Question: Have I considered gastric bypass?

June 3, 2009

Question: Have I considered gastric bypass?

This comment came in from Olivia yesterday:

i am a new reader to this blog and i am just wondering if you have ever considered getting gastric bypass. i am over 400 as well and i am 18 years old but anyway i dont know if you have posted about this topic. just asking!

Depends on the definition of “consider”.

I’ve had it recommended to me. I’ve read about how it works: usually the stomach is made smaller and the small intestine is shortened, which means you eat less and you absorb fewer nutrients from your food. I also know people who have chosen to get gastric bypass or a lap-band for various reasons, including to get rid of diabetes (temporarily or permanently)..

What initially stopped me from going to an “information session” or otherwise pursuing surgery was concern over the side affects: vitamin deficiences, hernias, incision leaks, hair loss, and so forth. I found the possible B vitamin deficiencies especially scary.

I also remember the phen-fen combination. It was tempting, too. But I was concerned about studies showing short-term memory loss as a side effect. I realized that I have a happy life as a fat woman. Screwing up my short-term memory would destroy my life – and thus made me too fearful of phen-fen to consider trying it.

Ah, you think, but what about my health? Well, what about it? The surgery is supposed to address:

Type 2 (insulin-resistant / adult-onset) diabetes
High blood pressure
High blood cholesterol
Gastroesophageal reflux disease (GERD)
Obstructive sleep apnea

The only one of those I have is sleep apnea. So does my thin father. It runs in families. Studies show weight loss doesn’t always cure it long-term; in my particular case, my sleep doctor does not think weight loss would “fix” it in me.

So what would be the possible benefit to surgery? Losing weight, aka, being less fat. Probably not thin. Just less fat.

Then add in: Two years ago I was diagnosed with a vitamin B12 absorption problem. I already don’t absorb enough of this critical nutrient from food—which exposes me to the risk of anemia, balance problems, depression, and dementia. Note gastric bypass often causes this problem that I already have. Gee, think it might make it worse?

But the other reason is this: Yes, I’m fat. I didn’t get that way overnight. I’m used to it. I live a happy life anyway. Why should I risk death, dementia and health complications for what would be cosmetic surgery—especially since I have no reason to assume I’ll keep the weight off? It just doesn’t make sense to me.

Update: It has been shown that patients with diabetes see improvement in fasting glucose and A1C tests after gastic bypass, however, glucose tolerance tests and continuous glucose monitoring demonstrates they’re still having diabetic-level glucose spikes after eating.

Nov 2012 update: Long-term study found

Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration.

More at NY Times and NIH.

Oct 2013 update: Heidi wrote about her six-year anniversary of her gastric bypass recently; she has maintained her “new” weight of 350 for many years now. (Warning: discusses eating disorders, purging, side effects of WLS, and includes NSFW before and after images.)

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Living 400lbs

I blog about what it’s like to be live life at about 400lbs. :)

49 responses to “Question: Have I considered gastric bypass?”

Noodles

June 4, 2009 at 2:31 am

Great reply. I understand some people who have had this surgery believe it’s a godsend, in as much as they get to have a different body, ranging from thin to just less heavy but still obese. I have no reason to disbelive them, but my impression is that a lot of their satisfaction comes from not being “the fat one” anymore, or at least “a fatty who did something” . I don’t even begrudge that. It takes a lot of courage to accept your body and accept being fat in a society that can be so harsh.

But here’s the thing, like you mentioned with Phen-Fen, I think the jury is way out on this surgery. I want to see some real long term studies. How much weight is on average lost…. and not just in the year following the operation but 5 years and 10 years out. I understand a lot can come back. Is that worth carving up your body and the associated risks?

My gut instinct is that in 20 years, we will be viewing this surgery the same way we view leeching.

Love your blog, BTW, and thanks for sharing and being so honest.

Reply
JoGeek

June 4, 2009 at 3:14 am

Please, please refer the reader to First Do No Harm http://fathealth.wordpress.com/ to read the first hand accounts of WLS. I have never met anyone who, 5 years after WLS (if they survived at all) were happy with the decision, but I’ve met many who both re-gained ALL their weight and were doomed to a lifetime of gastrointestinal and nutritional problems, a long list of foods that make them terribly sick, brittle bones, low energy and hosts of other health issues. I’m death fat myself but I’m very glad I never considered this gruesome procedure.

Reply
1. living400lbs
  
  June 4, 2009 at 7:07 am
  
  First Do No Harm is on the sidebar under “Healthcare Resources” but your pointer is appreciated :)
  
  Reply
RoseCampion

June 4, 2009 at 4:35 am

I’ve often wondered how the various forms of stomach amputation are supposed to fix GERD. From what I’ve read, it seems like it would make it worse and that the lap band in particular, can cause stuff to wash back up the esophagus. It just looks like something that can make what’s bad even worse, you know?

