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You Have Arrived

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Whatever else you have on your mind,  
Wherever else you think you're going, Stop for a moment and
 look where you are:

You Have Arrived!

I believe in you.
You deserve to be healthy.
 You deserve to be kind to yourself.
You deserve to achieve your greatest level of success with weight loss surgery when you harness your inner resources.
--Kaye Bailey
5 Day Pouch Test Owner's Manual

In This Digest
Peer-to-Peer Support Makes Weight Loss Easier
Three Keys to Lasting WLS Success
The Neighborhood
Four Truths About Weight Regain After WLS
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Weight loss surgery is no different from other diet programs: it comes with rules. But perhaps the most important factor in long-term success with weight loss surgery is the empowerment that comes from peer-to-peer support. People who surround themselves with a positive support network are more likely to lose weight and sustain weight loss than those who go it alone. Learn more about the value of support systems for weight loss:

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Online Peer-to-Peer Connections Key in Weight Loss Surgery Success


Rainbow ButtonAbout 250,000 morbidly obese adult Americans will undergo Weight Loss Surgery (WLS) this year to have their intestines cut and rearranged in a drastic attempt to lose weight and put their obesity in remission. In addition to surgical intervention they will agree to follow a high protein, low carbohydrate diet, engage in daily physical activity, avoid snacking on empty calorie foods, and drink lots of water. Most will lose significant weight; enough weight so they will no longer be classified obese. Many will sustain that weight loss but sadly, others will regain some or most of the weight they lose. A lack of support network is often cited by those who regain weight as one reason they struggled to lose weight and keep it off, even with the drastic measure of weight loss surgery.


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Support groups are old business for people pursuing weight loss. Many conventional mainstream weight loss programs are built around solid support systems. Most bariatric centers, as part of their surgical weight loss program, offer support groups to patients. In most cases support group attendance and participation is voluntary.

The Internet now provides a vast network of support groups that studies indicate are providing a viable method of peer-to-peer support, particularly in the life long battle of weight management. A 2002 study reported in the Journal of Medical Internet Research suggests that in a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. The help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others' experiences, providing sympathetic understanding and establishing social networks. The real time nature of online support groups is preferred by community members who may be forced to wait weeks before the next live group meeting is conducted at which they can share their concerns.

As the owner of an established weight loss surgery online support group I have observed members come and go. It is interesting to note that pre-operative WLS patients are highly active in the community asking questions and seeking knowledge about the WLS post-operative experience. They continue to actively participate in the community in the weeks and months following surgery. Almost like clockwork as patients achieve healthy weight goals, or perhaps struggle to reach goals, they drift away from the community and the support they valued during the phase of weight loss. Perhaps they leave because their improved health has given way to new lifestyle activities making less time for Internet connecting. Some admit leaving because they feel their weight loss does not compare favorably to others. Others have told me the WLS chapter of their life is closed once goal weight is reached and they chose to move along.

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More important to note is that many former community members return after an extended absence only to admit that giving up their online support network was the first step in getting off track in weight loss and weight maintenance with gastric surgery. The accountability and shared empowerment that comes in a peer-to-peer support network clearly plays a key role in the success or failure of bariatric patients. Members who join the group to receive support and then stay with the group to return support report the highest level of personal success with weight loss surgery.

"In good online support groups, members stick around long after they have received the support they were seeking." John M. Grohol reports in his article, What to look for in Quality Online Support Groups. He adds "Members stay because they want to give others what they themselves found in the group. Psychologists call this high group cohesion, and it is the pinnacle of group achievement."

Kaye Bailey (c) All Rights Reserved


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The Nurse Warned Me,
But I Gained Some Weight Back Anyway

"Dear Kaye,
Thank you for the Day 6 book. I guess I am one of "those people" - had the surgery and lost and then it came back, the weight. My WLS nurse warned me I could regain the weight and I didn't take her serious or maybe I thought I was more determined than everybody else or smarter or something. I wish I had asked her what would cause me to gain the weight back. I'm not sure that back in 2007 I ever heard of slider foods or liquid rules or anything like that. I just knew WLS was the answer for me. So now I'm up 48 pounds and want to stop it before it gets to 50 pounds and all of the sudden another 50 and I'll be back where I started. Thanks for explaining so many things in the Day 6 book. I wish I read this book before I even had the surgery, maybe I wouldn't be one of "those people" or at least not a 48-pound-regain one of those people.

This is the first time I have hope since the re-gain started.
Kelly Marca
Northern Ohio"

Printed with Permission.

Day 6: Beyond the 5 Day Pouch Test
Because we are all "One of those people" who have or could regain our weight.

