Lap-band: Maintenance mode

Today I got my first lap-band fill in what turns out to be two years. I knew it had been awhile since the last one, but I would have guessed one year, not two. OOPSIE.

(Super quick background on the lap-band, since I don't talk about it much: it's a plastic ring that goes around your stomach and has little pouches that are filled with saline through a port, slowly, over time. Filling the pouches increases the tightness of the ring around the stomach, increasing food restriction and making it easier to lose weight. This is done slowly after initial surgery over the course of a few months. In each of my pregnancies I had my lap-band emptied in order to reduce morning sickness and allow for consumption of sufficient nutrients, and then had it filled up again over the course of a few months post-partum. So, I had had it refilled after Annika was born, but then let it go two years without any further fills. In general, even once it's full, it still needs to be topped off every now and then due to fluid shifting and evaporating and the restriction loosening over time.)

Anyway! So, over the last two years I've lost the rest of the baby weight, about 30 pounds, which took me down to my pre-Callum weight, which was about 85 pounds below my pre-surgery weight. So, technically in the seven years since my surgery my weight is down 85 pounds, BUT an added wrinkle of the lap-band is that of course when you reduce your caloric intake by that degree, your metabolism also slows down (see also: this interesting NYT article on that topic), so when the band was emptied for my pregnancies, of course I gained a bunch of weight, and not just pregnancy weight, and ended up gaining 40-50 pounds per pregnancy. FUN TIMES. What that MEANS is that over the past seven years, I have actually LOST something like 175 pounds, BUT I also GAINED 90 pounds during that time, DAMMIT BABIES.

Anyway! Here I am now, and the lovely thing is that I HAVE lost the baby weight, TWICE, PLUS kept off the weight loss that I achieved in the first year post-surgery, before I got pregnant with Callum. So now, here I am, seven years later, finally in maintenance mode. Which doesn't mean weight maintenance mode, as I do want to continue to lose weight, but rather band maintenance mode. With the pregnancies and refilling and so forth over the past seven years, I've been in and out of my surgeon's office quite a lot with various fills and un-fills, and I will also say that it's kind of a mind trip to have your band un-filled for pregnancy because your nutritional needs shift and it turns out that postpartum isn't necessarily the most mentally stable, well rested and relaxing time to focus on your own nutritional needs. Meaning, while of course I'm always aware of my band and the accompanied restrictions (no bread, very few grains in general, no soda/carbonation, eat slowly, etc.), it hasn't really been top of mind for the last few years.

That has actually been GREAT. A huge reason why I wanted the band in the first place was because I wanted my weight to stop being such a THING in my mind all the time. I felt like I spent so much TIME thinking about my weight and my diet, and how much I weighed, and if I was losing weight, how to maintain that, and if I was gaining it back, how to stop it, and what I should and shouldn't eat. That sucked, frankly as much or more than the actual fact of being overweight, you know? Just the mental space devoted to it was so exhausting, and I really didn't want to spend the rest of my life that way. And that was a huge motivator to get the band, and that has been a huge success. Eating is no longer the Thing that it was, and I focus on nutrition and taste and have been able to almost fully remove any moral values from my opinions of food, and that's been so delightfully freeing. The band hasn't taken over my life, and that's been wonderful.

But it also means that I don't always think about how I could be using the band as the best possible tool for weight loss, and sometimes forget that I have it available to me, if that makes sense. So like, the 30 pounds that I've lost since my last fill two years ago were hard-fought, and slow, and I didn't even REALIZE that I could have gone in for another fill that would have made the whole process way easier and simpler. Like, it just did not cross my mind. I did occasionally think, "Oh, I should probably get another fill at some point" but there was always a conflict, a trip or a work meeting or something where I needed to be able to eat pretty normally (the first week or so after a fill, I have to be super cautious about eating) and so I'd figure I'd do it later, and then somehow... yeah, it's been two years.

But here I am now, I'm 85 pounds down from where I was seven years ago and that's a great place to be, and I have no further pregnancy plans and also no infants and can focus on my own stuff a little bit, as needed, and I have a fresh new fill and I feel good, and I hope it does help me lose a few more pounds without quite the Herculean effort that the last 30 pounds have required (the doc today was like, "I can't believe you lost 30 pounds with basically no restriction"), but the nice thing is, I don't feel like I have to have a renewed focus on weight loss or anything like that. More like, now I feel like I have the mental space to fit my band back into my life without it taking over, and I'm glad about that. And trying to feel proud of having lost those last 30 pounds without much help from the band, instead of dumb for letting so much time go by without taking advantage of it. Glass half-full, I guess.

Heart rate

I've now had my lap-band for 6.5 years, during which time I've lost 85 pounds, interspersed with two pregnancies and two sets of lost baby weight (so total pounds lost is actually WELL over 85, but alas, the baby weight doesn't count in the total). During that time I've also developed a lot of opinions about attitudes and language and self-image related to weight loss and concepts of health and fitness. At some point I will try to articulate all that stuff in a blog post. At this particular moment I will say that, counter-intuitive as it sounds, having the band has actually enabled me to care LESS about my weight, not just because it's lower and therefore a less pressing concern but because it's done wonders for my mental state.

That's really a topic for another post, but I started with it because it's a segue into the very specific niche thing I want to talk about recently, which is my obsession with heart rate as a measure of fitness. The reason this relates is that it used to be that I worked out to lose weight. And that was extremely frustrating, because I actually haven't noticed a major correlation, at least in myself, between frequency and intensity of workouts and rate of weight loss. For me, diet is the much more influential component of weight loss. So, if I'm working out to lose weight and I don't see an impact, I lose my motivation very quickly, and before I know it, weeks have gone by and I haven't worked out. Not good.

But! For a long time now, I've been able to separate working out and weight loss in my head, and it has been a huge mental bonus for me. I work out because it's good for me. It improves my fitness level, it's good for my heart, it makes me feel better physically and mentally. It's just a good thing, even if it doesn't result in any weight loss.

(This isn't to say that I am perfect about working out... various shifts in our lifestyle like babies, job changes, childcare changes, etc. have had their impact over the years and so how often I work out really depends on where we are currently, but recently I've been able to get back into it more and that's been great--though I know there will be more periods of less frequent working out in the future.)

