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If the many diets that you have tried over the years don't help you lose weight, weight loss surgery may turn out to be the only strategy that is able to get you to your goal weight. Still, weight loss surgery is just a tool, and your weight loss depends on your hard work over the years from when you first plan your surgery to when you are maintaining your goal weight. A healthy lifestyle includes eating right, exercising regularly, and silencing the doubtful voices in your head and of your family and friends.

Measuring each bite of food, and getting up before dawn to take a walk, and passing up your aunt’s homemade peach pie can get tiresome. Motivating yourself and setting good goals can help you consistently make the right decisions for your health. These are a few tips to help you.


Why Are You Losing Weight?
It’s easy to remember why you want to lose weight when you are having trouble finding small-enough clothes or your weight is above the limit for a theme park ride. It’s harder to remember why you want to lose weight when you and a group of friends are at the dinner table with a large chocolate cake. Making a list of the reasons why you want to lose weight and looking at the list often can keep the reasons fresh in your mind and strengthen your resolve to resist temptation.

These are some of the common reasons for getting weight loss surgery.
Live longer.
Be healthier – get off medications or manage your health conditions better.
Participate in more activities with friends and family.
Go shopping in regular stores with great clothes.
Fit comfortably into car seats, restaurant booths, and movie theater and airplane seats.
Feel better about yourself.

Make It Personal
Deepen your motivation even further and use it to help you stay on track if you think about some of the reasons why you are losing weight that have to do with people in your life. These might be some of your reasons.
You want to be an active parent who is able to play with your children.
You want to be alive and healthy when your children graduate from high school or give you grandchildren.
Obesity is making you miss out on important moments like family hikes.
You watched an overweight parent or aunt or uncle suffer from diabetes or heart disease at a young age, and know that you may be headed in the same direction.
Your siblings also suffer from obesity and its consequences, and you want to break the pattern.

Think About the Short, Medium, and Long Term
The weight loss journey is a long and difficult process, to say the least. You need to spend months or years preparing for weight loss surgery by getting the payment sorted out, choosing a surgeon, and following the pre-surgery diet. Then there is the actual surgery, followed by months of recovery that can include pain, nausea, and complications.

As you recover, you need to learn an entirely new way of eating and living, and may be hungry, cranky, and tired. Finally, there is the rest of your life, as you lose weight and stay on your new eating plan. Every day can be filled with challenges such as tempting but forbidden foods, the need to exercise, and how to deal with people who may not be supportive of your surgery.

Goals give you something specific to work towards. The long-term goals are the big ones. They may be the ones that you have in mind when you get weight loss surgery or that you tell other people. Some long-term goals might be losing 100 pounds, or jogging five miles without stopping.

Those long-term goals can take years to accomplish, and setting some short-term goals can keep you focused as you work toward the long-term goals. They can include losing 5 pounds this month or speed-walking for a mile. These are some other short-term goals that can keep you on track day-to-day.
Lowering your blood pressure or cholesterol or blood sugar levels enough so that your doctor tells you to lower your dose of medications.
Going for a month without going to a fast food restaurant.
Hitting your protein and water goals every day for a week.

Vary Your Goals
Victories can be few and far between if your goals are too narrow, and this mistake can leave you feeling unmotivated. Consider what happens if the only goals that you have are to lost certain amounts of weight. What happens if you do not hit a certain weight loss goal? Does that mean that your hard work has been pointless? Of course not, but you might feel that way if that was the only goal that you were working towards.

Learn to look for and recognize all kinds of progress by setting goals that go beyond your weight. When you achieve them, you have earned a non-scale victory (NSV). While a lower number on the scale is easy to see, NSVs are what make life worth living. They can include the following.
Getting in good enough shape to be able to walk briskly with your husband.
Making it through an entire dinner at your parents’ house without taking offense at any negative comments about your surgery.
Going out with your friends and enjoying their company without giving in to the food.

Celebrate!
We’re all a work in progress. With weight loss surgery comes years of working on improving your health. The only way to keep up the effort, and the only way to make the effort worthwhile, is to celebrate! Celebrate the small victories to be sure that you realize how valuable your efforts are. Buy yourself a new kitchen scale, get your nails done, go out for coffee with a friend, or plan a hiking trip. You are worth working for, and your victories are worth celebrating.

You can lose more weight and keep it off when you stay focused, but that can be challenged. Remind yourself of your motivations and celebrate all kinds of victories to keep yourself in the game.

Nutritional deficiencies are among the common risks of weight loss surgery. Calcium deficiency in particular can be a serious problem because it may not show up until years or even decades have passed and you are diagnosed with osteoporosis, or weak bones. Osteoporosis can cause:
Broken ribs from something as innocent as coughing or sneezing.
Broken hips and wrists from falling.
Broken ankles from stepping off a curb.
Loss of height and back pain from vertebral compression in your spine.



