The Hard Part Isn’t What You Think

It’s been five weeks since my surgery. At this point, the pain from the surgical sites is gone (although that’s only been in the last week), and as of tomorrow, I’ll be able to eat regular food. I’ve lost just a hair under 30 pounds.

When I was first contemplating surgery, I understood that my eating habits would be changed forever, but I don’t think I really understood the mechanisms behind it. I knew that the surgery itself wasn’t going to be what took the weight off. It would be the diet and exercise that happened afterward. While that’s strictly true, none of it is happening the way I thought it would.

Won’t or Can’t

In the 34 hours I was in the hospital, they tried feeding me 3 times. Each time, I was able to take a few sips of water and about as much food as would fill half a baby spoon. That was it.

Over the next two weeks, I had nothing but liquids – protein drinks and shakes, three times a day for the first week, supposedly going up to five times a day the second. Except that I couldn’t. It would take me half an hour or more to drink the entire 8 ounces of liquid, and by the time I was due to have my next protein drink, I was still full from the last one. And being too full meant risking vomiting. My one goal through this whole process has been to never vomit.

Week 3, I graduated to “blenderized” food. “Blenderized” meant baby food consistency. Which meant a lot of actual baby food. If you add salt and spices, it tastes like food. I put a chicken breast in the blender with an equal amount of chicken stock, giving me about 32 ounces of chicken baby food. Here’s another issue: since I could only eat ~2 ounces of chicken at a time, I had enough for 16 meals. Even eating 4 meals a day, that’s 4 solid days’ worth of food, and who wants to eat the same thing every meal? If I put 2 ounces of chicken and an ounce of veggies in my dish, I was often still too full for my next meal. Sometimes, nausea from pain made eating hard.

Week 5, I progressed to “soft” food. By now, I can eat 4 ounces at a meal – four and a half, sometimes. Any more than that, and I can’t do it, and I’m too full for my next meal.

All this is to say, it’s not that I won’t eat, or that I don’t want to as in I have no desire for food (although that’s certainly true, for the most part). It’s that often, I can’t eat.

What does “rapid” mean?

All the literature I was given said “You will lose 10-20 pounds in the first two weeks, 30% of your goal in 3-4 months, half in 6. You will plateau in 12-18 months.” It seems pretty fast. I did lose 20 pounds in the first 3 weeks. And I hit my 30% goal about a week later. I credited the rapid loss to the fact that I was eating almost nothing but protein and vitamins.

I log everything I eat so I can ensure I’m getting enough protein – too little and you can lose muscle and your hair will fall out. I eat somewhere between 350 and 550 calories in a day (meaning I have never had fewer than 350, or more than 550). So I know exactly how much I’m taking in versus how much I’m putting out. Every day, I’m on the treadmill for between 30 and 60 minutes, although yesterday, I took my first hike since my surgery.

I stopped weighing myself every day after the first day I gained a pound relative to the day before. How can a person eat almost nothing and not only still function, but put on weight? Beats the fuck out of me. Years ago, I read an article dating back to WWII that detailed Queen Elizabeth’s very frugal diet (I presume to prove to people that the monarch wasn’t living opulently whilst her people were doing without) that said that the Queen’s diet amounted to about 750 calories per day. At the time, I couldn’t believe that anyone could function for a long time on that little. Right about now, I don’t think it’s even possible for me to take in 750 calories in a single day, and I’m functioning just fine.

I weigh in on Mondays, and take my measurements so I can see not just how many pounds I’m losing, but how many inches. This past week, I lost a single pound, and gained 2.5 inches in my hips.

Half the game is 90% mental

Here’s the hardest part of the whole thing: Not losing weight, occasionally even gaining, is phenomenally discouraging. Downright depressing. And yet, I can’t angrily binge eat a pizza or down three Snickers in my car where no one will see me. If I eat the sugar, I’ll get violently sick. And at this point, the pizza would likely make me sick as well. Doing anything except taking care of myself will literally make me sick. And the only thing worse than being depressed is being depressed and sick.

Which means that the only thing I can do when I get depressed is to look at the horizon. I can’t afford to think short term anymore. Being discouraged now is just an emotional state. It doesn’t have anything to do with how I eat, exercise, take my meds.

It’s still early days for me, and yet, I don’t feel like the same person I was five weeks ago. We’ll see where that goes.

