Stomach cramps

On Saturday I experiened some severe stomach cramps. I began the day still constipated (four days!) - this has been a typical experience after each of my band adjustments, presumably because of the lack of fibre consumed while on fluids and mush. I decided some serious action was needed and took several measures to deal with the situation in a multi-pronged attack! I started the day with a good-sized bowl of All-Bran which packs in loads of fibre. Mid-morning I drank a strong coffee (caffeine aids digestion) and ate a banana. Later, I ate some brown bread and had more coffee (I'm normally a weak tea drinker). After my lunch, which included the bread and some mixed salad, I developed a sudden attack of stomach cramps - severe enough that I couldn't stand up comfortably, and I had to sit down. To begin with I was a little anxious that I had done something to my band. But then I realised the pain was too low down for that to be the case. I presumed that it was related to the constipation or perhaps to the sudden rush of fibre rushing around my digestive system!!

Anyway, a lot of sitting down, some soluble paracetomol and a couple of hours later, the pain gradually eased. Once I was able to stand up I moved around quite a bit and a little later I was fine again. By that time I had decided that it might have all been related to the olives I had in my mixed salad which have probably been in the fridge a little longer than they should have been. However, I mentioned this all to my Dad on the phone later that day and he said it sounded like trapped wind! I have heard of people getting trapped wind and talking of a lot of pain being involved, but I have never experienced anything like this myself. You live and learn.....!

Shopping woes

I went shopping for some new clothes on Saturday - without too much success I'm afraid to say. I seriously need some more tops to wear - I keep getting rid of old ones that are miles too big for me and my total clothes supply is shrinking fast. In fact, I only have two T-shirts suitable for wearing in public (I have a few other baggy tops that are OK for hanging around the house in). I am also getting very short on trousers. I have only three pairs that fit me now - two have been altered twice and one has been altered once. There is a limit to how many times you can put trousers under the sewing machine!

Anyhow, Saturday I concentrated on tops and I searched in vain in a number of clothes shops. All I could find were really bright, flowery, low cut or otherwise 'skimpy' tops. Everything I saw appeared to be designed for wearing on the beach! I am, and always have been, something of a Tomboy, so I like simple, plain clothes in pastel shades that don't show too much of my body. I ended up in Burton's - a men's clothes shop - and bought three T-shirts from there! They are not ideal, but in my opinion, better than anything I found in the ladies shops!!

While I was out, I thought I'd keep an eye open for any suitable trousers - and found some bootleg cut jeans I rather liked the look of. However, the biggest size they had was just a 16. The trousers I am currently wearing (altered twice, mind) are a 20 - so I know I'm no longer a 20. But to hope that I might be able to get into a 16? Well, I tried them on. The verdict? Well, let's put it this way - I got them on and even did the zipper up - and I was able to breathe (!). But I don't think I could have walked properly in them and they didn't feel comfortable. So I guess I am very close to being able to fit into a size 16, but just not quite there yet.

Metabolism slowing down

A few months ago I bought myself some Tanita scales. These are quite high tech and are a domestic version of the more expensive scales that they use in hopsitals. It tells you your weight (of course), total body water, muscle mass, visceral mass, metabolic age and rate, and total body fat. When I first started using it, my basal metabolic rate (the amount of calories I need to consume to maintain my current weight and just keep my body going - without any exercise or activity) was 1960. Over the past few months I have watched it go down and down - and this morning it was at its lowest ever - 1572! This is quite normal - your body needs less calories (it puts out less energy) doing basic fuctions when you weigh less. This means that if I laid down all day and did nothing but breathe and circulate my blood, I would need to consume that many calories to maintain weight. Of course, I don't usually lay down all day - more calories are needed to cover acivity, walking, working etc. But also I don't want to maintain my current weight of course - I want to lose weight. To lose weight, the total calories I consume needs to be less than my basal metabolic rate (BMR) plus calories burned through activity. So, every time my BMR goes down, one of two things happens. Either, my weight loss slows down, or, I can maintain my rate of weight loss by consuming less or exercising more. In other words, this is mathematical proof, if ever it were needed, that weight loss gets harder the more you lose!!!

I'm disappearing!

Well not exactly disappearing, but my weight is falling off at the moment. Only six days ago I weighed 13 stone 6.4 pounds. This morning I weighed in at 13 stone 1.8 pounds! I keep a daily record of calories in and calories out - so I know from my calculations that I should ony have lost two pounds in the last week - not four and-a-half! So why this sudden drop? Well, in the previous three weeks I lost nothing. The first two of those weeks I lost nothing because I ate too much (simple eh?!). However, the week before last, I ate quite sensibly and got lots of exercise. Despite that, I didn't lose an ounce last week - possibly related to the fact that I had my period? So, I figure that this week, two of the pounds I have lost are delayed losses from the previous week - after everything has 'settled down' so to speak. It's only a theory, but it might explain why I suddenly seem to be disappearing!

One of the potential side benefits of this apparently rapid loss, is that I might just reach a target I set myself several months ago. I worked out that if I lost weight consistently and there were no hiccups along the way, I just might get below 13 stone by 3rd July. I picked that date because it's the start of a period of holiday leave from work. To reach that goal I would have to lose 1.9 pounds this coming week - doable, I think. That would get me to 12 stone 13.9 pounds - the first time I would have been at that weight for at least 20 years!! I don't know whether I will make it - it's a tough call - my weight loss might slow down after this week's rapid loss. But I will keep my fingers crossed and let you know how I get on - as always!

More about the pub

I was telling you yesterday about my visit to the pub and how I ended up telling a lady about my band. What I didn't say was that I also told the two colleagues that I went to the pub with! Alan and I were waiting at the bar while Joyce was still making her way to the pub after a visit to the cash machine. Alan said "I don't know if it is polite to say, but you've lost a lot of weight, haven't you?!". I confirmed that I had. In fact, I have noticed that Alan has also lost weight over the past few months. However, as I explained to him, I didn't want to say anything to him in case he thought I was prompting him to compliment me!! There's nothing as queer as folk eh? Anyway, we chatted about it briefly, got our drinks (mine was Diet Coke) and went to sit down and wait for Joyce to arrive.

Joyce arrived soon after and immediately Alan mentioned that he had commented on my weight loss. The looks exchanged between them suggested to me that they had discussed my weight loss - and he had effectively 'done the deed' and asked me about it. Joyce asked the usual question - how had I done it? Now, because of the experience I had with the other lady (see yesterday's post), I hesitated before answering. I am quite happy to miss out a bit of the truth but I am not accustomed to lying - and it keeps getting a bit near the brink for my liking. In that moment of hestitation, Joyce caught my eye and then gestured with her hands in front of her tummy - making a cutting motion and then a motion like typing a knot! I concluded that she had guessed the truth and I thought there was no point in not telling them everything.

So, out I came with it. They were both quite interested and seemed to have an intelligent understanding of the limitations and difficulties of the band. It was shortly after this that I went to buy a round and ended up telling the other lady! So now there are FIVE people at work who know about my band. Two of them guessed. I wonder how many other people have put two and two together and worked it out for themselves? Am I being too coy when answering their questions? Funny how for years, no-one has ever mentioned my weight - and now everyone feels they have a right to ask me quite deep questions about it and discuss it with me and others?!!

