View Full Version : Weight loss surgery
Maybe this isn't the best place to ask this but hey, nothing ventured nothing gained right?
Has anyone here ever had any kind of weight loss surgery? Maybe a family member?
I am giving it some strong consideration after a number of other attempts at losing weight have failed. Frankly I am at the worst shape I have ever been in my life and am almost to the point of desperation here. So I am giving this some serious consideration.
Do what you can to lose it healthy and properly. Consult your doc and have a real man to man with him. Everybody goes through this. Life happens. I was waif then, then toned, then looked like a pro wrestler, then a Falcons lineman, now I look like Stan from American Dad. Was in real good shape but age and Pibb and Mexican food got to me.
Stress plays a lot. The Fitness forum people helped me here and there with some injury questions.
You're not alone. Try to do it natural if possible.
Good luck. You only quit when you give up.
I have not had anything done but know people who have. The fact is you are going to have to change your diet, there is no other way around it. If you get lap band or gastric sleeve then you will be forced to change your diet in an extreme way so why not keep trying to lose it naturally. I, my wife and mother-in-law got healthier using Advocare products and following their meal plans.
https://www.advocare.com/24daychallenge/VirtualCoach/mealPlanning.aspx
I say healthier because even though the girls lost weight I actually gained 10lbs but it was all muscle(because I worked out as well as dieted). The appetite control vitamins helped me not snack all day but the high protein, low carb diet itself makes the biggest difference.
Maybe start slow so you don't let yourself down taking on everything at once. Try only drinking water from now on, then after that is no longer difficult to do move on to no eating after 7pm or switch out sugary snacks with a piece of celery or a carrot. A single change is not as hard as a whole lifestyle change and small victories can add up to big weight loss over time.
Best of luck to you. It gets easier when you get into the swing of it.
First, consult an expert who can help you manage with diet and exercise. I mean, like someone who can tailor your diet and exercise, not a cookie-cutter one-size-fits-all approach. After you have exhausted all non-surgical options, then look for a surgical option. Take a look at this website for more info:
https://asmbs.org/
Just know, bariatric surgery is not a cure-all nor panacea; their are a lot of potential side effects and bad things that can happen.
I have just started working with a legit trainer and it has made a world of difference. He did exactly what Chuckman describes. I had to provide him with health history and the whole bit. He set up a meal plan and workout plan designed just for me. It is working. I have been able to loose weight at will to a point and then I hit a wall. I am four weeks in on this plan and blew through the wall this past week. I feel better than I have in years and am also feel like I am getting stronger every time I go to the gym. I would give it a serious go before considering surgery. You are going to have a meal plan for that too and I would bet it is not nearly as satisfying as what I am eating now.
Maybe this isn't the best place to ask this but hey, nothing ventured nothing gained right?
Has anyone here ever had any kind of weight loss surgery? Maybe a family member?
I am giving it some strong consideration after a number of other attempts at losing weight have failed. Frankly I am at the worst shape I have ever been in my life and am almost to the point of desperation here. So I am giving this some serious consideration.
Member here, Hmac, does that for living. He'll be the guy to ask.
OP, no one in my family but there's a co-worker of my wife at her hospital who had the Gastric Sleeve surgery. Done by some Doctor in Henderson/Las Vegas, Nevada. This was done @ a year ago. So far he has lost about 85 lbs. It seems the weight loss happens rather steadily over months but then starts to slow down. You're also drinking a lot of protein drinks from what I have been told.
In addition to the smaller stomach (which they call a pouch), there are some other changes that take place. This guy was a Coca Cola drinker, and now he has no taste for it. He tells my wife it taste bad to him. Other foods just don't taste the same, but others are just fine. Some kind of bio chemical change as well. If you start to "fall off the wagon" and eat more, you have to do something called a pouch "reset", where you start slowing down food intake again.
I never had any kind of weight problem until I hit my 40s. I'm 6 ft 2 and about 230. I feel much better when I am around 200 to 205. If I want to drop the pounds, it's a combo of more activity and fewer Hostess Ding Dongs. Little Debbie also has my interest from time to time:
"Whenever you get snack hungry, Little Debbie has a snack for you"®
My sister had the surgery. It's the one where they take out a portion of the stomach.....or something. She did it after years of trying different things. She never ate bad. No fast food no sodas, had a job where she was constantly moving but she was always fat and couldn't get rid of it.
The surgery itself was fast. Only an hour or so. She was home the next day. Recouping wasn't easy. Hard to keep anything down, no desire to eat but you had to put X amount of nutrients in the body in X amount of times a day. Mostly liquid with some soft food. I think she was home for something like 2-3 weeks.
This was about 1.5 years ago. Today she has lost A LOT of weight but she forever cannot eat certain foods. Nothing carbonated with the exception of a little wine. No beer, no soda.....the gas expands the stomach and makes it hurt. Nothing too fatty/greasy. That too gives stomach problems and a nausea feeling. Her stomach has adapted and expanded a little to accommodate more food than originally and the doc said this would happen but since it's still small she has to always make sure she's getting ALL variety of food to compensate for less space and less nutrients. A little salad and a little meat. Vegetables, fruit...etc.. All has to be accounted for and you have to make sure to eat enough fiber. She used to measure it all out but now she knows what and how much.
Some side effects are heartburn and occasional constipation. Even though she now eats lots of fiber she'll still have constipation from time to time. She fills up fast. Often leaving food on the plate because you can't really shovel more in. Normal stomachs can still expand to where we feel like we overate, hers not so much. If she doesn't stop it will cause hours of pain.
For the most part she's gotten the hang of it. Learned what, when and how and lives a normal life, goes out to restaurants with friends, eats normal food... etc.....etc. Just have to realize there are limits to how you will eat
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platoonDaddy
04-25-17, 08:18
I personally know 5 who had the surgery, one even had the tuck surgery.
Everyone single one of them wiitin 3-4 years are heavier than they started. They all returned to their previous eating habits
Very sad
Weight loss surgery is an excellent option for those who are unable to volitionally sustain the lifestyle change necessary to achieve and sustain a healthy weight, which is about 94% of the population. It's important to emphasize that it won't make you lose weight...it will help you to effect a lifestyle change, diet/exercise, and that is what makes you lose weight. The biggest mistake you can make would be to go into such an adventure with the thought that all you have to do is have the surgery and you will automatically lose the weight and keep it off. It doesn't work that way.
The place to start is to find a Bariatric program in your area. You do not need a referral or the blessing of your doctor. Be sure that the program and the surgeons are accredited by MBSAQIP. Give them a call and find out when they are having their next public informational seminar and go to that...it will be an overview of the disease, the operations, the potential complications, and their program. The program is subsequently designed around your health problems, if any, as well as your expectations and your insurance company's requirements. It can be a long process. Be very careful about the centers you might see that advertise outpatient sleeve gastrectomy and definitely stay away from the Lap Band. Call your insurance company and ask them if your policy has benefits covering weight loss surgery. They'll likely tell you that that determination is make when pre-authorization is requested, but you tell them that you only want to be sure that your policy doesn't specifically exclude it.
Weight loss surgery is a great choice for many people, a bad choice for some. A good Bariatric program will help you to make sure which category you fall into. It can truly be a life changer. Bariatric surgery is only about 20% of what I do, but it the most gratifying part of my job.
Good luck. Feel free to PM me anytime. Send me your location and I can advise you on surgeons and programs close to you.
Weight loss surgery is an excellent option for those who are unable to volitionally sustain the lifestyle change necessary to achieve and sustain a healthy weight, which is about 94% of the population. It's important to emphasize that it won't make you lose weight...it will help you to effect a lifestyle change, diet/exercise, and that is what makes you lose weight. The biggest mistake you can make would be to go into such an adventure with the thought that all you have to do is have the surgery and you will automatically lose the weight and keep it off. It doesn't work that way.
The place to start is to find a Bariatric program in your area. You do not need a referral or the blessing of your doctor. Be sure that the program and the surgeons are accredited by MBSAQIP. Give them a call and find out when they are having their next public informational seminar and go to that...it will be an overview of the disease, the operations, the potential complications, and their program. The program is subsequently designed around your health problems, if any, as well as your expectations and your insurance company's requirements. It can be a long process. Be very careful about the centers you might see that advertise outpatient sleeve gastrectomy and definitely stay away from the Lap Band. Call your insurance company and ask them if your policy has benefits covering weight loss surgery. They'll likely tell you that that determination is make when pre-authorization is requested, but you tell them that you only want to be sure that your policy doesn't specifically exclude it.
Weight loss surgery is a great choice for many people, a bad choice for some. A good Bariatric program will help you to make sure which category you fall into. It can truly be a life changer. Bariatric surgery is only about 20% of what I do, but it the most gratifying part of my job.
Good luck. Feel free to PM me anytime. Send me your location and I can advise you on surgeons and programs close to you.
I provided the OP a link to ASMBS, thought he may find it helpful WRT a provider in his area. You may have more gouge that would supersede that info.
I provided the OP a link to ASMBS, thought he may find it helpful WRT a provider in his area. You may have more gouge that would supersede that info.
The ASMBS website is an excellent place to start. https://asmbs.org/patients
Most competent weight loss surgery programs will always start with nutritional counseling and a medical weight loss trial, and the vast majority of insurance companies will require it too, usually anywhere from 3 months to a year depending on the company's policies. There are no accredited programs where you would see the surgeon and schedule the operation, even if you are self-pay. Unless you decide to have it done in Mexico. Then, anything goes.
SomeOtherGuy
04-25-17, 10:29
Two things:
1) Be sure you've really tried all other options, and look at nutrition broadly. I know many people who've made big, positive changes by changing their diet. It's not always just eating less either. For many people the low-carb diet, or the somewhat similar paleo diet, works great. I have a strong suspicion that deficiency of key minerals is making a lot of people fat - let me first say I'm not a doctor, so ask a doctor or do your own research - but it's very difficult to get recommended amounts of iodine and magnesium in a US diet, even a "healthy" one, and supplementing those is easy, cheap, and low risk. I found that my appetite and weight both decreased just by taking the RDA of iodine on a daily basis. YMMV. If you haven't already had blood work to look at your thyroid function, hormonal levels, and possible unknown allergies, you should. If your doctor isn't interested, find another one who's willing to look. The testing cost is in the $500 range, likely covered by insurance, and may be illuminating.
2) If you decide to go the bariatric route, research - research - RESEARCH the surgeon and program you are considering. In my job I get to see the med mal losses for a huge number of physicians and hospitals, and I can tell you that (a) bariatric in general is a high-risk field, and (b) there are very wide ranges of difference in the medical results of different bariatric surgeons. Hmac would be the expert here but I imagine he won't want to be too detailed, at least publicly, given the likelihood of stirring the politics within that specialty. You should be able to find useful information with diligent research. If all else fails, I would focus on the leading academic medical centers (just for example, Mayo Clinic, Cleveland Clinic, and U of Michigan - but without knowing anything specific to their bariatric programs or experience).
So what have you been doing/trying that hasn't worked for you? Both for diet and exercise. What exactly are your goals? I know it can seem like you've tried everything, but maybe you just haven't dialed it in completely to see results.
I would also recommend to look at a full hormone panel to get a better idea of what is potentially causing this underneath the surface. Just my opinion, but I'd look to surgery as an absolute last resort.
ramairthree
04-25-17, 13:46
If you cannot on your own change your eating habits to lose weight,
And are seriously considering surgery to force you to change your eatings,
Take a serious look at yourself and any issues.
Long and hard.
Do you really need surgery to change your eating?
Do you really need surgery to change your eating?
The answer to that question for the overwhelming majority of the US obese population is "yes".
I should mention to the OP that weight loss surgery wouldn't be contemplated in someone whose body mass index is less than 35. And if it's less than 40, wouldn't be contemplated unless there are significant co-morbidities such as diabetes, sleep apnea, degenerative joint disease, high blood pressure, hypercholesterolemia, or cardiovascular disease. BMI calculator (https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm)
Thanks for the input everyone. I am extremely unsure on what course of action to take next so all the input is greatly appreciated. Except for that Hmac guy. He sounds like a guy who doesn't know what he is talking about. :jester:
A bit of background. Up until my mid to late 20s I was extremely active. Sports, martial arts, similar activities. I stayed in good shape even when my weight fluctuated up and down. Tore up the muscles in my back in my late 20s and that put a big slowdown on things. Add to that just having to adult and things slowly started sliding backwards but not to an irreversible point. I was still active in some things from shooting to trying to do some biking.
