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Finding unflavored protein in a single serve packet will allow you to sample a brand without having to buy the larger container first. Single serve packets of whey protein isolate are available online with Bariatric Fusion, Jay Robb and Unjury. Whey protein powder is also found in the bulk bins at Sprouts Farmers Market. You can buy a small amount to taste test. Our patients have also liked the larger containers of unflavored whey protein by brands like Inspire , Isopure (GNC, online) and online (online). Keep in mind, whey protein must be kept under 140 degrees, otherwise, it will curdle. Soy protein isolate is also available. Brands include GNC and brands like NOW Foods and Genisoy, which are available online and some natural foods stores. These will be in larger containers. Sprouts Farmers Market also has soy protein in their bulk bins, so that you can buy a small amount to taste test. Sometimes you can get a sample taste of unflavored protein in stores that sell natural foods, supplements and sports nutrition products. Ask about the return policy if you don’t like the product. There are many other brands of unflavored protein powders on the market. If you have a group of bariatric buddies, perhaps the buddies can buy different brands to try and share. This cuts the cost of taste testing. May your protein status be awesome!

In this space remember the importance of prioritizing good self caretaking, talking more kindly to and about yourself, embracing and feeling your feelings, setting boundaries, declining to engage in gossip or negative chatter, walking away from low energy people and situations, being gentle with yourself, not putting unrealistic demands on your time or energy, and understanding that it’s actually GOOD to be SELFish. Bring to the forefront of your mind your innate knowing of the absolute necessity of nurturing your soul with things like art and music and movement and nature and deep conversations with people you love, respect and admire. Let this Valentine’s Day be a Reminder that you need to Love YOU FIRST. That you need to be your most significant other <3! Live In Love, Louisa

Ask Questions Your advocate should get the information you need. Ask your surgeon how you can best prepare for surgery, what you can do to recover faster, and which mistakes he or she sees most often so you can avoid them. Find out how to contact your surgeon for post-op questions, and learn where you can go for support group meetings. You will need to ask plenty of other questions, too! As your own advocate, don’t be shy about asking anyone about anything. Read everything you can online and on BariatricPal, then use the forums to ask about anything you’re not sure about. You are sure to get all kinds of helpful hints that you never expected! Provide for Your Needs Life does throw curve balls, but your basic needs stay predictable. You know which foods and fluids you will need in any given day, so make sure you have them. Plan your menu for each day and go grocery shopping for the week so you are sure to always have the food you need around. Always keep a stash of “extras” in case of unplanned circumstances. Have instant protein meals and other staples in your pantry for last-minute meals. Keep protein bars and nuts in your car, your gym bag, and at work. Have different flavors of protein powder for whenever you find yourself hungry and without other options. You can also help yourself out by planning ahead. For example, if you’re going to a party, make sure you will have the foods that you will need for that time without needing to wait until after the party to eat or depending on the host to provide healthy proteins. Stick a protein bar or some nuts in your pocket or purse, or bring a healthy dish to share and nibble on yourself. Be Your Own Planner If you were taking care of a child with certain needs, you would schedule them in, make sure your child had the materials needed, and get your child to where he needed to go. If you have children, you may keep track of their homework, take them to after-school activities, and make sure they get the nutritious meals and proper sleep that they need. You would keep healthy foods around and provide them with the pencils and sports equipment that they need for school and extracurricular activities. Why wouldn’t you be just as good to yourself? Provide the same level of self-care for yourself as you do for your family. Keep healthy foods on hand, and schedule your own exercise and meal planning in and keep your commitment just like it was school. Prioritize your commitments, just like you would do for your children. Your meal prep and workout time is important, but so is relaxation time with your family or friends, or by yourself. Over the long term, balancing work and play can keep you on track but satisfied. Speak up When Necessary Keeping quiet can sometimes seem easier or more considerate to others, but keeping a low profile can work against you sometimes. Learn when it makes sense to speak up for yourself. For example, at restaurants, the server may be willing to bring you what you ask for (like a slab of plain chicken breast or the kids’ meal), but will not even know that is what you want (and need) if you do not say something out loud. You may find that you need to explain your weight loss surgery as a medical condition to get your server to honor your request. These are some other times when you should not keep your mouth shut: When someone pressures you to eat something that's not on your diet. When you do not understand your surgeon’s or nutritionist’s instructions. When you need help around the house or preparing your food. Learning to be your own best advocate can pay off in a big way, as you will always have someone looking out for your best interests. It is one more thing you can do to help yourself succeed in your WLS journey.

