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The first tool every patient needs after surgery

Walk into a supermarket at this time of year and a loud voice is going to start chatting away inside your head.

Why? Because there are creamy eggs, tiny eggs, marshmallow eggs. Golden bunnies, hokey pokey, hazelnut.

There’s special chocolate at the end of every aisle, and shelf after shelf of hot cross carbohydrates.

You can feel the craving growing inside you. The voice in your head putting forward such a good case. It’s so persuasive, urgent. You’ve been ‘good’. It’s only once a year. The dark chocolate bunnies are a joy to the tastebuds. The family will feel bad if you don’t have something along with them. Why can’t you just enjoy the bloody chocolate and not be so different to everyone else?

The purpose of writing this isn’t to make you feel guilty, bad or ashamed about that voice or eating Easter chocolate. Having these thoughts as a response to wave after wave of carefully designed marketing campaigns is 100 per cent, totally normal. Almost everyone who walks around a supermarket at this time of year will find it impossible to ignore or at least not think about chocolate when it’s so in your face.

Why cravings are part of life, even after surgery

People who come to see me think having weight loss surgery will stop their cravings. For some, for a period of time, they do go away.

But the urge, the need, always returns. Patients believe their ‘bad habits’ are coming back and so they come to see me and hope I’ll help them stop feeling this way, or eating when faced with this type of barrage.

I wish I could wave a magic wand and do that for you. Sadly, there’s no magic wand, but there are tools you can learn that will help you immeasurably throughout the rest of your life when faced with that persuasive voice in your head or the automatic response where you find yourself eating and you don’t know how you got there.

These evidence-based tools include the practices of:

·       mindful awareness

·       gentle curiosity

·       compassion for self

With all the best intentions, with surgery, even weight loss drugs, you will always get urges, cravings, intense food desires. And even with these practices, you will still respond by eating at times. The goal is not that you’ll be perfect. Using these tools, it might be that instead of 10/10 times making a choice to eat, you only do it 4/10 times.

The more little moments of practice you do, the better you can get at responding consciously to cravings instead of reacting automatically.

The more you practice, the easier it gets because your brain starts to learn a new way of being, and that is the genesis of a different life.

What you need to know first

It’s crucial to understand that in the first 6-12 months after metabolic bariatric surgery of any kind (or when you take weight loss medications), your body’s physical feeling of hunger is turned off. Your brain is temporarily stopped from hearing the natural physiological signals that tell it to refuel.

That’s why we advise you to eat every 4-5 hours, because your body isn’t going to tell you. Four to five hours is about the natural time your body needs between meals, assuming you're eating a high protein, nutrient-dense portion. You eat, and then you have enough energy and nutrients to power yourself for the next four to five hours.

And yet, almost every metabolic bariatric patient I’ve met has told me there are times when they feel hungry – even right after surgery. Often, it’s really powerful urges to eat, and it’s almost always a craving for foods you see as ‘bad’.

One of my patients began to wonder if we’d not done the surgery, just put little cuts on her skin, so strong was her hunger in the days afterwards. It took her more than a week to realise it was cravings in her brain that she was so used to hearing and feeling that she thought it was what true hunger was.

This is psychological or ‘head’ hunger and there are three basic types:

  • Heart (emotional) hunger - you have a strong emotion followed by a powerful urge to eat. The foods that hit the spot are usually fatty, crunchy, sweet or doughy because your brain learned at a very young age that these give the biggest hit of dopamine which gives you a sense of well-being. These hits temporarily distract you from the emotion or emotions that have come up. Note, it can be caused by low feelings or happy ones like love and connection, for example when you have cake and sweets at a birthday party or a hamburger with friends on a night out.

  • Habit - this is often learned early on too. It’s why perhaps you ‘need’ coffee in the morning, something sweet at 3pm, or a snack at 10pm.

  • Environment- you’re in a place where there are overwhelming marketing messages specially designed to trigger your emotions.

The tool you need first is mindful awareness. A triggering environment such as a supermarket filled with Easter treats is the perfect place to start. However, what I'm about to explain works with all types of hunger.

