Episode 52: Breaking Down Misconceptions about Bariatric Surgery with Jamie Mills
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Participant #1:
Hello everybody. Welcome back to another episode of The Upbeat Dietitians podcast. Today we are joined by special guest Jamie Mills. Jamie is a registered dietitian nutritionist who specializes in weight loss surgery and bariatric coaching. Jamie is not just a bariatric dietician but a weight loss surgery patient herself. In 2017, after years of struggling with her own weight, she finally decided to have the vertical sleeve gastrocomy and since then she has lost and maintained over £100. There are so many myths and misconceptions around weight loss surgery with many assuming it is somehow the easy way out or it's cheating. However, nothing could be further from the truth. In order to be successful after weight loss surgery, so many habits and lifestyle changes need to be made. Jamie helps women navigate post op life so that they can truly change their habits for the long haul and live their healthiest and happiest lives. So be sure to enjoy this episode. We're excited to share it with you. Hello everybody. Welcome back to another episode of The Upbeat Dietitians. Hello everyone. Today we are joined by another very exciting guest, Jamie Mills. Now specialty bariatric dietitian on the pot. We've never had anyone on to discuss bariatric surgery or really anything about it, so we are so excited for today's episode. Jamie, thank you so much for joining us. Thank you so much for inviting me. I'm absolutely honored to be your first guest speaker to talk about bariatric surgery. That's all of what I do. So really excited. We are too perfect, but we like starting it right off out of the gate. We like hearing kind of about what your day in the life looks like, kind of tell us a little bit about what you like to do for fun, your previous education. Just kind of just share whatever you like about yourself. Sure. So again, my name is Jamie. I'm the sweet dietitian on Instagram and I specialize in bariatric surgery. I feel like I have a little bit of a unique story. So I guess I'll start by sharing that. I'm a registered dietitian. I went to school to be a dietitian. I graduated and passed my Rd exam in 2018 and I also had bariatric surgery. So my Instagram handle the sleeve dietitian. A lot of people think it's referring to my sleeve of tattoos, but that is not actually it. It's referring to my gastric sleeve surgery that I had in 2017. So I struggled with my weight my entire life. I was diagnosed with PCOS which is polycystic ovarian syndrome, when I was 14 and in high school I was somewhere between 270 and £290, give or take. And I just struggled a lot. My own struggles with my weight and health is what inspired me to go to school to be a dietitian. A lot of people think I became a dietitian after I had my weight loss surgery. But that's not quite true. I was in my Dietetic internship year, the year I decided to have weight loss surgery. So you know what? In typical dietitian style, let's just take on all the hard things at once. Why not? Hardest year of my life might as well add a major life changing surgery to that. But it was through all of my struggles with my own health and my own nutrition that I realized, like, okay, I've done everything within my capacity to try and get healthy and to try and lose weight and to manage my PCOS symptoms and to the point where I'd even gone to school and had my degree in nutrition. It's like, not that I didn't know what to do. I wasn't working hard enough to try and achieve my goals. I just really, truly needed something else. So it was a really hard decision for me to make because there's a lot of stigma around bariatric surgery, which we can talk about. It felt almost at the time, like, shameful. Like, gosh, here I am, I'm supposed to be helping other people get healthy in the hospital, doing my consulting, going to educate people on weight loss, and here I am struggling myself. So it was a really hard internal decision, but it was the best decision I could have made. So in December of 2017, I had two weeks off for winter break from my Dietetic internship. And I timed it just right. That's when I had my surgery to recover. And in 2018, I think it was June or July. I passed my Rod exam, so I was about six months give or take out from weight loss surgery when I passed the Rd exam. And I went right into working a full time clinical job. I was a full time dietician at a long term care facility in their rehab unit. And this whole time, I had been very active on Instagram for my own personal benefit. I hadn't really shared that I had weight loss. I'm sorry that I was a dietitian. I'm just there for the purpose of gaining support throughout my own weight loss surgery journey because it felt very isolating. It felt very alone. I felt like I didn't understand, like, anyone else had gone through it. So I was really in the bariatric space on Instagram, just for my own personal connections and meeting people and making friends and gaining the support that I really, personally needed. And I always knew I wanted to coach people one on one and help people with their habits. And I started to share on Instagram like, hey, I'm actually a dietitian. Like, yeah, I had weight loss surgery, but I have these credentials. And a lot of people were like, oh, my goodness. Can you help me or. Oh, wow, you've been through this too, you understand. I felt like a different type of connection with the people who were looking for the help that I could offer. So in 2019, I got my LLC and I started doing my own nutrition coaching. And now that's what I do full time as I help other women, both pre and post up from weight loss surgery, kind of go through the process and most importantly, understand the habits. There's a huge misconception that you have weight loss surgery because you're taking some kind of easy way out or it's this weird, like, cheated system and you just magically lose all your weight and everything's fine and that it could not be further from the truth. There's so many habits that need to be made and changed. So that's what I help other people do now. That is such an amazing story. Okay, I'll try to clarify. I work in Bariatrics currently, and patients ask me all the time, how can you understand? You've never had to struggle with this. And to their point, they're totally right. So I can only imagine how that is just such a great connection you can make with clients when they know that you've been through it yourself. And you can, like, at a very deep level, understand what they're going through more than someone like me who knows the education. I have, the Rd credentials, and I have been going through a couple of years to kind of learn about bariatric surgery, but I've never had it. And so I don't quite know the nitty gritty that perhaps you can probably provide your patients and clients. It's just so cool. I think also, yeah, I get it because I've been at the receiving end of that patient here. So I see things from both points of view. Like, I understand the education that needs to be given from the dietitian perspective, but I also know how it feels to be on that receiving end of it. And you do not have to go through this process to be an amazing bariatric dietician to give so much support and understanding. But there is something to be said for actually knowing what it's like. I know there's a lot of shame around it because you feel like you should be able to lose weight on your own or you feel like you should be able to get a handle on it. And whether you are actually being judged or not is like a case by case basis. But as someone who is living with such extreme obesity, you feel judged regardless. So even if you have the most supportive dietitian in the world sitting across the table from her telling you, hey, you can't eat anything other than a quarter cup of protein for the next year. It's hard. I will say. I think along with understanding and the empathy that I have been there. Do you have this extra element of tough love that I think really resonates or I'm like, listen, I know it's hard. I get it. I've