Obesity Bias, Weight Shaming, and Attitude Adjustments

As someone who has experienced obesity bias from youth until now, and having experienced the social norms of average weight, it bothers me when I see reality shows that do this:

Extreme Weight Loss

http://chrispowell.com/examiner-com-chris-powell-tells-what-it-takes-to-qualify-for-extreme-weight-loss/

If you can't see what's wrong with this picture in terms of the obesity bias that exists in the world, or you think these shows are great, stop here.

Are you still with me?  You see, when someone with obesity is publicly put on an industrial platform scale to be weighed on national television, the problem is both cultural and personal. Our culture's obsession with intrusiveness on private matters is disturbing.  I know, she's consented to this awful public display, but it's not a far fetch to say that she's seeking attention.  As a therapist, I know certain attention-seeking behaviors are not appropriate or effective in building long-term mental health and wellness.

You see, weight bias and fat shaming are known not to encourage weight loss.  There are more and more studies out there that reinforce the idea that this type of "shame display" does not lead to strong mental health and reinforcement of positive longevity of good behavior development.

So, when I try to point out the negative aspects of a show that people think are "doing good things" it's not me trying to disregard the feelings of anyone or their people, it's me trying to tell you that this is not the most effective way to reinforce positive habits of health.  If you feel the need to put yourself on display to the world, and then you regain, there are deeper seeded issues that need to be addressed. It's not the weight, it's a lack of nurture and a sense of neglect to be a grasp on.  We need to get you to where you love yourself.

I maintain my statement on shows like The Biggest Loser and Extreme Weight Loss, neither show is a practical guide to long term health development.  In fact, both of these shows make "pseudo-celebrity" status of their contestants, and well, if some is already inflicted with a gregarious personality, it could only exacerbate histrionic personality symptoms, which would be a downward spiral once the attention is no longer on them.

More important than teaching people how to lose weight, is how to approach health in a practical manner.  It is not realistic for someone at home to watch a TV show where someone is given a home makeover, $25k on a Wal-Mart gift card, and one-on-one celebrity fitness guru instruction.  There is more power in teaching someone to self motivate, drive their own emotional being (teaching emotional control from outside influences) and guide a self directed, practical search for health.  Light the fire of desire, not the candle for limelight.

Because once the limelight is gone, the drive and desire will fade.  The cycle of negative thinking will ensue, and the person will be worse off, but with a lot of nice gym equipment in their home.  (Personally, that part makes me a little jealous, I need a home gym, damnit! Don't we all?)

Anyway, I digress.  Are you surprised?  If you know me, definitely not.  My message here is that when you work in healthcare you have to have regard for personal feelings, attitudes and bias. You have to break the bias that exist in your own mind.  I once found myself particularly caustic with two dietitians who were waxing poetic about some "skinny girl in their class" and I made the mistake of telling them I thought it was inappropriate to speak about her. #1, she's not there, and #2, what if she struggled with her weight as well. What if, "being that skinny girl" was a negative self perception she had and the result of an eating disorder? 

It's just not appropriate to talk about someone in that context.  We should not use negative adjectives to describe people. "Fat" or "Skinny" are not terms of endearment, "chunky" or "chubby," "thin" or "svelte," people are emotional beings, and weight issues are an emotional subject matter.  Putting someone on display for their struggles is not a way to help.  It's the way of shaming, public humiliation. It is neither useful or helpful, it is plain staging humiliation. 

Now for the attitude adjustment.  I've also touched on this before.  Someone else's weight is not your business unless that person chooses to make it your business.  Believe me, if someone wants your help, they will ask for it specifically and directly.  It will be clear and apparent that you have been chosen as an authority for their considerations for their health.  I am appalled when I hear about clinicians making remarks about patients' obesity.  I am even more appalled when I hear about people intrusively making someone else's health their business.  As this has recently happened to me, and my primary care physician was just as appalled by the behavior as I was.  Thankfully, my PCP understands that this was done out of concern, my doctor called to let me know this was done, and told me he was supportive of me and respects that I know what is best for me.

You know what is best for you.  Don't allow someone to come up to you and make your health their business. And while you may think publicly expressing your concern for a stranger is appropriate, remember, you are not the authority over them.  You may think you are being compassionate, but you are not their doctor, nor do you know where they are in their journey. Be mindful of the people in this community who are still struggling and have other conditions contributing to their weight retention.  Is it true?  Yes.  Is it useful? More than likely, no. Is it kind?     Meh.  Will it come across as KIND?  If no, then proceed to STOP. 

It is time for our to be confidently in charge of our health and stick up for ourselves when people rudely and intrusively make our health matters their problem.  It's not their problem, it's ours.  We own our health, we take responsibility for all matters, whether we can control them or not, we take control by educating ourselves and making good decisions. That means in our actions, words, attitudes and behaviors. 

If you are a member of this community and you are trying to capitalize on other members of this community selling some product or service, it is in my nature to analyze, criticize and be concerned for other people who are not as discerning.  Please do not exploit your own post op success as an authority, work within your education and scope.  If you have a certification from XYZ organization that holds no clout, I have the professional and educational background to back my position that you should not be doing what you're doing in the capacity in which you do it.  End of story. 

CMS decides Your Life Doesn't Matter

As always, Ted Kyle of ConscienHealth sums it all up for us nice and neatly for us. The Centers for Medicaid and Medicare Services (CMS) have unfortunately made will have injurious consequences. It's going to get messy, and not messy in a way that will be cleaned up easily. It's going to cause people to lose their lives due to a lack of quality care and strict standards. Sadly, the group that will bear the brunt of this decision is.... Surprise, the poor and elderly.  Shame on you, CMS.  Shame on you, Congress (for your current lack of concern for healthcare in this country.)  I wish these public servants would put their egos aside and work for the people, not the corporations.

This decision has far-reaching consequences due to the guiding force that is CMS.  Insurance companies use the policies and protocols of CMS to make their own decision making models for their policy holders. This decision will trickle down to every individual who has dealings with bariatric surgery.  I guess the only good measure that might occur is that some surgeons may be more willing to see patients who've undergone procedures with other surgeons.  Maybe.  I mean, it certainly hasn't been helpful that so many refuse to perform follow up care on other surgeon's patients. Heck, most doctors shy away from it because they lack a knowledge and understanding of bariatrics. Honestly though, their malpractice insurance isn't anything to scoff at, so I don't blame them for taking a stand on their professional liability, but... everyone needs care. A patient presents with you a variety of symptoms, construct-- patient has had bariatric surgery, what kind and how do you adjust your treatment approach?

Let's go back to the undermined group in our American society today though.  That group that is so under-served, we don't even talk about them.  The working poor, the people who work so hard but have nothing in the means of healthcare.  No back up, no access to care, just their paychecks and the mercy of primary care doctors willing to see them for well-appointments for less than their average wages.  Those Americans wishing for a healthy life, should have access to the available treatments for obesity.  People who are educated enough to know they need to do something for their health, but can't because their employers have written them out of the quality equation.  It's sad but true, let's all get Federal Government Health Insurance, we are as deserving of it as the people who are suppose to be serving us.

But I digress, as of 2011, there were 48 million uninsured Americans. That number isn't shrinking, employers are shrinking coverage to quality treatment.  Healthcare providers are scurrying and in panic over the confusion of Obama care.  Let's stop making up programs and start providing CARE.  Let's stop trying to save the world and save our people home, Make Americans Well.  Let's find ways to support our nation by giving everyone the same access to treatment options if and when they want them, and support them in the follow up of their choices.

Let's educate our society about the benefits and the RISKS involved in surgical weight loss procedures.  Let's stop ignoring the fact that some procedures fail at an alarming rate of 40-60% .  Don't turn a blind eye to this statistic and blame the individual when the wrong treatment was selected.  Where is the compassion?  It's gone. We would rather shame people with obesity as a society than help them. The haves versus the have nots will always have a louder voice.  Be compassionate, you never know what someone else's story is until you listen to them. I won't turn a blind eye to the problems I see in the care continuum of bariatrics.

