On food. Again. Part 4. The things we would never do.

The best way to know that you’ll do something in the future is to say, “I would never do that.” It’s happened to me over and over-- mostly about things I said I would never do as a parent. I like to quote my friend Camille who has been known to say, "I did all my best parenting before I had kids." But backing up on things I'd never do hasn't just happened with parenting for me. And if you’re intellectually honest, you can probably think of at least one time you've done something you thought/said you'd never do.

I have talked about my struggles with food and weight a lot over the years. Like a lot, a lot. #Sorrynotsorry, but that’s what this post is about. Yes again. And so if you’d like to drop off now, I hereby grant you that permission*.

The last we “talked” about this together was in September 2018. I was coming into a place of more acceptance for my body and was continuing to work on that. I kept up my appointments. For the next year I worked on being intentional about intuitive eating. I focused on protein 5 times a day, I had almost weekly meetings with my nutritionist. I was trying to be more intentional about movement, but I suffered a back injury in January and was limited by my body for most of the year when most movement became incredibly painful. Still, I made so much progress. I haven’t binged in over a year. I was (am) able to listen to hunger and fullness. And it’s been a journey that hasn’t been perfect, but on a great trajectory. What hasn’t moved much is my weight. I mean, in one sense there was positive movement in that movement ceased. I stopped gaining weight after the initial rebound that happens with intuitive eating. I leveled off and I have been the same weight for over a year. (Yes, even through the holidays this year!) It’s even started going back down a little. A VERY little.

I was looking at insurance records a few weeks ago, and discovered that over the past year and a half, I have had over 60 appointments with my nutritionist and/or therapist about these issues. In other words, I have been giving it the ole college try. And yet I am helplessly stalled. So I had my metabolism tested. It sucks. (Yo-yo dieting my whole life has not been kind to me, and neither has the almost year of a back injury resulting in less movement.) And frankly, well, I am just tired of all of it. I am tired of the constant STRIVING with no results. But it’s not that I am discontent because of my appearance. I have been able to put that in a good part of my head space. I truly think I am at a settled place about beauty and thinness not being synonymous. I mean sure, in our culture that’s a thing. But when I examine the issue critically, it’s just so obvious to see the ways we have been brainwashed to believe certain things about certain kinds of people because of their appearance. Size is only one of those things, but it is a notable example. So that’s not what it’s about for me. Rather, I am tired of being so big because of how it limits me. I am tired of not being able to live life to the fullest because I am restricted by my size. I am missing out on things I want to do because I am limited by my body. And while I am a pretty healthy person, I do worry about my future health and mobility. And it all started feeling pretty hopeless.

And then I heard about set point theory**.

Set point theory is a relatively new idea in medicine, but it makes a lot of sense. The basic idea of it is that your body has a “set point” in terms of weight that it will defend. It will allow for overfeeding leading to an increased set point, but resists underfeeding to decrease a set point. The more weight you gain (for any reason-- genetic predisposition, emotional issues, environmental issues) the higher your set point gets. And your body will aggressively defend this new set point by slowing metabolism so that even much smaller portions result in weight gain, or at the very least, resist weight loss.

This is why teens who grow up fat often turn into fat adults. This is also why people who have experienced dramatic weight loss are so unlikely to keep it off in the long run. (Been there, done that like 100 times). Remember, 95% of diets fail long term. That’s some pretty bad odds.

That information, in and of itself, is a super duper buzzkill.

There is a way to try to work around set point by natural weight loss, but it is SO, SO SLOW. It’s a process of losing 10% of the weight you need to lose. And then wait 6 months without losing. And then start again, lose another 10%. And then wait another 6 months… etc. You get the picture. It means that healthy, sustainable weight loss is hella, hella slow. Like 7-10 years. And it may not work for you. It *may* work. It also may *not*.

And so, what doctors have determined is the most successful way to reset this set point is through bariatric surgery. Bariatric surgery is something I said I would never do. And frankly, a lot of people have a lot of negative ideas about bariatric surgery and the people who use it as a tool to release excess weight. I know this because I have heard these things, and because I have thought these things, and because I have said these things.

Everybody knows someone who has had the surgery, lost the weight, and gained most or all of the weight back. Everyone knows someone who has had some sort of complication that has been a giant bummer, sometimes resulting in future surgeries or feeding tubes or another terrible outcome. We have all heard it referred to it as “the easy way out” or the “lazy” way to lose weight. We’ve all heard about people whose bodies change quickly, gain a big shot of confidence, and end up leaving their spouse. Google “bariatric divorce”-- it’s a thing***. And we all know that most people who have the surgery end up with nutritional deficiencies and have to be supplemented for the rest of their lives. And we all know people who trade their food addiction for something else like alcohol, drugs, sex, or gambling. And I also get that at the same time people are dying in America from being too fat, there are millions of people around the world starving. (That one feels personal to me).

