The psychological effects of gastric bands and stomach stapling - Times Online

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From The Times

July 12, 2008

The psychological effects of gastric bands and stomach stapling

Slimming by surgical procedures are increasingly popular but the underlying emotional problems are harder to shed than the pounds

Having your stomach reduced does not resolve the need in your brain.

JOHN NAISH

Stomach-shrinking operations have captured the headlines recently, with the post-operative death in June of 29-year-old Suzanne Murphy, who wanted to lose weight so she could play with her young son, and the daytime-TV star Fern Britton's earlier admission that her dramatic weight loss was due to a gastric band rather than willpower. But amid the arguments about vanity and surgical safety, one of the most crucial dangers is ignored - the huge psychiatric toll of these operations.

The numbers having NHS stomach surgery leapt by 41 per cent between 2006 and 2007. Parliamentary figures show that there were 3,459 such operations last year, up from 2,448 the year before, but the total does not include the soaring number of private procedures performed in Britain and abroad. The most common operations in Britain are gastric banding and the Roux-en-Y gastric bypass (see box).

But amid the rush to slim by scalpel, doctors and patients are ignoring the fact that it isn't an easy cheat. While thousands of people do benefit, one operation in five fails because of a patient's significant psychological problems - the problems that led to their obesity - remaining unaddressed. The alarming way that many of these failures manifest themselves as binge-eating, severe depression, suicide or addictions is making experts increasingly sceptical.

Guidelines on who should have surgery

Guidelines by the National Institute for Health and Clinical Excellence (NICE) recognise this potential for difficulties. They state that patients with psychological contraindications should not be considered for stomach surgery. But clinicians say this is often ignored. The story of the 19st (121kg) Suzanne Murphy, who died after suffering a huge reaction to stomach-stapling surgery at Huddersfield Royal Infirmary, seems to exemplify this.

Sheila Connor, Murphy's sister, says that they both developed weight problems very young when they started comfort eating after their father died. She says that Murphy was bulimic before she became pregnant five years ago, and her weight had plummeted to 5st. After her son was born her weight spiralled, but she was never given proper psychiatric help for problems with food. "She was only given slimming pills, but whenever she got down to a certain weight, the problems kicked in," says Connor. Then Murphy had the ill-fated surgery.

John Morgan, a consultant psychiatrist at the Yorkshire Centre for Eating Disorders, began tracking obesity-surgery patients at St George's Hospital, South London, nine years ago. "Since then we have been turning out follow-up studies saying that psychological issues are powerful predictors of postoperative results. About a quarter to a fifth of patients who have surgery have bad outcomes, particularly if they have a history of binge eating, bulimia, depression or anorexia.

"If you are eating because of a need in your brain rather than a need for stomach satiety signals, having your stomach reduced is not going to solve that," he says. "In fact, having your stomach reduced will mean that you can't placate yourself in your usual way, so you can keep resolutely eating until you effectively reverse the operation by displacing the stomach band or creating a pouch in your intestines."

Patients cheat by liquidising food

A report in Pulse, the newspaper for doctors, highlights a problem called "soft calorie" syndrome, where patients cheat by consuming semi-liquid food that passes through the gut restriction. Nutritionists report stratagems such as melting Mars bars and liquidising McDonald's meals.

American psychologists have discovered how significant numbers of surgery patients become alcoholics, binge-shoppers or sex addicts. Melodie Moorehead, of the JFK Medical Centre in Atlantis, Florida, calls the problem "addiction transfer". She reports in the stomach-stapling journal Bariatric Times that people who have attributed all their problems to being overweight can suddenly realise that their emotional difficulties are not as easily shed as their excess pounds. Many of the patients become obese because they are compulsive eaters. When the eating stops, they develop another compulsion.

New research indicates that the neurological causes of compulsive eating may be similar to those of other self-destructive addictions such as cocaine addiction and alcoholism. Other studies suggest that obesity may protect against other addictions. A survey of 9,125 adults in the Archives of General Psychiatry found that obese people are 25 per cent less likely to abuse drugs. In 2004, Florida University researchers published a study of 298 women showing that obese women drink less alcohol than average. The researchers suggest that food and alcohol trigger the same reward sites in the brain.

