Left - Fitbloggin' 2012 Right - This Week - Lost the regain - Also, 3 pounds to my lowest weight.
Several years ago, a woman messaged on a weight loss surgery forum and told me that my weight chart resembled a roller-coaster and that she wanted to "help me get control." After a quick Google search -- I noted she was seeking a new client for her weight loss surgery coaching business and dumped her "friendship."
Friends do not pay friends to help them lose weight, maintain weight loss or to help them lose regained weight after weight loss surgery. If you are paying someone for your friendship, it might be time to redefine that friendship -- just saying. I suppose this changes if your friend happens to be a weight loss professional? But how often does that happen -- and how many weight loss professionals would potentially destroy a friendship with aligning with your weight loss journey?
Um. No. A professional would NOT.
Weight loss is personal.
It is something you choose for yourself when you are ready.
Weight loss is not something you can be talked into - nor shamed into.
Regain after weight loss surgery is also a very touchy subject. Countless bariatric patients go through it -- and less want to talk about it. But it seems like everyone wants to sell "us" something to fix it.
Let me repeat -
Weight loss is personal.
It is something you choose for yourself when you are ready.
Weight loss is not something you can be talked into - nor shamed into.
Yet it seems like the larger community wants "us" (the regainers) to feel shamed for regaining and wants to sell us another quick-fix.
Let us discuss: Regain is common. How much? Some is very typical. Sometimes even a lot of regain is normal. You do not have to be sold into another diet, quick-fix, or scam. You need to remind yourself why you had weight loss surgery to begin with --
When I post this image, it's a big deal for me. This indicates that Beth Has Been On The Treadmill For An Hour Almost Every Day 9/10 Days. I also don't typically chart my activity unless I do something on purpose so - this is "doing something on purpose."
I am trying to make a habit -- to create a new habit -- to learn to enjoy exercise before I develop complete loathing for it. Because it isn't that I hate exercise, I don't. I just don't enjoy many of same things that others LIKE to do and I am not cut out for a lot of the things that many of you might enjoy.
For example - I will never be a long distance outdoor runner. It just won't happen. I can't run outdoors, unsupervised. Why? I am an uncontolled epileptic and likely to dash into traffic. I can't swim alone for the same reason, nor can my kids. I can't kayak. I can't use a bike. Nor can I take my kids on bike rides. Yeah, yeah. It sucks. Whine whine. LOL.
I CAN walk briskly on a treadmill with a safety clip on - with people around me. (10 times, 10 hours. 3/5-4 miles each. I haven't fallen.)
Nobody needs to know I am a high-fall risk. (Even though I am.) I take two medications that cause "dizziness" and "sleepiness" among other things.
I CAN walk with the family away from the road, in the woods, trails, etc. I can hula hoop. I can roller skate! (I just did.) I can take classes at the gym when I can GET there. I've been lying to myself about all the "can'ts."
I am approximately five pounds above my very lowest post op weight, which I saw one year post op before I got pregnant and right before I bounced up to 175 lbs. I will say this, my lower weight looks different the second time around. That first low-weight crash post surgery looks like death-warmed over. I look healthier now, and I think it's honestly because I eat food now and haven't had a massive weight loss like in 2004.
People have asked me "What are you doing differently now?"
Food journaling and keeping myself aware of the calories I take in. I don't journal everyday, but I DO journal.
I stopped using soy milk, and swapped to unsweetened almond milk in my coffee and for whatever other "milk" uses I have. I don't use dairy milk at all.
I quit my Starbucks habit pretty much altogether. I get an iced coffee or cappuccino if someone else takes ME out for coffee, but it's rare, and definitely less than once a week. Dunkin Donuts iced coffee, once a week.
No crackers. If I must, one serving, with protein.
No potato chips, etc.
No candy, only super dark 70%+ chocolate if I must have something. One serving.
No protein bars, except to review them, unless I am REPLACING A MEAL with one.
No protein shakes, except to review them, unless I am REPLACING A MEAL with one.
This isn't "new" - but zero alcohol in my house. It's just a rule. If it's not here, I can't have it. It's just the rule.
If there's one thing I have learned this year - it's that I can't graze without noting. I can't just nibble all day long and expect that I won't see gains, because I do. I gain very fast on relatively low calories.
I have also learned that giving up things I can't control - stressors - outside influences - people, even - helps. I started losing the weight as soon as I made this connection.
Look at my weight loss timeline. Look at the dates.
Now look at my regain photos from the last year - same timing.
Seems easy enough, right?
Let. it. go.
“You will find that it is necessary to let things go; simply for the reason that they are heavy. So let them go, let go of them. I tie no weights to my ankles.” ― C. JoyBell C.
