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Monday, April 28, 2014

I am not a cheater

Two months into my bariatric journey and I am already astounded by the number of people who need to punish and shame my nascent victory in favor of their own self-righteousness and misinformation.
Bariatric surgery is not a cosmetic, elective whim. One does not emerge instantly transformed as if from a day at the spa. It is not cheating. 
For nearly everyone involved,  bariatric surgery is a life-changing, life-long commitment to better health. For some of us it is a matter of life and death, for others it's a hard look at the quality of life inflicted by our co-morbidities. 
But issues with heart disease, hypertension, diabetes and asthma, you say,  are self-inflicted wounds brought on my gluttony and ignorance.  I have in total "lost" my highest body weight two times over. I can give you the calorie, carbohydrate and protein count of all common foods and an embarrassing number of esoteric items. 
I've spent enough on gym memberships and trainers over the last three decades to fund an advanced degree program from a private university. I can't recall the last time I ate a french fry or had a second helping of dessert. 
In most cases, obesity is not food addiction, but a disease recognized as such by the American Medical Society in 2013. My disease is a combination of genetic and psychological factors as well as not recognizing fast enough there is no comfort in comfort food.
I can't unring this bell alone. But I am neither weak nor stupid because I lack that capacity. According to the American Society for Metabolic and Bariatric Surgery these surgeries have increased 16-fold in the United States in the past 10 years as patients and professionals recognize better solutions to a growing public health issue. 
Yes, my decision is confusing for the "naturals" who can lose and keep weight off through diet and exercise alone. There are also people who can easily sing, dance or do calculus. I'm not one of them. 
Bariatric surgery, a Vertical Gastric Sleeve in my case,  is a treatment course that will fail without my full commitment.  It requires daily, life-long work.
Years of yo-yo dieting have battered my metabolism to the point that it is geared to require much more effort to lose much less than smaller scale or rookie dieters.  My surgery helped my body to reset to a workable metabolism.
A 2006 study in the "Annals of Surgery" showed the 10-year failure rate for the gastric bypass surgery is 20 percent of the morbidly obese and 35 percent for the super-obese. It provides the numbers to back up what every fatty like myself knows, the more you have to lose, the easier it comes back. 
But the study also shows that despite the weight return, 10-year mortality for the subjects remains a low 3 percent. This is why I, and likely most of my seriously scale-challenged brethren, have jumped through all variety of medical, insurance and interpersonal hoops to make surgery happen. 
My primary and specialty physicians all had to provide letters as to their belief that the surgery could and should result in a healthier me. A psychiatrist gave me a battery of tests to make sure my issues were not simply emotional and that I had the capacity to make my surgery work. 
I then had three months of dietician appointments and pre-surgery dieting to again demonstrate I had both the capacity and information to make the surgery work. Only at this point did my thick file go to my insurance company for review. Once my surgery was approved, there was a battery of further medical testing including an upper GI and EKG that could disqualify me for surgery in spite of everything that had gone before. 
At this point, I have graduated from liquids, to "squishies," to any food I choose. My stomach pouch will not prevent me from ingesting thousands of calories in one sitting if I so choose, but I carefully select menus that give me 600-800 calories daily with 80 grams of protein, 64 oz. of water and as little sugar and carbohydrate as possible.  I have become a master at eating low-fat, part-skim, string cheese by the string.
I know that I will always need to eat protein first and foremost, but will likely never tolerate dense proteins like steak. Carbonated beverages are off the list for life and my beloved New Zealand Sauvignon Blanc is benched until July - when in small quantities I will relearn my tolerances and weigh each 120 calorie glass against the other things I need to eat that day to stay on track. 
I will never be able to enjoy that glass of wine -- or any other beverage -- with my meal because I know I can't drink anything one half-hour prior to or post mealtime because it won't allow for the necessary absorption of protein and will leave me hungry for more food than I am allowed to eat. I am frankly struggling with unlearning 54 years of food-with-drink mealtime habit -- but I know the consequences of surrender. 
I am now 45 pounds down with 70 to go. I am not so noble as to say that being able to buy clothing from the "regular" size racks again is not a rush. But it's the three prescriptions I no longer have to take and the way that I can already crawl around on the floor with my grandson that fuel my commitment. 
My size did not prevent me from enjoying a wonderful career or the love and support of family and friends. But around the half-century point it struck me that the only resource we can't replenish is time. I am willing to very work hard to find better health and possibly a little more time.  
And I'm not cheating to do it. 
For more information on the myths of bariatric surgery go to the American Society for Metabolic and Bariatric Surgery misconceptions page. 

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