By Sheri Sellars, BSN, RN
Bariatric Nurse Educator, Nicholson Clinic
Almost every patient has secret (or not so secret) pictures in our heads of how life would be if only weight were not an issue. Often these dreams fuel at least some part of the desire for weight loss surgery and can provide wonderful motivation as changes in eating habits and activity level take place. Like most dreams though, the reality can be a bit different than we thought. While the body is changing rapidly, the mind can take longer to get caught up. Sometimes these changes, while positive, carry baggage of their own and leave us reaching for coping skills we have not had to find before. Here are a few common psychological issues bariatric surgery patients report as their bodies rapidly change.
Body Perception Issues — Our surgery patients often report a sense of surrealism when it comes to personal perception of body size. Shopping takes on a whole new challenge and often patients report standing in a clothing store with no idea what size to try on. Glimpses in the mirror can yield a sense of shock or a feeling of “otherness” as they struggle to identify ownership of the image they see. Compliments from friends and family can be difficult to accept gracefully and may even trigger suspicion, embarrassment or feelings of shame.
Loss of Security — Morbid obesity remains a very marginalized population in our image-oriented society. Many people who battle this disease report a history of abuse, assault or other physical or emotional trauma, with obesity giving them safe harbor through a reduction of “visibility” or attention. The increase in noticeability that comes from rapid weight loss can result in a wide range of emotions, not all of which are positive. Learning to deal with attention from others who may not have paid attention before can trigger resentment and anger along with pleasure or validation. For some, it may even trigger shame, anxiety or fear.
Relationship Changes — The person we have been throughout morbid obesity is not the same after bariatric surgery. Learning to live a different relationship with food and exercise opens doors to new levels of confidence and a different way of seeing the world. While these changes are positive and empowering, sometimes through the journey of becoming we discover that relationships that have made up our lives also undergo changes. Friendships, familial relationships and marriages can be very challenged by our weight loss and our evolving relationship with ourselves and the world. Newfound confidence can undermine or completely eradicate the basis for relationships we had counted on up to this point. Adjusting to those who cannot make this journey with us can be emotionally painful and can challenge our inner strength.
Mourning Food — This is the one that seems to take most people by surprise. It rears its head early after surgery and can strike during times when food may have offered more than mere sustenance in the past. The inability to eat in large volumes and the elimination of food as a primary means of celebration, bonding, mourning or even just boredom can be shocking to the psyche. Many who suffer from morbid obesity have a long history of disordered eating. Losing the ability of food to feed us beyond mere hunger can trigger a very real sense of loss.
Addictions — Studies in populations who have undergone weight loss surgery are increasingly yielding information demonstrating an increase in addictions after surgery takes place. Alcoholism in particular occurs at a higher rate in patients who have had gastric bypass surgery than that of the general population. Other addictions also have been noted, including addictions to gambling, prescription or street drugs, shopping and sex addiction. The reasons for this remain educated speculation at this point, but the data is clear. Weight loss surgery patients are at higher risk for addictive behavior.
Anxiety — This emotion rears its ugly head after surgery for all sorts of reasons. The surgery itself is major, as are the changes that come with it. The availability of information on the Internet, while helpful at times, can contribute to this sense of concern. Few people take this surgery lightly and most all wish to do things “right,” which can lead to excessive, almost obsessive Internet searching, most of which causes more questions than it answers due to a plethora of surgeons and postoperative protocols. Additionally, former habits do not fade away easily or quietly. The surgery itself is simply a tool and most patients go through a period of shock in finding the habits, behaviors, cravings and hunger that was present prior to surgery is still present to some degree afterward. There is a fear of failure, unrealistic expectations to grapple with and the process of learning to change habits to battle through. Most patients report a sense of anxiety about everything from what to eat to deep-seated fears of regain or surgeon censure if weight loss is slow.
All of these issues can be present at any given point after surgery. Fortunately, here at Nicholson Clinic we are experienced in helping patients through the minefield of adjustment that comes with postoperative emotional changes as well as the physical ones. We partner with dieticians, licensed psychologists and keep a nurse educator on staff to help our patients over these hurdles and into the life that awaits them. Patient awareness that these issues can happen after surgery is important; knowing we are here and prepared to help even more so. If you are postoperative and struggling, the most important thing you can do for yourself is reach out for help to those who understand. We are with you all the way.
We invite you to participate in our Monthly Recipe Contest. The ingredient of the month for October is:
PUMPKIN
Each month the winner will receive a $50 VISA Gift Card!
Submit your recipe and pictures to recipe@nicholsonclinic.com to enter!
