Quickie.

I see my FP today for a weigh in. He used to make me come once a month, but decided to let me go two months in between them. I've lost weight since I was last there. He will be displeased. The minimum he wants me at is 103 in clothes (100 naked at home). I got to that, totally freaked out, and began dieting to get it off, which I did. But now it's time to pay the piper. I just hope he doesn't make me start coming in once a month again.

I don't play any tricks with him. I could put heavy things in my bun (I have long hair), pockets, shoes, etc., and weigh in that way. I could drink a lot of water and hold my urine until after. I could do a number of things. But I don't with him. I could never disappoint him--he's the best doctor I've ever had, and he really cares about me. I can't lie to him, so I'll take it on the chin. We'll see what happens.

I got another book in the mail from Amazon yesterday. It's the one that was a penny plus shipping. It's in perfect condition, which I never expected. The title is Weight in America: Obesity, eating disorders, and other health related risks. It's full of graphs, charts, numbers, numbers, numbers, and statistics. I didn't expect that since it wasn't in the book description. I thought it would only be writing. But I've looked at the stats and think they'll be useful, so that's good.

I'm having some trouble at work with a coworker, as I may have mentioned before. I feel out of control over my job and whenever that happens, I don't eat in order to have control over something. I was very frank with him yesterday and the day before, and felt pretty good about it. I don't find it easy to confront people who are harming me, but I couldn't let it go. I doubt it'll work, but it helped me.

Okay. Time to go to work.

Ramblings.

I'm done with the Grilo book, Eating and Weight Disorders, and will be starting either The Body Betrayed, or Eating Disorders. I also ordered two more books from Amazon--one very expensive, and one only one cent, which kind of makes up for it--with good sections on obesity. In fact, one is only about obesity, I believe. I think I've discussed all that would be of interest to us in Eating and Weight Disorders.

I got a copy of last month's Scientific American magazine because the cover story was on obesity. There was nothing new in it except talking about support groups and behavioral psychology, most of which we know. With a third of Americans obese, they felt that the best way to attack the problem was with diet and nutritional therapy with a registered dietician (a multi-pronged approach), but with behavioral counseling, too. They stressed the importance of group therapy, however, which surprised me, and said that virtual group support was just as good as face-to-face group support. That's what our circle here is doing, IMO. We're all virtually supporting each other.

I don't know if they meant group support for all EDs or just obesity. I tend to think it would work well for anorexia, bulimia, binge eating disorder, EDNOS, and compulsive overeating, too. I know that when an anorexic is hospitalized, she's put into group therapy along with private sessions. That makes sense to me. I don't think group therapy is for everyone, nor for every psych problem, but I think it makes sense for EDs of all kinds.

I was really disappointed in the article because Scientific American is usually quite detailed about its cover story. It was only three pages long and mentioned genetics, neurotransmitters, and environment in passing. There wasn't any in-depth coverage or discussion of them. I expected more. I could have learned the same thing in Newsweek or Time, you know?

I hope Allan blogs more tomorrow. I like it when he does three entries. Guess I've gotten very spoiled! He's not blogging for us. I have to keep remembering that. He just didn't need to, or want to, do it three times today. But I sure miss it.

I'm up way too late this evening. I'll be sorry for it tomorrow, because I'll only get four hours sleep. Sleep tight. See you tomorrow.

Bariatric surgery.

I read about bariatric surgery today. The first surgeries for weight control in this country began in the early 1950's, with jejuno-colic bypass at the beginning, to jejuno-ileal (JI) bypass from 1954 through the 1970's. The initial surgeries worked through malabsorption. Many had to be redone due to the nutritional deficiences caused by the surgery. Along came refinements, and the Roux-en-Y gastric bypass (RYGB) was born. It and its variants are very successful, safe, and have fewer post-op complications. These surgeries are now done by laparoscopic surgery, vastly reducing recuperation, pain, complications, cost, scarring, etc. People return to their normal activities much sooner.

