The rate of obesity is at a record high, a lethal side effect of a modern world full of cheap food and sedentary hobbies. Science is now coming around to the fact that for people like me, bariatric surgery is sometimes the only option. But because of the continued stigma of obesity (not to mentionbillboards like this that make the procedure seem like a spa treatment), surgery is often seen as the easy way out for people who are too lazy to diet and exercise, like a cheat code to skinny.
Let me assure you, it’s not. They’re reaching into your guts and either clamping off part of your stomach or patching in a hunk of intestines to bypass it completely. If you think that’s the kind of thing you can shrug off in a weekend, let me tell you that …
#1. The Surgery Results in Uncontrollable Shitting
Here’s what you need to know right away: if you’ve had surgery for weight loss, you’re vulnerable to “dumping syndrome,” which is exactly what it sounds like. It happens when foods that are high in sugar or simple carbohydrates, aka everything that tastes good, get processed too quickly by your newly-neutered digestive system, resulting in sweating, shaking, intense cramps, vomiting, and of course, uncontrollable diarrhea.
It can happen the instant you swallow the offending food, it may hit you hours later, or it may not happen at all. You might go months thinking you’re in the clear, and then one day, one tiny bite of ice cream does you in. It gives the word “crapshoot” a whole new meaning.
I didn’t think I would experience dumping syndrome because I had the less severe of the surgical options — gastric sleeve surgery as opposed to a gastric bypass. That means that instead of reducing my stomach to the size of a cupcake, it was reduced to the size of three cupcakes (God, even thinking about cupcakes is making me queasy). In theory, that should mean the food I eat is processed more before it hits my intestines, reducing my risk of dumping syndrome. Boy howdy, I was … not correct about that. A few days ago, I was woken up in the middle of the night by the foreboding stabs of intense stomach cramps, and knew I could look forward to spending the rest of my morning on the toilet, with no idea what I had eaten that caused it.
That’s really important, because the only way to prevent it is to remember what foods have triggered it in the past. Basically, you spend your life making sure you’re never too far from a restroom, never knowing when you’ll be possessed by the shit demon. You hope and pray that it doesn’t happen anywhere important, like when poor Al Roker shat his pants at the White House.
#2. Just Convincing Them You Need the Surgery Is Hard as Hell
The cost of bariatric surgery is usually covered by insurance, though not out of the charitable altruism these companies are known for. Successful patients will almost certainly experience fewer health problems down the line, so paying five figures now means not paying six figures later. Before they’ll pay up, however, they require pages and pages of proof that you’re not faking the whole thing (presumably with a fat suit like Martin Lawrence in Big Momma’s House).
Typically, the starting requirement is having a BMI over 40 (that is, a six foot-tall male would have to weigh at least 300 lbs), or being at least 35 with life-threatening conditions. So no, it’s not an option for anyone who wants to drop 25 pounds so they’ll look better at the beach. Once that condition is satisfied, some insurance companies like Kaiser require months of classes, support groups, and diet and exercise regimens. We know that surgery is the only reliable long-term cure for obesity, but they apparently want to be really, really sure that you’ve tried every other, ineffective treatment first. It’s like lying in the ER with appendicitis and the doctor turning you away to try acupuncture for a few weeks.
Once you’ve passed, next comes the horribly invasive testing. I had to have an endoscopy (which is where they stick a tube down your throat and look around for a while), a lengthy ultrasound, and an amount of blood drawn that convinced me they were secretly housing vampires in the basement (these bloodletting ceremonies will go on every three months for a year after surgery). None of this is even for insurance purposes — it’s necessary for your surgeons to plan how best to slice you open. You may be subjected to even more unpleasant procedures, like a colonoscopy, to satisfy your insurance company and probably their sick fetishes.
I kid, of course — the reality behind all of these precautions is that …
#3. The Potential for Things to Go Wrong Is Terrifying
It’s all the more laughable to regard bariatric surgery as a cop-out for people with no willpower when it’s not only got the word “surgery” in the name, but is also a pretty high-risk surgery. It’s only done on patients who are by definition high-risk — obese people usually have all kinds of health issues that can lead to trouble during and after surgery. The older you are, and the more of these issues you have, the higher your chances of dying during surgery. Since I’m young and relatively healthy, my surgeon told me I only had a 1 in 700 chance of dying. That’s on the low end.
Still, death wasn’t my major concern. I don’t say that because I’m this huge badass who laughs in the face of danger and ramps school buses for fun. When you hear about all the horrifying problems that can arise after surgery — including leakages, blood clots, abdominal pain, bowel obstructions, osteoporosis, gallstones, vomiting, hernias, anemia, and malnutrition, to name a few — death on the operating table can start to sound like the best-case scenario.
Many of these complications can arise years after the surgery, so you’re sort of like a ticking time bomb of fluids and pain. I have to take a giant handful of vitamins every day so that I don’t literally waste away. I was warned that I could be minding my own business weeks or months or years later when the tiny tube that was now my stomach would stop handling anything but liquid. That’s because as it heals, it can develop scar tissue to the point that it constricts without warning. You end up with a dent in your stomach that narrows it down to the girth of a nail. Swallowing anything that isn’t liquid then feels like swallowing a nail.
