Jean McMillan

We spend so many eager, anxious moments planning for surgery. We trudge through dozens of obligatory pre-op tests, evaluations, and diets. We research and ask questions until our heads could burst. Surgery day comes closer, but at the infuriatingly slow speed of cold molasses going uphill on a snowy winter day. Then suddenly the big day looms. It’s tomorrow! Are you ready? Do you even have a list of last-minute things to do before you leave for the hospital or surgery center? Have you packed your bag yet? Your surgery is tomorrow! Are you ready? Do you have a list of last-minute things to do before you leave for the hospital or surgery center? Have you packed your bag yet? What to Take to the Hospital or Surgery Center This isn't like packing for a two-week vacation. Most hospitals prefer that you bring a minimum of belongings with you and don't want to be responsible for keeping track of them. You'll need less than you'd think. The hospital will want you to wear their gown instead of your own nightgown or pajamas, and you can wear an extra hospital gown backwards to use as a robe so you won't moon anyone when you're roaming the hallways. If you're allowed to shower while you're there (you may not be), they'll provide soap and shampoo. If your feet get cold, the nurses will give you very attractive one-size-fits-few socks with non-slip soles. Here's what I suggest you bring: Insurance ID card Photo ID A copy of your advance health care directive CPAP machine (if you use one) A list of your medications (you may be instructed to bring the actual meds with you) Lip gloss (your mouth & lips will be very dry) Toothbrush, toothpaste and essential toiletries Cosmetics (if you must) IPod or MP3 player Laptop computer (if you must) Something to read (magazines, books, Bible) Loose-fitting clothing (elastic waist) A change of underwear Slip-on shoes or sandals Pillow(s) for the ride home A water bottle for the ride home Bring your cell phone if you like, but some hospitals don't allow use of cell phones on the premises because of possible interference with patient monitoring equipment. Do not bring cash or valuables. The medical staff is there to take care of you, not your engagement ring. Last Minute Things to Do 1. Have someone take Before photos of you (front, back, and side views). 2. Take your body measurements (neck, bust, waist, abdomen, thighs, calves, ankles, upper arms, wrists). 3. Set aside a pre-op outfit of fat clothes to preserve for posterity. 4. Put clean sheets on your bed. 5. Do laundry. 6. Clean your house. 7. Arrange for transportation to and from the hospital. 8. Arrange for child care. 9. Arrange for pet care. 10. Pay your bills. 11. Fill your prescriptions (your usual meds, plus pain-killers, anti-nausea meds and/or blood thinners for after surgery if your surgeon’s willing to prescribe them in advance). 12. Pack your bag for the hospital. 13. Complete & submit any forms your employer requires for your time off from work. 14. Pick up books to read and videos to watch while you recover. 15. Make sure there's easy-to-prepare food in the house for your family to eat. 16. Do your bowel prep if required (laxatives or enema). 17. Check your supplies: § The liquids you'll be allowed to drink in the first week § A blender or Magic Bullet® § Liquid Tylenol § Thermometer § Gas-X® § A heating pad § An ice pack (or a bag of frozen vegetables) § Witch hazel or anti-itch gel (to put on the skin around your itchy incisions, but not directly on the incisions) § Reading material, puzzles, games 18. Remove nail polish (if you wear it) from fingers and toes. 19. Remove all jewelry (including piercings) and put it in a safe place[1]. 20. Bathe with Hibiclens (or other antibacterial cleanser) as instructed by your surgeon. Almost without exception, bandsters’ response to this is that every item on the list is a good idea except items 1 and 2. Some also whine about items 17 and 18, but I’m not interested in hearing what dreadful thing will happen to you if you must undergo surgery while completely unconscious and denuded of your nose stud and blue fingernail polish. Save it for the pre-op nursing staff. I just want to reinforce items 1, 2 and 3. You may hate the camera and the measuring tape with a passion, but some day you’re going to be glad you have those pre-op photos and measurements. Similarly, you may plan to burn that fat outfit in a celebratory bonfire soon, but one day you’ll be glad you saved it. When your bathroom scale is stuck at on a number you hate, comparing your “now” photos, measurements, and clothing to those awful “befores” will remind you of just how far you’ve come, and give you a little push forward on the bandwagon trail. [1] This is not negotiable. I once had my wedding ring cut off by a nurse before she would transport me to the operating room.

10 years ago, I wore size 22-24. Summer has arrived in TN (where it will last at least until Thanksgiving), and today I bought shorts in size 2. First I tried on size 4 and was puzzled to find them a little...loose...what, loose?!?! Then I tried on size 2, and they fit perfectly. I've been thrilled with every pound lost, every inch lost, every size lost during my WLS journey, but never, ever did I dream I'd wear a size 2.

I was banded on 9/19/07. A red-letter day. Since then I've had ups and downs on the scale and in medical issues, but I've never regretted having WLS. It turned my life - and my head - around. Except that... After about a year of stable weight, I've been alarmed at gaining 5 pounds in the past month. That is such a puny number compared to my weight gains in the past that I'm embarrassed to admit it, but just 5 pounds freaks me out. It makes me want to smash my scale with a sledge hammer, if only I could find one. And perhaps that lack is a good thing. Knowing me, I'd smash my scale, my foot, and the porcelain tile in the bathroom, at a high cost all 'round. I've logged my food to test my calorie intake, and can't find an explanation there. It's possible that high sodium intake contributes to this, but I'm here to tell ya: my XS-capacity bladder gives me frequent and vivid messages quite soon after sodium indiscretion. So of course, with the weight gain/loss/gain/loss history I bear, I'm in a panic. Until today, when my XS bladder sent me to the loo for the 40th time in 4 hours (perhaps a small exaggeration) and I suddenly realized that (sorry if this is TMI) I'd pulled down my size 4 pants without unzipping them. Again. I raced into my closet to check the size tags on the pants hanging there, and they were size 4's. Yes, this has happened before. I report it now because (of course) I want your sympathy but also because the public declaration reminds me that this is, as I've said so, so many times, a lifetime journey. Jean

Yikes. Dealing with a medical "train wreck" like yours would put anyone off course. I'm so glad to hear that your health is now improved enough to allow you to concentrate on working that band of yours. Just understanding that your band alone can't do it all gives you an advantage. And as far as I'm concerned, exercise is super medicine. It not only helps me burn calories and stay fit and healthy, it's better than any psychiatric med I've ever taken for improving my mental health and outlook! And since I exercise with a group of women, it's a great social thing.