The truth will out

Yesterday, I encountered a couple of ladies at work who I haven't seen for a few weeks. They both explaimed at how marvellous I'd done to lose so much weight, how wonderful I looked and how I simply had to tell them what my secret was to such successful weight loss! I was a little overwhelmed by their slightly over-the-top compliments but managed to splutter the usual response. I said something along the lines that I was eating healthily, eating smaller portions and doing lots of walking - all of which is absolutely true. However, one of the ladies, who is quite obese herself, began to tell me how she had "tried everything" and had re-joined Weight Watchers in the hope of succeeding in weight loss this time. She was looking for more detail from me on exactly how I had so successfully managed to lose so much weight but it was quite difficult to say much without either telling her I had a band, or outright lying. I felt guilty, because here was a lady who was in genuine need of some advice and tips herself, and all I was doing was giving her platitudes.

That was yesteday. Today, I did something I almost never do, and went for a drink down the pub with a couple of colleagues (more about that tomorrow!). When it was my round, I went to the bar, and who should I bump into but the lady I referred to above! There was no-one else around so I made my decision. I said "I'm so glad to bump into you......" and went on to tell her that I had a gastric band! I told her that I wanted her to know the 'truth' of my successful weight loss. I explained that it has not been an easy ride, that some people fail with the band, that it doesn't stop the soft foods like chocolate etc, oh, and that it cost £8000!! She was quite interested and I could see her thinking through the implications for herself. She said she wasn't in a position to afford it at the moment - but I could tell that it is something she might hold in reserve as an option if her latest Weight Watchers attempt does not work.

So there you have it - now three people at work know I have a band. I must confess that each person I tell it gets easier. I'm getting more relaxed about it now - probably because I believe that even if I don't lose another pound, I have already achieved success in some people's eyes (not mine, I hasten to add). Whatever happens from here on, my health and body are already tonnes better than they were!!

Strange hybrid food

I was supposed to be on fluids still today, moving onto mush this evening. However, with all being fine with my post-fill eating, I jumped the gun a bit and went onto mush yesterday. I had some scrambled egg, baked beans and mashed potato. Today I have had a strange mixture of food and I've no idea if I have had a 'balanced' diet or not! The day started with a protein-rich strawberry shake, and a glass of orange juice. I got hungry quite soon after so had a low fat creamed rice. For lunch I ate a Weight To Go smoked haddock and potato meal - all very soft but it stank the office out!! By late afternoon I was hungry again and had a Weight Watchers soup to keep me going. However, within an hour I was starving again and succumbed to a bar of Dairy Milk chocolate on the way home! For evening meal I had some Tesco vegetarian cottage pie - I've had this before and it's delicious. I had some very soft-cooked marrow with it too. Later in the evening I ate a Muller Light yoghurt and some strawberries picked from the garden. In total today, I have consumed about 1200 calories - not too bad considering that includes the Dairy Milk. However, I'm going to bed very soon otherwise I will start snacking some more - I'm still hungry (or is that head hunger? how do you tell the difference?).

I seem to have got into a habit of eating around 1200 calories a day these days. It means the weight comes off a little more slowly but I simply can't manage less than that. I'm trying to get as much exercise as I can to counteract the extra calories but that's not always easy to fit into a busy working day either. It's far too early to say whether this latest fill has done the trick. However, I am ever so slightly concerned that I seem to be able to eat all kinds of soft food without any problems whatsoever. Everything goes down easily, and relatively quickly. I've not had any hint of pain, and have ony experiened very minor 'fullness' (yesterday after eating WW ocean pie). As I say, it's too early to say how it's going to go yet - but I am still keeping my fingers crossed.

Aren't sisters wonderful?

The weekend before last I spent with my my family down in London. I stayed with my Dad and his partner, but I saw most of the family at some point over the weekend, including my younger brother and sister (twins). I also saw my cousin and my favourite Uncle. I hadn't seen any of them since February so everybody commented on the weight that I had lost. I got loads of really nice, complimentary comments and everyone heaped praise on me over and again. I must say, I don't want to sound churlish, but it started to get me down after a while! I think, in a funny kind of way, it puts extra pressure on me to keep going and not to fail.... As I told my consultant at the Support group this weekend, I continue to look forward at the weight I still have to lose, not backwards at where I have come from. I think of it as though I had surgery yesterday and today is day one of the rest of my life. I know lots of people don't agree with this approach - but that's me - there you are!! So when people say nice, lovely things, I often feel like reminding them that the hard bit is still to come - I can take the complements but I can't be complacent.

Anyway, this morning, out of the blue, I received a card. It said 'Well done - I am so proud of you' on the front - and since I haven't passed my driving test recently or passed any exams, I was a bit confused as to why anybody would be sending me a 'Well Done' card! Upon opening, I discovered that it was from my sister, and this is what she wrote:

"Dear Theresa. Just to say I am pleased with your determination to improve to a healthier lifestyle. I know you have some time yet to achieve your target weight but you will do it. Keep up the pilates! Lots of love, Jayne. x x x". Ahhhh, wasn't that nice?!

Conference conundrum

I was out all day at a conference today, which normally would see me looking forward to some posh grub for lunch. But not this time since I am on fluids after yesterday's fill. The last occasion I was at a conference was in March this year - and I was also on fluids then after a fill. On that occasion I took a strawberry shake and some cold vegetable soup with me. I recall the shake being OK, but trying to drink cold soup was no pleasant and I left most of it. So, last night I gave some thought as to what I could take with me to eat at today's conference. My better half came up with the brilliant idea of taking some hot soup in a flask (I know it seems obvious to you but I didn't think of that last time!!). I also took a shake, with yoghurt, banana and apple blended in, and a Weight Watchers yoghurt. So while everyone else sat down to a lovely buffet with masses of fresh fruit and cream cakes for dessert- I ate a bowl of luke warm soup, some shake and a yoghurt! Oh, I suppose it wasn't so bad!

Here's a funny thing. At the conference I went to in March, I met a lady called Margaret who I am actually working on a project with. Up to that point we had communicated by telephone and email but I had never met her. I had to explain, on that occasion, that I'd had a 'minor hospital procedure' (referring to my fill) and that I was on liquids only for a few days. At today's conference, Margaret was there again - and again I had to explain I'd had a 'minor hospital procedure' and was on liquids only! I mentioned to her that I'd only met her twice and both times I was on liquids - I explained that I usually ate 'normal' foods! I almost told her about my band at one point because I think she thought I had some grave illness that kept necessitating these strange eating habits. But I decided against it and simply tried to reassure her that it was nothing serious.

Everything I have eaten so far has gone down fine without any problems.

Band adjustment number eight

I went to the Healthier Weight clinic in Manchester today for my eighth band adjustment. I had 0.3ml put in. This takes me back to 7.5ml - where I was a full four months ago! Oddly enough, when I was there the first time round it was far too tight. That began two cycles of saline out, saline back in, back out again and back in again!! I truly believe (and hope!) that I have the right amount of fill this time. Clearly 7.7ml was too much - but 7.3ml was not enough. Hopefully, at 7.5ml I am now at that ideal, in-between point.

