Tag Archives: bariatric surgery

Facebook's On This Day reminded me that today is my 2 year Surgiversary.

So much has happened in the last two years. My life hardly resembles that of two years ago, in a good way.

Here's a picture of me also from the general time period before surgery.

It isn't until photos like this show up on my feed that I really realize how big I was. It's always a little breathtaking since even when I was at my highest weight I never really saw myself as that big. It's like I had reverse body dysmorphia.

So here's what I look like now.

Forgive the blur, Im using my new selfie slick and my hand shakes.

Also, I'm on a vacation right now in case you couldn't tell from the hotel background. Check out how much slack I had in my seat belt on the plane!

I was JUST shy of needing a belt extender when I flew the last time before surgery.

I'm not perfect. I still have struggles with food. I don't eat how many WLS "gurus" say I should. I get obsessive about the scale and still sometimes beat myself up about my food choices or weight. I'm not as toned as I'd like to be. Or as active as I know would be better for me.

What I am, is a woman who decided to change her life, and did it. It wasn't easy, but I've held on. I'm 2 years out from gastric sleeve and am maintaining within 10#of my lowest weight. I only feel like I have another 10# I'd like to come off. My medical team is thrilled with how far I've come. I am off my CPAP, off 2 blood pressure meds, and my autoimmune arthritis has been in remission for over a year. While I still fight chronic illness, I'm healthier than I've been in 2 decades.

Not bad, if I do say so myself.

People ask me if I regret having surgery, especially when I complain that I can't eat more of some really delicious food. My answer? Not one iota. My only regret is that I didn't do it years before.

So if you're thinking about having bariatric surgery, and your medical team concurs, count mine as one voice saying "you can do it!"

I love caffeine.

It's a serious and lasting love I've had since I was a teenager.

I grew up in a religious denomination that teaches not to defile your temple (body) with drugs like caffeine. It wasn't a "you're going to hell" prohibition, but it was certainly discouraged. As a result, I didn't learn to like the taste of coffee as a teen or adult. But my parents weren't all that strict about it, so I started drinking sodas with caffeine and had a serious Dr. Pepper addiction starting from about high school forward. It wasn't until I developed some benign cysts and my doctor inquired about my caffeine intake that I had ever even stopped to figure out how much I was drinking most days.  (It was a LOT.)

Then came the day I discovered the Frappuccino® from Starbucks. That was heaven in a cup. With whip and drizzle. I was hooked. When I couldn't get Starbucks, I started drinking "regular" coffee with a lot of cream and sugar. Friends have told me I don't really like coffee, since it's not coffee when I'm done with it. It's a chocolate milk concoction with a little coffee in it.

I knew I was addicted. I have chronic migraine, and if I didn't have a good dose of caffeine by noon, I'd have a migraine headache by 3pm. The first neurologist Munchkin saw said that migraineurs self-medicate with caffeine and it can be a good thing. The next neuro she saw griped at both of us coming into his office with Starbucks. (We fired him.) The few times in my life I've tried to detox off of caffeine, it was 2 to 3 weeks of headache and fatigue and prescription doses of ibuprofen 'round the clock.

Nursing school and nurse life did nothing to dissuade me from continuing my caffeine habit. In fact, it's a standing joke that all nursing students have coffee in their veins instead of blood.

Then came my bariatric surgery.

My surgeon doesn't restrict caffeine after the 2nd day post-op, but a lot of people report not being able to tolerate coffee on their newly rearranged stomachs for periods ranging from a few weeks to a few months post-op. Knowing that coffee is pretty rough on the stomach, and since carbonated beverages and ibuprofen are completely prohibited for an extended time post-op, I knew I needed to get off of the caffeine. Withdrawal was not something I wanted to try while recovering from surgery and having a delicate stomach.

So a few weeks before surgery, I started weaning myself off of caffeine. It actually went pretty smoothly, with judicious application of ibuprofen and good migraine meds. By the time the surgery rolled around, I didn't need it anymore. I was "clean" for the first time in decades.

After the surgery, I didn't try coffee for a few months. I tolerated it fine when I did, but there was something freeing about not HAVING to have the caffeine in order to feel well. I also appreciated that since I didn't drink it regularly, when I did indulge in a cup, I got more of a "kick" from it than I had when I was drinking it multiple times a day. I decided I'd just continue with most days not having any caffeine.

