Monday, March 30, 2009

More on weight-loss surgery

Well, I suppose I can't write two posts back to back about weight-loss surgery and not follow it up with more discussion. So, let's discuss.

First of all, nearly all of your comments were incredibly supportive. I was very touched. I didn't agree with all of them, to be honest, but even when people said things I didn't agree with, they came from a place of genuine caring and meaning well. So I appreciate that.

I want to clarify a couple of things about all this. I think this may be something that is difficult for people who have never struggled with their weight to understand.

If there is a diet out there, I have tried it. If there is an exercise plan out there, I have tried it.

I haven't been blogging my whole life, so you can't know. But Weight Watchers was only the latest in a lifelong series of attempts at weight loss. And when I say lifelong, I mean it. I have diary entries from second grade talking about how I never wanted to go back to school because the boys in my class were mean and called me fat.

Here's a partial list of what I have tried: the Zone, Atkins, South Beach, Weight Watchers, diet pills, exercising for hours every day, a general "healthy diet" of lean protein and good carbs, the fruit diet, drinking water instead of eating when I'm hungry, eating lots of small meals a day, cutting out all snacks, cutting out dairy, restricting myself to 1,000 calories a day, detailed meal plans, making sure to get at least 30 minutes of exercise every day (and forms of exercise include aerobics, step, weight training, elliptical training, hiking, running, jogging, soccer, volleyball, frisbee, interval training, yoga, pilates, swimming, and many combinations thereof), not going to bed until I've done at least 500 crunches and sit-ups, working with a nutritionist, working with a doctor, starvation.

I have tried these things. Some of them have been effective, but only temporarily. Not only do I gain all the weight back, plus some, if I stop doing those things--but they also stop working while I am still doing them.

I do not see surgery as an easy way out. I do not see surgery as a magic pill. I would not be considering it at all if I thought that I could lose the weight, and keep it off, any other way. But years and years of going around and around and around and never really getting anywhere has shown me that I do need to do something serious to fix this, before I develop serious health problems.

Here's the thing. I know that everyone, EVERYONE, has to eat healthy foods and exercise regularly in order to maintain their weight. What I am saying is that doing those things isn't enough for me. Having surgery is not an easy way out because it requires that I do those things after the fact. But what it DOES mean is that doing those things will actually help.

I think that this post by Mandajuice articulates perfectly the mindset that is borne of so many unsuccessful attempts at weight loss. I'm going to quote some of it here:

Halloween is a perfect illustration of the way the surgery has worked for me. I LOVE candy. I eat it every day. Normally, though, I'll eat maybe one or two pieces and then I'm done. I stop. I just... don't want any more. I think this MIGHT be how "normal" people feel about candy. They like it and they eat it in moderation and then they stop thinking about it.

Obese people? HELL TO THE NO. When I was heavy and there was candy in the house, I would eat it until it was gone. And if I wasn't eating it? I was THINKING about eating it. It was THERE and I knew it and I would spend days, natch, WEEKS punishing myself over my inability to control myself. I never EVER felt full and as soon as the candy was gone, I would just buy more. I felt much the same way about cheeseburgers. And Hagen-Daas. And everything else.

The best part of having gastric bypass surgery and why I think it works so much better than dieting is that, if you're doing it right, you lose that internal dialogue. The one that distinguishes between what you "should" be eating and what you WANT to eat. I have these vivid memories of walking into a restaurant when I was heavy and reading the menu and REALLY REALLY wanting something "bad" like a cheeseburger or the fettuccine Alfredo, but also seeing that they had healthier choices that I "should" eat and feeling like being fat was always LOSE-LOSE. You lose if you eat what you WANT and you lose if you eat what you SHOULD.

Now WANT and SHOULD are completely the same for me and that battle is over, literally for the rest of my life. I order what I want and I naturally eat the amount of it that I should. WIN-WIN.

I know that surgery sounds drastic. And in a lot of ways, it is. I haven't decided that I'm necessarily going to do it. But Tess said this to me, and it really resonated: I don't think that it's any more drastic than a lot of the other things that I have tried in the past. Many of those things were unhealthy. Having your weight constantly go up and down is unhealthy. Starving yourself is unhealthy. Being pregnant at this weight is high-risk. Being pregnant after weight-loss surgery is not, as long as you make sure to take all the necessary vitamin and mineral supplements.

Over and over again, I have tried a new diet or exercise (or both) plan. I have had great results at first. I've thought that this was really the time that I was finally going to lose the weight for good. But that has never been the case. As long as I stick with this cycle, I will spend the rest of my life having to deal with this. I will spend the rest of my life going around and around, up and down. I will never break that horrible relationship with food. The guilt and shame will never go away. Even when, according to all the diet books and research about optimal nutrition and physical activity levels, I'm doing everything right.

