How To Make A New Year’s Resolution That Sticks

By: Danielle Houston, RDN, LD

Ask anyone in the United States–and possibly the world–and they will tell you that the month of January is associated with new beginnings and New Year’s resolutions. But when it comes to resolutions, there are things that are helpful as well as unhelpful. Additionally, people who have had bariatric surgery need to be even more cautious with their resolutions to ensure they have their eyes set on the RIGHT prize.

These are some of the most popular New Year’s resolutions:

• losing weight
• volunteering to help others
• quitting smoking
• getting more education
• getting a better job
• saving money
• decreasing stress
• taking a trip
• drinking less alcohol

From looking at these, you can see that these are broad, non-specific goals. So, at what point have you met your resolution if you just want to “save money”. If you save a $20 bill for a whole week, does this count?

The first tip for making attainable resolutions is to be specific! For example, if you want to eat healthier, consider making your resolution to “not eat fast food more than once per month” or to “decrease fried food consumption to one serving, once per week”. These types of specific goals are measurable so that you can be sure you are meeting it. If you find that you aren’t meeting your goal, reassess and change the goal to something more specific.

My second tip for making great resolutions is to make them reasonable and achievable. I know that many people like to set big goals because they feel this is motivating. However, a negative cycle often occurs when you don’t meet your goal and then become discouraged, leading to a depressing psychological pattern. Instead of making one big goal, break it down into smaller, specific pieces. For example, you may have a long-term goal to lose 50 pounds, but to make it reasonable and achievable, make your short-term goal 2-3 pounds per month.

A word of warning: a common trend with resolutions is to use the phrase “never”, such as: “I will never again eat fried food”. These types of resolutions are not reasonable because the only way to be successful in this goal is to stop doing something altogether. Again, you will likely fail in this resolution and then give up, or change completely, which is not what I want for my patients. Even when I teach patients about certain diets, I very rarely use the word “never” because it is human nature to immediately want what is forbidden. So don’t set yourself up for failure this way.

Given that people who have bariatric surgery are focusing on weight loss, let’s focus on appropriate resolutions for these specific patients. Your resolutions and goals will vary, depending on how far out of surgery you are. If you are less than six months out, you are likely still very focused on the scale. While there is nothing wrong with weighing yourself, I highly recommend also taking body measurements once/month. The scale is a tricky thing since our body weight can fluctuate quite a bit depending on hormones, muscle mass, fat mass and water retention. The tape measure, on the other hand, doesn’t lie as much. Measure:

• upper arm
• thigh
• hips
• waist
• chest

Document these measurements each month and you will be surprised to see how many inches you are losing. I have found that even if the scale doesn’t move, the tape measure often shows me the results of my hard work and keeps me motivated, while the scale alone is often discouraging.

For those patients that are more than six months out from surgery, I recommend making resolutions that bring you back to a healthy mindset. From working in this field, I have encountered many patients who have drifted away from healthy choices after losing a majority of their weight or when they are able to eat more normally. The New Year may be a good time to refocus yourself on making healthy choices to work along with your surgery. Examples may include: limiting high-fat and high-sugar foods, adding lean protein to your diet, or eliminating sugary drinks. It is important to remember that weight loss surgery is a tool and if you do not use it properly, you may not be successful. The goal of these surgeries is not just to remove excess weight, but also to help you lead a healthy lifestyle, which means making permanent changes in your diet and lifestyle.

Regardless of where you are in your post-surgical stage, there are two resolutions that should be on your daily list: exercise and vitamins. Cardiovascular exercise is important for all people, not only for weight loss, but also for heart and muscle health. If you are out of practice, set a goal to walk at 3 MPH for 30 minutes, 3-4 days per week. Once you meet this goal, increase your speed or number of days per week. Before you know it, you will be an exercise fool! If you are really motivated, add a goal to do weight training twice per week to help with muscle tone and bone health. Exercise should be part of every person’s everyday life and, if you make it part of your routine, you will find that you actually miss it if you stop going!

Now, let’s talk about vitamins. You should have been informed prior to surgery that there are certain vitamin supplements that need to be taken for the rest of your life. These should include multivitamin, calcium and B12 (depending on your needs, your doctor may have further recommendations). It is important that post-surgical patients do not stray from these supplements since many vitamin deficiencies can be life threatening. If needed, get yourself a pill box and add them to your other prescriptions to ensure you take them daily.

