Nine warnings and three suggestions for my loved one who’s considering weight loss surgery.
In 2002 I asked myself “Should I have weight loss surgery?” When the dart landed on “yes,” I made an all-too common mistake – I focused on the date of my surgery as though that were the moment when everything would change. But like any woman who’s ever said “I do” or given birth, I discovered that that moment was only the very barest beginning of a total, never-ending transformation of me. 1
Not knowing what I didn’t know, 2 I walked through my pre-operative doctors’ and dieticians’ appointments confident that I knew what I was getting myself into.
Turns out I knew nothing. 3
It’s been over a decade since I had my surgery, and doctors tell me mine is the healthiest and most desirable outcome for weight loss surgery they have ever seen.
People often ask me if I think they’d be a good candidate for weight loss surgery. It’s a question I can’t answer. Weight loss surgery has serious limitations, and can be no match for the sabotaging beast in your head.
So when someone I love came to me recently and asked “Should I have weight loss surgery?,” in lieu of “yes” or “no,” I gave her these warnings and suggestions.
I hope by reading them you’ll feel stronger and better prepared to do what you need to do to feel well and comfortable in your body and in your head, whether or not you ever have – or ever even consider having – weight loss surgery.
Nine Warnings 4
Weight loss surgery changes your stomach, not your head.
Unless your weight loss surgery includes a bonus lobotomy, 5 your brain will still have the exact same capacity to want, crave, rationalize, justify, manipulate, minimize, exaggerate, and regret after surgery as it did before.
In 2002, I imagined my problem was that I ate too much too often. I had WLS because I was on a mission to “fix” my weight “problem.”
Today I know that my real problem is shame-driven self-sabotage. Left untreated, it drives me to disregard, rebel against, ignore, deny, and pretend I never made the commitments I need to keep in order to be comfortable in my body and peaceful in my head.
This is true for many of us.
Today, my mission is to shed light on the real problem – and to teach women like me effective & sustainable modes of treatment. Treating self-sabotage is especially critical for folks considering weight loss surgery, because…
If you have gastric bypass, the pouch may stretch and eventually you may have less restriction, if any at all.
The stomach is elastic, and if you fill it often enough, it may stretch.
The same goes for any pouch or opening created during weight loss surgery.
By eating more than my pouch was designed to hold, I stretched my capacity back to normal within a few years after my surgery. I no longer have a noticeable restriction on how much I can eat, and I consistently eat as much or more than the people around me.
In order to maintain my most comfortable weight, I needed get a grip on this tendency in me, and to change what, and why, I eat. And to make strong choices for strong reasons, consistently.
Restriction or not, you can easily gain weight after weight loss surgery.
If you continue to eat processed foods (especially sugar and flour), it will be easy take in more energy (read: calories) than you use every day.
Processed sugar and flour is essentially pre-chewed into a fine powder before it’s shaped and cooked into the junk foods we all know and love. When eaten, these pre-chewed-sugar-and-flour foods break down quickly into a slippery paste, and can move through even the tiniest postoperative passages with ease. Add butter or sauce or mayo, and these processed foods go down the hatch even more easily.
While there may be strict physical limits on the amount of food you can eat after WLS (at least temporarily), after the initial healing is over, there’s little to no limit on how much you can drink. Once you’re over the dump-hump (see #5), soda, juice, and blended drinks from the coffee shop may be all you need to consume to halt weight loss (and possibly all it takes to gain back whatever weight you lose).
After surgery, you may be even less inclined to eat healthy foods than you are now.
With some notable exceptions, healthy foods are whole foods. Unlike fast food and most foods that come in bags and boxes, these protein- and nutrient-rich kibbles need to be carefully selected, prepared, cooked, and thoroughly chewed – especially after weight loss surgery. All that selecting, prepping, cooking, and chewing can feel like hard work, and it may be easier than you think to talk yourself out of. If the last thing you want to do when you get home from work is throw together a nutritious meal and then take your time eating it, see suggestion #1.
Eating sugar will hurt.
If your weight loss surgery involves intestinal re-routing, eating sugar – any sugar – may send you into painful spasms, vomiting, diarrhea, and cold sweats. 6 It’s called dumping syndrome, and if and when it hits, you’ll be praying for the pain to stop so you can pass out. 7
Eating sugar may stop hurting.
