NEW YORK (Reuters Health) - Severely obese people who undergo weight-loss surgery may have a higher-than-average risk of suicide in the years following the procedure, a new study finds.
From the current issue of "Your Weight Matters," a publication of the -
Weight-loss Surgery and Cross Addiction: A Look at Binge Eating Disorder
by Carolyn Coker Ross, MD, MPH
To view a PDF version of this article, click here.
Obesity has been identified as a major public health issue with more than 65 percent of Americans being overweight or obese. Rates of obesity have also tripled in children since the 1970’s and diseases that were formerly only seen in adults, such as non-insulin dependent diabetes, have increased in children. This has created more acceptance of and desire for rapid weight-loss measures such as weight-loss surgery, also called bariatric surgery. What many people are not aware of is that the presence of an eating disorder may make bariatric surgery more risky and less likely to be successful.
Binge Eating Disorder
Binge eating disorder (BED) is the eating disorder most commonly associated with obesity. Approximately one in three individuals who go to any weight-loss program actually have BED. They may experience repeated episodes of eating large quantities of food in one sitting or in a two-hour period. They may also feel unable to stop themselves when they binge eat.
Individuals with BED may also eat until they are too full, they may eat more rapidly than normal and eat alone because of embarrassment of how much they are eating. They may also have feelings of disgust, guilt or depression that come about after they binge eat.
Anorexia and bulimia are more publicized, but BED is actually more common than either of these. Another difference is that while anorexia and bulimia overwhelmingly affect women and girls, 40 percent of those with BED are male. BED tends to run in families just as obesity does and it’s also associated with more likelihood of depression, bipolar depression and substance abuse both in the person with BED and in their family members.
Those with BED are more likely to be overweight or obese and to seek bariatric surgery. Individuals with BED who have bariatric surgery may put themselves at risk for the development of complications after surgery if they are unable to stop binge eating.
Bariatric Surgery and Eating Disorders
Bariatric surgery is recommended only for those who are morbidly obese defined as a body mass index (BMI) of more than 40 or a BMI of 35 along with health problems such as diabetes or heart disease. Research has shown weight-loss surgery to be more effective for weight-loss than conventional methods in those who are morbidly obese. While weight-loss surgery does promote weight-loss, surgery also carries risks and it’s important to know these possible risks and complications before proceeding.
The following questions may be of help in identifying whether or not you are at risk for
Do you overeat to help deal with emotions that you are uncomfortable with?
Do you use food to give you comfort?
Do you have a family history of drug or alcohol addiction?
If you think about having to change what you eat and how much you eat, do you feel sad, lonely or afraid?
Have you ever felt that food is your best friend?
Do you have a history of trauma, abuse or neglect?
If you answered yes to one or more of these questions, you should consider addressing your relationship with food before you consider weight-loss surgery. It is important to realize that your relationship with food has developed to serve some need. Even if you feel ready to lose weight and are very motivated to do so, you should make sure that the need food has served is being met in some other way.
Nutritional Changes with Bariatric Surgery
Nutritional changes after bariatric surgery may contribute to the development of depression, destructive eating behaviors and body image issues. Changes from weight-loss surgery cause difficulty in absorbing vitamins and minerals and can lead to deficiencies in iron, calcium, several B-vitamins, vitamin D and other vitamins and minerals. The surgery can also affect the ability to absorb protein and cause lactose intolerance. Difficulty absorbing protein can affect mood and behavior because the amino acids found in protein are what the body uses to make the “feel good” chemicals in our brains – serotonin, dopamine and epinephrine.
One research study found that giving people who have been on a liquid fasting diet (that also causes some malnutrition) a supplement with amino acids decreased binge eating by 66 percent and reduced food cravings by 70 percent. When compared to a group who were not taking the supplements, they regained only 14 percent of their lost weight compared with 41 percent. Given that up to two-thirds of those who have weight-loss surgery do not take the prescribed vitamins and minerals, malnutrition is a very real concern and can be worsened by excessive alcohol or drug use.
Cross Addiction and Weight-loss Surgery
Beyond the complications and risks associated with surgery is the issue that has increasingly been coming to light – cross addiction. Cross addiction is loosely defined as exchanging one drug of abuse (such as food) for another (for example, alcohol). Many individuals who undergo weight-loss surgery develop disordered eating and other addictions, including gambling, drinking, smoking, drug use and may be more prone to shopping or sexual addiction after surgery.
