Kosher Cruising (Oceans, Not Bars)

I just got back from my first cruise and a lot of people had questions about how it went in general, and specifically how it went as a kosher consumer. My husband and I traveled with family on the Celebrity Millenium on a seven-day cruise of Alaska's inside passage (note: I found this blog, which details one passenger's experience of our cruise day by day, if you want photos of more details, and if my arms allow, I'll write my own reflections later).

Our biggest concern about this cruise, hands down, was the availability of food that meets our dietary needs. We keep kosher, and in addition, I don't eat gluten or sugar. Moreover, I have to weigh my food to treat my binge eating disorder -- meaning that combined foods don't work very well for me, i.e. I do much better with fish, potatoes, veggies than with a fish stew. If you just ask a cruise line for "kosher meals" you will get the disgusting airline meals. We weren't willing to cruise with that as our sustenance, so we upgraded our meal plan to Celebrity's Premium Kosher meals. These were strictly kosher, frozen, catered meals substantially upgraded from the regular airplane food that they serve you if you just specify that you keep kosher. Celebrity charged an extra $17 per meal per person for this service, but that airplane food is barely edible for anybody, and definitely does not work with my food plan, so it was worth it to us.

We had a whole hassle before our trip when we learned, quite by accident, that Celebrity had dropped their vendor for Premium Kosher meals. Panic ensued. Friends who have cruised have assured me that the ship's kitchen would cook fish double-wrapped in aluminum foil for kosher consumers (this would allow us to eat food cooked in an oven where non-kosher food is also prepared), but when we called Celebrity customer service to ask about this, they told us that this was up to the discretion of each ship's crew. Crap!

When we got on board with a ton of packaged food, we went straight to Guest Services to register our concern. We ended up meeting that night with Executive Chef Jason Baynor, who told us that "the most important thing" to him was that we were happy and satisfied. We worked out a system where they custom cooked our lunches and dinners for us every day; they actually have a portion of their kitchen separated with police-line-type tape that is covered in tin foil and reserved for kosher food, which we saw on a tour of the galley kitchen. Even better, they had brand new pans that they reserved for our use. For days, we ate delicious variations of fish, gluten-free starches, and veggies. When I got sick of fish, I ordered an omelet, and then Jason asked if his sous chef could make us Indian curries in the new pots, and that is where the fun began. For three nights, we had Indian feasts of fish curries, rice, vegetable curries, and naan made from rice flour, which was surprisingly delicious. Furthermore, Celebrity bakes all of its own bread on board, and the ice cream is made from milk, cream and flavors bearing reliable kosher supervision. Lucky David!

For kosher consumers contemplating a cruise who wouldn't be comfortable with this type of unsupervised kashrut situation, you have a decision to make: if you are one of these travelers who truly doesn't care about food and just wants to see the sights, you may be ok on a cruise. For me, I would have been furious and resentful choking down the airline food, and it would've ruined my trip. You've probably heard that a big part of cruising is the food. This is true, both in the sensual pleasure of it and the social aspect: you spend a lot of time socializing around food on a cruise whether you're with people you know, or with strangers. This is an important part of cruising culture, and I would be doing a disservice to pretend like our dining arrangements weren't important. They were huge in our enjoyment of our travels.

Chef Jason and his crew went way out of their way to bend over backwards to gladden our tummies and satisfy our complicated dietary needs. In fact, on two different nights, other diners in the dining room asked our waiter why they didn't see what we were eating on the regular menu and asked if they could get it too (answer: no). The last night of the cruise, I was speaking to the restaurant manager, who actually works on many different Celebrity ships, and he told me he knows his colleagues on the other vessels would be happy to do the same thing for us. Having this issue resolved so satisfactorily definitely means that we would be willing to cruise again, and truth be told, it was an issue of God giving us an outcome much better than we could've ever imagined for ourselves: the first night on board we had some of the remaining Premium Kosher food and it was less than premium. We ended up with delicious, freshly cooked food made to order! The staff was way more than grudgingly helpful; they seemed genuinely concerned and interested in making our dining experience good. The head maitre d', Lazar, whom I wanted to invite to live with us, told us that he was learning about kashrut (the noun form of "keeping kosher") to better understand his kosher clients. Interestingly, Lazar is Serbian Orthodox and said that his religion has many of the same restrictions as kashrut, such as requiring that you drain the blood out of an animal before you eat it. The point is, they really cared.

