Thursday, December 29, 2011

Is there a link between obesity & fibromyalgia?

In 2009 and 2010, researchers published the findings of three studies performed at the University of Utah and the Norwegian University of Science and Technology that found a link between obesity and fibromyalgia. As someone recovering from obesity and suffering from fibromyalgia, I’m glad when data comes to light that might help explain, treat, or prevent these conditions. A link that might reveal a common cause sounded promising to me.

The public in general and FM sufferers in particular heard something else in those reports, thanks to eager journalists who jumped on the studies’ findings and mined them for their shiniest nuggets. The studies included mostly female subjects, so a distorted message was broadcast: FM is a fat woman’s disease, and if those lazy gals would just exert enough willpower to diet, exercise, and lose weight, their FM symptoms would lessen or even disappear.

I recently wrote an article about the obesity-fibro link for Fibromyalgia & Chronic Pain LIFE magazine. In researching the article, I learned a lot about the possible causes of both obesity and fibromyalgia, things I’d never heard before at all. Sufferers of both obesity and/or fibromyalgia often hear that their problem is all in their minds, but it turns out there’s a whole lot more going on than the patient’s conscious behavior…that the problem is caused or at least affected by biological and other factors over which we have no conscious control. If you’d like to read more about it, go to http://fmcpaware.org/ and click on the image of the magazine cover on the left side of the page (it’s a woman wearing a red jacket, holding a globe).

Tuesday, November 15, 2011

The late bloomer


In early November, one of our rose bushes decided to produce one last perfect rosebud before nodding off into its long winter sleep. You couldn’t miss that rose: a bright coral spot in the otherwise dull brown and grey garden remnants. I cut the rose, brought it inside, and put it in a bud vase on the counter of the bathroom I use the most, so I could enjoy it every time I went into the room (which, with my small capacity bladder, is at least 500 times a day). I positioned the vase so that the rose would be looking at me whenever I entered the room. Later that day, I went off to work and forgot about the rose until I came home six hours later.

Of course I saw the rose as soon as I walked into the bathroom, but it wasn’t facing me as I had left it. It had turned its lovely head towards the mirror, so it could admire itself. I could swear I heard the rose talking to its reflection. This is what it said:

“Oh my! Aren’t you a lovely girl? I’ve never before seen such a pretty face, and your color! You are just stunning! And I can tell that you are beautiful through and through; I can see your soul shining in those coral petals; I can see your spirit supporting that slender stem, and just a few thorns to remind everyone that you deserve respect. It’s a delight to meet you. I hope you won’t mind if I stare at you a while and drink in your loveliness. Is that okay with you? Oh, good. You are as kind as you are beautiful.”

Clearly, self-esteem was not an issue for that girl.

And why would it be, you ask? She’s a rose…to paraphrase the Bible, she toils not, nor does she spin. In fact, she’s awfully self-centered, mooning over her reflection in Jean’s bathroom mirror. She’s not like me – she’s young and fresh and perfect, while I am old and tired and wrinkled and fat.

That’s an easy conclusion to make, but it’s not correct. You have judged both the rose and yourself wrongly, and here’s why.

Rose was a late bloomer. While she worked for weeks to grow from a glimmer in God’s eye into a tight little bud, while her bigger, showier sisters burst into bloom and, being incorrigible show-offs, made sure to taunt little Rose. They called her names: immature, ignorant, slow, stupid…well, I’m sure you can imagine how that went. But Rose persisted. She was determined to bloom before the first frost, to prove her sisters wrong. She knew it would be slow and difficult, but it was her last chance. The brevity of a rose’s life was obvious to her as her older sisters shed their limp, brown-edged petals and dried into sad, hard rose hips. It would have been wonderful to prove them wrong before they died, but Rose knew she must fulfill her fate whether or not she had an audience. She was going to be a glorious rose just for herself.

And she did become a glorious rose. She achieved her goal, brightened my life and even as her life expectancy shrank from weeks to days to hours, she gazed in the mirror and said, “Oh my! Aren’t you a lovely girl?”

Thanksgiving Dinner "Full"

The Thanksgiving theme is especially appropriate subject matter for this newsletter, not just because of the practice of giving thanks but because of the ritual overfeeding of Thanksgiving celebrants. It is an excellent allegory for the concept of satiety, in ways both physical and spiritual.
I often say that my pre-op idea of satiety was “Thanksgiving Dinner Full”. Because I loved food and the experience of eating (the physical aspects) and because I was trying to fill a bottomless hole inside me (the spiritual aspect), every meal consisted of huge portions with second and third helpings – so much food that I was over stuffed. I would have to stop eating not because I was satisfied but because I was so uncomfortable. As soon as the pressure and bloating in my abdomen eased up, I was ready for more food, not because I was physically hungry (in the way I know it now) but because eating was my default activity. My mom used to say that cats’ default behavior was bathing: “When in doubt, take a bath”. Mine was: “When in doubt, eat.”
I think a lot of WLS patients have eaten that way as pre-ops and, like me, struggle to identify and accept their post-op experience of satiety. They say things like, “I never feel full,” when actually, feeling full is not a sign of satiety. Satiety is feeling that you have eaten enough food, no more, no less. Enough is not the amount that makes you happy. It’s the amount that ends your physical hunger pangs. It takes a long time to retrain your conscious mind to recognize satiety and heed it. If you don’t recognize it or don’t heed it, and go on overeating in your attempt to reach your pre-op “fullness”, your overeating can cause a lot of damage, not just to your weight loss but by dilating your esophagus and/or stomach and possibly by putting so much pressure on your band that it slips out of place.
That’s why I keep harping on the importance of weighing and measuring your food before you eat it. I know plenty of bandsters who have never done that, have lost their excess weight, and haven’t had any complications, so I can’t say that weighing and measuring is a guarantee of weight loss success and prevention of complications. But I do know that mindfulness during food preparation and at mealtime is crucial for teaching yourself a new way of eating. Your old way of eating is one of the things that made you so obese that you needed WLS, so it’s time to bid it farewell.

Monday, October 31, 2011

I'm a Hollywood Star!

This year's Halloween theme is Hollywood. I went as a Hollywood star - as in a star on the walk of fame. Getting through doorways proved to be very tricky, so I'd have to say that this costume was more of a trick than a treat.

Sunday, September 25, 2011

My 4th Bandiversary Photo!

This photo, taken 6 days after my 4th Bandiversary, is remarkable because I'm wearing a belt! I think the last time I wore a belt was in 1968, when I proudly wore a white patent-leather belt with my bell-bottom jeans. Since then, I've never wanted to accentuate that pudgy middle!

Sunday, August 28, 2011

The Big Decision

Deciding to have weight loss surgery, and choosing which procedure to have, is a big deal. The surgery has life-changing potential, and we want our decision about it to yield only the best results: at the very least, weight loss without complications. But like many things in life, the adjustable gastric band doesn’t come with a lifetime weight loss guarantee . That lack, and the fact that many insurance companies cover only one bariatric surgery procedure in a patient’s lifetime, puts even more pressure on us to make the right decision at the outset. Are there ways to make the decision-making clearer or easier beforehand, and/or to reduce the doubt, regret, or second-guessing after surgery?

The answer to that is maddeningly general: it all depends.

First of all, it depends on your unique personality. What type of decision-maker are you? Does your style change (and your anxiety escalate) depending on the nature of the decision? Choosing a $14.99 entrée from a restaurant menu usually doesn’t take as much time and energy as choosing a $14,999 surgical procedure.

Here’s what I mean by decision-making styles. I am a quick, sometimes impulsive decision maker who’d rather make a bad choice than no choice. My husband is a slow, cautious decision maker, one who must carefully consider and discuss every aspect of a situation before making his decision. What could be a potential conflict has turned out to be a useful balancing factor in our relationship. My husband’s cautious nature prevents me from leaping before I look, and my more adventurous nature prevents him from being permanently cemented to a bad patch of road.

Here's a list of common decision-making styles. Which category (or categories) do you fall into?

Agony – agonizing over a decision should perhaps be reserved for a very important decision but can be a waste of energy for less important decisions. Choosing a WLS procedure is important; choosing what to eat for breakfast on Tuesday is less important. I encounter a lot of people who fall into the agony category. They tend to do so much research, thinking, and analysis that they agonize themselves into paralysis. Taking a mini vacation from the decision can help neutralize the pain and paralysis this decision-maker feels, but be careful not to turn into a procrastinator (see below).

Impulsive – Like me, you go with your first or “gut” reaction.

Escapist – You avoid making a decision by creating a false choice. For example, you’re reluctant to decide about WLS, so you escape it by saying, “I’m going to lose weight on my own,” for the millionth time.

Compliant – You let someone else decide for you. Your surgeon says, “You should have RNY,” so you have RNY.

Playing it Safe – You choose the least risky option. Risk might be assessed in terms of surgical mortality (0% for the band) or out-of-pocket cost (you choose whichever procedure your insurance policy will cover).

Procrastinator– You delay your decision indefinitely, so it stays in the background of your life, like mental wallpaper. This might be a wise choice if you truly believe you don’t have enough information to make a good decision. Perhaps the VSG looks good to you, but it’s too new a procedure to have enough studies and data about success and complication rates published about it.

Fatalistic – You shrug and say,”What will be, will be.”

None of these styles are any better or worse than the other. I just want to reassure you (if you’re slow to decide, it’s perfectly okay) and also to encourage you to consider other approaches to the decision-making process. As impulsive a decision-maker as I can be, several times in my life I’ve faced some decisions (especially in business, where the decision involved millions of dollars of my employer’s money) that looked like Mount Everest. A few times, I was fortunate enough to work for a man who was willing to listen to me debate the issue and to ask me things like, “What if you look at it a different way?” His different approach sometimes helped me see a path I hadn’t noticed before, and other times helped me see that a path I’d already considered was actually the best one.

Thursday, August 18, 2011

Punkalicious Birthday #58



This photo is supposed to show how punkalicious I look at age 58 (with freshly colored hair in dark brown with light brown and blonde highlights), but someone else managed to take over.


