Mindset and Motivation for Long-Term Weight Loss Success

Sooner or later you'll find yourself in a situation where you have little or no control over the food served. That doesn't mean you have to abandon all your band eating skills or go hungry. The key is to have plans, even for unpredictable situations.

Social eating poses all kinds of challenges to the bariatric post-op. How to resist the dessert cart? How to refuse an extra helping of potatoes that Mom mashed especially for you (with just a little gravy)? How to chat with nine people and still concentrate on taking tiny bites?

One recommendation applies to all social eating situations: do not experiment with new foods. You don't know how well they'll go down and you don't want to disgrace yourself in public. This has been a challenge for me because I love to try new foods, especially when I travel, but taking food risks in public is just not worth the potential pain and embarrassment.

How easily you can pull off social eating will depend in part on whether your hosts or fellow guests know about your weight loss surgery (a topic worthy of an article of its own, so stay tuned). Sometimes I think my new eating habits are harder on my friends than they are on me. For example, a few months ago I went out to lunch with a group of women, including a friend (we'll call her Kathy) who knew me when I was fat and knows I had weight loss surgery. This was not the first time I had dined with Kathy since my surgery, so I was a bit surprised to realize that she was studying me as I ate.

"Is there a problem?" I said.

"I'm sorry, I shouldn't stare," she answered, "But I just can't get over the way you eat now."

"Isn't it great?" I said with hearty enthusiasm.

"Um, yeah, I guess so." There was an awkward pause. Then she rallied and said, "So how many dogs did you say you have now?"

I have survived many post-op social eating occasions with acquaintances who don't know about my weight loss surgery (and I'd rather keep it that way). Most of them keep their opinions about my eating (if they even notice it) to themselves. Sometimes they ask, "Don't you like the food?" (I answer honestly, yes or no), or "Are you diabetic?" (yes), or "Are you allergic to nuts? (no). Sometimes I have to use Kathy's change-the-subject method of getting out of an awkward moment (asking the hostess for the recipe, or a portion of dessert to take home, works well as both a compliment and a distraction).

Advance planning is crucial for successful social eating. Try to find out what will be served and decide what you'll eat. Eat something before you leave home, because the old advice to save your calories for the party is risky business for a post-op. Imagine how irresistible the buffet table is going to look if you haven't eaten for 10 hours. You're not just risking extra calories at that point - you're risking a stuck episode, a productive burp (regurgitation), or sliming - because you're too hungry to eat carefully.

If at all possible, bring some food that you can eat and share with the other guests (tell the host or hostess you're going to do this or it might get whisked away and stashed in the refrigerator). If you know alcohol is going to be served, bring a pitcher of a non-alcoholic beverage you like and announce that you thought everybody might like to try your special punch or fruit tea or whatever it is.

Stand-up can be easier than sit-down affairs because everyone is busy balancing a plate, cutlery, beverage and conversation and it's easier to sneak off and ditch the food without being seen.

At sit-down meals, I'll grab my plate and a neighbor's (making sure it's empty first, of course) and head for the kitchen saying, "Do let me help clear the table" or "Can I get you anything while I'm up?" (that's hard to pull off in a restaurant, though).

Speaking of stand-up affairs, finger food is a terrible idea for bandsters. Human teeth are just not designed to take a small enough bite of anything solid enough to be held in the fingers, so proceed with caution.

Whether you're standing up or sitting down, cutting up your food into tiny pieces and occasionally moving it around your plate with your fork are good ways to camouflage your spare post-op eating style.

And one last piece of advice: please do not give your uneaten food to your host's dog (or cat, or potted plant), no matter how hungry the dog claims he is. You have no way of knowing if the food is even safe for the dog. My dogs are four-legged garbage cans, and they have even worse judgment about food than I do!

Related: Lunch is Over!

It's 12:15 pm. Sad to say, your meal is over now.

I used to work with a recovering food addict (I'll call her Wendy) whose work station was about four feet away from mine. We both went to lunch in the company break room at noon every day.

Wendy had lost over 100 pounds in a 12-step program, but food was still of paramount importance to her. At 11:45 every morning, she would announce hopefully, "It's getting close to lunch."

At 11:55, she would announce ominously, "It's getting dangerously close to lunch."

At 12:00, she would announce triumphantly, "It's time for lunch!", spring out of her chair, and head for the break room.

At 12:15, came the final, regretful announcement, "Lunch is over."

Our coworkers found this daily ritual both amusing and annoying. Only another food addict (like me) could understand what was going on in Wendy's head as she looked forward to her noon meal and then mourned its passing.

What's the take-home message from this story?

Lunch is over. It has to be over. You must put down your fork and stop eating when your planned portion is gone or the instant you get a stop message. But what if there's still food left on your plate? What about the children in Armenia (all starving, according to my mother)? What about that leftover food?

1. Get up from the table (say, "Excuse me" if it seems indicated).

2. Put the food in a storage container, and put the container in the refrigerator, or throw the food away (down the garbage disposal, where you can't get at it, is best).

3. Take your plate to the sink and rinse or wash it.

Did I say "throw the food away"? In spite of the starving Armenian children? I sure did. I'm not going to tell the World Health Organization that you threw out the extra food. You can donate money to a food charity to help feeding starving children (you'll be able to afford a few bucks for charity because you won't be spending $50 a month on soda). God will not strike you dead for this, I promise.

Remember what Rhoda Morgenstern said to Mary Tyler Moore as she tore into a chocolate bar back in 1973 (or thereabouts)?

"I don't know why I'm eating this. I should just rub it directly on my hips."

So look at that plate of leftover food and ask yourself, "Should I roll in it, or throw it away?"

Lunch is over!

Related: The Clean Plate Club

I belonged to the CPC (Clean Plate Club) for over 50 years, so I consider myself something of an expert on it (and I am, after all, The World's Greatest Living Expert on Everything). I thought it was a lifetime membership, but my bariatric surgeon rescued me from the CPC Cult - oh, excuse me, Club - and deprogrammed me so that I'm able to function more or less like a normal person now. Here's my story.

I was inducted to the CPC as a child, when I was too young to realize that the promise of going to heaven if I always cleaned my plate was a bit more complicated than it sounded at the time. All I wanted to do at the time was to please the cult leaders: my mother and my grandmother.

I have reason to believe that my grandmother, whom I called Dranny, was the original founder of the CPC. Orphaned as a small child, she was passed around the family like a piece of unwanted furniture, and she raised her own children during the Great Depression. Through the combination of those circumstances and her own peculiar (and wonderful) character, Dranny was a pack rat. She didn't live in filth and disorder (just the opposite, actually), but she couldn't bear to throw anything away, especially not food. If three green peas were leftover from a meal and she hadn't been able to persuade someone to eat them, she would lovingly place them in a custard cup covered with a shower-cap style cover (this was in the days before Glad Wrap), and store them in the fridge, where they would remain until someone ate them (or my mother threw them out while Dranny was in another room).

I'm a lot like my grandmother in various ways, and also something of a pack rat. So after eating my way through hundreds of childhood meals with Dranny and my mom (who was not a pack rat, but who was offended by the idea of wasting food that she'd worked so hard to procure and prepare), I emerged into adolescence with warring impulses - part of me still wanted to clean my plate, and part of me wanted to starve so that I could lose weight and be as skinny as the British supermodel, Twiggy.

101 WAYS TO CLEAN YOUR PLATE

One of my problems with meal planning and storage is that it's hard for me to predict how much food I'll be able to eat at a future meal. Often I don't know that until I've eaten several bites. My basic strategy for dealing with this unpredictability is to keep my plate clean from the very start so that the food I leave behind doesn't overwhelm me or provoke an attack of guilt that could bring down Dranny's loving wrath upon me.

A simple way to keep your plate clean is to prepare smaller batches of food so you won't be tempted by serving dishes overflowing with food or burdened with an excess of leftovers. I can't speak to recipes for baked goods (not my department), but most other recipes can be easily cut in half, thirds, or even quarters through the use of simple arithmetic.

Sometimes I prepare the whole recipe, subdivide into 2 or 3 batches, serve one batch immediately and freeze the other 2 for future use. When we lived in the northeast, the elderly widow who lived next door was delighted when we shared excess food with her. Sharing food with family, friends, and coworkers can yield multiple benefits. When I'm craving a food or recipe whose leftovers would be a problem for me to store (or resist), I prepare a big batch of it for whatever social event is on the horizon and keep only one or two portions of it at home so that we get to enjoy it without having to worry about to do with all that food. I use cheap, recycled, throw-away packaging so that no one can insist that I take my corning ware, Pyrex or Tupperware container of leftovers home with me.

You can also keep your plate clean by using the portioning technique I recommend for bandsters who are still learning their band eating skills, food portion sizes, and stop signals. Here's how it works for me. When planning my day's food (which I commit to my food log and my accountability partner every morning), I might decide that I'll eat 4 ounces (by weight) of chicken thigh and 1/2 cup of barley and veggy salad for dinner. Come dinner time, I grab my small plate (a salad plate) and put half of my planned meal on it: 2 ounces of chicken and ¼ cup of the salad. If I'm able to finish that, great. If I'm still physically hungry when I'm done with it, I go back to the kitchen and dish up the remaining 2 ounces of chicken and ¼ cup of salad. At the end of the meal, I'll probably have only 1 or 2 tablespoons worth of food to save or throw out instead of a plateful of food, therefore much less guilt to deal with.

When I do have a plateful of food leftover, I usually scrape it into a small plastic container that I can quickly grab and stick in my lunch bag when I go to work the next day. Fortunately, we actually like leftovers at our house, and arguments occasionally break out over unauthorized consumption of leftover food ("Who ate the rest of the eggplant Parmesan?!?"). The same approach works with restaurant meals. We're happy to take leftovers home in what used to be called a doggy bag (as if I'd share my Maryland crab cakes with a dog!).

My sister-in-law used to scrape leftover food into a bucket to add to her garden compost pile. I have no idea if that's a good practice. We'd have to have a 40' high electrified fence dug 20' into the ground and topped with razor wire to keep dogs, cats, deer, rats, raccoons, and other critters out of that kind of compost pile. I've also known people (including my mother) who fed leftover food to their 4-footed garbage disposals (dogs & cats), another practice that we avoid because why would you want to cultivate a fussy eater? Our pets have survived eating (stolen) candies (complete with foil wrappers), latex paint, and kip tails (fishing flies), and at our house, a fussy eater will end up starving because someone else is always willing to clean your plate for you, sometimes long before you've decided you're finished with it.

BUT WHAT ABOUT THE STARVING CHILDREN?

After over 6 years of post-WLS life, I'm now better able to detach myself from my emotional attachment to the food on my plate enough to throw out what's left. If it didn't taste right because my tummy was in an odd mood, if it caused me eating problems, if it wouldn't reheat or store well, I let it go. I haven't been struck by lightning for doing that, nor has God punished me with plagues, floods, or infestations (apart from the dog infestation, that is).

Like many, I was raised to eat every meal while listening to a chorus singing the Children Are Starving in (fill in the blank) hymn. I agree that in world where so many children (and adults, and animals) go hungry, it is just plain wrong for an overfed middle-class person like me to waste or throw out food. But the fact is that me eating more food than my body needs (rather than throwing out) is not the solution to the problem of world hunger. The solution to world hunger, and to diminishing global food resources, is far, far more complicated than that. Working in your community (be it a village, a city, a country, or a planet) to solve that problem is a worthwhile effort, but you taking personal responsibility for causing the death of a starving, unknown child in India or Appalachia because you threw out a chicken wing and 5 green beans last night is (in my opinion) a misguided and foolish use of your energy.

And you eating that extra bite of food just because you can't bear the thought of throwing it away is also foolish from a medical standpoint. If that extra bite causes you to PB, get stuck, or over-pack your pouch, it could lead to messy and expensive medical complications like esophageal or pouch dilation and/or band slips, especially if you eat that way on a regular basis.

Finally, as long as overeating endangers your health through co-morbidities and through disrespecting your band, you may never be able to help deal with the hunger problem, whether on an individual, local, or global basis. So, first things first: make a top priority of eating sensibly for your own sake before you tackle the rest of the world.

Related: Weight Loss Traps: Why Smart Women Stay Overwhelmed and Overweight

Peace with food and weight loss that lasts are possible, and yet, these aren't the places where most women who struggle with overeating end up. Emotional eating and overeating can feel like a never-ending battle and a roller coaster ride of diets, gimmicks, and "new" approaches that don't take you where you want to go.

It doesn't have to be this way. Here are some common traps that even the smartest women fall for and the success strategies you can use to avoid them:

1. Getting too focused on what to eat. Cycles of overeating and weight gain are rarely fixed by focusing only on the food. A focus on what to eat doesn't address or fix the situations, feelings, or relationships that may be triggering overeating. Yes, portion size matters and sometimes food intolerances or metabolic difficulties cause weight gain. However, even these situations become clearer and easier to sort out when you start listening to yourself and paying attention to how you feel, instead of focusing your attention on every bite, calorie, or fat gram that you put into your mouth.

2. Disregarding what you really need. You know yourself better than anyone. Instead of focusing on what "should" work and what you "should" do, take this bold step that many high-achieving women skip:

Ask yourself what you really need to be successful-and then give it to yourself. You're likely to spend less time, energy, heartache and even money in the long run when you trust your inner wisdom. Do you need the help of an expert? Be honest about that. Better tools to deal with stress or difficult emotions? Do you need some one-on-one mentoring or support? Don't cheat yourself. Investing in what you know to be true and getting the targeted help you need will likely make more of a difference than all the self-help books you can't figure out how to make work for you.

Too many women spend too much money on solutions that aren't thorough or individualized enough and don't really meet their needs. Not only does this lead to failure, it burns up your hope and your sense of effectiveness. Do you feel like you know what you need but it isn't possible? Don't let that stop you. Ask yourself what it would take to make it happen and ask what is do-able that would start allowing you to have more of what you need. Start believing that you deserve to get what you need and start asking for it. You might be surprised what shows up.

3. Refusing to ask for help. High-achievers can fall into the trap of believing that lifestyle change has to happen solo. Many women who are successful in other areas of their lives feel embarrassed and even ashamed of their struggles with overeating. They feel like they are alone in their struggles. Unfortunately, not reaching out for help increases the sense of isolation and decreases your potential effectiveness. Asking for help might be the scariest step you take to make peace with food, but stepping outside of your own head, your own mindset, beliefs, and traps, can start change happening-and quickly.

4. Not addressing time issues. My heart almost broke when I heard an outwardly successful professional woman tell me that given the hectic state of her life, she believed that she wouldn't be able to focus on her own goals for the next ten years. Really? What kind of life is that and what kind of example are you living? Change requires a making it happen. Whether it's taking the time to attend a class, listen to audios, create a plan for healthy meals, or meet with a coach, if you don't create the time, it isn't really a priority. Honest truth. If you need help learning how to make or find the time, or how to put yourself first, make this your first action step.

