This is about to get very autobiographical. Even people who’ve known me for decades will probably learn a lot about me from this.
Many people who’ve seen me lately have probably noticed that I’ve lost some weight. However, due to my frame (I’m built like a linebacker) and some other factors, they may not realize how much weight I’ve lost.
As of this writing (March 13, 2016), I’m down 116lbs from my maximum of 403lbs, “achieved” on May 3, 2015. The last time I weighed 287lbs was when I was 17. The time between then and now saw me gradually gaining weight, followed by extremely rapid loss during the past 5 months due to gastric bypass surgery on Oct. 20, 2015.
First, I want to say how I got to the point where I needed surgery, because many people look at it as “taking the easy way out” for people who are too weak-willed to just put down the fork and go for a walk. It’s not.
Ever since I was in elementary school, I knew I was overweight. I don’t know how I became overweight, because I was a reasonably active kid, playing a variety of sports, starting with tee-ball, then soccer, then a lot of baseball, and even some volleyball and half a year of football. I used to ride my bike all over the neighborhood, frequently biking to my elementary school or friends’ houses. In middle and high school, I was constantly biking 20 minutes to get to one particular friend’s house (Tim).
Since high school, I’ve been dealing with some major problems. It took me many years to realize it (and get diagnosed), but I have depression and social anxiety disorder. The two conditions acting together form a very effective little feedback loop that’s very difficult to get out of; I feel bad about myself or something I’ve done, so I get depressed, which makes me feel worse about myself, which makes me more depressed, and so on.
And I’m very familiar with what many people think about depression, that everybody feels depressed from time to time and you’ve just got to pick yourself up and move forward. But that’s not depression; that’s feeling sad or feeling down. Depression is an actual mental disorder; it’s a problem with your mind. You don’t just feel sad, you have no energy, no motivation, and it takes an incredible amount of willpower just to get yourself out of bed in the morning. Telling a depressed person to cheer up is like telling a leaking hose to stop leaking. It can’t, because it’s a physical part of them. Willing yourself out of depression (or social anxiety) is about 99% ineffective.
The same goes for social anxiety disorder. People think that it’s just a fancy-pants term for shyness, but it’s not. A disorder is a condition that gets in the way of having a normal life. For me, my SA causes me to start panicking whenever I’m around other people. It basically activates my fight-or-flight response, and tells me you have to get out of here NOW. I feel like people are constantly watching what I’m doing, judging me. I become paralyzed by fear and anticipate the worst things that could happen.
There’s a lot about weight loss that we don’t understand too, and there are many, many factors beyond exercise and proper eating. For example, we all have ingrained instincts that affect our behavior, and many of them affect your eating. There’s no doubt that I had some bad eating habits (more on that later) but I don’t think I was any less active while growing up than most other kids at the time. Maybe my metabolism is more efficient than average (we evolved to burn as few calories as possible, and store as much as we can). Maybe I have an overactive hunger reflex. Who knows? (If you’re interested in more of this, I strongly recommend the book Supernormal Stimuli by Deirdre Barrett.)
Other kids teased me about my weight of course, because that’s what kids do: tear you down to lift themselves up. So I’ve pretty much always been aware that it was a problem, and wound up feeling very bad about myself because of it. And as someone with a social anxiety disorder, I felt more and more self-conscious about my appearance – I was literally becoming more noticeable. (To be fair, the Hawaiian shirts I used to wear were a bad idea for avoiding notice, but I thought they were cool.)
Failing upward, but not in the good way
After high school, after I passed the 300lb mark, I began a very long line of failed attempts at losing weight. I won’t go into much detail about that, because I’m sure everyone’s at least somewhat familiar. Changing my diet never helped, because at first I wasn’t sure what to focus on, and even when I figured it out (calories and sugar), I could never restrict my intake enough to make a difference. I seem to have a very strong hunger reflex, and filling up on under 3000 calories per day (the rough amount for someone my age and height at the time to maintain their current weight) was impossible.
