Connie Stapleton PhD

Bariatric Realities I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress. Bariatric Realities I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress. I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored. Not to me, they aren’t. And these will be addressed in this series. In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…) I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real. Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series. Alcohol Use After WLS This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment. Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders. And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot. Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA? No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality. Food Addiction Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction. “Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real. Ask your patients. They believe food addiction is real. So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives? I’m frustrated. Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS! The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for? Connie Stapleton, PhD connie@conniestapletonphd.com Facebook: Connie Stapleton Twitter: @cstapletonphd LinkedIn: Connie Stapleton, PhD

“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!” 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

I’m writing this article as an invitation for each of you to help educate physicians about the issues you face related to weight loss surgery and what you believe is needed to enhance your care, either before or after weight loss surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) emails each new edition of “connect,” their official news magazine to its members upon publication. In it, they provide a synopsis of recent articles of interest related to WLS. One noted article this week is titled, “What Matters: What’s the magic behind successful bariatric patients?” and is written by Dr. Jon O. Ebbert, an internist at Mayo Clinic. In the article, Dr. Ebbert states, “I was left wondering how I can best help my patients using this information.” Let’s help him help his patients! I’ll share the short article, give my editorial (what I didn’t share with Dr. Ebbert) and then write the response I did share with him. Finally, I’ll provide the link where you, too, can share feedback directly about the article, or send it to me and I will be happy to forward it! The article: “MARCH 3, 2016 A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss. When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again. Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm. So, what predicts success – and can we facilitate it? Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss. In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery. The voice of the successful bariatric patient is an interesting and important one. Several themes were identified: 1) taking life back (“I did it for myself”); 2) a new lease on life (“There are things I can do now that I am not exhausted”); 3) the importance of social support; 4) avoiding the negative (terminating unhealthy relationships in which “food is love”); 5) the void (food addiction and sense of loss); 6) fighting food demons; 7) finding the happy weight; and 8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either). I was left wondering how I can best help my patients using this information. First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support. Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.” My Editorial I’m grateful that an internist is addressing the topic of WLS. I love that he is thinking about ways to use the information gleaned from the research he notes related to the behaviors of those who have “successful weight maintenance” following weight loss surgery. Pardon my sarcasm, but, WOW! Getting information about the behaviors that led to weight loss from patients who have 50% or more of excessive weight loss 24 months after bariatric surgery? Does that really tell us anything? I’d venture to say that the majority of professionals in the field would note the surgery itself as being primarily responsible for the “success” of the weight loss at 24 months out. I’m NOT saying that many patients fail to put forth a great deal of effort at that point, because I know many do work very hard during those first 24 months. But come on… let’s talk to successful weight maintainers at 5 years after surgery to get a better indication of what they are doing to manage a healthy weight. I’d also be curious to know at what point in time after surgery the statistic was obtained noting “Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.” How much weight regain? After how much time? If you look closely at research in many fields, you can find numbers that vary widely on a particular topic. Dr. Ebbert states, “Psychological burden and motivation have not been associated with weight loss.” I wasn’t at all sure what this meant. Questioning my comprehension skills, I asked some other people how they interpreted that statement, and they couldn’t tell, either. If the implication is that psychological issues have no impact on weight loss or lack thereof, I have to disagree. But then, I have no research to back up my hypothesis. I do have 11 years working in this field and the anecdotal evidence of hundreds of patients that says otherwise. I’d say depression interferes with the desire/ability to follow through with certain behaviors that require significant energy. I’d say that intense shame interferes with the perceived efficacy to follow through for the long haul with behaviors necessary to sustain weight loss – well past two years of having WLS. I don’t know… I believe poor self-esteem, a history of “failing” with “diets,” unresolved grief, loss, and abuse issues sometimes affect a person’s perceived ability to succeed. I also believe treating these psychological issues in conjunction with treating one’s physiology and teaching important skills such as healthy coping mechanisms, positive self-talk, and efficacy-enhancing skills is a recipe for better outcomes. My Response to Dr. Ebbert (in an attempt to be brief): “Dr. Ebbert - With all due respect, the medical field is, in my opinion, missing several very large pieces of the puzzle with the surgical weight loss population in terms of treating them. I am a licensed clinical psychologist. I work in a surgical weight loss clinic and have spoken with literally thousands of patients who have had weight loss surgery. Obesity is a complicated disease that is more than just physiological. I treat the underlying and associated psychological co-morbidities, which the medical community largely ignores, except under the broad category of "Behavior Modification." I assure you that there is a lot more than changing behaviors that needs to be addressed with this population. A vast majority of this population suffers with deep shame and low self-esteem, both rendering them inefficient at maintaining motivation to follow through on a long-term basis with "behavior modification." I am working tirelessly to try to address the elephants in the OR, but surgeons don't really want to listen to myself - or the patients - who are clamoring for additional mental health care (MORE than behavior modification) following WLS when their "issues" interfere with healthy behaviors - just like before surgery. More suicides? Maybe because in a sense, we take away the patients’ coping skill (food) and throw them to the wolves. I've created a video series that I require all of my patients to watch before surgery to help them understand the deeper issues they may face and to urge them to seek counseling. I could use help in the medical community. You in?” I do believe, and I thank Dr. Ebbert for noting, “this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure.” Let’s all pitch in and share with Dr. Ebbert and other interested physicians what you need to be successful, on and off the scale, for years and years following WLS. Please share your comments at: http://www.clinicalendocrinologynews.com/comments/what-matters-whats-the-magic-behind-successful-bariatric-patients/016f71fe2abdc0198ac42d75d039d712.html?comments_link=1 Or, post your comments here or contact me via my web page: www.conniestapletonphd.com Let’s pitch in and help! Connie Stapleton, Ph.D.

The American Society for Metabolic and Bariatric Surgery (ASMBS) emails each new edition of “connect,” their official news magazine to its members upon publication. In it, they provide a synopsis of recent articles of interest related to WLS. One noted article this week is titled, “What Matters: What’s the magic behind successful bariatric patients?” and is written by Dr. Jon O. Ebbert, an internist at Mayo Clinic. In the article, Dr. Ebbert states, “I was left wondering how I can best help my patients using this information.” Let’s help him help his patients! I’ll share the short article, give my editorial (what I didn’t share with Dr. Ebbert) and then write the response I did share with him. Finally, I’ll provide the link where you, too, can share feedback directly about the article, or send it to me and I will be happy to forward it! The article: “MARCH 3, 2016 A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss. When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again. Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm. So, what predicts success – and can we facilitate it? Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss. In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery. The voice of the successful bariatric patient is an interesting and important one. Several themes were identified: 1) taking life back (“I did it for myself”); 2) a new lease on life (“There are things I can do now that I am not exhausted”); 3) the importance of social support; 4) avoiding the negative (terminating unhealthy relationships in which “food is love”); 5) the void (food addiction and sense of loss); 6) fighting food demons; 7) finding the happy weight; and 8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either). I was left wondering how I can best help my patients using this information. First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support. Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.” My Editorial I’m grateful that an internist is addressing the topic of WLS. I love that he is thinking about ways to use the information gleaned from the research he notes related to the behaviors of those who have “successful weight maintenance” following weight loss surgery. Pardon my sarcasm, but, WOW! Getting information about the behaviors that led to weight loss from patients who have 50% or more of excessive weight loss 24 months after bariatric surgery? Does that really tell us anything? I’d venture to say that the majority of professionals in the field would note the surgery itself as being primarily responsible for the “success” of the weight loss at 24 months out. I’m NOT saying that many patients fail to put forth a great deal of effort at that point, because I know many do work very hard during those first 24 months. But come on… let’s talk to successful weight maintainers at 5 years after surgery to get a better indication of what they are doing to manage a healthy weight. I’d also be curious to know at what point in time after surgery the statistic was obtained noting “Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.” How much weight regain? After how much time? If you look closely at research in many fields, you can find numbers that vary widely on a particular topic. Dr. Ebbert states, “Psychological burden and motivation have not been associated with weight loss.” I wasn’t at all sure what this meant. Questioning my comprehension skills, I asked some other people how they interpreted that statement, and they couldn’t tell, either. If the implication is that psychological issues have no impact on weight loss or lack thereof, I have to disagree. But then, I have no research to back up my hypothesis. I do have 11 years working in this field and the anecdotal evidence of hundreds of patients that says otherwise. I’d say depression interferes with the desire/ability to follow through with certain behaviors that require significant energy. I’d say that intense shame interferes with the perceived efficacy to follow through for the long haul with behaviors necessary to sustain weight loss – well past two years of having WLS. I don’t know… I believe poor self-esteem, a history of “failing” with “diets,” unresolved grief, loss, and abuse issues sometimes affect a person’s perceived ability to succeed. I also believe treating these psychological issues in conjunction with treating one’s physiology and teaching important skills such as healthy coping mechanisms, positive self-talk, and efficacy-enhancing skills is a recipe for better outcomes. My Response to Dr. Ebbert (in an attempt to be brief): “Dr. Ebbert - With all due respect, the medical field is, in my opinion, missing several very large pieces of the puzzle with the surgical weight loss population in terms of treating them. I am a licensed clinical psychologist. I work in a surgical weight loss clinic and have spoken with literally thousands of patients who have had weight loss surgery. Obesity is a complicated disease that is more than just physiological. I treat the underlying and associated psychological co-morbidities, which the medical community largely ignores, except under the broad category of "Behavior Modification." I assure you that there is a lot more than changing behaviors that needs to be addressed with this population. A vast majority of this population suffers with deep shame and low self-esteem, both rendering them inefficient at maintaining motivation to follow through on a long-term basis with "behavior modification." I am working tirelessly to try to address the elephants in the OR, but surgeons don't really want to listen to myself - or the patients - who are clamoring for additional mental health care (MORE than behavior modification) following WLS when their "issues" interfere with healthy behaviors - just like before surgery. More suicides? Maybe because in a sense, we take away the patients’ coping skill (food) and throw them to the wolves. I've created a video series that I require all of my patients to watch before surgery to help them understand the deeper issues they may face and to urge them to seek counseling. I could use help in the medical community. You in?” I do believe, and I thank Dr. Ebbert for noting, “this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure.” Let’s all pitch in and share with Dr. Ebbert and other interested physicians what you need to be successful, on and off the scale, for years and years following WLS. Please share your comments at: http://www.clinicalendocrinologynews.com/comments/what-matters-whats-the-magic-behind-successful-bariatric-patients/016f71fe2abdc0198ac42d75d039d712.html?comments_link=1 Or, post your comments here or contact me via my web page: www.conniestapletonphd.com Let’s pitch in and help! Connie Stapleton, Ph.D.

Bariatric Realities I’m doing this series called “Bariatric Realities” as a result of many frustrations. In this case, the energy generated in my body and brain, as a result of these annoyances, is my motivation for developing this series. I need to “get it out,” put my thoughts and feelings on paper - and on video - and share them. I want to talk about what I see and hear, day in and day out, from the patients I work with. These vulnerable men and women tell me about the realities of dealing with weight issues, the struggles related to getting extra weight off and keeping it off, and the underlying emotional hurdles interfering with their progress. I’m frustrated that patients, whether they are seeking medical weight loss assistance or opting for weight loss surgery, are given only part of the story and only part of the solution. The emphasis in all bariatric programs, obviously, is on meal planning and “behavior modification.” These are, of course, essential elements of weight loss and healthy weight management, but they are only part of the deal. The emotional components related to weight issues – shame, self-esteem, body image, family of origin issues, past trauma, relationship changes following weight loss – these and many other crucial, emotional/psychological issues are so often ignored. Not to me, they aren’t. And these will be addressed in this series. In addition, I want to inform other professionals in the medical, psychological and psychiatric fields about things patients (and, to be fair, some professionals) know, but the scholarly types won’t listen to, because what I have to say isn’t “evidence based.” Meaning there are no formal research studies or statistics to verify or validate what I, and so many others, know to be true. Oh, I am a believer in, and supporter of evidence based research – without a doubt! And yet, so many topics that need to be addressed in the area of weight loss have not been formally researched, nor do they always lend themselves to scientific investigation. (Not to mention, the evidence found in evidence-based research is very often conflicting and ever changing. That, however is another paper…) I will address those very real problems related to weight loss and maintenance that are largely ignored due to a lack of research-based evidence. And yet, those topics are so very, very real. Here’s a sneak peak at the types of things I’ll be addressing in the Bariatric Reality series. Alcohol Use After WLS This topic is widely debated by patients and professionals alike. It is, indeed, discussed at the professional meetings. In fact, just a few years ago, a big fuss was made at one of the largest bariatric surgery professional meetings about brand new research related to Alcohol Use Disorders following weight loss surgery. The actual researchers presented findings of their newly published data recently released in The Journal of The American Medical Association (JAMA): Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. The authors reported a 2% increase in Alcohol Use Disorders at the 2-year post-surgical assessment. Is this information helpful? Of course it is! Does it tell much of a story, really? If you ask those of us who work day in and day out in surgical weight loss programs, I’d venture to say that the majority would report that this 2% statistic at two years post-op doesn’t even begin to tell the reality of the problems we see with “Alcohol Use Disorders” following weight loss surgery… some a year after, some two years after, some five years after. And it’s not just alcohol. It’s also abuse of pain medications, spending, promiscuous sexual behavior and eating disorders. And tell me… how many WLS patients who have “Alcohol Use Disorders” haven’t returned to their bariatric centers for follow up to be included in the research results? How many haven’t mentioned anything about “Alcohol Use Disorders” to the multidisciplinary team? A lot. Yet we can’t present the very real information from patients who tell us about their friends who won’t come see the doctor after their surgery … the ones they are worried about because the person of concern isn’t eating but is consuming the majority of their calories from alcohol. We can’t count, or report on, the patients whose won’t come in for a follow-up and who drink so much they are falling down and hurting themselves. There is no “data” to indicate the number of patients calling and insisting they need more or higher doses of pain medication and become hostile or abusive to the staff when told the doctor won’t prescribe any more. We don’t have “numbers” for the patients who sit in my office and cry because they are sleeping with anyone who shows any interest in them. We have no data on the number of patients who tell me and other providers around the country that they meet strangers at motels for sex, something they never did before. How do we help educate other professionals about very real, very dangerous “anecdotal” reports of problems, when, alas, we have no DATA? No, this type of information is not discussed at the “professional” meetings because we don’t have scientific evidence. But these things are happening. They are real. And they need to be talked about. So I’ll talk about them and hope someone listens. A lot of someones – so that people won’t be afraid to ask for help for these issues, knowing they’re not alone. And so that professionals may – just may – stop pretending these things aren’t happening because there are no “numbers” to support the reality. Food Addiction Last year, I spoke at a national weight loss conference for overweight and obese patients. The moderator of the panel of which I was a part, felt strongly that food/eating is not an addiction. He therefore posed this question to the audience of approximately 200 people: “How many of you consider yourself to be a food addict?” Nearly every hand in the audience shot up immediately. I explained to him, and to the audience, that the hallmark of addiction is knowing something is a problem and has caused problems (think of all the health-related problems associated with obesity), wanting to stop (wanting to lose weight) having made many attempts to stop (consider all of the prior dieting), but not being able to stop (most people regain any lost weight from dieting and feel hopeless about being able to make permanent changes to their eating and exercise behavior). These people who consider themselves food addicts are addicted to food/eating, physically and/or emotionally. They know their weight is causing serious problems in their lives, they want to stop, but they cannot. That’s addiction. “Where’s the evidence, Connie?” Well, I don’t have it. And I can’t find that many others do, either. I did find a “scholarly article” from 2013 of a study of 652 adults from the general population in Newfoundland, in which the prevalence of “food addiction” was 5.4%. The majority of other “scholarly articles” that even discuss food addition focus primarily on Binge Eating Disorder or the “neurobiology” of food addiction. Often the conclusions are similar: professionals differ on their beliefs about the idea of whether or not “food addiction” is real. Ask your patients. They believe food addiction is real. So if, at the professional meetings, we can only discuss food addiction based on the “research,” it seems we are limited to debating the existence of food addiction, or to sharing the percentage of “food addicts” in Newfoundland. How, then, are we supposed to talk to professionals about the myriad of non-scientifically-researched REAL issues that patients experience in their REAL lives? I’m frustrated. Bariatric Realities is my new outlet. I will talk in REAL language about the REAL issues experienced by the REAL patients I work with all day long. I hope it will get others talking! Share your REAL thoughts, feelings and observations with me and other readers! THANKS! The NEXT TOPIC for Bariatric Realities: Genetics and Sources of Weight Problems – What ARE You Accountable for? Connie Stapleton, PhD connie@conniestapletonphd.com Facebook: Connie Stapleton Twitter: @cstapletonphd LinkedIn: Connie Stapleton, PhD

