“You weren’t that big to start with”/”You took the easy way out”/and just plain “Hard work.”

Nearly 5 months out from surgery as of August 8th, and I’m writing an update a little early because I’m having a rest-and-write day.
Some people say to avoid Bariatric Surgery forums, but others recommend them for support. I generally find them supportive, and I find the photos people show of their progress to be inspiring.
But lately, there’s this vibe on the forums where people who have a hundred or more pounds to lose are coming across as demanding justification for having the surgery from those who had less than a 100 pounds to lose. It’s almost like, “What are you doing in this group? You weren’t that big to start with.”

Prior to my surgery, I told a few trusted colleagues that I was having gastric sleeve, and after I had the surgery, I was open with those I trusted about what I’d had done. I do not consider it a shameful thing, so why keep it a secret? The downside to being open about something like gastric sleeve surgery, however, is becoming an object of discussion: “We were talking about you and we don’t think you were that big to start with…”–which is like a veiled way of saying, “Why did you have surgery? You didn’t need it.”

Here’s the thing: I needed to lose 75 pounds to get to a healthy weight. I’m not there yet: I still have about 12 pounds to go, but I also don’t know where my body will stop. 75 pounds was a number I chose because that would get me back to where I was when I lost 100 pounds, long ago. I may not lose another pound. I’m okay with that. It won’t change the way I’m keepin’ on keepin’ on.

I’m only 5’3″ tall, and I have a small bone structure, so carrying extra weight, even though it was not hundreds of pounds, affected me adversely.  The weight I am right now is one of my “set point” weights that I often settled at in the past.

When I regained 75 of a 100 pound weight loss from the early 2000s, sleep apnea returned, and that is what qualified me for surgery because it is a  “co-morbidity,” meaning that in addition to having the disease of obesity, which can cause early death, I had another disease present in my body that could also cause death. My surgeon approved me; the psychologist approved me; the fitness people approved me; the insurance company approved me. I jumped through hoops for 4 months. I spent thousands of dollars because I have a ridiculously high deductible. I underwent an endoscopy. I had 12 vials of blood drawn in one sitting to check various things in my blood. I took time off from work to go to nutritionist appointments, which ended up costing me because I “ran out of days off” and I got docked.

As I stated in the post, “When I Made Up My Mind,” which is the home page for this site, the moment I decided to pursue this surgery was when I was walking through the airport and I realized I was waddling because it hurt so much to walk. Now: I know that part of the reason I had that pain was that I have a partially torn tendon where it attaches to my hip bone, but I’ve been told by the orthopedic doctor and the physical therapist that losing weight has helped this condition not be as painful.

I’ve gotten to where I’m not limping any more and I’m doing physical therapy for the torn tendon. (That’s part of my rest-and-write day now; I spent last week helping my daughter move from one house to another, and I was not quite as careful as I was supposed to be in going up and down stairs, which is the worst thing I can do with the problems I’m having. So, it’s ice & rest & physical therapy for a few days…and possibly another cortisone shot…)

Having sleeve surgery also has given me an extra tool for managing the eating disorder I have. I track everything I eat to check my protein and fluid intake–and keeping a food log like I do helps me with my ED. I work out 6 of 7 days a week on a recumbent bike because it helps loosen up my hips and I walk with less pain. And, yes, the exercise helps weight loss and toning, too.

BUT: One side effect of rapid weight loss is skin that just sort of…drapes. Given the just-right position, a glance in the mirror is an exercise in choosing the mindset to have about this. It’s either, “Oh, my god, parts of me are flat, parts of me look like I’m filled with cottage cheese, and….that part appears to be risen bread dough that was just punched down….” OR “Hm. Yep, that’s my body. Now, what is it that I need to do today?”

Here’s what I’ve decided about the parts of my body that make me uncomfortable to look at: it’s karma. Here’s why: over the years, if I noticed, for example, some woman in a sleeveless shirt and the skin hanging off her triceps brought to mind bat wings, I was judgy about them. My judgment was this, in my head: “Yuck. Oh, my god, I’m so glad my arms don’t look like that.” (I suppose I preferred my seat-cushion-like upper arms to be filled with Vanilla Oreos and Cookies and Cream ice cream…)

ALSO, as long as I’m revealing what a terrible person I am… you know the actress who plays Claire on House of Cards? I was always judgy about her neck–like, her neck looks like she’s had a tracheotomy…. well, guess what, guys? My neck doesn’t have extra skin hanging off it; instead, every tendon is visible and I have the crater at the base of my neck like she does. (Now if you see me all you’ll focus on is that crater, right? LOL LOL LOL).

I’m no longer a church going person, but I can still throw Scripture at the wall and see if it sticks: “You reap what you sow.”  I totally consider the stuff on my body that is cringe-worthy to be karmaic justice.