You can take charge of your bone health. Learn why calcium can help, and how you can get enough calcium after weight loss surgery.
Bone Loss Is Irreversible
Obesity is a serious disease that’s tough to overcome, but there is at least one positive thing about obesity: it is reversible. Hard as it may be, you can lose weight and get your health back. After losing weight, you may have lower blood pressure, sugar, and cholesterol levels, less joint pain, and more energy than you’ve had in years.
That’s not true with your bones. Your bone density increases from birth until your mid or late 20s. After your skeleton is mature and you reach peak bone mass, your bone density decreases for the rest of your life. Your job is to keep the decreases as slow as possible to preserve your bone mass.
Bone Health is for Everyone
A lot of people think that osteoporosis is something that only frail, older women need to worry about. That’s just not true. Men and women of all ages need to think about bone health after weight loss surgery.
Younger weight loss surgery patients are still building bone mass. If you get weight loss surgery before your late 20s, you may never reach your highest possible peak bone mass.
Middle aged adults need to protect bone mass so you’re not at high risk for fractures when you get older.
Women around menopause are already losing bone density quickly. If you don’t protect yourself after weight loss surgery, you could quickly develop osteoporosis even if you had healthy bones a few years ago.
Men have higher bone density than women, but you can still get osteoporosis. Your risk increases as you get older, and you don’t want weight loss surgery to increase your risk.

Calcium in Your Body
Most of the calcium in your body is in your bones, but 1 percent of the calcium is in your blood and other tissues. Calcium is necessary for vital processes, like muscle contraction, hormone secretion, blood pressure regulation, and sending nerve impulses. Calcium levels in your blood are very tightly monitored. If blood levels of calcium drop, you need more calcium in your blood. Ideally, your body uses calcium from your diet to bring calcium levels back to normal.
This works well when you get enough calcium in your diet. If you don’t, your bones suffer. That’s because your body pulls calcium from your bones to put in your blood when there’s no dietary calcium available. Your bones slowly get weaker every time this happens.
Why Bone Loss Is a Problem After Weight Loss Surgery
It’s harder to get enough calcium from your diet when you lose weight fast. That’s why you're at high risk for osteoporosis after weight loss surgery.
You’re eating less food overall.
You’re cutting out liquid calories, such as from milk.
You’re cutting way back on junk foods that have calcium, such as pizza, fortified but sugary breakfast cereal, and ice cream.

You may also be absorbing less calcium from your diet after weight loss surgery.
Calcium absorption drops after gastric bypass.
Vitamin D absorption, which is necessary for calcium absorption, drops after gastric bypass.
Vitamin D absorption drops if you eat a very low-fat diet, which is likely after weight loss surgery.

Get Three Servings of High-Calcium Foods Each Day
The following foods are good sources of calcium. They also have protein, making them great choices for your weight loss surgery diet.
1 cup of non-fat yogurt or Greek yogurt.
½ cup of non-fat cottage cheese.
1 ounce of reduced-fat cheese.
3 ounces of canned salmon.
3 ounces of canned mackerel.
½ cup of tofu.

Calcium at Breakfast, Lunch, and Dinner
Aim for one serving of a high-calcium food at breakfast, lunch, and dinner. These are some ideas for dishes with a good amount of calcium.
Oatmeal cottage cheese pancakes.
Baked tomatoes with low-fat feta cheese.
Broccoli with melted low-fat cheddar cheese and crushed cashews.
Salmon salad made with Greek yogurt instead of mayo and wrapped in a lettuce leaf.
Chili made with tofu instead of beef.
A fish wrap with canned mackerel, basil, tomato slices, and spinach or arugula on a small, high-fiber tortilla.

Other Ways to Protect Your Bone Health
Take the dietary supplements that your surgical center recommends. Those will probably include a daily multivitamin supplement and one or two daily doses of calcium. You may also be told to take vitamin D. Other nutrients affect your bone health, so make sure to eat the healthy foods on your meal plan. Regular exercise is another great way to keep your bones strong.
Osteoporosis puts you at risk for devastating fractures, and you may not even know you have it until you break a bone. You can lose bone mass after weight loss surgery, but you can protect yourself with a healthy diet and exercise plan. In particular, getting enough calcium on a daily basis can keep you healthy.

If you are anything like me, discipline or strong willpower is not something that comes natural. I have been developing mental toughness throughout the years when it comes to maintaining a healthy weight. Does your mind race with thoughts of eating a smorgasbord of different foods? Is every food going through your mind a carbohydrate loaded with sugar or salt? Do you think, “Let me just eat or drink what I want today, and I will get back on track tomorrow?” Do you go through a plethora of different feelings? You may not even know what you are feeling. All you know is that you are consumed with this urge to eat or drink, many times when you are not physically hungry.


Man, did I feel like that today. I just wanted to check out and lose myself in literally stuffing my face with junk food. I was consumed with thoughts of pizza, nachos and cheese, gummy bears and Ben & Jerry’s New York City super chunk ice cream. Oh, and let’s not forget the peanut butter cup candy. Maybe your favorite question is, “Wine, anyone?” Maybe your choice of food to emotionally zone out is different, but is any of this resonating with you?
So what do I do when this pattern pops up in me? This is where developing mental toughness will get you the desired results you deserve. Below, I am going to walk you through four quick steps that have worked wonders for me in developing mental toughness, and I know they can work wonders for you!
4 quick steps to developing mental toughness:
1. First, realize your pattern of internal dialogue and foods when you are getting ready to emotionally eat or start binge eating. Once you begin to pay attention, you will notice that you crave the same foods every time and that there is an impulse or urge to eat right away. You will have the same automatic dialogue of eating and watching TV or telling yourself you’ll just eat this one time and start fresh tomorrow, etc.
2. Stop and realize you are trying to avoid or escape a bad feeling. We automatically want to feel good. Tell yourself that having a bad feeling is not the end of the world; you are not dying. Take a moment to identify the feeling, where it is in your body and what is it trying to tell you. If you cannot find it, that is okay. Just continue to tell yourself that it is okay to feel bad. Allow yourself to just sit with it.
3. Remember to breathe. Through this time, take deep breathes, letting go with every exhale.
4. Have the mantra: “There is no tomorrow. I only have this moment. What I do right now is the only thing that matters. What I do right now is creating my future.” Repeat this over and over again as you breathe.
You will notice that as you go through this process, the feelings that were leading the desire to eat will lesson; as they lesson, your desire to eat will lesson.
The key to developing mental toughness is to become aware of your automatic behaviors to escape bad feelings. If you follow these four steps every time you have an impulse to emotionally eat, you will create a new pattern of reacting to your feelings. When you have a plan to decrease the number of times you emotionally eat, you will be amazed at how quickly you begin to see results in weight loss!

