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!

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