FIT AND WELL-NOURISHED. Can't get much better than that! At the end of the visit the last time I saw my internist (routine checkup), he said, "You're doing a wonderful job of taking care of yourself." That short sentence is solid gold to me.

Are you glad or sad about what’s tucked away inside your clothes closet? Today is Saturday, a day off for some of us, and a good day for peeking at the hidden trash and treasures. Let’s have a look in mine… My clothes closet is hidden deep within the house. It’s a very small interior room, the one where we’d hide if a tornado came our way. I’m glad to have it, but for most of the time we’ve lived in this house, that closet has not been a place I enjoyed visiting. The not-so-secret evidence of obesity was hidden there – 10 sizes of clothing (from 24 on down) in “slimming” styles and colors – souvenirs of my many trips up and down the scale. But unless you’re expecting a tornado, the closet is a lousy place to live. Let’s open the door, let the light shine in, and ask ourselves the $64 million dollar question: WHY ARE WE HANGING ON TO ALL THIS STUFF? Let’s grab a jumbo trash bag and get busy working on a Goodwill donation or a batch of goodies for the local consignment store. What, do I hear groaning? The short fat girl who dwells inside me whines, “But we might need them again someday!” LET ‘EM GO! The other day, I cleaned out my clothes closet. I had done that before, about 6 months into my WLS journey, with great difficulty. I was fond of some of those outfits even though they could work as window drapery as well as clothing. I had spent a lot of money on my work wardrobe, to say nothing of the shoes. I feared that the instant those clothes were gone, I’d gain 50 or 75 or 100 pounds and need them all again. I had little faith that my post-op weight loss would be any more lasting than my weight loss had been in previous dieting attempts. Eventually I acquired enough new-to-me, smaller-size clothing that the closet was about to explode, so I made myself cull out the big stuff and haul it off to the Goodwill Store. Getting rid of it turned out to be a relief, and then of course I had the fun of filling up the closet with more clothes in smaller sizes. Back to the Goodwill Store I went...again and again. In the 8 years following my WLS, I’ve dealt with some unexpected medical problems that led to band removal and a sleeve revision. While all that went on (and on, and on), I regained 30-35 pounds, and sizes 12 and 14 appeared in my closet again, followed all too closely by a few size 16’s. Eventually I lost that weight regain. When seasons changed and I hunted for something warm or cool to wear, I was delighted to find that most of that clothing was too big. I had nothing to wear! That’s what I call a First World problem, something foolish to complain about when so many Third World people have little or no food, clothing or shelter. But…there’s no denying that morbid obesity is also serious problem, so I can’t bring myself to downplay my weight loss success. The weird part of this is that saying goodbye to the big stuff wasn’t as easy as I thought it would be. You’d think that weeding out mountains of Goodwill donations would be a festive occasion, but my inner fat girl begged, “OK, get rid of the 14’s if you must, but please, please keep the 12’s! You never know!” I’m happy to report that I managed to ignore her. In the past 4 years I’ve waved goodbye to the big sizes and welcomed back the small sizes. No, we never know for sure what’s going to happen in the future, what unexpected event will drive our weight back up or our weight management commitment back down. But we don’t need to see constant reminders of past failure, and we shouldn’t give space in our closets or our minds to the negative stuff that weighs us down and slows our forward footsteps. So, whoever you are, whatever surgical procedure you had or will have, whatever your weight or clothing size is today, I challenge you to clean out your closet. Look at every single garment in there and ask yourself: does this fit my body now? does this fit my lifestyle now? is this required by law (state, federal, religious, or employer)? does this make me look and feel great? Any garment that gets 2 or more “No” answers goes in the Goodbye Pile. Simple enough, isn’t it? No, it’s not easy. I go through this at every change of season and probably always will, because my inner fat girl will never forget what pre-op life was like. The only residents of my closet are one fat girl outfit (that I drag out and try on when I’m having a fat day) and way too many adorable size 4/XS outfits. Spring is (I pray) just around the corner here in Tennessee, so I’ve been trying on my warm weather clothing and cheerfully telling the rejects, “Goodbye!”

I did something similar. I bought a beautiful skirt that was about 2 sizes too small, hoping that one day I could wear it. Sort of a motivation garment. Every time I saw it in my closet I was reminded of the future's "maybe". When I could finally wear it, I felt like a million bucks every time I put it on. The sad part is that eventually it became too big for me...or should I say I became too small for it...

Amen to that! One of the nicest compliments I got when I'd lost 30-40 lbs was, "I the outfit you have on. It fits!" The American Cancer Society has long understood the relationship between looking good and feeling good. They have a program called "Look Good, Feel Better" that partners with Cosmetologists and provides spa days and other services for women with cancer. I know I definitely feel much better about myself when I take the time to do my hair and makeup and accessorize on weekends and days I work from home. It's a challenge during weight loss, but I'm determined to wear clothes that fit now. I've been lost in shapeless knits and elastic waistbands for too long, and I'm ready to look as good on the outside as I know I'm going to feel on the inside. I know constantly buying clothes can get expensive, but this is a peeve of mine. As people lose weight, I feel it's SO IMPORTANT to wear clothes that fit your ever shrinking body! Not only does it just make you look more put together, it makes you FEEL more put together, thus encouraging continuing positive behaviors that got you there! Even if it's just a few nicer pieces you can mix and match until you have to buy the next size down. We lived our lives being frumpy and wearing over sized, ill fitting clothes to hide our bodies. Why continue to do that as we get smaller? We need to flaunt our confidence and success to the world!

