Thursday, June 21, 2012

Invincible Thinking

I'm sure we all wished we had super powers at some point in our lives where we felt out of control or we wanted to know what was going to happen. While the daydream of not being susceptible to ordinary recourse, reality is that we must be accountable in our daily lives, be it to our bodies in the form of calories, fat, sugar, carbohydrates, alcohol ingested, to our families, to our job and careers, but most of all, to ourselves.

Sometimes, the hardest person to tell the truth to is you.  The blinders go up, the problem is ignored and those few pounds, as some point, become 20, 30, 50, 100 or more.  How is it we came to this point where we lost accountability, lost sight, ignored a problem for so long that it became an epidemic?  There are many reasons I could postulate on how the media and government have encouraged an obesity epidemic, but truth be told, the responsibility lies within each of us. At some point, the choice was ours to continue to do things we new were not helping. 

Invincible thinking is often associated with severe psychiatric disorders, but anyone who has played video games has engaged in the idea that it would be pretty cool to have the ability to fly, x-ray vision, 9 lives... Do we engage in invincible thinking to perpetuate our obesity? Are we expecting that 5,000 calorie meal to not become fat on our bodies? Do we selectively ignore the calorie latent meal or do we eat in ignorance to the content of our meals?  Or is it a combination of both? 

And then there's alcohol.  Let me draw the picture for you.  I'll speak to the post ops of Gastric By-Pass and Vertical Sleeve surgeries first, these are the most commonly done that change the integral functionality of your organs. (While this information does apply to LapBand as well, the process of absorption of alcohol is not compromised, essentially your body stays the same, you don't get drunk as fast as someone with the former procedures because the stomach changed, just the amount the stomach can hold at one time. However, the same applies here...) As obese and formerly obese people, we are more susceptible to cirrhosis of the liver due to fatty liver disease or over-working of the liver from having processed large amounts of fatty foods over years of fat accumulation. When you add alcohol into the mix, time speeds up, processing of the alcohol must occur more quickly, and BOOM, there's a blackout. 

Kidney functioning becomes more impaired more quickly because the body is absorbing the alcohol at a faster rate. It's like your body on speed, moving quickly through those liquid libations and aging your liver and kidney much more quickly than the ordinary person.

Now, the real question is why is it that someone rarely or never drank before weight loss surgery would suddenly become a drinker?  Consider the changes occurring in self concept.  A formerly obese, shy person suddenly is receiving attention, positive praise and attraction from their preferred or the opposite sex.  The need to communicate but the anxiety of communication is easier with a few drinks. It's simple, alcohol makes coping with reality easier.  It makes you feel good.  It's a drug that aids in one's ability to deal with inhibition.

The trouble with that is if you aren't in control and the alcohol is, who knows what could happen.  The invincible thinking may start with the first sip, and the last sip may not be remembered until you wake up in the ditch. And by ditch, I mean an actual ditch, a hideous hangover, or worse, in the hospital waking up days later, not know what exactly happened. (This is not a person account but rather, a worse case scenario.)

Scary stuff. Again, I can't speak from personal experience.  Alcohol is not something I have struggled with pre or post op.  The moment I realized if I drank alcohol I could eat whatever I wanted as a post-op, I got scared. When I spoke to my surgeon about this, I got an answer that I refused, his mistake to tell a mental health counselor that it's okay to have a few drinks.... tsk. tsk.  There has to be an explanation as to why he would tell me it's okay to drink, because it my mind it's not okay to drink excessively or to the point where I am not in control.

I won't say I never, ever drink.  I never, ever drink more than one drink, and I drink less than once a month.  I can not drink red wine, the acid reflux is awful enough, and the rare occasion I drink white wine it is only one glass.  Recently, while celebrating my friend's birthday we met a very generous friend visiting from California who made it his job to buy a round of shots about every half hour.  It took a heck of a lot of convincing for me to continually refuse shots.  I would excuse myself from the pool when I saw him coming just so I didn't have to have the discussion again.  Drinkers can be pushy.

