Off the Plate Obesity

Regain is real and stigma may have something to do with it.

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.

Obesity

I’m getting totally hormonal

June 2, 2019August 16, 2019 Marilyn Clark

Really, it’s not what you think. Well, maybe it is. But the point here is that I’ve been studying Hormone Health through Institute for Integrative Nutrition and it’s been fascinating. It’s pretty amazing how the endocrine system works to keep everything in balance, but if one things gets out of balance, it has a big impact on the rest of the body.

So why hormones? Why now?

My focus as a nutrition and lifestyle coach has been helping women take control of their health optimizing nutrient balance and lifestyle changes. Every client is different, so the approach is different and tailored to specific goals. The common theme is hormones. Stress and sleep impact cortisol and adrenaline levels which can then impact the metabolism and cause weight gain. Thyroid hormone imbalances are common amongst my clients, and that impacts weight management as well. In today’s busy life, stress has become the norm, as have late nights, early mornings meals on-the-go, and work taking over as the number one priority.

How do I get started?

First, you need to take a good hard look at your nutrition and lifestyle. Are you choosing a lot of processed foods, quick meals on the run, or eating out a lot? Do you exercise? How’s your sleep? The quality of food, your activity levels, and your sleep habits all factor in to your hormone balancing act.

Are you feeling tired and worn out? Are you constantly fatigued? Are you having mood swings? Are you suffering from depression and anxiety? Are you putting on weight even though you’re on a restrictive diet? These may be signs of a hormone imbalance.

Over the next several months I will be rolling out some programs to help guide you with nutrition and lifestyle tips to restore balance to your body. Reach out if there’s something specific you have questions about.

Bariatric Surgery, Obesity

Bad Breakup: Why I am letting go of diet culture

February 27, 2018 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, Obesity, Uncategorized

Clean Eating: Bariatric Style

September 3, 2017 Marilyn Clark

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:

Keep It Whole
Experiment with Home Cooking
Limit Refined Carbohydrates
Maintain Consistent Eating Times and Try Not to Skip Meals
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:

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.

Obesity

Battling Weight Bias When You are Battling Obesity

June 1, 2017 Marilyn Clark

I call myself an obesity ass-kicker because it’s a battle I’ve fought for more than 30 years. And I’m winning! But the process isn’t easy, and along the way I have experienced weight bias by the very people who are supposed to help us achieve health: doctors!

Look at the state of health in our country. According to a recent New York Times article, one in every three people is obese. I can’t even imagine how much money is spent treating obesity-related diseases. That’s what doctors are trained to do. Treat diseases.

Raise your hand if you’ve been told by a doctor you need to exercise more and eat less. I know I have. Countless times. It took me years to get someone to actually look at me as a whole person and try to connect the dots between obesity, thyroid issues, a pituitary tumor, and the inability to lose weight, in spite of the 1200 calorie a day diet. Just treat the symptom and there’s no need to investigate the root cause.

That’s why it’s more important than ever to empower yourself to be your own advocate through the healthcare system. I’ll have a story on that in the future.

The driver for this post is this article shared by the Obesity Action Coalition, Barriers to Obesity Care and How to Create a Support Team. I react when I read that someone isn’t being offered the best medical options because of their weight. As an overweight person with knee pain, I was told it’s arthritis and there’s nothing to be done and I should stop running. Oh, and lose weight. That’s it. No guidance, no alternatives, nothing. I’ve been there.

However, I have also been lucky to have physicians who advocated for me, helped empower me to make decisions that led me to a healthy weight, helped me work with the insurance company to appeal bariatric surgery denial, and get me to a bariatric surgeon who understands the science of obesity and the challenges for someone who has struggled their entire lives and fighting an uphill battle against their metabolism and co-morbidities.

It takes work to build a support team, to research so you know how to ask the right questions, to understand not just “diet” but nutrition and lifestyle changes needed to be successful, and to navigate the complexities of insurance and the healthcare system. This gives me hope that the rise of holistic health coaching can be a compliment to medical care for people like me who battled obesity. There’s some great suggestions in this article about how to put together a medical team for support, but kicking obesity’s ass requires so much more support. I was fortunate to have a mentor through my weight loss process — another bariatric patient who could answer questions or tell me what to expect, cheer me on, or kick me in the butt when I needed it. That emotional support really completed the picture for me and launched me on this journey to becoming a health coach.

Category: Obesity

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