By Louise Petrou CBC, Mid North Coast Bariatric & Hernia Centre

People like you do not explore Bariatric Surgery because they want to go on another diet, or spend another few hundred on a pyramid scheme with ‘reportedly’ the best diet shakes or spend another $300 on 3 hours per night at the gym or spend sleepless nights worrying how you will afford two plane seats to visit your sister.

People come because they are desperate and sick of the rollercoaster that is ‘obesity’ the disease.

When someone has tried everything: succeeded losing weight, regained weight, succeeded, regained weight, succeeded, regained weight – they may  start to feel dejected as if they are just a failure – hopeless and helpless. Others will just accept ‘this is my lot in life’ or ‘I’m the jolly fat person’, though this will be laced with shame. Shame is debilitating and invites shame-based behavior for the ride.

In addition to this depressing and overwhelming daily existence, they may also start to feel unwell. They may have to take medications to keep health issues under control, they may seek anti-depressant medications, and they may have developed insulin resistance – Type 2 Diabetes.

Fast forward, if the person is in the correct headspace to make real changes in the way they do things by making better food choices and by adopting some physical activity as part of everyday life, Bariatric surgery resolves many negative feelings and health issues from the moment a patient recovers from surgery.

The weight is often dropping off at a rapid pace, a person’s self-esteem will begin to improve as they receive positive feedback and gain a spring in their step. Their mood will also improve as they move more, seeking exercise after possibly years of minimal physical activity. Many patients post-op say they could never have imagined feeling this good and so full of energy.

After a while, the training wheels come off and eating smaller healthier portions may become easy as the person seeks support from our support group and feels a real sense of community. They may be lucky enough to have a great support group via family and friends. The weight loss is gradual and consistent. The best part is, it is sustained weight loss – under the conditions mentioned in paragraph 4 – aka ‘correct headspace/lifestyle changes made’.

But, and there is a But. What about life’s bad or uncomfortable days, working night shifts, receiving negative comments, getting bad news, long hours, relationship challenges, financial pressure, finding new things to be self-doubting about. What happens then?

In the past food may have been a significant source of joy or comfort. Life’s stressful triggers may have been swiftly dealt with by eating a happy hearty portion of one’s favourite food. Perhaps if it is a family related ‘trigger’, a person may cope with the trigger by an eating response associated a childhood food to comfort. Remember buying lollies at the corner store with your pocket money?

Perhaps this personal childhood power is being regained if this is what you seek when stress is triggering you to eat (on top of the sugar rush).

Another interesting trigger is a person’s history with food. Perhaps their mother was always on a diet and coped with her own weight by putting her children on a diet. Perhaps this restriction evolved into eating in secrecy with so-called ‘banned’ foods. After such secretive eating behaviours, which we can call ‘problematic’ eating, or ‘dysfunctional’ eating, a person may develop a deep sense of shame. Unlike the biscuits or Mum’s old pantry, the shame doesn’t go away. It develops in to a sense of failure on some level, what’s wrong with me?

So back to the emotionally triggered eating – just as swiftly as the food is consumed, the comfort buzz is gone and on its way to be digested. Time for a bit more! (Please see our Emotional Eating chart in Patient Resources to get a feel for what this looks like).

Now having had Bariatric surgery – say a Sleeve Gastrectomy – this person will know their capacity for large meals is lessened or if they have had a Mini Gastric Bypass for example, they will not tolerate sugary or high-fat foods well – they will make a person feel ill. But while the comforting is happening – just like before surgery – none of this will matter at that very moment.

Some people have the added burden of disruptive sleep cycles through their night shift work. Perhaps they have a newborn and are experiencing a particularly sleepless cycle. Who could be bothered preparing a healthy spread at this point? How is a person to win? In addition to stressful triggers, our society celebrates everything with food!

The first step is to explore the problematic eating. What exactly is happening? (We will explain this as if you have regained some weight after bariatric surgery as a result of some dysfunctional eating patterns).

  1. Firstly, write down a list of your achievements from the moment you started the bariatric surgery programme. Not just achievements related to the scales. Have you learnt to prepare food better? Attended to your health better? Been taken off some medications? Helped a fellow patient? Gained a new job? Been a great daughter/sister/brother/son/Dad or Mum? Travelled? Exercised regularly? Had more joy in your life?
  2. Lay it on the line – write a food diary – every day. Buy the most beautiful looking diary that is precious to you for whatever reason. This is going to be your rock. Breakfast lunch dinner functions and everything in between. While you’re there make strict shopping lists and stick to them.
  3. Do a personal brainstorm. What are your triggers and to what part of your history do they relate? This may take some time to work on or it may be as fast as a comfort feed. Everyone is different.
  4. It may be better to have professional support via a Psychologist to assist you. This is one of the most rewarding things you could do for yourself and when the light bulb goes off – a little piece of your personal puzzle is solved and bingo – a part of you is free to explore ways to manage your ‘triggers’. Psychologists have specific tools to help you to discover more of yourself and manage better. Your GP can help you with this.