Why are there so many bizarre side effects after the fact? Well …
#4. The Required Diet Is Insane
It starts two weeks prior to surgery, when the doctor hands you a pile of protein powder and a list of vegetables that are okay to eat (I never even realized there were vegetables that weren’t okay to eat). These packets and sprouts are your best friends for the next 14 days, if your friends are terrible people who taste bad and make you fart. Sorry, you probably don’t think about how your friends taste. Just talking about this makes me feel like I’m starving.
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They don’t do this to torture you; the diet helps to shrink your liver, which is annoyingly in the way of your stomach when they’re trying to butcher you. That doesn’t mean you feel okay about it. Again, we’re talking about people who have eaten themselves into a potential early grave — legitimate food addicts who are used to regular fixes of the unholy trinity of sugar, salt, and fat. When you take their food away, their brains freak right the fuck out. After only a few days of constantly drinking nothing but the mushy, gritty, sickeningly sweet abominations that dare to call themselves “milkshakes,” my body was aching so badly for food that I started craving salad. Imagine how desperate you would need to be to cry out, “All I want is a goddamn salad!“
I started to think, “Oh god, is this going to be what it’s like for the rest of my life? Nothing but pitifully tiny portions of awful food every day as long as I live? How is this going to work?” I really started to get depressed and wonder if this whole thing would be worth it. Remember, the hell diet doesn’t end after you get surgery — food simply stops being a big part of your life at that point. Which means …
#5. It Can Ruin Your Social Life — and Marriage
I had at least three appointments with my surgeon’s office prior to my surgery, including one with a psychologist. Initially, I figured that everyone working there, from the nurses to the dietician, were all just really friendly, since they kept asking about my family and if they were supportive of my decision to have surgery. Wasn’t it nice of them to care about me, and not see me as a big, fat sack of cash?
It turns out it was because they knew something I didn’t: bariatric surgery and the rapid weight loss that follows changes your social life in ways you would have never seen coming. I can’t eat with my family without them chiming in that I need to be careful and not eat too much, even though I’m the one who’s going to throw it up later. It’s made me so defensive that I feel the need to explain myself to restaurant servers, because I’m sure they’re thinking, “Why is this fat girl ordering a tiny cup of soup?” even though I know they’re really thinking, “When will this asshole shut up so I can go get her damn soup?”
It can also have a profound, shocking impact on romantic relationships. The divorce rate for bariatric surgery patients increases so much that they have a term for it: “bariatric divorce.” I am not chained down by some silly husband, but I’ve seen how it happens. One obvious reason is that spouses become increasingly insecure around their new, hotter husband or wife. But a lot of patients also report feeling like a completely new person. They’re more confident and may develop interests in activities that they couldn’t do before. Their spouse may feel like they have nothing in common with this stranger who keeps calling themselves their spouse’s name. Remember — this person doesn’t look anything like the one you married. You can’t overstate how much that part alone messes with your head.
Also, friends and family who are overweight themselves might not want you to get healthier, because they don’t want to have to think about their own health issues, and might start actively sabotaging you. This is why an obese couple will be tremendously more successful, both in their relationship and in their weight loss, if they go through surgery together (to understand, imagine a couple of addicts, but only one of them decides to get clean).
I encountered one woman who expressed concern that she was getting too thin after her surgery. Why? Well, apparently her family had been telling her that her weight loss made her look “weird,” and they thought she was too thin. The woman in question was still a good fifty or so pounds from her goal weight and could not have been too thin by any definition. It took some convincing, but she finally realized with some helpful coaching that her family was showing signs of assholeishness and jealousy. Also, we get used to seeing people a certain way — any time a fat comedian loses the weight, you see plenty of comments from fans who liked them better fat. People hate change.
#6. After All That, It Still Might Not Work
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After all those tests and classes, nights spent shitting yourself, and risking freaking death, you could end up right back where you started. About 20 percent of patients will regain some amount of the weight they’ve lost (which is still a spectacular result compared to the near 100 percent of dieters who gain their’s back). I know a woman who regained half of the 150 lbs. she dropped. This can happen for two reasons: you keep eating a bunch of horrible food, but in small portions all day long instead of in a couple of giant binges, or you eat larger and larger portions until your stomach stretches back out. Think of it like those Japanese hot dog contest guys — you “train” yourself to hold more and more food, over time.
That’s why it’s really important to address the underlying causes of your obesity if you want to be successful. Surgery is a necessary stopgap, not a magic bullet. Then there’s loose skin, stretch marks — it’s not exactly a one-way ticket to Babe City. It’s a last resort when you’re staring down the barrel of a gun. I have no intention of failing, because this surgery was the only thing I could do to ensure that my health would be manageable later on in life. My only other option for losing weight would be when diabetes eventually loses me some limbs. Although, now that you mention it, what’s a leg weigh? Thirty pounds?