I’m writing this blog backed by over 25 years of clinical observation and thousands of scientific studies reported in the medical literature. I’ve also included advice from real patients who have “been there,” and then succeeded. During my years as a weight-loss doctor, offering surgical and non-surgical weight loss counseling, I’ve interviewed thousands of weight-loss clients. I’ve observed their habits and studied the patterns that result in success or failure. As I observed weight-loss surgery patients become successful, I saw that the habits resulting in their success were the same habits followed by people who had maintained fitness their entire lives. It became clear that my job wasn’t to come up with some strange and unique rule book that needed to be followed by “fat people” in order to help them lose weight; my job was simply to help weight-loss patients find their way to a fitness lifestyle. Nothing more.

Time has proven my approach.

Early in my practice, in 1997, I began to perform bariatric surgery. With formal bariatric surgery training during my residency I turned out to be the only formally trained bariatric surgeon in the area. At that time, bariatric surgery was still considered a radical approach to weight loss and many doctors doubted my prospects for long-term success.

The first procedures I performed were all revisions of prior bariatric procedures that had resulted in complications. What I noticed was that the patients being sent to me had undergone bariatric surgery without any real understanding of what the surgery entailed. These patients had no chance of success because nobody had explained to them how the surgery worked or what they needed to do to make the surgery successful. They had been led to believe that weight loss surgery was magical and would “change” their diet, somehow, making them thin for life. To me, this was no different than the magic diet pills on TV that made you “melt away fat in your sleep. I decided that the entire field of weight loss, whether through surgery or not, was hugely dependent on the patient modifying his or her behavior. This, in my opinion, involved the patient understanding their role prior to surgery, and then choosing to participate in the system.

In order to provide this prior understanding, combined with post-operative support, I decided to first put together what I called a Nutrition, Exercise and Wellness program (The N.E.W. Program) and then to add on surgery, when patients chose surgery as their best option. Patients could choose either a surgical or a non-surgical path, and I had every patient set his or her own goals and identify the people in their lives that were capable of support. I made one additional stipulation that I felt necessary for success: I insisted that each patient accept full responsibility for developing a combination of eating and exercise habits that would make the surgical approach successful.

Were all my patients successful? No. No process can claim a 100% success rate. But this N.E.W. lifestyle approach, combined with surgery, was more successful than simply doing the surgical procedures alone, and far more successful than any diet-and-exercise program out there. Period!

In the 20+ years since my first patient, I have developed a set of guidelines that has resulted in success for thousands of overweight individuals. These guidelines are described in the book. The book also contains invaluable insight into why people choose weight loss surgery, and how your friends, family and your physician should think about the problem of severe obesity.

Define your New Normal Diet

A very useful tool to use in discovering a new eating pattern that you enjoy is my Dietary Rebuild™ Program. The Dietary Rebuild is not a diet, it’s a method of identifying a personalized eating pattern that will be your new normal eating pattern.

Why a Dietary Rebuild?

Thousands of patients have come through my weight loss clinic and, once they’ve lost their excess weight, I’ve watched many of them struggle with developing a new set of eating habits that is enjoyable, sustainable and will not result in weight regain. Weight often comes off rapidly with a very low-calorie diet (VLCD), or after surgery, but once people get back to eating regular food, weight regain can begin. This does not have to happen!

The problem is that as soon as clients start eating their “normal foods” again, their normal eating habits that they identify with are the eating habits that resulted in their weight gain in the first place. This problem commonly occurs after commercial weight loss programs, physician-run weight loss programs, self-imposed diets, and even after surgical weight loss.

After losing weight, most people want to be given “the rules” for keeping the weight off and they expect a set of rules that will magically work for everyone. Amazingly, they are willing to listen again and again to the same failed rules they’ve been given after every diet in the past. Examples of these rules are:

1) Count your calories

2) Practice portion control

3) Always eat protein first

4) Avoid eating sweets, etc.…

These are the same or similar rules that were given to them by dietitians, doctors, nutritionists and others telling them which foods to avoid, which foods to minimize, and which foods are “bad.” This advice is easy to get, almost every diet program dredges this stuff up at some point. But, if this advice was so great, you would have succeeded long ago!

No matter how many rules you are given, no matter how much healthy eating advice you absorb, your prior diet (your past normal) will almost always creep back in and result in significant weight regain. And no matter how many “rules” you try to live by, your normal eating habits that resulted in your excess weight before, will become your eating habits again.

To solve this problem, I’ve designed a unique process that will reset my patient’s baseline, and help them to identify a new, personalized diet that works for you long-term. I call this process Dietary Rebuild™, Rebuilding your New Normal Diet™.

So, what was your new normal?

Dietary Rebuild™ is a structured process that I use to coach my patients to an eating pattern that is fundamentally healthy, satisfying, and personalized. The process involves throwing out all your old eating habits and starting with a basic dietary platform that you follow for the initial step. We then work together to rebuild your new normal diet back, one step at a time, until you define an eating pattern that you like and can succeed with long-term. This is the essence of the “Dietary Rebuild™ Program.” I start you with a broad, but very well-defined eating pattern for a period of 4 weeks. Then using a structured, step-wise approach, you “rebuild” your eating pattern back to a full-fledged diet with all the options and food choices that are available.

You are in ultimate control over the rebuild process, including how much of each type of food you wish to eat, and how often you eat it. In the end, no type of food is off limits, but your “New Normal Diet” is the eating pattern that you will think of as your normal diet going forward. Every patient has independent decision-making power in defining their new normal.

Defining your new normal diet is a critical step for you to succeed with permanent weight control. Remember, the goal is for you to achieve your best weight, and this means that you’ve found healthy eating habits that you are comfortable with, that do not result in weight regain. It also means that you’ve found an exercise program that they enjoy.