Shoes! I'd forgotten about shoes! Pre-op I wore size 8-8.5. Now I wear size 6.5-7. Too bad shoes are expensive. And I'm bit uncomfortable with wearing anything from Goodwill that can't be washed before I put it on. You're smart to start to envision your future now. Health, lifestyle, relationships...so many things change as your weight goes down. And I'm glad to encounter someone who realizes the importance of taking good care of your appearance no matter what your body size. I think it's a sign of strength and good health (mental and physical). As a pre-op, I would tear off my work clothes the instant I came home (well, not that very instant...as soon as I got to the bedroom) and put on something from the loose, bland, I-don't-care-about-me, please-don't-stare-at-me wardrobe in my closet. You didn't have to ask me how I felt back then - you could see it in one glance.

My clothes closet is hidden deep within the house. It’s a very small interior room, the one where we’d hide if a tornado came our way. I’m glad to have it, but for most of the time we’ve lived in this house, that closet has not been a place I enjoyed visiting. The not-so-secret evidence of obesity was hidden there – 10 sizes of clothing (from 24 on down) in “slimming” styles and colors – souvenirs of my many trips up and down the scale. But unless you’re expecting a tornado, the closet is a lousy place to live. Let’s open the door, let the light shine in, and ask ourselves the $64 million dollar question: WHY ARE WE HANGING ON TO ALL THIS STUFF? Let’s grab a jumbo trash bag and get busy working on a Goodwill donation or a batch of goodies for the local consignment store. What, do I hear groaning? The short fat girl who dwells inside me whines, “But we might need them again someday!” LET ‘EM GO! The other day, I cleaned out my clothes closet. I had done that before, about 6 months into my WLS journey, with great difficulty. I was fond of some of those outfits even though they could work as window drapery as well as clothing. I had spent a lot of money on my work wardrobe, to say nothing of the shoes. I feared that the instant those clothes were gone, I’d gain 50 or 75 or 100 pounds and need them all again. I had little faith that my post-op weight loss would be any more lasting than my weight loss had been in previous dieting attempts. Eventually I acquired enough new-to-me, smaller-size clothing that the closet was about to explode, so I made myself cull out the big stuff and haul it off to the Goodwill Store. Getting rid of it turned out to be a relief, and then of course I had the fun of filling up the closet with more clothes in smaller sizes. Back to the Goodwill Store I went...again and again. In the 8 years following my WLS, I’ve dealt with some unexpected medical problems that led to band removal and a sleeve revision. While all that went on (and on, and on), I regained 30-35 pounds, and sizes 12 and 14 appeared in my closet again, followed all too closely by a few size 16’s. Eventually I lost that weight regain. When seasons changed and I hunted for something warm or cool to wear, I was delighted to find that most of that clothing was too big. I had nothing to wear! That’s what I call a First World problem, something foolish to complain about when so many Third World people have little or no food, clothing or shelter. But…there’s no denying that morbid obesity is also serious problem, so I can’t bring myself to downplay my weight loss success. The weird part of this is that saying goodbye to the big stuff wasn’t as easy as I thought it would be. You’d think that weeding out mountains of Goodwill donations would be a festive occasion, but my inner fat girl begged, “OK, get rid of the 14’s if you must, but please, please keep the 12’s! You never know!” I’m happy to report that I managed to ignore her. In the past 4 years I’ve waved goodbye to the big sizes and welcomed back the small sizes. No, we never know for sure what’s going to happen in the future, what unexpected event will drive our weight back up or our weight management commitment back down. But we don’t need to see constant reminders of past failure, and we shouldn’t give space in our closets or our minds to the negative stuff that weighs us down and slows our forward footsteps. So, whoever you are, whatever surgical procedure you had or will have, whatever your weight or clothing size is today, I challenge you to clean out your closet. Look at every single garment in there and ask yourself: does this fit my body now? does this fit my lifestyle now? is this required by law (state, federal, religious, or employer)? does this make me look and feel great? Any garment that gets 2 or more “No” answers goes in the Goodbye Pile. Simple enough, isn’t it? No, it’s not easy. I go through this at every change of season and probably always will, because my inner fat girl will never forget what pre-op life was like. The only residents of my closet are one fat girl outfit (that I drag out and try on when I’m having a fat day) and way too many adorable size 4/XS outfits. Spring is (I pray) just around the corner here in Tennessee, so I’ve been trying on my warm weather clothing and cheerfully telling the rejects, “Goodbye!”