I'd rather go through surgery, followed by a year or so of big changes and adjustments, food restrictions, and all the rest, than deal with what I'm facing now for the rest of my life. And to be clear, this surgery does restrict not only how much you eat but also what you eat--but the latter restrictions relax with time. From what I've read, it seems that nearly everyone who undergoes weight-loss surgery is eventually able to eat pretty much whatever they want--just in much smaller portions than they did before.

If you take anything from what I'm saying here, take this: Diets might work for some people. Reasonable amounts of exercise might work for some people. But they don't work for everyone. The things that work for you are not the things that will work for all other people.

Everyone's body is different. Mine is particularly stubborn, and it's not because I lead an unhealthy, sedentary lifestyle. Multiple doctors have told me this as well: if someone with a different body were leading the lifestyle that I lead, they would be at a healthy weight. But, in large part due to genetics, those things aren't enough for me. If I choose to have surgery, it's not because I didn't feel like losing weight the "right" way. It's because what might be the right way for you wasn't the right way for me.

But having surgery will help make those healthy lifestyle habits--eating well and exercising regularly--effective for me. And that's what I'm really looking for.


  1. You have clearly put a lot of thought into surgery, Jess. So long as you know the risks. The challenges. And the potential upside. Essentially, so long as you know the devil in the details. Then whatever decision you make. It's all yours. And no one here has a right to judge.

  2. I totally hear you. I think a lot of people don't understand that "healthy" is a different weight for different people---and that for many people, they'd have to be UNhealthy in order to be thin.

  3. I so relate to you. As my (always thin) sister said to me (the always heavy sister) the other day, "I don't get it. You exercise way more than me and you eat less." Every BODY is different. And man does it suck being the dealt the card where our bodies just want to be heavier. Good luck with your journey. I know, that like every thing else you do, you will move forward with a (mostly) clear head and make the right decision for you.

  4. Oh Jess, you have obviously put a lot of thought into this. Do what is right for you and don't worry about what other people (with diff body types) say. Good luck with this difficult decision!

  5. What a huge decision to have to make. But clearly, you've thought about this a lot and you're definitely approaching it the right way. I'm confident that whatever choice you make will be the right choice for you. No one should judge you, but I'm pretty sure we'll all support you!

  6. This was a very thoughtful and compelling post. I hope you find the right answers for you.

  7. No matter what you decide, you have my support. :)

  8. You know the risks, you've looked at tons of different options, and you obviously have given a great deal of thought to this.

    So all I can say is good luck darlin'.

  9. I'm impressed by the clarity with which you write about this topic. It's obvious that you've given it a lot of thought. I think whatever you choose will be the right choice. Good luck!

  10. You've obviously put a lot of thought into this and weighed the pros and cons. I have no doubt you'll make the right decision for you... actually, it kind of sounds like you've made it. Whatever you end up doing, you know you have the support of your readers.

  11. after reading your post the other day, i went and read loralee's that was linked in the comments, and one of the things there really resonated - one commenter basically said (s)he didn't think "we" should have to pay (thru health insurance) for people to have weight loss surgery when it was "their fault" that they got fat. several commenters pointed out that we don't think it's wrong to send someone to AA, regardless of how they "got" drunk, or that we wouldn't deny chemo to someone with lung cancer even though they "gave it to themselves" by smoking. you've said it before, but it really is quite true - being overweight is one of the few places where people aren't required to be politically correct (or even polite). which sucks.

    do what you think is best, and we will all be here to support you.

  12. Hey Jess,

    I think you should do what you feel is best for you.
    If that is surgery, then it could be the answer.
    I wish you all the best and look forward to hearing what you decide. Best wishes!

  13. I followed your link and Manda's whole story about her surgery. It cleared up a lot of misconceptions that I had about the surgery. Only you know if it is the right option for you, but know this, if it is what you choose, I (and I'm sure all your other readers) will support you.

  14. I used to work with a woman who exercised every day- swam, ran, played tennis- all while I sat on my ass eating cookies and watching TV. I am overweight, but she was significantly overweight. I don't get it. Genetics suck. (Unless, I guess, your mom is Heidi Klum or something.)

    My MIL is an OR nurse in an OR that does many many weight loss surgeries. I hear about the risks, but I also hear about the amazing success stories. I'd be all about shutting down that internal dialogue too. GO JESS!

  15. I love you, and I'm so impressed by how thoughtfully and articulately you've written about this whole process.

  16. It seems like you've really put a lot of thought and heart into the decision to at least consider it, and I think that's the most healthy way to go about it.

  17. You have put a lot of thought into this....and I don't think anyone can judge you for that, or tell you that you are making a quick-witted decision.
    You are right-everyone's body is different. I eat healthy as hell, yet, I still have a muffin top.
    I think the only concern would be: will you be satisfied (read: love yourself/your body) after the surgery, even if you don't become a teeny tiny size 2? But ultimately, it is totally your decision! I think you should go for it, hon!

