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(For the purposes of this article, the identity of the patient will remain anonymous. I will refer to her as Allison)
What is bariatric surgery?
Bariatric surgery is a medical intervention for people who are significantly overweight and can’t seem to lose it. Candidates usually have additional comorbidities such as high blood pressure, diabetes and sleep apnea.
After surgery, patients can expect to lose 30%-50% of the excess weight in 6-12 months. The surgery works by reducing the size of the stomach to hold only a cup of food at a time.
How is surgery done?
The way the surgeon reduces the size of the stomach varies based on the medical needs of the patient. Some common options are gastric bypass, gastric banding, and gastric sleeve.
These methods range from permanent to temporary and it’s chosen based on what the patient wants and what the patient can handle medically.The expected pain level and down time after surgery also varies depending on the type chosen.
What to expect after surgery
It’s not just the size of the stomach that changes. The surgery also changes the patients metabolism. Obesity slows the metabolism to a halt, this means an overweight person can eat a modest amount and still not lose weight because they never feel full.
Never feeling full tells the body to hold on to every pound for dear life. After surgery, the patient feels extremely full after just a small amount, and this tells the patient’s brain they have had enough. That full feeling triggers a chemical reaction that tells the body it’s ok to lose weight. Over the next year, the patient’s metabolism should return to a healthy state.
Risks vary from person to person, but overall the risks for the surgery do not outweigh the risks for remaining obese. Because of the various health benefits from receiving the surgery, most of the time it’s covered by health insurance.
The surgery also comes with emotional risks. The patient can expect huge physical and psychological changes after surgery. The entire way the patient sees food has to change in order to be successful. In most cases, approval for the procedure comes with the stipulation that the patient stays involved in some sort of counselling before and after surgery.
Me: Allison, made you consider the surgery?
Allison: I decided to have surgery to force me to evaluate what I eat, to help with portion control, self esteem and the motivation to work out. I had loosely attempted to “diet”, but never followed through and would give up easily. My weight just kept increasing and I started having other health related issues such as high cholesterol and blood pressure.
Did you ever change your mind about having the surgery? If so, why?
Allison: When I did not think insurance would approve I was ok with it, but upset. On the way to the hospital I questioned the decision because of the fear of dying on the table.
Do you wish you had done it sooner, or did waiting give you the chance to try other ways?
Allison: I wish I would have done it sooner and not let myself get as big as I was.
What was your biggest fear about the surgery?
Allison: My biggest fear was dying.
What was the pain like after you woke up on a scale of 1-10?
Allison: Maybe a 1. I never took pain meds, not even at the hospital
Wow that’s impressive. How long were you out of work?
Allison: I took off work for about a week. The time off is really dependent on what kind of work you do though.
Most doctors require a mental health evaluation. Did you find this to be helpful and why?
Allison: The psych evaluation was not really helpful, just a requirement insurance had. They had to determine you had a good support system.
How much did you want to lose before surgery?
Allison: I just wanted to be out of the severely obese category. Did not really have a goal weight in mind and still don’t.
How many months out are you, and how much have you lost currently?
Allison: I am 9.5 months out. I have lost approximately 80 lbs since day of surgery and 100 from my highest weight.
That is amazing. If you could go back, would you make the same choice?
Allison: I would definitely make the same choice again.
If you could give people considering bariatric surgery advice, what would you tell them?
Allison: I would tell them they need to understand their relationship with food. Mental hunger is real. Surgery does not take away cravings or the “want” to eat foods. For me, I can eat everything I could eat prior to surgery with no problems. It is the amount that is different. However, after about 7-8 months the amount you can eat starts to increase and the “honeymoon” phase starts to end. The swelling is gone and you are able to eat more. Surgery is not a permanent fix. It is not the “easy” route. It is actually really hard. You spend a lot of money on food and waste a lot of money because you don’t eat as much. This is a lifestyle change, but you have to be ready. If you aren’t ready for that then you aren’t ready for the surgery. You can gain every bit of your weight back and then some. You can even gain weight back with the bypass.
Allison, thank you for speaking with me and being incredibly honest about your experience. It was eye opening.
Bariatric surgery is never the end of the weight loss journey, it’s just a tool to help reclaim your health. You have to make the changes permanently in order for the results to stick. It’s definitely no short cut.
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