been there, but we got to do it. And this is why. So I think my tough love that I give is sometimes a bit better received because they're like, okay, Jamie, Touche, you did this too. All right. I feel like with that population, what I've seen, tough love is often really well received. That's the right word. Really well received. And a lot of people that get surgery. So I think that's another awesome trait that I'm sure they appreciate very much for sure. And I always tell my clients, like, listen, I want you to feel as comfortable as possible with me. There is nothing you could say to me or tell me that you do or you eat or you have habit wise that I have not seen or done myself. There's nothing you could share with me that would horrify me. So let's just lay it all on the table so that we can start to figure out what we need to tackle. And that's usually how I open up. I'm like, listen, there is no need to hide anything. Like, if you struggle with something, I want to know about it so I can help you with it. I think it's also so cool because I know that at least a lot of the patients I see, I don't work with weight management, but I've seen, like, individuals that they've had the surgery and then they didn't really have a high level of support after they didn't really have a direction to kind of go in. So it's kind of like it felt very much almost like a quick fix or it was like they weren't really provided with lots of support before they had the surgery, and then they didn't really know what to do after 100% honestly, I think that's the reason right there that I am in business and do what I do because I do provide support preop. I don't do the typical counseling. So when you have weight loss surgery, at least in the United States, especially if you're going through insurance, there's usually an approval process. There's usually somewhere between three to six plus months of preoperative counseling where you have I know for my preoperative counseling, I had to go through 27 different appointments. Between seeing the surgeon, getting blood work, going to psychologist, going to my Cardiology appointment, getting my EKG, my endoscopy, I had six consecutive months with my dietician, which they tried to waive for me because they're like this girl, there's no knowledge deficit here. But the insurance company didn't care. They're like, no, if you're going to meet with your dietitian too, which I did happily, and she was amazing. So it's a long preoperative process. You have to check a lot of boxes. You have to make sure that you really understand the postop diet, not just for the purpose of the weight loss you're hoping to achieve, but for the true medical potential consequences that would come along with you not following it, whether that's risk for malnutrition if you're not hitting your protein needs or taking your vitamins or potentially hurting yourself, if you're not following the food stages, like the soft foods, it's very intense. But what happens is you get approved for surgery. You're like, Yay, I get to have my surgery, you get your surgery date. Usually at the surgical center, you have some kind of binder or pamphlet of all the education they've given you. You have your surgery. And then it's like, okay, we have your stomach now, good luck. And it doesn't mean to be that way. And I don't even fault like the surgical centers for that. It's just the way the system is, where it's like, okay, well, you've been through this counseling and how's your surgery? You have your instructions now. We'll see you at three months, we'll see you at six months, and we'll see you at a year. And every year we'll just keep doing blood work. But the missing piece of this, in my opinion, is the support. And I always say it to my clients and my audience, and I'm here to try and provide you the support that I did not have. I found myself just fumbling through Instagram to try and make connections and find people who are going through it because I felt so misunderstood and alone. And there's this huge emotional struggle that comes with weight loss surgery because there's almost like a grieving process. It sounds silly, but like you're grieving food or at least the way you used to eat it because not everyone but a lot of people who have weight loss, or do you struggle with emotional eating or coping with food, you take that all away. How do you cope? How do you find new habits? How do you even begin to implement new habits? And I remember thinking like, gosh, I am a registered dietitian. I've been to school for this, and I am still struggling so much with finding the support and accountability to hit my goals. How in the heck do people who don't have this education even understand the diet? How do people who don't have this background really grasp the importance of vitamins and why we need to take them? Because I truly believe that a big piece of this is not just the support and the accountability and some of the emotional support. That's huge too. But oftentimes I feel like as bariatric patients and I don't know what your take is on this because you are a bariatric dietician, but I feel like the nutrition education is kind of baseline. It's like, here's the diet, here's what you have to follow. And a lot of times patients also receive that as just kind of being told what to do and not why. And I'm a huge advocate for mine to make really conscious, empowered choices for ourselves on this journey where we're changing habits, you have to understand the nutrition education. It's huge. And we are very smart people and women going through the surgery. I think that really in depth nutrition education should be given and often isn't it's like, you can't have that. Okay, well, why I think the why we have to change things is the other missing piece, because it's really hard to make choices that feel good for yourself if you don't even know why you're making them. So that's another piece of what I'm really a strong advocate for is like, let's give people really great nutrition education so that when they're presented with a choice, they feel confident in the one that they're making for themselves. And that's how we start to rebuild the whole habits. Yes, you're so right, because some of the guidelines are seemingly very random. Like, okay, no carbonation. But like you said, why? What's the purpose behind that? And is that even true for everybody? Maybe not. It kind of just depends. Like you said, we have your stomach. Good luck. Just go eat less. It's so much more intense than that. There's so much fear as a bariatric patient, like, oh, my God, am I going to fail? I failed at every diet before, or am I going to mess this up? There's a huge misconception of I'm going to stretch my pouch out and ruin it, which is actually very challenging to do. It's not as common as people assume, but sometimes you just need some reassurance. Like, yeah, girl, you're doing a great job, because if you don't have any sort of feedback, it's like, well, is this right? I don't know. And it's not even just learning new habits. It's relearning your body whether you've had gastric bypass or the vertical sleep gastrectomy. And I can get into, like, all the different surgeries if you want me to. But it doesn't really matter exactly which surgical procedure you've had. You're relearning hunger and full signals. And for so many people who have been through bariatric surgery, hunger and full signals are so greatly skewed before you feel very out of touch with that. So suddenly your anatomy has changed, which does have psychological impacts and emotional impact. Also very realistically. Like, OK, is this what Full feels like? Is that enough food? Is that too much? It's very overwhelming. And again, there's just a lot of myths and stigmas around surgery that I think exacerbate that fear and anxiety. Yeah, 100%. Well, I like how you brought up the different types. Let's get more into, like, what the heck the surgery actually is for listeners who are clicking but don't actually know and just heard our whole spiel about why it's this, that and the other. So, Jamie, tell us what bariatric surgery is, who can benefit and how to find out