My thoughts about WLS and who should have (WARNING: Big Opinions You Might Not Like)

Yes, I have been very involved in NAAFA.  I have fought for people who have been severely discriminated against based on their size.

One thing to clarify -- I would NEVER tell someone to diet and exercise in order to lose weight.  I think that so many of us are used to hearing that that my words were construed to mean that.  There is a school of thought -- Health At Every Size -- supported by medical data and an absense of prejudice, that believes that being fat is like being short, tall, thin, bald, etc.  The thinking is that ALL people, whether fat or thin, should enjoy a healthy life, filled with good food and movement that is joyous.

I would never presume to tell someone to diet and exercise to lose weight.  It is still my belief that many "overweight" people can be and are very healthy.  Thin people who eat badly and don't exercise are not very healthy.  Same goes for fat people.  The point of my statement was about *health*, not weight loss.

Listen, Julie. Don't try to backpedal, and don't try to pseudo-psycholanalyze WHY people have responded to you as they did. You have grossly overstepped and you owe some big apologies.

So someone who has a condition like diabetes, which can cause among other things, blindness, coma, amputation, and seriously shorten a person's life shouldn't get WLS, but you should because your knees hurt and you smelled bad?  Are you serious, did you read this before you posted it? 

I am appalled that you made the decision to have WLS and know what a deeply personal and difficult decision it is and you approach other woman and tell them that they should use diet and exercise to control their weight?  Why didn't you try that?  What if someone had come up to you when you were overweight and said put down the ho ho's and take a shower, would you see that as supportive?  If you want to be on the lookout for "Uncle Tom's"  might I suggest you try looking in the mirror.  

I'm disgusted by you and I can assure you it had nothing to do with your weight, though your fat head is fairly offensive.

While I agree that there is discrimination towards obese individuals and I am concerned about how people are viewed and treated in this society, I am extremely concerned about many of your comments.  For one thing, as eloquenly stated by many others who have responded, everyone has thier own history, perception, issues to deal with.  I wouldn't presume to suggest to them what is right for them, and I am shocked that you feel able to do so.  

WLS is a very personal choice, I know it is for me, and I am not entering into it lightly.  I have been obese since my early teenage years, I have tried diets, excercise, pills, you name it.  I have succeeded in losing some weight, but never all my excess weight, and I have NEVER been able to keep it off.  I suppose that makes me a failure to a certain degree.  It is what it is, I live with that, because I don't have any option not to accept it.  I am now at a point in my life that I am sick and tired of fighting this disease.  I want to walk and move without pain.  I want to travel and do things I CANNOT physically do today.  My BMI is in the 43 range.  If I let it go much higher, I am not going to be able to do the few things I can do now.  I'm not willing to give up my quality of life any longer.  I can't wait to have my DS.

Just wanted to chime in with my opinions.

I started losing weight for my 6 month diets when my BMI was over 64. At 445 pounds and 5 ft 9. So, I know how it is to see people getting surgery in their 200s and thinking, "Wow! Their Before picture looks like I'm gonna look in my After!" And, it doesn't help when they describe that Before weight (my likely After weight) as looking horrible, miserable, and ugly.

It IS hard to take. It doesn't mean that they don't/didn't have valid reasons for getting the surgery, though.

But, at 400 pounds, you and I know SMO like nobody in their 2s or 3s. (Of course, for people who weigh in the 5 or 600 pound range, we're in the group that doesn't know.)

As far as being healthy and overweight, I believe that's true. To an extent. My lowest weight ever, as a teenager, was 160 pounds. In college, I got up to about 190 or 200 (which would be deemed 'overweight') and I was still in really good shape.  I'd take exercise classes with my best friend who was petite and about 120 lbs, and I could outdo her easily. All the time.

Even when I got up to 250, I was very active. I was fit AND fat. But, since my 300s and 400s, that hasn't been true. It only lasts for so long.

I also believe that our culture is VERY biased against fat people and it is hard to live fat in this society. I try very hard to love myself anyway, and my hubby is wonderful and loves me no matter how big I get. Everybody else, though, doesn't. It's been said before that being fat, in terms of cultural bias, is harder than being of a race in the smallest minority. I believe it.

So, there are things that I agree with you on, but I also understand some of the other reactions. At 383 pounds, I am truly set on getting this DS. To be somewhere near a normal weight, even if it's 200 or more, would be a dream for me. I would no longer stick out like a sore thumb. And, there have been plenty of 10 years and further out studies for WLS which say that if the patients had NOT done the WLS, they'd probably have been dead already.

Try not to take everybody's anger and dissent too hard. You attacked the whole section of LightWeights and took on all the good reasons to have WLS. If you're so down on it, how can you say how much you like YOUR WLS? Doesn't make sense.

-Barbara

Y'know what Julie? For someone who is ostensibly so intelligent, well educated and successful, you are one of the biggest ******g idiots I've had the misfortune to encounter on this board.