Coaching Challenge:

What's your biggest challenge when it comes to making peace with food? Where do you get stuck or thrown off course? Please join the conversation by sharing a comment. I'd love to hear from you. Then, be bold and share one step you will take to start doing it differently. Peace with food is possible. I challenge you to go for it.

Related: Helping you feel satisfied after weight loss surgery - the Low GI approach

There are two key ingredients in helping you to feel satisfied after eating:

1. High fibre, low glycemic index carbohydrate-containing foods

2. Protein-containing foods.

This post will demystify the glycemic index, or GI. Protein will be the focus of a later post.

The GI is a measure of the effect that different carbohydrate-containing foods have on blood glucose (blood sugar) levels. It describes the way our body digests and absorbs these foods. Carbohydrate-containing foods include:

- breads, cereals, rice, pasta and noodles

- starchy vegetables including potato, sweet potato and corn

- legumes including baked beans, kidney beans, chickpeas and lentils

- fruits and fruit juices

- milks, yoghurts, custards and ice cream

- any food containing flour or sugar.

Some carbohydrate-containing foods are broken down and absorbed quickly, so they raise our blood glucose level faster and higher. These are high GI foods. Other carbohydrate-containing foods are digested and absorbed more gradually, causing a slower, longer lasting rise in blood glucose levels. These are low GI foods. Low GI foods keep us feeling satisfied for longer after eating.

Often people experience a 'honeymoon' period following weight loss surgery, where weight loss seems automatic. Unfortunately this may not last forever and weight regain can occur with all surgeries. Maximising the satisfaction you get from the food you eat is crucial to keep losing weight and maintain that lost weight. A lower GI eating pattern also helps us feel satisfied for longer after eating, which can help with losing weight. For example, if you eat high GI foods at your meals, you are likely to become hungry sooner after the meal than if you eat low GI foods. This can make you more likely to snack and if you have not planned for this, you may be forced to grab something from the biscuit barrel or vending machine.

Appetite control is not the only benefit of a lower GI diet. Research has shown that people eating a lower GI diet can reduce their average blood glucose levels, which is particularly important for people with diabetes. Lower GI foods are often also higher in fibre. A high fibre diet helps prevent constipation, decreases the risk of heart disease as soluble fibres can help remove cholesterol from the body and helps protect against bowel cancer, haemorrhoids, irritable bowel syndrome and diverticulitis.

Foods are classified as low, moderate or high GI.

To follow a low GI diet, try to choose one low GI food at each meal. Eat high GI foods in small amounts, or less often.

Low GI

• wholegrain/multigrain breads
• soy and linseed bread
• fruit loaf/raisin bread
• pearl barley
• pasta (white or wholemeal)
• Doongara® Clever Rice®
• Mahatma® rice
• fresh rice noodles
• semolina
• porridge
• All-Bran® (all varieties)
• Guardian®
• Sustain®
• rice or oat bran
• Ryvita® Pumpkin Seeds & Oats
• Ryvita® Sunflower Seeds & Oats
• Arnott's® Snack Right®
• apple
• apricot
• banana
• grapes
• orange
• peach
• pear
• kiwi fruit
• mango
• plum
• prunes
• dried apricot
• dried apple
• milk or soy milk
• yoghurt
• Fruche®
• custard
• low fat ice cream
• sweet corn
• Carisma® potatoes
• lentils
• chick peas
• split peas
• kidney, soya, baked beans

Moderate GI

• wholemeal bread
• crumpets
• pita bread
• rye bread
• Basmati rice
• wild rice
• dried rice noodles
• cous cous
• popcorn
• Weetbix®
• Vita-brits®
• natural muesli
• Mini-wheats® (plain)
• Just Right®
• Special K®
• Ryvita® original
• shredded wheatmeal
• milk arrowroot biscuits
• digestives
• rockmelon
• pineapple
• cherries
• sultanas
• raisins
• dried fig
• fresh paw paw
• sweet potato
• broad beans

High GI

• white bread
• bagels
• baguettes
• English muffins
• Jasmine rice
• Rice Bubbles®
• Sultana Bran®
• cornflakes
• bran flakes
• puffed wheat
• Coco Pops®
• Mini-wheats® (fruit)
• water crackers
• rice cakes
• rice crackers
• Corn Thins®
• Sao®
• morning coffee biscuits
• watermelon
• most other potatoes

Go to www.glycemicindex.com for further information.

Sally Johnston

Accredited Practising Dietitian/Accredited Nutritionist

Your Bariatric Dietitian

Related: Making Meat Work for You

Red meat is an excellent source of protein iron and zinc, important nutrients for all but particularly after weight loss surgery.

After surgery, people may report difficulty eating red meat. This may be due to a poor eating technique, or not knowing how to best prepare food. To eat meat comfortably it needs to be tender, cut into small pieces the size of a five-cent piece and chewed thoroughly - until it is a puree in the mouth.

Whilst a steak on the barbeque or grill can be difficult to tolerate, marinating, slow cooking, or cooking in a sauce can help tenderise meat making it easier to chew.

Lean red meat, trimmed of fat is the best choice as it contains less teaspoons of fat and saturated fat.

However, the fat in meat can help it to soften during cooking and adds flavour. Lean meat is therefore often assumed to lack tenderness and flavour.

Whilst lean cuts of meat can be expensive, cheaper cuts with the fat removed respond well to marinating and slow cooking so can be an economical choice. Try slow cooking in crushed tomatoes, soup bases or salt reduced stock with lots of vegetables and your favourite herbs. To reduce the amount of fat, skim from the top prior to serving.

Marinating meat is another way to enhance the flavour and tenderness of meat. Whilst adding oil to a marinade may seem like defeating the purpose of choosing lean meat, unsaturated oils are a better choice than the naturally occurring saturated fat in meat. Commercial marinades can be high in sugar.

Try the following ideas for tasty homemade marinades:

• red wine, a dash of olive oil, Worcestershire sauce and garlic complements red meat
• for an Asian flavour combine soy sauce, a dash of sesame oil, sherry oil, white pepper and honey
• lime juice, sweet chilli sauce, fish sauce, brown sugar, coriander and a dash of peanut oil adds a Thai flavour to meat
• white wine, wholegrain mustard and crushed garlic cloves works well with beef
• lemon juice, oregano, garlic and a dash of olive oil complements lamb.

These tips and others like these can be found in our book, Spoons for Thought.

Related: What is Your Hunger Telling You?

Which causes you to consume more calories-physical hunger and physical hunger pangs or stress, restlessness, boredom, anxiety, excitement, a need to celebrate, a desire for comfort and other emotional triggers?

\tWhen WAS the last time you ate because you were physically famished? When was the last time you ate that you weren't?

Emotional eating is a major part of most women's lives. We're taught to use food for so many things in addition to fuel. Diets mess with our relationship with food and add so many "shoulds" to the equation that many chronic dieters hardly know if they are hungry or not. They are conditioned to judge their "fullness" by calorie counts, the clock, fat grams, carbs, and other external cues that are not hunger.

To make peace with food and break free from emotional eating, it's essential to identify the root cause of your hunger-the feelings or needs that trigger overeating. Find a program that will show you how to identify what you are really hungry for and how to start using tools and strategies that address your needs and emotions in ways that food never will. That's critical, but there is also another piece.

Taking control of overeating and making peace with food also means making peace with your physical hunger.

Hunger isn't a negative thing. It's not something to deny (like diets may tell you to do). It's a signal that helps you take care of yourself. Honoring your hungers and cravings with respect is an important aspect of self-care.

That doesn't mean you always eat everything your impulsive brain tells you that you want. You also don't impulsively gratify all your emotional hungers or desires. But it's important to acknowledge them.

That means learning to really listen to yourself.

It means learning how to understand your hunger and what it is telling you about what you need.

It means taking this information and making choices that are in your best interest (and that include compassion and respect).

\tA woman who is at peace with food feeds herself in high quality ways (and I'm talking about feeding her spirit and her soul as well as her stomach).

\tShe also allows herself to savor the food and the experiences that she takes in. Eating doesn't trigger guilt or self-loathing and responding to her hunger isn't something she does in secret.

Let's evaluate your relationship with hunger.

• How do you decide when you are hungry?
• Where do you feel hunger in your body?
• On a hunger scale of 1 (ravenous) to 10 (stuffed to the gills), how hungry do you allow yourself to become before you feed yourself? How full do you fill yourself when you do eat?
• When you determine that you are hungry, how do you decide what to eat?
• How do you tell the difference between physical and emotional hunger?

\tIf your Inner Champion was running the show and helping you live your BEST version of your life, how would you be responding to your physical and emotional cravings? Would it be different?

If you don't know all the answers to these questions, don't panic. Many emotional eaters don't. Knowing what you don't know is an important step to making a change.

Asking questions like I've just asked you will help you take control of your relationship with food in new ways and start creating strategies that work for you.

Related: Liquid Lunches

Solid food tends to empty slower from a stomach than liquid, helping us feel satisfied for longer after eating. This is a natural part of the digestion process. Whilst it hasn't been widely studied following bariatric surgery, a small study at LAPSurgery Australia in Melbourne found that solid food appears more satisfying than liquid meals in those with a gastric band. As this occurs naturally in people who have not had bariatric surgery, and those with a gastric band, it is likely to also occur in those who have had a sleeve gastrectomy or gastric bypass. For this reason, we generally encourage solid meals following bariatric surgery to help you feel more satisfied. Feeling more satisfied for longer after eating helps avoid grazing or snacking, which may help maximise weight loss and maintenance of that weight loss.

However, soups are a popular winter meal in our colder climates (yes, it is winter where I am writing this post in Australia). They are convenient, can be prepared in bulk and frozen and with the right ingredients, can be very nutritious. So should you avoid soup because it is, technically, a liquid meal? There is not a simple yes or no answer.

Soup means different things to different people. To some, soup means instant soup powers that you mix with hot water. These are not a great meal option. Apart from being high in salt, they offer very little nutrition and are not likely to be satisfying. Some people may think of soup as the tinned or tetra pack varieties. These offer a little more nutrition, but some varieties are better than others. Smooth, liquid soups will empty quickly from the stomach and provide little satiety (the feeling of satisfaction after eating). The chunky varieties with meat and vegetables pieces are a better option, as the chunks need chewing, taking you through the process of eating and allowing your body to recognise more of the signals you have eaten.

The best option is thick, chunky, home made soups, filled with lots of nutritious ingredients. The more chewing required to eat the soup, the more it will help satisfy you. Avoid thin broths or pureed soups, opting for chunks of vegetables and a protein containing food, either meat, chicken, seafood or legumes. Some pasta, rice, barley or noodles are also a good addition.

The following recipe for Chunky Winter Soup is one of my favourites for lunch on a cold winter day.

Chunky Winter Soup

Makes 4 cups

Oil spray

½ onion

1 small or ½ large leek, thinly sliced

2 cups salt reduced chicken stock

1 small or ½ large zucchini, diced

1 small or ½ large carrot, diced

1 cup no added salt, chopped tinned tomatoes

½ teaspoon curry powder

1 tablespoon no added salt tomato paste

Freshly ground black pepper

2 tablespoons macaroni

1 cup cooked red kidney beans

Heat a saucepan that has been sprayed with oil. Add onion and leek and cook until they are starting to soften. Add the stock, carrot, zucchini, tomatoes, curry powder, tomato paste and season with pepper. Bring to the boil then simmer for 20 minutes, until vegetables are tender. Add macaroni and kidney beans and simmer for a further 15-20 minutes until the macaroni is cooked.

Nutrition information (per cup): kilojoules 485, calories 116, protein 5.5g, fat 2g, saturated fat negligible, carbohydrate 15.5g, fibre.

Weight Loss Surgery Tip: This recipe makes approximately four cups (4 x 1 cup serves). Half to one serve may be adequate for those with a gastric band. Early in the gastric bypass or sleeve journey you should only require half of one serve and over time you may tolerate greater amounts, up to 1 cup. Those with larger appetites (family and friends) may require two serves.

For more recipe ideas, head to my blog, Bariatric Bites.

Related: What's So Bad About Cheating on the Post-Op Diet?

No, it's not great that you could only eat three McNuggets. And yes,cheating is a big deal, and I'm going to tell you why. You're not going to get away with this one. Miss Jean has eyes in the back of her head. She sees the cookie crumbs on your face and the neon orange faux cheese film on your guilty fingers.

SOME DEFINITIONS OF CHEATING

The word "cheat" has two main connotations. One is cheating in the sense of lying and deceiving. It's intentional dishonesty. You know what you're doing is wrong, but you do it anyway. The other connotation of "cheat" is unfaithfulness. Unfaithful to a vow or promise you made to another person or to an organization.

When someone cheats you, do you just shrug and say, "Oh well, he was having a bad day"? Let's say you bought a car that you thought was brand new, and later discovered that the dealer had fiddled with the odometer and charged you full sticker price for a car with 1200 miles on it. Would that be okay with you?

And what if your spouse, the person you trust with your life, cheated on you by sleeping with your best friend, would you be able to just shrug that off?

If your child got a B+ grade by cheating on a test by copying answers from the student at the next desk, would you be proud of him or her?

And what if you found out that a coworker betrayed you by using the great idea you confided to him or her and taking credit for it when it worked out splendidly? Would you still be eating lunch with that coworker?

Or what if you donated money to a political candidate who you admired, and he or she spent it on a vacation in the Bahamas instead of on re-election expenses. Would that be okay with you? Would you vote for that candidate ever again?

I'll take a guess at your answers to these questions. In none of the situations I've described would you be happy or proud. In fact, you'd be disappointed and angry. So just how can you think it's no big deal to cheat on your post-op diet?

EXCUSES, EXCUSES

I can hear grumbling in the room. I think I just heard someone saying, "I had to eat that mashed potato. I was so hungry and miserable and cranky from being on liquids for a week, I couldn't stand it another minute." I do understand very well how you felt, but in the big picture of world hunger, where babies die because their mothers eat so little that they don't produce enough milk for nursing, your and my hungry misery is a big So What.

And someone else is whispering, "My best friend's surgeon let her eat mashed potatoes on her third day post-op, so it must be okay for me to do that too, even though my surgeon told me to wait until my 15^th day post-op. It's not my fault that every surgeon has a different post-op eating protocol."