Anyway! The point is, in lieu of weight loss as my benchmark of effectiveness, I look to heart rate. I always wear a heart rate belt when I work out, so I can see my real-time heart rate on the machine and adjust the intensity of my workout to keep it in my target zone (120s-130s, typically). Awhile back, Torsten got me a watch that communicated with my heart rate belt so that I could see my heart rate while doing exercise not on a gym machine, primarily bike riding.

I LOVE being able to track my heart rate. First of all, it's data, and I'm sort of obsessed with data, so it suits my personality. But second, I find it incredibly motivating, because I see tangible improvements and I see them very quickly. I have to work SO MUCH HARDER now to get my heart rate into the target zone. When I first started working out, my heart rate shot into the target zone basically immediately. I recall, years ago, plodding along on the adaptive motion trainer (my gym machine of choice) with the resistance and incline on the lowest setting, having to force myself to basically walk interspersed with bursts of short jogging to keep my heart rate from flying into the 160s. Now, I usually do interval training with the incline on 3 out of 5 and the resistance ranging from 13 to 19 out of 20, and I still have to push pretty hard to get my heart rate into the 130s. It's such a huge difference. And! When I go without working out for a few weeks, I can see that my heart rate goes up faster, but! The flip side is that just a couple of workouts and I can already see it improving.

It is so SATISFYING, is what I'm saying. You can SEE your heart getting healthier and your body getting fitter as a result of your efforts! IT is SO MUCH MORE GRATIFYING than measuring results based on weight loss.

And now! I've been using a combination of iPhone apps (primarily MyFitnessPal for nutrition tracking and Pacer and MapMyRide for steps/activity tracking) as my fitness tools. Torsten tried out a FitBit a few years back and didn't love it, primarily because at the time it was wildly inaccurate, so he returned it, and since then neither of us has really thought about getting one. However, Torsten noticed recently that there's a new FitBit out, the Charge HR, that tracks... you guessed it! Heart rate! So, good man that he is, he got me one (AND it's purple).

I've only had it for a day, so I'll report back, but so far I LOVE it. It's so cool! And it's really accurate! And it has a great iPhone app, or an online dashboard if you want to be a Luddite using a regular computer. It tracks your heart rate and it can tell whether it's resting or active, and buckets those things separately so you can track them differently. It tracks the steps you take in a day and how many flights of stairs you climb and how far you travel and how many active minutes. It also tracks your sleep, which is so so cool, and it lets you track exercise, start a food plan, monitor calories, and track water consumption, too. So basically, it's everything that I've been managing across multiple apps, all rolled into one and conveniently synced with the FitBit itself.

I am so, so pleased. And also, I think I may now have a new obsession... now that I don't have to wear a heart rate belt to see my heart rate, and I have essentially continuous monitoring via wrist, I can start focusing on changes in my resting heart rate over time. Fitness, ahoy!

Sorry, I'm a geek. But seriously. It's purple, it streamlines activities that I was already doing, AND it tells me my heart rate ALL THE TIME. It was MADE for me. I am so happy.

On biking. And also fatness, accidentally.

Torsten and I had been talking about getting bikes for awhile before we finally bit the bullet about a year ago. We'd even gone to try out a couple models when Callum was a toddler but fallen at the final hurdle of the expense, particularly because we knew we wanted another baby and I was squeamish about the idea of being a novice bike rider while pregnant and also stuck on things like whether to buy a double trailer for the kids under the assumption that we would be lucky enough to have a second kid or not count our chickens and buy a single trailer that might not be sufficient for our lives a couple years later. So we kept talking about bikes and not buying them, until last spring, when Annika was six months old and sleeping well and we were both feeling more human and more up for it.

The thing was, the other reason why I had never been super pushy about getting the bikes was that I had this secret idea that maybe I wouldn't really be able to do it. I had a bike as a kid, of course, and I did use it, but I was... well, I was bad at it. I had one of those 10-speed bikes with a plastic piece on the handlebar that you turned to shift, but I didn't understand how the gears worked, how to shift properly, what gear I needed in any given situation. I would turn the gears at random until it felt like I could pedal, more or less, and then just leave them there. For lower gears, when I shifted into them it felt like my legs were spinning helplessly so I would shift right back out again. Which meant... well, it meant I could never get up hills. Because I wasn't using a low enough gear. Because I didn't know how. We lived on a corner at the bottom of two uphill streets and whenever I went for a bike ride I would just... pedal up the hill as much as I could and then walk the rest of the way.

It says something about my physical self-esteem and general personality at the time that I didn't, I don't know, ask someone for help? Say something like, "Hey when I'm riding my bike I always have to walk it up hills because I can't pedal to the top, am I doing something wrong? Is there a way?" But I didn't ask those questions. I didn't mention the fact that I found bike riding so hard. And the reason is because I thought it was due to the fact that I was fat. I thought I was too fat and out of shape to ride a bike properly and I was embarrassed to tell anyone that I was so fat I couldn't ride a bike like all the other kids and so instead I spent years walking my bike up hills while berating myself for being so fat.

Healthy! I know. And depressing to remember, and also apparently something that stuck with me because when Torsten first suggested, a few years ago, that we look into getting bikes, I panicked and told him that I didn't think that was a good idea because I was bad at riding bikes and too fat to get up hills. (Possible progress? That I was willing to at least TELL someone that I thought I was too fat to ride a bike?) In response, Torsten stared at me incredulously and was like, "What are you talking about? Anyone can ride a bike, even up a hill, if they use the right gear." And I was like, "...gear?"

This is going to sound super froofy, or something, but truly one of the most healing experiences I've had was the time we went to the store and test-rode our bikes, and Torsten explained to me how the gears worked and which gear to use for what, and then we went out and rode them around near the bike shop and got to a hill, and when the pedaling got too difficult, instead of climbing off and walking the rest of the way, I shifted to a lower gear and kept going, and then shifted to an even lower gear and kept going, and got all the way to the top of the damn hill. Me. On a bike. Not next to the bike, but on it. At the top of a hill. It was so FREEING, to realize I could do it.

