Labels

This world tries to label everyone and everything, forcing things into categories, compartments and stereotypes that do not define who someone is but what they are expected to be.  Often, as clinicians, we are forced to diagnose someone to appease insurance companies to pay for our services when we truly do not want to attach a label to a client for fear that they may live up to or grow into a diagnosis.  I see this with my work with children, where parents want to get them X diagnosis so they can qualify for Y services and get Z check.  It happens, all the time, every day, and it's not fair to the child or client.


Recently, I read a blog post by someone I truly like as a member of the WLS community about the high school labels we fit into here in this community.  I also read a response to that post by another dear friend, and responded to her post online.  I respect both of these women dearly, their voices are valuable and their personalities are bold enough to influence many.  However, I've seen what goes on between groups and cliques and I am appalled that so many people with similar goals can not get along and accept each other and their differences with loving kindness.


I believe part of this confusion is the name, or rather, "Label" attached to one of these groups and the misconception that what it stands for is "Bad." While one could misconstrue that the group of women (and men) are trying to defy the norms of weight loss surgery, that's not it.  The philosophy behind the group is that we are not the "norm", we do not want to be the norm, and we do not fit into a pigeon-holed category of post-ops. It's that we are each an individual, first and foremost, and secondly, we stand for finding who you are before and after surgery.


Life changes, always. But life changes a lot after weight loss surgery.  Relationships end.  Friendships end. New beginnings and new relationships come and go, but bonds with new family, brothers and sisters, per se, in the weight loss surgery community are established.  The comradeship established in a group that embraces being different holds steady for those who join, and the Mothership is a powerhouse of experience and support. The group is a powerhouse of EXPERIENCE and SUPPORT.


The group does not stand for condoning bad behavior.   If you believe that, your bubble will never burst, you will live in it and think that perfectionism is possible. It's not. I hate to burst the bubble, but no one is perfect.  When we learn that we must accept ourselves and out imperfections we can move toward a happier, less stressful life without depression and anxiety.  When we can accept everyone, even those who think differently, act differently, and speak differently and who are comfortable with themselves, we show we are accepting ourselves, our faults, and our own issues.  We all have issues.


We all will struggle with obesity for the rest of our lives. "Fuel" the Ani DiFranco song keeps coming to my mind about all of this...


"and they say that alcoholics are always alcoholics
even when they're as dry as my lips for years
even when they're stranded on a small desert island
with no place within 2,000 miles to buy beer
and i wonder
is he different?
is he different?
has he changed? what's he about?...
or is he just a liar with nothing to lie about?"


So, have you changed who you are and accepted people for who they are in your journey? Where are you with your journey?  Do you still judge others negatively because you don't feel good about yourself?  It's hard not to in this world.  I admitted recently to my mother that I get sad when I see someone who is obese, not because they are obese, but because I always want to help them.  However, I know from my obese self, if someone like me, at my size now, were to approach me, a complete stranger, to try to talk to me about my weight problem.... tears would flow like a river.  This is why I am a counselor.  My clients come to me for help. I don't approach them.  I don't recruit.  I just am here when they decide they are ready for change and want support, therapy and loving kindness.  That's all I can do, and I continue to be all I can be.  I specialize in trying to remain neutral.  It's tough sometimes, and it makes me sad to see people who have the same goals to support and help this community pick at petty issues that divide and separate, rather than join and conquer. 

Embrace Yourself

Right now, wherever you are, whatever you are doing… STOP.  Take your hands off the keyboard, phone or ipad, and give yourself a hug.  It’s okay, I’ll wait for you.  Give yourself a nice big squeeze of a bear hug, as though you are in a straightjacket of love for YOU.

Now you can stop.  Okay, let’s get on with the topic of this blog post.

Never, ever let someone else’s view of your imperfections get in the way of how you love yourself.  Other people’s issues with you should never interfere with your view of yourself.  Body dysmorphia, whether that imperfection is real or imagined by you, can only cause anxiety if YOU allow it to take over your conscious mind.

