The Bariatric Surprise

One night in 2007, sitting alone in my apartment, I came to a decision. After 22 years of marriage my wife had left me in 2001 for a younger man after a year-long affair. I was now in my 50s, over 420 pounds with a BMI over 57, hadn’t had sex in years, and had given up on dieting after numerous failed attempts. Comorbidities and conditions included type2 diabetes, binge eating disorder, diabetic neuropathy in my legs and feet, stasis dermatitis, varicose veins, sleep apnea, hypertension, depression, paraesophageal hiatal hernia, GERD, fatty liver, breathlessness, lumbar spine arthritis, difficulty walking and a removed gallbladder. On top of it all, I was a classic binge drinker, short of dependence, but stressing my body nonetheless. I realized that the road ahead was an early death. I had a choice to make and I chose life. I knew that losing weight had to be my first step as I clawed out of the dark place in which I found myself.

I felt out of my depth in losing weight. I had tried so many times and failed. My simplistic, though common, view of losing weight was to eat less and exercise more. Since dietary approaches had failed and it was clear to me that I could not do it alone, bariatric surgery seemed to be the only choice, with impressive sounding statistics suggesting success.

I was told by the bariatric team I met that the provincially funded options had a 7 to 10 year waiting list, but that if I paid $16,000, I could get an adjustable silicone band placed around the top of my stomach right away (gastric band). I would feel full faster, not be able to eat excessively, and my problems would be over.

I felt that if I waited, I would die before I could get a provincially funded operation, so I opted for the lap band.

On January 14, 2008 I had my surgery. I weighed 420 pounds on the day of the surgery. Eighteen months later I weighed 180 pounds with a lot of excess skin present. I had lost a lot of muscle mass, was skin and bones, felt cold all the time, had filled my band to the point that it was highly restrictive, and was drinking a protein drink for breakfast, a cup of plain yogurt for lunch, and a can of tomato soup and half a can of beans for dinner. I had received no significant counseling concerning diet and no ongoing support. But I felt happy.

In spring, 2010, I was diagnosed with Barrett’s esophagus, which may have developed earlier during a long period of untreated GERD complicated by the undiagnosed paraesophageal hiatal hernia. It was unclear whether or not the gastric band was making matters worse, but with this precancerous condition I didn’t want to take chances, and had the band completely deflated. I rapidly regained my weight. Now, in spring 2013, I find myself nearly back to the weight I was in 2007, and, with the exception of the hernia, which was repaired, with the same comorbidities and conditions.

The following is a brief summary of observations and thoughts about my experience.

No endoscopy was performed to determine preexisting conditions or the suitability of the procedure. Though many physicians suggest that if you “have a sweet tooth” bariatric surgery is unlikely to help you, the lap band team did not ask me if I experienced sugar cravings or had eating disorders, such as binge eating disorder. No long-term postoperative eating plan and support system was established before the procedure or available after the procedure. Little diet information was provided and the support available was generic, simplistic, group-delivered and of little value. It was not clarified that bariatric surgery still required a planned and managed diet and lifetime support, or that whatever you did to lose weight had to be sustained for the remainder of your life.

It was not stated that there was no known cure for obesity, that it was a chronic condition, and that bariatric surgery was not a replacement for diet management, only one tool in a total system weight loss methodology that may include all or some of the following: psychotherapy, a 12 step program, ongoing medical evaluation and intervention, family counseling, support from friends and family, nutritional counseling, spiritual support and growth, eating disorder treatment, treatment of comorbidities, advocacy and education of the entire circle of care to provide consistency and synergy.

Bariatric surgery is not an appropriate treatment response to food addiction or eating disorders, though it will not interfere with treatment if performed in conjunction with a collaborative team approach. Some studies suggest possible links between lap band surgery and GERD, Barrett’s esophagus and throat cancer, though no consensus is available and more testing is needed.

In my opinion, the way lap band programs are typically sold and delivered in Canada, with patients often abandoned after several months of generic and mostly useless “education” sessions, it functions as if it were just another weight loss scam, with similar results, broken promises and broken dreams.

My journey has not been fruitless. I married again in 2009 and I am deeply and happily in love. I have made a study of the science of obesity and addiction, and have much to share about my discoveries and experiences. Along the way I discovered wonderful and influential medical leaders, especially Dr. Vera Tarman, MD (Addictions Unplugged) and Dr. Arya M. Sharma, MD (Canadian Obesity Network). I am better armed and ready to start a planned, whole-system, whole-person, fully-supported obesity recovery program, with realistic expectations and lifelong commitment. There is reason for hope, even in our deeply addictogenic and obesogenic economy. In 2007 I chose life; in 2013 I can report that I found it along the way.