Connie Stapleton PhD

Fat-Shaming sucks. Addiction-Shaming sucks. Bald-Shaming sucks. Shaming-Shaming sucks. There’s no way around that. It’s just plain true. There is too much shaming going on all around us. My question is: As good as it is to call the world out on their shaming behaviors, would we maybe be better off working on ourselves and, if we are health care professionals, working with our patients, to focus on the ways they shame themselves? AND OTHERS? At least simultaneously to trying to put an end to “Other-Shaming.” The purpose of this post is twofold: · To have each reader assess themselves in regard to their own shaming-ness, and · To suggest we help individuals stop shaming themselves while we simultaneously encourage the masses to stop. There are Tweets and Posts galore inviting us, inciting us, and urging us to help stop the Fat-Shaming done by society! I agree these are worthwhile efforts and must be done. What I don’t see very often on Social Media are statements encouraging people to get help to stop shaming, bullying, and beating up on themselves. We want an end to shaming, an end to bullying and an end to domestic violence. Check it out! All of that occurs within many an individual’s head! Here are some recent posts from social media, along with my posted responses: “Stand up to #weightbias! Sign the #petition to end fat-shaming and weight bias today.” My response: “Yes, please! Also work to stop #SelfShaming and #SelfBias. Sign up for therapy in your community!” “Why We Need to Ban the F Word: Fat-Shaming” My response: “If you believe people deserve to be treated well (and I do), please start by treating yourself well in your thoughts, words and actions.” “Once a person has obesity, it’s too late." One more way to #dismiss people with #obesity.” My response: “I hate that people dismiss those with obesity. I hate even more how those with obesity often dismiss themselves in so many ways.” “I believe that the morbidly #obese population is stigmatized, abused, neglected and mistreated by most facets of society.” My response: “I hate it, but those suffering from morbid #obesity also abuse, neglect, and mistreat themselves through negative self-talk, self abuse.” “Don't blame the person, rather treat the disease.” My response: “Don't blame patient for factors related to obesity they can't influence. Hold them accountable for those they can.” Please be clear about the message I am sending. I do hate the very real fact that society shames people who suffer from obesity. I hate that many people, including doctors and other health care providers, solely blame individuals for being obese. It’s horrible that a person is dismissed because they carry extra weight. No doubt. I know from both my personal and professional work, as well as from life experience, that I can influence my own behavior a lot more quickly than I can influence the masses. Typically, a person has an emotional connection to an issue if they are working to right some wrong related to that issue. Not all, but many people fighting to end societal Fat-Shaming, have “some skin in the game,” as they say. I am one of those people. Much of my work is done in a bariatric center where we aim to help those suffering from obesity, both physically and emotionally. Many health care providers, people who are personally struggling with their weight, along with family members and friends, all work together to try to end fat-shaming. Keep on keeping on with those efforts because they are worthwhile! In the meantime, are you, regardless of your size, weight, color, or religion, looking within yourself in an attempt to “clean your own side of the street?” Do you have biases about other groups of people being stigmatized? And more importantly, are you aware of, and working on, the ways you stigmatize, dismiss and shame yourself? Calling a person who suffers from obesity an ugly name, overlooking them for a job, dismissing their opinion or making a critical comment to or about them is wrong. It is equally despicable that people say things like, “I wouldn’t date a bald man,” or “He wouldn’t be right for the job. He’s bald.” My husband is bald and he struggles emotionally because of it. Have you (to include anyone suffering from obesity, alcoholism, drug addiction or any other ridiculed member of society) made ugly comments about bald people? It is disturbing that subjectively unattractive people are considered less intelligent, are helped less frequently by the public if they have a flat tire, and are hired secondarily to “beautiful” people. Have you (to include anyone suffering from obesity, alcoholism, drug addiction or any other ridiculed member of society) made ugly comments about unattractive people? How dismissive it must be to be a person who is part of an ethnic minority to have people call you a hateful name, to overlook you for a job you are very qualified for, or assume negative things about you. Have you (to include anyone suffering from obesity, alcoholism, drug addiction or any other ridiculed member of society) made disparaging comments to or about minorities? Religions are always good fodder for shaming, dismissing and bashing. Have you partaken? “You don’t look like one of them,” said my doctor to me when I shared that I am a recovering alcoholic and addict. One of them. A patient in a therapy group of people suffering from obesity said, “I cannot, for the life of me, understand why an alcoholic doesn’t just stay away from the bar.” To which I responded, “What is it like for you when someone asks why you can’t just push away from the table?” Wrong is wrong and it is wrong when any of us engage in dismissive or shaming conversation or behavior. Check yourself. Youre human and that means you have your own prejudices. You’ve likely engaged in your own dismissive comments about groups other than the one(s) you’re most closely aligned with. Relax, I’m not shaming you! I’m asking you to look at your own side of the street. Does it need sweeping? We all need to keep a broom nearby because we are all guilty of judging others at times. In my work, it is a priority to help people stop shaming themselves. Negative self-talk is a powerful way in which we shame ourselves. Yes, you do it, too! “I’m such an idiot!” “How could I have done such a stupid thing?” “What is wrong with me?” “I don’t know why I even bother. I never follow through anyway.” The list of examples illustrating negative self-talk, or stinkin’ thinkin’ is endless. Every single negative statement you make about yourself is dismissing the value of the person you are. Ironically, the shaming statements people make about themselves are representative of their own internal shame. The negative self-talk says, “There’s something wrong with me.” “I don’t feel ok about myself.” Isn’t it odd that we run around making a fuss about stopping the masses from shaming people when we spend some much time shaming ourselves? I’m thinking we would all be better off if we “swept our own side of the street” first. When we treat ourselves more tolerantly and we are accepting of others who we tend to dismiss, then it’ll make more sense to focus on what the masses are doing wrong.

