PatientEleventyBillion

Get the Go-Ahead
Step 1: get your doctor’s approval! This can give you confidence that you are on the right track and that you are going to be safe while exercising. Find out whether you have any exercise restrictions such as type of exercise or a safe heart rate. Once your doctor gives you the okay, you have no more excuses!
Walk, Swim, or Bike
The first goals of an exercise program for beginners are often to get your heart rate up and burn a few calories. Walking, swimming, and stationary biking can be the safest and most comfortable options for many weight loss surgery patients.
Start at a slow, easy pace without pushing yourself before you are ready. Only go for a few minutes at the beginning, and work up gradually as you get into better shape. Focus on yourself, and don’t compete with others’ paces or workout lengths. Stay positive, since it gets easier as time goes on! Pump Some Iron
Walk into a co-ed gym, and you are likely to see two groups. The men are lifting weights, while the women are focused on cardio and tied to machines such as ellipticals, treadmills, and bikes. Which group should you be in?
Both! While cardio, or aerobic exercise, burns calories and helps your heart, blood sugar, and other health measures, strength training has its own benefits. It helps you lose weight by building muscles, which burn more calories all day, and it improves your bone health. Strength training does not bulk you up; it makes you toned and lean. You have all kinds of options.
Lifting dumbbells or barbells. Using weight machines at the gym. Pulling on resistance bands. Trying exercises that use your own body weight as resistance. Work on each of your major muscle groups, including biceps (front of arms), triceps (back of arms), shoulders, chest, back, hips, quadriceps (front of thighs), hamstrings (back of thighs), calves, and core – your abs and obliques. The ultimate goal is to work each muscle group at least two days per week, making it tired but not straining.
You might want to ask a trainer or an experienced friend for help with ideas for exercises, as well as for demonstrations on proper form. You do not want to get injured!
Do a Full Workout
What is the difference between a workout and a full workout, you ask? The workout is the main part of your exercise, such as a brisk walk and/or a weight lifting session. A full workout starts earlier and ends later because it includes:
A 5 to 10-minute warmup such as slow walking or easy cycling to gradually get your heart up from its resting rate to its workout rate. Your main workout, such as brisk walking, an aerobics class, or a tennis match. A 5 to 10-minute cool-down, such as slow walking on the treadmill or in the pool. 5 to 10 minutes of stretching to keep your muscles loose. The full workout takes a little longer, but keeps your injury risk down and lets you get more out of your workout and entire exercise program.
Be Realistic
Some exercises may not be comfortable or feasible when you are carrying around extra weight. Do not fight with yourself or get down on yourself. Just be patient. Do what you can, and you will gain new skills as you get in better shape.
Exercise can be one of your greatest gifts to yourself on the weight loss surgery journey. It is hard and getting started is hard, but the rewards are well worth it. Good luck!

1. Hummus. Despite being made from chickpeas, the average store bought hummus has only 1 gram of protein per tablespoon. Instead, opt for homemade hummus, homemade black bean dip or homemade Tzatziki (made with Greek yogurt) as dips for your veggies.
All of these dips are significantly higher in protein when made at home compared to their store-bought counterparts. 2. Chicken broth. Surprisingly, the average store bought chicken broth has only 1-3 grams of protein per cup. For this reason, your bariatric team likely recommended you choose higher protein soups immediately after surgery (ex. milk based soups or pureed legume soups).
Instead, opt for more filling thicker soups, such as a curried lentil soup, a roasted red pepper black bean soup or a hearty chili. 3. Cream cheese. Despite ‘cheese’ being in its name, the average store bought cream cheese has only 1 gram of protein per tablespoon.
Instead, opt for ricotta cheese (with a sprinkle of sunflower seeds and a drizzle of honey!) or peanut butter on your morning toast. 4. Quinoa. Quinoa is a filling grain product not because of its protein content, but more because of its fibre content. While quinoa is the only grain listed as a ‘complete’ protein, it only has 2 grams of protein per ¼ cup of cooked quinoa.
Always top your quinoa with a true protein source such as meat, fish, legumes, tofu or tempeh to make your meal truly balanced. Quinoa should not be the main event! 5. Almond/Cashew/Rice/Coconut milk. Despite these beverages having ‘milk’ in their name, these alternative milks contain on average a measly 1 gram of protein per cup.
Instead, opt for cow milk or soy milk when you are looking to add an extra splash of protein to your cereals, oatmeal or smoothies. Moral of the story? Don’t let misleading product names or sneaky advertising fool you! Get the facts. Always double check the nutrition facts tables on the back of your foods to learn the full story.
- Monica & Lisa

