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1. Hummus. Despite being made from chickpeas, the average store bought hummus has only 1 gram of protein per tablespoon. Instead, opt for homemade hummus, homemade black bean dip or homemade Tzatziki (made with Greek yogurt) as dips for your veggies. All of these dips are significantly higher in protein when made at home compared to their store-bought counterparts. 2. Chicken broth. Surprisingly, the average store bought chicken broth has only 1-3 grams of protein per cup. For this reason, your bariatric team likely recommended you choose higher protein soups immediately after surgery (ex. milk based soups or pureed legume soups). Instead, opt for more filling thicker soups, such as a curried lentil soup, a roasted red pepper black bean soup or a hearty chili. 3. Cream cheese. Despite ‘cheese’ being in its name, the average store bought cream cheese has only 1 gram of protein per tablespoon. Instead, opt for ricotta cheese (with a sprinkle of sunflower seeds and a drizzle of honey!) or peanut butter on your morning toast. 4. Quinoa. Quinoa is a filling grain product not because of its protein content, but more because of its fibre content. While quinoa is the only grain listed as a ‘complete’ protein, it only has 2 grams of protein per ¼ cup of cooked quinoa. Always top your quinoa with a true protein source such as meat, fish, legumes, tofu or tempeh to make your meal truly balanced. Quinoa should not be the main event! 5. Almond/Cashew/Rice/Coconut milk. Despite these beverages having ‘milk’ in their name, these alternative milks contain on average a measly 1 gram of protein per cup. Instead, opt for cow milk or soy milk when you are looking to add an extra splash of protein to your cereals, oatmeal or smoothies. Moral of the story? Don’t let misleading product names or sneaky advertising fool you! Get the facts. Always double check the nutrition facts tables on the back of your foods to learn the full story. - Monica & Lisa

Craving sushi? You likely will not be able to tolerate your favourite sushi rolls because of the rice and seaweed wrap, however there are several other equally satisfying options on every Asian-style restaurant menu to consider. Indulge in an order of tartar or sashimi. These rice-less options are easier to digest. Don’t be afraid to ask if your favourite sushi rolls can be made with a cucumber wrap instead of the traditional seaweed wrap. This is often a ‘low carb’ option on sushi menus. Order a side of edamame beans. These soybeans are not only a good source of protein, but they are also rich in fibre. Try a protein rich Asian soup. Asian-style restaurants often have a traditional soup with eggs, tofu, chicken, and/or shrimp. Prioritize the solid pieces and leave most of the broth behind. Salmon or tuna salad. Most sushi restaurants have a simple green salad with a seared piece of fish and a flavourful salad dressing. Sandwiches & Wraps· Choose a sandwich on toasted bread. If it is a large sandwich, remove the top piece of bread. Great options include: chicken salad, egg salad, tuna salad and deli meats. Wraps are also a good option. Opt for baked chicken rather than crispy chicken. Breakfast egg sandwiches Choose a breakfast wrap or a toasted english muffin sandwich. Skip the bacon and sausage. Salad Almost all restaurants now have a green salad with chicken. Again, opt for grilled chicken instead of crispy chicken. Other high protein options include: taco salads, chickpea salads and bean salads. Chili Whether you choose the vegetarian or meat version, chili packs a lot of protein. They are also very easy to digest making them the perfect option if you have recently transitioned to solid food. Here are some other helpful tips to challenge those old fast food habits: Skip the combo option… yes, even if it’s cheaper! Don’t order a drink. You will be less tempted to drink and eat at the same time if you don’t have a refreshing beverage staring you down during your meal. Eat in the restaurant instead of in the car. If you are driving and eating, food is more likely to block. You can’t be mindful if you are multitasking! Choose foods described as: grilled, baked, sautéed, broiled, steamed, boiled, etc. more often. These cooking methods are lower in calories. Many corner stores and gas stations now have ‘grab and go’ options in their fridges such as sandwiches, salads, protein shakes, yogurt parfaits, etc. Next time you get gas, make a mental note of 3 appropriate meal options you could choose if you were in a pinch. Bon appétit!- Lisa & Monica

