Calories underestimated in "healthy" restaurants
By Anne Harding
Fri Sep 14, 3:24 PM ET
People who opt for a meal at a "healthy" restaurant often consume more calories than they would dining at fast food joints that make no health claims, a new study shows.
The researchers found that individuals underestimate the calorie content of foods served at restaurants they see as healthier, to a degree that could easily lead to weight gain.
For example, "People think that the same 1,000-calorie meal has 159 fewer calories if it comes from Subway than if it comes from McDonalds," Dr. Pierre Chandon, at INSEAD in Fontainebleau, France, told Reuters Health. "If they choose to consume this fictitious 'calorie credit' on other food, and it they eat at Subway twice a week, they could gain an extra 4.9 pounds a year."
While restaurants presenting themselves as healthy have grown at a much faster rate over the past five years than traditional fast food restaurants, Americans' waistlines have not been shrinking; in fact, the nation's population is fatter than ever, note Chandon and his colleague Dr. Brian Wansink of Cornell University in Ithaca in their report in the Journal of Consumer Research.
The researchers theorized that people might take in more calories when they eat in "healthy" restaurants, and conducted a series of studies to test this notion.
In the first, they asked people who had just finished eating at Subway or McDonalds to estimate how many calories they had just consumed. On average, Subway patrons rated their meals as having 151 fewer calories than did McDonalds patrons. In fact, for a meal at either restaurant containing 1,000 calories, people would estimate it to contain 744 calories if they'd eaten at McDonalds and 585 calories if they'd dined at Subway.
In the second experiment, they asked people to estimate the calorie content of four different sandwiches: a six-inch ham and cheese sandwich (330 calories) and a 12-inch turkey sandwich (600 calories) from Subway; and a McDonalds cheeseburger (330 calories) and a Big Mac (600 calories). Study participants consistently rated the Subway sandwich as having fewer calories than the McDonalds sandwich with the same calorie content.
Next, the researchers offered people a coupon for a Big Mac (600 calories) or a Subway 12-inch Italian BMT sandwich (900 calories), and asked them whether they would like to order a drink or cookies with their sandwich. People eating the Subway sandwich were more likely to choose a large drink, less likely to opt for diet soda, and more likely to get cookies. This meant that, on average, they wound up consuming 1,011 calories, compared to 648 calories for the people given a McDonalds coupon.
People who want to control their weight or trim down need to think objectively about calorie content, and not let their perceptions be clouded by whether a food is supposed to be good or bad for them, Chandon said. "We have to move away from thinking of food in 'good food / bad food' (terms) and think also about 'how much food.' In France, for example, people enjoy relatively fat diets but are less overweight simply because portion sizes in restaurants and at home are smaller."
Chandon suggested one technique to help people judge calorie counts more accurately: "Instead of estimating the number of calories of the whole meal (which leads to undercounting) look at the sandwich, the side, the beverages, and the drink and add that up. Our research showed that this 'piecemeal' method is very effective."
SOURCE: Journal of Consumer Research, October 2007.
Friday, September 14, 2007
Thursday, September 13, 2007
2007 Livermore Walk From Obesity nears
The 2007 Livermore Walk From Obesity needs your help. Please do what you can to volunteer, join a team or donate to the cause. If you want to join my team or donate to it, visit my page here. Registration is $25 and includes a shirt, all-day pass to LifeStyleRx in Livermore (where the walk starts) and other goodies. The walk is from 8:30 to 10:30 a.m. Saturday, Oct. 6, at LifeStyleRx, 1119 Stanley Blvd., in Livermore. You can walk anywhere from a quarter-mile to three miles.
Thursday, August 23, 2007
Sunday, August 12, 2007
Cooled off...sorta
It's taken a couple of days but I think I can finally address the topic of the 12-year-old who had Lap-Band surgery in Mexico with some measure of civility. At least, I hope I can.
What disturbs me most about the case is this girl's mom and the apparent lack of accountability on the part of both of them. Mom has a fat kid, so her first step is cosmetic surgery (tummy tuck and lipo). When that fails, Mom takes daughter (now 12) to Mexico for bariatric surgery.
Now everyone is happy. Mom says daughter is a compulsive eater and she likes the band because whenever she overeats, she throws up (nice way to train for bulimia, I suupose). Mom likes that her daughter is finally thin and fashionable.
My personal favorite of all the comments Mom made were those related to why she didn't have her daughter go through the process in the states: Money. Nutritional and psychological counseling were too expensive. Really? Compared to a tummy tuck ($3K-$6K), lipo ($1K) and Lap-Band ($9K in Mexico)? Why do I have a hard time buying that story?
I was a fat kid -- not a chubby kid, a FAT kid. I understand how cruel children and adults can be to obese children. It's not a fun life, but is cosmetic and bariatric surgery the answer? I don't think so. A 12-year-old is not mature enough to understand the dangers/consequences of such decisions. The key to long-term weight-loss success is developing a healthy relationship with food and learning to balance consumption with exercise. What has this little girl learned about that? And how is she supposed to learn when Mom's answer to everything is surgery?
What disturbs me most about the case is this girl's mom and the apparent lack of accountability on the part of both of them. Mom has a fat kid, so her first step is cosmetic surgery (tummy tuck and lipo). When that fails, Mom takes daughter (now 12) to Mexico for bariatric surgery.
Now everyone is happy. Mom says daughter is a compulsive eater and she likes the band because whenever she overeats, she throws up (nice way to train for bulimia, I suupose). Mom likes that her daughter is finally thin and fashionable.
My personal favorite of all the comments Mom made were those related to why she didn't have her daughter go through the process in the states: Money. Nutritional and psychological counseling were too expensive. Really? Compared to a tummy tuck ($3K-$6K), lipo ($1K) and Lap-Band ($9K in Mexico)? Why do I have a hard time buying that story?
I was a fat kid -- not a chubby kid, a FAT kid. I understand how cruel children and adults can be to obese children. It's not a fun life, but is cosmetic and bariatric surgery the answer? I don't think so. A 12-year-old is not mature enough to understand the dangers/consequences of such decisions. The key to long-term weight-loss success is developing a healthy relationship with food and learning to balance consumption with exercise. What has this little girl learned about that? And how is she supposed to learn when Mom's answer to everything is surgery?