Remember this?
“I’m strong to the finish ‘cause I eats me spinach. I’m Popeye the sailor man!”


Growing up, I watched Popeye guzzle cans of spinach to instantly restore and increase his legendary strength as he battled his enemies and courted the thin, homely Olive Oyl. I didn’t identify much with Popeye or Olive Oyl – I was more like the portly J. Wellington Wimpy, who would gladly pay you Thursday for a hamburger today. But like millions of other children, I did get the message that spinach was good for me. Magically good! And if eating spinach could help me prevail in the endless fights I had with my brother, it was worth a try.
I never did win a battle with my brother, but I ate my spinach and actually liked it. Not canned spinach like Popeye’s (the very sight of canned spinach is revolting), but frozen chopped spinach, boiled, drained, and covered with melted Velveeta cheese. When asked if he liked spinach, Popeye replied, “I hates it.” He might have liked my favorite cheesy spinach better, but clearly he was taking his spinach like medicine at a time in history when medicine always tasted terrible. The worse the taste, the more potent it was.
Spinach didn’t give me bulging Popeye muscles (or, thankfully, his speech impediment), and since I hated gym class and avoided exercise as much as possible, I didn’t develop any more than minimal strength and endurance. When I reached puberty in the 1960’s, women’s liberation and the concept of a strong, independent woman were still quite new. My macho first boyfriend thought women shouldn’t be allowed to drive a car, never mind lift something heavy. As I wrote in Bandwagon, my parents scorned President Kennedy’s physical fitness advocacy and encouraged intellectual rather than physical strength. The exercise programs and studios I tried in the 1970’s and 80’s prescribed exercise for weight loss and toning; the dance classes I took taught me about form, agility and flexibility; but never did I hear any messages about strength. Perhaps I wasn’t listening very well. I thought that weight lifting would turn me into a muscle-bound freak like the ones I occasionally saw on television.
As an adult married woman, I’ve had a tall, strong husband to open jars, change flat tires, take out the garbage, and reach things stored on high shelves (he claims that’s why I married him, when in fact it was his dog, not his brawn that captured my heart). That allowed me to reserve all my meager strength for the herculean task of moving my obese body from my arm chair to the kitchen and back.
It wasn’t until I had weight loss surgery at age 54 that I learned about the value of muscle during weight loss. That was the first time ever that I heard that muscle burns calories faster, and takes up less room, than fat. The theory sounded good, but for my first post-op year I focused on cardio exercise because an online calculator showed that I could burn almost three times more calories doing an aerobic dance class than the same time spent weight training. I worked out faithfully, walking and doing a variety of cardio classes, and reached my weight goal, but I was still a weakling… a scrawny weakling instead of an obese one, a weakling who could wear a size 10 but struggled to pick up a 10-pound bag of dog kibble. Here at the 9 Dogs Howling ranch, that’s a serious deficit indeed!
Eventually I got bored with my workout routine. To add more variety and challenge to my exercise, I began working with a personal trainer when I was 20 months post-op. My trainer taught me lots of moves with free weights and weight machines, some of which I grew to hate, but after about three months of our weekly sessions, I began to notice some muscle definition in my flabby arms. Nothing like Popeye, but there before me was proof, visible to the naked eye, that I actually had some muscles underneath that sagging skin.
Even after I stopped working with my personal trainer, I kept working at strength training, hoping to see more and more muscles. All that effort was in the service of my vanity, you understand. I just wanted to look “ripped” and it didn’t occur to me that strongly-defined muscles could be pressed into service at home (lifting dogs as well as dog food bags) and at work (lifting boxes, shifting heavy display fixtures, climbing stock room ladders).
Gradually I came to realize that I was getting physically stronger. I could no longer claim to be a “delicate flower of womanhood” like Scarlett O’Hara. That turned out to be no terrible loss. It turned out that being strong(er) was as good for my insides as my outsides. Not only was strength training helping make my bones and muscles stronger, it was making my mind and heart stronger. Instead of being afraid to try something new, I just went ahead and did it, and even if I brought absolutely no skill to the task, I had enough strength of mind and body to tough it out.
Early in 2010 I joined a new fitness studio, one with Stott Pilates machines instead of weight machines. At first I worried that I would lose muscle definition without weight machines as part of my workouts, but in fact my muscle definition improved all over my body and especially in my legs. In late summer 2010, I did some personal training with the owner of the studio. Her first step was to give me a fitness evaluation. I had to do push ups, step ups, toe touches, and other moves to evaluate my strength, agility, flexibility and cardio fitness. Much to my (happy) surprise, I scored above average for my age in most of those areas. Just the process of being tested was a revelation, because each time Caroline instructed me to do a new move, I did it without any anxiety or hesitation about whether or not I’d be able to do it.
Since then, I’ve thought many times about the importance of fitness and strength to an average, everyday woman like me. Not an Olympic athlete, not a dancer, not a ditch digger, not a materials handler, just Mrs. Middle Aged American. Although I admire my late mother and aspire to be like her in many ways, I don’t want to end up the way she did after a lifetime of avoiding exercise. She was only in her early 70’s when she began to struggle with little tasks that most of us take for granted. Dressing herself, picking a pen off the floor, getting out of a chair, walking from her apartment to the elevator, opening a door, all of that was too hard for her. She had never claimed to be a delicate flower of womanhood, either. She was one of the most capable and energetic people I’ve ever known, but she never took care of her body and in the end, her body failed her. I’ve vowed that I won’t let that happen to me. I’m going to keep this body moving, or die trying, and that’s got to be a better way to go than lying helpless in bed while an attendant maneuvers a straw into my mouth. I hope that in 20 years when I’m 78, I’ll enjoy sitting in a rocking chair beside my husband for a while, and then getting up to kick ass in an exercise class.