There are surgeries available to remove excess skin, after a person is about 18 months out from their bariatric surgery. However, I will not be one of those people. The nausea, vomiting, failures of my I.V. that necessitated 2 more I.V.s than I should have had, and general unpleasantries I went through because I had a bad reaction to the anesthesia, all kept me in the hospital an extra day. I will not be having surgery again unless I am dying. Plus, I’m fortunate in that I did not have more than 100 pounds to lose, so I don’t have the amount of extra skin that others have. I hope those who want the surgery can have it done. But I’m not going to pursue that.

I go back to work next week; school is starting again, and I am aware that I have a drastic change to my outer appearance. I expect comments and questions about how I lost as much weight as I’ve lost, how much I’ve lost, etc., and I don’t mind curiosity–to a point. But I’m not going to tell people all the stuff I wrote above in terms of what feels like justifying my decision to have 85% of my stomach removed and commit myself to lifestyle changes that are permanent, as well as following rules so that I don’t regain lost weight.

Instead, I’m going to borrow a line from an author friend of mine who lost a lot of weight and when I asked her how she did it, she said, “Hard work.”
This is hard work. Weight loss is hard work, no matter how it happens. I’m not just sitting around doing nothing while weight falls off. I’m doing what I need to do to stay healthy while it’s happening and to make it happen, and I’m choosing behaviors that are in sync with weight loss. There are people who have this surgery and end up in the hospital because they are dehydrated, or they don’t eat enough protein and/or they don’t take their vitamins and become malnourished. The first few times I went to my bariatric surgeon after the procedure, the first question I was asked was, “Have you had to go to the E.R.?”

I suppose there are people who choose to do as little as possible and sabotage themselves by gaming the system, testing the boundaries of what is recommended in order to make best use of the “tool” of a smaller stomach. In the first orientation meeting I went to, there was a woman who was literally WEEPING because she would have to give up Dr. Pepper. At that time, I thought, “Woman, no one is holding a gun to your head forcing you to have this surgery, so if that’s something you don’t think you can change, don’t do it to yourself.”

The skinny banana-sized stomach left after surgery is not a panacea. It’s a tool, and tools can be misused. If I want to drink chocolate-peanut butter milkshakes all day, I could, but I won’t feel good, and I’ll gain weight, my hip pain will increase, I’ll be sleeping with a CPAP mask on again, and I guess I’ll be naked because I’ve been giving my too-big clothes to Goodwill and women’s shelters as I’ve gotten smaller.

I don’t know if my friend (who said “hard work” was the way she lost weight) had surgery or not, and it does not matter. What does matter, in as much as it comes across as patronizing, is the statement/belief that bariatric surgery is the easy way out. If you really think about it, that’s a shitty thing to say. It’s making assumptions that the person saying it is utterly unqualified to make, and it also implies that because the person is overweight, they are “less than.” Or that they should continue struggling against something that has not worked for them on their own.

Sometimes people cannot wait to share horror stories about people who did not do well following the procedure–which is also another thing that pops up on the forums–or I get tales of people who went back to their old eating patterns and regained weight.
What, exactly, are people who have not had problems with the surgery supposed to say to those, other than, “I’m so sorry”? What is the motivation for telling people about that?

I made a choice that affects me for the rest of my life. It is hard work to make the “tool” of a smaller stomach work.  Plus–and this is one of those times when a curse can be a blessing– I am obsessive-compulsive, I crave order and patterns of “being” since I had no order or established routines when I was a child, and I’m a teacher. I’m a rule-follower. I’m also stubborn as shit when I make up my mind. Once that switch flips and I choose to stay aware of what I’m doing instead of going on auto-pilot like I did when I relapsed, I’m where I need to be to reach my goals–and that’s any goal I set for myself, from following sleeve rules to writing a book.

Here’s some examples of how I live my life differently now– and this is not a list of “woe is me” at all; rather, it is evidence that this is not the “easy way out.” It is a choice to make changes and follow “rules”:

1. I take vitamins and supplements twice a day to keep from being malnourished.
2. Along with everything I eat, I also track my fluid consumption- I have to have at least 64 oz. of water/liquids a day.
3. I track my protein consumption- I have to have at least 60-80 grams of protein a day.
4. I eat no more than 1/2 cup of food at a time, and I always eat protein first then see if I have room for other food. (But after I’ve met my protein intake, I do eat stuff like salad, cooked vegetables, & fruit, too, between meals, etc.) I also have learned to wait while eating so that my food has a chance to go down before adding more.
5. I plan out what I am going to eat in advance–this was something I did when I lost weight before. And I don’t mean that I figure out everything I’m going to eat from moment to moment; I cook ahead and plan so that I am assured I have food available that is what I can eat. I put it in small containers so that it is already in the amount I can eat, too. I eat between 900-1000 calories a day.
6. I am religious about exercise in the way I was when I lost weight before. It makes me feel better, I write while I’m on the recumbent bike, and I love feeling my muscles.

So: I’m taking my vitamins, tracking what I eat, eating less, providing myself with healthy options, and exercising more, which is the “formula” for weight loss. How is what I do the “easy way out”? It’s not. It’s hard work.