So a year ago, we bought bikes and we brought them home, and we started using them, and I basically put Torsten's promise of "you can make it up any hill in the right gear, I promise you can" to the test on the very first ride, because we rode over to the High Line Canal Trail, and to get back to our house from the trail, we had to ride uphill, very steep uphill, almost a mile. At the end, no less, after a tiring ride along the canal. Torsten had the kids attached to his bike in a trailer, and I remember both of us staring up the face of that daunting hill, already tired from our ride, and me telling him to just go, use whatever speed he needed to get up the hill and not wait for me, and I would do the same, and we would meet at the top, but I would probably have to walk. And then we rode up the hill. And yes Torsten was ahead of me, and yes I was slow, and yes it was really fucking hard, and yes by the end I was all the way down to the very lowest of all 27 gears available on my bike, but I got to the top of that damn mile-long steep hill without having to walk. Me and all my fat. We did it together.

Since then I've ridden up that hill many times, and while the hill and I are not friends, and riding up it is not pleasant and never will be, I can do it, and I know I can do it, because I've done it every time I tried. I have never once walked my bike anywhere, because I can always ride it, because bikes are a thing that I can ride, even on difficult hills, even though I am fat, and now I know this, and it is an amazing piece of knowledge for me. And I've hardly become a professional cyclist over the last year, but I actually like cycling by now, like it even when it's hard, love being able to go places and see pretty things and use my muscles and get exercise that isn't completely miserable, that is actually enjoyable, and that can be done as a family, and that feels really good.

Next week we are riding in a fundraiser race for Annika's school, just eight miles, not a huge ride, for me probably a little less than an hour of cycling, and when the call for participants came out, I was the one who eagerly went to Torsten and suggested that we sign up, and I've been the one looking for opportunities to get out there on our bikes and train, and explore new places. Me. I'm the eager one, because I like biking. I'm the one who likes cycling enough to sign up for an actual race, albeit a short, noncompetitive one (at least for me). Me, the girl who thought she was too fat to get up a hill, and was too embarrassed to tell anyone.

I didn't actually mean to take the post in this direction--I was originally just going to post about the lovely eight-mile training ride we did yesterday, and how much I enjoyed it, and how when we turned around at the four-mile mark so we could get home before dark I felt like I could have kept going and going, and how pretty it was and how I loved the feeling of the miles just falling away below my handlebars, and it was so enjoyable--and yes, yes, all those things, but I guess this other stuff was still in me and needed to get out.

Revelation: I am not too fat to ride a bike. I love riding a bike. I am so happy.

Me, a year ago, before my very first ride on my bike, 

a couple hours before I conquered that hill for the first time.

Nutritious

This funny thing is happening as I get older: I'm developing a taste for more nutritious food.

Not SOLELY. I mean, I still like Doritos. And nice chocolate. And the occasional Fast Break bar. But not as much. And not as my first choice. And sometimes if I'm browsing for a snack at the airport, I'll look at a whole rack of candy and chips and not be interested in any of it. I KNOW. Not even as a special travel treat!

I've also noticed that I'm starting to be more interested in salty food than sweet, another change. When I do decide to indulge, it's much more likely to be in chips than sweets.

And beyond junk food, I'm starting to like more nutritious ingredients in my dinner as well. It started with whole wheat pasta, which I've been eating for years and which I've recently noticed that I actually prefer to white. The next thing was quinoa, which I tried since it's such a great option, but figured I wouldn't like it since I never seem to like "alternative" grains. But it turned out that it was delicious, and I often use it in place of rice or even pasta in my recipes. I've started cooking a big batch of it and keeping it in the fridge for easy use--which actually works great because I think it tastes even better cold.

And most recently, it was spaghetti squash. I don't even really like winter squash generally (no pumpkin, no butternut squash, etc.). But I'd never tried spaghetti squash so I figured it was worth a shot. I roasted it and sauteed some shrimp to go with it (based vaguely on this recipe, with many modifications) and tossed it all together and... it was delicious. It didn't taste like spaghetti, at all. But it was really good. Torsten and I had to carefully mete out the leftovers the next day since we both wanted it for lunch. Next time I'll roast a bigger squash.

Edited to add: I'm also starting to notice that a lot of foods I used to like, especially sweet stuff, taste like chemicals. I tasted frosting from a can recently and it had this very strange flavor and left an even worse aftertaste. And believe me, in years past I could have eaten most of a can of frosting and not noticed a chemical or HFCS flavor at all.

I'm not at the point where I'm like, why don't I give up all sugar! No more grains! No more dairy! How about paleo? I'm going vegan! I'm frankly not interested in making that kind of drastic change to my diet. I just generally try to cook fresh, nutritious, unprocessed foods, and then not worry when I'm in the mood for an occasional indulgence. It seems to be working for us. And sometimes Callum even eats the food we cook (despite his general distaste for food, he LOVES quinoa, though it makes a royal mess when he eats it).

Sadly I'm still not the kind of person who will be like, wow, carrots are so much yummier than gummi bears! Gosh, I'm feeling naughty so I'm going to indulge in a dessert of strawberries this evening! I still like dessert. And fruit doesn't count. I'm still not even at the point where I've decided I like dark chocolate better than milk. And I'm definitely not about to announce that I've discovered that I love running.

But still, it's progress. And maybe the other stuff will happen in another 10 years.

Farmers' markets

So. Labor Day. The end of summer, etc. Seems like the perfect time to start writing about farmers' markets, yes? Now that they're on their way out and all?

Honestly, I'm not sad about summer ending at all. Out here in Colorado we haven't had quite the misery that the East Coast experienced, but we did have the highest-ever August temperatures on record for Denver, and we smashed the previous streak of consecutive days above 80 degrees to smithereens, and, you know, our house doesn't have air conditioning. Thank god Colorado doesn't have humidity. (And there are many things I love about Colorado, but the lack of humidity? It might be the number one thing. It's definitely in the top five, at least.)

Anyway! Yes, fall. Cool weather, jeans, boots, sweaters, warm drinks, pumpkins, pretty leaves, etc. Also I am looking forward to a fall wardrobe not just for myself but also for Callum. Nothing is as cute as a little footed one-piece on a baby, and baby jeans are a very close second. So yes, I'm looking forward to fall.

But one thing I am not looking forward to is the lack of fresh local produce that fall brings. Except that you know where we have found to be the best place for really good local produce? Whole Foods. Isn't that sad? This is Colorado. It's an agricultural state. The whole state is full of farms. A lot of them are really close to Denver. I mean, when we replaced our fence we sold the old fencing to a nearby farmer for $150 (thank you, Craigslist). And when I decided I wanted to take Torsten to a goat farm for his birthday, I found one quite easily less than an hour away. You get my drift.

