Elizabeth Anderson RD

One nutritionist likens eating fruit to consuming Halloween candy. Bariatric Dietitian Elizabeth Anderson weighs in. Is Eating Fruit Like Eating Candy? In my opinion as a bariatric dietitian, no. Is fruit nature’s candy? Well, I don’t know about you, but I haven’t yet confused blueberries with blue jellybeans. Many of my post-op WLS clients are nonetheless extremely nervous to incorporate fruit back into their diets. Some have even been told ‘fruit is dirty’ by their providers. Most feel they ought to avoid fruit-- like mosquitoes in Florida. Now I think I know where this is coming from. Many folks with the best intentions believe the sweetness of fruit can prime the appetite-pump for MORE sweets—the high fructose kind. If you feel fruit might lead you to return to sweets with wild abandon then you are better off skipping it. But for those of you post op gastric sleeve and bypass clients, fully healed from surgery, and hankering for a small piece of watermelon to beat the heat or a tiny bowl of pineapple while vacationing in Hawaii, I say, enjoy. When I became a dietitian I took a solemn vow that I would always encourage well-balanced nutrition. To me, that means recommending to my WLS clients: lean proteins, whole grains, fruits and vegetables. I understand and encourage my clients to limit carbohydrates. I follow the bariatric plate guidelines and suggest 2 tablespoons of starch at lunch and dinner or, about 10 % of these meals. It’s late summer. This is your opportunity to enjoy the starchy vegetables of the season like sweet potato, fresh summer corn or green peas. And the delicious fruits of summer like Maine blueberries, Georgia peaches and succulent summer melon—in WLS portions. Fruits and vegetables, especially the deeply colored varieties like beets, raspberries, kiwi and tomatoes, are packed with disease-fighting antioxidants and nutrients that are so vital to good health. Plus, the loads of vitamins and minerals in fruits and vegetables are much better absorbed by our bodies than the version we get in supplements. I know many pre-surgery eating habits need to change after surgery. I sincerely hope that doesn’t mean you have to avoid some of nature’s tastiest treats of the season.

And you thought political ads were the worst? January ushers in a completely different-- but equally irritating ad campaign—dieting and weight loss commercials. Bariatric dietitian Elizabeth Anderson caught some TV this weekend --cheering on her New England Patriots (!!) and checked out the latest promotions for a skinnier 2017. You've got pills, powders, exercise gadgets and diet programs, all new and improved for the fastest, easiest weight loss EVER. Now before I launch into my diet rant, let’s clear the air about some of the exercise plan promises. Any exercise expert worth their salt will tell you those lean bodies you see—the glistening, tanned ones, are not made by any exercise alone. They’re realized with very strict diets and exercise. Exercise alone just cannot yield these results. But what I want to really vent about today is the popular diet ads. One popular diet program I saw advertised extensively this past week boasted, “Lose 14 pounds in two weeks!” I can see how well-intentioned folks are attracted to this message. It’s a no-brainer plan: · delicious looking food (brownies! Pancakes! Pizza!) · super-fast and significant results · comes with the endorsement of a well-known and liked celebrity What I’ll ask you to consider before digging out your credit card though, is all that tiny fine print at the bottom of nearly every screen of the ad. “Typical weight loss is 1-2 pounds per week.” That’s quite a discrepancy people. Would you feel disappointed if you spent money on two months of prepackaged diet food and lost the ‘typical’ amount of weight—4 pounds? I would be, since I can’t even diet for half an hour. ‘Knowledge is power’ sounds like a Power Rangers slogan but if you realize these ads are preying on your trigger points, you are going to be a lot more cautious in your purchase decisions. I don’t want to be discouraging here. It’s natural and healthy to want to improve your health at the start of a new year. I simply want you to do that as a savvy consumer. One who resists ‘too good to be true’ or exaggerated promises and invests in sustainable strategies for long-term, permanent weight loss.

You've got pills, powders, exercise gadgets and diet programs, all new and improved for the fastest, easiest weight loss EVER. Now before I launch into my diet rant, let’s clear the air about some of the exercise plan promises. Any exercise expert worth their salt will tell you those lean bodies you see—the glistening, tanned ones, are not made by any exercise alone. They’re realized with very strict diets and exercise. Exercise alone just cannot yield these results. But what I want to really vent about today is the popular diet ads. One popular diet program I saw advertised extensively this past week boasted, “Lose 14 pounds in two weeks!” I can see how well-intentioned folks are attracted to this message. It’s a no-brainer plan: · delicious looking food (brownies! Pancakes! Pizza!) · super-fast and significant results · comes with the endorsement of a well-known and liked celebrity What I’ll ask you to consider before digging out your credit card though, is all that tiny fine print at the bottom of nearly every screen of the ad. “Typical weight loss is 1-2 pounds per week.” That’s quite a discrepancy people. Would you feel disappointed if you spent money on two months of prepackaged diet food and lost the ‘typical’ amount of weight—4 pounds? I would be, since I can’t even diet for half an hour. ‘Knowledge is power’ sounds like a Power Rangers slogan but if you realize these ads are preying on your trigger points, you are going to be a lot more cautious in your purchase decisions. I don’t want to be discouraging here. It’s natural and healthy to want to improve your health at the start of a new year. I simply want you to do that as a savvy consumer. One who resists ‘too good to be true’ or exaggerated promises and invests in sustainable strategies for long-term, permanent weight loss.

