Will the Surgery Trigger Destructive Behaviours?

I mentioned that I've struggled with an eating disorder.

I think most women in our society have had eating disorders at some points in their lives, whether they realize it or not. We think our constant dieting, our obsession with our weight and size, is normal. I learned to think about eating disorders as a continuum of behaviours. When thoughts become obsession and behaviours take over your life, there is a problem!

My problem took the form of obsessive dieting and weighing myself. I was addicted to weighing myself. And it took me a very long time to quit. I put the scale in an inaccessible place... and then stood on a chair to reach it. I put myself on a regimen, only allowed to weigh myself once a day, then every other day. I succeeded a bit. I relapsed. I lied to myself. I gave up. I started again. And so on and so on. Everything you know about addictions, I did that.

OK, maybe not everything. I didn't sell the TV to buy a fix, I didn't lose my job, it didn't end my relationship. But trust me, even something seemingly harmless as stepping on a scale can strangle you.

For a time, I tried weighing myself only at the gym. I was swimming. I would leave the pool feeling great -- loose, invigorated, happy. Then I'd get on the scale and ruin my day. Day after day after week after month, robbing myself of all those good feelings.

In the past 15 years, I have tried several times to lose weight in a healthy and non-obsessive way. I lose weight verrrrry slowly, and healthy weight loss is slow anyway. So if I don't weigh myself occasionally, I'm not going to see any progress -- and you need some kind of progress as positive reinforcement.

But that word occasionally... that's the sticking point. Keeping myself off the scale has been very, very challenging, far more difficult than any dietary adjustments. Stepping on the scale is a giant trigger. It opens the floodgates to a rush of self-loathing.

Before and after surgery, there is going to be a lot of weighing. A lot of stepping on the scale. How am I going to handle that?

I don't have an answer to this yet, and I'm okay with that, for now.

But this is one of my greatest concerns about the surgery.

Getting Ready for the Referral

I asked my doctor for a referral for bariatric surgery. I told her I was reading a lot about it online and think it's for me.

She explained that a referral would be not for surgery, but for the bariatric program. Once in the program, it would be decided whether or not I would get the surgery. She also recommended I see the registered dietitian at our health centre, while I take care of other prerequisites.

I had some bloodwork, an electrocardiogram, and an in-home sleep apnea test. And I made an appointment with the RD.

RD was wonderful. Maybe they're all wonderful, I don't know, but I really enjoyed meeting her and working with her. We talked about goal-setting, motivations, how we make change in our lives. She had some great resources that I wouldn't have known about.

RD made a few suggestions on how I might be able to be less hungry, and how to put healthy snacks back in my daily routine -- something I used to do, but fell out of the habit.

I saw her once a month for four meetings. My work with her led to several changes.

• I bought this blender.
• I am drinking green smoothies.
• I bought this awesome container and bring four healthy snacks to work daily.
• I am making these babies which are delicious and so filling.
• I'm no longer eating pre-sweetened fruit yogurt, or eating them only occasionally as a treat. I was relying on them for convenient snacks, but they are very high in sugar. This was not a big deal to give up.

Meeting with the RD also gave me an opportunity to talk about my former eating disorder with someone who understands. But I learned that if I'm accepted into the bariatric program, I'll see a specialist RD who works only with bariatric patients. She's based in the city where the surgery will take place, a seven-hour drive from where I live. I don't know how many of those meetings will be in person and how many can be by videoconference.

Why I'm Choosing Surgery: About My Weight and My Health

Obviously, I'm overweight. Although I'm not shockingly huge, known as "morbidly obese," according to the prevailing wisdom, I am obese.

To qualify for surgery under the public health guidelines, the BMI threshold is 40. My BMI is less than 40. However, you can qualify for surgery if your BMI is over 35 and you also have two or more health conditions that could be improved by the surgery. I do qualify for that.

That's not good, but that alone would not be enough, would not lead me to take this drastic step.

Health Scare

Two years ago, I went for some routine bloodwork, and had a high fasting glucose -- not in the diabetic range, but high enough to raise an alarm. It's sometimes called pre-diabetes. I was completely freaked out. I already have more than one chronic health condition. My life already requires a lot of maintenance. I've adjusted to all of it, but I cannot even think about adding diabetes to that list.

