I plan to write an article to go along with this cartoon, but I don't have the time at present... so... sometime in the future I will revisit this topic and post a Part 2.

22 years ago at age 47, weighing 271 lbs. at a height of 5'0",  I had an RNY gastric bypass, open surgery, with NO removal of any intestine, which means that every calorie I eat is still digested, and still counts. 

The doctor's recommendation for post-surgery eating was simple. "Eat three meals a day of whatever food you want, but make half of each meal protein; avoid fried foods and sweets; and have no carbonated beverages."

My surgery was done when the procedure was still considered experimental.  At the time, it was performed here in California by only a few doctors. To get surgery, people had to travel to San Diego, stay in the hospital 2 or 3 days, then stay at a local hotel for an additional 10 post-surgery days before being released to return back home.  Follow-up care was received once a month during the surgeon's visit to one of the nearby temporary clinics located in various cities throughout California.  About five years later,  surgeons all over California began setting up specialized practices for weight-loss surgery, and coordinated with nutritionists who made specific post-surgery diet recommendations like protein shakes etc. That happened several years before laser surgery became common.

The first year after surgery my body would tolerate very little food.  Eating more than one-quarter to one-half cup of food at a time made me feel uncomfortably stuffed like after Thanksgiving dinner.  

I frequently experienced Dumping syndrome, which is caused by food passing too quickly into the small intestine. This caused immediate symptoms of flushing, weakness, fatigue, dizziness, and an intense desire to lie down. Severe episodes include feelings of nausea, and even stomach cramps.

I experienced severe dumping symptoms after just a swallow or two of fruit juice; or one or two bites of fried-or-greasy food; or a bite or two of any sweet like cookies, cake, pie, candy. I also became lactose intolerant. Milk made me feel ill, and even the tiniest bit of ice cream, with it's combination of milk and sugar, immediately made me lie-down-with-dry-heaves-ill.

Therefore, due to my weight-loss surgery, that entire first year my food intake was somewhere between 200 to 600 calories a day, which caused my weight to drop from 271 down to 161 lbs .... without dieting. This happened while I ate however much I could, of whatever food my body would tolerate.  The reason I did not binge, cheat, or quit, even when my weight-loss was slower than I believed I deserved, was because it was physically impossible for me to do so. 

Most people think that weight loss after WLS always happens rapidly.  That immense amounts of weight fall off everyone's body every week, 5-10-15 pounds, week-after-week, like on the Biggest Loser tv show.. only maybe even faster. 

However, Real Life AFTER a Gastric Bypass Surgery, works just like Real Life BEFORE a Gastric Bypass Surgery.  Even though after a RNY surgery Everyone has a smaller stomach, and Everyone eats just a small amount, the rate of weight-loss continues to be an individual matter.  Some people's bodies simply drop weight faster than other people's bodies, and surgery doesn't change that fact. 

Below is a graph of my own individual weight-loss results. This is what happened to MY body during the 64 weeks after a RNY gastric bypass surgery.  I did not diet during that time, but the surgery severely restricted what I ate, and the amounts I ate. I was physically unable to cheat, and I was physically unable to quit.  Plus, of course, I was strongly motivated to lose weight.  Remember, I was a 48 year old, sedentary female who was only 5 ft 0 in tall.

For the next 2 to 3 years I maintained in the 160s while eating as much food as my body would tolerate, however, my stomach begin stretching, and my body began to tolerate more food, and again, I had to begin dieting to keep my weight down.

For the next 10 years, I worked at dieting to keep my weight down, but my weight kept creeping up. I felt I simply could not bear weighing over 200 lbs again, after all my effort, pain, and expense. My struggle to avoid gaining more weight allowed me to maintain in the 190s for several years.  In September 2004 I began logging my food into DietPower, which is a computer software food journal that I discovered online.

At that point, I begun losing weight, and about 16 months later, after working to eat a daily average of approx 1230 daily calories, I reached my goal weight of 115 lbs.

During all of the 8+ years since that time I've been working to maintain at or near that goal weight.

SO ....to summarize the NEXT SEVERAL YEARS: 

Without Dieting

Maintained in the 160's the following 2 ½ years until weight crept into the 170s.  