if it's a good fit for anyone who's listening. So there are multiple different types of bariatric surgeries. And even as I sit here and listen to them, I'm sure I'll miss a couple. So if you're listening to this and I missed your surgery, please don't take offense. There's a lot come a long way. So I have the vertical sleeve gastroctomy, which is the acronym is BSG, which with that surgical procedure, they remove 80% to 85% of your stomach. So you are left with only about 15% of your stomach. There's this misconception that it's not as permanent as gastric bypass, but it is. It is a very permanent procedure and it is as equally as invasive as the others. Gastric bypass is when they reroute your intestines, essentially, so that you are completely bypassing your stomach and they create a little pouch that's usually about the size of an egg. People with gastric bypass tend to have a little bit more restriction in terms of what they can eat. People with gastric bypass are also a bit more prone to dumping syndrome, which happens when you eat too much sugar or fat, not even too much. It's just depending on the person, it can affect you differently and can make you very sick. Myth right here. People who have other surgical procedures can also get dumping syndrome because I am one of the very lucky BSG patients who gets it quite often. So just saying, there are other procedures too. There's the duodenal switch, duodenal switches where they also do some rerouting and there's more malabsorption. A lot of people will have stage procedures where they might have a vertical sleeve gastrectomy first and then knowingly after they lose so much weight they might have the duadmil switch after to complete their weight loss. There's also a lap band. Lap band is not done quite as often. And this is the one that is, quote, like, less permanent because you can take the band out. They put like a foreign band around your stomach and they pump it with fluid. That creates this restriction. There are pretty high complications that I don't know of, too many surgical centers that opt to do that one anymore. And one of the newer ones is the gastric balloon, which is not permanent either. I think it goes in for about eight months. Please correct me if I'm wrong, but they put a balloon in your stomach and they inflate it, which also causes this restriction and limits portions as far as who can benefit from it. There's this huge misconception that you have to be five, six, £700 to have weight loss surgery. I do think some reality TV shows play into that, but so many more people can benefit from it than we realize. So in order to qualify for bariatric surgery, again, it's different from country to country. It's also different if you are having insurance paid for it or not. But in the United States, if insurance is paying for it, typically you have to have a BMI of 40 or higher or a BMI of 35 or higher with I think, at least two medical comorbidities. So comorbidities would be things like sleep apnea, high blood pressure, diabetes, other medical conditions that have been correlated or caused by your weight. It is based off of the BMI, but also the other factors as well. And it's interesting because I think we think we have to have such a huge BMI or be a certain way on the scale to qualify. And that's not true. Was there any other questions in there I forgot to answer? I feel like I'm rambling a little bit. No, it was perfect. It was perfect. Everything you're saying is kind of what I talk about every day, too, in my day job. Like the BMI requirements, the comorbidities, the different sizes, and actually to kind of give a more personal take, too, our surgeon only goes up to a certain BMI so he won't touch anyone with BMI over 60. So there are even some centers that have like a maximum BMI, too. And certain centers have different requirements. As far as, again, the whole concept and misconception that you just want an easy way out and this is like a cop out of some kind is not true. Usually if you're at such a high BMI, your surgical center does want to see you lose weight prior to make sure that your surgery is safer and to show that you can commit to following the plan in the diet. And that will look different from center to center. I know one of the things that they also do at most centers is they'll do right before surgery. So right before you're going to surgery, there's usually some kind of two week preop liquid diet. There's usually some variations. Some centers allow certain foods, some do not. My surgical center was three shakes a day and two cups of plain veggies for two weeks, which during my clinical internship year, that was really not fun. It gave me an extra layer of empathy for all of my patients who were on NPO and liquid diets. I was like, I feel for you. But I know at my weight loss surgery center if you had a BMI of 50 or higher, you had to do three weeks of the pre up diet as opposed to two. And the main reason that they want you to do this liquid diet for two weeks before surgery is to shrink your liver. So for anyone listening to your liver is where we store glycogen, which is like stored sugar or glucose, and we want to use up all of that energy, which is why you're on a very low carb, very low sugar liquid diet to use up those glycogen stores that you then shrink your liver. So for people who have BMI for 50 and higher, they need usually some extra time to ensure that they are shrinking their liver so that it is a safer procedure. For them. Yes, we do that at my center. We do a two week prep diet, and we do allow more solid foods. So we have, like, the three shakes we allow, I think, one or two proteins, like chicken, beef, whatever, veggies, and like a milk or yogurt serving too. But it's either way very restrictive. That's why it's only for two or three weeks, I will say. I think for myself, well, this whole journey has been hard. I can't say that, but one of the hardest parts of this journey was the pre op diet. It was the first time, I think it really hit me how much of an emotional eater I was, because a lot of the times on the diet, I wasn't particularly hungry again in my clinical rotations, I would get to the hospital at 536 in the morning. I'd be there super early, and I would have my protein shake in the morning. Then I'd have my protein shake at lunch and maybe like a cup of raw veggies or something. And then I would go home after 12 hours at the hospital, and I wasn't even hungry. I was just so tired and emotional. I just wanted to sit there with a meal and relax and eat my meals. And I was like, Damn it, I have another shake to look forward to. And there are many times I would come home and just cry because I was emotional. And that was the first start of really realizing how often I gravitated towards food for coping when I was emotional or stressed. And that was really hard for me. But I can look back and say I'm really grateful for it because had I not done the pre approved centers don't do it. I don't know how well I would have done. Immediately after surgery, immediately after surgery, at my Center, I was on liquids for three weeks. I had five full weeks on liquids. It was a really great time. I also had my surgery, like, four days before Christmas. It was December 19, and my birthday is January 10. So I was just cleared for purees. It was a really great couple of months. That was a good time. I was like, yeah,
Participant #1:
