The Cone Matters

I was just at a local mall, buying some travel supplies for our imminent family holiday.  As we left, my daughters and I treated ourselves to (low fat, sugar-free) frozen yoghurt.  In the car, on the way home, I considered the caloric difference between ordering the yoghurt in a cup, as opposed to in a sugar cone. (And also considered the idea of enjoying a few bites, and then passing the cup on, or turfing it). 100 calories difference, at least! Which is absolutely material to a post-surgery bariatric patient.

And there’s probably very little nutritional value in the cone, so it’s essentially empty calories.  The yoghurt, arguably, at least has some measure of calcium, protein and probiotics.

I’m not a nutritionist or a doctor. So why am I telling you this...? Because, in the same car-trip home, I pondered further how I would never have done this mental maths in my pre-surgery days. I’d never have considered the benefit of ditching the cone. I’d never have viewed it as significant… 100 calories, here or there.

What difference would it possibly have made...? (Except that this is actually how most slim people think and reason, on a daily basis).

But I was eating for the first team, where 100 calories was hardly an hors d’oevres.

Or I was dieting for the first team. Where no yoghurt of any description would have made its way onto my eating plan.

One or the other; all or nothing.

Pre-surgery, it was either post-pizza chocolate fudge sundaes, or salad for everyone.

And that was never, ever sustainable.

Now, post-surgery, we sit with a dilemma. This lifestyle is forever. These 1000-1500 daily calories are all we have, and we need to make maximum use of them. We need to ensure that they are ‘filling’ enough to offset hunger, nutritionally-dense enough to nourish our bodies, and enjoyable enough to stave off any sense of deprivation.

And so the cone matters.

My musing then went a little further… And brings me back to my overarching belief about the value proposition of weight loss surgery:

I’ve said it before, and I’ll say it again. Bariatric surgery patients are master dieters. We know it all. There’s very little we can be taught about ratios and macros and carbs and GI and points and meal replacement shakes. We know about intermittent fasting and interval training and Body For Life. We’ve seen and done it all.

But, for most of us, in the final analysis pre-surgery, it simply didn’t matter. We were on a relentless treadmill of fat-again/slimmer-again/fat-again/slimmer again, fighting our set points and dueling our hungry demons.

And so the cone didn’t matter.

Eat it, or don’t eat it. The relentless treadmill powered on.

But surgery stopped the treadmill. Gave the gift of miraculous weight loss. At least for the first year or so. And took us to a point where the cone really does matter. And can matter. And eating the cone or not eating the cone is material to great success or diminished success.

Which I find so liberating and so empowering.

I feel like I have agency.

I feel like I have choice.

And, to be frank, I feel that I have control.

The Bicycle That Became A Harley

I’ve spoken before about how our pre-surgery journeys were akin to slogging uphill on a tired old bicycle. The surgery comes along and smacks an engine onto that bike, revving it up and making it far more possible to go the distance, with greater ease and finesse. It reduces hunger… It challenges our weight set point. It offers restriction during a meal. Of course a motorbike still requires human effort – there’s steering, there’s fuel, there’s maintenance.

But it’s simply easier to get to your destination with a motor, than it is without.

Post-Surgery Is Forever; Post-Surgery Isn’t The Latest Diet

It’s the forever nature of our post-surgery lifestyles that make cone-type conversations more important. It’s why, as a sleeved psychologist with an online platform, I post about managing buffet meals, hotel breakfasts, weighing ourselves and measuring our food, eating a quarter of a treat (rather than the whole thing).

Basically, once the weight is off, we have to think and act like naturally slim people. (And remember our sleeves and pouches). Depending on starting weight and rate of loss, we have a year or two of rather strict dieting. And then we arrive at the Promised Land of ‘Goal Weight’. And often that goal weight exceeds our greatest pre-surgery expectations.

And it provides us with a wonderful, wonderful opportunity: we get to figure shit out, in a way that was never possible before. We get to experiment with what works, and what doesn’t. Which treats are ok for us, and which aren’t. How many calories keep us stable, how many or few cause fluctuations. Which foods ignite our sense of restriction and satiety. What habits keep us safe… For myself, ordering a cappuccino at the outset of a restaurant meal keeps me safe… I enjoy it, and use it to slow myself down and really consider what food choices would be best for me. It also reinforces my newfound belief that I should soak up the ambience and immerse myself in the conversation and the company, and keep food as totally secondary.

But all of this ‘figuring shit out’ takes presence of mind. It requires conscious, mindful awareness. It takes application and courage. Courage to deviate a little from programs and diets. Courage to play with principles, rather than rules. And it takes strategy. Not willpower. Willpower doesn’t work. Strategy works. Choice works.

Bariatric Mind Mastery Through DBT (Dialectical Behaviour Therapy)

At roughly the same time that I was considering bariatric surgery, I was upskilling myself and acquiring DBT professional training. One of the biggest frustrations in private practice, until then, for myself and my patients, was the need for tools and skills, rather than just insight and support. DBT provided this with aplomb. Unlike CBT (its ugly stepsister), DBT is actually informed by a really robust and interesting philosophical underpinning. This philosophy I found to be kind, forgiving, calming and really quite profound. DBT has really become the treatment of choice for impulsive and compulsive behaviours, and teaches participants to monitor their feelings and reactions closely, in order to pre-empt and therefore prevent self-sabotage and self-destruction.

I’ve found such strength in the marriage of the actual surgery and the DBT principles, tools and skills. What I could not achieve with DBT alone, I can absolutely master with DBT and a sleeve. It’s the perfect union. The surgery ignites the engine of DBT. DBT works best with a set point ‘reset’ and the physiological restriction. And the surgery works best when real attention is paid to mental and emotional factors that play a role in guiding our hand-mouth behaviour!

Bariatric Mind Masters 8-Week Intensive Program

As a sleeved psychologist, I have created a transformational 8-module program for bariatric patients. It draws heavily, but not exclusively, on Dialectical Behaviour Therapy principles, and offers participants the opportunity to focus wholeheartedly on the emotional and mental obstacles in the way of their weight loss surgery success. Or to just pre-emptively develop really healthy strategies for long term success, and to prevent any sort of regain.

The program is fully digital, and takes the form of a series of teachings per week, along with homework exercises and activities.

If you would like to chat to me about enrolment, you can either email me on info@theshrinkonyourcouch.comor book a complimentary time in my diary by clicking here https://meetme.so/DebbieRahimi