ORBERA BALLOON and Eating for comfort, vs true hunger

[Rafterman]

Hey group
My wife has been fighting a weight battle since she was a teenager. She has tried every diet and sincerely put all her effort in to each one. She exercised religiously for years, but now it is dangerous for her to even do that. She was seeking to have an "ORBERA" balloon installed into her stomach. That's the latest of a line of devices that take up space in your stomach. The theory being that you will have less room for food and, thus, be less hungry. Sadly, while such a balloon will make one feel less hungry...it will not necessarily stop them from eating amounts similar to before they had their installation. That is because the majority of morbidly obese people have hunger that stems from psychological reasons. They are not truly hungry, as someone would be if they were at a caloric deficit at the moment. They eat for comfort. During the formative years, many children make an association between food and happiness and it stays with them on until adulthood. If my wife is stressed about something, just the smell of food works on her like a sedative would. It's really remarkable to observe. The smell of food does absolutely nothing for me. I am always analyzing her (and myself, and the world) and she, like many who came from a poor family, remembers the best moments of her life centering around eating. Her family getting together at the table. The sight's and smells and visceral satisfaction that she gained from those experiences, etc. Under stress now, as an adult, her mind calls out to her to reenact those moments, in order to gain a form of escape from her current worries. All this to say that people who eat for comfort will generally not do well with a balloon device, stomach stapling surgery, or anything that lessens the size of the stomach. The problem is not in their stomach, it is in their mind. I beg anyone who is considering this surgery to first have a psychiatric evaluation that seeks to discover the root of your weight problem. Not ever overweight person eats for comfort. You may be one of the lucky one's for whom a balloon device would work (if absolutely all other measures have been exhausted). Peace. 

[Linville]

Two good post talking about the OP's Rafterman, original topic.

In various ways . Oh isnt the body so much more complicated that just math, caleries in burn more and you are loosing weight.
only if it was that easy.
I thought both Audrey's and FirePlace's were good thoughts on what you have thrown out for discussion Rafterman.
What are you thoughts further?

I know my body has a high metabolism and burn rate higher than others.
I am active and move around .
The aspect Fire mentioned that one can crave more food even after just stepping away from the table is true IMO too.
Sometimes after  eating something sweet I will then want something salty crunchy and it can get into a crazy cycle.

But sometimes people also get overweight because it takes good money to buy healthy food.
I have marveled at the people going in and out of the cheaper stores buying cheap food that only encourages unhealthy eating.

Because they do not have the money it takes to buy healthy, ugh.

on the other hand Trader Joe's or a number of the health food store that have become mainstream are more expensive so this becomes another reason some people with a certain metabolism has trouble.

But Rafterman getting these other ideas and thoughts could be very valuable for you to use as something else in the tool box so to speak of trying to help another overcome the overweight issues.

Not that what you mentioned can and does happen but there are so many different angles it is good to get them too.

Good topic.
It will be interesting to see more thoughts on it.

[Rafterman]

Two good post talking about the OP's Rafterman, original topic.

In various ways . Oh isnt the body so much more complicated that just math, caleries in burn more and you are loosing weight.
only if it was that easy.
I thought both Audrey's and FirePlace's were good thoughts on what you have thrown out for discussion Rafterman.
What are you thoughts further?

I know my body has a high metabolism and burn rate higher than others.
I am active and move around .
The aspect Fire mentioned that one can crave more food even after just stepping away from the table is true IMO too.
Sometimes after  eating something sweet I will then want something salty crunchy and it can get into a crazy cycle.

But sometimes people also get overweight because it takes good money to buy healthy food.
I have marveled at the people going in and out of the cheaper stores buying cheap food that only encourages unhealthy eating.

Because they do not have the money it takes to buy healthy, ugh.

on the other hand Trader Joe's or a number of the health food store that have become mainstream are more expensive so this becomes another reason some people with a certain metabolism has trouble.

But Rafterman getting these other ideas and thoughts could be very valuable for you to use as something else in the tool box so to speak of trying to help another overcome the overweight issues.

Not that what you mentioned can and does happen but there are so many different angles it is good to get them too.

Good topic.
It will be interesting to see more thoughts on it.

