Update: One Month on the Minus-50 Plateau

It's been a month. Lots of good stuff has been happening.

• I'm still tracking my eating, and I feel like I'll be doing that for a long time to come. It gives me more peace of mind, and is very easy to do, so it's a very worthwhile habit. 

• I bought a whole bunch of new clothes! It feels wonderful to put them on. 


• I'm walking 5 kms 5-6 days/week, and usually once each week I walk a 7-km loop around our little town. It takes me past the bay, where there are eagles and herons, and snow-capped mountains in the distance. 


• I've discontinued one of two blood-pressure medications. I still take several other meds, and my goal has never been to discontinue any of them. But it's still a nice little perk.


• All my other bloodwork is normal -- blood sugar, liver enzymes, etc.

I'm weighing myself too often, but I'm trying hard not to obsess.

The last time I was the weight I am right now, I thought I was a fat oaf. I dieted obsessively, weighed myself constantly, hated my appearance, and was desperate to lose 25 pounds or more. 

Yet this is the weight at which my weight-loss settled. My post-surgery weight-loss gradually slowed and then stopped. So I feel that this must be my new normal weight, the weight that I can comfortably maintain.

However, the medical establishment and the weight-loss industry do not agree with me. According to BMI calculators, I am still obese. 

Now, I am not skinny. You might say I am "chubby" or "somewhat overweight" or similar expressions. But I could not rightly be called obese. 

Those same calculators say that my ideal weight is a minimum of 30 pounds less than I am now, giving a range of 30-50 pounds less! At current weight minus 30, I would be quite thin. Even if I could reach that weight (which is highly unlikely), I would never be able to maintain it. Current weight minus 50 is ridiculous. That would be my weight when I was 17 years old. 

From another perspective, the caloric intake per day needed to maintain my current weight is -- supposedly -- almost double what I am eating now. According to the information above, based on my size and what I am eating, I should be losing a pound per week. But I'm not. I'm maintaining my supposedly obese weight.

Something is seriously amiss.

I understand that being very overweight is not healthy. I get that. But the guidelines of what is supposedly healthy is conveniently aligned with the diet industry and all the other consumerism that feeds off people's unhappiness and insecurities.

When I say, above, The last time I was the weight I am right now, I thought I was a fat oaf, I can also say: today, at this weight and size, I feel great.

Why Are Wait Times for Bariatric Surgery So Long? Bias.

I saw this article when I was first researching weight-loss surgery, so I knew there had been a 24-month wait list.

But when I looked deeper, I saw Health BC showed very low wait times. The local RD confirmed that. A few times, my partner and I said to each other, so what happened to that long waiting list? .... It seemed to have disappeared.

But no.

The story criticizes BC Health's decision to cap the surgery at 400 per year.

Sheila Vataiki was struggling with obesity, sleep apnea, atrial fibrillation and high blood pressure, plus taking four medications to control her diabetes.

Her children were convinced she didn’t have long to live, but Vataiki’s problems were beyond her ability to fix.

She got progressively sicker for 10 years before she was finally offered a radical, but life-altering, solution: Bariatric surgery to reduce the capacity of her stomach.

“I had to be really, literally on the verge of death before I could get offered this as an option,” she said.

Since the surgery earlier this year, she has lost more than 100 pounds and every one of her related health problems has vanished.

“This literally changed my life, it gave me back my life,” she said.

Vataiki, now 62, only wishes she could have had the procedure years earlier.

More than 2,500 people in B.C. are waiting to enter bariatric surgery programs to address severe obesity and related health issues, but only 400 will get the procedure this year due to a cap imposed by the Ministry of Health.

“My endocrinologist, who is in the business of treating people with diabetes, can only get two or three people a year into the program (for bariatric surgery),” she said. “Imagine how many people he has that could benefit from this. It’s an incredibly effective treatment.”

