Lori Nevins LCSW

Holiday celebrations are all about food, right? Save up every year, to overeat and not keep yourself in check. It’s a losing mindset from the get-go. The end of the year is really about memories, gratitude and those who we care for in life, not just the Thanksgiving feast or the Christmas Day buffet. What makes a holiday special also makes it filled with emotions and triggers that enable our unhealthy excessive eating behaviors to be acceptable at this time of year. A few things that may sound familiar and affect many of us during the holiday season are: Family traditions and ethnic backgrounds with food memories that have followed us through life. Trauma, hardships or losses that make holiday cheer tough to enjoy or even tolerate on some levels. Falling back on a diet mindset and thinking it’s ok to eat recreate old habits from October 31-January 2. Awareness of mental and emotional struggles feeling more acute during the holiday season. For bariatric patients, an immediate fear presents itself: “How can I survive all the parties and family celebrations while embracing my post-surgery food choices so I don’t lose control with holiday eating and drinking this year?” The practical answer: Prepare for it, just as if the surgery was ahead of you. Think and plan for success with the least amount of guilt and destruction possible. Holiday foods are not “rewards” or “treats” or a reason to fall off the mindful thinking that you use every day. We all have family and cultural traditions of holiday foods, and the meanings behind them; that often follow us into adulthood. The connection is to people, not food itself. Holiday time often intensifies many people’s mental and emotional struggle with life issues. Food can often be an immediate distraction and way to receive immediate gratification in tough times. The trouble is, the stresses and issues remain after the food is consumed. Often, alcohol consumption increases at holiday time as well, so mindset is altered by allowing more uninhibited behavior to prevail. Using good judgment often decreases as well. So, if we can use the model of being prepared and accountable for ourselves, what would it look like? Think of the season on your terms. Where can you plan and take the lead on making good choices for yourself while still feeling the holiday spirit? Find control where you can make food to bring to others parties or meals. Host at your home to take pressure off of yourself. Be honest and ask to be considered when food is being prepared and served so that you can also taste but be flooded by the excessive choices and behaviors all around us. Find ways to relax and refresh so you are not overwhelmed or drained by the holiday madness. Keep a journal of your thoughts, fears, successes and challenges to remind you of the proud journey you are on now. Use meditative activities to bring a more even and peaceful attitude to the business of the season and the potential for burnout and self-destruction. Give of yourself to others that need to be uplifted. Find a community, group hobby or counselor if the season is troubling of extremely unmanageable. Many times the holiday triggers are too hard to handle alone. Ask for help and know that you are being proactive (helping yourself) instead of reactive (always behind and at the mercy of others decisions and actions). The key is to stay connected to the resources, the people, places and things that bring successful experiences to us, and avoid harmful or undermining circumstances that reinforce low self-esteem and bad, and often destructive, behaviors. As a bariatric patient, being accountable is helping yourself stay focused on a positive and productive mindset with help provide a fulfilling and peaceful holiday season each and every year. Yes, this is you, enjoying your life during the holidays.

A few things that may sound familiar and affect many of us during the holiday season are: Family traditions and ethnic backgrounds with food memories that have followed us through life. Trauma, hardships or losses that make holiday cheer tough to enjoy or even tolerate on some levels. Falling back on a diet mindset and thinking it’s ok to eat recreate old habits from October 31-January 2. Awareness of mental and emotional struggles feeling more acute during the holiday season. For bariatric patients, an immediate fear presents itself: “How can I survive all the parties and family celebrations while embracing my post-surgery food choices so I don’t lose control with holiday eating and drinking this year?” The practical answer: Prepare for it, just as if the surgery was ahead of you. Think and plan for success with the least amount of guilt and destruction possible. Holiday foods are not “rewards” or “treats” or a reason to fall off the mindful thinking that you use every day. We all have family and cultural traditions of holiday foods, and the meanings behind them; that often follow us into adulthood. The connection is to people, not food itself. Holiday time often intensifies many people’s mental and emotional struggle with life issues. Food can often be an immediate distraction and way to receive immediate gratification in tough times. The trouble is, the stresses and issues remain after the food is consumed. Often, alcohol consumption increases at holiday time as well, so mindset is altered by allowing more uninhibited behavior to prevail. Using good judgment often decreases as well. So, if we can use the model of being prepared and accountable for ourselves, what would it look like? Think of the season on your terms. Where can you plan and take the lead on making good choices for yourself while still feeling the holiday spirit? Find control where you can make food to bring to others parties or meals. Host at your home to take pressure off of yourself. Be honest and ask to be considered when food is being prepared and served so that you can also taste but be flooded by the excessive choices and behaviors all around us. Find ways to relax and refresh so you are not overwhelmed or drained by the holiday madness. Keep a journal of your thoughts, fears, successes and challenges to remind you of the proud journey you are on now. Use meditative activities to bring a more even and peaceful attitude to the business of the season and the potential for burnout and self-destruction. Give of yourself to others that need to be uplifted. Find a community, group hobby or counselor if the season is troubling of extremely unmanageable. Many times the holiday triggers are too hard to handle alone. Ask for help and know that you are being proactive (helping yourself) instead of reactive (always behind and at the mercy of others decisions and actions). The key is to stay connected to the resources, the people, places and things that bring successful experiences to us, and avoid harmful or undermining circumstances that reinforce low self-esteem and bad, and often destructive, behaviors. As a bariatric patient, being accountable is helping yourself stay focused on a positive and productive mindset with help provide a fulfilling and peaceful holiday season each and every year. Yes, this is you, enjoying your life during the holidays.