Case in point, today my mother made the statement to me, “I really wish we could have your arms done before the wedding.”  This took me by surprise, really. I don’t think about my flabby arms much, I just religiously do my arm routine at home 3-4 times a week (every other day) to improve the muscle tone without the expectation that it will ever go away.  I don’t consciously think about how awful it looks.  And while yes, I agree, it does look awful, it’s not something I let bother me.

However, it’s not something I dwell on, EVER.  It’s not something I can immediately change so I don’t give it a second thought or allow it to cause me anxiety or make me feel self conscious.  Yes, I do frequently avoid wearing sleeveless shirts, but more often than not, I’m grabbing a sweater because I get cold so easily. My response was to brush it off with a, “Meh, whatever Mom.”  Obviously it bothers her more than it bothers me.  There are far better things I can think of to need to spend money on than plastic surgery.  My flabby arms are not hurting my health, so it’s not on my mind much.

For many people, such a comment coming from anyone would suddenly cause severe self conscious reactions and anxieties. For me, I see it as a reflection of my mother’s own issues with her body. Somehow, I did not get that gene that makes me dwell on things I can’t change. However, this awkward situation today got me to thinking… Maybe I’m just not that girl who worries about what other people think of me, I don’t obsess over how I look to other people. I look in the mirror and I see myself as I am and I accept that.  I don’t delve deeper into if there was less fat here or there because in the last three and a half years I’ve realized that my body will lose weight wherever it does without concern for what I think.

I have worked hard to finely tune my ability to “Let it go.”  Don't be that person that gets worked over by the idea that I must be perfect. I am imperfectly moving through this life, living and understand that what will be, will be and I am happy if I say I am happy. I am working toward change so when I've worked hard to solve a problem its resolution does not come as a surprise. It just is. I just am. I will just continue to be, do, think and learn to accept myself as I am.

I'm not saying that goals aren't important, I'm just saying that when I set them I know I will achieve them, therefore I put little emphasis on the time it takes and more thought into the path of the journey.  Enjoy the journey, always.  

Protein Shake Price Comparison Chart

I know this information must be useful to someone out there who is considering weight loss surgery and is on a budget, or who has had weight loss surgery and on a budget.  Everything seems to cost more lately, so I compile the most popular protein shakes in this list. I tried to include those I know are the tastiest, but I have not included which I prefer.  Please feel free to comment as to which you like the best. I will say, the one that's the most expensive is the one I like the least!  


https://docs.google.com/open?id=0B61V7whb7XSKdDF4d2YxNHZUY0k

Preparing for life after bariatric surgery

Life before bariatric surgery was very different. The opportunity to eat whatever, whenever didn't have the tag attached to it of "how's that going to go down." Each of us has to find the right time to begin and not look back from the past poor decisions.  Establishing good habits in the here and now will lead you to a successful journey, no matter where you are in that journey. The decision to make good food choices needs to be motivated by a desire to be <healthier, thinner, more energetic.> This is an exercise in <insert your reasons here> defining your goals as realistic. It's important to start simply with a few good habits than trying to take on a list of new tasks all at once.  Our a level of commitment to a new program can be determined by so many factors, and  our collateral influences (support systems) and environment play a role in our ability to succeed. Set yourself up for success by recognizing your personal readiness to commit to well defined, specific goals.

Goal setting has to be realistic, meaning it has to work for you. It's not practical to make a goal that you will "give up <ice cream, soda, potato chips, etc.> right now" without considering your readiness to commit to that goal.  Practical goal setting makes goals attainable. I will use sodas as an example because it's an easy target. The "liquid candy" of sodas is most often a complex habit developed over time; it's a psychological dependency established on sugar and/caffeine that is often easier to move away from if you allow yourself to minimize usage over time. Cold turkey doesn't always cut it. A realistic goal would be to state, "I will reduce my soda intake from 5-6 cans per day to 2-3 cans per day."  Once you've reached the reduction rate established, you can revise the goal to something more like this, "I will reduce my soda consumption from 1-2 cans per day, to 1 can 2-3 days per week." This sets up a measure of success that is clear, quantitative, and realistic.

