I had to change my mind.
I got a master’s degree in nutrition prior to medical school. In nutrition school, most people were opposed to bariatric surgery. They believed that mindful eating of colorful whole foods would lead you to naturally reach your healthiest weight. “Weight Management” was an elective course.
My fat ass took that course, and to a significant extent I was freed by it. The tiny, feisty PhD who taught the weight management course believed in evidence, and she explained to us that 95% of people who lose more than 10% of their body weight without weight-loss surgery will regain it within two years, most within six months. Regardless of the diet and exercise regimen they choose, most people experience constant hunger and a slowing metabolism once they lose a significant amount of weight, and the vigilance required to push through that is more than most people can manage.
I am included in that. I have pushed through a lot, and I am a hard worker. Foremost, I got through medical school. While in medical school I started running long distances to manage stress, maxing out at 20 miles but mostly running half-marathon distances every weekend. I have lost large amounts of weight twice, and gained it back plus more both times despite a generaly healthy plant-based diet and sincere enjoyment of exercise.
That is, I used to enjoy exercise. I’ve been fat my whole life, even with the weight losses, and I always liked to move my big body. Walking, hiking, kayaking, swimming, yoga, weight training, pilates, eventually running...I think the only thing I tried that I didn’t like was Zumba (I am NOT a group-exercise person, I run alone like the wolf thank you very much). Oh and biking is a pain in my glorious ass.
But then, with the running in med school, my joints started to really hurt. I stopped running and they still hurt. Rheumatologist visits and x-rays and an MRI brought me to a very annoying truth: it’s osteoarthritis. I’m 41 years old and I can’t climb a flight of stairs without significant pain, and the only way to — maybe! — make this better is to lose a bunch of weight.
I never really wanted to lose weight. The first time I did it, I had a teenager’s determination to exert control. The second time I did it, I thought it would help me get into med school. It wasn’t because I hated my body (I didn’t) or couldn’t get a date (has never been a problem) or wanted to meet some celebrity standard of attractiveness (gross; I’m a queerdo and if I have a type it’s androgynous chubsters). For myself, all I’ve ever wanted from my body was the ability to enjoy life on my own terms. As a doctor, I’ve encouraged my patients to read “Health at Every Size,” by Linda Bacon, and to focus on feeling good in their bodies.
But now, I don’t feel healthy at my size. I am enjoying life less. I want to run, far. I want to zipline and skydive and ride crazy rollercoasters. I want to learn to fly a plane. I want to keep moving so as to keep my heart and my brain healthy for many more years. All of this is now being seriously impeded by my weight, and I know from experience and from scientific evidence that I can’t manage massive weight loss without bariatric surgery. Despite everything I know, it is still hard to accept that.
So, with some irritation — and still with whole-hearted support for the body-positivity movement that I love so, so much — I have started the process of qualifying for bariatric surgery. I am planning to have a sleeve gastrectomy, which has a very low mortality rate and allows me to keep my whole nutrient-absorbing small intestine. I have had an initial appointment with a surgeon, and two appointments with a dietician who seems somewhat amused by her vegan doctor nutritionist client. I see a psychologist next. I’m glad, because I have some ambivalence to explore.
I will document my experience through the lens of a highly educated, highly motivated, and very human patient. I will not be posting specific weights and photos, as I feel that they contribute to fat-shaming and an unhealthy focus on appearance as a way of measuring value. I may share body weight percentage changes, as I think that’s the most medically relevant number I can use to place myself in the context of the weight-loss literature. I will be focusing on functional goals and will be delighted to share my progress on that front.