Friday, August 10, 2007
12-year-old gets Lap-Band in Mexico
I need a moment to gain my composure on this one...but until then, watch the clip and leave your opinion:
http://www.cnn.com/video/#/video/us/2007/08/07/ochoa.tx.lap.band.kvue
http://www.cnn.com/video/#/video/us/2007/08/07/ochoa.tx.lap.band.kvue
Tuesday, July 31, 2007
Sunday, July 29, 2007
Changes are a comin'
I am in the process of negotiating with the Tracy Press to take over sole ownership of Inside Out, both in print and online. My work in the field of bariatrics and as the writer of this column/blog has begun to overshadow my actual full-time job as managing editor of the Tracy Press in the eyes of some.
What the general public has not realized is that I have never been paid by the Press for my work on Inside Out. I write all postings and attend all bariatric- and obesity-related events on my own time, either using paid or unpaid time off, depending on the situation. This has worked just fine for the last 2.5 years. However, demands on my time have increased exponentially this year, leading me to request more time off work and leading the public to think that Inside Out is my full-time job.
The Tracy Press and I have agreed that it would be best for everyone involved if I were to formally make Inside Out a personal endeavor. This is exciting news for me, because it means from this point on, I truly own my own words. Even with free columnists, the Press assumes the rights over everything it prints. It also means I get more freedom over my postings. The Press has never told me what I can and cannot write, but since I know that many readers consider this blog the property of the Press, I have stayed away from certain topics.
The only downside to this arrangement is that I no longer get media clearance into events as a representative of the Tracy Press. If an organization extends media credentials to bloggers and freelance writers, I will be able to obtain press passes under that umbrella but I can no longer use the Tracy Press' name or resources to gain entrance. Truthfully, though, I don't foresee that being a problem. It's not a privilege I took advantage of much anyway.
To better facilitate this division, I have created a consulting company with a business associate for my work in the field of bariatrics. We call our company Bariatric Network Associates, and we specialize in the education and support of those interested in surgical weight loss and the medical professionals who serve them.
We have our first Introduction to Weight Loss Surgery seminar tomorrow (Monday, July 30) at Sutter Tracy Community Hospital. Thanks to the generosity of the hospital, we are able to offer the seminar at no charge but we do request that those interested let us know they will attend ahead of time. The company's contact information is on the Web site.
What the general public has not realized is that I have never been paid by the Press for my work on Inside Out. I write all postings and attend all bariatric- and obesity-related events on my own time, either using paid or unpaid time off, depending on the situation. This has worked just fine for the last 2.5 years. However, demands on my time have increased exponentially this year, leading me to request more time off work and leading the public to think that Inside Out is my full-time job.
The Tracy Press and I have agreed that it would be best for everyone involved if I were to formally make Inside Out a personal endeavor. This is exciting news for me, because it means from this point on, I truly own my own words. Even with free columnists, the Press assumes the rights over everything it prints. It also means I get more freedom over my postings. The Press has never told me what I can and cannot write, but since I know that many readers consider this blog the property of the Press, I have stayed away from certain topics.
The only downside to this arrangement is that I no longer get media clearance into events as a representative of the Tracy Press. If an organization extends media credentials to bloggers and freelance writers, I will be able to obtain press passes under that umbrella but I can no longer use the Tracy Press' name or resources to gain entrance. Truthfully, though, I don't foresee that being a problem. It's not a privilege I took advantage of much anyway.
To better facilitate this division, I have created a consulting company with a business associate for my work in the field of bariatrics. We call our company Bariatric Network Associates, and we specialize in the education and support of those interested in surgical weight loss and the medical professionals who serve them.
We have our first Introduction to Weight Loss Surgery seminar tomorrow (Monday, July 30) at Sutter Tracy Community Hospital. Thanks to the generosity of the hospital, we are able to offer the seminar at no charge but we do request that those interested let us know they will attend ahead of time. The company's contact information is on the Web site.
Saturday, June 30, 2007
Living and eating well after all these years
Originally published Saturday, July 30, in Our Town for the Tracy Press.
This week marked the launch of the revised edition of “Before & After: Living and Eating Well After Weight-Loss Surgery” by Susan Maria Leach.
Leach’s first edition, affectionately known by many in bariatric circles as “the pink book,” has gotten a lot of coverage in this column as I’ve traveled on my journey toward a healthy weight.
I first discovered Leach through her Web site, www.bariatriceating.com, an online superstore of all things a bariatric patient could want or need. It didn’t take me long to find out that her promise of “great taste and good nutrition” was more than just mere words.
The pink book was waiting for me, along with a shipment of protein supplements from her company, when I got home from the hospital after having Roux-en-Y gastric-bypass surgery in 2005.
To this day, I credit Leach’s book and products for helping me to achieve my weight-loss goals without sacrificing my health, appearance or energy.
The revised edition, packaged in a light-blue paperback for convenience, is everything its predecessor was and so much more.
The hybrid of diary, no-nonsense advice and cookbook features 35 more recipes and updated information based on research and discoveries in the bariatric field since the original printing in 2004.
“I have a better perspective as a six-year post-op,” Leach said in an interview this week. “I now understand that people don’t do the right thing automatically. I see so many who give it all up for fast food and sugar, and begin a downward spiral again.”
Leach said she’s realized that many people who have suffered from morbid obesity have a difficult time figuring out how to deal with food. She hopes the new edition’s inclusion of meal plans for every stage of post-op eating will help those people adopt healthier eating habits.
“I offer different good food choices for each meal and simple recipes to combine their grocery list items,” Leach said. “My meal plans train people to create new food patterns that they will enjoy eating and will stick to long term.”
The book’s new recipes reflect Leach’s travels and constant quest for food that is fabulous and healthy. One of her favorite additions is the creamy Tuscan white bean soup, featured on Page 132. She said it’s a replica of a soup she enjoyed with her aunt in Tuscany last year.
“It’s a wonderful reminder of a fantastic trip,” she said. “Plus, it’s a 15-minute recipe that can be used in the earliest stages after surgery but will be a family favorite for years!”
In addition to new recipes, the book also features updated versions of previous favorites, like Leach’s light banana bread.
The new banana bread recipe is a perfect example of what is possible when the marketplace broadens its offerings. She replaces the Splenda (sucralose) and protein powder used in her original recipe with Nature Sweet Crystals (maltitol) and California almond flour.
“This superb sugar replacer makes a delicious, healthy loaf that is indistinguishable from a full-sugar, full-fat version,” Leach writes in the recipe’s introduction on Page 263.
Though the original edition of “Before & After” was a financial success for Leach, she hopes readers feel they get something for their money with the second edition.