So many people approach their weight as the singular problem.  It's usually not.  There are usually underplaying the psychological struggles they're having with food-- that's why you hear people say "How do I pass the psychological assessment process and get the green light to surgery?"  You wanna know how?  You learn to be 100% honest with yourself.  You dig deep, real deep.  You look at compulsive, obsessive, binge, and overeating behaviors with no filters.  You say to yourself, I got here over the long haul, and you realize the work is going to take a lot of time and effort to find health.

You also learn humility.  That even when you're doing it all right, you might meet biological forces that provide resistance.  Unseen resistance with the naked eye-- hormones: thyroid and metabolism-- medical conditions that will make it difficult, even with surgery, for you to get to a health weight.  BUT, you will persist in your efforts because you have and understand the importance of SUPPORT and EDUCATION. You won't shun the weekly or monthly groups your doctor's office has available to you or you will seek out support online and find others who are rooting for you.

Oh, wait... back to the CMS decision.

Those support groups and education efforts of your surgeons' offices will be at their discretion.  Never mind, giving you the tools to help yourself and stressing the underlying importance of addressing the psychological and emotional basis for your obesity isn't important.   Moot points... Well, I'm done.  Stick a fork in me. All arguments I have are invalid because a small lobby from the State of Michigan decided that MBSAQIP (Formally known as the Bariatric Centers of Excellence) standards are not as important as their own agenda. Credentials are a money making industry too, but respect is give to organizations that are run by the leaders in the medical field.  ASMBS and ACS are THE agencies in the US that provide standards of continuing education in surgery.

This all boils down to egos and agendas.  We're not on Congress' agenda.  We're not on CMS's agenda. If you don't have money in this country, you are powerless. Sad, but true.

We can only hope the all of the Congress persons will realize that every life is valuable.  Each person on this Earth has purpose.  The impact we can have in our generation to make sure others will live the longest and healthy lives possible.  Our digital age gives us access to one another to build ideas into realities. Find your passion.  Do good things for yourself and others.

Social Desensitization & Obesity Perception

As a society, have we become socially desensitized to obesity?  Or is it that we've developed a distortion of normal?  Yesterday, Ted Kyle of ConscienHealth posted a blog titled "Shopping for Obesity," which brought me back to an incident over the weekend.  My husband, you see, leads a sheltered life.  He'd never been to Sam's Club before this weekend, when we just so happened to be out and about together shopping.  I needed a new printer, so my trusty Sam's Club membership comes in handy when purchases, such as this arise.  Costco was all the rage here this weekend, our first in the state had opened in MidCity, so everyone was talking about it.  My husband's reaction:  what's the big deal?

So, we go to Sam's Club, he grabs the first printer we see (which happened to be the one I intended on purchasing anyway) and we set off to pick up oatmeal, apples, and along the way he grabs a can of mixed nuts.  When I'm ready to check out, he trails off to buy a pretzel and escape the madness.  Of course, I'm just going about my business, not really paying attention to the people around me, but rather, probably fiddling with my cell phone to avoid speaking to anyone I encounter.  I'm not very social in public when I'm oriented to a single task-- usually, to get in and out as quickly as possible.

As Jonathan licks his fingers clean of pretzel salt, he lends over to me in a whisper and says, "Did you notice anything odd in that store?"  I stumble over the throngs of people and say, "No, why?" He goes on to say, "So, you didn't notice the inordinate number of obese people in that store today?"  Well, no.  I didn't, honey. I imagine that with two-thirds of the population classified as overweight or obese there would be some people who fall into that category.  So, we questioned this phenomenon, and there, in Ted's post was the exact situation we encountered.  The overabundance of food supply and the enlarged waistlines of the American consumer present in our Saturday trip to purchase a printer.

As social media content development guru for my company, I came across an article yesterday that drove it home, "Is he healthy? Exposure to Obesity Changes Perceptions of Weight Status in Others."  We've been desensitized to appropriate size.  Not only in portion control but in what's considered normal in actual human physique.  Now, here's where I get personal about my journey in weight loss and gain and all the psychological distortions I've gone through in this process.  It's my personal, in-depth analysis of self.

I've never known a normal weight.  Therefore, when I lost weight and was a "normal weight" I wasn't entirely sure what to do with myself.  I enjoyed it, but I almost felt uncomfortable in this new body that I had.  It wasn't what I was used to at all.  It was the new normal, but my mind didn't have a chance to get caught up with my body.  As I have regained the weight after my band removal, I am more familiar with this size but more uncomfortable in this body.  Then there's the skin-- with the weight loss, the skin was just a necessary burden after having lost 180 lbs.  Now, I've only lost 80 lbs, it's just flab and fat, not skin.  I tolerate it a little be more openly because it's not just hanging there, being a burden.  Now, I have 100 lbs. to lose, again.

So, what does the counselor say to this, "How do you feel about that?"  Well, I definitely don't like my regain.  I definitely have paid attention to what I've eaten and exercised and still found myself in this place.  This place where I was once comfortable for so long, and now I am not.  I know I have to accept myself where I am right now to move forward in a healthy way.  I continually question whether or not having another surgery is going to make anything better or if it's just going to put a temporary relief on a lifelong problem.  I don't want to struggle with regain anymore.

I've broken down, broken out, and processed all I can about what got me here.  All I know is, I have to be come excruciatingly meticulous about what goes into my mouth and how I exercise my body and what I think about how I'm doing that.  How much I put needs to be an exact to a science.  What I do needs to be quantifiable in the gym.  It's not just time and type of cardio but keeping a record of weights in strength training.  It needs to be following a plan, rather than haplessly doing something because I'm there.

I think as a society, we're all working with a distorted view of size.  The new normal that should be developed is an old *societal* standard. However, you have to find where you are most comfortable.  In many ways, I feel like I cheated.  The band forced a diet of starvation and bulimia for an extended period of time, and my accountability tanked.  Now, the accountability must be exact, measurable. Those SMART goals we all should be making-- our dreams and our goals need to be specific.  They can't just be "I want to lose weight" and I want to lose it as quickly as possible without concern for my health.  They simply must be, "I am going to lose weight as a product of eating the right foods in the right portions. The byproduct of my efforts will be weight loss."

Back to my husband, he's not insensitive to obesity-- he's just never been obese.  He's learned what he's learned about weight bias and size discrimination and obesity from listening to me.  However, he's still one of these people who thinks that weight loss is easy, eat less, lose weight.  For so many of us, that's not the battle we are fighting.  We're fighting deeper seeded wars against ourselves.  My empathy for people with obesity is deep because I've outwardly fought this fight since I was seven years old.  My social cognition is in a state of acceptance for others as they are.

My perception of self is to accept myself as I am.  That doesn't mean I'm not driven to change the size of my body, I am, I think, talk and do things to it to drive that change every day.  But I don't go around judging other's place in their world.  I just don't have the knowledge of them to make judgments of their current body size, nor would I want to because I understand how much that judgment hurts when realized. I think we each need to realize that someone else's obesity is not our business unless they ask for help.

"Prophet"-izing your weight loss successes is great to a point. (Profiteering on your success inappropriately is another blog altogether!)  People will be happy for you, but you may turn them away in your gloating.  People will say you took the easy way out.  Accept that their words aren't meant to hurt you, and that yes, you made your success more attainable with surgery. It's certainly not easy to make the decision to go under the knife, and you can't take it back once it's done. Realize that it's okay to have surgical help to resolve your obesity. Never, ever forget the struggle you had, the emotional pain that you experience, and the harsh judgment you felt, heard, saw and experienced.  Think twice before you say to someone, "I have the key to success."

