About the Author

Introduction: Why I Wrote This Book for You

Chapter 1: Long-Term Success

Keep Doing What You've Been Doing

Recovery

Your First Day Home

Your First Week

When You're Going to Be Yourself Again – Only Better

Chapter 2: Weight-loss after Surgery

Rate of Weight-loss

Postoperative Diet Progression

Stage 1 – Clear Liquid Diet

Stage 2 – Full Liquid Diet for Days Three Through Seven Postoperative

Stage 3 – Smooth Foods Diet for Days Eight Through Thirteen After Your Procedure

Stage 4 – Soft Foods Diet for Days Fourteen Through Twenty-eight Postoperative

Enhancing Weight-loss

Your First 100 Days After Surgery

Why Your Friends May Be Your Saboteurs

Plateaus

Tips for Getting Off a Plateau

Liquid Meal-Replacement Plan

Follow-up Appointments

Hunger

How Hormones Work

Mental Hunger

Chapter 3: Mistakes, Strategies for Success and Rewards

Top 10 Roadblocks to Success after Weight-Loss Surgery… and Ways Around Them

Rewards, Inherent

Rewards, Not So Inherent

Chapter 4: Rebound Weight Gain

Combat Rebound Weight Gain With a Calorie-Restriction Program

Chapter 5: When a Revision Surgery Might Be Needed

Am I a Candidate for a Revision Surgical Procedure?

How Will I Know if Revision Surgery is Right for Me?

Laparoscopic Procedures

Types of Procedures

Privacy

Insurance Coverage for Complications

Chapter 6: Keeping It Off Forever

Not Unending Hardship, but Many Small Goals You Can Accomplish and Celebrate

Forget the Long-Term Future. Let's Focus on the Next Goal

Short-Term Goals Become Long-Term Accomplishments

You Don’t Have to Go It Alone

Believe in Yourself

Quiet the Voices of Negativism

Appendix A: Six-Week Liquid Diet

Appendix B: Potential Nutritional and Vitamin Deficiencies Following Bariatric Surgery

Glossary

About the Author

Kent C. Sasse, M.D., M.P.H., F.A.C.S.

Dr. Sasse is a nationally renowned authority on surgical weight-loss procedures and a leader in the rapidly evolving field of bariatric surgery. He founded the program for Adolescents and Weight-Loss Surgery at Western Bariatric Institute and wrote the research protocol for surgical weight-loss in teenagers. The distinguished recipient of several awards, including membership in the prestigious Alpha Omega Alpha Society for top medical graduates in the country, Dr. Sasse is founder and medical director of both iMetabolic (International Metabolic Institute) and Western Bariatric Institute (a nationally recognized ASBS Center of Excellence).

Dr. Sasse is the recipient of a bachelor’s degree in biochemistry from the University of California, San Diego, where he graduated cum laude. He went on to receive two master’s degrees, including one in public health stemming from research related to biostatistics and bioethics, from the University of California, Berkeley. Dr. Sasse completed residency training in surgery, focusing on gastrointestinal surgery and physiology, at the University of California, San Francisco, as well as fellowship training at the Lahey Clinic in Boston, Massachusetts, before establishing his practice in northern Nevada.

Dedicated to the highest levels of scientific research and individualized, state-of-the-art treatment of patients, Dr. Sasse brings a wealth of experience and expertise to the rapidly evolving field of weight-loss surgery. He has written and continues to pursue several IRB-approved research protocols regarding weight-loss and weight-loss surgery, and he lectures frequently on topics related to obesity and weight reduction at the University of Nevada School of Medicine. Through his nationally recognized programs, Dr. Sasse and his outstanding faculty provide patients the highest levels of compassionate medicine, scientific evidence and personalized care in the field of weight reduction.

Please visit www.sasseguide.com for more information on Dr. Sasse and his programs and facilities.

Western Bariatric Institute

Dr. Sasse and his colleagues have built upon modern, minimally invasive surgical techniques in applying advanced cutting-edge technology in surgical weight-loss solutions for patients in the West. Together with his colleagues John Ganser, M.D., and Robert Watson, M.D., Dr. Sasse founded Western Bariatric Institute, a nationally recognized surgical weight-loss center and American Society of Metabolic and Bariatric Surgery Center of Excellence. Dr. Sasse serves as medical director and dedicates himself to compassionate, individualized care of every patient. He has written and pursues several Institutional Review Board-approved research protocols regarding weight-loss and weight-loss surgery, including those related to teens and adolescents.