“Weight loss surgery was not my first choice; it was my last choice,” she said. “It is so important that people understand it is not a diet that ends at a goal weight; it is a new way of life.”
This week marked the launch of the revised edition of “Before & After: Living and Eating Well After Weight-Loss Surgery” by Susan Maria Leach.
Leach’s first edition, affectionately known by many in bariatric circles as “the pink book,” has gotten a lot of coverage in this column as I’ve traveled on my journey toward a healthy weight.
I first discovered Leach through her Web site, www.bariatriceating.com, an online superstore of all things a bariatric patient could want or need. It didn’t take me long to find out that her promise of “great taste and good nutrition” was more than just mere words.
The pink book was waiting for me, along with a shipment of protein supplements from her company, when I got home from the hospital after having Roux-en-Y gastric-bypass surgery in 2005.
To this day, I credit Leach’s book and products for helping me to achieve my weight-loss goals without sacrificing my health, appearance or energy.
The revised edition, packaged in a light-blue paperback for convenience, is everything its predecessor was and so much more.
The hybrid of diary, no-nonsense advice and cookbook features 35 more recipes and updated information based on research and discoveries in the bariatric field since the original printing in 2004.
“I have a better perspective as a six-year post-op,” Leach said in an interview this week. “I now understand that people don’t do the right thing automatically. I see so many who give it all up for fast food and sugar, and begin a downward spiral again.”
Leach said she’s realized that many people who have suffered from morbid obesity have a difficult time figuring out how to deal with food. She hopes the new edition’s inclusion of meal plans for every stage of post-op eating will help those people adopt healthier eating habits.
“I offer different good food choices for each meal and simple recipes to combine their grocery list items,” Leach said. “My meal plans train people to create new food patterns that they will enjoy eating and will stick to long term.”
The book’s new recipes reflect Leach’s travels and constant quest for food that is fabulous and healthy. One of her favorite additions is the creamy Tuscan white bean soup, featured on Page 132. She said it’s a replica of a soup she enjoyed with her aunt in Tuscany last year.
“It’s a wonderful reminder of a fantastic trip,” she said. “Plus, it’s a 15-minute recipe that can be used in the earliest stages after surgery but will be a family favorite for years!”
In addition to new recipes, the book also features updated versions of previous favorites, like Leach’s light banana bread.
The new banana bread recipe is a perfect example of what is possible when the marketplace broadens its offerings. She replaces the Splenda (sucralose) and protein powder used in her original recipe with Nature Sweet Crystals (maltitol) and California almond flour.
“This superb sugar replacer makes a delicious, healthy loaf that is indistinguishable from a full-sugar, full-fat version,” Leach writes in the recipe’s introduction on Page 263.
Though the original edition of “Before & After” was a financial success for Leach, she hopes readers feel they get something for their money with the second edition.
“Weight loss surgery was not my first choice; it was my last choice,” she said. “It is so important that people understand it is not a diet that ends at a goal weight; it is a new way of life.”
Sunday, June 17, 2007
Product Review: Better Balance Protein Cereal
The folks at Kay's Naturals sure do know their stuff when it comes to protein snacks. I was lucky enough during ASBS to sample a variety of their products, but the Better Balance Protein Cereal exceeds expectation. During the conference, I snacked on the Honey Almond and French Vanilla flavors right out of the bag. This morning for breakfast, I enjoyed the Apple Cinnamon variety mixed with my Fage 0% greek-style yogurt.
Though I like all of the varieties, Honey Almond is my favorite. It reminds me a bit of Smart Start, which was a cereal I regularly enjoyed as a pre-op. Apple Cinnamon tastes like Apple Jacks, and French Vanilla has a great vanilla flavor.
The O-shaped cereal comes in 1 oz. packages, providing 9 grams of soy protein in 100 calories with 1.5 grams of fat and 15 grams of carbohydrate (3g dietary fiber; 3g sugar). The cereal is sweetened with inulin.
Hit or Miss? A definite hit. The Kazemzadehs, who own the company, were nice enough to let me try almost all of their products at the convention tradeshow. Awesome product!
Though I like all of the varieties, Honey Almond is my favorite. It reminds me a bit of Smart Start, which was a cereal I regularly enjoyed as a pre-op. Apple Cinnamon tastes like Apple Jacks, and French Vanilla has a great vanilla flavor.
The O-shaped cereal comes in 1 oz. packages, providing 9 grams of soy protein in 100 calories with 1.5 grams of fat and 15 grams of carbohydrate (3g dietary fiber; 3g sugar). The cereal is sweetened with inulin.
Hit or Miss? A definite hit. The Kazemzadehs, who own the company, were nice enough to let me try almost all of their products at the convention tradeshow. Awesome product!
Saturday, June 16, 2007
From the "duh" files...
SAN DIEGO -- Though I appreciate the time and effort taken in researching obesity and bariatric procedures and outcomes, some studies make me shake my head in wonder.
For instance, comparing the success rate of bariatric surgery to commercial weight loss programs seems ridiculous. After all, does anybody really think counting POINTS! can hold a candle to rerouting one's digestive tract to reduce capacity and nutrient absorption? That doesn't even seem logical to me, much less a wise use of funding.
Here are two of what I'd call "duh" studies that were presented at the convention this week:
* Bariatric surgery makes people more sensitive to alcohol -- I don't think any of us with gastric bypass needed Stanford researchers to tell us that our rerouted intestinal tract makes us cheap dates when it comes to running a bar tab.
Dr. John Morton, assistant professor of surgery and senior author of the study, was quoted in today's Science Daily as saying, "I've heard the anecdotes of a patient who will drink one glass of wine and get a DUI, but I wanted to know if there is really a difference before and after the surgery."
Dr. Morton later says in the article that most patients aren't aware of this and that Oprah has done the field a favor by pointing it out on her show about the dangers of cross-addiction. I don't know about the rest of the post-ops in the world, but I discovered that fact the first time I tried wine after surgery. I didn't need Oprah or a study to enlighten me. Furthermore, I had been warned by other post-ops about the phenomena long before I ever had surgery, so I don't think it's as big of a mystery as Dr. Morton professes.
* Binge eating and a sweet tooth lead to gastric-band failures -- Just to make sure we're all on the same page here, a team of Swiss researchers reported that those post-ops who binged on food or indulged in sweets experienced a higher incidence of band failure than those who did not. The conclusion? The best candidates for banding are highly motivated patients who don't binge or eat sweets. Wouldn't you say the same thing for any type of bariatric procedure?
