2022, Mom thoughts, Weight Loss Surgery

Upsurges of Grief

Perhaps unsurprisingly, I’ve been thinking about my mom a lot lately, with the impending celebration of Mother’s Day and my upcoming surgery.

Since she died 5 years ago, any time big personal changes loomed on the horizon I have felt that familiar swell of emotion that seems to be located somewhere between my stomach and my lungs, overwhelming me physically and mentally. This sensation can last for mere minutes or even long hours. 

As I would imagine is normal, I imagine how she would react to these changes and achievements. Sometimes it’s easy to imagine her reactions.

When I defended my dissertation, she would have been proud and so pleased to see the culmination of years and years of work at last at its joyful end. 

She’d have celebrated as I taught my first (and probably only) study abroad course (something I always wanted to do!) in Italy in May 2019. 

She’d have hurrah’ed when I landed my first post-PhD job (with benefits!) at the Institute. 

She would have been proud, excited, and disappointed when I got a job at Vanderbilt and moved to Nashville. Disappointed, because I wasn’t moving back to Virginia, choosing my Nashville family “over her” (that’s how she’d see it), but still she’d have been proud and excited for my accomplishments. She loved me.

But…as my surgery date approaches, I am having a hard time picturing how she’d react to this choice and new frontier. 

Mom could—at times—let her own emotional hang-ups color her response to things going on in my and my siblings’ lives. Would her own struggles with her weight have influenced her reaction to my weight-loss goals? Would she have been less supportive than she’d have liked, whether intentionally or not? Would she, as she was sometimes wont to do with others who had gone through similar procedures, make snide comments about my potential to fail or relapse? Would her encouragement be a little too cloying, her smile a little too bright, suggesting that she didn’t actually believe what she was saying? Or worse, and definitely possible, would she barely attempt to contain her unique blend of judgment and jealousy? 

On the other hand, she may have reacted excitedly, full of support and pride. She did often tell me to try to lose weight before I got too old, because the older you get the harder it is and the more physically painful it is to try to take it off. My mother lived with daily pain in her joints and back, moving, sitting, and existing was a struggle. I know that this physical pain manifested itself emotionally too. I know she’d want me to avoid that. So perhaps knowing that I will avoid some of that pain in my life would make her happy for me.

But at the same time…would she have even realized that her reality was the very future I am trying to avoid? Even worse, would the idea that I was trying to avoid becoming like her— to not share this daily pain and struggle—give her (more) emotional pain? 

In some ways, her death has made this easier. The risk of not taking steps is clear. I need to go on this journey for my own mental and physical well-being. Because I will never know how she would actually react, I can choose to imagine her response as loving and supportive as I would like it to be at any given moment.

However, this too is a hard emotional line to walk, because in reacting this way, her death becomes akin to a gift. One that has allowed me both the freedom to act without causing her hurt and provided me the motivation  to change….

But…

How could her death ever be a gift? 

Right now, I like to think that my choice to pursue a WLS and strive for a healthy life honors both her life and her death. My mother wasn’t perfect. (I mean, whose mother is?) In many ways, I am on this obesity-related journey because she was. Since, in the long run, my mother would want the best for me, I’d like to think that she’s pleased by my choice to move forward with a gastric bypass, hopeful that it will work, but fearful that it will not. 

But I’ll never know. 

Lather. 

Rinse.

Repeat. 

2022, Personal, Weight Loss Surgery

IT’S FINALLY HAPPENING!

As you may know, I have been working toward having a gastric bypass for almost 2 years now.

Finally, I have a date for my surgery, and it will take place in late May.

I’ve decided to answer some questions here that I have been asked often since deciding to go through surgery, and a few I think people probably have even if they haven’t asked directly. I plan to update this at a few points after surgery to compare. 

Q: What made you decide to get bariatric surgery? This seems drastic. 

It was a decision that was simultaneously gradual and all at once. I didn’t realize until recently how long it had been in my head. Ultimately though, there were several factors that led me to this decision and kicked my butt into gear. 

I’ve seen very clearly what can happen if I don’t get certain habits under control through my mom’s example. This is a thing I’ve known for a long time, but have not been very successful altering on my own or with many of the “commercial” options out there (noom, weight watchers, etc). I am an emotional overeater. I can literally draw lines between certain life changes and stressors to moments when I gained weight, exactly 20 lbs each time in most cases. This incremental growth is not unlike what I saw happen to my mom. I wanted to break the cycle. 

As for the timing, several things all became really clear to me when I turned 35 a few months into the pandemic. There are things I want in my life and I was tired of feeling stalled. I had gained a pandemic 30 (more than my usual 20). I want a kid. I want to be more active and I didn’t want to tire quite so easily. I know that you can do and be all of these things while being fat. 