Of that list, GERD is the only thing I suffer from. But then, so does my very thin father. What makes it better is remembering to cut down on the sugary things. Those are my biggest trigger. And remembering to take my drugs.

Reply
1. living400lbs
  
  June 4, 2009 at 7:08 am
  
  Does GERD tend to run in families? I know Sleep Apnea does. Of course, so does diabetes.
  
  (I’m still waiting on more evidence that weight-loss surgery really fixes the things on that list, which is why I used the word “supposed”, but … )
  
  Reply
  1. Brigid
    
    June 4, 2009 at 3:05 pm
    
    I have GERD and so does one of my brothers. I think my father might as well, although not as badly as we do.
    
    My dad, both my brothers, and I all have Sleep Apnea. My dad is thin, one brother is thin, the other is muscular but not fat, and I’m fat. We’re all different sizes, and we all stop breathing while asleep. Fun times!
    
    Reply
bigliberty

June 4, 2009 at 5:10 am

I’m over 300, and on that list I suffer from — nothing.

And your line “Why should I risk death, dementia and health complications for what would be cosmetic surgery—especially since I have no reason to assume I’ll keep the weight off? It just doesn’t make sense to me.” is beautiful. It doesn’t make sense to you because it doesn’t make sense.

For the vast majority of people (regardless of what their docs say), it is a cosmetic surgery, and a dangerous, life-threatening, nearly-always health-endangering, surgery, at that.

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spoonfork38

June 4, 2009 at 5:14 am

I know this isn’t exactly the topic at hand, but what you’ve been saying all along about your sleep apnea finally clicked with me.

According to my husband, I’ve been snoring loudly for about six months. I stopped dieting almost a year ago, and he thinks my subsequent weight gain is responsible for my snoring (though, to his credit, he only suggested a different pillow). He admits to being worried about my snoring because his brother has bad sleep apnea—a condition my husband and mother-in-law also believe is related to his weight (my BIL is a throwback to the tall, broad, heavy men a few generations back in his mother’s family).

Now, my husband weighs about 150 and snores and has these sort of moaning breathing hitches that scare me to death. My FIL, who was of the same build as my huband, used to rattle the windows when he slept—I seriously thought it was someone mowing their lawn at midnight the first time we stayed with them.

My father, who is maybe 160, is a window rattler, and his mother snored as well (though in a more lady-like way).

So why would my BIL’s apnea and my snoring be due to our weight, while the rest of the family ‘inherited’ theirs?

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1. living400lbs
  
  June 4, 2009 at 7:12 am
  
  I’m told that weight can affect sleep apnea in a biomechanical sense—if your chest muscles aren’t strong enough to deal with added sleeping weight. I’ve seen some studies that weight loss can reduce sleep apnea, but I also wonder if weight training would help too ;)
  
  That said, it certainly can and does affect thin people too. If your husband stops breathing during the night he could probably benefit from a sleep study.
  
  Reply
  1. spoonfork38
    
    June 4, 2009 at 2:08 pm
    
    Well, we’ll see if weight training helps me—and my husband, too, since I’ll probably need all my muscle to get him to see someone about this. . . .
    
    Reply
    1. living400lbs
      
      June 5, 2009 at 9:15 am
      
      :) A cpap machine is basically a fan with a nosemask to keep your airway open, and is 100% effective for those who adapt to sleeping with it. There are other options too..
      
      Before the cpap the treatment for severe sleep apnea was a Tracheostomy – personally I’d MUCH rather have a cpap!
      
      Reply
      1. spoonfork38
        
        June 9, 2009 at 5:24 am
        
        Um . . . yeah!
        
        Reply
Bree

June 4, 2009 at 5:44 am

I have never had WLS recommended to me, but like you, the possible side effects sounded worse than the surgery. And especially since I have severe anemia, a possible B12 deficiency (both inherited from my mom), and IBS, which I control with lactulose, I know these things have a very high chance of getting worse with WLS.

WLS used to be a last resort for those whose weight actually was causing health problems. Now, it’s marketed as cosmetic surgery, the risks swept under the rug by doctors who encourage it, touted as the miracle cure, and foisted upon anyone who’s carrying extra body tissue, even if they’re not medically defined as obese or deathfat.

This is not a risk I’m willing to take.

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brahnamin

June 4, 2009 at 8:11 am

Last year I was looking for a new doctor and thought I had when I found one close to my home who was actually taking patients.

So I set up an appointment and went to see the guy to get a check up and keep tabs on the progression of my diabetes and blood pressure problems.