So why is it that all the local farmers' markets seem to totally suck? I mean, maybe we're looking in all the wrong places. But we've been to the huge popular farmers' market downtown, the tiny one near our house, and a couple other local ones in various suburbs. And we have never encountered more than two produce stalls at any of them, even the huge one. And all this year we haven't come across a single stall selling local jams. It seems to be mostly specialized stuff--salsas, pasta sauces, cheeses, sausage. I mean, that stuff is nice but sometimes I just want to go find some nice fresh local produce that isn't marked up to Whole Foods prices, you know?

And even the produce stalls that we do encounter aren't that impressive. They might have one or two nice-looking things, but as a whole it's nothing special. And whatever is especially good always sells out fast. Like we still haven't been able to buy any freaking fresh cherries at a farmers' market all summer because apparently they fly off the shelves.

And the big market, the really popular one where it's wall to wall people and drivers risk their lives to beat others to a parking spot? It's almost like a street fair. The vast majority of the booths seem to be selling prepared food. If it weren't so crowded it would be a great place just to go for lunch. But for local farmed products? Not so much.

I don't know what we're missing! It seems like here in Colorado there should be much better farmers' markets, but I am at a loss as to where we could possibly find them. I guess we have all winter to research and try to figure out what we're missing. And if it turns out that this is just how farmers' markets are around here, then maybe I have an idea for a new business come next summer.

What about where you live? Are there farmers' markets? Are they any good?

Weight loss and pregnancy

Over at Bodies in Motivation: How the lap-band affects my pregnancy

The beauty of the frequent blood draw

Over at Bodies in Motivation: Why I'm not afraid of doctors anymore

What's your real age?

One of my Tumblr crushes, Katie, posted yesterday about an online test that tells you your "real age," versus your chronological age. So, of course, I immediately clicked over and took the test.

I was a little worried, mostly because of my high BMI, but also because Katie is healthy and athletic and she got a real age result that was a couple years higher than her actual age, so I was envisioning the thing telling me that I am 50 in terms of health and if I don't fix things soon I will age to 80 over the course of the next three years.

But I took the test anyway, and entered in all this info about my health, including metrics like cholesterol, blood pressure, and resting heart rate, plus health conditions and family history, and then a ton of questions about diet, exercise, and lifestyle. Then I waited for my results, telling myself that I'd be happy with anything in the 20s.

And... it said that I have a "real age" of 22.9. Almost exactly three years younger than I actually am.

Now, I have to say, I think this is a flawed test. I mean, my BMI is high. And while I generally have a pretty healthy lifestyle, and I eat pretty well and I exercise regularly, and I don't drink or smoke or engage in high-risk behaviors... I am no Ironman, you know? I have a lot of weight left to lose and I don't work out seven days a week and I don't eat enough vegetables and my grandmother had breast cancer. How could this test say that Katie, who is so healthy, is several years older than her actual age, and then tell me that I am several years younger? It just doesn't make sense.

But still, ridiculous as it was, it made me feel better about my health. Like oh, it's not just me who sees this health indicators as being meaningful. And oh, maybe my BMI isn't the be-all and end-all that all those people who love to scream and shriek about the obesity crisis would have you believe. Maybe it's just one piece of a much broader picture. That's what I've always thought, but I wouldn't have thought that a website like this would agree.

Anyway! Now I want to find out if it skews down for everyone and Katie just somehow gave an answer that upset the test. So! Go take the test, and then come back here and tell me what it said your real age is compared to your actual age, and what you think about it. I'm dying to hear what everyone's results are!

Happy happy health update

Over at Bodies in Motivation: All about my health

Fat is not that bad

I've been thinking about something recently, something that seems really obvious to me and that probably everyone else would naturally agree with, except that based on small comments and actions, I'm not sure they really would agree. In fact I have no real perspective on this and no way of knowing if this is some sort of big revelation or more of an "oh duh" statement.

But here's the thing: being fat isn't the most terrible thing in the world. It isn't even close.

In a literal sense, of course that's true. Obviously, pretty much all of us would rather be fat than watch our loved ones be murdered or something equally horrifying.

But I'm talking on the level of personal problems, here. It seems that we would all do almost anything to avoid being fat. That we all have this horror of being fat. That we all think about it constantly and if we are fat, hate it, and if we aren't fat, try everything to avoid becoming fat and also beat ourselves up if we even get nearer to fat than we were before (i.e., gain a couple pounds).

And I'm not saying there's anything wrong with that. Clearly not. I mean, I just had freaking weight loss surgery and that is obviously all about not being fat anymore. Everyone has a weight they're comfortable with, and everyone wants to be healthy, and there's nothing at all wrong with trying to achieve those things. I support that.

And I will also be the first to admit that being fat does have a profound impact on your life. I think most of my readers know this, as I have written about it before (specifically here).

It sucks to be fat. Really, it does. And it sucks to be even just kind of overweight, and not actually fat. And I think that's why people get all up in arms about the use of the word "fat"--because we use it to describe such a broad spectrum of weights, that of course people who fall on the more extreme end of the spectrum don't appreciate it when the term is used to describe bodies that they could only dream of having.

But it's not the end of the world, being fat. It's not the end of the world weighing more than you'd like to weigh, period. Yes, it can be a problem, and yes, if your weight is a problem for you and your health or sense of well-being then I am all for trying to rectify that in a healthy way.

But we've taken our fear of fat too far. The hand-wringing about the "obesity epidemic"--especially considering that the numbers discussed in regards to the epidemic include people with a BMI in the low 30s, which is really not fat for a lot of people, because BMI is a very flawed statistic, and only very few people actually fall into the category of "morbidly obese," or into a category where their weight actually creates health concerns for them--is over the top.

But it's more than that. It's people refusing to be in photos with their children because they hate how they look because they think they weigh too much. It's people torturing themselves, beating themselves up because they think they need to lose weight. It's people creating huge mental angst for themselves or limiting what they think they can do based on concerns about their weight.

I see this all the time. And mostly it's from people who aren't even fat. They weigh more than they'd like to, sure, and some of them are overweight, and it's totally legit for all of them to be trying to lose weight and get to a size they're more comfortable with.

And I totally support that. I'm not saying that just because you're not as fat as I am, you don't have a right to be concerned about your weight. This isn't a game of relativity for me.

