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.

Bikini Season

I’ve often said (in the past 20 or so years) that I have no desire to ever wear a bikini again, not in public and not in private. I have to admit there’s an undertone of sour grapes in that statement, because I suspect that if I had a nice, trim waist and a flat abdomen, I’d look for excuses to wear a bikini, the way I now look for excuses to wear short skirts and show off my legs. I’d want to celebrate that nice-looking part of me – nothing wrong with that, is there? But it ain’t gonna happen unless I win the lottery (after buying a ticket for the first time, of course) and have some extensive plastic surgery on my mid-section. Most of the time I’m able to hide the jelly-roll (or Danish pastry, as I’ve called it in the past) by dressing carefully – nothing too clingy, nothing that smacks of maternity-wear, and nothing too short that would call attention to the trouble zone. Yet I struggle with the sight of my middle every day, when I step out of the shower, when I’m getting dressed, when I see my reflection in the big mirror at the fitness studio, when I’m in in a retail store fitting room. The pudge is always there. Why, I ask you? Why? I’ve been exercising 5-7 days a week since the day after my band surgery, doing aerobic/cardio training, strength training, flexibility and stretching exercises, everything I can think of to keep my body as trim as possible. For a year now I’ve been working extra hard on improving my posture, which has a greater effect on the appearance of your middle than you might expect, and on strengthening my abdominal muscles. I’m doing better with posture and I know my abs are stronger because my lower back has stopped complaining and I’m able to do exercises (like the plank) that you just can’t do for more than a few seconds without strong abs. But the pudge is still there. After obsessing about this for a few months, I began to wonder if the fat was in my head, not in my abs. I decided to prove to myself that I am genetically fated to have a flabby middle by comparing my pre-op and current torso measurements. This exercise would show (I told myself) that my middle (waist and abdomen) had lost a smaller percentage of inches than my bust or hips. Unless my math was wrong (which is not impossible), my measurements prove that my theory is not true after all: Bust – down 12% Waist – down 17% Abdomen – down 17% Hips – down 21% So, what’s really going on? Am I suffering from a mild form of body dysmorphia, or is the pudge truly there to stay? Well, after some research about belly fat (which did not include clicking on one of those omnipresent internet ads that proclaim, “Trim belly fat with this one weird old trick.”), I’ve decided that the pudge is real, not imagined. Some of the factors that influence the appearance of your belly include diastasis recti (abdominal muscles that become separated during pregnancy); excessive subcutaneous fat in the midsection (that’s the fat just below the skin), which is the evolutionary fate of child-bearing humans; excessive visceral fat (the more medically dangerous fat that clings to your internal organs, thereby pushing your abdominal muscles outward); and body proportions. I’m short-waisted and wide-hipped, so the short distance between my rib cage and pelvic bones, and the width of my hips, make me look thicker in the middle than a woman with the same waist measurement but a longer torso and/or narrower hips. In the diagram of 2 torsos, below, both torsos have the same “waist” measurement, but the one on the left looks “slim” while the one on the right looks “chunky” because it has a shorter torso. Other factors contributing to the appearance of a belly include age (skin loses elasticity we age, so at age 57, it’s no surprise that I’m sagging here and there); and finally, weak abdominal muscles and overstretched connective tissue (apparently not one of my problems now). So, what’s a jelly-belly to do? If I went on losing weight, eventually my visceral and subcutaneous fat cells would shrink, and so would my measurements. But I’m already on the verge of looking scrawny everywhere else, and losing more weight wouldn’t help that. I could invest in some shapewear, but my one encounter with a Spanx knock-off was discouraging. It took me 20 minutes just to get into the danged thing, and I was so miserably uncomfortable that after wearing it for an hour while at work, I ducked into the ladies’ room and peeled it off. I’m all about comfort, which is one of the reasons you’ll never see me wearing spiked high heel shoes (safety is the other reason). I could save my pennies up for a liposuction session, which I might be able to afford by the time I’m 79 or 80 years old. My plan now is to keep on doing what I’m doing. Exercise all my abdominal muscles, not just the showy ones in front but also the waist-cinching oblique muscles. Pay attention to my posture every waking moment, using the ABC method to pull in my Abs, tuck in my Butt, and push out my Chest with my shoulders back and down. Go on dressing carefully so that my appearance to others, and my own reflection in the mirror, don’t loudly advertise my jelly-belly.

With this band, I thee wed...

If you’ve been married as long as I have (today is our 24th wedding anniversary), you’ll probably know what I mean when I say that at times, my relationship with my husband is a love-hate thing. The hate is provoked by stupid little things, like: why must an adult male in good health and in possession of all his faculties spit toothpaste on the bathroom mirror every single day of his life? Ten minutes after wanting to throttle him for that, I catch a glimpse of him cuddling a tiny kitten and my heart melts. He has truly been there for me through thick and thin (more thick than thin) and I can’t imagine life without him, but the next time I walk into the bathroom and see the Colgate version of a Jackson Pollock painting on the mirror, Mr. P’s life will hang by a thread, at least for a few moments.
I also have a love-hate relationship with my band at times. I resent it because it prevents me from eating mindlessly. I love it for the very same reason, but when I’m tired or hurried or distracted, the effort to eat carefully seems enormous. Why can’t my band just do its job and leave me the heck alone? I’m by no means a lazy person but there are days when living with an adjustable gastric band is a lot of work. It’s certainly not a spectator sport – to win this game, you have to jump right in and get busy, and it’s not over when the cheers fade away…it starts all over again the next day, and the next day, for the rest of your life. Like me and the stupid bathroom mirror.

Happily ever after?

A few weeks ago, I wrote that 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? If surgery helps you lose all the excess weight, shouldn’t it help you maintain that weight loss without another thought for the rest of your life? Dream on.
I’ve seen a lot of bandsters (including the short blonde one in that bathroom mirror) crash into the Forever Wall, kind of like hitting the “seven-year itch” in a marriage. We prepare for band surgery with all the hope and care of a bride and groom planning a wedding – what we’ll wear, what we’ll eat, what music we’ll dance to. We enjoy a romantic honeymoon with the band, things go great for a while, and then things get harder and harder. At that point, 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’ve already got, survive some tough times, and come out of it all the stronger.
My friend Tami send me these wise comments:
“Your comparison of WLS to marriage made me chuckle. One time my daughter asked me whether I’d ever divorce her dad (sometimes he can be such an ass!). I said, “Absolutely not. He’s family. You sometimes can’t stand your brother, but you can’t divorce him.” Now, if there was a serious “complication” in my marriage, like abuse, I’d have to reconsider my options. And that’s exactly how I feel about my band. It’s part of me, and as long as it doesn’t abuse me with serious complications, we’ll stick together. And just like my husband, I have to respect my band, take care of it, and learn from mistakes.”

To have and to hold - until it's no fun any more?

I’ve survived two complications with my band that I suppose you could classify as on the low side of serious: a band slip, and a flipped port. Since the actions my surgeon and I took in response to these complications were swift (in the case of the slip) and sensible (in the case of the port flip), neither one of them ever endangered me – not in terms of my health, and not in terms of my quality of life. In fact, they seemed quite minor to me compared to other problems that my fellow humans face every day – a terminal cancer diagnosis; a fatal automobile accident; a crippling disease; the loss of a partner; parent or child – that except for the occasional moment of frustration or angry, “Why me, God?”, I just kept trudging onward. Perhaps another person with a different world-view and/or different expectations would consider a band slip grounds for divorce. I can’t criticize people who chose divorce, whether it involves their spouse or their band. Only I can decide what’s acceptable and tolerable for me, and others must decide that for themselves. But if you walk down the church aisle three minutes before your wedding begins thinking, “If I don’t like marriage, I can always get a divorce,” perhaps you don’t belong in the church in that fancy get-up in front of all your family and friends after all.
At this (fairly advanced) stage of my life, I’m convinced that God or the universe throws nails on the road before me as a way to get my attention, make me stop and get my bearings, make me enjoy the scenery and make me appreciate how far I’ve traveled so far. So I do my best to learn what I can from each challenging situation with the gastric band that’s complaining or my husband who’s vigorously brushing his teeth or the dog who’s chewing on a chair leg. For all I know, my greatest goal in life is to be a champion cleaner of bathroom mirrors!