There are several key tenets of post-bariatric life that will ensure your success rate. Our busy lives often have us being pulled in multiple directions at one time. Grasping the healthy habit of slow eating is so important. A bite is about the size of a dime. <I heard you gasp...> Yes, a bite should be about the size of a dime, ok maybe at most a quarter.  How about chewing?  My general rule has been to chew, chew, chew, until you've chewed about 25-30 times before you swallow.  Then wait until you feel the food hit your stomach. After 15-20 minutes of practicing these small bites, ask yourself, "Do I feel full? Am I still hungry?" Then take another bite.

Next up, let's talk about drinking.  We also must be mindful of taking it slow when it comes to liquids.  Learning to slip, not chug our liquids is very important to keeping the body hydrated at a constant rate while not stretching your pouch by filling it up like a water balloon. If you hear yourself gulp, you've probably taken in too much.  About 1/2 ounce to one ounce of liquid is gentle enough for the pouch to process at a time.  I'm sure you've heard by now, soda is a "no-no."  I hate to wag a finger, because I've pushed the limits on this one too, but it's really a habit that needs to be broken before you undergo surgery. The success in achieveing these small goals will help you moving forward with your weight loss journey and pre-surgical weight loss requirements.

There are several other important post-bariatric living principles that patients should work on becoming acclimated to for life long success. In my efforts to manage this blog more consistently, I will address awareness of emotional triggers and alternative, healthy behaviors to engage in when you feel <insert emotion here> due to <specific life stressors.> If you're sick of me putting things in <less than/greater than> signs, you might be concentrating on the wrong issues. That's a topic for another blog, because if you're overwhelmed by small issues like that, we might have bigger problems to discuss.

The Importance of Communication and Follow Up with your doctor

I knew I had an appointment today with my surgeon, and I was completely ready to get a fill in my otherwise empty band. I woke up this morning, after having coughed all night long, with a fever, sore throat and a pain in my stomach.  I knew I needed to go though, for the sake of follow up, though I am 3 years and 3 months out, I think it's still necessary to spend the time communicating with your doctor.  It may only be 5 minutes, but your doctor needs to know what's going on.  The reason I coughed all night?  I took my vitamins too late.  They sat in my pouch for hours. I knew better, but it just slipped my mind that it was already 11:30pm, way to late to be taking my vitamins. For the most part, vitamins should be taken with food. Cardinal rule broken there. Sometimes, even those of us who are years out, need to be refreshed in the simple order of things. Mistakes are made, it's best to just recover from them quickly and get back on track.

So, what happens when you're so off track, you've gained 5, 10, 15, or even 30+ back after surgery?  It's important to go back to your doctor.  Your doctor should have a list of trained psychologists, dietitians/nutritionists, counselors/social workers, and/or personal trainers who can get you back on the loser's bench.  Sometimes, we need the help of a trained professional to understand our disordered eating behaviors and lost motivation we had went we eagerly started our journey. Each of us has our individual disordered behaviors, both in our nourishment practices, lack of motivation with exercise, life stressors, food addictions, and/or transfer addictions that may need serious attention. Reach out. If you need help, email me.  I will be happy to find someone, wherever you are, to help you! 

Saturday Group

REPOST FROM ObesityHelp.com:


Hi, my name is Nanette Wilson and I am a Counselor Intern (#5099) with the Licensed Professional Counselor Board of Examiners.  I have a Master's degree in Counselor Education from the University of New Orleans (2006) and I am seeking to gain experience in conducting weight loss surgery group therapy sessions. Becoming a Licensed Professional Counselor takes 2 years and 1500 direct contact hours, and is conducted under the supervision of a Licensed Professional Counselor Supervisor. I am currently 6 months into the process and seeking to specialize my skills in bariatric counseling, pre and post op counseling. Individual counseling will not be required but encouraged if issues that should not be worked on in the group are recurring for some members. I've decided to take on pro-bono clients in Louisiana who have undergone bariatric surgery and would like to participate in group therapy. The group will be available,free of charge to anyone who is interested and emails me to sign up. The group will be limited to 6-8 people. If anyone is interested and lives in the New Orleans area, please let me know.