When bariatric dietitian Elizabeth Anderson decided to get back in touch with her cardiovascular endurance, she decided less is more. When you Google ‘Couch to 5K’ you’re likely searching for the fastest route from the fitness of well, a relaxed root vegetable to feeling like an Olympian on the cover of a Wheaties Box. And that’s fine if you’re an average root vegetable with a high tolerance to pain. I however, don’t really like pain, burning lungs or nausea so I sought a different route to resuscitate my fitness. And ladies and gentlemen, I found it! Last week, the app on my iPhone with the heart on it, confirmed that I had actually run 3 complete miles--that’s 15,840 feet without stopping. For the first time in my 48 years I had reached the level of fitness that many 4th graders only dream of. Now I know you're curious to know how I pulled it off, and in just nine months!! In honor of the holiday and the spirit of giving, I’ve decided to share my details of triumph-- as my gift to you. Aversion to Pain Here’s a fun fact. When you begin a new fitness plan you’re going to experience something called the ‘training effect.’ This is a very scientific explanation for the reason your lungs feel like hot lava is coursing through them and your feet feel like lead every day for the first month and a half of your training. Your body is simply trying to relearn how to handle all this new lactic acid you’re feeding it. It’s just 6 weeks people. A mere 45 days of wanting to die. Shockingly, I decided I wanted to circumvent the ‘training effect’ if at all possible. For the first 4 weeks I simply walked like an Olympian. Well, let’s say I power walked. But then I got impatient and decided to add a little running in. (By running I mean a chipper jog. And by a little, I mean a. little. ) I used the telephone poles along my route as start and stop markers. I’d walk the distance between two poles and then jog the next. Gradually I increased the ‘running’ portion as I felt stronger and my bladder was cooperating. 15 Minutes Max! Probably the cornerstone of my fitness feat is the absolute strict adherence to the 15 minute rule. Whether I walked or walked and jogged, I always kept my total workout time to 15 minutes. I know that might be hard to imagine and not everyone has this kind of discipline and fortitude; I am one of the fortunate ones. One Goal, No Timeline To be honest, I didn’t start with the 5K/3 mile mark as my goal. My only goal was to be able to run more than 50 yards without having to stop from utter exhaustion. This was really a day by day journey; my only quantifying measure was my perceived level of exhaustion. I Made it Kinda Fun Some running purists feel those who need music to run aren’t true lovers of the sport. What these snarks are missing out on is the pure bliss of rocking out to Donna Summer’s Bad Girls when they pass the one mile mark. The dance my soul does when it hears Petula Clark belt out Downtown or Spandau Ballet’s True, helps me bask in Eckhart Tolle’s Now instead of ‘how much longer??? And those neat apps that keep track of how far you’ve run? I figured out how to use them! And you know what? They’re actually kind of motivating. One day I started out jogging very slowly—no walking warm-up at all—and decided to see how long I could go without feeling I needed to dial 911. I nearly wept, well I did cry, when I saw I had gone a mile. A mile!! Now, I was on fire! Within just another four weeks, still following the extremely disciplined 15 minute per day model, I was at TWO miles!! Flash forward to last week when I hit the 3 mile mark. I’m surprised you didn’t hear the Chariots of Fire theme at your house. I realize these kind of success stories are rare and sometimes hard to believe. But I ask you to suspend your doubt and believe that these events sometimes DO happen. When you take a dedicated individual, unwilling to follow the rules, unconcerned what passersby might be thinking and challenge them to get fit in their own damn way, miracles can occur. Miracles.

Bariatric dietitian Elizabeth Anderson is a big advocate for bariatric surgery--her whole livelihood revolves around it. She goes a little bananas though when people misunderstand this potential game-changer. Tori* came to me 200 pounds overweight. She listened carefully to all the facts about bariatric surgery’s possibilities and limitations. She agreed that to reach optimal success, she needed to begin exercising, changing her eating habits and looking at her relationship with food. Tori lost 150 pounds in her first-year post-op. She didn’t have to follow any exercise program or deal with her issues with food. The weight just kept falling off. She was even able to eat her favorite foods, just a lot less. Tori was ecstatic and clearly over her battle with weight. At 18 months post-op, the good times stopped rolling. Tori was frustrated she couldn’t keep losing weight. In fact, it was getting harder to maintain her current weight. By two years post op, she had regained 40 pounds and was frantic. I have been as subtle as a mosquito urging Tori to check in with a counselor to better understand why she eats when she’s not hungry. Now she was ready to give it a try. 4 months later she said to me, “Elizabeth, this surgery can only take you so far. I thought if I lost the weight I would never regain it, even though everyone I’ve known that’s had this surgery, has regained it. I thought I would be stronger. Now I see that if you don’t face the issues you’ve got and that you’ve used food to self-medicate, all the old habits will come back and you’ll regain the weight.” And this is the reason I say weight loss surgery is not the solution. Calling it a tool is becoming a cliché; it’s simply the start of a different life. It can be a new and better life with healthier eating, daily exercise and taking care of yourself emotionally. Or, it can be a detour, a brush with a healthier possibility that is not embraced. Tori says she didn’t think it would be so hard to keep the weight off. She says she didn’t expect all the things in her life to stay the same after she lost weight. Now that she’s seeing things with a brand-new perspective, Tori seems more hopeful that the Weight Regain Train is not barreling toward her. I wish Tori wasn’t the exception but she is. Taking an emotional inventory is the scariest part of full immersion into a new life after WLS. But it’s worth it and I’m afraid, necessary for long-term success. Whatever you need to do to take the dive, seek it out, today and start to imagine a more peaceful, positive future with a weight you feel good in. _____________________________________ *client names and features are always changed to protect identity.

Tori* came to me 200 pounds overweight. She listened carefully to all the facts about bariatric surgery’s possibilities and limitations. She agreed that to reach optimal success, she needed to begin exercising, changing her eating habits and looking at her relationship with food. Tori lost 150 pounds in her first-year post-op. She didn’t have to follow any exercise program or deal with her issues with food. The weight just kept falling off. She was even able to eat her favorite foods, just a lot less. Tori was ecstatic and clearly over her battle with weight. At 18 months post-op, the good times stopped rolling. Tori was frustrated she couldn’t keep losing weight. In fact, it was getting harder to maintain her current weight. By two years post op, she had regained 40 pounds and was frantic. I have been as subtle as a mosquito urging Tori to check in with a counselor to better understand why she eats when she’s not hungry. Now she was ready to give it a try. 4 months later she said to me, “Elizabeth, this surgery can only take you so far. I thought if I lost the weight I would never regain it, even though everyone I’ve known that’s had this surgery, has regained it. I thought I would be stronger. Now I see that if you don’t face the issues you’ve got and that you’ve used food to self-medicate, all the old habits will come back and you’ll regain the weight.” And this is the reason I say weight loss surgery is not the solution. Calling it a tool is becoming a cliché; it’s simply the start of a different life. It can be a new and better life with healthier eating, daily exercise and taking care of yourself emotionally. Or, it can be a detour, a brush with a healthier possibility that is not embraced. Tori says she didn’t think it would be so hard to keep the weight off. She says she didn’t expect all the things in her life to stay the same after she lost weight. Now that she’s seeing things with a brand-new perspective, Tori seems more hopeful that the Weight Regain Train is not barreling toward her. I wish Tori wasn’t the exception but she is. Taking an emotional inventory is the scariest part of full immersion into a new life after WLS. But it’s worth it and I’m afraid, necessary for long-term success. Whatever you need to do to take the dive, seek it out, today and start to imagine a more peaceful, positive future with a weight you feel good in. _____________________________________ *client names and features are always changed to protect identity.

