I don't know the key to success, but the key to failure is trying to please everybody.
-Bill Cosby
Changing your lifestyle is hard-really hard! I can't begin to tell you how many patients have said to me, "I'm too busy to exercise right now, but I'll get started as soon as my job settles down," or "I'll start eating better as soon as I get my family situation under control." Similarly, many patients have told me, "My job requires that I go out to dinner with clients. I can't just sit there when we're at a fancy restaurant."
Then there is the ultimate rationalization: "I'm going to Italy," or "I'm going on a cruise, so I need for you to take the fluid out of my band so I can eat." Does that sound the least bit logical for someone who has just undergone a surgical procedure to help them lose weight? The reality is that logic often has nothing to do with it. We are creatures of habit, and we don't like change, particularly when the comforts of our lifestyle are challenged.
Six Factors for Success with the Band (And IQ Is Not One of Them)
Steven Greer, Ph.D.
Since I had complete data for 83 patients over a two-year period, I decided I'd try to determine statistically if there were factors we could identify from the psychological testing to help us determine who has a better chance for success with the band. I took the top performers, those in the top half of the group in weight loss, and looked for common patterns or characteristics in that group from the psychological testing. What I found was an equation weighted for six factors that predicted the more successful patients.
First, I want to note that intelligence was not a factor, meaning that there was no strong relationship between the person's estimated IQ and their weight loss. So the good news is that you don't need to be brilliant to do this.
But there were six characteristics from the psychological testing that typified the people who did the best. One factor was being female. Overall, the women were more consistent losers over the two-year period than the men. Women outnumbered the men nearly three to one, which is pretty much what we see with weight-loss programs in general. I have noticed, looking at the numbers, that some of the men seemed to pick up their progress again in year three. My guess from looking at the data is that some of the men had a setback, made an adjustment, and did better in their third year.
The second factor was marital status. People who'd been separated, divorced, or widowed did better than those who'd been married their whole lives or who had never been married. My guess from this is that people who have navigated severe life changes, who have faced some adversity, face up to the demands of the band better.
Third, people who could admit to having some troubles, at least some emotional distress, did better at losing weight. I compared the data with my notes on the one-on-one interviews. The pattern I discovered was that those who seemed invulnerable, who were annoyed at doing psychological testing at all, and said their only problem was that they ate too much, didn't do as well with the band. The ones who could talk some about their problems, most of which were minor, did better in their weight loss. My belief is that the patients who were more willing to admit some vulnerability are more realistic about themselves, more open to receiving help and advice, and accordingly they did better. If you're a paragon of virtue and think you're going to conquer the world, then you probably won't do as well.
The fourth factor of people who did well was that they had lower scores on ego strength, meaning they could admit they had some problems coping. This goes along with the third factor, of being able to admit vulnerability.
People who produced certain psychological test scores suggesting less addictive potential did better with the band. By addictive potential, I mean those who tested as not as susceptible to addiction. I believe that addictive potential shows up in one of two ways. First, there are people who have a strong need for excitement in their lives, and those folks usually find their way to stimulants such as amphetamines.
Second, another whole set of folks feel a need to control negative emotions, especially depression and anxiety. As an example, these people might learn that heroin makes you feel really grand for a while or that alcohol can suppress emotion. So this group tends to adopt chemical substances that remove negative emotion, which for a while leaves them feeling pretty good. As we know, long-term, both of these solutions (for either excitement or controlling emotions) lead down paths that produce problems. But the significance for us, in looking at band patients, is that the people with less addictive potential were more likely to be top performers in their weight loss at the end of two years.
The final variable suggested that a tendency toward a personality that is aggressive, competitive, and more self-absorbed did better with the band. In personality clusters these are Cluster B personality types.
Let me explain. There are three personality clusters. In the extreme, Cluster A people are detached, aloof, and not involved with people. Cluster B types are aggressive, competitive, looking out for number one, self-interested, Type-A personalities. Cluster C personalities are anxious, worried about relationships, and what used to be called "neurotic." Those people who had Cluster B tendencies did better with their weight loss, perhaps because they were more comfortable looking out for themselves.
Let me say that this data is not intended to be absolute. These are just predictors, things we look for to assist us in helping band patients be more successful. This doesn't mean that if you have only some or none of these characteristics, you won't do great having a band.
In conclusion, you don't have to be brilliant to do well with the band. However, it helps if you've gone through some difficult situations and survived. It also helps if you have less of a tendency toward an addictive personality. It's helpful if you can admit you've got problems in your life and perhaps even that there are times when you've contributed to your weight problem. And finally, we found that those who are a little competitive, selfinterested, more confident, and a little more aggressive did better.
Checklist: Characteristics of Top Weight-loss Performers with the AGB over a Two-year Period
The people who did best with the band included
✓ Women, who generally did better than men, especially initially.
✓ Those who had navigated severe personal distress in the past, such as divorce or widowhood.
✓ Those who could admit they face some emotional distress currently.
✓ People who could admit they didn't always cope well, meaning that they could admit they contributed in some way to their obesity.
✓ Those who tested with a lower potential for addiction.
✓ People who tended toward self-interest and more competitive types.
