Via Big Fat Deal, I read this interesting article in New York Magazine about fat people who have (at least temporarily) turned into thin people through weight-loss surgery. Here’s a few select quotes:
A 1991 study in The American Journal of Surgery also contains some interesting data about the mental-health effects of bariatric surgery. In the first six months, patients reported they were ecstatic. But after two years, most were back to where they started, at least in the aggregate. The crude explanation for this, says Walter Pories, one of the study’s authors and a surgeon at the Brody School of Medicine at East Carolina University, is that real life once again begins to reassert itself, and the trials of real life aren’t always things that skinniness can cure: bad jobs, neglectful spouses, rebellious children, faces and bodies that turn out only ho-hum. The more interesting mental-health discovery he and his colleagues made, Pories says, were the effects the surgery had on people’s marriages. “If the woman married when she was thin, had kids, became obese, and then had the surgery, the marriage almost always got a lot better,” he explains. (An estimated 75 percent of all bariatric patients are female.) “But if the woman married someone while she was obese and then became pretty . . . well, then she found a job. Got her colors done. Felt better about herself. And almost every one of those marriages ended in divorce.”
A few months ago, the various pressures of Show’s new life began to catch up with her, and she began to see a therapist, Jude Milner, who’s had bariatric surgery, too. “The problems actually started maybe a year after my surgery, when I was cast in a show where I was an adagio dancer,” Show explains. “The guy had to lift the girls up. At that time, I was 157 pounds, and all I could think was, This guy is going to break his back.” She’s quiet for a second. “That’s when I started. The vomiting and purging. That’s when I realized how easy it was to develop that habit.” Within two weeks, she’d gotten her weight down to about 145 pounds.
“I used to think that if I were thin, I’d be so much happier, and my life, from that moment on, would be perfect,” she says. “But it’s almost as if I’ve created other ways to be unhappy.”
“The day she went for her consultation,” she continues, “the doctor said, ‘I want you to understand that you’re not going to come out of this looking like Gloria. I can’t promise you’re going to be a size 8.’ And that was fine. She was not doing this to get skinny. And yet . . . when I see myself at 135 pounds, I see part of what Susie died for. By no means all of it. But part.”
Cahill’s crying now, discreetly but steadily. “It would be very easy for me to say, ‘This surgery killed my sister, and it’s the worst thing in the world,’ ” she says. “And her last moments of consciousness may have been imbued with terrible fear . . . “She looks away. “But also hope,” she resumes, looking directly at me. “This gave my sister hope, and nothing else did.”
I swear, I’ve almost never seen a better argument for fat acceptance than this article. (The article-writer, by the way, never mentions or considers the idea that it’s possible to be fat and healthy.)
Although the article does admit that gastric bypasses have high deathrates (some procedures as high as 1 in 100), it also implies that those who survive generally have long-term health improvements. Sandy Szwarc points out that the evidence is actually less than compelling.
For further criticisms of surgical weight loss, check out the Obesity Surgery Information Center, especially their letters section, for the kind of obesity surgery stories that will never get reported in the mainstream media. And also read this comment by Paul Ernsberger (you’ll need to scroll down a bit for it)..
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Stories like this just make me sad. It makes things sound so hopeless for fat people and I know it affects so many and encourages to feel just as dejected and worthless. This surgery has ruined so many lives, but it gets away with it because the victims think they either deserve it or can’t be worse off, even if they die. Its tragic and discouraging but it also needs to embolden people who believe in fat acceptance to keep pushing for change because things can’t continue like this.
I don’t have a comment so much as an anecdote. About 15 or so years back, before this type of surgery was well known, I worked in a restaurant. Once week a lovely, older couple would come in. They were in their 50’s. He was tall and thin. She was tall and overweight. I loved when they came in. They both were so full of life and enjoyed everything so much. It was a joy to wait on them.She was a beautiful woman. Always dressed to the nines, nice clothes and she wore them well. One night they came in positively giddy. Turns out she was going in for a bypass and this was the night out before she went into surgery a few days later. Everyone came by to wish her luck. She never mentioned any health issues, just that she was finally going go to do something about that 80 pounds she wanted to lose and hadn’t been able to. She was so happy. Went on about the clothes she was going to buy, the things she was going to do. We were all very happy for her. We didn’t see them back in for about 6 months. When they started coming back in, it was like both of them were different people. The beautiful lady I remembered was very thin. But she didn’t smile, she didn’t seem happy. Her husband was very quiet and didn’t joke around like he used to. She was dressed in very stylish clothes, but that glow she had before was gone. She wasn’t “beautiful ” anymore. She was just a thin older lady who was dressed well. Her diet was very limited. And there was very little we had on menu she was able to eat without getting sick. Her husband acted ashamed that he was eating in front of her and didn’t enjoy his meal. She seemed angry and upset the whole time. They came in several times over the next few months and then quit coming in. I do not know what ever happened to that lady, but I always think of her when I hear or read about folks who have bypasses. She lost weight, but she seemed to lose so much joy, so much life. She was a beautiful, vibrant lady before the surgery. I wish she would have known that. While I am sure that there are some people this surgery is necessary for, I always wonder how many people go into it thinking it’s going to make everything wonderful, only to find it doesn’t. Being thin doesn’t equal being happy. It’s sad that society equates the two.
It sickens me to think that a healthy and happy person would wreck their life like that. And I don’t think much of a physician who would wreck someone’s body for a lousy 80 pounds, either.