 

Part 4: All the Numbers

On October 22, 2019, I had a sleeve gastrectomy. I went into this process knowing that this would forever change my relationship to food and my body. This is part of a series of posts covering my history with food, weight loss, and my body. All opinions expressed in these posts are my own, and reflect my own lived experience. Nothing said here should be generalized, or taken as a suggestion for others. If you’re considering weight loss surgery, your first step is to reach out to your doctor.

Prurient Curiosity

There’s a class of questions everyone secretly wants to know, but is afraid to ask because weight and size are such fraught topics in our society. Those questions are all about numbers – how much did you weigh? How much did you lose? How much do you expect to lose? How long will it take?

Let’s start at the beginning.

When I first went to the doctor for a consultation, I weighed in at 243.8. For years, I had gone to every doctor’s visit and refused to be weighed. For most things, that datum isn’t relevant. I wasn’t surprised by the number, but certainly I was disappointed by it, although in a way, hopeful. My biggest fear was that I wouldn’t qualify for surgery. According to my doctor, the criteria was either a BMI of 40 or more, or a BMI of 35 or more and one or more co-morbidities – obstructive sleep apnea, high blood pressure, diabetes, high cholesterol (yes, no, no, no).  My BMI was 39.6. I was so relieved that I qualified, I nearly cried.

At that appointment, I was given a pre-surgery consultation appointment about 2 weeks later where I would receive my surgery date, get all my pre-surgery instructions, and get a list of the resources that would help me both before and after the process.

At the pre-surgery appointment, I was told that I needed to lose 5-10 pounds before surgery in order to shrink my liver (the stomach is under the liver, so shrinking it makes surgery easier and safer). And in the 2 weeks since my initial consultation, my weight had gone up to 245.4.

Ten days before my surgery, I started a liquid diet. Three times a day, I had a protein shake and a liquid protein drink. The shake was big, and could be really thick, so the ten days went by pretty quickly without my feeling very deprived. When I did feel sad, I could just look at the calendar and say “I can do this for another 5 days.” On the day of surgery, my weight was recorded as 238.7.

Where Do You Want to Be?

When I first considered this surgery,  it was because I had had back issues for years. I couldn’t lay in bed for more than a couple of minutes after waking, because the pain in my lower back (from the blown disc I talked about in Part 3) would become excruciating.  In the last year, I’d also had a problem with my left hip – it hurt when I lay on my side, or when I sat for too long. The doctor diagnosed it as bursitis. (I think if you’re old enough to have bursitis, you automatically have to put “the” in front of things like Google and Facebook.)

As I filled in the paperwork for surgery, I was asked several times what my goal weight would be. It was frustrating because even though the women recording my information were very encouraging and said “It doesn’t matter, we just have to put something down,” they didn’t give me any guidance. They told me what my BMI was, but not what a “healthy” BMI should be, nor what that would translate to in pounds. A “healthy” BMI is between 18.5 and 24.9, which would put my “healthy” weight between 115 and 154. That’s a 40-pound spread.

It’s really hard to know what your “ideal” look is, because even women of the same height and weight can have very different body types. With no guidance, I arbitrarily chose 160. I now know that the number you choose is important – it’s what the doctor will use to qualify whether your surgery and long-term outcome are a “success,” which is defined as keeping off at least 50% of your excess weight for 5 or more years. The success rate of gastric sleeve surgery is upward of 80%.

What Happens Next?

Doing a little math, we can see that my goal weight is 85.4 pounds less than my highest starting weight. I lost a few pounds before surgery, and as of right now, I’m down 21.6 pounds from that highest weight. It was easy, because for the first two weeks after surgery I was on a completely liquid diet, drinking clear protein drinks recommended by my doctor. Each packet of powder was to be mixed with ~8 ounces of water, and it was really, really hard to get that much stuff into my body. Surgery hadn’t just cut off a huge portion of my stomach, it had left my insides swollen and uncomfortable. Often in the first couple of days, I would take a sip of water and then struggle not to vomit. Over the next few days, drinking all my protein got a little easier, but that protein stuff is kind of gross.

Now, two weeks in, I am on “blenderized” food – any food that can be sucked up through a straw. At first I joked about putting pizza and burgers into the blender, but I had a huge secret.

I am terrified to eat real food. 