If the key to weight loss success is self-esteem, and you’ve got none stashed in the pantry where you used to keep cookies and potato chips, where do you go to find some? HOW WE GOT HERE In Part 1 of this article, I introduced the idea that positive self-esteem is the key to weight loss success. In Part 2, I’ll talk about why so many obese people have a negative self-esteem Now let’s have a quick look at how we came to be such sorry specimens. Any psychologist or sociologist will tell you that some of the most troubling factors contributing to low or negative self-esteem (on the levels of individual people as well as the aggregate of citizens called American society) are a person’s physical appearance, weight, intelligence and peer pressure. Very often all four of those factors are tightly intertwined. In an elementary school cafeteria, Jane, an obese girl with a tray piled high with food winces at her classmates’ teasing. Unable to find a friendly place to eat her lunch, she sits down alone and cries at the sound of other kids’ voices: “Fatso!” One of the school bullies shoves Jane’s lunch onto the floor and laughs, “You didn’t need that food, Fatty!” Jane heads to the lavatory to cry in private. She hides in a stall and hears the popular girls chanting, “Fatty Fatty, two by four, can’t fit through the bathroom door!” I’m sure you’ve guessed by now that Jane’s name is actually spelled Jean, and that the school cafeteria scene above lives in my distant memory. Even when I don’t consciously think about that unhappy incident, it and many others like it formed my beliefs and feelings about myself a long, long time ago. Sometimes I feel that I’ll never get them all weeded out of me. In my case, that ancient stew of negative self-esteem flavored my life with some miserable symptoms: hypersensitivity to criticism, perfectionism, guilt, shame, irritability, a defensive attitude, a sense of defeat and insignificance, and a persistent, low-grade “fever” of dissatisfaction with myself, my life, and everybody else. And yet, despite all that, at age 62 I can call myself a success, not just at weight management but at a host of other things. No, car repair is not one of those things, but on the whole I’m doing pretty well. I have my husband, my friends, and my own determination to thank for that. If I can turn myself around, you can do the same for you. Low self-esteem is not something that gets fixed overnight, and having bariatric surgery is not the cure. Choosing surgery is a wonderful first step, but it’s not the end of the journey. So please, be kind to yourself! I’m not talking kind in the sense of indulgence but in the sense of a loving caretaker who understands that you’re weak and believes that one day you’ll be strong. WHERE ARE WE GOING NEXT? Psychologists say that self-esteem is linked to a sense of competence – the awareness that you have the knowledge, skills, and resources needed to accomplish a task. It’s unlikely that you’re going to start your weight loss journey with a strong sense of competence regarding weight loss. In fact, it’s quite likely that your self-esteem in that area is torn down and tattered from all the diet and weight battles you’ve fought and lost in the past. No matter how much information you’ve gained from your pre-op education, you don’t yet have a history of weight loss success to buoy you along. So how do you even begin to feel good about your ability to make the lifestyle changes required for weight loss - make good food choices, control portions, take tiny bites, avoid grazing and so on? I’ll adapt the take tiny bites strategy to this effort. You tackle the weight loss project one tiny bite at a time. You repeat the effective actions of making good food choices, controlling portions, taking tiny bites and avoiding grazing over and over again until you’ve learned how to do it with less effort and more enjoyment. You seek and acquire the knowledge, skills and resources to help you succeed. You seek assistance from your surgeon, your support group, your family and friends. All this work may never become fun for you, but in my case, weight loss made it all worthwhile. TODAY’S WEIGHT LOSS SUCCESS FORECAST IS… Does the importance of positive self-esteem mean that you’re doomed to failure if your self-esteem isn’t already strong on the day of your bariatric surgery? Certainly not. If you take on the challenge of a weight loss winner’s lifestyle one tiny bite at a time, your WLS journey can actually help you increase your overall self-esteem while decreasing your weight. Each step you take, each new behavior, each pound you lose, will prove to you how capable and worthy you truly are. From time to time, you may have to ignore or silence the voice of self-doubt. I like the way my friend Lisa counsels self-doubters. She says, simply and firmly, “You can do this.” So when your inner Doubting Thomas (or Thomasina) whispers (or shouts), “Forget it! No way! Lost cause!” take a deep breath and tell her “I can do this. I will do this.” Eventually you’ll turn your eating behavior around, reach your weight loss goal, and finally feel proud of what you’ve accomplished.

HOW WE GOT HERE In Part 1 of this article, I introduced the idea that positive self-esteem is the key to weight loss success. In Part 2, I’ll talk about why so many obese people have a negative self-esteem Now let’s have a quick look at how we came to be such sorry specimens. Any psychologist or sociologist will tell you that some of the most troubling factors contributing to low or negative self-esteem (on the levels of individual people as well as the aggregate of citizens called American society) are a person’s physical appearance, weight, intelligence and peer pressure. Very often all four of those factors are tightly intertwined. In an elementary school cafeteria, Jane, an obese girl with a tray piled high with food winces at her classmates’ teasing. Unable to find a friendly place to eat her lunch, she sits down alone and cries at the sound of other kids’ voices: “Fatso!” One of the school bullies shoves Jane’s lunch onto the floor and laughs, “You didn’t need that food, Fatty!” Jane heads to the lavatory to cry in private. She hides in a stall and hears the popular girls chanting, “Fatty Fatty, two by four, can’t fit through the bathroom door!” I’m sure you’ve guessed by now that Jane’s name is actually spelled Jean, and that the school cafeteria scene above lives in my distant memory. Even when I don’t consciously think about that unhappy incident, it and many others like it formed my beliefs and feelings about myself a long, long time ago. Sometimes I feel that I’ll never get them all weeded out of me. In my case, that ancient stew of negative self-esteem flavored my life with some miserable symptoms: hypersensitivity to criticism, perfectionism, guilt, shame, irritability, a defensive attitude, a sense of defeat and insignificance, and a persistent, low-grade “fever” of dissatisfaction with myself, my life, and everybody else. And yet, despite all that, at age 62 I can call myself a success, not just at weight management but at a host of other things. No, car repair is not one of those things, but on the whole I’m doing pretty well. I have my husband, my friends, and my own determination to thank for that. If I can turn myself around, you can do the same for you. Low self-esteem is not something that gets fixed overnight, and having bariatric surgery is not the cure. Choosing surgery is a wonderful first step, but it’s not the end of the journey. So please, be kind to yourself! I’m not talking kind in the sense of indulgence but in the sense of a loving caretaker who understands that you’re weak and believes that one day you’ll be strong. WHERE ARE WE GOING NEXT? Psychologists say that self-esteem is linked to a sense of competence – the awareness that you have the knowledge, skills, and resources needed to accomplish a task. It’s unlikely that you’re going to start your weight loss journey with a strong sense of competence regarding weight loss. In fact, it’s quite likely that your self-esteem in that area is torn down and tattered from all the diet and weight battles you’ve fought and lost in the past. No matter how much information you’ve gained from your pre-op education, you don’t yet have a history of weight loss success to buoy you along. So how do you even begin to feel good about your ability to make the lifestyle changes required for weight loss - make good food choices, control portions, take tiny bites, avoid grazing and so on? I’ll adapt the take tiny bites strategy to this effort. You tackle the weight loss project one tiny bite at a time. You repeat the effective actions of making good food choices, controlling portions, taking tiny bites and avoiding grazing over and over again until you’ve learned how to do it with less effort and more enjoyment. You seek and acquire the knowledge, skills and resources to help you succeed. You seek assistance from your surgeon, your support group, your family and friends. All this work may never become fun for you, but in my case, weight loss made it all worthwhile. TODAY’S WEIGHT LOSS SUCCESS FORECAST IS… Does the importance of positive self-esteem mean that you’re doomed to failure if your self-esteem isn’t already strong on the day of your bariatric surgery? Certainly not. If you take on the challenge of a weight loss winner’s lifestyle one tiny bite at a time, your WLS journey can actually help you increase your overall self-esteem while decreasing your weight. Each step you take, each new behavior, each pound you lose, will prove to you how capable and worthy you truly are. From time to time, you may have to ignore or silence the voice of self-doubt. I like the way my friend Lisa counsels self-doubters. She says, simply and firmly, “You can do this.” So when your inner Doubting Thomas (or Thomasina) whispers (or shouts), “Forget it! No way! Lost cause!” take a deep breath and tell her “I can do this. I will do this.” Eventually you’ll turn your eating behavior around, reach your weight loss goal, and finally feel proud of what you’ve accomplished.

