Tag Archive | gastric bypass

by the time i got back from woodstock

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

how can you say no to a brownie?

Yesterday, I attended a conference on Bariatrics and Nutrition, put on by the Bariatric Department of my local university medical center. Bariatrics is the science of obesity. Spell check is questioning my use of this word, so let me go appease it. My quick search into its derivation informs me that its root bar is the same as in the word barometer–the measure of the weight of air. The word was created in 1965 and first used in 1977. It rhymes with allopatric, geriatric, pediatric, podiatric and psychiatric, in case you wish to use it in a song or poem.

A brownie on a napkin

The seductive brownie (Photo credit: Wikipedia)

We mainly use the word regarding bariatric surgery or the surgical approach to weight reduction. I have worked with a few people who have had this surgery. There are increasingly newer and easier procedures and more centers doing them–and thereby more people having them–so I chose to attend the conference to better inform myself.

I walked into the dimly lit hotel conference room, with bad feng shui, grabbed the last seat at a table with a few other women, put my stuff down and made my way over to the breakfast spread in the adjoining room. From left to right there was coffee, tea, small glasses of orange and cranberry juice, a big tray of danish, another of white bagels with little individual cream cheese servings, a platter of fruit and an icy bin filled with Sierra Mist, Pepsi, Diet Pepsi, and Brisk iced tea.

The morning session was well presented by highly credentialed physicians, a pharmacist, and a psychologist. I did learn some things that were of professional interest to me, but I was finding myself with another one of my nutritional dilemmas. An endocrinologist spoke about how these procedures and their concomitant weight loss results are greatly reducing blood pressure, cholesterol, sleep apnea, and even the high blood sugar levels of diabetes–and are thereby also reducing the cost burden to our health care system of these conditions. However, I was still unsettled by such invasive methods with major implications for nourishment and still uncertain as to how these experts felt about their own program.

After a few hours, I was drained from the bad room energy and hungry. I stuffed my dilemma and headed out to the more naturally lit lunch area. I was pleased to find myself satisfied by a meal that met my own personal nutritional needs and headed back feeling much better and fortified for the afternoon session. It was a good thing too. Three surgeons, whose mothers or kindergarten teachers must have taught them very good craft skills, were soon to reveal to me the gorier aspects of the art of bariatrics.

Currently, there are three major types of either restrictive or malabsorptive bariatric surgeries that are performed in this country–gastric bypass, gastric banding, and sleeve gastrectomy.  Sleeve gastrectomy is the newest of the three. While I imagined something more benign, a young boy wonder doctor described the procedure by way of both schematic and actual slides of our insides. He explained that the procedure entails using a stapling device that creates a thin vertical sleeve of stomach while the other two-thirds of the stomach on the other side of the staples–is lopped off. Oh.

The next surgeon, who at least looked like he was born before the first use of the word bariatric, also described various procedures. He was very careful to explain that all of these come with some significant complications. Despite his obvious experience and calm demeanor, transparent in his message was that the safest surgery is no surgery.

As I was digesting this, the woman I had been sitting next to all day raised her hand and asked that if one had already had gastric banding, which has the highest weight loss failure, could they be a candidate for sleeve gastrectomy.

At the next break, at risk of being intrusive, I asked the woman if she’d had the band procedure. She replied that she had, and was frustrated that she only lost 50 pounds. She had the band re-tightened which is done by filling it with more saline solution. Quietly, she admitted that she was responsible for having made some bad choices. I left it at that.

A few minutes later she returned from the break room which had been freshly stocked with a new array of sodas and sweets, with a Pepsi and a brownie. The other women at the table, who I had come to realize were not medical professionals, muttered something to her and she replied, “How can you say no to a brownie?”

The final speaker of the afternoon was a plastic surgeon. This guy was a Michelangelo in GQ clothing. Through a series of slides, I witnessed the graphic photos of about twenty post-bariatric surgery patients clad only in their underpants, before and after the liposuction and body contouring procedures he had sculpted on them. I saw the flaccid flesh of breasts, bellies, arms, thighs, and butts hanging in folds from alien-looking bodies. One woman’s belly flesh reached almost to the floor. Matter-of-factly, he showed how he lifted skin, sucked out fat from one area, stuffed it back into another, and sewed people back up often around their entire circumference. He told of removing up to twenty-five pounds of skin and fat during a single procedure.

As shocked as I was by what he was showing, it was what he explained in closing that was more distressing and deeply telling. He shared that some patients have said to him, that in retrospect, even though they may even feel better, they actually liked their bodies more before the procedure. They may have been fat but they felt they at least had a healthier glow or more natural body. Some, express dissatisfaction with other minute parts of their bodies that they had never thought about before, and many still perceive themselves as fat as they ever were. There is no guarantee that the person will experience a greater sense of well-being and less depression–though many do.

At the end of the day, the Bariatric Program Director and conference facilitator asked the panel of presenters, where did they think we are heading in the next five to ten years. Are we going to be doing way more procedures as the obesity rates continue to increase?  Do we fully know what percentage of people who have undergone these procedures truly keep the weight off and the diseases at bay? Do we know the correct prevention measures? The presenters looked a bit deflated in response.

Regarding the prevention question, I left one respectful suggestion on my evaluation form–that the medical community should be particularly mindful of the food it offers at conferences. We talk about healthy eating and yet are unable to establish a new food paradigm in this culture.

Digging for my car keys, I found my dilemma at the bottom of my pocketbook where I had stuffed it. It looked me in the eye and asked, “How can you say no to a brownie?” “It’s tough”, I responded. I headed out into the late afternoon traffic.

How do you say no to a brownie?

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In health, Elyn

my plate

My Plate Haiku

Adirondack lake

Soothes us from the heat–weightless

We float like feathers. by Elyn