For instance, comparing the success rate of bariatric surgery to commercial weight loss programs seems ridiculous. After all, does anybody really think counting POINTS! can hold a candle to rerouting one's digestive tract to reduce capacity and nutrient absorption? That doesn't even seem logical to me, much less a wise use of funding.
Here are two of what I'd call "duh" studies that were presented at the convention this week:
* Bariatric surgery makes people more sensitive to alcohol -- I don't think any of us with gastric bypass needed Stanford researchers to tell us that our rerouted intestinal tract makes us cheap dates when it comes to running a bar tab.
Dr. John Morton, assistant professor of surgery and senior author of the study, was quoted in today's Science Daily as saying, "I've heard the anecdotes of a patient who will drink one glass of wine and get a DUI, but I wanted to know if there is really a difference before and after the surgery."
Dr. Morton later says in the article that most patients aren't aware of this and that Oprah has done the field a favor by pointing it out on her show about the dangers of cross-addiction. I don't know about the rest of the post-ops in the world, but I discovered that fact the first time I tried wine after surgery. I didn't need Oprah or a study to enlighten me. Furthermore, I had been warned by other post-ops about the phenomena long before I ever had surgery, so I don't think it's as big of a mystery as Dr. Morton professes.
* Binge eating and a sweet tooth lead to gastric-band failures -- Just to make sure we're all on the same page here, a team of Swiss researchers reported that those post-ops who binged on food or indulged in sweets experienced a higher incidence of band failure than those who did not. The conclusion? The best candidates for banding are highly motivated patients who don't binge or eat sweets. Wouldn't you say the same thing for any type of bariatric procedure?
Thursday, June 14, 2007
Candelas San Diego
SAN DIEGO -- Words cannot describe the dinner I experienced this evening. We visited Candelas on Third Avenue. And I say visited, because it was so much more than just a place to eat; it was an all-encompassing environment with an amazing atmosphere, above-par staff and cuisine that was out of this world.
Our party decided on a collection of appetizers and one entree to share, because making a decision was so difficult. We all giggled a bit when our server, Tony, went over his recommendations on the menu. He said everything was "amazing" but suggested the duck, poblano soup and the avocado salad. We thought he was just angling for a good tip -- until we were presented with the incredible dishes we ordered.
The Carpaccio Franco ($12) had fan of paper-thin raw ahi drizzled with a lemon-cilantro mustard sauce served around a salad of marinated bell peppers, baby greens and tequila-marinated pear. The ahi was so tender that it melted on my tongue, but I would have liked a little more of the sauce to enhance its flavor.
Taking Tony's suggestions to heart, we ordered the Estructura de Aguacate ($11.50), which was a stacked salad of avocado, scallops, crap, shrimp, parsely and mild jalapeno with a light drizzle of mango-basil vinaigrette. The presentation was awe-inspiring. The salad was molded into a cylinder in the center of the plate with ribbons of dressing poured around the edges. It had a delicate flavor, with each ingredient complementing one another instead of competing for attention.
The Crema Fabiola ($14.50) is a stellar puree of poblano chile and cream with a half of a lobster tail poised in the center. The color contrast between the pink and white lobster and the sage-green soup was eye-catching but nothing prepared me for the taste of the soup. It was an explosion of flavor that led a few of us to consider licking the bowl when we were finished.
The only entree we ordered, the Pechuga de Pato Lucrecia ($25.50) was another sight to behold. The duck breast was cooked in its own juices until medium rare and then fanned around vegetables and mashed potato with a light passionfruit sauce. The duck barely required a knife to cut and its buttery texture dissolved easily on the tongue. Our only regret was that our pouches forced us to leave one succulent piece on the plate along with the potato. Even Tony remarked it was a crime.
We had planned to pass on dessert until Tony mentioned crepes covered in a goats milk caramel that sounded heavenly. The presentation was simple, two crepes swimming in thick, rich caramel with pecans sprinkled over the top. We each took only one bite, knowing that a second would leave us sick all night. But that one bite was all that was needed for an instant trip to nirvana. It was the type of dessert that makes you not want to put anything else in your mouth so you can savor the flavor as long as humanly possible and then burst into tears once it diminishes.
I could not even imagine a better way to end the most hectic day of the convention.
Our party decided on a collection of appetizers and one entree to share, because making a decision was so difficult. We all giggled a bit when our server, Tony, went over his recommendations on the menu. He said everything was "amazing" but suggested the duck, poblano soup and the avocado salad. We thought he was just angling for a good tip -- until we were presented with the incredible dishes we ordered.
The Carpaccio Franco ($12) had fan of paper-thin raw ahi drizzled with a lemon-cilantro mustard sauce served around a salad of marinated bell peppers, baby greens and tequila-marinated pear. The ahi was so tender that it melted on my tongue, but I would have liked a little more of the sauce to enhance its flavor.
Taking Tony's suggestions to heart, we ordered the Estructura de Aguacate ($11.50), which was a stacked salad of avocado, scallops, crap, shrimp, parsely and mild jalapeno with a light drizzle of mango-basil vinaigrette. The presentation was awe-inspiring. The salad was molded into a cylinder in the center of the plate with ribbons of dressing poured around the edges. It had a delicate flavor, with each ingredient complementing one another instead of competing for attention.
The Crema Fabiola ($14.50) is a stellar puree of poblano chile and cream with a half of a lobster tail poised in the center. The color contrast between the pink and white lobster and the sage-green soup was eye-catching but nothing prepared me for the taste of the soup. It was an explosion of flavor that led a few of us to consider licking the bowl when we were finished.
The only entree we ordered, the Pechuga de Pato Lucrecia ($25.50) was another sight to behold. The duck breast was cooked in its own juices until medium rare and then fanned around vegetables and mashed potato with a light passionfruit sauce. The duck barely required a knife to cut and its buttery texture dissolved easily on the tongue. Our only regret was that our pouches forced us to leave one succulent piece on the plate along with the potato. Even Tony remarked it was a crime.
We had planned to pass on dessert until Tony mentioned crepes covered in a goats milk caramel that sounded heavenly. The presentation was simple, two crepes swimming in thick, rich caramel with pecans sprinkled over the top. We each took only one bite, knowing that a second would leave us sick all night. But that one bite was all that was needed for an instant trip to nirvana. It was the type of dessert that makes you not want to put anything else in your mouth so you can savor the flavor as long as humanly possible and then burst into tears once it diminishes.
