Category: Bariatric Surgery

Regain is real and stigma may have something to do with it.
Bariatric Surgery, healthy habits, Obesity

Regain is real…and so is the stigma associated with it.

Marilyn Clark

While it’s easy to accept that there’s a certain amount of regain expected following weight loss surgery, regain is real. And when not kept in check, our habits can go off the rails and down the track of self-sabotage. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), as many as 50% of all surgical patients gain back a small amount of weight (approximately 5%) two years or more following surgery.

Keeping it real, I fall into that category. When I think about where I have come from, it’s no big deal. These pesky 5-10 pounds is nothing considering I started at 226. I keep chugging along, doing everything I know I can and am being patient before I write it off as the horrors of peri-menopause or my broken metabolism. I know it comes down 100% to habits and accountability.

I regularly engage with the bariatric community through Twitter, Instagram, my own surgeon’s support group, and other online groups. I see that there is a need for support, especially when patients experience regain. I reached out through Twitter to do some simple research with these questions:

  • What has been your biggest challenge since surgery?
  • What would it look like if you were able to overcome that challenge?
  • What is holding you back from overcoming that challenge?
  • Would you pay for support to help you overcome this challenge?

Guess what the answer was to the first question? Fear of regain. Even patients who hadn’t experienced any regain feared it. And what it would look like to overcome that fear? Regaining that feeling of invincibility that they had right after surgery. Digging deeper, they said that was the time when they were the most committed, followed their program’s nutrition guidelines to a T, and experienced no hunger in those months after surgery. For those that reached goal, that feeling of shopping in the “regular” stores and restored confidence was a common theme. And for those who experienced regain, they claimed the reason was that they let their good habits slide, making way for old habits, old thinking patterns, mindless grazing, and making less than healthy choices in all areas of their lives.

Having these conversations made me realize that there was a need for support right at the moment where things go off track. The problem is, people are embarrassed to go back to their surgical programs for help, thinking they will just take care of it on their own. Appointments get postponed while trying to shed those regained pounds. Structured eating turns into trying every diet under the sun from keto to paleo to intermittent fasting to vegan to carnivore to [insert name of latest nutrition trend here]. By this point, they stop going for annual checkups, don’t get lab work done, and may be going down a dangerous path.

Financial barriers are a driver for seeking out help. Insurance coverage may have changed, or the cost of protein or supplements may no longer fit into budgets. People seek support in a variety of online channels, but these are groups run by patients (or even by supplement companies) offering nutritional advice outside of the ASMBS guidelines for post-bariatric nutrition and follow-up support.

Hearing the frustration in the voices of my interviewees, I decided I needed to do something. In just a few weeks, I will be completing (yet another) certification as a bariatric coach. My goal is to offer free and low-cost coaching opportunities for bariatric patients, aimed at first reconnecting them with their programs for monitoring, and helping to reverse the regain by examining habits related to nutrition, fitness, and mindset.

So where does stigma come in?

Stigma comes from so many different places. First, there’s self-stigma. The story we tell ourselves about failure, again, along with negative self-talk is our very first challenge to overcome. There’s stigma in the fitness and wellness industry, especially related to weight loss surgery. Most trainers and health coaches are unaware of the specific nutritional needs and restrictions for bariatric patients, or they view people affected by obesity as lazy or taking the easy way out. That message, unfortunately, is broadcast loud and clear on the daily. So let’s add in social media as a source of stigma. I call it compare and despair. Seeing people posting their successes and how effortless everything is can be very de-motivating when you yourself are struggling. Finally, there is also bias in the medical community. We’ve all heard “eat less, move more” at the doctor’s office. Obesity is a complex disease and there is no simple formula for treating it. Even the dread of having a conversation about weight is enough to keep patients from scheduling appointments for even routine monitoring.

I am a member of the Obesity Action Coalition (OAC) who provides amazing guidance about taking a stand against weight bias. OAC’s advocacy work focuses on a number of areas – advocating for equitable treatment of people affected by obesity, improving access to the prevention and treatment of obesity, eliminating weight stigma and bias in the media, and providing a community of support for people affected by obesity. I regularly speak up when I see weight stigma in my industry and have shared information about person-first language to health and fitness coaches whose target markets include people struggling with weight management. I am often accused of being too sensitive, but so be it.

