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Over the 8 years I have met with weight loss surgery patients, the one concept I find myself going over and over is this idea of becoming full from within. The idea that if we don't fill ourselves up intrinsically- we will always need some thing to fill the void, whether it be food, gambling, sex, drugs, or alcohol. The problem is- we always end up on empty, psychologically. The next question often becomes, "ok so how do I fill myself up psychologically? I don't think I will ever be fulfilled because I have never been truly happy. I was not born a naturally happy person? I've spent most of my life feeling empty- how do I turn it all around now? I grew up with unhappy parents, how am I to unlearn all of that early programming?' "Wondering if you're happy is a great shortcut to being depressed." - Annette Bening, 20th Century Women I think, unfortunately happiness gets a bad rap. There is a wide misconception that for us to be fulfilled, or full from within- we need to be blissfully happy all the time, and that's just not the case. Not only is it untrue, but it is an unrealistic standard and one that sets people up for disappointment. Rather than always questioning how we SHOULD be feeling, we should just practice acceptance of whatever temporary state we happen to be in at the moment with non-judgement and non-attachment. Like busses, moods come around every five minutes. Even therapist's aren't immune to life's ups and downs. Believe it or not, as a psychologist who literally wrote a book on Happiness, I have to remind myself certain mantras that help me keep my own life in balance and my happiness and fulfillment sustained. I actually have a list on my phone that says "things to remember," and page through it daily, when I'm feeling off track. So if you're feeling off track yourself- first understand that you're human and give yourself a break + then thumb through my personal list of happiness tips, little pearls I've gained in my 37 years on this planet, and see if any of them might help to increase your happiness quotient today: 1) In silence, the heart begins to finish its unfinished business. I think I picked this up from a book I read about Sufism. In any case, I liked it and it stuck. Oftentimes, we think that we must actively and aggressively pray, yet Sufis believe that it is in the stillness that God comes to us. Whenever my life gets a bit too chaotic with all the "should-ing" all over myself- I remind myself that it is often when I take pause, let go, and let God- that what is truly important, rises to the surface and I begin to reclaim my life instead of it claiming me. 2) Do more want-to's vs. have-to's every day. Someone once told me that the "have-to's" will never be done. I repeat- they will never be done. So we might as well splice in some time for the things that we thought we were going to do once they were done. Take the scenic route to work, take a long walk and listen to that book on audible that you have been wanting to read for the last few months,go shopping with a friend, get a massage, take an extra long lunch and sit out in the sun, or just curl up with your loved one or pet. A wise man once said "time you enjoy wasting, is not wasted time," and I couldn't agree more. 3) Happiness is not the absence of problems, but the ability to deal with them. I remember when I was in grad school, thinking "if I can just finish school- then I'll be the relaxed, happy go lucky person I want to be," then it morphed into, "once I get licensed," then "once I get married," then "once I have kids..." You get the idea. It is not the situations or circumstances in our lives that determine if we are a happier person or not. It truly is the way in which we approach them as they come, that determines what type of person we are and how happy we will be. In the "car of life," that we all have to drive, will you wear stilettos or uggs? 4) Connection with others is key to fulfillment. I am an introvert by nature. I enjoy my downtime, and require coming back to my home base in silence, to relax and unwind. However, there is something inherent in our very nature about the need to feel connected to the world around us- introverts included. My best girlfriend from childhood came out for a week a while back, and so I was unable to get caught up in the hamster wheel of daily activity. I was forced to be fully present and engaged with her for four days in a row. As a result, I was actually more grounded, more at peace, less anxious, and more optimistic about the future. Whenever we notice our egoic drives propelling us towards isolation, judgement, rumination, or comparison- we should remind ourselves to get out and connect with our fellow man, and fakebook doesn't count. 5) Like attracts like. Happy attracts happy. When we find ourselves feeling left out, isolated, or out of touch with those around us- it is important to look at our recent focus. Are we always dwelling on the negative, gossiping about someone? You know the saying "what sally says about susie, says more about sally than susie." Although, many of us sub-consciously believe that if we can just "get it out" about whatever is chipping away at us- it will somehow allay our negative feelings- it really doesn't. In fact, research supports that when we ruminate on negative feelings, it actually increases our negative feelings. This doesn't mean we should all be superficial and "surface-y" towards everyone, but that we should work a bit harder to find the happy. 6) To receive abundantly, ironically we must give abundantly. It is engrained in our DNA to wake up each morning with a needs list: "when will I get that bonus?" "when will I hear back about that promotion," "when will she call me back?" Yet, spiritually I truly believe that when we make the shift from "what can I get," to "what can I give?" It is a complete gamechanger. It's almost as if the universe aligns with us and says "yep you finally figured it out." 7) Choose your thoughts like you choose your clothes. Our minds are quick and fast like ferraris. They are an intricate and complex machine designed for ultimate performance, but just like we must use the right fuel for a Ferrari, we must also carefully select and filter which thoughts we allow to permeate our consciousness. When you notice yourself feeling down, take a cognitive step back and look at what thoughts you were having. Most are unproductive. Choose to let them go. The same tool that created the problem (our mind) is not likely going to solve the problem. 8) Legitimately and truly don't care about what others think or do. I can honestly say that this is still a work in progress for me. I was born a people-pleaser, but as I get older, I realize the more I try to make others happier with me, the less happy I am with myself. 9) Go out into the world with your heart, not your brain. Yes, our brain is required for some part of our days. Otherwise, our bills wouldn't be paid, our tasks wouldn't get done, and our goals wouldn't be met. But, other than that- when we greet people, meet people, share with others, observe, smile, walk- it is quite a different experience to live in our heart space, in that emotional space that is more visceral than verbal. 10) Relish in the remarkable ride. I watched a movie a while back called "about time," and it was all about a man who had time travel figured out. He lived his day once all hurried and bothered about the little stressors of life, but then went back to live it again. He said he would just rest in the moment, relax, and relish in the remarkable ride that was his life. I love this. After all the late notices have come, all our debt has fallen or risen, our weight has gone up and down, our kids get a failing grade in school, our lover breaks our heart, our cars break down... it always ends the same: none of us get out alive. So why not just sit back and enjoy the ride?

