Now ye're talking - to someone who's had weightloss surgery

Boards.ie: Niamh · 14-05-2021 8:59am #1

We have a new guest for AMA today, something a bit different. From the guest:

I had bariatric (weight loss) surgery a few years ago and lost about 50kg or 8 stone. I went from a morbidly obese BMI of 40 to a healthy BMI of 25. I was overweight my whole life but quite fit. Once I finished college and started working as a doctor my weight ballooned. It took me years to even consider weight loss surgery and I thought it would be useful for people to hear about my hesitations/concerns, why I eventually chose the surgery, and what it has been like since.

Reminder: please do not ask for medical advice.

Brussels Sprout · 14-05-2021 10:40am

Did you find your diet changing in terms of the types of food you ate before and afterwards or just the total volumes?

Gloomtastic! · 14-05-2021 11:10am

Well done for doing this, should be interesting.

What was your biggest weakness, food-wise, before the op? What food do you miss the most nowadays?

gormdubhgorm · 14-05-2021 11:10am

Did you try the usual food portion sizes, healthy eating, regular exercise before you took the weight loss surgery option?
Considering you are doctor I assume you are well familiar with such advice.
Or were you not able to do so because of medical issues?

seamus · 14-05-2021 11:29am

Not entirely related to the actual topic; but you mention that when you started working as a doctor your weight ballooned.

From looking around in hospitals and even watching hospital documentaries on TV, you notice a lot of healthcare workers are overweight. More than you would generally see out and about. And not just a bit wobbly; properly obese.

Do you have any theories on why this is? Could it be a combination of irregular working hours and long shifts leading to a lot of snacking and poor meal choices? I would have always expected that a long shift on your feet would be great for fitness, but then if you're snacking all the way through it and having a chinese when you get home cos you're just too tired, you'll undo any good work.

miamee · 14-05-2021 11:47am

What does bariatric surgery involve, how does it work? Is it a permanent solution or could your weigh go up again at some point in the future?

Loueze · 14-05-2021 1:09pm

Did you have to undergo any specific tests / checks to assess your suitability as a candidate for surgery?

What procedure did you have - gastric band or gastric sleeve?

CassieManson · 14-05-2021 1:15pm

Did you have to have skin removal surgery afterwards?

Tork · 14-05-2021 5:36pm

Are you happier as a person now that you've lost all that weight? The reason I ask is because I know of somebody whose weight ballooned due to emotional eating. As a result of the surgery, that form of self-soothing was taken from them and they were miserable.

spurious · 14-05-2021 5:40pm

When they say afterwards that you can (or are only supposed to eat) golf-ball sized meals, how does that work in terms of getting proper nutrition, or do you have to eat things like Complan?

MaybeMaybe · 14-05-2021 6:32pm

have you noticed any difference in how people treat you since you lost the weight?

can you expand on this part "I was overweight my whole life but quite fit"? were you exercising regularly but not controlling your food intake?

wheresthebeef · 14-05-2021 8:48pm

Did you have the surgery done in Ireland or in another EU country?

nibtrix · 14-05-2021 10:21pm

Did you have to pay for the surgery? What kind of consultation / preparation did you have to go through, was it difficult to access the services you needed, how long did it take to get the surgery?

volchitsa · 14-05-2021 11:18pm

Were there aspects you weren’t prepared for, or had you been well prepared by the medical team?

Did you find it easier or harder than you expected?

krissovo · 15-05-2021 2:08am

Whats the story with alcohol? Can you have few beers on a night out with the lads or a few glasses of wine at home?

Segotias · 15-05-2021 8:41am

As someone who's also had bariatric surgery do you find it now impedes further weight loss as you are so used to eating lower calories

I've had weightloss surgery, AMA · 15-05-2021 10:44am

Brussels Sprout wrote: »

Did you find your diet changing in terms of the types of food you ate before and afterwards or just the total volumes?

Good morning! Yes, both the types and amounts of food changed. Immediately after the surgery I was on a liquid diet (soup, milk, yoghurt) which lasted a few weeks. Then I was able to manage small amounts of soft solid food which had to be chewed really well. Then over a few months I built to up being able to eat virtually anything but in much smaller amounts.