my now husband, we were dating at the time was very conscious of eating. I remember when he came to my house during that, and he ate his meal in the car before he came in, which is very considerate. But there was one day it was around Christmas time, and we were both sitting at the dinner table, and he had his meal, and I had my bowl of bone broth, and you could have a clear broth. And I just started crying. And he's like, what's wrong? I'm like, I'm just so sick of chicken broth. Like, I don't want to drink it anymore. It was emotionally taxing. I was not particularly hungry. Like I said, I had my protein and my shakes and my meals. It was just such an adjustment. But one of the things I say a lot to my audience and to the people who are in my programs is your pre and your postap diet. It's not a suggestion. You absolutely have to follow it for your safety. And I think that's the biggest piece, which is why I'm very grateful my center did the preop diet the way they did, because I don't know how immensely I would have been prepared for being on liquid once. It was absolutely crucial after surgery because of those risks. I'm learning so much. I do not know a lot about bariatric Besides undergrad. So this is very situational for me. We spent like two days probably learning about it in undergrad. This is my very first job out of College was becoming a weight management and bariatric dietitian. So I had to learn pretty much everything about pre off, post off, all that. We don't learn that in school very much. No. And I know you can cut this out if you want. I hope this isn't like taboo to bring up, but I think it's very well known at this point that the field of Dietetics is a little bit divided between, quote, weight loss or non weight loss dietitians. And I've had so many honestly, dietitians say very unkind things about what I do as a dietitian or tell me that weight loss surgery is barbaric and it's a terrible thing and nobody should do it. And it's all these complication rates and all I can think about when I hear those two things. There are two things, I think. One, you are very misinformed and are not understanding the research or the statistics that I can go over. But number two, the only thing I hear when another person, especially another person in the medical field, says those things to me is you didn't deserve a chance at a healthy life. You didn't deserve to have the life that you get now. And I know that's not actually true, but that's how I perceive it. And I know that's how other bariatric patients perceive it, because so many people don't have the support of their family, don't have the support of their friends, don't have a support system at all where they're told, well, if you just ate better and exercise, you'd lose weight. Why don't you just try harder? Have you tried dieting and exercise before? Those are honestly the most ignorant statements, because bariatric patients typically have exhausted every other option. And it's not for lack of trying or wanting to try after going through so many failed attempts is usually the last resort. And honestly, I hate that. I hate that we have to use the gold standard for weight loss approaches in obesity as a last resort. Why are we using the most effective form of weight loss for those who struggle with obesity, which I think people forget that morbid obesity and obesity in itself is a very complex disease. And just like other diseases, it deserves the attention and treatment. And so why aren't we giving people with obesity the gold standard treatment more readily? Why are we making them jump through these Hoops and hurdles if we know that this can help? Because 98% of traditional dieting attempts fail? I think both of you probably heard that before. Traditional diet and exercise usually quote fails, or most people do not keep the weight off, whereas with weight loss surgery, statistically speaking, it doesn't really matter which weight loss surgery you have. But just collectively, statistically speaking, people will lose anywhere from 60% to 77% of their excess weight. And long term, beyond five years will keep off 50% to 60%. So there's always a ten to 17%, give or take, like rebound weight. And that's anticipated. But the fact that people keep off 50% to 60% of their excess weight, there's an 85% success rate within that. So 85% of people who have weight loss surgery are likely to keep most of their weight off long term. So, again, why are we telling people you should just have more willpower, you should just try harder. You should just do another diet. And when we have this amazing tool, that's the piece that I get very passionate about. I did not know those numbers. That is so interesting. I mean, I obviously know that it's a great tool to utilize, utilize it more insurance seems like covering it sometimes. It's also a whole other battle to fight. But that is a pretty jarring number that's that successful for most people. The other piece I always hear as well, it's so dangerous. And you always especially depending on what platform you're on, if you're on like a Facebook group or whatever, it's always, well, I know someone who gained all of their weight back and it didn't work or, oh, I know someone and they had such terrible complications. And I am not in any capacity minimizing people's complications because that is a very real potential consequence. However, you go through all of this presurgical evaluation so that you can make sure you're a good candidate and the benefits have to outweigh the risk factors. And statistically speaking, less than 4% of people who have weight loss surgery develop severe complications. The complication rate is very low in comparison to other surgeries. And I believe the mortality rate for those going through bariatric surgery is less than 2%. It's like one point I have it in here somewhere. It's like 1% of people, which again, not minimizing anyone who's been through a terrible experience. But that is so much lower than other surgeries. So the risk factors for bariatric surgery are so much lower than that of so many other surgeries. And it's proven to be so effective for treating obesity. I don't know why it's still seen as this bottom barrel, last resort option. Well, Jamie, I also want to talk a little bit about how like what you said about there being kind of like a split in the Dietetics world because I think you're totally right. And even I myself kind of struggle with this because I work from eight to five as a weight loss dietitian. And then from five to nine I work as an intuitive eating like anti diet dietitian. So I had my own little internal struggle with this and I know that it is very black and white and split down the middle. So I'd love to hear your thoughts on that split a little bit more. I think the split has gotten very heated and I don't think that that's necessary because I think where this comes from is when there are two different extremes because you can absolutely be anti diet, anti diet culture, anti fad diet, which I am with the exception. It is a bit confusing because there is such a strict postdoc diet for bariatric dietitians and that is for medical necessity. It does not mean that we can't have, quote, normal foods or meals. One of the things my dietician said to me when I was going through surgery is the goal of your weight loss. Surgery is not to eat as little as possible for as long as possible. The goal is to get back to normal health portions and have a normal healthful diet with all nutrients. The reason the diet is so restricted in the beginning is because most people for the first six months are eating somewhere between three and 4oz. For six months to a year, most people are eating like four to 6oz. And for a year plus, people can usually eat eight to 12oz, which comes out roughly to a cup to a cup and a half of food at a time life's long. But once you're at that point, you should be adding more food into that first few months. When your restriction is super tight, it needs to be protein. Not because carbs are bad, not because we're restricting it's, because we need to make sure we're getting enough protein to avoid malnutrition. And I realized that certain anti diet dietitians strongly are against this. However, we have to weigh the risks and the benefits. And I think this is my personal opinion and we can get into it and go back and forth if you want. But I think it's irresponsible as dietitian to not support our clients and the things that they desire and need to be healthy because especially when we're talking about Hayes movement and help at every size. That movement was never meant for people who had BMI is above 40. Right. So when you have someone with a 60 plus BMI and you tell them have some joyful movement in your day, well, when you're that heavy. And I know because I've been there getting out of bed doesn't feel good. So how are we supposed to find joy in movement? One