@OKCPirate Sorry for the delayed response. You posted, "Dr. Stapleton, I'm really not nit picking, but why would you call obesity a "disease" as opposed to a "condition." I think a case can be made for those who really messed up their internal set points with years of yo-yo dieting it might be akin to a disease, but for some it is choice. The disease model is used in a number of complicated dependency issues, and while I agree there are some complicated brain issues with compulsive behaviors which can get so out of control that human rational will power is ineffective for creating change, for some though this is used as an excuse for inaction. It is an important semantic difference to me. It's what makes WLS a tool to me, not a magic wand or cure. I still have to work the program to get the results. Something for consideration, rhetoric, labels and words matter." The reason I describe obesity as a disease is because the American Medical Association refers to it as such. And clearly, there are numerous physiological issues at play when obesity is present, regardless of the particulars. People have opinions about this on both sides of the fence. I understand what you are saying and if the semantic difference is important to you, then I would stick to what you're comfortable with. I wholeheartedly agree that WLS is not at all a magic wand or a cure. Maintaining a healthy weight requires a great deal of consistent effort and defining obesity as a disease or not doing so does not change that fact. Similarly, if one has cancer or asthma or any number of other diseases/ailments, in order to obtain the most favorable outcomes, consistent effort and the choice for healthy behaviors is necessary. Thank you for your insights and observations.