By submitting your recipe you give Nicholson Clinic usage rights to share your recipe with others.
by Jeremiah Bailleu
Sometime it’s hard to stay motivated to eat your vegetables every day without mom standing over your shoulder forcing you to do it. There are thousands of ways you can prepare your vegetables, we compiled a list of a few that will make it that much easier to fit them into your diet.
Zucchini/Carrot Noodles
For many of you this is a strange concept but we promise that it is worth trying. There is a tool called the Veggetti that you can find in select stores like Target, Walmart, and Bed Bath & Beyond. This tool allows you to twist a zucchini or carrot into it and turn it into noodles instantly. These are a great substitute for spaghetti noodles and can be used in the same recipes. My favorite thing to do is to serve them with grilled chicken and red sauce with parmesan and fresh basil.
Lettuce Wraps
Tacos may be your go-to dish but those tortillas are packed full of calories, 467 calories each to be exact. Try substituting the tortilla for fresh lettuce and use that to wrap the other ingredients up with.
Spaghetti Squash
This is something that is so easy to make it will be part of your weekly routine. Spaghetti squash – or vegetable spaghetti – is only 31 calories per serving and is the perfect replacement for noodles. To prepare, cut the squash in half lengthwise, scoop out the seeds, and cook it at 400° F for 30-45 minutes, or until tender. For recipes using spaghetti squash, just do a simple search online. I eat mine with olive oil, salt and pepper and butter.
Sweet Potato Chips
Sweet potato is packed full of nutritious vitamins and minerals that your body needs. My favorite way to eat them is to slice them into thin pieces and bake them into homemade chips. I toss the slices in olive oil and sea salt before throwing them in the oven at 250° F until crisp and brown. If you’re feeling like they are missing something, sprinkle some cinnamon across the top to give them a little bit of sweetness.
Cauliflower Crust
If you thought making pizza without bread was impossible then get ready for a surprise. Cauliflower crust is becoming increasingly popular for people who want to be healthy but can’t kick their pizza addiction. Simply pulse the cauliflower in a food processor and drain excess liquid. Then heat in the microwave for 4-5 minutes, strain it, stir in egg, mozzarella, parmesan, and seasonings and it is ready to bake. This process takes a few attempts to master but once you do it may even make it to your list of your favorite creations.
by Jeremiah Bailleu
Working an office job and binge watching Netflix after work may be affecting your body more than you think it is. Recent studies have shown that sitting more than seven hours a day can cause some pretty serious health complications. The human body was not built to sit for long periods of time.
How Sitting Impacts Your Health
According to James Levine, MD, PhD, excessive sitting impacts our body’s metabolic system. “Today, our bodies are breaking down from obesity, high blood pressure, diabetes, cancer, depression and the cascade of health ills and everyday malaise that come from what scientists have named sitting disease.”
The average American sits between seven and 15 hours per day. Sitting too long throughout the day can lead to discomfort and health complications including:
• Joint pain
• Varicose veins
• Strained neck
• Back pain
• Heart disease
• Increased cancer risk
Research suggests that when you sit down, enzymes that help break down fat in your body drop as much as 90 percent. Sit longer than two hours and HDL (“good” cholesterol) levels begin to decline. Research shows that the risk for cardiovascular disease is noticeably higher for people who spend too much time off of their feet.
8 Ways to Avoid the “Sitting Disease”
1. Stand Up At Least Once Per Hour — You should sit 20 minutes out of every half hour at work. We recommend that you try to work for eight minutes and then stand for two. Believe it or not, this practice may actually help you kick the back pain and keep your focus.
2. Take a Quick Walk — Run to the kitchen to grab some water, go the restroom or take a quick walk around your office or building. This will help you sustain the energy you need to make it through the workday.
3. Take the Stairs — Yes, you read that right. We are programmed to avoid the stairs at all costs if it is more than just a few floors up or down. You will be surprised how quickly you will enjoy taking the stairs if you can just make it a habit.
4. Stretching — Try to reach down and touch your toes for 20 seconds to get the blood flowing again. Stretching can work wonders for your circulation and your cardiovascular system.
5. Count Your Steps with a Fitness Tracker — Counting steps is the new trend in staying off of the couch these days. Make it a challenge with your coworkers, friends or spouse; you will be surprised how fun this can actually be. Try to get at least 3,000 steps per day to start and work your way up until you hit 10,000.
6. Park the Distance — It is in our nature to fight for the closest parking spot when we go somewhere. Try parking in the farthest parking spot you can find next time you run an errand. Not only will you get some extra steps in each day but your car can avoid the dreaded “door dings.”
