By Francesco Fiondella

NEW YORK, Feb 18 (Reuters Health) - Severely obese people can potentially develop anorexic and bulimic symptoms after they have lost weight through strict dieting or stomach-reduction surgery, Spanish researchers report.

The flip-flop, they say, appears to come from an intense, obsessive fear of regaining weight--supporting the idea that obesity and eating disorders share some features.

Dr. Juan A. Guisado, of the University of Extremadura, and his colleagues described two such cases in a recent issue of the International Journal of Eating Disorders.

In the first case, the researchers analyzed 100 morbidly obese patients 18 months after each had undergone gastric surgery. Morbid obesity, also known as severe or clinical obesity, refers to people who are 100 pounds or more over their ideal body weight.

The investigators discovered a 32-year-old female who had developed an eating disorder after stomach-reduction surgery.

"She thought that she had to lose weight quickly, and became especially worried by the flaccid skin areas remaining in arms and legs after weight loss," they write.

Even after she had dropped 120 pounds, the woman remained obsessive and depressed about her weight, and would make herself vomit and use diuretics whenever she ate certain foods, according to the researchers. So drastic was her weight loss that she stopped menstruating 5 months after her surgery.

The other patient, a 19-year-old female, came to Guisado for psychiatric treatment. By following a severe diet, she had lost close to 200 pounds in 3 years and was depressed and reclusive.

The patient reported an "intense discomfort with food, considered herself fat, and felt unhappy with her body," according to the report. By the time Guisado interviewed her, she weighed 110 pounds, but still wanted to have stomach-reduction surgery--which was denied.

According to Guisado, these cases highlight the psychological effects that can come with severe obesity.

"It is necessary to change some concepts of morbid obesity," he told Reuters Health. He pointed out that while anorexia and bulimia are treated as eating disorders, severe obesity is seen differently.

Guisado said he finds that morbidly obese patients show high levels of "psychological discomfort," and he believes that psychiatric evaluation may be appropriate.

"Some obese individuals do seek psychiatric treatment for disordered eating, but it is far more common for them to seek obesity treatment," said Dr. Marsha Marcus of the University of Pittsburgh in Pennsylvania.

"I think that there has been much more dialogue between the eating disorders and obesity research communities in recent years, based on a growing awareness that problems with eating and weight do have commonalities," she told Reuters Health.

But Marcus warned against over-generalizing from such a small number of cases. "Certainly, some individuals who initiate strict dieting will develop aberrant eating, as did the patients described in the article. I have indeed seen patients like this, but they are not common," she said. "The growing gastric surgery literature has shown that, on average, patients' eating habits improve after surgery."

She added, though, that as the number of obesity surgeries performed increases, "there is a need to understand the potential complications of the surgery and the reasons for the poorer outcomes in some patients."

SOURCE: International Journal of Eating Disorders 2002;31:97-100.

http://www.reutershealth.com/archiv...218elin020.html

Sounds bizarre but I actually developed an anorexia-like mindset for 3 months in 1998 from Gwen Shamblin's Weigh Down program. She emphasizes going hungry, skipping meals, fasting, etc. I took it to heart. I was so weak and listless I could only lie curled up in a ball after a couple months of it. A couple weeks after the weekly meetings ended I reverted to old habits and regained far more than I lost.

I never thought I could fall into that trap but I did for a season.

I'm so glad to be in a plan now that emphasizes health, minimum calories and minimum protein. I feel great!

Allison

Throughout the 80's, I was always on some diet scheme or another, including more than one clinic-style diet, with daily weigh-ins and little packets of vitamins (but no injections or pre-packaged food or special formulas).

The last time I paid money for a diet was The Weight Loss Clinic, in 1988. I remember $10 per lb. paid up-front. Already a chronic yo-yo dieter by then, I'd ballooned to 150 lbs (horrors!) The program started me out at 900 calories a day, and that was all very nice until I got within 5 lbs of goal, where I stalled. They kept dropping my calories lower and lower ... always with a "nutritious" diet .. but the 2 teaspoons of vegetable oil was the first thing to go. I think I spent about 2 weeks at 600 calories a day .. I lost half a pound. I was exercising like a fiend, but back then it was all aerobics for the ladies, dancercise and aquafit. Anyway .. I just remember being afraid to eat. I struggled with even the 600 calories, fearing that every mouthful was going to absorb instantly and directly into my fat cells. The fact that I'd paid a lot of money, plus the clinic staff encouraged me to ignore my hunger pains, and gave me little tips and tricks to outwit hunger .. like drinking a cup of warm-not-hot weak tea or fat-free bouillon to trick my stomach into feeling full. The lbs eventually came off, and I "graduated" finally, but still felt flabby and fat, because .. I was. I'm sure I'd lost a great deal of lean muscle with such a hair-brained diet I was a health professional, and trusted this program because it was designed and run by drs. and nurses .. and it used real food, not shakes or powdered formulas. I blamed myself for anything that went wrong.

I struggled with their Maintenance for 6 months. Also low calories, 1200 - 1400 a day. I was so depressed, I figured the rest of my life was basically going to be a restrictive diet of skinless chicken and fat-free salad dressings. I didn't crave carbs or bread, and no sweet tooth. But I did crave FAT and meat .. steaks, cheese and butter. I started bingeing ... followed by agonies of guilt and terminal flatulence for punishment. Then I'd "fast" (a.k.a. starve) for a couple of days to undo the damage.

Low-carbing has been very freeing for me. Although I pay attention to portions to make sure I get enough, I don't worry about "overeating" meat and fat unless it makes me feel physically uncomfortable. But some days it still is a major conscious effort for me to recognize that yes, I am hungry and yes, I must eat something. For so many years I trained myself to ignore that rumble.

Doreen

p.s. - Interesting irony is that my previous "panic" weight of 150 lbs, is my current goal

do, sounds like our VLCD experiences are similar. nothing like gaining on 1200 calories a day to make you want to rend your hair, eh? (as if it weren't falling out badly enough already from the LF...lol)

Re: your oh-so-true article, here, I've read all over the place lately that there is NO record whatever of anyone bingeing who has not first been on a diet. That is, the binge does not come first--it's a reaction (and probably mostly physiological) to starvation.