Falling off the Wagon and Hopping Back On by Linda McGavisk, PA-C

Falling off the Wagon and Hopping Back On by Linda McGavisk, PA-C

  1. Feeling Deprived- When we diet, we often feel deprived of our favorite foods. We have spent a lifetime enjoying certain foods and restricting them leaves us craving them. Because the foods being avoided are usually abundantly available and because food visibility and availability are powerful eating stimuli, the patient often breaks his or her “plan” by eating a forbidden food. Once this happens, overwhelming guilt and feelings of low self esteem often motivates the patient to continue eating in an attempt to numb these negative feelings.Getting Back on track: Focus on the concept of “calories in vs. calories out”. Remember that eating one avoided food does not ruin your whole day or diet. Do not try to make up for it by not eating for the rest of the day. This will only increase the sense of deprivation, creating a cycle. Instead, continue to move forward, putting the event behind you and focusing on your low carb diet and exercise program.

    2. Boredom- Many of our patients report eating late in the evening after returning home from work, snacking either out of boredom or because they have nothing else to do. Television is often a favorite pastime, especially when we are tired after a long day or needing a source of companionship when we are home alone. Television runs food commercials at approximately 200 images per hour, making it difficult not to be drawn towards our refrigerators.

    Getting Back on Track: Breaking our habit of eating from boredom can be difficult. If you find yourself struggling and are grabbing for something out of the refrigerator, make some low carb snacks and leave them in the refrigerator. If the temptation to go to the fridge or pantry is too much to resist you will be prepared with an option that will not increase levels of anxiety and guilt. Develop activities to busy your hands that do not involve food such as knitting or journaling.

    3. Habits- The daily habits we have adopted may not be as healthy as they should be, and we may not be consciously aware of these habits. Overeating, sedentary behavior or lack of physical activity, and stress lead to excess pounds. Many patients may find that overeating tends to occur in specific places and times, such as in the evening when you’re at home watching television or eating in social situations when you are not consciously aware of the amount or how fast you are eating.

    Getting Back on Track: When you are home in the evening, keep your mind and hands busy. Take a walk, watch a movie instead of television (which runs McDonald’s advertisements!), or read a book. Another solution to stress-related overeating is to identify the sources of stress. Acknowledge and address feelings of depression, anger or anxiety. Do whatever helps you relieve the stress: get a massage, read a book, exercise or learn breathing exercise to help you relax.

    4. Fatigue and Lack of Energy- Many of us are raising children, working long hours, fighting traffic, taking care of a household…and the list goes on.

    Getting Back on Track: Identifying our individual low-energy times of day and substitute them with activities other than eating. Take a 10-minute walk, strike up a conversation with a coworker or friend. Energize yourself by listening to or telling a good joke.

    5. Loneliness- Often, our patients turn to food for comfort when they lack love, support, and reassurance. On a daily basis, patients juggle the pressures of work along with their personal lives. All of this is acceptable if supported with constant appreciation and love; however, some of our patients experience isolation, a lack of appreciation, discouraging or discriminating remarks which may leave them sad or lonely. Food becomes a source of consolation.

    Getting Back on Track: Stay connected with friends, family, coworkers and clergy. Ask for help, come to support group on a regular basis. We will help to find you a Weight Loss Buddy.

    6. Disgust or Resentment for Your Body- Patients complain of a lack of intimacy due to poor body image. Examine if you focus on what is wrong with your body or if you have an inability to see the progress you’ve made. One of the reason patients are unable to overcome eating triggers is the inability to accept their bodies and a lack of foresight to look into the future.

    Getting Back on Track: Get comfortable with the skin you’re in (at the time). Every time I meet a patient, I realize there is something beautiful, special or unique in all of us. Enjoy the process and transformation you are beginning. Seek professional advice from our dietician, Catherine, or one of our bariatric mental health specialists who will help you overcome some of the negative feelings and help energize you to map out a recovery process in close consultation. They can then try to help implement a plan and stick with it to develop a positive self-image. Define your own personal attributes, write them down in a weight loss journal and add to your list of attributes as you see yourself blossom. These attributes should be an honest, self-assessment, regardless of anyone else’s opinion. No one knows you better than you!

