Alfonso's Synchrony Health Weight Loss Journal

Dancin' the weight away...

2010-06-21T12:45:00.001-05:00

Down 0.8lb these past two weeks.

Silvia and I signed up for a month's worth of dancing classes at "Fred Astaire Dance Studios" (www.FredAstaireBurrRidge.com). The place is lively, fun, supportive, totally non-judgmental (important for someone like me with two left hooves). BTW, I have some free dance class vouchers if anyone wants them.

So, will I be able to continue classes forever? Nope, but my hope is to add a little lean muscle to get my metabolism up a bit. Silvia's hope is that I'll continue to take her out dancing after classes end. What is it that they say springs eternal..?

Seriously, though, it's always important to keep our activity levels up, and if you can have fun doing it, so much the better.

DETAILS:

121 Weeks of Synchrony;
93 Weeks at Goal Weight;

127.2lbs Official Weight Lost;
155.2lbs Unofficial;

173.8 (BMI 25.3) Official Weight;
169.8 (BMI 24.7) Real Weight.

Still on track...

2010-06-10T09:35:00.000-05:00

Down 1.8lb these past two weeks.

Using the Lap-Band the way God intended! Smaller portions, healthy meals, gentle weight loss!

DETAILS:

119 Weeks of Synchrony;
91 Weeks at Goal Weight;

126.4lbs Official Weight Lost;
154.4lbs Unofficial;

174.6 (BMI 25.4) Official Weight;
170.6 (BMI 24.8) Real Weight.

...and now slowly back down again.

2010-05-24T13:22:00.001-05:00

Down 1.0lb this past week.

A slight decrease in calories, a slight increase in activity, and I'm slowly easing on down again. God bless the Lap-Band!

DETAILS:

117 Weeks of Synchrony;
89 Weeks at Goal Weight;

124.6lbs Official Weight Lost;
152.6lbs Unofficial;

176.4 (BMI 25.8) Official Weight;
172.4 (BMI 25.2) Real Weight.

...and driftin' back up...

2010-05-17T13:22:00.001-05:00

Up 5.4lbs these past 7 weeks.

It's been a tough few weeks; hectic, stressful, disorganized. Excuses aside, I'm surprised I didn't gain more weight. Sigh. I'd like to post more but I'm really feeling out of sorts -- maybe the sore throat is a sign of impending illness rather than hoarseness from talking over the engine for 9 hours yesterday as I drove back from my brother's graduation through a neverending rain storm. BTW, I ate way too much over the weekend (Japanese hibachi and Bob Evans -- salt and more salt), so maybe that has something to do with the weight. Nonetheless, I'm going to crack down a little to get back to under 172.

DETAILS:

116 Weeks of Synchrony
88 Weeks at Goal Weight

123.6lbs Official Weight Lost
151.6lbs Unofficial

177.4 (BMI 25.8) Official Weight
173.4 (BMI 25.2) Real Weight

Driftin' back down

2010-03-29T10:44:00.003-05:00

1.8lbs down these past two weeks

So I've been cutting back a little bit on the calories, though perhaps not eating as well as I should. Saturday night I went to dinner with the family and had mostly meat; when I tried the veggies I had trouble keeping them down. My Lap-Band's been a little snug since I had the flu last week, and all the extra mucous production makes it difficult to keep foods down.

---

DETAILS:

109 Weeks of Synchrony
81 Weeks at Goal Weight

129.0lbs Official Weight Lost
158.0lbs Unofficial

172.0 (BMI 25.0) Official Weight
168.0 (BMI 24.5) Real Weight

18 months at goal, 6 months holding steady...

2010-03-15T17:25:00.000-05:00

So, trying to keep my weight around 170-175, I've managed to hold steady for 6 months now. I have my ups and downs, but that seems to be my average range.

This is an important point: your weight can vary day to day by more than a few pounds, so it makes little sense to weigh yourself every day. This is especially true if you've lost a lot of weight, where excess tissue can hold significant amounts of water.

I remember one weekend where my weight went from 198 on Friday to 206 on Monday. All I'd had was my usual diet of protein -- plus a small bag of Cheetos. Now, no matter what you may think, a bag of Cheetos does not weight 8 pounds! On the other hand, the sodium in the Cheetos can act like a sponge, so the large amount of water I normally drink was retained and pushed the needle on the scale over the top. A week later I was down to 197 without any other changes to my routine.

So clearly day to day weighing is pointless; however, especially if you're a woman, even week to week weighing can be misleading -- due to hormonal fluctuations.

So what's the answer? Well, although there's no perfect answer, here's a couple of suggestions (pick your fave):

1) If your clothes are starting to get tight, it's time to reduce your calories; or,

2) If you MUST have a number, do the following: keep a log, weigh yourself weekly and average the last FOUR weights. Compare those averages week to week. If the averages are moving up, cut back on food until the average gets down to your goal, then resume your usual diet.

The important thing is not to drive yourself crazy. The Lap-Band is there to help you take control of your life, so don't be a slave to the scale!

---

DETAILS:

107 Weeks of Synchrony
79 Weeks at Goal Weight

127.2lbs Official Weight Lost
155.2lbs Unofficial

173.8 (BMI 25.3) Official Weight
169.8 (BMI 24.7) Real Weight

Owie!

2010-02-12T16:21:00.001-06:00

1.4 lbs Up This Week

I threw my back out on Sunday. Yep, I was lifting a car up off a trapped little puppy when a raging bull charged out of nowhere and I had to rip Penelope Cruz's red dress off to distract the bull to drive it into a holding pen. Yep. That's the way I remember it...

Okay, it was either that or I threw my back out putting my pants on. One leg at a time. Sigh.

Either way, I spent all Sunday in bed, Monday on the couch, and Tuesday shuffling slowly around the house. Wednesday and Thursday I got some massage therapy; that plus a plethora of pain killers restored marginal functionality.

Needless to say, no exercise this week. The NSAIDs may have also led to water retention and weight gain. Well, that and the boxes of cookies and bags of chips I scarfed down out of sheer boredeom.

-----

DETAILS:

102 Weeks of Synchrony
74 Weeks at Goal Weight

132.6lbs Official Weight Lost
160.6lbs Unofficial

169.8 (BMI 24.6) Official Weight
165.8 (BMI 24.0) Real Weight

Slow and Easy

2010-02-03T08:41:00.002-06:00

0.4 lbs Lost This Week

It's been a good week, averaging over 5,000 steps daily and working out 3 times per week (resistance + cardio).

At the same time, I've been eating well (mostly) and generally feeling well too.

I had a minor tweak to my Lap-Band (0.1cc), which was just enough to clear up some of my trouble getting thick liquids down (before that, water was fine and meat was fine, but yogurt was a problem).

I had something else to report, but for the life of me I can't remember what it was. Oh well, I'll post it if and when it comes back to me.

-----

DETAILS:

101 Weeks of Synchrony
73 Weeks at Goal Weight

132.6lbs Official Weight Lost
160.6lbs Unofficial

168.4 (BMI 24.4) Official Weight
164.4 (BMI 23.8) Real Weight

Body Comp Results

2010-01-26T09:54:00.002-06:00

-- Okay, so I'm starting to work out and it made sense to have a "before" snapshot to gauge progress. My weight is good (165 lbs / BMI 24.0); my body fat percentage is very good (14.4%); and my water percentage is also good (62.7%).

For comparison, "normal" ranges are BMI 18.5-25.0; body fat 11-22%; and water 60-70%.

Now, what I need to work on is increasing muscle mass, which is currently: core, 75.2lbs; arms, 7.6lbs avg; and legs, 22.2lbs avg.

I've started on a light resistance training routine, 2-3 times per week. Two reasons for starting light: 1) as someone who was morbidly obese and has not worked out in years, I'm basically a rehab patient and likely to injure myself; 2) I don't want to "burn out" and quit.

Too many of our patients jump in headlong -- whether on their own or thanks to a bouncy high-school dropout gym "instructor" -- and get injured or quit.

Slow and steady my friends...

Family Concerns

2010-01-25T11:43:00.003-06:00

1.2 lbs Lost This Week

So my dad, who's a doctor, called me up this morning, concerned for my health, suggesting I get my Lap-Band loosened and an EGD to look for "narrowing of the esophagus".

Here's what led up to the call:

I went to a sushi buffet lunch with my dad, brothers, wives, kids, etc. yesterday, despite not feeling well and my general misgivings about buffets, and sat next to him and my older brother -- both of whom can put away quite a bit of food.

I felt embarassed that I wasn't giving my dad his money's worth, so I tried eating more than I should. I ended up having to go to the bathroom to spit up some mucous. After I came back, I still felt a bit uncomfortable and drank some water, which I promptly had to go spit up again.

On top of that, I had hurt my Achilles tendon and was barely hobbling along, plus I've been bone tired and a little sick all week.

My dad sees all this and blames the band.

He's an intelligent and educated man, an excellent physician (gynecologist though), and definitely has my health and happiness in mind, but he doesn't know much about the band or how it works.

This underscores a problem many of our patients have with their families, most of whom know much less than my dad and may have stronger preconceived notions.

They need -- WE need -- our families and friends to be supportive and trust in our physicians who have years of experience and expertise in this specific area.

My labs are excellent. My body mass composition is well within the norms for a healthy adult. And my nutrition is better than it's ever been. As long as Dr. Watkins and Dr. Ghani believe I'm doing well, then I'm doing well.

I love my dad, I love my family, and I'm trying to be nice because their concerns are well intentioned (though perhaps not well informed), but I'd rather have their support than their opinions.

I almost had my band loosened. I had no thought of doing it until my dad called, and there's little doubt that, whatever my rationalizations, I would have done it for him and not for me. The last time my band was loosened I started gaining weight. Since I had it retightened I've lost the weight I regained -- over the space of two months. Losing 8 pounds in 8 weeks is certainly not going overboard.

I don't know. Maybe my face looks a bit gaunt. That's inevitable -- we don't lose weight evenly all over the body. Now that I'm starting to work out, slowly and carefully, I should regain some more tone and look a bit better.

I guess the bottom line is -- as we say to our patients -- I have to do this for me, not for anyone else. If I feel happy and the experts say I'm healthy, then that's that.

-----

DETAILS:

100 Weeks of Synchrony
72 Weeks at Goal Weight

132.2lbs Official Weight Lost
160.2lbs Unofficial

168.8 (BMI 24.4) Official Weight
164.8 (BMI 23.9) Real Weight

Technical update

2010-01-20T15:59:00.003-06:00

I was using a calendar to count weeks and somehow missed one on the Optifast count, so I corrected this week's post to 99. Beginning next week, I'm going to stop counting Optifast vs Lap-Band weeks and switch to "Weeks" and "Weeks at Goal Weight" since these are really more relevant.

Since reaching goal, I've used Optifast bars as a snack and meal replacement, but I haven't been on what you could call an Optifast "program" per se.

At the same time, I don't follow the Lap-Band "program" per se either. I'm supposed to eat three square meals a day, but I often find myself skipping a meal and grabbing an Optifast bar instead.

So, I'm not following either "program" I guess, but instead found a balance that works for me -- my weight is good and my labs are great. And that, my friends, is what Synchrony Health is all about.

Hey! There you go! I'm following the "Synchrony Program"!

Whoa!

2010-01-19T11:12:00.002-06:00

Week 85 Lap-Band (Week 99 Optifast)
Weight Loss 2.8lbs (131.0 total lost)
Official Weight 170.0 (BMI 24.6)
Real Weight 166.0 (BMI 24.0)

Okay, so what do we think happened here? I was eating pretty well the whole week, and my activity level was pretty low (average 3,000 daily steps). And yet, I lost a whole bunch of weight.

Two possible reasons:

1) In previous weeks, I had been losing weight at a normal clip but the effect was masked because I had quite a bit of sodium, which helps retain water on the body and prevents the needle on the scale from moving in the right direction. In other words, I just shed a lot of water this week.

2) I've been feeling pretty poorly all week, and my metabolism may have been messed up. It's hard to tell what leads to what: was I feeling low because I had an accelerated metabolism that was quickly burning through the limited calories I was consuming and causing hypoglycemia, or was my feeling low causing me to eat less than I thought I was consuming?

Either way, I don't need to lose weight this quickly, and I certainly don't need to lose weight at the expense of not feeling well. I'm going to do my best to increase my calories; however, since I don't count them closely, there's a fine line between too much (gaining weight) and too little (losing too fast).

Sigh. I suppose I could just eat more when I feel down to bring myself up. But then that's one of the things we're not supposed to do! Double sigh.

Made it under the wire

2010-01-11T17:02:00.005-06:00

Week 84 Lap-Band (Week 96 Optifast)
Weight Loss 1.2lbs (128.2 total lost)
Official Weight 172.8 (BMI 25.0)
Real Weight 168.8 (BMI 24.5)

The holidays are almost over. Almost -- because people who were out of town or out of the country have returned bearing delicious gifts, and the holidays won't be completely over until all gifts are consumed.

Dr. Ghani mentioned that most Americans gain about 10lbs over the holidays, but I wonder if that's because he gained that many...

Bearing that in mind, gaining less than 10lbs is something to be grateful for, not gaining any weight is phenomenal, and actually losing some weight is clearly a gift from above.

So, to wrap up my disparate threads of thought, I managed to lose enough weight to squeak back into a "normal" BMI of 25 just before the holidays have really ended. Now THAT is a miracle!

Labs are in!

2010-01-09T09:18:00.002-06:00

So, after a year of keeping my weight mostly in check, and at least 6 months of eating whatever I want whenever I want, did I learn enough at Synchrony Health to make better choices and stay healthy as well as thinner?

YES!

My labs came in and they are clean across the board! I won't post all the results, but the tests that were run are below:

Complete Blood Count with Differential; Complete Metabolic Panel; Magnesium; Phosphate; Uric Acid; Thyroid Stimulating Hormone; Thyroid, total; Vitamin B12; Folate; Homocysteine, Cardiovascular; Cortisol; Cardio C-Reactive Protein; Insulin; VAP (Lipoprotein, Blood -- High Resolution Fractionation & Quantitation); Assay of Triglycerides; Testosterone, total; Vitamin D, 25-Hydroxy; and Vitamin D, 1, 25-Dihydroxy.

Oh yes, we are crazy thorough here at Synchrony Health!

It's much easier to be thin and UNhealthy -- just eat small portions of absolute crap all day -- than to be thin and healthy, and that's what it's all about.

Deja vu all over again

2010-01-06T14:26:00.002-06:00

Week 83 Lap-Band (Week 95 Optifast)
Weight Loss 0.0lbs (127.0 total lost)
Official Weight 174.0 (BMI 25.2)
Real Weight 170.0 (BMI 24.6)

Another holiday without any weight gain! Although I was confident I wouldn't eat much on New Year's, it's still a relief. I sat around doing nothing and nibbling on a fairly constant basis, so I was a little concerned.

Also, I'm working on a review of protein bars for our banded patients, and all that taste testing can be a bit dangerous -- especially with some of the bars that are pretty much all sugar. Mmmmm. Sugar!