I agree. I never knew the lady well enough to know if there were health reasons why she had the surgery. I hope there were. Because having the surgery did not seem to make her happier from the limited view I had. And bypass surgery is an elective, like plastic surgery. There are vast numbers of doctors who make their living preying on the insecurities of people who don’t fit into society’s version of what is beautiful.
I don’t get it. I really don’t. Why do people even think people starving themselves are pretty?
It’s like looking at Lindsey Lohan. When she was in the Parent Trap as a little kid, she had some actual body to speak of. Now she just looks skeletal…she’s fighting her actual body type.
If you’re born skinny, that’s one thing. But one should embrace whatever type of beauty they were born with.
I like me, all 5’5″, 165 lbs of me. This is me, and I am damn sexy, damn attractive, and damn beautiful. And even I wish I were skinnier sometimes, and that is fucked up past anything I could ever think.
I think I know why a person might be motivated to have WLS. The truth is that in very real ways, thin people are treated better than fat people. And on top of that, fat people are given messages all the time that simply being fat is not healthy no matter what their lifestyle might be like.
You’ve read the autopsy report on Terri Schiavo, right? The doctor all but came out and said that her struggles with weight were the most likely cause of the heart attack. I was unaware that she had lost 100 pounds and was still losing.
I really don’t think these surgeries as a “health-tool”, but more as aesthetic ones *)
Well, surely quickly losing 50 pounds might be great for your knees, but generally I think the motivation for having a surgery is “I don’t feel pretty, I feel no one else thinks I’m pretty, in fact I think everyone else seems me as a fat monster, so I just Gotta Get me a surgery” *)
*) When I say “aesthetic” and “pretty”, I’m of course refering to the beauty standards that the fat people him/herself considers widespread. These beliefs might be near to, or far from, reality, but that’s beside the point – what matters is the belief itself.
The bypass surgery is common enough at my work to be sort of ‘fashionable’. Every single person I know who has had it gained all the weight back. I don’t see the point in risking your life for a temporary result.
I’ve read far too many accounts of doctors telling fat patients “you’ll be DEAD in a year if you don’t have this surgery!” And to people whose weight was not extreme (one woman weighed 200 lbs) and whose health was otherwise pretty good.
After reading an account of a woman whose sister suffered brain damage from beriberi caused by nutritional deficiencies as a result of WLS, I’ve concluded that this procedure falls under the heading of “medical experimentation.” We don’t know what the long-term effects are or whether the quality of life for most people 10 years post-op will be better or worse than before the surgery.
A friend of mine who is part of an online support group for post-WLS patients tells me that it isn’t talked about much in the media, but a good percentage of people start regaining weight a couple years after the surgery, or have so many health complications they require further surgeries to remove scar tissue and/or hernias.
Yes some people are completely healthy being fat and some suffer in many many ways . It’s the obsession with stereotyping that’s creates these kinds of debates, gastric stapling is a valuable medical procedure when it is used in the right circumstances, like any procedure it can also be a disaster in the wrong circumstances. Taking a few cases and forecasting a negative stereotype across the procedure is intellectually dishonest . It is also less than compassionate to the fat people who undertook this procedure to assume they should just get their act together and start owning their weight issues, obviously many people have great difficulty accepting and rejoicing in their obesity. We are all individuals and its likely medical science will solve obesity in the next 20 years with much less invasive procedures than the one referred . Who among us given a safe medically proven option would choose to remain fat. Owning the fact that your larger than most usually comes at the end of a many years of non acceptance, people who truly accept and feel comfortable with their weight are usually people who have failed to change it over time. This would seem the most logical approach if all things in the past have failed and I congratulate those who can do this, but I would also suggest to those that have achieved this that other people find it very difficult to follow in your footsteps and they deserve compassion for their struggle .
Obesity, in the most part comes from a completely unregulated food manufacturing industry. Additives like Corn Syrup and Palm oil (just to name a few) have created a bonafide health epidemic, yes some people are reasonably healthy with a few extra pounds but as the level of obesity gets higher the relative health of people declines. To many people become obsessed with the stereotypes being played out by the media and fashion industry being the issue, when in reality the food industry has systematically perpetrated a great crime on humanity. Biological systems that took millions of years to evolve , systems that work perfectly well given the right fuel have been individually destroyed by a criminal lack of concern by the food industry for their customers, corn syrup is used as the main sweetener in 81% of manufactured products. Humans were not meant to eat the fructose found in corn syrup it creates insulin reactions that enables all the carbs and fat you might eat to be stored as fat. It should be banned like heroin or cocaine , I would argue that it causes more misery. I can give you a list of +50 products on the market today that should not be allowed to be used in the manufacture of our food.
Consider this at the turn of the century the average American consumed 4 pounds of sugar per year, this rose to an estimated 113 pounds per person in 1966 to 168 pounds in 2003. Now remember that’s the average it is estimated that 10% of Americans consume more than 350 pounds of sugar per year. In 1966 almost all sweetner sold was sucrose or cane sugar, high-fructose corn syrup, has climbed from zero consumption in 1966 to 72.4 pounds per person in 2003. Consumption of glucose kicks off a cascade of biochemical reactions. It increases production of insulin by the pancreas, which enables sugar in the blood to be transported into cells, where it can be used for energy. It increases production of leptin, a hormone that helps regulate appetite and fat storage, and it suppresses production of another hormone made by the stomach, ghrelin, that helps regulate food intake. It has been theorized that when ghrelin levels drop, as they do after eating carbohydrates composed of glucose, hunger declines.