In other oceanic food news, weighing my food was difficult on the ship, as both the motion of the boat and the magnetic interference made both digital and spring-loaded scales less than accurate. I just had to do the best I could at any meal, and some were definitely smoother than others. The bottom line is, I didn't eat compulsively, and if you have been on a cruise, you know what an accomplishment that is! It is literally a 24-hour food fest; you can get pizza or a steak in the middle of the night at no cost to you. I attracted more stares than usual with my food scale, but the truth is, I'd rather be stared at for weighing my food than for being twice the size I am now. There were some shockingly obese people on the ship. Far from feeling condemnation, I just felt sad, because they were truly limited because of their size. I am so grateful that because of my recovery in OA-HOW, I am pretty darn average looking and am not limited by my body weight. David and I went dog-sledding on a glacier in Juno. The company that organizes this charges a hefty surcharge for people weighing more than 280 pounds. Given that my top weight was 250, I was close to that a few years ago. Someone who previously went on this excursion joked with me to "not lie about my weight" (they weighed you there, so that wasn't an option anyway), and I am so unbelievably grateful to not be at a weight where I'm even tempted to lie about it. Weighing all my food so precisely is a huge pain in the ass sometimes, but for me the choice truly is between that and being back at 250 pounds, or more. There is no question for me which is worse.

The Power of Positive Thinking

I am coming up on five years of back-to-back abstinence in OA-HOW, a structured way of working the Overeaters Anonymous (OA) program, a Twelve Step program for people wrestling with any food-related compulsion. In OA, abstinence means "refraining from compulsive overeating" or other compulsive food behavior like anorexia or bulimia. In HOW, we put a lot of emphasis on abstaining from negative thinking, which is really hard for me. I am by nature, negative, and the brain does a lot to try to protect us from future heartache; one of its main ways of doing this is by anticipating the worst to "inoculate" us from bad things happening in the future. Of course, this is erroneous, because we just end up suffering twice: in the anticipation of the bad event, and then, if/when the bad event happens.

Pesach (Passover) has always been a miserable holiday for me. It is hard for any observant Jew: imagine preparing for Christmas and moving at the same time. There is a tremendous amount of work to prepare for the holiday, some of it very labor intensive. Even though my husband David carries most of the heavy lifting, I still do my fair share, and the necessities of the holiday preparation -- cleaning, shopping, cooking, entertaining, and staying up late -- really pushes all of my buttons. It activates my chronic pain in a bad way. All of this means that I usually approach the holiday with a lot of dread and negativity. This makes me miserable, but worse, it also erodes David's enjoyment of the holiday.

I have been getting deeper into my mindfulness practice, and I think I am growing weary of the suffering I cause myself. Pain in life is inevitable, but more and more I am clearly seeing that I am the source of most of my suffering. Stress happens, of course, but the stories I construct about what I am experiencing are truly the cause of my misery. There is a massive difference between pain and suffering. So, in an attempt to cut down on my suffering, I decided to try something different for Pesach this year: abstaining from negative thinking, just like my Twelve Step program advises me to do.

I wasn't sure I could successfully keep a positive attitude, but I was determined to try one day at a time. To my surprise, I was quite successful. To my amazement, it made a tremendous difference to the quality of my holiday. Yes, I am still exhausted. Yes, I am still in pain bad enough that it requires narcotics to manage it, which I hate taking. But I have enjoyed this holiday more than any in the past. I was more productive. David said, "You have gotten more done, with less pain to yourself, than you ever have in the time I've known you." My OA sponsor said, "I can tell how much calmer you are." Even my body bears the fruits of my efforts: this is the first time in a decade I haven't had my telltale Pesach cold sore, which is a stress response.

This has made for an infinitely sweeter holiday. It is is profoundly meaningful for my faith -- it is the story of God rescuing the Jews from brutal slavery in Egypt, ultimately leading to our redemption and giving of the Torah at Mount Sinai. This year, freed from the excessive negativity and crap stories I tell myself, I was able to relax and enjoy the holiday, both for what Hashem (God) did for the Jewish people, but also what Hashem did for me: leading me out of food addiction to a saner, freer existence. I used to dread Pesach because I was so driven by the compulsion to eat, I couldn't stay away from non-kosher food, or chametz, leavened food prohibited on the holiday, for even eight days. It was torture. This was a problem for me since adolescence.