Bariatric Dietitian Elizabeth Anderson explains why feeling sunshiney is the perfect reason to keep visiting your local phlebotomist. New Year, new calendar, time to enter in to your digital devices all those reminders and important events for 2017. Birthdays, anniversaries, car inspection and for bariatric post-ops…don’t forget your LAB WORK! I know this is one of the first things that gets forgotten in the avalanche of to-do’s in the first year after weight loss surgery. As a bariatric dietitian, I try to make it easier for my clients by sending reminder emails and letters to them and their PCPs. Many of my clients will say, “Elizabeth, I’m healthier than I’ve ever been; I feel great! Why waste time and co-pays on lab work?” Short answer? It’s critically important—no matter which procedure you had done. The American Society of Metabolic and Bariatric Surgery (ASMBS) recommends lab work after bariatric surgery at 3 months, 6-9 months and 12 and 18 months. After that, an annual work-up is usually sufficient. Here’s why: Vitamins and minerals play many key roles in weight management. If you don’t get adequate amounts, you’re compromising your health and slowing down your weight loss. Gastric Sleeve, Gastric Bypass and BPD surgeries ALL change your metabolism. This means the digestion and absorption of nutrients, vitamins and minerals can be negatively affected. Some nutritional deficiencies lead to severe consequences--some irreversible and at least one, fatal. Nutritional deficiencies continue to occur after surgery—some as far as 20 years post-op. a. Iron deficiency is most commonly seen 4+ years after surgery! b. Dietitians in Boston, MA report that in one group of post-ops—43% were B12 deficient 15 months after surgery. Many patients are deficient in key vitamins before surgery. a. One study showed 48% of WLS patients had at least one nutritional deficiency before surgery! (1) b. Another study showed more than 50% of all WLS patients are low in Vitamin D preoperatively. (2) It’s safe to say those pre-op deficiencies don’t improve with weight loss, reduced calories and smaller meals. I send my patients to their doctors and NPs with this list of recommended labs: ü Thiamine ü Folate ü Vitamin D ü Vitamin B12 ü Vitamin B6 ü complete protein ü complete metabolic panel (CMP) ü complete blood count (CBC) ü Lipid panel ü Liver function tests ü Parathyroid hormone (PTH) ü Bone density test or (DXA) every 2 years. More often than I like, providers will pick and choose from the list. They too, wonder if all the tests are truly necessary. I gently push back with the research data and thankfully, more labs are ordered. When the labs come back, make sure your bariatric dietitian or some member of your bariatric team reviews them. Many healthcare providers aren’t well-versed in the nutritional concerns after WLS and might miss an important trend. I know regular labs are one more thing on the to-do list, but remember, you made a life-changing investment in yourself and your health when you had bariatric surgery. Consider all those vials of blood just part of your insurance policy protecting that investment! -Elizabeth Anderson MA, RDN, LD References: 1. Ernst B et al. Obes. Surg 2009;19(1):66-73. 2. Gehrer S et al. Obes. Surg 2010;20(4):447-53.

New Year, new calendar, time to enter in to your digital devices all those reminders and important events for 2017. Birthdays, anniversaries, car inspection and for bariatric post-ops…don’t forget your LAB WORK! I know this is one of the first things that gets forgotten in the avalanche of to-do’s in the first year after weight loss surgery. As a bariatric dietitian, I try to make it easier for my clients by sending reminder emails and letters to them and their PCPs. Many of my clients will say, “Elizabeth, I’m healthier than I’ve ever been; I feel great! Why waste time and co-pays on lab work?” Short answer? It’s critically important—no matter which procedure you had done. The American Society of Metabolic and Bariatric Surgery (ASMBS) recommends lab work after bariatric surgery at 3 months, 6-9 months and 12 and 18 months. After that, an annual work-up is usually sufficient. Here’s why: Vitamins and minerals play many key roles in weight management. If you don’t get adequate amounts, you’re compromising your health and slowing down your weight loss. Gastric Sleeve, Gastric Bypass and BPD surgeries ALL change your metabolism. This means the digestion and absorption of nutrients, vitamins and minerals can be negatively affected. Some nutritional deficiencies lead to severe consequences--some irreversible and at least one, fatal. Nutritional deficiencies continue to occur after surgery—some as far as 20 years post-op. a. Iron deficiency is most commonly seen 4+ years after surgery! b. Dietitians in Boston, MA report that in one group of post-ops—43% were B12 deficient 15 months after surgery. Many patients are deficient in key vitamins before surgery. a. One study showed 48% of WLS patients had at least one nutritional deficiency before surgery! (1) b. Another study showed more than 50% of all WLS patients are low in Vitamin D preoperatively. (2) It’s safe to say those pre-op deficiencies don’t improve with weight loss, reduced calories and smaller meals. I send my patients to their doctors and NPs with this list of recommended labs: ü Thiamine ü Folate ü Vitamin D ü Vitamin B12 ü Vitamin B6 ü complete protein ü complete metabolic panel (CMP) ü complete blood count (CBC) ü Lipid panel ü Liver function tests ü Parathyroid hormone (PTH) ü Bone density test or (DXA) every 2 years. More often than I like, providers will pick and choose from the list. They too, wonder if all the tests are truly necessary. I gently push back with the research data and thankfully, more labs are ordered. When the labs come back, make sure your bariatric dietitian or some member of your bariatric team reviews them. Many healthcare providers aren’t well-versed in the nutritional concerns after WLS and might miss an important trend. I know regular labs are one more thing on the to-do list, but remember, you made a life-changing investment in yourself and your health when you had bariatric surgery. Consider all those vials of blood just part of your insurance policy protecting that investment! -Elizabeth Anderson MA, RDN, LD References: 1. Ernst B et al. Obes. Surg 2009;19(1):66-73. 2. Gehrer S et al. Obes. Surg 2010;20(4):447-53.

