Dr. Colleen Long

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!

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.

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]
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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]
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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.

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.

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.

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.

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.

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]

Why Psychologists Deny Certain People for Weight Loss Surgery and How to Not be One of Them


I have worked as a psychologist, providing psychological evaluations prior to bariatric weight loss surgery for the past eight years. For the most part, people need a power tool to help them lose and keep off the weight they have lost over and over again in their lives. The gastric sleeve, bypass, and now balloon are those tools. However, every once in a while, I will encounter someone who believes these procedures are the magic bullet.
I can pick this up in five seconds when I learn that:
this person has no exercise plan to maintain their weight loss a barrage of excuses as to why they can't exercise anymore zero insight into why they are overweight ("I don't know why I am overweight, I just eat steamed vegetables and grilled chicken mostly.") a lack of motivation or understanding for why they also have to engage in behavioral modification in addition to the surgery "Why would you reveal all of this?" you ask. Aren't I giving away the keys to the kingdom to anyone who reads this and wants to pass a psychological evaluation? Perhaps- but who are you really cheating if you don't go within and face the real demons that got you here in the first place?
When I ask people about their eating styles, I tend to group them into four categories:
1) emotional eater- someone who uses food when they are bored, stressed, tired, lonely, sad, or even happy in addition to eating when they are hungry
2) skip and binger- someone who fails to think about food until it is too late, and when they are ravenous end up going for whatever is available which is usually some type of carb and calorie laden fast food
3) miscellaneous- someone who just recognizes that they eat too large of portion sizes and/or the wrong types of food
4) food addict- usually someone with a history of other addictions, trauma, and a significant amount of weight to lose. They usually have comorbid psychological diagnoses that have been unaddressed or ill-addressed.
Out of the four categories, the 4th is the most troubling for a psychologist. This particular person is most correlated with the patient who fails to address their core issues, eats "around the sleeve," or bypass, experiences dumping syndrome, comes back a year later and asks for the bypass, or a different procedure.
This is the person who, ironically, is usually the most resistant to my recommendation that they seek therapeutic support prior to the surgery. They want it done YESTERDAY. They want it NOW. It is this type of thinking that got them into trouble in the first place. The impulsivity and lack of emotional regulation.
I've witnessed people fail to address their maladaptive eating patterns and never quite get to their goal weight. I had a male that would buy a bag of pepperonis at the grocery store and snack on them all day and couldn't understand why he wasn't losing weight. This daily "snack," which was a mental security blanket, served as a veritable IV drip of fat and calories throughout the day.
I've had a woman who figured out how to ground up her favorite foods into a liquid form because she never quite let go of her attachment to "comfort foods." One of her most notable liquid concoctions consisted of chicken and Cheetos. I'll just leave that for you to chew...er swallow.
They say with drug and alcohol recovery- you "slay the dragon," but with food addiction recovery, you have to take it for a walk three times a day. If you don't fundamentally shift your relationship with this dragon, you're going to get burnt when you are walking it.
My number one tip for transforming your relationship with food is to start looking at eating the same way you do as brushing and flossing: You don't necessarily salivate at the idea of what type of toothpaste you will use, where you will do it, who you will do it with, right? You just do it twice a day because you don't want to lose your teeth and you want to maintain healthy gums.
Food has to be thought of in the same way. You fuel up. You don't use food as a place to define your quality of life. You don't use food to Celebrate. You don't use food to demarcate the end of a long day. You don't use food to help you feel less alone. You figure out healthier coping alternatives to meet these needs.
Loneliness-call a friend for support
Celebrate- get a massage
Demarcate the end of a long day- start a tea ritual and use essential oils
Another reason you must say goodbye to comfort food is that it triggers the pleasure center of the brain, which ignites our dopamine, which perpetuates the addiction. Many people think we are just telling them to get rid of the comfort food because of the carbs or calories, but there are unique and harmful chemical consequences to ingesting these types of food we know are bad for us.
If you are ready to take a modern approach to weight loss and stop dieting for good- check out my wls/vsg psychological support course here for free.
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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.

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!

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!

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!

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!

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]

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]

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]

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]

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]

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]

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]

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]

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]

Thank you Dr. Long great article.