The NITTY GRITTY of WEIGHT LOSS SURGERY
\n\n\nNobody can predict the course or outcome of your weight loss surgery, but I'm going to try anyway, starting with a simile that most of us can understand.
\n\n\nWLS is like a marriage, with your band as your lifetime partner. At times you'll thank your lucky stars you found each other. At other times you'll wish you'd never met, never mind married. You'll never walk alone again, but you alone will be captain of your ship. You will lose weight and gain a new lifestyle, but some of your losses and gains will be bittersweet. You'll wonder what on earth you got yourself into, as well as why on earth you didn't do this a long time ago.
\n\n\nMost of all, you'll scratch your head and say, "Why didn't anyone tell me how much work this would take?"
\n\n\nI'm not telling you all this to scare you. A little fear is fine if it makes you a compliant patient, but I don't want fear to rule you. I just want to remind you that like every other human endeavor, the WLS journey has ups and downs. I believe that my band surgery saved my life and I've never regretted my decision to do it, but I can't claim that every moment of my journey has been sunny and carefree. If you don't want to hear about the tough stuff, that's fine. You have my permission to move on to another article (preferably one by me). But if you want to hear about some of the things I wish I'd known at the start of my journey, read on. Knowing these things in advance wouldn't have changed my WLS decision, but it sure would have helped me stick it out more easily when my weight goal seemed a million miles away.
\n\n\n1. The band is not magic. There is nothing in it that - hey, presto! - will make you lose weight. Changing your eating behavior and lifestyle, plus dozens of other factors that vary from one person to the next, will make you lose weight.
\n\n\n2. Your band won't do all of the work. If you don't (metaphorically) grab hold of it and use it as a tool, it will be about as useful as a cordless drill without a battery.
\n\n\n3. For most people, the band doesn't start working right away. As a new post-op, surgical swelling and/or a small "primer" fill may or may not kill your appetite (desire to eat) and physical hunger (physical need to eat), but most bandsters need several fills to get the weight loss going, and more fills after that to keep it going.
\n\n\n4. If you don't eat carefully, will you will suffer temporary, extremely uncomfortable side effects that can, if ignored, turn into permanent, expensive, and unhappy complications.
\n\n\n5. Once you achieve an optimal fill and restriction level (which will last for 30 seconds, 30 minutes, 30 hours, but probably not for 30 years), your restriction is very likely going to vary, for reasons too numerous to explain here. In this area you must remember that the human body is alive and always changing, whereas the adjustable gastric band is inert and changes only with the addition or subtraction of fluid. One day you can hardly eat, the next day you can eat anything and everything, and the day after that, you can eat just the right amount (remember Goldilocks and the Three Bears?).
\n\n\n6. Restriction may also vary according to the time of day (or time of month, if you're of the female persuasion). Morning "tightness" is very common, and it may limit your morning food choices. That is not, however, a good excuse for skipping breakfast and thereby depriving your body of the fuel it needs, and doing so can set you up for a monster binge when hunger suddenly hits you at 11:38 a.m. So you will have to be willing to stay flexible, try new foods, and practice patience (which is something I have to practice every day in every way anyway).
\n\n\n7. You will have to deal with restriction even when you wish you had none at all, when you're at a party or on vacation or sitting down to Thanksgiving Dinner at Mom's overloaded dining table. At times you will want to go on eating because the food tastes so good, but you'll have to stop because you physically can't eat more, and because eating more would cause uncomfortable and undesirable side effects (to say nothing of weight loss plateaus or regain). That experience of food "deprivation" has been very frustrating for me. Not every day, not at every meal, but often enough to remind me again and again that my upper GI tract is no longer the free and easy party girl it once was. That reminder is often a good thing, but sometimes it makes me want to put my fingers in my ears and chant, "I can't hear you, Stomach!"
\n\n\n8. This next piece of WLS Nitty Gritty is such a big, important one that I left it for last so that it will (I hope) stay burned into your brain a good, long time. NO WEIGHT LOSS SURGERY OF ANY DESCRIPTION WILL KILL THE EATING DEMONS IN YOUR HEAD. Vanquishing, subduing or managing those demons is something you'll have to do yourself, with the help of a counselor or support group, with daily practice for the rest of your life. But that's OK, because you are worth all that effort.
\n\n\n\n\n
Related: Different approaches to weight loss
\n\nIf you're like most of the population, you've probably tried a bunch of methods for losing weight. If you're still searching, then you probably didn't find one that worked for the long term. Sure, maybe they worked for a short time, or helped you lose a little bit of weight, but eventually you regained the weight.
\n\n\nWith so many advances in science and so much interest in an obesity treatment, you'd think there'd be a magic cure for obesity by now. But, there isn't. These are your current options for losing weight. Each of them relies on eating fewer calories than you expend.
\n- \n
- Dieting: eating less or choosing lower-calorie foods so that your total intake is lower.\n \n
- Exercising more: burning more calories through physical activity.\n \n
- Dieting and Exercising: naturally, doing both would lead to faster weight loss.\n \n
- Weight Loss Drugs: these can increase your metabolism or decrease your appetite.\n \n
- Weight Loss Surgery: make your includes diet and exercise\n \n
\nWeight cycling, or yo-yo dieting, is no fun - but that's what so many of us are doing! In fact, more than 90 percent of people who rely on diets and exercise for weight loss gain their weight back soon - or don't even achieve their goal weight in the first place. For most people, the problem with diets and exercise is that they're temporary; people get bored with them and stop following their programs.
\n\n\nWeight loss drugs have their own problems.
\n- \n
- There aren't too many options that are approved by the Food and Drug Administration (FDA).\n \n
- They're not necessarily effective - they may help you lose a few pounds, but probably won't get 100 pounds off of you.\n \n
- They're usually only allowed for a short time, such as 12 weeks or a year.\n \n
- Like all drugs, they have side effects.\n \n
\nWeight loss surgery is an increasingly well known option for weight loss. Many patients who have had previous failed diet attempts can lose hundreds of pounds and keep them off. Weight loss surgery procedures can be restrictive, which means that they make your stomach smaller or help you feel full faster so that you eat less. They can be malabsorptive, which means that the amount of nutrient that you absorb decrease. Or, they can be both restrictive and malapsorptive.