I’m guessing most of us understand that the disease of obesity is a complicated one. There are a number of factors that contribute to obesity. Some of these factors you may be very aware of; others you may be surprised about. Some of the causes of obesity are things you cannot do anything about; other causes of obesity are things you can influence. BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence? (Part One of Three) I’m guessing most of us understand that the disease of obesity is a complicated one. There are a number of factors that contribute to obesity. Some of these factors you may be very aware of; others you may be surprised about. Some of the causes of obesity are things you cannot do anything about; other causes of obesity are things you can influence. It’s important to recognize the difference. Why? For starters, you can stop beating yourself up over the things you can’t do anything about. It’s also important that you focus on putting forth effort where it will get you the best results! It’s essential for both doctors and those suffering from obesity to have a mutual understanding of these causes of obesity and which people can influence, so that: 1) Doctors can develop or increase empathy for the struggles of those suffering with obesity. When doctors better understand that many people with obesity have struggles that go beyond fighting their biology which negatively impact their weight, the doctors can more compassionately and appropriately address these issues and refer patients to see other professionals, if need be. 2) People struggling with their weight can evaluate the numerous factors impacting obesity and work toward accepting those things they cannot influence. In addition, they can take responsibility for putting forth effort into those aspects of their struggles with weight that they can positively impact. All righty, then! Let’s look at three of the main contributing factors of obesity and then talk about each one, emphasizing what, if anything, each person can do to have a positive impact on their weight. Genetics Culture and Environment Metabolism Genetics Obesity definitely has some genetic determinants, as researchers have clearly discovered. If there are a lot of obese people in your extended family, you have a better chance of being obese than someone from a family without a history of weight problems. Although there are many more obese people in the current population than in previous generations, this cannot all be linked to genetics. The genetic composition of the population does not change rapidly. Therefore, the large increase in obesity reflects major changes in non-genetic factors. Listen to this… According to the Centers for Disease Control and Prevention (2002): “Since 1960, adult Americans have increased in height an average of 1 inch but have increased in weight by 25 pounds.” So in 50 years, the human species has grown taller by only an inch but heavier by 25 pounds. That tells us there is more than genetics influencing weight gain in this country. PATIENTS: Even if you have a genetic predisposition for obesity, there are other factors involved, including the food choices you make and whether or not you exercise on a regular basis. Some of these behavioral factors are habits learned in your family, so what appears to be a genetic predisposition may be a familial pattern of unhealthy habits that can be broken. DOCTORS: Remind yourself that patients cannot “eat less/move more” and have any effect on their current genetic makeup. Acknowledge to patients their genetic predisposition for obesity in a compassionate manner. Help to gently educate them about the factors affecting their weight that they can influence. Do so in a “firm and fair” way, providing encouragement rather than admonishment. Culture And Environment In addition to one’s genes, a person’s culture and environment play a large role in causing people to be overweight and obese. The environment and culture in which you were raised impacts how and what you eat. Some people were taught to eat everything on their plate and couldn’t get up from the table until they did so. Others never sat at a table for a meal but watched television while they ate. Some kids are fed well-balanced meals while others exist on fast food or microwaved mac and cheese with hot dogs. In some cultures, simple carbs make up a substantial part of every meal. In other cultures, fruits and vegetables are consumed regularly. When you are a child, you’re not in charge of buying the groceries or providing the meals. You did learn, however, about what and how to eat from those with whom you lived. And guess what that means? How you feed your children is what they will think of as “normal” and will most likely be how they eat as adults. (I’m always concerned when weight loss surgery patients tell me their kids are “just fine” even though they eat the same unhealthy foods as the obese parent. It’s only a matter of time before the kids start to gain weight and have health problems as a result of their unhealthy diet and learned eating behaviors.) PATIENTS: Although your genetic composition cannot be changed, the eating behaviors you learned in your family, from your culture, or developed on your own can be changed. You alone now determine what kind, and how much exercise you do and what and when you eat. Your behavior is completely within your control. Work toward accepting the fact that you are in charge of, and responsible for, your behavior and every food choice you make. For every choice, there is a consequence, positive or negative. And NO EXCUSES! It doesn’t matter how busy you are, whether you get a lunch break at the office or whether you have to cook for a family. Even if you have five kids in different activities and spend your life taxi-ing them from one place to another, you are the adult and you are responsible for how you eat and how you feed your children. It takes a very responsible person to acknowledge, “Although I have a genetic predisposition for obesity, I am responsible for making healthy choices about my eating and exercise. For me and for my children.” Focusing on what you do have control over rather than that over which you are powerless, leads to believing in your capabilities. So take charge and make positive changes happen! DOCTORS: Engage your patient in a discussion about the cultural and environmental factors that helped shape their current food choices and exercise behaviors. Empathize with them, noting they are going to have to put forth consistent effort to change years of bad habit formation. Encourage them to get support, whether it is from friends with a healthy lifestyle, a health coach, a personal trainer, or the use of free online exercise videos. Help them set a short-term, reasonable goal and set an appointment with you to follow up. Remember, docs: That which is reinforced is repeated. Reinforce even small steps forward you see in your patients. This can go a long way in encouraging them to continue making healthier choices. A step forward is a step forward. Notice and praise every single step forward your patient makes! Resting Metabolic Rate Resting Metabolic Rate (or RMR) is simply the energy needed to keep the body functioning when it’s at rest. In other words, RMR describes how many calories it takes to live if you’re just relaxing. Resting Metabolic Rate can vary quite a bit from one person to another, which may help explain why some people gain weight more quickly than others. And why some people seem to find it more difficult to lose weight than others. There are some factors related to metabolism that you can’t change, but there are actually some that you can influence and change. Things you cannot change about metabolic rate: Metabolic rate decreases with each passing decade, which means the older you are, the slower your metabolism gets, making weight loss more difficult. Sorry ladies - Men generally have a higher metabolism, meaning they burn calories more quickly than women. You can inherit your metabolic rate from previous generations - which can be a benefit… or not. An underactive or overactive thyroid gland can slow down or speed up metabolism. Some things you can do to influence your metabolism and burn more calories include: Eat small, frequent meals. Drink ice water. You can boost metabolism temporarily with aerobic exercise. You can boost metabolism in the long run with weight training. PATIENTS: I’ll bet you didn’t there was much of anything you could do that would increase your metabolism. I’m hoping you choose to implement the ways you can help your body burn more calories. And what do you know? They are completely consistent with healthy post-op behaviors that you’re supposed to do anyway: 1) Eat small, frequent meals. CHECK. 2) Drink water (so add ice and boost that RMR). CHECK. 3) Engage in exercise, both aerobic and weight bearing. CHECK. There’s no reason NOT to anymore! (That’s a slogan from a really old commercial…) The point is, your specific RMR is both something that is unique to you, and that will slow down with age, is gender-influenced, and can be affected by thyroid issues. Accept the things you cannot change and DO the things you can to get the most out of your own, unique RMR. You DO have choices! Opt not to make excuses and JUST DO THE THINGS YOU CAN! DOCTORS: I’m pretty sure that educating patients is in your job description. Even though you have an allotted set of minutes during which to accomplish all your goals with a patient, point out the ways they can boost their metabolism while you’re looking into their ears, or hitting them on the knee with that little hammer. Present it as a, “Hey! Guess what I was reminded of today?” sort of thing. It’ll probably be absorbed better than a mini-lecture. Leave yourself a sticky note in the patient’s folder to bring it up in your next session… and then a new educational point for the next meeting, along with the small goal you set with them so you can be sure to praise them for their efforts! Patients and Doctors and all Allied Health Professionals: We need to work together to do the following: 1) End Fat Shaming 2) End Blaming 3) End Lecturing 4) Encourage reciprocal AWARENESS and ACCOUNTABILTIY 5) Encourage reciprocal EDUCATION and DISCUSSION 6) Encourage reciprocal GOAL-SETTING and FOLLOW-UP Stay tuned for Part Two of BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence?

@@4MRB4PHOTO Thank YOU for commenting! @@Inner Surfer Girl Thanks so much! Appreciate you reading it!

BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence? (Part One of Three) I’m guessing most of us understand that the disease of obesity is a complicated one. There are a number of factors that contribute to obesity. Some of these factors you may be very aware of; others you may be surprised about. Some of the causes of obesity are things you cannot do anything about; other causes of obesity are things you can influence. It’s important to recognize the difference. Why? For starters, you can stop beating yourself up over the things you can’t do anything about. It’s also important that you focus on putting forth effort where it will get you the best results! It’s essential for both doctors and those suffering from obesity to have a mutual understanding of these causes of obesity and which people can influence, so that: 1) Doctors can develop or increase empathy for the struggles of those suffering with obesity. When doctors better understand that many people with obesity have struggles that go beyond fighting their biology which negatively impact their weight, the doctors can more compassionately and appropriately address these issues and refer patients to see other professionals, if need be. 2) People struggling with their weight can evaluate the numerous factors impacting obesity and work toward accepting those things they cannot influence. In addition, they can take responsibility for putting forth effort into those aspects of their struggles with weight that they can positively impact. All righty, then! Let’s look at three of the main contributing factors of obesity and then talk about each one, emphasizing what, if anything, each person can do to have a positive impact on their weight. Genetics Culture and Environment Metabolism Genetics Obesity definitely has some genetic determinants, as researchers have clearly discovered. If there are a lot of obese people in your extended family, you have a better chance of being obese than someone from a family without a history of weight problems. Although there are many more obese people in the current population than in previous generations, this cannot all be linked to genetics. The genetic composition of the population does not change rapidly. Therefore, the large increase in obesity reflects major changes in non-genetic factors. Listen to this… According to the Centers for Disease Control and Prevention (2002): “Since 1960, adult Americans have increased in height an average of 1 inch but have increased in weight by 25 pounds.” So in 50 years, the human species has grown taller by only an inch but heavier by 25 pounds. That tells us there is more than genetics influencing weight gain in this country. PATIENTS: Even if you have a genetic predisposition for obesity, there are other factors involved, including the food choices you make and whether or not you exercise on a regular basis. Some of these behavioral factors are habits learned in your family, so what appears to be a genetic predisposition may be a familial pattern of unhealthy habits that can be broken. DOCTORS: Remind yourself that patients cannot “eat less/move more” and have any effect on their current genetic makeup. Acknowledge to patients their genetic predisposition for obesity in a compassionate manner. Help to gently educate them about the factors affecting their weight that they can influence. Do so in a “firm and fair” way, providing encouragement rather than admonishment. Culture And Environment In addition to one’s genes, a person’s culture and environment play a large role in causing people to be overweight and obese. The environment and culture in which you were raised impacts how and what you eat. Some people were taught to eat everything on their plate and couldn’t get up from the table until they did so. Others never sat at a table for a meal but watched television while they ate. Some kids are fed well-balanced meals while others exist on fast food or microwaved mac and cheese with hot dogs. In some cultures, simple carbs make up a substantial part of every meal. In other cultures, fruits and vegetables are consumed regularly. When you are a child, you’re not in charge of buying the groceries or providing the meals. You did learn, however, about what and how to eat from those with whom you lived. And guess what that means? How you feed your children is what they will think of as “normal” and will most likely be how they eat as adults. (I’m always concerned when weight loss surgery patients tell me their kids are “just fine” even though they eat the same unhealthy foods as the obese parent. It’s only a matter of time before the kids start to gain weight and have health problems as a result of their unhealthy diet and learned eating behaviors.) PATIENTS: Although your genetic composition cannot be changed, the eating behaviors you learned in your family, from your culture, or developed on your own can be changed. You alone now determine what kind, and how much exercise you do and what and when you eat. Your behavior is completely within your control. Work toward accepting the fact that you are in charge of, and responsible for, your behavior and every food choice you make. For every choice, there is a consequence, positive or negative. And NO EXCUSES! It doesn’t matter how busy you are, whether you get a lunch break at the office or whether you have to cook for a family. Even if you have five kids in different activities and spend your life taxi-ing them from one place to another, you are the adult and you are responsible for how you eat and how you feed your children. It takes a very responsible person to acknowledge, “Although I have a genetic predisposition for obesity, I am responsible for making healthy choices about my eating and exercise. For me and for my children.” Focusing on what you do have control over rather than that over which you are powerless, leads to believing in your capabilities. So take charge and make positive changes happen! DOCTORS: Engage your patient in a discussion about the cultural and environmental factors that helped shape their current food choices and exercise behaviors. Empathize with them, noting they are going to have to put forth consistent effort to change years of bad habit formation. Encourage them to get support, whether it is from friends with a healthy lifestyle, a health coach, a personal trainer, or the use of free online exercise videos. Help them set a short-term, reasonable goal and set an appointment with you to follow up. Remember, docs: That which is reinforced is repeated. Reinforce even small steps forward you see in your patients. This can go a long way in encouraging them to continue making healthier choices. A step forward is a step forward. Notice and praise every single step forward your patient makes! Resting Metabolic Rate Resting Metabolic Rate (or RMR) is simply the energy needed to keep the body functioning when it’s at rest. In other words, RMR describes how many calories it takes to live if you’re just relaxing. Resting Metabolic Rate can vary quite a bit from one person to another, which may help explain why some people gain weight more quickly than others. And why some people seem to find it more difficult to lose weight than others. There are some factors related to metabolism that you can’t change, but there are actually some that you can influence and change. Things you cannot change about metabolic rate: Metabolic rate decreases with each passing decade, which means the older you are, the slower your metabolism gets, making weight loss more difficult. Sorry ladies - Men generally have a higher metabolism, meaning they burn calories more quickly than women. You can inherit your metabolic rate from previous generations - which can be a benefit… or not. An underactive or overactive thyroid gland can slow down or speed up metabolism. Some things you can do to influence your metabolism and burn more calories include: Eat small, frequent meals. Drink ice water. You can boost metabolism temporarily with aerobic exercise. You can boost metabolism in the long run with weight training. PATIENTS: I’ll bet you didn’t there was much of anything you could do that would increase your metabolism. I’m hoping you choose to implement the ways you can help your body burn more calories. And what do you know? They are completely consistent with healthy post-op behaviors that you’re supposed to do anyway: 1) Eat small, frequent meals. CHECK. 2) Drink water (so add ice and boost that RMR). CHECK. 3) Engage in exercise, both aerobic and weight bearing. CHECK. There’s no reason NOT to anymore! (That’s a slogan from a really old commercial…) The point is, your specific RMR is both something that is unique to you, and that will slow down with age, is gender-influenced, and can be affected by thyroid issues. Accept the things you cannot change and DO the things you can to get the most out of your own, unique RMR. You DO have choices! Opt not to make excuses and JUST DO THE THINGS YOU CAN! DOCTORS: I’m pretty sure that educating patients is in your job description. Even though you have an allotted set of minutes during which to accomplish all your goals with a patient, point out the ways they can boost their metabolism while you’re looking into their ears, or hitting them on the knee with that little hammer. Present it as a, “Hey! Guess what I was reminded of today?” sort of thing. It’ll probably be absorbed better than a mini-lecture. Leave yourself a sticky note in the patient’s folder to bring it up in your next session… and then a new educational point for the next meeting, along with the small goal you set with them so you can be sure to praise them for their efforts! Patients and Doctors and all Allied Health Professionals: We need to work together to do the following: 1) End Fat Shaming 2) End Blaming 3) End Lecturing 4) Encourage reciprocal AWARENESS and ACCOUNTABILTIY 5) Encourage reciprocal EDUCATION and DISCUSSION 6) Encourage reciprocal GOAL-SETTING and FOLLOW-UP Stay tuned for Part Two of BARIATRIC REALITIES: Causes of Obesity – What Factors can YOU Influence?