We are here to help as well, maybe you just need a chat, some direction and resources from your Bariatric Surgeon or Bariatric Counselor or perhaps you’ve connected with one of our special team members – it is all part of the package when you have bariatric surgery with our clinic.

In addition to exploring your history and what may be triggering you to emotionally eat, here is some weaponry to help you at the time!

  1. List the healthy foods that you love – the ones that make you think YUM! Have those healthy items on hand, always.
  2. Eat mindfully. What this requires is some planning. What is on the menu today/tonight? When your food is in front of you appreciate and enjoy every mouthful. There is no rush. Learn to chew, savour every flavour.
  3. It is true, eat your protein first. Protein fills you up. This leaves less room for that ‘dinner roll’. Also starch begins its digestion process on our tongue. The second starch hits our tongue, enzymes trigger the digestion process sending signals to your brain that say “they’ve eaten”. This means by the time the big bowl of fried rice hits your actual tummy – you are ready for more! (Ever noticed how you feel like more more more after Chinese food? This could be your insensitivity to Leptin ‘the feeding stop button’ or it could be starch just doing its thing).
  4. Attend follow up appointments with Dr Petrou. There are real evidenced based indications from bariatric clinics worldwide that demonstrate bariatric patients do better with ongoing management with their surgical team. Those that avoid follow up and go back to the old habit of ‘its only my health’, do poorly. This is so important it should really be point number 1.
  5. Avoid grazing. This can be a completely innocent affair you have on a daily basis that becomes an emotional support without you realizing. We don’t want to make preparing food for your children a sin, although if you find yourself putting one piece in the lunch box and one in your mouth and so on, you may want to perhaps put a post it note on the kitchen bench – You are making lunch! Just a gentle personal reminder that you’ve just had breakfast – you don’t need more food in your tummy.
  6. Find what it is that you love doing for exercise, otherwise known as PA (Physical Activity). It improves your mood almost immediately, it gets you out and about, you can see and feel the benefits (and even hear them when people say, “hey you look well”). See more at the bottom of this blog.
  7. Listen to your dietitian – what are they really trying to tell you? It may seem they are just asking you or telling you the same stuff, although they are a mine of information. Don’t be afraid to speak your mind, and ask the questions that matter to you. Food = fascinating.
  8. Reach out. We are here to help. You can call, text or email even on weekends. Its time to give yourself the gift of health. What good are you to your friends/family/children/employer/future all of the above if you are unwell? There are some fantastic books and programs like the Get Back on Track programme, thousands of You Tube videos all at your disposal; we can point you in the right direction.
  9. When you have done points 1 and 2, why not come and discuss them as ‘homework’. We can do a Skype appointment if you are not based in Port Macquarie. This debrief just might keep you on track!

A bit more about exercise:

PA doesn’t just occur in gyms. Walking is a great exercise and you can get your essential Vitamin D from the sun. If you have painful joints, walking may be a turn off or turn you on to swimming or aqua aerobics.

Think about the benefits of Physical Activity:

Aerobic/endurance activities help you with vacuuming, raking leaves, pushing a child on a swing, walking up a gentle slope.

Strength training with gentle weights will help you get up from a chair, carry laundry, carry a small child, lift some bags of mulch or tend to the shopping. (this is to be attempted after a few weeks post op not day 2!)

Flexibility – gentle stretching will help when you make the bed, cut your toenails, drive safely, and feel overall wellbeing

Stability and balance exercises can help with walking up and down stairs, traversing an uneven footpath without falling, standing on tiptoe to reach the best capsicum in the fruit market!

Other benefits overall include, better mood, reduced anxiety, reduces stiffness in joints, maintains healthy bones, reduces all the nasties that can kill like Type 2 diabetes, cardiovascular diseases, stroke, cancer. Improve cognitive function and better quality of sleep just to name a few.

Perhaps you prefer the privacy of your own group – start one with some like-minded people and you will encourage each other to keep up the good work. (This is based on real patients who did this and it works!).

Another great help if you’ve had knee or mobility issues is a Physiotherapist who can design an exercise programme specifically for you! Remember many health fund plans cover these items. This is a really safe way to take care of exercise and your body at the same time. Win!

If you are worried about injury or have no clue where to start, why not spoil yourself with a personal trainer – they understand you are not planning on the Olympics yet they might just get you there!

Don’t have a health fund? Strapped for cash? Join a local community club and do something fun for exercise such as dancing or something like your surf club or bird watchers – there may be a professional in there somewhere who may help your journey in some way.

Used to love body boarding or a swim each morning in the ocean, splash about in the local river on a hot day? Used to potter in the garden? Get down there now! Find your personal joy again.

Next time our blog will focus on a patient interview. What is it really like after a Mini Gastric Bypass?