You Want Me To Eat What Now?

The road to being approved by your insurance company (and your surgeon) for weight loss surgery has a lot of components.  For my husband and I, first, we had to lose 10% of our body weight over the course of 6 months prior to surgery, documented monthly in your primary care physician's office.  At the time I remember thinking, "Dude, if I could lose weight on my own, I wouldn't need the surgery!"  But we went on a crazy low calorie diet (like 500 calories a day crazy low) and made it happen.  

In addition, we had to undergo a psychological exam and get a letter of approval from the psychologist basically stating that we weren't nuts.  I guess we both fooled him.  lol  It was an odd process.  We had to take a quiz and then spend an hour in discussion about the weight loss journey, familial support, etc.  The quiz was a really weird assortment of true/false questions.  I asked the psychologist about it, and they essentially use it to weed out people who lie (by making things seem overly good, or overly bad).

We also had to see a nutritionist/dietitian.  It was a little over an hour of this woman telling us what a normal and balanced diet looks like.  We each paid nearly $200 for her to tell us how we should have been eating all along to not be obese in the first place.  What she did *not* tell us was what we needed to eat after surgery.  I mean, I guess it's fine and dandy to have the information, but literally in a few weeks time, it would be meaningless.  What is the point in telling me that I need 46 grams of protein per day, if my surgeon is going to immediately rebuke that as being too much?

Which is exactly what he did.  He asked if I thought I was prepared for eating post-op and I said I was confused because the amount of food the nutritionist told us we needed to eat seemed like too much.  Then he yelled at me for not realizing I needed to follow his post-op diet in the workbook he gave me.  The post-op diet is very specific for the first couple of months after surgery (pretty much so you won't blow your stitches, explode your stomach, and die).  However, there wasn't a whole lot of guidance for what to do with the rest of my life after the surgical recovery was over.  And the nutritionist I had just seen made that more convoluted for me rather than less so.

So, my husband and I have muddled through for the last 4+ years.  For the most part, the restriction in the quantity of food we can eat has continued to keep our weights in check.  But it never was really because we had moved on to a phase of our lives where we were necessarily eating the "right" things.  The year I spent at home binging on chips and gaining weight was a testament to that.  Because although we cannot consume a large quantity of food at one time, snacking every hour is absolutely possible particularly with "slider foods" like chips that process quickly and (in general) don't fill you up (like protein would).

So, here I am 4.5 years after having gastric sleeve, back to maintaining the 100-pound weight loss, still not really sure what I should be eating.  Add in the layer that in the last year or so I have been diagnosed with binge eating disorder, and this gets pretty messy.  Working with my therapist is helping me with getting to the core issues of why I am binging in the first place, but it doesn't really address the dietary piece of the puzzle, which is why she recommended that I see a dietitian to get me on a better eating plan.

I have been maintaining a keto lifestyle for most of this year and thought I had finally found an eating plan I could stick with.  I am definitely addicted to carbs and they are 100% my favorite binge foods if I had to choose.  So, mostly eliminating sugar and carbs from my diet helps me two-fold.  Not only did I lose the weight I gained in 2017 and have been maintaining that, but I also don't really even have any of my favorite sugary binge foods on hand when I get overwhelmed.  Of course, I was still binging on other things, just things within the keto-friendly world.

You can imagine my disappointment when I visited my endocrinologist earlier this week and learned that 8 months of keto increased my cholesterol by 36 from just below the high limit of within range, to the high cholesterol range.  My doctor asked me if I had been doing the keto diet (she knew!).  She prescribed me a statin drug to take and advised me to change my diet.  So, I asked if I should continue doing low carb since it has been a good thing for my progress with my eating disorder, maintaining the weight loss, and keeping my hyperinsulinemia in check.  "Yes, you should continue doing low carb, and do low fat as well."  Really the only staying power with the fact that I gave up sugar and carbs was that I could still have cheese and bacon.

I decided that I should probably consult a dietitian after all, because information about food and what you should be eating is really confusing (all things considered).  I looked in the online directory for my insurance company to see if there were any covered providers and there was a list of 18 (2 of which were not even in Tennessee - West Memphis and Southaven).  The first group of 6 or so were all at the office of the same dietitian I had seen prior to my weight loss surgery.  "Great!" I thought.  I figured they would be the most qualified since they had already seen me and they consult with bariatric patients regularly.  

