Wednesday, March 16, 2011

Excuse me, I believe you have my stapler...

I’ve been thinking a lot lately about having weight loss surgery.

I’ll give you a few moments assemble the villagers and get into full-on angry mob mode. Got your pitchforks and torches ready? Great. Start marching, but promise me you’ll read the whole thing before setting fire to the comments section, ok?

It’s not the first time I’ve thought about it, of course. I’ve considered the pros and cons of the various procedures that fall under the umbrella of weight loss surgery (WLS) for years. In fact, I remember being in grade school the first time I heard about someone my parents knew who was getting their stomach stapled. At the time, the fat and I were just starting our life-long tango, and I was already painfully aware that my weight was a problem that needed solving. I recall hearing my Mom talk about how the person would lose a lot of weight after the surgery, but if they ate too much the staples could rip out and they could die. It scared the hell out of me, partly because the name of the procedure conjured up an image my head of my second grade teacher Mrs. Nelson pointing her taupe metal monster of a stapler at my midsection and slamming her palm repeatedly onto the arm of it (she was a scary broad) and partly because of the whole “if you eat too much you die” thing. Even then I knew I could never have my stomach stapled. I always ate too much.

WLS has come a long way since then, with a bevy of procedures with fancy names and less invasive techniques. Call it gastric bypass, roux-en-y, duodenal switch, lap band, or even good old stomach stapling, it all comes down to the same principle: drastically reduce the body’s ability to take in food by drastically reducing the capacity of the stomach. It’s major surgery, a measure once thought of as a last resort that has become an increasingly more popular. Hundreds of thousands of people each year weigh the pros and cons of jumping on the WLS bandwagon. I’ve weighed them myself.

Cons: It is major surgery that permanently alters the regular functions of the digestive system, and the effects cannot be reversed. It has a stated mortality rate of 2 % within 30 days of surgery because of the complications that severe obesity brings to the surgical table, and post-operative complications arise at a higher level for WLS patients for the same reasons. It’s life altering, dangerous, and comes with a long list of life-long limitations, requirements, and side effects that one must accept in return.

Pros: It works.

As weight loss techniques go, it’s hard to argue with results. Most people who have bariatric surgery lose weight. A lot of weight. They lose it faster than those who go with the diet and exercise route exclusively, and—this is important—they keep the weight off a lot longer. Because patients no longer have the ability to overeat (at least at first), the procedure takes the concept of willpower out of the equation for a period of time, allows the body to shed weight under the premise that it will be easier to keep it off in the long term. Of course there will always be notable exceptions, but statistically speaking if you want to take off a lot of weight and have a better than normal chance of actually keeping it off for a significant period of time, then going under the knife is your best chance at doing so.

But don’t say that too loudly.

Get any group of people together, and no matter how united they are in their common purpose, they will find a way to divide themselves. In the community of people who are fighting morbid obesity, WLS is a very divisive issue. Log into a weight loss message board and ask a group of people struggling to lose 200+ pounds whether they have ever considered WLS, and you’re likely to get a flurry of responses from people who have considered it, but ultimately decided against it. I’m one of them. It isn’t the content of some of these responses that surprises me, but the tone.

There’s an air of superiority that hovers over the debate against WLS. Much pride is expressed in the decision not to take the “easy way out” and to lose weight the “right” or “healthy” way. It’s as if there’s a moral code in fat-fighting circles, and those of us who go the traditional diet and exercise route are dutifully playing the hand we’re dealt by the rules, while those darn WLS people try to sit down at the table with aces stuffed up their sleeves. We’ll show them. We don’t need to cheat to win, we can lose just as much weight the old fashioned way!

But the thing is, most of us don’t. The weight loss recidivism rates for traditional diet & exercise are astronomically larger than those for WLS patients. And believing that there is a “right” way to lose weight only buys into the theory that obesity is primarily a character flaw, and that the tools we choose to combat it fall somewhere on that same moral compass. I can use a butter knife to loosen the screw holding the kitchen light fixture in place, or I can go the garage and get a screwdriver to do the same task. Just because it took me longer to get and use the screwdriver doesn’t make the light bulb replacement process more righteous or the light in the kitchen brighter. My choice of tool has nothing to do with the end result. And at the end of the day, that’s what WLS is. A tool.