Transformation of Habits
Our lifestyle is composed of a combination of personal habits that we repeat day after day, week after week, and year after year. Going to work, going to lunch, watching television, even what time we go to bed, are all part of our lifestyle. For some, sedentary habits make up their entire lifestyle.
A habit can best be defined as a repeated behavior that has become more or less automatic. Some habits are good, like brushing your teeth. Others are not so good, like always cleaning your plate because your mother told you to, back when you were a child. And, as the old saying goes, "Old habits die hard." Lifestyle habits are particularly hard to break when they involve an overindulgence such as overeating, or any other comfortable activity, such as lounging on the proverbial couch. One of Newton's laws of physics states that "objects at rest tend to stay at rest." I'm sure you can relate, right? But, if you are going to succeed in achieving your weight-loss goals, you must make changes.
The best way to eliminate any old habit is to develop a new habit to take its place. That is precisely what happens to people when they stop smoking without their even being aware. We have all heard people: "As soon as I stopped smoking, I started gaining weight." You may have even experienced this phenomenon yourself. Some people convince themselves that when they gave up cigarettes, something happened to their body that caused them to gain weight for no other reason. Obviously, instead of putting a cigarette to their lips repeatedly throughout the day, they simply used the same habitual hand-to-mouth motion to put food into their mouth. One habit was simply exchanged for the other. Clearly, it doesn't make sense to go back to smoking as part of your effort to lose weight. There really is no "lesser" of those "two evils." The key is to find healthful habits to take the place of unhealthful ones.
Before any new behavior can actually become a habit, it must first be performed once, then repeated over and over. Just because you eat a fruit plate for lunch tomorrow doesn't mean you are going to have the same thing the next day, or next week. You may want it to become a habit, but it won't be until it becomes automatic.
It's a Thinking-Style Change
G. Dick Miller, Psychologist
I hear a lot about the band as a lifestyle change. And it is. But the best, most efficient way to start is with a thinking-style change. I believe that band patients have to start filling their lives with something else besides food, and that starts in their heads.
It's an incredible change when you think about it. I'd say 90 percent of the conversations I have with people I know are around food. We talk about how delicious it is, how much we "love" certain foods, what restaurants we're going to, and on and on. But for a band patient, that needs to change. And some band patients resent that, at least for a while.
But the truth is, we've had this unhealthy thing in our lives, this relationship with food, and it's important to fill our lives with something else. Mental health starts with honest thinking. Stop romanticizing food. Stop organizing your activities around eating. Stop using chow to deal with anxiety. And that starts in your head, with your thinking. The lifestyle change starts with accepting that it would be in your best interest to think differently about food.
We can teach ourselves to believe that food is not a solution to our problems. It's not love. It won't fix us. It was killing us. We don't have to say how much we "love" a dessert or that casserole is to "die for." Instead, we can start talking about food like the necessary fuel it is.
You don't have to change your thinking. You can get a band without working on your thinking and let the restriction attempt to change your behavior enough so you'll change your mind. But it's harder to do it that way because you'll end up dragging along your will and emotions. It's much easier to come into the band lifestyle reframing your thinking from the start.
For those of you who don't know, here's how reframing your thinking works. Let's say you're upset because you know you can't eat the donuts a coworker brought in to work one day. So maybe you find yourself thinking how deprived you feel. You can reframe those thoughts by saying to yourself, "You know, being able to eat all the donuts I wanted wasn't worth all the pain and suffering I felt." Remind yourself how it felt to wedge yourself into an airline seat or not be able to sit in a booth at a restaurant. Or think of your future, how great it will be not to have those extra pounds under your arms or around your middle.
If you do that, will you suddenly just feel better, all glowing and grateful? Not at first. There'll be some discomfort. It will be necessary for you to tolerate those uncomfortable feelings for a while. But they will pass. And overall, you'll have what you've really wanted all along-a healthier you, both mentally and physically.
Getting Your Body in Motion
New behaviors only come about as a result of new thoughts. "I think, therefore I am." Descartes penned those famous words nearly 500 years ago. It remains true today-in order to develop new lifestyle habits you must first change the way you think. Instead of finding reasons why you can't exercise, you need to search for opportunities to exercise. Rather than thinking about all the foods you can't eat, make a list of all the things you like that are nutritious and consistent with the restriction of your band. When your thoughts are negative, your actions will be as well. By thinking positively you will act positively. Results follow action and action follows thought.
Part of your changed thinking process should include setting definite goals for yourself: not just in terms of pounds to lose, but very specific new habits that you wish to develop. Your dietitian can help you outline a diet strategy that can be the foundation of your new eating habits. If one of your goals is to get more exercise, don't just run out and join an exercise gym with a plan to "work out" three days a week. Like many, you may never actually set foot inside the place. (Don't tell me! You've already done that? More than once? You're not alone.)
If your plan is to establish a new exercise habit, first practice the behavior of actually exercising, even if it is just walking around the block every day. Make the activity, not a membership, part of your lifestyle.