Next week I hope to report at least a little weight loss. Until then, I have one recommendation to everyone out there who made a New Year's resolution to lose weight: take it easy! Most weight loss attempts fail because we're too hard on ourselves and we set unrealistic goals. Cut back on the mindless snacking, substitute a few foods for healthier alternatives, and increase your activity level a little without going overboard. Slow and steady wins the race folks!

I made it!

2009-12-29T17:49:00.002-06:00

Week 82 Lap-Band (Week 94 Optifast)
Weight Loss 0.2lbs (127.0 total lost)
Official Weight 174.0 (BMI 25.2)
Real Weight 170.0 (BMI 24.6)

I actually managed NOT to gain weight over Christmas! Woohoo! New Year's is not such a big eat-a-thon, so I should get right back on track for those last few pounds. Happy New Year everyone!

Holiday Eating

2009-12-22T18:01:00.001-06:00

Week 81 Lap-Band (Week 93 Optifast)
Weight Gain 0.2lbs (126.8 total lost)
Official Weight 174.2 (BMI 25.2)
Real Weight 170.2 (BMI 24.6)

Although my weight is nominally higher today than last week, it was lower on Saturday, suggesting I’m retaining water or something like that. I did eat a bit more than I should Sunday, but more likely it was the good selection of tasty (if salty) foods at yesterday’s office party. I have to remind myself that it’s a marathon, not a sprint…

As for holiday eating, here are a few tips you can use:

- Eat before you eat. Seriously. Have a nutritious snack an hour before mealtime; you wouldn’t go grocery shopping on an empty stomach, so why subject yourself to the hypoglycemia-enhanced temptation of an all you can eat smorgasbord of delicious but oh-so-wrong foods? You can still enjoy, but hopefully in slightly more moderation.

- Drink a glass of ice water before eating, then don’t drink anything during or after your meal for at least a half hour. This will give your stomach time to signal your brain that you’re full.

- Eat from a small plate. Serve yourself your favorite foods and enjoy the heck out of them, but limit yourself to what fits on that plate.

- Carry a glass of ice water in one hand, and a plate filled with a bunch of foods you don’t like in the other hand. You won’t be tempted to eat, and other partygoers won’t try to force you to help yourself to more food.

The holidays are a time to enjoy – and presumably you’ll want to enjoy more time with friends and family than with food. Most people feel guilty for spending too little time with family and too much time with food – not the other way around. I’m not saying you shouldn’t enjoy food, just keep things in perspective.

Warmest holiday wishes on a cold winter’s night,
Alfonso

That was easy!

2009-12-15T11:18:00.002-06:00

Week 80 Lap-Band (Week 92 Optifast)
Weight Loss 2.0lbs (127.0 total lost)
Official Weight 174.0 (BMI 25.2)
Real Weight 170.0 (BMI 24.6)

Following last week's Lapband adjustment by Dr. Watkins, I had one awkward night where I forgot to pick my foods carefully and not eat too close to bedtime. After that, the rest was smooth sailing.

I lost most of my less-than-ideal cravings and went back to a focus on protein and veggies. Not always perfect, of course, but better than before.

Bear in mind that I tend to discount the first week's weight loss; whatever I lose from here on is what I'll consider my "real" weight loss (ie, fat loss).

And yes, I am definitely feeling better than before. I wonder if my sugar consumption had something to do with my prior ennui...

[Insert clever title here]

2009-12-08T11:03:00.001-06:00

Week 79 Lap-Band (Week 91 Optifast)
Weight Loss 0.6lbs (125.0 total lost)
Official Weight 176.0 (BMI 25.5)
Real Weight 172.0 (BMI 24.9)

I finally got my Lapband tightened yesterday by Dr. Watkins. Just 0.25ml and I've gone from eating almost freely to sipping water slowly. Sigh. He suggested doing a little less than 0.25, but what does he know? He's only one of the top band surgeons in the country...

One immediate benefit I noticed is that I didn't feel as food-focused last night as I have over the past few weeks.

That said, I'm going to have to be careful for a while, focusing on protein and eating slowly. As I lose weight, the band will become looser, and I'll hopefully find a balance point somewhere south of 170lbs.

I should mention that I've been a little under the weather for more than a week now, and I'm feeling a bit lethargic. It doesn't help that yesterday was Chicago's first real snowfall of the season, and tonight we're expecting a serious snowstorm. Unlike previous years, I'm not really looking forward to winter this year. Double sigh.

So, no snappy goodbyes (or clever titles) today. See you next week.

Oops!

2009-12-04T17:23:00.003-06:00

Week 78 Lap-Band (Week 90 Optifast)
Weight Gain 0.6lbs (124.4 total lost)
Official Weight 176.6 (BMI 25.6)
Real Weight 172.6 (BMI 25.0)

I, umm, "forgot" to get my band tightened. Ah tee hee. Oopsie!

The worst thing is not the overeating, it's been the poor eating. I've gotten very little protein or healthy vegetables; instead it's been mostly junk food and treats. It doesn't help that I've been sick, but neither does that excuse what I know to be inappropriate eating choices.

The worst part is I fall victim to my own mindgames, doing the stuff I counsel others on how to avoid.

Sigh. I knew it would be a lifelong struggle, but at least I'm conscious of it and able (with a small needle stick and some saline solution) to do something about it. In fact, I'm going to schedule my adjustment right now. Hang on...

There, it's done. I'm scheduled for 2:30 pm Monday.

I know I keep saying this, but "Wish me luck!"

Something's definitely up...

2009-11-24T11:00:00.001-06:00

Week 77 Lap-Band (Week 89 Optifast)
Weight Gain 2.0lbs (125 total lost)
Weight 176.0 / BMI 25.1
Real Weight 172.0

My weight. There's no denying it anymore. Over the last six weeks, I have definitely gained 3 lbs (in addition to the bounceback effect).

Well, definitely time to tighten my belt (and band) and get back to business. Dr. Watkins will be back Monday, so I conveniently will have a few days to enjoy the Thanksgiving feast at my Dad's.

Which reminds me folks: everything in moderation -- including moderation. Enjoy!

Am I gaining weight?

2009-11-09T15:21:00.002-06:00

Week 75 Lap-Band (Week 87 Optifast)
Weight Gain 1.0lb (127 total lost)
Weight 174.0 / BMI 25.1
Real Weight 170.0

Although it can be hard to tell, I'm starting to think I may be slowly gaining weight. I had my Lap-Band loosened on October 12, almost a month ago. Since then, my official weight has gone from 170.8 to 174.0.

Of course some bounceback is expected as your go from a calorie (and food) deficit to a normal diet. Your digestive tract fills up, your liver and muscles store a pound or more of glycogen, your tissues start retaining more water as sodium consumption normalizes, etc.

However, I've been tracking my weight using the average of the previous 4 weeks' worth of measurements:
--10/13: 172.35 (baseline)
--10/20: 172.4
--10/27: 172.55
--11/03: 173.3
--11/10: 174.1

Since the 11/03 measurement of 173.3 would seem to account for any post-adjustment bounceback, the gain since then would suggest a real weight gain of almost a pound.

Sigh. Well, I'll keep things going the same for a few more weeks, and if weight continue to rise, I'll have the band re-tightened and maybe do a one-week full liquid Optifast diet just to kickstart things.

Steady as she goes...

2009-10-24T08:52:00.003-05:00

Week 72 Lap-Band (Week 84 Optifast)
Weight Gain 1.0lb (128 total lost)
Weight 173.0 / BMI 25.0
Real Weight 169.0

I had my Lapband loosened by Dr. Watkins a couple of weeks ago. I don't want to lose any more weight, but I was afraid I might start overeating.

I did at first, and I was surprised to find myself hungry. I was more than a little concerned about this, until I realized you're supposed to feel hungry if all you've had all day is coffee. This is what normal feels like. Weird, huh?

So Ive taken to eating breakfast from time to time, lunch fairly regularly, and a nice dinner every day.

So far the bounceback has been only 2 pounds from my low of 170.8 (166.8). Although I expected more, I guess I was hoping for none -- or even more weight losss, even though I don't want to get thinner.

Remember, I have 5-15 pounds of excess skin, meaning my weight is comparable to 158lbs for someone who hasn't spent a lifetime being obese. My 13% body fat is the same as my rail-thin teenage kids, so more weight loss is definitely NOT a good idea.

What IS a good idea is to exercise, but I've not been able to find time or energy. Yeah, I know, excuses, but be gentle -- my average workday is 12-16 hours five days a week, and another 8 hours Saturdays, plus an ocassional Sunday (like tomorrow) thrown in for good measure.

Getting back to the bounce, I was so nervous I considered asking Dr. Watking to put the fluid back, but I've decided to hold off for a month. I'll track my weekly average carefully and see if there's a clear upward trend before tightening the band up again.

In the meantime, I'm enjoying eating and drinking normal amounts of normal foods, although I do have to watch out for those pesky Vermonters Ben and Jerry...

Slow and easy...

2009-10-08T14:44:00.002-05:00

Week 70 Lap-Band (Week 82 Optifast)
Weight Loss 0.4lbs (129 total lost)
Weight 172.0 / BMI 24.9
Real weight 168.0

Well, in the last two weeks I have significantly increased my eating – I'm trying for 3 decent meals and one or two nutritious snacks in between. Okay, so no always succeeding, but definitely trying to slow or stop the weight loss.

One of the wonderful plastic surgeons from the Geldner Center in Oak Brook mentioned I might have a few pounds of excess skin (anywhere from 5 to 15), so my weight under all that might be in the 150s. That makes sense, given that my body fat composition (13.9%) is similar to my beanpole kids Danny and Erick, despite their wearing much tighter clothes.

Speaking of which, I fit into my first pair of size 34 jeans since I was a kid! My inner fattie made me buy the size 36 instead because I'm so used to loose clothes. Sigh.

Finally, I'm not sure I've mentioned this before but I've been helping Dr. Ghani out by giving his weight loss lectures at four of the Centers for Weight Management. I pretty much read through them and stick to the script, but I'm able to give my perspective on the various subjects, and the students seem to like that.

Okay, I'm being modest. I've been told that these are the "best classes ever" by folks who've been through many weight loss programs (including the big ones, so to speak).

The past six weeks consisted of behavioral topics: Embracing Change; Managing Food & Activity Cues; Change Your Eating Style; Stress Management; Time Management; and Making Changes, Managing Lapses.

Coming up we have a few health and nutrition topics: Knowing Nutrients I & II; Understanding Protein; Water; Reading Food Labels; and Weight Loss Supplements.

Following that there are lifestyle topics: Planning Meals; Shopping Smart; Cooking Quick & Light; Eating Out; and Accumulating Activity.

Our trainer "Dano" does the fitness topics: Introduction to Bariatric Fitness I & II; Strength Training; Endurance Training; and Flexibility Training.

I'm leaving it to Dr. Ghani to personally deliver the medical topics: Causes of Obesity; Consequences of Obesity; Diet Myths; and Obesity Treatment Options.

Although these lectures take a lot of time and effort, they are really worthwhile – not only do I get to listen to myself talk for an hour or two several times a week, I get a captive audience that has to sit there and listen to me. It's like a road trip with a chatty kid!

GOAL!!! golgolgolgolgolgolgolgolGOLAZO!

2009-09-25T13:31:00.002-05:00

Week 68b Lap-Band (Week 80b Optifast)
Weight Loss 3.2lbs (128.4 total lost)
Weight 172.6 / BMI 25.0
BP 102/58 HR 72

Yes! BMI 25! But wait! There's MORE! Or rather LESS!

Out of a sense of consistency, I've been weighing myself fully clothed and with shoes on. My actual weight is (drumroll please):

168.6 lbs
24.5 BMI
13.9% Body Fat

Can I get a woohoo! folks?

I'm in a rush but I wanted to share the good news!

Almost there...

2009-09-23T16:58:00.001-05:00

Week 68 Lap-Band (Week 80 Optifast)
Weight Loss 1.8lbs (127.0 total lost)
Weight 174.0 / BMI 25.3

Busy week (activity) plus good food (protein & veggies in appropriate portions) = weight loss!

So last week I was worried that some of the weight loss was just dehydration and malnutrition. After a week of eating and drinking well, I'm glad to see the needle is still sliding to the left.

One great thing I did this week is I did not eat ONCE in front of the TV! Of course, it helps that AT&T screwed up my installation and I didn't HAVE TV, but still...

Okay, fine, we'll see how it goes this week.

Meantime, I'm ecstatic about being a stone's throw from goal. Eek! Don't wanna jinx it!

Movin' on up (and down)

2009-09-14T09:53:00.004-05:00

Week 67 Lap-Band (Week 79 Optifast)
Weight Loss 3.8lbs (125.2 total lost)
Weight 175.8 / BMI 25.5

Silvia and I moved up to a nicer apartment over the weekend, and the needle on my scale moved down to a nicer location. Of course, I worked hard, didn’t eat much, and I’m partly dehydrated, so take my weight measurement with a grain of salt. Oh wait, scratch that – salt impedes weight loss.

It’s been easy keeping my weight steady over the last few weeks; however, since I still have a little bit more to go, I feel that some part of me is rebelling and sabotaging my efforts. Fear of success? Fear of completion? This can be a real issue. Once I hit my target weight, my “diet” is over. I’ve lost weight before, many times, but once the diet ended I started regaining the weight. Is it possible that some part of me fears ending the diet and starting my “normal” life?

I suppose I should remember that I’ve kept the same weight range for the last several months, and that I can continue doing so indefinitely. I certainly haven’t been starving myself (last night’s dinner was some steak, some veggies, a small bowl of broccoli cheddar soup, and half a slice of pecan pie a la mode), so I should be able to continue this lifestyle. In fact, it will be even better since I’ll be able to increase my daily calories a bit once I’m done trying to lose more; plus, I may take up regular exercise now that I have no excuse left (my new place has an indoor gym and I can no longer rely on the controversial “exercise impedes weight loss efforts” maxim).

Sigh.

How do you release the damn brake?

2009-08-19T14:22:00.000-05:00

Week 63 Lap-Band (Week 75 Optifast)
Weight Gain 0.6lbs (121.4 total lost)
Weight 179.6 / BMI 26.0

Seriously. I’m glad to be doing well and not gaining any weight, but I’m a few pounds away from my goal and it’s getting frustrating!

All week my best intentions to cut back on calories have come up short. I realize I’m ultimately responsible, but friends and family keep pushing food on me and I haven’t the will to say no. Well, to say no and mean it.

I try making it clear that I’m so close to my goal, and instead of encouragement I get the “Oh, you’re too skinny already” line. I may not NEED to lose more weight, but I would LIKE to do so. I would like to settle on a clothing size once and for all. I would like to settle in under 25 BMI. I would NOT like to settle for settling!

Maybe I’m getting cranky from sugar deprivation. Maybe I’m being unrealistic. Maybe I’ve bought into the whole Madison Avenue anorexia-chic. Maybe, but I’m not trying to do something unhealthy and I don’t think I’m harming anyone in the process. Is it too much to ask for a little help?