Bigger from Birth…And Then College Hit Michele was always big. She was at the top of her height and weight charts from the time she was an infant. She remembers times in her childhood when she couldn’t or wouldn’t participate because she was so big. She didn’t like physical education or sports, and the other children teased her. Food was a comfort. Michele describes the situation as a vicious cycle. The more kids teased her, the worse she felt. The worse she felt, the more she ate. The more she ate, the more she weighed. The more she weighed, the more she got teased. College was a disaster in terms of her weight. Forget about the freshman 15. What about the freshman 40? And the sophomore 40? Add to that the junior 40, the senior 40, and, for good measure, the super-senior (fifth-year) 67, and you now know how Michele Elbertson got to be 427 pounds at the age of 22 years. A Young Weight Loss Surgery Patient with New Relationships Michele made the decision to get the lap-band on her own. She needed a tool to help her control how much she ate, but understood that it was up to her to control what she ate. She only told her parents about her decision after she was sure about it. They were supportive, and have been since then. Michele has taken full advantage of and responsibility for the band. She has lost 260 pounds – 260 pounds! – in less than four years. As she says, she’s a determined person who will accomplish anything she sets her mind to. Michele began to “eat to live” rather than “live to eat.” As her relationships with food and exercise changed, so did her relationships with some friends. She lost some friends whose relationships centered only on food. She gained many more, though, through her new activities. She says the friends she’s gained through running and fitness far outweigh those she lost by changing her lifestyle. An Athlete Is Born Michele ran her first 5k after losing 100 pounds – when she was still 327 pounds. She was hooked. She loved the training, the atmosphere of the race, and the accomplishment. She has never looked back. Since then, she has run countless other races, including 38 half-marathons, 6 marathons, and a 50-miler ultra-marathon. She has also competed in triathlons. Now at an athletic 159 pounds, Michele has her sights on even greater challenges. In the near future, she wants to run a 100-miler and complete an Ironman. Both are feats that most people wouldn’t even dream of. Marathons, Ultras, and Ironmans Now, not everyone’s a distance runner or triathlete, so to understand Michele’s accomplishments, here are a few facts about these endurance sports. A marathon is 26.2 miles. All marathons are 26.2 miles. An ultra-marathon is anything over 26.2 miles. Michele’s recently completed ultra-marathon was 50 miles, and she is training for a 100-miler. A triathlon includes swimming, biking, and running. An Ironman triathlon consists of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile marathon. Fitting It All in Every Day Michele works out 6 days a week. Currently, she’s training for an ulta-marathon and is running 5 days a week and lifting weights 3 times. She also does Zumba classes. She takes a rest day once a week. Michele has built her life to be able to accommodate her training schedule. She recently quit her teaching career to focus instead on helping others achieve their fitness and health goals. She is a personal trainer and group fitness instructor. Working at a gym is pure genius – it leaves her with no excuse not to get her workout in! Eating Like a Bariathlete How do you have energy to train like an athlete and work full-time while losing over 200 pounds in 4 years? Ask Michele. Here’s how she eats and works out in a typical day. 7:00 a.m. breakfast: almonds and yogurt or eggs/romaine lettuce 9:00 a.m. snack: protein bar Workout, such as running, lifting, or group fitness class, such as Zumba or bokwa Noon. lunch: soup or salad, usually the largest meal of the day 2:00 p.m. snack: cheese and crackers or something small, equivalent to 200 calories (may include a fruit or vegetable) 4:00 p.m. snack: hot tea 6:00 p.m. dinner; lean protein, veggie, possibly a carb 7:30 p.m. snack: lemon water/hot tea. The number of calories Michele eats during a day is 1,800 (her resting metabolic rate) plus half of the calories she burns through exercise. So, if she runs 10 miles and burns 1,200 calories in exercise, she’ll eat 1,800 plus 600 calories, or 2,400 calories. She allows herself an occasional treat meal with junk food, but still counts those calories. The Accolades Michele is more than your typical bariatric patient, and she’s been getting the