Bariatric patients should embrace both of these powerful tools to enjoy long term post surgery success, with food and lifestyle choices, that are faced with well into the future. The Importance of Behavior Modification and the Role of Personal Accountability As a bariatric patient care professional, I encourage the following mindset with patients from all surgery time frames and life situations: Lifelong commitment to pursuing a healthier lifestyle, Compliance to the recommendations of behavior modification, and Addressing and grappling with the challenges that are life long Self-awareness and personal accountability are two areas that are not so obvious when assessing one’s own role in the struggle with obesity. We are aware of genetics, family history, medical co-morbid conditions and life stress that impact each patient’s history of their own struggle with being obese. So how do patients obtain the necessary tools to support the physical presence of bariatric surgery? Through engaging in a solution to the past disappointments of weight loss efforts that are already so familiar. Many patients report the path to insight and reflection often reveals mental justifications, old bargaining behaviors and frustrations that fuel negativity and inappropriate attachments to and uses of food. Although it is easy to lay blame for many things in life, self-deception only facilitates the repetitive cycle of anger and disappointment. In the professional arena, we often discuss the addictive quality of food and how food has a parallel function in the same manner that other behaviors do, i.e. shopping, drugs and alcohol, sex, gambling and the like. The need for emotional escape and mental distance can encourage us to use food as “anesthesia”, a way of shutting down and shutting out the world around us. We are careful to watch for those cross-addictive behaviors following bariatric surgery and recommend supportive resources across the board. These services provide a safe and secure way to investigate and discuss personal issues that are relevant and central to the patient’s path to success following surgery. The role of a supportive aftercare program or community of patients, even individual therapy, is a vital component to future success and and be a valuable tool on the road to recovery, helping to smooth the transition and adaptation to new food related behaviors and lifestyle choices. The ability for patient’s to share a parallel experience and be able to “relate” to a certain stage of recovery, or a certain type of struggle with others, will provide an opportunity for engagement and bonding with others. On a therapeutic level, individual counseling can expand one’s degree of awareness and promote a greater sense of personal accountability, once the roots of old behaviors and attitudes have been identified and deciphered. A patient can then restructure their responses to daily challenges that may have been inadequate prior to surgery. As patients walk the road of recovery from obesity, while engaging in physical as well as emotional healing, the element of discovery and pride is tangible and even contagious. Patients will enjoy improved health, greater energy and a strong positive attitude of self worth; what follows can be a heightened sense of calm, balance and overall peace of mind. Once personal discoveries have been made, individually or in a group setting, bariatric patients can feel a greater sense of control in planning the path in front of them. Commitment and compliance are two key elements that promote post surgery success. As patients employ newfound tools and wisdom on a consistent basis, quality of life can be infinitely better as well as profoundly rewarding.