There are more than 140,000 weight-loss surgeries performed every year and it is estimated that from 5 to 30 percent develop another addiction. This makes perfect sense when you think of the purpose that food serves. If an individual is using food for comfort, to hold down their emotions or to cope with stress or traumatic experiences, they will be left with no coping mechanism when they can no longer use food in this way.
Another factor that may contribute to the development of a cross-addiction is a history of childhood trauma or neglect. Often being overweight or obese can serve as a safety factor for a person who has this history. Being obese may make them feel less attractive to the opposite sex and therefore safe from any unwanted overtures or perceived threats to their safety.
Obese people who quickly become thin through surgery may find themselves feeling very vulnerable. Both women and men may find that they feel uncomfortable with the changes in their bodies after surgery. Those individuals who have loose skin folds or scars may feel unattractive and feel that surgery did not accomplish their goals of becoming more accepted socially.
As more weight-loss surgeries are performed, the issue of cross-addiction has become more of a problem. Just as an alcoholic may think that they can safely use marijuana in place of alcohol once they get sober, a person with BED or compulsive overeating may substitute alcohol for food without recognizing that this behavior can lead to a full blown addiction to another substance besides food.
The development of a cross addiction can occur with any of the weight-loss surgery procedures including laparoscopic adjustable gastric banding, gastric sleeve and gastric bypass surgeries. To avoid this problem, it is important that individuals considering surgery explore the possibility that they may be at risk for cross-addiction.
If you use food to cope with stress, for example, what are the coping strategies you are using in the place of food? If you have not practiced these coping skills, you should practice them regularly for some time before having surgery. If food is your comfort, how will you comfort yourself after surgery? Finding other ways to soothe yourself when you are anxious or angry, for example, should be in place before surgery.
Having surgery without addressing the emotional attachment you may have to food or the important purpose food has served in your life could lead to cross-addiction.
Honor your past. If you’ve used food for comfort or safety, recognize that perhaps that was the only way you knew at the time to get comfort or feel safe. Don’t beat yourself up about this. You are a different person now than you were when you started using food in this way. You may have been much younger when your disordered eating began. Affirm that you are committed to full and complete healing and if you choose to pursue weight-loss surgery, do so with the awareness of what you need to do to avoid cross-addiction.
Suggestions for Helping You Prepare Yourself for Surgery:
If you have a history of trauma, abuse or neglect, make an appointment to see a therapist to begin working on these issues. You don’t have to wait years to heal. The healing process begins with your commitment and awareness that you need help.
Keep a one week journal of stressful times and list next to each one what you did to deal with the stress. Notice how many times you turned to or wanted to turn to food to help you.
Keep a one-week emotional diary where you list times each day when you felt upset, angry, afraid, sad, guilty or shameful. Then list next to each how you dealt with the feelings. Again, notice if you wanted to or did turn to food to help you through a tough time.
Make a list of your comfort foods and see if you can go for two weeks without eating any of them. Keep a journal about how you feel when you turn down the cupcakes or cookies at work, for example.
About the Author:
Carolyn Coker Ross, MD, MPH, is a nationally known author, speaker and expert in the field of eating disorders, addictions and integrative medicine. She is the former head of the eating disorders program at Sierra Tucson. She currently has a private practice specializing in treating eating disorders, addictions and obesity. Her latest book The Binge Eating and Compulsive Overeating Workbook has just been released.
