrectomy is the new kid on the block. It’s not a new operation. We used to do the surgeries for other reasons not including weight loss. About 15 years ago a hormone was discovered called ghrelin. It’s a hormone made by part of the stomach that makes you feel hungry. We thought if we took that part of the stomach out, we’ve actually done two things. First we’ve made you a smaller stomach so you can’t eat very much. Secondly, when you take that part of the stomach out, ghrelin levels go way down. Since ghrelin makes you feel hungry, hunger levels go way down in its absence. If you think about it, one of the potential downfalls of every single weight loss plan in the world is hunger. If we can control hunger it’s a lot easier to lose weight and keep the weight off. Sleeve gastrectomy is the fastest growing option out there. It is the most common operation for weight loss right now. Last year about 2/3 of all operations done for weight loss were the sleeve gastrectomy in the US. It’s over 95% of what I do these days because it works so well and we see a quick recovery with very low risk. It keeps your anatomy normal.

Why is the education and support so important? We have Weight Management University for Weight Loss Surgery™. It’s a 12-month post-op program. It includes all kinds of thing including the following: preop and postop text books, monthly support group, 12 WMU4WLS courses, access to a private membership site via CFWLS.com, “Losing Weight USA” (weekly live webinars with access to Dr. Clark), and a private Facebook support group.

Weight Loss Surgery Options

Posted on October 15, 2019 by CFWLS

Let’s talk about the problem of obesity and what you can do about it. I will preview the operative procedures and the risks of having surgery, as well as the results. I’ll give you my opinion. For most people I think the sleeve gastrectomy is the better option! I see all the nutritional problems that arise and abnormal anatomy problems with the bypass. And I see the device problems with the adjustable bands. There’s relatively poor weight loss with the bands. The sleeve gastrectomy is a fairly low risk procedure. It’s a quick recovery and we see really good weight loss with it. And, you keep your anatomy normal. I’ve become convinced over the years that keeping the anatomy normal is probably a good thing.

Weight loss is hard. Surgery is an extension of an overall medical weight loss plan. Weight doesn’t magically fall off just because you have surgery. It’s still diet, exercise, and behavior modification. Surgery is a “tool” to assist you with weight loss. That’s all it is. A tool can either be used correctly, or it can be used incorrectly. If used correctly it can be very powerful. If used incorrectly it doesn’t work well and you can get into some real problems. Long term weight control is still very hard. Some people think they’ve had the surgery and lost the weight so they don’t have to worry about it anymore. YES YOU DO! You can regain your weight. It doesn’t matter what operation we’re talking about. You need to do the right thing. You have to know what the right things to do are. Then, how do you implement those things? Sometimes the concepts are really straight forward but you have to know what they are. Implementing the concepts is the hard thing. We have the expertise and support here. We can help you with how you do this in your life. Sometimes life tends to get in the way. Surgery combined with a Medical Weight Loss program gives you the best chance for long term success. It’s not that we’re doing better or different operations but we see better weight loss than other places. We see better weight loss because it’s the education and support side of this whole thing that really gets people optimizing weight loss and then keeping that weight off long term. That’s absolutely key.

Lots of different medical problems go along with weight. Every single one I’ve listed on the slide is directly related to weight. When weight goes up, they get worse. As weight comes down, they get better. Some of them completely go away with weight loss. If they don’t go away, at least they get under control. Some of them are very significant: diabetes, high blood pressure, heart disease, and more. These things can potentially be life threatening. Weight loss treats them all. If I could boil it down to the biggest problem it’s the risk of dying. It goes way up. For someone who is 75-100 pounds overweight, on average, you’re going to die about 10-15 years before someone who’s not overweight. That’s the issue. We want you to live a long, healthy life and die of old age. Last thing you want is that premature death. By treating the weight, we can treat all those other problems.

To learn more about your weight loss surgery options, check out our informative webinar: Weight Loss Surgery Webinar

Get your free digital copy of my best-selling book too! (Details here)

Breaking Through a Weight Loss Plateau After Bariatric Surgery

Posted on April 22, 2019 by CFWLS

Today we’re going to talk about those dreaded weight loss plateaus. What do we do about them? What should you look for? We all dread them. They are going to happen. It doesn’t matter what we’re taught. You’re going to go through plateaus. What do you look for? What can you do to break through the plateaus? At some point you need to think about whether it’s your weight maintenance. That’s a slightly different topic. We’re not going there today. I’m going to just assume that you’re not where you want to be and not where you can be. So subsequently you’re at a weight loss plateau.