Day 6 by Kaye Bailey

four_rules2011 Refresher Course
Weekly Digest Archive:
The Four Rules

Rule #1 - Protein First:

LivingAfterWLS Weekly Digest January 20, 2011


Rule #2 - Lots of Water

  LivingAfterWLS Weekly Digest February 2, 2011 



Rule #3 - No Snacking

LivingAfterWLS Weekly Digest February 9, 2011  


Rule #4 - Daily Exercise

LivingAfterWLS Weekly Digest February 18, 2011  




Good Stuff to Know:

LivingAfterWLS Newsletters: Free Online Archive   




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The health content in the LivingAfterWLS website is intended to inform, not prescribe, and is not meant to be a substitute for the advice and care of a qualified health-care professional.


Should you be 'Scared Straight' about life after WLS?     

Warning Signs & Direct Conversation


August 9,  2011

LivingAfterWLS, LLC - All Rights Reserved 


My work in the weight loss surgery community gives me a tremendous opportunity to learn from others who are fighting to manage their weight with the surgical tool. Next month I'll mark 12 years since going under the knife and in some eyes that makes me a veteran of gastric bypass. By popular accounts I should not be struggling with my weight because I took the naively called "easy way out" by having surgery. But the fact is, I work to manage a healthy weight and maintain nutritional balance every minute of every day. And it is work. Each day I learn new things from so many members of our WLS community and I understand that I am not the only one struggling to stay at a healthy weight.

The information I have collected from so many weight loss surgery patients who have been forthright in sharing their experience gives me a unique window into the realities of living after weight loss surgery. As one of the many voices of weight loss surgery my stewardship to you is to share what I learn from the collective experiences of many.

Bariatric centers are expert in providing pre-surgery counseling and outlining post-operative protocols to guide us in the first year or so after surgery. And most patients report for follow-up visits on the one-year anniversary of surgery; some patients continue to be seen in the second and third years after surgery. However, by five years out of surgery less than 10% of patients are in touch with their bariatric surgeon or initial support group. Because of this breakdown very little is know about the long-term successes and struggles of weight loss surgery patients by the medical and scientific community. But here, on the front lines, we have amassed a great collection of data and experience. My work brings me the good fortune of collecting this data and sharing it with you.

Last week in a discussion about carbonated beverages on Facebook I made this comment, "I can share what I have observed -- not from the surgeon's reports or lectures but from you, my Neighbors, who are on the front lines fighting obesity with WLS: In the majority of cases when weight loss has stalled or weight gain has occurred the truthful Neighbor (myself included) reveals they have been tipping the soda bottle, including diet soda. Take that for what it is worth."  In a private message a fellow WLS Neighbor scolded me for using "scare tactics" and exaggerating the harm caused by going against the Four Rules. Now, I don't expect any weight loss surgery patient to follow me blindly in this journey and I hope everyone is collecting their own database of knowledge that will help them improve their weight loss surgery experience. But, wouldn't I be remiss if I withheld the collection of knowledge that has been so generously shared with me by the weight loss surgery community?

The fact is, we have no better reference resource available than each other.

So many of us go into surgery making hand-on-the-Bible type promises to not become "one of those people who gain the weight back." Did you make that promise to yourself or to others? The best way I know to keep this promise is to learn from others and to keep building on personal experience and knowledge. So when I share with you what I've learned it is in the spirit of fellowship knowing we are all in this together. You can count on me to be direct and honest about my own experience and what I have learned from you. Here are a few nuggets of knowledge that are golden and that I learned in the WLS-afterlife, not from my bariatric center:

-Eating a meal of lean protein without liquids causes discomfort that is supposed to signal fullness and satiation, but more often causes us to break the liquid restrictions or turn to slider foods. This eventually leads to weight gain.


Online Articles: 

Understanding the Liquid Restrictions    

Slider Foods Spell Weight Regainl


Day 6: Beyond the 5 Day Pouch Test 

Pages 80-83: Liquid Restrictions & Slider Food


-Regardless of surgical procedure the Four Rules work to help us lose weight and maintain a healthy weight.

The Four Rules  do not expire and most patients who maintain a healthy weight long-term follow the rules closely.

Online Articles:

Rule #1 - Protein First 

Rule #2 - Lots of Water 

Rule #3 - No Snacking 

Rule #4 - Daily Exercise 



-The classic WLS laugh-line "I can eat anything I want, just less of it" is simply bogus. It implies we can go back to eating smaller portions of the things we ate before surgery without consequence. Let me assure you, patients who return to a diet of things that led to their obesity before surgery will certainly cease to lose weight and most likely regain weight. This return to old dietary habits usually starts with grazing on pretzels (presumably diet friendly food) or soft crackers because they set better in the pouch and go down more easily than lean protein.