I got a text this week from a former client who moved out of the state a while back. This woman, who I will call Mattie, had weight loss surgery four years ago. She lost the majority of her excess weight and has maintained that weight loss. She’s even had a baby and continues to maintain her weight loss! Mattie asked me a few questions. We exchanged a few texts before I told her I would send her an email with some thoughts. I was actually on the treadmill at the time and haven’t quite mastered accurate texting while hustling on the treadmill (and watching my guilty pleasure, The Young and The Restless) while I walk! Here’s how our messages went... I got a text this week from a former client who moved out of the state a while back. This woman, who I will call Mattie, had weight loss surgery four years ago. She lost the majority of her excess weight and has maintained that weight loss. She’s even had a baby and continues to maintain her weight loss! Mattie asked me a few questions. We exchanged a few texts before I told her I would send her an email with some thoughts. I was actually on the treadmill at the time and haven’t quite mastered accurate texting while hustling on the treadmill (and watching my guilty pleasure, The Young and The Restless) while I walk! Here’s how our messages went: Mattie: “I want your professional opinion… Orthorexia nervosa and body dysmorphia… real or not real?” I honestly had never heard of orthorexia nervosa, so, while contemplating whether or not I like the new actor playing Billy Abbot, I looked up orthorexia nervosa. Here’s the definition from the National Eating Disorders Association (https://www.nationaleatingdisorders.org/orthorexia-nervosa): “Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake. Body dysmorphia, just to get the formal definitions over with, is a clinical diagnosis in the Diagnostic and Statistical Manual (DSM V), the guidebook used by psychiatrists, psychologists, and other health care professionals. People who have Body Dysmorphic Disorder are: “preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance.” Keep in mind that the emphasis is on nonexistent or slight defects, not something that is clearly visible. “‘Preoccupation’ is usually operationalized as thinking about the perceived defects for at least an hour a day… The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” “At some point, the individual must perform repetitive, compulsive behaviors in response to the appearance concerns. These compulsions can be behavioral and thus observed by others – for example, mirror checking, excessive grooming, skin picking, reassurance seeking, or clothes changing. Other BDD compulsions are mental acts – such as comparing one’s appearance with that of other people.” Now that you know what we’re talking about, I’ll continue with our text conversation. In response to Mattie’s question about whether or not orthorexia nervosa and body dysmorphia are real, I responded: “Yes, real.” Mattie: “Thank you.” Me: J J J J Mattie: “I’ve been doing a lot of research on eating disorders and the psychological issues that come with them when I came across these. Me: Do you think you have those issues? Mattie: I don’t know. I think I may but I feel crazy saying that. I need to do some more research to know for sure but from everything I’m reading it describes me pretty well. I seem to have gone to the opposite extreme from where I was three years ago. Me: That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum. Mattie: That’s what I’m scared of. Me: Yeah, but you would not be exploring it if you weren’t willing to work on things. Mattie: Very true. I just feel like it’s all in my head but then again, not. It’s deeper than just my thoughts. It’s almost like these other little voices outside of myself telling me what to think and how to act. Me: What are the voices saying and whose voices are you hearing? Mattie: They are mine and the voices of lots of other people I have known throughout my whole life. Most of the time they are just telling me whatever I do isn’t good enough and that I have to do more. No matter what, don’t mess up because it’s impossible to undo. All my flaws are being pointed out along with the mistakes I make and how much I still need to do. Last week I had a full-blown panic attack because I ate some rice with my meal and felt like I could feel it going through my system and turning into fatter things and a big old stomach. After I finally calmed down I ended up at the gym doing cardio for 2 ½ hours. Stuff like that happens more than I care to admit. Sometimes when I think about it I freak out so much I actually get sick. All of this makes me wonder if the surgery wasn’t the result of my brain saying ‘you should do this because it will make you prettier and healthier.’” Me: I’ll email you… too much to say and I’m on the treadmill. I also didn’t want to miss finding out if Billy was in cahoots with Phyllis or if he was backing out of their deal… The more I thought about all I wanted to say to Mattie, the more I decided others would benefit from the information. I’m certain she’s not the only one struggling with many of the issues she brought up. To begin with, a great many people who have weight loss surgery find themselves engaging in behaviors that are unhealthy two to three years later. I’ve worked with patients who start drinking excessively, shopping themselves into financial distress, sleeping with people they don’t even want to be sleeping with, abusing/becoming dependent on pain medication, returning to unhealthy eating behaviors and starting to regain weight, spending too many hours exercising, behaving in other forms of bulimic behavior, engaging in anorexic behavior, and, I now learn from Mattie, orthorexia nervosa. It’s fairly predictable. For the first year to 18 months, people are thrilled because they are losing the weight they struggled to shed for so long. It’s exhilarating to see the results they so longed for. It is an exciting time and the body is doing what it is supposed to do following the surgery. As the body heals and weight stabilizes, sometimes people begin to engage in behaviors they may not even understand themselves. So what is the explanation for a return to eating unhealthy food in spite of knowing the misery of having been morbidly obese and experiencing significant health issues as a result? What sense does it make to become anorexic or orthorexic or alcoholic or a shopaholic or to engage in any sort of behavior to the point it creates problems in your life? To mental health professionals, it makes perfect sense. We understand that for many people who struggle with weight issues, there is emotional baggage beneath the surface. Weight loss surgery doesn’t treat “head issues.” When people have weight loss surgery, they lose the option (at least for a time) to use food as a coping mechanism, an attempt to avoid dealing with things that are under the surface. Mattie was quick to point out what is at the heart of the real problems, the issues underlying one’s weight and focus on food… it’s the voices of various people from your past who have told you things similar to what Mattie continues to hear in her head: You could have done better. You could have done more. You got all A’s but one B… why wasn’t that an A? Why can’t you be more like your sister? If you keep gaining weight, no one will marry you. You’ll never amount to anything. It’ll just never be ‘good enough.’ Mattie made it clear that it’s not just the voices of others she hears, but also her own. There’s a simple reason for this: Children learn what they live…and then they live what they learned. The negative messages you heard about yourself from others as you were growing up are what you learned as you grew up. Every time you repeat those messages to yourself in the present, you are living what you learned. As an adult, you’re reinforcing to yourself the negative things you initially heard from others about you. The solution? Simple – yet very difficult! You have to make a commitment to yourself to no longer talk to yourself about yourself in negative terms. Even if you don’t believe yourself at first. And you have to put a lot of effort into changing and restating the negative messages you repeat about yourself so they are at least neutral: · You could have done better. o When you hear this message, change it to, “Maybe I could have done better, and yet I can’t change the outcome of this situation. I’ll think about what more I might be able to do the next time this situation arises.” · You could have done more. o When you hear this message, change it to, “There’s probably always more that could be done in a given situation. That’s as much effort as I was willing to put into this situation at this time.” · You got all A’s but one B… why wasn’t that an A? o When you hear this message, change it to, “Perfection doesn’t exist, nor did I want to put forth the effort for that particular endeavor. I’m pleased with the results.” · Why can’t you be more like your sister? o When you hear this message, change it to, “I can’t be more like her because we are different people and I’m learning to like myself just fine.” · If you keep gaining weight, no one will marry you. o When you hear this message, change it to, “I’m learning to accept myself the way I am and I don’t want to marry or have close relationships with anyone who doesn’t accept me as I am.” · You’ll never amount to anything. o When you hear this message, change it to, “Never amount to anything according to whom? I’m becoming more and more comfortable with who I am and what I want in life. That’s what matters.” · It’ll just never be ‘good enough.’ o When you hear this message, change it to, “I’ve come to terms that I am, indeed, ‘good enough,’ and I like myself this way.” What makes this different is that people say, “I tried, but it doesn’t work.” Well, keep trying. The reality is you are battling years of negative messages and your brain has literally developed neural pathways so you slip back into those well-worn paths quite easily. In order to develop new neural pathways that are more optimistic toward self, it will also take thousands of repetitions. If you were learning to speak a completely foreign language, it would take days and weeks and months of repetition before the new language would come easily. It’s the same thing with positive self-talk. The good news is, you can benefit from positive changes as soon as you start talking better about yourself. Remember, no one is putting you down at this point in your life except you. (If there are others degrading you, then you need to learn healthy boundaries and tell those people to stop and/or get them out of your life.) The negative self-talk is part of the deal and changing that is a huge part of the solution. But, WAIT – there’s MORE! Of course there is! There’s actually a lot more, but this is supposed to be a short article, which it already isn’t. Therefore, I will only address one more essential issue related to weight regain and/or the transfer to another unhealthy behavior after weight loss surgery. In Mattie’s case, the transfer has been to a rigid attitude about eating healthy foods, feeling tremendously guilty if she eats anything but healthy foods, followed up by a form of bulimia known as exercise bulimia, as evidenced by her working out for 2 ½ hours after eating some rice. Regardless of what unhealthy behavior a person switches to following weight loss surgery, what needs to be addressed is the purpose the behavior serves. This points, also, to looking at what purpose food and/or obesity served prior to weight loss surgery. Simply stated, an almost obsessive focus on food, whether that is thinking about what one is going to eat next, pouring over recipes, relentless counting of calories and grams, watching every show on the Food Network, exercising excessively, obsessing about healthy foods, is a coping skill. In the adult world, people are capable of learning and understanding that these eating and food-related behaviors are unhealthy in that they negatively affect health and relationships. The reasons people remain engaged in these negative behaviors, in spite of knowing they are detrimental to their physical, emotional and relational health include the possibilities that: 1) they have addictions (to food, or other substances/behaviors), and weight loss surgery does NOT treat food addiction, 2) they are tremendously afraid of feeling their own feelings and are terrified of dealing with past emotional issues; what’s more, people often deny having any past issues they need to deal with in the first place. Trust me… we all do. Every human being has had some painful experiences in their lives. People are terrified of what I call cleaning out their emotional closets because they literally fear experiencing feelings. Here’s why: when people experience feelings from past losses and hurts, they feel it with the same intensity at which they felt it at the age they were when it happened. That frightens adults and they avoid dealing with their past at all costs. And these costs can be high; anyone who has had weight loss surgery understands the physical and emotional costs that being obese bears. Here’s the deal: if people don’t dig into whatever they are avoiding emotionally, or address any addictions head on, and if they don’t learn healthy adult coping skills, communication skills, and how to set healthy boundaries, then they WILL switch to another unhealthy behavior to use a coping skill (another name for avoiding reality and feelings). In Mattie’s case, she swung to the opposite end of the eating continuum. Either end of an issue often means the person is just acting out the same unhealthy coping skill in the opposite way. You often hear of people who are not at all religious becoming overly immersed in a religion. Same problems… just acting them out in opposite ways. Hence, my response to Mattie as she described “having gone to the opposite extreme” with her eating behavior, when I said, “That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum.” My suggestion to Mattie and to anyone else who is engaging in any disordered eating behaviors, anyone who has regained weight, and anyone who has begun engaging in other addictive or unhealthy behaviors following weight loss surgery: Get into individual and/or group therapy with a therapist who understands “family systems” counseling and/or addiction counseling. Talk about issues underlying your addiction to food (your emotional dependency on food), any losses you experienced throughout your life that you haven’t dealt with, and any trauma/abuse you have experienced at any time in your life. Work with a therapist to learn and develop healthy coping skills to implement into your adult life, how to implement healthy boundaries in your adult life, with yourself and with others, and learn healthy communication skills. Read about these same topics, and add to the reading list the topic of “re-parenting the self.” Orthorexia nervosa and body dysmorphia are real, as are bulimia and food addiction and transfer addiction. Weight loss surgery can inadvertently open the door for these problematic behaviors. Do what I always tell people to do: Get Help and Get Happier! Thank you, Mattie for bringing these topics up to me. I hope this has helped you and many others! Oh – and by the way, I’ve decided I like the new Billy Abbot… so far! 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

