A Decision to Try Again, Four Years After Surgery

Last year I wrote about my weight re-gain, and realized I was no longer getting the immediate cues of satiety that force you to eat less after bariatric surgery. I had re-gained 10 or 12 pounds (depending on the day). I found it very easy to maintain that weight, and was feeling all right about where I had landed. After all, I'm healthier, I went down two clothing sizes, and I'm still enjoying eating. I maintained that weight for more than two years. So, I told myself, accept it. And for the most part, I did.

Then I gained a few more pounds. I've been having some issues with my feet which cause severe pain; as a consequence, I've been less active. I don't know if that caused me to gain these extra pounds, or if I was just plain eating too much, but I did not feel happy at this new weight. It was past my comfort threshold.

Having flirted with the idea of more weight loss for the past two years, I already had identified a few things I changes I could make. I decided to:

• return to tracking my eating, which seems to go hand-in-hand with not gaining weight,


• be very mindful of portion size,


• eat a more substantial dinner, then stop eating for the day -- which will also help reduce incidents of acid reflux, 


• and drink more! which is surprisingly difficult for me, but worth trying.

So I did all these things, and very quickly lost the additional 2-3 pounds. Now I'm using this as incentive to try to lose more of the weight re-gain. My goal is another 7 pounds. This may not be possible, but I'm willing to try.

The challenge, of course, is doing this without becoming obsessed. My compulsive behaviour -- mild by diagnosable OCD standards, but present in my life -- has gotten worse with age, so I'm not sure where this is going. But I'm feeling good about trying.

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. 

The Average: My New Best Friend

This week I again started to worry that I'm eating too much. I'm eating only when I'm hungry, and tiny portions. On the other hand, I'm often hungry, and many days I eat slightly more than my goal calorie intake. 

I'm speaking with WRD monthly now, so I spoke with her about this. She reminded me:

* My goal is made up! There is no set amount of recommended calories per day that I'm supposed to be eating. I arrived at my calorie goal through guidelines and self-awareness.

* Calorie content is all approximate. The numbers on the packages -- or in my app -- are not exact. Obsessing over small differences in daily intake is pointless.

* Calorie tracking is a tool. It's meant to help me stay on track, not to control my eating. I should be controlling my eating based on feelings of satiety, and I'm doing that.

* I'm exercising 60 minutes/day, six days/week. Maybe I need a bit more more fuel.

* I'm still losing weight.

* I'm still eating about one-third of what I ate before surgery.

This all made me feel better, for a while. Then the nagging worry returned. 

I jumped on the scale -- thank you to R, who encouraged me to give myself permission to do this sometimes! -- and saw I had lost a few pounds since my last weigh-in. 

Then I searched online several times for something that would make me feel better. And I found it: the average.

Some days I eat more. Some days I eat less. What's my average calorie intake over one week or two weeks? 

I went back through the tracking app and chose random periods of time. And guess what? It's all fine. 

I did a weekly average for several different weeks, plus two-week averages, and a couple of monthly averages. Fine, fine, fine. In fact, my average daily caloric intake is remarkably consistent. 

This is a big relief. I'll try to remember it next time I start to worry.

Feeling Really Well: Increasing Daily Calorie Target Range and Allowing Myself a Mid-Month Weigh-In if I Want One

I am feeling really well! 

You may recall, I had a little freak out a couple of weeks ago (here, here, and here), and with the help of friends and readers of this blog, and a meaningful session with WRD, I was able to get back under control. 

Now it feels like that little earthquake threw me into a new place. 

I'm ticking off all the boxes on my healthy habits checklist almost every day, and days when I can't or don't, I can accept it: 85% thinking.

I increased my daily caloric range by 100 calories: from 1000-1300 to 1100-1400. This slight adjustment makes it much easier to stay within the range every day, which means it's probably what I need. 

WRD suggested I de-emphasize the calorie target in favour of mindful eating, but I don't feel ready for that. I still feel the need to track my food daily, and that means checking portion sizes, grams of protein, and calories. It's like wearing a seat belt -- a simple act that takes very little time and keeps you safer. I'm still working on mindful eating (driving under the speed limit?) (enough of this metaphor), but tracking my eating decreases my anxiety, increases my peace of mind.

After excellent advice I received from you all, I'm also letting myself hop on the scale an extra time or two, if I feel the urge. Once my weight hits a plateau, weekly weigh-ins are a good idea, and I'd like to be able to do that without going back to daily or more-than-daily weight checks. We'll see. I'm willing to experiment with this one.

Using an App to Track Nutrition and Exercise: Pros and Cons

Most people who track their diet and exercise use an app on their mobile device. I decided to track everything manually, beginning with the first day of the pre-surgery fast.

I have a beautiful blank notebook that I had never used. It was a gift, associated with a very special memory. (The book was a gift from my mother, a souvenir of our trip to France together in 2014.) I decided that this huge life decision deserved this special book. 

