Now What? Book Excerpt

Below is an excerpt from Chapter 8: The first three months after surgery of my new book Now What? What to Expect in Your First Year of Bariatric Surgery

Mindset

The first three months after your surgery, you will start to see some big changes, both physically and mentally, in your life. It can be challenging to navigate all of this, so in this section, I want to highlight a few mindset traps and habits you can incorporate into your life. 

Let’s start with the one habit you need to get right before you can tackle any other issues, and that is paying attention to you.

Mindfulness: paying attention to you

The word mindfulness has been used a great deal over the past few years, and for many people, it has lost its meaning. If you are one of those people, let’s change the word for you. When you see mindfulness, think paying attention because that is generally what it is. It’s paying attention to you, how you react to things around you and emotions that come up in you, and how they make you feel, physically. Paying attention is the foundation of all things that go into changing habits, whether they are physical, like eating and exercising, or mental, like how you think about yourself, how you set boundaries, or how you interact with others. I bring this up specifically because many people live a reactionary life. They act in ways that have no thought behind them. It’s like living in a fog—you don’t know where you are and only act when you bump into something. On the other hand, being more mindful (paying attention), you understand who you are, what you do, and how you react to things in your life; it’s lifting that fog from your life. It’s awareness of all things in and around your life. Being mindful is reflecting on your actions, it’s being aware of your emotions, how those emotions make you physically feel, and understanding what brought those emotions to the surface. It’s understanding your relationship with others, creating boundaries with others, being able to connect with others on a deeper level because you are aware of your needs and can articulate them. So how does all this mindfulness stuff help with your weight loss? Not to be too dramatic about it, but ignoring yourself, the probability that you will lose the weight you need to lose and keep it off is close to zero.

An example of this comes from a client who five years ago hired me as soon as she was cleared for exercise. She worked with me for about six months, was hit or miss with showing up for her sessions and doing her “homework,” as well as not following the rules of the tool. One day I got an email from her telling me that she was going to stop working with me, and she fell off my radar. Five years later, I got an email from her asking to start working out with me again. In those intervening years, she had gained all her weight back and then some. She had only contacted me because she was going in for a revision. A few years after she quit with me, she started working with a therapist who helped her become aware of who she was and what she was doing that sabotaged her weight loss. It became clear that she had an eating disorder, one that she never really saw. In her mind, that was only something skinny people had, not her. But by becoming more aware of herself, she was able to see what she could never see before. It was because of this work of lifting the fog around her life that she was able to understand why she initially failed with her weight loss. It was only then that she had the confidence to go in for a revision and genuinely put in the work needed to be successful. 

I am using this one story of many as a cautionary tale. As you go through this journey, you need to be aware of you, what makes you tick, and what areas you need to work on. 

Addiction transfer, or cross-addiction 

Addiction transfer is when one addiction is limited, but the underlying issues that created that addiction are not addressed—so another addiction will take its place. This secondary addiction can be most anything; shopping, sex, drugs/alcohol, smoking, gambling, and exercise are a few possibilities. Within the world of weight-loss surgery, there is a prevailing idea that addiction transfer will occur in this group more often than with other populations. This belief comes from the fact that a larger percentage of people who’ve undergone bariatric surgery have a food addiction, and that when food is reduced, another addiction will take over.[35, 36] But there is no strong evidence that transferring a food addiction to some other addiction is more prominent with bariatric surgery patients.[37] This isn’t to say a new addiction can’t take hold after surgery. As mentioned, there can be a tendency of people with the gastric bypass to increase their alcohol intake due to the increased absorption time of the alcohol and the more intense feeling they get from alcohol. There is also a study that shows a small increase in nicotine use a few years post-op.[37] It could be that this transfer of an addiction is associated with someone who has shown a history of certain risk factors, such as: 

• Binge eating or compulsive eating.
• Drug or alcohol addiction, including cigarette smoking.
• Avoidance of working on past traumas.
• Bouts of anxiety or depression.

If you have one or more of these risk factors, that doesn’t mean you will definitely move from one addiction to another. But knowing this and becoming aware that it may happen will possibly help you avoid an addiction transfer. If you are unsure if you may be starting to develop a different addiction to replace a food addiction, the following list can help you start to sort it out—or better yet, talk with a professional about your concerns.

• Experiencing anxiety, depression, or suicidal thoughts whenever access to the transferred addiction isn’t possible.
• Losing a job, home, relationship, or friendship because of the addiction.
• Obsessive thoughts about how to gain increased access to the object of the addiction.
• Health problems related to the addiction. 
• Money problems directly caused by the addiction. [38]

Whether addiction transfer is a big issue or not, it is wise to be aware that it could happen. And again, if you are concerned about it, talk to your doctor or a mental health professional.