Guess what.... You don't have their "key to success."  You only have your own "keys to success."  Finding one's own keys to success is an individual experience-- some may need others to help, some may not.  It's never, ever appropriate to go up to a complete stranger and assume you know how to fix their obesity because you've fixed yours.  You're keys don't fit in their door.  Walk away, or learn to be tactful, LISTEN to them and their STORY, and you might just walk away having learned something from someone you thought you could fix.  I learn more from my clients about myself when I listen and hear their stories.  

Your "Keys to Success in Recovery from Obesity" are not the same as someone else's-- Lose your perception of fixing others' problems, stop and listen to their story, and don't try to fix them.  Compassion can go a long way without offering "quick-fix" solutions.

The truth about my band...

I made the big mistakes, I broke some cardinal rules.  I aggressively filled my band for the first year, while I had free visits to see my doctor for fills. I had heartburn in the second year, and I could not sleep at night from this.  It would resolve, come back, resolve, then I'd gained.  I gained 10 lbs. in year 2.  My struggle to eat anything in the morning caused me to stay on soft foods for a long time.  In the third year, I had everything taken out. I still had issues keeping stuff down on a regular basis. The bad days started to out count the good days.  But I didn't go to the doctor because I didn't have insurance.  I attempted to go to the Charity Hospital Emergency in April 2012.  They told me to follow up with my surgeon.  At that point, if I'd had insurance, my band would have come out.  The problem was that serious.

But I didn't get that service.  I know, obesity surgery isn't on the top of the list of severe diseases that any insurance company wants to cover, but I made below the poverty line at that time.  I still got denied Medicaid benefits. What is really awful though, is even now I still don't have insurance. I work on temporary contract with the responsibility to pay my own taxes, and it just isn't affordable for me when my entire year of medical expenses is less than $1,000 out of pocket. I do have an emergency policy, if God forbid, I become critically ill but my "pre-exisitng condition" was not covered in that policy.  I will just die. And I still don't make much more than I did last year, when I worked for a Medicaid clinic that didn't provide insurance or even guaranteed work for its employees.

Our government cares more about fighting wars in other countries to kill people, in their conflicts, which we really should stay out of, which neglects everyone here at home. It takes away from education, health, and peace of mind.  We are a country at a constant war against taking care of people at home. No one person should have to without medical care.  When that is taken care of here, then let's offer our hand to other nations. Let's be the role model our forefathers had planned for us to be.  Let's be the peace leaders, the wise, calm, considerate model country of American humanitarian philosophy, but let's take care of our own people first, let's stop acting like keeping people at home healthy is not important.

I don't get publicly critical about in the government issues.  I have few friends whom have political views similar to my own, so I just don't talk about it.  My views a very different than most of my family.  I really wish anyone with medical insurance who can see a doctor would understand the neglect those of us who go without experience.  It cost me about $80-120 to see my primary care doctor to get two prescriptions twice a year.  No testing, no X-rays, no sleep study.  If I want that, it can cost me anywhere between $200-600.
That's a lot of money when you make wages below the poverty line.

Everyone says, "Well, why don't you get insurance through your husband's employment?"  Don't you think if I could, I would?  It's not financially beneficial for me to get on his plan.  Sure, he's an attorney, but the firm he works for is really small.  The unfortunate part it all is corporate greed that drives the decision for employers to not cover spouses. The skimpy plans, the denial of services...

But, I don't understand it.  I don't get it at all.  Because in my true nature to the core of my being, I believe everyone deserves the same chances at being healthy, well, and enjoying a very long life.

Tell me that it's okay to let people be sick and die.

Tell me.

Please.

Why?

It irks me that my story could have been different if I'd had the same benefits as Medicaid patients. That last year of my life with the Lapband would have gone differently. That life-threatening visit to Charity Hospital Emergency Room would have played out with a different story. I would have at least had the option to go to the OR for a revision within a few weeks or a month or two, rather than having to wait six months for my surgeon who'd ignored the problem because I didn't have insurance. I see it every day, people who don't work, get government assistance, have quality health care that I could never afford as a working individual. It's a crime and shame.  

It's an unfortunately circumstance to be put in.  I've lost a lot of money over it.  I missed work a lot when I was sick from Lapband complications for those last two years.  I've been bitter about it.  I am getting better though.  I am trying to not be so hard on myself when I know I am eating right, exercising, and doing what is within my capabilities to try to lose weight that I lost before.  The research isn't encouraging though.  The weight is getting harder to take off because of age, metabolism, my dieting history, and the mild feeling of hopelessness I get when I realize that this is hard. 

It's hard with weight loss surgery to help and it's hard without it.  I could be considered depressed, but honestly, I don't let those moments get to me for too long.  I try to combat the mental torture of not knowing when I will be able to get back to where I was, with the confidence that I am doing what I can to lose weight.  It's just not working.  It's not good enough to undo the damage I've done.  That damage being to trust a device and to trust that I'd have health care that would make my weight loss surgery situation right. 

I don't know when or how, but I know it won't do me any good to be depressed about it. It defeats the purpose of trying to live a healthy life and positive attitude.  I just wish my experience would have played out differently.  I wish I year ago, I wouldn't have been on the verge of death.  But I will count my blessings, it could have been much, much worse.  

Ways and means...

I've just wrapped up the most amazing conference I've ever attended (okay, it was 3 weeks ago, but I didn't post this when I wrote it!)  I don't know where or how to start this post. I guess I'll start with the thought I woke up with in my head this morning...

"I never want to try to lose weight again. I'm not going to lose weight anymore.  I am going to 'gain health.'"

For years, I have tortured myself over numbers.  Numbers on a scale that had no value other than to degrade my sense of accomplishment or to enable my pride in success.  It was a bipolar relationship that served me not.  It was a false sense of security.  It was unhealthy.

Even those of us who have education to tell us we shouldn't obsess over the little things... do.  We want to attach measures of success to this device that is faulty and provides only a false sense of security.  It means nothing.  In zero gravity, it has no purpose... it is a grave digit, a dirty secret to some, but to me, it meant I was finally able to shed the shield of darker days.  I was living and not hiding from my weighty secret.

Avoidance.

I avoided addressing the number on the scale for the first twenty-two years of my life.  I was told I was beautiful by my parents, but they were concerned about my weight.  They tried to help me.  I resisted.  I did not want to talk about my weight. It was the literal elephant in the room.  So, when they drug me to Children's hospital and that mean old doctor and dietitian insisted I ate buffalo meat for 6 months, I complied... to a point.  Then I hid in the closet and devoured 6 or 8 boxes of girl scout cookies to sulk in my "starvation."  I hated that everyone wanted to control me.  I hated that I wasn't just naturally like everyone else in my grade.  From the first time I went to the nurse in first grade to get weighed every Friday to Weight Watchers at 8 years old to the time I graduated from LSU, I resisted listening to them because the message was negative.  You're too fat.

When I decided to take control of my health at twenty-two, I initially was very successful. I went from weighing 353 lbs at a doctor's appointment with Dr. Danton (I remember this moment clearly) to starting Atkins and dropping 75 lbs relatively easy. I became more active. I worked out. I didn't let anyone's negative perception skew my goal to be healthier.  I just worked at it, but I stalled I stalled at 275 lbs for four years.  I remember torturing myself on the scale and trying to understand why it wouldn't do anything.

Then came the Lapband, that worked to a point.  Until year two when things started to go awry, I couldn't eat in the mornings, I got terrible acid reflux, I became an insomniac because I would lay in bed for hours at night feeling tortured. It felt like I was constantly being choked.  How pleasant is that?  I have conceded with my experience, the Lapband was not for me.  I know it works for some, it did not for me.  Anxiety played a role in it, but also, just general, constant uncomfortable always on my stomach.  That constant clenching was intolerable for me.

