headwork part 3 c 1

Headwork: Could it be the Missing Piece of a Bariatric Surgery Journey? Part 3

October 14, 2019

For Part 3, let's jump in and start working on the 3rd and final "C" of the Cognitive Behavioral Therapy Model (CBT)  “CHANGE the thought to a more accurate or helpful one as needed.” (Part 1 and Part 2)

Wouldn't it be nice if the surgery you had your stomach automatically helped you build your confidence and sustain motivation? So many of my bariatric surgery patients say “I have learned I have had surgery on my stomach but not my head.”

Giving Creditis a headword tool to help build your confidence. It's a tool to help you stay motivated. For the past 15 years in my obesity medicine practice, I have started every behavioral education group,  support group, and individual therapy sessions with patients sharing what they can give themselves credit for in managing their disease of obesity.

I have them take time to think over the past week and share with the group what is one healthy behavior or choice they can give themselves credit for. Some patients call this sharing a scale or non-scale victory. This is very hard for them to do.  If you are like my patients, you are an expert at beating yourself up.

Your stinkin’ thinkin’ may sound like this:

  • “I didn't do anything right this week”
  • “I blew the entire week”
  • “I didn't stick to my plan perfectly, I am a failure”

Let's take a look at how the above stinkin’ thinkin’ can affect your behavior:

Trigger: One day of off-plan eating or missed exercise

Thought:  Well that's it, I didn't do it perfectly. I am a failure

Behavior: ???????

You now know that every behavior is driven by a thought. What is your behavior going to be if you have the above powerful thought? Do you think it's going to be to get right back on plan and live as a bariatric surgery patient? I am doubtful.

My patients have told me their all-or-nothing stinkin’ thinkin’ often triggered very unhelpful and unhealthy behavior. This is where “Giving Credit” can come in.

When I first start working with a patient, I encourage them to start writing down 1-2 things daily they can give themselves credit for on their bariatric surgery journey. I encourage them to buy an old-fashioned paper journal or keep track on their smartphone.

Many patients will start to write down their “credit” in the same place they log their food. At first, this seems silly to patients.  It seems childish to praise themselves. It might seem that way to you right now. However, I assure you that learning to give yourself daily credit is the FOUNDATION of having success on your bariatric surgery journey.

You are an expert at beating yourself up and I ask you how has that worked for you in the past? This series is helping you develop NEW and effective headwork tools for your toolbox. Will you try this one with me? For the next 30 days, take time to write down 1-2 things you can give yourself credit for. Some examples include:

  • “I exercised today”
  • “I got in all my protein today”
  • “I took the time to plan my food”

I assure you that developing and using the daily “Giving Credit" tool will decrease the power of your stinkin’ thinkin’ which, in turn, will lead to empowered and healthy behavior.

The Giving Credit tool looks like this:

Trigger: One day of off-plan eating or missed exercise

Thought: Well that's' it. I didn't do it perfectly. I am a failure” (Except now, you have CAUGHT the thought)

Change the thought: Everyone makes mistakes. Missing my exercise session does not mean I am a failure.  Today, I can give myself credit for getting my protein in and logging all of my food

Behavior: Stick to your plan and exercise at the next scheduled time

A Tool Called The "Why Card"

I would like to close by teaching you the CBT tool called the “WHY card.” Wouldn't it be nice if your bariatric surgery tool helped you develop and sustain motivation? Wouldn't it be nice if your bariatric surgery tool could help you when you're struggling with strong cravings and desires to go off your eating plan?

Sadly, the change in your anatomy does not build or sustain motivation. However, the “ WHY card ” can.  There are going to be days that are difficult and you feel as if you have lost all of your motivation. Many of my patients describe it this way “ My honeymoon thinking is gone.” What if you had a tool that could help you keep your WHY CLOSE BY?

Think about that. what does it mean to keep your WHY close by?

What was your WHY for choosing bariatric surgery to get healthier? Through the years, I have had patients write their WHY down on a 3x5 card that often looks like this:


Take some time to write down all the reasons why you chose to have bariatric surgery. When complete, you have just filled your toolbox with one of the most powerful headwork tools. This card has helped countless patients make healthier choices when grocery shopping, stay on plan when eating at a restaurant, come to support group when they didn’t feel like it, or get out of a drive-thru line before they ordered.

Now that you have made your WHY card, it's time to use it. Take time to read your WHY card twice daily.

When reading, take the time to visualize your changes. See yourself getting off medication. See yourself fitting into that airplane seat. See yourself living longer and enjoying life with your loved ones.

Again, reading and crafting this card may feel silly. You might be thinking, “Why on earth do I need to write down all the reasons why I want to get healthier on a silly card? Don't I know them better than anyone else?” Of course, you do! However, your “WHY” will never automatically come into your head when you are struggling with cravings.

Instead, you will hear "Just one won’t hurt" or "I'll start again tomorrow."  Stinkin' Thinkin’ is powerful. This card will help you CHANGE the thought to a more helpful one. “Yes, drive-thru does sound good right now but controlling my diabetes sounds so much better.”

By reading your WHY card daily, you are cementing your motivation into your head to help you decrease the power of your stinkin’  thinkin’.

Incorporate Headwork Tools to Ensure Lifelong Success

In closing, I want to thank all of you for taking the time to read this three-part series. I give you credit for accepting that you must also incorporate headwork tools to ensure lifelong success with your bariatric surgery. This series has helped you see that successful obesity treatment must include the missing piece of headwork. Developing and maintaining a healthy mindset is just as important as healthy nutrition and exercise. All three are needed for success. When you focus every day on these three, you'll be ahead of the game to ensure lifelong success.

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Lora Grabow


Lora Grabow, LMSW, ACSW, is an obesity medicine behaviorist who partners with medical providers to empower patients to holistically change their lives. Holding a Masters in Social Work, Lora has worked with weight loss patients for over 15 years. She partners with a thriving obesity medicine practice located in Grand Rapids, MI. She is a member of the American Society for Metabolic and Bariatric Surgery and The Obesity Action Coalition.

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