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Craving sushi? You likely will not be able to tolerate your favourite sushi rolls because of the rice and seaweed wrap, however there are several other equally satisfying options on every Asian-style restaurant menu to consider. Indulge in an order of tartar or sashimi. These rice-less options are easier to digest. Don’t be afraid to ask if your favourite sushi rolls can be made with a cucumber wrap instead of the traditional seaweed wrap. This is often a ‘low carb’ option on sushi menus. Order a side of edamame beans. These soybeans are not only a good source of protein, but they are also rich in fibre. Try a protein rich Asian soup. Asian-style restaurants often have a traditional soup with eggs, tofu, chicken, and/or shrimp. Prioritize the solid pieces and leave most of the broth behind. Salmon or tuna salad. Most sushi restaurants have a simple green salad with a seared piece of fish and a flavourful salad dressing. Sandwiches & Wraps· Choose a sandwich on toasted bread. If it is a large sandwich, remove the top piece of bread. Great options include: chicken salad, egg salad, tuna salad and deli meats. Wraps are also a good option. Opt for baked chicken rather than crispy chicken. Breakfast egg sandwiches Choose a breakfast wrap or a toasted english muffin sandwich. Skip the bacon and sausage. Salad Almost all restaurants now have a green salad with chicken. Again, opt for grilled chicken instead of crispy chicken. Other high protein options include: taco salads, chickpea salads and bean salads. Chili Whether you choose the vegetarian or meat version, chili packs a lot of protein. They are also very easy to digest making them the perfect option if you have recently transitioned to solid food. Here are some other helpful tips to challenge those old fast food habits: Skip the combo option… yes, even if it’s cheaper! Don’t order a drink. You will be less tempted to drink and eat at the same time if you don’t have a refreshing beverage staring you down during your meal. Eat in the restaurant instead of in the car. If you are driving and eating, food is more likely to block. You can’t be mindful if you are multitasking! Choose foods described as: grilled, baked, sautéed, broiled, steamed, boiled, etc. more often. These cooking methods are lower in calories. Many corner stores and gas stations now have ‘grab and go’ options in their fridges such as sandwiches, salads, protein shakes, yogurt parfaits, etc. Next time you get gas, make a mental note of 3 appropriate meal options you could choose if you were in a pinch. Bon appétit!- Lisa & Monica

First off, I just want to say this very important thing, if you take nothing else away from this article, let it be this- People’s reactions to you are based on their relationship with themselves, not you. Always. Someone who is living at peace with themselves will have no need to harshly criticize, no desire to humiliate, and no feelings of unresolved jealousy. Sadly, once you understand this, you also realize how many people in your life are unhappy with themselves on some level. It makes it a little easier not to take things personally, but I would be lying if I said those things don’t hurt anymore. So how do you deal with friends and family members who are not living at peace with themselves? What practical steps can you take to be at peace with yourself so that you are able to reject those statements and hurtful judgments instead of internalizing them? Here’s the bottom line- You will always have people in your life who do not wish you well, who want to see you fail. If you do not learn to look past them and stay focused on you and your progress, and live at peace with yourself- you will experience re-gain. I love the words from Eleanor Roosevelt, “No one can make you feel inferior without your consent.” 1) Start with yourself- You need to be at peace with yourself. Who you are, what you weigh, your progress level, etc. Easier said than done, I know. But working towards that will allow you to bypass other’s opinions of you because you know who you are and where you’re going. A simple way to begin embracing yourself is positive self-talk. Start by looking into the mirror as often as you can, and saying things to yourself like, “I am a beautiful, peacefully person and I love me.” Say hello to yourself. “Hi Ash, you are a wonderful, beautiful person and I am SO proud of you.” It’s going to feel super painful and may trigger some emotions. Process those as they come, don’t shy away from the feelings that embracing yourself brings. If you need to cry, do so. If you smile, embrace it. Enjoy yourself. Changing that negative narrative in your head that so many of us carry around, is step one. 2) Be honest- When someone says something that’s offensive, it usually comes from one of 2 places: a poor relationship with themselves, or a lack of education. Use your best judgment to determine which it is. Keep in mind, there are a LOT of myths and misinformation surrounding bariatric surgery. Don’t assume people know more than they do. Think back to before you became an expert on Bariatric Surgery. How many questions you had, how many myths you thought were accurate. Seek to educate. But be honest, if someone makes a hurtful comment, let them know. Keep it simple, “Hey, that was uncalled for.” or “Please don’t say things like that to me.” Try to stay calm and in control. 