The Importance of Behavior Modification and the Role of Personal Accountability As a bariatric patient care professional, I encourage the following mindset with patients from all surgery time frames and life situations: Lifelong commitment to pursuing a healthier lifestyle, Compliance to the recommendations of behavior modification, and Addressing and grappling with the challenges that are life long Self-awareness and personal accountability are two areas that are not so obvious when assessing one’s own role in the struggle with obesity. We are aware of genetics, family history, medical co-morbid conditions and life stress that impact each patient’s history of their own struggle with being obese. So how do patients obtain the necessary tools to support the physical presence of bariatric surgery? Through engaging in a solution to the past disappointments of weight loss efforts that are already so familiar. Many patients report the path to insight and reflection often reveals mental justifications, old bargaining behaviors and frustrations that fuel negativity and inappropriate attachments to and uses of food. Although it is easy to lay blame for many things in life, self-deception only facilitates the repetitive cycle of anger and disappointment. In the professional arena, we often discuss the addictive quality of food and how food has a parallel function in the same manner that other behaviors do, i.e. shopping, drugs and alcohol, sex, gambling and the like. The need for emotional escape and mental distance can encourage us to use food as “anesthesia”, a way of shutting down and shutting out the world around us. We are careful to watch for those cross-addictive behaviors following bariatric surgery and recommend supportive resources across the board. These services provide a safe and secure way to investigate and discuss personal issues that are relevant and central to the patient’s path to success following surgery. The role of a supportive aftercare program or community of patients, even individual therapy, is a vital component to future success and and be a valuable tool on the road to recovery, helping to smooth the transition and adaptation to new food related behaviors and lifestyle choices. The ability for patient’s to share a parallel experience and be able to “relate” to a certain stage of recovery, or a certain type of struggle with others, will provide an opportunity for engagement and bonding with others. On a therapeutic level, individual counseling can expand one’s degree of awareness and promote a greater sense of personal accountability, once the roots of old behaviors and attitudes have been identified and deciphered. A patient can then restructure their responses to daily challenges that may have been inadequate prior to surgery. As patients walk the road of recovery from obesity, while engaging in physical as well as emotional healing, the element of discovery and pride is tangible and even contagious. Patients will enjoy improved health, greater energy and a strong positive attitude of self worth; what follows can be a heightened sense of calm, balance and overall peace of mind. Once personal discoveries have been made, individually or in a group setting, bariatric patients can feel a greater sense of control in planning the path in front of them. Commitment and compliance are two key elements that promote post surgery success. As patients employ newfound tools and wisdom on a consistent basis, quality of life can be infinitely better as well as profoundly rewarding.

You’ve made a commitment to adjustable gastric banding surgery, because you need to improve your overall present and future health. Sounds manageable, shouldn’t be too difficult; the results following bariatric surgery, 1 year, 3 years and so on, will be worth it. So, you have the surgery and, for awhile, it seems like magic, weight is coming off slowly but surely and you are working hard to move toward greater health goals day by day. If all goes well, you will have few bumps in the road, right? Well, that’s the hope, not always the reality. I can tell you this; you are not alone on this journey and you will probably experience a good degree of success with your adjustable gastric band even if you are faced with a struggle from time to time. The challenges and rewards of surgery go hand in hand. The challenges of all patients remain virtually the same: how do we combine all the team professionals, support services, along with family and friends, to make this surgery work for you? It may help to look at the big picture for a moment and remind ourselves of the common issues that weight loss surgery patients may be facing along the way. Here are some common challenges that bariatric patients may encounter at any point in the post-operative journey: YOUR HABITS ARE TOUGH TO BREAK: You are human and make mistakes; you have habits and memories of the way food is woven into your life over the years. YOU ARE BECOMING COMPLACENT: You are very motivated as a surgery patient at the beginning, then become complacent and lose motivation over time, after losing a large amount of weight. YOU'RE OFF TRACK: You experience daily life stress that distracts you from your post surgery lifestyle priorities and commitment to better health. YOU ARE AFRAID TO BE JUDGED: You have gained weight back now that you are 3 or more years post surgery but are embarrassed to reconnect with your surgeon and supports in your bariatric community, patients and professionals alike. In addition to team professional support from your bariatric surgery program here are a few things to consider: CONVICTION: Support and encouragement from family, friends and mentors. Those who have a vested interest in you and your success are the key people who help you post surgery and beyond. Try not to hear all or nothing of what others may say; seek what is helpful to you and leave the rest. Time and education help reassure those around you that your decision to have surgery is a sound one. CONSISTENCY: Staying on a regular schedule with the surgeon’s office consists of regular lap band fills every 6 weeks or more, follow up visits with the nutritionist, regular blood work and support group attendance are ways to promote best results with your adjustable gastric band. SHARING AND RECEIVING: Many patients find the use of individual therapy helpful or a group setting to reinforce continuous learning and lifestyle improvements. This would be recommended in addition to program support group attendance. ONLINE SUPPORT SYSTEMS: Online resources are very helpful as an addition to program as well as personal support. So here are the essential issues of bariatric living: Your consistent awareness of these issues will increase the effectiveness of your weight loss “tool” so you can maintain a long and happy partnership with it. It is an emotional adjustment at times and requires perseverance. You will bicker, even fight at times (with your band) and say things you will regret. Just remember, the band can be very flexible at times and allow you make mistakes but it cannot help you if you do not help yourself. That’s what life partners are supposed to do, right? They provide consistent support through all the ups and downs of life, through good times and bad. You will have a long and prosperous relationship with your gastric band if you work as a team; isn’t that really the goal, after all?

