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Fat-Shaming sucks. Addiction-Shaming sucks. Bald-Shaming sucks. Shaming-Shaming sucks. There’s no way around that. It’s just plain true. There is too much shaming going on all around us. My question is: As good as it is to call the world out on their shaming behaviors, would we maybe be better off working on ourselves and, if we are health care professionals, working with our patients, to focus on the ways they shame themselves? AND OTHERS? At least simultaneously to trying to put an end to “Other-Shaming.” The purpose of this post is twofold: · To have each reader assess themselves in regard to their own shaming-ness, and · To suggest we help individuals stop shaming themselves while we simultaneously encourage the masses to stop. There are Tweets and Posts galore inviting us, inciting us, and urging us to help stop the Fat-Shaming done by society! I agree these are worthwhile efforts and must be done. What I don’t see very often on Social Media are statements encouraging people to get help to stop shaming, bullying, and beating up on themselves. We want an end to shaming, an end to bullying and an end to domestic violence. Check it out! All of that occurs within many an individual’s head! Here are some recent posts from social media, along with my posted responses: “Stand up to #weightbias! Sign the #petition to end fat-shaming and weight bias today.” My response: “Yes, please! Also work to stop #SelfShaming and #SelfBias. Sign up for therapy in your community!” “Why We Need to Ban the F Word: Fat-Shaming” My response: “If you believe people deserve to be treated well (and I do), please start by treating yourself well in your thoughts, words and actions.” “Once a person has obesity, it’s too late." One more way to #dismiss people with #obesity.” My response: “I hate that people dismiss those with obesity. I hate even more how those with obesity often dismiss themselves in so many ways.” “I believe that the morbidly #obese population is stigmatized, abused, neglected and mistreated by most facets of society.” My response: “I hate it, but those suffering from morbid #obesity also abuse, neglect, and mistreat themselves through negative self-talk, self abuse.” “Don't blame the person, rather treat the disease.” My response: “Don't blame patient for factors related to obesity they can't influence. Hold them accountable for those they can.” Please be clear about the message I am sending. I do hate the very real fact that society shames people who suffer from obesity. I hate that many people, including doctors and other health care providers, solely blame individuals for being obese. It’s horrible that a person is dismissed because they carry extra weight. No doubt. I know from both my personal and professional work, as well as from life experience, that I can influence my own behavior a lot more quickly than I can influence the masses. Typically, a person has an emotional connection to an issue if they are working to right some wrong related to that issue. Not all, but many people fighting to end societal Fat-Shaming, have “some skin in the game,” as they say. I am one of those people. Much of my work is done in a bariatric center where we aim to help those suffering from obesity, both physically and emotionally. Many health care providers, people who are personally struggling with their weight, along with family members and friends, all work together to try to end fat-shaming. Keep on keeping on with those efforts because they are worthwhile! In the meantime, are you, regardless of your size, weight, color, or religion, looking within yourself in an attempt to “clean your own side of the street?” Do you have biases about other groups of people being stigmatized? And more importantly, are you aware of, and working on, the ways you stigmatize, dismiss and shame yourself? Calling a person who suffers from obesity an ugly name, overlooking them for a job, dismissing their opinion or making a critical comment to or about them is wrong. It is equally despicable that people say things like, “I wouldn’t date a bald man,” or “He wouldn’t be right for the job. He’s bald.” My husband is bald and he struggles emotionally because of it. Have you (to include anyone suffering from obesity, alcoholism, drug addiction or any other ridiculed member of society) made ugly comments about bald people? It is disturbing that subjectively unattractive people are considered less intelligent, are helped less frequently by the public if they have a flat tire, and are hired secondarily to “beautiful” people. Have you (to include anyone suffering from obesity, alcoholism, drug addiction or any other ridiculed member of society) made ugly comments about unattractive people? How dismissive it must be to be a person who is part of an ethnic minority to have people call you a hateful name, to overlook you for a job you are very qualified for, or assume negative things about you. Have you (to include anyone suffering from obesity, alcoholism, drug addiction or any other ridiculed member of society) made disparaging comments to or about minorities? Religions are always good fodder for shaming, dismissing and bashing. Have you partaken? “You don’t look like one of them,” said my doctor to me when I shared that I am a recovering alcoholic and addict. One of them. A patient in a therapy group of people suffering from obesity said, “I cannot, for the life of me, understand why an alcoholic doesn’t just stay away from the bar.” To which I responded, “What is it like for you when someone asks why you can’t just push away from the table?” Wrong is wrong and it is wrong when any