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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

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!

Paralleling the increasing use of bariatric surgery, there is a high demand for body contouring through plastic surgery. If you’re just beginning down this path, the questions are many. Who will do my surgery? How is recovery? What can I expect? Choosing and Evaluating a Plastic Surgeon Many of the surgical procedures performed on the massive weight-loss patient are complex and labor-intensive. The wide spectrum of body contour deformities that can follow massive weight loss often exceed the magnitude of what plastic surgeons have traditionally addressed. That is why weight-loss surgery patients need to work with a surgeon who specializes in bariatric plastic surgery. Dr. Joseph F. Capella, a plastic surgeon in New Jersey, affirms: Post-bariatric body contouring is a relatively new area within the field of plastic surgery, in that bariatric surgery only has become popular in the last 10 to 15 years. And because of that, many surgeons have come through their training not having been exposed to post-bariatric body contouring. Because of that these surgeries are not considered traditional procedures, in the sense that they’ve been honed over decades like many of the other plastic surgery procedures. And so what plastic surgeons may do is use these more traditional procedures and apply them to the post-bariatric patient, which often will lead to sub-optimal results. So, it’s very helpful then, in that regard, to go to a plastic surgeon who has committed to this kind of surgery and does this surgery frequently — and this would be true for any kind of plastic surgery, for that matter. But what’s different about post-bariatric surgery contouring is it is relatively new, and probably greater than 50% or more of plastic surgeons out there right now did not have any exposure to it in their training. Obviously there are on-going conferences to educate surgeons but there’s a difference with having it as part of your training rather than learning about it from a lecture. Read Dr. Capella’s comprehensive list of criteria for choosing and evaluating a plastic surgeon. Healing Body and Mind After a Post-Weight Loss Body Lift Once you’ve removed the loose skin and sagging, is the journey over? Are you obstacle-free? Well, not quite. The Plastic Surgery Center in New Jersey says: You’ve been through a life-altering experience, and with that, your body and mind need time to heal and adjust. It’s important to acknowledge that, so you can assist in your own recovery and eventually move on … Recovery from body lift surgery is extensive, which sometimes catches people off guard. And it can be painful, depending on the extent of the surgery and your perception of pain. You should be prepared for swelling (or even numbness) that can last for weeks and sometimes even months. In fact, most surgeons say that complete recovery and final results take up to a year. Of course scarring is a fact of body lift surgery, and scars are particularly distinct up until the first year following the procedure. Many (if not most) people experience strong emotions following plastic surgery. While excitement and elation are a natural result of such a positive life change, it is also customary that an entire range of feelings can result, including a phenomenon called post-plastic surgery depression which can resemble post-partum depression. Recovery creates the time and opportunity to focus on these emotions. On the plus side, the surgical results of a body lift are apparent almost immediately. They will remain permanent if you are able to maintain a stable weight (although normal aging obviously results in physical changes). And, depending on the person, the body’s healing process should mitigate scarring. Read The Plastic Surgery Center’s great advice for healing body and mind after a post-weight loss body lift. Plastic Surgery Improves Appearance, Mobility, Health and Emotional Well-Being People may not be fully aware of the many benefits of plastic surgery after weight loss. There are aesthetic refinements in the appearance and improvements in functional mobility, as well as an increased sense of emotional well-being. Dr. Edward Domanskis, a plastic surgeon in California, says: I think that the benefits of plastic surgery after weight loss are tremendous. When you’re massively overweight it’s one problem. When you lose the weight I think a lot of times the patient doesn’t realize that the problems don’t really go away; it’s just a different problem. It’s a problem of all this hanging skin. And to some people that can be almost as much of a problem as being overweight and having all this excess fatty tissue — physiologically for sure. In my experience I think it [plastic surgery after weight loss] is a very, very satisfying type of surgery not only to the patient but also for the physician to see the transformation in the patient. To see the reaction of their friends and family to what they’ve gone through and how their overall appearance and psyche tend to change. There’s no question that these procedures are very. very beneficial to the patient. Watch Dr. Domanskis’ video segment, “What to Expect: Improving Appearance, Mobility, Health and Emotional Well-Being through Bariatric Plastic Surgery.”

