I've always had a problem of looking in the mirror and seeing a fat chick no matter what my weight. Are y'all like that too? It's so frustrating now that we can't try clothes on and I always buy them too big and have to return them.

Is there anything you can do to see yourself the way you truly are? Thanks!

1 hour ago, ms.sss said:

Im thinking if anyone has some decent sewing skills, they could make a killing making/altering clothes for all of us on here.

Any takers, lol??

I’m talking to you, @GreenTealael

???

Oh goodness. Y'all want me to be a seamstress again?!?!? ????

14 hours ago, PollyEster said:

Roxane Gay had VSG two and a half years ago, in January 2018. You can read about her decision (it is not one she arrived at easily) and her process here and here.

Thanks for the link! I heard her on This American Life talking about fat acceptance, and it's really interesting to read her WLS experience.

I thought this was crazy: "A nutritionist cautioned us not to visit online forums about bariatric surgery, and I heeded her advice" What kind of frigging advice is this? I understand doctors don't like patients to hear competing medical advice. But this is also a terribly emotional process, and the medical staff often don't understand those issues if they haven't been through them. So many of the issues she talks about are things people here talk about. I feel like Roxane wouldn't have to feel so bad and confused about how the surgery has changed her life if she had the chance to talk more with others going through the same things.

Perhaps because Gay was so ambivalent about WLS, the nutritionist worried that Gay might read posts about complications, regret, diet neglect, etc. and reconsider surgery or develop bad habits afterward. Even in Gay's 2018 post-surgery posts, she still seems frustrated with her body.

Initially after surgery, my surgeon and nutritionist urged me to join an in-person WLS group, but after one attendance I dropped out because the issues discussed were not relevant to me (e.g., a couple talking about their marriage, a woman obsessed with an upcoming 10k) . Now both surgeon and nutritionist are really supportive of my visiting WLS forums, saying that this shows I remain "engaged."

14 minutes ago, Prestonandme said:

Perhaps because Gay was so ambivalent about WLS, the nutritionist worried that Gay might read posts about complications, regret, diet neglect, etc. and reconsider surgery or develop bad habits afterward. Even in Gay's 2018 post-surgery posts, she still seems frustrated with her body.

Initially after surgery, my surgeon and nutritionist urged me to join an in-person WLS group, but after one attendance I dropped out because the issues discussed were not relevant to me (e.g., a couple talking about their marriage, a woman obsessed with an upcoming 10k) . Now both surgeon and nutritionist are really supportive of my visiting WLS forums, saying that this shows I remain "engaged."

Maybe that's what her nutritionist was thinking - but that seems really uninformed to me. I would think that reading forums makes you more likely to go forward with surgery, and less likely to develop bad habits. Like you say - reading the forums shows you are engaged with the process. The people on the forums are more likely to be the successful, committed ones that are most inspiring. The people who are eating badly and regaining are not writing posts about it. I've sure never seen anyone around here saying "it's fine, eat all the ice cream you want" or whatever. ?

She does still seem frustrated with her body, and I felt sad for her about that. The issues she describes are definitely real, but also totally normal stuff that people here talk about all the time. It seems like she'd at least feel less alone to talk with her peers.

1 hour ago, Prestonandme said:

Even in Gay's 2018 post-surgery posts, she still seems frustrated with her body.

I'm also still frustrated with my body and I can't think of a person I know (be it a woman or a man) who isn't to some degree. It runs rampant in our society.

One has to learn to live with imperfections and limitations.

41 minutes ago, rjan said:

I would think that reading forums makes you more likely to go forward with surgery, and less likely to develop bad habits.

Honestly I'm on the fence with this one. I've seen unhealthy eating and/or exercise behavior promoted often enough on WLS boards or weight loss boards in general.

Support groups, be it one IRL or an online one can be very helpful. However, they can also be highly toxic environments. People seeking support should be aware of their own inner reactions and act accordingly. I for sure do.

Quote

The people who are eating badly and regaining are not writing posts about it.

Ever seen how the reactions to these posts are? Way too often plain smug, arrogant and downright insensitive. Who would want to talk about struggling and regain in such an environment? Not me.

14 minutes ago, summerset said:

Ever seen how the reactions to these posts are? Way too often plain smug, arrogant and downright insensitive. Who would want to talk about struggling and regain in such an environment? Not me.

