Mason

My initial post on this thread was a highly critical indictment of the abstinence model in regard to compulsive eating and I have been taking this position professionally since 1985. I have written numerous articles and professional book reviews that have essentially made the very same points. Not once have I ever been attacked by other professionals who also happen to be members of OA or AA or believe that abstinence from sugar, wheat, and alcohol is essential to their own personal recovery (and there are many who do). I appreciate that this is not a forum for professional people (although there are members with professional degrees) but I am not going to apologize to those who took offense because they live by an unsubstantiated model of recovery that I happen to be critical of and have been professionally critical of for 28 years. Does my promotion of moderation mean that I am encouraging people to live an unhealthy lifestyle or to subsist on junk food? Of course not and that's a completely disingenuous distortion of what I've written. I don't see this as a contest or issue between strict vs. "undisciplined?" sleevers. For me, this is strictly a matter of two competing models: disease vs. mental health. I stand behind everything I've written on this thread with the caveat that nothing I wrote was deliberately directed at anyone in particular. If you took offense, then challenge the argument, don't attack the member. You and Dean are right about one though: I really shouldn't be writing here with professional authority as an academician and then claim "regular member status" when feathers get ruffled and buttons get inadvertently pushed. I have been writing as if I were addressing colleagues, yet another book review, and you and Dean have made me realize that I need to write at all times as if I'm addressing patients, i.e., with a very different kind of sensitivity and mindset. Quite frankly, that's a burden I rather not assume. I won't be posting on these forums anymore. Best of luck to everyone in their life's journey towards a healthier and thinner body.

DesertMom, especially in light of the original post, what a wonderfully appropriate Freudian slip this is! Love it. Thanks.

I am a regular member on these forums without any professional responsibility—as an educator or a psychologist—to other members. Consequently, the posting of that article was not reckless: It was, perhaps, unkind. As a detective, do you have a fiduciary responsibility on this forum to investigate information suggesting the commission of a possible crime? I am only human. I have been sophomorically attacked and insulted on this thread on several occasions because two to three people took offense to a very general statement that I made that was not directed to anyone in particular. Is there a forum rule somewhere that states I can only respond in kind? Cheri, I don't know how you've managed to last as long as you have on these forums, but God bless you. From where I'm sitting, it's not worth it.

I've taught psychopathology for over 25 years and I don't believe that article suffers from selection bias or that the results could be applied to the general population at all. There is a far greater incidence of PDs in patients with morbid and super obesity than in the general population. Furthermore, NurseGrace, I am not here as a staff member or the forum psychologist. Given what's transpired on this thread, that article is entirely apropos and informs a great deal of what the OP complained about. The sharing of that article was not a bastardization of anything despite the fact that my motivation in doing so was obviously over- and multi-determined! As for your earlier idea about labeling members by their orientation to abstinence vs. moderation, i.e., "different ideas about how closely we follow the guidelines," the only long-term guidelines I received from my surgeon were: 1) no carbonated beverages ever and; 2) no alcohol for at least one year. For the record, I plan to follow both those guidelines religiously. So, please, put me down as "by the book!"

Here's a fascinating study on the association between personality disorders and morbid obesity that is particularly apropos for this thread. I've appended a small excerpt from the introduction. Click on the hyperlinked title for the full article. Enjoy! Personality Assessment in Morbid Obesity Clinical experience suggests that morbidly obese persons seeking treatment for their obesity do have significantly more psychological problems than the normal population (Grana, 1989; Berman, 1993) and often exhibit passive-dependent and passive-aggressive personality traits (Castelnuovo-Tedesco, 1975, 1987). They may appear passive but express their hostility in interpersonal relationships (Bruch, 1973). Other authors have reported immaturity and poor impulse control (Hutzler, 1981), higher scores on the oral cluster traits (self-doubt, insecurity, sensitivity, dependence, compliance and emotional instability) (Larsen, 1989), eccentric cluster traits (paranoid, schizoid, schizotypal) and dramatic cluster traits (histrionic, narcissistic, borderline, antisocial) (Black, 1992) in these patients. After bariatric surgery, morbidly obese patients seem less disturbed, with more control of their situation, the psychological discomfort decreasing after one year follow-up (Larsen, 1989; Charles, 1987; Solow, 1977; Harris, 1982; Garner, 983; Chandarana, 1988; La Manna, 1992; Adami, 1994; Karlsson, 1998; van Gemert, 1998; Guisado, 2001). Studies on this subject have found a poor response to surgery with little weight loss in the presence of preoperative personality disorder (psychopathy and borderline traits) (Jonsson, 1986; Barrash, 1987; Larsen, 1990), and this finding may indicate that patients with a personality disorder diagnosis have more difficulties adapting to the strong demands of controlled eating behavior imposed on them by the surgical operation (Jonsson, 1986).

