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

Boards.ie: Niamh

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.

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Wanderer78

shesty wrote:

There is huge psychology behind eating and weight loss, having struggled with it myself a lot over the years, I have learned this. I know somebody locally who had the same surgery as you OP, and the result is amazing. I think it is quite a brave thing to do in a way.

I'd like to jump in on this to, apologies shesty, obesity is deeply psychologically based, I fear not enough is being done to address this aspect of the disorder, and we default towards the more physical aspect in regards treatment. I have major issues with well known weight loss programs such weight watchers etc, even though I appreciate and acknowledge they do help many, but don't go far enough in their treatment, particularly psychologically, which in fact may cause some to engage in other maladaptive coping strategies post weight loss, such as other addictive behaviours, what are your thoughts, and well done on your weight loss achievements?

shesty

Hijacking a bit here too, but as a parent I find some of this extremely interesting. I fully believe that our parent's generational attitude of "you must clear your plate" has fed into some of this - as you say AMA you felt like it was almost a "sin" not to clear the plate. I absolutely refuse to insist this of my own children, I want them to realise when they are full, and that is the point they should stop eating at, and that it is ok to leave some food there.

There is huge psychology behind eating and weight loss, having struggled with it myself a lot over the years, I have learned this. I know somebody locally who had the same surgery as you OP, and the result is amazing. I think it is quite a brave thing to do in a way.

big syke

I've had weightloss surgery, AMA wrote: »

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.

May I ask why it was covered by your health insurance?

Was it to do with BMI?

seamus

Deleted User wrote: »

I was very much 'swimming against the tide' in that after a period of time you'd just cave in and have to eat. binge like a mad man. Which is why I am looking at the bariatric surgery options, as they (supposedly) will physically restrict the amount of food you can swallow.

We're hijacking the thread a bit here, but I think for anyone who has never had any kind of compulsion or addiction, this "swimming against the tide" feeling is hard to explain.

It's the same feeling you get when you fancy a drink even though you know you shouldn't. But you've got two in your belly and you fancy a third, so you give in. Or you're trying to cut down smoking and you know you shouldn't have another smoke, but it's just there and it "just one more".

It's the figurative "monkey on your back". Even while your rational brain is telling you that you don't need this, it's all in your head, you have the monkey whispering in your ear that if you just give in this time, he'll go away.

Ultimately, yes it is all in your head. It is a choice that you consciously make. But it comes so close to feeling like a physical *need* that fighting it feels as futile as trying to convince yourself that if you ignore the need to take a piss, that it'll just go away on its own.

I am a skeptic in terms of the surgery; in that it seems crazy to intervene surgically when the problem is in your head. But I say that from a position of privilege; I have lost huge amounts of weight using only willpower. That doesn't mean others can. However, the data is pretty clear that it's effective, and if someone is so at the end of their tether that they're willing to have such a major procedure, then it's a bit dismissive of me to say, "You just haven't tried hard enough".

Bili

During the calorie-restricted diet to shrink your liver did you ever think that you could continue to lose weight yourself and not going through with the operation?

(I ask as I'm a nurse with a BMI of 40+ but too ashamed to go for bariatric surgery because with all my knowledge I feel that I should be able to get control of my eating myself.)

Also, did you have any hair loss or thinning at any stage?

RedXIV

Like KKV, I've always been a character known to "enjoy" his food and as I've gotten older and less mobile, the food I was eating has lead to me getting to the point that I need to look at a plan sooner rather than later. For me though the problem seems to be taste rather than what I'd believe I'd pinpoint as emotional eating.

I had dinner a few hours ago but about half an hour ago I got it into my head that I'd love a curry and I'm sitting here trying to convince myself I don't need one.

I am interested in what the OP was saying about starting with psychologist/dietician before going any further as, while I don't believe I'm able to blame anyone yet other than myself, if there IS a trigger or something I can use to help address the issue, I'll take all the advantages I can.

