USING SURGERY TO FIGHT FATNESS A GIGANTIC STEP IN DIFFICULT TREK
By Fred Dickey
Feb. 11, 2013
My wife and I were walking past this hamburger joint in Solana Beach and happened to look through the window into the seating area. There was this really fat guy staring hungrily at the massive cheeseburger and fries in front of him. We each felt a pang for the fellow. Then, we were past.
“Fat” is a word that some consider too hurtful, but it has a certain cold-water shock effect that draws our attention to a health crisis that euphemisms allow us to glide by.
Nicer words may make the obese feel better about how people talk about them, but they won’t feel better about themselves or be healthier. And when we’re discussing this life-and-death war we’re fighting in our indulgent society, we need straight talk.
You might say, “I’ve been ‘heavy’ all my life and I’m fine with it.” No, you’re not. Otherwise, your favorite movie star might be the overweight John Candy. Oh, I forgot. He died of a heart attack at 43.
Lest you think I’m of a holier-than-thou attitude or a skinny lemon-sucker, I’ve got a dozen ill-placed pounds that mock me after every shower. Losing those trifling few pounds is a battle tougher than its name-alike, the Battle of the Bulge. And if history is any lesson, I’ll bet you a box of See’s candy that if I get them off, they’ll find a way to sneak back under my belt when I’m not paying attention — or even when I am.
I sometimes think the only surefire weight loss programs are surgery, divorce stress and a high school reunion. The last two are temporary, but the first may not be, so maybe we should look at it.
Judy Dolbey is a Tierrasanta homemaker and community volunteer of 62, a mother and former schoolteacher whose weight gain-loss has been there and back, there and back, and there and back. She has gone from obese to svelte and back again over the years.
She is a bright people person who has faced her problem and thought about it, and thought about it some more, and finally did something about it.
As does every afflicted person, she grew into obesity. She had been an outgoing cheerleader, a physical-education teacher and an active member of her church. She had no apparent reason to become heavy, but “apparent” is a shallow word that sheds little light on human behavior.
Why did Judy go from slim to a woman who became fat in everyone’s eyes but her own? She was of normal weight before her two pregnancies, but then things got tough. She gained 70 pounds when 20 or 30 are normal. And then she had serious postpartum psychological problems.
Those events seemed to trigger a decades-long battle with weight. By her own count, her weight has yo-yoed drastically more than 10 times over 30 years, once by more than 100 pounds. Each weight-loss victory was followed by the defeat of weight gain.
After being told of such tries and failures, it occurs to me that the mind circles its wagons to keep reality out. In resignation, we end up saying, “I look just fine, and I don’t care if you don’t think so.” Convincing ourselves thus is a defense mechanism that enables us to get up and face the day. We get tired of being knocked down, so we declare victory and withdraw from the fight.
We may ask, “How can an obese person be in denial?” Well, how can an alcoholic, a smoker, an adulterer, a gambler, a fill-in-the-blank? We could become exhausted citing the examples. We are not as gentle with another person’s vices as with our own.
“I didn’t allow myself to see me as a fat person,” Judy says. “I saw that I was heavy. My friends would say, ‘Judy, you always look beautiful. We love you. You’re the same person inside. You haven’t changed.’ Comments like that supported my feeling that I’m OK with who I am, and this is how God made me.”
Were her friends being a bit patronizing?
“It can be patronizing, sure,” she says. “Your friends don’t want to make you feel bad, so in a sense, yes, they’re enablers.”
I ask Judy to explain how an obese person can deny being overweight and then turn around and go on a crash diet.
“It is the nature of the illness,” she says, implying there are things not meant to be understood.
Judy wasn’t obese for lack of trying. “I’ve done Jenny Craig and Weight Watchers a couple of times. You name a program, I’ve probably done it: the cabbage diet, the eating-fruit diet.…”
At one point, she says, “I lost 100 pounds on Optifast, a liquid diet through Kaiser. But I didn’t learn how to eat properly. I did lose, but I fell back on my pattern [once I left the program]. I gained it all back.”
Then, as she surpassed 250 pounds on her 5-foot-2 frame, several events exploded her self-denial and triggered a conclusion that she had to do something.
“I was in a boutique in Rancho Bernardo looking at the smaller sizes, and the clerk came up and said, ‘Your sizes are over there,’ pointing to the plus sizes. That was rude.”
Were you being too touchy?
“Could be, but it hit me hard because, ‘Is that your perception of me? Do I look that bad?’”
“Then, an acquaintance said to me, ‘You don’t think of yourself as obese? Take your clothes off and stand in front of a mirror.’ My reaction was shock and resentment. I was thinking, ‘How dare you call me that?’”
Did you think, well, maybe …
“Yeah, maybe I am fat.”
I ask: In all of this, should your husband have been more aggressive in saying, “Judy, you have to take care of this weight thing”?
