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Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.


Bariatric Realities
I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress.
I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored.
Not to me, they aren’t. And these will be addressed in this series.
In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…)
I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real.
Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series.
Alcohol Use After WLS
This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment.
Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders.
And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot.
Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA?
No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality.
Food Addiction
Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction.
“Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real.
Ask your patients. They believe food addiction is real.
So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives?
I’m frustrated.
Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS!
The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for?
Connie Stapleton, PhD
connie@conniestapletonphd.com
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Twitter: @cstapletonphd
LinkedIn: Connie Stapleton, PhD

The prospect of “working out” may feel a little daunting. There are lots of things you might be afraid of -- getting hurt, being bored, feeling embarrassed, infringing on work or family time, and possibly the worst, not seeing results!
These are all normal and every new exerciser experiences these emotions. Whether you’ve already undergone surgery or are preparing to, these strategies can make it easier to begin exercising to support your weight-loss goal.


The prospect of “working out” may feel a little daunting. There are lots of things you might be afraid of -- getting hurt, being bored, feeling embarrassed, infringing on work or family time, and possibly the worst, not seeing results!
These are all normal and every new exerciser experiences these emotions. Whether you’ve already undergone surgery or are preparing to, these strategies can make it easier to begin exercising to support your weight-loss goal.
#1- Speak with your doctor about the safety of your intended program.
Are your heart & joints strong enough to handle the type of workout you have in mind?
Are there side effects from your surgery that may be exacerbated by certain types of exercise?

#2 Get organized!
Take out your calendar and put in everything you do during the day. How long does it take you to get ready for work? To commute? To eat lunch? You need a very clear picture of where you can make time for a workout.
Ideally, you’ll find one time for exercise everyday -- at least on weekdays. Consistency is crucial for creating a new habit. The more routine a behavior becomes, the less it will provoke anxiety!
Give yourself a bedtime & wake-up time; consider spending a week or so getting into better sleeping habits before you begin a new workout routine.

#3 Set Realistic & Reasonable Goals
Be honest with yourself -- are you SO not a morning person? Don’t set yourself up for failure by scheduling a workout before dawn. Maybe hitting the gym after work is better for you! You might be a little late for dinner, but at least you’ll get it in.
Remember that your body is NOT a Ferrari; it can’t go from 0-60 in 3 seconds! Start by doing 5-10 mins/day of very light activity, and build up gradually. Take a rest if you start to feel overwhelmed.
Don’t expect to see physical changes overnight, and don’t measure progress by weight-loss. As you begin to build muscle, the number on the scale may not shift at first. Remember that you’re still becoming stronger & healthier, and increasing your metabolism.

#4 Have a “Plan B”
The most common exercise for beginners is walking. But what about the weather? What if you’re knees are super sore? What if you’re travelling and don’t know your way around the neighborhood?
Invest in a set of free weights, resistance bands, and/or a gym membership. This will give you options for every situation.
Flexibility not only helps you stay consistent -- varying your workouts can also stave off boredom & help you stay motivated!

#5 Involve Your Friends & Family, but Don’t Depend on Them.
Let the people close to you know that you plan to start a new routine and how your schedule will change.
Tell them how important this is for your health, and ask them to be supportive.
It’s great if your spouse/friend/kids want to join you for a workout, but don’t expect them to be as committed as you are. Someone might bail out at the last minute; you have to be prepared to go it alone.

#6 Make Exercise a Priority
We all juggle so many responsibilities, and often feel pulled in ten directions at once. It can be tempting to ditch our workouts to save time. Think of working out as being as fundamental as brushing your teeth -- it’s simply non-negotiable.
“Put the mask on yourself first.” Whether it’s caring for children or older relatives, we often neglect our own needs to take care of others. But remember -- if you’re in poor health, you can’t be there for anyone else.
You may need to turn down some social invitations -- staying up late and drinking is simply not conducive to working out the next day. If your friends want to hang out, invite them along to the gym!

#7 Eat Around Your Workouts
Working out on a full stomach or totally starving will make you feel sluggish. Eat your pre-workout meal close enough to keep you energized, but give yourself some time to digest a bit.
This is especially true post-surgery, when you’ll be more likely to become nauseated from vigorous movement. You may need to experiment with different types of food and timing!
Most WLS patients are on low-carb diets to prevent “dumping syndrome,” a condition caused by sugary foods. However, if you’re going to have carbs, consider placing them in your post-workout meal, along with some protein. Slower-digesting sources, such as sweet potatoes with skin or lentils, can help repair your muscles while avoiding gastric discomfort.

#8 Positive Vibes Only
Acknowledge your hard work with self-praise, but don’t beat yourself up when you’re struggling. Making yourself feel bad is de-motivating and can even make you more likely to engage in self-destructive behaviors.
Have compassion for yourself! Changing your habits requires major psychological, neurological, and physical adaptations. These things take time, and they’re not easy! Having a hard day doesn’t mean you’re lazy or weak.
Focus on how your mood, energy, sleep quality, and even sex life, are improving.

#9 Ask for Help
Walking into the gym for the first time can be overwhelming and confusing. If you don’t know how to use a piece of equipment, ask a trainer. Unless they’re with a client, trainers are generally eager to help.
Most gyms offer a free introductory session when you join. Take advantage to learn the layout of the gym and how everything works.

*While you might feel embarrassed about sharing personal details with a stranger, always tell your trainer if you’ve had surgery and what your physical limitations are. Unfortunately, many people in the fitness world aren’t educated about surgical procedures for weight-loss.
#10 Don’t Let the Haters Get You Down!
You may be embarrassed about your size, and might worry that people will laugh or stare while you exercise. The truth is, they might, but that’s they’re problem!
Most people will actually applaud your efforts and be extremely encouraging. The few bad apples aren’t worth worrying about.
This is YOUR life -- don’t let anyone suck the health & happiness out of it!