So what am I going to do about regain?

I want to provide a number of free and low-cost tools that can help people who are struggling with regain or plateaus after weight loss surgery. The first offering I have developed is a habit tracker that’s structured around bariatric lifestyles. You can download your daily habit tracker free by signing up for my mailing list.

Next up is a new program called Reverse the Regain. I am offering limited spots at a dramatically reduced price while I work to refine the program. You can sign up for a free consultation with me to see if that program is a good fit for you.

Third, I’ve launched a brand new Facebook group which will remain free of charge, focused on cultivating healthy habits and a sense of community. Join my Healthy Habits Bootcamp group for extra support, free recipes and guidance, and fun prizes!

Finally, I’m working on developing some lower cost group programs, both online and in-person. Much more coming in 2020!

Does this sound like a lot for one person? It is. Maybe I am crazy. But — I am committed to helping people get on track and stay on track so they can continue on their journey towards improved health.

healthy habits, the key to unlocking your potential
Bariatric Surgery, healthy habits

Healthy habits are the key to everything

Marilyn Clark

I’ve been reading James Clear’s book Atomic Habits and find myself telling everyone about it given the opportunity. At the core of every aspiration or goal are the steps needed to get you there. I work with clients on goal setting and creating S.M.A.R.T. goals (specific, measurable, attainable, relevent, and time-bound) all the time, and we break them down into actions they can take to get closer to the goals. But we’re still talking about big steps at that point. Atomic Habits talks about how goals are achieved through the building of small habits consistently, that lead to gradual improvements over time, and which compound over time, much like interest in your bank account.

I’m still working my way through the book, but it’s a great read and provides some great lessons on how to keep your habits going, even when things get tough.

This ties in perfectly with some of the new programs I am working on. As a successful weight loss surgery patient, there are things I do habitually every day. I take bariatric formulated vitamins. I drink whey isolate protein. I get 7-9 hours of sleep. I exercise. I plan my meals. I track everything. I journal. I meditate. I take time out for self-care. I did NONE of these things before my surgery. I mean, I did some of them, inconsistently, but it wasn’t built into my DNA. For something to become a habit, it must be done consistently.

I’ve been engaging with folks in the bariatric community about some of the challenges they face, and the number one thing that came up consistently was the fear of regain. And when you dig into that a little further, you start to uncover that the reasons why people regain are not only that they slip back into to their old bad habits, but they also never put the healthy habits in place consistently to the point where they become automatic.

Based on these conversations, I decided I wanted to create a free resource for people to help them get back on track by going back to the basics of bariatrics! I developed a bariatric-focused habit tracker for download when they subscribe to my mailing list. Be sure to subscribe and get yours too!

Which leads me to the most exciting thing! I’m working on a program that’s specific to bariatric patients to help them navigate their post-surgery life with regards to maintenance, plateaus, and regain. When you download the habit tracker, you’ll get a little more information about what’s in store, but stay tuned. If you’re interested in learning more now, schedule a free discovery call with me or check out what’s in store for my Reverse the Regain program. I’m excited to help people wherever they are on their weight loss journey. Looking forward to continuing to connect!

Bariatric Surgery, Obesity

Bad Breakup: Why I am letting go of diet culture

Marilyn Clark

In my introductory post on my blog I briefly touched on the fact that since age 11, I had been on a diet. Obesity has been part of my life from an early age. I started off with Weight Watchers in the 70s where I learned about #3 and #4 vegetables, way before points, or whatever disguise of calorie counting have going on today. I spent my middle school years trying to get to a goal weight of 89 pounds, which, by the way, I never reached.

What did this do? Did it set me up with a knowledge of good nutrition and healthy weight goals? Nope. It set up a history of disordered eating — food as reward, withholding food as punishment, binge eating to drown out emotions, frustration with gaining and losing over the next few decades. Did I mention my father was the Weight Watchers instructor? All my life, I kept hearing that it’s “not a diet, it’s a lifestyle” and “nothing tastes as good as thin feels” and all the other marketing crap that was in at the time. Let’s just say that it didn’t do much for my relationship with my dad either.

