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We eat for nutrients, pleasure, and a dysfunctional need for love. It’s ok to eat for pleasure and we should. So ask yourself before eating: Am I eating for nutrients, pleasure, or a dysfunctional need for love?
Ask yourself one hour after eating how you feel? Do you feel like hitting the couch or doing something? When you pleasure yourself, how do you feel one hour after eating or the next morning? Can you limit your pleasure moments so that later you feel good? Dysfunctional love feels bad. And with food that bad feeling is noticeable one hour after eating and the next morning.
Is there a way to show love to yourself that is not dysfunctional? If its touch, go get a massage. If its acts of service, go get your car washed. If its words of affirmation, tell yourself how much you love yourself.
One of the posts showed a penne pasta recipe that had one stick of butter, one pint of heavy cream, one cup of Parmesan cheese, and cream cheese.
Can you eat a few bites and waste the rest? When you stop at a few bites you feel better one hour after eating. When you finish the plate, you will feel sluggish and foggy headed.
You choose.
Modifying Recipes
Everyone has their favorite recipe that they thoroughly enjoyed prior to weight loss surgery. But, just because you had weight loss surgery doesn’t mean you can’t still enjoy your old favorites. By modifying your favorite recipes, you can ensure that you will continue to enjoy them and continue on your path to wellness.
Modifying recipes is not an exact science and sometimes takes a couple test runs, but it can be fun! There are a couple things that will help you as you embark on modifying your family favorite:
Ways to Modify Recipes. The first thing you can consider is the cooking technique used. Making an item healthier doesn’t always mean changing the ingredients. Consider using some of the below low-fat methods:
Sautéing More Healthfully. You can still sauté in a healthy way. Recipes typically call for two tablespoons of fat and types of fats that aren’t healthy, like butter. You can reduce the amount and types of fat you use. First start with a non-stick skillet. By using non-stick skillets, some foods may not require additional fat, such as scrambling eggs. However, you can use vegetable sprays to coat the pan without adding too much fat. Try using canola oil or olive oil as your main types of sprays. You can also use a pastry brush to distribute oil on your foods, such as vegetables, helping to control the amount of fat in your food.
Consider using items other than fat for sautéing. Items like broth, table wine, water, or lemon juice make great substitutes. Also, you can microwave your vegetables like onions and mushrooms instead of sautéing. You can then add the items to the rest of your meal, such as an omelet or pasta dish.
Modifiying Salad Dressings. Try making your own salad dressing to reduce fat and sodium. Dressings that incorporate balsamic vinegar are good options because vinegar is low in calories and contains virtually no sodium or fat. Use minimal oil to maintain the healthiness in your own salad dressing.
What About Nuts. Should you keep nuts in a recipe? Nuts contribute quite a significant amount of fat and calories to the recipe. It is recommended to use them sparingly. However, the good news is that most nuts contain heart healthy fats and some protein. If you decide to use nuts, you may want to use ¼ to 1/3 the amount that the recipe calls for originally. Consider roasting the nuts for a more intense flavor. Roast nuts in the oven for 10 minutes at 350oF. Or you can dry roast them in a cast iron skillet over medium heat until browned. The more intense flavor of a roasted nut allows you to use fewer nuts in your recipe.
Varying Dairy Products. Many recipes incorporate cheese in recipes. Cheese can add a significant amount of calories and fat to a dish. When slashing calories from your eating plan, it doesn’t mean you have to eliminate cheese completely. Considering modifying the recipe instead. Considering mixing non-fat cheeses with reduced-fat cheeses to decrease the fat without compromising the flavor. You can also consider using soy cheese to cut down on the amount of saturated fat (bad fat) you consume. Another strategy is to use shredded cheese, which melts quicker and can allow you to use less cheese. Also, using stronger flavored cheeses in place of mild cheeses allows you to use less cheese as well.
Consider using yogurt cheese, which has 10 calories per tablespoon when using non-fat yogurt. You can make yogurt cheese at home by straining the whey out of the yogurt to make a “soft” cheese. Avoid using yogurts that contain thickeners like gelatin, modified food starch, or vegetable gums (usually found in light yogurts), which don’t allow the release of whey. Line a colander or sieve with cheesecloth or a coffee filter and place in/over a bowl. Pour in the low-fat or non-fat yogurt and cover with plastic wrap. Allow to drain for at least 12 hours. Transfer the new “soft cheese” to a separate container and use as a base for savory appetizers, spreads for breads, or substitute for sour cream or whipped cream desserts.