Thank you, Linville! As always, I sincerely appreciate and value your comments. I agree with everything that you said. My intention when starting any new thread is simply to open the door to discussion. It is never to attempt to present a comprehensive and exhaustive examination of the subject matter at hand. To try to do that would be fruitless. It would be like an auto mechanic trying to tell what he knows about car repair in a couple of paragraph's. My head is crammed full of experience's gained during a three decade career as a licensed psychotherapist in a very busy practice.

The potential danger of beginning a thread in that fashion is that some may confuse my opening post as everything that I have to say on the matter. I only lightly touched on my wife's experience's with her eating disorder and what she is going through while seeking bariatric surgery. I told only a small percentage of the story, leaving some to question why she can't exercise, etc. I will fully address that later in this post.

The point of the thread was to draw attention to the fact that many people who are thinking of undergoing bariatric surgery do not get the proper physical and psychiatric evaluation beforehand, do not understand that excessive hunger is sometimes due to psychological reason's that may be able to be unearthed and resolved, and that the appliances that they are seeking often fail because a person who is eating for comfort will keep right on eating (more on that in a minute).

I would want everyone considering this surgery to first fully explore every other possible potential reason for their failure to maintain the proper weight. From thyroid issue's, to caloric intake, to other issues of metabolism, and so on. Our practice was sent patient's for psychiatric evaluation ("PE's") by bariatric surgeon's, gastroenterologist's and even a few GP's. I handled dozens of these evaluation's myself over the course of my career. I then followed the cases to there outcome. This is why I can can speak from first hand experience on this matter. There is a lot of misinformation out there. I have never dealt with a case involving the Orbera appliance, but I have been involved in multiple cases where gastric banding, sleeve gastrectomy, or duodenal switch w/bd was employed. I have extensive and detailed records of the results (at 1 month, 6 months, 1 year, 3 years) on a case by case basis. It was required by law that we keep such records.  Simply put, I am attempting to raise awareness to these issues because my goal is to keep someone from jumping into such a surgery without having all of the facts.

It is assumed by many that having one of these appliance's installed will render an individual incapable of eating food past a certain volume. This is not the case. A person with such an appliance most certainly can swallow and retain food (albeit temporarily) and then will typically vomit thereafter. The installation of the appliance into a person who refuses to limit their intake essentially turns that person into an unwilling "purger". This can lead to esophageal erosion, and even esophageal cancer, over time.

Suffice it to say, there is much more to consider than one may realize before having one of these procedure's performed. Some in the medical community push them because they are hugely profitable. A former client that lives near us had her Orbera  appliance installed in less than 20 minutes, at a cost of nearly $12,000. I hate to appear cynical, but when the doctor advising you on whether or not you should have a procedure, is the same doctor who will clean up financially should you go through with said procedure, a conflict of interest is created. And not all psychiatric evaluation's are created equal! These surgeon's and GE's work hand in hand with the same psychiatric group's. I am not saying that a counselor will green-light a grossly unqualified would-be patient for bariatric surgery, but I have seen many be approved who should not have been. Some subsequently got their installation's, continued to overeat and vomit, had their appliance removed and were left in worse shape  (emotionally,physically and financially) than before they had the surgery.

Please indulge me a bit longer, as I flesh out my wife's case a bit. I am doing this to avoid any confusion over such matter's as her inability to exercise, her other health issue's, and other thing's that I did not mention in my original post. I was questioned about these things by another member, who also faulted me for analyzing my wife and presumed to tell me what my wife "really needs to hear from me". The remaining paragraph's should explain why I am giving her the advice that I am.

I pointed out in my original post that I analyze her, myself, and everyone. It's not just a hobby, as it would be if I were a layperson. I am a recently retired medical professional. Analysis is what I do. If I was a lawyer, would my wife not welcome my legal advice? My wife enthusiastically encourages me to continue to advise her on matter's of the psyche. In this case, the advice is particularly apropos because of my background in this matter. When I think of the word "analysis", I associate it with hope and healing. It's a good thing. Her and I have kept each other going through 39 years of marriage, and much of it has been through the good advice that we perpetually offer to each other.

With regard to my wife's inability to exercise: She has been instructed by both of her cardiologist's not to attempt any exercise at all, as she is a candidate for aortic-valve replacement surgery. (Both of these doctor's also advised against bariatric surgery for her, even before she had become pre-op with her heart). She damaged her heart through her use of Fen-Phen back in the 90's (something that I strenuously  discouraged). She doesn't want to have the heart surgery and think's that an Orbera installation will be the answer to all of her problems.