We've all heard it. 'Mind over matter. Want to lose weight? Try pushing back from the table more often.' Bariatric dietitian Elizabeth Anderson explains how these and other utterly ridiculous suggestions might finally be retired in light of new research on self-control, willpower and weight. Turns out, we aren’t that good at self-control. The good news? Who needs it?? Researchers are discovering that teaching people to resist temptation provides either short-term gains or is just an outright failure. “Effortful restraint, where you are fighting yourself—the benefits are overhyped,” according to Kentaro Fujita, a psychologist studying self-control at Ohio State University. Brian Resnick from Vox.com says the implications of this are huge. “If we accept that brute willpower doesn’t work, we can feel less bad about ourselves when we succumb to temptation. And, we might be able to refocus our efforts on solving problems like obesity.” So what does work? Because clearly some people are managing their relationship with frosting better than me! Fujita explains, “We tend to think of people with strong willpower as people who are able to fight this battle effectively. Actually, the people who are really good at self-control never have to fight these battles in the first place.” Say what?? A landmark study from 2011 revealed that people who rocked self-control, those who described themselves as ‘good at resisting temptation’ reported fewer temptations throughout the course of the study. And funnily enough, those who reported using willpower admitted they were not meeting their goals AND they were exhausted from trying! This, I understand. “People who are good at self-control seem to be structuring their lives in a way to avoid having to make self-control decisions in the first place, “says researcher and psychologist Brian Galla. Galla says creating a schedule or lifestyle that makes exercise and eating healthy the easiest most routine thing to do, are the ones most likely to consistently do it. “A trick to wake up more quickly in the morning is to set the alarm on the other side of the room. That’s not in-the-moment willpower at play, it’s planning.” Fujita suggests ‘the really good dieter’ wouldn’t buy a cupcake because they wouldn’t have passed by the bakery in the first place. Or, they would create a negative reaction to the cupcake instead of a positive one—i.e., ‘Ick! A cupcake. What an artery-clogging, life-shortening sugar bomb.’ (I’ll let you know if this works!) “Self-control isn’t a special moral muscle, it’s like any decision. And to improve the decision, we need to improve the environment and give people the skills needed to avoid cake in the first place,” Galla says. Neuroscientist Elliot Berkman from the University of Oregon believes the term ‘self-control’ needs to be abolished. “It’s really no different than any other decision making.” Berkman is testing out a theory in his lab called ‘temptation bundling’ where people make activities more enjoyable by adding a fun component to them. The research is still young but one study has already showed people were more likely to work out when they could listen to an audio copy The Hunger Games. I’m personally eager to try out some of these ideas. I’d like to create an index of strategies and habits you guys use to make the ‘healthy’ thing to do, the easiest thing to do. Please email me your ideas and I’ll compile the tips to share!

Thanksgiving didn't go exactly as planned? Are you already checking out New Year's diets? Bariatric dietitian Elizabeth Anderson offers a more pleasant alternative that's more effective and delicious. One of the first nurses I ever worked with told me about the Eating Season. Spanning from the time you buy your first bag of Halloween Candy until you consume your last nacho during the Super Bowl—this puppy runs 3 full months and includes the daunting period from Thanksgiving to Christmas or Hanukkah. The last month of the Eating Season provides both a lifeline for the overindulgent and a guilty reminder of the time-tested principle of cause and effect—courtesy of incessant ads for diets. Is there a different way? Oh yes my friends, there is. And it allows you to fully enjoy goodies of the season without gaining weight. Sound too good to be true? It is if you’re not willing to do some pretty close self-examination. Are you up to the challenge? #5 Eat Your Damn Protein WLS post-ops, you are SICK of hearing it but if you’re living it, you know it’s vital to success. At every meal, at every snack, seek protein foods and eat them first. Loop-hole alert: meals should be about 20-30 grams of protein and snacks at least 8 grams. #4 No Rules or Restrictions Following strict diet rules during the holidays actually makes perfect sense. It makes shopping easier, meal planning a breeze and decision making is a piece of cake? You’ve got enough to worry about; this is no time to be worrying about what to eat. Problem is, it’s a short-term strategy. Rules work when you use them but they’re not sustainable long-term. That means a period of rule-following always leads to overeating. Don’t do it. Decide what you want to eat and after your protein, enjoy it--fully. Eat it slowly and with full attention. Stop when you’ve had enough and you’re not overfull. You’ve got limited room, so fill it with great discrimination. Avoid the stale store-bought cookies, the picked-over cake in the breakroom and savor mom’s monkey bread with bliss. #3 Honor Your Hunger Don’t be skipping any meals to save calories or because you’re ‘too busy’ to eat. You’ve got to eat something every four hours to keep your metabolism in fighting shape and your blood sugar level. Caveman hunger does not serve you well. Your body, brain and bloodstream are all conspiring to get you to eat because it perceives a threat to your survival. Seriously! Don’t let this physiological mechanism take over. Take charge with self-care and regular eating. #2 Speaking of Self-care It’s impossibly busy this time of year but you’ll be one hot mess if you don’t sleep 7 plus hours a night, exercise your heart 15 minutes per day and take your vitamins. You compromise your weight when you skip any of these vital self-care essentials. #1 Believe Something is Different Research exploring the thought patterns of women with obesity revealed a consistent lack of confidence in their weight maintenance skills/capacity. You’ve seen the platitudes: ‘If you think you can or if you think you can’t, you’re right.’ Buddha knew it, positive psychology researchers know it but… you doubt it? Grab a Dr. Wayne Dyer book or Google byronkatie.com and begin to notice what you’re telling yourself and what you believe about yourself and your weight. Once you uncover some of those self-limiting beliefs, you might find fighting off the desire to have a piece of cheesecake has more to do with avoiding Cousin Charlie than your ‘weakness’ for sweets.