Putting the brakes on

2009-08-11T10:41:00.001-05:00

Week 62 Lap-Band (Week 74 Optifast)
Weight Loss 0.8lbs (122.0 total lost)
Weight 179.0 / BMI 25.9

I’ve been advised by several people that, at my present weight, losing 3 pounds in a single week is a bit too much. Although I’m not sure how much was fat and how much “other” (water, intestinal contents, glycogen, etc.), I don’t disagree with the advice. Over the course of the previous week, I was dizzy several times when standing up, and I felt generally listless and tired.

This past week I increased my intake, eating on average two to three small meals a day, a few times eating hearty portions (8 ounces of prime rib at Outback, two trips to New China Buffet, etc.), and one evening going nuts for no apparent reason and finishing off two pints of gelato. The result is a modest but mostly healthy 0.8 pounds.

Ideally, I’d like to lose between 1 and 2 pounds, so I’m going to try to cut back on the buffets and ice cream this week. Maybe I’ll substitute organic almond butter and chocolate chip cookies…

Good new / bad news

2009-08-04T11:57:00.001-05:00

Week 61 Lap-Band (Week 73 Optifast)
Weight Loss 3.0lbs (121.2 total lost)
Weight 179.8 / BMI 26.0
BP 92/64 / HR 80

The good news is I’m still losing weight, eating plenty of protein, using the band to limit portions, avoiding heartburn/reflux inducing late night meals and not throwing up.

The bad news is two-fold:

First, I’m probably eating too little. I’ve had a couple of dizzy spells and my blood pressure is a bit low. Generally, I only get one real meal a day, and that’s around dinner time. If I’m lucky, I get a protein bar in the mid afternoon. This has not been a conscious choice; rather, my life has been particularly hectic, not leaving me time to eat properly. Because my band is pretty tight, I have to eat slowly and chew carefully, and I haven’t been able to do so.

The second bit of bad news is that one third of my weight lost has been muscle mass. I did my body composition analysis and compared it to my previous results. Having reviewed the best medical literature on the subject, the answer seems simple: lack of exercise. Early on, I exercised or maintained high levels of activity, and my weight loss was mostly fat; later on, my activity decreased and muscle loss increased. One small study comparing diet alone, diet plus aerobics, and diet plus aerobics and weight training found lean muscle mass losses of 30%, 25%, and 3% respectively.

Sigh. And I just cancelled my gym membership…

Ch-ch-ch-Changes!

2009-07-28T10:44:00.003-05:00

Week 60 Lap-Band (Week 72 Optifast)
Weight Loss 2.2lbs (118.2 total lost)
Weight: 182.8 / BMI: 26.5

Although I do grab a delicious (and nutritious!) Optifast shake or bar when I need a quick boost, I have been relying almost exclusively on the Lap-Band for a month or two now (since Dr. Watkins did my last adjustment). Consequently, I'm switching my counter from Optifast to Lap-Band.

Also, my BP is pretty much the same week to week, so I'm dropping it from the reporting (as I did with my blood sugar when it normalized last year).

With all of my other health metrics normal, my last remaining goal is to get to a normal BMI of 25 or less (about 173lbs).

Having said that, this weekend was not exactly conducive to weight loss.

Saturday afternoon Silvia and I went to Chinatown's Dragon Boat Race and ate with Dr. Li and his family. There were more than a dozen huge dishes, all delicious. Special mention must be made of the Duck Butt, which was amazingly good (and an honor, since it is traditionally given only to the highest ranking person at the table). Ducks are hung from the neck, so all the juices run to the bottom (literally). Please note that this is the tail, not the cloaca...

As if Duck Butt wasn’t enough, we went to a dinner party that night and ate another bunch of tasty food.

Then, just to be extra stupid, we went to my Dad’s for a cookout Sunday noon. I grilled 6 filet mignons, 4 rib eyes, 4 NY strip steaks, 16 lamb chops, 12 Italian sausages, and a pound of bacon – for EIGHT PEOPLE! And no, virtually no leftovers.

Well, anyway, at least I got plenty of protein. Monday I ate nothing throughout the day, then a small chorizo and eggs dish for dinner, plus a cup of non-fat light ice cream (Edy’s Slow Churned Cookie Dough – highly recommended).

Bulimia ain't so bad...

2009-07-21T10:55:00.002-05:00

Week 71 Optifast (Week 59 Lap-Band)
Weight Loss 1.0lb (116.0 total lost)
Weight: 185.0 / BMI: 26.8
BP: 114/86 / HR: 78

So I'm learning the hard way to keep away from ice cream. A few times this week I figured I'd be able to sneak some in, only to have it sneak right out again.

Joke title aside, the kind of vomit you get with the band is not the same as "normal" bulimics induce. Because the pouch gets full quickly, the body produces extra mucous to wash food down. Unfortunately, this doesn't go through the stoma easily, so matters get worse. The vomit that results is generally pure drool (often foamy) and comes up easily -- unless, of course, you actually overdid it, in which case you toss your literal cookies as well.

While generally not painful or spastic, it's certainly not comfortable and can be embarassing. This serves as a motivator to avoid certain foods and excess quantities.

Protein (meat, chicken, fish) is still going down fine, filling my pouch and sitting comfortably atop my band stoma for hours.

The bottom line is that I've thrown up a few times since getting tightened, and though this is hardly ideal, it is keeping me from eating wrong. If I behave myself, I shouldn't have too many problems. Also, I'm only a few weeks away from a normal BMI...

Way to go bulimia!

PS I realize some people may read this not knowing my particular sense of humor. So, to be clear, bulimia is BAD. Vomiting is NOT a good way to lose weight. Sigh. Please don't sue me...

Ice cream, steak, and medium shirts

2009-07-14T10:55:00.002-05:00

Week 70 Optifast (Week 58 Lap-Band)
Weight Loss 2.0lbs (115.0 total lost)
Weight: 186.0 / BMI: 26.9
BP: 110/70 / HR: 80

I had a little too much peanut butter and ice cream last week (usually not together), but otherwise I’ve been pretty good. I’m using my band properly – though less by choice than by necessity. I’m tight enough that I can’t get liquids down easily (a sip every 5-10 minutes), but solid protein seems to go down without problems, filling my pouch and leaving me satisfied. So, ice cream is mostly out but steak works just fine.

One uncomfortable but necessary consequence of having my band this tight is that I have to eat dinner early and avoid any snacks afterwards; otherwise, I get nighttime reflux.

On the plus side, my medium shirts are fitting again, which was the whole point of this latest weight push. I’m at an awkward point where large shirts are too big (especially the neck) but mediums are too snug. Sigh.

If I can lose another ten pounds, I’ll be in the “normal” BMI range, but more importantly I’ll be able to stop dry cleaning my shirts to prevent their shrinking. More years in my life AND more money in my pocket!

Back on track!

2009-05-20T17:11:00.002-05:00

Week 62 Optifast (Week 50 Lap-Band)
Weight Loss 5.0lbs (112.0 total lost)
Weight: 188.0 / BMI: 27.2
BP: 114/79 / HR: 78

Fasting Blood Sugar: 90

Non-Fasting Blood Tests:
- Insulin: 17 (marginally high)
- Total Testosterone: 567
- Cardio CRP: 5.0 (slightly elevated risk, but may be transient effect)
- Cholesterol: 184 / HDL: 56 / LDL: 110 / Triglycerides: 84

Well, I'm finally back! It took a dozen retries (during which I lost a little weight, so no effort is wasted effort), but I finally managed to stop my nightly ice cream frenzy. Yay!

My name is Alfonso and I'm a Haagen-holic. I haven't had a taste in 5 days. Days are fine, but evenings I get that old familiar tingle -- you know the one, where you start circling the kitchen, maybe for a glass of water, then to see if there's anything healthy in the fridge. Maybe you "absent-mindedly" crack the freezer open and -- there it is. Just staring at you. Expiring. What a waste that would be! Well, maybe if you have just a bite. Couldn't hurt, huh? Just a spoonful to take the edge off the craving. Your fingers fumble as you tear the wrapping off, grab the spoon and dip it into the hard surface. You eagerly rush that sweet heavenly prize into you eagerly awaiting mouth and BOOM! The cream and the sugar explode in an ecstatic paroxysm of flavor, coating your tongue and palate in overindulgent luxuriousness.

And then, the feeling subsides. A quietness settles around you. The spoon starts to head into the sink but pauses, pensive. That first bit, it wasn't really a whole spoonful, was it? The ice cream was hard, you had to scrape some. It wasn't a taste, it was a tease. You have to be fair to yourself, don't you? So you work the spoon it, carefully trying to get a good -- fair -- chunk, and then pop in that nugget of goodness and light. This time you savor it more. Now we’re talking! Oh how that transports you!

You make it last as long as possible but, but, you feel cheated! By trying to make it last you watered it down with your own drool! That last swallow was disgusting! Ugh! No, your last memory of that sweet treat can’t be so sour, so you take just a little more – just a tiny bit to recapture the lost essence – and you accidently uncover a praline.

Well, this is a whole different matter now. How can you be satisfied? You just had a little vanilla, but this is Haagen-Dazs’ “Pralines and Cream”. How can you not have any pralines with your cream? So your spoon digs in and finds little resistance as the caramel’s liquid consistency lets it slide right through, pulling up a big ole chunk that you flip into your mouth without a second’s pause. And WOW! Unbelievable! How could that be so much better than the first bite?

And then it begins. You don’t even think about it as you grab just a little more. Then the edges of the cup are a little ragged, so let’s scrape away a bit around the edge to even things up. Oh, and there’s another lumpy praline sticking out. Let’s dig it out, and maybe smooth the ice cream edges away a bit.

Well, we’ve had maybe a quarter pint. That’s not so much, really. 240 calories? Nothing! We’ve been good all day, we deserve a little reward! So let’s make a deal: half a pint, and we call it quits.

Uh huh. Right. Sure. Now where’s that TV remote..?

Sigh.

I don’t want anyone to get the wrong idea. Yes, we should all enjoy a little something from time to time, but it has to be in a safe environment – like a court-supervised visit. Get one of those tiny quarter-pint containers. Take it home. Undress. Relax. Turn off all distractions. Focus all your attention on each delectable bite. Enjoy the hell out of it. When it’s done, it’s done.

And for heaven’s sake, don’t wait until the crave hits, do it early. Don’t make it a reward, make it a scheduled indulgence. Tuesday is ice cream night!

And finally, if you do toss back a whole pint of ice cream, don’t make things worse! Don’t wait until tomorrow or Monday or the first of the month or the first of the year! Start over immediately! Start over before your spoon hits the sink. It over, it’s done, now let’s move on!

Okay, this time I mean it!

2009-05-06T12:21:00.003-05:00

Week 60 Optifast (Week 48 Lap-Band)
Weight Gain 2.0lbs (108.0 total lost)
Weight 193.0 BMI 28.1
BP 116/81 HR 86

Metabolic Rate 16% Above Normal
Resting Energy Expenditure 2,174 calories per day
Estimated Daily Calorie Requirements 3,051

So I'm getting serious. The shirts are definitely tight now, and I've got a formal event coming up (my Dad's two-year tenure as president of the Bolivian American Medical Society is coming to an close; when I attended his inauguration I weighed 320lbs).

I got my blood drawn (see above) and metabolism checked, and I'm jumping into a full-liquid Optifast diet.

Why not just rely on the Lap-Band? I have been! If not for the Lapband I would be well on my way to 300lbs again! My belly buddy keeps me from going too far overboard when the crave strikes (and no, not those ghastly little White Castle slimers -- I crave sweets, such as cookies, cake, chocolates, etc.).

So, the band has been great and continues to keep me in line, but I need to ratchet back a little. Wish me luck!

Yikes! My Superweight is up up and away!

2009-04-16T17:58:00.002-05:00

Week 58 Optifast (Week 46 Lap-Band)
Weight Gain 7.8lbs (110.0 total)
Weight 191.0 BMI 27.8
BP 123/85 HR 79

Okay, so my tight-ish clothes still fit, so I'm not panicking -- but still. I'm guessing my diet of coffee and ice cream was not such a great idea. I started this during a tough time when I had truly an enormous amount of work. Now that things are better, I still haven't gotten back into the swing of things.

My latest excuse is a couple of bad teeth (two molars - one for extraction, the other root canal).

So I'm thinking of going full liquid again, just to get things started. After that, partial liquid with evening dinner.

Wish me luck...

Yaay! Achoo! -sniffle-

2009-03-23T11:07:00.006-05:00

Week 55 Optifast (Week 43 Lap-Band)
Weight Loss 2.2lbs (117.8 total)
Weight 183.2 BMI 26.5
BP 104/80 HR 74

-cough-

So I've been up and down the last few weeks, probably not eating particularly well. Okay, definitely not eating well. I kept getting severe cravings late at night and would finish off a pint of ice cream or some other no-no, which on top of a day's healthy eating and/or proper dose of Optifast was putting me over the top calorically, so I hit on a fantastic scheme instead.

-hack-

Eating nothing all day while sucking down cup after cup of coffee, I banked all my calories so that I could eat anything I wanted at night without breaking the bank. Genius!

-snork-
Unfortunately, genius boy here didn't figure on how hard the band would make it to get an adequate amount of good nutrition on top of a pint of ice cream and cookies at one sitting.

-insert disgusting onomatopoeic bodily fluid extretory noise here-

So, I've been eating poorly and -- surprise! -- my defenses fell and I'm sick as a dog and still having to work like a dog while being in the dog house with Silvia on account of barking at her for no reason from being so dog-tired all the time. It's definitely not been a dog's life for me. Doggone it!

Okay, I could probably keep this dog-theme going a while longer, but it's probably not as funny as I -- in my feverish state -- find it to be, so let's let sleeping dogs lie. See, that doesn't even make sense in context.

Anyway, I've lost weight but I need to be healthy. I keep wanting to lose weight on account of being stuck in that awkward stage between clothing sizes (many mediums too tight, lots of larges too loose). Of course, that's more vanity than anything at this point. I'm never going to be a 22 BMI, and the difference in health risk between a 27 and 22 is about 4% -- meaning I could do a lot more to improve my life expectancy (and quality) by not worrying about weight and focusing instead on cardiovascular and nutrition.

Now the question is, will I actually do it..?

Happy Optiversary to Me!

2009-03-02T16:43:00.001-06:00

Week 52 Optifast (Week 40 Lapband)
Weight loss 1.0 pounds (115.6 total)
Weight 185.4 BMI 26.8
BP 117/87 HR 81

Okay, so Friday marked the anniversary of the day I began Optifast. Yay!

So this is where I'm supposed to write something profound about how the whole thing changed my life. Well, it did, but I'm still the same person, just healthier and lighter, so profundity is having trouble bubbling up to the top.

I do have some random thoughts though (okay so most of my thoughts are random).