The first question – the bloody first question – this guy asks me is if I’ve ever considered lap band or gastric bypass surgery. WTF? No, “What have you done so far to address your weight issue as it relates to diabetes?” No questions about anything I may have tried or what my current exercise and eating regimen was. Just, have you considered lap band or gastric bypass surgery?

What is it with these guys? Are they on commission? Needless to say the man is not my physician.

In point of fact, I have looked into both procedures (because my wife was bound and determined to have one of them done), and the results of my investigation left me profoundly horrified.

The only “success” stories I found were testimonials on medical websites.

Every real personal not-out-to-support-the-medical-industry story was fraught with pain, complications, sickness, and disappointment.

Excellent post. Excellent answer.

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1. living400lbs
  
  June 8, 2009 at 12:10 am
  
  As noted below, I know a couple people (in real life) who are very pleased with the surgeries they’ve had, lap band and bypass. Part of what I find maddening is that the ARNP who recommended weight-loss surgery to me is the one who missed my vitamin b12 deficiency. Because of course weight loss will fix anything that a fat person has. *headdesk*
  
  Reply
QuiltLuvr

June 4, 2009 at 8:39 am

Even though I have been in FA for a long time, I did seriously consider WLS. I rejected the idea (both the banding and roux-en-Y) because:

1. The side effects are awful
2. The risk of death is way too high
3. The weight loss is mostly not permanent

Through one of the social/dance/groups, I am acquainted with about 200 people who have had the surgery. I know of just one who seems okay and has kept off the weight – not encouraging odds.

Then a friend who had the surgery 30 years ago died because her stomach became paralyzed. She was 5 years younger than me. Yikes!

That did it. I love living; I love my grandchild. No WLS for me, no way.

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Anastasia Beaverhausen

June 4, 2009 at 9:58 am

I had the gastric banding procedure 3 months ago, and would not change a thing. I think that if you are not interested in the procedure, then it is not for you. The biggest key to success is the approach of the physicians office. If they do not require counseling pre and post op, as well as have the patient committ to the new life-style prior to surgery it is doomed to fail.

A friend of my husbands had bypass, and has lost 90lbs in one year. He was barely 100lbs “overweight’ and they performed the surgery on him without any of the hoops that I had jumped through prior to surgery. He gained all this weght in a short period of time, and wanted a quick fix.

This surgery is not a quick fix, rather a diet tool, and I would not recommend it to anyone who has not tried any other way to lose the weight. After years of dieting and working out, only to keep gaining weight, I made the decision to help me. My goal is not to be a size 2, but I was 427lbs on my 30th birthday, and I was no longer comfortable in my own skin. I have always been an active, healthy fat girl, but I was crushed when I found out that my husband and I would not be able to get pregnant until I lost around 50-75lbs. (Too much pressure on my uterus to sustain a viable pregnancy.) This was the last straw in my decision to have the procedure. This was the first time I really had my weight prevent me from doing anything.

I think that this is a great blog, and continue to enjoy your posts. :)

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Bilt4Cmfrt

June 4, 2009 at 10:03 am

Great answer! Level headed, reasoned, through. Many, MANY people within F/A find WLS and the institutions that promote it to be morally bankrupt. When one considers the amount of information that ISN’T given to prospective applicants then the whole thing starts looking like criminal negligence. Yet it strikes me that you don’t often get this kind of reasoned response on the other side of the WLS fence when someone suggest NOT having it.

And your right. For a lot of people, what WLS amounts to is cosmetic surgery. What they fail to consider is that it’s also EXPERIMENTAL surgery. They’ve been doing this for close to 25 years now (back then it was stomach stapling) and they’re STILL not sure what it’s long term effects are. Some of those effects are, only NOW, coming to light. So the real question for people without dire health issues is; Do you really want to be the equivalent of a Cosmetics Industry Test Rabbit for the sake of being thin?

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Risha

June 4, 2009 at 10:35 am

I’ve never had a doctor suggest gastric bypass to me, and while I do get the semi-frequent suggestion that I should get more exercise (which is absolutely true), my PCP has never said much to me about my weight. I did have one specialist I saw one time for a (non-weight-related) consultation try to tell me all about a liquid diet inpatient program through the hospital – but he had only just gotten out of it himself a couple of weeks before, so I just chalked it up as the enthusiasm of the newly converted and ignored him.

From that list, I have high blood pressure and sleep apnea. I do believe that losing some weight might help them, as both have gotten worse as I’ve gained some weight over the years, but I doubt that they’d be eliminated altogether. High blood pressure runs in my family, and my thin and athletic father had some of the most terrible sleep apnea I’ve ever heard of (and rarely got more than three hours of sleep at a time!). But even if I believed that they would be completely eliminated, I would a thousand times prefer to have to take a pill a day and use my CPAP machine then deal with major surgery and the permanent side effects. I felt that way even before I found FA and read up on the topic, so I’ve never seriously considered it.

