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.