Motivating Mojo

Wouldn’t it be great if we could summon up weight loss motivation just by chanting a spell, holding up a charm, or some other magical mojo? Perhaps the very idea sounds foolish, but think about magic in the context of my mother’s life. She would have turned 92 on Sunday. In the course of her life, she used a crank-up telephone with a party line, a telegraph, a telex machine, a fax machine, and a computer to communicate with others around the world. When she was a lieutenant in the Coast Guard during World War ll, tapping out Morse code magically connected her to boats at sea, and a personal computer was just a twinkle in some geek genius’s eye. I wrote an entire book, 572 densely-packed pages, about how to succeed with the adjustable gastric band. I wrote about rules, skills, suggestions, solutions, all kinds of practical tools for success. Although I tried to embue that book with my own personal spirit and belief in the possibility of change and success, I can’t write down the mojo you’ll also need. I can’t put it in a bottle and sell it to you for $19.95 or $1995.00. That’s one thing you must find inside yourself. How? How can you do that when you don’t even know what mojo looks like? I hope today’s post will give you some hints about where to look and what to do when you find your mojo. First let's hear from my dear friend Lisa, who's been working on this very topic herself. I’m 2 years post-op from my Lap-Band surgery and after a pretty rapid weight loss of 120 lbs in the first year my weight loss came to a screeching halt for most of the second year. To be fair, I’ve never been much for exercise and I did let sugar (which I have a really hard time controlling once I start) back into my life, but for most of my second year I only lost what I gained, over and over again. I don’t have much to complain about. I’m wearing a regular size 16/XL, I no longer have sleep apnea, my constant knee and foot pain is completely gone and I can walk 3 miles easily while carrying on a conversation, just to name a few miracles! My only problem is that I want to weigh less than 200 lbs. I currently weigh 216 and even though I don’t NEED to weigh under 200 and I’m not even aiming for what the BMI chart says I should weigh (174), I WANT to weigh under 200 lbs.! I’m sure you understand this unfounded desire to reach that milestone. I WANT TO LIVE IN ONDERLAND! Just because! I spent a year trying to go back to the routine that helped me lose 100+ lbs. But like most things in life, it’s hard to go back once you’ve gained perspective through the lessons you’ve learned. We can’t re-capture our youth, we don’t get to un-do mistakes, and we can’t regain our virginity once we’ve lost it! I couldn’t go back to eating 800 calories a day, nor should I at my current weight! So I started to search, per my therapist’s suggestion, for my next passion. The excitement and novelty of having my weight loss tool had worn off. People are used to my new size and the scale isn’t moving. I have become (“Gasp!”) normal! I accomplished great things, amazing feats of behavioral change but hey! I’m not done! I want to weigh under 200 pounds! So the passion search began. I tried exercise, yawn. I tried Yoga, ouch! I even tried scrapbooking and all that got me was a half finished wedding album and a big dent in my checkbook! I realized that in order to find my passion I need to discover what motivates me first. The desired result is the same (losing weight), but the old methods aren’t working anymore so call it passion or whatever you want but what I need to find is the MOTIVATION to do what I now know needs to be done…Eat less, move more. It really is that simple! This whole self-exploration started me thinking about exactly what does motivate me. Oddly enough, I’ve never been motivated by money; I like it, but if I don’t want to do something money rarely works to get me moving. Some people set goals and find the determination inside themselves to strive for and achieve whatever goal they set. I’ve made a life-time of resolutions that get easily pushed aside and forgotten come January 2nd no matter how “realistic” they are. Some people like team sports and a rah-rah, cheering squad. Me, I’m a musician. We don’t cheer or jump up and down and we certainly don’t high five! But…we do like applause…hmmm, maybe I’m on to something here! I come from a musical family and ever since I can remember we were put in front of people and encouraged to perform. And what is the measure of success when you perform? Yes! It’s praise! I am very motivated by praise. I got a lot of “constructive criticism” as a kid, but very little out-right praise which made it even more desirable. My well-meaning parents always felt it was their responsibility to deliver a lesson with every effort or attempt I made to gain their approval when I performed. But no matter