“Pam’s message, combined with bariatric surgery, is what I have needed to reclaim my health and vitality. Pam has great passion to help bariatric patients toward lifetime weight maintenance. A significant number of us struggle to maintain, on one diet after another, and Pam’s mission is to help us gain the balance we deserve after this ultimate decision.”

Dr. Catherine Hebert Carpenter. Mandeville, LA

“It’s time that people become aware of how emotionally devastating extreme obesity is for the individual who suffers from it and that there is no long-lasting fix for this problem that does not include a change in one’s behavior and emotional relationship to eating. Someone has to get their attention. I think this book will do that for many people, whether they are obese, or simply caught in the terrible cycle of years and perhaps decades of dieting and food disorders.”

Tracy Asmussen, Sociologist and Teacher, South America

“Pam is a definite needed addition to gastric bypass and other obesity surgeries. She picks up where the operation leaves off. She has a great personality, is easy to work with and has a tremendous passion to help us all. Her own story coincides with so many others. She has been where we have been! Having an empathetic ear, with all the knowledge is so refreshing. Thank you so much for all you help, Pam. Saturday’s workshop was great.”

Gastric Bypass patient, Mandeville, LA

Retired personal trainer Pamela Harrelson offers readers personal inspiration combined with many expert resources. This book is neither a diet book nor a weight loss book. It is uniquely focused on weight maintenance. Surgery patients normally lose their weight, but many of them struggle to maintain their weight loss for a lifetime. Their emotional disappointment is devastating; most especially if they have been trim for several years. Pam utilizes the true story of her husband’s and her own weight loss struggles, including four bariatric surgeries between the two of them. Pam has trained 2,000 personal training clients since 1997 and dozens of them have been bariatric patients. Her husband died of obesity related causes in July of 2000 despite two bariatric surgeries. Pam has maintained her weight loss since 1996 with great balance.

If patients will study each chapter, they are on their way to lasting peace. Free at last!

www.pamelaharrelson.com

Practical Advice for Lifetime Maintenance After Bariatric

Surgery

by

Pamela Harrelson

Copyright 2012 Pamela Harrelson,All rights reserved.

Published in eBook format by eBookIt.comhttp://www.eBookIt.com

ISBN-13: 978-1-4566-0924-5

No part of this book may be reproduced in any form or by any electronic or mechanical means including information storage and retrieval systems, without permission in writing from the author. The only exception is by a reviewer, who may quote

short excerpts in a review.

DEDICATED TO BARIATRIC SURGERY PATIENTS(Pre-op and Post-Op)

Other people have no idea how courageous you are.I do!

Other people have no idea how hopeless and powerless you may have felt in the past. I do!

My heart leaps at the thought of being able to make a difference in your life, through my own years of impossible hopelessness and the last sixteen years of peace and

victory.

The wonderful academics I have learned are shared with you because they have empowered me to lifetime peace and success.

Thank you. Pam Harrelson

Lifetime weight maintenance starts with the mind, not with a diet,and not even with a scalpel on the operating table.

Foreword from Maureen Conolly

“I highly recommend this book to weight loss surgery patients and non-surgery patients that were formerly morbidly obese and are looking for guidance on long term

maintenance.

This book provides a no-nonsense, honest, heartfelt account of the author's struggles with weight loss, including two weight loss surgeries. Her first surgery was years ago as one of the first kind of stomach stapling procedures, and with very little after care or behavior modification, she gained the weight back. In 1995, she had gastric bypass surgery, and this time adjusted all aspects of her lifestyle (brain, physical, and spiritual) to stay committed to living the healthy way. She has maintained her weight loss now for since 1996. Her advice is practical and realistic.

She clearly communicates that weight loss surgery is not the easy way out and not a miracle cure. I believe it is a great read for weight loss surgery patients, especially those that have not gotten a firm understanding that the surgery is only the first step in a lifelong requirement to remain focused and vigilant on eating right, exercising regularly, and dealing with emotional eating issues.

