New Directions or What the heck am I doing?

This is going to be a long post. I considered breaking it up in several sections, but there never seemed to be a logical place to say “to be continued.” So you're getting it all in one dreary post.

It's been just over a week since I restarted the hospital weight loss program. I thought I'd write a bit about the program itself in more detail. I foresee that some of my future posts will include writing about my personal journey in this program. I wanted to give you all a glimpse as to what it is I'm actually doing and the support I get from the hospital as I go forward so you all have an idea of just what the heck it is that I'm talking about.

The New Directions program is designed, first and foremost, for the morbidly obese. It is not for those who have 10-20 pounds to lose. It is for those patients whose weight is seriously affecting their health.  There are risks, real risks, but those risks must be balanced against the risk of staying overweight. For me, there is the risk of becoming diabetic.  There is also damage being done to my heart because of my blood pressure right now, so getting the weight off is a very key component in stopping and possibly repairing that damage.

It is a low carb program. A patient starts off with 3 protein shakes a day, plus a lean meat and low carb vegetable for a meal (most choose supper). The goal is to stay below about 50 g of carbs a day. That is ridiculously low. But the goal is to get the body into ketosis.

Now, I don't claim to understand exactly what ketosis is, but I know diabetics avoid it like the plague It's when your body has used up most of the glucose in the muscles, the body starts burning the fat. It also starts burning muscle as part of the process, which is why protein is very important on this diet. The process also puts several different products in the bloodstream which, if unchecked, can damage the liver and kidneys.

(At this point, I am probably worrying my readers. Hang on...hear me out.)


It is important to drink 64 to 108 oz of water a day to flush the waste from the blood and keep the kidneys functioning. That, plus 2/3 of the glucose molecule is water, it means you're in the restroom a lot. The program makes use of the body's own process of using the fat stores but turning it up to eleven.

That's how I understand the process as it happens in the body. And I'm sure I have greatly simplified it.

Now, the program is done in the hospital. There is a health screening before one is accepted. It is directed by a nurse practitioner, overseen by a cardiologist/internist, and has a staff of registered dieticians (I prefer that spelling), personal trainers and two other nurse practitioners. Once a month the patient meets with a NP for essentially a health check up, just as one might see a doctor for a health and wellness checkup. Labs are drawn every month for 6 months to keep an eye on the kidney and liver. After 6 months, if there no indications of problems, labs are drawn every other month.

Now, to the meat and potatoes of it all, so to speak. Once a week the patient checks in. Weight and blood pressure is measured. This is when the patient purchases the shakes. The patient then meets with someone on the staff, usually the dietician, to go over the week prior. We review what we did for exercise and how often. We talk about problems encountered, feelings of success and failure, answer questions the patient might have and so on. It is also the time the staff asks questions geared to elicit information about the patient's general health and the director is notified if there is any change in health.

After the review, the patient attends class. These are real, in-depth classes covering nutrition, exercise, general health and emotional health. The last was always difficult because I feel the emotional connection to food is soooooo deep, it really can't be addressed in a group setting. Plus, the speaker has some woo woo ideas that I just couldn't always buy into, but more often than not was extremely helpful. Participation in the classes are mandatory if the patient wants to continue. However, some patients, like me, have been through the curriculum several times. These patients get excused from class if the director is comfortable that we “get it.”

Once the patient reaches his or her goal, maintenance begins. The patient works with a dietician to ween off the shakes and on to real food, using the lessons learned in class and specific work to the situations that arise. This goes for at least 6 months minimum. After that, the patient comes in for a checkup once a month for 6 months. If the patient is still maintaining the loss, he or she comes in once a quarter for a year. Then the patient is asked to come in twice a year after that.

Once you're in the program, you're in for life (or so long as the hospital funds the program). One can visit any class after the weight loss, purchase the products, meet with a dietician or nurse practitioner as needed or just simply call in if one needs a little encouragement.

I know some of you are skeptical of shake based programs. I was too. But the medical supervision, the educational component and the accountability has removed a lot of that skepticism for me. Eighty percent of their patients have maintained their weight-loss a year after meeting their goal. That was a statistic I couldn't ignore. If it hadn't been necessary for me to quit midstream last fall, I have no doubt that the transition to maintenance would have happened.

I'm NOT sure it would have been successful though.

I had a lot of work to do in self acceptance, self love and accepting & understanding emotional connections to food. In many ways I look at the last year as a time to work on these aspects without the stress of weight-loss I am much more confident restarting the program because of this work. And I have my readers and fellow bloggers to thank for that. I would not be at this point to begin anew if it hadn't been for your encouragement and understanding.

That's it in a nutshell.  Later I'll write about my personal adaptation to this program.  It isn't quite a severe as the description above sounds.

Ask me any questions you might have. I'm going to add a link to my email somewhere on the blog if you don't want to ask via a comment.  I believe in this program.  That in itself will take me a long way towards success.