\n\n\nNot all weight loss surgeries are the same, though, so you'd better look at your options carefully if you think you're interested. Chapter 2 of The BIG Book on the LAP-BAND® describes each of the common weight loss surgeries and how they work.
\n- \n
- Vertical banded gastroplecty: A restrictive procedure, also known as stomach stapling, in which the surgeon staples shut the majority of your stomach pouch.\n \n
- Vertical sleeve gastroplasty: A restrictive procedure in which the surgeon removes the majority of your stomach pouch and covers the incision with a "sleeve."\n \n
- Sleeve plication: A restrictive procedure, also known as curvature plication, in which most of your stomach is folded over so you can only use a tiny pouch.\n \n
- Laparoscopic adjustable banding (Lap-band): A restrictive, fully reversible procedure in which a band is placed around the upper portion of your stomach so you feel full faster.\n \n
- Gastric bypass: A restrictive and malapsorptive procedure in which part of your stomach blocked off and your small intestine is resectioned.\n \n
\nSo what is it going to take for you to lose weight and get healthy? It may seem impossible, especially if you've tried and failed so many times before, but one of the most important messages in Chapter 2 of The BIG Book on the LAP-BAND® is that you can get healthy! Successful weight loss requires lifestyle changes and a serious, long term commitment. For some people, losing weight and keeping it off also requires the lap-band. The important point is that you can do it if you set your mind to it and have the right tools.
\n\n\n\n\n
Related: What obesity is doing to you!
\n\nObesity is an epidemic that harms health and claims lives. One-third of Americans are overweight, and another third are obese. 6 percent of Americans are morbidly obese, with a BMI over 40 and frighteningly high risks for diseases. The effects of obesity are .
\n\n\nThe United States pays about $190 billion per year in medical costs related to obesity. That includes things like hospital bills, prescription drugs and special equipment necessary for treating obese individuals. Then, of course, there are additional costs related to things like worker absenteeism because of more illnesses among obese employees. Your own insurance costs and healthcare bills can go up because of your obesity.
\n\n\nYou know that obesity is unhealthy. Everyone says that all the time. But do you know just how harmful obesity can be? It increases your risk for heart disease, type 2 diabetes and high blood pressure and osteoarthritis. It can cause sleep apnea and asthma. It can make you ashamed of yourself and be a trigger for others to look down on you. Obesity can take ten or more years off of your life.
\n\n\nHere are a few quick fact about what can happen when you lose a significant amount of body fat.
\n- \n
- If you have type 2 diabetes and are obese, losing weight can almost certainly get you on lower doses of diabetes medications - or off of them entirely!\n \n
- Your knee pain, back pain and are probably being caused by your obesity. When you achieve a normal weight, you'll probably be pain-free.\n \n
- High cholesterol and high blood pressure will almost certainly drop when you lose excess weight.\n \n
- You'll feel happier and more confident when you can go shopping in normal stores and fit into your car without sliding the seat back.\n \n
- You'll have more energy because - let's face it - it's hard to carry around all that weight all day.\n \n
\nOkay. You know obesity harms physical health. It can cause depression and low self-esteem. People may look down on obese individuals. Nobody wants to be obese. So why are so many people obese? You already know this one! Too much eating, and not enough exercising! Our whole society is built to make us obese. Consider these factors leading to high calorie intake and not enough calorie burn.
\n- \n
- Fast food is cheap, tasty and high in calories, fat and sugar. Plus, it's everywhere!\n \n
- High-calorie food tastes good, is everywhere and is heavily advertised - so you can't get away from it.\n \n
- Healthy food is more expensive and often takes longer to prepare.\n \n
- We drive and take the elevator instead of walk and take the stairs.\n \n
- It's hard to find time for exercise.\n \n
- Sitting around and watching television means that you're not moving and burning calories - and it often means that you're eating potato chips mindlessly.\n \n
\nIf you're interested in learning more about what obesity is doing to you and millions of others, check out Chapter 1 of The BIG Book on the LAP-BAND®. It has simple explanations for all of these medical conditions and also a clear description of the body mass index - or BMI. Doctors use your BMI to assess your weight status, so you'd better be familiar with it as you continue your weight loss journey!
\n\n\n\n\n
Related: Ready, Get Set, Go!
\n\nYour surgery is tomorrow! Are you ready? Do you have a list of last-minute things to do before you leave for the hospital or surgery center? Have you packed your bag yet?
\n\nWhat to Take to the Hospital or Surgery Center
\nThis isn't like packing for a two-week vacation. Most hospitals prefer that you bring a minimum of belongings with you and don't want to be responsible for keeping track of them. You'll need less than you'd think. The hospital will want you to wear their gown instead of your own nightgown or pajamas, and you can wear an extra hospital gown backwards to use as a robe so you won't moon anyone when you're roaming the hallways. If you're allowed to shower while you're there (you may not be), they'll provide soap and shampoo. If your feet get cold, the nurses will give you very attractive one-size-fits-few socks with non-slip soles.
\n\n\nHere's what I suggest you bring:
\n- \n
- \nInsurance ID card\n \n
- \nPhoto ID\n \n
- \nA copy of your advance health care directive\n \n
- \nCPAP machine (if you use one)\n \n
- \nA list of your medications (you may be instructed to bring the actual meds with you)\n \n
- \nLip gloss (your mouth & lips will be very dry)\n \n
- \nToothbrush, toothpaste and essential toiletries\n \n
- \nCosmetics (if you must)\n \n
- \nIPod or MP3 player\n \n
- \nLaptop computer (if you must)\n \n
- \nSomething to read (magazines, books, Bible)\n \n
- \nLoose-fitting clothing (elastic waist)\n \n
- \nA change of underwear\n \n
- \nSlip-on shoes or sandals\n \n
- \nPillow(s) for the ride home\n \n
- \nA water bottle for the ride home\n \n
\nBring your cell phone if you like, but some hospitals don't allow use of cell phones on the premises because of possible interference with patient monitoring equipment.
\n\n\nDo not bring cash or valuables. The medical staff is there to take care of you, not your engagement ring.
\n\nLast Minute Things to Do
\n1.\t Have someone take Before photos of you (front, back, and side views).
