Dr. Colleen Long

Licensed psychologist, Dr. Colleen Long has worked in the field of bariatrics for 10 years and discusses the ins and outs of the pre-op psychological evaluation to put anyone getting ready to go through the process at ease. Every time I sit down with someone to do their VSG and Bypass psych pre-op evaluation- they are understandably nervous and on edge. My first question is: "Has anyone explained to you the reason for why you need a psychological evaluation?" and there answer is always, "no, I have no idea why I am here." I explain to them the reasons are threefold: 1) to make sure they understand the risks, benefits, and outcomes of the surgery, 2) to understand any psychological/behavioral ties to food that would benefit from behavioral recommendations/modification, and 3) to help the surgeon understand one's personality as it relates to a healthcare context, to better inform treatment. 1) Most people have been able to go over the risks, benefits, and outcomes with their medical team, but if not- I make sure last minute questions are addressed before they proceed. 2) During the evaluation- we talk about the patient's unique eating behaviors and how to modify them to help with maximum weight loss after the surgery. For instance, last week- I met with a guy who said he normally has a bowl of cereal at night in front of the TV and it provides him with a sense of "contentment." We talked about other ideas to create that same sense of contentment without sabotaging his weight loss surgery outcome, such as reaching out for support, taking a hot bath, listening to music, meditating, journaling, and/or creating a self-care ritual each night before bed. 3) The results of psychological testing provide me with really strong insight into each person's psyche as it relates to a medical setting. For instance, some results will say- " this person is uncomfortable talking about health care issues with strangers and may require more prompting than the average patient," or " this patient is likely to look compliant by being overly agreeable, but has a tendency to venture out on their own, and therefore frequent follow up is recommended," or " this person is uncomfortable in the patient role and will become increasingly agitated in the event of long-term health issues." The 3rd piece of this evaluation is of concern to some, but for the most part- it is meant to help better inform their treatment plan. If a surgeon understands that a patient is more apt to look compliant but "go rogue," they are probably going to incorporate more frequent follow up to make sure that person has the best chance of success. In the end- a psychologist's goal is not to be a hurdle in a patient's weight loss journey, but a catalyst.

Every time I sit down with someone to do their VSG and Bypass psych pre-op evaluation- they are understandably nervous and on edge. My first question is: "Has anyone explained to you the reason for why you need a psychological evaluation?" and there answer is always, "no, I have no idea why I am here." I explain to them the reasons are threefold: 1) to make sure they understand the risks, benefits, and outcomes of the surgery, 2) to understand any psychological/behavioral ties to food that would benefit from behavioral recommendations/modification, and 3) to help the surgeon understand one's personality as it relates to a healthcare context, to better inform treatment. 1) Most people have been able to go over the risks, benefits, and outcomes with their medical team, but if not- I make sure last minute questions are addressed before they proceed. 2) During the evaluation- we talk about the patient's unique eating behaviors and how to modify them to help with maximum weight loss after the surgery. For instance, last week- I met with a guy who said he normally has a bowl of cereal at night in front of the TV and it provides him with a sense of "contentment." We talked about other ideas to create that same sense of contentment without sabotaging his weight loss surgery outcome, such as reaching out for support, taking a hot bath, listening to music, meditating, journaling, and/or creating a self-care ritual each night before bed. 3) The results of psychological testing provide me with really strong insight into each person's psyche as it relates to a medical setting. For instance, some results will say- " this person is uncomfortable talking about health care issues with strangers and may require more prompting than the average patient," or " this patient is likely to look compliant by being overly agreeable, but has a tendency to venture out on their own, and therefore frequent follow up is recommended," or " this person is uncomfortable in the patient role and will become increasingly agitated in the event of long-term health issues." The 3rd piece of this evaluation is of concern to some, but for the most part- it is meant to help better inform their treatment plan. If a surgeon understands that a patient is more apt to look compliant but "go rogue," they are probably going to incorporate more frequent follow up to make sure that person has the best chance of success. In the end- a psychologist's goal is not to be a hurdle in a patient's weight loss journey, but a catalyst.

What does it mean to be “full from within?” "This concept refers to the idea that we no longer have this psychological “black hole,” that needs to be fed through external things such as; food, drugs, alcohol, spending, relationships, gambling." ~ Dr. Colleen, The Psychology of Finally Being Full From Within To be truly full from within means that our “tank” is mentally full. In other words, our self, although beaten up, bruised, and broken sometimes as a result of our journey down each of our unique life’s path - is repaired and felt as whole again. Like a patchwork quilt that only gets stronger as a result of its many tears and reparations. How does one achieve this, you ask? Borrowing from Aaron Beck’s cognitive triangle - we have three components of the mind that work to repair the self: THOUGHTS, FEELINGS, BEHAVIORS. These are the different components that must be running on all four cylinders to ensure that we aren’t at risk of developing or perpetuating an unhealthy relationship with any of the topics mentioned above, for the purposes of this article, specifically - food. Thoughts To Repair The Self Mindfulness Based Cognitive Therapy is a 25 cent term to describe the process of looking at the old tapes we run in our minds day in and day out for years upon years, and stopping them in their tracks, and replacing them with new ones. A hallmark approach in Byron Katie’s book “Loving What Is,” is to continuously challenge one’s thoughts by asking “is that really true?” 13 If we deem that we can’t say with absolute certainty that a thought is true, then we can replace it with a more constructive thought. For instance, if we find ourselves with a running narrative that goes something like “you are just never going to be someone that stands out, it’s ok you have other good traits,” then what is the behavior and feelings that it produces? Perhaps the person goes on feeling invisible like many people who are overweight feel. Maybe the person gives up on trying to stand out in the way they look and participate in life. Feelings To Repair The Self For my clients suffering from depression, I will often assign them a task of doing one social event, one bout of exercise (if they have never been inclined to exercise), and one learning activity (lecture, take a CE, attend a webinar, go to a pottery class, painting class, attend a speaking event). Many of them balk at the idea. Some of them have been doing things their way for years and there is an undercurrent of fear related to breaking their routine. It is almost as if the depression has a voice that says “don’t do it, you will only feel worse.” We must realize that when we have depression, our mind is sick. It is no longer serving us, and the messages are coming from crossed wires. In order to uncross those wires, we must physically and literally put one foot in front of the other and re-engage in those activities that we know from the research lead to a sense of happiness or at least contentment. Behaviors To Repair The Self One of the biggest misconceptions about our mind is the idea that we must feel a certain way to engage in certain behaviors. In other words, we must first feel happy if we are going to go to a social event and relate to others in a positive way. However, the cognitive triangle mentioned above is tri-directional14, meaning our behaviors can influence our feelings and/or thoughts, and vice versa. This is powerful information. This means that we don’t have to wait for happiness or joy to come around to engage in behaviors we know lead to more happiness. In fact, one of my first interventions with my patients who suffer from depression is the “just do it” approach, meaning they are given the task of doing three behaviors they don’t necessarily feel like doing in the six days in between their next therapy session. To explain depression via a very simple analogy- it is like the flu for the mind. What do you typically do when you have the flu? You cancel your appointments, stay in bed, drink lots of water, and get lots of rest. The reasoning is that if we minimize the number of life events for a brief bit of time, we will heal more quickly, and we do. BUT, this is not the case with depression. The same intuition we use to combat the flu is the antithesis of what we must do to combat depression, yet somehow our instincts tell us to do the opposite. When we feel depressed, our inclination is to isolate, do less, and wait for the clouds to part. The problem with this is that this type of behavior is what feeds the depression. Suggested Behaviors Benevolence - reaching out to others and getting out of our own head, focusing on how to make someone else’s life or day better through connecting or giving. Play- engaging in something that requires enough effort that we can’t run old unhelpful tapes (I’m not good enough, other people must be more disciplined than me, things will never change, etc), but provides us with enough fun that we leave the activity feeling light, like surfing, artistry, building, writing, playing an instrument, etc. When we are kids, we spend about 95% of our day playing and even trying to find play in our responsibilities (have you ever watched a kid brush their teeth or get dressed? it is never a straightforward buttoned up process). Yet, as adults - we flip that on its head and spend 95% of our time being a human doing vs. a human being. Learning- engaging in novelty is something our brain requires to feel happy and fed. It could be as simple as learning a new card game, all the way to enrolling in an MBA course. When we allow our minds to do what they are best at - our minds give back to us. Connection- We are social creatures by nature. There is a physiological rewiring process that occurs as result of being in near proximity to other humans. It is how we survived so long ago, and our minds still provide the payoff. We are not meant to live in isolation, yet so many of us drift in this direction when they are depressed. Even introverts require some social connection. While extroverts tend to thrive and recharge their batteries on social connection, it is true that introverts recharge in their solitude. However, there is a difference between being alone vs. lonely. As introverted as you may think you are, none of us are immune to going from alone to lonely if we don’t make time for some social connection. Exercise- There are about 99 reasons to exercise and happiness is one. I’m not going to waste space and wax poetic about the many benefits of exercise because I’m sure you’re well aware. But in addition to producing endorphins that have been proven to make us feel better, as far as weight loss goes- it also makes us less likely to put junk in our bodies. Ever do an intense sweat session and then make a beeline to the nearest McDonald’s? I didn’t think so.

