Sunday, August 25, 2013

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.

Saturday, August 24, 2013

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.

Monday, August 5, 2013

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!


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.

Saturday, August 3, 2013

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.