You have to develop a strong sense of self and purpose to continually refuse alcohol when you see others having a good time and enjoying themselves.  It's hard, but I continually told myself it was worth it.  We must learn to do this with food as well.  There is always something else you could be doing than grazing mindlessly on food. The empowerment comes from knowing that I was doing something good for myself.  The encouragement that you're making the right decision has to come from within.  The support won't always be there, standing up for ourselves or learning to take ourselves out of the situation of temptation is essential.  If you know you can't refuse, then make the right choice for you. Living in The Big Easy, I realized very early on that temptation would always be there, so I had to be the one in control.

So, next time you feel invincible... realize you're only invincible if you can remember what you're doing, when you're doing it. *Avoid Food Amnesia* The moment you choose to eat, drink (or smoke, or engage in casual sex or whatever your vice is), engage the stop button.  Ask yourself what's the worst think that could happen?  Are you willing to take that risk? Are you in a safe environment?

What's the benefit of this action? What's the worst thing that could happen? 

Tuesday, June 12, 2012

Pre-Surgical Assessment Disparities

It has come to my attention that there is a HUGE disparity in the pre-surgical psychological assessment requirements. I have heard stories of surgeons not requiring it at all, mostly in the case of self pay patients. I can't argue this one, as I was self pay and all my surgeon asked was that I write out my case history to represent all my attempts in the past at dieting and my therapeutic intervention history. However, in the event that an insurance company requires psychological assessment, there seems to be no formal, professionally accepted standard of assessment. Some patients report having to fill out a brief questionnaire, while others report 2-3 hours of personality assessment and interview with a psychologist.

Why is this harmful to the future outcomes of bariatric surgery patients?  Glad you asked.  There are certain indicators that may show a patient is susceptible to regain.  Past dieting history is the number one most important factor indicating success - if a person has not shown they can stick to a strict diet for at least 30 days at a time, that's a red flag no clinician should be willing to ignore. However, when you don't thoroughly assess for Axis II (better known as personality disorders) you discount the potential for deceptive factors of a client's character.

I know, I know... people don't lie to their therapists. Yes, sure they don't. Everyone wants the help of a trained therapist and everyone is willing to cooperate.  I know this to be a fallacy. Every day, I can tell you that my clients try to pull a fast one on me, they aren't committed to therapy for one reason or another because telling the truth makes them vulnerable.  In the instance of pre-qualification for surgery, patients are more worried about not being approved and they will hide what they think *might* disqualify them.

Honestly, the only thing that I've ever heard a clinician say would disqualify someone for surgery was a psychotic disorder, where the patient was unable to make good judgments on their own and could not be trusted to follow the post-op requirements due to their lack of mental capacity. All other instances have resulted in the clinician recommending a certain amount of counseling prior to surgery. Some clients will comply with this gladly, others will resist and even choose not to have surgery to avoid having to talk about the underlying problems contributing to their weight gain.

All I can say about the latter is that the person is doing a disservice to themselves by not taking the recommendation to seek more therapy prior to surgery. The weight loss journey after surgery is a totally different experience than just plain dieting and sticking to a diet. The weight loss journey after surgery is not an option. It's necessary, it's not a choice, it's a way of life. It is what it is, you have to commit to taking care of yourself all the time, not just when you feel like doing the right thing. The result of failure to follow doctor's orders puts a patient at risk... of death.  I am not trying to be the whistle blowing alarmist, but there is still risk involved when you have invasive surgery to change your stomach, guts and intestines.

Of course you can choose to do what you know what you're not suppose to do. We all have "free will." However, in the long run, it will catch up to you. We can't hide from our problems forever. They will manifest in some way, shape or form in areas of life that may be unrelated to affected area.

So, what do I propose?  I propose standardization of the basic psychological assessment process. There are a few very good tools that can be administered in a 2-3 hour time frame, including time for clinical interview and assessment feedback. The Beck Depression Inventory, The MMPI (Minnesota Multiphasic Personality Inventory), the EAT-26, which is available online and more focused on the Anorexia and Bulimia perspective but still provides a thorough assessment and is clinically useful, as well as the ACORN assessment. While this is just a baseline of what should be examined, it is my belief that these tools, intake interview, and intervention should all be utilized before going under the knife.

I welcome your thoughts and experience on this matter... 