Today I celebrate my 58th birthday. And I do mean celebrate, because even though I'm a creaky old grandmother of 9 dogs and 4 cats, I'm also a much smaller and feistier granny now than I was when I had WLS 4 years ago. I'm not thrilled with my sagging, wrinkly, aging skin or the aches and pains that seem to come with aging, but I'm far happier at age 58 than I was at age 18. Fortunately, I don't suffer from birthday anxiety, not even for milestone birthdays. As I creep toward The BIG 60, I'm proud of my accomplishments and the wisdom I've acquired, and looking forward to my 6th decade. Now that I'm a healthy weight, I have the energy and strength to tackle just about any project. The next life lesson I need to master is how to keep myself challenged but not overburdened. In life as in eating, I'm the type who tends to bite off more than I can chew, so my goal now is to work on creating a better balance of work, play and rest in my life.

Recently a friend who's about my age suggested that I could ease my burden by dropping some of my activities. I said, "I know you're right, but…if I could just stop getting ideas about things I want to do…!" Later, I mentally slapped myself for that wish, because I don't want to ever go back to the kind of life I had when sitting in a comfy armchair with a book, a dog, and a bowl of popcorn was my only idea of heaven. I love books, dogs, and popcorn, but not for 12 hours at a stretch!

Tuesday, July 26, 2011

My fashion model persona







My previously unknown inner fashion model had a chance to pose for the camera at the OH event in Bellevue, WA.





Monday, July 25, 2011

Adjusting my mind to a smaller body


I just returned from spending 10 days in the Seattle area, where I attended the OH event in Bellevue, partied with bandster friends in Seattle, WA and Portland, OR, and did far too much shopping. During that wonderful trip, I had an unexpected struggle to adjust my mind to my smaller body. Here in Tennessee, one of the most obese states in the USA, I know I look small compared to many other women, but in the Northwest, I saw far fewer obese people and therefore was surprised several times to learn that I'm considered small there, too.


First, I tried on a body shaper - size small, as recommended by the sales person. The shaper looked like it might fit my old Chatty Cathy doll, but not me. But lo and behold, it fit me and did a great job of smoothing out and containg the belly rolls. So I bought it, mainly out of gratitude.


Then, I tried on a sheath-style dress, size medium (my more-or-less automatic choice these days). I twisted and turned before the dressing room mirror, wondering why the dress didn't look good on me, before it occurred to me to try a size small. And lo and behold, it fit me perfectly (and is shown, in part, in the photo above).


Emboldened by the earlier body shaper experience, I consulted a lingerie associate at Macy's about their body shaper options. I was holding a size large of a style that I liked while we talked. She looked at the garment, looked at me, and said, "You're quite diminuitive" (i.e., short) "And I think you need a size small." So I obediently tried on a small, after first trying the large and a medium version. And lo and behold, the small fit me. I didn't buy it (due to sticker shock), but I was a happy camper as I left Macy's that day!


I can't resist mentioning that the first time I got to my low weight, I wore a size medium or 10-12, and size 7 or 7-1/2 shoes. Three years later, after regaining and relosing 25 lbs, I'm back at the same weight but wearing a size small or 8-10 garment, and size 6-1/2 or 7 shoes. Why the change? I think that the combination of my workout program and perhaps the continuing body changes from weight loss got me here. And I'm very happy to be here!

Sunday, July 24, 2011

How to Talk to the Doc

When I was in elementary school, we had Show & Tell Days. Betsy (future veterinarian) showed us her hamster and told us what he liked to eat. Joey (future geologist) showed us a lunk of quartz he'd found and explained how it was formed. Jeannie (aspiring art teacher, future author) showed a potholder she'd made and gave a fascinating and heartfelt lecture on how to weave a potholder. Paul (aspiring magician, future attorney) showed us a card trick he'd learned.
As grownups, when we go to the doctor “presenting” (as the docs would say) with a symptom, we play an adult version of Show & Tell. If we have a rash or a bruise, we can easily show the doctor what’s wrong. But often the problem is invisible, even to x-rays and blood tests, and sometimes a rash is just the tip of the medical iceberg. In that case, the Tell part of our presentation is extremely important. Our doctors are not mind-readers, each patient is unique, and graduating from medical school doesn’t automatically make a person perfect. As far as I know, there are no sensitivity training courses or even bedside manner courses in medical school. So we patients are trying to connect and communicate with a scientist, not a clairvoyant.

Communicating with doctors is a special interest of mine because of the extremely frustrating experiences I had while seeking a diagnosis and treatment for my chronic pain. It seemed to me then that my vaunted communication skills were completely ineffective when I was standing or sitting before a scientist in a white coat. I was told that my pain was all in my head; that my pain was typical of middle-aged women with emotional problems; one guy even said, “What do you expect at your age?” and “I can’t spend any more time with you now; I have sick people to take care of.”

I eventually realized that many of these docs saw me as someone seeking pain killers and/or disability income, not a diagnosis and cure. They distrusted me because I had “inappropriate” knowledge: how to pronounce medical terms, the correct names for various parts of my body; and the names of medications commonly used to treat symptoms like mine. I tried different approaches, different communication styles, as I went from one doctor to the next (which is called “doctor shopping”), but the results were always the same. I had no diagnosis, no cure, and no treatment after 6 months of consultations and tests.

Close to the point of giving up entirely and sinking further into despair, I made two more appointment: one with my counselor, the other with an internist who’d been recommended by a local nurse. My counselor assured me the pain was not all in my head (some maybe, but not all). The internist turned out to be a treasure, willing to listen to my whole sad story, asking me questions, and somehow able to believe my tale of woe. If Dr. H. held any opinions about my sanity, he kept them to himself. He diagnosed fibromyalgia and myofascial pain syndrome, contradicted other doctors who’d told me I exercise too much, and prescribed medications to help me sleep and to manage the pain. He didn’t cure me, but he offered a treatment plan that worked well enough to improve my daily functioning and give me hope for the future. And hope is a very powerful medicine.

During that long medical ordeal, I learned a few things about successful communication with a doctor. Solely for sake of simplicity, I will refer to the doctor as “he” (and at any rate, I think I may be the only feminist in the state of Tennessee).

1. Tell him why you’re there, as simply as possible and without extraneous information that may be important to you but probably has no value to the doc. “After lunch at Wendy’s the other day, when I was driving down Main Street on my way to pick up a ceiling fan at Lowe’s, I had to turn onto First Avenue and stop the car because I felt like I was going to vomit…” would be better said as, “On Tuesday afternoon, I regurgitated some chili about 30 minutes after eating it, and since then I haven’t been able to keep any food down.” When I met Dr. H., I wanted to tell him about every little physical and emotional hurt I’d experienced for the past 6 months, including derisive commentary on the medical professionals I’d dealt with. That approach probably would have set me up for another “neurotic middle aged woman” label. So I kept it short and pithy.

2. Avoid self-diagnosis. If your research has led you to what seems like a clear diagnosis and you start out by saying, “I have a band erosion,” (something even the doctor can’t definitively diagnose without doing an upper endoscopy), you will erode your credibility as well as your band. Frame it this way instead: “For the past week, I’ve been having these symptoms [list them] that make me worry that I have a band erosion.”

3. One thing at a time. When you make an appointment when your list of concerns has more than 3 items on it, tell the scheduler that you might need extra time with the doc because you have a lot of concerns to address. Repeat this at the start of your conversation with the doc. Then do your best to present each concern as a stand-alone issue, starting with the one that bothers or worries you the most. It’s up to the doc, not you, to make connections between your different symptoms. If you absolutely must point out a connection that’s obvious to you, frame it this way, “I’m wondering if the pain at my port site could be related to my difficulty swallowing.”

4. Show & tell, using clear, descriptive language. “My stomach hurts” is not clear enough. Pointing at your port site (which is on your abdomen, not your stomach) and saying, “It feels like someone is pressing a hot poker into my right side,” is better. Be sure to tell the doc how long you’ve had the symptom, if they’re constant or intermittent, if anything (time of day, body position, medication, etc.) makes them better or worse, and if you can reproduce the symptom. For example, can you trigger the abdominal pain by bending at forward at the waist, or is does it occur at random?

5. Just the facts, ma’am. Keep it drama-free, don’t exaggerate, don’t embellish. I have a habit of hyperbolic (wildly exaggerated) expressions. It entertains me, sometimes it entertains others, it’s my personal style, but it’s wasted on a scientist who yearns for precision. So I have to rein myself in, at least at the start of a relationship with a doctor, and say, “Since I’ve been taking this medicine, my mouth is always dry,” instead of saying, “My mouth feels like the 101st field artillery just marched through it.” When a symptom is worrying you, it’s tempting to verbally paint it in vivid colors, but if you use that same extreme style for everything that happens to you, you may end up as the little boy who cried wolf so much, no one paid any attention when the wolf finally ate him.

6. Ask for feedback. If your doc’s response to your show and tell is unsatisfactory because it seems that he’s not taking you seriously enough, or he’s misunderstanding you, or he’s in too much of a hurry to give you the attention you need, don’t sulk in silence. Speak up now. Remember, your doc is not perfect, he’s probably very busy, and he may be distracted by the fight he had with his teenaged son, or his worry about a patient he just admitted to the hospital. Bring his attention back to you by saying, “Have I described everything clearly enough?” or “I feel like I haven’t explained this very well,” or “What are your thoughts about this?” or “What is the next step in taking care of this problem?” or even, “You seem in a hurry today. Would it be possible for me to come back tomorrow (or whenever) to discuss my problem(s) in more depth?”

7. Establish a timetable. If the doc doesn’t say, “I want to see you again in a week (or whenever),” or “We’ll get you in for an upper GI study this week,” or “Call me if you’re not feeling better by Wednesday (or whenever),” ask the doc to establish a timetable, keeping in mind that he’s probably not the one who manages his appointment calendar or schedules medical tests.

Monday, June 27, 2011

Obey the Stop Signals!

