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It depends on what your surgeon says. You will notice, whenever it is, that a little wine may hit you HARD postop. You are likely to be told to wait three to six months - alcohol can be a powerful stomach irritant. Of course you can live without wine and cheese for a while. I've cut way, way down on it preop. A few months ago, I couldn't imagine dinner without my glass of wine. But these days I skip it unless it's a special occasion, and I have managed to survive. I know I'll have to do without for a few months after surgery, and I figure it's a small price to pay for giving up my chances of developing diabetes

I was wondering how soon I would be able to enjoy my wine ( mostly red wine) again. I can't live without wine and cheese!

Hi everyone! I'm doing great, I guess I shouldn't be fixated on a number considering if I stayed the weight I am right now forever I'd be ecstatic! I say I'd like to be 150 but then 15 more pounds means a little saggier skin and I'm really looking good right now. I guess I'll just not think about it and see what happens naturally. My doctor wanted me to get to 160 so there ya go. I did have plastic surgery on Dec 1st. I had my eyelids done and a brow lift. I've wanted to do that forever and also I had to fill out my now non existent breasts!! So, I had implants put in. I'm really pleased with how everything turned out. I think the only other surgery I will do is an arm lift. Legs aren't that cute either but I don't want the long scar down my thigh. My arms bug me more so they will have to go. I have found that I have began to drink red wine quite frequently and I'm a little nervous about that. I have read about patients that turn to alcohol after this surgery. Anyone else drinking a little more than they did before? Not a lot but I didn't used to drink a glass of wine every night. I know they say a glass of red wine is good for the heart but I don't want to become dependent on anything. Hope everyone is doing awesome and we are going to love this summer in our new thinner bodies!

Whoa! Did you feel ok? I couldn't imagine how that would feel!!!! Glad you caught yourself!I felt okay afterwards but I understand why they say no alcohol for 6 to 8 weeks.Mine made me sign a contract saying I understood no alcohol for 3 months and that even then it would only take a few sips to get me tipsy.Well now I have blood in my stool and have to double up on these meds that they prescribe to heal our tummy. How a tiny little .... oops... can bite us in the butt. I bet I don't forget that again.

Whoa! Did you feel ok? I couldn't imagine how that would feel!!!! Glad you caught yourself!I felt okay afterwards but I understand why they say no alcohol for 6 to 8 weeks. Mine made me sign a contract saying I understood no alcohol for 3 months and that even then it would only take a few sips to get me tipsy.

Good morning. I'm on vacation in Virginia Beach with my best friend, give me the strength to get through these next couple days without completely going off the deep end with food and alcohol lol. I'm just hoping to get through without a gain. Wish me luck.

Whoa! Did you feel ok? I couldn't imagine how that would feel!!!! Glad you caught yourself! I felt okay afterwards but I understand why they say no alcohol for 6 to 8 weeks.

@@librarianlk - Great question and you have received some great answers. I am only 8 1/2 months out, but not only did I have the same question as you pre-op, I recently had a similar conversation with my therapist about wanting to be "normal" with relation to food. In the beginning, I felt very food obsessed, so I completely understand where you are coming from, but now, I am just more mindful. Having said that, when discussing with my therapist she said something that resonated with me. "You aren't normal yet" she said. I obsessed about food for at least 40 years of my life and to expect that I would undo all that and be "normal" in 8 short months is unrealistic of me. I hope to reach a point in my life where I have a more normal relationship with food; however, 1) who is to say what "normal" really is? and 2) just as an alcoholic is a recovering alcoholic for the rest of their lives, I too will always be in recovery from my obsession of food. For the rest of my life.... That is daunting sometimes, but the struggle does change (and will continue to change) and I strive for being mindful yet not obsessed of every bite. I hope this helps a little. I am trying to explain that your fears are reasonable but please do not let them get in the way of making the decision of going forward with the procedure. It is an incredible journey and I would highly recommend therapy as you move through it. It will be the biggest tool you have (next to the actual surgery). There is a really good article posted today called "Food and Eating...the Extremes" that addresses the extreme obsessiveness on the other end of this journey. It is worth a read.