of my friends that I made in the bariatric community who had surgery as well. She's been amazing. I think she was over £500 at one point. And when she started College, she had to drop out of College because one, they didn't have desks that she was able to fit in and she couldn't make it around campus or up the stairs. So when you have people who are dealing with such extreme morbid obesity to say, just find joyful movement, any food that tastes good and are satisfying to you. But it's such a foreign concept. And that's because when these movements were developed, people like us weren't taken into consideration, or at least not fully. So it's why that some of those concepts just don't apply or make as much sense. Now. Weight loss is not inherently bad. It doesn't necessarily mean that you are submitting to diet, culture or doing this horrible, restrictive thing. For so many of us, losing weight is such an incredible thing because I can tell you, I almost like, cry, like thinking about it, because I felt so restricted in my body for so long. I couldn't move in the way that I wanted to. And when I was about three months post up, I think I was down about £40 or so. I started running for the first time. So I'm going to start by jogging and I was actually able to do it after just like £40. And as I kept losing, I was able to run. And to me it felt like flying. I had never felt so free. Because when you go from getting out of breath and like sweating and winded, from taking five steps to being able to run for a mile, it's a whole new world opens up. And that's one of the things I have a lot of my clients focus on in the veryatrical community is the non skill victories. I try and say we have these weight loss goals. Obviously we're here because we want to lose weight. But what are the other things that would like? What's the why? What would mean the world to you? For me, I'm a Disney adult. I'm a huge Disney person. Like, that's who I am. I could show you my office. I've got hidden Nicki's everywhere. But for me, like, going to Disney World is the biggest win of my life. I can fit on an airplane. I don't need a seatbelt extender. I can walk down to the center aisle of the airplane and not be bumping into people. I can make it through the airport, lugging my suitcase. I can walk in Disney World all day long and not get out of breath or have my knees hurt or have to stop. I can go to Disney and enjoy the foods that I love but not feel like that's the only focus. I can fit on the rides. I can go to the merchandise shop and get a sweatshirt and find one that fits. And these are the simple joys in life that people who struggle with obesity don't get to have. And I think it's invalidating to tell them that they shouldn't lose weight. We shouldn't do it in a restrictive, really unhealthy way. We should probably do it in a really mindful, realistic way for sure. And we shouldn't be excluding food groups long term. And absolutely, we should be adding food back in and working to have balanced plates and work through those potential trigger foods and all of that, like all of it. But it's not one or the other to me because I think it's absolutely possible to have an intuitive, really healthy approach to this but still have weight loss goals. And I think both can be okay. And I feel like our field of Dietetics just keeps going to bat with this, and I don't understand why it has to be one or the other. And again, I don't claim to be an intuitive eating dietitian. One of the terms I use with my community and in my program, instead of intuitive eating, is I use the term intentional eating. And that seems to really resonate with the women I work with because again, you're relearning these hunger cues. There's nothing really intuitive about having your stomach removed and having to relearn these things. It feels very unnatural. But I try and tell everyone, let's eat with intention. Okay, you're hungry. Let's honor that. If you are hungry, I want you to eat. I don't care if you ate 45 minutes ago. If you're hungry again, it means you need to eat. So let's take a plate. Like, one of my rules is whatever you have, put it on a plate so you're being aware of it. Make sure that we're not mindlessly grading. Make sure that you're maximizing your eating experience and having food that you love. Knowing that we have special needs as a bariatric population, we need to hit our protein. Let's make half of our plate protein. Again, the meal plate like method within the bearish community is a little bit different because we need that focus on protein. But let's have protein. Okay, you got your protein. Let's add something with fiber, like a fruit or a veggie. Okay, you had your protein and you were able to eat your fruit or veggie. Let's add a little bit of starch or carb on there too. Let's sit there and take our time with our meal. Let's enjoy it. I like to tell my clients, be a little bougie with your meals. Be a little picky, like what would be like fancy and delicious? And how do you want to play it it and make it like a whole experience. And I tell them, you should enjoy eating. It's okay to enjoy eating. You should enjoy eating. It's going to be a part of our life forever. How can we make it work long term? And this is where I think the principles of some of the principles of intuitive eating do come into play after surgery. It's not like, oh, well, we're just on this strict diet and can never have anything again. That's what I try and get through to my clients too, is the postop diet is there for a reason and it's out of medical necessity. But over time, you should slowly be added. And that's what I hope people do is slowly add things back in. We're not here to do Keto, we're not here to be on this restrictive, teeny, tiny portion diet forever. You should be able to have a plate of food and enjoy it and move on with your day and not obsess over it. So that's where I think the concepts from both worlds can come together. And I think it's when the conversation turns to not anti diet, but anti weight loss is where I just don't agree with it. And that's why, yes, that was a very refreshing perspective, because you're so right. It's like weight loss is good or weight loss is bad, and no one ever wants to talk about that middle part where it's dependent on the patient or the client. That's what matters the most. If they maybe would feel their best and be their healthiest self. With weight loss, we want to do it in the best way we can, of course, but if that's their goal, we need to support them in that and do it in the right way. And one of the things I'm a really big advocate for and I talk about a lot is especially after weight loss surgery, your lowest weight is not always your best weight. Usually statistically what happened and I kind of went over the numbers before. We lose most of our weight and then gain a little bit back. It's normal and anticipated. If you look at trends and graph charts of people losing weight, usually it's like, you'll lose, you'll lose, you'll lose. We'll rebound a little bit, which people tend to panic about, but that's okay. Usually if you're gaining a little bit, you need to gain a little bit and then we kind of level off. And with that, like for myself, I am about 15 to £17 up from my lowest weight. But guess what? I do CrossFit four days a week and I lift really heavy things and I go for runs and I built up this, like, body composition and building like muscle mass and I feel so much healthier than I ever have in my whole life. So that's also what I try and get through to the very after community. Is it's not just about losing as much weight as possible or being as skinny as possible or any of those concepts? How can we be as healthy and what does that look like for us? And that's going to look different for every single person. And as dietitians, I think it's irresponsible to put our own agenda or viewpoints on what people should or shouldn't be doing. I feel like as a dietitian it's my responsibility. If someone comes to me with a goal or a concern or wanting to do something, it's my job to present the evidence. Like, okay, if you do whatever it is you're going to do, these