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Tuesday, September 21, 2010

Is it too early for righteous indignation?

A while ago several of you wrote about a study that detailed the bias towards the obese held by the medical community. The study demonstrated that, among other things, medical professionals were more likely to view the obese as "non-compliant" with medical treatment. This bias even exists amongst bariatric medical professionals. This isn't the article that was passed around previously, but it is another article that references a different study that found similar biases.

I bring the topic up again because I was reading a post yesterday from a blogger who was banded about a month ago. I want to be really vague about the identity of this individual (although they did nothing wrong). Essentially the gist was that this individual was being criticized for choosing one specific food item by their surgeon and staff. Since banding, this person has lost considerably more than the recommended 2 lbs/week. My point was why was this individual being criticized for eating something with sugar in it? Why wasn't the surgeon looking at the results and saying, "Way to go! Keep up the good work!".

See, here's the dirty little secret: naturally thin people eat sugar (shh!). In fact, most of us have had the experience of dining out with our thin friends and watching them eat salad smothered in dressing and croutons, a fat-filled, smothered- in-gravy entree, a glass of wine or three, followed by a luscious dessert. Usually we are picking away at our dry salad while they enjoy their delicious dinner. They don't feel ashamed to have eaten it. They relish it, they enjoy it and they feel satisfied by it! Shocking, right?

Now I do realize that some people may have valid reasons for avoiding sugar. Truth be told, I chose to have sugary desserts only occasionally. But I don't avoid fruits, juices, milk, etc. simply because it has some sugar in it. In fact I like to say that I avoid sugar free foods (and fat free) like the plague. The reason I avoid them is because I am not dieting and those are diet foods.

I'm not dieting because diets don't work. 30 years of dieting is what got me to 280 lbs. (127 kg.). (I've written about some of this before so I apologize if you've heard this from me.) The reason that I believe that diets don't work is because they don't adequately address the problem. The problem is that people who develop weight problems have become alienated from their sense of hunger and satiety. They eat for reasons other than hunger and they don't stop eating when they've had enough. And the thing is that diets actually further alienate you from your sense of hunger and satiety. Diets tell you what to eat and when to eat and when to stop eating, but this information has nothing to do with whether you are actually eating due to hunger or stopping due to being full.

Of course with diets there's also the typical rebound when the diet is over. I think this rebound is what causes people to become so heavy. We think we need a diet so we restrict our eating for awhile. We lose weight. But then we resume our previous eating behaviors and we gain that weight back. And we gain some more. Rinse and repeat. Knowing this, it actually seems pretty crazy that ANYONE would suggest someone go on a diet. It especially is mind-boggling that medical professionals would recommend a diet. This cycle of losing weight and regaining weight and gaining additional weight is what makes us obese!

We all assume that WE are the problem when the diet fails, but I also challenge that idea (shocking, I know). I don't think it is natural for us to radically alter our eating behaviors permanently. We eat the way we eat. It is as natural to us as breathing, just as it is natural to a naturally thin person to eat the way THEY eat. Sure, we can strive to make healthier food choices. Of course we cannot eat crap all the time. Your thin friend doesn't eat that high calorie/high fat restaurant meal EVERY night. The diet fails because it doesn't correct the actual problem which is eating when we are not hungry and not stopping when we are full.

This is where the gastric band comes in for me. It doesn't work because we are on another diet, despite the recommendation of our surgeon's office. It works because it instills very healthy behaviors that are conducive to weight loss and maintenance. We eat small portions, we eat slowly, we are aware as we eat, and we stop when we are full. Many naturally thin people utilize these behaviors themselves. We need to do a few relatively simple things. We need to minimize sliders that thwart the band's effectiveness. We should (generally) eat only when we are hungry. Because we eat relatively small portions, we need to make sure that we are eating as nutritiously as possible (protein first, blah blah blah...). And that's all that is required for success with the gastric band!

Okay, I'm putting my soap box away for now. Thanks for putting up with me!


Blossom said...

I have never heard that bandsters shouldn't eat sugar (I know bypass patients can't)...or is it the school of "sugar is bad for you"? Well any over indulgance probably is bad for you...I know some bandsters are told to go low carb as well, but not me. Obviously they prefer me to eat healthy carbs, but I don't have to eliminate any foods from my diet (and so far I can eat anything :-/). I don't know....I just think eliminating any type of food just sets you up for failure; moderation is the key! Plus with sugar & carbs, there are so many healthy options like fruit and milk...

Mary H. said...

Great post! This brings up a lot of good points. I totally understand where you are coming from and you are right, the band is not a's a life changing tool. I, personally, don't count carbs or sugars or fats religiously. I look at calories and protein. I stay away from breads and other things that fill me up without giving me nutrition and that seems to cut away a lot only leaving a healthy amount of carbs, sugars, and fats. I do not have high blood sugar that needs correcting, so that does help, but I have taken a basic approach that units of energy in should be less than units of energy out. That is the basic, scientific process of weight loss and for now, I'm sticking to it!

LDswims said...

Great post! It's like you crawled around in my brain to express my very own thoughts! Except way more better like. :)

Great post!!

Read said...

I couldn't agree with you more. The idea that you can't eat certain food just flies in the face of common sense. Not allowing something makes you crave that very thing. I will add my own experience with my sergeon totally supports the studies you cite. I too look at the band as my reminder to stop when I'm full and to make sure I'm getting the healthy stuff in. Beyond that, this is just life - just like for everyone else. It's food and it's living.


TJ said...

That is one reason why I LOVE my surgeon. If you are eating sugar or white carbs all the time he will call you on it, but beyond that the goal is to be a normal person. Like you said normal people eat "bad" foods at times. His exact words were "it is unreasonable to think you will never have ice cream again."

I do use diet foods and techniques at times, but either because I like them or as a tool for when I am struggling. The same way my thin friends do when they need a little help. To consider any thing completely off the shelf is a crazy thought to me. Moderation is better to my long term success!

Band Groupie said...

You're singing my theme song Amanda. Even in my one page final query letter I'm sending out this week I squeezed in "I couldn't stay on a diet forever, diets and deprivation were a recipe for regain; diets got me obese."

Great post!

Bonnie said...

You can get on your soap box anytime, girl, cause you speak the truth. Hallelujah!

MandaPanda said...

I'll throw out an "AMEN!" for good measure. I couldn't agree more. What's really annoying is the different schools of thought. For instance, my surgeon says nothing is off limits (in moderation of course) and deprivation just creates a martyr mentality. The nutritionist from his office, however, thinks we should never eat grains, pasta or ice cream again...EVER. Go figure. Preach on sister!

Michelle said...

Great post! Loved and agreed with it that I read it twice.

Nicole said...

Thanks for this post. I am only two weeks out from being banded and I have a lot of anxiety about what I can and can't eat. Right now it is easy because I am on mushy food, but once I start solids, I am worried. I don't want to feel like I am dieting, but I also want to be successful. It helps to hear the point of view of someone who has been successful with the band.