Observations About Weight Regain in the Absence of Easy Cues

I last wrote about my small but significant weight re-gain, and returning to tracking my eating. Although in March I wrote "see you in a month," it's been several months, so there's a decent amount of data on how things are going.

Tracking my eating has been very helpful. But despite that, I noticed I was eating more. I was increasingly concerned that I my little stomach may have stretched irrevocably: I was able to eat larger portions without experiencing the sensations that would cause me to immediately stop eating. 

For more than a year after the surgery, when I ate, I would very quickly feel full. If I ate one bite past that feeling, I was uncomfortable. Two bites, I would be overwhelmingly uncomfortable. Three bites was impossible, or I would run to the bathroom gagging. Thus I learned to be satisfied eating less!

I gradually lost this instant feedback, slowly enough that I didn't notice it on a daily basis. And then one day, I realized I was eating larger portions. In the summer we grill burgers on the deck. Last summer I would cut my burger on a bun in half, eat one half, and save the other half. This summer, I ate a whole burger with no discomfort. This worried and scared me. 

Then something interesting happened. I tried eating the post-surgery portion sizes and stopping, even though I wasn't getting that stop eating now! feeling. And I found I could stop, and was no longer hungry.

This may sound ridiculous or obvious, depending on your experience. But in my past experience, pre-surgery, I was almost always hungry. If I ate a smaller portion, I needed to cope with the feeling of still being hungry. That is very difficult to do on a consistent basis. 

The half-burger is one example. Another example is my mid-morning snack, between breakfast and lunch. I could eat x amount and not feel uncomfortable. Or I could eat half-x amount and also feel like I'd eaten enough.

So it turns out I can eat more -- but I can also eat less.

This causes me to wonder whether the disappearance of the immediate and non-negotiable feedback cues are the reason for some people's long-term weight regain after bariatric surgery. Because the big difference post-surgery is that immediate stop eating now sensation. Without those non-negotiable cues, I must be much more mindful of portion size and quantity. I must make very conscious choices of when to stop. This is a whole different post-surgery outlook. 

If you've never been overweight, or you're not someone with a big appetite who enjoys food, this may sound easy. I can tell you it is not easy. It is challenging. However, I can now do it -- where in the past, I could not.

So now in addition to tracking my food, I have to negotiate my portion size in advance of every meal. This means I can never let myself get too hungry. That's always been important for me, but now it's crucial, if I'm going to avoid re-gaining weight. 

Right now my weight is -37 from my pre-surgery weight, same as it was one year ago, and three pounds less than it was in March of this year. I'd like to lose a little more, but most importantly, I don't want to gain any more. 

Using an App to Track Nutrition and Exercise: Pros and Cons

Most people who track their diet and exercise use an app on their mobile device. I decided to track everything manually, beginning with the first day of the pre-surgery fast.

I have a beautiful blank notebook that I had never used. It was a gift, associated with a very special memory. (The book was a gift from my mother, a souvenir of our trip to France together in 2014.) I decided that this huge life decision deserved this special book. 

In the notebook, in addition to diet and exercise, I've included my questions for the dietitian, notes from my dietitian sessions, any pain or discomfort I experience, any milestones, challenges, and so on. It's a record of my bariatric journey. 

I really like having a record of all this on paper, and associating it with a very joyous memory. I'll continue to use the book to record notes from my dietitian sessions, and any other issues (qualitative rather than quantitative evidence, as we say in the information biz).

But now that I'm moving into a permanent bariatric diet, I realized an app would be very helpful. I chose SparkPeople, and I signed up for the "premium" (paid) version right away.

The paid level has many good features, but the reason I'm using it is to eliminate advertising. Something I use every day, both on my computer and my phone, cannot be plastered with ads. I'm fortunate that I can easily spend another $5/month. Not everyone can, and there are free versions of all the weight-loss apps.

There are many advantages to using a mobile app for nutrition and exercise tracking. However, for me, there are also disadvantages. In some ways it makes my life easier... in other ways it makes things more challenging.

Advantages

The advantages to using an app are obvious.

1. When you enter the food you've eaten, it automatically enters the nutritional value -- calories, protein, and anything else you might be monitoring, such as carbs, fat, vitamins, and so on. No need to look up anything.

2. It tracks and calculates your totals daily, weekly, monthly, and all-time. No need to look back through your week or month, no need to add anything. 

3. Once you've eaten a food, and entered it into the app in a way that reflects your habits (brand, portion size, method of cooking), the next time you eat it, you just tap or click on it. Easy.

4. You can group foods and ingredients that you eat together. For example, I grouped "milk, 1%, 16 ounces," "frozen berries, 1 cup," and "protein powder, whey, unsweetened, 1 scoop" into "protein smoothie". I'll do this with everything I cook, too. 

For me, these are the advantages. The app saves me time and repetitive work.

5. If you are not accustomed to tracking your habits, using an app would make it easier, and hopefully increase the likelihood that you'll continue tracking.

6. If you need more support, the popular apps offer articles, blogs, recipes, workouts, and so on, and also have communities that support and encourage each other. Goddess knows there is no shortage of any of these things online! But it does put everything in one place, which might help you focus. 

Disadvantages

The disadvantages to using an app are less obvious, unless you already have a good awareness of eating disorders.

1. Most apps track your exercise against your eating. They encourage the idea of exercise as a way of eliminating calories: "I walked 30 minutes today, now I can eat more!" 

This can be the first step down a very dangerous road. 

- We do not only expend calories when we exercise. We burn calories every moment, with every breath, all day, even when we're asleep. 

- There are so many reasons to get regular physical exercise, for both your physical and mental health. Exercise lowers blood sugar, lowers blood pressure, reduces the risk of heart attack, stroke, and diabetes, combats fatigue, helps regulate mood, boosts metabolism, and more. A life that includes regular physical exercise is a healthier, happier life than one that does not. Weight-loss apps encourage you to think of exercise solely in terms of calories burned.

- Tracking exercise against eating can very quickly lead to feeling that you have to "burn off" everything you eat -- that eating anything without exercising afterwards will lead to weight gain. 

Have you ever excused yourself before eating something by referencing your exercise? As you're about to take your first bite, you say (either out loud or to yourself), "It's OK, I'm going to the gym later today." 

Maybe you say it once as a joke. Or maybe you think it all the time. Maybe you privately believe you don't deserve to eat unless you have exercised. Or that eating food without specifically pairing that food with exercise will cause you to gain weight. This is called exercise bulimia. In this case, the purging associated with bulimia takes the form of exercise.

In the paid level of the app I'm using, you can turn off the "track exercise against eating" function. I've done that... and now the app tells me "Calories Burned: 0".

2. The app tells you "calories left to eat for the day". 

Tracking calories over time is useful and important. I get that. Post weight-loss surgery, it would be very easy to eat a tiny bit more every day or every week, gradually increasing your capacity -- and ultimately preventing or even reversing your weight loss. 

However, basing your food choices on "calories left to eat for the day" could also create a dependence on the calorie counter, rather than learning how to assess your own hunger. Last night I noticed the app told me I had 250 calories left to eat for the day. But I was done eating. I had no interest or desire to eat anything else. 

The previous night, I had minus 300 calories left -- that is, I ate 300 calories too many. I had been genuinely hungry, and ate too fast (my ongoing challenge), not giving my brain enough time to register the food intake. 

In the second example, calorie tracking was very helpful. I can look at the daily total and remind myself to continue trying to eat more slowly. In the first example, tracking would encourage me to eat when I wasn't hungry.

* * * * *

I plan to continue to use SparkPeople, both on my computer and on my phone. But I want to stay aware of these pitfalls. I'm hoping awareness, plus my own discipline, is enough to keep me from falling into them. 

But honestly, I'm a bit nervous about it. My January 1 weigh-in is coming, and thinking about stepping on the scale, I'm already getting anxious. I'm not freaking out or anything close, but this is nagging in the back of my mind. 

I've Tried It All... And I Don't Want To Go Back There (Eating Disorders Are More Common Than You Might Think)

When it comes to my weight (size, body image, etc.), I've been there and back. More than once. I gained a lot of weight in my mid-20s, and used one of the many popular diets of the day to lose it quickly. This was the first, and as it would turn out, only time in my life I was actually thin.

As the weight came creeping back, as it inevitably does, I started dieting. And dieting and dieting. I became obsessed with what I ate and with weighing myself. It was a horrible way to live.

I was like this at least 10 years, when, coincidentally, I needed to research eating disorders. I was shocked to recognize my own behaviour.

When many people think eating disorder, they imagine an extremely thin person, probably a young woman -- an anorexic. But there's a huge spectrum of eating disorders, covering a wide range of behaviours. Once I became aware, I would see eating-disorder behaviour everywhere. 

For me it took the form of being addicted to weighing myself, addicted to dieting, and obsessed with restricting my eating. I was probably only 10 pounds overweight at the time, but I was obsessed with trying to lose weight.

After recognizing this in my late 30s, I started seeing a therapist who specialized in eating disorders, and I worked hard to free myself of these obsessions. Eventually, I got there.

I stopped dieting. I stopped strictly policing my eating. I even stopped weighing myself. It took a long time, but it was glorious. It was so liberating! I gained some weight, but I was healthier, and happier. 

I also learned that the link between weight and health is greatly exaggerated. Obesity is a health risk, but those 5 or 10 extra pounds that women become obsessed with are not. They're not even extra.

But keeping people insecure and unhappy is an essential part of our consumer culture -- and the diet industry thrives on it.

So I stopped dieting, started enjoying my life -- and food -- more. I was maintaining a weight that was heavier than most people want to be, but I was healthy and felt good.

Now I've gained quite a bit more than is healthy. But I don't want the demands of bariatric surgery to undo all my hard work and my hard-earned freedom from these obsessions.

I'm afraid the surgery will be a giant trigger that sends me back to weight prison. Pre- and post-surgery, you're supposed to track your eating. And post-surgery, you need to track your weight loss.

How am I going to do that and stay sane?

I'm thinking a lot about this. I want to make it work.