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.

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.

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!

Like pretty much everything else in your life, the holidays are a whole new ballgame after weight loss surgery. Your weight loss surgery diet is strict. It doesn’t include fatty foods and sugary desserts. Going off your weight loss surgery diet can stall weight loss and also cause complications. You could be prone to dumping syndrome if you have the gastric sleeve or gastric bypass, and lap-banders can face obstructions and acid reflux with the wrong foods or too much. If you let your guard down for the rest of November and December, you can find yourself slipping off of your diet and feeling pretty unhealthy. But by keeping your eyes open and planning ahead, you can keep yourself on track and get through the holiday season feeling proud of yourself. Watch Carefully to Avoid Extra Calories Calories show up everywhere at this time of year. Sometimes they don’t even seem that bad, but they add up quickly. Have a bite here and a handful there without paying much attention, and you might be disappointed when you weigh in on New Year’s Day. Don’t let calories slip into your diet. First, be aware of the extra calories that are around. They can include any of the following. Lunch or dinner out when a friend or family member comes to town. Chocolate truffles on the secretary’s desk or the break room at work. Cookies from well-meaning friends and family who want you to taste-test their creations. Sweetened, pumpkin-spice coffee instead of calorie-free regular coffee. Food court fare when you’re holiday shopping at the mall. Holiday parties, potlucks, and dinners. Stick to Your Good WLS Habits The first line of defense is to stick to your regular good everyday weight loss surgery habits. Log every bite of food you take to keep from getting in hundreds of extra calories from sneaking in a taste here and there. Even if you have to estimate the calories in some of your food, especially if you eat out or at a party, you can keep more discipline if you log your food. Also, think about your other healthy habits. Keep drinking water between meals. And, protein is still all-important. Make sure you have some at each meal and snack. Focusing on finding lean protein can keep you focused when you’re faced with all kinds of other unhealthy choices. Arm Yourself Against Temptation If you’re starving and you’re face-to-face with a basket of chocolate-covered pretzels, you might opt for the sugary, high-carb snack. Unless that is, you have your own weapon. Keep some high-protein and low-calorie choices with you at all times so you never need to go for the junk food in desperation. We have many health snack options at the BariatricPal Store! Take them with you to work, or in your car, purse, or pocket. You can have them if you’re stuck in traffic or at the mall at mealtimes. Almonds packed in 1-ounce portions. Beef jerky (not fatty beef sticks). Apples Cheese sticks Roasted soybeans or garbanzo beans Tuna pouch Work around Your Cravings You don’t need to deprive yourself completely at holiday time. If there’s a particular taste you want, there’s a good chance you can satisfy your craving with a healthier alternative. For example, you can have lean ham and turkey breast instead of brisket and turkey with the skin on it. Roast green beans with onions, rosemary, and balsamic vinegar instead of having green bean casserole, bake sweet potatoes instead of having candied ones, and puree cauliflower or carrot instead of making mashed potatoes. Use the same strategy for desserts. Go for sugar-free cocoa mix instead of chocolate fudge when you’re craving chocolate. Munch on plain popcorn while your friends are passing around the caramel corn. For breakfast, make high-protein oatmeal pumpkin pancakes instead of regular pumpkin pancakes. Plan for a Few Treats Almost everyone has a few holiday treats that are irresistible. There may be some family recipe that you’ve had at every Christmas for as long as you can remember, or maybe a coworker brings in her cinnamon rolls made from a secret recipe. Whatever it is, you feel as though the holidays are incomplete without it. There’s no reason not to plan for one or two key treats. Just be sure you plan for them and stick to a single serving. Savor it, and concentrate on the flavors and on the memories and feelings it brings up. Then get right back on your regular diet. There are a couple of reasons why some weight loss surgery patients might be better off skipping even the occasional special holiday treat. First, don’t start if you’re not sure you can stop. If you’re not confident that you can stick to a single serving, it’s best not to start eating. Second, some weight loss surgery patients can’t tolerate all kinds of junk food. Fried and doughy foods are risky for lap-band patients, since they can obstruct the band. Gastric bypass and vertical sleeve gastrectomy patients are at risk for dumping syndrome from eating too much sugar or fat at once. And, no weight loss surgery patient should eat too much, since that can stretch the pouch or sleeve. The holiday season is a happy time, but it’s a struggle if you’re trying to lose weight and get healthy. You can prevent it from sneaking up on you and interfering with your weight loss by staying alert and having a plan.