While it's true that surgeons' eating instructions vary widely, you signed on with your surgeon, not your best friend's. Presumably you chose your surgeon because you and/or your insurance company believe that he or she is well-qualified in laparascopic bariatric surgery. During your psych evaluation, you affirmed that you understand what the surgery involves and that you can and will follow instructions. You nodded when the shrink asked if you're ready to make all the lifestyle changes needed for success. You nodded when the dietitian asked if you understood your pre- and post-op eating instructions. You scribbled your own name on a sheaf of release papers to indicate that you were informed about the risks involved and despite those risks, gave your surgeon permission to perform surgery on you.

In addition to all of that, you spent weeks or months jumping through hoops to prove your need for bariatric surgery. Perhaps you suffered through a six-month pre-op diet. You had lots of medical tests and evaluations, most of them not much fun, because you were so eager to get your weight loss show on the road. You had surgery, suffered some degree of discomfort from your incisions and gas, and finally heaved a sigh of relief because all the struggles are over now.

But then you discovered that there are still more struggles to survive because of that stupid post-op liquid diet. Yet despite jumping through all those hoops, in less than 60 seconds you blow it by popping a Cheez Doodle in your mouth, and justify that with the aforementioned misery excuse.

And man oh man, that must have been some really serious misery, because evidently it drove out of your mind all the very good reasons for faithfully following that post-op diet progression. You forgot that one of the most common causes of band slips is the patient's failure to follow the post-op diet. You forgot that food can get stuck in the stoma or esophagus and cause an obstruction or vomiting. You forgot that vomiting can disturb the position of the band, especially when you're a new post-op and your stomach is still healing from surgery. You forgot that to move mashed potatoes or Cheez Doodles through your digestive system, your esophagus and stomach must expand and contract, which can disturb the position of your band and cause it to slip. You forgot all the promises you made to your bariatric team and to yourself about healthy eating and weight loss success, because you were so miserable and just a few little cheat bites are no big deal.

I'll try to give you the benefit of the doubt. Maybe you thought that being able to eat the Cheez Doodles without having any uncomfortable side effects or complications like a stuck episode, a PB, sliming, chest pain, esophageal dilation or spasms means that it's okay to eat the Cheez Doodles. Well, I'm here to tell you that's a wrong assumption. Cheating eating can cause problems without you ever knowing it until it's too late. Cheating eating is just plain foolish.

YOU'RE NOT ALONE

Now here's the good news. You're not alone. Nobody enjoys the post-op diet progression. If any of us were good at following diets, we might not need bariatric surgery in the first place. And only infants enjoy a liquid diet. But in a sense, as a new post-op you're a bariatric infant who must consume liquids because your body isn't ready yet to handle anything else. Cheating on your post-op diet is cheating your health in a major way.

If you already cheated once or twice or ten times, that's not a good reason for continuing to cheat, so don't do it again! I believe we should begin any project as we mean to go on. If you can't follow your post-op diet, exactly when are you going to begin your healthy post-op lifestyle? Are you going to wait until after your first fill, or your second fill, or at some hazy time in the future? If so, don't come running to me when your scale stays stuck on a number you hate. NOW is the time to begin your healthy lifestyle. NOW is the time to practice good band eating skills and making good food choices and controlling portion sizes. Doing that may not be easy, but it's not impossible either. Losing a massive amount of weight is a big, tough project, but if you respect your band, it's going to be easier than any of your past weight loss attempts. Let me clarify that: it's going to be easier if you follow instructions.

In addition to that healthy lifestyle, there's another very good reason to stick to your diet. At some point you're going to have to face up to your past and acknowledge that food and eating have been a major problem for you. The fact that you're struggling with your post-op diet is a symptom of that. There's no shame attached to that struggle. As mentioned above, if we didn't struggle with eating, we wouldn't need bariatric surgery at all. So I suggest that you look at the post-op diet (and your pre-op diet too, for that matter) as a rite of passage. During this rite, you'll be painfully aware of just how many food devils you possess, because without food to shut them up, they're going to be jumping up and down and screaming for your attention. But their wish is no longer your command. You're going to send them a clear signal: that you're not going to submit to their demands any more. From now on, you're going to follow your surgeon's and dietitian's eating instructions no matter how much commotion those devils make. You're in charge now. As the saying goes, today is the first day of the rest of your life. Do yourself a favor, and make it a day without Cheez Doodles!

Related: Creating Peace with Food Means Making Peace with Your Life

The yearning to find peace with food is usually a palpable one. When women speak about their motivation to stop struggling with food, find a weight that works for them, stop bingeing, and feel healthy and fit, the energy is usually intense. When you struggle with food, the wish to find peace-permanent peace-usually runs pretty deep.

No more diets. Pants that always fit. Feeling confident that your weight is going to be about the same as it was last week or last month or even last year. Peace with food means that food, weight, or your diet is not the first thing you think about when you wake up or before you go to bed. Peace with food means that sometimes the chips go stale and the leftover candy gets forgotten in the back of the cupboard.

Because the food is no longer that important.

Peace with food is definitely possible. But to get there, you have to go beyond the food. And to do that, many women need to come face to face with something much bigger.

to make peace with food, you must make peace with your life.

Many women say they want peace with food and an end to yo-yo dieting. They say they'd do just about anything to achieve it. But the truth is, many women are trying to stop overeating without changing anything else.

It doesn't work.

"I am lonely and I can't do anything about it-so I eat."

"I don't have time to eat lunch and then I come home and binge."

"I'm dealing with people who are angry and unreasonable. How do I make that okay?"

"I need someone to hold me accountable."

"I'm busy from the time I wake up until I go to bed. There is no time for me. Food is my comfort. How am I supposed to stop eating?"

Peace with food isn't really about food. Oh, on one level it is. It's about feeling in control and effective and able to make choices that are in your best interest. It means (usually) not choosing foods or portions that leave you feeling uncomfortable or sick afterwards. It's about you (not what's on the plate) having the power and the control. But I hope you can see that I'm talking about so much more than food here.

Food only loses its power when we own our own power and stop using food as a band aid. Too often, food is the quick fix for things that we are not willing (or are too fearful) to address directly.

No food plan in the world is going to help the women above with their loneliness, their unwillingness to take time for themselves, their struggles with assertiveness, and their ability to ask for help. These are really gnarly difficult parts of life to wrestle with. Honestly, fighting with the chocolate chip cookies (and even feeling guilty when you lose), can feel a lot less daunting. It's easier (in the short run) to stay on the diet roller coaster than it is to make peace with food.

Peace with food requires making peace with your life. And sometimes that means creating a life that you can feel peaceful with. Learning to say no. Addressing the difficult relationships. Finding ways to take good care of yourself and sometimes putting yourself first. It means addressing the places that may feel scary: loneliness, fear, worry-even boredom. Taking risks that you might have been putting off taking for years. It's hard stuff to swallow, but the payoffs can be huge. Creating peace with food really does have the potential to transform your life.

And before you get too overwhelmed, please remember that there are real tools (that work much better than diets) to help you do all these things. All of these challenges get more manageable and less terrifying when you find someone to help you through them-and when you take them on in small, palatable bites.

So imagine again that your pants always fit and your weight stays where you want it to. That you don't diet and you don't binge and you generally make good choices. And this time understand that it happens because you've looked the loneliness in the eye and gotten the help that you need to change it. You've learned to stand tall and speak up on your own behalf. You aren't ending the day feeling exhausted and used up and like you don't have the energy to do more than open the ice cream.

You've rebalanced your life. You've done the hard work. You've unleashed your inner champion. That's what it takes to make peace with food.

Related: Bariatric Realities - Medical Professionals' Guidelines about Alcohol Use & WLS

Bariatric Realities - Medical Professionals' Guidelines about Alcohol Use & WLS

I know I said my next article was going to be on causes of obesity, but I got carried away tonight doing some investigating about the professional medical guidelines for alcohol use after weight loss surgery. In summary, the gist of the recommendations are: "Patients undergoing bariatric surgery should be screened and educated regarding alcohol intake both before and after surgery… patients should be made aware that alcohol use disorders (AUD) can occur in the long term after bariatric surgery." (From: http://asmbs.org/resources/alcohol-use-before-and-after-bariatric-surgery.)

Well, now. Those are some non-specific medical recommendations by medical professionals who are the predominant leaders and caregivers of the surgical weight loss population. Education and awareness. Hey - I am all about education and awareness. Great things, education and awareness.

And yet, I'm gonna say that as a recommendation, that is a very "PC" non-recommendation recommendation, when one considers that we are talking about 1) ALCOHOL and 2) WEIGHT LOSS SURGERY patients.

Consider these educational nuggets and facts I found that WLS patients really ought to be aware of:

Psychologist Stanton Peele, writes, "readers now know that scientifically, it's not alcohol that causes people to live longer, but it is simply being with others and that they are less socially isolated when they drink that prolongs their lives. After all, alcohol is a toxin." (italics and bold added) (From https://www.psychologytoday.com/blog/addiction-in-society/201011/science-is-what-society-says-it-is-alcohols-poison.

My comments: Yes - alcohol is a toxin, and that means POISON. Those of us in the medical field really ought to know that people are not supposed to ingest poison. But the recommendations do not say, "Do NOT ingest the toxin, alcohol." No, no, no… they say be educated and aware.

Dr. Charles S. Lieber, M.D., M.A.C.P., in a publication for the National Institute on Alcohol Abuse and Alcoholism, writes, ""A complex interplay exists between a person's alcohol consumption and nutritional status," and … alcohol and its metabolism prevent the body from properly absorbing, digesting, and using essential nutrients" (italics added.) Dr. Lieber does indeed, educate us about the nutritional value of alcohol: "Alcohol would not fall under the category of an essential nutrient because not having it in your diet does not lead to any sort of deficiency. Alcoholic beverages primarily consist of water, pure alcohol (chemically known as ethanol), and variable amounts of sugars (i.e., carbohydrates); their content of other nutrients (e.g., proteins, vitamins, or minerals) is usually negligible. Because they provide almost no nutrients, alcoholic beverages are considered 'empty calories.' Therefore, any calories provided by alcoholic beverages are derived from the carbohydrates and alcohol they contain." (italics added)

My comments: People who have weight loss surgery (other than the band) experience absorption issues to one degree or another. Nutritional deficiency is one of the concerns the medical professionals monitor in the months and years following WLS. We stress to patients the importance of taking vitamin supplements for the rest of their lives to help ensure proper nutritional balance.

And yet, rather than saying, "Alcohol use is unwise after WLS," or "Don't drink alcohol after WLS," the governing body of health professionals for bariatric surgery recommends being "educated" and "aware."

Is that happening? Are the physicians and surgeons and nutritionists and mental health professionals educating patients and making patients aware that ALCOHOL IS A TOXIN THAT CAN INTERFERE WITH VITAMIN ABSORPTION - and it should not be consumed after weight loss surgery? I can't answer that, although I know we do this at the programs I work with. If it's not happening, why not?

Having a background in direct sales, which, ironically, was incredible education for my later career as a psychologist, I was taught to "anticipate the objections." Many health care professionals may be pooh-pooh'ing the vitamin deficiency issue associated with alcohol, stating it's only those who drink heavily who are at risk for this type of vitamin deficiency. That information, to the best of my knowledge, is relevant for persons who have not had weight loss surgery. What's more, we don't know the extent to which people are drinking many years after WLS. Most of the research, as noted in the ASMBS Guidelines/Statements entitled ASMBS position statement on alcohol use before and after bariatric surgery, states, "The existing studies do not present a uniform picture regarding the overall prevalence of lifetime or current alcohol use disorders (AUD) in patients seeking bariatric surgery. The vast majority of the existing literature is retrospective, with small sample sizes, lack of control groups, and low response rates. There are also varying definitions of alcohol disorders ("high-risk" versus "misuse" versus "abuse/dependence") in the bariatric surgery literature." In other words, this research does provide some information, but remember, we don't really know that much because there isn't enough research on enough people over a long enough period of time. We don't then, know the actual affect that alcohol use has on vitamin absorption for WLS patients. We DO know that vitamin deficiency is a concern, so WHY aren't we telling people not to drink?

Not only is alcohol a toxin for our bodies, "Alcohol is actually classified as a drug and is a known depressant. Under this category, it is the most widely used drug in the world. According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA)" (italics and underling added). http://www.medicinenet.com/alcohol_and_nutrition/article.htm

My comments: I am literally chuckling now at the absurdity of this situation. The situation being the medical professionals, all having a code of ethics that reflects the "do no harm" sentiment, ignoring potential harm for their patients. Please note that we would all consider alcohol as being "empty calories" and having sugar/carbohydrates and certainly no protein.

PLEASE let it be the case that the mental health practitioners around the world who deal with surgical weight loss patients are telling them, "Don't eat empty calories. Eat a lot of protein. Limit the simple carbs and sugar. And refrain from consuming your calories from liquids. NO STARBUCKS. BUT, HEY - GO AHEAD AND DRINK THOSE SUGAR/CARB LADEN, EMPTY, NUTRITION-ROBBING TOXIC CALORIES IN ALCOHOL, THAT ARE, BY THE WAY, THE MOST WIDELY ABUSED DRUG IN THE WORLD."

Honestly, that sentence should be the entire article.

But WAIT! There's MORE!

I really love this last tidbit I'll share with you. It's so much nicer for me when I can find it online so it's not that mean, alcohol-hating Dr. Stapleton being the one to blame!

"The truth is that no one needs alcohol to live, so regardless of what you've heard or want to believe, alcohol is not essential in our diets. Did you know that a glass of wine can have the same calories as four cookies? How about a pint of lager - surprised to hear it's often the caloric equivalent of a slice of pizza? You do not need to be an alcoholic for alcohol to interfere with your health and life."

https://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/appearance/calories-in-alcohol

Do you hear this, people in the medical profession? Are you giving the OK for your patients to eat four cookies "now and then," or "in moderation," or "not for the first six months, or year after surgery?" Do you realize that you may be DOING HARM by giving your patients "permission" to drink alcohol?

"But our job is not to be the watchdog or decision-maker for people." Another potential objection to my dismay about the recommendations being for "education" and "awareness," rather than a direct, "SAY NO TO ALCOHOL" stance. I agree that no one can make the decisions about what people can or cannot do, or what they will or will not do. People in the medical field do tell people things like, "Don't get that wet or you could get an infection," "Keep the splint on for the next six weeks if you want to heal properly." There ARE dos and don'ts that are educational and increase awareness. What's the real issue that medical professionals don't take a hard stance on alcohol after WLS? I don't know. I do know that I did my dissertation on medical doctor's attitudes toward addiction. Turns out it is much like that of their attitudes toward obesity: many don't know that much about it, very many do not feel comfortable working with it, and most don't care about/understand it.

To top it all off, HERE's the real kicker… Not only do the medical AND some of the WLS organizations not tell people, "Don't drink alcohol," THEY PROVIDE ALCOHOL AT THEIR EVENTS!