Unfortunately, I'm also a Spoonie. Multiple chronic illnesses, most of them with symptoms of extreme fatigue and brain fog, cause me to struggle to get through many days. I started having occasional sugar-free caffeinated sodas with lunch. Then it became a daily thing. (Yes, my sleeve lets me have carbonation if I don't drink it too quickly.) A couple of weekends ago, I was feeling particularly sluggish and decided to get a soda. It picked me up so well that I had coffee the next morning and I had another really good day energy-wise.

I was faced with the choice of inviting my coffee monkey to climb right back up on my back or staying true to being "clean" and forcing myself to push through days without any support.

(Most people probably don't think about this kind of thing to the extent I do. It's one of my charms.)

I looked at myself in the mirror and said, "Screw it." Then I made myself a cup of coffee. Lots of creamer, monk fruit sweetener (that stuff is AWESOME).

Since we're starting to have warm weather here in Texas, I tried some cold brew coffee in cold milk with chocolate. YUMMY! That's my new morning staple until it gets cold again.

This past weekend, I forgot to get coffee when I got up Sunday morning, as the habit is not yet ingrained. Around 2pm I was trying to figure out why I felt so groggy and headache-y. I went to grab some food from the fridge and saw my bottle of cold brew and the light bulb went off. Got myself some coffee and felt better within the hour. (Yes, I'm a dork sometimes.)

Part of me felt bad that I'd succumbed to my addiction again after being well and truly free of it.

The part of me that loves my coffee knocked the other part into a coma and suggested we stop at Starbucks on the way home.

I spent a few months as a client of Good Measures, and wanted to share my experience.

The short version is that Good Measures is a great service, especially for bariatric surgery patients who do not have easy access to a Registered Dietitian (not a Nutritionist) where they live.

For those not familiar, Good Measures essentially provides dietitian services over the internet. You track your food in their diary setup, and your macro- and micro-nutrients will be evaluated. The tools are available through the website or a mobile app. You get immediate feedback in the form of the Good Measures Index (GMI), a number from 0 to 100 that evaluates the quality of your food intake for the day.

Each client is also paired with a Registered Dietitian (RD) for individual meetings over the phone, up to once a week included in the monthly fee. The RD can make adjustments to your individual nutrient goals to better reflect your needs. For instance, mine ramped up my protein goal and decreased my carb goals as I am a bariatric surgery patient. During the weekly meetings, the RD gives suggestions for foods to expand variety or better address nutritional needs/goals. The website/app also gives meal/food suggestions including recipies from several sources, and you can choose which of those sources to use as well.

I read about Good Measures in the Bariatric Foodie blog and she reports that Good Measures requested her input to make their platform more helpful for bariatric patients. Her blog entry has a MUCH more detailed review of Good Measures, I recommend checking it out. I also found them to be very responsive to input about their product and services.

One of the challenges for the bariatric surgery patient is finding really good dietary information. Physicians don't tend to get a lot of training in nutrition during their schooling. What a bariatric surgeon knows about diet typically comes from his perceptions of the experiences of his patients, plus information he gets from his peers. As a nurse, I got more training in nutrition than most physicians, but it's still not anywhere near the level of training a Registered Dietitian has.

A word here about nutritionists, those we refer to on WLS boards as 'NUTs'. In my state, and probably most others, there is no required training, certification, or degree in order to call yourself a nutritionist. Literally anyone can hang a shingle and call themselves one. I would imagine some NUTs are great, somewhere. However, I've never met one. What I have gotten from NUTs include information copied straight from the American Dietetic Association, exchange diet information that's outdated, or some wacko fad diet that's all the rage. Oh, and they usually want to do blood tests on the order of several hundred dollars to inform me what I should eat based on my blood, and identify food allergies that are "sub-clinical". I'll spare you my rant on this quackery, since my use of the word 'quackery' should make my opinion plain.

Bottom line, in my honest opinion NUTs are rarely worth your time or money. If they are employed by a surgeon's office, they'll be handing out the same information to everyone with little to no customization for individual needs and no real critical thinking if asked a question outside the box. If they're in an independent office, expect a lot of billing for information you can easily get from the internet and most of it is likely bunk. Often, NUTs are all a bariatric patient has access to, and that's a problem.

