Weight loss surgery: Recipe for failure?
January 17, 2018 3:07 AM   Subscribe

You'll know from my question history that my life is pretty much defined by disorder. Long-standing cerebral palsy, depression and anxiety diagnoses, depressed parents, a messy house and no job, as of yet are just some examples of things that need changing. I have no energy to change much of this, and can feel my health deteriorating. I rely on way too many medications and caffeine to function. I almost never walk anymore. I need to lose about 100 lbs, but as someone in a wheelchair whose parents are not supportive, is WLS the right way to go? WOT and snowflakes inside, sorry.

I've gone through the seminars, had repeated consults with the surgeon and have completed all necessary requirements for insurance approval ( including six months of supervised weight loss efforts). I'm basically ready to go under the knife. The trouble is that my enthusiasm for the procedure has dimmed as sundry WLS Facebook groups show a trend of people being ecstatic about their first two or three years out, and then struggling not to regain.
Right now:
- I can't cook for myself, and my parents are themselves stuck in depressive ruts. Meals most nights are either prepared supermarket food, schnitzel with some sort of carb and a salad, and the occasional soup. Many nights it's " find whatever". My mom is not the home-maker I grew up believing she was. At least not anymore. She works full time and comes home increasingly tired.
-Our house is a mess. I can't prepare my own food because back pain but also because our small kitchen doesn't allow for things like meal prep, and the environment: bags of meds on chairs, dirty counters, etc. doesn't exactly inspire a pep in my culinary step.
- Nothing sticks, and my family's smarmy " we'll see how long this lasts" attitude doesn't help
- I eat out A LOT. Almost never fast food, but almost always too much. It's expensive, but it's the only way I can alleviate some subconscious anxiety about having something to eat.
- I can't afford therapy. When I have been able to, it hasn't worked.
- I have a pathological sugar and carb addiction, to a degree that confirms the theory that sugar is a drug. Soft, doughy, sweet carbs are and always will be my downfall.
-I still binge eat, especially when coming off from things like Adderall

My question then is: For someone who has little control over their environment and what they eat, but who needs to lose weight and keep it off ASAP, is there even a chance of WLS ( sleeve) kickstarting things? If not, where do I go?

My doctor is of the opinion that for someone with a BMI of 44, as is mine, permanent weight loss through diet is an impossibility, and that surgery is really the only way. He's salaried, so I'm not worried about his motives, but still. Hope me?
posted by marsbar77 to Health & Fitness (28 answers total) 4 users marked this as a favorite
 
I do not have personal experience but several folks st my workplace have done the surgery this year. It has been working for them, quite well.

There is a period immediately after surgery where you are VERY restricted about what and how much you can consume. Like, clear broth and jello only for at least a week, possibly more. Maybe protein shakes. After you heal, your stomach capacity is very restricted (duh that's the whole point) but it is VERY painful if you bump up against that. You will not physically be able to binge eat.

My concern is you will HAVE to gain some/more control over what you eat in order for this to be successful. There's lots of healthy stuff you can eat that doesn't require a ton of prep. Don't get me wrong, it's harder, but if you plan ahead it becomes much easier. Bariatric surgery works but what you bring to the table in terms of continued life-style change is also important. If I were you I'd go in for a consultation and raise these concerns with the healthcare provider.
posted by emkelley at 3:29 AM on January 17, 2018


Response by poster: Not to threadsit, just to clarify: Totally aware of how restrictive the pre and post op diets are (those are reasons enough for me to be scared away, aside from the permanence of it all). My concern ( and it's justified, from what I've seen) is that you need to be way more militant about what you eat than is made clear by the doctors, especially after the first year.
posted by marsbar77 at 3:34 AM on January 17, 2018


Response by poster: Clarification # 2: Hope to move out at some point, but I need to get a job, and need to have the stamina to apply for and keep that job
posted by marsbar77 at 3:35 AM on January 17, 2018


This is an anecdote... My coworker and his wife both had the surgery a couple years ago. My coworker lost, I'd guess, about a quarter of his body weight, but he is still very overweight and seems to have plateaued, plus he still has to keep up with the crazy diet that they make you do after the surgery. His wife lost 1/2-2/3 of her body weight and is I believe now not considered obese, but I do know she has other health problems that mean she is on disability. I do not know if those health problems are related to the surgery.

