Hey Bucko! Eyes Up Here



No, they’re not looking there. I wish they were. That would be easier to deal with, I think. 

I am a gastric bypass patient. I lost 160 pounds over 10 years ago. I have excess skin. I come from a long line of women blessed with both batwings and thunder thighs-even on the thin ones. Combine my genetic tendency with that amount of massive weight loss and well, yeah, my thighs would not make Heidi Klum jealous and my arms certainly do not rival Madonna’s. I rarely ever wear shorts because well, I rarely wore them when I was obese and I don’t really wear them now. However, I did wear sleeveless shirts before surgery because I live in Tennessee and it’s hotter than Hades here from April/May through September/October. 

I typically wear some type of shrug or sweater over my arms because I don’t love how they look. I realize they are not attractive; however, the number of people I’ve encountered lately who are staring at or making “eye contact” with my arms, more specifically my batwings, while I’m speaking is frustrating. Uh, hello, just need to clarify, my eyes are up here, not on my arms. Just like my personality, my intelligence and my worth were not and are not directly related to my weight; they are not tied directly to my arm jiggle.

I went shopping last week for some cute little dresses to wear at ASMBS. I found an adorable silky navy number, sleeveless of course, so my first instinct was to try and find something to wear over it. The adorable sales person asked me why on earth was I trying to find something to cover up that cute dress when it’s summertime in Tennessee. I looked at her, looked at the dress and wondered the same thing. So you know what? I bought the cute dress, I quit looking for something to cover up the cute dress and guess what? Both me and my arms will be rocking that dress at ASMBS, but just remember if I see you there, “The eyes are up here, Bucko.”


I am a Nurse, What’s Your Super Power?

I graduated nursing school in 1993. It was not my lifelong dream, it was a very practical decision my husband and I made together. At the time, his job could have moved him anywhere and together we decided it was time for me to go to college and I should choose a career where I could find a job most anywhere.

In the last 19 years, it has been my honor to care for many many people and their families. My first job out of school was at a large university medical center where I first worked on a general medical-surgical floor (which included bariatric surgery patients). I had the opportunity to care for some of the first HIV+ patients at our center. The overt acts of hostility and resentment they encountered from so many in their life made any kindness and comfort we could provide paramount to their recovery.

I then worked for several years in the Surgical Intensive Care Unit. Whether it was the adrenaline rush from never knowing what type of patient was coming through the doors or the pride from having obtained my Critical Care Nurse certification, I loved working in the SICU. I cared for the sickest of the sick; those who had undergone lung transplants, liver transplants, and trauma patients who could easily have been you or I on our way home from work.

I then became a case manager. One of “those people.” Now, now, don’t say it like that…case managers are not the enemy. In fact, they are the patients best friend. They help you navigate insurance the insurance waters, find specialists and follow you across the continuum of care to make sure you receive the care you need, when and how you need it in the most affordable manner. In 2001, I obtained the Certified Case Manager designation (that was the hardest test I’ve ever taken in my life! Yes, it was even more difficult than the critical care nurse exam.) I worked at an insurance company for a while, then went back to the hospital setting after having my gastric bypass.

In 2004, a friend and office mate handed me an ad for a hospital developing a new bariatric surgery program. They were looking for a coordinator. I had been dying to get involved in bariatrics and my current job had been completely realigned resulting in my dreading work each day, so I decided to call to learn more. Talk about fate! I faxed my resume and application on Friday afternoon, they called me Monday afternoon, I interviewed the following Friday afternoon and was hired during the interview. Finally I was a bariatric coordinator. I am now fortunate to work at the same program where I had my bariatric surgery. I sat for the first Certified Bariatric Nurse exam (and passed!)

I have been a nurse for 19 years.  I may not have entered this career as a “calling” but nursing has surely taken over my soul. I have worked with the best nurses and surgeons in the world (and some of the most cantankerous.) I have wiped noses, tears and hineys. I have held the hand of the dying. I have laughed with the healed.

I am a Nurse, what’s your super power? And most importantly, how will you use it?

BariBelle, RN, BSN, CBN

Response to ’20/20 Episode on 5/11: Losing It, The Big Fat Trap’

The build up to this episode was strong. The American Society for Metabolic and Bariatric Surgery sent an email to their membership and posted it on their website. The Obesity Action Coalition posted it on their social media outlets. I posted the reminder on our social media sites.

Dr. Robin Blackstone as President of the ASMBS gives multiple interviews. She is, after all, an expert in the field of metabolic and bariatric surgery. She represents an organization of thousands of surgeons, nurses, dietitians, exercise physiologists, physical therapists and psychologists dedicated to the care and treatment of those with obesity and severe obesity.

