One of my faithful readers (a small but fervent group, much to my delight) made a comment on my last post. Sybil asked why, if I've been struggling all my life with weight, I don't opt to have weight-loss surgery. This is a good question and one that deserves to be answered, so here goes.
Conventional Western medicine has tried for a hundred years to find solutions to obesity, from tapeworms to drugs to surgery. The surgical methods developed recently boil down to one thing – they make it hard to eat too much by restricting the stomach to the size of a walnut. It's an inside-out prison. Put me in a cage where I cannot reach food and I'll lose weight, I assure you. Force me to eat only blended broccoli and liquid protein and I'll lose weight. Constrict my stomach to the size of a walnut and I'll lose weight. Put me on a desert island. Tie my hands behind my back, pull out all my teeth, burn the taste buds off my tongue, sew my lips together, remove my epiglottis, feed me wood pulp – and I'll lose weight. Lots of it.
In the 70's, when I was just 18, I went to one of the most preeminent bariatric physicians in the world and faithfully followed his protein-sparing modified fast. I lost 100 pounds in 9 months drinking cherry-flavored liquefied pig snouts. I also lost my ability to think because I was in a malnourished haze, lost my ability to stand up without being dizzy because my blood pressure was so low, and lost the enamel on half my teeth from having to drink enough potassium to keep my electrolytes balanced enough not to die. What I didn't lose was the fundamental, human need to enjoy food of all types, to feel satisfied, and to have a lovely social time with friends over a meal. Do I need to tell you what happened when the program ended?
In the 90's, I jumped on the Phen-Fen bandwagon and lost 100 pounds. I also lost the ability to donate blood. I have a rare blood type and it is sorely needed by hospitals to use for infants, but because my blood pressure almost doubled while on the drugs, they turned me down at the Red Cross. If you've done any reading about the deadly side-effects of Phen-Fen, you'll know that I might have lost my life. When I went off the drugs, do I need to tell you what happened?
Fully one-third of gastric bypass patients regain their weight loss by circumventing the limitations of a small stomach (sipping chocolate milk shakes is a popular choice). Contrary to the claim that you are "satisfied and not hungry" when your tiny walnut-sized stomach is full to bursting with the one-ounce portion of tuna it took you ten seconds to eat, what you actually feel is sick – painfully full, dizzy, the famous dumping syndrome which is akin to the most uncomfortable moment you had just prior to throwing up. Almost all gastric bypass patients suffer from chronic vitamin deficiencies, the long-term effects of which have not been fully understood. Three quarters of patients have chronic diarrhea. A quarter of patients have surgical complications ranging from infections to perforations. A few die on the operating table. A few others die in the weeks following surgery. All will attend their family celebrations for the rest of their lives and eat a tiny bite of birthday cake – aware always that they cannot be fully present at the party, that they must remain ever vigilant, ever separate, ever different from the people around them.
The argument goes, so what if there are health risks to gastric bypass? Being obese is so much more unhealthy. Actually, surprisingly, despite all you've read and all you believe, what seems to be the most unhealthy things about obesity are the weight loss-weight gain yoyo that puts enormous strain on the heart and circulatory system, and the emotional distress of trying to be thin: the devastation to self-esteem of yo-yoing up and down the scales (failure being an unrelenting visitor to a dieter's door) and the overriding sense of guilt, shame, embarrassment and pain of being fat, of being reviled by most of society – of hating yourself.
My recent visit to the doctor surprised me and may astound you – normal blood pressure, normal cholesterol, normal triglycerides, greater than normal lung capacity, no diabetes, normal liver and kidney function, normal ECG. And I'm a 440-pound 49 year-old man. I'm supposed to be dead.
I am convinced that obesity is a puzzle that hasn't quite been figured out yet. I believe it is a complex, yet fundamental, coming together of cross-purposes between the mind and body, between the conscious and the unconscious, between the lizard brain and the frontal lobes, between DNA and the environment, between nature and nurture, between thought and feeling, between holy and profane, between life and death.
I am convinced that the solution will not come from the Medical-Industrial Complex. Their response so far is to treat symptoms, not causes – and make billions of dollars in the process. Whatever convoluted treatment they might develop, the mind/soul must have its own way.
I have an opportunity here – I am my own laboratory. I am a thinking, feeling, functioning person with 45 years of experience being fat. I can possibly make a breakthrough that will change my life. That breakthrough might even change others' lives.
Or not.
5 comments:
Well clearly you've given this much thought, and I must say - I respect your position.
To be honest, I really never considered the social/emotional aspects of altering one's digestive system. I only saw the tremendous weight loss that so many of my friends have experienced through bypass surgery.
Thank you for sharing your perspective, and allowing me to see a different one.