Years went by, and while I did get really good at losing weight, I was never able to maintain my weight loss. In my thirties, I was probably considered medically obese when I found out I had a pituitary tumor. Although it was benign, it caused me to overproduce the hormone prolactin, so it had to be medically managed and monitored. I went to an endocrinologist who told me I needed to “eat less and move more.” So continued the compulsive hamster wheel of logging food, burning calories at the gym — but it wasn’t working.

Fast forward past a mounting list of co-morbidities ranging from arthritis, to high cholesterol, to high blood pressure, the pituitary thing and then a thyroid thing, and my weight at its highest shot up to 230 pounds. My primary care doctor gave me a tough love lecture and recommended that I look into a medically managed weight loss program, which was actually a VLCD (very low calorie diet) consisting of high protein shakes for months along with group behavioral counseling and weekly check-ins with a doctor. The good news is I had great success on this program and lost about 80 pounds, but I was never able to maintain the weight loss, even with the continued behavioral meetings and regular accountability. I was exercising — in fact running half marathons — and logging everything I put in my mouth and staying under 1100 calories and averaging 100-120 grams of protein. I was doing everything right. But I was still gaining weight.

Stress, anxiety, depression were all factors — but I was always sure there was something else going on. I felt broken.

In a moment of frustration, the doctors told me that there wasn’t much else they could do for me, as I tried all kinds of medications to support weight loss and to manage the accompanying anxiety and depression which I always associate with my weight and my lifetime of failing to lose and maintain. So they referred me for bariatric surgery.

I actually went to several orientations for different surgeons and did a ton of research about what was entailed and what would need to change after surgery. I chose my surgeon because during her presentation, for the first time in my life, I understood that it wasn’t my fault. I learned that obesity is a disease, that I probably had a genetic disposition for obesity, and that my body was fighting to maintain a higher weight. But also learned that bariatric surgery is a powerful treatment for obesity and related conditions. I knew it was right for me. I was approved for surgery (after a couple of denials and appeals, which is a story for another day) and I had gastric bypass on July 5, 2016.

Fast forward to 2017 – after the first six months of maintaining my goal weight, I came to the sudden realization that I, for the first time since I was 11, was not on a diet. I have rules to follow — I have to take vitamins daily, I need to meet certain macro goals, I cannot eat sugar or fried foods to avoid the dreaded dumping syndrome. My small pouch that replaced my stomach handles all the restriction for me, so I always feel satisfied after meals. I also have made serious adjustments to my thinking — I have learned how to tell when I have reached fullness, and I’ve also learned when I am NOT hungry, just bored or thirsty or some other emotion that I used to quiet by eating. Just the freedom of not being ruled by the scale, calorie counting, and calorie restriction is so empowering.

Diet culture is what set me up for a lifetime of disordered eating, feelings of failure, and a constant battle with the scale and with my own feeling of self-worth.

A few weeks ago, Weight Watchers announced they were going to offer free membership to teens and the Internet blew up. The hashtag #WakeUpWeightWatchers got some major Twitter screen time and the whole response really struck a chord with me. It brought me back to feelings of failure at 11. But it also made me realize how far I had come. My measures of success go way beyond the scale. And it helped solidify my mission to help people struggling with obesity to free themselves from diet culture and set themselves up with healthy lifestyle and nutrition choices. Progress, not perfection. Small changes, small victories, and big celebrations. Everyone’s journey is different, but being your best self is the best reward of a total transformation. And you get to define what that means.

Bariatric Surgery

The power of your story

Marilyn Clark

Adobe Spark-16

A flutter of negativity can ruin your day. That’s when you take a step back and look at the bigger picture.

Honor your past to inspire your future. Loaded words.

This was one of themes in my training this week. And oddly enough before I completed the assignment, I was feeling very reflective. Monday night, I spoke to a room full of potential bariatric surgery candidates and shared my story. It was a very moving experience, and gave me a bit of a mind shift. You can read more from my personal Instagram account which documents my journey post-bariatric surgery.

Connecting the dots: I have to step back and look at where I started and where I am now, and use that to inspire me to push towards my future goals. As I build my coaching practice I have been thinking of what really differentiates me from other graduates of my program.