Started Dieting again, with following Results.

Back to the 160's for 4 months, then weight crept back up into the 170s.

Maintained in the 170's for 2 years, then weight crept on up into 180's. 

Maintained in the 180's for 2 years, then weight crept on up into the 190's

Maintained in the 190s for 2 years,  

          Next

Started Dieting Successfully - began tracking food daily using computer software.

September 20, 2004 - weight 190

January 27, 2006 - weight 115

8+ years later, now in 9th year of dieting to maintain weight-loss.  

Total Summary: 

            Weight                        Weight                  

Pre Surgery …...     241            Reached.... ...... 161  =   110 pound Loss

Post surgery …..     161      Regain….....… 190   =     29 pound Gain

Food Tracking...     190           Goal reached….115  =      75 pound Loss

For further information see the section ABOUT ME here at DietHobby.

A farmer wants the donkey to take the load and travel.
But, the donkey does not move.
He hits the donkey with a stick, but it still won’t move.
So, he ties a carrot to the stick  and holds it in front of the donkey, just out of reach.
The donkey wants to eat the carrot and moves forward.
At the same time, the carrot also moves by the same distance.
The donkey cannot eat the carrot, till the farmer reaches his destination.
 

Here is the Carrot used in Intermittent fasting.

“Just get through today, and tomorrow you can eat what you want.”

Unfortunately it isn’t the truth … unless what you WANT tomorrow is merely what a naturally thin person consistently eats in order to maintain a normal weight.

Successful self-discipline requires plenty of carrot as well as stick.
The stick without the carrot can be used for punishment, but as a reward that stick is ineffective.

Success with intermittent fasting ... (or even with other diets involving intermittment times of calorie restriction – such as: restricted weekdays with unrestricted weekends) ... requires the low-calorie eating days to be balanced together with days of eating at maintenance calorie level … in other words, the restrictive days need to occur alongside the kind of “healthy” moderate diet that is followed by the naturally thin.

This requirement actually makes intermittent fasting more challenging than many other diets, and, for all but the most dedicated, even more unappealing and more impossible to follow.

If I WANTED only “normal” amounts of “healthy foods”, being fat would never have been a problem for me, and a Binge/Fast eating pattern rarely proves to be an effective weight-loss strategy.

The promise of days of unlimited, unrestricted eating is what lures one to the diet, but for most people this is really only a stick with the false promise of a carrot. Here’s a statement by one of the people who have found Intermittent Fasting a personal success:

“What I found was that my appetite gradually changed as I adapted to fasting and I no longer needed to binge-eat on up days. I wasn't a saint exactly but I was more restrained and weight-loss was steady and noticeable.”

People who succeed at non-fasting, but still intermittently restricted diets, such as the No S Diet, ..(which has restricted eating for 5 days, and unrestricted eating for 2 days)...  make similar claims. They indicate that after time, maybe 3 months, 6 months, 1 year, 2 years, etc… their weekday restrained eating habits bleed over onto weekends, and they no longer wish to overeat even though the diet “allows” them to do so.

Allegedly … eventually, …. the fat person’s body and appetitive will adapt, and the formerly fat person will naturally choose to eat in a way that will maintain a “normal” person’s weight.

Yeah … and for those fat people who rely on that promise, I’ve got a bridge to sell you in Brooklyn. While this might hold true for some overweight or even some borderline obese people who are not that far away from “normal” weight, there is a great deal of evidence that this is an illusionary promise for most of the people who’ve spent years being truly fat. Despite numerous, lengthy attempts, that promise doesn’t appear to prove true for a great many people, including me personally.

These claims remind me a bit of that “trust your body” position followed by those who adopt Intuitive Eating principles, .. those who tightly close their eyes to all of the Scientific research available which clearly tells us, that what an obese body can be trusted to do is struggle to remain obese or … in the event a fat person manages to lose down to a normal weight … what a reduced obese body can then be trusted to do is to insist on its return to obesity.