Pam's personal stories of struggle, adversity (including Hurricane Katrina), and personal loss are very powerful to show just how it IS POSSIBLE to be a successful long term weight loss surgery patient.

There are not a lot of books or other materials that focus on the real work that is required for permanent weight loss maintenance.”

Maureen is an accomplished, professional woman with an MBA from Loyola University. She is a very active member in the online bariatric community and serves as a moderator on a popular bariatric support message board. In 2009 she had gastric bypass surgery and since then has maintained a 160-pound weight loss. This has helped to produce positive changes that have given her a new hope for her chances of living a healthy and happy life. I believe that Maureen will maintain the weight loss for her lifetime because of the changes I have witnessed in her life, not just a dependency on the surgery.

After having my own surgery in 1995, which was a whole different era for the surgery, I began writing this book in 2000. I didn’t become fully committed to the manuscript until 2006. I am thankful to Maureen for bringing me up to date 6 years later with some small but significant areas.

Pam Harrelson

INTRODUCTIONIf you are obese, a bariatric surgery patient, or even just an average-sized person

caught for decades in the terrible cycle of strict dieting and deprivation, I believe this message can change your life.

Important surgical clarification for those who are possible surgery candidates: After gastric bypass surgery, the tiny stomach pouch stretches enough that in about two years a normal meal can be consumed. In many promotional articles, it is made to appear that the new stomach pouch remains forever the size of a walnut. This excites potential patients a great deal.

The pouch does remain smaller than it once was, and you can make this an important edge for yourself, as I have done for sixteen years as of 2012. Or, you can make it nothing at all by out snacking your personal calorie boundaries, not exercising, and return to your same old dieting roller coaster, or even regain all your weight, plus more! Many of my clients have been in this category.

The weight will take longer to regain because you cannot eat as much at one sitting, but it really does not matter if you become obese again in one year or five years once uncontrolled snacking begins. Many health issues which have been cured by the weight loss only return with weight gain!

Important surgical definition: The “stoma,” the connection between the tiny new stomach pouch and the intestine, is how food exits the new stomach. This stoma, following the gastric bypass, is pencil-thin at first. For some patients, like me, the stoma stretches much too soon, just 4 months out for me. The result is that, although one can never binge again (a huge relief for many who are obese), one can snack continually.

Though patients are now given up to date and realistic warnings at the clinics, the ability to snack often still takes many of them by surprise. If there is a very long window of ease, which most patients hope for, this causes complacency for hard work in some personality profiles. Then, it is too late! Those are the people whom I believe I can help the most. I gained all my weight back in four years after my first surgery.

My focus is not on dozens of sensational fast weight loss stories. My husband and I lost and regained large amounts of weight 99 times over the course of our marriage. We never wrote a book because we were secretly and miserably right back on the dieting roller coaster even after bariatric surgeries. My husband died of obesity related causes in July of 2000 despite two bariatric surgeries.

I have maintained my weight, without any dieting, and without a killer exercise program, for sixteen years. I am now sixty one years old and eat plenty of wonderful food with great enjoyment and still love my moderate, consistent exercise. I have never passed out, cried, or thrown up during my exercise time! That has never, ever been necessary. I cannot wait to do it again!

Believe it or not, the primary reason for my long successful maintenance started with my stoma stretching very prematurely, about 4 months post op. I had two choices.

One was suicide. The other was working hard just to maintain the 37 pound weight loss I had lost in that four month period. I did not believe that I would continue to lose, but only that I had a chance to maintain that loss.

If you study all my chapters, you will see why I was blessed. I was unable to starve as I had done for years whenever I dieted and as I so desired to do again. I slowly worked up to a regular walking program of just 40 minutes, 5 days weekly. My metabolic rate rose. I continued to lose, but much slower than I wanted to. Later, I will tell you in my story how I developed an interest in a scholarly study of our metabolism. I wanted to know why I had experienced 38 years of failure in maintaining weight loss for even one week, and I wanted to know facts, not emotion. A patient can avoid regain if they believe these facts and want lifetime peace more than rapid weight loss!

