Getting Perspective and Finding Balance... with a Lot of Support

I had a tough week, wrestling with my old eating-disorder demons, but I am feeling much better! 

Friends and readers of this blog: you helped me tremendously, through your comments, emails, and texts, plus I had an excellent talk with WRD. 

I'm grateful that my writing lets me reach out to people, because I don't think I would have talked about it otherwise. A big Thank You! to you all.

* * * *

When you are involved in an eating disorder, your focus becomes very small. How many calories have I eaten, what does the scale say, how many minutes did I exercise, how many calories did I burn. How many hours can I go without eating. Can I eat less than I did yesterday. I think this is true for any addiction. The world becomes boiled down to your obsession.

Using the food-tracking app contributes to this addictive thinking, too. Food tracking is important, and portion size is important. But the downside is an over-reliance on external counts, when your goal should be mindful or conscious eating. 

While I was thinking this way, I purchased a kitchen scale. Dietitians don't recommend this; they prefer using visual cues, like those pictured here. But for many foods, those are not working for me. A medium-sized apple or a small banana -- fine. But I want to see what three ounces of salmon looks like, how many grams of ground bison I'm using per meatball, how much one chicken thigh weighs. I won't use it forever, but right now it feels like a useful tool. 

I knew this kind of addictive thinking would be a danger; it was my greatest fear about bariatric surgery. That didn't prevent it from happening, but it did minimize the damage. It was one crappy week. In the long run, just a learning experience. I'm sure it will re-surface, and next time I'll be even better prepared . . . I hope.

* * * *

"What did we learn today?"

Mkk reminded me that there have been so many positives in this experience. This may sound silly, but I had lost sight of that. That gave me the idea to write down all the positives.

J suggested printing out the list of positives and reading it aloud three times a day. Another great idea! This helped me slow down my thinking and re-focus. J also reminded me that what I'm doing is hard work, and I should give myself some credit.

M suggested being easier on myself, and continued to cheer me on.

A suggested focusing on my actions rather than thoughts, and not punishing myself for my thoughts. An entirely new perspective for me.

R shared her own experience with obsessive thinking, being "sucked into the spiral," as she called it. She suggested re-framing my urge to weigh myself as normal curiosity, without worrying if I am on a slippery slope.  

Also this: Let yourself be proud of the weight you have lost and also give yourself permission to eat a bit more sometimes. I'm printing this in big, bold letters and pinning it to my bulletin board.

My partner suggested I reach out to WRD, and even though I said, "What's the point, I know exactly what she'll say," I called anyway. And guess what? I didn't know what she would say! Newsflash: trained professionals know more.

* * * *

Here are some things that WRD reminded me of.

• I'm much more physically active now than I was before the surgery. When you're physically active, your body requires more fuel.
• The goal of a forever eating plan is not to hit a calorie limit or range every day. It's to eat healthfully and mindfully. In fact, although I'm using a caloric guideline from the hospital in Mexico, the Canadian bariatric centres don't use a calorie target at all!
• We need different amounts of food on different days. Some days you are going to be hungrier. When that happens, try to make good food choices, and eat slowly and mindfully. And if you don't... forgive yourself and move on.

There's also the mental checklist for when you want to eat.

• Am I truly hungry or perhaps bored or stressed? 
• Have I eaten enough protein today? Enough healthy fat? Both contribute to feelings of satiety.
• Am I well hydrated? If you haven't been drinking enough, you may feel hungry when your body is actually thirsty. This is definitely a pitfall for me! Working at my workplace, rather than home, and wearing a mask all day is also not conducive to adequate drinking.
• What would be a healthy and filling snack to eat right now? I actually keep a list in the kitchen of healthy snacks to bring to work, to avoid coming home overly hungry.

* * * *

Every one of you reminded me to be kind to myself. Thank you.

A List of Good Things that Have Happened Since my Surgery

For the first time since making the decision to have bariatric surgery, I'm struggling. That in itself is pretty good. I decided in September 2019, so it's been nearly a year and a half with no significant issues. 

I can't and won't deny the issues I'm having right now, but a comment from my friend and blog reader "mkk" made me stop and take stock.

Up to now, any negatives I've experienced were physical, such as pain from eating too quickly, or nausea from eating too much, or the dreaded constipation. I expected things like this and -- although yucky while they are happening -- they're not a big deal.

The negatives I'm experiencing now are mental and emotional, and we all know those kinds of issues can be much more difficult and persistent. There are two issues.

• I am obsessing. Obsessing on calories, portions, weight.
• My appetite has hugely increased. This is very concerning to me, because if this whole process becomes an issue of willpower... it will not be sustainable. More about this in a future post. I'm not ready to talk about it yet.

Here are the positives that have taken place so far.