The self-image of obese (or any other) people is complicated, isn't it? I've been contemplating that for years. On one hand, you have obese people who don't see themselves as obese, and apparently don't recognize the health risk that poses. On the other hand, we're living in a society that holds up "skinny" as divine, is extremely critical of the obese, and yet goes on super-sizing every meal we eat. In that setting, it's hard to keep your balance.

I have something important to tell you today about success with weight loss surgery. When you hear it, it may strike you as obvious, but I’d be willing to bet that your surgeon never mentioned it to you. Don’t begrudge him or her for that, because this particular crucial thing is something no surgeon can give you anyway. It’s something that no insurance policy covers, no pharmacy sells, and money can’t buy. You may already possess this thing in some degree, but do you have enough to ensure weight loss success? THE KEY This very important thing, the key to weight loss success, is self-esteem. Success requires positive self-esteem in a part of your life that’s never before given you a lasting good feeling about yourself: weight loss. If you were good at that, if you knew you were good at it, you probably wouldn’t need bariatric surgery in the first place. You’d already be maintaining a healthy weight, happy about that, and working on attaining goals in some other area of your life, such as qualifying for the Olympic pole-vaulting team. Self-esteem plays a role in many areas of human endeavor, and psychologists have identified it as an important predictor of relative outcomes. They believe that your level of self-esteem affects (or even predicts) the results of your efforts and activities, be they academic, athletic, professional, interpersonal, you name it. Their studies show that a person with high self-esteem (whether generalized, like “I’m a good person”, or specific, like “I’m a good tennis player”) is more likely to succeed at a given task than someone with low self-esteem. Although the Stuart Smalley School of Positive Affirmations would have you believe that chanting, “I’m good enough, I’m smart enough…” six times a day will bolster your self-esteem, it’s not quite as simple as that. While I agree that our thoughts and beliefs about ourselves have an enormous effect on our behavior, self-esteem often involves feeling rather than thinking. Let’s demonstrate how that works through 3 short interviews with Jean. Interview #1: “Jean, are you a good car mechanic?” “Heck, no.” “How do you feel about that?” “Perfectly fine.” [Translation: Jean knows she’s not a good mechanic and feels just fine about that because it’s not something that engages her emotions at all. Her self- esteem in this area is neutral.] Interview #2: “Jean, do you have a flat abdomen?” “Heck, no.” “How do you feel about that?” “Lousy. It makes me feel unattractive, I struggle to find attractive clothing to hide my belly, and I feel frustrated that none of my exercise routine seems to improve my mid-section.” [Translation: Jean knows her abdomen is not flat and feels unhappy about the way she looks and feels. Her self-esteem in this area is negative. Interview #3: “Jean, are you a good writer?” “Heck, yes.” “How do you feel about that?” “I feel wonderful about it. I love writing. It’s fun, challenging, and interesting. When I’m writing, I feel that I’m a talented and worthwhile person.” [Translation: Jean knows she is a good writer and feels happy about it. Her self- esteem in this area is positive.] The final step of this educational exercise is to look at the following list of endeavors and predict which one Jean will be most likely to succeed at. Choose one of the following: Rebuild her car’s engine. Compete in and win the swimsuit competition at a beauty pageant. Write and publish a book. Yes, you’re absolutely right. Endeavor #3 is the most promising one for Jean given the current state of her self-esteem. Not only does she enjoy writing, she has succeeded at it in the past and has plenty of confidence that she can do so again. CATCH 22 So, let’s take it as a given that positive self-esteem about weight loss is important for success with our bariatric surgery. We know objectively (through the weight on the scale in our bathroom or doctor’s office) that we’ve never enjoyed long-term success with weight loss, and we presumably feel miserable about that. It’s affecting our health, our relationships, and our careers in ways that make us unhappy enough to seek bariatric surgery. Our self-esteem in this area is negative, yet we need positive self-esteem in order to succeed. Sounds like a classic “Catch 22”, doesn’t it? But wait, it gets worse! For many people, negative self-esteem erodes not just one area (like weight management) but many areas in our lives. For some of us, negative self-esteem so pervasive that it taints every cell of our being: “I’m a bad person, and I feel bad about that.” That doesn’t mean that we’re hopeless neurotics or that our negative self-esteem is a permanent and unvarying feature in our lives. A few years ago, I had a very nasty telephone argument with someone whose company provides an important service to me. In fact, we were both nasty, and two days later I regretted that I had acted so obnoxiously. For an entire day, the balance in my self-esteem account was in the red. I’d have been struck dumb if you’d asked me to name even one good thing about me. The next day, I bought that guy a coffee and apologized to him face-to-face. Life went on and my self-esteem account balance crept back up above zero.