\n\n2.\t Take your body measurements (neck, bust, waist, abdomen, thighs, calves, ankles, upper arms, wrists).
\n\n3.\t Set aside a pre-op outfit of fat clothes to preserve for posterity.
\n\n4.\t Put clean sheets on your bed.
\n\n5.\t Do laundry.
\n\n6.\t Clean your house.
\n\n7.\t Arrange for transportation to and from the hospital.
\n\n8.\t Arrange for child care.
\n\n9.\t Arrange for pet care.
\n\n10. Pay your bills.
\n\n11. Fill your prescriptions (your usual meds, plus pain-killers, anti-nausea meds and/or blood thinners for after surgery if your surgeon's willing to prescribe them in advance).
\n\n12. Pack your bag for the hospital.
\n\n13. Complete & submit any forms your employer requires for your time off from work.
\n\n14. Pick up books to read and videos to watch while you recover.
\n\n15. Make sure there's easy-to-prepare food in the house for your family to eat.
\n\n16. Do your bowel prep if required (laxatives or enema).
\n\n17. Check your supplies:
\n\n§ The liquids you'll be allowed to drink in the first week
\n\n§ A blender or Magic Bullet®
\n\n§ Liquid Tylenol
\n\n§ Thermometer
\n\n§ Gas-X®
\n\n§ A heating pad
\n\n§ An ice pack (or a bag of frozen vegetables)
\n\n§ Witch hazel or anti-itch gel (to put on the skin around your itchy incisions, but not directly on the incisions)
\n\n§ Reading material, puzzles, games
\n\n18. Remove nail polish (if you wear it) from fingers and toes.
\n\n19. Remove all jewelry (including piercings) and put it in a safe place[1].
\n\n20. Bathe with Hibiclens (or other antibacterial cleanser) as instructed by your surgeon.
\n\n\nAlmost without exception, bandsters' response to this is that every item on the list is a good idea except items 1 and 2. Some also whine about items 17 and 18, but I'm not interested in hearing what dreadful thing will happen to you if you must undergo surgery while completely unconscious and denuded of your nose stud and blue fingernail polish. Save it for the pre-op nursing staff. I just want to reinforce items 1, 2 and 3. You may hate the camera and the measuring tape with a passion, but some day you're going to be glad you have those pre-op photos and measurements. Similarly, you may plan to burn that fat outfit in a celebratory bonfire soon, but one day you'll be glad you saved it. When your bathroom scale is stuck at on a number you hate, comparing your "now" photos, measurements, and clothing to those awful "befores" will remind you of just how far you've come, and give you a little push forward on the bandwagon trail.
\n\n\n[1] This is not negotiable. I once had my wedding ring cut off by a nurse before she would transport me to the operating room.
\n\n\n\n\n
Related: Last Meal Syndrome
\n\nIt's Friday night, and your long-awaited bariatric surgery is scheduled for Monday morning. Ahead of you are two days of the freedom to eat anything you want, in any quantity. You're supposed to be on a pre-op liquid diet, but when you walk into Cheesecake Factory with your friends, your resolution to order soup goes down the drain (literally as well as figuratively). You grasp the menu in sweaty hands. What to order, what to order? You'll never be able to enjoy food like this again, you think. Don't you deserve to order one of everything on the menu? After all, it's your last meal!
\n\n\nSound familiar? Last Meal Syndrome is very common among people facing weight loss surgery, and chances are you've already suffered it sometime in your life, perhaps the day before you started New Diet #832. Since New Diets almost always start on a Monday (there may be a law of nature covering that), you spent every minute of Sunday gorging on all the foods you could no longer eat come Monday morning. You ate so much that you made yourself slightly ill, and you probably didn't taste half of that food in your haste to cram it into your mouth.
\n\n\nOvereating because of anticipated deprivation is an old, old habit. Until the earliest humans learned to plant seeds and cultivate their own food supply, nutrition was largely a matter of opportunism. If you caught a big fish or felled an animal by heaving a rock at it, you ate it all because you didn't know when another meal would swim, crawl, walk, or fly by.
\n\n\nAlthough I sometimes joke that being self-employed as a writer is terrifying for me because it's a hand-to-mouth existence, at no time in my middle-class American life have I ever been truly threatened by significant food deprivation. My repeated bouts with Last Meal Syndrome have been caused mostly by my emotional over-attachment to food. When starting a new weight loss diet, or contemplating my coming bariatric surgery, I was terrified not that I would starve, but that I would suffer from emotional pain, boredom, or stress unrelieved by my usual comfort: whatever food I wanted, when I wanted it, in any quantity I wanted. Intellectually I knew that I would be able to eat small amounts of healthy foods and thus lose weight and gain better health, but the spoiled, petulant child within me feared and hated the very thought of that.
\n\n\nA few days before I was banded, my husband asked me, "Are you going to have anything special to eat before your surgery?"
\n\n\nI said virtuously, "I'm on a clear liquid diet for the next three days. I can't eat anything at all, never mind something special." My surgeon had told me that if my liver wasn't in good shape (that is, having a manageable size and texture), he would bail out of my surgery. After all I had gone through to get to the operating room, I wasn't going to blow it, and it wasn't (as I reminded myself) as if I would never be able to eat again in my entire life. I was facing food deprivation, yes, but for a matter of days, not years.
\n\n\nNow, let's get one thing clear here: I'm not claiming superiority over pre-ops who give in to Last Meal Syndrome and celebrate their own private food festival a day or a week before their surgery. My compliance with my surgeon's instructions was driven by fear, plain and simple. I wasn't (then or now) a paragon of virtue. But in the last 4-1/2 years, I've learned something important that newbies and wannabes may not realize about the adjustable gastric band. And that is:
\n\n\nThe only food deprivation you will suffer after band surgery involves the QUANTITY, not the quality or nature of the food you eat. With a properly adjusted band, you should be able to eat a wide variety of foods you like. You don't have to give up Cheetos or Haagen Daz or McDonald's or prime rib of beef forever. All you have to give up is eating those foods in excess. It's true that when your daily calorie budget is limited, your health will depend on your making the best possible food choices - eating a piece of cheese instead of the Cheetos, a Skinny Cow ice cream bar instead of a gallon of Rocky Road, a Happy Meal instead of a quarter-pounder, two ounces of prime rib instead of the whole cow. You and your band will still be able to tolerate just about anything, so when you look down the road that your bandwagon will travel, you should see plenty of nice places to stop and eat instead of a dry, barren desert in which you'll have to subsist on stale melba toast and lukewarm water.