One of the first nurses I ever worked with told me about the Eating Season. Spanning from the time you buy your first bag of Halloween Candy until you consume your last nacho during the Super Bowl—this puppy runs 3 full months and includes the daunting period from Thanksgiving to Christmas or Hanukkah. The last month of the Eating Season provides both a lifeline for the overindulgent and a guilty reminder of the time-tested principle of cause and effect—courtesy of incessant ads for diets. Is there a different way? Oh yes my friends, there is. And it allows you to fully enjoy goodies of the season without gaining weight. Sound too good to be true? It is if you’re not willing to do some pretty close self-examination. Are you up to the challenge? #5 Eat Your Damn Protein WLS post-ops, you are SICK of hearing it but if you’re living it, you know it’s vital to success. At every meal, at every snack, seek protein foods and eat them first. Loop-hole alert: meals should be about 20-30 grams of protein and snacks at least 8 grams. #4 No Rules or Restrictions Following strict diet rules during the holidays actually makes perfect sense. It makes shopping easier, meal planning a breeze and decision making is a piece of cake? You’ve got enough to worry about; this is no time to be worrying about what to eat. Problem is, it’s a short-term strategy. Rules work when you use them but they’re not sustainable long-term. That means a period of rule-following always leads to overeating. Don’t do it. Decide what you want to eat and after your protein, enjoy it--fully. Eat it slowly and with full attention. Stop when you’ve had enough and you’re not overfull. You’ve got limited room, so fill it with great discrimination. Avoid the stale store-bought cookies, the picked-over cake in the breakroom and savor mom’s monkey bread with bliss. #3 Honor Your Hunger Don’t be skipping any meals to save calories or because you’re ‘too busy’ to eat. You’ve got to eat something every four hours to keep your metabolism in fighting shape and your blood sugar level. Caveman hunger does not serve you well. Your body, brain and bloodstream are all conspiring to get you to eat because it perceives a threat to your survival. Seriously! Don’t let this physiological mechanism take over. Take charge with self-care and regular eating. #2 Speaking of Self-care It’s impossibly busy this time of year but you’ll be one hot mess if you don’t sleep 7 plus hours a night, exercise your heart 15 minutes per day and take your vitamins. You compromise your weight when you skip any of these vital self-care essentials. #1 Believe Something is Different Research exploring the thought patterns of women with obesity revealed a consistent lack of confidence in their weight maintenance skills/capacity. You’ve seen the platitudes: ‘If you think you can or if you think you can’t, you’re right.’ Buddha knew it, positive psychology researchers know it but… you doubt it? Grab a Dr. Wayne Dyer book or Google byronkatie.com and begin to notice what you’re telling yourself and what you believe about yourself and your weight. Once you uncover some of those self-limiting beliefs, you might find fighting off the desire to have a piece of cheesecake has more to do with avoiding Cousin Charlie than your ‘weakness’ for sweets.

Turns out, we aren’t that good at self-control. The good news? Who needs it?? Researchers are discovering that teaching people to resist temptation provides either short-term gains or is just an outright failure. “Effortful restraint, where you are fighting yourself—the benefits are overhyped,” according to Kentaro Fujita, a psychologist studying self-control at Ohio State University. Brian Resnick from Vox.com says the implications of this are huge. “If we accept that brute willpower doesn’t work, we can feel less bad about ourselves when we succumb to temptation. And, we might be able to refocus our efforts on solving problems like obesity.” So what does work? Because clearly some people are managing their relationship with frosting better than me! Fujita explains, “We tend to think of people with strong willpower as people who are able to fight this battle effectively. Actually, the people who are really good at self-control never have to fight these battles in the first place.” Say what?? A landmark study from 2011 revealed that people who rocked self-control, those who described themselves as ‘good at resisting temptation’ reported fewer temptations throughout the course of the study. And funnily enough, those who reported using willpower admitted they were not meeting their goals AND they were exhausted from trying! This, I understand. “People who are good at self-control seem to be structuring their lives in a way to avoid having to make self-control decisions in the first place, “says researcher and psychologist Brian Galla. Galla says creating a schedule or lifestyle that makes exercise and eating healthy the easiest most routine thing to do, are the ones most likely to consistently do it. “A trick to wake up more quickly in the morning is to set the alarm on the other side of the room. That’s not in-the-moment willpower at play, it’s planning.” Fujita suggests ‘the really good dieter’ wouldn’t buy a cupcake because they wouldn’t have passed by the bakery in the first place. Or, they would create a negative reaction to the cupcake instead of a positive one—i.e., ‘Ick! A cupcake. What an artery-clogging, life-shortening sugar bomb.’ (I’ll let you know if this works!) “Self-control isn’t a special moral muscle, it’s like any decision. And to improve the decision, we need to improve the environment and give people the skills needed to avoid cake in the first place,” Galla says. Neuroscientist Elliot Berkman from the University of Oregon believes the term ‘self-control’ needs to be abolished. “It’s really no different than any other decision making.” Berkman is testing out a theory in his lab called ‘temptation bundling’ where people make activities more enjoyable by adding a fun component to them. The research is still young but one study has already showed people were more likely to work out when they could listen to an audio copy The Hunger Games. I’m personally eager to try out some of these ideas. I’d like to create an index of strategies and habits you guys use to make the ‘healthy’ thing to do, the easiest thing to do. Please email me your ideas and I’ll compile the tips to share!

When you Google ‘Couch to 5K’ you’re likely searching for the fastest route from the fitness of well, a relaxed root vegetable to feeling like an Olympian on the cover of a Wheaties Box. And that’s fine if you’re an average root vegetable with a high tolerance to pain. I however, don’t really like pain, burning lungs or nausea so I sought a different route to resuscitate my fitness. And ladies and gentlemen, I found it! Last week, the app on my iPhone with the heart on it, confirmed that I had actually run 3 complete miles--that’s 15,840 feet without stopping. For the first time in my 48 years I had reached the level of fitness that many 4th graders only dream of. Now I know you're curious to know how I pulled it off, and in just nine months!! In honor of the holiday and the spirit of giving, I’ve decided to share my details of triumph-- as my gift to you. Aversion to Pain Here’s a fun fact. When you begin a new fitness plan you’re going to experience something called the ‘training effect.’ This is a very scientific explanation for the reason your lungs feel like hot lava is coursing through them and your feet feel like lead every day for the first month and a half of your training. Your body is simply trying to relearn how to handle all this new lactic acid you’re feeding it. It’s just 6 weeks people. A mere 45 days of wanting to die. Shockingly, I decided I wanted to circumvent the ‘training effect’ if at all possible. For the first 4 weeks I simply walked like an Olympian. Well, let’s say I power walked. But then I got impatient and decided to add a little running in. (By running I mean a chipper jog. And by a little, I mean a. little. ) I used the telephone poles along my route as start and stop markers. I’d walk the distance between two poles and then jog the next. Gradually I increased the ‘running’ portion as I felt stronger and my bladder was cooperating. 15 Minutes Max! Probably the cornerstone of my fitness feat is the absolute strict adherence to the 15 minute rule. Whether I walked or walked and jogged, I always kept my total workout time to 15 minutes. I know that might be hard to imagine and not everyone has this kind of discipline and fortitude; I am one of the fortunate ones. One Goal, No Timeline To be honest, I didn’t start with the 5K/3 mile mark as my goal. My only goal was to be able to run more than 50 yards without having to stop from utter exhaustion. This was really a day by day journey; my only quantifying measure was my perceived level of exhaustion. I Made it Kinda Fun Some running purists feel those who need music to run aren’t true lovers of the sport. What these snarks are missing out on is the pure bliss of rocking out to Donna Summer’s Bad Girls when they pass the one mile mark. The dance my soul does when it hears Petula Clark belt out Downtown or Spandau Ballet’s True, helps me bask in Eckhart Tolle’s Now instead of ‘how much longer??? And those neat apps that keep track of how far you’ve run? I figured out how to use them! And you know what? They’re actually kind of motivating. One day I started out jogging very slowly—no walking warm-up at all—and decided to see how long I could go without feeling I needed to dial 911. I nearly wept, well I did cry, when I saw I had gone a mile. A mile!! Now, I was on fire! Within just another four weeks, still following the extremely disciplined 15 minute per day model, I was at TWO miles!! Flash forward to last week when I hit the 3 mile mark. I’m surprised you didn’t hear the Chariots of Fire theme at your house. I realize these kind of success stories are rare and sometimes hard to believe. But I ask you to suspend your doubt and believe that these events sometimes DO happen. When you take a dedicated individual, unwilling to follow the rules, unconcerned what passersby might be thinking and challenge them to get fit in their own damn way, miracles can occur. Miracles.