But what I am saying is that it makes me sad when people let their weight get in the way of their lives. No matter if they're morbidly obese or just a little bit above their comfort zone.

I'm saying that I am fat, truly fat, and I have been even fatter, and yet I am happy with my life. I do pretty much everything that I want to do. I've achieved goals that I've set for myself. I've had thoughts of oh, maybe I'm too fat to do that, or oh, maybe this person will be judging me when I meet them because I'm so fat, or oh, maybe I shouldn't post this picture on my blog because you can see my whole body and I'm so fat.

Of course I've had those thoughts. But then I've set aside the fat concerns and just done it anyway.

I met Torsten online. Of course I was afraid he'd think I was hideously fat when I met him in person, even though he'd seen photos of me. Of course I was incredibly nervous walking into the restaurant to meet him for the first time, that he would hate me or think I was hideous or pretend not to recognize me. And of course none of that happened. And of course it was worth forcing myself past my own fat hangups and taking the risk. And the reward has been amazing.

That's all I'm saying. It sucks to be fat and I'm glad I'm doing something about it. But, if you think you're fat or even just a little bit overweight or even not overweight but still weighing more than you're comfortable with--and so on--by all means, do something to fix it. But don't put everything else on hold until you get there.

I heart the gym

Yesterday was a weight-focused day in blogland for me. I wrote here about body comparisons, and then I wrote over at Bodies about why I don't tell anyone my weight.

And then I went to the gym and swam for an hour, as usual. And my arms were extra sore because the night before that in water aerobics, we used weights for almost the whole time. And I felt really good after.

And this is period week for me. And yet, again, no PMS, and I've lost 2 pounds so far this week. This whole exercise thing is fabulous. And I've reached the point where I actually miss the gym if I don't go. Not that I love it when I'm in the middle of it--though swimming is by far the most tolerable form of exercise I've ever found--but it feels so good after, and on days when I don't go, I feel heavy and slow-moving.

I'm definitely thinner, not just in pounds lost but in inches and in the way clothes fit. Only a few weeks ago I started wearing a pair of jeans that had previously been too tight. Now they're too loose, and I can pull them off without unbuttoning or unzipping them. I can feel muscles, especially in my arms but really everywhere, that just weren't there before. I have more stamina. I've gone from swimming 40 laps in an hour to swimming 60. And this no PMS thing is one of the best perks of all.

So, yeah. The gym = great, and totally, totally worth it.

I'm still not sharing my weight, though.

Daily routines

Last week, I went to the gym six times. And this week, I'm on track to do the same thing.

I still can't get over how good I feel about this. It's not like this is the first time I've ever been to the gym, because it isn't, at all. But it's the first time that I've ever gone nearly this often. And I am really liking it. Maybe it's because this time the gym isn't free in our apartment complex, so I feel more compelled to go and make use of my paid membership? Or because it has a pool and water aerobics classes and I love swimming?

Regardless, I go. Almost every day. And I like it.

I like it so much, in fact, that I have this crazy niggling thought in the back of my mind about maybe, someday, some VERY FAR OFF day, doing a triathlon. I know. It's insane. But I'm thinking about it. And I really want to do it. I wrote more about that over at Bodies.

I think it's a good long-term goal to add to all my short-term goals. Last night as I was swimming, I was thinking about that triathlon, and I swam faster and with fewer breaks than I'd been able to do before. It's very motivating.

The one thing about going to the gym is that it has totally changed our daily routine. We work, and I finish sooner than Torsten, so I take Montana to the dog park while he finishes up. When I get back, we go to the gym. The gym takes about two hours, what with getting ready to go, driving there, getting all my pool stuff ready, actually swimming for an hour, showering, getting dressed, and driving home.

So by the time we actually get home, it's usually already 8:30 or so, and we haven't eaten dinner yet. Torsten usually grills food for dinner, which takes about half an hour, meaning that we don't even eat dinner until 9 or so. Sometimes it's really tempting to just go into Whole Foods to grab dinner instead. Especially because it's in the same plaza as the gym. In fact, it's literally right next door.

But for the most part, we're able to resist the temptation, which means we don't usually finish dinner until around 9:30. And we have to get up early for work because we start on East Coast time, so we try to be in bed by 10:30. So that leaves us an hour of time to relax, get something done that we've been needing to do, etc. And an hour just isn't very much time. Plus, with the time difference, by the time I have any free time it's nearly midnight on the East Coast, which makes it hard for me to find time to call my family.

Still, I kind of like the routine. It feels simple, and healthy. We're at the gym together, and plus we're in the house together working all day long, so it's not like we don't get to spend time together. We still have time to talk, in the morning and in the car and over dinner and in the evening and in bed. We definitely still have plenty of quality interaction. It feels privileged, really, to have the kind of schedule that allows us to do all this every day without feeling totally stressed and overwrought at the end of it.

However, I have to say, thank god we don't commute. Because if we had even short-ish commutes, this routine would be impossible. And in fact, now that I think about it, I think that's really the reason that I never went to the gym six days a week before. The round-trip commute added an extra hour and a half to my daily work time, and sometimes you'd get home after a long day at work and an unpleasant ride on the bus or Metro, and the last thing you'd want to do is put on your gym clothes and go work out.

Now, there are no excuses. When I'm done working, I walk down the stairs, and voila--I'm home. And therefore, we can use that time that would have been spent commuting at the gym instead. And we do.

What about you? What's your daily routine like? Does it stress you out, or does it work for you?

Just keep swimming

So, want to know how you can tell that I've officially gone crazy? I have the day off work, and yet I'm up early to go to a water aerobics class at the gym. I KNOW. I'm choosing EXERCISE over SLEEP. I don't know what's happened to me either.

Hence, I don't have a real post for you today. Instead, I'm going to send you over to Not a Diet in hopes that you'll lend some moral support as I try not to wish I'd had bypass surgery instead of lap-band.

Have a great holiday weekend!

CHEESE. And other solid food.

You guys. I don't think I can stress to you exactly how excited I am about what today means for me. Seriously, it's up there as a major life event.

Today is the last day of my two-week puree diet. Tomorrow, I can eat solid food. It has to be soft, but it will be solid. The list of allowed foods includes moist meat (chicken, turkey, fish), eggs, certain fruits and vegetables, and low-fat cheese.