I have been off the dieting roller coaster totally for sixteen years.

I so desire that same scenario for all the surgery patients in the world.

TABLE OF CONTENTS Chapter One

STOP, LOOK, AND LISTEN! HOW TO MAINTAIN?

WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter TwoSURGERY PATIENTS, DISCOVER A TRUE LOVE FOR MOVEMENT AT ANY AGE.

WORKSHOP PAGE OR DISCUSSION THOUGHTS .

Chapter ThreeA VERY BRIEF PERSONAL MEMOIR

WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter FourMETABOLISM AND GENETICS

WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter FivePERSONAL TRAINING FROM MY PERSPECTIVE

WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter SixQUOTES FROM BARIATRIC EXPERTS AND OTHER RESEARCH

WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter SevenSURVIVING HURICANE KATRINA’S LONG AFTERMATH WITH NO WEIGHT REGAIN!

WORKSHOP PAGE 0R DISCUSSION THOUGHTS.

Chapter EightTHE TRUTH WILL SET YOU FREE, BUT FIRST IT WILL MAKE YOU MISERABLE!

WORKSHOP PAGE OR DISCUSSION THOUGHTS.

APPENDIX 1: A brief list of more structured help for you in the form of websites and books.

ACKNOWLEDGEMENTS

NOTES

Disclaimer: The author of this book is not a medical doctor or registered dietician. The information presented is not intended to diagnose or treat any illness or medical condition. It is highly recommended that you consult your personal physician and

consider all alternatives before making any decision to receive any type of weight-loss surgery, weight loss diet, or exercise program. It is highly recommended that you pay close attention to all nutritional advice from your bariatric clinic. If you deviate from this, there could be unpleasant consequences. You must make your own educated choices, as the author did.

OUTLINE

Chapter One: STOP, LOOK, AND LISTEN! HOW TO MAINTAIN?• Six points, spelled out on one page. Print it. Do it. Maintain with ease.

o These six points do not pertain to the dieting mentality or typical food tips.

• Let’s take the mystery out of weight maintenance. IT EXISTS!• You can maintain without miserable diets every year! Take advantage of your

edge!• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter Two: Surgery Patients, Discover a True Love for Movement at Any Age.• We would all rather play than work; one is an obligation, the other is pure joy.• Focus on the excitement of great agility, passion in life for moving; resulting

from Holy Habits!• An educational bonus from Department of Health.• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

ELASTIC TUBING WORKOUT!

Chapter Three: A Very Brief Personal Memoir.• Surgery patients love to share their stories. We all have one!• The death of Al, due to obesity and genetics. Will YOU die from obesity? Let Al

motivate you!• A realistic perspective on body image and happiness before and after your

weight loss.• A One Page Bonus: Reconstructive Plastic Surgery which many patients have.• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter Four: Metabolism and Genetics.• A textbook study by many experts, in this field. Low Calories ruin your

metabolism.• What are calories? How many do you need to protect your weight maintenance

plan and not have to live on a strict diet all your life?• We do not have to be prisoners or victims of our genes.• The dreaded plateau, where most people quit.• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter Five: Personal Training from My Perspective.• The most valuable trait of personal training – accountability!• How to find the right trainer? How much does it cost?• What does one do with a trainer?• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter Six: Quotes from Bariatric Experts and other Research.• Dated research about weight re-gain and suicide among post op gastric by-

pass patients.• Positive commentary about the gastric banding procedure.• We are victims of our society. However, it is up to us alone to have control.• Media spotlights on celebrity surgeries.• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter Seven: Surviving Hurricane Katrina’s Long Aftermath With No Weight Regain!

• Everyone says a “crisis” makes them gain the weight back. It does not have to be so!

• This two yearlong crisis happened nearly a decade into weight maintenance for me. Thank God my lifetime changes in exercise and food habits were anchored.

• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Chapter Eight: The Truth Will Set You Free, but First It Will Make You Miserable!• These are many of my personal psychological and spiritual thoughts.• This chapter includes the “hurried lifestyle.” Is that you?• My personal experience regarding “transfer addiction.” Beware!• For a praying believer, remember that God’s methods and timing are

PERFECT!• WORKSHOP PAGE OR DISCUSSION THOUGHTS.

Appendix 1: Page listing of “how to” web sites and books which I personally recommend.

A short list of my favorite books and webs, which will give the reader more structured help. You will find a plan suited for you and you can work up a plan, based on their plan, which becomes YOUR PLAN! It must be individual and something you can live with pleasurably forever.

Chapter OneSTOP, LOOK, AND LISTEN! HOW TO MAINTAIN?

Research in Chapter Four validates the following Six points.1. Do not lose through starving2. Eat in your boundaries 5-6 times daily. (At least 4 times daily, for sure!)

a.Make sure the small meals are composed of a protein, carb, and fat.b.The surgery “results” in this good habit of several meals daily. Go with it!

3. Do not stop exercising after you lose all the weight. Decrease the duration of your cardio and increase its intensity (while always considering your miss-alignments and possible re-injury issues). Increase duration of your weight lifting. Example: Instead of doing 40 minutes on cardio and 20 minutes on weight lifting, maintain your weight with .... 30 minutes of high intensity cardio and 30 minutes of weights. Change modes or types of exercise at times. Don’t do the “same old routine” all the time. Your body needs a re-charge and needs to stay “mixed up” and surprised.

4. Add your missing calories back in with a methodical, deliberate plan. Well before the last pound is lost, have some self-talk about this plan. Add the 500 calories back one half at a time, three months apart. The calories you have added will help you build muscle, which is your new goal. Your old goal was losing body fat and scale weight. This lean body mass helps you build metabolism, which leads to more calorie capacity.

5. Never stop tracking food and movement. Every single client I have trained who has stopped all tracking has re-gained the weight. Surgery patients gain slower. However, it is MORE depressing to gain post surgery at ANY rate or at ANY time. TRACKING: www.livestrong.com. Later, from memory, do a daily “guesstimate” only. THIS IS EASY; NEVER FEELS LIKE DIETING! NEVER DIET AGAIN!

6. Embrace a higher weight instead of the “bean pole” look. It is easier to maintain because the more you weigh the more calories your body needs to maintain. A higher, healthy weight.

Never being on a diet is amazing to me.

Perhaps by using my own brief maintenance story, in clear bullets, the six points can be illustrated for you and weight maintenance will not seem

such a mystery.

It was always a mystery for me, as it probably is for you.

In 1997 when I studied textbook science in Chapter Four, I was stunned and amazed that my surprising and shocking maintenance experience was

fitting right into that science!

• I weighed 211 pounds in 1995. This was listed as 100 pounds overweight for five feet tall. Four months post-surgery; I decided to do the “formula” outlined for you in Chapter Four. This academic formula gave me 1,200 calories based upon my height, less than 5 ft. tall and my age of 45 at that time. I remained satisfied and full on low calorie veggies and gave myself treats in small portions. I knew I had never lost weight for the duration on an amount of

calories this large before. I decided to walk five days a week for forty minutes, consistently. (I eased into this 10 minutes at a time).

• The consistent walking and the 1,200 calories produced a slow, moderate weight loss. It also produced a higher metabolism where later I could maintain my weight for the first time in my life, and with ease. I was able to add calories back in and not confuse my body, causing my body to think “this is too many calories.”

• In eighteen months, my body weight went down to 115 pounds. This was a 96 pound weight loss, which averaged out to 5 ½ pounds per month. Over this long time period, I refrained from saying, “I AM NOT LOSING WEIGHT.” This is what everyone says on a slow weight loss program. Then they tell others they cannot lose weight this way and have to do something drastic. On my part and the part of others, we do not feel we are lying; we are just in terrible denial and are impatient because we are so heavy and so miserable and slow weight loss is hard to accept when you are in this desperate situation.

