I've been feeling frustrated by my current maintenance results, a web search about that issue turned up an article about a study of literature on the subject, which I found interesting, even though it wasn't particularly helpful to me.

Below is part of that article, originally published in Medscape on 1/6/2012

Psychological Factors Influencing Weight Loss Maintenance

Background.
It is well recognized that most individuals who lose weight are unable to maintain that weight loss. However, the lack of evidence about the factors that cause this regain is surprising. The purpose of this study was to review the available literature to try and identify the factors that are most consistently linked with weight regain and propose strategies to assist patients to maintain their success.

Methodology.
An electronic search identified studies of patients whose weight loss had been achieved through behavior modification and who were then followed for the subsequent 12-18 months. Included studies were determined to have good methodological rigor and relevant data.

Results.
The literature on factors potentially contributing to weight regain were examined and clustered into 8 categories:

1. Unrealistic weight loss expectations -- studies were mixed and it cannot be concluded that this issue is a consistent predictor of weight regain.

2. Failure to achieve weight loss goals -- satisfaction with one's initial weight loss was identified to be an important factor. Those able to reach their goal weight or, alternatively, those who were satisfied with their weight loss even if it was less than their original goal were more likely to maintain this loss.

3. Dichotomous thinking -- this is defined as a "black or white" thinking pattern that leads to difficulty in accepting anything less than the original goal. This type of thinking pattern was strongly predictive of unsuccessful weight maintenance.

4. Eating to regulate mood -- another strongly predictive factor identified in this review was use of food to relieve emotional distress.

5. Disinhibition vs dietary restraint -- higher levels of disinhibition, which led to more uncontrolled eating, were associated with weight regain. In contrast, those able to maintain weight loss were better able to exercise restraint in their eating.

6. Perceived cost vs benefit -- individuals able to successfully maintain weight loss continue to find that the benefits of weight loss, whether defined as improved appearance, better health, or some unique combination of benefits, outweighed the perceived costs of weight maintenance strategies such as regulation of diet or exercise.

7. Depression -- although depression has clearly been linked to obesity, its relationship to successful weight loss maintenance is less clear. Baseline depression was not necessarily a factor, but increasing levels of depression over the time of weight maintenance did predict regain.

8. Body image -- no surprise, individuals who were more satisfied with their appearance, with steady improvement in body image throughout the time period studied, were more likely to maintain their weight loss.

None of this is really news, but it's worth thinking about again. I found their Viewpoint summary to be rather standard and uninteresting. I found the following statement particularly uninspiring….

"A number of factors associated with unsuccessful weight maintenance
are the same as those seen in patients with binge eating disorder."

 Like DUHHHH!! Don't even get me started on what I think about the way every single "non-healthy" eating behavior is now being labeled an "eating disorder".

Uh Oh, 
I think my frustration is clearly showing here again, and so now I'm going to spend some time working on my Positive Thinking.
 

                
  The dictionary definition of bingeing is:

to be immoderately self-indulgent and unrestrained;
to engage in excessive or uncontrolled indulgence in food or drink.

I personally agree that Bingeing isn’t usually because of lack of self control and weakness.
We binge because of a complex interaction of habit, brain chemistry, and external cues that signal us to eat. This interaction can be overcome, but it's harder to do and takes longer to change than most of us realize.

In the 1960s the Health Profession began attributing psychological reasons, rather than physiological reasons to people who overeat to the point of obesity. Since that time, there has been a tendency on the part of Health Professionals to classify every kind of eating outside “moderate eating” as an “eating disorder”. There are many reasons for this…and one of them is financial motivation. Unless a behavior is labeled a “disorder” or and illness, health insurance won’t pay for treatment.

You may call me cynical, but since “Binge Eating Disorder” is far more common than anexoria and bulimia. It has a much larger population base. This means more patients to treat with Therapy, and/or Eating Disorder programs, and more money and more profit for that specific Health Industry field.

Binge eating disorder first appeared in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1994. Until recent times, “Binge Eating Disorder” has been categorized under the umbrella term 'eating disorders not otherwise specified”, or EDNOS for short. EDNOS includes a wide variety of disordered eating patterns.
It's often used for people who meet many of the symptoms of anorexia or bulimia but not all. For example, a woman who meets all of the symptoms for anorexia,  but still menstruates regularly -- a criteria for an anorexia diagnosis -- would be diagnosed with an eating disorder not otherwise specified.

