Big, Fat Lie

A while back, I wrote a post looking back at my bariatric surgery a year ago, and thinking about how my life has changed. That post got some attention, mostly by other health and lifestyle blogs. The conclusion I came to in that post was that, although there have been some lifestyle changes since the surgery, the weight loss was worth it.

Image of me in May 2019 weighing about 245 and image of me in January 2021 weight 145.
What a difference 100 pounds makes! Not surprisingly, I don’t have any full-body pictures of me from before.

I feel like that message might have been misleading. Yes, the weight loss has meant that a lot of things have gotten easier for me (exercise is easier, finding clothes is easier, social interactions are easier), but it’s important to be clear: this wouldn’t have happened without surgery.

Everyone will tell you that the way to control your weight is through diet and exercise. What they don’t tell you is that this advice only works if you have a “normal” metabolism that predictably burns calories as they are consumed. With the metabolism of a young, fit, healthy person, if you have a temporary imbalance of intake vs. output, you will have an equally predictable weight gain or loss, which is easily remedied by paying a bit of attention to your diet or exercise regimen.

If we’re both digging holes and I have a backhoe and all you’ve got is a spoon, it’s not your fault that I’m making better progress than you.

Lise Quintana

But there are a million things that affect metabolism, including long-term dieting, aging, certain chronic illnesses, lifestyle, and heredity. And once your metabolism starts to change, there is a cascading set of changes that reinforce it, like the production of the hormone that controls hunger and the hormone that control satiety.

It’s absolutely possible to use diet and exercise to get from morbidly obese to a “normal” BMI, those things won’t change your metabolism, and won’t change your hormones, which is why almost everyone who loses weight through diet and exercise fails to maintain that loss.

When I talk about surgery changing my life, I don’t just mean my behaviors and experiences. My body chemistry has changed. My metabolism is back to that of a fit, healthy person, the hormone that causes me to feel hunger has been curtailed, and the hormone that tells me when I’m full has ramped up. These are fundamental changes that mean that I stand a much better chance of maintaining a lower weight than I would have if I just dieted and exercised.

I say all this because I don’t want people reading about my weight loss to feel bad about themselves because they’re not achieving the same result. If we’re both digging holes and I have a backhoe and all you’ve got is a spoon, it’s not your fault that I’m making better progress than you, and it doesn’t make you weak, or a failure, or lazy.

The fact that I lost weight doesn’t mean I’m a better person than I was before. What I really want is for people to feel good about themselves – worthwhile and lovable and comfortable – regardless of their weight, shape, or lifestyle.