How to Lose 70 Pounds, (part 2)
**OR: "Isn't Bariatric Surgery 'the Easy Way Out'?"
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*Note: I recommend reading ‘part 1’ before continuing with this segment of my story. But by all means, if you’re feeling rebellious, I salute you!
When I finally made my decision that bariatric surgery was a good decision for me, I immediately felt anxious. I believed it would be a great tool for me in getting back on track with my health. But there were so many unknowns.
Is this the right decision after all?
Who should I tell about it?
I thought about the hypothetical reactions my church members, colleagues, and friends. What would they think about the idea?
What if I end up regretting it years down the road?
Is major surgery worth the risk when there are alternate safer treatments available?
My mind hummed with potentialities.
So throughout the summer of ’15, I began talking with many of my closest friends and family about the course of action I was considering. For the most part, these people I trust reacted with curiosity and positivity to the idea. So even though I only had a small sample of how others might absorb my news, I couldn't help but begin to think that it could just be reasonable.
Yet I still had great fear of the unknown. I’m a child of American subculture. I could hear implicit, unspoken, imaginary? criticism rattling between my ears, “isn’t that a little extreme?”, or “it’s too bad you feel you have no choice other than to take the easy way out”, or even “I had a relative, so and so, who tried this or that diet and it worked wonders for them”. Truth be told, it was more common for me to experience these expressions of incredulity solely in my head than in the real world.
We are funny creatures we humans. Full of prejudice and judgment, defensiveness and fragility.
Regardless of the cause, for my own state of mind and well being, I needed to exorcise these demons. (Back in college, a preacher I respect gave a sermon about how the satanic often embodies himself in our own negative and self-critical thought patterns. I use the word ‘demons’ here only partially as a metaphor.) In order to proceed with surgery, I had to work through answering that line of thought myself. And as I explained in my first post on this topic, giving myself grace was the first and most essential step in the process.
So without further ado, “Isn’t Bariatric Surgery the Easy Way Out?” (oh, and don’t worry, I’ll get to the details of some of the details of what the process has been like in just a sec. Hang with me here.)
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My first reaction to the question is “why do we ask it in the first place?” Why is effort, earning, and entitlement the subjects we go to when we think about someone getting help for their health problems? Why do we assume “the hard way” being morally superior to the alternative path?
If I refused to travel by automobile on the principle that it is “too easy” — and instead insisted on walking, claiming that because it's hard it's more desirable, my same imaginary critics would think my reasoning ridiculous. That sort of idealism pushes us too far afield from practical realities of life in the modern world. It might just be that over-valuing “the hard way” is actually idiotic -- not virtuous. And the more scientific research (let alone anecdotal reality) seems to be claiming more and more that self-control is a finite resource (https://www.apa.org/helpcenter/willpower-limited-resource.pdf), in the context of applying it to "the hard way" the idealization of willpower as a virtue becomes even more asinine.
My second reaction to the question about surgery being the easy way out leads me back to what I discussed in my previous article. In one sense, the line of thought contained in the criticism is rooted in the the application of what I’ve come to know as an immature model for human weight and metabolism. We're all familiar with that model. It essentially says: “Calories in, calories out. Stop eating so much and get off the couch, fatty.” This fallacious model made itself known in the comments section of my previous thread.
Incredibly common, it says that weight management is pathetically simple. A calorie is a calorie — consume more energy than you burn, gain. Create a deficit, lose. Simple. And so certainly within this model, the answers all really come down to self-control. And in a culture that so highly values proper reward for proper performance (whether the operating mechanism be entitlement or justice) — fat people are in a position of nothing more than reaping what they have sown. Furthermore, they are also kind of morally suspect because their bodies testify to a lack of self-control, a lack of earning, a lack of effort. As a consequence, those of us in American subculture who implicitly or explicitly subscribe to this metabolic model very naturally think of any weight-management plan that doesn’t exclusively rely on brute force self-control as “an easy way out”.