I will say that there’s one FA blogger who got it last year that I wholeheartedly agree needed it – she was quite literally eating herself to death. That’s the sort of shockingly urgent situation that gastric bypass should be reserved for, and even then, it shouldn’t be treated as anything but a desperate attempt to keep someone alive, like amputating a limb.

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Stef

June 4, 2009 at 3:18 pm

* Type 2 (adult-onset) diabetes
* High blood pressure
* High blood cholesterol
* Gastroesophageal reflux disease (GERD)
* Obstructive sleep apnea

I have all of these besides GERD, and like brahnamin, I’ve been subjected to doctors whose first words on seeing me are “OMG get weight loss surgery!!!!”

I choose not to get WLS for three reasons:

1. There isn’t much known about the long-term effects. Elderly people are more likely to suffer nutritional deficiencies as their digestive systems become less efficient. What does that mean for elderly people who have had WLS? I’d rather not take that risk.

2. In contrast, a great deal is known about treating type 2 diabetes, high BP, high lipids, sleep apnea, etc. Those are conditions that affect many/most thin people, especially as they age, and the baby boom is fueling a great deal of research into treating those conditions. As someone at the tail end of the Baby Boom, I am benefitting from this research. All of those conditions can be treated with medications or machines. If a medication or a machine doesn’t work, I can stop using it. That isn’t true of an operation that mutilates my digestive system.

3. I don’t think my sanity would survive the extreme intake restrictions required of people who get WLS. If I could permanently keep weight off by eating only a few teaspoons of food a day, I would have done that already.

Reply
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June 4, 2009 at 4:53 pm

[…] Question: Have I considered gastric bypass? This comment came in from Olivia yesterday: i am a new reader to this blog and i am just wondering if you have ever […] […]

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olivia

June 4, 2009 at 5:44 pm

wow i’ve never thought of it like that “being less fat” but not thin. i have 3 co morbidities and i think i will eventually get the surgery but now i have somethings to think about!
thanks!

Reply
1. living400lbs
  
  June 4, 2009 at 5:59 pm
  
  Glad you liked it. You may find Stef’s comment helpful too.
  
  Reply
randomquorum

June 4, 2009 at 6:23 pm

Something that I found really interesting and posted about a while ago (which I read on Wikipedia) is this:

The effectiveness of gastric bypass surgery in type 2 remission was long thought to be due to weight loss. When it was discovered that rats whose duodenum and upper lower intestine were removed also showed the type 2 remission effect, and when this was also observed in humans, the suspicion arose that some signal originating in the excised tissue was responsible for the development or maintenance of type 2’s insulin resistance. When that signal is removed, body cells revert to normal behavior and lose their insulin insensitivity. As of Q1 2008, the nature of the speculative signal is unclear, though there is near universal suspicion that it is chemical and present in very small quantities (eg, like hormones). Research is actively pursuing the mechanism of action.

So basically it now looks like the “WLS cures diabetes” thing has nothing to do with the actual weight loss, but something to do with the part of the stomach that gets removed – which also suggests to me that type 2 diabetes is not CAUSED by being fat – seems more likely that being fat is a symptom to me!

Reply
1. living400lbs
  
  June 5, 2009 at 5:19 pm
  
  I accompanied a friend to a hospital diabetes education class recently and they emphasized that diabetes is genetic. One student said, “But then why is the US rate of diabetes so much higher than undeveloped countries?” The nurse replied, “My immigrant clients will start off telling me they have no relatives with diabetes. After they learn more about the disease, they ask if maybe their parent/grandparent/aunt/uncle who went blind and died in their 50s might have had diabetes. Yes, they might. I ask if their relative ever went to a doctor? No.”
  
  Kinda makes you think about comparing the incidence of disease between countries with modern health care and counties that don’t.
  
  More on genetics of diabetes here.
  
  Reply
Regina T

June 4, 2009 at 9:26 pm

“I realized that I have a happy life as a fat woman. ”

This is where I am struggling these days. I am not a happy fat woman. Even with all the fat acceptance I have learned, I am still struggling right here. And trying not to allow myself to feel as if I would be betraying the movement if I chose to have the Lap band (which would be the only WLS I would consider most safe….AND I have been to an information session btw)

I have wholeheartedly accepted, and continue to fully understand and make real Fat Acceptance in my life and the lives of all others. I no longer compare my body to another’s, I stop all forms of critcism/staring/shame that attempts to derail my new way of thinking, and I share my thoughts with others freely and without fear of what others may think.

