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I’ll Take the C: On Becoming Average

Part Four of Let’s Talk About Fat

I’ve been writing as if there is a dichotomy between being obese and being thin.  There isn’t of course.    There are lots of in between people who are technically overweight.  I say technically because the most popular way to determine if you’re overweight is to calculate your body mass index.  You can calculate your BMI here if you want.

This is a notoriously crude measurement resulting in the muscular being categorized as obese.  You might find it helpful in figuring out where you are.   Or not.  Don’t bother if you are a wide receiver.

One thing about weight loss surgery you may not know is that most people do not lose all of their excess weight.  It’s also normal to gain a bit back before you reach an equilibrium, and from there, or at least this is my expectation, you struggle to keep the pounds off as you age like everyone else.  My nutritionist has set a goal weight for me of 170 pounds based on average weight loss for people of my age and starting weight.  When I reach this goal (he says it will take 14 months), I will still have a BMI of 28.3 which means I will be overweight.  I may very well never hit a normal weight.  One surgeon I talked to said that the people who did better than average were those who were more “compliant to the program.”  In other words, I can lose those extra 25 pounds if I just try hard enough.  Where have I heard that before?  I just hope I’m average.  I have failed at weight loss so very many times.   Really.  I’ll take the C.

Internet medical advice (this is where you get your medical advice, right?) also tends to lump obesity and overweight into the same category, chastising those that are a couple pounds over and citing statistics that really apply to people carrying many pounds more.  So how overweight is too overweight?  And if it isn’t causing health problems, why do we call it overweight at all? Just because you don’t look like a supermodel is your health truly at risk?    Actually, if you do look like a supermodel you might be in trouble.  A recent Danish study of 3000 models found that a whopping 75 of them were of normal weight. That’s 75 individual women, not 75%. The rest of them were underweight, and the average model was actually in a category the World Health Organization considers malnourished.  No wonder our perspectives are skewed.  Maybe it’s not all that hard to understand that for some of us who look at media images we know we can never emulate, our gut reaction is to give up and have another cookie.

You may be glad to know I have given up cookies permanently.  Rest in Peace, cookies.   And I’m still going to be overweight.  I think I’m going to be ok with being overweight.  Counting what I lost before surgery, I’m already 2/3 of my way to goal.  That’s a noticeable amount of weight loss.  My cpap is in the back of my closet, I bought a whole new wardrobe, and my blood sugar is getting close to normal.  I am undoubtedly healthier, so for all those charts that say that’s not good enough,   I’m here to say, it’s good enough.  I am good enough.

In fact, I’m feeling so sassy in my new retro-inspired vintage (read thrift-shop) wardrobe,  I’m even starting to have revenge fantasies. Look at me now! plusplus’m talking to you, the man I refused to sleep with who said I could attract a better class of men if just pushed myself away from the table once in a while.  And I’m talking to you, husband who said he was worried about my health but was adverse to actual lifestyle changes that involved vegetables.  And I’m talking to you, saleslady who said I couldn’t expect to find cute clothes in my size.  And I’m talking to all of you who said nothing but judged me silently.  I was always good enough.  Maybe I didn’t say so then. Maybe I was afraid you were right.  But you were wrong.  I’ve always been good enough.

So let me let go of the revenge body fantasies for a moment and just shout out to the people who accepted me the way I was.  I’d like to thank the man I was casually dating that thoughtfully bought a seatbelt extender for his Buick so I would be more comfortable.   I’d like to high five the Zumba instructor that welcomed me when I walked in with a whole extra person’s worth of weight on my frame.  I’d like to express my gratitude to the thin coworkers who brought fruit to the breakroom instead of donuts because none of us need donuts.

Do you know what unconditional love is?  It’s when your parents accommodate whatever diet you’re on every time you come home even though one time it’s no meat and the next time its bacon and eggs and the next time its cabbage soup.  And when you finally decide you’ve tried everything but surgery, they ask how they can help.    Love is when your kid hides all bread products in his bedroom and won’t give them up even when you beg and puts up with late dinners because you went to the gym and collects menus in his college dorm so you can figure out where you can eat when you visit.  And there is also my current and final boyfriend.   Do you know what I want you to know about him?  I met him when I was close to my highest weight. He thinks I’m pretty.  Now he weighs my food for me and buys me protein shakes when they go on sale.   And that’s it really.  That’s how you treat someone when they are good enough, even if they have a fat problem.  I am in recovery.  I will not be cured.  And I am good enough.

To read part one of this series, Let’s Talk about Fat, click here

To read part two of this series, What’s Your Trigger, click here

To read part three of this series, Loving the Fat that Weighs you Down click here

You might also like:  An Open Letter on Dating While Fat

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The Good, the Bad, and the Beautiful

Let’s Talk About Fat part eight

Most of the push-back I got from people who thought that weight loss surgery was a bad idea seemed to go along the lines of it being an overly radical solution to not-that big of a problem. I’m not sure why people thought that my failing health was not that big of a problem, but in any case, I can tell you that having weight loss surgery to address medical issues should not be that outrageous of an idea.  I’m not going to tell you that my weight loss has been effortless, or that everyone should go out and get their stomach stapled, but for me, the rewards far outweigh the drawbacks.

My boyfriend took the picture on the right today.  It’s been about 5 months since my gastric bypass, and I’m guessing I’m down about 80 pounds from my before shot.  Thirty of those were pre-surgery. My job still stresses me out.  I still have back problems.  But I sleep without the aid of a machine, and I’m not on any metabolic-syndrome related medications.   I can still get overtired if I’m not careful, but travel is easier.   Exercise is easier.  Daily life is easier because being well is easier.  Here’s a snapshot of how my life is different.  I’m happy to answer any questions because I wish I’d had someone to talk to when no one wants to talk about fat.