recognition she deserves for her extraordinary achievements. These are a few recent examples. Runner’s World magazine Cover Contest Finalist. Makeover on the Rachel Ray Show. Local feature on 6ABC Action News in Philadelphia. Dealing with Negativity – Don’t Worry About It One of the most striking things about Michele is her drive. She has worked very, very hard to get where she’s at today. She’s lost 60 percent of her body weight through being very disciplined every day. And, she has run marathons. Anyone who has run a marathon can tell you that it is was harder than they had ever imagined. Anyone who hasn’t run a marathon cannot imagine how difficult it is. But with all the publicity, Michele has receive a lot of nasty comments. How is she supposed to react when people slam her? They say she hasn’t accomplished anything, that the band has done it all. In fact, they basically say what a lot of weight loss surgery patients hear all the time from people who don’t know any better. So how does Michele react to negativity? She doesn’t want to respond directly and add “fuel to the fire.” She knows they don’t know anything about her, and she’s probably done more exercise and worked harder than they ever have. So, she just goes about her business. Leading by Example Michele says she hopes her successes and story will give others hope. She describes herself as a “real person” and “very down-to-earth,” and she hopes others will see that they can accomplish what she has. In the future, she would like to travel to seminars as a motivational speaker. In the meantime, we congratulate her on her amazing story and wish her well in her 100-miler this spring!

If you’ve made a commitment to change your diet, learn a new exercise routine, start or complete a project, be more assertive, or maybe connect with your intuition on a daily basis, know that you DO have the POWER to follow through with this. Set an intention to connect with and magnify your inner strength and focus. Often when we set out to make changes in our life we start obsessing about it and think way too far into the future which can overwhelm us: then we just say “Oh the heck with this: I’ll never be able to do that huge project or maintain that habit forever, why even bother?” If you notice your thoughts going in that direction slow down, take a deep breath, and get out of your head and into your body. Come back to the present moment. Take another breath. Ask “Is there one simple thing I can do in this moment to honor my commitment?” That might mean just not putting a piece of chocolate in your mouth in this moment: That’s it you did it! And I know you can do that again in the next moment!! Perhaps you will be guided to make a phone call. Pick up the phone and make that call. Or, there might not be anything you need to do in this very moment so relax into the not doing. It is important that you keep yourself surrounded by upbeat positive people and that you raise the vibrations of your surroundings as much as possible. Burn sage, put a crystal on your night stand or desk at work, keep plants and flowers in your environment, listen to uplifting music. Shield yourself from negative energies. Many of you who are drawn to read this are highly intuitive empaths: your are like psychic sponges who absorb the energies of the people near you and your environment. As part of your morning routine surround yourself with a beautiful white light ( or whatever color feels most safe and loving for you). The only thing that can penetrate this light is love and healing energies, no negative energy can pass through this. If you believe in angels, spirit guides, or any other sort of deity invite them to be with you throughout the day guiding you and keeping your thoughts and feelings uplifted and positive. Whenever possible remove yourself from negative situations, decline to engage in gossip or fear based conversations. Anger, negatively, jealousy and fear will only cause you pain. Clear your energy field daily: meditate, spend time in nature barefoot, take baths in epsom sales, move your body, drink plenty of water, etc. Law of Attraction/Source Energy is rooting for you and right by your side giving extra added energy to your thoughts. So keep your thoughts and focus on what you DO want to manifest. See yourself as happy fulfilled and loved….and know that is is so….. Feel gratitude knowing that your life is moving in the direction of your dreams gaining more and more momentum as your willingness to believe and receive all that is being offered to you opens and increases. BELIEVE and RECEIVE!! I'm sending you so much love! Go have an awesome day!! ❤️ Louisa!!