Substitute the Sour Cream. Sour cream is a smooth, dense product. However, it will increase your calories and fat dramatically. One cup of sour cream has about 490 calories and 48 grams of fat! Try substituting with low-fat yogurt, non-fat yogurt, or fat-free sour cream. You can also use non-fat greek yogurt, which makes a fantastic substitute for sour cream.
Healthier Milk. Instead of whole milk, use skim milk to save about 60 calories and 8 grams of fat, which is mostly saturated fat. You can also get evaporated skim milk instead of evaporated whole milk saving 140 calories and 20 grams of fat. To make a creamy sauce, mix 1-2 tablespoons of cornstarch or evaporated skim milk creating a “thick” cream; add to one cup of heated skim milk to make a creamy sauce. Season to taste with herbs and/or a small amount of grated cheese.
Baking More Healthfully. Fat, which is often in baked goods, adds a dramatic amount of calories and are often the saturated fats. You can make slight modifications to lower the fat and not destroy the recipe. First consider reducing the amount of shortening, margarine, or butter by a third or even a half. You can also try using light butter instead of other types of fats. In recipes that call for oil, you can use half the amount of oil and your recipe will most likely will taste the same. You can also decrease the fat in baked goods, by replacing the fat eliminated with the same amount of the following:
When using some of the above to replace some of the fat in the recipe, use a lower oven temperature for baking. This will help to preserve the moisture.
Exciting Eggs. You can reduce the amount of fat, cholesterol, and calories in recipes by using egg whites or egg substitutes for the whole egg. Use two egg whites for the first whole egg in baking and one egg white for each additional egg. Consider using an egg substitute product; the container will tell you the exact conversion.
Baking Chocolate. One ounce of baking chocolate adds 140 calories and 15 grams of fat. Consider replacing with 3 tablespoons of unsweetened cocoa powder and 1 tablespoon of oil. This combination has less saturated fat, but the calories and total fat are about the same. Another option is to use 3 tablespoons of unsweetened cocoa powder with 2 teaspoons of water. This substitution works for cakes, brownies, and puddings. Another option is they now make sugar-free chocolate chips that can be used in recipes.
Lowering Sugar Content. Using less sugar requires some experimentation since this ingredient helps retain proper texture and appealing flavor. You may need to try the recipe several times before perfecting it. Start by reducing the sugar by 1/3 to ½ the amount. If you cut the sugar by half, then decrease the liquid by ¼ cup. You can replace the sugar that has been eliminated by adding non-fat dry milk powder in cookie, bar, and cake recipes. Try using fruits for natural sweetness in cookies, cakes, and quick breads. Good fruit choices include raisins, dried apricots, dates, apples, and bananas. Another option is to use fruit juice instead of sugar and liquids (e.g., milk). If it is an acidic juice, add ½ teaspoon baking soda per cup of liquid. To reduce calories significantly, consider baking with sugar substitutes. Some options might include Splenda and stevia products. Also, enhance the recipe calorie-free, by spicing with cinnamon, allspice, nutmeg, cloves, etc. Extracts also work well (vanilla, lemon, almond, and chocolate).
Decrease Sodium and Salt. Many dishes do not require a lot of salt to make them taste good. If your recipe calls for salt, but you are trying to keep your sodium intake low, consider making these alterations. Start by using half of what it is called for in the recipe. Continue to reduce the amount until you find the minimal amount needed to season the recipe. Replace the salt with lemon or lime juice, flavored vinegar, fresh onion or garlic, onion or garlic powder, pepper, chili powder or ginger. Please note your taste for salt will diminish as you gradually decrease the amount you use.
Try to be creative and experimental in the kitchen so that you are able to strike a balance between healthful and exciting recipes. If it doesn’t work the first time, don’t give up, make another modification and try again. Just remember to write down the modifications as you do them, so you will remember for the next attempt.
Our resistance to change will be our main obstacle to our success. If you give up the resistance you will find them easy. However, giving up the resistance is not easy. Our eating habits did not develop overnight and will not resolve overnight.
