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Tag Archives: top weight loss doctor

Sabotage Behaviors

Posted on December 16, 2019 by

We’re talking about sabotage behaviors. Often it’s self-sabotage. We are our own worst enemy.  But sometimes it’s others who are sabotaging us.  Eat to live, NOT live to eat. If it were only this easy! Often you “know” what to do, but doing the right thing can be difficult. Why is that? Often sabotage behavior can derail the best intentions.

Sabotage is “the act of hampering, deliberately subverting or hurting the efforts of another.” Another definition is “the deliberate action to destroy property or equipment.” What about the self-sabotaging behavior? Here are some things to think about. Are your goals realistic? If they become unrealistic, typically it becomes easy to sabotage yourself. You might be trying to do too much too soon. For example, if you overdo it with the exercising you could be so sore you can’t move. Now you have to stop working out for several days. That “all or none” mentality does not work. The reality is, we all make mistakes. We need to be able to forgive ourselves as well. There’s the “excuse for every occasion” type of thinking. For example, “I only have a birthday once a year.” There’s always going to be a birthday or festival or something. Relying solely on willpower is another example of self-sabotage. I assure you that doesn’t work very well. Listening to how you feel will help you counteract this, as well as journaling. Thinking about it ahead of time will help you make better decisions. Another good way is writing it down. Journaling is one of the best ways to control what we do. It’s a great way to keep track of what we eat and keep track of what we’re doing. Writing your emotions down can be very helpful. You can ask yourself things like, “Am I truly hungry?” “Why is it I’m hungry?” “Am I angry?”

How do you combat this self-sabotage behavior?

Part of it is setting realistic goals. If the bar is set too  high there’s no way we’re going to get over it. It would be nice to lose 100 pounds. Is that realistic? Can you do it in a year? The goal is going to be different for every individual. Some of it is where we are trying to get in the long run. Secondly, throw away the excuses. Just decide what you’re going to do and do it. Don’t be in a hurry. You don’t have to do it all at once. We all make mistakes. We all fall off the wagon. You need to forgive yourself. Be realistic. This didn’t happen overnight.

Try not to overbuy. We talked recently about the “Costco effect” where we can get some great deals on everything in bulk. That’s wonderful except whenever we buy things in bulk we tend to eat it quicker. This is true with everything.  When you have a lot of it, you tend to overuse it.  When we have only a little bit of something we tend to conserve it. This is true with food too. Overbuying tends to lead to overeating.

Pre-plan your day or week, including meals and activity. Review them frequently. Review at night to see what you could have done better that day. Wake up in the morning and figure out what your plan for the day is. Keep track of your steps daily.

Replace the negative thinking wit what you’re doing right. We tend to beat ourselves up. Negative thinking is never helpful. Realize you made a mistake and do things differently. Most things in our life are recurring themes.

Finally, journaling is one of the most powerful tools there is. Writing things down helps you figure out what works well for you. Without writing it down you’ll never really know where the problem areas are, especially the eating and activity aspect. We often have the concept of thinking we’re doing everything just right. But if you actually right it down you can find areas of improvement. We can all improve. I can assure you of that.

Other people can sabotage your efforts. Some do it purposefully and others do it unconsciously. Unconscious saboteurs appear to be supportive and believe they are being helpful, but they actually knock you off track by acting out of habit. The conscious saboteurs are more obvious. They know you’re trying to lose weight but they try to entice you. “Just one won’t hurt.” “This is the best cookie ever.”  Some people ask you to do something else when they know it’s your fitness time. “Let’s stop by the bar and have a beverage and some food. “ Other people just have a constant discussion about food. I could never understand why someone who’s trying to lose weight would watch the Food channel. Turn it off. Why do you want to torture yourself?! You can be a foodie I guess, but it makes it really hard. When we talk about food, we get hungry.

How do you combat saboteurs?

Recruit people to help with weight loss. Communicate with friends and family assertively. Have responses ready. When someone encourages  you to eat some cake, just say, “No thank you.”  You don’t have to have a big explanation.  Place trigger foods out of sight. I’m not a big fan of saying you can never eat a particular food. The exception to that is for people who have trigger foods. If you’re someone who can’t eat just one potato chip and has to eat the whole bag, then you should avoid that trigger food. Stop being so polite.  “Ok I’ll have a little of this….” “I’ll skip my exercise because I know we haven’t seen each other in a long time.” Try to recruit your saboteur as a support person. If you can’t recruit them, it’s time to spend less time with them.