But then a couple years ago my life hit rock bottom. I posted about it on here one day when it got to be too bad. Depression kicked my ass and I shut down for a long while. Things are better now. I am happy with my life. But at this point I put on a LOT of weight. I now find myself 38 years old. 6 foot tall and 365lbs. obviously this is un****ingacceptable
Perhaps I am making excuses. However to give you an idea of my lifestyle. I work on average about 60 hours a week as a real estate broker including weekend. On top of that I spend a good bit of the rest of my time helping my parents out. Mind you I am not complaining. I love what I do, and I am always more than happy to help my parents. They deserve all I can do and more. My point is that it is hard to find the time to work out, and often my meals are comprised of no breakfast, maybe a quick bite for lunch, and a large dinner late at night because that is all I have time for. And the Gym? Yeah. If I could find more than 15 minutes of uninterrupted time I would love too...
SomeOtherGuy
04-25-17, 14:39
Perhaps I am making excuses. However to give you an idea of my lifestyle. I work on average about 60 hours a week as a real estate broker including weekend. On top of that I spend a good bit of the rest of my time helping my parents out. Mind you I am not complaining. I love what I do, and I am always more than happy to help my parents. They deserve all I can do and more. My point is that it is hard to find the time to work out, and often my meals are comprised of no breakfast, maybe a quick bite for lunch, and a large dinner late at night because that is all I have time for. And the Gym? Yeah. If I could find more than 15 minutes of uninterrupted time I would love too...
Trying to help here not be a jerk - but - your lifestyle and eating habits are the problem. Having bariatric surgery would force you to change them, with the possibility of putting your life in greater danger if you don't. Figuring out how to change your habits without surgery will get you to the same (or better) result with a lot less pain and money. Workout time would help but is not as important as the daily schedule and eating routine.
I guarantee that your body chemistry is messed up at your weight. And I'll bet you got the weight partly because your body chemistry wasn't perfect 5-10 years ago, combined with that lifestyle and the normal slowdown/spread in your 30's.
I would encourage you to seek a medically-supervised weight loss program, but table the idea of surgery for a while. Try the lifestyle changes that surgery would force you to make, before getting any surgery.
Your BMI is 49.5. By conventional calculations you are about 150 lbs overweight and fall into the category of Morbidly Obese (medical terminology...please don't take it as pejorative). The stakes are high for you. Weight loss, significant weight loss by whatever means works best for you, is very important, especially as you move into the age range where Type II diabetes and the other such co-morbidities begin to assert themselves and subsequently begin to shorten your lifespan and increasingly interfere with the quality of that lifespan.
If you can lose the weight by diet, exercise, lifestyle change then that's definitely the way to do it and every competent bariatric program will start with that approach - you should definitely try to do it that way. But...the odds are vastly against you. Success is clinically determined by you being able to lose 1/2 of your excess body weight (75 lbs) and keep it off for 2 years. Statistically overall, the success rate in the US is about 6%.
n
Your BMI is 49.5. By conventional calculations you are about 150 lbs overweight and fall into the category of Morbidly Obese (medical terminology...please don't take it as pejorative). The stakes are high for you. Weight loss, significant weight loss by whatever means works best for you, is very important, especially as you move into the age range where Type II diabetes and the other such co-morbidities begin to assert themselves and subsequently begin to shorten your lifespan and increasingly interfere with the quality of that lifespan.
If you can lose the weight by diet, exercise, lifestyle change then that's definitely the way to do it and every competent bariatric program will start with that approach - you should definitely try to do it that way. But...the odds are vastly against you. Success is clinically determined by you being able to lose 1/2 of your excess body weight (75 lbs) and keep it off for 2 years. Statistically overall, the success rate in the US is about 6%.
n
Keeping it off is always the hardest part. And it's the hardest part because a lot of times, people aren't taught anything when they go on weight loss programs. They don't learn about food, what calories or macros even mean, how they work for the body, and especially what a balanced diet looks like. Instead they are put on some fad diet that is usually very restrictive and that's what causes the weight loss...and in the meantime, crashes their metabolism and leaves them in a primed state for weight regain.
In Kwelz's case, I would guess that his body chemistry is way off (as mentioned earlier) and hes probably not eating enough (assumed from his description of his eating habits) to sustain a healthy metabolism. Lean body mass is probably very low as well...which again hurts overall health and metabolism.
Kwelz, just going by your description of your day to day, the hard truth is that your lifestyle habits are what got you here. Surgery won't fix that. Getting the proper nutrition and exercise, over the next several years (remember, this didn't happen overnight and it won't reverse overnight either) is what you should focus on first. Get your health in order before this turns into chronic illness.
Kwelz, just going by your description of your day to day, the hard truth is that your lifestyle habits are what got you here. Surgery won't fix that. Getting the proper nutrition and exercise, over the next several years (remember, this didn't happen overnight and it won't reverse overnight either) is what you should focus on first. Get your health in order before this turns into chronic illness.
Completely agree with all of this except for the assertion that surgery won't fix that. The primary value of weight loss surgery is as an adjunct tool to achieving and sustaining a lifestyle that will in turn sustain a healthy weight range. Without that tool, a morbidly obese person's chance of success at that is dismal. It can be done, and Kwelz should definitely try, it's just rare that it's successful.
Outlander Systems
04-25-17, 17:26
Cut the bullshit.
Snort this:
http://www.thenuwavefitness.com/wp-content/uploads/2012/05/cellucor-c4-extreme1.jpg
All lethargy will wash away from you in an awesome wave.
*Guaranteed to have cleaner carpets or your money back.
Cut the bullshit.
Snort this:
http://www.thenuwavefitness.com/wp-content/uploads/2012/05/cellucor-c4-extreme1.jpg
All lethargy will wash away from you in an awesome wave.
*Guaranteed to have cleaner carpets or your money back.
"The Weight Loss Product that Bariatric Surgeons Don't Want You To Know About"
Is it the NO3, or the Fruit Punch that makes it explosive? Whichever, it doesn't sound like a clear path to cleaner carpets.
Cut the bullshit.
Snort this:
http://www.thenuwavefitness.com/wp-content/uploads/2012/05/cellucor-c4-extreme1.jpg
All lethargy will wash away from you in an awesome wave.
*Guaranteed to have cleaner carpets or your money back.
Or you can quit ****ing around and do it right.
45301
Outlander Systems
04-25-17, 17:35
LOL
It's the "proprietary blend of products the FDA hasn't restricted yet," which give it that extra kick.
I've never snorted C4, but I'm EXTREMELY caffeine sensitive, so I'm pretty sure if I did, you sumbitches would see my corpse on the news.
Conspiracy theorists would pontificate that Xenomorphs were real, because, "that guy whose torso burst."
"The Weight Loss Product that Bariatric Surgeons Don't Want You To Know About"
Is it the NO3, or the Fruit Punch that makes it explosive? Whichever, it doesn't sound like a clear path to cleaner carpets.
Outlander Systems
04-25-17, 17:37
https://youtu.be/lmTr5qCCW3A
Or you can quit ****ing around and do it right.
45301
Outlander Systems
04-25-17, 17:44
Gummiberry Juice:
If I workout will I die?
.
..
...
If I DON'T workout will I die?
Activity, activity, activity. I read your post and realize that spare time is scarce, but weight control is an equation: input vs output = your weight. Perhaps a bit oversimplified, but it is time-tested. Make the time each morning, at the ass-crack of dawn, to do some form of cardio. At your weight I'd start with simply brisk walking, but be consistent and don't miss. If you've got the cash buy some decent cardio equipment. I find cardio much more palatable in the early morning and weights later in the day, but that's just me. A good mix, every day, of either cardio or weights will start the process. Then begin to eat sensibly.
It is important to remember that you didn't put the weight on in six months, so it won't go away in six months. It is a lifetime commitment.
As Hmac alluded to, your health is in a very precarious position right now. Whatever you do, do it soon.
skywalkrNCSU
04-26-17, 09:30
Exercise is important but it's nowhere close to as important as dialing in your diet. Learn about nutrition in a non-fad diet way, understand how important the different macros are, understand how to track your calories and macros, then put it into practice.
I wasn't as big as you were but a few years back I successfully dieted down from 245 to 190 and it was all from tracking what I ate and making sure I stayed within my limits. I didn't go off the deep end if I messed up one meal, I just got back on track the next and it helped me develop a much healthier outlook on dieting in general. Now that I have built that basic understanding of how much I'm eating and how much I need to eat I don't even track anymore unless I am making a specific effort to gain/lose weight and I generally stay where I want to stay. I did lift weights during all of this because I enjoy it but it's definitely not necessary to losing weight (though it will obviously help).
I'm sure some of these guys here are more knowledgeable than me on the subject but I am willing to point you in the right direction for some solid advice and reading that can help you if you want. It all comes down to you in the end though. Can you make yourself have the discipline to make this work? If so it's just a matter of knowing what you need to know and doing it.
Exercise is important but it's nowhere close to as important as dialing in your diet.
Yes. As long as you can eat more calories in 5 minutes than you can burn in an hour on the treadmill, appropriate nutrition is the major component of a morbidly obese person's lifestyle that has to be modified. It's also by far the hardest to sustain. Excercise is an important adjunct, not so much to help the weight loss as much as to minimize the potential for regain.
There are a lot of benefits to a good exercise regimen. Weight loss is pretty low on that list.
Yes. As long as you can eat more calories in 5 minutes than you can burn in an hour on the treadmill, appropriate nutrition is the major component of a morbidly obese person's lifestyle that has to be modified. It's also by far the hardest to sustain. Excercise is an important adjunct, not so much to help the weight loss as much as to minimize the potential for regain.
There are a lot of benefits to a good exercise regimen. Weight loss is pretty low on that list.
You've done the gastric bypass surgeries, which will no doubt reduce weight......but it is surgically induced weight loss by means of restricting caloric intake. For the morbidly obese it may be the only choice where time is-a-tickin' on one's health.
That said, how many obese individuals who have not had GB surgery have you seen lose weight through dieting alone? I'm sure there are some, but the vast majority who succeed at it (and keep it off as you mentioned) do it through a combined exercise/diet regimen. Sure, you can do the Adkins thing and watch your weight drop, but as soon as you throttle back on it---without exercise as an integral part---you will pack it right back on.
I'm sure you follow your patients post-op, so I will wager that even GB surgery weight-loss can be enhanced by increased physical activity, no? In other words your patients who have the surgery and also begin an exercise regimen no doubt lose more weight faster and tend to keep it off more consistently.
As I grew up I watched my parents try every diet known to man it seemed like at the time (late 70's-mid-80's). They never lost any significant weight. Why? They were lazy and wanted to do it the diet-only way. Granted, they weren't 365lbs, but they were chunky for sure.
My personal opinion is that a good, healthy diet plan coupled with exercise will drop the weight (morbidly obese, health-threatening conditions excepted). Both components will be necessary to keep it off also.
My personal opinion is that a good, healthy diet plan coupled with exercise will drop the weight (morbidly obese, health-threatening conditions excepted). Both components will be necessary to keep it off also.
You can lose weight without exercise. You cannot lose weight without modifying the diet. You are correct, both are essential for optimal health and have the higher probability of keeping weight off.
Outlander Systems
04-26-17, 10:17
The human body was literally made for sprinting across the Savannah, throwing spears, and drinking blood from skulls.
When I see 60% disabled vets that can run circles around normal folks, some soul-searching is in order.
FACT: If food is, "Yummylicious" it's probably bad for you.
FACT: Contrary to what the ****ing food pyramid says, human beings aren't meant to be eating refined sugars, dairy, refined grains, or hydrogenated ANYTHING.
FACT: "Food" is a business, and what passes as the majority of "food" today is empty-calorie laden junkshit.
FACT: Walking is good for you.
FACT: This thread makes me want to jump more rope, and lift more weights.
You've done the gastric bypass surgeries, which will no doubt reduce weight......but it is surgically induced weight loss by means of restricting caloric intake. For the morbidly obese it may be the only choice where time is-a-tickin' on one's health.
That said, how many obese individuals who have not had GB surgery have you seen lose weight through dieting alone? I'm sure there are some, but the vast majority who succeed at it (and keep it off as you mentioned) do it through a combined exercise/diet regimen. Sure, you can do the Adkins thing and watch your weight drop, but as soon as you throttle back on it---without exercise as an integral part---you will pack it right back on.
I'm sure you follow your patients post-op, so I will wager that even GB surgery weight-loss can be enhanced by increased physical activity, no? In other words your patients who have the surgery and also begin an exercise regimen no doubt lose more weight faster and tend to keep it off more consistently.
As I grew up I watched my parents try every diet known to man it seemed like at the time (late 70's-mid-80's). They never lost any significant weight. Why? They were lazy and wanted to do it the diet-only way. Granted, they weren't 365lbs, but they were chunky for sure.