You are doing nothing of the kind. You are droning on incessantly with hyperbole, gross mischaracterizations of what I wrote, and ad hominem attacks because you took personal offense to what I wrote about fear and denial. All these sidebar discussions about Cheri's use of the word Nazi (and my subsequent reference to it), not surprisingly, are coming from the abstinence police (no offense intended to those of you who are on the job or married to cops). It's a lot easier to complain about the use of the word Nazi than to validate the abstinence model. I never wrote that eating a Big Mac or Krispy Kreme doughnut, per se, was healthy, or--for that matter--that crack addicts shouldn't abstain from crack cocaine. My main point, one that I've repeated numerous times, is that there is NO empirical evidence to support the abstinence model in regard to food addiction and weight loss maintenance success. But, hey, if abstaining from certain foods makes you feel good about yourself, knock your socks off. Just stop trying to impose this philosophical crap on other members!

Fair enough. In the interest of time, would you be able to pull out any specific references to empirical research and post them here? If I don't finish grading the final exams for my Intro to Psych class today, I am going to be in big trouble. Smile.

For those who don't have access to a dictionary, a Sephardi is a Jew of Mediterranean descent. I lost a grandparent during German occupation of Greece: If you want write about deep sadness and pain, that covers it. Quite frankly, I think it is disgusting that some are deliberately belaboring the off-topic discussion of the earlier use of the word Nazi (a word that was used without intended offense by another Jew) to obfuscate the issue raised by the original poster and the subsequent points that have been made in support of her complaint. Perhaps we can shelve all the righteous indignation, drop this sidebar discussion, and return to the original topic?

I did not "through out" (sic) any swastikas or anything else for matter. I repeated and referenced the term "food Nazi" that had been initially used by another member in an earlier post (in fact, I specifically used it in quotes) and I most certainly was not directing it to anyone in particular. I wasn't even aware of you as a member until you started to post on this thread. And, for the record, neither Cheri nor I used this term in an historic sense in regard to the Third Reich or the Holocaust. It was obviously first and subsequently used to refer to the fascist- or dogmatic-like thinking exhibited by some in regard to abstinence and "bad foods." I happen to be a Sephardi, so you can drop the swastika references. Making some vague reference to another anonymous thread on this forum is not the same as providing citations to empirical research that has been published in refereed professional journals.

Butterthebean, I will repeat the bottom line for me. Ad hominem attacks and increased strength of personal conviction do not qualify as empirical evidence. In fact, recent longitudinal research from the prestigious National Institute on Alcohol Abuse and Alcoholism (2010) clearly demonstrates that many who had been previously diagnosed with alcohol dependency (alcoholism) in their 30s and 40s are able to safely drink in moderation once they are older. There is no empirical evidence in the research literature to support the premise that overeating is a physiological addiction. It’s a psychological problem. Consequently, as a rule—that is, on the average—abstinence is far less effective in maintaining weight loss than moderation. Insulting me doesn't change the validity of what I've written or serve as scientific evidence in favor of abstinence. Taking a few post-surgical bites of a Krispy Kreme doughnut or a McDonald's Sausage Mcmuffin with cheese is most definitely not unhealthy behavior... assuming these foods are eaten in moderation. The fact that several post-surgical patients on these forums fear the inability to have those few bites without later gorging themselves uncontrollably does not mean that all VSG patients should abstain from such foods. Notes Bufe, C. (1998). Alcoholics Anonymous: Cult or Cure?, (2nd edition). Tuscon, AZ:Sharp Press. National Institute on Alcohol Abuse and Alcoholism (2010, February). Alcoholism isn’t what it used to be. NIAAA Spectrum, 2. Retrieved from http://www.spectrum....alcoholism.aspx

