Tag Archive | Weight loss

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?

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

my plate

My Plate Haiku

Adirondack lake

Soothes us from the heat–weightless

We float like feathers. by Elyn

lose 14 pounds in three years

The Red Dress

The Red Dress Image via Wikipedia

It is always a blessed day when one is seeing Miss Henry. Miss Henry usually comes to see me early in the morning, so she is often already in the waiting room when I arrive at work. Sometimes, she is sitting alone with a book, but more commonly, she is engaged with someone nearby who she may or may not know. Many people in the community know Miss Henry. For those who don’t, it will only be a matter of time until they do.

Miss Henry should be staying at home writing her fascinating life story, but it is hard to keep that woman in one place. For someone reliant on a walker due to a  very bad knee and whose abdominal girth way exceeds her height, you might imagine that getting around would be difficult. However, when one has many kind words to say and good deeds to do, staying at home is not an option.

I have been working with Miss Henry for three years and she has lost fourteen pounds. That is about 4.6 pounds per year or .09 lbs per week! I am very proud of her and she is tickled pink too. I know what you are thinking–these are not very impressive results and that this is not headline-making news. Pounding down the pounds are the hallmarks of success in this business and the goal of effective nutritional counseling.

However, if you sat where I sit every day, you might see a different picture. When we focus only on the numbers we miss a lot of important subtleties and positive changes that occur in the process of optimizing our health. To ignore these is a serious disservice to both the individual and the model of care.

Miss Henry is 65-years-old. She was born and raised in the south as one of ten children and has raised children and grandchildren of her own. She has been responsible for the care and feeding of more people than most of us can even fathom. She still babysits, walks someone’s dog, tends to her partner, serves her church, cooks for others and takes a bus a few times a week to go visit her 91-year-old mother. She is black, and also Cherokee, Irish, and Jewish. Besides the bum knee, she has high blood pressure; and she has survived breast cancer. When I first met her she weighed about 300 pounds and used her shopping cart as a walker.

Through the time I have spent with her, she could have easily given up, and I could have too. Just for the record, in case you haven’t noticed, weight loss does not happen or sustain itself easily for most people–and some circumstances make it extremely difficult. It takes a lot of momentum and the attainment of a certain critical mass to move mountains so to speak, no matter what someone’s size.

Miss Henry knows food. She loves cooking it, sharing it, and shopping for it. For someone without a car, she always amazes me how she gets around for the best deals. Three supermarkets, Walmart, the Asian market, and the food coop are all within her domain. Oh, and she loves talking about it. For three years we have talked a lot about food. Even if I have not seen her for months, she will come in and tell me what she made for dinner yesterday or what she is planning for the next day. We have discussed eating more of some things, less of others and ways to support cleansing and elimination.

Miss Henry has had much to consider over the course of these three years including why she chose to overeat for much of her life. She has come to realize that she can care for herself as she has always cared for others. She asked for some support from her spiritual community, began to see the possibility of herself in a smaller body, focused on a red dress she so wished to fit into–and she watched Dr. Oz. Again and again, she slipped back into eating habits that she had hoped were behind her. Eventually, her excuses for overeating and her hunger began to decrease. She is now choosing to eat mainly vegetables two days of the week. Most powerful for me to observe was when she decided she no longer needed to say yes every time someone asked her to cook for a family, church or holiday event.

At first, she began walking the hallway outside her apartment and then joined an exercise program offered in her building. She started using some step machine that she had, and soon she was walking all over the city. Her frequent aches and pains began to lessen, her body became less puffy, her fat stores began to shift making her clothes fit more loosely, her blood pressure decreased and amazingly she began to rely on her walker less and less. If I had not been inquiring about these changes, and if we had not honored these transformations, the stubborn scale would have proved too discouraging.

When Ms. Henry next sees her doctor, the slightly lower number of pounds will hopefully give some modest proof of her efforts. However, for me, the important measurement that is often overlooked is how someone feels physically and mentally. I find that encouraging healthy practices is more beneficial than focusing on weight loss. Though by no means the biggest loser, this week, as Ms. Henry fit more comfortably in the chair in my office, she joyfully described just feeling lighter and having more energy. She is still the same beautiful and amazing woman but her face is glowing a little brighter.