how hard it was to get genuine praise, when I did receive a compliment, from anyone, that was the measure above all, the goal, the big prize, the golden ring! So, it should come as no big surprise that when I was 19 I started working for a company that was founded on the idea of service and family. They gave a lot of recognition to their employees for a job well done and I flourished in that environment. I've been greatly rewarded over the almost 30 years I've worked for this company and it wasn't always monetary. For me, getting a verbal thank you, a note, an award or a pat on the back was my greatest motivator and I excelled! I like my efforts to be recognized and I like to please people by exceeding their expectations! So, when I decided to join Weight Watchers this past January as a last ditch effort to lose the weight I had gained over the holidays, I found a connection there because I like gold stars and applause when I lose a couple of pounds! I like to weigh in and get a “good job” from the lady behind the counter! Sounds corny, I know, but it works for me! What motivates you? Answer that question and it might open some doors, uncover some missing truths about who you are, help you learn how to reward yourself with something other than food and may even help you find your next passion! As for me? I’m losing weight again so let’s hear it! “Good job, Lisa”! WHAT’S YOUR MOJO STYLE? Drill sergeant? Sweet Granny? Spiritual Guru? Calm Teacher? The Little Engine? My style? Drill sergeants make me want to bite their pointing fingers. I'll snatch up a sweet granny and take her home with me for tea and cookies, but probably won't stretch myself for her. My ideal motivator is a combination of guru, teacher, and The Little Engine That Could. I'm the little engine, chugging along, saying, "I think I can, I think I can, I think I can." What works best for you? "I can't find my mojo," you say? I can certainly understand that. When I began my WLS journey, I felt like I'd used up all my mojo on the 1000+ diets I'd done previously in my life. I wouldn't have recognized my mojo if it tapped me on the shoulder and introduced itself. You might need to take a look at other aspects of your life to identify what motivators work for you. What qualities do you prefer in a supervisor at work? What makes you get up and go to work (or school) day after day? In what environment do you do your best work? Do you need discipline or freedom? Peace and quiet; or commotion and excitement? Do you just want a brief punch list, or do you want your tasks explained in detail? Do you want someone who will answer all your questions, or do you prefer to figure out the answers yourself? What's more important to you, your salary or the knowledge that you've done a good job? When you excel at something, do you want shouts and applause, or a quiet pat on the back? At times in my life, I've been fortunate to have the support and guidance of good teachers, therapists, ministers, friends, and accountability partners. It's a huge comfort to know that I'm not in this alone. On the other hand, I need to be able to stand on my own. At the end of the day when my husband and all the dogs are snoring and I'm lying awake thinking about my day and planning for the next day, I'm alone and must rely on my own inner resources. So I chant myself to sleep with the Little Engine Spell, "I think I can, I think I can, I think I can." EVERYDAY MAGIC – HOW ABOUT A LUCKY CHARM? You don’t have to be a hoodoo prince or princess to conjure up some magic mojo. All you need is a square of red cloth, a few small symbolic objects, and a string or ribbon to tie it all up in a little pouch. Oh, no, I heard someone mutter, “Tut tut tut”! The magic of charms may be nothing but a myth, but myths endure because they speak to basic human stories of taking a journey to find something or someone important, overcoming obstacles, fighting demons, rescuing the helpless, and triumphing despite the long, difficult struggle and effort. And an object that represents something important to you can be very powerful indeed, whether it’s a cross or a dove, a shell from your favorite beach or a stone from your mother’s garden, your first dog’s collar or a lock of hair from your son’s first haircut. Perhaps all you need is a simple, private ceremony in which you write your goal on a piece of paper, fold it up, and put it away in your red cloth pouch or some other safe place. Don’t forget where you put it, because it’s very important. This charm is your promise to yourself, and your request to God or the universe to help you achieve your goal. Right now your goal might be expressed in the number of pounds you want to lose. In one year, your goal might be to finish the Boston Marathon. In two years, it might be a new baby, a new job, a college degree, or anything else that will fulfill your dreams.