I can't say any more.

Connie Stapleton, PhD

connie@conniestapletonphd.com

Facebook: Connie Stapleton

Twitter: @cstapletonphd

LinkedIn: Connie Stapleton, Ph.D.

Related: Spring Cleaning for Weight Loss Benefits in All Aspects of Your Life

You can! Keep reading to find out how you can live a cleaner lifestyle and give yourself a boost in the meantime. A bit of tidying up can help keep your weight loss on track, or help you break a plateau if you've been stuck for a while.

Spring Clean Your House

A large part of having cleaner home is about peace of mind and lower stress levels. Having less stress helps reduce hunger and lets you make better diet decisions. Beyond this, a clean home lets you be more efficient because you know where things are and you do not have to wade through piles of useless things. Housecleaning also burns calories, so it's a good thing for weight loss! Sweeping, raking, washing windows and floors, and scrubbing counters all get you moving and promote weight loss.

As you clean, don't forget to clean your closets. It is an excellent time to get rid of the oversized clothes that you plan to never be able to wear again. Seeing your progress can be extremely motivating, and removing these clothes makes room for new, smaller sizes that you will need to buy as you continue to lose weight.

Spring Clean Your Diet

You lose weight fastest when your diet is spic and span, and part of your spring cleaning should focus on your diet. Look carefully at whether your diet is as clean as it needs to be to stay healthy and lose weight. Are you measuring each bite? Are you choosing protein and vegetables first, and avoiding sugary foods that will make you sick?

It's far easier to follow your weight loss surgery diet plan when your kitchen is set up well. Get rid of any tempting junk foods that have snuck into your pantry and refrigerator, and stock up on healthy foods, such as tuna, vegetables, turkey, chicken breast, fruit and eggs. Dig out your food scale and measuring spoons from under the clutter, and use them consistently.

Spring Clean Your Commute

A nice side benefit of cleaning up your lifestyle is being able to help the environment. You can reduce air pollution and noise pollution by walking or biking whenever you can. If you are lucky enough to live near to your workplace, you may be able to walk or bike to work. If that's not practical for you, you can still walk more and drive less. Take a healthy lunch to work instead of driving to pick something up from a restaurant at lunch time. On weekends, challenge yourself to drive less. Park further away from destinations, and walk the final few blocks instead of driving.

Driving is so ingrained in us that sometimes we don't even realize that we could walk. Try to get in the habit of asking yourself whether you can walk from your home. If not, consider whether you can park in a central location and do several nearby errands on foot. You might be able to park in a supermarket parking lot to do your food shopping, and walk to the library, post office, or other stores without moving the car. Each half-mile that you walk burns about 50 calories.

Of course, if you do take the car to drop off and pick up your children, turn the engine off to reduce air pollution. Then get out of the car and give yourself a workout by walking until your children are ready to come home.

Spring Clean Your Schedule

Lack of time is a common excuse for all sorts of unhealthy behaviors. You might opt for fast food because you have no time to purchase and prepare healthy foods. You might not get enough protein during the day because you are too busy preparing your children's lunch to focus on yourself in the morning. Maybe you regularly skip workouts because you do not have time to exercise. You may overeat because you do not have time to measure portions. And, whether or not you realize it, you may be cranky because you are too busy.

That stops now. Take a hard look at your daily and weekly schedule, and clean it up if necessary. There may be several ways to tidy up your schedule so that you can fit in the healthy behaviors that will help you lose weight.

• Search your daily schedule for wasted minutes. They add up! How much time do you spend texting your family and friends and updating your social media profiles online? We're not suggesting that you stop these activities, but being aware of them can help you weed out the non-essential parts.
• Skip the television occasionally. Instead of watching a 30-minute television program, go for a walk. Or, instead of walking it from the couch, hit the treadmill or do some calisthenics while you watch.
• Multi-task to save time. For example, you don't have to sit down to talk to your children about their days. Talk to them while you're in the kitchen making dinner together or you're taking a walk.
• Get better sleep. Sleep in a dark, quiet, cool room to get better sleep and wake up more refreshed after less time.

Spring is a time of new chances, and this spring, you can clean up your entire lifestyle to feel better and lose more weight. All it takes is a close examination of some of the different areas of your life, and you will feel better about your weight loss surgery journey.

Related: Do You Need Accountability?

AND WHAT'S SO GREAT ABOUT ACCOUNTABILITY, ANYWAY?

Accountabiity is a popular term in the WLS community. When I first saw it used in an online forum post, it reminded me unpleasantly of a company I worked for a decade or so ago. We were acquired by a much bigger company whose watchword was ACCOUNTABILITY. Seemingly overnight, our procedures changed so that every action had to be accounted for with a signature (or 2 or 5), a report, a committee vote, and/or an Act of Congress. This approach was intended to ensure ethical behavior in a group of employees who had never dreamed of committing unethical acts before, so it seemed to many of us that Big Brother was watching our every move, and that we had to ask him for permission for even the most trivial things, from a restroom visit to changing the toner cartridge in a copier. The initials, signatures and codes we were forced to append to every piece of work seemed designed to enable a complicated system of extravagant punishments and meager rewards. Needless to say, all that had tainted the word "accountability" for me, so that I reflexively cringed every time it appeared on my computer screen.

Despite my unpleasant history with accountability, curiosity got the better of me. I began to read about accountability and accountability partners. I discovered a more positive and less punitive approach, in which reporting your eating, exercise, and other behaviors to a partner (or group) can help keep you honest about those things. For a long time, I had resisted any public declaration about my eating. When you're ashamed, you don't want to tell your secrets to friends, family, doctors, or the cop sitting in a speed-trap chase car. Even when I was active in OA (Overeaters Anonymous), I sometimes lied to my sponsor about whether I had followed my food plan for the day. I didn't like myself for that, so I attributed my own negativity to the whole accountability thing. It made me feel bad, therefore it was bad.

But here were all these WLS patients seeking accountability partners online. Were they all masochists, or was I missing something?

I must sheepishly (but happily) report (report? aargh! there's that word again!) that I had been missing something important and useful. Months after I'd reached my weight goal, when I was busy enacting the part of the Model Bandster, a friend and I joined up as accountability partners. She had lost over 100 pounds but found herself struggling with weight regain, and we thought a partnership might help her get back on the bandwagon. Little did I know how much it would help me!

Almost 2 years later, my partner still tolerates me, and I actually look forward to our daily e-mail check-ins. We tell each other our food plan (or lack thereof) for the day and report (aargh!) how well we stuck to the previous day's plan. My partner hasn't caught the exercise bug like I have, but I also tell her my workout plans. We share anything else that's affecting our eating and weight management, be it travel, stress, holidays, work, illness, or apathy. We ask each other questions and offer suggestions and advice. I don't hesitate to point out the lack of protein in my partner's food plan; she sees when I'm slipping into maladaptive eating with a few days of soft and slider foods and asks, "Have you been satisfied with your meals this week?" We cheer each other on and prop each other up. We laugh and cry, complain about obstinate husbands, and brag about our dogs, children and grandchildren (human and canine). And sometimes all we do is listen.

The bottom line? Accountability is not just about dotting your I's, crossing your t's, and signing "John Hancock" every time you take a pen out of the supply cabinet. It's about taking responsibility for your weight management while using the support of peers who know firsthand what that job is all about.

HOW DO YOU FIND & CULTIVATE AN ACCOUNTABIITY PARTNER?

A good place to find an accountability partner is in a WLS support community - at in-person support group meetings, in your surgeon's waiting room, or at online support communities like LBT. Go to a few meetings, eavesdrop on conversations and read forum postings until you identify someone "simpatico". By that, I mean someone you identify with for any reason, whether it's his/her age, profession, hobbies, geographic location, you name it. Try to avoid someone who would baby you when you need to be kicked in the butt. Initiate a conversation with that person. Introduce yourself, ask a question, give them a compliment, tell them a joke, express an opinion. If your interaction with this person goes well - they seem to "get" you and respond to you in a positive, caring and responsible fashion - ask if they'd be willing to try an accountability partnership with you. Tell them why. It might be, "I really admire your band success," or "Like you, I travel a lot for my job, and I'm wondering if you can share any eating tips with me."

When you find a partner and agree on how you're going to run the partnership, begin communicating immediately, every day without fail. If you're not going to be able to check in daily for a period (be it one day or one week), tell your partner in advance or as soon as you know - don't just disappear. Be as honest as you can be with your partner, and demand the same thing of her/him. Listen carefully to what your partner says or writes. You may not have the magic answers to all your partner's problems, but you'll be helping just by listening closely and respectfully.

If you and your partner seem to fall into a rut, it might be time to shake things up. You can give each other a challenge, like exercising 5 minutes longer every day or giving up fast food meals for a month. You can decide to read a book together and discuss each section or chapter. A good book for this purpose (besides Bandwagon!) is The Emotional First Aid Kit by Cynthia Alexander (available on amazon). You can pledge to list three positive things that happened to you every single day. You can take a short vacation and give up talking about weight loss completely for a set period of time, but go on talking about other events and issues. When you return to the task of daily eating accountability, you might bring new energy or ideas along with you.

If at some point the partnership doesn't seem to be working for you, tell your partner and ask him/her for ideas on how to improve the relationship. Your joint decision might be to end the relationship altogether, or to check in once a month instead of once a day, and that's OK.

Finally, here's an example of the kind of message I send to my accountability partner each morning:

Dear Partner (name withheld to protect the innocent),

It's 15F this morning. FIFTEEN DEGREES!!! WTF?! I moved all the way to Tennessee to get away from 15F weather!

I didn't eat according to plan yesterday, but I did OK. When I got done with my teeth cleaning and errands, I didn't have time to go home for lunch, so I got a chicken salad wrap at the coffee shop and ate most of half of it. It was pretty good, with grapes in the salad.

This morning I have a Zumba class. I've taken Zumba before at a different place and liked it a lot, but so far I'm not liking the new class because the instructor doesn't explain the moves or call them out before they start. You just have to play follow the leader.

I'll be at work from 11:00 am to 4:30 pm today. Food will be:

B&S: the usual (protein shake before workout, a latte afterward)

L: 2 oz catfish salad (like tuna salad), 2 Wasa thin & crispy sesame flatbreads

S: 1/4 c. trail mix

D: 3 oz crab cake, 1/4 c. barley & veggy salad

S: granola bar

I'm liking granola bars for an evening snack because they're so chewy. Gotta chew!

Have a great day and STAY WARM!

Jean

Related: It's About Time We Eat Real Food

Our food is killing us. Today's families are fat and diseased from a diet of processed foods, and our children will be the first generation to live shorter lives than their parents. Time is of the essence: We must change course right now. It's time to start eating real food and stop eating 'frankenfood.' This is not just another fad diet. It's about saving lives.

Gastric bypass weight-loss surgery was my wake-up call in 2003 to reverse my personal obesity epidemic and diabetes and hypertension - the death triad as I now call it (read my story). To borrow a phrase, I was sick, fat, and nearly dead in my 30s, a processed food junkie on ~10 prescription medications. Without bariatric surgery and lifestyle changes I would not be alive today. I would have missed out on my grandchildren. That's a very sobering and humbling thought. Instead, I cheated death, I surely did, thank you, G-d.

The problem underlying these health conditions is the modern American diet heavily-laden with grains, refined sugars, unhealthy fats, and toxic food additives. Obesity is even harder to treat than the diseases/health conditions it causes. The low treatment success rate associated with obesity is likely because people need to commit to changing patterns deeply woven into social fabric, food and beverage commerce patterns, personal eating habits, and sedentary lifestyle. And if you think the bariatric surgery is an easy pass to skinny, then I'm here to tell you that it isn't.

My approach is one of replacing grains, refined sugars, and unhealthy fats with fresh, local and seasonal food that is chemical-free, sustainable, and nutrient-dense. That was a complete turnaround for me. I had a career that kept me away from my home, and my kitchen, 45-60-hours per week. I did not want to cook after a long day, but I wanted to serve a nice meal to my family. So I relied on processed foods, aka frankenfood, like frozen stuffed chicken cordon blue, frozen broccoli in cheese sauce, and a white rice pilaf from a box.

However I learned to develop fast and simple recipes -- typically 5-ingredients that could be prepared in about 30-minutes. The food industry is very deceiving in their marketing. They craftily paint a picture of health and convenience for us, labelling processed food products as "healthy" or "all natural" and use words like wholesome goodness, when these claims in reality are not backed by truth. There are no regulations or standards that define "healthy" so just because something is labelled healthy doesn't mean that it is. And generally-speaking, if a food was "all natural" it would not be packaged in a box with an ingredients label.

The food industry also has somehow convinced us that it takes too long to cook a meal from scratch. I know, I used to believe that lie! It's really not much trouble to grill a chicken breast and some vegetables and serve it with a salad. In fact, in the amount of time it took me to serve up a dinner of processed foods, I was able to serve up a much tastier and far healthier meal of real food to my family - and the rewards are tremendous.

Dinner in my house typically is a grilled or roasted protein with fresh grilled or roasted vegetables and a salad. Sometimes I'll make a stir-fry served over quinoa, or a homemade soup, or crockpot chili. These are all examples of how I make real food real simple in my home, and anyone can learn to cook like this. By the way, this is the way my daughter cooks for her family, too, as cooking skills whether good or bad are passed down from generation to generation. What cooking skills are you teaching your children?

I use some minimally-processed foods. I try to avoid at all costs those foods with any chemical ingredients, or ingredients list that contains more than 5 items. And I never bring any processed foods desserts into my home, such as boxed cake mixes, frozen donuts, brownies from the supermarket bakery aisle. If I want dessert then I have to make it from scratch and that's fairly involved. Because it's so much work I won't make dessert every day; heck I won't even make it once a month! You won't, either.

Living larger than ever,

My Bariatric Life

www.mybariatriclife.org

Related: Lets Speak Up............There Is Always A Way

1. Have fewer temptations of either a sweet or savoury base in the house
2. Keep temptations out of sight, hidden in a non see through box
3. Keep temptations out of reach, encased in a box located in the highest kitchen cupboard possible
4. Creating space to present your exercise gear and equipment, ready to be used
5. Have you even considered sleeping in your t-shirt and track suit, with your runners at the base of your bed to easily slip on as soon as you wake up, ready for your walk
6. Slowly reducing sweet drinks and sugars even artificial sweeteners in your hot drinks
7. Slowly retrain your taste buds to not desire sweets and fats as much, by reducing the frequency slowly. It only takes two weeks for your taste buds to change and not enjoy the old flavours as much.

You would most likely have heard of Carnie Wilsons long battle with her weight. Her story is ever so inspiring as she SPOKE OUT and found her way out by forming a strong support team around her for success with the Lap Band.