My personal opinion is that a good, healthy diet plan coupled with exercise will drop the weight (morbidly obese, health-threatening conditions excepted). Both components will be necessary to keep it off also.
You can lose weight without exercise. TRUE You cannot lose weight without modifying the diet. ALSO TRUE You are correct, both are essential for optimal health and have the higher probability of keeping weight off.
You can also accelerate the weight loss by adding in exercise to the diet modification.
I will add this: say someone is 240lbs and sedentary. They could probably lose 10 or 15 pounds over time by beginning to exercise on a regular basis without modifying their diet much. However, they won't keep losing weight without diet modification. This of course isn't applicable to the morbidly obese, except that 10 or 15 pounds I mentioned (and only maybe at that).
Completely agree with all of this except for the assertion that surgery won't fix that. The primary value of weight loss surgery is as an adjunct tool to achieving and sustaining a lifestyle that will in turn sustain a healthy weight range. Without that tool, a morbidly obese person's chance of success at that is dismal. It can be done, and Kwelz should definitely try, it's just rare that it's successful.
Hmac,
I certainly respect what you do and you are obviously the expert in that field for this conversation. My understanding of typical bariatric surgery is that it effectively reduces the volume of food you can eat, which in theory, should help to facilitate weight loss.
But metabolism doesn't always work that way. In some cases restricting calories, either by diet or lifestyle, over time, can create a slowdown of metabolic rate. Combine that with stress and hormones being out of the normal range, and you have set the stage for massive weight gain. I use this example because it doesn't seem to me (and I could be wrong) that Kwelz is over eating to a point of needing a restriction in calories....although I'm sure his diet could be optimized and much better balanced.
So what happens if Kwelz (or anyone else in this particular situation) gets the surgery, and also makes other lifestyle choices such as more exercise with an emphasis on building back lean muscle mass? How would they be able to eat enough calories to support the higher daily energy expenditure AND build that lean mass? How would they be able to support a growing and improving metabolism?
In my opinion, and with my current understanding, surgery won't allow for the same level of growth/improvement, both metabolically and body composition, as would learning and executing a solid nutrition and exercise plan over the long-term.
Please take this as a discussion and not an attack on your profession. There may be, and probably are, some things that I don't know that I don't know, so I'm interested to hear your viewpoints.
You can lose weight without exercise. You cannot lose weight without modifying the diet. You are correct, both are essential for optimal health and have the higher probability of keeping weight off.
Here's my take on it: you CAN lose weight without exercise. But you cannot change your body composition without exercise. Exercise, specifically resistance training, will make the most significant change due to an increase in lean body mass. You can have two people that weigh the same as each other, but the one with the most lean mass will not only look better but be healthier in the long run.
Hmac,
I certainly respect what you do and you are obviously the expert in that field for this conversation. My understanding of typical bariatric surgery is that it effectively reduces the volume of food you can eat, which in theory, should help to facilitate weight loss.
But metabolism doesn't always work that way. In some cases restricting calories, either by diet or lifestyle, over time, can create a slowdown of metabolic rate. Combine that with stress and hormones being out of the normal range, and you have set the stage for massive weight gain. I use this example because it doesn't seem to me (and I could be wrong) that Kwelz is over eating to a point of needing a restriction in calories....although I'm sure his diet could be optimized and much better balanced.
So what happens if Kwelz (or anyone else in this particular situation) gets the surgery, and also makes other lifestyle choices such as more exercise with an emphasis on building back lean muscle mass? How would they be able to eat enough calories to support the higher daily energy expenditure AND build that lean mass? How would they be able to support a growing and improving metabolism?
In my opinion, and with my current understanding, surgery won't allow for the same level of growth/improvement, both metabolically and body composition, as would learning and executing a solid nutrition and exercise plan over the long-term.
Please take this as a discussion and not an attack on your profession. There may be, and probably are, some things that I don't know that I don't know, so I'm interested to hear your viewpoints.
Not to speak for Hmac, as bariatric surgery is his AO, but I believe he is referring to the morbidly obese whose health is threatened to a degree that perhaps they don't have 2 years (or more) to progressively drop the weight through what you are suggesting. i.e. they could die before they accomplished that goal.
[This is NOT meant to be critical of the OP] Probably the biggest thing folks have to remember is to not allow oneself to get that way in the first place. It is easy to have an epiphany at 365lbs, but it didn't happen overnight. If you see yourself gaining weight then do something about it. If you had an adverse health event (surgery, sickness, etc.) then pay much more attention to what you consume as your ability to exercise may be non-existent until you heal. When I had my prostate removed I couldn't touch a weight for 6 weeks. Fortunately I could resume doing cardio stuff as soon as the catheter came out (10 days) and did so every day since I couldn't lift. In those first 10 days of inactivity I restricted my caloric intake; I still ate, but I just ate less. I did not gain any weight, in fact I actually dropped a few pounds.
Hey their OP - I've been on a yoyo for the last several years - restrictive diets, primarily Atkins, and exercise. Several months ago I addressed the issue with my doctor during a routine visit. It just so happened that I had a can of Diet Pepsi with me in the exam room.
He asked me 'how much of that do you drink a day?' 'about a 12 pack' 'way to much Dr. Oz (said with a laugh) says that causes dementia' laughs over and a serious discussion ensued. One of the problems he pointed out to me was that my eating habits were like yours, no breakfast, generally get involved with stuff and forget lunch, supper, and then right before bed it catches up with me and I go insane with cheese and meat or fall off the Atkins wagon.
He told me breakfast is two words break and fast as in 'break the fast' and that my skipping it was one of the problems, he also reminded me that we had talked about grazing versus gorging and eating slower on other occasions. He ended with the thought that while we have talked about weight control during our visits we've never had an appointment just for that, and there are folks who are more versed in that subject than he, maybe I ought to see one.
Haven't made an appointment, but I'm down to 3 Diet Pepsi's a day just because I enjoy the taste, filling the water cooler jugs from the Mountain Springs place twice as often and away from home at meals I drink iced tea no sweetener.
I measure weight loss by pants fit - without a belt pants that were snuggish fall down while I walk.
See a doctor. break the fast, graze don't gorge, water.
P.S. - do you see a doctor on a regular basis? I would start if you don't. In today's world they can pull up your chart and make graph's of all recent visits to see any changes. In fact that is probably one of the reasons I have problems adhering to a diet - I'm a little chubby, but my labs continually indicate I'm healthy as eff otherwise.
You can also accelerate the weight loss by adding in exercise to the diet modification.
I will add this: say someone is 240lbs and sedentary. They could probably lose 10 or 15 pounds over time by beginning to exercise on a regular basis without modifying their diet much. However, they won't keep losing weight without diet modification. This of course isn't applicable to the morbidly obese, except that 10 or 15 pounds I mentioned (and only maybe at that).
As much as I love exercise, this isn't always true all the time. Other than the health benefits and body composition that I mentioned earlier, exercise is just a way to raise total daily energy expenditure and thus be in a calorie deficit for weight loss. However, metabolism is not linear and will adjust its caloric output for the same exact exercise, especially when on a restricted diet. I will say that the research this is based on seemed to indicate that lower intensity steady state cardio showed this effect more than other forms.
You can also accelerate the weight loss by adding in exercise to the diet modification.
I will add this: say someone is 240lbs and sedentary. They could probably lose 10 or 15 pounds over time by beginning to exercise on a regular basis without modifying their diet much. However, they won't keep losing weight without diet modification. This of course isn't applicable to the morbidly obese, except that 10 or 15 pounds I mentioned (and only maybe at that).
Yes, agreed
Here's my take on it: you CAN lose weight without exercise. But you cannot change your body composition without exercise. Exercise, Specifically resistance training, will make the most significant change due to an increase in lean body mass. You can have two people that weight the same as each other, but the one with the most lean mass will not only look better but be healthier in the long run.
Yes, agreed
As much as I love exercise, this isn't always true all the time. Other than the health benefits and body composition that I mentioned earlier, exercise is just a way to raise total daily energy expenditure and thus be in a calorie deficit for weight loss. However, metabolism is not linear and will adjust its caloric output for the same exact exercise, especially when on a restricted diet. I will say that the research this is based on seemed to indicate that lower intensity steady state cardio showed this effect more than other forms.
That's what I was driving at with the limited weight loss then no more after that.....your metabolism adjusts accordingly. And no, nothing is true 100% of the time! Well, physiologically-speaking anyhow. Too many variables. You can make generalizations that fit the majority of situations though.
BTW, what was the definition of "lower intensity" in the studies? I know what "steady state" is, but intensity is variable by how it's defined (i.e. HR? perceived intensity? etc.)
That's what I was driving at with the limited weight loss then no more after that.....your metabolism adjusts accordingly. And no, nothing is true 100% of the time! Well, physiologically-speaking anyhow. Too many variables. You can make generalizations that fit the majority of situations though.
BTW, what was the definition of "lower intensity" in the studies? I know what "steady state" is, but intensity is variable by how it's defined (i.e. HR? perceived intensity? etc.)
Roger that and I agree. Sounds like we're on the same page.
I would have to find that particular study to see how they quantified that but my takeaway was that the typical slow jog or walk that you can maintain for long durations would fall into that category...but again, your body will adapt to just about anything, which is why you have linear or periodized progression models. And like you said, what may be low intensity for one person could be high for the next. But I think there's plenty other research out there that, even though it doesn't specifically look for metabolic compensation, shows that higher intensity work has a higher metabolic effect even if duration is much shorter.
Hmac,
I certainly respect what you do and you are obviously the expert in that field for this conversation. My understanding of typical bariatric surgery is that it effectively reduces the volume of food you can eat, which in theory, should help to facilitate weight loss.
But metabolism doesn't always work that way. In some cases restricting calories, either by diet or lifestyle, over time, can create a slowdown of metabolic rate. Combine that with stress and hormones being out of the normal range, and you have set the stage for massive weight gain. I use this example because it doesn't seem to me (and I could be wrong) that Kwelz is over eating to a point of needing a restriction in calories....although I'm sure his diet could be optimized and much better balanced.
So what happens if Kwelz (or anyone else in this particular situation) gets the surgery, and also makes other lifestyle choices such as more exercise with an emphasis on building back lean muscle mass? How would they be able to eat enough calories to support the higher daily energy expenditure AND build that lean mass? How would they be able to support a growing and improving metabolism?
In my opinion, and with my current understanding, surgery won't allow for the same level of growth/improvement, both metabolically and body composition, as would learning and executing a solid nutrition and exercise plan over the long-term.
Please take this as a discussion and not an attack on your profession. There may be, and probably are, some things that I don't know that I don't know, so I'm interested to hear your viewpoints.
In the old days (10 years ago), even bariatric surgeons thought, like you, that weight loss was effected only by intake restriction and (in the case of gastric bypass) relative malabsorption. We now know that it is infinitely more complex than that. The metabolic effects are actually the main component....changes in levels of incretin, GLP1, grehlin, leptin, and they are profound. The restriction is still important because it teaches a more appropriate eating lifestyle, but it's not the main effect, as we learned with restrictive-without-resection procedures like gastric partitioning, vertical banded gastroplasty, and the Lap Band and now again as some gastroenterologists are piddling around with endoscopic gastric plication. These have all been and are doomed to failure because they don't change the metabolism as gastric bypass, sleeve gastrectomy, and the various duodenal switch variants do.
To the uninitiated, it all seems pretty simple. And many/most surgeons thought so too, at one time. Many primary care doctors today are just as ignorant despite the flood of literature indicating just how simple-minded in our understanding we were even a decade ago. Today, weight loss surgery is one of the most studied surgical arenas in the world. Every single patient that gets a weight loss operation in one of the 800+ accredited centers in the US is entered into the MBSAQIP database. Preop statistics, operation, complications, long-term weight loss are all tracked on an ongoing basis...currently somewhere around 150,000 patients. We don't have to guess if it works, and how often...we know how well it works, how often it works, and how dangerous it is in the short term and the long term. It works, it's safe, and it gives lives back to people who have not been able to sustain a healthy weight range for their entire life.
This forum is a great gun forum, but I've been here long enough to predict with certainty the general reaction to the concept of weight loss surgery by the cops, ex-military, current military, survivalists, and fitness mesomorphs that populate these forums. My body mass index is 25.6 and I bike 8-25 miles almost every day, but I know with absolute certainty that there are innumerable good and understandable reasons why the relatively common advice paraphrased as "just push yourself away from the table fatass" is pointless, and merely demonstrates ignorance of totality the problem, the causes, and the solutions. It's not willful ignorance...it's that the concepts behind obesity are just simply beyond the comprehension of many, many people, including physicians, who just can't conceive of someone eating themselves to a BMI of 40 or greater. You can push yourself away from the table and go out for a 15 mile bike ride. They can't. I know that that is hard to imagine. The average M4C poster is very smart...I know this with certainty and have known it for the 7 years I've been here, but I can't tell you, can't convince you of what I have learned, and re-learned, and re-learned again over the 20+ years I've been doing this.