I recommend you have a consult with a bariatric nutritionist?

nice one alex
when (stalls or no weight loss happens) one must merely keep on doing what they are doing....by that i mean eating healthier/cleaner and exercising..sure change it if it works for you because by continuing .....the results will show ...maybe not on the scale just yet but def by clothes getting looser, better mobility and better lifestyle living..
setbacks happen
its how we deal with it...one so called bad meal wont make one gain 20 pounds and one so called healthy meal wont make one lose 20 pounds...its day in and day out and keep on going...
thanks for sharing alex

All people meet it at some point in their weight loss journey. It might come after you experience complications from surgery, or when you travel for vacation, or when you are unusually stressed at work. It might even come when you least expect it, when your diet and weight loss have been going smoothly for months. “It” is the dreaded plateau.


How Do You Know When You Hit a Plateau?
Simply enough, a plateau is when you stop losing weight even though you want to. It’s not just a day or two without weight loss. It’s a period of a few weeks or more when you keep trying to lose weight, but the scale does not budge. You think you are doing everything you can and should be doing to lose weight, but still you do not see results. That is a plateau. It can be frustrating and discouraging and seem to be unfair.
Stay Positive
Plateaus can be maddening, but the absolute worst thing you can do during a plateau is to give up. If you decide that your diet is not worth the effort, you are almost certainly going to gain weight. Going back to your old, pre-surgery diet habits, taking oversized portions, and eating high-fat, high-sugary foods will not just make you gain weight. These bad habits can erase your health gains. Worse, they could cause some of the weight loss surgery complications that you already know about, such as the following:
Stretching of the sleeve in vertical sleeve gastrectomy
Dumping syndrome in gastric bypass
Esophagitis with the adjustable gastric band (lap-band)
Feeling nauseous or having diarrhea

Another reason to stay positive is to keep up your motivation to continue all of the other healthy behaviors in your lifestyle. Don’t fall into the trap of “all-or-nothing,” in which you decide to give up all of your healthy efforts just because your weight loss isn’t quite what you want it to be. These include:
Taking your daily vitamin and mineral supplements
Getting enough protein and fluids each day
Following your regularly exercise routine

It Could Be Worse
And it will be worse if you give up. It may sound strange, but you can stay positive by thinking about how much better your weight is now than where it could be if you gave up trying. If your careful diet is not leading to the weight loss you had hoped for, it is still preventing weight gain. If you give up, you will gain weight, and probably be pretty disappointed in yourself.
Measure Success in Other Ways
Another way to stay positive is to stop focusing on the scale. Find other ways to measure your progress. Tracking your body measurements, for example, can let you know that you are shrinking and building muscle even if your total weight is not decreasing right now.
Tracking behaviors instead of measurements is another strategy. For example, you assess your success according to whether you eat well, such as hitting your protein goals or sticking to your planned menu. Other successful behaviors to be proud of yourself for are planning and preparing meals ahead of time and making sure you drink enough fluids at times other than meal times.
Be Honest and Go Back to the Basics
“Why me?”
That’s a natural question when you hit a plateau, but most people don’t ask it seriously. However, if you think seriously about what is causing the plateau and how you can fix it, this question can actually help you break through the barrier and get back to losing weight.
In many cases, you can figure out “why me” by asking yourself these questions.
“Am I logging every single bite that goes into my mouth?”
“Am I following the meal plan my nutritionist or surgeon gave me?”
“Am I measuring – not eyeballing – all of the foods I eat?”
“Am I exercising as much as I am supposed to be?”
“Am I getting in my protein each day?”
“Have I been too busy or preoccupied to plan my meals and snacks in advance?”

If you answer these questions honestly, you might discover that you have slipped up and are not keeping up your good habits quite as well as you thought you had. Go back to the basics of meal planning and nutritious eating, and you are almost sure to see the scale move again within weeks.
You’re in Charge!
Plateaus are frustrating and nobody wants to experience them at some point, but almost everyone does. These steps can help you when you notice that you are in a plateau.
Stay positive and keep up your healthy behaviors.
Focus on other measures of success besides the scale.
Assess your diet honestly.
Make any necessary changes.

You can get over your plateau, and you will be stronger for it! Just be patient and do what you know is right for your health.

