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In the case of bariatric surgery and the questions patients ask about their post-op “diet,” most bariatric professionals speak in terms of the lifestyle and dietary changes that accompany post-op living. The majority of patients, both pre-op and post-op, understand that one of the goals of preparing for bariatric surgery is to begin making healthy, positive changes to one’s lifestyle. Which, of course, is code for changing behaviors (primarily eating and exercise). Hence, the popular phraseology that “bariatric surgery requires accompanying lifestyle changes” in order for one to maintain the weight loss they experience during “the honeymoon” stage.
For many (most?) people who have bariatric surgery, being on a “diet” of one sort of another has been a way of life prior to having a bariatric surgical procedure. Atkins, Paleo, low carb, low fat, vegan, gluten-free, DASH diet, ZONE diet, Jenny Craig, Whole 30, Weight Watcher’s, very low carb, Sugar Busters, etc. etc. etc. Sound familiar?
When I hear post-op patients talking about “going on a ‘diet,’” I really want to scream, “THIS ISN’T ABOUT A ‘DIET’! It’s about LIFESTYLE CHANGES!”
Don’t get defensive here if you have gone on a “diet” as a post-op. I understand that if you have regained weight, and are working with a bariatric professional, there may be a “diet” of sorts prescribed. That’s not what I’m referring to when I talk about my frustration. It’s when a post-op continues the diet-as-a-way-of-life mentality that I feel frustrated, and sad, actually.
Living life “on a diet” can be (and is, for some people), a way to: 1) avoid other things (feelings, relationships, etc.) by focusing all of their thoughts and attention on “the diet,” 2) remain obsessed with food (which may be an indication of a food addiction and/or my first point), 3) remain connected with others as “dieting” may have been the basis of their relationship with family members or friends, 4) attempting to have some area of control in life, and/or 5) lots of other things.
Regardless, dieting as a way of life is probably not a healthy way to live (for most people).
Sidenote: I add that “for most people” part because, sure as I’m sitting here, if I don’t say that, somebody is gonna get really ticked off and start thinking about how that isn’t the case for THEM and THEN they may miss the point of the whole article…
The POINT, by the way, is… choosing to have bariatric surgery is also choosing to make healthy, positive lifestyle changes. IF you want to sustain the weight you lose as a result of the surgery – and your efforts.
And YOU are in it to win it. SO… here’s how to change your thinking from making changes in your “DIET” to making changes in your lifestyle:
AWARENESS: Learn the difference between a “diet” and a “lifestyle change” if you don’t already know. Discuss this with your bariatric professionals, your support groups and your family members. Help those in your life understand the difference, as well. IF you fear not living on a “diet,” then perhaps consider getting some counseling to look into the reasons being “on a diet” is emotionally important to you. ACCEPTANCE: Realize that if you want to live the rest of your life at a healthier weight, then lifestyle changes in the way of “diet” (as in what you eat), as opposed to “A DIET,” such as the ones name above, are necessary. And the healthy dietary changes need to a lifestyle… meaning you continue them every day, one day at a time. In addition, the lifestyle changes necessary to life your healthiest life can include things such as increased physical activity, exercise, learning healthy coping skills, developing a healthy support system, etc. ACCOUNTABILITY: Find ways to be accountable for engaging in healthy lifestyle behaviors. Maintain food and exercise journals. Participate in support and/or accountability groups. Work out with others. Start a walking club. Start a support group. Take responsibility for your health. This day. Every day. ATTITUDE: Work to have a more positive attitude about the difficult parts of the journey. Read positive quotes. Maintain a gratitude journal. Encourage others. Talk to yourself when you’re grumpy and remind yourself that will not lead you in the direction you want to go! COMMITMENT: Make a list of the reasons you are working so hard to develop a healthier lifestyle and every day, SEVERAL times a day, state out loud your commitment to doing so. OUT LOUD! Your brain will hear you and respond in a positive way. EFFORT: Unless you do the doing, nothing much will happen in the way of results. So this EFFORT thing needs attention every day. Get help to get you going if you need to! Yep – that means: Ask. For. Help. You can do that! Your SELF matters. Be as loving toward yourself as you are to others. You are just important as every other person. Using these 4 ACES will get you to the place where a healthy diet is part of your healthy LIFESTYLE!

In a case of something that is old is new again: Have you ever used a bento box? The bento box dates back to the 5th century when Japanese farmers, hunters and warriors packed lunches in sacks or boxes. Farmers found that the seed boxes with multiple compartments worked better to transport their food. Instead of seeds, people used the different compartments to separate dishes like rice, vegetables and fish. The word bento comes from a word that means “convenient.” There are now bento boxes you can buy that can be plastic, glass or metal. Many now come with an insulated cover. You can find bento boxes in a variety of places including Walmart, Target, Amazon and Bed Bath & Beyond. Look for bento boxes that have removable compartments that are microwave and dishwasher proof. This allows you to pack a lunch with food that needs heating. A kid’s size bento box will provide more help with portion control.
Small servings of leftovers, hard boiled eggs, drained canned fruit, deli meat, cubes of low-fat cheese, tuna and a marinated vegetable salad are just a few ideas of foods you can carry in your bento box. Pinterest has a lot of low carb, high protein for food ideas to pack in a bento box: https://www.pinterest.com/baileybariatrics/food-storage-tips/.
So, what’s in your bento?

