When You're Considered a Success & Who Defines It

Early Support Systems

In the beginning it's fairly easy to get people on board to support you on your journey of weight loss. Mostly everyone who loves us wants us to be healthier, however there comes a point in time where you have to be your own support system.

Pre-op there are numerous support groups that discuss food, nutrition, exercise, clothing, lifestyle modifications, etc.  And family and friends are excited to see the incredible shrinking you.  They don't seem to mind that you're not eating like you used to as the pounds fall off of you.  But now you've reached that weight on the scale where you're just on the chubby side, very close to normal or even achieved a healthy bmi.  I noticed the more weight I lost, the fewer cheerleaders I had.  It reached a point where I was a size 16 in clothes where people just thought of me as average in size. Even my srugeons considered me a success.  However at this point I still didn't feel like one, and slowly my cheerleaders slipped away.

A Medical Success

The medical community has their own definitions of so many terms.  What they may consider a success may not align with your own personal definition of success.  When my surgeon considered me a success early on I questioned him.  Medically I was a success story, although I wouldn't have personally considered myself one.

Weight loss surgery is considered a success if a person loses 50%  or more of their excess body weight.  So at my highest weight of 350 pounds, losing 100 pounds would have been considered a success.  So at 5'5" tall and 250 pound I would have been a walking success story for bariatric surgery?   The American Society for Metabolic and Bariatric Surgery (ASMBS) cited that 90 % of patients are able to keep off a 50% loss.

At 250 pounds I was still fat, with a BMI of 41.6, technically Class 3 obese.  Yes still in class 3.  I hardly consider that a success.  But that's the standard measure of that surgeons go by.    So how did I get myself to a normal BMI of under 25?  I took bariatric surgery for what it was, a tool.  Surgery alone wasn't going to burn off years and over 200 pounds of excess body weight.  I dramatically changed my whole entire lifestyle and became my own cheerleader.

Lifestyle Modifications

So my journey from 250 pounds down another 100+ pounds to a normal BMI wasn't even expected by my surgeon.  That part was done through nutrition and exercise.  Along the way there were many challenges and still are.  There are still goals I want to achieve for myself.  It's no longer about being a medical success but about being a personal success.

Lifestyle modification is no easy task, even with a helpful support system.  Eventually you have to be the one to motivate yourself by becoming your own personal cheerleader.  If that motivation doesn't come from inside yourself chances are you aren't going to make it past being a medical success.

My sedentary lifestyle had changed to a very active one.  I lost interest in going out to eat with friends and socializing over food.  I was more interested in spending time doing an activity.  Spending hours eating was a behavior that wasn't going to help me meet my goals.

Some of my friends weren't interested in a more active lifestyle, so I saw them less and less over time.  I made new friends who were interested in a healthier lifestyle.  I enjoyed more activities and sports with my own children.  My sons became my work out buddies.  For me it was a win win situation.  Early on we cut out trips to Mc Donalds.  I told the boys, "Mc Donalds is dead!"  They took it to heart and we stopped going there.  Years later my boys don't even think about going there.  I have 3 sons who value their health and physically push themselves.  They're constantly inspiring me to be healthier and work harder.

A benefit of changing to a healthier lifestyle is that my kids are growing up around it.  When I first had surgery they were 3, 6 and 7 years old. They've had the benefit of seeing me change my eating patterns,  having a balanced diet, very limited junk food and realizing that if you set your mind to it you can reach your goals.  And at 12, 15 and 16 years old my sons are amazing people.  Each with their own physical and intellectual goals in life.  They're all out there pursuing them and have such internal motivation that it pushes me to do more.    

Welcome to life in a brand new body.  From this point on it's all about maintaining a healthy weight and making choices.  Yes, now it's a choice of eating, exercising and staying healthy.  Maintaining the weight is a balancing act that many people don't think about.  The statistics for weight regain following weight loss surgery are not all that positive.  People may lapse into poor eating habits at their goal weight, and a lapse may turn into a relapse.  The real work is done here, goals are set, revisited and revised.