In my work, I find that one of the most common explanations people give for their struggle with diets and with obesity is “I’m a food addict.” When asked what this means, most people explain that their inability to maintain the weight lost from diets and the fact that most or all of the weight eventually returns is proof of their “food addiction.” Additional evidence they cite is that their eating is “all or nothing,” that they can completely avoid so-called “forbidden foods” or binge on them with regularity, but nothing in between.
This kind of reasoning is called reasoning from the converse. This is where you have a conclusion or an end state and you then go backwards to explain the cause and use the existence of the end state as proof of the cause. This invariably leads to circular logic that goes nowhere. Here’s how it works: “I am a food addict which explains why I cannot moderate my intake of certain foods, and my inability to moderate my intake of certain foods proves that I am addicted to them and am therefore an addict.” But does it? There is actually another, more accurate explanation.
There are three facts that must be considered:
1) 95% of people will regain most or all of the weight they have lost on a diet within five years.
2) Many, if not most diets teach avoidance of “forbidden foods,” not moderate consumption of them.
3) Very few diets or weight loss regimens are successfully maintained indefinitely.
These facts are very important to our discussion because they are true for almost EVERYONE who has tried to lose a significant amount of weight. Therefore, either everyone who has failed to keep their weight off following a diet or eventually resorts to eating “forbidden foods” is a “food addict” or there are other explanations for this phenomenon.
But why is it that so many of the people I meet are eager to call themselves “food addicts?” Most people are uncomfortable acknowledging that they are addicted to alcohol or illicit substances such as cocaine or heroin, so why is being a so-called “food addict” easier to acknowledge? I believe it is because the label “food addict” removes the feelings of guilt and shame that so many people experience when they regain weight after all of the work they expended in losing it. It is absolutely heartbreaking to lose the weight, have people notice that you’re thinner and then a year later you’ve regained the weight and everyone knows it. It would be very tempting to blame this on a disease called “addiction.” “It’s not my fault that I regained the weight and am obese again…I’m a food addict.” I can certainly understand the desire to be free from responsibility from your obesity or weight regain; however, it’s not necessary to fall back on the explanation that you are a “food addict.” Perhaps if we looked at the facts about weight loss, there would be no need for all of the guilt and shame and the resulting need to explain it away by calling it an addiction.
Review the facts that I mentioned earlier. The overwhelming majority of people regain the weight they have lost from a diet, very few diets teach moderate eating of “forbidden foods” (so you’re left with only knowing how to eat them or not eat them), and most people find it very difficult if not impossible to stay on a regimen of controlled eating for extended periods of time. These are the problems faced by almost all human beings who try to lose weight, not just those who are “food addicts!” So what is the explanation when someone actually succeeds in losing weight and keeping it off? Great question…and the answer is not that these rare souls are not “food addicts” or that they are “recovered food addicts.”
The National Weight Control Registry (NWCR) is an organization that keeps tracks of “successful weight losers” who have lost 30 pounds or more and have kept it off for at least one year. What should immediately catch your eye is that “success” is defined as losing 30 pounds and keeping it off for one year. So if losing 30 pounds and keeping it off for one year is considered “successful,” if you’re morbidly obese and manage to lose 100 pounds and keep that off for several years that would be incredibly successful! Extensive research has been done on these folks over the years and the most recent study has discovered 7 common habits which most of the 6,000 people studied have in common. 6,000 participants in a study is a strong number of people and one where the conclusions drawn are likely very robust.
Interestingly, the researchers noted that 90% of the folks in this study who finally lost the weight and kept if off had a previous history of losing weight and putting it back on. Therefore, the overwhelming majority of people were not successful on their first try. The seven habits of successful “losers” were: 1. Engaging in 200+ minutes of exercise of moderate intensity per week, 2. Limiting TV watching to less than 10 hours per week, 3. Eating a low-calorie, low-fat diet with less than 30% of calories from fat, 4. Consistency – relatively little food variety and the same daily pattern of eating, 5. Eating breakfast, 6. Avoiding emotional eating and binging and limiting consumption of fast food to less than once weekly and, 7. Monitoring yourself such as documenting calories and/or fat. Notice that every one of the seven habits is just that…a pattern of behavior. There is no mention of the characteristics of the 6000 people. It’s not about who they are, but rather what they did and continue to do.
So what do we make of this “food addiction?” Neuroscience is recognizing the difficulty human beings have in resisting certain foods that we can call “engineered foods” that are high in sugar, salt and other additives. These foods are designed by fast-food companies and food manufacturers to be irresistible because they cause certain reactions in the brain that make it hard for us to say no. But these are challenges for us all. In fact, mass consumption of these “engineered foods” is likely one of the great contributors to the obesity epidemic. They explain why we, as a society, are getting fatter. Perhaps we will discover that some individuals (for neurological or other reasons) have a more difficult time resisting these “engineered foods” enriched with sugar, salt and other additives, and that these individuals are the true “food addicts.” But what would knowing that you are one of these individuals change? What would a “food addict” do differently to lose weight and keep it off?
The addiction model says that the addict should completely abstain from using the substance or drug. Should “food addicts” avoid all food (impossible) or just the ones they are “addicted” to? And how would we know which ones those would be? The most commonly cited addictive “substance” in food is sugar, but we’re not at all certain. There is also another problem. Much of the research on binge eating indicates that designating certain foods as completely “forbidden” and avoiding them results in feelings of deprivation and their becoming even more desirable which often results in binging on them when you finally give into temptation.
Perhaps someday there will be treatments for true “food addicts” if “food addiction” actually exists. What is more likely however; is that these folks will simply have to work even harder than most of us to stick to the seven habits that are detailed above. In the meantime, consider giving up the label of “food addict” and instead, recognize that losing weight and keeping it off is a tremendous challenge, but an achievable one. If you’re thinking of beginning to address your own personal “battle of the bulge” either for the first time or the twentieth time, or if you’re feeling hopeless and thinking there is no point in even trying, fear not…most successful losers apparently made several unsuccessful attempts before they finally got it right. And if you are thinking of starting yet again…the seven habits detailed above are a great blueprint to follow.