Exercising was also a very difficult thing for me to do. I’m a computer guy, so I normally spend about 90% of my day sitting in a chair. And unfortunately, the more out of shape you are, the harder it is for you to exercise. You have less energy, it’s harder for you to move, your body weighs more, and you discover that you’re stuck in another of those very effective feedback loops. Plus, have you ever counted how many calories you burn with 30 minutes of walking? It’s a really depressing amount.
And then there’s the psychological aspect. For the past 15 years or so, I’ve been constantly depressed about my weight (among other things), which made me self-conscious about how other people viewed me (thanks, social anxiety disorder). I simply didn’t have the willpower to overcome my desolation and hopelessness, and if I did, I couldn’t overcome my social fears to actually take action. I always felt like everyone was watching me critically – “oh, there’s some fat dude on a bike”, “hey, look at the big guy out for a walk, he can’t even run”, “wow, that guy sure is sweating a lot”, etc.
Here’s a good example of my physical decline. Each year since 2008, my friends and I have gone on a camping trip to one of our many great State Parks. The first year, we took a 2-hour hike that I participated in, and I barely made it. The next day, everyone went on an even longer hike, which I backed out of, claiming (falsely) to have blisters on my feet from the day before. (That turned out to be a good thing, since that hike is referred to this day as the “Ho Chi Minh Death March”.) The next year, I went on a hike of about an hour. The next year, I attempted to take a very easy hour-long hike, but turned around and went back after about 15 minutes. After that, I’ve avoided pretty much all hiking. It has been very difficult for me to even walk to the park showers, and last year it was a major chore just to put up my tent or walk up the hill to the bathroom. I’ve come very close to not attending the past couple trips.
Hitting the limit
For nine years after high school, I attended four different colleges. Each time I switched, I left because I couldn’t attend classes or do my work. My social anxiety disorder made it so I felt like every one of my projects wasn’t good enough, and so they always wound up being rushed or never completed (or sometimes, never started) because I couldn’t create something that was up to my extremely high standards. During that time, I saw a couple on-campus therapists and started on a long line of ineffective medications.
Here are some good lines from my MCMI-III test results, which I got a few weeks ago:
He is likely to remain over-concerned with the possibility of social rejection and to continue to anticipate as well as to elicit rejection.
Notable is Bryan’s self-image of incompetence and ineffectuality, both of which cause ordinary demands and responsibilities to provoke fears of failure and humiliation.
Preoccupation with matters of personal adequacy and chronic feelings of worthlessness and guilt appear to dominate the depression evident in Bryan. Worthy of note is his tolerance of daily unhappiness and emptiness, a willingness to accept his feelings of worthlessness and guilt.
(I think I’ll eventually post the full results from that test, since they’re pretty interesting.)
After I stopped attending college in 2009 (I finally managed to get an Associate’s degree, at least), I spent three completely miserable years living in my parents’ basement, stuck in my own head, barely able to function. I did a little freelance web design work, but I was out of school and effectively unemployed. I turned 30 and the fact that I was still living with my parents was a huge source of shame for me.
Things finally began to turn around for me in 2012. That January, I signed up with a job placement agency. Within 2 weeks I had an interview, and a week later I was hired by the company I’m still with now, 4 years later. Within 3 months I bought a car, and within 6 months I moved to my current apartment. With a steady paycheck, I also had steady benefits, so I could start seeing my doctor again. I got back on prescription antidepressants, though they still didn’t help. (More on that later.)
It gradually began to dawn on me that I couldn’t fix my weight problem on my own, through a confluence of events and just plain obvious logic. I was becoming more and more aware that my grandpa on my dad’s side had died (before I was born) of heart disease, my dad had already had a heart attack and was (and is) playing whack-a-mole with skin cancer, two of my uncles had recently died alone from strokes (and I’ve never even been on a date), and pretty much every member of my family over 50 has gotten diabetes. Although I finally had a great job, I felt worse than I ever had before – both physically and mentally. I was increasingly lethargic and low on energy. Some blood tests suggested that I could possibly have a problem with my pituitary gland (something like swelling, inflamation, or massive cancerous tumors), so I had an MRI scan, which was fortunately negative. I also started seeing a therapist again. Despite the depressed part of my mind, I realized that I still cared if I lived or died.
