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10/16/2014 1 Maximizing Health and Avoiding Regain: Success Strategies for Your Bariatric Surgery Journey Lloyd Stegemann, MD, FASMBS Ahhhh the Memories……
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Maximizing Health and Avoiding Regain: Success Strategies for Your Bariatric Surgery Journey
Lloyd Stegemann, MD, FASMBS
Ahhhh the Memories……
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First Things First
What percentage of patients regain weight after getting to their lowest weight after their weight loss surgery?
Virtually All!
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Typical Weight Loss Pattern After Weight Loss Surgery
Weight Loss
Year 2 and beyondFirst year
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What’s Your Plan?
“By failing to prepare, you are preparing to fail.”
- Benjamin Franklin
“Always plan ahead. It wasn't raining when Noah built the ark.”
- Cardinal Richard C. Cushing
Success Strategy #1 For Maintaining Health And Avoiding Weight Regain
Weigh yourself frequently
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Success Strategy #2 For Maintaining Health And Avoiding Weight Regain
Know Your Physical Hunger Cues
Am I Hungry?
T: Trouble ConcentratingH: HeadacheI: IrritabilityE: Empty FeelingF: Fatigue
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Success Strategy #3 For Maintaining Health And Avoiding Regain
Create An Environment That Promotes Success
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Don’t Dwell on the Past, Learn From It
Success Strategy #4 For Maintaining Health And Avoiding Regain
Life Journal At Least Twice A Year
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Items To Journal for Two Days
• Food• Sleep• Exercise• Stress• Vitamins
Wear a pedometer and check your food environment!
Success Strategy #5 For Maintaining Health And Avoiding Regain
Have A Plan In Place If Your Weight Goes Above A Predetermined Number
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How I Treat The Patient With Weight Regain After Weight Loss Surgery
• Welcome them with open arms!• Assess hunger control and portion control• Life journal• Assume that something is wrong with their
procedure or with their physiology– Check labs– Upper endoscopy
Common Reasons For Weight Regain After Weight Loss Surgery
Determining the cause of the regain is key to fixing the problem!
AnatomicalReasons
MedicalReasons
“Life”Reasons
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Anatomical Reasons For Weight Regain
When Surgery Goes Wrong
1. Erosion2. Port-tubing
dislocation3. Tubing leak4. Balloon
malfunction5. Band unbuckles6. Band too tight
1. Pouch enlargement2. Anastamotic
enlargement3. Gastric-gastric
fistula4. Hiatal hernia5. Stricture
Possible Anatomical Problems
1. Sleeve too big2. Dilation of sleeve3. Stricture4. GERD
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Medical Reasons For Weight Regain
When your body fights against you
Common Medical Conditions That Can Cause Weight Regain
1. Hypothyroidism2. Cushing’s Syndrome3. Polycystic Ovarian Syndrome (PCOS)4. Menopause5. Pregnancy6. Sarcopenia of aging (loss of muscle)7. New Medications8. Sleep issues
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“Life” Reasons For Weight Regain
Getting Back To The Basics
Common Findings in Patient Who Experience Weight Regain After Weight Loss Surgery*
1. Mindless eating, frequent snacking.2. Significantly increased carbohydrate intake.3. Increase in liquid calories.4. Lack of physical activity.
*After anatomic and medical causes have been eliminated
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0 0.5 1 512 25 125
Cumulative Effect of Small Daily Imbalances in Energy Intake on Body Fat Mass
04812
Excess intake (% total)Excess intake (kcal/d)
Rosenbaum M et al. N Engl J Med. 1997;337:396-408.
1 million
Energyintake(kcal/y)
1 million
Energyexpenditure(kcal/y)
Change in body fat (lb/y)
1lb 5lb 13lb
Let’s Put That In Perspective12 calories 125 calories
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So Which Of These Is The Most Likely Cause of Weight Regain After Weight Loss Surgery?
“Life” ReasonsAnatomical& Medical Reasons
So Which Of These Is The Most Likely Cause of Weight Regain After Weight Loss Surgery?
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Wrap Up
• Some weight regain is expected
• Have a plan
• Get help
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Shake it off and step it up!
• A parable is told of a farmer who owned an old mule. The mule fell into the farmer's well. The farmer heard the mule 'braying' -or-whatever mules do when they fall into wells. After carefully assessing the situation, the farmer sympathized with the mule, but decided that neither the mule nor the well was worth the trouble of saving. Instead, he called his neighbors together and told them what had happened ...and enlisted them to help haul dirt to bury the old mule in the well and put him out of his misery.
• Initially, the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back ... a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back, he should shake it off and step up! This he did, blow after blow. "Shake it off and step up...shake it off and step up...shake it off and step up!" He repeated to encourage himself. No matter how painful the blows, or how distressing the situation seemed the old mule fought "panic" and just kept right on shaking it off and stepping up!
