The Zone Diet
Melinda, who just had weight-loss surgery, identifies what she calls the blue zone and the red zone of the weight-loss surgery world.
On the one side are the people who truly believe with every bit of their being that WLS is bad and evil and unnecessary…They will call WLS mutilation and amputation and deformation, because it is the worst thing they can imagine anyone doing to themselves.
On the other side are the people who think that WLS is nothing short of a miracle, the answer to every medical problem ever associated with being obese.
She puts herself somewhere between these two camps, in the “green zone.” And Anne, in the wake of the Star Jones revelation, is dealing with conflicting feelings herself:
People, I understand why Star Jones didn’t want to talk about it. Because it feels like an admission of failure. It feels likes saying you know what? This diet thing isn’t working, and I cannot do this any more. I can imagine that it might have felt like publicly calling yourself too fat, and too stupid to lose weight.
Kate Harding has also written about this issue recently:
Weight loss surgery doesn’t just make you thin; it makes you physically unable to eat large quantities of food and in most cases, much less able to digest fatty or sugary foods. So basically, it forces you onto exactly the kind of diet already recommended to control diabetes, high blood pressure, and cholesterol — the kind of diet that, absent WLS, might not make you much thinner, even if it makes you much healthier.
And of course, there’s plenty more pro and con WLS blog entries out there (most of them firmly in one of Melinda’s zones). So what do you think? Is WLS miraculous, evil, or somewhere in the middle? Are fat acceptance and weight-loss surgery mutually exclusive? And if not, how do you reconcile the two?
(Thanks to Melinda and Anne for writing about their WLS experiences with such honesty.)
Posted by mo pie
Filed under: Celebrities, Star Jones, Weight Loss, WLS
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Maybe I’m in a green zone. I feel like I can live with being fat, for the most part. I can do almost everything I want to do, and my friends and family love me how I am. But I’m thinking more and more about WLS because of the health factor as I get older– I have some ongoing back/joint issues that are exacerbated by the weight, and while I haven’t had any major health issues yet, I’m terrified of diabetes or worse. As I approach 40 and people in my family are aging and dying, it’s occuring to me that I may not live into my 80’s in the style I’m going. And with more than 100 lbs. to lose and a long track record of falling back into old habits after every attempt at lifestyle reform, WLS is starting to look like a sort of reasonable approach to get me where I need to go. It’s scary, it sounds incredibly hard, and no, it doesn’t work for everyone, but it works often enough.
So, I do think you can accept your fat, honor the diversity of body shapes in this world, admit that really what needs to happen for your health is a change of habits, and yet, still recognize that WLS might be the best way for some people to salvage their health.
My answer got long. :) You can come read it if you don’t mind the babbling.
http://squares-ville.blogspot.com/2007/08/what-zone-are-you-in.html
I do not advocate for WLS anymore than I advocate for dieting. That said, both are personal decisions that people need to make for themselves.
I think that what, for me, is the most frustrating is that there are not good statistics that are easily accessible for folks about the very real risks of WLS – not only the complications, but the mortality rates. This information needs to be available for people to make an informed decision about whether this is a choice that will improve their health and quality of life.
I also think that losing weight has such emotional baggage attached to it that everyone who is being okayed to undertake WLS should be mandated to receive a psychological evaluation and undergo therapy for a certain amount of time. (But, I’m a therapist, so there you go.)
I think there is a lot left to learn about WLS. My personal suspicion, to put it bluntly, is that messing with your digestive system in such a significant way will prove to have long-term health effects (or risk of premature death) that outweigh those a person would have faced from just staying fat. People always start with a baseline assumption that being fat is so unhealthy that anything that “corrects” that must be an improvement healthwise, but I don’t think that’s necessarily true.
But we won’t really know about that for many years to come (the newer, thought-to-be safer methods haven’t been around that long yet) and I hope I’m wrong, since so many people are opting for the surgery these days.
As for my opinion on the surgery, I wouldn’t do it myself but I would never tell someone not to. Their body, their choice. I wouldn’t like to see them go into it uninformed, or to be swayed by doctors who make a profit off the surgery… but most people seem to do a ton of research before they undergo the procedure, so that’s a good thing.