Yes. Lifestyle change is the point. You have to eat less, you have to eat better, and you have to get some exercise. But the percentage of the population that can actually do that is extraordinarily low in this country. We do what we can to make them healthy - weight loss surgery is absolutely a last resort. We advise diets, exercise programs, nutrition consults. We incent people in hundreds of ways. We threaten, we penalize, we shame them. We advertise on TV, we have government programs, local and regional activity initiatives. And it helps some people, but has no impact on the rest, the vast majority. Do we finally just throw in the towel and say "too bad fatass...you asked for it"? Or do we actually take that last step and provide them with a tool that has an 84% likelihood of getting them their life and their health back? Well, I made that decision a long time ago. I went into Medicine to make a difference in people's lives and his is an effective way to do it.
Outlander Systems
04-26-17, 16:00
OP:
Eat less bullshit.
Get your ass off the couch.
Period.
Anything else is pissing up a rope.
OP:
Eat less bullshit.
Get your ass off the couch.
Period.
Anything else is pissing up a rope.
LOL. Just that easy.
In the old days (10 years ago), even bariatric surgeons thought, like you, that weight loss was effected only by intake restriction and (in the case of gastric bypass) relative malabsorption. We now know that it is infinitely more complex than that........... I went into Medicine to make a difference in people's lives and his is an effective way to do it.
You know you sound like a leftist science politicizing anarchist trying to get rich on the back of the folks that have been rendered obese by big government.
On a serious note, thanks for all the advice.
Outlander Systems
04-26-17, 16:56
It really is. No one's holding a J-Frame to his head and making him suck down Oreos, bruh.
LOL. Just that easy.
You know you sound like a leftist science politicizing anarchist trying to get rich on the back of the folks that have been rendered obese by big government.
On a serious note, thanks for all the advice.
Heh heh. There are a lot of people getting rich off America's obesity epidemic, either causing it or trying to convince people that they have a quick, easy cure for it...but I ain't one of 'em.
It really is. No one's holding a J-Frame to his head and making him suck down Oreos, bruh.
Man, I think you are over simplifying. Perhaps because you haven't any addictions? One of my favorite quotes:
When a trout rising to a fly gets hooked and finds himself unable to swim about freely, he begins a fight which results in struggles and splashes and sometimes an escape.
In the same way, the human struggles with the hooks that catch him.
Sometime he masters his difficulties; sometimes they are too much for him.
The struggles are all that the world sees, and it usually misunderstands them.
It is hard for a free fish to understand what is happening to a hooked one.
Karl A. Menninger - The Human Mind
Once again I want to thank everyone who has commented both positive and negative.
I will say this though. I am hardly sitting around eating oreos on the couch.
Let me give you a snippet of my day. I went to sleep last night at about 2AM. This morning I was up at 7:30. Had to run to my office to drop off a contract by 8:30. I then had 6 house showings and 3 other appointments scheduled today(thankfully no homeless guys in any of these). I got home about 15 minutes ago and now have to write 2 contracts and still talk to another agent about details on a deal we are working together. My total intake of food today has been a banana and a fruit cup from the truck stop. In addition I have had a large barqs root beer. (Without question soda is my biggest weakness in all of this).
My dinner will probably be something along the lines of leftover salsa chicken and rice. And tomorrow looks to be a near repeat of the day.
This is what I consider an average to slightly light day. Now people out there have a hell of a lot harder jobs than I do. So I am not complaining. I am just describing a normal day for me.
Once again I want to thank everyone who has commented both positive and negative.
I will say this though. I am hardly sitting around eating oreos on the couch.
Let me give you a snippet of my day. I went to sleep last night at about 2AM. This morning I was up at 7:30. Had to run to my office to drop off a contract by 8:30. I then had 6 house showings and 3 other appointments scheduled today(thankfully no homeless guys in any of these). I got home about 15 minutes ago and now have to write 2 contracts and still talk to another agent about details on a deal we are working together. My total intake of food today has been a banana and a fruit cup from the truck stop. In addition I have had a large barqs root beer. (Without question soda is my biggest weakness in all of this).
My dinner will probably be something along the lines of leftover salsa chicken and rice. And tomorrow looks to be a near repeat of the day.
This is what I consider an average to slightly light day. Now people out there have a hell of a lot harder jobs than I do. So I am not complaining. I am just describing a normal day for me.
Have you had a full hormonal profile done? Also, there are several threads in the health/fitness section from members who have been having solid success with their weight loss and you may want to jump in one of those for additional intel. Your OP thread would have been an obvious thread for that section BTW.
SomeOtherGuy
04-26-17, 20:40
Let me give you a snippet of my day. I went to sleep last night at about 2AM. This morning I was up at 7:30. Had to run to my office to drop off a contract by 8:30. I then had 6 house showings and 3 other appointments scheduled today(thankfully no homeless guys in any of these). I got home about 15 minutes ago and now have to write 2 contracts and still talk to another agent about details on a deal we are working together. My total intake of food today has been a banana and a fruit cup from the truck stop. In addition I have had a large barqs root beer. (Without question soda is my biggest weakness in all of this).
My dinner will probably be something along the lines of leftover salsa chicken and rice. And tomorrow looks to be a near repeat of the day.
Repeating that I am not a doctor.... you have something more than just too much eating for too little activity. Thyroid problems are very common, especially in 30's and 40's, and can make people lose or gain weight. I'm sure there are other hormonal problems too, and once you're heavy that generally messes up hormones all by itself.
Stop, do not pass go. Find a good doctor who has both solid MD/DO credentials and an open mind. Get a full hormone test and whatever else the doctor thinks is worthwhile. If it's inconclusive, get a second opinion. Even if it costs you a couple thousand dollars on testing and visits, that's a lot cheaper than surgery, and a lot better (though not necessarily cheaper) than dying. I have known many people with weight problems eventually diagnosed as hormonal issues. (Most of them were losing weight and heading towards emaciation, but it can go both ways.) I have read of studies where some morbidly obese people, kept in a locked and controlled environment, were discovered to be gaining weight despite eating less than was calculated to be needed for them to simply maintain weight. Not everyone is the same.
Thyroid or other "hormonal complications" as a cause for morbid obesity to the point of a BMI of 49.5 would be extremely rare, in my experience. Thyroid studies are always part of the initial workup, but only rarely is it a contributor to morbid obesity of that level. Nevertheless, no question that a visit to the doctor is in order, if for no other reason than to find out whether Kwelz already has Type II diabetes, and where is he from a cholesterol/lipids standpoint. In other words, find out what his health status actually is, and the extent to which obesity is already damaging his health. It would be unusual for someone in their 40's with that BMI to not have serious cholesterol issues and a HGB A1c that doesn't at least show pre-diabetes if not frank Type II diabetes.
Eurodriver
04-27-17, 09:46
Serious question - not trying to hurt anyone's feels.
How come I can eat sugar cookies, stuffed crust pizza, Doritos, ice cream, fried chicken and donuts until I literally feel sick (I ate a dozen Boston kremes from Dunkin on a bet in 6 hours two weeks ago) and still be a skinny chump while some folks eat a few carrots and put on weight?
Ive always found myself skeptical of heavier folks claims that they struggle to lose weight by dieting based on my own experiences. Is it possible they eat even more than I do??
Serious question - not trying to hurt anyone's feels.
How come I can eat sugar cookies, stuffed crust pizza, Doritos, ice cream, fried chicken and donuts until I literally feel sick (I ate a dozen Bostonian kremes from Dunkin on a bet in 6 hours two weeks ago) and still be a skinny chump while some folks eat a few carrots and put on weight?
Ive always found myself skeptical of heavier folks claims that they struggle to lose weight by dieting based on my own experiences. Is it possible they eat even more than I do??
Variety of possibilities: most obvious would be you move more than they do and the energy balance favors weight maintenance for you. You may go well above maintenance calories for a short period of time, they do it consistently over long periods of time, etc, etc. That's the classic answer, and generally correct in most cases.
Over weight people move less in all facets of life, and one of the more interesting areas on that topic is called NEAT. See:
NEAT – the ignored component of physical activity, metabolic regulation and total daily caloric expenditure (http://www.brinkzone.com/articles/a-neat-way-to-fat-loss/)
Although genetics plays a role, current science says it plays a fairly minor role. Personally, I think it plays a much larger role than currently understood or appreciated, but far more blame genetics on their weight issue than they should.
Or, voodoo is to blame.
Serious question - not trying to hurt anyone's feels.
How come I can eat sugar cookies, stuffed crust pizza, Doritos, ice cream, fried chicken and donuts until I literally feel sick (I ate a dozen Bostonian kremes from Dunkin on a bet in 6 hours two weeks ago) and still be a skinny chump while some folks eat a few carrots and put on weight?
Ive always found myself skeptical of heavier folks claims that they struggle to lose weight by dieting based on my own experiences. Is it possible they eat even more than I do??
The question has no answer without actual data. You say that you eat like a horse and don't gain weight, Kwelz says that he eats like a bird and can't lose weight. I hear the latter story 2 or 3 times a week in my office. We have found that some of those food intake self-perceptions begin to break down when the full nutritional evaluation is done, including extensive food-logging.
I saw guy in the office a couple of weeks ago. Regional territory manager for Verizon...lots of driving. He had gastric bypass 3 years ago, lost weight down to BMI 27, felt great. Back to see me because he had gained about 25 lbs over the last year. Absolutely swore..."no dietary change, doc"...."OK, maybe one handful of M&Ms a day while driving in the car all day". Subsequent nutritionist evaluation including food logs...two bags of M&Ms a day. All day in the car, gas at the convenience store, buy a bag of M&Ms for the center console...absent-mindedy grab a handful while driving from account to account. Two bags a day. The psychologist said "classic case of the importance of Mindfulness".
Variety of possibilities: most obvious would be you move more than they do and the energy balance favors weight maintenance for you. You may go well above maintenance calories for a short period of time, they do it consistently over long periods of time, etc, etc. That's the classic answer, and generally correct in most cases.
That's correct, but the other side of that coin is that it takes for more energy for a 300 lb person to walk from point A to point B than it takes for a 175 lb person to make the same trip.
The question has no answer without actual data. You say that you eat like a horse and don't gain weight, Kwelz says that he eats like a bird and can't lose weight. I hear the latter story 2 or 3 times a week in my office. We have found that some of those food intake self-perceptions begin to break down when the full nutritional evaluation is done, including extensive food-logging.
I saw guy in the office a couple of weeks ago. Regional territory manager for Verizon...lots of driving. He had gastric bypass 3 years ago, lost weight down to BMI 27, felt great. Back to see me because he had gained about 25 lbs over the last year. Absolutely swore..."no dietary change, doc"...."OK, maybe one handful of M&Ms a day while driving in the car all day". Subsequent nutritionist evaluation including food logs...two bags of M&Ms a day. All day in the car, gas at the convenience store, buy a bag of M&Ms for the center console...absent-mindedy grab a handful while driving from account to account. Two bags a day. The psychologist said "classic case of the importance of Mindfulness".
Studies and clinical experience finds people trying to lose weight consistently underestimate how many cals they eat and those trying to gain weight the reverse. One of the most consistent findings and experiences of all time, as you're well aware no doubt. How many of your consults start with the sentence "I have tried everything and nothing worked"?
Translates into "I have tried everything but being consistent with a good nutrition plan and exercise for an extended period of time and bounced around from fad program to fad program"
Individualized metabolism can play some small role, but the laws of basic thermodynamics can't be contravened.
Individualized metabolism can play some small role, but the laws of basic thermodynamics can't be contravened.
Says the science nerd. They know differently! :rolleyes:
Outlander Systems
04-27-17, 10:49
Kind of what I was getting at.
There's no way a daily food intake of a banana and a fruit cup induces morbid obesity. If it does, donate your ass to DARPA, so they can reverse engineer your ability to defy physics.
Individualized metabolism can play some small role, but the laws of basic thermodynamics can't be contravened.
Eurodriver
04-27-17, 11:11
So does that mean the reverse is also true?
I'm a skinny chump because while I eat a dozen donuts in six hours I spend the next 18 hours eating nothing because I'm sick and gross feeling?
skywalkrNCSU
04-27-17, 11:15
Kind of what I was getting at.
There's no way a daily food intake of a banana and a fruit cup induces morbid obesity. If it does, donate your ass to DARPA, so they can reverse engineer your ability to defy physics.