We take it for granted and perhaps do not recognize the many properties of water. Open the tap, and here it comes. Travel to the shore front and there it is, oceans and oceans of the stuff. It fills rivers and streams. It fills the shelves of markets and convenience stores. It falls on golfers who shake an angry fist and lament that their day on the green is ruined.
Just imagine how ruined all our days would be if it never rained. To state the obvious, water is vital.

How Much Water Should I Drink?
For as long as I can remember we have been told to drink eight 8-ounce glasses of water per day – more if you exercise heavily but less if you drink other beverages frequently. That seems a bit outdated to me. More recently, the Academy of Nutrition and Dietetics recommends that men should consume about 3.7 liters (about 13 cups) of water daily and women should consume about 2.7 liters (about 9 cups).

Read, Planning a Great Bariatric Diet Grocery List

During a workout or other physical activities, on hot or cold days, and owing to your weight and certain medical conditions, you may need more. The online daily hydration calculator is a great tool that calculates how much water you need by factoring in those criteria. I just used it to calculate how much water I need today. The result - 3.2 liters.
The benefits of this simple discipline are many.

Water for Optimal Health
Water is an energy booster, relieving the dehydration that makes you feel fatigued. When you are thirsty, you have already become a bit dehydrated. Dehydration also makes the body and mind feel stressed whereas 70 to 80% of your brain tissue is water.
Water helps to prevent muscle cramping and is a lubricate for the joints of your body. Water also hydrates your skin cells and gives your face a younger appearance. In addition, it is a good for digestion and helps to keep your bowels regular.
As an added bonus, it has been proven that drinking water helps to lose weight.

Water for Weight Loss
It has been shown that people who drink two glasses of water twenty to thirty minutes before they have a meal lost weight more quickly and lost a greater number of pounds then those who did not drink water prior to eating.
It was also discovered that people who drank water before meals consumed an average of 75 less calories over that course of that meal. If this action were continued for one year, a person would lose 14 ½ pounds.
It has also been shown that being just 1% dehydration causes a drop in metabolism that can interfere with weight loss.
The body has difficulty differentiating hunger from thirst. If you do not consume enough water across the day, thirst might be interpreted as hunger and more food will be eaten then is necessary.

Read, My Top 10 Bariatric Diet Tips for You!

Finally, drinking plenty of water to stay healthy during a fasting diet is essential.

Drink Iced Water for Maximum Calorie Burn
Calories can be used to define the amount of energy contained in food. Another definition for calorie can be the measure of energy it takes to raise the temperature of one gram of water one degree Celsius. Therefore, your body burns calories when you simply drink iced water.

Read, Eating Foods that Burn More Calories

Your body burns 17.5 calories raising the temperature of a sixteen ounce glass of iced water. If you comply with the eight glasses of eight ounces of water per day recommendation but drink iced water instead of non-iced water, you will burn 70 calories per day. Over the course of a year, the numbers will add up and translate into weight loss.

Living larger than ever,
My Bariatric Life

Freedom from Medical Chains
Medical benefits are probably most closely related to weight loss, but they are still worth noting as a “side” benefit of Weight Loss Surgery. As you lose weight, you may have improvements in blood sugar control, blood pressure, and cholesterol levels. You may have less joint and back pain. You may have fewer trips to the doctor, and be able to take fewer medications.
Better Sleep
Never underestimate the power of sleep! Losing weight can help you sleep more deeply so you feel better all day, every day. Your sleep can improve as you feel more comfortable in bed, and if you had sleep apnea that goes away or diminishes with weight loss. Just think how good life could be if you did not have to did not have to use a CPAP machine!
New Food Finds
Strange but true…there is a whole food world aside from burgers, burritos, fries, and bagels. Who knew that you might end up loving to start your day with oatmeal cottage cheese protein pancakes? Your favorite snack could turn out to be kale chips with parmesan. Dinner might be roasted cauliflower with grilled salmon – something you might never have considered when your go-to was mac and cheese from a box.
Sure, you might miss a few foods, but you might notice that you are loving all kinds of new health foods, and the way they make you feel. On top of it, eating slowly can help you savor each bite and enjoy the textures and flavors more.
Saving Money
Saving money probably was not your main reason for considering weight loss surgery, especially if your insurance is not footing the bill. Still, Weight Loss Surgery could be a financial gain in the long run as you consider some potential savings.
Lower medical bills for doctors’ visits, prescription medications, and complications such as complications of diabetes. Fewer sick days taken from work. Lower food bills as you eat less and potentially eat more homemade food. Fewer “extras,” such as higher prices of plus-sized clothing or needing to reserve two seats on a plane. More Meaningful Relationships
Were your relationships built around food before Weight Loss Surgery? Did you consider your friends your best eating buddies, with each of your meetings at a restaurant or each other’s houses for a (unhealthy) meal? Weight loss surgery frees you up to explore other interests. Deepen your relationships with your friends as you walk together or meet at museums or other sights instead of depending on food to bring you together. And, if you do meet for a meal or snack, feel good knowing you can focus on the conversation as you eat slowly.
Confidence
Ultimately, weight loss surgery is for you, and you can benefit inside as you look better on the outside. You can gain confidence from your new looks, maybe as you fit into clothes you love, or you see a few muscles popping out. Confidence also comes from your achievements. If you can do something as hard as going through Weight Loss Surgery and sticking to all those healthy lifestyle changes, you can do pretty much anything you set your mind to.
Energy
Energy is a wonderful thing, but it may be in short supply when you are carrying around extra pounds. Lose a few, and you might feel your endurance explode. You can keep up with your kids, enjoy a day at the mall or beach, and go on vacations. Getting through the work day can be easier. Life is better all around when you have energy.
Bariatric surgery is a weight loss tool, and it is so much more. Use it properly, and you can make great gains in many areas of your life. Part 2 of the series – to be published soon – will discuss ways to get what you deserve – maximum gains from Weight Loss Surgery!