My problem of late is this: My body is miserable. Albeit the creeping in of age, or the toll my size has taken on my body, I cannot deny that I am physically miserable. Especially with the latest heat wave here in Seattle….I am feeling every ache and pain, and the amount of energy it takes for me to move about is growing and leaving me breathless and worn out.

I know Gastric Bypass is not for me. I do not believe surgically altering your body’s ability to absorb nutrients AND digest them is a solution that would result in better health. Sure, the weight would be down, but to what end? The risks far outweigh the benefits, in my opinion.

I do, however believe the LAP band may be a TOOL that I can actually use, with minimal risk to my health. The hiatal hernia I have would actually be resolved for me since the hernia portion would be sewn around the band on one side, thus elimination it’s detriment to my health and especially the reflux. If it were just as easy as “eating the way someone who has had they surgery eats” then I would be well on my way to a better weight. But it’s not. My larger stomach is hungry. If it were smaller, I would feel less hunger. I see the benefit in not actually being ABLE to eat more, yet still have the ability to absorb and digest nutrients,medicine, etc.

To be completely honest, I am not just miserable, it is becoming increasingly difficult to “do the basics” because of the size of my stomach. I don’t care to walk the fashion runways, be viewed as attractive (whatever that is), or run a marathon. I just want to be able to do the basics without pain, strain, and fear of hurting myself. I have gone far beyond vanity, looks or cosmetics at this point. I just want a better way of living.

Reply
1. living400lbs
  
  June 4, 2009 at 10:12 pm
  
  *hugs*
  
  I know a couple people who are very happy with the lap-band, and yes, the adjustable stomach size makes a huge difference. One had it done at Evergreen, if that helps, and is very pleased. I also think the band’s ability for adjustments is helpful in other ways – another gal I know with a lap band had her OB recommend getting it loosened during her pregnancy. Her orthopedist also recommended she get it loosened leading up to her knee replacement so her body could build up reserves for the surgery.
  
  The heat has been getting to me too (it’s cooled off tonight, yay). And OMG the pollen! And when my asthma was bad enough I got out of breath just sitting at my desk, I stopped exercising. I had been up to 20 minutes on the treadmill as “okay” … tonight I finally got on the treadmilll again. At the gym, with a friend on the next one. I did 20 minutes on the treadmill, and I barely got up to 2 miles an hour and I was panting and sweaty and my friend was walking faster than me and not sweaty or really breathing hard at all. But … I also remember when I had trouble doing 5 minutes on the treadmill, and bad knee pain, and I fixed it, mostly by strengthening my muscles. Weight didn’t matter—strength did.
  
  It also helps that I’ve been through the “start working out, improve speed/strength/endurance, stop working out, return to less speed/strength/endurance” cycle enough that:
  
  1) I believe I can do it again, and
  2) I don’t see it as being about weight, but about moving my body and lifting heavy things that I make heavier on purpose.
  
  But, that’s me, and I’m not you. *hugs*
  
  Reply
  1. Regina T
    
    June 5, 2009 at 9:17 pm
    
    Okay….I am slowly coming down off the watchtower, so to speak. I re-read what you wrote about your recent knee problems and the effect of pollen on your breathing. Looking back, I realize that I have been so focused on planning my daughter’s recent wedding (she got married May 22nd) that I did not have the time or even the ability some days to do what I “normally” do….things like walks, working in the yard, planning meals, trying new recipes, yoga, and various other activities/self focus. I ate crappy, on the fly, and without much thought. I spent more time on the computer finalizing details and less time on just regular things that now seem more important than they did before.
    
    You’re right about strengthening. Absolutely right. Weak would be the best word to describe how I physically feel these days. That, paired with the ridiculous size of my ankles lately, and it’s the perfect recipe for my misery.
    
    Thanks for getting me to reflect. I think I’m going to try and return to my former way of life, so to speak and see how I respond. I hope you are breathing easier these days. Cool weather on the way this weekend. The breezes last night were so welcomed by me!
    
    Reply
    1. living400lbs
      
      June 8, 2009 at 12:15 am
      
      Glad you’re feeling a bit better mentally, and congratulations to you as mother of the bride! (Often also the wedding planner, bride’s therapist, and chief operations officer!)
      
      I do understand—I had a brief relapse of my knee problems in Feb—because I was so busy at work I wasn’t doing my strength exercises -or- walking. Now I’m not in pain usually, and I’m working on slowly increasing my strength and endurance.
      
      I hope you’re enjoying the 70F weather! :)
      
      Reply
2. Tiana
  
  June 5, 2009 at 2:22 am
  
  If it were smaller, I would feel less hunger.
  