While your statement isn't wrong, it is as simple as eating less, in reality putting that into practice is far more difficult, especially if the person doesn't have a decent understanding of nutrition. People are unreliable in tracking how much they eat, studies have shown this and so if you expect people to just tell themselves to eat less they might be thinking they are. When you teach people about proper nutrition, how different macro nutrients work in keeping you full and retaining lean body mass, how to track what you eat, how to know when you are in a deficit, how to eat well on the go, etc then they have a better chance at success.
Outlander Systems
04-27-17, 11:19
The Snake Diet. Shit works, bruh.
In my 20s I'd hit that Golden Corral right in time for the supper bell and wear dey asses out on bottomless steak.
Me and a buddy, around that time, got forcibly ejected from a Chinese Trough for straight donut punching their crab. We left the gym and proceeded to eat an easy $100 worth of crab apiece.
So does that mean the reverse is also true?
I'm a skinny chump because while I eat a dozen donuts in six hours I spend the next 18 hours eating nothing because I'm sick and gross feeling?
I had a friend, oh, 30 years ago. Let's call him Dave. Because that's his real name, Dave. Dave was 5'8 and 120 pounds. Dave also had a 10" shlong, but that's another story. Dave ate anything he could put his hands on, as long as it wasn't healthy. Burgers, fries, pizza, candy, pastries. I don't know if I saw him eat a vegetable. I always cautioned him, it'll catch up; you can't eat like that forever. Fast-forward 30 years. You know how much Dave weighs now? About 120 pounds, and he still eats like that.
I know he is an outlier, a statistical anomaly, but I do not know why people like him (surely he isn't alone) can do that, and people like me can sniff a donut and gain a pound. I eat generally healthy , I exercise regularly, and I am perpetually 10-15 pounds "overweight." Even when I was in the mil I always had to be taped, even though I could tear through the PFT.
I wish I knew all the answers, but as my kids remind me, I really don't know anything.
Kind of what I was getting at.
There's no way a daily food intake of a banana and a fruit cup induces morbid obesity. If it does, donate your ass to DARPA, so they can reverse engineer your ability to defy physics.
You're right, if you're only looking at that one aspect. But what's not being taken into consideration is metabolic adaptation, stress, hormone balance, and a whole bunch of other factors that we may not even fully understand yet.
So does that mean the reverse is also true?
Did I not address that in #58 and others?
I'm a skinny chump because while I eat a dozen donuts in six hours I spend the next 18 hours eating nothing because I'm sick and gross feeling?
If you examine it, you pretty much answered your own Q there.
Diet tracking takes effort. A lot of effort, but once you get in the habbit, it's not bad, or difficult.
My wife uses the "my fitness pal" app and has found it very useful to track calories and macros.
Diet tracking takes effort. A lot of effort, but once you get in the habbit, it's not bad, or difficult.
My wife uses the "my fitness pal" app and has found it very useful to track calories and macros.
Kids today! :cool:
I had to do it for myself and clients using a calorie book, pen and paper, and calculator. Now that was a PITA. Today, plug in what you ate on any number of free sites, etc and out spits cals, macros, etc.
Outlander Systems
04-27-17, 11:29
It's second grade math.
If Fatty McTwinChins eats 3000 calories a day, and burns 4500 calories a day, what is the caloric deficit?
Since 99.9% of Americans eat prepackaged psuedofood as it is, the back of the box tells you what you need to know.
The inverse is true as well.
If Tubby McSupersize eats 400 calories a day, but gains 3,500 calories worth of stored energy in the form of fat, which fundamental physical law related to the conservation of mass is being defied?
Diet tracking takes effort. A lot of effort, but once you get in the habbit, it's not bad, or difficult.
My wife uses the "my fitness pal" app and has found it very useful to track calories and macros.
In the old days (10 years ago), even bariatric surgeons thought, like you, that weight loss was effected only by intake restriction and (in the case of gastric bypass) relative malabsorption. We now know that it is infinitely more complex than that. The metabolic effects are actually the main component....changes in levels of incretin, GLP1, grehlin, leptin, and they are profound. The restriction is still important because it teaches a more appropriate eating lifestyle, but it's not the main effect, as we learned with restrictive-without-resection procedures like gastric partitioning, vertical banded gastroplasty, and the Lap Band and now again as some gastroenterologists are piddling around with endoscopic gastric plication. These have all been and are doomed to failure because they don't change the metabolism as gastric bypass, sleeve gastrectomy, and the various duodenal switch variants do.
To the uninitiated, it all seems pretty simple. And many/most surgeons thought so too, at one time. Many primary care doctors today are just as ignorant despite the flood of literature indicating just how simple-minded in our understanding we were even a decade ago. Today, weight loss surgery is one of the most studied surgical arenas in the world. Every single patient that gets a weight loss operation in one of the 800+ accredited centers in the US is entered into the MBSAQIP database. Preop statistics, operation, complications, long-term weight loss are all tracked on an ongoing basis...currently somewhere around 150,000 patients. We don't have to guess if it works, and how often...we know how well it works, how often it works, and how dangerous it is in the short term and the long term. It works, it's safe, and it gives lives back to people who have not been able to sustain a healthy weight range for their entire life.
This forum is a great gun forum, but I've been here long enough to predict with certainty the general reaction to the concept of weight loss surgery by the cops, ex-military, current military, survivalists, and fitness mesomorphs that populate these forums. My body mass index is 25.6 and I bike 8-25 miles almost every day, but I know with absolute certainty that there are innumerable good and understandable reasons why the relatively common advice paraphrased as "just push yourself away from the table fatass" is pointless, and merely demonstrates ignorance of totality the problem, the causes, and the solutions. It's not willful ignorance...it's that the concepts behind obesity are just simply beyond the comprehension of many, many people, including physicians, who just can't conceive of someone eating themselves to a BMI of 40 or greater. You can push yourself away from the table and go out for a 15 mile bike ride. They can't. I know that that is hard to imagine. The average M4C poster is very smart...I know this with certainty and have known it for the 7 years I've been here, but I can't tell you, can't convince you of what I have learned, and re-learned, and re-learned again over the 20+ years I've been doing this.
Yes. Lifestyle change is the point. You have to eat less, you have to eat better, and you have to get some exercise. But the percentage of the population that can actually do that is extraordinarily low in this country. We do what we can to make them healthy - weight loss surgery is absolutely a last resort. We advise diets, exercise programs, nutrition consults. We incent people in hundreds of ways. We threaten, we penalize, we shame them. We advertise on TV, we have government programs, local and regional activity initiatives. And it helps some people, but has no impact on the rest, the vast majority. Do we finally just throw in the towel and say "too bad fatass...you asked for it"? Or do we actually take that last step and provide them with a tool that has an 84% likelihood of getting them their life and their health back? Well, I made that decision a long time ago. I went into Medicine to make a difference in people's lives and his is an effective way to do it.
Hmac,
Thanks for the reply on this one. I do want to address a couple things though. I am well aware that calorie restriction and energy balance is not the only piece to the puzzle. I am familiar with the hormones that you mention, though I will admit that the scientific detailed inner workings within the body is something that I am actively learning to better apply in the nutrition space.
Secondly, bringing it back to application in the case of somebody like Kwelz that doesn't seem to fit the "over-eating mold", would you still think that bariatric surgery is a potential fix?
Also, BMI...not really a fan of the system. I'm 5'8ish and 183# so that puts me solidly in the overweight and health risk category. Yet I'm currently somewhere in the ballpark of 11-12% body fat and have abs. I'm sure you'll say it's a guideline that doesn't fit everyone, but I'm still not a fan.
skywalkrNCSU
04-27-17, 11:48
Something has to be drastically wrong for you to not overeat and still not lose weight. In every single metabolic ward study where calories in vs out are measured and controlled a caloric deficit results in weight loss.
Kind of what I was getting at.
There's no way a daily food intake of a banana and a fruit cup induces morbid obesity. If it does, donate your ass to DARPA, so they can reverse engineer your ability to defy physics.
Yup. Weight and its co-morbidities is about calorie intake. It's not about nutrition nor is it about what the sources of that nutrition are. 1000 calories of bananas = 1000 calories of Big Macs.
The problem is...how to limit calories, how to change metabolism. "Just push yourself away from the table and go run 5 miles, fatass" is one way, but it very, very rarely works.
It's second grade math.
If Fatty McTwinChins eats 3000 calories a day, and burns 4500 calories a day, what is the caloric deficit?
Since 99.9% of Americans eat prepackaged psuedofood as it is, the back of the box tells you what you need to know.
The inverse is true as well.
If Tubby McSupersize eats 400 calories a day, but gains 3,500 calories worth of stored energy in the form of fat, which fundamental physical law related to the conservation of mass is being defied?
Using terms in bold are not conducive to assisting people asking for help and advice in my experience. Most are fully aware of their obesity and so forth. Yes, some are convinced they are somehow defying the laws of physics, etc, but that's another issue. There's also been a number of lengthy threads here discussing long term weight loss, etc the OP and others should check out, such as:
https://www.m4carbine.net/showthread.php?183602-Long-Term-Weight-Loss-(Biggest-Loser-Study)&highlight=psychology
Also, BMI...not really a fan of the system. I'm 5'8ish and 183# so that puts me solidly in the overweight and health risk category. Yet I'm currently somewhere in the ballpark of 11-12% body fat and have abs. I'm sure you'll say it's a guideline that doesn't fit everyone, but I'm still not a fan.
I think BMI can be a generally useful tool for many people, but just one of many. It is very flawed for sure. I am similar to you, but hover closer to 190-195. I am by some "standards" overweight, but carry about 16% BF (sadly, no abs).
Same to be said for the tape test they do in the military. In the Navy at my height the weight was maxed out at 181 I think. I still ran 1st class PFTs and scored in the 95th percentile in the PRT/PRA, but still had to be taped every 6 months because by their standards I was "overweight."
Fortunately, the military is starting to catch up to the 21st century and change these policies.
I agree, I am not a fan of current way of figuring BMI.
It's second grade math.
If Fatty McTwinChins eats 3000 calories a day, and burns 4500 calories a day, what is the caloric deficit?
Since 99.9% of Americans eat prepackaged psuedofood as it is, the back of the box tells you what you need to know.
The inverse is true as well.
If Tubby McSupersize eats 400 calories a day, but gains 3,500 calories worth of stored energy in the form of fat, which fundamental physical law related to the conservation of mass is being defied?
For one, your body auto-regulates metabolic output (calories burned) which has been shown to be tied to calorie restriction. In other words, if you don't feed your body the necessary amount to sustain a healthy/functioning metabolism, your body will eventually reduce the number of calories burned for the same amount of output that you did previously. It will also begin to store any caloric intake that is absorbed. It's a basic survival mechanism within the body.
I think BMI can be a generally useful tool for many people, but just one of many. It is very flawed for sure. I am similar to you, but hover closer to 190-195. I am by some "standards" overweight, but carry about 16% BF (sadly, no abs).
Same to be said for the tape test they do in the military. In the Navy at my height the weight was maxed out at 181 I think. I still ran 1st class PFTs and scored in the 95th percentile in the PRT/PRA, but still had to be taped every 6 months because by their standards I was "overweight."
Fortunately, the military is starting to catch up to the 21st century and change these policies.
I agree, I am not a fan of current way of figuring BMI.
BMI is a crude tool in the tool box useful for population studies etc, and becomes less useful rapidly depending on how it's used and who it's applied to, and totally useless when applied to specific individuals without any consideration for more important metrics, such as BF%, activity levels, FFM, etc. Many fail to understand that, and will tell some guy with obviously low BF%, high degree of FFM, who exercise regularly, with low BP, excellent lipids, etc, etc he's at risk of X due to BMI.
I posted studies here a while ago about how the mil penalizes people with more FFM who do very well on the fitness tests, etc due to BMI. I believe that's improved quite a bit since I posed that.
skywalkrNCSU
04-27-17, 12:12
For one, your body auto-regulates metabolic output (calories burned) which has been shown to be tied to calorie restriction. In other words, if you don't feed your body the necessary amount to sustain a healthy/functioning metabolism, your body will eventually reduce the number of calories burned for the same amount of output that you did previously. It will also begin to store any caloric intake that is absorbed. It's a basic survival mechanism within the body.
This isn't really true. Yeah if you eat less you burn less because you burn calories while digesting food but the whole starvation mode is a myth. Metabolic ward studies have shown this every time.
Hmac,
Thanks for the reply on this one. I do want to address a couple things though. I am well aware that calorie restriction and energy balance is not the only piece to the puzzle. I am familiar with the hormones that you mention, though I will admit that the scientific detailed inner workings within the body is something that I am actively learning to better apply in the nutrition space.