To an outsider, it seems like I do a lot of extreme things for my recovery program: I weigh and measure all my food, yes, even in public, even when it's embarrassing. I make at least four telephone calls per day to other fellows in recovery. I do a daily reading and writing assignment. Most importantly, I work the Twelve Steps, which are simple but never easy. Yes, all of this takes time, and I do not always enjoy it, to say the least! However, when I reflect on my greatest blessings of recovery, it becomes clear why this is so worth it. Yes, losing so much weight is amazing. But living with integrity is priceless. Knowing that I won't have to go binge on non-kosher foods during Pesach, or the other 51 weeks of the year -- and end up hating myself for it -- is the biggest blessing. Recovery has given me integrity: my insides match my outsides. No more outwardly living an Orthodox lifestyle, while binging at Burger King, praying no one sees me (and again, hating myself for my "lack of self control" -- I know now that this was the cunning, baffling, and powerful disease of addiction, as the book "Alcoholic Anonymous" describes it). Living my values, having God redeem me from slavery to food addiction is truly priceless. Is my daily OA work worth it? Hell yes!

A Happy Weight

I heard a podcast today that featured an interview with Kathianne Sellers Williams, a registered dietitian, life coach, and artist. She made a comment about helping clients find their "happy weight." She defines this as a weight at which you feel comfortable and at which you don't have to do anything extreme to maintain it. The distinction is more holistic than the traditional mode of thinking about weight-loss goals: the ever-ambiguous, just-out-of-reach "healthy weight," which varies based on whatever chart you're using.

I've lost about 103 pounds but am still about 25 pounds overweight. For about a year, I have been trying to lose more weight, but in reality, I have gained and lost the same four or five pounds over and over again. I perked up when I heard Sellers Williams talk about the "happy weight," because I've felt very dejected by failing to get my body to release more weight by cutting down on my calories and increasing my exercise. I've tried, and it's not budging. I've worked with my registered dietitian to change my food plan, and I already weigh all my food, so I have exact portion control. I can't exercise any more than I am due to my physical limitations from Lyme Disease, so I'm really doing all I can. The truth is that my dietitian could cut more food from my food plan, but that leaves me hungry and unsatisfied, which then makes the temptation to binge quite unmanageable. I'm just not willing to walk around hungry and cranky all the time just to lose some more weight.

During this weight plateau, it also has occurred to me that I would mostly be satisfied at this weight if I didn't lose another pound. I can buy clothes off the rack, not in the plus size section. I no longer take up 1.5 seats on the bus, and people sharing an aisle with me in an airplane can have their full (albeit, tiny), seat to themselves. My weight doesn't limit any of the physical activities that I want to participate in. There was a time when I wouldn't ride a horse, or be able to walk to the movie theater close to my home, or feel comfortable swimming because someone would see me in a bathing suit. Thank God, that's not the case anymore. Do I love my body? Hell no! I wish. My body shows the scars of my eating disorder: stretch marks, cellulite, and hanging skin. It's not gorgeous, and as much as it pains me to say this, it probably never would be -- even if I lost these last 25 pounds. But by dressing semi-well and occasional judicious use of Spanx Higher Power Panties (they're the bomb!), I manage to look ok clothed.

When Sellers Williams works with clients to help them find their "happy weight," one way they arrive at that number is by looking at the client's weight history. I have had two nutritionists I've worked with tell me that given my weight history -- how obese I was and how young I was when I became obese -- that it would be extremely unlikely that I'd ever get to be an ideal weight on a chart. One of the nutritionists said, "If you ever made it below 150 pounds, that would be incredible. Much more than that is not realistic given your background." Happily, I am below 150! I've exceeded their expectations.

Although I find the concept of a "happy weight" quite freeing, there is still a piece of me that resists it. My rational brain says, "You need to be as healthy as possible, and it's not healthy to carry extra fat." True, but we can't say I haven't tried to lose it, and again, we have to acknowledge that my health history makes it unlikely that I'll ever be thin. More critically, we need to take a more holistic view of what health means; it certainly is more than a number on the scale. It includes data like blood chemistry, lung capacity, and endurance, but also sanity, balance, serenity, and other non-quantifiable markers of a quality, healthy life. For the record, with the notable exception of my Lyme Disease, I do seem to be quite healthy. I used to have elevated insulin levels and triglycerides, but those and other health markers normalized after I lost 40 pounds.

