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  1. 13 points
    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
  2. 11 points
    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
  3. 3 points

    The Great Sugar Hunt

    Another helpful addition is “Added Sugars”, which is found under the carbohydrate information. Naturally occurring sugars are primarily from fruit (fructose) and dairy (lactose). Vegetables and grains can also contain a small amount of naturally occurring sugar. For added sugars, look for the words sugar, syrup, agave, molasses, juice, beet sugar, brown sugar, turbinado and honey. Now that we have the total and added sugars, you can determine if the food or beverage is something you can work into your eating. While there are no formal guidelines, limiting foods and fluids to products that have less than 5 grams of added sugar is a starting point. A rule of thumb for carbohydrate foods is to eat the food that is closest to the farm. That means the least processed the better. For example, a peeled apple is better for you than applesauce. Applesauce is better for you than juice. One hundred percent real fruit juice is another way to say “sugar water” for bariatric patients. The Nutrition Facts Label will list naturally occurring sugars, but you won’t see added sugars listed. So, juice is a high sugar item. Your dietitian will assess your activity level, blood sugar readings, body composition and tolerances to help you find a healthy carbohydrate goal to work into your eating. We now have a better tool to hunt down the added sugars in our foods and beverages. Happy hunting!
  4. 2 points
    Make a List How can you chase what you want if you have not identified it? How will you know you have found what you are looking for if you did not know you were looking for it? You may have thought about making a list of motivators for weight loss surgery and weight loss. Have you considered making a list of what you want to get from your efforts? Making a list of what you want can help you figure out how to get it. The first article in this series might help you put together a list. It could include some of the following, and any of your own items. More confidence in social settings. Saying “yes” to anything – movies, restaurants, and airplane trips – without thinking about whether you fit in the seat. Staying away from the doctor’s office. More time with family because now you have the energy. Attitude: Gains over Losses It’s all about the attitude. You do lose a lot – besides weight – when you commit to Weight Loss Surgery and the Weight Loss Surgery diet, but you will not be doing yourself any favors if you focus on the losses. It is easy to feel discouraged and feel sorry for yourself if you focus on some of your losses: no more soda, no more free-for-alls at the all-you-can-eat buffets, no more eating whatever, whenever – because you literally cannot stomach it anymore. Cliché as it may sound, you are more likely to succeed when you put a positive spin on it. Also cliché but true: practice makes perfect. You can train yourself to think positively just by practicing. Don’t think about losing dessert at the restaurant; think about gaining the ability to enjoy friends and family without focusing on sugar. Don’t think about giving up your mornings sleeping in because you have to exercise; think about gaining better nights of sleep because you no longer need a CPAP machine and gaining clear-headedness that will carry you through the day. Celebrate! It is human nature to respond to successes. When you are doing well at something, you are likely to continue to do it. In the same way, you are more likely to stick to your Weight Loss Surgery meal plan and exercise program when you realize how well you are doing. Recognize each victory with a celebration. Some of your celebrations could be a tangible reward, such as a massage for hitting a weight goal or a new workout outfit when you meet your goal of hitting the gym 20 times in a month. For other victories, you might be able to give yourself the positive reinforcement you need with a simple sign of recognition, such as placing a gold star on the calendar to mark your difficult but healthy choice to pass up the bread basket in favor of a side salad. Eventually, even giving yourself a physical or mental pat on the back might be enough to remind yourself how good it feels to be moving in the right direction. Put Yourself Out There The gains are yours for the taking, but sometimes, you may have to make an extra effort to take some them. This is especially true with some of the gains having to do with people. Put yourself out there at work or in social settings, and you may get some of the most rewarding gains of weight loss surgery journey. When you show off your new confidence, people will respond to you. Add to that some clothes that you are proud to wear, and you are more likely to get the job and land the business deal. You will find it easier to enjoy the moments with old friends and to make new ones. The weight loss surgery journey has so much to offer, so do not let yourself miss out! Know what you stand to gain and keep your eyes open for opportunities to make those gains, and your weight loss will be only one benefit of the entire journey.
  5. 2 points
    Why Does It Matter? Support during your Weight Loss Surgery journey can help you succeed. It is motivating to know that the people who love you are on your side. Through the long days of diet restrictions and dramatic lifestyle changes, your journey will be easier if your family members and friends pitch in however they can, whether with verbal encouragement or concrete changes such as avoiding eating off-limits foods in front of you. Still, it is important to remember that you CAN succeed, whether or not you get the support you hope for. Get to the Heart of the Matter First, make sure you know why they are against your weight loss surgery. It is often because they are afraid for your safety. They may know people – or know people who know people who know people – who had complications from Weight Loss Surgery. You can talk to them about the real risks of surgery – using statistics rather than hearsay – compared to the risks of remaining overweight. Still, do not assume that your safety is why they are negative about your decision. It is important to let them express their concerns and to address them directly. These are some other common reasons why your family and friends might have a negative gut reaction to your exciting news. They may be worried that you won’t be able to stick to the Weight Loss Surgery diet, and that you’ll be disappointed with the results. They may think you don’t need it. A lot of family members have trouble seeing how overweight you are, and understanding how much it interferes with your life and health. They may feel insulted. Parents especially may feel as though they have failed if they see you, their child, opt for surgery. They may feel threatened. Your significant other, for example, may be comfortable in the relationship you have had for years, and may worry that the way you feel about him/her will