I remember that when I was young I would eat pretty much what I wanted and stay slim. I ate until I was full and then stopped. I always liked sweets, but didn’t “crave” them all the time. In the intervening years my entire problem with my weight has been one initially created by my mind, and assisted by my body’s attempt to actually help me survive. I had many things happen in my young life for which I needed coping mechanisms. I was molested by two different men, once at age 6 and another time at age 10 or 11; my parents divorced, and in the following years my Mom was so devastated by that divorce that she was emotionally absent a lot of the time; my Mom died suddenly when I was eleven; I was suddenly moved across the country to create a new family unit with my two brothers and my Dad and new Mom and brother, after only seeing them a few times in the intervening years between the divorce and my Mom’s death; my mother’s family cut off communication with our new family unit.
As I stated last blog, I never really got into drinking like my friends did because I hated what it did to me. I also didn’t really like drugs for pretty much the same reason, I hated its affect on my reasoning capacity and the high wasn’t really worth it to me. So, my drug of choice was food. Carbohydrates affect the serotonin levels with simple carbs, such as sweets, giving the quickest boost and the shortest lasting. It’s a recipe for disaster. Everyone in my family eats quickly. Proof of this was when we had our second AFS exchange student. He was from Switzerland. We sat down to dinner, and when we began busing our dishes at the end of the meal, we realized he’d only eaten a few bites. Eating quickly not only increases the amount of food consumed because you’ve eaten so quickly you don’t even realize you’re full until you’ve already overeaten, but it also makes a person twice as likely to be obese. Part of this is because when you swallow larger bites of food quickly they are harder for the body to digest. First, saliva is part of the digestion process and so chewing food more thoroughly gives the digestion a jump start by using the saliva for its intended purpose. Second, properly chewed food is easier for the stomach to digest without having to work as hard. Third, the nutrients in well chewed food is more readily accessible to the body parts that need it. Finally, food that isn’t chewed thoroughly enough leads to gas, bloating, and other gastrointestinal issues that can make one less likely to want to get up and move and exercise.
The body is an amazing mechanism. It changes as it sees fit to ensure your survival. So, when you deprive it of food, it slows your metabolism so that you can hold onto the fat you have because it thinks your starving. And then if you do lose the weight, the body does its best to help you put it back on by keeping that metabolism low. We have bodies that have a cave man mentality in a 21st century world. Our bodies are doing their best to help us survive in the way that centuries of evolution have taught them. But that very survival mechanism is what makes weight loss so difficult. So, eating quickly already predisposes a person to weight gain and other problems. Add in the body’s defense mechanisms, and then add in the drug like effect of the carbohydrates on the serotonin levels in the brain and voila, all the elements are there to become a food addict.
During the many times I dieted over my life, it became apparent just how much of a coping mechanism food was to me. Almost every time I was on a long term diet I ended up doing some kind of therapy. I figured it was because I needed help changing my behavior about eating. But, really it was because without my drug of choice, all of those issues I was subduing through my use of food as a drug came bubbling to the surface when I was no longer eating in the same way. Without those coping mechanisms, issues that I’d thought long resolved suddenly began rearing their heads and letting me know that I’d merely put a band-aid over a gaping wound, and perhaps I needed further treatment. And for a while I would enter therapy and I would deal with my various issues. And I would lose weight and get thin and feel good about myself. The therapy would help, but I never really followed it for long periods for several reasons. First, therapy is emotionally exhausting. Dealing with deeply embedded, painful issues takes a LOT of energy. Second, after some progress, you usually reach a plateau, and then it’s time to take a break for a while. But most importantly, eventually I would sabotage my weight loss efforts and would start using food as a drug again. Why would I do that?
I heard it described once in a way that made perfect sense to me. I was reading some article about weight loss and why some people get close to their weight loss goal but never really reach it. It’s because they’ve convinced themselves that the problems in their life are due to the fact that they are fat. But what if they are finally thin and they still are unhappy, still unloved, still unfulfilled? What if they lose all the weight and they still have problems? What are they going to blame their failures on then? So, subconsciously, they sabotage their own weight loss just shy of their goal, because it is so much scarier to face the fact that the problems in their lives have a much deeper root than merely being overweight. And being overweight is familiar. It’s not fun, but the devil you know is often more comforting than an unknown new world where there are new dragons to slay. Also, victims of sexual abuse sometimes gain weight to make themselves less attractive because they see it as a protection mechanism. I’m pretty sure that plays part of a role in my inability to keep the weight off. Whenever I’ve been thin I’ve felt so good and loved the male attention, but also been terrified by it at the same time. In certain situations I’ve been instantly transported in my brain back to the brain of a six year old child who felt powerless to protect herself against the adult who sexually molested her. Logically, rationally, I know that I could probably fight off unwanted advances, but it is not a logical, rational part of the brain that deals with those fears.
When I decided to have the bariatric surgery I was required to be tested by a psychiatrist before they would approve the surgery. At the time I wondered why they would require that. I figured it was to determine if I had the underlying strength of personality to be successful in changing my eating patterns. But I realized it was more than that. In the initial few months after the surgery there really is not a great desire to eat. I was not very hungry and I was full so instantaneously and so completely that I didn’t really have a lot of problems with it. Plus it was new and it is easy to follow the new rules when you are focusing on them to try and get them right, and it’s a medical necessity to get them right. But after it became more rote and I began to get back into regular schedules, things became a bit more blurred.
When I went out with girlfriends and everyone was oohing an aahing over the food and I couldn’t eat more than a bite or two without getting sick, suddenly my comfort zone was removed. And over time I realized that this was now my life. It was depressing. The surgery removes your ability to eat large quantities of food, but it doesn’t remove your desire to eat large quantities of food. Those coping mechanisms that were formed over decades are suddenly removed without any replacement mechanisms. The surgeons and the insurance companies know that there will be a psychological impact. And there are support groups for bariatric surgery patients. I attended a couple of them. But they were about once a month on a Tuesday in the middle of the day. To me, there should be active, intensive, professional, psychological support after bariatric surgery that rivals the physical therapy prescribed after other surgeries. But, as is often the case, people seem to see psychological issues as a form of weakness, or something that people should “snap out of.”
We would never tell a diabetic that he is weak for needing insulin, but have no problem telling people with psychological issues they need to “toughen up” rather than giving them the treatment they need. Obviously, insurance companies realize that there is a psychological factor in the success of bariatric surgery since they require the psychological testing prior to approving the surgery. So, why not spend a bit more up front covering scheduled, individual, professional, psychological support after bariatric surgery. I believe it would make the success rates of permanent weight loss even greater, and in the long run it would save them the cost of medical treatment or further surgery for people who gain the weight back due to an inability to adjust to a world without their drug of choice.