Weight-loss surgery for all!

Dr. Super is loving this.

Usually reserved for the most obese people, weight-loss surgery is unlikely to be a last-ditch option much longer. Technological advancements are turning it into a one-hour, incisionless procedure -- making it more attractive to moderately overweight adults [...]; overweight and obese teenagers; and normal-weight people with difficult-to-control diabetes. Several new procedures are already in human clinical trials.

I think we're all getting a little carried away and assuming that just because a procedure is easy to accomplish, its effects are also easy to live with after the fact. As many have discovered, and as this same article notes, even though the already low morbidity rates for this type of procedure continue to decline and operation recovery times become shorter, patients still have to contend with medium- to long-term problems, including "nutritional deficiencies, diarrhea, regurgitation and bowel obstructions."

According to the Agency for Healthcare Research and Quality, 19% of patients experience dumping syndrome, which is involuntary vomiting or defecation. Complication rates involving ulcers, wound problems, hemorrhage, deep-vein thrombosis, heart attacks and strokes range from 2.4% to 0.1%.

And where do we draw the line regarding preemptive surgery? One surgeon notes that "[p]eople 50 pounds overweight are the ones we should treat, before the problem gets worse," but isn't that number quite arbitrary? Unless we ascertain that at 50 lbs overweight (as opposed to 40 or 30), people start to see marked deteriorations in their overall health (in fact, we've been told that every 10 lbs packs its own share of doom), then the benchmark at which surgery becomes an option can arguably continue to shift downwards.

I suppose weight-loss surgery is now poised to enter the realm of cosmetic procedures, where if people opt to risk their lives and health in order to try and feel better about themselves, then they have that right. The rub lies in the fact that most elective cosmetic surgery is not covered by the majority of insurance plans or universal health care systems. And so it will be interesting to see - especially in the context of the raging US health care debate - how this particular argument evolves.

Happy *burp* Independence Day (Conversations in holiday eating)

It's Independence Day in Barbados - 43 years since we told England "thanks for the slavery and that but we can take it from here." I hadn't spent an Independence Day in Barbados for some time, before now, but it's one of my favourite weekends of the year, in part because of the conkies, which might possibly be the best food in the Western Hemisphere (next to steamed pudding and sweet bread). This morning, reading the news, I saw that when asked about Kate Moss's statement that "nothing tastes as good as skinny feels", Rihanna responded "I love food because I'm from Barbados." And I thought: what a simple and beautiful truth lies in that statement. The 'because' is the real poetry there. Simple cause and effect: since I am from Barbados, I love food. My love for food is based on my geographical provenance. No need for further examination. It's science.

And it's pretty accurate. Holidays and food go hand in hand in lots of places. But for many of us here, eating is an event. I've been planning activities with friends and colleagues, and after we've planned the menu and assigned responsibility for preparing the various items, the conversation has been known to go like this:

Me: So we have all the food and drinks sorted. What else will we do?
Friend 1: And the cups and ice? And the Banks? (Because apparently Banks beer is crucial enough not to count as a drink, and to merit a separate discussion point.)
Me: And the cups and ice and Banks. What else will we do?
Friend 2: How you mean?
Me: Well we can't eat all day.
Friend 1: *blink*
Friend 2: I don't understand.
Me: Well, we'll get there, we'll spread the blankets, unpack the food, eat it...
Friend 1: People will drink, talk, fall asleep, wake up, eat again, finish the drinks, eat the leftovers on the way to the cars and go home. Seriously...how long have you been away?

And of course it has changed a bit over the years. My generation and subsequent ones are pretty active. We'll set up some stumps for cricket and play paddle ball and volleyball at the beach, but whenever I'm at a daytime holiday event with people of all ages, the food is definitely the star. And it's a challenge if you have certain food preferences.

Say my plate has some rice, a flying fish and fried plantain:

Guy I've seen twice in my entire life: Why aren't you eating?
1st Stranger: You trying to reduce?
2nd stranger, wandering in: She trying to reduce?! Reduce where? Girl you big as a mosquito. (Note, I'm considerably larger than a mosquito.) Eat some food.
Me: I'm not trying to lose weight. This is enough food for me right now.
Twice-seen guy: Oh you sick?
Me: No. This is what I want now. I'll have more later.
Stares from all 3
3rd stranger, wandering over: That is all the food you want?
Twice-seen guy: She trying to reduce.
Pitiful glances from all.