Stop signals aren't there just to make you late for work. They're there for your protection. Some of the worst car accidents in my town happen at a major intersection on a busy road where some drivers seem to be ignoring the stop signals. As those drivers are sped away from the scene in the back of an ambulance, I wonder how badly they're hurt or whether they'll survive. I think it's good that our town has installed cameras at that intersection.

Stop signals are equally important to bandsters. How?

In addition to the 4 signs of restriction explained above, you will also get hints to stop eating that I call "stop signals". As newly-filled or newbie bandsters, we expect our bands to give us good, loud, clear stop signals with clanging bells and flashing lights, but eventually learn (if we work on it) to recognize the quiet stop signals such as mild queasiness, fullness or pressure in the back of the throat, difficulty swallowing, burping (or the urge to burp), sneezing, sighing, hiccups, watering eyes, runny nose, and so on. If we heed those signals, we stop eating before something more drastic and uncomfortable happens. You may not experience any soft stop signals, but don't stop looking for them just because you aren't noticing any; they could sneak past you at any time. And if you experience no hard stop signals (like stuck episodes, PB's, sliming), don't go looking for trouble! The absence of hard stops does not mean that your band isn't working or that you have no restriction. It just means you're doing a good job!

Restriction: the bandsters' Holy Grail

Restriction seems to be the Holy Grail of bandsters, a sacred thing that we hunt for with a level of passion and persistence that we may never have experienced before in our lives. In our minds, restriction is endowed with the magical power to make us lose weight. But exactly what is it?

We bariatric patients use the word "restriction" in every other sentence we speak, write, or think, but do we truly understand what it means?
In my 50+ pre-op years, the word restriction basically meant "no can do" or "you can do it, but within externally-imposed limits." To use extreme examples, that means "Thou shalt not kill" (no can do) or "Drive no faster than 55 mph on this stretch of road" (55 mph being the imposed limit).
Keeping those examples of restriction in mind, it's reasonable to say that a restrictive WLS procedure is one that allows you to eat, but in quantities no greater than ½ cup at a time (or whatever your surgeon's food amount limit is). That's clear enough, isn't it?
It's clear, but it's not specific enough to ensure safe and effective use of the "restrictive" WLS tool called the adjustable gastric band. For one thing, it implies that the band comes equipped with a monitoring feature, like the radar guns used by police to measure the speed of passing cars. It doesn't make it clear that the only monitoring feature that will work safely with the AGB is a conscientious, hard-working patient's conscious mind. Surgeons and patients who aren't aware of this aspect of the band are headed for accidents such as stuck episodes, PB's, sliming, esophageal or stomach dilation, band slips, or weight loss failure.

The adjustable gastric band was first approved for use in the USA in 2001. A decade later, we are just now beginning to understand the true function of the band. A decade of struggle and learning has gone by. Ten long years! How could that happen?
When the adjustable gastric band was first marketed in the USA, it was positioned as a restrictive WLS procedure. In the world of marketing, a product's "position" determines how its features and benefits are communicated to customers and how they compare to similar products in the market. When introducing a new automotive vehicle to the market, an automobile manufacturer must present it in a way consumers will understand: Is it a sedan or an SUV? Is it a sub-compact or a full-size vehicle? A car or a truck?
Manufacturers of medical devices like the adjustable gastric band must also educate their customers (surgeons) and end-users (patients) when they market a new product. They ask themselves: Is this a completely new concept? How can we make customers understand it and want to buy it? What other products on the market can we compare it to? In the case of the AGB, Allergan compared it to other bariatric surgical procedures: RNY (gastric bypass, which combines restriction and some malabsorption), DS and BPD (duodenal switch and bilio-pancreatic diversion, which combine restriction and a lot of malabsorption) and VSG (vertical sleeve gastrectomy, considered a restrictive procedure). The AGB doesn't cause nutrient malabsorption, therefore it fell into the restrictive category.
As a result of this perfectly ordinary business approach, thousands of surgeons and their patients were not fully informed about the mechanism through which AGB patients lose weight. It's quite possible that even Allergan didn't fully understand at the start just how the band works. If the makers of medical devices and pharmaceutical products waited until every last detail is known about a new device or a drug, some life-saving products might never reach the people who desperately need them.
So for the last decade, we all believed that the band is supposed to restrict the amount of food we can eat and cause weight loss through reduced caloric intake, but that's changing now. In the past year or so, Allergan has refined the band's market position and has been teaching surgeons that it should not be used as a restrictive device. Allergan, Endo Ethicon, and the bariatric medical community are realizing that a patient who eats until she or he "feels" restriction is far too likely to experience complications. They are coming to the understanding that the band's chief weight loss mechanism is reduced caloric intake through the reduction of hunger and appetite, with early and prolonged satiety after a small amount of food is eaten.

So if the AGB is not a restrictive WLS procedure, what the heck is it? How can we explain it without using the word restriction?
A better term for the true function of the AGB might be something like "optimization" - the process of modifying a system to make aspects of it work more efficiently, use fewer resources, and/or produce the most beneficial results. In a bandster, the system is made up of several important components: the band, the saline fill, the bandster's food choices and exercise level, with a few parts that are so top-secret, nobody knows what they are. Optimization is a clumsy-sounding word, though, and it makes the bandster sound like a machine instead of a human being. For the time being, we don't have a better term than restriction, so we'll go on using it until something better presents itself.

How will you recognize restriction? If you were hunting for the Holy Grail, you could equip yourself with a picture of a chalice to guide you, but there's no picture of restriction. Don't kid yourself into thinking that a fill under fluoroscopy (x-ray) is going to yield a picture of your very own restriction. That x-ray image is just a snapshot of part of a living, breathing, changing human body, and while it might illustrate a theoretically good fit on the band on the stomach, it cannot illustrate what's happening in your nervous system. It can't track the production of hormones that triggers hunger or satiety messages between your brain and your body.
To recognize, utilize, and safeguard your restriction, you're going to have to start paying attention to dozens of things that you took for granted or didn't even know existed before. I don't go on and on about eating slowly just because it helps prevent unpleasant side effects, but because it's mighty hard to pay attention to your body's signals when you're gobbling your meal.
I didn't realize this until perhaps 6 months post-op. Until then, I was eating carefully only to prevent stuck episodes, PB's, and sliming. Very gradually, over the next 6-12 months, I learned to listen to my body, not just when I was eating but between meals. It wasn't until after my 15th fill, at almost 3 years post-op, that I had mastered mindful eating enough to actually enjoy my experience of restriction. Three years is a long time, but don't let that scare you. I lost 100% of my excess weight with far less "restriction" than I have now. And when you remember that I spent over 50 years eating carelessly and excessively, changing my eating in only 3 years is pretty good!
So, what signs of restriction you should be looking for?
1. Early satiety after eating a small portion of food. You lose
interest in eating, feel that another bite would just be too
much, and/or feel a sudden distaste for the food.
2. Prolonged satiety after eating a small portion of food. You
are not physically hungry, and have no appetite (desire to
eat) for several hours after you eat. How many hours? It's
going to vary by person, and will be affected by many factors,
such as food choices (solid versus liquid, for example). For me,
3-4 hours is a very long time to experience satiety and I'm
delighted by that. Another person might not care to eat again for 5-6 hours after a meal.
3. Reduced appetite. You're just not as interested in food as you
used to be. You think about it less and you might even forget
to eat. The food may not even taste as wonderful as you
remember it.
4. Reduced physical hunger. You're just not as hungry, and not
hungry as often, as before.

All that sounds marvelous, doesn't it? A dream come true! It is indeed, but it's also very complicated because the human body and human behavior are very complicated. We're constantly changing, in changing circumstances. While our unconscious brain and body are trying to communicate hunger and satiety, our conscious brains and our lifetime habits are also at work. So even though you weren't especially hungry for that chicken dinner at 6 pm, it's quite possible that a phone call from a troublesome family member will trigger some comfort eating at 6:15 pm, or that boredom will send you looking for snacks at 8:00 pm, or that craving will send you looking for chocolate at 9:00 pm.

Sunday, June 26, 2011

NSV of the week

I realize it's a lousy photo, but take my word for it...these are size 9 shorts!

Monday, June 20, 2011

Seeing the world through fat-colored glasses

I'm sure you've heard the term, "seeing through rose-colored glasses." That would probably describe me, the eternal optimist. Many of us also see the world through fat-colored glasses, with lenses that look clear but drastically distort our perception of fat and thin. I've been going through a strange and frustrating period of seeing myself as fat every time I look in the mirror even though my weight has not changed. The other day I realized that my vision is also distorted when I look at other people, thanks to a lesson I learned from my friend Lisa B.
Lisa lost 114 pounds after having RNY (gastric bypass) in 2001. She was proud to be thin, and with obnoxiously big (her term) augmented breasts and movie-star smile, she was smokin' hot.
But eventually her stomach pouch stretched out, she ate more and more, and her weight shot back up, a 44 pound increase. In May 2009, Lisa had what's known as BOB surgery - band over bypass. Since then, she's lost 70 lbs. and is back to being that smokin' hot lady. Because I'm always recruiting before/during/after photos to help inspire other bandsters, Lisa kindly gave me permission to publish hers in the Bandwagon on the Road newsletter and in the 2nd edition of Bandwagon. When I first saw Lisa's after photos, I was disturbed and told her, "You look very scrawny. Have you seen your doc lately, and does he/she think your current weight is healthy?"
Lisa's reply was illuminating on several levels. She wrote (in part):
"I still see my surgeon every 3 months as well as my NUT and they both said that because I am small-framed, I am at a really healthy weight (I always thought I was big-boned, turns out I was just fat LMAO). All of my stats are where they should be...body fat percentage, waist-to-hip ratio, etc., and my labs are perfect each time too.
"This is the exact weight that my body stopped losing at 18 months ago and has remained at ever since...literally haven't fluctuated more than 2 lbs up. So my doctor said this is where my body is happy - this is my 'normal' now. He also said early on that if a "normal" (meaning never obese, I guess) person was my size their whole life, it would not be an issue...they would be considered a "naturally thin person," (you know, the ones we grew up hating lol) but since I have never been a normal size until now, I can expect people to comment that I'm too thin (rather than normal and/or healthy). Which did happen when I first reached this weight a long time ago...but now everyone around me is used to it - not to mention they see how much I eat (7-8 times per day) and what I eat (healthy food choices 95% of the time) and so they all know that clearly this must be my body's 'normal'."
Well, those 2 paragraphs gave me a brand new view of body image! And who am I to judge what's normal for another person? Lisa's words immediately reminded me of one of my coworkers at JCPenney, a “naturally thin” college girl named Hailey. Her mom is short and heavy while her dad is tall and thin, and Hailey looks nothing like her mom and quite a lot like her dad. She’s in good health, with beautiful skin, good muscle tone, thick shiny hair, clear eyes, lots of energy, and as far as I’ve been able to see, eats well (for a college kid, anyway). As much as I tend to focus on body size, I've never thought much about Hailey's body size or shape. Her prominent characteristics to me are her kindness, intelligence, sense of humor, and (in terms of appearance) her great sense of color in her clothing choices.
The other day a customer (an elderly man) said to Hailey, “Girl, you gotta put some weight on you,” and Hailey laughed and said, “I think this is the way my body is meant to be.” When I look at Hailey, I don’t think, “She’s too thin.” She looks normal to me. I've known her for 2 years, she's been thin the whole time, and thin is her "normal". So it’s really interesting that I looked at Lisa's “after” photos and thought, “She’s too thin”!
Why do I look at 2 thin, attractive, healthy women and think one looks normal and the other looks too thin? The only difference is that I know Lisa is a WLS patient, and with that ID tag on her, I assume a host of things about her, including a tendency of some WLS patients to develop anorexic behavior and become too thin. And we all know what happens when you assume, right? Assuming makes an ass out of you and and ass out of me. So shame on me! If Lisa walked into my JCPenney store tomorrow (which would make my day!), I'd just be blown away by her slim good looks and that movie star smile. "Too thin" wouldn't even be on the horizon!