As you develop new healthful habits, you'll find many opportunities to expand them. Joining the gym may be one of those expanded efforts, but be realistic as you expand your goals. You are not going to become a marathon runner in the next six weeks. How do you think people who exercise two or three hours every day ever find the time? Are they just not as busy as you are? The fact is that somewhere along the line they made exercise a priority, they had the "thought." Then they performed the "behavior" repeatedly. Eventually it became a "habit" that is now automatic. Because their new habit was enjoyable, they gradually and excitedly increased the amount of time they devoted to it.
I know what you're thinking. "He makes that sound so simple. Doesn't he understand that I can't exercise? It hurts too much!" Well, here's the truth. Yes it hurts, but it isn't going to get any easier until you lighten your load. One good option is swimming or a water aerobic class. The buoyancy of the water substantially reduces the stress on your hips and knees. Just try it! At first it will feel awkward and even a little silly getting in a pool with a bunch of other overweight people, so start by changing the way you think about exercise. What do you have to lose, except the weight you've been struggling with most of your life?
"Threading In" Exercise
Julie Hillis, Exercise Physiologist
Everyone knows that exercise is important. I don't have any trouble selling that concept. But I'm not sure people always know why. One critical reason that exercise counts is that it is a hormone stimulant. One of those hormones stimulated is serotonin, which helps to counteract emotional blues and depression. In addition, serotonin improves the quality of sleep, and thus patients feel less fatigued.
What I see a lot of is patients being told to "just start walking." Well, if you're someone with bilateral osteoarthritis in your knees, which is a breaking down of the joints especially common in obese people, then walking is going to be hard. It is important to realize that a good exercise program should be completely individualized.
What I do is "thread in" the exercise program with the patient's life. What that means is we start slowly and design an individual program to promote success. Frankly, we know that if the patient isn't successful, they're not going to continue. We don't want someone to go out and do "boot camp" for four to six hours a day. We want a lifestyle change.
To start, we do a "current abilities" assessment by taking measurements of the patient's performance and body. As patients progress, the measurements provide important feedback. Change doesn't happen overnight. But in three or six months, when we reassess, people often say, "Wow, I remember it taking me 12 minutes to walk a quarter-mile, and now it takes me only 6." I also encourage patients to keep a pair of pants and shirt or blouse, so they can try those on at points as they are losing and really see their progress. That is an easy way to get some encouragement when you need it.
If someone is not exercising at all, I start them with three days a week. A lot of people will start out with only five minutes of continuous exercise. The important thing, especially in the beginning, is to get into an exercise routine. For most people who haven't exercised, this isn't going to be easy. But we want to start small and increase the amount of time spent exercising slowly, so as not to promote orthopedic or soft tissue problems. So the first 12 weeks are spent simply working into a regular schedule of exercise. Then every 12 weeks (three months) we "add on to the house."
As we progress in subsequent 12-week periods, we add abdominal and toning exercises. Toning is important because muscle (which is what gets built during toning) burns fat. And the more muscle someone has the higher their resting metabolism will be, which means that they'll burn more calories even when they're not moving.
What I love is for patients to work up to a minimum of 40 to 45 minutes of continuous movement in an exercise session. Our body's fuel tanks of glycogen and carbohydrates are the primary fuel sources that get burned in the first 30 minutes. So during that time, the body dips very little into the fat stores. But at about 30 minutes of continuous movement the body shifts into the aerobic state, in which it begins to use the fatty acids floating in the bloodstream as the primary fuel source. By the end of 45 minutes the percentage has shifted and the body is burning more fatty acids. That is an important point for patients to be aware of.
There is some disagreement, depending on what study you read, about when precisely the shift to burning fat occurs, but the critical concept to keep in mind is continuous, steady movement over time. Some people want to get on the treadmill and sprint for 10 minutes so they can say they've run a mile. However, they haven't achieved the goal, which is to get their body into that aerobic state so it's burning fat.
Checklist: Six Steps to Success for Your Exercise Program
1. Work with someone who knows what they're doing.
2. Start small. Build the habit of exercise first.
3. Remember, exercise makes you feel better. It acts as a hormone stimulant, helps counteract emotional blues and depression, and it can help you sleep better.
4. The minimum to build to is 30 minutes, three days a week, of continuous, steady movement. The optimum for fat burning is 45 to 60 minutes, three to four days a week, of continuous, steady movement.
5. Keep a pair of pants and a shirt or blouse that you wore before the surgery. Try these on when you've hit a weight plateau or just need some encouragement.
6. If you fall off the exercise wagon, go back to your exercise therapist anyway. Your body may have changed, and you may need a new set of goals. Plus, life happens to everyone, so don't get shamed into not going back. Progress happens when you stay with the program.
Some people can get to the point where they do 40 to 45 minutes of steady movement three to four days a week after the first 12 weeks. Others take longer to get there. The idea is to build in a way so there's not a lot of soreness associated with the exercise, and that's what a gradual build-up over 12 weeks will accomplish.
It may be that a patient can't get to their exercise goal because of other reasons, such as a bad hip, bad knee, or even being in a wheelchair. There are alternatives to a treadmill or walking, such as getting in a pool, bicycling, or even using an arm ergometer (a device that sits on a table and looks like bicycle pedals that you turn with your arms).