When new bariatric patients come to my practice, one of the first things we discuss is how unimportant the operation will be for them, in the big picture. Once they recover from the shock of that news, we explain that their mindset contributed to their weight problem, and their mindset will be the secret weapon to ultimately get the weight off. Here’s the thing--we don't operate on your brain. Bariatric surgery will only take you so far. Long-term weight-loss success requires a firm commitment to living a healthy lifestyle—eating the right foods--and ignoring the others that made you feel bloated and too tired to do anything. You need to stay very well hydrated and discover an exercise (or two or three) that you perform about 4-5 times a week for about 30-40 minutes. Take this stress and… Then there’s the stress of everyday life—we all have it. The trick is to find ways to offset these unavoidable pressure points, so that you aren’t on a one-way road to the kitchen. Food is not the answer to your problems, it never was. While you are improving your health, feed your brain with positive feelings by improving the quality of your life. Make the effort to become more social: Join a gym, catch a movie with a long-lost friend, invite the nice parents of your child’s best friend over for coffee. Give a little, get a lot One of the activities I recommend to every bariatric patient is to give back to their community. Want to feel better than any junk food could make you feel? Volunteer. If you look around, you’ll see that you’re far more fortunate than you may realize. Help out, make life better for someone else, even in a small way. Give your time, give your heart. Everyone needs a little help If you think you can’t go it alone, reach out to your bariatric or family doctor to ask for resources who can offer mental health support specifically for people with food/weight issues. You are never in this battle alone, always remember that.

“Do you think I should keep taking my sublingual B12, Elizabeth?” Roxanne* is 3 years post op from her gastric sleeve and is wondering if the expense of the meltable supplement is worth it. “I’m not sure, what does your latest B12 lab show?” I respond. “Uh…..I haven’t had labs done in, well...years,” Roxanne admits. And she’s not alone. Scores and scores of WLS clients intend to keep up with the required post op labs but life gets in the way. People, I am here to tell you, if it has been a long, LONG since you’ve had your specific bariatric lab work done, run, don’t walk, to your nearest phlebotomist. Every few years, the Obesity Society (TOS), the American Society of Metabolic and Bariatric Surgery (ASMBS) and the American Association of Clinical Endocrinologists (AACE) update medical guidelines for bariatric surgery patients. They have a list of labs that need to be done at 3 and 6 months and those that need to be done annually. Yes, every-single-year, after surgery. Why? Believe it or not, vitamin and mineral deficiencies increase over time—regardless of your WLS procedure. I know many PCPs push back against ordering these regular labs--whether it’s the cost to their practice, the patient or both, many providers don’t understand the necessity for the work-up. What concerns me the most is that the damage from some vitamin and mineral deficiencies cannot be undone or corrected. The damage is permanent. A psychiatrist speaker at a recent convention I attended, talked about patients he’s seen that were 6-10 years post op that were suffering from mental health issues--sometimes incapacitating problems. When he looked at their lab work, he was shocked to see that for some patients, vitamin and mineral deficiencies were the sole cause. If your provider pushes back against these labs, I’m happy to provide you with the link to the scientific paper citing which labs need to be done and when. You can share this with your provider and insurer. Roxanne is off having her B12 checked as we speak. Armed with those results, we’ll be able to determine the most affordable and healthful path forward, specifically for her. You deserve the same so make that appointment today. I thank you. *names of clients have been changed

Without a doubt, obesity is stigmatized. The unfair bias that you face may be a major factor in your decision to consider or get weight loss surgery. Unfortunately, you will probably find that the obesity discrimination continues even as you try to use weight loss surgery to get healthy. Obese patients are blamed for their conditions, healthcare providers are not always sympathetic, and coverage for weight loss surgery is not guaranteed. Why Do Obese Patients Get So Much Blame? People are increasingly sympathetic to diseases that used to be stigmatized. Examples include cancer, many mental health conditions, and sexually transmitted diseases such as HIV/AIDS and syphilis. Now, treatment for these and other conditions, such as diabetes, is widely accepted as normal and an entitlement. Each of these conditions is largely the result of lifestyle choices, such as diet, use of