Spins, this might surprise you but the vast majority of WLS patients DO have to undergo a psychological evaluation; most insurance companies require it because they want to make sure that people are truly ready for the surgery (I not only had to see a psychologist, I had to undergo two personality assessment tests).
As for the statistics being easily accessible, they seemed pretty readily available to me when I was doing my research before deciding to go ahead and have the surgery. And because those statistics were available to me, I was extremely careful about which surgeon I chose and I specifically chose my surgeon because he A) is extremely aggressive in his pulmonary emobolism prevention B) does not automatically remove your gallbladder and C) has not lost a single patient or had any reported problems with leaks.
And I will be the first to admit that unfortunately, a lot of people do not take the time to research, and instead dive in head first, only to be surprised when there are complications. For me (because of my research) it was the opposite; I’ve been constantly surprised that there have been zero complications for me. WLS, just like ANY medical procedure, is something that needs to be decided upon after becoming as well-informed as possible about it.
That said, I’m not here to advocate the surgery; it’s what was right for me, but it’s not what’s right for everyone. What I am advocating is everyone deciding not to judge anyone else for their health care choices.
Melinda: Thanks for the info. Where did you find the info on mortality and side-effects? I’d love to have that information.
I worked with a client who did WLS, so I’ve had to work on my personal issues around this a lot. It’s why I continue to be clear that each person’s choice is their own, even while that is not the stance that I advocate.
My very limited experience was that the client was not evaluated, and no one ever contacted me as her therapist about it (which I know is not required, but being the therapist of someone who was considering such a surgery, I would have had valuable imput to the care team). It may be that I am mistaken on the first point and was just not informed by the client.
I’ve had my mind changed about WLS by knowing a woman for who it worked very well, and via Anne’s blog. I think the phrase that best describes me is one my doctor and I said almost simultaneously when discussing my weight, in that I am “not a candidate for weight loss surgery” — his opinion based on the fact that I’m “only” 220 pounds, my feelings is that its just not something I’d do. It seems too permanent for me.
That said, I learned that there USUALLY is a major screening process but the trouble with us Americans is that we don’t always follow the rules when we want something and we want it now. For every person who probably shouln’dt get the surgery because they’re not, “a candidate”, there’s probably at least 5 unscrupulous surgeons who will sidestep or otherwise get around the screening procedure and basically say, “you can make that check out to….” But you can say that about lots of elective (and semi-elective) procedures. All sorts of plastic surgery.
WLS appears to me to be successful, when (like all weight loss) the candidate approaches it fully knowing their own strengths and weaknesses, and has committed to the plan of action by taking responsibility for their progress. When you approach WLS as the end all, magic bullet, you’re going to be as successful as anybody who is looking for a magic bullet ever is.
Again, it’s not for me, but it’s not for a lot of people, but it is for some.
For me, WLS is such a scary proposition that I’d have to have *very* serious health problems before I considered it. I was horrified to realise, long after I lost weight, that I would have qualified for the procedure.
I lost almost all of my excess weight with help from Xenical; for me it was the magic bullet. (I’m the person who sparked the thread a while ago about Xenical as an alternative to WLS, but very few people responded.)
I don’t know what the situation re counselling before WLS is like here in Australia, but I suspect that it’s as easily circumvented as it appears to be in the US.
I’m now going through the long and expensive process of having plastic surgery to fix the loose skin from my weight loss. Just before my first operation, the surgeon was marking me up for surgery when he said, “I don’t know where you found the backbone to lose all that weight on your own. Everyone these days has a Lap Band!” – as though it were the latest fashion. Of course, as a surgeon, he would suggest a surgical solution, but it still freaked me out.
