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You’re Starving, or Not For some WLS patients, hunger goes away. For others, hunger is reduced enough so that you can keep it in check, even if you were constantly hungry before WLS. Some patients, though, still need to fight hunger. It is still a struggle to pass up certain foods and to keep portions small. Your Head Gets Hungry “Head hunger” is when you think you are hungry, but you are really just bored, the food looks good, or you feel like eating for some other reason. It is important to learn to recognize head hunger so that you know when it is not time to eat, but it is also important to realize that it may not be time to eat every time you are physically hungry. That is because you are losing weight, which means you are eating less than you burn, which means…your body is hungry. Pizza and Ice Cream Taste Great Often, your sense of taste changes after weight loss surgery. You may be one of the lucky patients who stops loving junk food. Pizza and French fries may be too greasy and salty for your new taste buds, and ice cream and muffins may be too sweet. On the other hand, your taste buds may be just as enamored with the food groups of sweet, salty, starchy, and greasy. You may need to work just as hard as you did pre-op to keep pizza, ice cream, fried chicken, and bagels from overwhelming your diet. Salads May Not Work Your game plan for weight loss may include a huge salad once or twice a day. It is filling, healthy, and low-calorie – the perfect weight loss combo. The problem is that many weight loss surgery patients can no longer stomach salads for months or longer after surgery. Instead of lettuce, a protein, and some dressing, consider building your meals with cooked vegetables, a protein, and a small amount of healthy fat such as avocado or peanut butter. Creativity Is the Name of the Game Many other healthy foods may be off-limits because your tastes change or they are too stringy or they make you sick. You will have to be flexible to find healthy substitutes for them. Here are some common trouble foods and some alternatives. Popcorn: try Protein Cereal as a quick snack. Celery: opt for Bean Crisps Lean beef and poultry: try fish, veggie burgers and other soy and bean products, and lentils. Cheese: try peanut butter or hummus. The good news is that most WLS patients tend not to develop aversions to vegetables, so pile your plate high! What Happened to Water? Water is the one calorie-free and free from cost food that is actually a nutrient…and it may have tasted great before surgery. Afterwards, not so much. Some patients have trouble drinking plain water after surgery. It just does not taste good anymore. Now that diet soft drinks and carbonated flavored water are off limits, you have fewer choices for hydration – but they are there. Flavored water without bubbles. Decaffeinated low-acid coffee and tea. Ice water with lemon or lime. Malnutrition Happens Malnourishment may be far from your mind when your goal is weight loss, but it happens quite often. It can be a deficiency of protein, but also of vitamins and minerals. You will have to get enough protein every day and take your nutritional supplements every day, probably for life. Sit Near the Bathroom You just never know when you may need one when you sit down to eat a meal. Dumping syndrome strikes fast and without warning. By the way, you also cannot predict how full you will get and when you will be able to finish your entire plate. You can make your weight loss surgery journey a tad easier by aware of what to expect, and there may be a few things your doctor does not tell you about.

The Key Points: The main key is the power of the motor. The more powerful the motor, the faster the blades rotate. A motor that is 900 watts will mix much better than a motor that is 300 watts. An evenly smooth texture is more likely with more powerful blenders and mixers. The products listed are ones our patients use more frequently. Look for a blender that is in your budget, works well for what you want to use it for and how easy it is to clean. Keep in mind how much space you have in your kitchen, too. Some of the blenders/mixers can only pulse and may list a time limit on how long to pulse. Products listed are for making protein shakes or smoothies only. Shaker Cups Widely available in many retail stores and in the BariatricPal Store. Prices range from $6-$20. Made to mix protein powders with fluids. Easy to carry with you. Great for traveling. Sometimes it’s more difficult to mix the protein powder completely in a shaker cup. PROMiXX (original) and version 2.0 Vortex Mixer Original lists for about $30 on Amazon. Needs regular batteries. The 2.0 has a rechargeable, lithium battery that requires a USB port. Starts about $50 on Amazon. Great for mixing protein powders and liquid. Great for traveling or when you are just on the go. Although this is not dishwasher safe, it is easy to clean. Vitamix Systems The product has been around since 1949. Prices range from $400-$720. Can make smoothies. An extended warranty is available. Ninja Systems Ninja Fit 16 oz. Blender – Comes