Are you struggling to get your fruits and veggies down? Here are some strategies to help you enjoy the good produce that yields good health.


Believe it or not, I actually love the fruits and veggies my doctor tells me will keep me healthy. When I was growing up, no one had to tell me that, like Popeye, I needed to eat my spinach. I’d rather not eat greens out of a can, but decades later, they appear on our dinner table often.
At home here in rural Tennessee, we enjoy many months of harvest from our big garden and small orchard. We are truly blessed in the produce department. The problem is that the harvest is too big for a big man and a small woman to eat. We give a lot to friends, coworkers, and the local food pantry, but my husband continues to overestimate how much I can eat nowadays, and I continue to work on strategies to make produce easier for my altered upper GI tract to handle.
During my pre- and post-op nutrition classes, my dietitian warned us that fruits and vegetables are a challenge for most gastric band patients to eat, and repeated the “take tiny bites and chew each bite 100 times” mantra many, many times. It took several months and band fills for me to truly understand why Susan had repeated her warning so often, and what was true for me as a bandster is still true for me as a sleevester. If you’re in the same situation, I offer you a delicious mixed salad of produce prep ideas.
But first, let me address the juicing of fruits and vegetables. It's true that juice is easy to get down. It’s true that you can get vitamins, minerals, and flavor from juiced fresh vegetables and fruits. It’s true that you can add protein powder to juice to amp up its nutritional benefits. But even the freshest juice won't give you the fiber and satiety of the solid versions. One of the things I like best about raw produce is its CRUNCH. Just the act of crunching a carrot makes eating it so satisfying to me. And no one can convince me that juicing is convenient. I used the fancy juicer my helpful husband gave me at the time of my surgery exactly twice. I love to cook and love kitchen toys, but assembling, cleaning, and reassembling a juicer takes far more time than I’m willing to give a glass of juice that takes me all of a minute to drink. I stuck to my pre- and post-op liquid diets like a good girl, but if I’d believed I could lose my excess weight and maintain a healthy weight by consuming liquids for the rest of my life, I wouldn’t have had bariatric surgery in the first place!
Here are some suggestions that might make it easier to eat your fruits and veggies, both raw and cooked.
Peel and seed everything within reason, except perhaps grapes (unless you can find yourself a cute slave boy to peel your grapes for you - and if you find one, ask him if he has a brother or sister who would like to move to Tennessee - MUST LOVE DOGS). It's easy enough to peel fruits like tomatoes, peaches and plums by dunking them in a boiling water bath for a minute. The skins of bell peppers can be a problem for me, but if you grill or broil the peppers until they're charred, the skins slip right off (you'll have to rinse off the stubborn bits) and the roasted flavor is wonderful.
If eating fruits or vegetables "out of hand" (such as two of my favorites - carrot sticks dipped in hummus and apple slices smeared with with peanut butter) is a problem for you, cut them into small pieces and eat them with a fork. When I eat with utensils instead of my fingers, I automatically eat more slowly and carefully.

Try shredding the food in a food processor. At times I haven't been able to eat broccoli, Brussels sprouts, cabbage, carrots, apples, spinach, kale and other things whole or even chopped, but they worked if I shredded them before I cooked or ate them.

Try alternating bites of a challenging fruit or vegetable with a less challenging food. For example, instead of just eating a banana, cut it up and mix it with other cut fruits and berries in a salad. Then (slowly) eat a bite of banana, a bite of melon, a raspberry, and so on. Or eat a bite of strawberry, then a bite of cottage cheese. “Lubricate” fresh blueberries by mixing them into thick, yummy, protein-rich Greek yogurt (a sprinkle of chopped nuts in that makes it even better).

Although I prefer fruits and most veggies raw, sometimes I have to do what my grandmother called "blanching". Bring a pot of water to boil. While it's heating, cut up the fruits or veggies into small pieces. When the water is boiling, throw the produce in, turn off the heat, and let it sit for one or two minutes. Then drain it and run cold water over it (or put it in an ice bath) to stop the cooking. The produce should still have its bright color and it hasn't lost a lot of nutrients, crunch, or flavor this way, but the parboiling takes some of the meanness out of the fibers.
Just before serving, mix the raw or cooked produce with a sauce, yogurt, light sour cream, hummus, dip or low-fat dressing. Sometimes all any food (including meat) needs is a lubricant to help it go down. Just don't overdo the sauce so that it covers up the flavor of the food and sends a flood of saturated fat into your circulatory system.
Corn kernels can be a challenge for us to eat (cooked or popped) because of the fibrous hulls. That doesn’t mean you can never eat corn again. It just means: eat it carefully, and in moderation. It’s mighty hard to eat corn-on-the-cob carefully, so I slice the kernels off the cob (which also reduces the annoyance of corn stuck in the teeth. I’ve also had good luck with fresh corn if I cut the kernels off the cob before cooking the kernels. Hold the corn cob so it stands with its stem end on a plate or bowl. Run a sharp knife from the tip of the ear straight down to the stem end, leaving 1/8 to ¼” of pulp behind on the cob. Then cook the cut corn with a little bit of water or broth, or proceed with your recipe. Use caution when eating generic brands of frozen and canned corn, which in my experience contain more tricky and/or indigestible stuff (like bits of cob) than the more expensive name brands.
If you love fresh fruits and veggies too, y’all are welcome to pick all you can eat from our garden and orchard this year. To find us, get yourself to Memphis and drive north until you hear barking. I must warn you, though, that our dogs love produce too, so you may have to negotiate your share of the apple harvest with them. But they also love company, so come on down!

