Monday, July 15, 2013

The Stages of Weight Loss

Before I get to the point of my post, let me say that I appreciate the folks who have left comments or sent messages asking after me. The truth is that I've been depressed and exhausted, though absolutely not idle. I have remarked to my husband on more than one occasion that I sometimes feel like I'm tied to the back of a car and am running as fast as I can to keep up with it. Most of the time, I barely manage to stay on my feet, and sometimes, I stumble and fall. When things are "good", I get back up again. When things are bad, I just get dragged along behind in a state of exhaustion and defeat. I've been dragged along a lot since coming back "home". It's been a rough road and it's not looking a lot smoother. However, I just keep going along.

Recently, I've been reading some things and one thing that I found has detailed the stages of weight loss pretty well and I'd like to share it with you. Perhaps this has verisimilitude for you, perhaps it does not. I can only say that it rang very true for me.

Step 1: Deciding to lose weight.

A crisis occurs which motivates one to take steps to get their weight under control. This can be reading about or experiencing the death of someone who had a weight-related illness, some sort of humiliation (an unflattering photo, inability to fit in an amusement park ride seat, etc.), or discovering that one can no longer fit into any of ones clothes comfortably. It can be a big "crisis" or a small one, but it is a turning point which motivates.

Step 2: Recognition and starting to make changes.

At this point, one starts to look at ones life and lifestyle and attempt to gain insight into what needs to be changed and then make what are deemed to be necessary changes to achieve ones goal of weight loss. Recognition can include the idea that one does not move or exercise enough, eats too many sweets, eats too much processed food, or simply eats too much healthy food. Once recognition of the underlying issues occur, plans to change are started and weight loss begins.

Commercial weight loss programs and forums are full of active losers at this stage.

Step 3: Changes in appearance with concurrent identity alterations

As one loses weight and appearance changes, there is a concurrent change in self-image and identity. Someone who formerly was not particularly athletic may now identity as a "runner" or "gym rat" as such activities are now part of their routine. A person who is on a particular diet may identify as "Paleo", "raw", "vegan", etc. Deeper changes may also occur such as seeing oneself as sexual, attractive, or more valuable.

Many people never get beyond this step. They tend to vacillate between this step and returning to being overweight as they cannot maintain this type of lifestyle long enough. It takes too great an investment. They will cycle between Step 1 and 3 until they tire or manage to move on. Commercial weight loss programs and forums are full of "success stories" at this level.

Step 4: Transition to a more concrete sense of self

At this point, depending on how long one has been overweight, the old sense of self as invisible, worthless, asexual, etc. may be memories and the novelty of relatively superficial identifiers is wearing off. A deeper sense of who one is comes about if a continuation of lifestyle changes and maintenance of weight loss occurs. This is where people tend to develop an understanding that losing weight doesn't solve all of their problems.

Few manage this step as well since it means that one is able to maintain weight and practices that keep the weight off in order to reach such realizations. 

Step 5: Addressing underlying problems

With the new sense of self and the loss of the rewards that come with success, one has to start facing life on the whole and the underlying issues that were making them unhappy. Sometimes those issues contributed to weight gain. Sometimes, they did not, but since "happiness" was not magically manufactured with weight loss, this is a time of larger introspection and analysis.

Many return to their old ways at this stage because they have not developed ways to manage their lives without falling back into old habits. Some people will bounce between step 3 and 5 for years because it is so difficult to fully change in this fashion.

Step 6: Long-term maintenance

Statistics tell us this is the rarest of things. This is when people have fully adopted and integrated changes such that they can continue to have a healthy relationship with food and maintain a healthy weight. Since so few get past step 3, very few ever reach a level at which they can fully integrate the changes into their life logistically, psychologically, and physically.

Does this seem far-fetched or does it seem realistic as a common pattern for people who lose weight? Well, for me, it seemed very realistic and I see myself as being step 5, and am currently bouncing between 3 and 5. This keeps me from losing a lot more weight, but also keeps me from gaining much either.