You will need to develop the mindset to embrace your resistance and chip away at learning these rules. This is the first and most important step to fitting into those skinny jeans. Learning the nutritional value of food is impor- tant, but put all your focus and energy here first.
Think back to a recent outing, event, vacation, family crisis or just a busy week. We live in a time where there is event after event after event. We all have them. Most likely if you had spent months developing the mindset to follow these rules, one, two or all of these events would have sabotaged your rule following. This is not a good time to beat yourself up. It is a time to look back and ask yourself, what could I have done differently?
What im- personal tool or technique could I use to allow myself to follow rules in any of these situations? Set yourself up for success next time. And if it was un- avoidable – and sometimes they are – then celebrate your understanding of the importance of these rules and know how to get back on track.
I have been a certified scuba diver since 1972. One of the key concepts is plan your dive and dive your plan. It also applies to long term weight loss surgery success.
In scuba diving it saves lives. By following success habits and doing what it takes to fit into those skinny jeans – it may save your life as well.
I ask patients, “Are you good planners, maybe even a little obsessive about planning?” It’s fun to watch their body language. Usually the patient, and sometimes the friend or family member start nodding their heads up and down in agreement. These patients easily plan, and in general do very well with long term success.
Most of us have good intentions about planning our day, but we act hap-hazard. We live in a very busy time. We need to go to bed at night and know exactly when and what we are going to eat the next day. Set your cell phone alarm to go off when it is a planned eating time and eat – hungry or not. Do it just like it was an important pill. Adjust those eating times for the next day if needed. The most important part is planning your meals and following your plan.
Go no more than four hours without eating a planned something
Most people need a small meal mid-morning, mid-afternoon, or both. It all depends on when you get up, when you can schedule lunch, when you can schedule dinner and when you go to bed. I have many patients that are school teachers and often their scheduled lunch is 10:30 A.M. And then the family eats around 7:00 P.M. They definitely need something mid-afternoon, even if it’s just something like half a protein bar or half a banana with peanut butter. Otherwise they will be too hungry.
You should go no more than four hours without eating. Once you have got- ten to the point of being crazy starving hungry you have already messed up.
It is then time to learn from your mistake and plan better for tomorrow. It is not a time to blame yourself for being weak, but a time to learn from your mistake and take action tomorrow. Chip away at it and eventually it will be- come what you do, a habit that you don’t even need to think about.
No unplanned eating
We have to eliminate unplanned eating for long term success. No un- planned eating. No unplanned eating. No unplanned eating has to be the mindset to eliminate this sneaky habit. I call snacking unplanned eating – the see food eat food diet.
You should not let food touch your fingers unless it is a scheduled meal time. You may have three, four, or five scheduled meal times, all OK de- pending on your lifestyle at the time.
It seems counter intuitive. What is the difference between eating several things unplanned through the day and planning several times to eat? It is the mindset much like the day to day spending of pennies on things of little or no value. They add up and cost us dearly.
We have to eliminate unplanned eating for long term success.
No liquid calories
If you can put something with calories in your hand and it will eventually flow out of your hand, then it is in the physical state of a liquid. Liquid calo- ries sneak up on us. Examples of liquid calories are soup, milk, orange juice, sweet tea, and alcohol.
So what to drink? Water, unsweetened tea, or Crystal Light – anything without calories built in are ideal. We want to spend our food calories on food that gives us something of value.
Visualize food that gives up fullness and nutrition. Liquid calories rarely have the fiber built into whole foods. Tell yourself you will not drink any- thing with calories.
And yes there are exceptions.
Do not drink with your meals
Liquid calories go in and out of the stomach pouch or sleeve very quickly and at best provide a brief sensation of fullness. Have you ever watched an eating contest on TV? The method they use to eat a gazillion hot dogs is to drink lots of water in the process. They simply wash the food out of their stomach and into the rest of their gastrointestinal tract which has lots of room. This is not healthy nor is it the way we were built to eat, but the way to win the contest.
We need all the calories that we eat to be calories that make us feel full and satisfied for about four hours. We need to eat solid food that makes us full and satisfied on a small volume of food. Meats that are moist and very chew- able are good choices along with a couple small servings of whole foods.
