WazzuCoug
Member
I thought I'd share what my 3 month appointment covered for people who are pre-surgery or not quite there post-surgery. Without a doubt, clinics will differ in exactly what they do at 3 months, but I suspect there would be some similarities. I thought some of you who haven't gotten there yet might be interested in what was asked and done. I met with my dietician, physical therapist and bariatric nurse practitioner for a check up. You may meet with slightly different people at three months.
Here is how things went down:
Of course, the first thing they did was weigh me. I'm 57 lbs down since surgery on July 16, 2020 and 67.5 lbs down since July 2, 2020. My percentage of "excess weight loss" or %EWL so far is 41%. The average is 30% at 3 months. Unfortunately, the %EWL is based on BMI, which is complete BS for 60% of women and 13% of men, but that is still the standard, which is a shame. There is a much better measure of obesity out there called Relative Fat Mass, which has been shown to be nearly as accurate as the DXA body composition scan (widely considered the "gold standard" in body composition testing). Anyway, I hope the drop BMI because it's just so misleading for so many people, and the insurance industry uses that to over charge and disquality people from insurance (particularly life insurance) all the time. I digress...sorry.
I met first with my dietician. She asked me how I was doing and what I've been eating, how often I've been eating, how much I've been drinking, etc. She asked which vitamins or supplements I had been taking. I shared that generally for breakfast I will either eat steel cut oatmeal sweetened with 1/4 of a premier protein shake, or I'll have a small omelette with some veggies. For lunch, it might be a bean burrito, or bean/veggie soup, or some sort of wrap. For dinner, often some sort of bean and vegetable dish, soup, casserole, etc. She asked if I was having any snacks. Generally, I have at least one snack during the day, either between breakfast and lunch or lunch and dinner. I usually have a protein bar or sometimes carrots and hummus. I also supplement some of my meals with unflavored protein. I eat a plant-based diet with occasional meat, fish and eggs (eggs are the most common). She said my plant-based diet was "music to her ears" so I feel good about the decision to do that. I know it isn't for everyone, but I think there is a general feeling in the greater bariatric community that you can't be vegetarian or Vegan and get what you need post surgery, and that isn't true. It's different, but totally doable. We spent the rest of our time talking about the microbiome, which was enjoyable. She told me to keep doing what I was doing, but she wanted to be sure I was adding in some additional snacks and not going more than 2 or 3 hours without food.
Next I met with my bariatric nurse practitioner. My blood pressure was checked (perfect), and she listened to my heart and lungs, checked my incision sites, and asked if I'd been having any issues with acid reflux, vomiting, diarrhea or constipation. She also verified what vitamins and supplements I am taking. I had some diarrhea early on, but that resolved about week three. I haven't vomited at all. I had three instances with acid reflux that all came when I was sleeping. It is not pleasant to weigh up choking on stomach acid. All three times seem to be strongly correlated with having a very late dinner not long before bed. I now make sure I eat earlier or stay up for a few hours after I eat before going to bed. I didn't have any other issues, so it was a fairly short appointment. I stopped at a lab and had several vials of blood drawn for the following tests: CBC, Lipids (cholesterol) Panel, Iron Panel, Thiamine Panel, and Folate panel. I'm still waiting for results. I had gotten a Metabolic Panel, Vitamin D, B-12, and A1C the week before, which were all normal.
Lastly, I met with a physical therapist. The first thing we did was a body composition scan and compared it to a scan I had last February. I had also recently bought a body composition scale, so I was curious how it would match up. As it turned out, they were very closely aligned, so I'm glad I can be pretty confident about the body fat and mass trends that I'm getting at home. Anyway, the main physical issue I've been having is thoracic back pain between my scapulas and spine. It can get really painful. He thinks it is related to posture, both from losing weight and having less mass in my middle and from working at home on a laptop. He gave me some exercises and stretches to do, and I'm going to start using a docking station with my laptop so I can use a larger monitor and regular keyboard and mouse at a table instead of working in my recliner. The other area that I'm going to be focusing on is increasing my fat to muscle loss ratio.
Right now, I'm at ratio of 2.1.1, which means for every 2.1 lbs of fat lost since surgery, I'm also losing a pound of muscle. This is pretty common in the first three weeks. The first month, when you are restricted from doing most lifting and heavy resistance training, your body is losing fat and muscle at close to the same rate. As you start moving more, and start doing resistance exercise that ratio should change. We want it to be above 2:1, but preferably closer to 3:1 or higher. I am genetically lucky in that my muscle mass is much higher than average, so even though I lost muscle, I'm still above the normal range, so now I need to kick up my resistance exercise to improve that ratio.
He said that it doesn't take too much: two times a week, exercising your main muscle groups to failure. HIIT is the best option and doesn't have to take a ton of time - 7-15 minutes, as long as you are hitting the intervals hard. You can just use your body weight, if you don't have other equipment. I'm alternating days on my walk to run program with HIIT on the opposite days. Just exercising arms, chest, torso and legs with pushups, crunches, and air squats would be effective. Of course you can add on a lot more if you desire. I'll have a body composition scan again in 3 months to compare. Of course, I'll be looking at the trends on my body comp scale at home too. Regardless of what you do though, since we are eating at extreme calorie deficits, your body will turn to muscle for energy at times, so it important to work in that resistance exercise and definitely kick it up a notch if your ratio is determined to be too low. Muscle mass also helps your metabolism, so trying to maintain that is beneficial in that regard too.
That was it, my 3-month checkup. Now it's on to the next 3 months to the half year mark!
All of our experiences and numbers on the scale and such will be different, but eating right, exercising and trying to get our muscle to fat loss ratio in a good place is common for everyone. Keep making good food choices (meat or veggie based), exercise to maintain a favorable muscle to fat loss ratio, and you will lose weight over time. It might go fast, or it might go slowly, but it will happen!
