Core Bariatrics

Episode 10: Battling Weight Gain

• Dr. Maria Iliakova & Tammie Lakose

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Have you ever thought that a little weight gain after bariatric surgery was a setback? Maria and Tammie are here to bust that myth wide open. Join them as they dissect the J-curve phenomenon and celebrate the body's quest for metabolic equilibrium post-surgery. No, it's not failure—it's science. And as they unpack the hormonal ballet that influences weight in both men and women, they'll also challenge societal body image norms and the endearing 'dad bod' trend to affirm that true attraction is an intricate tapestry woven from personality, individual quirks, and, yes, looks.

Now, if you think post-surgery life is just about sipping water and munching on veggies, prepare to have your mind refreshed. Maria and Tammie mix it up with creative hydration hacks and a candid look at nutrition that goes beyond the bland. From the importance of protein to the role of carbs and how to handle a Halloween candy temptation, they navigate the nutritional tightrope with finesse. And for those navigating the complexities of binge eating disorders, they share insights into personalizing your plate for success.

But it's not all about what we eat. Stress, sleep, and sweat play pivotal roles in the weight management waltz. Maria and Tammie will share their personal tales of weight plateaus and gains while unraveling how their emotional well-being can shape their physical journeys. Discover the underestimated power of REM sleep, and the vital need for intentional exercise—your daily grind doesn't cover it. In wrapping up, they extend a heartfelt thanks for joining these candid conversations. They are not just sharing tips; they're building a community rooted in the holistic pursuit of health and happiness. So, tag along and let's continue this transformative voyage together.

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Speaker 1:

Maria, am I failing?

Speaker 2:

Tammy, we're always failing Stop.

Speaker 1:

But am I failing because I've gained a?

Speaker 2:

little weight. Stop it, stop it. There's no such thing.

Speaker 1:

But that's what people think is that if they're gaining weight after bariatric surgery, they are failing.

Speaker 2:

Yeah, well, they're wrong. And here's why Because, one, this is not all about weight, right? That's part one. Two is did you know that actually, in the long run, after these kinds of surgeries and after losing your weight, you actually might gain a little bit back, and that's normal? That's normal, that's normal? There's actually even a term for it. It's called the J-curve. Okay, okay, okay, yeah and that's so. I'm not failing, you're not failing. There's no such thing as failing. Did my surgery fail? I don't think so.

Speaker 1:

So, yes, it is normal for a little bit of weight gain after your lowest point.

Speaker 2:

Exactly exactly, and that typically happens right around the time that you're talking about actually about a year, year and a half out from surgery. A lot of people will bounce a little bit up and that. Think of it this way if you came back from vacation and you reset your thermostat to a different temperature, is it gonna bounce immediately to that temperature and just kind of sit there in like five minutes? I wish, because my old house takes a long time to warm that up. Exactly exactly, and so right. It might even overshoot, right, like it might go like a little too high or a little too low, right? Yeah, absolutely right. Your body does the same thing. So, as it's resetting after all of these weight changes and your metabolism changing, it's actually going to fluctuate a little bit and it's very normal to have a little bit of weight gain after you get to your lowest point.

Speaker 1:

And so what do you think the fluctuating weight range could be if, like we all, are not gonna be set at one weight? Forever, exactly, exactly, and what range of weight 10, 20 pounds is normal, do you think, should a person be okay?

Speaker 2:

with. Yes, it is around there. For most people it's about 10 to 20% of the weight you lost. So obviously that ranges. For some people that's less than 10 pounds, for some people that's more than 20 pounds. But it shouldn't be like all of the weight you regained or half of the weight that you I'm sorry, all of the weight that you lost, or half of the weight that you lost. That would be above that normal J curve by a lot. So, yeah, but a little bit of weight is really just your body figuring out what its new set point is.

Speaker 1:

And so for women, obviously we have the time of the month and sometimes our weight fluctuates, especially during that time. Is there a time when maybe I haven't prepped you with this question at all? So is there a time where a man might expect to just hang on, to wait a little bit more, or even gain a little bit.

Speaker 2:

That's a really good question, and it is good because I don't know all the answers to this, because I don't think anybody knows all the answers to this, but I will say that there's starting to be a lot more understanding that men go through a form of well, it's called manopause, if you will in the ethers, but no, literally men go through some endocrine changes too that really affect their metabolism as they age. And you will see this because when you're in high school, as a teenager, as a guy, your body has one shape and then it starts to dad bod, and then it starts to as an older person, you get those kind of pot bellies with stick legs kind of situation in a lot of people, right?

Speaker 2:

So let's talk about dad bods for a second. I gotta go off course. Okay, tell me about dad bods.

Speaker 1:

Why are women we're so attracted to dad bods right. So I think my husband has gained most of my weight that I've lost.

