WLS is Like Baking a Cake

"Please help me!  I'm only 2 months out and I've ONLY lost 30 lbs."

I see these posts all the time on just about every board that I read.  A sense of panic that someone has not lost all their excess weight in a manner of minutes, hours and days.

*sigh*.  Big giant sigh!

You need to wrap your head around realistic expectations.  You did not gain 50, 100 or 150 lbs over night.  You will NOT lose it over night.  This takes time.  This takes the right ingredients.

WLS is like baking a cake.

When you decide to bake a cake, most of us just can't go into any cupboard, grab ingredients and within a matter of minutes, have a cake baked, done and frosted.   Weight loss (even with wls) takes time, balance and the RIGHT ingredients.

Before we decide to bake a cake,  most of us have to read and find the right recipe.   We might have to research a bit before something seems to be "just right" for us to make.  We have to find a recipe for success.   It may take lots of consultation, lots of reading, talking to experts until we find the right recipe for the occasion.

Then we have to go shopping for all the right ingredients.  We have to make sure that we have all the right food ingredients as well as pots, pans and utensils.  Measuring cups guarantee success.  Without that careful measurement, our cake may not rise or may be a total disaster.  Planning is key.

We might even take a "dry run" and practice that recipe before we actually make it for that special occasion.  We know that skills are not innate, they are practiced.  We might even find that the recipe needs a "little something" so we may consult others for advise.  We may talk to other baking experts about that one missing ingredient.  We may even tweak the recipe accordingly and find that our recipe is better than the original!

The day of the big event, we are prepared in all ways for the task ahead of us.  We know that a good cake will take some time.  We give ourselves plenty of time so that we can slow down and be exact with our measurements.  We know that being rushed won't help make the cake better.  It's about exact measurement and precision.  We don't just throw together ingredients.  That doesn't work.  It takes time.

Once we carefully measure, mix and pour, we wait.   We wait some more.  We wait some more.

Even the best cakes don't come out of the oven in 60 seconds.

That time waiting is precious.  It's exciting anticipation of what is to come.  We know that it will be totally worth the wait.  We know that the cake is worth waiting for.  Even though we have to wait, we don't question that we will have a cake when the process done.  We know that we've prepared the cake the way we need to.

We know that we are set up for success.  We added all the right ingredients.  We know that we have had good practice.  We know that we have all the ingredients and all the right tools.  We know that in 40 minutes our cake will be done and it will be a success because we've set it up that way. 

And even, when you take your cake out of the oven, there is more time to wait before you can frost it.  Patience is required.   It will take time, more time and even more.  

Stop thinking that your cake will be baked in 3 minutes. If you've done all the planning, followed the rules and set yourself up for success, you have nothing to worry about.  Everything worth waiting for takes time. 

Know and believe that it will be worth the wait.

Realistic Expectations

I put this on my webpage7 years ago and it has made its way through cyberspace on many, many blogs.

REALISTIC EXPECTATIONS!

While you will lose weight in the first few months after bariatic surgery, you reach your maximum weight loss in 12 to 18 months.  Here is what you can expect to lose post op!

For patients weighing 200 to 250 lbs.
10 lbs. in first 10 days
15 to 25 lbs. in 6 weeks
25 to 35 lbs. in 3 months
35 to 45 lbs. in 6 months
60 lbs. or more in 1 year
70 lbs. or more in 18 months

For patients weighing 250 to 300 lbs.
10 to 12 lbs. in first 10 days
15 to 25 lbs. in 6 weeks
25 to 35 lbs. in 3 months
45 to 60 lbs. in 6 months
80 lbs. or more in 1 year
90 lbs. or more in 18 month

For patients weighing 300 to 400 lbs.
10 to 30 lbs. in first 10 days
25 to 45 lbs. in 6 weeks
35 to 55 lbs. in 3 months
50 to 80 lbs. in 6 months
100 lbs. or more in 1 year
120 lbs. or more in 18 monthsee

(The error above is often copied on pages lol).

 For patients weighing 400 to 500 lbs.
10 to 30 lbs. in first 10 days
25 to 45 lbs. in 6 weeks
35 to 60 lbs. in 3 months
50 to 90 lbs. in 6 months
120 lbs. or more in 1 year
150 lbs. or more in 18 months

The Phrase I Hate

There's not a lot that irks me in the online world.  I spend much of my free time lurking on OH and reading and admining various wls specific groups on Facebook.  I understand the differences between newbies and oldtimers like myself and the different ways that we see the world.  There's generally not that bothers me, but there is one phrase that bothers me and I'll explain why today. 

