Observations About Weight Regain in the Absence of Easy Cues

I last wrote about my small but significant weight re-gain, and returning to tracking my eating. Although in March I wrote "see you in a month," it's been several months, so there's a decent amount of data on how things are going.

Tracking my eating has been very helpful. But despite that, I noticed I was eating more. I was increasingly concerned that I my little stomach may have stretched irrevocably: I was able to eat larger portions without experiencing the sensations that would cause me to immediately stop eating. 

For more than a year after the surgery, when I ate, I would very quickly feel full. If I ate one bite past that feeling, I was uncomfortable. Two bites, I would be overwhelmingly uncomfortable. Three bites was impossible, or I would run to the bathroom gagging. Thus I learned to be satisfied eating less!

I gradually lost this instant feedback, slowly enough that I didn't notice it on a daily basis. And then one day, I realized I was eating larger portions. In the summer we grill burgers on the deck. Last summer I would cut my burger on a bun in half, eat one half, and save the other half. This summer, I ate a whole burger with no discomfort. This worried and scared me. 

Then something interesting happened. I tried eating the post-surgery portion sizes and stopping, even though I wasn't getting that stop eating now! feeling. And I found I could stop, and was no longer hungry.

This may sound ridiculous or obvious, depending on your experience. But in my past experience, pre-surgery, I was almost always hungry. If I ate a smaller portion, I needed to cope with the feeling of still being hungry. That is very difficult to do on a consistent basis. 

The half-burger is one example. Another example is my mid-morning snack, between breakfast and lunch. I could eat x amount and not feel uncomfortable. Or I could eat half-x amount and also feel like I'd eaten enough.

So it turns out I can eat more -- but I can also eat less.

This causes me to wonder whether the disappearance of the immediate and non-negotiable feedback cues are the reason for some people's long-term weight regain after bariatric surgery. Because the big difference post-surgery is that immediate stop eating now sensation. Without those non-negotiable cues, I must be much more mindful of portion size and quantity. I must make very conscious choices of when to stop. This is a whole different post-surgery outlook. 

If you've never been overweight, or you're not someone with a big appetite who enjoys food, this may sound easy. I can tell you it is not easy. It is challenging. However, I can now do it -- where in the past, I could not.

So now in addition to tracking my food, I have to negotiate my portion size in advance of every meal. This means I can never let myself get too hungry. That's always been important for me, but now it's crucial, if I'm going to avoid re-gaining weight. 

Right now my weight is -37 from my pre-surgery weight, same as it was one year ago, and three pounds less than it was in March of this year. I'd like to lose a little more, but most importantly, I don't want to gain any more. 

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.

My New Kitchen Scale and Why I Wanted One

I decided to add a kitchen scale to my arsenal of healthy eating and cooking tools. 

The last time I saw a kitchen scale, they were little plastic things with a needle, something like this.

 

When I looked for one online, I discovered that, like everything else, kitchen scales are now sleek-looking and digital. I bought one that looks like this.

Dietitians like to use everyday objects as visual reference points -- three ounces of meat is about the size of the palm of your hand, a medium-sized apple is the size of a tennis ball, and so on. You can find many good guides on the internet, such as this one.

But I am so not a visual person, and I actually find these guidelines difficult to use. I've been trying to keep my guestimates low, but I've been growing curious. How many ounces (or grams) is that chicken thigh, really? 

I also wanted to standardize some of my cooking. For example, my partner I love the energy bites that are featured all over the internet. My standard are these by the Minimalist Baker: dates, peanut butter, dark chocolate, oats, and flax or chia seeds. They're delicious, super nutritious, and give you an amazing energy boost. (They're also vegan and gluten-free if that is important to you.)

I normally just throw ingredients in the food processor without any measuring. But now I want to know how many calories are in one ball, so I can eat one without guilt. So this morning I measured each ingredient on the scale. I looked up the calories for each amount, added them up, and divided by the number of balls. I was so happy and amazed to learn mine had only 80 calories per ball! It's very helpful to know that.

For some people, the scale might help keep you honest, so you're not fooling yourself, eating more than you think. I'm more prone to estimating high -- not allowing myself to eat more. I don't think the kitchen scale is a necessity -- you could definitely succeed on a bariatric diet without one -- but it can be a useful tool.

The Single Most Important Part of Healthy Eating: Preparation

Last weekend was a food-prep weekend for me. I try to do this when I have three days off, so I can spend most of a day (or two half-days) cooking without spending the entire weekend in the kitchen.

