Weight Loss Surgery Post-Op Program Second Chance: Transforming Your Life Stephen Burpee, MD Patrick Chiasson, MD Northwest Medical Center

TONIGHT’S PRESENTATION A NEW YEAR A NEW YOU Sandy Hogan, PCC Professional Certified Coach Vertical Sleeve Gastrectomy, 12/2008 SACMIS

A NEW YEAR – A NEW YOU! “I have some good news and some bad news. The good news is that you’ve met your weight loss goal. The bad news is that now you have to manage your weight just like everyone else does.” ~ Dr. Patrick Chiasson December 17, 2009 (One year after my VSG procedure)

It’s a fact:  The basic formula for weight loss is simple and widely known: consume fewer calories than you expend  It may sound simple, but it is not easy Many factors contribute to the obesity problem  Many factors contribute to the obesity problem

Obstacles to weight loss:  Environment: The eating habits of your family and friends The eating habits of your family and friends What food is most available and convenient What food is most available and convenient How much opportunity you have to move around at work or at home How much opportunity you have to move around at work or at home

Obstacles to weight loss:  Biology: Genetic predispositions for storing fat Genetic predispositions for storing fat Having higher satiety thresholds Having higher satiety thresholds Having more sensitive taste buds Having more sensitive taste buds

Obstacles to weight loss:  Economics & Marketing: Junk food has become much cheaper than fresh produce Junk food has become much cheaper than fresh produce Food companies are masterful at manipulating us towards unhealthy “food” choices Food companies are masterful at manipulating us towards unhealthy “food” choices

A NEW YEAR – A NEW YOU! “The behavioral approach, tested over decades, involves making many small, sustainable adjustments in eating and exercise habits that are prompted and encouraged by the people and the rest of the environment around us.” ~ How to Fix the Obesity Crisis, Scientific American, February 2011

James Prochaska, Ph.D. Professor, University of Rhode Island, Clinical Psychology Professor, University of Rhode Island, Clinical Psychology Director, Cancer Prevention Research Center Director, Cancer Prevention Research Center Developed a “stages of change” model of behavior that integrates stages, processes and levels of change, that applies to the understanding of how people transform health-related behaviors such as smoking, diet, exercise, stress and distress.

Prochaska’s “Changing For Good” “Stages of Change” Model

Step 1. Pre-Contemplation 1. Pre-Contemplation Resisting Change

1. Pre-Contemplation How to Recognize it: How to Recognize it: 1) Avoiding the subject 2) Being ill-informed about it 3) Not taking responsibility for it 4) Presence of defense mechanisms e.g. denial, rationalization, projection

1. Pre-Contemplation How to Move on: How to Move on: 1) Think about the subject 2) Become well-informed 3) Take responsibility 4) Become aware of your defenses : Change defenses into coping Change defenses into coping Concentrate on the problem Concentrate on the problem Apply a proper logical analysis Apply a proper logical analysis Give empathy to yourself Give empathy to yourself Discharge uncomfortable feelings through talking, sports or exercise, not on other people Discharge uncomfortable feelings through talking, sports or exercise, not on other people Be responsible to yourself and to those around you Be responsible to yourself and to those around you

2. Contemplation Change on the horizon Step 2: Contemplation

2. Contemplation How to Recognize it: How to Recognize it: 1) Seriously thinking about doing something 2) May procrastinate about change 3) May insist on more information (paralysis by analysis) or the perfect solution before acting

2. Contemplation How to Move on: How to Move on: 1) Get emotional arousal – e.g. encountering prejudice against overweight people, including remembering prejudice against yourself 2) Vividly imagine your problem and the bad effects it has – e.g. seeing yourself in a photograph or taking diabetes or other serious medications 3) Make the decision using a rational decision- making process – e.g. pros and cons, chart expected progress

