Caucasian, Latina, African-American. Each of us waiting in the auditorium of St. Michael’s Hospital has something in common. Once we were beautiful. Now we are obese.
I am not the only who is nervous about the upcoming informational seminar on bariatric surgery. The woman to my left scans her cell phone as though expecting a call from God. The woman to my right has been tapping her foot for the past 15 minutes. The woman in front of me rocks back and forth in her seat muttering to herself
There are 20 obese women and five men, none of who are overweight.
Two doctors approach the podium. They are part of a larger practice that requires that people interested in undergoing bariatric surgery attend one of these seminars. They are nice-looking fellows in their forties, wearing expensive suits and smiling as if they’re about to tell us we’ve just won a vacation to Antigua. I would have preferred them older and less polished, wearing scrubs and looking more like surgeons than sales executives.
Their PowerPoint presentation begins by telling us we are at risk for serious health problems like stroke, diabetes, heart disease.
Next we are shown a digitized image of a stomach. “It’s the size of a football,” says a doctor. “In people who are obese the stomach stretches to hold much more food than it needs.” I stare at the football size stomach, wishing I were Joe Namath instead of a 5’2″ woman with an inappropriately large abyss.
The doctors tell us effective long-term weight loss cannot be achieved without shrinking this stretched-out organ. “That’s why the obese have so much trouble losing weight. Their stomachs are constantly sending ‘feed me, I’m hungry’ signals to the brain.” It takes much more food to fill this demanding, insatiable maw. It’s not our fault, they say.
The surgeons describe the gastric bypass, the sleeve gastrectomy, and the Lap Band. They show slides of the bypass, where a tiny stomach is created along with an intestinal network that has been cut and rerouted. They show slides of the sleeve, a newer surgery that lops off and discards three-quarters of the expanded stomach. These two surgeries produce rapid weight loss.
They are careful to list possible complications like infection. Any surgery has potential complications, they remind us. But they are so enthusiastic about their successes that I am almost ready to sign up for the sleeve, which seems less drastic than the bypass and which I hadn’t even heard of before I entered the room.
Then they come to the Lap Band, which is why I am here. But the surgeons’ enthusiasm markedly drops. The Lap Band produces the slowest weight loss. It requires frequent office visits to adjust the amount of saline that regulates the tightness of the band that encircles the stomach. The band can erode and adhere to the stomach wall or slip out of place. People who have it removed may gain up to 30 pounds in a month.
Q&A. A woman on the verge of tears says that her Lap Band failed and wonders if she is a candidate for the bypass. Another woman asks whether a tube is inserted through the mouth to perform the gastric sleeve. The doctor says yes and I’m surprised he left this out during the talk. What else haven’t they told us?
The room is quiet but there’s a current of energy among the women. The statistics are terrifying, and time is running out. We have doctors to open us up and family and friends to put us back together. But the decision to choose surgery and to live with the consequences is ours alone. What other choices do we have?
* * * * *
The doctor closed my chart, laid it on the counter, and looked me in the eye. “You’re pre-diabetic,” she said. “In five to ten years you’ll have diabetes. You need to lose 40 to 50 pounds.”
“I’ve tried,” I told her. “Jenny Craig, Weight Watchers, South Beach. Every time I lose weight I gain it back and then some. I’ve hit rock bottom.”
She nodded. “When people say they’ve hit rock bottom I tell them it’s time for bariatric surgery. You should have the Lap Band.”
I was relieved when I heard this. I’d been asking for a magic pill and was told there was no such thing. I thought surgery would be like taking the magic pill. But four months into the process of signing up for surgery, I’ve found out I was wrong.
Surgery is not a cure for obesity. It pains me to use that word, obese, in relation to myself. It sounds so ugly, so pathological. But physicians consider obesity a disease that leads to greater risk of heart attack, stroke, diabetes. People who are obese have a shorter life expectancy of nearly 10 years. Obesity is associated with a range of co-morbid conditions like arthritis, depression, high blood pressure, and sleep apnea.
My father died of complications from Type II diabetes after suffering a massive stroke. The damage to his circulatory system caused paralysis of his left leg, macular degeneration, kidney failure, and gangrene, which eventually led to the amputation of his paralyzed leg. His suffering was so terrible that I wrote a book about it. It’s not a story I want to repeat.
Bariatric surgeries are tools to help people restrict their calorie intake. Post-surgery, people must comply with a low-calorie diet, a process that is aided by restricting the size of the stomach, which helps people feel less hungry. But these procedures can be circumvented, by consuming high caloric beverages like alcohol or milkshakes, because fluids pass through a constricted stomach more easily than solids. To be successful, the surgery requires compliance, motivation, and hard work.
Obesity is defined as a BMI (body mass index, based on the ratio between a person’s weight and height) as 30 or more. People who have a BMI of 39.9 or more are considered morbidly obese. In a July 2, 2012, article in The New York Times, Gary Taubes described a recent study that links obesity to a high carbohydrate diet which stimulates insulin, the hormone that stores fat in our cells. A sedentary lifestyle and genetic predisposition to gain weight are also factors.
I have been struggling with my weight since the birth of my first child, 27 years ago. I gained 50 pounds during that pregnancy, taking seriously the notion of eating for two. I lost 30 pounds of that weight and gained 35 pounds during my second pregnancy, of which I lost 15. So after the birth of my children, I weighed 40 pounds more than I did before I became a mother. In 1994, at age 38, I went to Diet Center and lost 35 pounds, which I did not maintain for very long. In 2001, the year my father died, I weighed the same weight I did before I went to Diet Center. I was overweight, not obese. Since then, I’ve gained 50 pounds. Somewhere along the way, I lost control. I stopped paying attention to the amount of bread and sugar I was consuming. When I stepped on the scale and saw the number, I told myself the scale was broken.
* * * * * *
I am sitting in the waiting room to meet a surgeon. I have decided to consult someone who is not part of the practice whose presentation I attended at St. Michael’s. This surgeon was recommended by a woman I know. I am hoping he will be more positive about the Lap Band.
A tall, elegant dark-skinned black woman approaches me. She is a wearing a long black dress and has a graceful, willowy shape. She starts to talk and I learn she lost 100 pounds after her gastric bypass. She has been hired to welcome newcomers, answer questions, offer encouragement and support.
I stare at her in disbelief. I thought I could tell when a woman had bariatric surgery by a certain roundness in the face and hips, indicating she was once much heavier.
“Don’t people who’ve known you flip out when they see your transformation?” I ask. She acknowledges this happens and says she tries to concentrate on what’s important, which is maintaining her weight loss through careful meal planning and daily exercise.
I believe I understand. It’s important to focus on what matters. An obese person is like a recovering addict. Abstinence from overeating is a lifelong struggle.
In a few weeks I start a pre-surgery bariatric support group. I am looking forward to meeting my new sisters. The Centers for Disease Control reports that obesity affects men and women in equal numbers, but these statistics do not match my experience. There were no men at the St. Michael’s presentation, and I’ve seen many more female than male patients in the surgeon’s waiting room. Do the emotional issues of obesity—shame, guilt, feelings of isolation and unattractiveness—affect women differently than men? I don’t know, but I do know this: we are all facing the knife.