Living with an adjustable gastric band is a partnership; it takes effort, compliance and conviction to live in a successful "team" effort. You’ve made a commitment to adjustable gastric banding surgery, because you need to improve your overall present and future health. Sounds manageable, shouldn’t be too difficult; the results following bariatric surgery, 1 year, 3 years and so on, will be worth it. So, you have the surgery and, for awhile, it seems like magic, weight is coming off slowly but surely and you are working hard to move toward greater health goals day by day. If all goes well, you will have few bumps in the road, right? Well, that’s the hope, not always the reality. I can tell you this; you are not alone on this journey and you will probably experience a good degree of success with your adjustable gastric band even if you are faced with a struggle from time to time. The challenges and rewards of surgery go hand in hand. The challenges of all patients remain virtually the same: how do we combine all the team professionals, support services, along with family and friends, to make this surgery work for you? It may help to look at the big picture for a moment and remind ourselves of the common issues that weight loss surgery patients may be facing along the way. Here are some common challenges that bariatric patients may encounter at any point in the post-operative journey: YOUR HABITS ARE TOUGH TO BREAK: You are human and make mistakes; you have habits and memories of the way food is woven into your life over the years. YOU ARE BECOMING COMPLACENT: You are very motivated as a surgery patient at the beginning, then become complacent and lose motivation over time, after losing a large amount of weight. YOU'RE OFF TRACK: You experience daily life stress that distracts you from your post surgery lifestyle priorities and commitment to better health. YOU ARE AFRAID TO BE JUDGED: You have gained weight back now that you are 3 or more years post surgery but are embarrassed to reconnect with your surgeon and supports in your bariatric community, patients and professionals alike. In addition to team professional support from your bariatric surgery program here are a few things to consider: CONVICTION: Support and encouragement from family, friends and mentors. Those who have a vested interest in you and your success are the key people who help you post surgery and beyond. Try not to hear all or nothing of what others may say; seek what is helpful to you and leave the rest. Time and education help reassure those around you that your decision to have surgery is a sound one. CONSISTENCY: Staying on a regular schedule with the surgeon’s office consists of regular lap band fills every 6 weeks or more, follow up visits with the nutritionist, regular blood work and support group attendance are ways to promote best results with your adjustable gastric band. SHARING AND RECEIVING: Many patients find the use of individual therapy helpful or a group setting to reinforce continuous learning and lifestyle improvements. This would be recommended in addition to program support group attendance. ONLINE SUPPORT SYSTEMS: Online resources are very helpful as an addition to program as well as personal support. So here are the essential issues of bariatric living: Your consistent awareness of these issues will increase the effectiveness of your weight loss “tool” so you can maintain a long and happy partnership with it. It is an emotional adjustment at times and requires perseverance. You will bicker, even fight at times (with your band) and say things you will regret. Just remember, the band can be very flexible at times and allow you make mistakes but it cannot help you if you do not help yourself. That’s what life partners are supposed to do, right? They provide consistent support through all the ups and downs of life, through good times and bad. You will have a long and prosperous relationship with your gastric band if you work as a team; isn’t that really the goal, after all?

In our complex and busy lives, we all belong to a system of people, places and things that connect us to others who, in turn, impact our lives in a variety of ways. Many people who struggle with morbid obesity find themselves virtually ”invisible”, feeling like or choosing to stay an anonymous person in the crowd as opposed to being an individual and standing out. Conversely, many bariatric patients maintain busy and interactive lifestyles regardless of body size or physical impediments. Human nature is strange; we often cannot decide how we would like to be perceived by others. In the area of bariatric support services, we are often reminded that both the internal (your own) response to your comprehensive changes and the external (everyone else) response are both quite evident as a patient begins, and continues on, the journey of recovery from morbid obesity. Either way, bariatric surgery will somehow spotlight your changing physical and psychological selves due to a dramatic change in body appearance and personal presentation. In attempting to assess how a pre-operative or new post-operative patient is filtering feedback from those around them, it is often helpful to ask a few pertinent questions to focus in on potentially difficult areas: Do you feel that people in your support system are fully aware of your needs as a pre-operative/new post-operative bariatric surgery patient? Have the people in your life system received adequate information/education regarding the basics of bariatric surgery and the importance of a supportive and behaviorally appropriate environment? Do you perceive friends or family members unable to relate to you/isolate from you due to the newness of bariatric surgery? Are support people feeling unsure as to how your relationship will be affected by your bariatric surgery in the future? Are there feelings of resentment or frustration apparent to you around old eating habits or the appearance of new ones? As support service facilitators, we are keenly aware of the possibilities of external (outside) reactions to bariatric patients and how it may impact the internal (sense of self) reactions patients are experiencing at an already heightened rate. When a patient decides