From Eating Disorders Review - Candidates for bariatric surgery are evaluated by a multidisciplinary team. The screening process typically includes a comprehensive medical evaluation, as well as a psychological evaluation, nutritional consultation, and education about the surgery and what to expect. Individuals seeking obesity treatment frequently report problems with depression, binge eating or night eating, and candidates for weight loss surgery are no different. Overall, mood and eating are greatly improved soon after surgery, and psychosocial functioning is improved. The main mechanism by which patients lose weight after bariatric surgery is eating less. Some procedures, such as Laparoscopic Adjustable Gastric Banding (LAP-BAND®), are purely restrictive. Due to their greatly reduced gastric capacity, patients consume less solid food at each meal or snack, and thus lose weight over 2 to 3 years. Other procedures, like Roux-en-Y gastric bypass, combine a small gastric “pouch” with “bypassing” a portion of the upper intestine to create a degree of intestinal malabsorption. Weight loss is more rapid after a procedure combining restriction and malabsorption, and body weight reaches a nadir around 12 to 18 months after gastric bypass. Weight loss following a LAP-BAND procedure is more gradual and, and occurs over a 3-year period. With any procedure, there is a limited amount of time when patients will lose weight. Afterward, they will transition to a period of long-term adjustment and weight stabilization. A small but signifi- cant proportion of patients (approximately 20%) will experience long-term failure, defined as inadequate weight loss or significant weight regain. Consequences of Malabsorption An additional consequence is the “dumping syndrome,” characterized by lightheadedness, sweating, palpitations, cramps, and diarrhea. This usually occurs when a patient consumes too much sugary food, such as ice cream or cake, at one time. Some patients view this complication favorably because it deters them from consuming “junk food,” whereas for others it becomes problematic. Fortunately, the dumping syndrome can be reduced or eliminated with dietary changes. Eating Problems after Ignoring Dietary Guidelines Certain postoperative eating patterns can lead to inadequate weight loss or even to weight regain. A pattern of frequent snacking or nibbling can interfere with weight loss. Additionally, because surgery does not restrict liquid intake, frequent consumption of high-calorie liquids, like juice or milkshakes, can become problematic. Specifically, these eating patterns make it possible for the surgery patient to consume a large amount of calories despite a reduced gastric capacity. Ultimately, patients who make and sustain healthy changes in their eating patterns, including consuming small portions of mealtime foods and snacks, are most likely to achieve optimal weight control. Full-onset Eating Disorders Segal and colleagues (2004) have observed the co-occurrence of eating disorders and anxiety symptoms in this patient population. As a result, they have proposed a new diagnosis, “postsurgical eating avoidance disorder (PSEAD).” Because patients with a history of eating disorders prior to surgery may be at risk for developing full-syndrome or subthreshold disorders after operation, these individuals may benefit from close follow-up. Psychiatrists, psychologists, nutritionists, and registered dietitians who treat patients with eating problems after bariatric surgery must work closely with the surgical team to rule out physiological and anatomic-surgical causes. A full diagnostic workup may include laboratory testing, a nutritional evaluation, psychological evaluation, and/or an upper GI series to assess the anatomy and functionality of the altered gastrointestinal tract. New Assessment Tools for Assessment Are Needed Summing It All Up These problems may be mild for some, but severe for others, causing distress or impairment. Unfortunately, we cannot yet predict who will experience clinically significant eating problems prior to surgery. Multidisciplinary interventions are needed to help patients both prepare for surgery and achieve optimal weight loss and psychosocial adjustment afterward.
Procedures involving malabsorption of food tend to be associated with some additional consequences or complications relative to purely restrictive operations. Malabsorption increases the risk for protein-calorie malnutrition and vitamin or mineral deficiencies, especially deficiencies of vitamin B12, calcium, and iron. Supplementation reduces the risk for protein-calorie malnutrition and vitamin or mineral deficiencies, especially vitamin B12, calcium, and iron. Supplementation reduces the risk of developing nutritional deficiencies but does not eliminate it.
Failure to adhere to postoperative dietary guidelines can lead to eating problems. For example, patients may vomit involuntarily after eating too fast, not chewing their food well enough, or overeating. Some will learn to self-induce vomiting to alleviate the discomfort associated with overeating. Much less commonly, self-induced vomiting is used to counteract the effects of eating on body weight and shape. Some patients describe a sensation of “plugging,” or the feeling that food has become stuck in Eating Problems Sometimes Encountered after Bariatric Surgery “Dumping syndrome” Persistent nausea or vomiting “Plugging” Frequent eating episodes or “grazing” Excessive consumption of high-calorie liquids Recurrent loss of control over eating Anxiety over eating or food aversions Chewing and spitting food out Eating in the absence of hunger their upper digestive tract or “pouch.” Eating problems like vomiting and plugging tend to improve over time as patients learn to use the results of their surgery as a “tool” to help them eat less. Most patients are eventually able to consume a diet with a range of healthy foods, with the exception of frequent intolerance of red meats and soft white breads.