Monday, June 13, 2011

The Clean Plate Club

Are you a member of the clean plate club? Perhaps even its president?

I belonged to the CPC (Clean Plate Club) for over 50 years, so I consider myself something of an expert on it (and I am, after all, The World’s Greatest Living Expert on Everything). I thought it was a lifetime membership, but my bariatric surgeon rescued me from the CPC Cult – oh, excuse me, Club - and deprogrammed me so that I’m able to function more or less like a normal person now. Here’s my story.

I was inducted to the CPC as a child, when I was too young to realize that the promise of going to heaven if I always cleaned my plate was a bit more complicated than it sounded at the time. All I wanted to do at the time was to please the cult leaders: my mother and my grandmother.

I have reason to believe that my grandmother, whom I called Dranny, was the original founder of the CPC. Orphaned as a small child, she was passed around the family like an unwanted piece of furniture, and she raised her own children during the Great Depression. Through the combination of those circumstances and her own peculiar (and wonderful) character, Dranny was a pack rat. She didn’t live in filth and disorder (just the opposite, actually), but she couldn’t bear to throw anything away, especially not food. If three green peas were leftover from a meal and she hadn’t been able to persuade someone to eat them, she would lovingly place them in a custard cup covered with a shower-cap style cover (this was in the days before Glad Wrap), and store them in the fridge, where they would remain until someone ate them (or my mother threw them out while Dranny was in another room).

I’m a lot like my grandmother in various ways, and also something of a pack rat. So after eating my way through hundreds of childhood meals with Dranny and my mom (who was not a pack rat, but who was offended by the idea of wasting food that she’d worked so hard to procure and prepare), I emerged into adolescence with warring impulses – part of me still wanted to clean my plate, and part of me wanted to starve so that I could lose weight and be as skinny as the British supermodel, Twiggy.

One of my problems with meal planning and storage is that it's hard for me to predict how much food I'll be able to eat at a future meal. Often I don't know that until I've eaten several bites. My basic strategy for dealing with this unpredictability is to keep my plate clean from the very start so that the food I leave behind doesn't overwhelm me or provoke an attack of guilt that could bring down Dranny's wrath upon me.

A simple way to keep your plate clean is to prepare smaller batches of food so you won't be tempted by serving dishes overflowing with food or burdened with an excess of leftovers. I can't speak to recipes for baked goods (not my department), but most other recipes can be easily cut in half, thirds, or even quarters through the use of simple arithmetic.

Sometimes I prepare the whole recipe, subdivide into 2 or 3 batches, serve one batch immediately and freeze the other 2 for future use. When we lived in the northeast, the elderly widow who lived next door was delighted when we shared excess food with her. Sharing food with family, friends, and coworkers can yield multiple benefits. When I'm craving a food or recipe whose leftovers would be a problem for me to store (or resist), I prepare a big batch of it for whatever social event is on the horizon and keep only one or two portions of it at home so that we get to enjoy it without having to worry about to do with all that food. I use cheap, throw-away packaging so that no one can insist that I take my corning ware, Pyrex or Tupperware container of leftovers home with me.

You can also keep your plate clean by using the portioning technique I recommend for bandsters who are still learning their band eating skills, food portion sizes, and stop signals. Here's how it works for me. When planning my day's food (which I commit to my food log and my accountability partner every morning), I might decide that I'll eat 4 ounces (by weight) of chicken thigh and 1/2 cup of barley and veggy salad for dinner. Come dinner time, I grab my small plate (a salad plate) and put half of my planned meal on it: 2 ounces of chicken and ¼ cup of the salad. If I'm able to finish that, great. If I'm still physically hungry when I'm done with it, I go back to the kitchen and dish up the remaining 2 ounces of chicken and ¼ cup of salad. At the end of the meal, I'll probably have only 1 or 2 tablespoons worth of food to save or throw out instead of a plateful of food, therefore much less guilt to deal with.

When I do have a plateful of food leftover, I usually scrape it into a small plastic container that I can quickly grab and stick in my lunch bag when I go to work the next day. Fortunately, we actually like leftovers at our house, and arguments occasionally break out over unauthorized consumption of leftover food ("Who ate the rest of the eggplant Parmesan?!?"). The same approach works with restaurant meals. We're happy to take leftovers home in what used to be called a doggy bag (as if I'd share my Maryland crab cakes with a dog!).

My sister-in-law used to scrape leftover food into a bucket to add to her garden compost pile. I have no idea if that's a good practice. We'd have to have a 40' high electrified fence dug 20' into the ground and topped with razor wire in order to keep dogs, cats, deer, rats, raccoons, and other critters out of that kind of compost pile. I've also known people (including my mother) who fed leftover food to their 4-footed garbage disposals (dogs & cats), another practice that we avoid because why would you want to cultivate a fussy eater? Our pets have survived eating (stolen) candies (complete with foil wrappers), latex paint, and kip tails (fishing flies), and at our house, a fussy eater will end up starving because someone else is always willing to clean your plate for you, sometimes long before you've decided you're finished with it.

But what about the starving children? After over 3 years of banded life, I'm now able to detach myself from my emotional attachment to the food on my plate enough to throw out what's left. If it didn't taste right because my band was in an odd mood, if it caused me symptoms, if it wouldn't reheat or store well, I let it go. I haven't been struck by lightning for doing that, nor has God punished me with plagues, floods, or infestations.

Like many, I was raised to eat every meal while listening to a chorus singing the Children Are Starving in (fill in the blank) hymn. I agree that in world where so many children (and adults, and animals) go hungry, it is just plain wrong for an overfed middle-class person like me to waste or throw out food. But the fact is that me eating more food than my body needs (rather than throwing out) is not the solution to the problem of world hunger. The solution to world hunger, and to diminishing global food resources, is far, far more complicated than that. Working in your community (be it a village, a city, a country, or a planet) to solve that problem is a worthwhile effort, but you taking personal responsibility for causing the death of a starving, unknown child in India or Appalachia because you threw out a chicken wing and 5 green beans last night is a misguided and foolish use of your energy.

And you eating that extra bite of food just because you can't bear the thought of throwing it away is also foolish from a medical standpoint. If that extra bite causes you to PB, get stuck, or over-pack your pouch, it could lead to messy and expensive medical complications like esophageal or pouch dilation and/or band slips, especially if you eat that way on a regular basis.

Tuesday, June 7, 2011

My Cup Runneth Over

I overate for something like 50 years, never feeling that there was enough food in the entire universe to fill the hole inside me. Now, my cup finally runneth over, in the sense of Psalm 23:5 - I have more than enough for my needs.

Psalm 23 is the "The Lord is my shepherd, I shall not want" psalm, nowadays often recited during funeral services as grieving family and friends send the deceased off into the valley of the Shadow of Death. Its message is that as long as we dwell in the house of the Lord, our tables will be filled for us while our enemies watch and perhaps starve. Of course, this scene of a table piled high with food and overflowing with wine is symbolic rather than literal. Christians (among others) seek spiritual as well as physical nourishment. But as in many songs, poems, and stories, the message of Psalm 23 is powerful because the symbols it uses are such important and recognizable ones, at least for me. Few humans can fail to grasp the ideas of "want" (meaning "lacking" rather than "desire) and of plenty ("my cup runneth over") when it comes to food and eating.
But although I was baptized as an infant, confirmed as a Methodist at age 13, and confirmed as an Episcopalian at age 49, I failed to grasp the concept of "plenty" for a very long time, especially in reference to food. It's truly a miracle to me now to feel that I have enough food for my needs.

What has changed? I'm still a well-educated middle-class citizen of a country so overflowing with food that a third of its population is overweight. I've never had to worry about where my next meal was coming from, though at times it felt that way to me. What's changed is that I now have an adjustable gastric band that is interfering (in a good way) with the satiety signals that zip back and forth between my brain and my body.

