Some Clarity: I Want to Lose the Pounds I've Regained (Updated)

It's now just shy of two and one-half years since my surgery. 

Recap: I lost 50 pounds, gained three or four (which I expected, based on everything I had read), and stayed at that approximately -45 weight for about a year. I was happy at that weight. 

Now I've gained 5-7 pounds over that, and I'm concerned that my tiny stomach may be stretching, my weight may be creeping upwards, and everything I've been through since the day I travelled down to Mexico -- by myself -- during covid -- will be undone.

I don't know if this fear is valid or not, but it's nagging at me. 

So I've decided I will try to get back to the -45 weight.

Today I reloaded the food-tracker app, which I have not used in more than a year, and started logging my eating again. I'm committing to tracking, eating less, and making better food choices for one month, then seeing where I am. If I lose weight in the one-month period, I'll continue. 

In this context, eating less means being very conscious about snacks -- how frequently I eat and how much. I must eat between meals, but I have to eat the least amount possible to not feel hungry. The differences are very slight.

I've been weighing myself daily, which must stop! The scale addiction is returning. I'm going to give the scale to my partner to hide, something that has worked in the past. Having to ask for the scale usually gives me enough pause to stop myself. 

See you in a month!

Update

After only two days of food tracking, I am feeling better. I am still concerned, but feeling calmer and more in control. 

Second Travel Experience Without Weight Gain

Last summer, I went on vacation, ate very well, and was thrilled to not re-gain any weight. In the past, travel almost always led to weight gain. Breaking that pattern was amazing. It re-confirmed that many of my fears about weight-loss surgery were unfounded. It also showed me that my new habits are becoming firmly rooted.

Now, 10 months later, I've recently returned from another trip, which included a lot of great food. I was so happy to discover my weight when I returned was exactly the same as when I left. 

I was worried, and now am greatly relieved.

This is a great incentive to also quickly return to my eating and exercise plan, post-travel. 

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.

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 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!

My State of Mind: Checking In on the Dark Side of This Journey

I'm feeling very positive about this whole experience so far, but at the same time, I'm also working hard to keep my more negative concerns in check.

You may recall I was concerned about the surgery triggering past behaviours that were harmful to my mental health (here and here). Having bariatric surgery means being very attentive to food choices and portion size. It also means monitoring your weight regularly -- my single-biggest trigger.

These negative thoughts and behaviours are already percolating in the back of my mind. Over the past month or so, I've calculated and recalculated what my final weight may be. Healthy weight is expressed as a range, and the expected percentage of weight loss from surgery is also a range. I'd sit there using the calculator on my phone or computer: what if I lose this much, I'll be this weight, and if I lose this percentage, I'll be that weight -- in all different combinations, thinking myself in circles -- and all to no avail, since I cannot predict the future -- and since ultimately, I have no control over the numbers. You can stick to the plan 100%, but you can't control how many pounds you lose.

Thank goodness I can now talk about this and express it in writing. Eating disorders are almost always secret obsessions, layered in shame. The secrecy allows the disordered thinking to snowball without any other, more rational input. 

Eventually I disclosed to my partner that I was doing this. He immediately reminded me that I'm going through this process for my health, not for the number on the scale. And, he said, I'm also avoiding future weight gain. I hadn't thought of that! Even if my "percentage excess weight loss" is on the low end of the range, my weight will stabilize there. As long as I follow the guidelines, I won't continue to gain more weight as I get older -- which up until now, has been happening with each turn of the calendar.

This is also why I'm writing about this: to get it out of my mind. There's no easy solution to behaviours that harm our mental health. They require mental discipline, to recognize the obsessive thoughts as they creep in, and talk yourself out of them. And if I need more help, from WRD or a therapist, I'm totally willing to go there.

One Week to Go: What's on My Mind

The surgery is in one week from today! 

My current concern is the travel. 

In the final 48 hours before surgery, you're on a true fast -- liquids only. During this phase, there are no protein shakes, just water, juice, or clear broth. People with diabetes (no) or hypoglycemia (yes) can eat a small amount of protein, such as a hardboiled egg, if they feel dizzy or lightheaded. 

This scares me, and doing this while dealing with multiple flights and layovers, and everything that's involved with that, scares me more. I know I'll get through it. I'm just kind of dreading it.

In addition to fasting, the severe urticaria (hives) I've been struggling with is back in full force. It was 90% gone, and the fact of its reappearance is not a good sign. It likely means this condition is chronic and will come and go repeatedly. The antihistamines help, but at various (unpredictable) times during the day, my skin is on fire with itching, burning, and sharp stinging.

And of course, there's covid. I'll do my best to distance, and naturally I'll be wearing a mask and using hand sanitizer frequently. I can only hope the airports will not be crowded, and the flights not sold out. (The airlines now allow you to check what percentage of seats have been sold, and re-book at no extra charge -- but if you have a connecting flight and an event you are traveling to, that's not much help.)