are the pros, these are the cons. How am I going to best support you and what's going to work for you versus saying, well, because I've had so many people come to me and say like, yeah, I was working with a dietitian and she doesn't support weight loss. So I can't see her anymore or I've been working with my dietitian, I'm healing my relationship with food and probably more of an intuitive eating dietitian. And I told her I'm going to have weight loss surgery and she won't let me see her anymore because she disagrees with it. And I totally understand if that's outside of your wheelhouse and you don't feel comfortable. But I've had people say like, yeah, my dietitian was really mad at me. I've had people say my therapist was really mad at me. And that's where I feel like dieticians and therapists alike should be figuring out how to support these people versus further shaming them for trying to get what I already explained is the gold standard for treating obesity. So again, I feel like I'm kind of in this middle ground and again, I see so many different aspects because of my profession and because of obviously my biased opinions, because of my personal experience with it. I feel like I'm struggling a lot with that too is finding the middle ground because for one aspect I have in the past, during my internship and other Dietetic experiences, I've worked with patients for weight loss and it felt very
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comorbidity side of it where for their health to reduce risk of other diseases and whatnot and also just from quality of life standpoint weight loss else was a goal for them and that was very easy. I don't want to say it was easy, but it was much more I guess it was easier to work with them because we knew kind of that goal straightforward. But then I have worked with a lot of weight loss just generally where it doesn't feel like that's where the diet culture starts playing with my head and I see in their head where it's like not a health related weight loss goal. I want to look the beauty standard and that's where it starts messing with my mind a little bit because everyone they can do whatever they want with their body. But I feel like that's when I guess I struggle the most is when there's almost more so the fixation on kind of how you look rather than like nonskill victories or just like why we're kind of doing what we're doing overall. It's a weird place to be and I don't know, I think there's also and I guess like to even challenge that. You have to answer this, but is it bad to have like vanity goals alongside your weight loss? And again, I think that's a case by case basis. Obviously, as dietitians, if we have someone who is of normal weight, healthy weight, and they are obsessed with being skinny or to be a size two, then we want to screen for some disordered eating behaviors and make sure that that's not coming into play. Again,
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I technically didn't have comorbidities when I was getting approved. I had PCOS, but I didn't have high blood otherwise. I was relatively healthy, I didn't have high blood pressure, I wasn't prediabetic, I didn't have sleep apnea. So technically, if I was healthy otherwise, would it be bad that at £275 and I wanted to lose weight to feel better and look better? And I guess as dieticians is our place to even tell someone that they should or shouldn't do that. And I like to encourage people if they're going to make healthy changes because they want to lose some weight. I always try and get them to make their goals from a place of abundance versus scarcity. So okay, you really want to lose weight, you feel like you would feel your best losing weight. You want to accomplish this for XYZ? We're not going to focus on what we're not eating, we're not going to focus on cutting calories. We're not going to focus on I don't have any of my clients count calories. For the record, even my very active patients, I don't think that that's helpful for anyone. What are we going to add to our plates? Are we going to add protein? Are we going to add veggies? Are we going to add fruits? Are we going to add more fiber? Are we going to add a snack during the day so we're not grazing or binging at night and really focus on the habits piece of it. And if they feel better doing that and losing weight, is that a bad thing too? And this is where I think it really is a case by case point. And I don't feel like as dietitians we should tell someone what they should or shouldn't desire for their bodies. If they come to us in there doing something that is hurting their bodies, or if losing weight is going to hurt them, then absolutely that is our responsibility to say. I don't think that this is a good approach for you, but if someone is overweight or obese and wants to lose weight and is looking for our guidance, here's the other thing. We all know there are hundreds and thousands of health coaches and nutritionists online selling all sorts of garbage information that is hurting people. I would so much rather people come to dietitian if they want to lose weight so we can help them do it in the most helpful and sustainable way possible versus shaming them for even wanting it. And then they go to some Joe Schmo who is giving them macro plans. That's really my thought. We are the most credible people to be supporting people in that. That doesn't mean that I never tell anyone you need to lose weight. Even my bariatric patients, I always ask them, what is your goal? The other thing I do with my clients is obviously most of them are coming to me for help either with weight loss within the first year or even regain. And in our first session, I tell them, Listen, you shared your weight loss goals with me. I know you have weight loss goals from here on out. I'm not asking you what your weight is. I will never and never have I ever asked my client on a call, what was your way in this week? Send me your weight log. What do you weigh? I don't do it. I tell them, we're going to take this number. We're going to kind of put it into the universe that you're trying to lose weight. But we cannot make the scale move. We have no control over that. What we do have control over is our habits, what we do and how we feel. So in my programs, I focus very heavily on mindset. I make all of them Journal and do Affirmations, which they resent me for in the beginning and thank me for later. And then we focus on, okay, well, what is your goal this week? Are we adding a snap? Are we increasing our protein? Are we increasing our movement? What are we building upon? And then most times really improving habits and routines. We see some weight loss and then people usually feel better and are really happy with their routine. And that's how I base it. I never say, oh, well, you should have lost weight. I think there's almost this idea that weight loss dietitians do that. And that's not necessarily the case either. Me and my clients almost never, actually, I tell them, if you have a win, if you are really proud because you lost weight or you want to share it with me or you're struggling with a stall and you want to look at that more closely, bring it to me. But I put that ball in your court. If you want to talk about your weight, you are free to do that on our calls. But by no means am I going to sit here and interrogate you about your weight. That's kind of how I approach it in the clinic I work at too. Like I get their way, I put it in their chart. It's just part of the process. But I don't bring it up unless they say, oh, I noticed that I'm down X amount of pounds. I'm like, cool, what's been going well for you to kind of help you with that. But I don't say, oh, my gosh, you're up £2 from last month. What did you do wrong? You're so right about what you keep saying about how it's patient client centered. And it's case to case, too. Like Emily kind of said, if a client or patient comes and their weight loss goals are stemmed from disordered eating thoughts or previous eating disorder or whatever it might be, then yeah, maybe weight loss shouldn't be something we really prioritize other ways to kind of go