Carnie Wilson is an example of how important it is to accept the personal responsibility required to slowly adjust one's lifestyle to control self sabotaging behaviors such as emotional and habitual eating.

When one's relationship with food supports a non-dieting approach, cravings are reduced and the ability to eat with more control enables the environment to be set up for success and maintained. Rather than getting in the car and travelling to buy food to graze on. This is just one example.

Repeated history of difficulty in losing weight can sabotage one's self confidence.

This is why I encouraged you SPEAK OUT and grasp onto who and what you need to help you manage your weight and health with your Lap Band.

Additional options to reach out and find your way could include:

1. Surgical review regarding the band adjustments
2. Psychologist to help manage emotional eating. There are 2 books I encourage you read if you like; If not Dieting Then What or The Happiness Trap
3. Dietitian to help eat the ideal foods with the lap band
4. Exercise group. I encourage EFM and STEP INTO LIFE as they offer group personal training at a reasonable cost
5. Forums for contact such as where we are. (Nothing like stating the obvious hey!)
6. Support group meetings face to face or online
7. Commit socially with a group of people to participate in a fun run/walk

Related: I Lost 201 Pounds, but I Didn't Get Healthy

When I had my roux-n-y gastric bypass surgery in 2005, my goal was to lose weight. Specifically, I wanted to lose 225 pounds.

At just over five feet tall and 343 pounds, I was super morbidly obese. Those are the facts, but what is also true is that my weight has been the bane of my existence for my entire life. Or, at least, since I was about three years old, when I first realized that my weight fell on the less socially "acceptable" end of the spectrum.

So, yes, weight loss was the goal I set for myself, but what I see now is that all I really wanted was to slip into the spectrum of acceptability enjoyed by women who wear single digit jeans. It was about fitting in. It was about not standing out. It was about being "normal."

At no point was it ever really about being healthy.

In the two years after my surgery, I dedicated my days to working out and eating as little as possible. Ultimately, I lost 201 pounds. It wasn't the hoped for 225, but I was a size eight - victory, right?

Not exactly. Even at a size eight, I struggled with body acceptance. I still felt like a fish out of water and worse, I couldn't seem to sync up with the woman in the mirror. I had a new body, but I didn't feel like "me" anymore.

And worse still, I didn't feel healthy. Sure, I'd lost 200 pounds. By all the usual measures (and certainly by societal expectations), I was "cured," but I felt sick. My energy was low, my sleep was all over the place, and I was incredibly frustrated by a diet that seemed barely sustainable for any length of time.

That diet piece was my fault, of course. So determined to lose the weight, I worked hard to hit my daily protein goal, even if that meant I consumed hard boiled eggs three times a day and literally nothing else. For much of the past 11 years since my surgery, I've been riding a roller coaster. I've lost and gained weight over and over, the pendulum swinging back and forth and my emotions following. I have suffered serious vitamin deficiencies and still struggle to disconnect guilt from the simple act of eating. In this state of mind, it's been easy for me to sacrifice overall well being for short-term gain, or in my case, loss.

Despite the fact that I didn't really feel that great, it still took a while to realize why. When weight loss was the goal, I needed only to focus on the aspects of my new life that supported it: protein, calorie counting, and obsessive exercise.

Health has been the missing piece all along.

Focusing on my health has required a total turnabout. It means that I've had to reevaluate my goals. I'd lived so much of my life with oversimplified ideals: thin equals good, fat equals bad. The reality is more complex, as it so often is.

Looking at my journey over the past decade-plus, I can see the fallout from my terrible mentality of weight loss at any cost. But, at what cost really? At the cost of my sanity? At the cost of my self-esteem? At the cost of my health?

People say you have nothing if you don't have your health, and as I get older, that truth can no longer be ignored.

Today, I am 89 pounds heavier than my lowest post-op weight. Typing those words makes the old me cringe… I feel waves of embarrassment, shame, anger, frustration, and the ever useless guilt.

The new part of me, the one I am working to healthfully feed mind, body, and soul, feels hope. I feel hope because I remember the young woman that weighed 138 pounds, and I know that I was less healthy standing on that scale back then than I am today in my double digit jeans. This new woman I see in the mirror still wants to lose weight, but as a byproduct of a healthy life.

Health has become my personal mission. I wasted a lot of time hating myself to obesity and then hating myself thin. My plan now is to love myself healthy. To do all that I do in the pursuit of weight loss and health with kindness to the woman in the mirror, no matter how she looks.

If any of what I've written resonates, I hope you too can break free. My wish for you is that as you walk your own path, you keep your eyes trained on your health goals and not simply on the scale.

Related: The Biggest Loser Effect

Believe it or not, I've never watched "The Biggest Loser" television show, but I'm very familiar with a phenomenon I call The Biggest Loser Effect. For several years now, a local health club has run a Biggest Loser Contest two or three times a year, as a way to boost club membership, improve attendance, and (of course) motivate people to lose weight. Individuals or teams work out, participate in exercise classes, weigh in weekly, and the winning man, woman, and/or team collects a nice price consisting of cash and services (for personal training, massages, pedicures, etc.). The club lays claim to some pretty impressive success stories, like a husband and wife who lost over 100 pounds between the two of them. That's a good thing. If health doesn't motivate you to lose weight, maybe cash and prizes will.

But who or what's going to motivate you to keep going back to the health club, watching what you eat, and avoiding the morning temptation of a warm bed or the evening temptation of a nacho platter and a pitcher of beer? Who's going to get your lazy butt over to the gym every day and power you through 45 minutes on the treadmill, stepper, or weight machines? When your lungs are searching for air and your straining legs are attempting the 9th jumping jack, is a piece of paper imprinted with "Federal Reserve Note" going to keep you going?

Maybe, maybe not. All I know is that I'm what makes Jean jump the 10th time, and I've watched dozens of people of all shapes, sizes and ages leap into the Biggest Loser Contest with only a dim idea of how much work (and luck) will be involved in winning that prize. They show up for one or two classes, do a few reps with two-pound hand weights, wipe the sweat from their brow, and head off to McDonald's for a light breakfast of sausage biscuits with hash browns, a cinnamon roll, and a giant Dr. Pepper (remember: I live in the South)…never to be seen again, except maybe on the obituary page of the local newspaper.

That's what I mean by The Biggest Loser Effect. The contest is a good start, a pledge to make important changes. Just stepping on the scale in a public place like a gym is a big deal. But the contest isn't enough. Weight management is a contest that goes on for the rest of your life, and the grand prize is far more valuable than $500 or even $1,000,000 cash. The prize is living 10 or more years longer and healthier than you would have otherwise. The Biggest Loser Contest winners are the people who think about their eating and exercise all week long, not just when weigh-in time rolls around on Saturday morning.

It may sound like I'm making fun of the losers who quit, but I can spot the quitters so easily because I used to be a quitter myself. A friend made me laugh the other day when she told me about checking through her "vast library of DVD's" to find a Leslie Sansone exercise video. It reminded me of a "less is more" phase I went through a few years ago, during which I cleared my house of a lot of the clutter that had accumulated through the years, including my own vast library of exercise videos, some of them still sealed in their original packaging. Apparently I had thought that simply purchasing an exercise video would count as real exercise, or I played the video once, quit after 10 or 12 minutes, and sent it to the video graveyard in my bookcase. So I know whereof I speak. And I also know I'm going to go on being a loser, but I'm not going to go on being a quitter. Are you?

Related: Obesity: It's A Global Problem

A recent study published in The Lancet highlights just how obese the world has become.

The study entitled, 'Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013, claims that over the past thirty years the number of overweight and obese people worldwide has tripled from 857 million to 2.1 billion. Meaning that across the globe, nearly 1 out of every 3 people is currently overweight or obese.

Researchers examined data from 183 countries and found that over the past three decades not one single country has achieved success in reducing obesity rates.

The heaviest country was unsurprisingly the United States, which accounts for approximately 13 per cent of the world's obese people, followed by China and India, which together represent 15 per cent.

The study also found that more than 50 per cent of the world's 600 plus million obese people live in only ten countries: the United States, China, Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia.

The results prove that obesity is now a major public health problem across both the developed and the developing world. As health professionals know all too well, obesity puts people at increased risk of diabetes, osteoarthritis, heart disease and cancer, among many other things. And according to the researchers who led the study from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, being overweight is estimated to cause 3.4 million deaths worldwide each year.

Other Key Findings from the Report

-Across the globe prevalence of obesity and being overweight rose by 28 per cent for adults, and 47 percent for children from 1980 and 2013.

-Over the past three decades the largest increase in obesity rates for women were in Egypt, Saudi Arabia, Oman, Honduras and Bahrain.

-Over the past three decades the largest increase in obesity rates for men were in New Zealand, Bahrain, Kuwait, Saudi Arabia and the United States.

-In Kuwait, Kiribati, the Federated States of Micronesia, Libya, Qatar and Samoa more than 50 per cent of the women are obese.

-In Tonga, more than half the population are obese.

-Rates of overweight and obese children worldwide rose by nearly 50 per cent between 1980 and 2013.

-In the developed world the highest increases in adult obesity were in the US (where approximately a third of the adult population are obese), Australia (29 per cent), and the UK (25 per cent).

Related: Are You Your Own Worst Enemy?

Before my weight loss surgery, I tried to anticipate who in my circle of friends and family might attempt to sabotage (with the most innocent and loving intentions) my weight loss effort. Since I share a home with an adult male who has a driver's license, a debit card, a hearty appetite, and easy access to all the junk food at Wal-Mart, fast-food restaurants and dozens of convenience stores, I warned him that I would need his help in keeping junk food out of our house. Although he's slipped up a few times, on the whole, my husband has been great in supporting my weight loss journey. Much to my dismay, I've discovered that JEAN is the worst saboteur in this household.

I've always liked to think that I'm a detail-oriented, logical, analytical person. I just hadn't noticed before that I frequently apply my (occasionally) brilliant mind to rationalizing the absolutely worst self-defeating actions. For example: I work with a dozen or so college students who are always hungry and always short of the cash, time, and willingness to cook for themselves. Since I have no (human) children of my own, I take care of these kids by baking for them. Brownies, cookies, cupcakes, muffins...you get the idea.

But let's be honest now. Somehow those baking binges happen only when JEAN is in the mood for a sweet treat. Somehow it's OK for me to bake a batch of cookies and eat six of them as long as I take the rest to work for my adopted kids.

And it's extremely ironic that these kids never observe me eating sweets or junk food. I bring my own healthy food for lunch instead of running out to Taco Bell. I have the reputation of being a health nut, but little do they know about the spoonful of cookie dough that disappeared down my gullet before those cookies went into the oven. At a meeting the other day, I forgot myself. I picked a mini Milky Way candy out of a basket on the table and began to unwrap it. The youngster sitting beside me watched in alarm and exclaimed, "I think I'm going to faint!" Someone else said, "What's the matter, Sam, are you sick?" and she replied, "No! Don't y'all see? Miss Jean is eating candy! The world as we know it is ending!"

WHY DO WE SABOTAGE OURSELVES?

As I explained in Bandwagon, self-sabotage is the deliberate destruction of property or the hindrance of operations by an enemy. As you start your weight loss surgery journey, you might believe that your mother and her famous biscuits and gravy, or your husband and his Pizza Palace Frequent Customer card, or your children with their 9:00 p.m. demands of "Mom, I need some cookies for our class Christmas party tomorrow", will be your worst saboteurs.

But beware! There is another saboteur who is with you 24 hours a day, 365 days a year. Who is it? Go look in the mirror. The saboteur is you. That earnest, innocent face hides a food demon who is determined to prove what you believed for so long...that you are destined to fail at weight loss...that you don't deserve to be slim and healthy....that without your protective layer of fat, you'll be too easily hurt or too easily noticed...that once you're up on the Pedestal of Success, you'll lose your balance and tumble back down into obesity anyway while all your friends and enemies point and laugh at you.

Melissa McCreary wrote an excellent 2-part article about overeating and self-sabotage for the LBT WLS Magazine. Check it out here: . It describes common erroneous (or dysfunctional) beliefs ("It's not OK to be selfish") and head-games ("I don't have time to spend on activities that are healthy for me) that can trip you up. If you read Melissa's article and even one of those beliefs or head-games sounds familiar, put that one up at the top of your to-do list.

Unfortunately, self-sabotage is sometimes disguised beyond easy recognition. If you're feeling frustrated and not losing weight but you're not sure why, take a look in your mental mirror. Some signs of self-sabotaging thinking are: jealousy (comparing yourself to others), extreme anxiety, negativity, procrastination, giving up easily, ignoring feedback, feelings of worthlessness, living in the past, blaming others, and the all-time favorite: DENIAL.

How can you overcome tough stuff like that? Professional counseling has helped me tremendously. Attending in-person support group meetings such as Overeaters Anonymous has also helped me. Checking in daily with my Accountability Partner helps me. What's an accountability partner? I'm working on an article about accountability now, so watch for it!

Related: 'No!': A Daughter Reacts to Mom's Decision to Have WLS

I hit 300 pounds by the age of 18. Dating back to early childhood, all my efforts to diet had failed, and always left me heavier than I'd been when I started.

In my 20s, I decided to accept my body - fat and all. No more diets. No more wasting time feeling bad about my size. From now on, I was gonna work on loving the body I had. If I remember correctly, about 10 minutes later, my mother broke the news:

"Sweetheart, I'm having weight loss surgery."

A chorus of 'No!' started singing in my head. Every reason why surgery was a bad idea tried to elbow its way to the stage.

"It's dangerous!"

"It's expensive!"

"It's a cop out!"

"It's society that needs to change, not you!"

"You're beautiful just as you are!"

"It's their problem, not yours!"

"NO!"

My mom had gone through periods of consistently eating nourishing foods in nourishing ways, exercising every day, and sleeping well. And as a result, she knew what it felt like to be more comfortable in her own skin, and to move through the world without the burden of 150+-pounds of excess fat.

I, on the other hand, was young, and had always been overweight and out of shape, but I wasn't gonna let that stop me from believing I knew what was best for my mother. I was an idealistic feminist college student who'd just stumbled upon the solution to suffering: loving myself just exactly as I was.

To my mind, by choosing to have surgery, my mom was being a narrow-minded, self-hating fool.

"Mom, you need to love yourself! Don't let society tell you how your body should look!"

"I do love myself," she said. "That's why I'm doing this. I want to be comfortable. I want to be able to do things I'm not comfortable doing at this weight. And I want to be alive and healthy for when you have babies."

I could hardly believe the depth of her ignorance.

"There's a support group for post-ops that's open to the public. Please come with me," she said.

Fine, I thought. There was bound to be some post-op there who'd almost died, or someone that couldn't swallow...All I needed was one flesh and blood person to base my argument on, and then my mother would have no choice but to come to her senses.