Is banding where it's at though?  So many other options are due on the market.  The FDA is approving new weight loss drugs that may or may not be a good option for consumers.  My only advice to anyone is to consume wisely.  Do not think you can have a surgical procedure and never have to worry again.  Your weight and your ways are a battle you can win by doing right for yourself.  Do good, be well.

I won't share my future plans, but I will say this.  I have the confidence in myself each and every day to eat healthy, move more and live with enough satisfaction that my actions matter. My life matters.  I care about how others address this problem in their own lives and work toward social awareness and the betterment of our communities.  I don't know if I'll ever have the opportunity to have WLS to help me.

I must address this as politely as possible.  I don't want to offend anyone.  BUT please recognize that weight loss surgery is only an opportunity-- I hate the "tool" concept.  You know what a "tool" is to me?  A tool is something that helps you in your work.  It makes your job easier.  So, when people say, "Weight loss surgery is the easy way out" and that ticks you off, then you turn around and call your procedure a "tool," you've just negated your belief system, IMHO.  Your weight loss surgery procedure is an opportunity for you to get healthy, learn to listen to your body more closely, and a way to good health.  You have to put in ALL the work, because at any point and time, you could fall down the slippery slope to bad habits again.

Don't do that.  Cherish your opportunity.  Realize that someone (or a collective someones-- called your insurance group policy) spent a lot of money betting on your success.  Or, if you were like me, you spend a lot of money out of pocket for that opportunity.  Realize your opportunity is bigger than yourself.

Have the determination to get out and do it.  DO what you NEED to do to gain health.  Gain life and develop a routine of fulfilling exercise and creative, healthy nutrition.  Feel good about your choices every single day.  "Take good care of yourself" is not just a mantra, it is the way of life.

Lying, Cheating, and Stealing

I'm tired of the lies people tell themselves to justify their behavior.  We all do it to some extent, but when it comes to lying to people in public when you put yourself out there as a "bari-celeb" I'll dub them, then you really lose all credibility in my mind.  When you behave like a jerk to other people in the community and think that your success matters to them, well, I think you've let your head get to you.

Cheating... there are lots of people who "cheat" on their bariatric nutrition plan.  They do.  We all need a little something special from time to time.  But when you make a vlog about how you eat pizza and act like walking away for 20 minutes is a practical option to food digestion management, I really think you're full of crap.  Yes, I do.  There's no one in this world who can take an extra crispy bite of pizza and then walk away for 20 minutes.  If you're having to wait that long, there's probably something else you're doing.

Stealing... there are a lot of people online who blindly follow others who've put themselves out there.  The bari-celebs will swoop in like sharks to get your money with their MLM coaching programs that bare no accreditation whatsoever.  These are not people who care about your well-being, I promise.  They are people who want to take your money so they can fund their own personal lifestyle. Their lifestyle change included becoming rich and "famous" so they could profit from your vulnerable need to connect with successful people.

Look around.  There are successful people willing to talk to you for free. 

Also, there are unsuccessful people here who were successful and had surgery that didn't work for them. There's more to be learned from those people who screwed it up, than those who want you to perceive them to have done nothing wrong in this journey.

Recently, there were a few heated posts about Rex Ryan.  I dropped my "weighing in" on the topic when I realized that I was talking to an audience that didn't want to her about what went wrong for me with my LapBand.  I am very happy to discuss with anyone what happened.  My stomach became convulsive, to the point where I could not keep anything down.  I had stuck episodes on occasion, I had that uncomfortable feeling many times, more than I would like to admit, but my doctor considered me successful.  My message is and has always been, it can happen to you anytime. Wouldn't you want to know about what happened so you can try to prevent it?  I realize the banded gastric procedures are not for everyone. I was one of the unfortunate ones it was not for, even though I was successful with it for 3 years. The last 6 months were hell.  So, instead of calling me a band hater, why don't you ask me what the hell happened and why it when wrong so you can learn from my horror?

But no... people want to pull wool over their eyes and act like it's all pooping rainbows all the time. It wasn't. I know some people are successful with it, but just because you're successful with it, doesn't mean you know everything about what could go horribly wrong with it in the future.  Grow up.  And if you get paid to promote it, don't even talk to me about it.  I'm not stupid, when someone pays you to promote something, you don't talk about the side effects, complications and hazards.  Why not?  Wouldn't it be beneficial to explain how those things happen to some, what those stats are, and how to prevent them?  Isn't that the socially responsible thing to do in corporate America?  No.

It's to turn a blind eye, ostracize those who speak negative words about your product, and never acknowledge the stats.  Never acknowledge that there are just some people who bands are not good for and for a good, long while, many surgeons were getting kickbacks from the company to get as many bands in as possible.  That's what they don't tell you.  It's to hard to act with integrity in corporate America.  It's to hard to have a warning label on a product that they've just installed inside you.  No, that's not good marketing.

Marketing... these perceived successful people toot their own horns so much.  But the sad part about it is they can't always empathize with you.  They never knew your story, your weight struggles, and they don't want to. They don't have the time to stop and listen to you.  They just want your money.  I'm sorry to be the bearer of bad news.  I'm sorry to be the person that has to tell you not to open your wallet for online support, and not to trust a few people's good experiences without asking yourself the question of "what are they not telling me?"  They aren't telling this... They got into this with the sole intention of making money. Because that's what people who market for a living do.  They want your money, they want your attention when they speak, but they don't want to take the time to listen to you and hear your story.

There are many of us here online that will listen to you, care about you, and support you for free.

23 Self-Regulation Executive Functions of Obesity Prevention

#1 We perceive ourselves to be successful at weight loss and maintenance and we exercise within our current limitations daily.

#2 We initiate positive behavior modifications in our lifestyles by choosing healthy foods and activities to engage in.

#3  We exert control over exert outside influences that could deter progress by modulating exposure to environments that are unhealthy.

#4  Wehonestly gauge our successesby rewarding ourselves with a feeling of satisfaction in our good behaviors, not with food as a reward.

#5 We focus on solutions to problem behaviors and select what we are ready to commit to fully.

#6 We sustain from engaging in negative behaviors and thought patterns that will disrupt our progress.  We listen to the advice of our doctors and develop a plan that works. 

#7 We stop ourselves when we find our thoughts drifting toward a poor choice, thus interrupting the behavior pattern by relying on our support systems. We don't "cheat" ourselves out of good health by making bad choices.

#8 We have become more flexible in ourability to ignore what is not good for us and shift our concerns on activitiesand experiences that will benefit our overall mood.  We do not allow food to dictate our mood.

#9 We avoid substances and/or situations that lower inhibitions nd gain confidence in our ability to control ourselves.

#10 We hold on to the principles established for our health and wellness, execute our prescribed dietary guidelines in a way we can enjoy food but not overdo it.

#11 We do not let others manipulate our values in quality and quantity.  We do not feel the need to finish anything for the satisfaction of a clean plate.

#12 We organize our lives with priority to our healthy principles, and we are not oppose to refocusing events off of food and onto physical activity.

#13 We foresee our bodies and minds becoming healthier, daily. We know what we look like as a healthy person, we see health in our future and do not obsess over what we can not control today. 

#14 We generate positive energy and attitudes everywhere we go and leave our judgment of what works for others to them.

#15 We associate our successes in the confidence we have in doing what we know is right for ourselves and accept the limitations of which we cannot control.  

#16 We balance our lives with our lifestyle choices. If it means taking your lunch everywhere you go, then let that be your signature behavior pattern.  There is nothing wrong with behaving differently than those around you.

#17 We store our gratitude in our hearts and continue to work toward our individual goals.  We share what works for us, but respect that our way is not the only way.  Find your way.

#18 We retrieve the knowledge we need and seek help from others when we know something is not right in our mind and body.

#19  We pace ourselves and have patience with attaining goals and being successful.  

#20 We manage time wisely, always.

#21 We execute our mission to become healthier by setting smart goals each day.