Step 3: Preparation 3. Preparation Getting Ready

3. Preparation How to Recognize it: How to Recognize it: 1) You have decided on an action plan 2) You are taking the steps necessary to prepare you for action

3. Preparation How to Move on: How to Move on: 1) Commit to change – make it a daily priority 2) Counter anxiety by: taking small steps (Kaizen) taking small steps (Kaizen) setting a realistic time frame setting a realistic time frame telling others about your decision telling others about your decision Track your progress Track your progress

Step 4: Action 4. Action Time to move

4. Action How to Recognize it: How to Recognize it: 1) You are taking the steps required to change – e.g. you have become conscious of what you’re eating, & if you’re over-eating and under-exercising

4. Action How to Move on: How to Move on: 1) Find healthy responses to cope with the real problem e.g. – if mindless eating reduced your anxiety, find other ways to reduce anxiety 2) Make the time to exercise and to relax

4. Action How to Move on: How to Move on: 3) Control your environment e.g. – remove unhealthy snack foods, avoid influences of friends’ habits, don’t go past the cake shop, use an ‘itemized shopping list’ & other helpful reminders 4) Reward yourself e.g. – buy fresh flowers, connect with a loved one, take time for a hobby or other enjoyable activity each day 5) Get others to help you e.g. – ask for their help and support when you don’t think you can do it on your own; schedule a walk with a friend both for exercise and for company

Step 5: Maintenance 5. Maintenance Staying There

5. Maintenance How to Recognize it: How to Recognize it: 1) After several months you enter this stage 2) You’re able to maintain your commitment to your new, healthier habits – it’s a new you!

5. Maintenance How to Move on: How to Move on: 1) Look out for social pressures, internal challenges and special triggering situations 2) Review a list of negative aspects of the problem regularly, e.g. – co-morbidities 3) Avoid people and places that can compromise your change 4) Make a “crisis card” to help you deal with occasions when you are tempted, e.g. your photograph at your highest weight

Step 6: Recycling or Termination 6. Recycling (Learning from relapse) Or 6. Termination (If no relapse)

6. Recycling (“Relapse”) How to Recognize it if you relapse: How to Recognize it if you relapse: 1) Old habits are picked up again, weight gain is observed, over-eating or under-exercising habits return

6. Recycling (“Relapse”) How to Move on from relapse: How to Move on from relapse: 1) Seeing it as taking one step back to take two steps forward 2) Learn the lessons of relapse: most people need more than one attempt most people need more than one attempt invest more time, energy & focus in your progress invest more time, energy & focus in your progress be prepared for physical or emotional setbacks be prepared for physical or emotional setbacks remember that small decisions lead to big ones remember that small decisions lead to big ones be aware that distress precipitates relapse be aware that distress precipitates relapse

6. Termination (“changed for good”) How to Recognize it if change has stabilized: How to Recognize it if change has stabilized: 1) You have a new self-image, self-determination, and minimal temptation in any new situation

6. Termination (“changed for good”) How to Move on from Termination: How to Move on from Termination: 1. Congratulations! 2. Take pride in your accomplishment! Celebrate! 3. Choose the next thing you’d like to “change for good” – begin it.

A NEW YEAR – A NEW YOU!  There is really nothing “new”  There is only your own “new approach” to changing for good  But that, if practiced, will lead to new happiness, fulfillment, health, vitality & longevity

QUESTIONS TO CONSIDER What one part of you and/or your life, would you like to be “new” in next year? Why is that? What stage are you in the process of change? How do you know? What incrementally small step (kaizen) can you take now that will help ensure your ultimate passage through that stage?

ONE SMALL CHANGE… THAT CAN CHANGE YOUR LIFE: In this New Year, you can lay the groundwork for continued growth without making any resolutions except this: let go of the past, connect with yourself, & be present for your “change for good”

RESOURCES How to Fix the Obesity Crisis, Scientific American, February, 2011 University of Rhode Island, James Prochaska, Ph.D., website:

THANK YOU!