Speaker 2:

I love it, which I'm not mad about. I love it why?

Speaker 1:

are dad bods. Let's be honest most women like some dad bods.

Speaker 2:

Most women like dad bods. I mean, I don't know. I think we're just a little more gentle with men and their weights, that we like and what body shapes we like in them. Okay, here's I want mom bods to be more gentle. I want mom bod too, and I'm not even a mom. But because I actually think that what media tells us we like and what we actually like are two different things, I think you are 100% correct. Yeah, because I think very few people actually want to look like stick figures or like stick figures or like. The alternative is like so much curve that, like I don't know. I think people are just a little bit more wide in what they like than what media typically wants us to believe.

Speaker 1:

Yeah, I agree, I just had to go off to the dad bods.

Speaker 2:

No, but I'm a fan of the dad bod too. I'm a fan of a lot of bods, so, and I think a lot of people are.

Speaker 1:

I'm a fan of Anybody that is attached to a good person, exactly, exactly.

Speaker 2:

again, I keep bringing up this guy jelly roll.

Speaker 1:

Yeah we still have yet to research him.

Speaker 2:

I know what jelly roll is oh.

Speaker 1:

So attracted, attractive to me. Yeah because he is such a sweet man. I've listened to his Wife's podcast. Yeah love them so much and he's just a sweet, funny, realistic guy and something about that Bakes him so attractive attractive, even though he is not a bodybuilder.

Speaker 2:

Exactly Well, and I think that if we were to be honest with ourselves, we don't necessarily like what we're told to like. I think again, like I Actually have listened to jelly roll by now Thank you very much and he is fantastic, I agree. But here's the thing is like I think we're kind of caught in a trap sometimes of we're supposed to look a certain way or we're supposed to be attracted to a certain thing, but if we actually think about it, where we like the way that we look at the way we are, or we like the way that other people look, despite their weight or, you know, even because of the weight that they have, so I do think there's actually a lot more diversity of what we like and what we like about ourselves Then maybe matches like what society wants us to.

Speaker 1:

I Think you're totally right because, for those that are listening, if you look at our cover picture of Maria and I, I am so comfortable with the way I am at, which is just under 200 pounds, which some people are like, ooh, that's still kind of chunky. I am so comfortable with it because, guess what? You look gorgeous and I'm still eating some of the Halloween candy that Maria.

Speaker 2:

Yeah, yeah, cuz I think that's okay. So here's the thing I think the happiest weight for someone, or the happiest body, is the one that makes them feel the best. Yes, that period like and that may be at 200 pounds for some people, that may be at 100 pounds for some people, that may be at 300 pounds for some people, and I don't think that this is like while, yeah, what weight is the gateway? We're never gonna get away from that, fortunately, unfortunately, that's probably not gonna change right, but it may be the gateway drug, but it's not the way we end.

Speaker 1:

Right, I do have another question for you.

Speaker 2:

Yeah, of course.

Speaker 1:

We have a friend who was a co-worker who after her gastric sleeve, did not lose a lot of weight. Yes. So we obviously told her you did not fail, and she probably eats better than I do From day one, like sometimes I've met her. She is very healthy, so why didn't she lose as much weight with her sleeve?

Speaker 2:

That's a really good question. So there's a couple of factors to this. One is all of these surgeries are not just Restrictive, meaning that they they change or lower the amount of food that you can eat and therefore absorb, so it's not just a matter of like oh, I can't eat as much and therefore I'm gonna lose weight. You have mentioned this in a prior podcast, but these surgeries are very metabolic too. They are changing how signals happen, they change how our hormones interact, and not everybody will actually lose weight with these surgeries. There are people who don't lose weight with bariatric surgery. Is that shocking? That might be shocking.

Speaker 1:

And that's why I bring it up, because I want people to know that this is a thing, and it's because, on these great Facebook groups, I know. Doesn't lose weight. All the some people are jumping to oh, are you not eating enough protein? Are you going to McDonald's too much? Like they assume that these people are doing something wrong.

Speaker 2:

Right, right.

Speaker 2:

And so I just want to say super out loud for everyone here and in the back to that bariatric surgery it does not guarantee all the weight loss in the world that you anticipate and it doesn't even guarantee weight loss period, right, okay, so that now that that's out of the way.

Speaker 2:

There, and there are people who don't lose weight with bariatric surgery, but there's a lot of people who regain weight with bariatric surgery. It's not the majority by any means, but we know that some people's bodies are different than other people's bodies, and whether that's the genes that they're expressing, or whether that's something happening with their metabolism that's above the level of the genes, what we call epigenetics or other things or whether it's how their hormones are interacting, or whether that person went through something like a pregnancy or menopause or, for men, their endocrine changes or a health event, those things all can work. For instance, they're having a huge stressor in their life and they're producing a ton of cortisol that's higher than than the level that it used to be. All of those things can contribute to weight gain, even if you've had a really good bariatric surgery.