#22 We monitor our success in a manner that works for us. We recognize behaviors that have a negative impact on us. (For some, the scale is negative reinforcer.  Have confidence in what you're doing without the scale. If you feel guilt for eating something, you need to choose not to eat that because you do not want to feel guilt.)

#23 We correct unsatisfactory thoughts and behaviors with appropriate actions.

Rise to the Challenge!

It's taken me a week to process the amazing experience I had at "Your Weight Matters" conference in Phoenix last week.  Each and every session impacted me, and each and every person I met there, means so much to me.  I did not spend as much time with any of you as I should, but I look forward to seeing everyone again next year.

I am a part of a team that has raised over $7k and bought the Obesity Action Coalition into so many people's lives, and that I got to meet so many of the forward-thinking, bias busting, advocates in this country made this my most favored educational conference.  We all get it, we all have struggled and believe that it is not okay to treat people with obesity in an abusive, hurtful or unethical manner.  It is a disease of many factors, all of which are unique to each individual.

Our personal responsibility in this fight is to find ways to educate others about the disease, while doing all we can to take care for ourselves to concur those elements that are within our control.  It is a balance of nature and nurture, always.  When we surround ourselves with people who think about health with positive intentions and physiological mindfulness, we can choose thrive at our own journey.  Wherever we are in that journey.

I accept that I have eaten foods to contribute to my weight gain, but I also have eliminated so much from my diet. I hope to someday have both an organic garden and chicken coup in my yard, it's my romantic little dream of a Cajun cottage growing herbs around the house, veggies out back, and fruits along the side of the house.  A girl can dream!  However, my mission current unfolding is my desire to see more urban edibles gardens and green spaces.  It's been nagging me that the park down the street, a former city golf course, is sitting there overgrown and unused. It would make a beautiful community space for health education and a farm co-op.  This has been something floating in my head for the last two years.  I feel like I need to make it happen.

Anyway, back to OAC... I have a new family.  They are wonderful people doing good things and truly care.  I have a job where I get to see what's going on in the healthcare field with regard to obesity research and prevention, every single day.  The passion I feel toward ending this epidemic goes down to my soul.  I'll sit and listen to anyone's story, I want to hear it, I want them to tell it.  If they want to hear mine, I'll tell it as well.  At some point though, the story moves on.  I decided to move this story forward this last week by occupying my time with opportunities to make my community and my nation a better place.
 

Am I Addicted to Food?

As a counselor intern clinician at Southshore Counseling & Wellness, I've been ask to start blogging there.  Faithful readers, you'll likely see it here first!  They aren't owning my posts, so some blogs you see will be indicating elsewhere, not just here at #BariatricCounselor. (Little useless hashtag'n)  I'll probably continue to post very random, less than orderly thoughts that provoke me and information I find, but when I said re-haul of this blog, I realize it must become more refined, less rough and tumble if I seek to put on that professional counselor image. But really, what am I, if I am not human, raw and unrefined, from at times?  The following will appear in the "Ask Dr. Andre" blog for Northshore & Southshore Counseling & Wellness. 

Am I addicted to food?

Food Addiction is often overlooked as a substance abuse issue, and logically so; how can one be addicted to something they need to survive?  It is not a strange as it sounds. Humans seek to find pleasure in consumption, and research shows that sweet, salty, and fatty foods activate the same sensors in your brain as drug and alcoholic addiction.  The first step is recognizing the social, emotional, and cognitive thought processes and environments that trigger abuse of food.  No one can deny the fact that the New Orleans area has some of the best eating in the world, but…

…how can one establish healthy eating behaviors and portion control to find lifetime success in weight loss?  

Many people struggle with the idea of “giving up” certain food groups. Telling someone they can't have something makes them want it more, especially with food. The mentality of an addict is, "I want, what I want, when I want it."  No one will get in my way until I have it.

Cravings for certain foods trigger similar obsessive thought processes that often can't be let go until the desire is fulfilled. While eliminating problem foods from one’s diet is an excellent approach to positive habit development, gaining control over and expelling thoughts that are not beneficial to success must be practiced and analyzed frequently until the new behavior becomes automatic. Some foods trigger people to eat more, outside of a regular serving size, and cause one to become susceptible to loss of control.  

Like any addiction, “one is too many and a thousand is not enough” for some when it comes to cookies, cakes, candy, chips, bread, and sweets. If they cannot be had in moderation, it might be wise to not keep it around for a time, and learn to live without it while working through understanding control. 

A key is to undoing unhealthy food behavior is to develop a plan of action to address how one will handle situations when temptations are present.  Establishing a relationship with someone TRUSTWORTHY and TALKING about what causes binge eating, helps to gain awareness; and as a plan is executed when faced with these difficult situations, one will realize that control can be had over the decisions made from hand to mouth.

Everyone fails to follow through on their own goals sometimes, and everyone is tempted at times by what is not good for them, but having the COURAGE to talk to someone about it and address the problem is a BIG step.  Be BRAVE enough to articulate what it was that triggered eating an entire pint of ice cream on a Friday night: loneliness, boredom, anger, anxiety, negative thoughts or impressions throughout the day, even happiness.

Counseling can help develop the appropriate coping skills and positive behaviors to pave the way to recovery from food addiction, binge eating, depression, anxiety, body image, self-esteem and weight related cognitive stressors. Good news! Now available at Southshore Counseling and Wellness in Metairie is Nanette Wilson Adams, Counselor Intern and National Certified Counselor. Nanette specializes in food consumption issues. Call for an appointment to discuss your weight-loss and food relationship issues and concerns with her today!

Can't make it to #YWM2013, LiveStream is here to help!

CLICK HERE TO JOIN THE LIVESTREAM: 

http://www.ywmconvention.com/program-agenda/ywm2013-live-stream/

Here's the deal, I'll be there.  You'll be there too, virtually.... now, isn't that cool?  Let's Learn and Prevent Obesity Together!

Anorexia after Bariatric Surgery

How much weight loss is too much?  When do you put the breaks on weight loss and find a balance of weight maintenance?  It's often a slippery slope that isn't properly monitored by surgeons, nor does the internet properly provide enforcement of good behaviors.  We like the "positive" feedback received from people "Liking" our photos on Facebook or Instagram, but sometimes, social media has a way of encouraging negatives. Self perception that your waistline needs to be piddled down to nothing, social media only serves to enable poor health as positive successes, the smaller the waist line gets.  The cognitive work necessary to develop a new, healthy body image is not being properly executed in treatment plans across the board in Centers of Excellence.  If you're seeking "Likes" on the internet for your latest side shot post, and your waist is so tiny that you appear sickly, you *might* be struggling with anorexia. Contrary to popular belief, anorexic behaviors include eating restrictively in both food types, timing, and content, and keeping secrets about food/refusing to talk about eating behaviors as problematic.

When patients come to a bariatric surgical center, they are often battling the exact opposite of anorexia, they are frequently binge, emotional, or inconsistent eaters.  They are often so anxious to have surgery, they become offended that a professional counselor might suggest treatment planning for counseling services.  The stigma of counseling and psychology is often met with resistance, and the notion that, "They are not crazy!"
No one said you're crazy, sometimes preparing yourself for the road ahead, understanding what a healthy self-concept is and how to execute that without developing more cognitive distortions, and learning healthy lifestyle behaviors needs a trained professional.

Obsessing over anything is harmful to your cognition.  If you can't stop thinking about your weight, if you're unable to let go and enjoy life, the cognitive work needs to be address. Cognition and Transfer Addiction are the two most under-utilized treatment options for obesity.

I have said it many times, but I will say it again. *This is worth repeating.* 

The difference between a coach and/or trainer and therapist is that the therapist can recognize and treat depression, anxiety, eating disorders, cognitive distortions, and severe mental illness, whereas a coach might approach things with a solution-focused training philosophy, a therapist is processing the behavioral patterns and diagnostic criteria while remaining non-biased, compassionate and discerning of a client's intentions.  We are A LOT more liable for *your actions* when you leave our presence, than an online coach or trainer.  We must take precautionary measures at all times to insure our client's safety and intention to themselves and others. 

