20/20 Interview Confessions

I am aware that I did not share the details of the interview with 20/20 this week in my previous post about the show.  I wasn't purposely keeping anything from you, in fact I wished I had documented the process as it happened, but I only had a phone and it happened so. very. fast.

Tis The Season To Transfer Your Addiction - WLS and Alcoholism

*Reposting from 2010*

A few month gastric bypass post op writes --

"Can I have a glass or two of wine?  I used to have a few glasses when I had a drink, would it be okay to just have one, or two now?"

No.  

Are you still beating yourself up? Self-Compassion...

Thanksgiving was nearly a week ago, and I'd bet that some of you are still concerned with your behavior on THAT DAY. 

"I can't believe I..."

Stop. it.

Are you holding grudges against yourself?  Are you hating on your own choices on that day --- and the days following?  How do you manage a full "holiday season" of temptations?

What about learning be be a little kinder to yourself -- do you think that would help? 

(MM is NODDING YES, BECAUSE, YES!  Because... yes.)  And, in our weight loss surgery community, THERE IS A WHOLE HELL OF A LOT OF SELF-LOATHING in regards to choices one makes.

I am bad in a whole lot of people's eyes in our community, for a variety of reasons and also because:  I have a logo that contains THE INSINUATION OF A CUPCAKE, y'all.  Food is not bad.  People are not bad.  It's all choices and how you handle situations.  /end rant

Take this quiz from Jean Fain, that I found on HuffPo this morning:

The Self-Compassionate Eating Quiz

This quiz measures your current state of self-compassion by helping you assess your mental, emotional, and physical reaction to diet, weight, and body image. When you can find a quiet moment away from distractions, take a pen or pencil and sit down to reflect on how compassionate you are toward yourself.

Check eight statements that come closest to reflecting your general experience. That is, they should reflect how you most often feel in the situation described.

___ 1. When I eat something "bad," like a donut, I can't stop thinking about how I've blown it.
___ 2. After an indulgent weekend, I trust myself to rein in my eating.
___ 3. I often feel alone with my eating issues, but I know I'm not.
___ 4. When I eat junk food, I try not to beat myself up too much.
___ 5. I may feel uncomfortable if I'm bloated or a few pounds heavier, but it doesn't stop me from enjoying social activities.
___ 6. I might never love my body, but I know I'd like it better 10 pounds lighter.
___ 7. No one struggles with eating like I do.
___ 8. I don't trust myself to eat when I'm hungry and stop when I'm full, but I'd like to learn.
___ 9. I can get down on myself when I'm bloated or a few pounds heavier, but I'll still go out in baggy clothes.
___ 10. Paying attention to my hunger makes me want to eat, so I try to ignore it.
___ 11. I'm always interested in what my body has to say about hunger and fullness.
___ 12. If I lose one to two pounds per week, I'll never reach my goal weight.
___ 13. I'd like to jumpstart my weight loss with a crash diet and then eat healthfully.
___ 14. I didn't stick to my eating plan the whole weekend; all my weight-loss efforts are for nothing.
___ 15. When I eat something less than healthful, I try to savor it all the same.
___ 16. I really indulged myself over the weekend; I'm afraid to step on the scale.
___ 17. When I feel bloated or especially fat, I won't leave the house.
___ 18. After overeating, I feel like punishing myself, but I know restricting and purging only make me feel worse.
___ 19. Overeating is a signal to care for myself more, not less.
___ 20. After I overeat, self-punishment (restricting food intake and/or purging, vomiting, or over-exercising) is the only thing that makes me feel better.
___ 21. My weight takes care of itself when I feed myself delicious, nutritious food.
___ 22. When I'm overweight, I feel gross; I hate my body.
___ 23. Everybody overeats and feels stuffed on occasion.
___ 24. I love and respect my body.

Scoring Sheet

Give yourself 1 point per statement for checking any of the following:
1, 7, 10, 12, 14, 17, 20, 22.
Subtotal: _______

Give yourself 2 points per statement for checking any of the following:
3, 4, 6, 8, 9, 13, 16, 18.
Subtotal: _______

Give yourself 3 points per statement for checking any of the following:
2, 5, 11, 15, 19, 21, 23, 24.
Subtotal: _______

Total Score: _____ Date: _____ / _____ / _____

Your Score and What to Make Of It

When it comes to self-compassion, 0-8 means you're sorely lacking, and you seriously need to go easier on yourself; 9-16, you've got some, but you could use some more; 17-24, you've got way more than the average American dieter, so you're in good shape. However, you can never have too much self-compassion.

Even if you're already pretty kind to yourself, know that even a slight increase in self-compassion can brighten your worldview, give you more emotional balance, help you get a handle on your eating and facilitate sustainable weight loss. (That is, if you are trying to lose weight.)

 

• Watch this YouTube video.
• Source - Huffington Post

EES + OAC Event

Next month, on April 14-15, I'll be joining some of my peers in New York City for an event sponsored by Ethicon Endo-Surgery and the Obesity Action Coalition.  

 

We'll hear and learn about -

This is a great opportunity for us, as bloggers to learn, and for the industry to learn from US.    I'm excited because it's not often that an event is created to discuss these topics, from this aspect, the blogger side, the writer's side.

*This event is sponsored by Ethicion Endo-Surgery and the OAC, and my expenses for this trip have been covered in full.  

Thank you.

NYC - 2009 - My photo

Awkward segue -

This makes the opportunity to meet some BBGC's in person in NYC!  I haven't been to New York since fall 2009, when I took a super-fast-run through the city for photos during a Obesity Help.com event.

At this point, several BBGC's have been invited to this event,  and why not meet you while we are already there?  Three of us are rooming together so far, we gave up our single rooms because, it's silly, we can share.   And, then there's always the cupcakes.  <g>  

I've set up an impromptu event page, for a get together after the event with local friends.  If you're near NYC, let us know!  

I guess I'll need some, shoes, too.  

Heightened suicide risk after weight-loss surgery

Please don't respond with, "Yeah, but...I didn't!"  Please take this seriously.  It happens.

NEW YORK (Reuters Health) - Severely obese people who undergo weight-loss surgery may have a higher-than-average risk of suicide in the years following the procedure, a new study finds.