I’ve spent quite a lot of time experimenting with these lower-eating/higher-eating concepts, and for me personally, they’ve tended to result in a binge/fast pattern. This is because the absence of a carrot leaves only the stick, and self-punishment is not a sustainable, or highly motivating, factor for me.

Here’s a recent article about Intermitted Fasting which I found interesting.

Is Intermittent Fasting Just Another Fad?
                             by Daniel Bartlett 2/9/2013 - Huffingtonpost.co.uk

Every year, without fail, a new diet gets media attention and every year I put my head in my hands. The newest trend for 2013 is fasting diets, dusted off and freshly repackaged to appeal to the masses.

Intermittent fasting, or the "5/2 diet", marks an especially exciting period for perpetual dieters, because these plans offer the idea that you can eat anything you like on your non-fasting days. The holy grail of binge eating has finally arrived and I can almost hear the collective sigh of relief across the airwaves.

The concept behind the 5/2 Diet is simple. Eat very restricted calories for two days and eat whatever you like for the other five. To think, most people were only throwing caution to the wind at weekends before. It's akin to telling an alcoholic the best way to cure his drink problem is by having more whisky.

There is nothing wrong with fasting, but nothing particularly new either. Civilizations have been practicing fasting for centuries as there are clear and demonstrated benefits, but the fasting part of the 5/2 diet is not the problem. It's the encouragement of explicitly unhealthy food consumption.

Just the other day I met up with a friend who gleefully informed me of this wonderful new diet whilst washing down a burger and fries with a thick strawberry milkshake. "The best thing about Intermittent Fasting" They said in between giant bites of burger. "Is if I can just get through a couple of days, I can eat whatever I like".

As I left the table I found it hard to believe that an extreme diet of highly processed foods in large quantities followed by periods of abstinence would deliver on its promises.

I know that not everybody following an intermittent fasting plan will eat so poorly in the non-fasting days, but when it comes to the mainstream this is the message that seems to be sticking.

I can hear the advocates of intermittent fasting frantically preparing the multiple studies on mice and fruit flies, ready to tell me about IGF1 and how they are going to live for eternity, and yes, there is evidence that fasting reduces oxidative stress, increases insulin sensitivity and resists the effects of aging. It would seem that there are benefits to reducing total calorific intake but surely not at the sacrifice of quality nutrition.

It may surprise you to learn that I have used fasting to great effect in clients experiencing difficulty losing weight or achieving health goals, but only after more proven methods are failing. In many cases IF does offer a suitable method of busting through a plateau, but in other instances, intermittent fasting leaves people irritable and performing terribly.

Crucially, in cases where intermittent fasting has been introduced successfully it is always alongside a healthy diet. This makes intermittent fasting not only more challenging than other diets, but more unappealing and impossible to follow for all but the most dedicated. You can't sell the stick without the carrot.

The first thing anybody should do to improve health and increase longevity is eliminate processed foods, not introduce them in large quantities on an empty stomach. By eating whole natural foods most people see an immediate benefit to health, weight and energy levels.

                         David Bartlett is a personal trainer of professional athletes 
                         who owns and runs a holistic health and fitness center in Chiswick, London

For me, as well as many other people (although not everyone), fasting is a form of suffering.

The False Promise involved with Intermittent Fasting diets … the message of eating as much as you want of whatever you want (who wouldn't want that in a weight loss plan?) … is reinforced over, and over again.

"Imagine the freedom that would come from being able to do whatever you want, eat whatever you want and know - not think, not hope, but know for certain - that you'll never gain another pound."

"Eat whatever you want as much as you want. But only eat during ... (a specific time-frame like an 8-hour period, or 5-hour window etc.) ... each day (or on alternate days, or on weekends).

"And the most remarkable thing of all: You only have to follow the diet 3 days a week. Three days a week!" (or 5 days etc.)

Fasting is the Stick.
The Promise of eating what you want on non-fasting days is the Carrot.

Since summer of 2006, I’ve had quite a lot of personal experience with Intermittent Fasting including QOD, Alternate Day Eating, JUDDD, 5/2, Fast-5, The 8 Hour Diet, and Eat Stop Eat, and for me, the Promise has always proven to be false.