Fructose is a different story. It appears to behave more like fat with respect to the hormones involved in body weight regulation. Fructose doesn’t stimulate insulin secretion. It doesn’t increase leptin production or suppress production of ghrelin.. If you consume allot of fructose you will get fat and there is no doubt about this whatsoever. High consumption of fructose will make you very very unhealthy so just accepting that being fat is ok and not worry about the cause is avoiding the real issues that underly the condition. The food manufacturers have been playing with our health biochemically, the combinations of their additives leaves todays obese person in a worse position than a cocain addict. Many of the additives in your food are harder to kick as a major drug habit, but at least the drug addict has some idea of the cause of their situation, in the case of the obese they have no idea why they cant control their cravings . In a society that assumes obesities root cause lies with the individuals inability to self regulate, great suffering must be endured by most who have little idea that they have been made chemically dependant on the additives in the food they buy from the supermarket. Accepting obesity as you suggest covers up the great crimes that has been perpetrated on society by the manufacturers of food. People need to be educated about the causes of obesity . It’s societies obsession with the drugs of addiction and the lack of intellectual scrutiny of other things we add to our systems that is the underlying issue. Coca Cola consumed in the quantities that American consumes is actually worse for you medically than the other type of Coke.
This lack of scrutiny about what we eat is the root cause. Anglo Saxons who have never in their genetic history consumed things like sugar and rice, now consume huge quantities of things that their ancestors never ever ate. Polynesians now consume huge amounts of animals fats and carbohydrates that their bodies have never been evolved to digest. If you look at you individual pre 1900 ancestors diet and compare it to what you consume now it will usually provide some pretty big clues about what is cause the weight issues.
Rather than accepting obesity you should fight it for humanities sake, the food manufacturers are slowly poisoning the human race. Obesity is doubling every decade and represents a threat the health and happiness of humanity, your suggestion that we should just accept this situation reflects a poor understanding of the issues that humanity faces. Suggesting that we might tackle this issue by not fighting it is just a reflection that you have given up yourself.
Yo-yo dieting puts more stress on the heart than being overweight (considerably more stress), yet society still puts it out that you must be thin to be healthy (being underweight is also quite stressful on the body) which leads to more yo-yo dieting. It’s funny we have all those stories about the fact that, as we’ve become more “health conscious” and offered more diet fare, the country’s obesity level has risen to epidemic proportion and yet we refuse to seriously acknowledge that it’s our culture’s fixation on being thin (and equating that with healthy) that has probably driven what was a problem to epidemic proportion.
Oh. My. God.
“But if the woman married someone while she was obese and then became pretty…”
Am I the only one who’s disturbed and personally insulted by that sentence?
-DC (“obese”, very pretty, and getting married in a month. Oh yeah, and healthy too)
But it is extremely dangerous. My aunt had it last spring and nearly died of toxic shock. She got home from the hospital and realised something wasn’t right, and ended up back in and in the ICU for two weeks. Once she recovered from that, she had a host of other issues, such as hair loss, sickness based food restrictions, etc.. A bit over a year later, she’s looking and feeling great, but she looked great before the surgery (wasn’t feeling as energetic or healthy she maintains though, but how much of that is due to her choice to start exercising daily to tighten up the area’s where she lost the weight).
I suspect I’d have a much more vehement reaction about this had she actually died, but just the same I still have an inherent suspicion of the surgery now. Does it help more than it hurts? It might, but it’s still too soon to tell.
What I’ve generally heard argued on this blog, with regards to fat politics is reframing the battle to one of health; both by exercise and nutritional eating. The focus being the largest factor of change, which helps people make positive changes based on positive and academic reasons.
Exercise and nutritious eating
Exactly. I just read the whole article, and it was one of the saddest and weirdest things I’ve ever run across. The most striking thing? I’m 5′-4″ and 200 pounds, with a 35″ waist, but somehow, in terms of appearance, physical ability, and social experience, I’m much more like the women post- rather than pre-surgery.
The problem these women had was not their weight, but their level of fitness and their self confidence. They are risking their lives without dealing with root causes. Our society encourages large people to blame all their problems on their size. That has got to change. Articles like that aren’t helping, except to highlight how bad things are. I’m just so shaken up after reading that.
All the improvements they talk about (with the possible exception of the lessened discrimination), could have happened without the surgery, with much less or even no weight loss.
I must disagree with several of Craig’s comments. Showing the major risks and lack of long-term advantages of this procedure is not dishonest. With weight-loss surgery, people do not end up happier, and the vast majority don’t end up any healthier. In so many ways, this is like reparative therapy for homosexuals. It is sold as a necessary treatment for something that was never a disease to begin with, and it does not create any change (at best) or creates devastating changes (at worst). Passively accepting the popularity of procedures which essentially seek to eradicate certain body types would be wrong and dishonest. I will not celebrate any new procedure that claims to get rid of large body sizes any more than I will celebrate therapies that claim to get rid of homosexuality. Both send the same terrible message – “Hate yourself” – to the world.
Nothing about obesity needs to be “solved” with less invasive procedures. We need to address nutrition and fitness in both fat and thin people, but nothing about body types needs to be solved through some miracle of medicine. It is true that many people who are fat have not fully come to accept their size. I am included in this group. That means absolutely nothing to this argument, however, because promoting procedures that would change body sizes only reinforces the body hatred we live with. Several years ago, I would have gladly taken a magic pill to make me straight. Now, I know better. I have been educated, I have received support, and I would not change my sexuality for any reason. In a similar way, I hope that education, support, and non-acceptance of these weight-loss procedures will lead to better body acceptance.