When people post their weight loss, I often see the phrase "100 lbs gone forever".  This is the phrase that bothers me.  It might seem strange but I feel that when we engage in talk of forever that we are taking something for granted.   We are taking our weight loss for granted.  Early out in the honeymoon period, we get this sense of invincibility because life is smooth, temptations are low and hunger is low.  We think that life is going to be that way forever. 

Tis not so for most of us.

I've gained back 10 lbs.  15 lbs, 20 lbs, 25 lbs.  I know that it is not necessarily FOREVER.

This is DAMN hard work.  It is hard to keep our mind always on what we should be doing. It is difficult to keep our demons away.  It is hard to stop eating emotionally when you've done so for 10, 20 or 30 years.  It's not all rainbows and unicorns.

Eventually you realize that this is WORK.  For the rest of your life nonetheless. 

And it is easy to slip into old habits.  Very easy.

It's very easy to become unfocused, to be unaccountable and to avoid the scale.

This is FOREVER, not just for one year.

And hunger returns.  And life goes on.  The compliments stop coming.  Motivation wanes.

I want to scream and shake people and say "Don't say FOREVER.  You don't know how EASY it is to do!!".

Don't take anything for granted.  Don't think that you can just do "moderation" when you sucked so badly before at it.  KEEP THE TRIGGERS OUT. 

I want to say that dessert shouldn't even be in your vocabulary at 4 weeks out.  You shouldn't be having a cookie! If you think it's a challenge now, wait until year three or four or eight or twelve.  Keep it out. 

When you are a long timer, you see so many people struggling early.  You see people that are failing. You want to reach out and say "Don't go there!!!!".  Stay the course. Don't give in yet!! Get to goal.  You want people to succeed.  You want people to do better than you and not to struggle with food demons.  It's hard.  You know what it's like when after a year, you started having goodies again.  You see people digging into Pandora's box far, far too early. 

But then you shut up because you know that newbies won't understand.  They'll think that you are just being mean and not letting them enjoy a "small bite" of everything because they think that their small pouch will keep them in line forever.  *sigh*. 

It's a different mindset. 

At 7.5 years out, and around 15 lbs up at the moment over my goal, I'm frustrated.  I'm angry. I'm pissed that I have to get back to all the incredible hard work it takes to lose the weight now at this juncture.  It's not the same as the first year.  It's a huge ass kicking to even lose a lb or two now.  It blows the mind how much effort it takes to lose when a gain can be acquired from a bad weekend.

Feeling a little down...but I've done it so many times before - pick myself up, dust myself off and begin again. It gets a little tiring though to be honest.  I just want to know how to do this whole damn moderation thing successfully after many years of yo yo-ing up and down the same 5, 10, 15 etc pounds. 

What a pisser :(

Ah well.  Here's to new beginnings yet again....

Things To Do While Waiting For Gastric Bypass

 A question on the OH Ontario board today has lead to this post today....

Here in Ontario, we have typically a wait of anywhere from 9 months to 2 years for surgery.  Most patients get through in just over a year.  Often I hear "how can I fast track through the process?".  I had a very honest lady in my support group spend a meeting discussing how she was one to think this and now that she's gone through the surgery, she realizes that she was the one who held herself back.  Rather than embracing the help from the Bariatric centre, she thought she could "talk her way to the front of the line".  She realized that this is what actually held her back in the process and made her wait even longer.  I admire her for her courage to tell the group about this and how her thinking has changed now that she's had her surgery.   Kudos to her.

The things is (and I know this all too well) you become somewhat obsessed with surgery once you've decided that you are going to go through with it.  It's understandable because we know that it's going to be an amazing change especially after seeing so many of our friends go through this surgery.  Quite frankly, we are also a society where we have very little sense of delayed gratification - we want what we want NOW.  So I'm here to shed a little understanding on WHY the wait is crucial.