I was also having a lot of health problems. I had knee pain from the excessive weight pushing on my joints, and even walking across a parking lot would leave me winded and sweating. I couldn’t stand up for more than 5 minutes without sweating, and 15 minute stand-up meetings at work would leave my shirts drenched, which was very embarrassing. I had a lot of back pain, and I could barely walk around a grocery store or mall because my back muscles hurt so much. I had to frequently stop and sit down to let them rest, and catch my breath.
I was also starting to have a lot of early symptoms of diabetes, although fortunately I never got that far. I had high blood pressure of course, as well as less-obvious things like swollen ankles, skin “tags”, numbness in my feet, eczema, sleep apnea, migraines, and perhaps the most troubling of all: eating sugar would make me tired.
During a visit to my doctor in 2014, we got on the subject of losing weight, which was obvious to both of us to be a big problem. He was just starting me on a blood pressure medication, and he briefly mentioned that it may be worth looking into bariatric surgery if my health continued to deteriorate. That was the first time I had ever considered that as a possibility. That was also probably the first time the phrase “morbid obesity” was mentioned.
A couple months later, when I saw my doctor again, I told him I had been thinking about the surgery, and asked for more information. He gave me some literature for the bariatric surgery program at HealthEast, a major St. Paul health network. They have monthly introductory classes that you can attend free of charge to get more info.
And somehow, I overcame my social anxiety and went.
When I went to the intro class in February 2015, there were about 20 or 30 other people there. I had a really hard time just walking into the room, because even though they were all there for the same reason as I, I still felt like they would all be judging me. I sat in the back so nobody could look at me without me seeing them turn around.
But I was also surprised to realize how much I was judging them. I was thinking the same things about them that I was always afraid that people were thinking about me, things like “what, you can’t just cut down on junk food?” or “why can’t you just go for a walk every now and then?” I’ve noticed the hatred that many people seem to have for overweight people, but I didn’t realize that I was one of the haters. Does that mean it was also self-hatred? Probably.
I got a bunch of info at the class, and after I talked to my doctor and therapist, I decided to start the program. Yes, it’s not just a quick-and-easy surgery undertaken on a whim – there’s a whole program that takes months to go through. I talked to the doctor who would be overseeing the whole program, and she needed me to talk to three people who needed to sign off on me before I could go through with the surgery. I felt a little like Ebeneezer Scrooge.
The first was the surgeon who would be performing the surgery. That was very easy. He was very friendly and clearly very smart, but we both had very little to say to each other; he seemed to be as much of an introvert as I.
The second was the staff psychologist. He needed to make sure I was mentally fit to undergo the surgery, since it’s such a big, life-changing thing. One of the first things he asked me was whether I had ever dealt with depression. I said yes, and he seemed genuinely surprised. I was surprised that he was surprised, and I wanted to say “Really? You’ve never encountered another person with morbid obesity with problems with depression? Everybody who comes in here just loves being fat?” but I kept my mouth shut. He was a really nice guy, and once he called my doctor to confirm that I was a good candidate for the program, he had me take a few tests, and approved me for the surgery.
The third person was the hardest to get approval from, and for good reason: the dietitian. She was about my age and, of course, in perfect shape. It was her job to try to correct any bad habits I had, and teach me the right things to eat. I wasn’t completely clueless, but she definitely taught me some important things. She had me start keeping track of my food, which I did (and continue to do) through LoseIt.
A lot of the things I had to change were obvious: I needed more vegetables, more fruit, and much less starch and sugar/carbs. But plenty of it was new to me. I had to make sure I was eating more than a certain amount of protein each day, which would be very necessary after the surgery, because when you lose weight your body burns stored calories and protein, and if it can’t find enough it’ll start gobbling up your muscles, hair, and nails. (It’s very common for bypass patients to lose their hair, but fortunately my excellent hair genes have pulled through once again and saved me from that.)