As always, our common cya statement: talk to your doctor before making any changes to your diet or exercise routine (although probably very few actually do that), LOL.
Here is how things went down:
Of course, the first thing they did was weigh me. I'm 57 lbs down since surgery on July 16, 2020 and 67.5 lbs down since July 2, 2020. My percentage of "excess weight loss" or %EWL so far is 41%. The average is 30% at 3 months. Unfortunately, the %EWL is based on BMI, which is complete BS for 60% of women and 13% of men, but that is still the standard, which is a shame. There is a much better measure of obesity out there called Relative Fat Mass, which has been shown to be nearly as accurate as the DXA body composition scan (widely considered the "gold standard" in body composition testing). Anyway, I hope the drop BMI because it's just so misleading for so many people, and the insurance industry uses that to over charge and disquality people from insurance (particularly life insurance) all the time. I digress...sorry.
I met first with my dietician. She asked me how I was doing and what I've been eating, how often I've been eating, how much I've been drinking, etc. She asked which vitamins or supplements I had been taking. I shared that generally for breakfast I will either eat steel cut oatmeal sweetened with 1/4 of a premier protein shake, or I'll have a small omelette with some veggies. For lunch, it might be a bean burrito, or bean/veggie soup, or some sort of wrap. For dinner, often some sort of bean and vegetable dish, soup, casserole, etc. She asked if I was having any snacks. Generally, I have at least one snack during the day, either between breakfast and lunch or lunch and dinner. I usually have a protein bar or sometimes carrots and hummus. I also supplement some of my meals with unflavored protein. I eat a plant-based diet with occasional meat, fish and eggs (eggs are the most common). She said my plant-based diet was "music to her ears" so I feel good about the decision to do that. I know it isn't for everyone, but I think there is a general feeling in the greater bariatric community that you can't be vegetarian or Vegan and get what you need post surgery, and that isn't true. It's different, but totally doable. We spent the rest of our time talking about the microbiome, which was enjoyable. She told me to keep doing what I was doing, but she wanted to be sure I was adding in some additional snacks and not going more than 2 or 3 hours without food.
Next I met with my bariatric nurse practitioner. My blood pressure was checked (perfect), and she listened to my heart and lungs, checked my incision sites, and asked if I'd been having any issues with acid reflux, vomiting, diarrhea or constipation. She also verified what vitamins and supplements I am taking. I had some diarrhea early on, but that resolved about week three. I haven't vomited at all. I had three instances with acid reflux that all came when I was sleeping. It is not pleasant to weigh up choking on stomach acid. All three times seem to be strongly correlated with having a very late dinner not long before bed. I now make sure I eat earlier or stay up for a few hours after I eat before going to bed. I didn't have any other issues, so it was a fairly short appointment. I stopped at a lab and had several vials of blood drawn for the following tests: CBC, Lipids (cholesterol) Panel, Iron Panel, Thiamine Panel, and Folate panel. I'm still waiting for results. I had gotten a Metabolic Panel, Vitamin D, B-12, and A1C the week before, which were all normal.
Lastly, I met with a physical therapist. The first thing we did was a body composition scan and compared it to a scan I had last February. I had also recently bought a body composition scale, so I was curious how it would match up. As it turned out, they were very closely aligned, so I'm glad I can be pretty confident about the body fat and mass trends that I'm getting at home. Anyway, the main physical issue I've been having is thoracic back pain between my scapulas and spine. It can get really painful. He thinks it is related to posture, both from losing weight and having less mass in my middle and from working at home on a laptop. He gave me some exercises and stretches to do, and I'm going to start using a docking station with my laptop so I can use a larger monitor and regular keyboard and mouse at a table instead of working in my recliner. The other area that I'm going to be focusing on is increasing my fat to muscle loss ratio.
Right now, I'm at ratio of 2.1.1, which means for every 2.1 lbs of fat lost since surgery, I'm also losing a pound of muscle. This is pretty common in the first three weeks. The first month, when you are restricted from doing most lifting and heavy resistance training, your body is losing fat and muscle at close to the same rate. As you start moving more, and start doing resistance exercise that ratio should change. We want it to be above 2:1, but preferably closer to 3:1 or higher. I am genetically lucky in that my muscle mass is much higher than average, so even though I lost muscle, I'm still above the normal range, so now I need to kick up my resistance exercise to improve that ratio.
He said that it doesn't take too much: two times a week, exercising your main muscle groups to failure. HIIT is the best option and doesn't have to take a ton of time - 7-15 minutes, as long as you are hitting the intervals hard. You can just use your body weight, if you don't have other equipment. I'm alternating days on my walk to run program with HIIT on the opposite days. Just exercising arms, chest, torso and legs with pushups, crunches, and air squats would be effective. Of course you can add on a lot more if you desire. I'll have a body composition scan again in 3 months to compare. Of course, I'll be looking at the trends on my body comp scale at home too. Regardless of what you do though, since we are eating at extreme calorie deficits, your body will turn to muscle for energy at times, so it important to work in that resistance exercise and definitely kick it up a notch if your ratio is determined to be too low. Muscle mass also helps your metabolism, so trying to maintain that is beneficial in that regard too.
That was it, my 3-month checkup. Now it's on to the next 3 months to the half year mark!
All of our experiences and numbers on the scale and such will be different, but eating right, exercising and trying to get our muscle to fat loss ratio in a good place is common for everyone. Keep making good food choices (meat or veggie based), exercise to maintain a favorable muscle to fat loss ratio, and you will lose weight over time. It might go fast, or it might go slowly, but it will happen!
As always, our common cya statement: talk to your doctor before making any changes to your diet or exercise routine (although probably very few actually do that), LOL.