tobacco and/or alcohol, sexual behavior, and physical activity levels. More than 80% of cancers are likely the result of lifestyle choices. Ironically, though, many people in our society remain unsympathetic to obese people. They are quick to blame obese people for having no self-control, for refusing to follow a diet, and for not wanting to be healthy. You know, though, that those accusations are far from the truth. If you are considering weight loss surgery, you are confident that you have the self-control for the weight loss surgery diet, that you have tried to follow numerous diets but none have worked for you, and that you desperately want to be healthy! You Did Not Ask to Be Obese: Some Factors are Outside of Your Control More than one-third of American adults are obese, and another third are overweight. That in itself should remind you – and the people who judge you harshly – that fighting obesity is hard! The food environment includes fast food, vending machines, restaurants, food-focused social gatherings, and inexpensive snack foods. There are also biological and family factors that you cannot control. Skinny people have no idea that you may be feeling extreme hunger all day, every day, or that your metabolism may be slower. Your family might have raised to choose high-calorie, high-fat foods, or even driven you into unhealthy emotional eating. Research shows that some obese patients’ brains even respond differently to food compared to lower-weight individuals. Obese individuals, for example, tend to get less pleasure out of food, meaning they need to eat more to get satisfied. Furthermore, high-calorie foods like sugar can be addicting, leading to the same brain responses as cocaine does. But nobody blames cocaine addicts for their situations! Instead, they encourage counseling and intensive program to help them overcome their addictions, not punish them. Discrimination in Obesity Treatment: A Look at Weight Loss Surgery Versus Dialysis Just as unfair is the fact that the healthcare system continues the discrimination against obesity. Compare weight loss surgery as an obesity treatment with dialysis as a treatment for kidney failure (end-stage renal failure). Far from being blamed for their conditions, kidney failure patients who need dialysis are provided the respect that all people deserve and the medical care that they need. Dialysis patients of all ages in the United States are able to apply for Medicare, the government’s health insurance program normally reserved for older adults. Dialysis treatments can cost about $40,000 per year, not including This is not to mention human factors such as reduced quality of life (the vast majority of dialysis patients are too sick to work) and early death (the life expectancy of dialysis patients is about 5 years). In comparison, a typical weight loss surgery procedure in the United States can cost $20,000 to $40,000, although it can be less, and successful patients are healthier and have more energy than before surgery. The irony increases. The fact is that kidney failure usually results as a complication of type 2 diabetes or high blood pressure (hypertension). Both of these conditions are often caused by obesity; losing weight after weight loss surgery can prevent, eliminate, or reduce these conditions. In addition, it takes years for kidney failure to develop once you have high blood pressure or diabetes – years during which patients are likely to be on costly medications and inconvenient treatments. Targeting obesity through weight loss surgery could prevent cases of diabetes and high blood pressure, reduce their effects in people who already have them, and prevent kidney failure, the need for dialysis, and early death. Searching for Fairness in the Medical Treatment of Obesity Your first barrier in your path to weight loss surgery may be your primary care physican (PCP). Some PCPs do not know much about weight loss surgery, or may be against it because they think obesity is your fault. Some PCPs take a narrow view of obesity, and feel that the only way to lose weight is for patients to “decide they want it badly enough” and “just eat less.” You already know that doesn’t work, so don’t let your PCP discourage you from learning more weight loss surgery if you think it might be the solution to your obesity struggles. Insurance coverage has improved for obesity treatments, especially for weight loss surgery. Medicare and many private healthcare coverage plans cover weight loss surgery if you meet their predetermined weight and/or health criteria. Some private insurance companies, though, take a short-term view because they want to make profits within 3 years. Since most weight loss surgeries do not pay for themselves within 3 years, some private insurers do not cover weight loss surgery despite the likelihood that they would pay for themselves within 5 or 10 years, and in addition improve your health and quality of life. Chance of Reduced Discrimination in the Future? The majority of Americans believe that health insurance should cover weight loss