When I first heard they were pulling the segment with Dr. Robin Blackstone and Melting Mama, I thought it was so they could dedicate an entire episode to bariatric and metabolic surgery and how it is a life saving treatment for so many. Instead we got a 60 minute long sensationalistic expose on practices those of us who are healthcare professionals working diligently to help those with obesity and severe obesity would never support!

Lose 90 pounds in 90 days!

Allow me to illustrate and elaborate on a few points your so called “reporting” missed.

1. There is no magic bullet, miracle discovery or new breakthrough cure for obesity.

2. Obesity is a life-long, multi-factorial, complex, chronic disease process that requires life-long, multi-factorial treatment by dedicated and experienced healthcare professionals.

3. Dobb-hoff tubes and tube feedings are for individuals who are either too sick or too malnourished to sustain their nutrient intake, it is not for weight loss.

4. Celebrities who represent various commercial weight loss programs have access to personal trainers, chefs, therapists and countless others in addition to the pre-packaged food provided while “on the program.”

5. Bariatric (weight loss) surgery is not only safe, it is life-saving when performed by experienced and skilled bariatric surgeons.

  • There are criteria that must be met to have bariatric surgery.
  • The criteria were established by the National Institute of Health in 1991.
  • Comprehensive Center of Excellence programs include access to Certified Bariatric Nurses, Registered Dietitians, Exercise Physiologists and Psychologists or other Behavioral Health Experts.
  • Laparoscopic bariatric surgery has been performed safely and effectively for over a decade.
  • Hundreds of thousands of successful bariatric surgery patients are not only surviving, they are thriving. I am one of them.
  • You interviewed one of them, Beth (AKA Melting Mama).

6. Instead of taking the opportunity to provide factual information from an expert on the most effective treatment we have at present for severe obesity and highlight the recent studies in the New England Journal of Medicine regarding how effectively bariatric surgery treats type 2 diabetes, you chose to “reveal” an expose on two surgeons. This story has been in the news for nearly a year. 


I am completely disappointed, irritated and flat out disgusted at the so called “journalism” that went into this ABC 20/20 episode. They completely and totally missed the opportunity to focus on legitimate, successful medically [and surgically] appropriate treatment for obesity and severe obesity. Instead I felt like I was watching a rogue episode of Entertainment Tonight.

Not good ABC, not good-shame on you.  ’20/20: Losing It: The Big Fat Trap’


Interview regarding the pros and cons of a junk food tax

Interview regarding the pros and cons of a junk food tax

I was interviewed on this subject earlier in the week. I would love for you to post your thoughts after you watch the clip.


I Forgot My Surgiversary!

Below is my before photo taken in January of 2001, just a few weeks before I had my gastric bypass surgery on March 2nd, 2001. I always remember my surgiversary. I usually write a pretty detailed post for our website, Facebook and ObesityHelp detailing how far I’ve come and how much better I feel. How did I forget this anniversary? At each seminar, when I’m doing our introductions and I speak about being a patient I always tell how many years postop I am. On Saturday when doing the opening, it hit me. Saturday was March 3rd. The day after my surgiversary. I’m now 11 years post laparoscopic Roux-en-y gastric bypass surgery at Centennial Medical Center in Nashville, Tennessee.

Wow. Eleven years. Weighing 330 pounds seems like a life time ago. It also seems like yesterday. That woman in the photo below, I know her well. I know for example that while many view her as a WLS success, she views herself as always one step away from sliding back into severe obesity. I know that she still misses treating herself with food so instead she treats herself with shoes, clothes, techno gadgets, etc. (some might say this is a transfer of addiction, I will address that later this week.) I know she has daily conversations with herself about her food choices, about trips to Starbucks, about what is more important today-the taste of a certain food on her lips or the fit of a certain skirt on her hips?

January, 2001 at 330 pounds, two months before gastric bypass surgery

A few weeks ago, it was my honor to be invited to speak at a Obesity Roundtable discussion held at Boston University. There were researchers and presenters from BU, Cornell, Stanford, Harvard and me (representing the patient, patient advocate, designated nurse and non-researcher.) Suffice to say, this was a very intimidating crowd. My topic was how we HAVE to change the public perception of obesity. Without doing so, these researchers will struggle to obtain the funding they need because, well, let’s face it, obesity is not a “sexy” disease. Without a change in the public perception of obesity, no matter what the research finds for cause and suggests for treatment, obesity will continue to be simply a character flaw, a lack of will. During my presentation, I shared my personal story of obesity. I shared the struggle of others too. I showed some of the images that are typically shown in the media, images used in the CHOA childhood obesity campaign, excerpts from media articles and sadly from healthcare journals that are disheartening, derogatory and downright demeaning. My plea, to understand while these images may have a certain “shock” value, these images are inappropriate and directly contribute to the way those with severe obesity are treated.