\n\n\nThat's the good news. Now here's the bad news:
\n\n\nAfter band surgery, you'll be able to eat a wide variety of foods you like. Yes, I know I already said that, up there in the good news paragraph. But the tolerance of almost any food you can imagine means that you will have to exert some self-control to avoid overindulging. Now you may be thinking, "If I had any self-control, I wouldn't need weight loss surgery." If the need for self-control is a deal-breaker for you, maybe you should consider a different bariatric procedure, one that will allow you to eat anything at all and lose a pound a day. I'm not convinced that such a procedure exists, because I've heard too many gastric bypass (and even duodenal switch) patients moaning about significant weight regain, but by all means give the Magic Weight Loss Surgery a go. Maybe self-control will never be an issue for you again.
\n\n\nMy thoughts about self-control would fill up another whole article, so right now I just want to reassure you that eating with your gastric band is not necessarily going to involve an endless series of bland, dreary meals. It's not going to be like the mysteriously popular diet that requires you to eat nothing but cabbage soup three times a day. It's going to involve eating like a normal person who enjoys food but has a small appetite. Depending on your experience of restriction after each fill, you may have to forgo certain foods at times, but just because you can't comfortably eat a bagel with cream cheese today doesn't mean you'll never again be able to have a few bites of toasted bagel. Your food tolerance is going to depend not only on your fill level but also on your eating skills. The day after my first fill, I suffered my first stuck episode after taking a huge bite of a grilled cheese sandwich. A year later, with a lot more fill in my band, I could eat that same sandwich for lunch because by then I was used to eating slowly, taking tiny bites and chewing the food very well. I probably wouldn't eat the whole sandwich because I'd get "full" so quickly, and that's a good thing!
\n\n\n\n\n
Related: In and Out of the Closet
\n\nIN & OUT OF THE WLS CLOSET
\n\nI was happy about my decision to have WLS and thrilled when my insurance company finally approved it. I shared this happy news with many friends, acquaintances, family members, and coworkers. I don't know but I assume that they discussed it amongst themselves , expressed opinions or concerns, and perhaps worried about my decision, but none of them gave me frankly negative feedback. They might have been thinking it, but they didn't say it. I very much doubt I would have reversed my decision if someone had said, "That's too risky/it's a bad idea/I don't want you to/you're crazy/or whatever."
\n\n\nI'm going to assume that you, the reader of this article, are an adult over the age of 18, with the right to vote, the obligation to serve in the military, and (at some point, depending on your location) the right to purchase and use tobacco and liquor. Unless a judge has declared you mentally incompetent (and that's harder to accomplish than you'd think), you are the one who's responsible for your body - for its care and nourishment and any medical treatments or procedures that affect it. So if you're in the early stages of considering WLS, whose input are you going to trust to inform your final decision? A bariatric surgeon, or your dad? Your primary care physician, or your sister? Your therapist, or your hairdresser? And hey, I'm not slamming hairdressers. Mine could do very well indeed as a therapist, but she has a cosmetology license, not a mental health practitioner license.
\n\n\nLast summer I was startled to hear a 50-something bandster state that she had gotten her husband's permission to have plastic surgery. His permission? Huh? Does that mean he's the only adult in that relationship, or what? I'm not against asking permission, mind you. I ask my boss's permission to undertake certain tasks or projects at work; I ask the State of Tennessee for permission (i.e., a driving license) to drive a car; if I still lived in a suburban development, I might ask the zoning board for permission to add a room to my house; I ask the government of China for permission (i.e., a visa) to travel in that country.
\n\n\nI'm an extremely independent person , so I have to stop and think carefully about what I might ask my husband permission to do. We have our own separate checking accounts as well as a joint account, so I might ask him for "permission" to spend a chunk of that joint account on a big purchase like a computer or a car. Everything else gets negotiated.
\n\n\nI have a lot of experience in negotiation because of my business career. I negotiated things with everyone from my coworkers to my suppliers. But people who do that kind of thing for a living aren't the only ones who negotiate, and negotiators aren't necessarily politicians or manipulators trying to advance some evil cause. My own career as a negotiator probably started when I was a child who realized that good behavior often yielded a treat. My negotiations with my mother went something like this:
\n\n\nIt's 7:00 o'clock on Thursday morning. Mom is brushing the tangled cobweb of my hair in preparation for braiding it. I am sniveling because the untangling hurts. The negotiation begins.
\n\n\nMom says: "Jeannie, if you stop whining right this minute, you can have Cocoa Puffs for breakfast." Jeannie sees an opportunity and negotiates this agreement by asking, "Can I have chocolate milk on my Cocoa Puffs?" Mom sighs and yanks at a hank of hair. Jeannie snivels a little bit more. Finally Mom says, "Yes, you can have chocolate milk on your Cocoa Puffs." Jeannie instantly shuts up. Negotiation over. It's a win-win situation. Everybody's happy… for maybe 15 minutes. In 15 minutes, Jeannie's hair is finally tamed into two narrow braids and it's time to choose an outfit for school. This time Jeannie begins the negotiation. "Can I wear my pink dress to school?"
\n\n\nMom says: "That dress is brand new. We're going to save it for church." Jeannie says: "I promise not to get it dirty." And so on and so forth.
\n\n\nWell, that's enough time spent traipsing along Memory Lane. My point (and, like Ellen Degeneres, I do have one) is that the "yes or no" WLS decision is yours. Everything else (how to make it work best; what your family can do to help you; how much to tell your nosy coworker) needs to be negotiated with (or modulated by) the people who will be involved in your WLS journey on a daily basis and renegotiated as time goes on and your needs change. The negotiation may be simple ("Will you take the kids to McDonald's for lunch if I pick up your dry cleaning?") or complex ("Let's talk about how we'll handle Thanksgiving Dinner this year") or downright messy ("I feel like you're trying to sabotage my weight loss."). That's life, isn't it?
