The hardest decision I’ve ever made

(April 2021 Edit: I no longer post on this blog. For more of my writing, please check my links.)

Trigger Warnings: Eating disorders, WLS (weight loss surgery), Poor Medical Care

Sharing this is hard. Which is weird, since I am, by nature, an oversharer. I share because writing things out helps me process my feelings. I share because I remember when I was 15 and in a eating disorder unit and realized during group therapy, for the first time in my life, that I was not alone in some of the “crazy” thought processes I had. That feeling of someone understanding where I was coming from was priceless. If I can give that back to someone who is struggling, I very, very much want to try.

I hope people will not knee-jerk react to this and will read through my thoughts because I feel there are always many sides to a story and it’s easy to get caught up in our own feelings about someone else’s story, without giving them their safe space and chance to share. It’s a lesson I’ve learned slowly over the past decade or so, but a valuable one. No one is responsible for my feelings but me, and people are allowed to share whatever they want in their own spaces, even when I disagree. If they are respectful I will even try to put aside my personal feelings and not just listen, but hear the other person’s point of view. That is easier said than done, and I am stubborn and thorough in my decision making process. That means my beliefs and opinions are not easily swayed. Which is why, in part, what I’m about to share will shock so many people.

On Tuesday, March 6th 2018 I did something that seems to, on the surface, contradict all I stand for and believe in. I had a procedure called vertical sleeve gastrectomy. During this surgery about 80% of my stomach was amputated. Yes, I said amputated. This is a word that people who have WLS will likely find offensive but it’s also accurate. My stomach was a healthy organ and I chose to have most of it sliced away and removed from small holes in my body (the surgery was laparoscopic).

Why would I do this? I said for years that WLS was off the table for me. My body doesn’t have a great history with surgery. I’ve had complications from all three past surgeries I’ve had. I’ve spent over a decade as a non-dieter, happier and – in many respects – healthier than I’ve ever been. I’ve been working at body positivity, at promoting body acceptance, fat acceptance, body diversity… so why would I join the “dark side” and undergo a risky, possibly deadly and definitely life-altering procedure? The simple answer would be “to be thinner,” but few things in my life are ever simple.

In October 2016 I fell while on vacation. I was leaving a crowded little cafe in Minnesota. There was a rather high step down to the sidewalk I had somehow not really noticed on the way in. A large crowd had gathered by the door and crowds make me anxious for two reasons. First, I just hate people and I get claustrophobic. Secondly, when you’re my size getting through a crowded space is not easy. So given my anxious state I was definitely not paying attention and before I knew it I was on the sidewalk. My poor instinct to try to hold on to the door led to a massive injury to my right bicep. It was suspected I tore it, but there was no way for me to know for sure.

Why? Because in our fucked up culture, despite fat bodies existing (and based on the media hysteria, taking over the planet like some kind of zombie apocalypse), medical accommodations are not made for them. I could not get an MRI to see the extent of the damage. There are those who will say, good. People like you shouldn’t be accomodated, as a response to this statement. To those I say, fuck off. No, seriously. You don’t have the right to tell a fat person they don’t deserve proper medical care because you find their body size whatever negative thing you find it. And you can’t turn it around and say it’s about concern for health when you start from a place that wants to deny fat people the very healthcare they need, the same healthcare given to a thin patient, so don’t even try spinning it into that old “it’s about their health” yarn.

I won’t get into the details of what my life became after that injury, but suffice it to say that it has been a brutal and often humiliating 18 months. I lost so much mobility. It was impossible to treat my injury properly when they could not diagnose it properly. It made me realize that if I ever got cancer (which there is quite a lot of in my family history), or if I was ever in a much more serious accident, I’d be screwed. I would probably die and then, because of how twisted this world is, I’d be blamed for my own death… it would be my fault for being too fat to get proper treatment, and not the fault of a medical community that has failed fat people.

I had already researched WLS for many, many years. First when I was dieting, as another option – the “quick” option. The “easy way out,” is how it was often perceived by myself and fellow Weight Watchers forum members. Let me just tell you, as someone who has since had 3 surgeries (unrelated and not counting this one), surgery is never an “easy” option. I had already come to that conclusion before my gallbladder surgery (which was the first) in 2010 and I certainly didn’t look down on people who had WLS the way I did when I was dieting and doing it the “hard” or “right” way.

If you think WLS (or any surgery) is easy you need a massive reality check. Doubly so if you’re considering doing it yourself.

I’ve been very outspoken against WLS in the past. Some of you reading this will probably think I’ve now become pro-surgery. Nope. But I’m pro-choice, and I think people have the right to make their own decisions for themselves. As far as WLS is concerned, I think it is pushed very quickly on people that don’t have a real need for it. I think a lot of surgeons prey on a marginalized group and offer them false promises and hope of a shiny, thin, healthy life post-surgery. I think the risks are often downplayed and that the benefits are overhyped, especially for a person who isn’t really that big. I think the surgery is often given to people who are not even remotely ready for it psychologically speaking. I think self-pay patients – the ones who don’t need insurance approval – are those at greatest risk of not getting thorough psych evals beforehand, and also the most at risk of being pushed to do something that maybe isn’t such a great idea for them. When you consider these self-pay patients are shelling out anywhere from $8k – 25k, however, it’s hardly surprising doctors will try anything to get them to sign up.

