I watch TV’s “My 600lb Life,” which follows the journey of 600lb+ people through prepping for bariatric surgery and recovery afterward.
Virtually all of the patients have been victims (or claim to be) of sexual and mental abuse. The majority are visibly poor and in families with serious problems.
Research says that very few people keep the weight off after bariatric surgery and it ultimately doesn’t make much positive difference for morbidly obese people. They return to the same family and socio-economic conditions that are a causative of the issues.
Are there persistent mental issues that underlie enormous weight? Amongst the TLC crowd (and yes, I do know they can certainly edit the story in any direction they want), I’ve noticed that patients hold family/spouse hostage with threats of anger if they don’t bring them the junky food and basically wait on them hand and foot when they become immobile.
Many patients on the show are downright angry, manipulative folks (or portrayed as such).
I think it’s obvious that folks in this situation are profoundly depressed and untreated depression was likely a precursor. Could there also be neurological issues?
Is there a damaged circuit wherein the brain doesn’t send a satiation “stop” warning? I’m a big girl and like food, but couldn’t down a sixth of what some of the patients do.
Can enormous weight serve, in the person’s subconscious, as protection against further sexual assault? A means of asserting agency through literally taking up more space?
Is the weight a method of slow suicide? A manifestation of overwhelming agoraphobia/social anxiety? After all, being too large to get out of bed or get in a car negates having to interact much with the outside world?
I have a lot of compassion for these folks and am saddened by how hopeless some of their situations are. I wish TLC would do more focus on psychological issues, but they have a different focus.
Lots of people have been abused, very few end up being 600 lbs. I’m not sure how much is just looking for a reason to blame the background. We used to do the same thing with illnesses like schizophrenia 80 years ago, try to figure out what childhood trauma directly caused it. But now that we know more, we know it is more complicated.
I thought the long term success rates for bariatric surgery were halfway decent. Not great, but far better than diet and exercise alone.
I don’t know if anyone truly knows why people end up that heavy.
This depends somewhat on the type of surgery, but long-term results are reported to be good for gastric bypass.
*"Researchers with the Durham Veterans Affairs Medical Center in North Carolina recently tracked the progress of 1,787 veterans who underwent gastric bypass surgery. They found that one year after surgery patients lost 98 pounds on average. Ten years later they gained back only about 7 pounds.
Earlier studies have tracked gastric bypass patients for relatively short periods of time, about 1 to 3 years. That has led to the assumption that most people who have gastric bypass surgery will eventually regain the weight.
This study, published online on August 31 in JAMA Surgery, is one of the largest and longest to evaluate the surgery’s effects on weight loss. It also did a better job than many studies at follow-up, with 82 percent of participants staying in the study for 10 years.
Researcher Matthew Maciejewski at the Duke University School of Medicine collaborated with Dr. David Arterburn, a senior investigator at Group Health Research Institute in Seattle, in analyzing the data. They expected to see gradual weight gain over 10 years, with some patients gaining back everything they lost.
But they were pleasantly surprised. Patients regained a small amount of weight in the first few years after surgery, but then they “actually plateaued and maintained their weight loss and even lost a little more weight over the next few years,” says Arterburn. Just 3 percent of the study participants gained most or all of the weight back in 10 years."*
As for associated mental disorders/abuse problems, I’m not sure that TV show provides a good representative sample of super morbidly obese people. What medical histories I’ve seen (quite a few women in this category are at risk for endometrial carcinoma) generally don’t mention such factors.
I used to work at a hospital that did bariatric surgery. Most of the people this surgeon operated on were towards the lower end of the BMI scale where patients qualify, usually in the 250-300 pound range and attempts to lose weight by less drastic measures had failed, or they had a co-morbid condition where losing weight had become a life-or-death kind of thing. Insurance won’t cover it until a LOT of things are done, including a psychiatric evaluation, and it’s this that usually gets a patient rejected. There were some people that this surgeon refused to operate on even if insurance approved it, because he didn’t feel this person would be successful, for any number of reasons.
“My 600-Pound Life” consists of profiles of extreme cases, which this hospital didn’t do.
People need to remember that judging all morbidly obese people by the subsection of those appearing on “My 600lb Life” is like judging all married couples by those appearing on “Maury”. In other words; don’t go to a freak show and wonder why you see so many freaks.
People that end up on shows like that are definitely extreme outliers, but sure there can be a link between mental illness and morbid obesity. I’d never say it’s the cause of obesity, but it can contribute and be one more obstacle in the way of better health. A lot of people end up gaining weight because they’re emotional eaters and food is comforting, or they feel like so much in their life is out of control but they can control what they eat. If you combine those reasons and give it enough time, it turns into ingrained habits and usually isn’t done as a conscious decision. It can become very easy to ignore your body’s signals when it comes to food, to the point where they may as well not exist.
Losing weight is a relatively simple task, but there’s just so much baggage and mental/emotional shit attached, not to mention the absurd amount of misinformation, that it can be very hard to actually do successfully.
