Small bites: One woman’s journey through weight-loss surgery

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The present I gave myself for my birthday last year isn’t something I ordered online, although a great deal of online research led me to choose it. I didn’t get it at a mall, and, thanks to excellent medical insurance, it didn’t cost me a dime. After passing my pre-op physical and lots of lab work, including a colonoscopy, I checked myself into Fairview University Hospital and had weight-loss surgery-the Roux-en-Y gastric bypass, considered the gold standard for surgeries of this type.

It’s something I thought about, researched and agonized over for nearly three years. At the time, I thought it was the absolute best thing I could do for myself. Seven months later, I’m glad I had the surgery–with qualifications; things are much different than I thought they’d be. I’m not the perfect weight-loss patient (if such a thing even exists). But I have a much healthier relationship with food.

Food, glorious food
It would be an understatement to describe the way I feel about food as a love-hate relationship. Prior to weight-loss surgery, I was addicted to food. I loved to eat but I lacked the ability to regulate what and how much I put into my mouth. I hated the result—obesity. Some people eat when they’re nervous. Excited. Worried. Happy. Sad. Or, like my younger daughter, only when they’re hungry. I ate all of the time. I love food: sweet food, fatty food, spicy food, tangy food, bland food. Fried potatoes and spicy-hot salsa; crème brulee and warm-from-the-oven brownies; ethnic food and Minnesota hotdish; lobster with drawn butter; creamy raspberry malts; hamburgers on the grill … you get the idea. Sometimes I ate without tasting my food; other times I savored it. I usually ate too much, and I seldom ate when I was hungry because I didn’t let myself get hungry.

I’ve always been a foodie. As a child my mother described me as a “good eater,” as opposed to my sister, the “picky eater.” I grew up to have a weight problem; my sister did not. My mother never had to coax me to clean my plate; she was a good cook and I liked just about everything she prepared, from spinach to sautéed liver with fried onions (yes, really). I didn’t grow up in a house filled with candy and sweets—my mother never saw the point, and my father, who did, died when I was 8—but I developed a taste for them just the same. My mother never had to watch her weight; in fact, when she was younger, she was so thin that she actively tried to gain weight. My father had a tendency to gain weight, but he maintained a normal weight by staying physically active and watching what he ate.

Weight gain
Unlike many of the gastric bypass patients I’ve met, I wasn’t a fat kid; I had an average build, but in our weight-conscious society, and surrounded by skinny friends, I felt overweight. When I look at pictures of myself as a young adolescent, I see a beautiful, perfectly proportioned body. Though I was never anorexic or bulimic, I understand what it is like to be in denial about the way your body really looks. No matter what my weight, my body image has seldom if ever coincided with reality. It still doesn’t.

In my late teens I began to gain weight. And every year I weighed more than the year before. I have been overweight every day of my adult life. There were, of course, times when I lost weight. And like most yo-yo dieters, it came right back on, and often with a few extra pounds to boot. I went on Optifast, the physician-supervised liquid fast. It was expensive and punishing. I lost some weight, but couldn’t get used to not eating anything. I joined Weight Loss Clinic and starved myself on 500 calories a day. I was a Weight Watchers member so many times that I’ve lost track, and there were countless diets of my own making. I once lost 70 pounds by counting calories. I gained it back when I fell in love and ate because I was happy. I read books like Fat is a Feminist Issue. I decided to seek psychological help and found a therapy group for obese women. The therapist asked me if I’d been sexually abused, and when I said no, she didn’t believe me. She insisted that sexual abuse had to be part of the makeup of an obese woman. I walked away from her—I would have run, but I was wearing heels.

Making the decision
If you read the paper or turn on the television, you have probably heard of gastric bypass surgery. Like many people, I considered it an “easy way out.” I began researching gastric bypass as an option in 2003. There was no real “Ah ha!” moment when I realized it was right for me, no final indignity that led me to choose to have my body permanently altered. It was more a realization that I needed to make a radical, permanent change.

In gastric bypass surgery, a small pouch is created at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper part of the small intestine. The patient feels full after eating a small portion of food, and fewer calories are absorbed because of the intestinal bypass. There are risks from the surgery, including bleeding and infections. Long-term risks include gallstones, gastritis, and vitamin and mineral deficiencies. The last can be avoided by taking supplements. It’s also not uncommon for patients to gain some or all of the weight back, and some people have even had a second surgery.

Bypass patients—and other weight-loss patients—can also have complications resulting from the weight loss itself, including problems with excess skin.

About a year into my research, I joined e-mail groups populated by people who’d had weight-loss surgery. Several expressed desperation, saying that even if the surgery was risky, not having it was even riskier. “If I die, I die. Living this way is not living,” more than one person wrote.

Their attitudes scared me. I felt I had everything to lose: most important, a wonderful family, including a beautiful young daughter and another in the works (we were adopting a second daughter), a loving, supportive husband, and a close extended family. I had fabulous friends, work I enjoyed, and overall, a really good life. I wanted to lose weight to make my life better, not to save it. And I definitely wasn’t willing to risk my life. I put the decision on hold.