Here’s how our messages went... I got a text this week from a former client who moved out of the state a while back. This woman, who I will call Mattie, had weight loss surgery four years ago. She lost the majority of her excess weight and has maintained that weight loss. She’s even had a baby and continues to maintain her weight loss! Mattie asked me a few questions. We exchanged a few texts before I told her I would send her an email with some thoughts. I was actually on the treadmill at the time and haven’t quite mastered accurate texting while hustling on the treadmill (and watching my guilty pleasure, The Young and The Restless) while I walk! Here’s how our messages went: Mattie: “I want your professional opinion… Orthorexia nervosa and body dysmorphia… real or not real?” I honestly had never heard of orthorexia nervosa, so, while contemplating whether or not I like the new actor playing Billy Abbot, I looked up orthorexia nervosa. Here’s the definition from the National Eating Disorders Association (https://www.nationaleatingdisorders.org/orthorexia-nervosa): “Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake. Body dysmorphia, just to get the formal definitions over with, is a clinical diagnosis in the Diagnostic and Statistical Manual (DSM V), the guidebook used by psychiatrists, psychologists, and other health care professionals. People who have Body Dysmorphic Disorder are: “preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance.” Keep in mind that the emphasis is on nonexistent or slight defects, not something that is clearly visible. “‘Preoccupation’ is usually operationalized as thinking about the perceived defects for at least an hour a day… The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” “At some point, the individual must perform repetitive, compulsive behaviors in response to the appearance concerns. These compulsions can be behavioral and thus observed by others – for example, mirror checking, excessive grooming, skin picking, reassurance seeking, or clothes changing. Other BDD compulsions are mental acts – such as comparing one’s appearance with that of other people.” Now that you know what we’re talking about, I’ll continue with our text conversation. In response to Mattie’s question about whether or not orthorexia nervosa and body dysmorphia are real, I responded: “Yes, real.” Mattie: “Thank you.” Me: J J J J Mattie: “I’ve been doing a lot of research on eating disorders and the psychological issues that come with them when I came across these. Me: Do you think you have those issues? Mattie: I don’t know. I think I may but I feel crazy saying that. I need to do some more research to know for sure but from everything I’m reading it describes me pretty well. I seem to have gone to the opposite extreme from where I was three years ago. Me: That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum. Mattie: That’s what I’m scared of. Me: Yeah, but you would not be exploring it if you weren’t willing to work on things. Mattie: Very true. I just feel like it’s all in my head but then again, not. It’s deeper than just my thoughts. It’s almost like these other little voices outside of myself telling me what to think and how to act. Me: What are the voices saying and whose voices are you hearing? Mattie: They are mine and the voices of lots of other people I have known throughout my whole life. Most of the time they are just telling me whatever I do isn’t good enough and that I have to do more. No matter what, don’t mess up because it’s impossible to undo. All my flaws are being pointed out along with the mistakes I make and how much I still need to do. Last week I had a full-blown panic attack because I ate some rice with my meal and felt like I could feel it going through my system and turning into fatter things and a big old stomach. After I finally calmed down I ended up at the gym doing cardio for 2 ½ hours. Stuff like that happens more than I care to admit. Sometimes when I think about it I freak out so much I actually get sick. All of this makes me wonder if the surgery wasn’t the result of my brain saying ‘you should do this because it will make you prettier and healthier.’” Me: I’ll email you… too much to say and I’m on the treadmill. I also didn’t want to miss finding out if Billy was in cahoots with Phyllis or if he was backing out of their deal… The more I thought about all I wanted to say to Mattie, the more I decided others would benefit from the information. I’m certain she’s not the only one struggling with many of the issues she brought up. To begin with, a great many people who have weight loss surgery find themselves engaging in behaviors that are unhealthy two to three years later. I’ve worked with patients who start drinking excessively, shopping themselves into financial distress, sleeping with people they don’t even want to be sleeping with, abusing/becoming dependent on pain medication, returning to unhealthy eating behaviors and starting to regain weight, spending too many hours exercising, behaving in other forms of bulimic behavior, engaging in anorexic behavior, and, I now learn from Mattie, orthorexia nervosa. It’s fairly predictable. For the first year to 18 months, people are thrilled because they are losing the weight they struggled to shed for so long. It’s exhilarating to see the results they so longed for. It is an exciting time and the body is doing what it is supposed to do following the surgery. As the body heals and weight stabilizes, sometimes people begin to engage in behaviors they may not even understand themselves. So what is the explanation for a return to eating unhealthy food in spite of knowing the misery of having been morbidly obese and experiencing significant health issues as a result? What sense does it make to become anorexic or orthorexic or alcoholic or a shopaholic or to engage in any sort of behavior to the point it creates problems in your life? To mental health professionals, it makes perfect sense. We understand that for many people who struggle with weight issues, there is emotional baggage beneath the surface. Weight loss surgery doesn’t treat “head issues.” When people have weight loss surgery, they lose the option (at least for a time) to use food as a coping mechanism, an attempt to avoid dealing with things that are under the surface. Mattie was quick to point out what is at the heart of the real problems, the issues underlying one’s weight and focus on food… it’s the voices of various people from your past who have told you things similar to what Mattie continues to hear in her head: You could have done better. You could have done more. You got all A’s but one B… why wasn’t that an A? Why can’t you be more like your sister? If you keep gaining weight, no one will marry you. You’ll never amount to anything. It’ll just never be ‘good enough.’ Mattie made it clear that it’s not just the voices of others she hears, but also her own. There’s a simple reason for this: Children learn what they live…and then they live what they learned. The negative messages you heard about yourself from others as you were growing up are what you learned as you grew up. Every time you repeat those messages to yourself in the present, you are living what you learned. As an adult, you’re reinforcing to yourself the negative things you initially heard from others about you. The solution? Simple – yet very difficult! You have to make a commitment to yourself to no longer talk to yourself about yourself in negative terms. Even if you don’t believe yourself at first. And you have to put a lot of effort into changing and restating the negative messages you repeat about yourself so they are at least neutral: · You could have done better. o When you hear this message, change it to, “Maybe I could have done better, and yet I can’t change the outcome of this situation. I’ll think about what more I might be able to do the next time this situation arises.” · You could have done more. o When you hear this message, change it to, “There’s probably always more that could be done in a given situation. That’s as much effort as I was willing to put into this situation at this time.” · You got all A’s but one B… why wasn’t that an A? o When you hear this message, change it to, “Perfection doesn’t exist, nor did I want to put forth the effort for that particular endeavor. I’m pleased with the results.” · Why can’t you be more like your sister? o When you hear this message, change it to, “I can’t be more like her because we are different people and I’m learning to like myself just fine.” · If you keep gaining weight, no one will marry you. o When you hear this message, change it to, “I’m learning to accept myself the way I am and I don’t want to marry or have close relationships with anyone who doesn’t accept me as I am.” · You’ll never amount to anything. o When you hear this message, change it to, “Never amount to anything according to whom? I’m becoming more and more comfortable with who I am and what I want in life. That’s what matters.” · It’ll just never be ‘good enough.’ o When you hear this message, change it to, “I’ve come to terms that I am, indeed, ‘good enough,’ and I like myself this way.” What makes this different is that people say, “I tried, but it doesn’t work.” Well, keep trying. The reality is you are battling years of negative messages and your brain has literally developed neural pathways so you slip back into those well-worn paths quite easily. In order to develop new neural pathways that are more optimistic toward self, it will also take thousands of repetitions. If you were learning to speak a completely foreign language, it would take days and weeks and months of repetition before the new language would come easily. It’s the same thing with positive self-talk. The good news is, you can benefit from positive changes as soon as you start talking better about yourself. Remember, no one is putting you down at this point in your life except you. (If there are others degrading you, then you need to learn healthy boundaries and tell those people to stop and/or get them out of your life.) The negative self-talk is part of the deal and changing that is a huge part of the solution. But, WAIT – there’s MORE! Of course there is! There’s actually a lot more, but this is supposed to be a short article, which it already isn’t. Therefore, I will only address one more essential issue related to weight regain and/or the transfer to another unhealthy behavior after weight loss surgery. In Mattie’s case, the transfer has been to a rigid attitude about eating healthy foods, feeling tremendously guilty if she eats anything but healthy foods, followed up by a form of bulimia known as exercise bulimia, as evidenced by her working out for 2 ½ hours after eating some rice. Regardless of what unhealthy behavior a person switches to following weight loss surgery, what needs to be addressed is the purpose the behavior serves. This points, also, to looking at what purpose food and/or obesity served prior to weight loss surgery. Simply stated, an almost obsessive focus on food, whether that is thinking about what one is going to eat next, pouring over recipes, relentless counting of calories and grams, watching every show on the Food Network, exercising excessively, obsessing about healthy foods, is a coping skill. In the adult world, people are capable of learning and understanding that these eating and food-related behaviors are unhealthy in that they negatively affect health and relationships. The reasons people remain engaged in these negative behaviors, in spite of knowing they are detrimental to their physical, emotional and relational health include the possibilities that: 1) they have addictions (to food, or other substances/behaviors), and weight loss surgery does NOT treat food addiction, 2) they are tremendously afraid of feeling their own feelings and are terrified of dealing with past emotional issues; what’s more, people often deny having any past issues they need to deal with in the first place. Trust me… we all do. Every human being has had some painful experiences in their lives. People are terrified of what I call cleaning out their emotional closets because they literally fear experiencing feelings. Here’s why: when people experience feelings from past losses and hurts, they feel it with the same intensity at which they felt it at the age they were when it happened. That frightens adults and they avoid dealing with their past at all costs. And these costs can be high; anyone who has had weight loss surgery understands the physical and emotional costs that being obese bears. Here’s the deal: if people don’t dig into whatever they are avoiding emotionally, or address any addictions head on, and if they don’t learn healthy adult coping skills, communication skills, and how to set healthy boundaries, then they WILL switch to another unhealthy behavior to use a coping skill (another name for avoiding reality and feelings). In Mattie’s case, she swung to the opposite end of the eating continuum. Either end of an issue often means the person is just acting out the same unhealthy coping skill in the opposite way. You often hear of people who are not at all religious becoming overly immersed in a religion. Same problems… just acting them out in opposite ways. Hence, my response to Mattie as she described “having gone to the opposite extreme” with her eating behavior, when I said, “That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum.” My suggestion to Mattie and to anyone else who is engaging in any disordered eating behaviors, anyone who has regained weight, and anyone who has begun engaging in other addictive or unhealthy behaviors following weight loss surgery: Get into individual and/or group therapy with a therapist who understands “family systems” counseling and/or addiction counseling. Talk about issues underlying your addiction to food (your emotional dependency on food), any losses you experienced throughout your life that you haven’t dealt with, and any trauma/abuse you have experienced at any time in your life. Work with a therapist to learn and develop healthy coping skills to implement into your adult life, how to implement healthy boundaries in your adult life, with yourself and with others, and learn healthy communication skills. Read about these same topics, and add to the reading list the topic of “re-parenting the self.” Orthorexia nervosa and body dysmorphia are real, as are bulimia and food addiction and transfer addiction. Weight loss surgery can inadvertently open the door for these problematic behaviors. Do what I always tell people to do: Get Help and Get Happier! Thank you, Mattie for bringing these topics up to me. I hope this has helped you and many others! Oh – and by the way, I’ve decided I like the new Billy Abbot… so far! 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

Quit dancing around the subject and start using the STAPLE ingredient in the Recipe for Recovery: COMMITMENT. If you're guilty of doing the RECOVERY HOKEY POKEY, it's time to put your WHOLE SELF IN! The Recovery Hokey Pokey You put your right thigh in. You put your right thigh out. You put your right thigh in… and it jiggles all about… You do recovery hokey pokey and it turns you inside out Yhat’s what it’s all about! Weight loss. There’s simply nothing like it. The pounds come off. You feel great. People notice how much “better” you look. The scale is showing numbers you haven’t seen since high school. And then…it stops. Everything stops. The great feeing…the compliments…the scale. Maybe this “losing weight” thing isn’t all it’s cracked up to be after all. What happens when all the excitement fades? What happens to the motivation? What happens to that “high” you felt when you jumped out of bed to greet the day each morning at the beginning of the weight loss adventure? What happens to the excitement of doing exercises you’ve never been able to do before? Oh – reality! Yes, reality and the ordinariness of life sets in and now you don’t feel so inspired to do the things you need to do to get what you say you want. You know – improved health and a better quality of life. Those are the reasons most people (initially) state as their reasons for having weight loss surgery. “I don’t think I’ll work out today because…I’m tired and deserve to sleep-in.” “Maybe I’ll workout tonight, after work, when the kids are asleep.” “Gosh! I had a long day, and the kids are down…maybe I should get some sleep while I can. I’ll exercise in the morning.” “You know, I haven’t eaten anything ‘bad’ in a long time; I ‘deserve’ a little treat for all of my hard work. I’ll just have a little bowl of something sweet.” “I’m really hungry. Maybe I’ll just eat the other half.” “Who brought the donuts? I wonder if there’s a “plain” one in there…that wouldn’t be so bad.” Sound familiar? Your enthusiasm wanes, then your motivation flies out the window, and whammo! You’ve lost enthusiasm for the commitment you made to your healthy recovery. What happened? What is commitment, anyway? A commitment is a promise you make to yourself to do something or to be loyal to someone or something. We love the definition of commitment from Urban Dictionary: “Commitment is what transforms the promise into reality. It is the words that speak boldly of your intentions. And the actions which speak louder than the words. It is making the time when there is none. Coming through time after time after time, year after year after year. Commitment is the stuff character is made of; The power to change the face of things. It is the daily triumph of integrity over skepticism.” by Ashbash January 13, 2005 Your commitment to living a healthy lifestyle can be a promise you make to yourself, to your children, or to your entire family. Commitments that you write down and share with others are more likely to be maintained. Stating your commitment to your healthy lifestyle every day (out loud is best) will remind you of the promises you made to follow through with the behaviors that result in improved health and a better quality of life – the reasons you chose to have weight loss surgery. SO – when you wake up each morning, maybe sing this version of the Recovery Hokey Pokey: I put my whole self in. I put my old habits out. I put my best effort in… And I get good results out! I stop recovery hokey pokey – And I get rid of all self-doubt! THAT’s what it’s all about! Are you singing the Blues or Happy Days in your Recovery? Tune into the June APODCast on June 17, and you just might hear The Doc might sing The Recovery Hokey Pokey.

The Recovery Hokey Pokey You put your right thigh in. You put your right thigh out. You put your right thigh in… and it jiggles all about… You do recovery hokey pokey and it turns you inside out Yhat’s what it’s all about! Weight loss. There’s simply nothing like it. The pounds come off. You feel great. People notice how much “better” you look. The scale is showing numbers you haven’t seen since high school. And then…it stops. Everything stops. The great feeing…the compliments…the scale. Maybe this “losing weight” thing isn’t all it’s cracked up to be after all. What happens when all the excitement fades? What happens to the motivation? What happens to that “high” you felt when you jumped out of bed to greet the day each morning at the beginning of the weight loss adventure? What happens to the excitement of doing exercises you’ve never been able to do before? Oh – reality! Yes, reality and the ordinariness of life sets in and now you don’t feel so inspired to do the things you need to do to get what you say you want. You know – improved health and a better quality of life. Those are the reasons most people (initially) state as their reasons for having weight loss surgery. “I don’t think I’ll work out today because…I’m tired and deserve to sleep-in.” “Maybe I’ll workout tonight, after work, when the kids are asleep.” “Gosh! I had a long day, and the kids are down…maybe I should get some sleep while I can. I’ll exercise in the morning.” “You know, I haven’t eaten anything ‘bad’ in a long time; I ‘deserve’ a little treat for all of my hard work. I’ll just have a little bowl of something sweet.” “I’m really hungry. Maybe I’ll just eat the other half.” “Who brought the donuts? I wonder if there’s a “plain” one in there…that wouldn’t be so bad.” Sound familiar? Your enthusiasm wanes, then your motivation flies out the window, and whammo! You’ve lost enthusiasm for the commitment you made to your healthy recovery. What happened? What is commitment, anyway? A commitment is a promise you make to yourself to do something or to be loyal to someone or something. We love the definition of commitment from Urban Dictionary: “Commitment is what transforms the promise into reality. It is the words that speak boldly of your intentions. And the actions which speak louder than the words. It is making the time when there is none. Coming through time after time after time, year after year after year. Commitment is the stuff character is made of; The power to change the face of things. It is the daily triumph of integrity over skepticism.” by Ashbash January 13, 2005 Your commitment to living a healthy lifestyle can be a promise you make to yourself, to your children, or to your entire family. Commitments that you write down and share with others are more likely to be maintained. Stating your commitment to your healthy lifestyle every day (out loud is best) will remind you of the promises you made to follow through with the behaviors that result in improved health and a better quality of life – the reasons you chose to have weight loss surgery. SO – when you wake up each morning, maybe sing this version of the Recovery Hokey Pokey: I put my whole self in. I put my old habits out. I put my best effort in… And I get good results out! I stop recovery hokey pokey – And I get rid of all self-doubt! THAT’s what it’s all about! Are you singing the Blues or Happy Days in your Recovery? Tune into the June APODCast on June 17, and you just might hear The Doc might sing The Recovery Hokey Pokey.

