There is a significant amount of variability as to how much weight people lose following weight loss surgery. Research indicates that up to 20% of patients fail to lose the expected amount of weight following surgery. While there are surely surgical and medical explanations for this outcome, patient behavior has also been shown to play a role. Therefore, it is important for anyone having surgery to anticipate and understand factors under their control to improve outcome.
I often tell patients, “The surgery does what the surgery does.” What I mean by this is that weight loss surgery almost certainly will affect how much food you can eat, but may do little to change what you eat. Weight loss surgery does not make you suddenly crave healthier and less caloric food. You have to make those choices for yourself. Additionally, while losing weight may make it easier for you to adopt a more active lifestyle, surgery itself will not make you suddenly fall in love with exercise. So making health behavior changes in addition to having surgery remains critical. So what specific health behavior changes have been shown to improve outcome?
1. Document what you eat – Many people strongly dislike writing down what they eat but there is evidence that this helps people after weight loss surgery as it does with non-surgical approaches. The reason is likely that documenting what you eat gives you valuable information about your behavior and allows you to make changes when necessary. Consider that your actual weight is the end product of what you eat, so weighing yourself gives you the results, but not the information necessary to make changes. For many, weighing themselves is a pass-fail exam. Either I’m a good boy or a bad boy. Consider that you can’t actually change your weight…you change what you eat and/or exercise, and that is what helps change your weight.
Many people seem to have little or no objection to weighing themselves so why do so many people despise writing down what they eat? Writing down what you eat is the truth teller. It forces you to acknowledge what you are doing. To avoid seeing the truth, you can either change what you eat or stop writing it down. Unfortunately, many people choose the latter. The good news is that in the smartphone era, there are literally dozens of apps and other technological devices that can make documenting your food and activity level extremely easy. If you do a little research you can find one that is right for you.
2. Exercise – You probably saw this one coming as well because it makes sense. Regular exercise is a way of burning calories and losing weight that does not involve changing what you eat. Given how difficult it is to lose weight and keep it off, it would be silly not to take advantage of one of the few methods known to work. Ironically, it might not work the way you would expect. Many people who lose weight through exercise notice that it helps them not just by burning off calories, but also by affecting their food choices. In other words, when you discover how difficult it is to burn off 250 calories on a treadmill, you may think twice before having that chocolate bar afterwards. Not everyone finds this effect, but for those who do, it can make a big difference.
When deciding what form of exercise to do, consider that you don’t need to become an Olympiad or a marathon runner. Many of the positive effects of exercise have been documented with just walking 30 minutes 3-4 times per week. If rigorous exercise is enjoyable for you, that’s great. But any time spent engaged in activity is beneficial...especially if you would otherwise be sitting on the couch watching all of those tempting food advertisements on television!
3. Stress Reduction – An increasing amount of research has documented a relationship between stress and weight gain. The obvious connection is that many people use food as a means of comforting themselves from distress, commonly called “emotional eating.” An interesting new discovery is that is that some people who report high levels of stress gain weight even when their calorie intake is unchanged. How is that possible? There is the suggestion that stress hormones and other chemicals may affect how our body metabolizes food and stores food. So even if you’re eating the same foods and the same number of calories, what your body does with those calories can vary.
If you’re going to be successful in reducing stress, you need to begin by discovering what “pushes your buttons” and take steps to change. One first step could be to document the things that you find to be stressful. Sometimes just writing down your problems makes them less frightening now that they’re just words on a page. For other people, writing their sources of stress naturally leads them to write what they might do about them. Another good idea is to investigate some simple stress management techniques. Many refer to them as relaxation or meditation exercises. As discussed earlier, there are a number of excellent smartphone apps and other technology-based methods of relaxation that you can explore. No one is better than the rest so just find one that works for you and begin to incorporate relaxation/meditation into your daily routine. If reducing your stress requires more than practicing relaxation techniques, consider speaking to a psychologist or other mental health professional to get the help you need.