Building up to 45 to 60 minutes a day, three to four days a week, is the patient's investment in their long-term health. Even just 30 minutes a day, three days a week, is beneficial. After all, if you're willing to pay thousands of dollars for surgery, it makes sense to invest an hour and a half a week of your time in yourself.
I have noticed a pattern of behavior in band patients as I see them over time. I notice at their three-month follow-up they're in heaven, they're so excited about their progress and their weight loss. At the six-month followup they say, "I didn't lose as fast." So they're not as excited, until we measure and they see the inches that have come off. Between six to nine months, patients say to me, "If I don't lose another pound, I'm happy." They tell me they have more energy, they can go up and down stairs without trouble, but they do acknowledge that while the weight is coming off, it's more work now. At a year, it's not like their weight-loss program is over, but it is slowing down. But most people say to me that they love their new lifestyle and wouldn't change it.
There is no magic key to weight loss. It's calories in and calories out. But those who are exercising are toning up muscles and increasing their metabolism. The band is a tool to keep you successful, because you can't eat as much, even if there are days you want to. It's not like you have to give up everything you like. You can still have the foods you love, and it'll be okay. But the band is about making healthful choices, including regular exercise.
One thing to remember is to stick with your exercise therapist. This means going back even if you're not compliant with your exercises. I tell patients, "Don't get shamed into not coming back in here. Life is a rollercoaster. Sometimes you do really well, and other times you don't. Stay in the game."
As you're losing, there will be a number of physiological changes, and your therapist may decide to start you on something entirely new. For example, if you no longer require medication for high blood pressure, you may be safely able to do exercises that were previously not recommended.
The main message is stay committed. Your commitment to your exercise program will eventually yield rewards, even if you don't do it perfectly.
What's for Dinner?
In the last chapter we discussed the issue of eating as a social activity, but for many of us eating out has also become a primary source of nourishment. Many families eat out more often than they eat at home. Sometimes it's at a sit-down restaurant, other times it's drive-through, and of course there is the alwaysavailable home delivery. The constant is that someone else cooks it, and either they do the clean-up at the restaurant or we toss the paper and plastic in the trash. How convenient!
The restaurant industry has been booming for several decades because it saves us both time and effort. We can eat what we want, when we want, without having to go buy the groceries, prepare the meal, or wash the dishes. And everybody in the family can have something different. What could be better? Maybe if it were free! While prepared food isn't exactly free, at some places you can get more than enough calories to meet your body's needs for little more than the spare change in your pocket.
Sit-down restaurants are obviously a little more expensive because of the services they offer. To make up for this higher cost, some places offer huge portions. The food is actually fairly inexpensive to prepare, so it doesn't cost them much more to ensure that no one goes home hungry. It's almost comical when the waiter comes to your table and asks, "Anyone save room for dessert?" Despite the fact that you're "stuffed," the sound of homemade pie with ice cream can be hard to pass up. The temptation can become simply irresistible if they bring out that tray of sweets, so you can actually see them.
Well, the reason for this description of modern American dining habits is to emphasize the need for change. The main reason why most people become obese is simply overeating. Now you've got the band to help you eat less, but you can't expect to lose weight unless you actually do eat less. That requires a change in eating habits, starting with where and how you get your food.
Now, I know what you are thinking. "This guy is crazy if he thinks I'm going to start cooking three meals a day at home. I don't have time. Besides, the rest of my family won't stand for it." I agree, it is unreasonable to suggest that we return to the lifestyle of the 1950s, when mom cooked breakfast for everyone, prepared their lunch boxes, and had a hot meal waiting when they came home from work and school. But at the same time, it is totally illogical to assume success with the AGB unless you make some changes to your current eating habits.
While eating at home more often may be a good place to start, it won't really make a difference unless it also includes preparing healthful, nutritious meals in reasonable quantities. This implies that infamous word: "diet." But, I'm not talking about the painful depravation of the numerous diets you have previously endured. Instead, you need to develop a new, rational, preplanned eating behavior that is consistent with the restrictive nature of your band. This starts at the grocery store. Map out a meal plan for the week and buy only those things you need to prepare the meals you have planned.
If you don't have a plan for what you intend to eat when you go to the store, you will wander down every aisle, picking up all the same junk you've always bought. This will include chips, cookies, candy, and everything else that goes down easily despite the band. You will have sabotaged your weight-loss efforts before you even get the groceries to the car. Understand, if you buy snacks and comfort foods you will eat them. It's that simple. Why would you do that, you ask? Habit!
I've had several patients tell me that they buy snack foods and sodas, but they are just for their family. One woman even told me that her son wouldn't stay around the house unless there were snacks available. While this may sound ridiculous to some, for others it represents one more unexpected obstacle to be overcome. You need to sit down with everyone in the family and explain that the snack foods and soft drinks they have come to expect are a thing of the past. They are being replaced by fresh fruit and low-calorie drinks.
No doubt there will be grumbling and moaning, but ultimately you and everyone in your family will develop better eating habits. So, how do you pull this off? First you must recognize the need (develop the thought), then be the instrument of change by initiating a new household policy (introduce the behavior). Only then will you be able to sustain it on your own behalf (the habit).