Another thing that conspires to keep me from embracing the concept of a "happy weight" is some peer-pressure from inside OA rooms to be a good role model for the program and demonstrate three-fold recovery: emotional, spiritual, and physical. When people see me, they see an average-looking American woman, meaning someone who could stand to lose a few pounds. They don't know how much weight I've lost and how hard I've worked to facilitate that. I think I just have to let this one go: if some people in OA rooms judge me for still being somewhat overweight, oh well. I can't control what they think, and they have the right to their self-righteous judgment. Whatever. It also occurred to me that fighting this weight my body seems to have settled at (which, by the way, it is evolved to do -- if you lose enough body weight it triggers the "starvation" switch in your brain, at which point the body fights like hell to hold on to every last pound) is very antithetical to Step 3: became willing to turn our will and our lives over to the care of God as we understood him. Step 3 is about surrender, not fighting. Isn't what I'm doing by trying to nudge the scale down -- and failing -- fighting? It sure feels that way, and I'm tired. And I think I'm done. If God, my body, or whatever sees fit to release more fat in the future, great, but I think I've given it a good go and now I need to let go, and enjoy my new, mostly healthy body.

Reflections on Three Years in H.O.W.: Spiritual

This is the first part of a three-part post discussing the spiritual, emotional, and physical facets of my recovery from an eating disorder.

May 25 marks three years of back-to-back abstinence (which is equivalent to sobriety in AA) in O.A.-H.O.W. HOW is one just one way of working the Overeaters Anonymous program, but it is a very structured approach. It is the reason that I do things like a daily writing assignment, making at least three calls to other people in OA, and committing and weighing all my food (yes, even my vegetables).

I chose to work the HOW concept because I was attracted to the spiritual, emotional and physical recovery that I saw in HOW meetings. I first began attending HOW meetings because I was desperate to see living examples of people who had as much weight to lose as I did, who did it safely and without surgery. I couldn't find examples in my local, traditional OA meetings, so I started hanging out in HOW circles. At the time, I thought people in HOW went overboard, and I found their approach quite threatening. Thankfully, I was able to find abstinence in traditional OA, albeit still with a strict sponsor. A sponsor is your guide in a 12-step program; people work with sponsors in a variety of ways, but at the very least, your sponsor is usually the main person who helps you work the 12 steps and holds you accountable.

I had my right ankle ligaments reconstructed in June 2006. It was very hard for me to leave the house, so I started doing OA phone meetings at that time in lieu of face-to-face meetings. The very first HOW phone meeting had just started on Wednesday nights, and I called in every week. In HOW meetings, we read a lot from primary 12-step texts. Anyone can do those readings. We also read summaries of the eight tools of recovery, and then HOW sponsors (and only HOW sponsors) share their personal experience with using those tools for up to three minutes. At meetings, only I grew frustrated being on the sidelines, and not being able to fully participate in the meeting since I was not a HOW sponsor. At the same time, I became willing to do the two things that up to that point had kept me from jumping into HOW with both feet: weigh my food in public, and give up alcohol.

At the time, I thought it was slightly amusing that I was taking all this on. After all, I was at my sickest with my Lyme Disease: I couldn't write, type, or cut vegetables, among many other things. I can see clearly now how much the HOW concept has saved my butt over the course of my extended illness. The reality of having to talk to three other people in program and my sponsor every day means I can't isolate. The emphasis on service both in and out of the program has really allowed me to get out of my head and think about how I can help others, which is especially useful when I'm full of self-pity about having been so sick for so long. The fact that I sponsor two amazing women who need to speak to me six days a week before they start their busy days means that I have to wake up by 7 a.m. instead of sleeping until noon like I would otherwise.