3) Take a break- If you need a break, take one! Go for a walk, get out of the house, go listen to music alone. Don’t feel bad for needing a break. Family time can be stressful, don’t allow others to jeopardize your progress. When you’re stressed and anxious, you’re more prone to overeating which puts you back on that harmful cycle you’re working so hard to stay off of. Give yourself permission to stay home sometimes too, you don’t need to be at every single family gathering. It’s okay to opt out. People may get offended, they may try to make you feel guilty, but remember- it’s not about you. It’s all about how they feel about themselves. Those who are at peace with themselves will support you and do their best to understand where you’re coming from. 4) Stay focused- This is a tough one. Holidays pull our focus in so many directions, it’s easy for us to lose focus on our goals. Be proactive about making plans for yourself for food and exercising during the holidays. Being ahead of the game and staying on top of your plans will make you feel peaceful and accomplished. When you feel this way, your confidence is harder to shake and you will feel more secure. When you’re focused on a goal, it consumes your focus and the other things that pop up to derail you just fade into the background. Stick to your routine, take your supplements, and stay on track. You can do this! 5) Stay connected- Join a support group in-person or online, find an accountability buddy, hire a coach, or grab a friend who will keep you focused without judgment. Someone you can call, text or write to keep them updated so they can provide you with the encouragement you may not be getting from others this season. Having connection fills an emotional need that many try to fill with food. If you’re getting that need met, you won’t be as tempted to eat for comfort. Connection is something we all need, so make it a priority to have someone in your corner this holiday season. Remember, at the end of the day- this season is temporary. All the food, all the family, all the hustle and bustle. The things that can make or break this season. It’s all temporary. You are what you carry into the New Year. Your health journey is what lasts. Keep your sights on the long term. You can do this, I believe in you!

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.

If you’ve made a commitment to change your diet, learn a new exercise routine, start or complete a project, be more assertive, or maybe connect with your intuition on a daily basis, know that you DO have the POWER to follow through with this. Set an intention to connect with and magnify your inner strength and focus. Often when we set out to make changes in our life we start obsessing about it and think way too far into the future which can overwhelm us: then we just say “Oh the heck with this: I’ll never be able to do that huge project or maintain that habit forever, why even bother?” If you notice your thoughts going in that direction slow down, take a deep breath, and get out of your head and into your body. Come back to the present moment. Take another breath. Ask “Is there one simple thing I can do in this moment to honor my commitment?” That might mean just not putting a piece of chocolate in your mouth in this moment: That’s it you did it! And I know you can do that again in the next moment!! Perhaps you will be guided to make a phone call. Pick up the phone and make that call. Or, there might not be anything you need to do in this very moment so relax into the not doing. It is important that you keep yourself surrounded by upbeat positive people and that you raise the vibrations of your surroundings as much as possible. Burn sage, put a crystal on your night stand or desk at work, keep plants and flowers in your environment, listen to uplifting music. Shield yourself from negative energies. Many of you who are drawn to read this are highly intuitive empaths: your are like psychic sponges who absorb the energies of the people near you and your environment. As part of your morning routine surround yourself with a beautiful white light ( or whatever color feels most safe and loving for you). The only thing that can penetrate this light is love and healing energies, no negative energy can pass through this. If you believe in angels, spirit guides, or any other sort of deity invite them to be with you throughout the day guiding you and keeping your thoughts and feelings uplifted and positive. Whenever possible remove yourself from negative situations, decline to engage in gossip or fear based conversations. Anger, negatively, jealousy and fear will only cause you pain. Clear your energy field daily: meditate, spend time in nature barefoot, take baths in epsom sales, move your body, drink plenty of water, etc. Law of Attraction/Source Energy is rooting for you and right by your side giving extra added energy to your thoughts. So keep your thoughts and focus on what you DO want to manifest. See yourself as happy fulfilled and loved….and know that is is so….. Feel gratitude knowing that your life is moving in the direction of your dreams gaining more and more momentum as your willingness to believe and receive all that is being offered to you opens and increases. BELIEVE and RECEIVE!! I'm sending you so much love! Go have an awesome day!! ❤️ Louisa!!