The onset of full-syndrome eating disorders—anorexia nervosa, bulimia nervosa, or binge eating disorder—after surgery is unlikely, but possible. However, it is important to recognize that aberrant eating patterns may develop after the operation that do not meet current diagnostic criteria for eating disorders, but that nonetheless are associated with distress and impaired weight management. For example, research studies indicate that the resumption of or onset of loss of control over eating is not uncommon at longer-term follow- up, and may be associated with inadequate weight loss or weight regain.
Currently, standardized assessments for postoperative eating behavior are lacking, and there is a need for new tools to fully characterize the range of eating pathology that can develop after surgery. Having a patient self-monitor his or her dietary intake (including any episodes of vomiting), along with the associated circumstances (including both external factors, such as the type and quantity of food consumed or interpersonal context, and internal factors, such as thoughts and feelings), may serve as the foundation for developing an appropriate individualized cognitive behavioral treatment plan. In extreme cases, a patient may benefit from hospitalization for observation of eating behavior. Interventionists should appreciate that the patients who seek treatment for postoperative eating patterns are not representative of the full spectrum of bariatric surgery patients, most of whom do not experience severe problems.
In summary, eating problems after bariatric surgery may include problems associated with malabsorption, including dumping syndrome or nutritional deficiencies; difficulties associated with failure to adhere to the postoperative guidelines for eating, like vomiting or a sensation of plugging; eating patterns associated with poor weight outcome, such as frequent snacking or excess consumption of high-calorie liquids; or eating disorder diagnoses or symptoms, such as loss of control over eating.
From Eating Disorders Review -Bariatric surgery is recommended for individuals with class III obesity (body mass index, or BMI, > 40 kg/m2) or class II obesity (BMI: 35-40 kg/m2) with obesity-related health problems who have failed previous medically supervised nonsurgical attempts at weight control. Bariatric surgery is associated not only with substantial weight loss, but also with improvement in or resolution of health problems such as hypercholesterolemia, high blood pressure, sleep apnea, and type 2 diabetes. These health benefits are weighed against the immediate and longer-term complications and risks associated with major abdominal surgery, including a small possibility (less than 0.5%) of death.
Candidates for bariatric surgery are evaluated by a multidisciplinary team. The screening process typically includes a comprehensive medical evaluation, as well as a psychological evaluation, nutritional consultation, and education about the surgery and what to expect. Individuals seeking obesity treatment frequently report problems with depression, binge eating or night eating, and candidates for weight loss surgery are no different. Overall, mood and eating are greatly improved soon after surgery, and psychosocial functioning is improved.
The main mechanism by which patients lose weight after bariatric surgery is eating less. Some procedures, such as Laparoscopic Adjustable Gastric Banding (LAP-BAND®), are purely restrictive. Due to their greatly reduced gastric capacity, patients consume less solid food at each meal or snack, and thus lose weight over 2 to 3 years. Other procedures, like Roux-en-Y gastric bypass, combine a small gastric “pouch” with “bypassing” a portion of the upper intestine to create a degree of intestinal malabsorption. Weight loss is more rapid after a procedure combining restriction and malabsorption, and body weight reaches a nadir around 12 to 18 months after gastric bypass. Weight loss following a LAP-BAND procedure is more gradual and, and occurs over a 3-year period.
With any procedure, there is a limited amount of time when patients will lose weight. Afterward, they will transition to a period of long-term adjustment and weight stabilization. A small but signifi- cant proportion of patients (approximately 20%) will experience long-term failure, defined as inadequate weight loss or significant weight regain.
Consequences of Malabsorption
An additional consequence is the “dumping syndrome,” characterized by lightheadedness, sweating, palpitations, cramps, and diarrhea. This usually occurs when a patient consumes too much sugary food, such as ice cream or cake, at one time. Some patients view this complication favorably because it deters them from consuming “junk food,” whereas for others it becomes problematic. Fortunately, the dumping syndrome can be reduced or eliminated with dietary changes.
Eating Problems after Ignoring Dietary Guidelines
Certain postoperative eating patterns can lead to inadequate weight loss or even to weight regain. A pattern of frequent snacking or nibbling can interfere with weight loss. Additionally, because surgery does not restrict liquid intake, frequent consumption of high-calorie liquids, like juice or milkshakes, can become problematic. Specifically, these eating patterns make it possible for the surgery patient to consume a large amount of calories despite a reduced gastric capacity. Ultimately, patients who make and sustain healthy changes in their eating patterns, including consuming small portions of mealtime foods and snacks, are most likely to achieve optimal weight control.