As for Craig’s claim that obesity comes from an unregulated food manufacturing industry, well, I won’t go into all the science here, but I will point out that since obesity is not directly related to health when other confounds are held constant, it is a moot point. Who cares what “causes” obesity? Obesity itself is a vanity issue, not a health issue, so why should we allow medical science to waste valuable resources seeking to change our bodies when it is not necessary. Why should we waste our own energy discussing the causes as if there was a need to change people’s appearance? Craig writes that as the level of obesity gets higher, health declines. I must disagree. Having read several studies on the issue, I have concluded that as fitness and nutrition decrease, health declines, but when fitness and nutrition are statistically controlled, there is little relationship between body size and health. Fitness, nutrition, and body size are not the same thing, nor are they perfectly correlated. The people at risk of health problems are those who are sedentary and eat poorly. If this was how medicine defined “obesity,” I could accept that we should fight obesity. It is not, however. We define obesity by a body size standard, and we use “treatments” to fight that body size, not the true risk factors.
It is simply a fact that thin, unfit people die far sooner than obese, fit people. Acceptance of size diversity is essential for the health of thin people as well as others. Of course, as more and more pressure is placed on fat people to undergo medical procedures, take on dieting, and hate their bodies, we may see them die sooner and sooner.
Am I the only one who’s disturbed and personally insulted by that sentence?
Oh HELL no.
whoops. bad tag.
Very pathological use of “obesity” there, Craig. I bet you love how this marginalizes fat people. Making them sound diseased. Your whole post presumes that fat people are a problem that must be solved and the only people allowed to discuss issues facing fat people are those who share your dim view of our existance. Its no surprise you come to the conclusion that amputation of a healthy and properly working bodily system is a “solution”. Never mind that most patients still end up clinically “obese”. Never mind that even the industry admits that 2% die in the first month alone. Never mind that studies have shown it takes 20 years off their life expectancy compared to “obese” people. People are dying in service of a way of thinking that’s never even been proven and for a solution that doesn’t work. I say we absolutely ought to discuss that.
Fat is not corporations’s fault. It is not a moral failing. We need to learn that so more people don’t keep dying at the hands of stomach amputation.
for the record I was 326 pound 4 1/2 years ago now I am just under 190 pound (6’2″?). I have been fat for most of my life adult life and now I am down to 15% body fat. I agree surgery is the best option for anyone but the very obese and my experience in Australia is that it is only reserved for those who will die without something being done, this may be a different experience in the US. If you look at the morbidity statistics in the UK and Australia the health issues you mention are not common at all, although this blog has triggered some research into the US and I was surprised to find the problem procedures running at about 2x my regional statistics . Lets remember that between 2-4% of all patients undergoing serious surgical procedures die of complications related to the procedure and about 30% of all deaths in hospital are in fact caused by the hospital.
Yes Fat is a the problem created by the corporations that produce the food and I have an enormous amount of information to prove my point (my phd topic Paleolithic nutrition) . I agree its certainly not a moral failing , we are being poisoned with substances that humanity was never mean’t to eat and that’s the truth.
I sympathize with the sentiments about the procedure seeming extreme but you can’t use ‘aunt Martha and the lady down the road’ style scientific analysis as the foundation of whether a procedure is good or bad. Someone who is normally overweight should not have access to the procedure but categorizing those folk who are seriously obsess as lacking the ability to accept themselves etc is really lacking compassion (in my view) .
Serious surgery does have a higher mortality rate, but bariatric surgery is elective, so this makes it (or should make it) more of an issue in judging whether to undergo it or not. If you are not more than 100 pounds overweight and suffering from incipient complications (osteoarthritis, hypertension, diabetes) you probably shouldn’t even be considered for the surgery.
There are other medico-economic factors that make the death rate higher — that is, alot of doctors see it as a financial bonanza and have started offering it under suboptimal circumstances. Several surgical programs have been shut down because they simply couldn’t bring their mortality statistics in line with the best programs.
I think that Craig’s point is correct insofar as it relates to the way in which public policy, and specifically agricultural policy, has dramatically affected our diet, frequently by turning okay or even good foods into bad foods by making it much cheaper to market food that has been “supplemented”? with high fructose corn syrup. As far as I am concerned, anybody who buys SunnyDelite and anything else that is basically a natural food modified by HFCS is doing a great disservice to their children. Vitamin C does not offset the pernicious effect of HFCS. Unless you read labels you probably don’t even realize the extent to which HFCS is used in food. And the impact of increased sugar consumption, now primarily in the form of HFCS, has not been studied as a long-term health related phenomenon. But it seems pretty clear that it is contributing mightily to weight gain among children.
Also, the death rate by age shows, basically, exponential increases in the death rate for those who reach the age of 65, and especially, those who reach the age of 75. (http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf). The rate of obese children was under 5% in 1982 ““ it is now something like 25% of children. There is no historical data that we have or that we could have that can test the impact of such long-term obesity on death rate. The CDC is extrapolating, but so are we all.
Craig, I’m happy your surgery has worked out well for you. Nonetheless, I’m not convinced that even with “incipient complications,” surgery is an option that makes sense. Over the long term, WLS seems as or more likely to kill someone than being 150 pounds overweight, and can have terrible effects on quality of life, as well. And the pro-WLS research seems biased and of dubious value.
Even someone who is “more than 100 pounds overweight and suffering from incipient complications” shouldn’t consider surgery until a Health at Every Size (HAES) approach, which is much less extreme, has been tried. It just seems logical to me that surgery ought to be the very last option tried, after HAES has been tried and failed.
