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.

Brightening the Lights

Recently, I've been learning more about the brain's reward system pathway. I don't want to go too deeply into it because, frankly, even people who know a little about it get frustrated and irritated when I go deep into the details. It's pretty dense stuff, and only those who want to know the science very well need to know about it. So, I'm going to speak in general terms, and entertain questions about details should my readers want more concrete answers.

What I've learned recently enhances what I talked about in the previous several posts, and it has mainly applied to substance use and abuse. In particular, I've learned a thing or two about how drugs that affect the parts of your brain that experience pleasure mess up your ability to take joy in anything else. The woman who was teaching the class I was sitting in on told us a story which, after hearing it, ran a bell very strongly with my experience with food.

This woman has a PhD, is a registered nurse, and a practicing licensed therapist as well as a teacher at a private graduate school. One can conclude she has a lot of practical as well as book-oriented knowledge. She told us about a client that she had who had spent several years using cocaine. Prior to his cocaine use, he used to enjoy music greatly. After using cocaine, music no longer could offer him the same joy, not even long after he'd stopped using the drug.

What had happened to this man was that the parts of his brain that were stimulated by the drug were the same ones that allowed him to take pleasure in other things. By abusing the drug to hyper-stimulate those areas, he changed the way they experienced the world forever. That's right. Forever. They were permanently changed such that nothing would ever give him pleasure in the same way again.

The reason this story really hit home with me was that, when I started changing my relationship with food, I wrote about how my life was changing. In this post (12th paragraph), "I should note that there is very much an aspect of this which is “duller” than things used to be. That is, the lights were more brilliant and the colors were brighter when food was fully centralized". This was a reflection of the fact that food was the thing that lit up the pleasure centers in my brain in a way nothing else could.

A lifetime of using food for comfort has almost certainly altered my brain's reward pathways just as those in the cocaine addict were altered. The highs were rarely as high for me as they were when I was fully invested in partaking in food with not restriction. However, I do believe that there is a difference between what happened to me and what happened to the cocaine addict. He was damaged and can't be repaired. I am damaged and am in the process of being repaired.

It continues to be a long and complex  path. Due to the psychological processing I've done, I can never regard food as the end all and be all of pleasure. The "buzz" I got from it died and I can't honestly say that anything has replaced it in intensity. I can say that things have slowly gotten better as I've tried to replace that pleasure with other types of pleasure, but it's more about collecting little bits of thing to enjoy then one whopper that delivered it's payload of joy in one sitting.

I don't know about the biology for certain, but I'd be shocked if people like me didn't see their reward pathways light up like a Christmas tree from food and provide dim lighting from other sources of pleasure. I think that this could be part of the complex picture of why people who lose weight regain. Just as the cocaine addict goes back to the drug because life becomes dim and joyless without it, the addicted eater may similarly find that the lights need some brightening when they try to abandon their drug of choice.

I know that it has taken me years to decouple destructive pleasure seeking in food and it's still there to some extent (as my last few posts illustrate) and similarly has taken years to elevate other pleasures to a meaningful status in terms of my response. I'm not saying every fat person does this, but I do think that for those of us who became fat as children and continue to be fat as adults, there's a good chance that our brains are built around this way of deriving pleasure from our world.

Food, the addiction

I read a study today which supported something I have contended for quite some time, but is often doubted by many. The study compared responses in the brain to food to responses to addictive substances. It was a small study of only 48 women, and not constructed with impeccable validity, but the brain scans suggested that the brains of those who are addicted to drugs and those potentially addicted to food are having the same sorts of responses.

This isn't an "a-ha" moment for me in which I am asserting triumphantly that I was "right" because one little study lends credence to the notion that people actually can be addicted to food. Frankly, brain scans are of little interest to me in "proving" what I believe. I have always seen addiction as a psychological issue. The fact that physiological analysis can be done to back that up is gravy. It's behavior that matters, and behavior that must be changed if people want to change their lives in the directions they'd prefer to go.

I knew I was addicted to food. I say "was" but recent events make me wonder if I still am and always will be. As my last several posts indicate, I've been in a state of enormous difficulty in my life as of late. It's the result of ongoing issues which, as of about 3 days ago, are starting to be resolved. It's important to note that, for the last 5 months as things have gotten worse emotionally, I have been hungrier than ever. This could be mere coincidence, but as of the breaking point after which things started to clear up and solutions looked like they may be at hand, that constant hunger has vanished.

I've written before that we are programmed to eat when stressed, but I'd gotten past the point where normal everyday stress drove me to eat. It was only the oppressive and psychologically damaging weight of long-term emotional difficulty that set off that hunger. Even in the face of it, I wasn't overeating, but I was having to battle wanting to eat all of the time regardless of my sense of actual physical satiety (that is, there was food in my stomach and sugar in my blood stream). I was starting to feel as if I'd jumped back to the point where I'd have to spend all day thinking about food and trying not to overeat, but now I realize that was not what it was.

The bottom line was that, while I consciously do not have a food addiction and do not think about having a pint of ice cream to comfort me, unconsciously and/or biochemically, I still have the same stress responses that compel me to eat when I am under prolonged difficulty and intense stress. I didn't act on the impulses to my detriment, but it was adding another layer of emotional wear and tear to my life as I struggled with a plethora of other problems.

This reminded me all too clearly that much of my weight loss to date has occurred under relatively ideal circumstances. Those who are in far less positive circumstances than me are going to struggle more as they respond both biologically and psychologically to overwhelming urges to eat when stressed. While I didn't need this reminder to empathize with others who are trying to lose weight, I was given it nonetheless.