After weight-loss surgery, a year of joys and disappointments (2016)

https://www.nytimes.com/2016/12/27/health/bariatric-surgery.html

by paulpauper • 4 years ago

39 82 4 years ago

nytimes.com

SV_BubbleTime• 4 years ago

https://archive.ph/W4pxI

Should be updated to reflect (2016)

oneepic8• 4 years ago

I didn't have surgery to lose weight, but I lost >110 lb via diet/some exercise and I feel similar to the people in TFA -- things haven't changed as much as I expected. For me, a big reason is that my overall body shape is the same.

I'm overweight, not obese, going by BMI (though pretty close to the borderline). but I still look fat in all the old places I used to look fat. I've gone down a couple clothing sizes, but it's very hard to see the change in a mirror unless other people tell me.

andrewstuart• 4 years ago

> diet/some exercise

Can you be specific?

oneepic8• 4 years ago

Sure. For context, I started about 150-160 lb overweight, meaning that many lbs away from having a BMI in the normal range. I was very obese, BMI in the 40's, I think. I started out by just restricting my calories in my diet (1100-1300 cal each day roughly [1], but I still saw some decent wt loss with up to 1600-1700 cals). My core weight loss diet has changed *a lot* but has generally been a mix of whole grains, fruit, veggies, dairy, and a serving of poultry. Hard to explain in one post, but I can try to be more specific if you'd like. 3-5 meals a day, no I.F., just ate less and I felt less hungry overall. The cravings have come and gone at different periods, though, never totally gone.

For the first ~70 lbs, I was able to lose 10 lbs in 1-2 weeks by staying on the diet religiously each day. I mainly ate the same exact meal plan every day. (I spent a lot of my day thinking about all the great food I missed.) After that week or two, I would "take a break" and get takeout or other nonsense each day for some weeks following that. Perhaps lucky on my part, I wouldn't generally see much weight come back, maybe only 2 or 3 lbs. In summary, my cycle was diet 1-2wks, break for a while until I convinced myself to get back on the wagon, and repeat. It always helped to see that the first few days of dieting were the ones where I lost the most weight, before it slowed down.

To answer the exercise part, literally all I did was take 1-2 walks a day of 30 min each. Not a brisk walk, just walking around the town or our trails. Occasionally I felt like trying to jog or run, or do some lifting, but never got consistent with it. Sometimes I paced around my apartment thinking about how to solve work problems, but that was about it.

Since I lost that first 70 lb, the rate of weight loss has gradually slowed. These days I sometimes lift weights or do cardio to help see a little more loss each day. If I'm consistent, my weight loss is like 3-4 lbs/week, but I haven't done it lately. Gotta get back on my diet soon.

[1] sidenote, that includes fiber calories which I think technically are not supposed to be included. I'm no nutritionist, even though I came up with a lot of this diet myself using some Internet research and Cronometer.

mjthrowaway12• 4 years ago

I tell people that losing weight is reverse Pareto. The last 20% of the work is worth 80% of the results.

kar5pt• 4 years ago

It's also 80% of the effort.

nyokodo2• 4 years ago

but it's very hard to see the change in a mirror unless other people tell me

Losing 110 lbs is going to be very obvious even on someone with a very large frame, but, your perspective may be highly warped preventing you from seeing the weight loss. It might be worth talking to a professional trained in body image issues.

Edit: Oh, and I should say congratulations! That is awesome progress!

oneepic8• 4 years ago

Thanks for the kind words. That's a fair point, it might be warped, although the micro-optimizer in me is leaning towards just losing more weight and seeing if I notice the change after some more progress.

One thing your comment reminded me of -- I was surprised to see a lot of my sense of weight loss came not from a mirror, but just feeling my old fat body parts. It used to be more dense, due to the fat, now it feels a lot more like excess skin. The skin is almost as big as before, but much lighter and more hollow, if that makes sense.

[edit: added "sense of"]

IkmoIkmo• 4 years ago

Would be cool to see two comparison pictures (no head needed). 110lbs is a fantastic result, I wonder if it’s hard to see for you because it was a gradual change?

oneepic8• 4 years ago

Yeah, I think that's a significant part of the explanation. I'm not comfortable with sharing the photos, though, to be honest.

hnburnsy• 4 years ago

check out r/progresspics, amazing how different people look after weight loss.

paulpauper2• 4 years ago

depends on your starting too. 110 lbs will not look like that much if you started at 400 vs 230

ipaddr3• 4 years ago

I lost 100 pounds in a month and a half (cipro poisoning). I went from 240 to 142. I became skin and bones and I lost fat in those hard to lose places. I instantly felt different and people treated me differently.