To be truly full from within means that our “tank” is mentally full. In other words, our self, although beaten up, bruised, and broken sometimes as a result of our journey down each of our unique life’s path - is repaired and felt as whole again. Like a patchwork quilt that only gets stronger as a result of its many tears and reparations. How does one achieve this, you ask? Borrowing from Aaron Beck’s cognitive triangle - we have three components of the mind that work to repair the self: THOUGHTS, FEELINGS, BEHAVIORS. These are the different components that must be running on all four cylinders to ensure that we aren’t at risk of developing or perpetuating an unhealthy relationship with any of the topics mentioned above, for the purposes of this article, specifically - food. Thoughts To Repair The Self Mindfulness Based Cognitive Therapy is a 25 cent term to describe the process of looking at the old tapes we run in our minds day in and day out for years upon years, and stopping them in their tracks, and replacing them with new ones. A hallmark approach in Byron Katie’s book “Loving What Is,” is to continuously challenge one’s thoughts by asking “is that really true?” 13 If we deem that we can’t say with absolute certainty that a thought is true, then we can replace it with a more constructive thought. For instance, if we find ourselves with a running narrative that goes something like “you are just never going to be someone that stands out, it’s ok you have other good traits,” then what is the behavior and feelings that it produces? Perhaps the person goes on feeling invisible like many people who are overweight feel. Maybe the person gives up on trying to stand out in the way they look and participate in life. Feelings To Repair The Self For my clients suffering from depression, I will often assign them a task of doing one social event, one bout of exercise (if they have never been inclined to exercise), and one learning activity (lecture, take a CE, attend a webinar, go to a pottery class, painting class, attend a speaking event). Many of them balk at the idea. Some of them have been doing things their way for years and there is an undercurrent of fear related to breaking their routine. It is almost as if the depression has a voice that says “don’t do it, you will only feel worse.” We must realize that when we have depression, our mind is sick. It is no longer serving us, and the messages are coming from crossed wires. In order to uncross those wires, we must physically and literally put one foot in front of the other and re-engage in those activities that we know from the research lead to a sense of happiness or at least contentment. Behaviors To Repair The Self One of the biggest misconceptions about our mind is the idea that we must feel a certain way to engage in certain behaviors. In other words, we must first feel happy if we are going to go to a social event and relate to others in a positive way. However, the cognitive triangle mentioned above is tri-directional14, meaning our behaviors can influence our feelings and/or thoughts, and vice versa. This is powerful information. This means that we don’t have to wait for happiness or joy to come around to engage in behaviors we know lead to more happiness. In fact, one of my first interventions with my patients who suffer from depression is the “just do it” approach, meaning they are given the task of doing three behaviors they don’t necessarily feel like doing in the six days in between their next therapy session. To explain depression via a very simple analogy- it is like the flu for the mind. What do you typically do when you have the flu? You cancel your appointments, stay in bed, drink lots of water, and get lots of rest. The reasoning is that if we minimize the number of life events for a brief bit of time, we will heal more quickly, and we do. BUT, this is not the case with depression. The same intuition we use to combat the flu is the antithesis of what we must do to combat depression, yet somehow our instincts tell us to do the opposite. When we feel depressed, our inclination is to isolate, do less, and wait for the clouds to part. The problem with this is that this type of behavior is what feeds the depression. Suggested Behaviors Benevolence - reaching out to others and getting out of our own head, focusing on how to make someone else’s life or day better through connecting or giving. Play- engaging in something that requires enough effort that we can’t run old unhelpful tapes (I’m not good enough, other people must be more disciplined than me, things will never change, etc), but provides us with enough fun that we leave the activity feeling light, like surfing, artistry, building, writing, playing an instrument, etc. When we are kids, we spend about 95% of our day playing and even trying to find play in our responsibilities (have you ever watched a kid brush their teeth or get dressed? it is never a straightforward buttoned up process). Yet, as adults - we flip that on its head and spend 95% of our time being a human doing vs. a human being. Learning- engaging in novelty is something our brain requires to feel happy and fed. It could be as simple as learning a new card game, all the way to enrolling in an MBA course. When we allow our minds to do what they are best at - our minds give back to us. Connection- We are social creatures by nature. There is a physiological rewiring process that occurs as result of being in near proximity to other humans. It is how we survived so long ago, and our minds still provide the payoff. We are not meant to live in isolation, yet so many of us drift in this direction when they are depressed. Even introverts require some social connection. While extroverts tend to thrive and recharge their batteries on social connection, it is true that introverts recharge in their solitude. However, there is a difference between being alone vs. lonely. As introverted as you may think you are, none of us are immune to going from alone to lonely if we don’t make time for some social connection. Exercise- There are about 99 reasons to exercise and happiness is one. I’m not going to waste space and wax poetic about the many benefits of exercise because I’m sure you’re well aware. But in addition to producing endorphins that have been proven to make us feel better, as far as weight loss goes- it also makes us less likely to put junk in our bodies. Ever do an intense sweat session and then make a beeline to the nearest McDonald’s? I didn’t think so.

Dr. Colleen talks about 8 simple behaviors that can help you really see the change you've been seeking in your life. Maybe if you are reading this, you have already begun to change. Maybe you have been chewing on the prospect of change but find yourself doing the same thing from week to week? Today's article is short and sweet. Below, I will outline the top 8 behaviors to implement on the daily to bring change forth or take the current progress you've made to the next level: 1. find a book, any book that deals with the change you want to happen (this can be someone else's success story, or a self help book, or my book ). The idea is to refresh your inner template for why you want to change in the first place. 2. Create a reading list of the resources you know help to keep you on the right track and make a point to read an excerpt for 10 minutes each morning to start your day (podcasts, blogs, IG story, my full from within course, a favorite book, an online support community, etc). 3. Yoga/meditation- create a space for the mind and body to heal. You will be surprised how much easier change is to implement when mind and body have been given the gift of stillness and when we shift from human doings to human beings. 4. Take self care breaks EVERY DAY. Doesn't mean you need to go to a spa every day. Make it a priority to carve out self time every day. If you were recovering or sick in the hospital you would have no problem giving yourself a break in an effort to recover. Change is also recovery from what was broken. 5. Exercise. 6. Create a gratitude practice. Change is often times about what is not working. However, gratitude helps us to focus on what is working. We can get so mired into the myopic view that we are wrong and everyone else must be doing it right. It is important to balance our view of our path with this practice. I highly recommend the gratitude app- which allows you to include pics from your day and serve as an ongoing gratitude feed. 7. Sit down and write down the reasons why you are changing in the first place. I know many of you think "of course I know why I'm doing this." However, it is important to reconnect with your core self frequently to get all of the motivation needed to change. You may be surprised what else was there waiting for you. 8. If it is food that you are trying to change (in terms of what you are eating or how much). This week try thinking "Yay, I don't have to eat that way anymore," vs. "ok now the vacation is over and its time to pay the piper." That's it. Good luck on this next chapter! PS- What are you struggling with? Did you read my book? Was there something missing you would have like to read? Was there something more you wanted to know about? What do you struggle with psychologically when it comes to WLS?

