Bariatric Surgery

I’ve officially decided to do the Vertical Sleeve Gastrectomy, with a timeframe of likely having surgery in early-mid July. I’m still a little hesitant on it, but only because it’s such a big decision. I hate having to tell people and explain it, though. I feel like a lot of people don’t know what the surgery is or assume it’s a cosmetic surgery, and I feel like folks will think I’m taking the easy way out or that I’m a failure for being unable to lose and maintain weight loss without surgery. I know that’s not true, logically, but there’s some shame associated with it that I need to get through.

When you are obese, your body strives hard to maintain that weight. There are multitudes of studies that show metabolism is forever impacted, and that all but around 5% of folks who lose weight end up regaining it. With weight loss surgery (WLS), the number of folks that maintain goes from 5% to well above 75%. I want to be in that 75% percent. I’ve been able to lose (and have regained) the same 65 lbs again and again over the last 10 years. I’ve only been under 200 lbs once that I can remember since elementary school, and that was when I ended up going to the hospital for passing out from not eating enough.

Weight has always been a shameful thing to discuss for me. My mother and sister wouldn’t stop talking about it. My mom’s self hatred because of her extreme obesity shaped my self-esteem and my life as much as it shaped her own. Her heart disease (and mental illness) and eventual death shaped me even more. My sister’s weight and the bullying and esteem issues that went with it didn’t help. In my family, I was the “tiny” one, but I myself was always medically obese too. I’ve been told I carry it well, and that I don’t look obese, but being honest, I am. I always have been. Despite that “tiny” label, I was only ever called pretty in my family with a caveat of “you look so good, keep up the diet” type of language. It fucks with you.

I’ve gone through cycles of weight loss and gain. I worked my ass off and got borderline anorexic in high school, only to hit a lot of 195lbs my junior year. Then I got a part-time job and quit dance, and then I went to college, and by the time I graduated college I was 260lbs. My first year of grad school I lost 20lbs, and then my second year when I moved to DC I lost another 20lbs when I had a cholesterol scare and needed a medical clearance for a job (weight watchers helped me out this time). My blood sugar, blood pressure, etc. have always been good, thankfully. I was in the clear. Then I graduated and had time again to have a social life, and over the next two years I gained back that 40lbs plus 5. Then my mom died, and I shoved all that into a personal trainer and calorie counting and working out again. I lost 30lbs, then the holidays hit and my grief won. I also started my happy new relationship. Over the next 2ish years, I gained that 30lbs back, plus 3olbs. I hit an all time high. I was miserable by it, so I did Whole30, lost 20lbs, and started working out. Then I tore my ACL and both meniscus in my left knee, and gained another 10lbs back. And that’s where I’ve been for about 8 months.

I’m not unhappy, and I’m not at death’s door. I can live my life. I also have faith I could lose some weight on my own. I don’t have faith that I can lose as much weight as I could with WLS, and I don’t have faith that I could keep it off. I have success in losing when I eat 1200 calories and work out literally every day, but that’s so impossible to maintain long-term without additional tools. My cholesterol has been testing high over the last 6 months, and that’s not a good sign. I have every weight-related illness possible in my family history (sister and dad with diabetes, dad/sister/mom with blood pressure and cholesterol issues, mom with heart disease…).  I don’t want to go down that road.

WLS isn’t dangerous anymore. 20 years ago, maybe it was, but there’s very minimal risk nowadays. The risk of the surgery itself is less than 2%, and the most common complications are heartburn or acid reflux afterwards. The benefits are extreme – most people lose over 50% of excess weight within 12-18months and keep it off, and all weight-related health issues go away. People are happier and have more active lives. My sister had WLS last summer, and she’s lost 200lbs. She started out much heavier than me (she’s only now at my weight), and it was definitely a life/death thing for her, but her success motivated me. It also taught me about WLS and how much safer it is now, and how much more likely it is for insurance to cover it. I never thought it was an option for me, but I learned it was.

There are multiple types of WLS. There’s gastric bypass, where they remove a large portion of the stomach and reroute part of the intestines. There’s the duodenal switch, where they remove a large part of the stomach and reroute all of the intestines. There’s the lap band, where they put a silicone band around the stomach, but there are lots of complications and most surgeons don’t do that procedure anymore. Then there’s the vertical sleeve gastrectomy (VSG), where they remove part of the stomach. The VSG has been done for decades as the first step in the duodenal switch procedure, and when doctors realized how effective it is on its own, people started getting the VSG alone about 5ish years ago. Now the VSG is one of the most popular procedures. I like it because it isn’t malabsorptive – they don’t touch your intestines. Bypass and the switch rely in part on reduced stomach size meaning reduced portion and less hunger hormone, but they also rely on food moving through the stomach and digestive process more quickly so that not all of it is absorbed, thus meaning less intake and more weight loss. That makes me nervous, and I don’t want to do that. The VSG is all about less food and less hunger hormone, and has none of the malabsorptive part.

For me, I want to lose weight and keep it off. I want kids, and I want to be able to get pregnant, have a healthy pregnancy, and be active with my children – being a lower weight helps with all of those things. I want to be healthy and not progress down the family history diseased path. I want my knee to have less weight on it so I can reduce arthritis risk.

Yes, appearance, more clothing options, etc. are nice side bonuses. I’ll be able to physically get in more sexual positions. More clothing stores will be available to me and those stores will cost less. I’ll never have to worry about fitting into chairs or seat belts or not being able to do something because of a weight requirement. As sociological studies show, I’ll be treated better by strangers and likely be respected more at work.

So this is my decision. It means post-op, I’ll be able to eat very little food at any given meal. I’ll have to focus on protein first to make sure I stay healthy. I won’t be able to eat much sugar without getting sick. I won’t be able to have carbonated drinks, alcohol will hit me super hard, and drinking and eating at the same time is very much not recommended. I’ll have to force myself to have a bunch of gross protein shakes and vitamins daily. But, I get all the aforementioned benefits, so totally worth it in my mind.

My pre-approval process is pretty straightforward. I’m lucky and I have good insurance. I have to see a dietician 3 times (1 for 1hr, 2 for 30min) and go to a nutrition pre-op 2 hour class. I have to do a 2hr psych consult. I have to have an endoscopy. I also have to get a letter from my primary physician, and see her and the surgeon in the weeks before surgery. Then I do a 14 day liquid diet leading up to the surgery itself, and ta-da. I’ll be in the hospital one night, then home. There’s a 4 week food phasing recovery plan – 2 weeks liquids, 2 weeks soft foods, then all foods are OK.

I haven’t figured out how much I’ll tell me office, but likely something along the lines of “stomach surgery” and not go into more detail than that. I have and still do feel that my weight and my health are my business. I will tell close friends and family because 1) it’s a surgery and that’s risky and 2) it will impact our interactions. I hate bringing it up though. I just feel like there’s so much judgement, and I’m probably or possibly projecting all that, but still. I hope people realize that it’s a big decision and not one I take lightly, and it isn’t a solve-all-your problems thing. I’ll still have to work out and eat right in order to make a long term difference. It’s a tool to help me find more success in the long run.