Don’t compare yourself with others

It can be difficult to see or hear of weight-loss successes that other bariatric surgery patients experience when you don’t see the same success. It’s important to remember that you cannot match their journey to yours; the only data points that should be meaningful to you are the ones that come from you. I know it’s easier to read than to practice, but working on your own journey is important. You don’t have to do it on your own—nothing could be further from the truth—but you do need to personally understand your needs and limitations and be able to address them. It’s these needs and limitations that are unique to you that makes any comparison to others fruitless and possibly harmful. If you are a fifty-year-old comparing your weight loss to that of a thirty-year-old, then you are going to find some big differences. Age plays a big factor in weight loss, even with bariatric surgery. Your metabolism is different, your endocrine system is different (hormones change as you age), and you may have injuries and movement limitations. You may also be in different phases of life when it comes to your career and family, and this can play a big role in your weight loss. Even if you are of a similar age to someone else, there can be big differences in how and why people lose weight. What you can do is start to get to know yourself better. This can include what exercises you like and will do consistently, how you can work around any injury with your exercise, what foods you can enjoy, and how your body responds to those foods. Know how your work and family life will affect this journey, and know who your support team is and what they can provide.  

It’s also good to get to know people who have had success. Asking them what they have done—both successes and failures—can give you new ideas to try, better ways to do things that were not working well for you, or permission to stop trying things that don’t work at all. For your own journey, it’s all about where you are now in comparison to where you were. Sometimes one small change will keep you going; things like this are known as nonscale victories. When you start paying attention to these, you can feel a positive difference in your motivation and mindset around this journey. The next section talks a bit more about this. 

Celebrating nonscale victories 

Nonscale victories (NSV) are just what they say they are: any positive change that isn’t a change of numbers on a scale. These are the “little” things that change during your weight loss that can provide a huge and positive boost to your mental well-being. It’s easy to let them pass by or not give them much thought, but being aware of them and even celebrating them a little can add more motivation into your journey. 

Some of the more common NSVs that show up with weight loss are:

• Fitting into a certain pair of pants for the first time in years.
• No longer needing a belt extender when flying.
• Easily fitting into a chair with arms.
• Not being out of breath after climbing a flight of stairs.
• Being able to get down and up from the floor without much effort.
• Confidently taking a bath.
• Sleeping without a CPAP machine.
• Reaching healthy levels in your blood work.
• Having more energy.
• No longer having joint pain.

This list could go on and on, but the idea is that you should look for the small things that have changed in your life due to your weight loss that make it easier. Take a few moments to appreciate these changes—maybe write them on your calendar or in a journal or keep a list on your phone. By keeping track of these victories, you’ll have a history of your progress that isn’t weight related, and in some ways, this is a more important metric of your success.

Emotional eating: non hunger reasons people eat

In earlier sections we discussed eating slower taking a specific amount of time and taking time to chew your food. This was all about keeping you from wanting to eat between meals. Those are good habits to work on and will help, but hunger isn’t the problem when it comes to emotional eating. Emotional eating is about soothing and/or avoiding difficult situations or over celebrating more positive situations. It’s something that happens on autopilot. It’s old programming that helped you cope in the moment but now isn’t helping. 

So how do you approach this situation? First, if you feel this is a big issue for you, then looking for a mental health expert who has experience with emotional eating is a good place to start. In addition, start becoming more aware of when you eat but are not truly hungry. Body hunger is a slow progression and over the course of an hour or so becomes more and more pronounced. Head hunger (emotional hunger) shows up much faster, with a craving for a particular type of food. Typically, emotional eating is triggered by a specific emotion or emotions, usually, but not always, associated with unpleasant feelings. Eating is a way to avoid the feeling and the discomfort that comes from it. For some, it’s something learned from an early age.

During one of my sessions with a client, we were discussing emotional eating. She had told me that emotional eating had been a part of her life since she was six years old. From her own admission, her family life wasn’t very happy or stable. Her parents had frequent and loud arguments. After the fights ended, her mother, with good intentions, would give my client ice cream or chocolate to apologize for the yelling. Over the years, sweets became her go-to when she found herself in similar situations. Most of the weight she gained happened while working for a verbally abusive manager. After being yelled at by her manager, she would hit the vending machine for chocolate and go back to her office and eat it all. It was only years later, working with a mental health professional, that she made the connection between eating and yelling. 

If this story sounds familiar to you, there are some actions you can take to help you avoid going directly to food when strong emotions come up. Before going directly for the comfort food of choice, try one or more of the following:

• If the desire to eat is coming from a stressful place, take some deep breaths. Controlled breathing is known to lower your blood pressure and stress level.[39]
• If you can, do something physical. Go for a walk, do some squats, dance, fidget. Anything that gets you moving will help preoccupy your mind and work out any stress. 
• Write in a journal about anything, talk with a close friend, or sing or talk it out with your pet or plants (they won’t mind).
• Plan ahead. If you know you are going to be in a stressful situation, think of things besides eating you can do in advance that can help you. 

Since we are talking about emotional hunger, once you start to stabilize your emotions through one of these suggestions or something else, you will notice that your desire to eat will have lessened as well.