Monday, June 4, 2012

Drama is so passé...

Arrogance is a fuel that feeds a nasty fire.  We are all vulnerable creatures, we all have feelings, and we all make mistakes. It shouldn't be about measuring up to others, but setting the standard for yourself. Some will choose an unhealthy standard that will be shared and spread like wild fire. Some will gain an understanding that their words are hurtful to others, and realize that their impact has viral, negative effects on others. Sensor what you share with the world.

The one thing I have to constantly be concerned about in the mental health profession is my professional liability. If you choose to have a YouTube Channel and share your experience, consider how healthy your message is and how it will influence others. Be responsible about what you say. Don't hate. Don't perpetuate negativity. Don't call people names.

If you read through my blog, you will understand that I have no financial investments in putting myself out there on the internet. I respect those who are honest about their intentions. I respect those who share information with others to help them in a positive way. I respect that each and every one of us has freedom of speech, BUT with FREEDOM comes RESPONSIBILITY.

To those of you who find this vlog and want the help I offer, please email me at  I can not practice outside of the state of Louisiana, but I will find a local professional in your area who has experience with the bariatric community and understands the impact of obesity, can provide size acceptance and motivation to help you find the change you need.

You don't deserve to be bullied by your peers. You don't deserve to hear negative messages (especially not from strangers.) You do deserve to be accepted where you are and understood by those whom you choose to share your journey. What you are willing to change and how you go about changing it is up to you. Don't subscribe to unrealistic standards, ideals and misinterpretations of healthy living. Your balance is not my balance and everyone's balance will eventually be adjusted, changed and rethought throughout our journey. Be realistic, mindful and considerate of other's individual journey, their place in this world and the opportunity you have to be a positive force without hurting them.

We've all experienced a lot of hurt having been an obese people. I do not know one obese or formally obese person who was never called a name. There is a girl from high school who nicknamed me "Jambalaya" which was hurtful to me at the time, but ya know what, she's a friend on Facebook now and I don't judge her for being a bullying teenager because I'd like to believe she's grown out of that type of behavior. I don't know for sure, but I would never confront her on this because it's been 20 years, and I'm better than that. I'm over it. I find it amusing now.

What I don't find amusing is Hatred, Bullying, Name Calling, and directed Negativity toward your peers (or anyone, for that matter.) It serves no purpose, it makes people feel like crap, and it causes drama. Don't we all have issues we could identify we need to work on rather than creating new ones for others?

I'm off my soapbox. I'm done with these issues.
Please, people. Be Socially Responsible, Be Genuine, and Understand your Influence and Impact. Or get off the internet and get a life.

And learn how to spell something if you supposedly have a degree in it.

Sunday, June 3, 2012

Starvation Justification

Recently, I had a colleague feel the need to justify her eating habits to me.  Naturally, I did my best to listen to her and reflect her feelings about her food choices, but I did not comment on solutions or what I thought about these patterns she disclosed to me.  I find it best to not get into deep discussion with colleagues about such specific issues they have with food because it is not a therapeutic invention, no, not an admission to another professional that you aren't taking the care of your body that you know you should.

The issues discussed and the issue I have had to deal with my most in my personal life is starvation.  I don't mean days of starvation but hours into half days of just ignoring the the fact that I need to fuel my body.  This is something I believe lead my path to obese life. From age 7 to age 30, I rarely ate upon rising. Between 7 and 20, 75% of the time, I neglected my body for the first 6-8 hours of the day by not eating.  I wouldn't eat at school, I wouldn't get up early enough before school to think about food, and I definitely wasn't eating at school.

I was ashamed to eat.  Cognitively, I felt like "well, if I don't eat, they can't say my eating is making me fat." Fat luck justifying that, when I would binge eat in the afternoons because I was starving. It was never healthy stuff in high school either. It was, honestly, gross stuff like Doritos and Spaghetti-O's or cookies and cream ice cream, or Snickers bars.  Stuff I wouldn't imagine eating now, but back then, it was what I wanted. I've come a long way when it comes to "what I want to eat." I've reframed my brain to crave cucumbers and pickles and Quest bars. But back then, I told myself I didn't like the healthy stuff.