I loved that Good Measures provides access to a RD instead of NUTs, and that they've made a concerted effort to improve their offerings for bariatric surgery patients. I found my RD very easy to talk to, and she was very helpful.

My only complaint is that I found their food diary program to be not quite as robust as MyFitnessPal, and a little less intuitive. I don't mean to say that their database is bad, it's actually pretty good, it's just not quite as robust as MFP. I believe that they're working on expanding their food database, and help is always available through email or phone with a helpdesk technician. It was not annoying enough to drive me away from the service. On the plus side, the food diary looks at more micro-nutrients (vitamins, minerals, etc.) than MFP does, and the GMI is a real benefit. Add that to the RD access, and the little gripes I have about their interface are minor.

In comparison to what consultations with an in-person run, it's an absolute steal. The costs when I was on the service were $39/month paid monthly or $29/month paid annually ($348/yr). While that's more than a Netflix subscription and might seem high, I found it absolutely worth it. Especially for bariatric surgery patients who don't have ready access to a RD, this service is indispensable.

There is one caveat I think I should mention. If you have not been released to a "full diet" by your surgeon, you need to continue with what he/she has prescribed. During that critical healing period, what your surgeon says should be what you follow, period. (I have an entire post dedicated to the subject here.)

I think Good Measures offers the most to bariatric surgery patients who are moving into maintenance and want to expand their diet while still focusing on quality nutrition and trying to avoid the weight "bounce" that's very typical for many patients. It might also be an excellent choice for those around a year out who may still be trying to lose weight, but are finding it harder and harder as the honeymoon period wanes.

I did drop my service after a few months, because all the stress of grad school and chronic illness flares during the winter left me without the energy or drive to spend the time and money on my dietary quality. I will probably pick it up again later when I'm actually ready to focus on the effort.

Conflict disclosure: I was not compensated in any way for this review. I paid full price for my Good Measures service, and was not asked to make this post by anyone.

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diet_what_dietI used to participate on a particular WLS support board, and we had an absolute deluge of people posting about “cheating” on their post-operative diets.  Some of the netizens would respond “oh, honey, that’s okay… we’re all human.”  Discussions about how impossible it is to fight food addictions would ensue.  As a nurse, I was horrified that these people did not seem to understand the critical importance of following the post-operative diet instructions from the surgeon.

In case this post runs on too long and you need the TLDR; (too long, didn’t read) version here it is:  STICK TO YOUR SURGEONS POST-OP INSTRUCTIONS TO THE LETTER.  IT IS NO LESS THAN YOUR LIFE ON THE LINE.

Understand your surgery

Most bariatric surgeries today are performed arthroscopically.  That means there are only a few tiny holes that you can see from the outside.  You need to understand that the surgery on the inside is HUGE.  If you’ve had the vertical sleeve gastrectomy (VSG) there is a suture line running the entire length of your stomach.  If you’ve had Roux-en-Y (RNY) also known as the gastric bypass, there are multiple suture lines throughout your digestive tract.  There are other surgeries, but those are the main ones, and the principles hold for all of them.

If you had a long cut on your arm, you’d (hopefully) know that you need to keep it clean, keep out dirt and other stuff that can get stuck in the wound, and how important it is to protect the area while it heals.  You can’t see the wounds that are on the inside, but they require the same kind of protection and support while healing.  But we can’t put bandages on them, or keep from eating.  So food is going to be in contact with those healing wounds.

Also, whichever surgery you had, your stomach has a new configuration and doesn’t know how to manage food easily just yet.  Your digestive system has to re-learn how to do its job with the new configuration, just like a newborn baby’s.  It’s important to start easy and work up to harder to digest foods.

A diet for healing

Any food you eat while the suture lines heal (about 6-8 weeks) will be in contact with a healing wound.  Most surgeons give very detailed instructions about what to eat after WLS, and it’s all designed to protect that suture line and ease the newly configured stomach into its new way of working.

Over the years, doctors have learned what foods are best for a healing stomach, and that translates into the post-op diet progression instructions.  Typically, that looks like this: Clear liquids, full liquids, pureed foods, soft foods.  Each phase typically lasts a week or two.  Only after those phases are complete will they have the patient slowly move into a "full" diet beginning with high moisture content foods first.  The surgeon will specify what foods belong in each phase, and how long to stay in the phase.