I tried to accept myself as I was. It seemed pointless to try to keep losing weight. But it wasn’t easy to accept myself as a fat person. I’d lost my father as a young child, and now that I was a parent, I worried that the extra pounds posed health risks that might prevent me from living a long life. I was relatively healthy for a fat woman, but my cholesterol was a bit high and I had sleep apnea. I have done a lot of writing about health issues, and I knew that I was a prime candidate for type 2 diabetes and heart disease. Health risks aside, there was no doubt that my weight compromised my quality of life. I will never forget having to ask a stranger to let my 3-year-old ride with him and his daughter on a kiddie ride at Knotts Camp Snoopy. I was too big to fit. I had to ask for a seat-belt extender when I flew (I followed the debate about whether large people should have to buy an extra seat with great interest), and when my Realtor and I went to look at houses, we had to ride in my minivan—the seatbelt in her Cadillac was too short.

In my early 20s I’d had to start shopping in “plus-size” stores and departments. Eventually I could no longer wear even the plus-size clothing from department stores; it “only” went up to size 24, and I was larger. I shopped exclusively online or in stores that carried “extended plus” sizes. Whenever I went out in public, or to a social event, I looked around to see if I was the heaviest person in the room. Increasingly, I was. Countless indignities became a normal part of my daily life. It would not be an exaggeration to say that my weight—and my obsession with food—controlled me. As a control freak, this was unacceptable. I knew that I needed to do something. I went back to my research.

I learned I was at relatively low risk for complications from gastric bypass surgery. I followed the stories of those who’d been successful—not the Carnie Wilsons, Al Rokers and Star Joneses, but the everyday women and men who’d lost phenomenal amounts of weight and gained, as the cliché goes, a whole new lease on life. When I made the decision to have surgery, my mentor, an acquaintance who became a friend, gave me bags of clothing she’d outgrown. We’d met in the process of adopting. Now we both had two girls from China. She had had the surgery and lost 125 pounds in a year. “You will zip through sizes,” she told me. I could hardly wait.

And so two days after my birthday, I woke up groggy and hot in an overheated recovery room. The surgery was over: Now the hard part began. Not the physical recovery, per se, but the redefinition of a passionate, obsessive relationship that had come to rule my life: how I dealt with food.

Eating after surgery
I did fine in the hospital, and when I got home, couldn’t wait to get on the scale. I was stunned: 11 pounds heavier than before surgery! I weighed myself several times but the result was the same. I had gained water weight in the hospital.

The water weight came off quickly and I had little pain. In fact, I recovered quickly. And I did lose weight fast, though not, of course, as fast as I had hoped. Seven months after surgery, I’ve lost 80 pounds. It’s amazing what losing that kind of weight will do for you. Underneath that round face and many chins is an oval-shaped one. I’m down six clothing sizes and I’ve even lost weight in my feet—I’ve gone from a size 10W to 8.5M. I can now shop for clothes in the regular sizes. It feels good.

Some gastric bypass patients do things perfectly and others don’t. I’m in the latter category. I still struggle with my relationship with food; though the surgery forces me to eat less, I still have to choose what to eat. Surgery is a tool: The rest is up to me. Mostly I do fine. In general, I eat healthier. I never use sugar; I buy the large bags of Splenda. I most often eat what the rest of my family does. When dinner is brats on the grill, I split one with my 4-year-old and take a tablespoon of potato salad. When I’m around friends and (extended) family, I am hyper-conscious of what I’m eating. Society judges weight-loss patients harshly.

On Memorial Day I rode the Ferris wheel, sandwiched between my 4- and 5-year-old daughters. My girls shouted with delight as they called the people on the ground “ants” and proclaimed, as they waved to their daddy down below, “We’re bigger than Daddy!” I wasn’t. In fact, I was right in the middle, size-wise, of the people we saw that day at the small-town carnival. I may never get to a size 6, and that’s fine with me. For once, being in the middle feels great.


How does gastric bypass surgery work?
The surgery works in two ways: by restricting food intake and by reducing the number of calories the body absorbs. A section of stomach referred to as a pouch is sectioned off so that the stomach holds less and the patient feels full more quickly. The small intestine is shortened and reconnected to the stomach in a different place, so that less food is digested and fewer calories absorbed.

Who is a good candidate for gastric bypass surgery?

• 18-35 years of age

• who have a history of obesity (100 pounds or more over the ideal weight for at least three to five years)

• with a body mass index of 35 with obesity-related medical conditions (like type 2 diabetes, heart disease or sleep apnea); or anyone with a body mass index of 40 or above.

How much does the surgery cost, and is it covered by insurance?
The cost of the surgery and the hospital stay ranges from $15,000 to $30,000. Most insurance companies will cover the procedure if they deem it medically necessary (see above). Some may turn down your first request or impose specific requirements such as following a physician-supervised weight-loss program for six months. They will often ask you to document weight-loss efforts.

How do I find a surgeon?
Ask for a referral from a primary care physician. It’s important that your surgeon specialize in bariatric (weight loss) surgery and that s/he has does a large number of gastric bypass surgeries. Experienced surgeons have a much lower incidence of complications.

How much weight loss? How long does it take?
The average gastric bypass patient loses about 65 percent of her excess weight 12 to 15 months after surgery. It’s common to regain a small amount of weight.

To read more about gastric bypass surgery or to calculate your BMI, go “here”:http://www.nhlbisupport.com/bmi/. For a list of bariatric surgeons in your area, go “here”:http://www.asbs.org/html/about/membersearch2.html and enter your zip code.

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