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I think their [Q2] report was for guidance of very moderate growth for the year What has been her weight trajectory over time? The average weight loss of the participants was 98 pounds. Melissa At this point she's probably met the BMI criteria, but she and her doctor need to be satisfied that non-surgical approaches to weight control have not, not proven effective for her. DIR mentioned before that many clothing brands have workout clothes in neon colors. Just getting you out of the hospital is the first step and if patients make it out of the hospital we know that their first 90 days can be rough. When we close this file in a half an hour from now, you'll not only know the outcome of this week's case, you'll be able to better take charge of your own health care.

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In Core plan, you can choose your own food and you also have free access to dietitians and counselors. You also get free access to dietitians and counselors. Fitness and nutritional needs vary for both men and women. Considering this fact, NutriSystem has designed individual plans for men and women separately. This helps the men in losing weight healthily without facing those hunger pangs. This is a specially designed plan for vegetarians. All the meals and snacks of this plan include good carbohydrates and protein.

The NutriSystem diet program is low in carbohydrates and rich in protein. Food at NutriSystem tastes good. In addition, to make it even tastier, you can add your choice of cereals and muffins, as well as oatmeal to the meals.

When you are dieting with NutriSystem, it will never make you feel that you are under weight-loss diet program. Other than breakfast, lunch and dinner, the company is offering desserts, snacks and shakes as well. All in all, almost all the food items offered in the diet program are tasty and the existing customers of the program are very happy with the taste.

Cost of the diet program depends on the chosen menu and diet plan. Initially, you may find it high. However, when you cross-check it by calculating your overall expenditure on your grocery items, time saved in shopping, preparation and other things, the cost is pretty reasonable. Existing customers of the program are very happy with the diet program cost, and most of them say that the convenience, taste and results associated with the program are worth the price paid.

It is very effective and you will start seeing the results in the first week itself. The diet program has assisted millions of individuals in losing and controlling their weight; in addition, it has even improved their health and fitness too. At our institution we tend to favor operating at the extreme end of the weight range; , pound patients because we know that that group clearly has all, all the bad effects of obesity; diabetes, hypertension, hearts that don't function well.

Obesity is a major problem in the United States and not everyone can make diet and exercise work. Diet pills don't seem to be the answer. Obese people then are left with the medical and social consequences of being fat and a lot of these are real. Well let me tell you about Sophie because Sophie decides to go see a Bariatric Surgeon.

So what questions need to be answered by Sophie before she gets the operation? Melissa At this point she's probably met the BMI criteria, but she and her doctor need to be satisfied that non-surgical approaches to weight control have not, not proven effective for her.

Has she indeed tried dieting? What types of diets or medications has she tried over the years? What has been her weight trajectory over time?

In considering that in conjunction with a good understanding of the potential outcomes, risks, and benefits of surgery and when she's satisfied that non surgical approaches have not proven effective and she's willing to accept the risks and likely outcomes of surgery, that she understands, that she can sense that she's opting for surgery and not doing it under duress from family or coworkers.

First of all we're talking about Bariatric Surgery like its one thing. In fact this is a cluster of operations that have evolved over the last 50 years really. You have to see the nutritionist twice when I was doing it. Seeing the psychologist they want to make sure that you're not a comfort food eater, you haven't been abused or eating food because of abuse or you're not an alcoholic.

I mean there are a lot of different things in your mind that you're going through when you're talking to the psychologist. How many people have had some sort of surgery for weight control in this country?

Every year about to , operations are now performed nationwide and that has just skyrocketed in the last 10 years. Sophie goes ahead and decides to try surgery and her surgeon and she decided to do something called Gastric Banding. What is it, how does it work, and why does it work? That band is connected to tubing which sits underneath the skin and the tubing gets inflated with water and the band shrinks or opens in size.

As the size of the band opens and closes with adjustments done in the doctor's office, the size between the top part of the stomach and the bottom part of the stomach changes as well. As that gets smaller and smaller it takes more time for food to go from the top part of the stomach to the bottom part of the stomach.

People feel that they have restriction in what they can eat. That restriction is really the goal of an Adjustable Banding Procedure and that restriction is something that we aim for with those adjustments. It takes a lot of time. I had to change my lifestyle.

The operation is part; you're part of a team when you have the operation. He comes to see his doctor, I'm sure you're seeing a nutritionist and social worker as they do in our program and you're part of a team that's affecting massive behavioral change. But the question is could you have done it without the operation? First of all, of everybody that comes to your office for this surgery and gets interviewed and has a psychological profile, perhaps does 6 months of intensive dieting What percent go to surgery, what percent do you say no you're not an appropriate candidate?