Berries are packed with antioxidants, vitamin C, fiber and water. Antioxidants help slow down the aging process by protecting our cells from oxidative stress, Vitamin C helps with healing and fiber helps with digestive health. Berries have about 15 carbohydrates and 60-80 calories per 1 cup serving but the type of carbohydrate in berries don’t raise your sugars very much. Bariatric patients can use berries by puréeing the berries and freezing them. Use snack size, zipper-type bags, fill with ½ cup purée and freeze flat, which will stack better in your freezer. Because antioxidants need some fat to be absorbed, consider adding 1 teaspoon canola oil per 1 cup puree. Use the pureed berries in yogurt or when you mix a protein shake. Use ½ bag of your frozen purée per small container (5.3 oz.) of yogurt or a protein drink. That is about ¼ cup berry purée. You may need to thaw some before using the purée. Berries provide a nutritional punch your body will love. Hope you have many berry good times this summer!

Weight shaming is nothing new. I would beg to guess that most children who’ve struggled with weight have been victims of weight-based bullying. I can remember, as a shy elementary school kid, rapidly gaining weight and being different from the other children in my class. This impacted my self-image as I grew up, and my school days were rampant with daily bullying. The damage this did to my self-esteem carried over into many aspects of my life.
As a therapist, I had to confront those ideas I had about my value in therapy as a graduate student. I had to stop blaming those kids, and instead, change my thinking to change my life. Today, in the first few days after my 20th High School Reunion, I realize I had to fully let it go. The children and young adults that once ignored me or superficially friended me were not completely at fault for their behaviors in grade school, I was at fault for carrying their bad behavior with me and perpetuating those negative comments in my daily life.
It has always been my belief and a widely accepted professional self-care philosophy that you must work on your own issues actively to be able to help others. To do the real work on your own issues, it is essential to identify where those issues originated. How you got to that place of brokenness often brings back memories of humiliation, shame, mocking, and criticism from people you’ve known throughout your life. I had to actively challenge myself to overcome those negative memories of grade school and not shy away from attending like I did my 10-year reunion, so I got involved. I challenged myself to head up the 20-year reunion effort by rallying the troupes. I put myself in a position that gave me no way out by researching venues and getting the committee together.
I conquered my anxiety about what those people would think about me now. And you know what, I enjoyed my time at the reunion. It helps that I also weigh at least 150 pounds less, but as I’m sure many of you know, anxiety doesn’t go away automatically when you lose weight. To conquer my anxiety, I confronted it— using all those coping skills learned in years of therapy. What did I learn? I wasn’t the only one questioning whether or not I should go because I wasn’t sure how I would be accepted. In the days after the reunion, another attendee posted concerns about how she felt she hadn’t gotten to a place in life that she was proud of yet and worried what people would think. My reaction was genuinely heartfelt and profoundly appropriate for anyone struggling with their place in this world:
Be unapologetically you. Love your life and the place you've arrived without regrets or envy of others. The positivity you put out into the world will reflect back into your life a thousand times, just as negativity does the same. If you wallow in shame, blame, hurt, and pain those emotions intensify as you carry them around, they are heavy and burdensome. Let them go, smile more, take care of your whole self: mind, body, heart, and soul through your thoughts, words, actions, and emotions.
We often shy away from connecting with people who can be supportive of our goals and ambitions because we may lack confidence ourselves or hang on to past impressions people have made on us. If I learned anything from this experience, it’s that I had a lot of smart, talented people around me growing up. We've done some incredible things with our lives. There’s no reason feel like an outcast anymore. They were people I perceived to judge me in school who probably didn't understand the impact of their actions, and my perception was screwed because I didn't like myself back then. I love myself now and want to share the joy and be supportive by connecting, encouraging, and promoting a better mindset to attain happiness. If we continue to hang on to the negative, we never provide an opportunity to establish the positives. Forgiveness is an asset in your ability to cope. Shutting people out and never affording them the opportunity to do better will promote those negative memories rather than turning them around to make positive relationships.