The Early Stages After Surgery: What are you going to eat? Why are you going to eat it?

The two big questions with weight loss and changing your lifestyle come into play:  What are you going to eat?  Why are you going to eat it?

(A very basic summary of dietary changes that happen in the few few months following surgery)

And these questions at first may seem easy.  Support groups prepare you with great meal plans for the first month.  Everyone discusses their favorite brand of protein shake, protein jello recipes, etc.  Protein is stressed as it's a building block of healing.  You learn read nutritional labels to make sure you get in that protein. It's so heavily stressed you feel like you're turning into a body builder with the amount you're buying.

Yes I love my protein mixed with a coffee concentrate, that's a growler of concentrated coffee from Revolution Coffee Roasters.  I love it with two scoops of EAS Lean 15, which was recently discontinued so I'll be finding a new powder that I like soon enough.  That's one of the things about protein powder, companies are always changing their product lines.  Initially I love, love loved Designer Whey, however the product was discontinued.  When you've been supplementing with protein shakes for 9 years these things happen and you learn to take it in stride. There's the scavenger hunt to find a new shake you find palatable, nutritious and easily digestable.  The great members at Bariatric Pal have composed a list of companies offering free, discounted or inespensive samples of their protein powder so you don't have to commit to a whole pound or two of something that isn't going to work for you.

The Initial Post Op Stages, Liquid First My Dears

And in the beginning people follow the plan, a meal every 4-6 hours, get in X grams of protein a day, progress through the liquid stage, the mushy stage, the soft food stage and finally the solid stage.  Those are the easy days as the pounds fall off and your hunger is completely gone.  It's amazing, wonderful and no one around you seems to mind that your lifestyle has completely changed as they're seeing the incredible shrinking you.  You're going to your support group, have a good support system of friends and family who are hopefully happy you're getting healthy.  And you're following the plan of your whole bariatric team most of the time.  And soon enough you're done with the liquid stage and get to move onto the purees.

Purees

You move into the mushy/purred stage.  The food processor is your new best friend, of course you buy a small one because you're only going to be eating a very very small amount, at most 1/4 cup of a baby food consistency of whatever protein you puree.  And happily you slowly eat it.  For me this stage came around Thanksgiving in 2007.  I was so very happy to have mashed potatoes with yogurt.

Soft Foods

On soft foods you get to cottage cheese, ricotta cheese, scrambled eggs or egg whites, fish, beans that you don't have to puree.  You're glad to be able to chew food again.  But at this point you still have to supplement with those protein shakes as it's hard to get in enough protein.  My nutritionist recommended 60 grams of protein per day, with a maximum of 30 grams consumed in at once.  It was difficult to get this in so I still supplemented with a protein shake once a day.

Solids

Then the solid foods, slowly, slowly you cut your meat, chicken, pork, duck, mammal protein into tiny pieces about the size of a single dice.  And you chew chew chew until you break apart all those bonds between the proteins so that your stomach will better be able to accept that hunk of meat.  Then it hits your stomach. It sits there.  For some digestion is easy, others it's a nightmare.  I started to opt for a vegetarian diet around bariatric surgeries and very different experiences digesting food.  So everyone varies here and what may digest easily for one person may not for the other.  All surgeries and all stomachs after surgery are not the same.  And any complications along the way have to be taken into account.  It's this point when you begin to realize the exactly how much you have to commit to this new lifestyle.
this time.  

So you're finally though the initial process and eating normal food again, however with a new mindset.  And that's when things start to get complicated.   You may be closer to a normal size, now just class 1 obese or maybe even overweight.  And now, Boom! Welcome to a whole new lifestyle.  Stay tuned...

I Love Exercise vs I don't mind biking while I watch TV

This journey for me was a whole lot of baby steps.  Now I can firmly say, "I love exercise!"  But that wasn't always the case.  In 2007 at 350 pounds I hated exercise, seriously hated it.  Sure like just about every overweight person I had a gym membership, owned a treadmill, had a collection of workout DVDs, and lots of other dust collecting things.  

