Leaderboard

I have worked as a psychologist, providing psychological evaluations prior to bariatric weight loss surgery for the past eight years. For the most part, people need a power tool to help them lose and keep off the weight they have lost over and over again in their lives. The gastric sleeve, bypass, and now balloon are those tools. However, every once in a while, I will encounter someone who believes these procedures are the magic bullet. I can pick this up in five seconds when I learn that: this person has no exercise plan to maintain their weight loss a barrage of excuses as to why they can't exercise anymore zero insight into why they are overweight ("I don't know why I am overweight, I just eat steamed vegetables and grilled chicken mostly.") a lack of motivation or understanding for why they also have to engage in behavioral modification in addition to the surgery "Why would you reveal all of this?" you ask. Aren't I giving away the keys to the kingdom to anyone who reads this and wants to pass a psychological evaluation? Perhaps- but who are you really cheating if you don't go within and face the real demons that got you here in the first place? When I ask people about their eating styles, I tend to group them into four categories: 1) emotional eater- someone who uses food when they are bored, stressed, tired, lonely, sad, or even happy in addition to eating when they are hungry 2) skip and binger- someone who fails to think about food until it is too late, and when they are ravenous end up going for whatever is available which is usually some type of carb and calorie laden fast food 3) miscellaneous- someone who just recognizes that they eat too large of portion sizes and/or the wrong types of food 4) food addict- usually someone with a history of other addictions, trauma, and a significant amount of weight to lose. They usually have comorbid psychological diagnoses that have been unaddressed or ill-addressed. Out of the four categories, the 4th is the most troubling for a psychologist. This particular person is most correlated with the patient who fails to address their core issues, eats "around the sleeve," or bypass, experiences dumping syndrome, comes back a year later and asks for the bypass, or a different procedure. This is the person who, ironically, is usually the most resistant to my recommendation that they seek therapeutic support prior to the surgery. They want it done YESTERDAY. They want it NOW. It is this type of thinking that got them into trouble in the first place. The impulsivity and lack of emotional regulation. I've witnessed people fail to address their maladaptive eating patterns and never quite get to their goal weight. I had a male that would buy a bag of pepperonis at the grocery store and snack on them all day and couldn't understand why he wasn't losing weight. This daily "snack," which was a mental security blanket, served as a veritable IV drip of fat and calories throughout the day. I've had a woman who figured out how to ground up her favorite foods into a liquid form because she never quite let go of her attachment to "comfort foods." One of her most notable liquid concoctions consisted of chicken and Cheetos. I'll just leave that for you to chew...er swallow. They say with drug and alcohol recovery- you "slay the dragon," but with food addiction recovery, you have to take it for a walk three times a day. If you don't fundamentally shift your relationship with this dragon, you're going to get burnt when you are walking it. My number one tip for transforming your relationship with food is to start looking at eating the same way you do as brushing and flossing: You don't necessarily salivate at the idea of what type of toothpaste you will use, where you will do it, who you will do it with, right? You just do it twice a day because you don't want to lose your teeth and you want to maintain healthy gums. Food has to be thought of in the same way. You fuel up. You don't use food as a place to define your quality of life. You don't use food to celebrate. You don't use food to demarcate the end of a long day. You don't use food to help you feel less alone. You figure out healthier coping alternatives to meet these needs. Loneliness-call a friend for support Celebrate- get a massage Demarcate the end of a long day- start a tea ritual and use essential oils Another reason you must say goodbye to comfort food is that it triggers the pleasure center of the brain, which ignites our dopamine, which perpetuates the addiction. Many people think we are just telling them to get rid of the comfort food because of the carbs or calories, but there are unique and harmful chemical consequences to ingesting these types of food we know are bad for us. If you are ready to take a modern approach to weight loss and stop dieting for good- check out my wls/vsg psychological support course here for free.

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!

