By Kishani Turner
BARIATRIC DIETITIAN
For most it is long journey to the point of considering or undertaking bariatric surgery. Many feel like they have failed having exhausted every diet or weight loss measure. Others have given up exhausted by monitoring their weight, intake & exercise, let alone the plethora of confusing information.
If only it were as simple as energy (food & drink= calories) in VS energy (exercise) out. This is what the weight loss/exercise industry would have us believe and how some consider bariatric surgery (less in). With the implication that it’s your fault or lack of will power that limits your success. The truth is that there are missing pieces to this equation.
If you are like most people who make the major decision to undertake bariatric surgery you intend on having a successful outcome and to do what it takes.
It is important to address why losing weight or maintaining weight loss has been difficult- bariatric surgery does not magically make these go away!
You will have heard the catch phrase “bariatric surgery is a tool”.
Here at Sunshine Coast Medical Weight Loss Centre we believe Bariatric surgery is a tool to mindfulness.
Mindfulness is commonly thrown around but what does it mean? Mindfulness is a Buddhist tradition which has been adopted & adapted over time. Mindfulness is deliberately paying attention non- judgementally. It helps us disengage from habitual behaviours.
Ah , yes…. but what does that mean I hear you say?
In short- “If you always do what you always did, then you always get what you always got”
Without embracing your tool bariatric surgery can feel like a permanent diet that continues to consume your life. Often resulting in maladaptive eating habits & emotional eating issues such as:
- Eating too quickly, taking large bites, not chewing thoroughly
- Eating while distracted, leading to overconsumption
- Not savouring food and, therefore, having difficulty feeling satisfied with small volumes of food
- Eating too much, leading to discomfort, vomiting, and/or distention of the pouch
- Grazing or frequently eating small amounts of food
- Consuming high-calorie soft foods and liquids that do not provide satiety
- Emotional eating or eating for affect regulation
- Continuing to consume certain foods despite dumping syndrome
- Preoccupation with food
- Not consuming enough protein and other nutrient-rich foods
- Struggling to establish consistent physical activity
- Feeling deprived, guilty, or left-out in social situations
- Weight regain and weight cycling
Learning to eat mindfully allows balancing eating for nourishment & enjoyment, freeing up your energy & focus on living life.
Mindful eating is eating with purpose & awareness.
When we were very young we intuitively knew when we were full and learned how to chew our food.
Often as adults we over ride/ stop listening to our intuition as our eating habits are a result of our childhood/ upbringing, lifestyle (work, family, stress etc.), dieting and emotions.
How often have you: Over-eaten or been unable to leave food on your plate? Eaten foods that later give you an energy slump or made you feel unwell? Been “good” all day only to blow out later?
Bariatric surgery is a tool to re-set. In the early post- surgery stages you literally go back to eating like a baby.
This allows healing, minimises symptoms such as vomiting, reduces your risk of leak and allows you to get used to your new stomach size.
By 6 months (this is often when hunger/ appetite return – the honeymoon phase is over) it is important to be able to recognise hunger cues & act appropriately.
You will need to build awareness so your eating choices & amounts will become in tune with your body’s needs.
Your tool will give you feed back about your eating style – your bite size, pace of eating, chewing skills and amount/ volume you eat.
Your attention to food choices, preparation & eating is needed to prevent unwanted symptoms and poor weight loss or weight regain
With your new stomach/ pouch you need to relearn hunger, fullness, nourishing foods & changes in taste.
MINDFUL EATING TOOL KIT
Go Slow:
- Use small utensils eg: teaspoon, cocktail fork
- Cut food to thumb nail size pieces (use a paring knife)
- Cut as you go
- Nibble vs bite
- Put utensils or food down between mouthfuls
- Chew, chew, chew
- Pause and check for subtle early signals of satiety-sigh, hiccough, feeling comfortable
Slow eating prevents unwanted outcomes ( reflux, vomiting, over-eating/ stretching stomach or undereating/ grazing), allows time to recognise comfortably full (vs full / overfull) & savour food leading to satisfaction.
