A Passionate and Very Heartfelt Discussion About Restriction, Deprivation, Mindfulness and Moderation

The Debate That Sparked This Article

There was quite an interesting debate in my Bariatric Mind Masters Facebook group recently. It was prompted by an article that essentially linked to a different bariatric group, which espoused the guiding values of thatgroup. I saw that there had been quite a lot of action on that post, and so I clicked the link and had a read.

The Food Police Position:

The authors were identifying themselves as “The Food Police” (their words), and asserting that their very hard-line, militant approach would be the only avenue by which long-term bariatric success would be achieved. You may have seen it, but if you didn’t, the fundamentals were that:

• All carbs (bread, milk, pasta, rice, crackers), and sugar be permanently obliterated from one’s diet, and viewed as “The Devil”. Any aberration from this was implied (and overtly stated, in parts) to be very shameful, and letting oneself down appallingly. To be disrespectful of one’s surgery, and basically stupid.
• Any entertaining of moderate eating was trashed as a pre-surgery style of eating, and there was much fear-mongering that such would lead to certain disaster.

 (Now I don’t know about you, but I was certainly never moderate pre-surgery; I was on the wagon or cataclysmically off it; it was pretty all-or-nothing, like their approach).

I was certainly also never ‘mindful’ of my eating. I was mindful of my shame, mind you.

• There was a criticism of the gracious support offered in many bariatric groups when someone reaches out in despair, and admits to having fallen off the wagon. They view this to be enabling bad behaviour in the short term, and regain in the longer term.
• They caution against eating post-surgery in a similar manner to pre-surgery (which I must just step in and say is wholly obvious, right..?).

My Knee-Jerk Reaction

I wasn’t too perturbed by the article… I’ve read similar before, and also went through a very militant phase post-surgery. I did have a knee-jerk, rather primitive “I’m being judged” feeling. And judged even more harshly for actually running a group that focuses on mindful eating, balance, scrutiny of head hunger and heart hunger, holding of people in all kinds of distress, etc. I felt a little scolded, and a fleeting tweak of shame.  

These reactions are human. They are human responses to being chastised. Even virtually.

But I was quite surprised by how many of my group members had loved and liked the post, and related so strongly to such legalistic, black-or-white, all-or-nothing rhetoric. To be honest, that unsettled me more than the content of the article. Someone even commented something to the effect that the food police people were speaking directly about my group, and while it’s hard to infer tone, it seemed as though she agreed, and could just as well have emoji’ed it with an eyeroll at me. (I’m sure they weren’t referring to my group; their group is 60 000-strong and very established. Mine has 3000 members, and is quite new). 

But I was a little hurt, and somewhat dismayed.

“Us” and “Them”.  “Food Police” vs. “The Hopeless Overweight”.  

The DANGER of Polarisation, and How Very Extreme People Push Others into Corners They Don’t Subscribe or Relate To.

There was also another very interesting dynamic created by the posting of this link. It polarised bariatric groups into “us” (the food police), and “them” (the ‘hopeless overweight’ who will only ever be that). And while I actually agreedwith some of what they were saying, I was painted into a corner by them, and pushed out of having the balanced view that I do in fact have. Their polarisation wouldn’t allow for that. That’s what unipolar, one-dimensional extremism does, unfortunately. And, to be honest, as much as I believe wholeheartedly in mindful, moderate eating – and teach it! – I am aware that this doesn’t mean what “they” think it does… It’s NOT an ‘eezi-peezi, let it all hang out, go mad approach’. 

In fact, it often involves more really tough work than just engaging sheer willpower. 

Searching For Truth By Embracing WHOLE Truth

Polarisation, which speaks the language of  “good group/bad group”, “good diet/bad diet”, “good food/bad food”, “food police/The Hopeless Overweight is so dangerous.Everything I teach in my Bariatric Mind Masters course, and even beyond that, is that BOTH POLES always hold valid truth. And that we do ourselves and immense disservice when we encourage thinking that is so differentiated. We healour minds and reduce anxiety when we embrace and explore all positions, and do so so vigorously that they almost collapse into each other and form a new whole of truth. I teach that we should always explore both sides of an argument, and mine BOTH for gold, and then use gold from both camps to find a middle ground that is truly rounded, informed, brave and psychologically healthy.

The Worst Advice I Ever Received…

I speak, in my formal Bariatric Mind Masters program, about the worst piece of advice I everreceived, from a very lovely, respected and skilled psychotherapist. My father had just died, suddenly, tragically and traumatically, and I was bingeing like a crazy person. I confided this to my therapist, who instinctively said, “Oh Debbie, with all you are enduring, that is the leastof your worries. Just comfort and soothe yourself now, and you can figure that out later”. 

She meant SO well, but it was terrible advice. Because I gained nearly 50 pounds on her professional watch, and that was the weight that tipped me from a “maybe I can fix this” weight, to a “I’m totally screwed and need a sleeve” weight. (I am not blaming her; don’t hear me wrong… She was giving common-sense, loving advice. And I was in emotional agony).