The Digestive Diva

Last week we talked about food addiction and the compulsive eating behavior that makes many of us obese. Those are emotional, spiritual and psychological issues. Today we’ll have a look at some biological aspects of what makes us obese – our hunger, eating and satiety.

Before we start, let's play a classic kid’s quick quiz game.
Can you guess what this is?
Q: What’s black and white and re(a)d all over?
A: A newspaper.

Got the idea? OK, let’s try another one.
Can you guess who this is?
Q: She’s small and whiny, self-centered and never happy. She complains constantly, and nothing I do ever makes her happy for more than a few minutes. She’s been with me forever, goes with me everywhere and always speaks up at the worst possible moments. Who is she?
A: No, she’s not my spinster great-aunt Adeline. She’s my tummy.

With apologies to my long-departed Great Aunt Adeline, I have to say that I’ve never had a happy relationship with my tummy. She’s always been an interfering little piece of business, and trying to humor her has gotten me into trouble more times than I can count. Although she is small, fist-sized and shaped, she has a big mouth and a nasty temper. The little band of silicone at the top of her has done a wondrous job of keeping my tummy quiet, but every now and then she gets herself into a snit. Like today. As I write this, it’s 2:03 pm, 2 hours since my last meal (lunch), and my digestive diva is nagging me:
I’m hungry.
I said, I’M HUNGRY!
Isn’t anybody listening to me? Let me repeat: I’M HUNGRY! Feed me NOW!

It’s not just my stomach that’s talking about hunger. In researching the relationship between hunger and eating, I learned that the stomach tells only part of the hunger story. Wouldn’t you know, the rest of my body also has to have its say.

The purpose of the stomach is to store and process the food and liquid we ingest. It uses mechanical action (muscle contractions) and chemical action (enzymes, acids) to break food down into a form that can be handled by the small intestine, where nutrients pass through the intestinal wall and into the bloodstream for transportation to the rest of the body. When my stomach growls, it’s not necessarily communicating hunger. The growling sound is generated by peristalsis, the rhythmic muscle contractions that occur as my stomach and small intestine churn up liquid and solid food as well as air and gas, turning it into a sludge called chime and sending it on through my lower digestive tract.

About two hours after the stomach empties out, it begins to produce hormones that stimulate local nerves to send a message to the brain requesting more food, kind of like telephoning the China Supreme Restaurant to place an order for a Number 8 platter with a side of pork fried rice. The brain replies by telling the digestive muscles to restart the process of peristalsis, at which point the muscle contractions move out any remaining bits of food that were missed the first time around and also tell you, sometimes quite loudly, that you’re hungry again. The muscle contractions last 10 to 20 minutes and recur about every hour until you eat again.

But scientists know that the growling empty stomach isn’t the only reason you feel hungry because even people whose stomachs have been removed report feeling hungry. And bandsters with optimal restriction also report feeling no hunger even when both parts of their stomach (upper and lower pouches) are empty. So what else is going on in there?

Researchers have proposed a number of explanations for hunger. At its most basic level, the purpose of hunger is to motivate us to eat the food our body needs for survival. The body signals the need for fuel in several ways. We may feel hungry when our blood glucose level is low, but under normal conditions, blood glucose doesn’t change enough to account for extremes of hunger. I know this is true because I’m diabetic and spent several months last year dealing with frequent and extreme hunger no matter what I did and didn’t eat. I checked my blood sugar every time an “attack” hit me and not once did I get a reading that medically qualified as “low”.

We may also feel hungry when our insulin level increases suddenly, a theory that seems contradictory to me because the #1 way to increase insulin levels is to eat…in other words, our hunger is caused by eating. I don’t know about you, but most of the time, my eating causes satiety, not more hunger. And why then would Type 1 diabetics, whose bodies produce no insulin, ever feel hungry?