The Rules

Every surgeon has a different set of rules for post-surgical patients.  Fortunately, mine is a bit of a minimalist and his stipulations are generally agreed upon by the bariatric surgery community without the weird extra ones like never drink out of a straw or chew gum (I have done both to no ill effect).

So my rules are:

No carbonation: I had to give up soda and I’m still sad.  The bubbles apparently expand in your pouch.  I’ve heard it will stretch it, but that may be a myth.  Anyway, it is painful or so I hear.

Drink a minimum of  6 cups of liquid a day.

Very little sugar: My pouch just can’t digest much sugar.  I can get away with barbecue sauce or something like that.

Don’t drink within 30 minutes of eating:  This is a weird one, and it’s hard to get used to, but it’s generally accepted as necessary in order for you to get the nutrition out of the food you eat.

1000 calories a day for weight loss and 1200 for maintenance.  More if I get into endurance sports.

A minimum of 60 g of protein a day: This is hard unless you drink protein shakes, so I drink one every day.  I don’t like them much.

Exercise: So I was, but I threw my back out doing Zumba.  This really should be a suggestion rather than a rule.  Exercise is a good idea, but it really doesn’t affect weight loss much at least not in the first year.  It will surely help with muscle tone, though, which I am going to need.

The Diet

So due to the above rules, which are pretty restrictive long-term, I do feel like I am on a forever-diet. I don’t just get to eat normally or have whatever I want.  I don’t seem to do real well with grains.  Some people have trouble eating dairy or red meat, but for me it’s grains. I eat four times a day. I drink a protein drink, one cup of coffee, and 6 cups of Snapple.  I have a glass of red wine maybe every two weeks.  My favorite meals are an egg with bacon, a taco, or a steak salad.  I also really like french fries.  I write down everything I eat, and I’m pretty strict about it. I plan to continue to do so indefinitely.  The only difference between this diet and other diets I’ve been on is it isn’t making me homicidal, and it’s working.

The Temptations

I still get hungry and have cravings occasionally.  I wish I had different words to describe the hunger and cravings I experience now because they are nothing like the hunger and cravings I had pre-surgery. They are about 80% less intense.  This makes them pretty manageable.  Is this the way other people experience hunger and cravings?  No wonder they do not understand why people are fat.  I used to have a demon that told me to eat things.  He was loud. He promised me one cookie wouldn’t make a difference.  He promised.  I think he lived in the part of my intestine the surgeon removed.  He is dead.  The release from his control may be the best thing that has ever happened to me.

 

Restaurants

I eat in restaurants a lot less than I used to, but I still really enjoy going out.  I just order an appetizer or I get a full meal and take 2/3 of it home.  I’ll even do the Chinese Buffet if my kids beg me enough.  I have teen boys.  I’m still getting my money’s worth.  There used to be this little card going around that was an explanation to the wait staff about your surgery that, with no actual authority whatsoever, instructs them to let you order off the kids’ menu. I think that is a really dumb idea.  You aren’t really paying for the food as much as the service you know, so cough up the money like the adult you are or stay home. Also, leftovers are the bomb.

Vitamins

Because Gastric Bypass is a malabsorptive procedure, meaning you don’t get all the nutrients out of the food you eat, it’s really important to take vitamins to avoid malnutrition. They make a huge deal out of this pre-surgery, and I honestly thought I’d be taking handfuls of expensive vitamins every day for the rest of my life. At my four month checkup, I was put on one multi a day which I order from Amazon and 2 tums.  It’s less than $20 a month. It’s just not that big a deal. I’m off all my other medications except I do take a pill twice a day to protect my gallbladder.  Rapid weight loss is hard on your gallbladder.  There are some medications I cannot take like birth control pills, NSAIDS and anything extended release.

 

The Scale

I weigh every day.  A lot of people will tell you this is a terrible idea, but I have to follow all the rules and diet every day, so I figure why not collect an extra data point first thing in the morning to remind me to stay on track.  Sure the numbers go up and down.  I have been unable to correlate the numbers with anything I actually do on a day to day basis, which is frustrating, but hey–I have a graph!  Many people lose 30 or even 40 pounds the first month after surgery.  I did not.  I’ve actually been holding pretty steady at 2 pounds a week ever since I started solid food. Vast amounts of exercise or a reduction or increase in calories, fat, protein, or carbs does not affect this in any way.   This may not sound very impressive.  After all, lots of diets promise you two pounds a week, but it does add up fairly quickly.  It can still be frustrating though.  According to a weight loss calculator I found online, I should be able to eat over 1800 calories a day and lose 2 pounds per week.  I eat 1000.  That would still be 104 pounds in a year, but my nutritionist says a realistic goal is 70. So I guess Newton’s laws still don’t apply to me. Or maybe we should just quit pretending we know why people can’t lose weight.

The Clothes

I know a lot of people do not go out and buy new clothes until they absolutely have to or they reach goal weight and then they celebrate with a big shopping spree.  I do not know what is wrong with these people.  I consider every single pound a victory, and who knows if I’ll ever reach goal.  As soon as I can manage to stuff myself into a new size, the old stuff has to go.  I am on my third new size since May, so this requires almost constant shopping.  I still like the same brands and styles I’ve been buying, but that may change especially as I get out of the Plus section. I budget about $80 a month for thrift/consignment shopping which is less than I used to spend on lunches out. And I look cute.  I got a full length coat from Goodwill yesterday for $11.  Size 14.  It fits.  I like clothes that fit.  Next October, I’ll buy myself another $11 coat that fits.  And I’ll take this one back to Good Will.  I consider it a rental.

