Saturday, February 18, 2012

Weight Loss Surgery (WLS)

Several years ago, I started reading a blog about food written by a particular woman. It had nothing to do with dieting or weight loss. She was writing reviews of various restaurants and snacks that she tried. As time went by, she stopped that blog and started another. The new one was about her life married to a man in her husband's particular profession (which is hardly rare, but relatively uncommon and wives with such husbands have unique challenges). I mention that I started reading her blogs with these topics because now she has changed to writing about having weight loss surgery. I generally do not read blogs about people who are having, have had or are contemplating WLS, but I already have a "relationship" with this writer and an interest in her life.

I've said before that I think people who have weight loss surgery are essentially putting a biological gun to their heads in order to lose weight. I still believe this is true. I also said that they are likely braver than me for having the courage not only to endure the pain of surgery, but also to force themselves into this position. That also remains true. However, I have changed my thinking about the value of such surgery as I've learned more and more that it can be an incredibly destructive force in some people's lives and a sizable number of people (somewhere in the vicinity of 1/3) end up regaining the weight they lose and more.

It seems likely that it  metabolically damages people in a manner which is more severe than extreme dieting (under 1000 calories). I once read someone say that they believed WLS would one day be considered as poor an answer to weight problems as extreme lobotomies were to mental illness. Yes, it can fix a problem, but it creates many others. People can die from WLS complications and their food issues are not fixed if they don't change their relationship with food forever as a result of that surgery. I continue to believe that psychology, not biology, is the main driving force in weight problems whether they be related to overeating or under-eating.

That is not to say that I believe some women do not ultimately benefit from WLS. Clearly, some adapt to the lifestyle change, never stretch their reduced size stomach and it becomes a catalyst for lifestyle changes that they couldn't manage pre-surgery. That being said, such adaptation would have been possible without surgery. The surgery just makes it harder to overeat initially because you vomit if you eat too much and feel full quickly. When you try to eat less without surgery, the only thing stopping you is hunger and psychological issues. Both of these are potent forces that are hard to ignore when you have the biological capacity to fully sate yourself. I don't underestimate the value of a biological stopper for people who can't find their way to eating less. However, the price to me has always seemed too high.

The woman whose blog I've followed through various permutations has presented me with a lot of personal challenge in terms of taxing my self-restraint. I have wanted to say, "don't do it, there is another way," but I realize that there may not be another way for her. I also know that everyone has to make their own choices and, yes, mistakes in life. I've been allowed to  make my own and have made plenty. I have refrained from commenting unless I can be honestly supportive in line with my views.

I wish her well, but I feel that the odds are stacked against her given that she has always been a much bigger consumer of junk food than I ever was (because I never ate that much of it). She eats out a lot. I believe that the binge before the restriction habit among people who are attempting to lose weight is always a bad sign and she went crazy the weeks before surgery and gained 17 lbs. before going on the pre-op diet that she had to endure. She eats poorly, and has already overeaten and thrown up several times with barely a week and a half of time between her and the surgery. I think that, while the pouch is small, she will be restricted and lose a lot of weight. Ultimately though, I think she'll return to old patterns with a heap of metabolic damage on top of it and be worse off in the long run. I hope I'm wrong. I'd love to be wrong.


Princess Dieter said...

I was at a point of desperation a few years ago when I thought WLS might be my only real hope, and I researched it. I would start diets in the AM, only to be binge eating by the late PM, and I couldn't seem to stay on any plan or keep calories under even 2500. I concluded, after voraciously reading blogs, articles, etc, that it was not for me. I didn't like the regain stats, the nutritional deficiencies, complications. I had visions of being the one who dropped dead from some vile infection post-op or had her teeth fall out from lack of X or Y or Z nutrient....

I felt jealous when I saw a friend drop 100 pounds with Lap Band and another blogger drop to near goal weight with bypass. THEN...I noticed the friend having complications and then regaining nearly 50 lbs. Huh, I thought? Then the blogger got terrible complications which made her days pretty scary. And I was very glad I reconsidered...cause I imagine THAT would be me, regaining or having medical complications and living with crap quality of life.

I guess I'd rather fight the hunger and food issues on my own that have surgery that may, a few years down the road, be a huge source of regret and illness. It scares me.

But I always wish well to those who do choose it...despite my misgivings. I always hope they are the ones who make it work out, who learn, who eat better, who exercise, and who take the honeymoon of WLS and turn it into a life of better habits. This is always my desire.