Personally, I wouldn’t recommend WLS, but as others have said, it’s each person’s decision to make. I had a vertical banded gastroplasty 10 years ago when I weighed 350 lbs (I’m 5′ 8″). I had been on fen-phen for 6 months and was losing weight, but when it got taken off the market, I started regaining and my doctor decided WLS was the way to go since regular diets didn’t work long-term for me. I lost 70 lbs in the first couple of months after the VBG. Then, on doctor’s advice, I started adding regular foods instead of eating everything mashed or pureed. That was the worst mistake I ever made. Almost everything I ate ended up coming back up. When it got to the point where I could eat without losing everything I ate, my stapling had come undone from all the vomiting. I not only gained back the 70 lbs I lost, I gained an addtional 40 lbs. My doctor wanted me to have the VBG done again, and I refused. So here I am today, at 390 lbs, healthy (as I’ve always been, my blood pressure has never been high, my blood sugar has always been good, and so has my cholesterol). The only reason my doctor wanted me to lose weight was because I have arthritis in my right knee (I used to rollerskate as a teen/young adult and every time I fell, it was on that knee) and I have back problems from a fractured pelvis (I was a pedestrian hit by a car when I was 19). Doctor said my weight was causing the problems and refused to do any testing to see if there was another cause for all my pain until I lost weight (because we all know that fat is the cause of everything wrong with us, there are no other reasons…..yeah, right). So now I see another doctor (got married and moved) once a year for a physical and general 100,000 mile check-up. As long as the numbers stay where they should be, I don’t care if I lose weight or not.
I had a good surgeon (he teaches other doctors how to do WLS at the U of MN), but my primary care physician wasn’t very good with the follow-up care. I did all the psychological testing, did a lot of research on my own, and thought it was a good idea. Hindsight is 20/20 and if I had known then what I know now, I would have passed on it. When people ask me about it, I tell them what happened to me, and let them know that I don’t think it’s a good idea, but that it’s their decision to make, and I give them all the information I’ve dug up in the years since I had mine.
I got a lap-band almost four years ago now. At first it was awesome. The miracle I needed to help me not be hungry. Now, I’m still not that hungry, it does keep me from eating as much as I used to (I consume roughly 25% of the calories I did pre-band) but my metabolism has adjusted such that I now weigh within 10 pounds of what I did when I had the surgery. I never dropped below 250.
I exercise regularly. I eat well. My body wants to be fat, and there’s really nothing more that I can do. So now I have a band where I didn’t before, and I’ve given myself an eating disorder because there are things that I loved that I can’t eat anymore (sushi – pure evil, the sticky rice gets stuck) and some of the toughest things to eat are fibrous fruits and vegetables. I still eat them, but it can take me 90 minutes to eat an apple at top speed.
If I could have the thing removed, I would.
Sony and Vesta – I’m sorry you’ve both had such lousy experiences.
Sony – Why can’t you have your lap band removed?
A very interesting read over at Shapely Prose. It heightened my conviction that the medical community (well, at least the bariatric surgery sector) is glossing over facts about WLS. After all, there’s a lot of money to be made.
I generally keep still about my opinions of surgery because there are people I like and respect who’ve had it, and I don’t want them to think I don’t like and respect them. But I think it’s too radical unless one has an immediately life- or mobility-threatening condition. Any surgery offers the chance for deadly complications, so my standard for going under the knife is, “You died on the table and came back to life long enough to explain yourself to your loved ones. Can you get the words out?” If I’m undergoing surgery for something life-threatening, sure. Cosmetic? I just can’t see it.
Further, if I lose weight by eating a severely restricted amount of high-quality, nutritious food every day and I decide that that lifestyle is no longer working for me, I can change it. Cheaply, easily, and without medical risk. And I don’t have to explain myself to an insurance company.
Of course, in the interest of full disclosure, I must say that I’m searingly envious of people who get WLS. Who wouldn’t want to lose so dramatically and with such an apparent lack of effort?
This is where writers such as Anne are so valuable, opening up so people can understand the interior struggle WLS patients undergo. In spite of my own pettiness and bitchery, I think Anne is the bee’s knees and everyone on both sides of the WLS discussion should read her column. Perhaps if more people understood that it isn’t easy, there’d be less jealousy and judgment [a climate to which Star Jones contributed by acting for so long as though she something of which to be ashamed].
P.S., though: Depending on the type of surgery, WLS is mutilation and/or amputation and/or deformation. That doesn’t make it bad. But words mean things. Shying away from accurate words because you don’t like their connotation just gives your attackers more power — cf. people who will say “fluffy” but won’t say “fat” are tacitly agreeing with people who think fat is bad. Why not say, “Hell yes, I mutilated my stomach — and I’ve never been happier. What’s it to you?”
I have an aunt who had WLS surgery so I’ve seen the pros and cons first hand. As with any weight loss choice, you have to take into account everything that goes along with it and be willing to stick to it. I’ve seen people who have had surgery yet don’t change their habits and still gain the weight back.