But. 

It is hard to be in my body physically as it presently exists. Of course, lots of the external things that make it hard could be (and should be) shifted to easily make room for bigger bodies—seats on planes, societal expectations, etc. However, there were lots of internal things. I was beginning to feel constraints—things that were harder than they used to be because of my size. Some recurring issues that were directly caused by being overweight. I didn’t always feel as stable on my feet. It was becoming harder to get up and get down and get comfortable. 

Sweaty and tired, but I had so much fun!

I have always been fairly physically active–and I’ve definitely kicked that up since 2019. This past week, I danced my ass off for 2 hours with no breaks with 3 super high-energy dance instructors. Every jump, every skip, every move, while carrying double the weight of the people around me. It’s, I can only imagine, doubly exhausting. 

I knew all of these problems wouldn’t get better with age, and I want to get myself in the best shape possible for (hopefully) pregnancy, childbirth, and parenthood, and just simply for the rest of my life. I want to have more endurance. I’d like to be able to walk farther, go longer, and dance harder. I’d like to trust my body to be capable of things it hasn’t and hadn’t been able to do in the past. 

Q: What procedure are you having? What were your choices? 

There are two types of surgeries that were on the table: a roux-en-y gastric bypass and a sleeve gastrectomy. 

Both surgeries, in essence, make the stomach smaller reducing the amount of food you can consume in a sitting. Neither surgery is a magic pill and neither will work without hard work on the part of the patient to change various behaviors. 

L: Gastric Bypass, R: Gastric Sleeve

A sleeve gastrectomy involves removing the lower part of the stomach so that it resembles a sleeve and is vaguely the shape of a banana. The pros to this surgery is that it is less invasive; it’s a shorter surgery and a simpler procedure. The cons are that it tends to not work as well—folks frequently regain the weight and or need surgical revision to a bypass; it can make worse or cause new acid reflux problems; and the weight loss tends to not be as profound. 

The RNY Gastric Bypass is more involved. It makes a small pouch out of the stomach and connects the small pouch to the small intestines thus bypassing most of the stomach, the pyloric sphincter, and the intestinal duodenum. The pros are that the weight loss is more profound and sustained over time and it can often cure GERD/acid reflux. The cons are that it is a more complicated procedure, and thus more dangerous. 

Both surgeries tend to see obesity-related illnesses and side-effects reversed or see them under control, like Type II diabetes and high-blood pressure. (On the other side of the coin, 15% of people who go through weight loss surgery become alcoholics. They replace food with booze.)

I am having a RNY gastric bypass. I have had issues with reflux caused by postnasal drip/allergies, so the sleeve wasn’t a great choice. Additionally, at the beginning of my weight loss surgery journey, if I lost 200 lbs, I would still be considered overweight (according to BMI calculators, which is of course, a questionable indicator of health). 

Q: What is your goal weight? 

I don’t have a goal weight and contrary to what a lot of people think, my doctors have not given me one. Generally, you can expect to lose 70-80% of your excess weight. For me, that would be around a loss of 100 lbs post surgery, and I’ve already lost 56 lbs in the prep stage. 

I think my goal would be around 120 lbs post surgery. This, as absurd as it may seem, would still put me in the overweight part of the BMI chart. 

Q: You lost weight before surgery, why not just do it naturally/why are you taking the easy way out? 

Left, April 2021 after my supervised weight loss. Right, July 2020, right around when I took steps to get started with WLS.

Dude, this is hard. I lost 56 lbs, but since moving, I have maintained but not lost much. I’m okay with this, and I see this as success in and of itself. The more weight you have to lose, the more stalls you have and the easier it is to backslide. I’ve seen the reality of this in the months since moving to Nashville. Surgery is a tool to help me both lose weight, but most importantly, to assist me in getting some unhealthy habits under control. The program I went through helped me to, for the first time in my life, NOT gain 20 lbs during a major life change. I eat relatively healthily, I work out three times a week and I’ve seen no movement (in inches or lbs). 

Q: What did you have to do before surgery to qualify? 

Sigh. I’ve had to do this process twice since I moved and got a new job with different insurance. Long story short: you have to do what your insurance company says and what your surgeon’s office says. All the requirements are different. 

The first time around: I had to do 6 months of supervised weight loss, a psychological evaluation, an appointment with a nutritionist/dietician, and several meetings with my surgeon. 

The second time around: 12 independent meetings that could consist of meetings with my surgeon, dietician, a psych evaluation, screening for sleep apnea, etc. The meetings from my previous office counted toward the 12. I had to do the psych evaluation over again and that definitely was frustrating, and took a very long time to get straight. 

