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.

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.

Bariatric Surgery, Obesity

Bad Breakup: Why I am letting go of diet culture

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.