I could not even imagine a better way to end the most hectic day of the convention.
A whirlwind of a day
SAN DIEGO -- Thursday was such a crazy day that it took me until Friday to realize that I didn't publish this post. I'm back-dating it so it's chronological:
I sat in today on an interesting session for primary clinicians. The opening speaker was Dr. Sasha Stiles of Kaiser South San Francisco, where I had my bariatric surgery two years ago. Dr. Stiles is the program's medical director, creating Kaiser's Northern California program with Dr. Prithvi Legha (my surgeon). During my time with Kaiser, I grew to know Dr. Stiles more than Dr. Legha because she is the one who handled my pre-operative screenings and post-operative follow-up. I was very sad when my employer switched from Kaiser coverage, because she is such an amazing doctor. At least I'm still able to be in Dr. Legha's capable hands.
Dr. Stiles provided a brief introduction to the Primary Clinicians Tract that was an overview of the advancements made in the treatment of obesity. For a rail-thin woman, she knows a lot about obesity. She sees 6,000 patients a year through Kaiser's bariatric program, and the South San Francisco facility treats about 200 patients a month.
She didn't report anything that was new or earth-shattering but did pose some interesting questions for the audience to ponder. Her over-arching theme regarding the success of bariatric surgery was that it provides hope for the morbidly obese. Hope, she said, is what motivates patients to make the lifestyle changes required for long-term success.
She called the physicians collectively on the carpet for not doing a good enough job in following up with their patients to ensure long-term success. Studies show that dieting is stressful and that even the most successful weight loss programs have followers who fall off the wagon and start over. Dr. Stiles said anticipating this aspect of human nature can make bariatric programs more successfull, too. After all, if you anticipate that after two years, post-ops will stop attending after-care programs and possibly begin to gain back weight, doctors could then build services into their programs to bring those patients back to the fold in a supportive manner.
Makes sense to me. What do the rest of you think?
I sat in today on an interesting session for primary clinicians. The opening speaker was Dr. Sasha Stiles of Kaiser South San Francisco, where I had my bariatric surgery two years ago. Dr. Stiles is the program's medical director, creating Kaiser's Northern California program with Dr. Prithvi Legha (my surgeon). During my time with Kaiser, I grew to know Dr. Stiles more than Dr. Legha because she is the one who handled my pre-operative screenings and post-operative follow-up. I was very sad when my employer switched from Kaiser coverage, because she is such an amazing doctor. At least I'm still able to be in Dr. Legha's capable hands.
Dr. Stiles provided a brief introduction to the Primary Clinicians Tract that was an overview of the advancements made in the treatment of obesity. For a rail-thin woman, she knows a lot about obesity. She sees 6,000 patients a year through Kaiser's bariatric program, and the South San Francisco facility treats about 200 patients a month.
She didn't report anything that was new or earth-shattering but did pose some interesting questions for the audience to ponder. Her over-arching theme regarding the success of bariatric surgery was that it provides hope for the morbidly obese. Hope, she said, is what motivates patients to make the lifestyle changes required for long-term success.
She called the physicians collectively on the carpet for not doing a good enough job in following up with their patients to ensure long-term success. Studies show that dieting is stressful and that even the most successful weight loss programs have followers who fall off the wagon and start over. Dr. Stiles said anticipating this aspect of human nature can make bariatric programs more successfull, too. After all, if you anticipate that after two years, post-ops will stop attending after-care programs and possibly begin to gain back weight, doctors could then build services into their programs to bring those patients back to the fold in a supportive manner.
Makes sense to me. What do the rest of you think?
Food, fabulous food
SAN DIEGO -- It occurred to me last night after signing off that I've yet to post about food. One of the reasons I promote Susan Maria Leach's book, "Before and After: Living and Eating Well After Weight Loss Surgery," (revised edition goes on sale in two weeks) is because it proves that enjoying great food does not end when you go under the knife.
A lot of non- and pre-ops I meet fear gastric-bypass surgery means a life without taste, texture and gastronomical pleasure, but nothing could be further from the truth. If anything, most of us become food snobs after weight loss surgery. I ate fast food at least twice a week as a pre-op. Now, I could hardly be paid to eat at McDonalds or Carl's Jr. -- the food doesn't even taste good enough to be pouch-worthy. I can find something to eat just about anywhere, but I'd rather not waste valuable space in my gastric pouch on mediocre food.
So, what does the American Society of Bariatric Surgery have served at its annual conference? Last year, I made the mistake of thinking that because it was an event about bariatrics, the catering would reflect the needs of bariatric patients. Wrong. What I forgot in my naivete is that the conference is geared toward bariatric health care providers -- not patients -- so the food did not match what my pouch could tolerate. If it hadn't been for the BariatricEating.com booth last year, I would have surgery fainted for lack of protein. That's part of the reason I agreed to help Susan at her booth this year -- I owe her a debt of gratitude for saving my pouch last year.
So far this year, I've been pleasantly surprised. Yesterday's breakfast was the obligatory continental convention fare: pastries, muffins, bagels, fruit, juice and coffee. The BE.com gang picked up coffees and went to the booth to make protein lattes and cappuchinos. I enjoyed a delicious latte made up of Nectar Cappuccino, Matrix Chocolate, Micellar Milk and hot water (12 oz offers about 25 grams of protein). For my mid-morning snack, I sipped coffee mixed with vanilla Micellar Milk and a shot of Davinci sugar-free Englis Toffee syrup and Cinnamon Bliss (a sugar-free caramel replacement that tastes just like a spicy cinnamon roll). OK, I'll be honest: I had two of those for about 20 grams of protein combined.
Lunch, however, offered something for everyone. The buffet featured a selection of salads and build your own sandwiches. I enjoyed a small green salad with tomato-basil vinaigrette and swiss cheese rolled up with deli ham and grainy mustard -- fast, filling and delicious. I was wise and steered clear of the decadent desserts.
Back at the booth, we were serving Revial soy chips (I'll have to review those at a later time), parmesan cheese crisps, AchievOne, Nectar Twisted Cherry mixed with Cherry-Pomegranate Crystal Light, ThinkThin bars and New Whey protein bullets in addition to the Micellar Milk lattes. Again, my body has never been so happy. My blood sugar only dipped once all day.