Everyone’s journey is different, and destination too. But what I have learned along the way is what inspires me to help others, whether they are considering bariatric surgery or another medical intervention for obesity. I have learned through mistakes, I have gathered a significant amount of information about the disease called obesity and the negative stigma associated with it. I understand weight bias. I understand the frustration of feeling hopeless and like a failure.

But I also know what it feels like to emerge from the darkness and capture the true power of my own story.  I am ready to share what I have learned, and what I am learning.

View this post on Instagram

Monday night I had the honor and privilege of being the guest speaker at my bariatric surgeon’s New Patient Seminar. Before I was called up, she played a video with the song “everybody wants to rule the world” over dozens of transformation photos (which of course made me a little teary-eyed). At the end of the song, it paused on these three “before” pictures. And then I walked up. Hard to imagine standing in front of this crowd of people knowing I was in the audience not so long ago. My journey is different than most, but still inspiring to people who are just starting on their path. It made me feel completely relevant. And the person on the left is so much happier — and healthier. It made the difficulties of this year fade away and gave me renewed inspiration and a sense of accomplishment. I have maintained my weight loss for a year. I never expected I could do it. But I did. Time to reflect and give myself some credit for a year of hard work, mental toughness, and asskicking victories. #obesitysurvivor #wlsjourney #longstrangetrip #2017inreview #whatayear #enjoytheride #livelife #seizetheday #carpediem #healthcoach #iinsession

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Bariatric Surgery, Uncategorized

Life is not binary

Marilyn Clark

Adobe Spark-8

There’s this concept in my coaching program called “the magic of mirroring.” When listening to clients, there’s often this inner dialogue going on where you completely relate to what they are saying, and as you go on in dialogue providing guidance, you hear yourself answering your own struggles. Speaking with one of my “practice” clients, we got into a conversation about being good or being bad.  Why is it that we take this all or nothing approach to so many things? We say, “I eat really well, except when I am bad.” We let this notion of being “good” allow us to indulge in “bad” things as a reward, or we punish ourselves for being “bad,” by spiraling into more “bad” behaviors.

Life isn’t that clear cut. And for people who have struggled with weight loss, it’s time for a new way of thinking. We’ve been shamed into thinking that we are being bad if we make a poor food choice or if we chose to sleep in over going to the gym. It’s time to listen to that voice in your head and tell it to STFU.

This a-ha moment I had made me very conscious of my inner monologue and how often I think of things in terms of good or bad. I have rephrased my self-talk. I only choose food that will nourish me because that’s just how I eat now. I choose to eat this way because I am proud of my success and I don’t want to go back to my old way of life.

Is it all butterflies, unicorns, and roses?  Hell no, but the awareness of that negative self-talk is the best answer to defeat it when things are tough. Weight loss after gastric bypass surgery isn’t just automatic. Well, part of it is — in the beginning, but there’s a lot of work that goes into making smart food choices, getting proper nutrition and supplementation, showing up for exercise, and creating consistently healthy patterns with sleep and stress management. I hear myself telling fellow patients that it’s a marathon, not a sprint, and I stop and listen to myself. Health coaching is the thing that will keep my inner evil voice quiet and will keep me focused on my own health and wellness.  And that, my friends, is good.

Bariatric Surgery, Obesity, Uncategorized

Clean Eating: Bariatric Style

Marilyn Clark

Adobe Spark-6

There’s so many resources about diet after bariatric surgery when you are post-surgery to about 6 months. Moving from liquid, to puree, to solid stages during weight loss comes with a lot of guidelines. What life looks like post-weight loss is not nearly as well-documented. I know when I was researching surgery, I followed so many blogs of people who were going through weight loss, and they all seem to get to a certain point and then stop documenting the journey. Even my own blogging has slowed down now that I have reached maintenance.

This week in my health coach training, one of our assignments is to create a resource for my clients about clean eating. Do you need to recreate the wheel for bariatric patients? I think not.

Here’s some guidance from our curriculum:

  1. Keep It Whole
  2. Experiment with Home Cooking
  3. Limit Refined Carbohydrates
  4. Maintain Consistent Eating Times and Try Not to Skip Meals
  5. Balance Your Plate

Let’s put the bariatric spin on this.