Apparently not.  They told me they couldn't treat someone with binge eating disorder and gave me the number to the local in-patient facility for eating disorders.  WTF.  I don't need to be hospitalized, or my therapist would have recommended that.  And so I proceeded calling down the list of providers, only to find that they either worked within a hospital and only treated patients of the hospital, or they worked in an endocrinologist's office and only treated patients of the doctor at that office, or they worked in a diabetes treatment program and only treated patients who were in the (year-long) program.  There was one (1!) dietitian covered by my insurance who was even willing to make an appointment with me.

I will concede that there are a lot of dietitians in Memphis that are not covered by my insurance plan.  The group that was recommended by my therapist does not even bill to insurance, you can just try to be reimbursed after the fact.  It is $185 for the initial visit (1 hour and 15 minutes), $95 for each follow up visit (45 minutes).  Alternatively, you can sign up for a basic coaching package including 4 visits for $425, or a solid nutrition coaching package including 7 visits for $650.


And the powers that be wonder why this country has a problem with obesity.  


Seeing a dietitian isn't even covered by a lot of insurance companies.  And the ones that are all seem to be affiliated with diabetes treatment in some way.  Here's a novel idea... perhaps if we had access to see a dietitian for coaching BEFORE we are diagnosed with diabetes, it may actually save everyone a lot of time and money in the long run (and lives).  I managed to get my appointment set up.  But I know that there are a lot of people who would not have access to this via insurance in the first place, and definitely wouldn't be able to afford to pay for something like that out of pocket.

But, Mary, you can find all of this information online or in a book anyhow.  It isn't like you have to see a professional to tell you how to eat!

Sure.  Right.  I spent the better portion of this week researching what I needed to be eating that is both low carb and low fat.  You know what I found?  That "food experts" argue over whether you should eat fat or not, and which fats are bad vs. good.  Some say to avoid all fats.  Some say just healthy fats (then define that however they see fit).  Some say avoid saturated fats only, or trans fats only, etc.  That's just fats.  Let's not even try to talk about whether the cholesterol in an egg is good or bad or if it matters at all.  The only conclusion I arrived at was going vegan and eating uncooked organic fruits and veggies for the rest of my life - but not any that are high in carbs!  Doing something like that is absolutely not sustainable for me.

I apologize that this turned into kind of a rant.  I'm mad because I can't do keto (when doing it seemed like the only thing that has ever really worked for me).  I'm frustrated with everything I have gone through this week to get the appointment with the dietitian.  I'm pissed off that I am probably going to have to eliminate cheese and bacon.

Honestly, I'm mostly upset about the cheese.


TL/DR: The healthcare system sucks.  Not eating sugar sucks.  Not eating cheese sucks the most.

Turquoise And Elephants

'Who are you?' said the Caterpillar.

Alice replied, rather shyly, 'I — I hardly know, sir, just at present.'

That's where I am at today.  Mid-life crisis?  Existential crisis?  All of the above?  

Two weeks ago I went to see my therapist and we talked a lot about my recent struggles with my eating disorder.  Specifically, I've been eating a bunch of crap I don't need to eat every time my husband is out of the house.  He's been going to more music shows recently, and so I've been left to my own devices in the evenings more often than usual.  I take advantage and binge on food while he's gone and I'm "unsupervised".  

At first, I spoke about it almost as if I was acting out like a child.  Nobody is here to see what I'm eating, so I'm going to eat all of the things that I'm not supposed to have.  There will be no judgment from anyone, because there's nobody home to judge.  The thing is, he doesn't judge what I eat anyhow.

But in talking more about it with my therapist, and thinking more about it on my own, it wasn't really about me taking advantage of being left alone to eat what I wanted.  It was more so some level of anxiety of being by myself.  One could immediately assume I mean that I'm anxious about being without my husband (for whatever reason), but I arrived at the conclusion that it was specifically about me being alone with myself.

Binge eaters eat to numb whatever uncomfortable feelings they are experiencing.  Identifying what is uncomfortable is one of the first steps to not binging anymore.  It could be for a lot of different reasons (or feelings) and it isn't always the same reason over and over.  In the past, I have binged for a lot of feelings that were uncomfortable: grief, loneliness, sadness, failure, etc.  2017 was a year long binge because I had a shit bag and it was my only old faithful coping mechanism for a LOT of feelings about that whole situation.