\n\n\nBE CAREFUL WHAT YOU ASK FOR
\n\nGetting feedback from others is usually a mixed bag experience. It's wonderful to get the positive stuff and uncomfortable to get the negative stuff. It's also very frustrating when your announcement elicits no response at all. What if you tell your sister, "I've decided to have weight loss surgery," and all she says is "Oh." What's that all about? She's shared her thoughts about your hairstyle, your boss, your kid's struggles with math, your parents' new car, your high blood pressure and now she has nothing to say about something as momentous as weight loss surgery?
\n\n\nIf you're like me, your mind gets busy filling in all the empty spaces with scenarios and speculation. My own little mind is always full of running commentary (most of it - well, some of it - never uttered aloud). When I'm exercising, I'm planning what to wear to work that day. When I'm driving to work, I'm considering the best way to write the first or fifth or fifteenth sentence of my next article. When I'm driving home at the end of that day, I'm replaying a conversation I had with a coworker and fiddling with what I could have said better. So when I encounter my complete opposite (someone who has nothing to say on a matter that's important to me), I cast my fishing net into my teeming mental pond, scoop up a dozen squirming fish, and off I go into Wonderland. "Wonderland" as in the land where I wonder, and wander, on an endless circular track. Around and around Jean goes, and where she stops, nobody knows, least of all Jean.
\n\n\nThe official term for that is "projection". You project your own internal drama onto someone else's blank white movie screen without having the first clue about what's really going on behind that blank screen. You've known your sister all her life, ever since she supplanted you as the baby of the family. That's what, 35 long years? After 35 years together, you might think you could predict her reaction to almost anything, but it's also quite possible that you cannot correctly read her mind. Your suspicions about her reaction to your weight loss surgery announcement may be accurate, but you'll never know that unless you specifically ask her.
\n\n\nThat's more or less what happened to me when I first began discussing weight loss surgery with my husband. We had been married for 20 years, so he had two long decades of experience with his wife launching herself into risky situations (be it a new job, an overseas trip, adopting a pet, redecorating a house, taking fen-phen). He had been amazingly patient through all of that, not just because he loves and supports me but also because he knows that hell hath no fury like Jean with an obstacle in her path. So when I said, "Today I made an appointment to go to a bariatric surgery seminar," and he said nothing in response, a dozen things ran through my mind. He thinks I should be able to lose weight by dieting. He doesn't want me to lose weight because he likes fat girls. He thinks this is another of Jean's wild goose chases and if he leaves it alone, she'll get over it and move on to some other project…and so on and so forth.
\n\n\nWhat was actually going on in his head was probably more like, "I wonder if there's more rice in that saucepan, but if Jean forgot to buy soy sauce again, I won't have another helping because I can't eat rice without soy sauce. If Jean has weight loss surgery, will we ever get to eat rice with soy sauce again? Will we be living on warm water and melba toast? Did I remember to fill the cat's water dish before I came in the house? We really need to get the cat fixed but I don't want another argument about whose turn it is to take a critter to the vet. Oh no, Georgie's puking in the living room again. If I ignore it, can I get Jean to clean it up? I'm going to write SOY SAUCE on the grocery list in big letters so Jean won't forget to buy it. Maybe if I ignore the weight loss surgery thing, it'll disappear, like Georgie's puke"…and so on and so forth.
\n\n\nI'm not trying to make my husband's thought processes sound asinine (for a taste of truly asinine thinking, you really need to listen to a few minutes of my own stream of consciousness). I'm just making the point that our minds are full of stuff that may be worthwhile or interesting to us but doesn't necessarily have to be shared in detail with everyone around us, and that nobody but the Amazing Kreskin can hear someone else's thoughts. When my husband finished his dinner (without a second helping of rice) that night without making any response to my bariatric ambitions, I asked him, "So what do you think of the idea of me having weight loss surgery?" And he said, "I'm not crazy about it, but if you really believe it will help you, I'll do my best to support you."
\n\n\nAnd what did I say to that?
\n\n\nAll I said was, "Thank you."
\n\n\nI could have said a lot of other things. I could have said, "Why aren't you crazy about the idea?" I could have quizzed his knowledge about weight loss and weight loss surgery. I could have asked him if he would still love me and desire me when I was thin. I could have gone on and on for hours, while adding to my own anxiety and creating a host of brand new anxieties in his poor head. But instead I said, "Thank you," because his promise of support was all I needed to hear at that time, and we had a lifetime of conversations ahead of us. And I said "Thank you" because when I'm in the planning stages of something big that will require a group effort, I try not to invite discussion that will derail the whole project even before its engine starts. You may have a different style, and you may think I was postponing a discussion that should be tackled immediately, but my approach is: one step at a time. I don't try to build Rome in one day. I pick up one brick, walk it over to where I want the wall, put it down, and go back for another brick. Eventually the wall (or Rome) gets built.
\n\n\nIN & OUT OF THE BAND CLOSET
\n\nMy feelings about sharing my WLS journey with other people have changed as time has gone on. For three months before and about 18 months after my band surgery, bariatrics was the #1 subject in my mind at least 75% of the time. I had to exert effort to not talk about it constantly. If I hadn't discovered online WLS forums, where I could talk about it constantly with other people who talked about it constantly, I think my head may have exploded.
\n\n\nI didn't talk about WLS with every single person in my everyday circle of friends and acquaintances (for example, I decided not to tell my church friends about it, mostly out of laziness), but most of the people who knew me as obese also knew about my surgery. When I had lost my excess weight, the focus of my life began to shift to other things. Yes, bariatric surgery was still important to me, and so fascinating that I wrote a 500+ page book about it, but as my interests and activities grew and changed, I acquired a whole new set of friends, acquaintances, and coworkers who had never known Fat Jean. It didn't occur to me to tell them I'd had WLS any more that it occurred to me to tell them I'd had a hysterectomy or hemorrhoids. If the subject of weight loss or dieting or exercise came up, I was willing to talk about those topics, but not necessarily in the context of weight loss surgery. I guess you could say I was in the band closet then, though I won't admit to hiding in there. I still wanted to talk about bariatric topics, but not with the general public. I made two new friends during that time who know about my band surgery. One of them had heard about it from her mother (a former coworker of mine) and the other heard about it from me. Otherwise I was kind of enjoying being perceived as a "normal" woman by people who couldn't even imagine me as a fat woman.