• It wasn't long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him, actually blessed him...all because of the manner in which he handled his adversity. If we face our problems, respond to them positively, and refuse to give in to panic, bitterness, or self-pity, the adversities that come along to bury us usually have within them the potential to benefit and bless us.
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• A young woman was in her kitchen.• A pan of water was simmering on the stove. • She was making boiled eggs for breakfast. • He walked in.• Their eyes met. • "Make love to me here, now," she said. • They made love on the kitchen table. • "Couldn't resist me, huh?" he said. • “No,” she replied “The egg timer is broken,“.
As long as you are getting hunger control and portion control,
your surgery is doing all it can!The rest is up to you!
Stay Focused, Stay Diligent, and Watch Out For “The Creep”!
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• A couple were dining out together celebrating their 40th wedding anniversary.• After the meal, the husband presented his wife romantically with a beautiful very old gold antique
locket on a chain.• Amazingly when his wife opened the locket, a tiny fairy appeared.• Addressing the astonished couple, the fairy said, "Your forty years of devotion to each other has
released me from this locket, and in return I can now grant you both one wish each - anything you want.."
• Without hesitating, the wife asked, "Please, can I travel to the four corners of the world with my husband, as happy and in love as we've always been?"
• The fairy waved her wand with a flourish, and magically there on the table were two first-class tickets for a round-the-world holiday.
• Staggered, the couple looked at each other, unable to believe their luck. • "Your turn," said the fairy and the wife to the husband.• The husband thought for a few seconds, and then said, with a little guilt in his voice, "Forgive me,
but to really enjoy that holiday of a lifetime - I yearn for a younger woman - so I wish that my wife could be thirty years younger than me."
• Shocked, the fairy glanced at the wife, and with a knowing look in her eye, waved her wand.....• and the husband became ninety-three.
• Shoe Salesman• There was a man who was a shoe salesman in New York City and he was doing really well with his
business. So he decided to branch out and open a factory in a small village in Africa. He sent all his developers and engineers over there and everything was going as scheduled. One day the shoe salesman wanted to see how the factory was doing and set out for Africa. He arrived in Africa and set out for the village. When he arrived he noticed that nobody in the village wore shoes. Stunned, the man called back to New York City and stated, “You’re never going to believe this, nobody around here wears shoes. Cancel the order!!!” Another man who was a shoe salesman in Los Angeles decided to branch out and open a factory in a small village in South America. He sent all his developers and engineers over there and everything was going as scheduled. One day the shoe salesman wanted to see how the factory was doing and set out for South America. He arrived in South America and set out for the village. When he arrived he noticed that nobody in the village wore shoes. Stunned, the man called back to Los Angeles and stated, “You’re never going to believe this, nobody around here wears shoes. Double the order!!!”
• The point is that both shoe salesmen saw the same thing, that nobody was wearing shoes, but they had different reactions. One saw it as a catastrophe and the other saw it as an opportunity. You will all see the same things here on this retreat: the same talks, the same skits, the same activities, the same everything. It is up to you how you are going to react to what you see. Some of you will close yourself off and say, “What a waste of time, cancel the order.” While others might be open to the experience and say, “That was great! Double the order!” It is all up to you.
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• Susie's husband had been slipping in and out of a coma for several months. Things looked grim, but she was by his bedside every single day. One day as he slipped back into consciousness, he motioned for her to come close to him. She pulled the chair close to the bed and leaned her ear close to be able to hear him.
• "You know" he whispered, his eyes filling with tears, "you have been with me through all the bad times. When I got fired, you stuck right beside me. When my business went under, there you were. When we lost the house, you were there. When I got shot, you stuck with me. When my health started failing, you were still by my side. "And you know what?"
• "What, dear?" she asked gently, smiling to herself.• "I think you're bad luck."
• When I was a young minister, a funeral director asked me to hold a grave side service for a homeless man with no family or friends. The funeral was to be at a cemetery way out in the country. This was a new cemetery and this man was the first to be laid to rest there.
• I was not familiar with the area and became lost. Being a typical man, of course, I did not ask for directions. I finally found the cemetery about an hour late. The back hoe was there and the crew was eating their lunch. The hearse was nowhere to be seen.
• I apologized to the workers for being late. As I looked into the open grave, I saw the vault lid already in place. I told the workers I would not keep them long, but that this was the proper thing to do. The workers, still eating their lunch, gathered around the opening.
• I was young and enthusiastic and poured out my heart and soul as I preached. The workers joined in with, "Praise the Lord," "Amen," and "Glory!" I got so into the service that I preached and preached and preached, from Genesis to The Revelation.
• When the service was over, I said a prayer and walked to my car. As I opened the door, I heard one of the workers say, "I never saw anything like that before and I've been putting in septic systems for twenty years."
