A Pill To Make Me Stop Eating Lasagna

She asked me to help with her weight problem. At 25 years old, she could not have been more than 25 pounds overweight.

“I need a pill to make me stop eating lasagna,” she told me.

I went into my maternal mode.  “Oh no, my dear, that is not a really good thing to do.”  I explained patiently that if she were hungry enough for her hunger to wake her at 6:30 in the morning and propel her to the preparation and consumption of microwave lasagna, she was probably hypoglycemic and she needed enough protein snacks in the evening to maintain her blood sugar in the morning.

I think I explained the physiology as well as I could to the young lady, without aid of graphics — let alone a pre-medical education.

In the past, I would have asked for some around the clock blood sugar checks, but even if I wanted them, it would take a short infinity to obtain them in the context in which I was working.

It is not the blood sugar numbers, but how the patient lives them.

I’ll admit I threw in a little psychodynamic frosting, telling her that binge eaters often binged at least in part because they feel empty inside, and that she may have “other issues.”

She told me she could not figure out how to get protein snacks while she was living where she was, so couldn’t I just prescribe her a little “appetite suppressant” until she could move.

I am quite proud of myself for not tearing my hair out at that moment.

I had to say “no,” which nobody likes to hear from anybody.  I learned long ago, from a brilliant senior preceptor in Kansas, how to go “limp” and avoid getting adversarial.

I explained that so-called “appetite suppressants” were uppers and very addictive, and if I prescribed them I would get fired, and I really needed this job to feed my husband.

Luckily she liked me enough to feel sorry for me, and we moved on.

Eating, including (if not “especially”) compulsive eating is best assessed, like most complaints made to a psychiatrist, as multifactorial.  No paradigm comes to mind that is faster — or simpler — than that of Dr. Engel, who taught at the University of Rochester in the 50’s.

No — I’m not that old … I wasn’t there in person … but I’m pretty sure it was the school in New York State.  I don’t think it was the Mayo Clinic (Rochester, Minnesota) or the African-American who took care of Jack Benny.

The model goes “biological/psychological/social.”

Biological: Human blood sugars fluctuate, by their very nature.  Low blood sugar is what normally wakes up folks in the morning, if the alarm is not on.  High blood sugar is what makes you feel like napping after Thanksgiving dinner. Eating sweets makes your blood sugar “spike” like a Mohawk hairdo…and plummet back down, often making you hungry for more sweets. The best way to keep things as level as possible is to eat protein. I have sent lots of people into the world with eggs and nuts to fix their “attacks,” but this patient resisted the idea, which takes a little bit of planning and effort, but not terribly much.

Psychological: Did eating microwave lasagna at 6:30 am make her feel “special?”  Or give her “alone” time which she could not have engineered into her life otherwise? Or maybe she just felt “empty” for some other reason.  Maybe no boyfriend to love.  Maybe an unlovable boyfriend to love. Maybe she is just more interested in other women or pets, let alone a butterscotch sundae.

Social: There is pressure, real or imagined, on women to be thin.  I have seen more than my share of perfectionist anorexic sometimes brilliant and clearly obsessional women.  I myself have been fat, and consequently invisible to all but the most discerning of men, one of whom actually had the requisite guts to marry me. Now, at 63, thin but at least reasonably well groomed, I have to decline rather aggressive offers from men while my husband fetches the car in the parking lot to rescue me from the front door of Walmart. Sometimes, I think people may have missed how clever I could be when there was more of me.  Of course, now I have the authority of age and the blood probably makes it to my brain easier, anyway.

I had to come at her second request for a “temporary appetite suppressant” from another direction, since logic and science had not been particularly helpful here.

I told her that when I had been 200 pounds overweight, I — who could prescribe myself anything in the world I wanted (not terribly ethical or legal; I would never do this, anyway) — well, I would never prescribe “appetite suppressants” for me, because they are dangerous drugs, and I cared enough about her I would not give her anything I thought was too dangerous for me.

She nodded, after a little hesitation, and seemed to like me well enough to give me a little hug.

Making peace with food is tough.  A simple thing like learning to eat only when you are hungry can become fairly overwhelming.

Me, I still remember my mother and grandmother, both of blessed memory, who told me to clean my plate because kids were starving in Europe.

I remember them most, if not every time, I return a plate to a (restaurant) kitchen that still has food on it, because I could eat no more.

Mommie was also correct when she said, “when you have a kid, they don’t give you a book that tells how to do it.”

She actually did a pretty good job, and has long since been forgiven.

Forgiveness is the cornerstone of moving on.

THE END