A major thing HOW has done for me is really spur my spiritual growth. The most poignant example of this is my change in my observance of kashrut [the practice of keeping kosher aka adhering to Jewish dietary laws]. One of the most painful and shameful parts of my food addiction was the discrepancy between my public face of being an Orthodox Jew, and my private hell of binging five days a week on McDonalds, Burger King, etc. I felt like a fraud. Oh yeah, that's because I was a fraud. I prayed and prayed to God to keep me from sinning in this way; I knew it was wrong, but I couldn't stop. Now I know that as long as I was putting addictive foods in my body that triggered my compulsive eating, and as long as I engaged in compulsive eating behaviors, there was no way in hell I could have stopped. When I am eating sugar, my compulsion is off to the races, religion be damned. This is really like the alcoholic who has only one drink, but soon is blacking out. For an addict, one is too many and a million never enough.

The feeling of sneaking all of this treif [non-kosher] food was one of humiliation, fear, disgust, and exhaustion. It took a lot of planning to procure the cash to binge, because I wouldn't use a debit or credit card at a restaurant that would allow my husband to see how I was drawing down our bank account. He used to wonder why I was regularly withdrawing $60-100 in cash a week that mysteriously disappeared. When I ran down our bank account, I would go to a drug store and buy junk food there, since that was a "legitimate" looking charge on our statement. Then there was the whole element of how I would avoid seeing Jewish friends when going on my daily sprees; I had ready-made excuses about why I was buying such-and-such thing. I was always looking over my shoulder.

Thanks to recovery, that dark time of sneaking around fast food joints is long passed. It feels so light, clean, and honest to be able to look in the mirror and have my outward appearance and behavior match my inner faith and values. Please don't think I'm never tempted: the other day I walked by an Italian restaurant and could feel the texture and taste the mozzarella sticks and tomato sauce in my mouth. I'm thankful that I can have cravings today and know that they're just cravings -- I don't have to give in to them, and they will pass. Now, when I go into a McDonalds, it really is just for a diet coke or bottle of water!

Thanks to the work I've done in the HOW concept, I feel closer to God now than I ever have. I have true joy in celebrating my faith, and have made it a priority to engage in regular, formal prayer, in addition to my freestyle prayer in the mornings. I'm even becoming one of those people I've wanted to be for so long: the type who regularly checks in with God, not only at set times of the day or when I need something, but just to check in. More and more, when I have to make a decision, I try to discern God's will for me instead of making it all about me. It's good.

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Insurance company readers: this post took me two days.

Doctors: Your Patients Know Obesity Is A Problem

I have no doubt that my obesity compromised my health care. I'm not referring to my health, but to my actual health care. When I weighed 250 pounds, I felt dismissed and looked down on by many doctors. I felt disrespected. So it was gratifying to see that my experience was not unique, and indeed is quantifiable: scientists reported in the November issue of the Journal of General Internal Medicine that the higher the patients' body mass index (BMI), the less respect doctors have for them. The irony is not lost on me that the patients with the highest BMIs might also be the people most likely to be in dire need of quality health care from an empathetic practitioner.

Being an obese patient caused me enough anxiety that I searched online databases of "fat-friendly" doctors to try to find a practitioner who wouldn't make me feel like a freak. Some of my concerns were very tangible and practical: Would they have a gown big enough to fit me? Would they weigh me in a public hallway? But what really worried me was the disdain that I often encountered.

Upon seeing an internist for the first time, he chided me about my weight and told me. "If you just reach for baby carrots instead of Oreos when you're hungry, you'll lose weight." I nodded sheepishly, my cheeks burning. What I really thought was, "You dumbfuck. Congratulations! You just solved America's obesity crisis. Who knew it was that simple? Wow, carrots instead of Oreos. What a chiddush [insight/epiphany]!"

Another barrier to health care for the obese is the presumption that anything wrong with you must be directly or indirectly related to your obesity. I saw a jerk of an orthopedist shortly after a car accident in which I sustained whiplash. After ruling out major injuries with an MRI, his #1 recommendation to me was to follow the South Beach Diet. My pain persisted, and I sought follow-up care from him, but he was very dismissive. "If you'd just lose the weight, your back wouldn't hurt," the mean orthopedist said. Here I am, 102 pounds lighter. To be fair, my back is substantially better, but I still need chiropractic care. By the way, I ran into the aforementioned orthopedist on the street last year. He didn't recognize me at my new weight, and I seriously considered pulling him aside to tell him how hurtful and harmful his derision was to me, and to tell him how I finally did get a handle on my eating disorder (not with the South Beach diet). I chickened out.