Here’s how our messages went... I got a text this week from a former client who moved out of the state a while back. This woman, who I will call Mattie, had weight loss surgery four years ago. She lost the majority of her excess weight and has maintained that weight loss. She’s even had a baby and continues to maintain her weight loss! Mattie asked me a few questions. We exchanged a few texts before I told her I would send her an email with some thoughts. I was actually on the treadmill at the time and haven’t quite mastered accurate texting while hustling on the treadmill (and watching my guilty pleasure, The Young and The Restless) while I walk! Here’s how our messages went: Mattie: “I want your professional opinion… Orthorexia nervosa and body dysmorphia… real or not real?” I honestly had never heard of orthorexia nervosa, so, while contemplating whether or not I like the new actor playing Billy Abbot, I looked up orthorexia nervosa. Here’s the definition from the National Eating Disorders Association (https://www.nationaleatingdisorders.org/orthorexia-nervosa): “Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake. Body dysmorphia, just to get the formal definitions over with, is a clinical diagnosis in the Diagnostic and Statistical Manual (DSM V), the guidebook used by psychiatrists, psychologists, and other health care professionals. People who have Body Dysmorphic Disorder are: “preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance.” Keep in mind that the emphasis is on nonexistent or slight defects, not something that is clearly visible. “‘Preoccupation’ is usually operationalized as thinking about the perceived defects for at least an hour a day… The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” “At some point, the individual must perform repetitive, compulsive behaviors in response to the appearance concerns. These compulsions can be behavioral and thus observed by others – for example, mirror checking, excessive grooming, skin picking, reassurance seeking, or clothes changing. Other BDD compulsions are mental acts – such as comparing one’s appearance with that of other people.” Now that you know what we’re talking about, I’ll continue with our text conversation. In response to Mattie’s question about whether or not orthorexia nervosa and body dysmorphia are real, I responded: “Yes, real.” Mattie: “Thank you.” Me: J J J J Mattie: “I’ve been doing a lot of research on eating disorders and the psychological issues that come with them when I came across these. Me: Do you think you have those issues? Mattie: I don’t know. I think I may but I feel crazy saying that. I need to do some more research to know for sure but from everything I’m reading it describes me pretty well. I seem to have gone to the opposite extreme from where I was three years ago. Me: That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum. Mattie: That’s what I’m scared of. Me: Yeah, but you would not be exploring it if you weren’t willing to work on things. Mattie: Very true. I just feel like it’s all in my head but then again, not. It’s deeper than just my thoughts. It’s almost like these other little voices outside of myself telling me what to think and how to act. Me: What are the voices saying and whose voices are you hearing? Mattie: They are mine and the voices of lots of other people I have known throughout my whole life. Most of the time they are just telling me whatever I do isn’t good enough and that I have to do more. No matter what, don’t mess up because it’s impossible to undo. All my flaws are being pointed out along with the mistakes I make and how much I still need to do. Last week I had a full-blown panic attack because I ate some rice with my meal and felt like I could feel it going through my system and turning into fatter things and a big old stomach. After I finally calmed down I ended up at the gym doing cardio for 2 ½ hours. Stuff like that happens more than I care to admit. Sometimes when I think about it I freak out so much I actually get sick. All of this makes me wonder if the surgery wasn’t the result of my brain saying ‘you should do this because it will make you prettier and healthier.’” Me: I’ll email you… too much to say and I’m on the treadmill. I also didn’t want to miss finding out if Billy was in cahoots with Phyllis or if he was backing out of their deal… The more I thought about all I wanted to say to Mattie, the more I decided others would benefit from the information. I’m certain she’s not the only one struggling with many of the issues she brought up. To begin with, a great many people who have weight loss surgery find themselves engaging in behaviors that are unhealthy two to three years later. I’ve worked with patients who start drinking excessively, shopping themselves into financial distress, sleeping with people they don’t even want to be sleeping with, abusing/becoming dependent on pain medication, returning to unhealthy eating behaviors and starting to regain weight, spending too many hours exercising, behaving in other forms of bulimic behavior, engaging in anorexic behavior, and, I now learn from Mattie, orthorexia nervosa. It’s fairly predictable. For the first year to 18 months, people are thrilled because they are losing the weight they struggled to shed for so long. It’s exhilarating to see the results they so longed for. It is an exciting time and the body is doing what it is supposed to do following the surgery. As the body heals and weight stabilizes, sometimes people begin to engage in behaviors they may not even understand themselves. So what is the explanation for a return to eating unhealthy food in spite of knowing the misery of having been morbidly obese and experiencing significant health issues as a result? What sense does it make to become anorexic or orthorexic or alcoholic or a shopaholic or to engage in any sort of behavior to the point it creates problems in your life? To mental health professionals, it makes perfect sense. We understand that for many people who struggle with weight issues, there is emotional baggage beneath the surface. Weight loss surgery doesn’t treat “head issues.” When people have weight loss surgery, they lose the option (at least for a time) to use food as a coping mechanism, an attempt to avoid dealing with things that are under the surface. Mattie was quick to point out what is at the heart of the real problems, the issues underlying one’s weight and focus on food… it’s the voices of various people from your past who have told you things similar to what Mattie continues to hear in her head: You could have done better. You could have done more. You got all A’s but one B… why wasn’t that an A? Why can’t you be more like your sister? If you keep gaining weight, no one will marry you. You’ll never amount to anything. It’ll just never be ‘good enough.’ Mattie made it clear that it’s not just the voices of others she hears, but also her own. There’s a simple reason for this: Children learn what they live…and then they live what they learned. The negative messages you heard about yourself from others as you were growing up are what you learned as you grew up. Every time you repeat those messages to yourself in the present, you are living what you learned. As an adult, you’re reinforcing to yourself the negative things you initially heard from others about you. The solution? Simple – yet very difficult! You have to make a commitment to yourself to no longer talk to yourself about yourself in negative terms. Even if you don’t believe yourself at first. And you have to put a lot of effort into changing and restating the negative messages you repeat about yourself so they are at least neutral: · You could have done better. o When you hear this message, change it to, “Maybe I could have done better, and yet I can’t change the outcome of this situation. I’ll think about what more I might be able to do the next time this situation arises.” · You could have done more. o When you hear this message, change it to, “There’s probably always more that could be done in a given situation. That’s as much effort as I was willing to put into this situation at this time.” · You got all A’s but one B… why wasn’t that an A? o When you hear this message, change it to, “Perfection doesn’t exist, nor did I want to put forth the effort for that particular endeavor. I’m pleased with the results.” · Why can’t you be more like your sister? o When you hear this message, change it to, “I can’t be more like her because we are different people and I’m learning to like myself just fine.” · If you keep gaining weight, no one will marry you. o When you hear this message, change it to, “I’m learning to accept myself the way I am and I don’t want to marry or have close relationships with anyone who doesn’t accept me as I am.” · You’ll never amount to anything. o When you hear this message, change it to, “Never amount to anything according to whom? I’m becoming more and more comfortable with who I am and what I want in life. That’s what matters.” · It’ll just never be ‘good enough.’ o When you hear this message, change it to, “I’ve come to terms that I am, indeed, ‘good enough,’ and I like myself this way.” What makes this different is that people say, “I tried, but it doesn’t work.” Well, keep trying. The reality is you are battling years of negative messages and your brain has literally developed neural pathways so you slip back into those well-worn paths quite easily. In order to develop new neural pathways that are more optimistic toward self, it will also take thousands of repetitions. If you were learning to speak a completely foreign language, it would take days and weeks and months of repetition before the new language would come easily. It’s the same thing with positive self-talk. The good news is, you can benefit from positive changes as soon as you start talking better about yourself. Remember, no one is putting you down at this point in your life except you. (If there are others degrading you, then you need to learn healthy boundaries and tell those people to stop and/or get them out of your life.) The negative self-talk is part of the deal and changing that is a huge part of the solution. But, WAIT – there’s MORE! Of course there is! There’s actually a lot more, but this is supposed to be a short article, which it already isn’t. Therefore, I will only address one more essential issue related to weight regain and/or the transfer to another unhealthy behavior after weight loss surgery. In Mattie’s case, the transfer has been to a rigid attitude about eating healthy foods, feeling tremendously guilty if she eats anything but healthy foods, followed up by a form of bulimia known as exercise bulimia, as evidenced by her working out for 2 ½ hours after eating some rice. Regardless of what unhealthy behavior a person switches to following weight loss surgery, what needs to be addressed is the purpose the behavior serves. This points, also, to looking at what purpose food and/or obesity served prior to weight loss surgery. Simply stated, an almost obsessive focus on food, whether that is thinking about what one is going to eat next, pouring over recipes, relentless counting of calories and grams, watching every show on the Food Network, exercising excessively, obsessing about healthy foods, is a coping skill. In the adult world, people are capable of learning and understanding that these eating and food-related behaviors are unhealthy in that they negatively affect health and relationships. The reasons people remain engaged in these negative behaviors, in spite of knowing they are detrimental to their physical, emotional and relational health include the possibilities that: 1) they have addictions (to food, or other substances/behaviors), and weight loss surgery does NOT treat food addiction, 2) they are tremendously afraid of feeling their own feelings and are terrified of dealing with past emotional issues; what’s more, people often deny having any past issues they need to deal with in the first place. Trust me… we all do. Every human being has had some painful experiences in their lives. People are terrified of what I call cleaning out their emotional closets because they literally fear experiencing feelings. Here’s why: when people experience feelings from past losses and hurts, they feel it with the same intensity at which they felt it at the age they were when it happened. That frightens adults and they avoid dealing with their past at all costs. And these costs can be high; anyone who has had weight loss surgery understands the physical and emotional costs that being obese bears. Here’s the deal: if people don’t dig into whatever they are avoiding emotionally, or address any addictions head on, and if they don’t learn healthy adult coping skills, communication skills, and how to set healthy boundaries, then they WILL switch to another unhealthy behavior to use a coping skill (another name for avoiding reality and feelings). In Mattie’s case, she swung to the opposite end of the eating continuum. Either end of an issue often means the person is just acting out the same unhealthy coping skill in the opposite way. You often hear of people who are not at all religious becoming overly immersed in a religion. Same problems… just acting them out in opposite ways. Hence, my response to Mattie as she described “having gone to the opposite extreme” with her eating behavior, when I said, “That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum.” My suggestion to Mattie and to anyone else who is engaging in any disordered eating behaviors, anyone who has regained weight, and anyone who has begun engaging in other addictive or unhealthy behaviors following weight loss surgery: Get into individual and/or group therapy with a therapist who understands “family systems” counseling and/or addiction counseling. Talk about issues underlying your addiction to food (your emotional dependency on food), any losses you experienced throughout your life that you haven’t dealt with, and any trauma/abuse you have experienced at any time in your life. Work with a therapist to learn and develop healthy coping skills to implement into your adult life, how to implement healthy boundaries in your adult life, with yourself and with others, and learn healthy communication skills. Read about these same topics, and add to the reading list the topic of “re-parenting the self.” Orthorexia nervosa and body dysmorphia are real, as are bulimia and food addiction and transfer addiction. Weight loss surgery can inadvertently open the door for these problematic behaviors. Do what I always tell people to do: Get Help and Get Happier! Thank you, Mattie for bringing these topics up to me. I hope this has helped you and many others! Oh – and by the way, I’ve decided I like the new Billy Abbot… so far! Connie Stapleton, Ph.D. www.connie@conniestapletonphd.com FB: https://www.facebook.com/connie.stapleton.923 Twitter: @cstapletonphd LinkedIn: Connie Stapleton, PhD YouTube: Connie Stapleton