Here's a reminder of my fill history so far:

Surgery 15th november 2008
1. Fill no. 1 - 19th january 2009 (5ml: total = 5.0ml)
2. Fill no. 2 - 15th February (1.5ml: total = 6.5ml)
3. Fill no. 3 - 26th February (1ml: total = 7.5ml)
4. De-fill no. 1 - 4th March 0.5ml: total = 7.0ml)
5. Fill no. 4 - 22nd March (0.3ml: total = 7.3ml)
6. Fill no. 5 - 7th May (0.4ml: total = 7.7ml)
7. De-fill no. 2 - 28th May (0.5ml: total = 7.2ml)
8. Fill no. 6 - 21st June (0.3ml: total = 7.5ml)

When I left the clinic I told the nurse that, in the nicest possible way, I hoped I wouldn't see her again for some time!! Since getting home I have drunk a 0.5l bottle of Ribena and some sieved mushroom soup. So far these have gone down well an without any problems. I'll keep you informed as I progress onto pureed foods later in the week.

Food textures

I have had a much better day today for some reason! I started the day with baked beans and poached egg on toast (about 380 calories). For late lunch I ate a Philadelphia Light sandwich and some mixed salad (260 calories). This evening I ate vegetarian mince with potatoes, spinach, courgettes and chestnut mushrooms (220 calories). I'm now feeling quite full but we're settling in to watch a film on TV later - so in case I get peckish we have some strabwerries picked from the garden plus a Weight Watchers yoghurt (about 120 calories). This is one of my favourite desserts - one I used to eat even before I got much more health conscious! Chop up the strawberries and pour the youghurt over the top - lovely!


I went to the Healthier Weight support group meeting today in Manchester. I will report on what was discussed in more detail in the next few days, but I just wanted to share this one thing with you. I asked for clarification about what we bandits should eat in terms of getting the texture of food right. I understand that at one extreme, we have the so-called 'slider' foods (such as soup, and soft, runny foods), and at the other extreme, are the crunchy, dry foods (such as salad and crunchy vegetables). What I am less clear about are the foods in between! For instance, I have never really understood why some people frown upon things like lasagne. Lasagne contains pasta, tomatoes (and maybe other vegetables) and mince - what's wrong with these? Well, I got my answer today. The thing that is 'wrong' with lasagne is the high amount of oil it usually contains - and all the high fat cheese. It's these foods that turn what might otherwise be a fairly 'dry', solid-textured food into something that goes down through the pouch and into our main stomach much more quickly than is desirable.


To seek further clarification, I suggested that the main content of the take-away I ate the other day (that caused a little laughter) was probably good, healthy, dry food of the right consistency - rice, prawns, mushrooms and onions. However, what turned this 'healthy' food into something that slipped down through my stoma into my stomach very easily (and left me not feeling particularly full) was the curry sauce that was poured over it - this probably contained oodles of oil which turned it all into mush - effectively making it a slider food.


So, there you have it - I think I understand this all a lot better now. It's not necessarily the actual texture of the food - it's the fat content that determines whether or not it turns into a slider food or not and goes through the pouch easily.

Money for weight loss?

We watched the tail-end of a TV programme this evening about the award of financial incentives to people to lose weight. The programme featured two teams of people set against each other in a competition to see which could lose the greatest total amount of weight. The red team were told that for every 1% of their individual excess weight loss, that member would be given £10. The blue team did not receive any financial reward and were not told that the red team were getting the cash incentive. Both teams were given full support through a six week programme of weight loss and exercise and fitness training.

At the end of the six weeks, the red team had lost the greatest amount of total weight and all the team members received their individual cash rewards. One lady received £70 for losing 7% of her excess weight! The blue team were then told about the cash incentive for the red team and they were a little 'miffed' to say the least. Some of them said that they would have tried harder had they been getting money!

However, one year later, every member of the red team had re-gained all or most of their excess weight, and every member of the blue team had kept off the weight they had lost. For some experts, this is seen as evidence that the financial reward for weight loss scheme currently being piloted by the NHS, is doomed to failure. The outcome of this mini-experiment is interpreted as showing that the people who lost weight without any financial reward did so because they were truly motivated and committed to losing weight. The other group, conversely, were motivated by the incentive - and once that was gone - so was the motivation to lose weight.

Personally, I think the NHS is barking up the wrong tree in providing payments to people for weight loss. Granted, they do have the built-in safeguard that no money exchanges hands until participants have kept off the lost weight for at least 6 months. However, the whole philosophy of this initiative encourages people to tackle weight loss - motivated by money. I find it difficult to see how this can be succesful in the long run. On another point, I was a little concerned that the exercise programme had overweight people going from no exercise at all, to running a 10km race in just six weeks. In a previous life (!) I used to be a road-runner and I know only too well the damage that can be caused to knee and ankle ligaments when (a) running with too much weight, and (b) training too hard over too short a period. For overweight people, slowly does it is the watchword - both for exercise and weight loss!

Self sabotage

Oh dear.....! For anyone who hasn't got a band but is thinking about it - here's a warning. The band may fix your stomach, but it doesn't fix your head! I've had a whole day of the dreaded 'head hunger'. I was doing OK until early afternoon. After yesterday's KitKat silliness I took extra precautions and took some healthy snacks to work with me - a Muller Light yoghurt, an Alpen Light cereal bar and a banana. That lot ought to have kept me going, but alas, it was not to be. Having eaten my healthy lunch of salmon, brown rice and green beans, I proceeded to scoff my way through the cereal bar and banana. An hour or so later and I was 'head hungry again'. If you're not familiar with this term, it simply refers to those occasions when we think we are hungry but we're not. We are not actually suffering from the physical hunger that comes from not eating enough - this is characterised by rumbling in the tummy and a sense of 'weakness' or light-headedness. No, head hunger is when we crave food to satisfy our psychological needs rather than physical needs.

Still head hungry, and not getting any satisfaction from my healthy snacks, I went to the vending machine and bought two bars of chocolate and a packet of crisps. I can hardly believe that I visited the darned machine again a couple of hours later and got another choccie bar and more crisps. Arriving home from work, I gorged on a large chunk of baguette and then started on cooking the dinner. My dinner (mash, veggie sausages and mixed veg) was probably the most healthy thing I had eaten since lunchtime. But it didn't stop there. I folllowed that up with a Muller Light, then more baguette and then a packet of mints. To be honest, sitting here now, feeling like a complete pig, I could still easily eat more chocolate - if I had any.

So what's this all about [Alfie]? If you've been following my blog for a while you'll know that I have had the occasional 'blow out', but mainly, I'm quite a good girl! I generally behave myself where food is concerned and stick to all the 'rules' given me by my band provider. So is this a physical problem - simply down to lack of restriction since my last de-fill? Or is it entirely psychological? Certainly it's not 'that time of month' (!), I am not under any particular stress at work and things are fine at home and in my family.