B.C. has had some success speeding patients through to surgery once they qualify. There are 75 people on the surgery waiting list, compared with 488 in 2010/11. The median wait time has dropped from 126 weeks to just 4.9 weeks today.

To qualify for the bariatric surgery program headquartered at Richmond Hospital, patients typically must have a Body Mass Index above 35 and a host of obesity-related illnesses, such as diabetes, high cholesterol and high blood pressure, according to surgeon Dr. Sharadh Sampath, president of the B.C. Obesity Society.

All three bariatric procedures — the sleeve, gastric bypass, and duodenal switch — are covered by MSP, if you can get admitted to the program. Sampath’s waiting list is about 1,400 patients, and a similar number are waiting to be admitted to the program at Victoria’s Royal Jubilee Hospital.

Any increase in the cap on surgeries would help manage heavy demand, he said.

Further increases could help patients get the procedure before they are critically ill, in particular diabetics with a BMI above 30, who can benefit, said Sampath.

Per capita, Alberta funds twice as many procedures as B.C., Ontario three times, and Quebec five times as many.

“The disease processes get worse to the point that they can’t be cured by bariatric surgery, or patients are too sick to even have the surgery,” said Sampath.

Diabetics can develop end-stage symptoms such as heart disease or renal failure that could disqualify them for surgery.

“If you are too sick for the surgery, we have missed our window of opportunity,” he said.

There is a compelling business case to be made for raising the cap.

Bariatric surgery and post-operative care costs about $13,000. Vataiki’s medications alone cost $15,924 a year, not to mention all the visits to specialists and a period of hospitalization.

Patients who miss their window of opportunity can end up in our hospitals for months, costing the system millions of dollars, said Sampath.

From the Globe and Mail, May 2018. After a description of the surgery, how much weight the patient is expected to lose, and how his health outcomes will improve...

It’s time to admit what is patently obvious: The western world’s approach to reducing the ever-burgeoning size of its citizens has been a colossal failure. With its emphasis on diet and exercise, this approach has been utterly ineffective in controlling our expanding waists.

Worse, it has essentially shamed the hundreds of thousands of people who are unable to lose weight or fail to maintain weight loss. And fail they do: According to a 2015 study in the Lancet medical journal, up to 90 per cent of patients on a diet-and-exercise regime regain any weight they lost within five years. Yet we continue to offer trite advice and ineffectual platitudes, along with a stern wag of our collective finger at the obese.

This notion is quietly being put to rest in Quebec, home to the largest per-capita number of bariatric surgeries in the country. One in 90 obese people get bariatric surgery in the province, more than double the national average. As home to some of the skinniest people on the continent, and among the lowest per-person health spending in the country, Quebec might seem an odd place to be at the forefront of bariatric surgery research and practice.

Two surgeons, Rae Brown and Lloyd MacLean, were among the first to perform earlier, far more invasive versions of bariatric surgery, at McGill University in the 1970s and 1980s. Most of the advancements in the surgery, including the sleeve gastrectomy and the laparoscopic duodenal switch, were developed in Quebec. Dr. Gagner was the first to do both.

Today, the vast majority of bariatric surgery procedures in Quebec are performed in the private sector, in large part because the stigma against the overweight has become institutionalized within the province’s health bureaucracy.

Quebec is the only province that has paid for all types of bariatric surgeries. Yet, even now, bariatric surgeons have difficulty getting operating time for their patients. “They’ll give a liver transplant to an alcoholic before they let me operate on an obese person,” Nicolas Christou, one of the world’s leading bariatric surgeons, told me recently.

Past health crises have spurred government action. Cancer, among other diseases, has its own society and myriad hospital and governmental research facilities dedicated to its treatment and avoidance. Yet there are no such initiatives with obesity, even though the condition will affect some 34 per cent of Canadians over the age of 18 by 2025, according a 2018 World Obesity Federation report. Instead, we stubbornly believe that the obese are such because of their own failings and overindulgence.