I’m at a point after many months of dieting and exercising-with doctors and nutritionists and fitness coaches-and seeing no results that I’ve considered all versions of weight loss surgery.
I feel that if you have tried everything that is possibly out there for you and you still cannot lose the weight and get to a healthy point in your life, sometimes you need that extra surgical help.
If I myself were to choose WLS, I would go with the lap band option mostly because it’s not as permanent. i haven’t done enough research yet and it would take a lot for me to decide to do so.
I don’t like to see people work their doctors in order to get the surgery simply because they do not want to do the hardwork. I myself struggle daily with changing my habits and lifestyle only to have no change whatsoever. As with anything, it’s a personal choice and only YOU know if it’s the right one for you. No person should be looked down upon for choosing to have WLS.
“On the one side are the people who truly believe with every bit of their being that WLS is bad and evil and unnecessary…They will call WLS mutilation and amputation and deformation, because it is the worst thing they can imagine anyone doing to themselves.”
I’m in that camp, I really believe this surgery is barbaric.
there is some antecdotal evidence (stories, right now) that many people who have WLS have problems with drinking, shopping, or other “self-soothing” behaviors.
i’m not saying this is the case for all people, but is worth noting that WLS won’t cure what really ails you, if you don’t deal with the underlying problems.
personally, i’m in the green zone, but i think it’s a real last resort, because i’m generally opposed to any invasive procedure unless its medically necessary.
I had one of the several flavors of WLS there are available, and it was indeed the best thing I’ve ever done. I’d do it again in a heartbeat.
However, there are certain Weight Loss Surgeries that I consider barbaric, too.
I think the key for anyone even wavering on the brink of considering WLS is to research ALL of the available surgeries. There is the BPD/DS (Biliopancreatic Diversion with Duodenal Switch), the RNY (Roux-en-Y Gastric Bypass – the one that Al Roker & Carnie Wilson had), the Lap Band, the VBG (Vertically Banded Gastroplasty), and the VSG (Vertical Sleeve Gastrectomy).
There are very different rules associated with each of these surgeries, governing things like diet, exercise, and vitamin supplementation. They are definitely not done for vanity reasons, and the vast majority of those having WLS are having it for true health concerns, like diabetes, sleep apnea, and hypertension.
I’m in the “green zone”, too, I guess. I am debating WLS right now, and I go back and forth. I feel ashamed that I can’t lose weight the regular way, that my willpower is shit and I am lazy and it’s just not working for me, and I feel like surgery is a cop-out — but only for me, for anyone else I applaud them. This is because my self-image is totally healthy and appropriate.
Anyway, my take is that it’s one of those personal choices – it’s not for everyone, it has risks and benefits, and it all boils down to you alone, to what you personally think and feel and believe. It’s not something you can try to convince someone to do or not to do, it’s something you have to decide all by yourself, because it’s your body and it’s your choice.
Susan – I paid cash, and chose not to go to Mexico to do it. I also had a break and had to have the port replaced a couple of years ago. Between the two surgeries I’ve sunk 40K into the band, and had a lawsuit since Allergen (who now owns Inamed) refused to pay the inflated fee the hospital asked for. Removing it isn’t covered by insurance either, unless it becomes life threatening. It has destroyed me financially. It will be several years before I can recover that to the point that I can consider paying to have it removed.
Hey all, you know – I read all of these posts with a great deal of interest. I guess my feeling about this surgery is the same as my feeling about any elective surgery – including non-reconstructive plastic surgery. Somehow I think, maybe naively, that doing stuff to your body when it’s working fine can’t do anything but upset its natural equilibrium. So it’s great to hear other people’s opinions to the contrary and testimonials.
But the post that made me stop and get upset was Sony’s second one. That really hurts (and I’m not even the person who’s gone through this). I can’t believe that the break, and the eventual removal of the lapband, wouldn’t be considered/predicted in the initial cost as follow-up care. To make a crap analogy, remember when you get braces and what your parents pay at the outset covers anything that will ever, ever, ever happen – even a million years later? Perhaps that information should be included in the literature on pros and cons of the surgery – that, beyond complications, some people just want the thing removed after a time. And they will have to pay dearly.
