The professional medical literature has well documented that morbid obesity affects health in numerous ways, including impacting the female reproductive system. Increasingly, many women seek weight loss surgery with the hope of resolving infertility that is related to conditions such as polycystic ovary syndrome (PCOS), or failure to conceive without diagnosed pathology. Our bariatric center has had dozens of such patients present for weight loss surgery over the past six years.

During the pre-operative evaluation period, patients are informed that it is unsafe for both patient and fetal health for pregnancy to occur in the first 18-24 months following gastric bypass surgery. This is the time period corresponding to rapid weight loss and possible nutritional insufficiencies. Some patients who have tried unsuccessfully to conceive, sometimes for years, are frequently distressed to learn of this additional delay to their well laid plans. Other patients are concerned about their ability to carry a pregnancy and deliver a healthy baby after weight loss surgery. On a very positive note, the good news is that post-operative gastric bypass patients who closely follow the recommendations of their bariatric surgery team and knowledgeable obstetricians can have a pregnancy and delivery free of complications resulting in a healthy baby. According to William P. Homan, M.D., Director of New York Bariatrics, the guidelines to a healthy pregnancy following gastric bypass are quite clear: 1) use reliable contraception and do not become pregnant too soon; and 2) prepare for pregnancy by becoming (and staying) nutritionally well-balanced.

On the issue of the timing of your pregnancy, Dr. Homan states that the 18-24 month waiting period is crucial. “Patients are losing weight at a rapid rate in the first months after surgery. The very window of opportunity that makes the surgery so effective for weight loss is potentially disastrous to the developing fetus.” Dr. Homan describes a presentation at the 17th Annual Meeting of the American Society of Bariatric Surgery in

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Morbid obesity affects approximately 9 million Americans and it is on the rise and an increasing problem for our society. It negatively affects those that suffer from it medically, emotionally and even socioeconomically. If you are over 100 pounds overweight or have a BMI (body mass index) of over 40, you are considered morbidly obese. The chances of premature death are quite high in comparison to those at normal weight. This has been shown to be the case statistically, but it is also a logical outcome of its association with so many medical conditions. If there is any good news here, it is that effective treatment for a morbidly obese person can lessen these risks dramatically.

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While on the cusp of the summer solstice, June 20, we are in full swing of the season. At the box office, Sex & The City beat Indiana Jones in ticket sales. When the going gets tough, release a chick flick and women will respond in   big numbers! Of course I went to see Sex & The City with several gal pals on opening day, having purchased my tickets   online   in advance. These gal pals are a talented group, comprising of one fashion illustrator, two authors, several clothing designers - all with one common thread, we all teach or have taught fashion courses at university level or at a respected design school. This   was a tough crowd to judge the wardrobe in the movie. The wardrobe is the star of the film, followed by close ups from the four fab fems!

And the clothes didn’t disappoint. Whether you liked them, got them, wanted them, or not, you noticed them. Most of us don’t get to see clothing like this much. There are few cities, even fewer streets, where these clothes are for sale and   worn. But the impact of a big fashion film like Sex & The City on our personal style choices is huge. Why? It gives us freedom…freedom to push the envelope,   to break the rules and make new ones - white shoes after labor day, anyone?

Many of us   worry about how we look in our clothing, we struggle to find clothes that fit AND flatter. A movie like Sex & The City raises questions about how we really feel about following fashion:   Can we fall in love with a “fad,” make a style statement without wearing designer clothing or wearing a smaller size?

Yes to all of the above. Here are six suggestions to take the heat off Summer in The City.

Style Tips for Summer

> use self tanner on legs - tan legs camouflage veins and cellulite

> wear leggings under a baby doll top with ballet flats   - longer tunic length covers tummy, umpire waist is youthful, narrow legging suggests longer and leaner. leggings come in different lengths so you can find one that works for your leg shape, ballerina shoes elongate the foot, open up the ankle

> try some lip gloss - gloss is fun to wear and attracts attention to the face and sparkling smile

> get a french manicure for your toe nails - pretty, soft, sexy

> add color - try a gauzy, crinkled skirt or a v-neck t-shirt in a color that makes your eyes look bright - shades of blue, lavender and light green look good on everyone

> experiment with a hair product and wear your hair in a more natural, carefree way - add an accessory like a patterned scarf or head band.

My Summer In The City
Reading: Look Fit & Fabulous in 15 Minutes by Teresa Tapp www.t-tapp.com
Watching:   Sophia Loren in That Kind of Woman on TCM - Turner Classic Movies - ( you’ll love seeing how voluptuous she and Barbara Nichols are in this film! )
Drinking: Crystal Light Spritzers -   Half and Half Orange Grapefruit Flavor with Crystal Geyser Sparkling Lime Water
Activity: Swimming Every Day - wearing my sexy and sturdy Miraclesuit from www.Cyberswim.com
Listening: “I’ve Just Seen A Face,” by The Beatles, Soundtrack to Help!

