BMI » weight training

MAKING THE MOST OUT OF LIFE AFTER BARIATRIC SURGERY

ramana — Sun, 08 May 2011 13:26:34 +0000

Those who undergo or contemplate bariatric surgery do so essentially as a second chance at life. I mean that the severely obese man or woman feels that he (or she) has lost out in life on multiple fronts. Here are a few examples:
Loss of body contour/beauty: you can’t forget how you were once before the fat started piling on.
Poor self image: you hate the thing you see in the mirror.
Poor quality of life: you can’t dance, surf, skip, run or walk without some kind of pain or discomfort. Going up one floor makes you breathless. You avoid holidays where you would need to walk, especially on hilly terrain.
Sexual issues: whether it is inability or unwillingness of one’s partner, sex life may take a back seat or even come unseated!
Health loss: you suddenly have been diagnosed to be having diabetes or heart disease (or anything else) and, suddenly, life sucks!
Social alienation: Even though there have never been as many obese people in the planet as the present, the morbidly obese individual catches everyone’s eye the wrong way. People make jokes, there is job discrimination, and even marriages get burnt!
The need for bariatric surgery serves as the wake-up call. What many people don’t realise is that bariatric surgery should not (and is not) a short cut. You cannot eat all you want and stay slim after the surgery. Therefore, if you look at the long term figures of weight loss after bariatric surgery, it may be as low as 40 to 50 percent, though the initial weight loss achieved may be 75%.
Obviously, we know weight regain is an issue for patients, and has to be addressed properly.
Even better is if you can program your life to prevent weight regain.
An unnamed BMI patient (we take our patients’ privacy seriously) writes to me:

Seems like such a long time ago that I was through surgery. I am still learning what I can and cannot do regarding food. I have a different attitude towards food now, which I never would have believed possible. I find the Paleo Diet hard to follow but have taken some of it on board and restrict foods, such as bread and potatoes to a bare minimum (a couple of slices of bread per week) and I haven’t eaten rice since surgery. I eat an egg for breakfast and sometimes mushrooms. The days of a full Ulster fry-up are long since gone, and dinner is served on a small side plate. I see the portions people eat and shudder. I have seen me ask for a children’s portion and still not finish it. I still have some milk in coffee and I eat natural yoghurt, which is not permitted but in general, my eating habits have really improved. Fresh fruit and veg, and some fish or chicken. I can only digest minced red meat and even then, only in small quantities, but nothing can equal how I feel.

(Eat This!)

(And This!)

As I keep saying, eat natural foods and avoid man-made food products.

(Stay strong when life tempts you!)

She reflects the pursuit of that kind of eating style (like primitive or Paleo man) that I teach. In addition, she has taken up kettlebell training and getting active in general. What does a lifestyle like this (without chips, pizza, cakes and bread on a daily basis) feel to the mind?

I can’t really explain the change which has occurred inside. I have my positive attitude back and feel I can tackle the challenges with more confidence than I have had in ages. The fact I am free of all medication is also a tremendous bonus.

And the bonuses keep coming to keep you motivated.

I saw my cousin today and she couldn’t believe how well I looked since the last time she saw me. I didn’t tell about the surgery, reasoning it was my business and she didn’t need to know. She congratulated me but then admonished me not to put it back on again. I assured her that wasn’t going to happen and left it at that.
I’m enjoying being normal and, for the time being, I am happy about that. I remember you saying that was a very low priority but for the moment, I am content. I now weigh what I did in 1995 and most people have never seen me this size so it comes as a bit of surprise.

Thank you, my dear (you know who you are): these words have inspirational content that mere doctors can only hope to provide!

All photos are original property of BMI.

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PERSPECTIVE

ramana — Wed, 26 May 2010 04:34:09 +0000

“When you have a hammer, everything looks like a nail!”

We have all heard of this saying, and all of us agree. A skilled laparoscopic surgeon plots to take out huge tumors and cysts through the keyhole method, while the dinosaur surgeon tends to think of employing his hands to remove organs (like the appendix) that may have been better left alone.

Let me tell you a small story about myself. Not too long ago, at a Bariatric Surgery conference three or some years back, I had a chat with a renowned endocrinologist who was known for his work in obesity and diabetes. At that time, I was 86 kgs heavy, and most of it was fat. A hard-working surgeon, I was in the peak of physical un-fitness and a heart attack waiting to happen. My resting heart rate was always around 100 and my blood glucose was similarly poised over the century mark. I asked this gentleman how I could improve my markers and lose my fat. I also didn’t want to become a diabetic, I said.

He told me what anyone in his position would have: take a metformin pill, and do some walking. If your sugar levels go up, we will add another drug, he said.

I thought long and hard over what he said. I embarked on a new journey in life: a life of health and fitness. I trained hard and started IF (Intermittent Fasting). After an year of blundering along, I found my groove and results came in: resting heart rate down to 6o, blood glucose and lipid levels normal, and body fat well down (BW now 75 kgs).

To come back to the point, the doctor I asked hit my problem with the drug hammer he was holding by default. I did the smart thing by trying something different. I now firmly believe that everyone should try healthy eating and exercise in order to improve health and reduce body fat. As bariatric surgeons, we should not use the surgery hammer to hit every obese patient. When there is clear burden of disease (diabetes, hypertension, sleep apnea, gallstone disease, etc.) and the level of obesity is such that it is statistically unlikely to come off with lifestyle regulation, we recommend bariatric surgery. Not otherwise.