I am WELL AWARE of all of these things. These things have been racing through my head for the past 4-5 months as I have considered if bariatric surgery is right for me. Because while all these things are factors to consider, another factor to consider is that obesity will rob the average person of 20 years of health and about 8 years of life. And beyond that, it’s already robbing me of quality of life. There are so many things that I want to do that I cannot currently do. Fat people try to keep that a secret, but we all know. And the bigger you get, the more you CANNOT do. I don’t actually have the energy to go into all of the things I realize I can’t do right now. Maybe another time.

And so, I have been on some bariatric forums for a while now just reading and listening. Nick and I went to a seminar at Duke about their bariatric program. I have reached out to multiple people who have had weight loss surgery to get personal stories. I’ve done research on the different kinds of bariatric surgeries and learned about the process to get approved. I’ve considered the giant expense and the financial pinch this would put on our family. (Yes, it’s covered by insurance, but I still have a $6800 out-of-pocket max on a policy that is wicked expensive every already) and I won’t be able to work for a little bit as I am adjusting to life directly before and after the surgery.

And I have spent time going over the pros and cons. And honestly, there are a lot of cons to consider. I am not unaware. But it is also has the potential to give me the chance to spend better time with my loved ones. It also means I have the chance to more fully participate in my life, my marriage, and my kids’ lives. It means I might have an extra 8 years on this earth and an extra 20 good years on this earth. I want that. I come from a family line where relatives (and let’s just be honest, fat relatives) have died young. I want a different outcome.

And so a few months ago I decided that I am going to do it. (PS- Nick was in on this whole process-- went to appointments with me, learned about the process, etc. He encouraged me to do what I wanted to do and was quite neutral, other than to ensure me that he’d be my biggest cheerleader no matter what I chose).

And so, next month, I will have a Roux-n-y bypass surgery. Out of the three main bariatric surgeries that are done to address obesity, it’s the oldest and most used. I am doing this process through Duke, which is a trusted and reliable entity. I have been in the approval process for about 2 months now. And I am still seeing the same nutritionist on the regular. From a surgery standpoint, there are only a handful of nutrition appointments that are necessary, but I have invested a lot of time, money,and energy into developing a healthier relationship with food. And I feel that is crucial to success on this journey.

I don’t expect this process to be easy. From what I’ve read and observed, it is very difficult, and changes SO many areas of your life-- not just your weight. I am going to have to renegotiate more than just the food I eat. I am going to have to figure out fun things to do that aren’t centered on food. I am going to have to figure out how to handle food (and alcohol) in social settings. (Y’all, I can’t drink for at least a year!) But nearly everyone I have spoken to has no regrets-- other than they did not do it sooner.

This is not a free ride. There is work to do. And there will always be work to do. And even if I am able to establish a new set point, there will be work to keep it from creeping back up. But one thing that I have learned about myself is that I can do hard things. It’s my 2020 motto.

And so, I want to share this journey on my blog. Not because I think anyone else needs to choose this path. I don’t think that even a little bit. And not because I am looking for permission or affirmation. I am in my 40s-- I don’t need that from others anymore. Instead, the reason I want to share is because I think proximity to a situation leads to empathy. And I think our world would benefit from increased empathy. I want to continue to be honest and authentic about what it’s like to struggle with something that is personal. Shame lives in dark places. And this is an area of life that A LOT of people struggle with and for which a lot of people feel shame. (As in 60% of Americans are overweight and 39.6% of Americans are obese). Food, weight, body image, eating disorders. It’s so complicated. But it’s also SUPER common. And so let’s just agree that this is not a situation that has to do with morality, or worth. Let’s just agree that all people, regardless of size, are full, whole and worthy people. And let’s honor their stories and their struggles, and their experiences, and their decisions on how best to live their truth.

Thanks for reading!


Post Script:
I am willing to answer questions about this process, but am not really up for people trying to talk me out of it. I am going in with eyes wide open. I’ve come to a decision that’s best for me and I hope you will respect my autonomy in decision making. :) 

* Just an obvious FYI, you never needed my permission to drop off.

** If you're interested in learning more about set point theory and obesity, I highly recommend this 7 minute video my doctor shared with us. 

***  Sidenote: I would also say that some bariatric divorces are good-- specifically when the fat spouse has stayed with an abusive partner because they think they can’t do any better. Then, upon losing weight they finally gain the confidence to leave the abuser. And I get that it’s wrong that losing weight would increase people’s confidence, but that’s just the world we live in. This world hates fat people. But I digress. 

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