Did I make all of this up? No, actually, I did not. This is an adaptation of the 5 steps of recovery for alcoholics and substance abuse addict (Gorski and Miller, 1986). I've been studying addiction, but it has become crystal clear to me that I am food addicted by any definition of the word "addict". What is more, many people are like me, but resist the idea that they are actually addicts because of the lack of control that the word implies.

In no way am I saying that everyone who is fat is food-addicted. However, it is clear to me that I am, and also that a lot of other people are as well. Just as is the case with substance addictions, fat people are looked at in terms of moral failures and character flaws for their "choices". They are viewed as weak. They go through periods of relapse (weight gain) and recovery (weight loss).

A lot of smart people insist that you cannot be addicted to food. They believe you can only be addicted to substances which create a particular neurological situation, but they ignore the fact that there are actually two types of addictions. They are substance and process. Process addictions include things like gambling and sex addiction.

My feeling is that food is a combination of both process and substance addiction because it stimulates pleasure centers as well as the act of having it creates a sense of well-being. One of the more well-known food bloggers who has been struggling with a cycle of loss and regain once said that she was not satisfied with small portions. She needed to have "an experience" in which she ate a lot. This is a sign of process addiction. She derived comfort from the act of eating as much as she wanted, not from the pleasure she got from tasting the food or having a full stomach. In fact, those who have such issues, and I am one of them, will eat until physically ill or uncomfortable because the action of eating is what one requires, not the food itself.

The reason I'm talking about this is because I think that knowing that this is, at least in part, an addiction means that managing it is a permanent process. Addiction is forever. All you can do is be in a state of remission. There is no cure. The best you can hope for is to stave off relapse or to not relapse too often or too copiously. Like other types of addictions, relapse is the more common experience and total remission is extremely uncommon. I think that, once I realized this, I felt a sense of relief. It's not because I think this makes things easier, because it has never been "easy", but rather because the path is clearer.

My father is an alcoholic. He is addicted to alcohol. Addiction is often genetic, generational and a family issue. I may or may not have "inherited" addiction, learned it, or reacted to one addiction in the family with another. The only way for me to live from now on is look at this as a disease that I'll have to battle forever. The best I can hope for is to "manage" it, not cure it.

15 comments:

dlamb said...

OMG, OMG, OMG!!!! Welcome back, girl!!! I had to check the date three times before REALLY believing that it is a new post (but no pressure, you know, just post when you can and feel like it). Did I JUST WRITE THAT???? I try to mean it but I really don't. Does it show? Am I manic? I am so excited that I don't care what the subject is. WELCOME BACK!!!

So, now that I got that out of my system, I really appreciate the thoughtful post. Applying the stages of Alcoholism is, I think, inspired (not that you need my approval) because it addresses several aspects of OUR ADDICTION.
I always insisted that it is the most difficult addiction to keep in check (and really, that's ALL it is, keeping it in check), because it engages and affects so many aspects of our lives, including physical, emotional, cultural and all the others that everyone knows about.
I find that some of the people who reach stage 5 and 6, often transfer part of their addiction from one aspect of eating to another, often managing their new "normal" in a way that requires as much of an investment of EVERY KIND, as the previous addiction. THERE IS NOTHING WRONG with that, of course. My meandering point is that I do not know many people, however long they've been successful and whatever their comfort level with their new bodies, food, exercise program, who function "internally" the way that the non food-addicted function.
Whatever some successful maintainers claim about this new way of living, I believe that it is rare that it becomes a "thought-free" process, the way it is for those who have never been food addicted.
This is a bit off the topic but depending on how those is stage 6 perceive their achievement, some of them may make it more difficult for the "strugglers" to move through the stages by implying that it is easy, simple, achievable by anyone because "if they did it, so can anyone".
I understand why some maintainers NEED to do that but I find it more helpful when successful maintainers who are AWARE of the daily, minute by minute decision process, the self denial, the obsession with what goes in their mouths in order to maintain, would share THAT daily battle with those who are in the "lower stages" of the process.