change as you lose weight. They may not know what it means for them. Friends may worry that you won’t want to hang out with them anymore, especially if your time together tends to revolve around food or if they think of you as their dependable “fat friend.” Whatever the true concern is, address it directly. Reassure your friends and family that you are doing this for you, and that you will not become a different person. Offer Them a Role Some friends and family members may feel overwhelmed by your news of Weight Loss Surgery, and that can lead to their negative response. Surprisingly, offering them ways to be more involved in the experience can actually help change their minds. They may feel better about your WLS once you tell them the details about the prep, procedure, and diet, and may even be grateful if you let them know specifically what they can do to help. Address Meal Times Directly Food is central to relationships at home and in social settings, so it is understandable if your loved ones are worried about how your upcoming Weight Loss Surgery will affect the time you spend together. If you think this may be a concern, discuss meals at home and in restaurants with your friends and family. Let them know that you will still be present at the table and interested in being good company, even if you are not eating as much as them or ordering the exact foods that they are. If you are comfortable with the situation, they are more likely to be. Agree to Disagree In most cases, family members mean well. It may be hard to remember or see in the heat of the moment, but they often do genuinely want the very best for you. If you have already tried your hardest to convince them to support your Weight Loss Surgery decision and they are not ready to do so, your next hope is to keep them as an ally in other aspects of your life. Hopefully, you and they can agree to disagree about your Weight Loss Surgery. You can let them know that you respect their opinion and will not be pressuring them to support your WLS. In exchange, you can ask them to continue to be your friend regardless of whether you are a bariatric surgery patient. Be Patient Sometimes, it just takes time. Your own Weight Loss Surgery success may be the best argument for why your loved ones should support you. It may take weeks, months, or a year, but they may come around as they see how happy you are, and as they realize how much they miss you. Bariatric surgery is a lot easier when everyone you love supports your decision, but that’s not always the case. Don’t let resistance from family members and friends get you down, though. They’re probably trying to act in your best interest, and in most cases, you can still get Weight Loss Surgery while keeping strong relationships with them.
  6. 1 point
    The 3rd Annual National Obesity Care Week (NOCW), October 29th through November 4th, seeks to ignite a national movement to ensure anyone affected by obesity receives respectful and comprehensive care. [Insert your organization’s name] is proud to join the Campaign, which was founded by The Obesity Society, the Obesity Action Coalition, Strategies to Overcome and Prevent Obesity Alliance and the American Society for Metabolic and Bariatric Surgery. All NOCW supporters recognize the 5 Reasons to Care: Obesity is a serious disease. Weight bias is faced by many. Healthcare providers need to have positive, helpful conversations about weight with their patients Science-based weight management options are available for treatment. We need your help passing the 2017 Treat and Reduce Obesity Act (TROA). Although we must educate people about these 5 reasons to care, we must also address barriers to care, such as weight bias in both society and among the medical community. We need more voices – your voice – to reach our goal of achieving better care. You can join us and take action to change the way that you care about obesity by taking the Take 5 Pledge. The Take 5 Pledge is intended to inspire action by addressing the 5 reasons to care and encourage us to change the way that we care about obesity. More information about National Obesity Care Week and their Take 5 Pledge, including information and resources, is available on www.ObesityCareWeek.org. Mark your calendars, and join us in recognizing National Obesity Care Week, October 29th – November 4th.
  7. 1 point
    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.
  8. 1 point
    As you age, your metabolism slows down. Older people also tend to have less muscle mass than younger people, which also reduces metabolic rate. This is why we encourage older patients to add light weight-bearing exercise to their fitness routines. So how do you keep that furnace burning in order to burn calories, even if you’re already achieved your goal weight? There are many simple tools to accomplish this task. I’ve outlined my favorites below: Exercise This weapon is key to maintaining and increasing metabolism. Seniors, take note−The Centers for Disease Control and Prevention (CDC) recommends people 65 and older get 2.5 hours of moderate-intensity aerobic activity every week and perform weight-bearing exercises on all the body’s major muscle groups at least twice a week. At any age, indoctrinate a 30-minute daily work-out, just like brushing your teeth and eating lunch, into your daily routine. Sleep To increase the chances of boosting metabolism, adults should get seven to nine hours of sleep each night. Getting too little shut-eye can significantly alter your body’s processes enough to predispose you to gain weight. (Do you ever feel hungry for no reason when you’re exhausted and then reach for the wrong foods to boot?) De-Stress When you’re tense, your body releases cortisol, a hormone produced by the adrenal system that is linked to weight gain. It can also significantly weaken your immune system and open the door to acute and chronic illnesses. Turn to regular physical activity, deep breathing, a quiet evening stroll, or professional help from a psychologist or counselor if you are experiencing chronic stress. Eat and Drink (First and foremost, follow your bariatric practice's instructions on post-op nutrition.) Eating the right foods−clean proteins, fruits and vegetables−fuels your metabolism firing on all cylinders. As soon as you awaken, charge-up those calorie burners by feeding them a protein and a fruit (think omelette with feta cheese, spinach and veggies and a cup of berries). Eat small meals throughout the day but stop by around 7 p.m. Staying hydrated is key to maintaining good health. Keep a glass or refillable water bottle with you throughout the day. You are properly hydrated if your urine is nearly clear. Other than choosing the right foods to eat and finding spiritual solace in your life, these tools serve as a roadmap to good health, including maintaining a healthy weight. Best of all, once you’ve adopted these tips, you will look and feel better--sooner than you think.
  9. 1 point
    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.
  10. 1 point
    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!

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