My wife was placed on her first diet in second grade. When I met her, thirteen years later, she weighed about 250 pounds. Over the next 20 years, she see-sawed between 250 and 350…losing a little on this diet, a lot on that diet, as much as 100 pounds over a year and a half on one…but eventually those losses would slip away, usually leaving her heavier than when she started.
I say this not as a criticism, but to point out that she is completely familiar with the curse of obesity. She knows more about dieting than some nutritionists. She knows what it feels like to weigh two or three times her “ideal weight.” She knows what it feels like to lose a significant amount through months of hard work and deprivation. She’s read up on genetic causes of obesity, and has intimate knowledge of food addiction, stress-related overeating, financial penalty of a healthy diet, dieting as a family, dieting with a partner, dieting with a support group, and dieting alone. No matter what aspect of obesity or weight loss you want to bring up, she’s been there and done that. Despite a lack of formal training on the subject, she has a level of expertise that no 120-pound aerobics instructor, patronizing doctor, or egotistic talk-show hostess with a private chef and a personal trainer can possibly match.
Her obesity has caused her many problems over the years. She has been denied jobs due to her weight – in one case, she was refused an unpaid volunteer position at a library because of her size. She has suffered from health problems due to her weight. Some of those were directly caused by the excess weight – a problem with weak ankles has been repeatedly exacerbated by the extra force her body put on them. Other problems were caused by the reaction of her doctors – no matter what health issue she brought to them, they blamed it on her size. Sometimes they claimed it was the cause of the problem, sometimes they claimed it would interfere with the treatment, and sometimes they simply felt the need to lecture her – as in the doctor who delayed treating a painful case of swimmers’ ear so she could lecture Rita (in her good ear) about dieting. Perhaps she thought that fat earlobes trapped excess water in the ear canal? The fact that she was generally quite healthy, despite her size, was lost on them – for instance, her comfortably low blood pressure and normal blood sugar levels were a constant surprise to them, though that seldom prevented them from warning her about hypertension, diabetes, heart attacks, and strokes. Unsurprisingly, she developed a hatred of doctors’ visits – a problem would have to get very serious before I could convince her to see one, and even then she wanted me to come along to protect her from unwarranted attacks by these so-called professionals.
Even walking in public was a trial for her. People would turn and stare, pass by her with whispers and giggles, make rude comments pitched for her to overhear or even make them directly to her. I felt she was overly sensitive to such things, seeing insults where none were actually given…but I saw enough of them confirmed to make me unable to reassure her when she saw something I didn’t.
About two years ago, she underwent that most extreme of weight-loss surgeries, a gastric bypass. Prior to the surgery she spent a few weeks enjoying eating whatever she wanted, knowing what she’d be giving up – then we had to move before the paperwork was finished, forcing a year-long delay while she started the process from scratch with her new doctor. That “last chance” mindset, the interminable delays, and a crippling broken ankle just two months before the surgery pushed her well over 400 pounds for the first time in her life, and finally broke her normal healthy constitution into “incipient diabetes.”
In those two years, she has dropped over 270 pounds. She reached her goal weight of 165 a few months ago, and has successfully maintained her weight within five pounds of that goal since then. She dropped from a dress size of 5X down to a size 10. She no longer attracts attention on the street. Her weight loss turned around the diabetes. She watches her nutrients carefully, and has had no complications at all. By almost any possible measure, the surgery has been an outstanding success.
These days, anyone who has noticed her weight loss or otherwise finds out she has had the surgery asks the inevitable question – “Are you happy about it?” The question is universally accompanied by a pleased smile, inviting Rita to gush about how much better she feels, how much happier she is, how much her life has improved. Sometimes they even make it a statement – “I bet you are so much happier now!”
They lose. She isn’t.
- The post-surgery care was a travesty. Poor pain management, contradictory instructions from the doctor’s brief visits and the nurses’ written orders, and no physical therapy whatsoever. The hospital’s lack of a comprehensive post-op plan set her recovery back by weeks, and forced her to manage her own recovery by trial and painful error.
- She has to record every bite she eats. On a normal diet, you mostly count calories, or food exchanges, or points…in any event, a fairly straightforward process. Post-surgery, however, she has to cram maximum nutrition into a sharply limited amount of food. She tracks calories, protein, iron, calcium, and potassium, and has to tailor her diet to accommodate all of those factors…within the restriction of three cups of food a day.