Why Easter is a wonderful place to start

Ask people what Easter means to them and you’ll usually hear happy childhood memories. The gift of special chocolate, delivered by a cute bunny, just for you. The unwrapping of the foil, the oddly satisfying bite into a hollow bunny, a little bag of chocolate eggs hidden inside. There’s connection with your parents and siblings as you enjoy the sweetness of the chocolate, maybe the fun of an egg hunt with friends.

Marketers know this and they count on your emotions to influence whether you buy for yourself and your family.

I can’t emphasise enough the power of the environment created by marketers to influence people’s moods and subsequent choices. Food design (taste, texture, smell), packaging, and messaging is a multi-billion dollar industry. Its only goal is to manipulate you into buying their products, repeatedly.

And that you do is entirely understandable. This messaging affects everyone, whether you’ve lived in a bigger body or have never been overweight.

Having these thoughts and emotions and acting on them has nothing to do with your character or value as a human being. It doesn’t mean you’re a bad person.


Whether you do or don’t choose to buy chocolate this Easter, you can use the shopping experience as an opportunity to start learning the practice of awareness, the very first tool you need in your life after surgery.

Note I said practice. You may go through this exercise and choose not to buy chocolate, or you may buy and eat the chocolate. There’s no right or wrong, no judgement from me. Both experiences are incredibly useful in the learning process.

Firstly, as you wander around the supermarket, try to bring awareness to your thoughts. What is your brain saying to you? This is hard – your brain runs along at a million miles an hour, mostly on automatic. You’ve shopped every week of your adult life, so there’s a rhythm and long-formed habits, much of it trained into you by the supermarket environment.

You might believe you’re not thinking about much, but when you start to bring awareness to it, you’ll find it’s chattering away at you the whole time.

The goal is to try and have a short burst of a second or two of noticing what it’s saying. This tiny moment of awareness will create a little change in your brain’s normal pattern. It’s small but it’s value is gold.

Even better, if you can bring short bursts of awareness to your thoughts again and again each day when you’re doing anything, you slowly strengthen your awareness abilities.

For example, you may notice your voice saying ‘oh my god, I need coffee’ when you sit down at your desk in the morning or ‘yum, that smells so good’ when your colleague brings in a hot cheesy scone from a café.

By having that moment of moment of awareness, you’re slowing down your brain’s response to the trigger (seeing chocolate in the supermarket, sitting at your desk in the morning, smelling a hot scone). Every time it slows down, even for a second – literally one second – you give your thinking brain time to come online and make a choice as to how you respond.

That response might be to ask yourself ‘am I hungry?’ You can check in with your body (nope, no tummy grumbling) and remind yourself you ate breakfast an hour ago. ‘You might ask, ‘is eating/drinking this in line with my goals?’. It might be that it is. Or it might be you remind yourself you have a protein-filled meal ready to eat at your next meal and that you want to stick to your plan.

Without awareness, your brain will have an automatic, instant reaction in response to the urge for chocolate, coffee or scones. There's a deeply entrenched pathway that it heads down. Once you’re eating something delicious, especially something sweet or fatty, your body’s natural physiological response is to want more.

It’s important not to judge or get angry when you do notice the voice or craving for something. The dopamine caused by eating energy-dense food hits a very basic part of the survival mechanism of the human body – ‘remember this, get more’. Your brain was designed to do this through hundreds of thousands of years of evolution. For most of that time, food was scarce. The problem is now, food isn’t scarce and all the things that the brain regards as precious resources are all around us, 24-7. Your brain, your body is just doing its job.

However, you can train yourself to develop a new response by practicing little moments of awareness. Tiny moments now will pay bigger and bigger dividends over time.

You won’t be able to bring awareness to everything all the time - even the most devout Buddhists who dedicate decades to it can't do that. Your brain has been having instantaneous responses to triggers since the day you were born as a completely natural physiological process. 

The beauty of awareness is you can still practice it after an experience is over. Let's say you intend to practice awareness, forget while you're forging around the supermarket and only remember on the drive home or later that night. You can still practise awareness by remembering your experience later on.

Here's how it might work for you this Easter.

How it works

You decide you'll practice awareness. You get to the end of the third supermarket aisle and right ahead of you are shiny, golden-wrapped rabbits.

“Those bunnies taste so good. You’ve worked hard, you deserve a little treat. You can’t overdo it, it’s so small. And it has a bell!”

That’s a great moment of awareness if you can catch it. But if you miss it, you might notice instead the voice in your head start to rant as you look at those bunnies.