Speaker 1:

Yeah, so so obviously weight gain has to do with metabolic, hormonal, all that. But let's say Everything's perfect there.

Speaker 2:

The surgery is perfect all of that.

Speaker 1:

Yeah, some people need to be honest with themselves, including myself sometimes.

Speaker 2:

Yes. So what are the basics? Let's, yeah, let's talk about the basics of keeping yourself healthy after bariatric surgery, which also helps with weight maintenance.

Speaker 1:

Okay, so this is just my list and not the scientific Mental health support system. Yep Do you have anything more to add to that? Yep. I would say 64 ounces of fluids a day. Oh that thing. Yep, I have my Stanley Cup and another cup next to me right now.

Speaker 2:

I love you. I stay both, stanley. You're the bomb. Go Stanley. By the way, too, I remember just reading about that car that caught on fire and the only thing that was remaining was that Stanley Cup. That was pretty impressive, oh my gosh. Yes, stanley Cup is something. So go Stanley. There's so many ways to get the fluids in. It doesn't have to be water, it can be any fluids, but yeah, so fluids. Staying with a healthy diet and by diet I don't mean eating less or no carbs or anything like that, I mean small meals throughout the day, right?

Speaker 1:

I hate that. Carbs are a friend guys.

Speaker 2:

Carbs are your friend. You have to have carbs yeah, you've got to have carbs and there's some nutrients and vitamins, ultimately, that you really don't get any other way but carbs. So if you're cutting the carbs, that actually may be something that's holding you back.

Speaker 1:

So let's be honest with ourselves and look at our diet. Yes, If you're gaining weight post-op, especially when you're hitting that 12 to 18 month post-op, which is when people start leveling out, I believe right.

Speaker 2:

Yes, yes exactly.

Speaker 1:

Let's be honest with ourselves. Are we meeting our protein goal? Now, this is a protein goal that your surgeon or dietitian will give you specifically. Yes, are you meeting your water intake? I think, across the board, 60 ounces is usually the recommended amount.

Speaker 2:

right, yeah, 64, which translates into eight glasses of eight ounces a day, and again, doesn't have to be water. So I think that's a really big stumbling block for people. They're like I don't like water. I don't normally remember to drink water.

Speaker 1:

I used to love plain water. I can't stand it now, so I mean I'll obviously drink it if I have to. But I literally carry around crystal light packets or those type of packets everywhere I go. So, you need more than just water. I got it?

Speaker 2:

Yeah, exactly, and there's actually a lot of different products out there that are really good substitutes or really good flavored versions, and even things like broth, for instance, are good. And don't forget your fruits and vegetables, because those actually have a lot of water content to them too. So again, sometimes, yeah, if you're cutting out carbs, interestingly enough because you're not getting enough fruits and vegetables, you may actually be taking your fluid intake too. Wait what? Ah? So think about it this way If you're eating a nice juicy plum or a nice juicy cucumber or something like that, that has a lot of water in it In fact, it's majority water, right? So if you're not eating those things, you are really restricting how much fluid your body has. Oh, yes, yes.

Speaker 1:

Okay, I thought you went somewhere else with that. Oh, yeah, yeah. So, yeah, again back to the basics of are we eating too much sugary and carb high foods? Or unhealthy carbs Exactly Unhealthy sugars, because obviously fruits are natural sugars.

Speaker 2:

stuff like oatmeal, I think, is an oat healthy carb, right, right, and I will also say, like I know that there's a lot of discussion about what's a healthy carb, what's a healthy fat, what's a healthy you know XYZ. I will say that portion probably matters most than anything. So, like you said earlier, Halloween candy after bariatric surgery, are you forever restricted from eating Halloween candy and is it the reason that you're gaining weight again? Not no, that's no, that's not the case. Everyone eats Halloween candy, as far as I know, pretty much, and right, right, and I think it's. It just kind of depends on your personal strategy. If eating one Halloween candy is something that you can do, then I think that's a really good thing to do once in a while, because it it create it, you know, it hits that spot and you can move on.

Speaker 2:

I do think there definitely are people out there for whom eating one piece of candy or something like that triggers, leads to binging, definitely, and I personally have binge eating disorder.

Speaker 2:

So I can definitely relate to the idea of just eliminating some kinds of food from my diet altogether because they serve as such powerful triggers for me. So, believe me, that does exist, and if that's your personal approach and you need to do that, then do that, because because that's something to take very seriously and it's not worth it to include something like that in your diet and have it completely derail your whole progress and insert another episode here. Yes, yes, yeah, we definitely need to go into binge eating and eating disorders in general and just in general, having like more, more materials on how to eat after surgery, but overall, I think anything that makes you overthink it is not worth it. Right? This is the whole. We probably will have another episode on this topic too. But of food noise that you've mentioned before, oh gosh, food noise, yes, and that contributes to more food noise in your brain is not helpful.