Another helpful addition is “Added Sugars”, which is found under the carbohydrate information. Naturally occurring sugars are primarily from fruit (fructose) and dairy (lactose). Vegetables and grains can also contain a small amount of naturally occurring sugar. For added sugars, look for the words sugar, syrup, agave, molasses, juice, beet sugar, brown sugar, turbinado and honey. Now that we have the total and added sugars, you can determine if the food or beverage is something you can work into your eating. While there are no formal guidelines, limiting foods and fluids to products that have less than 5 grams of added sugar is a starting point. A rule of thumb for carbohydrate foods is to eat the food that is closest to the farm. That means the least processed the better. For example, a peeled apple is better for you than applesauce. Applesauce is better for you than juice. One hundred percent real fruit juice is another way to say “sugar water” for bariatric patients. The Nutrition Facts Label will list naturally occurring sugars, but you won’t see added sugars listed. So, juice is a high sugar item. Your dietitian will assess your activity level, blood sugar readings, body composition and tolerances to help you find a healthy carbohydrate goal to work into your eating. We now have a better tool to hunt down the added sugars in our foods and beverages. Happy hunting!

Paralleling the increasing use of bariatric surgery, there is a high demand for body contouring through plastic surgery. If you’re just beginning down this path, the questions are many. Who will do my surgery? How is recovery? What can I expect? Choosing and Evaluating a Plastic Surgeon Many of the surgical procedures performed on the massive weight-loss patient are complex and labor-intensive. The wide spectrum of body contour deformities that can follow massive weight loss often exceed the magnitude of what plastic surgeons have traditionally addressed. That is why weight-loss surgery patients need to work with a surgeon who specializes in bariatric plastic surgery. Dr. Joseph F. Capella, a plastic surgeon in New Jersey, affirms: Post-bariatric body contouring is a relatively new area within the field of plastic surgery, in that bariatric surgery only has become popular in the last 10 to 15 years. And because of that, many surgeons have come through their training not having been exposed to post-bariatric body contouring. Because of that these surgeries are not considered traditional procedures, in the sense that they’ve been honed over decades like many of the other plastic surgery procedures. And so what plastic surgeons may do is use these more traditional procedures and apply them to the post-bariatric patient, which often will lead to sub-optimal results. So, it’s very helpful then, in that regard, to go to a plastic surgeon who has committed to this kind of surgery and does this surgery frequently — and this would be true for any kind of plastic surgery, for that matter. But what’s different about post-bariatric surgery contouring is it is relatively new, and probably greater than 50% or more of plastic surgeons out there right now did not have any exposure to it in their training. Obviously there are on-going conferences to educate surgeons but there’s a difference with having it as part of your training rather than learning about it from a lecture. Read Dr. Capella’s comprehensive list of criteria for choosing and evaluating a plastic surgeon. Healing Body and Mind After a Post-Weight Loss Body Lift Once you’ve removed the loose skin and sagging, is the journey over? Are you obstacle-free? Well, not quite. The Plastic Surgery Center in New Jersey says: You’ve been through a life-altering experience, and with that, your body and mind need time to heal and adjust. It’s important to acknowledge that, so you can assist in your own recovery and eventually move on … Recovery from body lift surgery is extensive, which sometimes catches people off guard. And it can be painful, depending on the extent of the surgery and your perception of pain. You should be prepared for swelling (or even numbness) that can last for weeks and sometimes even months. In fact, most surgeons say that complete recovery and final results take up to a year. Of course scarring is a fact of body lift surgery, and scars are particularly distinct up until the first year following the procedure. Many (if not most) people experience strong emotions following plastic surgery. While excitement and elation are a natural result of such a positive life change, it is also customary that an entire range of feelings can result, including a phenomenon called post-plastic surgery depression which can resemble post-partum depression. Recovery creates the time and opportunity to focus on these emotions. On the plus side, the surgical results of a body lift are apparent almost immediately. They will remain permanent if you are able to maintain a stable weight (although normal aging obviously results in physical changes). And, depending on the person, the body’s healing process should mitigate scarring. Read The Plastic Surgery Center’s great advice for healing body and mind after a post-weight loss body lift. Plastic Surgery Improves Appearance, Mobility, Health and Emotional Well-Being People may not be fully aware of the many benefits of plastic surgery after weight loss. There are aesthetic refinements in