"I'll come on one condition."

"What's that?"

"I want you to listen to everything that gets said in that meeting. I'm not going if you're gonna ignore the truth."

"It's a deal."

My mom drove us to the meeting in Englewood, NJ. There was a facilitator, and just under 50 people in the room, mostly women in their 40s and 50s. Some had had surgery already, some were scheduled to have it, and some were just thinking about it.

I sat against the wall in silent protest. While waiting for the meeting to start, I invented a life and a personality for the facilitator, compared her to me, and decided I was superior. She started with some house-keepy details and then launched right in.

"Welcome, everyone," she said. "First we'll hear check-ins from the post-ops, and then, if there's still time, we'll take some questions."

The post-ops shared personal stories ranging from the straightforward: 'I had surgery, I lost a lot of weight, I feel better, and here I am,' to the gripping: 'I had surgery, had a bunch of post-surgical complications, and here's what life has looked like since.'

Everyone's story was a little different, but one thing was universal: these people hadn't gone under the knife to get hot; they'd undergone surgery because they wanted to live as fully as they could in the time that remained, and for them, that meant being a healthier weight. Dieting had failed them, like it fails most of us, but surgery felt like it might be the answer.

The facilitator called a break. I watched as my mother got up and introduced herself to a post-op who'd shared that losing weight meant getting her blood pressure, cholesterol, and type 2 diabetes under control. The woman was older, she was not meeting any popular standards of beauty, and appeared positively . I hadn't realized how down my mom looked until she started to brighten up talking to this woman.

The moderator called us back. People were smiling and whispering, quietly exchanging cards and phone numbers. She thanked everyone for their shares, and opened up the floor, as promised.

"Does anyone have any questions for the post-ops?"

Now was my chance. I raised my hand.

"How many of you wish you hadn't had surgery?"

Not a single hand went up. Maybe they're embarrassed, I thought. Surely the ones who'd had complications felt foolish for having had surgery, but maybe peer pressure was keeping them quiet.

I needed to ask a better question, get them to talk about the danger.

"Uh...can I ask one more?" the facilitator nodded.

"What's the biggest, scariest risk to having surgery?"

There was a tiny pause. My brain fired off all kinds of answers: Vitamin deficiencies! Pain! Death!

"Judgement."

What?

"Being criticized."

Wait, what?

"When people think surgery's the easy way out, or a sign of weakness, or just a stupid idea, and they never stop letting you know." Huh.

According to a roomful of WLS post-ops, having to deal with my criticism might be the biggest, scariest risk my mom would face if she had surgery. Compared to daily, holier-than-thou judgement, even post-surgical complications might seem trite and manageable.

My mom do go ahead with her surgery. In under a year, I watched her regain much of the health and livelihood she'd lost. A little over a year later, I went to the same surgeon.

Ever since I opted to have gastric bypass surgery myself in 2003, I can tell you that the folks at that meeting were right.

I've worked my tail off to get well, to get an honest handle on my relationship to food, and to create a body I love. I became a personal trainer, coach, and educator to help others do the same. As a wellness professional, I've been judged for having had surgery in much the same way I was judged for being the fattest kid on the playground, except now, it's often by other fitness "professionals."

I've since apologized to my mother for the grief I tried to give her when she first started exploring surgery as an option. And I've thanked her for sparking the greatest lesson I've ever learned - the lesson that I've dedicated my career to teaching to others:

Self-acceptance and the desire to change are not mutually exclusive propositions - they can co-exist. In my experience, and that of countless clients and students, the only way to make lasting, sustainable, positive change is to begin from a place of love.

Related: Obese & Malnourished

As a dietician working in a bariatric clinic I meet a lot of patients who over eat. This is far from surprising. However, what never fails to astound me is how many of these very same people are malnourished.

It's easy for the general public to make the connection between malnutrition and starvation in the developing world, but when it comes to overweight Westerners being malnourished it's a different story.

In the developed world, where obesity has reached epidemic proportions, we are seeing more and more people who are overweight or obese being diagnosed with malnutrition because they consume too much of the wrong foods; foods with little to no nutritional value that are low in protein, vitamins and minerals.

To understand this contradictory situation you must understand the different types of nutrients and how vital they are. This is one of the main reasons why so many Westerners are plagued by chronic diseases.

According to Joanne Slavin, a nutrition professor at the University of Minnesota, the main culprit of malnutrition is usually poor protein.

"If you don't get enough protein, you might still get enough calories without getting enough nutrients," says Slavin.

In my experience the main "shortfall" nutrients tend to be calcium, fiber, potassium and vitamin D. Many overweight individuals have packed on extra weight over the years because they have poor diets that are typically high in refined foods. These highly refined foods are high in unhealthy fats and sugars and low in the aforementioned nutrients.

In this age of calorie counting, it's important to consider all aspects of your diet. But let me tell you, calorie content is not the be all and end all. A calorie from a Mars bar is the same as a calorie from an Apple when it comes to energy exchange, however, an apple is much richer in vitamins and minerals.

As US based nutritional consultant, Carol Cottrill, points out "when we eat the empty calories found in processed foods instead of wholesome, real food, our appetite is curbed temporarily, and our stomachs feel full, though our bodies have not taken in the nutrients they crave. This is the setup for what's known as subclinical malnutrition. Not to be confused with the undernourishment experienced in famine-stricken countries."

To keep our body healthy, we must fuel it with the necessary ingredients that can only come from a healthy, well-balanced diet. When we don't get nutrients, our internal functions don't work as well - and this is when we become vulnerable to diseases such as obesity.

Image Credit: Melissa Gruntkosky

Related: Inertia - The Real Weight Loss Killer

Inertia - The Real Weight Loss Killer

We do what we do because that's what we do. That may seem like one of the most ridiculous sentences ever committed to paper, but read it again. We do what we do because that's what we do.

This means that we don't necessarily do what we do because we made conscious choices to do it that way. It means that much of our behavior is on autopilot. Think of this phrase with regards to eating. We spend so much time talking about emotional eating that we've forgotten that most of the time that we're eating unhealthy or eating "comfort foods" it is not because we are depressed or anxious, it's because we're just not thinking about what we are doing, and eating has become a seemingly automatic behavior. Our minds are somewhere else. I'm not saying that emotional eating isn't a problem, but rather that the behavior of eating without thinking is as big if not the bigger problem much of the time. Think about it. How often do you go into the kitchen to have some cookies because you are depressed? Now, think about how many times you go into the kitchen to get some cookies and you have no idea why you went into the kitchen. I bet the latter situation happens much more often. Ever find yourself in the middle of eating some cookies and you don't even remember going into the kitchen or opening up the box of cookies? See what I mean!!!

It may be true that we learned to eat as a means of comforting ourselves from negative emotions such as anxiety and depression. However, the behavior of eating often persists long after the anxiety and depression is gone. Why? Habits are really hard to break and your brain isn't in the business of breaking them without a whole lot of effort. A great deal of any individual's behavior occurs outside of his or her awareness and with very little conscious thought. What this means is that many of our bad habits persist because we are not aware enough to do anything about it. We don't necessarily reach for the cookies because we CHOOSE to have cookies. Our brains just automatically crave cookies when we are in circumstances that we have commonly eaten cookies in the past. We don't even need to think about it anymore. Because you've engaged in the behavior of eating cookies under specific circumstances so many times (let's say at night, feeling tired, watching television, a bit bored with the show) your brain now cues you to go for cookies without any conscious thought from you. No thinking required! And if you're not actively thinking about your choices, you're not making a choice. You're operating on inertia.

What is inertia? You remember that phrase from high school physics… "an object in motion is likely to stay in motion…." What this means in terms of behavior is that a behavior that is repeated over and over (also called a habit) will persist unless something comes along to interfere with that behavior. Inertia is when behavior just keeps going because it's been going. John Lennon had this wonderful lyric that said "life is what happens to you while you're busy making other plans." This means that as long as you are alive, even when you're not trying to make decisions or to make change, life goes on. Therefore, if you don't do something to make changes in your behavior, you'll likely keep performing the same behaviors you've always performed under similar circumstances. This is exactly what happens with eating most of the time. Diets are an exception. Consider just how different your eating behavior is from its normal state when you're on a diet.

When you're on a diet, you are contemplating every decision. You are in the moment and you are making choices. You are reading labels. You are measuring servings. You are counting calories, points, carbohydrates, etc. You are "on." When you go off the diet, if you're like most people, ALL of this stops. No more thinking, no more measuring, no more counting, no more making choices…just running on inertia. Eating with very little thought and your brain seems to eagerly resort back to its old ways. That's inertia.

The keys to change are therefore rather obvious. Be in the moment. Contemplate as many food decisions as you can. Plan your meals and snacks ahead of time rather than trusting that your brain will help you make the right decision in the moment. It won't. Anticipate high-risk eating situations like parties, weddings, and barbeques. Maybe you've heard all of this before. You probably have. There are many different terms used for this approach and they are likely speaking to the same concept. A hot term these days is "mindfulness." It's not really a new concept…the Buddhists have been talking about it for several thousand years. It's really very simple in theory…be aware and observe your thoughts and feelings, and be present in the here-and-now. Then make your decision.

Why is mindfulness so important? Because habits and the power of inertia are incredibly powerful and the weight you have lost or are trying to lose wants to come back. Your body isn't the least bit interested in helping you lose weight. So if your mind isn't very conscious of what it's trying to achieve, it's just not going to happen. In fact, your body is fighting tooth-and-nail against you. Inertia is what happens when you're not fighting back. Remember…we do what we do because that's what we do. If you want to lose weight and keep it off, your new phrase needs to become "I do what I do because that's what I've decided to do," or better stated, "I eat what I eat because that is what I choose to eat."

Related: European Obesity Epidemic

According to the report presented at the EuroPRevent congress in Amsterdam by Dr Laura Webber from the UK Health Forum, rates of obesity and overweight are projected to increase in almost all European countries by 2030. However, as one would expect, growth rates vary significantly from country to country. In total 53 European nations were put under the microscope, and in almost all countries the proportion of overweight and obese citizens was projected to increase over the next 20 years.

"Our study presents a worrying picture of rising obesity across Europe. Policies to reverse this trend are urgently needed," Dr Webber said.

Her concerns are founded on a statistical modelling study which brought together a wide berth of data on body mass index (BMI) and obesity trends within all 53 countries. Definitions were based on the WHO's standard cut offs -- healthy weight (BMI ≤24.99 kg/m²), overweight and obesity combined (BMI ≥25 kg/m²) and obesity (≥30 kg/m²).

Dr Laura Webber believes governments should be doing more to restrict unhealthy food marketing and is calling for a tax on soft drinks and subsidies for fruit and vegetables.

"The UK and Ireland, where obesity prevalence is among the highest, possess unregulated liberal market economies similar to the US, where the collective actions of big multinational food companies to maximise profit encourages over-consumption... We need to make healthier food more affordable and less healthy food less so, by using taxes on sugary drinks for example and subsidies on fruit and vegetables."

The Worst Performers: the proportional increase of overweight and obesity in males by 2030

-Ireland [90%]

-Czech Republic [80%]

-Spain [80%]

-Poland [80%]

-United Kingdom [75%]

The Best Performers

-Belgium [44%]

-Netherlands [47%]

Related: Best Lap Band Cook Books

I would like to change your thinking and open your mind up to migrate away from looking for cook books specifically tailored for the Lap Band. Instead learn how you can quickly and easily create your own Lap Band friendly meals yourself. This will enable you to eat in all social settings freely.

To achieve this there are two key take home messages, to creating Lap Band friendly meals.

1. Avoid biting into food
2. Modify the food prior to cooking or food served to you, as though you were feeding a one year old to prevent them from choking

Let me reassure you, this will make sense if you understand how the band works as a "funnel" concept rather than a small stomach. Professor Paul O'Brien who I also work with has produced a great 2min clip explaining this at (the second clip on the page)

Lets extrapolate the above two points further.

1. Avoid biting into food

As adults we have big teeth and big mouths. If we bite into food we are likely to exceed a teaspoon portion. This is likely to result in inadequate chewing and over filling the "holding bay" before the esophagus pushes the food through the Lap Band.

Pick with your fingers and eat with a knife and fork to portion control instead. Try an oyster fork.

2. Modify the food prior to cooking or food served to you on a plate, as though you were feeding a one year old to prevent them from choking

Removing tough skins, strings and food cut into small pieces, makes an amazing difference in being able to tolerate a big variety of foods. The third mouthful syndrome is less likely.

For example, salads can be challenging because they are usually present in large chunks of vegetables which have leathery skin. An alternative example would be a cherry tomato cut into half is much harder to eat compared to being cut into 4-8 segments. Diced salad is easier than an untouched chunky salad as an alternative.

Another example would be at a food court,. The falafal wrap looks appealing but there is no way you would attempt to eat this because the chances of a food blockage is high. Well with the above two suggestions to creating Lap Band friendly meals, all you would need to do is place the wrap on a plate, unravel it and cut into small pieces before eating with a knife and fork rather than biting into it. Voila, the meal has become band friendly.

To help you, I have uploaded a large number of recipes and made comments in red how to modify them that tiny 5% to create Lap Band Friendly Meals. Take a look and enjoy increasing the variety in your diet.

Related: Becoming a Lean, Clean, Fat Burning Team

Research supports that most people are more able to lose weight if they adapt a total lifestyle change and have an exercise buddy. That's one of the reasons couples can be so successful if they work together to help each other become more active and eat healthy. Women use food to manage emotions such as anger, boredom, loneliness, and anxiety more than men do. Therefore, if women can talk to their partner about how they are feeling, many times this alone will help them curb their munching. Men have more tendencies toward drinking and watching TV than women. If women can encourage their partner to go for a walk or a bike ride with them, this helps him cut calories and become healthier. Working together can also lead to a closer connection with each other. You have a shared vision; rather than worry about your partner sabotaging you, they are going to be motivating you.

Before you begin, it is important to understand a few basics about men's and women's bodies in relationship to losing weight:

1. Men lose faster. They have more muscle mass, faster metabolism and more water. Therefore, the same exercise and diet will be reflected differently on the scales. Women lose slower, and the body fluctuates more due to menstruation as well as our higher fat content.
2. Women get hungrier than men with strenuous exercise. Women's bodies are designed to give birth, so what we burn we feel the need to restore.
3. Both men and women can be addicted to trigger foods, but it is more common with women. If your partner understands this, you can ban specific foods from your home.