Driving more to the root of my current binge eating problem, being alone with myself, my therapist asked me, "What is so uncomfortable about you being alone with yourself?"  And the answer that kind of slapped me in the face is that I don't really know who I am, and it is uncomfortable sitting around alone with a stranger: particularly when that stranger is you.

Thinking over the course of my life, I cannot think of a lot of instances where I have done things, or liked things, or been really devoted to certain things, just because I (me) had a passion for them.  If you ask most people what their favorite movies, music, books, general things in life are; they typically have an answer for you.  Even if you asked someone to pick 5 albums, books, movies, etc that define them; they would be able to come up with a list, and maybe just struggle to limit it to five.

The thing is, I can't answer questions like that.  There are periods of my life that I was really in to certain bands or whatever and the root of the reason is that the person I was dating or the friend I was hanging out with was really in to them.  The movies I saw were based on someone else's desire to see them.  The books I read were based on the favorite books of my friends.  Even when I did my Cherry Mary booth, it was because so many people had told me over and over again, "You should do this, you would be good at it."

Maybe that was why it was such a failure; because my heart wasn't really in it.  I mean I worked REALLY hard on all the stuff I made, but it wasn't because it was my passion.  If you show me cute little paintings on pinterest or etsy, I can usually copy whatever it is and make a cute little painting.  But you sit me down in front of a blank canvas and tell me to create something, and my mind is as blank as the canvas in front of me.

I don't feel like I have a passion (a real passion) for anything.  When I have days off from work, and I don't have some sort of outside obligation for things I need to do, I struggle with what to do with myself.  There are lots of things I could be doing, but nothing drives me into any particular direction.

I do not know who I am outside of who I am to other people: my husband's wife, my mother's daughter, nana's granddaughter, my siblings' sister, someone's friend.  I don't think I am alone in feeling this way, I just think most people (particularly women) don't even think about things like this.  As adults, it's easy to get caught in being defined by being someone else's mother, or by your career, but that isn't really who you are; it isn't your passion.

But although I think a lot of women fall into being defined by the roles they play in their lives, families, careers, etc; I still think the majority of them could tell you what their passion is outside of those things if you asked them.  They would still have a favorite book, a favorite album, a favorite game, a favorite hobby, a lot of little things that define who they are.

I know my favorite color is turquoise and I love elephants.  That's all I've got that is just me.  My favorite author for a while was Anne Rice, and it was because of my best friend in college.  I have a lot of tattoos that I got when I was dating a guy who was really into body art.  Don't get me wrong, I love them all and designed most of them myself.  But at the end of the day, it was under his influence.  I hear a song on the radio and I think to myself, "Oh I was super in to that band when I was hanging around XYZ."  Now, my feeling about that music is mostly indifference.  I've created a lot of artwork because other people suggested I should.  I've tried out a lot of things because other people thought I would be good at them.  

The other day, I had a conversation with a coworker about what we would be doing if we didn't work the jobs we have.  Like if money wasn't an issue and we were doing whatever we wanted in the world.  When I asked him, he said he wanted to own and run a golf course.  Didn't skip a beat, it just flowed out of his mouth like it was something he had thought a lot about.  He's 25.  He asked me the same question and my response was, "I have no idea."

I feel like for the longest time, I just wanted to be financially secure.  As long as whatever I was doing paid the bills, I could find self-satisfaction elsewhere.  But what if you don't?  What if you don't even know what would satisfy you because you don't know what you want?  

I also spent a lot of my life defining myself as the fat girl.  And although I still technically fall into the obese section of the BMI chart, if I refer to myself as the fat girl now, I get some strange looks.  I don't want to be that person that is smaller than someone else, referring to myself as fat, and unintentionally making them feel bad about themselves because of it.  I know what that feels like because I have been there before.

The thing is, I don't know who I am if I am not Mary, the fat girl that does what everybody else wants her to do.  It reminds me of one of Tori Amos' lyrics: "She's been everybody else's girl, maybe one day she'll be her own".  (This is ironic because I was super in to Tori Amos because a friend of mine was at one point.)

My therapist gave me a suggestion today for trying to figure out who I am.  She said she wants me to start with this simple question: "If you were an animal: what would you be and why?"  My first thought was wondering what animal all of my friends and family members would say I am.  And there we have the source of the problem right there.  

It's a simple question, but at least it's a place to start.  

My name is Mary.  I like the color turquoise and elephants.  Check back later and maybe I can tell you something more than that.