Saying "No" to Life With Obesity

mytrans april14 post.jpg

Photo by gchutka/iStockphoto

This winter, a writer living in Washington, D.C., underwent gastric bypass surgery, which he discusses in this ongoing series, written in real time. The first installment explains why he decided surgery was his only option left. The second explores daily life after gastric bypass.

Before a bariatric surgery support group meeting one day, several larger women shared stories about the small but scarring indignities of airline travel. A captain ordered one woman off a small plane because she upset the weight balance. A flight attendant used the PA system to ask for a seat belt extender for the "woman in row 7F," causing a planeload of families to swivel around and stare in her direction. Another woman recalled how she was blamed for holding up a planned departure because there were no seat belt extenders on one plane; the Delta ground crew had to scrounge for one.

Incidents like these are emotionally devastating when they happen to you, but they're a staple of comedic fiction; Robert, the obese chef contestant on Fox's Hell's Kitchen, can't join his team for a reward outing because he's too fat to fly. The show's producers chose to play it up for yuks. (Funny thing: having no desire at all for the food, I can appreciate the presentation and plating techniques now in cooking competition shows.)

Recommended Reading

Conventional Weight Loss Wisdom, as exposited by an industry of self-help gurus, posits that people who are fat are holding themselves back--that they don't commit to a real diet or radical life changes because they haven't yet hit a misery threshold. It's all horsepucky. Fat people are plenty miserable. There is no one mental paradigm for the decision to lose weight, much less the decision to allow a surgeon to rummage around your abdominal cavity.

I did not have an epiphany. I wasn't especially or particularly miserable the day I walked into Dr. Afram's office. After his short presentation, though, I felt as if a cinder block had been lifted from my shoulders. I knew I was going to have the surgery. And the moment I listened to myself think through the consequences of it, 30 years of accumulated brine around my pickled self-image began to drip away.

I had always been sensitive about how I looked around other people. But during the four months between the first doctor's visit and my surgery, I stopped caring. I even, if the truth be told, stopped being self-conscious at meals--for the first (and probably only) time in my life, I ate what I wanted. It was glorious, actually. I was medicating myself in anticipation of my new life, and probably was trying to stuff in as much crap as possible--just because I would never get the chance to do it again.

I've described my surgery before: a total success. That doesn't mean that I adjusted to my new life so easily. Radical weight loss + surgery + returning to work quickly → stress and anxiety. Weight loss leaves a physiological void that exacerbates a sort of a psychic hole that develops. My coping mechanisms, so carefully built up over decades, are inoperable now. I found that I could not hide my stress gracefully.

Beginning about week two and lasting for three weeks, I began to experience a sort of nervous insomnia in the night that produced a fairly debilitating melancholy during the day. I had expected some sort of adjustment after major surgery, but all of the popular literature had described this period as a "honeymoon." Not for me. I could barely eat. I went days without consuming more than 200 calories per 24-hour period--the model's diet, I called it. I began to exhibit classic signs of malnourishment: my eyes sunk back into their orbits; my skin was dry and scaly; halitosis bloomed in my mouth. I regurgitated different types of water. I began to lose control of my GI system. Once, as I was waiting for a train at Union Station, an ounce of tomato soup zoomed up through my mouth and onto the platform. An Acela conductor stared at me. I started at him, looked at the ground, and walked down to the next car.

I called my various docs together--the psychiatrist, psychologist, pulmonologist, and surgeon--and they came up with diagnosis and cure fairly rapidly. My incision and stomach pouch were just fine, save for one small infection that went away on its own after a few days. I was simply very, very anxious, and I could no longer use the chemicals in carbohydrates and fat to calm me down. Ambien and Lunesta didn't work either--wouldn't you know, those darn pills get absorbed far too quickly. We found something that did work (good old Valium, which has a longer half-life). I settled down. It is a temporary solution. I haven't sufficiently trained myself to eat with a stomach the size of a walnut yet. My new life and my new stomach are a work in progress. And my mental checklist of what to look at in the mirror, worry about, and use to muffle that worry is changing.