What is a weight loss plateau? Sometimes we look at the scale and it hasn’t budged in three days and therefore it’s a plateau. That’s not really a plateau. A weight loss plateau is when you’re doing the right things and your weight is stuck for a few weeks. So, for two or three weeks nothing is happening. Subsequently then, yes, you can be in a weight loss plateau. Shorter than that means there can be just a lull in the action, so-to-speak. Your body adjusts. As it adjusts, it’s going to try and turn off weight loss. It doesn’t want you to lose weight. With any weight loss plan, your body is going to assume you’re in a state of deprivation. So, it doesn’t actually want you to lose weight. It wants to hang on to that energy source if you truly were in a famine.

We’re in a weight loss plateau. What is going on? What I usually do is give people questions to ask themselves about certain things. I’m going to give you this list of questions and we’re going to talk about what some of the solutions are.

Question #1—Have you actually cut your calories too low? Sometimes people do cut their calories down too low. If you cut them down too low, your body is going to go into starvation mode and you’re not going to lose weight very well. It’s hard to put an exact number on that. Potentially if you’re going lower than 1000 calories and you’re not in a medically supervised plan, that’s generally not the greatest thing. In the surgical plan right after surgery you’ll often be between 700-800 calories. Long-term that’s really not the right answer either. You want to make sure you haven’t cut calories too low.

Question #2—Are you getting enough water? This is probably one of the most common reasons I see initially in a weight loss plan and especially after surgery when things start slowing down. If you start to get a little behind in your water, the body will tend to hang on to everything-fat included. I encourage people to push the water.

Question #3-How many carbs are you really taking in? At The Center for Weight Loss Success we talk about restricting carbohydrates. Everyone is going to have a tipping point with carbohydrate. If you go above that tipping point you struggle with weight loss. Are you above your tipping point? If you don’t know what your tipping point is, it’s hard to know that answer. It is something we can figure out. It’s not necessarily easy to do. You have to write it down! That goes along with one of our solutions-Journaling! Write these things down, especially carbohydrate. If you’re going to measure one thing, count your carbs. I don’t know how many times I’ve said that over the past couple of years.

Question #4-Are you getting enough protein? Carbohydrate influences insulin. You want to keep your insulin level as low as possible. Insulin is a hormone we can’t survive without. You’ve got to have some but you want to survive with the absolute smallest amount possible. Insulin can cause so many problems. Weight gain is just one of them. If you’re not getting in enough protein, your body will preferentially break down lean body mass, slowing your metabolism down. Protein manipulates other hormones too. Protein is more satisfying so you stay fuller for a longer period of time. It also increases growth hormone and glucagon. Glucagon is the opposite hormone of insulin. Insulin is telling your body to store fat. Glucagon is mobilizing the fat. As adults we don’t need that much growth hormone, but we make it because we can’t survive without it. If we can optimize what we do make, it’s going to help you preserve lean body mass, keeping your metabolism higher. So you want to make sure you’re getting in enough protein.

Question #5-Is your exercise too routine? Your body will get used to whatever exercise program you’re doing. When you’re body gets used to it, it doesn’t get the same out of it as it did originally. If your exercise gets too routine you don’t get as much out of it. The real trick with exercise is you want to preserve lean body mass to keep your metabolism as high as possible. Exercise alone typically doesn’t make you lose weight, but if you can preserve or build lean body mass you’re going to increase your metabolism and keep you on a weight loss track. The flip side to your exercise routine is whether you are exercising too hard? That can also slow down weight loss. Inherently that doesn’t make sense but it actually can do that because too much exercise can cause our stress hormone, cortisol, to go way up. When cortisol levels go up, it’s hard to lose weight. It makes us resistant to weight loss. This was a survival mechanism when we were stressed. Typically our biggest stress was not being able to find food. Stress typically makes us resistant to losing weight. It leads us into the next question.

Question # 6- Are you handling your stress alright? If you’re going through a stressful event, whether it be social, work, family, or medical, if you’re not handling stress well then it could turn on the plateau.

And, finally a couple things to look at as far as asking yourself about weight loss plateaus. What about caffeine and artificial sweeteners? Inherently both of those don’t make sense in a weight loss plan of turning off weight loss. But some people are sensitive to caffeine because it will increase your stress hormone because it’s a stimulant. Increasing stress hormones can make your resistant to losing weight. You want to be cutting back or getting rid of the caffeine. Caffeine can stimulate appetite which makes it harder to stick with the plan.