surgery, in addition to other obesity treatments such as dietetic and mental health counseling. The Affordable Care Act (“Obamacare”), though, is not the ultimate solution. In nearly half of states, obesity treatments are not required to be covered by plans sold on the health exchanges. This determination is based on the available competitive services in the region. Since the most obese states are the ones least likely to have competitive anti-obesity care, these states are also least likely to have obesity treatments covered under the Affordable Care Act. Overcome the Discrimination Discrimination is an unfair fact of life as an obese individual, and it unfortunately does not end when you decide to get healthy using weight loss surgery as a tool. These are some of the ways that you can keep going strong and overcome the barriers you encounter as you work to get healthy. You have the right to a second opinion if your primary care physician recommends against weight loss surgery but you would like to find out more. Do not take “no” for an answer from your insurance company if you know you are entitled to reimbursement for surgery. Do not listen to negative family members or friends who do not understand your obesity or interest in weight loss surgery. It is your life and health. Educate others as much as you can to try to reduce the discrimination. Chances are that they are only being discriminatory out of ignorance, not out of true mean-spiritedness. Like it or not, some discrimination remains as you go through your weight loss journey. You cannot prevent it, but you can change how you react to it. Expect it and respond as positively as you can, keeping your own health and goals in mind. Over time, as you and others prove that weight loss surgery can be a worthwhile treatment for obesity, discrimination by insurance companies, healthcare providers, and the public will decrease.

I often tell patients, “The surgery does what the surgery does.” What I mean by this is that weight loss surgery almost certainly will affect how much food you can eat, but may do little to change what you eat. Weight loss surgery does not make you suddenly crave healthier and less caloric food. You have to make those choices for yourself. Additionally, while losing weight may make it easier for you to adopt a more active lifestyle, surgery itself will not make you suddenly fall in love with exercise. So making health behavior changes in addition to having surgery remains critical. So what specific health behavior changes have been shown to improve outcome? 1. Document what you eat – Many people strongly dislike writing down what they eat but there is evidence that this helps people after weight loss surgery as it does with non-surgical approaches. The reason is likely that documenting what you eat gives you valuable information about your behavior and allows you to make changes when necessary. Consider that your actual weight is the end product of what you eat, so weighing yourself gives you the results, but not the information necessary to make changes. For many, weighing themselves is a pass-fail exam. Either I’m a good boy or a bad boy. Consider that you can’t actually change your weight…you change what you eat and/or exercise, and that is what helps change your weight. Many people seem to have little or no objection to weighing themselves so why do so many people despise writing down what they eat? Writing down what you eat is the truth teller. It forces you to acknowledge what you are doing. To avoid seeing the truth, you can either change what you eat or stop writing it down. Unfortunately, many people choose the latter. The good news is that in the smartphone era, there are literally dozens of apps and other technological devices that can make documenting your food and activity level extremely easy. If you do a little research you can find one that is right for you. 2. Exercise – You probably saw this one coming as well because it makes sense. Regular exercise is a way of burning calories and losing weight that does not involve changing what you eat. Given how difficult it is to lose weight and keep it off, it would be silly not to take advantage of one of the few methods known to work. Ironically, it might not work the way you would expect. Many people who lose weight through exercise notice that it helps them not just by burning off calories, but also by affecting their food choices. In other words, when you discover how difficult it is to burn off 250 calories on a treadmill, you may think twice before having that chocolate bar afterwards. Not everyone finds this effect, but for those who do, it can make a big difference. When deciding what form of exercise to do, consider that you don’t need to become an Olympiad or a marathon runner. Many of the positive effects of exercise have been documented with just walking 30 minutes 3-4 times per week. If rigorous exercise is enjoyable for you, that’s great. But any time spent engaged in activity is beneficial...especially if you would otherwise be sitting on the couch watching all of those tempting food advertisements on television! 