What this means is I can eat FOOD. I can CHEW. I can eat something other than yogurt, cottage cheese, and protein shakes, which is literally all I've eaten for the past two weeks. And let's not forget the three days before that spent on the clear liquid diet. I haven't eaten actual food since Sunday, May 10. Mother's Day. In Germany.

Maybe this makes me food-obsessed, but I have been planning what to eat on this first day pretty much since the first day that I got all nauseated looking at a protein shake. The menu includes scrambled egg whites and fruit for breakfast, rotisserie chicken and some avocado slices for lunch, string cheese as a snack, and grilled salmon for dinner.

Of course, I have to take it one new food at a time, to make sure that I can tolerate it and that it doesn't get stuck in my band. And I have to chew really well to make sure everything goes down easily. But oh my god. You guys. Food! Real food! Varied food! Food that I like and ate pre-surgery too!

I am curious to see how much I can eat, since I don't have any fills so still no restriction, but I've been surviving on about 700 calories a day (or less) for the past two and a half weeks, so I can't imagine that I'll want to toss 1800 calories down my throat tomorrow. I have definitely noticed my appetite increasing since the surgery, though, which I think is normal--I think it's related to the internal swelling going down. At first I could only eat a tiny amount of anything, like half an individual container of cottage cheese, and now I can eat two containers of cottage cheese as a meal.

Also, I'm thinking I might start the party early and have a "transition" dinner of chicken noodle soup tonight. Just thinking about that makes me so happy. And don't worry, I'll be careful to chew thoroughly.

Lastly, I'm not sure if I'll ever be able to look at a container of yogurt without gagging, ever again.

Surgery day!

OK, I'm off to the hospital now for surgery, so no time for a real post! Wish me luck and if you do want to read an actual post, I wrote about the surgery more in-depth over at Not a Diet yesterday.

Catch you on the flip side!

Minor pre-surgery freakout

Today we leave for a week-long trip to visit Torsten's parents in Germany. Other than a party with his family to celebrate our wedding (since most of his relatives couldn't make it to the actual wedding), we don't have much planned other than generally hanging out while we're there. So, the blog will be quieter than usual but I'll still probably be posting occasionally.

When we get back from Germany, it will be three days before my surgery, which means that I have to start my liquid diet on the plane. Here's hoping there will be broth available on the plane. What do we think the odds of that are?

But basically what that means is that I'm done with my former eating habits. I mean, I don't have terrible eating habits to begin with. But I'm a little bit in that "OMG what have I done?" mode. Like will I be able to eat at Jimmy John's again? Or enjoy Torsten's grilled bratwurst on baguette? Lap-band isn't incredibly restrictive about these food choices but if you want it to work you need to make better choices--namely, protein first, and lean protein at that (I wrote about this in more detail over at Not a Diet). So not so much with the carb-heavy sandwiches, and not so much with the greasy bratwurst.

Which is good, because those things aren't good for you. But I didn't eat them all the time. But I liked having the option to eat them sometimes. And I know that I will still have that option, a little bit, occasionally. But I don't really want to avail myself of it.

But it's not just the unhealthy stuff. Things like Cheerios for breakfast are a no-no in favor of scrambled egg substitute and/or lox. And I'm used to thinking that fruit is a freebie--if I'm hungry, I can always eat it, and as much of it as I want. Now I have to stick to three small meals and one protein-heavy snack per day. No grazing, even on healthy foods.

I think it was Mandajuice who said that right before her surgery she treated every meal as if it were her last and went crazy eating all sorts of unhealthy things because she thought she'd never be able to eat food she liked again. And no, I'm not doing that. But I can totally relate to the feeling. Kind of a "Oh my god what have I done is this really about to happen and wait, will I ever eat mac and cheese again?" Even though I hardly eat mac and cheese to begin with, and I know that I can still eat somewhat "normally" post-surgery, it's still like, "Wait, is this for real? Grilled chicken breast for dinner from now until eternity?"

I'm not going to go nuts and stuff my face with all sorts of unhealthy crap in my last week of unrestricted eating. To be honest, my eating has been restricted for a very long time as I have attempted to lose this weight on one diet after another. So nothing is really changing except that this time the restriction will work and it won't be as mentally exhausting.

And I'm not regretting my choice to have the surgery at all, $10,000 price tag notwithstanding. I know this is the right thing for me and I'm really looking forward to starting down this road. I know that the first month or so will likely be sucky, but it will all be worth it ultimately.

But still, at the airport today I think I'm definitely going to buy some gummi bears for the plane.

Eating and pregnancy after surgery

A couple of you asked some good questions about how things like eating and being pregnant work after having lap-band surgery. Obviously, having not done it yet, I can't speak from experience, but I can tell you that I asked the surgeon and nutritionist all of those questions as well and they gave me some very useful responses.

As far as the eating goes, with the lap-band surgery you sort of pare down what you eat gradually. So once I've recovered from the surgery I'll probably be eating about a cup and a half of food at every meal. As they start to fill the band and tighten the restriction, that amount will be reduced until it ultimately settles at about 3/4 to 1 cup of food at every meal.

And by the way, since this was a question I had about the fill--the way it works is that there's a little port that's connected to the pouches on your band. The port is attached to your abdominal wall during surgery. After the surgery, the doctor gives you your fills by using a small needle to inject non-acidic saline fluid into the pouches on the band through the port. So basically, it's a small shot in your stomach.

The recommended diet is three meals a day, plus a protein-heavy snack (like cottage cheese). And the beauty of the surgery is that that's all you need in order not to feel hungry. You are supposed to take at least 20 minutes to consume each of your meals (unless you start feeling full sooner, in which case you should stop eating immediately). This means that you thoroughly chew all of your food before swallowing it, and make sure to put your fork down between bites. Eating slowly gives your stomach time to send the brain the signal that it's full, so that you won't want to eat too much. Because the pouch above the band is in the part of the stomach that senses fullness, it doesn't matter that the part of the stomach below the band is empty--your brain will still think you're full, even though you're only consuming something like 1,000 to 1,200 calories every day.

So, I won't have to deal with cravings and feeling hungry at other times. The food that I eat will be enough to prevent me from feeling hungry until my next meal. That's the difference between the surgery and a diet. Whereas now, it takes a lot of calories to maintain my weight, and my body thinks that it's doing me a favor by trying to maintain or even increase my weight (I'll be the last one standing in a famine!), after the surgery I'll feel full after much less, and for longer. This is what causes the weight loss without the unsustainability of a regular diet that makes you feel hungry all the time.