The Adventist tribe, of which I am a grateful member, has believed and taught for many years time that the healthiest possible diet is built first upon things that come from the ground: fruits, veggies, nuts, grains, etc. Although I would be slow to categorize Adventist health recommendations throughout the decades as being 100% consistently gold-plated or perfect, they've overwhelmingly trended toward accuracy and innovation. When this religious model is applied to an immature understanding of physiology, the perfectionism or judgment can sometimes be thick. It fits quite naturally into the broader American cultural phenomenon of earning. We only get what we deserve.
In my previous post, I dealt a little bit with this cultural artifact by suggesting a different window through which to view weight and metabolism: that of health and disease. "Grace isn’t opposed to effort," says the great theologian Dallas Willard, "it is opposed to earning". I’m afraid that for all the hot air expended insisting America is a ‘Christian’ nation, we have an incredibly difficult time embracing the very basis of Christianity: because God is love, people never get what they deserve (including that mansion on the hill or that persistent muffin-top).
The truth is that I have never received what I have earned. And neither have you. It's truly arrogant to assume otherwise. I interact regularly with people who complain about the entitlement of this or that segment of our population; how so and so expects certain rewards without having earned them — while at the same time these same individuals believe in their heart of hearts that all they presently enjoy was in fact earned. Neither ideologies are true - nor productive.
Life is full of hard work. And life is a gift. Insist that it’s exclusively one or the other, and you're bound to encounter or create problems.
My third reaction to the question about "the easy way out" leads me to a more helpful (and truthful) model for metabolism and obesity. There’s a reason that researchers and physicians are increasingly using definitive language to speak about weight loss surgery: “The only effective and enduring therapy for morbid obesity is weight loss surgery.” A clear preponderance of evidence and research presently points in that direction. This isn't to say that it's the only path. But its difficult to credibly argue that it's not a legitimate and useful treatment (far from the quackery I originally assumed it to be). And so to say that I was shocked about the truth I discovered in my initial research would be an understatement.
For people as heavy as I was (over 40 BMI and diagnosed with clinically morbidly obese), medical science has no more consistently effective option for returning people back to health. This includes the application of willpower through diet and exercise. The truth is that the odds of a person as heavy or heavier than I had become attaining a healthy weight through diet and exercise (read: self-control) alone is something like 1 in 1,200 for men and 1 in 700 for women (http://www.reuters.com/article/us-health-obesity-weightloss-odds-idUSKCN0Q42O020150730). I might as well pick up a hand-full of lottery tickets on the way to the gym.
Is surgery really the easy way out then when the odds are so highly stacked against the alternative treatment? Or is it more likely that surgery is only baffling because of the way some of us cling to adolescent idealism about our bodies?
It is my perception that an improved model for understanding weight and metabolism is coming into vogue. Scientific evidence of late is points toward a theory often dubbed as “set-point” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990627/). In very very simple terms according to my non-medical educational background), it says that body fat is a regulated body system not unlike blood pressure, temperature, cholesterol, respiration, hormonal, etc. This does not imply that intentional action cannot affect the fat system, but that it isn't as simple as imposing our will. According to a growing body of research, our bodies seem to gravitate toward a certain weight or settling point that it in turn defends rather vociferously to outside threat - this defense occurs in both directions and thereby helps to explain why some people struggle with weight gain (there are clinical diagnoses for such maladies as we know) as well as weight loss. When our bodies sense that fat content doesn’t match it’s internally recognized set-point, it automatically adjusts metabolism, appetite, mood, activity level, etc. to cope.
A calorie isn’t just a calorie after all (something my clinical nutritionist again reminded me of just last week). As a consequence of this highly tuned system, when we employ self-control to impact weight, the first 10% of loss is about the average we are able to change before our bodies kick in and ‘sabotage’ the process. It helps to explain why, for example, I’ve been eating ~1,000 calories a day for the past month, but only lost about 4 pounds total. You do the math. It doesn't add up. For most people, a 2,000 calorie a day diet would be normal — for me it would be severely over eating because my set-point is still being adjusted downward. It helps to explain why people who lose weight so often have a bounce back regain at the end — set point pulls them back. We've all lived within this reality, but haven't often had a systematic model for understanding it.
