An open letter to Judith Beck :( #wls #CBT @beckdietsolution

Some of you may have seen this Huffington blog post from Judith Beck to Carnie Wilson about her repeat gastric band surgery.

I am really bummed out by this, as I have been a huge huge supporter of Beck Diet Solution and my copy of  the book is always close by and very dogeared. I have even paid for a coaching session with beck institute, and seen great value.

But, this open letter is  just….wow.

In the theory of CBT, how would you have Carnie reframe her reaction to this column?  Ouch. This would be enough to make me pissed off, defiant and trigger all my bad habits.  I don’t get the logic about this at all, unless it was just to sell books, in which case, not only am I disappointed, I think that it probably backfired.  The response by the weight loss surgery community has been swift.  The problem is, Dr. Beck, your work IS the foundation of what we all need to do to change the mental part of our struggle with food.  Your work is so good, and now this post totally drags you down and will make people question your credibility.

I’m not saying that most of your points aren’t correct–of course they are.  I think a large majority of people who have WLS have food issues; I certainly do.  And our surgeons encourage us to work the psychological part of this program — its a requirement to even get the surgery.  Its how, ultimately, I found your book, upon recommendation.

What I am now left feeling like, is that the person who’s work has inspired me the most, may think that those of us who have weight loss surgery are copping out.  Maybe its only those of us who have had it twice? But now I would have to suspect that any WLS is seen as a copout.  Its just not true — the medical statistics speak to the fact that the likelihood of morbidly obese people being able to lose the weight and keep it off is less than 5%–and its not just the mental aspect.  There are mechanisms in our bodies that are simply “broke” when we are that overweight.  Our bodies physically and mentally fight against us to lose weight the “right” way.

I am not saying that I don’t question Carnie’s choices too….but the reality is, I get it.  I get her, I get the struggle.  I don’t like her trying to use it to make a career comeback.  I do think it takes a lot of courage to admit you’ve failed and have to try again.  I don’t understand how any doctor could suggest that getting a lap band again would be a good choice for her.  It didn’t work the first time, and definitely is not the surgery with the best track record out of the 4 primary WLS types.  But I do think a revision is appropriate, just not to repeat the band.  So why choose it again?  Why not pick a more permanent WLS?  Why take the way that didn’t work last time?  I don’t get that.  I’m not trying to dis the band, but the statistics seem to support a lower level of success with band than other procedures.

Anyway, so Dr. Beck, while I guess, as Carnie is a public figure and has made her weight loss issues public, its fair to talk about it, but wouldn’t a call or direct private reach out with an offer to share your considerable knowledge and approach have been more humane?  Imagine the long term payoff if your method could have been the reason carnie really kept it off this time? Now THAT would sell books.

Because I already know that the approach is best, I won’t be abandoning the principles of CBT for sustained weight loss but I am sad that this appears to be a judgement against weight loss surgery and I am sad that the WLS community will probably not dive into this important book because of this issue.

In one of the primary aspects of the beck diet solution, you’re supposed to give yourself credit for the good choices. Let’s find something to give Carnie Wilson credit for….

6 week post op, Groundhog day, awash in behavior change options

Well, yesterday I was officially six weeks post-op. I am really surprised how fast the time went. The time sure CRAWLED to get to the surgery date and through the liquids phases of the post-op diet. At this point, I basically feel like me again. I don’t have any tenderness in my tummy, my energy level is pretty much back to normal, and I am allowed to have a full range of diet options. What does all that mean? It means I feel like I am teetering on the edge of my own personal possibility of groundhog day, of either spring coming early, or an interminable stretch of time ahead of me where I continue to battle darkness, personal choices and challenges. I want spring to come early for myself, and with it the possibility of change, new behaviors and new hope. I want spring to come and bring me new confidence, increased self-esteem and higher belief in myself that I can change my behaviors, tiny steps at at time, to develop a new normal.