You need to reframe your thinking on the whole process. This is not merely a set of hoops to jump through.  To be a success with gastric bypass you are going to need to make some drastic changes BEFORE surgery.  There's so much to learn, to know, and to understand that there needs to be a process.  Recently I've seen some turnarounds for surgery at 3-6 months through Humber River Hospital and to be honest, I'm SCARED for most of these patients.  This is a HARD road.  This is not brain surgery people.   That's the problem.  We get our bodies rerouted but we still have the same fat brain.  That fat brain will want to sabotage us along the process.  We have to outsmart it with education and by establishing some positive habits now. 

We have SO much to learn through this process in order to be a success that I often suggest to people that they EMBRACE the time as preparation time for what is going to be the most amazing (but often challenging) time of your life.  So start preparing now:

Prepare your Resources:

Begin by preparing your resources for surgery.  I would suggest that most people read at least two good books on surgery to understand the basics.  I've seen so many people not read a thing other than the handouts given by the surgical centre.  There's barely any information there to be honest.  The best resource I suggest is Weight Loss Surgery for Dummies.  Truly I think it should be mandatory reading for anyone preop.   Some other ones I like are the Real Skinny on WLS (Janeway)   and the Complete Weight Loss Surgery Guide and Diet Program by Sue Ekserci.

Start a binder with ALL your resources given by your hospital.  If you can get a copy beforehand, get a copy of your eating plan through your surgical centre.  Start creating meal plans according to each food stage.  Make a shopping list.  Know your eating stages like the back of your hand.  Try a few shakes but don't get carried away as your tastes may change.  If you see any samples, buy them to try after surgery.  Remember protein is key.  Learn what makes a good quality protein shake.  Don't get fooled by people you know that might want to try and sell you their inferior shake that "worked for them".  Learn and read! Collect recipes and calculate nutritional info if possible. 

Write down a list of complications and what to watch for.  Learn and read your message board on OH every day.  See what it is like as a new post op after surgery.  Learn the differences between foamies, things getting stuck and dumping syndrome. 

Research your hotel options and travel options for your spouse.  I did this months ahead for my hubby so that I knew where we would stay, routes and even shopping areas in Guelph.  Loved ones will benefit from your thoroughness. 

Document every visit to your dietician, social worker etc.  Keep your homework.  Write down your responses and document what you've learned as you go through.  You'll appreciate your thoroughness later!

Oh did I mention that you could go in expecting to get a Roux En Y (If you are asking what that is, you need to research!) and you may come out with a VSG.  Again research!!  You need to know these things.  Learn the difference between dumping syndrome, foamies and things getting stuck.  Read about a stricture, hypoglycemia, slider foods, plateau/stall,  NSAID (we cannot have them), malabsorption, restriction, why carbs matter, vitamins, etc.  Read and read and then read some more! (Seriously!). Read about what dumping syndrome is and why you cannot count on having it.  Learn what the expected loss rate is.  Learn about things that you can do to increase your rate of loss.  The bariatric centre won't tell you all things.  Some people lose 50 lbs, other lose 150...find out the differences to their level of success. 

Prepare Your Mind:  

I have always said that the mental aspects of this surgery are the hardest.  While the six months to a year are fairly easy (albeit the first 6 weeks can be TOUGH), after that this surgery is going to be hard.   Explore the issues that have lead you to this point.  Look into whether you have an eating disorder,  learn about what your patterns are and why you've gotten here.  What are you replacing with food?  Are you a binge eater? Emotional eater? Boredom eater?  Start working on these issues now because some time after a year, it is no longer going to be a constant high and the amounts that you'll be able to eat will be greater.  I'm going to be honest here and say that there is a failure rate for surgery.  Some people do gain all or most of their weight because they have not dealt with these issues.  You need to know that and really start to explore your eating issue.  Do you just "like food"?  Is it instant gratification? Then it's time to start teaching yourself about delayed gratification.  Yes, it's going to be about willpower again certainly after a point.  Start to teach yourself about discipline, putting off a craving, finding other outlets for emotions and stress.  I know this sounds preachy but my surgical centre did nothing about this and I really wish they'd did.  At 2 years out I had to find therapy in community and was lucky that I had it.

Utilize your centre's dietician and social worker for these changes.  Start making big changes now.  You can only benefit from this.  Start exercising. Start getting rid of all the negatives in your life.  Time for a positive change. Get rid of the baggage.

Prepare Your Family or Spouse:

There may need to be some changes in your house.  Although you cannot DEPEND on your family to go through all the same changes as you, you will need their support and their help especially for the first 2-4 weeks.  Time to prepare everyone about what you'll be needing and what they'll need to do to pitch in to make your recovery smoother.   Remember too - if you are keeping your surgery a secret, you need to draw boundaries with your family as often the "secret" gets out.