Full-onset Eating Disorders
Segal and colleagues (2004) have observed the co-occurrence of eating disorders and anxiety symptoms in this patient population. As a result, they have proposed a new diagnosis, “postsurgical eating avoidance disorder (PSEAD).” Because patients with a history of eating disorders prior to surgery may be at risk for developing full-syndrome or subthreshold disorders after operation, these individuals may benefit from close follow-up.
Psychiatrists, psychologists, nutritionists, and registered dietitians who treat patients with eating problems after bariatric surgery must work closely with the surgical team to rule out physiological and anatomic-surgical causes. A full diagnostic workup may include laboratory testing, a nutritional evaluation, psychological evaluation, and/or an upper GI series to assess the anatomy and functionality of the altered gastrointestinal tract.
New Assessment Tools for Assessment Are Needed
Summing It All Up
These problems may be mild for some, but severe for others, causing distress or impairment.
Unfortunately, we cannot yet predict who will experience clinically significant eating problems prior to surgery. Multidisciplinary interventions are needed to help patients both prepare for surgery and achieve optimal weight loss and psychosocial adjustment afterward.
Beth says, probably.
The notion that binge eating is a form of addiction comes up frequently in experts' discussions of the diagnosis.Many binge eaters themselves talk about "cravings," "benders" and "hangovers," often describing a dynamic in binge eating that is eerily familiar to an alcoholic's descent into oblivion, as the first drink -- or the first after-dinner cookie -- leads uncontrollably to another and another. Rina Silverman says a binge "numbs me."
Like many who struggle with the problem, she attended Overeaters Anonymous meetings for a while. Modeled on the 12-step program of achieving abstinence, Overeaters Anonymous urges its members to -- among other steps -- identify and abstain completely from foods that seem to trigger powerful cravings to overeat.
Refined sugars and processed foods are a common ingredient.
But this approach, Silverman says, left her more depressed and discouraged. Many researchers and others who identify themselves as binge eaters are similarly critical of such advice.
Chavese Turner, who last year founded a national advocacy organization called the Binge Eating Disorder Assn., found that Overeaters Anonymous simply felt wrong. Identifying certain foods as "bad" and therefore off-limits, said Turner, seemed too simple and off the mark. There were always other, allowable foods to eat in excess. And racking her brain for what she could eat, rather than dealing with an anxiety or noticing that her stomach already felt full, seemed to miss the point.
Having grown up with an alcoholic mother -- now sober for 23 years -- Turner was open to the idea that her eating benders might be an inherited form of addiction. But alcohol, Turner knew, was something you could live without. Food was not; the temptation to binge was unavoidable at least three times a day.
The notion that binge eating and addiction are linked is supported by brain imaging studies that show significant overlap between the brain circuits activated by a drug addict's "craving" and those of a binge eater pondering an eating jag. Researchers also find that the brains of overeaters and those with substance addictions share a common shortage of receptors for the neurotransmitter dopamine, a key chemical in the activation of reward-seeking brain circuits.
"Those are fascinating studies that might yet establish that binge eating and substance abuse and addiction share common origins," says Steven Wonderlich, a University of North Dakota eating specialist who also serves on the American Psychiatric Assn.'s work group on eating disorders.
But Wonderlich cautions that such evidence so far falls far short of doing so. The brain's far-reaching reward circuitry is involved in lots of behaviors that involve motivation, learning and emotion -- not just pathological cravings. And dopamine imbalances are implicated in many neurological disorders, including Parkinson's disease.
"I think the case for the addiction model is extremely weak," says Rutgers University psychologist Terry Wilson. In addiction, the abused substance is the focus of urges, cravings and a high. Those who binge eat are not so focused on their substance of abuse, Wilson noted.
In time, however, the brain studies that have spurred interest in an addiction link may help refine the diagnosis of binge eating. So too will work that has found a role for genetic inheritance in the development of binge eating.
Says Turner's mother, Donna Underhill, who has struggled with eating disorders herself: "Getting sober was probably one of the hardest things I've ever done."
But, Underhill says, she looks at Chavese and thinks "alcoholism was a piece of cake compared to this. She can't not eat."
It's no surprise that a lot of Americans watch what they eat. Counting calories, nutrients and fat grams is practically a national pastime.