7. Take the Pup for a Lap — If you have pets, they need to be getting as much exercise as you do. Put your active wear on and go for a quick stroll around the block with your dog. This is a great way to wind down after a long day of work and can help you burn some extra calories.
8. Schedule Your Evenings — Set time aside for dinner, television, walking and preparing your food. This will help you manage your time so you can take the stress out of your night. If you prefer to get your exercise as soon as you get home from work, make that part of your schedule and commit to doing it as soon as you walk in the door. This will allow you to watch your favorite shows guilt-free at the end of the night.
By Sheri Sellars, BSN, RN
Nicholson Clinic Nurse Educator
For many people in farming communities, the seasons of the year dictate activities and goals. Planting takes place in the spring and harvest is, of course, in late summer/early fall. Time spent in the interim revolves around maintaining progress toward the stated goal — a bountiful yield that reflects the effort toward the outcome. Sometimes everything aligns and conditions are perfect all throughout the growing season. Other times, extra effort is required to give the best odds of a great end result. Regardless, the season after harvest is one of rest and planning. This predictable pattern of behavior outlines a methodical approach to any desired outcome, one that we can use to forward our own healthy ambitions. Here are a few key tips from the farmer that you too can use:
Know what it is you are planting. When farmers plant, they don’t toss seed on the dirt and hope it results in the crop that they want. They spend considerable time examining what it is they wish to plant and why. First and foremost, they identify the desired outcome. What is your end goal for your health and wellness? Set realistic goals and develop a plan to achieve them. It can be helpful to ask your doctor or a professional fitness trainer for help identifying goals and what you need to do to accomplish those goals.
Know what it needs to grow. Nothing grows without proper tending. All crops are not created equal and all soil is not the same. What deficits exist that will make your goal more challenging and how can you address them? Once you know what the goal is, research and commit to the actions needed to make it happen. Each of us has our own weaknesses. Don’t let yours become a hindrance, but rather find ways to address those weaknesses and use them as stepping stones toward achieving your end goal.
Put in the work. After the planting season comes the long days of tending. Even a dream planted in fertile soil will be lost to the elements if it isn’t nurtured. The elements of life — jobs, family demands, fatigue, stress, poor diet, limited income — impact our results as surely as watering, fertilizer and sunshine impact that of a field. Just as a farmer has to walk the field and pull the weeds, we too must visit our vision daily, pluck out the negativity that shows up seemingly overnight and protect the straight lines of our effort. The farmer is never surprised when rogue weeds show up or storms come along. These are normal, natural parts of the growing season and he deals with them accordingly without wasting time bemoaning they exist at all. Don’t allow the elements of life to throw you off course. If you have a bad day, start again tomorrow. These “challenges” should be expected. Prepare yourself to meet them with a sense of determination that the obstacles life throws your way won’t keep you from achieving your goals for a healthier you.
Get help when you need it. Recognize that you may not know all you need to about growing this particularly dream. Just as the farmer hires others to help plant, maintain and harvest, we too must be able to recognize when the job has gotten beyond us or when a little assistance could make the difference between failing or hanging in there. Rather than giving up, seek out help when you need it! Some of the key people who can help you along your journey to health include: family and close friends, your primary care doctor, a certified nutritionist or dietitian, a professional fitness trainer and a health coach.
Rest. Not every moment can be spent planting, tending or harvesting. Rest is a vital component for any change to take root. Whether it be a nap at midday like Grandpa used to do or a winter of the spirit to be spent in reflection, everyone needs some downtime to ultimately reach their goal. It is okay to let go for a while and trust that the dream is still there when you return to the field. Likewise, your body needs time to rest and sometimes, a few days “off” can give be just what you need to refresh and renew your mind and revamp your motivation to live a healthier lifestyle.
Recognize it is ongoing. Everything is cyclical and to everything a season. The farmer does not bring in one harvest and expect the field to continue to yield. Building and maintaining the life that we want is ongoing and requires sustained recognition that there is no finish line. Even when the harvest is plentiful, the next season lies waiting, golden with promise and uncertainty. Each opportunity in pursuit or maintenance of the life we have dreamed of is a gift. The work doesn’t stop when you achieve your goal. A healthy lifestyle is something that must be maintained for a lifetime. If your goal is to lose weight, for example, once you hit that magic number on the scale, you cannot allow yourself to revert back to your old ways.