Attitudes come in all sorts of “flavors,” including the obvious, of course: a positive attitude or a negative attitude. Some attitudes might be considered rather bland: cooperative, compliant and tolerant. What flavor is your attitude? Are you complacent, entitled, enthusiastic, apathetic, grateful, superior, confident, hostile, cautious, suspicious, inferior, sincere, persistent, flexible, decisive, humble, jealous, judgmental, courteous, competitive, gloomy, sarcastic, sympathetic, cynical, critical, caring, earnest, jovial, hopeful? How important has your attitude been to your journey in your Recovery From Obesity? Recovery from obesity is both a set of behaviors and a mindset (ATTITUDE) about your health, your sense of self worth, and your willingness to do what it takes to have the health you want and to feel about yourself the way you want to feel about yourself. ATTITUDE IS THE FLAVORFUL INGREDIENT IN THE RECIPE FOR RECOVERY and it makes all the difference in how you approach your Recovery from Obesity. Your ATTITUDE also influences how you choose to use the other ingredients in the Recipe for Recovery: Awareness, Acceptance, Commitment, Accountability and Effort Attitudes come in all sorts of “flavors,” including the obvious, of course: a positive attitude or a negative attitude. Some attitudes might be considered rather bland: cooperative, compliant and tolerant. These are desirable attitudes, in most cases, and yet some people may not consider them to be very flavorful. On the other hand, a sassy attitude, an exuberant attitude, and a highly determined attitude may be considered a bit more “flavorful.” In some Zumba classes, the instructor encourages participants to add some personal “flavor” to their moves! What flavor is your attitude? Are you complacent, entitled, enthusiastic, apathetic, grateful, superior, confident, hostile, cautious, suspicious, inferior, sincere, persistent, flexible, decisive, humble, jealous, judgmental, courteous, competitive, gloomy, sarcastic, sympathetic, cynical, critical, caring, earnest, jovial, hopeful? How important has your attitude been to your journey in your Recovery From Obesity? Recovery from obesity is both a set of behaviors and a mindset (ATTITUDE) about your health, your sense of self worth, and your willingness to do what it takes to have the health you want and to feel about yourself the way you want to feel about yourself. Attitude is the FLAVORFUL ingredient in A Post Op & A Doc’s RECIPE for Recovery from Obesity. You choose your attitude throughout the day and your attitude most certainly can add flavor to any given moment, whether that is specifically related to the food/weight loss aspects of your Recovery from Obesity or the non-food aspects of your Recovery. Examples of attitude and food/weight aspects of Recovery from Obesity: SCENARIO 1: The boss brings pizza, hot dogs, chips, brownies and every variety of sugary drink you can imagine for a Memorial Day office picnic. You choose the flavor or your attitude (keeping in mind what your behavior will likely be in response to the flavor of your attitude)! A HOSTILE Attitude: “What a jerk, bringing in all kinds of junk food. Doesn’t she care about the health of her employees? And look at them…they know I’m not supposed to have that kind of crap and yet they bring their plates heaped with food with them to chat with me. How rude!” A DECISIVE Attitude: “Okay, so it's not the kind of picnic I like to attend these days, but it doesn’t matter what food is served. Anywhere I go, I am prepared with a protein bar and a protein drink. I’m glad for the camaraderie with my co-workers! And I’ll be grateful for feeling good about my choices!" SCENARIO 2: You are scheduled to meet your personal trainer in 30 minutes. You are comfortably settled in on your couch watching a favorite TV program when you notice the time and realize you need to get moving in order to be there on time. You choose the flavor or your attitude (keeping in mind what your behavior will likely be in response to the flavor of your attitude)! A COMPLACENT Attitude: “Ah… I’ve already paid for the sessions. I can skip one. I’ll let him know I’m not gonna make it tonight. He’ll probably be glad to get to go home early.” An ENTHUSIASTIC Attitude: “You know what? It might be nice to stay home and relax tonight but I made up my mind to get and STAY healthier. Exercise is part of the Recipe for Success, so I’m gonna get moving so I’m there on time.” An ENTHUSIASTIC Attitude: “Well! It might be nice to stay home and relax tonight but I made up my mind to get and STAY healthier. Exercise is part of the Recipe for Success, so I’m gonna get moving so I’m there on time.” Examples of attitude and non-food aspects of Recovery from Obesity: SCENARIO 1: Your sister-in-law, herself overweight, continues to make negative comments about your appearance since you’ve lost weight. A JUDGMENTAL Attitude: You think to yourself, “You just want me to feel bad so I regain some weight. You want me to feel badly about myself because you feel badly about yourself.” A HUMBLE Attitude: You think to yourself, “I feel sad listening to her make comments about my appearance. Before I lost weight, I would do that to others who had lost weight. It sure didn’t make me feel better and it doesn’t look like this is making her feel any better. I’ll talk to her about it later when all these people aren’t around.” SCENARIO 2: A close friend sits you down to share her observations with you. She tells you she is worried about you because you seem to be seeking attention in sexually inappropriate ways since you’ve lost so much weight. She is kind and compassionate as she shares this with you. A GRATEFUL Attitude: You thank her for sharing her observations with you, admitting you were enjoying some flirtatious attention but concerned that you might be giving messages you don’t intend to send. A CRITICAL Attitude. You tell her you know that she is saying those things to you because she is jealous that you are getting attention that she obviously wants. Just a thought: in all of the examples above, all of the negative attitudes were “A” and the positive attitudes were “B.” Perhaps consider switching these two. • • • ATTITUDE makes all the difference in how you approach your Recovery from Obesity. Your ATTITUDE also influences how you choose to use the other ingredients in the Recipe for Recovery: Awareness, Acceptance, Commitment, Accountability and Effort. Ultimately, your ATTITUDE has a large impact on your long-term success in managing a healthy weight and in how you approach life! It’s your choice as to how to use the ingredients in the Recipe for Recovery! Choose wisely!

Attitudes come in all sorts of “flavors,” including the obvious, of course: a positive attitude or a negative attitude. Some attitudes might be considered rather bland: cooperative, compliant and tolerant. These are desirable attitudes, in most cases, and yet some people may not consider them to be very flavorful. On the other hand, a sassy attitude, an exuberant attitude, and a highly determined attitude may be considered a bit more “flavorful.” In some Zumba classes, the instructor encourages participants to add some personal “flavor” to their moves! What flavor is your attitude? Are you complacent, entitled, enthusiastic, apathetic, grateful, superior, confident, hostile, cautious, suspicious, inferior, sincere, persistent, flexible, decisive, humble, jealous, judgmental, courteous, competitive, gloomy, sarcastic, sympathetic, cynical, critical, caring, earnest, jovial, hopeful? How important has your attitude been to your journey in your Recovery From Obesity? Recovery from obesity is both a set of behaviors and a mindset (ATTITUDE) about your health, your sense of self worth, and your willingness to do what it takes to have the health you want and to feel about yourself the way you want to feel about yourself. Attitude is the FLAVORFUL ingredient in A Post Op & A Doc’s RECIPE for Recovery from Obesity. You choose your attitude throughout the day and your attitude most certainly can add flavor to any given moment, whether that is specifically related to the food/weight loss aspects of your Recovery from Obesity or the non-food aspects of your Recovery. Examples of attitude and food/weight aspects of Recovery from Obesity: SCENARIO 1: The boss brings pizza, hot dogs, chips, brownies and every variety of sugary drink you can imagine for a Memorial Day office picnic. You choose the flavor or your attitude (keeping in mind what your behavior will likely be in response to the flavor of your attitude)! A HOSTILE Attitude: “What a jerk, bringing in all kinds of junk food. Doesn’t she care about the health of her employees? And look at them…they know I’m not supposed to have that kind of crap and yet they bring their plates heaped with food with them to chat with me. How rude!” A DECISIVE Attitude: “Okay, so it's not the kind of picnic I like to attend these days, but it doesn’t matter what food is served. Anywhere I go, I am prepared with a protein bar and a protein drink. I’m glad for the camaraderie with my co-workers! And I’ll be grateful for feeling good about my choices!" SCENARIO 2: You are scheduled to meet your personal trainer in 30 minutes. You are comfortably settled in on your couch watching a favorite TV program when you notice the time and realize you need to get moving in order to be there on time. You choose the flavor or your attitude (keeping in mind what your behavior will likely be in response to the flavor of your attitude)! A COMPLACENT Attitude: “Ah… I’ve already paid for the sessions. I can skip one. I’ll let him know I’m not gonna make it tonight. He’ll probably be glad to get to go home early.” An ENTHUSIASTIC Attitude: “You know what? It might be nice to stay home and relax tonight but I made up my mind to get and STAY healthier. Exercise is part of the Recipe for Success, so I’m gonna get moving so I’m there on time.” An ENTHUSIASTIC Attitude: “Well! It might be nice to stay home and relax tonight but I made up my mind to get and STAY healthier. Exercise is part of the Recipe for Success, so I’m gonna get moving so I’m there on time.” Examples of attitude and non-food aspects of Recovery from Obesity: SCENARIO 1: Your sister-in-law, herself overweight, continues to make negative comments about your appearance since you’ve lost weight. A JUDGMENTAL Attitude: You think to yourself, “You just want me to feel bad so I regain some weight. You want me to feel badly about myself because you feel badly about yourself.” A HUMBLE Attitude: You think to yourself, “I feel sad listening to her make comments about my appearance. Before I lost weight, I would do that to others who had lost weight. It sure didn’t make me feel better and it doesn’t look like this is making her feel any better. I’ll talk to her about it later when all these people aren’t around.” SCENARIO 2: A close friend sits you down to share her observations with you. She tells you she is worried about you because you seem to be seeking attention in sexually inappropriate ways since you’ve lost so much weight. She is kind and compassionate as she shares this with you. A GRATEFUL Attitude: You thank her for sharing her observations with you, admitting you were enjoying some flirtatious attention but concerned that you might be giving messages you don’t intend to send. A CRITICAL Attitude. You tell her you know that she is saying those things to you because she is jealous that you are getting attention that she obviously wants. Just a thought: in all of the examples above, all of the negative attitudes were “A” and the positive attitudes were “B.” Perhaps consider switching these two. • • • ATTITUDE makes all the difference in how you approach your Recovery from Obesity. Your ATTITUDE also influences how you choose to use the other ingredients in the Recipe for Recovery: Awareness, Acceptance, Commitment, Accountability and Effort. Ultimately, your ATTITUDE has a large impact on your long-term success in managing a healthy weight and in how you approach life! It’s your choice as to how to use the ingredients in the Recipe for Recovery! Choose wisely!

Recovery from Obesity is a choice and, while your Recovery is unique, the ingredients in the Recipe for Recovery are not. What that means is, you determine what matters most in your life and then choose HOW to use the ingredients (Awareness, Acceptance, Commitment, Attitude, Accountability, and Effort) to live fully. Before we get much further, let’s explain what we mean by “Recovery from Obesity.” Is Recovery from Obesity… …being skinny? No. .,..a number on the scale? No. …being cured and never having to worry about weight again? No. Is Recovery improved health and quality of life? Yes. Recovery from Obesity is learning to live life on life’s terms by making the next wise choice one day at a time. Recovery from Obesity is following the Recipe for Recovery to live FULLY and become your healthiest physical, mental, emotional and spiritual self. You choose HOW to use the ingredients in the Recipe for Recovery to create your own healthy life! Recovery is a mindset, so it’s up to you to come to terms with the good, the bad and the ugly! THE POST-OP: My Recovery journey began when I lost weight (the good), but stalled when I came face-to-face with the realities of the disease of obesity and my compulsive overeating (the bad and the ugly). I wanted to be cured of obesity and hoped surgery would do the trick. I wanted to be “normal” and didn’t want to worry about gaining weight again. I quickly learned that there is no such thing as “normal” and had to decide whether I wanted to spend my life worrying about gaining weight, or managing my obesity. The choice was mine, and I chose Recovery, starting with AWARENESS of my disease. Since then, I have had to ACCEPT some difficult realities. Here are a few of the things I’ve learned to ACCEPT about myself: I ACCEPT that I do not have an “OFF” switch around certain foods. Once I start, I won’t stop until I am sick or run out of food. Therefore, I ACCEPT that those foods are off limits for me. Period. I ACCEPT that I have shrinkles on my belly, butt and legs. Needless to say, I choose not to wear a bikini. I ACCEPT that I cannot take anti-inflammatory meds (NSAIDs) to treat my joint pain because I had weight loss surgery and am prone to ulcers. I ACCEPT that I am susceptible to anemia and vitamin deficiency and must be vigilant about taking my iron and supplements. I ACCEPT that I don’t like to workout, but I know I have to if I want to be healthy. That’s the short list of stuff I had to come to terms with (ACCEPT) if I wanted what I said I wanted in my life – to live fully, free from the unhealthy obsession with food and weight. Of course, these are just “physical” things. Doc, what about the mental and emotional realities in Recovery? THE DOC: As Cari very often says, obesity is “all about the food but is not about the food.” Clearly, food is part of the problem when one is obese, and yet, obesity is so much more than just the food. For example, some people are “emotional eaters,” turning to food when they are upset, angry, bored, worried, etc. They eat in response to feelings. In this case, it’s not really about the food. Learning to deal with emotions in healthy ways is the issue! If you are an emotional eater, then choose to ACCEPT the following: ACCEPT that food is an unhealthy way to cope with feelings. ACCEPT that you may need to learn about healthy coping skills via reading books and articles or, you may need to attend therapy. ACCEPT that there may be unresolved issues related to the learned behavior of turning to food as a coping skill and ACCEPT that in order to live fully in Recovery from Obesity you will need to address those underlying issues. Relationships often change after a person loses a significant amount of weight. It can be difficult for both people in a relationship to deal with their thoughts and feelings related to the changes that seem to be brought about by weight loss. If you are struggling with relationships after losing weight, whether they are marital, friendship or family relationships: ACCEPT that changes in relationships are common after weight loss. ACCEPT that the changes need to be addressed openly and directly, that feelings need to be acknowledged and discussed, and that wants and needs change for people. ACCEPT that sometimes people need help from a professional to get through periods of significant change in relationships. “Self” often changes after weight loss surgery… self-esteem, self-image, and self-efficacy. Along with the changes in “self”: ACCEPT that these changes can affect one in positive ways and in potentially unhealthy ways. ACCEPT that others may accept or reject the changes, may celebrate or dismiss the changes, may change with your or may choose not to change. ACCEPT that you may feel uncomfortable with the changes as your body and mind adjust to them. People sometimes report being disillusioned about not being “happy” after losing weight, which they expected they would be. If this is the case for you: ACCEPT that “happiness” is an inside job and not based solely on your weight, size, appearance. ACCEPT that there are other aspects of yourself to explore including your personality traits, your talents, your interests, your behavior toward self and others. ACCEPT that “happiness” is closely related to your thoughts, then examine your thought patterns and ACCEPT that only YOU can choose if they will be positive or not! Obviously, we could write for days about how ACCEPTANCE of the “good, the bad and the ugly” is a necessary part of Recovery from Obesity. What do you need to ACCEPT in order to move closer to obtaining those things related to obesity that are the most meaningful to you? What do you need to ACCEPT that is directly about the food and what do you need to ACCEPT that is not directly related to food, but does affect your eating and exercise habits? Stick with the winners, get outside help when you need to, stay open-minded, use the ingredients of the Recipe for Recovery to live the healthy life you want…AND, be sure to join us daily on our Facebook page for ongoing motivation, education and inspiration. You can’t do this alone, and no one can do it for you!

Is Recovery from Obesity… …being skinny? No. .,..a number on the scale? No. …being cured and never having to worry about weight again? No. Is Recovery improved health and quality of life? Yes. Recovery from Obesity is learning to live life on life’s terms by making the next wise choice one day at a time. Recovery from Obesity is following the Recipe for Recovery to live FULLY and become your healthiest physical, mental, emotional and spiritual self. You choose HOW to use the ingredients in the Recipe for Recovery to create your own healthy life! Recovery is a mindset, so it’s up to you to come to terms with the good, the bad and the ugly! THE POST-OP: My Recovery journey began when I lost weight (the good), but stalled when I came face-to-face with the realities of the disease of obesity and my compulsive overeating (the bad and the ugly). I wanted to be cured of obesity and hoped surgery would do the trick. I wanted to be “normal” and didn’t want to worry about gaining weight again. I quickly learned that there is no such thing as “normal” and had to decide whether I wanted to spend my life worrying about gaining weight, or managing my obesity. The choice was mine, and I chose Recovery, starting with AWARENESS of my disease. Since then, I have had to ACCEPT some difficult realities. Here are a few of the things I’ve learned to ACCEPT about myself: I ACCEPT that I do not have an “OFF” switch around certain foods. Once I start, I won’t stop until I am sick or run out of food. Therefore, I ACCEPT that those foods are off limits for me. Period. I ACCEPT that I have shrinkles on my belly, butt and legs. Needless to say, I choose not to wear a bikini. I ACCEPT that I cannot take anti-inflammatory meds (NSAIDs) to treat my joint pain because I had weight loss surgery and am prone to ulcers. I ACCEPT that I am susceptible to anemia and vitamin deficiency and must be vigilant about taking my iron and supplements. I ACCEPT that I don’t like to workout, but I know I have to if I want to be healthy. That’s the short list of stuff I had to come to terms with (ACCEPT) if I wanted what I said I wanted in my life – to live fully, free from the unhealthy obsession with food and weight. Of course, these are just “physical” things. Doc, what about the mental and emotional realities in Recovery? THE DOC: As Cari very often says, obesity is “all about the food but is not about the food.” Clearly, food is part of the problem when one is obese, and yet, obesity is so much more than just the food. For example, some people are “emotional eaters,” turning to food when they are upset, angry, bored, worried, etc. They eat in response to feelings. In this case, it’s not really about the food. Learning to deal with emotions in healthy ways is the issue! If you are an emotional eater, then choose to ACCEPT the following: ACCEPT that food is an unhealthy way to cope with feelings. ACCEPT that you may need to learn about healthy coping skills via reading books and articles or, you may need to attend therapy. ACCEPT that there may be unresolved issues related to the learned behavior of turning to food as a coping skill and ACCEPT that in order to live fully in Recovery from Obesity you will need to address those underlying issues. Relationships often change after a person loses a significant amount of weight. It can be difficult for both people in a relationship to deal with their thoughts and feelings related to the changes that seem to be brought about by weight loss. If you are struggling with relationships after losing weight, whether they are marital, friendship or family relationships: ACCEPT that changes in relationships are common after weight loss. ACCEPT that the changes need to be addressed openly and directly, that feelings need to be acknowledged and discussed, and that wants and needs change for people. ACCEPT that sometimes people need help from a professional to get through periods of significant change in relationships. “Self” often changes after weight loss surgery… self-esteem, self-image, and self-efficacy. Along with the changes in “self”: ACCEPT that these changes can affect one in positive ways and in potentially unhealthy ways. ACCEPT that others may accept or reject the changes, may celebrate or dismiss the changes, may change with your or may choose not to change. ACCEPT that you may feel uncomfortable with the changes as your body and mind adjust to them. People sometimes report being disillusioned about not being “happy” after losing weight, which they expected they would be. If this is the case for you: ACCEPT that “happiness” is an inside job and not based solely on your weight, size, appearance. ACCEPT that there are other aspects of yourself to explore including your personality traits, your talents, your interests, your behavior toward self and others. ACCEPT that “happiness” is closely related to your thoughts, then examine your thought patterns and ACCEPT that only YOU can choose if they will be positive or not! Obviously, we could write for days about how ACCEPTANCE of the “good, the bad and the ugly” is a necessary part of Recovery from Obesity. What do you need to ACCEPT in order to move closer to obtaining those things related to obesity that are the most meaningful to you? What do you need to ACCEPT that is directly about the food and what do you need to ACCEPT that is not directly related to food, but does affect your eating and exercise habits? Stick with the winners, get outside help when you need to, stay open-minded, use the ingredients of the Recipe for Recovery to live the healthy life you want…AND, be sure to join us daily on our Facebook page for ongoing motivation, education and inspiration. You can’t do this alone, and no one can do it for you!