4. Get some sleep – Here’s another suggestion that you’ve probably seen in the media recently. There is growing consensus of an obesity-sleep connection. Like exercise, the benefits of sleep are more than meets the eye. The obvious connection is that if you’re up longer, you become hungrier and are likely to eat late at night. This interpretation is not wrong, however, new research suggests that people who get 7 or more hours of sleep tend to maintain lower weights even when people with fewer hours of sleep consume the same amount of calories. How is that possible? Again, it’s not just how many calories we eat…but what our bodies do with those calories. Unfortunately, an increasing number of people are so busy between their work and social lives (not to mention all those tempting television shows) that sleep is not a priority. Just know that making sleep the last priority comes at a cost.
Consider how we train children to sleep. We create a nighttime ritual to ease kids to bed. There’s dinner, wind down time, then bath time, maybe reading a story or two in bed, and then lights out. Many adults however have a terrible routine. Eat a big dinner at 9pm, catch up on emails and pay bills, watch television for an hour or so and then fall asleep on the couch and stumble into bed at 2AM only to have to wake up three or four hours later. Try to change your sleep habits by changing your nighttime ritual. Eat an earlier dinner. Try to pay bills and check your emails at another time. Use the evening as wind down time. Rather than fall asleep on the couch, watch a set amount of television or Internet time and then turn it off and “put yourself to bed.” Begin by trying to go into bed a half-hour early every night for a week and see how you feel. If you notice some improvements in your level of energy, mood, appetite or other factors, see if you can make it permanent.
5. Join a Support Group – Some research has demonstrated that patients who participate in support groups lose and maintain more weight than those who don’t. Of course it may depend on the content of the group and who attends, but adding a social element to your weight loss and weight maintenance goals seems to help. This may relate to the accountability factor discussed earlier. If “we’re all in it together,” there may be more of a commitment to stick to your goals to help out the group. Or perhaps it motivates you not to be the one group member who is falling behind. Either way, participating in support groups seems to have benefits both in terms of weight loss as well as emotional well being after surgery.
There are other suggestions of course, such as improving your diet by reducing carbohydrates in favor of lean Protein and a more plant-based diet. However, for many people, changing their diet can push all of those emotional “diet” buttons; so before you make those changes (or in addition to making those changes), strongly consider some of the changes recommended above. There is evidence that the benefits are additive. For example, many people find that when they exercise, they sleep better and in turn these changes help them manage stress better. The key is to acknowledge whether or not some of the factors above are problem areas for you and to begin making small changes. Sometimes small changes can lead to big results!
Michelangelo was considered the greatest artist of his day. Even now he is considered to be one of the supreme artists of all time. His works in painting, sculpture, and architecture rank among the most famous in existence. His creations in every field during his life time was prodigious. The sheer volume of correspondence, sketches, and reminiscences that have survived to this day is also part of his legacy. He is the most documented artist of the 16th century.
He could take a piece of stone, say marble, look at it, study it and see what lay inside that piece of rock. He saw beauty in it and worked until that beauty was exposed. He would chip away at the stone little by little shaping it, molding it, working every angle of the rock to make sure that what he saw inside would come to life at his hands. He stood back and looked at his progress and wondered if he was getting the results he knew was inside. He measured, considered and chipped away until the piece was perfect in his mind.
Did he expect to find the beauty within the stone in two months? Or even a year? Maybe! Most likely not as his work was calculated and loved as he proceeded to get the most out of the marble that he was working with. His love and artistry has lasted down through the centuries and has awed many of us to this day. Some who dabble in the arts would long to be a fraction of the greatness attributed to Michel Angelo. He worked at it until it was the beautiful piece that he intended it to be. Did he give up! No! Did he question his thoughts and his fortitude to complete the work? Most likely. But without his hard work and seeing his art through to a finish, he would not have been the man everyone considers to be the ultimate artist of all time.