For dinner, we attended the conference's welcome reception. Again, I didn't know what to expect. Imagine my delight when I spied appetizer tables overflowing with oysters on the half shell, succulent shrimp, snow crab claws, cheese trays, canapes and beef and turkey carving stations. I didn't even glance in the direction of the pasta and dessert areas, though I did spy a few people enjoying chocolate-covered strawberries and baklava. But personally, those are treats in which I could never eat just one. Instead, I helped myself to oysters with Tobasco and fresh lemon, shrimp and crab sans cocktail sauce, green olive tapenade eaten with a spoon, Jarlsberg cubes, and melon-wrapped proscuitto and brie with a dab of cream cheese and mandarin orange (it was easy to set aside the little squares of toast atop which the melon and brie canapes were served).
Heavenly food aside, the best part of the cocktail party was that you couldn't easily tell the post-ops from the non-ops. We were mostly all enjoying the same delicious cuisine combined with excellent conversation. And like I told a couple of very handsome Australian surgeons yesterday, that -- to me -- is what the gift of surgical weight loss is all about: looking, acting and living a normal life. I could have kissed just about every doctor there for that blessing.
A lot of non- and pre-ops I meet fear gastric-bypass surgery means a life without taste, texture and gastronomical pleasure, but nothing could be further from the truth. If anything, most of us become food snobs after weight loss surgery. I ate fast food at least twice a week as a pre-op. Now, I could hardly be paid to eat at McDonalds or Carl's Jr. -- the food doesn't even taste good enough to be pouch-worthy. I can find something to eat just about anywhere, but I'd rather not waste valuable space in my gastric pouch on mediocre food.
So, what does the American Society of Bariatric Surgery have served at its annual conference? Last year, I made the mistake of thinking that because it was an event about bariatrics, the catering would reflect the needs of bariatric patients. Wrong. What I forgot in my naivete is that the conference is geared toward bariatric health care providers -- not patients -- so the food did not match what my pouch could tolerate. If it hadn't been for the BariatricEating.com booth last year, I would have surgery fainted for lack of protein. That's part of the reason I agreed to help Susan at her booth this year -- I owe her a debt of gratitude for saving my pouch last year.
So far this year, I've been pleasantly surprised. Yesterday's breakfast was the obligatory continental convention fare: pastries, muffins, bagels, fruit, juice and coffee. The BE.com gang picked up coffees and went to the booth to make protein lattes and cappuchinos. I enjoyed a delicious latte made up of Nectar Cappuccino, Matrix Chocolate, Micellar Milk and hot water (12 oz offers about 25 grams of protein). For my mid-morning snack, I sipped coffee mixed with vanilla Micellar Milk and a shot of Davinci sugar-free Englis Toffee syrup and Cinnamon Bliss (a sugar-free caramel replacement that tastes just like a spicy cinnamon roll). OK, I'll be honest: I had two of those for about 20 grams of protein combined.
Lunch, however, offered something for everyone. The buffet featured a selection of salads and build your own sandwiches. I enjoyed a small green salad with tomato-basil vinaigrette and swiss cheese rolled up with deli ham and grainy mustard -- fast, filling and delicious. I was wise and steered clear of the decadent desserts.
Back at the booth, we were serving Revial soy chips (I'll have to review those at a later time), parmesan cheese crisps, AchievOne, Nectar Twisted Cherry mixed with Cherry-Pomegranate Crystal Light, ThinkThin bars and New Whey protein bullets in addition to the Micellar Milk lattes. Again, my body has never been so happy. My blood sugar only dipped once all day.
For dinner, we attended the conference's welcome reception. Again, I didn't know what to expect. Imagine my delight when I spied appetizer tables overflowing with oysters on the half shell, succulent shrimp, snow crab claws, cheese trays, canapes and beef and turkey carving stations. I didn't even glance in the direction of the pasta and dessert areas, though I did spy a few people enjoying chocolate-covered strawberries and baklava. But personally, those are treats in which I could never eat just one. Instead, I helped myself to oysters with Tobasco and fresh lemon, shrimp and crab sans cocktail sauce, green olive tapenade eaten with a spoon, Jarlsberg cubes, and melon-wrapped proscuitto and brie with a dab of cream cheese and mandarin orange (it was easy to set aside the little squares of toast atop which the melon and brie canapes were served).
Heavenly food aside, the best part of the cocktail party was that you couldn't easily tell the post-ops from the non-ops. We were mostly all enjoying the same delicious cuisine combined with excellent conversation. And like I told a couple of very handsome Australian surgeons yesterday, that -- to me -- is what the gift of surgical weight loss is all about: looking, acting and living a normal life. I could have kissed just about every doctor there for that blessing.
Wednesday, June 13, 2007
New key studies on morbid obesity and bariatric surgery
SAN DIEGO -- The following studies will be released Wednesday at the American Society of Bariatric Surgery annual meeting in San Diego:
The Impact of Bariatric Surgery on Health Care Costs
Date/Time: 8:45 a.m. Wednesday
Lead Author: Anita P. Courcoulas, MD, University of Pittsburgh Medical Center
Key finding: Bariatric surgery reduces health care costs over time, especially those related to medication usage.
Bariatric Surgery in Adolescents: Analysis of 309 Cases
Date/Time: 9 a.m. Wednesday
Lead Author: Esteban Varela, MD, MPH, VA North Texas Health Care System and University of Texas Southwestern
Key finding: Bariatric surgery outcomes in adolescents appear to be as safe as for adults.
Preoperative Weight Gain Does Not Predict Failure of Weight Loss or Co-morbidity Resolution of Gastric Bypass for Morbid Obesity
Date/Time: 10:30 a.m. Wednesday
Lead Author: Michael C. Harnisch, MD, Duke University
Key finding: Gastric bypass surgery can be performed safely with improvements in co-morbidity and extended weight loss regardless of preoperative weight gain or loss.
Presurgery Psychiatric Disorders are Associated with Smaller Reductions in BMI at 6 Months After Gastric Bypass
Date/Time: 10:45 a.m. Wednesday
Lead Author: Melissa A. Kalarchian, Ph.D., Assistant Professor of Psychiatry and Psychology, Western Psychiatric institute and Clinic University of Pittsburgh Medical Center
Key finding: Preliminary analyses suggest pre-surgery psychiatric disorders are related to poorer weight outcome at six months after gastric bypass. Results suggest that intervention to improve psychosocial functioning, especially anxiety and depression, may improve surgery outcomes.