Supersize Me, directed by and starring Morgan Spurlock
This Oscar-nominated documentary is about American fast food and its effects on everything from elementary school children to legislation. In it, filmmaker Morgan Spurlock lives on nothing but McDonald's food for an entire month, with three simple rules:
1. No options: he could eat only what was available over the counter (water included!).
2. No supersizing unless offered.
3. No excuses: he had to eat every item on the menu at least once.
Spurlock received the award for Best Director at the Sundance Film Festival in 2004, and the film has received a number of accolades since.
Roseann's Story
I'm 50 years old, and my first 50 years were spent destroying my body. I didn't think it was fair to me or my husband that I couldn't be what we both wanted me to be. I tried diets, like Weight Watchers°, and lost and regained a lot of weight.
I'm a nurse, but that had nothing to do with my decision to get the band. I heard about gastric bypass, and it scared me. I went on a trip with another band person, and she told me about the band. I started looking up more information on the Internet. I knew I had to do something.
Within a month after meeting Dr. Sewell, I decided that he was going to be my doctor. I also decided to become responsible for my actions from then on. I knew the weight loss would be slow, but I didn't care how long it took me. I have to work for every pound of it, but that's okay.
I also knew my insurance wouldn't cover it. My husband said, "I'm behind you one thousand percent. Give me the checkbook. This is your new car." I think I might be a little more lax with my care if I hadn't had to pay for it myself. But since I did, I've been extra careful.
I had my surgery in April of 2004, and so far I've lost 64 pounds. I'm 5 feet, 2 inches and weigh 187 now. My goal weight is 132. That's 50 more pounds to go, but it doesn't sound like so much now. People around me say I should not have that much more to lose, but I assure them I do.
I remember Dr. Sewell saying when I went for a fill, "Some people just don't get it." Honestly, it took me about eight months to "get it." I would argue nonstop, saying things like, "I'm not losing," "I can't tell when I'm full," "Something is wrong here." He said I wasn't patient with the process. And then, about two and a half months ago, I got it. I realized it really was the portion size, and I had to trade food for exercise.
Exercise got easier and more manageable as I've lost. Now I enjoy jumping out of bed, doing my workout, and moving on with my day. I can do an hour to an hour and a half, but our dietitian advised me not to exercise seven days a week. She said that she doesn't exercise that much. I was so afraid that if I didn't go all seven days, I wouldn't lose the weight. There was still that fear factor.
I feel normal now. I'm acting like real people do. I was on blood pressure medication, and I'm off as of September 2004. I never had reflux again after the band surgery, but I waited to go off the medicine until September, too. I was prediabetic and now I'm fine. I had sleep apnea, tried the machine, then had airway surgery, but that didn't help either. I went through a lot of hell and pain for nothing. I still wake up sometimes in the night, but I don't have a real problem.
Some days are better than others. I have days when I can eat what seems to me like a lot and others when I can hardly eat anything. But overall this is a lot easier than being fat ever was.
Sometimes people ask me about my weight loss. When I tell them, they ask, "In how long?" Like it's a race or something. So I say, "I'll tell you how long it took, but it really doesn't matter because it's not a contest. I'll never go back to where I was."
Eating Out
Okay! You're not going to eat at home every meal, that's obvious. Going out to eat will continue to be something you do with family and friends. The key then becomes developing a strategy for eating out that helps ensure your weight-loss success and allows you to continue to enjoy this important group activity. You need an "eating out plan."
It isn't enough to assume that the band will control your portion size. Ultimately, that is your responsibility. At most restaurants the server will bring you more than you can eat. But I don't have to tell you that once it's in front of you, it can be hard to make yourself stop eating, even when you're full. Your "battle plan," and I mean that literally, should consist of several specific strategies that will make going out to dinner much easier.
One of the easiest ways to control your portion size is to share a meal. Before you decide where you are going out to eat or where you are going to order your meal from, get together with your spouse or your friend or whoever you are planning to eat with, and agree to share a meal. At the restaurant, order only one meal and an empty plate. When the food arrives, take a small portion for yourself and let the other person keep the rest. Don't let the server divide it for you; they will likely split it evenly, which may be too much for you and not enough for the other person.
Also, don't ask them to divide it for you back in the kitchen. Remember, part of the restaurant's strategy is to make sure you have plenty. They want you to come back, so they are likely to add a little extra to each plate. That's not what you need.
Depending on the restaurant, you may be better off ordering an appetizer rather than a full meal. Some restaurants even offer appetizer portions of most of their entrees, if you ask. Not only are the portions smaller, but they are generally much less expensive. If all you are going to have is the appetizer as your meal, have them bring it at the same time they bring everyone's appetizer or first course. You don't want those around you to feel uncomfortable eating while you are just watching. With your new eating style (slow down, small bites, chew well), it is likely to take you about the same amount of time to eat that appetizer-size portion as it will everyone else to eat their entire meal. So don't rush through it.