How to begin a couple's exercise program:

1. Choose an exercise you both want to do. It should be done at a level that you can continue to talk to each other, thus enhancing your emotional connection, as well improving your cardiovascular health.
2. Choose the number of times each week you will engage in this activity and the time. If you are a morning person and your partner is an evening person, maybe you can go together on the weekends and separately during the week.
3. Don't compare your weight loss with your partner. What is important is you are encouraging each other. Congratulate each other more on their clothing size as they lose weight and how they appear. Are they more energetic? Do they seem happier? These are the things to notice.
4. Take turns cooking healthy. Make dinners at home special. This will save you money as well as save you unwanted calories.
5. If you feel a binge coming on, alert your partner that you need additional support to stay on track. Many times just telling someone else will stop the binge in its track.
6. Supervise yourself only. Don't become the sergeant to your spouse. The goal is to get healthier and whittle away the waist, not your marriage.
7. Prepare for more intimacy. Women especially desire sex more when they feel better about their bodies. Sometimes losing one or two inches from her waist can turn a woman into a sex goddess.
8. Be consistent. It takes about 30 days to make a behavior a habit. Everyone has the money and means to live a healthier lifestyle.
9. With weight loss, as with everything else, you get better results when you encourage rather than shame.
10. The more couples engage in activities, the happier they report their marriage. The more couples share a vision, the happier they report being. Losing weight with your partner achieves both of these.

A few more tips to remember…..

1. Reward yourself: Every time one of you hits a goal, reward yourselves together. The reward must be something uneatable.
2. Split restaurant meals: Whenever you dine together, cut your calories in half by splitting meals.
3. Make sure sex is part of your exercise. Sex burns calories and reinforces the team spirit.
4. Don't make dining a date: Make your date nights "movement nights". Take a walk, golf, bowl, or shoot pool.
5. Focus on health not weight. If you focus on getting healthier you can embrace your life style with more determination than if you focus on being able to fit into a particular suit.

Teams are formed with like minded people. When you and your partner agree together that your team will be the best team, weight loss and healthy living are sure to be achievable goals. -Mary Jo Rapini

For more information and MONTHLY FREE RELATIONSHIP TIP go to: www.maryjorapini.com

Talk to me on my fan page: http://www.facebook.com/maryjorapini

Tweet me: @ Mary Jo Rapini

Get your "MOJO MOMENT" each day on Fox 26 at 9a.m.CST.

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Join me every Monday and Thursday Morning for "Mind, Body, Soul with Mary Jo" on Fox 26 Houston at 9 a.m

Related: How to keep your immune system strong during weight loss

Losing weight after bariatric surgery demands a lot from your body and mind. You are engaged in a completely new way of eating and daily living ─ it's a big change. During this transformation, the last thing you want is to face a setback due to an acute illness such as flu, cold or other viral infection.

Being 'under the weather' can also derail whatever exercise program you are engaged in ─ and that's not good either.

Those of us who work in hospitals know several tips and tricks to keep from getting sick by boosting our immune systems. I'd like to pass these 'insider' tools on to you:

• Get at least 7 hours of sleep every night, no matter what.

• Find ways to help lessen stress and do them every day.

• Stay hydrated; aim to drink 5 water bottles daily.

• Sweat it out. Keep moving and sweating at least 30 minutes daily.

• Wash your hands for a full minute, all the time.

• Eat foods rich in zinc, such as grass-fed beef, pumpkin seeds and spinach. Zinc stimulates your body to produce immune-boosting antibodies and overcome cold viruses.

• Add vitamin C-rich foods (I favor oranges and bell peppers) to your diet. Vitamin C stimulates the production of antibodies to help fight infections (and lessen cold symptoms such as a runny nose).

• Super-charge your gut with healthy bacteria just by eating Greek yogurt.

• Go ahead and eat the garlic ─ it's a potent antiviral, anti-fungal and antibacterial weapon.

Germs and sicknesses, in varying degrees, are out there right now ─ but that doesn't mean you have to fall victim to them. Living a healthy lifestyle every day makes serious chronic diseases and common seasonal bugs less likely to take hold of you.

Just like overcoming obesity, it's another way to boost your quality of life, every single day.

Related: Emotional Eating: It's Time to Take a Stand

Here's a simple truth. If you were more direct, you'd struggle less with emotional eating. Emotional eating is about using food to deal with a feeling or a situation instead of addressing it directly. Really. It's that simple. When you resort to stress eating you aren't really addressing the stress. When you comfort yourself with food, you aren't really responding to yourself with care and compassion (at least it rarely feels that way in the morning). When you binge on ice cream to drown your sorrows, you aren't actually tackling the sadness or hurt or the situation that is causing you pain.

And emotional eating triggers go beyond feelings. Many people overeat instead of dealing directly with the situations that cause the uncomfortable feelings.

• You're worried someone's mad at you. So you eat.
• You are mad at someone and that doesn't feel good (and you don't want to show it). So you eat.
• You don't want to disappoint someone. So you eat.
• You have a truth to tell that you know won't be popular. So you eat.
• You are uncomfortable asking for what you want. So you eat.
• You need something and it may cause a conflict. So you eat.

Sound familiar? Sometimes emotional eating isn't only about stuffing your feelings. Sometimes overeating is a way of not taking a stand.

Want to be effective with food? Want to know how to be effective with weight loss? It's simple. Start working to be more directly effective in your life.

If you want help with emotional eating (or overeating in general), there's a question that can get to the heart of matters pretty quickly. Next time you find yourself reaching for food you aren't really hungry for, ask yourself this:

"What am I not facing head on and directly?"

Be honest, be compassionate, but be firm with yourself. What are you avoiding, side-stepping, or soft-selling?

What do you need to help you be more effective and direct? Sometimes you just need to step into your big girl shoes, take a deep breath, and get the job done. Sometimes you'll find you need some better tools or strategies. Maybe it's time to get some support or education or a coach so you can stop stuffing your feelings instead of effectively speaking your mind.

What have you faced head-on and how has it helped?

Related: Lap Band Video Presentations

I worked with Allergan soon after this post. Together we developed some great 1-2 minute video presentations, providing an update regarding the research surrounding the band including how and what to eat.

The videos can be viewed at . Please refer to the 2nd, 3rd and 4th clip from the top.

Hope you enjoy. Any questions of clarrification please just ask, I'm only a few clicks away.

Or you can also attend a FREE online support group meeting if you prefer.

Related: Managing Barbeques Following Weight Loss Surgery

Summer in Australia means barbeque time! We love to entertain and there is nothing more enjoyable than catching up with friends and family and enjoying a good barbeque. However following weight loss surgery many of our favourite barbeque foods are those that can be more challenging to tolerate; grilled meats, chicken, sausages, bread, sauce and salads fill plates and soft drink, beer and wine are plentiful. The buzzing social aspect of barbeques can also mean the focus on your eating technique is not as sharp. Due to these challenges, some people may find invitations to barbeques make them feel uneasy.


With some forward planning in place and an awareness of common barbeque traps, there is no reason you shouldn't be welcoming your next invite.


Common Barbeque Trap 1: Dry, overcooked meat and chicken


We have all been there, you head over to the grill to see a pile of meat looking rather dry and shriveled - no matter how much you chew this, or how much sauce you add there is just no way you are going to tolerate it.


So how do you manage this?

• Offer to take something to contribute to the grill that is will be more tender when cooked and easier to tolerate:
• Make some lean minced meat patties (adding plenty of egg and relish to your mix to ensure they stay moist).
• Marinate chicken thigh fillets and thread onto skewers.
• Wrap salmon fillets in foil with lemon and herbs and pop on the grill near the end of the cooking time.
• Tenderise some good quality steak with marinade and again pop on the grill, again near the end of cooking.

Common Barbeque Trap 2: You overload your plate and push your capacity 


With the wide array of choices at a BBQ it can be tempting to have a little bit of everything, leading to a plate that is overflowing.

To manage this:

• Make sure you use a side plate/small plate.
• Fill half of this with protein, this may mean you only select one to two of the options on offer. 
Pick your favourite salad items to fill the other half of your plate - avoid those drowned in creamy dressings.
• Avoid the bread and butter.

Common Barbeque Trap 3: You forget to focus on your eating technique


It can be very easy to be engaged in conversation and forget to eat slowly and chew well at barbeques, yet focusing on these fundamentals can be the difference between a successful outing and one that sends you home feeling poorly. 


To manage this:

• First and foremost, ensure you sit down to eat.
• Cut your food into very small pieces, chew each mouthful well and take time between mouthfuls.
• Stop when you are satisfied and remember this may be before your plate is empty.

Managed well, barbeques can be both an enjoyable and healthy part of your social calendar this summer. Just be aware of these common traps and plan ahead to avoid them. 


Related: Letting Go of Old Hurts

"Letting Go: How to let go of old hurts so you can heal"

Letting go. "Let go" of a kite string and your kite soars to the heavens. "Let go" of a rope during tug-of-war and it drops. Sounds easy!

In daily life, people say, "let it go" This refers to "letting go" emotionally, or no longer being upset by people or situations. If you aren't "letting go", you must be "holding on", meaning you are clinging to some negative emotion(s) that prevents you from getting on with life.

Sounds easy. Letting go of a kite string or a tug-of-war rope is easy. What about "letting go" of hurt resulting from your mother calling you derogatory names? How easy is it to "let go" of the fear you felt as you watched your father beat your mother? Is it easy to "let go" of your own habit of referring to yourself as "stupid"? No - letting go of emotional issues is not easy.

There are similarities to the process of letting go of emotional issues and letting go of a kite string or a tug-of-war rope. Having a fight with your husband about which route to take to the movie theater may upset you for a few minutes, but letting go of the frustration should be as easy as letting go of a kite string.

Some emotional issues are more like a tug-of-war game. If the game isn't important to you and you let go of the rope, you won't be upset with yourself. In real life, this is like going shopping with a girlfriend and hoping to have lunch at a new deli. Turns out she has her heart set on Italian food. Because you are not concerned about where you eat, you "let go" of your initial disappointment that she doesn't want to go to the deli, and you eat Italian. You don't "hold on" to the frustration. You "let it go" and enjoy your day.

If the tug-of-war game means a lot to you, you will hold on to the rope longer. If your opponent is physically stronger and it becomes clear that you are going to get hurt if you continue to hold, you "let go" of the rope so you don't get rope burns. In life this could be like attempting to resolve an emotional wound with a sibling who treated you badly throughout high school. She regularly made fun of you in front of friends. You have "held on" to the pain for years and want to "let go" of the power that the feelings, and your sister, still have over you. You confront her: "I felt angry when you made fun of me in front of my friends all through high school. I was hurt because I looked up to you and wanted you to like me. I am choosing to let go of my anger toward you and will no longer be intimidated by you". Your still-cruel sister laughs at you and calls you "ridiculous". No matter. You didn't talk to her so she would agree with you. You talked to her so you could stop being intimidated by her and so you could let go of painful emotions. You put up a good fight at the tug-of-war match and smartly "let go" of the rope (stopped fighting with your sister) before she hurt you further (like getting rope burns).

Many emotional issues are like this. It's good to stay in the game to show your strength and willingness to fight for yourself. If the others involved don't respond in healthy ways, it may be good to let go of the rope. That doesn't mean you have "lost". It means you have done what you needed to do and have chosen to "let go" to avoid getting hurt further. In life this means standing up for yourself. It means protecting yourself from harmful people and situations. It means taking yourself seriously and treating yourself with the care and respect you treat your best friend.

Sometimes we hold on to painful emotions for too long and for unhealthy reasons. This is equivalent to holding on too tightly to the rope in tug-of-war and ending up with badly burned hands. A woman may blame her husband for not being a good partner. She complains to her friends that "he doesn't want to go anywhere with me", and "he doesn't hold my hand". In therapy, she recognized that it was easier to "hold on" to resentment toward her husband than to admit she is afraid of intimacy and did not make attempts to improve her marriage, either.

How do we let go of emotional issues?

1. Identify the issues (this often requires therapy):

• childhood wounds and being angry with mom/dad/whomever
• betrayal by friend/spouse/whomever
• a history of being harshly criticized/called names and having residual low self-esteem

1. Recognize thoughts and feelings related to the issues:

• I am angry with my father for beating my mother and brother; it was very scary to witness that.
• I am hurt that my friend shared what I told her in confidence. I think it was rude.
• I am sad that I was called names and am angry that my self-esteem was damaged. I think it's terrible that parents can treat their children so cruelly.

1. Determine what we need to "let go" (meaning that the issue no longer has power over our lives).

• My father is deceased, but I need to talk about and feel what it was like when I was a child. I need to talk about how situations in my present life remind me of back then and how I sometimes feel like I did then. I also need to learn to respond to my situations in the present from an adult perspective and not that of a scared child.
• I need to let my friend know how badly I was hurt. I need to remember that she may or may not apologize for her behavior and that my purpose for sharing my feelings with her is so that I don't develop resentments toward her or keep negative feelings inside myself. I need to hear her side of the story and see if I can understand her perspective. Then I need to determine if this is a healthy friendship and if I want to continue in it.
• I need to tell my parents how badly they hurt me and affected my self esteem. I need to stop calling myself derogatory names. I need to stop using low self-esteem as an excuse for not taking healthy risks.

1. Follow through with action, remembering to let go of the rope if there is danger of additional hurt. Sometimes people are stubborn and because they need to win they will hold on long after their hands are badly burned. We need support in the way of healthy friends or a trained therapist to "let go" of past hurts.

We need to let go of past hurts to help ourselves heal.

Connie Stapleton, Ph.D.

www.conniestapletonphd.com

WLS Magazine

4/12

Related: Obesity Can Take a Serious Toll on Your Teeth

Specifically, overweight people have higher tooth decay levels, more missing teeth and fewer required dental fillings. They also visit a dentist less frequently, have more difficulty accessing dental care on a regular basis and are likely to visit a dentist only when they have a problem.

Dental issues after bariatric surgery

Keep in mind, dental issues can continue even after obesity is defeated. Once bariatric weight-loss surgery has been completed and the weight begins to fall off, there are nutrition guidelines that patients need to follow. If this protocol is not adhered to, resulting gastrointestinal issues can cause damage to the teeth and mouth.

Overeating causes stomach distension which frequently leads to regurgitation and reflux exposing the teeth to caustic gastric juices at pH levels high enough to dissolve tooth structure. This can lead to cavities, root degeneration and gum disease.

Tooth erosion is a common condition that includes hypersensitivity to eating or drinking cold or hot items. This can be compounded by sugar ingestion which produces even more acid in the mouth. The combined acid attacks invites uncontrolled enamel demineralization that defeats daily oral hygiene efforts even in someone who has never experienced dental decay issues.

Six ways to get back on the dental health track

active dental hygiene and early diagnosis of any problems will contribute to your overall health and wellness strategy. Here are steps to take to get rolling in the right direction:

• Have a thorough dental cleaning and examination and take care of any problems before they become more serious.