Laparoscopic Adjustable Gastric Banding in Patients >65 Years of Age
Date/Time: 2 p.m. Wednesday
Lead Author: David A. Provost, MD, University of Texas Southwestern Medical Center, UT Southwestern Medical Center
Key finding: Laparoscopic gastric banding provides a safe and effective weight loss option in patients 65 years and older
The Impact of Bariatric Surgery on Health Care Costs
Date/Time: 8:45 a.m. Wednesday
Lead Author: Anita P. Courcoulas, MD, University of Pittsburgh Medical Center
Key finding: Bariatric surgery reduces health care costs over time, especially those related to medication usage.
Bariatric Surgery in Adolescents: Analysis of 309 Cases
Date/Time: 9 a.m. Wednesday
Lead Author: Esteban Varela, MD, MPH, VA North Texas Health Care System and University of Texas Southwestern
Key finding: Bariatric surgery outcomes in adolescents appear to be as safe as for adults.
Preoperative Weight Gain Does Not Predict Failure of Weight Loss or Co-morbidity Resolution of Gastric Bypass for Morbid Obesity
Date/Time: 10:30 a.m. Wednesday
Lead Author: Michael C. Harnisch, MD, Duke University
Key finding: Gastric bypass surgery can be performed safely with improvements in co-morbidity and extended weight loss regardless of preoperative weight gain or loss.
Presurgery Psychiatric Disorders are Associated with Smaller Reductions in BMI at 6 Months After Gastric Bypass
Date/Time: 10:45 a.m. Wednesday
Lead Author: Melissa A. Kalarchian, Ph.D., Assistant Professor of Psychiatry and Psychology, Western Psychiatric institute and Clinic University of Pittsburgh Medical Center
Key finding: Preliminary analyses suggest pre-surgery psychiatric disorders are related to poorer weight outcome at six months after gastric bypass. Results suggest that intervention to improve psychosocial functioning, especially anxiety and depression, may improve surgery outcomes.
Laparoscopic Adjustable Gastric Banding in Patients >65 Years of Age
Date/Time: 2 p.m. Wednesday
Lead Author: David A. Provost, MD, University of Texas Southwestern Medical Center, UT Southwestern Medical Center
Key finding: Laparoscopic gastric banding provides a safe and effective weight loss option in patients 65 years and older
Tuesday, June 12, 2007
Dinner at Henry's
SAN DIEGO -- We ate dinner tonight at Henry's, an Irish Pub near the intersection of Market and Fifth. Though Henry's definitely has a pub atmosphere, the food choices were superb. No bangers and mash on the menu at this place.
Eating among post-ops is such a refreshing change from what I'm used to. Five of us are post-ops -- from two to six years out from surgery -- and discussing what to have for dinner is a fun experience in itself. No mention of pizza or fried foods.
The biggest decision we had was whether to order our own entrees or share. We all decided that we hadn't eaten enough during the day so we opted not to share. Us post-ops were copy cats; we each ordered the salmon with dill cream sauce and a double portion of veggies instead of mashed potatoes. Being the "youngest" post-op in terms of when I had my surgery, I ate the smallest amount but I held my own with the veterans.
What I loved most was watching each of them following the rules even at their stage: No drinking with meals, protein first, eating slowly and chewing each bite thoroughly. We had incredible conversation on topics ranging from WLS issues to work topics to just life in general. It was like a night out with my best girlfriends, except that these girlfriends eat the same way as me.
Eating among post-ops is such a refreshing change from what I'm used to. Five of us are post-ops -- from two to six years out from surgery -- and discussing what to have for dinner is a fun experience in itself. No mention of pizza or fried foods.
The biggest decision we had was whether to order our own entrees or share. We all decided that we hadn't eaten enough during the day so we opted not to share. Us post-ops were copy cats; we each ordered the salmon with dill cream sauce and a double portion of veggies instead of mashed potatoes. Being the "youngest" post-op in terms of when I had my surgery, I ate the smallest amount but I held my own with the veterans.
What I loved most was watching each of them following the rules even at their stage: No drinking with meals, protein first, eating slowly and chewing each bite thoroughly. We had incredible conversation on topics ranging from WLS issues to work topics to just life in general. It was like a night out with my best girlfriends, except that these girlfriends eat the same way as me.
Gringas like to party
SAN DIEGO -- Popping in for a second after helping to set up the BE.com booth at the ASBS convention center. I've learned many skills in my short time here. For instance, there is a lot of skill behind the building of a trade show booth, particularly when the shipping company crushes most of your boxes and leaves you to make do with damaged products. You'd never guess we had any trouble by looking at it, though.
Susan Maria Leach's new edition of "Before and After: Living and Eating Well after Weight Loss Surgery" hits bookstore shelves at the end of the month. The new version of the "pink book," as its known by many fans, is now a teal blue paperback that features updated information on the various types of surgeries, meal plans and even more recipes than its predecessor. Presale orders are now being taken at BE.com.
The best part of hanging out with the BE.com crew is that I never go hungry. We were all famished at light-headed while working on the booth, but that wasn't a problem because we had plenty of Revival soy chips, Power Crunch and Oh Yeah! bars and Protein DeLite Protein on the Go (chocolate coconut is soooo tasty!). My blood sugar hasn't been as level as it is today in weeks -- and I've been traveling -- not too bad, if you ask me.
Susan Maria Leach's new edition of "Before and After: Living and Eating Well after Weight Loss Surgery" hits bookstore shelves at the end of the month. The new version of the "pink book," as its known by many fans, is now a teal blue paperback that features updated information on the various types of surgeries, meal plans and even more recipes than its predecessor. Presale orders are now being taken at BE.com.
The best part of hanging out with the BE.com crew is that I never go hungry. We were all famished at light-headed while working on the booth, but that wasn't a problem because we had plenty of Revival soy chips, Power Crunch and Oh Yeah! bars and Protein DeLite Protein on the Go (chocolate coconut is soooo tasty!). My blood sugar hasn't been as level as it is today in weeks -- and I've been traveling -- not too bad, if you ask me.
Flying Southwest
Even after two years, the novelty of flying at a normal size has not worn off. Though I still feel like a world-class klutz when trying to negotiate my suitcase and carry-ons throughout the maze of airport lines and security checkpoints, I'm amazed at how effortless it is to move around -- even when loaded down with all my luggage.
This was my first time flying Southwest. I can see why people enjoy it. The lines weren't overly long, the staff was nice and the peanuts were yummy. I love that the seat belt fits me now, but the best part is still the tray table. Not only does it drop down completely, but I can also cross my legs beneath it!