With repeated exposure, eventually sugar may stop hurting. Then, unless you’ve done the work to treat shame-based self-sabotage so you can eat well consistently, 8 that may be when the real trouble starts.
I’ve watched many women just like me gain back 100 pounds and more after WLS. Many of them did it with modern American menu standards like ice cream, and vaguely coffee-based, sugary drinks. Others regained the weight they’d lost on supposedly “healthy” foods like organic, locally-made granola. 9
The truth is, if you’re eating processed sugar, it won’t take much to stall weight loss, or regain whatever weight you’ve lost.
Overeating will hurt like hell, and that may not stop you.
After WLS, eating as much as your stomach can hold may hurt like hell, but depending on how much work you’ve done to heal shame-driven self-sabotage, that pain may not keep you from eating yourself sick over and over again.
Many of us who default to morbid obesity have behavioral norms 10 and strong internal forces 11 urging us to ignore our body’s signals, and eat (and eat). Until we do the work to develop new coping strategies for stress and boredom, new associations with celebration and sadness, and new ways to spend our transition and “me” time, stomach pain may only serve to slow the pace of the binge.
Many standard post-operative menu suggestions may keep you craving sugar, even if they’re sugar free.
Popular post-WLS menu plans include sugar-free Jell-O, pudding, and protein shakes and other sports drinks. Many of them are SUPER sweet, thanks to a glut of artificial sweeteners. Even if it’s not “real” sugar, that artificial sweetness can keep the sugar-craving fires alight in your brain. If those fires stay lit, it’s more likely that you’ll slide back into an addictive relationship with sugar after your stomach is healed.
If you’re like many of us, that addictive relationship must be addressed for weight loss to be sustainable in a healthy way long term.
Many of the same menu suggestions may keep you relying on processed, pre-packaged foods, too.
That same post-op menu plan relies heavily on processed, pre-packaged foods. 12. From the doctor’s perspective, this makes sense – she wants to make sure you’re getting plenty of fluids and protein, and prescribing pre-packaged and -portioned foods and drinks makes that easier for her to do.
But from the post-op patient’s point of view, some of these menu suggestions may undermine the new habits we need to develop to maintain a more comfortable weight in a healthy way.
Which brings me to the suggestions I gave the loved one who asked me “should I have weight loss surgery?”
Three Strong Suggestions 13
Begin NOW to develop a deeper, more involved relationship to the foods you eat.
Whether you’re pre-op, post-op, or not-gonna-op, learn to shop for ingredients, and to prepare and cook the foods you eat.
Folks who’ve recently had weight loss surgery can make their own yogurt, 14 blend their own protein-rich drinks, 15 and simmer huge pots of delicious, nutritious broths and full, soft soups 16 in order to feel connected to and invested in the foods they eat.
It takes time and forethought and energy, but post-ops can create most or all of the food and drinks they need for healthy and successful healing and the healthy maintenance of a more comfortable weight long term.
Begin NOW to treat self-sabotage.
If you’re still reading this, you probably have a long, hard history of trying and failing to reach and maintain a more comfortable weight – hence your interest in weight loss surgery. I have that history, too. And while I thought surgery would be the thing that fixed me, I learned that weight loss surgery is only a tool. It wasn’t until I learned exactly how to follow through on my healthy intentions in the moment of decision 17 that my weight finally stabilized and I began to live well and be comfortable in my body and in my head.
Begin NOW to dig deeper, and to ask for clarification, suggestions, and support.
If you’re considering weight loss surgery, don’t be afraid to ask questions. Ask your doctor if you don’t understand something about your options or the pre- and post-operative process.
If you decide to go forward with weight loss surgery, don’t hesitate to ask your dietician what you can do to incorporate more real, whole foods into your post-op menu so you can rely less on processed and pre-packaged foods.
Don’t talk yourself out of getting every bit of information and support you need to have a healthy, vibrant, comfortable life, before and/or after, and/or in lieu of, having weight loss surgery. That may mean saying “Can you please explain that again?” or “I’m not sure I understand” or “I don’t feel like this is the strongest choice for me – please let me know what my other options are.” And you may need to say it a lot, and that’s OK. Asking questions until you understand is self-care in action.