I know people who have had WLS and are living healthy, fulfilling lives in bodies that let them move freely through the world in a way they never could when they were morbidly obese. They have followed the post-surgical recommendations, accepted the limitations of their newly plumbed digestive systems, and tell me that what they’ve lost is absolutely worth the new life they’ve gained. The comorbidities that their obesity brought with it are gone, and they are healthier than ever. They are the poster children for what WLS can do for someone who has struggled with obesity for most of their lives.

But I also know people who have had WLS whose experiences haven’t been as picture perfect. People who never lost all the weight they expected to, who experienced debilitating post-surgical complications, who weren’t able to follow the strict guidelines they were given after their procedures and suffer because of it, who changed their physiology without addressing the psychological components of their obesity and eventually ended up right back at the weight they were before the surgery, and higher. I know of people who have lost their lives as a result of the same surgery they hoped would save it.

I believe that it’s crucially important that both sides of the story be told, that anyone who is contemplating a surgical remedy for their obesity should know that it isn’t a cure, and that there can be disappointing, dangerous, and sometimes fatal consequences to WLS, that the risks sometimes outweigh the rewards. But I believe that it’s equally important that we should also accept and celebrate the successful outcomes of WLS, we should revel in the successes of our fellow fat fighters who have chosen to add WLS to their arsenal of weapons in their weight loss battles, and that the reward is sometimes worth the risk.

For the record, I’ve decided against WLS. I have weighed the pros and cons, and my obesity and I are living together pretty peacefully lately and continuing with Weight Watchers still feels like the right path. For me, the possible risks of WLS to my health and future aren’t worth what might be gained, nor are the sacrifices I would have to make worth it to me right now. But that doesn’t mean I think it’s a universally bad choice, or that I might never consider it again. If I have learned anything on this journey, it is that I don’t have all the answers. I do not begrudge anyone the right to choose their own weapons in fighting our common enemy, and I wish us all peace in making the choices that are right for us.

Friday, March 4, 2011

Come on baby, (re) light my fire...

Psssst! Hey, fellow fat-fighter. Yeah, YOU!

Are you losing your motivation?  
Did you start this journey with a long list of reasons to get healthier and an iron resolve that seemed to only get stronger with every pound shed? Did you feel invincible and wonder why on earth everyone couldn’t get their act together like you did?
I did.  
And then one day I woke up and it just…wasn’t…there…anymore.
I searched for it, I tried to relight it, I even accepted that it might never burn as bright as it did once upon a time.  I missed the old flames, yearned for them.  Wished and hoped that one day they’d rekindle.
And then I got over it.
I can make a list of a thousand reasons I want to lose weight, but the truth is that weighing enough to call this board home means that there is a single reason to stay in the fight that I must never lose sight of:
I want to LIVE.
I want to experience life in a body that doesn’t limit my choices and opportunities at every turn. I want a life that isn’t cut short by the health issues that obesity fosters. I want to make decisions free of the fat, to not have to the width of my body decide what I can and cannot do.  I don’t want to be crushed under the weight I carry or the emotional burden it brings with it.

If I was stuck in a burning building, I wouldn’t sit idly by while the smoke got thicker wishing I could breathe better.  I wouldn’t walk half way to the door where the air was a little clearer and sit back down.  And I certainly wouldn’t stay there as the flames got closer, telling myself “Well, at least it’s warm in here…”  
Of course not.  I would run, I would fight, I would break down the walls if I had to. I would do everything I could to escape the flames and breathe clean air again.
This is not about wearing cute clothes or turning heads.  It’s not about being a certain size or shedding a specific number of pounds. This is about LIFE and DEATH.
I choose LIFE.  
Which do YOU choose?  What are you going to do today to make it happen?

Tuesday, March 1, 2011

Have Food Issues, Will Travel

You know how when you go into the monkey house at the zoo, and the smell of the place assaults your unsuspecting nostrils and you can’t help but gasp and exclaim “Wow, it smells AWFUL in here!” to anyone in earshot? And then you’re all like “Hey, look! Baby gorillas!” and you find yourself enjoying watching the chimps frolic on their jungle gym and laugh as the cranky old orangutan flips the bird to the crowd with a big, gummy grin, and after a while it doesn’t smell so bad because you’ve gotten used to it and you don’t even notice it anymore until someone new walks into the building and you hear them gasp and say “Wow, it smells AWFUL in here!”

Turns out I was living in the monkey house.

It didn’t occur to me just how much life I’d been missing out on in the last several years until I started actually living again. All of a sudden I felt free to actually DO things, amazing and exciting things like running out to the store on a whim, or going to a movie on a weeknight, or having a leisurely Saturday night dinner with a friend, or going to sleep before 10 PM. And—if I wanted to get REALLY kooky—maybe even a romantic weekend trip to someplace exotic and fabulous.