But what happens when people go over the line, and the pursuit of healthy eating actually becomes unhealthy?
Click here for the 20/20 segments, and reaction from Johnny, who was featured.
This is a very scary proposition they are entering into in France:
"Anyone encouraging dangerous thinness and excessive dieting could be jailed under a draft law aimed at tackling the growing problem of anorexia in France.
The proposal would punish "incitement to excessive thinness" in magazines, on websites and in other media. Up to 40,000 people, the vast majority women, suffer from anorexia in France - an illness that strikes most frequently in adolescence."
That means, people like you or I, could be considered criminals - if our content was read the wrong way - if we were misread as "encouraging excessive thinness?"
We were in the grocery store today, when a woman, clearly less than 90 pounds walked by. The gap between her legs was wider than the reach of my hand.
Bob outright gasped. He told me later that he was just overwhelmed by the sight of her, and when he saw what was in her shopping cart, he was just sort of disgusted.
We discussed what was in her cart.
- One dozen eggs
- 16 container of egg whites
- Five jars or Gerber Graduates Carrots
- One other small food item I couldn't make out.
He immediately decided that she was "anorexic," and "OMG." I say to him, "But, Bob, she could be one of us." He looks at me like I've lost it. "What if she's dealing with a serious malnutrition issue due to a weight loss surgery problem?" He's like, "That's SO unlikely, Beth."
Then I say, "What if she USED to be obese, what if she lost it all and couldn't stop? What if she grew into another eating disorder?" He doesn't get it. (He only knows binging and not binging, and that, at four years post gastric bypass is a very different animal for him, it's "contained.")
But, you can't judge. We have no idea why this woman is standing on toothpicks, looking like the wind would shatter her spine.
If she were 350 pounds and buying the same line up of groceries, would "we" commend her for "making good choices," because she obviously had "Weight Loss Surgery?"
Probably. And then, when she fell apart several years later, and her hair fell out? We'd blame her for making a bad choice.
Click to make it full-size.
Back when we (my husband and I) were in the pre-operative program for our weight loss surgeries, we had lots of meetings with a behavioral psychologist. I do not remember her once mentioning eating disorders being a possibility after gastric bypass. While she did refer to my husband as a "binge-eater," that was as far as the conversation really EVER went. It never delved further into the "what if, down the road..." regarding when things go too far. It was almost like these professionals assume we're going to fail at some level and regain anyways - that things wouldn't go too far - or become unmanageable.
I should mention also, that pre-operatively I didn't consider being just simply being morbidly obese an eating disorder, and I do now, at least without any triggering physical ailments that cause obesity without overeating.
This morning, I read another blog, another post roux-en-Y gastric bypass-er with a full-blown eating disorder.
This time, it's a girl just like me - same age, kids, husband, everything. The only difference, is that she explains that she had a severe eating disorder BEFORE weight loss surgery as a teen. I don't think she expected it to come back, so intensely.
Eating disordered post-ops are popping up all over, and it's so very scary. Here we are, cutting our guts up to cure this issue of morbid obesity, to only have those same (but different!) food demons come back so very fierce when we get to our normal body weights.
I know those ladies would love to know WHY.
I was just reading a thread on a WLS message board regarding night eating, lack of sleep, sleep-aids and finding yourself eating when you don't remember getting up to get a snack in the middle of the night. This seems to be a huge problem for those folks taking "Ambien" - some get up and start cooking On! A! Stove! while under the influence of Ambien. Nice.
I can't take anything to go to sleep with little kids in the house - BUT - I can commiserate with the lack of sleep. I realize much of my problem is due to having little kids in the house - one that gets up at least twice, and one that may swap beds in the middle of the night.
Sure, that's a given. But - I do wake up at assorted times unrelated to a child - wanting to go roast a damn turkey. It's not always that intense, but sometimes I wake up with such an urge to have a meal, that I do make my way upstairs and eat something. It's almost always a protein bar, which I'll bring back to bed and leave half by the bed if I wake AGAIN, looking for food.
I've also been blaming my rapid cycling blood sugar - that since I eat up until bedtime - that four hours after that meal - I truly AM "starving" because my brain is lacking any glucose. If I wake in a moment of hypoglycemia - it's worse - since I'm a mess, shaky, sweating and confused. Generally I don't make it to the food at those times - because I'm usually mumbling to my husband in a semi-sleep state. Also, I don't remember when that happens.