I'd make it to the gym, feel out of place, intimidated, sticky sweaty gross and that was before doing much of anything.  I was already in a sweat.  Swimming to cool off?  Ummm, no.  No one needed to see me in my swimsuit, for pete's sake I didn't want to see myself in that contraption that did it's best under such pressure to hold everything in it's properish place.

So I invested in a personal trainer at the YMCA.  Well our first session I hated every single part of it, literally every single part.  And this was just a fitness assessment, honestly it proved I was not fit. Well I already knew that.  2 miles per hour on the treadmill was tolerable; I could do that.  3 miles per hour on the treadmill was pushing me to tears.  It hurt to breathe, and in my head all I could think was that this whole having a personal trainer thing was as my grandma would say "for the birds".  My whole body hurt. That was both our first and last session.  I realized I needed to be in some sort of shape before I could have a trainer.  I know some people swear by them, and later I did have a wonderful trainer.  This particular one was not a good fit.  So I moved on.

The one thing I took away from that fitness assessment was that biking on a recumbent stationary bicycle wasn't that bad.  I was comfortable sitting down, my back was well supported, and at 350 pounds it wasn't putting pressure on my knees or ankles.  

The next day after work my husband and I went to buy a bicycle for me.  I brought it home,  opened it up, assembled it, placed it in the living room with a clear view of the TV, sat down and biked, trying to ignore the warning label and stickers.  

My husband was pretty surprised as other exercise equipment we had magically transformed into coat racks, backpack holders, places to hang clean laundry; you know the usual things that happen when one piece of exercise equipment might just be "the one that saves you."  

I continued to bike in spite of being over the maximum user weight.  However when you're obese it's very difficult to find equipment so I found myself gingerly sitting on it as to not break the seat.  Someone we both managed to survive.  

The bicycle and I, we became a team, joined by our dear friend Mr. TV.  Endless shows to watch all at the flick of the remote.  I biked through movies, DIY Network, the Discovery Channel, The Biggest Loser, Survivor, Grey's Anatomy, all my favorites.  It turned into a habit of mine,  If someone was watching TV I went and sat on my bicycle and just peddled along.  It turned into a bit of a joke that it was my reserved tv watching seat.  I had stopped sitting on the couch altogether.  The bicycle became my spot, much like Sheldon's special spot in the Big Bang Theory.  Yes, I'm that girl, do not sit on my bicycle.  No one sits on my bicycle.

Over months and months the weight started coming off.  I had more energy and would bike longer and longer.  Eventually I reached the point where I felt confident enough to return to the gym.  I met with a personal trainer for a second time.  This time around I knew the fitness assessment was going to be difficult.  I was prepared for the hard work because I'd already accomplished a lot on my own.  I was ready for someone to push me further.

Now, years later, I love exercise.  I no longer have a personal trainer.  I work out at home, in the gym, run with my kids, am passionate about kettlebells, hiking and tennis.  My bicycle is still a part of my day and as silly as it may sound is my most prized possession.  

Anyone can go from I hate exercise to I love exercise.  It's just a matter of discovering what is their bicycle.

The Emotional Tole

When you step back and take a look at all the dimensions of wellness, whether your subscribe to a 4,7,8 or 9 dimension model of wellness, physical wellness is just one aspect of the wheel.  The Substance Abuse and Mental Health Services Administration does a great job explaining models of wellness and how they effect one another.  Shhhh, I'll let you in on a secret food can be a substance that's abused by many.  I know I used food as a coping mechanism to the point that it was detrimental to my life.  But that's for another blog post.

Back to the topic at hand, making a drastic change to the physical aspect creates in the best cases ripples and in the more extreme tsunamis .  The physical aspect is connected to the emotional, environmental, spiritual and social aspects, the interconnected web that defines who we are as a person and how we interact with the world around us.

No one ever prepares you for the tole loosing 200 plus pounds will take on your life as a whole.  There are support groups which focus primarily on what to eat after surgery, how to get in enough protein, debates about which protein shake tastes better, how to get in enough nutrients, how to deal with the physical side effects.  All the physical side effects like thinning hair, loose skin, brittle nails, vitamin deficiencies, etc.  People are so happy about loosing the weight that serious complications are very rarely discussed and often shushed by the surgeons that run the groups.  At least this was my experience with the two support groups I attended.

