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5 Red Flags To Look Out For Post-WLS!

June 12, 2017 12 Comments

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 !

Related Articles:

  • Do You Know The 20:20:20 Rule?Do You Know The 20:20:20 Rule?
  • Are You Really Hungry?Are You Really Hungry?
  • Coping With Head HungerCoping With Head Hunger
  • Are You A Scales Stalker?Are You A Scales Stalker?
  • How to Deal with Hunger after WLSHow to Deal with Hunger after WLS
  • You Must Be Mistaken!You Must Be Mistaken!
  • Weight Regain and the Return of Old HabitsWeight Regain and the Return of Old Habits
  • Shopping … A Transfer Addiction?Shopping … A Transfer Addiction?
  • 5 Ways To Avoid Weight Gain After Bariatric Surgery5 Ways To Avoid Weight Gain After Bariatric Surgery
  • The Best Day of the Week to Weigh Yourself is…The Best Day of the Week to Weigh Yourself is…
  • Are You A Food Addict?Are You A Food Addict?
  • What Behaviours Are Important For Optimal Outcomes With WLS?What Behaviours Are Important For Optimal Outcomes With WLS?

Tags: 20 20 20 rule, addiction, drinking with meals, emotional eating, grazing, red flags, snacking, transfer addictions, weighing Categories: Bariatric Basics, Bariatric Beginnings, Coping mechanisms, Weight Regain

Reader Interactions

Comments

  1. Fiona Hutchinson says

    June 12, 2017 at 1:28 pm

    This is me!! I had my weight loss surgery in September 2014 and lost lots of weight and as I expected I have gained back some of it, but I hoped it would plateau but sadly I am still creeping up. I know that I am still not eating anything like the amount I used to, my appetite is still small but I fall into two of your categories I think. I do graze too often, and I find my sweet tooth is still there and I am eating too much sugar. I lost near on 6 stone and I have gained back a stone, so I am not near my large size, but I really want to remain small. Any advice?

  2. CAROL says

    June 12, 2017 at 1:42 pm

    You’re certainly not alone Fiona and there’s a little advice in the blog to follow, but I’ll also be covering some strategies later in the week as to how to tackle some of these. Look out for it towards the weekend – it will cover food choices, portion control, emotional eating and tactics for success. Hope you’ll come back to check on them. C x

  3. Penny Bowers says

    June 12, 2017 at 3:29 pm

    Thank you for the encouragement you give us all. Most people do great with their surgeries. I think I’m one of the few exceptions to the rule. I had my surgery in August last year. I did pretty well for about a month then I couldn’t keep anything down, including water. I ended up on TPN (a picc line and a bag with liquid nourishment 24/7). My sense of smell is way off, but I am able to keep food down now. But there are many foods I can’t tolerate because of smell, taste or digestion issues. Have you run into this before? I’ve been encouraged by what I’ve read and since I’m making progress I know this is a very good thing.

  4. Donna Tickner says

    June 12, 2017 at 5:53 pm

    OMG I just read through this and can see myself in all five lol , I’ve had an incredibly tough year what with one thing and another, lost 12.5 stone altogether and have gained a stone back, everyone tells me I look better for the small regain but deep down I am terrified it will get out of hanD. I swing from eating rubbish and grazing to eating nothing just drinking and I feel rubbish , I want to get back in control before all the hard work comes unravelled.

  5. Paula says

    June 13, 2017 at 12:04 pm

    Carol thank you for the tips. I am really enjoying the site. I am day one on the liquid diet and it was very interesting to find out why not to drink. The man explained so simply.. I am one for drinking when eating so I really will not drink now knowing this.

  6. CAROL says

    June 13, 2017 at 3:58 pm

    Glad you have found it all useful and it’s good start off with the right information – you’ll do better that way. The liquid and soft food stages can be challenging but thankfully don’t last long – it will be no time at all before you can enjoy some of the more interesting recipes on the website – unfortunately you still won’t be able to drink with your meals but it’s a small price to pay I’ve found. Good Luck! C x

  7. CAROL says

    June 13, 2017 at 4:03 pm

    As you will have seen from other comments Donna you are not alone and it’s fairly commonplace to experience some regain but far better if you can stop the rise before it gets out of hand. I’ll be covering some strategies later this week to stop the rot. Come back and have a look at them and see if they could help you. C x

  8. Sandra McGown says

    June 15, 2017 at 10:18 am

    Hi Carol
    The Red Flags couldn’t have come at a better time for me — 6 month post op, with 84% of my stomach removed, living in Turkey, my blood pressure shot up to 228 though not getting enough liquid and kidneys overworking. Your Red Flags helped me to inform the hospital what was wrong and get the right treatment. Thank you. Any further tips to assist me would be be most appreciated.
    Regards
    Sandra

  9. CAROL says

    June 15, 2017 at 10:35 am

    Heavens Sandra sounds like you’ve been in the wars and I’m so pleased to hear you’re not getting some help to try and resolve these issues. We’ll be looking at some strategies to help with these red flags later this week. Do come back and have a look at them – some might help. C x

  10. carol says

    August 6, 2017 at 10:08 am

    Thank you for your advice. It’s been good reading. I am not a run of the mill post op patient. I have had a number of complications, issues/surgeries post op. I had a gastric bypass 1 year ago. I have lost 50kg and look great. Well I think so BUT I have to eat little an often due to being so sick for so long. I also have been told I need to put on at least 5kg. How can someone who has been over-weight and now lost it convince herself to put on weight when all they ever wanted was to lose weight. I feel like I’m forever grazing and developing bad habits. How can I get back to 3 meals a day and eat enough to fulfil my daily requirements an keep it down.

  11. CAROL says

    August 7, 2017 at 12:57 pm

    Hi Carol, it is tough to try and change a mindset for sure but I think your dietitian could help with some ideas for more calorie dense food so that you don’t fall into the snacking and grazing mentality. I found that by increasing my healthy fats in a meal I could eat more calories without the huge quantity upload. Just adding a little oil to things, a spoonful of thick yogurt or s little soft cheese helped. Likewise if I find the scales creeping up then I cut back on these to lose any regain. Don’t be tempted to ‘cash in’ on calories from snack type foods like chips, crisps, biscuits, cookies and crackers because they often don’t have much great nutrition and can become addictive slider-type foods. I have a number of bean type pates and pastes that I have with cucumber slices for example that help between meals and seems to help enormously. C x

  12. Heather says

    April 3, 2018 at 12:36 pm

    Positively me ALL 5 –which assisted in me regaining 65# of my 95$ WLS loss 🙁

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