The most important value we can get while eating is getting full and satis- fied on a small volume of food that lasts for four hours. I think that fullness sends messages to our brain that tells it to burn calories instead of conserving calories. In other words, a whole different biochemical pathway goes into action.
Avoid carbonated beverages, diet or otherwise
Have you ever noticed all the people that are overweight drinking diet car- bonated soft drinks? Have you also noticed how those people that are fit rarely drink diet soft drinks? I do not have a scientific reason to suggest why you should not drink them. But simple observation tells us the diet drinks do not work in our favor.
I think the carbonation tickles the stomach making it less sensitive to full- ness and the sweetness drives us to snacking. And more importantly, right or wrong about this theory, this is one of a small number of rules to follow that are associated with success. You need to develop the habit of following the simple rules and not pick and choose. Possibly the most important thing we can do is to learn to give up the resistance to following rules. This is a good time to test your self.
Learn to feel what fullness is
In the chapter on inner secrets I talk about the amygdala and how when we focus on something, we can become very aware of it. So is true with the sen- sation of fullness. If for example we wanted to become more sensitive to touch, we could do so by focusing on touch. Take your index finger tip and touch things around you. Think of colors as you touch, translating to your touch; red, blue, or orange. Very quickly your finger tip touch would become more sensitive. Learning to become aware of the sensation of fullness is a very important tool for success.
I remember about twenty years ago eating at a fast food place with one of my fellow chief residents and good friend. I sat in amazement as he told me he had never felt full in his life. At the time, I thought that was very odd. It turns out to be common, but in different degrees.
Think in terms of having an ongoing conversation with your stomach as if it were a friend and keeping asking, “Hey, stomach down there, wake up, how do you feel? Start talking to me. Was that one bite too many?” Pay attention to how feeling satisfied, but not overly full feels. Visualize it and tell your brain you want to remember that sensation.
Get comfortable with the wasting food rule
We live in a time of food abundance, yet we have difficulty wasting food. We have to learn to get comfortable wasting food for success. So at every meal try wasting some food. Over time the habit becomes easy, at first there is resistance. No matter how good something tastes, never eat all of it. That inner drive to clean your plate is present in all of us. We blame it on our mothers and fathers telling us to clean our plate. I however feel we are hard wired from our ancient ancestors who had to eat all they could eat when it was available because it may not be available tomorrow.
The habit of wasting food will help you learn proper portions to eat. The habit of learning to feel full and satisfied on four to six ounces of food is important to long term success. It is portion control and it works.
Eat slowly
If you are a fast eater, learning to eat slower will take time and practice and will not happen over-night. It will however help you have long term suc- cess and is worth the effort. So what to do? Try letting go of whatever tool you are eating with after every bite, whether is a spoon or fork, chopsticks, or something you are eating with your hands. Set it down. You will feel an inner sigh of relief and relaxation.
Think of this almost like you are taking recess at school as a child, recess from intensely pursuing your goal. Feel that. Remember that. We tend to be chewing one bite and have the next bite locked and loaded ready to enter our mouths as soon as we swallow. If setting your utensil or food down for a recess does not get the job done, then try eating with child size utensils or better yet, switching to your non-dominate hand. Switching to your non- dominate hand has the extra benefit of rapidly teaching you to be ambidex- trous,
while serving the purpose of slowing you down. Never mind the fact that it might add a little humor to your meal.
Celebrate your success
These habits do not develop overnight, but stay focused, chip away at them and celebrate your success of fitting into those skinny jeans. You can do it!
Leslie is a mother of two boys 6 and 8 years of age. She came to my office to learn more about the sleeve gastrectomy. Not long into the conversation she began crying and saying that she was sorry that she did not have the will power to do it on her own and had to do something.
She said she had tried very hard with every diet imaginable, but she just could not do it. She did not have the energy to be a good mother and was worried about her health and possibly not surviving to see her boys grow up.
I watched as she blamed herself over and over. It was like she was defeated and in defeat would have to have an operation. I began talking to her about blame and how it works against her. I emphasized that nearly zero people walking in her shoes can accomplish her goal without help. We talked about how this is not a character weakness but something much more complex.
The simple observation of people she knows or those she has heard about who have struggled with losing weight, should tell her it is nearly impossible to do on her own, otherwise more people would be successful. It is intuitively obvious. This feeling of blame and the belief that they should be able to do it on their own is the essence of why we only perform weight loss surgery on one percent of those that would benefit, despite the overwhelming evi- dence that it works.