When bandsters complain that their band isn't working because they never experience satiety, I have to wonder what their definition of satiety is, and sometimes I want to say in a quiet, nerdy, Zen-esque way, "You're not listening closely enough." While it's true that a great deal of my weight loss success is related to my conscious meal planning, food choices, and portion control (just like dieting in the bad old days), another big chunk of it is a mystery to me, perhaps beyond my capacity to ever understand. I don't think it's simply a placebo effect (in which the efficacy of my band is caused by my belief in its power to work), because pieces of the mystery are revealed to me in such a haphazard way. For example:

Yesterday I made a beautiful dinner of teriyaki pork kebabs, edamame cakes, and roasted peaches. It smelled divine while it was cooking and I was well-supplied with both appetite and physical hunger when we sat down at the table to eat. The first bite of the pork tasted very bland to me despite the teriyaki sauce and I wondered if I'd forgotten an ingredient. The second bite tasted the same as the first bite, plus its texture was unpleasant. It was moist and tender, but I wanted to spit it out. I think I was probably a toddler the last time I spit food onto the dining table (or high chair). I finished chewing the bite of pork and said to my husband, "I'm sorry, this pork is nothing special." And he said, "What are you talking about? It's delicious!"

Suddenly I heard the flapping of tiny wings in my brain...my band fairy waving her magic wand and singing in a twinkling little voice, "You don't have to eat it!" So I didn't. I enjoyed my edamame cake and roasted peach half very much instead, and although I'd eaten perhaps half a cup of food altogether, I felt very satisfied. I was still a bit puzzled about my "rejection" of the pork, but on the whole, my cup runneth over. I had more than enough for my needs, and the uneaten food on my plate went into the mouth of our electric pig. Throwing out uneaten food is no small deal for me, and I've promised my friend Claudia to devote a future newsletter to that subject, so all I'll say right now is that although I felt a slight twinge of disappointment as I scraped the food off my plate, as soon as it was gone my mind moved on to the next thing (cleaning the kitchen) without any regret.

Hmmmm...I seem to hear some murmuring from your direction...you're muttering, "That's all very well for Jean to say, but I've only had my band for 3 months and I'm not feeling anything like satiety yet!" All I can tell you is, hang in there. You might need more fill, or different food choices, or more frequent meals/snacks. Unfortunately success with the adjustable gastric band is not an exact science. Individual patients don't react identically to the band any more than individual patients react identically to a dose of a pain killer. After taking 30 mg of codeine, some people experience blessed pain relief, some people get high, and some people get sick to their stomach. This is one of the reasons that there is no such thing as DIY bariatric surgery or DIY pharmaceuticals (or legal ones, anyway).

Tuesday, May 24, 2011

Last Meal Syndrome

Last Meal Syndrome is very common among people facing weight loss surgery, and chances are you've already suffered it some time in your life, perhaps the day before you started New Diet #832. Since New Diets almost always start on a Monday (there may be a law of nature covering that), you spent every minute of Sunday gorging on all the foods you could no longer eat come Monday morning. You ate so much that you made yourself slightly ill, and you probably didn't taste half of that food in your haste to cram it into your mouth.

Overeating because of anticipated deprivation is an old, old habit. Until the earliest humans learned to plant seeds and cultivate their own food supply, nutrition was largely a matter of opportunism. If you caught a big fish or felled an animal by heaving a rock at it, you ate it all because you didn't know when another meal would swim, crawl, walk, or fly by.

Although I sometimes joke that being self-employed is terrifying for me because it's a hand-to-mouth existence, at no time in my middle-class American life have I ever been truly threatened by significant food deprivation. My repeated bouts with Last Meal Syndrome have been caused mostly by my emotional over-attachment to food. When starting a new weight loss diet, or contemplating my coming bariatric surgery, I was terrified not that I would starve, but that I would suffer from emotional pain, boredom, or stress unrelieved by my usual comfort: whatever food I wanted, when I wanted it, in any quantity I wanted. Intellectually I knew that I would be able to eat small amounts of healthy foods and thus lose weight and gain better health, but the spoiled, petulant child within me feared and hated the very thought of that.

A few days before I was banded, my husband asked me, "Are you going to have anything special to eat before your surgery?"

I said, "I'm on a clear liquid diet for the next three days. I can't eat anything at all, never mind something special." My surgeon had told me that if my liver wasn't in good shape (that is, having a manageable size and texture), he would bail out of my surgery. After all I had gone through to get to the operating room, I wasn't going to blow it, and it wasn't (as I reminded myself) as if I would never be able to eat again in my entire life. I was facing food deprivation, yes, but for a matter of days, not years.

Now, let's get one thing clear here: I'm not claiming superiority over pre-ops who give in to Last Meal Syndrome and celebrate their own private food festival a day or so before their surgery. My compliance with my surgeon's instructions was driven by fear, plain and simple. I wasn't (then or now) a paragon of virtue. But in the last three years, I've learned something important that newbies and wannabes may not realize about the adjustable gastric band. And that is:

The only food deprivation you will suffer after band surgery involves the QUANTITY, not the quality or nature of the food you eat. With a properly adjusted band, you should be able to eat a wide variety of foods you like. You don't have to give up Cheetos or Haagen Daz or McDonald's or prime rib of beef forever. All you have to give up is eating those foods in excess. It's true that when your daily calorie budget is limited, your health will depend on your making the best possible food choices - eating a piece of cheese instead of the Cheetos, a Skinny Cow ice cream bar instead of a gallon of Rocky Road, a Happy Meal instead of a quarter-pounder, two ounces of prime rib instead of the whole cow. You and your band will still be able to tolerate just about anything, so when you look down the road that your bandwagon will travel, you should see plenty of nice places to stop and eat instead of a dry, barren desert in which you'll have to subsist on stale melba toast and lukewarm water.

That's the good news. Now here's the bad news:

After band surgery, you'll be able to eat a wide variety of foods you like. Yes, I know I already said that, up there in the good news paragraph. But the tolerance of almost any food you can imagine means that you will have to exert some self-control to avoid overindulging. Now you may be thinking, "If I had any self-control, I wouldn't need weight loss surgery." If the need for self-control is a deal-breaker for you, maybe you should consider a different bariatric procedure, one that will allow you to eat anything at all and lose a pound a day. I'm not convinced that such a procedure exists, because I've heard too many gastric bypass (and even duodenal switch) patients moaning about significant weight regain, but by all means give the Magic Weight Loss Surgery a go. Maybe self-control will never be an issue for you again.

After your surgery, will you be sentenced to a lifetime of stale bread and water?

No.

I have a few more words to say about self-control, but right now I want to reassure you that eating with your gastric band is not going to involve an endless series of dreary meals. It's not going to be like the mysteriously popular diet that requires you to eat nothing but cabbage soup three times a day. It's going to involve eating like a normal person who enjoys food but has a small appetite. Depending on your experience of restriction after each fill, you may have to forgo certain foods at times, but just because you can't comfortably eat a bagel with cream cheese today doesn't mean you'll never again be able to have a few bites of bagel. Your food tolerance is going to depend not only on your fill level but also on your eating skills. The day after my first fill, I suffered my first stuck episode after taking a huge bite of a grilled cheese sandwich. I have a lot more fill in my band now but I could eat that same sandwich for lunch today because now I'm used to eating slowly, taking tiny bites and chewing the food very well. I probably wouldn't eat the whole sandwich because I'd get "full" so quickly, and that's a good thing!

Thou Shalt Not

Somewhere in the dark mists of my distance past, the term “reverse psychology” entered my awareness, especially as applied to child-rearing. The idea was that if you told your child “Please slam the door when you leave the house,” the defiant devil in that child would shut the door quietly in opposition to your instruction. I don’t have human children and never observed reverse psychology work magic in my childhood home. No matter how firmly you told my brother not to brush his teeth, his teeth went unbrushed. Telling him to jump on the bed would trigger a marathon jumping session (causing the box spring to violently part company with the bed frame) instead of a peaceful bedtime story. And I was no angel – I rewarded my mom’s laissez-faire attitude towards teen dating by involving myself with the worst losers I could find.

Despite all that, I know there’s a kernel of truth in the concept of reverse psychology. If you told me I must never, ever eat chocolate again, I’d get started on a chocolate binge before you even finished your sentence. And if you told me, “Thou shalt not even think about potato chips,” my every waking and dreaming moment would be filled with potato chips.
Unfortunately, this principle doesn’t work in both directions, at least not for me. If you told me, “You must eat nothing but ice cream this week,” I’d be happy to comply. I’d grab my car keys and ice cream scoop and race to the frozen foods section of the nearest supermarket (after a quick stop at Baskin Robbins).

Author and eating disorder expert Geneen Roth tells a story about a mother who worried about her daughter’s weight. Even when the mom locked sweets up in a cabinet, the daughter managed to smuggle sweets into the house and hide in her bedroom to gorge on them. When the mom took Roth’s advice to give the child free access to sweets, the girl tired of them and began to make healthier food choices within a few days. This was a clear case of what I call Forbidden Food Syndrome, in which forced abstinence increases the person’s desire for the “bad” food.
I don’t doubt that Roth’s advice in that case was sound, but in my personal experience, food rules aren’t the only cause of secretive food hoarding and gorging. My mom’s food rules had more to do with good manners than with nutrition. I had to take at least one bite of each food on my plate, chew with my mouth shut, ask for permission to leave the table, and dirty no dishes after supper. Other than that, I could eat whatever I wanted, in any quantity. Even with that much freedom, I would hoard and binge on sweets, alone in my room, at every opportunity. I wasn’t eating out of defiance, but neither was I eating for “good” or healthy reasons. Even at age nine, I was eating for emotional reasons – comfort, numbing, entertainment, you name it.
As an adult, I have a better handle on my emotional eating than I did at age nine. I’m well aware of the food-obsessed Jeannie who will run without hesitation right into rush-hour traffic if a brownie might be waiting for me on the other side of the road. I know intimately the defiant Jeannie who insists on eating a piece of garlic bread even though she knows that the third or fourth bite could easily get stuck in her stoma and cause a lot of discomfort. I have to monitor myself every day in order to maintain the delicate balance between choosing not to eat a piece of birthday cake because eating it doesn’t serve my weight management goals and choosing to go ahead and eat the entire cake simply because I know it doesn’t serve my weight management goals.