I think I would be very suspicious of a doctor who says that because you weigh X you have to have surgery to lose weight, unless what he really means is that you are incapable of exercise due to your size. BMI is stupid, it truly is, it's a metric that wasn't meant to be used for individual humans, but over the last year or so I have gone from a BMI of 50 to a BMI of 37 and at BMI 50 I had no major health problems due to my size (per my primary care doctor). I used diet, exercise, and weight loss drugs to accomplish this. I am sure my results aren't typical, but whose are?

I think I would not have the surgery if it is the only thing that is going to change in your life right now. But I am not a doctor. It just seems like a LOT to go through if you cannot change the other stuff in your life that puts you at risk for being overweight. It would probably be better to get your food issues under control first. Again anecdotally but the two people I know who were also on the exercise/diet/weight loss drugs train are gaining their weight back because they did not change their eating habits at all, and they both lost a lot of weight while on the program.
posted by possibilityleft at 4:59 AM on January 17, 2018 [2 favorites]


Quick rhetorical question, how do you plan the very careful and rigorous diet you need to follow afterward, when you yourself say even basic meal prep is beyond you with your current kitchen setup?
posted by wwax at 5:08 AM on January 17, 2018 [19 favorites]


You need to work on your food addiction before going under the knife for weight loss surgery.

You "understand" the risk of surgery but you don't yet comprehend that your impulse control and compulsive eating won't change unless your addiction and depression are addressed. I have met plenty of people who have undergone the surgery and exchanged their food addiction to another substance such as opiates or alcohol. They either regain the weight or spiral out of control with depression or substance abuse.

There are plenty of support groups online through Facebook or Reddit etc without needing to leave your house or pay out of pocket.

You can do this, one tiny step at a time. But only if you can break the circle of depression and addiction.
posted by IndigoOnTheGo at 5:30 AM on January 17, 2018 [6 favorites]


Response by poster: Logistics are perhaps less of a problem than I made them out to be here. It's the whole psychosocial environment. I've never planned most things in my life, much less eating. And I would, after the initial excitement, be going it largely alone. But, if this isn't the solution (I still hold out hope) then what is?
posted by marsbar77 at 5:31 AM on January 17, 2018


Start small, do what you can. Don't expect everything to change all at once.

Youfeellikeshit.com can walk you through some of the basics.
posted by aniola at 5:43 AM on January 17, 2018 [4 favorites]


I've never planned most things in my life, much less eating. And I would, after the initial excitement, be going it largely alone. But, if this isn't the solution (I still hold out hope) then what is?

Go you for moving forward on your health issues.

When you say, I would be going it largely alone, the truth is even those of us with the most supportive partners still end up having to decide what goes in our mouths every day. Your environment does sound challenging but even from what you’ve written here there are choices you could work with. You could eat the protein from the supermarket and a big pre-washed salad and frozen vegetables with a spice mix shaken over them. Although the sodium is high in frozen meals, they are portion controlled and easy to prepare so you could have those in the freezer, and so on.

If people have soft squishy carbs in front of you or bring in junk, yes, that is a huge challenge and it sucks. Saying you will never be able to resist that holds both some truth and some falsehood. I kicked a pop/soda habit while living with soda drinkers. It was hard and took longer than it would have otherwise but I can’t stand almost any of the stuff now. I am still working on potato chips. The key is doing something every day.

I’m not writing this to blame you at all. I’m just saying that I think you are waiting for an ideal time and there never really is one.

Please believe in yourself. Start small. But have faith that you are capable of contributing to bettering your health, even in the swamp of your current home.

I have a friend who had the surgery had a very difficult point in her life. She has regained some of the weight and she lives with the fear that she will regain more. But, the surgery also provided her with new feedback from her digestive system, and a little bit of space to reset her habits. She counts it as a success. But it wasn’t a get out of jail free card, so the first step is to start the change yourself.
posted by warriorqueen at 5:48 AM on January 17, 2018 [6 favorites]


I had bypass and while I'm in a better place health-wise than I was, I probably should still lose about another 30 lbs to be at an ideal spot (if I were going by BMI it would probably be lower but my regular dr and I agree that that would be a realistic maintenance weight for me).