Artificial sweeteners can turn off weight loss for a couple of reasons. They can make us want sweet things. We get used to the sweet taste. They tend to be so much sweeter (even 1000 times) than sugar. Artificial sweeteners have no calories but it trains us to want something sweet. It makes it harder to stick to the diet plan. Also, they can often increase insulin levels. Inherently that doesn’t make sense. The sweetness you’re tasting from the artificial sweetener make the body think that you’re getting something that has a lot of calories. It’s expecting those carbohydrate calories so the body releases insulin. Hunger and cravings will increase. Insulin tells your body to store fat. Artificial sweeteners can turn your body into fat storing mode even though there are no calories in it.

What do we actually do about this? These are questions to ask yourself once you’ve hit a plateau. What are we going to do about these things? Some of these answers I hit a little bit on during the questions themselves. What can you do?

Write it down. Go back to journaling. It is a basic thing. If you don’t write it down, you’ll never really figure out where the problem area it. You have to write down everything. I’m referring to what you’re eating, drinking, and how much activity.
You need to make sure you’re counting the carbohydrate, protein, and water. You want to watch all those things. If they’re all good, then we have to figure out how we work with that. Push the water. Hydration!!
Go back to the beginning. Many people do the Jump Start diet. It’s using some of the protein meal replacement shakes. It gives you a good protein source, controlled carbohydrate, calories will be fairly low, and it gives you exact numbers so that you know exactly what happens when you have X amount of calories, carbs, and protein.
Look at the exercise. Is it routine? Now it’s time to change gears. You really want to make sure you’re doing plenty of resistance training. You can do body weight exercises (push-ups, pull-ups, sit-ups, squats). You don’t necessarily need weights to do it. The best exercise for weight loss is high intensity interval training (HIIT). The best piece of exercise equipment you can have is a heart rate monitor. You’re pushing your heart rate up to near max, back and forth. Potentially you’re going into the anaerobic training where you go up to your heart rate max. You’re crossing over into anaerobic metabolism which gives you the best fitness gains. You can’t do that if you’re just starting in fitness. But if you are into fitness and you’re good at that, this is something that can really get you going and get you back on that weight loss plan.
Something I mentioned is ratchetting down that carbohydrate and lifting up that protein. You can do it with food. Again, you have to count it.
We can start looking at over-the-counter products. There are a lot of different things out there. Green tea is actually one of the things that can be helpful. It can boost your metabolism about 4%. In a 2000 calorie diet that’s about 80 calories. If you’re on a 1000 calorie diet, it’s about 40 calories. It’s not really that much but enough that can help to get you back on the weight loss curve. Cayenne peppers as a supplement or eating the food can boost your metabolism. There’s some evidence that probiotics can change your intestinal flora. Often it can help with weight loss.
Make sure you’re doing the basics. Are you taking your vitamins? We often think of B-vitamins as our energy vitamins. You can either do B-vitamin injections to potentially jump start a weight loss plan or a high dose of B-6. I would encourage doing an activated form of B-6. It can bump up your metabolism some. We’re talking about 50 or 100mgs. If you’re buying B-6 by itself it’s usually 1 or 2 tablets.
It’s kind of like an amino acid. It helps mobilize fat molecules into the mitochondria. The fat molecules are what you’re trying to get rid of. The mitochondria are your energy furnace. That’s what is actually being burned for energy and truly converted to energy. By itself it’s not energy until it’s converted to ATP. That happens in your mitochondria. Carnitine helps mobilize fatty molecules into the mitochondria. It’s like a steam engine. You’ve got to get the fuel into the furnace. Carnitine gives you a bigger shovel so it’s easier to move the fuel into the furnace. Typical you may need to take 1-2 grams of carnitine. You can find it in most health food stores.

Those are some things you can do as far as working through some weight loss plateaus. We went through a lot of information. Weight loss plateaus are very common. It happens to everybody until their finally in maintenance. So it’s literally going to happen to everybody. You want to work through it. The last thing you want to do is throw in the towel. You can go through those questions as well as the solutions that I talked about. You can also use appetite suppressants. They are carefully regulated by the FDA. But if you’re in a medical or surgical weight loss plan and are stuck or have cravings, appetite suppressants can be very helpful. They just have to be monitored very carefully. Some people are not candidates for them. Another thing that helps with cravings is chromium. It’s a mineral just like sodium and potassium. We need minerals in tiny amounts. If we take them in higher doses it can help with cravings. You can buy it at health food stores, pharmacies, and here at CFWLS. You do need to take it three times a day. It will say take one a day on the bottle. That doesn’t work. You usually need to take it three times a day.