Get the Go-Ahead
Step 1: get your doctor’s approval! This can give you confidence that you are on the right track and that you are going to be safe while exercising. Find out whether you have any exercise restrictions such as type of exercise or a safe heart rate. Once your doctor gives you the okay, you have no more excuses!
Walk, Swim, or Bike
The first goals of an exercise program for beginners are often to get your heart rate up and burn a few calories. Walking, swimming, and stationary biking can be the safest and most comfortable options for many weight loss surgery patients.
Start at a slow, easy pace without pushing yourself before you are ready. Only go for a few minutes at the beginning, and work up gradually as you get into better shape. Focus on yourself, and don’t compete with others’ paces or workout lengths. Stay positive, since it gets easier as time goes on! Pump Some Iron
Walk into a co-ed gym, and you are likely to see two groups. The men are lifting weights, while the women are focused on cardio and tied to machines such as ellipticals, treadmills, and bikes. Which group should you be in?
Both! While cardio, or aerobic exercise, burns calories and helps your heart, blood sugar, and other health measures, strength training has its own benefits. It helps you lose weight by building muscles, which burn more calories all day, and it improves your bone health. Strength training does not bulk you up; it makes you toned and lean. You have all kinds of options.
Lifting dumbbells or barbells. Using weight machines at the gym. Pulling on resistance bands. Trying exercises that use your own body weight as resistance. Work on each of your major muscle groups, including biceps (front of arms), triceps (back of arms), shoulders, chest, back, hips, quadriceps (front of thighs), hamstrings (back of thighs), calves, and core – your abs and obliques. The ultimate goal is to work each muscle group at least two days per week, making it tired but not straining.
You might want to ask a trainer or an experienced friend for help with ideas for exercises, as well as for demonstrations on proper form. You do not want to get injured!
Do a Full Workout
What is the difference between a workout and a full workout, you ask? The workout is the main part of your exercise, such as a brisk walk and/or a weight lifting session. A full workout starts earlier and ends later because it includes:
A 5 to 10-minute warmup such as slow walking or easy cycling to gradually get your heart up from its resting rate to its workout rate. Your main workout, such as brisk walking, an aerobics class, or a tennis match. A 5 to 10-minute cool-down, such as slow walking on the treadmill or in the pool. 5 to 10 minutes of stretching to keep your muscles loose. The full workout takes a little longer, but keeps your injury risk down and lets you get more out of your workout and entire exercise program.
Be Realistic
Some exercises may not be comfortable or feasible when you are carrying around extra weight. Do not fight with yourself or get down on yourself. Just be patient. Do what you can, and you will gain new skills as you get in better shape.
Exercise can be one of your greatest gifts to yourself on the weight loss surgery journey. It is hard and getting started is hard, but the rewards are well worth it. Good luck!

The Right Mindset for Smart Decisions
It is no surprise that you are at your best when you are rested, relaxed, and confident. That goes for almost every aspect of your life, and it holds true for weight loss. Thinking clearly lets you “weigh” the consequences of the hard-boiled egg versus the French fries for a snack so you can see the benefits of choosing the egg for weight loss outweigh the benefits of choosing the fries for a few minutes of pleasure.
Self-confidence also lets you make the right choices. When you are confident, you know that you have the power to choose. You realize that are not a victim of circumstances, and you do not need to eat something just because it is available to you. You know that you have the power to say no to the things you should not eat, and the power to find the things you should.
Better Sleep, Better Choices
Sleep is not just a luxury to feel guilty about. Adequate sleep may be the missing key to your weight loss program. When you get enough sleep, you have lower levels of a hormone called ghrelin. Ghrelin makes you hungry, and less ghrelin helps keep hunger in check. Getting enough sleep also lowers carb and sugar cravings and gives you the strength to make rational decisions. Think protein and veggies, not potato chips and cookies.
Stress, Hormones, and Your Weight
In addition to your daily choices, there are behind-the-scenes factors that can cause weight gain when you are stressed. Hormones affect your metabolism and can cause weight gain when they are not balanced. Too much stress, for example, raises levels of a hormone called cortisol. Cortisol increases raise your hunger levels, which can lead to you overeat. It also affects your fat storage. You might gain more fat in your abdominal area, which is a health risk for diabetes, heart disease, and more.
Tips for Chilling Out
The first trick for relaxing is to get over your guilt. It is not only okay to kick back, but it is healthy. It may be surprisingly tough when you are out of practice, though. Here are some ideas for stepping back from your busy life and giving your mind a chance to recover for a healthier body.
Set aside 10 minutes for yourself every day. Meditate, take a bath, read, or do something else that is just for you. Get more sleep if you find yourself waking up tired or struggling to get through the day. Exercise most days. A quiet stroll on the beach or a hike may seem like out-of-reach dreams, but any exercise helps clear your mind. Restorative yoga, a cycling class, and home exercise DVDs all do the trick. Stretch. It loosens your muscles and gives you a chance to think through your day. Weight loss surgery success takes a lot of hard work, but there are some ways to get more bang for your buck without working harder. Take a chill pill, and you might find that the extra relaxation gives you the strength and stamina to lose more weight.