I got a text this week from a former client who moved out of the state a while back. This woman, who I will call Mattie, had weight loss surgery four years ago. She lost the majority of her excess weight and has maintained that weight loss. She’s even had a baby and continues to maintain her weight loss! Mattie asked me a few questions. We exchanged a few texts before I told her I would send her an email with some thoughts. I was actually on the treadmill at the time and haven’t quite mastered accurate texting while hustling on the treadmill (and watching my guilty pleasure, The Young and The Restless) while I walk! Here’s how our messages went... I got a text this week from a former client who moved out of the state a while back. This woman, who I will call Mattie, had weight loss surgery four years ago. She lost the majority of her excess weight and has maintained that weight loss. She’s even had a baby and continues to maintain her weight loss! Mattie asked me a few questions. We exchanged a few texts before I told her I would send her an email with some thoughts. I was actually on the treadmill at the time and haven’t quite mastered accurate texting while hustling on the treadmill (and watching my guilty pleasure, The Young and The Restless) while I walk! Here’s how our messages went: Mattie: “I want your professional opinion… Orthorexia nervosa and body dysmorphia… real or not real?” I honestly had never heard of orthorexia nervosa, so, while contemplating whether or not I like the new actor playing Billy Abbot, I looked up orthorexia nervosa. Here’s the definition from the National Eating Disorders Association (https://www.nationaleatingdisorders.org/orthorexia-nervosa): “Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake. Body dysmorphia, just to get the formal definitions over with, is a clinical diagnosis in the Diagnostic and Statistical Manual (DSM V), the guidebook used by psychiatrists, psychologists, and other health care professionals. People who have Body Dysmorphic Disorder are: “preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance.” Keep in mind that the emphasis is on nonexistent or slight defects, not something that is clearly visible. “‘Preoccupation’ is usually operationalized as thinking about the perceived defects for at least an hour a day… The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” “At some point, the individual must perform repetitive, compulsive behaviors in response to the appearance concerns. These compulsions can be behavioral and thus observed by others – for example, mirror checking, excessive grooming, skin picking, reassurance seeking, or clothes changing. Other BDD compulsions are mental acts – such as comparing one’s appearance with that of other people.” Now that you know what we’re talking about, I’ll continue with our text conversation. In response to Mattie’s question about whether or not orthorexia nervosa and body dysmorphia are real, I responded: “Yes, real.” Mattie: “Thank you.” Me: J J J J Mattie: “I’ve been doing a lot of research on eating disorders and the psychological issues that come with them when I came across these. Me: Do you think you have those issues? Mattie: I don’t know. I think I may but I feel crazy saying that. I need to do some more research to know for sure but from everything I’m reading it describes me pretty well. I seem to have gone to the opposite extreme from where I was three years ago. Me: That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum. Mattie: That’s what I’m scared of. Me: Yeah, but you would not be exploring it if you weren’t willing to work on things. Mattie: Very true. I just feel like it’s all in my head but then again, not. It’s deeper than just my thoughts. It’s almost like these other little voices outside of myself telling me what to think and how to act. Me: What are the voices saying and whose voices are you hearing? Mattie: They are mine and the voices of lots of other people I have known throughout my whole life. Most of the time they are just telling me whatever I do isn’t good enough and that I have to do more. No matter what, don’t mess up because it’s impossible to undo. All my flaws are being pointed out along with the mistakes I make and how much I still need to do. Last week I had a full-blown panic attack because I ate some rice with my meal and felt like I could feel it going through my system and turning into fatter things and a big old stomach. After I finally calmed down I ended up at the gym doing cardio for 2 ½ hours. Stuff like that happens more than I care to admit. Sometimes when I think about it I freak out so much I actually get sick. All of this makes me wonder if the surgery wasn’t the result of my brain saying ‘you should do this because it will make you prettier and healthier.’” Me: I’ll email you… too much to say and I’m on the treadmill. I also didn’t want to miss finding out if Billy was in cahoots with Phyllis or if he was backing out of their deal… The more I thought about all I wanted to say to Mattie, the more I decided others would benefit from the information. I’m certain she’s not the only one struggling with many of the issues she brought up. To begin with, a great many people who have weight