I spoke to a GP about issues before and he mentioned weight and had some printouts about Mediterranean diet but that was it. OP, is there a better set of resources to look at? I have health insurance and a decent job so I don't mind paying for something that will give me a better chance.

air

Deleted User wrote: »

In theory you'd assume that a smaller body would require less energy to keep it ticking over

Thanks for the insight, very interesting.
I may have been premature with my speculation regarding your satiety issues so, for me personally if I'm at the stage of feeling uncomfortable, that's definitely also "100% full".
I can't imagine an irresistible compulsion to eat more at that point.

With regard to the quote above, we do in fact we expend a lot of energy keeping ourselves warm.
Maintaining 20st of human at 37C in a 20C room is an ongoing battle.
In this regard the 20st you actually requires less energy to keep warm than 14st you, muscle mass etc all being equal.

Your surface area to volume ratio is reduced and you are better insulated by subcutaneous fat.
You will also feel colder at the same air temperature due to the subcutaneous fat between your blood filled muscles and your skin (temperature is predominantly sensed by the skin), so you're more likely to wear more clothes, reducing thermal burn yet further.

So an overweight person has physics to battle on top of everything else.

You can use these facts to your advantage too though.

[Deleted User]

air wrote: »

Clearly when you eat to the point that it's "uncomfortable" you're full, your body knows it and you know it.

I would feel uncomfortable, not 'full'. I'd still have a feeling of being hungry enough that I'd continue to eat.

For what it's worth, I'm not trying to pull the "it's everyone's fault but mine" victim card - I have lost weight before. Large amounts. I'd hover about 20st, and have gotten down to 14st before. In theory you'd assume that a smaller body would require less energy to keep it ticking over, but, as above, I still just always felt hungry.

I was very much 'swimming against the tide' in that after a period of time you'd just cave in and have to eat. binge like a mad man. Which is why I am looking at the bariatric surgery options, as they (supposedly) will physically restrict the amount of food you can swallow.

air

Deleted User wrote: »

coupled with an ability to never feel full.

Deleted User wrote: »

I can sit down to a massive takeaway, and although it may start to be uncomfortable,

Deleted User wrote: »

I've an insatiable appetite.

Not wishing to go off topic and you've made a valuable contribution here, but just thought I'd point out the contradiction in the above statements.

Clearly when you eat the the point that it's "uncomfortable" you're full, your body knows it and you know it.

This would indicate that you don't have any issue with satiety, or indeed appetite, you are just wilfully choosing to over eat when you know you've already had more than enough.

Similarly, it's not a shortcoming of your body that is causing you to order two desserts.
You know this isn't normal behaviour at any level but yet you go ahead and do it for some reason.

I hope that if you haven't perhaps realised this before, then doing so might help you decide which direction you need to take to start dealing with the root cause.

With regard to obesity as a disease, I believe it's now understood that being obese long term does permanent damage to the endocrine and other systems. This may explain why medical intervention is required to recover from it beyond a certain point in many cases.

Best of luck to you both and thanks to the OP for the insights.

[Deleted User]

SimonTemplar wrote: »

I think that is fairly out of order from your patient. He may have been correct but it was also inappropriate in a patient / doctor relationship.

Not really, think of it this way, a dentist with a mouthful of rotten teeth telling you dental care is important would be worthy of a challenge too

SimonTemplar

I've had weightloss surgery, AMA wrote: »

Yes, all of the above were in the mix.

At work I was advising patients who were lighter than me that they urgently needed to lose weight so prevent diabetes, etc. One day a young patient asked me why I hadn't taken my own advice. I had no answer and I realised it was ridiculous.

I think that is fairly out of order from your patient. He may have been correct but it was also inappropriate in a patient / doctor relationship.

greenbicycle

You have definitely made me think while reading your answers, thank you!

One thing I wonder though, you have had to change your diet significantly, you have changed the types of food you eat, the quantities and the frequency, and for that reason you have lost weight. Is it purely the side effects of not eating like that, that have forced you to change. As in, post op, you tried to eat a bag of chips but you felt sick if you did so, so you trained yourself to not do that. Is that an accurate summary?

I wonder is it a case of needing something that just means you have no option but to eat correctly. It is the ultimate form of motivation when all else fails.

Like others, I'd love to know your stats too like age, height and weight and the process of getting surgery done. would also love to know if you have amazing health insurance or is it just a standard kind of plan.

I very rarely drink soft drinks but when i do, it is a treat I enjoy, do you have things you miss?