\n\n\nBut one day my feelings changed. I opened the door of my band closet and peered out. It was time to get out of there. Here's what happened.
\n\n\nDuring an exercise class at my fitness studio, another (naturally slender) student began making fun of fat people, and a few more people there chimed in. They just couldn't imagine how someone could "let themselves go" like that. It sounded to me like these well-meaning people were saying that obesity is a choice - that the fat people had made a conscious decision to overeat, under-exercise, and gain an unhealthy amount of weight. It sounded to me like these well-meaning people were saying that fat people don't have the willpower or intelligence to maintain a healthy weight. And suddenly I heard myself say out loud, "Those people aren't proud of their fat. Don't be making fun of them."
\n\n\nAfter a minute or two of mumbled objections, those well-meaning people fell silent, and soon the conversation took a new direction.
\n\n\nMonths later, when I was about to publish Bandwagon Cookery, my friend, instructor and personal trainer, Caroline, suggested holding a book-signing event at the fitness studio. At first I was wary of the idea. It would require me to step out of the band closet and expose my bariatric secret to a community of people who had never known Fat Jean. It would require me to step out of my comfort zone and into the limelight. I'm not afraid of public speaking - I actually enjoy it in most circumstances - and I've told my WLS journey story plenty of times, but mostly to bariatric patients and professionals.
\n\n\nAt Caroline's loving insistence, we hosted the book signing, which was well-attended by women for whom weight management was an interest but for whom obesity was not an issue. One of them had a sister who was banded, but the rest of the guests were blank slates when it came to bariatrics. I want to share with you what I told this audience after announcing that I had weight loss surgery, something that I felt they needed to hear before I could tell my nitty-gritty obesity story:
\n\n\n"I need to talk about the elephants in the room. The elephants are the beliefs that many people have, that obesity is a moral failing and that weight loss surgery is taking the easy way out. Obesity is not a choice, nor is it evidence of inadequate willpower. It's a chronic and incurable disease caused by a combination of genetics, environment, and behavior. Weight loss surgery is the only effective long term treatment for obesity available in the United States today. And weight loss surgery is by no means the easy way out. Weight loss is hard work with or without the help of surgery. Has my weight loss been easier because I had bariatric surgery? Of course it has. That's one of the reasons I chose surgery - because without it, my previous weight loss attempts had been so difficult and so ineffective.
\n\n\n"I'm glad to have my Lap-Band, but it's just a little piece of plastic, a tool that reduces my appetite. When I stick my hand in a bag of potato chips, my band doesn't yank it out again. When my alarm goes off in the morning and I want to roll over and go back to sleep, my band isn't what gets me out of bed, into workout clothes, and into this fitness studio. When I'm thinking that I need a 2nd helping of mashed potatoes, my band doesn't shout, "Don't do it, Jean!" When I'm sad and thinking that buying and eating a gallon of ice cream would make me feel so much better, my band doesn't hide my car keys on me.
\n\n\n"I am the one who makes decisions about what I eat and how I exercise. I am the one who's responsible for making good food choices and changing my eating and exercise behavior. So I get the credit for my weight loss, and I'm the one who has committed to maintaining that weight loss for the rest of my life."
\n\n\nLooking back, I'm not sure how much of an impact that speech had on any of my listeners, but it had an impact on me. Hearing myself say those words affirmed my important and life-changing decision to have bariatric surgery. Whatever you do as you go forward on your weight loss journey, be proud of what you're doing. It's a courageous thing. If no one else congratulates you for the undertaking, you should still pat yourself on the back for it.
\n\n\n\n\n
Related: Pre-Surgery Resources That Will Start You Off Right!
\n\nWith the New Year comes the New Year Resolutions. For many people, one of the largest resolutions is a change in lifestyle - that includes losing weight! I remember my resolution in 2012 was to lose weight and get healthy. And I was able to do that with the help of the vertical sleeve. 2015 is going to hold that for many people and thousands of people undergo weight loss surgery to help them achieve their healthy goals for the new year.
\n\nFor those of you that are just thinking about surgery, I want to encourage you to know that you are not alone! You have a wealth of resources at your fingertips. I wanted to take a moment to share with you some amazing resources that you may find helpful on your journey!
\n\nWebsites
\n\nBariatricPal.com Of course, BariatricPal is one of the very best websites to find information and support. Here there are "rooms" geared for each surgery as well as pages for recipes, articles, and much more. You will find information on everything you might want to know from before surgery to years after. I suggest checking out the Before/After pages for a good dose of motivation and inspiration!
\n\n7BitesShow.com 7 Bites is the first cooking series on YouTube geared specifically toward the bariatric community. The website has videos, recipes and blog posts.
\n\nweightlosssurgerychannel.com Weight Loss Surgery Channel has a collection of videos on everything WLS related weather it be health, food and recipes, and more.
\n\nBariatricFoodie The Bariatric Foodie has some great recipes for those that still love food, but want to stay on track
\n\nTheWorldAccordingToEggface Eggface is one of the most popular of the bariatric cooking blogs. You will find great recipes, blog posts and giveaways on her blog.
\n\nBariatricCookery.com This is a great resource page for everything from recipes to products.
\n\nBooks
\n\nThe "Big Book" series by Alex Breacher and Natalie Stein. There are four books in the series and all are great reads. They have a wealth of information on everything you need to know before, during and after surgery. The very best thing about these books is that they include personal stories from people that have been there.
\n\nBreaking The Chains: A Guide To Bariatric Surgery by Jennifer DeMoss and Suzette Munson. The ladies of 7Bites pull from their and others' experiences with weight loss surgery to provide a simplified, but thorough guide. Information on everything from how to pick your surgery and doctor to how to survive the first two weeks after surgery are included.
\n\nThe Sleeved Life by Pennie Nicola. This book tells about Pennie's experience with the Vertical Sleeve procedure and discusses the ins and outs of the surgery from start to finish.
\n\nWeight Loss Surgery For Dummies. The everything you ever wanted to know and then some guide to all things weight loss surgery. Many, MANY doctors and nurses recommend this book to their patients.
