The Last Supper: Last Meal Syndrome

Sound familiar? Last Meal Syndrome is very common among people facing weight loss surgery, and chances are you've already suffered it sometime in your life, perhaps the day before you started New Diet #832. Since New Diets almost always start on a Monday (there may be a law of nature covering that), you spent every minute of Sunday gorging on all the foods you could no longer eat come Monday morning. You ate so much that you made yourself slightly ill, and you probably didn't taste half of that food in your haste to cram it into your mouth.

Overeating because of anticipated deprivation is an old, old habit. Until the earliest humans learned to cultivate their own food supply, nutrition was largely a matter of opportunism. If you caught a big fish or felled an animal by heaving a rock at it, you ate it all because you didn't know when another meal would swim, crawl, walk, or fly by.

Although I sometimes joke that being self-employed as a writer is terrifying for me because it's a hand-to-mouth existence, at no time in my middle-class American life have I ever been truly threatened by significant food deprivation. My repeated bouts with Last Meal Syndrome have been caused mostly by my emotional over-attachment to food. When starting a new diet, or contemplating my upcoming bariatric surgery, I was terrified not that I would starve, but that I would suffer from emotional pain, boredom, or stress unrelieved by my usual comfort: whatever food I wanted, when I wanted it, in any quantity I wanted. Intellectually, I knew that I would be able to eat small amounts of healthy foods and thus lose weight and gain better health, but the spoiled child within me feared and hated the very thought of that.

A few days before my Lap-Band surgery in 2007, my husband asked me, "Are you going to have anything special to eat before your surgery?"

I said virtuously, I'm on a clear liquid diet for the next three days. I can't eat anything at all, never mind something special. My surgeon had told me that if my liver wasn't in good shape, he would bail out of my surgery. After all I had gone through to get to the operating room, I wasn't going to blow it, and it wasn't (as I reminded myself) as if I would never be able to eat again in my entire life. I was facing food deprivation, yes, but for a matter of days, not years.

Now, let's get one thing clear here: I'm not claiming superiority over pre-ops who give in to Last Meal Syndrome and celebrate their own private food festival a day or a week before their surgery. My compliance with my surgeon's instructions was driven by fear, plain and simple. But in the last five years, I've learned something important that newbies and wannabes may not realize about bariatric surgery. And that is:

The likeliest food deprivation you will suffer after surgery involves the quantity,not the quality or even the nature of the food you eat. Once you've survived your post- op diet progression, you should be able to eat a wide variety of foods you like. You don't automatically have to give up Cheetos or Haagen-Dazs or McDonald's or prime rib of beef forever. Depending on the surgical procedure you have, certain foods may give you trouble at different times, but just because they don't work for you on Day 42 doesn't mean they won't work for you on Day 420. All you have to give up is eating those foods in excess. It's true that when your daily calorie budget is limited, your health will depend on your making the best possible food choices, eating a piece of cheese instead of the Cheetos, a Skinny Cow ice cream bar instead of a gallon of Rocky Road, a Happy Meal instead of a quarter-pounder, two ounces of prime rib instead of the whole cow. You'll still be able to tolerate lots of tasty things, so when you look down the road ahead of you, you should see plenty of nice places to stop and eat instead of a dry, barren desert in which you'll have to subsist on stale Melba toast and lukewarm water.