One of the things I love about being part of the team for weight loss surgery patients is the excited and the hope that each patient has prior to surgery.   On a daily basis, I speak with patients about all of the reasons why they want to have surgery and the hopes they have for a brighter, healthier future.   Despite the fact that I spend a significant amount of time talking to patients about the possible struggles that come after the surgery, most patients are gung-ho to make a go of it.   Fast forward to twelve or eighteen months after surgery, the patients I speak with are not as enthusiastic about the life changing event they made months prior.

The reality is that weight loss surgery is life changing, but a lot of the changing needs to happen after the surgery on the part of the patient.   The surgery is the first step to making lifestyle changes that need to be long lasting for continued success.  The patients I speak with during this crucial period are still happy about the surgery but are somewhat discouraged about either the plateaus or the needle on the scale moving in the wrong direction.  This is the time to get back on track.

There is no magic formula to getting back on track after the honeymoon of the initial surgery has gone.  I generally suggest to patients to go back to the beginning.   Review all of the information that you were given at the beginning of the journey.   Here is a list of things to keep in mind!

1. Don’t drink your calories.  Don’t work against yourself by taking in liquid that has no nutrition value.  This includes any coffee drinks that you might think are a great way to get the day started!  Most of the drinks at Starbucks and other popular coffee chains are filled with calories.  Of course, this does not mean protein shakes or other meal replacement liquids.  Make calories count by focusing on lean protein, fruits, and vegetables.

2. Avoid sugar. Sugar is the ultimate empty calorie.  It will make your blood sugar climb and cause cravings.  This includes hidden sugars.  Avoid foods that have sugar in the first three ingredients.  Certain foods and condiments have more sugar than you would think like ketchup for example.

3. Protein! Protein! Protein! Protein should again be your primary focus at meals.   Remember your mantra!  Protein, then vegetables, then fruit and if any room (there won’t be) then carbs.   This is probably the biggest area where patients wander after surgery.  I always ask when patients talk about hitting plateaus, “How much protein are you getting a day?”  The most common answer is, “I don’t know.”  The goal is between 60 and 100 grams of protein a day.    Protein helps you maintain your muscle mass while losing fat and it helps you feel full longer between meals.

4. Don’t snack. This seems like an obvious one; however, difficult habits die hard. This can hamper long term success. For those of you who graze or eat without thinking about it, those calories add up.  Stick to high-quality meals and avoid junk food. If you are hunger, go for a protein shake or other meal replacement.

5. Skip alcoholic drinks. Sure we tell you to avoid alcohol right after the surgery but for many people this one also creeps back into the menu.  Alcohol is full of empty calories. It also can slow your metabolism down.

6. Chew! Chew! Chew! Remember the digestive process starts as soon as you see or smell food.   Your brain needs time to process that you are eating.  Chewing your food slowly helps to process your food and tell your brain that you are full.  If you are not chewing up your food, it can also feel like it is stuck and will be harder for your stomach to digest.  Take a bite and then put your fork down allowing yourself plenty of time to chew!

7. Find a support group. Get back on track by finding a support group whether it is virtual, online, or in-person.  Studies consistently indicate that patients that utilize support—in any form—will be more successful than those who do not.  Don’t go it alone.  We are more successful as a group.  The group holds us accountable.

8. Again, this seems like a no-brainer, but we all get off track.  If you are exercising and not seeing results, maybe it is time to change things up.  Get a personal trainer or simply try something new.  Our bodies tend to get used to what we do on a regular basis.  Spice things up with interval training or add some light weights to the mix.  Remember muscle burns more than fat—so build up that muscle!

9. Stay hydrated. Drink lots of water.  Dehydration can mask itself in hunger.  Before reaching for something to eat when you perceive that you are hunger, drink some water first.   I can’t tell you how many times I talk to people post-surgery who have let their water intake decrease.

10. Find healthy coping skills. Many times people come to surgery because they have used food as a way to cope with stress.  Now is the time to find other ways to cope with stress.  It might be exercise, talking with a friend, finding a new hobby, etc.  Just find something that is going to help you with your day to day stress.

11. Schedule a follow-up appointment with your surgeon or primary care physician. After surgery, many patients only see the surgeon one time for a follow-up.  Depending on the type of surgery you had, you may need yearly blood work.  If you are vitamin deficient that might also account for some fatigue.  Checking in with your doctor is also a great way to get back on track.

12. Avoid simple carbs. Simple carbohydrates are highly processed foods such shite bread, pasta, sugar and white rice.  The rule of thumb is if it is white, it is probably a simple carb.  Try more complex carbs like brown rice or go for vegetables.

13. Eat mindfully. When you are eating, you are eating.  Focus on what you are eating.  No more eating during meetings or watching television.  If you are multitasking while eating there is a good chance that you will not stop when you are full.

14. Pick one skill to work on each day. Generally, change does not happen overnight.  Pick one skill to work on first. If you are not getting enough water, then focus on getting eight glasses a day.  Make that your goal for the day or the week. Once you have mastered that skill, move on to another one.