In other words, as specialists dealing with obesity and related diseases, we should have a broad perspective. We are always in danger of using a narrow knife-wielder’s perspective and eyeing every patient as a potential victim. We must be very careful. At BMI, we never stop telling each other this.

In clinical practice, the psyche of the patient is very important. But a more important factor (and an often unrecognized one) is the psyche of the doctor.

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NO EXCUSES TRAINING

ramana — Tue, 22 Dec 2009 04:30:08 +0000

This morning, I was supposed to train with Ranadeep Moitra (the fitness coach of BMI) and a group of youths at his bootcamp (usually sprint intervals and stuff) at a local cricket ground. I was late, and reached the camp when it was on its way.
I had brought my kettlebells anticipating this, and started practicing my TGUs, presses and snatches with the 25 kg bell (as part of my variety, light day).

Halfway through my practice, a couple of trucks bearing sand and soil, came to the ground and started dumping them near me. I had to escape the dust and fumes, and abandoned the training.

(An Indian truck looks like this; pic source- from here)
But the disquiet of an incomplete session did not leave me as I proceeded home.

I live on the sixth floor of a building in Kolkata. As a routine, I never use the elevator, as part of my NEAT principle (check out the link).
Today, I decided to make a workout of my return home from the ground floor.
I walked to the floor above with one kettlebell (Kali- the 25 kg bell), ran down and brought back the other one (Sita- the 17 kg). Then I ran all the way down to the ground floor and back up. Now I had to carry one bell to the next floor, run down to two floors below, bring the other bell back, and then run down all the way to the ground floor and back. In other words, whenever both bells were on one floor, I had to run down to the ground floor and back up.
So, to put both bells up from, say the 3rd to the 4th floor, I carried one bell up straight from the 3rd to the 4th, ran back to the 2nd floor, sprinted up (two stairs at a time) to the bell at the 3rd floor, and carried it up to its partner in the the 4th floor. For the next round, I would start by going down to the ground floor and sprinting up all over again.
I calculated the floors and steps run in the few minutes of this workout:
1st- 2
2nd- 3
3rd- 6
4th- 7
5th- 8
6th- 9
TOTAL—35 floors
18 steps per floor—630 total steps up.
I am not calculating the steps run down.
At the end of it, my legs were saying, “PLEASE!!”
I was happy. No excuses training. That is what I want. So, the next time I take 3 kettlebells out, I know I would love the return of the kettlebells home.

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EXERCISE AFTER BARIATRIC SURGERY

ramana — Mon, 10 Aug 2009 10:30:50 +0000

We have some patients who, a few months after bariatric surgery, want to maximise the weight loss following the procedure, and want to start off with exercise. This article will attempt to answer some of the most common questions we have faced.

When can I start working out after my gastric bypass?

The answer depends on who you are. If you have heart or lung problems, we would advice you to go easy. Morning and evening walks would be a great way of getting active, and the level of activity can be escalated slowly and steadily. Jogging is not a great activity, when you consider the impact on the joints which, in many bariatric patients, are damaged anyways. In the absence of major contraindications, we would encourage you to start exercising at any time your body tells you to. This could be one week after surgery or may be more, depending on the individual.

I have heard that I will get a hernia if I exercise. Is that true?

Hernias are known complications of any type of surgery, but are less common after laparoscopic surgery (compared to the open approach). However, if the 10/12 mm port sites (keyholes) are closed with sutures (internally, not on the skin) the incidence of hernias comes down significantly. BMI policy is to close all 10 or 12 mm trocar sites with vicryl sutures, in accordance with international standards. Once these are sutured shut, it should not matter if you start exercising in a week’s time. Go easy, though, if you are on the very heavy side.

Can I do crunches after surgery?

Sure, but why would you waste your time with them? Crunches don’t build your abs. Losing fat mass will itself help in revealing your abs. Some of the best ab exercises are planks, bird dogs and power wheel rollouts. Moreover, major compound exercises like squats, Turkish Get Ups, and Deadlifts work on the abs to a tremendous extent.

If you are really serious about getting abs, try hanging leg raises- this exercise, if done properly, can smash your abs to pulp!

Please note that these exercises should be done only if you do not have significant problems with your heart, lungs, back or knees. We offer you exercise advice according to your unique limitations.

Can I join swimming?

Absolutely, yes. Just wait for the port site areas to heal- you don’t want to get bad germs into the cuts. In other words, wait for a week or two before the plunge!

How can I lose more weight by exercising?

Realise that your body, after bariatric surgery, will behave more or less like any one else’s. In other words, if you exercise smartly, you can kickstart your metabolism, build muscle and burn calories in order to lose more fat and build some muscle.

In order to do that, train smart! That means you should get the maximum bang for your buck. If you do exercises of a certain nature and in a certain way, you will get the best and quickest results.

This means that weight training should be largely multi-joint oriented (deadlifts, squats, overhead presses), intense and short, and provide ecalating density of the load. This basically means you must work out of your comfort zone, train hard, use short rest periods and lift heavy. If you add cardio, try to do High Intensity Interval Training (HIIT), as you will find it more interesting than low/moderate cardio (which lasts longer). Don’t waste time training your arm muscles– they are for vanity only, and you won’t get leaner doing bicep curls!

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