And, while you are getting a lot fewer calories, once you get down to a healthy weight, those calories are all you need to maintain your weight. You aren't starving yourself. You're just eating a lot less than what your body used to think that it needed to eat.

This doesn't mean that I won't have to deal with "head hunger," or emotional hunger. The social worker gave me a handout on that, and I think it's the kind of thing that everyone experiences to a certain degree. An example would be if you weren't feeling hungry, and then you saw a photo of a cupcake and suddenly you were like, I WANT A CUPCAKE. That's emotional hunger, as opposed to physical hunger. That won't go away. But since I'll have such a small stomach pouch, I won't be capable of acting on any head hunger that I might experience. And I've never had huge problems with emotional hunger to begin with.

Also, you can't drink during meals or for half an hour after. This is to prevent you from washing all your food down your stomach too quickly, which would mean that you'd feel hungry again too soon. And you can't gulp big glasses of water, ever, because it'll just come back up--there's no room in the pouch for that much water. (Plus, you can't use straws because they get air into your pouch.) So, my plan to stay hydrated is to get a 64-ounce water bottle, fill it at the beginning of the day, and slowly sip it all day, making sure that it's empty by the time I go to bed.

As far as eating during pregnancy goes, I'm not sure what the hunger and the cravings will be like, but all the doctors I've talked to agree that you do not need to really eat much more than normal during pregnancy, whether or not you've had the surgery. When I do get pregnant, I'll meet with the surgeon and dietitian and make sure I have an OB/GYN who is familiar with post-surgery patients, and decide on what's right for me. But the dietitian said that most likely I can just add in one extra snack a day and I'll be fine. The good thing is that because I'll already be eating a protein-heavy diet rich in nutrients, I'll be ahead of the curve in terms of eating good-quality foods that provide nourishment to the fetus.

I don't know if I'll experience massive hunger during pregnancy and breastfeeding, or if the pouch will override that. If I do need to eat more calories (like if I were carrying twins or something), I could have the band's fill temporarily removed or reduced, which would mean my stomach wouldn't be so restricted and I could eat more. That's one of the nice things about the lap-band as opposed to the bypass.

But honestly, it sounds like I probably will not need to dramatically increase my food intake in order to nourish the fetus. As long as I'm getting enough vitamins and nutrients, it should be fine. The research that I've done online corroborates this--see here for an explanation of how it's not about how many calories you eat while pregnant, but about the quality of the food. It looks like most pregnant women need to add only about 300 calories a day, and only during the last six months of pregnancy.

If anything, I'll probably need to add less than that. Since I will never be tiny, I will have enough fat and calories already stored that I won't need to gain as much weight during pregnancy as most people. While a lot of pregnant women seem to aim to gain 25-30 pounds during pregnancy (and many come in much higher than that, I know), my goal will probably be more like 15 pounds.

This is a bridge that I will have to cross when I come to it, and it will very much depend on my personal situation. The nice thing is that there's a whole team of nutritionists, social workers, and the surgeon himself, plus my endocrinologist and future OB/GYN, to help me deal with any issues that might come up and help me make the decisions that best fit my individual situation.

So, there you go. Eating habits and pregnancy after lap-band surgery explained, at least to the best of my current knowledge. As I go through this experience myself, I'm sure I will have a lot more to say about how it works and what it's like. Really, it won't be that different from my current healthy living efforts--there will just be an extra aspect to it, an amazing one that means that everything I do will be much more effective. But there will still be the efforts to eat right, get to the gym, and generally struggle with my feelings about my weight. But knowing that it will really pay off this time, long term? That makes all the difference.

The date is set.

Well. The appointment went well. So well, in fact, that I'm scheduled to have the surgery in a month. A few days after we get back from Germany and about six weeks before we go to the beach in New Jersey with my family. I was prepared to wait until after the second trip, if necessary, but the surgeon told me that it's fine to travel after about two weeks--and I'll be on a normal diet by four weeks out.

The surgery that I'm having is the less invasive procedure, the lap-band. I'm a good candidate for that procedure because I'm young (and apparently younger people have a better success rate with the lap band), I don't have any health problems that require me to lose a lot of weight immediately, and I don't have a weakness for high-calorie foods that go right through the pouch, such as ice cream or cream soups. Granted, I LIKE those things, but it won't be a problem not to eat them.

Lap-band surgery is different from gastric bypass. Gastric bypass is the most common weight-loss surgery, the one that most people think of when they're talking about weight-loss surgery. It's very effective. If you have gastric bypass, you can expect to lose a lot of weight very quickly. This is because you come out of the surgery as restricted as you're going to be. A small part of your stomach has been cut off from the rest and attached directly to your small intestine, bypassing the rest of the stomach and part of the intestine (hence the name). It's a more risky, invasive surgery, and it leads to malabsorption of not only food but also nutrients, pills, etc. It also leads to dumping syndrome (when your body reacts negatively to high-fat, high-sugar foods). It's a great surgery for what it is, and it's right for a lot of people, and it's very effective in curing diabetes--but it just didn't make sense for me.

Lap-band surgery is different. It's done laparascopically, which means that there will only be a couple small incisions in my abdomen and the surgeon will use a camera to see what he's doing. Nothing in my stomach will be cut off or rearranged. Instead, a band will be attached around the top of my stomach, creating a small pouch. The band has chambers attached to it that the doctor will fill over the course of a few months post-surgery. As he fills the chambers, they will press more tightly against the stomach, further restricting the opening between the pouch and the rest of the stomach. This means that the amount of food that I can eat will get further restricted over time, unlike with the gastric bypass.

The post-surgery diet is a lot less restrictive. It's about portion control more than anything else. This doesn't mean that I can go eat only unhealthy crap and expect to lose weight. Once I've reached full restriction, I will likely be able to eat between 3/4 and 1 cup of food, three times a day. The majority of that food needs to be lean protein and the rest can be made up of complex carbs or whatever else I want. There's more of a learning curve with the lap band. A Weight Watchers-style eating plan should be very effective.

The weight will not pour off like it would with a gastric bypass. Instead, I can expect to lose about 1 to 2 pounds a week--but the weight loss will continue over a longer period of time and will end up at about the same as the gastric bypass after three years or so. Plus, because it's a tougher battle at the start, it means that it's easier to avoid regaining weight down the road.

