Obesity, Psychology and Weight Loss Surgery

by Marilyn Armstrong co. 2003 (write to author for re-print permissions)


Okay. Time to shove my (unasked) oar in these waters.

I am a gastric bypass patient (3/4/02) who has had multiple complications. In fact, I still have multiple complications. AND I have lost much more weight than I intended and am now downright skinny, although others seem more disturbed by it than I am. And no, I do NOT regret the surgery. Sure the complications have made my life difficult. Sometimes, my life has been beyond difficult ... downright impossible. But thin is STILL better.

I am not complaining.

I also greatly question Weight Watchers' stats. Do they count the dropouts who do not lose weight, cannot keep on track, and are too embarrassed to continue to come to meetings? Or do they only count those who stay in the program? This is a pretty self-selecting sample. The people who stay with the program are, for the most part, people who are succeeding at it so the statistics will clearly show that IF YOU CAN STAY WITH THE PROGRAM, YOU WILL LOSE WEIGHT. Maybe you'll even keep it off, although I doubt they have tracked the stats on those who do well, then stop coming. What happens to them?

I lost weight on every single diet I was ever on until right before surgery when my battered metabolism just gave up and refused to lose weight no matter how little I ate. Jennie Craig got me down 85 lbs. and I kept it off (or most of it, anyway) for more than ten years ... then stuff happened and I threw in the towel, regained all of the weight I lost and added about 40 bonus pounds. Why? It's a long boring story and I'll skip it for the nonce.

So here I am, 19 months post op.

Am I happy with my weight? Yes, although I admit that 10 - 15 more pounds would probably look a bit better ... but I'm a little frightened of trying to gain weight and in any case, I figure once the docs get my other issues sorted out, I'll probably put on a few pounds as a matter of course. My body has a natural set point and after I can eat more normally, I expect that I'll find it.

Am I happy about food? No. I really can't eat much and am highly limited in my choices. It has certainly taken the fun out of food for me, but I have learned to enjoy table talk and ambiance and discovered that there are other reasons for dining than just eating. Would I like to be able to eat a bit more normally? Sure, but life goes on regardless.

Has my marriage fallen apart? No, it hasn't. Is it better? No, it's about the same as it was. Whatever problems we had before, we have now. The strong points are still strong. The weak points are still weak. IMHO a lot of people have crappy relationships and all it takes is one big precipitating event and the whole house of straw comes tumbling down. Are morbidly obese people inclined to have crappy relationships more than "regular" people? What do YOU think? Take a person who feels physically poorly much of the time, probably has a self-esteem issue -- if not from some childhood issue, than certainly as a result of being a very fat adult in a society that idolizes "thin" and voila -- low self esteem served up on a silver platter.

I know a lot of divorced couples. I've been divorced too. In fact, the stats in the northeast are something like 1-in-3 regardless, and probably among certain professions (like media, say -- and yes, I do speak from experience here) it's a lot higher. Also higher in cities than in the country. Also higher among those with higher incomes. Divorce is very very very common in our society and a sampling of ten couples who didn't make it post WLS hardly constitues a meaningful sample. Among the Weight Loss Surgery (WLS) couples I know -- maybe 30 couples in all -- only one actually went to divorce ... but they weren't in great shape before. Other couples had a bunch of issues to sort out, but thus far (in this last 19 months that I've been paying attention to this stuff) seem to be working it out ... as least as far as they are concerned. Others might argue the point and some of them would probably be better off divorced ...

Should there be a better way to lose and keep off weight than massive reconstruction of the digestive tract? Yes, I really wish there were. This procedure is very drastic and not for the faint of heart. If you are doing it so you'll look better in your clothing and that's all, well, that's not good enough to get you through any rough times that might develop. But I think most of us did it because we believed that it was the last-best chance for a healthy life. In some cases, it was do or die, quite literally. As for me, I was either going to lose at least 100 pounds or probably be confined to a wheelchair for the remainder of my time on earth. That was not much of a choice.

Now, about psychological components to obesity.

I tend to think that as many psychological components as there are, there are far more sociological components. Certain ethic groups are far more food-centric than others ... certainly my background (Jewish) celebrates every single event in the human life by preparing and consuming inordinate amounts of food. My Italian daughter in law and a whole bunch of Italian friends say that it was the same for them. Oh hell, my Black (excuse me, African-American ... my husband -- who is non white -- absolutely HATES being called African-American, by the way) friends and family say the same thing. Many many ethnic groups celebrate life by overeating. It is a cultural imperative and gets pretty hard-wired into your brain. Even though I don't eat very much, I still cook and when I do, I still cook too much. I am programmed. And I still get a nice warm fuzzy feeling watching others eat, even though I can't really participate. I am a result of my conditioning. As are we all.

Did I put on some of the extra weight I carried because I comforted myself with food? Yes. But most human beings do that. Just some of us either carry it to extremes or are simply more inclined to put on and keep on extra weight.

Now, about real psychological issues. On one list on which I participated for a long time, the subject of childhood abuse came up and a surprisingly large number of people, mostly female, but some men too, had been abused as children. I don't know if there's been any research to see if there is any link between childhood abuse and obesity, but I bet there is one. But of course, that is apocryphal. Just my gut suspicion.

America is a food-centric society these days. If you doubt this, watch the ads on TV. Count how many ads there are for food in a given hour. I never really noticed it until after surgery when I felt absolutely bombarded with ads for pizza, burgers, fried chicken, ribs, Italian food, soda, beer ... and more and more. For a while it made me crazy. Now it just makes me queasy. I look at ads with happy (thin!) people scarfing down chunks of pizza and fried chicken and all I can see is grease. Yuck.

Last I heard, the average woman in this country wears a size 16 ... AND our sizes are MUCH bigger than they were 30 years ago. If you doubt that, go buy some clothing made during the 50s based on your current size and you'll discover that they won't fit. Americans are MUCH bigger ... in every way ... than they used to be. We are, on the whole, overweight. Some of us are just a little overweight, some much more so. How many restaurants sell themselves on serving big portions, eh? The morbidly obese are not exactly their singular target audience, so eating a lot must be a pretty prevalent phenomenon. So maybe ... just maybe ... we who have been or still are morbidly obese somehow think that we have ever so much more baggage than Normal People, whoever they may be.

I have a theory. It is unscientific, unproven, and as such is merely my subjective thoughts on a clearly delicate subject.

I think most people overeat some of the time. A lot of people overeat most of the time. Some people overeat all of the time. I don't think that psychology accounts for it, except for a small percentage. We live in a society where food is plentiful and cheap ... where fatty, rich food tastes really good. Food is a social function. We get together and we eat. Because we can eat more than we need, we do. In societies where food is scarce, people eat less. In societies where overeating is anti-social, people are -- on the average -- thinner. Some of us are genetically pre-disposed to gain weight and for whatever reasons, are also more inclined to not lose it. That's why it's so common to see multiple siblings in various sizes, even though they've all had essentially the same upbringing. I have two siblings. My brother is overweight, but not fat. My sister is thin. I was fat, now thin. My father was fat, lost it all, kept it off for the rest of his life (50 years to date). My mother never let herself get fat, but she had the discipline of a Marine drill instructor. If she gained five pounds, she immediate increased her exercise, decreased her intake, and lost it. Of her five siblings, 3 were heavy, 3 thin. In my dad's family, the women were fat, the men thin, except for my father who was fat then thin. Does this prove anything? I dunno. Does it?

Many of us have really bad eating habits. I'm not sure that bad eating habits are quite the same as Serious Psychological Issues.

I think we beat ourselves up a lot. I think we incorporated other peoples' judgments of us into our opinions of ourselves. I think that because we feel that we have somehow failed, that we are more inclined to fail.

Whether it's ghrelin levels, sociological conditioning, childhood trauma, low self esteem, some combination of the preceding or whatever, WLS works better than any other solution for the disease of morbid obesity. The rate of long term success for any traditional diet program is poor. And for those of us with complicated medical issues, dieting success percentages approach zero on a close order.

And finally, I find it interesting in a society where the average woman is pretty hefty that somehow, those who are more than a little hefty come in for so much abuse. Is it because the merely overweight amongst us feel somehow better because they aren't as big as we are? And when we have surgery and lose the weight, why do so many of them get so hostile? Maybe they feel a little threatened, eh? Maybe even jealous?

Maybe by the time the next generation grows up, there will be better, less drastic, solutions to overweight. In the meantime, this one works.


Marilyn Armstrong
Open RNY 3/4/02
Starting weight 258lb., current 110lb. (more or less) at 5'3"


Marilyn's WLS page



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