This surgery is sooo not about the physical and mechanical aspects of all of this. I keep thinking of other analogies in life and none of them quite work but have parts that resonate. At first I thought, its like declaring bankruptcy. But that is long before I realized the truth of the matter about weight loss surgery, about how the day of surgery is really just the beginning of hard work. Up until the last while, I realized that even a part of me felt I was taking “the easy way” out. But this is not the easy way out. Just because my stomach is smaller doesn’t change my personality, my habits, my behaviors. It is easier to stick to the post-op diet in the early phases, ironically. Honest to god, I do think its like the “rehab” equivalent for a drug or alcohol addict. The radical change in behavior, supervised medically, to ensure you don’t hurt yourself and have a chance at a do over. You don’t feel like yourself, you feel very “medical”, you fear complications if you choose the wrong behavior. But I can see that as the medicalness fades, and the risk of complications decreases over time, its just me out there. Me and the things I choose to do next to make my life different than it was before.

I started with a therapist locally last week, and I was given two homework assignments. “Stay in Today” and think about what triggers me to eat. The first assignment is better for me right now, because I can do that. I know that I have the tendency to spend my life thinking about everything but the day in front of me, and making today the best day I can make it. Imagine what the world would be like if you lived each day just focused on today? Trying to do what I can, just in the day, to make it good. After many of those days, the past starts to become easier to look back on, and the future starts to potentially become something less to worry about, if you’re taking care of each day, one at a time. I know this cognitively, but it is hard to change the behavior of daydreaming about tomorrow, in particular. When I pay off this bill I can….when I get my tax refund I can….when I weigh 199 I will….when I am a size 14 I will….What a shame that I have been living my life in suspended animation, always holding off the good stuff for later. What is going to be good about today? What is going to be good about today for you? Think about that. Because that is at the core of this thing, I think.

The thinking about what triggers me to eat is much harder, particularly because I’m post-op and everything just feels kind of different right now, if that makes any sense. I think because i have gone through my six week rehab, whatever triggers there are aren’t working the same way on me, so its hard to pinpoint what they are. I did identify the ones about travel back in October or whenever that was, for sure. So that was good, but in day to day life, I’m not necessarily seeing it. I know that at the end of a work day, I can feel pretty mentally wiped out and lazy, and that its easy just to succumb to going out. That is still true, and we eat out a lot, even now, post-op, but I am able to make good choices still when I am out. It is easier now that I have a wider choice on the menu. When i was in liquids or softs, I felt pretty pissy about eating only what I could eat. Now I feel pretty happy that I can eat a good portion of protein and try some tastes of other things. My worry is, its a slippery slope? Do I valiantly NOT have any tastes of other things, to avoid sliding down the slope, or is it better to have the tastes and get some joy out of it, so that I don’t take a nosedive off the top of the slope at some point? My guess is, that answer is different for everyone, and we have to find that truth within ourselves. Shit, I hate that answer. 🙂

Another thing we talked about was fear being at the base of a lot of behaviors like addictions (and i consider that I have a food addiction) And she mentioned that for a lot of people with issues with food and money, that fear of lack is at the core of it. I haven’t been magically been able to put my finger on the reasons I am the way I am. Its like an elephant in the room that I truly can’t see. I know certain truths about my past that I can logically see have probably influenced my life, but I haven’t had that big “a-ha” moment that I feel like I should have.

I am working so hard right now on amassing my knowledge around behavior change. I am a researcher my nature, I love to know about stuff, and why it works. So that is pretty time consuming. I can’t blindly follow one methodology either, so I am in the midst of learning about several, including The Beck Diet Solution, Change Anything, and Tiny Habits. Honestly they all support each other, and have different steps to approaching the same thing, which is behavior change. I like comparing them and taking different ideas from them, but at the moment I’m feeling a little overwhelmed by it all. I wish God would just knock on my head and say, “here, this is the way, you’re making this way too complicated.” But honestly, I feel that I have to practice some critical new skills that come out of these methods to get to the other side and see it get easier. One of the things I liked hearing about in Change Anything is this idea of “being a scientist” — to try different approaches and after you try them, look at them to see why they worked or did not work. This is something that honestly happens in my work life all the time, so why this should be so novel to me in my personal life is kind of ridiculous, but I like the idea of framing that way. Because again, it takes out the “that was a failure, therefore, I am a failure.” thought process. It makes all of this an experiment to see what works and what doesn’t, and then a matter of assembling those things that work and figuring out how to hang them together to make a total program of change.

