Surgery is on your stomach not your Brain – This is a phrase that you will hear often when preparing for Bariatric Surgery. There is a reason you need to see a full interdisciplinary team of health professionals before being approved to go ahead and have this life changing procedure. You need to have a plan for how you’re going to eat high protein, low refined sugar foods. You need to be aware that you cannot binge eat in one sitting, our you could find yourself in a medical emergency – at the very least a lot of pain. And as I’m sure everyone is aware- how much and what we eat is often a decision made in our brain not our stomach.
Researchers at Cornell University estimate that humans make more that 226 decisions about food alone PER DAY. Some may think that after surgery you need to think less about food than before. This is definitely not the case. After surgery – I can speak for the immediate post op period for sure- you make SO MANY decisions about food. You have to think about what you are eating, the speed of eating, the texture of food, the timing, the protein content and the sugar content. For a person who is starting off a weight loss surgery journey with a poor relationship to food, surgery, and the care needed after can be extremely overwhelming and mentally taxing.
In this blog post I would like to talk a little about my mental health history with food, how I worked on that relationship before surgery, and how I’m feeling one month post op.
History of Food Addiction and Disordered Eating
I’ve said it before and I’ll say it again. I love food. I will also love cooking and creating new recipes. Trying new foods and going back to the old comforts every now and then. For as long as I can remember I have found my mind occupied with food.
The earliest memory I have is around the time I transitioned from elementary to middle school. At the time I didn’t equate the food habits to my life (I was only 10-12 years old), but looking back it was a rocky time. In school I bounced around from friend group to friend group. Trying to climb that hierarchy of popularity so coveted at that age. I was changing who I was in almost every way and morphing my personality to fit with whatever clique I was trying to be friends with. I knew that I carried more weight than my peers but that never stopped me for garlic sticks with dipping sauce and pizza at lunch. I would feel upset about my weight but did not fathom changing how I nourished and moved my body.
I don’t want to focus too much on my garlic stick lunches – because at the end of the day thats what every single kid ate. In fact it was a mad rush to make sure you got one before they sold out everyday. What is more disturbing to me now looking back, is the behaviours around food at home. The sneaking and hiding, knowing what I was doing would be frowned upon and finding new and creative ways of hiding my bingeing.
We had an extra fridge in our basement, and the basement was also were all the children were relegated to when family visited. During the holidays there were a lot of children and a lot of food. So much so that my Mom would store deserts in the downstairs fridge when the kitchen fridge was overflowing. I have a clear memory of escaping to the small room that held that spare fridge and eating small scoops of the homemade whipped cream meant for our apple and pumpkin pies. I was aware I needed to – 1. not get caught in the act 2. not eat enough that it would be noticed and 3. make sure the swirls on top looked natural, not like a finger or spoon had been dipped in.
From that time, I don’t remember the feeling eating the secret deserts gave me. I do remember the guilt and the fear of being caught. Moving on to junior high and high school. My brother and I were mostly turn key kids. In that, most days when we would return home from school we would be there alone. There was a designated after school snack cupboard that we would each grab something from and then go on to do our homework. Although somedays – both after school times and any time I was left alone – I would want to eat more. A few “snacks” that stick out in my mind, in terms of things I felt guilty about were – cooking and eating 2 – 3 hotdogs out of the freezer, or 2 packs of mr.noodle, or melting butter with brown sugar to make “fudge”. The reason these stick out is the memory of how I covered up my crime. After indulging on a snack I shouldn’t have had, I would wash and put away every dish I used. I would take any garbage and bring it out the big dumpster, then bury it deep – as if my parents would riffle through the kitchen garbage after work to find evidence like in CSI- they didn’t have time for that!
I don’t know why I went to such great lengths to hide food. I think I knew my parents were trying their best to be supportive of healthy eating, and that I came home from school crying about bullies taunting my weight enough times that they wanted to support a healthy body image. I felt guilty that I had urges to eat foods that were not on the healthy spectrum – or would want to eat a high volume of foods.
Something I’ve always struggled with was feeling like people were watching me when I ate and judging me for what I was eating given my appearance. This stemmed from insecurities passed down from my mom and from comments made during lunch periods in high school – from well meaning friends.
In university, dining hall felt like being in a fish bowl of people watching and judging each meal. In some cases this feeling steered me towards healthier options while in dining hall but promoted binge eating in my dorm room.
After university and living alone I didn’t feel the pressures I’d had previously. This time was also my 10 year long journey with every diet and work out regimen under the sun. So there were waxes and wains of binging and restricting. Something that sticks out as evidence I still felt the need to hide what I was eating – when my mom would call and ask “what’s for supper” – I’d look down at my plate of homemade fully loaded nachos and say “salad”.
Accepting Addiction and Disordered Eating
Addiction is a touchy subject for me. Unfortunately, there is a strong history of addiction in my extended family and a lot of the behaviours I witnessed around addiction had a negative impact on me. Even without that prior experience it is extremely difficult for someone to admit they have an addiction. You are accepting defeat – accepting you need help, that you weren’t strong enough to stop this activity/substance from taking over your life.
Throughout my 20’s I would repeat this phrase over and over again – you can quit drugs and alcohol and still be alive – you can’t quit food and still live. I’m my opinion that is complete admission of a food addiction, but I wouldn’t be open to accepting that concept until I was in my early 30’s.
It was at the weight loss clinic where I was initially referred for surgery that I was confronted with my addiction. The same doctor who said “surgery is the only way you’re going to loose weight” also said “you should go to a support group for food addiction”. As I mentioned before, both of these suggestions made me furious at the time. In my mind I had complete control over food, I just had cravings sometimes, and I didn’t need surgery, my will power was strong enough to loose weight naturally.