That being said, I don't see you being successful given the parameters of the situation you're in now. Food prep is pretty critical both for immediately post op and longer-term maintenance. I planned out a week ahead of time what I would be eating to make sure it was all portioned correctly and that I had everything I needed.

There are a few different directions you can come at this from, but I would try some other things before you have the surgery.

Meal planning/prep: Are you able to get the groceries you need? If you're reliant on your parents shopping and they aren't supportive then you're going to have a WAY harder time than if you can get your own groceries or they're fine getting what you ask for but just don't want to cook with it. If sourcing the food isn't an issue then I'd start planning one meal a day to be healthy, easy to make, and portioned well for weight loss now. Aim for high protein since if you do ever have the surgery it becomes a regular concern, and given your carb/sugar addiction I'd skip any filler like toast or potatoes. As long as your eating habits stay the same outside that meal, you're moving in the right direction.

I would also look at starting a protein shake meal replacement on occasion. Costco has Premier Protein and they're the least bad ones I've tried that still actually fit the bariatric requirements - high enough protein with low to no sugar. You can also order online from Amazon. I use Bariatric Advantage, which was recommended by my surgeon and has some flavors I'm ok with.

I had a pretty supportive network and it was still hard at times - people will ask if you're sure you don't want more food (and some won't take no for an answer). Most people have some foods that don't sit well with them after the surgery, which means you have to explain why you're avoiding them. You can actually hurt yourself if you try to binge after the surgery (and it doesn't make the mental pressure to do it go away). Someone else mentioned it above but transfer addiction is definitely a thing - if you don't deal with the roots of your addiction issues then you could end up in a way worse spot. Even if you don't switch to alcohol etc you could end up mentally craving sugar while actually having it makes you feel really sick. Same with caffeine - you're supposed to be totally off it for a while and I find I'm a lot more sensitive to it than I used to be. If you're currently dependent on it then you'll be losing a crutch.

This is not meant to be super discouraging. I just think that surgery now when you're not in a position where your environment will not help you succeed is a waste of the time and effort. You need to find ways to get to a better place and then see if you still need it. Every little bit counts - every bit of exercise you can do, every healthier food choice you can make, every bit of mental health treatment/help you can get.
posted by brilliantine at 6:26 AM on January 17, 2018 [10 favorites]


I know how challenging it can be to "eat healthy," and the increasingly restrictive cultural ideas about "clean eating" aren't helping. I cursed when I saw that whole #cook90 challenge. The last thing people need is more pressure to cook gourmet food nonstop for a month. (And I say this as a person who loves cooking! And vegetables!)

One trend I can get behind, however, is intermittent fasting. I've been dabbling for the last couple of months, and I'm a big fan, for some unexpected reasons. Chief among them that, unlike dieting, you don't have to spend time shopping and cooking and planning and *thinking about* eating only the best combination of foods with perfect macros: you just skip meals. I've been rewarded with mental clarity, better sleep, insulin and blood sugar control, and, yes, weight loss.

Jason Fung is considered one of the experts on the effects of fasting. I read his book, but to be honest it's not that complicated. Basically everything you need to know can be summed up in a blog post.
posted by libraryhead at 6:28 AM on January 17, 2018 [1 favorite]


Some of us get sick if we try to fast, so I would not generally recommend that for everyone. If I do not eat regular meals I get depressed and very nasty, just ask my husband. So you might try to fast, but for people who have blood sugar issues or emotional anxiety about food, this may make things worse, not better.
posted by mermayd at 6:54 AM on January 17, 2018 [1 favorite]


Would it be possible for you to try to do a keto diet for a month before you go the weight loss surgery route? If you're going to have to keep to a very restrictive diet after the surgery anyway, why not see if you can do the restrictive diet before the surgery and thus avoid the surgery altogether? I am also someone who is addicted to sugar and starchy carbs - but the person I am on the keto diet is an altogether different person - someone who has "willpower" and "self-control". Thinking of these two mythical quantities as physiological can really help. I would start by looking at the Reddit keto group. Try searching by top posts, you should be able to find lots of really inspiring success stories, many from people with a lot more than 100 lbs to lose. I think you need to take this one step at a time, see if you can get to a week within the parameters of the new diet, even if your meals are not super varied, and then there's every chance that you'll have more energy and enthusiasm and be able to plan more.
posted by peacheater at 7:37 AM on January 17, 2018 [2 favorites]


I have no experience with the surgery but I do have a slightly different perspective to offer.