For equipment, think about bringing a shaker cup or small blender to mix protein shakes, carry protein powder with you (try single serve packets or put a single serving of protein powder in a small container or small zip bag.), carry a stash of utensils (plastic forks, spoons and knives), and bring clean up helpers (paper towels, napkins or wet wipes). If you are going to a hotel that has a microwave, bring microwave-proof dishes or paper plates to heat a frozen meal or leftovers. A small coffee maker can make a decaf cup of coffee you can add vanilla protein to make a latte or chocolate to make mocha type drink. Drink it hot or cool it down and put ice in it. If make a hot drink, keep the temperature under 140 degrees.
If traveling in a car, bring a cooler packed with protein drinks, cheese sticks, cottage cheese, hard boiled eggs, light yogurt or protein snacks like the P3 Protein Packs. You can either buy the individual servings of yogurt or cottage cheese or get a larger container of these foods and divide into small, plastic containers. Be prepared to stop by a grocery store to purchase single servings of yogurt or cottage cheese. There are veggie-fruit-protein snack packs now in many of the produce section of grocery stores. Some convenience stores carry protein shakes and protein bars. These are usually found on shelves towards the back of the store. Other protein snacks include protein chips (Quest, Kay’s Naturals) and protein bars. Look for protein bars that have more protein than carbohydrates such as brands like Premier Protein, Pure Protein, Six Star Nutrition, Quest and Nature Valley Protein Bars. Pouches of tuna or salmon, or the tuna and chicken salad kits to make an easy meal. Softer texture jerky and nuts are other protein options. Pack your bags and pack your protein to have a great trip!