One good thing I managed to do on my own prior to getting involved in the program was to switch to zero-calorie beverages, which I strongly recommend doing no matter who you are. (Contrary to popular belief, there’s nothing wrong with artificial sweeteners. We’ve got over 30 years of evidence showing the safety of aspartame and other artificial sweeteners.) In high school, I was addicted to Cherry Coke, and after high school I switched to Mountain Dew, drinking over 100oz per day. Switching to Diet Dew was a good thing to do, but at best it may have merely slowed my rate of weight gain.
However, my dietitian needed me to go even further. I needed to cut out caffeine entirely, which was something I’d been trying to do for years (my doctor and therapist had recommended it because it can make you even more anxious). With that requirement effectively set in stone, I finally bit the bullet and gradually reduced my caffeine down to zero over the next few weeks to avoid withdrawal. (I’ve never been a coffee drinker, fortunately.) I also had to cut out carbonation, because the bubbles cause a lot of gas once you’ve had the surgery.
Since my consumption of carbonated beverages was so habitual, I had to find something else to replace it. Also, I had to make sure I was drinking a lot of water, especially after the surgery. I wound up settling on orange Crystal Light powder and orange Mio flavoring, which somehow scratch the same itch that Mountain Dew did for years.
By the way, stop drinking fruit juice; even if it’s 100% fruit juice. It’s just sugar with all of the beneficial parts of fruit taken out of it. Look at fruit juice the same way you look at ice cream: a tasty treat that you can have occasionally, but preferably no more than once a week.
I also got a bunch of blood tests done. I found out that I have very low Vitamin D, which is very common for people with Northern European genetics, as well as people who live in Northern latitudes (I’ve lived in Minnesota all my life), as well as people who close all their blinds and sit in front of a computer all day. This can cause, among other things, lethargy and depression. It isn’t the complete cause of my depression, but it’s almost certainly a significant factor. The fix for this is very easy: I take a tiny 5000iu D3 supplement each day. No need for special lights or magic crystals that don’t work.
There were a few other interesting findings too. I have abnormally high iron, which can cause lethargy (boo) but gives you slightly tanner skin (yay). I also have very low testosterone, which – you guessed it – causes lethargy (boo), but probably also prevents you from losing your hair and going gray (yay). I tried taking a testosterone supplement (a weird gel that I had to rub into my arms each day) but it didn’t seem to do anything, and I’m still working on the iron problem.
There’s plenty more to the story of my interactions with my dietitian, but since this post is already excessively long, I’ll move it along. After several meetings with her across several months, I got her approval to go ahead with the surgery. I would be getting the surgery on October 20th, eight months after I started the program, and one week before my 34th birthday.
Under the Knife
Finally, if you’ve read everything up to this point, you may be wondering: what the hell is this surgery anyway? The goal of all bariatric surgery is to shrink your stomach, so you feel full sooner and absorb less food overall. It’s a surprisingly simple equation. And there are actually several different types of bariatric surgery, though I’ll only mention a few.
The one that’s the most well-known is the lap-band. However, it’s also the one that all my doctors and clinicians discouraged me from doing. Apparently it’s not very effective (or at least not as effective as the other options), and is pretty uncommon these days. Some people like it because it’s reversible, though I don’t know why that would be desirable.
Another type is the gastric sleeve, often called “stomach stapling”, where the stomach is vertically stapled into a much smaller size, with the remainder being removed.
However, the type I got was the Roux-en-Y bypass, which is the most common these days, as well as the most effective. Like the sleeve, it involves stapling the stomach into a much smaller size to create a pouch, but they do it horizontally instead of vertically. Yes, that means that they completely separate your stomach from your intestines. There would be no way for food to exit your body without the (obviously crucial) next step.
They don’t remove the lower part of your stomach, because it still produces chemicals and stuff that are useful to the digestive process in the intestines. Instead, they go down a few feet of your intestines, separate that, and bring it up and attach it to your upper stomach pouch, then attach the remaining part of intestine lower down the intestinal tract. Essentially, you wind up with two small stomachs, only one of which ever receives food. And all the rearranging of the intestines means that there’s less distance for the food to go through the tract, which means you absorb less from food (good and bad).