  Is that actually true? I’ve been wondering that for ages. I mean, I thought the amount of hunger we feel was caused by how many nutrients we are currently missing, not by how empty our stomachs are. Could somebody please enlighten me?
  
  Reply
  1. brahnamin
    
    June 5, 2009 at 2:44 am
    
    Nutrient deficiencies do indeed cause hunger (which is why you are hungry again about an hour after eating a bunch of empty calories – once your body digests the bulk it realizes it didn’t really get anything).
    
    That said, the more bulk you have the more nutrients you will need. That is only one component, of course. Growth spurts require more nutrients, bodies recovering from injury require more nutrients, etc.
    
    Long story short, the more work your body has to do the more nutrients it requires. The more physical mass you have to maintain, the more nutrients you will need.
    
    But no, an empty stomach does not necessarily trigger the hunger response. Conversely, a full stomach will never trigger a hunger response (provided you don’t have that weird disease I saw on CSI where you’re always hungry from never getting the *full* signal). That comes after digestion and, as you suggest, is based on what the body decides it needs at that point.
    
    Lap Band and Gastric Bypass restrict the amount of food you are physically capable of eating (though eating more than you should over a period of time can stretch the stomach right back out) and the procedure requires taking supplements along with certain medications to keep your system on track.
    
    Reply
    1. Tiana
      
      June 5, 2009 at 7:44 pm
      
      Hmm, that makes sense.
      
      I do have to say that I sometimes feel hungry and full at the same time, though … but that’s from not getting enough food; I doubt I have any weird CSI diseases. ;)
      
      Reply
  2. living400lbs
    
    June 5, 2009 at 9:40 am
    
    I’m not sure. It may make you MORE hungry to be thinner, at least, a LOT thinner. There’s research indicating that when a fat person becomes thin, their bodies react more like a starved person than a thin person.
    Specifically:
    
    [S]ince this was a research study, the investigators were also measuring metabolic changes, psychiatric conditions, body temperature and pulse. And that led them to a surprising conclusion: fat people who lost large amounts of weight might look like someone who was never fat, but they were very different. In fact, by every metabolic measurement, they seemed like people who were starving.
    
    Before the diet began, the fat subjects’ metabolism was normal — the number of calories burned per square meter of body surface was no different from that of people who had never been fat. But when they lost weight, they were burning as much as 24 percent fewer calories per square meter of their surface area than the calories consumed by those who were naturally thin.
    
    The Rockefeller subjects also had a psychiatric syndrome, called semi-starvation neurosis, which had been noticed before in people of normal weight who had been starved. They dreamed of food, they fantasized about food or about breaking their diet. They were anxious and depressed; some had thoughts of suicide. They secreted food in their rooms. And they binged.
    
    The Rockefeller researchers explained their observations in one of their papers: “It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved nonobese individuals.”
    
    So if a significantly fat person becomes thin, they might be MORE hungry, MORE anxious, and so forth. What the lap-band does is LIMIT the amount of food you can eat, so that you HAVE to stick to the diet.
    
    Reply
    1. Regina T
      
      June 5, 2009 at 12:30 pm
      
      Thanks for this clarification. I think I misspoke about not feeling less hungry. Having dieted many times during my life, I can tell you with absolute certainty that I will be hungry. I am especially ravenous in the beginnings of dieting and during increases in my exercising. I. AM. HUNGRY. It is so strong, that I dream of food, become cranky, lethargic, and have specific tastes appear in my mouth during the hardest parts of my hunger stage. This is also often the point in which my diet fails. The feelings of hunger are that strong.
      
      My only consideration for using the LAP band is that it will physically be impossible for me to ingest more food in one sitting, thus buying me time to regain control of my mental state overwhelmed by hunger. Small meals that semi-satiate me will have to suffice until my body gets used to the decrease in the amount of food I eat.
      
      I know this will be difficult. Believe me, I know. I am still in the figuring-out stage of this, but truly do feel I need change to occur for me physically to help me be a happy fat lady.
      
      Thanks for your insight and hugs :)
      