I’m in New Zealand today, where I have been for the past three weeks. It has been a privilege to work with a number of bariatric professionals from different disciplines associated with the Foundations Healthy Living Retreat. During this five-day retreat, a small group of post-operative bariatric patients live together, eat together, exercise together, learn together and share with one another. Various staff members share their expertise about healthy living. Topics include much more than how to eat well and exercise. Participants learn the importance of focusing on personal values in all areas of their lives, discover the importance of positive self-talk, address self-sabotage and learn the importance of living mindfully. Coping skills, communication skills, and boundary setting skills are discussed. The topics of shame and vulnerability are explored, as well. Participants get what all bariatric patients in all corners of the world need following bariatric surgery: the Foundations of Healthy Living. Hmmm… good name for the retreat!
What I think as I look around me are the many “non-coincidences” in my immediate surrounding. I do not believe that my being here, halfway around the world, is a coincidence. To begin with, Dr. David Schroeder, a bariatric surgeon, and his wife, Andrea, are, in many ways, absurdly similar in personality to my husband Steve and myself. David and Steve are both kind, intelligent, rational, left-brain thinkers who are mild-mannered and soft-spoken. Andrea and I, on the other hand, while also kind and intelligent, are passionate, passionate and more passionate. Translated, we are thinkers and DO-ers, we are upfront and direct, and are most definitely whatever the opposite of soft-spoken is. Oh, loud. That’s it!
Andrea and David are passionate about their work in the bariatric field. They are zealous about the physical health of surgical weight loss patients and are also super passionate about the patients’ psychological health. The Schroeder’s know that the journey of recovering from obesity takes a lifetime and includes the physical and the psychological wellbeing of each person. Andrea created the Foundations of Healthy Living Retreat and they have been hosting the retreats for the past five years.
It is definitely not a coincidence that David reached out to me after reading my first book, Eat It Up! Our professional philosophies are very much in sync. My work, with great help from Steve, is all about addressing the psychological needs of patients while their physical needs are being medically managed. David and Andrea, like Steve and myself, dedicate much more than our careers to providing bariatric patients with education and support. We address the WHOLE person, pre-operatively and after weight loss surgery. We put our hearts and souls into the work we do because we are convinced by the feedback our patients provide that they want and need much more than the surgical procedure can provide in order for them to live healthy lives, both physically and psychologically following bariatric surgery.
Since meeting in 2011, I have learned a great deal by working with both Andrea and David. The Schroeder’s have twice brought me to New Zealand where I have had the opportunity to learn from and contribute to, the lives and education of their patients and staff.
Andrea and David, as well as every person presenting information at the retreat, address bariatric patients from a whole person perspective. Each participant is treated respectfully and compassionately, as a human being who is much more than a bariatric patient. Their emotional support needs are emphasized, as a success following bariatric surgery involves more than dealing with a person’s biological innards.
Is it a coincidence that Andrea and David, in New Zealand, know the same things that Steve and I know in the US? We all know and work toward, helping patients and bariatric professionals realize that bariatric patients have tremendous emotional and psychological needs that require attention. Behavior modification by itself is not enough when it comes to sustaining weight loss. If it were, well… wouldn’t more people have kept weight off after diets and bariatric surgery?
Is it a coincidence that the bariatric patients I have talked with during individual sessions, along with the participants at the retreats, all from New Zealand, talk about the exact same issues as the bariatric patients I have worked with in the US for the past 15 years? I’m not talking about the physical problems. I’m talking about the lack of self-care this population acknowledges. Not just in their eating and exercise behaviors. These people talk about a great lack of self-value that translates to a lack of proper self-care. The greatest common denominator aside from the physical co-morbidities of the bariatric patients I have spent time with in both countries boils down to this: I don’t believe I’m good enough. That, my friends, is the definition of shame.
Our bariatric patients need to heal from the shame that draws them back into unhealthy habits. Healing from shame requires much, much more than a bariatric procedure in an operating room, or “theater,” as they call it in New Zealand. It is not coincidental that bariatric patients across the globe suffer from shame. It is tragic that so few bariatric professionals around the world are willing to provide the full spectrum of care that patients require in order to be able to follow through with behavior modification techniques. Deep shame will eventually extinguish behavior modification efforts.
How long before more bariatric professionals get it? How long before more than a handful of patients get the emotional support and psychological care they need after bariatric surgery? How long before we provide a truly comprehensive program to help our patients eliminate shame and establish self-acceptance?
The shame belongs to the programs and professionals who do not provide a comprehensive program… because those programs simply aren’t good enough. (Along with the Schroeder’s, I will be offering residential retreats through bariatric centers in the near future. For more information, contact me at connie@conniestapletonphd.com.)
I’m grateful for the non-coincidences that have led to meeting Andrea and David Schroeder. I am not surprised to see and hear that the patients in our very distant geographical countries are so very similar. Mostly, I am thrilled to know that there are professionals and patients who know that the Foundations of Healthy Living go way beyond medical care alone!
For now, patients can participate in the GAIN While You Lose 10-week program. This is a great way for patients around the country (and the world) to have access to the same topics discussed in the Foundations of Living Retreat. This class includes an hour and a half “lesson,” taught live but available online or via recorded session, followed by weekly homework to make the information applicable to each person’s life. (http://www.conniestapletonphd.com/onlin…/weight-loss-program)
Why aren’t we currently doing retreats in the US? Are you, the patients, willing to pay to attend? Are you willing to take the time and spend the money to invest in yourself? Do you value yourself enough to work on your emotional issues? You’ve most likely been willing to pay hundreds to thousands of dollars for weight loss programs, powders, gimmicks and scams. What about actually finding a way to find self-acceptance, a requirement for being able to follow through with behavior modification tools?
Patients: there is no shame in having problems. It is tragic to me if you know there are problems, but choose not address them. Please seek the help you need! After all: YOUR HEALTH is YOUR RESPONSIBILITY. THIS DAY. EVERY DAY.

