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Publish Date: 3/18/2005

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Health News Headlines

Bypass backlash
Seeing is not believing for many who undergo surgery


LONGMONT — Wedding cake and wine seem like poor carrots to motivate an obese person to lose weight, unless that person is a young woman hoping to get married someday.

Visions of being a bride and living a happier life ultimately motivated Laura, who requested anonymity, to undergo a complicated six-hour gastric bypass surgery in 2001.

The 5-foot, 5-inch tall woman weighed 320 pounds then and figured the procedure would melt the 200 pounds between her and Mr. Right.

Doctors in Denver told her they would reduce her stomach to the size of an egg, a pouch that would hold less than 1 cup of chewed food at a time versus the average stomach’s 4-cup capacity.

They also explained that refined sugar and alcohol could make her violently ill, because her surgery would also bypass a section of her small intestine most responsible for properly absorbing the ingredients found in wedding cake and wine.

Laura understood the Catch-22 aspect of her decision.

But she signed on the dotted line anyway, spent the going rate — now somewhere between $20,000 and $35,000, according to the National Institutes of Health — and shed 120 pounds in less than a year.

Today, however, Laura is heavier than ever. She weighs 350 pounds, the exact number NIH uses to divide the obese from the “super obese.”

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What happened to Laura?

She survived the surgery, which NIH says has about a 1 percent mortality rate. She ate baby food for weeks during her recovery to avoid upsetting her new innards, and she avoided sugar, alcohol and high-fat foods.

After the surgery, the bright, efficient office administrator in Boulder County happily discarded memories of squeezing into everything from her red junior high gym suit to her white high school graduation gown.

Instead, she asked her mother to snap a photo of her every weekend posing in the hallway near the kitchen. The Kodak collection shows a young woman shrinking as if a pin had been pulled.

Co-workers even commented that they could see Laura’s collarbones emerging underneath her necklaces and that she was looking better by the day.

But Laura’s self-image never really caught up with her dramatically changing silhouette.

Laura said the thinner she got, the fatter she felt.

Before long, she began cheating on the lifestyle changes — the careful diet and regular exercise — that are supposed to go hand-in-hand with the radical surgery.

Namely, she tried taboo beverages and foods. The experiment started out innocently enough, with her sipping a beer at a friend’s house after work. Then, testing the limits became routine.

Before long, Laura had stretched her stomach considerably and was back to her most shameful food-related secret: waking up in the middle of the night obliviously eating bedside snacks.

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Psychologists treat patients like Laura before and after surgery to safeguard both their weight-loss success and well-being. But food addiction is like other addictions in that it often fosters isolation, Laura said.

“In some ways (food addicts) are very lucky,” said Jenn Berman, an American Psychological Association spokeswoman and therapist in Beverly Hills, Calif. “If they were heroin addicts, they’d be dead on the street alone with a needle in their arm.”

A food addiction might not have the acute side effect of a drug overdose.

But NIH statistics show nearly a third of American adults are obese, and that chronic condition shaves between two and five years off life expectancy by causing an increased risk of death from all causes when compared to healthy weight counterparts.

Laura needed no statistics to know she had a problem.

“I was never able to let go of what my therapist called, ‘Fat Laura,’” she said.

However, her mother’s tears one summer afternoon in 2004 underscored the seriousness of her ballooning post-surgery weight.

“She was worried that she would have to bury me,” Laura said.

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Coming to terms with the surgery’s backlash deepened the disappointment and sadness Laura had felt since before seventh grade, when she first joined Weight Watchers and Jenny Craig.

“When I realized that I was a food addict, and I began telling people, I felt so ashamed. You’d rather say, ‘Hello, my name is ________ , and I’m an alcoholic or drug addict,” she explained. “Socially, people don’t look at (compulsive eating) as an addiction.”

Nor do many people appreciate that the cold-turkey option is out.

“You can give up alcohol and drugs, but food is always there,” Laura, now 27, said. “You have to eat to survive.”

To thrive, Laura just needs to eat much less. And that, for her, goes beyond counting calories or measuring portion sizes.

It involves following Overeaters Anonymous’ 12-step program with a support group and counseling with a weight-loss expert twice monthly in addition to soul searching.

“With a food addiction, all emotions shut off after a while so you don’t have to feel the hurt and you can pretend it’s not true. It’s like being in a fog,” she said. “And it was my drug of choice.”

To kick that drug, one that’s on most tables around the world three or more times a day, food addicts need a multi-faceted approach, according to a Longmont OA facilitator who goes by the name Lori to keep with the group’s spirit of anonymity.

“It’s a three-legged stool of physical, spiritual and emotional recovery,” she said. “If you don’t deal with all three issues, you’re off-balance.”

Patrick DeMarco, a Fort Collins psychologist and board-certified expert in trauma stress, uses guided imagery to help patients in recovery to redraw their mental shape to match their new physical shape.

APA reported that other psychologists use mindfulness meditation to raise awareness of addictive behaviors; patient journaling to better self-monitor patterns between emotional upheaval and food consumption; and an eat-to-live versus a live-to-eat mentality model.

Berman helps her clients learn how to listen better to hunger cues by eating lunch with them at her desk. Every so often she takes “time outs” between bites to help them identify how hungry or full they are as the food disappears.

Psychologists also try to get patients to let themselves off the hook for attempting a surgery that might be more or less successful depending on many factors.

“Some people think (gastric bypass) is a cop-out, and that patients are somehow inadequate,” said David Stettner, an APA spokesman and psychologist at UnaSource Heath Care in Berkley, Mich. “But this is a person who doesn’t live in your body, who doesn’t go through your troubles.”

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Laura’s bathroom scale does not show her losing weight like she did in the early days after gastric bypass surgery.

But late last fall she got a second wind to win the battle of the bulge with a new therapist who specializes in weight-loss issues.

By journaling and talking through the brew of embarrassment, sadness, shame, disappointment and anger she feels about being overweight, Laura said she hopes to get a handle on the real issues that feed her food addiction.

Another breakthrough came in early March at her church’s weekend women’s retreat in the mountains, she said. There, she actually got in touch with herself enough to cry for the first time in years over self-acceptance and body image struggles.

“I had finally given this addiction over to God, and really, truly grasped that this was an addiction, and I was powerless over it,” she said.

Still, Laura keeps celebrating baby steps on her long journey to a healthy and unified body and body image.

In years’ past she would have bought 20 bags of conversation hearts throughout the Valentine’s Day store display season. This year, she didn’t buy one.

And she has goals that range from feeling better about herself to perhaps one day wearing white without worrying about her weight.

“Now, I’m looking into the real issues of why I eat, why I do what I do,” she said. “For me, a big thing was realizing I was not alone in this.”

For more information visit

•Association for Morbid Obesity Support, www.obesityhelp.com

•The National Institutes of Health, http://win.niddk.nih.gov/publications/gastric.htm

•Overeaters Anonymous, www.oa.org

Pam Mellskog can be reached at 303-684-5224, or by e-mail at pmellskog@times-call.com.

 

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