Finding Your Sweet Spot

Yesterday I read a sad post online. Tierney Marie, a girl whose weight loss surgery result is as beautiful as her name, wrote it. I feel like I know her even though we've never met. She lost 150 pounds in 14 months and wears a size 14 now. Her wide arrays of serious, pre-surgical, medical problems have all but disappeared and her health has never been better. Unhappily it isn't enough. Tierney Marie feels desperate to keep the pounds coming off. She wants to wear a size 8.

Two years ago Tierney Marie was afraid she might not live to see her daughter graduate from high school. The possibility of buying her clothes in the "regular department" was a fantasy akin to wining the lottery. Today a Tierney Marie dream is of being super slim and is prepared for extreme measures to meet her goal. Her weight loss has slowed to a creep, maybe even stopped, and her 'honeymoon' -that 12-18 month window of opportunity for losing weight after surgery- is clearly drawing to a close. Fear and anxiety are becoming constant companions and old compulsive eating behaviors are lurking once again. Her hunger has returned with force and tiny little portions no longer fill her up. Tierney is terrified! She is also at a critical point in her WLS recovery.

I wrote to Tierney Marie. I wanted to congratulate her on her fabulous weight loss. I also wanted to suggest that the expectations we have for weight loss surgery sometimes need to be re-examined as our 'honeymoon' phases draw to a close. After three years of coming to terms with my own surgery results, and 15 years of clinical practice in eating and weight disorders, I think one of the great secrets to WLS success has little to do with weight and everything to do with body image and self acceptance. The numbers on the scale aren't what's crucial, but what we think about them is. A certain amount of acceptance and knowing what is 'enough' is essential to recovery from weight loss surgery as it is to other recoveries related to eating behaviors. We need to develop acceptance about what is 'enough' to eat and acceptance about what is 'enough' to look like. It's a kind of personal 'sweet spot', a place where our weight levels out and stability is manageable with reasonable care. If we have established healthy eating and exercise plans by that point, and if we continue to follow them, (two big ifs) we may continue to lose a bit more over time. I'm not sure it is ever as much as many of us come to want. It is probably 'enough'.

Many of us are intoxicated by our own success and the extraordinary compliments we receive as the pounds melt away. Some of us rationalize that we are merely 'going for the gold' as our egos inflate like little hot air balloons and we grow ever more determined to join the ranks of the emaciated like Kate and Lara and Allie. It may seem like a perfect route to righteous revenge or an ideal angry pay back, but linking arms with the icons of our thin-obsessed culture won't erase the years of pain and humiliation that all morbidly obese people have endured. Even with surgical help a personal history characterized by compulsive overeating and morbid obesity doesn't argue very convincingly for a long run as Twiggy. Remember that those who refuse to learn from history are condemned to repeat it.

We all reach a place in the end where we must carefully define what 'enough' really is. That's how we find our balance. And that's how we find our 'sweet spot'. Often this insight comes at the moment when we feel most out of control, like the place where Tierney Marie is now. When terror has us in its grip, that's when we let go of cultural edicts and fantasy selves and shake hands, at last, with our own reality, our own biology. Accepting this reality means being fair and reasonable with our bodies and our expectations. Balancing can't happen unless we let it.

How well have we learned to nourish our new selves post honeymoon? How do we view and feel about our 'thinner' bodies? When and what is good enough? These data are more crucial than any numbers on the scale. Unless we make peace with what is 'enough' for us we will probably continue to battle food and weight long after our surgeries.

For those who keep a journal during their experience (and I highly recommend the practice!) it helps to go back at the end of the honeymoon and reread early entries about the reasons that prompted surgery in the first place. What were the most important goals? Have we achieved them? Tierney Marie needs to do this now.

Whatever formula you develop is yours alone and the ingredients for each 'sweet spot' are probably as individual as each of us. I agree with many nutritionists about increasing protein consumption during periods of frequent cravings or weight fluctuation, especially for those who have had distal surgeries, but less sugar, fewer carbs and more exercise are probably just as effective for most proximals. Following your personal 'sweet spot' formula must become as natural as breathing. Long-term maintenance depends on long term commitment. Handling rough patches requires a long list of dependable strategies. It also helps to remember that rough patches smooth out eventually.

I think each of us comes to a very 'sweet spot' after our weight loss surgery honeymoon. But we need to recognize it when we see it. This balancing phase of WLS is the most critical phase of recovery. It is where real success is determined. Not the surgeon's skill (although that's clearly important), not the rate of loss, not the clothes size achieved, or the compliments collected. True success is acquiring that lower healthy weight and the ability to maintain it. Sound familiar? It's like every diet we ever went on in the old days, right? No. Now we have our new small pouch to help us. It's our 'secret' weapon for knowing how much food is 'enough'.

Once you find your 'sweet spot', embrace it! Go with the grace and balance of that safe, stable, GOOD ENOUGH place for you. In my experience, people have a terrible time maintaining when they force their weight down below their 'sweet spots'. I suspect that kind of pushing may actually be one of the reasons for the oft' mentioned 'bounce'. You can't fool Mother Nature! Well, you can but it's costly!

Perfectionism sometimes stalks us all after this surgery. Most of us have never dreamed of so much success and I think we can be excused for getting carried away by it a bit at times...especially in the early stages. But if we don't come to grips with a reasonable place to land eventually, and learn to know what is 'enough', I think we are in trouble. We set ourselves up again for too much deprivation, too little self-satisfaction and the inevitable turbulence that results from trying to adapt to the storm instead of finding shelter and staying out of harm's way.

I wish Tierney Marie and all of us peaceful ports in the storm. And I hope we all recognize the shelter of our very own "sweet spots" when we find them.

Carol Signore, MAT, MS, LMFT. Ms. Signore is a therapist in Philadelphia with over 50% of her practice devoted to eating and weight disorders.