After the presentations, we had lunch (yes, it was healthy!) I was pleased that a few people actually wanted to sit with me and ask more questions. One gentleman is a professor at Harvard who teaches a mandatory 9 hour nutrition course to their medical students. I was very impressed with both this young man and that Harvard required this training…until we discussed it further over lunch. He shared with me how the students really dislike this class and look at it as something they are forced to do. He asked me how he should ingrain in these students the message they should treat their obese patients with respect. I responded that as future physicians, they should be taught to treat ALL of their patients with respect and be sensitive to their needs. I asked if he agreed with me that patients should be treated respectfully regardless of their age, sex, gender, race, ethnicity, sexual orientation, and physical and mental disabilities. “Of course,” he said. Then why is their physical size any different? Why does that number correlate to the level of respect due to an individual. His response was so simple but so true, “It shouldn’t, but we both know that it does.” There is so much work to be done.

Over lunch, we also discussed what life is like as a bariatric patient. I described a recent afternoon when I had had a really rough day at work. As I was leaving, I had that thought, “I’m going to Starbucks. It’s been a crappy day, I want Starbucks, I deserve Starbucks, I’m going to get Starbucks.” Then I reminded myself that what I really wanted has about 300 calories in it and my skirts have been a little snug lately so I really shouldn’t go because I really didn’t need those calories, especially since I could fix me a cup of coffee with SF creamer and splenda when I get home. As I was walking to my car, I started bargaining and negotiating, “well, just drive by there and if the drive thru line doesn’t go past where you order, you can stop; but if the line’s longer than that, well it’s a sign you shouldn’t stop.” Then, as I’m driving down West End, quickly approaching Starbucks, I’m thinking, “You know, you tell you’re patients all the time, they don’t deserve food rewards, remember you’re still a patient, crappy day or not, Starbucks is not going to make it better. This deal about how many cars are in line will determine if you stop or not is crap, don’t even look at the line, you don’t need it, don’t stop.” So, I pulled over in the far right lane, I didn’t look left, I don’t know how many cars were in line, I didn’t stop. When I finished that story, this poor professor is looking at me with his mouth hanging open and looking totally perplexed, he says, “Wow, I have never, ever put that much thought into anything I was going to eat or drink, if I want a cup of Starbucks, I just stop and get it.” I told him he should think what it’s like for a patient who has similar thoughts about pretty much any and all foods and drinks they take in, constantly trying to find ways to “justify” what/how/why/when and how much they are eating. Realizing that it’s not always feeding a true physical hunger, but often feeding an emotional need. We then had a great conversation about how what I described is just one factor that influences our weight. With so many complex factors at work, how can obesity treatment ever be so simple as eat less and exercise more? How can we continue to look externally and judge so severely what occurs internally?

I am a 46 year old white female with severe obesity. Eleven years ago, I underwent successful surgical treatment for the chronic disease process of severe obesity. I continue to keep my severe obesity in remission by committing to lifelong dietary modifications, lifelong lifestyle changes, regular attendance at support groups and weighing daily. I can slip at any time, I am susceptible to recurrence of my severe obesity. I am a patient deserving of ongoing treatment. I am a person deserving of your respect regardless of my size.


I love this as it can apply to so many areas of your life!

Daily Health Boost

Today’s Inspiration: Positivityblog.com

“I love this article so much because it is sooo easy to get distracted! Every minute we are bombarded with information. Lets not even start with out own thoughts that seem to always distract us! This article has so many great ideas, I hope you like it!”


How to Focus Your Attention on What is Most Important in Your Life



“Tell me to what you pay attention and I will tell you who you are.”
Jose Ortega y Gasset


“Give whatever you are doing and whoever you are with the gift of your attention.”
Jim Rohn

Keeping your attention on what is most important in your life is one of the most essential ingredients if you want to be able to:

  • Stick with your goals.
  • Achieve what you want to achieve each day.
  • Appreciate what you have in your life.
  • Clearly see how you can…

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I’m Curious

Nearly four years ago I attended a conference where one of the sessions included an overview of social media, specifically Facebook. I came home from the conference, spent a couple of hours online and created my Facebook profile as well as a page for the bariatric program where I work. At that same time, I gave Twitter a try, set up my profile, etc. and I just didn’t get it! I deleted my account and pretty much kept wondering what all the hype was about. Eventually, I started watching some videos (you know, the cute kitten and puppy type) on YouTube. Then I discovered cooking videos, then videos by lots of people I know in the bariatric field, so I expanded my profile to actually have a channel for both me and my work.

