Educational content provided by Dr. George Northrup, South Tampa's weight loss and weight management doctor. 

A Consuming Addiction

By DONNA KOEHN - The Tampa Tribune

Even now, Mary Lou Volbert, 65, can't get food off her mind.

Knowing she can't eat with abandon, not as she did when she weighed 420 pounds, she transfers her obsession into recording every carbohydrate she consumes from food. Her tallies in a lined notebook are meticulous:

One carb for the lemon she squirts into her tea.

Two for the low-carb milk that goes into the coffee she sips throughout the day.

One for the chunk of Muenster cheese for lunch.

Her daily total can't exceed 16.

She also puts great care into creating magazine-worthy, low-carb desserts for herself. But her husband keeps a separate refrigerator in their home's second kitchen, and she does not go there.

"I know I am addicted to food," she says.

And as surely as drug addicts and alcoholics face death as a consequence of their behavior, Volbert, a former psychiatric nurse, realizes that the food she loves could kill her.

Increasingly, researchers are exploring the similarities between compulsive eating and other self-destructive behaviors such as alcohol and cocaine addiction. Scans reveal similar neuropathways in the brains of addicts and the morbidly obese. Food increases the feel-good dopamine levels in the brain, paralleling the effects of addictive drugs.

Those specializing in the surgical treatment of obesity also are beginning to address the social and psychological aspects of their patients' care. Although it remains controversial, one theory suggests that those who curb their food addiction are more likely to take up another vice.

Volbert realized she had two options: die of pulmonary hypertension, kidney problems from type 2 diabetes or congestive heart failure, or undergo bariatric surgery.

So when she and her husband, Arthur, sold their home in New York and retired to a smaller place in St. Petersburg, they used the money they made to pay for a $17,000 Lap-Band procedure. The adjustable band, surgically placed in October 2005, created a small pouch at the top of her stomach, restricting the amount of food she can eat and lessening her hunger.

"The doctor told me if I waited even a few months, I would probably be dead."

At her weigh-in this month at her surgeon's office, Volbert was down to 169 pounds, her lowest point in 35 years. She swims at a gym for exercise and loves shopping for new clothes - a potentially expensive habit because she's dropping a size per month. For that reason, she sticks to thrift stores.

"What's wonderful is that no one notices me now," she says. "No one stares."

Despite her joy, she finds it hard to shake an oppressive sense of guilt. Her sister, her daughter and her granddaughter share her food obsession, and all of them have followed her into bariatric surgery. Relatives who don't battle their weight are hoarders, unable to throw things away. She recognizes that tendency in herself.

She worries about her grandchildren and great-grandchildren, and hopes to spare them the family's legacy of misery.>

'Lady, Does It Hurt To Be That Fat?'

Volbert's parents were thin, although her mother's mother was obese and a source of family shame. Although her father accepted Volbert's early struggles with weight as a medical issue, her mother believed she was committing the sin of gluttony.

"My father loved me no matter what, but to my mother, I was an embarrassment."

The surgeon who treated her at age 11 for an intestinal obstruction - made up of bits of erasers, hair and newspapers - told her he would keep it a secret if she would stop eating these things. In the early 1950s, no one had heard of eating disorders. Instead, the child was weak, lazy, a pig.

She starved herself svelte in high school, beautiful but miserable. She also smoked up to three packs a day, which helped keep the weight off. It gave her that psychological boost of putting something to her lips. When she quit, the weight gain accelerated. With the birth of each of her three children, she gained more and did not lose it.

When the nasty comments began, she tried to think of comebacks. Children didn't bother her.

"One little boy said, 'Lady, does it hurt to be that fat?' I told him that if it had happened all at once, it probably would have. Of course, his mother was horrified."

But the snide remarks from adults sometimes left her speechless.

"Once, when I was in a mall, a woman came up to me and told me I had no business being out in public. I didn't know what to say."

Eventually, forced to use a wheelchair because she couldn't support her own weight, she was trapped on the first floor of her three-story house. For rare trips by plane, she bought three seats, and once had to be raised to the plane by the device that loaded the serving cart. "It was just so terribly humiliating," she says. "I would see the pity in people's eyes, and it was so awful."

Her husband called ahead to restaurants to see whether the chairs would support her. She once got stuck in a booth.

"I would always be self-conscious about what I ate, because I didn't want people to see me eating a lot and thinking worse of me. I would never go to an all-you-can-eat place."

About five years ago, she lost 160 pounds. When she began putting it back on, she realized surgery was her only hope.

Surgeon Ernie Rehnke, with a subspecialty in bariatric surgery, treated all four family members at Palms of Pasadena Hospital in South Pasadena, just east across Boca Ciega Bay from St. Pete Beach. Rehnke, who has been performing the procedure for about 10 years, requires patients to undergo psychological testing beforehand and encourages them to attend food-addiction support groups.

"Why bariatric surgery didn't work so well even 20 years ago is that we failed to address the psychological issues and the need for support beforehand," he says. In the past, patients who expected miracles had the surgery and then continued to consume milkshakes and high-calorie sodas, negating the effects.

"I describe the procedure as a tool like a rake," Rehnke says. "If you leave the rake leaning against the wall, it doesn't work."

Eating To Live

Food addiction can be a greater challenge to treat than addiction to hard drugs, says Joseph Molea, an assistant professor in the University of South Florida College of Medicine who specializes in addiction disorders. "All of us have to eat," he says. "One of the dilemmas of people addicted to food, unlike people addicted to chemicals, is they have to continue to eat. They can't become abstinent."

Mood disorders such as depression and anxiety are common in people who undergo the surgery, according to a January report in the Harvard Mental Health Letter. Tests measuring mood show improvement in the first year after surgery, but that dips when measured two and four years later. Other research has found suicide at higher than expected rates after surgery.