Happy New Year/New You Everyone!

2023 marks the 15th year since I started the Bariatric Surgery program for Garnet Health Medical Center, and 19 years since beginning the professional journey with the bariatric surgery specialty.  All throughout my tenure creating/coordinating/administrating bariatric surgery programs and facilitating support group meetings, seminars, and pre-op education classes for bariatric surgery patients, I have always circled back to the very important underlying concept that is, “you are the driver in everything you do.”

I have been very fortunate throughout these years getting to know hundreds of bariatric surgery patients from all walks of life, who enter the bariatric surgery program with the main goal of making a commitment to having a successful weight loss journey. What has become very clear to me is that it is imperative to have the right mindset from the very beginning to ultimately be successful with not only initial weight loss efforts, but to maintain the majority of weight lost throughout the remaining years of your now longer lifespan.

Some patients enter our bariatric surgery program with more realistic expectations and more readily understand the importance of taking ownership for this process, while others have not taken the time to fully process the personal commitment required; expecting the surgery to ultimately do the work for them. While in all likelihood every patient will lose some degree of weight after bariatric surgery regardless of their initial mindset, without fully embracing and taking to heart the “you are the driver…” concept, patient’s will not reach their goal weight, and most likely regain much of the weight lost over time.

To become the “driver” in your weight loss process, it’s important to be aware of a few facts:

  • 95% of obese patients are not successful at taking the weight off and keeping it off without bariatric surgery. Once the BMI reaches *qualifying levels, bariatric surgery is a very important tool to help you successfully lose weight.

*The guidelines to determine eligibility for bariatric surgery with insurance companies have been in existence since 1991 with the National Institute of Health (NIH) issuing a Consensus Conference Statement on Bariatric Surgery. This guided patient selection, weight-loss procedures and obesity for > 30 years.  Here, BMI of ≥ 40 qualifies for weight loss surgery, and a BMI of 35-39.9 with 1+ disease, i.e., (diabetes, high blood pressure, sleep apnea) qualifies too.

*In 2022, new guidelines have been created by members of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). The new guidelines have yet to be approved by The Centers for Medicare & Medicaid Services (CMS), followed by private insurance companies. With the new guidelines, BMI ≥ 35 qualifies for weight-loss surgery, and a BMI of 30-34.9 with 1+ disease, i.e., (diabetes, high blood pressure, sleep apnea) qualifies too.

Therefore, the new guidelines improve access to bariatric surgery for patients with expanded eligibility.1

  • 50% of your success is having bariatric surgery because it is a very important tool to help you do the remaining work to reach your weight loss goals.

The other 50% of the success equation is to embrace and adhere to the following lifestyle changes:

  • Drink fluids, but stop 30 minutes prior to eating and restart 30 minutes after eating.
  • No fluids with meals.
  • Drink 64 ounces of fluid per day once you are eating soft solids.
  • Do not drink with a straw.
  • Do not drink alcohol.
  • Avoid caffeine.
  • Avoid carbonated beverages.
  • All food must be chewed to an applesauce consistency.
  • Place utensils down between each bite.
  • Chew food thoroughly and count your bites.
  • Stop at the first sign of fullness.
  • Always eat your protein first.
  • All meals should be balanced nutritionally.
  • Take 20 minutes to consume your meal.
  • Vitamin and mineral supplementation must be taken every day.
  • Exercise 30 minutes per day.
  • Avoid high-fat foods and sweets. These foods may cause dumping (post-op gastric bypass) or slow down the weight-loss process due to an abundance of calories (post-op gastric band or sleeve gastrectomy).

In the highly successful book, “The Success Habits of Weight Loss Surgery Patients,” Coleen Cook, a post-op bariatric surgery patient recommends setting weight loss goals. She explains that it’s important to keep aware of your weight, especially after reaching your goal weight to prevent your weight from slowly regaining over time. She suggests the following:

  1. Set a goal weight (total weight loss goal at program inception, and one-year weight loss goal). Set reasonable expectations.
  2. Set a warning weight of 5 to 7lbs above your goal.
  3. Weigh your self weekly and no more frequently, to prevent from obsessing the number on the scale. Don’t pass the one week mark without weighing or you can get off track.
  4. Make a consistent weigh-in routine – weighing same place/time/with same amount of clothes.
  5. Evaluate progress regularly.
  6. Plan to set intermediate goals as needed.2

It’s important to know that your bariatric surgery team is here to assist you before, during, and after your surgery (for life) to facilitate weight loss and long-term weight maintenance. However, the team can only do so with YOU as the driving force. You must make sure to be ready to make a serious commitment with your bariatric team, schedule and show up for all of your appointments both pre and post-operatively.

Afterall, the same years will pass you by, if you choose to sit in the back seat. Choose to be the Driver, to achieve your weight loss goals and ultimately improve the overall quality of your life.

1Eisenberg,D., Shikora,S.A., Aarts,E. et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. OBES SURG (2022).

2The Successful Habits of Weight Loss Surgery Patients. Jordan, Utah, Bariatric Support Centers International, 2012. Pp11-13, 33-35.



Janet Klein, MS, RDN, CDN, CDE
By Janet Klein, MS, RDN, CDN, CDE
Janet Klein, MS, RDN, CDN, CDE is Garnet Health Medical Center's Bariatric Surgery Program Director. 

She received her Bachelor of Science Degree in Dietetics from the State University at Oneonta and her Master of Science in Education from Queens College University. She is a Certified Diabetes Educator, a Registered Certified Dietitian-Nutritionist, holds an Academy of Nutrition and Dietetics certificate of Training in Obesity Interventions for Adults and is a member of the Integrated Health group of the American Society for Metabolic and Bariatric Surgery (ASMBS).

She brings more than 35 years of clinical, educational and leadership experience to Garnet Health Medical Center, where she spearheaded the Bariatric Surgery Program in 2008, received Accreditation for the program through the ASMBS in 2011, re-accredited the program through the American College of Surgeons (ACS) Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) in 2014, 2017, currently and continues to lead the program with passion.

Janet can be reached at 845-333-2123 or

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