Life Sustaining - The Impact of Bariatric Surgery

Bright green sugar-free Jell-O beacons in the brown plastic hospital cup. Two large cubes await consumption. It is the first post-operative meal. On the tray, alongside the Jell-O filled cup, is another small bowl of warm yellow-brown liquid – chicken broth. For the next several weeks these items will be the mainstay of your diet. First bite. The saccharin taste of the artificial sweetener in the Jell-O renders the bite almost too sweet. This is a strange taste - it tastes sweeter than you remember. Small bites. It now takes several bites to eat the portion that once would have been consumed in two rapid bites. Slowly. Slowly. Will the new stomach tolerate it? It stays down. No nausea. No urge to vomit. I think we are good. Now for the other bowl. The yellowish-brown liquid does not look appetizing. Compounded by a lack of appetite or even feeling hungry, putting the bowl to your lips to slowly sip the salty liquid it a slow process. One sip. Okay, it is staying down. Two sips, this tastes too salty. Three sips, do I have to drink this stuff for the next 2 weeks? What else in on the list of foods that I can eat on the liquid diet?

Alongside the tray is a water log displaying times and amount by ounces to check off. Rule one about drinking – you cannot drink 30 minutes before or 30 minutes after a meal. Rule two - water is the liquid of choice. Rule three – the goal is to consume at least 64 ounces a day, but that it going to take several weeks because your stomach is swollen and can only hold 2-4 ounces. It has had 85% of its pre-operative capacity surgically cut away. The gleeful anticipation of finally making it to bariatric surgery has now been countered with the realization that your relationship with food now is forever altered. A relationship that started to be forged shortly after your birth.

Everyday throughout American hospitals newly born infants are encouraged to suckle at the breast. It is instinctive. They know what to do. Even with a soft swipe down the cheek, the primitive rooting reflex is elicited and the infant opens their mouth and turns their head in that direction of the stroked cheek to search and latch onto a nipple. Intake of nutrients is one of the first exercises that we accomplish in life. Food comes to encompasses much more than providing our bodies with the necessary nutrients to sustain life. Food represents love. Food is comfort. Food is involved with social gatherings, work events and quick lunches with friends. We delight in trying new recipes or making a recipe that has been handed down for generations in the family.

Consumption of nutrients continues to take on new variations and cultural meaning as one age. From festive holiday traditions to the comfort of a beloved family recipe, we garner a sense of the familiar and perhaps even nostalgia for times past. However, in the United States, our love of food and eating has also correlating with ever increasing waistlines and “The Obesity Crisis”. Obesity related illnesses such a diabetes, hypertension, heart disease, stroke and high cholesterol take center stage in exemplifying this ever-increasing issue that not only effects adults, but also children.

With the increase in obesity, comes the growing practice of bariatric surgery. While obesity carries a litany of stereotypes and misconceptions attached to it, so does stigma follow for those who have undergone weight-loss surgery. Bariatric surgery patients are oftentimes told that they have taken the “easy way out”, and that all they really needed to do was eat healthier and exercise. This misconception exemplifying the lack of understanding of the multifactorial and complex nature of severe obesity. How unsupportive for individuals who have chosen to tackle the looming problem of their weight and inability to lose significant amounts of weight. Don’t many extremely obese people already feel separated from society? Haven’t they spent enough time feeling ashamed for how they look?

You cannot look at a person and know exactly their state of health. Seemingly skinny and acceptable weight individuals have high blood pressure, high cholesterol and other issues often attributed to being overweight, while “fat” individuals can actually be free of these conditions. The mantra of judging a book by its cover before you read it, or in the case of judging obese people before getting to know them, does not apply in a society focused on looks and the acquisition of material possessions.

As a child once remarked to his mother as she returned from the hospital, “Wait, I thought you were going to be skinny”. The physical changes will take time. In many cases, even over a year to realize a “normal” weight. Many do leave the hospital with unseen changes, aside from the surgical changes to their digestive system. Gastric bypass is considered a cure for type 2 diabetes and many people even go home from the hospital off their high blood pressure medications. While the metabolic changes are immediate, now the process of changing eating habits and learning to love physical activity begins.

So, what does undertaking a major, yet elective, weight loss surgery actual entail? Is it a simple and easy “fix” to lose weight fast? The answer is simply – No! Not only does one’s relationship with food change, but their behaviors as they apply to family and social gatherings are altered. The inability to tolerate the consumption of once loved foods. The ability to only take a few bites before feeling full. Taking that one last bite may even lead to nausea and pain. Changing from a mindset where one may live to eat, to one where you have to focus on your intake of the right foods to live is difficult. It is a major life shift.

The discrepancy between eating when you are hungry and eating due to emotions or boredom becomes strikingly apparent. Food becomes a chore to consume, not the pleasurable intake to boost the pleasure centers or literally feed food addictions. The gooey warm sweetness of grandma’s cinnamon rolls fresh from the oven slathered with the richness of sugary cream cheese icing is now replaced with eating a container of low sugar Greek yogurt with a hint of cinnamon using a tiny dessert spoon to regulate the size of the bite. No longer is the salty crunch of a potato chip a viable option.

Alternate snacking and food options have to be discovered. In a world now consumed with eating Keto, the options have increased. High protein, low carbohydrate foods are the mainstay of the post-bariatric diet to avoid the body using muscle as a means of fuel during this time where the body perceives that it is being starved. Consuming even 700-800 calories a day can be difficult. The chips are replaced with cheese balls made 100% of cheese that has been dehydrated to yield a salty crunch. The odd hollow crunch of the hard cheese is not the same, but it works. The binges of emotional eating also have to be harnessed. While the drive to consume excess food during heightened emotional states may still exist, the ability to consume the food is gone. Now, alternatives to dealing with emotional eating have to be replaced with activities like exercise, journaling or seeking support through friends and family.

For, there are consequences to eating the wrong food or trying to eat more than your stomach or digestive system can handle. Sugary food is now unable to be processed appropriately and can lead to “dumping syndrome“ which is associated with abdominal pain and diarrhea. A few bites of bread, pasta or rice expand in the tiny stomach pouch causing pressure and backing up in the esophagus because there is literally nowhere for it to go. The stomach has been alerted and it does not stretch. It no longer churns the food as one of the first steps in processing it for digestion. Each bite needs to be chewed, chewed and chewed some more. Chewing at least 30 times until the food is an unrecognizable pulp before swallowing is recommended. It doesn’t come instinctually, and one forgets in the beginning leading to pain, pressure and discomfort. You learn fast that each bite is to be small, savored for the taste and chewed to oblivion before being “safely swallow”.

To many, it seems like too much of a burden to undertake such a daunting task as to change from long patterns of familial ritualized eating of large qualities of rich and savory foods to the slow, methodical intake of food picked for their nutrient components and benefits. But, to those who have lost significant amounts of weight, even more than 100 pounds for some individuals, the benefits now outweigh the challenges of the process. Food is now a friend. Food is now not the enemy that made you obese. Food is fuel. Food is necessary, but not the focus of your life or the greatest source of pleasure. The new rituals have improved your life and, if done according to the recommendations of your surgeon, has set you on a path to a longer and healthier life. Bariatric surgery is a tool. It is not a quick fix. The most commonly reported regret – I wish I had done it sooner.