      Reply
Patsy Nevins

June 5, 2009 at 2:44 am

That statement also shows an acceptance of the popular wisdom that fat people are fat because they eat ‘too much’ & having a stomach too small to eat much must result in a lot of weight loss, while the truth is that the amount of food a person eats has at best a tenuous relationship to his/her body size & one cannot tell a thing about a person’s food intake by body size. I wish you all well & I keep hoping that the majority of people will realize how unhealthy & horrific this mutilation is & that it is not a ‘cure’ for anything, but it is a good way to suffer a lot more pain & malnutrition, to need more surgeries, &, oh, yes, to die younger than is necessary. And, yes, I am speaking here as a woman who only weighs around 200 pounds, but I am also disabled, approaching 60, & dealing with the changes aging brings, chronic pain, & the knowledge that I will lose more mobility with age, & as well as the ironic truth that a good part of my chronic pain & joint deterioration is caused by the fact that, all my life, I have exercised TOO Much…enough to cause joint deterioration & pain in someone who started out able-bodied & surely enough to do so to someone born with cerebral palsy. I am still staying active, but trying to be more sane than I have been…several periods of exercising 3-4 hours daily for 3-4 years at a time, three years of lifting weights for an hour or more daily with my son when he was in high school, wearing out an exercise bike & another exercise machine, after putting more than 3500 miles on each one, years of trying to do modified pushups (arm & shoulder pain anyone?), doing 1000-1500 stomach crunches daily, & the fact that I have walked, aside from things like housework & shopping & general daily life, over 50,000 miles in my life. Yes, my body is aging & I am having pain a lot of the time & having more difficulty doing a lot of things (which I can perhaps deal with more comfortably than those who start out able-bodied, since I have NEVER been able to do a lot of things & other ordinary things have always been very difficult for me), but losing weight would not change that & much of what I am experiencing is caused not just by the passage of time, but the things I HAVE done to try to ‘mold’ or ‘control’ my body. I come from a long line of fat people who have lived well into their 80’s & 90’s & no one is mutilating my body for any surgery not needed to save my life, nor will my chronic pain convince me ever to diet again, since dieting is also harmful to health & becomes moreso with age, enough so that by the time a person reaches my age, weight loss increases mortality risks.

Being fat is not unnatural, it is not a disease, it is not a failure, it is a natural, genetic variation in body size & shape, as well as, in the case of increased weight, both a function of aging & hormones & a side effect of attempts to lose weight. Maybe I should not have an opinion, since it is doubtful that anyone would try to force WLS on me, but I really believe that WLS causes many more problems than it solves, it kills a lot of people, & it breaks my heart that so many people see it is as some kind of ‘solution’ or something which they should risk because they have committed the ‘sin’ of being very fat.

Reply
1. justagirl
  
  June 5, 2009 at 3:04 pm
  
  Well, I will be hated for my opinions…but I am in the process of having WLS. I have researched this for about a year now and I know several people who have had it, one had it almost 10 years ago and has had babies and done wonderfully. Sure, it is a lifetime committment to taking vitamins and changing the way you eat…but right now I take 12 pills in the morning and another 5 at night…all for weight related issues. So whats the difference? I would rather take vitamins than drugs with horrible side effects that I am taking now. I don’t know anyone who has put the weight back on. And as far as complications, my husband is an ICU nurse who takes care of WLS patients (they all HAVE to spend the first night in ICU as required by our hospital here) and has never had any complications or seen a patient be sent back to ICU as a result of the surgery.
  I have also attended support group meetings for the last year and out of all those meetings, I have only met one girl who had a complication which they were going back in to fix.
  I have ALL of those :
  Type 2 (adult-onset) diabetes
  High blood pressure
  High blood cholesterol
  Gastroesophageal reflux disease (GERD)
  Obstructive sleep apnea
  
  Plus more things that will go away when I have the surgery. If anything, just getting rid of my diabetes will add years onto my life. Am I willing to go under surgery to add years to my life? you bet! Is it risky? Sure…but theres a greater risk that you will die in a car accident. As far as some people saying its cosmetic? I don’t believe that for a minute. Have you seen people with big skin folds? They obviously weren’t going into surgery thinking they would come out looking like Barbie. This is a life saving surgery for me. My diabetes is so bad and other problems that I can’t even walk up the stairs in my house without feeling like I can’t breathe when I get to the top. My joint pain is so bad, I can’t exercise. This is going to save my life and give me that boost I need to loose weight and be around for my kids.
  
  Reply
  1. living400lbs
    
    June 5, 2009 at 11:31 pm
    
    As far as some people saying its cosmetic? I don’t believe that for a minute.
    
    To be clear, the reason I stated that WLS would be cosmetic FOR ME is because it would NOT address any of my health issues—in fact it could easily make them worse.
    
    My current health issues are:
    
    1) Allergies/Asthma—working on getting this under control.
    2) B12 absorption problem—currently controlled by taking 4000 iu daily.
    3) Sleep apnea—Controlled by cpap. The sleep doc’s opinion (based on my airway and family history) is that losing weight won’t help.
    
    Have I ever been tired and out of breath walking upstairs? Yes. Getting my asthma under better control and getting diagnosed and treated for my B12 deficiency changed that for me.
    
    Have I ever been in constant pain and worried I wouldn’t be able to walk? Yes. Physical therapy – which involved hundreds of leg lifts and other exercises – changed that for me.
    