the appearance and improvements in functional mobility, as well as an increased sense of emotional well-being. Dr. Edward Domanskis, a plastic surgeon in California, says: I think that the benefits of plastic surgery after weight loss are tremendous. When you’re massively overweight it’s one problem. When you lose the weight I think a lot of times the patient doesn’t realize that the problems don’t really go away; it’s just a different problem. It’s a problem of all this hanging skin. And to some people that can be almost as much of a problem as being overweight and having all this excess fatty tissue — physiologically for sure. In my experience I think it [plastic surgery after weight loss] is a very, very satisfying type of surgery not only to the patient but also for the physician to see the transformation in the patient. To see the reaction of their friends and family to what they’ve gone through and how their overall appearance and psyche tend to change. There’s no question that these procedures are very. very beneficial to the patient. Watch Dr. Domanskis’ video segment, “What to Expect: Improving Appearance, Mobility, Health and Emotional Well-Being through Bariatric Plastic Surgery.”

In this space remember the importance of prioritizing good self caretaking, talking more kindly to and about yourself, embracing and feeling your feelings, setting boundaries, declining to engage in gossip or negative chatter, walking away from low energy people and situations, being gentle with yourself, not putting unrealistic demands on your time or energy, and understanding that it’s actually GOOD to be SELFish. Bring to the forefront of your mind your innate knowing of the absolute necessity of nurturing your soul with things like art and music and movement and nature and deep conversations with people you love, respect and admire. Let this Valentine’s Day be a Reminder that you need to Love YOU FIRST. That you need to be your most significant other <3! Live In Love, Louisa

Bigger from Birth…And Then College Hit Michele was always big. She was at the top of her height and weight charts from the time she was an infant. She remembers times in her childhood when she couldn’t or wouldn’t participate because she was so big. She didn’t like physical education or sports, and the other children teased her. Food was a comfort. Michele describes the situation as a vicious cycle. The more kids teased her, the worse she felt. The worse she felt, the more she ate. The more she ate, the more she weighed. The more she weighed, the more she got teased. College was a disaster in terms of her weight. Forget about the freshman 15. What about the freshman 40? And the sophomore 40? Add to that the junior 40, the senior 40, and, for good measure, the super-senior (fifth-year) 67, and you now know how Michele Elbertson got to be 427 pounds at the age of 22 years. A Young Weight Loss Surgery Patient with New Relationships Michele made the decision to get the lap-band on her own. She needed a tool to help her control how much she ate, but understood that it was up to her to control what she ate. She only told her parents about her decision after she was sure about it. They were supportive, and have been since then. Michele has taken full advantage of and responsibility for the band. She has lost 260 pounds – 260 pounds! – in less than four years. As she says, she’s a determined person who will accomplish anything she sets her mind to. Michele began to “eat to live” rather than “live to eat.” As her relationships with food and exercise changed, so did her relationships with some friends. She lost some friends whose relationships centered only on food. She gained many more, though, through her new activities. She says the friends she’s gained through running and fitness far outweigh those she lost by changing her lifestyle. An Athlete Is Born Michele ran her first 5k after losing 100 pounds – when she was still 327 pounds. She was hooked. She loved the training, the atmosphere of the race, and the accomplishment. She has never looked back. Since then, she has run countless other races, including 38 half-marathons, 6 marathons, and a 50-miler ultra-marathon. She has also competed in triathlons. Now at an athletic 159 pounds, Michele has her sights on even greater challenges. In the near future, she wants to run a 100-miler and complete an Ironman. Both are feats that most people wouldn’t even dream of. Marathons, Ultras, and Ironmans Now, not everyone’s a distance runner or triathlete, so to understand Michele’s accomplishments, here are a few facts about these endurance sports. A marathon is 26.2 miles. All marathons are 26.2 miles. An ultra-marathon is anything over 26.2 miles. Michele’s recently completed ultra-marathon was 50 miles, and she is training for a 100-miler. A triathlon includes swimming, biking, and running. An Ironman triathlon consists of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile marathon. Fitting It All in Every Day Michele works out 6 days a week. Currently, she’s training for an ulta-marathon and is running 5 days a week and lifting weights 3 times. She also does Zumba classes. She takes a rest day once a week. Michele has built her life to be able to accommodate her training schedule. She recently quit her teaching career to focus instead on helping others achieve their fitness and health goals. She is a personal trainer and group fitness