The Road to Bariatric Surgery

(Part 1 can be accessed here - The Life That Led Me to Bariatric Surgery. )

When I decided to have Bariatric Sleeve surgery I knew I did not want to announce it to the world. I needed to keep it quiet and secret to all but one or two close friends and relatives. My reasons were simple. I had made my decision based upon my own issues, needs, and what I felt was best for me. I did not want to listen to a litany of opinions and admonishments. Most of all, I did not want to be scrutinized, as had happened any time throughout my life when I was foolish enough to tell anyone that I was dieting.

Every morsel that went into my mouth was commented on; my body was examined every time someone saw me. Did I look like I had lost weight? Did I look like I had gained weight? Discussed in front of me and behind my back were the questions and statements………..Why DIDN'T I eat this or that? Why DID I eat this or that? I SHOULD eat this, not that.

No, this was a private decision, a private battle, a private journey. IF the time came that it was successful enough that it was highly noticeable, I would tell my story.

As with any major medical procedure, I did, however, have to inform my immediate family, which consisted of my sister and my son. Besides them, the only other person I decided to tell was one of my closest friends, one who shared my weight struggles. We had seen each other through 4 different sizes in the 12 years we had known each other. Her reaction shocked me. She said that I could take the “easy way out” if I chose, but she was sticking with Weight Watchers. “Easy Way Out”?????????? Anyone who categorizes weight loss surgery in this manner knows nothing about what is involved. It requires months of determination, persistence, perseverance, and commitment just to go through the Pre Surgery Program. Much more is involved post-surgery.

Because I was a member of the Cleveland Clinic Health System, I made an initial appointment with their Bariatric Department Head Nurse. Upon entering the building, I was confused and lost, as there seemed to be an endless array of long corridors and doors leading every which way. I was also in extreme pain from my back issues, and even with leaning on my cane, it was very laborious for me to walk.

I do suppose being more than 100 lbs. overweight had something to do with my difficult mobility, but I was not about to admit that to myself or anyone else.

As I stood looking around, a woman came up to me, pointed to the left, and said, “The Bariatric Department is that way." For not the first time in my life, I was appalled. How could she know that was the department I was looking for? Yes, of course, I knew I was fat, but I had never been able to reconcile my perception of my size with the ACTUAL size that other people saw. Now totally insulted, in terrible pain, and out of breath, I hobbled down to the correct corridor.

The Bariatric nurse was tall, blonde, beautiful, and THIN. Damn. However, she was also knowledgeable about weight issues, and completely understanding. After an hour of explanation, I left there with a large three-ring binder of information and instruction as to what was involved before I would be allowed to undergo the surgery. Here is the laundry list:

1.Medical clearance by a primary physician

2. Medical clearance by a cardiologist if needed – I required a stress test and echocardiogram.

3.Medical clearance by a pulmonologist if needed

4.Endoscopy by the bariatric surgeon to determine the condition of the esophagus, stomach, and surrounding areas

5.Psychological clearance

6.Blood lab work at beginning of program and 30 days before surgery

7.Minimum of three dietician appointments

8. Multiple classes of pre-op teaching, involving an explanation of surgery; what to expect physically after surgery; how and what to eat before and after surgery

9. Attend at least one ongoing support group.

10. Lose 5% of body weight before surgery to show commitment.

11. Two-week pre-surgery minimal calorie, no fat, no carbohydrate, no salt, high protein diet

12. Show commitment to the program by attending all scheduled appointments.

This is NOT an “easy way out”. It involves a tremendous amount of perseverance and commitment. Most importantly, the surgery is a TOOL to help you lose weight. It MUST be combined with a strict diet, behavior modification, and exercise.

You don’t have the surgery and magically lose weight without any effort. What the surgery does is ENABLE you to stick to that diet you have been unable to stay with your entire life. It reduces the size of your stomach, so you cannot hold much food, and it reduces the hunger hormones secreted by the stomach.

Hunger hormones? I had never heard of them. The nurse explained that in people with the disease of obesity - yes, obesity is now classified as a disease - the hunger hormones do not work properly. They do not shut off after eating a normal meal, as they do in non-obese people.

At that moment, a giant, cresting wave of relief overcame me and washed away a lifetime of self-loathing. I was not a weak-willed, lazy slob, just a few of the names that had been attributed to me over the years. There was an actual, medical, scientifically based reason I ate uncontrollably. I felt vindicated and hopeful for the first time in decades that it was possible for me to lose the weight.

As you can imagine, the most difficult part of the pre-op requirements was trying to lose 5% of my body weight before surgery. EVERYONE, including me, who hears about this requirement says the same thing. If I could do that on my own, . Any legitimate bariatric program will insist upon this requirement in order to demonstrate your commitment to the program.

Once ALL of these requirements are satisfied, and believe me, they are very strict about it, you are approved for surgery. It was a 6-month process for me, fraught with frustration and tears.

NEXT: Part 3 - My struggles through the requirements.