Other times - it's just the waking to eat - feeling normal but STARVING. Who knows if I really need a snack, but it "helps" and I can go back to sleep, for at least three hours.
It could be considered "night-eating syndrome," I'm sure - it's almost always related to obesity.
Some people wake up as many as four times a night and are unable to get back to sleep without having something to eat. Others don't even wake up. They sleepwalk to the refrigerator or kitchen cupboard and snack away without ever being aware of what they're doing - until they find the evidence the next morning.
These are actually two separate disorders. NES or Night Eating Syndrome leads people to wake up and need to eat. SRES or Sleep Related Eating Syndrome refers to those who eat in their sleep.
But these two syndromes do have several things in common. First, both do disturb sleep and can lead to sleep deprivation. Even if you never wake up, still the sleep walking and sleep eating are enough to disturb the deep sleep you need. Second - Both may be, in some way, stress related, and third, both syndromes, unfortunately, lead to obesity.
According to ANRED (Anorexism Nervosa and Related Eating Disorders, Inc.) in reference to Night Eating Syndrome:
- People suffering from NES have little or no appetite for breakfast.
- They eat more after dinner than during the meal.
- They eat more than half their food intake between dinner and breakfast.
- The condition has persisted for at least two months.
- The person tends to be moody and tense, especially at night.
- They have difficulty falling asleep and staying asleep.
- Their night eating consists mostly of foods high in sugar and starch.
- It's not binge eating because it continues throughout the night.
- They feel guilt and shame rather than enjoyment.
What about you?
Do you find yourself night-eating, night-binging (considering binging for us as WLS'er is slightly different,) or preoccupied and trying to sleep but thinking about getting a snack? Do you wake up with an insatiable appetite? Do you wake more than once? Is this something that bothered you prior to your WLS - or is it triggered by your WLS?
So, yesterday - I'm working - and this gaggle of teenage girls come in.
They are the very typical of this area group of upper-middle class wanna-be Coach-bag carrying future trophy wives. I'm not being harsh, they totally had little miniature Coach clutches, and each of them bought their 'cinno drinks with a twenty dollar bill. (This is in comparison to all the kids that look like they come from my street, in pants with chains and pink hair, asking me what they can buy with "this?" while showing me two crumpled one dollar bills.)
They're standing all around the counter, discussing nutrition - and how someone on TV "got wicked fat, Oh Mah Gawd."
I'm there - in my Walk From Obesity tee shirt.
They go on and on and on about how some of their aquaintances are "so fat, really, can you believe it," and how they restrict their own eating because they don't want to "be like that, like, evah."
All the while, I'm whizzing 500 calorie blended coffee drinks for each of them.
And, I'm thinking to myself, and trying very hard not to say - "Are you girls going to hold each others hair back while you gang vomit this back up in a little while?"
You know, cause, like, they totally don't wanna get fat. It's like, so freaking disgusting.
(Little piss heads like THAT are why people like ME got fat.)
- 165 lbs.
- Breakfast - ISS Oh Yeah Protein Wafers - Vanilla Creme (180 calories)
- Snack - 4 oz skim milk + 4 shots espresso (50 calories)
- Lunch - 3 oz turkey breast + 1 oz havarti cheese + deli mustard (200 calories)
- Snacks - 1 slice flax bread (80 calories) + 1 piece nut/chocolate (60 calories)
Forgive my butter balls post last night. I found that entirely by accident, I wasn't even looking for recipes - have you noticed, I don't really "cook" anymore? (Another post idea.) It was from someone else's blog, and I was all, Butter Balls? STFU! So, that's all. I had no inclination to cook the stupid things, nor did I have any of the ingredients. I don't eat butter or cream cheese anymore. Well, butter, sure, once in a while - but I try to save it for a fresh veggie, and Not Deep Fried Balls.
I like to save my decadent calories for, uh, bread or, um, dark chocolate. But, anyway!
I ended yesterday at a decent calorie place. I ate a protein bar just before bed, very late. I think I ended around 1200 calories. Very good for me.
You know - it slays me when people say it's impossible to gain weight, regain, or eat That Much!? after WLS. Just know, it can, it does, you might. So many of us are struggling every.single.day, if not every single moment, with this whole Eat It Or It's Going To Eat You issue.