Morgan adds: "There is also something we call multi-impulsive eating disorder, which affects a minority of patients who not only overeat, but also cut themselves or take drugs or alcohol, because their instability of personality leads them to do these things when faced with difficult emotions. Frankly, addressing these psychological problems can be necessary, but it's barely sufficient on its own. Obesity surgery basically involves retraining someone's behaviour, and that can take years." This is often ignored, he says. "Booming demand means that services are being developed that are like plastic surgery. But it's just not like breast augmentation.

"There are some good centres in the UK that focus on comprehensive treatment to address both mind and body issues. But there are many more where people don't really know what they are doing. I would like to see services be given minimum standards before they can start operating. There needs to be access to eating disorder experts and budgets for the significant minority who need postoperative support."

Samantha Scholtz, who gives NHS patients pre-surgical psychiatric assessments at the Imperial Weight Centre, Charing Cross Hospital, West London, cautions that post-surgical support is often lacking. "The first few weeks after the operation, people are very emotional.The effects of the surgery, not being able to eat, and losing weight all cause depression and anxiety. Six months down the line, more depression arises. Often this is because their expectations have not been met. The body image is often not great. There is a lot of loose skin and it is cosmetically not a good operation. But sometimes it is sold that way."

Scholtz, the lead author of a study in Obesity Surgery on postoperative complications in 37 patients, adds that suicides right after surgery go up. "You have to prepare people to have realistic expectations. The benefits are primarily for their physical health, diabetes and blood pressure, but not body image. Obesity surgery is good for certain people. But they need the right follow-up and support."

Around the country, patients have similar difficulties. At the MSN online gastric bypass support group, "Calavandrial", from Hull, had an operation five months ago and has lost 4st. But she feels thatshe is getting a "raw deal in the postoperative phase", and adds: "I'd have liked some counselling for my 'inner food fiend'. My doctor refuses to support what he calls 'experimental surgery' and my surgeon has retired with no replacement. To say this situation is getting me down is putting it mildly."

In similar vein, "Stamperlou", on the Mini-Mins support forum, reports: "The surgeon gave me a card for a support group on the web that I could never access and a flyer for some group meetings that were held 20 miles away."

Complaints such as this are particularly disturbing in the light of research underlining the importance of postoperative support. A report last year in Surgery for Obesity and Related Diseases says that support groups can make a significant impact on weight loss, especially after six months when the rate of loss from surgery normally begins to decline.

But no matter whether support is given or not, there is strong evidence that unless patients are properly screened, long-term failure rates are far higher than surgeons tend to admit. In a study of 317 gastric-banding patients, by the Hôpital du Chablais, in Switzerland, investigators found that, after seven years less than half the operations could be called a success. The 2006 study, in Obesity Surgery, concluded that gastric banding "should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer-lasting procedures should be used."

Backlog of 60,000 patients, say doctors

This caution has fallen on deaf ears. Now that bariatric surgery has been approved as effective by NICE, NHS primary-care commissioning groups have an obligation to fund it. And enthusiastic proponents want to see many more operations as soon as possible. The British Obesity Surgery Society, for example, claims that there is a backlog of about 60,000 patients needing a gastric bypass - and more NHS surgical training and resources are needed to catch up.

The British Obesity Surgery Patients Association describes the growth rate in NHS-funded bariatric surgery operations as "woefully inadequate". But given the psychiatric evidence, it may be wiser to consider carefully the long-term emotional fallout from all these operations - and to develop effective ways of preventing it before weighing in with even more.

Weightloss surgery - the facts

In the 1950s, doctors in America reslised that ulcer patients and cancer survivors often shed pounds after having parts of their stomachs removed.

Surgeons in Minnesota began to experiment with operations that were designed solely for weight loss. Their early approaches have been abandoned because they proved too risky, but refinements have led to the most common weight-loss surgery techniques - gastric bypass and gastric banding.