"Body image assessments tend to vary focus, ranging from an evaluation of the cognition related to body image disturbance, affect and/or behavior to other others that focus less on subjective dissatisfaction and concentrate instead on perceptual disturbances that may contribute to body image distortion." More research is needed on the effects of online social media bariatric communities and their affect on, and relationship with disturbances in self image and eating disorders.

Cognitive Medicine: Positive Thoughts & Scientific Certainty

Food Addiction is the often overlooked as a substance abuse issue, and logically so, how can one be addicted to something necessary to survive?  We tell ourselves we need more of it than we really do.  It’s simple though, we seek to find pleasure in consumption, and research shows that sweet, salty, and fatty foods activate the same sensors in your brain as drug and alcoholic addiction.  Some of us just don't need more than 1200 calories a day, our metabolic functioning is impaired, and our bodies just don't know what to do with the excess.  Our furnaces simmer at a lower fire than other people. We must develop the balance of positive thinking toward development of better cognition and design an action plan that works for us. What we need is a total eclipse of thought. Consume what we need, expend what we don’t, and find balance when we have over or under done things. For the last eleven months, I have purposefully rejected accountability to what went into my mouth at all times.  Yep, there, I said it.  I decided that I didn’t want to continue to live in the misery of thinking I had failed.  I went from loving food with limitlessness, to embracing my relationship with strict boundaries. 

13 years ago, when I had decided I needed to lose weight, I embraced a healthy, active lifestyle by getting a dog.  Hannah has been the reason I get up and walk every day.  Before age 21, I never really exercised.  In 2002, I participated in my first 10k race.  Walking it took me 2 hours and 15 minutes that first year.  Later on, I came in my best time at 1 hour and 40 minutes in 2010.  That was the best I had ever done.  It was also 1 ½ years after my Lapband was installed and before the band began to cause me extreme anxiety from the variable issues with tightness. I was eating like a dietitian, as I like to say.  My delusion was that I would run marathons, but honestly, lifelong obesity and recovery from obesity, is hard on the heart.  Extreme exercise after your body has been through so much stress can not be good for the heart.  I now advocate for strength training in the form of pilates, weight lifting, and HIIT (High Intensity Interval Training.)  

While in Austin from 2007 – 2008, I had really gotten exceptionally better at portion control and diligent logging and journaling about what caused me to eat poorly, how did I feel, process the bad episodes with intention, understand events and reactions that would make me cave to a moments that care forgot. Well, I see through it all now much more clearly in this relapse.  I realize that it is no longer an option to not be strict with myself.  I need to measure and account for what goes into my mouth at all times.  We all have different goals and needs in our personal journeys, unique motivational activations. We all process our relationships with food and others in a different light. I get that. I study it daily, and I clearly see my own faults in myself. 

I’m a solutions oriented counselor in my day job, I talk to people on the phone about their interest in medical and surgical weight loss programs I conduct a motivational interview where I question them with clarifying intention and solve a problem: give them an action plan. Some are easy, medical or surgical, this way or that way, here’s an event you should go to, let’s get you started.   However, weight is a sensitive subject, and sometimes I have had people break down on the phone with me.  I have people who suddenly, without notice, might have a false perception of context, and think I’m just a receptionist type person who is only answering the phone. 

I had an interesting conversation with someone who just suddenly after a few seconds of silence where I was entering information into the computer, accused me of passing judgment on her as being a crazy fat person, and I had to calmly reassure her that I was a trained counselor. I understood her and was not judging her. I promise, I’ll never think you are crazy, I will just try to figure out what is getting in your way and help you move it, mentally. I’m not thinking you’re crazy because you’re calling us for help. I’m not judging you.  I am not a doctor, but so while your medical problems are concerns and attributions to your mission, I can’t tell you what to take, not even for a headache. (With the exception of providing evidence based information from professional societies conducting non-biased research, I know a thinkg or two about the common knowledge of bariatric vitamin and nutrient deficiencies.)  All in all, I am a therapist with a lot of compassion and empathy for everyone’s struggle, and if I had all the time in the world, I would want to hear everyone’s story.    

As an obese child, I began ballet and tap lessons at 4.  Into adolescent and teenage years, I became so apathetic to this routine, and couldn’t find enjoyment in it.  The only exercise I every deliberately got was Wednesday ballet classes.  I hated them with a passion, as I was too obese to be graceful, and flexible enough to bend and contort myself in every which way.  Funny, Nanette means, “full of grace.”

My graces are my kind heart, intentional inquiry, studious knowledge, joyful heart, and counselor’s ear Not my ability to pleat across a church room studio with a bunch of skinny girls who felt sorry for me.  Because I know, the looks and stares didn’t really lie, and no matter how beautiful a people those girls are, at the time, in that moment, I perceived it to be that.  What you perception tells you is often what you will be.

We can’t let bullying and negative thoughts prohibit us from doing good things to take care of ourselves, ever. Therapy can be the medicine for good cognition. Processing the underlying influences and motivations from your thought processes and your actions-- having someone evaluate how you conduct your internal dialogue, and working through negativity by analyzing and reflecting feelings, processing intentions and releasing anger, hurt, resentment, apathy, lethargy, guilt, grief and loss, to find the other side of negative... it is the birthing of a new you when you find motivation to change how you think about your issues/problems/troubles. This is why "online coaching" is risky, those people can not diagnose and treat major mental, cognitive, and emotional disorders-- risking further damage to your psyche and causing more harm than good. It is often the practice of "bullying" clients with aggressive tactics rather than meeting them where they are with warmth and compassion.

Developing iron clad positive-thinking, goal directed planning, structured, scheduled meals and movement; that is how we take the first step in addressing obesity.  We accept that portion control and exercise are essential. We take journaling and logging exact intake as an evidence based personal data study to our doctor and say, “Look doc, this is what I did, and this is what did or did not happen with weight reduction.” I do not discount the genetic susceptibilities, medication side effects, or outside determinants of obesity, and proper medication, hormonal balance, proper nutrition, disease management, a positive attitude and self advocacy are essential to the treatment plan.  Environmental influences and choice are primary controllable factors for the individual.  We are all individuals, who function uniquely toward our motivations for health of mind and body.

As an advocate for a obesity prevention and treatment programs, it is with medicine and cognitive that are our health and wellness.  I think we have to employ all courses of action: medicine, education, advocacy, and community involvement. In an ideal world, we would have a community garden in every mile of every city, where we could all walk there to get our food each day.  Every park would be a community recreation center where we meet to learn about healthy lifestyles.  We would work with each other to change, not ridicule those who are trying from those who may see themselves as better off than the other because they are stronger, or perceive themselves to be wiser.  We will all respect the notion that we all have an impact from each other’s presence in the world.

Knowledge changes everything

As this week closes out, I realize today why it is so important for people to have the right job for them.  It changes a lot of our overall happiness with life.  My knowledge of bariatrics is challenged, all the time.  My knowledge of metabolic disorders is challenged, and I rise to the challenge.  My continual efforts to read and educate myself on what we know between science and what we're doing in society and government is important to me.

Today, I had the opportunity to speak to a patient who had weight loss surgery 30 years ago. While I wasn't shocked that she didn't know the exact name of the procedure she'd had, once she described it to me I knew the exact name, without hesitation.  I connected with her and earned her trust and was able to help her with ease.  It was one of those moments that I was impressed with my brain, it didn't feel so broken. 

It's easy to feel broken. We can feel tired, worn out and desperate for change, but life has a way of knowing when change will come. We have control over what we do, what we say, what we put in our mouths and what comes out.  When positive things start to happen, it seems like it becomes easier to bring in more positive. Positivity is abundant as dreams come true if you open your heart to it.