Secondly, bringing it back to application in the case of somebody like Kwelz that doesn't seem to fit the "over-eating mold", would you still think that bariatric surgery is a potential fix?
Also, BMI...not really a fan of the system. I'm 5'8ish and 183# so that puts me solidly in the overweight and health risk category. Yet I'm currently somewhere in the ballpark of 11-12% body fat and have abs. I'm sure you'll say it's a guideline that doesn't fit everyone, but I'm still not a fan.
I have had the detailed metabolic pathway components explained to me in detail on at least a few occasions. I can regurgitate it, but I don't understand it. Fortunately, I don't need to - I'm a clinician and it has no practical applicability for me. I only need to know that the rationale for the treatments that I recommend is sound. It is. All the smart doctors say so. Who am I, a simple mechanic, to disagree?
I see patients every..single..day that, by history, don't seem to fit the "over-eating mold". Since I do know that people are not absorbing calories out of the air, I know that calorie limitation will solve their problem if they have the motivation to use that tool as designed. In Kwelz' case, yes, weight loss surgery will solve his problem. Whether or not it's the appropriate choice at this time, I don't know. Maybe he is one of the 6-or-so percent that can achieve and sustain a healthy weight through sheer willpower with diet and exercise. He owes himself that attempt before undergoing surgery. I don't know what previous attempts he's made, their degree of success, nor what his underlying health status is. Those are all crucial components of the decision as to whether or not weight loss surgery is appropriate for a given individual.
BMI is, in the general scheme of things, a crude tool....the current holder of the Mr. Universe title has a BMI of 44. But we aren't talking about using it as a valid screen on people with 11-12% body fat..for you, the weight category that that puts you in is a problem between you and your life insurance company. We're talking about using it as a preliminary health screen for the 45-year-old woman in my office who is 5'-3" tall, weighs 255 lbs, who doesn't work, doesn't exercise, has had 3 kids, and has a terrible diet. That patient has been on innumerable diet and exercise programs, everything from Atkins to Weight Watchers, to every bullshit device and diet sold on the late night infomercials. She's lost as much a 60 lbs with some of those efforts and has always gained it back, and sometimes more. She can't get down on the floor to play with her kids, she can't riide an amusement park ride, and she can't fit in a movie theater or airline seat. What do we do with that lady? How do we give her her life back?
Using terms in bold are not conducive to assisting people asking for help and advice in my experience. Most are fully aware of their obesity and so forth. Yes, some are convinced they are somehow defying the laws of physics, etc, but that's another issue. There's also been a number of lengthy threads here discussing long term weight loss, etc the OP and others should check out, such as:
https://www.m4carbine.net/showthread.php?183602-Long-Term-Weight-Loss-(Biggest-Loser-Study)&highlight=psychology
But tossing such pejorative terms around so casually is illustrative of the vast gulf between those who don't have a tendency toward obesity and those who do. It signifies a total inability to grasp the struggle that those people have and to just thereby assume that the reason that they're obese is that they're simply a lazy fatass. I see those people in my office all the time. That automatic assumption is totally unwarranted, But it is true that we all see what we want to see, and that we all have different levels of compassion for those suffering from the Human Condition -- that alone can determine the extent to which we can try to look beyond the form factor of that person.
Outlander Systems
04-27-17, 12:29
That and it defies the laws of physics.
This isn't really true. Yeah if you eat less you burn less because you burn calories while digesting food but the whole starvation mode is a myth. Metabolic ward studies have shown this every time.
That and it defies the laws of physics.
Not really. It gets complicated real fast here, but changes in the conversion of T4-->T3, leptin, adaptive thermogenesis, up regulation of enzymes that tend to shunt food toward storage vs thermogensis and reduce fatty acid mobilization, etc does not change the energy equation, it's just a shunting of the energy into different pathways.
How much any metabolic changes due to calorie restriction plays a role in the slowing of weight weight loss is unclear and in my view, yet to be fully elucidated. Metabolic ward studies suggest it has minimal impact, and the "starvation mode" mantra over stated to be sure, but it takes tiny incremental changes in the overall system to have profound effects that I feel have yet to be full elucidated by research quite yet. Per usual, the human body far more complex than we appreciate and still has plenty of unknowns to show us.
Hell, they're still finding basic anatomical parts in the body much less all it's pathways, hormones, etc.
This isn't really true. Yeah if you eat less you burn less because you burn calories while digesting food but the whole starvation mode is a myth. Metabolic ward studies have shown this every time.
This was something that I heard discussed by Alan Aragon...who is considered one of the top nutrition researchers in the industry. It's not something that I made up or heard from the bros at the gym.
I'm open to being corrected though, as my goal is to have the best understanding of the current information out there that I can.
This was something that I heard discussed by Alan Aragon...who is considered one of the top nutrition researchers in the industry. It's not something that I made up or heard from the bros at the gym.
I'm open to being corrected though, as my goal is to have the best understanding of the current information out there that I can.
A good review. Might be a newer one with updated data however and Alan tends to be very on top of that type of thing and is solid intel, and I'm not just saying that because he lists me as one of his primary influences of getting into the biz when he was a kid reading the mags, etc:
http://onlinelibrary.wiley.com/doi/10.1002/oby.20027/pdf
A good review. Might be a newer one with updated data however and Alan tends to be very on top of that type of thing and is solid intel, and I'm not just saying that because he lists me as one of his primary influences of getting into the biz when he was a kid reading the mags, etc:
http://onlinelibrary.wiley.com/doi/10.1002/oby.20027/pdf
Thanks for the link Will. I'll have to read the rest of it when I get a few minutes, and I'll try to find the reference that Alan made to see if there was a newer study that was cited or not.
Didn't realize you were the OG. Haha. You must be a little older than you look.
For one, your body auto-regulates metabolic output (calories burned) which has been shown to be tied to calorie restriction. In other words, if you don't feed your body the necessary amount to sustain a healthy/functioning metabolism, your body will eventually reduce the number of calories burned for the same amount of output that you did previously. It will also begin to store any caloric intake that is absorbed. It's a basic survival mechanism within the body.
I know some one else just said this is not true, but I have seen it be true in my wife.
When we were dating she ate high glycemic foods, and not enough and all at once mostly. Pasta, reeses, alcohol. When she moved in with me I got her eating at proper intervals, and watching her intake of high glycemic index foods. But most importantly eating more (calories). She lost weight doing this. She has a light build and went from 5'9" 138lbs to 118lbs at her lightest. She has since had our son and finished up beast feeding, she is at 125lbs that seems to be a good healthy place for her.
OP, I'd be interested in what would happen if you ate the same amount of calories a day but spread out over 5 meals instead of essentially one.
Outlander Systems
04-27-17, 13:31
Will is actually 72.
He's living proof that solid nutrition, and lifting weights work.
Thanks for the link Will. I'll have to read the rest of it when I get a few minutes, and I'll try to find the reference that Alan made to see if there was a newer study that was cited or not.
Didn't realize you were the OG. Haha. You must be a little older than you look.
I know some one else just said this is not true, but I have seen it be true in my wife.
When we were dating she ate high glycemic foods, and not enough and all at once mostly. Pasta, reeses, alcohol. When she moved in with me I got her eating at proper intervals, and watching her intake of high glycemic index foods. But most importantly eating more (calories). She lost weight doing this. She has a light build and went from 5'9" 138lbs to 118lbs at her lightest. She has since had our son and finished up beast feeding, she is at 125lbs that seems to be a good healthy place for her.
OP, I'd be interested in what would happen if you ate the same amount of calories a day but spread out over 5 meals instead of essentially one.
There are a couple of nutritionist/diet coaches that I follow that talk about this same scenario all the time. Basically they put their clients on a reverse diet and increase their calories, slowly over time, and the end result is a much healthier body weight and composition and not to mention a healthier metabolism. It may or may not be "science-based" (yet), but application seems to prove it out.
Will is actually 72.
He's living proof that solid nutrition, and lifting weights work.
No F'ing way! I was thinking early to mid 50's based on looks, then thought ok maybe 60's after his last post, but 72?! You're pulling my leg right?
skywalkrNCSU
04-27-17, 13:58
This was something that I heard discussed by Alan Aragon...who is considered one of the top nutrition researchers in the industry. It's not something that I made up or heard from the bros at the gym.
I'm open to being corrected though, as my goal is to have the best understanding of the current information out there that I can.
If you can find Alan saying that I'd be interested in reading it. I don't follow him much these days (or anyone else really) but he was always one of my go-to people for this sort of thing and I could've sworn his stance was more in lines of starvation mode is more of a myth than not.
Outlander Systems
04-27-17, 14:04
I'm just jackassing around, but I know he's healthy as a horse and fit as a fiddle. ;)
No F'ing way! I was thinking early to mid 50's based on looks, then thought ok maybe 60's after his last post, but 72?! You're pulling my leg right?
There are a couple of nutritionist/diet coaches that I follow that talk about this same scenario all the time. Basically they put their clients on a reverse diet and increase their calories, slowly over time, and the end result is a much healthier body weight and composition and not to mention a healthier metabolism. It may or may not be "science-based" (yet), but application seems to prove it out.
Some that may be explained as changes in macros, etc, all of which is science based. Higher P intakes for example are superior for changes in body comp through several mechanisms. The human body is not a bomb calorimeter...
I'm just jackassing around, but I know he's healthy as a horse and fit as a fiddle. ;)
Haha jerk. Yeah pure right about the other part though.
If you can find Alan saying that I'd be interested in reading it. I don't follow him much these days (or anyone else really) but he was always one of my go-to people for this sort of thing and I could've sworn his stance was more in lines of starvation mode is more of a myth than not.
I'll see what I can do, I'm almost positive it was on a podcast but to be honest, it may have been one of the other nutrition guys that mentioned what I'm thinking of. You may be right about Alan's stance and the link that Will sent seems to show that adaptive thermogenesis is inconclusive as of that study (only got to read the abstract so far).
Some that may be explained as changes in macros, etc, all of which is science based. Higher P intakes for example are superior for changes in body comp through several mechanisms. The human body is not a bomb calorimeter...
I can't disagree with that. Correlation vs causation. My main point was that body weight/composition doesn't always follow the simple energy balance formula where you should eat less to lose weight. Protein is the first thing I look at after caloric consumption when working with people on their nutrition.
Haha jerk. Yeah pure right about the other part though.
It's not that I'm that old, it's that I have been in the biz along time and Alan not all that old and was reading the musclemags in the 90s when I was one of the top writers who was one of the only really science based no BS guy.
Got get an MRI tomorrow for what might be partial tear of RC muscle in shoulder, so not feeling all the fit. Two, my health history is more extensive than people might think.
I know this thread has taken some turns, but to answe the OP's question about bypass surgery. In my opinion, bypass surgery is a terrible thing. You have a group of people who by definition can't reliably follow a diet, then do a surgery that sets people up to have nutrient deficiencies. You expect this patient population to follow a strict diet to help avoid surgical complications, and get surprised when they can't. Not to mention the large percentage of undiagnosed psychiatrically disorders in this group.
It just seems to set patients up for failure, and can lead to a cascade of bad things. A surgical problem, where no surgeon will touch you.
I might be biased, as I'm not a surgeon, and the single most batshit crazy patient I've ever encountered who had years of hospitalization before she died started off as a gastric sleeve operation.
It's second grade math.
If Fatty McTwinChins eats 3000 calories a day, and burns 4500 calories a day, what is the caloric deficit?
Since 99.9% of Americans eat prepackaged psuedofood as it is, the back of the box tells you what you need to know.
The inverse is true as well.
If Tubby McSupersize eats 400 calories a day, but gains 3,500 calories worth of stored energy in the form of fat, which fundamental physical law related to the conservation of mass is being defied?
I don't know why you quoted me in that. What point were you trying to make?
I know this thread has taken some turns, but to answe the OP's question about bypass surgery. In my opinion, bypass surgery is a terrible thing. You have a group of people who by definition can't reliably follow a diet, then do a surgery that sets people up to have nutrient deficiencies. You expect this patient population to follow a strict diet to help avoid surgical complications, and get surprised when they can't. Not to mention the large percentage of undiagnosed psychiatrically disorders in this group.
It just seems to set patients up for failure, and can lead to a cascade of bad things. A surgical problem, where no surgeon will touch you.
I might be biased, as I'm not a surgeon, and the single most batshit crazy patient I've ever encountered who had years of hospitalization before she died started off as a gastric sleeve operation.
Certainly at odds with my own experience, as well as the vast majority of other bariatric professionals around the country.