Off to the convention center...more later
This was my first time flying Southwest. I can see why people enjoy it. The lines weren't overly long, the staff was nice and the peanuts were yummy. I love that the seat belt fits me now, but the best part is still the tray table. Not only does it drop down completely, but I can also cross my legs beneath it!
Off to the convention center...more later
Monday, June 11, 2007
Look out, San Diego
I'm leaving tomorrow morning for the American Society of Bariatric Surgery annual conference in San Diego. My goal is to blog daily from the event but if this year is anything like last year, I'll be lucky to eek out a posting or two each day. The conference is jam-packed with educational sessions, events and an overwhelming trade show.
Tuesday, May 29, 2007
Open mouth; insert foot
I attended tonight's meeting of the Tracy Express Network (a local chapter of the American Businesswomen's Association).
During the networking portion of the evening, I was chatting with an engaging woman from New York Life. We were talking about all the illnesses that seemed to be going around this spring, which both of our husbands caught with gusto. I told her that I get very worried when my husband is ill, because he's such a thin guy, adding that I don't have the same concern for myself. She chuckled a bit and looked me up and down. I realized then that this woman had no idea I have ever looked contrary to the way I do today. I let the subject drop and we parted ways to mingle further.
We caught up again a few moments later when another member, a woman I know rather well, greeted me by calling me "Skinny." She made a comment to the New York Life agent about how great I looked. Finally, I let the agent in on the secret.
"You have no way of knowing this, but I used to be almost 200 pounds heavier than I am today. That's why calling me 'skinny' is humorous."
She was obviously shocked and after congratulating me, said she never would have guessed. I told her that I realized she had no idea based on her reaction to my earlier comment about my husband.
"Truly," I told her, "I have to be careful. I often forget I'm no longer a big girl and will make comments that come off as insensitive or rude."
It's not that I'm a narcisist who thinks the world revolves around her. It's just that I've chronicled my weight-loss experience for so long and so many people approach me in public about it that I forget it's not common knowledge. And then there are times like tonight that jolt me back into reality. I assume that the further out I get from surgery, the more common it will become to meet people who assume I've always been thin. I'm not sure I'll ever get used to it. I want to say that it'll become old had after a while, but that's hard for me to picture. I guess time will tell.
During the networking portion of the evening, I was chatting with an engaging woman from New York Life. We were talking about all the illnesses that seemed to be going around this spring, which both of our husbands caught with gusto. I told her that I get very worried when my husband is ill, because he's such a thin guy, adding that I don't have the same concern for myself. She chuckled a bit and looked me up and down. I realized then that this woman had no idea I have ever looked contrary to the way I do today. I let the subject drop and we parted ways to mingle further.
We caught up again a few moments later when another member, a woman I know rather well, greeted me by calling me "Skinny." She made a comment to the New York Life agent about how great I looked. Finally, I let the agent in on the secret.
"You have no way of knowing this, but I used to be almost 200 pounds heavier than I am today. That's why calling me 'skinny' is humorous."
She was obviously shocked and after congratulating me, said she never would have guessed. I told her that I realized she had no idea based on her reaction to my earlier comment about my husband.
"Truly," I told her, "I have to be careful. I often forget I'm no longer a big girl and will make comments that come off as insensitive or rude."
It's not that I'm a narcisist who thinks the world revolves around her. It's just that I've chronicled my weight-loss experience for so long and so many people approach me in public about it that I forget it's not common knowledge. And then there are times like tonight that jolt me back into reality. I assume that the further out I get from surgery, the more common it will become to meet people who assume I've always been thin. I'm not sure I'll ever get used to it. I want to say that it'll become old had after a while, but that's hard for me to picture. I guess time will tell.
Monday, May 28, 2007
Too skinny?
I met a woman over the weekend who said something I consider interesting. Her husband had gastric bypass a handful of years ago. She said he's since gained about 40 pounds or so. I nodded, letting her know that's a common occurrence for veteran post-ops. Her response gave me pause for a moment.
"I think most people get too skinny after WLS," she said. "Your body has to put on an extra 20 to 40 pounds just to look normal."
I said nothing.
Then she added, "Then again, maybe it's just that the rest of us are used to seeing our loved ones be so big that we have trouble adjusting to their new size."
Hmmm...that was profound.
I get told I'm too thin all the time now. My favorite is when people inform me that it's time for me to stop losing weight -- as if I'm blind to my own size. I always let people know that I could lose another 20 pounds and still be within a normal weight range for my height, but I'm also clear that I'm happy at my present size. Though anything is better than carrying 335 pounds on a 5-foot, 3-inch frame, 138 pounds seems to be my body's preferred weight.
I don't understand why people feel obligated to tell me their opinion of my size. I assume it's because in our society, it's considered appropriate to tell someone when they are too skinny in your eyes even though you'd get a dirty look or backhanded if you pointed out an obese friend should lose a few pounds. I'm guessing that woman I met over the weekend has a clearer view into the average person's psyche than I do. If what she says is true, it's a matter of comfort. We know obesity is unhealthy but we're not comfortable with those close to us changing their appearance too much.
I wonder if this phenomenon will change down the line. Maybe in three years, people will be so accustomed to my size that they don't think twice about it. Then again, maybe well-meaning acquaintances and relatives will continue adding their two cents.
"I think most people get too skinny after WLS," she said. "Your body has to put on an extra 20 to 40 pounds just to look normal."
I said nothing.
Then she added, "Then again, maybe it's just that the rest of us are used to seeing our loved ones be so big that we have trouble adjusting to their new size."
Hmmm...that was profound.
I get told I'm too thin all the time now. My favorite is when people inform me that it's time for me to stop losing weight -- as if I'm blind to my own size. I always let people know that I could lose another 20 pounds and still be within a normal weight range for my height, but I'm also clear that I'm happy at my present size. Though anything is better than carrying 335 pounds on a 5-foot, 3-inch frame, 138 pounds seems to be my body's preferred weight.
I don't understand why people feel obligated to tell me their opinion of my size. I assume it's because in our society, it's considered appropriate to tell someone when they are too skinny in your eyes even though you'd get a dirty look or backhanded if you pointed out an obese friend should lose a few pounds. I'm guessing that woman I met over the weekend has a clearer view into the average person's psyche than I do. If what she says is true, it's a matter of comfort. We know obesity is unhealthy but we're not comfortable with those close to us changing their appearance too much.
I wonder if this phenomenon will change down the line. Maybe in three years, people will be so accustomed to my size that they don't think twice about it. Then again, maybe well-meaning acquaintances and relatives will continue adding their two cents.
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