Maybe if you are reading this, you have already begun to change. Maybe you have been chewing on the prospect of change but find yourself doing the same thing from week to week? Today's article is short and sweet. Below, I will outline the top 8 behaviors to implement on the daily to bring change forth or take the current progress you've made to the next level: 1. find a book, any book that deals with the change you want to happen (this can be someone else's success story, or a self help book, or my book ). The idea is to refresh your inner template for why you want to change in the first place. 2. Create a reading list of the resources you know help to keep you on the right track and make a point to read an excerpt for 10 minutes each morning to start your day (podcasts, blogs, IG story, my full from within course, a favorite book, an online support community, etc). 3. Yoga/meditation- create a space for the mind and body to heal. You will be surprised how much easier change is to implement when mind and body have been given the gift of stillness and when we shift from human doings to human beings. 4. Take self care breaks EVERY DAY. Doesn't mean you need to go to a spa every day. Make it a priority to carve out self time every day. If you were recovering or sick in the hospital you would have no problem giving yourself a break in an effort to recover. Change is also recovery from what was broken. 5. Exercise. 6. Create a gratitude practice. Change is often times about what is not working. However, gratitude helps us to focus on what is working. We can get so mired into the myopic view that we are wrong and everyone else must be doing it right. It is important to balance our view of our path with this practice. I highly recommend the gratitude app- which allows you to include pics from your day and serve as an ongoing gratitude feed. 7. Sit down and write down the reasons why you are changing in the first place. I know many of you think "of course I know why I'm doing this." However, it is important to reconnect with your core self frequently to get all of the motivation needed to change. You may be surprised what else was there waiting for you. 8. If it is food that you are trying to change (in terms of what you are eating or how much). This week try thinking "Yay, I don't have to eat that way anymore," vs. "ok now the vacation is over and its time to pay the piper." That's it. Good luck on this next chapter! PS- What are you struggling with? Did you read my book? Was there something missing you would have like to read? Was there something more you wanted to know about? What do you struggle with psychologically when it comes to WLS?

This time of year, we are constantly bombarded with messages of change- so much so, that many of us throw our hands up in the air and say "I don't make resolutions anymore," or my favorite "I don't believe in resolutions." Try to make a big change with one simple tool this time. I know so many of you are in some way thinking about how you'd like to hit the reset button in 2018. One of the most common issues clients face is the discrepancy between their long term desires and their short term actions. Here's a quick 5 minute tool, that if you use it as a framework each Sunday (or whatever the day before your week starts is), will change your life in terms of how you feel you manage your time. Use my following 6 point framework to help organize your week and start to feel like you are finally living your life instead of it living you.... PS- "Mike" is my partner, so feel free to change that category to someone in your life that helps to support you throughout your week Psssst... If you want to receive periodic tips on the psychological aspects of VSG and WLS, please shoot me an email at talkdoc126@gmail.com or friend "drcolleen long" on Facebook and let me know you're interested in support. I'm also taking half off my Full From Within Ultimate course today through January 8th with promo code HALF2018 - if you want to really hit the reset button and step up your eating game in 2018. Just as a reminder, in the course, you receive: and weight, from a psychological perspective. The catalyst you need to rebuild motivation and/or stop yourself from plateauing, or worse- re-gaining the weight. In this course you will get: the ULTIMATE weight loss guide which is chock full of resources including apps, websites, and books to make your weight loss journey as easy as possible understanding of how to create a new relationship with food understanding WHY you eat vs. just focusing on WHAT you eat eliminate overeating and bingeing journal challenges to help you critically think about how these principles will be applied to your new life tips on how to stay slim in a work from home culture, where food is always readily accessible guided hypnosis to target the deeper subconscious that is so difficult to change and can impede our goals despite our best intentions daily habits of highly successful weight loss how to become a natural exerciser yoga & mindfulness for weight loss how to navigate the psychosocial aspects of weight loss such as family, friends, and social events hard and fast tips to get rid of the grey area that gets so many people in to trouble behavioral steps that will help make this attempt feel "real" and solid identifying the triggers of over eating whether it be emotional eating, lack of planning, cognitive distortions, etc the ONE fundamental shift that must take place so that this doesn't feel like yet another diet practical real life psychological coping strategies to avoiding over-eating and food addiction recovery from food addiction visual tools that will help in your weight loss journey learning to define a new quality of life personality factors to consider that can effect your weight loss success clipping your psychological addiction wires- unpacking emotions related to excessive calories

I know so many of you are in some way thinking about how you'd like to hit the reset button in 2018. One of the most common issues clients face is the discrepancy between their long term desires and their short term actions. Here's a quick 5 minute tool, that if you use it as a framework each Sunday (or whatever the day before your week starts is), will change your life in terms of how you feel you manage your time. Use my following 6 point framework to help organize your week and start to feel like you are finally living your life instead of it living you.... PS- "Mike" is my partner, so feel free to change that category to someone in your life that helps to support you throughout your week Psssst... If you want to receive periodic tips on the psychological aspects of VSG and WLS, please shoot me an email at talkdoc126@gmail.com or friend "drcolleen long" on Facebook and let me know you're interested in support. I'm also taking half off my Full From Within Ultimate course today through January 8th with promo code HALF2018 - if you want to really hit the reset button and step up your eating game in 2018. Just as a reminder, in the course, you receive: and weight, from a psychological perspective. The catalyst you need to rebuild motivation and/or stop yourself from plateauing, or worse- re-gaining the weight. In this course you will get: the ULTIMATE weight loss guide which is chock full of resources including apps, websites, and books to make your weight loss journey as easy as possible understanding of how to create a new relationship with food understanding WHY you eat vs. just focusing on WHAT you eat eliminate overeating and bingeing journal challenges to help you critically think about how these principles will be applied to your new life tips on how to stay slim in a work from home culture, where food is always readily accessible guided hypnosis to target the deeper subconscious that is so difficult to change and can impede our goals despite our best intentions daily habits of highly successful weight loss how to become a natural exerciser yoga & mindfulness for weight loss how to navigate the psychosocial aspects of weight loss such as family, friends, and social events hard and fast tips to get rid of the grey area that gets so many people in to trouble behavioral steps that will help make this attempt feel "real" and solid identifying the triggers of over eating whether it be emotional eating, lack of planning, cognitive distortions, etc the ONE fundamental shift that must take place so that this doesn't feel like yet another diet practical real life psychological coping strategies to avoiding over-eating and food addiction recovery from food addiction visual tools that will help in your weight loss journey learning to define a new quality of life personality factors to consider that can effect your weight loss success clipping your psychological addiction wires- unpacking emotions related to excessive calories