I don’t know what prompted me to do a google search of books on food addiction but I did. That summer I was rebuilding after a rocky relationship. I went home to Nova Scotia to see my parents and brought with me a book called Food Junkies by Phil Werdell and Vera Tarman. This book changed my life and allowed me to final accept and say out loud – I am addicted to food and I need help.
Changing my mindset around what is an eating disorder was also really important. Even as a health care professional I had the mindset that binging, purging, restricting, was only medically significant if you were at a dangerously low weight. I think as a society we need to accept that NO MATTER what your outward appearances is, disordered eating is serious and can have long term affects on mental and physical health. Any disordered eating, no matter what your weight is an eating disorder.
Thankfully I was already engaged in therapy with a wonderful practitioner for 4 years. When that practitioner left the practice I was referred to a therapist who specialized in disordered eating and food addiction. Building this new therapy relationship was much easier once I accepted how disordered my history with food was and I made a commitment to changing it.
I read books and worked hard on getting out of the dieting headspace, some my say found the anti-diet lifestyle. I also worked on intuitive eating, listening to my body for hunger and full cues, paying attention to how some foods made me feel physically and how I felt when I avoided those foods. I changed how I viewed food. Instead of allowing food to be good, bad or affecting my self esteem – I changed to – is this food nutritious or not nutritious, what portion of this food will I choose.
I will say I was offered many times to participate in food addiction support groups. This is also something recommended in the pre-surgery assessment process. With my first attempt at a surgical referral the need to attend this groups was on the list of reasons I wasn’t ready for surgery. I have accepted that these groups maybe helpful, but have not reached out to attend any. I bring it up to be accountable for my own resistance but also to make sure you know there are resources out there.
Still a Struggle Everyday
It might sound like I’ve come a long distance from the kid sneaking whipped cream in the basement- and in some ways I have. It is still a constant daily struggle, with some days being better than others.
Before surgery, my binging and restriction patterns had greatly improved, but at times I still found myself occupied, even obsessed with foods until I could get some. I also stopped bringing foods into my home that I know I would have little control over eating or eating too much of. I continue to work with my therapist and I feel that recognizing behaviours and thoughts is extremely important to me.
Shouldn’t vs Can’t
Since having surgery I’ve been thinking a lot about these occupying thoughts of certain foods. For instance on the east coast we have a dish called garlic fingers with donair sauce. Calling it a dish makes it sound a lot fancier than it is. Essentially, garlic fingers are cheesy bread sticks dipped in donair sauce which is an extremely sweet garlic flavoured dipping sauce.
Before surgery when I would crave this meal I would think, I really shouldn’t – there is no nutritional value, it’s a dish I tend to eat too much of, and I almost always have a stomach ache after. In the end there were no really consequences to prevent me from eating it.
Now, post surgery when I think of eating garlic fingers and donair sauce again I think, I can’t eat this. There are a few reasons I will probably never eat garlic fingers again – 1. There is no nutritional value. I have so little that I can eat in a day that one or 2 sticks would be filling, and the nutritional value does not coincide with my goals for the day 2. Unless I want to be in extreme discomfort, the taste and satisfying a craving would not be worth the dumping syndrome and abdominal discomfort afterwards. 3. I don’t need to eat it, eating this meal will not change how I feel about myself.
Garlic fingers and donair sauce are just one example of how I’m working on my mindset around food post operatively. I think the list of foods I said shouldn’t before and can’t now will be low. For the most part I’ve been using my love of creativity with food to reimagine meals I enjoy in bariatric friendly ways. Like bunless burgers, or buffalo chicken salad instead of chicken wings. Deserts will be tricky going forward but I do feel I’ve “detoxed” from sugar since the pre-op diet phase. There are a lot of low sugar options out there to allow for deserts, whether or not I struggle with portions is yet to be determined. It is a bridge I must cross one at a time.
How I’m Feeling 1 Month Post Op
I do feel that the immense amount of work I put into my relationship with food and developing the tools to work with my addiction pre operatively has helped with my transition to a post op bariatric diet. I also think that I would’ve really struggled if I had had weight loss surgery any earlier in my life. Like I said above, the struggle is not over now that the surgery is completed, in some ways the struggle has taken on a new form.
Counting protein and sugar has a different meaning for me now. In previous attempts with marco counting for weight loss there was a lot of guilt around not meeting or going over targets set. Now, I need to focus on these two measurements to ensure I heal quickly and I feel well. Protein is essential to keeping muscle mass and not allowing the body to burn muscle instead of fat. This affects my energy levels and quite frankly my goals in having surgery. I want to run 10k races, play sports and climb walls. I need my muscle mass to do so. Paying attention to sugar is important because, like most, I’m terrified of dumping syndrome. So anything to avoid discomfort is worth it.
I still have an incredibly long road ahead of me, and I hope to share the hills and valleys of that journey on this blog. I will say that caring for your mental health after weight loss surgery is, in my opinion, as important if not more than counting macros and exercising.
Resources for Ongoing Support
Ongoing support is important. I have a wonderful support system in my friends and family but I still set a high level of importance on therapy was well.
I would recommend Food Junkies to anyone. Not just a person in the process of accepting an addiction to food, but also to the people who surround them in life.
I am grateful that the bariatric surgery program where I am a patient is extremely supportive and provides a lot of resources to help guide through every stage of surgery.
In addition to that support I’ve also found the Bariatric Surgery Nutrition program extremely helpful.
From social media there are is also a lot of support. One account in particular as meant a lot to me. The information is frank, is evidence based and really resonates with me. Please check out Healing is Freedom on Instagram!
I want to thank each and every person who takes the time to read this blog. It means a lot to me to have this platform and share my experience. I’m so looking forward to continuing on this journey!