Bariatric Dietitian Elizabeth Anderson learned lots of new things at Obesity Week this year. In no particular order she shares what she remembers after a crazy week in NOLA. Here are just a few fascinating facts from the world's leading obesity researchers, scientists and surgeons gathered in NOLA for ObesityWeek2016: 1. There are 3 centers in the brain driving the ‘eat’ or ‘not to eat’ decision: the ‘I’m so hungry I would steal candy from a child’ drive, the ‘Ben and Jerry’s will make this sucky day, better’ drive and the ‘Oh, that cinnamon bun is so crazy gooey I need to eat one NOW’ drive. 2. The good news? Researchers have discovered that our hormone, Oxytocin or the ‘Love Hormone’ helps reduce our impulse to eat AND reduces calorie intake by rewiring the reward center in our brain. Only problem? It doesn’t last long in the bloodstream before breaking down. But researchers will try to make something similar. 3. People struggling with obesity are STILL being treated horribly by some healthcare providers. One study shows providers across the globe associate obesity with poor hygiene and dishonesty!?? 4. The medical and research experts treating obesity now understand it is definitely a more complicated issue than balancing ‘calories in’ with ‘calories out.’ 5. If a state like North Carolina charged a one cent tax on sugar sweetened drinks, they could raise 400 MILLION DOLLARS in one year! 6. Visits to registered dietitians are covered by the Affordable Care Act. 7. Employers can ‘opt out’ of covering obesity medications. I don’t think this option exists for blood pressure meds, do you?? 8. One of the hormones in our gut actually raises H. E. double toothpick when we lose weight through dieting. It sets off bells and whistles begging us to eat! 9. Up to 70% of patients have copper deficiency pre-op and it’s usually due to taking zinc supplements! 10. More and more providers are adding obesity medications to their therapy regimen for WLS patients ‘stuck’ in their weight loss efforts.

Here are just a few fascinating facts from the world's leading obesity researchers, scientists and surgeons gathered in NOLA for ObesityWeek2016: 1. There are 3 centers in the brain driving the ‘eat’ or ‘not to eat’ decision: the ‘I’m so hungry I would steal candy from a child’ drive, the ‘Ben and Jerry’s will make this sucky day, better’ drive and the ‘Oh, that cinnamon bun is so crazy gooey I need to eat one NOW’ drive. 2. The good news? Researchers have discovered that our hormone, Oxytocin or the ‘Love Hormone’ helps reduce our impulse to eat AND reduces calorie intake by rewiring the reward center in our brain. Only problem? It doesn’t last long in the bloodstream before breaking down. But researchers will try to make something similar. 3. People struggling with obesity are STILL being treated horribly by some healthcare providers. One study shows providers across the globe associate obesity with poor hygiene and dishonesty!?? 4. The medical and research experts treating obesity now understand it is definitely a more complicated issue than balancing ‘calories in’ with ‘calories out.’ 5. If a state like North Carolina charged a one cent tax on sugar sweetened drinks, they could raise 400 MILLION DOLLARS in one year! 6. Visits to registered dietitians are covered by the Affordable Care Act. 7. Employers can ‘opt out’ of covering obesity medications. I don’t think this option exists for blood pressure meds, do you?? 8. One of the hormones in our gut actually raises H. E. double toothpick when we lose weight through dieting. It sets off bells and whistles begging us to eat! 9. Up to 70% of patients have copper deficiency pre-op and it’s usually due to taking zinc supplements! 10. More and more providers are adding obesity medications to their therapy regimen for WLS patients ‘stuck’ in their weight loss efforts.

The best minds in obesity research and medicine have convened to share their newest ideas and advances. Bariatric dietitian Elizabeth Anderson gives us a peek at some of the highlights. The official opening ceremony for the 5th annual Obesity Week started first thing this morning in beautiful downtown New Orleans. More than 4900 obesity surgeons, researchers, clinicians and policymakers gathered from 53 countries for this epic scientific meeting. Keynote speaker Dr. Sadaf Farooqi delighted the huge audience by sharing a shocking one on one exchange she had with Queen Elizabeth's husband Prince Phillip. Let's put it this way--his understanding of the disease of obesity is horrifyingly ignorant. Dr . Farooqi's main address covered her landmark work in understanding the pivotal role the hormone leptin plays in hunger, weight and satiety. Other highlights of the day included big wig researcher, author and policy shaper, Dr. Kelly Brownell from Stanford University. Brownell discussed how "strategic science" or strategic studies allow scientists to use their research results to actually improve our quality of life instead of merely being showcased in obscure science journals. Also today we heard from patients that we still have a long way to go in eliminating weight bias in and among healthcare providers. Encouraging news from healthcare giant Kaiser Permanente however. Dr. Trina Histon shared that KP has totally overhauled their physical facilities to ensure a safe and respectful experience for patients of all sizes. One of the most exciting pieces of this year's meeting is the encouraging results and promise for many of the obesity meds on the market. There is a positive shift in attitude about the role this line of treatment can offer patients with obesity. More tomorrow, stay tuned!