Well, how did you do? One of the biggest "foodie" holidays of the year just passed us by, which can be a MAJOR trigger for those who struggle with food addiction. If you're shaking your head in regret, please read on below to learn how to quickly get back on track. Well, how did you do? One of the biggest "foodie" holidays of the year just passed us by, which can be a MAJOR trigger for those who struggle with food addiction. If you're one of the lucky few, who is able to look back over the holiday proudly, and say "there is nothing I would have changed," then congratulations! I am genuinely interested in reading your comments below about what worked for you; did you remove yourself from the triggering environments, distract yourself by playing a card game or talking with another family member trying to do the same, did you re-read your bariatric surgery "why's," to reinforce your motivation that day, or was there something else that worked to keep you on track? "It's not how we fall. It's how we get back up again." - Patrick Ness For those of you who are shaking your head in regret this morning, you are not alone. There are thousands of other WLS patients who struggled to stay on track over the holidays. The biggest struggle I've hear throughout the years is that the motivation is dented, diluted, or zapped when one first gets off track from their plan. Enter code CYBERSALE to get my Full From Within Psychological Tools for WLS patients course 50% off today only. There is a lot of psychology behind this. Part of the magic in resolutions is their novelty: an implicit contract within the self that says "this will be unlike anything I've ever done before." When we relapse (or "slip" as I prefer to call it), the self goes "oh wait a minute, I know how this goes, maybe this is no different than before, who am I to think I could do this, I have no willpower, etc., etc., etc." So the idea is to find a new plan. It can be bits and bobs of the one you had before, but it needs to have that new car smell again to have longevity. I am including an excerpt of an earlier article I wrote about how to do just that: What do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? “The secret of change is to focus all of your energy not on fighting the old, but on building the new.” - Socrates Everyone does well out of the gates. We all impress ourselves when we start, what we believe to be, a new lifestyle change. However, "out of the gates," can mean different things for different people; for some it is two months, for others (usually depending on how strong the addiction or habit is) it can be two minutes. But what do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? One magical ingredient in the secret sauce (and one of many concepts I talk about in my book and my wls courses) that is lifestyle change is the novelty effect. The new plan to quit something or change a bad habit is something unlike we have ever done before, so we hope that we can achieve something we have never done before. The problem is that the moment we slip, that novelty loses its magic - and each time we start over, it loses its power to give us hope. So the solution is to cultivate more novelty. Our ability to continually grow and change is largely limited by our creativity. The more creative we become, the easier it is to take a different approach to change. To open a window when life seems to shut the door. In other words- what I am telling you, is that the only secret to long term weight loss maintenance is the knowledge that there isn't only one secret. There is no ONE diet that will forever change someone. Eventually people get tired of eating bacon and eggs every meal on Atkins, or grapefruit, or cabbage soup- but the thread they all share is their novelty. This is why all of them can work initially. Even as powerful as weight loss surgery is- people still find that they start to plateau or even gain the weight back if they aren't simultaneously addressing the behavioral and psychological factors that got them there in the first place. They too, must also continuously be creative about renewing one self throughout their lifetime. So the following is for all of you who are struggling today. Those that feel they have lost their way and perhaps feel disenchanted or disappointed. Below is a recovery "map" I created a long time ago for my clients, some struggling with substance abuse, others with food. It all works the same. Print it out, or copy and paste it in the notes section of your phone and take 20 minutes to fill it out with the things that are personally meaningful for you. This is not THE answer to long term recovery from addiction, but it is a fresh approach for many who feel stale at the moment: Baptism - Some ceremony to signal a renewed sense of hope and a fresh start. One client trying to recover from substance abuse, buried all of his wine and liquor bottles in his yard. Another client had a "garbage party" with her kiddos, and they loved smashing all the processed foods they had in their pantry and throwing them in the trash. Associations/triggers list all of the things that get you into trouble (being at a bbq, wanting to Celebrate something, holidays, 7-10pm at night, date night, etc) Coping Skills (what gets you through the crave waves) These are the behaviors that you do INSTEAD of the addictive behavior. Extra credit if you are able to make a coping skill for each trigger listed above. Enter code CYBERSALE to get my Full From Within Psychological Tools for WLS patients course 50% off today only. Higher Desires/Vision of Self when you let go of your attachment to food and all the self loathing, mental, and physical heaviness it brings- what are you freeing your life up for? will you write a book? will you do more outdoor activities with your kids? do you want to resume an activity you once loved as a child? Is there a role model that inspires you that has done what you want to do? Cons Why are you doing this in the first place? These are the things that are hard to keep in mind when our reptilian mid brain (see last article) is at the wheel. What is personally meaningful? Does it age you? Does it make you feel out of control? Do you dread going on airplanes because you know you'll need an extender? does it prevent you from going to amusement parks with your kiddos? Spirituality (religion gets us into heaven, spirituality gets us out of hell) All addiction is what disconnects us from our deeper self and edges us further and further away from God (or whatever you like to call it) and our deeper spirituality. Spirituality is what allows us to move into the unknown, be comfortable with discomfort, and have faith that everything will be ok. It can include a gratitude practice, volunteering, play, aligning one self with nature, connecting with a spiritual e newsletter (mind body green, daily om, etc), generosity, etc. Daily Recovery Ritual (symbolic gesture to self every day that we are consciously devoting time to our recovery) What are the things you can do daily to symbolize to yourself that today is a new day? Keep it realistic or you won't do it. Vitamins, meditation, lemon Water, supplements, self care, reaching out to a loved one, exercise, etc. Reward System What will you do for yourself if there is a certain period of time reached where you meet your goals? Will you get a massage at the end of every month? Will you plan a vacation after three months of solid goal hitting? Will you reward yourself with one day per week of going to the movies in the middle of the day and playing hooky if you're on the straight and narrow for five days? Strategy This is your "what." What are you doing daily to ensure that you are in alignment with your goals? Are you reading something fresh all the time? Do you make a timeline of your addiction and how it has affected your life? Do you go to local support meetings each week? Do you keep in touch with an online community? Do you make sure to give yourself small breaks while with the kids every day? Do you have a self care space set up in your house? Do you talk to a partner about how to change behaviors of theirs that might be hindering your efforts? can they get a mini fridge? Do you do acupuncture to balance your chi? Do you do yoga to manage your depression? Do you find a therapist? Recovery Resources (try to hit one each morning) what resources are in your pocket when you are feeling weak? bariatricpal.com? WLS journeys on Instagram? The Fix, Reddit, unique blogs documenting their weight loss journey, wls and vsg searches on Pinterest, etc. Good luck on your fresh start! Need extra motivation? Use code "CYBERSALE" to get my course: Full From Within Ultimate Psychological Tools for WLS patients half off today only, or try my FFW mini for free.

Well, how did you do? One of the biggest "foodie" holidays of the year just passed us by, which can be a MAJOR trigger for those who struggle with food addiction. If you're one of the lucky few, who is able to look back over the holiday proudly, and say "there is nothing I would have changed," then congratulations! I am genuinely interested in reading your comments below about what worked for you; did you remove yourself from the triggering environments, distract yourself by playing a card game or talking with another family member trying to do the same, did you re-read your bariatric surgery "why's," to reinforce your motivation that day, or was there something else that worked to keep you on track? "It's not how we fall. It's how we get back up again." - Patrick Ness For those of you who are shaking your head in regret this morning, you are not alone. There are thousands of other WLS patients who struggled to stay on track over the holidays. The biggest struggle I've hear throughout the years is that the motivation is dented, diluted, or zapped when one first gets off track from their plan. Enter code CYBERSALE to get my Full From Within Psychological Tools for WLS patients course 50% off today only. There is a lot of psychology behind this. Part of the magic in resolutions is their novelty: an implicit contract within the self that says "this will be unlike anything I've ever done before." When we relapse (or "slip" as I prefer to call it), the self goes "oh wait a minute, I know how this goes, maybe this is no different than before, who am I to think I could do this, I have no willpower, etc., etc., etc." So the idea is to find a new plan. It can be bits and bobs of the one you had before, but it needs to have that new car smell again to have longevity. I am including an excerpt of an earlier article I wrote about how to do just that: What do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? “The secret of change is to focus all of your energy not on fighting the old, but on building the new.” - Socrates Everyone does well out of the gates. We all impress ourselves when we start, what we believe to be, a new lifestyle change. However, "out of the gates," can mean different things for different people; for some it is two months, for others (usually depending on how strong the addiction or habit is) it can be two minutes. But what do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? One magical ingredient in the secret sauce (and one of many concepts I talk about in my book and my wls courses) that is lifestyle change is the novelty effect. The new plan to quit something or change a bad habit is something unlike we have ever done before, so we hope that we can achieve something we have never done before. The problem is that the moment we slip, that novelty loses its magic - and each time we start over, it loses its power to give us hope. So the solution is to cultivate more novelty. Our ability to continually grow and change is largely limited by our creativity. The more creative we become, the easier it is to take a different approach to change. To open a window when life seems to shut the door. In other words- what I am telling you, is that the only secret to long term weight loss maintenance is the knowledge that there isn't only one secret. There is no ONE diet that will forever change someone. Eventually people get tired of eating bacon and eggs every meal on Atkins, or grapefruit, or cabbage soup- but the thread they all share is their novelty. This is why all of them can work initially. Even as powerful as weight loss surgery is- people still find that they start to plateau or even gain the weight back if they aren't simultaneously addressing the behavioral and psychological factors that got them there in the first place. They too, must also continuously be creative about renewing one self throughout their lifetime. So the following is for all of you who are struggling today. Those that feel they have lost their way and perhaps feel disenchanted or disappointed. Below is a recovery "map" I created a long time ago for my clients, some struggling with substance abuse, others with food. It all works the same. Print it out, or copy and paste it in the notes section of your phone and take 20 minutes to fill it out with the things that are personally meaningful for you. This is not THE answer to long term recovery from addiction, but it is a fresh approach for many who feel stale at the moment: Baptism - Some ceremony to signal a renewed sense of hope and a fresh start. One client trying to recover from substance abuse, buried all of his wine and liquor bottles in his yard. Another client had a "garbage party" with her kiddos, and they loved smashing all the processed foods they had in their pantry and throwing them in the trash. Associations/triggers list all of the things that get you into trouble (being at a bbq, wanting to Celebrate something, holidays, 7-10pm at night, date night, etc) Coping Skills (what gets you through the crave waves) These are the behaviors that you do INSTEAD of the addictive behavior. Extra credit if you are able to make a coping skill for each trigger listed above. Enter code CYBERSALE to get my Full From Within Psychological Tools for WLS patients course 50% off today only. Higher Desires/Vision of Self when you let go of your attachment to food and all the self loathing, mental, and physical heaviness it brings- what are you freeing your life up for? will you write a book? will you do more outdoor activities with your kids? do you want to resume an activity you once loved as a child? Is there a role model that inspires you that has done what you want to do? Cons Why are you doing this in the first place? These are the things that are hard to keep in mind when our reptilian mid brain (see last article) is at the wheel. What is personally meaningful? Does it age you? Does it make you feel out of control? Do you dread going on airplanes because you know you'll need an extender? does it prevent you from going to amusement parks with your kiddos? Spirituality (religion gets us into heaven, spirituality gets us out of hell) All addiction is what disconnects us from our deeper self and edges us further and further away from God (or whatever you like to call it) and our deeper spirituality. Spirituality is what allows us to move into the unknown, be comfortable with discomfort, and have faith that everything will be ok. It can include a gratitude practice, volunteering, play, aligning one self with nature, connecting with a spiritual e newsletter (mind body green, daily om, etc), generosity, etc. Daily Recovery Ritual (symbolic gesture to self every day that we are consciously devoting time to our recovery) What are the things you can do daily to symbolize to yourself that today is a new day? Keep it realistic or you won't do it. Vitamins, meditation, lemon Water, supplements, self care, reaching out to a loved one, exercise, etc. Reward System What will you do for yourself if there is a certain period of time reached where you meet your goals? Will you get a massage at the end of every month? Will you plan a vacation after three months of solid goal hitting? Will you reward yourself with one day per week of going to the movies in the middle of the day and playing hooky if you're on the straight and narrow for five days? Strategy This is your "what." What are you doing daily to ensure that you are in alignment with your goals? Are you reading something fresh all the time? Do you make a timeline of your addiction and how it has affected your life? Do you go to local support meetings each week? Do you keep in touch with an online community? Do you make sure to give yourself small breaks while with the kids every day? Do you have a self care space set up in your house? Do you talk to a partner about how to change behaviors of theirs that might be hindering your efforts? can they get a mini fridge? Do you do acupuncture to balance your chi? Do you do yoga to manage your depression? Do you find a therapist? Recovery Resources (try to hit one each morning) what resources are in your pocket when you are feeling weak? bariatricpal.com? WLS journeys on Instagram? The Fix, Reddit, unique blogs documenting their weight loss journey, wls and vsg searches on Pinterest, etc. Good luck on your fresh start! Need extra motivation? Use code "CYBERSALE" to get my course: Full From Within Ultimate Psychological Tools for WLS patients half off today only, or try my FFW mini for free.