I appreciate the enormous self-honesty reflected in your post. If someone is aware of having unresolved psychological issues around food and finds abstinence to be a safer solution than moderation, so be it. In addition, not all psychological conflicts are resolvable. Patients with certain eating disorders that have their etiology in early childhood trauma may always be vulnerable to those disorders. I have worked with many obese women who chose to become obese and remain that way as a defense against incest for example. Even after years of therapy and considerable weight loss, there was a deliberate attempt at understating their appearance at all times. Please go back and take another look at what I wrote. I never stated that those who abstain from certain foods and don't track their daily food intake will necessarily fail. What I wrote is that those who track their food intake and use moderation in their food choices will have greater success over the long haul, on the average, than those who don't. That statement happens to be unequivocally true in the field of food addiction and in the weight loss industry, which is why I was able to safely bet the house on it. Smile. In the meantime, until your psychological issues with food are resolved one day, I wish you continued success with your low-carb diet.

Of course I am not suggesting that. What I am stating is that if you can't nibble on a part of a doughnut, two ounces of hamburger, or two to three ounces of Ben and Jerry's New York chocolate chunk ice cream (contingent on whatever your particular sleeve can hold), this is not a medical issue, it's a psychological one. I am also stating that those who can eat half a doughnut or just two ounces of Ben and Jerry's without craving more should not be made to feel as if they are jeopardizing their weight loss success and health and that happens here all the time! I am willing to bet the house that in two-year follow-up studies, the VSG patients who enjoy the greatest success are those who: 1) tracked their food intake, and; 2) did not deliberately abstain from any particular foods.

Obviously, patients should not violate dietary restrictions imposed by hypo- or hyperglycemia. However, barring these medical conditions (most of which go into remission after weight loss), there is absolutely no empirical evidence to support the effectiveness of abstinence from certain foods in weight loss and weight loss maintenance: NONE. Barring the aforementioned medical conditions, rigid abstinence from certain foods, such as a hamburger or piece of cake, is a psychological issue, not a medical one. I can write this with confidence as a professor of psychology who worked in the field of addictionology for over 15 years. The problem with abstinence is that it leads to the well-documented abstinence violation effect: I must abstain from doughnuts. If I break down and have just one, then I must have 100. This effect is psychological, not medical. There is no more evidence to suggest that compulsive eating is a physiological addiction than alcohol dependency is a disease. Porting over the AA philosophy of disease and allergy to overeating is a psychological travesty. I challenge anyone who disagrees with this to present empirical evidence to the contrary that has been published in a referred professional journal. You won't find any. Granted, abstinence may be temporarily working for someone (although it won't over the long haul). However, this does not mean that those wedded to the abstinence model should try to shame those who are trying to learn how to eat in moderation. The underlying premise of abstinence is unfounded, shaming and chastising are never helpful, and that kind of post is entirely self-congratulatory. If I were unable to eat, for example, one hamburger without obsessively craving more and more of them, I'd see a cognitive-behavioral therapist who specializes in eating disorders. I would not be attempting to shame those who are able to successfully eat just one in an attempt at denying and avoiding my own highly conflicted relationship with food. Doing so may not rise to the definition of Nazism or fascism, but maybe we can all agree that it's not very nice.

