“The Fat Trap” from The New York Times

I was at my therapist today and she suggested this article to me.

http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html?pagewanted=all

It's very interesting to read how losing weight often changes our bodies and actually can make it harder to maintain that loss.

My therapist gave me this article because of the many times I beat myself up or blame myself completely for my failure to lose weight.  She stated when she read this article, all she could think of is how hard it really is to accomplish and it isn't just on the mental side.   Even if you get the mental side down, the physical side is fighting against you.

Some exerpts that really surprised or spoke to me:

 A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.

“What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”

Well isn't that nice?  Talk about an uphill battle.  I think that one of the things that will help me personally is that the sleeve surgery removes a lot of ghrelin.  A lot of people say that they never even feel hungry after the sleeve.

For years, the advice to the overweight and obese has been that we simply need to eat less and exercise more. While there is truth to this guidance, it fails to take into account that the human body continues to fight against weight loss long after dieting has stopped.

Wouldn't it be nice if it was just that simple?  I have had people say this to me more times than I can count.

Regarding members of the National Weight Control Registry:

But their eating and exercise habits appear to reflect what researchers find in the lab: to lose weight and keep it off, a person must eat fewer calories and exercise far more than a person who maintains the same weight naturally.

In this journey, I have always wanted to be "normal".  I don't know what truly defines normal, but what makes me said is it sounds like I will never be able to be "normal".  I guess the sooner that I come to accept that, the bettter off I will be.  This journey is going to be for life and I will probably need to watch what I eat for the rest of mine.

“I think many people who are anxious to lose weight don’t fully understand what the consequences are going to be, nor does the medical community fully explain this to people,” Rudolph Leibel, an obesity researcher at Columbia University in New York, says. “We don’t want to make them feel hopeless, but we do want to make them understand that they are trying to buck a biological system that is going to try to make it hard for them.”

The research shows that the changes that occur after weight loss translate to a huge caloric disadvantage of about 250 to 400 calories. For instance, one woman who entered the Columbia studies at 230 pounds was eating about 3,000 calories to maintain that weight. Once she dropped to 190 pounds, losing 17 percent of her body weight, metabolic studies determined that she needed about 2,300 daily calories to maintain the new lower weight. That may sound like plenty, but the typical 30-year-old 190-pound woman can consume about 2,600 calories to maintain her weight — 300 more calories than the woman who dieted to get there.

I think I have seen this in a lot of people who have been successful.  That even when they reach goal, they can't eat the same as someone else.  That they still have to eat less.  I think this will be a reality of my life as well.

“After you’ve lost weight, your brain has a greater emotional response to food,” Rosenbaum says. “You want it more, but the areas of the brain involved in restraint are less active.” Combine that with a body that is now burning fewer calories than expected, he says, “and you’ve created the perfect storm for weight regain.” How long this state lasts isn’t known, but preliminary research at Columbia suggests that for as many as six years after weight loss, the body continues to defend the old, higher weight by burning off far fewer calories than would be expected. The problem could persist indefinitely.

This explains a lot.  After years of yo yo dieting, I struggle so much to lose a pound, but then one night of eating I seem to gain 5.  I think of a great quote from Geneen Roth, "For every diet, there is an equal and opposite binge".  Makes complete sense if my brain is having a greater emotional response to food after I've lost weight.  It explains why we crave so much more once we are losing.  Why it gets harder and harder and why it's so much of a fight.

So where does that leave a person who wants to lose a sizable amount of weight? Weight-loss scientists say they believe that once more people understand the genetic and biological challenges of keeping weight off, doctors and patients will approach weight loss more realistically and more compassionately.

I think this is fantastic.  I used to hate going to the doctor.  I hated it because I hated getting lectured and yelled at.  I hated the feelings of guilt that came with going to the doctor because I "wasn't where I should be".

Until I found a doctor that understood that being overweight/obese/fat/etc. wasn't a choice.   Understanding that there was something more than just choosing to eat less.  That it was a hard thing and that it wasn't the way I wanted to be personally.  That it wasn't that I didn't want to change, I couldn't figure out how to change.

I talk to so many people who still get yelled at and berated by their physicians.

I'm still figuring out how to change.  I am trying something new (the surgery on 2/13) and I'm not giving up.  I just hope that by putting further research into this, we might find non-surgical ways to help people who are obese, but also as a society might be more understanding on how hard it is to get healthy.

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About nancykerins

I am a 38 year full time working mother of one doing my best to get healthy. I had lapband surgery in November of 2010 and then had a revision to the vertical gastric sleeve in February 2012. The purpose of this blog is a therapeutic tool for me to work out my feelings and write about what is going on during this experience. If I can help others through this blog, that is just a bonus.
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3 Responses to “The Fat Trap” from The New York Times

  1. nwhiker says:

    After years of yo yo dieting, I struggle so much to lose a pound, but then one night of eating I seem to gain 5.
    God, yes, this. I was off program for three days around Christmas, gained 6lbs. 1 came off, the water weight one, I guess. People insist that you can’t gain 5lbs like that, but BS! 😛
    This article really shook me up, to be honest. I wrote about it here as well as touching on some current struggles: I’ve been on a plateau for over 6 months now, and I’m starting to slowly regain.
    The thing is, I already knew much of what she wrote about, but it was seeing it all together than freaked me out.
    I’m following your journey with interest…. and self-interest as well. I am going to lose my good Cadillac insurance plan next year, and so any surgical moves I want to make, I should make now. I technically no longer qualify for the gastric sleeve, but I’m doing some reading, and thinking I’m going to talk to a surgeon to see if I might be a candidate based on my highest weight rather than my current one, in hopes of preserving my current weight, and maybe even losing a bit more. We’ll see. It takes a lot of courage to make that call, and unlike you, I seem to be too scared, despite really wanting and needing to get a handle on this battle.
    but also as a society might be more understanding on how hard it is to get healthy.
    This still breaks me heart: that they go on and on about how it’s almost impossible to lose weight etc, and yet everyone seems to be content to continue to allow fat people to be mocked and berated.
    I do, really, wish they would do more research, or different research. Because it’s becoming clearer and clearer to me, reading the research, and listening to people, that there are different types of people. My spouse, no matter what he eats, will never be 100lbs overweight. When he starts getting less exercise, and eating a lot more (adding in a few sodas a day), he gains 5lbs. Maybe. If that. I think there are people who can “overeat” to the point of gaining 30-50lbs, but those of us who gain more, who end up 100+lbs over our “ideal” weight? There is something different going on. I see in my children, one of whom eats non stop and never goes beyond painfully thin, and one who eats a normal healthy diet, and yet seems to gain weight on that. Anyhow. Just random musings, sorry!

    • nancykerins says:

      The thing that really pushed me to move on this revision surgery was my surgeon reminding me that because I overeat on the band, I might be doing harm to my body.
      Not just the harm of gaining weight, but the harm of stretching my esophagus or the band slipping, etc.
      Right now, I’m feeling skeptical about another surgery. I’m afraid to get my hopes up, but at the same time, the status quo is not good enough.
      I’m scared shitless, but I’m going through with it anyway.
      If you are considering revision to either the sleeve or the bypass, I say talk to your surgery while you have the good insurance. What is the worst that can happen? They deny you.
      Just because you start to go through the process doesn’t mean that you have to have the surgery.
      I don’t come from a fat family. My mother is a size 2 and my sisters were size 0 almost all of their life. One is now a 4 after two kids and complains constantly about how “fat” she is.
      Both sisters try to say they know how I feel and I tell them bluntly that they don’t.
      Why is it that I can eat the same as them and they are a healthy weight and I’m 150+lbs overweight? It’s unfair.
      Even though the article makes it feel hopeless, I think it gives a better understanding how why we “fail”. Why we gain the weight back. How hard it really is.

      • nwhiker says:

        I do SO hope this works for you!

        If you are considering revision to either the sleeve or the bypass, I say talk to your surgery while you have the good insurance. What is the worst that can happen? They deny you.

        The thing is, I haven’t had any surgery. My issue is that I don’t under current BMI guidelines qualify for the gastric sleeve, the one I’m looking at. But I did at my highest weight. Does that make sense? I’m afraid they’ll look at my current weight and say no, both the surgeon and the insurance.
        Why is it that I can eat the same as them and they are a healthy weight and I’m 150+lbs overweight? It’s unfair.
        Yup. And we’ve spent waaaaaay too much time and research money on blame the mother (“your mother loved you less than your siblings and you compensated by eating more) and blame the fattie (you just don’t remember you ate that!), without getting, really, anywhere. There really does need to be some different kind of research, about what makes some of us different.
        The whole obesity research thing is a major ball of knotted yarn, and it’s been too easy to use blame and surgery to avoid attempting to untangle what is really happening, imo. Surgery is an ok current tool, but right now it’s the only tool to an issue they can’t even explain.

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