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!
Tuesday, May 24, 2011
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,
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.
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.
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.
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