Now that's definitely true. I remember a post a few months back from some poor guy struggling with losing too much weight after a bypass, which is definitely a real thing that sometimes happens. The first people here who responded to him were "nice" enough to believe him, and he was so grateful that a few people were taking him seriously and not accusing him of lying or looking for an excuse to cheat on his diet or trying to sabotage others. I felt so bad for him. It was kind of like the rescue dog I had in my 20s, who always seemed to look at you like "thank you for not beating me."

Opinionated arrogant a-holes are everywhere though, unfortunately. Some of the comments on that Roxane Gay article were from people in the fat acceptance movement who seem to view anyone who gets WLS as a traitor. That ain't healthy either.

9 minutes ago, rjan said:

Opinionated arrogant a-holes are everywhere though, unfortunately. Some of the comments on that Roxane Gay article were from people in the fat acceptance movement who seem to view anyone who gets WLS as a traitor. That ain't healthy either.

True. There will always be a-holes and batshit crazy zealots around.

I absolutely hate what the above mentioned idiots have done to both the fat acceptance and HAES movement.

Edited July 3, 20206 yr by summerset

On 6/9/2020 at 2:16 PM, ms.sss said:

...its funny because when I was bigger, I thought I was smaller than I really was. Now that I’m smaller, I think I am bigger than I really am....

Truth, I'm feeling the same way. I never thought I would experience, Body Dysmorphia.

In her essay, Gay described the decision to have bariatric surgery as "the last straw", clearly a pragmatic choice shaped by a lifetime of cultural and personal indignities and abuses. Her exquisite honesty is balm for a crude world, and a lesson in humanity.

Attitudes and decisions about weight, body image, and health are profoundly personal, but burdened and fraught. Many people make the arrogant assumption that they have a vote in what obese strangers – particularly women – decide to do (or not do) with their bodies, something Gay herself doesn’t subscribe to. She's never condemned the choices of other women, advocates for (and fully embodies) having painfully honest conversations, and makes it abundantly clear that she has "nothing but empathy for anyone who decides on weight loss surgery... or not."

Weight management, including bariatric surgery, is a complex, multifactorial decision, just as obesity is a complex, multifactorial disease. It should begin and end with respect for the individual, with the goal of improving health – nothing more, nothing less.

It was the right decision for me at the right time in my life, but I fully identify with the ambivalence, the resentment, the resistance to surrendering, and the replacement of one set of anxieties with another – and this is without the unimaginable, colossal pressure of worrying about publicly betraying fat positivity.

17 hours ago, rjan said:

Thanks for the link!

I thought this was crazy: "A nutritionist cautioned us not to visit online forums about bariatric surgery, and I heeded her advice" What kind of frigging advice is this?

You're welcome!

My clinic -- and it's not alone in this -- also advises patients to be cautious about where and how time is spent on online bariatric forums. The main reason is that they are rife with false and inaccurate information, and BariatricPal is no exception. It's not as unbridled as Facebook, but it's still social media: brimming with opinions and beliefs and thoughts, not evidence-based science and medicine.

Given the vulnerabilities many bariatric patients face in the immediate pre-op period -- but especially the hormonal, emotional, and interpersonal vulnerabilities that can arise during the post-op period -- and the numerous studies correlating the link between social media use and stress, anxiety, and depression, perhaps it would be wise to limit time on bariatric forums in order to mitigate the potential stress-cortisol-nutrition-weight connection.

30 minutes ago, PollyEster said:

The main reason is that they are rife with false and inaccurate information, and BariatricPal is no exception. It's not as unbridled as Facebook, but it's still social media: brimming with opinions and beliefs and thoughts, not evidence-based science and medicine.

While I agree with this in general I also hold the opinion that there don't seem to be really that much evidence-based treatment guidelines around. Most of the stuff seem to be more eminence-based instead.

If there would be really evidence-based guidelines out there about what treatment protocol provides the best outcome possible then why do e. g. days of planned hospital stay, peri-operative eating guidelines and longterm diet protocols vary that much, not only from country to country but also from treatment center to treatment center? The only reason I can think of is that there is no evidence-based best protocol out there yet (and honestly, I doubt there will ever be).

On 6/9/2020 at 4:16 PM, ms.sss said:

...its funny because when I was bigger, I thought I was smaller than I really was. Now that I’m smaller, I think I am bigger than I really am....