And Craig, I’m not saying that everyone who uses surgery “lacks the ability” to accept themselves; I’m saying that, at least in the US, most people who have weight-control surgery haven’t even tried a fat-acceptance, HAES approach. Most people who have WLS are convinced, without justification, that being 100-200 pounds overweight is going to mean that they will inevitably die young unless they get the weight off; and that’s simply not the case for the vast majority of fat people.
Barbara, where does this statistic come from, please?
I’m worried about making generalizations based on my own experience. Really. I’m 5′-4″ and weighed 220 at my heaviest. That’s an under-40 BMI (“obese” as opposed to “morbidly obese” – but I dislike those terms). I understand that things may be different for people who are a lot larger, or who have health problems. I’d hate to be uncompassionate.
At the same time, the women in that article were under 250 pounds when they had the surgery. I DO know what it feels like to be that size. In my experience, it isn’t anything like what was described. I mean, plenty of people in that weight range (Jennifer Portnick comes to mind) are in great shape and feel good about themselves.
I have no doubt that most people who decide to have weight loss surgery have dieted and regained weight many times. I doubt many have tried a “health at any size” approach. If someone asked me for my advice, I’d say “try the healthy, unrestricted eating, regular exercise, and size acceptance approach first. Get a good haircut and some nice clothes. Try living the life you want at your current size. Then see how you feel.” That’s all.
As with all anti-fat measures, stomach amputation started out just being for “extreme” cases but is rapidly expanding to serve primarily people in the 250 and under catagory. This makes sense for the doctors as its a rather large market to expand into for a surgery that brings in well over 3 billion dollars already. Whats more, these patients make better poster children for stomach amputation as its more likely they can get to that mythic 135lbs. For a person who is 350lbs, they’d be lucky to end up 300 when all is said and done, and may never get lower than 200lbs. We’ve seen how stomach amputation thrives on getting recent post-ops to pitch the procedure to prospective clients. People still in the euophoria stage that comes with the weight litterally falling off. But every single patients, the weight stops coming off. And for every single patient, the weight starts coming back on. Except for the 1 in 50 who dies in the first month.
I am outraged that this surgery is even allowed in this country, much less brings in more than $3,500,000,000 in revenue a year and rising. All the surgery does is provide horrible punishment if a person doesn’t maintain a strict and severe diet for the rest of their life. That’s not treatment. Its surgically enforced anorexia. You’re amputating a system of the body which is healthy and opperating properly. Last I checked, I couldn’t go to a surgeon and ask for an arm to be removed. Or to have your excretory system torn from your body even if it has no defects. All with fat people do doctors get the bright idea to start amputating parts of the body that have nothing wrong with them.
My husband recently lost 105 pounds by a severely restricted diet (doctor supervised), combined with drastic changes in the types of food we eat (from cakes, white flour, and cheese to whole grains, lean meats, etc.). He had the willpower to diet in a manner almost as extreme as WLS. Now that he’s thin and at his target weight, he’s no happier. He still has difficulty making friends, still hates how he looks (though from excess skin rather than fat), and our relationship is no better. He derives his self-worth from the scale, because he doesn’t know where else to get it. Every pound (even of water weight) is a defeat in his battle to stay thin. At least he’s exercising now instead of being sedentary.
I’m presently looking for a counselor to help both of us deal with these problems, but I think our experiences corroborate the experiences of the people in the article. While the people featured were experiencing serious health problems before they had WLS, their psychological problems were not necessarily with the fat but how they saw (and continue to see) themselves.
My sister had the surgery a few months ago. She was told she was at the “Lower end” of the group of people who need the surgery, but no one dissuaded her from getting it. She’s still in the euphoria stage a bit, but…other things have come to light.
It was obvious to everyone in our family that her marriage is unhappy–has been from almost the day they got together. Her weight did balloon during that time, and the fact that he was already obese didn’t help her fight it off. Food is a great numbing agent when you’re miserable, and she’s been miserable for years. But she just isn’t able to think about leaving him, no matter how vicious their fights get. So now she’s slowly starting to realize that even skinnier, she still has most of the same problems. He on the other hand got very alarmed when she lost all the weight (he was always good at sabotaging her previous diets) and openly stated that he thought she would leave him. So now he’s getting the surgery, too.
In the end, they will both have gone through all this pain and risk and damage and will find out that they’re still miserable, and the surgery didn’t really fix anything. Then what will they do?
My mom’s talking about getting the surgery now, and I’m doing all I can to discourage her–I’m really afraid she’ll die. But she’s never forgiven herself for not staying the tiny, anorexic, heavy-smoker size she was at 17. She fusses over my weight too, despite low cholesterol and blood pressure and lots of activity…the messages about fat as evil have really penetrated my family in a bad way.
Does anyone know of any resources for finding therapists or counselors who are non-judgmental about weight and able to help you accept yourself at your present size? Because I haven’t the slightest idea how to go about it.
I read this article a few weeks ago and was just not happy with it. The author did present some of the negatives, but the glamour photos of the women at their lower weights made it clear that overall, there was approval for doing it for looks.
Zuzu,
You might want to check out the Fat Friendly Physicians list at http://www.cat-and-dragon.com/stef/fat/ffp.html and the tips for choosing a physician at http://www.cat-and-dragon.com/stef/fat/nesbitt.html. Even if you cannot find a therapist through those lists, you might call a doctor on the list and ask for a referral. They may know other fat-friendly professionals in their own area.
Thanks!
There is also a list of therapists who don’t advocate dieting or WLS on the Overcoming Overeating website (www.overcomingovereating.com ) The OO approach is anti-diet, and feminist-based.
Congratulations, DC.