Speaker 1:

So and I think food noise comes more when we aren't eating as often as we should be to.

Speaker 2:

Oh, my goodness, so much. So if you're going long periods without eating after bariatric surgery, your body will crave food differently because you can't like. You know, if you're really busy and you don't have bariatric surgery and like when I was a resident, for instance, right, I would go hours, sometimes more than a day, without necessarily eating and you are so starving by the point that you you know you actually do eat that you scarf and actually my friends still make fun of me because I still eat like a resident and it takes me like three seconds to gobble down everything. Military, military, yes, yes, yes, like military, my brother.

Speaker 1:

He was like hurry up and eat and I'm like slow down. He's like, but I went through so many years.

Speaker 2:

Yes, just having to scarf it down Totally, yeah, totally, and that's different. Yes, and you can't do that afterwards. If you do that, you're going to feel really sick, you're going to feel bloated, you might have dumping syndrome, yeah, so that's, that's not an approach, and it's not even an approach with food, but it's not even an approach with liquids. Like if you don't drink for 12 hours after you know, when you have a bariatric surgery, because you're really busy, or nurse, or you're a doctor, or you're a pilot, or you know whatever a lot of jobs where you can't drink that easily throughout your day Like you're going to be suffering because you can't just chug a bottle of water when you are available. So these are really things, like you said, going back to the basics.

Speaker 2:

If you're having a weight stall or a weight gain and it's, it's continuing to happen, even though you're, you're doing other things right, it's really, really important to go back to the basics and, like you said, be honest with yourself about am I drinking enough water? Am I getting enough food in the gate? Is the food that I'm eating the stuff that makes me feel good and the stuff that makes my body work well, and am I taking my vitamins? I think that's a really, really big stumbling block for people. Those daily vitamins can feel like such a chore. Look why you got to call me out like that for real. Hey, you called me out earlier, girl, so I got to do it too.

Speaker 1:

I don't even know why they're such a chore because, like my other medications, if I don't take them I know I'm going to derail. Yeah, and I'm not great way, but I should think. I should think the same way because my vitamins, especially my iron, I derail because I am tired and I could sleep all day, so yeah, know how to battle that I mean. Do you think it's so did?

Speaker 2:

itself. Do you think it's partially because vitamins kind of feel like a joke, like they don't feel like real?

Speaker 1:

Yes, and I also am still struggling to find the vitamin that doesn't make me nauseous.

Speaker 2:

That's fair. So there's actually this is a really good point and we are going to have a separate episode also about vitamins. Man, we're like finding all of our episode topics in this one, aren't we? But all of our conversations end up with rabbit holes. That's where so many like this is a thing.

Speaker 2:

But the vitamins is a really interesting point because there's so many of them out there and they don't have to. You know, for you to be healthy and take the vitamins you need to after these kinds of surgeries, they don't necessarily have to be bariatric vitamins, even though some of those can be a little bit easier because they're formulated specifically. Sometimes they do handle that, that nausea or, you know, the way that they're absorbed is a little bit different, a little bit easier, but they can be more expensive. So what I would say is find the thing that works for you. If it's gummies, great. If it's chewables, great. If it's something you swallow, great. Even using patches for some people is an appropriate thing to do not for everyone, but it can be for some people. So I don't know. I know that there's a bunch of like apps out there that can make you feel like vitamins are a game or your medications in general, just kind of make it fun to do it and track it. I know it's boring, I know it's not fun, but it is really important.

Speaker 1:

Yeah, and I have a lot of listeners to comment of what if they were dealing with nausea, what their vitamins, what vitamin you have found that works? Because even if though I've worked in a bariatric clinic and have had all these samples right, I think I've found one the fusion.

Speaker 2:

Yeah.

Speaker 1:

That's a capsule that has iron in. It is definitely my the best one so far. Right If anybody has any other suggestions, especially iron specific?

Speaker 2:

Yes.

Speaker 1:

Let me know.

Speaker 2:

Yeah, good, good call. And honestly, in general, I think the vitamin thing is a community sourced thing. You talk to people, talk to other people. Hopefully we're creating a community in which people can talk to each other about good vitamins and what's worked for them, because I don't think that's a one size fits all solution for people either along that route, even though they're really important. So, yeah, back to the basics, more back to the basics, and also one exercising. Well, actually, before exercise. I just want to say one other thing about diet. Is that cool? Can I do that? Okay, my lab very good.