The first day I prepped food just for myself. I made:

• tuna salad
• salmon salad
• both from canned fish, stored in portions in muffin tins
• brussels sprouts
• part of my return to eating vegetables I love that my partner doesn't eat
• sweet potatoes
• ditto!
• chicken broth, using healthy bones from truLocal and my Instant Pot
  

The second day I cooked these dinners, to freeze. Each is a double batch, which should be enough for three or four meals, for two people, times two.

• spaghetti and meat sauce
• made with ground bison in one pot, using the Instant Pot on pressure cook -- super easy and delicious
• turkey meatballs
• also pressure cooked
• chicken burrito bowl, made with brown rice
• Instant Pot on slow-cook
• pork tenderloin with honey-garlic sauce
• my first time making this! very easy

I was so pleased with myself!

I have more truLocal meat waiting for another round of cooking. Right now my entire arsenal of Pyrex containers are in use, along with an assortment of repurposed glass jars. Plus four dinners in one morning was my limit. I'll do another round three or four weeks from now. (I also have really nice frozen seafood from truLocal, specifically for quick dinners on days I'm not working.)

All this food-prep reminded me of something I wrote several years ago on another blog. I'm re-posting it here in slightly edited form. 

* * * *

Healthy eating has one cornerstone, one key concept from which everything flows: advanced planning.

You can't eat healthfully without planning in advance. The more you can plan ahead, the more you can control what you eat. The more last-minute and spontaneous your eating, the less healthy it will be.

This applies to whatever manner of healthy eating you're trying to achieve, whether it's cutting down on sodium, fat, white sugar, or processed food, eating less meat, eating more vegetables, or anything else. It all comes down to planning. There are probably exceptions to this, but it's as close to an infallible rule as you'll find.

Here's one small example from my own life. Healthy breakfasts are [were -- at the time I wrote this] an ongoing challenge for me. One healthy breakfast that I like is scrambled eggs with veggies. If I'm going to eat that once or twice a week, I have to remember to put the vegetables I want on the shopping list and -- this is the key -- prep them and put them in containers in the fridge in advance. Without that, it doesn't happen. 

In the morning -- after I exercise, take the dogs out, have my coffee and check my email --  I'm hungry, but I'm also anxious to start my day. If I have to chop onions, wash and slice mushrooms, and wash and slice bell peppers, this healthy breakfast is not gonna happen. But at another time, if I run an onion through the food processor, slice a load of mushrooms, and dice a whole bell pepper, then put them in separate containers in the refrigerator... in the morning, everything is there when I need it. The actual cooking takes only a few minutes.

Not only does this encourage me to eat the better breakfast, it's also much more efficient, since the onion, shrooms and pepper will stay fresh for around two weeks. In fact, it was while I was throwing some already-chopped onions into the skillet, so pleased with myself for having organized this yummy breakfast, that I thought of writing this post.

[You can create an exception to the Advanced Planning Rule if you can afford to buy salads already prepared, lettuce already washed, or vegetables already washed and cut up. This can be very helpful, but still requires some advance planning, as these won't stay fresh as long as whole vegetables.]

To people who are natural planners, the idea that healthy eating requires advanced planning may seem incredibly obvious. But to people who are not naturally inclined to plan ahead or who are resistant to planning, or both, it can be a major obstacle.

If you're accustomed to a lifestyle where you shop weekly with a list, make dinner at home most nights, bring your lunch to work, then planning ahead is so ingrained in your life, you may barely think about it, even though it's something you do all the time.

If your schedule is erratic, or you're constantly pressed for time, if you generally don't think about food until you're hungry, if you have the means to dine out frequently, or any combination of these, planning ahead may seem impossible or undesirable. But you may not realize how much that spontaneity is preventing you from having healthier eating habits.

For many of us, the movement from no or minimal planning to a greater degree of planning occurred with age. In general, young adults plan less, eat more convenience food, are less concerned with nutrition or economizing. But learning how to plan ahead doesn't necessarily come naturally with age. I know lots of people my own age who find it very difficult. I'll bet many planners, like me, have partners whose response to "What do you want to do for dinner tonight?" is "I don't know, I can't think that far ahead."

So I've learned not to ask, just to plan. I take responsibility for planning dinners for the week, because I don't like what happens when I don't. I like efficiency. Even though I'm not the one doing the shopping, I hate needing multiple trips to the same store that could have been avoided with better planning, or getting takeout not because we want to, but because there's nothing in the house to eat.

Flexibility is important. Sometimes when you have a bad or crazy day, the best thing you can do for yourself is to say, "Let's make this chicken tomorrow night, let's get Chinese food tonight." But on a regular basis, if you "can't think that far ahead" to dinner, chances are good that you'll spend more money, eat more, and eat less healthfully than you would have if you had planned. 