I thought the quote about obesity and marriage from the article was telling. People who got married at their higher weight didn’t improve their marriages by having surgery. Suggests the obvious: The person who married you desires you the way you are, not the way somebody else thinks you ought to be. It’s tragic that we’re all so brainwashed about fat (and height, and skin tone, and hair, and whatever else) that we sometimes struggle to see the evidence before us.
There’s something a bit disturbing about those very revealing post-weight-loss photos in that article. Seems to imply that it is a cosmetic procedure, though with the attendent risks it’s impossible, I would think, to justify as one.
On looking up the details of the surgery, I found them to be unexpectedly distressing. The comparison that came most readily to mind was genital mutilation – taking a healthy part of the body and reshaping it to suit, no matter the consequences. There is something so absolute about chopping off part of a stomach.
Although I agree with much of what everyone has to say, you can’t make a statement like “fat = happy” the same way you can’t make a statement like “thin= happy.” I agree that everyone should embrace themselves for who they are, but that by no means is an excuse not to stay in shape. The terrible truth is that our society, while enforcing the thin ideals, is also promoting obesity at alarming rates. We should try to promote health with a healthy image- because both extremes are undoubtably damaging to our well-being.
And I have NEVER heard of a doctor promoting gastric bypass surgery without first warning a patient of its possible health risks. I don’t believe many surgeons (excluding cosmetic surgeons) would push for GBS unless the patient’s obesity-related health risks outweighed the surgery’s.
Caitlin,
It sounds like you don’t believe it is possible that some obese people are perfectly fit. Are you familiar with the Health at Every Size movement? You might be surprised how much these obese women DO stay in shape. We all emphasize fitness. I don’t think you’ll find too many people in the fat acceptance arena that don’t place a lot of emphasis on fitness. Please don’t imply that we are making excuses for not staying in shape. Obese people CAN be and often ARE in shape. You cannot judge my life or my fitness level by the numbers on a scale or a visual shortcut of your own. As some jokingly put it “I am in shape — Round is a shape!” If everybody were perfectly fit, we would not all be the same size and shape, and it is about time people began accepting this.
Zuzu–in most cities, you can find therapists who use cognitive-behavioral techniques regardless of the specific issue.
One of the things that cognitive-behavioral therapy does, very effectively, is to alleviate distress by helping people challenge automatic thought patterns that don’t reflect reality.
One common tendency is toward what’s called “catastrophizing”. Many people who get bent out of shape about fatness get bent out of shape not because of an underlying reality about the health consequences of fatness but because their mind leaps to false, catastrophic conclusions. Ampersand’s posts about the science of fatness are anti-catastrophizing on a social level.
On a personal level, though, many people think thoughts such as, “I am fat and therefore, I cannot be healthy and happy.” The last part of that thought is a catastrophizing over-conclusion. Many folks who have that thought would recognize it on some level as being false, but nevertheless find themselves still believing it on some level.
Cognitive-behavioral therapy is pretty effective at helping you successfully challenge thoughts like that.
The problem isn’t that doctor’s don’t communicate the risk. Its that they don’t communicate them in proper context. The risks of stomach amputation are downplayed because the risks of being fat are so horribly overplayed. The only way this surgery makes any sense is if you literally believe any given fat person will probably die in a year or two. And this is exactly what the surgeons tell people. The pitch is never about the risks of the surgery until after a patient is told they will die without it. That’s simply not remotely true. It creates a “what do I have to lose?” outlook in the patient that persists even when the surgery goes bad. I’ve seen these articles repeatedly detail how a patient will compulsively never express regret. Even when they’ve lost a leg or an arm to this surgery. Even when they feel like they’ve died already. Even when they are so sick they don’t want to live. To them, it is perminantly better than the option of staying fat. Even if they end up gaining back all the weight they lost.
Fat acceptance isn’t about “excuses”. You’re doing what Craig did before you and insist we talk about fatness under the pretense of assuming that fatness is a problem to be solved. Its not. Fat people’s health will be better served with weight loss off the table. Weight loss has not been shown to be safely achievable, but even very fat people are shown to make extreme improvements to their health just by adopting a healthy lifestyle. What hasn’t been shown is that this will induce anything more than incidental weight loss. You want to think that we’re just all looking for excuses to be lazy and gluttonous, but frankly you’re exhibiting prejudice that you think those things are fat vices in the first place. We aren’t looking for excuses. We’re looking for respect.
The Sunday Washington Post has this long article about a woman (a therapist) who has two children conceived by donor sperm. She started this process around the time that she had WLS.
Fat people’s health will be better served with weight loss off the table.
Especially the part about ‘weight.’ We fetishize those numbers on the scale without thinking about whether we are really looking at a healthy body.
Especially the part about ‘weight.’ We fetishize those numbers on the scale without thinking about whether we are really looking at a healthy body.
I always think that too.
My own body issues aside, I am nearly 5’10” and I weigh around 150 pounds. But I am a size 4 (with some stuff a size 6 … grrrr, women’s sizes). I was a competitive swimmer growing up, I also played soccer and competed in downhill skiing. Now as an adult I do mountain biking and road cycling. I have muscle. I’ve always had muscle even though I’m thin. But when I read weight/height charts I’m at the upper limit of the ‘healthy’ range. It would only take a little more, not much at all (say an increase in my weight level reps) and I’d have a weight that popped over to ‘unhealthy’.
I went through anorexia in my early 20’s because I thought I was too fat, in that I never saw 125 pounds on the scale. It’s taken a lot of work to make myself get over that, but I still have that demon on my shoulder that tells me off for having fries occasionally or that I am fat when looking in the mirror. Or that wonderful feeling of self-worth and strength and power you get when your stomach yells at you that it needs food. I still calorie count.