I remember as a kid my mum saying a nursery rhyme. I can't recall all of it, but I know one bit went something like this: "when she was good she was very, very good, but when she was bad she was horrid!". And that's a fair description of how I think my head works. Basically there's a vicious cycle going on. My restriction is pretty poor at the minute (though only three days now to my fill - and counting). As a result it is more of a struggle to keep hunger at bay and eat the right foods. So I occasionally go off track a little and that disappoints me. Being disappointed in myself I feel lousy - and so I eat a bit more - comfort food, you understand. Then I think, 'well I've blown it for today so I might as well blow it proper and eat all the 'nice' things that I can't usually eat' - and on the cycle goes.

Writing it all down this does spell out to me just how silly it all is. If I could just find a way to satisfy my head hunger through some means other than food - I'd have this thing beaten for life. However, I want to finish on a positive note. Well, two actually. The first is this. Despite having had several binges and bad days over the past three weeks or so since my de-fill, I have not gained any weight. I have actually lost a pound or two. This gives me great hope for the future - that even if it all goes competely belly-up (not a good metaphore under the circumstances!) - I won't end up back at square one. The second thing is that I have my fill in a few days and this should have two positive outcomes. One is that I'll be forced to go onto fluids and mush for a total of six days. That will get me back into some better discipline and I'll amost certainly lose an extra pound or two. The other is that I should have much better restriction so will be back on the road to thinness!

Be careful out there.

Silly girl

Referring to myself of course! I've been an angel all day, honest. Then I dragged myself off out for a walk to get some movement into my bones, and what did I do? I stopped in a Co-op shop and bought a KitKat and some Giant Chocolate Buttons!!! Oh, and obviously I ate them - on the way home can you believe?! The only saving grace is that although I consumed about 440 completely unecessary calories in total, I actually burned off about 400 on my walk! What a waste!

I have been doing some silly things like this on and off over the past four weeks or so - ever since I had a de-fill and lost some restriction. I don't think it's entirely down to getting hungry - because I am only hungry some of the time. I also think I'm getting 'head-hungry' more often because I'm a little sad at not having enough restriction - if that makes any sense?!!

Anyway, only a few days to go now before I go for what I truly hope will be my last fill for some time. It's on Sunday and I don't think I have been more desperate to get a fill than on this occasion. I think this will be the first time I have seen the nurse and won't be able to show any weight loss (well there might be a pound or two but it won't be any more than that). Hopefully, that alone will convince her that I need some more saline. Wish me luck.

Any secrets to weight loss?

I was complemented on my weight loss today by a fellow bandit and asked if I had any secrets to share on how I'd done it. Below is roughly what I replied:

I don't really have any secrets to weight loss - just 'rules'!! I am very lucky because I have always eaten very healthy foods (eg loads of vegetables, fruit, fish etc) - my problem is that I've eaten a lot of the unhealthy stuff as well!!! Especially chocolate and cheese. I'm also lucky that pizzas, KFC and burgers have never 'done it' for me - and I'm a vegetarian which helps too! So for me, I haven't had to re-learn eating good food, just cutting out the bad stuff. I don't keep chocolate or cheese in the house, or crisps or anything else that I might be tempted to snack on (although I 'steal' some of my husband's French baguette when I'm feeling naughty). I also stick to most of the band rules most of the time (eg not drinking after eating, chewing well, eating slowly, eating off a small plate, getting lots of exercise etc etc).

HOWEVER - I'm no saint! I have very bad days when I binge like crazy and am just coming to the end (I hope) of a period of about three weeks when I've generally been very naughty and not lost an ounce!

If I could pass on ONE lesson to others that has helped me enormously, it would be to maintain a daily record of everything you eat, everything you drink and every bit of exercise you do. Count every calorie, weigh everything and write it down - and keep doing it even when you are SOooooo bored of doing it you could cry. When I go off the rails, it helps to look back at the days when I did well and remind myself what I ate and when. And when I'm just getting bored with the whole thing, I can look at my record and remind myself of how far I've come.

All the best, Theresa

Ten things about weight loss: Part 9

This is the final part of my report on the TV programme Ten Things You Never Knew About Weight Loss. The final lesson is about exercise - for those who don't much like it!

10. Keep moving and lose weight

We all know that exercise is a critical part of the weight loss equation. Weight loss is essentially a function of calories in minus calories out - the more exercise we do, the more calories we burn, the more weight we lose. However, regular exercise is often a very difficult habit to get into. For a start, any form of vigorous exercise can be almost impossible for a person with a very high BMI - I know. At 20 stone I was never able to climb the stairs to my office at work - taking the lift was the only realistic option. I would never have dreamt of signing up at the locaal gym - imagine the embarrassment of attempting to exercise amongst all the fit, young bodies that I would have doubtless have encountered?! Going to the gym also takes a great slice of time out of the day and iis often simply unrealistic for obese people with young children, hectic lifestyles or demanding jobs.

So, this episode of the programme looked at whether it really is possible to achieve calorie burning by making small changes to our daily routine. The programme focussed on a lady called Amy. Amy's lifestyle is mainly sedentary. A typical day for her consists of sitting down at a desk and engaging in very little activity at home or work. On day one, her heart rate is recorded through the day and it simply confirms that she gets very little exercise. On day two, Amy is told to vary her routine a little. She has to be a little more active. For example, she has to use the stairs more at home and while she is sitting down (at home), she has to 'move around'. When she goes to work she has to get off the train at an earlier stop, walk up the escalator, and generally spend more time walking and talking. Even when she is at work standing in one place she is encouraged to move around as much as she can.

Her higher average heart rate on day two demonstrates that she has got much more activity - and more often. The result is, that on day two she burns an additional 240 calories! Now, this does not sound like much, but if repeated on a daily basis - that's half a pound a week or nearly two stones in a year!

The conclusion of the programme is that small changes in our daily routine are often enough to get us back into some physical activity without having to join a gym or take part in formalised activites that often cost quite a lot and take up a great deal of time. There was a reminder at the end of the programme that the benefits of burning calories would clearly be lost if we eat more than we otherwise would - so it's important to maintain the same calorie intake (or reduce it further).

I am keeping up with my attempt to walk an average of 10,000 steps per day and wear my pedometer everywhere I go. I don't always manage 10,000 on average but at least I have a target to aim for. I rarely manage 10,000 during the week - more like 5-7,000, but I generally do more than 10,000 on Saturdays and Sundays. I've been increasing my mid-week steps by parking further from the building in the car park at work. I also park further away from the shops if shopping at the weekend. I tend to 'pop out' of the office during the day and walk to the shop to either buy lunch or buy a bottle of drink. I also walk to the toilets furthest from my office rather than going to those closer - though I have to be careful that I don't waste too much work time (I do have things to do y'know!!!). I go for a half hour walk quite often when I get home from work - and it all adds up. I've also been swimming once a week and doing a once-a-week pilates class. I calculate the 'steps equivalent' of these activities and add it to my daily total. I must confess that I'm not very good at 'moving about' when I'm sitting or standing. I tend to walk when I'm walking, sit when I'm sitting and stand when I'm standing! In a typical week I probably walk at least 50,000 steps which is equivalent to 3000 calories - or nearly one pound. So it really is worth the effort, and I'm feeling much fitter and livelier than I used to.