    I realize that you have different issues. The best argument I’ve seen for weight loss surgery is something randomquorum already mentioned, that removing the section of the stomach and small intestine typically removed in gastric bypass can put diabetic rats into remission. That would be a benefit—for you.
    
    But for me? It wouldn’t fix any of my health problems. It could make my B12 deficiency worse and perhaps open the door to more deficiencies. It would open the door to semi-starvation neurosis. And it would make me less fat. It is a totally optional surgery for me, and I don’t see being thinner as a big enough reason.
    
    Reply
  2. Dagny
    
    June 8, 2009 at 10:32 am
    
    I blogged about my WLS experience for about three years. I started a webring that grew to over 40 members, all of whom had gastric bypass or duodenal switch and a very few with lap band. Of those women, one had severe complications. One had serious emotional issues, rooted in lifelong addiction problems (pre-op psych testing should have screened her out). One developed a host of conditions that may or may not be exacerbated by her WLS. The rest found varying degrees of success, for the most part everybody did really quite well, finding the highs and lows and bumps in the road to change as the years went by.
    
    As much as many of you would like to bash it, the medical science behind WLS is really quite sound. I think it can be reasonably said that for a great percentage of WLS patients, post-op adjustments are largely social and personal. Many people see their relationships change dramatically. Some people find themselves having to re-evaluate their entire identity. It can be quite overwhelming. Not everyone likes everything about who they become and the same is true for the people who know them. I have found it much easier to make new friends than to try to re-connect on a different level with people from my past. That was completely unanticipated.
    
    Reply
    1. living400lbs
      
      June 8, 2009 at 1:01 pm
      
      As noted elsewhere, I have friends who have had gastric bypass or lap band varying success, and most are very happy with the operation. But when I weighed the risks against the one benefit I can reasonably expect (being less fat) I decided that it’s not worth it for me.
      
      Reply
      1. Dagny
        
        June 9, 2009 at 5:32 pm
        
        I have discussed WLS with MANY people and I am adamant about making sure they understand EVERYTHING about it. I try very hard to NOT be persuasive, rather I want to help people determine their own priorities, identify their primary decision issues, and arrive at whatever their choice will be. I know first-hand how deeply personal this has to be.
        
        I will say, however, that I think a lot of postings here are misrepresentative, anecdotal and largely influenced by personal bias and lack of current information.
        
        Reply
        
        living400lbs
        
        June 9, 2009 at 8:37 pm
        
        I mis-read when I replied to your comment and thought it was in reply to my post, not to JustAGirl’s comment.
        
        Reply
cynth

June 9, 2009 at 5:44 am

Three people in my family have had WLS.

One of them is now blind (surgery complications), though he lost a lot of weight the first 3 years he is now gaining and is nearly back to the size he was before the surgery.

One of them (now passed) lost a lot of weight and kept it off for about 8 years. Then started gaining even though he had dumping syndrome and spent the better part of each day in the bathroom or in bed. The surgery gave him what he would say is a better quality life (as being able to move more freely) for about 4 years but he was very sick the rest of his life. He developed heart problems and had to have back surgery, both of which he never really recovered from.

One of them lost about 80 pounds and kept it off for about 9 years. She is now back to nearly as heavy as she was before and has diabetes which she didn’t have before the surgery. She still has dumping syndrome and vitamin problems.

WLS is not the answer for everyone, it seems to be the answer for some for a while, and for a few it perhaps was the answer. I still don’t personally know anyone who after 10 years is still a cheer leader for WLS.

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Jerome

September 11, 2009 at 2:01 am

Hooray! Great post, fantastic blog. I’ve spent just about my entire night shift (I’m a nurse) reading your blog archives, and I can’t even begin to tell you what a wonderful resource you are providing and how inspiring you are. I’ve always thought that the risks of WLS far, far outweigh the benefits for most people, and it was nice to see that articulated so eloquently by someone who is fully and happily participating in their life as a fat person rather than subverting all of their mental energy into a diet doomed to fail. Please keep up the great work!

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Amanda

November 2, 2012 at 4:32 pm

I like reading everyone’s side of the WLS debate. I myself am 28 and had a sleu of the problems you mentioned- type 2 diabetes/insulin resistance, severe sleep apnea, high blood pressure, and pain in my neck/back/knees. So, I had gastric bypass on July 26th. It’s not for everyone, and hey, if you’re happy and healthy at the weight you are now, then more power to you. At 365 pounds, I was effing miserable, and had so many health related issues that I couldn’t exercise. To me, the surgery consequences outweighed positively the life I was living. I do admire your ability to be happy in your own skin and at your weight. I came across your blog when I was at a low point and needed someone advocating that you CAN be happy and over 300 pounds.

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