Some physicians and researchers work suggests that food is better viewed as a hormone than as an energy source. More than acting simply as fuel, different foods affect our body's defended set point in different ways. These researchers are beginning to think that food acts on our bodies something like a hormone: either keeping set-point down or pushing it up. This is complex…far less simple than I am able to absorb or convey. But as the author of the above study suggests, simply thinking of food in this way could potentially change a great deal for how we relate to healthy diets. Incredibly enlightening for me. Do a quick google search and you’ll see dozens of articles and studies on the subject. Again, this seems to point to something deeper about weight that we’ve also kind of known all along. Certain foods, despite their fat, calorie, or whatever content — are healthy and important for us (I’m thinking especially avocados, nuts, seeds, etc.). Others that would seemingly be great options because of their relative high ratio of tastiness to substance (think: splenda) are perhaps not so healthy.
Because of our lack of a thorough understanding of how this all works, there are yet mystery consequences to bariatric surgery. For example, one of the less-than-understood results is how it seemingly single-handedly resolves Type-2 Diabetes for many patients while they’re still in the hospital. At one of the insurance-required seminars I attended with the bariatric clinic in Spokane, the surgeon who would later work on me talked about how his patients consistently enter the hospital reliant upon injected insulin -- only to leave 3 days later with normal blood sugar and insulin levels managed only by their bodies' physiology. Scientific explanations for this phenomenon are still yet to be clearly demonstrated. But it certainly has something to do with the metabolic system that is apparently more complex than our standard American cultural model passed down colloquially. While surgery has more than one mechanism, it seems to fundamentally change set-point in and of itself.
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So that’s a lot of data. But the truth is that much of this research, reading, and growth helped me to have more peace with my fledgling decision. For right or for wrong, surgery became what I believed to be the best choice for me at the time.
And so now, here's a snapshot of the “easy way out” from my perspective. Please don’t read this as a sob story either. I have happily (even eagerly) embraced both consequences and associated hard-work in this process. The truth is that it's been far from easy.
Premier Protein and I have become close friends.
My initial consult with the surgeon was last May. It took place at his clinic in Spokane and continued to occur at least monthly all the way up until surgery this past December. This first visit coincided with an hour long consult with the clinic’s licensed nutritionist as did each of my subsequent visits. Monthly meetings with this individual continue to this day. By the time I hit Thanksgiving, I had dropped 20 pounds through following their program which essentially involved eating 5-6 smaller meals per day, and making healthy food choices within those meals. Cool.
Some people who love me greatly even suggested at that time that I just continue on the plan and forgo surgery because obviously what I had been doing was working. In a sense, they were correct. However, my 'success' hadn’t given me the same hope given the fact that losing 20 pounds for me had kind of become like saving up for a vacation. Not always the funnest thing but because I had done it more times than I could count, I knew it was possible. Part of the reason I had registered such despair with my primary care doc the previous April was precisely because of this cycle: the first 10-30 pounds is the easy part. Truly. It's only after this that the wheels come off the wagon. My weight (as is the case for most people with obesity) always came right back with a vengeance.
As of thanksgiving last year, I was traversing on well-trod ground. Nothing was new.
My surgery was scheduled for the first of December. Part of the insurance and clinic required workup included a battery of tests: psychological, blood work, heart, etc. (truly the easy part). More substantially, they required a mandatory 2-week liquid diet before surgery. Bye-bye Thanksgiving dinner (and Christmas too, but we’ll get to that).
The idea is that for people as heavy or heavier than me, an enlarged liver is common. This physiology can be problematic for surgeons who use laparoscopic tools to perform the procedure (no, I don’t have a 10-inch scar across my abdomen; rather, I have 5 very small incisions). So all patients are required to go on this extreme diet for a minimum of 2 weeks in order to attempt to shrink the liver out of the way. (Indelicately put, I know.) On a side note, my process of weight loss has been quite the adventure in shedding vestiges of bodily dignity (and yet it does not approach that which my wife went through to bring our 2 sons into the world).