What do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? “The secret of change is to focus all of your energy not on fighting the old, but on building the new.” - Socrates Everyone does well out of the gates. We all impress ourselves when we start, what we believe to be, a new lifestyle change. However, "out of the gates," can mean different things for different people; for some it is two months, for others (usually depending on how strong the addiction or habit is) it can be two minutes. But what do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? One magical ingredient in the secret sauce (and one of many concepts I talk about in my book and my wls courses) that is lifestyle change is the novelty effect. The new plan to quit something or change a bad habit is something unlike we have ever done before, so we hope that we can achieve something we have never done before. The problem is that the moment we slip, that novelty loses its magic - and each time we start over, it loses its power to give us hope. So the solution is to cultivate more novelty. Our ability to continually grow and change is largely limited by our creativity. The more creative we become, the easier it is to take a different approach to change. To open a window when life seems to shut the door. In other words- what I am telling you, is that the only secret to long term weight loss maintenance is the knowledge that there isn't only one secret. There is no ONE diet that will forever change someone. Eventually people get tired of eating bacon and eggs every meal on Atkins, or grapefruit, or cabbage soup- but the thread they all share is their novelty. This is why all of them can work initially. Even as powerful as weight loss surgery is- people still find that they start to plateau or even gain the weight back if they aren't simultaneously addressing the behavioral and psychological factors that got them there in the first place. They too, must also continuously be creative about renewing one self throughout their lifetime. So the following is for all of you who are struggling today. Those that feel they have lost their way and perhaps feel disenchanted or disappointed. Below is a recovery "map" I created a long time ago for my clients, some struggling with substance abuse, others with food. It all works the same. Print it out, or copy and paste it in the notes section of your phone and take 20 minutes to fill it out with the things that are personally meaningful for you. This is not THE answer to long term recovery from addiction, but it is a fresh approach for many who feel stale at the moment: Baptism - Some ceremony to signal a renewed sense of hope and a fresh start. One client trying to recover from substance abuse, buried all of his wine and liquor bottles in his yard. Another client had a "garbage party" with her kiddos, and they loved smashing all the processed foods they had in their pantry and throwing them in the trash. Associations/triggers list all of the things that get you into trouble (being at a bbq, wanting to celebrate something, holidays, 7-10pm at night, date night, etc) Coping Skills (what gets you through the crave waves) These are the behaviors that you do INSTEAD of the addictive behavior. Extra credit if you are able to make a coping skill for each trigger listed above. Higher Desires/Vision of Self when you let go of your attachment to food and all the self loathing, mental, and physical heaviness it brings- what are you freeing your life up for? will you write a book? will you do more outdoor activities with your kids? do you want to resume an activity you once loved as a child? Is there a role model that inspires you that has done what you want to do? Cons Why are you doing this in the first place? These are the things that are hard to keep in mind when our reptilian mid brain (see last article) is at the wheel. What is personally meaningful? Does it age you? Does it make you feel out of control? Do you dread going on airplanes because you know you'll need an extender? does it prevent you from going to amusement parks with your kiddos? Spirituality (religion gets us into heaven, spirituality gets us out of hell) All addiction is what disconnects us from our deeper self and edges us further and further away from God (or whatever you like to call it) and our deeper spirituality. Spirituality is what allows us to move into the unknown, be comfortable with discomfort, and have faith that everything will be ok. It can include a gratitude practice, volunteering, play, aligning one self with nature, connecting with a spiritual e newsletter (mind body green, daily om, etc), generosity, etc. Daily Recovery Ritual (symbolic gesture to self every day that we are consciously devoting time to our recovery) What are the things you can do daily to symbolize to yourself that today is a new day? Keep it realistic or you won't do it. Vitamins, meditation, lemon water, supplements, self care, reaching out to a loved one, exercise, etc. Reward System What will you do for yourself if there is a certain period of time reached where you meet your goals? Will you get a massage at the end of every month? Will you plan a vacation after three months of solid goal hitting? Will you reward yourself with one day per week of going to the movies in the middle of the day and playing hooky if you're on the straight and narrow for five days? Strategy This is your "what." What are you doing daily to ensure that you are in alignment with your goals? Are you reading something fresh all the time? Do you make a timeline of your addiction and how it has affected your life? Do you go to local support meetings each week? Do you keep in touch with an online community? Do you make sure to give yourself small breaks while with the kids every day? Do you have a self care space set up in your house? Do you talk to a partner about how to change behaviors of theirs that might be hindering your efforts? can they get a mini fridge? Do you do acupuncture to balance your chi? Do you do yoga to manage your depression? Do you find a therapist? Recovery Resources (try to hit one each morning) what resources are in your pocket when you are feeling weak? bariatricpal.com? WLS journeys on Instagram? The Fix, Reddit, unique blogs documenting their weight loss journey, wls and vsg searches on Pinterest, etc. Good luck on your fresh start!