Good luck out there!

Ten things about weight loss: Part 8

Nearly done with these now!!

9. Exercise goes on burning fat - even while you sleep

According to the programme, new research shows that we burn fat while we asleep..... Michael, our TV doctor, takes part in an experiment. He does a fairly exhausting treadmill exercise. After a full 90 minutes, he has burned off a mere 19 grammes of fat. Not surprisingly, after all that effort, he is a little disappointed! However, the next day, he takes part in a second series of tests.

First, he has to lie down on a couch and rest for about 45 minutes, while breathing into a large bag-thing. This enables another doctor to measure Michael's Basal Metabolic Rate (BMR). Now, remember that since the previous days treadmill exercise, Michael has had no activity. I am not entirely clear about how this was done, but from the BMR, they were able to determine that since the previous day, Michael had burned off an additional 49 grammes of fat (i.e. in addition to the 19 grammes burned the previous day). This is known as 'afterburn'.

In fact, it would appear that more fat is burned after a period of activity than during. Why is this? Well, because during exercise, our muscles mainly get their energy from using readily-available carbohydrates - these are easier for the body to burn. Once the store of carbohydrates is used up, it takes the body some 22 hours to replace it. The use of carbohydrates during exercise in this way, is why marathon runners use 'carbo-loading' before a race - to try and boost the amount of carbs available in the body. Now, if the body takes 22 hours to replace the used carbohydrate, how is it going to get energy in the meantime? Simple, it feeds on the body's fat stores. This will keep the basic bodily functions going (digesting, sleeping, heart beating etc). This is the so-called 'afterburn' effect. Calories burned from fat in the afterburn phase are considerably more important than calories lost through carbohydrate usage (not least beause there are more than twice as many calories in a gramme of fat than in a gramme of carbohydate).

There, simple!

Drink: Should it be water?

Did you watch 'Embarrassing Bodies' last night? They had a feature on drinking water. Thhey showed that (a) you need to drink about 2 litres of fluid per day, and that (b) it doesn't have to be water - it can be in any liquid form:

Experiment 1: They showed two people - one who drank 2 litres of water and one who drank 4 litres of water in a day. The colour of their urine, and hence their hydration levels, were identical. So, in other words - 2 litres is enough.

Experiment 2: They also showed two people who drank 2 litres of fluids in a day. One drank water only, the other drank a mixture of tea, cofee, soft drinks etc. Result? Exactly the same hydration levels in their body!

So, if you are like me, and find drinking water a bit of a bore, my advice to you is to find a range of low calorie (or zero calorie) drinks that you can have instead. I use low sugar Ribena (20 cals per half a litre), fruit tea, black tea and coffee and the occasional Diet Coke.

Ten things about weight loss: Part 7

...and the next lesson to be learned about weight loss:

8. Low fat dairy helps you excrete more fat

The programme rightly said that when we go on a diet, dairy products such as cheese, butter and milk are often the first things we 'give up'. However, this is not necessarily the best move. All of these dairy products contain calcium - vital for the healthy growth and maintenance of our bones, hair and nails, and even more important for middle aged women to avoid osteoporosis in later life.

The calcium in these foods, when it reaches the small intestine, binds to fat molecules that have come from our food and turn this fat into a thick, soap-like substance that cannot be absorbed. Anything that cannot be absorbed into the body is simply removed as a waste product. So, when we eat calcium-rich foods, the calcium means less fat is absorbed and more of it simply gets excreted. This means it does not end up on our hips!

In the programme, a diary farmer called Alex, takes part in an experiment. During one week he eats a diet containing very little dairy food. In week two he includes quite a lot of low fat dairy food in his diet. In both weeks he eats an identical calorie and fat content. Then, his faeces is analysed for fat content. The results showed that in week one, his faeces contained 1.5g fat per 100g of faeces. In week two, the figure was 3.09g/100g. This means that the addition of low fat dairy to the diet resulted in the excretion of twice as much fat - that's all fat that is not being absorbed by the body and being added to our fat stores.

So, low fat dairy is food for weight loss. Example of good food types include low fat creme fraiche, cottage cheese, low fat yoghurt and skimmed milk. Now, I have been a little concerned about the lack of calcium in my diet for some time. Calcium is particularly important for middle-aged women and helps stave off diseases like osteoporosis. To address this in part, I take a calcium supplement every day (in the form of chewable tablets from Boots the Chemists). However, I also try to consume some low fat dairy every day too. Most mornings I have some soya milk with my breakfast cereal. I also have a low fat yoghurt most evenings after my dinner (either Muller Light or Weight Watchers). Most days, however, that is all. I occasionally have some cottage cheese or Philadelphia Light with my lunch and occasionally have a low fat creamed rice.

We shouldn't forget too, that many other foods contain moderate portions of calcium (content in mg per 100g):

Dried skimmed milk - 1277
Whitebait - 860
Cheddar cheese - 810
Sardines - 409
Fresh milk - 120
Tinned salmon - 66
Cabbage - 65
Turnip - 59
Eggs - 56

So, the message seems to be - don't cut out the dairy. Look at it like this - you may not be fond of spiders, but they kill flies that spread diseases........ think of the spider as the dairy (low fat, of course) and the flies as body fat. Dairy is good!

Drinking harder than eating - EUREKA!

On My 22nd, a couple of weeks after my last fill, I posted ("Saliva, tightness, choking and all that jazz") about the weird experience I was having of being able to get food down, but struggling with liquids. I had asked a number of people about this and although I found a few others who had experienced the same, nobody could explain the phenomenon. Logic suggests that liquids should go down much more easily than solid foods - but t'was not the case..... Anyway, today I happened upon a web site called http://www.fillprovider.net/. It has been set up by an anaesthetist Dr. Kai Rabenstein who, on one morning per week, runs a clinic (in the south east of England) providing fills for gastric band patients(at £75 a time). He started the clinic after his wife had a gastric band fitted. The web site includes some really interesting advice and guidance - interesting because it is particularly frank and honest. For example, he says:

"I think it needs to be spelled out clearly that, certainly for the initial weight loss period, perfect restriction sometimes means being so tight that you experience some regurgitation of food, drink and saliva - known as "productive burps" (PBs). Patients who are horrified by this prospect and the consequent need to develop strategies to hide PBs from others in a social context ....... are unlikely to find success with AGB [adjustable gastric band] implantation and should probably choose a different WLS [weight loss surgery] strategy".

I don't know about you, but I find this approach refreshingly honest. So, back to the drinking and eating thing. Dr Rabenstein says:

"Because the oesophagus (the gullet) and the stomach itself are designed by nature to actively advance food "down the line" through a wave of muscular contraction (called peristalsis), patients with AGBs may find that with tight restriction they can still swallow food (which is solid and therefore will be gripped and propelled beyond the band by the peristaltic movement) but not liquid (which is too "elastic" for peristalsis to get a grip on). That means that in case of temporary severe restriction, the need for an emergency defill can sometimes be avoided by eating sodden solid food or semi-solids."

So I wasn't going mad after all!!