Sometimes when we are really in a deep hole, we need something radical to shake us.

The surgery could be the radical thing that sets in motion the other things you'll need to do to succeed (develop food strategy, improve environment, seek support, treat depression, etc.)

Ideally, the physical limitations of the surgery will force you to eat less, which will force you to figure out the food and kitchen issues, which will drop some weight off you, which will improve physical and mental health, which will motivate you to become more independent, etc.

Because you're aware of all the points where this might fail, you know enough to set yourself up for success. Can you pay a neighbor to clean the kitchen once a week? Can you order food online? Can you join a support group?

You seem to know exactly what needs to happen but it's not like knowing that is working and none of can tell you or anyone to "just eat less, get a job, move out, be less depressed" or whatever because obviously if it were that simple you'd do it. So maybe you need to take this radical step first and have faith that you'll rise to the occasion.
posted by kapers at 8:51 AM on January 17, 2018 [1 favorite]


You've only mentioned seeing a surgeon, but also please go see a registered dietitian before you try fasting/keto diets/any other fad diet/surgery. Dietitians are healthcare providers specifically trained to help you figure out your own special nutritional needs while also understanding the science behind why things work. Look for someone who has had training in motivational interviewing, which is a counseling approach that's also been successfully used in the substance and alcohol abuse world, to help you deal with your self-diagnosed sugar addiction.
posted by astapasta24 at 8:53 AM on January 17, 2018 [3 favorites]


I mean you can go see a registered dietitian if you want, and I can guarantee that they will recommend against a keto diet or low carb diets in general. However, this is an area where the practitioners in the field have not kept up with the science showing that low carb diets are very effective in keeping off weight. I understand the impulse to call it a fad diet, but there's a reason that there's a new flavor of low carb diet in the bestseller lists every year - whether you call it Atkins, or South Beach, or Whole 30, or primal or paleo, or keto - they're all variations on the theme of keeping your carbohydrates under check, thereby reducing insulin secretion and reducing blood sugar fluctuations and your urge to keep eating.
posted by peacheater at 9:15 AM on January 17, 2018 [3 favorites]


I had a gastric bypass 9 months ago and have lost 77 pounds so far. I'm still technically overweight, and want to lose more, but the health benefits are astounding so far. No more CPAP, no more knee pain, more stamina, more energy, etc. Cooking and meal prep are very important, but there are plenty of shortcuts. Grocery stores have lean protein sources (deli meat, rotisserie chicken), salads, greek yogurt, cottage cheese, protein bars/powders, and vegetables & fruit for the vitamins and fiber.

I will echo the others and tell you that surgery only changes how much and how often you can eat. It will not treat an underlying food addiction, and in many cases leads to transfer addictions like shopping, alcoholism, gambling, etc. So you will need to address your addictions at the same time, and find good WLS support online and/or in real life. Feel free to memail for the ones I'm a part of.
posted by jhope71 at 9:20 AM on January 17, 2018


- I can't afford therapy. When I have been able to, it hasn't worked.

I'm uncomfortable with the way you tried to sweep this off the table. If you can afford to eat out a lot, you can afford therapy. And if it didn't work, you can try another therapist, or many therapists, who are different people with different philosophies and methods. You can call and interview them first on the phone and see who makes you feel good to talk to, who gives you a sense of confidence.

You mention the real problem is your "psychosocial environment" -- yes, you need someone who is unequivocally on your side, and not emotionally attached to any one of these conditions in your life. This person can help you sort through what seems like a giant ball of knots, and find the end of the thread, and start unwinding - and I'd recommend giving this an honest try before doing something physically drastic and irreversible. If you haven't dealt with the underlying issues in your eating patterns, surgery is not going to solve that - not even with a supervised diet. Please give therapy another try.
posted by Miko at 9:25 AM on January 17, 2018 [19 favorites]


You mention the real problem is your "psychosocial environment" -- yes, you need someone who is unequivocally on your side, and not emotionally attached to any one of these conditions in your life.