Audio + Transcripts - Strategies for Deconstructing Jealousy

   
I'm not a Buddhist, but this is very interesting to me.  Everyone is equal.
 

The surprising truth about what motivates us.

This is GREAT.

Where can I find bariatric foods and supplements in Massachusetts?

  

I get a lot of "where can I find ____ in _______, MA?" queries here.  Thing is, it can be difficult to find specific WLS-friendly products out there in the stores, impossible at big-box stores, and don't get me started about getting help at a G N C.

Someone today wanted "chewable calcium for WLS in Wareham, MA."  Well, there's Wal Mart, Target and GNC.  Whoop dee doo.

Wouldn't you love a local bariatric-themed shop?  (Yes. Please.)  But, if that doesn't exist, and you cannot find what you need in your area -- my suggestion is to shop online.  There are a billionty places to do so. Many of which are linked Right Here.  I know, there are folks out there who plain refuse to do so.  

Or -- you need to get personal with the product before you purchase?  Well, as much as you can with a bottle of vitamins. 

There are a few locations that I am aware of that have some WLS-friendly goods.

First, you know about GastricBypassSupplements.com, right?  They are a super-cool sponsor of MM.net, but they are also sortakindabutnotreally local to me.  You can visit their actual store, Faunce Corner Nutrition in North Dartmouth, MA.

Marc, the store's owner, and his staff are very helpful and personable, and totally worth the visit.

Find them at:

Faunce Corner Nutrition 
350 Faunce Corner Road 
North Dartmouth, MA 02747 
(508) 998-2155

Next, Cape Cod Nutrition, in Hyannis and Plymouth, MA.  I haven't been in to the Hyannis location, but they do carry a host of things we can use.  The Plymouth store has a limited selection of protein items, and some vites and supplements, but they do not carry bariatric-specific items.  (Though I have asked.) I've met two of the employees, one seemed awfully new and didn't know what I was talking about when I asked for a certain protein product, but they were both pleasant.

Find them at:

Cape Cod Nutrition Corner 
75 Iyannough Rd. Hyannis, MA 02601
221 Colony Place Plymouth, MA 02360
1-888-666-3058

Up north?  You can visit Nashua Nutrition -- which may be the only bariatric-only shop that I am aware of in our area.  I've been there, they've got a nice spread of WLS foods and supplements, I left with a big bag of goodies when we visited.

Find them at:

Nashua Nutrition 522 Amherst Street Suite 1 Nashua, NH 03063

Susan Powter on her radio show. :)

Support a worthwhile cause: "Inspired By Diabetes."

As obese people, many of us have been touched by diabetes, or have tried to avoid potentially getting it by losing our excess weight.  Lilly has created a contest, for those with diabetes and those touched by it to share, creatively - what it means to them.  It's a great cause!

About "Inspired by Diabetes" from the website:

"Inspired by Diabetes is a global campaign asking people with diabetes, as well as their family, friends and healthcare professionals, to express how diabetes has impacted their lives — and share those stories with others around the world.
 
Inspired by Diabetes is a collaboration between global champions Eli Lilly and Company and the International Diabetes Federation's Unite for Diabetes initiative. Inspired by Diabetes builds on the goals established by the IDF campaign: bringing diabetes to the public's attention, inspiring action to improve diabetes care and uniting individuals, families and communities affected by diabetes around the world.

At the heart of Inspired by Diabetes is the Creative Expression Competition, which seeks expressions of the challenges and triumphs of the diabetes journey through art, essay, poetry, photography and music.  By telling your story in a creative way, you will help bring life to children in need."

Want to enter?  Read more...
           

What shape?

From Igigi.com, this plus-size clothing website has a neat body-shape calculator:

Beth is a triangle.

The shape which most closely approximates your body dimensions is:

Triangle

Shop By Shape: Triangle

If this seems to be in error, try going back and adjusting your responses on the shape calculator page.
Go Back

             

Description        You have very full and fleshy hips and thighs. Sometimes, your buttocks can also be very full and round (although, sometimes, your derriere can be quite flat).            Your face, shoulders, arms, bust, and ribcage appear to be overall much smaller relative to your bottom; you have a defined waist.        Characteristics   The Triangle Figure type has the following characteristics:        Shoulders are proportionately narrow or average Face tends to be smaller relative to the rest of the body Neck is proportionally slimmer Back is smaller or average in size and is not so full relative to the bottom Bust is relatively smaller than the lower torso Waist is well defined due to a much more pronounced hips and thighs Full, round, and fleshy buttocks (in some cases, buttocks are flat) Hips are usually much wider comparing to the rest of your body and do get fuller at the lower hip line that frequently bulges outward Thighs are full and very voluptuous Lower legs are often proportionately heavier        Figure's assets   The greatest Triangle Figure’s assets are:        Proportionately slender face and shoulders Curved in waist Shapely neck and bust Relatively slim arms   Enhance and Balance   To enhance and balance the Triangle silhouette, the objective is to:   Emphasize the middle section and waist area Visually elongate and slenderize bottom torso Broaden upper torso with soft shoulder pads, lighter colors. and wider necklines Draw attention to the shoulders, face, neck and arms De-emphasize thighs and hips Create an overall balanced silhouette

Ooh, a reader question!

"MM, may I ask you why you decided to have WLS? Did you try losing weight through diet and exercise? If so, if you could go back and do it all again, would you have tried harder with diet and exercise?"

Short answer:  It seemed like a good idea at the time?  Don't you hate it when people answer questions with answers that sound like questions?

Here comes the longer answer, but not nearly thorough enough. 

I had weight loss surgery in 2004, after having children, repeatedly and often, and getting quite fat.  I have always been overweight, obese and then after babies, became morbidly obese.  Weight was always an issue.  I went in junior high at about 200-220 lbs, lost a few pounds while taking Ritalin for "ADD", and graduated at about 200 solid pounds.   I got pregnant Way Younger Than Ever Necessary If Ever the following year, and ballooned up to about 250 lbs or more, I never paid much attention.  I remember vividly, though, that I was working at Lane Bryant as an assistant store manager, and all my clothes were in the 22/24 and eventually 26/28.  I had another baby 19 months later - and was bigger, probably closer to 300?  When baby number three came along, I topped out at 320ish, in 2002.  I hovered around that size for a long time. 