My diet now is very varied but I eat a lot more protein than before and very little junk food. My taste for food has changed and I don't like sweet stuff as much as I did.

I'm physically unable to wolf down food (it would make me feel sick) but that's a good thing in my view. If I was out for a meal no-one would notice that I was eating any differently, I'm just a bit slower and would usually bring some of the food home.

One of my worries before the surgery was that I would not be able to enjoy food any more. I always enjoyed nice restaurants and trying new dishes especially when abroad. Thankfully it hasn't been an issue, I just eat smaller amounts of whatever I like and I think I enjoy it more as I savour it.

I've had weightloss surgery, AMA · 15-05-2021 10:58am

Gloomtastic! wrote: »

Well done for doing this, should be interesting.

What was your biggest weakness, food-wise, before the op? What food do you miss the most nowadays?

Thank you, I wanted to do this as I had so many worries before my operation and I found it really useful to talk to people who had been through it.

My biggest weaknesses were irregular meals and poor portion control. Due to work I would sometimes go 24 hours without eating or drinking anything. It is shocking to admit that, but it was so common when I started working as a doctor. When I finally got time for food I would eat things like toast or mashed potatoes just to feel full. Now I make sure to eat small amounts at regular intervals and keep some nuts or a protein bar with me.

I had no real concept of calories. I would just eat whatever was on my plate and I felt like not clearing my plate was some sort of sin. That was a major problem that I only realised when I spoke to a dietitian and psychologist when preparing for surgery.

I am able to eat all food now, I just have smaller portions, so there isn't one I miss in particular.

I've had weightloss surgery, AMA · 15-05-2021 11:10am

gormdubhgorm wrote: »

Did you try the usual food portion sizes, healthy eating, regular exercise before you took the weight loss surgery option?
Considering you are doctor I assume you are well familiar with such advice.
Or were you not able to do so because of medical issues?

Hello, yes that is an important part of the pre-op assessment. You have to show that you have tried diet, exercise, lifestyle changes and that they have failed. You also see a psychologist or psychiatrist who goes through any other issues which may affect your weight.

I spent about 20 years trying to control my weight with varying success. I mistakenly thought that it was about willpower and self-discipline and that if I was putting on weight it was my own fault. When I met the obesity consultants and dietitians they explained that willpower can help you lose a couple of kilos but that for obese people it is a physical disease that requires treatment. Like asthma or arthritis. It took me a long time to accept what they were saying - I was in denial and I thought I knew better than the experts!

I realised that I had never in my life really understood what it meant to feel satisfied after a meal unless I was uncomfortably full. That was a revelation to me. The consultants explained that obesity affects the brain's appetite control centres and so even if I tried my hardest my brain would always override my desire to diet and make food irresistible. I am simplifying it a bit here but that is the general gist.

I am ashamed to say that I bought into the idea that if people were fat they were to blame and that they (and I) were just too lazy. Having this operation and losing weight has made me realise I needed to change my attitude to overweight people and be kinder.

Day Lewin · 15-05-2021 11:16am

What did you mind most about being overweight, before?

Was it appearance, fatigue, self-image, health issues, Potential health issues, breathlessness, sex-appeal, -- or whatever, or something else??

I've had weightloss surgery, AMA · 15-05-2021 11:18am

seamus wrote: »

Not entirely related to the actual topic; but you mention that when you started working as a doctor your weight ballooned.

From looking around in hospitals and even watching hospital documentaries on TV, you notice a lot of healthcare workers are overweight. More than you would generally see out and about. And not just a bit wobbly; properly obese.

Do you have any theories on why this is? Could it be a combination of irregular working hours and long shifts leading to a lot of snacking and poor meal choices? I would have always expected that a long shift on your feet would be great for fitness, but then if you're snacking all the way through it and having a chinese when you get home cos you're just too tired, you'll undo any good work.

Hi seamus, I think you're spot on. A lot of my colleagues in all sorts of healthcare jobs face the same problems. Irregular shifts affect your meal patterns and your sleep. Disrupted sleep is a risk factor for weight gain and obesity. We do get treats from patients and often we are guilty of bringing in cakes and chocolates to boost team spirit, so that doesn't help.