I’m still in that mindset of “my food choices got me into this in the first place.” To top that off, the advice given for life after surgery can be conflicting – I need to get a specific percentage of protein, carbs, and fat, I need to get at least 60-80 grams of protein a day, I have to drink 60 ounces of water, but I can’t drink either 30 minutes before or 30 minutes after a meal, and I have to eat 5-6 times a day, and I should make my meals last 30-60 minutes. I can’t eat cruciferous vegetables for a few months after surgery, I can’t eat red meat until at least 6 months after surgery….I am paralyzed.

Don’t Overthink It

I said this to the doctor on my first follow-up visit, and he gave a small laugh and just said “You’re overthinking this. Just eat food. Nothing processed, wait on anything with too much fiber, no simple carbohydrates.”

The best advice I was given came from the dietitian I had to consult before my surgery. She told me to eat slowly enough that I would be able to tell when I went from “I’m hungry and want more,” to “I’m no longer invested in this.” Not waiting until I was full, but waiting until the food was less important.

To this end, I bought myself a set of coffee spoons and dessert forks. I already own a fairly large selection of sushi plates and sauce dishes, as well as a food scale.

lunch plate

The remains of 2 ounces of cottage cheese and 1 ounce of unsweetened applesauce. 

When I talked to my doctor about using tiny utensils and plates, he sort of laughed at me, as though it were some kind of affectation. What this tells me about my doctor is that, while he sees and deals with the bodies of severely obese patients every day, he doesn’t have much insight into the mental processes of the severely obese. By taking tiny bites, I can tell exactly how I’m feeling as I eat, and can pay attention to the point where continuing to eat is no longer compelling.

It’s a challenge. I’m supposed to eat 5-6 times a day, but I can eat 4 times, tops. Even then, I’ll portion myself out 3 or 4 ounces of food and can’t finish it. I have no idea how much longer that’ll be the case, but I’m really, really hoping that the habits I’m establishing now will have solidified and be the foundation of how I eat going forward.

Next time, I’ll talk about the ins and outs of self image for the fat.

 

 

Part 2: More to Love

On October 22, 2019, I had a sleeve gastrectomy. I went into this process knowing that this would forever change my relationship to food and my body. This is part of a series of posts covering my history with food, weight loss, and my body. All opinions expressed in these posts are my own, and reflect my own lived experience. Nothing said here should be generalized, or taken as a suggestion for others. If you’re considering weight loss surgery, your first step is to reach out to your doctor.

What You Love is Beautiful

I’m currently reading a biography of Alma Mahler, a fascinating woman born at the end of the 19th century. Alma’s distinguishing feature (aside from her tragic anti-Semitism) is her passion. Her teen years were spent listening to and composing music, and all her thoughts as recorded in her journals were wild, passionate, and outsized. In her late teens, she met Alexander Zemlinsky, a composer who mentored her in a weird, emotionally manipulative kind of relationship. Alma fell deeply in love with him, and even though she had earlier admitted his glaring physical flaws (short, “practically chinless”), eventually she talked about him as the most beautiful man in the world.

Okay, he’s not hideously deformed, but in an ensemble show, he would definitely be the hunky hero’s comedy sidekick.

If you ask a small child what they think of the people they love, they will tell you that their loved ones are beautiful. And how many truly ugly  babies have you seen whose parents can’t stop cooing about how perfect their little goblins are? Love is a filter that smooths the rough spots in the loved one’s appearance or character. It’s why people who have been in a relationship for decades can put on dangerous amounts of weight, and their partners still see them as beautiful.

This notion that the person you love is automatically beautiful to you explains couples where one person may be much more conventionally attractive than the other (sure, money can also be a factor, but let’s face it, I don’t know anyone with that kind of money, and neither do you).

There’s Someone for Everyone

The flip side of this notion that what you love is beautiful is a truth that I didn’t find out until I was in my 20s: it doesn’t matter what shape you are, what color you are, what parts of your body/mind/heart are missing/broken/different, there is someone who finds you attractive. Media has shown us for years that the physical ideal is young, white, and a shape that is natural to only a tiny fraction of the population. That image of beauty isn’t some platonic ideal that has existed throughout time. That image of beauty is a way of controlling women by making them constantly feel inadequate. But in the real world, all kinds of people are looking at all kinds of other people and liking what they see.