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.

The Struggle Often Continues For some patients, Weight Loss Surgery can lower your interest in food, so you are not constantly thinking about it. There’s no question Weight Loss Surgery can help you gain control of your eating, but it’s unlikely to eliminate your struggles with food disappear. A few lucky Weight Loss Surgery patients really do stop being tempted by food. The rest, who make up the vast majority of Weight Loss Surgery patients, continue to struggle. You still may be hungry, enjoy salt, fat, starch, or sugar, or be tempted to use food as an emotional crutch. Your family members may continue to insist on keeping high-calorie foods in the house, or pressure you to eat things you shouldn’t. Your friends may still be going out to eat and inviting you to join them in ordering high-fat, high-sugar items. “Why Me?” Isn’t Appropriate It’s easy, even natural, to think of yourself as unlucky. Why should you have to struggle with food? Why should you have to monitor every bite you take, while some people don’t? The fact is, almost everyone does. Ask almost any skinny person how they stay skinny, and you’ll get some variation of the same answer: “I work hard for it.” Just like you, they are aware of what goes into their bodies. They sometimes may be hungry; they sometimes may want to eat more than they should. But they, like you now, take responsibility for their decisions. They may: Skimp on portions if they over ate at the previous meal. Choose healthy foods first. Have a strategy for dealing with emotions and boredom that doesn’t involve eating. Have a support system that promotes healthy behaviors. Accept It and Manage It If you find you still have a rocky relationship with food after weight loss surgery, don’t conclude that WLS didn’t work for you. Instead, accept that you will need to fight the cravings and urges for months, years, or life, and start making a plan. Don’t be afraid to ask for help in developing strategies – whether you ask other BariatricPal members or an always-thin person you admire! Persist in Order to Get the Answers You Need We all want to be able to trust our doctors. You want to believe your surgeon takes care of all aspects of your Weight Loss Surgery, including your post-op, long-term nutrition. But it doesn’t always happen like that. Nutritional counseling may not be part of your surgery package, or you may only get a limited amount of generic information. Or, your surgeon may simply not know how to help you nutritionally. Remember that many doctors have no more than an hour of nutrition education in medical school. To become a weight loss surgeon, doctors need to learn surgery. There is no dietary education requirement. If you need help finding strategies to satisfy hunger – physical or head hunger – and your surgeon and primary care doctor are not able to help, keep looking. A session with a nutritionist may be more affordable than you think, and worth every penny. Your Emotional Support System and Your Relationship with Food The support system you built so carefully can come in handy right about now. Take advantage of your ability to talk to a therapist or psychologist if you have one to bring up your concerns. Discussing your ongoing struggles with portion sizes, food choices, and over-frequent nibbling with a mental health professional can help you come up with some strategies that work for you. Group sessions are also appropriate forums to talk about food struggles and strategies. Though it may feel embarrassing at first to admit you’re still thinking about food a lot, you will find nearly everyone in that room did or does have that same experience. Most Weight Loss Surgery patients do not find their surgery instantly eliminates their food struggles. You can take months or years to come to terms with a food addiction, and it may be something you need to learn to live with for life, but in a healthier manner than before Weight Loss Surgery. Be honest with yourself and those around you, and be open to suggestions, and you can figure out strategies that work for you. Do not assume WLS did not work for you!