This group will take place on Saturdays at a local library where we could meet in a conference room. If you or anyone you know is interested, please message me.  Also, if anyone participating in the group is interested in individual therapy outside of the group, I will see clients on a sliding scale fee ($25-$50/per session) as I can not currently take insurance because I am not yet licensed as a Professional Counselor.  If interested, please contact me by email at nanette@bariatriccounselor.com.  I will require a brief intake questionaire over the phone to get some information from you regarding your experience with counseling and your currently weight loss surgery status/progress. 

Evaluating Your Impulse Control

The essential key to success after weight loss surgery is impulse control.  Sure, you were able to follow so many diets and exercise programs for weeks and months, even years on in, but when it came to the slip ups, were you able to own it and take new actions?  Let's look at the bigger picture.

In order to be successful as a post-bariatric surgery patient, you must learn new health habits that are sustainable.  If you commit to the lifestyle for the first 6 months and then revert back to old habits, you will inevitably gain weight back.  This is a learning experience when it happens, and hopefully, if it has happened to you, you've found resiliency and jumped back on the wagon.  However, if you continue to struggle with impulse control issues and you don't keep accurate records of your food and calorie input and output, you may see yourself on the failure end of WLS.

The key is owning your behaviors and actively making efforts to change those behaviors.  I recently ran had a visit with my great aunt and she said to me, "I'm so happy to see you're maintaining your weight loss after surgery because "so-in-so" seems bigger than before."  I refrained from calling her out on this third person judgment of "so-in-so" because I don't know "so-in-so"'s circumstances, but I can make a solid assumption that she isn't practicing impulse control or following the rules her doctor gave her.

Why?  Why not?  What is it that keeps us from truly changing our habits?  There are usually deeper seated control issues going on underneath the weight gain and food addiction.  It's the way they've learned to cope with stress, anxiety, and depression by using food.  Those behaviors have not been unlearned when the doctor when in to perform surgery.  This is why the movement should be to work with a Professional Counselor to process the client's motivation to change and their ability to control the impulse to reach for food to soothe themselves.

Ask yourself a few questions:

Am I ready and willing to spend time preparing my foods at home for my work day and in the evenings?

Do I understand what good post-bariatric surgery food choices are?

Do I comprehend the size of my pouch?

Generally, post-surgery, your pouch will be the size of a walnut.  It will inevitably stretch some, but the idea is not to have it stretch to the size of a baseball but rather possibly a golf ball. You must commit yourself to planning ahead or having a plan when you're out of the house.  If you fail to plan, you plan to fail.  I keep a list of good choice WLS friendly meal options out, I look for high protein options when it comes to soups and order that as my entree or find an high protein entree and order it sans rice with extra soft steamed veggies.

Another big issue is alcohol. Anytime you consume alcohol your ability to make good judgments is compromised.  This can be a big problem when you're post-surgery and your consumption levels can cause severe problems, such as low inhibitions or blackouts.  You must become increasingly aware of the effect drugs and alcohol have on your ability to make good decisions.  Seek professional help if you find yourself risking your safety due to a transfer addiction.

So where is your impulse control?  Are you able to make good choices all the time?  Are you still struggling with making good choices and grab those cookies when you've had a stressful or emotional day?  What's behind the emotions of those bad habits?  It's wise to seek out a Professional Counselor that specializes in Dialectical Behavior therapy for binge eating disorder or food addictions.  If you need help finding one in your area, please feel free to email me and I would be glad to locate someone to help you!

nanette@bariatriccounselor.com