Thursday, July 22, 2010

Pushing the Envelope

Another cognitive pitfall that came up at the Brigham talk was pushing the envelope after recovering from bariatric surgery. Immediately following surgery, patients usually follow a liquid diet for a time and then gradually introduce foods back into their diet. Most people can tolerate soft plain foods pretty quickly but may have trouble with dairy, sugar, or other items.

Some patients experience dumping syndrome, an extremely uncomfortable rapid emptying of the stomach contents into the small intestine. Symptoms may include nausea, sweating, fainting, weakness, and diarrhea. Sometimes specific foods can be identified as the causes of dumping syndrome, and other times it is unpredictable. Other times, certain foods simply cannot be tolerated and cause patients to very quickly vomit to get them out of the body.

Now, one might think that if a specific food caused one of these very uncomfortable responses, an individual might be highly motivated to avoid that food in the future. But this is not always the case. The 3 counter-examples I wrote about in the last post apply here too:  job, marriage, kids. We typically don't push the envelope in these 3 areas, as in "I'm going to do the least amount of work I can and see what it takes to get fired."

Pushing the envelope becomes a mindset in competition with the goal of self-care. Instead of a positive, health-promoting mindset like, "I'm going to take the best care of myself that I can," the opposite becomes the default.

A mindset of pushing the envelope might sound like:

"Let's see how much ice cream I can eat without getting sick." (Setting the bar pretty low, right?) 

"I'm going to count the French fries so I know how many I can tolerate." (Really?)

"I can have 2 cigarettes a day." (WHY BOTHER?)

"A naturally thin person eats cookies." (If you have had bariatric surgery, you are not a naturally thin person!)

"I need to see how much I can get away with." (Are you 12?)
    Sound familiar? That last bullet point has a decidedly adolescent flair to it, don't you think? I hear that a lot from surgery patients. If you have adopted this mindset, please ask yourself why you feel you must risk mistreating your body and sabotaging your health and your weight loss.

    Try becoming aware of these dangerous thoughts. That's the first and often most difficult step in changing them. Perhaps you can jot them down in your journal.

    When you become aware of pushing the envelope, see if you can challenge yourself to have another response, one that expresses respect for your body and for the surgical procedure you had. Perhaps one of these:
    • "I'm not going to risk getting sick just for the taste of that food."
    • "Why would I sabotage all I went through to have this surgery?"
    • "I can't control my intake of certain foods and it makes sense to avoid them."
    • "If I eat this, I will not have the stomach capacity for the healthful food I must eat."
    • "I don't want to risk falling into bad habits again."
    Now, I don't mean to say that you will never have a piece of birthday cake again. Far from it. But I do want you to distinguish the occasional mindful indulgence from a way of thinking that seriously jeopardizes your success. Start your day with the mindset of an adult, not an adolescent. You have the capacity for mature decision making. Use those frontal lobes!

    Wednesday, July 21, 2010

    All-or-Nothing Thinking

    Recently I had the opportunity to address the support group for bariatric surgery patients at the Brigham and Women's Hospital here in Boston. One of the topics we discussed is familiar to many people who have engaged in almost any kind of treatment for obesity: all-or-nothing thinking.

    You know what this is. It's the idea that you have to stick to a diet and exercise program perfectly, daily, and indefinitely, starting on a Monday, or else you are a failure and might as well shove any old junk into your mouth and live on the sofa. I have been making the point to patients for years that this is the only area of life in which we think this way!

    Let's take a look at a few examples of important parts of our lives and test this idea. First, your job. Give this a reality test:  "Starting Monday, I'm going to arrive on time, finish all the tasks on my to-do list, return all phone calls within 24 hours, be prepared for every meeting, and smile while doing it all! And I'm going to do this every day for the rest of my career!" And then, on Tuesday, you arrive 5 minutes late for work:  "Well, that's it! I'm going to the beach and I'll come back when I'm ready to re-commit!"

    Next, consider your marriage. Is this you? "I'm going to be the best spouse on the planet! Starting Monday, I'm going to put my spouse's needs first, tell my spouse how wonderful he/she is, prepare his/her favorite meals, and have sex every night! Forever!" Then on Tuesday, when you argue over whose turn it is to take out the trash:  "Enough! I tried to be the perfect spouse! I knew it wouldn't work! I'm outta here and I'll come back when I'm ready to be the perfect spouse again!"

    One more example and I think I will demonstrate my point. Let's talk about your kids. Is this you? Careful how you answer! "Starting Monday, I'm going to be the perfect parent. I'm not going to lose it when my kids misbehave, I'm going to help them with their homework, drive them to school, soothe the baby when she cries, and never ever complain. Every day and every night!" Then on Tuesday when the baby simply can't be soothed and you feel frustrated and defeated:  "That's it! You kids are on your own! I'm going away and I'll come back when I can be the perfect parent again!"

    I'm betting you could not identify with these examples. So perhaps it's worth reconsidering the all-or-nothing approach to eating and exercise. Remember:
    • You don't have to wait until Monday to make a self-respecting choice.
    • Every moment is an opportunity to choose health.
    • The steps you take create the path of your life.
    • Everything you do matters. What you do is a demonstration of who you are.
    Have a mindful day!