    7. Physiologic triggers such as glucose intolerance- Many of our patients have a condition known as glucose intolerance. All starchy and sweet foods (yes, even fruits, whole grain breads, and cereals) raise blood sugar quickly. When we eat carbohydrates, they are rapidly absorbed into the bloodstream, causing a rise in insulin which acts to clear sugar and fat from the blood. The stored energy in the carbohydrates is then stored in the body tissues for future use. This causes weight gain. Remember, we all learned in high school science class the first law of thermodynamics, which gives us the principle of the conservation of energy and states that energy can be transformed (changed from one form to another), but it can neither be created nor destroyed. The energy we consume in food must either be consumed by life processes, or expended through exercise, or it must be stored, usually in the form of body fat for later use. In a healthy person, carbohydrates are converted to glucose and a blood glucose level of ~60-100mg/dl is maintained without alteration in the dietary fat, carbohydrate or protein. However in the glucose intolerant patient, carbohydrates are readily converted to glucose and the pancreas responds to rises in blood sugar by secreting excessive amounts of insulin. Insulin’s role is to remove the glucose from the blood stream and help the body cells to uptake it as an energy source. If done properly, our blood sugar level returns to the normal range regardless of the amount of carbohydrate consumed. If this system is not working correctly, a quick rise in blood glucose followed by an over production of insulin occurs. The excessive insulin is not recognized by the body cells so it is unable to remove the glucose from the blood. The result is an increase in the amount of insulin in the blood which has an appetite stimulating effect. The patient has an increased drive to consume food and if carbohydrate is consumed, the cycle continues.

    Getting Back on Track: Eliminate the named carbohydrates from your diet that we often discuss. Remember to eliminate bread, rice, pasta, potatoes, fruit, and cereal from the diet. These foods, along with food made from wheat and sugar, cause the rapid spike in insulin. Protein is preferred as fat interferes with the effectiveness of insulin. If blood glucose levels do not rise rapidly, there is less likelihood of excessive insulin secretion and less appetite stimulation. It is important to increase water consumption along with an increase in protein. Water aids in carrying nutrients and oxygen to cells and removes waste.

    8. Unrealistic expectations-Weight gain is evolutionary. It begins with “jeans that must have shrunk,” a looser belt notch, or lying down to zip your pants. It takes approximately 3800 calories to equal a pound. Eaten over months or years, we don’t recall “where those pounds came from,” yet we expect them to drop off like an anvil out of an airplane. A 10 to 20 lb per week weight loss is awesome but not realistic.

    Getting Back on Track: Get in check with your reality. Keep a food journal. Write down everything that passes your lips. This includes food, drinks, sugar-free gum and breath mints… everything counts, except your toothbrush. Keep a piece of paper in your pocket and write it ALL down. You might be surprised what sneaks in and we don’t even consider it as calories and carbs! Remember to exercise. You may not be able to compete in the Iron Man competition this year, but begin with a 10 minute walk daily and work your way up and before you know it you may be competing in a marathon. Baby steps in the beginning will lead to great strides in the future.

    9. Confusing thirst with hunger-Many patients do not drink our recommended minimum intake of fluids. We recommend at least 64 fluid ounces daily of sugar-free, non-carbonated beverages.

    Getting Back on Track: Drink more water. Recipe enclosed: 2-parts H, 1-part O. Carry your water bottle with you everywhere you go and sip throughout the day.

    10. Lack of Empowerment-Our cravings are attempting to control us and our behavior. Our actions, feelings, and thoughts about food are molded by our attitude. When the weight is coming off quickly and we are seeing results, like in the all liquid phase of the diet when we are preparing for surgery and immediately post-op, we begin to feel good about the process. However, toward the end of this phase, we rely on our strength, our willpower and determination to fight back and control our cravings. If we succumb to the cravings we will fall off in the weight loss plan.

    Getting Back on Track: We each have the capacity to strengthen our minds, as well as our bodies through exercise. We must exercise our ability to make good food choices on a daily basis to encourage a strong foundation for lifestyle change, just as we must exercise our bodies to build muscle mass. It takes time, and some days are easier than others to exercise. Regardless, the effort counts.


Linda McGavisk, PA-C

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