The Hair

About 60% of weight loss surgery patients experience hair loss.  It’s temporary.  It grows back.  My plan was to be one of the 40% of the non-balding fortunate, so the Goddesses laughed.  I cut my hair.  I don’t know that a shorter cut really hides thinning hair, but at least there’s less of it covering every surface in my house when I shed.  Excuse me while I go sit in my closet and cry about it for a minute.

Pachidermia

Excess skin.  Okay.  Yes, I made pachidermia up.  I’m down about 80 pounds now, and I’m just starting to notice some odd wrinkling in weird places.  I hope it blends in with my stretch marks.  Clearly, it is only going to get worse.  I’d like to tell myself that saggy skin is a badge of honor, just scars from when I was sick.  I’d like to tell myself that looking like a skinny elephant is better than looking fat.  Maybe it won’t be that bad.  I can tell you, however, with some certainty, that losing a couple of cup sizes will not make you perky.  These are things that can be fixed surgically, of course.  Skin removal surgery is usually not covered by insurance and is both more risky and more painful than the bypass itself.  My plan, at present, is to not have cosmetic surgery.  But never say never.  I also thought Spanx were going to be more comfortable.

I just want to thank those of you who are still reading.  In some ways, despite the unwavering support of the people who really matter, this has been a particularly lonely journey.  I hope you found something you identified with even though we all have different paths to hike.  Take care of yourself, whatever that means to you, even if you have to fight for it.

 

Obstacle Course

sysPart 7 of Let’s Talk About Fat

The hardest part about bariatric surgery is being cleared for bariatric surgery.

The first step is proving you are sick enough for surgery.  Fortunately, this was pretty easy for me as all my medical records are at the same teaching hospital as my surgeon.  It’s a pretty standard requirement that you have a BMI of at least 40 or a BMI of 35 and a couple of extra issues like sleep apnea or high blood pressure. I had a BMI of 41 and a whole slew of co-morbidities.

The second step is proving you are healthy enough for surgery.  No, not just healthy enough, but worthy enough, and rich enough, and prepared enough, whatever that means.  I went to 17 different appointments plus 4 rounds of blood tests over 9 months before I got approved.  It was bull shit. These were not insurance requirements, by the way, this was just my program.  My program being a certified bariatric center.  This was the biggest bullshit of all.  There was no “team of specialists.”  There are people who work there, sure.  They do follow-up, mostly.  As for all the tests and appointments needed to qualify, they farmed those out to other specialists all over town, specialists with four month waiting lists, specialists who treat various body parts but have no particular knowledge of obesity or weight loss surgery.  There was psychiatry, cardiology, endocrinology, hematology, and gastroenterology.  Despite the fact that I had already paid cash for the surgery, they billed my insurance for all of these specialists and tests which means, of course, I had copays in addition to what I paid for my all-inclusive surgery.  Pretty shady, I think.  My boss actually threatened to stop letting me go to appointments and insisted on me rescheduling anything that happened on the middle of a Friday afternoon.  This may or may not have resulted in me hysterically yelling “Do you know how hard it is to get into see a hematologist when there is nothing actually wrong with you?”  I still don’t see why these tests could not be ordered by my “bariatric team.”  The specialists I saw were completely unnecessary. I kept being told it was for my own good and they wanted to make sure I was in the best possible health and I would be glad I was extra prepared.  It was infantilizing at best and demoralizing at worst, and I’m still really pissed about it, especially in light of the fact that my anomalous blood levels that caused much of the delay were not newly discovered, but have been in my chart for years, almost a decade. No one ever mentioned them or was worried about my health until I handed them the liability of signing off on my surgery.  I strongly suspect they are related to inflammation which is related to obesity.  I mentioned this to the hematologist who shrugged and said, sure, maybe.  In any case, she was sure I didn’t have any blood diseases but since I went to all the trouble of coming to see her, she’d test me anyway.  And we wonder why health care is so expensive.

Not all doctors, it was kindly explained to me by my “team,” are completely on board with bariatric surgery.  But it is my right as a patient to have it if I want.   I really don’t think it should be my job to figure out which doctors are stuck on the sin of gluttony instead of doing their damn jobs.  You’d think they’d have a list or something.

I also had to sign a piece of paper saying I would use two forms of birth control for the first year after surgery.  Due to the fact that even moderate weight loss can seriously increase your fertility, a conversation about birth control is certainly warranted.  Birth Control pills, for example, are not the best choice as they may not be completely absorbed.  But I didn’t get birth control counseling, I got hounded to promise to double up which is completely unnecessary if you are using say, the shot.  I found it offensive and overly paternalistic, but I signed it.  Sure.  I am using two forms of birth control.  The first one is that I’m 47.

