Mary Jo Rapini

There was an interesting article in the New York Times about a young woman who had a Lap-Band weight loss surgery after years of suffering the emotional journey of an overweight kid. The story was very honest about what to expect with this type of surgery, and it also tracked the journey of the young woman. The story is of interest to many as more and more teens and adults are turning toward the option of weight loss surgery. The latest number of weight loss surgeries performed in the United States is 220,000 per year. That is a seven-fold increase over the past 10 years according to the New York Times article. Weight loss surgeries do save lives and also improve quality of lives for sure, but they aren’t for everyone. The surgeons do the surgery and are skilled at centers of excellence, but unless the patients come back, join support groups and stay in contact with dieticians, falling off track is way too easy and, unfortunately, many of them do, including the young woman in the NYT story.
I run several food addiction groups in Houston, and was featured as the psychotherapist for TLC’s show “Big Medicine.” On the show, I worked closely with Drs. Robert and Garth Davis. We tried to give the viewer an honest look at what happened with the weight loss surgery and the journey after. My work now is primarily with revisions. Revisions are the surgery done when the first weight loss surgery failed. My office is full, as are my support groups. What happened to the patients that so eagerly came into our offices feeling empowered and ready to give up their morbid obesity forever? They are replaced with patients who hang their head feeling like they failed. Even though they feel defeated, the ones I see are the fortunate ones who were able to step out of their shame cycle, call their insurance company and ask for a second chance. They need a second chance because neither they nor we (the health team) had a full picture of what was underneath their weight. They couldn’t see it prior to surgery, and since they are their own historians telling us their story, we are blinded also.
I believe in weight loss surgery, but I believe more in the knowledge we impart to the patient prior to and after the surgery. Performing an alteration, such as a weight loss surgery, is a huge decision, but in the case of a minor I think the whole bariatric medicine team must be on board. There has to be a built-in safety net to handle the transformation of the child as well as their family. Everyone who loves the patient must change when someone they love has weight loss surgery. The counselor, dietician, and surgeon must know all of the family members. We must know who is sabotaging and enabling that patient on an emotional level. Enablers are the people still giving the patient food as a source of love. Our bariatric treatment teams must also understand if simply making better food and lifestyle choices worked, it would have worked 20 diets ago. It did not. Obesity has an addictive component, and addictions are kept in place by denial. Most patients will tell you they are not addicted to food exactly the same as an alcoholic will tell you they aren’t addicted to alcohol. The question is: “Do you use food to comfort yourself?” If the patient says “YES,” then treat them for a food addiction. Do this because they are telling you they have a relationship with food that is emotionally based and most likely they are choosing food with high fat or high carbohydrates (not one of my patients has ever had an addiction/emotional relationship to steamed or raw vegetables).
Whenever a patient feels like a failure after going through the process of weight loss surgery and everything it entails, it is heart wrenching not only to them, but to me and anyone working in this field. If insurance companies won’t cover patient care for years to come after the surgery, then we in the field are going to have to put these measures in place and make them affordable to the patients. We cannot tell a patient they need to continue in groups and follow-ups if they can no longer afford the cost. Whoever said, “Weight loss surgery is a quick fix” truly never had weight loss surgery or worked with my patients. There is nothing quick about it. Obesity is a disease and once you have it, losing the weight is the easy part, managing that loss is a life long journey.

Have you ever caught yourself watching TV at night and feeling lonely, bored or sad? Your partner may be sitting next to you or in their favorite chair, but you get up anyway; making the routine trip to the freezer to fix a bowl of ice cream, which will provide the comfort you are craving. It may not be ice cream; your comfort food may be a bag of Doritos, a pizza delivery, or a can of coke and leftovers from dinner. You aren’t really hungry, you may feel miserable, but the effort it would require to hug your partner, or become intimate with them isn’t as easy or comforting as food. People who struggle with weight often times struggle with intimacy as well. This struggle extends beyond their family, and affects their personal friendships as well. Eating for comfort may lead to more isolation. The more weight people gain, the less they want to mingle and the more they worry about what others will think or say.
Have we become a society of people medicating with food in order to feel better? Have we stopped turning to loved ones for support and comfort in lieu of food? Yes and no. Although overeating has always been a problem, the stress of technology speeding up our lives and forcing us to bring home more work, or never leaving work at work, we are all working more and more, and feeling less and less connected with those we love most. We return home feeling exhausted and overwhelmed. Rewarding ourselves with food is a lot easier than becoming vulnerable and open to criticism from our partner or friends. There are other reasons more people are turning to food for emotional comfort rather than a relationship.

You don’t have to leave your home to get comfort. Food delivery is available within blocks of our homes.
Food is easy; you don’t need to invest any effort or time.
You don’t have to get dressed to enjoy comfort food.
You don’t have to look handsome, desirable or pretty for food.
Food doesn’t judge you, leave you, or criticize you.
Eating a delicious dinner is longer and more enjoyable for many people than sex (the average length of lovemaking is less than ten minutes).
Food doesn’t cheat on you.
Food is available anywhere, anytime, and for any reason.
Food may be tied to memories of love and childhood which makes you feel loved.
Food doesn’t require a partner.

So is it a bad thing if we prefer gourmet truffle macaroni and cheese along with a filet mignon and a fresh garden salad with gobs of ranch dressing? Is it bad to add chocolate mousse if you’ve had an especially rough day and need an additional reward? It’s not a judgment call of right or wrong, but it can be adding to your unhappiness and health. Intimacy with another is important. When you are intimate with someone they want you to be healthy; choosing food for comfort rather than reaching out to them would be hurtful or a sign of rejection. There are other reasons you need to find comfort in one another rather than food. Below are a few.
Intimacy shared with another gives you a deeper connection.
Intimacy doesn’t leave you with guilt, feeling disgusted, or body hate.
Intimacy helps you lose weight, not gain.
Intimacy lowers your heart rate.
Intimacy lowers your blood pressure.
Intimacy won’t cause diabetes.
Intimacy is good for your heart.
Intimacy improves your thinking.
Intimacy is exercise and exercise is good.
Intimacy won’t leave you feeling isolated.
Intimacy doesn’t take your mobility away.
Intimacy doesn’t cost anything.
Intimacy doesn’t make your hips, knees or ankles hurt.
Intimacy makes your brain work better.

Everyone understands the feeling of working and having a bag of chips or a package of cookies nearby only to realize at the end of their task the bag or package is completely gone. They were eating them mindlessly. Eating to calm anxiety is more and more common. The primary reason for relationships growing apart is due to couples choosing other vices to fill the void they feel. Becoming aware of your behavior and what you are eating, as well as writing down what you eat (we forget) is a good way to begin eating less and becoming more in touch with the emotions you are repressing with food. A simple practice of not eating past 7 or 8 pm can help you lose weight, and communicate more with your partner, family or friends. Breaking the habit of turning to food is not easy, but with practice it does work. Intimacy and sex are better for you than food!
–Mary Jo Rapini