I very rarely drink alcohol but admittedly I am probably a binge drinker so I wouldn't drink all year but if I went out two or three times a year I would have a good few drinks and enjoy myself, would nights like that be totally out for you now?

I suppose, ultimately I am asking, do you have any regrets at all?

FGR

Well done OP! That took strength and courage especially as a Doctor knowing the risk involved in surgery. It's no easy feat and appreciate you taking the time to answer questions.

May I ask if you were always overweight or did the urge to eat come as you got older?

Also - can this option be available for someone in their 40s or 50s?

Thanks again.

[Deleted User]

cloudatlas wrote: »

It's strange to see something that is a compulsion being described as a disease.

10-15 years ago it may have been, but studies have come on a bit since then.

For what it's worth, I've a higher BMI than the AMA guest, and although I don't think I wholly subscribe to the "it's all a disease and beyond your control" approach, I do understand and agree with a lot of the argument in favour of that.

For me personally, and this is where I'd like to put a question towards the AMA guest, I would characterise myself as having a sugar addiction of sorts, coupled with an ability to never feel full.

I can sit down to a massive takeaway, and although it may start to be uncomfortable, I will manage to eat it all, or of i do have to stop, within 15 minutes, I'll be back eating the remainder again.

I'd often have been in restaurants with people, and we'd order similar/same things, and everyone else would be busted after the dinner, some not finishing, whereas I'd be thinking "will i look bad if i get two desserts.. pretending i want to just see what they're like".

I've an insatiable appetite.

Did you, AMA Guest, have any of these issues at all? From reading your posts here, and I'm not trying to be a smartass or anything, it seems like you didn't really eat all that much (you mention going 24hours without food, and then the food you mention is mashed spuds and stuff, which on the surface of it, doesn't sound like the kinda diet that would leave you overweight, unless the portions were just huge?)

Also, I've lost significant weight before (for short periods), and gained it back (and more). Have you been through these cycles much, and did the people you were talking to about the surgery comment at all on these things?

Also, you mention loose skin not being a big issue - can I ask what weight/height you were, and your age? From looking online, joining facebook groups, etc. it seems a lot of the people that eventually cave and go for the surgery are nearing 50 by the time they've done it, and they get a bit of loose skin.

I've come to the conclusion that the younger you are, the more chance you have of not being afflicted with the loose skin issues, would you agree with this?

(I'm also considering Sleeve surgery, but I've been thinking about it for 12 months now and still haven't done a thing!)

cloudatlas

It's strange to see something that is a compulsion being described as a disease.

[Deleted User]

How hard was it to convince your GP that you needed this?

Do you have to be above a certain BMI to be allowed to have this surgery?

Can you go off your own bat and just make the required appointments (psych, dietician etc) and do it all without a referral?

Asking because I've been pushing for a referral for 4 years from my GP, done the dietician etc but still nothing

I've had weightloss surgery, AMA

Day Lewin wrote: »

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??

Yes, all of the above were in the mix.

Funnily enough, I always thought I looked nice in photos and my friends and family always were positive about my appearance. Looking at old photos now I am amazed, I was so big. I was unhappy with my mobility and it was affecting normal activities.

One of the things that started me thinking about it was being in a theme park and barely being able to squeeze into the rollercoaster. I was so sad that I might not be able to bring the kids on days out because of my weight.

At work I was advising patients who were lighter than me that they urgently needed to lose weight so prevent diabetes, etc. One day a young patient asked me why I hadn't taken my own advice. I had no answer and I realised it was ridiculous.

Then my GP just said it to me one day when I was in for something minor. He said you are young, you are successful, but you are shockingly overweight and you will regret it if you don't act now. That jolted me, I knew I was neglecting my health.

The thing my obesity team drilled into me was that losing weight would not make me happy, they really emphasised that from the beginning. But what I found was that it removed a very big barrier to happiness so I can use my energy to look after other things and I don't have to stress about my weight and appearance. It was a sort of a reset and a 2nd chance at life.

I've had weightloss surgery, AMA

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.

I've had weightloss surgery, AMA

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

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

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

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

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

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

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

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

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?

Deleted User 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

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.

Day Lewin

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

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.