The Psychology of Obesity

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An awfully pretentious title for early on a Friday, right? But today will be my first visit to a psychiatrist in many years, after a couple of very bad patient/doctor relationships – and telling myself to not worry about the visit today has got me thinking about why it is that a person becomes obese in the first place.

The Background of Obesity

Visit any forum or message board dealing with obesity these days and you will find a few trolls – those individuals who have taken time out of their day to drop in and tell us that we are only “fatties” due to a lack of willpower. If we only had some self-control (as, presumably, these individuals believe they do) we would not suffer from this problem. To them, the condition of obesity is a product of nothing more than laziness. Running into an especially obnoxious troll post can infuriate me for hours afterward – which tells me that something inside that post has resonated with me. Apparently, I believe at least in part that if I had just tried a little harder over the past 20+ years, I would not be obese.

And here lies the problem with obesity, in a nutshell. The vast majority of us thinks that we alone are responsible for our condition. But, other than being fat, where is the evidence? The majority of us go to work, we raise families, we practice religious devotions, we do chores around the house – we do a hundred things a day that prove that we are not lazy – and yet we accept that the state of our bodies results from a failure in willpower.

Obesity sits in the same corner with drug addiction, alcoholism, and depression – conditions that a person who has never suffered from will never really understand. These afflictions of the mind are easy to marginalize and make fun of because they are invisible to the naked eye. A person on crutches wearing a cast is accepted as having a broken leg. But, in our culture, obesity is not accepted as a sign of a broken mind.

Rejection by Society

A few years back, Lor and I stopped by a local gym to check into monthly rates, thinking maybe we could get this thing moving on our own. The young and heavily muscled twerp behind the counter took one look at the two of us and suggested that maybe this wasn’t the gym for us. We couldn’t afford it anyway, so I just let it go. But I guarantee you that I went home and ate something afterward. “Healthy” society had just rejected me and made me feel bad. So, I went home and ate, which made me feel good.

Now, which activity do you think I return to most often? It is called a conditioned response – your mind drives you towards those things that feel good. The mind associates things which are good for itself (eating, sexual response) with pleasure, and things which are not good (being cast out of a social group, hitting oneself with a hammer) with pain. This is Mother Nature at work here, trying to secure the continued survival of a species. What Mother Nature did not count on is that we’ve now developed a cycle:

  • There are so many things to eat which cause pleasure.
  • Overeating develops obesity.
  • Obesity causes rejection by social groups, which is painful.
  • One retreats from the pain of rejection, by embracing the pleasure of eating.
  • Back to step one.

This is, of course, a vast over-simplification – and I am no psychiatrist. But the logic is clear: why would I endure rejection and exercise (which is initially painful as well) when I could instead feel good by eating? Eating is a short-term pleasure, of course, but there is always another Quarter Pounder or Snickers bar just around the corner. I am not only eating things which are bad for me, then – I am also eating them more often.

See where this is heading?

The Final Rationale (Rationalization?)

I am not looking forward to bariatric surgery because the smaller stomach size will force me to eat less. I am looking forward to bariatric surgery because I will finally have the chance to look for “pleasure centers” that do not revolve around food. Weight loss will allow me to finally seek endorphin-releasing exercise. It will enable me to live a life where I am not constantly in pain. It will enable me to have a normal sex life. And, yes, it will enable me to interact with other people without the prejudice against obese people working against me. I am willing to have the majority of one of my internal organs removed and THEN go through all the normal work of weight loss, just to reset my association with food as the sole source of pleasure in my life.

It may seem unfair, but there it is. I have to live in the world as it is, not as I wish it to be.  I can only hope that my psychiatrist today agrees with me, and does not instead want to turn me into a multiple-year case study or something. Wish me luck!

Still Looking For Endorphins That Don’t Make Me Fat,

– Hawkwind

 

The Hunger Games

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Things are strangely quiet here in the household, the kind of silence that descends in a horror movie right before something lurches out of the shadows. Think Rime of the Ancient Mariner kind of calm. We are 24 hours into Lor’s “liquid phase”, and…

 

…What’s that? The great majority of you have no idea what I am talking about? Let me back up a bit, then.

