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printer-friendly version| Food for Thought by Carol Signore, MAT, LMFT, FAED What will life be like without compulsive overeating? Lucy a pre-op, asked me a powerful and interesting question. A compulsive overeater, she thought that her "compulsivity" might be hard to give up after surgery. As excited as she was about her upcoming surgery, she was genuinely concerned about what her life would be like without overeating, and she wondered where all that compulsivity would go. What a great question!
Eating is a complicated experience. The social and pleasuring implications of eating go way beyond the fuel it provides. For most of us, our earliest experiences of feeling loved and cared for were enjoyed in the arms of our mothers while eating. Compulsive overeaters learn to reach for food to obtain that feeling of nurturing again and again when life feels empty or boring, happy or sad, or like it is just missing something. Eating can also be a way to celebrate. Lucy saw it as a special, secret time just for her. She chose a secret food and ate it ravenously. The social rewards of eating are completely lost when eating is practiced alone like this. That?s why, when Lucy finished an episode of compulsive overeating, she didn't feel nurtured for long. She was quickly filled up with self-hatred and shame. Compulsive overeating takes much more than it gives. The fix is temporary and the harm is long term. Dangerous Substitutes Substitutes for overeating abound. Some look harmless but may not be. Here are common substitute behaviors to avoid. PurgingThe urge to self-induce vomiting is very strong for some WLS patients?especially in the early post-op months. Once this habit is begun it can be very hard to stop. Patients with histories of bulimia are at particularly high risk. Some medical issues early in recovery can cause vomiting, but they are rare, and should not be expected. Most of the time post-ops can and should control their vomiting by eating appropriate quantities of food and chewing it slowly and thoroughly. The pain that follows overfilling the pouch or eating too fast is an important teacher. Don?t shortcut that lesson by removing the evidence you need to feel and remember that you chose to eat too much or too fast. When self-induced vomiting becomes habitual it is very dangerous, and, as any bulimic knows, purging is powerfully addictive. If it happens more than twice a week over several weeks you should seek professional help as quickly as possible. Clothes Shopping Post-ops should be wary, however, of the potential for overindulgence in clothes shopping and the return to compulsivity that can develop around this behavior. Overindulging in clothes is a close relative to overindulging in food; both are cover-ups. Newly slim post-ops may be drawn to clothing as a way to prolong the attention their weight loss initially generated and may now be waning. They may feel seduced by the excitement that surrounds the world of fashion and clothing. It's easy to be caught up in this thin obsessed western culture and clothing may feel like an important ticket into that world. Beware! The world of fashion is a world plagued with eating disorders. Weight loss surgery aims to move you toward health. Your love and acceptance for yourself does not depend on your size or the style of your clothing. New clothes seem to provide an emotional fill-up, and as with other behaviors that become compulsive, the temporary relief heightens the need for repeat fill-ups. Dependence is established on that need for more. The real need is for self-acceptance and balance. Using clothes shopping to cope with feelings is a dangerous path back into compulsive behavior. Enjoy your new clothes and size as just one part of the many ways your new body is changing and enjoying better health. Spending Money Relationships Adults who were morbidly obese as teens will not easily forget the profound isolation they endured. Anger may assert itself in aggressive ways. Personalities that were unflappable and compliant before surgery seem to rise up in righteous indignation afterwards pushing away anyone who tries to get close. Friends and family will feel this wrath and resent being targets of this rage. Some post-ops will be tempted to throw out old relationships along with their larger clothes and start anew. Sometimes pre-op relationships are toxic enough to warrant this but it?s important to go slow here. Relationships that were rocky before surgery will probably get rockier and may eventually have to be abandoned, but relationships that were solid before surgery will likely weather the transition and be even better in the end. Post-ops need to take their time and be sure to make wise choices. Friends and family are never perfect but they are precious resources; protect them from your swirling emotions until you arrive at a calm and stable place in your recovery. You need to understand your anger and compulsive urges and develop lots of new effective coping strategies. It will take at least two years?or even longer for many. Substance Abuse Alcohol and other drugs can anesthetize some