The gastric bypass

The Roux-en-Y gastric bypass, or gastric bypass for short, includes stapling off a golfball-sized pouch from the rest of the stomach. The small intestines are re-routed so that food no longer passes through the upper portion of the gut. Patients can't eat as much because their stomachs are smaller, and fewer calories are absorbed because food doesn't remain in the intestines for as long.

Gastric banding

Weight loss is less rapid with this reversible procedure. An adjustable silicone band is fitted around the upper part of the stomach to create a pouch. This fills quickly with food, which passes slowly into the rest of the stomach. Patients can eat only small meals and they feel fuller sooner. The band can be tightened or loosened by injecting or removing fluid from a balloon on its inside surface. Injecting fluid tightens the band; removing fluid loosens it. Both procedures are done through an access port under the skin.

Other types of operation

Other versions of bariatric surgery are carried out sparingly, including operations to staple the stomach or to remove a large portion permanently (sleeve gastrectomy).

Risks

Some are common to any surgery, such as infections or blood clots in the lungs. Others - including bowel obstructions and leaks in the new connections - are related directly to gastric bypass surgery.

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Friday, November 14, 2008

Costa

Is it bad when the woman who serves me knows my coffee order.
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Sunday, November 09, 2008

Still trying to get blogger widget working on my dashboard

Friday, November 07, 2008

Apple Genius bar

Off to the genius bar with Jeans Ipod touch. Didn't get satisfaction 2bh. Then again mood I was in probably pistols at dawn may have helped. After the brass I have pumped in to the apple coffers this last month I expected more. So we shall see. If I have to go back I shall demand satisfaction.
Amazing how smug they all seemed on my way out. Consoling myself with a pot of tea in the John Lewis espresso bar while the traffic settles.
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Apple Genius bar

Posthelwaites Lear

The review in the guardian isn't sparkling. Think I am glad I haven't got tickets.
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Reuters - BSkyB and Virgin Media settle channels dispute

This article was sent to you from Ken.clare@blueyonder.co.uk, who uses Reuters Mobile Site to get news and information on the go. To access Reuters on your mobile phone, go to:
http://uk.mobile.reuters.com

BSkyB and Virgin Media settle channels dispute

Tuesday, Nov 04, 2008 4:34PM UTC

By Kate Holton

LONDON (Reuters) - BSkyB and Virgin Media have agreed a new deal to carry each others' basic channels, they said on Tuesday, following a highly public row in 2007.

BSkyB channels such as Sky News were taken off Virgin's cable platform last year after the two sides failed to reach an agreement over pricing in a public spat which dominated the headlines and angered many of Virgin's customers.

Shares in BSkyB were up 7.2 percent on the news and Virgin Media shares, which are listed in the U.S., were 17.3 percent higher at 1535 GMT.

"As part of the agreements, both Sky and Virgin Media have agreed to terminate all High Court proceedings against each other relating to the carriage of their respective basic channels," both groups said in the statement.

BSkyB and Virgin said the Sky basic channels would return to the cable service on November 13 and under a second agreement the Virgin Media TV basic channels such as Living and Bravo would continue on Sky.

The agreements include fixed annual carriage fees for the channels with both suppliers able to secure additional capped payments if their channels meet certain performance-related targets, they said.

"I believe this agreement represents a fair deal and is the right thing for our customers," said Virgin Media Chief Executive Neil Berkett.

"We recognise the quality and popularity of Sky's channels and look forward to welcoming them back to Virgin Media's TV service," he said. "We are also pleased to secure Sky's continued carriage of the VMTV channels until June 2011."

The BSkyB Chief Executive Jeremy Darroch said he was delighted to see the Sky channels returning to the Virgin Media platform.

(Reporting by Kate Holton; Editing by David Cowell)

Tuesday, November 04, 2008

Tea in Starbucks

Bloomsbury Brunswick centre - cool.

Posh cake shop

www.patisserie-valerie.co.uk

Most enjoyable.
Non disclosure agreement prevents discussing what I purchased.
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HENRY

http://www.henry.org.uk

Sounds like it is worth a look.
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Friday, October 31, 2008

On my home.

