I'm an angry bastard!

Alright. I've been thinking seriously about this WLS thing for about a year now. It takes me a long time to work myself up to big decisions like this, which is fine. Once I decided that it really was a logical choice for me, which was last fall, this thing has really gained momentum as I've gone through all the presurgical workup and done a lot of reading and generally prepared myself for this massive change. This year, as I've mentally prepared to have surgery in a couple of months (or possibly even sooner) I've really worked on starting to make some of the changes needed to be successful. I'm facing the reality that I have an unhealthy attraction to sweets and that I need to be more limited in what I eat than most people do. After all, my normal diet, when left to my own devices, is not really much different than that of normal-weight people. People who know me well and see me eat can attest to that. Yet I consistently gain weight, even with a fairly active lifestyle that includes regular aerobic and weight training exercise. So, all the well intentioned advice I get from my PCP and other folks about portion control, exercise, limiting snacks, all the "little things" that often work for obese people, don't do a thing for me because I already do them all.

This period of time before surgery, I have considered as a bit of a holiday. It's borrowed time that I get to use to do two things:
1. Learn new eating ideas and habits,
2. Say goodbye to old ways and old foods.

This has been going well until the last couple days. Suddenly, I'm angry that I have to deal with this. Why can't I eat in front of the TV, dammit? Can I really say goodbye to sugary treats? And I don't want to vomit at all! So, to try to understand better why I'm feeling this way, I turn to the web and other WLS patients' blogs to see if they went through similar things. Well, yeah, they did, but most of those blogs are by people who had over 200 lbs to lose. I admire the hell out of them, but I can't relate. If I do not have surgery, I will remain obese and probably gradually gain more and more weight, but I will have fewer health consequences than most people because my family genetics are exceptionally healthy. My total cholesterol is lower than most people's LDLs. My heart is strong and responsive, and while there is heart disease on my mom's side, I seem to be like my dad's side, which has no history of heart or pulmonary problems. In fact, looking at the numbers, I probably have a better heart than my mom did at my age, and she was 120 lbs. (She's even less now.) It doesn't seem like I'll keel over dead in 10 years without WLS. My quality of life will just suck because I'm just getting fatter. If I have my father to look to as an example, my health will be great despite my weight for a long time, then things will sort of start to give out all at once. He will be 63 this year, and he can barely walk, between his bad hip and his bad knees. So I'm not looking at WLS as something that will save my life, just something that will improve its quality greatly.

I can look at other people's blogs to my heart's content, but it won't tell me what I really want to know: is this right for me? I have between 50-85 lbs to lose, depending on how you figure it and whom you ask. I think 70 is a reasonable number. Given how my body hoards fat, will I lose weight quickly like most people do, or will it be slower for me, especially since I have less to lose overall? Will it be easy to regain the weight? Is all of this worth losing only 50 lbs, if that's all I could lose? I don't know. Last week I would have said yes, without a doubt. Today I am angry about it all. I'll just keep working on my brain and my eating habits while I wait to hear from the surgeon's office.

Of course, some of my anger today may be over the prospect of losing one of my stress coping strategies: emotional eating. My husband has been away for the last 2 days on a business trip, and I miss him. I've been bored and lonely without him here on my days off from work, and while I have made good use of my time and I generally value my alone time, I am more aware than usual of the desire to eat when I feel lonely or bored or sad. So by the end of the week, when he's back home, maybe I won't be so angry. That would be good...but it illustrates nicely that I have more to work on than I previously thought.