“It’s all downhill if you buy one, you’ll eat it, you know you won’t stop. You’ve just paid $25,000 for surgery – if mum/dad/husband/wife knew, they’d be so angry, you’re so disgusting, just wasting money and still being dumb.”

That critical voice in your head will always paint you as a bad, often immoral person in catastropic terms ('downhill', 'disgusting', 'dumb'). It believes it’s helping you by firing off these types of thoughts because that’s how you learned things as a small child. An authoritarian figure shamed you to control your behaviour, probably because they couldn’t cope with whatever was going on for them at the time, and you learned that's the way to talk to yourself if you're less than perfect.

The trouble is that the feeling of shame that this criticism incites in us is one of the most powerful and destructive emotions a human can have.

In response to that kind of criticism, most of us find an automatic downward spiral is triggered, where there are even stronger urges to soothe ourselves. The stronger the criticism, the more likely you are to go into an automatic response mode and have no chance to be aware, no moment for your thinking brain to catch up.

That’s how you might end up buying and eating that bunny on the way home, hiding the evidence so no-one knows, and then having a cascade of ever more critical and negative emotions, with no idea why you did this other than ‘I’m a bad person’.

Actually, what happened is you walked into an environment that counted on your emotional and physical response to buy and eat that product.

In the moment, or if it’s sometime afterwards, try to notice how quickly all of this happens. We’re talking tiny fractions of a second. Literally one moment, you’re in an aisle making high-protein, nutrient-dense ‘good’ food choices with a strong focus on your health. Ten metres later, and boom, there’s a stand of deliciousness, all shiny and pretty, and another opportunity for an urge to sound off.

Once this process repeats three or four times, most people are going to be strongly affected and will buy some chocolate. Notice how the Easter options are spread throughout the store, not just in one area. That’s very deliberate.

Bring awareness also to how the voice in your head is or was being viciously critical of you. Your perception is you’re wrong and bad for what's happening, but those things aren’t true. It’s just the voice in your head desperately trying to control things in the way it has since forever.

Imagine saying these critical thoughts out loud to a child or your best friend. How would you expect them to respond to something so devastating? Would they learn something? Would they be enlightened? Change their behaviour? No – they’re likely to feel shame and go down into sadness, depression and self-loathing. It’s unlikely they would take it as encouragement or a sign of your love. Neither do you.

 How does awareness really help?

This might seem like a stupid or ‘woo woo’ thing to practice. How can tiny moments of awareness change what you’ve been doing for 30, 40, 50 years?

There are libraries of scientific research that prove becoming more mindful – aware, then curious, then compassionate about your thoughts and emotions – is the best long-term way to help yourself learn how to love and nurture yourself, in all aspects of your life. Someone who truly cares about themselves is less inclined to be affected by their environment or strong emotional responses or habit. They won’t be perfect! However, they’re far more likely to consciously choose what they do and do the loving thing, such as choose not to eat, and recognise there's perhaps an emotion bubbling away about something else (perhaps stress at work, not enough sleep, an issue with your partner or children).

Becoming more aware is simple, but not easy. And you can’t get to the other two strategies that will help you long term – curiosity and compassion – without first learning how to practice awareness in these teeny, tiny steps.

My Masters of Nursing – the foundation of my work with metabolic bariatric patients – found that self-care is not innate. Truly caring yourself in a loving manner doesn’t’ just burst out of you once you lose weight. Some patients figure out self-care for themselves. Most people don’t. They end up in a spiral of unhappiness and don't know why, which can lead to weight gain, sadness, and depression. Their conclusion - they're the problem. They failed. 

Learning to love and care for yourself is a series of tiny steps, not something that magically happens.

Also, it's really important to know that while some of you may try this and find you can do it, a lot of people need help to get started. They might try this, it doesn’t work and they think ‘it’s me, I can't do this’. It’s not – you just might need a little help. It's like learning anything new. Remember learning to drive? Your brother picked it up in 30 minutes, you needed a couple of hours, your best friend needed intensive lessons. 

There are proven ways to learn the steps to self-care and it all starts with these tiny moments of awareness.

If you need guidance in getting started, Kate is available via Zoom for hour-long sessions – email admin@tiaki-whaiaro for appointment options


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