  18. Jess, this was a great post. You make a great point - that the surgery might make it so all those healthy things you are doing finally work.

    Again, whatever you decide I have your back! And I am so, so proud of you.

  19. I think Swistle hits on something important- what is healthy and normal for you, or anyone else, is so hard to figure out. I think what I would be most frustrated with if I were you is not being able to figure out what you can and cannot do because of plain old DNA.

    Good luck on your journey and decision making regardless!

  20. This was a great post. A close family friend has the surgery at 50 years old and its changed her life in so many great ways.

    You seem to have not come to this decision lightly. And as long as you know this is right for you, that's all the justification I need.


  21. With the absolute utmost respect I have to say what I'm really feeling because that's what you really want to hear, I hope. Surgery reduces that amount of food that you are able to eat, that's basically the gist of what it does. So if you just ate less then it would be the same, basically. That's way oversimplifying things I know, but really if you were doing everything right (as you said) then I just have a hard time believing that the weight is still there. As I said before, my mom had the surgery and she's done well and she was "doing everything right", but yet, she wasn't. She was overeating even though she thought she wasn't. For her, the surgery was what she needed to stop her inner fight with herself.
    She just can't eat more and that's the bottom line and she's losing weight. She wasn't strong enough to put down the spoon or fork and bag or whatever. But she was strong enough to say that she couldn't lose weight by herself and I am insanely proud of her for that.
    Us Americans (and I'm sure other places in the world) routinely overeat and the standard amount of food had increased that it's hard to even know how much to eat anymore. Our culture is all about bigger is better and that encompasses cars, bank accounts and cheese burgers. It's easy to see why it's reported that over 50% of adults in the US are obese.
    Please know this comes from respect and understanding. I wish you peace with your choices and even though you don't even really know me I repect you and your choices, whatever they may be.

  22. I agree with everything you've said. (Also, it kind of sounds as if you've sort of decided.) Good luck with everything, and I don't think that any logical person would accuse you of taking the "easy way" out. Please.

  23. You are so right about bodies being so different.
    I have one particular friend who is OBSESSED with working out (she's not super-skinny, but she's 'fit' and looks nice even though she thinks she looks terrible and fat - and that after three kids) and she's always telling me I should try and this and that...and let's face it, I don't have a size two body. If I 'weighed in' as a size two, I would look gaunt and anorexic.
    This is one instance where doing whatever is going to be best for your body chemistry, is precisely what you should do.

  24. This is not in any way to suggest you do this or anyone else who gets the surgery... but so what if you don't do everything right. Or so what if you overate your whole life and are unhappy with that. I am just upset that you or anyone else feels like this choice has to be justified. When I exercise, or when I eat a salad, I don't have to justify that to someone. I just think sometimes all of us are too quick to judge someone else's life.

  25. I'm all for informed choices, and doing what is right for you. Whatever you need to do to get healthy, you should do without feeling like you have to apologize for those decisions.
    You do what you need to do :) If it helps, you have my wholehearted support.

  26. Thanks for sharing more details about what's going on. I completely agree that if a patient came to me, and had tried all those things, and had minimal results, I would agree that gastric bypass surgery would be the next choice.

    Sometimes, we can do everything right. But we can't change our genetics. My sister and I gained the same amount of weight during our pregnancies. She lost all of it within 6 weeks after delivery. Me...well, I lost 1/3 of it. And have stayed that way, even with dieting. My metabolism changed.

    You have to do the right thing for your body. Only you can make that choice. Good luck!

  27. It's a really, really big decision. I know a few people who have had the procedure done and it has been successful, but I know that the first year or so was pretty dreadful.

    In order to maintain any weightloss you have to change habits and behaviors or you will gain back, even with surgery. With something drastic like surgery, it gives you no choice but to lose so you can't fight your body. But in the end, you still have to relearn and change behaviors and attitudes about food.

    You DID lose 75 pounds which is awesome and amazing and you should be very proud of yourself. If you're maintaining it now, you know that some of your behaviors and habits have changed.

    Have you ever looked into the Optifast program? The one my hospital offers is very successful, roughly 50% maintain their loss for 5 years (which is pretty high). It's similar to surgery in that you don't have many options for food for the first six weeks and then you start gradually introducing food back to your diet. It's all directed so the first week you add food back it's like 4 oz of lean protein in addition to the shakes. It's very intense and this program requires that you go to weekly meetings with support groups offered three times a week and a required six week nutrition course. It's worth looking into if you haven't before. If you'd like I can e-mail you more information. (I didn't do optifast but I took the nutrition course with the rest of the participants).

    I don't want you to think that I'm suggesting this to be contrary. It's another option that's dramatic but not as drastic as surgery and also, I believe, cheaper.