She is a compulsive eater, and those are the people who have the highest failure rate with these appliances. Her sister had Lap-Band done in late 2013. She went home and continued to over eat, vomiting several times each day. She subsequently required a second surgery to remove the band. She followed up with a gastroenterologist, and when scoped she was found to have three large ulcers of the lower esophagus. These were consistent with the damage done by someone who continually vomit's. She was blessed, as they are almost healed as of today. She was not so lucky with her front teeth. They suffered acid erosion to the point that she had two of them replaced with implants. Yet, she "passed" her psych eval and was found to be a suitable candidate for the surgery. She was not a good candidate. She had a long history of binging and purging, as does my wife. The only thing that the Lap-Band did was let her continue binging, while it did the purging for her.

Her sister looked at the band as a quick fix, and never pursued any counseling for her eating disorder. I am not saying that all people can be helped by counseling for an eating disorder, but I believe that one should attend such counseling before even considering one of those appliances. A psychiatric evaluation, even if done well, does not substitute for counseling. My wife is resistant to the proposition of such counseling, as she considers emotional problems to be a sign of weakness. She is a hard-nosed RN of over 30 years and is tough as nails. She needs to realize that she may be helped by a counselor who specializes in eating disorders. I have seen miracles happen through cognitive therapy. There might not be a miracle waiting for her, but she should at least give it a chance. It is ultimately her decision and she will have my full support in whatever she decides. This does not mean that I will remain silent in advising her at this time. That would be immoral, given the pertinent information that I possess. I would seek her advice if I had an injury to my physical body, and would fault her if she did not give it to me.

Thanks for reading this through. I am enjoying the discussion and will jump back in from time to time. I believe in maintaining all the thread's that I start. Nothing worse than a thread that is abandoned by it's originator. Thanks again, Linville, and I hope that you have a fine day!       Rafterman

[Linville]

Rafterman, may I ask you what type of work you do? Or did do? ( retired medical professional of what discipline )

I might have missed it, if so sorry.

It is early and I got thru most of your post but not all just now.

Are you a doctor, psychologist etc. ? counselor maybe. before retiring.

I guess you do know that it is hard to hear such heavy life advice from someone so close , "usually ".

Although I may have missed some but it kind of sounds like she did not want to do what you advised, it that it ?

She is an RN of 30 years then she will have certain knowledge as well pertinent to her situation, how do you receive hers?
Or has she said?

So many unknown factors in this as you say.

But ur bottom line is that getting optional surgery needs to be well one needs to have done their due diligence ? Right.

anyway....just rambling

[invisiblejungle]

I used to work with a girl who had gastric bypass surgery. If someone took such a serious measure to lose weight, you would think that they would commit to it with lifestyle changes, etc.

She would actually come to work everyday with a big bag of Doritos and eat one every 5-10 minutes. I saw a picture of her a few years later, and she hadn't lose any weight.

[Linville]

I know a guy that had the reducing the size of the stomach via surgery.
I just know of him was not really friends with him but I did talk upon occasion.

He lost weight and then had hanging skin and had to have surgery to correct that.

So it can work.

Sometimes people struggle so much with weight. I know it. And to others it seems like no biggie just stop eating so much, but really I realize it is not that simple.

I am glad I have never had to deal with it.

We all seem to have something though, so .....

[invisiblejungle]

Is it possible she had the surgery reversed and gained the weight back?

Frankly, If we are talking ethics, I don't feel comfortable judging/"analyzing" people that aren't here to defend themselves, or to give facts and insight about choices they made.

I see your point regarding the ethical considerations of discussing people who aren't here. I was simply relaying the only personal experience I have with this area. I guess it did come across as a bit "judgy."

[Rafterman]

Thank you for providing details to your original post.
My response was not meant to be condemning; I was simply posting my opinion and experiences based on the limited information you shared.  I wish your wife lots of luck.

