Unstoppable

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!

Attempting to lose weight can be thought of as engaging in a complicated battle with your brain. Consider all of the various factors that are involved: hunger, cravings, appetite, emotions, memories, environmental cues...the list is seemingly endless. Neuroscientists tell us that these factors are controlled by many different parts of our brain, making it even more complicated. This helps explain why the quest for a truly effective weight loss drug has been so elusive. The drug would have to address so many different parts of the brain to truly hit every target. Not an easy task.


Despite the fact that losing weight would have so many health benefits; our brains seem to have no interest in helping. In the battle to lose weight, your brain is not your ally. Your brain wants chocolate, potato chips and pizza, not the fruits, vegetables and grilled fish we know would be healthier for us. The struggle to lose weight demonstrates the reluctance our brains seem to have to learn new behaviors when it is comfortable with the old ones. But why?
One reason, albeit perhaps not the whole story, is that brains are lazy. Brains don’t seem terribly motivated to learn new habits. Once we learn to do something that either provides pleasure or avoids pain, the brain just wants to keep doing the same old thing. The brain does not urge you to go out of your way to do things differently when the current way is fine. The brain wants to put as much of our behavior on autopilot as possible. Consider this. How much of your daily behavior occurs with no thought whatsoever? It’s much more than you may wish to believe. When you walk down a flight of stairs do you have to decide which foot to move next or do you just seem to glide downward effortlessly? Ever arrive at work after a 30-minute drive and not remember over half of the details of your commute? How did you remember to stop at the red lights? How do you avoid getting into an accident?
Like walking downstairs and even driving a car, eating can easily become a mindless activity…from choosing what you eat, to preparing the food, to consuming the entire plate, without a single thought. Similarly, when a behavior becomes part of our repertoire we are very reluctant to change. For example: If you grew up using one brand of toothpaste, it’s very unlikely that you will switch to another in the future. Marketing experts know that changing brand loyalty is extremely difficult. Coke drinkers usually stay Coke drinkers and Pepsi drinkers usually remain Pepsi drinkers. While we would honestly like to believe that we make willful choices at every turn, more often than not the reason we do what we do is because that’s what we’ve always done. It’s not really a free choice at all.
The complexities of the brain will continue to be explored for many years and while we may never fully understand how to control each of the areas within the brain that affects our eating behavior, the good news is that we do have the ability to change our brains…by changing our behavior. Although your brain may not want to change on its own volition, with a concerted effort you can make it change. It’s called learning. Learning occurs when we discover something new. Learning is change. It’s figuring out the solution to a problem for the very first time. Once you know how to do something correctly, there is no more learning…its just repetition and autopilot. Ironically, all of your bad eating habits were learned to. You would never crave pizza if you had never tried it. You can’t crave what you’ve never tasted. Cravings are learned.
Earlier I mentioned that your brain doesn’t want to change, which is true. But if you put in the time and effort, our brains are quite malleable to acquiring new skills. The premise is really quite simple, but if you listen to how people explain why they do what they do, you might be confused. Many folks seem to believe that our feelings govern our actions. When asked why he didn’t take out the garbage, the young boy replied, “I didn’t feel like it.” When asked why she didn’t accept the invitation to go to the party, the woman said, “I wasn’t in the mood.” When asked why he couldn’t go on stage, the man replied, “I was too nervous.” One could falsely be led to believe that changing behavior requires changing one’s mood or emotions. While a change in our emotions clearly would help change behavior, it is often a very unreliable method for doing so. We can’t control our emotions very easily, but we can change control the other two aspects of our human experience…our thoughts and behaviors. Stated differently, “To change a thought, move a muscle.”
To lose weight, you must become aware of as many of the “cues” or “triggers” that influence your eating as possible. These are the things that “push your buttons” to eat. Keep a journal and write them all down, especially in the moments before and while eating. Here are some examples:
External or Environmental Cues:
What food choices were available in your environment?
What time of day is it?
What day of the week is it?
What eating cues are in your environment (television, window shopping)?
What foods can you smell in your environment?
Where are you? Avoid standing in the kitchen and other food-related areas.
Cost. What was on sale in the market?
Are you influenced by “new and improved” or other food marketing tricks?”
What’s left in the fridge?
Social Influences: What are your friends and family eating?
Cultural Influences: What food do you have a history of eating?
Holidays…special foods for special occasions