Fasting, itching, and social distancing. I normally look forward to any travel, but this seems onerous. Maybe instead of counting the days, as I'm doing now with the semi-fast, I'll count the hours. I'm also telling myself that the anticipation is almost always worse than the event. 

(A reminder: I'm not freaking out. Just expressing my concerns.)

On the way back, I'll also be a liquids-only phase, but according to the dietitian, this will be much easier, as most people have very little appetite at that time. The surgery itself is laparoscopic -- that's why you can travel so soon after it -- but still, it is surgery, and I'll need to be careful.

Once I'm back, I'll have to self-isolate for 14 days, which will be very easy, as I'm working from home. I've taken two weeks off work for the surgery and recovery, but even after that I have no need to go anywhere while the quarantine period runs out.

Meanwhile, in the present, the semi-fast and caffeine step-down are going really well. It can be a bit challenging to open the fridge and see the food I've made for my partner... and pull out only the coconut water! But I'm doing it -- one glass of water, one protein shake at a time. 

When Is a Fast Not a Fast?

When it's a slow?

I don't know the answer to that riddle, but I now know that my pre-surgery diet is not a big deal at all. I have read that different surgeons have their own variations on what they prefer to see pre-op, and that an Optifast fast is not always required. But I didn't want to start hoping one way or the other.

This pre-op eating plan is a light, healthy diet, supplemented by protein drinks, electrolyte drinks, and a lot of water. There are fruits and vegetables, a small amount of whole-grain carbs, and a small amount of soft protein such as turkey or fish. No high-fat food regardless of the kind of fat -- no cheese, nuts, cream -- and no processed sugars. No alcohol, which is not a problem these days.

It's a mostly liquid diet, but not a completely liquid diet. So... I'm good!

It was a bit of an ordeal trying to get this information from the clinic. If I needed Optifast, I would have to order it, and things take a bit longer to arrive here. I was trying to explain to the patient coordinator that I needed to plan, and Monday (presumably the day I start the fast) is a holiday in Canada -- there's no mail and stores are closed. She seemed to think I was just being nervous. 

Today, finally, the clinic dietitian emailed the information. We may have to drive to Campbell River this weekend to have a choice of protein drinks, but we always have things to do there.

So one of the things I was most apprehensive about has been resolved. As usual, anticipation is worse than the thing being anticipated. I find this is almost always true.

Concerns About the Surgery

I want to write about some of my fears and concerns about the surgery, but I feel the need for a preface. 

I am comfortable with my decision to have bariatric surgery. But the way I see the world, nothing is perfect. The best experiences have downsides, and usually even the worst experiences eventually bring some silver linings. Everything is a trade-off. If the downside is occasionally annoying or troublesome, that doesn't mean the decision is wrong or a mistake. And it doesn't mean we have to pretend the downside isn't there. 

I have certain fears and concerns about what my life will be like post-surgery. I'm not freaking out, I'm not losing sleep, and I'm not having second thoughts about my decision. But the concerns are there. I need to write about them, in order to think about them and process them.

* * * *

I have three major concerns about the surgery:

- the pre-surgery fasting,

- my enjoyment of eating, post-surgery -- and forever, and 

- having to weigh myself, and this possibly triggering unhealthy patterns.

Fasting before the operation may seem like a silly thing to be concerned with. You drink Optifast or something similar for nutrition, and you don't eat. This shrinks the liver and makes the surgery safer. Most patients do this for two weeks. Some morbidly obese people are told to do it for a full month.

I'm not good at fasting. I have hypoglycemia, and when I am hungry and my blood sugar drops, it is very unpleasant. I get headaches, cannot concentrate, feel irritable and shaky. Perhaps drinking the Optifast prevents the blood sugar from dropping. 

I know it is temporary and short-term, but I am nervous about it.

The post-surgery terrain is long -- it's forever! -- and it's much scarier. I love good food and I love to eat. I think eating good food is one of life's most basic pleasures. Will I still have this pleasure in my life, post-surgery, or will it be a thing of the past?

Perhaps my love of good food will become part of my past, and I won't miss it. I can think of many things that I really loved and enjoyed while I did them, but when my life changed, I didn't miss them. My partner and I used to love to go to high-end restaurants when we lived in New York City. We spent a lot of money going out for dinner, and I never regretted a penny of it. When we left NYC, we stopped doing this, and I never missed it. I still enjoy going to a great restaurant as a treat, but that's not a regular part of my life anymore, and that's totally fine.

I can think of several other (non-food) examples of this. Will my love of food fall into this category? Will that leave eating boring and colourless? 