“It probably would have been helpful. It’s a catch-22 for men. They don’t know what to say to their women. It’s like they want to be supportive, but they don’t want to harp [on their wives] or make them feel bad.”
The old idea of I will love you, regardless.
It was a vacation, though, that finally pushed her to act. “We were at Mammoth [wilderness area] at 9,000 feet elevation. I couldn’t walk around the lake, I couldn’t hike with my husband, I couldn’t get in and out of the kayak. I felt like a big whale. For the first time, I was embarrassed. Who’s watching me? My husband was feeling very sorry for me. I came home and told myself that something had to change.”
So, Judy Dolbey, it’s October 2010 and you want the truth. Your physician gives it to you: You’re almost 61 years old and 252 pounds. You’re on three blood-pressure meds and other drugs, and you’re prediabetic. You have to spend each night wearing a face mask for sleep apnea. You have a body mass index of 48. That’s lots and lots of fat. You are morbidly obese, and statistics say you will not likely live past 70.
Morbid. That’s a mean word with no softness to it. It foreshadows death.
Soon after, Judy started a program at Kaiser to prepare for gastric bypass surgery.
Gastric bypass, she says, is now the most commonly performed method of surgery intended to reduce weight. It creates a smaller stomach and bypasses a portion of the upper small intestine. This surgery reduces, by approximately 90 percent, the size of a meal that can be digested at one time. You eat less before feeling full, and the body does not easily tolerate refined sugars and fats. Consequently, you absorb fewer calories.
Before approving the procedure, Kaiser required Judy to attend classes and do exercises and journaling for six months. As the date drew close, she met with the surgery team and a psychiatrist. Their intent was to give her an opportunity to back out if she decided not to proceed, and to be mentally and emotionally equipped to make the surgery successful. Judy says her husband and two grown children were supportive.
She underwent surgery on Nov. 15, 2011. Since that time, she has dropped 120 pounds — her current weight is 133 — and cut her BMI in half.
“Now, people who’ve known me for a lot of years say we’ve got the old Judy back, because now I’m dressing more modern, more fun-loving. I’m doing things I haven’t done for years. I ran my first 5K, and I’ve been walking six miles each day.
“My daughter says we’ll do things together, we’ll have a spa day, have a mud bath and stuff. I’m not afraid of being seen in a swimsuit now. I want to live to see my grandkids. I’m off all the drugs and the sleep apnea machine.
“I feel the best I’ve felt since I can remember. I can shop now and buy new clothes. I bought some new pants the other day and they’re size 10; I used to wear size 28. That’s huge.”
Time to declare victory over the waistline. With a new, cutdown stomach, Judy no longer has to worry about gaining her weight back, right? Well, not so fast.
“The doctor told me: I’m giving you a tool. I can give you a little tummy to lose weight, but you can abuse that tool by going back to all your old habits. The stomach can gradually be stretched and you can gain the weight back. It’s happened to people.”
Judy explains that the surgery reduces the stomach to 1 ounce, the size of an egg. After two years, it normally stretches to 4 ounces. However, if the person abuses food intake, the stomach can stretch even more, and before you know it, the weight starts creeping back on.
“That’s why I go to my support group. Most of them have gained part of it back. Maybe they’ve lost 200 pounds, and maybe gained 40 or 50 back. It’s harder for them to lose that weight again. It’s not foolproof to keep you skinny, to keep you healthy.”
If she were to start overeating and abusing her diet right now, her body would react and she would either throw up or get diarrhea, because, Judy says, the first 18 months is the honeymoon stage. After that, the body adjusts and allows more diet abuse, and with that you’re on your own. Her honeymoon is ending in a couple of months.
Judy Dolbey is smart and educated, a person of goodwill, and is a rock to her family and friends. But the tough questions remain.
Why do you think you won’t abuse this in the manner they’ve cautioned you about?
“There’s always a fear of doing that. But I have to have the willpower to say, ‘No, I can’t do that. I’ve worked too hard to get where I’m at.’”
You’ve said that before. The last time you lost 100 pounds, you said that same thing.
“Yeah, mmm. What happens is —”
Do you have a great fear of backsliding?
“I do. But I have come to a point that I have to trust all that I’ve learned that I’m going to eat better, eat properly, stay away from sugar, alcohol, white flour. I stay away from alcohol because it runs in my family.”
Do obese people commonly have addictive personalities?
“I probably do. Foodaholics, once they get rid of that food addiction, can fall into another addiction, whether it’s sex, gambling or shopping, but the number one is alcohol.”
Could you have achieved this determination, this level of commitment without the gastric bypass?
“Probably not. No, I couldn’t have.”
You have ratcheted the stakes up so high that you dare not fail this time.
“Exactly. I dare not fail this time.”
Fred Dickey of Cardiff is a novelist and award-winning magazine writer who believes every life is an adventure. He welcomes column ideas and other suggestions; contact him at email@example.com
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