Internal Cues:
Beliefs:
Old internalized messages from childhood. “Clean your plate,” “Don’t waste food, there are starving children in Africa.”
Self-defeating messages. “What’s the point…I already blew my diet. I might as well eat what I want and start over on Monday.”

Biology:
What is your current level of hunger?
Some foods trigger the desire for others (salt – sweet)

Emotions:
Current mood state and emotional factors
Comfort foods associated with certain emotions or situations

Habits:
Do you have dietary restrictions (kosher, low-salt)?
Learning history…what have you eaten in similar situations in the past?
Current and past consequences of eating certain foods. What tastes good?

While the above list may look comprehensive, there are others so be eager to discover as many as you can. Then, get started with the process of changing as many triggers associated with eating as you can so that you are making thoughtful decisions every time you eat and are operating on autopilot as little as possible. Making substantial changes in your eating-related behaviors over time will eventually change what your brain asks from you. Your new autopilot will change the foods you crave, your triggers for eating, your food choices and maybe even the way you eat as well. As you develop a comprehensive list of eating cues and triggers, try to employ some of the suggestions below to start making real changes in your eating behavior:
Keep a food and eating diary. Write down what you ate, how much, when and what was going on. All of these are triggers you need to recognize and learn to change or control.
Formalize your eating. Plan your meals and snacks so you can be focused, rather than eating when you “feel” like it.
Rehearse reasons for improving eating habits…why am I doing this?
Change and control as many food-related cues in your environment as possible. For example: Stop keeping cookies and cake in your house if you really don’t want to be eating them.
Put less on your plate. Many people are “see-food” eaters. They see food and they eat it. See less…eat less. This helps the “clean your plate” problem.
Eat slowly: Be mindful while you eat and avoid engaging in other activities so you can “tune in” to your body. If you read or watch television, you are focusing on those things…not signals of fullness, satiety and satisfaction.
Discover alternatives for emotional eating and bored eating

It’s hardly a quick fix and it is admittedly easier said than done, but with consistent effort, you can learn to partner with your brain rather than battle with it and accomplish your weight loss and weight maintenance goals. Keep up the fight!

Personally, about two years ago I went from 8 cups and a Keurig on my office desk to 0 cups and a poland spring water fountain instead :-)

I gave up caffeine back in April. Never much of a coffee drinker, but I could put away a few Diet Cokes! I was told the carbonation could stretch out my pouch.
I don't even miss it!

Thank you, Alex! Now, the next time somebody asks me why I have given up caffeine (I'm still pre-op and haven't told anyone outside the family) I can tell them that caffeine makes my acid reflux worse! And that's all they need to know!

Caffeine is a part of daily life for millions of Americans. Some people limit themselves to a single mug of half-calf to help them wake up in the morning, while others depend on the drug at all times of the day. There’s the morning cup of coffee to wake you up, the travel mug on your morning commute as you fight traffic, the morning coffee break to help you focus, and the afternoon pick-me-up soda.