Of course there are huge upsides to this piece. Many people say after the surgery, they have to remember to eat. I am almost always hungry. No longer having that in my life would be incredible.

Lastly, and most importantly, is my dread of having to weigh myself and track my weight. Many of the behaviours that people are supposed to adopt before and especially after bariatric surgery are exactly the behaviours that signal eating disorders. 

There are no quick fixes for this. It's going to take a lot of willpower, and mental energy, and maybe some therapy, to track my progress without becoming a slave to the scale. I've written about this before, and I'm sure I'll revisit the topic many times. 

Of course looking at the downsides on their own leads to a very negative conclusion. Presumably, along with these concerns, there will be a significant reduction in my weight, and improvements in my health, and those together will lead to many positive benefits.

Will the Surgery Trigger Destructive Behaviours?

I mentioned that I've struggled with an eating disorder.

I think most women in our society have had eating disorders at some points in their lives, whether they realize it or not. We think our constant dieting, our obsession with our weight and size, is normal. I learned to think about eating disorders as a continuum of behaviours. When thoughts become obsession and behaviours take over your life, there is a problem!

My problem took the form of obsessive dieting and weighing myself. I was addicted to weighing myself. And it took me a very long time to quit. I put the scale in an inaccessible place... and then stood on a chair to reach it. I put myself on a regimen, only allowed to weigh myself once a day, then every other day. I succeeded a bit. I relapsed. I lied to myself. I gave up. I started again. And so on and so on. Everything you know about addictions, I did that.

OK, maybe not everything. I didn't sell the TV to buy a fix, I didn't lose my job, it didn't end my relationship. But trust me, even something seemingly harmless as stepping on a scale can strangle you.

For a time, I tried weighing myself only at the gym. I was swimming. I would leave the pool feeling great -- loose, invigorated, happy. Then I'd get on the scale and ruin my day. Day after day after week after month, robbing myself of all those good feelings.

In the past 15 years, I have tried several times to lose weight in a healthy and non-obsessive way. I lose weight verrrrry slowly, and healthy weight loss is slow anyway. So if I don't weigh myself occasionally, I'm not going to see any progress -- and you need some kind of progress as positive reinforcement.

But that word occasionally... that's the sticking point. Keeping myself off the scale has been very, very challenging, far more difficult than any dietary adjustments. Stepping on the scale is a giant trigger. It opens the floodgates to a rush of self-loathing.

Before and after surgery, there is going to be a lot of weighing. A lot of stepping on the scale. How am I going to handle that?

I don't have an answer to this yet, and I'm okay with that, for now.

But this is one of my greatest concerns about the surgery.

I've Tried It All... And I Don't Want To Go Back There (Eating Disorders Are More Common Than You Might Think)

When it comes to my weight (size, body image, etc.), I've been there and back. More than once. I gained a lot of weight in my mid-20s, and used one of the many popular diets of the day to lose it quickly. This was the first, and as it would turn out, only time in my life I was actually thin.

As the weight came creeping back, as it inevitably does, I started dieting. And dieting and dieting. I became obsessed with what I ate and with weighing myself. It was a horrible way to live.

I was like this at least 10 years, when, coincidentally, I needed to research eating disorders. I was shocked to recognize my own behaviour.

When many people think eating disorder, they imagine an extremely thin person, probably a young woman -- an anorexic. But there's a huge spectrum of eating disorders, covering a wide range of behaviours. Once I became aware, I would see eating-disorder behaviour everywhere. 

For me it took the form of being addicted to weighing myself, addicted to dieting, and obsessed with restricting my eating. I was probably only 10 pounds overweight at the time, but I was obsessed with trying to lose weight.

After recognizing this in my late 30s, I started seeing a therapist who specialized in eating disorders, and I worked hard to free myself of these obsessions. Eventually, I got there.

I stopped dieting. I stopped strictly policing my eating. I even stopped weighing myself. It took a long time, but it was glorious. It was so liberating! I gained some weight, but I was healthier, and happier. 

I also learned that the link between weight and health is greatly exaggerated. Obesity is a health risk, but those 5 or 10 extra pounds that women become obsessed with are not. They're not even extra.

But keeping people insecure and unhappy is an essential part of our consumer culture -- and the diet industry thrives on it.

So I stopped dieting, started enjoying my life -- and food -- more. I was maintaining a weight that was heavier than most people want to be, but I was healthy and felt good.

Now I've gained quite a bit more than is healthy. But I don't want the demands of bariatric surgery to undo all my hard work and my hard-earned freedom from these obsessions.

I'm afraid the surgery will be a giant trigger that sends me back to weight prison. Pre- and post-surgery, you're supposed to track your eating. And post-surgery, you need to track your weight loss.

How am I going to do that and stay sane?

I'm thinking a lot about this. I want to make it work.