Speaker 2:

So the one thing that gets overlooked a lot is fiber, and fiber is actually super important, and here's why the best way it's ever been described to me is like toilet paper from the inside. How do you like that Toilet paper from the inside? So think of it like something that's scrubbing you out from the inside and helping push things along. It helps to absorb water and, in general, just helps you have better BMS, better bowel movements. Okay, okay, that makes more sense. You're like what the heck are you talking about? So, yeah, and what is what contains fiber? So that's fruits, vegetables, whole grains and then things that have added fiber. You can even take fiber supplements as well, okay, yeah, so look for that.

Speaker 2:

That can be a really, really important component of a diet that people are missing. Yeah, you're absolutely right. Right, because, especially if your whole, if your whole world is protein and you're a lot of people yeah, they only focus on protein, because sometimes it is hard to get that protein goal in it is it is your whole diet cannot be protein. It can't be protein, and if it is all protein, you're going to have constipation and you're going to be, you're going to feel miserable. You're probably surprisingly going to have low iron because you're not actually allowing your body to absorb things properly, and, yeah, so there's, there's lots of things to do here, but tweaking it, just tweaking it with those things that you were taught in your program and also the ones that the things that we're going to talk about in our diet episodes too. Just take a look at that, because that's oftentimes people are are focusing a little too much on one thing versus the big picture in their diet. Right?

Speaker 1:

Well, okay.

Speaker 2:

Now can we get to exercise. Let's go exercise, let's, let's do it, let's do it.

Speaker 1:

All right. So being honest with yourself, are you exercising at all? Yeah, More than around 30 minutes a day outside of your normal activity. Yes, nurses, I'm calling you out.

Speaker 2:

You are running around the floor?

Speaker 1:

Yes, but that's your everyday activity, yes, so we need to do an especially 12 hour days. It's so hard. Yes. I mean there's so many jobs out there, but nurses especially, healthcare providers especially. Look, I'm a respiratory therapist. I know, our ends get hauled out a lot, right. But even though you're active, you're moving around. You want 30 minutes outside of your normal activity and that doesn't have to be 30 minutes at a time.

Speaker 2:

Yes, exactly. So that's, I think, really key, because I think a lot of people see 30 minutes and they're like, oh my gosh, I'm going from zero to 30 and it's every day. That's crazy, I'm never going to get there. That's overwhelming, and so I'm just not going to try and I honestly like I felt out of breath just saying that out loud. So I really understand, and I mean out of breath because it feels so anxiety producing, right.

Speaker 1:

I think you're absolutely right, but even if you do have a lunch break, just walking 10 minutes yeah.

Speaker 2:

Yeah.

Speaker 1:

You do normally do?

Speaker 2:

Yes, because right. So breaking it up and actually walking from a little bit further away in the parking lot and taking the stairs and going like not sending your coworker a message, but actually going to their office or having a standing desk or going on a walk with lunch not necessarily instead of lunch, because, again, we don't want people doing activity instead of eating when they need to eat. That's a good way to get back to the problem of having the eating too little be the problem, but finding ways to build in more regular, steady activity throughout the day. And, believe me, I do not think that people can lose 100 pounds by taking the stairs once or twice a day. I think that is a lie. That is an offensive way to tell people to lose weight. That's not true, that's not the case.

Speaker 2:

But, just like we talked about in prior episodes, diet and exercise are great ways to maintain the health of your body and to maintain your weight. So, making sure that you're staying active for 30 minutes a day, just like you said, above your normal level of activity, and that can be walking, it can be yoga, it can be hiking, it can be doing squats by the dishwasher, it can be doing some kickboxing moves while you're watching TV. It can be trampoline. Oh my gosh, so many people have now gotten trampoline exercises. Those are really popular right now.

Speaker 1:

Oh, I bet, I bet those are intense yeah.

Speaker 2:

But is it safely? Absolutely, but yeah. So I mean, there's just so many ways to get creative and do things and it's really difficult to get it wrong unless you're injuring yourself that it's really, you know, unless you're causing injury or doing something. That's really excessive. Try it. If you don't like it, don't do it. If you like it, do it again.

Speaker 1:

But if you do like, something you're doing it for a long, long period of time.

Speaker 2:

Yes.

Speaker 1:

So if you're stalling out or gaining weight, change it up a bit. Exactly, if you're walking on the treadmill 30 more extra minutes a day, try inclining it, try doing the snare stuffer, so your body gets used to what you're doing.

Speaker 2:

It does, it does so changing it up, even If you go six months with doing this, then going six months back to this, exactly Six months back to this, you know, changing it up, yeah, and there's actually been a lot of research in this area of cross training. So mixing up your activity having the best benefit not just for your weight, but even for things like your balance and your flexibility and your overall ability to move your body. It's pretty interesting, but I think over time, especially as we age, we become less flexible and, as a result, we have a lot more injury when we move, like sometimes you can literally injure yourself moving from bed, getting up out of bed, or I actually had a couple of years ago I sprained my ankle really, really badly walking my dogs and I had to be like in a cast and ridiculous Okay For people that missed that episode.