Just look at me - with what you think I'm eating most days, I should be a stick! I'm not. I have been bouncing around this weight for months, and prior to pregnancy, was also bouncing around The Same Weight. Even while in serious "diet head" - I am always bouncing around this weight.
What does this mean?! It means that I am so obviously eating too many calories - even if I feel like I'm stahhhhving.
Just a quick gander at my weight history?
- Spring 2004 - 298 lbs.
- Summer 2005 - 147 lbs.
- Fall 2005 - 159 - 165 lbs.
- Winter 2006 - 165 - 175 lbs.
- Spring 2006 - 175 - 185 lbs.
- Summer 2006 - 185 - 195 lbs.
- Fall 2006 - 195 - 210 lbs. (Baby born)
- Winter 2007 - 200 - 185 lbs.
- Spring 2007 - 185 - 159 lbs.
- Summer 2007 160 - 175 lbs.
- Fall 2007 - 163 - 166 lbs.
I could very easily slip into naughty eating patterns and regain a lot. I've done it to a point, as you can see! I can gain ten pounds eating a slice of pizza, I swear. (No, really, it doesn't take much.) My body is so ****ed up metabolism-wise that I think eating one or two slices of bread a day causes immediate weight gain. I'm sure it does. I'm certain the cure to my weight issues (even temporarily) is the removal of ALL forms of carbohydrate, entirely. That would probably include fruit and vegetables, at least any with glucose spikers. But, what is left after everything is removed and we take into account my dislikes and aversions?
Not much, I'd probably be gnawing on a wedge of cheddar cheese all day long. Seeing as I also seem to have hypoglycemic issues after "dieting" on protein first plans - that might not work for very long.
That means, most dairy is probably out, because I crash HARD after skim milk and cottage cheese, and I hate yogurt.
I hate eggs.
Many meats make me gag.
So, we're back to hard cheese and, well, hmm... beans.
Beans that don't cause sugar spikes. Lentils? I like lentils!
But, beans are high in calories, and carbohydrates.
So, we're back to cheese. Hard cheese.
Hard cheese is high in fat, and calories, and is the reason I am overweight to begin with!
Argh. Who wants pizza?
Months ago, when I read of the over the counter approval of the "poop your pants weight loss drug," Alli, I blogged about it.
What did I predict? This is what I said, in February: "Kids will buy these. They will find a way to buy this stuff to use it while dieting, like diuretics or energy pills. You're going to have teenage girls binging after taking a fat-blocking "Alli" pill and poopting themselves in the bathroom stall while purging it up."
From Newswise, this month:
Eating disorders patients are likely to abuse Alli, the first over-the-counter diet drug approved by the FDA, predicts a Saint Louis Behavioral Medicine Institute psychologist who specializes in treating these patients. “Because it’s been approved by the FDA, people think it’s safe. But if patients are already at a healthy weight and are using Alli as part of their eating disorder, then it is not safe. It can make an eating disorder even worse because it magnifies symptoms these patients already have,” says Randall Flanery, Ph.D., who also is an adjunct associate professor at Saint Louis University School of Medicine. One of the main side effects of Alli is diarrhea. “For someone who has been abusing laxatives, diarrhea is no big deal. What might be a more discouraging side effect for a healthier individual becomes an attraction for someone who has a serious eating disorder.”
I know, how depressing! Here, nevermind that - look at this poop instead.
You might have thought eating disorders were for young girls (and boys, sometimes)... but you normally don't picture full-grown women dealing with issues like anorexia or bulimia.
Apparently more and more women are seeking treatment for eating disorders at a later age.
From The associated Press:
"Eating disorders such as anorexia and bulimia have long been considered diseases of the young, but experts say in recent years more women have been seeking help in their 30s, 40s, 50s, and older. Some treatment centers are creating special programs for these more mature patients.
Most of the women in this age group who seek treatment have had the problem for years, said Dr. Donald McAlpine, director of an eating disorders clinic at Mayo Clinic in Rochester, Minn. “The epidemiology is pretty clear that anorexia and bulimia both peak in the late teens, early 20s,” yet “a lot of (patients) continue to be symptomatic right on through to middle life.”
Apparently, I'm not a binge eater, and never was. (If this is what binge-eating is?)
Just a copy + paste post from Obesity Help this morning: