Sunday, March 23, 2008

Why am I fat?

On LapBandTalk.com there is a thread entitled “Why am I fat?” I have been reading through people’s stories and thinking about that question as it relates to my own problems. My answer was way too long to post on a message board, so I posted it here:

I believe that I am fat because I am hungry all the time and my metabolism is not what it should be. Plus, I tend to prefer sedentary activities. I do not believe it has anything to do with emotional issues, though I do think I have some bad habits and some emotional issues. However, I think the fat came first and those are just contributory factors, not causes of my weight problems.

I am not sure why I am hungry all the time, but it seems to be related to entering puberty. I'm fairly certain that my metabolism is not what it should be, because I fell into the trap of yo-yo dieting.

As for being sedentary, my body has always fought to be at rest. My mom would make me go outside to play and I would sneak out a book and find a place to sit and read. I do have active hobbies but they aren’t things like running a marathon. I prefer yoga and stretching to Jazzercise and ice skating and ballroom dancing to playing soccer. I don’t think that’s going to change any time soon, though I do have periods where I enjoy working out a gym. I take advantage of them when they come and try not to feel like I’ve failed when they go.

Believe it or not, I was born tiny. I am the oldest of three girls and my next youngest sister, two years younger than me, who I will call MacSis I, was always as big as I was throughout elementary school. Seriously! I actually have a picture to prove it. Some time between starting elementary school and fifth grade, I got boobs, hips, was slightly pudgy, and became "the fat kid". But MacSis I -- who these days is morbidly obese just as I am and wore the same sizes as me even though two years younger -- did not.

At age 13, I gave into the pressure and started my first diet. I was 110 lb. and 4' 9" and had a BMI that is now considered in the normal range. But I was "the fat kid" so I spent the summer dieting. My goal was to lose ten pounds. I was in what I now think of as the “I need to lose ten pounds” stage of my life.

The diet went so well that I lost the ten and decided to keep going. I ended up losing 15 pounds just by only having one serving of whatever was served for breakfast, lunch and dinner (instead of my normal two to three) and eating raw fruits and vegetables in between. I was hungry all summer, but I was getting thinner and I thought it was worth it.

I went back to school and things were better. I got teased a bit less and had more friends. I still got teased a lot, though. Once I was wandering around the neighborhood and some kids I never met started calling me fat. I weighed 95 pounds! I was TINY.

It was at this point that I made a conscious decision to not fight the hunger any more. I didn't see what the point was of being hungry all the time if people were still going to treat me the same way.

Somewhere in there, my father started molesting me. I don’t think that could have helped, but I don’t think it had as much effect as being molested does on some people.

For one thing, the hunger stuff had started a few years before and was not related in any way. For another, I’ve always had good relationships with other males and enjoyed being thought of as sexy. I definitely didn’t eat to cover up my womanliness or to push down my feelings. I mostly considered being molested as an aberration and part of an unpleasant childhood I was intent on escaping.

Soon after that, I largely did escape, which I am sure helped me deal with the issue and move on. My parents separated and I got a scholarship to a local boarding school. I was, for the most part, on my own, making my own choices. I saw my dad rarely and never overnight and I considered that chapter of my life over.

During High School, I did "go on a diet" several times but this consisted of watching what I ate for less than a week, losing maybe five pounds, maybe nothing, and then going back to my old ways, rather than true dieting.

I stopped being labeled as "the fat kid" though. I loved my High School and it loved me. I had boyfriends who though I was a “sexy thang” because I had boobs and hips. But the charts at the time said I was ten lb. overweight and I often hated my body while loving being curvy and loving my life.

I also continued to be hungry all the time. But my food intake was limited because I was at boarding school. I do remember one year being the class treasurer and raiding the change in the collection box to buy candy bars from the snack bar. Yes, I embezzled money to feed my hunger.

I was much more active at this time than I had been before that. I voluntarily did PE every semester even beyond what was required and I was on the lacrosse team and tried out for the archery and swim teams. I also walked a lot. I was still a klutz. I was still out of shape. My body still preferred to be at rest. I didn’t think of myself as an active person, but I definitely was active at least as much as experts recommend.

By the time I graduated from High School, I had gained the 15 lb. back that I lost at thirteen, but considered my weight under control. I had also grown several inches and was now almost 5' 1". So again, I wasn't really overweight by today's standards even if I was by the standards of the time. I still believed I needed to lose ten pounds to be “the right weight”, but was mostly happy with my body.

I entered college and gained some more as food was more available. I also was constantly "on a diet" and convinced that if I was only ten pounds lighter, everything in my life would be wonderful -- even though my life was mostly wonderful.

As in High School, I was moderately active. I continued to take PE every semester and even participated in some intramural sports, including being on a volleyball, soccer and basketball team. But I was not as in shape as my friends and this contributed to my perception of being a big fatty.

One summer my mom got engaged to a 6’7” 300 lb. man. The Atkins book came out and he decided to try it. So my mom and I did too. I lost about ten pounds that summer. But went back to my regular eating, and my regular weight, once school started up.

The Fall after I graduated, I was 5' 2" and 135 pounds. At this point, I was actually overweight, but not by much and most of it was still in my boobs. I still was "on a diet" all the time. I still hated my body. I was still out of shape. However, without activity being served up on a platter, I became a complete couch potato.

It was at this point, that I found that I wasn’t willing to do very much to prepare food. I had been fed by others my entire life and now that there were no parents to prepare food and no cafeteria to go to, I would rather eat M&Ms for dinner than prepare a real meal. I also stopped being “on a diet” all the time.

Naturally, since I was eating poorly and not exercising, my weight continued to rise. I was going up about five-ten pounds a year. At the beginning of my twenties, I was in the “if I only lose 25 pounds” portion of my life, but by the time I reached my thirties, that had changed into “if I only lose 50 pounds” as I had crept up to just over 200 lb.

I got engaged at thirty-two and that is when I took a serious look at myself. The idea of having wedding pictures of myself in that state and looking at them twenty-five years later disgusted me. I decided something had to be done.

I joined Nutri/system. I joined the gym. I did aerobics two to three times a week for about 45 min. I ate my little tins of Nutri/system food. I lost weight. I had set my mind to it, and like most things I’ve set my mind to, I stayed the course. I got down to my goal weight of 145. I adjusted my goal weight to 140. I hit that and adjusted again to 135.

At that point, I just couldn’t lose any more. My weight hovered between 135-138. I started to get gallbladder attacks. Yes, I had dieted my gallbladder into illness! I didn’t care though, because I looked fantastic. Yes, I still had some loose skin around my arms and I still had a poochy tummy. I had an enormous surgery scar too. But I was a size 12 for the first time since High School and I was in heaven.

I was sure I had conquered my weight problem, too. I had just lost around 70 pounds and I figured if I couldn’t maintain, I’d just go back to Nutri/system. But I was sure I’d maintain. I was going to be a success story -- not like those other people!

But I was still hungry much of the time. I also started easing up on some of my dieting behaviors. I stopped going to the gym as the aerobic classes and stationary biking started to bore me. Drinking 64 oz. of water a day seemed excessive, so I started cutting back.

On top of that, I found I couldn’t maintain with the 1500 calorie a day diet that I was given. I started cheating more and more and my weight started creeping back up. I had gotten up to about 155 pounds, and was starting to feel desperate, when I became pregnant with my first child.

At this point, I went nuts. I started eating everything in sight. I tried to keep my weight gain to the recommended 20-30 pounds, but ended up just under 200 by the time I gave birth. At my six week check-up, I had gone back down to about 165 pounds -- 30 pounds over my lowest post-Nutri/system weight and ten pounds higher than I had started my pregnancy.

I hoped to continue losing the pregnancy weight, but instead I started to slowly gain it all back. I ended up going back to Nutri/system at some point -- or maybe it was Jenny Craig. Somewhere in there Nutri/system went bankrupt and I converted to being a Jenny Craig gal. The food was better and the program got updated regularly.

At one point, I was weighed in at 217 -- so I’d gained EVERYTHING back and another ten pounds. Just like I always did.

Unfortunately, I was less successful this time. I wasn’t as willing to go to the gym two to three days a week. I wasn’t as willing to eat the special food. I lost about 25 pounds, but it was taking me much longer and I was much less motivated. I ended up quitting and watching the weight slowly creep back on.

About five years after I had my first child, I realized that if I were to get pregnant again, I would be in bad shape. I was over 200 pounds again and I remembered how miserable my first pregnancy was when I ended up at 200. I just couldn’t imagine what it would be like if I started at 200.

So I went back to Jenny Craig. Because I had a goal -- having a second child -- I was more motivated and this time it worked better. I still didn’t go back to the gym, but I did start ice skating regularly. I dieted for a few months, it’s hard to remember exactly how many this time, but it was at least three and I had lost at least 25 pounds when I discovered that I was pregnant already!

I was a bit freaked out and of course I stopped dieting and ice skating immediately. As far as food was concerned, I just slide from counting Jenny Craig portions to counting pregnancy nutrients. I had a list of how many servings a day I needed of certain kinds of food and I attempted to get them all in each day. Other than that I didn’t worry about what I ate, but just getting those nutrients in filled me up so I didn’t gain a lot of weight for this pregnancy -- about 23 pounds. This put me at about 195 by the time I had the baby, but unlike the last time, I was much more comfortable and much healthier.

Once the baby was born, I dropped quite a bit of weight -- I weighed less than I had when I found out I was pregnant! My OB was very happy with me and I was happy with myself.


I wanted to continue to lose the extra weight so I went back to Jenny Craig. They have a special version of their diet for nursing mothers and I went on it. But I didn’t stay on it very long. Once again I was hungry all the time. Plus I was worried I would lose my milk. It was very important to me to be successful at breastfeeding this time (I had had issues with working and breastfeeding with my first child) and being on a diet made me nervous.

So I dropped out and decided to wait until my new baby, Mini-Mac, weened. In the meantime, I ate everything and anything and my weight climbed up again.

Eventually, Mini-Mac was a toddler and I was over 200 pounds again. I knew I had to do something but I was sick of Jenny Craig and eating special food. Someone started a Weight Watchers at Work group so I joined that.

I found it somewhat annoying though. The group meetings contained all the same information and tips and tricks that I had learned over the years from Nutri/system and Jenny Craig and I didn’t like losing with a group of people. I found did better with individual counseling. I was thinking of quitting when I got laid off from work and had to quit.

I did try Weight Watchers Online for while, but my life was pretty crazy at that point, trying to decide if I wanted another software job then starting my own photography business and I eventually decided to save the money and quit as I wasn’t really following it and had stopped losing weight.

I also stopped skating as much because I couldn’t afford it. I would do these big jobs one weekend a month that were really tough on my body, but not exercise much in between. I ate a lot of junk food because I couldn’t be bothered to fix healthy food for myself or I was eating out because I was on a job.

Of course I gained back everything I had lost with Weight Watchers and then some. It was at this point that I had a revelation. DIETING DOESN’T WORK! I had been dieting off and on for most of my life and all I had gotten was fatter and fatter.

I decided to I would never diet again. I would eat whenever I wanted, whatever I wanted but I would only eat when I was hungry. I would stop weighing myself more than one to two times a month. I would see what happened. Surely I would lose weight as I finally started listening to my body. I figured I wouldn’t get back down to 135, but as long as I was under 200, I would be okay with that.

What happened is that I lost ten pounds. I was under 200 for the first time in years, though only barely. Of course I was pleased as punch. Until I gained it all back and then some. That wasn’t as fun. But my weight did stabilize. I now fluctuate between 220 and 223 pounds. I haven’t gone over that in more than a year. Apparently, this is the weight my body thinks it should be for some reason.

So I’m the heaviest I’ve ever been. My blood pressure is high enough to need medication. My cholesterol is the highest it’s ever been, though I still have about 15 points before the medical profession cares. I have trouble bending over to tie my shoes. I developed plantar fasciitis in my left foot. I have problems with pain in my shoulder and with carpal tunnel syndrome. I feel physically tired a lot of the time. I stopped ice skating because I wasn’t having fun any more. Finally, as embarrassing as it is to admit it, I can’t keep my bum clean!

I am depressed and frustrated. I do not want to live like this, but I don’t want to diet either. I want to do something that works, not something that doesn’t.

I wish I could go back in time and never start that first diet when I was thirteen. Maybe the rest of it never would have happened, if I had loved my body when it was beautiful and accepted myself as I was. I tell myself that I’d be about 150 and healthy as a horse -- overweight, but not morbidly obese.

But who knows? Maybe my hunger never would have fixed itself. I do know that dieting has made everything worse. But I don’t know what it would have been if I hadn’t dieted ever.

That is the point I had gotten to a few months ago. Then I was over at a neighbors house -- one who Mr. Mac told me had gotten ‘that lap band surgery’ about six months ago -- and I was shocked by how thin he’d gotten and how much healthier he looked.

It was at this point that I decided to seriously consider weight loss surgery. I had never seriously considered gastric bypass, but I was willing to look at lap band. I liked that it was adjustable and could be reversed if something went horribly wrong and that, for the most part, getting this surgery doesn't kill people. I wasn’t exactly sure how it worked, but it did seem to work and that was reassuring to me.

Of course, it also involved surgery and between two c-sections, two dental procedures under general anesthesia, and a gallbladder removal, I feel somewhat surgeried out.

So I started off slow. First, I would just try to eat like a lap band patient. After all, if chewing thoroughly and eating small portions are what make you lose weight, why not do that without a band and avoid the whole surgery thing?

Because I’m hungry all the time was my body’s response to that idea. Okay, that didn’t work. On to Plan B.

I decided to research the lap band in earnest. I discovered how it works. The band puts pressure on your vegas nerve which is involved in feelings of hunger. Therefore, being banded helps control the hunger. On top of that, it forms a little pouch at the top of your stomach. Filling up the pouch causes it to expand and sends the signal to your brain that you are full. This happens much sooner than when you have to fill up the whole stomach. Then the food in the pouch slowly makes its way into what I think of as the second stomach and is digested normally. At this point on, the digestive system works the way it normally does.

So it’s a two piece solution. It controls hunger and it controls portion size. Since hunger is a big issue for me, my chances of being a band success story are good. Portion size is less of an issue for me -- I have trained myself to eat mostly normal portions as defined by the medical community -- but having a little extra help in that department can’t hurt. I'll take it.

So I’ve decided to get a band, right? I started this blog. I found out my insurance doesn’t cover it. Shock #1. I got hysterical. I prepared for a big fight. I found out my insurance probably will cover it. I calmed down. I started to prepare myself for life as a banded person.

As a first step, I gave up carbonated beverages and started drinking more water. It was easy (once I stopped also trying to give up caffeine and artificial sweeteners at the same time) and I feel much better. I started to log my food intake so I could see what my nutrition is really like. Shock #2: I develop chronic reflux. Was all that diet coke settling my stomach and masking a reflux problem? I hope not because I feel so much better not drinking diet soda and don't want to go back. I’m trying to figure out what is causing the reflux and hopefully I can fix it.

In the meantime, I receive shock number three. Just by drinking more water and logging my food, I am losing weight! I’m losing weight without dieting and without being hungry. How can this be? It seems the food journaling is causing me to clean up my eating habits a bit.

Since I have to write it down, I am eating less junk. Plus when I see my fat intake going over 30%, I make sure I don’t eat high fat foods for the rest of the day so I can get it back down to 25% -- which is where I want it. I’m logging my water too and that has caused me to drink a bit more. Maybe the two or three extra glasses of water a day are causing me to consume the 500 extra calories I thought I was consuming but aren't showing up in my food journal.

Which leads to the following thought:

Maybe I’ve been fooling myself all this time. Maybe I could live on a 1700 calorie a day diet without being hungry all the time. Maybe if I added 30 minutes of exercise every 2-3 days on top of that, I could get down to under 175 pounds. That’s what all the calculators say should happen and that would not be a bad weight for my height. I think I could be happy at that weight.

Then again, maybe my body will notice the weight loss and start rebelling. Maybe my hunger will increase until I eat more. Maybe my metabolism will slow down some more on top of it and I’ll go back to weighing 220-223 pounds.

I don’t know what will happen, but I do know that 95-98% of people who diet don't lose significant amounts of weight and don’t keep it off what they do lose, while over 50% of lap band patients do lose significant amounts of weight and do keep it off. In the meantime, I have at least six months until I can take off from work to have surgery. So I have time to try doing it “the natural way” before I have to decide if I’m going to do it “the surgery way”.

I plan to spend that time learning more about my eating habits, practicing eating only when hungry and stopping when full, and getting in all my pre-surgery testing and other requirements.

When the Fall comes, I’ll be ready one way or another.

Saturday, March 8, 2008

I have always been "overweight"

It is interesting how our attitudes towards weight change as our circumstances change.

I remember being given a hard time about my weight, nagged about every bit of food I put into my body as a child. Yet, I wasn't particularly overweight. I was 110 and 4 ft 11 inches at 13 and most of that was boobs and booty. According to the BMI charts, my BMI would have been around 23 and that is considered a healthy weight.

Yet I felt the pressure to go on a diet and did, thus starting a lifetime of yo-yo dieting as I took the first step on my journey towards morbidly obesity.

I look back and I remember how dissatisfied I was with my body most of my life. When I was 110, I wanted to be 100. When I was 120, I wanted to be 110. When I was 135, I wanted to be 125. Yet, it wasn't until I hit 135 that my BMI truly qualified me as being overweight and even then only barely.

Now, I look back on 135 with envy and awe. Sometimes I wish I could have those "overweight" years back so that I could enjoy how I looked instead of constantly being critical of myself for not meeting some unrealistic standard.

Wednesday, March 5, 2008

Medically Necessary

So it seems that Weight Loss Surgery is excluded from my insurance coverage. But the fine print says "unless medically necessary." I'm not exactly sure what that means, but I'm pretty sure it means that I can get lap band surgery and not have to pay for it myself!

My doctor will have to make a case for it being medically necessary, of course, and I will probably get denied the first time we submit the paperwork and have to appeal, but eventually I SHOULD WIN! Assuming my case goes the way of others I have read about with the same wording.

Between figuring this out and first finding out the surgery was "excluded", I have run the gamut of emotions. I've been angry, I've been depressed, I've had second thoughts. And third and fourth and ...

Getting surgery is a major step, of course, so I think second thoughts are natural. There is also a societal prejudice that fat people got that way through bad choices and only need to make good choices and their problems will be solved. I don't believe that intellectually, but I do sometimes fall into that way of thinking anyway.

My biggest fear is that I'll get this surgery and it won't work. I'll have had my body cut open and a piece of silicone put in and I'll still be hungry all the time. I am firmly convinced that my problems come down to hunger and adjustable gastric banding is supposed to curb hunger. But what if it doesn't?

I can never remember, even as a child, feeling full. I would eat dinner with my family and I'd gulp down my food and everyone else would still be eating. So I'd take a second helping and, sometimes, a third. I wouldn't stop until there was no food left or we kids were shooed away from the table. All that time I'd never get that feeling of satiety that other people supposedly get.

Of course, I could be fooling myself and my problems are all mental. I have this fear that as I go through the WLS process, it will come time to "shrink" me and they'll try to say that I eat to fill up an emptiness inside me or some other bogus psycho babble like that. It's true I had a crappy childhood. It's true that once I got boobs, my dad decided I'd make a better bedmate than his about-to-be-ex-wife. Plus there are lots of crazy people in my family and hints that depression is an issue for many of us.

But I don't buy that this is why I eat. If it was, my weight would fluctuate based on life events. But it doesn't. It just goes up and up. The only time it goes down is if I go on a diet. Then when I can't take the hunger any more and stop dieting, it goes back up. It does that without fail and has been doing that ever since I started puberty.

Plus I don't really feel an emptiness inside me. I know I'm supposed to be really screwed up because of what happened to me as a kid. But I don't feel like a victim. I feel like a survivor! I feel victorious because I got myself out of a bad situation and made something good out of my life when I was given crap ingredients to start with.

I am, by my nature, a happy person and that has helped me survive and get through bad periods. Not food. Food can be fun and food can be tasty, but mostly it's just food. I don't think about it when I'm not hungry and sometimes I don't think about it much when I am. I just want something fast and quick to make the hunger go away.

So I think if I could JUST NOT BE HUNGRY, that would be half the battle for me. More than half probably. And that's what lap band surgery is supposed to do -- tame the hunger.