Then there’s nutrition counseling which is also required.  The initial visits are not about your life post-surgery, but rather on how to lose weight before surgery.  When I was in the surgeon’s office, he gave me a check list of the weight loss programs I have tried.  I checked off almost 30. But, sure, let’s try it again.  You are a bariatric specialist after all.  The prevailing wisdom is that weight loss surgery is safer the smaller you are.  It stands to reason doing surgery on a 600 pound person is riskier than on a 200 pound person, but I’m not wholly convinced it matters if you weigh 260 or 240.  Oh, but I am supposed to prove I know how to diet. As if I am not already an expert.  I mean you can call them “post-op lifestyle changes” if you want, but there are some strict rules to follow after surgery.  Not following them yields consequences ranging from malnutrition to vomiting to weight gain.  So you need to follow the rules.  Of course, you haven’t had surgery yet, so you don’t get post-surgery rules, you get a different set of rules to see if you can follow those.  In this case, it was a 1300 calorie American Heart Association diet and a food journal which I had to turn in every three months.  Why the American Heart Association diet?  Why not a diet designed for weight loss based on the latest research?  Well, this is the one my nutritionist knows, apparently.  Not surprisingly, I’ve done this one before. In the 90’s.  Among my least favorites.  Anything low-calorie low- fat makes me absolutely miserable.  Been there.  Done that.  I did it again with only moderate enthusiasm and a considerable amount of cheating.

I was only required to maintain entries 5 times a week, which is a really low bar, and I still managed to lose about 8 pounds over the course of my 9 month limbo in addition to the 25 I’d taken off through Keto until Keto stopped working.  Some programs set actual weight loss goals, but I was just told to write everything down and make sure I didn’t gain anything.

So it took me 9 months to prove I know how many calories are in an egg and I do not have leukemia. Now I get to do the pre-op diet.  The purpose of this diet is to shrink your liver so it won’t be in the way when the surgeon is digging around in there.  Of course they don’t know how big my liver was to begin with, so I don’t know how they know if it works.  They weigh me constantly, though, so I can’t get away with not doing it. Some people have to do a complete liquid diet for 2 weeks, but my surgeon allowed me 800 calories a day with a little meat and green vegetables.  It wasn’t as bad as I thought it would be.  I drank a lot of pho and ate sugar free jello and popsicles and I lost another 8 pounds or so.  If you ever have to do a liquid diet for any reason, you definitely should get a hook up with the local pho joint.  You might want to ask your doctor if this is ok, but I didn’t.

The surgery I chose is the gastric bypass.   There are several different options, each with pros and cons, but the gastric bypass is considered the gold standard.  This procedure involves the surgeon taking a small portion of your stomach and fashioning a new pouch.  Your remaining stomach stays in there, but no food goes into.  It’s bypassed.   The hormone grehlin aka “the hunger hormone” is mostly produced in this part of leftover stomach, so in addition to being able to take in less food, you’ve cut off access to that hormone.  The surgeon also removes a small part of your intestine.  The research is a little fuzzy on the mechanisms here, but it’s this part of your intestine that causes insulin-resistance and Type II diabetes.  Current research is exploring removing it as a way to cure Type II diabetes in skinny people.  It looks promising.  It works in mice.  This is why many bypass patients are able to leave the hospital off insulin and other diabetes meds before the weight loss even starts.

So when I woke up, I had 5 tiny scars and a drain, a pouch the size of a small egg, and slightly less intestine.  My blood pressure was normal.  My blood sugar was almost normal. I had very little pain.  I had a morphine drip which I played with a little until I remembered I hate narcotics and asked them to turn it off.  I was up and walking in a few hours.  Eventually I got ice, then water.  There was jello.  I went home after two pretty miserable days during which the nursing staff forgot to hook up my IV and I got so dehydrated, they had to stab every vein they could find to get fluid into me.  They also apparently forgot how thermometers worked and ignored my fever until my boyfriend started yelling, “She’s not normally bright red like this,” to anyone who would listen.  Glad I got out alive.  Hospitals, man.

All in all, I wish I had gone to Mexico.  They do mostly the same tests, but they do them over a series of days instead of months because they have actual bariatric centers that are dedicated to doing the things bariatric patients need before surgery.   It’s a whole industry. If you’re paying cash, it’s about a third of the price.  The big down side, of course, is if you have post-op complications, your doctor is in another country in another medical system, which would suck.  And who knows if your insurance is going to kick in.  They sure won’t tell you ahead of time. That’s ultimately why I stayed state-side, but medical tourism is absolutely an option.  In my research, I came across several weight loss surgery horror stories out of Mexico.  I traced every one of them back to this one chop shop in a strip mall.  As far as I know, it is still operational.  Do not go there.  Go to a hospital.  I hear the hospitals are nice. Maybe the nurses can read thermometers.

I spent the next several days on my boyfriend’s couch with a timer.  I had to take in half an ounce of liquid every 15 minutes.  I took walks up and down the street and slept a lot.  My kids brought me jello.

On the fourth day after I got home from the hospital, my boyfriend broke his wrist in three places playing soccer in the forest with the scout troop.  It turns out that a broken wrist is much more painful than gastric bypass surgery and requires almost as much recovery time.  There were not 17 appointments involved in the decision to surgically correct his medical problem, nor did he “have to prepare.”  Also insurance covered it.  We spent a month on the couch watching Fringe with my liquid intake timer and his physical therapy play dough.  It was a bonding experience.   My kids drove us to doctors’ appointments.

I’m still trying to process what’s so different about weight loss surgery that you have to beg for it when it’s a medical solution to a medical problem.  I’m really not against nutritional or psychological counseling in theory, but I can’t say either one of them really prepared me for weight loss surgery.  Thirty years of dieting and failing is what prepared me for weight loss surgery.

The Decision or It’s the Science, Stupid

helpLet’s Talk About Fat Part 6

I have been overweight my whole life.  I don’t have any idea what it’s like to not be overweight.   I am in high school; I eat like a high schooler and swim 6 days a week.  I get down to 150 pounds.  It’s the 80’s, and this is considered over weight for my height, and I certainly consider myself overweight. I can swim 2 miles without stopping, but I am the fat girl, and if you don’t like it, you can suck eggs. Because it’s the 80’s.