Eat regularly & small serves :
If you go too long without eating you may feel unwell or too hungry by your next meal often resulting in eating too fast, past the point of comfortably full and/ or poor food choices (usually high in fat/ sugar)
- It can be helpful to set alarms/ reminders if you forget to eat
- In the early stages it is useful to measure your serves (it can take a long time for your eyes & mind to adjust to your new stomach size)- use a measuring cup. This volume is a maximum so you don’t accidentally over eat BUT it is important you listen to your full signal- check in “ Am I comfortable, could I stop here?” vs chasing full
- Over time it is helpful to find crockery that will hold your volume eg: ramekin , Japanese bowl, a beautiful teacup saucer (take the focus off measuring/ weighing until you internalize you mechanism of portion control)
- As you are having small quantities now, you really want to enjoy it! Make your eating experience pleasurable with gorgeous plates/ bowls. Think fine dining experience except now you won’t need to eat before or after to fill you up
- Nibble vs bite
- 3 meals (breakfast, lunch & dinner) will assists adequate nutrition, metabolism & energy through the day
- 2 mid meal snacks – adding small snacks is preferable to having larger portions at meals which can stretch your stomach/ pouch. As your serves are small these are needed to assist energy through the day and are an opportunity for protein & nutrition
These are dedicated meals & snacks SO whatever is not consumed in 20-30min is put away for the next opportunity or thrown away. If you extend meals/ snacks out, eat every hour or constantly have little amounts, you are grazing. This results in consuming too many calories over the day/ night without feeling full and satisfied.
Limit Distractions:
You can’t eat slowly, pay attention to how full you are, let alone enjoy/ taste your food which results in reduced satisfaction & increased symptoms if you are:
- Eating on the run
- Eating whilst driving, working
- Eating whilst watching TV, on devices
- Some find eating out challenging as there can be a lot going on – focus on slow eating, enjoy conversation between mouthful & taste your food
Hunger ( nourishment- physical) vs craving ( enjoyment- head):
Many of our clients at SCMWL describe a changed relationship with food from “Living to Eat” to “ Eat to live”. This highlights a shift from food having power to being empowered around food.
- Hunger is a physical cue- an emotionally neutral body function. This is best satisfied with protein & nutrient rich foods.
- You may need to learn your hunger cues- growling or grumbling in the stomach, trouble concentrating, loss of energy, irritability/ crankiness, light headedness
- Letting yourself get too hungry (by skipping meals or snacks or delaying these) can lead to eating quickly, poor choices (high calorie foods)
- Support yourself by planning ahead, have a supply of food at work, take left overs
- Learning about nutrition, particularly how it applies to bariatric surgery is important. (Refer to food composition chart below)
- Buy nourishing foods, play with flavours & cooking
- Pay attention to how food makes you feel – energy, satisfaction/ how long it holds you not calories.
- Focus on what you can eat comfortably rather than what you can no longer eat
Cravings are more about enjoyment and less about physical hunger
- These can be confused especially if meal/ snacks skipped.
- It can be useful to look at the set- up: eating too quickly/ on the run or skipping, getting too tired, angry, lonely, stressed etc
- Cravings tend to come & go – try distraction, “ride the wave”. If cravings persist then have the food eaten mindfully and stop when it is no longer pleasurable
- It is important to explore foods as taste can change due to surgery and/ or eating mindfully – what was once pleasurable may be no longer. Alternatively if you are not missing something or it is no longer enjoyable why have it? Especially when your stomach/ pouch is small. Sometimes it is more of a head-game (remember you did not have surgery on your brain).
If you are finding this challenging it is important to see your dietitian/ psychologist we are here to help
Non-Hungry eating:
We are human beings and we eat for a range of reasons (celebration, comfort & pleasure, stress, reward, procrastination, distraction etc). It is normal to engage in some non-hungry eating.
- It is a problem when it is a primary coping mechanism.
- Non- hungry eating can include cravings, grazing, picking, overeating, bingeing. It can occur at meal times, between meals & even during the night.
- When we do too much non-hungry eating (large amounts – not necessarily volume ,over a significant period of time) it can get our eating out of balance causing weight gain.