When I think of how I show my authenticity with clients, I show it by being patient, kind, nurturing, inquisitive, non-judgmental with a little bit of humor and a lot of love for listening, empathizing, problem solving, creating, collaborating and designing a better life. Reaching out for help has a lot of stigma attached to it. You have to be able to trust a strange with your story and how it ends. Who you trust and how they process your concerns-- will they act in your best interest to facilitate conversation that will motivate positive behavior and action?

Counseling is not Freudian psychoanalysis or Gestalt talk therapy. While I do think it is highly beneficial to talk to an empty chair when you're struggling with the words you need to describe your pain, it is finding the release for all the anger, fear, hurt and pain in a counseling session. That's what counseling is. You have a place where you can describe the ugly truth, how you really feel about anything and everything and what you can do to move away from that negativity.  

Therapy is not solely counseling though, and many people get the same contemplative satisfaction from recreation, entertainment, and sports.  Simply put though, if you do these things to avoid thinking about negative situations and decline action toward coping and processing your emotional pain, it may catch up to you. It may prevent you from leading the life you could have lived.  In order to lead the life we want to live, e have to talk about what it is we want.  Do you know what you truly want?  Understand your motivations and live your dreams! 

Exploitation of Self... and others.

Over the years, I've realized that there are many people on this Earth who will stop at nothing to make a buck.  While I understand their entrepreneurial spirit, this week I have seen more than I'd like of new lows.  First, I've blogged before about the impracticalities of The Biggest Loser, but the recent uproar in the media with Tara Costa, The Biggest Loser 2009 contestant and her endless legal battles, really upset me.  Not that she is exploiting her reality TV show fame, though there is that, it's the selling of her image and the "fired because she gained weight" part that outrages me.

http://video.foxbusiness.com/v/2546539407001/biggest-loser-tara-costa-on-getting-sued-for-weight-gain/?playlist_id=937116503001

I must note, I hate the way this male Fox reporter questions her and gets her on the defensive. He bullies her. "Lead a positive, healthful lifestyle." says Costa, and I wish her the best with becoming a physical education teacher.  Let's hope the government moves to bring back physical education is ALL school. What outrages me is that she has to defend her weight.  But to add insult to injury she had a lawsuit with him in the first place, and clearly, all this is about is money and her body image.

On the juxtaposed, we have Tammy Jung, but in the same arena of money earners who don't mind exploiting themselves for a dime:

http://js.dailymail.co.uk/femail/article-2321812/Tammy-Jung-23-feeds-5000-calories-day-funnel-hope-obese-internet-star.html

No.  Words.

"My career ambition is to become as popular as possible and I hope I just continue to make lots and lots of money."  

It's hard to understand why someone who was not obese would want to become obese for profit to me. I realize my moral upbringing does influence the way I define appropriate behavior.  As a counselor, self awareness is essential, however, I don't think this is me viewing my moral code through a foggy lens. My therapist's intuition is that there is much more deep-seeded conflict in this young lady's life that we are not hearing the story on.  While I understand mental health issues, I don't understand why one would deliberately deteriorate their health for money.  It's JUST MONEY.  It means nothing in the end.  The quality of your life right now is ALL YOU HAVE.  I could go on about this, but I won't.  It will just upset me and make me feel helpless because I can't do anything for her.

Next up, Let's talk about the BOY SCOUTS OF AMERICA.  Do they need anymore bad press coverage?  Seems to me they are looking for it.  I can't understand WHY they would ostracize the young adolescents members that need them the most.  http://www.scouting.org/scoutsource/HealthandSafety/risk_factors.aspx
And I quote, "Excessive body weight increases risk for numerous health problems. To ensure the best experience, Scouts and Scouters should be of proportional height and weight. One such measure is the Body Mass Index (BMI), which can be calculated using a tool from the Centers for Disease Control here: http://www.cdc.gov/nccdphp/dnpa/bmi/ . Calculators for both adults and youth are available. It is recommended that youth fall within the fifth and 85th percentiles. Those in the 85th to 95th percentiles are at risk and should work to achieve a higher level of fitness."

Umpfhhh... So, you mean to tell me that overweight and obese male adolescents wouldn't benefit in the reduction of their excess weight by participating in scouting?  Seems to me to go against their motto: On my honor I will do my best to do my duty to God and my country and to obey the Scout Law; to help other people at all times; to keep myself physically strong, mentally awake, and morally straight.

If "a Scout" is trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent-- aren't they also NOT A BULLY.  Don't they their peers with respect and help them to improve themselves together?  Let's outcast the overweight and obese kids, not include them so they can feel lonely and discluded from normal adolescent activities. You know what happens when kids are ostracized, lonely, and discluded from physical activity?  They show increased depression, anxiety, anger and lethargy.

How does that solve the obesity epidemic?

It doesn't.

It does nothing to move society forward and away from obesity.  It encourages bullying.

And while I'm on the topic of bullying and people asking you for your money.  Please do not join "secret groups" on Facebook that ask you to spend $49.95 for support.  There's plenty of free support and weight ins available from your peers.  When someone asks you for money for their support, they are no longer your peer, you are their customer.  All you are to them are $$, when you stop giving them $$, they will likely no longer support you. They might even bully you when you aren't successful.  Is that what you really need when you are down in the dumps and seeking help because you fell off the wagon?

No.

I didn't think so either.

Now, I must go do the duty.  A solid hour at the gym, every single day. 

Treat me like you would anyone else...

I'd like to address a topic that is somewhat intangible and taboo because it's just not always grasped by everyone.  Bedside manner and word choice in how doctors and surgeons present with obese patients.  I find the time surgeons really spend with their patients greatly lacking in depth. The patients they advise to change, to lead a healthier life, that education part falls far too short.  It's embarrassing to hear stories of patients being operated on and being set out to fend for themselves.  No guidance and poor advice or thoughtless direction-- there's really is no excuse in this day and age.

We have WEBCAMS and INTERNET now.  It's not difficult to support your patients as a group anymore.  Every surgeon could spend one hour a month in an online seminar, facilitated on a different topic, each month... Why Not?  I feel like, to me, the tech savvy counselor who, when free for an hour or so, will jump on cam and just talk with my peers, this is a simple gesture that really could go a long way. I just do it because I like to hear people's stories and understand -- because they share a single common factor with me:  the struggle with obesity.

I have heard too many instances of our peers writing of their experiences with primary care doctors who don't recommend surgery because they have not taken the time to educate themselves about the advances in surgical techniques.  It's their responsibility to take part in the follow up care necessary, but they just don't understand a bariatric patient's needs.  Every primary care doctor should understand that obesity is not a condition to blame on their patient.  Blaming an obese person for being obese is not going to send the message that needs to be sent.

The message that needs to be sent is this: "I am your doctor, I care about you. I want you to care about yourself by taking an interest in becoming healthier."  How do you do that?  Well, there are so many prescriptions for healthy, without drugs, without surgery.  If either of those things are used, it should not be shamed, it is just one element in a myriad of factors that can reduce body fat.

It's the head stuff we're so hesitant to talk about, all around.  All around, nobody wants to talk about feelings.  Obesity is a topic that evokes heavy emotion in those of us who have suffered with it.  It hurts our hearts, literally and figuratively. Who hasn't experienced negativity toward them because of their weight?  *No one.* Not even thin people, because they are just as scrutinized, because no one can be happy with what God gave them, they seek perfection constantly.  Just be.  Be happy with what you have and who you are, just for a minute.

Take in the moment in knowing that it is the way you feel about yourself that matters most.  While so many of us want so much to be at a place where we are happy with our bodies, it is how we present who we are today that makes all the difference.  Content with one's self. Right now, BE.  Be happy. Treat others with respect, you will if you show yourself respect too.  Respect that you're working toward BIG GOALS, at small paces.  Tiny, daily steps... it's a hard road, a tough journey, a difficult road that you can never predict accurately, you just have to roll with what is put in your path.

