Leaderboard

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.

The honeymoon period. The time period after the surgery, when the weight is coming off without much effort, and you feel like it was the best decision you ever made. The compliments are coming from everyone, you're fine with taking the supplements, the protein shakes, heck, you're even okay with losing some hair – it'll grow back, right? But what about when you've reached “that” point? The point where the weight loss has slowed. The “head hunger” has started and, well, the “fun” has worn off. Reality sinks in that this “real life.” This is something that you need to keep up with. This is now your...gulp...”everyday” life. Did you expect to have depression creep in? Or maybe creep back in? Most of us thought this surgery would correct our mood issues, thinking that losing the weight would help get rid of that which was bothering us. So what happened? Why are we sad, frustrated, mad? Why aren't we...well...happy? A lot of this can be attributed to losing our primary coping tool to deal with depression and stress: mindless consumption of food. We may not have realized it at the time, but food was our comfort, our companion, sometimes the only thing that was there for us when nothing/nobody else was. Now, that support is no longer something we can reach for in hard times to get us through. We are physically and emotionally missing/grieving our former “companion.” Our coping tool. Sometimes, our best friend. So what do we do? First, we have to look at the physical way food was affecting us. Not just related to weight, but in our brain. Food was giving us satisfaction in a way that was “rewarding” receptors in our brain that control the chemical dopamine. Dopamine is a chemical that makes us feel good. This is the same chemical that is triggered when someone uses drugs or alcohol. Yep, scary thought, huh? That's why we often hear about “food addiction.” We are literally “feeding” that addiction when we overeat. That's hard to accept, I know. Second, we have to look at WHY we may be overeating. What thoughts do we have that lead us to seek food as comfort? Are they thoughts about ourselves? Are we thinking that “I'm so fat” or “I shouldn't even try” or maybe even “Why do I even bother?” Sometimes the addiction is so deep, it's hard to identify the thoughts that made the behavior start. Then it may be more helpful to think about the feelings. What feelings direct us to start overeating? Is it anger? Boredom? Defeat? Do the words or actions of another make us feel “less than” and lead to lowered self worth, thus leading to the desire to overeat? The concept of looking at Thoughts-Feelings-Behaviors is at the core of Cognitive Behavioral Therapy, a standard therapeutic method of behavioral therapists. Finding a therapist that can help us figure out the source of how these 3 things work together to lead us on the path to overeating can go a long way toward correcting the behavior. The key to CBT is retraining those thoughts to become more positive, leading to more positive feelings and behaviors. Often, we get stuck with “ants” - Automatic Negative Thoughts – and they are hard to undo. With the assistance of a therapist that is trained in CBT, particularly one that is familiar with bariatric surgery, we can retrain our brains to think more positively about ourselves, thus leading to be less dependent on food to nurture feelings of happiness. What kind of “ANTs” do you want to get rid of? Can you think of a chain of Thoughts-Feelings-Behaviors that you would like to change? What would you rather that chain look like instead?

Dependence on food will be habitual, while addiction to food will be somewhat unpredictable (e.g., a morning cup of coffee versus the sudden, inexplicable drive to eat four servings of cheesecake) Dependence on food will have few, if any, emotional causes, but addiction to food is provoked by emotions and circumstances that cause feelings of powerlessness (e.g., a treat to get through a trying day at work versus a binge to avoid focusing on painful thoughts Dependence on food will have few, if any, emotional effects, whereas addiction to food will cause great anxiety if not properly attended to (e.g., being cranky due to caffeine deprivation versus feeling panicked because a planned binge is interrupted) Dependence on food will cause minimal interference in other areas of a person’s life, but addiction to food will disturb every aspect (e.g., a love for red wine with dinner versus preferring to eat alone for the sake of overeating) Dependence on food can be controlled at will, but food addiction appears as an unstoppable force in the person’s life (e.g., giving up pizza after noticing slight weight gain versus trying to stick to a healthy eating plan but derailing constantly; having a divided mind that seems to want opposite things) Dependence on food is pleasurable, but food addiction is a torment (e.g., traditional Christmas cookies versus the horror one has that one has eaten the whole box of cookies, coupled with the knowledge that one isn’t done yet) Dependence on food is casual, whereas food addiction appears to the addicted person to be closely tied to his or her identity (e.g., the guilty pleasure of Cheetos versus the shame and feelings of inadequacy that often accompany a binge) Perhaps one of the most important paragraphs is below: (helpful to read the entire article) What happened in this scenario demonstrates what, for many people, is the central issue of food addiction. Bingeing allows the food-addicted person to avoid dealing with threatening emotions (such as his or her perceived failure, powerlessness, or inferiority) by replacing them with guilt and shame, which are also threatening, but in a familiar, almost comfortable way. In the mind of the food-addicted person, the pivotal issue is lack of willpower. But in truth, they are using food to defend themselves against the pain in their life. By facilitating this transfer and avoidance of emotions, food has become a drug, and it is at this point that the food-addicted person needs to seek help. Bingeing has a different meaning for most people. When I was obese I thought it meant that you ate in the closet in the dark with a whole package of Oreos and a gallon of milk. Of course I didn't do that so I didn't think it applied to my behavior. (umm...denial) Finally I realized that my weekend routine of buying a huge Bucket 'O Chicken and locking myself in my apartment from Friday evening until going to work on Monday morning was certainly a form of bingeing. The same thing applied to my Quarter Pounder with Cheese obsession. I'm sure the Dallas quarterly earnings dropped significantly around the time I woke up to my dependence on this junk food. Most importantly please, please, please....do not walk the path of shame. From that same paragraph the very important part of the article... "In the mind of the food-addicted person, the pivotal issue is lack of willpower. But in truth, they are using food to defend themselves against the pain in their life." How sad it is that we are just trying to avoid the pain of life by using food. The problem is that it never works without paying a great price. Ask for help, educate yourself, and know that freedom from this disease is truly possible.