We need to get away from the weight question. There needs to be a different language.
Sarah in Chicago – Yeah, those weight tables bug me, too. I’m 5’9″ and currently weigh 202, but when I graduated from high school, I weighed 120. I was really active in high school and didn’t eat very well, now I’m less active but am eating a very healthy and balanced diet, plus overall I feel better. I did spend a few years at the 150-160 range and was always getting grief from my doctor about how I needed to lose 10 pounds; now he’s happy I’ve stabilized and is now pushing me to exercise more (which I agree I need to do). So by the weight tables, I’m obese and have to pay higher health insurance and so on, but on the other hand, I think I’m healthier and I definitely feel better than I did when I was the “correct” weight for my height. But it’s all about reducing perceived risk – the insurance companies will do anything they can get away with to earn a greater profit, including revising the weight tables down.
Does BMI have different scales per gender? I’m 6’0″ and 145 lbs, and I’m on the cusp of underweight on BMI. I wonder if sexism is another shortcoming of the Body/Mass Index.
I also get lots of friendly inquiries from strangers about whether I’ve been ill, or how I’d look better (and sometimes they say, more masculine) if I gained some weight. I’m not going to claim that this is anywhere near as bad as the way people who are larger than average are treated — just that it’s the flip side of the same problem. People vary — deal with it.
Oh, that snarky bit at the end is aimed at people who criticize others for failing to conform to a narrow set of standards, not at the people commenting in this thread.
No, BMI is the same for men or women.
Unless they really want to tell a woman she’s fat and then they might reinterpret it.
Okay, I’m wondering where weight charts that say 150 lbs at 5’10” is overweight could be coming from. According to the BMI, that’s in the normal range, and at the 2oth percentile, significantly below average. (I used this calculator.)
If a woman who is exceptionally thin is being told she’s overweight, things are even crazier than I thought.
I certainly recall being 5’9″ and 153 in high school and finding charts that listed me as verging on overweight. I think nowadays that’s classified as “at risk” and just as aggressively targeted. I was extremely thin, but still felt uncomfortable about my weight because of those charts. And that was as a man who already knew something about fat acceptance because of my attraction to fat women.
It was, indeed, the MetLife Height/Weight table. For a medium frame at 5’9″, 153 was the upper limit. At 5’10”, 150 would be normal except for someone with a small frame. Specifically, I’d think this would include women. If I had a large frame at 5’9″, I’d be on the low end of normal, so I recall being quite intent on getting people to tell me that I had a large frame.
Its amazing that gaining weight is what got me to really confront my own personal issues with weight with the same vigor I tried to encourage others to use, but I’m very glad I broke out of that nonsense.
You know what really struck me about this story? None of the women looked either healthy or happy in their post-surgery pictures. The redhead in particular had a deer in the headlights look that I found quite distressing. In fact, they all looked happier in the “before” photos. Of course the grim/blank facial expressions might be some photographer’s idea of seductive, bit still it bears thinking about.
Second, did you notice the way they dismissed the feelings/opinions of the one husband who said that his wife had changed, and not in a good way? The implication was that since he was still fat he wasn’t worth listening to, or at least that’s how it seemed to me.
Oh, and the weight tables are absurd. I have a friend who qualifies as “overweight” by those tables, and she’s a size 2 and runs marathons.
The Metlife Tables
The Metlife tables seem to assume much lower weights for men, and much, much lower weights for women than the BMI, and it’s already been discussed that the BMI recommends excessively low weights as ideal.
Oh yes, Brian, things are indeed crazy. Just a couple of examples from my own life… I’m currently 5’5″ and weigh about 119 lbs. When I was around 125 (not that you could really tell the difference between then and now just by looking at me) my mother would make pointed comments about how I should consider losing a few pounds. I have a picture of myself and a college friend posing before our senior formal a couple of years back. I look very, very skinny. In fact, I look skinnier than usual because my friend (who is lovely and looked beautiful that night) is overweight. My mother wanted to see pictures from the formal, so I showed her that one, and she immediately asked why I looked so fat in it. (“Almost as fat as [friend]!”) And it’s not like Mom’s as trim as she used to be, either, after 3 kids and quitting smoking. I also had a boyfriend once tell me that my legs were too big and I should go on a diet. I think maybe he was just jealous because mine had more muscle than his.
This sort of thing happens all the time. It gives me a lot of sympathy for all the heavier people I know who struggle with body image issues. After all, if I get that kind of crap while wearing a size 4/6, what the hell do they have to deal with every day?
Thanks for the link to the table. I remember when they revised it about 10 years ago and thinking, “Jeez, I haven’t gained an ounce and overnight I’m overweight.” Notice this is an insurance company table. Guess whose life insurance policy payment took a big jump the year after this table came out? I’ve said it before and I’ll say it again: it’s not about health, it’s about adjusting the risks so the insurance companies can make money.
A personal anecdote on the article’s obese/pretty dichotomy:
I am, according to the charts, obese. I am also very pretty and have an hourglass figure. People tell me that I’m pretty all the time, without qualifications, such as “you have a pretty face” which I used to get when I was younger and far, far less confident in myself.
So it brings me up short when I encounter someone, usually a date, who makes comments, the subtext of which is a) that I am pretty despite being overweight; and b) I should be grateful for him pointing that out because, presumably, nobody else recognizes this and fat girls should be grateful for any positive attention at all.