International Metabolic Institute™ (iMetabolic^®)

Dr. Sasse founded International Metabolic Institute™, a center offering sound non-surgical medically-supervised solutions for weight-loss that involve dietary modifications, behavior-changing techniques, prescription weight-loss medications, fitness training, psychological counseling and inspirational life coaching. As medical director of iMetabolic^®, Dr. Sasse oversees its outstanding medical faculty in developing the highest quality medically supervised weight-loss programs. Visit www.iMetabolic.com for more information.

Together these centers provide state-of-the-art weight-loss solutions for people suffering from excess body weight.

Obesity Prevention Foundation

In 2006, Dr. Sasse founded the Obesity Prevention Foundation, a nonprofit organization dedicated to the prevention of obesity and excessive weight gain among adolescents. Through his work treating thousands of individuals suffering the health consequences of excessive weight and obesity, Dr. Sasse has seen that the real path to resolving this health crisis in the future will come from prevention. He has brought experts from many fields to work together to prevent excessive weight gain and obesity among children and teens. Visit www.ObesityPreventionFoundation.org to learn more.

Introduction: Why I Wrote This Book for You

The decision to have a surgical weight-loss procedure is a life-affirming decision. Once made, the decision requires responsibility, hard work, determination and resourcefulness to get you to what seems like the end of the process: the day of your operation. The journey does not end after your weight-loss operation. It really just begins there.

I wrote this book about what happens after your weight-loss procedure to give you the keys to successful weight-loss in your new life. I wrote this book to help you stimulate weight-loss if it has stalled, to get off plateaus and start losing weight again so you can move ahead in your life and feel great, enjoy long-term successful weight-loss and experience better health. I wrote this book to help you renew your confidence in your journey if you have regained weight and to give you keys for maintaining the weight-loss for the long term.

Modern weight-loss operations are extremely effective tools for successful weight-loss, unlike anything that has ever come before. Unprecedented numbers of people have lost weight successfully with bariatric surgery, and you can too. But it's not easy, and it's not without hard work and dedication on your part. You've already seen the amount of work that's gone into the process as you've attended your preoperative education classes, support groups and meetings with the medical professionals guiding you along your journey.

To succeed in creating a new you, you need the right tools. The surgery itself is one powerful tool, but there are many more that you need in your tool chest to succeed.

Not everyone who undergoes a surgical weight-loss procedure fully internalizes the important methods necessary to keep the weight off. Some programs don’t spend enough time on the educational components of successful weight-loss and, to be honest, many patients have told me they were so excited about having surgery and their chances for a new future they failed to recognize the importance of the information they were receiving. They didn't understand it was important to learn every facet of medically proven weight-loss science.

I've been fortunate enough to have helped thousands of people successfully lose weight through surgical and nonsurgical weight-loss methods. Two of the positions I hold make me uniquely qualified to write this book. First, I serve as the medical director of a nationally recognized weight-loss surgical center, Western Bariatric Institute, and I founded and direct a nonsurgical, state-of-the-art medical weight-loss center known as the International Metabolic Institute™ (iMetabolic^®). Through the combined efforts of both institutions, I've learned a great deal about how successful people lose the weight – and keep it off, whether they've chosen the surgical or nonsurgical path. The unique combination of methods offered by both institutions allows me to put together a program that can work for anyone.

So if you've already had a surgical weight-loss procedure or if you're just about to have your operation or if you had your operation a year ago and it's getting harder and harder to maintain that weight-loss, it's time to marshal all your enthusiasm, resources and dedication to the singular goal of losing weight. If you've regained weight after weight-loss surgery, don’t despair. You can lose weight again and keep it off this time. If you have lost some weight but know you need to lose a good deal more, you can do it with the right tools, the right information and the right program.

I will show you how.

Chapter 1: Long-Term Success

Congratulations! You've reached the day of your weight-loss operation. I'll bet you never thought you were going to get here. Achieving long-term success with weight-loss procedures is a process that starts before the procedure itself. It's been a long road and taken a lot of courage, pluck and determination to get to the day of your operation, but you did it! While the preoperative butterflies consume you, you have a few minutes to start concentrating on the new life you're going to have after you leave the surgical facility. You have so many opportunities in front of you, chances to make the most of the new life you've given yourself time to explore.