There are rules we have to follow as bariatric patients (and they may vary from surgeon to surgeon, so it’s important to follow YOUR program). First and foremost, we must take our vitamins and supplements. For me, this means a bariatric formulated multi-vitamin, calcium with vitamin D, vitamin B-12, and 60-80 grams of protein specifically from protein supplement. Since we’ve got through a major surgery to reroute our digestion, supplementation to ensure proper absorption of these nutrients is critical.

Emphasize Quality Over Quantity

This applies to your supplements as well as food. I have chosen bariatric formulated products to ensure maximum absorbtion. It is expensive? Not compared to feeling like crap and being 90 pounds overweight. It’s all relative. We have one body in this lifetime and we’ve already put it through a lot to get to where we are going, so invest in your health.

The same goes for the rest of the things we eat. We’re so limited on how much food we can intake. In the beginning, I was fine with 1/4 cup serving sizes for meals, but as I got more into my exercise program, I gradually increased to 1/2 cup per meal, and now that I am in maintenance, I can eat much more — depending on the food, but the quality of that food matters.  Since we can only eat so much, nutrient dense food is the way to go. So:

  1. Choose Whole Foods

When planning meals, think of choosing the most unprocessed food and keep it simple. I always include a protein source as my primary food and eat that first, followed by whole vegetables and fruits. I lean towards a plant based diet, so protein sources can include beans, lentils, tempeh, tofu, or hummus but I will also include vegetarian sources like eggs, cottage cheese, string cheese, greek yogurt, or other reduced fat cheese. Occasionally I will eat chicken or fish, but try to choose organic and sustainably raised animal products when I do choose them. I will typically pair these foods with organic fruit or vegetables, usually fresh, sometimes frozen. Simplicity is the key.  I will meal prep simple “lunchables” that are roughly the same quantities that I can mix and match over the course of the week and have prepped and ready to go to throw in my lunch bag.

Here’s a few examples:

  • Eggs with sliced tomatoes
  • Cottage cheese with sliced peaches
  • Tempeh with hummus in a lettuce wrap
  • Kale and red cabbage salad with beans or hummus
  • Roasted root vegetables with grilled chicken

You are only limited by your imagination.

2. Experiment with home cooking

Food prep keeps things fun and interesting. Typically I will find a recipe on Pinterest that I will make as an entree to have for lunch or dinner for the week, or I will find some kind of plant-based salad to make that can be paired with a protein source or just enjoyed as a snack between meals. My pinterest account has a collection of bariatric friendly and plant-based recipes that I will adapt based on my current nutritional needs.

I am still recovering from my kidney surgery, so I have had to adapt my portions and my food to a reduced intake due to reduced exercise quantity and intensity. Eating at home really helps me to control what I take in, reduce the amount of sugar, salt and carbs I eat, and the quality of food. And home cooking doesn’t have to mean elaborate meals. Choosing one or two recipes a week keeps things interesting, and helps keep things simple. Use herbs and spices and find homemade recipes for things like salad dressing to avoid any additional additives outside of “real” food. Once you find recipes that are easy, you can adapt them to fit your own nutritional needs and your creativity.

3. Limit refined carbohydrates.

Actually, really just leave these out. I’m not an “everything in moderation” advocate. For most bariatric patients, refined carbohydrates is what got us into this mess.  Sugar, flour, rice, pasta and the like. There are some people who can work these back into their diets, but I know how easy it can be to go back to old habits. My recommendation is to steer clear of processed foods and find whole food alternatives to your favorites. Bariatric Eating is a great resource for recipes to help keep those cravings at bay.

I have been experimenting with whole grains, like millet, quinoa, and freekah. I find that I can use them as a condiment. I will add a tablespoon or two to a salad to provide some density and add fiber and protein. It’s satisfying enough, but doesn’t trigger any cravings for me. I am intentionally avoiding food like edamame or chick pea pasta, because I know if will be a trigger for me. I am a realist, and I see how quickly I can gain weight if not following the bariatric diet recommendations. I don’t want to be that person who gained all their weight back and more after gastric bypass.  I’ve just worked too hard for that. Everyone needs to find their own tolerance level.