Or, say my plate has a variety of foods but no meat:

Neighbour: Why aren't you eating? (You'll notice there's a very clear definition of eating that is more than just 'ingesting a food item and swallowing')
Me: I have food. All that's left is meat and I don't eat that so...
Neighbour: Oh you don't eat pork! There's lamb and chicken.
Me: No I mean meat. And poultry. And shellfish.
By 'shellfish', I'm mumbling and ashamed.
Neighbour, confused: Oh. There's a lasagna there. That has vegetables.
Me, trying to disappear: Right. That's beef. I'm alright, though. This is enough. Thanks.
Neighbour, calling in reinforcements: She says she doesn't eat meat. No meat in that soup, right?
Stranger: No. Only some pigtail.
Me: Right. That's um...from a pig. But you know, I'm good here. I have plenty.
Both look at my plate disapprovingly.
Stranger, calling in more reinforcements: Straw! What here doesn't have in meat?
Straw, also a stranger, walking over: Ahm. I ain sure. Eat some chicken!
I think he believes that if he says it with enthusiasm, I'll be spontaneously convinced to eat chicken.
Me: No, thanks.
Straw: Eat li'l piece. It can't kill you.
Straw is not even in the vicinity of the point.
Me, backing away lest I be force-fed some lamb stew: I have plenty, though. Seriously. Thanks.
Pitiful glances from all.

Of course, we're a modern society, for what that's worth, and we have our fitness competitions and fashion industry and a desire to be thin that is not pervasive, but exists. (We also, for the record, have a non-negligible vegetarian population, so I never understand why so many people act as if non meat eaters are of some kind of cult.) Fat people are still teased, as are thin people. But in general, the thin ideal is a lot less thin than it is in other places. It's more a kind of medium-sized ideal. Still, this type of food philosophy, though seeming quite food- and body-positive in some ways, is quite intolerant in others. It assumes that it cannot create disordered eating, and so does not really allow for its existence in the way food is discussed and treated among groups of people. That assumption is of course incorrect, and I think we're on our way to realizing that.

But there's a certain level of comfort that we have with food, and a pride in creating it that historically comes from doing interesting, innovative things with very little, laboriously-, locally-grown food. That pride is deliciously experienced around Independence Day, and in honour of this day, I give you the afore-mentioned greatest food of the Western Hemisphere. The Conkie.

Ingredients:
2 cups corn flour
1/2 cup flour
3/4 lb finely grated pumpkin
6 oz margarine/shortening melted
1/2 lb sweet potato
3 cups grated coconut
1 tsp salt
4 oz raisins (optional)
3/4 lb brown sugar
1 cup whole milk
1 tsp spice
1 tsp freshly grated nutmeg
1 tsp almond essence
Banana, Plantain or Fig leaves (singed over fire)*

*They'll say you can use wax or foil paper if you have no banana leaves, but They lie. No, you can. But you shouldn't. They simply won't taste the same.

Banana leaves are used to wrap the conkie mixture, so you need leaves that aren't shredded. Strip leaves from stalk with a sharp knife. Leaves are very delicate and tear easily. To use them in your recipe, you must make them pliable by briefly singeing them over an open flame. If your leaves start to curl up, that means they've been on the flame too long. If your leaves spontaneously combust, that means you're using old, dried up leaves. So, you know, don't do that. Use green leaves.

Tear singed leaves into individual squares for wrapping your conkies. The standard size square is 8" x 8", but they can be bigger depending on how big you want your conkies to be. Cut the leaves into desired pieces.


• Combine grated coconut, sweet potato & pumpkin.
• Mix in sugar, spices, flour, corn flour, salt and raisins.
• Add milk, margarine and almond essence.
• Mix ingredients well. Mixture should be thick and drop slowly from a spoon.







• Place 2 to 3 heaping tablespoons in the centre of each banana leaf square.
• Fold the banana leaf neatly around the mixture. Be careful not to tear the leaf, or the mixture will leak.




•Steam conkies over rack of boiling water in a large saucepan or steamer until firm to the touch.









And vIola! Here's your unwrapped conkie goodness:













These lovelies freeze very well. My mother once made them on Independence weekend and froze me a batch until I came home in May the following year. I don't think I did any grocery shopping that entire first week I was back.

Happy Independence Day.

Recipe and photos adapted from www.justbajan.com

You're fat because your chicken breast is bigger than your fist

If you watch The Biggest Loser, you know that it is essentially a weight loss competition where overweight people form teams to see who can lose the most weight collectively. Each week, whoever has lost the least as a percentage of her total body weight is eligible to be sent home. By the end, one person will have been declared the biggest loser, and will receive a $250 000 prize (in the UK it's £10 000. We can't catch a break) amid much fanfare and confetti. Sound potentially problematic? Well no kidding.