Another good option is to order off the child's menu. Some restaurants frown on this because they think you are just being cheap. They may even say that you can't order one of those items unless you are 12 years old. To address this problem I give each of my patients a small doctor-directed "portion card" that the patient can show to the server, or manager if necessary. Should the restaurant continue to refuse you the option of ordering off the child's menu, just remind them who is paying the bill and offer to take your business elsewhere next time. As I said, this is a "battle plan."
Sometimes you just don't want to share a meal, or you don't see any appetizers that sound appetizing, and the stuff on the child's menu is, well, "kid's stuff." Go ahead and order what you want, eat what you want, and take the rest home. But here's the trick. Tell your server that you want him or her to bring out only half of the meal. Ask them to box up the other half. Having less on your plate will help you avoid the temptation to overeat, and the food you take home will look more presentable when you get it home than if you scrape it off your plate into a "doggy bag."
While desserts are typically higher in calories than most other foods, that is not always the case. Again, sharing a dessert can allow you to sample a piece without eating the whole pie. It's all right to allow yourself a treat every now and then. Just don't do it repeatedly, and it won't become a habit.
There is one more important strategy that you will need to employ whenever you eat out at a restaurant. One of the jobs of the server when you first sit down is to bring you something to drink. Throughout the meal they will make sure your glass is always full, whether it is water, or tea, or whatever. But remember, with the band you are not to drink and eat at the same time. You can, and should, drink fluids as much as you like until your food arrives; then you need to stop drinking. Otherwise you'll eat too much. Drinking and eating at the same time is something you have done your entire life. It's a habit. Breaking that habit is not easy, especially when there is a full glass right in front of you. You'll pick it up and take a drink without even realizing it. The next thing you know they'll be right there, filling it up again.
Especially early on, you're going to need help to avoid drinking with your meals. One option is simply to ask the server to take your glass away when your food arrives. He or she is not likely to understand why, so you'll be asked whether there is something wrong. If this situation makes you uncomfortable, you can just leave the glass on the table, but you may need help remembering not to pick it up. Try this. Place a small napkin or even a bread plate on top of the glass as a reminder. This may sound silly, but it works. You will not be able to drink out of the glass unless you first remove the object that you placed on top of it.
This additional step will help you avoid the automatic behavior of drinking between bites of food. Any object on top of your glass will also send a clear signal to that guy who keeps coming around asking, "More tea?" Once you have mastered the technique of separating liquids and solids, it will become an established habit and you won't need any reminders.
No matter how careful you are to eat slowly, take small bites, and chew thoroughly, everyone has problems occasionally with overeating. It may happen that the food you just swallowed is not going down. In fact, it is causing considerable discomfort as your esophagus pushes harder and harder to force it down. You be come convinced that it's not going down, it's coming back up. Certainly this can be a problem at home, but it is more of a problem when you go out to eat.
I had one patient tell me that every time she goes anywhere to eat, the first thing she does is locate the bathroom. She knows that at some point during the meal she will need to excuse herself and quickly make her way there to bring up what she just swallowed. Some patients face this situation at virtually every meal and just accept it as part of their new lifestyle.
Eating doesn't have to be that way. If this is happening regularly, one of two things is going on. Either the band is truly too tight and needs to be loosened, or you are still taking bites that are too big or not chewed adequately, or you are consuming food too fast. Spitting up your food should be a signal that something needs to change.
Patients tell me that they avoid spitting up by just ordering soup. They do this to avoid embarrassment, but that is not the best way to handle the situation. If you are spitting up all the time, and losing more than a couple of pounds a week, the band is probably too tight. But most people who come in complaining of spitting up at nearly every meal are often not losing any weight at all. Their food is going through the band; it just can't go through as fast as they are putting it in, or they swallow bits of food that are too large and the bites get stuck.
Checklist: Tips for Successful Eating Out
✓ Share a meal.
✓ Consider ordering an appetizer or off the children's portion of the menu.
✓ If you order a regular meal, ask the server to box up half of your meal in the kitchen to take home. The meal will look more appetizing for later, and you won't be tempted to eat too much.
✓ Follow Dr. Sewell's Golden Rules for AGB Patients on page 140.
✓ To avoid drinking with a meal, ask your server to take away your water glass when your food arrives. If that's not practical, place your napkin or bread plate over the glass. That way you can retrain yourself not to drink unconsciously out of habit during your meal.
✓ If you're struggling with eating out, find another band patient who is doing well and eat out with them. Watch how they conduct themselves during a meal.
One strategy that you may want to try in your quest to learn new eating habits is to go out to lunch or dinner with another AGB patient who seems to be achieving significant weight loss. With that idea in mind, we actually offer a mentoring program to our patients even before they have their surgery. If you don't know any band patients, the best way to get acquainted is through a support group. The experience of eating out together will not only benefit you as you watch how the other person eats; it will also serve to reinforce the behavior of the mentor.
Increasing Your Metabolism
Kirk Evans, Exercise Physiologist
I find, working with band patients, that they now have a tool they can use to help them with their eating style. What I mean is that the band helps them control their appetite and their quantity of food. However, the band doesn't control their exercise or their quality of food choices, and that's what I'm trying to get people to do.