• I was terrified of the pre-op fasting, and it turned out to be fine. 
  
• I traveled to the surgery and back -- multiple flights and hotel stays -- with zero problems.
• My experience at the hospital in Mexico was excellent. 
• I traveled to the US and Mexico and back and did not get covid!
  
• Throughout my recovery, I was on paid work time, and working from home, so it was easy to work with the post-op eating plan and other self-care.
• A month before the surgery, I received a check in the mail -- out of the blue, totally unexpected -- that covered the full costs of the surgery! We ended up paying only for transportation, which was very manageable.
  
• My physical discomfort while recuperating was minimal.
  
• I've lost 39 pounds. This includes a sneak-peak at the scale in mid January. Without this surgery, losing almost 40 pounds was completely impossible.
• I'm comfortably wearing t-shirts that haven't fit me in 10 years.
  
• My low-back pain has returned to levels I experienced in the early 90s -- easily dealt with with a few stretches.
• My knees feel much better.
• An issue I was having with my bladder has disappeared. 
• My ankles and feet are no longer swollen -- a condition that was chronic.
• I am less self-conscious about my appearance in video-conference meetings (Zoom, Teams, Hangouts). This feels really nice.
  
• I'm still enjoying food! I was afraid that the surgery would rob me of this basic enjoyment, and that has not happened. This is wonderful.
• I'm still enjoying cooking, and my partner and I are eating mostly the same food.
  
• I'm able to eat almost anything in small quantities. I'm choosing not to eat unhealthy food, but if I wanted to have a small portion of something on my "avoid" list, I could. Having choices rather than being told what I can and cannot eat is important to me and much more sustainable.
  
• With my knees and back feeling better, I am already more physically active, and I'm feeling the rewards of that every day.
  
• And this is all without knowing the results of any bloodwork. I have my first post-op tests in early February.  

 Really great. 

The two issues I mentioned above are real, and they are troubling me. But they are not the whole story.

The Challenge of Obsessive Thinking (the Eating Disorder Spectrum)

Obsessive thinking is back. 

I'm remembering how awful this feels, how it sucks up energy, how it clouds the mind, making rational decision-making a monumental task.

Obsessive thinking about diet and weight is one reason I gained so much weight. I had been so trapped in the dieting cycle, so unhappy with my own unrelenting focus on my weight, that once I liberated myself from it, I was afraid to take one step towards it again. That wasn't the only reason for my weight gain, but it was definitely in the mix.

Now I have to monitor my eating and weight very carefully. That's what I agreed to when I decided to have the surgery. Most days it's all right. But sometimes I feel the obsession creeping back. 

About one day each week, I feel noticeably hungrier, and I eat a little more. I tell myself that this shouldn't matter. I tell myself: 

• It's one day a week. Most days I am well within the low end of the preferred calorie range.
• It's only about 300 calories.
• It's only because I'm hungry. I'm not eating out of boredom or from stress.
• Even with this few hundred extra calories, I'm eating way less than I did before the surgery.
• I'm getting a lot of physical exercise, so a few extra calories once a week is not going to hurt my weight loss.
• This is a lifelong process. It's not going to be perfect every day.

I run down this checklist of rational thought, but the truth bounces off the wall of obsessive thoughts, and I can't convince myself. I think about these extra calories... and think, and think, and think. The thoughts run around a hamster wheel in my mind.

The next step down this slippery slope is weighing myself. 

This week I searched for -- and found -- where my partner has hidden the scale, and jumped on. It's my form of bulimia. My obsessive thoughts are triggered and I reach for the scale.

This is what I was afraid of, and I do not want to do this.

Last night I told P a bit of this, and he suggested I ask someone about it, like WRD. I said I knew exactly what WRD would say. She'd say exactly what I'm telling myself. But I should tell her anyway. She always has good ideas, maybe she knows some tricks that I haven't tried. 

I do not want to do this!

Eating Less, Exercising More

As the days and weeks go by, something strange is happening: I am eating less. Not just less compared to pre-surgery -- that's been happening every day since I started the pre-op fast in October -- but less than when I first started to eat real food. 

When I look back at my nutrition tracking, I see fewer days when I hit the upwards limit of calories, fewer days that I exceeded the range, and more days when I'm towards the lowest end of the range.

A regular bariatric diet is in the range of 1000-1300 calories per day. (Don't try this at home!) When I first started tracking calories, most days were in the 1300 range, and a few days were around 1500. I considered that a good start. I wasn't concerned about going over for a few days, as the amount I was eating was still well below what I had been eating before surgery. 

But more recently, I never have days over 1300, and am usually well below. On a few days, I needed to add a snack to avoid being under 1000 calories!

I think this is coming from a combination of factors.