In the notebook, in addition to diet and exercise, I've included my questions for the dietitian, notes from my dietitian sessions, any pain or discomfort I experience, any milestones, challenges, and so on. It's a record of my bariatric journey. 

I really like having a record of all this on paper, and associating it with a very joyous memory. I'll continue to use the book to record notes from my dietitian sessions, and any other issues (qualitative rather than quantitative evidence, as we say in the information biz).

But now that I'm moving into a permanent bariatric diet, I realized an app would be very helpful. I chose SparkPeople, and I signed up for the "premium" (paid) version right away.

The paid level has many good features, but the reason I'm using it is to eliminate advertising. Something I use every day, both on my computer and my phone, cannot be plastered with ads. I'm fortunate that I can easily spend another $5/month. Not everyone can, and there are free versions of all the weight-loss apps.

There are many advantages to using a mobile app for nutrition and exercise tracking. However, for me, there are also disadvantages. In some ways it makes my life easier... in other ways it makes things more challenging.

Advantages

The advantages to using an app are obvious.

1. When you enter the food you've eaten, it automatically enters the nutritional value -- calories, protein, and anything else you might be monitoring, such as carbs, fat, vitamins, and so on. No need to look up anything.

2. It tracks and calculates your totals daily, weekly, monthly, and all-time. No need to look back through your week or month, no need to add anything. 

3. Once you've eaten a food, and entered it into the app in a way that reflects your habits (brand, portion size, method of cooking), the next time you eat it, you just tap or click on it. Easy.

4. You can group foods and ingredients that you eat together. For example, I grouped "milk, 1%, 16 ounces," "frozen berries, 1 cup," and "protein powder, whey, unsweetened, 1 scoop" into "protein smoothie". I'll do this with everything I cook, too. 

For me, these are the advantages. The app saves me time and repetitive work.

5. If you are not accustomed to tracking your habits, using an app would make it easier, and hopefully increase the likelihood that you'll continue tracking.

6. If you need more support, the popular apps offer articles, blogs, recipes, workouts, and so on, and also have communities that support and encourage each other. Goddess knows there is no shortage of any of these things online! But it does put everything in one place, which might help you focus. 

Disadvantages

The disadvantages to using an app are less obvious, unless you already have a good awareness of eating disorders.

1. Most apps track your exercise against your eating. They encourage the idea of exercise as a way of eliminating calories: "I walked 30 minutes today, now I can eat more!" 

This can be the first step down a very dangerous road. 

- We do not only expend calories when we exercise. We burn calories every moment, with every breath, all day, even when we're asleep. 

- There are so many reasons to get regular physical exercise, for both your physical and mental health. Exercise lowers blood sugar, lowers blood pressure, reduces the risk of heart attack, stroke, and diabetes, combats fatigue, helps regulate mood, boosts metabolism, and more. A life that includes regular physical exercise is a healthier, happier life than one that does not. Weight-loss apps encourage you to think of exercise solely in terms of calories burned.

- Tracking exercise against eating can very quickly lead to feeling that you have to "burn off" everything you eat -- that eating anything without exercising afterwards will lead to weight gain. 

Have you ever excused yourself before eating something by referencing your exercise? As you're about to take your first bite, you say (either out loud or to yourself), "It's OK, I'm going to the gym later today." 

Maybe you say it once as a joke. Or maybe you think it all the time. Maybe you privately believe you don't deserve to eat unless you have exercised. Or that eating food without specifically pairing that food with exercise will cause you to gain weight. This is called exercise bulimia. In this case, the purging associated with bulimia takes the form of exercise.

In the paid level of the app I'm using, you can turn off the "track exercise against eating" function. I've done that... and now the app tells me "Calories Burned: 0".

2. The app tells you "calories left to eat for the day". 

Tracking calories over time is useful and important. I get that. Post weight-loss surgery, it would be very easy to eat a tiny bit more every day or every week, gradually increasing your capacity -- and ultimately preventing or even reversing your weight loss. 

However, basing your food choices on "calories left to eat for the day" could also create a dependence on the calorie counter, rather than learning how to assess your own hunger. Last night I noticed the app told me I had 250 calories left to eat for the day. But I was done eating. I had no interest or desire to eat anything else. 

The previous night, I had minus 300 calories left -- that is, I ate 300 calories too many. I had been genuinely hungry, and ate too fast (my ongoing challenge), not giving my brain enough time to register the food intake. 

In the second example, calorie tracking was very helpful. I can look at the daily total and remind myself to continue trying to eat more slowly. In the first example, tracking would encourage me to eat when I wasn't hungry.

* * * * *

I plan to continue to use SparkPeople, both on my computer and on my phone. But I want to stay aware of these pitfalls. I'm hoping awareness, plus my own discipline, is enough to keep me from falling into them. 