When you spend your whole life being the fat girl that other girls make fun of and boys just view as their pal, growing up a tomboy.  Well going from squeezing into a size 28 to fitting into a size 4 brings about levels of attention that I just wasn't adequately prepared to handle. 

Handling bullies, yup, got that down to an absolute science.  Handling compliments based purely on physical appearance, well that's completely foreign territory.  I'd much rather be complimented for something funny I said, something interesting, gosh even be joked with about my bad hair days.  But complimenting me on a physical trait of my body, those are hard to take.  Because they're new things.  I haven't always been a size 4, a "little, tiny, cute, adorable thing."  I have however always had a certain level of intellect which used to be appreciated and sought out by people more so than it is now.  

There are days where I miss my 350 pound body.  Yes, I said it.  And the main reason being that people who were interested in me were truly interested in who I am as a person and very much overlooked what I looked like on the outside.  My fat was a protective layer, insulating me from shallow people, protecting me from so much and filtering through genuine individuals.  

People were once attracted to my personality, yes my moments of silly awkwardness and excitement about the oddest little things.  People who would laugh along with me during those awkward embarrassing moments that I seemingly always found myself in.  Friends who I could have deep meaningful discussions with one moment and the very next listen to their quick wit.  People who were as interested in me as I in them on intellectual, emotional and spiritual levels, mutually adding to one another's life.  Those people where you don't even have to try so hard with, where you just flawlessly get along with one another.  When I was 350 pounds it was so much easier to find this connection with people.  Now, it's a rare find.

It's been an evolution of myself, looking inward after meeting new people to see where it is we connect.  And a lot of times it's just a physical attraction and nothing deeper.  And for me that does nothing.

If you subscribe to the one of the many wellness 

The Physical Side of It

Transitioning from 350 pounds  in September 2007 to my current size 4 body, that does exist and flex in the range of 125-135 pounds has been life altering.  Most people just look at the physical aspect of weight loss, which I have to admit is wonderful but there is also the intellectual, emotional and spiritual aspects as well.

The Physical Aspects

Surgeons are gifted mechanics, skilled at the art of repairing and redirecting human anatomy, making precise incisions inserting trocars into patients for laparoscopic surgeries, without being able to physically touch with their hands all of the human internal plumbing.  Operating at a distance through trocars.  If you're like me and really want to know how it's done, the science, the skill and the amount of absolute precision it requires here's an article to read on possible Laparoscopic Trocar Complications by Ronald A Rhodes, MD.

Physical benefits of bariatric surgery are endless.  Going from Class V Obesity to the classification of Normal Weight is a physical feat of endurance, nutrition, exercise, dedication, a medical marvel and for me involved bariatric surgery.  Countless people do it without surgery.  I admit, I tried my best without it.  It was my last resort.

The mortality rates scared me.  I was the mother of 3 young adopted children and 30 years old.  I made a whole binder of information for my husband just in case I didn't survive.  In the military people keep binders of important information, yes that's where the idea came from.  It listed everything from bank account numbers, our monthly budget and bill paying schedule, doctor's numbers, allergies that kids had, their friends phone numbers, recipes that they enjoyed when I cooked them,  favorite bedtime stories, and even went to the extent of having an updated will as well as letters to my children, husband, close friends and family members just in case I didn't make it.  I took a very calculated risk and was prepared for the worst possible outcome.  I was also a nervous wreck and nearly walked out of the pre-op area four times, goaded back into the reclining chair by my husband.

September 2010

Physical benefits: lower cholesterol, lower blood pressure, lower insulin levels, no more edema in my legs.  That awful feeling when walking, as if my weight wasn't being distributed through my feet, but rather like I was walking purely on my ankle bones, was gone once I lost a substantial amount of weight.  My inhaler that had once been my life line while attempting to chase around growing toddlers was no longer being grabbed for on trips to the playground.  I started playing with my sons outside, hiking, climbing trees and enjoying it.  My children now had an active mom who instead of cheering them on at the park from a bench was right along side them nudging them onward and upward.