Exercise is the key for the pre and post Bariatric patient to maintain a healthy range BMI and to become more independent, with increased base line functional movement. The question of exercise is something that is under increasing debate in the Bariatric community. Some surgeons recommend a structured and progressive exercise routine, such as stretching and a basic walking regimen, while other surgeons feel that it is less important. They may feel it is less important because the actual exercise routine may only burn 150-250 calories after 20-30 minutes of slow walking. This may seem overwhelming to the obese patient, especially if he/she has many health concerns such as high blood pressure or joint concerns. In order to lose one pound of fat through exercise one must burn 3500 calories or some combination of increased activity and decreased caloric consumption.

Many patients both pre and post Bariatric surgery feel frustrated when they only burn 100-200 calories after a power walk. Depending on the weight class range certain patients feel short of breath even taking 50 steps. The point is every person is an individual and every workout should be customized based on of course, your individual Bariatric surgeons recommendation, and your own check in assessment of how you are feeling. One day you may feel you have more energy than others and some days your joints may not fell up to excess movement. Therefore, it is essential to educate your self on ways to adjust your intensity on days your motivation and energy level is lower. I recommend purchasing a pedometer to check your step count and a diary to record the steps of how you’re feeling after each workout. As you progress you have a recording of your exercise progress chart, which is a solid indication of overall improvement. This information should be shared with your surgeon and or your support group leader so that they may advise you to increase or decrease your intensity and duration. This will also motivate you in the future when you refer back to a time when you were unable to move as freely or experienced a fatigue at a shorter interval of walking.

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For those who have struggled with weight from childhood into adulthood, we are forever hopeful that a certain diet regimen, over-thecounter diet product or pill or participation in a commercial weight loss program will be the “magic” answer to our seemingly endless weight gain frustrations. We often find ourselves in a disappointing situation: We begin with a high expectation of what any weight loss procedure can do without a realistic plan of how to get to our goal and maintain it. This often recalls the old dieting roller coaster mentality of temporary success with the frustration of regaining weight down the line. Bariatric surgery is not a temporary solution; the trick is to view bariatric surgery as a journey in the sense that it’s a life transition, a lifestyle change and a quality of life enhancer.

The existence of a permanent solution to struggle with weight through a surgical option presents both excitement and trepidation. When patients begin to investigate bariatric surgery, they are often flooded with seductive thoughts of incredible weight loss, increased confidence and attractiveness as well as the resolution of major medical co-morbidities. Surgery will certainly provide patients with the results they seek if patients are able to understand the importance of having manageable goals and realistic expectations during the post-operative healing and recovery period. It is essential that patients comprehend the difference between high expectations pre-operatively and realistic outcomes post-operatively in all areas of recovery: medical, nutritional and psychological. Every patient is an individual with their own set of needs and circumstances; a comprehensive bariatric program will recognize that fact and evaluate each patient and their particular needs.

Medical

Bariatric surgery will alter one’s bodily functioning through food restriction or food restriction with a bypass feature that encourages food malabsorption in the digestive tract.

One should recognize the lengths that a patient goes to in obtaining the placement of this “tool” to encourage weight loss and the resolution of chronic medical conditions and body pain.

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Studies indicate your water needs depend on many factors including one’s health, how active you are, where you live and your surgeons/nutritionist recommendation.   As we approach the warmer temperatures it is important to prioritize hydration to get through the summer and really enjoy the outdoors!

What really motivates me is information-so, don’t tell me to drink 8-10 glasses of h2o a day. Tell me why! Even slight dehydration can sap your energy and make you tired. Just yesterday my gorgeous plant with large green leaves were drooping- an extreme droop of 6 inches. After watering my favorite plant it almost instantly perked. And, even more amazing, within 24 hours it was back to normal. That was a great visual reminder to drink up! Other signs of dehydration may include mild to excessive thirst, fatigue, headache, dry mouth, muscle weakness, light headedness, dizziness and little or no urination.

As you may have read my Cinnabon celebrity-Jerry Seinfeld blog – I would like to mention that Jerry hydrated throughout his show. My other favorite entertainer –Tom Jones always has several bottles of water on stage during his performances. Tom Jones is a great singer (actually sings), a grandfather who performs a cardio-level dance on stage with very hot stage lights. These are several reasons to increase ones intake–activity, warm temperature and dry vocal prevention.
 
Remember lack of h2o can lead to dehydration, a condition that occurs when you do not have enough water in your body to carry out normal function. So, perhaps now is a great time to take a water break-go grab that bottle of water and drink up. Why not toast-let’s toast happy summer! Who said you can only toast with champagne or wine? Want to get fancy? Pour your water in a tall wine or martini glass, add a slice of lemon or lime or of course, one of my personal favorites add Focus28 Wild berry Passion drink mix-you get water and 15 gs of protein too!
 
So, as we get close to our summer kick-off, remember hot or humid weather can make you sweat and require additional intake of fluids. The recommendation for men is roughly 3.0 liters or 13 cups and for women 2.2 liters or about 9 cups. And, lastly be patient, habits can take between 21-28 days to form. Hydration is a great habit to form. Drink up and enjoy your hydrated summer!!!!!!!!!!!!

Lisa Avellino
Focus28 Fitness Expert