After weight loss surgery, you need to plan your meals ahead of time. You always want a high-protein, low-calorie option to be available at meal time. You might find yourself carrying your own prepared food with you to be sure that you have the food you need. Sandwiches are good “go-to” option, but not just any old sandwich will do! This article can help you build sandwiches that are good fits for your meal plan.


What is Wrong with the Sandwiches You Used to Eat?
A typical workday might have started off with a trip through the drive-through for a breakfast burrito or sandwich, or a bagel and cream cheese sandwich at work. Lunch could have been a brown bag peanut butter and jelly sandwich or a trip to a nearby restaurant for a sandwich, burrito, or burger. Where might these options leave you?
Sausage, egg, and cheese croissant or biscuit from a drive-through (600 calories with 42 grams of fat)
Bagel with cream cheese (500 calories with 70 grams of carbohydrates)
Peanut butter and jelly sandwich (600 calories and 40 grams of sugar)
Club sandwich (1,000 calories and 2,500 milligrams of sodium)
Chicken patty sandwich (60 grams of carbohydrates and 1,100 milligrams of sodium)
Beef, bean, and cheese burrito (900 calories and 40 grams of fat)

Your breakfast and lunch sandwiches could have added up to over 1,500 calories. Add in beverages, sides (hash browns, fries or chips, anyone?), and snacks, and you could have been at 3,000 calories by lunchtime!
These Choices Don’t Work After Weight Loss Surgery!
Needless to say, these options do not fit into your weight loss surgery diet.

First, some of those sandwiches have more calories than you are supposed to be eating in a day, not to mention that some also contain more saturated fat, sodium, and sugar than you should have in a day.
Second, those sandwiches emphasize starchy breads and fatty condiments, not the lean proteins and nutritious vegetables you need to stay full and nourished after weight loss surgery.
Third, they can cause complications. Doughy bagels and fried chicken, for example, can cause obstructions in lap-band patients; fatty sausage and sugary jelly can cause dumping syndrome in gastric bypass patients; and these low-nutrient foods can fill you up and cause malnutrition.

Luckily, this does not mean that you need to give up the convenience of sandwiches and the pleasure you get from biting into one. There are plenty of ways to make sandwiches that are weight loss surgery-friendly: low-calorie, high-protein, convenient, and delicious!
Protein Fillings for WLS Sandwiches
Start by choosing a lean source of protein, just like you do when you plan all of your meals. These are some healthier options compared to what you might have chosen before weight loss surgery. Don’t forget to measure your portions if you are making your own sandwich, or eyeball your portions if you are ordering in a restaurant.
2 scrambled egg whites (30 calories)
2 ounces of canned light tuna (60 calories)
2 ounces of chicken breast, lean ham, turkey breast (80 calories)
2 ounces of fat-free cheese (90 calories)
½ cup cooked beans or 1 vegetarian burger (120 calories)
2 ounces of turkey or vegetarian bacon or breakfast sausage (130 calories)

Load up on Vegetables and Fruit
Vegetables and fruit are the next food groups to add to your meals. Vegetables especially are low-calorie, so add more if you want a bigger sandwich. Try classic combinations, or get creative. You can also experiment with herbs such as fresh cilantro, basil, and dill. These are some ideas.
Lettuce and tomatoes with meat and cheese
Grilled eggplant, zucchini, and/or bell peppers with beans
Cucumbers and sprouts with fat-free feta cheese
Diced celery, carrots, onions, and water chestnuts with tuna
Spinach and mushrooms with egg whites
Pear or apple with fat-free cheddar cheese
Cantaloupe with ham and/or fat-free cheese
Blueberries with egg whites

Breads and Alternatives
Most bread is high in carbohydrates and low in protein – clearly not what you need for your nutritious weight loss surgery diet. Besides adding calories and carbs, bread can cause obstructions in lap-band patients and make gastric bypass patients sick or overly full. When possible, skip the regular bread.
Bagels
Tortillas
Subs
Croissants
Biscuits
Regular sliced bread

Instead, choose whole-grain, high-fiber, low-calorie breads, and consider open-faced sandwiches, with the filling on 1 slice of bread, instead of regular 2-slice sandwiches. These are some good options.
Reduced-calorie bread (45 or fewer calories per slice)
Light English muffin (50 calories per half)
Mini whole grain bagel (60 calories per half)
Low-carb tortilla (50 calories per small tortilla)
High-fiber, light wrap (90 calories per wrap)
Also, look for creative, non-bread alternatives.
Lettuce leaves to make lettuce wraps or cups
Egg roll or wonton wrappers
Sheets of dried seaweed
Grilled eggplant
Your fork (skip the bread and just eat the filling)

Keeping Condiments Under Control
The condiments that you add can make or break your sandwich, both in terms of nutrition and taste. Skip the full-fat mayonnaise, dressings, dips, sour cream, and butter, and be wary of high-sugar jam, barbecue sauce, and honey mustard. Instead, consider the following condiments.
Salsa
Fat-free mayo, dressing, dip, or sour cream
Regular mustard
Plain, non-fat Greek yogurt
Hot sauce
Shredded fat-free parmesan cheese
Reduced-calorie, trans fat-free margarine