Q: What is recovery like?  

This seems to vary widely. I will stay in the hospital at least one night, and then will be off work for at least a week. My work is an office job and I work primarily from home, so I’ll play the weeks after that first week by ear. 

The surgery will be done by robotic laparoscopy so it won’t be full open/large incisions, but several smaller incisions. Some people bounce back quickly, others take longer. 

It’s hard to know where I will fall! I’ve only had one minor surgery on my hand, not much pain, but sleepiness. This is entirely different. 

Q: How have you been preparing mentally and physically for the surgery? 

Oh boy, the prepping mentally is really what it is all about. I’ve been working toward getting this surgery since October of 2020. The surgery is not a magic pill. It will not make my bad food habits disappear. I see both surgery and therapy as co-tools to becoming a healthier version of myself. 

Physically, I have just tried to stay active and hydrated, both things that will help me recover faster. 

Q: What will you be able to eat post surgery? 

This is a process. 

Before surgery, I have to go on a liquid diet for a week, drinking 4 to 5 protein shakes a day, plus at least 64 oz of other liquid such as water, broth, etc. This liquid diet helps shrink the liver before surgery and prepare the stomach for surgery (which the surgeon has to move aside to perform the procedure). 

After surgery I will be on a liquid diet for 2 weeks, followed by 2 weeks of soft foods, and then I’ll move on to ‘normal’ foods, which will be dictated by what I can tolerate. Soft foods will be things like yogurt, refried beans, ricotta bake, etc. Once I’m back on “normal foods” I may have issues with fattier meats and “stringy” vegetables. People tend to have a hard time processing things that are ‘tough,” fatty, rich, or sugary—a good thing. 

Q: What other potential side effects are there? 

It’s a surgery so there are plenty of risks that come with going through a procedure and under anesthesia. To mitigate these risks I get to go through a bunch of pre-surgical screening. 

After surgery, there’s the risk of ulcers and hernia as well as nausea for a while as I adapt. I will also be susceptible to what is called Dumping Syndrome (it sounds awful) and is a good motivator for sticking to the plan. I will likely lose some hair temporarily 2-3 months after surgery (I might be more nervous about this than all the other things). 

Q: What other lifestyle changes are there? 

There are some things post-surgery that I will have to do forever.

  1. I will need to keep meals to around 1 cup of food at a time for the rest of my life. 
  2. I will take a vitamin regimen for the rest of my life in order to avoid becoming deficient. 
  3. I will need to not drink 30 minutes before or 30 minutes after eating–as the stomach’s lower sphincter will no longer be there, drinking that close to eating will cause me to become hungrier sooner. (You can take tiny sips.) 
  4. One of the hardest is that I will no longer be able to use ibuprofen (my chosen pain reliever) or other NSAIDs post surgery because the risk of ulcers will be too high.
  5. Carbonation will forever be a no no–it can stretch my stomach and lead toward overeating and slipping back into bad habits. 

Q: Is there anything you think you will miss about your pre-surgery self? 

Sure. I definitely have thought about how right now my identity is as a fat person. I like me. I like who I am and it will be weird to lose that part of my identity, and to look different than I have my entire life. 

I will also miss eating cake. (After I am pretty far out from surgery, I may be able to have some cake again, but sparingly, and only a few bites.)

Q: What do you look forward to post surgery? 

Honestly, at this point, I am looking forward to it being done and being past this limbo moment. Having to go through the approval process twice under two different programs and insurances has been frustrating. 

I am looking forward to seeing how I look after weight loss, but in a very analytical rather than vain kind of way. I’m astounded at how different people look in their before and afters. I’m curious to see–will I look more like my mom when she was younger? More like my sister? Just myself with less fluff? Or will I look mostly the same? 

Q: What are some weird things that have come up that you did not expect as part of surgery? 

TBD! 

Do you have other questions? If so, let me know!

This post is not intended to be medical advice. Any and all discussions about your own post-op bariatric care or the choice to have bariatric surgery should be had with your own doctor. WLS is a choice that every individual should make for themselves. It’s not going to be everyone’s cup of tea, and that’s okay. Big is beautiful, wonderful, and strong. I am lucky to have had really excellent medical care that hasn’t been–as far as I can tell–negatively impacted by fatphobia. I know this is not everyone’s situation. This was a choice I made and one that I brought up to my PCP, not the other way around. She helped me talk through some of the pros and cons, as well as some other medical weight loss options (such as drugs that encourage weight loss), and made it clear she supported whatever decision I made–even if it was to be none of the above.