Miss Henry always ends our visits with two exhortations. She says, Miss Elyn, whatever you do, don’t get fat. And, Miss Elyn, you have a blessed week. Bless you, too, Miss Henry.

How fine do you think the line is between health and weight?

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

My Plate Plate

My Plate Haiku

Hearts are not

Just reserved for romance

Every living thing is in love. by Kat

I Speak for the Fat People: middle part

Let’s put the issue of overweight into perspective. If we look at weight historically, I’m pretty certain that from the beginning of time, there have been fat people. We have all seen the pictures of early Cro-Magnon and Neanderthal men. Even those quintessential hunters and gatherers seemed capable of packing on a few pounds. After them came Confucius, King Henry the Eighth, Mamie in Gone with the Wind, Jackie Gleason, Pavarotti, Aunt Bea, and my grandmother. Chances are your grandmother was fat, too.

English: Luciano Pavarotti in Vélodrome Stadiu...

Pavarotti Image via Wikipedia

Since our early beginnings, human beings have come in varying shapes and sizes and large-size was not necessarily an aberration of medium-size. It is good that there are large-sized people. A world without them would mean a world with fewer great opera singers, chefs, women of ample bosom, football players, construction workers, and cuddly grandmothers.

It is not very difficult to become fat. You do not have to go out of your way to try.  If Chinese youth can become fat, then anyone can. Only about 4% of the population has naturally model-thin bodies. That means that many models are starving themselves in order to be models. It also means that the rest of the size 2 wannabes are expending a lot of physical and mental energy in the pursuit of thinness. Carolyn Knapp, in her book Appetites, tells the story of a woman who describes the angst she feels putting on her stockings every morning. She wonders what she could have accomplished in her life with the time she has spent worrying about her weight.

There are the naturally skinny–and then there are the neurotically and pathologically skinny; and the metabolically hyper-activated skinny–those who sustain themselves on a steady diet of excessive caffeine and nicotine—or maybe extensive exercise. For the rest of us, the possibility of becoming overweight is just around the corner. We are physiologically and neurologically wired to pack it on. The ability to store fat came in pretty handy a time or two during our multi-millenial evolution. We have about 107 compensatory mechanisms that prevent us from starving to death.  A bunch of those certainly kicked in to save our forefathers when they were unable to kill a bison. In people who attempt to starve themselves toward thinness, the body fights back–it regains the lost weight plus more, and then absolutely refuses to budge.

In addition, we are wired for comfort. Research shows that the food habits that sustain us are those that we developed while still wrapped in the loving veil of early childhood.  Whether that happened to be gazelle, chicken soup, mashed potatoes or cheeseburgers, you will probably turn to those foods as an adult. Believe me, the corporate world certainly knows this.  The Happy Meal ensures that today’s toddlers will become tomorrow’s adult fast-food consumers.  The concept of comfort foods is one I hear a lot about during my spy missions. Women have confessed to me that they would choose a good loaf of bread over sex. The quality of the sex is not indicated in this context.

Then, of course, there are our natural temperaments as well as good old genetics.  I listened once to the tender story of a woman who was adopted as a child.  She never met her birth mother, but she possessed a very old, poor quality home movie that she believes is of her mother. Though she struggles to see the face better in search of subtle resemblances, it is the woman’s thighs that confirm her finding.  She states, “Look at the thighs. Those are my thighs.”

On top of all this, let’s sprinkle on a life change, or just daily, chronic stress. Take your pick. Break-ups, abuse, graduate school, poverty, working long hours, caregiving, depression or menopause are possible choices. And, God forbid you should simply possess a deep sensuous life-affirming passion for cooking and eating.**  Throw any of these on your plate and if your primal wiring wasn’t enough to enlist you, then current circumstances will. Even the once-thins can become the now-fat–especially in this current milieu where food is literally out to get ya. Not even the high school cheerleader is immune. Any emotional state that is heightened, increases for many, the desire to seek food for a reward. When one is working their way up the weight chart, it is because they are possessed by physical or emotional hunger or physiological changes that they can neither understand nor control.