Before losing the 102 pounds, I asked my ex-chiropractor if he thought my weight was causing my back problems. He replied, "Look around my waiting room. Most of my patients are not overweight." I'm not arguing that obesity does not cause or aggravate some health problems; just that the assumption that this is always the case is erroneous and damaging. I have run into this assumption so many times, it's infuriating. I feel like obesity is the biggest scapegoat in health care; it's far easier for a doctor to say "lose weight" than to take the time to address the complex factors that might be causing the complaint.

I'm sympathetic to health care providers who have to walk the fine line of counseling patients on their health -- which includes information on attaining or maintaining a healthy body weight -- but who risk angering their patients. I think whether or not a doctor broaches this subject with patients depends on their relationship, the patient's health, and other factors. However, if doctors choose to go there, they have to be tactful when broaching the subject, and I have some tips for them:

1. Context is everything. If I'm going to a dermatologist because of an acne flare up, it would be inappropriate for her to offer unsolicited advice about my weight.

2. I think doctors need to acknowledge how difficult weight-loss is, especially for obese people. I give my old internist, Dr. Graves (no, that's not a made up name!), a lot of credit in this area: he would suggest that I lose weight but always said, "I know it's so hard, Sarah. In fact, I haven't had any patients who have really been successful in the long run, but please keep trying." I found this simultaneously comforting and discouraging at the same time, but I appreciated his candor.

3. Providers should be prepared with suggestions beyond trying Weight Watchers or the latest fad diet. Those might be helpful tools for some people, but I personally believe that most people who are as obese as I was are true food addicts, not merely people who need a cheerleader and a public, weekly weigh-in to motivate or shame them into compliance. Many of you know that the Overeaters Anonymous-H.O.W. Concept was and is my gateway to recovery. I don't think it's an answer for everyone, but I do my best to educate my doctors about OA-HOW and its role in my recovery. Therapists and nutritionists with specialties in binge-eating disorders are other resources doctors could refer patients to.

4. Doctors in glass houses should not throw stones. It was very hard for me to take seriously any exhortations for me to lose weight when the doctor nagging me was overweight or obese himself.

5. Finally, health care providers should approach obese patients with the understanding that no one in this country thinks that his/her obesity is not a problem. Often doctors would speak to me as if they were the first person to bring this up, when in fact, they were the hundredth. This is akin to smokers; there are no smokers left in this country who don't know that smoking is dangerous to their health and their social lives. The same is true for overweight people. They understand the danger, but don't know how to control the compulsion that leads them to overeat, or how to overcome the deeply ingrained lifestyle habits that contribute to their body mass.

I am grateful that Dr. Huizinga published her research on doctors' disdain for obese patients. I hope that it sparks some soul-searching on the part of doctors to think about how they relate to their fat patients and how their attitudes might compromise the care of this already vulnerable population.

Bariatric Surgery for Children = A Terrifying Idea

Recently, I had a shocking conversation with two health care providers from Baltimore. They work in an inner-city hospital that soon is planning to do bariatric surgery, such as gastric bypass, on children as young as five, and it hopes to do the procedures on babies as young as two in the next few years. How is this horrifying? Oh, let me count the ways! But first, some background.

I am a grateful member of Overeater's Anonymous, which has helped me lose 99 pounds and has given me the support to not eat compulsively since Dec. 31, 2005. The program is patterned after that of Alcoholics Anonymous, but helps people who have any kind of disordered eating whether they are compulsive overeaters, anorexics, bulimics, or some combination of all three. All of the local OA meetings are under the umbrella of the D.C. Intergroup, which purchased a booth in the exhibit hall of the Obesity Society's annual meeting in Washington, D.C. I was the co-chairwoman of this project, primarily taking care of scheduling and working with volunteers from OA who handed out OA literature and spoke with conference participants about the program and how it can complement their practices and help them help patients with eating disorders.

I felt like the Obesity Society booth was an amazing project to work on, because we were talking with doctors, therapists, nurses, researchers, nutritionists, and anyone who works to cure or manage obesity. They came from as far away as Argentina, Australia, Saudi Arabia, South Korea, and the United Kingdom. I asked each person I spoke with about their jobs so I could give them relevant information about OA. This is how I learned about the Baltimore hospital's plans for pediatric bariatric surgery. Until then, when I've heard the adjective "pediatric" modifying bariatric surgery, it has referred to teenagers aged 14-17. Note that it is controversial to do bariatric surgery on kids in this age range, and it's tough for teenagers to find docs willing to operate on them at that age. So, when the women told me they plan to do this surgery on two year-olds I repeated what they said to make sure I heard them right.