It’s not about the food, but it’s all about the food. Wait a minute -- if it’s not about the food, then why do we (the Post-Op & the Doc) keep talking about the RECIPE for Recovery? Don’t recipes involve food? Not always… Think about it: Don’t you have a recipe for success? How about a recipe for the perfect day? …A recipe for family fun? …A recipe for a natural spot remover? …A recipe for composting? What the…composting?! Remember, the Post-Op is from Southern California, where recycling is the law. Well – you may or may not be into recycling, but we’re pretty sure you’re into living fully. If you really want to live fully during and after the process of weight loss, then the RECIPE FOR RECOVERY is something you need! Over the course of the year, we are looking at ways you can combine the ingredients for the recipe (AWARENESS, ACCEPTANCE, COMMITMENT, ATTITUDE, ACCOUNTABILITY, and EFFORT) to create your very own, personal, healthy life in RECOVERY – from…whatever (obesity, unhealthy relationships, habits, and behaviors)! In last month’s article (Six Simple Ingredients to Get the Weight Off and Keep it Off) we introduced you to each of the ingredients in the RECIPE, and briefly discussed the how each is required to live fully in Recovery From Obesity. This month is all about the “essential” ingredient: AWARENESS. We refer to awareness as being “essential” because you have to become aware of problems (food and non-food related) needing attention in order to work on them…which can be tricky… After all, some things we are aware of and some things we might not be… AWARENESS of things we don’t like A food-related example: eating simple carbs usually results in weight gain [*]AWARENESS of things we may be powerless to stop A food-related example: what other people serve in their homes when we’re invited to a large dinner party A non-food-related example: how others react to our weight loss [*]AWARENESS of things that are scary A food-related example: knowing that many holidays mean tempting foods will be prevalent in the media, at work, etc. A non-food-related example: experiencing the feelings that accompany significant weight loss [*]AWARENESS of things that seem overwhelming A food-related example: avoiding unhealthy “treats” in the work break room A non-food-related example: beginning and maintaining a regular exercise program Fortunately, the RECIPE FOR RECOVERY is perfect for addressing all of those “things” – you know, those thoughts, feelings and behaviors that can distract us from making healthy changes in our lives. That’s precisely why we are presenting the recipe for you to follow! Note: We are deliberately using the verb phrase “to follow” in relation to the Recipe for Recovery because the success of the recipe in creating what it is intended to create requires your ACTION. In this case, the recipe is intended to help you create a healthy life that allows you to live fully at a healthy weight. Just how much “action” is required depends on what you say you want for your life! For example, You decide how much and what type of exercise you’ll do, depending on how physically fit you want to be. You decide how much and what type of food you’ll eat each day to manage the healthy weight you desire. You decide who you associate with and how much time you spend with those people to live as healthy an emotional life as you want to live. You get it! So, we’re clear that AWARENESS is the essential ingredient in the Recipe for Recovery because, well… nothing can be changed if you’re not AWARE that it needs to be changed. If you’re not aware that starches have little nutritional value, then you won’t reduce the number of starches you eat so you can maintain a healthy weight. If you aren’t aware that you have a habit of talking negatively about yourself and/or others, you can’t change it. If someone brings that negative habit to your attention, then you can make a decision about the type of person you want to be and put forth the effort and action needed to make those changes! Awareness IS the first step and the essential ingredient for change. AWARENESS without ACTION, however, is like a treadmill with a bunch of clothes hanging on it – you’re aware that the treadmill is there, but you aren’t using it. We are providing you with the ingredients to include awareness, but it’s up to you to put them into action. We know that being aware of things can be difficult and uncomfortable. This may be the reason so many people focus so much time and energy being aware of things in others rather than focusing on their own problematic behaviors! How often do we know what others must do to change? How much time to do we spend telling others how to fix their problems? We are aware that the neighbors need to mow and water their lawn, but happily ignore our own weeds! Hmm, that might be why one of the main tenets in the 12-Step Recovery world is: Sweep your own side of the street (mind your own business). If you’re more worried about what others are doing wrong, the first step is to become aware of your own “stuff.” To do that, turn those binoculars you’ve pointed at the neighbors directly around and look at yourself. You know, like the “selfie” button on your camera phone…uh, but this time, you don’t have to post your “self-examination” on Facebook! How do you begin to USE the essential ingredient, awareness? Well, if you’ve decided that you want to live fully in Recovery and want to follow the Recipe, we suggest you start by paying attention to your thoughts, feelings, and behaviors – especially when you eat. Start writing down the circumstances surrounding your eating and see if you spot trends. Remember to focus on yourself and what you need to do to live fully. Let others follow the recipe for themselves! Over the course of the next few weeks, we’ll be posting some questions on our Facebook wall to help you identify areas of your life that will benefit from healthy change, so be sure to check in regularly to A Post-Op & A Doc on Facebook. And join us on March 18th for our March APODCast, which will be all about AWARENESS. Be sure to RSVP…it’s totally free (http://www.spreecast.com/events/apodcast-awareness-essential-ingredient)!

Think about it: Don’t you have a recipe for success? How about a recipe for the perfect day? …A recipe for family fun? …A recipe for a natural spot remover? …A recipe for composting? What the…composting?! Remember, the Post-Op is from Southern California, where recycling is the law. Well – you may or may not be into recycling, but we’re pretty sure you’re into living fully. If you really want to live fully during and after the process of weight loss, then the RECIPE FOR RECOVERY is something you need! Over the course of the year, we are looking at ways you can combine the ingredients for the recipe (AWARENESS, ACCEPTANCE, COMMITMENT, ATTITUDE, ACCOUNTABILITY, and EFFORT) to create your very own, personal, healthy life in RECOVERY – from…whatever (obesity, unhealthy relationships, habits, and behaviors)! In last month’s article (Six Simple Ingredients to Get the Weight Off and Keep it Off) we introduced you to each of the ingredients in the RECIPE, and briefly discussed the how each is required to live fully in Recovery From Obesity. This month is all about the “essential” ingredient: AWARENESS. We refer to awareness as being “essential” because you have to become aware of problems (food and non-food related) needing attention in order to work on them…which can be tricky… After all, some things we are aware of and some things we might not be… AWARENESS of things we don’t like A food-related example: eating simple carbs usually results in weight gain [*]AWARENESS of things we may be powerless to stop A food-related example: what other people serve in their homes when we’re invited to a large dinner party A non-food-related example: how others react to our weight loss [*]AWARENESS of things that are scary A food-related example: knowing that many holidays mean tempting foods will be prevalent in the media, at work, etc. A non-food-related example: experiencing the feelings that accompany significant weight loss [*]AWARENESS of things that seem overwhelming A food-related example: avoiding unhealthy “treats” in the work break room A non-food-related example: beginning and maintaining a regular exercise program Fortunately, the RECIPE FOR RECOVERY is perfect for addressing all of those “things” – you know, those thoughts, feelings and behaviors that can distract us from making healthy changes in our lives. That’s precisely why we are presenting the recipe for you to follow! Note: We are deliberately using the verb phrase “to follow” in relation to the Recipe for Recovery because the success of the recipe in creating what it is intended to create requires your ACTION. In this case, the recipe is intended to help you create a healthy life that allows you to live fully at a healthy weight. Just how much “action” is required depends on what you say you want for your life! For example, You decide how much and what type of exercise you’ll do, depending on how physically fit you want to be. You decide how much and what type of food you’ll eat each day to manage the healthy weight you desire. You decide who you associate with and how much time you spend with those people to live as healthy an emotional life as you want to live. You get it! So, we’re clear that AWARENESS is the essential ingredient in the Recipe for Recovery because, well… nothing can be changed if you’re not AWARE that it needs to be changed. If you’re not aware that starches have little nutritional value, then you won’t reduce the number of starches you eat so you can maintain a healthy weight. If you aren’t aware that you have a habit of talking negatively about yourself and/or others, you can’t change it. If someone brings that negative habit to your attention, then you can make a decision about the type of person you want to be and put forth the effort and action needed to make those changes! Awareness IS the first step and the essential ingredient for change. AWARENESS without ACTION, however, is like a treadmill with a bunch of clothes hanging on it – you’re aware that the treadmill is there, but you aren’t using it. We are providing you with the ingredients to include awareness, but it’s up to you to put them into action. We know that being aware of things can be difficult and uncomfortable. This may be the reason so many people focus so much time and energy being aware of things in others rather than focusing on their own problematic behaviors! How often do we know what others must do to change? How much time to do we spend telling others how to fix their problems? We are aware that the neighbors need to mow and water their lawn, but happily ignore our own weeds! Hmm, that might be why one of the main tenets in the 12-Step Recovery world is: Sweep your own side of the street (mind your own business). If you’re more worried about what others are doing wrong, the first step is to become aware of your own “stuff.” To do that, turn those binoculars you’ve pointed at the neighbors directly around and look at yourself. You know, like the “selfie” button on your camera phone…uh, but this time, you don’t have to post your “self-examination” on Facebook! How do you begin to USE the essential ingredient, awareness? Well, if you’ve decided that you want to live fully in Recovery and want to follow the Recipe, we suggest you start by paying attention to your thoughts, feelings, and behaviors – especially when you eat. Start writing down the circumstances surrounding your eating and see if you spot trends. Remember to focus on yourself and what you need to do to live fully. Let others follow the recipe for themselves! Over the course of the next few weeks, we’ll be posting some questions on our Facebook wall to help you identify areas of your life that will benefit from healthy change, so be sure to check in regularly to A Post-Op & A Doc on Facebook. And join us on March 18th for our March APODCast, which will be all about AWARENESS. Be sure to RSVP…it’s totally free (http://www.spreecast.com/events/apodcast-awareness-essential-ingredient)!

A Post-Op & A Doc (Cari De La Cruz and Connie Stapleton, Ph.D.) have officially designated 2015 as the Year of Recovery. There are just six, basic ingredients, which, if added to your life, can help you reach and manage your goals to lose weight and keep it off. The good news is: 1) You already have everything you need to begin following the recipe. 2) It doesn’t involve shellfish, peanuts or milk, so you can’t possibly be allergic to it, 3) There is no baking, cooking, sautéing or mixing required, because the Recipe for Recovery doesn’t involve food, but does involve eating. We like to say that obesity is “all about the food, but it isn’t about the food” (which makes you wonder why we’re talking about a recipe and ingredients). Well, let’s start here: Do you eat when you’re upset, stressed or worried? What are you eating to avoid? Are you eating to avoid a person? a situation? a feeling? By following the Recipe for Recovery, you can learn to deal directly with any upset, stress or worry related to any “what” or “who” so you don’t need to turn to food for a short-term “high” or “fix.” Here’s another one: Do you eat when you’re bored? What do you need when you’re bored? Are you in need of a hobby? Companionship? What are you doing to find a healthy hobby or seek healthy companionship so you don’t automatically turn to food? These are some of the important questions you’ll begin to ask yourself as you learn follow the Recipe for Recovery. We know these are tough things to think about – especially when we’re busy plotting our next snack or obsessing about the box of donuts in the break room at work – fortunately, you don’t need to answer these questions BEFORE you can begin choosing to live in Recovery From Obesity. In other words, you don’t have to know what, where, or why in order to stop the destructive eating behaviors. Basically, food is often a SYMPTOM of a problem – not THE PROBLEM. For example, you might have a problem with interpersonal relationships or issues at work, or perhaps a battle within yourself – like an “emotional storm” -- where you say really mean, negative, unpleasant things TO yourself ABOUT yourself. Rather than addressing the problem, you turn to food, so food becomes the focus rather than the actual problem! Unfortunately, food is a temporary (very temporary) reprieve from unpleasant feelings, memories, or thoughts and though it provides a chemically induced euphoria…it’s short-lived. What is true for the alcoholic is also true for people who abuse themselves with food, which means the problem will still be there when the food is gone…. and then you have the hangover to deal with -- usually in the form of self-brutality by way of horrendously abusive self-talk. Yikes! We created the Recipe for Recovery from Obesity to help you learn to deal with the real issues (stress, worry, boredom, frustration, fear) in healthy ways (and to hopefully avoid the self-destructive eating and subsequent emotional hangovers). Here are the six ingredients that make up the Recipe for Recovery: 1. AWARENESS: Awareness is always the first step in change, which is why we refer to it as the essential ingredient to weight loss and weight-management. It’s pretty hard to change something you’re not aware of. You might know that you’re obese, but are you aware of how you are contributing to the problem? Maybe you’re stuck in your weight loss journey, or you’re regaining, or you never made it to your “goal” – you’re aware that there’s a problem – but you don’t know what to do next. Becoming AWARE of your issues is the place to start. 2. ACCEPTANCE: This is often an overlooked ingredient in weight loss/management. If you don’t accept that weight and the associated issues are ongoing problems in your life, then it’ll be pretty difficult to make the necessary changes to lose that weight and keep it off! The truth is, there are many things we need to accept in our journeys of weight loss/management that you may not have ever considered, such as the fact that you’ll have to eat right and exercise regularly, and will probably have to forego (or greatly limit) some of the foods you really love. The process of acceptance may include having some anger, fear and even mourning. Accept it – and get on with the process! 3. ATTITUDE: We call this the flavorful ingredient (and for some of us, this one is pretty spicy!) We all have different “tastes” when it comes to food… and life, which means that we don’t all like the same things or do the same things in exactly the same ways! Variety is the spice of life? Well, we think attitude is the FLAVOR of recovery! Focusing on attitude and having a positive one can make all the difference in your Recovery results! 4. COMMITMENT: You’ll use this staple ingredient at least once (and sometimes several times) each day in your Recovery journey, especially when you inevitably develop a case of the “I-don’t-wannas” – you know, those moments when you just “don’t wanna…” workout…log your food…manage your portions, pass on the cookies, etc. Adding a dash or a splash of commitment to your life helps you make the next wise choice. Every wise choice moves you toward your desired goals – a healthier self and a better quality of life. 5. ACCOUNTABILITY: Often quite underused, Accountability is an ingredient to help ensure the recipe is prepared as directed. We know it can be tempting to try to do things your own way, and we also know how that’s worked in the past! That’s where accountability really brings the Recipe for Recovery to life! Use accountability to do what you said you’d do when you began your weight loss journey. Whether you chose surgery, medically supervised weight loss, or another structured program, you agreed to do certain things, so this ingredient really matters. Hold yourself accountable for following through with doing the things you said you would do to get the weight off and keep the weight off. 6. EFFORT: The sixth (and key) ingredient in the Recipe for Recovery is Effort. Without ongoing, consistent, “use-it-whether-you-feel-like-it-or-not” – continual effort, the recipe will NOT turn out the way you want. Let us repeat: Your Recovery will NOT be successful if you do NOT use this key ingredient. When you put forth effort, you see results in the direction you are working toward. When you withhold efforts, you also see results – but not the ones you want! And, guess what? You can’t overuse this ingredient, so add it liberally and realize the fullness of a life in Recovery! It may sound like a lot of work, but if you want what you say you want (a healthy life in Recovery From Obesity) -- these ingredients really add up to a winning result!