with two blender cups. Motor is 700 watts. One speed. Starts around $60. Nutri Ninja Pro 24-Oz. Blender – This is just for blending shakes. Motor is 900 W. Comes with 18 oz. and 24 oz. blender jars. One speed only. Starts around $100. Nutri Professional 3-Speed Blender – Comes with 72 oz. pitcher and 16 oz. cup. Price starts around $140. Ninja Auto-iQ Blender – There are several models that have the Auto-iQ cycle. This pauses through the cycle to allow food to fall towards the blades. These will have different speeds and may have both automatic and manual settings. Designed to make blended (“extracted”) smoothies using vegetables, seeds, nuts and fruits. Prices range from $120-$160. Magic Bullet/NutriBullet Systems Magic Bullet is the original product in the line. The original can blend protein powders and fluids to create smooth protein shakes. Does a fairly good job pureeing soft, fresh fruit, canned or frozen fruit that has been thawed. Don’t expect the Magic Bullet to provide a completely smooth texture for blended or extracted smoothies. Motor is 250 watts. Starts at $40. Check to make sure whether you are buying a new or refurbished machine. NutriBullet Series comes in several models. Check websites and advertisements to find discounted prices. Most come with recipes. Check to see if parts are hand wash or dishwasher safe. NutriBullet (Original) – Eight or 12 Piece Sets. Starts around $80. Motor is 600 watts. NutriBullet Pro 900 – Nine to 15 piece sets. Starts around $100. Motor is 900 watts. NutriBulletRx – 10 piece set. Starts around $180. Motor is 1,700 watts. Has an extra heating feature to make soups or warm beverages. Could use other NutriBullets and heat product in microwave. This is larger than the original and Pro 900 machines. Other Smoothie Blenders: Look for other personal blenders by Oster, Farberware and Elite. Immersion Blenders are hand-held blenders that you immerse in your cup or glass to blend. These can also be used to puree soft cooked vegetables and soups. More Options Consider using a hand-held mixer to mix your protein powders and fluid together. Get a work out by using a whisk to blend the protein powder and fluid together.

What’s Wrong with Away-from-Home? There is nothing wrong with eating outside the home – unless you are average. That is because the average restaurant meal has more calories, more fat, and more sugar than the average home-cooked meal. You can reverse this, though, with some awareness. Classic Breakfast Sandwiches The classic breakfast sandwich or burrito can have eggs, cheese, and meat. From there, the sandwich can vary widely. An egg white McMuffin from McDonald’s, for example, has 260 calories, while a Croissan‘wich with bacon and sausage from Burger King has 620 calories. Skip the butter and any fried potatoes, such as hash browns or shredded potatoes, and choose: Ham instead of bacon or sausage. An English muffin (or nothing) instead of a bagel, biscuit, croissant, or tortilla. Egg whites instead of whole eggs. Café Choices Coffee shops and bakery-café’s offer all kinds of fresh, tantalizing, and absolutely off-limits foods. Hint: you do not need a cinnamon roll with 50 grams of sugar to start your day. Stay away from the breakfast pastries and breakfast sandwiches on bagels. Instead, you may be best off with an “a la carte”-style breakfast. Look for items such as: Plain oatmeal or oatmeal with nuts as an add-in. Fruit cups or whole fruit. Low-fat cream cheese – you can spread it on half of a whole-grain bagel. Smart Suggestions Starbucks offers some hot breakfast options for under 300 calories – their egg white bites have only 170 calories – and Dunkin Donuts offers some DD Smart Wake Up Wraps for 160 to 240 calories. By the way, a Bismark donut has 490 calories. Subway offers egg whites, ham, and reduced-calorie cheese on 3-inch subs, so you can avoid too much bread. Lunch for Breakfast You may not need to depend on the breakfast menu if the restaurant serves lunch early in the morning. If that is the case, you may be able to get grilled chicken, turkey breast, and cheese on a salad. Bring Your Own There is a chance that you may not realize how easy and quick it can be to bring your own breakfast from home and avoid restaurants altogether. We understand if you have exactly zero seconds to dedicate to making your breakfast in the morning before you leave home. You can stash it in the car or fridge the night before. If you have access to hot water before you have breakfast, these options can work: Protein Oatmeal with an apple or some walnuts. Protein Muffins in flavors such as Blueberry, Double Chocolate, and Maple Pumpkin. Protein Hot Chocolate with milk for extra calcium or protein. If you are going to eat in the car or have no microwave at work, you’ll need something ready-to-eat. Consider: Protein Cereal in Honey Nut, Chocolate, or other favorite flavors. Oatmeal Raisin Protein Cookies. Fruit and cottage cheese or yogurt. A Protein Bar. You can have the best of both worlds: a meal as quick and easy as a fast food meal, with nutrition that fits into your meal plan like a home-cooked meal. Way to start the day right!