But honestly, I'm a bit nervous about it. My January 1 weigh-in is coming, and thinking about stepping on the scale, I'm already getting anxious. I'm not freaking out or anything close, but this is nagging in the back of my mind. 

Quarantine is Over! Plus Some Fun Facts About Phase 3

Hurrah! Yesterday was my last day of self-isolating! I've had no symptoms, so my calculated risk of traveling through US airports during covid-19 was a good one. I promptly cashed in my rain checks for hugs and kisses, and moved back into our bedroom.

I also used the occasion to dismantle my alternative workspace downstairs and move back to my home office. We set up the kitchen workspace to encourage better habits during the liquid diets, before and after surgery. I'll have to be more vigilant about drinking water than I've been in the past, but I think I can do it.

The pureed food diet is going really well. I sometimes feel a bit burdened or discouraged when I'm starting the food prep -- then I do it and it's no big deal. I'm aiming for making three or four pureed foods at a time, and putting the pre-measured portions in a muffin tin. So far I've done:
- canned tuna, made with greek yogurt, dijon mustard, and pickle relish
- canned salmon, made with greek yogurt, red-wine vinegar, and dijon mustard
- tofu, garlic, ginger, and a touch of sodium-reduced soy sauce

Each one is pureed in the food processor with some protein powder, one teaspoon per serving.

For the tofu, I cooked the garlic and ginger in a little olive oil, added the tofu and soy sauce, cooked that for a while, then transferred it to the food processor. It had the thick texture of hummus, and was very tasty.

I'm also going to try:
- chicken and low-fat ricotta puree
- lentil soup puree
- white bean and ricotta puree

Here's an example of what I'm eating in the course of a day:
- smoothie made with 16 ounces of dairy milk, 1 cup of frozen fruit, and 1 scoop of protein powder (in 3 or 4 portions throughout the morning)
- can of tuna, pureed, protein powder added (broken up into 3-4 portions)
- jar of baby food fruit or vegetable
- very small portion of soft cheese, such as Laughing Cow Lite
- water, herbal tea, V8

I had a weird feeling that I was eating too much. WRD asked me to scan a few pages of my food diary, so she could calculate approximate daily calories. It turns out I'm eating too little, or at least the very low end of the suggested intake for this phase. Very strange!

Eating slowly is a big challenge, especially pureed food! I'm working on it, one muffin cup at a time. 

Hopefully this is not TMI: for years my ankles and feet have been (seemingly) permanently swollen. I take a diuretic for blood pressure, and I eat a lower-sodium diet, but puffy ankles and feet have been the reality. This is suddenly gone. I was putting on my socks and lo and behold, thin ankles with an actual shape, and smaller feet! 

I will ask WRD about this, but I'm guessing it's from not eating in restaurants (or take-out). I use very little salt when I cook, and we don't even keep salt on the table, but I was eating take-out two or three times each week. Perhaps that, plus a big increase in water intake, has given me back my thin ankles.

I'm still talking myself out of getting on the scale. As we get closer to our planned December 1 weigh-in, this will become more difficult to do!

Also Starting Today: the Food Journal

Today also begins tracking all my food and liquid intake. This is considered mandatory. 

All studies show that people who track their habits -- any habit they are trying to develop and maintain -- have much more success than those who don't. Tracking keeps you honest, allows you to see your progress, and I find it can be a morale booster. Plus who can remember how much water you've drunk in one day? Tracking alleviates the need to remember everything -- worth it for that reason alone.

I already do a lot of habit-tracking for physical exercise, practicing piano, and all kinds of other things. (That's a post for another day.) But I haven't tracked my eating for a very long time. So I start today.

Many people prefer an app for this, but I am avoiding more reasons to use my phone.  

For habits, I use a spreadsheet (I'm a total spreadsheet geek), but that's more useful for something you do once daily -- for example, every morning, checking off what I did the day before. 

For this, I've decided to go old school: a paper journal.

Recently I was showing my partner two beautiful blank books I have, but have never used. 

One book was a memento from my trip to France with my mother in 2014. Throughout the week she was trying to buy me things, mostly crappy tourist stuff that I didn't want -- and didn't want her to waste money on. In the town of Rouen, we went into a beautiful paper-goods and writing store, the kind of store I drool over. There, I made my mother very happy by suggesting she buy gifts for both me and my partner (poor guy, home with the dogs*) from this store. 

The second book was a gift from a friend when I moved away. 

Both books are beautiful with artwork and interesting designs inside (examples here), and both are meaningful to me.

And because of that, I have never used them! In this respect I am my mother's daughter: they're too nice to write in. Ha!

Recently this came up in conversation with A, my partner -- how I have these beautiful books and would love to use them, but can never bring myself to write in them. He suggested using them for my surgery journal. And I'm going to!

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* Don't feel too sorry for him: we went to London, Paris, and all over Spain the year before.