 

Any bariatric surgery is surrounded by several periods of time (or “phases”) in which diets are radically changed to either prepare for or recover from surgery. We have been in one of those phases for months now – the low carbohydrate phase, where patients are supposed to drastically reduce their carb intake for the 3 months preceding surgery. However, 2 weeks out from surgery, another major dietary shift occurs. The patient is now required to spend two weeks eating (drinking, really) nothing but protein shakes, clear liquids (like broth), and water. Why? In order to shrink the size of the liver, which has to be moved out of the way (laparoscopically, of course) in order to perform any bariatric surgery. The smaller the liver, the easier it is to move around in the abdominal cavity. But the patient still requires high amounts of protein to stay alive, so protein shakes and vitamins it is.

 

Immediately upon release from the hospital the patient will go back on the “all protein shakes, all the time” diet. This is to give the digestive system time to recover from the traumas that have been inflicted upon it, but also means that the patient will spend 4 weeks on nothing but protein shakes and an occasional yogurt. Many successful patients report that after they are done, they never want to look another protein shake in the face as long as they live.

 

We are now 24 hours into Lor’s protein shake phase. And, while I had anticipated what would be happening to Lor, I hadn’t realized what was going to happen to me as well. You see, I will not be eating any food that Lor loves during this 4 week period. Why torture her like that, right? What I had not anticipated is that cooking boring food for one, I would be really reducing my caloric intake as well. For example, yesterday, Lor got a whole 750 calories in protein shakes. But, I was right behind her, managing only 950 calories in “real food”. Plus, she hit her 60 grams of protein target for the day – I actually missed mine.

 

I am little perplexed as to what to do next, honestly. Do I increase my intake to make sure I stay sane and stable for the next month? Or do I stick it out, suffering in solidarity with my wife like I had originally planned? I feel pretty decent now, I must admit – I have not suffered through the constant hunger that nothing but protein shakes creates. I think I will just wait and see what happens next.

 

One thing is for sure, though – the next 4 weeks are going to be more interesting than I initially thought they would be.

 

Hoping Lor And I Do Not Cannibalize Each Other,

– Hawkwind

The Pre-Final Countdown

 

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Procrastination is a living, breathing animal that eats your best intentions and leaves you with the remains of wasted time.

 

I had every intention of producing a blog yesterday morning. When I sat down to write it, it occurred to me that the momentous events of the day were coming up later in the morning, so surely I should just write later, right? But later came and went, and left me in such a dither of emotions that I could never actually get anything coherent down to be published. So, here we are, 24 hours late, with the news that we’ve all been waiting for.

 

The day has come, the die has been cast, etc. – I go under the knife (the scopes?) on July 25th, just a hair under 6 weeks from Lor’s surgery date. I do still have to pass muster with a psychiatrist, but that evaluation is scheduled for 2 days from now. Barring any catastrophic failures, this thing is a go.

 

I am not exactly ambivalent about the whole thing. The meeting with the nutritionist yesterday was extremely positive. I’ve lost a total of 30 pounds since we started the process in February. Lor and I are exercising every day, dietary changes have been made successfully – I’ve received a glowing report on my pre-surgical prep from the team over at ABQ Health Partners. It seems like I am prepared to succeed at this.

 

But…(there is always a but) I am still having trouble wrapping my head around where this is all going to wind up. My loved ones are cautioning me to not be overly optimistic about the final results of my surgery –  high blood pressure and sleep apnea, for example, have been a part of my family genetic makeup regardless of size or weight. Thanks to my currently over-sized body I will probably never be built like Hugh Jackman, but will instead be left with an apron of left-over skin reaching down to my knees. I mean, I am happy to accept all those results if it means I can finally walk without being in constant pain. But I was kind of hoping for more dramatic results than what I am being cautioned to expect. No one is trying to talk me down off the ledge, but I seem to be receiving plenty of warnings that the landing won’t be as comfortable as I was hoping for.

 

I am left looking in the mirror now, trying to figure out what (if anything) will be different about me when this process is all said and done. My surgeon airily informed me back in March that the surgery would “Get me down below 200 pounds”. I am 30 pounds down now, and I am just not seeing it in the mirror. Granted, I already feel better – I can walk two miles now and carry on a conversation afterwards. This from a guy who 3 months ago couldn’t carry groceries out of the car without gasping for air during the process. I guess I was just hoping for something more tangible, and I am kind of afraid that even losing over 100 pounds post-surgery is still going to leave me looking like a deflated balloon. A deflated balloon with high blood pressure, sleep apnea, and excess skin hanging off me everywhere.

 

Later today is our bi-weekly “measurement” routine. I am hoping for some positive results there, because right this second I could use a win. I am not nearly as pumped up about having a date for my surgery as I had thought I would be.

 

Curiously Ambivalent,

 

– Hawkwind