Health professionals admit that a Binge Eating Disorder is more than simply eating too much food, and that many obese patients don't have it. However still they claim that up to 5 percent of obese patients and 30 percent of patients participating in weight loss programs meet the criteria for binge eating disorder.

"It is important that clinicians and the public be aware that there are
substantial differences between an eating disorder such as
binge eating disorder and the common phenomenon of overeating,"
says B. Timothy Walsh, chair of the DSM-V Eating Disorders Work Group,
in a press release. "While overeating is a challenge for many Americans, 
recurrent binge eating is much less common and far more severe and
is associated with significant physical and psychological problems."

Proposed changes in the upcoming DSM-V, to be released in May 2013, would categorize BED as a specific eating disorder.
The proposed criteria require that episodes of binge eating, defined as:

“the consumption of unusually large amounts of food,
accompanied by a sense of loss of control
and strong feelings of embarrassment and guilt”

occur a minimum of once a week over the last three months for a diagnosis.

Such a diagnosis would fit almost every obese person that I’ve even known.….I’ve been one myself and I’ve known many, many others… Almost every obese person…and some of those who are not obese… experiences a sense that they have lost control of their behavior, and has strong feelings of embarrassment and guilt after eating an “unusually large amount of food”.

Weekends come every week, vacations and holidays come rather frequently, other celebrations and special events happen frequently as well.  Plus, most of us experience times of sadness, anxiety, or crisis more frequently than we like. It is common for an obese person to engage in excess overeating on these occasions. In fact it is also a very common occurrence for an obese person to “binge out” at least once a week for months at a time.

The disgust and aversion that modern Society has for fat people pretty much guarantees that fat people will feel embarrassment and guilt due to their failure to keep from engaging in behavior that contributes to their fat condition.

It is my opinion that, despite the “conditions” that psychologists attach to the “Binge Eating Disorder”, by their proposed definition, almost everyone who engages in excessive or uncontrolled indulgence in food, which is the dictionary definition of Bingeing, could easily fall into thecurrent medical classification of having an “eating disorder”.

I find something really wrong with this reasoning, and it is one of the reasons I was drawn to Gary Taubes’
research and theories about obesity having a physiological cause, with the psychological problems being a RESULT of the condition, not a CAUSE of the condition.

Taubes makes a compelling argument. My own experience and my observation of the dismal long-term success rate
of “eating disorder” treatments, especially those that include the use of “Intuitive Eating” as a tool of recovery tend to support my belief that while Therapy is helpful to gain self-understanding of one’s behaviors, and can help one learn alternative behaviors, the underlying conditions causing obesity are not cured through that process.

So…my position is that, for those who are obese, bingeing is normal, and not abnormal, eating behavior.

Society’s current label of “eating disorder” and suggested “treatment” is simply another attempt to shame fat people into believing that they need not starve themselves to become thin and stay thin. This is a misplaced effort, because an obese body wants to maintain itself, and this is a survival instinct that will never leave, no matter how thin one becomes, or how much therapy one has.

                                             
                                 
A gastric bypass...or stomach reduction, is exactly that.
18 years ago, when I chose to take this option, it was still considered experimental
and there were only a couple of doctors in California performing it.
I was required to travel to San Diego, which is 6 hr drive from my home, for that surgery,
and stay at a hotel there for at least 10 days immediately following my hospital release
with another person.  My husband accompanied me.

In my case, over 18 years ago, this was before laser surgery was common,
and my body was cut open vertically from chest to stomach...somewhere around 12+ inches.
My stomach was then cut apart into 2 pieces.
The top piece being a relatively small pouch,
and the bottom being the majority of the stomach.
At the place of division, the bottom part of the stomach was closed off and stapled shut.

As Food intake comes in through the top of the stomach,
and leaves though the bottom of the stomach,
the intestine connected to the bottom part of the stomach was cut away,
then brought up to the bottom of the small top part of the stomach and attached there.
The bottom part of the stomach remained inside the body, unattached to anything,
while the small top part of the stomach became the functioning body part.

In some of these surgeries, ....but not in my case......,
the intestine is shortened before it is reattached to the smaller, top portion of the stomach.
This interferes with the natural digestion process, so that ALL of one's food
...both calories and nutrients....are not absorbed but therefore pass through the body more quickly.
HOWEVER, in my case, all calories and nutrients in food are still absorbed.