@@beinghappy2day Transfer addictions do happen, I believe. My point in writing this article is in relation to the governing body's recommendations. My point is not about being absolute or overbearing... it's specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects. Thank you for posting!

@@My Bariatric Life Wow! You have made some incredible decisions for your health! Awesome! Thanks for sharing!

@@Babbs I definitely agree that the bariatric team need only give patients education and information. As I keep reminding people, my issue is about the governing body of the bariatric team not making a sound medical recommendation. My point is not about being absolute or overbearing... it's specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects. Continue making the healthiest choices for you!

Get that Anger OUT! In the group class I am currently leading, we have been talking about the importance of learning to identify feelings – the word that describes the feeling (mad, sad, glad, scared) AND where and how you feel it in your body (heaviness in your heart, tension in your jaw, tingling in your arms). We have also been discussing healthy ways to express and deal with feelings. A woman who I’ve known and worked with in therapy for several years has been very quiet throughout the first nine weeks of class. To my surprise, as we were talking about some of the most noted healthy ways to deal with anger (breathe deeply, set aside time to talk to the person using fair fighting techniques, talking to a friend), from the back of the room, this woman, who I will refer to as Kathy, blurts out in a healthy vocal level: “Why do we always talk about such ‘nice’ ways of dealing with anger? When I’m angry, I need to do something physical and not so nice!” Being like Kathy myself in that I have a pretty intense anger response, I laughed and told her I completely understood where she was coming from. The class offered a few helpful suggestions for dealing with anger in physical ways. I promised her that I would create a list just for her delineating healthy physical ways to deal with anger. Tonight, sitting at my favorite calming spot, the swing on my second-story deck that looks out into the sky and newly budding trees of the woods behind my house, I saw a dinosaur in the clouds. Its ribs were showing, it’s head rather distorted, and it’s tail very, very long. I thought of taking a picture for my grandkids, but my phone was upstairs charging and I didn’t want to move from my swing. Wish I had. I guess it was actually a dissipating jet stream, but I thought it was cool and remembered seeing some really cool cloud pictures recently online. I don’t know for sure what that has to do with anything, but all of a sudden I decided I needed to make Kathy’s list. I did the very scientific thing and Googled, “Healthy ways to physically express anger,” “Physical expression of anger,” “Ways to work out your anger,” etc. I found ONE little article that had four lame little suggestions. Everything else focused on… yep, the standard things - breathe deeply, set aside time to talk to the person using fair fighting techniques, and talking to a friend. Too passive for folks like Kathy and me who need to find a physical outlet when we are really ticked off and want to scream at someone. Of course, that option is just not okay (which I worked really hard to try to convince Kathy of)! Because I couldn’t find anything worthwhile on line, I sat down and to my own surprise, came up with this list in just minutes! Enjoy it. Share it with your friends (and family)! And use it!!!! Kathy’s List of Ways to Express Anger in a Physical Way that Won’t Harm Anyone 1. Scream – where no one can hear you. a. Scream into your pillow. b. Go into a closet, shut the door and scream. c. Sit in your car with the windows up and scream. d. Then get a cold glass of water and cool down. 2. Do an ANGER dance! a. Be like Goldie Hawn in Housesitter and have yourself a good old “expressive” dance! Shake what your mama gave ya! b. Jump up and down like you’re on a trampoline – and scream while you’re doing it! c. Actually jump on a trampoline if you have one handy! d. Then turn on a love song and have a good cry. 3. Exercise … yes, move your groove thing! a. Walk or run – outside or inside on the treadmill. b. Get a kickboxing DVD and kick some arse! c. Do that strenuous type of yoga – you’ll get the energy out and relax yourself all at the same time! d. Then lay on the cool floor and have a laughing fit, remembering it’s probably not so serious after all. 4. Find a dog… a. Chase it in circles… big circles, small circles… b. Play tug of war with it. c. Have a growling contest with it. d. Then, pet the little friend and you’ll feel much better! 5. Get one of those old toys that kids practice doing hair on… a. Comb the mess out of it with all your might! b. Pull that hair! c. Tell the mannequin head all about your anger. d. Then listen to what it says back to you… 6. Stand in front of the mirror… a. Tell yourself what the matter is. b. Use foul language. c. Make horrible, mean, ugly faces at yourself. d. Then laugh with yourself. 7. Have an imaginary conversation with the person or situation you’re mad at… a. Exaggerate the details so they/it sound really horrible. b. Tell them about how wonderful you. c. Remind them how valuable you are to them. d. Then find some rational thought and calm yourself down! 8. Go outside… a. Pull some weeds. b. Throw some twigs. c. Stomp some dirt. d. Then look at the clouds and find a fun shape. (Maybe that’s the connection to the dinosaur I saw in the sky.) 9. Make some angry art… a. Watercolor a dark scene. b. Draw out the situation you’re mad about. c. Write an angry poem. d. Then write yourself a love note. 10. Write the “THERAPEUTIC Letter!” a. Spill it all out on paper! (Do NOT send this letter!) b. Use red ink or red font color. c. Use whatever language feels best. d. Then thank the person or situation for the lessons you’ll eventually glean from this. Connie Stapleton, Ph.D. www.connie@conniestapletonphd.com FB: https://www.facebook.com/connie.stapleton.923 Twitter: @cstapletonphd LinkedIn: Connie Stapleton, PhD YouTube: Connie Stapleton