 Online Article:

 No Snacking. It's the Rule that Works 




Today's digest includes several articles and links that are meant to inform and educate all of us in the LivingAfterWLS community. I hope you will find them helpful in your journey. As we forge ahead toward better health I believe we each discover strong, capable, beautiful beings inside. May each new day be one of discovery, growth and empowerment. 


Best Wishes!

Kaye Bailey



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Hot Topic: Carbonated Beverages
Are you a weight loss surgery patient asking questions about including carbonated drinks in your diet? I confess, the heat of the summer is when I really crave a refreshing Diet Coke on ice - before surgery I considered it to be my "Breakfast, lunch & dinner of champions." And late last year I found myself hooked on it again - 11 years after surgery. We are discussing this very issue in the LivingAfterWLS Neighborhood. Join us in the discussion and let us know what your bariatric center told you and how you are treating the carbonated beverage advice!  This is a great topic- thanks to Swampymoo from Australia for opening the discussion!

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Three Keys to Lasting

WLS Success

by Kaye Bailey - Syndicated Article Copyright 2010


Gerber Daisy

Nearly a quarter-million people in the United States will undergo weight loss surgery this year to arrest their morbid obesity and lose weight. In spite of the drastic nature of gastric surgeries not all patients will reach a healthy weight and some may eventually regain weight they lost initially with surgery. Obesity is not a simple cosmetic problem of excess body weight than can be corrected with surgery. It is a metabolic disorder where the body stores an abnormal amount of body fat. Bariatric surgeries help arrest the disease by reducing the amount of calories a person may eat and some surgeries reduce the amount of nutrients the body absorbs and stores as fat. The surgery does not remove the disease but with patient compliance weight is lost and obesity can be put in remission.


Chances for healthy weight loss and weight maintenance with surgery can improve with patient commitment to recovery. Patients must accept that the burden of treatment for their disease obesity is with them. Bariatric counselors tell patients the surgery is only a tool and it is up to the patient to use it correctly. This applies to all procedures including gastric bypass, gastric sleeve, and adjustable gastric banding (lap-band). There are three pro-active things patients can do to use their tool wisely:

Lifestyle: Accept that bariatric surgery brings with it an entirely different lifestyle that you must adopt for the rest of your life. Unlike conventional diets there is no finish line: surgery requires an almost religious-like lifestyle change. Patients must follow a high protein, low carbohydrate diet every day for the rest of their life in order to lose weight and maintain that weight loss. Patients will need to avoid simple carbohydrates including sugary snack foods and fried food. Snacking, when allowed, must be mindful including lean protein and low-glycemic fruits and vegetables. Liquid restrictions mean no beverages before or after meals and no drinking with meals: this helps the surgical pouch work correctly. Patients learn and accept that some things will make them sick, smells will affect them differently, and sometimes they will feel emotionally blue because of the irreversible restrictions of surgery. We have this life-changing surgery with all its restrictions and then return to the very environment in which we became obese: of course we suffer feelings of sadness at times.

Support: As with other life-changing disease, patients seeking treatment and recovery from morbid obesity with surgery benefit from support. While no one can understand another persons exact journey we can certainly share the collective experience of obesity, life long dieting and weight gain, and finally the somber decision to undergo treatment with surgery. While patients are likely to cluster to support groups both live and online before surgery and in the first year following surgery, there is a tendency to drift away from support groups as time passes. Evidence suggests, however, that solid support relationships are a key in sustaining personal efforts for health, weight control and wellness with bariatric surgery.
Join the LivingAfterWLS Neighborhood for strong peer support.

Activity: The inclusion of physical activity as part of lifestyle change with surgery will make a difference in the long term successful weight management of bariatric patients. Early post-operative patients are directed to get 150 minutes of exercise a week, that is about 20 minutes a day. Patients who do this and more will successfully manage their weight loss and weight maintenance. Patients who regain weight often admit they never really got around to including physical activity in their new lifestyle. Studies indicate exercise need not be strenuous or exhausting. Physical activity simply must move us beyond the normal motion required of daily life.

Weight loss surgery patients tend to idolize their surgeons and bariatric teams crediting them with restoring their health. But long after the surgical wounds have healed and the routine checkups are simply annual office visits it is up to the patient to own their surgical tool and manage it in a way that keeps their disease in remission.

Kaye Bailey copyright 2010 - All Rights Reserved


Please read "You are worthy of your own care giving." on pages 32-38 of Day 6: Beyond the 5 Day Pouch Test  



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The LivingAfterWLS Neighborhood: an online compassion driven social space evoking feelings of comfort, understanding, knowledge, warmth, acceptance, trust and happiness for those who have undergone gastric bypass, lap-band or any type of weight loss surgery or those struggling with weight control.