Consider Macros That is, “macronutrients,” or carbohydrates, fat, and protein. The news is bad on the surface since the average fast food meal has more carbs and less protein per calorie than the average home-cooked meal. You can work to turn this around, though. Carbohydrates: Cut back on carbohydrates by skipping the starchy sides: French fries, potato chips, and hash browns, steamed, fried, or Mexican rice, and breadsticks. Try to go “green” (lettuce wrap) or “naked” (no wrap) with your burger, tortilla, or sandwich; if the fast food joint cannot honor your request, just eat the filling with a knife and fork, and throw away the bread, bun, tortilla, or taco shell (if you are feeling guilty because of starving children in third-world countries, make a donation. You’ll do more good than you would by adding starch to your hips). Protein: How can you boost your protein intake at a fast food restaurant to be what you need? Skinless grilled or baked chicken, lean cold cuts, cheese, and beans can all up your totals, and yogurt is an increasingly common side option. Even a small burger patty can give you 10 to 15 grams of protein, although it comes with a few extra grams of fat. A good protein goal for a meal is about 20-30 grams. You can get that for 200-300 calories with any of the following. Burger King Double Cheeseburger, no bun; Grilled Chicken Garden Salad, no croutons; or Veggie Burger with cheese, no bun or mayo. McDonald’s Grilled Southwestern Chicken Salad, no cheese; or Grilled Chicken Sandwich, no bun or spread. Taco Bell 2 grilled or fresco steak soft tacos, no tortillas; chicken or steak Power Menu Bowl, no rice or cheese. KFC Grilled Chicken Drumstick plus green beans or side salad. Panda Express Grilled Teriyaki or Asian Chicken. Fats: Your first order of business is to avoid anything fried. You will be avoiding excess grease while also avoiding sneaky carbs in breading – did you know that the amounts of carbs in onion rings and fried chicken are comparable to the amounts in bread? Also, watch the fatty spreads – think mayonnaise – salad dressings, and dips. Find the Vegetables Protein and vegetables…does this sound familiar? It should, since your goals when eating at a fast food restaurant should be the same as when you eat at home. Vegetables help fill you up without filling you out, and it is best to eat as many of them as you can handle with your pouch or sleeve. It may take a little more digging to find vegetables at fast food restaurants than at home, but you can usually do it. Here are a few leads. Ask for extra lettuce, tomatoes, and any other available vegetables on burgers and sandwiches. Order a side salad or baby carrots with your meal. Check for salads with grilled chicken as an entrée. Pile salsa and diced vegetables onto your naked burrito. When “Value” Isn’t Besides the convenience, the deals are among the most tempting things about fast food. For pennies more, you can often add fries and a drink, or you could get a second burger or taco for half the price. Don’t do it! “Value” depends on what you want and need; why would you pay extra, even if it is “only pennies more,” for extra fat, sugar, starch, and calories? A healthier definition of “value” might be to pay the least you can for a meal that is convenient, delicious, and healthy. Why include “oversized” in your definition? For those times when fast food simply makes sense, go for it – just keep yourself on track by reading the menu carefully and staying focused. You can do it, no matter where you end up. You might as well enjoy it!

