FILLING THE VOID
FILLING THE VOID:
Dealing with Emotional Hunger
Atlanta Bariatric Support Group
J. K. Champion MD FACS and Susan Champion
Hunger and eating often have nothing to do with food in patients who have the metabolic disorder called “morbid obesity”. Recognition of the lack of association between “head hunger” and a physical need for nutrition is an important step in developing a successful approach to maximize weight loss after bariatric surgery.
“Head hunger” is a popular term discussed on Internet support groups describing a real entity, which is better classified as “emotional hunger”. Food is comforting and can serve the same purpose as a drug in dealing with our emotions. This action is usually sub-conscious, but becoming aware and recognizing the behavior gives patients the power to change old habits. This process of regaining control over your life is called “behavior modification”, and it is crucial to long-term success after weight loss surgery.
The disease of morbid obesity has slowed the body’s metabolism down to the point that most people need only 1000-1200 calories daily to maintain their weight after bariatric surgery. They don’t have the luxury of eating chocolate when sad, or nervously snacking on junk food when dealing with stress, anger, or boredom. Many patients with morbid obesity are not over-eaters, but are “foragers” or “grazers”, who eat not when they are hungry, but when they are stressed emotionally. This insidious weight gain is usually around 10 pounds per year, which over a decade adds up to being 100 pounds overweight again.
Current bariatric operations (Roux gastric bypass, VBG, or Lap-band) rely on a small gastric pouch to severely limit or restrict food intake to aide in weight reduction. This limitation on food intake can create a large “void” or “hole” in a person’s ability to emotionally handle the trials and tribulations of everyday living if food has been a method of coping with stress. The utilization of food to deal with stress has nothing to do with hunger, but the brain often interprets it as hunger, because it is the only way a person may know to deal with stress. The ability to deal with sadness, anger, frustration, or boredom is called “coping skills”, and it is a learned behavior, not something we are born with like brown eyes or blond hair.
There are three changes in your life, which need to occur after bariatric surgery in order to realize the full benefit of the operation and maintain weight loss long term.
One: CHANGE YOUR EATING PATTERN:
(3 meals per day and 1 snack on a set schedule 4-5 hours apart)
The principal pattern for eating before surgery is people eat whenever they are hungry or believe they are hungry. This may be 6, 8, or 10 times per day of small amounts of high calorie junk food (carbohydrates or fats). Eating is often not related to a physical need for food, but rather in response to a mental or emotional craving for the act of eating and the comforting effect it produces. In other words, we use it to make us feel better mentally. This is emotional hunger. Ask yourself; “Am I eating this because I’m hungry, or because I’m angry, sad, or bored?”
The gastric pouch must be filled with a small amount (8-12oz) of fibrous bulky food every 4-5 hours, and remain in the pouch for at least 30 minutes to relieve physical hunger and control appetite. This means eating on a set schedule, by the clock !! It does not mean eating whenever you think about or obsess about food. It does not mean skipping meals or making excuses. It does not mean drinking fluids with meals to wash the pouch out. It does mean following directions and changing a behavior, which endangers your health and shortens your life expectancy.
TWO: CHANGE YOUR ACTIVITY PATTERN:
(exercise 5 days per week for 30 minutes)
This is a major compliance issue for post op patients. Exercise improves your energy level, releases endorphins, which reduces stress and improves your mood, it builds muscle mass, which burns more calories and tightens loose skin, and it resets your body’s metabolic rate to a higher level to drive weight loss. This requires action on a patient’s part, to set aside time to exercise and to repeat it enough to make it a habit.
THREE: CHANGE THE WAY YOU DEAL WITH STRESS
(develop coping skills to deal with stress thru outside advice)
If we could change on our own, we would! All people have stress and frustration in their lives, as it is a part of daily living. In addition, change brings on stress, so post op there are many bridges to cross in regards to food, exercise, work, and personal relationships. Many people do a poor job dealing with stress and may turn to food, which is comforting and makes us feel good. Unfortunately for morbid obese patients, food has become self destructive, and cannot be used to deal with emotional hunger. Individual or group counseling can provide insight into ways to deal with stress in a healthy fashion. Outside advice is like a mirror held up in front of us so we can see our faults and ways to change. Suggestions to deal with stress constructively may include developing new hobbies or activities, or the development of new relationships. Attendance at support groups, asking questions, talking to others and sharing your own experiences helps not only yourself, but also others present in developing a new approach to life. Remember you don’t have to accept all outside advice, just be open to look and see if it fits your situation and can it help. Instead of trying to compare and see how you’re different, look for ways how you are like others and can use their experience to grow.
The overall theme of change is activity. Success depends on action on the part of the post op patient. Relying on the bariatric operation to “do all the work” without changing eating habits, exercise levels, or ability to manage adversity, will result in failure long term. Emotional hunger will create a void, which will demand to be filled.
Will you fill the void with calories or action?