The first meeting with a patient preparing to have weight loss surgery, whether it be sleeve, bypass, or balloon, carries so much hope, anticipation, and excitement- that you can almost cut it with a knife. For many people, by the time they have reached the point of considering weight loss surgery, they have gained and lost hundreds of pounds. They finally have a beacon of hope in what was once a desolate psychological place of despair and hopelessness.
Trying to emphasize the need for simultaneous behavioral and psychological change, often makes me feel like Rachel Dratch in her SNL portrayal of Debbie Downer.
The reality is that there are many people who go into the surgery, carrying a magic bullet fantasy who don't intend to change anything about their lifestyle or psychological landscape, and that actually still works - for a while....
The sheer reduction in portion size over time would dictate that most will lose a significant amount of weight. There is no other way of losing weight that has such a fail safe element to prevent "cheating," or "relapse." You simply can't go overboard after the surgery, or you will get very sick and regret it.
However, after the party is over. All the folks have gone home, all the social reinforcement has diminished, and six to twelve months post- you are still faced with the demons that got you here in the first place; depression, past trauma, abuse, a bad relationship, lack of purpose, addictive propensities, boredom, loneliness, lack of a sense of self efficacy, etc.
Your Psychological Tool Belt is Here.

Baptism - go back to the drawing board when you know you've gotten off track. I am in the midst of potty training my three toddlers at the moment and am reminded of her directive if the kids start to have accidents more frequently that we need to go back to square one and do another three day round of the pants off dance off, where we are sequestered to our home for 72 solid hours so that I can act like a psychological seismograph and quickly put a peeing kid on the potty mid stream.
Same thing applies to bad habits or addiction. To have the same motivation and gusto you once came out of the gates with, you have to go back and come out of the gates again. Perhaps this means reading the literature that got you motivated to change in the first place. Maybe this means going back to OA meetings. This could mean training for a half marathon. Whatever helps to signify to you that another major shift is coming.
Psychological Absolvement- This is a layer of guilt that I see many who relapse, carry. This serves no one. In fact, it sometimes perpetuates the problem because when we feel bad, we do badder (that's a word right?). Understand that this journey you are on is not a simple downhill road, but a twisting, winding, and sometimes uphill battle. This struggle is all part of your process.
In any true change process or metamorphosis there is significant struggle, whether it be the caterpillar in its cocoon, or the crucible in the kiln.
Higher Desires- Make a list of what you at your best self feels and looks like. Are there famouss people or celebrities that have recovered from addiction that inspire you? Are there people in your life that live it with vigor that you would want to emulate?
Environmental prompts- make sure your life is surrounded by items that inspire and motivate you. It could be a beautiful quote on your mirror, a poem on your bedside journal, a beautiful picture on your phone's wallpaper, making sure your favorite health sites are showing up first in your social media feeds, making an effort to tune out negative social media, or triggering/toxic people. Whatever the things are that you know lend to you being your best self, need to be in place. Think of it like psychologically nesting for change.
Cons list- you need to have a list on your person or on your phone of all the reasons you did this in the first place; heart disease, hypertension, sleep apnea, chronic pain, not being able to keep up with the grandkids, poor sex life, feeling of embarrassment in public, social isolation, etc. These can be powerful reminders of why we started such an endeavor in the first place.
Spirituality- This doesn't mean religion but it can. If you have a solid faith- wonderful, use that. Allow your guiding principles to help you during your most vulnerable weak moments. If you don't have any form of spirituality - think about what that might look like for you; yoga, mindfulness, realignment with nature, serving your community.
Spirituality allows us to connect with our soul. It allows us to be in a place of openness and vulnerability without knowing all the answers. It provides us with the opportunity to have faith that everything is going to be alright even though things are really uncomfortable right now.
Daily/Weekly- What are you daily and weekly rituals that keep you on the right track? Make a list of the things you know you need to be doing daily and weekly to signify you are in a good space. Maybe daily it is drinking hot lemon water in the morning, meditation or "bed"itation, prayer, exercise, vitamins, meal prep. Then maybe weekly it is acupuncture, therapy, journaling, volunteering.
Try starting with these tools and see if you don't start to feel a sense of renewed motivation. For more tools, please check out the full psychological tool belt here. For my free supplemental course on weight loss, click here.

