Weight Loss Surgery: The Easy Way Out?
Are you frustrated with diet and exercise? Feel like it’s too much effort for little to no payoff? Is weight loss surgery something to consider? Probably not. Why? The qualifying criteria for surgery is strict; the lifestyle changes required are extreme, and after surgical healing is complete… a healthy, low calorie diet must be followed. And exercise? That doesn’t go away either. In fact, the recommendation is about an hour every day.
Weight loss or bariatric surgery has become more common in the U.S. / Canada / Mexico as surgical techniques and outcomes have improved and most insurance companies are covering it. As a bariatric dietitian, I see patients before, after and many years out from surgery. Sadly, there’s a common misconception that patients who choose to have surgery are taking the easy way out. Short story: going under the knife is copping out.
I find this comment uninformed and hurtful. I have never seen a patient who hasn’t carefully considered the risks of surgery or what they will have to incorporate and eliminate from their lives afterward. Proactively choosing a surgical tool, when all other measures have failed, is a courageous example of taking personal responsibility for one’s health…not a stroll down Easy Street.
Bariatric surgery is not for those with 10, 25 or even 50 lbs. to lose. Surgeons will only operate on patients with a body mass index or BMI that is 35 or greater. If a patient has a chronic disease as well as obesity, the qualifying BMI drops to 30 since the health urgency is even greater.
When an individual meets the BMI minimum and has had no luck with a long series of diet and exercise plans-- weight loss surgery could be the tool helping them regain their health.
Ironically, there’s a lot to gain from bariatric surgery but it comes with a high price. In Canada the cost is waved if your doctor supports your decision, however wait times of several years could count against you. Always start by asking yourself if your considering surgery if you are prepared to do the following….permanently.
· Never drink with meals again
· Give up smoking, carbonated drinks and severely restrict if not outright eliminate, alcohol
· Exercise an hour per day 6+ days per week
· Take a minimum of 5 vitamin/mineral supplements throughout the day
· Chew food at least twenty times per bite
And there’s little margin for error. If patients push the limits of their new stomachs, they pay for it with intense physical pain including nausea and vomiting.
The journey after weight loss surgery is exciting, scary, motivating and hard. As more weight is lost, confidence grows but new challenges appear. Relationships can be tested; self-esteem may soar or sink. It’s no surprise that support during this journey is essential. Research repeatedly shows patients receiving professional, non-judgmental support after surgery lose the most weight and keep it off. Since surgery is only step 1 in the weight management marathon, it’s clear to me, patients choosing this option aren’t slackers at all—more like superheroes. Easy way out is the furthest thing from the facts.
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Article #2
A common comment people who have had weight-loss surgery hear is: “So, you took the easy way out.”
Speaking from personal experience, I can say that those who utter (or think) this miss the mark by a mile.
People who turn to weight-loss surgery do not do so on a whim. Doctors and insurance companies frequently require verified previous attempts at weight loss. Counseling sessions are scheduled and dietician meetings held. There’s psychological testing. Blood work. Cardiac clearance. You need to stop smoking.
All of this before you are cleared for the operating room.
Weight-loss surgery is major, involving significant changes to the gastrointestinal system. While it is mostly now completed laparoscopically, some weight-loss surgery patients know before surgery that it will be completed via a major, open incision while others learn that the operation was converted to an open procedure when they wake up in recovery.
After surgery, the possible side effects are endless. Pain. Dehydration. Nausea. Gas. Fatigue. Hair loss. Dumping syndrome (that's when undigested contents of your stomach move too rapidly into your small bowel; symptoms often include cramping, diarrhea and nausea). Sliming (a white, foamy discharge from the mouth). These are considered minor setbacks that patients may suffer.
The Hardest Part
So there is nothing easy about weight-loss surgery. I don’t say this looking for sympathy. I say it because the so-called easy way is hard.
You are on a liquid diet for 14 days prior to surgery. Five protein shakes at 160 calories each — 300 calories per day. That’s about one-fourth of what I typically consumed.
The hardest part? No carbonated beverages. None. I was a Coke junkie. I loved Coke. Craved it. I’d have at least eight cans a day.
I was also a connoisseur. I knew that McDonald’s Coke was the best. Better than cans. Better than bottles. Better than any other fountain Diet Coke at any other store or restaurant. And I knew why, too. Because McDonald’s invests more in water filtration, so it has better water, and because it chills both the water line and the syrup line, making its blend of Coke have more bite than any other I found.
Gone. My beloved Coke was gone. I began weaning myself in June and had my last one around my birthday at the end of July.
And no beer either. I don’t drink much, but beer was my favorite. It, too, is carbonated. It, too, was gone.
I’ve not had any caffeine since my last Diet Coke. I can’t say that my body misses it, but my brain sure does. (And yes, it is ironic that drinking zero calorie pop can make you fat.)
A New Way Of Eating
The gastric sleeve reduced the size of my stomach by about 75 percent. It’s no surprise that I needed to learn a new way of eating.
Immediately after surgery, for Phase 1, what I had to eat made the pre-operation protein-shake diet look like a Las Vegas buffet. Clear liquids. Oh sure, you can have protein, as long as it is in a clear liquid, which means it tastes awful. This lasted several days post-op.
Phase 2 was the return of the protein shakes for two more weeks wit purees.
Phase 3 was pureed/soft foods, basically anything rich in protein that you could put in a blender or food processor before eating. Blended cottage cheese. Blended eggs.
Phase 4 was soft/hard foods, high in protein and easily digestible. This lasted two more weeks.
On Oct. 13, 2014, I reached Phase 5: regular foods.
That’s the plan for the rest of my life: eat protein first, followed by vegetables. Avoid carbs. Avoid sugars.
I have averaged 800 to 900 calories per day since reaching Phase 5. I track my food on an app on my phone. I drink at least 64 ounces of water each day. No bread. No dessert. No refined sugars.
The surgery helps me feel full faster. It helps me achieve the dietary goals I was unable to achieve for the past 30 years.
A Tool Vs. a Cure
But weight-loss surgery is not a cure. As surgeons commonly and rightly state, it is a tool, and not a perfect one.
There are legions of stories of people who have figured out how to eat around the surgery. While the sleeve limits my ability to eat large quantities of food at one sitting, I suppose I could graze all day on ice cream and consume enormous quantities of calories without upsetting my new, much smaller stomach.
But I won't do that. Part of my motivation for writing this blog is to achieve a level of self-accountability that might help me succeed.
My New Exercise Regimen
In addition to significant dietary change, exercise is my new normal. My goal is for my cardio workouts to last 180 minutes per week. I try for light strength training three times per week.
Exercise is very important to prevent the loss of muscle mass during rapid weight loss. It also is starting to make me feel better for the first time in many, many years.
My previous attempts at exercise made me sore and tired. The weight loss from the surgery has made exercise more pleasant, though I am still waiting for the endorphin high that people claim to get from it.
I hope my long-term outcome does not include a route toward a new unhealthy eating pattern. I have lost 90 pounds since my surgical consultation in May 2014 — 76 pounds of that since the surgery in August. I am within 30 pounds of my goal after not quite four months.
The window of time to lose weight in a rapid manner lasts six to 12 months, according to the literature and the people who've been so brave and caring to share their stories and advice with me.
Now, all of this writing about dieting and food is making me hungry. I'll drink more water and go for a short walk. It’s a new life after all. It wasn't so easy getting here.
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Stay Tune~ Nat
Mind/Body Under Construction
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