Sometimes I feel like a freak because I have to deal with issues like this. I watch “normal” people making carefree eating choices and enjoying complete eating freedom with no awful consequences (or at least, that’s the way it looks to me), and deep down inside, I hate those normal people. They’re not yoked to this heavy burden of disordered eating like I am. It’s just not fair. But I’m gradually relaxing about my eating issues enough to be able to listen better and to hear more messages from my normal friends and acquaintances, and to realize that they too struggle with things like Forbidden Food Syndrome from time to time.

I have a disgustingly healthy co-worker who told me recently that she can’t eat chocolate because it gives her bad migraine headaches. She avoids chocolate, but she confessed that she wants it all the more because she can’t have it, and when she tells herself it’s OK to eat one small piece, she finds that she can’t stop – she eats three, five, seven pieces even though she knows she’ll pay for it sooner or later. She doesn’t pay with obesity, she pays with pain. She doesn’t know the pain of obesity as I do, but she and I struggled with the same basic problem. Little does she know how valuable her chocolate story is to me. It reminds me that I’m really not a freak – I just have a more intense and widespread eating problem than hers. It’s a matter of degrees. She’s five degrees off-center while I’m 45 degrees off. Neither of us is perfect. We both have to work at making good choices – not just in our eating behavior, but in every piece of behavior that could have good or bad consequences for us or for our family and friends. To my mind, this is just part of human existence, part of the responsibility that adult humans bear for maintaining a civilized and (we hope) peaceful co-existence with each other and ourselves.
Having to deal with eating choices may seem like an awful burden at times. So many people have bariatric surgery believing or hoping that it will solve everything, that they’ll never have to struggle with eating again. Most of the time, that’s not the happy ending to their story. Their story has a different ending that could be happy if they adjust their thinking to it. Is the burden of good eating choices too heavy for you? Your surgery helped you lose all that weight, shouldn’t it help you maintain that weight loss without another thought for the rest of your life? That’s a nice idea, but it’s not realistic. It’s kind of like hitting the “seven-year itch” in a marriage. You had a romantic honeymoon with your band, things were great for a while, and then things got harder and harder. You can fall in love with another bariatric procedure, believing that a revision to gastric bypass or whatever will hand you the key to happily-ever-after. Or you can stick with the partner you already have, survive some tough times, and come out of it all the stronger.

All this may be too philosophical for you, but I’m telling you about it because thinking about my eating problems this way has helped to put them in perspective, and putting them in perspective makes them a lot more manageable. Perspective is the art of seeing things in correct relationship to each other. As I wrote in Bandwagon, without perspective, my computer’s monitor looks ten times bigger than my neighbor’s barn across the road. In fact, my computer monitor is tiny compared to that barn. Without perspective, my weight management challenges seem enormous. I lost all that weight in just one year, but my maintenance job goes on forever. But consider the alternative. I could go back to obesity. I could have a stroke and become a human vegetable, reliant on others for everything from speech to toileting. I could lose my limbs to diabetes, reliant then on others for everything from tooth-brushing to transportation. I could suffer cardiac arrest and die at age 60. Or I can work at maintaining my weight and my health, with a huge payoff of mobility, independence, and longevity.

So…back to Forbidden Food Syndrome. Although I’ve said that reverse psychology doesn’t always work with me, I must also say that one of the reasons I chose the band was that living with it would allow me to choose from a wide variety of foods I like. (Yes, I know I’ve used that phrase before, and I’ll probably use it again.) My nutritionist told me I might have problems eating certain foods, like celery or pasta, and I was willing to take the chance because life without celery or pasta still looked pretty good to me. But when my surgeon, speaking at the bariatric surgery informational seminar I attended, said that gastric bypass patients need to avoid all foods that are high in sugar, fat, or simple carbs because of the possibility of dumping, I mentally walked into a barbed wire fence and backed right off. At the time, I had one gastric bypass friend who didn’t dump, but the bypass patient who spoke at the seminar reported that he does dump, and when he described a typical day’s eating, I thought, “That’s not for me.” That guy was justifiably proud of his weight loss and didn’t mind a limited list of food choices, but I knew that limited food choices would send me running straight for the junk food if only out of sheer boredom. The night of that seminar, I hadn’t eaten a chocolate chip cookie for several months, but just the idea of giving up cookies forever made me want to stop at a bakery on the way home.

I chose the adjustable gastric band, and the breadth and flexibility of my “OK Foods” list is one of the things that makes my post-op life enjoyable. I do overeat from time to time, but not because of Forbidden Food Syndrome. Taking foods off the Forbidden list has robbed them of some of their power over me. As a pre-op, I would attend a co-worker’s birthday party and eat two pieces of cake (Forbidden) because I’d been avoiding cake and missing it so much. As a post-op, I recently walked through the break room at work and saw a birthday cake on the table. I briefly wondered what flavor it was (impossible to tell from the decorative frosting, whose colors can’t be found in nature) and told myself I could try a little piece of it later, on my official break. Lo and behold, come break time I was quite hungry and not in the mood for cake. I wanted my chicken salad, and when I was done with that, I had no room for cake, so I went back to work without another thought about birthday cake. Now,

Tuesday, May 17, 2011

Forbidden Food

Somewhere in the dark mists of my distance past, the term "reverse psychology" entered my awareness, especially as applied to child-rearing. The idea was that if you told your child "Please slam the door when you leave the house," the defiant devil in that child would shut the door quietly in opposition to your instruction. I don't have human children and never observed reverse psychology work magic in my childhood home. No matter how firmly you told my brother not to brush his teeth, his teeth went unbrushed. Telling him to jump on the bed would trigger a marathon jumping session (causing the box spring to violently part company with the bed frame) instead of a peaceful bedtime story. And I was no angel - I rewarded my mom's laissez-faire attitude towards teen dating by involving myself with the worst losers I could find.

Despite all that, I know there's a kernel of truth in the concept of reverse psychology. If you told me I must never, ever eat chocolate again, I'd get started on a chocolate binge before you even finished your sentence. And if you told me, "Thou shalt not even think about potato chips," my every waking and dreaming moment would be filled with potato chips.

Unfortunately, this principle doesn't work in both directions, at least not for me. If you told me, "You must eat nothing but ice cream this week," I'd be happy to comply. I'd grab my car keys and ice cream scoop and race to the frozen foods section of the nearest supermarket (after a quick stop at Baskin Robbins).

Author and eating disorder expert Geneen Roth tells a story about a mother who worried about her daughter's weight. Even when the mom locked sweets up in a cabinet, the daughter managed to smuggle sweets into the house and hide in her bedroom to gorge on them. When the mom took Roth's advice to give the child free access to sweets, the girl tired of them and began to make healthier food choices within a few days. This was a clear case of what I call Forbidden Food Syndrome, in which forced abstinence increases the person's desire for the "bad" food.

I don't doubt that Roth's advice in that case was sound, but in my personal experience, food rules aren't the only cause of secretive food hoarding and gorging. My mom's food rules had more to do with good manners than with nutrition. I had to take at least one bite of each food on my plate, chew with my mouth shut, ask for permission to leave the table, and dirty no dishes after supper. Other than that, I could eat whatever I wanted, in any quantity. Even with that much freedom, I would hoard and binge on sweets, alone in my room, at every opportunity. I wasn't eating out of defiance, but neither was I eating for "good" or healthy reasons. Even at age nine, I was eating for emotional reasons - comfort, numbing, entertainment, you name it.

As an adult, I have a better handle on my emotional eating than I did at age nine. I'm well aware of the food-obsessed Jeannie who will run without hesitation right into rush-hour traffic if a brownie might be waiting for me on the other side of the road. I know intimately the defiant Jeannie who insists on eating a piece of garlic bread even though she knows that the third or fourth bite could easily get stuck in her stoma and cause a lot of discomfort. I have to monitor myself every day in order to maintain the delicate balance between choosing not to eat a piece of birthday cake because eating it doesn't serve my weight management goals and choosing to go ahead and eat the entire cake simply because I know it doesn't serve my weight management goals.

Sometimes I feel like a freak because I have to deal with issues like this. I watch "normal" people making carefree eating choices and enjoying complete eating freedom with no awful consequences (or at least, that's the way it looks to me), and deep down inside, I hate those normal people. They're not yoked to this heavy burden of disordered eating like I am. It's just not fair. But I'm gradually relaxing about my eating issues enough to be able to listen better and to hear more messages from my normal friends and acquaintances, and to realize that they too struggle with things like Forbidden Food Syndrome from time to time.


I have a disgustingly healthy co-worker who told me recently that she can't eat chocolate because it gives her bad migraine headaches. She avoids chocolate, but she confessed that she wants it all the more because she can't have it, and when she tells herself it's OK to eat one small piece, she finds that she can't stop - she eats three, five, seven pieces even though she knows she'll pay for it sooner or later. She doesn't pay with obesity, she pays with pain. She doesn't know the pain of obesity as I do, but she and I struggled with the same basic problem. Little does she know how valuable her chocolate story is to me. It reminds me that I'm really not a freak - I just have a more intense and widespread eating problem than hers. It's a matter of degrees. She's five degrees off-center while I'm 45 degrees off. Neither of us is perfect. We both have to work at making good choices - not just in our eating behavior, but in every piece of behavior that could have good or bad consequences for us or for our family and friends. To my mind, this is just part of human existence, part of the responsibility that adult humans bear for maintaining a civilized and (we hope) peaceful co-existence with each other and ourselves.

Having to deal with eating choices may seem like an awful burden at times. So many people have bariatric surgery believing or hoping that it will solve everything, that they'll never have to struggle with eating again. Most of the time, that's not the happy ending to their story. Their story has a different ending that could be happy if they adjust their thinking to it. Is the burden of good eating choices too heavy for you? Your surgery helped you lose all that weight, shouldn't it help you maintain that weight loss without another thought for the rest of your life? That's a nice idea, but it's not realistic. It's kind of like hitting the "seven-year itch" in a marriage. You had a romantic honeymoon with your band, things were great for a while, and then things got harder and harder. You can fall in love with another bariatric procedure, believing that a revision to gastric bypass or whatever will hand you the key to happily-ever-after. Or you can stick with the partner you already have, survive some tough times, and come out of it all the stronger.