I have worked as a psychologist, providing psychological evaluations prior to bariatric weight loss surgery for the past eight years. For the most part, people need a power tool to help them lose and keep off the weight they have lost over and over again in their lives. The gastric sleeve, bypass, and now balloon are those tools. However, every once in a while, I will encounter someone who believes these procedures are the magic bullet.
I can pick this up in five seconds when I learn that:
this person has no exercise plan to maintain their weight loss a barrage of excuses as to why they can't exercise anymore zero insight into why they are overweight ("I don't know why I am overweight, I just eat steamed vegetables and grilled chicken mostly.") a lack of motivation or understanding for why they also have to engage in behavioral modification in addition to the surgery "Why would you reveal all of this?" you ask. Aren't I giving away the keys to the kingdom to anyone who reads this and wants to pass a psychological evaluation? Perhaps- but who are you really cheating if you don't go within and face the real demons that got you here in the first place?
When I ask people about their eating styles, I tend to group them into four categories:
1) emotional eater- someone who uses food when they are bored, stressed, tired, lonely, sad, or even happy in addition to eating when they are hungry
2) skip and binger- someone who fails to think about food until it is too late, and when they are ravenous end up going for whatever is available which is usually some type of carb and calorie laden fast food
3) miscellaneous- someone who just recognizes that they eat too large of portion sizes and/or the wrong types of food
4) food addict- usually someone with a history of other addictions, trauma, and a significant amount of weight to lose. They usually have comorbid psychological diagnoses that have been unaddressed or ill-addressed.
Out of the four categories, the 4th is the most troubling for a psychologist. This particular person is most correlated with the patient who fails to address their core issues, eats "around the sleeve," or bypass, experiences dumping syndrome, comes back a year later and asks for the bypass, or a different procedure.
This is the person who, ironically, is usually the most resistant to my recommendation that they seek therapeutic support prior to the surgery. They want it done YESTERDAY. They want it NOW. It is this type of thinking that got them into trouble in the first place. The impulsivity and lack of emotional regulation.
I've witnessed people fail to address their maladaptive eating patterns and never quite get to their goal weight. I had a male that would buy a bag of pepperonis at the grocery store and snack on them all day and couldn't understand why he wasn't losing weight. This daily "snack," which was a mental security blanket, served as a veritable IV drip of fat and calories throughout the day.
I've had a woman who figured out how to ground up her favorite foods into a liquid form because she never quite let go of her attachment to "comfort foods." One of her most notable liquid concoctions consisted of chicken and Cheetos. I'll just leave that for you to chew...er swallow.
They say with drug and alcohol recovery- you "slay the dragon," but with food addiction recovery, you have to take it for a walk three times a day. If you don't fundamentally shift your relationship with this dragon, you're going to get burnt when you are walking it.
My number one tip for transforming your relationship with food is to start looking at eating the same way you do as brushing and flossing: You don't necessarily salivate at the idea of what type of toothpaste you will use, where you will do it, who you will do it with, right? You just do it twice a day because you don't want to lose your teeth and you want to maintain healthy gums.
Food has to be thought of in the same way. You fuel up. You don't use food as a place to define your quality of life. You don't use food to celebrate. You don't use food to demarcate the end of a long day. You don't use food to help you feel less alone. You figure out healthier coping alternatives to meet these needs.
Loneliness-call a friend for support
Celebrate- get a massage
Demarcate the end of a long day- start a tea ritual and use essential oils
Another reason you must say goodbye to comfort food is that it triggers the pleasure center of the brain, which ignites our dopamine, which perpetuates the addiction. Many people think we are just telling them to get rid of the comfort food because of the carbs or calories, but there are unique and harmful chemical consequences to ingesting these types of food we know are bad for us.
If you are ready to take a modern approach to weight loss and stop dieting for good- check out my wls/vsg psychological support course here for free.

Success is not always about the number on the scale!

We know you guys hate it when we say this, but it’s the truth… and we are about to show you the PERFECT example.

Check this out – http://people.com/bodies/fit-mom-looks-drastically-different-2-lb-weight-loss/

Adrienne’s transformation is truly incredible! Despite losing a measly 2 lbs, a quick look at her before and after picture clearly shows a dramatic change in her body composition.

What do we mean by ‘body composition’? Body composition refers to what proportion of our body is fat, muscle, bone and water. Since the weight of our bones and water stay relatively stable, it is the percentage of our fat and muscle that change when we gain weight, lose weight and, in the case of Adrienne, also when we exercise.

Unfortunately, what we measure on our home scales is simply the total weight of all of these (i.e. fat + muscle + bone + water). This means when we gain muscle and lose fat, which is what happens in the case of exercising and weight lifting regularly, our scale is not able to express these shifts in body composition.

Moral of the story: the scale does not always dictate your progress. If you are sweating your butt off in the gym, you are definitely changing your body.

It breaks our hearts when we see clients who are healthy, super fit and 3-5 dress sizes smaller, but they are still not happy with their ‘success’ because of the number on the scale. Sadly, in some of these cases, the clients were so desperate to lose more weight that they stopped their weight training to intentionally lose muscle. Crazy right? All just to see the number on the scale go down.

Remember: Success looks different on everyone.

Weighing yourself is only one measure of progress. Ask yourself the following questions if you are exercising regularly but not seeing results on the scale. If you answer yes to any one of these questions, you are most likely changing the composition of your body for the better (i.e. gaining muscle and losing fat).

- Do your clothes fit slightly looser?
- Are you less out of breath when walking?
- Are you using a smaller hole on your belt?
- Do you feel powerful at the gym?
- Is there more definition to your arms and legs?
- Do you feel stronger?

Although Adrienne’s story does not involve bariatric surgery / weight loss surgery, she is a perfect example of how you can dramatically change your body while being ‘plateaued’ or ‘stalled’ in terms of your weight.

What are your favourite non-scale victories? Post below in the comments!

One patient told me that a plastic surgeon said to her, “I operate with a scalpel, not a magic wand.” While another patient told me her plastic surgeon said, “Let’s go for a 10!” I wonder about these statements. Does the first plastic surgeon lack the skills to deliver the results that the patient wants? Is the second plastic surgeon just telling the patient what she wants to hear?

A patient must have realistic expectations going into plastic surgery after massive weight loss. The plastic surgeon must manage those expectations and explain to the patient her realistic outcome. This is done by the plastic surgeon pulling tight her excess skin on each area of the body to simulate her results after plastic surgery. As well, showing before and after photos of other patients with similar body types.