It is virtually impossible for me to believe food addicted individuals in stage 5 or 6 who insist that all things being equal, meaning that physically, psychologically and medically the results would remain the same, they would follow the identical regime. Perhaps this may be true, but then why have a problem with the existence of a pint of ice cream (or whatever) in the house?
Sorry for the thesis. Can you tell how glad I am that you are back so I can discuss these things more in depth than I can anywhere else? More openly and honestly too!
I also want to say that I am truly sorry that your home coming has not been lovely, care-free and full of joy. You have worked so very hard to make it an easy transition and I cannot tell you how I wish that it had been that way for you.
Hugs

FredT said...

Have you looked at the SMART website? It has some useful information on it or his subject.

screaming fatgirl said...

Hi, dlamb, and thank you for welcoming me back. I hope I posted the correct comment for you!

I agree completely with you that it is a difficult addiction to keep in check because it's not so simple to eliminate all food that may inspire weight problems from your life. Food is everywhere, and the potential to overeat, even with healthy food, is always present. It's not like alcohol or cigarettes, which tend to be present in very specific situations and have to actively be sought out. People don't bring bottles of vodka to morning meetings at work,but they do bring boxes of donuts.

I also agree with you that few people who have weight issues (especially serious ones) functionally internally as those who do not have such problems. It is rarely a thought-free process, as you say, though I think that it can come close for those who have been doing it for a very long time. And, I am absolutely in agreement with you about people who make it harder for others because they say it's "easy". It is not easy for those who have a problem with it, and there's a very low chance that it ever will be.

You also have a very good point about people who can't have certain foods in the house because they can't resist it. They are the equivalent of drunks who can only stay sober if they are not in the presence of any alcohol. Once they are exposed to temptation, they no longer can maintain sobriety.

For me, I'm probably the equivalent of a largely "social drinker" who occasionally gets a little drunk, but overall does not have issues. However, I have to be careful, not vigilant, but careful. I'm just glad that I can be surrounded by goodies and not feel drawn too much to them or to lose all control. This is what has worked for me. It's "imperfect", and may keep me a little fat, but it's as good as it gets for me without becoming food obsessed and I just cannot live that way (worrying about every calorie that goes into my mouth, calculating calories burned in exercise, etc.).

Thank you also for your kind words about my transition. I can honestly say that it has been more awful and difficult than I could possibly imagine. It's very hard to explain here in this blog without tipping my hand too much about my true identity, but it really has been an unexpectedly difficult adjustment. Frankly, I'm just relieved that I didn't gain 70 lbs. like I did last time I was living where I am now! That's actually a pretty big victory!

screaming fatgirl said...

FredT: I don't know what SMART is and a search yields a lot of links. If you'd like to point me to a specific page that relates tot his topic, I'll have a look.

dlamb said...

Thank you, dear Girl. Yes, it is the right one. I swear, I must have some sort of "syndrome" from which nobody else seems to suffer: I catch my errors AFTER I click "publish" or "post" or whatever the system does to make my mistakes public.

I mentioned your blog in a very specific context yesterday. One of the very many things I appreciate about it and of course, about you is that your comments represent a BONUS communication. You are so gracious and your replies are so complex that they are like another "mini blog". Oh I DO SO LOVE THAT!!!
First, I understand completely why you want to protect your identity, as well as your privacy. I am totally in support of that (not that you asked for my approval, so sorry for the gratuitous thumbs up). Secondly, I am also very impressed that you did not gain weight during this stressful time. You had mentioned so often that food is not just about keeping your body alive; it serves many purposes. Something with which I agree wholeheartedly. For so many reasons, this achievement seems almost more difficult than your amazing weight loss.