When someone has gastric bypass surgery, a surgeon sections off part of the stomach to make a tiny pouch that can hold very little food, and rearranges the intestines to join that pouch. There are other forms of bariatric surgery, like the Lap-band, an inflatable device that goes around the top of the stomach and that the doctor inflates with saline to reduce the amount of food the stomach can hold at one time. Bariatric surgery, especially gastric-bypass, is a serious procedure with a not-insubstantial risk of severe complications and death. Of course, since it's only performed on people who are morbidly obese (typically defined as being 100 pounds or more overweight), one could argue that the patients were dying from their obesity anyway and that their obesity puts them at risk for surgical complications. Even if it's true, I don't think even that warrants surgery with high complications and spotty efficacy.

People who work 12-step programs have sponsors, who are like your guides on your recovery journey. I have sponsored several women who have had bypass surgery, and guess what? They're all doing the same work I'm doing every day for my recovery, like making 3 phone call to other food addicts, doing a daily reading and writing assignment, and weighing their food, but they struggle with nausea and/or diarrhea and/or vomiting, and have to get intravenous iron infusions because they're anemic as a result of their surgeries. Moreover, all of my sponsees who have had bypasses have gained nearly all or all of their weight back, which shouldn't surprise you, because the things that cause someone to be eligible for bariatric surgery are not in the stomach. They are in the mind, heart, and soul, and no surgeon can fix those things.

I have several friends who have had gastric bypass, and all of them suffer complications -- some major. My friend, H, lost more than 200 pounds in OA and had so much hanging skin, she had to walk with a cane. She had to get that extra skin removed via a body lift, which is a really nasty and drastic surgery. She was hospitalized for nearly two months because her wounds wouldn't heal. Granted, they are enormous -- they cut from both sides of your navel and cut all the way around your circumference, stopping just before your butt crack. But one of the reasons she wouldn't heal is that she couldn't assimilate enough protein to heal because of her bypass surgery.

The women from the hospital in Baltimore told me that they have two year-old patients who weigh 80 pounds (normal is up to 30 lbs.) How did these babies get so fat? They're not in the kitchen baking lasagnas or going to CVS for Ben N' Jerry's and Oreos. Their caretakers are overfeeding the kids and making them obese, and unless these kids are reassigned to foster care after their bariatric surgery, the same parents are going to overstuff their kids post-operatively. Why would this be different with children?

I think if this trend of operating on very young children catches on, we're going to see a lot of kids who are both fat and sick. It's one thing for an adult to choose a life disrupted by potential diarrhea or vomiting, yet another to impose it on helpless kids. We also should be freaked out about this because we have no idea how weight-loss surgery will affect growth and development when done on a young child. What will be the consequences of limiting dietary calcium on bones that are still growing? Bariatric surgeons will tell you that patients will take supplements, but we already know that the body does not integrate nutrients from dietary supplements the same way it does from food (duh). Could limiting food quantities adversely affect neurological development? We don't know, and the professional hubris that says it's safe to do gastric bypass on 2 year-olds is really galling.

If you're thinking, "Kids are fatter than ever and getting comorbidities of obesity like Type 2 diabetes, which was unheard of 20 years ago. So, what would you propose instead of pediatric bypass surgery?" First of all, I'd tell you to chill with the obesity horror stories -- I think it has become the healthcare boogeyman, which I'll discuss in another post. I won't solve the obesity crisis on my blog, though I hope to explore its many facets. But I did read a summary of a clinical study with impressive outcomes that might be a step in the right direction. A facility in West Virginia created a summer camp for overweight kids that was followed up with family programming throughout the year. So after the camp, the entire family participated in healthy cooking and exercise classes. The kids responded really well, both losing weight and keeping it off. I don't think that cooking and exercises classes are of much use to true food addicts, but hopefully we can intervene with overweight kids before they become addicted. I strongly believe that bariatric surgery on two year-olds is most definitely NOT the answer to our obesity problem.