While this is the longest I've been "on a diet," I've learned that the diet mentality is very destructive. I will be "on a diet" for the rest of my life -- as is every human being (and every biophage for that matter). Whatever we consume is our "diet" (look it up in the dictionary. While some diets are meant for weight loss (the popular perception), others are meant for weight gain (bodybuilders), but most people are on "weight maintenance diets" -- a combination of nutrients we ingest that is intended to satisfy our physical (and frequently psychological) needs without excess.

In that regard, Optifast will probably always be part of my diet because it's convenient, tasty, nutritious, and satisfying. I'm not trying to plug Optifast -- I really do believe this. I believe it's better than commercially available products (such as Slim-Fast) and worth every penny.

At the same time, the Lap-Band is a godsend. Yesterday was Erick's 14th birthday, and I took the family to eat at his chosen restaurant (Phoenix) for awesome dim-sum. I ate everything I wanted -- but one bite each. I was full and satisfied and happy. What more could I want?

So, I would like to get down below 180 so that the bounceback and long-term maintenance plan can have 190 as the threshold -- the point at which I go "back on a diet" (that awful misleading expression again). At 185 I'll throttle back the calories, and at 190 I'll go on a full- or partial-liquid diet to get back down.

Some of you folks won't understand. If you've been normal weight most of your life, and have gained a few pounds, you can make an effort to lose the excesss, then go back to your normal routine. For those of us who've been 50, 100, or more pounds overweight, the "normal routine" is hardly normal. We have to be continually vigilant to avoid relapses.

This is why Synchrony Health offers free lifetime maintenance. Coming in every couple of weeks (or at least every month) for a weigh-in, lecture, and group support helps us all stay honest and hold ourselves accountable. Without this touchstone, we ignore the signs until it's too late, and then fall into a vicious cycle of weight gain, guilt, and guilty eating.

Don't worry if you don't understand. Lots of folks don't understand alcoholism or smoking addictions, but that they affect so many people belies the notion that it's a lack of discipline or some other personal failure. Natural selection tends to weed out self-destructive tendencies over time. It can be argued that overeating was actually adaptive for most of humanity's history, but that doesn't explain the wide distribution of adictive traits and tendencies toward other forms of excess.

Although overeating may seem less destructive than other addictions, which tend to be more acute and dramatic, the consequences affect more people and account for more loss of life and decreased quality of life than anything else.

Personally, I can say that it was easier to "just stop drinking" because I didn't have to put booze in my mouth every day for the rest of my life, whereas no one can "just stop eating." Every morsel of food brings back the entire rush of emotions and sensations that can snowball into a relapse. Ask any recovering drinker or smoker who's had a relapse.

I won't say that food is "harder" than drinking, smoking, drugs, gambling, or even sex addictions. I've seen the ruinous consequences of these and don't ever want to belittle the efforts of someone who has successfully pulled themselves out and stayed out.

I just hope people will understand that similar factors are at play -- whether to a lesser, equal, or greater degree, I won't comment.

So, is my diet "over"? No. It will never be. But hopefully it will, over time, become so much a part of my everyday life that it won't feel like a diet -- it will just feel normal. And for most of us, "normal" is a dream come true.

Did I accidently plumb the shallows of profundity? Sorry!

No reason to panic!

2009-02-23T18:45:00.002-06:00

Week 51 Optifast (Week 39 Lapband)
Weight loss 2.0 pounds (114.6 total)
Weight 186.4 BMI 27.0
BP 108/76 HR 92

So we're coming up on my "Opti-versary" and things are still looking fine. My weight varies a few pounds up or down, but all in all I'm not having any problems.

For a while there I was kind of freaking out because I tried on a few shirts and they were way too tight. I figured eating all of Erick's baseball league fundraising chocolates might have actually caused me to gain a little weight.

Nope. Although I was up a few pounds (low 190s) , it turns out those shirts had been left in the dryer (on HIGH, Daisy) just a little too long. Other, identical shirts fit just fine. Seriously, the tight ones were (are) crazy tight.

I hope to have some insights or meaningful things to say next time. For now, just remember: if you think you've gained weight, find someone else to blame.

Well well well...

2009-02-10T15:08:00.002-06:00

The last month or so I've been trying to "get back on a diet" without success. I start one day, make it for a few days or just hours, then jump right off the bandwagon (no pun intended Allergan).

So, some days I eat whatever I want, others I watch my intake. Sometimes I fast, sometimes I feast. I usually get adequate nutrition (protein, fats, carbs, vitamins & minerals). I'm generally well hydrated, and I feel pretty decent most of the time.

So what's the problem?

Nothng.

That's my sudden realization. There's nothing wrong. I've been at a relatively stable weight since August, up and down no more than a few pounds. I'm at 190 and I feel fine.

I suppose I could nitpick and say that I'm kind of stuck between shirt sizes: medium looks good when I'm standing up but stretches when I sit, and large is comfortable when I'm sitting but billows out when I stand.

Hmm... Slightly awkward clothing versus dying prematurely from obesity-related complications... Tough decision!

Anyway, here's some updates:

I foolishly tried to do Optifast on 800 calories a day AND started a rigorous exercise program at the same time. Not such a great idea.

Erick brought home cases of fundraising chocolate for his baseball team AIIIGHHH! Why can't they just take my money? Why must they torment me so? I'm in debt to Erick to the tune of forty bucks already!

Last Wednesday I got an adjustment from our RN Karen (good job BTW). I had hiccups Friday and Saturday, but I don't think they were necessarily related. Wednesday and Thursday I had nothing, and since Sunday they've been gone, so they were most likely something else. I should mention I used to suffer from sever bouts as a teenager -- they were often violent and could last for days. I've fortunately had few incidents since then, but they can and do recur. Again, I'll wait and see if they come back before getting my band loosened.

That's pretty much it. I'm eating a little less since the adjustment, but still enough to be satisfied. I don't have any major food issues (besides the late-night fundraising chocolate attacks), and I'm comfortable with my appearance. So is Silvia, BTW...

I have another bout of craziness in the offices, after which I hope to get back to the gym (at normal calorie levels).

Meantime, it's 63 degrees outside in February in Chicago, so I'm putting the top down and going cruisin' with my baby. See ya!

Gotta love Mexico!

2009-01-05T09:25:00.002-06:00

Week 44 Optifast (Week 32 Lapband)
Weight loss 4.6 pounds (112.6 total)
Weight 188.4 BMI 27.8
BP 104/72 HR 68

After a crazy hectic holiday season with too much work and no exercise, I took off for a 6,000 mile road trip to Mexico with the family. Although I got to sample a wide variety of delicious (and some not so delicious -- e.g., fried grasshoppers) dishes, I really couldn't eat much thanks to the Lap-Band.

So lots of walking and driving combined with not so much food to get my weight down a good bit. Yeay!

Now the challenge is to make that final push down so that my bounceback will bring me into the 180s and not the 190s. I realize we're not supposed to say "I'll start Monday" but -- well, I'll start Monday. Wish me luck!

Relatively unscathed...

2008-12-05T09:23:00.000-06:00

Week 39 Optifast (Week 27 Lapband)
Weight gain 5.6 pounds (108.0 total)
Weight 193.0 BMI 27.7
BP 110/82 HR 86

Okay, so Thanksgiving went on a little longer than hoped, though not longer than expected. Between all the sugar and salt I packed on a few pounds, but some of that is just junk in my system. Maybe I added a real pound or two, but I'm not going to stress about it.

What I am stressing about is that I have not been able to go to the gym the whole week. Every day has brought a new set of crises as projects are piling up and progress has been slow or nonexistant. In that context, taking an hour off every day to help save my life seems kind of selfish on my part, right?

Sigh. Maybe next week. Oh, no, that's right, I'm leaving for Mexico the week after next to spend Christmas with Silvia's family again. Double sigh. Maybe next year..?

I'm walking on sunshine...

2008-11-21T12:44:00.000-06:00

Week 37 Optifast (Week 25 Lapband)
Weight loss 3.6 pounds (113.6 total)
Weight 187.4 BMI 27.2
BP 106/80 HR 82

This is usually when the hammer hits. Just as I'm starting to feel good. Okay, so it's not really the hammer, it's just that I get all caught up in the emotional rollercoaster (I lost weight, yay! I gained weight NOOO!!!!).

I have a tough week coming up, what with Thanksgiving and all. I'll call it good if I come back under 195. It's just an arbitrary number, I suppose, but there it is. I'll keep to my Optifast during the day to bank calories for when I'm eating my good 'n' tasty scrumptious yummy naughty feast for all senses!

Hmm, maybe I'm building it up a bit too much.

Anyway, good luck everyone! Have a great Thanksgiving Day!

Why don't I ever learn?

2008-11-14T19:56:00.005-06:00

Week 36 Optifast (Week 24 Lapband)
Weight loss 4.8 pounds (110.0 total)
Weight 191.0 BMI 27.7
BP 116/82 HR 68

Okay, I admit it, I'm a whiny little so and so. I over-reacted (again) last week. You'd think I'd know better by now. A lot of the weight "gain" was probably water on the body, glycogen in the liver, and food in the gut.

After some serious consideration, we've decided on my goal weight: 190lbs.

No, it's not a cop-out because I'm almost there. I actually have to get down to around 185 to buffer the initial bounceback (water, glycogen, gut -- see above).

The plan is to stay at or below 190.

Above 190, I restrict my calorie and sodium intake and increase my water consumption.

Above 195, I begin a partial liquid diet (Optitrim).

At 200, I go back on a full-liquid diet (Optifast).

So why the sudden change from my earlier goal of 178 (BMI 25)? Well, the BMI ranges are arbitrary in nature. BMI is certainly better than weight for predicting health because it takes height into account. Unfortunately, it's not really ideal because it doesn't take into account bone structure and density or muscle mass. Purely by BMI standards, every NFL linebacker would qualify as morbidly obese.

A better measure is Body Mass Composition. The desirable range for males my age is 8-20% fat mass. That is, 8-20% of my body mass should be fat.

I started at 36.7%. Today I'm at 19.8%. Yes, I'm flabby, but I have very little internal (ventral) fat left, and there's not a significant increase in health and longevity much beyond my present level.

Getting back to BMI, there's only a very small difference in mortality in men between a 27 BMI and a 25. The lowest risk is between 22-24 BMI (men, women about 23-25), but again, the mortality ratio goes up a minute amount, from 1.00 (baseline) to about 1.02. Previously, my mortality risk ratio was over 2.5.

Mortality actually starts to increase slightly below BMI 23 (for men, 24 for women), so that BMI 27 and 20 are comparable. Below 18.5, the risk shoots up dramatically, even faster than BMIs above 35-40 (severely to morbidly obese).

A man at BMI 18.5 has a risk profile similar to BMI 30 (the beginnings of the "obese" category).

A woman at 18.5 has a similar risk to one at 33.

The whole thing looks like an uneven parabola, with the left asymptote closer to center than the right. That is, there's very little play between "ideal" weight and morbidly underweight (on the left of the scale) than there is between ideal and morbidly OVERweight (on the right).

I'm going to try to attach a picture to this post so you can get a better idea, but here are a few not-so-random (yeah, you know who you are out there, I'm talking to you!) sample weights for the BMI-impaired:

5'6" females have the lowest mortality risk ratio at 135-150 pounds. Yes, you heard me ladies.
At 124 lbs, your risk is similar to 174 lbs!
At 110 lbs, you may as well be 204 lbs!!! You'll probably live as long (though maybe not as well).

5'9" males have the lowest mortality risk ratio at 148-164 pounds.
At 136 lbs, your risk is similar to 184 lbs.
At 126 lbs, you may as well be 204 lbs!

Men have it worse. While women can safely pack on a bit of weight, men have to be more careful. Ironic, then that excess weight in males is actually considered MORE acceptable than in females. Ladies, are you trying to get rid of us by encouraging us to overeat? Of course, the flip is equally true: gentlemen, are you trying to save a few bucks on a divorce attorney by encouraging your lady to be dangerously thin? Hmm...

Silvia, my curly-brown-haired cutey-pie, at 5'0" is at a healthy BMI of 22, but could stand to weigh between 118 and 128 safely and healthily. Readers will recall she joined me at the outset and lost 20 pounds in the first 8 weeks, and a total of 27 pounds before stopping. I think she looks fantastic, but that's probably the subconsciously-wife-killing male chauvinist pig in me. At 128 lbs she was definitely not happy with how she looked, even though statistically speaking her weight was healthy. Okay, in my meager defense, I told her (and actually believed) that she didn't need to lose any more weight, but she insisted. So there. Not so piggy after all. Umm, that's a male-chauvinist-pig reference, not a "fat-pig" or "Obama-Sara-Palin-lipstick-on-a-pig" reference).

Anyway, these are averages and estimates. Other factors play significant roles, such as the ones I mentioned earlier (bone structure/density and lean muscle mass), but of course diet, lifestyle, genetics, and a host of other issues will have a greater impact than 5 pounds of belly fat too much or too little. Speaking of which, fat on the gut: bad. Fat on the hips and thighs: not so bad.

To complicate things even further, I may be at greater risk if I continue to lose weight because we don't lose weight evenly. Although I still have a paunch and some baggy areas, it's likely that my internal organs and tissues (excluding skin) are getting too lean. At some point they may begin to lose proper functioning. If I had started out at a low 22-23 BMI and gone up to 27, then come back down from there, no problem. But, having started at a very high weight and lost a lot of fat, I may be at greater risk.

Okay, so it may seem suspicious that I've found a good argument to stop losing weight, but this suggestion came as a surprise to me and I initially resisted. Logic and facts (and my burning passion for Debbi Fields) won me over.

I have maybe a couple more weeks to go and I should transition to full solid (Lap-Band supported) normal diet. Woo-hoo!

PS Here's a little shout-out to my lovely and charming cousin Maria Antonieta Arana de Ackermann (don't you love long Latin names?) who recently found me on the Internet after more than 20 years. She gained 80 lbs after her first baby and successfully lost it (the weight, not the baby). Anyway, she's absolutely delightful and I'm thrilled by her success!

PPS Here's the chart (I hope) from one of our Synchrony Health Academy presentations.

Another setback (well, set"side" is more like it).

2008-11-08T17:29:00.001-06:00

Week 35 Optifast (Week 23 Lapband)
Weight GAIN 2.0 pounds (105.2 total)
Weight 195.8 BMI 28.1
BP 108/70 HR 82

I started out really well, but Monday of last week Silvia got an urgent call - her dad was in the hospital dying. She called me at 11am, and our plane was in the air at 2pm. I won't give you the details (which are long and hard to believe), but he came back from death's door (well, it's fair to say he was in death's vestibule already hanging up his hat and coat).

While in Mexico, I had little or no access to band-friendly food and was deathly afraid of getting "stuck," so I pretty much ate tacos and washed them down with lots of yogurt smoothies. Not the best diet, but because of all the activity I didn't really gain much weight (or maybe none at all).

I asked Silvia how she would feel if I just stayed around my present weight and she was perfectly fine with it. I don't really feel any pressure to lose any more, but I think I might help myself in the long run if I get down to a BMI of 25 or lower.

Anyay, I'm going to restart again (again) and try to break through to the 170s. Wish me luck (again)!