Thanks, Audrey
You are right about the limited info that I provided in the opening post. I should have told more about the situation with my wife right from the get-go. Perhaps I also should have included the experience's of her sister. I honestly wasn't certain that anyone would have interest in the thread, and I figured that I would add details as it moved along (if anyone took and interest and wanted to hear). I tend to be very well longwinded and I am often tended to start thread's with huge opening statement's. I worry about boring people and about long post's turning them away. In this case, I should have gone for a more comprehensive post right off the bat. I appreciate your concern for my wife and you taking the time to try to help her. Thanks a lot for your comments.   RM

---

Rafterman, may I ask you what type of work you do? Or did do? ( retired medical professional of what discipline )

I might have missed it, if so sorry.

It is early and I got thru most of your post but not all just now.

Are you a doctor, psychologist etc. ? counselor maybe. before retiring.

I guess you do know that it is hard to hear such heavy life advice from someone so close , "usually ".

Although I may have missed some but it kind of sounds like she did not want to do what you advised, it that it ?

She is an RN of 30 years then she will have certain knowledge as well pertinent to her situation, how do you receive hers?
Or has she said?

So many unknown factors in this as you say.

But ur bottom line is that getting optional surgery needs to be well one needs to have done their due diligence ? Right.

anyway....just rambling

Hey Linville,
I retired recently from a career as a licensed psychotherapist. I hold a master's in clinical psych. Every state is different in what you can do in that field with a master's. All I ever wanted to do was see client's and be solely responsible for their care. I didn't want to be "under" anyone. With the exception of the fact that our office did use prescribing doctor's to script for controlled substances, I was given free reign in the treatment of my client's. No one oversaw what I did and I could prescribe for anything unscheduled. For example, before August 2014, I would script from TRAM fairly regularly. (Off label, as an AD. IMO, it's far quicker in reaching people who are truly in crisis). I gave it all up when diagnosed with motor-neuron disease 11 months ago. Being able to post on here definitely gives me a sense of purpose. I have never been a member of a forum that had so many gracious, caring, non-judgmental and knowledgeable people. It's like a dream. I am able to continue to learn things and also to share what I know.

Oh, the reason that I always say that I was a "medical professional" is that my job had much to do with pharmacology and psychopharmacology, and we treated the body as well as the mind. An advanced clinical psychology degree brings with it a huge amount of actual medical training. After my undergrad degree, I spend countless semester credit hours attending nursing classes and working in hospitals. At one point, I ended up assisting MD's with prostate biopsies! (I was like "what exactly does this have to do with psychology?" lol ) It was crazy.

While completing my master's, I also worked as a "psychiatric aid" in the biggest psychiatric hospital in my state. My job was essentially to examine patient's, help them dress, etc. It was more like working as a medic. They want to give you a "baptism by fire" by making all potential future psychotherapist's prove that they can handle any situation because the job is not for the feint of heart.

My wife has seen a lot of action, too. She has worked in just about every capacity that a nurse can work. We have traded off advice for the entire time we have been married. I welcome any advice that she has for me. She just went back to school to complete her MSN, and is becoming a Nurse Practitioner. Pretty bold move after 30 years as an RN. RN's are a tight bunch and after that many years in the business, they usually stay put. I want her to be whatever she wants to be and to be fulfilled. I couldn't live one minute without her.

Yes, I just want her to complete her due diligence before jumping into the surgery....as she would want me to complete mine if I sought to have elective surgery. We respect each other's opinions. It's all good.

Thanks for asking! If I am nothing at all, I am longwinded. Sorry about that! Take care for now, my friend.  RM  

[Linville]

Thank you Rafterman for the detailed answer.

Good luck to you .

I suppose that ur recent diagnosis has given you a desire to participate in a forum such as this, so do not be afraid of being long winded, that is okay.

Did you say that you retired before the diagnosis or just after it?

Did that cause you to want to retire?

With your knowledge you could help so many others that are in need.
Gently advising or suggesting.

Anyway just thinking on paper so to speak.

Again good luck, Rafterman and thank you for engaging in conversation and understanding especially,
ALL the Pioneers have good intentions in mind for members.

You might be surprised members enjoying discussions going very deep here.

remaining civil is critical as you know even if you think another is not,  that can only lead to bad .

Enough rambling......have a good day.

[Popster]

Nice thread Rafterman....and nice posts.

It is indeed a difficult and complex subject, and one well worth discussing.

None of us knows it all when it comes to either food or psychological motivations.