When Comments Hurt

This is the third in a series of posts I’ve done regarding my Weight Loss Surgery.  You can find the others here: Losing Myself and FAQ: Gastric Sleeve Journey.

Anyone who has known me in real life or from my former knitting podcast knows that I have been open about my surgery from the beginning.  I decided to do that because once I got into the Weight Center program, I learned a lot about weight loss surgery (WLS), including things that directly contradicted my former personal beliefs about it.  I quickly realized there were a lot of fallacies and misunderstandings out there about the surgery, how one gets approved and why it works.  It has changed my life so much, I guess I’ve become a minister of weight loss motivated to preach my journey to the masses!  Seriously, though, I just want people to understand the truth about WLS and other forms of medically assisted weight loss just in case they are in a position where it might benefit them.  The stigma attached to this surgery is real, believe me.  I want to do anything I can to lessen that stigma.

I learned a few things about the stigma attached to WLS in my weight loss program.  People assume you are getting the surgery because you are too lazy to work out and diet.  People assume you are looking for a quick way to get thin.  People think that after surgery you will be a freak who can only eat a few tablespoons of food at a time.  People think most people regret the surgery, gain all the weight back, or have a lifetime of health problems associated with it.  Some of those things have a grain of truth and some of those things are just wrong.  None of them apply to every WLS journey.

I’ve been so fortunate that most of the people in my life have supported my decision to go through WLS.  My friends and family had a lot of questions initially, but once I explained the things I learned in my program, they were 100% behind me.  Almost a year later, they are all so happy I made the decision to have surgery as they watch me getting healthier, being more active and looking happier than I’ve been in years.

On the next level are acquaintances.  I live in a neighborhood school district where I’ve known the parents of my children’s school mates for many years.  Obviously, those people noticed when school started in September that I had lost a lot of weight over the summer.  Now, when I’m close to my “normal” BMI, I get a lot of comments from the people that don’t see me often.  I am always honest when asked how I did it.  I’m not embarrassed about having the surgery because I know the reasons I needed it and how hard it’s been every step of the way.  For the most part, my acquaintances have reacted positively (at least to my face!)

Which brings me to when comments about WLS really hurt me.  I belong to a couple of internet forums (Ravelry is one of them, obviously) where I post regularly.  I’ve found a great group of supportive people in the Have Your Innards Been Rearranged group on Ravelry.  Also, all of the questions and comments I’ve received from my former podcast viewers have been wonderful, including a few telling me that people were inspired to start their own weight loss journey after hearing about mine!  But the comments I just got on another long time internet forum (I’ve been a member for 10 years) really surprised me.

Someone asked if people who underwent bariatric surgery would describe their experiences and give her more information as she was considering looking into it.  Another woman and I described our journeys.  I personally described the MGH Weight Center program and the fact that surgery was only one of the options available, as there is also weight loss through medication and weight loss through diet, both supported by the medical, psychological and nutritional staff there.  I also described the process for getting approved by both the program and your insurance to get surgery (it’s not a short process).  The other woman gave similar information.

Within a day, many people came into the thread to offer commentary.  Not to provide bariatric surgery information, which is what the poster originally asked for, but to critique the surgery!  Since this other woman and I were the only ones who had undergone the procedure, it felt very personal to me.  It also pissed me off big time.

Some of the comments that really hurt me were 1.  If you had to lose weight before the surgery through diet and exercise to get approved, and you had to change your diet and continue to exercise after the surgery to lose the weight, why did you even need the surgery at all?  2.  Doctors only prescribe this surgery because being fat is stigmatized to be bad, not because it helps you health.  If obesity wasn’t stigmatized, doctors wouldn’t make patients lose weight this way and the surgery would be considered dangerous.  3.  WLS is over-prescribed and given to anyone who wants to get thin quick, which is why it’s so dangerous.

Don’t get me wrong, there were a significant number of people popping into the thread to take the naysayers to task for making these comments.  A few people who happen to be in the medical field even provided studies showing that, statistically, the surgery isn’t any more dangerous than a gallbladder removal and the biggest risk of complication is infection (which is a complication that can happen with any surgery).  But the fact that people felt comfortable saying these things at all to me and the other bariatric surgery patient made me so angry.  The poor woman who asked for information kind of got scared off by all the negative comments.  This is EXACTLY why I am so open about the procedure.

I’m going to get ranty and address each of these comments here.

Why Get The Surgery If You Were Able to Lose Weight Without It to Get Approved

Here’s the deal.  I can’t speak for every obese person, obviously, but I can speak for myself and recite some things I learned in my program.  If you are morbidly obese, you can lose weight without the surgery.  It is possible.  If you have ever seen The Biggest Loser on TV, you have seen morbidly obese people lose massive amounts of weight through nutrition and exercise.  But there is a catch.  The more times you diet and lose, the worse your metabolism becomes.  Your body is programmed to hold on as hard to calories as it can when it fears you are starving.  Each time you diet to lose, your metabolism gets slower.  This means that each subsequent time you try to diet, you have to restrict your calories even more to have any success.  You are literally fighting your own body to lose weight.

