realCdn-great article.I really wish people would believe this more and make the lifestyle change and not go under the knife.Seriously, I have seen so many complications.I have never seen complications from a lifestyle change.
I don't think that obesity is always a compulsive disorder, but there are some very pertinent parallels between weight loss struggles and those of alcoholism, substance use, sex addiction, and other compulsive self-harming behaviors like compulsive shopping, gambling, and in extreme cases even OCD.
Treatments for each are often very similar, with similar success rates. However, medical insurance is most likely to cover treatment for alcohol or substance abuse, but less often for other compulsive disorders (especially those without a direct link to physical health problems. Compulsive shopping affects your pocket book, not necessarily your physical healthy). If it takes the form of illegal behavior (like shoplifting) insurance may cover it, IF it constitutes a mental health diagnosis.
In the past, some obese patients were given psych diagnoses in order FOR insurance to pay for treatment. When I was working in law-enforcement, in the 90's I found an in-patient obesity clinic that my insurance "might" have covered, but it would have required a diagnosis of severe clinical depression, personality disorder, or bi-polar disorder (effectively ending my career). The program was known for "finding" a disorder that would be covered by patients' insurances, but in most states it would prevent patients from ever owning a firearm, or being employed in law enforcement and some other fields. Basically, I had to admit (or pretend) that I was "crazy," and give up my career - and I seriously considered it.
I think that treatment options need to be explored. I realize that insurances can't afford to insure "everything," but the research dollars do exist in the weight loss field - right now though most of the weight loss research money is spent on wls and on dietary programs, not behavioral change plans.
It's difficult to study multi-faceted approaches BECAUSE of non-compliance and drop-out rates. Exercise may be part of the program studied, but subjects may lie about whether they're participating as directed. Measuring compliance can be difficult. With alcohol and substance abuse there are blood and urine tests that can detect non-compliance, but there's no blood test that will detect whether you're following a diet and exercise regimen.
I think there are signs that things are changing. Obesity is such a wide-spread problem that it is drawing attention of the medical and scientific community. I think our local areas weight management clinic is a sign of that. Even though insurance doesn't cover their program, it is able to support itself, people are willing to pay out-of-pocket. I also think they have a great multi-faceted approach. Monthly counseling with the doctor and the dietitian co-heading the program (the doctor heading the program lost nearly 100 lbs herself), there are group counseling sessions, and sessions with a personal trainer/physical therapist, and a discounted YMCA membership is available (the whole program is housed in a center that was co-funded by the hospital and the YMCA so the gym is also an accredited physical therapy center).
I'm saving for the program, because the $2500 for 18 months is pretty affordable in the scheme of things. They have a payment plan, but it's outside our budget.
It isn't that I think I can't lose weight without their program, but it does include everything that I would include in a program, if I were designing one.
If my insurance covered part of the cost, I would be be on board in a heartbeat.
For me, the only way to lose weight and keep it off was literally step off the cultural path. No more fast food, no more "easy cook" meals from the grocery store, no more hitting vending machines. No more giant sodas, great big coffees, no more giant pastries with my coffee, giving up huge plates of food at restaurants. Every now and then, I get whiny about this. I want the easy, yummy, tasty, fast life that other people get to enjoy. Other times, I'm proud of my determination to get off that bus and be healthy.
Yeah, because with the easy, yummy, tasty, fast-food life that everyone else is enjoying come the big jeans with the elastic waist....the huge, shapeless tops with sofa-upholstery print (or kittens and sparkles). The chunky, swollen joints, the bad feelings ......yeah, I'll pass. I still do eat some fast food, I'll admit it, but NOTHING like I used to. Not the same quantity and definitely not the same frequency. Wendy's is a 1 time every 8-10 weeks now, not a weekly (or more) occurance.
I hear a lot of people say "I don't eat all that much, I don't know why I;m overweigh". Heck, I used to say it myself... then I added up a few days on The Daily Plate and discovered go to lunch meals with 1500+ calories, dinners with 2500+ calories, days of 4000-5000 calories.... I had to look back and say "I guess I do eat that much, no wonder."
Shannon, this is so true. And I think that many people who say, "I don't eat that much!" truly believe it. Heck, I believed it when I said it, too! Because "All I had for lunch was a SALAD!". Yeah, but that was a gut-buster from a chain restaurant and had 1200 calories! Or "All I had for breakfast was 2 frozen waffles!" But I had them with a tablespoon of butter and 1/2 cup of syrup; the syrup alone was 450 calories!!!! So I think what they mean (and what I meant when I used to say it) was that I wasn't eating much VOLUME. I didn't feel full, but what I didn't realize was that I wasn't really getting any nutrients--it was all junk, so my body was still hungry. For FOOD!
Megan, wanted to share this with you. It's part of one of our lessons from the Precision Nutrition Lean Eating Program I'm participating in, but it's a habit that many of us could use. I know it hit home for me....
If I could embrace this idea it would definitely help me, Pat. I have gotten rather caught up in the "this is a serving so I will eat a serving" - even if it's a properly portioned serving of vegetables or skinless chicken breast. If I don't eat the whole serving, I'll have an unever number of leftover servings, and all of my even numbers will be thrown off. This is what goes through the mind of an person with tendency towards OCD (not so bad that I've ever been diagnosed, but I definitely have a thing with numbers - need to have even portions of food, and for a long time I could only turn the volume on the TV up in 2 pushes of the button increments, little things like that).
I think this is a good idea, though. I need to remember not only to eat when I'm truly hungry, what is what I usually focus on, but also to stop in time (just as important!). Thanks for the idea.
Quote:
Originally Posted by kaplods
I don't think that obesity is always a compulsive disorder, but there are some very pertinent parallels between weight loss struggles and those of alcoholism, substance use, sex addiction, and other compulsive self-harming behaviors like compulsive shopping, gambling, and in extreme cases even OCD.