Ten things about weight loss: Part 6

The next lesson from the TV programme is that.......

7. The wider the choice the more you eat

Sounds fairly obvious, but in fact, this desire to eat more when offered more choice is actually hot-wired into our brains for sound, evolutionary reasons. Over millenia, it has assisted mankind to survive against the odds. Think about it - early man would have had a moderately varied diet consisting of meat, fish, berries and nuts. Together, these foods provide all the nutrients we need to keep the body going. Those who ate a more limited diet were more vulnerable to disease and malnutrition - as continues to be the case today. So the brain automatially responds to seeing a wide choice of food by sending out 'eat me' signals around the body.

In an experiment, two bowls of sweets were left out for people to pick. The two bowls were actually identical, except for one thing. One bowl contained all-purple sweets and the other contained multi-coloured sweets (they tasted the same, were the same size and shape). In the event, the multi-coloured sweets were eaten much more quickly than the purple ones. We cannot resist choice! This explains why, when we go to a buffet, we tend to eat much more than we really need. In fact, we are likely to eat 30% more when given lots of choice than if we are faced with a more limited range of options.

The lesson from this for weight watchers, is to limit choice - choice is dangerous!! Choice triggers our instincts to try a bit of everything. So, if you want to lose weight - keep it simple!

Ten things about weight loss: Part 5

Here's an interesting thing you never knew about weight loss. In fact, the programme called it "one of the best kept secrets of dieting". It's particularly interesting for us bandits because it goes completely against the grain of everything we have been told about avoiding slider foods.....

6. Soup keeps you feeling fuller for longer

The programme conducted an experiment with two groups of army recruits. They were each given an identical meal, consisting of chicken, rice, vegetables and a glass of water. The calorific value of the meals was absolutely identical, as was the portion size. However, there was one very big difference. While one group ate their meal served in the conventional way - i.e. on a plate, the other group had the entire contents of their meal (and the water) blended in a liquidiser!! So, in effect, the second group ate a large bowl of soup.

The two groups then spent the afternoon undertaking various physical activities. Two hours after eating, each man underwent an ultrasound investigation of his stomach - the ultrasound showed up how much food was still left in the stomach. At this stage, the second group's stomachs were still quite full and distended, while the first group were beginning to get early signals from the brain that they were hungry again. The same experiment was repeated four hours after lunch. On this occasion, the first group's stomachs were completely empty and the men were definitely feeling very hungry again. The stomachs of the second group were, by this time, mainly empty and the men were starting to experience hunger.

So, the experiment showed that soup keeps you feeling full for longeer. But why is this the case? Well, when you have a meal and a glass of water, the liquid temporarily expands the stomach making it feel very full. However, the liquid drains away quite quickly leaving only solid food behind, and the stomach then shrinks back to a fairly small size - so it isn't very full. This means that hunger is felt quite soon after eating. However, when water is blended with food, the total volume of food is much greater. The liquid, in this case, does not drain away very quickly because it is competely mixed in with the solid food and is much thicker. This means the stomach is expanded for quite some time leaving you feeling full for longer.

As I said, this completely goes against the grain of everything we are taught as bandits. For us, the aim is for the small upper stomach - or 'pouch' to remain full for as long as posible, keeping us feeling full. Liquids, even thick soup, drain away fairly quickly into the main stomach whereas dry, solid foods stay in there. However, when we do eat soups or slider foods - they don't just disappear! They pass from our pouches into our main stomach and perform the same function as they would for a non-bandit. Certainly I have experienced an extended full feeling quite some time after eating soup - despite having a band. So I am encouraged by this lesson. As long as our soups are fairly low calorie and not too fatty, then they have the potential to contribute very positively to our weight loss efforts. I very often snack on a low calorie Weight Watcher's mushroom soup when I get home from work and find it staves off hunger competely until I get around to cooking later in the evening. So - soup it up!!

Ten things about weight loss: Part 4

Here's the next installment of the lessons to be learned from the programme about weight loss.

5. Protein staves off hnger pangs

At any one time in the UK, some 10 million people are on a diet! However, what people don't recognise is that some foods are much better than others at staving off hunger and making us feel full for longer. When the stomach is empty, it sends a hormone to the brain and tells the brain that the stomach needs more food. The brain then tells the rest of the body to provide more food. Now, it has been known for some time that proteins keep us feeling fuller for longer. However, until recently, no-one really understood wy this is. In fact, just adding 10% more protein in breakfast cereal can make you feel full for longer.

In the programme, they conducted an experiment with three men who were busy painting the Forth bridge!! Each man was given a comparable breakfast to eat with an identical number of calories. However, man A had a carbohydrate-rich breakfast (he was given more muesli); man B had a fat-rich breakfast (he was given a double cream smoothie and bacon); and man C had a protein-rich breakfast (he had added baked beans and lean ham). Each man was given a pocket computer and asked to rate how hungry they felt - every hour, on the hour - until their next meal. After 4 hours of work they returned their computers and the data was analysed. The results showed that despite only having 10% extra protein, C felt fuller for much longer. This man was also more likely to eat less at lunch time than A or B.

So, why does protein have this effect? Protein releases a hormone called "PYY" that suppresses hunger pangs in the brain. Of all food types, protein triggers more of this hormone than any other food type. So, although it is true to some extent that calories are calories - regardless of where they come from - protein switches off hunger much more effectively than any other type of food.

I posted ages ago about the apparent emphasiss on proteins on some of the American web sites about gastric band surgery. I was curious as to why this was, since they also seem to frown upon carbohydrates in the diet to a degree that is not evident in the UK. I asked around to see if anyone knew why this was and learned that the emphasis on protein was probably aimed at ensuring bandits got enough protein to support the healthy growth of bones, nails, teeth and hair. I had also heard that proteins keep you feeling full for longer but nobody seemed to be shouting this out very loudly. So, I am very interested in this particular lesson because I don't think I do eat enough protein in many of my meals. My provider says our plates should be filled with one quarter protein, one quarter carbs and half veg. However, I bought an American post-gastric banding recipe book where all of the meals in it are primarily protein-based with some veg and fat, and have very little carbohydrate.

I have to work at reducing my carbohydrate intake because many years ago I was a runner, and regularly did carbo-loading before races. My brain is conditioned to think that carbohydrate = energy. In reality, calories are calories - and calories are energy. So energy gained from proteins is just as good as energy obtained from carbs. I need to re-learn this!!

It started with a biscuit......

...and ended with a Chinese takeaway - with a milk chocolate bar and KitKat for dessert. More truthfully, it started with an Ambrosia low fat creamed rice - but I didn't think that would make such a punchy title! To what am I referring? I am referring to my latest in a small string of binges. OK, I have only had about five since I started out with this band but the fact that they are still with me is demonstrable proof, if I needed it, that although my body has changed, my brain is still the same ol' fatty.