  28. I can't say I relate with you as genetics has blessed me with a super fast metabolism. People often forget the role genetics has to play in body type.

    I work with three people who've had the surgery and they look better (and most importantly) feel better about themselves and that's what matters.

    You've got to do what you have to do to live the life you want to live and you've got 100% of my support.

    Take care,


  29. like you i have tried every diet known to man, and after having them all fail it's depressing.

    i don't think i'm heavy enough to qualify for surgery but if i was i would do it.

    you've obviously thought about it and i hope it helps! just be realistic with the risks, not to be a downer but a client of mine passed away while having gastric by-pass.

    just be careful - good luck!

  30. You have articulated so well, for so many people, the struggles you have gone through with weight. I know it's been hard, but whatever you decide to do, I just want you to know what an articulate and compassionate voice you are in a world of so much ignorance, stupidity and judgement.

  31. So many more positive comments and so many less negative ones than before. doesn't mean epople will agree with you and some might even be badmouthing you on their blog (happened with a friend of mine). But, you are a very itnelligent woman who, I ahev seen through this blog, weighs the pros and cons of every decision before making it. It's your life and it's your choice to take control and say you don't want to be unhappy anymore.
    Just one response to the commenter who said somethign about just eating less. I wonder if they've ever had any psychology classes. Without a physical restriction, if you deprive your body of anything it's craving for long enough, you tend to binge on it eventually. Witht he physical restriction of this surgery, people are given a tool to work with. You can still eat more than you should and stretch your stomach out. But, having ahd the surgery,t rust me when I say I think twice before I put the second square of chocolate in my mouth. Before the surgery, sure, I could have not had it. For a few days and then, I would have had 2 bars because I just WANTED it that bad.

    I'll also reiterate that having worked out through college and seeing results that then reversed themselves even when I was still going to the gym daily, I hated the thought of working out and at close to 300 lbs, you coudln't get me to show up at a gym. I lost about 50 lbs and still was the heaviest at the gym I joined, but I felt ebtter and wanted to supplement the weight loss and avoid the loose skin. I had goals again and I didn't feel so crappy about myself.
    There is always a fear in the back of my mind that I am going to gain all this back but I am sure that's no different from somebody who's lost 30 lbs by running daily or eating like a goat. I am sure there are severely obese people out there who exercised their hearts away to lose all their weight ... but till some of you tell me you weighed 300 lbs and are now at even 150 and have kept it off for 5 years, don't tell me surgery is the easy way out.

  32. I like healthy food. Before surgery, I was sooo hungry all the time that I couldn't make the best choices. My stomach was all "id".

    The surgery doesn't solve anything. It is a tool that helps you make the right choices. If you were a diabetic, would you refuse insulin?

    The thinner people have the easier way out... they have a metabolism. I tried for years to get one of those. LOL

  33. I just wanted to say that I have been overweight for years. During my school years I was picked on and made fun of. I thought this would end when I grew up. I was wrong I have been judged by my weight still. I feel because of my weight I was passed over for supervision positions as well as other management positions. I have thought about weight loss surgery and I know its not a magic pill. It is a tool and it still has to be worked. I have tried so many diets only to gain weight back after losing. I am very tired of being told EAT LESS EXERCISE MORE..This has not worked for me.I have read alot about weight loss surgery and know that it is a risk but walking out to your car is a risk too. I want to live a good life and am so tired of not being able to do certain things due to being overweight.I will continue to learn all I can about this surgery and then make a educated decision. As I feel now I am thinking that this would be a way to help myself. Since I know no one else can help me in this field.I have to make the choice. I have seen and meet people who have had the surgery and yes there are adjustments to be made but all in all I feel that this is a good option for us who have trouble losing weight. I am sure that this option may not be good for all but there is no harm in doing research and reading and maybe even seeing a doc. In the end we have to make the call and realize fully what we are doing...I hope that this will help others to know you must do your research and then make a choice that will fit your needs. I wish all who are thinking about the surgery good luck in making a this decision.I feel for each and everyone who is struggling with the weight demon....Julie

  34. Jess - I just wanted a news article about how some hospitals are doing the bariatric surgery laparoscopically. Four TINY incisions that all together measure about an inch. The infection rate and complication rate is much smaller.

    If you decide to do the surgery, please look into this option. It's much safer - and you my dear - are worth every penny of prevention!

    (not to mention, no big ugly scar!)

  35. I had the surgery the nromal way and I have a light 3-4 inch scar that's barely noticeable.

    The problem with laparoscopic is that if they can't get to the stomach via that method because of ecess fat, they still have to do an incision, so some insurances won't cover that. I am sure you will be thorough in your research with your surgeon and your insurance.

  36. When someone gets to be so obese that they feel helpless, hopeless, and fearful, it is time to realize that something drastic needs to be done. Phentremine weight loss treatment is a natural appetite supressant.