There are certain situations and events that are saboteurs. The big three are vacations, office life, and holidays. The reality is we’re all going to be part of these things. You can’t just ignore them. Everybody needs a vacation. You should have fun when you go on vacation. Incorporate activity into your vacation. Try some new foods. Search for new protein sources. Keep alcohol in check. There’s a lot of calories alcohol and it turns to sugar very quickly. It also decreases inhibitions so you tend to eat more. Plan your splurges. For example, be careful during the day because you want to go to a certain restaurant at night. Enjoy the splurges and then get right back on track. Deprivation diets don’t work very well.

Office life can be a saboteur. We obviously have to go to work. We have to socialize. You don’t want to hide what you’re doing. If you’re losing weight, people are going to know what you’re doing. If you talk about what you’re doing then you can get support. Everyone is going to have an opinion so you want to be a little careful who you’re sharing things with. Don’t listen to everything they say. Take a walk during your break. Keep healthy snack available. Plan your eating times. There are also unplanned eating times. There should be periods of time when you’re not eating.

During the holidays plan for events and don’t go hungry. Have a plan to socialize away from the food. Take a look at the spread of food so you can “pick your poison.” Keep it to a minimum. Watch the alcohol. It’s a good time to schedule a personal trainer during the holidays. Have someone that is going to hold you accountable and to push you. Don’t go it alone. Find a weight loss buddy. You can support each other.

Here are some tips for success.

Identify sabotaging behaviors you or others might have. It’s very important to figure these things out. The situations are not going away. They are going to be there forever. Review the tools for combating saboteurs and risky situations. Separate yourself from risky situations as necessary. There are a couple of good resource both written by Judith Beck. She’s a psychologist/behaviorist. The first is “The Diet Trap Solution” which is an older book. It’s a really good book about how to change your behavior with eating. The other is “The Beck Diet Solution.”

Right now we have 2 specials running to help you with your weight loss goals.  The first is our 28 Day Weight Loss Plan and the second is our Weight Loss Surgery Reset.  Check them out!

Why is Your Protein to Carb Ratio So Important?

Posted on November 25, 2019 by

Baja Chicken Bowl

Why is the protein to carb ratio so important? Why do we harp on this stuff? If you’ve come into my office to see me you’ve heard me talk about the protein to carb ratio. The protein part is important for a number of different reasons.

Protein tends to be more satisfying. So, you tend to stay full for a longer period of time. It’s also harder to digest. Digestion is work your body has to do. Eating protein increases your metabolism.  Protein increases a couple of hormones that help with weight loss. Those hormones are glucagon and growth hormone, and are stimulated by protein. Protein is really important after surgery because we want to make sure as you’re losing weight you are preserving lean body mass. It’s the combination of the protein and the exercise that helps do that.

The carb part is the antithesis of the protein side. The carbohydrate typically works against weight loss. It stimulates the hormone insulin. Insulin has multiple jobs. Its main job is trying to keep blood sugars normal. It also tells your body to store fat. In a weight loss program you want to be mobilizing fat. You want to keep insulin levels way down. One of the nice things about insulin is that it’s a hormone you have some control over. Most hormones you don’t have any control over. Insulin only goes up in response to blood sugar levels going up. You want to keep your carbohydrate lower and protein higher. Both of those things have nothing to do with calories. It doesn’t mean calories aren’t important. In a weight loss plan you need to be in a calorie deficit. But if we can manipulate hormones, sometimes that’s going to help with weight loss even more.

Creamy Tuscan Shrimp

I’ve seen thousands of patients throughout my surgical career.  You tend to figure out a few things. One thing I see the best weight loss occurs when people get their protein in the 90-100 gram range. It’s typically higher for men (120). With carbohydrate we see the best weight loss when carbs are below 50 grams a day. That’s where we get the protein to carb ratio of 2-1. Protein should be about twice as much as your carbohydrate. We typically see the best weight loss in that ratio. For any one individual the protein could be a little higher or lower. There is a limit to how much protein you should take in because at some point it drives your calories too high. There isn’t any limit to how low your carbohydrate should go. The lower the better. It’s just harder. There’s carbohydrate in lots of foods. The best foods that will keep those carbs as low as possible are generally going to be the colorful vegetables and salad stuff. Both of those are very low in carbohydrate. We literally don’t need to eat any carbohydrate. Your body actually does need some carbohydrate, but it can make the carbs. You don’t have to eat it. The lower your carb intake, the lower your insulin levels, and the easier it is to lose weight.

Every individual has what I call a “tipping point” with their carbohydrate. Most of our surgical patients are very sensitive to carbs. Often times when they drift up and get into that 70-80 gram range I see them start to struggle. Some of them have to be as low as 30 grams a day. Most of them do very well if they can keep it below 50 grams a day.

If you’re looking to lose weight and need some help, we offer the most comprehensive surgical and non-surgical programs anywhere.

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What You Need to Know About the Gastric Sleeve

Posted on November 20, 2019 by

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!