"Overall, studies generally report weight losses of roughly 40% of excess weight within six months of surgery with the maximum weight loss (roughly 50-60%) generally achieved by two years after surgery. In striking contrast to all other obesity treatments and weight loss methods, the weight loss produced by bariatric surgery is both substantial and highly durable over time."

Follow-ups at five and ten years post-op show around 50% are successfully maintained. That's incredibly impressive when compared to non-surgical weight loss methods. Patients have significant improvement or total resolution of co-morbidities such as diabetes, high blood lipids, hypertension, etc. The most interesting thing for insurance companies to get through their heads is that bariatric surgery for obese people saves huge amounts of money. There are "very substantial decreases" in long term health care costs of severely obese persons. There are also significant decreases in health care resource use, and morbidity, in those who have the surgery.

A megastudy which included 22,094 patients showed a complete resolution of diabetes in 76.8% of patients; hypertension completely resolved in 61.7%, and obstructive sleep apnea in 85.7%. It's interesting, however, that the improvement depended on the type of surgery in some obesity-related medical problems. "In particular, complete resolution of diabetes was observed as follows: 98.9% (for biliopancreatic diversion or duodenal switch), 83.7% (for gastric bypass), 71.6% (for gastroplasty, and 47.9% (for gastric banding)."

The RYGB had more weight loss and greater medical improvements than any other bariatric surgery. The "method is currently generally regarded as the 'gold standard' given its impressive clinical outcomes (weight loss plus broad improvements in co-morbidities) coupled with good safety record."

I didn't realize how different the results were among the various types of surgery, particularly percentage of weight lost. The band is the other one I have some idea about, since I've been reading a woman's website that's very well done. She didn't have all that much to lose, however, so it was a very good choice. You can eat a wider range of foods post-op with it than you can with RYGB, and the potential problems seem to be less severe, or more easily repaired, if you have them with either surgery. There's the whole filling thing to adjust the band to each user; I like that. But I also don't like that. In this woman's case, the port became displaced and is highly visible under her skin. As a matter of fact, they can erode the skin or stomach because they stay in. I doubt that happens much, though. Still, it's something to keep in mind.

This got me to thinking about under what circumstances I would choose bariatric surgery. At 200 lbs.? I don't think so. That's a low enough weight that I'd give dieting, therapy (cognitive, probably), exercise, etc., a good try or three. But 300? Now we're getting into serious weight. An RYGB is forever. I look at someone like Allan's success taking off nearly 200 lbs. and ask myself--do I have what it takes? Because all he's doing is following the bariatric surgery diet he'd have to follow anyway if he had the surgery. He's doing it without the surgery. It's such a marvelous decision (would I have thought of it?). . . However, it's truly not for everyone, nor even 10% of people. Will it have the same success rate as surgery, and for as long a time? It should about equal it, I think. Anyone can eat his/her way back up to 400 lbs. after surgery. Anyone. (Another thing I didn't know before I started reading about all this.) Surgery is (the cliche)--a TOOL. The patient did and does the work, just as if s/he was on a weight-loss diet, which s/he actually is.

My lovely friend here, who had RYGB done, was kind enough to explain her surgery and decision to have it in her blog. Now, having read her reasons, plus as much as I could about the surgeries, I think she made an excellent choice. I'm so happy the modern surgeries are available. I still think that researchers must get on board with finding a very safe drug to effect the same results. It's imperative, now that weight has become such an issue for so many people. Oddly, there are dozens and dozens of medications to help someone gain weight, some of them quite rapidly, such as the steroids and some of the older antidepressants (Elavil, in particular). Ain't that a kick in the head? Just what we need, eh? Not.

It won't help if you tell me it's a good thing that I gained weight. Really, it'll hurt--a lot. But I weighed 95.1 last Sunday, and 95.9 today, for a pound gained. All I can do is cut back this week and quit indulging myself. I should have known when I wasn't hungry all week that I was gaining. Too late now. I can only aim for next week.