Track other people's journeys:

As you see some people preparing for surgery that will have surgery before you, watch their journeys.  Read how they manage the first month out.  Look at what they struggle with, how they solve their problems and record and write down what you learn.  You'll only benefit from what you learn.

Find Mentors: 

Find a mentor - whether online or in person.  Find someone that wouldn't mind you emailing them if a question should arise.  You might be feeling panicky after surgery or you might not want to post everything to the masses online.  Find that person who you've learned from and respect and who will give you quality, sound advice.  Find someone who is stable and secure.   If they seem flighty or highly emotionally charges, stay away.  Find someone who seems to give helpful advice and is willing to answer your questions.  Find someone you relate to.  Actually, if anything, find MORE THAN ONE mentor.  Sometimes people fall off the face of the earth or they might get to a point that they are struggling themselves and might not respond.  Always nice to have a backup.

Find a Support Group:

Look for a support group in your area.   Many communities have them.  If you can get to one in a nearby community, I think it is just as valuable and worth a trip. Bring your spouse if they are a bit leery of surgery or bring a friend who is willing to support your surgery.  Face to face contact is important.  You have to be careful who you trust to be a mentor and seeing people in person may help you find someone.   Don't be hestitant to email someone in your support group, they probably will be more than happy to help you.  Even go out for coffee if they are willing.  It helps to settle the nerves when you have a one on one talk.  Go to meetings.  Sometimes newbies feel a disconnect from the people in their support group.  To quote one of the members in my support group, "Suck up every bit of information" from people that you can learn from, especially from people that have been there, done that.  Experience is an amazing teacher.  Taking advice from someone who has not gone through the surgery can be iffy at best.  Learn from others.  This is by far the most valuable piece.  Make connections of support.  Some times that means "putting yourself out there" and it is worth the risk!

I wish you well in your journey.  Embrace the time you have now.  You may find that before you know it, you'll feel a sense of panic because surgery "has come so soon!".   It can be a funny thing!

Good luck, my friend!

Dawn

Keep It Real

If you know me, you know that I spend a lot of time online.  Recently on one board I belong to, there was a bit of a discussion about the aspect of "Keeping it real".  Someone started another board entitled that name for those that didn't want to be coddled about some of their decisions post op.

Here's the thing:  I'm a big believe in keeping it real (and see the discussion below that follows for what I believe in regards to that) but I'm also a big believer that there are many wls patients that completely struggle due to the head issues, the mental aspects of surgery and the fact that they are trying to overcome an addiction.  It is well documented that wls patients often have a mental health issue.  Some are dealing with depression, bipolar, and various issues.  Not all of us are though.

Previous to surgery, I have not had any detected mental health issues.  No history of depression or anything like that throughout my life.  But now that I am long term post op, I can see how much of an addiction I have to food and how I use it to cope, to distract, to deal with stress and well, just to get pleasure from.  I still have my FAT HEAD.  I'm now realizing that I'm every bit an addict.  I am a binge eater and I didn't even label that before surgery.  I just thought I "liked food" too much.   So I understand how when we deal with patients who are failing that we also have to consider that they may have some mental health issues.  Sometimes we have to have compassion and not just attack people for their food choices.   So I try when someone is failing to encourage them to pick themselves back up right away, to get back on track asap and to seek mental health resources if they are struggling.

But we also have to KEEP IT REAL and by that I mean we have to acknowledge what is written in our plans, our diet given from our surgical centres and we need to try to adhere to them especially in the first year or two of the "magic window" of loss.  So we also NEED to have the frank discussions about things like 100 calorie snack packs, cookies, chips etc. not being a regular part of our diet.  Often new post op people are running out to buy "protein chips", "protein cookies" etc and well, protein bars. I have not seen these in Ontario's Bariatric centre instructions.  They are still crap plus protein. Processed foods.  

I hope that every centre will start to push this more as well as a rule about how many sugars.  I see many people that seem to have the understanding that rules for sugar only apply to avoid dumping.   That's so not true.   I have seen a new post op eating Clif Builder bars that have something like 20 grams of sugar!!  Seriously, sugar is the enemy.  If you are eating highly sugary things at two months out, what will you be craving in the next 6 months?  I find that scary.  Really scary.