The combination of weight loss from the N.E.W. Fit Program and identification of your new normal diet from the Dietary Rebuild Process puts permanent weight control within your grasp!

Complications can occur after any type of surgery. Most of the time, when a complication occurs, the surgeon has done everything correctly and yet something goes “wrong.”

When a complication occurs, you often need a highly experienced surgeon to evaluate your situation, identify the problem and then correct it, if possible.

Dr. Quebbemann has been seeing patients regarding many different types of bariatric complications for more than 22 years. He has evaluated highly complex surgical situations and often been able to intervene and correct the problem. A partial list of complication he’s evaluated and corrected is below.

1. Incorrect Gastric Sleeve Anatomy
2. Fistula after Gastric Bypass
3. Erosion of the Lap-Band
4. Lap-Band Slip
5. Chronic Vomiting after Lap-Band
6. Stricture after Gastric Bypass
7. “Dilation” of Gastric Sleeve
8. Hiatal Hernia after bariatric surgery
9. Bleeding Ulcer after Bariatric Surgery
10. Post-operative Malnutrition
11. Chronic Vomiting
12. Internal Hernia

At the time of your initial consultation, Dr. Quebbemann will review your surgical history, the symptoms that you have been suffering from, and perform a physical examination. He will order some basic laboratory testing do be done in order to assess your nutritional status. He will almost always order testing which will help define your current anatomy. Sometimes patients do not actually know exactly what their original surgical procedure was, and identification of the actual anatomy is very helpful in determining the cause of the complication.

The evaluation process includes;

1. Initial Consultation
2. Nutritional Evaluation
3. Evaluate Your Anatomy as it is currently
   1. X-Ray testing
   2. Endoscopic Evaluation
4. Second Consultation to discuss results and recommendations for correction

Dr. Quebbemann has been performing corrections and revisions for patients since 1997. The process involved in correcting complications is often not simple, and extensive training, experience and technical skill is needed. As one of the most experienced and skilled minimally invasive bariatric surgeons in America, patients struggling with complications can be comfortable knowing they are in good hands.

How the Gastric Band Works

(Although Dr. Quebbemann was an investigator for the FDA Trial for the Lap-Band, and has performed over 1000 Lap-Band procedures, he no longer performs the Lap-Band procedure.)

The Gastric Band is a hard, plastic device that is wrapped around the upper part of the stomach. It is attached by a thin tube, called a catheter, to a hollow reservoir in the shape of a disc. The disc-shaped reservoir has one hard side with a round metal plate and one soft side made of rubber. The entire system—reservoir (called a port), catheter, and band—is filled with saline (salt water).

When a bariatric surgeon places the band around your stomach, he connects it to the catheter and the port, placing the port below your skin but on top of your abdominal muscle. The port is positioned with the rubber side up and the metal plate down and stitched in position.

— Gastric Band diagram

In order to tighten or loosen your band, the surgeon will pass a small needle through your skin, through the rubber side of the port, and into the reservoir. The metal plate stops him from passing the needle too far. He will then add or withdraw saline, to tighten or loosen the band, as needed.

When a person with the Gastric Band eats, food passes down the esophagus into the small stomach pouch above the band, then passes through the band and into the stomach. Because the band restricts the flow of food through the upper stomach, a person with a Gastric Band will need to chew food very well to prevent it from getting stuck. Food will stay in the upper stomach for a while, giving the person a sense of “fullness,” before passing downward through the main portion of the stomach.

Valentine’s Day is just around the corner. And, contrary to popular belief, it’s entirely possible to enjoy the day without depriving yourself. Here’s how:

5 Tips for Nutrition Success

1. Plan Ahead. If you already know you want to indulge a little on Valentine’s Day, plan accordingly. There are plenty of things you can do before and after the actual holiday to offset any “cheating” you might do on the day itself. Eating lighter the day before and after Valentine’s is a great way to accommodate for any extra calories you might consume the day of. Adding some extra cardio, even just 30 minutes, to your routine for a few days can also help equalize the extra indulgences that come with celebrating Valentine’s Day in style.
2. Dine In. There’s no rule that says you have to go out on Valentine’s Day. In fact, when done right, dining in can actually be more romantic. And it’s almost always healthier. Restaurants are notorious for using generous amounts of butter and oil when preparing food. Cooking a meal at home can help you avoid the oversaturated, fatty food you’ll find at a restaurant AND it can be a great way to spend time together while you prepare the meal.
3. Don’t Skip the Wine. It is Valentine’s Day after all! Wine, especially red wine, is a great way to set the mood and stay healthy. Red wine contains antioxidants that help preserve your arteries, boost blood flow, and improve circulation. When consumed in moderation, it’s a great way to celebrate and a great way to protect your heart health.
4. Indulge a Little. Depriving yourself is never the answer. The more you limit your food intake, the more likely you’ll be to cheat down the line. It’s ok to indulge every now and then, and there’s no better day to do it than Valentine’s Day. As long as you are aware of the food and alcohol choices you’re making, there’s no harm in letting yourself enjoy the day. In fact, we recommend it!
5. Relax and Enjoy. The fastest way to ruin a nutrition plan is by stressing about it. Not only are you more likely to “fall off the wagon” down the line, you’ll also be counteracting all the good you’ve done up to this point. The body goes into fight-or-flight mode when under stress, and it will automatically start conserving resources and storing fat under these conditions. The more you can relax and enjoy yourself, even if you decide to cheat a little, the better equipped your body will be to handle any extra calories you may consume this Valentine’s Day. So relax and enjoy yourself!