“The secret of change is to focus all of your energy not on fighting the old, but on building the new.” - Socrates Everyone does well out of the gates. We all impress ourselves when we start, what we believe to be, a new lifestyle change. However, "out of the gates," can mean different things for different people; for some it is two months, for others (usually depending on how strong the addiction or habit is) it can be two minutes. But what do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? One magical ingredient in the secret sauce (and one of many concepts I talk about in my book and my wls courses) that is lifestyle change is the novelty effect. The new plan to quit something or change a bad habit is something unlike we have ever done before, so we hope that we can achieve something we have never done before. The problem is that the moment we slip, that novelty loses its magic - and each time we start over, it loses its power to give us hope. So the solution is to cultivate more novelty. Our ability to continually grow and change is largely limited by our creativity. The more creative we become, the easier it is to take a different approach to change. To open a window when life seems to shut the door. In other words- what I am telling you, is that the only secret to long term weight loss maintenance is the knowledge that there isn't only one secret. There is no ONE diet that will forever change someone. Eventually people get tired of eating bacon and eggs every meal on Atkins, or grapefruit, or cabbage soup- but the thread they all share is their novelty. This is why all of them can work initially. Even as powerful as weight loss surgery is- people still find that they start to plateau or even gain the weight back if they aren't simultaneously addressing the behavioral and psychological factors that got them there in the first place. They too, must also continuously be creative about renewing one self throughout their lifetime. So the following is for all of you who are struggling today. Those that feel they have lost their way and perhaps feel disenchanted or disappointed. Below is a recovery "map" I created a long time ago for my clients, some struggling with substance abuse, others with food. It all works the same. Print it out, or copy and paste it in the notes section of your phone and take 20 minutes to fill it out with the things that are personally meaningful for you. This is not THE answer to long term recovery from addiction, but it is a fresh approach for many who feel stale at the moment: Baptism - Some ceremony to signal a renewed sense of hope and a fresh start. One client trying to recover from substance abuse, buried all of his wine and liquor bottles in his yard. Another client had a "garbage party" with her kiddos, and they loved smashing all the processed foods they had in their pantry and throwing them in the trash. Associations/triggers list all of the things that get you into trouble (being at a bbq, wanting to celebrate something, holidays, 7-10pm at night, date night, etc) Coping Skills (what gets you through the crave waves) These are the behaviors that you do INSTEAD of the addictive behavior. Extra credit if you are able to make a coping skill for each trigger listed above. Higher Desires/Vision of Self when you let go of your attachment to food and all the self loathing, mental, and physical heaviness it brings- what are you freeing your life up for? will you write a book? will you do more outdoor activities with your kids? do you want to resume an activity you once loved as a child? Is there a role model that inspires you that has done what you want to do? Cons Why are you doing this in the first place? These are the things that are hard to keep in mind when our reptilian mid brain (see last article) is at the wheel. What is personally meaningful? Does it age you? Does it make you feel out of control? Do you dread going on airplanes because you know you'll need an extender? does it prevent you from going to amusement parks with your kiddos? Spirituality (religion gets us into heaven, spirituality gets us out of hell) All addiction is what disconnects us from our deeper self and edges us further and further away from God (or whatever you like to call it) and our deeper spirituality. Spirituality is what allows us to move into the unknown, be comfortable with discomfort, and have faith that everything will be ok. It can include a gratitude practice, volunteering, play, aligning one self with nature, connecting with a spiritual e newsletter (mind body green, daily om, etc), generosity, etc. Daily Recovery Ritual (symbolic gesture to self every day that we are consciously devoting time to our recovery) What are the things you can do daily to symbolize to yourself that today is a new day? Keep it realistic or you won't do it. Vitamins, meditation, lemon water, supplements, self care, reaching out to a loved one, exercise, etc. Reward System What will you do for yourself if there is a certain period of time reached where you meet your goals? Will you get a massage at the end of every month? Will you plan a vacation after three months of solid goal hitting? Will you reward yourself with one day per week of going to the movies in the middle of the day and playing hooky if you're on the straight and narrow for five days? Strategy This is your "what." What are you doing daily to ensure that you are in alignment with your goals? Are you reading something fresh all the time? Do you make a timeline of your addiction and how it has affected your life? Do you go to local support meetings each week? Do you keep in touch with an online community? Do you make sure to give yourself small breaks while with the kids every day? Do you have a self care space set up in your house? Do you talk to a partner about how to change behaviors of theirs that might be hindering your efforts? can they get a mini fridge? Do you do acupuncture to balance your chi? Do you do yoga to manage your depression? Do you find a therapist? Recovery Resources (try to hit one each morning) what resources are in your pocket when you are feeling weak? bariatricpal.com? WLS journeys on Instagram? The Fix, Reddit, unique blogs documenting their weight loss journey, wls and vsg searches on Pinterest, etc. Good luck on your fresh start!

A large percent of pre-op weight loss surgery candidates feel that once their waistline changes, so will their thinking, and their dead wrong. Today, during one of my pre-op psych evaluations, I heard a woman say “I just feel like once I start losing weight and start feeling so much better about my self- I will stop doing all the destructive things that got me here. Don’t you think?” My response was “no I don’t agree.” I went on to explain that hers was a common assumption, a dangerous “magic-bullet” fantasy about what weight loss surgery can do. Here’s why: The part of our brain that is responsible for the thought : “wow I look so much better, I better not mess this up,” or “I feel better than I have ever felt in my life, I am a changed person,” is not the same part of the brain that wakes us up in the middle of the night and says: “go on, finish that 1/2 pint of Chunky Monkey in the freezer, there’s only a little bit left anyway, and I have been so good here lately.” We are dealing with two very different brains; the frontal cortex and the reptilian mid brain. The frontal cortex is the most newly developed (relative to other parts of the brain) part of the brain. It is the component that separates us from animals. It gives us the ability to think about consequences, plan, and execute. It is the “higher” part of ourselves, that often says “why do I keep on doing the same things I keep saying I won’t do anymore?” Or “I feel so out of control. This _______ (eating, smoking, drinking, gambling, pick your poison) is a temporary solution that produces long term pain. I have to find a different way.” Our reptilian midbrain is the Commodore 64 to our MAC; it is the palm pilot to our iPhone; the horse and buggy to our Prius; the Tommy Lee to our Oprah. Our midbrain is antique equipment, long ago evolved to keep us alive and hence the reason it is still with us today- it keeps us alive. Our midbrain contains the parts of the brain that make us recoil at the site of a snake or a spider in our peripheral vision. It is hardwired to not have to go through superfluous channels of the brain that might otherwise say “hmmm what is that crawling over there? How do I feel about that? Oh its just a spider, my aunt had a collection of spiders, maybe I should collect things, etc etc.” We just jump, and process later. That very system has helped humans survive for thousands of years. There is an adaptive quality to a brain that proverbially acts and asks forgiveness later. That very old structure once kept us out of harm’s way when a pack of tigers were first seen galloping across a horizon, or when a rivaling tribe could be heard in the far off distance, threatening to pillage our territory. Our midbrain is associated with learning and reward. Learning what makes us feel bad, what eats us (in the past that would be in a literal sense- like tigers, but presently it might be a mercurial supervisor or unending debt), and even more relevant to this article- what makes us feel good. When our brains come across something that makes us feel good (ex: sex, drugs, food), we are then flooded with an influx of the powerful neurotransmitter- dopamine. Just like not everyone that is exposed to drugs will develop an addiction, not everyone that eats a Nutella crepe will develop a food addiction. Much of the research on obesity currently, postulates that food addiction, no dissimilar than alcohol or drug addiction- is a reward system dysfunction or dysregulation, born out of genetic predisposition. It’s almost as if some brains think “if one slice of pizza feels good, how would four slices of pizza taste?” To break these two very different parts up in a different, more basic way; our frontal cortex is the voluntary, while our midbrain is the involuntary. This very dangerous fantasy, many people carry into weight loss surgery is a myth that I try to dispel quickly. This type of “magic bullet’ thinking is the very thing that gets so many gastric bypass and sleeve patients into trouble years down the road. No one wants to look at triggers. No one wants to sit with a therapist and devise a strategic coping plan. We want a pill, a surgery, a 16 minute solution to a 40 year old problem. This is not to say that weight loss surgery is not a solution, just that its only part of the solution. Despite our best intentions, we are still in some ways animalistic, hedonically-driven to feed our most basic impulses. This is part and parcel of why recidivism is the rule not the exception when it comes to recovery from most addiction. So what does this mean? Are all weight loss surgery patients destined for disappointment and disenchantment when the WLS honeymoon ends? No. But the answer to long term change lies more in two-pronged approach to long term weight loss success; surgery + behavioral change. Simply thinking ourself slim is a fantasy. Think about your specific triggers for eating. For some it is that golden hour when all the kids are in bed and Narcos is queued up on your Netflix. For others it is that 2-3pm mid day slump. For some - it is when they are alone, the only time they can eat with abandon free from others’ judgement or their own embarrassment. Whatever your triggers- the key is to identify what need is being met in that moment and to find a non-food alternative to meet each particular need ( many people have multiple triggers for over eating). If it is because its “your time,” after the kids are in bed- maybe you invest in a foot massager, or cultivate a self care space with textures, aromatherapy, candles, and books. If your trigger is that mid day slump, maybe you develop a yoga routine easily done in the office to help re-energize you. If it is the secretive quality to the trigger of being alone and eating, maybe it is finding another thing that is just your own that no one knows (going to a movie in the middle of the day, getting an overly priced facial on your lunch hour, playing hooky with your kid one day, etc). The rule of the brain is : what fires together, wires together. So over time- if you have paired 8pm, Narcos, and nachos- you have created a neurological super highway. The moment 8pm rolls around, you are likely already getting the chips ready and didn’t even realize the thought pathway that just occurred. The idea is to repair our triggers with alternative behaviors and over time “clip those wires” or create “toll roads” to our superhighways (aka neurosynaptic pruning), so that we no longer experience such strong urges and can call upon the higher structures of our frontal cortex to guide the way again. When we are in the midst of addiction, it is important to understand that our frontal cortex is not at the wheel. It has been duck taped and tied to a chair in the basement by our hedonic midbrain who is used to getting what it wants when it wants it. The closer we come to accepting this principle, the closer we come to being more mindful of our midbrain’s powerful rationalizations and sick contracts and see them for just that. We are better able to dis-identify from the thought, knowing it is not coming from our best self, but from our most carnal self. Think of that distant cousin that only shows up when they need something, the Uncle Eddy that tells you he’ll move the RV when he leaves next month, indifferent to how it makes you feel. Except in addiction- that distant cousin has taken over, pretending its you until you can no longer tell the difference. References http://brainspotting-switzerland.ch/4_artikel/Corrigan & Grand 2013 Med Hyp paper (proofs).pdf Blum K, Chen AL, Giordano J, Borsten J, Chen TJ, et al. The addictive brain: all roads lead to dopamine. J Psychoactive Drugs. 2012;44:134–143. [PubMed] Avena NM, Gold JA, Kroll C, Gold MS. Further developments in the neurobiology of food and addiction: update on the state of the science. Nutrition. 2012;28:341–343. [PMC free article] [PubMed] Gearhardt AN, Yokum S, Orr PT, Stice E, Corbin WR, et al. Neural correlates of food addiction. Arch Gen Psychiatry. 2011;68:808–816. [PMC free article] [PubMed] Saper CB, Chou TC, Elmquist JK. The need to feed: homeostatic and hedonic control of eating. Neuron. 2002;36:199–211. [PubMed] Stice E, Yokum S, Zald D, Dagher A. Dopamine-based reward circuitry responsivity, genetics, and overeating. Curr Top Behav Neurosci. 2011;6:81–93. [PubMed] Blum K, Sheridan PJ, Wood RC, Braverman ER, Chen TJ, et al. The D2 dopamine receptor gene as a determinant of reward deficiency syndrome. J R Soc Med. 1996;89:396–400. [PMC free article] [PubMed] Comings DE, Flanagan SD, Dietz G, Muhleman D, Knell E, et al. The dopamine D2 receptor (DRD2) as a major gene in obesity and height. Biochem Med Metab Biol. 1993;50:176–185. [PubMed] Noble EP, Noble RE, Ritchie T, Syndulko K, Bohlman MC, et al. D2 dopamine receptor gene and obesity. Int J Eat Disord. 1994;15:205–217. [PubMed] Blumenthal DM, Gold MS. Neurobiology of food addiction. Curr Opin Clin Nutr Metab Care. 2010;13:359–365. [PubMed] Volkow ND, Wang GJ, Fowler JS, Telang F. Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology. Philos Trans R Soc Lond B Biol Sci. 2008;363:3191–3200. [PMC free article] [PubMed] Volkow ND, Wang GJ, Baler RD. Reward, dopamine and the control of food intake: implications for obesity. Trends Cogn Sci. 2011;15:37–46. [PMC free article] [PubMed]