The contestants exercise for hours and hours every day on a restricted-calorie diet. So clearly the show is just about entertainment for its viewers, since this lifestyle is not practical for anyone outisde the show who's not a professional athlete, a member of the Armed Forces or from the planet Krypton. (They do have a Biggest Loser Club, though, which is essentially a less psychotic, online diet and exercise support plan geared toward weight loss, and based on the show.) I've watched a couple episodes of the US version, and even though I have several issues with almost everything about the show's premise and execution, I at least found the trainers/team leaders entertaining.

Celebrity ubertrainers (or should that be ubercelebrity trainers? Whatever. They're uber) Jillian Michaels and Bob Harper each take a team through daily workouts and help drive their success. Jillian is your typical, tough taskmaster, who often appears bewildered and victimized when progress does not occur as expected; while Bob is a positive-thinking, bright-eyed, bushy-tailed sort who I'm almost positive is being dosed with happy pills without his knowledge. He seems to think that fat people are just broken thin people. And doggone it if he ain't gonna fix 'em. I'll admit: I've often caught myself liking Bob despite myself and all the things wrong with his apparent philosophy. He's just so earnest.

The UK version is decidedly worse. Because it features all the things wrong with the show - the unrealistic, stress-inducing workout regimen; the weight-loss as competition dynamic; the stripping down of contestants for weigh-ins as if they're livestock at market, and as if to remind us that they are in fact huge and have the rolls to prove it, in case we'd forgotten - but has none of the entertainment factor. Yes, I acknowledge the problem with this statement: why do I want to be entertained by the show if I concede that the entire thing is a mess? I don't. I've only watched it a handful of times in order to be able to make an informed judgement. But I notice that the UK version has not one redeeming factor: the trainers - whose personalities are meant to be at least interesting enough that their interaction with the contestants creates some intrigue - are dull as grass.

One also gets the impression that the UK producers were aiming to recreate a similar match-up to that of the US version: one of the trainers is a tough, non-bullshit-having woman, and the other is a focused (but milder-mannered?) man. Both try too hard. And the result is a big pile of snore.
But today, my second time watching the show, there were some fireworks, and by 'fireworks' I mean extra-loud yelling, dramatic camera shots and plenty food- and fat-shaming. Trainer Angie stops by the house for a surprise lunch inspection. Don't you hate when that happens? She walks in to find Jennifer, the mum in the mother-daughter team above (contestants are paired up in this series), eating chicken breast she had just prepared. Angie then begins to yell at Jennifer, in front of everyone including Jennifer's daughter Sadie, about the fact that there are no carbs or vegetables on the plate, and that she is eating more than a single portion of chicken. She also belittles her for having had steak the night before. While Angie stands there bellowing, pointing at the offending meal, flailing about and otherwise losing her sh*t over this unforgivable food transgression, Jennifer sits there looking morose, embarrassed, and most of all, hungry. Sadie, who is directly next to her, tries to pull it together for the both of them by agreeing to eat some spinach.

The segment is interspersed with video clips of the other contestants remarking that Jennifer knows she's eating too much, and that they've tried to speak to her about it. The implication is that the only thing that will get through to her is a good old verbal flogging delivered by Angie who, I'm sorry, seems to have no idea how to do the tough love thing, if it is even appropriate here.

I suppose none of this should be surprising, given the premise of the show: let's haul some fatties in here and beat them into shape. But I admit that I was alarmed by the abuse this woman was forced to suffer. First, as the slowest loser to date, apparently, Jennifer was trying to accelerate her weight loss by eating low-carb. Ill-advised though this may be, it does indicate a level of effort and an unwillingness to once again be in the spotlight as the weight-loss failure. Do they expect to throw these people into a competition under extreme physical and psychological conditions and have no bad/compulsive habits develop? I'd be more surprised if they didn't all end up with patterns of disordered eating.

Second, the woman is obviously hongray! During the entire dressing down, she sat there staring longingly at her delicious chicken breast that was going cold and was probably now covered in spittle and hate. And it isn't necessarily because she's greedy, as she was forced to mutter. It's because a body her size probably can't subsist on the fist-sized portion measure that Angie was waving in her face. That's not to say that it's impossible to stick to the diet and lose weight. Clearly it's not: almost everyone on the show loses. But they're not all the same person. Not everyone can change their bodies by sheer force of will. Hunger is not a figment of the imagination, and it won't be exorcised by another hour on the treadmill.

Sadie was worried that after the embarrassing talking-to, her mother would tell Angie where to shove her fist(-sized portion) and give up. And I would think that's a very real concern with anyone who's struggling to lose weight. This show already makes no secret of its extreme methods of trying to get all bodies to look and behave the same. Now they've added express public humiliation to the mix. I don't think the contestants are the only 'losers' here.