What does that mean?  It means that you have to go to extremes to lose weight.  It’s really slow going.  And you can’t slip up or go away from your regimen because the weight will come back (usually even more than you lost).   As shown in the article I linked, all but one person followed in the Biggest Loser study regained significant amounts of weight.

WLS, however, CHANGES your ability to lose weight.  Your metabolism is reset to a much higher level, meaning you don’t immediately go into starvation mode like before surgery.  WLS also reduces the production of ghrelin hormone, which can reduce or prevent hunger for a period of time.  My doctors call WLS a tool.  It makes all the nutrition and exercise work better for you.  It stops your body from fighting against you, and instead your body works FOR you, burning up all that excess fat.

The changes don’t last forever, but you have a 12-18 month window where you can optimize your weight loss.  For people who have health uses caused by or impacted by their weight, this is so important.  People have been able to cure their Type 2 diabetes, get off sleep apnea machines, or as in my case, stop fatty liver disease from creating permanent liver damage.  Also, according to my doctor, since your metabolism is reset, it would be difficult to gain back as much weight as you lost as quickly as you can without the surgery.  You start at square one again.  That doesn’t mean you can’t regain weight (you can if you go back to poor exercise and nutrition habits), just that it will take a lot longer than it would without surgery, where you can gain back the weight in a matter of months.

Doctors Only Prescribe This Surgery Because Being Fat is Stigmatized

Okay.  This one really goes to the whole fat shaming and body confidence issue that I still struggle with today.  I will be the first person to admit that there could possibly be some fat-shaming, fat-hating doctors out there who tell their patients to get WLS simply because they don’t like fat people.

There is definitely prejudice against people who are overweight.  They get judged when they eat ANYTHING other than salad, and people assume they are lazy and that they are personally responsible for letting their weight get out of control.  I am fully behind every woman feeling comfortable in her own skin, regardless of her shape or size.  I am also aware that being overweight does not necessarily mean you are unhealthy, lazy or personally responsible for weight gain.  People gain weight due to medications they have to take, due to medical issues or even due to simple genetics.  I used to run three miles a day when I weighed 250 lbs, so I definitely know overweight people are not necessarily lazy.  You can also be healthy and overweight, in the same way that you can be unhealthy and skinny.  Basically, you cannot judge a book by its (overweight) cover.

That being said, in legitimate bariatric programs no one prescribes WLS willy-nilly.  Most insurance companies will not even consider coverage without a thorough vetting by a psychologist, bariatric specialist and nutritionist.  Insurance companies often require you to show that you can stick to the plan provided by your program for a period of time.  You also have to be at least a 35 BMI with a comorbidity (like diabetes) or over 40 BMI to even be considered.  A person who is 20-30 lbs overweight, for example, is not going to become a candidate just because a doctor referred her to the program.

You can pay for surgery out of pocket, but legitimate programs require the same process for approval.  Of course, some people have opted to go outside the US for surgery, and those standards may be different.  And I do know from my program that there are places (many plastic surgery offices) that will do a lap band procedure for anyone who wants to pay for it.   My program will not do the lap band procedure, but they do end up doing a lot of corrective surgeries on people who have had it done.

So the short answer?  Legitimate bariatric specialists do not approve people for this surgery lightly.

WLS is Over-Prescribed and Dangerous

See above re: why I don’t believe WLS is over-prescribed.  It also has risks, just like any other surgery.  But it’s actually more dangerous to people with morbid obesity to stay heavy than it is to get the surgery.  Many studies have been done on the safety and effectiveness of the surgery and there is a nice summary of the misconceptions and an explanation of the facts HERE.  As mentioned above, the risk of death associated with bariatric surgery is lower than with gall bladder surgery, and no one thinks that procedure is “dangerous!”

What I’ve Taken Away From This

Reading the comments in that internet forum really troubled me for days.  I wondered if some of the acquaintances and even possibly some of the people in my circle of friends and family feel this way about the procedure and just aren’t telling me to my face.  But after mulling it over and thinking about everything that was said, I decided I don’t care.  Yes, I was hurt and angry by the comments, but they were made out of ignorance.  Honestly, I had many of the same thoughts before I started my own journey.  I just hope that when those posters read the additional information provided by me and others they began to understand the facts behind the story.

Also, I want everyone to remember that you don’t know an overweight person’s story.  Try really hard not to make judgments about WHY they are overweight.  Try not to judge them for enjoying a meal – they have the right to enjoy food just as much as anyone else.  And do not assume things about their health, personality or level of activity just based on how they look.  There are some lazy, unhealthy, out-of-control skinny people out there too, but no one makes assumptions about them.  If you have a friend or loved one thinking about doing medically assisted weight loss, please support them.  It’s not an easy decision and it’s definitely not an easy journey and your support could really help someone make a positive change in their lives.  I know my friends and family did for me and I’m grateful every day!

 

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