around that, I think. But even if their goal is weight loss, it's about how you approach it. And like you said, too, I love how you pointed out also, there are plenty of people out there approaching it in the wrong way, health coaches, nutritionists, personal trainers. And I would much rather have these people who have weight loss goals be a dietitian too. And like I said, I guess I just firmly believe that we should be supporting people in the things they want to accomplish in the best way possible. Because I've had clients and I think also I very heavily rely on motivational interviewing. That's like the foundation of everything I do. So if someone comes to me, check out this happened. Like someone comes to me and says, I really want to do Keto or I really want to do Weight Watchers. I get that a lot. Even after weight loss surge, I'm like, okay, well, why do you want to do it? And then they ask me my thoughts and I give them the pros and the cons and I let them choose. And more often than not, they choose the better choice, which is probably not to do the diet, but we have to give them the education and the choice because I think when you're just told what to or not to do, it limits your ability to feel empowered in your habits and in your health going forward. That's why I'm never going to tell someone like, no, you should never do that. Do I support that? Not particularly. But if my client came to me and was like, Jamie, I'm doing this, I'm 100% doing this. And this is why I would give them the pros and cons. And if they're like, no, I don't care what you have to say, I'm going to do this anyway. Square had this happen before I was, okay, let's do it. And usually it's a check in or two after a couple of weeks. And they're like, you're right, I probably shouldn't have done this. And I'm like, okay, let's go back to what we were doing then, because I think at a certain point, it takes people time to change the person, to dismantle the diet culture that has been imposed on them, especially in the population I work with. Because most people I work with, like myself, I was over £200 when I was nine years old. I struggled with morbid obesity from a very young age. So I had been put on every diet. I had been told, like anytime I lost weight, it was praised, even if it was in an unhealthy way. So I think so many people are used to that. It's almost like they don't care how they get there. So it's our democraticians to start to get them to care how they get to that process. And I try and tell everyone, you have to fall in love with the journey, because no number on the scale is going to make you happy. It might seem glamorous at first, but trust me when I say you need to fall in love with your day to day routines and trusting the process and the journey itself, because if you're just looking for happiness, once you hit a number, you're never going to get there. And it's going to be horribly disappointing. Let's start to fall in love with your morning routine. Let's fall in love with you making these meals that you like. Let's fall in love with the things that bring you joy, but you will continue to do it regardless of if the scale moves or not. I like that. I like that a lot. I try to take that approach, too. The scale is one thing. Yeah. We'll watch it, see how it's going. But there's so much more to your health than just that one piece of the puzzle. Absolutely. Well, we had a list of myths we really want you to cover, and you did a wonderful job kind of going over most of them. I think the only one that we didn't get too much into it, I guess, actually, we kind of just did a little bit. But one big myth that people often either hear me say is that bariatric surgery is a cosmetic procedure, and I want to go over that last R1 quick. What are your thoughts on that, miss? No, it's not a cosmetic procedure at all. Again, obesity is a disease, a complicated disease, and bariatric surgery is a surgery that treats that disease. Can it bring cosmetic I can't even say that, I guess. I mean, you lose weight, which does show in your appearance, for sure. But it's not a cosmetic surgery in and of itself.
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I can go over different statistics here about how it reduces your rate for diabetes and all of these things. It really, truly helps people improve their health and improve their quality of life, which cosmetic procedures really don't do. That debunked. Yeah. I think I really just like our general discussion about how it's like more of like almost the like what you're talking about with the preop postop diets. And whatnot if someone had celiac, maybe like on a gluten free diet? There are specific reasons for why the origins of keto, they were like those developed around more like Pediatrics with epilepsy. There's reasons why kind of these tools were developed. It's not just surface level. Right. And I know I had mentioned I didn't have diabetes, and I was generally pretty healthy going into my surgery, but I did have PCOS, which I was told from the time I was diagnosed at 14, again, I was over £200 the time I was nine. It was a struggle. I was told at 14 years old, you're probably not going to be able to have kids because of this. And it's true. People with PCOS struggle with infertility and the way I was and with the way my PCOS symptoms were, there was no way that was even possible for me. And one of the only things that really helps with PCOS specifically, or anyone who has different hormone imbalances, because again, obesity is a disease. It's not like it's this choice all the time that people are just lazy and not trying. There is usually a reason why we struggle to lose weight or why we have these issues. And with PCOS specifically, one of the only things that improves symptoms is weight loss. But how do you do that when your body is so strongly working against you? One of the things we didn't touch on and I could go on the whole rant, so cutting off if you need to. But one of the reasons bariatric surgery works as well as it does is it's not just restricting your portions. This is a piece people forget. I almost forgot to mention it. It is a true metabolic surgery because it truly changes your hormonal makeup. Whether you've had your stomach bypass or removed, ghrelin, which is the hunger hormone, is removed. And with that hormone being removed, there's kind of like a cascade effect of other hormones that start to function differently, especially if you struggle with insulin resistance, your hormonal makeup changes, which is why people who have tried their whole life to lose weight and even people who had done small portions or low calorie diets haven't lost before and are now suddenly losing weight. And it's like their hormones are becoming improved and more hormone levels improved. My monograph to my endocrinologist, all my hormones are in normal ranges now. And hopefully theoretically, once the time comes, like I'll be able to have kids now and before I couldn't. And this is again why I'm so passionate about this. Because when I hear that people say that one, weight loss is bad or two, you shouldn't be losing weight or that bariatric surgery is barbaric personally, because it has such a personal tie to me, what I hear is I didn't deserve this life. I didn't deserve a chance to correct my PCOS or improve it so that I could have kids. I didn't deserve to be able to go for runs and feel free in my body. I didn't deserve to get to go to Disney and walk around all day and buy a sweatshirt at the shop. And I know that's not what people are saying. I know people don't realize that. But personally, that's how I feel when I hear people say that weight loss is better, that we shouldn't desire or want it because unless I feel very strongly. But unless you have been in that position of being severely obese to the point that you qualify for weight loss surgery, how can you tell someone that losing weight wouldn't be healthy for them? It was very healthy for me in so many ways. And the fact that now if I decide to start a family soon, I have that ability, at least I know I have a fighting chance is huge. Yeah. Again, case by case. And as I mentioned, the hormone changes, too. And that, again, proves the point that it's not just cosmetic that wouldn't affect your hormones if it was