You know what might be really helpful for you? Overeaters Anonymous. First of all it's free, second, it gives you a built-in community of people who are struggling with the exact same issues you are, and provides you a network of support to work through it. You will probably meet a number of people who have considered and either done or not done gastric bypass in circumstances that are very similar to your own. I believe it will also help you with what seems like a pervasive sense of social disconnectedness and isolation in your life.

Not everything works for everybody, but as anecdata I have a friend whose life turned around 180 degrees after joining because it gave her a safe, supported framework and network to address the stuff that underpinned not just her struggles with weight, but also with her career and romantic relationships. She learned to turn to others for help with her deep fears and anxieties, which is more satisfying and effective long-term than what most of us usually do -- ignore, suppress, tamp down with food or substances or numbing behaviors.
posted by mrmurbles at 12:41 PM on January 17, 2018 [4 favorites]


I am curious about your six-month supervised weight loss effort - how did it go? I had RNY gastric bypass two months ago, and my surgeon wouldn't schedule my surgery until I had lost a predetermined amount of weight, for two reasons - the more I could shrink the liver, the easier the surgery; and I think he wanted to ensure that I was committed to the process. My insurance required a three-month supervised diet, and during that time, the nutritionist in my surgeon's office had me practice the necessary post-surgical habits (small bites; eating over 25-30 minutes; not drinking with meals, etc.). That way, I lost 26 lbs. before surgery (I've lost another 38 post-op). They gave me a strict post-op meal plan that phases in different food textures over six weeks... I haven't had to do much meal planning at all, aside from, for example, making myself eat 1/2 cup of plain low-fat yogurt or cottage cheese over 20 minutes. And most of the time I didn't feel like eating. Now that I've lost enough weight that I can stand up straight for longer than a few minutes (I was already obese, but recently had gained over 50 lbs. after a fall on black ice that wrecked my back and hip), I feel better able to do more in the kitchen. You don't have to be a gourmet chef the day you are discharged from the hospital; your surgical recovery can help you ease into the new normal. And as for needing to be militant about what you eat... this may be different with gastric sleeve, but with RNY, I am finding out that many of the things I used to love make me violently ill. I am pretty much done with bread, and anything with too much sugar. And it's totally worth it for the way I feel these days.
posted by candyland at 1:13 PM on January 17, 2018 [1 favorite]


I still binge eat, especially when coming off from things like Adderall

I'm coming to the conclusion since going off of it--and I probably will wind up taking it again at some point--that Adderall did some weird things to my blood sugar, because I had a lot of times when I was on it that I absolutely could have polished off an entire 2-liter of soda in a day, and my doctor made noises about how I was totally going to lose weight on it, but that never happened. When I'm not taking it, not like I don't like carbs, but it's a very, very different sort of thing. If you're going to try some kind of diet and exercise program, you might see if your doctor will let you try out some alternative medications, especially if you know this has this impact.
posted by Sequence at 1:40 PM on January 17, 2018


While I'm a practitioner and a big fan of low-carb / keto, the evidence is now quite clear that RNY gastric by-pass is by far the most effective form of weight loss intervention -- surgical or not -- for morbidly obese people. It is plain and simply the cure for many patients' lifelong or near-lifelong overeating. (By no means all, though ... some people's eating addiction simply redoubles its intensity, others transfer addictions. Nothing's perfect, or close to it.) Beyond resolving many patients' overeating, the gastric bypass itself, separate and apart from the weight loss, appears to have some very strong salutary effects, particularly for those with T2 diabetes or its precursor metabolic syndrome.
posted by MattD at 2:05 PM on January 17, 2018 [1 favorite]


Victoza is licensed to help in weight loss and I have dropped about 45lb on a dose lower than that used for the treatment for obesity. I haven't had any side effects except a reduced appetite (and a couple of week at the start where I woke every morning belching like an elephant seal looking fondly at Sir David Attenborough). It might be worth considering as a kickstart prior to surgery. Even soft squishy carbs lost their appeal.
posted by Martha My Dear Prudence at 2:22 PM on January 17, 2018


It sounds like there are two questions here: whether surgery would be a good idea at some point (now or later on), and what you can do to eat better (which is relevant whether you do the surgery or not). Given that, it sounds like it would make the most sense to focus on the second question, and revisit the first later.