Grin and bear (down on) it...

2008-10-15T11:00:00.003-05:00

Week 32 Optifast (Week 19 Lapband)
Weight Loss 6.4 pounds (107.2 total)
Weight 193.8 BMI 28.1
BP 102/74 HR 66

After coasting for several weeks, I've decided to bear down for real and get myself down to a healthy weight once and for all.

A lot of people have told me I should stop losing weight, I look great now. Well, had I been 150 and gained 40 pounds, they would have said the opposite.
The point for me is not that I'm going to look much better if I lose another 20 pounds -- let's face it, I was gorgeous at 300.

The point is that, below a BMI of 25, the risk of weight-related health problems mostly disappears. There are still issues regarding body composition (lean muscle vs. adipose tissue), lifestyle (sedentary) and dietary risk factors (cholesterol, CRP, etc.)., but those are risks that "normal" weight folks face, without the extra risk of overweight and obesity.

So, after coasting and enjoying a very normal dietary lifestyle (thanks to the band), with the ocassional overindulgence (ice cream and cookies mostly), I'm going hardcore one more time to get down below goal (always overshoot so that the inevitable "bounce back" doesn't take you over goal).

I started Monday last week, and so far things are looking good. I got together with my friends Ethan, Stephanie, Jon, Christy, and Dan (whom I haven't seen in years) at a great Chinese restaurant and got through dinner without eating and without any temptation to do so).

I did have some trouble last night (unexpected stress + Lutz truffles + Affy Tapple = uh-oh!), but otherwise I've been good. Let's hope the trend continues...

Bounceback

2008-09-29T22:18:00.003-05:00

Week 30 Optifast (Week 17 Lapband)
Weight Gain 3.8 pounds (101.8 total)
Weight 200.2 BMI 29.1
BP 120/70 HR 80

Hmm. Four big meals and several servings of sweets and snacks lead to weight gain? Who knew?! Of course, I'm sure I didn't actually gain 3.8 pounds - much of it is probably water gain and retained food, but I'm sure I didn't actually lose any weight either. Sigh.

Hopefully, in a day or so I'll make one last hardcore push and get down to my ultimate goal weight (25 BMI).

Until then, I just gotta be me...

Sorry, it's late and I'm tired. Until then, I just gotta keep it from getting out of hand.

G'night!

Sugar control

2008-09-19T18:20:00.003-05:00

Hi folks, just a quick update on my blood sugar. I quit medications some time ago, and my diabetes has gone away.

90 - 6:00 AM, fasting 7hrs (first thing in the morning)

91 - 11:00 AM, fasting an extra 5hrs (right before lunch)

131 - 1:15 PM, 1hr after finishing a "big" meal (New China Buffet, mostly protein and carbs)

86 - 2:20 PM, 2hrs after lunch

87 - 3:30 PM, 3hrs after lunch

So, not 20 year old athlete but not bad.

Food + Fun = Weight Loss (really!)

2008-09-15T13:49:00.002-05:00

Week 29 Optifast (Week 15 Lapband)
Weight Loss 3.2 pounds (104.6 total)
Weight 196.4 BMI 28.4
BP 119/76 HR 84

Obviously it's been a great week. I did have some trouble sticking to my guns, but it (mostly) involved going out, being active, and having fun.

Last Tuesday I had a late night snack attack. It was the usual thing, stress, tired, one nibble leading to another, etc.

Saturday, against my better judgment, I agreed to go to lunch with my older brother who's flew in from Mexico for a law conference. We went to Denny's, where I had a grilled tilapia and steamed vegetables. By itself, not bad, but I was already planning to have dinner (and dancing!) with Silvia at Nacional 27, so I needed to bank calories. Dinner included a pisco sour (Peruvian drink), black bean soup, half a flatbread stick with bean and chipotle dip, huachinango with chile lime pesto sauce, a fried plantain with an amazing garlic dip, a few sips of sangria, and half a scoop of tres leches ice cream. I have no idea how many calories I ate, but I can't imagine it was an insane amount.

Sunday I took the family out to lunch with my cousin Nevy and her husband Jorge. We went to Ay! Ay! Picante! for Peruvian food. The anticuchos (beef heart kabobs) were amazing, as was the aji de gallina (chicken in a spicy cream sauce). The rest was fine: humintas (similar to tamales), arroz con mariscos (paella), papas a la huancaina (potatoes in spicy cream cheese sauce), seafood and tilapia ceviche, fried plantains, flan, pastel de tres leches (cake saturated with evaporated milk, cream, and sweetened condensed milk), alfajor (cookie stuffed with caramel), mil hojas (similar to baklava but with caramel instead of honey), and cheesecake. I had one or two bites of everything, which was okay, buts I had a few extra bites of the mil hojas, which led to a sugar crash a few hours later, at which point I scarfed down some cookies and chocolates. Yikes!

Keeping things in perspective, though, I stayed under budget for the week. Although some of the 3.2 pounds is probably just statistical variation, I feel good that I'm being mostly conscientious about banking calories and eating better.

It's a rocky road uphill against a driving wind, but if I can survive these awful metaphors I should do alright with my weight.

I should also mention that Dr. Watkins and I have visited several area family practitioners to introduce ourselves. It is incredibly heartening to see how many are keenly interested and genuinely concerned for their patients' well-being. It makes me think there is hope for the future of our healthcare system that docs like these are still out there fighting lawyers, insurance companies, and hospital bureaucrats to take care of their patients.

So the ice cream diet is probably not for me...

2008-09-08T22:29:00.002-05:00

Week 28 Optifast (Week 14 Lapband)
Weight Loss 1.4 pounds (101.4 total)
Weight 199.6 BMI 28.9
BP 100/68 HR 80

Ahem. Well, Daisy had her wisdom teeth removed, and, um, could only eat ice cream for a few days, so, um, there were like all of these flavors of ice cream around, and, yeah, it happens.

Often.

Yep, I still lost some weight because I was pretty good most of the time, but man that ice cream was good! Sigh.

I should be better this week, though, so let’s hope for some better results next week.

PS Let’s just keep thing in context: I didn’t gain any weight. That’s good. I actually lost weight. That’s really good. It’s hard to ask for more without sounding whiny.

Last Saturday’s Synchrony Health Academy lecture was “Change Your Eating Style” – tips for identifying and dealing with issues that make it hard to eat properly. It’s the sixth lecture on bariatric health psychology.

100 Pounds!

2008-08-25T14:48:00.002-05:00

Week 26 Optifast (Week 12 Lapband)
Weight Loss 4.6 pounds (100.0 total)
Weight 201.0 BMI 29.1
BP 102/72 HR 88

Yes! That's a big 1-0-0! Woo-hoo!

Besides all the general wonderfulness of the situation, I have a guilty reason to celebrate - I expect to increase my caloric intake slightly.

Gasp! Yes, I know, but although I've been eating solid foods and using the band, I've still been keeping a strict, tight control on my food intake, maybe too tight, because I wanted that big beautiful round magical number under my belt (or out from under it, I should say).

I still plan to do what I've been doing, but less agressively. I don't need to lose 4 pounds in 1 week, I can lose 1 or 2.

So, Happy 100th Poundiversary to me, and to everyone who's helped, a huge THANK YOU!

I'm overweight today!

2008-08-18T09:37:00.004-05:00

Week 25 Optifast (Week 11 Lapband)
Weight Loss 8.6 pounds (95.4 total)
Weight 205.6 BMI 29.8
BP 110/68 HR 80

Why am I happy about being overweight? Because I'm no longer obese for the first time in 15+ years!

I mentioned last time that I figured my sudden 7 pound gain was mostly salt (liquid) and full digestive tract, and it seems to have been the case.

Back to the happy stuff: I feel great! Although I worked the grill at my dad's cookout yesterday, thanks to the gastric band I ate maybe less than a fourth of what I usually put away – half a steak and half an Italian sausage versus 2 steaks and 2 sausages plus sides.

I'm only a few pounds away from my goal, after which I'm going to gradually increase my caloric intake. I'll still be eating less than normal, and I expect my weight loss to continue but at a more gradual pace.

Aiiiiggghhhhh!

2008-08-11T11:59:00.001-05:00

Week 24 Optifast (Week 10 Lapband)
Weight GAIN 6.8 pounds (86.8 total)
Weight 214.2 BMI Who cares?!
Fasting Blood Sugar 117
BP 104/68 HR 82

So the week started out okay enough. I got to see my friend Jon, who hasn't seen me in a few months. That's always nice.

Unfortunately, I started to feel pretty sick around the middle of the week. Some of it was certainly stress from the home purchase issues we're having, but I've heard from others at the office building who are having similar symptoms (feeling sick symptoms, not home-purchase symptoms). Friday was particularly bad: I got up, showered, then came back to the bedroom unsure whether to throw up or pass out. I crawled into bed instead.

Anyway, all that back story to explain how I ended up overeating. Thank God for the band, though, without which I would've eaten much more.

Yes, I know the scale says 7 pounds gained, which is really quite impossible. At my weight I would have to eat more than 5,500 calories daily to gain that much in one week, and there's no way I averaged even half that. More likely it's a full digestive tract, full liver, and liquid retention from the salty foods.

Well, we'll see in a week. I'm back on my regular protocol now and feeling much better.

I've got sunshine...

2008-08-04T09:51:00.000-05:00

Week 23 Optifast (Week 9 Lapband)
Weight loss 2.2 pounds (93.6 total)
Weight 207.4 BMI 30.0
Fasting Blood Sugar (no more tests until further notice)
BP 106/70 HR 78

...on a cloudy day...

Just following last week's theme of magical mellow melodies. Just a little more and I break the Obesity Barrier! Yep, me and Chuck Yeager...

Saturday we finished revisiting Dano's lecture series on bariatric fitness (Intro, Endurance, Strength, and Flexibility). We have three to reshoot with Dr. Ghani, and then four more original lectures. That should finalize our video library! After that, I can start taking my days off off!

Cruisin'...

2008-07-28T11:07:00.000-05:00

Week 22 Optifast (Week 8 Lapband)
Weight loss 2.2 pounds (91.4 total)
Weight 209.6 BMI 30.3
Fasting Blood Sugar (no more tests until further notice)
BP 104/69 HR 89

Although I feel a little tighter than before, I experienced a similar effect as last time, with the band starting out tight and loosening a little over time. It's not bad, though. I've been trying to stick to liquids during the day and a small meal at night, but a couple of times I got a hankerin' fer sum 'taters 'n'

Okay, let's stop that. I've done alright this week. My only complaint is that damn recurring rash. On the positive side, I bought new pants and shirts so I don't look like I'm wearing my big brother's clothes any more. That's the second time I've had to replace my wardrobe! Even bigger news is that I finally caved and replaced my 3x underwear (guys will understand how momentous that is -- it takes a LOT to get a man to buy new shorts).

Second adjustment

2008-07-21T21:42:00.003-05:00

Week 21 Optifast (Week 7 Lapband)
Weight loss 4.0 pounds (89.2 total)
Weight 211.8 BMI 30.7
Fasting Blood Sugar (no more tests until further notice)
BP 126/78 HR 86

After the initial restriction from my first adjustment, I kept feeling "looser" each day. By Thursday I could eat as much as before the adjustment -- which is not an obscene amount, mind you, but certainly more than the sample plates in the office suggest.

Dr. Watkins' theory is that my stomach is shrinking, and Melody's theory is that the stomach is irritated initially by the tightening and gets a little inflamed for a few days.

Either or both may be right, or perhaps it's meddling by mischievous djinns as I suspect Dr. Ghani might suspect.

I have to say the adjustment was a lot less scary this time. There really is virtually no pain from the needle (physically, though fortunately the psychological horror is in temporary remission).

Afterwards, as I drank the requisite 8 ounces of water, I could feel it going down. Later I went to McDonald's and had a grilled chicken filet and a double cheeseburger (meat and cheese only). Like last week, mind you, all in the name of science. The meat went in just fine and filled me up quite well. I ate at about 5 PM - it's now 9:55 and I'm still feeling a little full.

I should touch on the 4-pound weight loss. A pound of that might be the smaller pants I bought yesterday (38 waist, down from 56!). Definitely eliminating caffeine has had an impact!

First adjustment

2008-07-14T19:53:00.003-05:00

Week 20 Optifast (Week 6 Lapband)
Weight loss 2.8 pounds (85.2 total)
Weight 215.8 BMI 31.2
Fasting Blood Sugar (no more tests until further notice)
BP 121/84 HR 80

Today was my first adjustment. A long needle was inserted into my abdomen (through the skin but not through the muscle) and into the port to inject saline solution into the band and tighten it up.

That's the short version.

The long version is a little more convoluted, as was the process.

First I had to be poked to locate the band's position (uncomfortable but not painful).

Second, as I did a leg lift to tighten up my abdominal muscles, the needle was inserted (some pain) but hit the side of the port, which was slightly turned on its side.

Finally, the needle was removed and a fresh needle inserted at an angle, finding its mark and succeeding in its task.

The whole thing was made somewhat unpleasant (to Dr. Watkins) by my incessant meowing in fear.

Having gone through it the first time I don't think it will be bad the next. The pain is actually quite minimal, notwithstanding my obscene fear of needles.

Diet-wise I did okay, except for Saturday night when I visited my Dad and one ice cream led to another, led to another, and another, and more, and finally 3-4 protein bars. Over 2000 calories I would say -- were my mouth not stuffed with protein.

I'm actually glad my band is tighter now. Next time the crave calls, I'll answer it with a White Castle slider (behold the power of advertising). Sliders may not be good for you, or even taste very good, but it's small and should fill my pouch up.

Okay, so instead of a slider I'll get some other tasty "forbidden" thing that fills me up and prevents the second through fifth servings of ice cream.

Sunday I ate a little too much, but not obscenely so. Silvia made a delicious chorizo and bean dip that I had to munch. Again, tightnes in the band would have reduced my portion size.

All in all, though, I have to say that 2.8 pounds is pretty good at this stage.

There is no joy in Mudville...

2008-07-07T19:01:00.001-05:00

Week 19 Optifast (Week 5 Lapband)
Weight loss -1.2 pounds (81.4 total)
Weight 218.6 BMI 31.5
Fasting Blood Sugar (no more tests until further notice)
BP 90/54 HR 86

I had another overindulgence last week. In addition, over the weekend I went to Naperville's RibFest 2008 (the number of calories I ate, not the year; okay the year, but close on the calories).

Still, I was surprised that I didn't lose any weight. I averaged 1400-1600 calories per day for the week, so I should have lost about a pound and a half. I could be retaining water or have extra food in my GI tract, so I'm not going to panic. I'll continue doing the same (minus the ribs) next week and see what happens.

Okay, so I am a little concerned. As I mentioned in an earlier post, I once did Seattle Sutton for two months and got nothing out of it.

Umm, I think that last sentence can be read the wrong way, but I'll leave it anyway. Anything for a laugh...