At that time, I tried diet after diet, each one working really well for 20, 30, 40 lbs., and then a regain.  Atkins + Weight Watchers were the most effective for me, but I'd always rebound back immediately.  Of course having been overweight my entire life, it's not like the first time I wanted to lose weight was THEN, after having gained the most to my highest point, but nothing ever worked previously, so, why beat a rotten decayed horse? 

To be perfectly honest, I never once thought about weight loss surgery before my husband asked me about it.  It was sometime in 2003.  I didn't think I'd EVER do "that!"  My gawd, I'd have to be the size of an elephant before I'll STAPLE MY STOMACH!?  He did some research, told me that the risks of dying were purdy slim compared to dying from obesity, so, let's apply, they're going to deny us anyways!

Nope.  Both of us.  Hook, line, sinker.  Immediately we're in it to get it - and we trudge through what seemed like ENDLESS meetings with a behavioral psychologist. (Little Did I Know?!)  One or two meets with a surgeon, and, approvals + surgery dates.  The deed had been done.  It seemed like a huge process, but it really wasn't. 

The both of us had nearly been kicked out of the program to begin with. 

WHO ME?!  Yeah.   Wipe the shock off your face.

I had the audacity to be honest about eating habits.  The nutritionist and behavioral psychologist were "concerned" that Bob (in particular) might be a risk, due to his tendency to BINGE EAT.  (WELL DUH!  HE WAS NEARLY 400 pounds?  We do not get that big without EATING to the level of a binge. Jaysus!)  It's my fault, for mentioning in a group setting, that my husband may have partook in a stack of Oreos dipped in milk at one sitting.  THE HORRAH!  (Who, as a morbidly obese person hasn't?!)

I wasn't told that we were SUPPOSED to lie about our true eating habits to get the approval of the shrinks for surgery.  Yes, of course, I figured out pretty damn quickly that I had to.  Those FOOD logs, bullpoop, pure and simple.  They KNOW you're not following the plan pre-operatively.  They're supposed to clear you for this surgery, and being honest about your eating issues might not allow you to get approved, even if it is the truth, and the reason you are Having WLS.  (Whole 'nother issue.)

Anyway - after getting the approvals and dates, it happened, five weeks apart, in the spring of '04.  I was approved, paid, 100% by my health insurer, with No Physical Co-Morbidities of Obesity.  (That, I know of.)  Bob, paid, 100%, with a few co-morbids and "Binge Eating Disorder, NOS"

Everything was sunshine and butterflies and rainbows in the honeymoon period after surgery.  He went from 370 to 165.  (Yeah, that's a lot.) I went from 320 to 147.  There is no way, other than the "Getting On The Biggest Loser" with trainers and nutritionists 24/7 that I'd have lost weight like this.  I don't think I'd have EVER gotten so close to goal without it.  I think I will see goal again, BECAUSE of the surgery having given me a tool of a stomach pouch.  It's the only reason I am successful in weight loss.

But.

What if all this crap is what kills me in the end?  Was it worth it?  Would I say I'd do it all over again?  That remains to be seen.

If I could do it all over again - would I diet and exercise and do it the regular way?  I'd like to say YES, but deep down I know that my 320 lb. self would say NO.  My 320 lb. self would say that it's worth the risks to have WLS.  The 164 lb. version of myself doesn't think so.

Most of us are nuts, it turns out.

Psychiatric Disorders Among Bariatric Surgery Candidates

OBJECTIVE: The present study was designed to document psychiatric disorders among candidates for weight loss surgery and to examine the relationship of psychopathology to degree of obesity and functional health status.

CONCLUSIONS: Current and past DSM-IV psychiatric disorders are prevalent among bariatric surgery candidates and are associated with greater obesity and lower functional health status, highlighting the need to understand potential implications for surgery preparation and outcome. Future work also will focus on the course of psychiatric disorder during the post-surgery period and its relationship to weight loss and maintenance.

                Am J Psychiatry 164:328-334, February 2007
                doi: 10.1176/appi.ajp.164.2.328
                © 2007 American Psychiatric association

 

We so cwayzee.

Got it together? No, but does anybody?

I got an email today from a reader, who comments that she's surprised in a way that I seem to have it all together for the amount of life changes that have gone on.  (Aside: What life changes?!)  I laughed, out loud. 

Certainly I don't mean to come across as having anything together, because I don't.  It couldn't be further from the truth.  I don't want you to read this thinking that there is anything to be learned from ME except a lot of What Not To Do situations, not just about weight issues, but everything.  I guess it's hard to tell the reality of a situation without actually being there, you know?  I hate to think that someone would read this blog thinking that I've really got it together, when, truthfully, it's all I can do to wake up and make it through each day. 

This is something you realize, after/during weight loss (Go up and read the quote at the top of the page) it's entirely true.  I don't necessarily like Dr. Phil - but - that little tidbit is golden.  Losing weight is not a cure for life. 

The issues that were there that caused you to get fat in the first place do not magically disappear, and certainly the weight issue never resolves itself, it's lifelong.  This is why I have a blog.  I'd love to be able to share more - many times I write things and delete them - but that's my fault for putting a face to the blog.  Sometimes I wish I started this anonymously in order to be much more blunt and in your face about issues.  I promised I would delve into deeper issues this year with the blog, because I believe we should be able to share all the negatives about weight issues (and anything else) and not just the stupid "yay, I lost a pound" crap.  Have I rambled enough?

Weight Loss Surgery Called Riskier in Older Adults

According to a new study reported by Edward H. Livingston, M.D.,  in the November Archives of Surgery, older folks are much more likely to have problems after weight loss surgery than younger people.  Seems like it would be an obvious problem, and should be kept in mind when choosing weight loss surgery at an advanced age.  You've got to weight the risks vs. the benefits. 

If the obesity is more likely to the the cause of your early death, the surgery might be more beneficial.  What do you think?  Would you have weight loss surgery at age 65?

"The postsurgical adverse event rate increased with age to more than 32.3% for patients 65 and older, compared with 8.0% for younger patients.