Leading up to the surgery, I had to spend 2 weeks on a liquid diet, which would shrink my pancreas somewhat, thus making things easier for my surgeon. I subsisted on cream of wheat, greek yogurt, unsweetened apple sauce, light soups without noodles, and 3 protein shakes per day, which essentially means I was starving for 2 weeks. However, after 3 or 4 days, the starvation pangs do decrease. A little. On the last day before the surgery, I could eat nothing but a cup of chicken broth at each meal, which was thoroughly disgusting.
The surgery went perfectly. It was laparoscopic, so rather than cutting in and prying my stomach open, the surgeon just made seven very small incisions, which he inserted special instruments into. None of them were more than ½ – ¾ in. long, and afterwards they were all closed with a special type of glue and some small pieces of surgical tape – no stitches.
When I woke up from the surgery, I had some pretty serious discomfort and pain. The downside of laparoscopic surgery is that they have to essentially “inflate” you with CO2 under the skin in the areas that need to be worked on, to give the surgeon room to work. I felt a lot of pressure on the areas that had been worked on, but I got pumped full of painkillers and felt a bit better.
The second-worst thing I had to deal with was thirst and drymouth, because I couldn’t put anything into my stomach – including water. If I remember correctly, I was able to drink 500ml of water every 20 minutes, and that was it. Other than that, all I could do was dunk a little sponge into a glass of water and suck on it.
I got out of the hospital a day and a half after the surgery, and went back home to stay with my parents for a week. I got a very strong prescription for the pain, but after about 3 days, I stopped taking it because I didn’t need it.
Let me repeat that: I had my stomach cut in half and my intestines rearranged, and I went home 36 hours later with a few band-aids and only needed painkillers for 3 days. Medical science is incredible.
After the Storm
The full liquid diet continued for a week after the surgery, and then I was on to pureed foods for two weeks. And I’ve gotta say, you don’t realize how important texture and separation are to food until you’ve eaten a paste made of tuna, mayonnaise, and water. For several days. I tried really hard to enjoy cottage cheese, and failed miserably. I still can’t eat hummus after those dark days.
After that, I graduated to soft foods for…I don’t know, maybe a month. It’s a little fuzzy now. That basically meant I could eat anything that didn’t crunch; that you could break apart with your tongue. That was big improvement. I couldn’t eat any bread, rice, or pasta, nor anything with a skin (from chicken to grapes) or seeds, because that stuff could get stuck in the corners of the stomach pouch while it was healing.
Then I got on the “regular” diet, which was pretty much anything except grains and skins and seeds again. That took 3 months. After that, the training wheels were finally taken off, and I can eat anything I want…or at least anything I can handle. I still have a hard time with a lot of different types of food, because they make my stomach queasy. White breads of all kinds are still a problem, though whole grains are mostly fine. (I started eating those round sandwich thins instead of bread, and I really like them.) The few times I’ve tried fried foods have been mistakes. Basically, anything with high sugar, high carbs, or high calories usually still bothers me. But I shouldn’t be eating that stuff anyway.
I’ve actually gotten a new appreciation for fruits and vegetables. Now that I eat so little sugar, I think my taste buds have changed, and I find certain types of food much more appealing, and other much less.
Oh, and I haven’t even talked about portions yet. Essentially, my stomach was shrunk to the size of a golf ball, so for the first 3 months, my meals could be no bigger than ¼ of a cup, or they would try to…exit. They call that “dumping syndrome”, which basically just means that your stomach has rejected what you’ve put into it, and it’s either going to come up rapidly or go out rapidly. I’ve only had it happen a few times, during Christmas celebrations and once when I ate some fried Chinese food.
My stomach will naturally stretch a bit over time, though it can certainly be stretched too far. Currently I can handle about ½ a cup per meal, plus liquids. Eventually it will get up to 1 full cup, and that’s hopefully where it’ll stay, although if I overeat it can stretch further, and it could even rupture if I really overdid it. But, I don’t think I’m going to overdo it. My habits have changed, my tastes have changed, and even my lifestyle is changing.
Eating in restaurants has been interesting. I never realized how huge the portions are, and how much unnecessary stuff we get. I usually only order appetizers or soup now, and even then, I take at least half of it home with me. (I’m saving a ton on food and grocery bills.)
