This Surgery May Make Life Worse
Have you ever considered weight loss surgery?
Since puberty, I’ve had a serious weight problem. In my late twenties and then into my thirties, my problem turned into a full-blown, Manhattan Project level crisis. A combination of factors kept the pounds ticking skyward: hormonal issues thanks to polycystic ovary syndrome (PCOS), insulin resistance, bipolar disorder, emotional issues with food, lack of work-life balance, and, honestly, a fair amount of avoidance.
Clinically termed “morbidly obese,” I struggled to find a way to change my life. I tried every diet under the sun. I ran (as much as I could), and P90x’d until I blew out my knee. I tried everything from green juice and cayenne lemonade to vegan, paleo, and pescatarian diets — and all I ever got was minor results (which is 40 pounds or under for me, personally). I tried over-the-counter weight loss drugs, and when they didn’t work, I tried all sorts of weight-loss medication, eventually switching to the type you inject daily. Still, the only time I lost major weight (80 pounds in less than three months) was due to a breakup and my subsequent depression and addiction to running. It wasn’t healthy, and I knew it. I gained half the weight back within a year. Basically, I never stayed with any diet or exercise routine longer than three months, and all this flip-flopping caused me to gain back most of the lost weight and sometimes, a little extra.
I was dangling at my wit’s end when I decided to meet my doctor and discuss gastric bypass surgery. We had talked about it and dismissed it for about five years, but I was finally ready to put it on the table — and with it my health, body, and my very life.
What Is Bariatric Weight Loss Surgery?
According to the American Society for Metabolic and Bariatric Surgery, over 196,000 people had bariatric weight loss surgery in 2015. It seems there are countless commercials and centers springing up all across the U.S. advertising the ease of bariatric surgery. Before-and-after photos and testimonials from people who have undergone massive bodily change flood these commercials, selling the surgery as the miracle weight-loss cure that works when everything else will not.
Weight loss surgery as a practice was born in the 1950’s at the University of Minnesota. The first type of weight loss surgery performed was the Jejunoileal bypass (JIB) which is an “…induced state of malabsorption by bypassing most of the intestines while keeping the stomach intact.” While people did lose weight, they often had to have the procedure reversed due to side effects like malnutrition, kidney stones, and toxic bacterial growth in the bypassed intestine which led to liver failure and intense arthritis. The JIB is no longer performed, but served as a lesson for future surgeries. Doctors Mason and Ito invented Gastric Bypass surgery in the 1960’s by noticing the significance weight loss patients experienced when undergoing partial stomach removal for ulcers. This later evolved into what we know today as Roux-en-Y Gastric Bypass surgery.
Today, with additional medical knowledge and light-speed levels of technology, four types of bariatric surgery are now offered as weight loss surgery. The most popular surgery is Roux-en-Y Gastric Bypass, in which a smaller stomach pouch is surgically created, bypassing most of the stomach and part of the small intestine. Dietary sugars are not digested and the nerves and hormones that stimulate hunger are bypassed, resulting in significant weight-loss. Second most common is Vertical Sleeve Gastrectomy, where most of the stomach is removed, significantly limiting the amount of food that can be eaten. Laparoscopic stomach banding, commonly known as the lap band, is another method of gastric surgery. In this procedure, a band is surgically put around the stomach to reduce the amount of food a patient can eat. As the patient hits plateaus, he or she attends outpatient visits to tighten the band to lose additional weight. This process continues until goal weight is achieved. The lap band is reversible. Duodenal Switch is the last bariatric weight loss surgery option and is best described as a combination gastric bypass and gastric sleeve. A large section of both the stomach and small intestine are removed making this the surgery with the most complications and longest recovery time.