Prader-Willi is a genetic disorder where there is, indeed, no “stop” button on hunger. But it’s rare and typically carries other symptoms. I’d like to think that this would be noted earlier than adulthood but for people who are poor with limited or not access to health care it’s possible.
I expect most of the morbidly obese do NOT have Prader-Willi.
Obesity in general can be caused by many different factors…there is research considering the role viruses play in a sudden onset, and now people are researching the role played by gut microbes. Certain microbes can trigger insatiable hunger, for example, or determine the kind of food a person craves. Everyone is different. One person gains weight on a diet that helps another one lose weight, and vice versa.
But as far as extreme obesity goes, I have no clue. It’s probably such a blend of so many different factors, some psychological, some physiological, it must be hard to separate them out, or know which ones to treat first.
Yeah…more than half of people with PW have an intellectual disability, so there are likely ethical concerns keeping them off of reality TV. Plus, if they do have an ID they also tend to have other adults helping them with food management so 600 lbs is unlikely.
I took an abnormal psychology class 15 years ago (DSM-IV). We went through all the major disorders and I don’t remember any one syndrome in which overeating led to super obesity. In the time since I haven’t come across anything like that, either, which doesn’t mean it doesn’t exist, but going by what I know, I’d guess that you have to have a perfect storm of conditions for super obesity to happen: the person’s self-esteem, motivation, and life prospects have to be so poor that eating themselves into a housebound state is preferable; they have to have at least one household member who will care for them and bring them food (which would have to be a highly manipulable person); and quite probably some biological factor that makes the overeating tolerable is there, too.
I’d guess that these people end up in this condition and on this show because all those factors happen to intersect, and not because those factors necessarily tend to come all together.
Losing weight is simple in that one ‘simply’ uses more calories than one takes in, but very few who have tried it would say it was easy. It isn’t just ‘mental and emotional’ and it isn’t just misinformation, either. The physiological processes involved are far more complex and difficult than previously thought.
Fascinatingly, if the TLC patients follow the diet given – which is a requirement before approval for surgery - they shed a required 50-60lbs. I’ve lost and gained the same 30lbs for decades and losing 12-14lbs in six weeks is the most I’ve ever managed.
Why might a huge person lose weight so rapidly? Does the sudden change from 6,000+ calories a day to 1200 rev up the body’s metabolism or something?
Few patients are able to adhere to instructions the first time around, often because their family resumes bringing them food to keep his or her ragey anger at bay.
It takes about 10 calories per pound per day just to stay alive, so an initial rapid weight loss on 1,200 calories a day would indeed happen if a person weighed 600 pounds.
Weight loss is mostly calories in vs calories out.
If you are 600 lbs you could easily burn 6000+ calories a day. If you are somewhat physically active that could be closer to 10000 calories a day.
A pound of fat has 3500 calories in it, so if you are burning 8000 calories a day but only eating 1000, that means your body has to break down 7000 calories in fat and muscle to keep your body working. Even assuming the weight loss is 100% fat, that means you’d lose 60 pounds in the first month. But some of the weight is water and muscle.
Weight loss doesn’t rev up the metabolism, it slows it down. Conversion of T4 to T3 is reduced by 10-20% which reduces RMR.
I wonder if it is any different for the super-obese than for the average patient who has gastric surgery for weight loss. ISTM that to weigh 600+ pounds, you really have to work at it, perhaps more so than “just” being 100-150 pounds overweight. The compulsion to over-eat, I would think, is much stronger if you are 300 pounds overweight vs. a lesser amount.
I haven’t seen the show, but I wonder if there is any kind of family intervention that could take place to convince the other family members to not bring food to the immobilized person. Changing family and interpersonal dynamics is hard, of course. But if nobody will bring you food, and you can’t leave the house, I would think you would lose weight no matter what your compulsion.
In the book, he discusses an internist, Dr. Vincent Felitti and what went on to become the Adverse Childhood Experience (ACE) test. From wiki:
Continuing:
My bolding.
Yes, there is an established relationship between adverse childhood experiences and severe obesity.
Obviously, not all obesity if caused by high ACE scores and not all high ACE scores lead to that particular problem, or even other problems. One hot topic for research now is seeing which factors lead to greater resilience in some people who have had severe trauma and yet have not had corresponding problems later in life.
However, despite some people having greater resilience than others, many people with high ACE scores develop a wide range of problems.
In the Body Keeps Score, Bessel van der Kolk lists several reasons why potential problems such as obesity can be a “solution” for some people. He relates some findings from Felitti, including one formerly obese woman who had undergone bariatric surgery, but then had become suicidal.
van der Kolk shows how trauma causes changes in the brain which have been found by various brain scans and such. These changes include emotional regulation (or lack thereof).
There was one woman on the show (I think she’s now a counselor for people who are in similiar situations), who said that she started gaining weight as a child after being molested. She said she felt if she made herself as unattractive as possible, she could ward off her abuser and he’d leave her alone.