What I find is that many band patients have never exercised. I try to get the patient to become aware of why it's important to exercise. One of the things I emphasize is weight training to maintain muscle mass and to help people keep their metabolism up. Most weight-loss patients have experienced losing weight on a diet, then have gained back more than they lost. The reason they gain back more, and put it on quickly, is that their metabolism is slower.
An especially useful tool I have to aid patients is a scale that allows me to do a body composition analysis. The scale sends an electrical signal through the patient and makes a composition diagnosis of the fat mass and the fat-free mass in the patient's body. (The fat-free mass is made up of muscle and water.)
This is useful because if you get on your scale at home, you'll see that you've lost 10 pounds, but you don't know if it's 10 pounds of fat, water, or muscle. With this scale you know what you've lost.
Another plus is that you might get on your scale after working out the way you've committed to and find that you've lost nothing. That can be discouraging. But using this scale, I may be able to see that you lost 2 pounds of adipose tissue (fat) and gained 1 pound of muscle and 1 pound of water. So this provides us with another way to measure progress.
While the band offers a more gradual weight loss than other surgical options, it's still a pretty drastic procedure. You're immediately going to reduce your calorie count. And your body needs to make a choice if it's going to burn fat or muscle to replace the food you're not taking in. As I've mentioned, I stress the importance of weight training so the patients can maintain their muscle mass and not suffer setbacks in that realm. I encourage the use of free weights or body resistance. For example, if people haven't exercised before, they might start with what we call chair standsjust getting in and out of a chair over and over. These exercises, while they sound simple, initially allow the use of the patient's own body weight to build up resistance.
My advice is to get out of the negative cycle. Exercise can be enjoyable and is obviously beneficial. I try to stress the importance of the overall health aspect of it. People can be thinner but not healthier. Patients who commit to exercise enjoy even the simple things, such as the ability to walk longer without shortness of breath and with less joint pain. They find that they can do things they either haven't been able to do in a long time or were never able to do. Overall, they become stronger and more conditioned individuals-both thinner and healthier.
Obesity Is Expensive; Thinner Is Cheaper
Whatever your lifestyle, it comes with a price tag. That's obvious. But are you aware of how high that price actually is? Being extremely overweight is expensive. The cost of food alone can be substantial if you have been eating twice as much as you need or more. I had one man tell me that he would routinely eat six chicken breasts at one meal!
Extra-large clothing also costs more, especially when you get into business suits and nice dresses. It is not uncommon for "plus size" garments to cost two or three times more than standard sizes. Transportation costs can also be substantially higher. Inexpensive compact cars may not even be an option if you're too big to fit behind the wheel. Coach class airline seats may not fit either, forcing you either to buy two seats in coach or to pay extra to sit in first class.
The point is that there are many day-to-day expenses that are higher because you are obese. Add in the cost of medications for diabetes, high blood pressure, high cholesterol, and other problems, and the cost of "living large" goes even higher. What about doctor visits and other medical treatments? If this is you, I don't have to explain the financial stresses of obesity. But the good news is that with weight loss comes substantial savings.
One patient kept a very comprehensive log of his living expenses, both before and after his band. Within four months of his surgery his average cost of living was down $440.00 a month. Other patients have shared similar results and are shocked at how much less they spend on food and medications alone. The clothing issue tends to be a two-edged sword. As you lose weight you are able to buy much less expensive clothes. You'll get really excited the first time you buy something off the department store sale rack. But at the same time, even sale items can add up if you are replacing an entire wardrobe. I urge my patients not to buy too many clothes the first time they drop a couple of sizes, because as they continue to lose, the new clothes probably won't fit in a few more months.
The fact that you are thinner will continue to pay financial benefits over the remainder of your life. That can be an important motivator to stay "on the band wagon." Try keeping your own log of your monthly expenses, and you will be amazed by how much money you have "left on your plate."
Linda M.'s Story
At the end of 2004 I talked to my doctor about a bypass, but he said he wouldn't recommend it. I weighed 249 and I'm 5 feet tall. Dr. Sewell was recommended by a friend and I went to his seminar, then decided to have the band surgery.
I lost 17 pounds on the pre-op diet, and I found it to be very difficult. But I had no problems with the surgery, though Dr. Sewell kept me overnight, anyway. He does that with everyone. But I had no restriction at all after the surgery. I got my first fill at six weeks, and I had very little restriction then.
The problems for me are not particularly eating. I've never thrown up food. If something gets stuck, I notice that I get a buildup of saliva and that usually has to come up. I've found that I have more trouble eating earlier in the day, so while breakfast is my favorite meal, I now have it at lunch.
I have reached a plateau and that's difficult, but my goal was to improve my health, and that's happened. My plan is to get another fill. I've lost 58 pounds, so I'm at 191. I had diabetes, and I'm taking only one medicine for that now at a 15 mg dosage and expect to be off it soon. I was taking 500 mg three times a day. I was also taking medication for high blood pressure and for acid reflux, and I'm not doing that anymore.
The band has also saved me money. I'm self-employed and was in a high-risk pool for health insurance in Texas that cost me $725 a month with a $1,000 deductible. Now I'm on a major medical and drug plan that costs $325 a month because I'm no longer considered high risk.