Today, during one of my pre-op psych evaluations, I heard a woman say “I just feel like once I start losing weight and start feeling so much better about my self- I will stop doing all the destructive things that got me here. Don’t you think?” My response was “no I don’t agree.” I went on to explain that hers was a common assumption, a dangerous “magic-bullet” fantasy about what weight loss surgery can do. Here’s why: The part of our brain that is responsible for the thought : “wow I look so much better, I better not mess this up,” or “I feel better than I have ever felt in my life, I am a changed person,” is not the same part of the brain that wakes us up in the middle of the night and says: “go on, finish that 1/2 pint of Chunky Monkey in the freezer, there’s only a little bit left anyway, and I have been so good here lately.” We are dealing with two very different brains; the frontal cortex and the reptilian mid brain. The frontal cortex is the most newly developed (relative to other parts of the brain) part of the brain. It is the component that separates us from animals. It gives us the ability to think about consequences, plan, and execute. It is the “higher” part of ourselves, that often says “why do I keep on doing the same things I keep saying I won’t do anymore?” Or “I feel so out of control. This _______ (eating, smoking, drinking, gambling, pick your poison) is a temporary solution that produces long term pain. I have to find a different way.” Our reptilian midbrain is the Commodore 64 to our MAC; it is the palm pilot to our iPhone; the horse and buggy to our Prius; the Tommy Lee to our Oprah. Our midbrain is antique equipment, long ago evolved to keep us alive and hence the reason it is still with us today- it keeps us alive. Our midbrain contains the parts of the brain that make us recoil at the site of a snake or a spider in our peripheral vision. It is hardwired to not have to go through superfluous channels of the brain that might otherwise say “hmmm what is that crawling over there? How do I feel about that? Oh its just a spider, my aunt had a collection of spiders, maybe I should collect things, etc etc.” We just jump, and process later. That very system has helped humans survive for thousands of years. There is an adaptive quality to a brain that proverbially acts and asks forgiveness later. That very old structure once kept us out of harm’s way when a pack of tigers were first seen galloping across a horizon, or when a rivaling tribe could be heard in the far off distance, threatening to pillage our territory. Our midbrain is associated with learning and reward. Learning what makes us feel bad, what eats us (in the past that would be in a literal sense- like tigers, but presently it might be a mercurial supervisor or unending debt), and even more relevant to this article- what makes us feel good. When our brains come across something that makes us feel good (ex: sex, drugs, food), we are then flooded with an influx of the powerful neurotransmitter- dopamine. Just like not everyone that is exposed to drugs will develop an addiction, not everyone that eats a Nutella crepe will develop a food addiction. Much of the research on obesity currently, postulates that food addiction, no dissimilar than alcohol or drug addiction- is a reward system dysfunction or dysregulation, born out of genetic predisposition. It’s almost as if some brains think “if one slice of pizza feels good, how would four slices of pizza taste?” To break these two very different parts up in a different, more basic way; our frontal cortex is the voluntary, while our midbrain is the involuntary. This very dangerous fantasy, many people carry into weight loss surgery is a myth that I try to dispel quickly. This type of “magic bullet’ thinking is the very thing that gets so many gastric bypass and sleeve patients into trouble years down the road. No one wants to look at triggers. No one wants to sit with a therapist and devise a strategic coping plan. We want a pill, a surgery, a 16 minute solution to a 40 year old problem. This is not to say that weight loss surgery is not a solution, just that its only part of the solution. Despite our best intentions, we are still in some ways animalistic, hedonically-driven to feed our most basic impulses. This is part and parcel of why recidivism is the rule not the exception when it comes to recovery from most addiction. So what does this mean? Are all weight loss surgery patients destined for disappointment and disenchantment when the WLS honeymoon ends? No. But the answer to long term change lies more in two-pronged approach to long term weight loss success; surgery + behavioral change. Simply thinking ourself slim is a fantasy. Think about your specific triggers for eating. For some it is that golden hour when all the kids are in bed and Narcos is queued up on your Netflix. For others it is that 2-3pm mid day slump. For some - it is when they are alone, the only time they can eat with abandon free from others’ judgement or their own embarrassment. Whatever your triggers- the key is to identify what need is being met in that moment and to find a non-food alternative to meet each particular need ( many people have multiple triggers for over eating). If it is because its “your time,” after the kids are in bed- maybe you invest in a foot massager, or cultivate a self care space with textures, aromatherapy, candles, and books. If your trigger is that mid day slump, maybe you develop a yoga routine easily done in the office to help re-energize you. If it is the secretive quality to the trigger of being alone and eating, maybe it is finding another thing that is just your own that no one knows (going to a movie in the middle of the day, getting an overly priced facial on your lunch hour, playing hooky with your kid one day, etc). The rule of the brain is : what fires together, wires together. So over time- if you have paired 8pm, Narcos, and nachos- you have created a neurological super highway. The moment 8pm rolls around, you are likely already getting the chips ready and didn’t even realize the thought pathway that just occurred. The idea is to repair our triggers with alternative behaviors and over time “clip those wires” or create “toll roads” to our superhighways (aka neurosynaptic pruning), so that we no longer experience such strong urges and can call upon the higher structures of our frontal cortex to guide the way again. When we are in the midst of addiction, it is important to understand that our frontal cortex is not at the wheel. It has been duck taped and tied to a chair in the basement by our hedonic midbrain who is used to getting what it wants when it wants it. The closer we come to accepting this principle, the closer we come to being more mindful of our midbrain’s powerful rationalizations and sick contracts and see them for just that. We are better able to dis-identify from the thought, knowing it is not coming from our best self, but from our most carnal self. Think of that distant cousin that only shows up when they need something, the Uncle Eddy that tells you he’ll move the RV when he leaves next month, indifferent to how it makes you feel. Except in addiction- that distant cousin has taken over, pretending its you until you can no longer tell the difference. References http://brainspotting-switzerland.ch/4_artikel/Corrigan & Grand 2013 Med Hyp paper (proofs).pdf Blum K, Chen AL, Giordano J, Borsten J, Chen TJ, et al. The addictive brain: all roads lead to dopamine. J Psychoactive Drugs. 2012;44:134–143. [PubMed] Avena NM, Gold JA, Kroll C, Gold MS. Further developments in the neurobiology of food and addiction: update on the state of the science. Nutrition. 2012;28:341–343. [PMC free article] [PubMed] Gearhardt AN, Yokum S, Orr PT, Stice E, Corbin WR, et al. Neural correlates of food addiction. Arch Gen Psychiatry. 2011;68:808–816. [PMC free article] [PubMed] Saper CB, Chou TC, Elmquist JK. The need to feed: homeostatic and hedonic control of eating. Neuron. 2002;36:199–211. [PubMed] Stice E, Yokum S, Zald D, Dagher A. Dopamine-based reward circuitry responsivity, genetics, and overeating. Curr Top Behav Neurosci. 2011;6:81–93. [PubMed] Blum K, Sheridan PJ, Wood RC, Braverman ER, Chen TJ, et al. The D2 dopamine receptor gene as a determinant of reward deficiency syndrome. J R Soc Med. 1996;89:396–400. [PMC free article] [PubMed] Comings DE, Flanagan SD, Dietz G, Muhleman D, Knell E, et al. The dopamine D2 receptor (DRD2) as a major gene in obesity and height. Biochem Med Metab Biol. 1993;50:176–185. [PubMed] Noble EP, Noble RE, Ritchie T, Syndulko K, Bohlman MC, et al. D2 dopamine receptor gene and obesity. Int J Eat Disord. 1994;15:205–217. [PubMed] Blumenthal DM, Gold MS. Neurobiology of food addiction. Curr Opin Clin Nutr Metab Care. 2010;13:359–365. [PubMed] Volkow ND, Wang GJ, Fowler JS, Telang F. Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology. Philos Trans R Soc Lond B Biol Sci. 2008;363:3191–3200. [PMC free article] [PubMed] Volkow ND, Wang GJ, Baler RD. Reward, dopamine and the control of food intake: implications for obesity. Trends Cogn Sci. 2011;15:37–46. [PMC free article] [PubMed]