A gastric bypass is, of course, major surgery,
although now laser surgery is commonly done,
which avoids the long vertical cut through the body.

It is painful, but my San Diego gastric bypass surgeon felt
that potential complications from pain medication outweighed the benefits.
So he did not routinely prescribe it.
In fact, a day or two after my hospital release,  I lay on my hotel bed in such pain,
that my husband phoned the doctors office for a pain prescription and was given one.
My husband returned from the pharmacy with TWO pills....TWO single pills.
That was the only pain medication I received after leaving the hospital.

 As my stomach healed, for several days I could only tolerate small sips of water.
Then I added jello and broth for several days.
On about day 8 or so, I was able to eat 1/2 a poached egg and a couple of bites of toast.
Eating more was physically impossible.

In those days, bariatric surgery was uncommon, and there were no large clinics
with nutritionists giving pre-surgery diet requirements or even post-surgery diets.
My only contact was with my surgeon...who like many doctors skilled in surgery...
lacked a pleasing "bedside manner".

My surgery was the Monday after Thanksgiving Day, and my pre-operation diet requirement
was not to "stuff myself" the week before surgery, as this might make surgery more difficult.

Regarding my post-surgery diet, after the first 10 days,
I was told that I should eat three meals a day, with only water in between;
that each of  those meals should be one-half protein:
and within those restrictions I could choose to eat whatever my body would tolerate.

 In fact, my surgeon's words to me were:

"You really only need the protein,
but I let people eat other thing too, just to make them feel good"

All carbonated beverages were strictly forbidden,
Sugar, fruit juice, and starches were discouraged
on the basis that they activated Dumping Syndrome..
....and they did...
It wasn't willpower that kept me away from sweets and starches.
It was the pain of "Dumping Syndrome" that ingesting these foods
generated inside my body which caused me to avoid them.
Protein shakes were not required or recommended.
My only additional medication was one daily multivitamin and an additional B-12 vitamin.

For the next six months, my body would only eat small amounts of food at a time,
and the amounts I could tolerate varied depending on what food I was eating,
and what food I had eaten within the 24 hours previously.

By small amounts of food, I mean, for example, during the first several months.
a maximum of perhaps between 1/3 of a small container of yogurt up to 1 egg and 1/2 piece of toast
...or perhaps 1/2 of a small sandwich, even sometimes a small lean cuisine dinner.

When I say tolerate...I mean that at the end of eating that amount,
I would feel stuffed like I had just overeaten a large Thanksgiving dinner,
and could not take another bite...
sometimes I had to lie on the bed in pain for 1/2 hour or so until some of the food digested.

People lose weight after a gastric bypass because they physically cannot overeat,
in fact at first, they can barely eat.
The first 6 months or so my daily calorie intake was between 300 and 600 calories a day
...and I felt stuffed and ill much of the time.

After 6 months, my food tolerance level grew and 2 or 3 years later it  sort of "topped out".
WLS made me lactose intolerant which has continued even now.
Sugar-free yogart and hard cheese has never been a problem,
but I still cannot drink milk nor eat more than 1/2 cup of ice-cream.

For example, now I can eat a 10 inch plate of food and feel full, but not stuffed---
depending on the type of food...and how empty my stomach was before eating.
This difference is not based on fat or calorie content, but is based on volume inside the stomach.
I still cannot physically eat large amounts of food at one time..
That is why, for me, seconds is not a problem.
However, snacking is a very large problem,
because after the surgery, nibbling and grazing was the most comfortable way to eat,
and after a few years, this became a firmly entrenched habit.

At present I can physically take in a great deal of food, by eating small amounts of food at a time
....like, for example, a couple of 100 calorie bags of snack food, or 2 or 3 cookies,
or a candy bar, or a couple of ounces of cheese, a small bag of chips, 1/2 cup of nuts...every 1/2 hour or so.
...even after having 3 small meals the size of a lean cuisine and small dinner salad.

My body, with an hour of daily low-impact exercise, burns less than 1200 calories a day.
My maximum physical calorie tolerance limit in one 24 hour period now is around 3500 calories,
where before my surgery there were days when I could take in over 10,000 calories.
I was a binge eater, and did not purge.

