This week I had the opportunity to meet Dr. Peter Rubin, the head of the Life After Weight Loss program here at the University of Pittsburgh Medical Center (UPMC) http://lifeafterweightloss.upmc.com/Default.htm
He told me a bit about their nutritional and body contouring programs and services and it got me to thinking. Their program is primarily geared to the needs of WLS patients, of which some of us are and some of us aren’t. What if we were to broaden the target group and come up with our dream vision of a Life After Weight Loss program for all of us? What services and programs would YOU like to see? What needs do YOU have that aren’t being addressed anywhere else?

Here’s the wish list that I’ve been kicking around (I’m sure I’ll think of more but it’s a start):

• Doctors who can answer all our questions about the physical changes that happen to our bodies after a weight loss, especially a massive weight loss — on every level from hormones to metabolism to appetite to skin problems
• Nutritionists who wouldn’t just parrot the food pyramid but realize that there are other healthy ways to lose (and keep off) weight
• Exercise consultants — how about an awesome gym too?
• A readily available way to assess body fat % (and I’m not talking Tanita scales — they’re pretty much worthless)
• Group support where people like us can get together in Real Life and discuss common issues and problems. I’d love just to meet other people like me who are successfully maintaining a large weight loss (sometimes I feel like the freak that a doctor once called me).
• Free (or at least covered by insurance) PS to get rid of excess skin — OK, this one’s a dream, folks!

What about you guys? Let’s build our own version of a Life After Weight Loss Center!

Hey Meg, Great idea!

- Resources for problems that can happen and affect maintanence (gall bladder problems, Eating Disorders, depression etc)

-Nutritional counselling to maintain

-Relapse counselling

-Group sessions are, great. I loved the meetings aspect of WW, but when I went there while I was maintaining, some people thought I shouldn't be there (I had a woman say that I didn't need to lose weight and I told her yes, but I had lost weight and she said "what 10 lbs?").

-Life coaches (to help us use the motivation for weight-loss in other areas of our lives).

Cheers!

Ali

i've heard about UPMC and their wonderful surgery program... those plastic surgeons do a great job.

my wish list includes:

docs from ALL specialties who understand what's happened with the surgery and can help me meet the challenges.. i need a doc who understands iron metabolism, and insulin resistance, and who doesn't think i'm screwing up!!!!

dieticians who don't try to cram '4 oz protein at every meal' down the throat of people whose tummies can hold about 2 oz!!!!!

psychologists who understand that it's not all about the food...

stress management HELP!!!

seminars on negotiating what i need... no more [what is it that karen calls it? somethiing about people pleasing.... fat... something? wish i could remember it.. ]

oh. i'm sure i'lll come up with more stuff!!!!!

love the exercise issues..

PEOPLE PLEASIN' FAT CHICK!!!

Yep, Karen says we all are or were PPFCs! Don't make waves, keep everyone happy, go along to get along, you all know the drill ... except for Jack, who may have been a people pleaser but probably not a chick.

Great ideas! Keep 'em coming -- I think I'll pass them on to Dr. Rubin after we get all our thoughts together.

Ali -- I really like the idea of Relapse Counseling -- how to keep 10# from turning into fifty or a hundred!

Good ideas, here are my thoughts about them:

1) Unless the powers that be in medicine are revamping the curriculum, we here know more than most docs do about physical changes that happen during and after massive or even not so massive weight loss. Given the new recognition of obesity, I expect that in 10 or so years it may be a specialty. Currently, my rhuematologist and internist are using me as their resource. I even got my rheumatologist and his wife to join the gym and his wife trains with me.

2) There are already a lot of nutritionists out there who don't believe in the food pyramid. Lots of new research is coming out on the role of carbs, complex carbs, GI index, low-carb vs. low fat diet success rates. It's just beginning to be published. You can subscribe to Medscape and get synopsis of current research. I think it finally is trickling down, but not yet to the institutional nutritionists' level. School lunches being a case in point.

3) Um, well, I'm an exercise consultant.

4) The easiest bf% measurement tool I've used is an Omron Body Fat Analyzer : http://www.bodytrends.com/products/f...atanalyzer.htm
It is way more accurate than the Tanita scales, but still not as good as a 9 point caliper test done by an experienced hand. It uses an age based calculation which skews body fat higher the older you are. For "normal" folks, that is accurate, but for athletes/bodybuilders who don't carry as much visceral fat, it reads a few percent high the older you are.

5) Support groups: Well, Hello! Here we are! But I know what you mean.

6) Dream on about the ps, though my SIL's sister who had WLS is having it done COVERED BY INSURANCE in 2 months. Life is not fair.

What I'd like to see is the magic pill. You know, the one where if I eat right and on target calorie and ratio wise, I'm not STILL STARVING.

Mel (must be time for another meal!)