You may already know that you should think about the quantifiable aspects: think numbers. You want to know how much weight that surgeon’s patients tend to lose, what kind of complication rates does the surgeon see and which types of complications do they tend to be, and how much experience the surgeon has in terms of lifetime surgeries and current number of surgeries they performed per month.
But what about the rest? What about “bedside manner” and all the things it includes? Finding a surgeon with great statistics may not be enough to guarantee that you have found the best surgeon for yourself. There are some less definable characteristics to think about.
Explains well
Your surgeon should be able to explain everything you want to know in terms you can understand. If you are the type of person who needs to question every detail, you need a surgeon who is willing to take the time to explain everything you want to know at the level of detail you are requesting. Don’t accept “because I said so” as an answer.
Even if you are not the type to ask many questions, you still need to be able to communicate with your surgeon. You need to understand basics such as your surgery options, what to expect in the hospital, and your pre-op and post-op instructions. Keep looking for another surgeon if the one you’re considering now cannot explain well. It is the surgeon’s responsibility to do so; you are not “dumb” for not understanding.
Treats You with Respect
Basic respect can make your entire experience more pleasant, safer, and more successful. “Respect” is complicated, but it can include some of the following.
Treating you as an individual rather than giving you cookie cutter treatment. Taking your concerns seriously. Giving you information to help you make decisions, rather than forcing decisions on you. Discusses risks and expected weight loss seriously with you, and does not make unrealistic promises about surgery safety and impossibly fast weight loss. Is Accessible
There may be times when you have a question or concern that cannot wait until your next appointment. Is your surgeon accessible? If not, does your surgeon have someone else you can call at any time? Find out what happens if you need to contact your surgeon, or a nurse or the nutritionist, during or after business hours. You want to be sure you are in good hands at all times.
Focuses on the Future
You’ve heard over and over that weight loss surgery gives you a tool, and that the rest is up to you. You’ve also heard that this is a change for life, not a quick fix for a few months or a year. Your surgeon should be giving you that same message.
Stay clear of any surgeon who does not discuss the future with you. Be wary if the surgeon seems to believe that his surgery will be enough to get you to the weight you want. As much as you may want to believe it, it is not true. You will need to eat right and work hard for years to get your weight under control, and you need a surgeon who will support you every step of the way.
Gives You Confidence
No matter what happens in your life, which decisions you make about surgery, and what triumphs and challenges your weight loss surgery journey includes, things will be better if you feel positively about them. Your surgeon can help by giving you confidence that:
He or She will take care of you no matter what. He or She believes in you. You are making the right decisions for yourself. This can be difficult to judge, but see how you feel after walking out of the surgeon’s office. Do you feel excited and hopeful? Or do you feel overwhelmed and daunted? A few nerves are normal, but you should also feel that you can do this. If not, find a surgeon who does let you feel self-confident.
Fantastic surgeons are out there, and you deserve one, but you may need to put in some effort to find one. After checking out the statistics, you may need to depend on your gut to help you make the right decision. You can go into surgery with more confidence when your surgeon is communicative, respectful, and positive.