Guess what? People with BMI's of 35 can be in living hell, too. So take your fat acceptance speech and your so-called "fat education" **** and choke yourself on it.

There. THAT is my opinion.

OK Julie, despite your request to not be flamed, your right to your opinions, and the fact that I very much like you in real life -- this is beyond the pale, and will not go unremarked upon by me.

(NOTE: edited because I realized that I had used "fatist" (a word I was not familliar with) exactly in opposition to its meaning -- I have replaced "fatist" (which I know realize means anti-fat, like racist) with "fat-acceptance.")

First and foremost, your so-called "opinions" about the medical facts you espouse are FULL OF ****  You are absolutely WRONG on most everything you have said, and you are drawing unfounded conclusions from the little bit that was correct.  Yes, people who are slightly overweight are on average healthier than those who are underweight, but it is a J-curve -- and one for which the slope is VERY VERY upwardly steep above a BMI of about 27.  There are MULTIPLE published studies which have demonstrated that bariatric patients live LONGER than their matched peer non-ops.  For example, in the Marceau 15 years out study (Obesity Surgery, 17,1421-1430, 2007 http://files.meetup.com/379062/DUODENAL%20SWITCH%20LONG-TERM %20RESULTS.pdf):

Survival

During the 15 years of follow-up, 67/1423 died including 16 (1.1%) operative deaths for an annual mortality rate of 0.5%. Survival rate at 15 years was 92%, a greater success rate than that reported by Flum et al8 for a similar series of 3,328 patients after Roux-en-Y gastric bypass (RYGBP) and followed for an equivalent period. They reported a survival rate of 88.2% after RYGBP and 83.7% for morbidly obese subjects without operation. The risk of dying (EHR: Excess Hazard Ratio) for morbidly obese patients after OS was 1.2, comparable to the normal Quebec population." Mortality risk has been reported to be three times greater (EHR: 3) for the Canadian morbidly obese population.

As for your UNFOUNDED assertion that diabetes can be adequately controlled by diet, exercise and medicine, perhaps you could point to a reference that says this?  Oh wait – no, you CAN’T, because that is a patently FALSE statement.  See for example: http://care.diabetesjournals.org/cgi/content/full/31/Supplem ent_2/S290

 