In fact, it happened to me last night. The guy I was with said something like, “Do I make you feel beautiful?” I sort of let that slide until he said something similar and I responded (not in a snarky voice), “I don’t need you to make me feel beautiful, because I know I am.” I don’t think he was expecting that.
“Do I make you feel beautiful?”?
WAAAAAAUUUUUUGGGGGHHHHHHHHHH!!!!!!
Zuzu: how did you avoid punching his teeth out? Or at least banging his head repeatedly against the nearest hard object?
I can’t even fathom that sort of arrogance.
Goodness.
The most I want to do when I’m with a woman is to communicate how beautiful I think she is and for her to recognize this as a genuine sentiment. Not a situation of “I think you’re beautiful because I’m supposed to think that,” or “I think you are beautiful in spite of yourself.”
I’d hope she felt that I thought she was beautiful, but I know enough to know that men don’t have some natural ability to inspire self-confidence and self-acceptance in a woman. I guess it’d be a nice superpower, but it doesn’t work like that. I’d want her to know how I felt, and I’d hope she could agree.
By the same token, though, a lot of women do place a lot of their feelings of self-worth into how others feel about them. Just a couple days ago, 2 female friends of mine (both lesbian, actually) were commenting on how special it was that their current girlfriend made them feel beautiful while they were unable to do so on their own. Still, their feelings were entirely isolated to the instances where the other person was with them. It didn’t translate to any feeling of genuine self-acceptance so in my mind, I’m not sure it really meant anything at all.
Zuzu: how did you avoid punching his teeth out? Or at least banging his head repeatedly against the nearest hard object?
I can’t even fathom that sort of arrogance.
Honestly, I think with this guy it came from a kind of insecurity. Annoying nonetheless, and I’m not sure it’s worth pursuing anything to the point where I would wind up correcting him.
zuzu:
“The guy I was with said something like, ‘Do I make you feel beautiful?’ ”
“Not unless ‘beautiful’ is a new synonym for nauseous.”
I empathize with people who struggle with weight. I went down from 128 to 110 in a few months…and I’ll admit I feel wwwwaaaayyyyy better with myself. But people whose bones stick out…and you can even see them poking out through their clothes….being a size one is ssssooooo not worth that!
I am a gastric bypass patient. My life has pretty much been destroyed by the long term complications of the procedure. I am looking at more surgery to correct the complications. In almost 6 years not one day has gone by where I haven’t puked. My bowels obstruct. It goes on and on. Stories like mine and like this are squelched from the general public. Surgeons threaten to sue their own patients if they are outspoken about the complications. More sites like this need to be out there if we want to make the public aware. Thanks for sharing.
I am not dead, but there are far worse things than being dead or being morbidly obese. One of those things are living with the horrid complications this all too popular surgery brings.
I had a RNY gastric bypass FEB 2005, I weighed 430lbs the day of surgery, I now weigh 200lbs. I didn’t feel that I had a choice it was either die or get the surgery. What upsets me is how very little the realities of living with the surgery is told to pre-surgical candidates. I eat much worse now than I did before having surgery, I was a vegan and avoided refined sugar other than 2 or 3 days a year. Now unless it is liquified or full of sugar anything I eat comes right back up. I can eat a cookie but not steamed vegetables. Social eating is a thing in the past. The few times I have tried eating soup in a restarant I’ve spent the evening in the ladies room. I had the silastic ring removed and have been surgically dilated 4 times. I do not dare to eat more than 1000 calories a day or I’ll gain weight as my body has become so much more efficient at absorbing what I do manage to keep down.
Now get this, I’m not even accepted by others who have had the surgery because I never have reached a chart goal weight, and have no intention of having a revision surgery (a more extream bypass) so that I can lose more weight. I’m already dealing with deficency issues despite taking lots of vitamins and protein suppliments. Constapation is a daily battle and I had a proximal (short) bypass.
I now weigh a little less than when I got married, but I have no sex drive anymore and we do not socialize like we used to. I used to love to cook and give parties now cooking is no fun and I’m too tired to entertain. Anyone out there that is thinking of a gastric bypass to fit in to societys ideas of beauty and does not have health issues due to your weight, talk to someone like me, before you have surgery. Would I do it again? yes, but as I said, I really had no other choice. I chose surgery over a very short life.
This appeared in the times today–the diagnosis column, this time wiht a patient suffering from the effects of weight loss surgery.
http://www.nytimes.com/2006/11/12/magazine/12wwln_diagnosis.html
I am looking forward to WLS. Although I am not planning the bypass, I am and have been researching the Lapbanding procedure. I have many comorbidity issues, even a stroke, last year. I am 5’4″ and 260lbs. My doctor has told me that the Lapband may very well save my life.
I have read many many accounts of people dying from complications due to the bypass, not only on this site, but others, as well. I made my decision when I went to a reknown Surgeon’s Seminar, and learned how the procedure is done and that it is minimally invasive. I know it has it’s risks , as well, but I believe this is for me. I have tried every and I do mean every diet, out there, but did not lose an ounce. I even joined Curves, I enjoyed it, but still did not lose weight.
I, also, do not like th comment that you lose weight and beome pretty. I used to think I was pretty, when I was single, I did not lack for dates. But now, I have taken on the world’s view of obese people, I have those jaundiced eyes, when I look , in the mirror. I see ugly looking back at me. I don’t like that. It’s starting to bleed over into my marriage. I really don’t like that. I feel it’s time to “take back my life,” and that’s totally what I intend to do. So, now that I’ve stood on my”soapbox” and shouted my feelings, I step down, and let you good people get back to your blogs. Thanks and wish me luck!!