Is it the time of year or am I just a little more sensitive to the pleas for help that have been coming my way? Some patients have written to me to ask for help since they’re struggling big time; others have expressed doubts that their surgery is still working for them (and there’s more than a handful). And some brave souls have spoken up at groups I’ve attended recently, or taken the time to stay behind afterwards to express their beliefs that the ‘red flags’ I had mentioned had had real resonance and suddenly rang bells and became the wake-up call they needed to tackle poor habits that had returned either gradually or with a vengeance.
So what are these red flags? And what can we do to tackle them?
Most of the red flags I highlight happen after the WLS ‘honeymoon’ – usually post-op about 9 months plus down the line. The first major signal can be a prolonged stall (not just the typical few weeks when you’re still doing ‘everything right’ but the scales don’t register a loss but you’re seeing a few non-scale victories); or a weight gain that is not going away or gradually getting worse. Appetite has returned and maybe a few old habits have resurfaced …
Here they are …
1. SNACKING AND GRAZING
In this scenario a regular meal-time regime has been substituted in part (or wholly by) a snacking and grazing one. So instead of 3 planned meals (and maybe 2 planned snacks if required) a little and often regime has become more the norm. There are several reasons for this – sometimes lack of planning, sometimes due to mixed up hunger signals, and frequently due to confused tolerability issues. Many patients find hard/solid protein a challenge in the early days and find grazing on ‘slider’ foods easier to tolerate. It’s understandable to turn to something quick and easy (like easy to eat carb based foods) for nutrition in a hurry or because you know it will ‘sit well’. By adopting this regime you’re setting yourself up for a poor daily nutrition tally on all fronts – not enough protein; too many carbs; mixed fat messages and often not enough vitamins and minerals.
THE ANSWER: Go back and re-evaluate your regime and make a conscious effort to plan and prepare meals with good solid protein as their basis. Keep those grazer or ‘slider’ carbs well out of reach and plan a week’s meals in advance to see how it works out with getting back on track.
2. DRINKING WITH MEALS
So many patients tell me they drift back into drinking with meals – and not just water. We have covered the reasons why this isn’t a good idea nor recommended on the website many times. See this video for the basic reasons and check out the links at the end about problems with alcohol – it’s often the gateway for many WLS patients to cross-addiction-transfer.
THE ANSWER: Go back to the 20:20:20 rule (see here) and don’t drink for 20 minutes before, 20 minutes after or during a meal. Plus save the alcohol for only special occasions especially if you find it’s becoming a too regular habit. If you know you’re struggling with this then seek help from your bariatric team asap.
3. AVOIDING THE SCALES
In the early days many patients scale hop too frequently and in the latter often too little. The urge to see them move south early on is a great motivator. When they don’t move at all or go northwards patients take one of two actions or paths. Some see it as signal to make change and re-examine their habits and regime and others prefer the ‘ignorance is bliss’ route.
THE ANSWER: Don’t become obsessed but don’t ignore the scales either. A once a week weigh-in is sufficient to tell you whether you’re getting things right or not. Weigh on the same day, at the same time, in the same place, with the same clothes for accuracy. Record this and use as a tool to understand and adjust your regime. It will quickly become clear what is working and what isn’t. Write alongside your chart what you did that week in terms of exercising, socialising, cooking etc to get some clues as to how to ‘tweak’ your body to doing the right thing. But do remember your weight is only one aspect of your health – it’s not everything and the scales won’t reflect that.
4. EMOTIONAL EATING
Head hunger, emotional eating, comfort eating etc are all terms we are all to familiar with and during these times we don’t reach out for the salad, fruit or quinoa do we? It may well be that these were problems you thought were behind you after surgery only to find they rear their heads later – a most unwelcome return guest. Whether it’s carbs, cake, chocolate, crisps, fries, ice cream, pizza, wine or other trigger foods you may well find they become ‘unwelcome friends’ again.
THE ANSWER: Acknowledge they’re a problem and then set about making some plans for how to deal with them when they raise their ugly heads. Diversionary tactics might well work; having a little and limiting the damage is often another; preparing a better alternative is what we often use here at Bariatric Cookery (we don’t say NO to pizza, cake, ice cream foods just show you some ways of making a bariatric-friendly version). If you are suffering big-time with these then seek some professional help for binge-eating-disorder from your bariatric team. Don’t wait until it becomes so bad that you want to give up, isolate yourself or undo all the progress you have made to date.
5. TRANSFER ADDICTIONS
Sadly I hear of too many transfer addictions at groups and through personal messages. These may be in the form of alcohol abuse, shopping addiction; sexual inhibition (where it is a problem); fanatical exercising, gambling, over-the counter drug addiction etc. Usually the WLS patient is aware of the problem and often prefers this addiction initially to the food one they hope they have kicked. In the case of the alcohol many will have a couple of glasses of wine instead of a meal; in the case of the exerciser it’s a means of controlling weight better than before and often means food input can be increased without the weight gain; gamblers get their ‘hit’ from a waging high rather than food one; shopping likewise can be thrilling when there is so much more to choose from; and in the case of sexual encounters many WLS patients will simply claim they are making up for lost time! All are highly dangerous in the long run …
THE ANSWER: Acknowledge that any excessive new behaviour is equally as poor a choice as the eating one of the past and make strides to reduce, control or eliminate it. Most counsellors will suggest the latter and have strong reasons for saying so. First port of call should be your bariatric team or GP/MD for a referral to services to help with this. Don’t delay …
LATER THIS WEEK WE’LL LOOK AT SOME STRATEGIES TO GET BACK TO BASICS AND DEAL FURTHER WITH THESE RED FLAGS !