The Doc: “What made you decide to have Weight Loss Surgery at this particular time in your life?” I ask every patient I see for a pre-surgical psychological evaluation. The responses to this question nearly always revolve around health. “I want to get off so many medications.” “I need to get rid of this diabetes.” “I want to be healthy enough to see my children/grandkids grow up.” “I want to be able to do things I can’t now because of my weight.” “I want to be healthy enough to walk/go places with my family/ride amusement park rides/not have to use a seat belt extender on an airplane.” The vast majority of the time, when people make the decision to have weight loss surgery, their health has become an issue that interferes in their quality of life. Sure, some people are interested in the benefits of being able to wear smaller clothing, many are interested in being less discriminated against, and most are enthusiastic about seeing the scale show a much lower number. It is safe, however, from my experience of having completed over 3000 pre-surgical evaluations, to summarize people’s reasons for wanting to have weight loss as being 1) seeking improved health and 2) seeking an improved quality of life. The Post Op: All I know is, by the time I dragged my size 30 behind into the doctor’s office to talk about getting the weight off, I was sick…and I was tired…and I was sick and tired of being sick and tired. It sounds trite, but it was true. My obesity was mentally, physically and emotionally exhausting, and every day represented weight gained and battles lost. At 320 pounds, I was Alice, and I’d been stuck down the rabbit hole of obesity and poor health for so long, I was willing to do anything to get out – yes, even take a swig from that bottle on the table with the “drink me” tag. In my mind, weight loss surgery was a magic potion and I was about to get really small. I didn’t know how it would feel when I got there, but I knew I’d be set free. I believed my life would get better and I’d be healthier if I could just get…smaller. The Doc: Fast-forward two years after surgery. The weight has melted off! The scale, of, course, never seems to reflect a low enough number. No matter – people are taking many fewer medications than they had to prior to surgery. And they are riding roller coasters and Ferris wheels and they are going on airplanes and not needing seatbelt extenders. They are going bike riding and hiking and playing with their children and grandkids like they have dreamed of doing. In other words, the majority of post-ops at around the two-year mark, do have improved health and do have a better quality of life. The Post Op: Losing large amounts of weight in a short period of time really messes with your head. One day, you’re buying double-digit stretchy pants and tops in the plus-size section, and the next, you’re venturing into the foreign world of single-digit labels on non-spandex jeans and fitted suits. Yesterday, you couldn’t find a single “before” photo but today you’ve got a thousand “after selfies” and attention from people you aren’t even sure you like. It’s exciting and new… and confusing… Somewhere along the way, you lost the plot, stopped focusing on your health and started focusing on your image. Like so many post-ops, you’ve learned that losing weight doesn’t guarantee happiness, hopefulness or health. So, with that said, can you refocus your focus and choose to live in Recovery From Obesity? What do you think, Doc? The Doc: It’s been really interesting observing the journey of post-ops, two of whom are my closest friends. After the initial weight loss and the joys of experiencing many of the NSV’s (non-scale victories, on the off chance you don’t know what NSV stands for, many people start whingeing (pronounced win – jing), a term the Post Op and I learned on our trip to work with bariatric folks in New Zealand. It means whining! “I don’t want to exercise.” “I’m tired of restricting myself.” “But sometimes I just need chocolate.” And then there’s the gossiping. “Have you seen so-and-so? She’s regained so much weight.” “Do you think I look smaller that that woman?” And, of course, there’s a continued? new? renewed? obsession with numbers! ““If I could only fit into a size smaller.” “Just ten more pounds and I would be satisfied. Really.” And what I actually find the saddest is the addiction to food… “I watch all of the shows on the Food Network.” “Look at the ‘bad’ food I ate… I posted it on Facebook!” My, how the focus changes! No longer do people seem to remember the reasons they had surgery… they appear to overlook the fact that their health is improved and the quality of their lives is vastly improved. All of a sudden the numbers on the scale, the size of the clothing and how they compare in size to other people are the focus. And maybe the saddest part from my perspective is that no matter how much weight they’ve lost, so many people are dissatisfied. They either want to lose more weight, hate their body just as much as before weight loss, or find some other thing(s) to focus on that were never mentioned as being important prior to surgery. The Post Op: I’ve seen this play out a thousand times, Doc, and it makes me so sad to realize that many people who desperately want to be free from the prison of obesity actually imprison themselves by the tyranny of numbers, the scale and their clothing size! As you sagely point out, far from living a life in Recovery, many post-ops lose sight of what they said matters most and focus on the food, the food and the food! You call it an unhealthy obsession – I call it addiction, but either way, it’s not the goal of life after weight loss surgery…at least, not in my book. What’s missing from the equation? The Doc: Where’s the gratitude? Somehow, the life-saving, life-enhancing weight loss surgery that was done to improve one’s health and improve their quality of life, and that DID exactly those things, often morphs into what we believe are simply manifestations of that same disease of obesity. Because, as Cari often points out, “obesity is all about the food but not at all about the food.” And she’s right! Obesity includes a mindset, an attitude, an obsessiveness on food, size, and weight. Perhaps most tragically, there is a self-defeating component that lives on when one becomes obsessed with their eating, their weight, their sizes and/or what others are eating, what others weigh and what size others are wearing. Again, I ask, “Where’s the gratitude?” The Post Op: In my case, genuine gratitude was a mystery. I mean, I’d spent a lifetime focusing on my compromised health, physical limitations, poor quality of life, disappointments, shame and failures. Clearly, going to the doctor wasn’t a reason to celebrate, because I believed I’d be “blamed” for my condition, then blithely be told to “move more and eat less.” And I know I’m not alone – I talk to many post-ops who share my misunderstanding about the power of gratitude and the importance of practicing it in everyday recovery. Of course, when the focus is on the negative, it doesn’t even occur to you to consider something positive! Maybe that’s why I view gratitude as the unsung gift of Recovery and work hard to work on it every day. The Doc: Maintaining what is commonly referred to as “an attitude of gratitude” can have a positive overall affect on your life. By focusing on the ways your health has improved, you feel pleased and grateful for the changes in your life, regardless of the weight your body has settled at. Focusing on the ways the quality of your life has improved after weight loss results in being grateful for being able to participate more actively and fully in your own life! Take the time and literally make a list of the things your weight loss has resulted in regarding your health and quality of your life. The Post Op: I get it. Lists are usually filled with work you have to accomplish before the day ends (things to do today), or before you die (bucket list), but they aren’t usually things you look at to feel good. I say it’s time to change that paradigm and start making lists of things you’ve already done (or, get to look forward to!) Your gratitude list doesn’t have to be a thing of literary genius (which means it doesn’t have to rhyme, be written in haiku or iambic pentameter, and doesn’t even have to include complete sentences!) Your list can include positive words, pictures, names of people you love – whatever – but it has to be a real list…so why not start now by considering some of the things The Doc mentioned? In case you’re wondering my list starts like this: 1. I’m eternally grateful for the opportunity to work with an amazing and compassionate friend to help others find the joy of Recovery From Obesity. How about you? ACTION STEP: Download a GRATITUDE APP (any one will do) for your smart phone and make a practice of typing in a minimum of three things each day that represent your improved health and/or the improvements in your quality of life. If you’re open to it, you will experience an overall improvement in your daily attitude.

We like to say that obesity is “all about the food, but it isn’t about the food” (which makes you wonder why we’re talking about a recipe and ingredients). Well, let’s start here: Do you eat when you’re upset, stressed or worried? What are you eating to avoid? Are you eating to avoid a person? a situation? a feeling? By following the Recipe for Recovery, you can learn to deal directly with any upset, stress or worry related to any “what” or “who” so you don’t need to turn to food for a short-term “high” or “fix.” Here’s another one: Do you eat when you’re bored? What do you need when you’re bored? Are you in need of a hobby? Companionship? What are you doing to find a healthy hobby or seek healthy companionship so you don’t automatically turn to food? These are some of the important questions you’ll begin to ask yourself as you learn follow the Recipe for Recovery. We know these are tough things to think about – especially when we’re busy plotting our next snack or obsessing about the box of donuts in the break room at work – fortunately, you don’t need to answer these questions BEFORE you can begin choosing to live in Recovery From Obesity. In other words, you don’t have to know what, where, or why in order to stop the destructive eating behaviors. Basically, food is often a SYMPTOM of a problem – not THE PROBLEM. For example, you might have a problem with interpersonal relationships or issues at work, or perhaps a battle within yourself – like an “emotional storm” -- where you say really mean, negative, unpleasant things TO yourself ABOUT yourself. Rather than addressing the problem, you turn to food, so food becomes the focus rather than the actual problem! Unfortunately, food is a temporary (very temporary) reprieve from unpleasant feelings, memories, or thoughts and though it provides a chemically induced euphoria…it’s short-lived. What is true for the alcoholic is also true for people who abuse themselves with food, which means the problem will still be there when the food is gone…. and then you have the hangover to deal with -- usually in the form of self-brutality by way of horrendously abusive self-talk. Yikes! We created the Recipe for Recovery from Obesity to help you learn to deal with the real issues (stress, worry, boredom, frustration, fear) in healthy ways (and to hopefully avoid the self-destructive eating and subsequent emotional hangovers). Here are the six ingredients that make up the Recipe for Recovery: 1. AWARENESS: Awareness is always the first step in change, which is why we refer to it as the essential ingredient to weight loss and weight-management. It’s pretty hard to change something you’re not aware of. You might know that you’re obese, but are you aware of how you are contributing to the problem? Maybe you’re stuck in your weight loss journey, or you’re regaining, or you never made it to your “goal” – you’re aware that there’s a problem – but you don’t know what to do next. Becoming AWARE of your issues is the place to start. 2. ACCEPTANCE: This is often an overlooked ingredient in weight loss/management. If you don’t accept that weight and the associated issues are ongoing problems in your life, then it’ll be pretty difficult to make the necessary changes to lose that weight and keep it off! The truth is, there are many things we need to accept in our journeys of weight loss/management that you may not have ever considered, such as the fact that you’ll have to eat right and exercise regularly, and will probably have to forego (or greatly limit) some of the foods you really love. The process of acceptance may include having some anger, fear and even mourning. Accept it – and get on with the process! 3. ATTITUDE: We call this the flavorful ingredient (and for some of us, this one is pretty spicy!) We all have different “tastes” when it comes to food… and life, which means that we don’t all like the same things or do the same things in exactly the same ways! Variety is the spice of life? Well, we think attitude is the FLAVOR of recovery! Focusing on attitude and having a positive one can make all the difference in your Recovery results! 4. COMMITMENT: You’ll use this staple ingredient at least once (and sometimes several times) each day in your Recovery journey, especially when you inevitably develop a case of the “I-don’t-wannas” – you know, those moments when you just “don’t wanna…” workout…log your food…manage your portions, pass on the cookies, etc. Adding a dash or a splash of commitment to your life helps you make the next wise choice. Every wise choice moves you toward your desired goals – a healthier self and a better quality of life. 5. ACCOUNTABILITY: Often quite underused, Accountability is an ingredient to help ensure the recipe is prepared as directed. We know it can be tempting to try to do things your own way, and we also know how that’s worked in the past! That’s where accountability really brings the Recipe for Recovery to life! Use accountability to do what you said you’d do when you began your weight loss journey. Whether you chose surgery, medically supervised weight loss, or another structured program, you agreed to do certain things, so this ingredient really matters. Hold yourself accountable for following through with doing the things you said you would do to get the weight off and keep the weight off. 6. EFFORT: The sixth (and key) ingredient in the Recipe for Recovery is Effort. Without ongoing, consistent, “use-it-whether-you-feel-like-it-or-not” – continual effort, the recipe will NOT turn out the way you want. Let us repeat: Your Recovery will NOT be successful if you do NOT use this key ingredient. When you put forth effort, you see results in the direction you are working toward. When you withhold efforts, you also see results – but not the ones you want! And, guess what? You can’t overuse this ingredient, so add it liberally and realize the fullness of a life in Recovery! It may sound like a lot of work, but if you want what you say you want (a healthy life in Recovery From Obesity) -- these ingredients really add up to a winning result!

The Doc: Fast-forward two years after surgery. The weight has melted off! The scale, of, course, never seems to reflect a low enough number. No matter – people are taking many fewer medications than they had to prior to surgery. And they are riding roller coasters and Ferris wheels and they are going on airplanes and not needing seatbelt extenders. They are going bike riding and hiking and playing with their children and grandkids like they have dreamed of doing. In other words, the majority of post-ops at around the two-year mark, do have improved health and do have a better quality of life. The Post Op: Losing large amounts of weight in a short period of time really messes with your head. One day, you’re buying double-digit stretchy pants and tops in the plus-size section, and the next, you’re venturing into the foreign world of single-digit labels on non-spandex jeans and fitted suits. Yesterday, you couldn’t find a single “before” photo but today you’ve got a thousand “after selfies” and attention from people you aren’t even sure you like. It’s exciting and new… and confusing… Somewhere along the way, you lost the plot, stopped focusing on your health and started focusing on your image. Like so many post-ops, you’ve learned that losing weight doesn’t guarantee happiness, hopefulness or health. So, with that said, can you refocus your focus and choose to live in Recovery From Obesity? What do you think, Doc? The Doc: It’s been really interesting observing the journey of post-ops, two of whom are my closest friends. After the initial weight loss and the joys of experiencing many of the NSV’s (non-scale victories, on the off chance you don’t know what NSV stands for, many people start whingeing (pronounced win – jing), a term the Post Op and I learned on our trip to work with bariatric folks in New Zealand. It means whining! “I don’t want to exercise.” “I’m tired of restricting myself.” “But sometimes I just need chocolate.” And then there’s the gossiping. “Have you seen so-and-so? She’s regained so much weight.” “Do you think I look smaller that that woman?” And, of course, there’s a continued? new? renewed? obsession with numbers! ““If I could only fit into a size smaller.” “Just ten more pounds and I would be satisfied. Really.” And what I actually find the saddest is the addiction to food… “I watch all of the shows on the Food Network.” “Look at the ‘bad’ food I ate… I posted it on Facebook!” My, how the focus changes! No longer do people seem to remember the reasons they had surgery… they appear to overlook the fact that their health is improved and the quality of their lives is vastly improved. All of a sudden the numbers on the scale, the size of the clothing and how they compare in size to other people are the focus. And maybe the saddest part from my perspective is that no matter how much weight they’ve lost, so many people are dissatisfied. They either want to lose more weight, hate their body just as much as before weight loss, or find some other thing(s) to focus on that were never mentioned as being important prior to surgery. The Post Op: I’ve seen this play out a thousand times, Doc, and it makes me so sad to realize that many people who desperately want to be free from the prison of obesity actually imprison themselves by the tyranny of numbers, the scale and their clothing size! As you sagely point out, far from living a life in Recovery, many post-ops lose sight of what they said matters most and focus on the food, the food and the food! You call it an unhealthy obsession – I call it addiction, but either way, it’s not the goal of life after weight loss surgery…at least, not in my book. What’s missing from the equation? The Doc: Where’s the gratitude? Somehow, the life-saving, life-enhancing weight loss surgery that was done to improve one’s health and improve their quality of life, and that DID exactly those things, often morphs into what we believe are simply manifestations of that same disease of obesity. Because, as Cari often points out, “obesity is all about the food but not at all about the food.” And she’s right! Obesity includes a mindset, an attitude, an obsessiveness on food, size, and weight. Perhaps most tragically, there is a self-defeating component that lives on when one becomes obsessed with their eating, their weight, their sizes and/or what others are eating, what others weigh and what size others are wearing. Again, I ask, “Where’s the gratitude?” The Post Op: In my case, genuine gratitude was a mystery. I mean, I’d spent a lifetime focusing on my compromised health, physical limitations, poor quality of life, disappointments, shame and failures. Clearly, going to the doctor wasn’t a reason to celebrate, because I believed I’d be “blamed” for my condition, then blithely be told to “move more and eat less.” And I know I’m not alone – I talk to many post-ops who share my misunderstanding about the power of gratitude and the importance of practicing it in everyday recovery. Of course, when the focus is on the negative, it doesn’t even occur to you to consider something positive! Maybe that’s why I view gratitude as the unsung gift of Recovery and work hard to work on it every day. The Doc: Maintaining what is commonly referred to as “an attitude of gratitude” can have a positive overall affect on your life. By focusing on the ways your health has improved, you feel pleased and grateful for the changes in your life, regardless of the weight your body has settled at. Focusing on the ways the quality of your life has improved after weight loss results in being grateful for being able to participate more actively and fully in your own life! Take the time and literally make a list of the things your weight loss has resulted in regarding your health and quality of your life. The Post Op: I get it. Lists are usually filled with work you have to accomplish before the day ends (things to do today), or before you die (bucket list), but they aren’t usually things you look at to feel good. I say it’s time to change that paradigm and start making lists of things you’ve already done (or, get to look forward to!) Your gratitude list doesn’t have to be a thing of literary genius (which means it doesn’t have to rhyme, be written in haiku or iambic pentameter, and doesn’t even have to include complete sentences!) Your list can include positive words, pictures, names of people you love – whatever – but it has to be a real list…so why not start now by considering some of the things The Doc mentioned? In case you’re wondering my list starts like this: 1. I’m eternally grateful for the opportunity to work with an amazing and compassionate friend to help others find the joy of Recovery From Obesity. How about you? ACTION STEP: Download a GRATITUDE APP (any one will do) for your smart phone and make a practice of typing in a minimum of three things each day that represent your improved health and/or the improvements in your quality of life. If you’re open to it, you will experience an overall improvement in your daily attitude.