The general idea in the very early weeks is to eat foods that will not stress the healing suture line, and do not have particles that are known to cut into the raw tissue or get embedded into the suture line. If a cut or embedded food particle gets infected, it can become an abscess and develop into a life-threatening leak. Foods that are particularly known to cause issues are those that swell up like rice, have seeds like strawberries, or have rough hard edges or hard to digest fibers like wheat crackers or raw vegetables.

When moving from one stage to the next, it's typically advised to add just one food at a time, in small amounts, and see how it's tolerated. A food that's not tolerated well can be tried later on as well. If an entire stage is not being tolerated, back up to the previous stage for a while, and then try again more slowly.  For example, eggs were on my soft foods list, but I couldn’t tolerate them until after I was eating moist proteins.  My surgeon said that was common, and many food intolerances early on will clear up later after more variety of foods is well tolerated.

A very real risk

Just as there are people who smoke a pack a day while drinking a pint of whiskey and live to be a hundred, there are people who eat all sorts of things against their doctor's orders and suffer no ill effects.  This is not a justification to ignore your surgeon’s instructions, it’s pure luck on their part, or possibly some amazing genetics.  You shouldn’t count on either.

The reality is that some people will develop abscesses and leaks because they ate things before they were cleared to by their doctors, and there is no way to predict who will have the complications and who will not. And the consequences can be as severe as death.

I don’t say this to scare you away from WLS.  These complications are very rare.  But you increase the risk significantly when you ignore your surgeon’s post-op instructions.  The doctors are not testing you or trying to make your life hard. They are giving you the best information they have to keep you safe.

It’s incredibly difficult to deal with cravings or “head hunger” as some of us call it, or wanting desperately to chew real food.  It’s very hard to be on liquids only for weeks.  Acknowledge that it’s hard, and seek support in getting through it, but understand how vital it is to muscle through.  Violating these orders is not "cheating" on a diet. It's risking your life.

Trust your surgeon

If you spend any time talking to other WLS patients, you’ll find that every surgeon has a slightly different protocol.  Some skip entire phases listed above, or shorten them dramatically.  Some seem to be completely radical and start patients back on solid food in just days after surgery.  This is not a case of right or wrong.  Each surgeon operates based on what they were taught combined with their personal experiences.  They may even make modifications for an individual patient based on that patient’s health and history.

If you are trusting this surgeon to operate on you, then you need to have trust in their protocols.  The time to make sure you fully understand the protocols, have documentation about the specifics of the protocols, and that you agree to the protocols is BEFORE SURGERY DAY.  If you don’t trust everything your surgeon advises, get a new surgeon.  If there’s a particular concern about part of a protocol, sort it out before you schedule the surgery.

I personally would never stay with a surgeon, for instance, who doesn’t allow any protein drinks (even clear ones) for 2 full weeks post-op.  (Relayed by a patient online, I don’t know if it was truly in the plan.)  I know from my training that healing requires lots of protein, and a huge amount of the healing happens in those first 2 weeks.  If that were in a surgeon’s protocol, I’d get a referral to another.

In conclusion

WLS is a fantastic tool for many people in retaking control of their health.  It’s a huge commitment.  Do yourself and your surgeon a favor, and don’t risk all the time, energy, and money you’ve put into it.  Follow your instructions.  Believe me, it’s over faster than you know, and it sets you up for success in the rest of the process.

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Well, it’s that time of year again. 2016-i-was-the-most-awful-year-possible-2017-hold-my-beer

Time to look back and see how the year went, and try to decide what’s important for the upcoming year.

2017 has been a rough one, certainly.  I think the country made a mistake with the election of #45, and I find him to be a complete embarrassment.  I believe we’ll be cleaning up his mess for the rest of my natural life.  I find myself anxious and upset over politics and political maneuvers every single day.  It doesn’t help that our representatives in Congress don’t seem to care about the lives of their constituents, only the grift lining their pockets.  I know it’s been that way for a long time, but it seems to be getting worse and worse since Citizens United.  I honestly fear for my country.

On a personal level, it’s been a year with ups and downs, but mostly ups.

Since having the weight loss surgery in August of 2016, I have lost approximately 110-115 lbs.  This has resulted in vast improvements in my health overall, and likely contributed to my auto-immune condition going into remission this year.  My health news hasn’t been all good, though.  I developed thyroid nodules and a host of odd symptoms that seemed to resolve after stopping my auto-immune medication.  I also was formally diagnosed with fibromyalgia.  The fall/winter brought a string of migraines and respiratory problems, and that seems to be a seasonal pattern for me.  With all of that, plus grad school, my weight loss has stalled out about 15-20 lbs away from my goal.  I’ve been able to maintain pretty well, which is good.  Once the winter-related health issues start resolving in the spring, I’ll hopefully be able to get that last 20 lbs off.

Ah, grad school, how I loved thee… NOT.  I am happy and proud to say I slogged through my last semester of grad school, and passed with a GPA of 3.57.  I got seriously behind with the capstone project due to health complications, and lost a lot of points in my topics class due to late postings as I tried to keep up.  I seriously considered abandoning the semester and trying again in the spring, but good friends and family convinced me to push through.  My capstone professor was flexible with it and helped me catch up, which I greatly appreciate.  I am SO happy to have it done now, and so glad people who care about me convinced me to push through.

Now I have 2018 upcoming, which was the year I told everyone I’d get back into a social life.  I have so many things that I wanted to do that I had to shelve until 2018, so now I have to see which ones I still want to do and what the priorities are for all of it.  It’s strange to have free time again and not worry about assignments or reading that I’m behind on all the time.

On the homefront, the Mister and I continue to be blissfully (and annoyingly according to Munchkin) happy together.  After getting it so badly wrong a couple of times, it’s still a wonder to me that I got it completely and totally right this time.  I truly feel blessed.  All our kids are doing great.  We did gain a new fluffy member of the household when a young tuxedo tomcat invited himself in on a chilly evening.  I posted to the neighborhood boards and no one claimed him, so George became a member of the family after getting vetted and fixed.  Princess Buttercup is decidedly NOT amused, Ginny is alternately interested in playing and ticked off about him.  The dogs don’t know what to do with him, especially since he keeps trying to go into their area of the house.  But it’s fun having a young boy cat in the house again… he demands playtime or he gets truly obnoxious with the other cats, and he CLIMBS EVERYTHING.

Well, that’s most of the update for 2017.  I’m planning to do a lot more writing in 2018, so stay tuned for that.

I hope every good thing in the new year for all of you!

And it doesn't even look like it's an oncoming train.

I'm in the final countdown for #gradSchoolSucks -- 3 weeks left.  It's hard to accept the fact that I'll no longer be a student a month from now.

Well, IF I get my paper done for my Capstone and I don't flake on the rest of my Topics units.

I am imagining all the things I'll get done with all that spare time.  And then laughing at myself, because most of it will assuredly be spent catching up on my reading list and Netflix binging.

But to have a life again!  Woohoo!  5K's, dance lessons, learning languages... I have a list of things I want to start or take up again in 2018.  Whether all of them will happen or not is anyone's guess.  I just won't have the crush of grad school pressing on me.

In a way this feels like a brand new start on life.  Even though I still struggle with chronic illness and everything that goes with it, I'm so much healthier than I was when I started back to school all those years ago.  I even broke another weight plateau this morning, putting me only 5# away from the top of my ultimate weight goal range, and 15# away from the low point of the range.  I had been only marginally watching my intake, and haven't been terribly active with all the migraines, allergies, upper respiratory infections, and such that seem to be my life in October/November each year.  I'd resigned myself to maintaining my weight until after the holidays.  So anything that comes off on its own is a fantastic bonus.

So right now I'm still in the tunnel, but I see the light and all I have to do is keep moving and I'll get there.

If you can't fly then run,
if you can't run then walk,
if you can't walk then crawl,
but whatever you do
you have to keep moving forward.
― Martin Luther King Jr.

A few weeks ago I got to take a week long business trip to Irvine, California.  I took advantage of the opportunity to go out to the beach a couple of evenings I was there, and walk in the sand.

I lived about a year and a half in Hawaii when I was a child, and it's been that long since I've been in real surf.  (I maintain that beaches in the Gulf of Mexico do NOT have real surf.)