First "no-no" but not too bad

2008-06-30T17:07:00.002-05:00

Week 18 Optifast (Week 4 Lapband)
Weight loss 2.8 pounds (83.6 total)
Weight 217.4 BMI 31.5
Fasting Blood Sugar (no more tests until further notice)
BP 118/78 HR 87

Last Wednesday I came home to a less than ideal situation, which prompted a bit of an overindulgence.

It started out okay. I grilled myself a burger patty (95% lean) with a slice of American cheese, and sauteed half a can of string beans with some Tostito's Chunky Salsa (Spicy) and EggBeaters.

After that I had a hankering for something sweet, so I sucked down a sugar-free Popsicle. Then another. And another. And one more for good measure.

I retired to my bedroom to watch TV. I suddenly realized I'd forgotten to drink some Benefiber. Too late now, since the food was in the pouch, but I figured I could sneak one of Silvia's FiberOne yogurt cups (only 70 cals, but 20% DV fiber).

Great. That got me jonesing for more sugar. I circled the kitchen like a vulture, until my trained eye spied a Chocolate Chip ClifBar. Hey, nutritious and delicious, right? Yep, but 280 calories, mostly carbs, and pretty dry for a banded patient.

The second Cliff Bar was probably not a good idea either.

So I sat in bed, propped up by half a dozen pillows, breathing shallow and waiting for this too to pass. For a couple of hours. It's amazing how uninteresting reruns of MythBusters can become when you're staring at the clock every other minute.

Time did pass, and so did my food. I didn't throw up or even get the heaves. Despite my indulgence I still lost 2 pounds.

But the incident served to underscore two important points:

1) never let your guard down -- in retrospect I saw a clear chain of events that left me psychologically vulnerable and ready to lapse;

2) the band is an awesome insurance policy -- even with what amounted to way too much food still totalled at most 1,000 calories, which made my day's consumption only about 1,600!

By lovely coincidence, this week's Synchrony Health Academy lecture was on Managing Lapses.

The rest of the week went by fine. I loved my burgers and string-bean sautees, and may continue them for another week. I want to practice "stimuli narrowing" -- another concept I learned at Synchrony Health Academy. Since I haven't really eaten anything in a long time, everything tastes new and exciting, so why not have it over and over again until it loses its charm? If I buy several different things at once, I'll be tempted to have a bite from each, and it's guaranteed that I'll eat more than I otherwise would (think buffet vs. regular restaurant).

I did, however, have some delicious gyros meat with cucumber sour cream for lunch today, so I'll try to be good and have shakes for the rest of the day, then return to my burgers for dinner tomorrow.

Slow and steady wins the race...

2008-06-23T18:22:00.000-05:00

Week 17 Optifast (Week 3 Lapband)
Weight loss 2.0 pounds (80.8 total)
Weight 220.2 BMI 31.9
Fasting Blood Sugar (no more tests until further notice)
BP 108/68 HR 84

So my first week back on solids went pretty well. Actually, it was mush - not solid, but close enough. I had salmon and tuna steaks for dinner, accompanied by leftover sag paneer and later fresh spicy spinach puree.

I still kept to the liquid protein shakes during the day, though. Hey, I'm stuck in the office and away from temptation all day, so why not? Plus I like the taste, and I love the convenience of not having to pull myself away from work just to feed my body.

I still have a little minor discomfort around my gallstone incision and the port site, but this mostly has to do with my being a little wussy, as my wife would say if she didn't prefer more direct and less polite synonyms for "wussy."

Other than that, it's been smooth sailing so far!

Optifast, Lapband, Lightning, Fireworks, and Naked Bicyclists

2008-06-16T11:10:00.007-05:00

Week 16 Optifast (Week 2 Lapband)
Weight loss 4.6 pounds (78.8 total)
Weight 222.2 BMI 32.2
Fasting Blood Sugar (no more tests until further notice)
BP 130/68 HR 78

Today is the last day of the all-liquid diet. I actually had some mush yesterday, which is kind of jumping the gun, but it was Father's Day after all and we were at my favorite Indian restaurant (Sri Ganesh in Villa Park on Roosevelt Rd -- highly recommended). I had a few spoonfuls of Sag Paneer (just the spinach, not the cheese). Delicious!

Those few spoonfuls (by the way, "few" meaning 3-4, not 30-40) filled me up pretty well and left me satisfied. Go Lapband!

Besides the lovely Indian food, I had a couple of interesting experiences this weekend. Silvia and I were cruising in the convertible downtown Saturday night when we got stopped by more than a thousand naked bicyclists. Silvia loved it and was jumping up and down on the seat, whooping at the nekkid folks, who in turn repeatedly encouraged her to "take it off". Her reply was, of course, "I can't -- my husband's here." Sigh. I limited myself to accepting their political manifestos and (once) high-fiving a naked man at 20mph. Yeah, he misunderstood. I had my arm up to avoid getting slapped by something other than his hand...

On the way back we stopped on Lake Shore Drive and watched the fireworks over Navy Pier. The next morning lightning struck in front of our building and knocked a tree over. We were without power for the whole day, but it gave us an excuse to go out (hence the Indian food).

I have not been hungry once since I got the band, but I do have a culinary interest in food and look forward to sampling more dishes in the weeks to come. I might actually finish writing my restaurant guide that's been languishing the last few months.

Back in the saddle!

2008-06-09T09:21:00.002-05:00

Week 15
Weight loss 4.8 pounds in 1.5 weeks (74.2 total)
Weight 226.8 BMI 32.5
Fasting Blood Sugar 76 (no more tests until further notice)
BP 111/74 HR 80

After taking a week off to have band surgery, I'm getting back into the groove. My weight loss was a little less than usual, probably due to several days of inactivity.

I'm feeling pretty well, despite some intestinal distress (gas bloat).

I have one more week of all liquid diet before I start transitioning to soft foods, followed by solids a couple of weeks later.

It may be a bit too early to start reminiscing, but I just have to say I wasn't expecting a band, so looking forward at the beginning I was optimistic but wary. Optimistic about being able to lose the weight on Dr. Ghani's Optifast liquid diet and keep it off for for the foreseeable future with our maintenance program, but also wary about returning to the "real world," with all the temptations and unpredictability that implies.

Dr. Mobley's words still resonate, that the band is a great insurance policy against crises.

At Synchrony Health we try to teach that the different disciplines must work together to achieve the best outcomes. As much as I've known and understood that from the beginning, it's always different when it happens to you. I plan to continue indefinitely on a partial-liquid diet because I am able to do so: being stuck in the office away from food 5-6 days a week means I can substitute breakfast, brunch, lunch, and linner with shakes, then enjoy a nice, small normal meal at home each night, as well as eat small portions of normal meals over the weekend.

This approach combines the use of the band as a weight loss support tool with a medically-supervised partial-liquid diet. The nutritional aspect comes from learning what to eat -- not just what's nutritious, but what is satisfying as well. For instance, a little cream in your coffee is better than a lot of creamer; fat satisfies while fat-free does not, often leading to more calories; steak and eggs for breakfast are better than oatmeal (trust me on this).

Psychology and behavioral modification are also equally important. I've learned to identify and avoid or deal with some of the cues that were triggering my evening snack attacks. Staying on top of these issues requires continuing attention and education, though, else we slide back into old patterns and behaviors.

Physical fitness is an intrinsic part of the equation. Ultimately, our goal is to be fit. It would be kind of pointless to be thin and out of shape, since that rarely leads to a longer and better life. Some of the exercise routines Dano has taught us are easy to do and very effective, but again these need continuing reinforcement.

In the end, combining these "Five Pillars of Weight Management" (medicine, surgery, psychology, nutrition, and fitness) is so self-evident and obvious that I'm amazed to find that no one else has been doing it. I guess someone needed to go first...

Initial aftermath

2008-06-05T21:30:00.002-05:00

I wasn't able to sleep Monday night, and maybe caught a few winks Tuesday night. The pain was bearable, more of a dull pressure than anything else. Moving around produced small stabbing pains, but even these were not too bad. I think the worst part was my fear that I would tear open my incisions by moving around too much. Yeah, I'm a wussy, I know. Silvia pointed out that she's had three laparoscopic surgeries and was up and cooking the same day. Of course, she didn't mean it as a criticism, rather to remind me that there's little risk. Yep. She's very supportive. Or so I prefer to believe, though it would be easier if she hadn't been smiling when she said it.

Wednesday was a long, boring day. I felt fine, but I didn't want to push it, so after I checked my email and researched products to support our upcoming webinar service, I spent the day staring at the TV. Long and boring. Except for "The Price is Right" -- that always conjures up a smile, even if Drew Carry is no Bob Barker. Of course, laughing is painful, so Drew Carey is a good choice for me right now.

Last night I discontinued my pain meds. I hadn't had a bowel movement since Sunday and the gas bloat was getting worse. Silvia pointed out that constipation was one of the listed side effects. I managed to get past the gastric difficulties, but the pressure in my chest (I think it's called "restriction") is more noticeable. I haven't had the urge to throw up, and I've been extremely careful to consume only thin liquids in tiny sips. Still, I get the same feeling I used to get after powering through a Fogo de Chao all-you-can-eat-meat extravaganza -- like there's a half-chewed chunk of recently-delectable porterhouse refusing to follow its brethren into the dark abyss.

While it's an uncomfortable feeling, I can still swallow my nutrients so I shouldn't complain. This morning I woke up early and went to work for a few hours, but came back home because of the aforementioned discomfort.

My friends and family all called several times this week. They wanted to come over and keep me company and/or cook for me, but I really prefer solitude when I'm sick. I have an overwhelming impulse to be a "good host," so visitors under these circumstances actually make me uncomfortable. The Ghanis actually sent me a lovely floral arrangement in lieu of food, which is definitely appreciated. Normally a bag of Mrs. Field's cookies would have been my first choice, but I don't think it would be a good idea this time.

If I feel better tomorrow, I'll stop by the office for a little while. I don't think I'll be able to set up the Synchrony Academy lecture for Saturday, but I can still make a little progress on some other things I've got cooking.

Hmm, there's another food reference. The irony is I have not been hungry at all this week, nor even had a desire for food. The food references are just an inedible part of my nature. Indelible. I meant "indelible," not "inedible." Sigh. Good night everybody!

I got the LAPBAND today!

2008-06-02T20:14:00.011-05:00

Yep, about twelve hours ago they were slicin' and dicin' - okay, that may turn some people off. Basically it was straightforward procedure, or rather three procedures: laparoscopic adjustable gastric banding (LAGB), laparoscopic cholecysectomy (gallbladder removal), and laparoscopic repair of hiatal hernia (a weakening or tear in the diaphragm that allows the upper part of the stomach to protrude into the thoracic chamber).

It was all done at the Oak Brook Surgical Centre (OBSC). The OR staff and I had a lot of fun before, during, and after. I aked them to tape it, plus record the procedure through the scope. I'll be editing it and posting whatever I can on YouTube soon enough.

So, now I continue on my liquid diet for a couple of weeks, then start on a partial-liquid/partial-soft food diet, and eventually normal food (with a couple of liquid meal supplemenations to ensure accelerated weight loss and proper nutrition). With my solid gold (well, hollow silicone) insurance policy, I know this will be the last "diet" I need.

I want to thank the friends who helped make this dream a reality:

At Synchrony my surgeons Dr. Mohammed Arain and Dr. Brad Watkins (who is among the best laparoscopic surgeons I've seen and one of the nicest people I've met - a rare combination, and rarer still in a boss); Dr. Ghani and Husna who stopped in to check on me and offered their genuine support to Silvia; Dr. John Mobley at the Cincinnati Synchrony office who gave me the best argument for band after weight loss (it's my insurance policy against cravings and crises); Karen, Melody, Stacey, and Tanita, and everyone at Synchrony who expressed concern and supported me.

At OBSC, Dr. Bruce Nadro (anesthesia and humor specialist), Dr. Kianoosh Jafari (president and my former employer), Ali Nili (COO), and my good friend Steve Kowalewski (who gave me the best financial arguments for doing this), all of whom stopped by for support; recovery room personnel and nurses Karla, Donna, Nicole, Gina (awesome needlework!); Theresa who made the pre-op easy and is always so supportive; my step-grandma and pa Christina and Myron Khomyn; and everyone else who were so incredible.

I have to give Allergan rep Sany Nassar a huge "thank-you" for doing me a solid.

Finally, my friends and family: Jorge and Nevy (who accompanied me to surgery); my Dad who stopped several times and kept me company; stepmom Ruslana and little brother Rafael who also came in; little brother Pedro who prayed extra hard for me last night; great friends and fellow co-conspirators Ethan Lewis and Jon Levy who were on standby to make sure no one would pull the plug on me if I slipped into a coma (pet fear of mine); my wonderfuls friends Dr. Carlotta Rotman and Dr. Carlos Rotman (best laparoscopic surgeon I've seen, a great friend and excellent boss), both of whom called me to wish me well and express their confidence; and, of course, my lovely wife and kids Silvia, Daisy, Danny, and Erick for everything.

I love all of you and thank you from the bottom of my heart for all you've done and all you do.

Warmest regards,
Alfonso

I'm getting a LAPBAND!

2008-05-31T10:54:00.002-05:00

It's official! A shadow on an abdominal x-ray taken at my very excellent chiropractor/acupuncturist Dr. Li's office turned out to be a humongous gallstone. This happy coincidence dovetailed perfectly with a few other factors in my life and made it possible for me to join the band!

So, why am I having the band after successfully losing so much weight on the Optifast liquid diet?

It was something Dr. Mobley, our Cincinnatti surgeon, said. I went out there to film some surgeries and he told me what made him get banded. Without getting into details, every time he lost weight he could hold it off until a crisis hit. I realized that reflected the same pattern in my own life. There have been times when I was holding on to sanity by the skin of my teeth, and there was no way I was going to a maintenance session or a psychiatrist or even getting out of bed.

The band is an insurance policy against those moments when an angry cougar better not stand between you and the fridge.

Having lost so much weight already, my band surgery will be easy. I'll continue on my Optifast protocol, transitioning to partial solid as soon as the band allows. Optifast will remain my meal replacement option when I'm in the office, and the band will prevent me from overindulging late at night or on weekends.

In fact, I'd go so far as to suggest that everyone who has yo-yoyed should get a band when their weight is low, not waiting for the weight to come back up.

Of course, everyone is different. If you've been relatively trim all your life before gaining weight, a medically-supervised diet is probably the best option -- remembering that the key to keeping it off is a lifelong maintenance program (free at Synchrony Health).

Likewise, if you don't feel like the lifetime of portion control that the band enforces is right for you, then again the Optifast program is likely the right choice for you.

Everyone is different, which is why at Synchrony Health everyone gets a different plan. The best plan is whatever works for you.

Anyway, wish me luck!

70 pounds in 3 months!

2008-05-28T18:13:00.000-05:00

Week 13
Weight loss 5.0 pounds (69.2 total)
Weight 231.6 BMI 33.2
Fasting Blood Sugar 95 (no more tests until further notice)
BP 112/68 HR 70

So yesterday marked 3 months since I officially began - although to be fair I had to reboot twice, so technically Saturday makes three calendar months. Okay, so February had 29 days, so -- alright, enough already.