loss surgery find themselves engaging in behaviors that are unhealthy two to three years later. I’ve worked with patients who start drinking excessively, shopping themselves into financial distress, sleeping with people they don’t even want to be sleeping with, abusing/becoming dependent on pain medication, returning to unhealthy eating behaviors and starting to regain weight, spending too many hours exercising, behaving in other forms of bulimic behavior, engaging in anorexic behavior, and, I now learn from Mattie, orthorexia nervosa. It’s fairly predictable. For the first year to 18 months, people are thrilled because they are losing the weight they struggled to shed for so long. It’s exhilarating to see the results they so longed for. It is an exciting time and the body is doing what it is supposed to do following the surgery. As the body heals and weight stabilizes, sometimes people begin to engage in behaviors they may not even understand themselves. So what is the explanation for a return to eating unhealthy food in spite of knowing the misery of having been morbidly obese and experiencing significant health issues as a result? What sense does it make to become anorexic or orthorexic or alcoholic or a shopaholic or to engage in any sort of behavior to the point it creates problems in your life? To mental health professionals, it makes perfect sense. We understand that for many people who struggle with weight issues, there is emotional baggage beneath the surface. Weight loss surgery doesn’t treat “head issues.” When people have weight loss surgery, they lose the option (at least for a time) to use food as a coping mechanism, an attempt to avoid dealing with things that are under the surface. Mattie was quick to point out what is at the heart of the real problems, the issues underlying one’s weight and focus on food… it’s the voices of various people from your past who have told you things similar to what Mattie continues to hear in her head: You could have done better. You could have done more. You got all A’s but one B… why wasn’t that an A? Why can’t you be more like your sister? If you keep gaining weight, no one will marry you. You’ll never amount to anything. It’ll just never be ‘good enough.’ Mattie made it clear that it’s not just the voices of others she hears, but also her own. There’s a simple reason for this: Children learn what they live…and then they live what they learned. The negative messages you heard about yourself from others as you were growing up are what you learned as you grew up. Every time you repeat those messages to yourself in the present, you are living what you learned. As an adult, you’re reinforcing to yourself the negative things you initially heard from others about you. The solution? Simple – yet very difficult! You have to make a commitment to yourself to no longer talk to yourself about yourself in negative terms. Even if you don’t believe yourself at first. And you have to put a lot of effort into changing and restating the negative messages you repeat about yourself so they are at least neutral: · You could have done better. o When you hear this message, change it to, “Maybe I could have done better, and yet I can’t change the outcome of this situation. I’ll think about what more I might be able to do the next time this situation arises.” · You could have done more. o When you hear this message, change it to, “There’s probably always more that could be done in a given situation. That’s as much effort as I was willing to put into this situation at this time.” · You got all A’s but one B… why wasn’t that an A? o When you hear this message, change it to, “Perfection doesn’t exist, nor did I want to put forth the effort for that particular endeavor. I’m pleased with the results.” · Why can’t you be more like your sister? o When you hear this message, change it to, “I can’t be more like her because we are different people and I’m learning to like myself just fine.” · If you keep gaining weight, no one will marry you. o When you hear this message, change it to, “I’m learning to accept myself the way I am and I don’t want to marry or have close relationships with anyone who doesn’t accept me as I am.” · You’ll never amount to anything. o When you hear this message, change it to, “Never amount to anything according to whom? I’m becoming more and more comfortable with who I am and what I want in life. That’s what matters.” · It’ll just never be ‘good enough.’ o When you hear this message, change it to, “I’ve come to terms that I am, indeed, ‘good enough,’ and I like myself this way.” What makes this different is that people say, “I tried, but it doesn’t work.” Well, keep trying. The reality is you are battling years of negative messages and your brain has literally developed neural pathways so you slip back into those well-worn paths quite easily. In order to develop new neural pathways that are more optimistic toward self, it will also take thousands of repetitions. If you were learning to speak a completely foreign language, it would take days and weeks and months of repetition before the new language would come easily. It’s the same thing with positive self-talk. The good news is, you can benefit from positive changes as soon as you start talking better about yourself. Remember, no one is putting you down at this point in your life except you. (If there are others degrading you, then you need to learn healthy boundaries and tell those people to stop and/or get them out of your life.) The negative self-talk is part of the deal and changing that is a huge part of the solution. But, WAIT – there’s MORE! Of course there is! There’s actually a lot more, but this is supposed to be a short article, which it already isn’t. Therefore, I will only address one more essential issue related to weight regain and/or the transfer to another unhealthy behavior after weight loss surgery. In Mattie’s case, the transfer has been to a rigid attitude about eating healthy foods, feeling tremendously guilty if she eats anything but healthy foods, followed up by a form of bulimia known as exercise bulimia, as evidenced by her working out for 2 ½ hours after eating some rice. Regardless of what unhealthy behavior a person switches to following weight loss surgery, what needs to be addressed is the purpose the behavior serves. This points, also, to looking at what purpose food and/or obesity served prior to weight loss surgery. Simply stated, an almost obsessive focus on food, whether that is thinking about what one is going to eat next, pouring over recipes, relentless counting of calories and grams, watching every show on the Food Network, exercising excessively, obsessing about healthy foods, is a coping skill. In the adult world, people are capable of learning and understanding that these eating and food-related behaviors are unhealthy in that they negatively affect health and relationships. The reasons people remain engaged in these negative behaviors, in spite of knowing they are detrimental to their physical, emotional and relational health include the possibilities that: 1) they have addictions (to food, or other substances/behaviors), and weight loss surgery does NOT treat food addiction, 2) they are tremendously afraid of feeling their own feelings and are terrified of dealing with past emotional issues; what’s more, people often deny having any past issues they need to deal with in the first place. Trust me… we all do. Every human being has had some painful experiences in their lives. People are terrified of what I call cleaning out their emotional closets because they literally fear experiencing feelings. Here’s why: when people experience feelings from past losses and hurts, they feel it with the same intensity at which they felt it at the age they were when it happened. That frightens adults and they avoid dealing with their past at all costs. And these costs can be high; anyone who has had weight loss surgery understands the physical and emotional costs that being obese bears. Here’s the deal: if people don’t dig into whatever they are avoiding emotionally, or address any addictions head on, and if they don’t learn healthy adult coping skills, communication skills, and how to set healthy boundaries, then they WILL switch to another unhealthy behavior to use a coping skill (another name for avoiding reality and feelings). In Mattie’s case, she swung to the opposite end of the eating continuum. Either end of an issue often means the person is just acting out the same unhealthy coping skill in the opposite way. You often hear of people who are not at all religious becoming overly immersed in a religion. Same problems… just acting them out in opposite ways. Hence, my response to Mattie as she described “having gone to the opposite extreme” with her eating behavior, when I said, “That means you haven’t dealt with the issues but are acting them out on the other end of the spectrum.” My suggestion to Mattie and to anyone else who is engaging in any disordered eating behaviors, anyone who has regained weight, and anyone who has begun engaging in other addictive or unhealthy behaviors following weight loss surgery: Get into individual and/or group therapy with a therapist who understands “family systems” counseling and/or addiction counseling. Talk about issues underlying your addiction to food (your emotional dependency on food), any losses you experienced throughout your life that you haven’t dealt with, and any trauma/abuse you have experienced at any time in your life. Work with a therapist to learn and develop healthy coping skills to implement into your adult life, how to implement healthy boundaries in your adult life, with yourself and with others, and learn healthy communication skills. Read about these same topics, and add to the reading list the topic of “re-parenting the self.” Orthorexia nervosa and body dysmorphia are real, as are bulimia and food addiction and transfer addiction. Weight loss surgery can inadvertently open the door for these problematic behaviors. Do what I always tell people to do: Get Help and Get Happier! Thank you, Mattie for bringing these topics up to me. I hope this has helped you and many others! Oh – and by the way, I’ve decided I like the new Billy Abbot… so far! Connie Stapleton, Ph.D. www.connie@conniestapletonphd.com FB: https://www.facebook.com/connie.stapleton.923 Twitter: @cstapletonphd LinkedIn: Connie Stapleton, PhD YouTube: Connie Stapleton