Therapy was intersting will be going back again.
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On the train to therapy

Quite literally. Going to Hartford for Human Givens Therapy. Sleep is still pants. Been to see my long suffering gp frank he agrees I am better. Start therapy and see him in two weeks. I got some blood sugar testing gear and sticks to see what's happening when I have these hypos.
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Now I have bought a macbook too. 13" screen old fashioned white but it is as far as budget would stretch.

Thursday, October 30, 2008

Blogging from my new mac book the laptop dream version of my mac world

Saturday, October 25, 2008

Going to see a chap from here on Friday
http://www.hgi.org.uk/index.htm

Friday, October 24, 2008

Seyying up the iMac is a good mental challenge. Be glad when its done.
will get there

Went out for a meal last night with Steve Terry and Tommy. Oh how we laughed.

Thursday, October 23, 2008

The notice board.

A harbinger of gloom. Breast cancer survivors victims of family suicide survivors. Bloody hell I fee worse.
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Once again sat in the GP

Back to where I have spent so much time in recent years. Waiting to go and see Frank. October is often bad for me its a busy month and I often feel a seasonal swing coming on me.
Yesterday email was up the pole. Blueyonder was down nationally, and I didn't seem to get much through the gravitas account. There is always the chance no one sent me anything but I prefer the technology is goosed explanation.
A questionairre from the receptionist about standards of service.
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Wednesday, October 22, 2008

I love my iMac and despite the steep learning curve it is fantastic

Support group tonight at greenbank went well.They have a new coffee machine which is v. good. The suppliers are - double espresso good.
http://www.rijo42.co.uk/

Monday, October 20, 2008

Working on the website.
Been to a maes mums funeral - nice service nice church.
Now grafting at the iMac

Ally found my passport BTW. It was in her bedroom

Want to stay up all night playing with the iMac is this a bad thing. Cant. got to go to a friends mothers funeral tomorrow am. Day off work.

Saturday, October 18, 2008

IMG00183.jpg

Dave and Maria at daves 40th party.
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Friday, October 17, 2008

There are men scraping the tarmac off the road outside. I was awoken at 9 to move the car- its a tough old life.

Thursday, October 16, 2008

Got to go see mum drop WLSinfo stuff there for storage. Then hotfoot to town to town to meet Ally. Then back here. Gym tomorrow I think.

Just had an iChat conference with Conor live from Gravitas it was peachy. Got to go to mothers to drop stuff off then go to town to see Ally.
Busy Busy Busy.

Now using a dashboard widget on my iMac to post this it is unbelievable. A steep learning curve but well worth the climb for sure.
I love the Mac.

Sunday, October 12, 2008

IMG00180.jpg

Fox at macdonalds
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Monday, September 29, 2008

EMDR

http://www.emdrassociation.org.uk/index.htm

Today I spoke to an EMDR therapist.

Ken

Friday, August 29, 2008

Flying home.

Its been a great couple of days with the team from web integrations. They have really helped me focus on the work required to take the website forward and improve the quality of our content side. Bob Euan and Liz are a great team and it was a pleasure working with them. The hotel was primitive in the extreme. Redeemed mainly by the pleasant lady who served brekkie. Mobile phone and internet connection were pants. Still I enjoyed the rest. Looking forward to going home. 2 years today. Feels good. People who matter know what that means. Next week sees the 6 year anniversary of my bypass. Another big milestone. Planning another visit to gustav klimt tomorrow with dinner out. Sunday ruth and paul here so a busy weekend.
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Wednesday, August 27, 2008

IMG00152.jpg

Stonehaven the view from the ship inn.
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Touch down Aberdeen

If anything feeling a little hyper. Manchester airport better organised than the shitshed coach station named after john lennon. It was faster cheaper smoother more organised. Now sat in the back of the cab mobile for stonehaven. Reassured to see cab driver doesn't know where we are going either. Good to see Mick last night looking bronzied and refreshed from a week in Majorca. Anyway here for 2 days training with Pip by Bob and Liz on our new content management system Sitellite.
Got weighed yesterday down 2.6 pound so pleased with that. Now last 4 stone plus since starting me preop diet. Need to get back to the gym again.
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Monday, August 25, 2008

Basin st Blues.

