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.


  1. WOW! That's a lot to to speak. I get where you are coming from. I have weighed the options myself and decided against it for morally superior reasons (not I did decide not to "take the easy way out", but not because I feel like it is the "easy way out", but because it is the "easy way out" for me. I feel like if I don't earn it...I don't deserve it and I won't appreciate the difference as much. I am also not a big fan of taking any chance with my life. (funny coming from someone who has spent the better part of 20 years morbidly obese) Even 2% is an unacceptable percentage, if I can lose it without going under the knife.

  2. Oh whew! You scared the bejesus out of me! In fact, I skipped to the last paragraph to see if you were serious. When I read it wasn't for you, but you understood those that had WLS, I breathed a sigh of relief.

    I'm with you 100% on this one. I know it's the only way for some people, and if anything, I don't think it's an easy way out. All of those WLS's have side effects, and permanently change how people live. For some, it's the only answer, but it cam be very scary.

    I'm so glad you're sticking with Weight Watchers. It's safe, healthy and relatively cheap in comparison to any of the surgeries.

  3. The only thoughts i have on WLS (which is not popular or common here as it seems to be in the States) is related to the surgery.

    I have had a number of emergency abdominal surgeries in my time, including a c-section with my daughter, and let me tell you, the recovery from such a thing is so difficult, painful, disgusting and life-chaging that i simply cannot fathom how anyone would want to do this to themselves.

    That's all i have to say, and it's not a superiority thing. Surgery = horrible and not an easy way out. Given any opportunity to do it another way, i'll take it

    Nice to see you blogging again

    Did you ever get into your white trews?

  4. My neighbor had the roux-en-y surgery and told me it was the best thing she ever did. My sister also had that same surgery and said to me that she would do it again tomorrow. You may want to talk to her at and get some first-hand advice from her. Whatever your decision - best wishes.