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Is maladaptive eating slowing or sabotaging your weight loss? Let's take a look at how that happens and what we can do to change it.


WHAT IS MALADAPTIVE BEHAVIOR?
The term “adaptation” brings Charles Darwin to my mind. His theory of evolution is considered heresy where I live, but whatever your personal belief about the origin of the human species, you’ve probably observed many times that humans and other living things have an amazing ability to adapt their behavior, and even their forms, to better survive and thrive in its environment, and that as the environment changes, so do the creatures living in it.
Here in Tennessee, the weather is getting hot enough to send us into our closets to bring out the shorts and sandals and bathing suits we need to comfortably survive the summer. At the same time, our dogs and cats are shedding the extra fur they’d acquired to keep them warm during the winter. The humans are adapting their dressing behavior and the cats are adapting their forms to adjust to hot weather. This is adaptation in its positive sense, but adaptation also has a dark side.
Defining “maladaptation” requires us to assume that certain behaviors are normal, while others are abnormal. That does not necessarily mean that normal is healthy and abnormal is unhealthy. Someone (or something) is considered “normal” if they conform to a widely accepted standard or practice, and abnormal if they deviate from the norm.
A behavior can be identified as maladaptive or abnormal only in the context of an environment. It is not intrinsically wrong or evil, and its degree of deviance or abnormality depends on things like cultural and social rules and norms (cannibalism may be a normal behavior in one society, but not in another), systems of psychological and medical thought (a mentally ill person may be “abnormal”, but able to function despite that); as well as political beliefs and ideals (in a democracy, the practice of communist principles is considered “wrong”). I’m going to try to bypass all those interesting but knotty aspects and give you definitions and examples that don’t require a PhD in sociology or psychology to decipher them.
Some maladaptive behavior is disruptive to society because it interferes with group functioning. A child “acting out” at school in reaction to the stresses he experiences at home is an example of this. His frustration with his home life turns into anger that fuels temper tantrums in the classroom. His behavior is maladaptive because it doesn’t eliminate the stresses at home and creates a whole new spectrum of stresses and problems at school as his teachers and fellow students react to his aggression. He can’t learn lessons in school that he needs to learn because his “bad” behavior gets in the way.
Other maladaptive behavior is expressed in an inward fashion. A shy, anxious art student is horrified when her painting teacher publically critiques her painting and tells her and the rest of the students that her artwork is exactly what they should not be doing. The art student loses confidence in her talent and changes her major to another subject. Her behavior is maladaptive because it makes it much harder for her to achieve her original goal of becoming an art teacher.
My own definition of maladaptive behavior is this. It’s a nonproductive behavior that prevents you from adapting to situations, or changes in yourself or your environment, in a healthy way. It can begin as an attempt to deal with or avoid an unpleasant experience but it does not solve the original problem and eventually becomes dysfunctional. You adjust to a situation in a way that makes sense at the time but that eventually misdirects your energy and focus, and interferes with your personal and interpersonal functioning, your health, and your ability to achieve your goals. At the start, the behavior feels like a helpful, even positive response to abnormal, difficult, or negative circumstances.
As a bandster, I used both old and new maladaptive eating behaviors. My decades-old behaviors, like eating to deal with stress, did not disappear on the morning of my band surgery, and 5 years later, I’m still working on changing that. I also developed new behaviors in response to the experience of having an adjustable gastric band. The long-term result of these maladaptive behaviors is unintended and undesirable. The maladaptive eating tactic may seem to solve a current problem while it's actually creating future problems: slowed or stopped weight loss, weight gain, band slippage, band erosion, and so on.