Nail on the head !!

2 hours ago, summerset said:

While I agree with this in general I also hold the opinion that there don't seem to be really that much evidence-based treatment guidelines around. Most of the stuff seem to be more eminence-based instead.

If there would be really evidence-based guidelines out there about what treatment protocol provides the best outcome possible then why do e. g. days of planned hospital stay, peri-operative eating guidelines and longterm diet protocols vary that much, not only from country to country but also from treatment center to treatment center? The only reason I can think of is that there is no evidence-based best protocol out there yet (and honestly, I doubt there will ever be).

There are *many* evidence-based clinical bariatric surgical and nutrition guidelines available to health care professionals. They are updated regularly based on the quantity and quality of the best available scientific studies. I’m attaching just one example here: it’s the most recent (2019) guideline provided by the American Association of Clinical Endocrinologists, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologist (and endorsed by the American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, International Federation for the Surgery of Obesity and Metabolic Disorders, International Society for the Perioperative Care of the Obese Patient, and Obesity Action Coalition).

In my experience at the intersection of biology and medicine, I've observed that eminence-based medicine tends to be the rule, not the exception. Medicine functions in the gulf between ideas/beliefs and science. Science is based on doubt. Medicine is a road built upon a foundation of good ideas and beliefs put into practice, but it is also a road literally paved with the cadavers of every good idea and belief that didn’t pan out. Even when they do pan out, they still need to be meticulously studied and regularly verified and updated to determine precisely how, why, and which patients benefit the most and the least. The results are not straightforward because bodies are not straightforward: there are incalculable external/environmental variables that are constantly in flux colliding with incalculable internal/genetic variables that are constantly in flux. I don't know any good scientist or clinician that wouldn't trade everything they know for everything they didn't know in a heartbeat.

All researchers and practitioners, including bariatric clinicians, should ideally continually examine and assess their own results, making changes where and when necessary, to ensure they are delivering the best outcomes for their patients. Even though this inevitably leads to variations in form -- but not function -- it's just good medical practice.

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures 2019 Update.pdf

Edited July 4, 20206 yr by PollyEster

7 minutes ago, PollyEster said:

There are *many* evidence-based clinical bariatric surgical and nutrition guidelines available to health care professionals.

If there are many, there isn't obviously a best one because if there would be a best one, there wouldn't be many.

Guidelines differ, evidence-based or not, depending on what studies are included or not. If one wants to cherrypick studies in one direction it's always possible. There are also too many unpublished studies rotting away in desks because the results were not the desired ones (that might be more of a problem when it comes to drug therapy though). Crappy study designs. Sky-high drop-out rates and having to rely on self-reporting (that seems to be a big problem in the weight loss field). Thats why I lost quite a bit of trust and belief in EBM over the years. There's also always the question of "Cui bono?" hovering and the principle of "publish or vanish".

Bonus icing on the cake: whenever I read a study about nutrition, behavior, psychological or environmental factors that might have impact on losing and maintaining weight (or not for that matter) one term at the end of the discussion almost always seems to catch my eyes: "needs further evaluation". What's a clinician supposed to do with that? Wait and see or change treatment protocol?

Quote

In my experience at the intersection of biology and medicine, I've observed that eminence-based medicine tends to be the rule, not the exception.

What I said.

Quote

The results are not straightforward because bodies are not straightforward: there are incalculable external/environmental variables that are constantly in flux colliding with incalculable internal/genetic variables that are constantly in flux.

And that's where this whole guideline and rules thing seems to go out the window. In the end it boils down to trial and error for the patient and I wish treatment teams would admit to this and therefore being more flexible in their approaches instead of practicing a one-fits-them-all approach.

Quote

I don;t know any good scientist or clinician that wouldn't trade everything they know for everything they didn't know in a heartbeat.

The clinicians I know usually want to have trustworthy diagnostic tools and effective treatments they can offer their patients. Nothing more frustrating than not coming to a proper diagnosis and being able to offer effective treatment.

Quote

All researchers and practitioners, including bariatric clinicians, should ideally continually examine and assess their own results, making changes where and when necessary, to ensure they are delivering the best outcomes for their patients.

Most likely they do and that's why there is so much eminence-based treatment out there, hence the difference between recommended diet protocols after WLS.