I appreciate your feedback re. my comments. I was thinking about it while I walked this morning. I wonder if there might be a difference re. this "thought free" NEW eating style, between people who've had difficulty with weight and/or food/eating issues since childhood, as opposed to ones that gained wt. later in life.
The reason I say this is because I believe (unsubstantiated thought) that if someone did NOT have a weight problem and/OR a food/eating issue as a child, but gained weight later, that person may reach and maintain stage 6, faster and easier than one who did.
I am differentiating people with weight AND/OR food/eating issues from the others for the following reason: someone like me, for example, did not have a wt. problem but I did have major eating/food issues. For this reason, it is a struggle to stay with the approach that works to keep me within about 10-15 pounds of my "normal" wt. I gain and lose quite quickly and relatively easily so this range, though wide, works for me. I struggle DAILY, though. Due to my own approach, which entails my eating only once, in the evening, I am spared the minute by minute decisions and my calorie level is so high that for all practical purposes, I can eat just about anything BUT NOT AS MUCH as I want, during my eating time (sorry, TMI but it is in order to make a point)
My husband, on the other hand, was always extremely thin. He had no food/eating issues either, but as of about 20 years ago, he went from being quite underweight (6' and 130-135#), to looking "normal" to a bit overweight, by 10-15 pounds. When he decides he needs to drop some weight, he eliminates some unnecessary calories, mostly in the form of snacks, eats his normal meals and that's it. No thinking, no ruminating, no stressing, no planning, no analyzing. For him, there is no "stage 6". His LIFE is a stage 6, when it comes to eating.

To me, the distinction is like the difference between someone with chronic eczema vs. someone with Poison Ivy. Superficially the symptoms look similar, but the person with Poison Ivy applies some calamine lotion and is done in a few days, while the eczema sufferer needs to address the symptoms in a different manner. Both may appear to have clear skin but what it takes each to reach that stage is entirely different. I know this is an oversimplification but for the purpose of illustrating what I meant, I offer it as a simplistic example.
This, of course, does not EVEN address the development of fat cells that an overweight child has to deal with FOR LIFE. I was only addressing the issue of "stage 6 " ease.
Sorry, did not mean to highjack your blog and definitely do not expect you to carry on an endless exchange of ideas with me, unless you absolutely want to :):):):)

Jackie said...

Hi SFG,

Thank you so much for this post. I have sometimes wondered about the alcoholic/food issue connection. (There are *generations* of alcoholics on both sides of my family, but neither my parents nor I have ever really touched the stuff). Wanting to have the "experience" of food, the emotional connection, the symbolic worth (what celebration doesn't have food?)... It's such a layered thing, you know? What is the demarcation between healthy and not? I know skinny folk with crazy-fast metabolisms who are way less than balanced in this regard.

And my thoughts are with you as you continue this transition. Moving/relocation is one of the top-5 life stressors. ((((SFG))))

(I relocated to start my own business a few years ago and I am only just now feeling "enough" to really address how much emotional/physical/mental stamina it will take to manage weight successfully. It's one of those "simple, not easy" situations, for me at least.)

Thanks again for such thought-provoking writing, SFG. If it would be alright with you, I will be "holding your situation to the Light" to use the Quaker parlance.

Peace--

LHA said...

So glad to see you back! This is another meaningful and interesting post, so thank you for that. I especially appreciate you pointing out that newly minted "weight loss experts" who say it is easy to lose weight do a big disservice to those of us struggling with it. I know that sometimes it can FEEL easy, when you get in a kind of groove with your eating and feel comfortable with it, but eventually you the feelings, situations and triggers that led to overeating in the first place do rear their ugly heads and have to be deal with. Then it doesn't feel easy any more...it is a struggle and many people lose this fight.

On the subject of your depression, my sympathy to you for that. I have had some very big depressive episodes in my life and it is a special kind of hell. No one who hasn't experienced clinical depression can understand the pain of it. Your description of being pulled along behind a car is an apt one, and a good description. I wish you luck in regaining your emotional health and congratulate you on not diving head first into a mountain of food in response to your situation. Thanks for posting!