In April of 2011, I had the opportunity to attend Obesity Online, an event sponsored by Ethicon Endo-Surgery and the Obesity Action Coalition with the featured guest speaker being Melissa Lierman Melissa, AKA “Time Out Mom” was an awesome speaker on social media. I could have easily listened to her for oh, two or three weeks! After hearing Melissa and her helpful hints, tips and suggestions, I decided to give Twitter another try. I beefed up our Twitter feeds at work and have now created my own Twitter profile once again. This past week, I was part of an awesome experience at work. We tweeted live from the OR our first two robotic assisted bariatric surgeries! Super cool.

So realizing how much I interact with social media personally and how much our bariatric community interacts with social media, I’m really curious which ones do you use? Which ones do you like best? Least? I’m asking that you please take the poll below and also post in the comments which social media outlets you like best and why.

Please feel free to connect with me via any/all of the following!
Via Facebook as BariBelle (my personal page, it’s new and needs some likes)
Like/Follow my work page Centennial Center for the Treatment of Obesity for hints, tips, recipes, and reminders for both surgery and non-surgery folks
Via Twitter as BariBelle (my personal Twitter account)
Via work Twitter posts from Centennial Center for the Treatment of Obesity (Work Twitter account and where you will find the live tweets from the OR by searching hashtag #cmcwls then “select all posts”)
Via my YouTube Channel BariBelleCBN (I’m going to be adding videos over the next few weeks)
Via our Centennial Center for the Treatment of Obesity YouTube Channel (video testimonials, procedure videos, and lots of other cool stuff)
Via Google+ (I’m really new to this one and not getting the hang of it too quick, so I could really use your help!)

I’m really excited to hear/see/read your thoughts on which social media outlets are your favorite and why. I’ll be keeping up with you via Facebook, Twitter, Google+ and YouTube and whatever is new and exciting!


I thought I was done with cliques in high school.


I know you know life in high school is seldom fun for everyone. In fact, unless you’re in one of the cool cliques or you’re so self confident you don’t care, it may not be much fun at all. I attended Caverna high school in rural Horse Cave, KY. in the early 80s. There were 63 people in my graduating class.

Our standard cliques at the time:

  • The jocks (same group since 5th grade and usually the same for all sports)
  • The cheerleaders (same group since 5th grade)
  • The smarties (today’s nerds)
  • The party crowd (today’s stoners)
  • The good ol’ boys (it is the south after all)
  • Then you had the rest of us. Not part of an official clique, we were friendly, smart, fun and more than willing to hang out with anyone in any of the “official cliques”

I survived high school never being an official member of any of these cliques. I played on the tennis team, but by no means would I ever be considered a jock; was always too fat to even think about being a cheerleader; I made pretty much all As and Bs but definitely was not in with the smarties; partied some in high school (what else do you do in small town, USA?) but definitely wasn’t part of that crowd either. Oh, I had friends. Several, we were part of the unofficial “chubsters” clique. 

Fast-forward nearly 30 years to present day and I find there are still cliques everywhere. Even at the dog park! Maybe it’s just Franklin, but somehow I doubt it. I’m sure by now you know we’ve adopted two shelter dogs. Sweet, cute, lovable fur balls, Geordie who is a one year old Scottie mix who loves to chase tennis balls and Brady who is a four year old Cocker Spaniel who is adorable but still seems a little lost as to why his original family gave him up (who knows?) Now that we have two sweet, young, active boys who need frequent exercise, the dog park has become a very regular hangout for us. Just like taking your kids to the playground and meeting other parents, the same thing happens at the dog park. You tend to see the same people with the same fur babies and you can’t help but strike up conversations. We’ve been going to the same dog park multiple times every week since October and let me tell you cliques are alive and well at the dog park!