In any case, although I firmly believe I can pretty much stick to anything for just 2 weeks — please, imaginary friend, tell me again how what I did is the easy way out. I’ve never particularly relished Thanksgiving dinner, but throughout this past holiday season, I routinely registered the pain of loss as I sipped on my protein shake while my friends and family gorged on meats and sweets. And yet it was worth it. I did not put solid food in my mouth for about 10 weeks after that point. Easy (I know).
For my first surgery (you read that correctly, stay tuned for part 3), my wife had to take off two weeks of work, sacrificing paid vacation leave we could’ve otherwise used for family fun. I too had to leave church matters in the hands of wonderful volunteers and staff who had to pick up my slack.
The procedure took place in Spokane, and for the 48 hours leading up to surgery, I was not only relegated to liquids — but an upgraded? clear-liquid regiment. Super. Let’s just say that my G.I. system was a little less than appreciative. The morning of surgery, I weighed in 30 pounds lighter than my all-time heaviest weight from April of 2015. Good progress. Believe it or not, the policy of my clinic was that if patients show up at any appointment along the 6-month workup process having gained weight, their surgery gets pushed back in the schedule. This would include the morning of surgery. The folks I have been working with are serious about patients following their program — and about attacking the fallacy that having surgery is some kind of magic bullet. They only want to take people to surgery who are committed to permanent change in their lives.
When they wheeled me away for surgery, I was terrified. So was my wife and sister who were there with me at the hospital. I had never been under general anesthesia before and the fear of not waking up was palpable. This could be spun a number of ways: I like to think that I was willing to put my life on the line to give the gift of longevity and high-energy presence first to my family and second to the world. In other words, going through with surgery felt and feels like a courageous choice to me. And I’m proud of that.
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To close, why share all this?
Obviously, I'm at peace with my decision. I'm sure I'll have consequences in the future. God knows I've had moments of regret show up here and there along the way!
Do I write as an advertisement trying to convince others to follow my steps? Is it public self-justification? Well, neither I hope.
In the beginning of all this, I only shared my choice and my journey with a small group of friends and family. I didn’t want to go through this in secret because I'm all too familiar with the problems that can create. But I also didn’t want the whole world weighing in on my decision either. As a Christian, I strive to love all people -- that doesn't mean I have to trust all people with my most intimate battles. I have a somewhat public profession, I'm on stage at our church rather often, and people have begun to notice my new look. It's sometimes been awkward for me knowing how to respond to questions and compliments about my body. I'm flattered - and I also want to be careful about sharing too much. In many ways, weight-loss is a private matter just like many other issues relating to one’s health. There’s no reason to share it per se, although I do think good reasons exist sometimes.
By profession, however, I’m a pastor. I’m here to help people move the ball down the court a little bit. I love to help people grow. And my greater purpose in the world has to do with inclusion: helping people feel and embrace the fact that they are wanted and welcome at the table — that there is a place for them and a community of people who loves them as they are.
And so really, my hope in sharing my story here is pastoral more than anything else. It might be that for you or for someone you know, bariatric surgery would be a very helpful choice. It's certainly not right for everyone and I by no means am an evangelist. This journey is my own. However, my impression is that there is a cultural stigma around bariatric surgery. I've hinted to as much in each of these posts on the subject. I would hate to imagine people out there who feel like outsiders and losers for considering surgery -- and even worse ultimately shrinking away from it because they were too afraid of taking on the stigma. I would hate to imagine someone else going through what I did all alone, feeling like they are a failure or a bad person for needing that kind of help. I would hate for someone to think that it’s unspiritual to reach out to the medical community for these kinds of solutions to health problems.
And so as a pastor, I share my story to perhaps add a modicum of legitimacy to the path it represents. I believe this process has been God-ordained thus far and I’m looking forward to what will evolve out of it next.
If you’re being called to leap — in whatever sphere that might arise in — may you have the courage to do it. May you act with confidence and decisiveness. May you know that the Spirit is with you. May you know that even if the haters tell you that you're a lazy fraud, a cloud of witnesses cheer you on. You are the only one who gets to live your life.
Take hold of it. I hope I’m practicing the same.
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By all means, contact me via private channels if you’d like to interact with me on this topic. Or feel free to leave comments on medium.com, my site, or social media outlets.
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