Source:  http://www.medpagetoday.com/PrimaryCare/WeightManagement/tb/4572

What happens when you cannot compulsively overeat anymore? (Besides going nuts.)

What can happen when you can't compulsively overeat as a post-op?  Many things, some dangerous, like a substance abuse problem, and some seemingly harmless, (oh no, computer use?!) but still directly linked to the loss of the compulsive eating?  So what does it mean if I'm still a compulsive eater (I went through half a small jar of green olives yesterday) - AND I use the computer too much?

Oh dear, I shouldn't read things like this article from OH Magazine:

"Eating lots and eating often seems to fill us up, but it serves our emotional appetite not our physical hunger. We aren’t actually that hungry, but we feel hungry, so eating helps us gain control over our lives when we are needy.  Compulsive overeating crowds out healthier ways of coping. As we rely on it more and more exclusively, it depletes our repertoire of coping strategies. It seems effective in the moment. We get attached to it. Giving that practice up forever is a daunting thought—although not all pre-ops see the challenge as clearly as Lucy did. In the end, compulsive overeating actually covers us up more than it fills us up, and it makes it tough to know what we really need. Compulsive eating seems to help us manage stress and soothe powerful feelings, but it is more likely to increase our levels of stress and even intensify our feelings of being out of control.

Eating is a complicated experience. The social and pleasuring implications of eating go way beyond the fuel it provides. For most of us, our earliest experiences of feeling loved and cared for were enjoyed in the arms of our mothers while eating. Compulsive overeaters learn to reach for food to obtain that feeling of nurturing again and again—when life feels empty or boring, happy or sad, or like it is just missing something. Eating can also be a way to celebrate. Lucy saw it as a special, secret time just for her. She chose a secret food and ate it ravenously. The social rewards of eating are completely lost when eating is practiced alone like this. That’s why, when Lucy finished an episode of compulsive overeating, she didn’t feel nurtured for long. She was quickly filled up with self-hatred and shame. Compulsive overeating takes much more than it gives. The fix is temporary and the harm is long term.

Weight loss surgery trims our ability to overeat by giving us a small pouch/stomach, but it is unlikely to reduce our head hunger or dampen our appetites for love and nurturing. Without overeating, as Lucy rightly predicted, we are exposed to all our deepest needs and compulsive feelings. We fully feel the stress we’ve been covering up with food. It can be very scary at first. If you truly observe yourself at this stage of your recovery, you will probably be surprised at how quickly you attempt to substitute new compulsive behaviors for overeating. Try to avoid substituting new cover-up behaviors. It’s important to learn to feel and manage your feelings without covering them up. Get help if you need it; many of us do. If you work through this rocky emotional period well, you can use your weight loss surgery as a springboard to build healthy new ways of coping and being in your life. Surgery can’t repair an abusive childhood or revitalize a bad marriage. It can’t put reward in an unrewarding job or excitement in a life that’s grown dull, but it can provide a unique opportunity for you to get started doing those things for yourself.

Substitutes for overeating abound. Some look harmless but may not be. Here are common substitute behaviors to avoid.

Purging

The urge to self-induce vomiting is very strong for some WLS patients—especially in the early post-op months. Once this habit is begun it can be very hard to stop. Patients with histories of bulimia are at particularly high risk. Some medical issues early in recovery can cause vomiting, but they are rare, and should not be expected. Most of the time post-ops can and should control their vomiting by eating appropriate quantities of food and chewing it slowly and thoroughly. The pain that follows overfilling the pouch or eating too fast is an important teacher. Don’t shortcut that lesson by removing the evidence you need to feel and remember that you chose to eat too much or too fast.

When self-induced vomiting becomes habitual it is very dangerous, and, as any bulimic knows, purging is powerfully addictive. If it happens more than twice a week over several weeks you should seek professional help as quickly as possible.

Clothes Shopping

Shopping for clothes is a terrific high for many bariatric surgery patients. Some have never been small enough to buy “normal” sizes in regular stores, so reaching that goal is momentous. It’s important to celebrate such milestones and to buy new clothing that fits well and feels good. Clothing that looks good and makes us feel attractive can provide a helpful boost of confidence for our morphing bodies.

Post-ops should be wary, however, of the potential for overindulgence in clothes shopping and the return to compulsivity that can develop around this behavior.  Overindulging in clothes is a close relative to overindulging in food; both are cover-ups. Newly slim post-ops may be drawn to clothing as a way to prolong the attention their weight loss initially generated and may now be waning. They may feel seduced by the excitement that surrounds the world of fashion and clothing. It’s easy to be caught up in this thin obsessed western culture and clothing may feel like an important ticket into that world. Beware! The world of fashion is a world plagued with eating disorders. Weight loss surgery aims to move you toward health. Your love and acceptance for yourself does not depend on your size or the style of your clothing. New clothes seem to provide an emotional “fill-up,” and as with other behaviors that become compulsive, the temporary relief heightens the need for repeat fill-ups. Dependence is established on that need for more. The real need is for self-acceptance and balance. Using clothes shopping to cope with feelings is a dangerous path back into compulsive behavior. Enjoy your new clothes and size as just one part of the many ways your new body is changing and enjoying better health.

Spending Money

Spending money on anything to cover up your real feelings or problems is another way to substitute for overeating. Overspending, like overeating, seems to sooth us for a short time and temporarily helps us manage our emotions. New toys, electronic gadgets, CDs or DVDs, trinkets from the mall or souvenirs from trips can pile up around us like insulation. What are we trying to cover up? This is the time to figure it out. There can be a very addictive quality to spending money regardless of the items purchased. For big wallets, compulsive spending might mean more furniture, more art, more antiques, newer cars, etc., but any new acquisition that gives us a brief lift or a momentary respite from reality can begin a pattern of spending that becomes compulsive. Spending feels exciting and dangerous at the same time. Sometimes you can feel your heart pounding as you pull out your credit card. Those are powerful feelings, and all that adrenalin makes you feel very alive, but spiraling spending can be devastating to long-term security and financial health. Find your excitement in simpler ways and learn to know and love the new person your WLS has uncovered.