Programs need to push the fact that people need to be eating natural, wholesome food and avoiding processed foods at all costs to maximize loss.  Even though it says this in their plans, I think they need to directly say "avoid this and this" because people seem to run out for sugar free this and sugar free that and have the understanding that because the chocolate bar is sugar free - it's "on their plan".  Egads.  It's very easy over time to start to rationalize foods we shouldn't be eating.  If you get too hooked on sugar now, what will you be eating later?  Get it out.  Trick your senses into getting sweet from fruit.  Avoid the processed stuff as much and maximize your loss.  Once you open Pandora's box of sugar, it's very hard to close it.  I struggle with it daily at 7 years out and I did not venture off course much at all early out.  I didn't buy any bariatric foods.  I ate all regular food - lots of veggies, chicken and fish.  Boatloads.  But now I can get so obsessed with carbs and sugars.   They make me feel like crap but I still crave them.  Sugar is the bane of my existence.  I feel like a crack addict when it comes to sugar.

I hate the bariatric food industry.  I think there are waaay too many people sucked into products they don't need.  Factory produced food that's fake but given a label of "bariatric" so it must be okay.  Whole food is so much better for you.  I hate that something like 80% of new products marketed are simple carbohydrates, crackers, cookies, etc.  It is frustrating as heck.  Sugar is highly addictive.  I know.  I am an addict.

The problem is that after a long time out, we get to be so good at not keeping it real with our selves.  We become experts at justifying our food choices even when they are way out of whack with what we should be eating.  When we start making poor choices, it is easy to spiral and make other poor choices.  The key is to pick yourself up back right away and get back on track.  As you can tell, I'm doing this right now and feel very powerless over food.   Again, I have to keep myself real too.  

If you can have a friend to help you keep it real throughout your journey, that's a good thing.  I think those that keep it real will be survivors.  I worry for those who get really good at kidding themselves.  Your thoughts?

Reading Labels

If you know me in person, you know that I'm a HUGE fan of myfitnesspal.  Recently, I had a person ask me why I use this program being 7 years out.  Aren't I a natural at figuring this all out?  Not at all.  I was never good at balance and moderation before my weight loss surgery.  Nothing comes naturally to me in this regard.  I suppose if I had been a normal person who perhaps gained pregnancy weight that I might have a "normal" relationship with food....but I don't and never have.  I can remember as a teenager having a friend who could eat a single serving bag of chips and keep half for later.  I never could.  So this is a constant thing I have to work on.  I MUST be accountable for what I put in my mouth on most days.  That doesn't mean that I will record every day but you better believe when I'm trying to get back on track, I make it part of my regimine again.

Which brings me to a topic that I see a lot of newbies struggling with and that's not reading labels.  I recently talked to a newbie who was only a few weeks out and she'd had a Starbucks Iced Chai Tea Latte and wondered why she wasn't feeling good after having one.  She wondered if maybe she had an ulcer.  I asked her if she'd read the stats on it before drinking it.  She had not.  I explained to her that it's no wonder she didn't do well with it.  Her guideline said no more than 10 grams of sugar and this drink had over 40. 

One of the best things that you can do for yourself as a weight loss surgery patient is to read labels and to read them incessantly.  Stay far away from sugars, watch the calories and carbs.  Be sure to get your protein goals met.  The best thing you can do in your first year by far...and well quite frankly, a necessary evil if you want to KEEP it off long term.  If you get too hooked on sugar early out, you are doomed to regain. Seriously.  It's way tougher later on.

I have a non wls friend that I recently met for coffee and she is one person that I know that is always complaining about her weight.  When we went out, she'd had a Maple French Toast bagel with butter.  Now, while I love a carb now and again, she ruminiated again and again over what to eat and pronounced that the bagel was a far "healthier" option than something like a cookie.   Little did she know that the cookie or even a donut would probably have been a bit of a better choice.

Her totals for her bagel were:  420 calories, 12 grams of fat, 67 grams of carbs (!!!) and 10 grams protein.
A peanut butter cookie was:  280 calories, 16 grams of fat, 27 grams of carbs, and 6 grams of protein.

At least the peanut butter cookie would be more of a "snack" (100-200 calories) than a meal.

Label reading is HUGE.