• When I got down to 115, I started adding calories back in 250 calories at a time. Instead of being on 1,200 with exercise, I started taking in 1,450 with exercise. I did this for three months and I maintained! I then added calories up to 1,800 and still exercised. In another three months, I was at 118 pounds. I continued to have 1,800 calories and maintained the 118 pounds for eight years with no problem. (Warning on this…. in addition to regular exercise, my job entailed walking around the medical school quite a bit on a full time work schedule and later walking around an athletic club on a full time work schedule. Strictly a desk job would have required fewer calories)!

Why was I at 118 pounds a clothes size smaller than when I weighed 115 pounds? My body fat was lower and I was more “compact!” Therefore, I

did not let the scale bother me or sabotage my confidence. I just continued to focus on my program, with the knowledge that muscle weighs

more than fat. I had gained a few pounds of muscle which was great for my metabolism and easier lifetime maintenance.

• Then, I switched to a weight maintenance exercise program of a slow jog at 30 minutes (still five days weekly) and about 60 minutes of weight lifting per week (only four hours of formal exercise weekly)! Exercise for a weight loss program focuses on “more duration” and a weight maintenance program focuses on “more difficult intensity.”

• However, eight years later and post-menopausal, I noticed that my tops were tight. I weighed myself and realized some numbers had changed due to menopause and age. Also, I no longer walked around as much because I had stopped full time work. My body was changing because of the trauma of menopause, semi-retirement, and I had burned fewer calories than in the past year. I was at 124 pounds.

• I went back to 1,200 calories and continued to exercise and very, very slowly the weight went back to 118-120. Then, for the next four years I maintained on 1,500 calories instead of 1,800. My exercise program is different again because of age. I ride my bike for 50 minutes a day four days a week, instead of jogging. I weight lift an hour a week. I have active hobbies for fun. Numbers, lifestyles, and exercise programs change over time. If you understand how your metabolism works, you can always find a way to manipulate your program to make adjustments to changes in lifestyle or age, just as you can learn to be satisfied with a few pounds extra if you don’t want to diet all the time.

• I had a transfer addiction of cigars, told about in Chapter Eight. When I quit smoking the cigars I noticed a slight weight gain, and realized it was because my metabolism had been raised by the smoking. Therefore, when I quit, my weight flew back up to 124 pounds. Diet pills do the same thing. They artificially raise your metabolism so that when you quit them, your metabolism plummets. Smoking and using diet pills to lose or maintain weight are basically a no-win situation.

• I have learned the facts of how my body metabolism works. I know how to achieve my weight goals without hurting myself, whether physically or psychologically.

• As you can see from these bullets, despite the fact that I still have an active lifestyle after menopause, the calorie boundaries are lower. I have 1,500 a day now, to maintain a higher weight than before, and still exercise. Thank goodness that I raised my metabolism years ago, or I would be much heavier today, just because of less calories needed at an older age.

I understand I am not a “twig.” I am a healthy, happy weight, with great mental balance. I have written this very personal and honest testimonial in the simple bullet form to give you a realistic view of reasonable weight maintenance, with great ease, even as you grow older.

I am 61 years old now and am just going to maintain my present weight, which is only six pounds heavier on the scale after sixteen years, but the same size in clothing, with exceptions of my tops. A somewhat higher weight is always easier to maintain with ease!

The more we weigh the more calories we can maintain on! This is a matter of choice and personal taste; I know that if I decide to drop a few pounds, I can do that in a healthy manner by adjusting my numbers because I have educated myself.

I was on the miserable dieting roller coaster from age eight until age 45.

Free, free at last!

WORKSHOP PAGE OR DISCUSSION THOUGHTS.

What are the 6 most important things to do from the beginning in order to have a fighting chance at peaceful lifetime weight maintenance?

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