Bank holiday and trying to get sleep hygiene sorted. Been going to bed to late and sleeping in. Been doing me no good. In to work tomorrow and off to Scotland on Wednesday. Come back Friday night. Going to revisit the Klimt exhibition before it closes on Sunday. Got plenty of wlsinfo and gravitas stuff to sort. Professional membership website content and gravitas website improvements to work on. All go. Looking forward to meeting bob and liz up at web integrations at stonehaven. No sat in costa listenin to willie nelson and wynton marsalis in costa. Trying to do some of the physical thing.
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I saw a Venezuelan firefighter in Tesco.

Assuming Caracas is in that country and Bomberos is the word for fire fighter. Must be part of the world fire fighter games.
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Thursday, August 21, 2008

Thursday am

Up early. Legs achingl beyond belief. I guess yesterday I walked a helluva lot. And without crutches. Guess I am using muscles I didn't know I had after being in that plaster of paris.
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Monday, August 18, 2008

Return of the banana splits

http://news.bbc.co.uk/1/hi/entertainment/7567840.stm

complete with tune - wow

Thursday, August 14, 2008

On the 86C

Girls gone shopping. Me on the bus. Watching the world. Nearly home now.
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Results lunch

Just been to ill forino. For lunch delicious italian gaff in duke street it was recommended by Mick. I will be going there again.
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A Levels

Ally has excelled again. 4 A grades french english theology and general studies. We are extremely proud. Of that there is no doubt.
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The royal

Sat in fracture clinic waiting. What a pain in the bum. Had an xray which thanks to modern NHS IT was not done as a film but sent electronically to the clinic. The system prints me a chit to hand in and I hobble away. Intercepted by sister in clinic. Who looks accusingly and exclaims "is this yours. " Innocently I said yes - the name on the chit betrays me. I am not mrs patricia macintyre. I do though ask what she has and whether her prognosis is better than mine. Identity theft seems an option for a few minutes. In the meantime the A level news comes in.............
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Tuesday, August 12, 2008

Trip to Stonehaven

Going up to see our web hosts Bob and Liz at http://www.webintegrations.co.uk/

Going to stay at http://www.belvederestonehaven.co.uk/ and flying up on a http://www.flybmi.com/bmi/en-gb/index.aspx plane from the land of manc.

Saturday, August 09, 2008

Yet more complaints

That I haven't been blogging. Truth is I have been mad busy. Was lecturing in Leeds. Came back busy at work. Busy on website doing my utmost to get all done even with a broken leg. Involved in two projects I had to sign non disclosure agreements about. So they remain secrets for now. All will come clear one day. Not that exciting really.
Ally gets a job with Liverpool PCT for the summer doing stuff based at Earle Road medical centre. Dublin based work takes up a lot of my efforts. Involved with the web space and radio advertising big time. I hate not being able to drive have to rely on Jean, Conor for work, and friends for meetings. Writing this for the museum conservation centre having just seen a great exhibition Stewart Bale photographs called Metropolis. Closes tomorrow and I was keen to catch it. Jeans birthday yesterday so a lot of birthday foccused activity. Yesterday saw debut of Sophia my great niece and goddaughters child. She is delightful pictures on flickr.
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Sunday, August 03, 2008

Lazy days

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Thursday, July 24, 2008

Sprain my arse its fractured

Broken leg. Feels crap can't drive hate it.
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Tall ships from Radio City Tower

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We are a great uncle

Baby sophie
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Friday, July 11, 2008

The Pain The Pain

It got worse overnight. I succumbed to going to Garston Hospital walkin centre.
I was triaged and told it was probably ligaments. Sent for x-ray and waiting a long time to be treated. Took a long time telling them all the meds I am on and my medical history.