For starters, Cheri, your posts are always so insightful, temperate, and helpful, you should really be paid to contribute to these forums. The Food Nazis are coming from a place of fear and denial. There is a rather large contingency of sleevers on these forums who have never worked on their food issues. In an attempt at defending against them, that is, working around their compulsive eating, they live and preach a model of abstinence. They boast of attending a holiday party with a blender and Protein powder, one whole year after surgery, or they'll publicly scold a member who shared that they ate a real pepperoni instead of a turkey pepperoni. This position is nothing short of absurd. Of course you can eat a Big Mac, Chili's baby back ribs, or a Dunkin' Donuts Bavarian creme doughnut after surgery... albeit not very much of them, just as long as you track or monitor your daily caloric intake and meet your protein requirements. If you cannot successfully eat in moderation after surgery, that is, if you cannot eat 3oz of Ben and Jerry's ice cream without eating 16, if you cannot eat one cookie without finishing the entire bag, then substituting the foods that you crave with low-fat alternatives is not the answer... not over the long haul. If you cannot eat in moderation after having had 75 to 80 percent of your stomach removed, then you have serious psychological problems with food and, trust me on this, low-fat yogurt and carrot sticks are not the answer. The answer is to get yourself into a good psychotherapy as soon as possible so that you can start redefining your relationship with food. And, in the interim, stop bullying other members who do not share your need to abstain from the foods they enjoy. The key to good health and a good life is moderation, not abstinence.

While we are all assuming that the rather enormous differences in early recovery are attributable solely to individual differences between patients, I am now thinking that, perhaps, these differences can be attributable to physician skill and his/her surgical protocol. There are not that many physicians performing this procedure in Abu Dhabi. I know five other patients who had this surgery performed by my doctor. In every case, the experiences surrounding early recovery (day of and the day after) were virtually identical despite the fact that we are all very different in regard to age, starting BMI, overall health, and gender. Obviously, there are individual differences between patients in regard to pain threshold and particular sensitivity to discomfort. However, there are also tremendous differences between physicians in their levels of skill and expertise. Just because, for example, an appendectomy is now considered routine surgery does not mean that every general surgeon enjoys the same post-operative results, on the average (that is, controlling for individual differences between patients). Please be advised that not all laparoscopic surgeons are created equally. In this case, consulting with other patients who had the procedure from the same doctor you are considering is a very good idea.

Find other VSG patients in your area—either through your pre-op support group or via these forums—and use them as your support group. I have told absolutely no one at work, only one family member, and one good friend from high school. Next Saturday, a few VSG patients are getting together for a "sleeve friendly lunch" and we're all the way out in the Middle East. One of the other patients and I were sleeved on the same day and were in adjacent rooms. Use other patients—particularly those at different stages of the post-operative process—for social support. Who else can better understand what you're going through than another patient?

I have a very low threshold to physical pain and I felt none after surgery except when I moved or tried to get out of bed. I asked the nurse to give me a shot of Ultram100mg I.M. just before being discharged and that took care of whatever discomfort I might have felt for the ride home. Although I was prescribed some pain medication at discharge, I never needed to take it. My wife had to help me out of bed until the fourth day after surgery and, then, by the fifth day, I was fine. If you are feeling a lot of pain, you should tell your surgeon immediately and ask for more pain medication. There is no reason for you to be this uncomfortable. I have never given birth (smile) but I had an abscessed wisdom tooth a few months ago and the pain from that infection was 100 times worse than my VSG surgery. PS. Make sure you are walking. The only real discomfort I felt after surgery was from the trapped CO2. PPS. I am NOT a bariatric surgeon pretending to be a patient. I am a real VSG patient not affiliated or associated with any physician in the practice of weight loss surgery.

As I have a history of yo-yo dieting with a maximum BMI of 38, my self image is more of an average-weighted person than someone who is (was) obese. The wife and I went to TGIF last night for dinner. She ordered the baby back ribs and gave me about 2oz's worth (58g) of meat and about an ounce of mashed potatoes. I was full to the brim after consuming those 3ozs of food and not the least bit resentful that I was satiated after just a few bites. As others have written, that's precisely why I had the surgery. The only emotional reaction I am having to the restriction is relief. I do wish I could drink with my meals, especially at restaurants, but I can live with that loss. The difference in my energy levels is nothing short of remarkable. Two weeks ago, I joined my wife and brother-in-law at a local theme park and walked for five hours without pain or fatigue. I now accompany my wife to the mall as often as I can and I never get tired from walking around. Before the surgery, I could not walk more than a few yards without the soles of my feet feeling as if they were on fire. As my sleep apnea dissipated after I lost the initial nine pounds, I now enjoy a good night's sleep and wake up feeling refreshed and relaxed. My blood glucose levels are now normal with medication (88mg/dl fasting). I was just instructed to reduce my medication down to one pill a day. After I lose another 20lbs, I know I will be able to discontinue the medication altogether. I am thrilled with my results. The first month or so is difficult, especially the first two weeks when you're limited to liquids. However, as the weight comes off and you start reclaiming your life, you will know you have made the right decision.

Each physician has his/her own set of post-op instructions. I was allowed to drink caffeinated coffee from day 7, the same time I could add milk to my diet. I've been having about three-quarter's of a mug of coffee every morning for the past 28 days without incident.

It takes a few days after surgery for the excess ghrelin to dissipate from your blood stream. I was ravenous on days three and four post-op. By day five, there was no hunger at all.

It's a good question. In my neck of the woods (Abu Dhabi, UAE), there is virtually no pre- or post-op support. One week before surgery, you show up at the hospital for blood work, a chest X-ray, and an echocardiogram. They want to make sure you're strong enough to survive the surgery. That's it. I researched this surgery for a solid year-and-a-half before undergoing it. I consulted with three different surgeons, interviewed a half-dozen patients about their personal experiences, and read as many journal articles on the procedure and early recovery process that I could find. I was well-prepared mentally for the surgery but, as others have already written, no amount of mental understanding can prepare you experientially for what you will encounter. The specific phenomenology of this surgery varies considerably by patient given each person's history, overall physical and mental status, particular issues with food, and—no less so—personality organization. Writing entirely for myself, I was so fixated on the mechanics of the surgery (particularly how much pain there would be and whether I'd be able to return to work in three weeks) that I really didn't focus on what it would be like, for example, to consume nothing but fluids for two weeks. I mean, by day nine, I felt like I was drowning! From what I've read on these forums, I do believe a lot of people unfortunately delude themselves into viewing the surgery as a cure for their obesity and, of course, it is not. Now that my staple line is completely healed and all the swelling has subsided, I see how easy it would be to start eating excess calories if I wanted and I'm only 32 days out. My wife is a Filipino and, just the other night, she made a big pot of a tomato-based dish consisting of ground pork called Giniling (better known by its Spanish name Picadillo in the States). I happen to really like this dish. According to the food database on MyFitnessPal.com, Giniling has 554 calories per cup and, "of course," you can't eat this dish without rice. At that point, as I'm on a 1290 calorie per day program and only had just over 300 calories left, I watched my wife and brother-in-law enjoy big scoops of Giniling poured over large mounds of long-grain rice while I ate my two ounces of deli-sliced turkey breast and one ounce of cheese. (I can cry now just thinking about it!) I can easily understand how pissed-off patients become when they realize (some much later than others) that the sleeve is not going to do all the work for them. If they don't make the effort to track their food intake on a daily basis and exercise at least three times a week, it's very unlikely that they will reach goal and they should plan on regaining at least some of the weight back. The bariatric surgeons here don't emphasize the persistence of food cravings, the pesky phenomenon of "head hunger," the fact that they don't remove your taste buds along with your stomach, or that you can still easily go way over your BMR caloric requirements for the day even after having had 75 to 80 percent of your stomach removed! It's simply not in their best interest to stress these facts of life for the typical VSG patient. Sure, it is truly a lot easier to do the right thing after getting sleeved, but it's certainly not a walk in the park by any means.

I was cleared for sashimi (not sushi) at the start of week 4 and it went down very easily and stayed down. Couldn't eat very much of it but what I ate was delicious.

I believe the key to long-term success is self-honesty, a realistic understanding of the procedure, especially the recovery process, and the strengths and limitations of the surgery. The surgery is most effective long-term with patients who had trouble with portion control and between-meal (and after dinner) hunger pains. The surgery is less effective in helping compulsive eaters, what forum members refer to as "grazers" or perpetual "snackers," i.e., those who are driven to eat frequently out of boredom or the sheer taste of it, people who can't pass the kitchen without popping a cookie or a handful of potato chips into their mouths. Related to grazing is the problem of emotional eating, that is, eating to self-medicate anxiety, depression, and frustration. The problem here is that you can very easily continue that type of problematic eating behavior shortly after the surgery. Before the surgery, try to honestly reflect on what kind of problem eater you are. If you are an emotional or compulsive eater, then you should be in some sort of psychotherapy before the surgery to start dealing with these issues. Cognitive behavior therapy (CBT) often produces the most efficacious short-term results but a good psychodynamically-oriented treatment will more likely help you mourn your old relationship with food and help you to understand the complicated symbolic meanings of food in your life. Both personally and professionally, I don't believe in abstinence, i.e., deliberately avoiding foods that you enjoy or substituting foods low in calories for preferred high-calorie foods. If you feel like eating Ben and Jerry's New York chocolate Chuck ice cream, then learn to eat two to three ounces of it instead of eight or 16 ounces. If you can't do that, then substituting eight ounces of Dannon's low-fat yogurt is not an effective strategy. If you can't exercise moderation then it is better to deal with this problem directly in treatment than to try and work around it with food substitutions. Over the long haul, who here has ever successfully satisfied the urge to eat potato chips with a handful of carrot sticks? An essential part of the moderation approach is food tracking or monitoring. In consultation with your nutritionist or surgeon, agree to a daily calorie goal and stick to it using a program like My Fitness Pal or Fitocracy. Track everything that goes into your mouth and you are far more likely to reach goal and keep the weight off. Those who fail to reach goal and regain significant amounts of weight are, almost entirely, not tracking their food intake.

I agree with you 110 percent in theory but I think there is more to this than immaturity or ignorance. Psychologists have explored this very phenomenon in what is referred to as the online disinhibition effect. When online forum members are posting anonymously, they are able to express feelings and thoughts that they would never post if they were writing with their real names. Depending on your point of view and the purpose of the forum, this can either be a really good thing or a very destructive one. There are two basic types of disinhibition: toxic and benign. Toxic disinhibition is frequently expressed as cyberbully and cyberstalking, i.e., making anonymous death threats towards another member, particularly one who is onymous. Benign inhibition often takes the form of expressing amorous or intimate feelings or, in the case in question, a regression in the service of the ego. I think anyone with an I.Q. above 70 understands, at least in a very general and practical way, what it will mean to have 75- to 80-percent of one's stomach removed. Unfortunately, that doesn't mean it won't be hard and that there won't be regret. I am guessing the original poster knows that she can't return to her surgeon and ask him to reattach her old stomach. There is no other choice but to find a way to adapt to it. For some members, belly-aching anonymously on these forums and inviting the stories of how other members coped with the early stages of this surgery helps enormously with the adjustment. It's not my style or apparently yours but it does actually work for some. Anonymity allows members to "whinge and whine" (as an American i would write "moan and groan"... smile) in a way they would never even think of doing if they were writing with their real names. It's self-soothing in the way that eating a whole quart (liter) of Ben and Jerry's ice cream had been before the surgery. It's an attempt at achieving an emotional catharsis in the same way a good cry in private often does, "Oh my God, what did I do?! Please tell me I didn't make the biggest mistake of my life!!" ___________________________ For anyone who is interested in this topic, just conduct a search on online disinhibition effect and, especially, look out for the work of Prof. John Suller, who's a major pioneer in this area of study.

@OregonDaisy, I want to thank you for sharing your frustration and personal struggles with weight loss maintenance. Thank you, in particular, for continuing to share with us four years after surgery. What I would like to write in response is that I have never been able to keep my excess weight off for more than a few months at a time. That's why I had the surgery 29 days ago. If four years from now, I can come back here and report that I have been able to maintain my weight loss at just 10 measly pounds above goal, I would personally consider that a raving success—even (perhaps especially) if I had to work at it every day. Is this not a result you should be very proud of? I would be.