Relationship

Long years of morbid obesity and social ostracism leave many post-ops with powerful feelings of low self-esteem. Even after WLS our old fears of rejection will battle with our longings for acceptance. In the absence of compulsive overeating to sooth such intense and conflicted feelings, the emotional ride into recovery is likely to be rocky. Surgery can help patients acquire a more normal looking body but the transition into better self esteem and real body acceptance is much more complicated.

Adults who were morbidly obese as teens will not easily forget the profound isolation they endured. Anger may assert itself in aggressive ways. Personalities that were unflappable and compliant before surgery seem to rise up in righteous indignation afterwards pushing away anyone who tries to get close. Friends and family will feel this wrath and resent being targets of this rage. Some post-ops will be tempted to throw out old relationships along with their larger clothes and start anew. Sometimes pre-op relationships are toxic enough to warrant this but it’s important to go slow here. Relationships that were rocky before surgery will probably get rockier and may eventually have to be abandoned, but relationships that were solid before surgery will likely weather the transition and be even better in the end. Post-ops need to take their time and be sure to make wise choices. Friends and family are never perfect but they are precious resources; protect them from your swirling emotions until you arrive at a calm and stable place in your recovery. You need to understand your anger and compulsive urges and develop lots of new effective coping strategies. It will take at least two years—or even longer for many.

Substance Abuse

Alcohol is a high-risk substance for all bariatric patients. Most discover the change in their tolerance for alcohol early in their recoveries. Patients who have persistent dumping syndrome will find it uncomfortable and unpleasant to drink at all. Others may enjoy a new and pleasant sensation of intoxication that they have not experienced before. Post-ops need to exercise extreme caution with alcohol.

Alcohol and other drugs can anesthetize some of the powerful feelings that patients notice after surgery; these substances also reduce normal inhibitions. This is a dangerous combination for people who are trying to get used to life without their old and best coping mechanism: overeating. Recovering patients need to feel, and cope—in healthy ways, without covering up. Even a small portion of alcohol can cover up important feelings, obscure danger and induce a very vulnerable and impaired state after surgery.

Alcohol intoxication is short lived for most post-ops. A small drink has a big impact but can disappear quickly. Post-op drinkers have trouble adjusting to these new parameters. Some patients may try to drink small amounts over longer periods of time in order to sustain the new feeling of intoxication they are enjoying.

Driving risks will be magnified more than normal for post-ops under the influence of alcohol. People who are used to feeling safe after one or two drinks at a meal will no longer be able to operate their cars safely using that formula. At the same time it is easy to underestimate these risks because the amount of alcohol consumed seems so small.

Sex

Most people dream that after WLS they will finally realize the love and happiness their morbid obesity and disfiguring weights denied them before. Some patients are keenly disappointed when broken marriages don’t revive after surgery and romance is more elusive than they imagined. A cautionary word about dating and sex is especially important.

Adolescence and young adulthood are the times when most people explore their sexuality and look for life partners. But as we noted earlier, post-ops who were morbidly obese during adolescence are apt to be very inexperienced in matters of sex and dating, and may have very weak or inadequate social skills when it comes to sharing intimacy.

New daters often misread the cues and signals of their peers. They may unknowingly reach out to inappropriate partners when seeking physical and sexual acceptance. They didn’t learn “how” and weren’t taught the rules at the normal developmental stage of life. It’s awkward and difficult to try to learn these skills later in life when everyone else already knows them. It would not be surprising to find adult post-ops engaged in dating scenarios more common to teens than adults. Risk-taking increases when sexually stimulated people experiment carelessly without their old coping strategies.

For a person who has had little positive sexual experience, the sense of suddenly being sexually alluring to another can be very exciting, seductive, and terrifying all at once. Powerful needs that have gone unmet for years will cause enormous pressure and may propel people into sexual experiences they are not prepared to have. New sexual appetites and behaviors are best explored slowly and carefully. If sex is used as a way to satisfy empty feelings and unmet longings it can easily become a compulsive substitute for overeating and block the formation of a wider, healthy range of coping skills. Promiscuity can develop and jeopardize the formation of healthy intimate relationships. In extreme situations a recovering patient may unwittingly place themselves in the very real danger of becoming the victim of an assault or a sexually transmitted disease.

Compulsive Computer Use

The internet is a natural pitfall for post-ops because they use it so extensively when researching their surgery and establishing their post-op support networks. It sometimes becomes a new best friend, or a habit-forming substitute for food and eating. Recovering overeaters also fall into excessive computer use to zone out or to cover up their feelings of loss or stress just as they did with food before surgery. The computer can be a lifeline for patients who are isolated or live in rural areas—and many patients will want to take advantage of the enormous array of help available online—but it’s important to put appropriate boundaries around the time spent on the computer. It’s possible to get so caught up in the online world that the real one slips away. Computer use becomes excessive when it interferes with business at work or with family at home or when it keeps us insulated from being fully present in our new lives. Instead of learning and practicing new coping strategies we substitute compulsive word processing, emailing and chatting for compulsive overeating. The first time the substitute fails to be effective overeating will be waiting to return. 

Exercise

Exercise is important for post-ops, as everyone should know, but exercise should be part of a thoughtful plan with moderation, consistency, and an appropriate goal in mind. I emphasize appropriate because exercise is about better fitness and health, not about losing weight. Unfortunately it is easy for compulsive overeaters to set unrealistic expectations for exercise, especially in the first few months after surgery. The set-up is very dangerous. The novelty of surgery generates high levels of excitement early in recovery, but failing to stay with an unrealistic exercise regime can throw a tender new life style far off course. Our old patterns of behavior with food resurface quickly almost as if they have been waiting in the wings. Failing at over-exercising translates quickly into failing at all exercise and eventually failing at recovery altogether. If we fail at extreme exercising we must be one of the hard-core ‘losers’ who “just can’t do it.” We throw our ‘baby’ surgical tool out with the exercise bathwater and then wonder why surgery didn’t work.

Another concern is the bounce-back regain. Some patients who engage in a strenuous exercise routine over the first post-op year will lose more weight than their body is able to maintain. As soon as the strenuous exercise routine ends (and it almost always does) patients experience a 10 or 15 or even 20 pound bounce back. The bounce back precipitates a crisis of faith in surgery and a panic about regain. Dieting and yo-yo restricting begin out of habit and patients find themselves in the familiar territory that fueled their morbid obesity in the first place.