of us engage in dismissive or shaming conversation or behavior. Check yourself. Youre human and that means you have your own prejudices. You’ve likely engaged in your own dismissive comments about groups other than the one(s) you’re most closely aligned with. Relax, I’m not shaming you! I’m asking you to look at your own side of the street. Does it need sweeping? We all need to keep a broom nearby because we are all guilty of judging others at times. In my work, it is a priority to help people stop shaming themselves. Negative self-talk is a powerful way in which we shame ourselves. Yes, you do it, too! “I’m such an idiot!” “How could I have done such a stupid thing?” “What is wrong with me?” “I don’t know why I even bother. I never follow through anyway.” The list of examples illustrating negative self-talk, or stinkin’ thinkin’ is endless. Every single negative statement you make about yourself is dismissing the value of the person you are. Ironically, the shaming statements people make about themselves are representative of their own internal shame. The negative self-talk says, “There’s something wrong with me.” “I don’t feel ok about myself.” Isn’t it odd that we run around making a fuss about stopping the masses from shaming people when we spend some much time shaming ourselves? I’m thinking we would all be better off if we “swept our own side of the street” first. When we treat ourselves more tolerantly and we are accepting of others who we tend to dismiss, then it’ll make more sense to focus on what the masses are doing wrong.

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!

Pushing Your Way Through I have a few Hollyhocks in my garden that just grew there. I did not plant them. I did not take the time to make a place for them so that they would stand out as specimen plants. No tender loving care was bestowed on these flowers to help them become the plants I found stunning and beautiful with their rich outer color of burgundy with soft pink centers. What a delight to find these treasures in my garden. They found their way into my world without so much as a finger lifted on my part. Before this summer I saw Hollyhocks as a simple, common plant. To someone else it is possible that they are the gem of plants. Maybe a reminder of the good old days when things were simple and sweet. My grandmother grew hers around back of the old outhouse on her farm. That is how I remember them. How did they come into my garden? The seed was most likely transferred in the breeze and made its way to me. Even though I did nothing to help them grow and take root in my garden, I have come to see that they now belong there. They did all the work and I now admire them for their resilience. When referring to ecological resilience, it is the ability to return to its original state after being disturbed. You see, about nine or ten years ago I pulled every single Hollyhock out of my garden replacing them with other tall flowers. I had not seen any trace of them since. But now there are new ones. They were insistent and settled themselves in among the other plants and kept pushing until they stood tall and bloomed in all their glory. Resilience has yet another meaning. It is the ability to make realistic plans , being capable of taking the necessary steps to follow through. A positive self-concept and confidence in ones strengths and abilities. Having communication and problem-solving skills. And the ability to manage strong impulses and feelings. Are we resilient in our weight loss journey? Do we know our weaknesses and strengths and fight the urges to give into our old ways? Do we still use food as a form of comfort, celebration, reward, socialization and escape from the feelings we are having at that moment, good or bad! Can we push our way through these deep rooted emotions and become healthy and happy? Or are we easily stomped out and have little to no strength and will power when it gets difficult. Becoming overwhelmed by other things that can easily crowd out our conviction to reach our goals. By retraining our brains, finding our trigger points and looking at food in a new light we can win this battle and become successful in our endeavor to feel better and healthier. Having real control. Finally putting dieting in the past and living each day a new. Learning more and more how we can win the war not just the battle of obesity. The odds are against us, our past experiences of weight loss and regain have made us timorous about our future and our weight management. At those times maybe we were not ready or we denied ourselves food or it was a fad diet of some sort that we had to follow. Whatever it was. That is in the past! Now is the time to see a new and improved you with a brighter future of no weight related health issues. A busier and more fulfilled life ahead of us. If we really want it, it is there for the taking. Weight loss surgery is the tool that will give us the time we need to get help to fix why we became obese in the first place. No one said it was going to be easy. No wait! Those who have not experienced what it takes mentally, emotionally and physically to be successful might not understand all of it and use the over used quote, ' you are taking the easy way out.' But no matter. It is about us forcing our way through the hard times, the painful times and yes even the good times. Like the Hollyhocks in my garden that planted themselves there against all probability. We too can push our way through and plant ourselves in the garden of life with a new healthier us with a bright and colorful future ahead of us with the help of one of the weight loss surgeries that are available to us.