Perspective is a highly under-rated thing, isn't it? When I look out the window at my worktable, I can see a neighbor's barn (we live way out in the boondocks, where barns and cows are more populous than shopping malls and poodles). From here, it looks tiny, but in fact it's huge. It's just one of his barns (we're in the agri-business heartland) and he can fit several pieces of modern farm equipment in it, things that look like they just landed from Mars and are getting ready to take over the world. That's why I have to constantly supervise my own thoughts and make sure I'm reacting to real things in the appropriate degree to achieve the end I so very much desire.

THE KEY This very important thing, the key to weight loss success, is self-esteem. Success requires positive self-esteem in a part of your life that’s never before given you a lasting good feeling about yourself: weight loss. If you were good at that, if you knew you were good at it, you probably wouldn’t need bariatric surgery in the first place. You’d already be maintaining a healthy weight, happy about that, and working on attaining goals in some other area of your life, such as qualifying for the Olympic pole-vaulting team. Self-esteem plays a role in many areas of human endeavor, and psychologists have identified it as an important predictor of relative outcomes. They believe that your level of self-esteem affects (or even predicts) the results of your efforts and activities, be they academic, athletic, professional, interpersonal, you name it. Their studies show that a person with high self-esteem (whether generalized, like “I’m a good person”, or specific, like “I’m a good tennis player”) is more likely to succeed at a given task than someone with low self-esteem. Although the Stuart Smalley School of Positive Affirmations would have you believe that chanting, “I’m good enough, I’m smart enough…” six times a day will bolster your self-esteem, it’s not quite as simple as that. While I agree that our thoughts and beliefs about ourselves have an enormous effect on our behavior, self-esteem often involves feeling rather than thinking. Let’s demonstrate how that works through 3 short interviews with Jean. Interview #1: “Jean, are you a good car mechanic?” “Heck, no.” “How do you feel about that?” “Perfectly fine.” [Translation: Jean knows she’s not a good mechanic and feels just fine about that because it’s not something that engages her emotions at all. Her self- esteem in this area is neutral.] Interview #2: “Jean, do you have a flat abdomen?” “Heck, no.” “How do you feel about that?” “Lousy. It makes me feel unattractive, I struggle to find attractive clothing to hide my belly, and I feel frustrated that none of my exercise routine seems to improve my mid-section.” [Translation: Jean knows her abdomen is not flat and feels unhappy about the way she looks and feels. Her self-esteem in this area is negative. Interview #3: “Jean, are you a good writer?” “Heck, yes.” “How do you feel about that?” “I feel wonderful about it. I love writing. It’s fun, challenging, and interesting. When I’m writing, I feel that I’m a talented and worthwhile person.” [Translation: Jean knows she is a good writer and feels happy about it. Her self- esteem in this area is positive.] The final step of this educational exercise is to look at the following list of endeavors and predict which one Jean will be most likely to succeed at. Choose one of the following: Rebuild her car’s engine. Compete in and win the swimsuit competition at a beauty pageant. Write and publish a book. Yes, you’re absolutely right. Endeavor #3 is the most promising one for Jean given the current state of her self-esteem. Not only does she enjoy writing, she has succeeded at it in the past and has plenty of confidence that she can do so again. CATCH 22 So, let’s take it as a given that positive self-esteem about weight loss is important for success with our bariatric surgery. We know objectively (through the weight on the scale in our bathroom or doctor’s office) that we’ve never enjoyed long-term success with weight loss, and we presumably feel miserable about that. It’s affecting our health, our relationships, and our careers in ways that make us unhappy enough to seek bariatric surgery. Our self-esteem in this area is negative, yet we need positive self-esteem in order to succeed. Sounds like a classic “Catch 22”, doesn’t it? But wait, it gets worse! For many people, negative self-esteem erodes not just one area (like weight management) but many areas in our lives. For some of us, negative self-esteem so pervasive that it taints every cell of our being: “I’m a bad person, and I feel bad about that.” That doesn’t mean that we’re hopeless neurotics or that our negative self-esteem is a permanent and unvarying feature in our lives. A few years ago, I had a very nasty telephone argument with someone whose company provides an important service to me. In fact, we were both nasty, and two days later I regretted that I had acted so obnoxiously. For an entire day, the balance in my self-esteem account was in the red. I’d have been struck dumb if you’d asked me to name even one good thing about me. The next day, I bought that guy a coffee and apologized to him face-to-face. Life went on and my self-esteem account balance crept back up above zero.