Weight shaming is nothing new. I would beg to guess that most children who’ve struggled with weight have been victims of weight-based bullying. I can remember, as a shy elementary school kid, rapidly gaining weight and being different from the other children in my class. This impacted my self-image as I grew up, and my school days were rampant with daily bullying. The damage this did to my self-esteem carried over into many aspects of my life. As a therapist, I had to confront those ideas I had about my value in therapy as a graduate student. I had to stop blaming those kids, and instead, change my thinking to change my life. Today, in the first few days after my 20th High School Reunion, I realize I had to fully let it go. The children and young adults that once ignored me or superficially friended me were not completely at fault for their behaviors in grade school, I was at fault for carrying their bad behavior with me and perpetuating those negative comments in my daily life. It has always been my belief and a widely accepted professional self-care philosophy that you must work on your own issues actively to be able to help others. To do the real work on your own issues, it is essential to identify where those issues originated. How you got to that place of brokenness often brings back memories of humiliation, shame, mocking, and criticism from people you’ve known throughout your life. I had to actively challenge myself to overcome those negative memories of grade school and not shy away from attending like I did my 10-year reunion, so I got involved. I challenged myself to head up the 20-year reunion effort by rallying the troupes. I put myself in a position that gave me no way out by researching venues and getting the committee together. I conquered my anxiety about what those people would think about me now. And you know what, I enjoyed my time at the reunion. It helps that I also weigh at least 150 pounds less, but as I’m sure many of you know, anxiety doesn’t go away automatically when you lose weight. To conquer my anxiety, I confronted it— using all those coping skills learned in years of therapy. What did I learn? I wasn’t the only one questioning whether or not I should go because I wasn’t sure how I would be accepted. In the days after the reunion, another attendee posted concerns about how she felt she hadn’t gotten to a place in life that she was proud of yet and worried what people would think. My reaction was genuinely heartfelt and profoundly appropriate for anyone struggling with their place in this world: Be unapologetically you. Love your life and the place you've arrived without regrets or envy of others. The positivity you put out into the world will reflect back into your life a thousand times, just as negativity does the same. If you wallow in shame, blame, hurt, and pain those emotions intensify as you carry them around, they are heavy and burdensome. Let them go, smile more, take care of your whole self: mind, body, heart, and soul through your thoughts, words, actions, and emotions. We often shy away from connecting with people who can be supportive of our goals and ambitions because we may lack confidence ourselves or hang on to past impressions people have made on us. If I learned anything from this experience, it’s that I had a lot of smart, talented people around me growing up. We've done some incredible things with our lives. There’s no reason feel like an outcast anymore. They were people I perceived to judge me in school who probably didn't understand the impact of their actions, and my perception was screwed because I didn't like myself back then. I love myself now and want to share the joy and be supportive by connecting, encouraging, and promoting a better mindset to attain happiness. If we continue to hang on to the negative, we never provide an opportunity to establish the positives. Forgiveness is an asset in your ability to cope. Shutting people out and never affording them the opportunity to do better will promote those negative memories rather than turning them around to make positive relationships.

There are many options when it comes to paying for bariatric surgery. Let's explore them. Click on each hyperlink to learn more on the topic. Having health insurance does not mean that weight-loss surgery is covered in your policy. About one quarter of people seeking weight-loss surgery will be denied three times before they receive weight-loss surgery insurance approval. If you have insurance coverage for bariatric surgery and are denied, you have the right to contest the decision and write a bariatric surgery insurance appeal letter. Since many health insurance plans exclude weight loss surgery, this leaves people faced with the decision to self-pay for bariatric surgery or to forgo what could very well be a life-saving procedure given the devastating effects of obesity and obesity-related diseases on health. An option is to take out a medical loan for weight-loss surgery. However, bariatric surgery is expensive if health insurance will not cover the surgery. And many people seek bariatric surgery outside the U.S. and engage in the process of weight loss surgery medical tourism. Thousands of individuals head to Mexico for Bariatric Surgery to realize excellent quality care, fast wait times, and attractive prices. With the question of safety of weight loss surgery in Mexico being being top of mind, I turned to Alex Brecher founder of BariatricPal Hospital MX for further exploration. Alex Brecher opened the BariatricPal Hospital MX in 2017 after having run a Mexico medical tourism business for 10 years. As far as free bariatric surgery in the US, while it will no doubt be a challenge, free weight-loss surgery is within the realm of possibility. Free or reduced cost WLS grants and charity care are available. There also are bariatric surgery clinical trials for surgical weight-loss candidates. Use our Match to Clinical Trials in 60-seconds widget on the bottom right column of MyBariatricLife.org to locate a trial near you.

