Gastric sleeve surgery isn’t the answer to all your weight problems. In ‘doctor speak’ bariatric surgery must be a ‘multi-disciplinary’ solution, and it requires lifelong changes, which only happen with commitment and work.
I made one of the most difficult decisions of my life, and I have followed that up with a commitment to making sustainable changes to my lifestyle.
So what do I mean by this?
- The hard decision
I didn’t decide to have the gastric sleeve surgery because I woke up one day and I was a bit fat and thought, “I’ll just get rid of this fat by popping into the hospital and having 2/3 of my stomach sawn off”.
This was my last and desperate option. Over 40+ years I had tried and tried to lose weight. I almost always succeeded; the failure came with the inevitable weight regain, and along with this the loss of hope and self-esteem.
I was a failure, despite all of the other good things that happened in my life.
This sort of failure is debilitating. It can lead to all manner of other issues not the least of these being low self-confidence, low self-esteem, and mental illness. Many of we fat people are loud, jolly, the life of the party. This is often a front for desperate sadness.
The other thing I have heard over and over again is, “So why don’t fat people just change the way they eat and get off their backside and get some exercise?”
In some cases this is very true. I do know overweight people who would benefit from a change of attitude towards exercise. I have heard fat friends say countless times, “I just don’t like exercising.” This may be a front for “It hurts when I exercise”, but sometimes it’s just complete lack of motivation.
I was in fact one of those people who believed that my overweight problem was all of my own making. I had actually discounted completely the option of having bariatric surgery because I thought that it was the easy way out and all I needed to do was to apply myself.
Well, I had been applying myself for most of my 49 years, and failing. Not only that, I don’t think I ate that badly. I loved fruit, salads, my favourite take-away foods were sushi or kebabs, none of those big brand fast foods. But I am only 157cm tall (5’2”), and both of my husbands have been at least 180cm (6’) tall, and I ate the same amount of food as them. I was always hungry.
Then, in May 2013 I met someone in the elevator at work. We were only on the third floor of the building, but in that short three-storey trip I discovered that this woman was a bariatric surgery success story, and she was quite open about it. Chris, you remain my inspiration.
I walked out of that lift with a seed germinating inside my brain. Around that time SBS broadcast an episode of the BBC Horizon series called “The truth about fat”. The spiel about the documentary says:
"Surgeon Gabriel Weston discovers the surprising truth about why so many people are piling on the pounds, and how to fight the fat epidemic.
She discovers the hidden battles of hormones that control people's appetites, and sees the latest surgery that fundamentally changes what a patient wants to eat by altering how their brains work.
Gabriel is shocked to find out that when it comes to being overweight, it is not always your fault you are fat."
Through this research she discovered that the stomach produces hunger hormones and fullness hormones, and that in normal people, the proportion of production of these hormones is well balanced. However, obese people produce more of the ‘hunger’ hormones than the the ‘fullness’ hormones. The result is that obese people are usually hungry much sooner after eating than a normal weight person. These messages are transmitted to the brain, and can drive that insatiable craving that overweight people have for food.
So while I still believe that there is a lot of ‘habit’ associated with overeating, there are also physiological, and psychological, differences that make the changing of that habitual behaviour so much harder.
The other thing Gabriel discovered was that these hormones are produced in the stomach, the part of the stomach that is bypassed by gastric bypass surgery or removed by the gastric sleeve.
So the insatiable hunger is removed by bariatric surgery.
Once this huge barrier is removed, the focus can then shift to the psychological aspects of weight loss.
- I measure everything!
Having bariatric surgery merely sets up the foundation for making sustainable changes to your life. This gets back to what the doctors call a multi-disciplinary approach. I thought I had a pretty good handle on nutrition, until I started on this journey.
I wouldn’t say I am a font of nutritional knowledge now, but I can say that I know a whole lot more about healthy eating than I did before the surgery. This is because my surgeon insisted on my consulting a Deititian before I had surgery.
Through my visits with my dietitian I learned about portion sizes, and the difference between carbohydrates and protein as energy sources. I had previously virtually ignored protein intake, and like most westerners, by diet was heavily carb-loaded, and often in the form of highly processed foods.