It was awesome to walk on the beach in the edges of the surf.  It was awesome in a different way to get reminded of the sheer power of the ocean when I didn't pay attention and got my feet yanked out from under me by one of the larger waves.  (No serious damage was done, just Mother Nature reminding me that she'll knock you on your ass if you don't respect her.)

As it was, I walked a LOT further down the beach and back than I originally intended to.  I had forgotten that walking on sand at an incline is a LOT more strain on the legs and feet than on level ground.  So I was incredibly sore when I got back to my car (not to mention having sand EVERYWHERE) but it didn't appear to flare my rheumatoid disease any worse than it already was.

Yes, it appears that my RD/PsA is not in remission as we had hoped.  We're currently waiting on blood test results that will inform our treatment decision, but just from my pain levels and where the pain is, I can definitively say I am *not* in remission.  It was a nice thought, but now it's time to reassess, remake the plans, and move forward.  My pain levels are reaching the point of interfering with good sleep and trying to keep me from moving.  But my week in California taught me that moving actually lessens the pain - at least after the first few minutes.  I was

My pain levels are reaching the point of interfering with good sleep and trying to keep me from moving.  But my week in California taught me that moving actually lessens the pain - at least after the first few minutes.  I was in a situation where because of parking costs, I had to walk about 2 city blocks each way to get lunch every day.  This is in addition to my evening forays to the beaches.  Once I got up and started moving, I felt better.  (The weather helped because it was drop-dead gorgeous the entire time I was there.)  So I'm committed to stay on my exercise program.  Right now I'm focusing on water walking/swimming twice a week, and plan to start adding on light weight training soon.

I also went to a meeting of an in-person weight loss surgery support group, and found that I like them and the format very much.  They even convinced me to join them in a 5K walk later this month.  So the Mister and I are going to start walking as much as we can in the Texas heat to prepare for it (he's doing the 5K with me).  I may not finish, but I'm going to give it my best shot.  I have told my friends who are runners that this is NOT a gateway for me to start running.  They just laughed.

So that's where things stand in TheAntiChick's world.  Not perfect, but doing OK.

So today marks the one year anniversary of my life-changing surgery.  I had my checkup with my surgeon yesterday and got the best surprise.

You see, I have a scale that is consistent but not accurate.  It has consistently throughout this process weighed me 5 lbs lighter than the doctor's scales.  I thought I could trust it.  Yesterday morning, I got on and it said 198# which I converted in my head to 203#.  I had been down to right at 200# and had been waiting to break into what WLS peeps call "ONE-der-land".  I'd perversely hoped that it would happen for my check up day.  But alas, weight fluctuations happen and while I wasn't upset about the seeming gain, I was a little disappointed to have my official 1-year weight over 200#.

But, when I got on my doctor's scales, this is what was displayed:  199.74# with a BMI of 29.5 - which made me VERY happy.

A BMI of under 30 means I am no longer clinically obese, now I'm just overweight.  I actually reached that point a few pounds ago, but this is the first time it's been recorded in my chart.

I don't like the BMI for a lot of reasons, but it is the measurement that's used most often clinically.  So getting that "Obesity" classification off my record is a big win.

I don't usually post a lot of pictures on this blog, but today's a special day.  Here's where I started.  The picture on the left was a few years ago at my nephew's wedding, the one on the right is my wedding in 2015.  I topped out at 306# a little after this.  I don't actually have any pictures of me at my highest weight.

 

 

Here's my pics today:

 

And a face-to-face comparison from just before surgery to now.  This is where I think the weight loss REALLY shows:

I've already written about the health improvements I've seen from the WLS.  While I'm afraid that my rheumatic disease is not, in fact, in remission, the other improvements are amazing.

I was setting up my pills today for the next couple of weeks and kept looking for more pills.  That can't be all the medicine I take!  Yep.  I now have only 4 prescriptions I take regularly - my allergy medication (one pill and a nose spray), my proton-pump inhibitor to protect my sleeve from meds, and my cholesterol pill.  I hope to lose the cholesterol pill soon as well.  I do still have migraine medicine for when I need it, but no longer take a preventative.  Even with the vitamins and supplements I need to take, I'm taking MUCH less each day than I used to.

So 1 year out.  Not quite to goal, but under 200# and that's amazing.

More to come...