So once you are the fat girl, you have the luxury of not worrying a great deal about your weight. Oh sure, there were diets, but they made me miserable and shaky and sick and didn’t work very well, so maybe I’m just the fat girl.  I put on the freshman 15 like everyone else. So what?  And the sophomore 15 and the Junior 15, and then there was grad school and pregnancies.  There was also Slim Fast and Accutrim and my first of several memberships at Weight Watchers.  There was lap swimming and step aerobics and sugar free jello and chicken broth before meals.  And in the 15 years after high school, I gained 100 pounds. I am no longer the fat girl.  I am the obese woman.  And I still figure if you don’t like it, you can suck eggs.

If the goal is self-love, what is the actualization of that goal?  Is it accepting your body the way it is, or is it loving yourself enough to make hard changes?  I’ve spent my adult life vacillating between these two strategies, and I just ended up fat and sick and frustrated.

This is not to say that my years of yoyo dieting were a complete failure.  I’m convinced that my willingness to try again and again is what prevented me from a spot on My 600 Pound Life. Losing and gaining the same 30 pounds over and over has to be better than gaining 30 and gaining another 30 and another until you cannot bathe yourself, but it’s not a lot better.  It really messes up your metabolism.  I learned a lot about myself and how food affects my mind and body.  I quit eating pasta.  I don’t keep bread or cookies or chips in the house.  I don’t eat desserts.  I have small plates and a zillion healthy cookbooks and I actually cook. I get a handle on my cravings at least most of the time.  My anxiety-related binging stops when I ditch my husband.  I make “lifestyle changes.” I do not lose weight.   By the time I am 40, my weight stabilizes at around 250.  I am not thrilled about it, but I go about my life with all the non-weight related joys and frustrations of everyone else.  I am the fat girl.  Nothing new to see here. Move along or suck eggs.

But my health begins to deteriorate. I am insulin resistant.  I am diagnosed with prediabetes and then diabetes.  I have a serious sleep disorder that required a machine to keep my airway open at night. My blood pressure is up and my cholesterol is up.  My back hurts. My doctor starts putting me on medications.  And those medications make me gain weight.  And so now I am sick, medicated, and up another 25 pounds.

I am just at a complete loss that I cannot solve this problem.  My doctors cannot solve this problem although they are willing to keep giving me new pills. They refer me to weight loss programs whose goal it is to make money.  Weight Watchers, a program more successful than most, is a capitalist enterprise not a medical treatment program. Those weekly support groups I used to go to were just hours of discussions on how to game the system.  How to hoard your points so you can have an entire pizza in one sitting every Friday night, how to manage the diarrhea that comes with too much Weight Watchers brand candy,  and how you can cover just about anything with fat free velveeta and still stay on plan.  And still, you’d count your points and their fancy scale would stall.  And no one would clap for you anymore, and you wouldn’t get a sticker, and you’d feel like a failed kindergartner, only poorer because you’d paid 6 months up front and bought a dress in your goal size and you had a cabinet full of fat free velveeta.

Why can’t I figure this out?  I have the entire internet at my disposal.  The truth is out there.  I am just going to science the shit out of this thing.  So I got out a notebook and a pen, and I spend a solid month doing research.   If there is a particular diet that actually works, there should be science that backs it up.  I don’t want to read any more biochemical explanations about why low carb is better than low fat.  I want to know how much weight people keep off 5 years out.  I want to know what works.

Nothing works.

Well, that’s not true. Weight loss surgery works.

I’d like to note here that not one doctor ever suggested weight loss surgery as a solution to my problem.  In fact, they never had much to say about my weight at all.  Maybe they were afraid of offending me or maybe they just had nothing to offer.  They should have offered weight loss surgery.  It’s a medical solution to a medical problem.  And I deserve a solution.

The first step in deciding to pursue weight loss surgery is accepting the stats.  You should do your own research of course, but the truth is, and this is well represented in the literature,  your chances of taking off a significant amount of weight and keeping it off permanently without surgery are in the range of 5%.  And yet we keep trying.  We keep believing we will be one of those 5%.  You probably know someone who has done it.  That person is a rock star!  Now ask yourself if you know 9 and a half people who haven’t.  You do, don’t you?

The next thing you should know is that weight loss surgery is not a guarantee, but it gives you about a 90% chance of losing a significant amount of weight and keeping it off.  That’s not to say you will reach “normal” weight, mind you, but you’re likely to lose a good 60% of the excess weight you are carrying.  Dipping below that and coming back up a bit is considered normal. It’s the best deal out there.  Period.   Surgery is not the answer to the global obesity epidemic.  There aren’t enough surgeons in the world.  But it is absolutely the best we’ve got, and I think the fact it was never offered to me is medically negligent.

The next thing you need to consider going forward is the dangers of the surgery itself.  If you were like me, you might be under the impression that weight loss surgery is particularly dangerous.  It is not. Weight related issues like heart or lung problems might make it more dangerous, but not more so than any other surgery.  It is much less dangerous than say a knee replacement or a hysterectomy.     The last 10 years have brought great advances to the technological aspects of the surgery, and it’s all laparoscopic.  In other words, you get a series of small incisions rather than a gash through your abdomen.  There are potential side –effects, of course, but don’t let fear stop you from at least looking into the process.  My pages of research make it clear.  The surgery is much less likely to kill me than my fat.

The answer is there.  It’s staring me in the face.  Now I have to fight for it.

 

 

 

 

 

Me. Just Smaller.