Contrary to popular belief, gastric surgery is not easy, nor is it always as successful as it seems. Complications, infections, unhealthy food behaviors, like anorexia and purging, and secondary disease are common with bariatric surgery. Twenty percent of patients have incisional hernias. Dumping Syndrome, where food moves from the stomach to small bowel too quickly, resulting in painful abdominal cramping and diarrhea, affects some 40 percent of all patients. Also, up to 50 percent of those who have bariatric weight loss surgery gain some weight back. There is a chance of death during surgery (significantly reduced now), but still there’s high percentages of issues with infection.
The upside is the immediate weight loss. But, there’s one valuable piece of information that doesn’t make the commercial cut: the surgery does not work on its own; patients must make huge lifestyle, eating, and physical activity changes in order for their weight loss goals to be successful.
The Pre-Approval Process
Here’s what’s especially crazy about the whole Bariatric process. Most insurance companies and surgeons require a mandatory amount of weight loss before surgery, in my case it was a 20 pound weight loss. Candidates must maintain a strict “pre-surgery diet” to qualify, as well as taking high dosages of certain vitamins like calcium citrate to get used to the plethora of supplements they must take after the surgery. Most insurance companies (like mine) also require that you have a fitness or activity plan and keep a log.
The diet I was put on encouraged meats and vegetables and restricted carbohydrates. Healthy fare like beans, nuts, quinoa, barley, wild rice, and fruit are strictly prohibited, since we had to stay away from all carbohydrates. Here’s the wild part: the diet encouraged some diet foods like Crystal Light and sugar-free Jell-O as ways to satiate the need for sugar. Here’s the thing: if you must abide by a strict diet and mandatory exercise to lose weight for surgery, why not just keep abiding by it to lose all the weight instead of having weight loss surgery? I lost weight on the plan even though I cheated, but it did take me six months to lose the required 20 pounds. I was low on energy, and my once-clear skin broke out. I knew it wasn’t the long-term plan for me, but it was a requirement so I gritted my teeth and did it long enough to lose the weight.
I was also required to attend support group meetings, have a psychological evaluation, and have monthly weigh-ins. If I gained weight, I would have to start the entire process again. The psychological evaluation consisted of sitting with the health group’s psychiatrist and answering nearly two hours’ worth of questions. It ranged from why I think I have a weight problem to known triggers to traumatic events that have happened over my nearly forty years of life. We discussed my mental health and how I manage my bipolar disorder. There was no follow-up, no deep-dive or explanation of why I have a weight problem. All I had to do after the evaluation was have my current therapist fill-out a form.
Support group meetings were with people who were getting the surgery and others who successfully had it. It was not run by a medical professional, but instead by peers. At monthly weigh-ins I was weighed in, a few vitals were taken, then the Physician’s Assistant saw me for three to five minutes for questions and (if he didn’t no-show or cancel last minute which was often the case) I would meet with the nutritionist who offered no value in my opinion and gave me about three minutes of his time. Then I was ushered out and scheduling my next appointment. Did it feel like an assembly line? Yes. I felt like they were just trying to move me from the scale to the table as quickly as possible, and I didn’t like it.
Right when I hit my weight loss target, I decided that surgery wasn’t my answer. I quit the process. After attending meetings, talking to others, and doing an insane amount of research, I had realized that the surgery might make me less healthy and undoubtedly more obsessed with food.
Stories Of Post-Surgery Horrors
According to the support group meetings I went to, after the first month or two after surgery, you don’t want to eat because you are recuperating and getting adjusted to a new “eating reality.” Yes, the weight comes off fast, but there are certain plateaus. Patients must eat and drink on a schedule. If you have the lap band, you have to go to the doctor to get it adjusted when you hit plateaus. If you have the other surgeries where your once expansive stomach is now the size of an egg, you will have to take even your water in portioned increments. No carbonation, no alcohol (your blood alcohol drastically changes), and a still restrictive diet. I met a man at the meetings who had a timer on his watch go off every eight minutes of his workday so he would remember to sip water. Every eight minutes! All this planning and focus on food creates a new, but just as damaging, pattern for people who are already obsessed with food, making the cycle worse even though the outcome may be different.
