The Marathon Journey of Weight Loss Surgery

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I’m a runner. I’ve been a runner since I was a teenager. I’ve run five or more miles three times a week for the past four years and rarely take a day off. Many of my runs have been over ten miles. I’m the crazy guy you’ve seen running in the rain and the snow on the side of the road at 7 AM. I’ve learned a lot from running and many of those lessons I have applied to life in general. I’ve shared much of what I’ve learned about running with many of my patients because I believe that there are a number of parallels between long-distance running and the journey through weight loss. Many of my patients agree. I’d like to share some of these parallels with you to provide you with a helpful way to think about all that you’ve gone through and may still experience going forward.

I should make an admission to you first. I’ve never actually run a marathon. It’s something I very much want to do someday but have yet to attempt because of some nagging injuries and such. However, I know enough about long-distance running and have spoken to enough marathon runners to understand the psyche of the marathon runner. Therefore, I feel comfortable speaking of it here.

Consider the entire journey of weight loss surgery from before surgery to years afterwards as a marathon. For those of you who are unfamiliar, a marathon is a race of 26.2 miles. The modern Marathon commemorates the run of the soldier Pheidippides from a battlefield at the site of the town of Marathon, Greece, 26.2 miles to Athens in 490 B.C. It is seen by many as the ultimate test of endurance (although there are now ultra-marathons that can go for 100 miles or more!).

There are many things one must do to prepare for the running of a marathon. A marathoner has to complete several practice runs and work up his stamina and endurance to get into peak physical condition for the race. A marathoner is encouraged to make dietary changes, especially in the few days before the race. A marathoner has to mentally prepare for the grueling 26.2 run and plot out the course and a strategy of how he is going to make it from start to finish. The process of weight loss surgery is quite similar. There are many steps to take before your big day. There is research to do. Perhaps you will talk to doctors or to those who have had surgery to better understand what you will be experiencing. When you decide that surgery is for you, there are pre-surgical assessments, medical tests and other things that must be done to ensure that you are prepared for what lies ahead. You are instructed to make dietary changes in anticipation of your surgery
perhaps a liquid diet for a week or more. And certainly you must mentally prepare for all of the physical, behavioral and emotional changes that lie ahead.

For the most part, your surgery date is the starting line. You’re nervous. You’re excited. You’re hopeful. Similarly, the marathoner heart is pounding long before the starting gun is fired. The gun is fired and suddenly
they’re off! The first few days after surgery, you’re just trying to do as told. Listen to what the surgeon, the nurses and other professionals’ tell you and get home from the hospital as soon as you can. The marathoner is just putting one foot in front of the other and trying to find a good pace
a comfortable groove. Nothing fancy, just moving ahead. The first few weeks after surgery are like the marathoners first few miles
nice and easy. Learning to chew, learning what to eat and what not to eat
adjusting to the new pace of eating and making other changes in your life to improve your chances of success. Much of the journey lies ahead and thinking too far ahead can be daunting. Keep your head in the present.

At some point, there will be bumps in the road. The runner may have a side-stitch, a cramp, pain, fatigue, a pebble in his shoes; some complications to be addressed. The marathoner understands that some of these discomforts will come and go. Sometimes, if you just let it be and shift your focus to other aspects of the running experience and away from the discomfort
the discomfort goes away. It is important that the marathoner not panic about the situation. The journey through weight loss surgery will also have its discomforts. Like the marathon, many will simply come and go. Some days may be more difficult than others. On some days eating may be more difficult than other days. On some days, cravings will seem stronger than others. In most instances, the discomfort will be temporary. Avoiding “catastrophic” thinking is the key.

I am speaking of the mental demons that we all must deal with. Often while running, it seems as if a little devil appears on my shoulder whispering negative comments in my ear. “You’re never going to make it.” “You can’t do it.” “What were you thinking trying to run so far!?” “You’re not into it today
just go home and try again tomorrow.” Weight loss surgery patients also hear the voice of a little devil who attempts to derail you. “How am I going to avoid eating some of those foods that I love?” “What am I going to do at the holiday barbeque
I’m going to go nuts!” “I can buy a pint of ice cream and just have a little
what’s the big deal.” “A few cookies couldn’t hurt.” Part of your preparation for the marathon of weight loss surgery needs to include maintaining a positive attitude that can help you last the equivalent of 26.2 miles and to develop strategies for coping with these mental “cramps” and “side-stitches.” What am I going to tell myself when and if things get a bit complicated? What you tell yourself is immensely important in determining how and whether you will reach the finish line. Believing that you can cope with some of the temporary and unpleasant bumps in the road is essential for your success.

