Did you enjoy stuffing your Thanksgiving turkey? I hope so, because right about now, you're probably regretting where you stuffed it. This is the time of year when we pat our bellies and wish we could eat without gaining weight.
Well, maybe we can.
Our ancestors would have been thankful to have our problem. They spent their brief lives scrounging for enough sustenance to fend off starvation. But once our species developed the technology to feed itself, our taste for fat and our talent for storing it turned against us. We fumbled with elixirs, corsets, and quack diets. Science made diets more effective, but we still hate them.
If only we could manage food the way we've managed sex. Sex, like eating, is fun, and for good reason. Food nurtures us to maturity and keeps us alive so we can procreate and raise children. Sex passes on our genes. If food and sex weren't fun, you wouldn't be here. But in the age of abundance, these appetites are out of sync. Infant and juvenile mortality have plummeted. You don't need to get pregnant all the time to raise enough kids. You'll end up with too many if you let nature take its course. So we invented birth control.
The point of birth control is fun without consequences. You still want sex, and you still get it, but we tinker with the process so you don’t get pregnant. Last week, the U.S. Conference of Catholic Bishops complained that separating sex from procreation violates nature. Of course it does. Nature put the fun and the consequences together, but for reasons that no longer apply. Nature has produced a creature clever enough to take nature apart. We get the orgasms without the organisms.
Why not try the same with food? Keep the fun and lose the consequences. We invented birth control; why not girth control?
In fact, we're already working on it. Food abstinence, like sexual abstinence, was the original option. Then came the rhythm method: no snacking between meals. Randy teens fortify their resolve at True Love Waits; hungry adults do it at Weight Watchers. To relieve the hots, there's safe sex; to relieve the munchies, there's SlimFast. With foams and jellies, we can kill sperm in the reproductive tract; with lipase inhibitors, we can neutralize fat in the digestive tract. The pill blocks pregnancy by fooling your body into thinking it's pregnant; appetite suppressants curtail eating by making your body think it's full.
Even barrier methods are crossing over. To control fertility, you can insert a diaphragm or vaginal ring; to control obesity, your doctor can slide a gastric balloon down your esophagus. Once inflated in your stomach, the balloon takes up space so you eat less. Thousands of people are walking around with these balloons; many thousands more are wearing implanted gastric bands that constrict their stomachs. Last month, doctors proposed the digestive equivalent of a female condom: a sleeve that would be shoved up your intestines to block calorie absorption.
The girth control debate, like the birth control debate, pits chastity against practicality. Idealists point out that exercise, a balanced diet, and self-restraint are the best ways to control weight. Realists point out that diets, like abstinence, fail because people don't stick to them. The weak link is willpower, and the focus of current research is how to get around it.
The most obvious answer, as we learned with birth control, is surgery. Eight years ago, 13,000 people had operations in which doctors constricted, cut up, or removed parts of their stomachs or intestines. This year, the number of surgery patients will exceed 200,000. The stomach portion of these procedures is called "restrictive" because it reduces the amount you can eat. The intestinal portion is called "malabsorptive" because it bypasses your bowels so you don't absorb fat or calories. Food goes right through you.
Restrictive procedures are supposed to limit your intake by making you feel full. But lots of people cheat. You can stretch your reduced stomach by eating past the point of fullness. You can keep refilling it with high-calorie liquids, which may be why gastric bands and balloons haven't worked as well in Americans as in Europeans. Some doctors even offer to "readjust" your band so you can "relax more on holiday."
The most common stomach-intestine surgery, gastric bypass, is supposed to deter cheating by exposing you to " dumping syndrome," a punishment inflicted by your body if you eat too much sugar. But you can escape that penalty by resorting to intestine-focused procedures: biliopancreatic diversion (BPD) or duodenal switch (DS). Both procedures leave you with a stomach three to six times bigger than you'd get from a gastric bypass. "There is no incidence of the 'dumping syndrome,'" and within 18 months, "the stomach will have stretched out to almost normal size, allowing the DS patient to eat very well," notes one purveyor. Another advertises that BPD "allows the morbidly obese patient to lose the excess weight without changing the eating behavior."
How do these surgeries let you pig out and still lose weight? By cutting 80 percent of your absorptive small intestine out of the digestive tract. The more you cut out, the less food you absorb. That's why gastric bypass sheds more fat than bands do—and intestinal surgeries shed even more. Reports indicate intestinal procedures are spreading. This year, surgeons persuaded the federal government to pay for them under Medicare.
Intestinal bypass is no picnic. It's traumatic, and it means taking supplements for the rest of your life. The ideal solution would be to find the same benefits in a pill. Wouldn't you know it, two studies have come out this month suggesting that a compound called resveratrol neutralizes the harmful effects of a high-fat diet in mice. "Guilt-free gluttony might not be a fantasy," scientists concluded in Nature.
Think about that as you try to sweat off this year's turkey. Maybe next year, you won't need an ounce of self-discipline to keep off the pounds. Something to give thanks for. Or not.
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