To fill or not to fill?



		To Fill or Not To Fill First read these 4 things: You may need an eating adjustment You may need a behavior adjustment You may need an activity adjustment You may need an attitude adjustment If the above 4 things are ok, then read on: You may need a fill You may need an un-fill (see new x-ray photo!) How to Tell When You Are Perfectly Adjusted You are losing 1-2 pounds per week. If you are not losing 1-2 pounds per week: A. You may need an eating adjustment 1. Are you eating 60 grams of protein a day 2. Are you eating 25 grams of fiber 3. Are you avoiding all liquid calories a. Soup can be sign of soft food syndrome b. Alcohol contains a lot of calories “ 7 calories per gram (1) It is also a stomach irritant c. Fruit juice is just sugar water 4. Are you making healthy food choices from a wide variety of foods? a. Are you avoiding soft foods b. You cant just eat what's easy c. Cheese is glorified fat 5. Are you drinking 6-8 glasses of water a day between meals 6. Are you eating too much junk a. Chips, chocolate, nuts, ice cream, cookies and other highly processed junk foods are too calorically dense to be regular parts of a healthy diet. But dont avoid them completely to the point where you feel deprived. b. Stay out of fast food places 7. Are you getting in two servings of calcium daily 8. Do you always eat the protein first 9. Then the vegetables or fruits a. Five servings a day b. Potatoes are NOT a vegetable 10. Is your portion size appropriate? a. Meat or fish (1) 3 ounces the size of a deck of cards b. Vegetables (1) ½ cup the size of your fist c. Starch (1) If you eat the protein and the vegetables first you dont need much (2) Avoid: rice, potatoes, pasta 11. You might try avoiding artificial sweeteners a. Some people think that artificial sweeteners stimulate the appetite b. They are HUNDREDS of times sweeter than sugar c. They teach you to like things too sweet d. There is no evidence that people who use them are any thinner than people who dont 12. Avoid most diet foods a. Real food usually tastes better b. Real food is more satisfying than low calorie substitutes c. When you are only eating a tiny bit the caloric savings is not that great (1) Use a teaspoon of real butter instead of a tablespoon of diet margarine (2) The body has no way to break down artificial fats a. They may go into permanent storage b. Some people think liposuction is the only way to remove hydrolyzed fats from the body B. You may need a behavior adjustment 1. Are you eating only when you are hungry? a. If youre not sure drink 8 ounces of water and wait. 2. Are you eating three meals a day? a. With maybe 1 or 2 small snacks 3. Are you sitting down to eat? 4. Are you eating consciously? a. No distractions, turn off the TV, put the book or newspaper away, pay attention to your food and your companions 5. Are you eating slowly? a. Put the fork down between bites b. Take 20 to 30 minutes to finish a meal c. Taking longer might cause the pouch to begin emptying 6. Are you taking small bites? a. Tiny spoon, chopsticks, cocktail fork 7. Are you chewing well? 8. Are you drinking with your meals or too soon after your meals? a. Practice water loading between meals b. You wont be thirsty if you are well hydrated before the meal 9. Are you stopping at the first sign of fullness? a. Sometimes its a whisper: not hungry, had enough b. Hard stop versus soft stop 10. Do not eat between meals. Stop grazing. 11. Do not eat when you are not hungry C. You may need an activity adjustment 1. Are you getting in 30 minutes of physical activity at least 3 times a week? a. Over and above what you would do in the usual course of your day b. Could you make it 4 or 5 times a week? c. Could you make it 45 or 60 minutes? 2. Are you taking advantage of opportunities to increase your physical activity? a. Taking the stairs instead of the elevators or escalators b. Walking on the escalators instead of riding c. Parking your car further away from the entrance d. Getting out of the car instead of using the drive through e. Getting off the bus one stop before your destination f. Washing you car by hand instead of the car wash g. Playing with your kids D. You may need an attitude adjustment 1. Are you committed to your weight loss journey? 2. Are you totally honest with yourself about how much you are eating and exercising? a. Log your food and activity on www.fitday.com for 3 days 3. Are you using food inappropriately to deal with emotional issues? a. Have you identified what the emotions are that drive your eating? b. Can you think of more appropriate ways to deal with those emotions? c. Are you willing to seek help from a qualified counselor? 4. Are you attending and participating in support group meetings? 5. Have you drummed up some support from your family and friends? 6. Have you dealt with saboteurs realistically? 7. Do you have realistic expectations about the weight loss journey? 8. Are you still obsessing about food, weight, dieting, eating? a. Obsessive compulsive thoughts (1) Obsess about something else b. Perfectionism (1) All or none, black and white thinking c. Patience with the pace of healthy weight loss 9. Are you acknowledging your successes with non-food rewards? 10. Have you learned how to take a compliment? 11. Are you giving up diet mentality? a. Stop weighing yourself several times a day or every day b. Stop dieting c. Stop depriving yourself d. Stop defining food as good and bad e. Stop rewarding and punishing yourself with food 12. How do you feel about all the changes taking place? E. You may need a band adjustment 1. You feel like you are making healthy food choices in appropriate portion sizes but getting hungry between meals? 2. You can still eat white bread, fibrous vegetables and large portions. 3. You are having to struggle to lose 4. You are gaining weight in spite of eating right, exercising and having a good mind set. F. You may need your band loosened Above is a x-ray photo of a band that is too tight. As you can see, the barium is stuck above the band and very little to no barium is able to pass through. 1. There are times when you cant get fluids down 2. You are vomiting too much a. How much is too much? (Daily basis) 3. Do you have frequent reflux or heartburn at night? a. Do not lie flat or bend over soon after eating b. Do not eat late at night or just before bedtime c. Rinse your pouch with a glass or water an hour before bedtime d. Certain foods or drinks are more likely to cause reflux: (1) Rich, spicy, fatty and fried foods e. Eat slowly and do not eat big meals f. If you smoke, quit smoking g. Reduce stress h. Exercise promotes digestion i. Raise the head of your bed j . Wear loose fitting clothing around your waist k. Stress increases reflux l. Take estrogen containing medications in the morning m. Avoid aspirin, Aleve and ibuprofen at bedtime 1) Tylenol is OK n. Take an antacid (Pepcid complete) before retiring o. Try other over-the-counter heartburn medications 4. Things to avoid a. Chocolate b Caffeine c. Alcohol d. Some fruits and vegetables a. Oranges, lemons, tomatoes, peppers 5. Peppermint a. Baking soda toothpaste 6. Carbonated drinks 7. See your health care provider immediately (or call 911) if a. You have a squeezing, tightness or heaviness in your chest, especially if the discomfort spreads to your shoulder, arm or jaw or is accompanied by shortness of breath, sweating, irregular or fast heartbeat or nausea. These could be symptoms of a heart attack. b. If your symptoms are triggered by exercise. c. If your pain localizes to your right side, especially if you also have nausea or fever d. If you throw up vomit that looks like black sand or coffee grounds. Or if your stool is black, deep red or looks like it has tar in it. These are symptoms of bleeding and need immediate attention. (Note: Pepto-Bismol or other medications with bismuth will turn your stool black. Iron supplements can also make the stool tarry.) e. If your pain is severe This was written by Jessie H. Ahroni, Ph.D., A.R.N.P., C.D.E., B.C.-A.D.M.