Tis the season ready or not! The holiday season can be one of the most joyful times of the year with its dazzling colors, familiar music, social gatherings, and yes, food, food and more food! For those who have recently lost a significant amount of weight following WLS or have remained serious throughout the year about managing the healthy weight they have sustained since having WLS, the food-infested holiday season can present physical and emotional challenges. For at least five solid weeks, food is even more ubiquitous than usual in our eating-obsessed society. It's almost impossible to avoid fanciful confections almost anywhere you go from Thanksgiving until the end of the year. Cookies, candy, fudge and a host of other home-made delights in the break room at the office. Gift baskets abounding with fruits, nuts and bottles of apple cider arrive at the doorstep. Samples of gooey baked goods with sparkling decorations are handed out from kiosks in the grocery store. And bubbly libations accompany the gourmet delicacies served at every office and neighborhood social gathering. For people who have had WLS and are serious about maintaining a healthy weight, the fact that the average American gains 7 & 12 pounds throughout the holiday season, can evoke strong feelings of anxiety. Another anxiety-producing holiday stressor can be the family gathering. Most of us spend time with relatives during the holiday season. Like food, there are lots of varieties of families; some food and some families are healthy and others are not! Regardless of the emotional health of one's family, nearly all family holiday gatherings revolve around a meal, featuring time-honored secret family recipes and dishes that aunts, uncles and cousins eagerly await all year long. At no other time of year are there so many triggers that have the potential to steer off course those who have used food as a way to deal with emotions. In her brilliant, practical book, The Beck Diet Solution , Dr. Judith Beck notes several categories of triggers that can ultimately lead to eating. Three of these categories are emotional, biological, and environmental. Identify the Triggers in this scenario: Your family has decided to have Thanksgiving dinner at your Grandma Smith's house this year. You haven't been to that house in nearly a dozen years, since moving out of state. When you were a child you adored spending time at your grandma's house. She is the person who taught you about gardening, how to sew, and how to bake. It's hard to think about Grandma Smith without recalling the smell of fresh bread wafting throughout the house. As soon as you walk in the door, the smell of her homemade biscuits mingled with the traditional aroma of the turkey and dressing takes over your entire being. Before you can turn and walk toward the kitchen, you see cousin Sally. Sally was the mean cousin when you were kids. She called you fatty Patty and always tattled to the adults when you did anything wrong. You are assaulted by her booming voice, Hey, there, fatty Patty!' What have you done to yourself? You're not fat anymore! You wish you could just punch her, but refrain from doing so as Aunt Cindy wraps you in a bear hug. That smell! Her perfume. It takes you back to the time you ate three pieces of her birthday cake before dinner. Her husband, uncle Bill had screamed at you for what seemed like an hour, but Aunt Cindy had wrapped you up in a hug then like she was doing now and she was wearing that same scent! You finally make it into the living room and see the old blue rocker that you and Grandma sat in countless evenings while she read to you. Your eyes mist with tears. However, your thoughts are interrupted by the angry sounds of two male voices coming from the next room. They were at it again. Your twin uncles. They never got along well and used to get into fist fights, scaring you when you were a child. You would take a bowl of Grandma's homemade cookies and hide in the closet upstairs until they would leave. Just the sound of their harsh tones made you turn and look for a sweet treat to take your mind off the fear you felt, even now as an adult. There are lots of triggers in this story with potential for thoughts and feelings that could lead to eating as a coping response. Emotional triggers include reminiscing on the happy memories of spending time with Grandma in the garden, while sewing and when baking in the kitchen. Cousin Sally's name-calling would certainly trigger an emotional response, as would the memory of Uncle Bill screaming at a young Patty who ate Aunt Sally's birthday cake. Biological triggers in this scenario would be the sight and smell of the food when Patty walked into Grandma's. Salivating at the thought or actual smell of the food is also a biological trigger. The sound of angry voices producing anxiety is another example of a biological trigger, as is the smell of Aunt Cindy's perfume. The blue rocking chair in the living room would be an example of an environmental trigger. The closet upstairs where Patty hid when she was a child is also an environmental trigger. Triggers and Emotional Eating Songs often evoke strong emotions. When you hear a song that played at your high school prom where you slow danced with your first love, you experience the joyful emotions you did when you were in that high school gymnasium-turned-ballroom. Holidays, and especially family holiday gatherings similarly evoke strong emotions. For an emotional eater, this can lead to high calorie disasters. In the scenario above, Patty experienced a range of emotions based on in-the-moment triggers and intensified by memories from the past. Emotional eaters often turn to food when they are experiencing emotions, sometimes as a way to avoid unpleasant feelings. It may be tempting for Patty to grab an entire pie off the counter and run to the upstairs closet to gobble the pie down in an attempt to get away from the hurt of Cousin Sally's rude remark, to forget about the smell of Aunt Cindy's perfume and the memory of being severely scolded by Uncle Tim years ago, and to quiet the sound of her twin uncles' arguing. Triggers are powerful. In order to make it safely through this minefield of eating triggers during the holiday season, a person needs to have a plan in place ahead of time and then they need to utilize the plan throughout the season! A Post Op & A Doc have created an entire program for WLS patients to help them get through the holidays while maintaining their commitment to their health. You can download the plan called APOD's GPS Great Plan for Success and take it with you as you head into the holiday season! Go to www.conniestapletonphd.com/apod/ and look on the right hand side of the page to print off your copy! The following Ten Tips can also help you prepare ahead of time for dealing in a healthy way if you are overwhelmed by the urge to eat after being triggered at the family holiday gathering. (You can use these to safely navigate the holiday trays in office break rooms, at neighborhood social gatherings, and any other place you are deluged by tempting holiday goodies!) Anticipate triggers. Think about situations you are likely to encounter throughout the holiday season that pose threats to your healthy eating habits. Make a list of probable triggers you will encounter at your family holiday gatherings and use the following steps to deal with them in healthy ways. Visualize healthy responses to triggers. Instead of responding to triggers in an unhealthy way (yelling, arguing, eating) start preparing now to respond to them in a healthy way by visualizing yourself calmly walking away from arguments. Imagine yourself walking outside and taking a few minutes for yourself to regroup before returning to the situation. Picture yourself finding a place to call a supportive friend and talking about how you're feeling. All of these healthy responses will keep you away from the high calorie options you may have turned to in the past. Learn quick relaxation techniques. When we encounter triggers, we often become tense, anxious, scared or angry. In a highly emotional state, you are more likely to react rather than respond. Reacting may mean mindless eating of empty calories. If you are able to utilize a simple, quick relaxation tool, you will be better able to respond to triggers in a healthy, rational manner. One example of a simple relaxation techniques is to very slowly breathe in and out 12 times. You can do this in a room full of people and no one will even know! Another simple technique is to slowly count to 10, 20, or 100 however long it takes you to feel calm enough to respond in a healthy way. Get away from the crowd and mentally note ten things you are grateful for. This will definitely improve your frame of mind and you can resume your activities with a better outlook, a sure defense against harmful overeating. Remind yourself why. In preparing for the holiday gatherings, write answers to these questions and have it on your smartphone or an index card to read if you feel yourself getting overwhelmed emotionally and/or feel tempted to eat things you will regret later: What are the negative consequences of eating unhealthy foods and of overeating? What are the reasons I decided to lose weight and improve my health habits? What are the benefits thus far of losing weight and improving my health habits? [*]Say to yourself, I made up my mind! When you're aware that your desire to eat/overeat has been triggered, say to yourself, I made up my mind: a. to stick to my healthy eating plan. b. to focus on relationships rather than food. c. to honor my recent weight loss by maintaining healthy behaviors during the holiday season. d. whatever else you have made up your mind about! [*]Focus on your own behavior. It's easy to get worked up about things other people are saying (perhaps they make negative comments to, or about you or others). It's just as easy to get upset over other people's behavior (family members who may be arguing, or drinking too much, or vying for everyone's attention). Focus on your own behavior. After all, you have no responsibility for anyone else's! And you have full responsibility for you own behavior which, by the way, includes what, when, and how much you eat! [*]Keep a progress piece in your pocket . A progress piece can be anything that reminds you of the progress you have made losing weight and/or improving your health. For example, if you are now able to bend over and tie your shoes after losing weight, carry a shoestring with you. If you recently flew on an airplane and no longer needed a seatbelt extender, carry your boarding pass or a picture of a plane with you. When you're tempted to engage in unhealthy eating, look at your progress piece and give yourself credit for the hard work you've done and remind yourself of the commitment you made to continue your healthy behaviors. [*]STOP. Imagine a large STOP sign in your mind that you can pull out whenever you need to before indulging in food (or behavior) that you will later regret. [*]Set boundaries. If people give you a difficult time for eating healthy (Why can't you just have one bite? or You must have a piece of Aunt Sally's pie or you'll hurt her feelings.), set boundaries by saying, I've made up my mind to eat healthy, even on Thanksgiving. I don't expect you to understand, but I hope you will respect my decision. [*]Plan your work and work your plan. Take an index card (or make a note on your smart phone) with any of the above suggestions or other things that work for you to help you get through difficult food and/or family situations so that you maintain your healthy lifestyle behaviors. Read your reminders any time you feel the need to and UTILIZE them! Happy holidays to you and your families! Enjoy the relationships they last so much longer than the food!

POSITION AVAILABLE: Hours: M-F 24/7. No vacation pay. No sick days. No experience required, but must be willing to learn on the job… and put forth a tremendous amount of effort. GREAT BENEFITS. If you saw that employment ad, would you apply for the job? Most of us would probably be curious…but that business about no vacation days and no days off may lead us to say, “No, thanks!” What if the job opening was for…MARRIAGE? Let's say you would be applying to be a wife or husband? Would you take the job? What if the job opening was for PARENTHOOD? You'd be applying to be a mother or father. Would you sign on the dotted line? Those two "jobs," spouse and parent - fit the job description above. You don't get days off from being a mom, dad or spouse - not if you want to be a really good parent or want your relationship to be healthy. You have to show up every day -- whether you feel like it or not. In 2007, Cari (the Post Op of A Post Op & A Doc) accepted a position that was neither spouse nor parent (although she also held both of those positions). Her new job had the same requirements: 24/7, 365 days a year. Her new position was as a WLS post-op living a life in Recovery From Obesity. Oh, she didn't know it at the time, but living healthy is a full-time job. The benefits have been incredible for her – being able to enjoy improved health, wear cuter (and less expensive) clothes, enjoy activities she couldn’t when carrying excess weight (biking, hiking, and kayaking to name a few), being able to travel with ease, and enjoying an improved self-esteem leading to a more enjoyable work and social life. Those benefits come with responsibilities, because being healthy is a JOB. Being healthy doesn't just happen. You have to show up and do the work. You don't get to "take a break" because you're tired and you don't get to play hookey or take sick days. If you're sick, you still need to take care of yourself. Are you treating your obesity like a full-time job, or a hobby? Recovery From Obesity is a full-time job. What sort of performance evaluation would you give yourself? How would a real-life employer deal with you if you weren’t performing the job duties you signed up for when you accepted the job? Most employers would give you a warning and expect you to improve your efforts and performance in order to secure your position. If you continued to put forth minimal effort and consequently didn’t meet even minimal performance criteria, you’d eventually be fired. When you made the decision to have weight loss surgery, you were made aware of the requirements for keeping your weight off: eating healthy foods in healthy portions, drinking lots of water, and getting exercise on a regular basis, to name a few. If you’re not following through with the job criteria you accepted when you decided to have weight loss surgery, who’s going to give you a warning? Maybe the doctor or nutritionist – if you attend your follow-up appointments. If you continue to treat your weight loss surgery like a part-time position or hobby, the benefits won’t be part of the package. But who can fire you? A better option than quitting is to go after that great benefit package the job of healthy living offers and get some ON-THE-JOB TRAINING. Get to support groups, make an appointment with your nutritionist, get into therapy, find a mentor who lives a healthy lifestyle, and commit to your job/yourself. In order to perform better on your job, you need solid instruction on healthy living, eating and thinking. This on-the-job instruction requires a whole lot more than a single visit to a nutritionist, a stopover at a support group meeting, a session with a surgeon and a 1-hour psych-eval. Yeah. A LOT MORE. It might take a solid year or more of working with a life coach or personal trainer. It might take regular attendance at 12-Step meetings. It might take annual attendance at educational conferences, targeted toward living fully in Recovery From Obesity. It might take 3-5 years of therapy (we vote "highly likely" on this one)…Heck, It might take ALL of these things, and more. THINK ABOUT IT: In the past, most obese people did a horrible job of managing a healthy weight. In fact, an employer would have fired The Post-Op (Cari) after moments of observing her on the job, based on how she took care of her health when she was at her highest weight. The idea that anyone would magically and immediately be able to perform the job of taking good care of their health simply by having weight loss surgery seems a bit…far-fetched. Don't you think? To live fully in Recovery From Obesity, people need regular and ongoing ON-THE-JOB TRAINING. If you want a certificate suitable for framing or perhaps a 90-Day chip from OA, and a smiley face on your lab results as rewards for your efforts – go for it! Positive reinforcement… in non-edible forms! Recovery From Obesity is a full-time position that requires ON-THE-JOB TRAINING for a long, long time. Understand that the benefits are the result of your very own effort and investment (of both time and money). What sorts of "training" programs are you involved with aiding your "job performance" in Recovery From Obesity? A Post Op & A Doc have a copy of the Gotta Do ‘Em’s (and a lot more free handouts for you) on our website and on our Facebook page.