\n\nAnother great resource not listed here is your local bariatric support group! If you haven't found one yet, contact your Surgery Center of Excellence or your nutritionist, they should be able to give you a good idea of one or two in your area. Or you can check out the list here on Bariatric Pal - it's a very thorough list of support groups around the world!
\n\n\n\n\n
Related: From This Day Forward
\n\nREADY TO BE WEDDED TO YOUR BAND?
\n\nOn a humid May morning 37 years ago, after a four year courtship, I married my first husband. We exchanged our wedding vows in front of a Catholic priest, a Presbyterian minister, and 40 guests consisting of family and friends. We walked out of the church and into our married life with "until death do us part" in our young minds. Six years later, we divorced. Eventually each of us married again, this time to the right partner, and we're all still happily married today. As the saying goes, practice makes perfect.
\n\n\nIt's practice that will make your "marriage" to your adjustable gastric band perfect, or as perfect as any human endeavor can be. It's important to know that when you wake up in the recovery room after your surgery, you won't be magically endowed with all the knowledge, experience, and habits you'll need to succeed with your band. Even if you did tons of research, faithfully attended every pre-op educational class, and listened closely to and made detailed notes of everything your bariatric team told you, some things - important things - you'll have to learn through the everyday experience of living and eating with your band.
\n\n\nWhen you leave the hospital or surgery center after your surgery, you probably won't be headed for your honeymoon quite yet. That will come later, when you've had enough fills to achieve optimal restriction and you begin to feel that your band is really working. The excess weight will start coming off and you'll walk around in a dreamy pink haze, delighted with your new life partner. You might even give your band a silly private pet name, the way my husband calls me "Love Bug" (which always makes me think of my first car, a chubby little Volkswagen Beetle).
\n\n\nThen one day, the reality of banded life will wake you up. You'll think, "Who is this creature I've married?" And like Jenny, a former coworker of mine, you'll realize that while the engagement, wedding and honeymoon were exciting and fun, the day-after-day business of marriage isn't exciting or fun 24 hours a day. It's hard work. It's boring. It's frustrating. It's humdrum. Jenny divorced her new husband after only three months of marriage not because she didn't love him, but because she didn't love being married to him. For many of us, being a wife isn't nearly as fun as being a bride. One day you're a smiling princess dressed up in flowers and lace; the next day you're a haus frau frowning at the skid marks in your prince's underwear.
\n\n\nI suspect that Jenny just wasn't old enough or mature enough to be a wife. Neither was I when I married the first time. One of the reasons most bariatric surgeons and insurance companies require a patient to have a pre-op psychological consult is to evaluate the patient's understanding of what they'll have to do to succeed after surgery. Are they ready for a lifetime commitment? Do they have reasonable expectations? Can they follow instructions? Are they capable of learning the new behaviors they'll need for a productive, peaceful partnership with their band?
\n\n\nHABIT FORMING
\n\nNew bandsters need dozens of new habits - something like 60-70% of my book Bandwagon is devoted to explaining those habits, so I'm not going to try to cram them all into a single article. I'll pick one at random. Hmmm…how about EAT SLOWLY? How are you going to turn that behavior into a habit that will serve you well for the rest of your life?
\n\n\nSo Dr. McMillan tells you, "Eat slowly," and you nod your assent while thinking, "Get real! I'm too busy to do anything slowly. I have 3 kids and 2 dogs, I work 2 jobs, I take care of my elderly Aunt Bertha, I coach my daughter's softball team, I have a house to run and a spouse who's always on the road…" Well, you get the idea. Dr. McMillan has just told you to do something that's very simple and yet impossibly difficult, you think Dr. McMillan needs to wake up and smell the coffee, and a door in your mind slams shut.
\n\nActually, Dr. McMillan is already awake, has had a cup of coffee, has tended to all 10 of her dogs and all 3 of her cats, is about to leave for the fitness studio, and when she returns she will deal with a home renovation project while running her home-based publishing business off the kitchen table; tomorrow the fun will start all over again, including a 5-1/2 hour shift at her retail job and a trip to the supermarket. She'll get someone to come look at the leaking French doors, do the laundry, pick another batch off ticks off the new dog, and cook several meals. Dr. McMillan's friend Nina calls her the "Tennessee Tsunami", and despite all that, Dr. M. still manages to eat slowly every time she sits down to a meal. As a pre-op, it took her maybe 5 minutes to hoover her way through a meal that would feed a farmhand, and now it takes her 5 minutes to chew her way through the first bite.
\n\n\nBut that EAT SLOWLY habit (or any other habit) didn't become a habit for me overnight. It takes many, many repetitions to turn a new behavior into a habit (a British study found that it takes anywhere from 18 to 254 days of daily repetition to make a new behavior "automatic"). I know it's a big challenge, especially when you're also trying to learn a few dozen other new behaviors and turn all of them into habits while somehow conquering the dozens of bad habits you already had, but I assure you, it's worth the effort.
\n\n\nMIND OVER MATTER?
\n\nSometimes the biggest stumbling block in changing my behavior isn't the behavior itself - it's me and my stubborn, willful mind. I rarely have a valid reason to refuse a new, healthier behavior, whether it's a small thing like putting my fork down while I chew each bite, or a bigger thing like always wearing seat belts in the car. My brain stomps its feet and cries, "I don't WANT to do it!" I have to ease into the new behavior gradually, so that I don't become overwhelmed and end up crying, "See, I TOLD you it wouldn't work!" So although part of me knows that this is a huge, lifetime deal, I dole out the changes in small pieces, one day at a time, one hour at a time, one minute at a time. If I live as long as my mom did, I have another 32 years of eating ahead of me. I eat 6 times a day, 7 days a week, so if my arithmetic is correct (no guarantees there), I have another 69,888 meals to chew my way through. That is a truly mind-boggling number, so I'm tackling this task one meal at a time, and I suggest you do the same.
\n\n\nI also suggest that you tackle one behavior at a time. Even simple things can become too complicated when you try to do them all at once. Last year, I bought a new cell phone. I hate the telephone and always have; as far as I'm concerned, cell phones are the work of the devil. I chose a phone with far more capabilities than my old one. It seemed like a dandy little gadget when the sales associate was showing it, but when I'd had it a week, I had to return it because (as I told the puzzled 20 year-old who processed the return), I simply could not deal with a device that required me to hop on one foot while patting my head, rubbing my tummy, and singing the "Star Spangled Banner" to send an e-mail.