Yesterday I managed to wolf down an impressive 2800 calories. It all went wrong from the moment I arrived at work. I had a long meeting to attend between 9.30am and 1pm so made sure I was at work well before 9am, giving me time to cook my Oatso Simple porridge and eat it before the meeting started. The room containing the microwave also doubles as a meeting room and isn't supposed to be booked for meetings before 11am. But someone had broken the rules and was in there with men in suits at 9am - meaning I had nowhere to cook my breakfast. As a back-up I keep a couple of pots of the low fat creamed rice to which I referred earlier. I ate one of those instead, and although it contains a similar number of calories as my porridge would have done, it makes up a much smaller volume. The result is, an hour into my meeting I was starving again.

Everyone else in the meeting was munching their way through the luxury chocolate chip cookies provided with the refreshments - so I joined them. The trouble was, I couldn't stop at a couple - I ended up eating six. Now, they're about 75 calories each so by snacking my way through the morning (450 calories) I had wolfed down nearly half my daily calorie allowance! That made me depressed. So when it came to lunch I was not feeling at my most 'robust'. I had a choice for lunch. Alternative one was to return to my office and fish out my own lunch rom my mini-fridge. It consisted of leftovers from an evening meal a couple of days before. It was a mixture of tuna, chick peas and chopped up tinned mushrooms, together with some chopped cucumber and red onion that I'd added the night before. Now, try to imagine what chick peas, tuna and tinned mushroom actually looks like - they're all the same 'beige' colour! The meal did not look at all appetising, and of course, I'd have to eat it cold - because the microwave was still out of bounds with the men-in-suits meeting. Alternative two was to stay and join the others in the sumptuous lunch that had been provided for us - gorgeous prawn mayonnaise sandwiches, cheese salad wraps, veggie things on sticks and a platter of fresh fruit. It looked good, smelt good - and by god, it tasted good too!!

Around mid-afternoon I was feeling ever so slightly cheesed off with myself because at this early stage in the day I had consumned more than my usual daily intake. Ironically, when a fat-head like me gets 'down' for eating too much - they turn to more food for comfort. So I promptly went out and bought a cheese sandwich, a KitKat and a bar of Dairy Milk - and ate the lot.

I got home from work to find my husband chatting with a couple of relatives who had popped over for the evening. To save me from having to cook for them all just after I'd got home from work, they had very kindly decided to get us all a Chinese takeaway. I ate a very healthy (not!) vegetable chow mein. Well, actually, I ate about half of it - but that half still had more calories in it than I usually eat in more than half a day's food! Later in the evening, still miserable for my over-eating, I sneaked two lots of chocolate from my husband's not-so-secret stash!

Putting all of yesterday behind me, I started out this morning keen to analyse what went wrong? How did I go from being Miss Goody-Goody over the past few weeks, to suddenly having a complete blow-out? Having done the analysis, and discussed it with my better half (including confessing to knowing about his 'secret' chocolate stash), here's what I've decided:

1. At work, keep an alternative breakfast available in the event that the microwave is not available for porridge. On Monday I'm going to take a couple of pre-weighed bags of All-Bran that I can keep in my desk drawer and use in 'emergencies'.

2. When anticipating long meetings, avoid biscuits and other attractions by taking something with me to nibble on - like a cereal bar (Alpen Light cereal bars are only 59 calories).

3. Don't use meal leftovers for lunch (especially not from two days before!) and make sure the lunch I take with me to work is at least as attractive as any lunch that might be offered to me at a meeting. Remember the Healthier Weight doctrine "I am not a waste bin".

4. [This one is already done]. Ask my husband to completely remove his 'secret' chocolate stash from the house. Don't hide it somewhere else - I'll find it. Give it away or throw it away.

The main lesson I have learnt from this experience, though, is that in my head I was a 'fatty', I am still a 'fatty', and I will probably always be a 'fatty'. It's lovely to hear people say nice things about how great I look and how well I have done, but at the end of the day, in my head, I am still exactly where I was six months ago. This doesn't mean the band is doomed to fail - far from it. It does mean, however, that (a) I must not become complacement, and (b) I must keep developing strategies for how to deal with different situations. Strategies that mean I do not have to rely on willpower or strength of character - just on good habits.

I hope this message helps you to think more about developing your own good habits and strategies and also makes you realise that you're not alone in having 'bad' days. Good luck out there!

Ten things about weight loss: Part 3

Here's the next installment in the ten things you never knew about weight loss.....

4. Don't blame your metabolism

This part of the programme focussed on a lady who is overweight, but who seemed unable to lose weight. She explained that she ate a very healthy diet and has an active lifestyle. Despite watching what she eats and claiming not to eat very much, the lady remains overweight and never loses anything. Her explanation for this is that she has a slow metabolism.

I have discussed metabolism on earlier posts following a presentation that I sat through at the Healthier Weight support group. Basal metabolism is basically the number of calories a person needs to maintain their current weight - assuming a completely sedentary lifestyle. In other words, the number of calories (energy) needed to support the body's vital functions (e.g. breathing, heart-beating, digestion etc). The reality is, that heavier people need more energy to maintain their bodily functions, and therefore, obese people are likely to have a higher metabolic rate than thin people - completely contrary to the oft-claimed myth.

So, back to the lady in the programme. She had her metabolic rate accurately measured in the laboratory and it was found to be absolutely normal for a lady of her age and height! I think she was a little embarrassed and perhaps realised that her long believed claim was actually an excuse for not dealing with her weight probem more seriously. However, knowing that her metabolic rate was normal did not solve the problem - she still had to get to the bottom of why she was not losing weight. Michael asked her to keep a detailed food diary over a nine-day period. In the first four days she had to make a video diary at the end of the day. For the last five days she had to keep a written diary - and write things down at the time that she ate them. She was also asked to drink an isotonic drink each day and provide a urine sample. What she wasn't told was that the medical team were testing her urine on a daily basis and were able to tell exactly how many calories she had consumed!!! Talk about Big Brother! For the record, she should have been consuming about 2000 calories a day to maintain her current weight.

At the end of nine days all of this information was assessed. According to her video diary she was consuming about 1100 calories a day. According to her written diary she was consuming about 1400 calories a day. However, what was rather shocking is that the urine analyses demonstrated that she was actually consuming about 3000 calories a day!!!!

The experiment showed that when she recorded her food intake at the end of the day on the video diary, she 'forgot' 60% of her intake. This reduces to 45% when she writes it down as she eats it. This is good evidence that all of us are likely to genuinely forget things that we have eaten if we leave it until the end of the day to record it. How can we forget so much stuff? Well, Michael suggested that a big part of it is forgetting about sauces, dressings and snacks. It may also be that we delude ourselves that we are eating smaller portions than we actually are. I know I am guilty of this unless I religiously weigh everything. Breakfast cereal in particular, is so easy to under-estimate. I also know that my eyes are bigger than my stomach a lot of the time. For example, if I don't weigh my breakfast cereal I am much more inclined to put a huge portion in my bowl - and eat it. Whereas if I weigh it, I have a much smaller portion and yet still feel full when I have eaten it!!

So, the lesson here, is that if I am going through a period when I am not losing weight, rather than blaming it on spurious arguments about metabolism, get serious about accurately assessing what my intake is and deal with it. There is also a lesson to record intake as I eat - not leave it till the end of the day when I will be relying on my memory. And then the lesson that we probably all know already - unless we accurately count calories, we will almost certainly under-estimate intake.