People Pleasin Fat Chicks. PPFC. People Pleasin Fat Chicks. PPFC

thanks meg.. i KNEW someone would know..

and one more thing. i want a doc WHO WILL BOTHER TO KEEP UP WITH THE LITERATURE!!!!

or who, at the very least, recognizes his/her limitations and has EXPERTS AND OTHER RESOURCES to ask. rather than just spouting off harmful and stupid or insulting comments [can you tell i'm still POd at that former PCP???]

My Wish List:
A nutritionist that can develop a plan for an Old Broad weighing under 120 pounds that doesn't match the metabolism of a 150 pound 20 year old male.

The magic pill. Thank Yewwww.

More running time.

A spiffy-looking cane that could keep up with my running speed and doesn't look like a cane.

That should be good for starters...

These are great! So in addition to everything you've said, I'd like to see some therapy. Not just for relapses, but for coming to terms with this new body you're dealing with. For being able to look in the mirror and see reality. For handling the changes in the way the world sees and subsequently treats you. It's a little overwhelming at times.

1. Doctors, including endocrinologists, who are up to speed on PCOS. Gynos who have better ideas than just prescribing B.C. pills or saying "if you get pregnant it will all go away."

2. More objective research on PCOS, with less undue influence from the "infertility" industry and the drug industry.

3. More emphasis on PCOS in menopause and beyond. Millions of baby-boom PCOS women are right in the danger zone and deserve better info that they get.

4. An accurate pre-pubertal test for PCOS, along with effective therapy strategies that can start as young as possible, including gene therapy.

5. Research to illuminate the connections and interactions between PCOS and other hormone-related disorders, such as hypo-thyroid, Congenital Adrenal Hyperplasia, Type 1 and 2 diabetes, etc.

6. Research on the psychological impact of PCOS, including gender identity issues.

7. Research on the effects of steroids and steroid act-alikes in the diet on PCOS women with high testosterone levels. Research on exercise strategies specifically designed to reduce testosterone levels on a long-term basis. In fact any and all info on reducing high testosterone levels permanently, preferably without drugs.

8. A better understanding of the fact that PCOS can help make you fat all by itself, just like a thyroid condition, and doesn't necessarily imply you have an eating disorder or "issues" with food.

9. A button that says: "PCOS: it's not 'all in my head.' It's in my genes."

Seek -- thank you for adding in the PCOS perspective! Though I don't know much about PCOS myself, I'm aware of the huge interplay between the problems of obesity and PCOS and that it's a whole set of issues that's crying out to be addressed.

StarPrincess -- you're so right about the therapy to deal with all the "head stuff"! Without all of you guys to talk to about these issues, I'd think I was (no comments, Jack ). Here I can bring up something goofy and have five people jump in and say, "me, too!" But it sure would be nice to have some professional guidance too, eh?

Star Princess: so true, it was an adjustment... took time, it was a real ugly duckling story for me kind of deal. I am dealing with some of the stuff now (stuff I should have dealt with years ago).

One thing I have learned though.... I used to get yelled at by strangers when I was fat. Now guys will do it and say stuff like "hey sexy" or even worse stuff (very sexually degrading stuff)... I was sad to learn the yelling thing doesn't stop.

Seek: a friend of mine had EVERY symptom of PCOS, yet her family doctor could never identify it. Only after her mom has a convo with a lady with PCOS did her mom suggest to her to ask her doctor... her doctor took forever to officially diagnose it.

Cheers!

Ali

If anyone here wants to learn more about PCOS, there are some excellent stickies in the PCOS sub-forum on this disorder, which affects something like 6 - 10% of all women (estimates vary widely). BTW-- Noodles, Jennifer, and Jujuridl, 3 of the moderators here, have PCOS and a lot of expertise in this area.

Jack's post sent me off to a corner thinking for two days! And in fact, was the topic of conversation at last night's dinner. The dearest Hubster was willing to discuss the question: Why are some people successful with weight loss and keeping it off when there are so many who start and quit?

I truly think it all goes back to Meg's original title: Life After Weight Loss.

It's a whole different life style. Socializing does not equal eating. Exercise every day is not something to decide whether or not we will, it's what we do. Journaling what we eat and drink isn't a chore, it's part of the day like brushing teeth - and who would dream of skipping either? (ewwwww)

Magic Pill? Pure cussed determination and a different life view. Anybody up to walking to Home Depot? We need a fish griller for our dinner tonight. It's not much more than three miles, round trip...

I'll join you Tig , and we could discuss this "life after weightloss"... The time will fly!

Well, now you've all got ME thinking (great posts, everyone!) --

We all agree that there's:

• no magic pills
• no magic books
• no magic diet plans or food combinations
• no magic ab machines or any of that ridiculous infomercial crap
• no secrets

So what DOES it take to lose the weight and keep it off forever?

• desire (maybe even obsession?)
• sweat
• hard work
• planning
• making a hundred choices every day -- big and little
• changing your life forever
• "Pure cussed determination and a different life view" -- Tig

More ideas?