You’re tired of your old body – the fat one that’s caused you so many problems – but are you ready to move into a new one? The idea for this article came to me in a dream. It was what I call an anxiety dream, in which I’m trying to accomplish something important but encounter obstacles everywhere I turn. That’s kind of a parable of life itself, isn’t it? When I wake from a dream like that, I feel frustrated because I didn’t get to finish my dream task, but at the same time I’m relieved to be released from the endless struggle. So in this particular dream, I was moving into a new, multi-story house, kind of like the old tenement buildings you see in dying New England mill towns. It was essential that I quickly locate and organize all my belongings so that I could use them to start an urgent and important project. Every time I carried something into another room to put it away, I would find other people there, already moving my stuff, wreaking havoc on my carefully ordered household. When I went back outside for another load of stuff, more people would be poking through it as if it was so much garbage left out to be collected and buried at the dump. These interfering people ignored my pleas to leave my things alone. For every armful I took into the house, they carried out ten. Then my husband started a load of wash in the laundry room a few feet away from the bedroom, and the sound of the washer’s spin cycle woke me up. Thank God. I trudged off to the bathroom, pondering the meaning of the dream. I haven’t moved into a house for 14 years, so why was I having a dream about moving house? As I made the bed and thought more about the dream (which didn’t want to leave my head just then), I suddenly knew what it was about. My big moving project for the past 6 years hasn’t involved moving into a new house. It’s involved moving into a new body. Like any move into the unknown, it’s been both exciting and scary. I no longer have a jumbo, custom-built pantry to hold 50+ years’ worth of bad habits and warped beliefs about myself. I keep forgetting where I’ve put things, and have sabotaged my own efforts numerous times. At times, circumstances beyond my control have put my new “home” into disarray, but I’ve kept working at it, carrying things in, bringing things out, rearranging things…a seemingly endless task. I think I’m pretty much settled now. I watch elderly people who have to work so hard to accomplish the simplest tasks – sit down, get up, button a shirt, open a jar – and remember my mom talking about the way her body had betrayed her as she aged. I suppose that could happen to me sooner or later. But for right now, I’m in a good place: my new body - the home I carry with me everywhere. As you continue on your weight loss journey, please take good care of your body. You may not like it much now, but it’s your home. Your very own home. As it changes, you will have to learn its new floor plan. When you go to a closet to fetch a size 16 dress and find only size 18’s, you may feel so disoriented that you forget the size 20, 22 & 24’s you took to the Goodwill Store last week. As you pass through the front hallway of this new home and see yourself in the mirror, the person you see might look like a complete stranger. What’s she doing there? She’s fat, I’m not, so why is her reflection all I can see? Where did this mirror come from, anyway, the funhouse at a circus? Don’t give up. One day you’ll have all the curtains hung, the walls painted, the furniture arranged, a fire burning in the fireplace, and you’ll think, “I’m so glad to be home.”

I took 2 weeks off and was bored and restless by day 3. I worked from home then (nothing physically strenuous) but if I'd been working outside my home, I probably would've longed to go home and rest after a few hours of work. And, I wasn't allowed to drive for 2 weeks - both to protect those new incisions and because I was taking a painkiller. Some very simple, basic things were a challenge for the first month or so post-op. Like getting up out of a chair, reaching to get something out of a kitchen cupboard, lifting my little pug. The other thing was that sleeping when I had all those new incisions was a challenge. I used pillows to support and/or take the weight off anything tender or sore, but I can't say I got a good night's rest until a month or so post-op.

Skin loses elasticity as we age. No way around that. I'm in a tough demographic group - I've lost 100+ lbs in the past 8 years, and now I'm 62 years old. So I have some loose skin, as every older person does. But plastic surgery is far beyond my means, and in fact, I'm in fantastic shape for someone my age and size, and I want to praise God and the Universe and fate and every other thing, little or big, for that, because it is such a huge gift. And I have to praise me, too, because I'm the one who got me into this lifelong challenge, and I'm the one who's taken on the lifelong challenge of maintenance. One of the saddest things I've read during my WLS journey was a post from a young woman who said that if weight loss left her with loose skin, she wouldn't have it at all. Maybe I'm too old to understand that...or maybe I do. It sounds like an excuse to me, something that person is clinging too because she fears that WLS won't be a quick fix for her body (and other) problems. And it won't, I guarantee. Weight loss is never, ever going to solve all your problems and make life wonderful and taste better than a million of Jenny Craig meals (no disrespect to JC). But will WLS and weight loss and the hundreds of changes connected to that make a wonderful change in your life?ABSOLUTELY! But...only if you take charge of it. And you can do it. Because if I can do it, you can. In fact, I double-dog dare you to it. And...in the double dog department, I'm pretty sure I have you beat!

Friend? I think not.