Take a minute and think back over what you've done in the last few months. You've found a bariatric surgeon to work with, scheduled appointments, and gone through the lab testing and required medical procedures in order to be accepted as a candidate for surgery. You've probably attended educational classes as part of your program. Hopefully you've had a chance to take advantage of support groups offered through your weight-loss program and met with other people who are going to have or have already had the procedure you're about to undergo. Maybe you've met with a nutritionist or dietitian, and taken a good hard look at how you have been eating and how you need to start eating.

It's likely that for the last four to eight weeks you've been following a liquid protein diet of meal-replacement shakes so you've probably already lost quite a bit of weight while preparing for your operation. Good for you! This is a promise of good things to come.

Here's what to expect now that your new life is about to begin.

Keep Doing What You've Been Doing

In the last few months you've created all kinds of new habits and followed a liquid meal-replacement program to lose weight preoperatively. Hopefully you've utilized tools available to you through your surgical program to make preoperative weight-loss easier and get more information on everything to do for long-term weight-loss. Don’t stop! If you continue to take advantage of educational materials and support groups like you did before your operation, you give yourself more tools for success.

Having gone through preoperative classes, met with experts and had access to online educational materials for months before your procedure, you will probably have heard the answer to every question about your procedure three times over. But when you come out of your operation, you may still find you have questions, and once you go home from the surgical facility, you're going to either have to call someone or wait for an appointment with your surgeon’s office to ask those questions not related to critical medical care. Some questions you’ll either have to answer for yourself or wait for follow-up appointment with your doctor, questions such as: "Can I move all my furniture on the second day out of surgery?" (probably not) or "Has anyone else ever felt this particular sensation?" (probably). If you’ve taken advantage of the support groups in your area, chances are there's someone else in your group who has had the same procedure you have and can answer your questions or provide support when you're feeling doubtful or worried.

Many weight-loss programs build in support mechanisms, so there are plenty of resources for questions that might arise. In our program at Western Bariatric Institute, clinical staff in the office can answer unforeseen questions (during normal working hours), and a host of former patients who serve as support group leaders can offer a wealth of knowledge. Some special individuals we call Helping Angels work with our program, visiting with patients at the hospital and making themselves available if questions arise. So take advantage of all the resources available to you and keep in touch with your support network.

If you've been educating yourself with audio programs, don’t stop once your procedure is over. The more knowledge you have, the more tools for success you have. You can listen to audio programs on weight-loss success while you're driving, while doing household chores or, since you've now started incorporating physical exercise into your life, while working out. I've mentioned in my book, Outpatient Weight-Loss Surgery: Safe and Successful Weight-loss with Modern Bariatric Surgery, that in our country today we're exposed to approximately 20,000 messages about food in the course of a year, and most of those messages are about the unhealthy kinds of food. Advertisers bombard us with images and messages, most of which are picked up by our subconscious and never fully examined, just squirreled away. Most of them are garbage we could do without. So why not replace them with healthy messages? You can find top-notch audio programs on nutrition and weight-loss, exercise and healthy living from Weight-loss CD's Audio Diets Weight-loss Audio Programs.

Recovery

With today's weight-loss procedures, when you wake in recovery it's likely you'll only have been under the effects of an anesthetic for 30 minutes to a couple of hours. For the rest of the world, not much time has passed and not much has happened. For you, the entire world has just changed for the better.

When you first wake, you'll be in the first stage recovery room. This is where you'll emerge from anesthesia, and it's unlikely you'll even remember being there. If you've never had a surgical procedure or awakened in recovery, the room is nothing more than another hospital area, much like the area you were moved to for preoperative work. It's a calm place, with nurses and staff present to take care of you.

Recovery isn't a private area, though, only sectioned off with curtains, and there will be other patients recovering there as well so there's usually no way for your family to join you there (because there's no way to protect the privacy of the other patients.) You'll still have an IV and will still be wearing your stylish hospital gown. If I'm your surgeon, I'll probably come in to make sure recovery is progressing well, though it's unlikely you're going to remember seeing me there.

Don’t worry – you won't be in recovery for long. As soon as you're awake and declared stable, you'll be moved to a second stage recovery area, often a private room, where your loved ones can visit.

Physically every person feels a bit different, but many people can expect to feel some pain or soreness or discomfort from the operation. This will most likely be felt at the abdominal incision areas and in the upper back, chest and shoulder blades. These upper chest and back pains are caused by what is called referred pain, meaning nerves that are irritated by the laparoscopy gas at the diaphragm or upper abdomen create the sensation that the chest, back and shoulder areas are actually hurting. Just let your nurses know what you're feeling and they can work to keep the discomfort down to a tolerable level.

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