Part Five of Let’s Talk About Fat

If you have spent the majority of your life trying to lose weight, you must be forgiven for the fantasies you had while you were hungry and denying yourself food.  You should be forgiven for imagining a different life, a life where you’ve successfully beat your demons, lost the weight, look 25 when you’re actually 45, fit into your high school jeans, and run into Sting at a party where he teaches you that tantric thing.  This is supposed to be motivating, but the truth is even if you lose the weight, you will still be stuck with your regular life.  I can attest to this now that I’ve lost 70 pounds.  I assure you, it’s still me, just smaller.

Physically, everything is just easier, whether it is traveling or hauling things up the stairs, or working out.  I have ditched my cpap and my blood pressure medication, and my sugar levels are stabilizing. So that’s a pretty big deal.  You might be tempted to congratulate me.  Don’t.  I have done nothing other than make the decision to seek serious medical intervention.  Would you congratulate someone for having heart surgery?  Yes, I have made significant life style changes involving watching what I eat, trying to find time to work out, reading labels, and staying away from wheat and sugar.  But these are changes I made years ago.  The only difference between my lifestyle now and my lifestyle a year ago or even five years ago is that the diet/exercise program I am currently following (extreme caloric deprivation and occasional Zumba) is actually working.  Also I spend a lot more time clothes shopping.  A lot.  And I’m somewhat preoccupied with my collar bones.  Are they really supposed to stick out like that?

In the months it took me to be cleared for gastric bypass surgery, I was told both that losing weight would not solve all my problems, and that I should be prepared for it to cause major changes in my life, especially in my relationships with other people.  I really had no idea how to prepare myself for people treating me differently, but I read up on the possibilities.  People will be jealous, I read.  People will accuse you of cheating and taking the easy way out by having surgery.  People will try to sabotage you with food.  Your family will taunt you with your favorite treats. Your partner will become insecure and no longer be attracted to you.

None of these things has happened to me, at least not so far.  I have another 30-50 pounds to go, so people could still turn on me.  Or treat me better. Thinner women tend to do better professionally and financially, so that would be great.  I’ll take that, even if it’s a horrible reflection of the culture at large.  After all, the size of my clothing does not make me better at my job.  Maybe I am lacking in social awareness in that I am not perceiving a change in microaggressions, the number of cat calls I get on the street (and I did get them 70 pounds ago), or people checking out my grocery cart or what I eat at restaurants.  Or maybe it’s just because I live in Mississippi where obesity is the norm.

I am starting to suspect that it may have more to do with changes in how you see yourself that affects your relationships.  I’d like to think that my self-perception and self-worth were never tied to my weight to begin with and are therefore somewhat impervious to change.  But the truth is, it probably just hasn’t caught up to me yet since I still get really startled when I see myself in a mirror.  I’m definitely experiencing some body dismorphia. That may not go away. Will report back.

People don’t seem to be treating me differently, but that’s not to say they haven’t noticed, of course.  Prior to surgery, I remember talking to my mandatory therapist about setting boundaries with people.  I will not want people to comment on my looks all the time, I said.   I don’t want people to ask me how much weight I’ve lost every time they see me.  It’s so embarrassing.  I don’t want people looking at me all the time.

This turns out not to be a problem.  Unpredictably, I love the attention!  Please, tell me I look great! Tell me I look like I’ve lost a ton of weight.  I have.  I’ll even tell you how I did it if you ask and how much to the tenth of a pound.  And I’ll tell you where I got all my new clothes and what I eat for breakfast if you want to talk about how great it all is.  I’ll talk about it until you get bored. I’m sure the attention will fade in time, and that’s ok.   It’s really not all that interesting, after all.  It’s not that I have succeeded through some secret new diet plan or an increase in will power. I chose a medical solution to a medical problem, and now I’m healing.  It’s sort of odd that you can watch me heal as I shrink, but that’s all it is, healing.  I’m not becoming a better person.  I’m not even becoming a different person. I’m only becoming a smaller person.  Just make sure you let me know when you see jeans go on sale.  And I’m still up for Sting parties.

 

To read part one of this series, Let’s Talk about Fat, click here

To read part two of this series, What’s Your Trigger, click here

To read part three of this series, Loving the Fat that Weighs you Down click here

To read part four of this series, I’ll take the C: On becoming average click here.

You might also like:  An Open Letter on Dating While Fat

 

 

Loving The Fat That Weighs You Down

Part three in the Let’s Talk About Fat series.

There is something absolutely heroic about loving your body while fat.  Some women have managed to make a career out of it.  They use social media to say I’m fat.  I’m beautiful.  Here are some pictures. I think that’s fantastic, and while I just don’t have it in me to post Instagram pictures of myself in lingerie,  I do post pictures of myself on facebook and have a profile picture of my actual fat face.   This itself is an act of courageous self- love.   I know a lot of you don’t feel you can do that, and that’s just why we need people out there posing in bikinis with their stomachs hanging out.  Because they are beautiful.  And maybe they can help you see that you are beautiful, too.

The body-positive fat acceptance movement is an absolutely crucial reaction to our worship of thin culture.  Critics who whine that it encourages people to be unhealthy are completely missing the point.  Fat people don’t want to be idolized like supermodels, we just want the love, respect, and job opportunities everyone else gets. When 12 year old girls start idolizing plus-size models and binging to get rid of their size 10 bodies, get back to me. Fat bodies exist.  They are beautiful.   If people look at my body and don’t see that, it is their problem, not mine.  It’s that simple.