First, let me be clear, I love [nearly] all dogs, their owners, well, maybe not always so much. The groups I have observed are very near to the cliques in high school:

  • The jocks (these tend to be the single guys who bring Boxers, Rottweilers, Great Pyrenees, German Shepherds, Pit Bulls and other big dogs) The dogs tend to be focused on running, running and a little more running. The owners tend to drink red bull or other energy drinks, have a permanent five o’clock shadow and pay little attention to what their dog is doing.
  • The cheerleaders (these tend to be young ladies who are dressed and made up as if they were going out on date night who bring the mini dogs such as Chihuahuas, Yorkies, Mini Poodles, etc.) The dogs nearly always have matching collars, leashes, sweaters and bags. Many of them act like they’ve never been on grass before and have no idea how to react when another dog barks at them or tries to play. The owners tend to drink Starbucks, carry designer bags and stand in one corner of the park with the other cheerleaders holding their dogs and speaking to them and the other dogs in some sort of strange baby language.
  • The smarties (this is a wide variety of breeds) Both the dogs and owners are pretty quiet, they stay to themselves and are heavily concentrated on mastering the jumps, ramps and tricks at the park.
  • The party crowd (adolescent and young 20 somethings who tend to come in packs, like this is a group date.) They come with dogs of all shapes and sizes, usually 4-6 people with 2-3 dogs. They hang out in a corner of the park while the dogs run completely crazy.
  • The good ol’ boys (we are still in the south afterall; these tend to be the single dog moms or dads with big fun dogs like Goldens, Labs, standard size Poodles and Schnauzers.) This is the group Reo and I and our dogs best identify with – they usually have a coffee mug in hand and dog treats in their pocket. The dogs love to run, play, bark, chase balls and sometimes wrestle. The parents like to talk sports, weather, and watch their dogs run, play, bark, chase balls and sometimes wrestle.

I love to people watch and frequently when I have a break from throwing the tennis ball non-stop for Geordie, I’ll stand back and watch the cliques and how they work.

While writing this, I can’t help but think that over the years, I’ve now become a part of another clique, one I’m really proud of – the bariatric or WLS clique. Now before anyone feels the need to draw the parallel, trust me, yes, I am fully aware that among WLS patients all the cliques listed above, the jocks, the cheerleaders, the smarties, the party crowd and the good ol’ boys are alive and well; however, I would argue these are more sub-cliques of the greatest clique of all – the one where we’ve taken responsibility for our lives, we’ve made profound decisions to affect our health and as we joined the WLS clique, that provided a conduit for us to also join one of the sub-cliques we always wanted to be a part of in high school. 

Pretty profound for only one cup of coffee and 6 AM in the morning, right? Off to work where those same cliques can be found!


Recipe Adaptation

I seem to not be able to follow a recipe. Not because I’m not capable of reading it. Not because I’m not open to trying new things. I think it’s because quite simply, I don’t like to be told what to do! I’m not a great cook; however, I seem to always think I can improve a recipe or make it better. I prefer to think of recipes as sounding boards from which great things (and sometimes, not so great things) are born. I have discovered a really cool Facebook and website, Six in the Suburbs. They have many neat decorating ideas and some wonderful sounding recipes. The one in the photo is my version of their Breakfast Omelet Muffins. Below is their recipe, bold print is how I changed it, the photo is my end result.

1 pound Italian Sausage (sweet, mild, hot variety depending on your preference) I didn’t have Italian sausage so I substituted the MorningStar veggie sausages I had with a dollop of pesto added
1 cup broccoli florets (or other veggie) I hate broccoli so of course, I substituted shredded potatoes 
8 large eggs
1/4 cup milk (or half and half depending on how you’re feeling that day) I substituted unsweetened Vanilla Almond milk
1/2 tbsp vegetable oil I used Italian herb olive oil like you would dip bread in
1/2 tsp baking powder I didn’t have any, so I substituted Bisquick
salt & pepper to taste
Freshly grated Parmesan Cheese as needed I had some leftover shredded Velveta so I threw it into the sausage/potato mixture.

ImageDirections-these I actually followed, except I used the mini muffin tins so they would be bite size, the yield was 48!
1. Preheat oven to 375 F.
2. In a large saute pan, over medium high heat, brown Italian Sausage for about 5 minutes, or until the sausage is no longer pink. Remove from heat and stir in broccoli.
3. Whisk together eggs, milk, oil and baking powder.  Season with salt and pepper.
4. Lightly spray a 12-cupcake pan with oil.Spoon out the sausage and broccoli mixture evenly into each cupcake.
5. Ladle the egg mixture over sausage and broccoli. 
6. Sprinkle with Parmesan cheese.
7. Bake for 15-20 minutes. 

I don’t think my version turned out bad at all. My husband and I added a little dollop of salsa on top. Now, I have breakfast for the next few days to take to work instead of going to the cafeteria and being tempted by the aroma of bacon in the air!

The moral of the story (if there really is one), is that you don’t always have to go with the flow of the recipe, you can create your own flow based on what you like or what you have on hand. Also, check out the Six in the Suburbs site, I will definitely be trying more of their recipes!



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