So look: preparing food doesn't need to be complicated or require much physical exertion. Frozen vegetables remove the need for chopping, and if you cook using an oven, toaster oven, crock pot, instant pot, rice cooker, or microwave you can make a ton of things without having to stand at the stove. Cooking even really good food can be a matter of dumping things into a pot or pan, turning up the heat, and coming back when it's all ready.

That said, the feeling I get from this question and your previous one is that what you're really wishing for is support. And I think you need to start providing it for yourself. What is your budget? (I know you say you can't afford much, but if you add up the costs of eating out and all the expenses related to this surgery, how much are you working with?) Can you post an ad for someone to come over once a week for two hours to cook with you (and work with you to find recipes that you can also make by yourself, and teach you how to do it if need be)? If you plan well you can actually make food for an entire week in that time. If you really feel you can't take part in the cooking itself, then sit in the kitchen while they cook and work on your job apps and hold yourself accountable to them on your progress.

I know it would be wonderful if your family could provide all this help, but honestly most people (and certainly most single people in the US) have to figure out ways to provide themselves with the support they need. And since the need for support is an eternal problem and having surgery won't make it go away, I'd focus on that aspect right now more than anything else.
posted by trig at 2:46 PM on January 17, 2018 [4 favorites]


If you can't cook for yourself, you can't plan meals, and you can't control the environment food's prepared in — whether you wind up deciding to do WLS or not, it might be useful for you to look into a meal delivery service. Trifecta Nutrition will send you either complete meals, or a la carte protein/veggies/carbs, that's already portioned out. All you need is a fridge or freezer to keep the food in, and a microwave or oven to heat it up. There's similar services out there, but they're probably the most cost-effective one.
posted by culfinglin at 2:51 PM on January 17, 2018 [1 favorite]


Try not to beat yourself up for being sick! You've got a lot of health problems going on, of course you're tired and taking medication and sometimes not coping in the healthiest ways. I think a therapist would be really helpful, especially if you can get a referral for someone who works with weight loss surgery patients, because changing your diet and losing a bunch of weight is likely to bring up feelings and probably increase conflict with your parents. And a therapist will work with you to figure out, logistically, how you can meet your need for healthy food. Look for therapists with action-focused modalities (CBT, ACT) vs. say, psychoanalysts.

Weight loss surgery is the best option to lose large amounts of weight, based on clinical studies. Don't let society's judgement cause you to discount it. You deserve appropriate medical care. Dieting works for very few people, especially past about the two year mark, and your health presents extra obstacles. Weight loss surgery appears to have benefits besides simply restricting how much/what you can eat. A recent paper found more complications with the gastric sleeve vs. other methods, so maybe talk to your doctor about that. See if you can get prescribed some sessions with a dietician to help you come up with some healthy meals you can buy.
posted by momus_window at 4:45 PM on January 17, 2018


The evidence clearly supports your physician, and I would not hesitate to go for the surgery, but I would seriously counsel you to start with the head stuff pre-op and maintain regular talk therapy before during and after.

I've supported bariatric patients for 15 years and the long term successes have all employed life-coaches, therapists, support groups etc., They get into better routines like making physical activity more enjoyable to ensure it becomes a regular part of their lifestyle. Someone upthrre

the #OBSM hashtag has lots of advice and support and the OAC is a great organization to get involved in.

Support is essential.
posted by Wilder at 12:39 AM on January 18, 2018


Check out Jen Larsen's book about her experience with weight-loss surgery. As far as I know, she is still satisfied with the results, and the tone of the book is positive, overall. But she gives you a very detailed look at that it's like, physically and emotionally. She is also someone who, I get the sense, was feeling at an impasse in life generally and the surgery was part of a process of making a lot of changes.
posted by BibiRose at 6:56 AM on January 18, 2018


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