Another theory states that hunger is triggered by an increase in the body’s fatty acid level, while yet another theory states hunger is increased by a drop, and decreased by an rise, in body temperature, which might explain why we tend to eat more during the winter, but doesn’t account for hunger fluctuations in people who live in climates with unchanging temperatures.

Obviously, hunger cannot truly be explained only by biology. As human beings, we also experience learned and cognitive aspects of hunger. We use an external clock to dictate our daily routine: when to eat, when to sleep, when to rise, when to eat again. Before my band surgery, I felt hungry for lunch at noon every day even when I’d eaten a substantial snack at 11:00 a.m. That hunger was triggered by learned behavior: when I see the clock (which I learned to read), I want to eat lunch (a meal called lunch that happens only at midday is another learned behavior).

The smell, taste, or texture of food also triggers hunger. For example, the smell of fried food as I drove past McDonald’s once made me “hungry” for French fries (amazingly, that smell nauseates me now). This kind of hunger (triggered by taste, smell, or texture) is a culturally learned preference. In my travels overseas, I’ve been exposed to smells (such as the smell of rancid tofu) that turned my stomach but made my Taiwanese companion suddenly start a conversation about where to have lunch.

Colors also contribute to hunger. In experiments, a yellow banana made subjects want to eat it but a red banana did not. The colors of red, orange, yellow, green, and brown foods can trigger hunger while a blue food may suppress the appetite because so few natural foods are blue. Fresh white yogurt is appealing but aging yogurt covered with blue mold is not. Humans learn to avoid poisonous or tainted food based on color, smell and/or taste, and also avoid or favor foods based on their knowledge (whether or not it’s accurate) of what foods are good or bad for them. My father disliked bananas because when he was a child, his mother endorsed a trend at the time that said bananas are bad for you. My mother disliked chicken skin because her own mother repeated so often the lesson that fatty chicken skin is not just bad for you but that it tastes disgusting (which sure ain’t my own experience!). When traveling in Asia I used to get homesick for cheese, but a Chinese friend watching me eat a cheeseburger wrinkled her nose and said, “How can you eat cheese?” as if I were eating dirt (or rancid tofu).

Longing for a particular taste (sweet, sour, bitter, salty) is another learned behavior. If you say, "I’m hungry for something sweet" but eat a pickle instead of a strawberry, you’re probably going to go on eating until your craving for a sweet taste is satisfied. Unfortunately, many obese people seem to have a bottomless pit of a stomach (and brain) when it comes to satisfying a craving. Which brings us to what I consider (as a bandster) to be the crux of the matter: SATIETY.

The mechanism of hunger and satiety are not necessarily the same, and in obese people, hunger, eating and satiety often seem to have no relationship to each other at all. That’s what I mean by the bottomless pit. As a pre-op, I ate so much at each meal, I couldn’t possibly still be hungry, but I went on eating because I didn’t feel satiety. There was never enough food to satisfy me. As I wrote in Bandwagon, I suspect that my lack of satiety has a spiritual basis, but right now let’s stick to physiology.

Satiety – the sense of having eaten enough food – occurs in the brain (in the hypothalamus, which controls hunger and eating) and also in the gastrointestinal tract. Nuclei (clusters of nerve cells) in the hypothalamus send signals to tell you to stop or start eating, based on what your body’s estimated long-term fuel needs are. Since your body doesn’t know you’re going to compete in your first marathon in the next five minutes, it has no instant way to tell you to fuel up with the extra 2000 calories you’ll need to get through it; it can only use past experience to forecast your future caloric needs. If you’ve been training for the marathon for three months, there’s a good chance your body will forecast your calorie needs accurately, but if your previous exercise consisted of manipulating the television remote control, that marathon’s going to be a big surprise to your body in more ways than one.