• Rinse with mouthwash for one minute twice a day prior to brushing and flossing.

• Use one of the new toothpastes that helps to preserve and protect tooth enamel.

• Add baking soda to your toothpaste to help neutralize acid levels in the mouth.

• Drink water throughout the day to help offset the negative effects of dry mouth.

• Eat more seeds, nuts, soy, seafood and spinach-this starves decay-producing bacteria and reduces acid levels in the mouth.

The bariatric weight loss process is a way of regaining control over your health. During the journey, it is important to take care of your teeth, gums and mouth. Not only will your mouth be fresher and healthier, white teeth will serve as a terrific accessary to your new outlook and your new body.

(Photo courtesy of FreeDigitalPhoto.net)

Related: Diabetes in the UK Reaches all-time high

The number of people in the UK living with diabetes has reached an all-time high.

According to the UK Department for Health (DH) there are currently 3.2 million Britons diagnosed with the disease, with more than 90 per cent of suffers having the obesity-related Type 2 variant. However, the figures look even worse when one takes into account the more than 630,000 people in the UK estimated to be living with the condition unawares.

The UK - like many nations - is failing to tackle 'epidemic' rates of obesity. And with this in mind, the Department of Health predicts that the percentage of people living with diabetes will jump from the current rate of 7.3 per cent to 8.8 per cent by 2030; a rise that would put the UK on par with the US, where 8.3% of the population currently lives diabetes.

As part of their strategy to address this significant problem, the British Government is urging people aged between 40 and 74 to have an NHS Health Check.

Early detection of diabetes is important, as it allows those living with the disease to better manage their condition, and in this regard, the program has been a huge success with more than 1.3 million patients having taken the health check so far. However, we all know that prevention is better than cure, and if the UK wants to properly address this epidemic, efforts must be made to stop people from developing the disease in the first place.

Professor Kevin Fenton, director of health and well-being at Public Health England (an executive agency of the DH), said: 'With Type 2 diabetes becoming more common, the NHS Health Check presents an opportunity for individuals to take steps earlier, such as weight control, to prevent or even reverse diabetes in its early stages.

'It is important that those who are eligible take up the offer of an NHS Health Check so their risk of serious, but avoidable conditions, can be assessed, and lead to early intervention.

'PHE is committed to increasing physical activity and reducing physical inactivity across England, and these aims are prominent in a number of public health campaigns.'

The Stats

· According to Diabetes UK there are currently 630,000 people living with undiagnosed Type 2 diabetes.

· 90% of sufferers have the Type 2 variant.

· Number of people living with diabetes in Britain has reached an all-time high.

· Currently 3.2million people in the UK have been diagnosed with diabetes.

Related: Kitchen Sanity (or lack thereof)

I love to cook, and that's been a big help at every stage of my weight loss journey. Finding WLS-friendly food at restaurants or in vending machines has rarely been an issue for me, because I'd rather cook and eat at home. Eating my way around the world during business travels was fun at the time, but the weight I gained through the years was not in the least fun. I realize not everyone shares my love of cooking (in fact, some of you hate it), so when I wrote Bandwagon Cookery, I took pains to make the book entertaining. This is an excerpt from the book. If reading it doesn't change your thinking about cooking, I hope that at least it amuses you.

One of my mom's cardinal kitchen rules was: clean up as you go.

It's possible to take this to ridiculous extremes. My Aunt Jeanne (for whom I was named) was not a great cook but she was a dedicated dishwasher. If you were cooking anything in Jeanne's kitchen and let go of it for a minute (let's say you were stirring the sauce and put the spoon down while you spent 30 seconds searching for the dried basil), she would wash it. You'd reach out your hand for that spoon and it'd be gone...over to the dish drainer.

And then there's my husband, Mr. P., who is (in more ways than one) cut from the same piece of cloth as Jeanne. In the small kitchen of our first home, the food prep area was to the left of the sink. We stacked anything that needed to be washed to the right side of the sink. After years of cleaning up after myself, I certainly appreciated it when Mr. P., would automatically, without being begged, coaxed, or bribed, wash anything that was sitting on the right side of the sink.

But one Sunday I spent something like 49 hours (yes, I do know there are only 24 hours in one day, but it felt like 49 hours) making my own beef stock. I roasted a cow's worth of beef bones, then I boiled them in huge vats (lobster pots, actually) of water with onions, carrots, celery, and herbs. Then I drained the stock, put it back in the vats, and added crushed eggshells to help "clarify" the broth. (By now you're thinking, "You are a very sick lady, Jean", and I agree, and you haven't even heard yet all the gory details about the time I boned and stuffed a game hen into a chicken into a turkey before adding gourmet stuffing and roasting the whole thing one Thanksgiving).

Then I poured the broth into large bowls and left them to cool for about 10 minutes while I washed my hands, visited the bathroom, and had a hit of wine.

Refreshed, I returned to the kitchen ready to pour this fabulous stock into freezer containers and… it was gone! Mr. P. had discarded every last drop, carefully washed all the bowls, and was sitting virtuously at the kitchen table reading the Sunday newspaper. The kitchen counters were clean and tidy...and the stock and everything I'd used to make it had disappeared.

"Where is the stock?" I screamed.

Mr. P. looked up from the financial pages and said, "What stock?" (OK, I just added the financial pages for fun. He would only read the financial pages if there were ads in there for guns and knives - hey, not a bad idea!).

"The stock I left on the counter!"

"You mean that brown stuff in the bowls?"

"Yes, the brown stuff in the bowls! Where is it?"

"I threw it out and washed the bowls. Why?"

For a moment I was speechless (hard to imagine, I know). I looked at the gleaming, empty kitchen counters and thought of all the work I had put into that stock. What was more important, a loving husband or 20 quarts of beef stock?

And always having sensible priorities, I said, "What the f***ing f***?! That was the f***ing beef stock I've been working on all day, and you threw it out? Why would you do that?!"

He carefully set the newspaper on the table and said (slowly, and with equal care, as any sensible man must do when dealing with a loved one's psychotic break), "It was on the right side of the sink. That's where we put everything that needs to be cleaned, right? On the right hand side of the sink?"

Silence again. How could he think that those bowls brimming with fragrant, glorious, homemade beef stock were something that needed to be discarded? Was he totally witless? Or was I? Because he was right: I had put them in the Goodbye Zone. I shook my head at him ("You got me!"), wearily refilled my wine glass and retired to the living-room with two dogs who were probably thinking, "That beef stock sure would've tasted good poured over my kibble."

Related: New WLS Approved! Orbera Intragastric Balloon

New WLS (weight loss surgery) Approved!

Oct 14, 2015

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How exciting to hear about the new WLS approved for those suffering from Obesity! The appeal of the Orbera Intragastric Balloon is that its temporary, unlike the other weight loss surgery options currently available, is less invasive and costs less.

Although the balloon is not covered by insurance, the fee is more affordable at between $5000 to $7000. This new weight loss surgery tool, coupled with education and counseling, could lead to a decrease in Obesity worldwide.

Very sincerely,

Marcy Palmeri

WL Solutions #viralwls #viral

Related: Defining Myself After Weight Loss Surgery

Defining Myself after Weight Loss Surgery

to define who you are after weight loss surgery, it's important to answer a few questions. The most important question may be "Who do you want to be"? However, before you answer that question, let's walk down the road of your past and define who you have been. You will discover qualities about yourself that you want to hold on to and develop as you move forward in life. You will also discover some things about yourself that it is time to permanently abandon. Life after bariatric surgery is most assuredly about redefining yourself. You have gone from seeing yourself, and being seen by others, as "the fat person" to being "that person who had bariatric surgery and has lost so much weight". It's easy to find yourself wondering who you are at this point, many pounds lighter than you were not so very long ago. You're probably tired of all of the comments and questions related to how much weight you have lost and how you have done it. It's time to start living the new life you have worked so hard for. However, you may be confused about who you are now that you have lost so much weight and the hype of the weight-loss process is over. You may find yourself staring into the mirror wondering, "WHO AM I"?

Let's find out, starting by identifying your "titles" or the "hats that you wear". Imagine you have a wall in your house with a great big board affixed to it. On the board are a number of hooks. On each hook hangs a hat and under each hat is a small sign with a label, one for each of the roles you play. For example, you may have a multicolored, floppy hat to represent the many dimensions and of being a "mom". There may be a fedora or a nursing cap or a chef hat with a label underneath that says "working professional". Is there a whimsical hat with a sign that says "friend"? A hat to represent yourself as a daughter? a woman? a spouse or partner? a dancer? a pianist? a photographer? a volunteer? a mentor? a student?

Make a list of your titles and alongside the list, state the benefits and drawbacks for you in each of these roles. Are there any roles that you want to eliminate? Are you at a place in your life where you no longer want to play some role on your list and that you can responsibly let go of? Maybe your parents forced you to play a musical instrument as a child and you continue to play in a community orchestra even though you don't want to. Would now be a good time to say good-bye to being a "musician"? There are some roles you may have that you wish you didn't, but you accept them because you are a responsible person. For example, you might wish you had a sun visor on the wall where your professional hat is because you want to be retired. However, you keep the hat of the working professional because you are a responsible person and have a family to feed. (Idea: Hang the visor underneath the professional hat as a reminder that the retirement hat is one you will be wearing one day!) Is there a role you would like to add to your life? Would you like to become a tap dancer and add a top hat to your wall? Are there some roles you love that you already have but would like to improve on? Would taking parenting class help you to be an improved version of "mother"?

Now make a list of words that you use to describe yourself and that other people use to describe you. Make this list of words descriptive of your personality. For example, are you "bubbly", "grumpy", "responsible", "gossipy", "adventurous", "whiney", "moody", "outgoing", "a good listener", "lazy", "serious", "silly", "friendly", "mean", "motivated", "introverted", "lively", etc.? Be sure to include the names you have been called related to your obesity, such as "fat", "chunky", and "husky". Were you called "smart", "stupid", "idiot", "baby doll", "princess", "daddy's girl", "spoiled", or "alcoholic"?

Next to each of these descriptive words, write down your feelings related to each of these labels. Which of these things do you want to continue to be? Which do hope to never hear again in reference to you?

Okay. You've got a really great start toward answering the question, "Who Am I"? You have identified the roles you currently play in life. You have identified words and labels that describe you. You have chosen which ones you like for yourself and which ones you are ready to leave behind. To get rid of the ones you are ready to discard from your life, write the words or labels on separate pieces of paper. Next, light a fire in the fireplace or a large coffee can and drop each piece of paper into the fire, and say out loud, "I am no longer a 'fatso'". Then throw the word into the fire and refuse to ever refer to yourself as that again. Do this with each word and label you are getting rid of.

The final steps to figuring out who you are at this time in your life are to verbalize and write down who you want to be! Simply state out loud and then write down, "I want to be and will be "a person who thinks positively about myself and others". "I want to be and will be "a person who plans what I eat every day and sticks to my plan". I want to be and will be "a person who exercises 60 minutes a day, five days a week". I want to be and will be "a person who focuses on gratitude throughout the day". That's the easy part. The more difficult part is to determine specifically what you are going to DO to be each of the things in your list. For example, "I will be a person who thinks positively about myself and others by stopping all judgmental thoughts as soon as I am aware that I am having them and by immediately replacing all negative thoughts with positive ones". "I will be a person who focuses on gratitude throughout the day by writing down one thing I am grateful for three times each day".

By specifically defining your goals and visualizing yourself doing them, you will do them and become the person you imagine yourself to be. Picture yourself eating healthy meals. See yourself walking the dogs. Imagine yourself giving genuine compliments to others. Picture yourself looking into the mirror and smiling kindly at yourself.

Decide who you want to be by:

• identifying who you have been
• deciding what parts of your previous self you want to keep and what parts you want to discard
• determining specific things you want to do and specific ways you want to behave.

Choose to become the person you were born to be before the "genuine you" got lost beneath unhealthy extra weight. "Who Am I"? Whoever you choose to be!

Connie Stapleton, Ph.D.

4/12

WLS Magazine

Related: Zero Weight Regain 2017

Zero Weight Regain 2017

What are your long term weight loss goals? Likely you have a positive, upbeat vision of a thin and healthy you. Bariatric surgery might be an option you are considering. Or you may have already undergone one of these weight loss procedures.

Given your dreams and all the hard work you are going through to achieve them, would it be a shock to hear: Many studies show that in the five-years following surgery, patients often gain back most or more of the weight that they had lost.

What makes it so easy to gain weight even after bariatric surgery Unfortunately, any bariatric surgery fails in the long term when not married to a maintenance plan.

Let's commit to zero weight regain in 2017. Are you with me? Who's all in? Then let's get started with some required reading. The following are good habits you can put into action right away!

Eat Healthy

The ball is down, Times Square is back to business as usual, and January 1st is bloated with stroke of midnight promises. As we close on January, the month of the year when the most traditional date for personal improvement offers itself up, it's a good time to check the progress you are making on your resolutions. Among those promises made is the pledge to get fit by eating healthy. If you are among those who share this intention, here are 10 healthy eating resolutions to get you started!

Read, "10 Healthy Eating Resolutions."

Build a Support Network

Patients voice concerns about the difficulty of establishing a bariatric support network. And they struggle to find the balance needed to address their personal recovery needs in the post-weight loss surgery world. Such concerns are well-founded and not unusual. But many bariatric patients meet that challenge and successfully build a viable, multi-dimensional bariatric support network. There is no reason why any person who has had weight loss surgery cannot construct a reliable and useful post-bariatric support network.

Read, "How to Build a Bariatric Support Network."

STOP Stress Eating

Knowing what we need to do can be quickly overturned by what we want to do. Stress demands relief. Harmful and unhealthy choices are often exercised to relieve stress because they are familiar. Emotional eating can provide that relief, but it is a short-lived solution that can have the side effects of overweight or obesity. And if you have had bariatric surgery, you are setting yourself up to regain weight that you have lost.

Read, "What to Do about Emotional Eating!

Step-up to Permanent Weight Loss

So, you've had bariatric surgery and think never again will food be a problem. Right? Well, its not quite that simple. Bariatric surgery is a powerful tool that helps you lose weight, but it is not a cure-all. Permanent weight loss requires more than a bariatric surgery. Permanent weight loss requires that we forever change the way we feel, think, and act around food. Follow our steps to turn "bad habits" in "healthy habits." They'll set you on a straight course toward permanent weight loss.

Read, "10 Easy Steps to Permanent Weight Loss!"

Be Committed!

Stay on your path to weight loss. It takes dedication. So be dedicated. It takes perseverance. So persevere. The surgery is not a means to an end. It is only the beginning.

Living larger than ever,

My Bariatric Life

http://www.mybariatriclife.org