There are a couple of nutritionist/diet coaches that I follow that talk about this same scenario all the time. Basically they put their clients on a reverse diet and increase their calories, slowly over time, and the end result is a much healthier body weight and composition and not to mention a healthier metabolism. It may or may not be "science-based" (yet), but application seems to prove it out.
To me what is happening with high glycemic foods and all your food at once is body can't handle the sugar and releases insulin and has to store the extra as fat.
If you body can do 400 calories of sugar in a meal, but you eat 2000 calories, 1600 have to become fat.
If you do that 400 calories five times spread out it adds up to 2000 calories but none were turned to fat.
This is oversimplified but is what my thinking is on it.
Outlander Systems
04-27-17, 19:26
You brought up intake monitoring.
Let me offer some non-surgical advice before I pop smoke on this shitshow.
If you don't want to be a fatbody:
Eat less
Become more active
It's literally that ****ing simple.
http://images.memes.com/meme/834605
I don't know why you quoted me in that. What point were you trying to make?
You brought up intake monitoring.
Let me offer some non-surgical advice before I pop smoke on this shitshow.
If you don't want to be a fatbody:
Eat less
Become more active
It's literally that ****ing simple.
Did you go to the 'Baby Doc School of Offshore Medicine' under Uncle Duke?
You brought up intake monitoring.
Let me offer some non-surgical advice before I pop smoke on this shitshow.
If you don't want to be a fatbody:
Eat less
Become more active
It's literally that ****ing simple.
http://images.memes.com/meme/834605
Still don't know why you posted that, you support the premise of my post, but in a way that came across like you disagreed, hence my confusion. But maybe I took it the wrong way.
Completely agree with all of this except for the assertion that surgery won't fix that. The primary value of weight loss surgery is as an adjunct tool to achieving and sustaining a lifestyle that will in turn sustain a healthy weight range. Without that tool, a morbidly obese person's chance of success at that is dismal. It can be done, and Kwelz should definitely try, it's just rare that it's successful.
Surgery can be an option for weight loss, but that is treating the symptoms, not the cause of the issue. I've taken care of many bariatric patients in the hospital, but it is usually a last resort as a result of poor lifestyle choices.
The OP should consider a better diet and adding some exercise to his daily routine. Even a 15-20 walk every day can help. if you can't find 20mins to spare for your health, then you are not trying hard enough.
Once again I want to thank everyone who has commented both positive and negative.
I will say this though. I am hardly sitting around eating oreos on the couch.
Let me give you a snippet of my day. I went to sleep last night at about 2AM. This morning I was up at 7:30. Had to run to my office to drop off a contract by 8:30. I then had 6 house showings and 3 other appointments scheduled today(thankfully no homeless guys in any of these). I got home about 15 minutes ago and now have to write 2 contracts and still talk to another agent about details on a deal we are working together. My total intake of food today has been a banana and a fruit cup from the truck stop. In addition I have had a large barqs root beer. (Without question soda is my biggest weakness in all of this).
My dinner will probably be something along the lines of leftover salsa chicken and rice. And tomorrow looks to be a near repeat of the day.
This is what I consider an average to slightly light day. Now people out there have a hell of a lot harder jobs than I do. So I am not complaining. I am just describing a normal day for me.
Start with changing your diet slowly. Consult a dietician or nutrionist to help modify your eating habits.
The hardest things to cut out is sugar/carbs, and fat. Basically any candy, soda, chips, fries, etc. Eat more natural food such as salads, fruits, grilled chicken, yogurt, and nuts.
Good luck to you. At least its good that you are open to hearing others' opinions and advice. Its not easy, and its easier said than done. But it can be done.
Variety of possibilities: most obvious would be you move more than they do and the energy balance favors weight maintenance for you. You may go well above maintenance calories for a short period of time, they do it consistently over long periods of time, etc, etc. That's the classic answer, and generally correct in most cases.
Over weight people move less in all facets of life, and one of the more interesting areas on that topic is called NEAT. See:
NEAT – the ignored component of physical activity, metabolic regulation and total daily caloric expenditure (http://www.brinkzone.com/articles/a-neat-way-to-fat-loss/)
Although genetics plays a role, current science says it plays a fairly minor role. Personally, I think it plays a much larger role than currently understood or appreciated, but far more blame genetics on their weight issue than they should.
Or, voodoo is to blame.
That's a great article. Thanks for the link.
I'm a firm believer that genetics plays a major role in metabolism, but it is very individualized and varies significantly for everyone. Its maybe 50-60% genetics and 40-50% lifestyle. There are people who are always going to be skinny their whole life, while others struggle with weight, and anything in between. There's a saying that goes "we are a slave to our genetics". If you're tall, you're tall; if you're short, you're short. Some traits can't be changed, while others can.
That's a great article. Thanks for the link.
I'm a firm believer that genetics plays a major role in metabolism, but it is very individualized and varies significantly for everyone. Its maybe 50-60% genetics and 40-50% lifestyle. There are people who are always going to be skinny their whole life, while others struggle with weight, and anything in between. There's a saying that goes "we are a slave to our genetics". If you're tall, you're tall; if you're short, you're short. Some traits can't be changed, while others can.
Studies currently suggest it's much lower then that but I'm of the opinion genetics plays a larger role than current science suggests. An important emerging area of science is called Nutrigenomics:
"Nutrigenomics is a branch of nutritional genomics and is the study of the effects of foods and food constituents on gene expression."
https://en.wikipedia.org/wiki/Nutrigenomics
Extension intel:
Nutrigenomics: A controversy
http://www.sciencedirect.com/science/article/pii/S2212066115000058
I've been following this thread for a while and wanted to reply since I have personal experience but just haven't had time.
It's simple for all but less than 1% of adults: Calories in. Calories out.
When I saw that it comes from a place of also 'thinking' I was eating alright a few years ago and ultimately I wasn't eating as crappy as I could have been but it still wasn't eating healthy. Your story resembles mine in many ways so I can relate to what you're going through. I was always the bigger of my friends but wasn't super fat... just thicker but always strong and always athletic. I played lots of sports and ate just about anything I wanted. Then, sometime in my mid-20's the sports stopped happening and I got into weight lifting and cardio as an outlet in an effort to maintain the shape I was in. Fast forward to my 30's and the weight lifting and cardio just became monotonous and boring. It was more of a chore than something I enjoyed and I quickly lost the desire to do it and once I got out of the routine it was very difficult to start it up again and when I was able to it didn't last very long. I kept eating the way I had pretty much my whole life and this just wasn't conducive to not getting fat. My routine and food cravings were pure shit.
By my mid 30's I got onto a scale and it was 299.8lbs (I'm 6' tall) and I made the decision in that exact moment in time that I would NOT see the 300lb range on the scale. I decided that I would have to do something drastic to effect change and briefly considered surgery but quickly decided that I needed to really exhaust every option available to me before I elected to volunteer for that drastic of a method. I stumbled upon juice fast info online and gobs of videos on YouTube but decided that I would be able to just restrict my food intake instead. Seeing the scale a biscuit shy of 300lbs changed that for me. I immediately made the decision on the spot that I wouldn't eat another piece of food for two months. My short term goal was to juice fast for 60 days, lose 60lbs (based on the videos I saw about 1lb a day was reasonable) and then once I was at 250ish pounds I'd be able to start some Crossfit and hopefully get into a healthy lifestyle that was sustainable. I went to the grocery store and bought a bunch of Bolthouse Farms, Odwalla and other brand name juices. I then began researching juicers and switched from bottled juices to my own juice recipes. I consumed nothing but juice and water from that point forward.
The first few days the hunger was definitely there. I was craving all sorts of crappy foods and the cravings were VERY strong like something I hadn't experienced before. I recall vividly seeing a commercial for Sonic and some new hotdog they came out with a couple of days after I started. It was odd because I could actually taste the ingredients in my mouth and in that moment I wanted to just hop in the truck and go get it and say screw it. But I didn't. I stuck with it. The weight melted off the first couple of weeks. I think I averaged about a pound or more per day the first couple of weeks. By the end of the first month I was down 30lbs. I was on pace to lose the 60lbs in two months that I set out to do. More importantly, at this point I noticed something interesting: my cravings had changed. I now wanted to eat the whole fruits and vegetables I was juicing. The very thought of eating the other foods I once craved made me feel ill. In fact, that same commercial for Sonic came on about a month after I started and it was a bit of an interesting moment when I realized that it repulsed me. The very thought of eating it made me sick to my stomach. The next couple of weeks my weight loss had dipped to a couple of tenths of a pound here and there and even gaining a tenth or two here and there. Lame. The research online said that this plateau was common and you had to power through it. Eff that noise. I made the decision to end the juice fast and start the next step of the plan: Crossfit.
Yeah, I said the scary word everyone who doesn't do fears and feels the need to ridicule. When I started eating food again I put on a little bit of weight but it wasn't as much as I thought I would. I put like 4lbs back on the first week off of the juice fast but it steadied as I started Crossfit. One of the bigger factors was that I reset my idea of what food was and what I wanted to eat. I still had no idea what amounts I needed and what not. This goes back to when I said 'Calories in. Calories out.' because I worked my ASS off at Crossfit and ate nearly Paleo and thought I was eating pretty well. I was eating well but my portions weren't where they should have been. I learned that you simply can NOT out work a poor diet and this is emphasized by factors like genetics and age. My first year of Crossfit I basically lost zero weight. My body composition got much better but I wasn't losing at the rate that was equal to what I felt I was putting forth in terms of working out. I was putting muscle on at almost the same rate as burning fat and as fat as I was this simply wasn't good enough. At this point I was loving the process which was the second of the big changes mentally that lead to where I am today. The first was changing the types of foods I craved and the second was coming to a place where I wasn't focused on the results and instead was simply enjoying working out. I was back to the feeling I had when I played sports and I was looking forward to working out and I felt 'off' if I didn't get to Crossfit that day.
Now I had the basis for success and I just needed to take another step in the right direction. Back to 'Calories in. Calories out.' and I had to swallow some pride and admit that, even though I felt like I was eating healthy I likely was messing up somewhere. My buddy recommended a free app called MyFitnessPal. Go and download this app NOW if not sooner. I can't explain how important it is to know how many calories you are taking in each day and what the caloric value of each item you eat is. Once you do this, commit to entering every single thing you eat no matter what. Nothing is exempt from being tracked. Ever. I don't care how big of a drinking night you have or how much that big lunch adds to your calories. You track it. Before long you will spot things that stand out. For instance, one of the healthier foods I ate was Qdoba with my wife... or so I thought. My wife loved that place and she ate it regularly and my wife is not fat. In fact (humble brag) my wife is smokin' hot. So she would order her burrito with all the trimmings an then I would come in and get no rice, no beans, no cheese, no sour cream and all the other things I thought was bad for you. When I entered this into MyFitnessPal I was shocked at how many calories it had. Some research lead to the discovery that the tortilla is 320 calories. Just the burrito coverin' is 320 calories. Chips and salsa seems sort of healthy, right? Did you know that a basket of chips and a serving of salsa from Chili's is over 1,000 calories? I didn't and my wife and I would kill a couple of those things sometimes. Tracking everything you will start to see things that stand out at you and can instantly (I even put stuff in before eating or ordering/cooking it to see where it is and often change my mind) give you feedback that you will use to make better decisions based on actual knowledge instead of guessing.
Now that you are armed with that your next step will be to start to fine tune all of this. Go to a site like IIFYM.com or any of the other sites that have a calorie calculator. Find out what your target caloric goal is to maintain your current weight. You can then add 400-500cal if you want to gain weight or deduct 400-500cal to lose about a pound per week. Now you have a genuine set number and a genuine way to track this. This is similar to having a speedo, fuel gauge and similar items for your car. You wouldn't drive your car w/o any gauges to constantly track what it's up to so why would you not apply similar tech to something as important as your health? Next you can get into macros and see what your macros should be. The three macros you will track are: protein, fat and carbs. Everything you eat will be comprised of those three macro-nutrients. A rough (you can also find online calculators to get more exact if you feel like it) breakdown of these to give you an idea would be 50% carbs, 25% fat and 25% protein. I don't kill myself over these or even really the calories now-a-days but I get pretty damn close most days w/o trying too hard. Careful though, that's after over a year (2?) of tracking everything I ate every day. Don't kill yourself over these figures out of the gate but you will want to make an attempt to get close. The calorie one is more important to get you going. Most will say that a quarter of your intake should be fat and you can add protein while subtracting carbs if in a strength gaining phase but the point here is that you should NOT cut out anyone of those macros as some fad diet might suggest and your body needs those macros to survive but you need to be careful of the amount in each bucket. I'm trying not to make it seem like you need to be a rocket scientist to figure this stuff all out because you don't. Install the app, add some friends who also use it if you like (it's fun to track each other's progress) use some online calculators to set your parameters and then just track what you eat. There's a learning curve but you will quickly find shortcuts and better ways to health.