to undergo surgery, that decision can be an alarming, even threatening event, for people in their life system, be it family, friends, co-workers or intimate partners. A change in a relationship between two people may possibly shift the focus of eating behaviors from one to another, possibly putting the spotlight on someone else and their less than perfect lives. We all, to some degree, experience scrutiny around our behaviors but as we all know, body image and self-worth are very susceptible to criticisms from those in our life system. Expectations of what bariatric surgery will change also affects the patients issues about their own acceptance in a mirror image sort of way. Patients often wonder: Will I be accepted by my old crowd of friends even though I may not eat the same way or for the same reasons after my surgery Will I be able to enjoy socializing, holidays and celebrations following bariatric surgery? What if my feelings towards some people in my life change and I decide to minimize certain relationships because they do not support my new style of life? Most people want to be accepted for who they are in a holistic sense, not just what they look like. The adjustment needs for both patient and support persons are often the same: that the newness of the situation will pass and interaction between people will become less uncomfortable. Often, patients report having to reinforce the importance of certain relationships with others just as patients need to receive the same “validation” from others. Patience, tolerance and acceptance are three areas that everyone could benefit from as patients and support people learn from each other that the most valuable teaching tool is life experience. Bariatric surgery begins a journey toward a healthier, improved quality of life the patient will pursue in their physical and emotional recovery from the devastating affects of morbid obesity.

Many people who struggle with morbid obesity find themselves virtually ”invisible”, feeling like or choosing to stay an anonymous person in the crowd as opposed to being an individual and standing out. In our complex and busy lives, we all belong to a system of people, places and things that connect us to others who, in turn, impact our lives in a variety of ways. Many people who struggle with morbid obesity find themselves virtually ”invisible”, feeling like or choosing to stay an anonymous person in the crowd as opposed to being an individual and standing out. Conversely, many bariatric patients maintain busy and interactive lifestyles regardless of body size or physical impediments. Human nature is strange; we often cannot decide how we would like to be perceived by others. In the area of bariatric support services, we are often reminded that both the internal (your own) response to your comprehensive changes and the external (everyone else) response are both quite evident as a patient begins, and continues on, the journey of recovery from morbid obesity. Either way, bariatric surgery will somehow spotlight your changing physical and psychological selves due to a dramatic change in body appearance and personal presentation. In attempting to assess how a pre-operative or new post-operative patient is filtering feedback from those around them, it is often helpful to ask a few pertinent questions to focus in on potentially difficult areas: Do you feel that people in your support system are fully aware of your needs as a pre-operative/new post-operative bariatric surgery patient? Have the people in your life system received adequate information/education regarding the basics of bariatric surgery and the importance of a supportive and behaviorally appropriate environment? Do you perceive friends or family members unable to relate to you/isolate from you due to the newness of bariatric surgery? Are support people feeling unsure as to how your relationship will be affected by your bariatric surgery in the future? Are there feelings of resentment or frustration apparent to you around old eating habits or the appearance of new ones? As support service facilitators, we are keenly aware of the possibilities of external (outside) reactions to bariatric patients and how it may impact the internal (sense of self) reactions patients are experiencing at an already heightened rate. When a patient decides to undergo surgery, that decision can be an alarming, even threatening event, for people in their life system, be it family, friends, co-workers or intimate partners. A change in a relationship between two people may possibly shift the focus of eating behaviors from one to another, possibly putting the spotlight on someone else and their less than perfect lives. We all, to some degree, experience scrutiny around our behaviors but as we all know, body image and self-worth are very susceptible to criticisms from those in our life system. Expectations of what bariatric surgery will change also affects the patients issues about their own acceptance in a mirror image sort of way. Patients often wonder: Will I be accepted by my old crowd of friends even though I may not eat the same way or for the same reasons after my surgery Will I be able to enjoy socializing, holidays and celebrations following bariatric surgery? What if my feelings towards some people in my life change and I decide to minimize certain relationships because they do not support my new style of life? Most people want to be accepted for who they are in a holistic sense, not just what they look like. The adjustment needs for both patient and support persons are often the same: that the newness of the situation will pass and interaction between people will become less uncomfortable. Often, patients report having to reinforce the importance of certain relationships with others just as patients need to receive the same “validation” from others. Patience, tolerance and acceptance are three areas that everyone could benefit from as patients and support people learn from each other that the most valuable teaching tool is life experience. Bariatric surgery begins a journey toward a healthier, improved quality of life the patient will pursue in their physical and emotional recovery from the devastating affects of morbid obesity.