Note: Written with Megan Ramos of Intensive Dietary Management Program.
Have you eaten a loaf of garlic bread, a bowl of pasta, and a dish of pistachio gelato and still felt hungry? Have you come home from dinner and then ate a bag of popcorn in secret to satiate you before bed? You’re not alone. I hear these stories from people every day, and I’ve had some of my own. Your mind is telling you that you are full because you must undo the top notch on your belt, but your stomach is still complaining it’s empty. Some people continue to eat, sometimes all day long, until mere moments before they go to bed. They feel helpless and out of control, binging on foods they know they should be avoiding.
Then everybody knows people who are the complete opposite. Those people who eat half a sandwich or a small salad at lunchtime and then declare themselves completely stuffed. And they’re not trying to be modest. They are actually completely full. They won’t eat more because it is uncomfortable for them to do so. These people are often quite thin.
Many of our IDM Programclients have undergone bariatric surgery. Their appetites were so far out of control that they felt they needed invasive, expensive surgery to regulate their unruly bodies. And despite all the promises of bariatric surgery to allow patients to lose weight and improve health, it fails almost invariably. The stories are eerily similar. Initially, they lose some weight, but after several months the weight creeps back on. But worse, they feel that their appetite is just as out of control as it has ever been. “How can this be?” they ask despairingly. “I’ve had my stomach physically stapled to make it smaller!”
They misunderstood the problem with hunger. It’s not about the size of your stomach. Hunger does not occur because your stomach is too big. And if that is not the problem, then surgically cutting it smaller is not going to help. Likewise, hunger is not about your willpower or self-control. You cannot will yourself not to be hungry. You cannot ‘decide’ to be less hungry. You are hungry or you are not. Your appetite is hormonally driven. That is what we need to fix. Not surgically rewiring our intestines. Not counting calories. If you don’t regulate your appetite on a hormonal level, you’ll never regain control no matter how small your stomach is.