Happy 100: The Post-Game Analysis on Bariatric Weight Loss

Salutations, friends!

I love it when the universe aligns for a fortuitous coincidence, and how’s this for kismet: yesterday was the six-month anniversary of my sleeve gastrectomy, and when I stepped on the scale in the morning it read: “168.0” One hundred pounds lighter than I was about a year ago.

I’ve been carefully monitoring my progress throughout the procedure, all the way back to the first pre-op appointment in 2014. The total process from an initial seminar at Hartford Hospital to the surgery proper on January 19 took roughly one and a half years. That time was spent in close consultation with a dietitian, pulmonologist, and cardiologist in addition to my surgeon, the rock-star and pioneer in his field, Dr. Pavlos Papasavas. A psychiatric examination, sleep study, and support group attendance were also part of the preparation.

Considering the significance of a centenary drop in body weight (and, incidentally, a drop in BMI from 39.0 to 24.5), I think a recapitulation on the journey is needed. If you’re thinking about surgical weight loss, or you’ve had it, or you’re just curious, you’ll enjoy my look back at what I’ve lost and gained from having my stomach removed.

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January 19, 2016 – three hours after surgery. 

The replay on…the value of surgical weight loss.

The question I’m most often asked is, “Why have surgery?” Some folks want to know if I tried it “the old fashioned way” first (I did, many times) and others wonder why I took the risk of going under the knife for a serious elective procedure. In medicine, everything is about odds. Treatment for an illness, whether with drugs or surgery, is always a risk. The health care team calculates the dangers of treatment against the risk of not treating an illness at all. I approached my surgery with the same mathematical rationale: was the risk of complications and even death from surgery greater or smaller than the long-term damage of morbid obesity? I already had a very high BMI, hypertension, hyperlipidemia, sleep apnea, and a pre-diabetic fasting blood sugar (my A1C was 6.5). The research showed that each of these symptoms related to weight would be dramatically reduced or eliminated by surgery. Overall, life expectancy for someone who has a gastric bypass or sleeve is increased by 85% compared to obese persons who do not have surgery.

So it was, logically speaking, a no-brainer. Of course I was nervous ahead of surgery – who wouldn’t be? But after the procedure, the payoff became immediately evident. Within a few months, my hypertension, hyperlipidemia, and blood sugar levels were resolved. Sleep apnea was gone by May, and I felt incredible – more energetic, focused, and grateful than I had been in decades. At six months out, my doctors concur: I’m in outstanding health.

The next step: At my last consultation with the surgery team, in May, we set a weight goal of 170-175lbs. I’ve exceeded that, so technically my weight loss target has been met. I still continue to lose weight, however, at a considerable more modest rate of one to two pounds biweekly. I would be happy to settle in at around 155-160, providing a comfortable buffer for any weight gain after the so-called “honeymoon” phase is over. But with all of my health issues resolved, any surplus weight loss is really just icing on the low-carb, sugar-free cake.

Mashamoquet Before and After.jpg
In 2010 (258 lbs) and again in 2016 (185 lbs). 

The replay on…diet and exercise.

Of course, surgery is the catalyst for a weight-loss journey, not the panacea for obesity. I used the initial “boost” of losing 40 pounds in the first month to exercise constantly. Sticking rigidly to the nutrition guidelines prescribed by dietitian have also made this process a success. I have a “rule of five” to which I adhere fanatically; these five foods are strictly verboten, never to be eaten: rice, pasta, bread, refined sugars, and ANY kind of corn or potato-based fried or baked snacks (chips and their like).

For proteins, I stick to non-fat dairy (Greek yogurt), 1-2 ounces of nuts per day, fish, beans, and lean meats. About 70% of my daily diet is vegetables, greens like kale and spinach, and low-glycemic load fruits like cherries, raspberries, and strawberries. Never before in my life have I eaten so many salads, nor did I ever think I could relish a good salad as the old me did a fat pork chop or bowl of Chee-tos. River and I counted the number of salad dressings (no more than 5 grams of fat per two tablespoons) in our fridge the other day, and there were nine!

I am obligated to take in a minimum of 64 ounces of water per day, and since I can’t “chug” 32 ounces of that in a go, I need to sip constantly throughout the day. I still take my morning coffee – with skim milk and Stevia. Soda is a never, ever – I have not had a single drop since the start of this year, and never will again.

Eating out has been a bit of a challenge. Not only is it hard to ascertain what you’re eating when someone else prepares it, but I’m budget-minded and dislike paying too much for a meal I can’t possibly finish. I get creative and order side dishes, salads of course, or just plan to take my meal home to finish over a few days. On the bright side, I have a much greater appreciation for the quality of food. Like many of us, I used to go for quantity – line me up at the buffet so I can pack in as much crap as possible. Now, I can afford to eat small portions of excellent-quality foods.

The next step: Despite the protests of my dietitian, I’m considering going pescetarian (a vegetarian who still consumes fish). The goal for someone post-surgery is 70 grams a day, and I’ve calculated out how to take in that amount through beans, dairy, nuts, and fish. It isn’t very difficult at all. Relying more on these foods for protein would cut out some of the very unhealthy and hard to avoid saturated fats in meat. In terms of fluids, I grew tired of plain water about a month ago and have been adding those dreadful aspartame/sucralose based sweeteners to it. Not only are the sweeteners problematic for health, but the dyes are nasty as well. I’m challenging myself to return to plain water, or sweeten my drinks with fruit.

In terms of fitness, I have a lot of sagging skin around my lower abdominal region, and I need to strengthen and tone my core. Time to use my gym membership and left those weights.

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One week ago, at Mount Misery.

The replay on…emotional and spiritual benefits.

You’ve already read about my renewed sense of gratitude and joy. To some extent, I’m sure, these are products of improved biology, but it’s also how different I perceive myself…and how others treat me. I must say, I have not been complemented on my physical appearance this much since, well, ever. It comes so constantly that I’ve become quite unsure of how to respond, anymore. It’s flattering and I am always humbled. My dating options have improved; apparently I’m now in a different “league.” Even strangers seem warmer and more appreciative of me. It’s bizarre, too, being one of the lightest people in certain places, or realizing in a room of people who’ve never met me before that I’m not “fat” to them. A guy at work even asked if I’d been on a wrestling team before…it blew my mind.

Next step: Interestingly, the surgery has completely eliminated my libido (and I didn’t have much of one to begin with). I don’t know if this is a result of the surgery itself or just a facet of my new perspective on life or understanding of myself. I now struggle with dating, even though I have more options in that arena. Do I really want a partner? Have I become a sapiosexual or even an asexual person, now? Has my sexual identity changed? I’m still trying mostly because I feel obligated to not “give up” on romantic life, and the superficial perks (a readily available babysitter, second income, someone to go out with for fun) are compelling. But most of the time, I’m rather frustrated and even feel some antipathy for becoming romantically attached to someone. Maybe I just haven’t given it enough time.

I also want to keep up with mindfulness practices like yoga and meditation. As work in nursing is very stressing and frantic, I need to cultivate more pose and calm in my life.

So there you have it! I’d really love to hear from YOU, readers, so do feel free to post in the comments below.

Stay positive!

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