Monday continued

So after the art gallery (well recommended) we hobbled across St Georges plateau rather flashy pictureand tried to gain access to the heritage centre which sounds good but was shut.Bit more details there.
the rain was coming down so we limped across the road past the penny farthing (looks like its still a dive). Past the Royal court and along the side of st Johns. Looking for a brew/coffee and primarily a seat we end up in the met quarter. My foot is blooody killing me its swollen and painful but I hardly mention it. We toy with the idea of a rip to the walk in centre then but its late so I let the rest and the coffee do a bit. A small walk around the met quarter see 4 bananas then its over to the 08 shop and then into Liverpool 1. I am impressed. I take a mineral water in Debenhams cafe.
Eat in La Tasca then I am off a meeting.

Last night a friend made a request

he wants to see more posts in the blog. He cant be bothered with Twitter, the pictures provide only minor diversion he wants something a bit more meaty to bite into at lunchtime. He works in the city centre in a very posh building in a lovely environment, one could suggest better uses of his lunchtime but who am I to judge.
Anyway I always say (like any good performer I dont do requests)- but with with a regular readership that can be counted on the fingers of Homer Simpsons right hand I have to keep them sweet.

Friday, July 04, 2008

IMG00115.jpg

My sprained ankle. Ouch.
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Wednesday, June 25, 2008

Forbidden snack

Been to the gym bought some snacks jane confiscated this dried fruit. Its all banned.

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Saturday, June 21, 2008

The Camera is out and so is the Sun

Ally and I are off in pursuit of Superlambananas. We find some see our results On Flickr
I play with Geotagging on my blackberry. We enjoy some time with a good walk around the city.

Saturday, June 07, 2008

Travel Insurance that includes cover for pre existing medical conditions and for those over 65 and 70.

Travel Insurance that includes cover for pre existing medical conditions and for those over 65 and 70.
Might be useful

Friday, June 06, 2008

Homemade Cakes and Desserts Bakery in Liverpool

Homemade Cakes and Desserts Bakery in Liverpool Went here tonight for some cakes.

Tuesday, June 03, 2008

ASO part 2

Steven Cummins - Environment determinants of food purchases: inside and outside of the home.
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ASO conference

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ASO

Obesity and the built environment.
Awards - Denise Robertson. Metabolic cross talk between the colon and adipose tissue.
Catia Martins - the effects of exercise on appetite control.
Nick Cavill Building health:challenges and aopportunities.
Martin Birley. Health impact assessment in practice.
Amelia lake measuring the food environment.
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ASO