\n\n\nSo sitting down to each post-op meal trying to remember whether you're supposed to hop, pat, rub, or sing is a set-up for failure. Better to pick out one new behavior as this week's challenge. Next week, add another new behavior to your repertoire. The week after that, another one. During that time you'll be repeating all the new behaviors as you slowly add new ones, and gradually the behaviors that were new become old…in other words, they become habit, and you won't have to think about them much if at all. When I was a little girl, my mom had to remind me to brush my teeth every day, but eventually the tooth-brushing became an automatic part of my routine.
\n\n\nIf I were in a car accident (God forbid) and suffered a spine or brain injury that erased all my old habits (good and bad), I'd have to start it all over again. I'd probably festoon my house with reminder notes: BRUSH TEETH on the bathroom mirror; EAT SLOWLY on my placemat; FEED DOGS (well, maybe not - the dogs come complete with their own extremely reliable and audible meal reminder system). That's a lot of work, I know, but the pay-off is enormous!
\n\n\n\n\n
Related: Fix Relationship Issues before Bariatric Surgery
\n\nCounseling Before and After Bariatric Surgery Helps Couples Manage Change
\n\nRelationship issues after bariatric surgery are a common topic discussed during the orientation class prior to surgery. Any drastic change that takes place in one spouse affects both of the partners. In fact, bariatric surgery will impact the lifestyle of the entire family. In a prior post, the high rate of divorce after bariatric surgery was explored.
\n\nRelationship Issues after Bariatric Surgery
\nThere are two leading causes of relationship issues after bariatric surgery.
\n\nPerhaps the relationship was poor before the bariatric surgery. The new more confident bariatric surgery partner now finds the esteem and courage to end a bad situation. Bariatric surgery can have a positive effect on a solid marriage but it can tear apart a marriage that is already on the rocks.
\n\nSometimes the partners can no longer find a common ground where interests are shared. The partner who had bariatric surgery has been energized and is no longer attracted to a sedentary lifestyle centered around eating. Whereas the remaining partner is comfortable with the lifestyle that existed prior to the bariatric surgery.
\n\nIt is this latter relationship dynamic that I wish to explore. Specifically, what can be done to resolve these sorts of relationship issues after bariatric surgery?
\n\nResolving Relationship Issues after Bariatric Surgery
\nDramatic change comes with bariatric surgery. Food shopping, mealtime, and the activities engaged in for enjoyment must shift to accommodate healthier habits if the bariatric surgery is to succeed. The loss of familiarity with "what was" calls for adjustment. And change, whether positive or negative, can be charged with emotions that promote stress. Stress will in turn grate patience, especially if the partner who did not have bariatric surgery is unenthused about the changes taking place.
\n\n\nEach spouse's job in couples therapy is to focus on his or her own learning and growth, not to try to get the other person to change.
If common ground cannot be found then you have to be ready to turn the page and end that chapter of your life. In the lifespan of a relationship sometimes a couple becomes incompatible. It is better to be alone and understand the power of aloneness than to be in a dysfunctional or incompatible relationship. But let it not go unspoken that a divorce after bariatric surgery is a decision that should come after an honest effort has been made to find solutions to the problems inherent in a marriage. Why abandon a relationship that may be able to weather the winds of change?
\n\nIf after bariatric surgery your relationship becomes strained then counseling might help to resolve your issues. The purpose of relationship counseling is for a therapist to assist in moving the couple from conflict to resolution.
\n\nResolving Relationship Issues before Bariatric Surgery
\nWe are a society that was raised on a false notion of romantic love. We think that true love means "happily ever after" and not having to work at compatibility. That's just a fairy tale we were told as children. Perhaps, then, a deep exploration of feelings and the solidarity of the relationship should be undertaken sooner rather than later. Read, "True Love after Weight Loss."
\n\nResolving relationship issues after bariatric surgery may not be the ideal time to seek counseling. With the extremely high divorce rate after bariatric surgery, it makes sense to play the odds and resolve relationship issues before bariatric surgery.
\n\nPre-marriage counseling is often done to help couples address differences prior to taking their marital vows. Likewise, relationship counseling for bariatric surgery can be undertaken. Even couples in healthy relationships can attend couples counseling to further strengthen their already strong unions. In either case, relationship counseling before bariatric surgery will prepare and strengthen the couple to better withstand the changes that will come.
\n\nWhat to Expect from Relationship Counseling
\nRelationship counseling is a type of psychotherapy and is usually practiced by licensed professionals such as a marriage and family therapist. Counseling is usually short, and both partners should participate. The benefit is that couples counseling avoids the victim or "poor me" attitude that can be a by-product of individual therapy, which encourages people to dig deeper into their own world view. Each spouse's job in couples therapy is to focus on his or her own learning and growth, not to try to get the other person to change.
\n\nCouples therapy will involve discovering the strengths and weaknesses in a relationship, improving communication, and developing problem-solving skills. Partners work on understanding their spouse's feelings and viewpoint, negotiating the differences that can be negotiated or accepting those differences that cannot. Sessions can be animated, argumentative, or pass in stony silence. The therapist must be able to guide all sessions regardless of the climate.
\n\nCouples need not be married to participate, and a couple can be heterosexual or homosexual. As is stated, another term for relationship counseling is couples counseling and marriage is not a prerequisite. A couple sharing a relationship will suffice.
\n\nWhen selecting a counselor some of the more pertinent questions might be about the counselor's level of education, general availability, number of sessions per week, length of therapy, fees and coverage through health insurance. You may find a licensed Marriage and Family Therapist in your area through TherapistLocator.
\n\nIf additional but separate problems surface then the therapist should involve other mental health counselors that specialize in those areas of need.
\n\nIf the sessions lead to the discovery that the marriage is beyond repair then it could very well in the best interest of both partners to terminate the relationship. Although such decisions can be emotionally difficult, such difficulty is probably preferable to remaining in a hopeless relationship. Sometimes relationship issues only can be resolved by dissolution of the marriage.
\n\nLiving larger than ever,
\nMy Bariatric Life
\n\n\n\n