As a reminder, please remember that, regardless of having had weight loss surgery or just being overweight, losing weight does not HAVE to be on your resolution list. It may be more helpful to focus on a different area of your life to take the pressure off of your waist line or physical appearance. As a dietitian, I can tell you that resolutions regarding weight or body changes will not be on my list. This is not because I’m not working on this area of my life, but because I tell myself every day that I am striving to live a healthy lifestyle. This is not something that starts each January, it is something that is continually evolving and happening in my day-to-day life. So get out there and live a healthy life–you deserve it!

The Struggle is Real!

By Dr. Charlotte Hodges

The Obesity Action Collation (OAC) is a non-profit organization of nearly 60,000 members. Their mission is “to elevate and empower those affected by obesity through education, advocacy and support.” The core focus of the organization is to:

• raise awareness and improve access to the prevention and treatment of obesity
• provide evidence-based education on obesity and its treatments
• fight to eliminate weight bias and discrimination
• elevate the conversation of weight and its impact on health
• offer a community of support for the individual affected

The organization was formed in 2005 after the need for advocacy for patients affected with obesity arose in the legislature.
As a member of the American Society of Metabolic and Bariatric Surgery (ASMBS) and surgeon who works with insurance companies on a daily basis, I know first-hand the struggles that patients can have to access to care. I was very pleased to hear that OAC along with the AMA were able to bring a very strong voice to congress to affect change. I recently received an updated briefing about a reduction in pre-operative medical management for Cigna policy holders. As of January 1, Cigna policy holders no longer have a 90 day supervised diet. Prior to this policy change, a patient had to undergo a 90 day diet prior to a pre-authorization for bariatric surgery. As a clinician, I have not seen a difference in long term or short term outcomes between patients who have to undergo pre-operative diet/weight management programs versus those who do not. This is regardless of the time spent in these programs. Some insurance providers require a 6 month program up to a year. ASMBS has done much research in this area and agrees. They too have an official policy stating how this is seen as more of a barrier to entry rather than providing better outcomes. (Most programs require the patient to meet for a specific time over consecutive months. If you miss a month, the clock starts over. So, if you have a 90 day diet which you begin in September, you cannot even submit a request for prior authorization until December, after your last diet visit. And, if you miss month, FOR ANY REASON, the clocks starts over. The patient will have to wait until the next year for surgery. The deductible starts over, and they risk changes to their policy that could reduce or even remove bariatric coverage all together).

When I received the update for Cigna, I was overjoyed and excited to share the news with my patients! So, how do we work to increase bariatric coverage for all of our patients? It’s through advocacy. The OAC, Obesity Medicine Association (OBA), and ASMBS have been lobbying our local and state medical societies as well as the AMA on our patient’s behalf.
On June 12, 2018, the AMA accepted a policy drafted by the Obesity Medical Association, “Removing Barriers to Obesity Treatment.” The OMA was able to garner support for this measure from AMA Colorado delegation, the Minority Affairs Section, the American Association of Clinical Endocrinologists, American Society for Metabolic and Bariatric Surgery, the Endocrine Society, American College of Surgeons, and the American Gastroenterological Association. The statement reads, “AMA work with state and specialty societies to identify states in which physicians are restricted from providing the current standard of care with regards to obesity treatment… and that AMA actively lobby with state medical societies and other interested stakeholders to remove out-of-date restrictions at the state and federal level prohibiting healthcare providers from providing the current standard of care to patients affected by obesity.”

Additionally, National Lieutenant Governors Association (NLGA) passed a policy resolution during its June 27-29, 2018 Annual Meeting. The resolution, which was introduced by Lieutenant Governors Fairfax (D-VA), Gregg (R-IA), Nungesser (R-LA), Wyman (D-CT) and Zuckerman (D-VT) will help: reduce obesity stigma; establish statewide obesity councils and taskforces; support additional training for current and future healthcare professionals; and support access to obesity treatment options for state employees and in other publicly funded healthcare programs.

If you are struggling with your weight, a current or future bariatric patient, or have a family or friend in the bariatric community, I encourage you to join OAC. It is free to join, and I’m looking into how I can, as a provider, better support the work that they do.

Located on the OAC website, patients denied access can learn more about their insurance policy, contacting elected officials, working with their employer, and much more to help them improve access to obesity treatment! Learn more today by visiting www.obesityaction.org/access.

REFERENCES
1. https://www.obesityaction.org/our-purpose/about-us/story/
2. Medtronic Obesity & Metabolic Health Solutions Bulletin, January 2019