When establishing a post-op exercise routine, emphasize how great exercising makes you feel. It should make you feel good! It’s hard to find the time for this important part of life but exercise shouldn’t hurt—and it shouldn’t ruin the day if we do or don’t do it. Exercise can become a very cruel overseer if we espouse the “no pain, no gain” philosophy. That kind of exercise begs us to quit.  It also sets a very negative tone for the day if it feels like an obligation instead of a contribution we make willingly. It’s a little like excessive-compulsive weighing on the scale. It’s important to keep an eye on the scale on a regular basis, but if your day is completely colored by the numbers on the scale or the number of reps or sit-ups, then something is out of kilter.

Some would argue that compulsive exercise is healthy—better than compulsive eating. They fantasize about cultivating exercise as a new and healthy addiction. Don’t fall for that trap. Obsessions and addictions are never healthy and anyone who thinks they are has never seen the pain in the eyes of a young anorexic running in place, alone in her darkened room at night, or the frenzy of a binge-eater with no more ice cream.

Compulsivity doesn’t disappear

Compulsivity is a main ingredient in the morbidly obese person’s lifestyle. Surgery doesn’t make it go away. We need to learn to manage our compulsiveness in healthy, constructive ways. Compulsivity is likely to linger for most post-ops. It will be very tempting to substitute other compulsive behaviors to fill the space over-eating occupied before surgery. We will have to learn to recognize our pressing urges, and plan effective ways to deal with them and with the feelings associated with them. Compulsive and addictive behavior is not healthy. When any activity or substance becomes compulsive or excessive we need to figure out why. When compulsivity begins intruding on our normal routines or begins stealing time and money that belongs to our work, our families, and our friends, then something’s wrong.

Gastric bypass surgery gives us a tool to battle back and makes it possible to triumph over obesity, probably for the first time, but we must learn to use it well."

Thank you. <3

I feel like I must explain the ad above.  I'm now sort of sponsored by Medifast.  I logged into my advertiser thingie last night, which I hadn't done in a month or so, since I've never made a dime on the ads that sit on the site here.  So last night, I log in, to see if I could add advertisements from Moth*rwear (they sell nursing clothes), because they had an affliate program where you could earn $ towards clothing at their site.  The clothes are Moth*rwear are hugely overpriced, and I could use a couple of dollars towards a couple of shirts, so why the heck not, right?  Well, I got DECLINED.  ::sigh::  But, in looking at my account, I hadn't noticed, I made a commission on another advertiser!  Yay!  I don't know who/what/when/where the money will actually GET to me, but it looks like by two weeks into the new month, they'll cut me a check.  I would just squeal with delight if I got a "paycheck" in the mail right now.  How exciting!  It's not much - but - it'll buy me two nursing shirts NOT AT MOTH*RWEAR, or, two Christmahkwanzahah presents, or... a good chunk of my 1,850+ photos that have yet to be printed at Flickr. 

Thank you for clicking the ads specifically the ones that  help you start losing weight now, anonymous blog readers!  I <3 you! 

Dude, help Del.

I just found an article about the guy in the photo, Del.  He's a big guy who wants to get weight loss surgery and has been repeatedly denied by his insurance carrier.  He's now pimping himself out (in nice wholesome ways!) on eBay to raise the funds for his surgery.  I say, why not help?  I was insanely fortunate to have a health insurance company that not only approved my surgery but also approved my husbands' surgery nearly 100%.  Not only were both procedures easily approved, I really didn't have any co-morbidities.  So, why do insurance companies pick and choose who gets what?

So from the article:

He loves to fish. His sister married his best friend. He likes children and once hoped to be a father to nine of his own. He is funny, especially in a sarcastic kind of way. He likes all kinds of music except classic rock. He moved to Oregon because of a girl. It didn't work out.

But hardly anybody knows any of that.  What everyone knows about him is the obvious: He weighs more than 450 pounds. He is Del Krueger. He is desperate. Somewhere inside Del is a thin man that people would take the time to get to know. Just because it's a cliche doesn't mean it's not true. But to become that person, he first has to be this person: "OK, here's the story. My name is Del, and I'm fat."

That is an excerpt from Del's eBay auctions. He has three of them going in a last-ditch effort to raise money, a lot of money, for weight-reduction surgery. If Del had cancer, people would be organizing benefits for him. But he is obese. Not many will contribute for that. He needs $15,000. He has raised about $60.

People can to go to eBay and buy shares in the We Support Del Fan Club. A thousand shares are being offered at a buck each. Members receive a monthly newsletter about Del's life and his autograph. Anyone who buys 500 shares gets an original painting by Del. Anyone who buys 200 or more shares will receive a personal visit from him.

The auction for the rights to paint your company's logo on his 1994 Lincoln Town Car has a $5,000 minimum bid. There are as yet no takers.

The third auction is to have Del be your personal "handyman, husband or manservant" (but nothing sexual) for 30 days. It began yesterday. That minimum bid is also $5,000.

Wayoutauctions.com, a site that trolls eBay for odd and unusual auctions, picked up one of Del's. It soon became the top attraction at Wayout.

He set up a page at Blogspot (search for: fatguyneedshelp), and one of his friends posted this: "Del is my best friend, and I will do what I can to help him with this. He's one of the coolest nicest and funniest people you will ever meet and I know it hurts him to reach out for help like this, but it would change his life and that of his family and friends who worry about him all the time. People like Del are the people who help you when your car is broke, or you need a ride. ... Help Del please ... help my friend."

  How did it come to this?

Del grew up in Chatham and graduated from Glenwood High School, class of 1992. He went from a chunky kid to a morbidly obese adult. There is nothing he can say about himself that is any worse than the things he has heard others say. He has battled depression. He developed his biting sense of humor as a defense mechanism.

His mother was obese. She had weight-reduction surgery. It worked. His friend, Dan, had it and it worked for him as well. Another friend, Tim, had the surgery. He died a couple of weeks later from a blood clot in his lung.

So there is risk. Del will take the gamble. He is already on medicine for his cholesterol and blood pressure. He has no cartilage left in his knees, which makes it hard for him to walk. He doesn't think he has long to live. He is 32 years old.