Last night I asked DH what kind of bread he wanted me to make today, and he said he had a real craving for focaccia. That was about the last thing I wanted to make, but I did it, anyway. I had a piece and it was great. He'll take in the rest to work tomorrow.

I'm off to read now and decide what my menu is going to be this week. I have to lose this pound. It will be on my mind all week. Take care, people.

A sad, even scary, survey.

In 1961, researchers did a survey of societal stigma among a large group of children. They were to rate six things in order of desirability, from best to last. The things were: an average, normal person; an obese person; a person with a facial disfigurement; someone with only one hand; someone on crutches, and a person in a wheelchair. The order in which they were ranked by the children from best to last were: An average person; a person on crutches; someone in a wheelchair; a missing hand; a facial disfigurement, and finally, an obese person.

Children would rather be permanently disabled than obese, something which can be changed. In fact, they'd rather be facially disfigured than obese. These were remarkable findings, and the study became famous in sociology circles. The study was repeated with nearly 460 children in 2001, 40 years later.

Once again, they rated the average person as most desirable, but differed somewhat on the others. Second was a facial disfigurement; third, crutches; then a missing hand; a person in a wheelchair, and once again, someone obese was in last place. The results were surprising, in that a facial disfigurement, something permanent and highly visible, was rated as more desirable than being on crutches, which is temporary and heals itself. Obesity's scores were even lower than they'd been in 1961, while obesity itself had increased in numbers across the board, adults, teens and children--including those who participated in the survey!

Just when one would expect that negative feelings toward obesity should be dropping, it turned out that children had learned at a young age that it's worse to be fat than almost anything else. Even the obese children had internalized these negative images and outright hate of the obese, and were engaged in self-loathing.

This certainly must be worked on with people's kids, both at home and in school. Just as most intelligent people are doing with racism and other bigotry, we need to purge it from our country's culture of prejudice. We'll have the easiest time of it, as we do with any bias, by starting with children. But intelligent adults can change. We'll never get anything out of the stupid, so there's not much hope for them, but we haven't been able to change them about any prejudice they have. As far as I'm concerned, let them keep each other company. I have no need of them in my life. I have enough bright, funny, talented, and imaginative/creative friends. I don't need to waste time fooling around with morons.

So that's my rant for today. I apologize for disappearing for so long. Work just wore me out. No real excuse; that the explanation. I hope it gave you respite from my nonsense. :~)

See you tomorrow.

Nothing much to say.

I don't know if you remember or not, but I baked a loaf of Italian bread Sunday just to see how it would come out. It was braided, nicely browned, and covered with sesame seeds. I have a photo I'll put up once I get around to it. The flavor was exceptionally good. It's as light as a feather with a good texture. The crust is crispy but not thick. El husband said I could make it any time I feel like it and he'd be happy. His way of saying make it next week again.

Gained a pound since yesterday. See what I mean about drinking a glass of water and gaining weight? A pound or two, up or down, might just be an artifact of bladder or bowel activity, not fat mobility. Damn. I was so happy, too.

I'm having a good time reading NewMe's links to medically-based obesity websites. I got a little caught up in Dr. Sharma's and have to be careful about that, since I missed a class assignment because of it. Couldn't help myself. Once I start reading something interesting, I often can't stop.

He was talking about how the relationship between obesity and diseases which are commonly attributed to it isn't what common thinking says it is. He doesn't find obesity to be a cause of excess cardiac death, stroke, etc. I think he makes a point in some ways, and it's a theory I read many years ago in a good book on the fat pride movement. I agree that there's a healthier obese person and an unhealthier one. Certainly if you're obese and fit, and eat nutritious (but scrumptious) foods instead of crap, and have decent genes, you're in a whole lot better position than the person who doesn't exercise, goes to Taco Bell and whose parents died at 60 of diabetes complications. I disagree that there's no relationship other than a statistical one, however.