Speaker 1:

Maria has also flown off a treadmill.

Speaker 2:

Yes, yes, so I'm very injury prone as a person anyway, but the thing is is if you're not building a body and maintaining your body in such a way that you have enough flexibility to be able to go about your daily life in a safe way, and then, especially when you take on extra activities like helping a friend move, or during Christmas, when you're delivering presents, or when you're doing some construction work or renovation work at your house, or doing gardening or whatever it is that you do, you want to be able to be active in your daily life and be able to take on extra challenges without really having to think too much about it. So, thinking of activity as not just oh, I have to burn 500 calories and I have to, you know whatever make this happen in order to not gain weight or to lose weight or to for some weight related goal. Think about it instead of how do I want to be able to move and use my body?

Speaker 1:

Right, absolutely. And one tip that I was given actually just for daddling, like the ADHD paralysis of seeing your house dirty, whatever. So the recommendation I was giving is that your timer for five minutes. Just do it for five minutes. Yes, 99% of the time you start that five minutes and you're going to exceed the five minutes. Yeah, so, it's tricking your brain.

Speaker 2:

Yes, it's tricking your brain, because this is the whole. How do you eat an elephant? Well, one bite at a time. Mentality of you, don't. You do not have to work out every day and you do not have to work out for 30 minutes every day, but if you are active for 30 minutes every day, you're setting yourself up for a body that's going to be really as functional as you can get it for the longest amount of time Absolutely.

Speaker 1:

And I think with exercise it really does help your mental health.

Speaker 2:

Oh yes.

Speaker 1:

It helps clear your mind somehow.

Speaker 2:

Is there any science to that? There's a lot of science to that, tammy, and I love your segue into mental health because that's a really, really important element of thinking about weight management in the long term, with or without surgery, and the way that to think about it is. Exercise is another, or physical activity in general, it's just, it's another way to clear your mind, to help refocus, to help get your mind off of things that are stressful for you, and there's really good research that shows doing exercise can be as effective as medication for mental health in some cases. I am not telling people to exercise instead of taking their medications, just to be super clear. Just to be super clear, medications and exercise are different and they're not equally appropriate for everything, but in terms of elevating mood and in terms of treating depression and in terms of helping people recover from stressful situations, it's very, very effective and can be as effective as medications for some people.

Speaker 1:

Oh, wow, that makes sense. But yeah, if we are gaining weight or really at a standstill, especially early on in our journey does stress and anxiety or not getting good sleep have? Do you think that has anything to do with weight stalls or weight?

Speaker 2:

gain? Yes, definitely. I mean, I would say what do you think about that, since you've gone through it?

Speaker 1:

I would say yes, 100%, because when I'm more stressed out or anxious, I've again I talk about my ADHD paralysis. I feel like sometimes my anxiety or being super stressed out gives me some paralysis too, and so I don't want to be active at all, and then if I don't get good sleep, y'all better watch out.

Speaker 2:

Well, I think we've all been there right. We've all been had a horrible night where we're tossing and turning and the next day we're just miserable all day long, even if it was something that was supposed to be a great day or whatever. We're just not present for ourselves or for other people in the way that we want to be, absolutely.

Speaker 1:

And so I'm going to go respiratory therapist here on everybody and I worked in a sleep doctor's office who tested for sleep apnea, treated sleep apnea and when you have sleep apnea, which most people that are obese not all I should say and not all skinny people don't have sleep apnea. But when you have sleep apnea, the whole thing is is you're not getting good deep sleep, you are not getting in that REM sleep.

Speaker 2:

Yes.

Speaker 1:

And why that is is because you are obstructing at night, which, like snoring and stuff, is a sign of obstruction your body. When your oxygen levels drop and your CO2 levels go up, your body wakes you up, and so you never get into that REM sleep. And so that's where people say, oh good, sleep is good for your weight.

Speaker 2:

Yes.

Speaker 1:

Okay, but why?

Speaker 2:

Yes.

Speaker 1:

It's because when you get good REM sleep, you have more energy, and I can say that from no-transcript, going from having sleep apnea and wearing a CPAP.

Speaker 2:

Yes.

Speaker 1:

I used to get up in the middle of the night like three or four times to go to the bathroom. I thought it was just normal. No, it's because I kept waking up from having sleep apnea Right, and actually people don't necessarily.

Speaker 2:

I love, by the way, your breakdown of how sleep apnea works and how it affects people's sleep and energy, because you're right.