There are lots of little solutions. Hopefully something there will help you with your weight loss plateau. Work through it. If you have questions please let us know. We’re here to help. If you want more information go to our corporate website which is www.cfwls.com If you want to join me each week in a webinar, we talk about all kinds of different topics about weight and overall health. You can go to losing weight USA and sign up there. The website is: www.losingweightusa.com Sign up and you’ll get access to me plus recipes and tips every week. Thank you all for listening. If you have questions just give us a yell here at Center for Weight Loss Success. I will talk to you on the next podcast. Remember-it’s your life. Make it a healthy one!

5 Tips for Long Term Weight Loss Success

Posted on April 02, 2019 by CFWLS

Commit to a lifestyle change

Long-term weight loss is achieved through permanent changes in your lifestyle and food choices, not through fad quick fix diets or pills. Before beginning on your weight loss journey, make a commitment to your health and stick with it!

Keep moving

Regular exercise is a critical component of permanent weight loss. We recommend a minimum of five 30-minute sessions per week. Read our exercise tips on this blog for ideas on how to stay motivated and enjoy your exercise routines.

Go slowly and keep your expectations realistic

Remember that drastic weight loss in a short amount of time is not healthy, and it is more likely the loss is coming from water and muscle, not fat. Fat loss is best achieved when weight is lost slowly. Strive for a weight loss of no more than 1-2 pounds per week.

Tracking your foods & fitness

Tracking in an app or keeping a weight loss journal can be very helpful for long-term weight loss and keeping you focused on your goals. Each day, record what you have eaten, how much, and your mood and emotions. A journal not only keeps you accountable for your food choices, but can also help you identify any behaviors or emotions that trigger overeating. (We recommend an app like Baritastic to track daily)

Don’t go it alone

An important factor of long-term weight loss is the support and encouragement from others, whether it’s from your doctor, nutritionist, family or friends. Connecting with others helps you stay motivated, learn tips and techniques, and keep focused on your weight loss goals.

If you’re not already a part of our private Weight Loss Surgery Support Group on Facebook, request to join now! Any patient that is 2 weeks or more post-op will be approved to participate – it’s a fantastic group of people!

What If Your Doctor Doesn’t Agree with Weight Loss Surgery?

Posted on March 19, 2019 by CFWLS

Has your doctor mentioned weight loss as a solution for your ailments, aches and complaints? If obesity related diseases are problematic or your body mass index exceeds a healthy range, your doctor may refer you to a weight loss specialist or nutritionist. You, like the majority of people with weight issues have tried numerous diet plans, most resulting in failure at long-term results. You’ve possibly even considered weight loss surgery. Do you know if your doctor is on board with surgical weight loss options? We receive patient referrals from many practices but not all doctors are in favor of the surgical option. Their bias may be based on lack of research or experience with patients who have had successful weight loss procedures. Seeking a second opinion is common-place in the medical field. Don’t be afraid to keep looking.

At CFWLS, we encourage people considering weight loss surgery to be their own best advocate for personal health. Gather the information necessary to have an educated discussion with your doctor. Watch our Weight Loss Surgery WebClass or attend one of our free Weight Loss Surgery Seminars to get started.

The medications that are prescribed to combat high cholesterol, diabetes, hyper-tension and other conditions often simply mask the symptoms while failing to get to the heart of the problem. Losing weight and keeping it off may result in eliminating these medications from your daily routine! The benefits don’t stop there, you may notice less joint pain, more energy, better sleep and a host of other positive outcomes!

Finding an experienced, board-certified Bariatric Surgeon who can answer your questions and explain your options to you is imperative. A comprehensive post-surgical follow-up plan will provide your best possible long-term outcome. Your search may be over. Dr. Thomas W. Clark is double board certified as a surgeon and Bariatrician. He has performed over 5,000 weight loss procedures and has dedicated almost 25 years to helping people lose weight and learn how to keep it off for life. His experienced staff will guide you and help you enjoy the process along the way!