Some Breakfast Sandwich Ideas to Start Your Day Off Right
Egg whites scrambled with spinach, mushrooms, and fat-free feta cheese on ½ English muffin
Cottage cheese and strawberries wrapped in lettuce leaves
Shredded fat-free cheese and lean ham toasted on a slice of reduced-calorie, whole-wheat bread and topped with salsa and tomatoes
Egg whites cooked with turkey bacon and broccoli in a small, high-fiber wrap
½ whole-grain mini bagel spread with fat-free cream cheese and topped with canned salmon with diced celery and water chestnuts

Lunch Sandwiches
Lettuce wrap filled with diced chicken breast, bean sprouts, mushrooms, and bell peppers, and soy sauce or light Asian dressing
Dried seaweed sheet rolled around tuna salad made with fat-free mayo, chives, and celery
Pinwheels made by layering slices of turkey breast, lean ham, and fat-free cheese slices, spreading them with mustard, and rolling them
Bean burrito with black beans, fat-free cheddar cheese, salsa, and fat-free sour cream on a small, high-fiber tortilla
Chicken breast with sliced apple and light vinaigrette between slices of grilled eggplant
Tomato sauce, fat-free mozzarella cheese, and mushrooms on a light English muffin
Toasted Rueben sandwich with low-fat Swiss cheese, shredded cabbage or sauerkraut, lean corned beef, and fat-free Thousand Island dressing on a light English muffin

Are You Ready for Some Sandwiches?
You can eat these sandwiches at home, or make them ahead of time and carry them with you in a reusable container. As a weight loss surgery patient, you should own plenty of reusable containers with tight-fitting lids. If you do not already have some, they are worth the investment so that you can carry healthy foods with you wherever you go.
We hope that you enjoy these sandwich ideas and that you are inspired to make some of your own healthy, high-protein sandwiches!

Those who have had weight loss surgery often ask how much they should be eating. Whilst is seems a simple question, there is no simple answer.


Those who have had weight loss surgery often ask how much they should be eating. Whilst is seems a simple question, there is no simple answer.
How much you should be eating is a hot topic on many online forums or support pages. If you have read the discussions it becomes clear that weight loss surgery clinics and support teams widely differ in how much they are recommending their patients eat. This is also clear when I chat with other health professionals at our obesity surgery conferences. If the professionals working in the area can’t get their story straight, how are people to know what to do?
Some surgeons recommend you limit meals to half a cup, some may say one cup, and others will say a bread and butter plate of food. Interestingly, one cup of food nicely fits on a bread and butter plate and this is the guide we use in our clinic.
Accredited Practising Dietitians (in Australia, Registered Dietitians in the USA) are university‐qualified experts on food and nutrition. Whilst even their recommendations on what you should eat following surgery will vary, what they will generally agree on is that it is difficult to meet your nutritional requirements eating half a cup of food, three times a day.
To date, there are no scientific studies on the exact amount of food people should include after gastric band and gastric bypass surgeries. Hopefully in time this will evolve. Research from Mercy Bariatrics in Perth, Western Australia, provides some excellent data to help guide serving sizes for those who have had a sleeve gastrectomy. Whilst initially very small amounts are tolerated, at six months after surgery most people will manage about half a cup of food at a time. By 12 to 18 months most people will manage about one cup of solid food. This is a guide only and will vary between people as there are different size sleeves.
A point relevant to all surgeries is that the people studied found they could indeed ‘fit’ more food in than what they felt satisfied with. After all forms of weight loss surgery, eating to the maximum amount you can tolerate is not recommended. I have a favourite quote from Dr. Teresa Girolamo, one of the GPs in our clinic: “It’s not a matter of seeing how much you can eat and get away with, but how little you can eat and be satisfied.” Testing the limits of how much you can eat increases your intake, particularly if it occurs repeatedly, and can compromise your results. Tune in to your feeling of satisfaction after eating and let that guide the amount of food you need to eat. Always stop eating before you feel any discomfort.
Create an environment that makes it easy for you to eat small portions. Ensure family and friends know you use a smaller plate/bowl/cutlery. Take these items with you if you travel. When eating out, order entrée size meals or if there are none available, separate your meal into an appropriate portion before you start eating. Tapas style menus, Asian or Indian eateries are often tailored to meals being shared, allowing you to dish up a small serve to suit your needs. It is fine to leave food on your plate when you have had enough, even if it is a smaller serve. Avoid the temptation to ‘clean the plate’. If ‘wasting’ food concerns you, carry a container with you when you eat out and take a serve home to have for another meal.
After gastric band surgery some people may find it takes some time before they feel satisfied on small amounts of food. Many people need their gastric band adjusted several times to help them feel satisfied on small serves. If small meals of solid food do not satisfy you, keep in regular contact with your support team until they do. Some people will find this will occur early in their journey, for others it may take longer. Be patient.
Whilst it is not necessary for you to measure or weigh everything you eat, it may be helpful to measure the amount you are usually serving. When you eat a meal, take note how much food it takes for you to feel satisfied and how much it takes to feel full. The aim is to feel satisfied after eating, so if you know roughly how much food this is you can avoid dishing up too much in future.
The recipes in my book and on my blog have been designed to provide approximately four, one cup serves. This does not mean a one cup serve is right for everyone, but does allows you to easily adapt the recipes to your requirements.