The social worker I met with warned me as well that after the surgery, there will be a point when I feel discouraged, like it's not working and I tried everything and surgery was a last resort and even that isn't working and I'm doomed to be fat forever. She says that because lap-band surgery is so slow to start being effective, and because it's more of a tortoise than a hare approach, nearly every lap-band patient feels that way sometimes. That was actually really encouraging to hear, and I repeated it to Torsten so that if/when I start feeling that way, he can remind me that it's normal and I was told it was going to happen, and that I will move past it.

And I will. I'm so excited about this. I can't believe it's really happening. Everyone I've met with thinks that this is the best option for me, and I totally agree. The main driver being my health--I don't want stress on my heart. I don't want stress on my joints. I don't want stress on my future fetus. But there's another side to it, too. I want to fit into the world. The surgeon's office, being designed for overweight people, had this extra-wide chairs? And I sat in one and there was SPACE on either side of me. It was such a novel feeling! I want to fit into chairs. I don't want to worry that I'm going to be squashed whenever I fly, or go to the dentist, or go to the hairdresser. I want to be able to find bras that fit. The world isn't designed for fat people, and therefore being fat is UNCOMFORTABLE. I'm so ready for that to be over.

I may never get into a bikini, but I will get to a healthy weight. I WILL. And the journey starts now.

P.S. I have to wait a year after the surgery to get pregnant. So all of you people on Baby Watch are just going to have to wait. Just thought I'd throw that out there.

Feeling groovy

THIS was worth missing Dooce for:




This morning I have a three-hour consultation scheduled with the surgeon's office. I've figured out a bit more about the insurance situation--there was some confusion with my insurance network because my insurance company isn't known here in Colorado, so people think they don't take it when actually they do. It turns out that either the surgery would be covered at 100% or it won't be covered at all. Which is actually logistically easier and a relief, because it means that if I do have the surgery, I don't have to worry about finding one surgeon who's in-network and another who offers a reasonable self-pay option.

The appointment will include a meeting with the surgeon (who also conducted the seminar last week), a meeting with a psychologist (or maybe it's a psychiatrist?), a meeting with a nutritionist, and a meeting with the insurance coordinator for the surgeon's office. It should be, if nothing else, very informative, and it will be good to have a one-on-one conversation with the surgeon about my particular situation and what's best for me.

It's been a good start to the week. I feel good. I'm excited about the house, and feeling good about the surgery thing, and the dog isn't sick anymore, and it's been sunny and nice out, and we're both feeling very settled in Denver. It feels like ages since we were living in DC, and neither of us misses it. It's just so right here. It's such a good fit.

Oh, and also? In case I haven't mentioned it yet? GO UNC.

Surgery seminar and follow-up

So, last night Torsten and I went to a seminar at a bariatric surgery center of excellence here in Denver. It was very informative. I knew most of the information already from the research I'd done, but it was good to hear it from someone who's been there, and be able to ask questions and do a closer comparison of the two main types of surgery.

It was also very good for Torsten, who is incredibly supportive but hadn't done as much research. We both really liked the sound of everything, and it seems like this may really be a viable option for me. The newer type of surgery, called lap-band, seems to be the option that makes the most sense. It's not malabsorptive, which means that it takes longer to lose the weight because you absorb all of the calories you eat, unlike gastric bypass--but the flip side of that is that you don't have quite as many restrictions on what types of food you can eat, and you don't have to worry about vitamin deficiencies.

The surgery is less invasive and less expensive, and it's reversible if there are any complications, and the long-term weight-loss outlook is the same. It just makes more sense. Of course, I haven't made any final decisions, but that's definitely the direction I'm leaning in.

I've scheduled a consultation with the surgeon for next week. At the same time, I'll meet with a nutritionist and a psychologist, and discuss my insurance plan in more detail with the office.

And oh, speaking of the insurance? I'm a little pissed about this. My company has put an exclusion on weight-loss treatment of any kind on their insurance policy. As in, the insurance would cover it, but the company has opted not to allow it. Which is a little horrifying considering that a big thing that we work on is obesity prevention, and yet we don't even offer our own employees assistance of any kind with losing weight? It's not just the surgery that's not covered--it's any kind of medical weight-loss intervention.

There is an exception to the inclusion, though, and it almost makes it worse. If you have a condition that contributes to your weight problem, THEN the surgery will be covered. In other words, if you can't be BLAMED for being overweight, then they'll help you. But if they think you could just man up and eat less, then no help for you! It's putting weight-loss surgery, and other weight-loss programs, on a level with unnecessary cosmetic surgeries.

However, I shouldn't complain too much about the clause, because it may be my saving grace--my thyroid condition does contribute to my weight, and my endocrinologist is going to write me a letter to that effect, which is what the insurance claims they need. We'll see if they really authorize this after all is said and done, but it's a ray of hope. However, even if they do cover it, it's only at 70%, and there may or may not be a $5,000 deductible before that starts. So, all in all, insurance may help or they may not. But if they don't, while the surgery isn't cheap, it isn't as expensive as some surgeries, and the hospital has a payment plan so you don't have to pay all at once.

Point being, I have options. And we'll see how the consultation goes, but I'm feeling very good about this. And in some ways, even though it's more expensive, it would almost be nice to just pay for the surgery on our own because we could avoid so much stress and red tape with the insurance company.

So, yeah. Moving forward on this, and feeling good. Although I still haven't wrapped my head around the idea that I could have this surgery. And then lose weight, for real, permanently. I'm not there yet, mentally. Which is probably good because it means I won't be as disappointed if something comes up that prevents this from working out.

But still. At the seminar the surgeon was talking about how his patients love him because he enables them to do things they could never do before. One of the examples he gave was wearing a bikini. And I snorted internally, because me? In a bikini? It is seriously inconceivable. SERIOUSLY. I can't ever imagine doing something like that.

You guys, seriously, I've never been thin, or even at a healthy weight. Never. I don't even know what my goal weight should be, because it's not like I can look back and be like, oh yeah, in high school I was at a good weight, I'd like to get back there. I really don't know. I suspect that my goal weight is something I haven't seen since middle school. How crazy is that? That I could ever potentially get down to such a healthy weight? Seriously, inconceivable. But also: SO AWESOME.