People CAN be TOXIC to your HEALTH. Let. them. go.
(*Not the ones in this photo. LOL. But, I am also 25 lbs lighter SINCE these photos and the timeline. It's a visual.)
I'm not a shopper. Since I work from home, I rarely get new clothes.
The other day I noticed that New York + Co had a 50% off everything sale and went in. The saleswoman said to me, "You look like you'd rather be anywhere but here."
I told her that I am not fan of clothes shopping, and she called me "Cute," and "Small."
I laughed, and realized soon why I have so much dismay for clothes shopping. THE FITTING ROOM. THE LIGHTS.
THE VARICOSE VEINS. I have the legs of an 80 year old woman.
It's not about SIZES or the number on my scale, because I am nearly to my lowest weight. I reached my lowest weight just after one year post op, I hit 149 pounds for one day and regained immediately.
I am 156 pounds today.
I still don't like the melted candle puddle of skin that I have -- nine years later. Full honesty, I am FINE with it once I am wearing appropriate undergarments and everything is in it's place, but even in a size 8P (I also bought a pair of 6P) - sometimes you feel like a puddle of flesh.
"Workplace wellness incentive programs are not a new phenomenon, but the Internet is in turmoil today over a recent announcement by the national drugstore chain CVS. Beginning in May, CVS will require employees on the company’s insurance plan to undergo health testing—including body mass indexing and blood glucose testing—or face a $600 annual penalty.
The company’s rationale? Coercing employees to submit to health testing will provide incentive for workers to get—and stay—in shape. Employees’ health information will not be accessible to the company itself, but rather to a third party responsible for administering company insurance benefits. Reportedly, with the advent of Obamacare and rising healthcare costs, practices like this threaten to become more commonplace in the corporate environment.
Attention everyone, everywhere. If you’ve been struggling for years to get in shape, whatever that means to you, you can just quit whatever it is you’re doing right now because CVS has got it all figured out. It turns out whatever silliness you were attempting, you just didn’t have the proper incentive. Except, as it happens, this regimen already exists and it’s called humiliation and fat-shaming. Have someone tell you you’re overweight, or pay a major fine.
Then there’s the next major issue. CVS, which really should by keyed in to the latest, or at the very least some,health news, ought to know Body Mass Index (BMI) is by no means an accurate indicator of health. As Keith Devlin over at NPR pointed out back in 2009, there are at least 10 good reasons BMI is entirely bogus, not the least of which is it hinges on the notion of the “average man.”
Gastric bypass surgery is something of a medical marvel. In Roux-en-Y surgery, a small pouch is made from part of your stomach, building a new, smaller one. The pouch is then connected to the middle portion of the small intestine (the jejunum), bypassing the upper part (the duodenum). Because your new stomach is about 90% smaller than your old one, you feel full with much smaller amounts of food and take in many fewer calories. Another popular smaller-stomach operation is adjustable gastric band surgery, in which an inflatable silicone device is placed around the top of the stomach.
In all, the American Society for Metabolic and Bariatric Surgery estimates that approximately 200,000 people have bariatric surgery every year. The Roux-en-Y operation generally costs between $15,000 and $30,000; the band is cheaper by about $10,000. Many private insurance policies offer no coverage for what they consider an elective procedure.
There have been previous reports of bariatric surgery patients having serious trouble with alcohol use after their surgeries. A 2012 Archives of Surgery study by the New York Obesity Nutrition Research Center looked at 100 people who had Roux-en-Y and 55 who had the adjustable band. The post-op patients were significantly more likely than the general population to use addictive substances, especially two years after the procedures. The Roux-en-Y cohort seemed particularly susceptible to alcohol use.
If food has always been your drug, and surgery abruptly denies you your fix, you turn to other drugs.
A much larger 2012 study in the Journal of the American Medical Association came to a similar conclusion. University of Pittsburgh researchers followed almost 2,000 people who had Roux-en-Y, adjustable band or another weight-loss surgery. Before their operations, 7.6% of the group abused alcohol; after the knife, 9.6% did so. And, the patients who had the Roux-en-Y surgery were twice as likely to abuse alcohol as those who had the gastric band.
Health experts have long known that obesity and depression often go hand-in-hand. Depression can lead to becoming obese, and the opposite is also true. Many obese people are depressed before they have surgery and are therefore at high risk of depression afterward. For one thing, recovery is a slow process, and health complications of the surgery are very common; 40% of patients suffer from infection and post-operative bleeding. Perhaps more important, bariatric surgery is no magic bullet, and some patients become disillusioned as they realize that in order to "solve" their serious weight problems, they have to maintain good eating and exercise habits—lifestyle changes that likely proved elusive in the past.