Like, say, St. Louis.

Ok, so maybe it isn’t exactly synonymous with romance, but it was the destination of my first weekend getaway with Tim last November. I could tell you that we settled on that city because the prospect of a ride up to the top of the Gateway Arch and the promise of two free beers at the end of the Budweiser Brewery tour was just too tempting to resist. Or maybe because we both love long car rides that are unencumbered by a bunch of pesky scenery, but you wouldn’t believe me. Of course if you’ve been reading this blog for any length of time, the real reason we chose to go there won’t surprise you at all. We decided to spend the weekend in St. Louis because it was the closest metropolitan area to this:

Lambert's Cafe in Sikeston, MO.  The birthplace of many an eventual heart attack, I'm sure.

Several years ago, I saw Lambert’s Cafe featured on a Food Network special about the country’s best places to “pig out”. Famous for it’s gigantic portions of down home specialties, side dishes served family style by roaming restaurant staff, and their world famous “throwed rolls” (which are served to you from across the room via jump-shot, and if you want one you have to catch it midair—totally worth the burned fingertips!), a visit to Lambert’s went on my personal bucket list. When I mentioned to Tim that I’d always wanted to eat there, being a foodie himself (and a fan of car trips in general) he was all in. We decided to make a weekend of it, and thus found ourselves spending a three wonderful days driving across Missouri, drinking free blueberry beer, roaming the charming shops of St. Charles, viewing the city from 630 feet above the river, and driving two hours to the thriving metropolis of Sikeston where I was served this slab of chicken fried steak & mashed potatoes smothered in cream gravy in a 12 inch stainless steel skillet (a meal which I believe legally qualifies as a suicide attempt in every state except Missouri).

It was a long way to travel for dinner, but you know what? It was totally worth it. We had a fantastic time, and look forward to going back someday. It won’t likely be any time soon, though. Partially because we value our cardiac health, and partially because there are lots of other restaurants in the world that we’d like to visit.

The idea of foodie-tourism is something that’s always appealed to me (surprise!), and I’ve had a running list of places I’d like to eat someday that’s been growing for years. I blame cable TV, which is the food-addict equivalent of internet porn. If Guy Fieri features a particularly interesting Diner, Dive or Drive-In, it goes on my list. If Adam Richman from Man v. Food eats sandwich on french bread loaded with grilled pastrami, cheese, cole slaw and french fries (ON the sandwich! OMG!), then you can bet that someday I’ll find an excuse to get to Pittsburgh and try one.

There is a piece of conventional weight-loss wisdom that says we should strive not to have food be an “event” in our lives. If we remove the mystique surrounding special occasion meals and diminish the excitement of an anticipated treat, we can begin to view food only as the fuel our body needs to function, and nothing more. We can train ourselves to believe that Thanksgiving is about family, not oodles of food as far as the eye can see. July 4th is about the celebration of our freedom, not eating the world’s best lemon bars. Vacation is about seeing new sights and experiencing the culture of unfamiliar areas, and not about catching a hot roll with your bare hands before slathering it in sorghum & butter and devouring it.

I disagree.

Well, not totally. I believe that my food-crazy is part of who I am, and I am never going to eliminate it from my life. But I also believe that I can train myself to channel it in a way that makes my life easier to live on a day-to-day basis. For me, the problem isn’t that I put special food events on a pedestal, it’s that I put EVERY food event on one. There are days that I look forward to having a stick of string cheese with the same anticipatory glee that the thought of dumplings and kraut once a year at Thanksgiving induces. I have daydreamed all afternoon about the tater-tot casserole that we’ll be having for dinner with the same kind of palm-rubbing glee that a piece of my sister in-law’s chocolate cake incites in me a week out from a birthday party. Maybe the trick is to make everyday food unimportant, and to let the special event foods keep their mystique. If I can work each day to see food as fuel, then I honor my body by keeping it healthy and fit enough to really enjoy those moments when food is allowed to take center stage.

So that’s what I’m trying to do. Tonight I fuel my body with grilled chicken & brown rice & veggies. Tomorrow I fill the tank with steel cut oats, fresh strawberries, and low calorie popcorn. And the day after that I will cheerfully dine on low fat cottage cheese, steamed brussels sprouts, and baked tilapia--because I know that, someday, there’s a 22 inch loaded chili dog in Phoenix that’s got my name all over it…