Prior to surgery I was aware of the process, the risks, and the after-effects.
It was a decision I did not make lightly, and in fact, a year before I had it,
my therapist and I together decided on taking that option in one year's time,
if I was unable to get back on some food plan that would drop some weight
or at least stop my weight from climbing further within that time limit.

I was around 47 years old at the time, and in good health
...except that I was 5'0" tall weighing 271 lbs....
after having lost over 100 lbs three separate times in my life,
and each time regaining that weight and more.
I had undergone many years of therapy on that issue (as well as others).
I had exhausted every effort, and I was ready for that step.

About 9 months after my surgery I weighed 160 lbs
and during that time I ate everything my body would tolerate without restriction.
ALTHOUGH, my doctor's instructions were to "eat 3 meals a day
...no snacking...with 1/2 of each meal protein."
I found myself unable to follow those instructions.

My weight stabilized in the 160s for several years,
and then as my tolerance for food grew, weight began to creep back on,
and I had to AGAIN, begin making effort to watch what I ate.
So, sometimes dieting and sometimes not,
in September 2004, my weight was 190 lbs....and climbing.
It was at that point I discovered the software program, Diet Power, 
and I began using it daily, writing down every bit of food that I ate,
and working to eat around 1000 to 1200 calories daily.
I had extensive food knowledge from my life of dieting.
I had been successful by counting calories in the past,
but it had proved too hard to keep up long-term
while using a pen and paper and a calorie dictionary.

The computer food journal was an answer to my prayers.
I found it easy to develop habitual use, and as of today,
I've recorded all my food every day in Diet Power for 2379 consecutive days...
I know that, because it says so right in my Diet Power history journal.

 So, now I've been working on maintaining my goal weight of 115 lbs for more than 5 years.
I do all kinds of different diets and food plans,
and learning about them and experimenting with them is part of my Dieting Hobby. 
The one consistent factor since September 2004 and 190 lbs
has been that I've logged all of my daily food intake into Diet Power.

Okay, so.......here's the thing...
I've described the Gastric bypass surgery, and its after effects.
Since my surgery, bariatric surgery, has gotten better
and some of the side effects I suffered aren't as much of an issue.
After my surgery, my adult daughter, my sister, and my adult nephew
.....as well as numerous friends....
have also chosen to have gastric bypass surgery with great success.
A negative is that my first cousin had the surgery, and died one week later from complications.

In the entire almost 18 years since that time, I have seldom regretted having the surgery,
and I would make the same decision again, if I were given the chance to relive the past 18 years.

What many "normal" people don't understand
is that, for many people,
the physical sensation of being empty or full
is not the real problem that causes overeating.

For some people, eating food is a successful device for handling uncomfortable emotions,
and there are also some people who simply enjoy the sensation of taste,
and the pleasant side-effects of eating far more than other people.

Personally, I've spent a great deal of my life feeling actual hunger,
and a great deal of my life feeling uncomfortable from being too full.
I find the physical sensation of hunger by far the most acceptable of those two feelings.

I hate being Fat.
I've been Fat, and I've been Thin.
Thin is better.

So as an intelligent being,
why would I choose to engage in behavior that makes me fat?
I've found I couldn't FIX that in myself... 

• through a lifetime of dieting;
  
• by my major surgery; or
  
• by more than 20 years of therapy.

So what I've learned to do is ACCEPT
that the desire to overeat is a problem for me that isn't ever going away
...and since I want to be thin...,
I just have to deal with it every single day...one-day-at-a-time.

When I'm in a public place and I see an obese woman
eating a really high-calorie treat
.....I DON'T think...."oh, dear...they shouldn't be doing that".
What I intensely know from my own personal experience
is the HIGH PRICE they have chosen to pay for that food,
and therefore how valuable and desirable it is to them.

I say :

"Go Girl, you enjoy that food,
because you've paid a high price for it,
and you deserve to enjoy it
far more than those people who are naturally thin."
 

Disordered eating is defined as
having eating habits that might present a risk to mental or physical health,
without exhibiting all the symptoms of a “recognized eating disorder”.

The term “eating disorder” is defined as
a mental illness; a brain problem that creates obsessive thoughts
and compulsive behaviors around food and the body.

Using the above definitions, it seems clear to me that mental health professionals
could manage to place almost every obese person somewhere in those categories,
which increases their marketing target and their potential financial profit.