Takeaway meals are the norm for many people on night duty. In most hospitals the canteen closes at tea time. I did work in one hospital which opened the canteen around midnight but the menu was mainly fried food. People will eat what is convenient so it would be great if hospitals made healthy food available to night staff.

I've had weightloss surgery, AMA · 15-05-2021 11:35am

miamee wrote: »

What does bariatric surgery involve, how does it work? Is it a permanent solution or could your weigh go up again at some point in the future?

Loueze wrote: »

Did you have to undergo any specific tests / checks to assess your suitability as a candidate for surgery?

What procedure did you have - gastric band or gastric sleeve?

There are several types of bariatric surgery and they all have different risks and benefits. Some of them are only suitable for certain people.

The most common ones in Ireland are sleeve gastrectomy (where most of the stomach is taken away and a small pouch remains) and roux-en-y (making a small pouch and re-routing it to the small bowel).

I had a sleeve gastrectomy but everyone is different and the surgeon should go through all of the pros and cons of each option.

I had to meet the surgeon and the endocrinologist (obesity consultant) a couple of times, then a dietitian, then a psychologist. So about 4 appointments over a few months. Once they were all happy that I was suitable I had some blood tests and a gastroscopy (camera test in my stomach) to make sure everything was healthy. Then I got my surgery date and had to go on a calorie-restricted diet for a couple of weeks so my liver would shrink which makes the surgery safer and easier for the surgeon.

The surgery was keyhole and took a couple of hours. I stayed in hospital for one night. I was off work for I think 6 weeks but I was feeling pretty good about 2 weeks after the operation. I didn't find it any worse than when I had my appendix out.

You have to take medication for a few weeks afterwards - blood thinners to prevent clots, laxatives as you will be quite constipated, and you have to be on multivitamins long term.

My abs were quite sore and I got cramps for a couple of weeks when I tried to sit up. I also found it hard to drink enough so I was a bit dehydrated.

The aim of surgery is not to make you a "perfect weight" but rather to help you stay as close to normal BMI as possible so that you can be healthy. I was aiming to lose 30kg and when I hit that target I was thrilled. I continued to lose weight but that was a bonus. People do put some weight back on but most people are able to lose and maintain a significant weight loss.

Once I copped that my BMI was 40 I realised that even if I only lost a small amount of weight it would be better for my health than continuing as I was.

I've had weightloss surgery, AMA · 15-05-2021 11:40am

CassieManson wrote: »

Did you have to have skin removal surgery afterwards?

I haven't had that done yet. I thought it was going to be a big deal for me and believe it or not it was one of the main hesitations I had before surgery! In fact I hardly notice the extra skin most of the time so I'm not sure if I will bother having it done. Many people do opt for it and it can be covered under health insurance in some cases although I don't know the details of that.

I've had weightloss surgery, AMA · 15-05-2021 11:46am

Tork wrote: »

Are you happier as a person now that you've lost all that weight? The reason I ask is because I know of somebody whose weight ballooned due to emotional eating. As a result of the surgery, that form of self-soothing was taken from them and they were miserable.

Yes, I am 100% happier. It is one of the best decisions I ever made. My family and friends have all noticed too.

The number one thing is I feel healthier. I can exercise again like a 20 year old (well, almost!) and I have so much more energy. I do not spend my day thinking about food or worrying about food or feeling guilty that I ate a few chips. My sleep has improved too.

The emotional eating element is really important and the psychologist went through that with me before the operation. They went into a lot of detail and we spent hours really examining the things that triggered overeating and what I would do if I lost that outlet. Like you mentioned, some people find it difficult to switch to a new habit or activity and some can turn to alcohol, etc. I took up exercise which had the added benefit of sustaining my weight loss.

I've had weightloss surgery, AMA · 15-05-2021 11:52am

spurious wrote: »

When they say afterwards that you can (or are only supposed to eat) golf-ball sized meals, how does that work in terms of getting proper nutrition, or do you have to eat things like Complan?

At the beginning it is about getting fluids in. I was drinking sips for the first few days, then cups, then bowls of liquidised food or broth.

They gave me a prescription for a protein drink which was like complan but I hated it and I drank milk instead.

My meals now are maybe the size of a soup bowl. I would eat an egg or a small salmon fillet no problem. But then I would be full for a good while. Last night for example I had a slice of home cooked bacon for dinner and I was still full when I woke up.