I have joined an accountability group for six weeks with Tracy from mytinytank.net and some other lovely ladies that hopefully will join us as we go along. The idea is to commit to a single thing we want to make a change around and be accountable to each other to report our progress, our successes and our challenges. We have a once a week brief call to report on this, and are free to reach out to the other members durign the week to ask for support at crucial moments or victories. I like this! I think two elements I’ve avoided in past attempts to change behavior is social support and exercise. So therefore, these are two areas I am focusing on the most right now to help with setting in new habits.

Phew. That was soapboxy. Thanks for reading.

4 weeks post op, travel next week, another book review

Well, I can’t believe I’m already 4 weeks post op.  I have 4 more days of softs and then I get to move onto regular bariatric diet.  Which is just in time, because it is looking like I will be traveling for a quick trip for work leaving on Wednesday to go to Franklin, TN. Not sure yet though.  I am kind of looking forward to it happening, not for the stressful situation that I will head into down in Franklin, but rather to see the seatbelt fit (I hope) without an extender.  I have to think with the pounds and inches I’ve measured away that I should be a bit more comfortable in an airplane seat now.  That’s cool to think about.  My incisions all look good, the one that was problematic still has a large scab that isn’t letting go, but no further issues from it.  This was my first almost full week back at work, monday was a holiday.  I have the flexibility to work from whereever, but on Tuesday I actually went in to my local office and tried to get back in the work mindset.  The last time I was in the office was pre-op, and I found it interesting that I felt like I could walk a lot faster than I used to–at lunch I walked all around the inside hallways (its a very large office) and felt energized afterwards.  Weird!

I am finding myself falling into a habit with breakfast being a premier protein drink.  I hope that is ok.  I’m not much of a breakfast person, I know its important though.  It seems like the premier protein gives me a really good start with 30 g of protein and a lot of other vitamins and minerals.  Is it really terrible if I continue to do this long term?

I also worried myself with a meal that I feel I was able to eat way too much.  I took a 5 oz can of canned chicken breast, a T of light mayo and pureed it in the bullet, and also had about 2 oz of cottage cheese.  I was able to eat ALL of this.  Folks on VST seemed to think that since it was pureed (and it was quite liquidy) that even though it was chicken it might not have been that far off of liquid so was able to pass through rapidly.  I hope so.  This evening though seemed better, we went out to a chinese buffet (what a waste of money for me, but everyone else wanted it) and I had about 2 oz of really soft cooked honey chicken, 2 oz of cottage cheese and half a hard boiled egg.

I really am able to drink very well and don’t have issues with eating anything. Nothign has upset my sleeve so far.   I do feel when I start to get full, and that is wild to me.  Preop I would have had to have the mother of all binges to feel anything close to physically full.

last week I was doing a good job of getting my steps in and this week I’ve just sucked it, other than that one day I was in the office.  Exercise really is a mental block for me.  I can give myself every excuse in the world for not doing it.

As many people seem to experience, I hit the three week stall right on time, with the scale not moving (except for up, as  the days went on without poop…LOL) this week.  It did gradually at least get back to where I was, but I am hoping now that the movement will continue on down.

The book I started this week is Beck Diet Solution, which I think is finally the nirvana I was looking for in terms of an eating focused cognitive behavioral approach.  Its a six week plan compatible with any eating plan to retrain the way we approach, think and feel about food, and hopefully then impact our actions related to food.  It has a nice format in breaking down each day into something to do to take a step forward.

The first day had me writing an “Advantage Response Card” — a card to remind me of all the advantages of losing weight.  I’m not much for paper any more, so I am using the flashcardlet app on my phone instead.  I am also supposed to write it down in one other place, so that will be here.  I used a lot of what I wrote down pre-op but here are the things I am looking forward to (and one or two already there)

1. I can fit in an airplane seat comfortably without an extender.

2. I won’t feel like I need to use the big stall in the restroom to feel like I have enough room.

3. It will be easier to be clean, shower, shave and etc.

4. I will hurt less during and after being active.

5. I might be able to try new activities or sports.

6. I will be able to enjoy amusement park rides more again (an old favorite)

7. I will fit in restaurant booths easily.

8. Maybe I can ditch the CPAP.

9. My diabetes will improve or resolve.

10. I can tie my shoes easily.

11. I can easily paint my toenails.

12. I will have energy to play with my kids.

13. I can buy pretty clothes and even <gasp> lingerie.

14. My wedding rings fit (already!)

15. I can kneel at church without leaning back.

16. My bed and furniture won’t sag permanently where I sit and lay.