of the powerful feelings that patients notice after surgery; these substances also reduce normal inhibitions. This is a dangerous combination for people who are trying to get used to life without their old and best coping mechanism: overeating. Recovering patients need to feel, and cope in healthy ways, without covering up. Even a small portion of alcohol can cover up important feelings, obscure danger and induce a very vulnerable and impaired state after surgery. Alcohol intoxication is short lived for most post-ops. A small drink has a big impact but can disappear quickly. Post-op drinkers have trouble adjusting to these new parameters. Some patients may try to drink small amounts over longer periods of time in order to sustain the new feeling of intoxication they are enjoying. Driving risks will be magnified more than normal for post-ops under the influence of alcohol. People who are used to feeling safe after one or two drinks at a meal will no longer be able to operate their cars safely using that formula. At the same time it is easy to underestimate these risks because the amount of alcohol consumed seems so small. Sex Adolescence and young adulthood are the times when most people explore their sexuality and look for life partners. But as we noted earlier, post-ops who were morbidly obese during adolescence are apt to be very inexperienced in matters of sex and dating, and may have very weak or inadequate social skills when it comes to sharing intimacy. New daters often misread the cues and signals of their peers. They may unknowingly reach out to inappropriate partners when seeking physical and sexual acceptance. They didn't learn how and weren't taught the rules at the normal developmental stage of life. It's awkward and difficult to try to learn these skills later in life when everyone else already knows them. It would not be surprising to find adult post-ops engaged in dating scenarios more common to teens than adults. Risk-taking increases when sexually stimulated people experiment carelessly without their old coping strategies. For a person who has had little positive sexual experience, the sense of suddenly being sexually alluring to another can be very exciting, seductive, and terrifying all at once. Powerful needs that have gone unmet for years will cause enormous pressure and may propel people into sexual experiences they are not prepared to have. New sexual appetites and behaviors are best explored slowly and carefully. If sex is used as a way to satisfy empty feelings and unmet longings it can easily become a compulsive substitute for overeating and block the formation of a wider, healthy range of coping skills. Promiscuity can develop and jeopardize the formation of healthy intimate relationships. In extreme situations a recovering patient may unwittingly place themselves in the very real danger of becoming the victim of an assault or a sexually transmitted disease. Exercise Another concern is the bounce-back regain. Some patients who engage in a strenuous exercise routine over the first post-op year will lose more weight than their body is able to maintain. As soon as the strenuous exercise routine ends (and it almost always does) patients experience a 10 or 15 or even 20 pound bounce back. The bounce back precipitates a crisis of faith in surgery and a panic about regain. Dieting and yo-yo restricting begin out of habit and patients find themselves in the familiar territory that fueled their morbid obesity in the first place. When establishing a post-op exercise routine, emphasize how great exercising makes you feel. It should make you feel good! It?s hard to find the time for this important part of life but exercise shouldn't hurt?and it shouldn't ruin the day if we do or don't do it. Exercise can become a very cruel overseer if we espouse the no pain, no gain philosophy. That kind of exercise begs us to quit. It also sets a very negative tone for the day if it feels like an obligation instead of a contribution we make willingly. It's a little like excessive-compulsive weighing on the scale. It's important to keep an eye on the scale on a regular basis, but if your day is completely colored by the numbers on the scale or the number of reps or sit-ups, then something is out of kilter. Some would argue that compulsive exercise is healthy better than compulsive eating. They fantasize about cultivating exercise as a new and healthy addiction. Don't fall for that trap. Obsessions and addictions are never healthy and anyone who thinks they are has never seen the pain in the eyes of a young anorexic running in place, alone in her darkened room at night, or the frenzy of a binge-eater with no more ice cream. Compulsivity doesn't disappear Gastric bypass surgery gives us a tool to battle back and makes it possible to triumph over obesity, probably for the first time, but we must learn to use it well. What will fill you up? Just a little food for thought!
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Carol Signore, MAT, LMFT, FAED, is the Executive Director of My Self Design, an individual, cognitive/behavioral counseling program for lap ban and gastric bypass patients,