But I'm still glad I didn't go for it when I was so down and nearly in despaire as a morbidly obese woman...

screaming fatgirl said...

Amen to all that you say. I also was terrified at the prospect for all of the reasons you state.

I am not really envious of the rapid weight loss because I lost about 100 lbs. the first year or so. When you have a high starting weight, fast comes without surgery as well. I do wonder how the whole "head hunger" thing is managed and if it's easier not to eat when your stomach feels uncomfortably full so quickly. I can't imagine that blood sugar isn't a problem though as starving is starving no matter how stuffed your belly is. There's really no way for me to know though.

Thanks for commenting, and I hope you're feeling better. I know you've been having a hard time of it lately.

LHA said...

Your comments on WLS are interesting, and I share many of your feelings on this. I was acquainted with a woman who did die from complications after surgery and it was shocking and so very sad! Another woman who was a "friend of a friend" became an alcoholic after WLS, apparently in an attempt to find a way to deal with stress and other issues without overeating. She ultimately did gain most of the weight back also, so she was left with two problems to deal with.

I also agree that it seems logical that someday WLS surgery will be looked at as a bad idea that was abandoned by medical science.

I enjoy your blog very much, so thank you for sharing your experiences and thoughts.

The Paris Chronicles said...

I once read someone say that they believed WLS would one day be considered as poor an answer to weight problems as extreme lobotomies were to mental illness.

My sense is that the opposite will happen. WLS will become the gold standard for a certain willing market of obese people. As the surgery becomes more and more democratized (indeed, there is little stigma attached to it as compared with even five years ago) and more and more professionals learn how to perform it, it will become what teeth whitening has become. Remember when teeth whitening was confined to specially-trained dentists? And cost a fortune? Now, you can get your teeth whitened in a mall by a high-school kid for the cost of a scarf.

This surgery is a huge money-maker for any clinic or hospital. And the peripherals are raining money down on the industry as well. As long as you have people making profit off of it and a willing market, it is not ever going to be seen as something barbaric (like a lobotomy). My sense is WLS will be to go-to solution to weight loss for the obese and even the "merely overweight"--look at how the criteria for WLS has shifted--they are proposing this to patients who weigh 200 lbs, as well as teenagers. You don't have to be morbidly obese anymore to qualify.

Escape Pod said...

Sigh... It's probably too early for me to be expressing thoughts on this issue, because I'm in the midst of this experience. I had weight loss surgery less than a year ago and am nearing my goal weight and beginning to transition to maintenance. Maybe that means I'm too new to really know what I'm talking about yet.
I've also been pretty close to this weight twice before in my life through traditional diet and exercise, and gained it all back and then some, along with the emotional baggage that accompanies the experience of colossal (and very public) failure.
I know the hardest part is yet to come, as maintenance is always far harder than loss. And the surgery didn't "fix" my food issues, I still have to work on those as so many of us do, all on my lonesome. Which is why I'm still devouring blogs like this one, trying to learn from people who struggle with the same food issues I do.
But there's something to be said for being able to do that free of constant, gnawing hunger or unsustainable levels of exercise. For being able to work on these issues from a place in my heart where I feel strong, and capable.
I do see so many people who treat the surgery as their magic wand, and think they can eat "normally", but in smaller quantities and live happily ever after. I worry for them, but maybe some people can make that work. Me? I'm still trying to figure out what normal means, and wonder if it's even possible for me. In the mean time, I've been blessed with a very smooth recovery and no complications. I'm back to a weight where I can contemplate things like jogging and long day hikes, and enjoy them, without injuring myself or feeling the pain for days afterwards. I've learned a lot about what my body actually needs in the way of nutrition, what makes me feel good and strong and what doesn't, and what helps me feel full and satisfied. But it's sort of like training wheels. If I don't develop good habits, I may see substantial regain. But the assistance it's giving me isn't inconsequential, and compared to the stats of those who try to lose a lot of weight and keep it off on their own, I like my odds as a post-op much better, even though my odds may still not be great. It was a risk I was willing to take, which I think says a lot about what life is like as a very overweight person.
All that said, it's not a good path for everyone.

screaming fatgirl said...

I wouldn't presume to predict your future, Escape Pod. I only know the pain we all suffer because of our relationship with food and wish everyone the best no matter what path they choose.

I still think enduring weight loss surgery is incredibly brave, and absolutely no "short cut" or easy. Now, more than ever, as I follow this web acquaintance's blog, I see how horribly difficult it is. I wouldn't want anyone to endure all of that and not have permanent positive results.

My very best to you.