Sleeve = anorexia?

[ToDream 18]

Something I've been struggling with recently. I'm looking at the caloric needs of a person post-sleeve and comparing it to what a typical anorexic might intake. It's the same.

Persons with anorexia nervosa continue to feel hunger, but deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600–800 calories per day, but there are extreme cases of complete self-starvation

Anorexia nervosa and the associated hair grows on face and body recipes, or pills, Water pills; may engage in self-induced vomiting; may run to the bathroom after eating in order to vomit and quickly get rid of the calories ^[21] [22]

may engage in frequent, strenuous exercise ^[23]

perception: perceives self to be overweight despite being told by others they are too thin

becomes intolerant to cold: frequently complains of being cold due to loss of insulating body fat or poor circulation due to extremely low blood pressure; body temperature lowers (hypothermia) in effort to conserve energy ^[24]

depression: may frequently be in a sad, lethargic state^[25]

solitude: may avoid friends and family; becomes withdrawn and secretive

clothing: some may wear baggy, loose-fitting clothes to cover weight loss if they have been confronted about their health and wish to hide it, while others will wear baggy clothing to hide what they see as an unattractive and overweight body.

swollen joints^{[citation needed]}

abdominal distension^{[citation needed]}

Where is the difference? Just the mental aspect?

**excerpts taken from wikipedia**

[Foxbins 625]

The mental aspect is the major component as the disordered eating behavior is accompanied by a distorted self-image. Anorexics can. literally, be starving and look like they are starving but continue to perceive themselves as fat. You might consider their beliefs delusional as they fit the definition--an unshakeable belief not shared by most other people (i.e., that they are fat). Many anorexics feel out of control is many areas of their lives and use food as the one area where they have the power to control intake.

People who have bariatric surgery generally don't have disordered eating behavior--they are not surviving on 2 saltines and a cup of tea. After post-op restrictions are lifted, most WLS patients follow their doctor's orders. Although it may take some time, their self-images also adjust so that they no longer see themselves as fat. And WLS surgery patients don't use food to give themselves a feeling of control, although many report feeling pride in mastering formerly out-of-control impulses to overeat.

(Sorry, don't mean to lecture, but I'm a psychologist!)

[ToDream 18]

I don't consider it a lecture, I'm interested in the differences (other than the mental aspect). Does the body not view the restriction in calories the same way it would an anorexic?

[Coookies 12]

One of the main differences is the number of calories we intake... typically anorexics will only intake around 100-300 calories per day, and if they do take in more, they purge.... Whereas most of us take in around 600 calories per day for the first 3 months and then 800 for the next 3....

Another thing that makes a huge difference is that typically anorexics are already average weight or below... thus the side effects of their diet... ie. the lanugo, swollen joints, and arrhythmias....

** i'm not saying that all anorexics/bulimics are normal or below normal weight... i have fought bulimia for about 9 years now...

[mina 27]

Are you talking about the weight loss stage or the maintanance stage? With anorexics lanugo hair is form to keep the body warm because the body fat is gone. also, they will have electrolyte imbalance and kidney failure because the body is breaking down muscle for energy. during the weight loss stage you are encourage to get in a lot of Proteins (to prevent muscle breakdown), fluids and Vitamins (since you are on strict low caloric intake). you are also eating more frequently so the body doesn't think you are starving. you will feel the tiredness after surgery because of decrease in calories and carbs but your body adjust to eat and eventually energy will increase.

I don't consider it a lecture, I'm interested in the differences (other than the mental aspect). Does the body not view the restriction in calories the same way it would an anorexic?

[Foxbins 625]

I don't consider it a lecture, I'm interested in the differences (other than the mental aspect). Does the body not view the restriction in calories the same way it would an anorexic?

Starygirl is right that most anorexics begin anorexia at or near normal body weight and "diet" way below safe levels of restricted intake. So you have someone of normal BMI who is eating very few calories and who has few reserves to burn. We sleevers have fat to burn. The body will use the fat we have as an energy source until it is gone, which is when true starvation begins and the body begins to consume muscle, nerve, and other tissues. However, because we don't have the disordered thinking, we will never reach the point of true starvation. We will increase calories to prevent the body from consuming itself.

Edited to add: Plus, it is about the mental--anorexia is considered a mental disorder in the DSM-IV, the manual of the American Psychiatric Association that has the criteria for diagnosable mental diseases/disorders. I doubt that many of us here on the forum would presently meet criteria for an anorexia diagnosis, and it would certainly bar someone from receiving this surgery without a psych eval and treatment.

[ToDream 18]

Are you talking about the weight loss stage or the maintanance stage? With anorexics lanugo hair is form to keep the body warm because the body fat is gone. also, they will have electrolyte imbalance and kidney failure because the body is breaking down muscle for energy. during the weight loss stage you are encourage to get in a lot of Proteins (to prevent muscle breakdown), fluids and Vitamins (since you are on strict low caloric intake). you are also eating more frequently so the body doesn't think you are starving. you will feel the tiredness after surgery because of decrease in calories and carbs but your body adjust to eat and eventually energy will increase.

I was thinking specifically the weight loss phase.

Thanks for your replies everyone!