3. Stress Reduction – An increasing amount of research has documented a relationship between stress and weight gain. The obvious connection is that many people use food as a means of comforting themselves from distress, commonly called “emotional eating.” An interesting new discovery is that is that some people who report high levels of stress gain weight even when their calorie intake is unchanged. How is that possible? There is the suggestion that stress hormones and other chemicals may affect how our body metabolizes food and stores food. So even if you’re eating the same foods and the same number of calories, what your body does with those calories can vary. If you’re going to be successful in reducing stress, you need to begin by discovering what “pushes your buttons” and take steps to change. One first step could be to document the things that you find to be stressful. Sometimes just writing down your problems makes them less frightening now that they’re just words on a page. For other people, writing their sources of stress naturally leads them to write what they might do about them. Another good idea is to investigate some simple stress management techniques. Many refer to them as relaxation or meditation exercises. As discussed earlier, there are a number of excellent smartphone apps and other technology-based methods of relaxation that you can explore. No one is better than the rest so just find one that works for you and begin to incorporate relaxation/meditation into your daily routine. If reducing your stress requires more than practicing relaxation techniques, consider speaking to a psychologist or other mental health professional to get the help you need. 4. Get some sleep – Here’s another suggestion that you’ve probably seen in the media recently. There is growing consensus of an obesity-sleep connection. Like exercise, the benefits of sleep are more than meets the eye. The obvious connection is that if you’re up longer, you become hungrier and are likely to eat late at night. This interpretation is not wrong, however, new research suggests that people who get 7 or more hours of sleep tend to maintain lower weights even when people with fewer hours of sleep consume the same amount of calories. How is that possible? Again, it’s not just how many calories we eat…but what our bodies do with those calories. Unfortunately, an increasing number of people are so busy between their work and social lives (not to mention all those tempting television shows) that sleep is not a priority. Just know that making sleep the last priority comes at a cost. Consider how we train children to sleep. We create a nighttime ritual to ease kids to bed. There’s dinner, wind down time, then bath time, maybe reading a story or two in bed, and then lights out. Many adults however have a terrible routine. Eat a big dinner at 9pm, catch up on emails and pay bills, watch television for an hour or so and then fall asleep on the couch and stumble into bed at 2AM only to have to wake up three or four hours later. Try to change your sleep habits by changing your nighttime ritual. Eat an earlier dinner. Try to pay bills and check your emails at another time. Use the evening as wind down time. Rather than fall asleep on the couch, watch a set amount of television or Internet time and then turn it off and “put yourself to bed.” Begin by trying to go into bed a half-hour early every night for a week and see how you feel. If you notice some improvements in your level of energy, mood, appetite or other factors, see if you can make it permanent. 5. Join a Support Group – Some research has demonstrated that patients who participate in support groups lose and maintain more weight than those who don’t. Of course it may depend on the content of the group and who attends, but adding a social element to your weight loss and weight maintenance goals seems to help. This may relate to the accountability factor discussed earlier. If “we’re all in it together,” there may be more of a commitment to stick to your goals to help out the group. Or perhaps it motivates you not to be the one group member who is falling behind. Either way, participating in support groups seems to have benefits both in terms of weight loss as well as emotional well being after surgery. There are other suggestions of course, such as improving your diet by reducing carbohydrates in favor of lean protein and a more plant-based diet. However, for many people, changing their diet can push all of those emotional “diet” buttons; so before you make those changes (or in addition to making those changes), strongly consider some of the changes recommended above. There is evidence that the benefits are additive. For example, many people find that when they exercise, they sleep better and in turn these changes help them manage stress better. The key is to acknowledge whether or not some of the factors above are problem areas for you and to begin making small changes. Sometimes small changes can lead to big results!

