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Get the Go-Ahead Step 1: get your doctor’s approval! This can give you confidence that you are on the right track and that you are going to be safe while exercising. Find out whether you have any exercise restrictions such as type of exercise or a safe heart rate. Once your doctor gives you the okay, you have no more excuses! Walk, Swim, or Bike The first goals of an exercise program for beginners are often to get your heart rate up and burn a few calories. Walking, swimming, and stationary biking can be the safest and most comfortable options for many weight loss surgery patients. Start at a slow, easy pace without pushing yourself before you are ready. Only go for a few minutes at the beginning, and work up gradually as you get into better shape. Focus on yourself, and don’t compete with others’ paces or workout lengths. Stay positive, since it gets easier as time goes on! Pump Some Iron Walk into a co-ed gym, and you are likely to see two groups. The men are lifting weights, while the women are focused on cardio and tied to machines such as ellipticals, treadmills, and bikes. Which group should you be in? Both! While cardio, or aerobic exercise, burns calories and helps your heart, blood sugar, and other health measures, strength training has its own benefits. It helps you lose weight by building muscles, which burn more calories all day, and it improves your bone health. Strength training does not bulk you up; it makes you toned and lean. You have all kinds of options. Lifting dumbbells or barbells. Using weight machines at the gym. Pulling on resistance bands. Trying exercises that use your own body weight as resistance. Work on each of your major muscle groups, including biceps (front of arms), triceps (back of arms), shoulders, chest, back, hips, quadriceps (front of thighs), hamstrings (back of thighs), calves, and core – your abs and obliques. The ultimate goal is to work each muscle group at least two days per week, making it tired but not straining. You might want to ask a trainer or an experienced friend for help with ideas for exercises, as well as for demonstrations on proper form. You do not want to get injured! Do a Full Workout What is the difference between a workout and a full workout, you ask? The workout is the main part of your exercise, such as a brisk walk and/or a weight lifting session. A full workout starts earlier and ends later because it includes: A 5 to 10-minute warmup such as slow walking or easy cycling to gradually get your heart up from its resting rate to its workout rate. Your main workout, such as brisk walking, an aerobics class, or a tennis match. A 5 to 10-minute cool-down, such as slow walking on the treadmill or in the pool. 5 to 10 minutes of stretching to keep your muscles loose. The full workout takes a little longer, but keeps your injury risk down and lets you get more out of your workout and entire exercise program. Be Realistic Some exercises may not be comfortable or feasible when you are carrying around extra weight. Do not fight with yourself or get down on yourself. Just be patient. Do what you can, and you will gain new skills as you get in better shape. Exercise can be one of your greatest gifts to yourself on the weight loss surgery journey. It is hard and getting started is hard, but the rewards are well worth it. Good luck!

For equipment, think about bringing a shaker cup or small blender to mix protein shakes, carry protein powder with you (try single serve packets or put a single serving of protein powder in a small container or small zip bag.), carry a stash of utensils (plastic forks, spoons and knives), and bring clean up helpers (paper towels, napkins or wet wipes). If you are going to a hotel that has a microwave, bring microwave-proof dishes or paper plates to heat a frozen meal or leftovers. A small coffee maker can make a decaf cup of coffee you can add vanilla protein to make a latte or chocolate to make mocha type drink. Drink it hot or cool it down and put ice in it. If make a hot drink, keep the temperature under 140 degrees. If traveling in a car, bring a cooler packed with protein drinks, cheese sticks, cottage cheese, hard boiled eggs, light yogurt or protein snacks like the P3 Protein Packs. You can either buy the individual servings of yogurt or cottage cheese or get a larger container of these foods and divide into small, plastic containers. Be prepared to stop by a grocery store to purchase single servings of yogurt or cottage cheese. There are veggie-fruit-protein snack packs now in many of the produce section of grocery stores. Some convenience stores carry protein shakes and protein bars. These are usually found on shelves towards the back of the store. Other protein snacks include protein chips (Quest, Kay’s Naturals) and protein bars. Look for protein bars that have more protein than carbohydrates such as brands like Premier Protein, Pure Protein, Six Star Nutrition, Quest and Nature Valley Protein Bars. Pouches of tuna or salmon, or the tuna and chicken salad kits to make an easy meal. Softer texture jerky and nuts are other protein options. Pack your bags and pack your protein to have a great trip!

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.