Many of my patients initially get quite deflated by setbacks or slips. Most times, they are engaging in what I call “black and white thinking.” In this way of thinking, eating one serving of ice cream immediately becomes “I’m sabotaging my surgery!!” One day of feeling deprived or hungry becomes “My band isn’t working!” or “I’m never going to be able to live this way!” It is dramatic, exaggerated and self-defeating thinking. The marathoner’s mindset needs to be focused on “how I can” not “why I can’t.” There is nothing propelling the marathoner forward other than his or her own desire to persevere. He can stop with one step, but CHOOSES not to. He tolerates the discomfort. You also can stop. You can “cheat.” You can avoid getting your band adjusted. You can eat around the bypass. You can drink your calories. You can eat sweets. But you won’t finish the race and you’ll feel terrible for it.

Several miles further down the road, the marathon becomes a strange combination of harder and easier. The marathoner has plenty of discomfort. Discomfort is probably an understatement. His body aches, his feet burn and his mind is often numb
but at the same time, he is beginning to almost taste the finish line. There are fewer miles ahead than behind. There is a mild euphoria as he considers that he might actually make it!! The surgery patient has lost a lot of weight several “miles” into her race. Perhaps most of the weight has already been lost
or maybe it’s already all off and now she’s focused on keeping it that way. But perhaps there are still some discomforts. Maybe some people continue to make annoying comments, or you have some body image concerns, or are experiencing other sources of anxiety and insecurity. It will be ok. Keep the focus on the here and now, avoid catastrophic thinking, and address what needs to be addressed. Try to taste the finish line. It’s not much farther now.

This is where the analogy ends. The marathoner raises his arms as he crosses the finishing line and gasps in a combination of exhaustion and euphoria
.I did it!! It is an incredible accomplishment. He is finished. But as a person who has had weight loss surgery, you will always be running your race. Through time, your pace will hopefully become more predictable and steady, but the journey of weight loss surgery never truly ends. There are always “side-stitches” and “cramps” and little “pebbles in your shoes.” Rub out the cramps. Take a few breaths to relieve the side-stitches. Step off the track for a moment and shake out the pebbles in your shoe. Focus away from whatever the source of discomfort. There’s no timer anymore so there’s no rush to the finish line. Take each day as it comes, some better than others. Just keep a steady pace, a clear focus, and a positive attitude and you will successfully cross a thousand finish lines.

Lessons to remember:

• Stay focused in the present. Avoid thinking of how far you still have to go. Instead, focus on how far you’ve come. You cannot effect change in any moment other than the present one, so thinking about and certainly worrying about the future is in many ways both pointless and counterproductive. It only creates anxiety and ruins the present moment. By focusing in the present, you will get to the future faster than you think. When I run, if I focus on the fact that 90% of the distance lies ahead, I immediately feel tired and overwhelmed. When I simply take it one step at a time and enjoy the run, by the time I next think about my distance I’m that much further along and confident that I’ll get through it.

• Keep your “qi” (pronounced “chee”) about you. Qi is the circulating life energy that in Chinese philosophy is thought to be inherent and flowing in all things (it’s like “the force” in Star Wars). I think of qi as being a peacefulness, and being at one with the world around me. When I run, I feel more alive than at any other time. I am at one with the world around me. I am moving through the world and feel the world moving through me. Live in the current moment and allow yourself to experience all that you are experiencing. Be present in the present. Avoid thinking of what is wrong or what could go wrong. Instead focus on what is wonderful right now.

• Most of the physical and emotional discomforts that you will experience on your journey will come and go. Maybe not right away or even today. But most discomforts do not last forever. Just as many of the runner’s side-stitches and cramps work themselves through, so will yours.

• Avoid focusing on small and meaningless detail. Don’t weigh yourself incessantly and get down on yourself for every calorie. Do not become overly disappointed if you do not achieve these silly and arbitrary goals. The marathoner can choose to obsess about his slightly slow pace and tragically turn a remarkable event into an unbearable trek.

• Believe that you can “stand” some discomfort. Telling yourself “I can’t stand it” will lead you to not stand it. The marathoner perseveres through extraordinary physical and psychological challenges to reach the finish line. It is not an easy path. Your path too will be littered with obstacles. Trust in yourself and believe that you “can stand it” as well.

• Focus on the journey and the big picture. The transformation. The accomplishment of weight loss surgery is not in losing a certain amount of weight. It is about being able to make positive, meaningful change in your life that is now possible at this lower weight. Success isn’t achieved through a number on a scale; it’s by being able to live the life you’ve always dreamed of.

• Enjoy the run, not just crossing the finish line. In every moment of the race and in every moment of your journey
take a look around. Breathe in what is beautiful and enjoy each moment. Don’t live your life only in anticipation of crossing the finish line. When you have reached the finish line, I promise you that you will look back and think very fondly of the race you’ve run.

Dr. Huberman is a Clinical Psychologist with a practice in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New Book Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.

For more information, visit warrenhuberman.com.

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