Every time I sit down with someone to do their VSG and Bypass psych pre-op evaluation- they are understandably nervous and on edge. My first question is: "Has anyone explained to you the reason for why you need a psychological evaluation?" and there answer is always, "no, I have no idea why I am here." I explain to them the reasons are threefold: 1) to make sure they understand the risks, benefits, and outcomes of the surgery, 2) to understand any psychological/behavioral ties to food that would benefit from behavioral recommendations/modification, and 3) to help the surgeon understand one's personality as it relates to a healthcare context, to better inform treatment. 1) Most people have been able to go over the risks, benefits, and outcomes with their medical team, but if not- I make sure last minute questions are addressed before they proceed. 2) During the evaluation- we talk about the patient's unique eating behaviors and how to modify them to help with maximum weight loss after the surgery. For instance, last week- I met with a guy who said he normally has a bowl of cereal at night in front of the TV and it provides him with a sense of "contentment." We talked about other ideas to create that same sense of contentment without sabotaging his weight loss surgery outcome, such as reaching out for support, taking a hot bath, listening to music, meditating, journaling, and/or creating a self-care ritual each night before bed. 3) The results of psychological testing provide me with really strong insight into each person's psyche as it relates to a medical setting. For instance, some results will say- " this person is uncomfortable talking about health care issues with strangers and may require more prompting than the average patient," or " this patient is likely to look compliant by being overly agreeable, but has a tendency to venture out on their own, and therefore frequent follow up is recommended," or " this person is uncomfortable in the patient role and will become increasingly agitated in the event of long-term health issues." The 3rd piece of this evaluation is of concern to some, but for the most part- it is meant to help better inform their treatment plan. If a surgeon understands that a patient is more apt to look compliant but "go rogue," they are probably going to incorporate more frequent follow up to make sure that person has the best chance of success. In the end- a psychologist's goal is not to be a hurdle in a patient's weight loss journey, but a catalyst.

Why Does It Matter? There is an expression that goes, “Shoot for the stars and you’ll hit the moon.” The idea is that if you set your sights high but fall short, you will still achieve something great. The theory may sound good, but it may neglect to consider reality. The truth is that for many of us, another saying is truer: “Success breeds success.” That is, when you hit one goal, you are motivated to keep working towards your next one. You build momentum as you hit goal after goal, and those goals then act like stepping stones to those proverbial stars. The Trap of “Too Much, Too Fast” There is a common tendency overshoot when it comes to weight loss goals. These are some reasons why. We want to lose weight so badly that we think only of the dream goal. Most of us tend to think of ourselves as above average – so we set our weight loss goals at higher than average. We set deadlines that are too short because we are so focused on getting there that we forget to recognize how wonderful the journey is. We set our goals based on what someone else lost. Classic Failure: “All or Nothing” One of the surest ways to set yourself up for failure is to set your weight loss goal to be too many pounds within too little time. It is comparable to the “all-or-nothing” mentality that so often comes with dieting: you are doing fine until you eat a cookie, and then you figure that the day is wasted, so you might as well finish the bag of cookies, skip your workout, and order pizza and breadsticks for dinner. The same mentality after weight loss surgery can get you into the same trouble. If you aim for an unrealistic 20 or 30 lb. in your first month and instead hit a respectable 5 to 10 lb., the “disappointment” can discourage you so you do not try as hard. Realistic Weight Loss The amount of weight you can realistically expect to lose depends on your procedure, how much you have to lose, and your own drive and other individual characteristics. An average gastric bypass or sleeve patient might lose about 50% of excess weight. For example, Someone who is 5’4” tall and weighs 245 lb. has about 100 lb. of “excess” body weight and might set a goal to lose about 50 lb. Another way to look at it is to take a rough estimate of average weight loss with your procedure for your surgeon’s patients. You might use that number as the basis for your own weight loss goal. You could also look at your final goal – say, 100 lb. down – and divide that by 1 to 2 years – in this case, a seemingly modest 1 to 2 lb. per week. Setting Realistic Goals For weight loss or any other goal, you can follow certain guidelines for realistic goal-setting. Set your goal to: Include a realistic amount of weight loss. Leave yourself enough time to achieve that amount. Include interim goals that you can celebrate and use as motivation. Provide for rewards as you progress, so you stay motivated. Allow enough time for plateaus and setbacks. They will come. Keep It in Perspective Strange but true…weight loss is only one of many reasons to get weight loss surgery and follow a healthier lifestyle. What about…? Gaining energy? Getting healthier? Feeling more confident? Participating in more of life? Along with setting weight loss goals, you can set other goals for healthy eating, working out, and trying new things. You will always have something to chase after and you will be able to see more progress every day.