My husband has said he thinks surgery is a ‘copout’ but as I’ve known someone who’s died from complications from WLS, I can’t see it that way.
The fact that one is made to feel inadequate for attempting to be exactly what society wants him/her to be — thin — is just another example of how deeply ingrained fat hatred is in our society. We’re damned if we do, damned if we don’t.
My husband & I both had RNY on the same day, one of the best things we’ve ever done. We did massive research on all types of WLS available, about our surgeon and his program, and spent a lot of time consulting with our PCP who was the one who advocated for us to have the surgery. I would do it again in a heartbeat. I own it and I will never be ashamed of it. As far as this being a recent phenomenon and time will tell…this surgery has been around since the 60s and I had a friend who did it in the 70s and she’s still alive and happy. I do not advise anyone have the surgery until they’ve done everything they can to lose weight by diet and exercise AND who have decided (after thought and research) that it’s the right thing for them to do.
We have not had one complication and we both feel very good 6 mos. out, but then again we are following the instructions of the surgeon, PCP, nutritionist and the program staff to the letter. I know that we could experience problems in the future, and we will deal with it if it happens. That’s a risk I was willing to take and I stand by that. We have and will continue to work on our heads and strive to understand why we overate and became morbidly obese. We went through months of classes and psychiatric evaluations so we were full prepared for this change of lifestyle and body. I don’t believe it’s been a cop out or the easy way out. It’s hard and worth every minute to me. I eat the small portions of good healthy food that I could not control in the past. It’s not right for everyone, but for those who do the homework and have come to this very personal decision, it can be a wonderful thing.
Sony – thanks for explaining your situation. That sucks! I hope it all works out well for you.
This is a very thought-provoking thread.
I guess my feeling about this surgery is the same as my feeling about any elective surgery – including non-reconstructive plastic surgery. Somehow I think, maybe naively, that doing stuff to your body when it’s working fine can’t do anything but upset its natural equilibrium.
Just thinking about this comment in relation to my plastic surgery. I guess my tummy tuck could be described as reconstructive, as it included a muscle repair. As is the case with many obese people who carry a lot of extra weight in their belly (and some women after pregnancy) my abdominal muscles had separated. I didn’t even realise this until my consult with the second plastic surgeon. He made an offhand remark about how the tummy tuck would strengthen my back. It’s been a godsend – I was plagued with lower back pain and now, not only am I pain-free, but I can do things (like deadlifting) that I wouldn’t have dared to do before. I wish I’d had the operation earlier.
But getting back to the cosmetic aspect, yeah it’s vain, but it’s done wonders for my self-esteem. I can’t tell you how disheartening it is to lose weight through diet and exercise yet still end up looking “fat” due to loose skin and, as the surgeon put it, “fat cells which have shed their contents”.
I can understand why people wouldn’t want to have cosmetic surgery after losing weight, but for me, it’s just finishing off the job.
The first questions I asked my doctor were about the long-term research data and long-term prognosis for WLS. She explained to me that WLS had evolved from decades of surgical procedures performed to treat stomach and intestinal cancers and diseases after which patients lived long healthy lives. She referred me to a surgeon whose specialty is abdominal laparoscopic surgery, NOT bariatrics. I did my homework, I have a wonderful, very knowledgeable doctor, an awesome surgeon, I did everything they both told me to do. I’ve had zero complications and came off SEVEN daily medications including Avandia and the same blood pressure med taken by my 96-year-old aunt. I feel fortunate and grateful every day of my life.
You know how valuable anecdotal evidence is. Two years ago WLS was all the rage at my workplace and several people had it done. Each dropped some amount of weight, some more than others. Every last one has gained at least 25% of her weight back at the two year mark, and gaining. I think it is great as a weight LOSS tool. The maintenance (diet and exercise) is no different from someone who did it without surgery, at least amongst my limited, unscientific (and unaware) research pool. I think in the long run, it relies on the dramatic loss itself as a motivator to maintain a lower weight. Physically, the body adapts enough to allow for unhealthy, ultimately fattening eating habits to creep back in.
I think the body adapts enough that some people maintain or gain even on the starvation rations they are giving themselves. For some it could be changes in eating habits returning, but others seem to just keep doing what they are doing and still find they can’t lose any more.