In short, carbohydrates are an essential source of energy, however, carbs are quickly digested, and excess carbs are quickly turned to fat. So if you eat too many carbs and don’t get the exercise, they will end up on your hips instead of being burned as fuel.
Protein, on the other hand, is more slowly digested. It therefore gives a more sustained release of energy. Protein also protects muscle, so while too much of anything will ultimately end up as fat, the right proportions will result in a nutritious diet that maintains sustained energy levels and protects, or builds, muscle.
Apart from my increased nutritional knowledge, I also monitor my food intake. That means I write down everything I eat, the time I eat it, the quantity, the calorie content and the protein and carbohydrate grams. That possibly sounds a little over the top, but have a think about it. Do you really know how much food you eat?
At my first appointment with my bariatric surgeon he asked me questions about my eating habits. I thought I ate a pretty good breakfast (half a cup of raw oats, 200 grams of Greek yoghurt, some honey and a banana). I was a little shocked when he raised his eyebrows and commented on the calorie intake of that breakfast.
| Food | Calories | Carbs |
| ½ cup of rolled oats | 230 | 36 |
| 200gms Greek yoghurt (low fat) | 200 | 24 |
| 1 spoon honey | 40 | 10 |
| 1 banana | 120 | 27 |
| TOTAL | 590 | 97 |
What on the face of it seems like a good healthy breakfast is in fact very high in calories, and in carbohydrates, and that didn’t include coffee. Basically I was eating about a third of my daily calories for breakfast, and about half of my carbs. That doesn’t leave too much room for the other two main meals or morning and afternoon tea.
Nowadays my breakfast is much more moderate (less than 300 calories) plus one or two cups of coffee. I do drink too much coffee, but you can’t give up living entirely!
I also go to work with small containers of food, and one large one with my lunch in it. Each container has carefully measured portions of food. For example, I might have 20 grams of pretzels in one container, two digestive biscuits in another. I also have one or two pieces of fruit, but I do make sure I keep my fruit intake to no more than three pieces per day. My lunch container has salad in it. I don’t weigh and measure my salad, because it is all raw vegetables and without anything added like dressing, vegetables are very low in calories. I don’t classify pasta or potato salads, or even coleslaw as salad because they are full of dressings and high in carbohydrates. Salad to me is raw vegetables. A generous serving of spinach leaves with some chopped cucumber, capsicum, tomato, onion and carrot is around 40 calories. What I put with the salad, however, is meticulously measured. I might have 50 grams of lean chicken, 25 grams of cheese, and an egg. That is a meal that is about 313 calories, with less than 5 grams of carbohydrates and nearly 30 grams of protein. It’s a big meal so I have to eat it slowly.
And about that coffee? I use a measuring spoon to measure my sugar. I have one spoon of sugar (I have cut down from 2 spoons). However, have you ever looked at the teaspoons that come in your cutlery set? They can vary in size dramatically, so I use a 5 millilitre teaspoon measure so that I am having exactly the same amount of sugar in my coffee every time.
This may sound all a bit OCD. But the fact is, detergent sellers bank on the fact that we often measure in “dollops” instead of grams or millilitres which means we are using much more than the recommended amount, therefore, we go through our detergent much more quickly. You can apply the same logic to what we put in our mouth. A flat teaspoon of sugar can easily become a little rounded and end up over time being heaped. Then, eventually, we are eating twice as much as we had originally intended.
So, I keep a teaspoon measure with my sugar bowl, and a set of electronic kitchen scales on my kitchen bench.
So really, I’m about 56 kilograms (123 pounds), well in the middle of the healthy weight range for my height. You’d think I don’t need to monitor my food intake any more. But it’s letting that get out of control that can lead to that gradual weight gain.
One of the things I can recall from being overweight was when I put on a couple of kilograms I would think, “That’s just a couple of kilograms, I can lose that again”. Then it would be five kilograms, and I would think, “That’s only five kilograms, I’m OK”. Then it would be 10 kilograms and by then it was too late. It would reach 15, then 20. And the cycle of weight loss and weight regain would continue.