@@OKCPirate Thank you for the very kind message. Much appreciated.

@@SweetPeas Glad to hear that Mayo is giving a consistent message. And glad that it's not overbearing. My point is not about being absolute or overbearing... it's specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects. A recommendation is different than a "thou shalt not." Now that pizza... that's another issue all together! Take care and thank you.

@@CowgirlJane I'm with you on the cigarettes! We could certainly rant about that! Please remember that my comments are specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects. A recommendation is different than a "thou shalt not." Thanks.

@@Christinamo7 Given that alcohol is a toxin, then it's not a "wise" thing for anyone to do, really! But I'm not saying anything about no one, WLS patient or not, EVER having alcohol. Every person is individually responsible for whatever they put into their bodies. My message is not about judging those who drink or smoke or whatever... My message is about a governing body taking a more clear stance in their RECOMMENDATION. Please remember that my comments are specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects. A recommendation is different than a "thou shalt not." Thank you for sharing your thoughts.

@@OKCPirate I agree very much with the minister's quote: "very little good comes form the absolute shall." Please remember that my comments are specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects. A recommendation is different than a "thou shalt not." Thanks for the website referral. I'll definitely look at it! I definitely agree that people are different and also agree with Dee Hock. I am suggesting that there are simple, clear recommendations with the medical reasons as to why alcohol is contraindicated for WLS patients. I'm not saying to set rules. I'm so glad hearing that you and your kids have great communication. Very awesome. Thank you so much for sharing your thoughts!

@@CowgirlJane I love your comparison between alcohol and ice cream and how one calls your name and one doesn't. I also completely agree that WLS is not a "one size fits all" kind of thing. People definitely need to know the things that may need to be "off limits" for them and make healthy decisions accordingly. That will be different for every person. Please remember that I am only talking about RECOMMENDATIONS. And recommendations from those who are the governing body of WLS. It's not about saying ALL or NOTHING, nor does where I am coming from having anything to do with WLS patients being able to make good decisions - or not. What I am saying is that BECAUSE alcohol is a toxin and may interfere with absorption of essential nutrients, the governing body's RECOMMENDATION, not MANDATE, be that it is not a wise decision to consume alcohol after weight loss surgery. Thank you!

@@2goldengirl Please remember that I am only talking about RECOMMENDATIONS. And recommendations from those who are the governing body of WLS. It's not about saying ALL or NOTHING, nor does where I am coming from having anything to do with WLS patients being able to make good decisions - or not. What I am saying is that BECAUSE alcohol is a toxin and may interfere with absorption of essential nutrients, the governing body's RECOMMENDATION, not MANDATE, be that it is not a wise decision to consume alcohol after weight loss surgery. I totally agree that each and every person is responsible for their own health. Thank you!

@@Tssiemer1 You CAN drink wine... it's just not a very good idea!

@@SweetPeas So glad to hear that the medical professionals on your team said no alcohol! Where did you have your surgery? @@SweetPeas So glad to hear that the medical professionals on your team said no alcohol! Where did you have your surgery?

