I’ve done a lot of thinking about my weight in the last year, for a lot of reasons. I’ve decided to write a series of posts about that journey to try and process how things have changed. This is the first post in that series.
In December 2014, I had my second breast biopsy in 13 months. Both times, they found atypical ductal hyperplasia, which is a long scary term for pre-cancerous cells. Will they turn into cancer? Not necessarily, but they could. The first time it happened, I opted not to go on chemoprevention therapy. The second time, I decided I should speak to the medical oncologist about chemoprevention.
The oncology appointment in February 2015 was a huge eye opener. My lifetime risk for breast cancer was almost 50%. The average woman has a 12% risk. I asked the doctor what I could do to lower the risk. The first obvious step was to get on a chemoprevention therapy regimen. The second step — lose weight. At the time, I weighed more than 270lbs and (although no one said it out loud) I was classified medically as morbidly obese.
I left that appointment in shock. I hadn’t realized how high my risk was and it scared me. I decided then and there I was going to start chemoprevention therapy and lose weight to improve my chances. A few years earlier, I had lost more than 50lbs. If I could do it then, I could do it now. I started on Tamoxifen the next week, which I will continue to take for at least five years. I also started an intense diet and workout program.
Fast forward to September 2015. I found myself sitting in my annual physical with my GP crying. I said “Please help me, I cannot lose this weight.” I had struggled for months, but repeated injuries and a general lack of energy made me hover around the 270lb mark. It turned out I could not lose the weight and I was terrified. My doctor told me that he was referring me to the MGH Weight Center and that a team there would conduct a full medical and mental health evaluation and then determine my best course for weight loss. And then he said the thing that rocked my world. “Five years ago I would not have recommend this, but there have been so many advances in weight loss surgery, I think you should do that. It will change your life.”
I didn’t know I could get weight loss surgery. I thought you had to be above 300lbs. It turns out you just need to have a BMI of 40 or greater for most insurance plans to cover it. I had my first appointment at the Weight Center in November 2015. I met with a bariatric doctor, a psychologist and a nutritionist. They became my weight loss team. Each of them told me they would be recommending surgery. I also learned that two of my regular medications actively prevent weight loss, something I did not know. My bariatric doctor suggested a Gastric Sleeve procedure. He also told me I would need to begin losing as much weight as possible and would have to go through an insurance process to make sure the surgery would be covered.
I got final word that I was recommended for surgery and began working on losing weight in January 2016. I tracked all of my food, and managed to lose about 6 lbs. I went in to see my nutritionist in February and she went over my food and helped me see where I could improve things. For example, I would eat two cheese sticks for a snack. Why not eat one cheese stick and an apple or some other kind of fruit? She brainstormed with me to come up with healthy foods that I liked and we created a personalized eating schedule. It really changed the way I thought about eating healthy.
I finally got my insurance approval in March 2016 after a few annoying glitches. By the time my surgery date rolled around in May 2016, I had lost about 20lbs (Sadly, a chunk of that weight was from food poisoning in February, but at least I managed to keep it off). At my highest weight, I was 277lbs by my scale. My paperwork for admittance to surgery said in large letters: Reason for Admission: MORBID OBESITY. It was the first time I had seen myself characterized that way officially. I knew I was obese, but seeing it in writing like that was like a smack in the face.
Above: Me rocking George Washington hair after weight loss surgery (L) and sitting up for the first time after surgery (R).
I learned a few things about my health after the surgery. I had long considered myself a healthy fat person. I had relatively low blood pressure, good blood sugar numbers, and no major weight-related health issues. The surgery proved otherwise. I knew I had signs of fatty liver disease from an ultrasound in 2015, but a liver biopsy during my bariatric surgery showed I had Stage 3 Fatty Liver Disease. You can sustain permanent liver damage and even die from Fatty Liver Disease at Stage 4. The scary thing about that diagnosis was that I had no symptoms, other than generally feeling tired and a slight pain when the area above my liver was pressed on. Fortunately, my bariatric doctor told me there were no signs of serious permanent liver damage, so I am hoping to rehabilitate my liver due to my weight loss and lifestyle change. I also learned that while my numbers for blood sugar were not in the diabetic range, they were slowly creeping towards it. So I really was not a healthy fat person at all, I just didn’t know it.
The whole process makes me think about body positivity. I was never one to bemoan my weight. I truly did think I was happy with how I looked at every weight I have ever been. I just didn’t dwell on my body image much. Looking back from my after surgery vantage point, I see now that I subconsciously made a lot of choices based on my weight — I stopped going on amusement park rides because I feared I wouldn’t fit in the seats. I stopped wearing dresses and skirts because they emphasized my apple shape. I avoided having my picture taken, because I didn’t like how I looked. I rarely bought new clothes because I didn’t ever feel like they made me look good. I stopped enjoying the beach and water parks because I felt uncomfortable in my bathing suit. I stopped wearing my favorite necklaces because many of them were just too small for my neck. I stopped wearing flashy earrings because they drew attention to my face. I stopped wearing bracelets because my arm had grown too round. The list goes on.
I guess what I’m trying to say is that I was sacrificing a lot of the little things that used to give me joy. At the time, I had convinced myself it was because I didn’t have time for those things, or I no longer liked or needed them. It was like I had shoved my feelings about body image into a closet and forgotten about them, and my brain made up other excuses for the sacrifice. I had no idea AT ALL how much I was giving up to prevent my weight from making me feel bad. It turns out that when it came to my weight I had almost no insight into my real feelings. As I’ve been able to do all of the things I gave up, I’ve had realization after realization that I was giving them up to keep myself from feeling fat. It was the only way I could keep positive about my body.
I do want women to keep feeling beautiful no matter what their ages or sizes are. But I hope people also realize that there are serious health issues that can be caused by obesity and that you might not even know you are unhealthy. Inhabit whatever body you feel comfortable in, but make sure you are addressing health risks. And really look deep inside to make sure you aren’t achieving positivity by giving up the things that bring you joy.
Anyway, that’s my rant for the day. Being a strong proponent for body positivity in the past, I’m having a hard time reconciling that with my weight loss. I’m still coming to terms with the fact that I could have had liver failure due to obesity without ever realizing I was facing that risk.