Have you ever caught yourself watching TV at night and feeling lonely, bored or sad? Your partner may be sitting next to you or in their favorite chair, but you get up anyway; making the routine trip to the freezer to fix a bowl of ice cream, which will provide the comfort you are craving. It may not be ice cream; your comfort food may be a bag of Doritos, a pizza delivery, or a can of coke and leftovers from dinner. You aren’t really hungry, you may feel miserable, but the effort it would require to hug your partner, or become intimate with them isn’t as easy or comforting as food. People who struggle with weight often times struggle with intimacy as well. This struggle extends beyond their family, and affects their personal friendships as well. Eating for comfort may lead to more isolation. The more weight people gain, the less they want to mingle and the more they worry about what others will think or say. Have we become a society of people medicating with food in order to feel better? Have we stopped turning to loved ones for support and comfort in lieu of food? Yes and no. Although overeating has always been a problem, the stress of technology speeding up our lives and forcing us to bring home more work, or never leaving work at work, we are all working more and more, and feeling less and less connected with those we love most. We return home feeling exhausted and overwhelmed. Rewarding ourselves with food is a lot easier than becoming vulnerable and open to criticism from our partner or friends. There are other reasons more people are turning to food for emotional comfort rather than a relationship. You don’t have to leave your home to get comfort. Food delivery is available within blocks of our homes. Food is easy; you don’t need to invest any effort or time. You don’t have to get dressed to enjoy comfort food. You don’t have to look handsome, desirable or pretty for food. Food doesn’t judge you, leave you, or criticize you. Eating a delicious dinner is longer and more enjoyable for many people than sex (the average length of lovemaking is less than ten minutes). Food doesn’t cheat on you. Food is available anywhere, anytime, and for any reason. Food may be tied to memories of love and childhood which makes you feel loved. Food doesn’t require a partner. So is it a bad thing if we prefer gourmet truffle macaroni and cheese along with a filet mignon and a fresh garden salad with gobs of ranch dressing? Is it bad to add chocolate mousse if you’ve had an especially rough day and need an additional reward? It’s not a judgment call of right or wrong, but it can be adding to your unhappiness and health. Intimacy with another is important. When you are intimate with someone they want you to be healthy; choosing food for comfort rather than reaching out to them would be hurtful or a sign of rejection. There are other reasons you need to find comfort in one another rather than food. Below are a few. Intimacy shared with another gives you a deeper connection. Intimacy doesn’t leave you with guilt, feeling disgusted, or body hate. Intimacy helps you lose weight, not gain. Intimacy lowers your heart rate. Intimacy lowers your blood pressure. Intimacy won’t cause diabetes. Intimacy is good for your heart. Intimacy improves your thinking. Intimacy is exercise and exercise is good. Intimacy won’t leave you feeling isolated. Intimacy doesn’t take your mobility away. Intimacy doesn’t cost anything. Intimacy doesn’t make your hips, knees or ankles hurt. Intimacy makes your brain work better. Everyone understands the feeling of working and having a bag of chips or a package of cookies nearby only to realize at the end of their task the bag or package is completely gone. They were eating them mindlessly. Eating to calm anxiety is more and more common. The primary reason for relationships growing apart is due to couples choosing other vices to fill the void they feel. Becoming aware of your behavior and what you are eating, as well as writing down what you eat (we forget) is a good way to begin eating less and becoming more in touch with the emotions you are repressing with food. A simple practice of not eating past 7 or 8 pm can help you lose weight, and communicate more with your partner, family or friends. Breaking the habit of turning to food is not easy, but with practice it does work. Intimacy and sex are better for you than food! –Mary Jo Rapini