instructor. Working at a gym is pure genius – it leaves her with no excuse not to get her workout in! Eating Like a Bariathlete How do you have energy to train like an athlete and work full-time while losing over 200 pounds in 4 years? Ask Michele. Here’s how she eats and works out in a typical day. 7:00 a.m. breakfast: almonds and yogurt or eggs/romaine lettuce 9:00 a.m. snack: protein bar Workout, such as running, lifting, or group fitness class, such as Zumba or bokwa Noon. lunch: soup or salad, usually the largest meal of the day 2:00 p.m. snack: cheese and crackers or something small, equivalent to 200 calories (may include a fruit or vegetable) 4:00 p.m. snack: hot tea 6:00 p.m. dinner; lean protein, veggie, possibly a carb 7:30 p.m. snack: lemon water/hot tea. The number of calories Michele eats during a day is 1,800 (her resting metabolic rate) plus half of the calories she burns through exercise. So, if she runs 10 miles and burns 1,200 calories in exercise, she’ll eat 1,800 plus 600 calories, or 2,400 calories. She allows herself an occasional treat meal with junk food, but still counts those calories. The Accolades Michele is more than your typical bariatric patient, and she’s been getting the recognition she deserves for her extraordinary achievements. These are a few recent examples. Runner’s World magazine Cover Contest Finalist. Makeover on the Rachel Ray Show. Local feature on 6ABC Action News in Philadelphia. Dealing with Negativity – Don’t Worry About It One of the most striking things about Michele is her drive. She has worked very, very hard to get where she’s at today. She’s lost 60 percent of her body weight through being very disciplined every day. And, she has run marathons. Anyone who has run a marathon can tell you that it is was harder than they had ever imagined. Anyone who hasn’t run a marathon cannot imagine how difficult it is. But with all the publicity, Michele has receive a lot of nasty comments. How is she supposed to react when people slam her? They say she hasn’t accomplished anything, that the band has done it all. In fact, they basically say what a lot of weight loss surgery patients hear all the time from people who don’t know any better. So how does Michele react to negativity? She doesn’t want to respond directly and add “fuel to the fire.” She knows they don’t know anything about her, and she’s probably done more exercise and worked harder than they ever have. So, she just goes about her business. Leading by Example Michele says she hopes her successes and story will give others hope. She describes herself as a “real person” and “very down-to-earth,” and she hopes others will see that they can accomplish what she has. In the future, she would like to travel to seminars as a motivational speaker. In the meantime, we congratulate her on her amazing story and wish her well in her 100-miler this spring!

As you age, your metabolism slows down. Older people also tend to have less muscle mass than younger people, which also reduces metabolic rate. This is why we encourage older patients to add light weight-bearing exercise to their fitness routines. So how do you keep that furnace burning in order to burn calories, even if you’re already achieved your goal weight? There are many simple tools to accomplish this task. I’ve outlined my favorites below: Exercise This weapon is key to maintaining and increasing metabolism. Seniors, take note−The Centers for Disease Control and Prevention (CDC) recommends people 65 and older get 2.5 hours of moderate-intensity aerobic activity every week and perform weight-bearing exercises on all the body’s major muscle groups at least twice a week. At any age, indoctrinate a 30-minute daily work-out, just like brushing your teeth and eating lunch, into your daily routine. Sleep To increase the chances of boosting metabolism, adults should get seven to nine hours of sleep each night. Getting too little shut-eye can significantly alter your body’s processes enough to predispose you to gain weight. (Do you ever feel hungry for no reason when you’re exhausted and then reach for the wrong foods to boot?) De-Stress When you’re tense, your body releases cortisol, a hormone produced by the adrenal system that is linked to weight gain. It can also significantly weaken your immune system and open the door to acute and chronic illnesses. Turn to regular physical activity, deep breathing, a quiet evening stroll, or professional help from a psychologist or counselor if you are experiencing chronic stress. Eat and Drink (First and foremost, follow your bariatric practice's instructions on post-op nutrition.) Eating the right foods−clean proteins, fruits and vegetables−fuels your metabolism firing on all cylinders. As soon as you awaken, charge-up those calorie burners by feeding them a protein and a fruit (think omelette with feta cheese, spinach and veggies and a cup of berries). Eat small meals throughout the day but stop by around 7 p.m. Staying hydrated is key to maintaining good health. Keep a glass or refillable water bottle with you throughout the day. You are properly hydrated if your urine is nearly clear. Other than choosing the right foods to eat and finding spiritual solace in your life, these tools serve as a roadmap to good health, including maintaining a healthy weight. Best of all, once you’ve adopted these tips, you will look and feel better--sooner than you think.