Are we like Michelangelo's in our journey to find the beauty within the shell that we are chipping away at bit by bit. Shaping and forming and rebuilding until we have the desired results needed to say our work is complete. Or do we continue to chip and chip away at ourselves with negative talk or expectations of more then what we can find in ourselves?
Do we want to go far beyond what is possible and put ourselves in a position where we will never be content and happy about who we have become. Or who we are meant to be for that matter. Do we long to look like we did at sixteen and therefore set ourselves up for failure! What is the goal here? Is it working to get healthy and improve our lives and well being! Yes most definitely!!!
We need to see ourselves as we are meant to be. Not what society dictates as normal today. Stick thin and then some! There is so much fat shaming out there and sadly it is accepted by many! If we buy into this thinking we will believe that our body type is not 'correct'. Therefore we may never see our true wonderful selves. The sacrifices we have made to change our lives such as changed personal and family relationships, even financial sacrifices. Not to mention the courage required to even take this step. Why should we allow society to dictate to us what we should look like.
When we decided to have weight loss surgery our goals were to lose the excess weight so that we could become more active and live a better, more fulfilled life. While some of us end up ten or even twenty pounds below what was expected there is another group that have gone well beyond this. Some have traveled this journey and have not taken care to find who they are inside. They have gone beyond what was suggested by their surgeon and nutritionist. Their health has suffered because they did not see the beauty of who they were inside the outside coating. New addictions surfaced by following a rigid former failed diet along with the pressure of wanting to be like others we have seen in movies, magazines, friends or even relatives. Some of us have pushed ourselves to the brink of unhealthiness.
Some keep carving and chipping away until there is nothing left to work with and the desired finish is not met. Going beyond what was necessary, to see just how small we can be or weigh can become the central point of our existence. Would it be possible to maintain this new life style? In most cases no. Setting ourselves up to fail again is not the answer to long lasting health benefits. Being balanced in everything will bring us good health. Not to mention the ability to do all the things we listed on that piece of paper stuck to the refrigerator or the goal weight we put down here in our profiles. When deep inside we thought we would never ever get to that goal. Right!?
Learning to retrain our brains to see food as a form of nourishment, rather then a reward or a comfort for troubled times. We must learn the best way to feed our bodies so that we will reach our proper weight level resulting in sound health.
So where does it end? When will we see ourselves as successful? When will we be able to say, “I finally got here and now I can maintenance it and enjoy the fruits of my labors.” When will it be okay to say, “I am happy with myself and proud of all I have accomplished?” We deserve to say it. We deserve to live it. We need to learn to enjoy the new us and look forward to what life has to offer us. So we can grab it, run with it and live it to the limit!
When Michelangelo grew older he started to feel and see his mortality. That was when he sculpted the Rondanini Pieta. This was likely his last sculpture. It was never to be completed because Michelangelo carved it until there was not enough stone left. The legs and a detached arm remain from a previous stage of the work. As it is, the sculpture has an abstracted quality, in keeping with the 20th-century concepts of sculpture.
So, may we never over sculpt our body's, suffering the results of it going far beyond who we were meant to be. Believing that there would never be a size that is right for us. We must find a place of contentment. Most of all we must see the beauty within ourselves as we travel this life as a successful weight loss surgery patient.
It sounds like your husband is concerned about the risks of major surgery. Encourage him to attend your appointments with you so he can ask the surgeon/nurse/dietician/PT all the questions that he has. If he hasn't been to an informational seminar, drag him to one of those as well. Once he understands the risks of the surgery vs. the risks of morbid obesity, he will probably relax a bit. Good luck!
I would just reassure him that you are losing weight for your you, not to find a new man. Tell him that you want to be healthier and feel better about yourself.
Chatham , Ontario here
Waiting gor a meet & greet with the surgeon. Then a surgery date. To be done at Toronto Western Hospital . Started out Sept.2013 hope to have surgery within the next few months.
Good luck to everyone on your journey, be bleesd
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