Dr. Staso: Welcome to our support group this evening at Chapman Medical Center. Let's start the meeting with a
few introductions. Mr. T, would you like to start?
Mr. T: I had surgery 10 weeks ago and so far I have lost 57 pounds. I used to have sleep apnea and
had to be on a breathing machine. Since I lost weight, I don't have to use that machine anymore.
I used to wake up many times during the night and always felt tired the next day. I have a lot more energy
now, and my wife says I don't snore nearly as loud.
Ms. J: I am the wife of Mr. T. I am in the process of getting approved for gastric bypass surgery.
I failed my sleep apnea test, which will help me in getting a referral from my physician for the surgery.
Ms. D: I have lost about 115 pounds. I had my surgery May 1998.
Ms. B: I had my surgery April 1998. I have lost 140 pounds.
Tracy Owens, RN: Ms. B is our reigning queen. (Editor’s Note: At the Coastal holiday reunion
party in December 1999, two successful Coastal patients were selected as King and Queen). She exercises
on a regular basis and she is very supportive of other patients one-on-one. Gabe Ramirez is our reigning
king. He was unable to attend the Christmas party when we crowned the King and Queen, so his wife Valerie
accepted the award on his behalf. Valerie and Gabe had surgery on the same day. Gabe has been keeping a
diary that will eventually be posted to our web site. He has great pictures documenting his progress, and
he is a good writer. Gabe and Valerie are the second husband and wife team to have surgery on the same day.
It would seem like a very good thing to do, because they can be so supportive of each other.
Ms. M: I had my surgery November 1991. I have lost 110 pounds.
Dr. Staso: Who has a New Year’s resolution in this group?
Ms. B: My resolution is not to consume candy when I am under stress. I need to find some other way
of dealing with it. I have been under a lot of stress lately. My mother recently died. When my father
passed away several years ago, I gained 80 pounds. I went from 220 pounds to 300 pounds. I don’t
want to wind up gaining weight again. I consumed a half-pound of candy between yesterday and today.
That’s the worst thing I’ve done in two years. It doesn’t bother me in terms of making
me dump (feel sick and nauseated). I ate four pieces of candy at one time and didn’t dump (feel sick).
Tracy Owens, RN: We know one person who dumps on watermelon. Just the sugar in watermelon can trigger
dumping. We have another patient who took cough medicine and got queasy because of the sugar in it. The
sensitivity to sugar does vary from one person to another. One person may not be able to eat salad dressing,
but can still eat a chocolate candy bar with no problem. Some people are more sensitive to fat in their
food, and others to sugar, while some people are sensitive to both.
Ms. B: I ate a half-pound of candy in a 24-hour stretch. That’s about 12 pieces of candy! Afterward,
I get like an alcoholic hangover. I woke up with a headache this morning.
Tracy Owens, RN: Well, eating candy stimulates your insulin. The sugar drives your insulin up. It will
secrete more than what you need. Then it stimulates your appetite because your body says you have too much
insulin and it needs some food to act on.
Ms. B: The good news is that I stayed on my exercise program and watched the other foods that I ate.
Sometimes I used to say to myself, well, you blew it, so there’s no sense in exercising now.
Dr. Staso: Who else has a New Year’s resolution?
Ms. M: I resolve to put all of my conflicts on hold that keep me from going to the gym. They take second
place from now on. My goal is to go to the gym at least three times a week.
Mr. T: My wife and I made a resolution to do something physical every night. When I used to play football
I used to go out there and sweat, sweat, sweat. I haven’t done that in I don’t know how long. I
played in a softball match last weekend where we played three games back to back. The next day I was so
stiff! I wound up having to get a shot in my back because the nerves were acting up. So, my resolution is
to get physical, to do something physical every night. I want to stop copping out, using different reasons
like, Îoh, it’s raining’ or ÎI have to study’, or Îmy wife has the
car’. I can think of a million and one excuses not to exercise.
Ms. J: For me, my goal for the next 90 days is to get into a better eating plan. I keep saying I
don’t have to eat healthy because I haven’t had the surgery yet. I realize that’s not
the proper attitude to have. My husband’s post-surgical lifestyle is soon going to be my lifestyle.
The quicker that I adapt to that change, the easier it’s going to be for me after I have the surgery.
My biggest concern is sweets. I’m so scared of having to give up so much. I’m going to try to
make better eating choices and get into the habit of exercising so that when my surgery comes around it
won’t be such a drastic change for me.
Ms. M: Ms. J, as far as sweets go, I didn’t miss them after the surgery. Not a piece of candy
crossed my lips for one year. Then, one day, I cruised past See’s candy. I said to myself, I’ve
done so well, I deserve one piece of candy. And then I liked it again. So the lesson is, if you don’t
miss it, don’t put it in your mouth. Leave it alone.
Ms. J: I want to control my eating and not let my eating control me. I just don’t like the idea
of deprivation. It probably will take one dumping incident to change my attitude. I have heard horror
stories from everybody who talks about experiencing dumping. I know I have a low tolerance for pain.
Mr. D: All you need is to experience dumping one time. You feel like, "Let me take my clothes off
and lay down." That’s how you feel. The next time, you’ll walk right by the food that
caused the dumping and say, "I don’t need that."
Ms. J: My friend had his stomach stapled about three years ago. One morning he ate a croissant for
breakfast. He immediately said he had to go lie down. He is going to have to have his surgery done
again next month. He stretched his stomach pouch and the staples have broken down.