Just like the diet industry, weight loss surgery is a highly profitable industry. It’s business, and business and medicine often make for messy bedfellows. The funny (not in a haha way) part is that weight loss surgeons are often the only doctors willing to be honest about how dieting fails the vast majority of people. Go to any surgeon’s website and you’ll likely see the statistics, often even with citations posted, on the decades of research that have demonstrated this fact. There’s also no denying that WLS works better than conventional dieting… but long term results are still not necessarily stellar, so it’s a huge decision to make and if you go into it expecting or hoping to be thin or to have a “normal” BMI weight there’s a good chance you’ll wind up disappointed.

When I went to the surgeon’s office last summer I was about 517 pounds. My body used to settle around 350 – 375 when I’d diet (this was the point at which I’d “plateau” and stop losing weight). I’m the ideal “candidate” these surgeries were originally intended for, before the obesity epidemic bullshit made people panic and it became evident that doctors could push much, much smaller people than myself into a surgical “solution” for their “obesity” problems. My surgeon has done over 6,000 surgeries. That’s a lot of fucking money, and while I trusted him as a surgeon I disagree with a lot of his viewpoints. I made that very known to him during my consult, and to his credit, he accepted my criticisms and feelings with grace. He was also willing to accept my caveats (like no, I’m never sharing a before or after pic with the office and at some point I may stop viewing my weight, if it becomes problematic for me). When he said a goal of 240 pounds was “reasonable” for me I quite literally laughed in his face. I’ve been over 300 pounds since I was 15. I’m not viewing this through rose colored glasses.

So here are the things you need to know about how I feel about WLS, and specifically my having had it.

1. I don’t think having had WLS will neccessarily make me healthier. In fact, it may very well cause health problems I didn’t have before, so it could maybe help some issues but replace them with new ones. I’m diabetic, but between PCOS and genetics, I likely always will be, and even if WLS seems to “cure” it, that is going to be temporary. I have multiple genetic risks for diabetes (and I can say that with absolute certainty since I’ve done DNA testing) and long term studies have shown that many people who are “cured” of diabetes post-op redevelop it later on in life – and this has been true even in people who maintain their weight loss. My blood pressure is always good, my cholesterol is normal and so there was no need to “fix” any of that going into this.

2. I don’t expect to be thin, nor is that my goal. In fact, even if I got to the weight I gave the surgeon as the weight I’d like to be after having done this, I will still be “morbidly obese” if you use the BMI charts (which, btw, you shouldn’t).

3. You will never hear me talk about how much weight I’ve lost, at least not in a celebratory context. There may be a factual context where I mention it, so I won’t say it will NEVER come up but it won’t be an “omgilostsomanypounds” sort of way. This doesn’t mean that I expect YOU not to share your own weight loss in your own space, whether you’re dieting or have had surgery. But I am not going to comment on it or congratulate it, either for reasons I’ve previously discussed on this blog.

4. You will also never see me post an unflattering “before” picture next to a flattering “after” picture. Just as I won’t give them to my doctor’s office, I won’t share them in my personal space. Any pictures of myself I share I do because I’m having fun in said pictures, whether they be silly selfies, makeup selfies, vacation pics… etc.

5. I really, really don’t want to hear your “compliments” on my weight loss, no matter how well intended they may be. That’s not my goal and I don’t intend to let myself be sidetracked into, what is for me, a negative headspace where I let it become my goal.

6. I still don’t want your diet “tips” or “tricks” or “suggestions.” If I think you have information that might be beneficial to me, I will ask you directly. Otherwise, please consider it unsolicted and unwanted advice and just don’t. I have never deleted someone simply because they had WLS surgery or they are dieting or eating in a certain restrictive way, but I have removed/unfollowed people who cannot seem to talk about ANYTHING else because that’s too much for me to deal with personally, given my ED history. I’ve been that person and I don’t want to go back to that place. It was deeply unhealthy for me and I have to do what’s best for me. You get to control your content in your space, so I’d never, ever ask someone to change what they talk about… but I reserve the right to remove someone from my life if what they talk about is simply too harmful for me – and I respect your need to do the same.

7. I will NEVER tell you that YOU should do this. I won’t ever push anyone towards this surgery. I won’t push anyone towards dieting. I’m more likely to tell you the reasons not to do it, in fact. But only if you asked, of course. Otherwise, it’s just not something I’d ever bring up.

8. I most definitely will not speak of this in safe spaces that have been created for fat people to be themselves without pressure from the outside world.

So what are my goals? Why did I do this? I know people will wonder, and while I don’t owe anyone explanations, I like talking things out. So I’ll share on my terms, in my way.

