This is a follow-on post to one below, which quoted an essay about head hunger, trying to make WLS patients responsible for how they deal with it.  I think another point of view is appropriate.

"Head hunger" is a broad term for the urge to eat that is driven by both emotional and physiological factors.  Blaming it all on emotional issues is inappropriate, and unfairly puts the blame and responsibility on the patient to try and control via "willpower" something that is utterly not within their ability to control.

A significant and in many cases overwhelming source of "head hunger" is biological, and stems from a broken metabolism.  It is a REAL and BIOLOGICAL hunger being driven by inappropriate signals from the complex interactions beween insulin and glucose metabolism, gut hormones and brain signalling factors.  It is a basic biological drive, rooted in primitive instinctual mechanisms that were evolved to ensure survival.  Trying to control or ignore this biologically-motivated imperative is just as likely to work long-term as trying to not breathe.

The duodenal switch significantly improves broken metabolisms.  The removal of ghrelin-producing tissue from the stomach is an important factor, as is the simple mechanical issue of having a smaller stomach that feels full and gives the mechanical sensation of satiety, as compared with pre-op, when there was little or no satiety felt.  But even more importantly, the specific rerouting ot the intestines provided by the switch part of the surgery, completely changes the metabolism, by mechanisms that are not yet well understood.  It is THIS effect, which is not present in other surgeries, that I believe provides the superior results of the DS in the amount and durability of excess weight loss, resolution of comorbidities, as well as the improved quality of life.

Do some MOs have psychological issues?  Of course.  Years of stuffing food along with their feelings, blah blah blah - that's real too.  But, as my surgeon said to me when I asked him about this, except in the case of bulemia, in the vast majority of the cases, what he has seen with the DS is that the psych issues are MUCH more amenable to treatment when the underlying physiological issues of lack of satiety and inappropriate hunger urges are controlled by the surgical corrections to their metabolisms.

Look at these references.  (Marceau's study references the old BPD, which has a different stomach configuration than the modern and improved DS, but essentially the same intestinal configuration, which is the source of the metabolic effects that they have in common.)

http://care.diabetesjournals.org/content/31/Supplement_2/S29 0.full

Obes Surg. 2005 Jan;15(1):3-10.

Contribution of bariatric surgery to the comprehension of morbid obesity.

Marceau P.

Laval Hospital, Quebec, Canada. [email protected]

Convinced that morbid obesity was not due to food excess but rather to a metabolic disorder, we searched in the literature for data in favor of a metabolic disorder. We have found evidence in support of the thesis that the cause of morbid obesity is the inability to burn excessive caloric intake normally. It would involve the difficulty to increase heat with the amount of calories taken, which would be faulty and force fat deposition. This mechanism called dietinduced thermogenesis (DIT) allows the dispersion by heat of excessive calories to obtain energy balance. Results from bariatric surgery and particularly biliopancreatic diversion (BPD) give further support to this thesis. BPD would improve heat production to a meal (DIT) by one of these mechanisms: increased insulin sensitivity, change in intestinal hormone secretion, or chronic lipid malabsorption. Available results show that surgery, to be efficient, must change the physiology and not solely decrease food intake.


My point is, you can cheerlead all you want about learning self-control, and addressing your psychological issues with food, but if those issues arise from and are driven by physiological factors that are not addressed by your surgery, I think most of you are doomed to fail, because long-term, you can't fight those primitive and fundamental biological urges that are driving your inapprorpriate -- and VERY REAL -- hunger.  Articles like the one quoted below just add to your misery by unfairly placing all of the responsibility and blame on you.


I didn't need to get right with food, food needed to get right with me.
THINK TWICE, CUT ONCE!

 

Here is the Conclusion of the Marceau paper:

That good results have been obtained when the physiology was changed in contrast to poor results when only food restriction was employed, is another demonstration against the prejudice that obesity is due to gluttony. In reviewing the literature for data that fits our clinical evidence, we have been able to make a strong case in favor of deficient thermogenesis rather than over-alimentation as the prime mechanism of morbid obesity. We believe that the fundamental characteristic of morbidly obese patients is their inability to disperse extra calories to maintain energy balance, resulting in fat deposition.  Permanent cure of this disease requires physiological change.

Holy Cow!

You barely posted this and the buzzards are circling already, a few more seconds should bring the rest of them out.  LOL

This describes my exactly and one of the reasons I was convinced that the RNY would never work for me.  I knew my body would be screaming for food as soon as the 'honeymoon' period was over. I know myself well enough to know I could never do the required RNY diet the rest of my life and I have had enough experience with dieting to know that without great metabolic change, my body would gain weight on a small amount of calories. Period.

Another great post!

Michele

These people are called "mean girls." They wait and watch for posts that threaten them and then attack to protect the choices the really dont feel confident about. Normal, adult, mature people would just move along without even bothering to respond to something they seem to hate.

Karen

Diana......this is the most pertinent, constructive, and technically valid post on the topic of weightloss that I've seen anywhere in the last two years of perusing this (and other wls related) board. I'm posting a reply mostly to bookmark it for myself! But also to thank you for all you do in your work to make this information more readily available. This discussion needs to continue and it needs to continue in this forum....respectfully of course--because this is where ppl come for "the real sknny" on weight loss.

I spent a great deal of time and employed considerable research skills learning everything I could about WLS prior to having my RNY earlier this year. But it was very difficult to get unbiased information w/respect to types of WLS available. Unless you happen to luck out and visit one of a handful of surgeons in the world for your initial consultation both willing and able to share the whole truth w/every single consult that comes through their door, it is impossible to single source the why, where, and how of this critical decision making process.

I am forever grateful to my surgeon for effectively rerouting my digestive system w/out killing me or causing latent fallout related to the operation itself. I'm even grateful I am one of the many more recent patients to benefit from a revised RNY procedure in the wake of earlier lessons learned by the WLS industry. But we have a long way to go in making informed consent available to everyone who can live healthier, if not longer, lives thanks to WLS.

Because of other DSers like yourself I have since become aware that the "gold standard" leans to the DS in many cases. This doesn't mean I regret my RNY.....how can I afford to at this stage? It doesn't even mean I would choose the DS if I was still pre-op today; althought w/a BMI of 42 I very well might have. It just means after having gone through the process (which is deliberately tailored to pull ppl into and through a blind pipeline) I realize I was not privy to all the facts. And I do personally and strongly recommend anyone w/a BMI over 45 extensively research the option for themselves.

Until the vast majority of surgeons and their teams learn to build trusting relationships w/their patients, this remains the best forum for vetting surgeons, insurance, and WLS options available to the growing number of affected w/this disorder.

Thanks Again.

thank you.  An educated post without the childish foot stomping by some of the people who try to, unsuccessfully belittle Diana.  Kudos.

.....i understand the temptation to foot stomp (trust me) and hope you do too.

diana, you make a very valid point.  Hats off to you.  I think that you should build and constituency and lobby on capital hill, and outlaw all other surgeries and mandate that Lap-band, RNY, FOBI, what ever else is out there, be eliminated.  That will allow everyone to have DS.  Then we can all support one another.  We wont have to fight anymore.  You are right, food needs to get right with us, not the other way around. 

   

Hey, Head, your bitterness is really shinning bright today.