• Eating real food. This gives me more variety and enjoyment from the food I eat, which is important to me.
  
  
• Choosing foods that give me more bang for the buck. Peanut butter, for example, is very healthy, but also packed with calories. I'm using less per serving and eating it less often.
  
  
• 85% thinking! One night last week, my partner was having breaded chicken strips and hash browns for dinner, both from frozen. This is convenient, yummy, reasonably nutritious (if you choose the right brands) but higher in fat and sodium, and not something we should eat too often. But I wanted some, too! So I made sure that breakfast and lunch were on the low-calorie end, and asked P to make a specific amount for me (frozen foods are his domain). I had 3 chicken strips and 4 hash-brown discs. (The discs are about the size of a loonie, the Canadian one-dollar coin.) I'm not going to eat this food frequently, but it was a nice treat on a night P was working, and I was still well under 1300 calories for the day. Having the occasional indulgence is going to help me stay with this for the long run.
  
  
• Planning, planning, planning. Plan the meal, plan the day, plan the week. Perhaps I'll write a post with tips for planning eating and exercise.
  
  
• Eating more slowly, then waiting at least 20 minutes before eating or drinking anything else. This is still quite challenging, but I am making progress.

The increase in exercise is down to one simple change: I've discovered I can read on the treadmill. 

I'm a voracious reader, and like many readers, I never have as much time to read as I would like. I can't read at night, and it's often difficult for me to concentrate on a book, when a big to-do list is always waiting.

Most people I know watch Netflix or other TV while they exercise at home, but I have never enjoyed that, and I certainly don't need any more screen time in my life. I normally listen to music.

Two weeks ago I decided to try reading -- and it worked. This has been motivating me to get on the treadmill more often and stay on it longer. I feel all the other positive effects of exercise, but it's no longer boring. Big win!

Eating and Enjoying Real Food; Sustainable Self-Discipline

One of the things that concerned me most about weight-loss surgery was the idea of losing the enjoyment of eating and food. I heard and read that this would not happen, but there's a difference between knowing something in your mind and seeing it in practice in your life. 

Now I am eating. And enjoying. And this is a great relief! For the last 10 days, my partner and I have eaten the same food for dinner almost every night. If we didn't, it was because we got takeout and ordered different things.

"Eat protein first"... not really

Some of this concern was about cooking. All the info on bariatric diets advise you to eat protein first, then vegetables, then if you are able to eat more, a small portion of whole grain or complex carbohydrates. I cook mainly one-pot dishes. Whether soup, stew, stir-fry, sheet-pan, or casserole, the protein, vegetables, and grains are all cooked together. The one exception to this is grilling in the summer. Other than that, I'm combining simple ingredients in various ways. How was that going to work with "eat your protein first"? 

WRD explained that this "rule" really means to make protein the focus of your meal. You want to make sure you are meeting your protein requirements, and if you fill up on carbs, you won't be able to do that. Then why don't they say so?

For a one-pot cook, this means adjusting the ratio -- bumping up the protein, reducing the carbs. That's easily done. I might change the ratio when I'm cooking, or I might do it only when I serve myself. Either way, it's not difficult.

Sustainable self-discipline

Despite the tiny stomach, the bariatric diet still requires discipline and self-control. Although I can't eat a lot at once, I could eat small amounts that would add up to too much. If we're binge-watching something on Netflix, I could easily have a small snack every half-hour, and/or I could snack on the wrong food, filling up on empty calories. It's possible to do.

The difference is that the tiny stomach makes the discipline sustainable, because I'm not hungry all the time, or if I am hungry, a small amount of food is all I need.

When I was doing the pre-op fast, someone mentioned that I was proving that I could modify my eating behaviour. But behaviour modification was never my issue; my long history of dieting demonstrates that! I was overweight because I had consciously given up on dieting, and I was always hungry. Now, because of the surgery, I can eat a very calorie-restricted diet, without being hungry. Sustainable self-discipline.

85% thinking

Using an app to track diet and exercise can really run counter to 85% thinking. Calories eaten, calories burned, calories left to eat for the day... it has the potential to cultivate some very unhealthy thinking. But tracking my intake is really important right now. So I have to do it, and stick to it, but at the same time I have to give myself leeway and not give in to all-or-nothing thinking. It's a challenge!

January 1 Weigh-In

Pounds lost since last weigh-in: 7

Total pounds lost so far: 35

I'm very pleased. Losing seven pounds in one month is amazing to me. When I dieted in the past, a half-pound per week, or 2 pounds per month, was the most I could hope for. Even if the weight loss slows down more, I'll still be happy. Weight loss after surgery is supposed to continue for 12 to 18 months. I have time.

Also, Happy New Year! Thanks for reading, and for your support.