Addiction experts see the problem as one of switching addictions. People become obese because they use eating as a drug. Excessive eating is a form of self-medication for painful feelings associated with depression, anxiety and deeper personality disorders. Like most drugs, food, especially carbs and sugars, trigger the brain's reward pathways, causing a feeling of pleasure. But sustained excessive eating causes the brain to lose its capacity to produce these feel-good chemicals. That's whenaddiction starts.
Weight-loss surgery fixes the outside of a person, but not the inside. While it can reduce the harm of obesity, it leaves the needs driving your addiction untouched. So if food has always been your drug, and stomach-minimizing surgery abruptly denies you your fix, you turn to other drugs. Alcohol, being legal, is the most available, but patients can take their pick among the panoply of addictive substances.
Hogwash, says John Morton, MD, a bariatric surgeon at the Stanford School of Medicine and member of the executive council of the American Society for Metabolic and Bariatric Surgery. Like many other surgeons who specialize in this procedure, he favors a physical rather than a psychological or switching-addiction explanation for the high risk of alcohol abuse. "[There is a] heightened sensitivity to alcohol [and it is] purely physiologic," Morton says. Along with the liver, the stomach produces alcohol dehydrogenase, an enzyme that breaks down alcohol into other, less toxic molecules. Because gastric bypass patients have much less stomach, and therefore less of that enzyme, more alcohol enters their bloodstream.
"As a result," Morton says, "you get drunker faster and stay drunker longer." The same phenomenon occurs with people who have their stomachs removed because of cancer. If alcohol abuse in bariatric patients were due to psychological issues, you wouldn't expect cancer patients to have greater alcohol sensitivity, Morton argues.
Mitch Roslin, MD, a specialist in bariatric medicine at New York's Lenox Hill Hospital, agrees. He calls the switching-addictions theory "BS.” Drinking alcohol in your post-Roux-en-Y life is "the epitome of drinking on an empty stomach"—after all, your stomach is almost nonexistent. "Essentially," Roslin says, "drinking alcohol after Roux-en-Y is like having an alcohol IV."
"Essentially, drinking alcohol after Roux-en-Y is like having an alcohol IV," Roslin says.
But why does alcohol sensitivity show up more in the second year after the surgery? Roslin suggests that the second year is when you realize that your surgery will not, by itself, keep you healthy, that you do indeed have to "fix the inside." At that point, you might feel depressed, use alcohol to escape and comply less with your post-op instructions.
Morton’s and Roslin’s explanations may account for why people who have had gastric bypasses can get a buzz by drinking a small amount of alcohol, but they don't quite explain why some people who never abused booze before end up becoming post-op alcoholics. Nor do they account for another, even more serious, health risk for people who have had gastric bypasses: suicide.
Two recent studies—in Pennsylvania and Utah—reinforce the link between obesity and emotional distress by focusing on suicide rates. A study of 17,000 weight-loss surgeries performed in Pennsylvania from 1995 to 2004 showed a surprisingly high incidence of suicide. Of the 440 deaths that occurred, 16 resulted from suicide or drug overdose; by comparison, the rate for the general population is only three. And this August, a study published in The New England Journal of Medicineshowed that a group of almost 10,000 bariatric patients had a 58% higher than average risk of dying in an accident or suicide. When the bariatric patients' suicide rate was compared to that of obese people who had not had surgery, it was close to double, 11.1 per 10,000 compared to 6.4 per 10,000.
When the high risk of suicide is coupled with the high risk of alcohol abuse, a psychological, if not a switching-addiction, explanation is almost inescapable. Patients may be aware of these risks, but the need for the surgery overrides such concerns. While prospective patients often undergo psychological evaluations before the procedure, doctors often do not follow up with the patients and patients often do not participate in post-surgery counseling. The addiction to food is typically viewed as more or less having been "treated" by the gastric bypass. The danger of developing a new addiction remains low on the list of health priorities.
There is no denying the benefits of bariatric surgery. Without it, many people struggling with obesity would be doomed to lives burdened with diabetes, heart disease, mobility problems and high risk of stroke and early death. At the same time, it's clear that the surgery's benefits would be increased by improved screening of patients for mental health problems—and addiction—before surgery as well as deeper, longer counseling afterward. This may mean fewer people will be eligible for the surgery—a prospect that neither doctors nor patients would embrace. At the very least, reframing how patients understand the surgery is in order: It is not a magic bullet but one in a serious of interventions that are, like it or not, lifelong.