SOFT CALORIE SYNDROME & OTHER DANGERS
A classic example of bandster maladaptive eating behavior is known as Soft Calorie Syndrome. I discovered the perils of this syndrome for myself when I traveled to New York City to attend a trade show when I was about 8 months post-op. I had gotten a fill the day before I left, and by the time I got to New York I had realized that my band was too tight for me to tolerate. I couldn’t eat any solid food, so I spent the next 3 days eating soft, high-calorie, low-satiety foods like soup, milkshakes, and ice cream. I was just trying to survive long enough to go home and get an unfill. My eating behavior achieved a temporary goal (comfortable survival) while sabotaging my long term goal of losing weight. In fact, I gained weight during that trip and ended up feeling disappointed in myself.
A frustrating aspect of maladaptive behavior is that it’s often easier to see in others than it is in yourself, but even someone who’s fully aware that her or his behavior is counterproductive may feel helpless to change it. If I had a dollar for every time a bandster has confessed to eating to relieve stress or boredom, I’d be a wealthy woman now. Emotional eating tends to be so longstanding and deep-rooted that it takes on a life of its town, like a devil lurking inside us who seductively whispers, “Chocolate! Chocolate will make you feel soooo much better!” when you’re too vulnerable, tired, or upset to make a different or healthier choice.
When I was being treated for PTSD years ago, a counselor asked me to make a list of behaviors and activities that I could choose to do instead of engaging in self-destructive ones. At first the exercise seemed contrived and silly, but eventually I realized its usefulness. I was not able to think clearly and make good choices when in severe emotional distress. All I could think of was razor blades. My index card of alternate behaviors reminded me that I could telephone a friend, go for a walk, take a bath, listen to music, pet a dog, and the like instead of playing with sharp objects.
Now, I very much hope that you’re not dealing with severe emotional distress (which I would wish only on my worst enemy), but I do believe you can benefit by making your own list of alternatives to emotional eating. Carry a copy of that list with you everywhere you go and keep a copy in an easily-accessible spot at home (I tacked mine to my bulletin board).
TRUTH OR CONSEQUENCES
In the 1960’s and 70’s, contestants on the “Truth or Consequences” game show would try to answer ridiculously obscure trivia questions and be forced to perform silly stunts in punishment for getting the answers wrong. The host ended each episode by saying, “Bob Barker saying goodbye, and hoping all your consequences are happy ones!"
The relief or pleasure or other immediate consequences of a maladaptive behavior may seem like happy ones, but they generally short-lived, so the behavior must be repeated over and over for the benefit to be felt. As with an addiction, it takes more and more of the behavior or substance to cause relief or pleasure. An anxious person, whose mother lost a leg to gangrene (death of flesh) from bacterial infection in an untreated injury, naturally fears germs. She washes her hands thoroughly and often, especially after touching anything that might harbor germs. At the start, her own home is clean and safe, but because her hand washing doesn’t remove her basic fear, eventually she must practice it all day, every day, over and over, even in her own home, until her skin is scrubbed raw. She sees the abrasions her scrubbing has caused as more vulnerable to germs and increases the hand washing. Soon the hand washing excludes all other activities and she dares not leave her home. The salutary practice of hand washing has become a maladaptive and destructive behavior.
Unlike the hand washing or other compulsive, fear-based, abnormal and ritualistic behavior, maladaptive eating is rarely perceived as strange. Eating is socially acceptable as long as the meat on your plate belongs to a different species. It’s also something that’s easy to do in secret, while you’re alone in your car or your bathroom or wherever you go to escape other people. But when you do it over and over again, your repetition of the behavior cements it into a wall around you, keeping you locked inside instead venturing forth to find relief elsewhere. And should you confess to this maladaptive eating behavior, people who don’t use food in this way simply cannot fathom why you would do it. They say impatiently, “Put the fork down! Step away from the table! Just say no to chocolate!” Ah, if only it were that simple, that easy…
SMALL-TIME CRIMINALS
Some maladaptive behavior arises from ignorance, misconceptions or misunderstanding. Take the case of Martin. He received minimal pre-op education, so when he found himself PB’ing (regurgitating) on a daily basis after his 3rd fill, he assumed that this was simply a fact of life for bandsters. His problem is ignorance. The same thing happened to Annie, who assumed she was doing something wrong but was too shy, ashamed and embarrassed to ask her surgeon about it. Her problem is misconception. And when PB’ing intruded into Carol’s daily life, she believed it was like vomiting, caused by “a stomach bug”, so it never even occurred to her that her eating behavior might be causing it. Her problem is misunderstanding.