Reaping a harvest of health doesn’t come without careful thought and hard work (and maybe a bit of blood, sweat and tears). For generations, the farmers have lived by these rules in order to reap a bountiful harvest. Apply them to your own life and with time, you’ll begin to see the changes you’ve been waiting for.
If you are considering weight loss surgery but aren’t convinced the results can last? This story is for you. Chantel had surgery with Nicholson Clinic in July, 2013. Today, more than three years later, she is thriving and continues to keep the weight off. In the months following her bariatric surgery, Chantel sent us the following email to share her success.
Hear more weight loss inspiration from Chantel on her own blog, Glow Fig.
“I just wanted to let Dr. Nick and his staff know that I met the weight loss goal that Dr. Nick and I set at my consultation last year on May 1st. I started my 2 week pre-op diet on 6/25/13 and had surgery on 7/9/13. I weighed 205 at my consultation, 212 at the start of the pre-up diet, and 197 on day of surgery. This past Saturday, I weighed in at 129.4. Dr. Nick had said a good goal for me would be about 130 pounds. I’m 5’3″ tall. Just over 9 months from the start of the pre-op diet and just under 9 months from my surgery date! 82.6 pounds lost.
Here are some of my non-scale victories since WLS…
I’ve logged over 250 miles since the beginning of January (January 3rd, I think).
I climbed over 2,000 flights of stairs in less than 2 months.
I can comfortably cross my legs.
I’m rarely getting blemishes on my face anymore. (I attribute this to a better diet.)
I ran 4 miles in less than 42 minutes (the last 3 in 30 minutes).
I’m no longer wearing plus sizes (size 6 pants, size small/medium tops).
My shoe size has gone down from an 8.5 to 8 or maybe even 7.5 (which was my shoe size in high school).
I’m wearing a size medium belt on the smallest hole.
I’ve completely given up soda.
My children are eating healthier foods (not perfect, but better), since my husband and I are too.
I’m setting a good example for my kids in terms of being active and fitting exercise into my daily life (and I know for a fact that they’ve noticed because of the things that they say about it).
I’m off blood pressure medication.
I’m no longer snoring and keeping my husband awake at night.
I’m sure there are others, but those are the ones that come to mind quickly.
Thank you, Dr. Nick!”
At Nicholson Clinic, it is our goal to offer our patients the very best in lifesaving weight loss surgery options. Providing our patients with top-notch care is why we carefully select our partner surgery centers. Each of our patients’ bariatric surgery procedures is performed in one of the most advanced medical facilities in North Texas.
Adding to our list of award-winning, state-of-the-art facilities, Nicholson Clinic is thrilled to partner with Texas General Hospital, expanding our weight loss surgery services to patients in Grand Prairie and surrounding communities.
Not only does this partnership allow us to reach more patients in a location convenient for them, the partnership with Texas General Hospital allows us to offer more competitive pricing with the same high quality level of care and service.
“The medical and support staff at Texas General Hospital have been amazing to work with,” said Dr. Nick Nicholson, founder of Nicholson Clinic. “The high staff to patient ratio ensures our patients receive attentive care and exceptional service.”
Overcome:
- To get the better of in a struggle or conflict; conquer; defeat.
- To prevail over.
The definition of the word “overcome” evokes thoughts of war – a hard-fought battle, won.
The reality is, for many of us, gaining and maintaining our health is a battle we fight day in and day out. It’s a war against old habits, against cravings, against laziness, and peer pressure. At times, it may feel like a battle we fight against ourselves – and it is.
To fight this battle, to wage the war on obesity and disease, is exhausting. But to overcome means success – not without struggle – but success nonetheless.
To struggle – and to overcome – is what makes us human.
Tom Hooper said: “I think we all have blocks between us and the best version of ourselves, whether it’s shyness, insecurity, anxiety, whether it’s a physical block, and the story of a person overcoming that block to their best self. It’s truly inspiring because I think all of us are engaged in that every day.”
What is the block that is holding you back from being the best version of yourself? Before you can win a war, you must be able to identify the enemy – you must know whom you are fighting.
Is your battle against addiction to food, or lack of desire when it comes to exercising? Is it against the inner voices that have convinced you that you are unworthy? Is your battle against disease that has held you back, or negative people who themselves are a disease on your life?
Identify your opponent, and develop a strategy to overcome.
If you’re reading this, you’ve already made the first step—you are conscious of the need to change. Now, begin crafting your battle plan. Surround yourself with an army of people who will fight with you—through their encouragement, motivation, accountability, and inspiration from their own overcoming.
Most of all, believe you can overcome.
“True success is overcoming the fear of being unsuccessful.”