I think it's my combination of experiences butting up against the medical/pharmaceutical world with mixed results. Plus my friend Ande, who works in a hospital, told me about a young guy, about 25, who weighed 600 pounds and went in for a gastric bypass. Ande saw him in the emergency room a few days after surgery. His incision had become infected, his internal organs swolen, and he finally just exploded. That image stays with me, even though I know that the procedures these days are much less invasive and much more safe. I don't know, Sybil. Mostly I'm afraid that I would be one of the people for whom the procedures don't work, and I've gone to that well before - the one where I say, "This is it, it's your last chance, there's no choice, you either lose weight or you die." It's true that I've thought about it a lot, and I revisit the idea about every six months, it seems, doing another round of research, weighing the pros and cons. Thank you for giving me the opportunity to put it in writing, at least how I feel about it now.
xxx Stevie
You know - once, I wrote here that you and my brother Steve are kindred spirits. He too is very overweight. He too is gay. He too misses having someone special in his life.
Two years ago this week he showed up on my doorstep. The circumstances of how he got there are irrelevant, but for three months I worked hard to get him back on his feet.
In October he was in a new job, a new apartment, and enjoying new friends.
In March he was complaining of not feeling well. In April, he couldn't walk 10 steps without feeling faint.
I took him to the doctor, and he was sent immediately to the hospital in an ambulance, hours from death. A virus had attacked his heart. He was in the hospital for 3 weeks, until finally, his heart was stable enough to go home...BUT - upon entering the hospital he weighed 420lbs. He was told clearly and directly that unless he lost weight, he would die. Period.
We are now 15 months post, and he has lost 100lbs (give or take.) He has plateaued though, and while I'm very proud of his results, I'm afraid because he needs to lose at least another 50lbs in order to get the treatment that he needs to regulate his heartbeat.
His doctor is trying very hard to convince him to undergo gastric bypass surgery, and he adamantly resists.
Until reading your post, I was completely blind as to why he could possibly not want this surgery. Perhaps, he like you, isn't ready to undergo a "last resort" so-to-speak.
I don't know. I wish you and my brother had eachother to talk to.
Sybil, oh my God. I'm sorry about the situation your brother finds himself in (and the frighteningly close call he had a little while ago.
I understand where he is right now. I, too, have lost a hundred pounds and plateaued, only to put it back on. And I've thought about why. I think there's a tendency to say, "Wow, look how much I've lost, look how much better I feel, I can do so many things now, I look so much better!" And a sort of complacency sets in, coupled with an intense boredom with whatever program you've been following, and a year's worth of cravings you haven't been able to feed. It all comes together to make it really tough to keep losing, to hold onto the progress made.
In my own case, after losing a hundred or so pounds, feeling lots better but bored with things and desperate for a distraction, I would latch onto a crisis of some kind, a big bouncing problem (with a built-in excuse) to give me a reason to stop focusing on the weight loss. And sure enough, as my business partner snorted up our profits or some other problem loomed ominously,I'd let go of my progress - with a huge sigh of relief - and utter sorrow. Here we go again. They call it a vicious cycle for a reason.
Another thing I've grappled with on this blog is the idea that guys like us, we're self-destructive by nature. I mean, would a self-caring, self-loving person do this to themselves? I wonder sometimes if my core belief of "I'm not good enough" comes running into the equation right at the time when I should be feeling pretty good - lost a 100 pounds, feeling better. Not being used to feeling all right about myself, maybe I start to feed again to return to the comfort of the self-destructive behavior.
From a practical standpoint, I believe someone who has lost a 100 pounds but still has a distance to go needs to do some severe mental work to see himself not as 100 pounds thinner but as a 320-pound person. If Steve's like me, he will remember when he weighed 320 pounds before and didn't much like himself, thought he was really fat. Strange as it may seem, I think he has to wipe the slate clean in his mind so that he can see himself now as a person ready to drop another 100 pounds. It's like the marathon is over, with all its training, and tomorrow we start to train for the next marathon. It's daunting. It's really really hard. But it's possible.
I know it seems like an obvious thing: "Stop doing what could kill you!" But we don't hear it like that. For some reason, it doesn't work.
Minute by minute, hour by hour, day by day, for the rest of his life, Steve must choose to do something completely different from what every instinct, every physiological, emotional, psychological system is screaming for him to do. To be confronted with that can be too much. What trick of the mind can we do to suspend the perceived dread of that particular life sentence and allow things like health and vitality and comfort supplant it?
I know, you're saying, "Well, what about the life sentence - the death sentence - of being severely obese?" All I can say is it's a prison we know very well. There's a post from a couple of months ago where I talk about Sisyphus, the guy who had to keep rolling a huge boulder up a hill. It's kinda like that, the horrible task or condition that takes over your life to such an extent that eliminating it seems wrong somehow. My life is a total disaster, but at least it's MY disaster. Something like that.
This is an intensely difficult problem. Steve may feel like he's on the edge of a knife, teetering always with the foreboding of gaining again, of even dying. The impulse to be done with it, to jump off the path - is real.
Please know that I'm in Steve's corner and your corner - and I'm sending both of you my love.
xxx Stevie
It's a complex, self-feeding, matrix of issues, and it's America's last allowable prejudice.
When I see Jenny Craig's new tagline, "I'm a size healthy," I think that perhaps we may have learned something about ideal body images.
I will say this; I'm so glad that you're physically healthy; and emotionally strong.
Good On You !
-Sybil-
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