Only it’s never that simple.  Some in the movement claim body acceptance means not subjecting yourself to diets and gym memberships.   I get it.  Dieting and exercise are painful when you’re really heavy.  And there is the inevitable failure that comes when the diet stops working, you hurt yourself at the gym because your size 0 trainer pushed you too hard, or you do everything right and the scale doesn’t move.  Failure after failure after failure.  Who wants to live that way? The hell with that.  Put on some lipstick.  Find a guy that loves your curves.  Live your life and stop counting every calorie as if it matters.

Pretend you are not sick.

There are also those in the movement who claim that being overweight is not unhealthy.  And I’m so sorry to say, I just don’t believe that’s true.  The evidence is not there.  Excess fat puts tremendous stress on your organs, on your joints, on you whole body every minute of every day.  It’s really just a matter of what’s going to give  out first?  Your heart?  Your pancreas?  Your knees?  Obesity is a chronic disease.  And it’s slowly killing us.  Be happy in your own body if you can.  Love your rolls and stretch-marks and jiggles.  But don’t be delusional.

I don’t actually have a solution for you.   If I did, I’d be rich and you’d be skinny, and Instagram pictures of 300 pound models would be an interesting historical anomaly.   I am not far enough out from weight loss surgery to declare it as a definitive solution, and it’s just not a practical option for everyone although I’d encourage you to at least look into it.  You might be surprised to find the risks are lower and the benefits higher than what is commonly understood.  Meanwhile, what should you do?  Love yourself and keep packing on the pounds or aim for a beauty standard you know deep down you will never reach?

I tried the former.  I am fat.  That’s who I am.  And I am going to eat.  Because that is also who I am. That’s how I made it to a high weight of about 275 pounds.  Some days, I didn’t think my body looked all that bad, to be honest.  I was lucky enough to carry my weight in somewhat desirable places, or at least that’s what I told myself.  And I live in the fattest part of the country, so the social stigma is somewhat lessened.  Other days I hated my body.  Those days did not make me a better person.  But even on my best days, my body did not function well.  I designed my life to accommodate my girth without really consciously thinking about it, so any activity outside my normal routine was really uncomfortable.  That’s not who I am at all.  I’m adventurous by nature.  I want to learn to scuba.  But I didn’t even try to find a wetsuit designed for someone who is 5 foot 5 and close to 300 pounds. Zip-lining?  Don’t even tell me what the weight restrictions are.  I don’t want to know. Would I even fit on a roller coaster?  It’s much less humiliating to pretend you want to be a home-body.

I have also tried to lose weight in the name of self-improvement and self-love.  I read the literature showing how diets don’t work long-term and I dieted anyway.  Maybe I’d be one of the lucky few it works for.  Richard Simmons.  Weight Watchers.  Mayo Clinic. Oh but this time maybe it will work. Nutrisystem.  Slim Fast. South Beach.   My body is a temple.  I will treat it with love and compassion and vegetables.  Veganism. Keto. Intermittent Fasting. I went to the gym.  I lost. I regained.  I started over.  Atkins. Cabbage Soup. Whole30. I tried hypnosis.  I popped some pills. I got a check in the mail from a class action lawsuit against the pill company for false claims along with an admonishment from the legal team that I should have known better and that anything that sounds too good to be true probably is.  You lazy fat-ass, you know you have to suffer if you want to lose weight. You deserve to suffer.  You don’t deserve a magic pill.  You don’t even deserve this $29 we’re sending you.  I spent the money on food.  That whole fuck it I’m just fat thing started to look really good.

Here’s the thing, though.  Every pound you lose, and I know how hard you have to fight for that pound, is a victory.  If I count all the pounds I have lost over the course of my adulthood, it’s well over 150 pounds.  I regained them, but I probably would have gained them anyway because that’s what I do.  If I add in all the pounds I did not gain during periods I was actively trying to lose weight and at least maintained, that’s probably another 100 pounds.  Which means if I’d never tried at all, I’d be over 500 pounds right now and I’d probably be approaching immobility.  Or I’d be dead.   So it matters. No one looked at my 275 pound body and saw victory, but it was a victory.  A hard-won victory at that.   Celebrate your body, wherever you are, celebrate the wonderful things about yourself that have nothing to do with your weight.  Celebrate your victories. Big is beautiful, but beautiful isn’t enough.  You deserve so much more.  Be body-positive and know your body deserves for you to not give up.  Don’t fight to be thin.  Fight to get old before you die.

 

To read part one of this series, Let’s Talk About Fat, click here.

To read part two of this series, What’s Your Trigger, click here. 

You may also like An Open Letter on Dating While Fat

 

What’s Your Trigger?

Part two in the Let’s Talk About Fat series.

Seeing a shrink before Weight Loss Surgery is probably a good idea.  There is some research that suggests an increase in suicide rate amongst post-surgery patients. These are the types of studies where the study group is really small and 2 people committed suicide and now there’s a protocol. Still, screening people for undiagnosed psychological issues seems prudent. Plus, it’s required.

So, says the shrink. Tell me about any past traumas.

Past traumas? I say.  I am 47.  How much time do you have?

She looks at me silently. This one likes to use silence to make you talk. She does not appreciate my humor. I am weak.  I cave.

Let me put it this way, I say.  I do not have any traumas associated with weight gain.   I just like to eat.  I like to cook, I like to grocery shop, I like to go to restaurants. That’s all.

Ah.  She says, tapping on her keyboard.  Your trigger is food.

My trigger is food?

It’s not that you have deep secret unresolved issues that make you eat, she says.  The presence of food is your trigger.

No shit?

If you have never faced food addiction, you might not understand what a food trigger is.  You probably know someone who has one, but they won’t talk about it.  It’s embarrassing because they know that everyone faces food choices all day long, but they have a demon they  can’t beat.  Nobody wants to tell you the monkey on their back is a donut.