@@VSGAnn2014 Very nicely stated. Thank you for adding your experience! I agree with your psychologist on several points but not on others. I have also had certification as an alcohol and drug therapist for 25 years, so in addition to my 12 years specifically in the field of bariatrics, I have an extensive background in substance abuse. The data is limited about alcohol and WLS. I happen to think the problem is much more extensive than the literature suggests regarding transfer addiction. No matter what, alcohol is and always will be a drug, a toxin and has an effect on the absorption of nutrients. You, and all persons, are free to choose what to eat and drink! I'm very sad to hear about your husband. Please take care of yourself while you are caring for him. Thank you. Connie

@@OKCPirate Thank for the reading by John Grisham! Indeed, a very good narrative! As I have said, I don't have a problem with people drinking alcohol - if it's not contraindicated for them for whatever reason. I stand firm in my belief that for those who have WLS, alcohol has no place in their "diet." Very much enjoyed the video! Connie

@@Inner Surfer Girl Thank you! I will definitely read some of the threads. Going on vacation next week so that will be a good time to do so! Connie

@@CowgirlJane I respect your position. Many people make the choice to consume alcohol in a social manner. I have no issues with people drinking alcohol. I believe each individual needs to consider their circumstances (medical and others) and make their own choice. I believe that the medical community, however, needs to make it clear that alcohol is a toxin, can interfere with the absorption of essential nutrients, and that it is definitely nothing but empty calories.

@@VSGAnn2014 Thank you for your response! I'm not a nutritionist, or a physician, but I'll answer each of your questions from my perspective and having worked in a bariatric center for the last 12 years. But please consult your physician and nutritionist. So you're anti-alcohol of any kinds for WLS patients and think all WLS patients should be or become tee-totalers ... right? Personally, I am against alcohol for all WLS patients for the reasons mentioned in the article, including: alcohol is a toxin, it is empty calories, it is empty liquid calories, and there are potential nutritional absorption issues that could be made worse by drinking alcohol. Do you feel the same way about alcohol for patients a year out (and in maintenance) as during the weight-losing phases? Yes, for the same reasons as stated above. Do you also recommend no-Cookies for WLS patients? Ever? Even in maintenance? Recommend? Yes, I would recommend no cookies, although I wouldn't expect in reality that a person may never have a cookie again. Four cookies at a time? I would never recommend that. Unlike alcohol, however, a cookie is not a toxin that interferes with absorption of essential nutrients. What about cake? Recommend? Yes, I would recommend no cake, although I wouldn't expect in reality that a person may never have cake again. Unlike alcohol, however, cake is not a toxin that interferes with absorption of essential nutrients. Barbeque (and all the sugar in those BBQ sauces)? Chili? There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free. Breads? If not all breads, which kinds / brands? There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free. Always the healthier the better. What about coffee? Tea? Marijuana? I would ask your doctor and nutritionist about coffee and tea. I believe there are other reasons they suggest to limit these. Marijuana? No, I would not ever RECOMMEND that someone use marijuana (unless POSSIBLY in the case of medical illness). What about sweet potatoes? White potatoes? There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free. Fruits -- with or without sugar? There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free. So - those are my thoughts. Again - please consult your physician and nutritionist as those are not my areas of expertise. Be well!

Great thoughts, opinions and ideas! Thank you for sharing your experiences and beliefs. Helps us all learn and grow!