How do you know whether weight loss surgery is for you? Will it be the weight control solution you have been searching for for years? Or will it be a decision you regret? Nobody can answer that for you, but here are some considerations as you think about whether weight loss surgery is for you. The Qualifying Criteria You are not a candidate for bariatric surgery unless you meet certain criteria set by your surgeon or, if applicable, your healthcare coverage plan. The standard criteria are: Body Mass Index (BMI) over 40 or BMI 35 with an obesity-related comorbidity, such as type 2 diabetes, high cholesterol, or sleep apnea. Confirmation that your obesity is not caused by an underlying condition that would make weight loss surgery ineffective. A psychological exam to show that you are capable of sticking to the post-op diet and lifestyle changes that are necessary. Previous documented attempts at losing weight with diet and exercise. Ineffectiveness of Previous Efforts Weight loss surgery is a last resort, not a first try at losing weight. It is for patients who have been obese for years and who have tried to lose weight using lifestyle changes, such as a modified diet plan and a formal exercise program. Many weight loss surgery patients try “every diet under the sun” before deciding that it is time for WLS. They may have had trouble losing any weight at all, or may have lost weight initially but been unable to keep it off. Readiness to Change Weight loss surgery is just the beginning. The way you eat after weight loss surgery determines how well you will be able to control your weight for the rest of your life. You need to be ready to change if you want to be successful with weight loss surgery. No longer will you be able to down a pizza or hit the drive-through on a whim. Are you ready to possibly: Give up coffee and regular and diet soda? Cut sugary treats and fried foods, especially with gastric bypass? Pass on the alcoholic offerings at home, parties, and restaurants? Count protein, slash carbs, and measure portions? Addressing Other Issues Weight gain does not always take place in a vacuum, and weight loss does not solve other problems you might have in your life. First, identify why you became overweight in the first place, and what is keeping you from losing the weight. Is weight loss surgery the answer, or do you need to first deal with an abusive relationship or lack of self-confidence, for example? Emotional eating is a common reason for weight gain. If you tend to eat your feelings away, you are best off figuring out other ways to handle your feelings before you get surgery. Can you use walking as a form of therapy? Maybe you can join an in-person or online support group to turn to when you feel sad, lonely, or angry. If your emotional eating is related to a specific problem, such as stress at work, your best bet may be to handle the problem before getting WLS. That could mean finding a healthy coping mechanism, or it could mean getting counseling to help you work through the source of stress. It could even mean finding a new job, as scary as that sounds. Consider Replacement Addictions Replacement addictions are common after weight loss surgery. They happen when you give up food – which can be an addiction – for a different addiction. Instead of turning to food for comfort, entertainment, or companionship, some weight loss surgery patients turn to “replacement addictions” or “cross addictions” They may take up smoking, or start to abuse alcohol. Replacement addictions can also be healthier than eating; some weight loss surgery patients become gym rats or take up gardening, sewing, or other hobbies. As you consider weight-loss surgery, think about the possibility of food addiction being replaced by replacement addictions. What role does food play in your life now? What do you see replacing that emotional or physical role after surgery? The decision to get weight loss surgery requires a lot of soul searching for most candidates. These points can help you work through some of the doubts you may have as you try to decide what is best for yourself.

Food will not rule your life Once obesity sets in, life is about food, first and foremost. But after bariatric surgery, you’ll see that food isn’t really your ‘best friend’ anymore; it just keeps you alive, nothing more. Get ready to say goodbye to the constant worry about your next snack, next meal or which drive-through you’re going to visit. Going forward, you will learn that food gives your mind and body fuel to perform at its highest level possible. Food is not a crutch or a protector from the challenges of daily life. You’re going to feel so much better Preparation is the number one key to weight loss success. Before surgery, you’ll work with our Bariatric Navigator to start the process of changing what you eat. Go ahead and dump the junk food, the sugar products and empty carbs now. Your body doesn’t need artificially processed foods (nor does your family). After about a week or two of excluding these foods from your diet, you’re going to feel the difference. Read articles, blogs, magazines and books about healthy living. Prepare your body and your mind to make changes toward living a healthier lifestyle. By utilizing all of the resources from our comprehensive bariatric weight loss program, you will have many levels of support and education available to you. You are not alone in this journey Through your surgeon or hospital's bariatric program, you are going to meet people at all stages of the bariatric process. You will garner the tools to live a healthier life and learn how to meet and overcome obstacles. There is strength in numbers so seek out both live and online support groups. Sign up for a few and build relationships with people. You will be as big a help to them as they will be for yo u! Only you can change your mindset about food, exercise and weight The struggle against obesity is not just physical. It’s also mental and emotional. Having the courage and dedication to have weight loss surgery is a strong statement about your regard for your value and self-worth. The battle against obesity is complicated; if you feel you need psychological counseling services, we’ll be happy to provide you with recommendations based upon our patients’ feedback. You will be amazed that you actually like to exercise Once you are eating solid foods again, you can incorporate exercise into your routine, in most cases. Many patients enthusiastically report that weight loss surgery gave them a new chance to reap the benefits from working out. After weight loss surgery, you call the shots about what happens next. How will you reclaim your body, redeem your health, and start a journey toward a healthier quality of life? Discover or re-discover activities that you enjoy—start with walking around the neighborhood; jog/walk on a treadmill while you watch your favorite TV show or play ball with your kids (they will be elated, I assure you). Have you always wanted to hike? Take a water aerobics class? Try Yoga or Zumba? Embrace the new life you are creating for yourself. Dive in, try everything! The battle against the disease of obesity is often in the mind. When you see the physical changes happening, your mental outlook will improve as well. Seize that momentum and go after your goals with everything you’ve got. It’s well worth the effort.

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.