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. 

Getting Perspective and Finding Balance... with a Lot of Support

I had a tough week, wrestling with my old eating-disorder demons, but I am feeling much better! 

Friends and readers of this blog: you helped me tremendously, through your comments, emails, and texts, plus I had an excellent talk with WRD. 

I'm grateful that my writing lets me reach out to people, because I don't think I would have talked about it otherwise. A big Thank You! to you all.

* * * *

When you are involved in an eating disorder, your focus becomes very small. How many calories have I eaten, what does the scale say, how many minutes did I exercise, how many calories did I burn. How many hours can I go without eating. Can I eat less than I did yesterday. I think this is true for any addiction. The world becomes boiled down to your obsession.

Using the food-tracking app contributes to this addictive thinking, too. Food tracking is important, and portion size is important. But the downside is an over-reliance on external counts, when your goal should be mindful or conscious eating. 

While I was thinking this way, I purchased a kitchen scale. Dietitians don't recommend this; they prefer using visual cues, like those pictured here. But for many foods, those are not working for me. A medium-sized apple or a small banana -- fine. But I want to see what three ounces of salmon looks like, how many grams of ground bison I'm using per meatball, how much one chicken thigh weighs. I won't use it forever, but right now it feels like a useful tool. 

I knew this kind of addictive thinking would be a danger; it was my greatest fear about bariatric surgery. That didn't prevent it from happening, but it did minimize the damage. It was one crappy week. In the long run, just a learning experience. I'm sure it will re-surface, and next time I'll be even better prepared . . . I hope.

* * * *

"What did we learn today?"

Mkk reminded me that there have been so many positives in this experience. This may sound silly, but I had lost sight of that. That gave me the idea to write down all the positives.

J suggested printing out the list of positives and reading it aloud three times a day. Another great idea! This helped me slow down my thinking and re-focus. J also reminded me that what I'm doing is hard work, and I should give myself some credit.

M suggested being easier on myself, and continued to cheer me on.

A suggested focusing on my actions rather than thoughts, and not punishing myself for my thoughts. An entirely new perspective for me.

R shared her own experience with obsessive thinking, being "sucked into the spiral," as she called it. She suggested re-framing my urge to weigh myself as normal curiosity, without worrying if I am on a slippery slope.  

Also this: Let yourself be proud of the weight you have lost and also give yourself permission to eat a bit more sometimes. I'm printing this in big, bold letters and pinning it to my bulletin board.

My partner suggested I reach out to WRD, and even though I said, "What's the point, I know exactly what she'll say," I called anyway. And guess what? I didn't know what she would say! Newsflash: trained professionals know more.

* * * *

Here are some things that WRD reminded me of.

• I'm much more physically active now than I was before the surgery. When you're physically active, your body requires more fuel.
• The goal of a forever eating plan is not to hit a calorie limit or range every day. It's to eat healthfully and mindfully. In fact, although I'm using a caloric guideline from the hospital in Mexico, the Canadian bariatric centres don't use a calorie target at all!
• We need different amounts of food on different days. Some days you are going to be hungrier. When that happens, try to make good food choices, and eat slowly and mindfully. And if you don't... forgive yourself and move on.

There's also the mental checklist for when you want to eat.

• Am I truly hungry or perhaps bored or stressed? 
• Have I eaten enough protein today? Enough healthy fat? Both contribute to feelings of satiety.
• Am I well hydrated? If you haven't been drinking enough, you may feel hungry when your body is actually thirsty. This is definitely a pitfall for me! Working at my workplace, rather than home, and wearing a mask all day is also not conducive to adequate drinking.
• What would be a healthy and filling snack to eat right now? I actually keep a list in the kitchen of healthy snacks to bring to work, to avoid coming home overly hungry.

* * * *

Every one of you reminded me to be kind to myself. Thank you.