My inhaler became a thing of the past, prescriptions for it never refilled.  Somewhere in a drawer it's old expired self lies there as a memento of the past.  My metformin for insulin resistance lies next to it, little buddies in a box from my past with an old favorite t-shirt and pair of jeans.  My body shows the physical signs of having lost over 200 pounds, loose skin, stretch marks, however that will be saved for another post.

 

The Pivotal Moment: A run in with a Chair

Summer 2007.  Me at 350 pounds

I can't tell you the exact moment when I became fat.  I was the chubby baby that never as my grandma would put it grew out of her baby fat.  She always said I was her beautiful granddaughter and never made me feel like anything less.  Grandmas have a certain way about making everything in life pretty darn wonderful.  But I'll save the wonderfulness of my grandma for another post.

Back to the original topic, I can't tell you the moment I became fat.  I can however tell you the moment I decided to stop being fat.  I had just gone back to school to start my Masters Degree in Teaching.  It was something at the time that I thought would fit in with my life.  I had taught before getting married but once we adopted our sons I became the stay at home mom.  So going back to a job where I'd have summers off seemed like it would be a perfect fit for our family.  I was balancing school with parenting  3,6 and 7 year old boys.  Things were tiring but manageable.

Here comes the moment July 2007.  I was about to do my student teaching in the fall of 2007.  My university required a photo for it as well as Praxis exam scores.  So the morning of the exam my husband took the photo for me, then I went off to the exam.  Nervous of course, that dreaded test anxiety.

I arrive to take the test on campus.

The Pivotal Chair

The moment.  The turning point.  I find a seat in the back in one of those chairs with the attached desk that flips to the side.  A Flip Tablet Arm Chair.  The table part was up.  I wiggled in my chair anxiously and lowered the table.  No, I attempted to lower the table.  It was stuck just below my chest at the most awkward angle.  Panic set in.  How was I going to take this exam sitting here, squished into a desk that was not constructed with the thought that a 5'4 1/2" 350 pound woman would be sitting in it one day to take an exam.  I got out of said design flawed chair, and went to the front of the room where the two exam proctors were seated at a large standard table with chairs.  I explained the situation and asked if I could sit at the table or in a chair that fit me.  The proctor told me no as I hadn't filed for an accommodation for test takers with disabilities or health related needs.  I explained that I had no idea I even had a disability. My eyes welled up with tears.  The other proctor realized what was happening and offered me her chair for the exam.  Looking back at the list of accommodations, being too fat for the chair was not listed as a disability.

This moment was the first time that I felt academically inferior due to size.  My fat nearly got in the way of taking an exam, an exam which I received a certificate of excellence for scoring in the top 5% of test takers.  I made it through the exam, but as I walked to my car tears filled my eyes.  I was so upset leaving the parking garage and distracted that I accidentally hit the gate.  I know, right.  Thankfully the lot attendant wasn't upset as apparently these things happen all the time.  He told me it was fine and that I didn't need to cry about it or give him my insurance.

So back into my car I called my husband in tears, in a bumbling tangent of unintelligible garbled words with sobs that well only a well trained therapist could decipher, which he is not.  Forty minutes later I walked in still in tears and told that was it.  I was going to have bariatric surgery.

People had been telling me my whole life to loose weight.  I'd been on every imaginable diet  starting at age 12, from cabbage soup, atkins, grapefruit, weight watchers, south beach, medifast to slimfast.  I played sports, tennis in high school in spite of my size.  However nothing ever worked for me in the long term.  My mother was always on my case about everything I ever put in my mouth, asking me if I really needed to eat that.

It wasn't until that moment where my weight threatened my intelligence that I was willing to take a drastic step.  I had a friend who had bariatric surgery, so I called her to ask her for her surgeon's number.  I scheduled an appointment with him for later that week.  And in true to myself form began reading everything I could find on bariatric surgery and all of the options available.