All too often, a maladaptive behavior seems like such a small “crime” – it was just one ice cream cone – that the bandster minimizes its importance without realizing that the cumulative effect of a series of small crimes can be just as destructive as a single big one. It’s kind of like ignoring the posted speed limit when you’re driving your car. You shudder at the news of a fatal car accident when an acquaintance driving at 70 mph in a 35 mph zone loses control of his vehicle and crashes into a telephone pole. In that instance, ignoring the speed limit is clearly a bad choice. But when you’re late for work (again), run a few yellow or even red lights (again), and drive at 70 mph in a 35 mph zone (again) in your eagerness to get to work on time, and nothing bad happens, speeding doesn’t seem like such a terrible crime…until the day you can’t stop in time to avoid the car turning into your path and end up as a bleeding mess choking on dust from your car’s air bag while an ambulance carries off the person you killed because of your maladaptive behavior.
IS THIS BEHAVIOR GETTING YOU WHERE YOU WANT TO GO?
A bandster once confessed, “I eat pretty good all week and then I allow myself a junk food day...a bad mistake on the weekend since that usually means a junk food weekend...once I start, it’s so hard to stop and of course weight gain is the result and I end up beating myself up. I'm never going to be where I want to be if I continue this behavior.”
I want to repeat that all-important last sentence: “I'm never going to be where I want to be if I continue this behavior.” That, my friends, is the take-home message of this article. Take it to heart, take it home, and take it out and study it often. Ask for help in identifying and dealing with your maladaptive eating behaviors. Take them seriously, but don’t build them into mountains right in the middle of your path to success. Sometimes the solution or treatment for a big maladaptive behavior can be a small piece of common sense. One of my favorites is: Don’t keep trigger foods in the house. If chocolate is your bête-noir (the black beast that’s the bane of your existence), you’re not going to be able to gorge yourself with it the next time you’re feeling weak if there is no chocolate in your house. Yes, I know you can hop in your car, ignore the posted speed limits, and pull up in front of the Chocoholic Market in a matter of minutes. That’s why we have to be vigilant, honest and aware.
And remember this, from page 299 of Bandwagon: It takes anywhere from 18 to 254 days of daily repetition to make a new behavior automatic….so, practice, practice, practice!

And other things you need to know about WLS but are afraid to ask...
I wonder sometimes if bariatric professionals forget to emphasize the importance of good band eating skills because they they've never had to live with a gastric band. Of course, a few bariatric professionals are also bariatric patients, and thank goodness for that.
I also wonder if bandsters are unaware of the importance of good band eating skills because their brains slipped into neutral during that part of their pre-op education. You'll have a hard time convincing me that's never happened to you, because I am the Queen of Lists and Note Taking. In high school and college, classmates would pay me for copies of my class notes. (Not only were they thorough, they were neatly penned in my prize-winning handwriting and decorated with cunning cartoons depicting my teachers and professors in embarrassing situations.) I take a notebook and a list of questions to every medical appointment, I ask questions, I re-read my notes, but despite all of that, my brain tends to shift gears when I see or hear something that strikes me as unimportant or irrelevant. And aside from being The World's Greatest Living Expert on Everything, what exactly qualifies me to make the unimportant or irrelevant judgment? Nothing. Nada. Nichts. Niente.
During my pre- and post-op patient education, which was tailored exclusively to bandsters and administered by well-prepared bariatric dietitians, nurses, physician's assistants, and so on, I must have heard the eating skills lecture a dozen times. I was told that if I didn't eat carefully, I would end up in pain or with my meal in my lap. I nodded my understanding each time I heard that and could repeat the lecture verbatim, but it wasn't until I took a huge bite of a grilled cheese sandwich 24 hours after my first fill that I truly understood what all those folks had been telling me. And that’s not an experience I’m likely to forget.