I hear patients blame themselves as they are trying to learn healthy eating habits. The energy in our bodies is much like money. We can control where we spend it. We can control whether we spend it on something of value or not. Spending our energy on blame is wasted energy on something that does not help us. We need to focus on what we can control and use the tools such as impersonal techniques to learn new and give up old eating habits. After weight loss surgery these are very do-able.
Most people trying to lose weight spend their energy chasing new magic methods of weight loss and blaming themselves for not having the character or will power to do it. And neither practice gives us anything of value. This is the essence of why most people cannot lose weight. They are spending their energy on something that does not work.
I want to talk about tools. Tools have great value when trying to accomplish a task. Just sit back and close your eyes for a moment and walk through your day thinking of all the tools you use and how difficult it would be without them. Don’t forget about that early morning cup of coffee and that early morning trip to the toilet. Every aspect of our lives uses tools to get the job done.
I like the metaphor that weight loss surgery is a tool. Tools are impersonal. Hopefully your surgeon is personable, but the actual technique of surgery is impersonal, much like working on a machine. And the biochemical pathways are impersonal much like baking bread where the right ingredients and right temperature at the right time is needed for the bread to rise.
Weight loss surgery and the successful habits involved in the eating rules are tools to help you lose your excess weight. We are all the same and all different. We are the same that we all need tools to accomplish a complex task like losing excess weight. However we are all different enough that we need to tailor which surgery is best for you and tweak the eating rules and health habits so they fit your life.
The failures following weight loss surgery are small in number – but real. We need a shovel to dig a hole, and most can do it, but some people can’t dig a hole even in sand with a tool like a shovel.
The secret to long term weight loss surgery success begins with tapping into the strong emotions and feelings of what life is like after losing weight. Using those emotions as a key to open the door to basic changes in our day to day eating is instrumental for our success. The result is getting rid of that nasty thing called resistance, allowing us to accomplish something that is simple – that we know is right for us – and very do-able.
I tell patients that if they were given a million dollars to follow some of these eating rules they would think it was the easiest million possible. When asked, my patients agree – it would be an easy million. But in contrast to try- ing to lose the weight without weight loss surgery as a tool, it would be nearly impossible in the long term. Learning healthy eating habits is very do-able. Losing 50 or more pounds and keeping it off long term without weight loss surgery is not.
By the way, Leslie did have a sleeve gastrectomy and lost her excess weight. Now she says, “Why did I wait so long!”
Our lives are like a movie where we get to write the script.
Imagine for a moment what it would feel like to:
We all sometimes talk in the abstract, “I just feel better.” But to really know what it’s like to fit into those skinny jeans we need to capture and embrace the emotion that goes along with it, using very specific words of exactly what is better. That’s when the magic occurs.
I ask patients, “Now that you have lost weight, what is it that is better?” They all start off with something abstract like, “Well, I just feel better”. That’s when I push for specifics. These are those stories – the stories that have moved me, the stories that inspired this book, the stories about the changes in peoples’ lives after losing the weight.
A buddy of mine had a lap band and the result was that he no longer suf- fered from sleep apnea. I asked him the question.
“I’ll tell you what it’s like - it’s like waking up feeling ten years younger!”
Carol has been very successful with her lap band. She is a little OCD (ob- sessive compulsive disorder) and for her, following rules is easy. I asked her the question. Her answer as usual, was, “I just feel better.” Then I pushed. Suddenly her lips widened and turned up in a smile, her face developed a glow, her voice became louder and full of infliction.
“I can cross my legs for the first time!”
I get lots of stories about being able to buy fashionable clothes off the rack. Linda decided to have a surgery because of unbearable knee pain, hyperten- sion, and sleep apnea. But when I asked her the question she said enthusias- tically as her voice softened and her eyes began to have that look that she was looking inside and re-visiting and feeling the emotion.
“I went to Victoria Secret and was able to buy a bra off the rack.”
Terri is a thirty five year old mother, wife, and nurse. Before surgery she carried herself with the posture of someone who felt good about herself.
And even though she did not have as much weight to lose as most, she felt her weight was bothering her. She is self-motivated and has will power, but she had tried every diet known to man and could not lose the weight.