We haven't figured it out yet. I would say that most of your patients, most of my patients who come end up going on to surgery.

She had the surgery and she lost pounds in a period of 16 months all right? I think I know the answer to this, but just reiterate this for me. Is that it, is she done? She doesn't have to do anything else? You know it takes much longer to lose the same amount of weight with an Adjustable Banding Procedure as it does with the Bypass so I was surprised that she lost so much weight in so little amount of time, but certainly it can happen in a motivated patient.

With a Bypass that makes it take 3 years to get there, is she there forever? She's at risk of regaining that weight if she doesn't continue to see her doctor and get those adjustments of the band and actively participate in these behavioral changes. It's unusual for somebody who's had a Band Procedure to track equally with somebody who's had a Bypass Procedure. What are the side effects of the surgery that most patients complain about? The first is that that's a major operation. Just getting you out of the hospital is the first step and if patients make it out of the hospital we know that their first 90 days can be rough.

People estimate that 1, between 1 out of down to 1 out of 50 people die within 30 days of the operation. That includes people who are at high risk like Medicare patients who are disabled and patients who are at very low risk; patients who are like Sophie who are at extremely low risk.

And I was specifically talking about the Bypass operation there, not the Banding. I think most large series don't show even the 0. They're complaining, you asked before about what do they complain about. I'm not going to step on Brian's toes, but what people tell us about are Let's stop for a second shall we and sum up where we are before we go even forward because I can tell you that at this point Sophie's really happy with her surgery. Bariatric Surgery requires changes in your lifestyle and that will include eating habits; you've got to comply with an exercise program, there's a lot going on here, just, not simply just surgery.

So I want to go back to Sophie. Sophie is experiencing now some difficulties after her initial rush of enthusiasm. She ends a relationship because she's embarrassed about her body. She was not prepared for what, Brian you alluded to, which was excess skin. What's that all about? We know this is a side effect of the operation and yet the health care system really hasn't kicked in to address it.

It's still considered cosmetic. Medicare for example doesn't; really cover that intervention nor would Medicaid. Did you have excess skin? I haven't had my annual checkup yet, the 1 year checkup to go through the plastic surgery process.

She had to re-learn how to eat; she didn't like that. She complains about, and here's a quote from her; the stress is causing me to eat more and she's gaining weight.

I mean she said right from the beginning she didn't see herself as overweight. Somebody else told her she needed to have the surgery and she was on the fence the whole time.

I know, you know, a handful of people who have had the procedure; 3 of them have gained significant amounts of weight to the point now where they are obese again.

Those are the stories that you don't hear in the media. But it's one that you very rarely hear. My patients very often if they go to Bill will say, I'm kind of surprised how he was just very, you know, very nonchalant about what the risks were and this is not, he didn't sell it. I think that's an important point is to really lie out in an unemotional way what the real risks are. It doesn't sound like she ever really was on board.

One part of that is that there will be major changes in eating and that there are certain patients or habits that can lead to re-gain.

She had an Adjustable Band placed and unlike the Gastric Bypass, which is really an irreversible operation, but with the band, that is a removable device and it is completely reversible. It requires an operation to reverse it. We talk like this is some kind of magical thing. This is a technical procedure. Yes we can do a Bypass on her, but the same issues about control of what she's taking in and what she wants in terms of behavioral modifications will come to bear and if those things have not changed because it's coming from her, then this too will be a failure.

What can she expect now? This is a lady who originally was told to lose weight because somebody else told her to and she didn't see herself as fat. I'm hoping at some point somebody has sat down with her and said why do you want the surgery?

Does she have to eat differently, supplement differently, vitamins, anything else? If they weren't taking enough vitamins in before, they'll need to supplement that. I, I was not worried about the operation at all. I did a lot of research, my mom sent me a lot of emails and cut a lot of articles out so you know I did a ton of research on it and I was pretty comfortable.

Bariatric Surgery is an effective weight loss procedure but there are consequences, there are risks you need to be aware. You need to have good communication with your doctor so that you're not surprised with any of the results and you've got to get on with the program. Let me tell you a little bit about Sophie now because she's had her surgery.

She's down to pounds. She's had skin reduction surgery and while she's experiencing some vitamin deficiency, according to her doctor she's repleting the vitamins along with a plan that her doctor has suggested.

Brian, at the end of the day how're you doing? This is not the end of the day is it? It will never be the end of the day.

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