It's not as if he hasn't tried. The Atkins Diet. Weight Watchers. Counseling. More diets. Years of it. All of that, and he still weighs more than 450 pounds.

The latest solution is lapband surgery. It is less invasive than gastric bypass. He has talked with Dr. Sidney Rohrscheib at the Illinois Bariatric Center in Clinton. Rohrscheib said yes. He talked with his insurance company about coverage. The company said no.

"So I'll continue to (rent) myself out," Del says. "And see what happens." He was smiling when he said that. It's just that he doesn't know what else to do. He likes himself, he says, and has a lot to offer.

"I always say I'm the sexiest fat man alive," he says. "I love myself no matter what. But I'm physically breaking down. I used to want nine kids. But I can't find anyone who would want to have any kids with me until I lose weight."

Del works as a headhunter for an executive recruitment company, CMW & associates, in Springfield. On his eBay sites, he stresses that he could easily apply for disability and go on the public dole. But he prefers to work as long as he is able.

"I am a 32-year-old male," he explains on his auction page, "who wants to live long enough to have a family and watch them grow up. That's all."

But there is more to it than that, isn't there?

Pregnancy No-No's

Pregnancy No-Nos By Leah Hennen http://www.clubmom.com When I was expecting my first child, threats to my baby's health seemed to lurk everywhere. I knew, of course, that alcohol, cigarettes, and drugs of any kind were off-limits. But what about those lattes I'd chugged before I knew I was pregnant? Did I need to get rid of my beloved cats? What sort of environmental hazards was I unwittingly exposing my fetus to? Nine months of caffeine withdrawal, cat avoidance, and breath-holding-around-noxious-odors later, my strapping baby boy arrived. Unlike me, you don't have to be paranoid when you're pregnant. "You can't put yourself in a glass bottle during pregnancy—all you can do is avoid known risks," says Dr. Robert Resnik, a professor of reproductive medicine at the University of California, San Diego, School of Medicine. Since some women, such as those with high blood pressure or gestational diabetes, need to take extra precautions, talk to your doctor about special circumstances that relate to you. Also steer clear of the following: Too Much Caffeine For java junkies like me, the research on caffeine during pregnancy has been maddeningly contradictory. Some studies point to problems such as miscarriage and low birth weight, while others show no such relationship. The latest consensus is that only excessive amounts of caffeine (more than 300 milligrams a day) are likely to cause these problems, says Dr. Kathleen Bradley, a maternal-fetal medicine specialist and assistant clinical professor of obstetrics and gynecology at the UCLA School of Medicine. The caffeine content of different brews varies, but you should be able to stay under the 300-milligram mark by limiting your daily quaffing to one or two 5-ounce cups of coffee or tea or a few 12-ounce cans of soda. (Since even non-colas can pack quite a caffeine punch, check the label before you imbibe.) And while chocolate does contain caffeine, it typically has much less—1 to 35 milligrams per one ounce—than coffee. Cat Litter Cat feces may play host to a parasite that causes toxoplasmosis. The symptoms (fever, fatigue, and sore throat) are similar to those of a garden-variety flu, but the results (miscarriage, preterm labor, or serious health problems in the newborn) can be devastating. Even so, having a baby on board doesn't mean you need to send your puss packing, says Marion McCartney, a certified nurse-midwife and the director of professional services at the American College of Nurse-Midwives in Washington, D.C. It simply means you should put your mate on litter-box duty for the nine-month duration. It's also a good idea to wash your hands after heavy petting sessions with the cat and after handling raw meat. Don't feed yourself or the cat undercooked meat (which can harbor the parasite). Wear gloves when you're gardening and avoid children's sandboxes. (Roaming cats may use these as litter boxes.) Certain Foods Beware, foodies: Uncooked, soft cheeses (such as feta, Camembert, Brie, and blue-veined varieties), unpasteurized milk and the foods made from it, and raw or undercooked meats, fish, and poultry may contain listeria bacteria. During pregnancy, listeriosis (symptoms include fever, chills, diarrhea, and nausea) can cause miscarriage, preterm labor, or stillbirth. Some seafood may also contain high levels of mercury, PCBs, and other toxins. If these foods are consumed during pregnancy, the baby is put at risk for developmental delays. (Your local health department may be able to tell you which fish to avoid.) Experts recommend that expecting mothers limit their servings of shark and swordfish—which contain higher levels of mercury than other fish—to one three-ounce serving a month. Finally, lab tests have linked heavy consumption of saccharine to cancer. Though you're not likely to swill enough of the artificial sweetener to equal several times your body weight, you may still want to forgo those little pink packets for now. Aspartame (NutraSweet, Equal) appears to be a safe sugar substitute. Herbal Remedies You know that many prescription drugs are off-limits during pregnancy, but the natural remedies you can pick up at health-food stores are okay, aren't they? Guess again: Herbal remedies can have a potent effect on your body—and your baby's—cautions McCartney. Don't take anything without running it by your health-care provider first. She'll most likely tell you not to use any during your first trimester. Throughout your pregnancy, steer clear of goldenseal, mugwort, and pennyroyal, all of which have been associated with uterine contractions (which could possibly lead to miscarriage or preterm labor); Asian ginseng (which interferes with metabolism); and feverfew (though popular for migraine headaches, it has unpredictable effects on pregnant women). It's also wise to avoid herbal teas that purport to have medicinal benefits. Home Hazards If you haven't been gripped by that famous pregnancy cleaning-and-nesting frenzy, chances are you will be soon. Safety tips for those 3 a.m. floor-scrubbing and nursery-decorating sessions: Read labels carefully. Wear gloves and work in well-ventilated areas. And avoid aerosols (which disperse more chemicals into the air than pump bottles do), oven cleaners, paint fumes, solvents, and furniture strippers. Although frequent, heavy exposure to chemicals in the workplace (home workshops count, too) has been linked to birth defects, Bradley explains, home use of most products is more likely to make you feel faint or nauseous—not a great proposition when you're nine months pregnant and perched high on a ladder or wedged behind the toilet. Overheating Soaking in the hot tub or relaxing in a sauna may seem like the perfect way to pamper your pregnant body, but raising your core temperature—especially during the first trimester—may boost the odds of birth defects. It's safe to soak in a lukewarm bath, though. Just make sure that the temperature is not above 100 degrees and that you get out after about ten minutes, Resnik advises. Sustained exercise in very hot, humid weather can also raise your core temperature. When you do exercise, be sure to drink liquids before, during, and after, and if you find that you're heating up, take a five- or ten-minute breather. Lead Lead exposure has been linked to miscarriage, preterm labor, low birth weight, and mental and behavioral problems in children. Residue from the toxic metal can lurk in places you might not suspect: houses built before 1978 (the year lead paint was banned), tap water, even calcium supplements. A few precautions will reduce the amount of lead you come into contact with: Call in a lead-abatement specialist if you live in an older home with chipping or peeling paint. (Whatever you do, don't try to sand or scrape it off yourself.) Filtering your water may help, or have your tap water tested. (Call the Environmental Protection Agency's Safe Drinking Water Hotline at 800-426-4791 for a testing lab in your area.) Finally, if you take a calcium supplement, ask your doctor to recommend one that's low in lead, such as Tums 500 Calcium Supplement. Oral Sex Don't worry, you needn't swear off oral gratification entirely. (After all, when you hit that physically awkward last trimester, there may not be much else you can do between the sheets.) But when he's pleasuring you, your mate should be careful not to blow air into your vagina, if that's something that's part of his, uh, repertoire. Why? Your blood vessels are dilated during pregnancy, and, though the chances of this happening are very rare, a fatal air bubble could potentially enter your bloodstream, McCartney explains. Certain Over-the-Counter Drugs Your back is aching, your heart is burning, and your stomach is roiling—do you have to forgo all pharmaceutical relief? Not necessarily, says Bradley. But since even benign-seeming remedies, such as aspirin, ibuprofen, and certain cold preparations, can cause problems for your baby, don't pop any pill without your doctor's approval. If one medication is off-limits, she can suggest an alternative. Acetaminophen (Tylenol), for instance, is fine. Secondhand Smoke You may have given up cigarettes, but if your mate's still puffing away, your baby's getting hefty doses of the 43 cancer-causing chemicals in cigarette smoke. In fact, exposure to secondhand smoke during pregnancy raises the risk of low birth weight, sudden infant death syndrome, and other health problems. So ask your partner to quit or to cut down—if not for his own health, then for yours and your baby's. And tell anyone who lights up around you to kindly take it outside. Stress Every time you look down, your growing belly reminds you of just how much your life will change once your baby is born. Exciting, yes. Stressful? You bet. Even so, try to take it easy. Stress causes the release of hormones that reduce blood flow to the placenta and triggers contractions, and it has been linked to miscarriage, preterm birth, and low birth weight, Bradley explains. If you hold a high-pressure job, do what you can to scale back. If you're feeling the heat in your personal life, practice relaxation techniques, surround yourself with supportive people, and seek counseling if need be. Vitamin A As is the case with its chemical relative Accutane (a prescription acne drug), high doses of vitamin A during pregnancy can cause heart and facial defects, says Resnik. How much is too much? Some studies have indicated that problems can occur when pregnant women take more than 10,000 international units (IU) a day, while others list 25,000 IUs and even 50,000 IUs as the threshold. You get a fair amount of vitamin A from the food you eat, and though the dose in your prenatal vitamin should be fine, your doctor can tell you whether it's an excessive amount. Leah Hennen is a writer and editor in San Francisco and the mother of two, ages four and one. Copyright © 1999-2004 ClubMom, Inc. All rights reserved.