She had family members with much more severe weight problems and was frightened of getting bigger. When I asked her the question she leaned for- ward, her eyes softened but intense and answered me.
“My sex life is better!”
Terri went on the say that she and her husband love each other very much and he never said anything or did anything for her to think otherwise. She explained, “I felt better about the way I looked, I had more energy and en- thusiasm and it showed in the bedroom.” I could visualize a big smile on her husband’s face.
She continued to beam and the intensity she radiated totally filled the room. I too could feel that energy. It was like she was a teenager again.
David is a good hearted man. He is a husband, father, and home builder. His faith is very important to him and you can sense how that guides his heart. His weight was causing unbearable knee pain and his high blood pres- sure was getting worse.
He intuitively knew that it did not make sense to have knee surgery, that what he needed was to get all that weight off those knees. So he decided to have surgery and has been very successful maintaining an excellent weight.
His hypertension and unbearable knee pain was resolved. So when I pushed him with the question he began talking about his boys. His boys play base- ball. They not only play it, they live and breathe it.
He talked with pride about now being their coach, no longer sitting in the stands or on the fence. He is participating. His answer to the question was heartwarming.
“I can finally be the father that in my heart was there. I am no longer held back by pain and shortness of breath.”
Christine and her husband had been married for ten years. They both came from big families and having children and being parents was important to both of them. There was no doubt that they loved each other very much. But they had been unable to get pregnant. Christine had some hormonal issues that her gynecologist was working on but without success.
On the first office visit the tension the situation was causing Christine was obvious. She decided to have a sleeve gastrectomy and lost her excess weight. Two years later she walked into the office carrying the car seat with her newborn baby girl, Cari. I asked her the question with a smile knowing quite well how she would answer.
“I get to be a mother.”
It is one of those little known secrets that when women lose significant weight they become very fertile. Every year some patient walks into the of- fice with her twenty-something year old daughter helping her carry her new born baby. After many years without using contraception and not getting pregnant, and now in their forties, they don’t believe it can happen. But it does. At first they are in shock, but then they feel re-born themselves.
Mike is an audio sound specialist. He came to the office weighing 350 pounds. He has many jobs, but one is traveling with a promotional speaker. He always had a moment of fear as he entered the plane. He was uncertain how the seat belt would or would not buckle, and how the person sitting be- side him would respond.
Carrying luggage was a chore. He would easily get short of breath and have to stop and rest. He was too proud to ride a cart. He had a lot of equipment to set up and that was a challenge.
He had difficulty staying awake during the talks because his sleep apnea was bad and he rarely had a good night’s sleep. He would listen to the self- help talks and ask himself why? Why can’t I have what it takes to lose weight? What’s wrong with me?
He had a gastric bypass and has lost his excess weight and resolved his sleep apnea.
Andrea sprung to action and saved her daughter from the car. She said from a deep place in her heart,
“That moment was very special to me, I was able to protect my daughter, knowing quite well that before surgery I would have been incapable of that feat.”
Breaking chairs happens when you are very over weight. Mary told me that she is more outgoing and goes more places. Before weight loss she felt people looked and watched her differently. When I asked the question and pushed for specifics, she told me,
“I was able to go to a cookout and sit in a lounge chair with no worry if it was going to break. And I did not feel like people were watching me as I sat down. And I noticed that no only did I not break the chair, there was room left over. It really felt good.”
Feeling emotion is a chemical event in our bodies. An emotional experience is very hard to forget. So what is going on when patients regain weight after surgery? We get lazy and we forget where we were.
With the gastric bypass and the sleeve gastrectomy there are chemicals changes that stabilize the way your body handles food. In the beginning these operations do most of the work for you. This is the easiest time ever to es- tablish good eating habits. It is easy and very do-able.
We are all resistant to change. Giving up the resistance to change your eat- ing habits is the obstacle preventing you from reaching your goal of long term weight loss success. How do you give up resistance? You tap into the emotions of what that thing or things are that made you feel better, those specific things – and feel them.
Whether it’s fitting into skinny jeans or buckling your seatbelt, remember them, close your eyes and feel them deeply. Feel the way your body feels as you remember. Re-live it over and over.
What you will find is that there is less resistance to doing what is needed for long term success.