ASO conference

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Monday, May 26, 2008

Surgical Review Corporation

Surgical Review Corporation
Interesting reading

Saturday, May 10, 2008

ScouseVeg » The Egg Cafe - Newington Buildings, Liverpool

Sunday, April 27, 2008

Road to Revision

Its been a long slow journal my weight log diligently kept till I really started gaining shows a interesting journey. I can support this with pictures too. No doubt my blog tells some of the truth too. I lost 16 stone in year one. I became an exercise junkie. I loved it< and fully embraced a complete lifestyle change. It seemed the more I did the more I could eat and the more I would lose weight. The next stone in about the same period. The following year an acute obstruction, peritonitis and pneumonia took me down to 15 something. I didn’t look good. They put me on a diet to build me up. After two years of eat less being my mantra they started to chant eat more eat more. I can remember being in hospital being ravenous and eating what I wanted (with the staffs permission). M&S trifles became a firm favourite. I had dumped a handful of times in year one, but sadly no more.
My mental health which has never been great rumbled along in various stages. I had a hypomanic episode in year one followed by a depressive episode. A diagnosis of Bi-polar followed swiftly, I was reluctant to accept this initially and did so at my peril. I eventually became 100% compliant on medication. Anti depressants and sodium valproate. I was to suffer the effects of the black dog of depression on several occasions since and live aware it may be round the corner.
I tried to get back into exercise with some success, its positive virtues made sense, it did lift my mood if I could be bothered to get there.
I turned to increased amounts of alcohol, for its pharmacotherapeutic effect and paid scant regard to its calorific value. As a positive, my passion for malt whiskey which I had abandoned before my op never returned.
My full time employment ceased I felt blessed to be pensioned off due to ill health. My mental health was making working at senior manager level in a high stress environment unsustainable. I got a new post at a very junior admin level part time giving me all the positive virtues of work with none of the downsides.
In March 2006 I suffered a fit, later to be diagnosed as the first sign of a sub arachnoid haemorrhage, I underwent minimally invasive neuro surgery, and was back at home before I knew what had happened. I lost my driving licence and I was constantly fatigued and plagued with severe headaches. I took the maximum dose of pain killers ranging from paracetamol, through codeine to tramadol. Alcohol seemed to help my sleep pattern, though looking back that was an illusion.
I was officially told to put my feet up and not to exert myself – for once advice from professionals which I complied with 100%.
I was angry, why had this happened to me? What had I done to deserve this. I tried as ever in my life to rebel, to do the opposite of best advice. I thought I knew what was good for me.
It took five months to come to my senses, I had little insight into the mess I was in. My mental health tetered, my personality under went changes. I was supported admirably over this couple of years by a clinical psychologist who helped me learn.
I decided to stop drinking in August 2006 and sought help from several agencies, friends, and professionals to help extract me from one part of my situation. In check date I underwent a weeks management in the neuro unit to treat my headaches. It involved cessation of all painkillers, intravenous infusions and caffeine free diet. It worked despite my scepticism.
My spiritual health has been a factor in this journey. I have been a Christian since 1990 and have had three dalliances with organised Churches and 1 fellowhip. My belief and values are stronger than ever, though still I am far from perfect and see myself as a work in progress. I believe that good works and deeds will help oneself often more than who you help and it continues to be part of things.
My self esteem (a lifelong problem) remains in a buoyant state. I often feel that I have a switch with only two settings – full on and full off. If I join a club I want to be a big part, achieve great things. I have traditionally found long term commitment impossible I set up WLSinfo with a plan to withdraw after 6 months and maybe I am changing for the better in that I continue to commit. I don’t know all the answers in fact I think I know less now than when I started, but life feels a whole lot better today than it has for a long time.
I have just got up to review this, count words and make a cup of tea. There seems to be a major omission. Apart from passing reference to trifle food doesn’t seem to get a mention. Thats unfair it obviously played a major part of the picture of regain. My omission, or initial denial is something I have often seen in fellow suffers from obesity. Even some less enlightened Health care professionals sneer at the 34 stone patient who claims to survive on lettuce. I believe at my biggest my inability to discuss this was through self disgust and even a disbelief that I could do such injurious things to myself. I believe those feelings are compounded by being a health care professional and by having lost the weight once before. I have heard talk about the slimmer of the year syndrome, where successful dieters gain the weight. The spotlight of exposure and the media make it worse, and in February I turned down a TV appearance because of my appearance. Even the action of sitting at the front of a group or on a stage can put pressures on.
I have heard an eminent professor say we are all obesophobic and harbour negative attitudes to fat and fat people. That applies even to obesity professionals and extends to patients (even the ex obese) themselves.
I have faced some hard harsh comments about my weight and have tried to deal with them honestly and openly. Some still hurt.
Even now I continue to prevaricate my portion sizes grew exponentially. I could devour a three course meal, or a complete fish and chip supper though feel full. My passion for cakes and sweet things had exploded. In the last few months I could open a packet of biscuits and not stop till the last had gone and I had eaten a days food, and full knew each morsels calorific content. I know what its like to full disgust afterwards too. To eat so fast I would be looking for leftovers, to make special stops on the way home from work.
Buying new bigger clothes became a nightmare, I remember the delight when I started shopping at the normal shops after my first op, but felt it more deeply when forced back to my old internet suppliers. Fortunately friends helped in this situation.
It became a spiral put on weight feel crap eat more put on weight feel crap. Fortunately I had continuous after care and was being monitored. I needed help.

Thursday, April 03, 2008

Post op man

My Belly afterwards - note the fetching ventilating gastrostomy tube

Preop Man

Apple - iPod touch My new purchase

Apple - iPod touch It is a dream. bit miffed I had to buy 12 quids worth of software and a case. They were out of stock on the 8gig so I had to buy the 16gig - shame

Friday, March 28, 2008

Waiting for Ally

First night at work for the girl. Finds me sat outside the echo arena.
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Thursday, March 20, 2008

PureText Home Page

Monday, March 17, 2008

Bplay : Monopoly

Bplay : Monopoly
Games for Mick

BlackBerry Cool | The voice of the Blackberry community.