Some WLS patients still feel like there is a missing element to their long term weight loss. Healing old psychological wounds can be key. Author of Full From Within, psychologist Dr. Colleen Long, explains just where to start. “ The wound is where the light enters you.” - Rumi When I work with pre and post-op bariatric surgery patients, I consistently go over this idea of being "full from within." Many people question, "what does that mean for me? What does that look like?" My response is that for one to be truly full, we must first clear out the old toxicity, wounds, and hurtful schemas we've picked up throughout the years. How does one get over a hurt? There is not "getting over." You go through it. You have to feel it to heal it. If you have underwent gastric sleeve, bypass, or balloon surgery and still feel like there is a missing piece- it is likely that there are some deeper psychological toxicities that need to be cleared. The first step to doing so is sitting still, sitting with the feelings, and it is in stillness that our heart finally starts to answer the questions our mind has failed to thus far. Yet so many have been taught not to feel. That there must be an easier way- a shortcut. 1 in every 8 Americans is on some form of psychotropic medication. 1 In his book, Anatomy of an Epidemic, science journalist Robert Whitaker states that since 1987, the percentage of the population receiving federal disability payment for mental illness has tripled; among children under the age of 18, the percentage has grown by a factor of 35.1 While Whitaker recognized that in the short-term, these medications help people to feel better, he started to realize that over time- drugs make many patients sicker than they would have been if they had never been medicated. 1 He does not make the argument that all people should stop their meds. He believes in the utility of them, just more sparingly than they are currently utilized. However, throughout my years in the practice of therapy- I have noticed a trend of moving people away from feeling. Crying is actually a symptom in the DSM-V. We have pathologized a human feeling! When psychiatrists and therapists witness a patient tearful too many times in session, their next conclusion is that something must be wrong and they must be medicated. This frustrates me so much as a clinician and as a person who has done her share of work in her own personal therapy. When we are broken, we are broken open. Being broken is a starting point, not a symptom that something has gone awry. It is at the point of our deepest pain and grief that we have the greatest opportunity for growth. I find myself telling patients over and over- “you can’t “get over” it, you must “go through” it.” Yet, so many of us have been indoctrinated to think that if we spend more than a day being sad, we must have depression, or if we feel nervous a little bit longer than we’d like to- we must have an anxiety disorder. We definitely “are Bipolar” if we have a mood swing. We have been taught to not feel the yin, only the yang of our emotions. It’s societally acceptable to talk about how happy your weekend was, or how much fun you had on vacation- but watch the uncomfortable shifting in chairs that takes place when you open up about how you just haven’t felt like yourself lately. In our world of quick fixes, where we can have a conference across the world, over a computer, communicate a message in two seconds via text, or post a picture that all of our family can see instantly- we also want instant relief for our suffering. Yet, suffering is part of the human condition. It is through experiencing our deepest sorrows, we are able to appreciate our greatest joys. But we must first be willing to sit in the muck. "Out of the mud, grows the lotus." -Thich Nhat Hanh Part and parcel of any addiction (food, drugs, alcohol, etc.) is that the addict is particularly uncomfortable with being uncomfortable. However, the cure is right there for the taking. “So what does this look like in real life?” you ask. “How do I open the wound, bring in the light, and clear out the infection that started all of this in the first place?” You start with presence. You start with a still and open heart. You start with a spiritual vulnerability that allows you to be at peace with not knowing what will happen next. You sit broken open and wait for the light to enter over time. The most important piece in all of this is being able to create a consistent forum where you hold the space. This could be a therapist’s office, it could be a weekly walk with a friend, a journal practice, or it could be as simple as a prayer every night. You set the priority to hold the space and to sit in the muck. Maybe it starts with emotions that have no words? Maybe it starts with visceral, physical feelings, that you have to simply sit with for a while? Maybe you are lucky enough to immediately put in words where your wound all started and its just floating around in your thoughts, waiting to be articulated? Perhaps it starts with a behavior you tend to do all of the time that you know comes from a place of pain? Case Study: I had a client who continuously posted on social media sites. She had a constant need to feel recognized and admired. She knew there was something behind it and wanted to get to the bottom of where this was coming from. Session over session, we sat with that need. We talked about what she wanted to get from each of those posts and why she was still “on E,” left with an empty psychological tank. The short story of Narcissus goes that he disdained people who loved him. After Nemesis noticed this he lured him to a pool that cast his own reflection. Narcissus fell in love with this pool, not realizing it was merely an image. Unable to leave the beauty of his reflection, he lost his will to live. He stared at this reflection until he died. 59 Growing up, this client never quite got the love and admiration we all need from our parents. When we love something so much and don’t get that back- it is that unrequited love that leaves a narcissistic wound. It doesn’t necessarily always start with parents. It can be a formative romantic relationship, but it usually starts with parents. When we are flying from couch to couch saying “look at me mommy I’m superman!” and our mom says “get off that couch now!” instead of “look at how strong and powerful you are,” we begin forming the wound. Unfortunately, without recognizing this- many people will go throughout their life trying to heal it through other people or other things instead of within themselves. (recall the wizard of oz’s moral of the story). It was up to this client to stop the instinctual need to post and each time she had this inclination to look within for what she needed. Eventually, she developed a muscle for self validation, and the posting behavior stopped. The lesson in this case study is to hopefully help guide you to your wound. If we have a food addiction and feel out of control, you can bet we have a wound. Instead of distracting through bad habits, addictions, unhealthy relationships, or external wants- it is time to finally create a place of presence to start the healing process. Mind Meal: Sit in silence for at least 15 minutes. Visualize in your mind’s eye your heart with a bridge of white light to your head. What does it say? Where is the pain? Where is the wound? How might you start filling yourself up for good? Want to learn more about how to be truly full from within. Check out Dr. Colleen's latest book aimed at helping one focus on why they eat vs. what they eat, and stop the "diet yo-yo" for good. You can also sign up for her free course : Full From Within, here. 1 Retrieved: June 2, 2017 https://www.madinamerica.com/author/rwhitaker/