All this may be too philosophical for you, but I'm telling you about it because thinking about my eating problems this way has helped to put them in perspective, and putting them in perspective makes them a lot more manageable. Perspective is the art of seeing things in correct relationship to each other. As I wrote in Bandwagon, without perspective, my computer's monitor looks ten times bigger than my neighbor's barn across the road. In fact, my computer monitor is tiny compared to that barn. Without perspective, my weight management challenges seem enormous. I lost all that weight in just one year, but my maintenance job goes on forever. But consider the alternative. I could go back to obesity. I could have a stroke and become a human vegetable, reliant on others for everything from speech to toileting. I could lose my limbs to diabetes, reliant then on others for everything from tooth-brushing to transportation. I could suffer cardiac arrest and die at age 60. Or I can work at maintaining my weight and my health, with a huge payoff of mobility, independence, and longevity.

So...back to Forbidden Food Syndrome. Although I've said that reverse psychology doesn't always work with me, I must also say that one of the reasons I chose the band was that living with it would allow me to choose from a wide variety of foods I like. (Yes, I know I've used that phrase before, and I'll probably use it again.) My nutritionist told me I might have problems eating certain foods, like celery or pasta, and I was willing to take the chance because life without celery or pasta still looked pretty good to me. But when my surgeon, speaking at the bariatric surgery informational seminar I attended, said that gastric bypass patients need to avoid all foods that are high in sugar, fat, or simple carbs because of the possibility of dumping, I mentally walked into a barbed wire fence and backed right off. At the time, I had one gastric bypass friend who didn't dump, but the bypass patient who spoke at the seminar reported that he does dump, and when he described a typical day's eating, I thought, "That's not for me." That guy was justifiably proud of his weight loss and didn't mind a limited list of food choices, but I knew that limited food choices would send me running straight for the junk food if only out of sheer boredom. The night of that seminar, I hadn't eaten a chocolate chip cookie for several months, but just the idea of giving up cookies forever made me want to stop at a bakery on the way home.

I chose the adjustable gastric band, and the breadth and flexibility of my "OK Foods" list is one of the things that makes my post-op life enjoyable. I do overeat from time to time, but not because of Forbidden Food Syndrome. Taking foods off the Forbidden list has robbed them of some of their power over me. As a pre-op, I would attend a co-worker's birthday party and eat two pieces of cake (Forbidden) because I'd been avoiding cake and missing it so much. As a post-op, I recently walked through the break room at work and saw a birthday cake on the table. I briefly wondered what flavor it was (impossible to tell from the decorative frosting, whose colors can't be found in nature) and told myself I could try a little piece of it later, on my official break. Lo and behold, come break time I was quite hungry and not in the mood for cake. I wanted my chicken salad, and when I was done with that, I had no room for cake, so I went back to work without another thought about birthday cake. Now, that's freedom!

Your assignment for today
What's on your forbidden foods list?

Tell all! Write to me at: jmcmillan159@gmail.com and give me your list of forbidden foods. Are they forbidden forever, or just for today? Is it safe for you to keep them in your house, or is it better to enjoy them at a restaurant where you don't have access to the whole pie or cake? How long have you been abstaining from these foods? Do you long for them every day, just occasionally, or when menstruating or stressed?

Although I try not to even think in terms of forbidden foods these days, I do have a short list of foods that are just plain dangerous for me. Here's it is:

1. Ice cream - it's not safe for me to keep ice cream in the house. In my obese days, I used to eat one half to a whole gallon of ice cream a day, straight from the container - no scoop required, just a spoon. I don't crave it any more, but I'm afraid that one spoonful is never going to be enough. The last time I had ice cream was August 2010, when my friend Lisa and her husband and dogs took me to the beach in Oregon. It was divine, and I was sorely disappointed when my little scoop of heaven was gone.

2. Cool Whip - after eating an entire 8-ounce container of Cool Whip one night when I was craving ice cream, I realized that Cool Whip isn't safe to have around either. Fortunately, it doesn't appeal to me in the least when I'm walking down the freezer aisle at the supermarket.

3. Potato Chips - I literally cannot eat "just one". Ever! I don't care if they're baked instead of fried, or made of organic Tasmanian parsnips enriched with pomegranate, green tea and beet extract. The last time I ate potato chips was at a potluck lunch at work last Christmas. I was surrounded by coworkers who believe I'm a health food nut, so their attention made it possible for me to limit my consumption. I don't walk down the chip and snack aisle at the supermarket any more.

Tuesday, May 10, 2011

The Weight Loss Window of Opportunity

The fabled weight loss "window of opportunity" puts a lot of pressure on its believers, who worry constantly that if they don't begin losing weight immediately after their surgery and keep up the pace of weight loss week after week, their ability to lose more weight will disappear sometime between 12 and 18 months post-op.
I’m going to share with you my opinion on this issue. If I sound emphatic about it, it’s because I feel strongly, not because I’m a medical professional who can quote 200 studies that prove my point. But give it a listen anyway…maybe it’s time to open your mental window.
As far as I can tell, the weight loss window may exist for people who’ve had RNY (gastric bypass) surgery for 3 reasons. It’s possible for their stoma to stretch out over time, not because of overeating but because that’s what can happen under the circumstances of ordinary use. The malabsorption feature of their intestinal re-routing may diminish as the intestinal villi (little finger-like projections from the intestinal wall) re-grow and thereby increase the surface area available for absorption of nutrients. Their physical hunger may return or grow stronger as their body adjusts the metabolism to the patient’s reduced caloric intake. So at some point, the RNY patient may have to exert more effort in the form of portion control, food choices, exercise, and the like in order to continue losing weight or avoid weight regain.
The adjustable gastric band patient, on the other hand, has a tool that can be fine-tuned with fills and unfills to achieve optimal weight loss at any time after their surgery, be it at 2, 12, 18, 36, or 360 months post-op. Each fill can re-set the patient’s hunger, appetite and satiety controls so that weight loss can re-start or continue. If the patient regains weight, the regain can be lost and the weight loss journey started again without the need for further bariatric surgery. I’m not claiming that it works this way for every single band patient because the band doesn’t seem to work for everyone, nor does it seem to work in the same way for every patient, and there are far too many other factors affecting weight. But the potential for weight loss is definitely there.
At a WLS support group meeting I attended last year, Danielle DeKay, R.D., nutritionist for Swedish Weight Loss Services in Seattle, Wa, commented that band patients and RNY patients all have to make the same behavioral changes in order to succeed. Band patients must start that work before or at the time of their surgery, while RNY patients can lose weight without a lot of effort for 12 to 18 months…but sooner or later, everybody’s got to do the work. I was personally very gratified to hear her say this because it confirmed my own suspicion (and like most people, I do like to be right every now and then).
There are at least two more factors that can open or close the window of weight loss opportunity. Again, this is my own personal observation, not the result of years of scientific research in properly-controlled clinical studies. One factor is this: it’s extremely difficult for anyone, no matter what bariatric surgery they’ve had, to sustain a weight loss effort beyond 12 to 18 months. Over and over again, I’ve seen bariatric patients run out of gas somewhere on the road to their weight goal. They’ve already lost a great deal of weight, they feel better, they get comfortable, they get busy with other perfectly worthwhile things (like childbirth, career advancement, college, you name it), and their attention is no longer 100% on weight loss. I don’t see that as an unhealthy thing, and I don’t think any shame should be attached to re-thinking your weight goal after you’ve moved from the obese to the overweight category and your health has greatly improved. Nor is it a shame to decide after a lengthy weight loss plateau (I’m talking 6 to 12 months, not 6 to 12 days!) that further medical intervention is needed – like weight loss medication or revisional surgery. I also believe that anyone can achieve any weight goal if they dedicate enough time, energy, and resources to it.
The other factor is this. As I wrote in Bandwagon, no bariatric surgery of any description is going to banish the eating demons that live in your head. They must be dealt with sooner or later, like it or not.

Thursday, April 28, 2011

Holiday Eating - from the 12-20-10 issue of Bandwagon on the Road

Food has been the guest of honor at human gatherings since the beginning of time. When I watch my gang of dogs attack their kibble, ferociously protecting it from others, I think that sharing food must be a uniquely human impulse (but then again, I'm not a zoologist). I've visited poverty-stricken countries where even a starving family will share a bowl of rice with a beggar. For many people, offering food to a guest is a point of pride. My own grandmother would not let anyone leave her house even remotely hungry. To be polite, you ate her food (with 2nd, 3rd and 4th helpings) even if you'd already eaten a generous meal before you arrived.

With that code of behavior underlying human social relationships, refusing food at holiday celebrations can make you look rude and unappreciative. So how do you safely navigate all those meals? You want to avoid the embarrassment of eating problems like PB's, sliming, or stuck episodes. You want to stick with your weight loss eating plan and go on losing weight (or at least maintaining your weight), but at the same time, you want to enjoy foods that only appear at this time of year. You don't want to call attention to your eating because it's nobody else's business (especially if you're with people who don't know about your weight loss surgery). What's a bandster to do?

Let's look at 3 of the most common holiday eating situations:

1. a meal or party at someone's home

2. a meal or party at a restaurant or other public venue

3. a meal or party at your own home

There is one piece of advice that applies to all three situations. I've mentioned this before...can you guess what it is? That's right, it's:



A D V A N C E P L A N N I N G !



Before each event, do your research. Make some calls to find out what food will be served. Restaurant parties sponsored by employers, unions, clubs & associations often involve a limited set menu - a choice of 2 or 3 entrees - so choose a safe one. I'd go with the fish instead of the prime rib or lasagna, for example. At other restaurant events, you can order from the menu, so call the restaurant (or look it up online) and choose 2 possible meals (in case one isn't available the day you're there).