For most people, this drug is about as harmless as a drug can be. It wakes you up, keeps you mentally sharp, and even helps you burn a little extra fat. There aren’t many serious health risks, as long as you don’t have too much.
For weight loss surgery patients, though, caffeine is a bit of a bigger deal. Find out what it can do to your body, how much is safe to have after surgery, and where to find it.
Caffeine and Your Digestive Tract
Caffeine is an acid, and it can irritate the lining of your stomach pouch or sleeve. This is true whether you have the lap-band, vertical sleeve gastrectomy, or gastric bypass. One way to prevent symptoms is to make sure you don’t have your caffeine on an empty stomach. However, that’s not really possible when your weight loss surgery diet doesn’t allow you to have beverages at the same time as solid food! Limiting your consumption is the best way to avoid trouble.
Caffeine and Acid Reflux
Acid reflux occurs when acid from your stomach comes up into your esophagus or throat, causing symptoms like heartburn or an acid taste in your mouth. Acid reflux is considered gastro esophageal reflux disease (GERD) if it persists. Weight loss surgery often helps with GERD, since obesity is one of the main factors. However, you can still get GERD after weight loss surgery, especially if you have the lap-band.
What does all this have to do with caffeine? Coffee and other source of caffeine are among the foods beverages that make acid reflux worse. There are plenty of other risky foods, such as citrus fruits, spicy foods, fried foods, and garlic. If you do choose to have caffeine, just be watchful for signs of acid reflux and ask your doctor if you think there may be a connection between caffeine and your symptoms.
Does Caffeine Dehydrate You?
Staying hydrated is a big deal after weight loss surgery because it’s so important and so tough. It helps keep you full and healthy, and you can only do it if you plan carefully and pay attention to your fluid intake.
Coffee and caffeinated diet iced teas and other drinks may seem like a great alternative to water, which can get pretty boring. Unfortunately, caffeine is a diuretic. That means it increases the amount of water your body loses. That means it helps dehydrate you.
It’s not a serious problem if you don’t have too much caffeine and if you’re drinking plenty of other liquids, especially water. If you’re already struggling to hit your 8 to 10 cups of water a day, though, you might want to think seriously about skipping the caffeine so you don’t get dehydrated.
Caffeine and Your Nutrient Status
One of the most serious problems with too much caffeine for bariatric surgery patients is that it interferes with nutrient consumption. This comes at a time when you’re fighting hard to give your body the nutrients it needs through healthy eating and supplements.
Caffeine reduces your body’s absorption of two key nutrients: calcium and iron. Miss out on your calcium, and you’re at risk for developing osteoporosis and a high risk for bone fractures later on. Skip the iron, and you could get anemia, making yourself tired and weak. If you do choose to have caffeine, make sure it’s not at the same time you’re taking your nutritional supplements.
How Much Caffeine Is Safe?
There’s no single recommended amount of caffeine that’s best for everyone. The right amount for you depends on a variety of factors.
How it affects you.
The type of surgery you have.
Your surgeon’s recommendations.

A good amount for many bariatric surgery patients who can’t face the thought of quitting might be a cup in the morning to get you awake.
Cutting Back on Caffeine
If you’re addicted, cutting back on caffeine can be challenging. You can get some headaches, feel groggy and cranky, and get constipated. These symptoms only last a few days, though, and you can use them as motivation to take good care of yourself. That’s because healthy behaviors like getting enough sleep, exercising, and drinking enough water can help reduce withdrawal symptoms.
If you’re trying to have less caffeine, it’s helpful to know the sources. Everyone knows about coffee, but there are plenty of other places where you might find caffeine.
Hot and iced coffee and coffee drinks.
Hot and iced tea.
Diet and non-diet energy drinks, including 5-Hour Energy.
Some over-the-counter migraine, pain, and cold and flu medications.

Caffeine has a lot of uses in everyday life, and it’s not necessarily a bad drug. But, after weight loss surgery, it can be a problem if you have too much. If you love your coffee, ask your surgeon how much you can have to make sure you don’t harm yourself while you’re working so hard to get healthy and fit.

I don't find it helpful to weigh too often. I weigh twice a month and that's enough for me. I'm feeling fitter and my clothes are getting looser, so that's how I judge my progress. I have 'only' lost 6.5lb over the past two weeks and I'm sure that if I'd been weighing every day I would have found it demotivating after the higher initial weight loss.

Tuesday is my weigh n day. I ONLY weigh once a week.... Trying not to get in the habit of going to the scale all the time.