The official opening ceremony for the 5th annual Obesity Week started first thing this morning in beautiful downtown New Orleans. More than 4900 obesity surgeons, researchers, clinicians and policymakers gathered from 53 countries for this epic scientific meeting. Keynote speaker Dr. Sadaf Farooqi delighted the huge audience by sharing a shocking one on one exchange she had with Queen Elizabeth's husband Prince Phillip. Let's put it this way--his understanding of the disease of obesity is horrifyingly ignorant. Dr . Farooqi's main address covered her landmark work in understanding the pivotal role the hormone leptin plays in hunger, weight and satiety. Other highlights of the day included big wig researcher, author and policy shaper, Dr. Kelly Brownell from Stanford University. Brownell discussed how "strategic science" or strategic studies allow scientists to use their research results to actually improve our quality of life instead of merely being showcased in obscure science journals. Also today we heard from patients that we still have a long way to go in eliminating weight bias in and among healthcare providers. Encouraging news from healthcare giant Kaiser Permanente however. Dr. Trina Histon shared that KP has totally overhauled their physical facilities to ensure a safe and respectful experience for patients of all sizes. One of the most exciting pieces of this year's meeting is the encouraging results and promise for many of the obesity meds on the market. There is a positive shift in attitude about the role this line of treatment can offer patients with obesity. More tomorrow, stay tuned!

Hi there! There are a lot of strong opinions about this issue but scientifically, no hard facts. I tell my clients, you are the expert on YOU so...what will work best for you? Will a little sweetener from all fruit preserves trigger you or, be just enough to satisfy you? If a little Splenda or Truvia helps right now, that's okay. Experiment as time goes on and see what works in your life. The trickiest thing is the normalcy you mentioned. What is normal? Be sure and check in with yourself and ask if the normal life you want to return to is the one that you wanted to leave when you decided to have surgery.

Bariatric Dietitian Elizabeth Anderson didn't exactly love school but she has an odd fondness for it now as September approaches and she's had a great deal of quality time with her teenager! Find out what she learned in all those nutrition science classes as she answers some common WLS questions in Protein 101. Which foods have protein? Protein is found in meat, fish and chicken. For vegetarians and those less keen on meat, there’s protein in cottage cheese, eggs, Greek yogurt, tofu, cheese sticks all the beans you might put in chili—except green beans. There’s also protein in meat alternatives like products from Morningstar Farms and Boca. You can usually find these products in the frozen food section. Protein amounts vary so check the labels. How much protein do I need? I tell my clients aim for 60-80 grams per day. Anyone with kidney issues might need to be much lower so it’s important to work with a dietitian specializing in bariatrics and kidney disease to get the protein prescription right for you. Can you get too much protein? If you’re drinking more than a two protein drinks per day along with multiple servings of protein, it’s easy to get up to 90 grams per day or more. There IS such a thing as too much protein and greater than 95-100 grams per day is starting to push healthy levels. p.s. Did you know the body simply cannot absorb more than 30 grams of protein per meal? If any of your protein drinks or bars are promising more than this per serving, don’t be fooled into thinking you are giving your body that full amount. Is protein really that important, anyway? Oh yes my friends, it is. Here’s why. Your body needs protein for its daily operations—cell building, transportation and repair work-- just to name a few. If you don’t feed it enough protein it will use the protein it has in storage (your muscles!!!) while stopping all fat burning activity. It does this because it senses that this is a crisis situation and perhaps a famine is ahead. Any body fat on hand has become more precious than a winning Powerball ticket and will be protected appropriately. It’s a common myth that after WLS you can eat whatever you want because you can’t ‘overeat.’ My advice? For optimal weight loss, that you can sustain, pull a Goldilocks and strive to get the amount that’s not too low and not too high but just right.

Thank you for your reply. Please note, as a healthcare professional and registered dietitian, it wouldn't be ethical for me to post articles based on arbitrary or anecdotal evidence.

Miraculous metabolism? Great genes? How DO some people enjoy the buffet without gaining weight? Bariatric Dietitian Elizabeth Anderson shares tips from food psychologist and best-selling author, Dr. Brian Wansink and the accidental weight watchers at the buffet. Now here is a researcher I like. He’s down to earth, funny, non-judgmental and driven to understand what we eat and why. I recently saw Dr. Brian Wansink speak at the Obesity Action Coalition’s Your Weight Matters 2016 annual convention. Wansink is Professor and Director of the Cornell University Food and Brand Lab. He’s also the author of the books Mindless Eating and Slim by Design. Wansink describes his work at the lab this way: “Using new tools of behavioral science, we invent healthy eating solutions for consumers, companies, and communities. We invent, redesign, and empower.” Wansink tells great stories about his unique research and I wanted to share one that I thought you might find interesting. Wansink and his team of researchers were curious how people with ‘normal’ BMIs could frequent all you can eat buffets and not gain weight. First, he flat-out asked them, “What’s your secret?” Know what? They honestly didn’t know what they did differently, at all. Wansink decided to set up cameras and monitor the behaviors of the slim diners at the buffet as well as what people with obesity did. Every. Single. Thing. After hours and hours of video recording and analysis, Wansink came up with a list of 8 differences between the groups. The slim diners… 1. Sat an average of 16 ft. away from the salad bar. 2. Sat with their backs to the buffet. 3. Used chopsticks instead of silverware. 4. Put their napkins in their laps. 5. Chewed their food more times. 6. Sat at booths, not tables. 7. Scouted the buffet completely before putting anything on their plates. 8. Used smaller plates. I think one of the coolest things about this list of behaviors is that the ‘healthy’ weight people unknowingly limited their exposure to food, chose their food with careful consideration and didn’t rush the experience. Wansink told us the owner of a large chain of buffet restaurants employed some of the slim diners’ habits to subtly influence his customers to eat less. Thus, increase his profit margin. After just a year, the restauranteur had saved tens of thousands of dollars. My take-away from Dr. Wansink’s talk is that the food and foodservice industries use science to influence our buying and eating habits. Usually, without our knowledge. Wansink’s work changes that. It does empower us to be more mindful of the many influences on our food environment and make deliberate choices in light of that. Until next time, I’ll see you at the buffet, look for me in the booth in the back. J