Long term study of gastric banding

Professor Franco Favretti (my surgeon!) has published a paper reporting the results of the most long term study of gastric band patients ever conducted. The study is based on monitoring the outcome of 1791 gastric band patients over a 12-year period. The paper reports on the incidence of post-operative complications, weight loss, remedial surgery and the like. You can access a .pdf file of the full article at the following address: http://www.healthierweight.co.uk/research/gastric-band-articles/study-of-gastric-band-patients-12-years-on/

Here are a few of the findings:

1. Conversion during surgery from keyhole to open surgery was 1.7%.
2. Additional surgery (i.e. during the banding procedure) was performed in 11.9% of cases (including 2.4% hiatus hernias and 7.8% cholecystectomy*).
3. Post-operative surgery was performed in 5.9% of cases (including 3.7% band removal and 2.7% band re-positioning).
4. Port-related complications occurred in 11.9% of cases.
5. There were no mortalities.
6. The average % excess weight loss (%EWL) over a ten period lies between 35 and 40% (depending on how obese the people were to start with).
7. Life expectancy is increased by 60% on average, compared with obese people who did not have LAGB surgery.

*Removal of the gall bladder

The study concludes that "the LAGB is safe and effective for the treatment of both morbidly obese and superobese patients in the short, medium and long term. In experienced hands, the complication rate is low and stable weight loss to at least 12 years has occurred" (Favretti et al 2007).

The full reference for the article is:
Favretti, F., Segato, G., Ashton, D., Busetto, L., De Luca, M., Mazza, M., Ceoloni, A., Banzato, O., Calo, E. and Enzi, G. 2007. Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results. Obesity Surgery 17, 168-175.

None of this surprises me, except one thing - number 6 above. I was told that the average % excess weight loss was between 55 and 60%. I have certainly seen other articles where these figures have been reported. Personally, I have never been satisfied with the thought of less than 10% excess weight loss - only 35-40% would still leave morbidly obese. Better than nothing, I suppose, but still very disappointing. This study only reports the findings for morbidly and super-obese people - so I supose it is possible that the results could be better for obese people (morbidly obese is BMI more than 40). However, super-obese people appear to do better in this study than morbidly obese people - so this seems unlikely.

What is also suprising is that the average %EWL is actually 38.5 +/- 27.9. What this means is that there is enormous variation between the cases studied and that while some people actually do considerably better than this, others do much worse. Looking at these figures, some people, after TEN YEARS, only lose about 10% of their excess weight!!! So, if you started out at say 20 stone and you were 10 stone overweight - you would only have lost one stone over ten years.

One of the authors is my consultant - Dr David Ashton. I will ask him about these figures when I see him next and report back!!! ....or I might even drop him an email!

On the plus side, LAGB increases life expectancy and considerably reduces the incidence of a wide range of obesity-related diseases such as diabetes. So it's not all bad by any means. I certainly have no regrets!

Weight Loss Ticker

You will notice that I have added my weight loss 'ticker' at the top of the page. It struck me that it would be a good way to keep you informed about my general progress. I've added a link to the Ticker Factory web site in the useful links at the side (and to the title of this post) so that you can set up your own if you wish. You can set it up to record your weight loss, your waistline measurement and your BMI. It also maintains a chart so you can see your own progress over the course of time. In fact, if you click on the Ticker Factory logo it takes you to a page where you can see my chart!

Ten things about weight loss: Part 2

Here are the next couple of gems from the programme (see yesterday's post):

2. Use smaller plates

Michael is about five pounds overweight (lucky man!!). He aims to lose this over the next few months and more importantly, to keep it off. He is looking for a 'diet' that works, or some principles by which he can improve his diet in general. The first tip he discovers is that we should eat off smaller plates. He cites the example of an experiment whereby a group of cinema-goers were each given a tub of popcorn. One group were given a large tub and the other group a small tub. The group that were given the small tub generally did not eat all of the popcorn. The group who were given the large tub also left some of theirs - but of course they had much more to start with - so they ate a great deal more. The moral of this tale is that if more food is available - we will eat it - even if we are not hungry!! A simple solution for meals then, is to use a smaller plate. Michael suggests that if we simply reduce our plate size from 12 inches down to 10 inches, we will typically consume 22% less food.

I wonder how much less food I eat because I switched from 12 inch plates down to 7 inch side plates!! I was so determined to get this rule right, right from the beginning, that even before I started the pre-op diet I went out and bought myself four really nice, quite expensive side pates. I thought I would get plates that were distinctive and 'special' - so I don't feel like I am getting a second class meal - but dining like a king off my 'special' plates!! I don't know how the psychology works, but it does!!

There's a saying about work - that work fills the time and space made available for it. In other words, if we work for twelve hours a day, you can bet we will find enough work to do - just as if we worked eight hours a day. I think it's pretty much the same with food - your stomach generally accommodates whatever it is filled with - regardless of whether it actually needs it. This is one of the bad habits that us bandits have to wean ourselves off. But I do find it hard sometimes, just forcing myself to stop and think about whether I am actually hungry, or whether it's just the old 'head hunger' in action!

3. Count your calories

It sounds fairly obvious but the next lesson is to count calories. The downside of not doing this was shown very clearly in the programme when Michael was asked to guess the calorie content of six different foods. The food items were:

A large bowl of fruit salad
Some chocolate
A medium size pork pie
A chicken dinner with potatoes and cabbage
A muffin
A sandwich (it was not clear what kind of filling was used)

He struggled to guess their respective calorie contents and then discovered that they were, in fact, all exactly the same - at 300 calories!!

There are three important lessons here:
a) Even when we think we know how many calories something contains, we are often wrong. The only sure way to be accurate is to use a reliable calorie counting book and weigh food (or rely on what it says on packaging in the case of prepared foods).
b) The volume of food is no guide to its calorie content. Who would have thought that a decent sized chicken dinner would have the same calories as a measly pork pie?!
c) Apparently healthy foods still contain calories (sometimes a lot) - and if you eat large portions of them (like the large bowl of fruit salad) you will be ratcheting up your daily calorie count - just as if you were 'naughty' and ate a muffin!

Michael suggests that we therefore put a great deal more thought into what we eat. It's relatively easy to exchange high calorie foods for comparable voumes of low calorie foods - thus keeping us feeling full but for many less calories. I know about this because a few years ago I went on a low fat (of my own design). I lost four stones. Obviously, I put it all back on again (!), but in terms of the diet itself it was 'successful'. I say this because I was never hungry. Why? Because I made quite large meals but packed them out with low calorie 'bulking' foods. For instance, I would make myself a veggie stir fry and add loads of chunks of marrow and mushrooms - which are both very low in calories. So I was eating quite large portions which were filling me up, but with only a fraction of the calorie content of a much richer, high fat meal.

Michael suggested some examples of where calories could be 'saved' in a relatively easy way: Having a piece of toast for breakfast instead of a pastry; a chicken dinner without any sauces or dressings; a thin based veggie pizza instead of a thick based pepperoni; and sugar-free versions of drinks instead of sugar-laden drinks (like smoothies).