Did I mention the vomiting? I was actually advised that vomiting “before you get used to your new way of life” was part of the process for most people. You would, undoubtedly, overeat and your body would reject the food. You would then vomit. And this is considered normal. I call it an eating disorder.
Terrible And True Bariatric Tales From An ER Doctor
After speaking with Dr. Akram Alashari, M.D., an emergency room surgeon, I learned of several issues that arise post-surgery that my research didn’t uncover. He puts post-surgery care into two separate groups: acute and chronic.
Acute care involves life-threatening, surgical measures that must be taken to save a life. As an emergency room doctor, I have seen many post operative bariatric patients come in for things like leakage after surgery. So, a patient may take a few days to heal, then there is leakage, and the patient has to go back into surgery.
Alashari also enlightened me on the chronic issues which can arise due to the surgery. Intestines can get obstructions from the scar tissue that builds up after surgery. Blood flow is constricted in the intestine, which then leads to gangrene which “requires immediate surgery. Some also come in with sepsis. Both can result in death.” Patients also get twisted intestines and internal hernias from the surgery. Lap bands can migrate, get stuck, or actually grow into the stomach; all of which require immediate surgery.
Bariatric patients are malnourished, vitamin deficient, and tend to gain weight back because they drink more calorically dense drinks. “These aren’t one-in-a-million occurrences either,” he says, “This can happen to anyone and is hard to predict. Factors like your surgeon, age, and disease will play into your post operative condition.” Based on his experience, he advises, “Before you do this, exhaust the other measures and remember, it takes a while to get results.”
Bariatric Weight Loss Surgery And Lap Band Woes
I spoke with others and heard every horror story under the sun about both gastric bypass and lap band. One acquaintance who had gastric bypass surgery said in the first two years of her life post-surgery, the constant “dumping” she personally experienced was horrible. She was always in the bathroom and often at very inconvenient times, including on airplanes and romantic dates when diarrhea is particularly embarrassing. She still experiences some issues today (five years later) and wishes she took a different route to losing the weight.
Another woman I spoke to, Jesse Heimann, experienced unbelievable trauma because of her lap band. She found doctors unwilling to adjust her band if they themselves did not put it in. Since she experienced many complications. from her lap band, she had to have several expensive, unnecessary surgeries. She couldn’t eat and even had trouble drinking water. She was sick all the time, had no energy, and was miserable. She was thinner than she’d ever been but she was living the exact opposite of “happily ever after” life she would come from having such a body.
A doctor eventually recommended she remove her gallbladder to improve her health, but she continued having the same problems after surgery. After 10 years of grueling health issues, she finally had her lap band removed. She was then offered Roux-en-Y surgery, which she quickly declined. She is now much happier, even after she gained all her weight back, because she is finally able to feel healthy and be active. She is currently working with a health coach to bring her weight into balance.
Since deciding not to have weight loss surgery, my weight has hit a plateau as I prepare for the weight loss method I believe will work best for me — a total lifestyle change. I am leaving the U.S. for a year to travel the world which will totally transform my relationship with food and activity. In a new city abroad every month, I will be walking multiple miles per day, logging more miles on hikes and excursions, enjoying an un-American relationship with food, and learning work-life balance. It is the ultimate lifestyle reset I need to lose over half of my body weight, and my doctor heartily agrees that this experience will teach me what I really need to learn: how to prioritize my health without obsessing.
I’m glad I have given pause over the last six years when deciding whether or not to have gastric bypass surgery. It is easy to get caught up in all the hype of a quick-fix solution. Just remember one thing: the after pictures don’t tell the whole story. They don’t show people getting extra surgeries. They don’t show people stuck in airplane bathrooms cramping in distress, utterly embarrassed. They don’t show people purging as they get used to the “new normal.” They also don’t show the craziest of all the results, the day-to-day obsessive planning of every piece of food to be eaten or each ounce of beverage to be consumed.
If you plan on getting weight loss surgery, just give pause. Consider all the options. This is not a fairytale; this is real life.
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