Mark my words... you can NOT out work a shitty diet. Period. I thought if I did something as intense as Crossfit and pushed myself to the limit 6 days a week I could slack a little on the diet and I'd lose weight. Nope. Calories in. Calories out. Once I started tracking my eating & got serious about my macros and calories I dropped nearly 30lbs in a matter of a few months. People were constantly asking me what I was doing and my simple answer was 'You HAVE to track your calories and MyFitnessPal is the easiest way I've found of doing it and it's free.'
Diet is 90% and exercise is 10% of being healthy. That's not to say you don't need to exercise because you do. It's simply to stress that diet is key to health and no matter what you do you simply can't out work a shit diet. Even if you do say piss on all of this information I've posted and have the surgery you will HAVE to adjust your diet anyway or you will either die or get fat again. It's not the magic bullet. There is no such thing at this point in time.
So before you go under the knife don't you owe it to yourself to put forth a real effort to responsibly account for your diet? Stop the bullshit man. You aren't eating good. Period. I've been there. I would tell people I was the poster child of healthy eating and I just didn't have the time to work out and I didn't know why I was still fat. I knew why I was fat and so do you. Nobody could tell me anything though I had to realize that myself and take the first step to REAL lasting change. It sounds like you may be there but you really have to want it or anything I've listed above or the surgery will fail. You have to make life changes and you have to do it right now. It will change how you live your life. It will change how/when/where you eat. It may cost you some friends. In the end your health is the most important thing you have so **** anything and anyone that does anything to derail your journey to health. Seriously. Soda pop? Cut that bullshit out of your life right now. Never drink it again. It's pure death in a can/bottle and that's coming from someone who used to drink it 'occasionally' like you claim to too. My guess is you are drinking much more of it that you realize or are admitting. I was there man. You can't BS me and you need to stop BSing yourself.
In less than 2 years time I lost 75lbs and am now around 225lbs with a MUCH better body composition. I'm healthier right now than I have ever been in my life. I love working out and I'm slowing becoming happy with who I am. All of my clothes fit better. My attitude and brain function is better. I can't begin to tell you how much better my life is as a result of making fitness and health my primary hobby and surrounding myself with people who feel the same way. This is where Crossfit is nice. I make healthier choices during the day because of how I know it will affect my workouts & overall health. I get lots of people call it a cult but man is it amazing. You will get motivated every workout to push yourself harder than you ever thought you could go before. At first you will compete against yourself. I won't lie, will kick the shit out of you and keep coming for more. You will scale all of the movements. Your weights will be next to nothing on the resistance stuff. You will feel embarrassed and you will feel awful. Your first workout you will feel like you're going to die. Your second workout will likely be even worse because you will be sore from the 2nd workout. The 3rd will be even worse yet as you are fully sore from the first workout and now you're sore form the second workout too. Soon thereafter something will happen however. You will walk into Crossfit, see the workout and say to yourself 'Dear mother of god, no way in HELL can I get through that.' and you're right but you won't allow yourself to accept that as a reason to not do it. You will do the workout to the best of your ability and meanwhile 20 somethings around you will finish well ahead of you and you will notice, but you won't care. You are doing your own workout and most who finished already will be well aware of the fact that you are doing the most work in the room. Not them. You. You will push harder than you had previously pushed and you will struggle and you will come to the brink of death and then... finally... when you finish the workout that took you 3x longer than anyone else... it happens. You get that feeling. That amazing rush that you feel that no drug on earth can replace of feeling like you not only survived the workout but you exceeded what you thought you'd be able to do. You will be out of breath and you will be wishing for death and then... you will find yourself looking forward to the next day's workout. And then, my friend, it's all downhill.
I know this sounded like a commercial for Crossfit but 1) it satisfies my contractual obligation to mention Crossfit in every conversation and 2) I speak from experience and know countless people with a similar story. There's a load of hate from anti-Crossfit people but, like any workout, it's what you make of it. Sure you can get hurt but you're doing something physical so you can get hurt doing anything. I'm not saying you must go do Crossfit because it worked for me I am rather saying you need to find SOMETHING physical to do for exercise and it has to be something you thoroughly enjoy so you stick with it. Maybe it's Crossfit or maybe it's not but I can tell you that the money I pay for our Crossfit each month is easily the best money I've ever spent. Even though exercise might only make up 10% of the 90/10 ratio I mentioned earlier that doesn't make it any less important.
But it starts with a simple concept: Calories in. Calories out.
BTW, sorry for the word wall above. I was trying to be concise because I knew I had a lot to say but, as you can see, it's now something that I'm pretty passionate about.
There are morbidly obese people in the world who can wake up one morning and commit to a lifestyle that will get them to a healthy weight and give them a healthy life without a tool like weight loss surgery, a big-dollar Subway contract, or a Nutrisystem commercial gig. They are motivated, disciplined, admirable people. Sadly, they are rare.
Eurodriver
04-28-17, 20:17
That soda tho :(
don't drink calories. Mich Ultra beer. Water. Maybe a neat makers mark every once in a while.
Ditch that nasty habit pronto. Soda isn't even tasty.
That soda tho :(
Would go into DT's if I didn't have Sprite on hand all day.
Eurodriver
04-29-17, 10:34
Would go into DT's if I didn't have Sprite on hand all day.
How tho?!?
Doesn't it make you burp though? And burn on the way down? Or burn your nose if you burp and hold it in? And give you a nasty sticky mouth afterward?
Have you ever finished a soda and thought "That was refreshing"?
The only soda I find mildly tasty is Mountain Dew and even then after half a 12oz can I am done.
Have you ever finished a soda and thought "That was refreshing"?
Every single one is refreshing. And I ain't no tub o' lard. Think I'll have a Sprite and several yogurts(with peanut butter added) right now. I am literally going to finish typing and dig in. "Disgusting eating noises go here."
Outlander Systems
04-29-17, 14:50
Screw both of ya's.
As soon as I can figure out how to fill a Camelbak with a Vanilla milkshake and have it not thaw out I'll, show you what refreshing looks like.
Screw both of ya's.
As soon as I can figure out how to fill a Camelbak with a Vanilla milkshake and have it not thaw out I'll, show you what refreshing looks like.
Kinky..... 😂😉
Sent from my XT1585 using Tapatalk
Outlander Systems
04-29-17, 15:00
LOL. Real talk, homie.
Whenever I do a backpacking trip, after mile 10 I get an absolutely insatiable desire for a Vanilla milkshake.
Kinky..... ����
Sent from my XT1585 using Tapatalk
In better times, After a 5 mile run....I needed a cigarette.
Also I hate running.
Screw both of ya's.
As soon as I can figure out how to fill a Camelbak with a Vanilla milkshake and have it not thaw out I'll, show you what refreshing looks like.
Back at ya'!:)
Now I am off for a vanilla milkshake; not kidding.
Outlander Systems
04-29-17, 15:49
I'm sitting here, straight Jelly.
Back at ya'!:)
Now I am off for a vanilla milkshake; not kidding.
I had a Vanilla Butter Pecan Shake with my bowl of chili for lunch. Yummy.
thanks again everyone. I have been reading the comments even though I have not had a chance to reply.
Sitting at a very slow open house so finally having some time to catch up!
Even before I had posted this I had made a Drs appointment. Not about the surgery but just to talk to her about what I needed to do.
Without question my diet is the biggest single issue. So I am working on monitoring that closely to see how close or off I have been. Overall I was pretty close. The occasional candy bar if I am hungry and in a hurry. The main issue though as I thought is soda intake. I greatly underestimated how much I was drinking in a given day. So I have taken immediate steps to curtail that. Other than that it is probably a lot of inconsistency. Yesterday I had a burger and fries for dinner with my wife and friends. That is all I ate all day.
Today I had breakfast. Would kill for something right now, and may or may not eat both a late lunch and dinner.
A couple people have commented on eating 4 or so smaller meals and I feel that could go a long way towards balancing things out. I know my metabolism has to be bi polar at this point given my lack of schedule and consistency on meals.
In the end I have seen a lot good thoughts here on both sides of the fence and I do appreciate it.
I had a Vanilla Butter Pecan Shake with my bowl of chili for lunch. Yummy.
Damn I hate you man....
A good buddy of mine likes to brag about how some weekends he will go buy an entire dozen Krispy Kreme donuts and eat the entire box over a weekend. He is around 6 foot and under 200lbs, not to mention older than I am. Sometimes I feel the need to smack him obviously. LOL. If I ate like that I am pretty sure I would die immediatly.
Eurodriver
04-30-17, 15:00
Damn I hate you man....
A good buddy of mine likes to brag about how some weekends he will go buy an entire dozen Krispy Kreme donuts and eat the entire box over a weekend. He is around 6 foot and under 200lbs, not to mention older than I am. Sometimes I feel the need to smack him obviously. LOL. If I ate like that I am pretty sure I would die immediatly.
LOL A WHOLE WEEKEND TO EAT A DOZEN?
What takes him so long? I have eaten a dozen KKs in one morning.
Hold on my wife just turned on NASCAR what the ****...
Hold on my wife just turned on NASCAR what the ****...
http://i1372.photobucket.com/albums/ag347/GTF425/14425537_zpsngzygu4w.jpg
Eurodriver
04-30-17, 16:42
Oh yeah....
That happened.
Oh yeah....
That happened.
The liberals have euro now. It's over.
Kwelz, good luck man. Sounds like you're taking the right initial steps.
thanks again everyone. I have been reading the comments even though I have not had a chance to reply.
Sitting at a very slow open house so finally having some time to catch up!
Even before I had posted this I had made a Drs appointment. Not about the surgery but just to talk to her about what I needed to do.
Without question my diet is the biggest single issue. So I am working on monitoring that closely to see how close or off I have been. Overall I was pretty close. The occasional candy bar if I am hungry and in a hurry. The main issue though as I thought is soda intake. I greatly underestimated how much I was drinking in a given day. So I have taken immediate steps to curtail that. Other than that it is probably a lot of inconsistency. Yesterday I had a burger and fries for dinner with my wife and friends. That is all I ate all day.
Today I had breakfast. Would kill for something right now, and may or may not eat both a late lunch and dinner.
A couple people have commented on eating 4 or so smaller meals and I feel that could go a long way towards balancing things out. I know my metabolism has to be bi polar at this point given my lack of schedule and consistency on meals.
In the end I have seen a lot good thoughts here on both sides of the fence and I do appreciate it.
Good plan...consulting with a physician. Excellent place to start as long as it's a physician with some knowledge of obesity medicine. I say that because there are a LOT of doctors that have no clue, with less of an understanding that what I've seen expressed in this thread (with one or two notable exceptions). It's not a discipline that is commonly well-understood by your average primary care doctor.
Your BMI is not at a point where you just need to just tweak your lifestyle. You are in for a major renovation because losing 150 lbs and keeping it off is a Herculean task. Be realistic, be open-minded, be smart. Best of luck to you.
thanks again everyone. I have been reading the comments even though I have not had a chance to reply.
Sitting at a very slow open house so finally having some time to catch up!
Even before I had posted this I had made a Drs appointment. Not about the surgery but just to talk to her about what I needed to do.
Without question my diet is the biggest single issue. So I am working on monitoring that closely to see how close or off I have been. Overall I was pretty close. The occasional candy bar if I am hungry and in a hurry. The main issue though as I thought is soda intake. I greatly underestimated how much I was drinking in a given day. So I have taken immediate steps to curtail that. Other than that it is probably a lot of inconsistency. Yesterday I had a burger and fries for dinner with my wife and friends. That is all I ate all day.
Today I had breakfast. Would kill for something right now, and may or may not eat both a late lunch and dinner.
A couple people have commented on eating 4 or so smaller meals and I feel that could go a long way towards balancing things out. I know my metabolism has to be bi polar at this point given my lack of schedule and consistency on meals.
In the end I have seen a lot good thoughts here on both sides of the fence and I do appreciate it.
In terms of weight loss? Remember, docs have minimal to no training and education in nutrition. Been a while since I looked at recent stats, but of the 100+ med schools in the US, 12 required a single course in nutrition. I suspect it's higher since that stat came out, but regardless, not their area as a rule. I would say nothing wrong with getting a physical and full steam ahead on the weight loss/exercise focus clearance from doc. Doc may refer you to a clinical nutritionist that's in your network and such, so might work out well, just don't expect doc to be well versed on the best approach to lose weight via nutrition and exercise.
Good luck
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