What weight did you start/end at?

oneepic8• 4 years ago

310 then, 200ish now. I got down to 193 for my latest physical, but have been off my diet for the past couple weeks.

quickthrower22• 4 years ago

That would be 350,000 calories, or about 7000 calories a day? Wow.

I guess your must have body must have dumped fat directly out through urine?

mod• 4 years ago

What kind of differences were you seeing in how you were treated?

D13Fd• 4 years ago

Wow. I lost much less than that, a bit more than 20 lbs, in the last 2 months and it feels like a big change to me. My old clothes fit again and I don’t snore as much. It’s different for everyone I guess.

oneepic8• 4 years ago

The clothes thing was a huge motivator for me. I was at 2X (in US measurements) and was about to burst out of those :) (edit: I neglected to mention, congratulations. It's no small feat to lose weight.)

devin• 4 years ago

I’m in the same boat as you. Not even 20 lbs, but even 10 for me is a change in waist size and ring size. When I’m kicking butt on my exercise my wedding band starts to accidentally fall off and I can pretty clearly see a difference overall. It’s strange how my fingers getting slim is perhaps more noticeable to me than my waist or whatever, but that is my cue I’m on a roll.

Teknoman1172• 4 years ago

The only way I've been able to tell visually so far are before/after pictures. I'm down 55 pounds after 6 months (diet and exercise) and I don't feel like I've noticed changes in the mirror. However, I've gone down a number of belt sizes and the pants I previously wore around my waist can now be worn comfortably over my gut.

Visually it only occurred to be because a friend sent me a picture from a dinner I had with them and I saw how much smaller I looked.

q7xvh97o2pDhNrh• 4 years ago

Initially I was in a similar boat, but recently I stumbled on a way to be more aware and positive about the change.

I lost 55 pounds and still felt like a chonker. At the time, I only had about 10 pounds to go to hit the "ideal weight" I'd set for myself (which was still at the high end of the acceptable range, based on BMI). I never did hit that number; I ended up wandering around that plateau for 1-2 years, feeling thoroughly fat the entire time.

A recent injury led to me not being able to lift (for now), and so I've lost about 3-7 pounds of muscle and gained about 14-18 pounds of fat. Now I can definitely notice the difference! For me, it's the little stuff that really drove it home -- my face is noticeably chubbier (to me), and my rings and shoes fit more tightly.

I wouldn't recommend going about it this way, but it definitely drove home a lot of retroactive gratitude for what I had -- and sparked some motivation to get it back.

pengaru• 4 years ago

The thing about getting to a normal weight is it makes being active so much easier, more fun, and less destructive.

So once you get the weight off you gotta live the active life and the fit shape will emerge.

Being normal weight is basically easy mode for being active, but it doesn't guarantee fitness if you still don't play the game.

krageon• 4 years ago

If you've lost that much weight and you can't see it (where others can), that's not normal psychological functioning. That's an eating disorder.

AnIdiotOnTheNet• 4 years ago

AS someone who's lost a similar amount of weight (actually a bit more), trust me when I tell you that no one loses that kind of weight intentionally without cultivating an eating disorder.

jackling• 4 years ago

I went through the same thing, lost a bunch of weight, people around me noticed, but I still had my belly and love handles. Ended up gaining the weight back, maybe if I kept up with the healthy diet I would've eventually gotten the physique I wanted.

P_I_Staker5• 4 years ago

I can't say I relate completely, but I do to some extent. 60-100lbs makes an enormous difference for me, even as a tall dude.

That said, even bottoming out at 6'2" 155lbs, there were still noticeable pockets of fat in the "bad areas" (chest, belly). This was probably due to low muscle mass, but it can be pretty crushing.

All that work and you don't look any better without a shirt on... but cloths fit better and I definitely looked better. That weight makes around a 5-20 year difference in appearance for me.

You could argue this should be a part of the fitness conversation. You probably won't achieve perfection and people with long term weight issues may never really get the desired results. This is definitely an area where body positivity is important.

PeterStuer5• 4 years ago

Yep, not looking fat is a non-linear function. The good news: you are/have been on the slowest part of the curve. WRT looks&perceptions, things are going to accelerate along the journey.

clumsysmurf• 4 years ago

(Much) more recently, Tirzepatide could be useful in treating obsesity:

https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

and for a more gentle read

https://medicalxpress.com/news/2022-06-diabetes-drug-patient...

ggm2• 4 years ago

I think this is an under-rated side of the entire process. Things like "jenny craig" waitloss work because of the huge psychological investment and support, the managed dieting is in some ways, the side issue that goes with a collossal amount of CBT.