Obesity--even simple overweight--does indeed cause insulin resistance, and thus diabetes, which is an extremely serious disease. The thinking now is that while genes are part of the problem, most people have some point at which they'll become insulin resistant, even if it's farther down the road than others. To say that overweight doesn't cause it is simple denial. Many people who lose weight go back to a normal blood sugar without meds. They do have to eat a good diet and do have to exercise, but hell--we should all be doing that anyway. Unfortunately, the disease isn't always reversed that way. It's usually asymptomatic for several years before being discovered during a routine blood test, so it's worse than it might have been if one were getting regular checkups. (And seriously--who does that? Does insurance even pay for it?)

So to say there's not much evidence that obesity causes disease and early death is whistling in the dark. But it's not as though every obese person is going to drop dead in between dessert and the drive home. Not every smoker gets lung cancer and dies young. If they did, I sincerely doubt there'd be any smokers.

I'll have to keep reading his site, though. I didn't check his sources or citations, so right now I don't know how large the studies were, what the controls were, how the studies were designed, and all that jazz. If he has the evidence about things other than diabetes, I'm willing to change my mind or at least, follow his lead wherever it goes.

Here's the link to Sharma's website:  http://www.drsharma.ca/

I started a chapter in Grilo's book on bariatric surgery. I know extremely little about it, but want to learn. One thing I wonder is why someone would choose a Roux en Y over a band, or a sleeve, etc. Why a sleeve over a Roux en Y? I imagine that if one surgery were good for every patient, there wouldn't be so many different types.

I think the early bypasses, which worked strictly through malabsorption must have been grueling. I had a coworker who had one around 1978 or so, and he had a lot of complications. They finally had to go in and restore what they could. Several years later, he had another surgery--which kind, I don't know--and tolerated that one well. To the best of my knowledge, he had no problems and is still maintaining his weight.

A relative by marriage had her stomach stapled--remember that procedure?--and it helped, but she had to have the staples removed. Or, it could be that they're supposed to be removed after a certain period of time? See, I know nothing whatsoever.

I'm going to try to discuss the surgeries next time, as long as I get my reading done. I can't believe that I've heard people say that surgery is the easy way out. OMG, it seems to be far more difficult than any other way! Must be ignorance, that's all.

Anyway, that's for next time. Take care and sleep tight.

Interesting development of obesity.

There was a violent wind and rainstorm last night, so I was reading by candlelight. I love to do that, even though it causes eyestrain for me. It makes whatever you're reading more interesting. Seriously--candlelight makes you focus on the words more.

It was Grilo's Eating and Weight Disorders. He has some charts which show things like personality traits, common environmental factors, etc., where the research points to reasons for obesity's development. One is like a genealogy chart that goes step-by-step up a ladder: social and cultural factors; unhealthy dieting or weight control; psychological vulnerability; personality-tempermental vulnerability; personality-tempermental genes; obesity genes (vulnerability for bulimia nervosa), and finally, full-blown BN. It's interesting to me that he sees obesity as a stop on the way to mental illness, since he writes that obesity is primarily a physical illness, not a mental illness, whereas the reverse is true for BN.

Take the same chart to the personality-tempermental genes, then follow it with AN genes, rather than obesity genes, and you end up with full-blown AN. He writes that studies on the personality of BN sufferers shows "novelty seeking and impulsivity," while those with AN show "obsessiveness, inflexibility, perfectionism and harm avoidance." He says that the differences "converge with findings from molecular genetic research suggesting AN and BN [thus obesity] have distinctly different underlying biological (genetic) vulnerabilities."

Hmm. . . . There, I disagree. Why? All of the other research I've read says that the commonest mechanism leading to AN is the pursuit of weight loss on a reduction diet by an overweight or obese person, generally at a young age, but not always. Furthermore, about half of anorexics use binge-purge methods for weight loss in addition to restriction, thus overlapping with BN. The EDs are too close to have different genetic causes on a molecular level, IMO. Besides, our knowledge of molecular biology in this field--in almost any field--is in its infancy. Yes, we know lots, but to base hardcore theories of something as complex as obesity--and it's extremely complex--on it, is unwise. Again, IMO.