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.

How do you know whether weight loss surgery is for you? Will it be the weight control solution you have been searching for for years? Or will it be a decision you regret? Nobody can answer that for you, but here are some considerations as you think about whether weight loss surgery is for you. The Qualifying Criteria You are not a candidate for bariatric surgery unless you meet certain criteria set by your surgeon or, if applicable, your healthcare coverage plan. The standard criteria are: Body Mass Index (BMI) over 40 or BMI 35 with an obesity-related comorbidity, such as type 2 diabetes, high cholesterol, or sleep apnea. Confirmation that your obesity is not caused by an underlying condition that would make weight loss surgery ineffective. A psychological exam to show that you are capable of sticking to the post-op diet and lifestyle changes that are necessary. Previous documented attempts at losing weight with diet and exercise. Ineffectiveness of Previous Efforts Weight loss surgery is a last resort, not a first try at losing weight. It is for patients who have been obese for years and who have tried to lose weight using lifestyle changes, such as a modified diet plan and a formal exercise program. Many weight loss surgery patients try “every diet under the sun” before deciding that it is time for WLS. They may have had trouble losing any weight at all, or may have lost weight initially but been unable to keep it off. Readiness to Change Weight loss surgery is just the beginning. The way you eat after weight loss surgery determines how well you will be able to control your weight for the rest of your life. You need to be ready to change if you want to be successful with weight loss surgery. No longer will you be able to down a pizza or hit the drive-through on a whim. Are you ready to possibly: Give up coffee and regular and diet soda? Cut sugary treats and fried foods, especially with gastric bypass? Pass on the alcoholic offerings at home, parties, and restaurants? Count protein, slash carbs, and measure portions? Addressing Other Issues Weight gain does not always take place in a vacuum, and weight loss does not solve other problems you might have in your life. First, identify why you became overweight in the first place, and what is keeping you from losing the weight. Is weight loss surgery the answer, or do you need to first deal with an abusive relationship or lack of self-confidence, for example? Emotional eating is a common reason for weight gain. If you tend to eat your feelings away, you are best off figuring out other ways to handle your feelings before you get surgery. Can you use walking as a form of therapy? Maybe you can join an in-person or online support group to turn to when you feel sad, lonely, or angry. If your emotional eating is related to a specific problem, such as stress at work, your best bet may be to handle the problem before getting WLS. That could mean finding a healthy coping mechanism, or it could mean getting counseling to help you work through the source of stress. It could even mean finding a new job, as scary as that sounds. Consider Replacement Addictions Replacement addictions are common after weight loss surgery. They happen when you give up food – which can be an addiction – for a different addiction. Instead of turning to food for comfort, entertainment, or companionship, some weight loss surgery patients turn to “replacement addictions” or “cross addictions” They may take up smoking, or start to abuse alcohol. Replacement addictions can also be healthier than eating; some weight loss surgery patients become gym rats or take up gardening, sewing, or other hobbies. As you consider weight-loss surgery, think about the possibility of food addiction being replaced by replacement addictions. What role does food play in your life now? What do you see replacing that emotional or physical role after surgery? The decision to get weight loss surgery requires a lot of soul searching for most candidates. These points can help you work through some of the doubts you may have as you try to decide what is best for yourself.

As a weight loss surgery patient from 1995, I often wonder how I would be doing if I were not involved in the bariatric community each day. Would I still be in the ‘successful group’ or would I be struggling. Would I want to go to support groups to ‘stay on track’ or reach out to a support group to help me get back on track? I don’t know but the one thing I do know for sure is that my bariatric connections provide me not only a network of supporters, but a point of accountability as well. Support groups can be fun, informational, educational and motivational. Support Groups are designed for patients and our voice about helpful elements, topics and structure is both needed and welcomed. To that end we have re-launched our unprecedented survey on bariatric support groups. Please take a moment to tell us about your experience in support groups. Why do you go when you go? Why don’t you when you don’t? What are the most important elements a quality support group should include? Who should lead the group? Those who take the survey will receive our “Top 5 Things Every Bariatric Patient Should Know About Support Groups.” Take the Survey here and watch for the results soon.