Bariatric surgery is fantastic, but I know people who learned how to eat "around" it and the net effect was to undermine the "win" -If the same $ went into the psychology of food, into support, into dietary interventions AND exercise AND mental health, as went into the surgery, I wonder if that would have been true?

And then in the end, you have self-ideation, how you look at yourself in the mirror. Maybe others see change you can't see or maybe you see change you do not see in the reaction(s) from others. Its hard.

Rebelgecko• 4 years ago

What does CBT mean in this context?

ggm2• 4 years ago

Cognitive Behaviour Therapy: a virtuous circle of ideation, action and mood which is reinforcing.

boloust• 4 years ago

Semaglutide is a new drug that results in ~20% weight loss. Previously, only surgery could accomplish that kind of reduction in a single intervention.

It's going to be an absolute revolution in the fight against obesity.

bpodgursky• 4 years ago

Unfortunately I'm confident that the FDA will make it hard enough to prescribe (need to get it through a GP, only after you've tried diet and exercise, only for a limited duration) that it's only ever used by a tiny fraction of the target population.

mysore• 4 years ago

thats fucked up. they should just prescribe it to anyone.

rswail• 4 years ago

Speaking as a T2 diabetic that relies on Semaglutide, I'm really pissed that doctors are prescribing it "off label" for weight loss to the point that it is becoming difficult to get for its primary use.

nradov4• 4 years ago

Have you tried nutritional ketosis to reduce your need for medication?

https://www.virtahealth.com/reversediabetes

epylar• 4 years ago

There is a form of semaglutide that is not off-label for weight loss called Wegovy.

PeterStuer5• 4 years ago

A person in my direct environment has been on that (Ozempic) for 2 years. While at first the results were very decent, longer term (> 9 months) things seemed to reverse. Now, about 2 years in, weight-wise things seem back to the original starting position.

Unfortunately, there literally does not seem to be a free lunch.

miketery• 4 years ago

Dr. Kaplan reports that surgery immediately alters the activity of more than 5,000 of the 22,000 genes in the human body.

What does this mean? How is activity of genes altered?

But surgery only alters the intestinal tract. That tells you, Dr. Kaplan says, that there are whole classes of signals coming from the gut and going to the brain and that they interact to control hunger, satiety, how quickly calories are burned and how much fat is on the body.

This makes sense - you're disrupting signaling. But what does altering genes mean?

rycomb• 4 years ago

I'd imagine that it's referring to their endocrine system changes leading to changes in gene expression (of that many genes).

mrmincent• 4 years ago

I’ve always struggled with my weight, every 5 or so years I’ll get really motivated and lose 20-30kg, and then slowly gain it back over the next 5 years to hit the same point I’m at right now, about 120kg and a BMI of 40.

Reading the article I’m glad I’ve never been tempted by surgery, but at the same time, gosh it’d be nice to have my brain rewired with the stroke of a scalpel. But surgical intervention just feels like it’s too much, especially when I know that calorie counting and putting in some effort to get active achieves the results I’m after.

ASalazarMX• 4 years ago

20-30 Kg is amazing! Even more if you managed to motivate yourself every 2-3 years instead of 5. It'll probably become progressively harder to lose that amount as you age, though.

themgt• 4 years ago

I realize this is more of a pop culture, human-framed narrative driven story but words like "insulin", "leptin", "mitochondria", "carb(ohydrate)", "glycemic", "glycogen", "ketones" don't appear a single time in the 5000+ word piece.

My take as someone who has some personal anecdata is a) no one really quite knows what is causing the incredible and nationally, geographically, socioeconomic/culturally, etc divergent crisis in weight gain and obesity, however b) there is a lot of interesting and useful information at the intersection of biomechanical, endocrinological, psychological, cultural, etc research and attempt at explanations.

What's worked for me is a moderate all-of-the-above approach: eat real unprocessed food, do some lazy IF/low-carb, focus on nutrient and protein-dense plant and animal foods, find enjoyable exercise outdoors in the sun, lift some weights, eat fermented and fiber-rich foods, etc. Basically there's a slippery slope and positive feedback loop, where if you're sedentary and eat processed junk you're going to gain weight and wind up feeling like remaining sedentary and eating processed junk, which will cause you to gain more weight, and so on.