It’s 8:00 am. You have come to work prepared with a lunchbox full of homemade meals you spent all of your Sunday prepping.  It is good food. You are a good cook and you are prepared.  All carbs are accounted for and logged.  You heat up your crustless spinach quiche and go to your office.

It’s 8:15.  Oh my God.  What is that smell?  Is it donuts?  You are pretty sure it’s donuts.  Just in case, four different colleagues stop by your office to let you know there are donuts in the break room.   But what kind of donuts?  You need coffee anyway.  You may as well just mosey on in there and see if they are Krispy Kreme.  They are.  But you can’t have one.  Because you are fat.  That’s why.  Not eating a donut is your punishment for past gluttony.

It’s 10:30.  Maybe the donuts are gone.  Maybe you should go see if the donuts are gone because if they are, then you don’t have to worry about them anymore.  You go look.  Only about half of the donuts are gone.  You can’t have one, though.  Because you are fat.  Esmerelda is fat, and you know she had two. Well Esmerelda is going to stay fat.  You are going to resist because you are better than her.  Also she wastes a lot of paper on unnecessary photocopying. Orangina ate one and she’s skinny as a rail.  And a truly lovely person. How is that fair? Why is she better than you that she gets to have a donut?  Why is she more worthy of donuts?  You are a good person. You always put the buggy back into the corral at the grocery store. Even if it is raining.  It’s not fair.

It’s 12:00 and time for lunch.  You have homemade chicken wings from your airfryer with raw vegetables and blue cheese dressing from scratch.  You have to eat in the same room with the donuts.  You sit as far away from the donuts as possible.  You give the donuts dirty looks.  You hate the donuts like an ex-boyfriend you still sleep with. You check to see how many are left. You are miserable.  You’re starting to sweat a little.  You clock in early and go back to your desk where there is at least a wall between you and the donuts.

It’s 3:00. Surely they are gone by now.  Your anxiety is rising so you eat an emergency pack of unsalted nuts you keep in your drawer.  It doesn’t calm your nerves so you eat another one. You are having trouble concentrating.  Maybe, just maybe, you could eat a donut.  Let’s be real here, if you eat a donut now, tomorrow you will be fat.  If you don’t eat a donut now, tomorrow you will be fat.  What difference could one donut possibly make?  You could probably get away with it.  What if you just had salad for dinner? What if you started parking in the back of the parking lot? Surely if you parked in the back of the parking lot you could get away with one donut. No one would ever know. But no!  You’ve made it this far.  You can do it.

It’s 5:01.  You casually slide into the break room to make sure you haven’t left any of your carefully prepared food in there.  As if you hadn’t eaten it all.  There is one donut left.  One.  It is the runt of the donut litter. It is mishapen and small, and some of the icing is missing.  It is cold, and it is stale.  But you only had 8 hours and 45 minutes of willpower in you.   You eat the crappy runt donut.

Your desire for donuts has not decreased due to your indulgence.  On the contrary, now  the sugar high has hit your system, you want more.  You only refrain because you just ate the last one.  You wonder how many donut shops you will pass on the way home.  You decide to count them.  The self loathing kicks in.  The determination and self-love that prevents you from eating whatever the hell you want have now been undermined.  You may as well have pizza for dinner.

 

I fail the psych eval.   I get referred to a therapist.  She is a specialist in obesity and I have to wait 6 weeks to see her. So I wait.

My theory, says the therapist, is the prevalence of obesity is caused by the almost unending access we have to food.  And not just food, but advertisements for food.  It’s cheap and easy and there is always someone reminding of us that.

I do not find this profound.  Thank you, Dr. Obvious.

I have a great respect for academia, but I am now thinking that a PhD in fat psychology does not teach you more about being fat than 47 years of being fat.  I figure it is prudent to keep this to myself.    Instead, I say, just for the sake of argument, That’s like saying that if you are never exposed to heroin you will not become a heroin addict.  I mean it’s true, but it’s really unhelpful to the heroin addict.  And it doesn’t explain why I’m fat and you’re skinny.  Did you used to be fat? I ask, hopefully.  I mean there must be some reason why she went into this line of work. No, she says.  She was never fat.

I don’t like her so much.

I put away my distrust of skinny people and try to be a better sport because I have already given her my copay.  I ask for help giving up diet soda.  Bubbles and caffeine are both forbidden post surgery, so the Diet Dr. Thunder has to go.  I am in mourning just thinking about it.  The one calorie-free joy in my life and it has to go.  I don’t know if I can do it.

I can’t make you want to give up soda, she says.

Well I guess you feel really stupid about all that time you spent in grad school then.  Student loans are a bitch, huh?

I am fat because I have a trigger for food which is food. You can check my chart,  It’s in there. No one knows why I have a food trigger.  Why what goes in my mouth has such a severe effect on my brain. Was it because I was a preemie underweight newborn or because my grandparents were malnourished?  A virus affected my gut bacteria? A genetic mutation?  Nobody knows although they are pretty sure it’s my fault.

I had a Weight Watchers leader once who ended every meeting by yelling NOTHING TASTES AS GOOD AS THIN FEELS.  I am sad for her because she has forgotten Krispy Kreme. And I don’t know how good thin feels.  And I am going to let them cut me open anyway.  It seems crazy.  Crazy like I should see a shrink crazy.

To read Part 1 of this series, Let’s Talk About Fat,  click here.

To read Part 2 of this series, Loving The Fat That’s Weighing You Down, click here.

You might also like An Open Letter On Dating While Fat