Thanks for pointing those out! The use isomalto-oligosaccharide instead of soluble corn fiber, so I might be able to handle them and the nutritional info looks good. Only slight red flag is the amount of sugar alcohol, but I think I'd be willing to give them a try. Do you know any brick-and-mortar stores that sell them? I just googled them - looks like Vitamin Shoppe carries them. I may swing by today and pick one up! Yes, I got ones at Vitamin Shoppe to try. Mine only had 2 flavors. Online they come in a lot more though.

Yesterday I went to a friends after work and like normal she handed us all a glass of wine. I thought nothing of it forgot all about the fact that I have a new stomach and took a sip of wine. My body reminded me immediately that it was not ready for alcohol and I felt that wine burn all the way down into every crevice of my stomach. My face turned bright red I got hot and I started to panic I grab some water and started sipping on water. I won't be making that mistake again an ytime soon.

Thanks for pointing those out! The use isomalto-oligosaccharide instead of soluble corn fiber, so I might be able to handle them and the nutritional info looks good. Only slight red flag is the amount of sugar alcohol, but I think I'd be willing to give them a try. Do you know any brick-and-mortar stores that sell them? I just googled them - looks like Vitamin Shoppe carries them. I may swing by today and pick one up!

Thanks for pointing those out! The use isomalto-oligosaccharide instead of soluble corn Fiber, so I might be able to handle them and the nutritional info looks good. Only slight red flag is the amount of sugar alcohol, but I think I'd be willing to give them a try. Do you know any brick-and-mortar stores that sell them?

That's how I received mine too. Well except the syringes were in those bubble packs like when they put individual pills on a sheet with a bubble around each. Never would have occurred to me that they should provide the alcohol wipes or whatever. I figured that was my job to provide. Theirs is just to provide the medicine.

I received the pre-filled syringes in a package. No alcohol wipes, but just use a cotton ball and some alcohol - easy enough.

I'm so mad I could spit, and part of the problem is me! I filled the doctor's prescription for the blood thinner injections before my surgery. I was handed a brown paper bag. It felt like a box; I didn't even look at it. (I know, I know. This is where it's also my fault!) Got home from the hospital today, looked in the paper bag and all I saw was several individually packaged syringes inside a plastic baggie. That was bad enough. There was no alcohol swipes or anything to cleanse the injection site before giving the shot. WTF Do they expect me to just jab myself? So I phoned the pharmacy and was told, "Oh, we don't provide any of the wipes. We just offer the syringes." (In a tone of voice that distinctly sounded like "sucks to be you!".) Obviously, they won't take them back so I can fill the prescription elsewhere. Guess this is more of a rant than anything else. Did everyone else receive their syringes this way?

For me, I have eliminated: carbonation, alcohol, anything fried, sugary things like cake, most starches most of the time, pasta, and anything sugary like fruit juice.

We were told no alcohol for at least a year. I am just staying away. I do not want to drink any calories except my Protein shake. I don't tend to have a lot of variety in my meals. I just don't have the room in my stomach. I am 9 months out and at goal weight (over 150 pounds lost). I work out 6 days a week. Just to get that out there. I typically eat around 800 to 1400 calories a day. It really depends on the day! For Breakfast it is usually a Protein Shake and a turkey sausage patty. Some days it is eggs and turkey sausage. Some days it is sugar free oatmeal. Those are my 3 to-gos for breakfast. For lunch, I either have zoodles with sauce and turkey meatballs, chicken and a green vegetable, Soup. dinner...we do "dump meals" that I prepare ahead of time and then freeze and then heat in crockpot. So, salsa chicken, orange chicken, bbq chicken, etc. Also fish, shrimp, or whatever we what on the grill. We usually have a green veggie with it. Snacks are usually greek yogurt, turkey, cheese, etc. Since I am in maintenance, my surgeon and NUT says I can have whatever I want in limited portions. I stay away from any trigger foods from my past. I still limit sugar and fried foods. I say all of that to say this: in losing mode, you have to be super strict. I see maintenance mode as just a modified version of that. Doc says to eat clean 5 to 6 days a week. That's pretty much how we operate. I do get carbs like brown rice, oatmeal, carrots. I eat air popped popcorn as a snack sometimes. Going out is hard. I can make wings at home that are baked without the skin so the calories are very minimal. I can only eat one wing though and some veggies. I still portion out my food on regular basis. I know my stomach can handle a half cup of regular food or almost a full cup of soup. If that is what it takes, then carry around measuring cups. I do!

My surgeon / his team have never said, "No alcohol after WLS." Their program, however, includes information about the possibility of WLS patients developing cross addictions post-op. I see a tendency on WLS boards for participants to interpret "possibilities" as "probabilities" or, worse, "100% likelihoods." This applies to discussions about cross-addictions, post-op divorces, post-op complications, and weight loss success/failure predictions. My take on the "alcohol post-op" debate is that we should be observant / mindful about how alcohol affects us. We all recognize that alcohol may (or may not) have negative effects on our health post-op, including: alcoholism, liver damage, ulcers, GERD, lowering of inhibitions against eating, etc. If you wish to avoid any possibility of any kind of damage from alcohol use, then you can decide not to drink. For myself, I've chosen instead the mindful / observant route. Since Month 6 I've been drinking wine. I drink no more than one 5-6 ounce glass of wine per day and no more than 7 glasses a week, which keeps me in the "social drinker" category -- in which there are no perceived risks. I really enjoy wine, especially with food, but also don't want to wash down my meals with liquids. So I stretch out my wine over a couple of hours before, during and after dinner. Honestly, most nights I don't even finish the glass. And now at 18 months post-op, I'm happily and easily maintaining my 100-pound weight loss at 135 pounds. That's just one woman's story. Things could change for me, e.g., GERD could get worse, I'd start gaining weight, I could start drinking more, in which case I would have to re-evaluate the upside/downside of my alcohol intake. I just see this as one small aspect of living in Wearing Big Person Panties World.