You have to be very careful with liquids as they will slide through you. Soft drinks and milkshakes are dangerous as the calories add up very quickly.

I've had weightloss surgery, AMA · 15-05-2021 12:06pm

MaybeMaybe wrote: »

have you noticed any difference in how people treat you since you lost the weight?

can you expand on this part "I was overweight my whole life but quite fit"? were you exercising regularly but not controlling your food intake?

This was something that shocked me. People treat me completely differently. It made me quite sad when I realised how my appearance had been affecting my life beforehand and also made me reflect on how I treat overweight people too.

People who knew me when I was obese are all very complimentary and positive, which is nice for the ego at first but then gets a bit intense. Most people are genuinely thrilled for you though. I did get some cold remarks from overweight people who seemed annoyed with me.

When I meet new people I find that they treat me very differently too. Much friendlier and more interested in me. It opened my eyes to how much we judge people based on weight.

The other side of it is that my attitude and demeanour changed. I am more confident and assertive, so people probably treat me differently as a result.

Your wardrobe options change radically when you go from 46 inch waist to 32 inches. After years of buying whatever was available in XXXL, I now put on a daily fashion parade and I am unapologetic!!!

RE: fitness, I swam and went to the gym 3-5 days a week, played sports, walked but was always a bit chubby as my calorie intake was too high. So my heart rate was low and I was strong but I was still too heavy. This got worse when I started working as the exercise options were greatly reduced so my weight went up but my muscle mass also went way down - a double whammy.

I've had weightloss surgery, AMA · 15-05-2021 12:08pm

wheresthebeef wrote: »

Did you have the surgery done in Ireland or in another EU country?

I had the surgery in a large hospital in Ireland. It was covered by my health insurance.

Given the pre-op assessment required, the importance of having a good team around you, the risks to be considered, and the post-op follow-up required I would not have gone abroad.

I've had weightloss surgery, AMA · 15-05-2021 12:13pm

nibtrix wrote: »

Did you have to pay for the surgery? What kind of consultation / preparation did you have to go through, was it difficult to access the services you needed, how long did it take to get the surgery?

I didn't have to pay for the surgery as it was covered by my health insurance. I did have to pay a few hundred euro for some of the pre-op assessments, e.g. psychologist and dietitian.

It was easy to access the services I needed, I just made an appointment, but bear in mind that I have health insurance and I work in healthcare so I am not representative. The biggest piece of advice I would give is to find an obesity team that you can trust and who will not push you into anything. My team really spent time figuring out if surgery was right for me, they were not selling me anything.

I think from first appointment to the surgery it was maybe a year, possibly a bit less.

I've had weightloss surgery, AMA · 15-05-2021 12:16pm

volchitsa wrote: »

Were there aspects you weren’t prepared for, or had you been well prepared by the medical team?

Did you find it easier or harder than you expected?

I was really well prepared and I spoke with people who had been through it.

The big thing that I was not ready for was the constipation. It was pretty rough for the first few weeks. I was used to going twice a day and suddenly it was twice a week. I was not drinking enough fluids and I was not taking enough laxatives. It eased off after a while and soon I was back to normal.

Overall it has been easier than I expected. I went into it with modest expectations and I had prepared myself for the possibility it could all fail, so I suppose hope for the best and prepare for the worst was my approach.

I've had weightloss surgery, AMA · 15-05-2021 12:18pm

krissovo wrote: »

Whats the story with alcohol? Can you have few beers on a night out with the lads or a few glasses of wine at home?

You can still drink alcohol. It goes through you a bit quicker so you have to be careful with spirits and pace yourself. Anything fizzy is tricky as it will make you feel bloated. Also alcohol has calories so it will affect your weight goals.

I've had weightloss surgery, AMA · 15-05-2021 12:20pm

Segotias wrote: »

As someone who's also had bariatric surgery do you find it now impedes further weight loss as you are so used to eating lower calories

No, I haven't had any problems like that. I aim for 1,500-1,800 calories and that keeps me steady.

Exercise is the key. Now that I am lighter I can do way more, so I would walk 10-12k every day, do weights 2x per week, and before covid would swim and do classes.

Now ye're talking - to someone who's had weightloss surgery

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