What I hope to achieve

Here are my real goals for WLS:

1. Reduce my body fat percentage to 27% or less
2. Reduce my body weight by 60-70 lbs, more if it seems appropriate & achievable
3. Eliminate obstructive sleep apnea
4. Reduce my resting heart rate to 90 or below
5. Exercise at least 5 days a week
6. Eliminate sugar addiction
7. Prevent degenerative joint disease
8. Feel healthy and great
9. Live to 100
10. Keep weight off permanently
11. When the time is right, have a healthy pregnancy and return to prepregnancy weight

Where I've Been

After over a year of contemplation and weighing my options (no pun intended), I have decided to have weight loss surgery. I realize that some people would be shocked to learn this. I do not look like a candidate for WLS. I carry my excess weight well, and most of my friends and family would be surprised to learn that my BMI is over 40. I am able to lose some weight with dieting, but my results are so modest and hard won, and I am unable to sustain these losses for any length of time. In the end, I decided that this was the only way to give myself a reasonable chance of permanently keeping the weight off. I believe that the years of yo-yo dieting have left me worse off than ever, and I don't think that is a realistic way to expect to live the rest of my life. And with the genes in my family, I stand an excellent chance of living to be 100. I'd like my knees and heart to make it there with me.

Before I seriously contemplated this option for myself, I used to think of WLS (gastric bypass, Lap Band, or any of the other surgical options available) as the extreme, last-ditch effort, made only when you are sure that staying at your current weight is more risky than having this extremely dangerous surgery. But some research on the current statistics behind WLS shows this is a fallicy. In the past 5 years surgical techniques and postoperative care regimens have advanced to the point that it is considered very safe elective surgery for most patients. And I was surprised to learn that only 1 in 20 morbidly obese patients are able to lose weight and keep it off for any significant length of time. Currently, WLS is actually considered to be the only effective method of achieving and maintaining a healthy weight for the morbidly obese patient who has tried and failed more conservative methods of weight loss. And that, my friends, is me. Just because I don't look "THAT heavy" doesn't mean that I am not considered by medical professionals (including myself, a health care professional) to be morbidly obese.

In future posts, I will attempt to address many of the philosophical and emotional issues surrounding WLS, at least from my own perspective. Today I wish to simply take stock of where I am and where I've been, lay out the groundwork for my plan, and possibly draw some conclusions for myself about this next phase of my life. This blog will mostly serve as a place to journal my thoughts and post my photos and successes and failures for my own edification. It might also become a place to point friends and family who wish to join me on the journey, if I feel ready for that next step in the future.

Today I am 225.8 lbs wearing only underclothes. I am 5' 3.5" tall. This makes my BMI just over 40. I've been obsessed with these numbers lately, because my approval by my insurance company hinges on the numbers. If my BMI is 39.9, they will not cover my surgery, unless I had diabetes, which I don't. Luckily, my measurements on my "official" weigh in day were higher than that, so I met the BMI-40 threshold. Next I had to have a significant comorbidity to qualify. I am not hypertensive or diabetic. GERD doesn't count for Regence, although I do have mild GERD. It all hinges on the sleep study I had 2 weeks ago. My snoring has gotten worse over the last year, significantly so. My husband tells me that I do have apnea periods during my sleep. If my sleep study showed obstructive sleep apnea, that is a significant comorbidity that causes known complications later in life, and can be alleviated by weight loss. In fact, the sleep medicine doctor informed me that I do have mild sleep apnea that showed up on my sleep study, and I should start using CPAP, and lose weight. According to these conditions met, I should be approved for surgery, but that still might not happen. I won't find out until the surgeon's office submits my paperwork to my insurance for approval.

Obsessing over my exact weight in pounds (or kilos) is new for me, as I spent many years training myself not to worry about the numbers. For several years I didn't step on a scale, which didn't prevent me from gaining a lot of weight, just from feeling worse about it than I felt about not fitting into my clothes. I am hoping that I can stop obsessing about it for a little while until I have surgery, but it hasn't abated yet. If I am approved for surgery, I will have a laparoscopic Roux en Y, since that is what is covered by Regence BCBS. If I am not approved, I will have a Lap Band, which I will have to pay for myself. I would much rather have this covered by my insurance, of course, but if it can't happen, I still need to do something now, before my health starts to seriously decline and before I move on to graduate school and then hopefully parenthood.