The only way Intermittent Fasting works to cause weight-loss, is if “normal” on the eating days is about the same as one’s maintenance energy burn.

For larger, younger people – especially males -- whose daily calorie burn is around 2000 calories, this can be relatively easy for if they “normally” eat that amount and just occasionally eat higher-calorie.
However, I am a small, older female whose “normal” daily calorie burn is around 1050. It is a continual struggle for me to keep my food intake within that “normal” range, and for me … the reward of getting 1050 calories the next day doesn’t seem like much great reward for a day of eating 300 to 500 calories. So, far, despite my best efforts, my results on the up days have often been more like 1400 to 2000 calories … which cancels out any weight-loss results of the 300 to 500 calorie fast days, … while still being FAR LESS than the amounts I really want to eat after a day, or alternate days, of calorie deprivation.

Fasting is in and of itself, "a form of suffering" for me and many other people, ... although certainly not for everyone.  Even so, unless some other type of Diet / way-of-eating / lifestyle comes along that works well for me to maintain my body within a "nomal" weight-range, I expect I will continue doing further such experiments with diets that contain the promise of even an illusory “carrot”, because that’s the kind of thing I do as a part of my Dieting Hobby.

 
What about eating frequency? How often should we eat?

Should we eat 3 Square Meals?

Or should we eat 6 Small Meals?

Or should we eat only inside a window of 8 hours or 5 hours?

Or should we, intermittently, have days with only one small meal, or even zero food in a total water fast?

Or should we eat whenever we feel Hunger?

Each of these “Diets”, “Non-Diets”, “Ways-of-Eating”, or “Lifestyles” claims that Scientific Research supports their individual position.

So what DO we do?
The following article by Dr. Yoni Freedhoff of WeightyMatters, supports my own personal position on this question.

Does New Study settle the
3 Square vs. 6 Small vs. the 8 hr Diet Debate?

So this month yet another study in a never-ending line of studies looking to compare the impact of meal frequency on fullness and biochemistry came out. This one suggested that small frequent helped decrease energy intake in normal weight men.

Honestly I pretty much disregard all of these studies.

Not because I'm doubting or questioning their results, just that I don't think their results really matter.

What I mean is that all of these studies fail to address the practical aspects of living with their recommendations, and as a clinician, that's really all that matters to me.

I've seen people controlling calories, loving life and preserving health with 6 small meals daily. I've seen people do the same on 2, 3, 4, and in some cases even 1 meal a day.

Regardless of the research that comes out, what matters more than what a physiology paper says is how you personally feel.

In my office we do tend to start people on small and frequent meals and snacks. But if that doesn't suit or help the individual we'll shift to 3 square meals. We've also recommended the intermittent fasting style that's suddenly finding some traction on the diet book shelves.

You need to find a life that you enjoy, and just because a new study or diet book suggests there's a "better", or "right", way, if you don't happen to enjoy it, it just isn't going to work.

The specific new study referred to is: Psychology and Behavior
www. sciencedirect.com/science/article/pii/S0031938413000243

According to all of the scientific research I’ve read, when we get right down to it, any actual “Health” or “Metabolic” Benefit Differences between all of these eating plans are truly miniscule, and therefore, not even worth the individual effort of personal consideration. The question to consider is which one can we DO?

I ask myself:

• Which Eating Behavior will work for ME in MY weight-loss or maintenance efforts?.
  
• Which Behavior will allow ME to consistently eat less than, or the same as, the amount that My body uses for energy?
  
• Is one Eating Behavior more manageable for ME than another?
  
• Which one can I consistently stay on?
  
• Can I live with one of these Behaviors as a lifetime Habit?

 "The Fast-5 Diet and the Fast-5 Lifestyle" (2005) by Bert Herring M.D. is a weight-loss and weight-maintenance plan based on the concept of intermittent fasting. It consists of a single rule: limit calorie intake to no more than five consecutive hours in each day. The Fast-5 Lifestyle is an indefinite continuation of that diet for weight maintenance after the weight loss goal has been reached.