Speaker 2:

When you're not getting oxygen where it needs to go like you're breathing right, you're breathing, but that breath isn't getting to your lungs and isn't then getting to everywhere else that needs to go in the body appropriately, because your airway is shutting down then absolutely you don't have that oxygen to power your muscles and to power your heart and to power your brain, and then you're also building up CO2, which is toxic and something that your body needs to get rid of in order for everything to work well. So you're right when we're not getting good sleep whether it's because of sleep apnea or stress or just literally being so busy at work or otherwise, that you're physically not getting to sleep, your body has no way to recover and has no way to reset, and those are really really important things to do. And then the other thing I don't think everyone knows about is that sleep apnea can actually be treated with bariatric surgery, and it doesn't necessarily go away for everybody, but it gets a lot better for most people, right, right.

Speaker 1:

So most obese patients have a little extra tissues in their throat area. But yes, I've told patients that even if you lose weight, you don't necessarily get rid of it, depending on the structure of your mouth.

Speaker 2:

Yes.

Speaker 1:

If your jaw is sunken back. Yeah, some people just will have sleep apnea unless they have some kind of surgery to help with their jaw or their nasal passageway. All of that stuff.

Speaker 2:

Yes, so, yes, some of it can be structural, which bariatric surgery does not change the structure of your mouth or nose or your throat. Obviously you can stay away from my nose, right, I don't go there, I promise. But you're right, sleep quality has such a huge impact on not just weight. But honestly, the thing is we're talking about diet and exercise and mental health and sleep and all these things as if they kind of live in separate boxes. But they don't right. No, they all go together. They all go together, right. Exactly. It's sort of like if you're not getting good sleep, then where are you supposed to get the reserve to have a good day and be able to work out and eat well, and you know, let's be honest, when we're all in a bad mood, we always get sweets or salty.

Speaker 2:

I guess Sweet or salty? I'm a salty person, you're a sweet person. I think that's true. Yeah, right, but you're right. I think it's this overall picture of am I filling my cup? Am I over-filling my cup? Am I getting enough good rest? Am I getting enough good mental health? Am I getting enough good physical activity? Am I? You know? And all of these things feed into each other. So if you're not able to take care of yourself and not able to take care of each of these things, they can start to affect each other too.

Speaker 1:

Yeah, and I think all of that. You need a good support system.

Speaker 2:

Definitely.

Speaker 1:

Because if you are one that's prone to want sweets on me and I've had to tell my husband like I literally don't want this in my house- Right right. We can sure I need just more self-control. But he is more apt to keep his sweets at work because he has self-control when it comes to sweets. Exactly, exactly, so having a good support system has a lot to do with weight gain and weight stalls Definitely, definitely, if you go out to eat are people that you're going out to eat with keeping your health journey in mind.

Speaker 2:

Yes, and or the McDonald's, or are we going to maybe Applebee's? That has some good, healthy options. And are people going to be shaming you for the choices you're making or making fun of you? And if they're making fun of you, is it like oh, I'm ribbing you but really I love that you're taking care of yourself? Or are they ribbing you because they have other feelings and aren't necessarily supportive? So I noticed actually recently you were talking about having friends and good community and support and things.

Speaker 2:

Living in Iowa City, there's a really, really fantastic dog park that's really close to where I live and it's right by the Iowa River and there's really beautiful woods back there. And I've started to do this activity when I moved here every day of walking my dog back there and she loves it, and then I started going on walks with friends and with neighbors and things like that and it's kind of become a tradition now for me and it's such an easy way to have some social interaction with people, which is really huge in terms of mental health and to have a good support system and to take care of some physical activity, because it's just I'm out walking my dog, I don't even notice that I'm being active and it's just such a beautiful way to sort of incorporate more than one thing at a time. So even think and it didn't come out of me being strategically planning OK, how do I kill two birds with one stone here? How do I go do something active and do something good for my mental health? But I think we can Hold on. Sorry, I just sneezed, but we actually can look at opportunities to build more than one thing at a time.

Speaker 2:

There's ways to eat healthily with other people and make that part of your day. There's ways to do physical activities with people. Another example actually that I had recently was I started doing yoga with some friends and I hadn't done that for a long time because I typically work out at home. But I didn't even see it as a workout necessarily. I saw it as a oh, this feels really good for my brain and it helps me relax. Yeah, and you're hanging out with your friends. And you're hanging out with your friends? Yeah, so really leaning into where can your support system help you or hurt you? Yeah, or hurt you.

Speaker 1:

And so that's where my husband's still trying to get out of the mentality. So obviously, before bariatric surgery I wanted the closest parking spot and this is not him being malicious or anything, this is just him stuck in his ways, or what was normal. I have to remind him all the time that when he's going through trying to find a parking spot, I'm like yo bro, go into the back 40. I'm fine with that. Yeah, he's very supportive. But, his support used to be different of. Let's find the closest parking spot.

