When last I left off in, By the Time I Got to Woodstock, I was chewing blissfully on arugula while practicing mindful eating in a cafe in Woodstock. Well, right after that little sweet outing, I began working with a new client who had recently had gastric bypass surgery–and so, since, the concept of mindful eating has taken on some new dimensions.

Holding someone’s hand as they enter into an entirely new relationship with food and eating relative to digestive restructuring is a fascinating and fragile task. Recognizing how many people are now undergoing these procedures, makes me realize this is a societal shift as profound as online dating. According to my quick search, more than 200,000 people in this country are undergoing some type of weight loss surgery in a year and the numbers are growing steadily.

My client had the Roux-en-Y procedure, which is currently the industry’s gold standard. It was one of the earliest procedures developed and ensures some of the best long-term success. It can now be done laparoscopically through small incisions in the abdomen thereby further decreasing complications and post-surgical discomfort. In the Roux-en-Y procedure, the stomach is stapled to create a smaller food pouch about the size of an egg and is then reattached to the small intestine further down, bypassing the upper portion. Most people who undergo the procedure lose pounds fast and furiously for the first few months and ultimately seem to shed about 65% of their excess weight–though this number can be higher as well. Additionally, serious medical conditions like diabetes, hypertension, sleep apnea and arthritis that plague this population significantly abate.

These surgeries and their aftermath, of course, entail some serious risk (including death) and have many profound physical, emotional and nutritional implications as well. However, highly remarkable are the changes in eating behaviors that these procedures both impose and demand. From the moment an individual awakens from the anesthetic stupor through the rest of their life, the relationship with food is forever changed. Some foods will be kissed a sad goodbye, while others will be reduced to tiny portions of their former selves. Sugary and fatty foods once-beloved will wreak severe and painful havoc on the altered innards; gas-forming foods will even more so make their presence known far and wide; proteins will demand front row seating at every meal and something as innocent as the skin on a tiny blueberry can pose a gigantic digestive problem. But, that is not all. Very big men and women will perforce be required to eat like little toddlers.

The refeeding path will wander from clear liquids to pureed foods and then to very carefully chosen solids. Liquids will be sipped slowly in frequent timed intervals throughout the day to prevent dehydration and they will not be taken at mealtimes. Bites will be teeny tiny, as teeny and tiny as a pencil eraser and sometimes tempted to the mouth on little baby utensils. Each mouthful will be so carefully chewed, quietly and consciously until fully emulsified. There is no room for feeding error as severe pain or vomiting easily can ensue. Portions per meal will be a mere quarter cup, then a half cup and eventually up to a one-cup maximum more or less for good. An ounce of food (or two tablespoons) will require about ten minutes to consume and a full one cup meal greater than an hour. Often fullness will set in before the meal is done.

I have turned to various readings lately to get a deeper appreciation of this extreme and tedious process from people who have experienced it– because it is difficult for me to fathom it on my own. I have taken to trying to eat one, just one, eraser sized bite per meal and to chew it consciously in some kind of solidarity with those who have chosen this path as a means to ameliorate years of physical and emotional pain. The decisions to undertake what these procedures required are not taken lightly.

Exploring this world more fully is challenging some of my own hesitancy regarding these procedures and I have been recalling my reactions to the bariatric conference I attended last fall and wrote about in How Can You Say No to a Brownie? Though there are at least two sides to every story, a recurring theme for many who have chosen weight loss surgery seems to be that despite all the attendant problems and adjustments–and there are many–eventually the new lifestyle is one that they become accustomed to and when the initial difficulties resolve–they feel so much better and have no regrets.

It is difficult but not impossible to imagine. But even in so considering the benefits, I have been struck by a certain irony. Is not the insistence or instruction of these procedures essentially mindful eating? Choosing food with care, approaching it respectfully, chewing it slowly, tasting it thoroughly and giving the body time to say enough and thank you–like I did with my meal in Woodstock? Interestingly, I just came upon an interesting clue regarding this.

“Profound changes in body weight and metabolism resulting from RYGB cannot be explained by simple mechanical restriction or malabsorption. Changes in food intake after RYGB only partially account for the RYGB-induced weight loss, and there is no evidence of clinically significant malabsorption of calories contributing to weight loss. Thus, it appears RYGB affects weight loss by altering the physiology of weight regulation and eating behavior rather than by simple mechanical restriction or malabsorption.”*

Well, I am not positive, but I think that is what mindful eating does too. I don’t know what we will come to find when we look back at this period of extreme procedures for weight loss or review its long-term results. Surely, newer weight reduction methods will be developed that won’t be as invasive and extreme as those that are currently being employed. Hopefully, we will find a gentler solution, but, maybe we will come to realize that there has always been a simpler way.

What do you think?

For an enlightening understanding of the physiology of eating, check out Marc David’s book, The Slow Down Diet.

In health, Elyn

*Nicholas Stylopoulos, Nicholas, Hoppin, Alison G., Kaplan, Lee M (2009), “Roux-en-Y Gastric Bypass Enhances Energy Expenditure and Extends Lifespan in Diet-induced Obese Rats”, Obesity 17 10, 1839–1847. doi:10.1038/oby.2009.207

**It is actually amazing that I don’t write about Chico more. He really is the most remarkable cat as his large fan base can attest to. He does have some food and eating issues yet has actually lost weight through a diet, therapy and exercise program. He enjoys cantaloupe and cucumbers, takes walks with me and waits outside when I visit my neighborhood library. Here he is reading the Count of Monte Cristo upside down!

MyPlate Haiku

Food made joyfully

As a gift of time and self

Feeds body and soul.  Anne-Marie