"THOU SHALT NOT?" Somewhere in the dark mists of my distance past, the term “reverse psychology” entered my awareness, especially as applied to child-rearing. The idea was that if you told your child “Please slam the door when you leave the house,” the defiant devil in that child would shut the door quietly in opposition to your instruction. I don’t have human children and never observed reverse psychology work magic in my childhood home. No matter how firmly you told my brother not to brush his teeth, his teeth went unbrushed. Telling him to jump on the bed would trigger a marathon jumping session (causing the box spring to violently part company with the bed frame) instead of a peaceful bedtime story. And I was no angel – I rewarded my mom’s laissez-faire attitude towards teen dating by involving myself with the worst losers I could find. Despite all that, I know there’s a kernel of truth in the concept of reverse psychology. If you told me I must never, ever eat chocolate again, I’d get started on a chocolate binge before you even finished your sentence. And if you told me, “Thou shalt not even think about potato chips,” my every waking and dreaming moment would be filled with potato chips. Unfortunately, this principle doesn’t work in both directions, at least not for me. If you told me, “You must eat nothing but ice cream this week,” I’d be happy to comply. I’d grab my car keys and ice cream scoop and race to the frozen foods section of the nearest supermarket (after a quick stop at Baskin Robbins). Author and eating disorder expert Geneen Roth tells a story about a mother who worried about her daughter’s weight. Even when the mom locked sweets up in a cabinet, the daughter managed to smuggle sweets into the house and hide in her bedroom to gorge on them. When the mom took Roth’s advice to give the child free access to sweets, the girl tired of them and began to make healthier food choices within a few days. This was a clear case of what I call Forbidden Food Syndrome, in which forced abstinence increases the person’s desire for the “bad” food. I don’t doubt that Roth’s advice in that case was sound, but in my personal experience, food rules aren’t the only cause of secretive food hoarding and gorging. My mom’s food rules had more to do with good manners than with nutrition. I had to take at least one bite of each food on my plate, chew with my mouth shut, ask for permission to leave the table, and dirty no dishes after supper. Other than that, I could eat whatever I wanted, in any quantity. Even with that much freedom, I would hoard and binge on sweets, alone in my room, at every opportunity. I wasn’t eating out of defiance, but neither was I eating for “good” or healthy reasons. Even at age nine, I was eating for emotional reasons – comfort, numbing, entertainment, you name it. As an adult, I have a better handle on my emotional eating than I did at age nine. I’m well aware of the food-obsessed Jeannie who will run without hesitation right into rush-hour traffic if a brownie might be waiting for me on the other side of the road. I know intimately the defiant Jeannie who insists on eating a piece of garlic bread even though she knows that the third or fourth bite could easily get stuck in her esophagus or stoma and cause a lot of discomfort. I have to monitor myself every day in order to maintain the delicate balance between choosing not to eat a piece of birthday cake because eating it doesn’t serve my weight management goals and choosing to go ahead and eat the entire cake simply because I know it doesn’t serve my weight management goals. Sometimes I feel like a freak because I have to deal with issues like this. I watch “normal” people making carefree eating choices and enjoying complete eating freedom with no awful consequences (or at least, that’s the way it looks to me), and deep down inside, I hate those normal people. They’re not yoked to this heavy burden of disordered eating like I am. It’s just not fair. But I’m gradually relaxing about my eating issues enough to be able to listen better and to hear more messages from my normal friends and acquaintances, and to realize that they too struggle with things like Forbidden Food Syndrome from time to time. I have a disgustingly healthy co-worker who told me once that she can’t eat chocolate because it gives her bad migraine headaches. She avoids chocolate, but she confessed that she wants it all the more because she can’t have it, and when she tells herself it’s OK to eat one small piece, she finds that she can’t stop – she eats three, five, seven pieces even though she knows she’ll pay for it sooner or later. She doesn’t pay with obesity, she pays with pain. She doesn’t know the pain of obesity as I do, but she and I struggled with the same basic problem. Little does she know how valuable her chocolate story is to me. It reminds me that I’m really not a freak – I just have a more intense and widespread eating problem than hers. It’s a matter of degrees. She’s five degrees off-center while I’m 45 degrees off. Neither of us is perfect. We both have to work at making good choices – not just in our eating behavior, but in every piece of behavior that could have good or bad consequences for us or for our family and friends. To my mind, this is just part of human existence, part of the responsibility that adult humans bear for maintaining a civilized and (we hope) peaceful co-existence with each other and ourselves. All this may be too philosophical for you, but I’m telling you about it because thinking about my eating problems this way has helped to put them in perspective, and putting them in perspective makes them a lot more manageable. Perspective is the art of seeing things in correct relationship to each other. As I wrote in Bandwagon, without perspective, my computer’s monitor looks ten times bigger than my neighbor’s barn across the road. In fact, my computer monitor is tiny compared to that barn. Without perspective, my weight management challenges seem enormous. I lost all that weight in just one year, but my maintenance job goes on forever. But consider the alternative. I could go back to obesity. I could have a stroke and become a human vegetable, reliant on others for everything from speech to toileting. I could lose my limbs to diabetes, reliant then on others for everything from tooth-brushing to transportation. I could suffer cardiac arrest and die at age 60. Or I can work at maintaining my weight and my health, with a huge payoff of mobility, independence, and longevity. So…back to Forbidden Food Syndrome. Although I’ve said that reverse psychology doesn’t always work with me, I must also say that one of the reasons I chose the band was that living with it would allow me to choose from a wide variety of foods I like. My nutritionist told me I might have problems eating certain foods, like celery or pasta, and I was willing to take the chance because life without celery or pasta still looked pretty good to me. But when my surgeon, speaking at the bariatric surgery informational seminar I attended, said that gastric bypass patients need to avoid all foods that are high in sugar, fat, or simple carbs because of the possibility of dumping, I mentally walked into a barbed wire fence and backed right off. At the time, I had one gastric bypass friend who didn’t dump, but the bypass patient who spoke at the seminar reported that he does dump, and when he described a typical day’s eating, I thought, “That’s not for me.” That guy was justifiably proud of his weight loss and didn’t mind a limited list of food choices, but I knew that limited food choices would send me running straight for the junk food if only out of sheer boredom. The night of that seminar, I hadn’t eaten a chocolate chip cookie for several months, but just the idea of giving up cookies forever made me want to stop at a bakery on the way home. I chose the adjustable gastric band, and the breadth and flexibility of my “OK Foods” list is one of the things that makes my post-op life enjoyable. I do overeat from time to time, but not because of Forbidden Food Syndrome. Taking foods off the Forbidden list has robbed them of some of their power over me. As a pre-op, I would attend a co-worker’s birthday party and eat two pieces of cake (Forbidden) because I’d been avoiding cake and missing it so much. As a post-op, I recently walked through the break room at work and saw a birthday cake on the table. I briefly wondered what flavor it was (impossible to tell from the decorative frosting, whose neon colors can’t be found in nature) and told myself I could try a little piece of it later, on my official break. Lo and behold, come break time I was quite hungry and not in the mood for cake. I wanted my chicken salad, and when I was done with that, I had no room for cake, so I went back to work without another thought about birthday cake. Now, that’s freedom!

CG, You continue to amaze me with the lessons you've learned, even before your surgery. I am so, so proud to see how you've worked through your WLS journey and lots of personal issues that would make a saint cry for mercy. Please, please believe me when I say, You are a rock star! J