I’m in New Zealand today, where I have been for the past three weeks. It has been a privilege to work with a number of bariatric professionals from different disciplines associated with the Foundations Healthy Living Retreat. During this five-day retreat, a small group of post-operative bariatric patients live together, eat together, exercise together, learn together and share with one another. Various staff members share their expertise about healthy living. Topics include much more than how to eat well and exercise. Participants learn the importance of focusing on personal values in all areas of their lives, discover the importance of positive self-talk, address self-sabotage and learn the importance of living mindfully. Coping skills, communication skills, and boundary setting skills are discussed. The topics of shame and vulnerability are explored, as well. Participants get what all bariatric patients in all corners of the world need following bariatric surgery: the Foundations of Healthy Living. Hmmm… good name for the retreat! What I think as I look around me are the many “non-coincidences” in my immediate surrounding. I do not believe that my being here, halfway around the world, is a coincidence. To begin with, Dr. David Schroeder, a bariatric surgeon, and his wife, Andrea, are, in many ways, absurdly similar in personality to my husband Steve and myself. David and Steve are both kind, intelligent, rational, left-brain thinkers who are mild-mannered and soft-spoken. Andrea and I, on the other hand, while also kind and intelligent, are passionate, passionate and more passionate. Translated, we are thinkers and DO-ers, we are upfront and direct, and are most definitely whatever the opposite of soft-spoken is. Oh, loud. That’s it! Andrea and David are passionate about their work in the bariatric field. They are zealous about the physical health of surgical weight loss patients and are also super passionate about the patients’ psychological health. The Schroeder’s know that the journey of recovering from obesity takes a lifetime and includes the physical and the psychological wellbeing of each person. Andrea created the Foundations of Healthy Living Retreat and they have been hosting the retreats for the past five years. It is definitely not a coincidence that David reached out to me after reading my first book, Eat It Up! Our professional philosophies are very much in sync. My work, with great help from Steve, is all about addressing the psychological needs of patients while their physical needs are being medically managed. David and Andrea, like Steve and myself, dedicate much more than our careers to providing bariatric patients with education and support. We address the WHOLE person, pre-operatively and after weight loss surgery. We put our hearts and souls into the work we do because we are convinced by the feedback our patients provide that they want and need much more than the surgical procedure can provide in order for them to live healthy lives, both physically and psychologically following bariatric surgery. Since meeting in 2011, I have learned a great deal by working with both Andrea and David. The Schroeder’s have twice brought me to New Zealand where I have had the opportunity to learn from and contribute to, the lives and education of their patients and staff. Andrea and David, as well as every person presenting information at the retreat, address bariatric patients from a whole person perspective. Each participant is treated respectfully and compassionately, as a human being who is much more than a bariatric patient. Their emotional support needs are emphasized, as a success following bariatric surgery involves more than dealing with a person’s biological innards. Is it a coincidence that Andrea and David, in New Zealand, know the same things that Steve and I know in the US? We all know and work toward, helping patients and bariatric professionals realize that bariatric patients have tremendous emotional and psychological needs that require attention. Behavior modification by itself is not enough when it comes to sustaining weight loss. If it were, well… wouldn’t more people have kept weight off after diets and bariatric surgery? Is it a coincidence that the bariatric patients I have talked with during individual sessions, along with the participants at the retreats, all from New Zealand, talk about the exact same issues as the bariatric patients I have worked with in the US for the past 15 years? I’m not talking about the physical problems. I’m talking about the lack of self-care this population acknowledges. Not just in their eating and exercise behaviors. These people talk about a great lack of self-value that translates to a lack of proper self-care. The greatest common denominator aside from the physical co-morbidities of the bariatric patients I have spent time with in both countries boils down to this: I don’t believe I’m good enough. That, my friends, is the definition of shame. Our bariatric patients need to heal from the shame that draws them back into unhealthy habits. Healing from shame requires much, much more than a bariatric procedure in an operating room, or “theater,” as they call it in New Zealand. It is not coincidental that bariatric patients across the globe suffer from shame. It is tragic that so few bariatric professionals around the world are willing to provide the full spectrum of care that patients require in order to be able to follow through with behavior modification techniques. Deep shame will eventually extinguish behavior modification efforts. How long before more bariatric professionals get it? How long before more than a handful of patients get the emotional support and psychological care they need after bariatric surgery? How long before we provide a truly comprehensive program to help our patients eliminate shame and establish self-acceptance? The shame belongs to the programs and professionals who do not provide a comprehensive program… because those programs simply aren’t good enough. (Along with the Schroeder’s, I will be offering residential retreats through bariatric centers in the near future. For more information, contact me at connie@conniestapletonphd.com.) I’m grateful for the non-coincidences that have led to meeting Andrea and David Schroeder. I am not surprised to see and hear that the patients in our very distant geographical countries are so very similar. Mostly, I am thrilled to know that there are professionals and patients who know that the Foundations of Healthy Living go way beyond medical care alone! For now, patients can participate in the GAIN While You Lose 10-week program. This is a great way for patients around the country (and the world) to have access to the same topics discussed in the Foundations of Living Retreat. This class includes an hour and a half “lesson,” taught live but available online or via recorded session, followed by weekly homework to make the information applicable to each person’s life. (http://www.conniestapletonphd.com/onlin…/weight-loss-program) Why aren’t we currently doing retreats in the US? Are you, the patients, willing to pay to attend? Are you willing to take the time and spend the money to invest in yourself? Do you value yourself enough to work on your emotional issues? You’ve most likely been willing to pay hundreds to thousands of dollars for weight loss programs, powders, gimmicks and scams. What about actually finding a way to find self-acceptance, a requirement for being able to follow through with behavior modification tools? Patients: there is no shame in having problems. It is tragic to me if you know there are problems, but choose not address them. Please seek the help you need! After all: YOUR HEALTH is YOUR RESPONSIBILITY. THIS DAY. EVERY DAY.