And naturally, now that I’m taking in so much less food, I have to supplement it with vitamins. In addition to the vitamin D3 I mentioned earlier, I also have to take Calcium Citrate (to prevent osteoporosis), Flintstone vitamins, and B12 (for some damn thing). That’s in addition to Cymbalta for depression and Trazodone for sleeping. Last, I take Ursodiol, which is a gall-bladder medication. Bariatric patients have about a 30% chance of getting gallstones due to the very rapid weight loss, but Ursodiol reduces that chance down to about 3%. Unfortunately, it has a lot of irritating side-effects, like giving you all the symptoms of having a cold. Since I have to take it for 6 months, I feel like I’ve had a cold for the past 5 months, and my nose has been constantly running, dripping, or stuffed up the entire time.
And as I said in the first paragraph, I’ve been able to lose 116 pounds so far. And it’s still going. When I was approved for the surgery, the official documentation said that my goal weight was 250lbs, which I laughed out loud at when I first saw the number. I thought it’d be amazing if I hit 280, but thought that 300 was more realistic. However, I’ll almost certainly hit 280 by the end of April, and 250 is starting to seem more and more possible. I haven’t weighed 250 since…maybe 10th grade? That’d be pretty cool.
The way to lose weight is simple, of course: burn more calories than you take in. The number of calories required for someone my size, age, weight, and lifestyle to maintain their current weight is about 2700 calories. For the first 3 months after my surgery, I was only taking in 500-600, and right now I typically take in around 1200. It’s gradually inching up (as it should), but it seems that I still have a long way to go until I hit my lowest weight.
And because I’m burning more calories than I’m taking in, I also get tired much more easily. Around 2-3pm, I start to feel like I need to take a nap, and usually when I get home after work I go straight to bed and sleep for 40-50 minutes. (I could definitely sleep longer, but I don’t want to mess up my nightly sleep cycle.)
Aside from that, I have a lot more energy. Going up stairs isn’t a problem anymore, and I actually enjoy walking now. The weather here in Minnesota is getting to be really nice (above 50°!), and I’m looking forward to trying out the bike I inherited from one of my aforementioned uncles a few years ago, which has been collecting dust in my bedroom for the past 3½ years.
I’ve been amazed by some of the other effects of the weight loss. I have a jawline again, and it’s really weird to actually be able to feel my bones under my skin, such as my collarbone and ribcage. I never noticed that I was walking bowlegged before, but now I can walk with my legs closer together. I actually get cold now, which is pretty new for me. I used to sit at my desk at work with a fan going all day, but now I leave it off and sometimes even wear a sweatshirt.
I knew my clothes would get looser, but I never expected that my shoes would, which is pretty weird. I probably went down a whole shoe size, although that would just be from a 15 to a 14. My “camping hat” is also not as tight.
I’ve been buying all my clothes at Casual Male or Destination XL for the past 15 years or so, and…I probably will continue. Frankly, I like what they sell, and even though I’ve lost a lot of weight, I’m always going to be over 6 feet tall and built like a linebacker, and their clothes just seem to fit my dimensions better, especially in the shoulders. But I’ve gone down 12-13 pants sizes so far, and I’ve gone from wearing 3XL shirts to 1XL. I’ve tried shopping in “normal” clothing stores, but their 2XL shirts still don’t fit me. In the past month I finally started replacing my old clothes (which are very loose now) with new stuff, but that takes a while.
I still have some work left to do, but the majority of the ordeal is behind me now. Physically, I’m feeling better than I can remember ever feeling, and mentally I’m on a definite upswing. I’ve been gaining a lot more confidence and have been trying to get out more often. Since nearly all of my friends had kids and stopped doing things, I’ve been learning how to get out on my own and do the things I want to do, and that’s been pretty fun (though still anxiety-inducing). I’m trying new things, taking slightly more risks (up from zero), and generally getting my life in order, which has been great.
I don’t really have a good way to end this insanely long post (5378 words!), so feel free to leave your questions and comments below, or email them to me, or whatever.Tags: health, medicine, personal, psychology
This post was written by Bevans