On the other hand, signals from the gastrointestinal tract (including your stomach) control short-term eating. Enzymes and hormones secreted in the GI tract while you eat respond to your food intake by sending satiety signals to your brain and to the rest of your body (via the vagus nerves at the top of the stomach and via the bloodstream). Your body measures your satiety based on many internal conditions like how much body fat (stored energy) you have and on external conditions (like your habits, learned eating behaviors and preferences, the sight and smell of the food, the social setting of the meal, and stress).

All this may be far more than you ever wanted to know about hunger, eating, and satiety. If you think this is information overload, you should take a look at the scientific extracts I’ve been reading! If nothing else, my attempt at explaining all this shows you what a complex matter it is, and what a marvelously sophisticated machine the human body is (but not just a machine – don’t forget you have a soul, too). Our hunger and eating may also be affected by processes not even known to scientists yet.

Although all my research and thinking has helped me understand more about how my body works, but I still don’t understand why hunger, eating and satiety has made me, but not all my fellow humans, so fat. And I don’t think anyone fully understands how the adjustable gastric band helps me to function more like a “normal” human.

What Causes Obesity?This is a chicken and egg question. Which came first: the defective satiety detector, or the obesity that seems to have resulted from it? Why are some people are obese and others not obese? Is it because obese people have a different hunger and satiety mechanism from people who are not? Or is it because the obese peoples’ overeating overrode and eventually reprogrammed their inborn, “normal” satiety response?

We know that obesity can be caused biologically because so many studies show that twins who grew up apart still weigh about the same as each other, and because adopted children's weights are similar to their biological parents, not their adopted parents. But this does not explain all cases of obesity.

Set point theory, which states that we each have a predetermined weight, set by the hypothalamus, that our body attempts to maintain no matter what diet we follow. In fact, the more we try to reduce our calorie intake, the more our body wants to keep the weight that is set by the hypothalamus. According to this theory, our set point weight is too high due to damage to (or over-stimulation of) the Ventromedial Hypothalamus (the brain’s satiety center).

A study published in 1971 showed that obese people respond to external cues of hunger, such as time, more than non-obese people, who tend to respond more to internal cues of hunger. But why do they do that? A later study linked the external cue response to increased insulin levels. In one experiment, just the smell and sound of steak cooking increased the insulin levels of subjects who were “external cue responders”. But based on the decade I spent with my naturally slim ex-husband, who was tempted by the smell of grilling steak just as I was, I find it hard to believe that the external/internal cueing is a major factor in obesity. Since insulin’s purpose is to maximize the body’s use of glucose as fuel, it seems to me that the smell of steak would alert the brain and body of anyone, no matter what kind of eater they are, to get ready to process a meal by pumping out more insulin. And since my understanding of human physiology has holes in it the size of Rhode Island, I’m not going to propose an alternate theory…not right now, anyway.

Mind and Body
No matter what causes it, hunger is a very basic experience, one of the first that causes us distress when we are helpless infants. Hunger motivates our earliest communication: we cry for mother to feed us. As we grow older (both as individuals and as a species), we learn a variety of ways to prevent hunger – we hunt and gather food; we horde food; we grow, catch, or hunt food; we cook or otherwise prepare our food to make it palatable and safe to eat. It’s very natural for such a basic thing, something so central to our existence and our survival, should arouse a host of ideas, beliefs, and emotions as well as mold dozens of habits and behaviors. I don’t think it’s possible to separate mind and body when it comes to hunger and eating. They must be intricately entwined, and that’s one of the things that makes us human (that doesn’t make us superior to other animals, it just makes us human).

Try to imagine what it felt like for you as an infant, crying about your empty belly, to have your mother or another caretaker respond by feeding you, over and over again, until you acquired some very special feelings about her: trust, attachment, love. And imagine what it felt like to cry and cry and be ignored (because mother was absent, or trying to get you to function according to an imposed schedule): frustration, anger, despair. Is it any wonder that as obese adults we turn to food for comfort (rejoining us to safety of the mother we trusted) and to deal with our feelings of frustration, anger, and despair?

I ask you to be patient with yourself as you do the adult job of figuring out whether you need to feed your mind or feed your body. It ain’t easy, but it’s worth it!