I’m Doing You a Favor

Boys started noticing me in first grade (although I did have a 17-year-old boyfriend when I was 3, but I later found out he was just using me to hook up with high school girls). So it didn’t seem odd to me that they would keep noticing me as I got older. But when viewed through the filter of my family’s unrelenting negative messages, I soon came to feel that I was somehow unworthy of attention. In fact, I was sexually assaulted twice before I was 16, and both times when I tried to tell my family, I was labeled as “dramatic” because the men who assaulted me used the defense “why would I want that?”

A weird thing happened when I kept receiving something good I thought I didn’t deserve – complete dissociation. The person receiving all the attention couldn’t be me, because me was unloveable. People who claimed to be attracted to me weren’t seeing me clearly. For whatever reason – the way I dressed, the way I wore my hair, the way I spoke – they were somehow blind to the fact that I was fat, because if they knew that, if they could see it, they would laugh at me and walk away.

As an adult, the men I dated fell into two categories – the ones that were genuinely interested in me, and the ones who may have been interested in me, but who felt the need to let me know they were doing me some kind of favor by going out with me. When I was in college, I was at a party at a guy’s house, and my friends and I were all laughing and talking about my (even then) hilarious romantic history. Later, when the guy and I were alone, he said “I just don’t get how all that stuff they were saying could be true when-” and he made a vague gesture taking in my body. This question didn’t stop him from wanting a relationship with me, but his presumption that dating was a new world to me and that he was somehow going to improve my life by approving of my body was so off-putting that I dumped him within weeks.

Cinderella, But With Character

Throughout all of this, I had an idea in my mind of the kind of relationship I wanted – someone whom I found physically attractive who was also smart, capable, and fun to be around. As a kid, being convinced that no one would ever love me, I devoted myself to reading, to learning, to mastering things that interested me. As an introvert, making a good life for just myself came really naturally – I didn’t feel like I would die without a partner. On the other hand, who doesn’t want to be loved? Even the most hardcore introvert needs a core person or group of people to bond with.

So, while I was doing the things that interested me, I was still waiting for that perfect person. And I wasn’t shy about kicking the imperfect ones to the curb. When I was a freshman in high school, there was a boy I went out with maybe two or three times – long enough for me to consider him my boyfriend. But then he told me he was dumping me for the girl that he then went on to date for the rest of our time in high school. That was the last time anyone has broken up with me. Since then, it’s always been me who breaks up because the other person isn’t living up to my standards. Which are, admittedly high – but why shouldn’t they be?

Oh, yeah. Because I’m fat.

Building an Adult Life

In 2000, I met my current husband. I found him very attractive the minute I met him, and as we talked, I found out he was hilarious and smart. There were some obstacles to our getting together (notably, my 3rd husband), but even after we got together, we had some real struggles. I was operating on the assumption that I was always going to be hurt, disappointed, betrayed. For years, I continued to have a dream I’d had regularly since I was a teenager: that I would be in some very public place, surrounded by people who knew me (work, school) and my significant other would approach me with another woman by his side. He would say, in a very matter-of-fact way, that I was out and she was in. When I got upset, he would act disappointed, say “I really thought you’d be more adult about this,” and encourage the onlookers to agree with him that I was the one being unreasonable.

It literally took me a decade to relax into the idea that this person that I valued so highly actually did think of me as attractive. That he loved me – not some fantasized, idealistic version of me, but ME. He’s smelled my morning breath. He’s seen my pimples, my stretch marks, every part of my own body that I find embarrassing or repulsive, and he still tells me he thinks I’m beautiful every day.

Will It End?

I’ll be honest – now that I have a relationship where my husband thinks I’m beautiful, what will happen when I’m no longer that shape? What if he’s just one of those guys who only likes bigger women? This is one of those times where I have to force myself to stop letting my fears run away with me. When my husband met me, I was about 50 pounds lighter than I was before I had surgery, and he was really into that person. The person he’s into is smart, and silly, and curious, and adventurous, and that’s not going away.

Next time, I’ll talk about figuring out who I am, what I like, and how I could make peace with my past. 

Part 1: Forty Five Years of Dieting

On October 22, 2019, I had a sleeve gastrectomy. I went into this process knowing that this would forever change my relationship to food and my body. This is part of a series of posts covering my history with food, weight loss, and my body. All opinions expressed in these posts are my own, and reflect my own lived experience. Nothing said here should be generalized, or taken as a suggestion for others. If you’re considering weight loss surgery, your first step is to reach out to your doctor.