I’ve already explained the medical shit. Sort of. I explained the logistics of it. What I haven’t really explained are the emotional feelings that came with that injury. Not being able to do some very basic things because of that injury really robbed me of my pride and fueled a sense of helplessness. But it wasn’t just from that fall. In the past 7 1/2 years I’ve had 3 surgeries, two broken bones that kept me off my feet for 8 weeks each time and a number of other minor injuries that, when combined with the others, add up. All of these things resulted in decreased mobility, which resulted in weight gain despite the fact that my eating habits remained the same (and my weight had previously been stable for several years), which then further reduced my mobility.

You never know what your “breaking point” will be, or if you’ll have one. But I did. It came about 18 weeks after my accident, when I realized my bicep was as good as it would get. That was the time my doctor gave me to heal, while I (yet again) restricted my movement. I felt a lot like I did when I stopped dieting in 2007… I was desperate for another way, whatever it was. I took my years of research and began investigating sleeve surgery because it has (so far, at least) demonstrated the lowest complication rates of any of these surgeries. I also picked it because it was (ultimately, after I heal) going to be most compatible with Intuitive Eating. In theory, I eventually will be able to eat pretty much anything I could before, just in amounts that work with my altered physiology. With my history with binge eating disorder this was absolutely critical to me. Deprivation/restriction and I don’t mix well together.

Ironically, had I gone into this process from my dieting days I’d have been in an absolutely horrible place for the consequences of this surgery. Psychologically speaking, it would’ve been devastating for me. It was the 10+ years of eating disorder therapy, working on mindful eating, learning to recognize when I was eating for emotional reasons or boredom that led me to a place where this was an option that wasn’t potentially life threatening from an ED standpoint.

I’m still me. I still stand by all of the statements I’ve made in the past about WLS, or at least the ones I’ve made since I stopped being an asshole and stopped claiming surgery was “an easy way out.” I was not superior to anyone for losing 25 pounds through Weight Watchers, trust me. I may have wanted to believe I was at the time, but I definitely was not. Nor would I have been in any way morally superior because of following X (insert keto, paleo, raw food, vegan, Whole30, Jenny Craig, etc here) diet (or “lifestyle”) plan. I look back at the person I was when I was dieting and I cringe. I was a person who told a dying friend that at least losing 100 pounds because she had scleroderma was a “silver lining,” and I did not understand how she could possibly mean it when she said, trust me, Jess. No one wants to lose weight this way. Because I sure thought I did. I’d have done anything to lose weight and, more importantly, be thin. “Healthy” never entered the equation, though I certainly claimed it did.

When I stopped dieting, people said, but your health! You’re going to die young because of your fat! My response to that? Even IF that’s true (and that’s questionable, as there is much contradictory research/evidence on the matter), I’ll die happier and mentally healthier. That matters more to me.

Well, that still matters more to me. Maybe the surgery means I’m less healthy and maybe not. Only time will tell, and frankly even then I likely won’t really know for sure what has made me healthier (or less healthy). But if it gives me a chance to do more of the things that the extra weight I gained because of health shit over the past 8 years has robbed me of, it will be worth it. If it means the next time I fall I can get an MRI and not have permanent damage and lifelong pain because of an injury I couldn’t get proper treatment for, it will be worth it. If it means I can get treatment should I develop cancer, it’s worth it.

I plan to continue to be a warrior for fat acceptance and for changing the world in which we live so no one feels they are backed into a corner with no other options than surgery. That’s just not a fun place to be, and I know that from experience. No one should have to resort to something so drastic to get adequate healthcare. It’s one thing to make a choice for yourself because you want to for whatever reasons, and quite another to do it because you feel it’s your last resort. So I’ll keep fighting for a world where one doesn’t have to feel that way, but in the meantime I live in this world. This was hardly the only thing that factored into my decision, but it was definitely a major reason I went through with the surgery.

And there you have it… the hardest decision I’ve ever made. Hopefully, in the long run, I don’t regret it, but just as it is for everyone else, it was my decision to make. It’s my body and I get to choose how to take care of it. You don’t have to agree with it. You can try to use it as “proof” a fat person can’t be happy, if you want. But I have been and will continue to be a happy fat person, so I have to burst your bubble there. If you feel it’s a betrayal of what I’ve said I stand for, I’m not sorry because you don’t get to decide for me and because I still stand for all of the same things I have over the past decade. I understand the feeling of betrayal because I’ve been there myself, any time a body positive actress or celeb suddenly has had WLS or signs on with WW or Jenny Craig. But what I’ve realized is that I have no right to that thought process. No one owes me their fat body, anymore than they should expect to be in some way obligated to try to make their bodies thin for the sake of societal beauty standards and ideals. It is just as wrong of me to expect a person to decide to stay fat for me for X reason as it is to want them to become thin for X reason. It’s just as fucked up. Yes, it’s disappointing to hear someone formerly body positive start trashing their bodies or start pimping diet products, but it’s not my choice to make. And we very often don’t know what led them to that decision, either. Regardless, body autonomy is something very precious to me. I respect a person’s right to make decisions for themselves, even when I don’t personally agree with said decisions. Your life, your choices.

It’s honestly really that simple, if only we let it be.

~JK