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complicated. Again, it's kind of a taboo topic to make people uncomfortable. I'm a very strong and I would never just tell people, oh, yeah, go have surgery. It's a huge life change. A huge lifestyle change comes with a lot of responsibility and relearning things. But if you feel like you're ready for that, like you could use the tool. I just want more people to know and be aware of what the surgery is and how it could potentially help them. So they can go talk to their doctor, they can go talk to their dietitian about it to see if it's an option. Yes. A tool in the toolbox is what I always tell them. Absolutely. That is about all we have to say on this topic. Jamie, if you could really just sum it up or provide any final topics or any thoughts on this topic, that would be wonderful. Well, I'm just really grateful that you had me on. So thank you again for having me. Like I said, bariatric surgery is not going to solve all of your problems. It doesn't mean that you wake up one day and are suddenly happy because you lost weight. It takes a lot of hard work. It's not this cheating. The system easy way out. You still have to put the work day in and day out and work on your mental hurdles and coping mechanisms and finding new routines. But if you think that you could benefit from it, I want to be that resource. That's why I have all the on my page and I talk about it. And I'm such a strong advocate for it in my day to day life. And honestly, I tell everyone I know or meet like, oh, yeah, I had weight loss surgery. So I'm trying to normalize it. I want it to be this more normalized and just think that's accepted by society versus this shameful thing we keep in the dark. Yeah. And we so appreciate you sharing perspective, because I personally, myself, get kind of bogged down in the anti weight loss space sometimes. And it's so important to have both perspectives and be open minded when it comes to client care. Like, you just keep saying this whole episode that's what matters most is the client or the patient. Yes. And you can absolutely apply anti diet and intuitive eating principles to bariatric lifestyles. They're not mutually exclusive from one another. Yes, exactly. Not black and white. Well, we like to wrap up our episodes with guests and with ourselves, too, actually, but with a bonus question. Kind of a little mental relief from sometimes some heavy conversations that we have with people. So today's bonus question, we let our guest go. First, Jamie, is what is the best PB and J combo? And by that, I kind of mean like chunky or smooth peanut butter? What kind of bread? What kind of jelly? What's your ideal PB and J? Okay, I have to admit, I kind of agonized over this question when I first read it. This is a really hard choice. I really love peanut butter and jelly. Traditional white bread with smooth Skippy peanut butter and grape jelly for me. Classic. So good. Emily, what are your thoughts? So good. I feel like I like chunky peanut butter just because I like the crunch. But from a bread perspective, I am not picky. I've always eaten on, like, the whole wheat bread because that's all my parents had ever bought. So I feel like that's all I've ever known. I feel like I might be good on sourdough. I'm a big sourdough fan from a jelly perspective. Any Berry, you're a Berry jelly. Interesting,
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Jamie. Every episode I am, like, the worst. I'm making hard decisions like this. So I always just talked for 20 minutes about stupid stuff. So let me do that real quick. I also was raised in a home where you got the seedy, like wheat bread. But as an adult who makes her own food choices, I love me some PV and J on white bread, so I'm lucky on that one. I feel like I have to do my mom justice right now because she'd be like, But, Jamie, I always bought a dekiel bread. We've always had a deep yellow bread in the house. And for someone who grew up with more of an obesity, you wouldn't think that would be the case. But she always had such not only organic but really helpful products in the house. And we almost never had white bread, which is part of the thing. And I'm like, but like a good also protein. If you've never had this, you got to take rich crackers with peanut butter and put a little jelly on top for a snack. Ooh, that sounds really good. It's really good. That does sound good. You're welcome. I will add that the PB and J toasted, that's really good, too. Adds, like, a whole new layer of textures. Yes, absolutely. I might contradict myself. I think we did an episode before, we talked about our favorite peanut butter type preference back in the day, and I forget what I said, but I think I'm going to go with creamy in this day and age. For a PB and Janwich, my taste change like, every day. And then jelly. I'm going to have to go with like, a strawberry. Yeah, I know. I will eat any PD and J. It's given to me. So let's just make that clear. Yeah. So, Jamie, we always like ending the episode with giving you the space to share where listeners can find you and kind of this is your time to share. Like any social media accounts and websites, this is real. You can kind of promote whatever you want right now. So if you want to find me, I'm most active on my Instagram page. I do have a Tik Tok also that I'm trying to be better about posting on, but primarily I'm on Instagram. I'm the Sleeved dietitian. I also have a program that is listed on my Instagram page. I have a membership. It's called The Tribe. It's the Real Insights of Bariatric Eating. It's an acronym and it's a membership program. This is the primary service I offer. I still do take one on one clients, but most of my clients are in my membership program at this point, which is a combination of self paced videos and modules of all of my resources. My full approach to nutrition after weight loss surgery. And what's so great about this community that I've created is when it is that safe space for various patients to go to get the support and the guidance. And all of the women who helped me run this program have also had weight loss surgery and are credentialed as well. So we have personal trainers who had weight loss surgery, who do workout videos. We do guest experts every month. We do a new topic every month. And then every single month, we put out a calendar of different support groups. We have ten different support group leaders. We have a therapist, psychologist, a health coach, a postpartum Duala, all of whom have had weight loss surgery. And they helped me. We have two dietitians in there who had a weight loss surgery as well. And we all leave support groups every month. So every month we have anywhere from 20 to 30 live support groups, we assume so. If anyone is listening and needs more support on their bariatric journey, please don't hesitate to reach out. You can always yell me or email me. And I just hope that my page is always that resource in this community. That's so awesome. We will share links below to all those different things so you guys can find them. Well, thank you again, Jamie, so much for being on today. We love having you on talk about this. It's a very nuanced topic sometime. This is a good episode for our listeners. Thank you guys so much for listening and we will see you next week. Thank you. Bye. Thank you so much for tuning in on this episode of The Upbeat Dietitians with your host, Emily Crowe and Hannah Thompson. We appreciate you all so much for continuing to support US In order to support us and sustain the success of this podcast, please subscribe and leave a rating and review. If you'd like to provide us feedback for future episodes and guest stars, follow us on Instagram at the Upbeat Dietitians. Lastly, you can show us support by providing a monthly donation using the link at the end of our bio. Once again, thank you so much for listening today and stay tuned next Wednesday for a new episode. Until then, we hope you have a wonderful rest of your week.