But I say, in my program, what I have now learnt is the correct response to a person in such pain is, “I know you are going through hell, and I’m here with you. And you obviouslyneed to soothe your searing pain. But we both know how dangerous binge-eating is, both physically and emotionally, in terms of compounding shattered self-esteem, loss of confidence and lack of grounding. There will be days when you won’t be able to help it, but whenever you can, try to distract yourself from your distress through a whole range of tools and skills that I can teach you”.

The fundamental message of the Food Police and a group like mine  is the same: “Don’t eat your pain”. But the difference perhaps, is that the Food Police say, “just don’t!!” whereas I believe I show one how not to. 

And thatis the middle ground and the balanced position. There’s a voice that says, “I’m in so much pain; I cannot eat well andcope. And there’s another voice that says, “We need to keep you on track, because veering off will compound your problem by miles. The way to walk that middle ground is through mindfulness, self-awareness, distress tolerance skills, and by learning to regulate emotion”.

So with all of that as a pre-amble, I recently actually wrote up the premises of my BARIATRIC MIND MASTERS program and group, and I thought it may be useful to present it as some sort of ‘counter-manifesto’.

My aim is to colour in what mind mastery actually is, what mindfulness is, and what moderation really is.

What Is Mindful Eating?

• Awareness of when an urge to eat is related to craving, compulsion, addiction, boredom, or cultural programming, and thus resisting that particular urge (head hunger management).
• Awareness of when an urge to eat is related to a need to soothe an emotional state, and thus resisting that urge and tending to the emotion.
• Conscious direction and leadership of food choices, based on personal consideration and desire – not simply on an eating plan. The eating plan remains very important though, as does a long-term relationship with your dietician.
• The ability to skilfully PARTICIPATE in food choices, and debate these internally, almost like a conversation between a nurturing mother and a child (i.e. “you may have x now, but you will then need to forego y later”; “you had a lot of leeway yesterday, so for the next few days we’re going to be particularly careful”, etc). 

To Restrict Or Not To Restrict? What is Bariatric Victory Actually?

Do we eat religiously according to a plan, or do we apply the principles of moderation? You need to take a personal position on this, which may be vary depending where on your bariatric journey you are. 

I believe that the ultimate, long-term goal and experience of Bariatric Mind Mastery is to eat like a normal, healthy, well-adjusted yet aware slim person who never had an eating problem. 

This would likely involve constant and consistent healthy food and eating choices 80-90% of the time, and deviation from this 10-20% of the time (if at all). This is not an exact science, but in the absence of a better way to articulate this, that, I believe, is the goal. That is freedom. 

(And obviously, in such a framework, Bariatric Victory means to reach an ideal weight and maintain it actively, indefinitely. I say ‘actively’ and ‘indefinitely’ as I simply cannot conceive of a time when it is not a daily mindful consideration. I do believe good choices generally beget good choices, and that a string of these become automatic and somewhat habitual. But I don’t believe it will ever notbe something we are very aware of and careful with). 

My Position Statement and the Guiding Assumptions of Bariatric Mind Masters (the Facebook group and the formal program).

1. You Need To Almost Date Your Dietician (said tongue in cheek).

Every bariatric patient needs a lifelong relationship with a trusted specialist dietician, and THAT partnership together (you and your dietician) has the ultimate say on your diet and what you put in your mouth. This partnership with such a medical professional is essential from an accountability perspective, as well as from a scientific knowledge perspective.  I will never be arrogant enough to assume that my own weight-and-diet struggle is tantamount to a postgraduate degree in dietetics or a bariatric surgery qualification . And I have ridden enough fad-waves over the decades to confirm this. My position is that each bariatric patient needs their own trusted, hand-selected dietician, for life. Even if meetings are infrequent. 

2. Bariatric Basics Are Essential, Always.

Within all the variances that exist amongst bariatric eating plans, there are certain commonly accepted fundamentals that we need to adhere to in the main. We can debate keto, low-carb, low-fat, ‘all things in moderation’, old-school food pyramid, paleo, grazing vs. 3-solid meals, etc, until the cows come home. But the common bariatric fundamentals I think remain, are:

• Protein first.
• A decent amount of protein (although even here there is controversy).
• A focus on water.
• Consistency and regularity with vitamins.
• An eye kept on calorie consumption, with a view to keeping energy intake relatively low. Again the actual numbers vary.
• An eye kept on sugar consumption, especially insofar as it may make a person ill.
• Not eating and drinking at the same time.
• Slow chewing and swallowing.
• Exercise.

To my mind, limiting the range of food that is available as a choice is a diet. And diets ALWAYS, invariably, eventually fail. But, in amongst all of my teaching, please know that I generally embrace an 80-20 principle in life: that at least 80% of the time, we need to be doing exactly what we know to be best practice. At times, there will be up to a 20% deviation on this, but within Bariatric Mind Masters there is NO INJUNCTION to negate generally accepted healthy bariatric eating principles. 

But Life is a Dance, and We Need Versatility and Flexibility to Flow With It.