Karen in SC said...

I'd like to welcome you back, too! Great thoughts for me to ponder...

Anonymous said...

Good job on the healthier lifestyle. It's not easy.

RedPanda said...

Addiction is forever. All you can do is be in a state of remission. There is no cure.

As a food addict in remission, I agree.

This statement about the permanency of the psychological/behavioural aspect of food addiction is mirrored in the physiological changes that occur in the formerly obese. See the comment from bariatric specialist Dr Sharma, on the post below about how the "hypometabolic state" in the previously obese "appears to be for life – so ‘no cure’"

http://www.drsharma.ca/obesitywhy-is-it-so-hard-to-maintain-a-reduced-body-weight.html#sthash.vuIbI1jz.dpuf

Anonymous said...

Very nice post. I was thinking about addiction lately too. I think sugar is a substance addiction enforced by habitual addiction that is why it is so difficult to break free of sugar. You may be interested in this article http://ngm.nationalgeographic.com/2013/08/sugar/cohen-text
I also believe that habits pass from parent to child but don't know if this is true.

hopefulandfree said...

How gratifying it feels to see a recent update from you on your blog. For better or worse, I do tend to worry a bit much whenever there is a period of silence from a blogger whose posts have often offered some helpful insights to me regarding various challenges that I, too, share.

I also share similar struggles with feelings that seem to beg for immediate solutions...i.e. "be gone damn anxiety and inertia and uncertainty!!!" when such solutions can only arise gradually through one's commitment to healthier practices, day in and day out.

I am familiar with the SMART Program that FredT mentioned, a systematic approach for "Self Management and Recovery Training" that leaves out the requisite spiritual aspects suggested by other programs (such as 12 step groups) while focusing on harm reduction strategies and on learning new ways of coping with problematic urges, emotions and other triggers that have typically prompted relapses into old, unhealthier patterns of response. It helps people identify the perceived benefits of addictive or compulsive behaviors vs. the costs...both short and long term. For instance, the SMART literature emphasizes concepts such as seeking new values by participating with helpful behavioral models and teachers, taking small steps, practicing persistence, being mindful of day to day thoughts and actions, staying motivated by keeping a balanced (realistic) perspective, and gradually developing new, healthier (rewarding) habits over time. SMART RECOVERY also acknowledges that positive changes occur in stages, not all at once (as with a religious conversion experience.)

Thomas Horvath's workbook, "Sex, Drugs, Gambling, and Chocolate", for instance, offers many self help exercises and ideas for breaking free from compulsive or addictive behaviors.

dlamb said...

Just thinking of you and hoping you are well.

dlamb said...

Hi SFG,
Just a quick note to tell you that I miss your posts and I hope you are well. The topic of quality blogs and bloggers came up on a site on which I participate and you sprang to mind immediately.

hopefulandfree said...

Hi SFG,

Just popping in to wish you a happy and peaceful new year. Keep sharing your personal wisdom and ideas with others, as you see fit, of course.

Even with our spats and disagreements, and my sometimes orneriness, I value the relationship we managed to create, together, no matter how small or insignificant it may have seemed on the surface.

Be well. Be good to yourself. You deserve love and respect, I assume you know, and I shall be thinking fondly of you and the courage you showed when you moved from your old home far away to this country of strange contrasts. I, too, am leaving my home (by myself) and moving to a place where I know not a soul. Sometimes, as you suggested more than once, a person must take a leap of faith, trust their own inner intelligence or their mysterious intuitive promptings, and just GO FOR IT!

Otherwise, by not acting, or taking that risk, a choice is still being made...and it, too, will come with unknown consequences.

I hope your life in 2014 will bring you all good things, including the fulfillment of your longings and dreams for a more peaceful and happy life.

Hugs,
hopefulandfree