Take Tiny Bites
I talk about good eating skills a lot. Why do I go on and on about that? Is it because I like the sound of my own (editorial) voice? Well, sure - that's no secret. But for what reason besides that?
Important information bears repeating, and repetition is one of the ways that we acquire new information and learn new habits. If you doubt that, pay attention to how many times the Geico lizard appears on your television screen each day. Good band eating skills must become a habit if you're going to succeed with your band and avoid side effects and complications. Those eating skills must be your habit every hour of every day, not just as a new post-op or after each fill, but every day for the rest of your life.
That sounds like a pretty tall order, doesn't it? Don't panic, though. A well-ingrained habit doesn't take as much conscious thought as a brand-new one. Your own behavior has already proven that if you've ever found yourself with a half-finished Twinkie or a cigarette or a beer in your hand and couldn't remember how it got there. It works the other way too. Your healthy new habits will eventually dig themselves into your life and using them will get easier as you go along.
When you forget your band eating skills, your band will give you a loud reminder in the form of side effects like PB's, sliming, or stuck episodes, but I beg you not to rely on your band's built-in warning system on a regular basis, because doing so will send your bandwagon skittering down the road to complications like esophageal dilation, stomach dilation, band slips and even band erosion.
One of the problems with the band's alarm system is that the truly destructive behaviors it reacts to may trigger relatively mild warnings so long before the damage is done that it's easy to shrug them off. For example, let's say that you often take big bites, don't chew very well, eat quickly, and/or eat beyond your soft stops (soft stops are gentle stop-eating signals, like hiccups). Each time you do those things, you experience mild discomfort. Nothing horrific. It happens, you think, "Oops," and you go back to whatever you were doing before the discomfort happened. Eventually this mild discomfort becomes just a part of your post-op life - the same as the way you sneeze when you pet a cat, pass gas when you eat beans, or get a headache when you don't wear your eyeglasses. Hey, that's just the way it is, right?
But one bad day after dozens of ordinary days you can't even swallow your own saliva. You rush to the doctor, who does an upper GI x-ray and tells you your band has slipped. "How can that be?" you cry, "Everything's been fine until now!"
In fact, everything has not been fine, because your careless eating has been pushing, pushing, pushing at your band's limits, until finally it pushed your band up your esophagus or down your stomach. I don't like finger-pointing any better than you do, but whose responsibility is that band slip? Is it your surgeon's, for not stitching it on there well enough? Is it the band manufacturer's, for not making your band slip-proof? Or is it yours?
There can be a happy ending to your story, though. Even if the band slip is clearly your fault, you won't get sent to prison to sip brackish water and gnaw on stale bread for the rest of your days. Your surgeon can unfill your band (or, less likely, re-operate to reposition your band), and you can revamp your eating skills, lose weight, and live happily ever after. Or better yet, you can avoid the pain, inconvenience, financial and emotional costs, and pay attention to your eating from now on.
I ain't gonna lie to you...acquiring and practicing this new habit won't be easy, but I can think of a lot of things that could be worse. A lot worse.
The official Bandwagon® Eating Skills are:
1. Don't drink while you eat or for 30 to 60 minutes afterwards.
2. Take tiny bites.
3. Chew, chew chew.
4. Eat slowly.
5. Eat the protein first.
6. Learn your stop signals.
7. Pay attention to problem foods.
8. Eat only when you're hungry.
9. Avoid liquid calories and slider foods.
10. Use a small plate.
11. Plan your food in advance.
12. Don't watch TV or read while you eat.
13. Don't put serving dishes on the dining table.
14. Eat sitting down at the dining table.
15. Follow the HALT rule (don't eat when you're too hungry, angry, lonely or tired).
You’ll find full explanations of each skill in Chapter 12 of Bandwagon, Strategies for Success with the Adjustable Gastric Band, by yours truly.