Having a supportive doctor is important, but ultimately, it’s your body and Weight Loss Surgery is a personal choice. Do your research and obtain all pertinent information. Weigh the risks versus the benefits. Make an informed decision. Schedule a call with our office manager, Cat Williamson, to discuss your next step.

Phentermine – Could it Help You Lose Weight?

Posted on February 21, 2019 by CFWLS

I’d like to talk to you about Phentermine. Phentermine is an appetite suppressant. It’s been around for a long time. Appetite suppressants are really carefully regulated by the FDA, so there are some hoops to jump through for those people utilizing them, but it’s very doable. Potentially it can be helpful from a weight perspective, but also from a hunger/craving perspective. It works very well for cravings.

A lot of appetite suppressants have come and gone. There have been a number of them over the last 20 years or so. They got approved by the FDA, were around for a few years, and then gone. One of the reasons is because the drugs were causing other problems. There are a couple of newer ones in the last few years. None of them really work any better than phentermine. The new ones can be really expensive. Phentermine has been around for about 60 years now. It can be very helpful. And it’s very safe. We’ll talk about the risks, which are something we do have to keep an eye on. It can help with any medical weight loss plan. You have to be doing the right things. Phentermine will not make up for a bad eating and exercise plan. It’s very closely monitored by the FDA. Part of that is because back in the 90’s they had phen-phen. It was a combination medication of phentermine and also phenfluramine. They put two medications together and it worked wonderfully. Unfortunately, the phenfluramine ended up causing heart problems. It was taken off the market. Because phentermine was associated with it, it’s very closely regulated. Overall, it’s a very safe medication. It has stood the test of time. It can actually be used long-term but it needs to be monitored. There can be some potential side effects. You do have to watch blood pressure. It’s rare but not impossible.

The clinical indications for using phentermine are a BMI over 30 or BMI over 28 with medicals problems. It’s similar to having weight loss surgery. Generally what they’re talking about mostly are sleep apnea and diabetes. Chemically, phentermine looks like amphetamine. Because amphetamine can cause all kinds of problems, and can be addicting, it was thought that phentermine was in the same class as amphetamine, and therefore just as dangerous. It was more regulated by the FDA. A lot of those theoretical problems really never panned out.

I’ve been utilizing phentermine in the patient population for about 15 years now. Just like surgery, it’s a good tool. It’s just another tool in the toolbox. There’s nothing magic about it. It can be a good additive tool along with the surgery. All it really does is takes the edge off hunger. It really takes the edge off cravings. It won’t prevent you from eating. It can also help with carbohydrate withdrawal. Most of our patients are very sensitive to carbohydrates. If they fall off the wagon and start eating too many carbs and then try to cut them back again they’ll go through withdrawal. Carbohydrates are like a drug. The phentermine can help with the carbohydrate withdrawal symptoms. We have found that phentermine can give you 8-12 pounds of extra weight loss. It’s the same with our surgical patients. If they feel like they’ve stalled out, the phentermine can give them some more weight loss.

If you are keeping your carbohydrates down while utilizing phentermine, you can lose a tremendous amount of weight. The weight loss from phentermine will vary from person-to-person depending on age, genetics, sex, and other health problems.

There are potential side effects. You absolutely need to have an EKG done prior to starting phentermine. You want to document that your heart is fine. It’s not going to cause a heart problem. But if you’ve already got a heart problem, it can worsen the problem. Almost everyone starting phentermine gets a dry mouth. Make sure you’re drinking a lot of water. It can make you feel slightly jittery. It’s kind of like having a few cups of coffee. They typically fade away in about 7-14 days. It’s a side effect. It’s not how the medication works. I tell people that if it makes you jittery and it bothers you, then quit taking it. The medication will be out of your system within 12 hours. One of the uncommon side effects of phentermine is insomnia. If you take it too late in the day you might have a hard time going to sleep. But that typically over time goes away. Other uncommon side effects are tremors, dizziness, and high blood pressure. It’s really rare for blood pressure to go up, but that’s one of the reasons why we have to monitor it. Theoretical potential problems (which are related back to the phen-phen) are heart problems and addiction/withdrawal. You can get used to the medication, but that’s not necessarily addiction. You can build up a tolerance to the medication where it stops working as well. But you can’t go through withdrawals. You don’t have to wean off the medication. You can just stop taking it.