Bariatric Dietitian Elizabeth Anderson is no stranger to the faux-pas. She's put her foot in her mouth on more than one occasion. In her unending quest for improvement, she may have found a solution for navigating the thin line between compliments and criticism. Lara loves it when people comment on her weight loss. She’s 6 months out from surgery and she’s on top of the world. She admits she gets a little ‘high’ from the positive attention of family, coworkers and even strangers. If someone doesn’t mention her new look, she feels a little irritated. Why haven’t they noticed?? Melissa wishes you would mind your own freakin’ business. She’s three months out from surgery. She considers her weight loss private and wishes everyone would just stop making a fuss over it; it’s embarrassing. For Melissa, it really boils down to this: did she really look so awful BEFORE surgery? Where do you fall on the spectrum? I’ll bet there are as many different preferences here as there are people who’ve had WLS. As a provider, this is a dilemma. Obviously rapid and dramatic weight loss is hard to ignore. My natural inclination is to gush and hug. But the ‘Melissas’ out there do not want my hero-confetti parade. Recently, I learned about a new strategy for this conundrum-- thanks to the experts the 13th annual Bariatric Summit in Nashville. One of the psychologists who’s also a dietitian suggested we all ditch the ‘You look GREAT!’ greeting for our WLS clients. Why? Because it can lead some people to feel their value/worth/success is rooted in their appearance and weight. Looking slim? You’ll surely be regaled with, “Fabulous!” and “You look awesome!” But what if you’ve regained some weight? Are you suddenly less interesting? A failure? Invisible? And what if people perceive the comment like Melissa, as sort of a velvet hammer or thinly veiled insult, “Thank God she finally did something about her weight.” I’m not new to this planet people; I know what you’re saying. Yes, our society does put the focus on external appearance. I’m just declaring that I’m joining the movement recognizing the remarkable human inside the body. And here’s another good reason to hit the pause button on our mouths. Ever been congratulated on a pregnancy that is in essence a poor fitting garment? I have. While it’s awkward and painful there’s another side to that coin. Think of all the folks among us--in your own town, that’ve lost a noticeable amount of weight because they’re undergoing chemo or just lost a parent or spouse? I'm pretty sure they don't want to be told how fantastic they look. So from here on out, when I see a client for the first time in a few months, I’m going to greet them and take in their energy vibe. If they’re glowing, I’ll remark that it looks like things are going well and ask if I’m on target. If they seem down, I’ll remind them how smart they are to stay in touch with a loving support system through the highs and lows after surgery. I invite you to join me. After all, we’re simply acknowledging what we already know-- our appearance is only the gift wrapping our (presents!) brings to the universe.

Lara loves it when people comment on her weight loss. She’s 6 months out from surgery and she’s on top of the world. She admits she gets a little ‘high’ from the positive attention of family, coworkers and even strangers. If someone doesn’t mention her new look, she feels a little irritated. Why haven’t they noticed?? Melissa wishes you would mind your own freakin’ business. She’s three months out from surgery. She considers her weight loss private and wishes everyone would just stop making a fuss over it; it’s embarrassing. For Melissa, it really boils down to this: did she really look so awful BEFORE surgery? Where do you fall on the spectrum? I’ll bet there are as many different preferences here as there are people who’ve had WLS. As a provider, this is a dilemma. Obviously rapid and dramatic weight loss is hard to ignore. My natural inclination is to gush and hug. But the ‘Melissas’ out there do not want my hero-confetti parade. Recently, I learned about a new strategy for this conundrum-- thanks to the experts the 13th annual Bariatric Summit in Nashville. One of the psychologists who’s also a dietitian suggested we all ditch the ‘You look GREAT!’ greeting for our WLS clients. Why? Because it can lead some people to feel their value/worth/success is rooted in their appearance and weight. Looking slim? You’ll surely be regaled with, “Fabulous!” and “You look awesome!” But what if you’ve regained some weight? Are you suddenly less interesting? A failure? Invisible? And what if people perceive the comment like Melissa, as sort of a velvet hammer or thinly veiled insult, “Thank God she finally did something about her weight.” I’m not new to this planet people; I know what you’re saying. Yes, our society does put the focus on external appearance. I’m just declaring that I’m joining the movement recognizing the remarkable human inside the body. And here’s another good reason to hit the pause button on our mouths. Ever been congratulated on a pregnancy that is in essence a poor fitting garment? I have. While it’s awkward and painful there’s another side to that coin. Think of all the folks among us--in your own town, that’ve lost a noticeable amount of weight because they’re undergoing chemo or just lost a parent or spouse? I'm pretty sure they don't want to be told how fantastic they look. So from here on out, when I see a client for the first time in a few months, I’m going to greet them and take in their energy vibe. If they’re glowing, I’ll remark that it looks like things are going well and ask if I’m on target. If they seem down, I’ll remind them how smart they are to stay in touch with a loving support system through the highs and lows after surgery. I invite you to join me. After all, we’re simply acknowledging what we already know-- our appearance is only the gift wrapping our (presents!) brings to the universe.

Coffee confusion abounds. Some surgeons say, "Sure." Others say, "Never!" And the forums? As many opinions as there are people. Bariatric Dietitian Elizabeth Anderson sets us straight with science. "Elizabeth, regular coffee after surgery or decaf for life? Let's keep this simple. If you can drink a cup of regular coffee every day without trouble, go for it. This isn't my opinion folks and that's why it's so magically delicious. There is a ground-swell movement among bariatric dietitians to fact-check some of the standard nutrition no-no's we've been sharing with clients. If there's no science to back up the recommendation, we're not going to keep promoting it. The latest worn-out bariatric rules without evidence? No straws, no gum, no soda. Today I'm dispelling the no coffee/caffeine rule. A recent review of the scientific literature reveals no evidence supporting the avoidance of caffeinated drinks to prevent dehydration or stomach lining damage. “Here I come quad espresso over ice???” Whoa, Nelly. Sane caffeine consumption after WLS means: 1. waiting six weeks post op or until you are fully healed from surgery 2. aiming to limit regular coffee to one cup per day 3. groping with the painful truth that a medium pumpkin spice latte with whip = 420 calories Dietitians are working hard to create nutrition plans individually based on client’s unique needs and wants. The next time you hear one of those bariatric no no’s, ask the provider if the current science is still robustly supporting that recommendation. It might take them aback a bit but a good provider will thank you for your smart thoughtfulness and self-advocacy.