One last thought, when a doctor makes you feel uncomfortable and does not listen to you, speak up for yourself. Tell them when you feel they are being insensitive toward you because you are carrying extra weight.  Call them out on their poor bedside manner. They are taught to question everything, NOT judge you.  Assess and advice, not judge and be insensitive. Hush that voice inside you that tells you negative things like your opinion is not valid, your feelings don't matter. THEY MATTER 100% OF THE TIME.

This is how you advocate for yourself.  It's how you start a movement.  It's how you make the system change.  It's how you develop a model for care that includes the validity of every patient's feelings on their health.  Our healthcare system, surgeons, doctors, nurses, techs, counselors and social workers, ALL need to understand that being insensitive to obese patients is not what they deserve.  They all must be given the opportunity to rethink their philosophies on how to treat obesity as a disease, just as alcohol and drugs are given that status, even more so, this is a much more unique to the individual's genetic and social identity.

Treat me like you would anyone else. Without shame or blame.  With Love. With Compassion. With Care.

A Recipe and a Thought

Wedding Cake Protein Shake

1 scoop of Vanilla Pure Protein (By far my favorite economical protein supplement, available at Sam's Club for $20 for 20 servings)
1/2 c. Greek Yogurt (Great Value brand, non-fat is 11g protein @ 60 calories)
1/2 t. vanilla extract
1/2 t. almond extract
3/4 c. Almond Milk (Blue Diamond, unsweetened original or unsweetened vanilla @ 30 calories per cup)

Blend with ice. Drink or pop in the freezer for a few hours, stirring every 20 minutes or so. Great alternative to ice cream! Stir in some chopped almonds and frozen raspberries for a low calorie, high protein meal.

A "meal," what does that mean anymore? 

As a pre-op, a meal consisted of several items to me. There was a meat, a veggie, a carb and a drink. I am happy to say that I have moved away from all sodas long before weight loss surgery (though, I was never much of a soda drinker to begin with) and exclusively drink water or unsweetened coffee or tea. Even since the LapBand was removed, I continue to not drink during meals. But a "meal" becoming 10 or 12 oz. of a protein shake, still is really not a meal to me. I never adopted the thought that these "meal replacements shakes" were going to be my way of life. I'm too much of a foodie.

This shake really helps to sort out my negative feelings about giving one of my favorite things up. Wedding cake. I am a sucker for it, sugar free wedding cake snowballs are my favorite summer treat. Now, this Wedding Cake ice cream or protein shake is a go to "meal" for me, any day of the week.

A few things Paleo - Avocado and Coconut!

Chocolate Avocado Mousse & Coconut Whipped Cream

Anyone who knows me well, knows I enjoy making tasty food. I have really transformed that habit into making healthy tasty foods. I love avocados and coconut, both are healthy fats that are utilized in the brain functioning to regulate neural synapses firing patterns. Omega 3 fatty acids, when taken on a regular basis, help to improve executive function in ADHD children. Don't make me pull up that research, it's been a while since I was knee deep in that stuff, but it is certainly applicable to obesity--- your brain functions best on healthy, natural foods.

4 ripe avocados, mashed
1 T. cocoa powder
2 T. honey
1 T. powdered stevia
1 t. vanilla extract
1 T. coconut oil
1/2 c. dark chocolate chips, or 4 oz. unsweetened chocolate

Use stick blender to blend to blend all ingredients except chocolate chips. Melt chocolate chips on low heat and blend into mousse. Let set for an hour in the refrigerator.

Coconut Whipped Cream --- this was an experiment that came out well! I didn't know if the coconut fats would mimic the HWC fats.

1 can coconut milk
1 T. coconut oil
1 T. powdered stevia
1 t. vanilla

Mix together. Put into whipped cream container. I used 3 CO2 cartridges because I didn't know if it would work. I refridgerated the mixture, waited 2 hours, and I had coconut whipped cream. Color me impressed... tomorrow I shall use it with my coffee...

Love people, cook them tasty food. 

Take good care of yourself. 

It's not about Blame, it's about Change

Obesity is a disease, as much as alcoholism is a disease.  It's part of our genetics, conditions, choices and behavior within our environment.  It is a complex relationship with our mind and body.  As someone who has experienced uncontrolled hunger that willpower could not overcome, and at other times, felt to be in control of, that makes sense to me-- that it is driven by the impacts of hormones in our bodies. The relationships between our hormones: insulin, ghrelin, leptin, testosterone, estrogen, and the processes activated in the brain between dopamine and seratonin, fed by the circulation of water and nutrients--  are all working together to support our biochemistry and are influenced by all of these factors.  It is certain there are people who eat an unhealthy diet and have no instances or struggles with obesity, and others, who suffer dearly, starving into desperation as certain foods act as a drug for them. We are all impacted by certain substances differently.

Many people have inaccurate opinions, pass judgment, and entertain prejudices towards those who suffer from Obesity, and it is an abomination that there are still people who think it is acceptable to be insensitive to those who do. 

I am sad to say that I know for a fact that there are many very smart people in the medical field that fail to consider that we all differ as individuals and that obesity is not merely caused by overeating, or rather, eating the wrong foods. While I agree with the "Wheat Belly" and Paleo theories, I fear tunnel driven opinions to undermine quality standards, education, support and structural services to aid bariatric patients may be cut from insurance, rather that included and encouraged. Let us lobby that these things DO NOT occur. Bariatric patients need to be able to see their surgeons 1-2 times a year at 3-5 years out. Continuation of care, follow up, and interfacing with multiple MD caretakers has much, much merit in our evolving medscape.

There are notable prejudices that come with obesity treatment. Learning to treat someone with empathy, and while this is not a skill of every surgeon, when their demeanor comes across as compassion: sympathetic pity and concern for the suffering and misfortune of others-- we should treat patients with tenderness and benevolent concern .  It is unfortunate that surgeons can not walk a mile in their patients shoes, though, they could try walking a mile with their patients. I am a big believer in walk and talk therapy.  Trusting relationships and programs built around success are what bariatric service providers need to develop.  Community awareness, education services, commitments to each patient's success. That is the future I would like to see.  To ensure success at the highest rates possible, we must lobby to change our society.

If hospitals would integrate food as medicine kitchens (over pharmacies) as they have wellness centers for exercise physiology and physical therapy, we could change a lot. Attitudes and perceptions are skewed in this "Fight from Obesity," it's not a fight, it's a progressive movement toward change, societal paradigm shifts in attitude and access to care. Support groups should be available every single week.  Topics should be covered on every element of lifestyle change. Our people must push for community gardens and turn around the marketeers to cater to low calorie options at restaurants and in schools.  No one should live in a food desert, community markets should carry natural food products produced locally, and we should make our food at home as often as possible.

Every Step Counts. Why limit "Walks from Obesity" to once a year or even once a month. Once a week with someone who will hold you to your commit, and once on your own every week is both therapeutic for mind and body. But truthfully, the Walk from Obesity is EVERY SINGLE DAY. 20k, 15k, 10k... whatever you can do to move forward. With the help of surgery, we are able to conquer many metabolic imbalances that occur from obesity.

But it is not the end all, be all for everyone. I don't like the idea of obesity drugs, but they have their place in the profit margins of "Big Pharma." With side effects yet to be discovered, we risk developing more dependency on psycho-pharmcology. Everyone has an opinion, but we're all out to make a buck.  There's a difference between an honest buck and a buck of persuasive luck. Good marketing of fads has long driven the weight loss industry. But this thinking that bariatric surgery, which has proven to be an effective form of weight reduction when behavior changes are also made, should not be shot down, deregulated, and allowed to be done in environments that do not support the long term outcomes but rather, hack a gut alteration and send a patient on their way. That is not what this medical specialty area needs, what it needs are constantly examined and improved methods to drive the health of society.