I've eaten like  fool the past 48 hrs.  Filled with nervous anxiety and taking it out on myself in the worst way.  I will pull myself together today.  Focus on my oversized to do list and eat sensible meals in between.  These 15 lbs have to go.  The good news is the pants I wore to the OH conf in ATL are falling off now.  Out of the double digits as they were an 11Jr.  Yay!.  Getting there but eating like a fool will not do! 

Anyone struggling with being too fat knows it is a complex issue.  Calories in vs calories out is only the most simplistic of explanations.  We are... people are... far more complex.  Eating disorders are not just for the under weight.  Thankfully, the medical community is beginning to get a clue.  I am hoping and praying this will lead to addressing the psychological issues that divide those of us who like to eat from those of us with eating disorders.  We each need a different kind of help.  Surgery may help us all physically but to maintain over the long haul we must address the individual sources of our struggle with obesity. 

A friend on another site has recently printed a number of excerpts from the DMV-V.  That is, the body of documentation used ot identify diseases for medical coding.  In the past disorders leading to obesity were wholly excluded.  At last, it has been recognized that we do not need to purge to be binge eaters.  We just get and stay fat; or, we learn to binge low cal.  

Below I've shared some of this information.  It is all in the public domain should you want to do your own research.  It may be worthwhile for each of us to gain some personal introspective and improve our chances of lifelong term success over fat. 


 

1. Rationale Binge Eating Disorder is one of the disorders in the DSM-IV appendix. It is recommended that it be formally included as a disorder in DSM-5. The rationale for recommending inclusion of binge eating disorder (BED) in DSM-5 is based on a comprehensive literature review (Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009). Below we address several key recommendations offered by Kendler et al. as they apply to BED. Consistent with Kendler et al’s recommendation for making decisions about diagnoses in the Appendix, the Eating Disorders Work Group addressed the question, “Should the BED diagnosis should be a) deleted from the appendix, b) promoted to the main manual, or c) retained in the appendix. Synopsis of the Review of Validators. The following comments are organized according to the structure of the table of validators provided by Kendler et al. (2009) and based on a literature review (Wonderlich et al., 2009). BED has been compared to both other eating disorders (i.e., anorexia nervosa, bulimia nervosa) and obesity in validational studies. Overall, BED distinguishes itself from other eating disorders and obesity across a wide range of validators, including high priority validators. In terms of antecedent validators, there is evidence from family history studies that BED tends to run in families and is not a simple familial variation of obesity. Furthermore, in comparison to other eating disorders, BED shows a relatively distinct demographic profile with a greater likelihood of male cases, older age, and a later age of onset. Regarding studies of concurrent validators, BED is also differentiated from obesity in terms of greater concerns about shape and weight, more personality disturbance, and a higher likelihood of psychiatric comorbidity in the form of mood disorders and anxiety disorders. Also, BED is associated with lower quality of life than obesity. Finally, in terms of predictive validators, BED may be differentiated from other eating disorders in terms of its lower level of diagnostic stability and greater likelihood of remission. In clinical course, BED also shows a greater likelihood of medical morbidities (e.g., self-reported weight gain and metabolic syndrome indicators) than is typically seen in other eating disorders, or in obesity. Finally, in studies of treatment response, there is evidence that individuals with BED have a more positive response to specialty treatments than to generic behavioral weight loss treatments in terms of reduction of eating disorder psychopathology. These findings suggest some evidence of clinical utility of the BED diagnosis in terms of treatment selection; for example, antidepressant medication is useful in the treatment of BED, but is not generally useful in the treatment of obesity. Level of change: Major. References: Literature review (Wonderlich et al., 2009). Criterion D: In the DSM-IV appendix, it was suggested that the frequency of binge-days, as opposed to binge episodes, be assessed, and a minimum average frequency of twice/week over 6 months be required. A literature review indicated that criteria identical to those for Bulimia Nervosa would not change caseness significantly. Therefore, Criterion D for BED is recommended to be similar to criterion C for Bulimia Nervosa. Level of change: Clarification/Modest/substantial. References: Literature review (Wilson & Sysko, 2009). Literature Cited: Wilson GT, Sysko R: Frequency of binge eating episodes in bulimia nervosa and binge eating disorder: Diagnostic considerations. Int J Eat Disord 42:603-610, 2009. Wonderlich SA, Gordon KH, Mitchell JE, et al.: The validity and clinical utility of binge eating disorder. Int J Eat Disord 42:687-705, 2009.
2. 2. Other specific syndromes not linsted in DSM-5: Night Eating Syndrome Recurrent episodes of night eating, as manifested by eating after awakening from sleep or excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better accounted for by external influences such as changes in the individual’s sleep/wake cycle or by local social norms. The night eating is associated with significant distress and/or impairment in functioning. The disordered pattern of eating is not better accounted for by Binge Eating Disorder, another psychiatric disorder, substance abuse or dependence, a general medical disorder, or an effect of medication.
3. Please see the research criteria below from DSM-IV Appendix B: Criteria Sets and Axes for Further Study. The work group is proposing that this disorder be moved from the Appendix to a free-standing diagnosis in DSM-5. Research Criteria for Binge Eating Disorder A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar cir****tances a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) The binge-eating episodes are associated with three (or more) of the following: eating much more rapidly than normal eating until feeling uncomfortably full eating large amounts of food when not feeling physically hungry eating alone because of being embarrassed by how much one is eating feeling disgusted with oneself, depressed, or very guilty after overeating Marked distress regarding binge eating is present. The binge eating occurs, on average, at least 2 days a week for 6 months. Note: The method of determining frequency differs from that used for Bulimia Nervosa; future research should address whether the preferred method of setting a frequency threshold is counting the number of days on which binges occur or counting the number of episodes of binge eating. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

We must keep having that "talk" with ourselves.  We can do this.  Yesterdays mistakes are done.  In this minute we are doing well. 

Yes, I know about the injection, it's cortisone.  They also use it to flatten out keloids once they form. I had it once for an eara piercing gone wrong when I was a teenager,(that's how I discovered I was prone to keloids) and  I had to have them "shoot up" my scar from my DS ( it was open, not lap) to get it to flatten out, but it's still dark.  I'm going to see if my dermatologist can give me something a little more powerful than Ambi to lighten it. The saving grace of the surgery is that the incisions will be on the inside of my thighs, so they'll be hidden for the most part.  Thanks for your well wishes and advice!