I'm a therapist, and I have a patient who had the band surgery with another doctor, who was in her healthcare network. But she's had problems because her port didn't heal for six months, and she couldn't get a fill. So she lost six months of weight loss. I have another patient who had a bypass and she's thin, and I mean thin, but she's been sick a lot.
One of the things I like about Dr. Sewell's plan is the comprehensive program, with the support group and the exercise therapist. I was over 9 minutes in the beginning on a quarter-mile, and after six months my quarter-mile was 4 minutes, 15 seconds. I got a treadmill after the surgery and joined Curves.
The other thing, and this is just me, but I'm a psychotherapist, so I think it's a good thing they have the psychological component. I didn't have to do that. I already have that training. But I know it's needed.
I met someone who had a bypass because that's all her insurance will pay for. This woman still wears long T-shirts and baggy clothes, even though she's thin now. That's a mindset problem. She still dresses as though she's heavy. She went to a doctor who doesn't have a comprehensive program. She did some support group online, but it's not the same.
It's my opinion that you shouldn't get a band if you think it's going to change your self-esteem or make you like yourself. You need to have that going in. Health is the best benefit, not vanity. Will looking better improve your self-esteem? Yes. But it's good to have that psychological component of the program to help people who are going to be disappointed or still struggle with their self-esteem.
I believe I'm going to want plastic surgery. I am in a size 16, and I can't get myself in a size 14 because of the apron of hanging skin from my stomach. I also want to have my arms done. In order to have the plastic surgery I will have to pay for myself, so I need to earn some more money. The plastic surgeon's office did tell me I could finance it.
Oddly enough, I won the money to finance my band surgery in Las Vegas while at a conference. And it was the exact amount I needed. I decided then it was meant to be.
If you do what you're supposed to, the band works. I like it that I can eat whatever I want, just not much, but that small amount is enough. No one needs to eat as much as they give you in a restaurant anyway. The people in China are not going to benefit from me finishing my plate. I like the idea that I can take food home and have two more meals. I had to work to find something I could eat in the morning, and now I eat protein bars. Overall, I like it that I don't have to struggle anymore. It's just easier. I don't have to think about what I'm going to eat and what I'm not going to eat. My life is not an ordeal. And it was before.
Your Image
We have spent considerable time discussing how to change your lifestyle and how you will benefit from it. We've listed many of the things that are likely to happen to you. But, how are you going to feel about these changes in your life? How will you respond to your new life? How are you supposed to deal with this new person you have become?
These are difficult questions to answer, because every person reacts differently. Some people embrace their new life with excitement and enthusiasm. Others are fearful of the unknown and tend to remain pessimistic, even after they have tasted success. Some patients have a very difficult time ever seeing themselves as anything but a "fat" man or woman. That is why it's important for you to participate in a support group or a psychological improvement program to help you develop a true sense of who you really are.
When it comes right down to it, you probably won't know how you will react until you actually begin to experience significant weight loss. Physically, almost everyone relates that they have more energy. I had a patient recently tell me that she has so much more energy now that she needs only about 6 hours of sleep each night, instead of the 8 to 10 hours she used to require. She's up and ready to go at 5:00 uN7. every morning and is far more productive throughout the day. While that's a bit more energy than most people have, it's an example of just how much natural vitality obesity can rob you of.
Having more energy affects every aspect of your life, from your job to your family life, your ability to exercise, and yes, even your sex life. Perhaps most important, when you have more energy other people see it and respond positively to you. Those around you will feed off your energy, making you a valuable part of virtually any situation. The natural progression then includes increasing selfconfidence and a feeling of self-worth.
Another aspect of change comes in how people treat you. Anyone who is morbidly obese knows the reality of "obesity bias," especially in the workplace. Employment opportunities can be limited, and advancement may be blocked by those who perceive obese individuals as lazy or even less intelligent. But part of the problem may also be related to how obese people perceive and project themselves. Losing weight certainly changes your appearance, but for many the most important change is in their self-confidence. And it is this change that tends to open doors and eliminates ceilings in the workplace.
I have one patient who was very quiet and reserved prior to her band surgery. She had worked at the same job for several years and would never consider asking for a promotion or a raise for fear of being turned down. Within about four months of her band operation she lost around 40 pounds and her personality changed dramatically. She became far more self-confident and self-assured. She sought out a new job where she quickly became a much more visible contributor. Within a few months she was discovered by another company and was hired away with a new salary that was three times what she had been making less than a year earlier. Same woman different attitude.
Other patients have shared similar experiences, and in each situation the story revolves around self-image. Virtually every self-help book ever written is based on the principles of self-confidence, self-motivation, and self-reliance. If you have perceived yourself as a failure because of your inability to lose weight, those ideas may seem foreign and unachievable. But deep down, under that "Walter Mitty" exterior, is a dynamic and enthusiastic individual who can't wait to get out and show the world what you can do. The key to unlocking that person lies not only in achieving your weight-loss objective but also in your willingness to embrace the fact that your success is truly the product of your own efforts.
Part of your self-image is the shell you're encased in, known as your skin. We'll cover changes in your outward appearance as it applies to that part of your body in the next chapter.