- Non-hungry eating can be about changing your emotional state
- Obviously reducing non- hungry eating is desirable but the opportunity is to look at WHY you eat when you are not hungry which allows you to develop specific strategies for sustained change
- Unchecked non-hungry eating/ drinking is what can limit success – your yard stick is do you have control over it? Or does it have control over you? Christmas, birthday’s anniversaries come & they go. Celebrations, rewards and comfort can be blips on the radar when you have a balanced relationship with food & your body
- At Sunshine Coast Medical Weight Loss Centre we believe that bariatric surgery creates the space to make a choice vs reaction
- Inviting you to trust & experiment vs feeling deprived of loved foods as it gives you the power to choose foods that are nourishing, pleasurable & lack uncomfortable side- effects
- After years of over-riding eating intuition, dieting or being on auto- pilot it can be difficult to know what hunger is, fullness & cravings. Some may be afraid of these from years of deprivation, feeling out of control.
- Remember it’s not wrong to enjoy food – all food is morally neutral. It is common for dieters to think of “good vs bad” food & label themselves as “bad” and fear cravings or “bad” foods can be eaten in moderation. When we make peace with food it loses its power over us.
To achieve your goals it’s about balancing nutritional knowledge (in particular how it applies to your bariatric surgery) with eating intuition and disengage from habitual, unsatisfying & unskilful habits/ behaviours.
- Ask your self is this (food/ behaviour) supporting my goals?
- It can be useful to check in on your goals- Unfortunately it is natural in our society to have a weight (kg or clothes size goal) BUT have you noticed how the numbers are not what makes you happy? It’s what they translate into- energy, confidence, mobility, health, fitness etc.
- Focusing on numbers can influence your eating & sabotage your success especially when you are comparing yours to somebody else’s.
- Focus on non-scale goals. it is important to celebrate the journey on the way & for some if their goals have been achieved they can lose their motivation & revert to old habits as they feel they have reached their destination.
- Revising goals & setting new ones can keep you anchored/ on your path.
It can be normal to revert to old habits, especially as life gets back to normal. There is no right or wrong about it – it’s part of being human. When you are on autopilot mode it is likely to be old habits. It takes mindfulness/ awareness to recognise the detour and gently return to your healthy path. This is part of learning.
Some may travel along beautifully for years until something happens (called life) that takes your energy & attention so the newer habit falls by the way side (the totem pole of priority changes). It takes mindfulness to determine which part of the equation is missing.
A part of the equation that is important for successful weight loss but more importantly well – being is exercise. Currently there is a strong movement which really is eating/ exercising & body disorder masquerading as health & fitness – BE mindful. Exercise in moderation not to excess.
Just as with food- people’s relationship with exercise can be “all or nothing” especially with new found motivation/ results (losing kg’s) this can be an old habit in disguise and can lead to injury, in turn limiting your success. A mindful approach to exercise would be moving in ways that make you feel strong (build muscle, increase flexibility & fitness), is enjoyable & makes you feel good (releases endorphins – the body’s happy hormone, Vit-D exposure) which is reframing the relationship from the past where exercise has often been a means to an end and uncomfortable/ painful.
A final word on comparing yourself with others on social media/forums- sharing, supporting & being supported/ connected with those on the same journey is important. When it stops being an add on to you/ when it takes away then step away. Remember you are you, they are them & none of you are the same ( genetically, backgrounds, environment, lifestyle …. the list goes on) so even if you had your surgery the same day with a similar start weight comparisons are a non- sense . You are on your journey path & they may be walking beside you BUT nobody walks in your shoes. Equally it is important to not judge others.
It would be fair to say all of us are unique & come with our own baggage – genetics, upbringing, lifestyle, food rules (dieting), emotional all of which influence eating & exercise. It will take customising your mindful eating tool kit to achieve & maintain your healthy weight.
The team at Sunshine Coast Medical Weight Loss Centre are here to guide, coach & support you.
Acknowledgements:
If Not Dieting then What? By Dr Rick Kausman
Non Dieting Approach for Dietitians Handbook by Fiona Willer & Fiona Sutherland
Am I Hungry? By Dr Michelle May