[fattypattynomore 1]

Another diff is the surgical aspect, the stomach is shrunk by surgery, the hunger hormone ghrelin is removed and the patient is following dietary guidelines from a doc/nutritionists to be Protein rich, in anorexics, none of the above is true, anorexics are usually hiding their strict calorie cutting and deny it if asked. They have a psychoses about perceived body image and control so no, totally different indeed than wls!

[missmeow 156]

Anorexia nervosa is a psychological disorder in which certain criteria have to be met in order to be diagnosed with it (including a BMI under 18, IIRC). Now if you lost all of your weight and ate a restrictive diet and met all of the other criteria of anorexia nervosa, then yes, you could be diagnosed as having anorexia nervosa.

Just eating low calories in and of itself is not anorexia nervosa, especially when it is a medically monitored restriction. Obese individuals have a lot of body fat. Our bodies have evolved to store fat and the burn it during times of calorie restriction. Us obese individuals are like the x-men of fat storage In any case, the body burns fat to get its energy. The doctors use the high Protein diet to ensure that what we do eat is providing enough Protein and amino acids so that our bodies don't burn muscle too (although some level of muscle loss happens, obese indivudals usually have higher muscle mass to begin with from carrying the extra weight).

Anorexia as a word is just as a general term just means loss of appetite. In that sense, the post-operative healing period is a surgically induced anorexia (loss of appetite). Once the stomach has healed and the swelling goes down, the calorie counts can go up and appetite returns even if it is not at the same level as pre-op. IMO, its that post-operative period where the "magic" happens. There is little desire or ability to eat, so eating on the restrictive diet plan is much easier to accomplish compared to just sticking to the same diet without the surgery. That's why they push for you to be at or near goal at 6-12 months. It seems that 6-12 period is where the stomach completely heals, people are having more of a desire to eat, and people have learned to eat with their new stomachs so it becomes harder to meet the goal. That's just my opinion though.

[ngory07 22]

It's the mental aspect but also here way I understand it our very low calorie restriction is for Thr first 9 month or less. There is no way if you are less than 75 overweight you should consume less than 1000 calories a day!

[bellabloom 2,467]

The difference is that to truly be considered medically anorexic, a person has to be underweight.

We all have weight to lose, or bodies are using our stored far as fuel. An anorexic no longer had stored far to use and so begins to exhibit physical symptoms of malnutrition.

One could definitely transition from a non- anorexic dieter to an anorexic if one continued to restrict calories after reaching the lowest weight for ones height.

There are other differences as well. food rituals, extreme behavior, etc.

[Inner Surfer Girl 12,015]

I don't consider it a lecture, I'm interested in the differences (other than the mental aspect). Does the body not view the restriction in calories the same way it would an anorexic?

Starygirl is right that most anorexics begin anorexia at or near normal body weight and "diet" way below safe levels of restricted intake. So you have someone of normal BMI who is eating very few calories and who has few reserves to burn. We sleevers have fat to burn. The body will use the fat we have as an energy source until it is gone, which is when true starvation begins and the body begins to consume muscle, nerve, and other tissues. However, because we don't have the disordered thinking, we will never reach the point of true starvation. We will increase calories to prevent the body from consuming itself.

Edited to add: Plus, it is about the mental--anorexia is considered a mental disorder in the DSM-IV, the manual of the American Psychiatric Association that has the criteria for diagnosable mental diseases/disorders. I doubt that many of us here on the forum would presently meet criteria for an anorexia diagnosis, and it would certainly bar someone from receiving this surgery without a psych eval and treatment.

Actually, the way I understand it, even if we have fat to burn, we will still burn muscle and organs if we don't get enough Protein. That is just one reason it is critical that we get enough Protein daily.

[Tssiemer1 549]

The difference is that to truly be considered medically anorexic, a person has to be underweight.

That is correct according to the DSM 5.

[Tssiemer1 549]

There is this diagnostic gem though.

[VSGAnn2014 12,992]

Nope. I'm not suffering from anorexia or other eating disorders that put me at risk of not receiving good nutrition from a sufficient amount of nourishing food.

Yes, when we're losing weight, we HAVE to eat less than we'll eat during maintenance. Duh. It's called "losing weight." And early on, our healing, swollen stomachs keep us from eating much of anything. Gradually, over many months, we add more food. Those months are wisely spent not just losing weight, but learning how to choose, prepare and eat nutritious food that will keep us healthy long-term.

I'm 5.5 months into maintenance and now eating an average of 1700 calories/day. Most days I get 80-100 grams of Protein, typically 5 veggies and fruits, and 21-30 grams of Fiber. I seldom exceed the daily sodium limits for my gender / size. I walk 1-4 miles a day. I typically sleep 7 hours a night. I take all my Vitamins / minerals / Rxs on time and daily. I drink 8 glass liquids daily.

Most days I plan my meals and track my food using My Fitness Pal. I find it a helpful tool.

Finally, just because I'm controlling what I eat doesn't mean I'm "restricting" food in the sense that "restricting" figures into the diagnosis of food disorders. I do have treats (wine and occasional carbs and desserts), and I plan for them.

These are some of the ways my behaviors (and those of most other WLS patients) are different in type and degree from those behaviors that characterize people who suffer from anorexia.