My results may seem amazing but they actually are not far removed from the national average of 52 pounds in 16 weeks (12 weeks full liquid plus 4 weeks partial liquid transition period). That's the national average, which includes women (who lose weight slower than men), and not that many 300+ pounders like myself. Men my size tend to lose 4-5 pounds weekly, and my weight loss has averaged 5.3 lbs/wk, so again, good but not spectacular.

Nonetheless, I'm feeling really good, especially since - if things work out - I have a big announcement coming soon! Stay tuned...

Back on track

2008-05-19T17:51:00.004-05:00

Week 12
Weight loss 5.4 pounds (64.2 total)
Weight 236.6 BMI 33.9
Fasting Blood Sugar (no more tests until further notice)
BP 104/62 HR 80

Despite a cookie attack last Thursday (I walked in and they flew at me from out of nowhere!), I managed to make good progress. At this pace I might make it to my goal of 220 in the next 4 weeks.

This is significant because at 16 weeks I'm going to have to switch from my current (and relatively easy) full-liquid diet, to a partial liquid/partial solid diet.

This upcoming transition has me a little scared. If I could do a "balanced meal" I wouldn't have gotten to this weight in the first place. Sigh.

On the other hand, I got to 335 by eating to excess for breakfast, lunch, dinner, and all points in between and beyond.

But now, 6 days a week I'm pretty much stuck in the office. If I substitute a shake for breakfast and lunch, and a low-carb high-protein snack bar in between, that's only 500 calories. As long as I can keep dinner under 1500 calories, I won't gain weight. If I can restrict dinner to about 1000 calories, I'll still lose about a pound a week. Not stellar, but not bad at all.

On a fun note, yesterday one of my little brothers had his first communion. My two aunts and several cousins came in from out of town. I arrived a little after they did, walked up to my aunts in their pew and waved hello. They stared at me, squinted, and gave confused little waves back. What a kick! Of course, neither was wearing her glasses (one is blind as a bat without them), but still, I suspect my changed appearance had something to do with it. I'm going to post some pics of Silvia and myself from the church soon.

Reality check

2008-05-12T10:16:00.000-05:00

Week 11
Weight loss 3.2 pounds (58.8 total)
Weight 242.0 BMI 34.7
Fasting Blood Sugar (no more tests until further notice)
BP 115/75 HR 86

So I went on a business trip to Cincinnati last week. I couldn't resist trying Cincy's famous Skyline Chili -- both straight up and "5-way" (chili, spaghetti, onions, red beans, cheese, plus sour cream and crackers). I got two small portions and ate half of each. It was... different, for sure. Because of that, it's not the kind of thing that will get you a trophy at the International Chili Society World Championship or at Terlingua, but locals love it and will defend it to the death.

Saturday and Sunday I had my no-cal salads for digestive purposes. Sunday night I got serious cravings and added a Slim-Fast Optima bar that inexplicably had appeared in the fridge. Not long thereafter (and possibly due to the high sugar content in most Slim-Fast products), the cravings got worse and I ended up eating a dozen candied peanuts and a Hershey bar.

Not surprisingly, my weight loss, though acceptable, was not great, despite the extra activity from the trip.

On the plus side, for a few weeks I had my eye on a size 48 sport jacket for my brother Pedro's first communion, coming up Sunday May 18. Saturday it finally fit me and I snatched it up. I used to wear a size 58, so this is very nice.

Can I get another "woo-hoo!"? (Or is that asking too much..?)

2008-05-05T15:19:00.006-05:00

Week 10
Weight loss 7.4 pounds (55.6 total)
Weight 245.2 BMI 35.1
Fasting Blood Sugar (no more tests until further notice)
BP 126/78 HR 80

What can I say?

Little better, little worse

2008-04-28T11:23:00.002-05:00

Week 9
Weight loss 3.8 pounds (48.4 total)
Weight 252.6 BMI 36
Fasting Blood Sugar (no more tests until further notice)
BP 122/72 HR 100

It was a pretty good week all around, except that I had another recurrence of that rash under the pannus and in the groin. My weight loss was better than last week, and the half-size-too-small clothes I bought a couple of weeks ago now fit properly.

One other thing I developed was both upper and lower back pain, plus a pain in the right gluteus maximus (no, not the kids, actual pain in the butt). The lower back is chronic and recurring, the gluteus is new and I don't know how that happened. The upper back is clearly a result of the insance amount of worok I've been doing hunched over my desk trying to read my too-small computer monitor. I have an appointment to see Dr. Li tomorrow for either chiro or acupuncture.

Okay, I'm not exactly your fuzzy wuzzy New Ager type, but Dr. Li is very practical and not at all hocus-pocusey about acupuncture. Essentially, it deadens the nerves, which reduces your body's over-reaction to a perceived threat. This reduces inflammation at the affected site and allows your body to heal naturally. I know a few internal medicine physicians who are honest enough to say that 80% of the afflictions patients go to see them for will take care of themselves, so this jibes pretty closely to what Dr. Li says.

Anyway, long story short (I know, too late) acupuncture in the past gave me immediate and lasting relief from sciatica pain, something which used to take weeks with conventional therapy and steroid injections.

I felt pretty good this week. A little dizzy at times getting up fast, but otherwise fine (except for the painful rash and back). :)

Intermission...

2008-04-21T14:27:00.007-05:00

Week 8
Weight loss 1.8 pounds (44.6 total)
Weight 256.4 BMI 36
Fasting Blood Sugar 85 (no more tests until further notice, see below)
BP 110/78 HR 80

Okay, so I lost less than 2 pounds. My excuse is that I drank half a gallon of water this morning. I've been good all week [except for the dozens of cups of Splenda-sweetened mint tea (decaf) I drank Saturday].

And the half-dozen spoonfuls of the delicious chorizo and eggs that Silvia made. But that's all. Honest. I think...

I got my second shot of testosterone Saturday after Synchrony Health Academy (Dano talked about aerobic endurance training).

I also picked up a prescription for "AndroGel," a new testosterone replacement treatment which helps me sidestep the horror of needles. But one horror is replaced by another: a one-month supply costs about $260 at Wal-Mart! Fortunately my insurance covers it, so my co-pay of $20 is fine, but if I were uninsured..?

Last week Dr. Ghani switched me from phentermine to tenuate. It doesn't work quite as well, but the physical hunger is manageable. Also, it's important to switch off because we develop a resistance (and addiction) to phentermine otherwise.

He also reduced my metformin to 500mg once daily, from twice daily. Since my fasting blood sugar remained the same all week, I'm going to stop checking until we make the next medication or dietary change. The only reason I'm taking any at all is it helps as a diet aid.

I only had two workouts this week, but yesterday Silvia and I walked around the Morton Arboretum. My pedometer (Omron HJ-112, dual sensors for maximum accuracy, $20 through Amazon, highly recommended) measured more than 12,000 steps that day, more than half aerobic. This is more than enough for us to brave the American Cancer Society 5K Walk next month. Remember, obesity doubles and triples the risks of many types of cancers, and makes them harder to diagnose and treat.

Unfortunately, my pannus rash came back a few days after I discontinued treatment. It's painful and embarassing, and treatment works marginally at best.

On a final note, I shaved my beard off and freaked out everyone I know. The combination of weight loss, new clothes, and bald face took (they say) 20 years off. I don't want to post a picture yet, since there are still a few people out there I'd like to surprise in person...

Sweet!

2008-04-14T17:35:00.005-05:00

Week 7
Weight loss 6.6 pounds (42.8 total)
Weight 258.2 BMI 36.8
Fasting Blood Sugar 85
BP 106/80 HR 80

Admittedly some of the weight loss might be the smaller clothes I bought yesterday, but DANG! And I haven't been at this weight in 15 years.

I bought clothes half a size to small. Yeah, normally I try not to be optimistic, but there you have it.

Also, my cholesterol is down to 164, from 217. Double dang!

Okay, enough with the potty mouth. This is all good news.

I did workout 3 times this week, 60 minutes each of resistance training. I also went mall walking for half an hour one time (1 mile aerobically).

Finally, my lab results revealed abnormally low testosterone levels, which leads to reduced lean muscle mass and, ahem, the aforementioned issues in the budoir. I got a testosterone shot from Dr. Ghani and, well, let's just say Silvia told me to thank him. 'Nuff said.

On the downside (for me, every silver lining has its cloud), I was hungry a couple of times (missed my 3-hour meal window), and felt a little dizzy standing up a few times.

Hey, it can't all be wine and roses, especially with all the calories in wine...

Uh-oh...

2008-04-07T09:10:00.004-05:00

Week 6
Weight loss 3.8 pounds (36.2 total)
Weight 264.8 BMI 37.9
Fasting Blood Sugar 85
BP 110/70 HR 84

Well, well, well. What can I say? Mea culpa, mea culpa, mea maxima culpa?

Saturday I got the munchies really bad. I ended up scarfing down half a head of lettuce with my patented dressing (see below), 3 cups of low sodium chicken broth, 2 sugar-free Jell-O cups, a low-calorie pudding cup, and a low-calorie yoghurt cup. Total 180 calories. True, I'm on a liquid diet and this was not liquid, but not too horrible, huh? Well it gets worse.

As I sat alone in the dark watching a documentary, the cravings got worse. I ended up tossing back two Chewy Chips Ahoy cookies and some unknown Mexican treat that consists of a chocolate cookie topped with marshmallow and coconut flakes.

So, not a million calories, but the problem is I'm very sugar sensitive. Back when I was on Atkins I found that as few as 10 grams of carbs would throw me out of ketosis (fat burning mode).

Worse, the sugar hangover the next day can be pretty bad. It's Monday and I'm still recovering from it.

Okay, so some of you will probably want to slap me around a bit. Yes, I did lose 3.8 pounds and my blood sugar is 85. These are great in any context, and I'm not complaining about the results.

I'm just ticked at myself for the weakness. I know we all go through it, and I think the anger/guilt is probably negative thinking, self-destructive, and contributes to more cheating. It's just hard to break these thought patterns, you know?

So here is some positive thinking. Yesterday was a gorgeous day and I wanted to go for a ride with Silvia on Danny's motorcycle. My size 56 pants have been sagging and my belt is on the last notch, but I didn't want to give those overcharging jerks at Casual Male Big & Tall any more money than I had to. While at Wal-Mart (evil, yes, I know) I found some size 50 slacks and tried them on. Too big. I grabbed the 48s. Same thing. I finally tried on the 46s and they fit perfectly. I picked up a size 46 belt and skipped out the store. Okay, so I paid first, but you get the enthusiastic idea.

Anyway, we biked down to the Lincoln Park Zoo, met up with an old friend of mine and his adorable kids, and had a pretty good day.

That's positive thinking.

Also on a positive note, I managed 3 workouts this past week, about an hour each. They're all still upper body resistance training, because a) walking with a hundred extra pounds is a hell of a workout for my lower body already, and b) I don't have a treadmill at home and hate sweating in public.

Dr. Ghani praised my performance this week and admonished me not to feel guilty. He also suggested two snacks I can keep handy that would satisfy better than my current fallbacks: chicken breast kabobs broiled with plenty of spices and a light coat of extra-virgin olive oil spray, individually wrapped and frozen until needed; and 100-calories pouches of raw almonds or walnuts to satisfy the crunch factor.

Saturday's Synchrony Health Academy lecture was a recap and finalization of a previously unfinished lecture on the consequences of obesity: health, social, psychological, and economic. It's pretty thorough.

Finally, here's my salad recipe: coarsely chop a quarter of a medium head of iceberg lettuce and shake dry; powder liberally with Mrs. Dash salt substitute, ground pepper, and 1/2 packet of Splenda; sprinkle on a teaspoon of Valentina hot sauce and 2 tablespoons of balsamic vinegar; toss thoroughly and enjoy! Total calories about 15, sodium about 70mg. Consider adding a tablespoon of unsalted sliced raw almonds, just an extra 43 calories and even greater satisfaction.

Can I get a “woo-hoo!”?

2008-03-31T15:15:00.001-05:00

Week 5
Weight loss 5.2 pounds (32.4 total)
Weight 268.6 BMI 38
Fasting Blood Sugar 94
BP 104/66 HR 80

Dr. Ghani is taking me off of captopril (BP meds)! My BP is actually getting too low. He still wants me to continue on metformin because it helps regulate insulin levels, and it doesn’t cause low blood sugar.

I’ve lost 26 percent of my excess weight. Initially Dr. Ghani thought 220 would be a reasonable goal for me, but now he thinks I should try for 200. I don’t think I’m ever going to get to 178 (my top normal BMI of 25), but I think I might be able to do 200.

One thing I’m lucky about is I have an abnormally high metabolism for a person my age and size – 46% higher than average! I had a “Resting Metabolic Rate” test done at the beginning, and it said I could sit on my butt all day and still eat 3,730 calories without gaining any more weight. With normal activity and exercise I could eat 5,237! Of course that number will come down as I lose weight, but it does mean I’ll be able to eat normally, maybe even a little more than normal, without hurting myself.

Okay, I know, that’s not the right way to think about it. Saturday’s Synchrony Health Academy lecture was by John Burkhardt, II, MA (yes, I like to write their names down correctly and formally). He’s a psychology intern and adjunct professor at Argosy University’s Illinois School of Professional Psychology. One point I learned was that we sabotage ourselves by thinking about diet as a privation (see my earlier notes) instead of an opportunity or challenge.

I have to think not in terms of how much I’ll be able to eat when I’m “done” with this diet. That paints the diet in negative terms. I have to think of the diet as an opportunity, as a positive. Not what I can’t eat, but what I can now do, and what I’ll be able to do later on.

Also, I’ll never be “done” with the diet. I have a lifetime of maintenance ahead of me. Once or twice a month I’ll attend the support group (free for MOM grads – let me get a plug in for Synchrony), for the rest of my life. If I start to creep up, back on the active diet, right away.

This can sound bad on the surface, but many people go to church every Sunday and don’t consider it an imposition, rather an opportunity. My friends and I used to have a monthly poker game, which was fun and something I scheduled my life around. Synchrony Health Academy is actually fun. The topics are interesting, I like seeing all the familiar faces there, and we all get a chance to catch up and discuss the problems (and successes) we’re having with other people who are going through the same thing.

My friends and family, God bless ‘em, love me and sympathize, but they have no idea how hard it is. “Just stop eating so much” is basically the attitude. Sure, just stop breathing so much. As hard as it is for a drug addict, alcoholic, or smoker to quit, at least when they get off the addiction they don’t have to have the drug or booze or cigarette shoved into them every day, three times a day. As soon as I put a bite in my mouth the whole brain goes into a frenzy and demands more more MORE. It would be easier if I could just give up food completely. For some of us, dieting is just plain hard.

Yeah, sure, calories in, calories out. Eat less, exercise more. But it’s not that simple. Dr. Ghani keeps a list of 273 factors that promote weight gain, most of which are untreatable. So maybe I have 8 factors that make it harder to lose weight. I went on Seattle Sutton’s 1800 calorie diet, which with my metabolism should have had me losing 6-7 pounds a week. In two months of strict adherence, I lost nothing! How is that normal? How can anyone say it’s easy to lose weight with so many damn factors working against us?