Body Image and Media

The media has baited the hook, and the public chases after a trophy that will probably never be had. It is similar to purchasing a winning ticket for the lottery: It is possible but not probable. As a matter of fact, the average five foot four inch tall American female will never be tall and slender. She cannot match the media sales image of “desirable.”

A major global study concluded that current characterizations of beauty are restraining and normally beyond reach. A current contention is that this unrealistic presentation helps to promote social acceptance of discrimination against obese people.

It also sets the bar too high for realistic expectations of what we should strive to look like following post-bariatric plastic surgery.
Plastic Surgery Post Bariatric Surgery

While I was recovering from my body lift I thought deeply about the body image held by many of the patients I’d interacted with online, as well as my own image of my body. What are the emotional implications of plastic surgery post bariatric surgery?
We found our bodies unattractive, or even ugly, after losing 100 pounds or more. We were left with excess sagging skin that could not be exercised or dieted away. Having body image issues about breasts, thighs, and tummy being deflated and sagging is quite understandable. Wanting the sexy body you have always wanted is normal. Body contouring plastic surgery was the only way to restore the body’s normal shape. Read, “Female Body Image and Sexuality.”
Reality Check after Plastic Surgery
The patient must understand that it takes several months to see plastic surgery results. If months have passed and the patient remains unsatisfied, it is a good idea to pull out before and after photos for a reality check. Improvement is more likely than perfection for a massive weight loss person, but it should be significant improvement. Read my article, “18 Insider Tips of Plastic Surgery.”

Body Image after Weight Loss

Reeducating people about self-image is a critical component to accepting oneself after weight loss. This will help lessen the extremes people employ as they try to grab a brass ring that is always beyond reach. Your goal should be one of significant improvement in functional mobility, stability, and aesthetics, rather than perfection.

One patient told me, “I am not looking to be Barbie or Twiggy, but rather a more compressed me if possible. I feel like a barrel even after the plastics I’ve been able to have via my ***. At some point I have to just accept me for me with my bodily flaws; and every scar on my body has meaning to me!”
Self-acceptance is, after all, a state of mind. Self-image is the idea a woman has about her abilities, appearance, and personality.

Zero Weight Regain 2017

What are your long-term weight loss goals? Likely you have a positive, upbeat vision of a thin and healthy you. Bariatric surgery might be an option you are considering. Or you may have already undergone one of these weight loss procedures.

Given your dreams and all the hard work you are going through to achieve them, would it be a shock to hear: Many studies show that in the five-years following surgery, patients often gain back most or more of the weight that they had lost.

What makes it so easy to gain weight even after bariatric surgery Unfortunately, any bariatric surgery fails in the long-term when not married to a maintenance plan.

Let’s commit to zero weight regain in 2017. Are you with me? Who’s all in? Then let’s get started with some required reading. The following are good habits you can put into action right away!

Eat Healthy
The ball is down, Times Square is back to business as usual, and January 1st is bloated with stroke of midnight promises. As we close on January, the month of the year when the most traditional date for personal improvement offers itself up, it’s a good time to check the progress you are making on your resolutions. Among those promises made is the pledge to get fit by eating healthy. If you are among those who share this intention, here are 10 healthy eating resolutions to get you started!
Read, “10 Healthy Eating Resolutions.”


Build a Support Network
Patients voice concerns about the difficulty of establishing a bariatric support network. And they struggle to find the balance needed to address their personal recovery needs in the post-weight loss surgery world. Such concerns are well-founded and not unusual. But many bariatric patients meet that challenge and successfully build a viable, multi-dimensional bariatric support network. There is no reason why any person who has had weight loss surgery cannot construct a reliable and useful post-bariatric support network.
Read, “How to Build a Bariatric Support Network.”


STOP Stress Eating
Knowing what we need to do can be quickly overturned by what we want to do. Stress demands relief. Harmful and unhealthy choices are often exercised to relieve stress because they are familiar. Emotional eating can provide that relief, but it is a short-lived solution that can have the side effects of overweight or obesity. And if you have had bariatric surgery, you are setting yourself up to regain weight that you have lost.
Read, “What to Do about Emotional Eating!


Step-up to Permanent Weight Loss
So, you’ve had bariatric surgery and think never again will food be a problem. Right? Well, its not quite that simple. Bariatric surgery is a powerful tool that helps you lose weight, but it is not a cure-all. Permanent weight loss requires more than a bariatric surgery. Permanent weight loss requires that we forever change the way we feel, think, and act around food. Follow our steps to turn “bad habits” in “healthy habits.” They’ll set you on a straight course toward permanent weight loss.
Read, “10 Easy Steps to Permanent Weight Loss!”


Be Committed!
Stay on your path to weight loss. It takes dedication. So be dedicated. It takes perseverance. So persevere. The surgery is not a means to an end. It is only the beginning.

Living larger than ever,
My Bariatric Life
http://www.mybariatriclife.org