BlackBerry Cool | The voice of the Blackberry community.
A link for my blackberry toting friends. Mick has a new girlie pearl.

Sunday, March 16, 2008

Another day on that diet.

Kept to it. Took my mum cafe 23 I had soup. Tea was a freedom chicken posh carrots mayan gold spuds and cauliflower cabbage. Trying to do it. Ts proving hard.
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Thursday, March 13, 2008

We was robbed.

The blue boys did a great job to win 2-0 then hold them through extra time and then get beaten on penalties. It was exciting but highlight for me was the abuse of the clearly biased ref and a player callled Neville.
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Wednesday, March 12, 2008

IMG00066.jpg

Everton 2 fiorenta o

Penalties
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Sunday, March 09, 2008

Weekend

Hope the weigh in tomorrow is ok. Struggled with the diet if I am on honest. Saw a fox last night. Nearly set fire to the kitchen this afternoon.
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Thursday, March 06, 2008

Thursday

Flakes but no soup. Wasted carbs on butties in patient presentation. Fruit in the afternoon. Mayilones car had been vandalised and tunnel tag pinched at the match. Mince tomato sauce and veggie stir fry for tea
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Wednesday

Cereal,soup then out for a chinese with the Gravitas Team. Mike is up from HQ with the gravitas logo goodies. We now have pens and mugs.
Some samples of a sports bag, and I get a laptop bag too. My portfolio gets donated to Barbara.
The chinese was good but sitting between my surgeon and dietitian did curb the most wanton of my excesses. I did eat too much. Went to winwick quiz afterwards and succumbed to a small slice of birthday cake. We won the quiz.
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Tuesdays tea

Lamb steak baked spud and salad
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Tuesday, March 04, 2008

Tuesday.

Hard graft in wlsinfo. Search stuff headaches. Cereal and juice
Off to cafe 23 on bus for lamb soup. Walked along allerton road mooching. Bought amateur photographer and some salad.
Americano in costa coffee. Then into pharmacy to check script.
For info

Ferrous sulphate
Depakote
Cacit d3
Forceval
Fluoxetine
Solvazinc
Aspirin
Perindopril
Lomeprazole

That's for Micks interest when he is at lunch.
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Mondays food and weigh in.

Cereal and juice for breakfast. Off to work. 4kg down in a week. Made up. Fruit. Soup - carrot and orange I think. More fruit. Home. Salmon and broccoli healthy eating meal wirth extra salad. Extra salad. Yum yum. Still its been worth it. This weeks plan is to increase the exercise.
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Sunday, March 02, 2008

Mothers day.

breakfast, was flakes and fruit juice. Lunch was half a chicken leg, with carrots, broccoli, peas, cabbage two boiled baby new spuds and gravy, was full. Had two weight watchrs fromage frais with raspberries in the mid afternoon. Plan to take a chicken salad to me mas for tea,

Saturday

Breakfast in little chef - wanted big fry up but settled for - scrambled egg on two rounds dry toast. Soup for lunch - two pieces of fruit.
Committee meeting, moderators meeting. went well. Went to the plough at diseworth. Had a stew in a loaf - pictured below. V.nice. Home via A500 and M6. M6 blocked between 18 and 19 10 mile detour.

Saturday, March 01, 2008

IMG00060.jpg

Stew
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Today

Got up late. Two media calls following audreys appearance in the daily record. Out to cafe had tom yam soup. Apple and banana in car driving to derby. Traffic was pants. Off to derby for tea. Funny old city dearth of eateries. Ended up in some chain prawn cock minimal dressing. And club sandwich hold the mayo and coleslaw. Substitue salad for fries. Leave some bread. Wonder if I have eaten enough. By the way 18 months since I had a drink today.
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Tuesday, November 18, 2008

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