Unfortunately, the etiology of this condition is still elusive and conventional therapeutic modalities cannot achieve a cure. Furthermore, if medical therapy is suspended, invariably, plasma glucose rises and the disease progresses. In fact, type 2 diabetes is usually considered a relentless and progressive disease.

~~~~

A meta-analysis involving 136 studies for a total of 22,094 patients showed that type 2 diabetes was completely resolved in 76.8% and resolved or improved in 86.0% of patients who had undergone bariatric surgery (7). The same study showed that complete remission of diabetes occurs in 48% of patients after laparoscopic gastric banding, 84% after RYGB, and >95% after BPD (7). The remission of diabetes after RYGB and BPD is also durable, and recurrence of diabetes >10 years after surgery is rare (8). Intriguingly, whereas remission of diabetes after laparoscopic gastric banding typically occurs over several weeks to months (9), consistent with the consequences of weight loss, RYGB and BPD can cause complete remission of diabetes within days to weeks after surgery, long before substantial weight loss has occurred (4,5).

 

OK, now will you PLEASE STFU about your medical "opinions" cloaked as fact that there are no long term studies showing that bariatric surgery can INCREASE our lifespan, and that diabetes can be “controlled" by diet and exercise and medicine??  You are simply and undeniably WRONG.  SHAME ON YOU FOR TRYING TO SPREAD YOUR LIES!  You simply CANNOT justify these statements with data – they are what you seem to need to believe to justify your fat-acceptance views.

 

My next point – your hypocrisy.  I don’t believe in the context of this post that I am speaking out of turn, since you “opened the door," but when we talked when you were pre-op, you were bemoaning how you felt that by having WLS you would be viewed by your oh-so-open-minded fat-acceptance friends and lovers as having betrayed your fat-acceptance beliefs, and they would abandon you.  At that time, you told me that you had no desire to get under 250 lbs., and that if you got anywhere close to it, you would try to stop your weight loss, because you consider yourself beautiful as a fat woman and didn’t want to lose  your connection with your fat-acceptance identity.  And yet, less than a week ago, you posted this:

 

Post Date 1/27/09 1:13 am
Topic: Big WOW -- made it to "Twoterville!"

Woo Hoo!  I'm in the 200s!  For the first time in --- damn, I can't remember.  15 years?  More?

Went for my 6-month physical.  Healthy except for some vitamin deficiencies and mild anemia.

Have lost 122 pounds so far -- right on track for my personal goal weight of 180.  Woo hoo!!!!!!!!!!!

I can't believe how well the DS works.  I have no regrets!

 

Now, just how do you explain this??  Why has your goal changed so drastically?  If you were so happy being fat, why do you want to get to such a normal weight now?  If as you say, you can be fat and healthy, and you think you are beautiful FAT, why not start putting the brakes on now, so you can stay FAT and healthy?

 

Third point: OMFG – how DARE you walk up uninvited and tell people who are contemplating WLS that you – with NO qualifications WHATSOEVER – don’t think they should have WLS??  That is unspeakably judgmental, arrogant, rude, impertinent, obnoxious – I’m running out of words to describe it.  It is absolutely as despicable as thinking it’s OK to walk up to an MO person and asking them if they have considered WLS!  And what is worse is that it is SO self-evidently based on your FAT-ACCEPTANCE BIAS, coming from trying to reconcile your fat-acceptance past with your current situation.  How DARE you judge whether someone is unhappy enough – whether based on physical disease or pain, or emotional pain! – to qualify for WLS based on YOUR terms.  Good for you that you were happy at a BMI of 72+.  THEY are not, for their own reasons.  The SURGEON is responsible for giving them a MEDICAL opinion of whether WLS is appropriate for them, NOT YOU.  This is like some perverse reverse self-loathing – if someone isn’t happy at a BMI that you spent YEARS invested in seeing as OK, it somehow lessens your own happiness?  This is very disturbed thinking Julie – and your taking action on it and involving others in your distorted thoughts and upsetting them (yes, I have received PMs begging to be reassured after you have upset these pre-ops at Rabkin’s meetings) is unacceptable.  JUST ******G STOP IT!  It is NOT your place to do this to people.

 

Fourth – just because YOU think fat people are beautiful doesn’t mean everyone should.  You purr about how you modeled, loved how your body looked, and had many lovers at your fattest.  Well whoop-de-doo.  Just as there is a subset of people in the world who find anyone with an ounce of fat on their bodies disgusting, there are people who find super morbidly obese people sexually appealing.  I consider both to be fetishists – they are judging sexual attractiveness BASED ON SIZE.  Either viewpoint is biased.  There are many many people who don’t judge based on looks – but those who seek out super morbidly obese people as sexual partners are generally either fetishists, or are looking for situations where the partner will be less likely to be judgmental about their own deficiencies.  Note that I am not saying ALL relationships where one partner is MO or SMO – I’m talking about the ones that originate in and because of the self-selecting social setting of size.  So pardon me if I find your viewpoint skewed by your long-term association with the fat-acceptance movement.  That you found acceptance there is great – that it somehow justifies your biased views of others is not.

 

You point to this as somehow justifying your view: “Before having my DS, at least two people showed me their before pictures and referred to their before selves in some derogatory fashion."  I hope one of those wasn’t me – I showed you my before picture to demonstrate where I came from compared to where I am now, because it has been my experience that pre-ops seeing a “normal" person can’t fully imagine what that person was like as a fat person – and a picture is worth 1000 words – and I probably commented that I didn’t realize how big I was at the time – do you consider that to have been derogatory?  What is it to YOU if I didn’t find myself attractive at that weight anyway?  Did I have to accept and love myself being FAT to be considered OK by you?  I don’t accept fat discrimination in the workplace, or making fun of fat people as acceptable, but that doesn’t mean that I have to accept being FAT as an acceptable lifestyle for myself, nor do I have to have some sort of moral reconciliation with myself about how I felt about myself fat vs. “normal."

 

Finally (because I just can’t stomach this anymore), you are right that for the DS in particular, there are no studies going out 20-50 years, because the surgery was first performed in 1988.  However, even assuming that our life spans are compromised by having the DS (which I think the data cited above ALREADY refutes), the fact remains that almost every one of us is so much happier after our DS, that we would be willing to risk a shorter lifespan for the improved qualify of the life we now have.  So, your unfounded scare tactics are just so much bull**** ab initio.  Again, from the Marceau long-term study:

 

Finally, one of the striking conclusions of this study is that, in spite of the inherent mortality risk of the bariatric surgery, the long-term outcomes are more positive than the mortality risk without surgery. Furthermore, in spite of the side-effects which are not minimal, the overall patient satisfaction dominates. These two points hiighlight the profound effect that morbid obesity has, not only on mortality, but also on quality of life.

 

Julie, you are certainly entitled to your “opinions" – but as I think you have seen here, they are not shared by the majority of us who have lived our own lives with morbid obesity.  I think your views are very much colored by trying to reconcile your years of living in the confines of the fat-acceptance movement with your having WLS to save your mobility and your life, and your current opinions are a thinly-veiled rationalization, based on FALSE data (i.e., LIES) that attempt to shoehorn your previous views into consistency with your current life.  You are welcome to look through whatever color glasses you need to make yourself comfortable with your decisions, but DO NOT BASE THEM ON, NOR TRY TO SPREAD, LIES.  We will call you out on them every time. 

 

And PLEASE leave your obnoxious proselytizing of your medically unsound views to pre-ops at the door – you are NOT entitled to do that.

 

Diana, I love you.