You'll find now that the advertising is now devious when it comes to healthy and unhealthy foods.  Just because something is "lite" or made with (my personal favourite) "Whole grains" does not make it healthy.  I love, love, love sites that debunk "healthy" products such as:

Nutrition Unplugged

Nutrition Action

Do you have a good blog to share? EMail me it!!

 

Emotions After weight Loss Surgery

Many people find that the first few months after surgery can be very emotional for them.  Many books and websites fail to mention this and so, after explaining it to many people, I decided to do a post on it.   I find that when people understand what is going on it is less overwhelming to them.  There are a few reasons for some people being highly emotional after surgery and here are just a few:

First off, for most of us, the journey to surgery has been a very long road.  A very emotional road no less.  It's like we spend months and months working towards this goal of surgery with the preop diet, the lifestyle changes, Optifast and the like.  It's a constantly build up and sometimes flood of emotions. It hits us to the core in so many respects.  Once we have surgery, often there's the sense of "What now?".  It is not that we expect to really wake up thin but sometimes our brain works this way that we are subsconsiciously expect this big post op change and really for most of us, the days preceeding surgery do not have a lot of change with our weight, our size and our body image.  It takes a while before we start to look different, before we start to feel different and before the payoffs of surgery start happening.  So we often wonder or question "is that all there is?" and "what now?".  Pretty common and typical response.  Many of us feel no different and wonder if truly we've been operated on.

Others, can be overwhelmed by the change with their relationship with food.  Food is no longer a quick solution to an emotional problem.  For most of us, it is no longer pleasurable and quite frankly, for many of us the pleasure of food is a huge key aspect with our relationship to it.   Eating is not pleasurable for may of us.  It's labourous at best with the amount of chewing, the restrictions, the sometimes vomiting, etc.  So this is a very different feeling for us.  There's no more pleasure in eating and that's a big issue for many of us until we start to reframe our brain that it is a good thing because we now have power over food.  Many, many new post ops, miss food, miss the sensations, miss the taste and go into a mourning period.  The trick at this time is to remember that this is a HUGE step in redefining your relationship with food for the better.  You are no longer living to eat, you are now eating to live.  If you are not hungry, embrace it and eat to fuel your body nutritionally and to reduce the "crap" in your diet.  Eat clean, get faster results and get off the weight quicker. It's a good thing once you learn to retrain your brain on this!

Another issue with food can be the fact that it is around us.  It is hard to avoid and hard to resist.  People may find social situations tricky for a while.  I tell people it is not uncommon to "take a break" from social situations that involve food....and if that's what you have to do, to stay on program, then really you need to do it for you!  Going to birthdays may be a tricky thing.  It may put you in a position that you are resentful of others, that you are tempted to cheat etc.  It's okay to give yourself a break.  For others, it's not a problem.  I went to a barbecue 2 weeks post op, and sucked my shakes down happily thinking the whole time how powerful it was to resist. It's whatever works for you!

Here's the thing as well - as you are losing, your hormones are also all over the place.  Some hormones are stored in fat. As you reduce the size of your fat cells, these hormones can be released in amounts higher than you're used to. This can cause mood swings for some people and can be really odd and difficult.   Some people find that they are just more over emotional and cry at the drop of the hat while others find that they are a bit more snippy to people around them.  Others are unaffected.  Depending on your age and how much it's disrupting your life, you might want to see your doctor if it becomes unbearable.  

One more key item to mention is for those of you who may be on medications for conditions such as depression.  With your newfound malabsorption with RNY, your meds may not be absorbed properly.  This is very, very common.  Make sure that they are not time-released meds too.  It's a good idea to talk to your doctor or psychiatrists as you may need an alternate form of meds or an increase in dosage since you may not be absorbing your medication completely anymore.  Whatever you do, do not take yourself off depression meds after surgery thinking that your depression will be cured with "losing weight".  That can be a very dangerous assumption.  The rate of suicide is higher for those that have had gastric surgery and this is one possible reason that has been speculated upon.  Make sure you have a friend to keep you in check with your moods.  

Typically, people who do become emotional as a new post op, find that a few months in, things start to calm down as life resumes more normally, as the new diet changes and routines are in place and when they see the pounds start to drop.  If you are having trouble with your emotions, contact your doctor.  If you are just noticing the changes, be patient and know that it WILL get better! Seek professional help when you need it.  This is a big challenge for many and give yourself any supports that you need. Good luck!