I won't rule it out, though, until I've read more about it. This will require a lot of digging. My training is in research, not psychology or medicine or biology. I say that to you guys, but not often enough. i should put up a notice here, and will.

But what do you think on this subject? 

Today is weigh-in Sunday. I'm going to participate from now on, or until I get too embarrassed and stop. This morning, with underwear and slippers, 95.1 pounds. I normally round up, and don't include tenths of a pound, because a glass of water or taking a piss can change that. But I want to join the crew properly. (You realize that Allan has shit out nearly two of me? lol.)

I have a braid of Italian bread dough rising now. Off to take a shower and wash my hair, then bake the bread. I hope it doesn't come out a rock-like mess like last time I made it--which was 30 years ago. I've topped the braid with sesame seeds, so it'll be pretty to look at, even if it turns out to be an inedible brick.

Two new books on EDs.

Can't keep my mind off obesity/EDs, food, eating, etc., and our blogs. Even at work, my mind wanders to blogspot, wondering if there are new posts. The self-revelatory entry I made is still up, and I decided this morning to stay brave and keep it up for a variety of reasons. The biggest one is your comments. They're beautiful, and I'll return to them when I need to read them. Thanks, guys, again.

I was crazily antsy about getting some more ED books, and studied Amazon for an hour or two trying to decide what to get. I already have one that I haven't blogged about yet, even though I've finished reading it, so I didn't need any, but chose two. They were just delivered ten minutes ago.

The first was two cents, plus $3.99 s/h. It's in nearly brand-new condition, too. I've decided not to get anything older than 2005 since there's so much new science in the field. If there's something good on the philosophy, politics, etc., I don't care if it's older, but science changes too rapidly to stick with old stuff.

Anyway, the first one is called, The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment, by Kathryn J. Zerbe, M.D. You'll notice that I emphasize women in my blog. Part of it is that I'm a woman and understand women's problems better. Another part is that all of the EDs, even obesity, have more women in them than men, although obesity is almost half-and-half. But the biggest part is that women comment here, and I think Allan is my only male reader. He's never sexist in his blog--he blogs for everyone. I started out that way, but until I get some male readers, it'll probably stay geared to women.

Zerbe is a staff psychiatrist at the Menninger Clinic, among other things. In addition to basic principles involving EDs, she's written chapters on "the impact of sexual and physical abuse, the relationship between eating disorders and chemical dependency, medical complications, the biology of nutrition, pregnancy, athletics...and much more." It sounded good, and like I said was only two cents. Couldn't pass it up.

The second one is the one I've been eagerly anticipating. It was recommended by Amazon itself based on my reading habits. Eating Disorders, by Pamela K. Keel. I paid a small fortune for it, and it's a skinny book, completely the opposite of the other one. But it looks well worth it. It's brand new, not second-hand, and is used as a graduate level college textbook, which explains its price ($30+!!). Just opened it and it went right to a page talking about "forbidden" foods and weight maintenance. It's discussing how it's probably easier to avoid whole groups of foods, such as desserts, than it is to eat them in moderation; that moderation may not be possible for those with an ED. I notice in several of the blogs I read regularly, particularly AGB, that's the thinking. Just don't eat the thin sliver of cheesecake to begin with, and you won't then eat the whole damn thing later that evening when you're alone. Makes sense to me, although many times I'm able to stop after that first bite. (Other times, not, which incites terrible fear; panic, actually. I want to run and run and run 'til I collapse.)

I'll be starting on the second book tonight: Eating and Weight Disorders, by Carlos M. Grilo. I have Post-Its stuck all through it to talk about. You poor people--more research papers. Well, no other blog I've been reading routinely addresses this stuff, so I guess I've found my niche.

Hope to see you later.