Bariatric Realities – Medical Professionals’ Guidelines about Alcohol Use & WLS I know I said my next article was going to be on causes of obesity, but I got carried away tonight doing some investigating about the professional medical guidelines for alcohol use after weight loss surgery. In summary, the gist of the recommendations are: “Patients undergoing bariatric surgery should be screened and educated regarding alcohol intake both before and after surgery… patients should be made aware that alcohol use disorders (AUD) can occur in the long term after bariatric surgery.” (From: http://asmbs.org/resources/alcohol-use-before-and-after-bariatric-surgery.) Well, now. Those are some non-specific medical recommendations by medical professionals who are the predominant leaders and caregivers of the surgical weight loss population. Education and awareness. Hey – I am all about education and awareness. Great things, education and awareness. And yet, I’m gonna say that as a recommendation, that is a very “PC” non-recommendation recommendation, when one considers that we are talking about 1) ALCOHOL and 2) WEIGHT LOSS SURGERY patients. Consider these educational nuggets and facts I found that WLS patients really ought to be aware of: Psychologist Stanton Peele, writes, “readers now know that scientifically, it's not alcohol that causes people to live longer, but it is simply being with others and that they are less socially isolated when they drink that prolongs their lives. After all, alcohol is a toxin.” (italics and bold added) (From https://www.psychologytoday.com/blog/addiction-in-society/201011/science-is-what-society-says-it-is-alcohols-poison. My comments: Yes – alcohol is a toxin, and that means POISON. Those of us in the medical field really ought to know that people are not supposed to ingest poison. But the recommendations do not say, “Do NOT ingest the toxin, alcohol.” No, no, no… they say be educated and aware. Dr. Charles S. Lieber, M.D., M.A.C.P., in a publication for the National Institute on Alcohol Abuse and Alcoholism, writes, ““A complex interplay exists between a person’s alcohol consumption and nutritional status,” and … alcohol and its metabolism prevent the body from properly absorbing, digesting, and using essential nutrients” (italics added.) Dr. Lieber does indeed, educate us about the nutritional value of alcohol: “Alcohol would not fall under the category of an essential nutrient because not having it in your diet does not lead to any sort of deficiency. Alcoholic beverages primarily consist of water, pure alcohol (chemically known as ethanol), and variable amounts of sugars (i.e., carbohydrates); their content of other nutrients (e.g., proteins, vitamins, or minerals) is usually negligible. Because they provide almost no nutrients, alcoholic beverages are considered ‘empty calories.’ Therefore, any calories provided by alcoholic beverages are derived from the carbohydrates and alcohol they contain.” (italics added) My comments: People who have weight loss surgery (other than the band) experience absorption issues to one degree or another. Nutritional deficiency is one of the concerns the medical professionals monitor in the months and years following WLS. We stress to patients the importance of taking vitamin supplements for the rest of their lives to help ensure proper nutritional balance. And yet, rather than saying, “Alcohol use is unwise after WLS,” or “Don’t drink alcohol after WLS,” the governing body of health professionals for bariatric surgery recommends being “educated” and “aware.” Is that happening? Are the physicians and surgeons and nutritionists and mental health professionals educating patients and making patients aware that ALCOHOL IS A TOXIN THAT CAN INTERFERE WITH VITAMIN ABSORPTION – and it should not be consumed after weight loss surgery? I can’t answer that, although I know we do this at the programs I work with. If it’s not happening, why not? Having a background in direct sales, which, ironically, was incredible education for my later career as a psychologist, I was taught to “anticipate the objections.” Many health care professionals may be pooh-pooh’ing the vitamin deficiency issue associated with alcohol, stating it’s only those who drink heavily who are at risk for this type of vitamin deficiency. That information, to the best of my knowledge, is relevant for persons who have not had weight loss surgery. What’s more, we don’t know the extent to which people are drinking many years after WLS. Most of the research, as noted in the ASMBS Guidelines/Statements entitled ASMBS position statement on alcohol use before and after bariatric surgery, states, “The existing studies do not present a uniform picture regarding the overall prevalence of lifetime or current alcohol use disorders (AUD) in patients seeking bariatric surgery. The vast majority of the existing literature is retrospective, with small sample sizes, lack of control groups, and low response rates. There are also varying definitions of alcohol disorders (“high-risk” versus “misuse” versus “abuse/dependence”) in the bariatric surgery literature.” In other words, this research does provide some information, but remember, we don’t really know that much because there isn’t enough research on enough people over a long enough period of time. We don’t then, know the actual affect that alcohol use has on vitamin absorption for WLS patients. We DO know that vitamin deficiency is a concern, so WHY aren’t we telling people not to drink? Not only is alcohol a toxin for our bodies, “Alcohol is actually classified as a drug and is a known depressant. Under this category, it is the most widely used drug in the world. According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA)” (italics and underling added). http://www.medicinenet.com/alcohol_and_nutrition/article.htm My comments: I am literally chuckling now at the absurdity of this situation. The situation being the medical professionals, all having a code of ethics that reflects the “do no harm” sentiment, ignoring potential harm for their patients. Please note that we would all consider alcohol as being “empty calories” and having sugar/carbohydrates and certainly no protein. PLEASE let it be the case that the mental health practitioners around the world who deal with surgical weight loss patients are telling them, “Don’t eat empty calories. Eat a lot of protein. Limit the simple carbs and sugar. And refrain from consuming your calories from liquids. NO STARBUCKS. BUT, HEY - GO AHEAD AND DRINK THOSE SUGAR/CARB LADEN, EMPTY, NUTRITION-ROBBING TOXIC CALORIES IN ALCOHOL, THAT ARE, BY THE WAY, THE MOST WIDELY ABUSED DRUG IN THE WORLD.” Honestly, that sentence should be the entire article. But WAIT! There’s MORE! I really love this last tidbit I’ll share with you. It’s so much nicer for me when I can find it online so it’s not that mean, alcohol-hating Dr. Stapleton being the one to blame! “The truth is that no one needs alcohol to live, so regardless of what you've heard or want to believe, alcohol is not essential in our diets. Did you know that a glass of wine can have the same calories as four cookies? How about a pint of lager – surprised to hear it’s often the caloric equivalent of a slice of pizza? You do not need to be an alcoholic for alcohol to interfere with your health and life.” https://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/appearance/calories-in-alcohol Do you hear this, people in the medical profession? Are you giving the OK for your patients to eat four cookies “now and then,” or “in moderation,” or “not for the first six months, or year after surgery?” Do you realize that you may be DOING HARM by giving your patients “permission” to drink alcohol? “But our job is not to be the watchdog or decision-maker for people.” Another potential objection to my dismay about the recommendations being for “education” and “awareness,” rather than a direct, “SAY NO TO ALCOHOL” stance. I agree that no one can make the decisions about what people can or cannot do, or what they will or will not do. People in the medical field do tell people things like, “Don’t get that wet or you could get an infection,” “Keep the splint on for the next six weeks if you want to heal properly.” There ARE dos and don’ts that are educational and increase awareness. What’s the real issue that medical professionals don’t take a hard stance on alcohol after WLS? I don’t know. I do know that I did my dissertation on medical doctor’s attitudes toward addiction. Turns out it is much like that of their attitudes toward obesity: many don’t know that much about it, very many do not feel comfortable working with it, and most don’t care about/understand it. To top it all off, HERE’s the real kicker… Not only do the medical AND some of the WLS organizations not tell people, “Don’t drink alcohol,” THEY PROVIDE ALCOHOL AT THEIR EVENTS! I can’t say any more. Connie Stapleton, PhD connie@conniestapletonphd.com Facebook: Connie Stapleton Twitter: @cstapletonphd LinkedIn: Connie Stapleton, Ph.D.