There is simply the knowledge that YOU and YOUR PLAN are not the same entity, and it will not always suit you. And on days in your life when it doesn’t suit you, for whatever reason, you need to have a different plan, and a different strategy that actually wells up from deep within you; from mindfulness, permission and choice. And so my hope is that YOU learn to direct, drive and manage your eating life (as you do your entire life). Once the basics are in place, you will learn to DANCE WITH YOUR PLAN… To work with it… For it to lead at times, and for YOU to lead at times, based, largely, on the music in the room (the requirements of the rhythm, tone and volume of real life). It’s like removing the training wheels from a bicycle and trusting yourself to manage… Because you’ve learnt how to manage, without the very, very strict punitive dictates of a Food Police-type approach.

• Capitalise on Year One!
  
  Weight loss is easiest right after surgery, and becomes increasingly more difficult in the months and years post. Thus there is no time for dilly-dallying initially. Much as I, personally, am a huge proponent of balance and moderation in general, in the early days, the focus is on GETTING THE WEIGHT OFF. That first year is your BIG CONCERTED EFFORT. It’s your time to shine. It’s the phase in your life when everything you’ve ever learnt on every diet you’ve ever been on actually becomes POSSIBLE, and must be implemented. And in that golden window, even if it only lasts 3 or 6 months, one really should capitalise on the reduced hunger, the massive restriction, even the nausea and general unpleasantness. Moreover, even purely from a safety perspective, that first 6 months requires strict adherence to the dictates of your medical team.

• Get to Goal!
  
  You have to get to goal. You just have to. I don’t say this to be mean or punitive, or to make you feel bad if you haven’t, as yet. And I have no designs at all on what your goal should be. (ALSO, AND I TYPE IN CAPITALS: THE GOAL OF BARIATRIC SURGERY IS USUALLY TO LOSE 70% OF EXCESS WEIGHT. SO BE KIND TO YOURSELF – HAVE A SURGERY GOAL THAT IS FAIR AND APPROPRIATE!. But you have done really well and are a surgical success story when 70% is gone). 

99% of the posts I have read on social media about regain include the sentence, “I never got to goal”. Before we speak about treats, about sugar, about moderation and about balance, you need to get to goal. Until then, you need to be using all of the tools and skills presented in Bariatric Mind Masters thus far to hit that target. For the physiological benefit of the reduced weight, but mostly for the sense of mastery and accomplishment that comes when you do. As with every eating plan the world over, you get to goal, and THEN you learn how to moderately maintain. But you have to get to goal.  By way of analogy, it’s not unlike being in mountains of consumer debt. One needs to rid oneself of that before one plans luxury experiences. If the hard work is done upfront, and the debt depleted, the luxury experiences become a consideration. But until then, it’s simply not possible.

BUT THE BALANCING CAVEAT TO THIS: You will not eat perfectly every day from surgery to goal. This is an unreasonable and unrealistic expectation, least of all for people who have struggled with food and eating for decades. There will come a day when you will cheat for the first time. I hope you feel frightfully sick on that day, to make a repeat less desirable. But, in all likelihood, you won’t feel sick. You’ll probably feel fine. You may well really enjoy it, and feel reunited with your friend of old! And this will be a danger to you. 

But on that day, resolve that your PROGRAM is your new normal. This little deviation is just a bump in the road, and it had to happen, sooner or later. Put it in a mental box, seal it, and keep going. Get right back on track. Do not fixate. Resist the urge to self-deprecate and go into “I am a global failure” mode. Just get back on track, right from the very next meal. Not from “tomorrow”. Not from “Monday”. But from the very next meal. And on that point, if you overate now, do not skipthe next meal, unless you are absolutely stuffed. Meal-skipping has the tendency to create further bingey behaviour.

And if you find that too much restriction makes you compulsive and bingey too (I do!), then work with your dietician to incorporate niceties, or a calorie allocation for bits-and-pieces that make you feel ‘ok’. Most countries have imposed such heavy sugar-tax on food production that even ‘splurges’ of old can be quite decent options now. But you need guidance on that from a dietetic professional.

My Apology

I apologise for this mini-dissertation… It was too long, I know. But that post weighed heavily on my heart… And not because it was patently inaccurate… But because it was so unipolar… And many bariatric patients have struggled so terribly with that kind of thinking, and that it’s that thinking that became their ultimate downfall. 

I’m dieting today. I’m bingeing tomorrow.

It’s one or the other.

You’re eating salads, fish and protein shakes, or you’re eating McDonalds, chocolate and Coke.

I’d suggest, in fact, in closing, that it’s possibly the Food Police that encourage pre-surgery behaviour far more than those who encourage true mindfulness, true head-and-heart work, and true freedom, WHILST STILL FOLLOWING THEIR PLAN (though their plan may include the odd slice of cake, take-out, or diet soda).

And interestingly, I had a flick through that group, and there were as many “I’m screwing up, I’m eating badly, HELP!” posts there as there are in any other forum. The difference was just that the comments seemed to be closed, and admins warned that any “it’s ok, it happens” posts were bad advice. Leaving the person desperate and uncontained, I'd imagine.

Much love,

Debbie