There are some real reasons to avoid phentermine. If you have an allergic reaction to it, obviously you shouldn’t take it. If you have a history of heart problems (no matter what it is), I would discourage you from taking it. You shouldn’t take it if you have high blood pressure that’s poorly controlled. You can take it if your blood pressure is well controlled. Theoretically you should avoid phentermine if you’re taking antidepressants. Because of the chemical make up of phentermine, there was a thought that there would be a cross over, and some antidepressants would make this exacerbate heart problems. It would make antidepressants not work as well or the antidepressant would make it exacerbate heart problems. But it’s absolutely fine to take it with antidepressants. There is actually some antidepressant affect with phentermine.

Legally I have to have a discussion about the” art” of taking phentermine to a patient if they’re going to be taking it. I have to talk about the potential side effects as well as the” art” of using the medication. It tends to last for 10-12 hours. So, since most people don’t wake up starving, don’t take it first thing in the morning. There’s no sense in taking it then. Take it mid to late morning. Play with the timing. If you find you’re having a hard time getting to sleep, then take it earlier. If you have a lot of hunger and cravings right before bed then you need to take it later. It’s one of those medications that work if you take it. It doesn’t work if you don’t take it. You don’t have to build up to it or wean off of it. Therefore you can use it intermittently. It’s fine to use it certain days of the week. We typically write it as a daily dose but there’s no reason you need to take it every day. Take it as you need it. It can be used long term. It originally was written in the PDR to be used for only 8-10 weeks. They originally said that because the original studies were only done for 8-10 weeks. It was then approved by the FDA but never approved for long term use. It has been used for long term use for many years the PDR has never been changed. So most physicians only prescribe it for a few months. It’s kind of silly to think we can fix something in a couple months. I’ve had people on phentermine for 10-12 years. It just has to be monitored. We’re making sure there aren’t any blood pressure problems, ensuring it’s still helping, and make sure there are not side effects bothering you. If it’s not helping, you shouldn’t be taking it anymore. There is evidence that if a person is taking it long term that if they stop it every few months for 7-10 days, and then it tends to work better.

There are some cautions about phentermine. Sometimes it may work so well that you don’t eat. We’ve talked about intermittent fasting and how that works. The problem with skipping meals and intermittent fasting are two different things. If you’re just skipping means, then it was unintentional. Fasting is intentional. You don’t want to be skipping meals all the time. If you’re doing intermittent fasting for a day or two, you can take phentermine. It’s another tool in the tool box. Starvation has never been a good weight loss plan. Phentermine won’t stop you from eating. If you’re eating for many reasons (not hunger), then it’s not going to help you. You need to take a good look at the behavior side of things. Why are you actually eating? Work on solving those problems. Without a good nutritional and exercise plan, any weight loss with the phentermine will likely be temporary.

In summary, phentermine has been around for a long time. It has stood the test of time. It can be very safe. It can be very helpful, especially for cravings. But it still needs to be used with a good diet and exercise plan. It doesn’t work to fix a poor life plan. You need to have a normal EKG. We have to monitor your blood pressure as well as side effects.

Come in and get your body composition done. Make sure your losing body fat and not lean body mass. Remember it’s your life! Make it a healthy one! Take care everyone.

What If I Can’t Find a Qualified Bariatric Surgeon or Comprehensive Program in My Area?

Posted on July 16, 2018 by CFWLS

If you cannot find a qualified bariatric surgeon or comprehensive follow up program in your area, you will have to either compromise what you want/ need or continue your search until you find the surgeon/program that will meet and/or exceed your expectations.

A few experienced surgeons offer a travel program for surgery. At the Center for Weight Loss Success, we offer such a program for appropriate surgical candidates. Not only does the program include surgery with arguably the most experience bariatric surgeon in the United States who has performed over 5,000 weight loss procedures, but it also includes our comprehensive Weight Management University for Weight Loss Surgery™ program. In addition, it is one of the most affordable options available in the United States. You can learn more about it at www.cfwls.com

The bottom line is that you have to be comfortable with your choice. We are fortunate to have many excellent bariatric surgeons in the United States. Your long-term success is the most important thing under consideration here. I hope this book has helped to inspire you, answer your questions and better prepare you for an amazing journey. Only you know if this journey is something that is right for you. If we can be of further assistance in any way, please let us know at success@cfwls.com. If you desire additional information and would like to view helpful videos that address each of these questions, please visit our main website at www.cfwls.com or at www.myweightlosssurgerysuccess.com.

Rhonda’s Opinion: Travel to the surgeon/program of your choice – it’s all worth it!

Thanks to Dr. Clark...