Speaker 2:

Right, and there is a little bit of retraining that goes on in relationships, I think, after people go through this experience, Because a lot of times people, we accommodate each other, we don't want to cause problems and we love our friends and we love our family and we want to make the world easier for each other. Right, Absolutely. And sometimes you have to almost have conversations with people of well, actually now I'd like something different, and can we do something different together?

Speaker 2:

Yes, my husband has taught me I cannot read your mind, so you need to tell me you need to communicate, yeah, yeah, and well, yeah, and some people are going to be really supportive of that and some people aren't, and that is an important decision sometimes of who gets to be in your life, who gets to participate with you and how do they get to participate with you.

Speaker 1:

Right, and so having a person going through the same thing or the same journey, I think is so vital and I think this is why I'm also selfishly building this community with you is because, I don't necessarily have a super close friend that we're doing the same thing together.

Speaker 2:

Right.

Speaker 1:

And friends are very supportive, like even you and whatnot, but having someone that's going through the journey with you and has the same goal in mind, I think, is a powerful thing, and so that's where let us help you find a person to keep you accountable. Right Help you stay accountable and that's where this community comes in is a lot of people may have had, or is going to have, bariatric surgery.

Speaker 2:

Yes.

Speaker 1:

But it's still just a sliver of the world. Yes, so sometimes especially in our small rural areas, like I'm in not a lot of people have had bariatric surgery, and so sometimes we've got to go online to find those accountability partners, exactly, and I don't think of accountability as punitive here.

Speaker 2:

I think of accountability as a lot more support and, yeah, to feel like you're not alone. Because, again, there's no such thing, I don't think there's such a thing as failing in this process. And I don't say that because I mean, you know me, I'm not a super rose-colored glasses the world is kumbaya person. But the reason why I say that is because there's no such thing as a clear, there's no winning Like this isn't a war, this is not a clear cut Like, ok, we're here and we've finished it and we achieved it, and now we're done. That doesn't exist. So there's no such thing as failing because there's no end point.

Speaker 1:

Exactly, exactly, and so the definition of failure is a lack of success?

Speaker 2:

Right, and there's no such thing here.

Speaker 1:

The failure to come or rewind. I found a good one.

Speaker 2:

Okay, well, let's keep going. Okay, no, that's fine, but no, I just think that that concept of failure to me means that you've, you've, like, tried everything and nothing's working and we're done. There's no such thing as being done with weight Like there's no such thing as being done with this process, because it is a process and it's lifelong. So kind of reframe, even how we talk about people and just the number of times that people have walked into, like my office after having had surgery years and years ago and they're like I didn't want to come back. I never wanted to see another provider in this because I thought they would be really mean to me or they would really judge me for having failed.

Speaker 2:

So we sort of eliminate that mentality or eliminate that the way, like the way that people are seen in that space to more of okay, well, this is where we're at now and what can we do? What can we do differently? What can we do now? And we haven't really talked at all about medications, and that's on purpose, because we will have a separate episode on medications and how they can help with weight gain too. But I really, really wanted to focus in this episode on all of the lifestyle things and all of the people. That are all the things that people can do without even having to go to a doctor's office or even having to go get any kind of specific medical care. But, in a way, think about what's going on in your life and what are the things that you can do to set yourself up for success. Ask other people to help you in that and figure out ways to make yourself to enable yourself.

Speaker 1:

Yeah, this episode was definitely more just getting back to the basics, being honest with ourselves and making sure that we're doing all of the things that we were told to do. That way, you can eliminate if anything is medically wrong, because if you are honest with yourself and all of these are in tip top shape and you're doing pretty good most of the time, then we can start looking at okay, what is going on Exactly.

Speaker 2:

What medically might be going on Exactly. And then we start to talk about okay, this person really never lost weight to begin with. Maybe that wasn't the right surgery for them, right? And then there's a possibility and that needs to be addressed in a medical or surgical way or maybe we need to start using medications, or maybe we need to start focusing on some other things, or maybe we need to do a work up because someone's thyroid is completely out of control.

Speaker 1:

Right, so right, stay tuned for that episode of going outside the basics and knowing that you're doing all the things.

Speaker 2:

Yes. And then where did we go from there? Yes, Everyone who's listening, by the way, thank you, but I'd love to hear your approaches on weight fluctuations and weight changes or plateaus or gains, especially as they relate to what you're eating, how you're moving your body, your mental health, your sleep and your support system. So tell us, We'd love to hear it.

Speaker 1:

Yes, yes, please, and don't forget to follow the podcast, and we will be back with you again another day. Thank you for listening everybody.

Speaker 2:

Thank you, see you soon.