I think that's very interesting b/c as I said above, in some ways I behave in an OCD-like fashion. The reason I had to turn the volume on the TV up in 2 push of the button increments was that if I sat there and the volume had only been pushed once, it would bother me. Long after the volume display disappeared from the screen. I knew it was "wrong". In a very similar way if there is cake or cookies in the kitchen it just bothers me. I absolutely do not forget about them until they're gone, which usually means I've eaten them all. Now I'm wondering if this is something that many problem eaters like me experience or if it's an OCD-like tendency.
If I could embrace this idea it would definitely help me, Pat. I have gotten rather caught up in the "this is a serving so I will eat a serving" - even if it's a properly portioned serving of vegetables or skinless chicken breast. If I don't eat the whole serving, I'll have an unever number of leftover servings, and all of my even numbers will be thrown off. This is what goes through the mind of an person with tendency towards OCD (not so bad that I've ever been diagnosed, but I definitely have a thing with numbers - need to have even portions of food, and for a long time I could only turn the volume on the TV up in 2 pushes of the button increments, little things like that).
I think this is a good idea, though. I need to remember not only to eat when I'm truly hungry, what is what I usually focus on, but also to stop in time (just as important!). Thanks for the idea.
Much as I hate to say it, and it goes against everything we've been taught from childhood - it is okay to throw food away! Really. I was always guilty of saving evey little bit of leftovers, letting them become science experiments in the fridge, and then throwing them away. Now I skip the middle step! It's liberating. I never know how much my DH will eat - some days a lot, others not so much, so we frequently have leftovers. If it's not enough for a lunch - which can be several small bits combined - out it goes.
And another thought, how about just making your portions smaller? You can do it by increments so you're not shocked by small servings all at once. ANd two other things that help me: using smaller plates (we usually have luncheon size unless there's something "large" on the menu, like corn on the cob); and serving the plates at the stove, not putting the food on the table. This makes seconds less easy. I will put the veggies on the table, but not meat or carbs. And we usually have a salad as well.
It's a hard animal to get your head around. Yet even though if you're eating the calories you aim for, if you're gaining, or not losing, something's not working. I've been there a long time as well. Now upping my exercise (which is still an effort for me) and eating whole foods pretty exclusively, and less carbs I'm seeing the scale and my clothing size moving down again.
Wow....just looked at your post, and feel like I found someone who is like me. I started with lifestyle changes last year, and took off 25 pounds. Then, this year, I started to really work out and took off another 30, at which point my husband decided he wanted a divorce. Change is so hard. Since then, I've taken off another 70 pounds, for a total weight loss this year of 100 pounds. I still have another 30 to go until I have body lift surgery, and I expect to loose about 10-15 through that. I became morbidly obese only after the birth of my daughter at 40 years of age, a little over 6 years ago. Prior to that, I was at an ideal weight in my 20s and early 30s and a little overweight in my late 30s. I have a thyroid condition which requires constant treatment, and after the death of my parents and brother in quick succession, I entered an emotionally abusive marriage and just blew up. When you're ready to get better, you do. I have just been writing down everything I eat, and trying to eat lean meat, fruits and vegetables and whole grains. I had 5 sessions with a dietician last year. I just learned how to do it. Then, I started walking...it was hard as I was amost 300 pounds. I got up to 3 miles, then I started to run/walk. Then I joined a gym. I'm not burning up the road, but I'm getting a lot of exercise. I hit a plateau this summer where I did not loose any weight for 6 weeks. But I am loosing again, thanks to morning and evening walk/runs. Loosing weight this way is so hard....but once you get momentum, you can really get going! I am afraid to tell people how much I have lost.....I went out with a minister friend for lunch today and she didn't know what to say when I gave her the numbers...and I'm feeling more and more like a sideshow attraction. The cosmetic surgeon I contacted for the body lift has almost no "diet and exercise" loosers of more than 100 pounds. People ask me breathlessly whether I think I can keep it off......and I just want to scream. This is what I am supposed to look like....the really large person I became for 6 years wasn't me. I feel like I have no one to talk to who knows where I've been. What I've done feels natural....there are more people like me out there.....right? I understand that weight loss surgery is a viable alternative....I would have asked for it by now if my lifestyle changes weren't working. And loosing this way is hard. But its not as rare and unheard of as people seem to think. Now, I just want to finish loosing, get rid of the extra skin through surgery and get back to who I was before all the weight gain.
Wow, what a wonderful story of overcoming your weight in the face of so many obstacles! I sure hope you'll stay around! You'll find lots of folks here know exactly what its like...
In relation to insurance, my husband's company has instituted a program where if the employee and spouse have a company physical and biometric analysis, they will reduce the amount we have to pay for our medical insurance by about $300 / year. They do counsel you at the end based on your risk factors, but don't penalize you if you are overweight, high bp, etc. They also have as a part of this program, we can earn $ to be put in a HCRA account if we do a number of "get healthy" programs, e.g. attend classes on stress management, get a yearly physical, quit smoking classes, manage diabetes classes, attend x number of (documented) sessions at a gym, etc. So at least they have made the connection if they help their employees learn to live healthier, their insurance costs may go down. (they do have a free gym for employees and families, but we live too far away -20 miles - to make it convenient for us - so I belong to a more local gym)
Really. I was always guilty of saving evey little bit of leftovers, letting them become science experiments in the fridge, and then throwing them away. Now I skip the middle step! It's liberating. I never know how much my DH will eat - some days a lot, others not so much, so we frequently have leftovers. If it's not enough for a lunch - which can be several small bits combined - out it goes. 
I sure hope you'll stay around! You'll find lots of folks here know exactly what its like...