- She cannot eat processed sugar. At all. Even a couple bites of anything sweetened, iced, or frosted causes her extreme nausea in a matter of minutes or even seconds. In many cases, she can use sugar-free substitutes, but not always – sugar-free candy, for instance, almost universally includes Maltitol, which affects her just the same as sugar. Alcohol also has the same effect – a couple sips of a margarita or long island iced tea will send her running for the restroom.
- She is always cold. Last week, temperatures hit 80 in this area, and the building in which she works has not yet turned on their air conditioning. She stood at her cash register not merely fully dressed, with her “uniform” jacket on top of that, but with an extra layer of thermal underwear hidden beneath her dresses – and still noticed a chill from a fan running nearby. When we go biking together, she wears her long johns and a jacket, and sometimes gloves, on nights when I am comfortable in a t-shirt and shorts.
- Her flesh literally hangs from her bones. Skin has a limited ability to shrink back down after being stretched, and her weight loss has far exceeded that limit. While her shoulders and back show her bones, she has inches of loose skin hanging from her arms and sagging around her middle. This excess flesh bunches up under her clothing, sometimes even developing open sores. All that extra skin is why she has stopped at 165, when the “ideal weight” for her height is probably 30 pounds less – you can’t diet away skin, and if she tried, she could well suffer the health problems related to anorexia while still being counted as “overweight” on the BMI Index. We still both hope that her skin will slowly “tone up” over time – but what we’ve read on the subject doesn’t do much to confirm that hope.
- She lives with the constant fear of relapse. She’s looked at the limited statistics publicly available – they show that the majority of bariatric surgery patients are successful. But that depends on a weak definition of “success.” Apparently as long as the patient keeps off HALF of their excess weight, then the surgery is successful…and the time period they consider is not “forever,” but merely “long-term,” a measure of time so far undefined in her searches. From what she’s read, she could regain 130 pounds over the next few years and still be considered successful…and could regain the rest eventually, while still suffering all of the permanent side effects and risks. As near as we can tell, if she gets back up to 400 pounds by age 55 and then dies of a weight-related heart attack, she’d still count as a “success” on their statistics – which means she has no prospects of ever being able to relax her rigid control of her eating.
- She feels cheated. All her life people have told her how much better her life would be if she “only” lost the weight. “You’ll be healthier,” “You’ll be so much prettier,” “People will like you better,” “You’ll be so much happier.” That turns out not to be the case. Except for those last few months, she was always healthy, despite the extra weight – she has to be more careful of herself now than ever before. She can’t look in the mirror at her hanging flesh and tremendous scar and tell herself she’s prettier – and my opinion has never convinced her, then or now. Most people liked her no matter what she weighed, as she’s always been a friendly and likable person – but now, she hesitates to trust new people, wondering if they would have liked her when she was heavy, or if their friendship is too shallow to go beyond obesity. She even worries that some of her old friends and family with their own weight problems will turn away, jealous of her “success.” Is it any wonder that she isn’t any happier…or that she feels the world broke a promise?
Imagine spending two months in constant intense pain, prescribed only enough medication for someone half your size. Imagine spending at least an hour a day calculating the food value of everything you put in your mouth - forever. Imagine never, ever eating a candy bar or drinking a glass of wine again. Imagine needing long johns as beach wear. Imagine doing all that, with no assurance that it would do any good at all, “long-term.”
Now imagine dozens of people, even total strangers, coming up to congratulate you on your accomplishment, expecting to share in your excitement and joy. Imagine feeling that most of them would have ignored you or turned away in disgust rather than talked to you a mere two years ago. Imagine trying to blandly agree with them, confirming their evident belief that fat people can’t be happy, and that you must be skinny to be worthwhile. Or imagine trying to answer them honestly, hint at the prices you’ve paid – only to have them show confusion, disbelief, or even anger when you betray their moral certitude. Imagine even your doctor, when confronted with an honest answer, hemming and hawing, finally dismissing your honest uncertainty, confusion, and anger with a facile “You were too young to have really suffered much from your weight – if you hadn’t had the surgery, you’d have had a lot of problems when you reached 60.”
THAT is a successful gastric bypass.