Did I start out fat?

I have a brother and two sisters. All of us, at one time or another, went through a period of weighing more than we should, and when I reach back into my childhood memories, the thing that’s really clear is that weighing more than you should made you a Bad Person.

My mother has always been stocky, and has been on a diet for the entirety of my life. Rather than recount it all, I invite you to read this article I wrote about food and how it has affected my relationship with my mother. My older brother is built more like my mother – on the short side, and stocky. In fact, even though he’s an ultra-marathoner who runs like a million miles a week, he still has kind of a dad bod. My two sisters favored my father more – dad was a string bean as a kid, and as an adult, was the sort of person who, whenever he thought he was putting on weight, he’d skip lunch and it would be gone.

Sadly, both my mother’s constant dieting and my father’s utter disdain for fat had the same effect: to make me hate myself. I’ve seen pictures of myself as a child, and I don’t look particularly fat. I know that in first grade I weighed 40 pounds (the average weight for a first grader is 46 pounds). And I don’t recall being mocked for being fat in school – like, not ever. Whatever I looked like out in the world was just fine with everyone. It was only at home that I was unforgivable.

I was on my first diet at 9 or 10, my second big diet at 13, all through high school I took over the counter diet pills and would exist for weeks at a time on the pickles off my friends’ hamburgers and diet Coke while swimming for hours every day. In college, my father paid for me to go on one of those medically supervised diets where you drink shakes that add up to (and this is no exaggeration) 400 calories a day. After I had my first daughter, I joined OA and for years followed their very restrictive Gray Sheet diet.

When I was dieting, my family would praise me for making “good” choices, even when those choices were horribly unhealthy – the medically supervised diet made my blood pressure so low that I would faint and my vision would black out. But how I felt wasn’t important. When I lost weight, everyone was quick to tell me how attractive I was, but when I was heavier, I wasn’t unattractive. I was invisible.

It’s Not Just the Food

What compounded the issue was the fact that I am an extreme introvert. I love being around people, but I burn out quickly, and once I’m burnt out, being around other people is a nightmare. My father comes from a family of 7 kids, and all of them had a bunch of kids of their own, and all of those kids went on to marry and have more kids. That side of my family numbers in the hundreds at this point. And I would always rather stay home and read a book than go on family outings (which invariably included some kind of athletic activity). For a long time, both of my extrovert parents took my reluctance to leave the house personally. As though I were purposely trying to spoil their good time. And they decided that I wanted to stay home, not because leaving the house felt horrible, but because I was just too lazy to get my shit together to go out.

It meant that the reason I was fat was because I am lazy. To this day, my entire personality is built around proving to the entire world that I am not lazy. It’s the reason why I feel inadequate if I’m not doing as much as all my friends. I don’t mean doing as much as any one of my individual friends – I mean doing as much as all of them put together. Saying it out loud sounds crazy, but in my head, it’s the only logic I hear sometimes.

Both my parents, whether they admit it or not, equate excess weight with personal failure. I would go so far as to speculate that my mother’s weight was a factor in their splitting up when I was a toddler. My mother longingly recounts times in her life when she was thin the way other people might recount being briefly famous or wildly rich. Those were the highlights of her life, and the memories she falls back on when she feels inadequate. My father isn’t shy about making fun of fat people, despite the fact that much of his family is overweight. He thinks it’s hilarious, like we’re performing monkeys. And it doesn’t matter if those performing monkeys have feelings, or lives, or accomplishments of which they are justly proud – nobody cares what the monkey thinks.

What Happens When You’re Only Important If You’re Thin

The fallout of growing up with this kind of self-hatred was the inescapable idea that I’m not worthy. I don’t deserve happiness, or pleasure, or success because I haven’t “earned” it by being attractive. When my siblings were given things I was denied (which happened more than most of my family will admit), I couldn’t complain, because after all, I didn’t really deserve them. When I experienced successes out in the world and looked to my parents for validation, I was more often compared to other people who were more successful, as though my own personal success wasn’t meaningful. Because it really doesn’t matter what you do when you’re fat. It doesn’t count.

Next time, I’ll talk about the impact of being fat on my dating life.