Pumpkin also delivers a punch of potassium, a comely amount of copper, an interesting bit of iron, a pleasing amount of magnesium and a fair amount of fiber. A caution for bariatric patients is the 10 grams of carbohydrates found in a ½ cup pumpkin puree. And who doesn’t love carving Jack-O-Lanterns with your children (or just for you) for All Hallow’s Eve? Who has not posted adorable pictures of their kiddos in your local Pumpkin Patch? You can prepare your own pumpkin puree or stock up on the canned type. Perhaps our greatest love of pumpkin awaits us at Thanksgiving with our beloved pumpkin pie. One estimate says Americans eat 50 million pumpkin pies at Thanksgiving. Alas, a pie is known as a confection loaded with sugar and fat. What is the bariatric patient to do? Modify the recipe, of course! Lower the sugar and fat and pump up the protein is the goal. Try the Pumpkin Pie pudding recipe on the BariatricPal website. If you need a pumpkin treat before Thanksgiving, there are many pumpkin-flavored protein shakes, protein bars and yogurts in the stores right now. So, pumpkin can be a health partner this season. Enjoy!

With the New Year comes the New Year Resolutions. For many people, one of the largest resolutions is a change in lifestyle - that includes losing weight! I remember my resolution in 2012 was to lose weight and get healthy. And I was able to do that with the help of the vertical sleeve. 2015 is going to hold that for many people and thousands of people undergo weight loss surgery to help them achieve their healthy goals for the new year. For those of you that are just thinking about surgery, I want to encourage you to know that you are not alone! You have a wealth of resources at your fingertips. I wanted to take a moment to share with you some amazing resources that you may find helpful on your journey! Websites BariatricPal.com Of course, BariatricPal is one of the very best websites to find information and support. Here there are “rooms” geared for each surgery as well as pages for recipes, articles, and much more. You will find information on everything you might want to know from before surgery to years after. I suggest checking out the Before/After pages for a good dose of motivation and inspiration! 7BitesShow.com 7 Bites is the first cooking series on YouTube geared specifically toward the bariatric community. The website has videos, recipes and blog posts. weightlosssurgerychannel.com Weight Loss Surgery Channel has a collection of videos on everything WLS related weather it be health, food and recipes, and more. BariatricFoodie The Bariatric Foodie has some great recipes for those that still love food, but want to stay on track TheWorldAccordingToEggface Eggface is one of the most popular of the bariatric cooking blogs. You will find great recipes, blog posts and giveaways on her blog. BariatricCookery.com This is a great resource page for everything from recipes to products. Books The “Big Book” series by Alex Breacher and Natalie Stein. There are four books in the series and all are great reads. They have a wealth of information on everything you need to know before, during and after surgery. The very best thing about these books is that they include personal stories from people that have been there. Breaking The Chains: A Guide To Bariatric Surgery by Jennifer DeMoss and Suzette Munson. The ladies of 7Bites pull from their and others’ experiences with weight loss surgery to provide a simplified, but comprehensive guide. Information on everything from how to pick your surgery and doctor to how to survive the first two weeks after surgery are included. The Sleeved Life by Pennie Nicola. This book tells about Pennie’s experience with the Vertical Sleeve procedure and discusses the ins and outs of the surgery from start to finish. Weight Loss Surgery For Dummies. The everything you ever wanted to know and then some guide to all things weight loss surgery. Many, MANY doctors and nurses recommend this book to their patients. Another great resource not listed here is your local bariatric support group! If you haven’t found one yet, contact your Surgery Center of Excellence or your nutritionist, they should be able to give you a good idea of one or two in your area. Or you can check out the list here on Bariatric Pal - it’s a very comprehensive list of support groups around the world!

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!

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.

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.