If you saw that employment ad, would you apply for the job? Most of us would probably be curious…but that business about no vacation days and no days off may lead us to say, “No, thanks!” What if the job opening was for…MARRIAGE? Let's say you would be applying to be a wife or husband? Would you take the job? What if the job opening was for PARENTHOOD? You'd be applying to be a mother or father. Would you sign on the dotted line? Those two "jobs," spouse and parent - fit the job description above. You don't get days off from being a mom, dad or spouse - not if you want to be a really good parent or want your relationship to be healthy. You have to show up every day -- whether you feel like it or not. In 2007, Cari (the Post Op of A Post Op & A Doc) accepted a position that was neither spouse nor parent (although she also held both of those positions). Her new job had the same requirements: 24/7, 365 days a year. Her new position was as a WLS post-op living a life in Recovery From Obesity. Oh, she didn't know it at the time, but living healthy is a full-time job. The benefits have been incredible for her – being able to enjoy improved health, wear cuter (and less expensive) clothes, enjoy activities she couldn’t when carrying excess weight (biking, hiking, and kayaking to name a few), being able to travel with ease, and enjoying an improved self-esteem leading to a more enjoyable work and social life. Those benefits come with responsibilities, because being healthy is a JOB. Being healthy doesn't just happen. You have to show up and do the work. You don't get to "take a break" because you're tired and you don't get to play hookey or take sick days. If you're sick, you still need to take care of yourself. Are you treating your obesity like a full-time job, or a hobby? Recovery From Obesity is a full-time job. What sort of performance evaluation would you give yourself? How would a real-life employer deal with you if you weren’t performing the job duties you signed up for when you accepted the job? Most employers would give you a warning and expect you to improve your efforts and performance in order to secure your position. If you continued to put forth minimal effort and consequently didn’t meet even minimal performance criteria, you’d eventually be fired. When you made the decision to have weight loss surgery, you were made aware of the requirements for keeping your weight off: eating healthy foods in healthy portions, drinking lots of water, and getting exercise on a regular basis, to name a few. If you’re not following through with the job criteria you accepted when you decided to have weight loss surgery, who’s going to give you a warning? Maybe the doctor or nutritionist – if you attend your follow-up appointments. If you continue to treat your weight loss surgery like a part-time position or hobby, the benefits won’t be part of the package. But who can fire you? A better option than quitting is to go after that great benefit package the job of healthy living offers and get some ON-THE-JOB TRAINING. Get to support groups, make an appointment with your nutritionist, get into therapy, find a mentor who lives a healthy lifestyle, and commit to your job/yourself. In order to perform better on your job, you need solid instruction on healthy living, eating and thinking. This on-the-job instruction requires a whole lot more than a single visit to a nutritionist, a stopover at a support group meeting, a session with a surgeon and a 1-hour psych-eval. Yeah. A LOT MORE. It might take a solid year or more of working with a life coach or personal trainer. It might take regular attendance at 12-Step meetings. It might take annual attendance at educational conferences, targeted toward living fully in Recovery From Obesity. It might take 3-5 years of therapy (we vote "highly likely" on this one)…Heck, It might take ALL of these things, and more. THINK ABOUT IT: In the past, most obese people did a horrible job of managing a healthy weight. In fact, an employer would have fired The Post-Op (Cari) after moments of observing her on the job, based on how she took care of her health when she was at her highest weight. The idea that anyone would magically and immediately be able to perform the job of taking good care of their health simply by having weight loss surgery seems a bit…far-fetched. Don't you think? To live fully in Recovery From Obesity, people need regular and ongoing ON-THE-JOB TRAINING. If you want a certificate suitable for framing or perhaps a 90-Day chip from OA, and a smiley face on your lab results as rewards for your efforts – go for it! Positive reinforcement… in non-edible forms! Recovery From Obesity is a full-time position that requires ON-THE-JOB TRAINING for a long, long time. Understand that the benefits are the result of your very own effort and investment (of both time and money). What sorts of "training" programs are you involved with aiding your "job performance" in Recovery From Obesity? A Post Op & A Doc have a copy of the Gotta Do ‘Em’s (and a lot more free handouts for you) on our website and on our Facebook page.

Obesity is a selfish disease. A lot of people think that sounds mean and untrue. They think obesity is actually a sign of someone who doesn’t have time to take care of him or herself, because they are so busy taking care of everyone else that they ignore their own needs. In other words, they believe that obese people are actually selfless, not selfish. Let’s say it’s true that some obese people spend a great deal of time “doing” things for other people. Why do obese people do that? Is it because they truly care only for others? Or perhaps they feel “obligated” (lest people think badly of them or less of them)? Maybe they do so much for others for fear they won’t be included by others if they don’t? Maybe they do so much for others because it makes them feel better about themselves? Here’s another question: What, exactly, does that “caring for others” look like? In a lot of “obese homes,” the obese parent(s) feed their children junk food because they don’t want to “deprive them” of “fun foods” that “other kids get to eat…” In other words, they “selflessly” take care of their kids by feeding them junk. How, exactly is poor nutrition caring for a child? Could it be that the obese parent(s) feels guilty about their own, poor eating behaviors? Maybe they don’t want to have to explain why they are “allowed” to eat one way, but the kids are expected to eat another? Could it be that the obese parent(s) really want the junk food at home for themselves and use the kids as an excuse for having it there? “I wouldn’t want them to have to be deprived because I can’t have it.” Makes you think. Doesn’t it? Obese people are definitely going to find ways to take care of (feed) their obesity – with frequent trips to the fast food drive-thru, late night runs to the market to pick up ice cream, or having dinner at the all-you-can-eat buffet (because it’s a “good value” for the money). Obese people create ways to take care of their own “needs” very well. They take great pains to ensure there are always emergency treats squirreled away in the pantry or bottom drawer at the office, just in case. They’ve always got some cookies, chips or candy in the car (so they won’t starve.) Does this make them selfish? Not in and of itself… What makes the behaviors of the obese person selfish are the consequences to other people… Read on. Let’s talk for a minute about the many obese people who have co-morbid diseases including high blood pressure, high cholesterol, sleep apnea and diabetes (to name a few). Diabetes and each one of these diseases individually kill people every day. The combination of obesity with any of them (and obese people usually have several co-morbid diseases, especially as they get older), increases the likelihood of a premature death. Ah – but, “I can always take medicine” and “more medicine” and “more medicine” to treat those other diseases. The reality? In effect, many obese people are saying, “I’d rather take more and more and more medications, all of which have side effects, than to change my eating and eliminate the need for the medications. By changing my eating behaviors… I could eliminate the diseases. But I’d rather eat.” Right now, you might be thinking: Obese people like to eat – everyone needs to eat – how is that selfish? Easy: It’s not just about the food. Let’s talk about the effects on others of the above-mentioned behaviors. What happens when an obese person’s health declines to the point that he/she isn’t able to walk easily? Perhaps they eventually need a scooter to get around? And maybe they become couch-bound or bed-bound? The ability of the obese person to get around on their own affects everyone involved in their lives – especially if the non-obese members want to engage in outside family activities. Spouses and kids often forego sporting activities, extra-curricular events, and social gatherings because it creates too many problems for the obese parent, who is unable or unwilling to drive the kids to events, is too embarrassed to attend events, or is unable to get around once they get to an event. Kids and spouses often have to cater to the obese parent at home by fetching them food, books and TV remotes. Family members have to help with activities of daily living such as bathing and dressing the obese family member. Many a teenager has dedicated considerable time to care-taking for obese parents and in the process, misses out on an important developmental stage of life. The obese person needs help attending numerous doctors’, wound care and physical therapy appointments. Ultimately, the obese person’s needs dictate what others can and cannot do. That doesn’t sound all that “selfless,” especially when an obese adult, like an adult alcoholic or adult compulsive shopper or adult cigarette smoker has options for seeking treatment and therapy. Yes, there are many contributing factors to obesity, many that a person has no influence over (genetics, diseases). There are even more contributing factors to obesity that one can influence (environment, food choices, exercise). On the contrary, the above examples sound like the actions of a person who is looking out for “number one” – not someone more concerned with the needs of others…which sounds suspiciously like the definition of selfish, don’t you think? Now, don’t get us wrong, being selfish isn’t necessarily a negative thing…there are healthy ways to be selfish, including: Going to the gym regularly to take care of your health, even if it means you’ll miss some television time with the family. Not bringing junk food into the home – even if the kids might like it – because it’s not good for your health, or theirs. Spending money on vitamins and supplements each month, even if it means you’ll have less money for “entertainment” or “dining out.” Basically, healthy selfishness means that you take care of yourself in healthy ways. You take care of yourself AND keep in mind the important people in your life and how your actions will affect their lives as well. It’s important to note that being selfless is not necessarily better than being selfish, because selfless people often ignore their own needs and wants, resulting in their feeling unworthy, unvalued or unimportant. And most of the time, also leads to their feeling resentful (being the “victim” of always doing for others … although it’s really being the victim of their unconscious neediness). That’s not a good thing, either! In other words, both extremes – being selfish and being selfless - are equally unhealthy. Of course, this couldn’t be an article by A Post Op & A Doc without noting that seemingly “selfish” or “selfless” people (whether obese or not) are not “bad,” which the words (selfish especially) connotes. Like anyone whose lives on the continuum of dysfunction (which means all of us), obese people have learned to use food for what is referred to in the world of psychology as “experiential avoidance.” This means food and the obsession on food, weight, scales, recipes, food shows, etc. keeps them from dealing with “unacceptable” thoughts, feelings, memories, and/or physical sensations (such as anxiety, sadness, etc.). Don’t believe us? That’s okay. Getting to that awareness is a process. What’s important is to understand that we are not “dissing” anyone for being “selfish.” Ultimately, it’s important to be grateful for eating and food that was, at one point in time, for most obese people, a way to cope with situations or people that caused emotional distress. The “selfish” or “selfless” behaviors we are talking about are the long-term result of not dealing with life by numbing with food because one didn’t have the skills. In life today, as an adult, you can learn (and, we believe, have the ability to respond = responsibility,) to learn to deal with life stressors in healthy ways … without “using” food or other numbing agents (shopping, alcohol, other drugs, gambling, etc.). Hopefully, you’ll read this as an invitation to dig deep into your issues, learn healthy responses to life, and be a healthy “selfish” or “selfless” person. Ultimately, a healthy, balanced person understands and meets their physical, emotional and spiritual needs while keeping in mind the needs of others. Does this sound like something many obese people practice? We would argue that it doesn’t. Adults who haven’t known how to meet their needs in balanced ways, can now take the opportunity to learn healthy “selfish” and “selfless” ways of behaving. (Note: it usually requires therapy in addition to changing behaviors). Wait… this is getting deep! Why is this article called “Me, My Selfie & I”? In this fast-paced, Facebook world, where everyone has a camera phone, people spend all day connecting with other people through status updates and tweets about what they’re doing, where they’re going, what they’re eating, how they’re dressed, and who they’re dating. And, it often doesn’t seem to matter how mundane it is. Apparently everyone thinks their “friends” need to know, “Hey! I’m at Starbucks, drinking a sugar-filled Frappuccino with whipped cream and criticizing that guy at the next table. And, just to convince you I’m actually there, here’s a picture of ME and my drink (but not the annoying guy at the next table.)” “Hey! Guess where I am now? I’m in the try-on room in the junior department of that cool clothing store and I can’t believe I fit into a size medium. Don’t believe me? Here’s a picture of my butt in some teeny jeans. Don’t think that’s my butt? Here’s a picture of me in front of the mirror, holding my phone towards the mirror so you can see me… with my real butt in my teeny jeans. Whoo-hoo! I rock!” “Now I’m at the gym, sweating a lot. See? Here I am with sweat running down my face. Phew!” “After that workout, I’m hungry, so here I am at the restaurant eating this amazing food. (See the food? See me with the food? Oh, I had to have the person at the next table take my picture so you could see me and the food at the same time.)” “Man, it’s been a long, hard day…so now it’s time for some ‘me time’ at the nail salon. I’m having a pedicure (here’s a picture of my feet – I had them put little diamonds on my big toes. I really love my toes…) Here’s a picture of me wearing new shoes so you can see my painted toenails.” And that was just today. Maybe you think that sounds nasty or sarcastic or absurd, but we ask you: how many of your Facebook friends fit that description? Maybe YOU fit that description…? Okay, it’s true that when people lose a lot of weight, they feel good about themselves and are no longer afraid to have their picture taken. This is a sign of increasing confidence (you say). It’s evidence that the person finally cares about him or herself (you contend). There is nothing wrong with having a lot of pictures of you (you believe) – after all, you spent a lot of years on the other side of the camera. You’re making up for lost time. Well, we won’t argue about someone’s self-confidence, self-worth or belief about their appearance, but will say that, at some point, 4,000 pictures of you on your Facebook wall can give others the impression that you don’t have any friends or family in your life – or, at least none that you care enough about to include in your photos. It can seem pretty selfish…which makes us wonder why they don’t call Selfies, “Selfy-ishes.” Maybe you see yourself in this article. Maybe you don’t. Maybe you can understand how selfish obesity really is…and maybe you recognize that you need to work on achieving a balance of “healthy selfishness” in your own life. Whatever the case, next time you think you need to post a selfie…why not invite someone to join you in the shot? You can still hold the camera, if it makes you feel better. Cari De La Cruz and Connie Stapleton, Ph.D. The Post Op and The Doc info@apostopandadoc.com

Confidence is a turn-on. Arrogance is a turn-off. We, the Post Op and the Doc, discuss RECOVERY all the time. ALL. THE. TIME. Why? Because we believe in it and know the healing power it brings. We’ve never really talked specifically about "confidence" and "arrogance" per se, but we talk about narcissism and selfishness and how destructive they are to our Recovery from Obesity. That makes it entirely understandable that many recovery "newbies" could easily confuse the two. If a person comes from (a perceived place of) “nothing” into a big, new life of potential “everything,” the pendulum can (and often does) overcompensate (swings wildly in the other direction). In other words, if you start from a place where you’re thinking you have little value (perhaps based on your weight) – it is sometimes the case that to people appear to be … overvaluing themselves (think a posted selfie … or two or three… each day for a solid year). Is either of those extremes a healthy place to be… or could it be that they may actually represent the same issue? There is a continuum on which most “issues” can be placed. Think a straight line with a far left side, a center, and a far right side (sounds like politics, right?)! On that continuum we are talking about at the moment, there is a line of unhealthy to healthy behaviors. Think of feeling insignificant on the far left of the line, feeling confident in the middle, and feeling arrogance on the extreme right end of the line. In other words, sometimes when a person goes from a place of feeling insignificant (in this case, perhaps related to being obese), sometimes they "overshoot" the goal of having confidence and end up acting "arrogant." And this is true for many other “issues” we could put on that imaginary line. Think “completely independent/I don’t need anyone” as being on the far left, healthy independence being in the center and “totally dependent on others” as being on the far right end. Here’s the deal: both the far left and the far right “issue” actually represent the same thing … an unhealthy extreme… of the same problem. Think about it. A person who feels/acts terribly insignificant AND a person who feels/acts arrogant are both acting out the same issue… feelings of poor self-esteem. The healthy place to be on a continuum of healthy self-esteem is in the middle… feeling/acting confident. It truly is often the case that people swing from one end of the extreme to the other. It can look very different, but to those who understand this tendency of human behavior… it makes perfect sense. Balance lies in the middle of extremes. In this case, confidence is the healthy place of balance between feeling and acting insignificant and feeling and acting arrogant. In the example of someone who acts like they don’t need anyone else in their life, whether for companionship or ask assistance from on one of the scale to the person who is so “needy” or dependent on the other, the issue is the same – dependency. On one end is the person who refuses to acknowledge the need for depending on others at times. On the other end is the person who can’t seem to think for themselves, go anywhere alone, or be alone for five minutes. The healthy place of balance is in the middle – being someone who has healthy dependency… can manage on their own at times and knows they need others, as well. In recovery, the goal is to allow the pendulum to settle, rather than swing wildly, and arrive at the center of the continuum! (Hmmm…pendulums and continuums…who knew?) A great way to encourage balance is to listen to trusted friends who are willing to tell you things you might not want to hear. And…get ready to say "Ouch!" because it often hurts… Fortunately, if you are open to considering the possibility that your trusted friends might be right, you open yourself to the possibility of health and peace of mind in recovery. Doesn't that seem like a healthy trade-off? A little hurt for a lot of healing? If you were to place yourself on that continuum of self-worth/self-value, where do you think you'd be? No judgment -- Remember, AWARENESS and ACCEPTANCE are critical to recovery, so if you don't admit stuff, you can't change it.