Dieters using the Fast-5 diet fast for nineteen hours total each day. This nineteen hours includes sleep. After the nineteen hours of fasting is complete, dieters then have five hours in which they can eat whatever they choose.

The suggested eating window is from 5pm - 10pm, but Dr. Herring indicates that the nineteen continuous hours of fasting time is the key to the diet's effect, and that the five-hour eating window may be set whenever it is most personally convenient.

The Fast-5 approach does not stipulate a calorie intake level. It relies on the eating schedule's effect of correcting appetite to determine proper intake, but doesn’t discourage the addition of a calorie counting approach. The Fast-5 Diet also does not specify food content or forbid any foods, allowing the approach to be used with any dietary preference.

The Fast-5 diet was developed based on the personal results Dr. Herring experienced while working at the National Institutes of Health and incorporates estimates of the eating schedule of ancient hunter-gatherer humans who ate without benefit of food storage or refrigeration.

Dr. Herring distinguishes Limbic hunger, which comes from that part of the brain that connects primitive drives, emotion, and memory, from Somatic hunger, which is the sensation of discomfort in the stomach area that is commonly known as hunger, or hunger pangs. Somatic hunger is the result of the interaction of many hormonal and nerve signals and incorporates more information than just whether the stomach is empty.

He says that Limbic hunger is the reason why it is hard to eat only one potato chip. Eating one chip triggers more appetite because primitive limbic signals tell the brain we should eat as much as we can while food is available. This leads to more eating, connecting in a vicious circle that doesn’t stop until the bag of chips is empty. The ancient instinct takes control of behavior, ignoring higher thinking and preferences. Limbic hunger in a land of plenty causes one to eat too often and too much.

Two ways in which the Fast-5 plan is helpful, according to Dr. Herring, is that:

• Having a 19 hour short-term fasting period eliminates the potential…during that time period, for eating to-drive-more-eating, and keeps limbic hunger from taking over control.
  
  
• 19 hours of daily fasting enhances the body’s fat-burning capabilities by providing a long period every day when the body’s fat-burning machinery is switched on and stays on. Once the body is using energy from stored fat, rather than from fresh glucose absorbed from digesting food, continuous fat burning is more efficient than when the body flips back and forth from fat to glucose and back again. Also, changing back and forth causes fluctuations in the levels of hunger related hormones (insulin, ghrelin, leptin and more) resulting in the sensation of hunger.

I have had brief and limited experiments with the Fast-5 diet, usually in combination with alternate day eating. I am currently involved in another entirely different Fast-5 experiment.

My normal pattern is to wake up about 4am. and go to sleep about 8pm.

During my past experiments, I chose an eating window of 2pm until 7pm, which in my lifestyle is the equivalent of a 5pm to 10 pm window. This did not work well for me because during the entire Fast-5 dieting experiment I found myself simply killing time every day until 2pm, totally focused on wanting to eat, while I did everything possible to distract myself from food until the time finally came for me to eat.

I am a morning person, and normally prefer my breakfast and lunch over my dinner, so with a late-in-the-day window, my preferred mealtimes were not available to me.

I had difficulty in getting myself to set a morning 5 hour window because of the idea of how hard I might find it to go without food during the long afternoon and evening period.

Recently, I decided to try Fast-5 with a morning window from 9am to 2pm and found that this suits my body and personality a great deal better. A five hour window from 9am to 2pm allows me to eat at my preferred mealtimes. It also seems that so far…..I, personally, feel less physical hunger and less desire to eat after 2pm between lunch and bedtime, than I do in the mornings before 2pm. Whether this will continue to be the case over time, is something that I just don’t know.

My present Fast-5 experiment is in the early stages, and is combined with calorie counting and other dietary preferences. I haven’t set a time-period for how long I’ll continue on with it. Right now, it’s day-by-day, and I’m deciding each morning whether or not to go forward with it.

I know that there are times when I find eating zero food easier than eating a tiny amount of food, and other times when this isn’t true for me. I’m interested in learning more information about that difference. I’m also curious as to whether this way of eating will cause me to eat less overall, for more than just a few days, and if that behavior will provide me with any weight-loss results. I mention this just as another example of how I treat Dieting as a Hobby.