"her urge to eat, as powerful as the urge to breathe when holding your breath, defeated her" just seems like learned (taught?) helplessness "misinformation" - you need to breathe every one or few dozen seconds or you die. You certainly don't need to eat every one or few dozen seconds or you die. This isn't to understate the difficulty and I was never hundreds of pounds overweight, but fundamentally you need to commit to turning the dial in the other direction at a pace that feels sustainable, and then sustain it. Nutrition science provides good explanations for why the urge to eat low nutrient crap is going to be very powerful if you're 200lbs overweight, not totally unlike the urge to inject heroin is going be very powerful if you've been injecting heroin for a decade. Your body down to the cellular level has adapted to it and you can't just hit an off switch.

At a personal level I'd urge everyone to disregard the learned helplessness narrative and try to make a healthy lifestyle work - at a societal/policy level I think we desperately need to stop greasing the path down the slippery slope. It's as if a syringe full of heroin ready to inject was on sale BOGO for $2 at the supermarket and completely socially accepted while you had to cook up aspirin yourself on the stove for $8/pill with 30 minutes effort. "Why are so many addicted to heroin? Experts have no idea." Please.

notimetorelax• 4 years ago

A delivery app in my area has hundreds of options of pizza delivery and not a single option for a salad place. I don’t get it, but it is true that eating healthy is just harder.

ikt• 4 years ago

Yeah this was essentially what Jeff Nippard came to

https://www.youtube.com/watch?v=keBZfGAmq2Q

A massive oversimplification of the above video:

Most people aren't consciously choosing to be more obese compared to people in the 1950's, there's simply a much higher availability of high caloric foods and marketing/psychology around it.

intothemild• 4 years ago

Not just that. But let's say i decide to go out for something at the healthy place... I can give an example.

I went to a place that markets itself as super healthy foods. I had just finished a 7km run and was feeling like treating myself to something other than the usual calorie controlled foods i usually eat.

I ask the girl behind the counter "how many calories are in this salad" ... She gets a big book and starts flipping through the pages.... After what feels like 5 minutes she says "1500 kcal"

That's heaps. So I decide to enter the things inside it and some rough weights into MyFitnessPal... The salad came out to about 200-300 kcal. So the dressing must have been the rest.

I ordered it without the dressing.

My point to this is even at the healthy places that are marketed as healthy so order anything.... You could be eating more than a big Mac meal.

circlefavshape• 4 years ago

It's as if a syringe full of heroin ready to inject was on sale BOGO for $2 at the supermarket and completely socially accepted while you had to cook up aspirin yourself on the stove for $8/pill with 30 minutes effort. "Why are so many addicted to heroin? Experts have no idea." Please.

This is a v good analogy.

throwaway0a5e2• 4 years ago

I'd urge everyone to disregard the learned helplessness narrative and try to make a healthy lifestyle work

That requires a hell of a lot of time and effort investment. Time and effort are a finite resource. It's probably better for society as a whole if we find a way to be healthy that doesn't involve all of us to actively work at it every day. That's like expecting people to grind their own coffee and hand wash their clothes. Sure it's theoretically possible but in aggregate less coffee will be drunk and less clothes will be washed.

PeterStuer5• 4 years ago

Some more anecdata. More than one obese person I know does really psychologically feel like missing a meal is incredibly dangerous, not just for themselves, but also for their children and friends. It is not just a worry, but a real panic attack that sets in if this threatens to happens.

The aggro-food industry has been relentlessly aiming for maximal consumption/addiction in an epic Darwinian race to the top for decades. The results are incredible. Every aspect of that simple bag of crisps has been tuned to maximize recurring consumption. Hacking into the gut biome for behavior control has been trial and effort so far, but is bound to take a next revolutionary step as predictive models emerge to steer the research.

And do not count on regulators to defend your sanity. They've been captured to the core. Good luck.

sshine• 4 years ago

it's very hard to see the change in a mirror unless other people tell me

I bet that others can see the difference if they've tracked you.

I get told that I look different when I can't see it.

Try and have someone honest close to you point out what those differences are by holding two pictures up.

paulpauper2• 4 years ago

weight regain is a huge problem

https://www.mayoclinic.org/medical-professionals/endocrinolo....

Apparently despite such drastic efforts, the weight finds its way back

mbrodersen• 4 years ago

Weight-loss surgery is not only dangerous but also (in a lot of cases) ineffective. Before thinking about taking such a dramatic step, I recommend trying a low carb diet. Reduce carbs as much as possible and increase protein/fat an equivalent amount so that your overall calories stay the same. The science behind it: Search for “low carb down under” on YouTube.

After weight-loss surgery, a year of joys and disappointments (2016)

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