I can hear you begin to protest that it has to be more than just this. Aren’t we soooo bad?  We ate the piece of chocolate cake (and we loved it). How could we? How dare we?  That translates into four hours of floor mopping according to the calorie expenditure charts.  That must be fair penance for the crime. As a spy, my days are peppered with the monologues and dialogues of self-hate and recrimination that people utter like a mantra before and/or after each foray into eating. The guilt is palpable. We must have all been ____________ in a previous lifetime. (insert your own response.)

(one more segment to follow)

Thank you for listening, sharing, following, and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

Related Posts:  I Speak for the Fat People: First Part and I Speak for the Fat People: Last Part

In health, Elyn

Related Resources 2010: The end of overeating. Taking Control of the Insatiable American Appetite (David A. Kessler, MD); Born Round:  A Story of Family, Food and a Ferocious Appetite (Frank Bruni)


a cinderella story

Yesterday, at 2:00, I had my last client guest of the year. I was visited by the young Haitian princess Atabei. I have had the pleasure of working with her over the course of the past year. I was granted permission to be in her highness’s presence because her royally endowed figure put her by age sixteen very close to 300 lbs. Now, she is almost eighteen. She is not the heaviest of my young clients but I do particularly worry about her because she has Type 2 diabetes.

HISTORY | Her Serene Highness Princess Olive, Daughter of Emperor Soulouque. Haiti C. 1858

Haitian Princess

As we know from many fairy tales, life is not always easy for the crown-wearing crowd. Atabei has had a not so rosy past and has been fending for herself for a very long time. She has a queen mother and an older prince brother who love her–but who are caught up in their own problems to have much time for her. She navigates most of her medical care essentially on her own. Unfortunately, Medicaid doesn’t pay physicians for castle calls.

Like many royals and commoners alike, Atabei was used to eating in a bacchanalian fashion and was not subscribing to my pedestrian nutritional guidebook. She mainly craved and consumed foods that in her own giggly adolescent words were magically delicious. For those of you who may not know what that means, Lucky Charms, Toaster Strudels, and Dunkin’ Donut Munchkins are magically delicious, while whole wheat bread and oatmeal are not.

Progress was very slow, but she got a lot of credit for what we call just showing up–despite multiple challenges and limited ability to change her food environment; and she was succeeding at what I like to refer to as weight gain stabilization–she wasn’t losing weight but she wasn’t gaining either. Being evicted from the castle and landing in a motel does not usually lend itself to being able to focus on one’s eating habits and feeling good about oneself. Still, despite a few missed appointments here and there, she kept coming and she kept journaling. She was never too shy to hide her utter disgust at some of my suggestions and held tight to the foods that comforted her.

Eventually, I began to encourage her to get over to the local YMCA, where I have a partner in crime–Ben. Ben’s a little wiry guy, but as the wellness director responsible for youth programming and as a trainer, he is deeply committed to catching any kid–no matter how big- I can throw his way. Patiently, he serves to help re-knit the self-esteem that has been unraveled from so many through the art of attention and physical activity.

After a few failed attempts, Atabei gathered her horses, got in her coach, and proceeded over to the Y. Yesterday was the first time I had seen her in a while. She arrived in her radiant beauty, sans tiara, more alert and positive than I have ever seen her. She has only been going to the Y for a month, but she is already enjoying that her endurance and strength have increased. She is drinking a lot more water, is less obsessed and possessed by her old magically delicious foods, and is shocked to realize she can now choose to leave food behind. Gradually, she has made some significant diet changes which will help heal her insulin resistance. I had to almost stand on my desk and shout for her to acknowledge this. But, when the scale confirmed what I already had, her beautiful princess smile widened even more.

At the end of the session, I helped her set some of her goals for the new year. She had never before been able to even imagine that there was a possibility for change that she could empower herself. Now she finally could. What did I ask of her? That she keeps really listening to her body and seeing what it actually needs; and that she does not give up on herself. She will try–she does like to humor me.

When the clock struck three and she stepped off the curb in front of the building, she may have looked like just another poor, black, fat kid– but things are not always as they appear in the kingdom. Blessed be. Tres Bonne Annee, Atabei!

Please acknowledge the health and dietary impacts resultant from our huge cultural and environmental challenges and inequities–and honor your own small victories. Cheers.

Thank you for listening, sharing, following, and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn