(I thought this was worth sharing...)
There’s a deep, dark hole in a bag of potato chips - one that seems to have no end for people like Joel Meriwether of Mt. Juliet.
It leads to a maelstrom where shame and isolation spin them back toward the food that keeps them obese and depressed. Nine years after gastric bypass surgery, Meriwether has gained back about 100 pounds of the 300 he lost.
“My issue is not caring enough about myself to have the willpower,” he said.
Scientists have discovered that depression and obesity feed on each other in a cycle that is difficult to break, no matter which comes first. Obese people have a 55 percent increased risk of developing depression, and depressed people have a 58 percent greater likelihood of becoming obese, according to an article published last year in the Archives of General Psychiatry. But obesity researchers do not fully understand the triggers in the mind that cause people to overeat.
“I think in general it’s a missing part of the puzzle,” said Dr. Kevin Niswender of Vanderbilt University.
Few mental health providers have expertise in weight counseling, he said. And drug makers have not been able to fashion a medicine for weight loss without adverse psychological effects, including depression.
Increasingly, the medical community is endorsing weight loss surgery for people with life-threatening levels of body fat and obesity-related diseases. But surgery does not always work. The Roux-en-Y gastric bypass that Meriwether received, which studies have shown results in more weight loss than Lap-Band procedures, has long-term failure rate of more than 20 percent.
SHAME DOESN'T MELT AWAY
Meriwether went into the surgery in 2002 weighing 580 pounds and had lost 275 pounds a year and half later. He kept shedding until he had lost about 300.
But then he started gradually gaining.
“Over time as one goes through one’s life after they have had the surgery, the pouch will just naturally begin to extend,” he said. “It may be that one day you eat a little bit more and you will not realize it.”
Although he underwent counseling before and after his surgery, he still put on weight. Self-image issues are at the root of his problem, he said. Meriwether now weighs 400 pounds.
“There is shame. Shame is an extremely powerful motivator,” he said. “There is fear of change. There’s that fear of changing who you thought you were.”
And there’s the sense of being alone.
“I’ve never really had a full-time romantic relationship,” he said. “It can be very difficult because society seems like it is based on couples rather than singles. It can be very, very difficult. Thank goodness I have a huge circle of very close friends.”
He’s maintaining - not gaining - by closely watching what he eats, avoiding white-flour carbohydrates and limiting his intake of dairy products and sugar. This summer he has kept the weight off by traveling, which forces him to walk more.
But the extra pounds prevent him from strenuous exercise. The 45-year-old man has developed arthritis in his knees.
GROUP OFFERS SUPPORT
Meriwether won’t go to a YMCA to exercise in a pool, where the water would cushion the impact on his knees, because he doesn’t want people to see him in a swimsuit. On Tuesday, he could go without worrying about people staring. That’s when the Green Hills YMCA will start a Restore Ministries program for people with body image issues.
A group of 10 people will go into a room behind a closed door on that day and start meeting every Tuesday for eight weeks.
“We’ve actually had some groups where we’ve had people who struggled with obesity and people who struggled with anorexia,” said Charity Mulhern, a field specialist with Restore Ministries. “What it all boils down to is underneath they look very similar.”
The participants talk about their struggles and give one another encouragement. By the end of the course, those who complete the program are exercising with everyone else.
APPETITE SUPPRESSION TRICKY
Unraveling the circuitry within the brain that causes different people to respond to food in different ways could some day lead to better medicines to treat obesity.
“Those parts of the brain that regulate feeding behaviors and appetite are also important to mood - the same neurochemicals, the same receptors, the same neurotransmitter systems,” Niswender said. “The problem with a lot of the weight loss drugs is they have been causing mood problems: depression.”
But so is the food. Comfort food lulls people into the depression-obesity cycle when they try to eat through problems, worries and insecurities. The same chemical reaction from the food that calms has another effect.
“It’s a vicious cycle,” Niswender said. “Whatever somebody’s stress food might be, we know that insulin and insulin resistance are part of depression. What does a potato do? It invokes profound insulin secretion.”
Meriwether’s problem is more pizza than potatoes.
“One of my downfalls was pizza,” he said. “I used to say pizza was the perfect food group because it had dairy, it had vegetable, it had protein and it had bread. Now, I don’t eat pizza at all because I can’t handle it.”
He plans to have a revision of the surgery from nine years ago, but so far he hasn’t convinced his insurer to cover the cost.
“What I have been told is that the gastric pocket that was created was not as strong as the ones they do now,” Meriwether said. “I was able to gradually add weight after that surgery because the pocket grew. It grew through natural extension like one’s stomach does originally.”
Next time around, he hopes to do a better job of keeping the weight off..
“You’ve got to really be ready for the consequences of having the surgery, psychologically, because if you’re not ready you’re not going to be successful,” Meriwether said. “One needs to combat the entire issue of shame and fear and realize that on the opposite side of that surgery you are going to have to deal with the same issues that you did before the surgery.”
Written by Tom Wilemon
The Tenessean August 18, 2011