Are you a weight loss surgery patient whose weight loss has slowed, stopped, or even started to go in the wrong direction? If so then you may be wondering what is keeping the pounds from falling off. In most cases poor weight loss in weight loss surgery patients (gastric bypass, gastric sleeve, lap band) can be contributed to 1 of 5 factors including:

1) Inadequate protein intake (remember that females need 60gm protein/day and males needs at least 80gm/day)

2) Poor compliance with vitamin/mineral supplements

3) Excessive intake of soft calories (juice, milk, soft drinks, puddings, etc.

4) excessive grazing (eating very small amount of high calorie foods very frequently)

5)excessive loss of lean body(muscle) mass due to failure to perform resistance type exercises.

As you can see, weight loss plateaus usually have a reason behind them; however, if you want to address the reason for your lack of weight loss then it’s important that you address the reason for the reason. You see, the reason for you your lack of weight loss may be due to inadequate protein intake, lack of vitamin/mineral intake, excessive intake of soft calories, excessive grazing and loss of lean body mass, but the TRUE reason is poor compliance on your part. If you consumed adequate protein and vitamins/minerals, stopped grazing and consuming liquid/soft calories, and got in the gym and built some muscle mass then your weight would likely start heading down again. So, just improve your’ compliance and you will start to lose weight again!

Now, while that may sound like an easy statement for me to make I understand that it’s not an easy thing for you to do. Behaviors are inherently difficult to change and that’s why we call them habits. Despite the fact that your poor compliance may be sabotaging your weight loss efforts there is a tool that can help put you back on the right track. This tool is known as Contingency Management.

Contingency Management is a this for that (or carrot and stick approach). Essentially it means that you get rewarded for good compliance and get punished for poor compliance. With some of my clients I have them write me 12 $75 checks. Next, I measure their compliance to a particular behavior goal (say getting enough protein in each day) each week. If the client shows 90% compliance for the week then I give them their check back and top it with a $15 gift card to a Spa (or something similar); however, if compliance is less than 90% then I cash their $75 check. As you can imagine, this technique has a unique way of getting my clients to comply with a particular behavior goal, and that’s why my clients are significantly more successful than clients in other programs.

If you are struggling with a particular behavior and this poor compliance is side-tracking your weight loss efforts then I encourage you to give Contingency Management a go to see if it can get you back on track. Here are 8 rules that should be followed in order to use this behavior modification technique correctly:
1. Only use Contingency Management for behaviors that you tend to struggle with on a frequent basis (for example: if performing resistance type exercises is not a struggle for you then don’t use a Contingency Management approach to modify this behavior, but do use it if hitting the weights is a constant battle for you)
2. Set a standard by which you can measure your actual level of compliance (example: I will lift weights 30min 3x/week minimum)
3. List some intrinsic and extrinsic rewards that you will receive if you are compliant with the standard that you set in step 2 (**intrinsic rewards are internal such as increased energy, more self confidence, etc…., and extrinsic rewards: $ 15 gift cards to get a massage, tickets to a movie, etc..)
4. List a negative consequence that will result if you don’t achieve your goal (for example: Donating a set amount of money to an organization that you can’t stand ,or to me)
5. List who will monitor your compliance level and determine how/when they will distribute any rewards/consequences.
6. Write up a contract with these 5 components and have yourself and the compliance monitor sign the contract.

If you are struggling with a particular behavior, and this behavior is affecting your weight loss then I encourage you to implement Contingency Management. Done correctly this behavior modification technique can get you losing weight again.

In Good Health,

Kyle Rose RD,LD
Bariatric Solutions
www.mybariatricsolutions.com