Tracy Owens, RN: Stomach stapling is a different procedure from gastric bypass surgery. Basically,
your friend can eat that kind of stuff because what they do in a stomach stapling procedure is divide
and partition the stomach with staples. What the gastric bypass procedure does is surgically divide the
stomach and create a new pouch. You can’t disrupt the staple line because a new stomach pouch is
created. Whereas, if you just staple the stomach, the staples are simply dividing the stomach. If you
stretch the divided stomach by overeating, the staples pop and you have a large stomach again.
With the gastric bypass you have a separate stomach, and the intestines are bypassed in a certain way.
It’s the intestinal bypass that causes dumping when you eat foods that are high in fat or sugar.
Stomach stapling doesn’t cause dumping because it doesn’t affect the intestinal tract. In
gastric bypass, there are limits to the kinds of foods you will be able to tolerate. Stomach capacity
limits and intestinal changes will you make you more sensitive to sugar and fats. Not very many surgeons
currently perform the stomach stapling procedure because the failure rate is extremely high.
Dr. Staso: Let me tell you how you can improve your chances of having your New Year’s resolution come
true. The first thing is to be very clear about the exact outcome of what you are looking for. Then you
need to start writing down all of the small steps you need to take. Make these steps very specific and
very behavioral. Then, put down a time frame as to when you are going to be doing each one of these
small steps. It’s better if you make the plan for no more than two days in advance.
So, if you are planning on exercising, you look at what you are going to do today and tomorrow. Plan
it out exactly. Write it out and specify what time you will be doing these behaviors. What time are
you going to exercise? What are you going to be doing before, and what you are going to be doing after?
Then you find a buddy. You show them the plan and, hopefully, they can be on a similar plan as yours.
This way, you will have to account to someone. Everybody needs a manager. Tell someone what you are up
to and show him or her your exact plan, and report to them every two days. If your buddy is on a similar
plan, they should also report to you every two days.
We are all creatures of habits, and these habits are not always easy to change. What you don’t
want is to be real mean to yourself when you don’t follow through. Let’s say you plan to be
walking and then do some sit-ups 48 hours from now. You procrastinate, and then you don’t do it.
What you shouldn’t do is beat yourself up because that further entrenches the problem that you are
trying to fix.
Instead, you should write down what happened and then analyze what you did that day to stop your progress,
then you make another plan for the next two days. What are you going to do over the next two days? If you
have certain stressors that block your progress, then write them down. Note what you are saying to yourself.
You might hear, "It’s too much work. I’ll do it tomorrow. I don’t have the energy."
What could you say back to yourself the next time? If there is something that gets in the way, ask yourself
how else could you cope with it? What else could you say back to yourself? How else can you deal with it?
Then you mentally rehearse it.
What else could you do? I recommend repeating the phrase, "No exceptions and no excuses."
Write that down and mentally rehearse saying that to yourself every time you procrastinate or make an
excuse. It’s important to keep a journal. Keep track of your progress. Give feedback to yourself
every day. You don’t have to show your journal to anyone else, but you do need to discuss it with
your buddy.
It isn’t that you are answering to someone, it’s just that there is someone else besides you who
is keeping track of what you’re doing. In the world of weightlifting it’s called "spotting".
Just a little bit of leveraging goes a long way.
Changing habits is typically not very easy. The reason for this is your brain prefers to have routines.
Your brain wants to operate efficiently. You don’t want to have to reinvent the wheel every single
day. Your mind prefers these habits. It’s a good a thing, provided these habits are helpful. The
actual process of making habits is neutral.
Your brain can’t really tell the difference between what’s a good habit and what’s a bad
habit. It just prefers to have habits. When you wake up in the morning, you don’t have to ask yourself
what needs to happen between now and the time you get to work. It’s all part of a routine your brain
has memorized.
So, let me give you an idea of what it feels like to change habits. Everybody cross your arms. Okay,
now uncross them and cross them the opposite way. It feels less natural doesn’t it?
Changing any habit is like this. It feels different at first. You will be successful in phase one,
because you are consciously interrupting your habit. In phase two, you will forget to do it, but it
won’t be very long before you remind yourself. Phase three is getting back on track again. Phase four
is where you forget again, this time for a longer period of time. Phase five is a critical phase. You
realize that you have failed to make the change a lasting one. You are either going to give up, which most
people do, or you are going to retool and buckle down and put the energy into it. To move forward, you must
have a good reason to do it. Why is it important to exercise? What’s in it for you? Why is it important
to stop eating sweets?
The way you make it easier for yourself is to commit to writing in your journal every day. If you can do
it every day for two consecutive months, you will be successful. You can change virtually any habit that
you want.
Very few people are going to follow through for two months unless they have a buddy who reminds you of
your commitment. If you still can’t make the changes, it means that you don’t have sufficient
motivation. It’s just not important enough for you.
For the days when you don’t go to the gym or you do eat sweets, mentally rehearse what else you could
have done differently. If you have stress in your life, what else could you have done to handle that stress
rather than put sweets in your mouth? There must be at least five different things you can do when you are
under that kind of stress. Write them all down. Then close your eyes and mentally rehearse engaging in one
of those alternative behaviors. Walk it through. Do not beat yourself up for failing that day, as that does
not help. Do not punish yourself for not achieving your goal. And remember you are only working with two
days at a time.
Ms. M: When my mother died, it became the hardest time ever for me to deal with my eating. I heard Ms.
B talk about this too tonight. Do you have any suggestion about how to deal with this topic?
Dr. Staso: This is where your stress level goes to "10". It stirs up all kinds of emotions
like abandonment, loss, death, and there is a part of the mind that is willing to go to any extreme to
sedate those feelings. Of all the stressors in a person’s life, the loss of a parent is one of the
highest. It triggers a lot of death anxiety. Why don’t I discuss this topic in further detail at a
future meeting.
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