Low glycemic index best?

Source Reuters via Yahoo:

A diet rich in carbohydrates with a low glycemic index appears to be more effective in reducing fat mass and lowering the chances of developing cardiovascular disease (CVD) than diets with a high glycemic index or high in protein, an Australian research team reports.

The glycemic index of a food indicates how quickly it is broken down and causes a rise in sugar levels in the blood. Generally, low glycemic index foods are complex carbs like whole grains, rather than refined sugars, for example.

According to a paper in the Archives of Internal Medicine by Dr. Jennie Brand-Miller at the University of Sydney and colleagues, there have been no clinical trials comparing the effects of glycemic index and high-protein diets on weight loss and cardiovascular risk.

They therefore conducted a trial in which 129 overweight subjects ages 18 to 40 were randomly assigned to one of four weight-loss diets for 12-week. All four diets were comprised of reduced fat (30 percent of total energy intake) and held daily calories to to1400 kcal for women and 1900 kcal for men.

The diets varied in target levels of carbohydrates, proteins, and glycemic load (i.e., glycemic index multiplied by the amount of carbohydrate, divided by 100) as follows:

Diet 1: carbohydrates comprise 55 percent of total energy intake, protein 15 percent of total energy intake, high glycemic load (127 g)

Diet 2: similar to diet 1 except a lower glycemic load (75 g)

Diet 3: protein comprises 25 percent total energy intake (based on lean red meat), carbohydrate reduced to 45 percent total energy of intake, and high glycemic load (87 g)

Diet 4: Similar to diet 3, except low glycemic load (54 g).

Brand-Miller and her team report that the diets resulted in similar reductions in weight (4.2 percent to 6.2 percent of body weight), fat mass and waist circumference.

However, in the high-carbohydrate diets, lowering the glycemic load doubled the fat loss.

The investigators also found that total and LDL ("bad") cholesterol levels increased with diet 3 and decreased in diet 2.

"In the short term, our findings suggest that dietary glycemic load, and not just overall energy intake, influences weight loss," the team concludes.

In a related editorial, Dr. Simin Liu, from the University of California in Los Angeles, points out that "foods with a low degree of starch gelatinization, such as pasta, and those containing a high level of viscous soluble fiber, such as whole grain barley, oats, and rye, have slower rates of digestion and lower glycemic index values."

Therefore, the commentator continues, "Without any drastic change in regular dietary habits, one can simply replace high glycemic index grains with low glycemic index grains and starchy vegetables with less starchy ones and cut down on soft drinks that are often poor in nutrients yet high in glycemic load."

SOURCE: Archives of Internal Medicine, July 24, 2006.