The Struggle Often Continues For some patients, Weight Loss Surgery can lower your interest in food, so you are not constantly thinking about it. There’s no question Weight Loss Surgery can help you gain control of your eating, but it’s unlikely to eliminate your struggles with food disappear. A few lucky Weight Loss Surgery patients really do stop being tempted by food. The rest, who make up the vast majority of Weight Loss Surgery patients, continue to struggle. You still may be hungry, enjoy salt, fat, starch, or sugar, or be tempted to use food as an emotional crutch. Your family members may continue to insist on keeping high-calorie foods in the house, or pressure you to eat things you shouldn’t. Your friends may still be going out to eat and inviting you to join them in ordering high-fat, high-sugar items. “Why Me?” Isn’t Appropriate It’s easy, even natural, to think of yourself as unlucky. Why should you have to struggle with food? Why should you have to monitor every bite you take, while some people don’t? The fact is, almost everyone does. Ask almost any skinny person how they stay skinny, and you’ll get some variation of the same answer: “I work hard for it.” Just like you, they are aware of what goes into their bodies. They sometimes may be hungry; they sometimes may want to eat more than they should. But they, like you now, take responsibility for their decisions. They may: Skimp on portions if they over ate at the previous meal. Choose healthy foods first. Have a strategy for dealing with emotions and boredom that doesn’t involve eating. Have a support system that promotes healthy behaviors. Accept It and Manage It If you find you still have a rocky relationship with food after weight loss surgery, don’t conclude that WLS didn’t work for you. Instead, accept that you will need to fight the cravings and urges for months, years, or life, and start making a plan. Don’t be afraid to ask for help in developing strategies – whether you ask other BariatricPal members or an always-thin person you admire! Persist in Order to Get the Answers You Need We all want to be able to trust our doctors. You want to believe your surgeon takes care of all aspects of your Weight Loss Surgery, including your post-op, long-term nutrition. But it doesn’t always happen like that. Nutritional counseling may not be part of your surgery package, or you may only get a limited amount of generic information. Or, your surgeon may simply not know how to help you nutritionally. Remember that many doctors have no more than an hour of nutrition education in medical school. To become a weight loss surgeon, doctors need to learn surgery. There is no dietary education requirement. If you need help finding strategies to satisfy hunger – physical or head hunger – and your surgeon and primary care doctor are not able to help, keep looking. A session with a nutritionist may be more affordable than you think, and worth every penny. Your Emotional Support System and Your Relationship with Food The support system you built so carefully can come in handy right about now. Take advantage of your ability to talk to a therapist or psychologist if you have one to bring up your concerns. Discussing your ongoing struggles with portion sizes, food choices, and over-frequent nibbling with a mental health professional can help you come up with some strategies that work for you. Group sessions are also appropriate forums to talk about food struggles and strategies. Though it may feel embarrassing at first to admit you’re still thinking about food a lot, you will find nearly everyone in that room did or does have that same experience. Most Weight Loss Surgery patients do not find their surgery instantly eliminates their food struggles. You can take months or years to come to terms with a food addiction, and it may be something you need to learn to live with for life, but in a healthier manner than before Weight Loss Surgery. Be honest with yourself and those around you, and be open to suggestions, and you can figure out strategies that work for you. Do not assume WLS did not work for you!