It is the position of mental health professionals that
all people with disordered eating behaviors and
all people who exhibit symptoms of eating disorders
should receive psychological treatment to correct those conditions.

        I don't agree.

Therapy is helpful to relieve mental distress,
and if disordered eating or an eating disorder is the cause of extreme mental distress,
therapy can be beneficial when its purpose is to make people feel better about themselves..

However, in the case of “disordered eating” psychological treatment frequently
appears to merely be an effort to force people to conform to specific social norms of behavior.
And, perhaps, conformity isn’t always such a worthwhile goal.
Maybe other values are more important.

My opinions about “disordered eating” and “eating disorders” are somewhat controversial,
and over time I’ll be saying a great deal more on the subject.
But for now, I’ll leave you with the following song about disordered eating.

                             

Here's my Opinion.
Lighten up.
Having a "Food Obsession" is okay.

Personally, I have no desire to reduce my own "food obsession".
I'm the kind of person who really gets into anything I do, any interest I have.
So what if I'm not "normal" around food.
So what if food, and issues around food, are important to me.
So what if I spend a lot of my time thinking about food and/or weight.
I'm not going to waste my life shaming myself because of it.
Food is just as important or interesting as anything else...
....in fact it is the one thing that is vital for life to exist.

Just because a "saying" is old, doesn't make it right.. 
  I think "Eat to Live, not Live to Eat" is just a B.S. Value Judgment.
It really is just another way for people who don't share my values to negate them.
Am I REALLY going to let that part of Society legislate my morality?
No.

Acceptance of oneself and one's personal interests apply generally,
in that much of modern Society now has a "live and let live" morality,
or "do what you want, as long as you don't' hurt others" ...
....but it makes a BIG EXCEPTION
about allowing a fat person to feel okay about food and their fat,
and it generally agrees that it's okay to tell a fat person
how they are SUPPOSED to feel and behave,
and to try to shame them into feeling guilty for what is natural to them.

Just watch one episode of the TV show, The Biggest Loser,
and see Society's current value judgments about the obese contestants.
Notice how the obese contestants buy into those negative Beliefs about themselves,
and how they state their belief that unless they are thin, they have no life.
Notice how they feel they deserve the ill treatment they get on that show,
including severe verbal abuse...and even (what I would call) physical abuse.

Then, when they lose weight, notice how they are encouraged to become
missionaries to the world and work to convert other fat people to their new beliefs.

"Obsessed is what the weak and lazy call the Dedicated"

Society in general, finds it acceptable for people to be obsessed with
exercise, sports, television shows, video games, hobbies, work, money,
shopping, relationships, family, sex, parenting, vacations, etc. etc. etc.
But, God Forbid, that anyone should feel okay about being obsessed with food.....

ESPECIALLY, if that person is overweight, obese, or very thin...
Only a "normal" sized female can acceptably demonstrate a strong interest in food...
and even that Acceptance is very limited.
Actually, this Quote is not exclusively related to food issues.
Dedicated, not Obsessed, could be an extreme interest and focus on Anything at all.

Terming someone as "Obsessed" is generally a negative value judgment
concerning the extreme interest and focus of another,
while terming such behavior as "Dedicated" is generally a positive value judgment.

The above quote is an amusing,  rather clever "return put-down" to negative people
who label those with an excessive interest and focus in any subject as "Obsessed".
The point of the quoted statement is that terming anyone "Obsessed" is totally unacceptable.

In this saying, the negative label: "lazy and weak" only applies to those people
who GIVE the negative label "Obsessed" instead of a positive label like "Dedicated".
i.e. IF YOU THINK I'm "obsessed", THEN I THINK you're "weak and lazy".

Someone who feels that it is acceptable to refer to someone as obsessed,
might be offended by seeing the original insult: "obsessed",
returned by another insult: "weak and lazy, even when this is done in an amusing way.
To anyone who is offended by this quote: 
I didn't create it, I merely quoted it. It is, however, one of my favorites.
I think it's amusing, and I like it.  Probably because I've had personal
dealings with negative people who term anyone with a strong focus as "obsessed".

It could be that some people need to actually have experiences similar to mine
before they can fully appreciate the "black" humor within the statement.
The saying is essentially an amusing twist of semantics,
and like any kind of humor...
if one just doesn't "get" a particular joke, an explanation of that joke
still doesn't make it funny to the one needing the explanation.