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Connect with others who had weight loss surgery the same year you did and share the journey! From the Pioneers of the 1980s to our newbies of 2010, everyone has a place in the Alumni Club to call home.


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Four Truths About Weight Regain After WLS

I was born with the disease obesity and by the time I was out of college it had advanced to morbid obesity. At age 33 my disease was treated with gastric bypass surgery which affected a loss of weight that put my disease, morbid obesity, in remission. Three years later I suffered a relapse of my disease with a weight gain of 20 pounds. Through dietary and lifestyle compliance, much like a person with heart disease who suffers a relapse, I was able to put my disease, obesity, back in remission. I will always have the disease of morbid obesity and am fortunate that I was able, at a young age, to be treated with the best medically available option.



The Facts:

-Obesity is a disease.

-Weight loss puts the disease in remission.

-Weight gain puts the disease in relapse.

-Like most diseases, victims of obesity are responsible to make dietary and lifestyle changes that work with medical treatment to keep our disease in remission.

-Like most diseases, relapses occur, obesity manifests relapse in weight gain.

-We are not the disease, we have the disease.


My Four Truths:


Regain Is Likely: It is generally believed that 80% of people who undergo weight loss surgery (WLS) will experience weight gain (relapse) of 10-30 pounds depending upon initial weight loss. It is further believed that 20% of those will relapse to their former weight and possibly gain more as the disease of morbid obesity advances. This relapse can be the result of failed gastric surgery (the surgery was improperly performed or medical device failure); a non-compliant patient who does not evolve their eating and exercise habits; the active intestine becoming more efficient at absorbing calories; and potential stomach pouch stretch. Dr. Anita Courcoulas, chief of minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center said, "Regaining weight down the road is a common phenomenon for weight loss patients. These patients need to be educated and prepared for it if it happens."


100% Conviction: It is my experience that 100% of patients who take to the operating table for the treatment of their disease say, "I'm not going to be one of those people  who gain weight after surgery." You can bet the farm I said that - and imagine my embarrassment and shame when I did in fact become one of those people. At the time I didn't understand my disease had relapsed, in part because I had relaxed my newly evolved eating and exercise habits, but also because my body has a disease that wants to store excess fat. I thought I gained weight because I was a failure at surgery.


I failed AGAIN! I am not alone in my feelings of failure over weight regain. Dr. Courcoulas said, "These are people who feel that they have failed at everything they tried in their lives. If they feel that they are failing surgery, they're embarrassed and they don't want to come back for help." How sad for us. When a cancer patient suffers a relapse do they take it as a personal failure? I sure hope not. Popular media perpetuates the belief that weight gain equals failure. WLS celebrities are splashed across mainstream media and tabloids alike for weight regain. But the celebrity with cancer who suffers relapse? Charity benefits are hosted bearing their name and their bravery is lauded. With a relapse in obesity the celebrity becomes the brunt of jokes for late night comedians. No wonder we don't want to become one of those people but statistics are not on our side


I Am Not Obese. Since kindergarten the word "fat" defined me and I actually thought that was who I was because "You are fat" and "I am fat" were constant phrases in my world. By about age 40 I finally figured out that I am not fat. I have obesity, a disease. Have you heard a heart attack patient say, "I am heart disease" or a leukemia patient say, "I am cancer"? We are not the disease! We have a disease that is part of the whole person that makes us the wonderfully unique and powerful person we are.


Relapse to Remission: Just like other diseases, obesity relapse can be put into remission. There is hope! As noted above there are (at least) four reasons for relapse including: failed gastric surgery; a non-compliant patient who does not evolve their eating and exercise habits; the active intestine becoming more efficient at absorbing calories; and potential stomach pouch stretch. Keeping in mind that statistically weight regain is likely, that you are not a failure, and that you are not the disease, you can pragmatically go about mapping a plan to fight your relapse.


 -Seek medical help and treatment: you are fighting a killer disease


-Assess your eating and exercise evolution and return to the lifestyle prescribed at the time of surgery


-Educate yourself on nutrition, physical and spiritual health so they may work in harmony to heal your body


-Seek support, family, friends, community, and fellow patients to help maintain your personal motivation


-Educate others to stop the ignorance and blame and promote the understanding of this illness we are fighting.


Kaye Bailey 2010 - All Rights Reserved

Thank you for being a loyal Neighbor of LivingAfterWLS. We are proud to serve you in your weight loss surgery journey.



Kaye Bailey

LivingAfterWLS, LLC