4. Maintain consistent eating times and try not to skip meals

One of the most important things for me was to create a schedule/routine for myself around my meals. On a typical workday, I do a protein shake before my workouts, eat a small mid morning meal when I get to work, walk at lunchtime and then have a small lunch at 1ish, eat dinner around 6 and then have a shake before bed, or have my shake as a mid afternoon snack. This has worked well for me once I met my goal weight. I’m currently a few pounds higher than my goal weight which I attribute to being a limited activity, so I am reducing the number of snacks I have and really focusing on nutrient dense and lower calorie meals.  It’s HARD, but sticking with the routine helps me from getting too far off the rails.

5. Balance your plate

I have always tried to have a good balance of protein, carbs and fat at each meal, but the fat typically comes from healthy sources like nuts and seeds, avocado, or olive oil. Carbs are never simple carbs – they are typically vegetables or fruit, and I stick with he lower glycemic fruit like melon and berries per bariatric recommendations. I do my food prep and thinking about variety and creating balanced meals. Very often food prep for me is just making sure everything is washed and chopped and ready to go for mix/match salads, stir fries, or snacking.

So there’s my bariatric take on the IIN clean eating recommendations. When working with clients, I stress that everyone has their individual needs and can typically figure out which foods work best for them, but I look forward with helping clients with those discoveries to encourage variety, simplicity, and health — whether they choose a plant-based approach or not.

Interested in setting up a free coaching session? Contact me and we’ll set something up. You will help me develop my coaching skills, and we can work to find some tips to help you achieve your health and fitness goals too.

 

 

 

 

 

 

Bariatric Surgery

Completing the puzzle for bariatric patients

Marilyn Clark
Adobe Spark (1)

When I was researching bariatric surgery for myself, I was initially given very little guidance from the referring doctor. Pinterest became my friend, and I discovered a few valuable resources, namely Reeger Cortell’s Weight Loss Surgery Podcast, which I recommend for anyone considering bariatric surgery and for post-surgery patients at any and every stage. I have links to a few other resources on my personal blog. I also joined a number of different Facebook “support” groups.

On these groups, you’d see questions like:

I’m six weeks out from surgery. When can I eat pizza again?

No joke. This is the one that I always cite as an example of a SMH moment. You’ve undergone major surgery, with many risks, and you’re thinking about pizza? I see people making taco shells out of cheese or pizza with wonton wrappers — basically continuing the same eating patterns that resulted in the need for surgery.

A few things about bariatric surgery: whether you choose a sleeve gastrectomy or Roux-en-Y gastric bypass, the surgery is on your stomach, not your brain. Your sleeve or bypass is just a tool and part of the equation. And it’s a very powerful tool! To some degree, the weight loss will continue over the course of 12-18 months. Some people lose with easy, while some people have to follow the dietary guidelines to a T (that’s me — more on this later). And incorporate exercise immediately post surgery. Behavior change is key. And building healthy habits needs to happen before surgery.

Some bariatric programs have amazing support. Orientations, nutrition classes, guidelines for supplementation following surgery, meetings with psychologists and nutritionists, and active support groups. It’s obvious, however, from observing the conversations in these Facebook groups that people are not researching this surgery prior to permanently altering their bodies, nor do they receive proper pre-surgery education or post-surgery follow-up. This education and support is something I see as a gap in the bariatric surgery process.

I’m one of the most fortunate patients. Not only am I a rule-follower who thrives on structure and rules, but I also had a fantastic surgeon who provided excellent guidance both before and after surgery. She teaches the nutrition classes herself, and is far more knowledgeable about nutritional needs, malabsorption, quality of supplementation, adjusting for stubborn metabolisms, and other guidance following surgery. Her practice now has a private support group ( which I’ll add that I helped start up and function as an admin), and she is actively participating in the discussion.

As a health coach, I can help close that gap by coaching from experience. I am still working on reinforcing the positive lifestyle changes required for being an obesity ass-kicker. The most important thing I have learned is that everyone has their own unique journey. People lose weight at different rates, people have difference medical co-morbidities that may change how their bodies’ metabolism functions, and people react differently to certain foods. Guidelines are just that – guidelines. Everyone has a unique prescription for unlocking their optimal health, even bariatric patients. They just need to discover what that is. I still have more discovery to do in order to hit that sweet spot, but I am enjoying what I am learning from the process.

And the answer to the question “when can I eat pizza again?” — for me, it’s never. However, the exploration of more appropriate options is all part of the fun.