That is why I measure everything. I know from painful experience just how easy it is to let things get out of control. And the bottom line is, when I am not sufficiently stimulated, my mind naturally turns to food. That is what I call my ‘fat psychology’. I look thin, but in my head I am still fat. When I am tired at work, I tend to eat. If I am at my desk for long periods of time, I tend to eat (and I have a desk job). I will think about food whenever I have nothing else to think about.
So I need to use tactics such as measuring my food and using strict portion control, as well as getting up and going for a walk at lunchtime, not only to get some exercise, but to reset my brain for the afternoon, to stimulate my appetite for lunch, and to energise me so I don’t get tired during the afternoon.
Here's another tip. I don't watch a lot of TV, but when I do, I usually do something like crocheting at the same time. This keeps both my mind and my hands occupied so I don't think about food so much, and I don't reach for it if my hands are already full.
- I keep an eye on my body
So Sunday morning I perform my ritual weighing and measuring. I have a set of body composition bathroom scales. I don’t think for a minute that these scales accurately tell me my fat, water and muscle content, but they give me a trend over time. I write down my weight, body composition, and then measure myself from neck to calf muscles.
Then I enter the stats into a spreadsheet. Those who know me well know that I am a bit of a spreadsheet junkie!
The chart below shows my weight loss from the time I started the Optifast two weeks before my surgery. I had lost about 4 kilograms in the lead up to this point, probably through the stress associated with making the decision to go with the surgery; that was during my crocheting frenzy.
This is not a new thing for me. The reason I can quote my weight at various stages of my life is because, off and on, I have been monitoring my body for years. Such has been the nature of my battle with overweight.
- I get a lot of exercise
I climbed Mount Kilimanjaro that year. I was over 90 kilograms. A couple of years earlier, I had walked to the glacier at the top of the Ganges River in the western Himalaya in India. That’s not an onerous walk, you just follow the river upstream until it runs out. But over the two days I walked about 32 kilometres at over 3000 metres above sea level.
In my younger days, despite my weight, I played Squash and Tennis, and my job had me on my feet most of the time.
I continue to get a lot of exercise. I go to the gym to work on my upper and lower body. I do strength training, not muscle building or toning. I need strength to pursue my passion for hiking, bushwalking, and endurance walking.
This year I completed the 100km Oxfam Trailwalker, will participate in a 60km fund raising walk for women’s cancers, and at Christmas will walk the Overland Track in Tasmania. My training for these events has me walking most weekends.
If you want to eat, you have to burn the calories off. So I keep active, fit, healthy, and strong. I do this because I can, but mostly because I love the outdoors, and I love the meditative aspects of walking.
Here’s another thing, the more muscle you have, the more energy that is spent feeding the muscle, and the higher your metabolic rate. So you can actually eat more!
I am not advocating becoming a body builder. The muscles you see on my back don’t look like that when I’m not working out. They just stand out because I’m skinny and I was lifting about 30 kilograms. But under normal circumstances, I just look like an ordinary normal weight woman. I have different reasons for my gym-workouts. But that’s another story.
The bottom line is, on the outside I am a skinny person. I am fit, healthy, and strong.
On the inside, I am still fat. That is something that I will continue to manage for as long as it takes.
I have fixed the body but the mind is an ongoing battle. The way I handle my mind is by using the tactics I have discussed here. I keep myself stimulated, I monitor my body and what goes into it, and I keep myself fit and active. I spent the first 49 years of my life unhappy with my body, and I never realised just how that impacted the rest of my life. If I have to spend the rest of my life measuring and monitoring myself, it is a very small price to pay for the huge benefits that have accrued as a result of this surgery.
There is little doubt that my gastric sleeve surgery has been a remarkable success. The degree of success is very much up to you as an individual. I have worked hard, and will continue to work hard. I can remember not that long before I had the surgery, thinking to myself, “Jan, you will never be a normal weight person, so stop dreaming about it.”
Now I am a normal weight person. And while that is very nice, and I can wear just about anything I want and look pretty good, that isn’t the main game.
I am now much fitter and healthier. I will probably never get Type 2 Diabetes; I have reduced my Cholesterol medication dosage from 20 mgs to 5 mgs; and I have substantially reduced my risk of heart disease, cancer and a whole range of other nasty diseases and disorders.
But most of all, I am happy, confident, and have fairly high levels of self-esteem.