Start with these steps to get back on track.  If you continue to have problems with maintaining your weight loss, then it is probably time to really get serious and enlist some help of a Weight Loss Surgery coach or get back on your surgeon’s schedule for follow-ups and meeting with the team that got you started.   It is possible to get back on track.  Remember that a healthy lifestyle and maintaining your weight is a marathon and not a sprint!

Fitbit allows you to share with friends so that you can cheer each other on. It provides accountability when you let others know that you are “on track.” More than that it gives you solid, objective feedback about your activity level of the day. I sit a lot for my job. If I did not get up and move once a while, I might only have a couple of hundred steps. By tracking how many steps I take, I can make a game out of getting in more activity.

This is a great way to slowly increase your activity.

Remember!  Every step counts toward your goal of a new, healthy lifestyle!

There is a great documentary called Forks over Knives that also highlights this!  You can watch it on Amazon.

The article goes on to say that according research that just even a little bit of weight loss can be beneficial health wise.  Even as little as five to ten pounds.  That is something to keep in mind as you are on your journey!  Just a little bit can be a healthy thing.  So many times I hear patients get frustrated when they have “only lost 5 pounds.”  Five pounds is good!  It is all relative.  Five pounds lost is better than five pounds gained!  Keep that in mind.  Whatever it is going to take to make sure that you keep your mind on the right track to lose weight.  I have said it before and I will say it again–one step at a time, one day at a time, one minute at a time if necessary.

Weight loss surgery is not the easy way out.  You have to put one foot in front of the other just like any other life changing plans.   It is more than just the surgery–it is changing your lifestyle.   You can’t just have surgery and expect that your life and weight is going to change without some effort on your part.

In my experience there are actually a lot of people who have weight loss surgery who do not tell everyone.   Some people only tell their spouse.  It is not really necessary to tell everyone and their brother that you are having the surgery.  Who you decide to tell about it is really a personal choice.  I know that a lot of people do not want to be known as the weight loss surgery poster child at work or with their circle of friends.   You really do not have to tell anyone.  It is a medical procedure and really it is none of anyone’s business but your own.

With the lap band, you lose weight more gradually so really there is no reason to tell a lot of people.  You can simple tell people that you are eating better and exercising, which is hopefully, really true.  The procedure is usually only about thirty to forty-five minutes.  You can just tell your work that you need the day off for some doctor’s appointments.  With the gastric bypass and sleeve, there is more recovery time involved.  Therefore, patients sometimes feel the need to tell more people.  Again, you can if you want but you don’t have to tell anyone, only unless you feel comfortable.

Of course, there are people who do want to tell everyone about their surgery.  This is also acceptable.  It is completely up to you.   No one needs to know anything about it unless you want them to know.  You can make your journey as private or as public as you want.

No matter what you decide, remember to take advantage of the support that your surgeon’s office offers.   This is the most important, especially if you do not tell people.  You want to make sure that you have some people in your corner when the going gets rough!

Remember using all avenues of support is the best way to continue with your ongoing weight loss success. If you don’t attend a live support group, make sure that you are getting support from somewhere. It might be as easy as hooking up with someone via email or text.

See you Thursday!

The same thing goes for your success with weight loss surgery. Hold yourself accountable to someone else. You can do this in a number of ways. You can find a support group to attend. There are a number of support groups that you can find on the internet close to you. Many times you can go to a support group at a facility even though you didn’t have surgery there. Getting involved with a group allows you to get back on track and stay focused on your goals for the week. Even if you just go and not talk (although I do encourage participation!)

Another way to get support is simply with your doctor’s office. Particularly those of you who have had the lap band. Schedule regular follow-up appointments even if you are not going to get a fill. If you had the gastric bypass or the gastric sleeve, schedule appointments and regular follow-ups to have your blood drawn to make sure that you are getting all of the nutrients that you need. This is a good check-in point for you. Schedule the appointments several months ahead of time so they are on your calendar.

Get a virtual buddy. There are a lot of people who have had the surgery that have access to email, texts, twitter or other social media outlets. Find someone you connected with and email that person on a regular basis to go over how you are doing with the diet and exercise plan. Make a deal with a fellow weight loss surgery patient that the two of you or more are going to be each others’ “surgery buddy.” If you are having trouble finding someone who fits the bill for this, you can ask your surgeon’s office to hook you up with someone.

Utilize some of the websites like http://www.lapband.com http://www.obesityhelp.com and others to get information or post your own information. Make one of those websites your home page on your browser. That way every time you get online you are reminded about sticking to your program.

Get your family involved. Ok. So this one might be hard especially if your family was less than helpful during the initial surgery process. However, you can be the catalyst to get your family moving in the right healthy direction. Get your kids moving with you by taking walks. Make healthier meals. Educate your family on nutrition content.

There are so many ways that you can get involved in the weight loss surgery community and find someone to help you through this process. Again, studies show that if people use support during their weight loss they are going to be more successful. This is one of the reasons why this question is asked during the psychological pre-operative evaluation. Use the resources that your surgeon’s office offers. Use the web. Get to a support group. I think you will find that every little bit helps!

Take time for yourself. Take at least enough time to have a meal! That is not too much to ask! Eat slowly and chew your food. Enjoy your food.

Ok. I know this is short and sweet but this is for all of you who don’t chew and are still struggling! Just a friendly reminder from your favorite psychologist!