I’m sorry, I don’t mean to sound bitter. One of the other things John covered in his lecture is how our friends and family actively try to sabotage our weight loss, even unintentionally. And it’s true. First off, I will never be thin, so at 200 people will say “Try a little harder, you’re so close” instead of “Way to go! Just keep it off!” I won’t be invited to dinner because they don’t want to make me uncomfortable. If they do invite me, I’ll be uncomfortable when the only healthy menu item is a plate of salad with no dressing. I’ve been the fat kid most of my life. How will my older brother feel if I lose the weight and he’s suddenly the fat one in the family?

We change as we grow thinner. We get more confident. People start to think we’re becoming full of ourselves. They change as we grow thinner. I’ve seen it before, I just didn’t understand it. Most people don’t like change. We categorize each other and are disturbed when those categories don’t fit anymore, or when the dynamics in a relationship change.

John talked about a woman who was highly educated and smart as a whip. People judged her on her performance, but she felt they were slightly prejudiced against her because of her weight (this is common, studies show). She figured if she lost the weight she would be taken more seriously and get more respect. So, she was extremely successful at losing weight, but unfortunately she turned into a babe. Now, instead of paying attention to what was coming out of her mouth, they were focusing several inches below. Heads they win, tails you lose.

I know I’m rambling on a bit, and some of this is probably a sugar low (I’m 4 hours overdue for my shake!). The bottom line is I have to do this for myself, not for anyone else. My family loves me and wants the best for me, as they see it. That doesn’t matter. What does matter, what I need to remember, is that I’ll live longer and I’ll feel better doing it.

Mixed bag

2008-03-24T12:47:00.003-05:00

Week 4
Weight loss 4.2 pounds (27.2 total)
Weight 273.8 BMI 39.2
Fasting Blood Sugar 95
BP 110/74 HR 88

I took the family to Wisconsin Dells on Friday in the middle of yet another seemingly endless series of snowstorms in this eternal Chicago winter. We had a great time, but. But:

But #1: I took the kids to dinner but there wasn’t a single healthy item on the menu. Because of the weather we couldn’t (or didn’t want to) leave the resort (Kalahari, great indoor water park), and I didn’t realize there was another restaurant at the other end of the (big) resort where they had grilled ahi tuna on the menu. So we all had the buffet. I ate two enormous helpings of salad (that I seasoned with pepper, Equal, and balsamic vinegar), several chilled shrimp (no sauce), two small sautéed mystery fish filets, and three small grilled salmon filets. That was probably another thousand-calorie boo-boo.
But#2: Silvia also started on the Synchrony Health diet but was having a hard time and giving me a hard time. She figured crabs=protein, so they’re on the meal plan. When I say crabs, I mean plural. She had at least two whole giant crabs. I can’t calculate how much that was, but she ate until she couldn’t. This kind of irritated me because a) Opti-Fast is good, but it ain’t cheap; and b) she was sabotaging my efforts instead of supporting me. I was the one supporting her, and she only needs/wants to lose ten pounds. The next day for lunch I took the kids to the other restaurant, reviewed the menu, and decided to be strong. I left them enough money to eat whatever they wanted, and started to leave. Silvia did not like that one bit. “We’re on vacation!” was her argument. “From work, not from life,” was my reply. She left with me, but it took her a while to stop giving me angry looks.
But #3: Dinner that night was delivery pizza. I left the room to avoid the temptation. Silvia stayed and had, she reports, “one slice.” That’s about 500-600 calories, give or take. I spent the next hour in the gym. Silvia came by later and we walked and talked. I guess I didn’t realize how badly she was jonesing for sugar. It doesn’t matter how big you are, when you go on a diet your body does everything it can to make you stop this crazy, unnatural act (remember my Wendy’s adventure?).

At any rate, despite the “buts” we had a great time overall. Lots of insane water slides followed by idle drifting in an inner-tube on the appropriately-named “Lazy River.” The excess activity probably helped offset the excess consumption, because I still managed to lose four pounds.

Weirdly enough, and I swear completely by chance, Dr. Ghani took his family to the same resort the same day. We ran into him playing water basketball with his kids. Silvia and I tried the same with our kids, but 18 and 17 year olds are a little tougher to beat and a little more competitive: Daisy “accidently” ripped my bathing suit clear down the side (she got her foot tangled in my pocket trying to block my shot). She apologized though, since she had only meant to kick me, not tear my shorts. Apparently kicking is kosher in water basketball. It was a little tough getting out of the pool, and I couldn’t leave with the towel so I had to make my way back hunched over holding my shorts closed with both hands.

Getting back to the diet, last week’s results were not a fluke. My BP and sugar are still normal, even after cutting my dosages in half. Dano gave us a demonstration of upper and lower body resistance training we can do safely, at home, with nothing more than a chair and an elastic band. Silvia and I tried it out, and I have to say I’m surprised how out of shape I am. I used to bench press 240 pounds (300 max) and curl 50 as a kid, and now I’m exhausted by stretching a little band. I reluctantly bought an adjustable dumbbell that goes up to 25 pounds, thinking with remorse that even though it could be adjusted down to Silvia’s level, 25 pounds was going to be too light more me. Hah! With 10 pounds my bicep burns after only 4 sets of 10 reps, and I have to struggle to finish 6 sets. Dano suggests not increasing weight until we can comfortably complete 10 sets of 10. I feel like such a pansy.

Wow!

2008-03-17T18:19:00.002-05:00

Week 3
Weight loss 7.4 pounds (23 total)
Weight 278 BMI 40
Fasting Blood Sugar 106
BP 112/62 HR 88

Okay, so the week didn’t start out so well. Danny got accepted to the University of Illinois in Urbana – wait, that’s not the bad news for Pete’s sake. The bad is we went out to celebrate (again, not bad, but wait for it) to Red Lobster (wait for it) where I had (now!) a jumbo shrimp cocktail, large grilled salmon, and half of Silvia’s grilled mahi-mahi, plus the garden salad (okay) with the light vinaigrette (not okay).

Yeah, I know, all protein and a little healthy fat, but still, I’m supposed to be on an 800 calorie diet, and that meal was more than 1,000. I’d already had two shakes in the morning, and I ended up having another at night, so we’re talking double what I’m supposed to be on.

So, I didn’t punish myself the next day, ‘cause experience has shown me that will lead to even more cheating the following day. I just went back to my normal diet. I was pretty good the rest of the week.

The one thing is, I get antsy when I get home. The kids are old enough that they don’t need (or often want) attention or entertainment from the parental units, so I’m left to sit on the couch and watch TV. If you’ve got weight problems, you probably know the feeling – it’s not hunger, it’s not necessarily low blood sugar, it’s just a sort of compulsion. I don’t smoke, so I can’t say for sure if it’s like withdrawal, but I’ve heard that smokers, even after they’re over the physical addiction to nicotine, have these sudden, overwhelming urges to smoke under certain conditions, usually stress-related.

What this means is, I can be saintly good all day at work, but when I get home I end up nibbling on something I shouldn’t. Fortunately, it was no more than a spoonful or two of some delicious, fatty Mexican meat dish Silvia was cooking up. A couple of times I had a bite of a Chips Ahoy cookie, which I chewed, thoroughly enjoyed, then spat out into the garbage.

The thing is, I know if I wasn’t on the phentermine I would have been swallowing and secretly coming back for more. Often. I just feel like I’m missing out on what used to be a big, wonderful part of my life. I’m working on an ethnic restaurant guide for Chicago, and my two years of “research” were an amazing experience (ironically, I lost weight during that time because I was eating healthier food than my usual).

I love food, plain and simple (and fancy and complex), so I can’t help feeling that I’m depriving myself and sacrificing and I’m worried what will happen when the diet ends and I go back to the “real world.”

So there you go, two big problems: eating at night and missing out on life.

But back to the wow, two big successes: my blood sugar and blood pressure were both normal for the first time since Dr. Goofus rabbit-punched me with the news eight years ago. The two things that scared me the most about my weight were blindness and amputation (besides, of course, premature death, which most of us don’t really think about too much since it seems kind of remote).

I can’t tell you how profoundly I felt seeing both of these normalize, and I don’t think I’m able to express it adequately, since no one in my family was particularly impressed (depressing, really, but I’m told it’s pretty common). The people here at Synchrony were really happy for me, and Dr. Ghani’s reaction in particular (Wow! That’s awesome!) gave me a much needed boost.

He also suggested cutting my blood pressure and diabetes medication dosages in half, which felt pretty good (I’ve been feeling kind of dizzy when I stand up).

Dano finished his introduction on Saturday. Next week (we’re off this weekend) he’s bringing in some elastic bands we can use for resistance training. It seems that, while aerobic exercise is good for cardiovascular health and to burn a few calories (half an hour to burn an apple), resistance training is great since muscles burn fat even while you’re resting.

What an awful, miserable week

2008-03-07T16:13:00.001-06:00

Week 1
Weight loss 15.4 pounds
Weight 285.6 BMI 41
Fasting Blood Sugar 134
BP 110/70 HR 100

Dizziness, depression, hunger. I started out last Wednesday and made it to Friday before I got the shakes (sugar withdrawal, not OptiFast shakes). I ended up scarfing down a chicken sandwich, fish sandwich, and double quarter pounder at Wendy’s.

I got back on the horse Saturday and fell on my ass Sunday night with half a dozen Mrs. Field’s cookies.

Monday I asked for a prescription and got phentermine 37.5mg. It helped. I stayed on diet the rest of the week. It didn’t take all the hunger away, but I wasn’t staring at the clock desperately waiting for the time to take my next Opti-Fast shake.

Sure, the scale says 15.4 pounds weight loss, but that’s just water and Wendy’s and glycogen flushing out. Next week we’ll see what happens.

The topic at Saturday’s Synchrony Health Academy lecture was “Introduction to Bariatric Fitness” by a Certified Personal Trainer, George “Dano” O’Donnoghue. He’s good. He specializes in helping overweight patients start a customized fitness program that reduces the risk of injury for those of us who’ve been inactive for a long time, plus he also gives one-on-one training at our homes (he brings a portable gym). He didn’t get to finish the lecture, so that’ll be next week.

My Weight Loss History

2008-02-27T17:23:00.003-06:00

D-Day
Weight 301 BMI 43.5
Fasting Blood Sugar 156
BP 158/102 HR 100

So I finally caved in. I’d been hoping to save enough money for the Lap-Band, but I did my taxes and it turns out I owe the IRS a chunk of change. That, plus the house that Silvia has her heart set on buying this year means it’s going to be a while before I can have the procedure, and I don’t think I can wait.

I’ve been working for Synchrony Health/Center for Weight Management of Oak Brook for almost six months and I kept getting asked if I had the Lap-Band or was on medical weight management. It was kind of embarrassing, which with my personality made me more defiant and resistant to the idea.

Yeah, like most of us I’ve dieted before and lost weight lots of times, then gained it back with interest.

At 14 I lost 40 pounds in a few months on the typhoid fever diet, from 185 to 145 (not recommended). That’s when I first started working out regularly.

By 17 I gained it all back, even with the exercise.

By 20 I was a full 335 pounds.

At 21 I graduated college in winter, and not having anything to do until the fall (med school), I went on an insane diet and exercise plan:

700 calories per day (two Slim-Fast shakes and a Healthy Choice dinner)
11 hours of exercise per day, 4 times a week (strength and aerobic), alternating with
7 hours of exercise the other days, 3 times per week.
I lost 148 pounds (335 to 187) in 19 weeks (7.8 pounds per week)

One year later I gained it all back.

At 31 I tried Atkins and lost 60 pounds (don’t listen to all the baloney, Atkins works – I ate thousands of calories of meat each day and lost weight; the problem is, I got sand in my gallbladder and got sick of eating all that fat).

One year later I gained it all back.

At 32 I tried Chicago’s most advertised weight loss guru – I mean, doctor. What a goofus. It was nothing but a “pill mill.” I got to see him once. He talked for a couple of minutes about my weight history. Then his nurse drew my blood, and gave me 7 pills and a badly photocopied “diet plan” (what a joke: eat half an apple and a glass of skim milk for breakfast, 3 ounces of fish and a yogurt for lunch, blah blah blah). I came back the next week and was told I had diabetes. I was given a prescription for metformin and 7 diet pills, plus another badly photocopied joke. I went back there a few times, never got to see the doctor again, never had my questions answered nor my lifestyle and issues discussed. I gave up.

All those times, what I didn’t have was a support group. I was pretty much winging it on my own, even with Dr. Goofus Guru. Well, Dr. Ehtesham Ghani told us in Synchrony Health Academy about the National Institutes of Health finding that 70% of weight loss patients who participate in regular (monthly-bimonthly) maintenance programs are able to successfully keep the weight off even after 5 years. Meantime, 95% of those who don’t participate regain their weight in as little as one year. I guess I feel better being in such company.

The thing is, it didn’t used to be too bad. I was obese but active and strong. The only problems I had, which were humiliating but infrequent, were not being able to fit in an airline seat or walk through a turnstile. When I got married, though, my activity level went way down. Instead of biking 12 miles early each morning, I had a reason to stay in bed. Instead of walking downtown and visiting the bookstore, I had a family waiting for me at home, to talk, play, and sit and watch TV.

So anyway, things have gotten pretty bad:

my knees hurt when I get up;
my leg hurts once I’m standing;
I get severe leg cramps at night;
I’ve got peripheral neuropathy (numbness in my limbs);
my diabetes is getting worse;
my eyesight sometimes gets blurry;
my blood pressure is bad;
and I’m having more trouble in the boudoir.

Erectile dysfunction is a very common consequence of obesity, but so is male infertility. Years ago I was diagnosed with very low sperm count (5 million), and though it’s too late now to have children (and Silvia’s kids are wonderful!) I still feel a bit of a sting about that.

I’ve learned that all of these problems: diabetes, heart disease, ED, infertility, neuropathy, joint pain, etc., can begin to get better with as little as 10-15% weight loss. So even if I don’t become a swimsuit model, I can get better. For me to be a 25 BMI (highest “normal”), I’d have to go down to 178. I don’t think that’s going to happen. But if I can lose 12-18 pounds and keep them off, I might start feeling well.

Of course, the first several pounds is water loss, emptying my intestinal tract, and losing the glycogen reserves in my liver. I always figured the first week’s worth of weight loss was meaningless, but every pound after that is real fat being burned off.

Okay, so I’m starting Synchrony Health’s Medical Obesity Management (MOM) program. Dr. Ghani has had a lot of success with the Center for Weight Management (Hinsdale, which helped Oprah lose all that weight she brought out in a wheelbarrow, Naperville, Brookfield, Berwyn, and now Oak Brook). He tells me the average weight loss is 53 pounds in 12 weeks. That’s the average. On top of that, he’s got an excellent long-term success rate with the patients who stay on the maintenance program.

Fingers crossed, here goes nothing.