If you're going to someone's home or to a potluck meal at work, church, or wherever, bring something healthy that you know you can eat and/or drink. A buffet style meal can be scary - how will you resist all those treats? - but it actually gives you some control over what ends up on your plate and in your mouth. First of all, take a tour of the buffet to identify the foods you can eat and want to eat (treats are allowed in small portions if you're sure you can resist the urge to go back to the buffet for more helpings). Choose 4 to 6 items that you're going to enjoy. If you want to try something you've never had before, use common sense in evaluating its risks. Avoid foods that in some other form have caused you eating problems in the past, and inspect the new food for texture and consistency - soft or cooked food is probably OK, but if you got stuck on a raw veggy last week, that gorgeous crudité platter probably isn't going to work for you this week.

Grab a salad or dessert plate instead of a dinner plate, and a small salad fork (if available). Put one spoonful of each of the selected items on your plate. Ignore the champagne fountain - it's mighty hard to balance a plate and a glass at the same time anyway. Find a place to sit or stand far away from the buffet. Eat your food slowly, paying attention to your eating skills and to the flavors in the food. Don't try to eat and chat at the same time. Use a conversation with another guest as a chance to take a break from your eating. You can also use it as an excuse to get rid of your plate (even if food is still on it) by saying something like, "I can't juggle this plate and visit at the same time - let me just put it down somewhere." Then you can become so engrossed in the conversation that you "forget" your plate altogether.

If the event is a sit-down meal, you'll have to adjust your approach depending on how the food is served. If your host or a waiter serves you a loaded plate, you can take a small bite every now and then while pushing the food around on your plate as if you're eating it, and if someone comments that you haven't finished your food, you can say, "Gosh, it's all so good, but it's just too much!" If the meal is served in a pass-the-serving-dish fashion, just pass the dish you're not going to eat without any comment at all. If someone says, "Aren't you going to try my special turtle-and-frog salad?" you can respond with something like, "Can you believe I had a huge turtle dinner just last night?" or "I'll have some of that the next time the dish goes around," or "Not tonight, thanks."

A meal or party at your own home will involve more work on your part but give you the most control over the menu. One of the advantages of being the host or hostess is that no one's going to be surprised if you're always busy fetching and carrying food and never seen actually eating it. If someone comments on your light (or non-existent) eating, you can say, "I'm so bad - I nibbled while I was cooking and now I'm too full to eat anything else."

Monday, April 25, 2011

The guest at my table

I may not always be aware of it, or care to acknowledge it, but there is an uninvited guest at my table, and it’s not the Ghost of Christmas Dinners Past.

Recently my friend Wilbur, who is active in Overeater’s Anonymous and has lost 45 pounds as a result, sent me an e-mail with something striking in it. I’m paraphrasing the message a bit for brevity, but I think you’ll get the message. Wilbur wrote:

"I have come to see that for me it is not about food addiction. It is not about trigger foods. It is about the mind, the crazy mind that suddenly, quixotically tells me it is okay to start eating. I can binge on anything. It is not about picking up one piece of food. It is about a mental state which tells me to do things I don’t want to do. And it is about a bodily state which sets up craving where there is never enough. That is the obsession that’s been lifted from me now. Healthy eating of healthy foods in healthy amounts is eating with God. Not drinking alcoholic beverages is drinking with God."

When I wrote Bandwagon, I was beginning to have inklings that there was a spiritual issue at the core of my eating problem, but I didn’t write much about it then because my own awareness was so new. And I’m trying to be careful with how I present it in the Bandwagon™ on the Road newsletters because I don’t want to turn off people who don’t want to hear the word God. Sometimes when I’m writing I hear myself switch into Preacher mode and feel that’s not a good thing. (I think Teacher mode is better on the whole.) But I’d be lying if I said I don’t want to eat with God. I do want to, on so many levels, in so many ways, that it’s really the subject of an entire book.

Breaking Bread Together

Many of us feel anxious when we contemplate what it will be like to share a meal with others after our weight loss surgery. Will we be able to enjoy a nice restaurant meal? How will we deal with food-centered celebrations at work, at church, at home? What about that Caribbean cruise we’ve always dreamed of, with wonderful food available 24 hours a day? Will we be forced to sip water and nibble on a piece of stale Melba toast while everyone else parties hearty? Should we just avoid social eating altogether?
I’m here to tell you that life does go on after weight loss surgery, a life that includes both food- and non-food- centered activities, but in my case the whole business of social eating is quite different now than it was pre-op. And that’s a good thing, when you consider how much overeating I did and what poor food choices I used to make, especially in my overseas travels. (Let’s face it, what I practiced then was plain old gluttony.) Life after weight loss surgery involves a new and improved approach to eating in order to optimize weight loss (and weight maintenance once you’re at your weight goal), but it should not involve Draconian deprivation, suffering, torture, or entombing yourself inside a brick wall like a medieval nun trying to avoid all temptations of the flesh. Breaking bread together is a vital part of human life that does more than fill our bellies – it fills our souls and cements our communities, be they lay or religious.
What does it mean to break bread together? Although many Christians believe that “breaking bread” symbolizes the Last Supper, history tells us that the “breaking of bread” is in fact a standard Jewish expression from pre-Christian times which refers to the action of “breaking bread” at the start of a meal, a ritual performed by the head of a household or the host presiding at the meal. The host would break the loaf of bread in two pieces and speak a prayer thanking God for the bread and the meal, and for the fellowship in sharing God’s blessings with the family and guests present at the table.
That kind of fellowship is no small thing, especially in an age with a highly mobile population that communicates more via text than via voice or face-to-face meetings. The weekly Sabbath meal with an extended family that those of raised in the Judeo-Christian tradition once took for granted seem to be disappearing…we’re too modern, too fast-paced, spread too far apart, to spare the time for that kind of gathering now.
I’m not saying that you ought to spend every Friday evening or Sunday afternoon trapped in a small room with bickering relatives, but we all need social activities in order to thrive as human and social beings. If your family’s Sunday gathering involves making your mother cry because you won’t eat a third helping of lasagna, you can still enjoy fellowship with people who are less likely to push your guilt buttons. And if everyone you know, from your partner to your office mate to your best friend from high school, keeps telling you things like, “It’s OK, one little piece of cheesecake won’t hurt,” it may be time to rethink your relationships and the boundaries you need to set.

Monday, April 18, 2011

Fear of Fat

One of the aspects of weight maintenance that I didn’t expect is the persistent fear of fat.
When I say “fear of fat”, I’m not talking (right now, anyway) about the cultural phenomenon that makes us worship emaciated celebrities and scorn the obese ones. I’m talking about fear of fat on the local level, inside our own hearts and minds.
You’d think that my track record with my band would give me confidence. I lost all my excess weight, I regained 25 pounds, and then I re-lost those 25 pounds. I still have the basic tools I need to deal with weight gain: my band, my knowledge of how to use it, and my own inner resources (perseverance, intelligence, discipline). I’ve gained a boatload of self-confidence and feel strongly that I can accomplish anything I set my mind to. I can skate smoothly over the bright, shiny surface of my new life for days on end, forgetting that I was once fat, forgetting that I could become fat again. But sooner or later, something pushes my fear button and I hear Sting singing the melancholy song, “Fragile:”

If blood will flow when flesh and steel are one
Drying in the colour of the evening sun
Tomorrow's rain will wash the stains away
But something in our minds will always stay
Perhaps this final act was meant
To clinch a lifetime's argument
That nothing comes from violence and nothing ever could
For all those born beneath an angry star
Lest we forget how fragile we are

On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are

On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are
How fragile we are how fragile we are

I don’t want to live my life with the fear of fat (or anything else) coloring my every thought, spoiling my pleasures, steering me away from taking risks that might yield wonderful things, inhibiting my to function like a normal (whatever that is), healthy person. On the other hand, fear of loss or injury helps me behave safely. I wear a seat belt when I’m in a car, I don’t exceed the speed limit when I’m driving, I lock my car before I walk away from it, I wash my hands, take my medication, and look both ways before crossing the street. Perhaps it’s a good thing to remember how fragile I am, so that dangerous impulses won’t send me and my bandwagon flying off the edge of a cliff, and so that I remember to thank God for the blessing of just being alive.
I was fat for a long, long time. Many of the important events of my young and middle adulthood were shaped, or at least influenced, by my obesity. Entire thought systems grew up around my fat, to explain it, justify it, banish it, nullify it. My daily habits, what I ate and how I moved, were coordinated by my fatness for over 30 years. I lost my excess weight in a fraction of that time, so it’s no wonder that my brain hasn’t quite caught up to the change in my body.
On the other hand, I arrived at my weight goal 2-1/2 years ago. That’s 30 months. If my brain devoted one lousy month to each year of twisted development, I could have been free by now! But it didn’t. I guess I was too involved with all these interesting and absorbing new activities: exercise, making new friends, clothes shopping, socializing, book and newsletter publishing, volunteer work, paid work. I forgot that Fat Jean was still inside of me, scratching her head and saying, “Hey, what’s going on here? Did anyone bring donuts?”
Although sometimes I wish I could find an exorcist to get rid of Fat Jean, I’m enough of a realist to sense that she’s never going to go away completely. She’ll be at my side as I step on the scales in the morning, whispering, “I told you so,” as I groan about a weight gain. She’ll be pulling on my elbow when I walk into a room full of people, encouraging me to investigate the food rather than introduce myself to a stranger. She’ll embrace me when I’m tired and sad, reminding me that true comfort is found only in chocolate.
Fat Jean is another reminder of how fragile I am. As much as I hated the obesity she led me into, I know that she’s not evil. She was doing the best she could to survive in difficult life circumstances, using some tools and skills I no longer need. The memories she holds are full of the strife and sadness that – along with many other factors – made me who I am today. That’s a strong, sensible, compassionate woman. I don’t need to dwell on Fat Jean, on what she reminds me of or what I fear, in order to benefit from the lessons she and I learned together. My plan is to do my best to balance the sad and fearful thoughts with joyous and hopeful ones. Yes, I know I already have the reputation of being the Eternal Optimist, but even I have to watch for the negative stuff that seeps through my walls from time to time. The Negatives are going to have to audition from now on to earn a moment on stage. If a Negative can teach me or remind me of something important, it can do its song-and-dance routine. If not, it’s outta here.