I have had alcohol maybe 4 times since sugery. My tolerence is the same. When my weight gets lower that might change, but i am not in the liquor hits me fast camp. If you have your mental issues worked out before surgery, you shouldn't have to worry much about transfer addictions. This is a lifestyle, not a diet banning things forever is unrealisitic and makes them too tempting to people. My plan was alcohol allowed after 3 months.

You can search my posts and comments for lotsa info, support, and hostility on this subject. While many doctors have cited health benefits from moderate alcohol consumption, I don't think it has any real medical value. That said, I find it quite enjoyable. Many programs say: - Never drink - Wait a year - Wait 6 months - Wait 3 months - Wait 6 weeks - Nothing on the subject My surgeon recommended the sleeve (over RNY) for patients who plan to drink. The reason is simple - once you heal (6 weeks), you basically have a normal metabolism - except your stomach is puny. RNY patients have more plumbing rerouting and thus have a greater chance of developing ulcers, although many RNY patients on this forum report drinking alcohol with no complication. So, if you drink after VSG, you must follow all the same rules you SHOULD have followed all along: - Don't drink to drunkeness and/or operate machinery. - Don't ignore the potentially high calories in some alcoholic beverages (sweet drinks, most beers, etc). - If you find yourself drinking everyday, watch out! I would add, if you were a food addict before your VSG, you may be at risk for developing other addictions - including alcohol. That said, I suspect soda, candy, or chips would be a more slippery slope for a former food addict! As long as you account for your calories, and meet you Water & Protein goals, it's no different than eating whole wheat bread, oatmeal, or sweet potatoes... I am 2 pounds away from goal and trying to develop more of a maintenance plan. Although I drank most of my life, I seldom drank during the week. My current thinking is to allow myself a limited number of Yellow and Green days. Basically, I plan to count my calories and track my steps about 16 days a month. On these days, my calorie intake is limited to 1,000 a 1,200 with no alcohol (Red Days). I will allow myself 12 Yellow Days a month. On these days, I will allow moderate alcohol consumption, but still track calories and activity. I will limit my calories to 8 times my target weight (about 1,500). Finally, I will allow myself a couple of Green Days a month where I won't count calories at all. So far this seems to be working well, stay tuned...

My doctor also recommended not drinking anymore, weight loss patients have been known to become dependent upon alcohol because it goes through our system fast. Meaning it hits us fast and then we sometimes feel like we sober up and go again. Which in turn can really harm the body. That being said I am almost four years out and drink socially. I drank almost an entire bottle of wine last night! The biggest thing is make sure you are getting your nutrients first before alcohol. Also start with liquor beer is carbonated and fills you up (not fun). Keep in mind it will hit you fast!!!!!

I enjoy alcohol when I go out on weekends. I'm 4 months and my surgeon is okay with it. I used to be a big beer lover. More accurately....i was just BIG....and loved beer. lol. Now, I drink high grade liqueurs with low calorie mixers. I try to avoid anything carbonated. If I'm mixing something at the house, then I"ll use a really good vodka or tequila mixed with Ocean Spray Diet Cranberry (5 calories per serving) over ice. Smooth and tasty. Prior to surgery when I'd go out....I didn't do well with nursing a beer....it was normally 6-8 beers with some tequila shooters over the course of an evening. Watching a football game at a sports bar.....more than that. Now....a couple of those "skinny" liquor drinks and I'm good to go. I had this surgery to improve my health....and quickly. I'd have agreed to anything.....any terms or conditions in order to do that. What happened over the course of these 4 months post-op, though, has been much more than simply my health being improved.....but my state of mind as well. I truly enjoy every aspect of life in ways that I'd just forgotten about. Going out and having fun with others.......or just lone-wolfing it and flirting with a hot bartender or two.....fun stuff that helps in many ways. It's almost therapeutic. If having a few occasional drinks is fun......then so be it. I didn't have this surgery to live like a monk. I did it to feel better......and feel better, I shall. Hell.....two weeks ago....one of the gals on the surgeon's staff...who was a tremendous help with me getting throughout my pre & post op.....met me for a couple pitchers of skinny margaritas. We had a blast and were able to laugh about all the crazy stuff related to my case and then with her job. Fun stuff. I seriously doubt she would've bought the second pitcher had she been worried about it hurting me.......thusly, I consider it part of my ongoing care when we do it again. All things in moderation...........

My surgeon said to wait a year before having alcohol again. I'm not a big drinker so this isn't a big deal. I think they are worried about cross addiction and drinking your calories.