If this is an issue for you, like any new habits, you might try starting small: make one change, live with it a while, let it take root as a habit, before adding in another change. If bringing your lunch to work is a stumbling block that you'd like to get past, maybe aim for bringing lunch one day a week. See how that works, then add a second day. Make one dinner in advance, and see if you like the trade-off. 

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.

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!

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. 

Week 9: Arriving at a New Almost-Normal

I seem to be naturally segueing into a bariatric diet, meaning a new way of eating that I'll continue for the rest of my life. The frequency of stomach discomfort is way down, at most once or twice per week. I'm finding more things that I can eat. And I'm gradually figuring out how to prepare food for our home -- some for me alone, some for my partner alone, and some for both of us. 

New stuff I'm eating (or not eating)

- I had sushi and sashimi this week. Sushi is one of my favourite foods -- actually it might be my very favourite food at this point -- and it was wonderful to eat it again. Portion size will be a challenge, but on the other hand, I can eat it regularly.

- I also had soup from our local Chinese restaurant, a "house special" wonton soup that they make with bits of roast pork, shrimp, chicken and vegetables. I separate the broth, which keeps the vegetables crunchy and hugely reduces the salt content, as I eat a very minimal amount of broth. 

- After the liquid and pureed phases, I was really missing eating something with crunch. In the past I would get that from raw vegetables -- and yes, the occasional chips -- but both those categories are off-limits right now. This week I started eating the whole-grain (brown) rice cakes that we always have on hand, with a small amount of peanut butter spread on. Healthy crunch!

- I've given up my decades-long habit of having strong black tea in the afternoon. I'm trying to limit my caffeine intake, so I've switched to herbal tea. Previously I've only occasionally gone for herbal tea, but now it's daily. I'm not sure if I can keep this up long-term. I've never liked decaf black tea, but if I could find a good brand, I'd try that. 

- I'm going to try different later-stage foods a little at a time, randomly, as I feel like it. I think as long as I eat slowly, it will be OK.

Things I've learned

Calculating the grams of protein I eat every day has led to some interesting insights. I've always paid attention to nutrition, but as most dieters know, it's also easy to fool yourself.

- We've always eaten a lot of seafood, and I've known that it is very high in protein and sometimes rich in healthy and important fats. Looking at the actual numbers has really reinforced this. Seafood is pure protein, a big bang for your protein buck. We eat tuna and salmon, both fresh and canned, trout, halibut, Pacific cod, scallops, shrimp, and probably a few others. 

 (I often joke that my tuna consumption is turning me into a thermometer. That's the big but of seafood... and why I switched to Skipjack (or "light") tuna, from Albacore (or "white") tuna. Skipjack is also less dangerous to marine mammals that die in driftnets.)

-  I've always thought that hummus is a healthy food and imagined it was rich in protein. Nope! As a spread or dip, it is certainly healthier than mayonnaise or sour cream, but it's not high in protein. Hummus, at least the commercial variety, really doesn't qualify as a protein source at all. 

- Much to my surprise, tofu is not very high in protein either -- nothing like chicken, fish, or meat. You would have to eat a lot of tofu to meet daily protein requirements. I realize that different people have different protein needs, but this partly explains why, when I was a vegetarian, I was so unhealthy.

Cooking for two, or 1.5

My partner and I have never eaten the exact same food, but normally any dinner I would cook would be for both of us. Now this has become a challenge. 

So far, as you may have read, I've been doing advance cooking for him, which we save for the nights he is working. At first these meals were 100% for him. Now I'm including some meals that I can also eat, or eat in a modified way, such as giving myself more meat and less rice. 

I'm also still cooking ahead for myself, and putting portions in muffin tins. This has turned out to be so useful for me, both for portion size and variety, that I want to continue it. 

One positive piece of this is that I'm eating food that my partner doesn't like, foods I had stopped eating at home, because I didn't want to bother making them just for myself. A large sweet potato -- baked until it's completely soft, almost syrupy -- lasts me almost a week. That's just one example of several.

All this has led to a great deal of food prep, and it sometimes feels burdensome, especially when I'm working long hours. This week my partner did a lot of prep for me -- cleaning, chopping, mincing, and leaving everything in tiny pyrex bowls in the fridge. That made a huge difference, but I don't want to make a habit of it. (Well, I'd love to make a habit of it, but I won't.)

This is something I'm going to have to feel my way through and make changes as I go along. In the past, anything I couldn't completely plan out in advance was very challenging for me. I'd feel anxious about having too many unknowns. But these days I'm much better about living with unknowns, and adjusting as needed.

Every day I see evidence of how weight-loss surgery is really a tool for people who already understand nutrition, who have had experience dieting and monitoring their food intake, who are mentally stable enough to deal with a lot of change, and who have support. Without those factors, it would be much more difficult to succeed.