Tuesday, August 16, 2011

I guess I "cheated" but I don't care

The other day my attention was drawn to a post in an online "newspaper" where some blogger not only said that having weight loss surgery was taking the easy way out and cheating but also that, if you didn't agree with her, you were the kind of person who enables drug addicts!!

Part of me thought the whole thing was too stupid to respond to, but then I found out that not only was she holding herself up as example of how to lose weight the "right" way -- by eating only 500 calories a day and indulging in the sort of exercise program normally associated with exercise anorexia, but that lately (because somehow that didn't result in permanent weight loss – go figure), she's jumped on the whole juice fast craze and I just had to respond. (I admit it. It was the juice fasting pushed me over the edge.)

First of all, when did doing something the hard way become a morally superior option vs. being smart about it and using whatever tools are available to you? In all other aspects of our lives, using tools is seen as smart, not cheating. But in weight loss apparently the only true path has to involve suffering. Lots and lost of suffering.

Let's say you have two people who both love to garden. One of them uses gardening tools and even owns a tiller to help dig up the ground before planting. They use an electric hedge trimmer too. The other one does the whole garden using a teaspoon and a pair of scissors. Their results aren't as good as the first person, but, hey, at least they didn't "take the easy way out" by using power tools!

Yeah, when you put it that way, it sounds a bit crazy. But that’s definitely some people’s attitude toward losing weight. If it’s not as hard as digging a garden with a teaspoon, then somehow it’s suspect.

The whole "easy way” knock also assumes that we were never successful at long-term weight loss before because we didn't know what to do and/or weren't willing to do it. Then, instead of learning what we need to know and buckling down to do the work, we just waved our magic wand had bariatric surgery and the weight fell off and we never had a problem ever again.

Yeah, right. If only.

Perhaps there are people who fit that picture. But most of us have been on many diets and have worked hard many times to lose weight only to not be able to lose all our excess weight and be able to keep it off. We've been to the classes on nutrition and goal setting. We've read the articles and books on how to lose weight. We’ve kept a food journal. We’ve role-played dealing with food saboteurs. We've gone to the gym and taken up jogging.

We know what to do and we've done it many times before. It just hasn't resulted in permanent weight loss.
“But I know someone who knows someone who lost 100 pounds and kept it off for seven years!”
Good for them! It’s great if you can lose weight without surgery because, hey, it's surgery. Why not avoid it if you can? But it’s not a moral failing if you can’t.

Let's say you have two people who are both addicted to heroin. They both get clean. One does it by going cold turkey and the other does it by going to a clinic where they get counseling and methadone. Is the first person somehow "better" than the second?

There are people who would say so, but I am not one of them.

Does that mean that any way you lose weigh is okay and there is no cheating or "easy way out" in weight loss?

To be honest, I do think there are "easy way out" and "cheating" methods. But the ironic thing is that I would put the original author's methods in that category way before weight loss surgery!

Most people would agree that, if you do something extreme like only eat 500 calories a day for a month or drink nothing but juice several days a week, you are trying to lose weight via some sort of trick (a.k.a. cheating) that doesn't require you to make permanent changes to your life (a.k.a. taking the easy way out).

But weight loss surgery doesn't fall into those categories.

Now, it used to be believed that weight loss surgery worked because it forced you to eat less and, if you got a kind with malabsorption, not all your calories are absorbed. So maybe that’s where the whole “easy way out” and “cheating” ideas came from.
See, you get surgery and then you can eat anything you want because you won’t absorb the calories and you can’t eat a lot even if you want to. So you have to lose weight whether you want to or not and it’s easy!
Again, I say: Yeah, right. If only.

Yes, you don't eat a lot in the beginning, but that's because of medical necessity. As soon as you can eat more, you do. Plus, while you can’t eat as much at each meal as before, there is nothing to stop you from eating every hour or just drinking all your calories.

Then, with bypass, the malabsorption goes away over time so eventually you do absorb everything. (With duodenal switch, which is a lot less common, malabsorption is more permanent, but 100% of carbohydrates are always absorbed, so you still have to watch what you eat.)

As many have learned, weight loss surgery isn’t a magic fix and, if you don’t make permanent changes, the weight comes back just like it does when you juice fast or go on the HGC diet.

So why doesn't everyone who has weight loss surgery just eat around their surgery and gain all their weight back? Or better yet, why don’t they just do those things without having surgery?

It's because bariatric surgery fixes a part of our body that was broken - the homeostatic system that controls energy balance.

And this is where all these analogies fall down. Because weight loss surgery isn’t a “tool” like a hedge trimmer or methadone, as popular as that analogy is in the bariatric community.

It’s a repair job.

It’s a repair job in the same way that heart bypass surgery is a repair job. It’s a repair job that has various degrees of success – sometimes everything is repaired 100% and sometimes you’ve just improved the situation over what you had before. (And, in very rare cases, you fix one system, but break another.)

Then, once you are repaired, it’s up to you to make the necessary changes to keep everything from breaking again. Only now it’s a lot easier to do that because you aren’t working with broken machinery and doing things like exercise and eating less actually results in weight loss while eating as many calories as you burn doesn’t leave you ravenously hungry.

So I was broken and I chose surgery to fix me after exploring many other (reasonable) options without success.

If you think that’s cheating, I think that says more about you than it does about me.
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