I used this scare as a motivation to make smarter food choices and get more exercise. At the time I was very busy, with very little time to myself, and regular exercise had really fallen out of the picture. So I did this for some months, got tested again... and there was no change. Or, there was a change but it was insignificantly small.

Now fast-forward to the present. I'm eating healthfully, I'm getting regular exercise, and I'm taking supplements that are supposed to help with blood sugar levels. My blood sugar readings after eating are normal. But my fasting levels are still in that pre-diabetes range.

Age

I'm 58 years old. I've seen a lot of information about the determinants of a healthy old age, and much can be determined by your health as you head into old age. Being a healthy senior and maintaining my independence as I age is really on my mind. There's so much we can't control. I want to control what I can.

I do eat a very healthy diet. I do get exercise -- not a huge amount, but I aim for that minimum 150 minutes per week. That's all good. But I am never going to lose enough weight, and maintain a lower weight, to significantly lower my BMI and change my health outcomes. The most I could hope for would be to stop gaining weight.

And I'd likely ruin my life while I tried. (I'm not exaggerating.)

My Diet...

I said I eat a very healthy diet. That's both true and not true.

I don't eat fast food, I don't drink soda or anything with sugar in it. I don't eat processed food.

I do eat a lot of fresh fruits, vegetables, and whole grains. I'm an omnivore, which I believe is a healthy way to live.

I don't stress eat, and I don't eat from boredom. I eat only when I'm hungry.

...And My Brain

But. There's the but. I'm always hungry. I eat, and I feel full. Ninety minutes later, I'm hungry again.

And when you're always hungry and have access to food, it's very difficult to always make good choices. I do all the things you're supposed to do. I plan ahead. I have healthy snacks on hand to help with hunger between meals. I'm the queen of healthy snacks. But it doesn't always work.

In the last 10 years, I have gained five pounds per year. And I was about 10 pounds overweight to start with.

Bariatric surgery shrinks your stomach, so that it can only accept small amounts of food. But it does more than that.

Your stomach secretes hormones that tell your brain when you are hungry or sated, and tell your pancreas how much insulin to secrete -- and a lot of other things that medical science doesn't completely understand. After bariatric surgery, those hormones are drastically reduced. It's believed this contributes to both weight loss and the maintenance of a healthy weight.

I've Tried It All... And I Don't Want To Go Back There (Eating Disorders Are More Common Than You Might Think)

When it comes to my weight (size, body image, etc.), I've been there and back. More than once. I gained a lot of weight in my mid-20s, and used one of the many popular diets of the day to lose it quickly. This was the first, and as it would turn out, only time in my life I was actually thin.

As the weight came creeping back, as it inevitably does, I started dieting. And dieting and dieting. I became obsessed with what I ate and with weighing myself. It was a horrible way to live.

I was like this at least 10 years, when, coincidentally, I needed to research eating disorders. I was shocked to recognize my own behaviour.

When many people think eating disorder, they imagine an extremely thin person, probably a young woman -- an anorexic. But there's a huge spectrum of eating disorders, covering a wide range of behaviours. Once I became aware, I would see eating-disorder behaviour everywhere. 

For me it took the form of being addicted to weighing myself, addicted to dieting, and obsessed with restricting my eating. I was probably only 10 pounds overweight at the time, but I was obsessed with trying to lose weight.

After recognizing this in my late 30s, I started seeing a therapist who specialized in eating disorders, and I worked hard to free myself of these obsessions. Eventually, I got there.

I stopped dieting. I stopped strictly policing my eating. I even stopped weighing myself. It took a long time, but it was glorious. It was so liberating! I gained some weight, but I was healthier, and happier. 

I also learned that the link between weight and health is greatly exaggerated. Obesity is a health risk, but those 5 or 10 extra pounds that women become obsessed with are not. They're not even extra.

But keeping people insecure and unhappy is an essential part of our consumer culture -- and the diet industry thrives on it.

So I stopped dieting, started enjoying my life -- and food -- more. I was maintaining a weight that was heavier than most people want to be, but I was healthy and felt good.

Now I've gained quite a bit more than is healthy. But I don't want the demands of bariatric surgery to undo all my hard work and my hard-earned freedom from these obsessions.

I'm afraid the surgery will be a giant trigger that sends me back to weight prison. Pre- and post-surgery, you're supposed to track your eating. And post-surgery, you need to track your weight loss.

How am I going to do that and stay sane?

I'm thinking a lot about this. I want to make it work.