Finally, practice investing in and availing yourself of resources that can increase your odds of being consistent, following through, and enjoying the process. Depending on how you roll, this might include professional support, books, classes, and/or high quality peer support networks. 18
Whether or not you have any desire to lose weight, and whether or not you opt to have weight loss surgery, it’s up to you to be your own best caretaker, to be honest about what you need, and to be your own strongest advocate. Practice investing more time, energy, and money in yourself and in your health. If you do, you’ll feel more comfortable in your head and in your body no matter what you weigh today, and no matter what you may weigh tomorrow.
And really, feeling genuinely comfortable is where it’s at – no matter what route you take to get there.
- Including both how I related to the world, and how the world related to me. ↩
- Because you can’t know until you know, you know? And usually you need to actually live it before you REALLY know, you know? Yeah, I know you know. ↩
- You know, relative to the experience of living as a woman in the world who’d had weight loss surgery. I actually knew a lot of things. Just not that. ↩
- I didn’t pull these out of a hat – these are all based on my own experience. ↩
- This is a joke. Sort of. ↩
- Sexy, right? ↩
- Here’s the definition of Dumping Syndrome from the Mayo Clinic: Dumping syndrome is a condition that can develop after surgery to remove all or part of your stomach or after surgery to bypass your stomach to help you lose weight. Also called rapid gastric emptying, dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly.
Most people with dumping syndrome develop signs and symptoms, such as abdominal cramps and diarrhea, 10 to 30 minutes after eating. Other people have symptoms one to three hours after eating, and still others have both early and late symptoms.
Generally, you can help prevent dumping syndrome by changing your diet after surgery. Changes might include eating smaller meals and limiting high-sugar foods. In more-serious cases of dumping syndrome, you may need medications or surgery. For more from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/dumping-syndrome/basics/definition/con-20028034 ↩
- See suggestion #2. ↩
- It’s a fact: granola (yes, even that stuff we can buy at the farmer’s market that’s made with maple syrup from free range trees growing in fairy forests) regularly has 2-3x as many calories per cup as your standard-issue puffy coco “breakfast” cereal. Don’t let brilliant marketing or buzzwords like “natural” and “organic” fool you into thinking something is “healthy” and therefore something that can be consumed with impunity. Assume that, if it’s been prepared for you, it probably isn’t, and shouldn’t be. ↩
- Like maybe eating to officially signify “me” time, or snacking while doing other things, or shoveling as much rice into our mouths as we can while we’re putting away the leftovers. ↩
- Shame and fear. ↩
- Pudding! Jell-O! Shakes in a can! ↩
- These suggestions can help you hit and hold a more comfortable weight whether or not you have weight loss surgery. ↩
- THIS is absolutely the best page I’ve ever found on making your own yogurt. ↩
- Using delicious, homemade yogurt or low-fat cottage cheese as the protein-rich base. ↩
- HERE is a great book of simple, nutritious recipes, all of which can be blended for a smoother consistency if need be. (Post-ops may want to tone down or eliminate the salt and make other appropriate adjustments, too. Check in with your dietitian for specific recommendations.) ↩
- The lights dim on everything but the cookie in the display case. “Get it” a voice in my head says.
“There’s no good reason not to.”
“It doesn’t matter.”
“You deserve it.”
“Normal people eat cookies.”
“Don’t make such a big deal out of a cookie, freak.”
But I’ve learned by studying my own truth that it’s not just one cookie for me. For me, that one cookie becomes the first step in what can be a long and difficult and gross-feeling cascade of actions that feel beyond my control.
So, when the lights dim, I do what I’ve been practicing for years – I use that moment as a prompt to follow a simple series of steps that change the story. It might end with me grabbing coffee and sitting in the sunshine, breathing deep, actually enjoying a moment in my real life (as opposed to an eternity trapped in craving and regret). It’s pretty awesome. You should try it sometime. ↩
- A quick word on peer support networks: To get support, you need to make yourself vulnerable. That can be really difficult to do with friends, nevermind in groups where cruel trolls may be lying in wait. If you possibly can, look for peer support networks that charge a subscription fee, because trolls very rarely pay to be assholes. ↩