Picture from the No Body Shame website

I have previously talked about my struggle with the cognitive dissonance between wanting to support/promote/embody body positivity even though I have had WLS.  Cognitive Dissonance

My news feed this morning sent me to Dances With Fat, specifically to a post talking about not allowing weight loss talk in body positive spaces.
Do Body Positive Spaces Have to Allow Weight Loss Talk?

And this led me to another post by the same person about Weight Loss and Size Acceptance

These two posts got me to thinking hard about body positivity and weight loss, specifically weight loss surgery. I don't want to think that I am not an advocate of body positivity. But the Size Acceptance (SA) community, the Fat Acceptance (FA) community, and the Body Positivity (BP) community seem to have a blanket exclusion for anyone who wants to change their body size/shape, regardless of the reason.

There are two separate issues I identified with the articles linked above - speech and behavior in SA/FA/BP spaces, and where people who want to change their bodies for whatever reason fit in the movement.

I agree that SA/FA/BP communities need safe spaces in both internet space and meat space, away from talk about weight loss. I totally get that and wholly support it. I don't expect to go into SA/FA/BP spaces and say or do anything that sends the message that people of size need to change themselves. It's their space, and they establish guidelines for speech and behavior in order to protect the other people in that space. It would be pretty rude of me to go in there and say that people are okay at whatever size but that it's still better, for me at least, to be smaller.

Then there's how people who have or want to lose weight fit in the SA/FA/BP movement. I know a lot of people through my WLS support boards who got fed up with their body and size and looking "better" is their primary motivation for weight loss. That's totally cool, and I consider that as valid of a reason for weight loss as any other. But I'd have a hard time saying that they promote body positivity or size acceptance.  They can advocate against discrimination and bullying of people of size (and most do), but when aesthetic reasons are their primary motivation, it doesn't mesh with the ideals of body positivity.

Then there are people who share my mindset about weight loss. My primary motivation is my health, period. If I could have affected the health improvements I have had through WLS through any other means, I would have done it. I wasn't all that unhappy with my size, and would never have done anything this radical just to fit in smaller clothing. I am finding myself thrilled with some of the superficial changes, but they are absolutely secondary (or even tertiary) to my health goals. I had WLS *because* I love myself.  But the SA/FA/BP community doesn't just want me to respect their need for safe spaces without diet talk, they want me to believe that I'm not SA/FA/BP because I want to be healthier.

Therein lies the problem for me. One woman commented  that she needs to lose some weight because the fat itself is impeding her from being able to take care of herself. Her lymphedema (extreme swelling of the extremities) requires her to compression wrap her legs and she's unable to physically do it because of the amount of belly fat she carries. Her health is impaired by the fat itself. It's not a theoretical exercise of whether fat people can be healthy, or if losing weight really leads to better health. Her fat keeps her from taking care of herself. She doesn't care about fitting into smaller clothes or an airline seat, she needs to be able to move well enough to maintain her own hygiene, dress herself, and take care of her medical needs. Yet the author's response was that losing weight is never permanent, and the commenter needs to focus on accepting herself where she is.

As a nurse, this kind of one-way thinking horrifies me.  Hell, as a rational thinking human, this horrifies me.

Yes, the evidence shows that diet and lifestyle changes are rarely successful long-term. The evidence also does not support the idea that being overweight automatically means that someone is not healthy, or that someone who is thin is automatically healthy. Weight is not the only factor in health, and it needs to stop being treated as if it is. The overweight patient with an ear infection needs treatment for the infection, not to be told to lose weight. The overweight patient who tears a major ligament in their knee needs surgery and physical therapy, not to be told there's nothing to be done until they lose a set amount of weight. Shaming someone about their weight is counter-productive. No one should feel bad about themselves because of their weight/size. And frankly, if you're not part of that person's medical team, their weight and size is none of your concern.

But when the excess tissue ITSELF is causing health problems, it is irresponsible to maintain that the person should do nothing about it in the name of SA/FA/BP. And some health conditions, even if they are not directly caused by excess weight, can be vastly improved by losing weight. It is irresponsible to tell a person that there is no benefit to losing weight because it cannot be kept off. Shaming a person for wanting to better care for their body should be completely against the tenets of Body Positivity. That person is not saying other people need to make the same choice or preaching that her size is unacceptable. She is saying that she - and she alone - needs to try to do something in order to maintain or improve her health.

