Eating Disturbances (carbohydrate craving)

[Guest guest]

I came across this article on www.beyondchange.com -I thought you

might like to read:

Thanks,

Sharon Hagins

ville, FL = Open RNY 05/13/02

Dr. Thoburn Gainesville, Fl

5'9 " 310/170 -140 pounds " Living and Loving Life "

Eating Disturbances

Abnormal eating behavior may contribute significantly to weight gain

before, or weight regain following obesity surgery. As discussed in

last months article, carbohydrate craving is likely to be the most

common eating disorder of the obese, and possibly of society, in

general, with reports of incidence rates as high as 100% among

females seeking weight loss therapy.

There are, in addition to carbohydrate craving, various other

abnormal eating patterns common to the obese that may cause weight

gain or prevent successful weight reduction. These abnormalities

include such behaviors as: 1) eating in response to emotions, both

negative (anger, loneliness, depression, boredom) or positive

(celebrations); 2) eating in response to environmental cues (time of

day, food) rather than to hunger cues; 3) overeating when your

attempts to control your eating behavior are disrupted, such as when

you Œblow your diet'; 4) nibbling while you eat; 5) eating large

amounts of food at night and avoiding breakfast; 6) drinking large

amounts of sodas and other high calorie fluids; 7) not having

restraint over the amount of food eaten and having either an absence

or a loss of satiety (feeling of fullness); 8) desiring, or craving,

high calorie foods; 9) having a susceptibility toward hunger; 10)

eating rapidly; 11) binging with a loss of eating control, and 12)

various others.

Can you identify with any of these eating disorders? The author

certainly can! In fact, the author did not even realize that many of

the eating behaviors described above are Œabnormal' until she

examined such behaviors in obese and lean populations. It was quite a

shock to discover that not everyone eats in response to changes in

their emotions, or craves sweets, or nibbles, or has any one of the

various other eating behaviors described above that are common to the

obese, but not lean, individual.

Among the eating abnormalities common to the obese, Binge Eating

Disorder (BED) has been studied in the greatest detail. Do you have

BED? You may, according to the American Psychiatric Associates, if

you: 1) eat in a given amount of time a larger amount of food than

most people would consume during the same time period; 2) feel a loss

of control over eating during such episodes; 3) suffer from binges

frequently (at least twice a week); and 4) do not purge after you

eat, that is do not vomit, take laxatives, diuretics, or exercise

excessively after the binge. If you binge and then purge, you have a

condition called bulimia nervosa.

According to community studies conducted in the United States, as

well as other Western industrialized nations, approximately 1-5% of

the general population has BED. The prevalence of BED, however, is

far greater among the obese. Studies have shown that approximately 23-

47% of obese individuals treated in weight control programs has BED.

IN our study of more than 550 morbidly obese pre-surgical patients,

76% binged and 41% of the populations had, by definition, BED with

episodes occurring as frequently as 2-3 times per week. Other

investigators have also found BED to be fairly common among their

morbidly obese pre-surgical populations, with prevalence as high as

65% reported.

What causes BED and other eating abnormalities? Little is known, at

this time, what actually causes BED, or the many other less studied

eating abnormalities common to the obese. Such disorders may have a

physiological or genetic bases, and there are a number of studies

showing, primarily in rodents, that defects in certain Œmessengers'

in the brain or in the gut result in eating disturbances.

Eating behavior may also be affected by one's environment. For

instance, there are studies showing that individuals with BED

generally have greater psychological distress (depression, anxiety),

lower self-esteem, and greater interpersonal sensitivity than obese

non-bingers. Furthermore, individuals with BED tend to become obese

at an earlier age than non-bingers, have had more dieting and weight-

cycling episodes, and are more concerned about their body shape and

size.

Can obesity surgery improve or resolve aberrant eating disorders?

There are a few studies that have attempted to answer this question

by examining BED, and certain other eating disturbances, before and

at various time periods after obesity surgery (gastric banding,

gastroplasty, gastric bypass, and biliopancreatic diversion), along

with changes in body weight. For the most part, these studies have

shown that individuals with eating disturbances before surgery

generally lose less weight than do those obese individuals who do not

have pre-existing eating disorders. Furthermore, studies have also

found that following surgery pre-existing eating abnormalities often

reoccur, resulting in weight regain.

If you think you may have BED or other abnormal eating behaviors,

what can you do to assure maximum weight loss after surgery? Prior to

surgery, most obesity surgeons provide questionnaires designed to

identify specific eating abnormalities that may impede maximum weight

loss following surgery. When completing these tests, be very honest

and thorough. If eating behavior questionnaires are not provided,

make certain that you let your surgeon know that you believe you may

have eating disturbances. If your surgeon is aware of such

information, he/she may be able to alter the surgical procedure in

such a manner as to provide for greater restraint or malabsorption

which could help to prevent weight regain should your eating

disturbances persist or return post-surgery.

Some individuals tend to regain a little of their weight around 2 or

3 years following surgery, and studies have shown that this is about

the same time that certain abnormal eating disorders reoccur. If you

find after your surgery that you are losing control over your eating,

craving sweets or other foods, starting to overeat in response to

changes in your mood, or experiencing any other eating disturbances,

immediately inform your surgeon or physician. Your surgeon or

physician may be able to assist you in preventing weight regain by

prescribing certain appetite suppressants or by referring you to a

nutritionist, therapist, or other specialist that can help you to

alter your eating patterns.

We can win our own personal battles over obesity, but such will

require that we become knowledgeable of those factors, including

eating abnormalities, that may cause, or worsen, the disease. It is

our hope that this column and newspaper provide such knowledge to

you.

In the next issue, we will discuss the role that one's mood may have

on weight gain (or regain) and overall health, and we will provide a

summary of the information regarding carbohydrate cravings before and

after surgery which you have so kindly provided.

Buffington, Ph.D., is the Director of Research for The

Obesity Wellness Center

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