– Paul Sweeney
Dr. Thomas Roshek joined the Nicholson Clinic in 2011. Dr. Roshek is board certified in General Surgery and is fellowship trained in advanced laparoscopic and bariatric surgical procedures. His interests include the treatment of abdominal and groin hernias, gastroesophageal reflux disease, obesity, and disorders of the gallbladder, skin, and soft tissues.
Dr. Roshek has received several awards during his tenure as a surgeon, including:
• D Magazine’s Best Doctors in Dallas 2012–2013, 2016
• D Magazine’s Best Doctors in Collin County 2013 and 2016.
• Texas Monthly Super Docs, Texas Rising Stars 2014 and 2015
• Society of Laparoendoscopic Surgeons Resident Achievement Award 2009
We want to help you get to know Dr. Roshek a little bit better, so we asked him some questions. Here’s what he had to say:
Why did you choose to specialize in bariatric surgery?
The obesity epidemic is negatively affecting the lives of patients all over the world. It is causing so many other medical problems, and I was not satisfied with the results of non-surgical weight-loss techniques. During my general surgical training, I could see the positive changes our patients underwent after weight loss surgery and wanted to help make a difference in our patient’s lives. The ability to provide Laparoscopic Bariatric Surgery with small incisions, minimal pain, and shortened post-operative recovery was a natural choice for me as I continued in my training and completed a fellowship in advanced laparoscopic and bariatric surgery.
What is the most rewarding part of your job?
In addition to what I’ve mentioned above, I also enjoy the camaraderie all of us at the Nicholson Clinic share. We enjoy working together as a team and enjoy each other’s company.
Who/what is your biggest inspiration?
God and my family.
What’s the best piece of advice you’ve ever received?
I never shy from receiving sage advice from a trusted friend or colleague, and many have shared with me over the years. I think the greatest advice is to always keep an open mind, to question the status quo, and to never stop learning from others.
If you could say one thing to someone considering weight loss surgery, what would you say?
If you are committed to this journey, there is no better way to achieve your goal of a new you.
What do you enjoy doing with your time off work?
I spend most of my limited free time with my family. But occasionally I can be found playing softball, golf, or even kickball (apparently it is acceptable for adults to run around like elementary school kids kicking a ball, and gosh it sure is fun!).
Artificial sweeteners are intended to help people cut calories and therefore lose weight. The harsh reality is that consuming low or no-calorie sweeteners may actually make you eat more, leading to weight gain.
For years, we’ve known that artificial sweeteners like those in diet sodas may be more detrimental than beneficial when it comes to weight loss, but we’re now a step closer to understanding why.
A new study published this month in Cell Metabolism suggests that artificial sweeteners trigger a starvation state in the brain, causing the brain to seek more energy by consuming more calories. The brain generally associates sweet tastes with calories. But when the sweet exists without the calories, the brain adjusts by increasing hunger, causing us to eat more.
In the study, Australian researchers fed fruit flies either a diet of yeast and sucrose or one with artificial sucralose that is used in a variety of low-calorie foods. The flies fed the sugar-free diet consumed 30 percent more calories than those who consumed sugar. And when the artificial sweeteners were removed from their diet, calorie consumption returned to normal. These findings were replicated in mice.
Previous research also underlines the potential detriment of synthetic sugars, linking artificial sweeteners to an alteration in the gut microbe population that promotes calorie absorption, and suggesting that sucralose may impair the body’s ability to process regular sugar. In addition to the biological reaction to artificial sweeteners, the fight is also mental.
“Battling our ingrained eating habits is a challenge every patient undergoing weight loss surgery must face. Many who have utilized sweets as a form of comfort, reward or socialization find it difficult to give these things up,” says Sheri Sellars, BSN, RN, Nicholson Clinic Nurse Educator. “Studies do show a more severe consequence for remaining obese than it does for use of artificial sweeteners.”
Despite the findings by Australian researchers, it isn’t recommended to ditch the artificial sweeteners in favor of real sugar, which on its own can lead to overeating and weight gain. Instead, focus on a diet that is low in sugar — artificial or real — and high in fiber, protein, healthy fats and vitamins.
If you are looking to sweeten your tea or morning coffee, a new genre of natural sweeteners are also available that “may be a solution to the poor health potentials of obesity and its link to sweetened foods, presenting an alternative to the artificial sweeteners like Splenda, aspartame or saccharin,” Sellars explains. “Patients may wish to consider natural sweeteners such as Stevia or monk fruit extract to flavor their coffee instead when they find cutting sweets out entirely to be challenging.”