Interestingly, when doing a little research for this post, I found that the Health at Every Size (HAES) curricula does not, in fact, teach that everyone is at the size/weight they should be, and instead states that many people have weight-related health concerns. HAES advocates learning to eat intuitively and physical movement to improve health. The difference is that HAES wants people (especially medical professionals) to start looking at more health indicators than weight and de-emphasize weight as a primary health indicator.

Here's what I believe. People of all sizes need to learn to love their bodies and quit buying into society's media-driven image of what beauty is because diversity is beautiful.  People who don't fit society's warped view of an appropriate size/weight suffer a great deal of discrimination right now. Size shouldn't impact your ability to get a job or raise or promotion. It shouldn't impact your ability to exist in public spaces (doors, chairs, etc.). It shouldn't be the only thing medical professionals look at, and it absolutely shouldn't be a determining factor in treatment decisions. Fat is not a moral failing, and it shouldn't be treated as one. Fat people aren't lazy, and they are not fat because they have no self-control. No one should be harassed or bullied in any fashion because of their size. In fact, someone's size/weight is none of your business unless you're on their medical team. Even then, the person deserves nothing less than professional and compassionate care.  Diets don't work and are very damaging to health.  Weight-cycling is more damaging to someone's health than being overweight alone.  Basically, I believe almost everything that the SA/FA/BP groups purport to believe.  The only point I differ on is the exclusion of people who have reasons to need to change their body.

So I'd like someone to educate me as to why I have no place in the SA/FA/BP movement. Because I just don't get it.

 

<--- this pic is where I started

this pic is where I am now -->

I actually started this post back in March, when I was 7 months post-op.  Work, grad school (#gradSchoolSucks btw), family issues, etc. derailed my good intentions to start writing regularly again.

May 17 was my 9 month anniversary of surgery.  I met with my surgeon and my rheumatologist that week.  They were both very happy with my progress.

There are days when I wonder what the heck I did to myself. But they are few and far between, and usually right after I've eaten 1 or 2 bites too many, or eaten something that my sleeve disagreed with. Most days, I really can't complain, and would do this surgery again in a heartbeat.

My rheumatologist believes my rheumatoid disease (RA/PsA) is in remission.  She'll re-do all my bloodwork in August and see where it stands.  Right now, I still have some joint aches, but it's mostly minor.  I seem to have been right about the meds causing a thyroid issue, because all of the associated symptoms are gone.  I am now off my RA/PsA meds, we are tapering off the meds for fatigue, and I accidentally stopped the migraine prevention meds without tapering but didn't have any issues.  Since surgery, I have gotten off (or am currently tapering off) 5 medications, including all blood pressure medicine, the med for fatige, my RD meds, and my migraine preventative.

Back in March, I had to run out at lunch and get some new slacks for work. I had been able to get by through "shopping my closet" for pants I'd stored away years ago thinking "I'll get back into these someday". Well, someday came, and it's now long gone. Those pants from almost 2 decades ago had become too baggy to be respectable, so I took a chance on some lunch shopping.  I went from a 22/24 pant to an off the rack 16.  I couldn't find off the rack pants that fit the last time I was in a 16 as a teenager.  But now "curvy fit" pants are available, and they work for me, as I have a small waist compared to my hips.  I also didn't plan ahead, and did the shopping in 3" heels, without any issues.  That would have crippled me a year ago.

Now at the end of June, those pants are getting loose.  Not so loose that I have to replace them, but starting to look a little sloppy.  I'm now in an adult Large shirt from a 3X.  I bought skorts at Sam's the other day, which never could have happened when I was in plus sizes.  I have lost 102# as of right now.  My BMI is teetering on the overweight/obese line.  One more pound lost, and I will no longer be clinically obese.  I could stop losing weight right now and all of my docs would be thrilled.  But I'm not stopping.  I have another 30# or so to lose to get to my target weight, which I set by looking back to the weight I was the last time I looked and felt awesome.

I still haven't started exercising regularly again since the health issues of the winter/spring.  But I'm feeling good and it's only my insane time pressures with work and school that are keeping me from it.  I have a plan to ease back into the workouts so I can start rebuilding some lost muscle.

Life is pretty darned good from this side, I must say.