Early post-surgery, I complained that I couldn't eat early in the day. I would refuse to drink even a protein shake until at least 10am. My resistance was high because I felt how tight my stoma was in the mornings. I aggressively got fills in my band because I wanted the weight to come off NOW. That got me into trouble in the long run, but now with an empty band and the emotional wellness to say, "This is what I need to eat, when I need to eat it," I'm doing things right, making the good choices for maintenance will always take effort.

Refusing to starve myself takes planning. You won't find me caught dead without a backup meal. Be it a mix a meal soup, pre-measured protein shake in my blender bottle, or protein bar, I am never without something that will curb my hunger and refuel my body. It took me a long time to realize I couldn't ignore myself, ever. Even those of us who understand the in's and out's of the psychology of it all experience resistance.  This addiction is unlike any other, the need to feed will always be there.

The need to plan for fueling is necessary. My doctor has preached to me that "you should be eating solid foods, not shakes" but shakes work for me on the go. They keep me in line. They provide the protein, and they work. So, I don't buy that need to have solid foods at every meal, ticket. I have a need to do what works for my lifestyle and my day. Understanding my typical day is difficult for most people, even my significant other. I'm in my car, at schools, at client's homes, at my office (for very brief periods), stopping at CVS or Walgreens to use the bathroom because my office is my car. It's hectic. I long for the days when I have a clinical setting that isn't constantly revolving. It's coming, soon, but until then, I need to do what works for my hectic schedule.  I'm fine with protein shakes, heck, I LIKE THEM.

So, find what works.  Starvation does not.  It's essential to eat or drink your nutrients within the first 1-2 hours of rising. Take in at least 100-150 calories, it gets your body ready and your brain in motion. It's for the best, really!

Saturday, June 2, 2012

What is Normal Eating?

Normal eating behavior, to me, sounds like something far fetched, unrealistic and rarely done.  Honestly, when I hear the term "normal eating" I wonder what exactly is normal when more and more of our population is becoming obese. However, if we deconstruct the meaning behind "normal eating" we uncover what should actually be termed "acceptable eating" and "eating for wellness" rather than "normal eating."  If we were to consider the "norm" here, we would be looking at most American's habit of fast food or dining out at least 3-5 times a week.

Acceptable eating behaviors after weight loss surgery means: 1) Always making healthy food choices and 2) Monitoring the volume and quality of food you eat.  Healthy food choices after bariatric surgery is always being mindful of and minimizing the number of carbohydrates and sugars you take in while maximizing the amount of protein and fiber. While you may eventually be able to "get away with" eating foods from your former life, make it your practice to choose lean protein and low carbohydrate foods at least 90% of the time. When you rebuild that tolerance of sugars and carbs to be the norm again, you are putting yourself at risk for regain.

Volume of food increases over time.  Often, this occurs as we revert back to ignoring satiety. Satiation is that stopping point where you are satisfied with what you've had because it fulfills your body's need for energy, not your stomach's capacity. Some may say, "Well, I don't feel full ever."  If that's the case, you understand that your body's needs are only between 1/2-3/4 cup of food. Measure it out, take care of your maximum intake before you start, so you will know where to stop.

Quality of food is what I liken to eating at a fine dining establishment. If you're ever been to a 4 or 5 star restaurant, you'll notice that the plates come out with these small portions but the menu touts these inflated prices.  Well, good food costs more, but the care you take with your body and what you put into it is invaluable. Value your body, feed it slowly, with care and high quality ingredients. You deserve it!  Anyone who has made the decision to have weight loss surgery makes a decision to place a higher value on their life.  That bag of Cheetos or Doritos that just cost you 99 cents won't give you the satisfaction of feeding your body high quality protein will.

So, this "normalized eating" thing is really understanding and respecting quality and nutrient dense foods that will fuel you like a well oiled machine. If you put crap into your body, you're going to get crap out of it... Errh, okay, maybe let's not use that analogy.  What I'm saying here is that when we've made the decision to take extreme measures to improve our health, we must make the extreme decision to change what and how much it is we fuel our engine with daily.  Be kind to your body. Fuel it well.