WEIGHT-LOSS SURGERY AND TRANSFORMATION, FINAL PART

Earlier parts begin here.

PART SIX: MY BODY’S COUP D’ETAT. THE NEW RULES.

Earlier I compared dieting, for the morbidly obese, to walking across the United States, but with the addition of a sadistic joker God — rather like Robert Heinlein’s book JOB: A Comedy of Manners, in which two innocent people are the target of a bet by an unfeeling Jehovah, who will at random times dump them into alternate universes without money or clothes and they have to start all over again. You get on the scale and discover the last two weeks might as well never have happened; and by the time you make it to the end of the road you’re physically and mentally wrung out. You’ve only lost 30 or 40 pounds out of a hundred, but body and soul can only take so much.

The difference between this scenario and that of your post-gastric-sleeve surgery is that when you do the work, your body will allow you to lose the weight. Not in a ridiculously fast way; stick to the diet and you’ll see a sensible loss of maybe two and a half pounds a week. But it’s consistent. You don’t wake up back in Utah. Your body’s setpoint has been set spinning, and it doesn’t know where it’s supposed to be, so it stops fighting you every damned step of every damned mile.

I know there are people out there thinking, “Two and a half pounds a week? Big deal, I can lose three pounds a week just by not putting sugar in my iced tea!” (I will add that most of those people are men.) If you’re not chronically obese, you may well have dieted occasionally, achieved your goal, and moved on. Surely everyone can lose three pounds a week without surgery, if they just try!

My friend, if I could have, I would have.

What do I eat?

Immediately after the surgery, it was a liquid and then a pureed diet. My compatriots at work compared my meals (pureed veggies or ground meat in ice-cube form, three ice cubes per plate) to something a futuristic machine would slot out. This phase passes quickly; on Christmas I celebrated with an egg, and never looked back.

Now I can, theoretically, eat any damn thing. But this is the way I’ll be eating for the rest of my life, and I want to enjoy it, so I make it a constant pleasure. Small, pretty bowls and plates. Presentation matters; I learned this some years ago when I visited a resort spa called Miraval, and asked them about the big, creamy, delicious mountain of yogurt in the breakfast buffet. “It’s just Yoplait,” they said. I couldn’t believe it. Did it really make such a difference not to be spooning it out of a narrow plastic cup? From that day forward, I always put my yogurt in a bowl, often with some fresh fruit on top. I served it that way once to a writer who was at my house working on a script with me. “Where did you get this fantastic yogurt?” he asked. “It’s just Yoplait,” I told him. “This is not Yoplait,” he insisted.

Besides, I have a soft spot for charming painted ceramics. This is a dangerous passion for someone in an earthquake zone to possess, but I can’t seem to turn it off.

Now you’re thinking, “Poor thing. She’s obsessed with presentation because the food she’s eating is a disappointment and she’s trying to feel better about it. How sad.”

Not so. I realized with some surprise, months into this, that I had not “dieted” at all. I’d been determined from Day One to never eat anything I didn’t wholeheartedly enjoy, but hadn’t quite seen what a demarcation this was between my past weight-loss efforts and my present ones. In the past, I would have had a lunch of chicken salad mixed with unpleasant nonfat mayonaise on thinly sliced, uninteresting, sort-of bread.

Those days are gone.

Greetings, mortal, from the land of summer fruit! (And charming painted bowls.)

fruit bowls

They told me before surgery that my sense of taste would likely change; I might find sweet things too sweet to enjoy. That didn’t happen to me. I still adore sweet things, and I’ve incorporated them into my menu.

I discovered Gloria Jean’s coffee, and have a good half-dozen flavors in my pantry. First cup of the morning, I’ll take some dark roast beans, grind them, and add zero-calorie, brown-sugar cinnamon syrup. (Torani and DaVinci sugar-free syrups — I add them to coffee and to protein shakes at will. Not for me the austere mysteries of black coffee, no sugar; I mix a concoction that would offend the sensibilities of any true follower of the way, but which pleases my pagan heart.)

Then, on a cool summer morning, I might cut up a peach or a sugar-kiss melon into a charming ceramic bowl; and I take this and my coffee out into the garden and have breakfast in a big Victorian chair under a pear tree. While my dogs doze in the dappled sunlight.
I’m not supposed to mix liquids and solids, and this is the one moment of the day when I cheat. Because brown-sugar-cinnamon coffee and slices of sweet sweet melon are meant by a sometimes kindly universe to go together.

Meyer lemons from my tree, squeezed into water every morning, with enough stevia to make my heart glad.

LEMONS HOPEFULLY

They also told me before surgery that most people who go through it don’t really get hungry. One woman said that she sometimes forgets to eat. (At the time I thought how alien that concept was.) Well, this also never happened to me; I can start to become hungry as early as ninety minutes after my last “meal.” But I get satisfied quickly, so I end up eating a number of times throughout the day — at least one protein shake, and the rest filled out with things like fruit, an egg, a sweet potato (with butter and salt), a yogurt, or a small plate.

On that small plate I might have three ounces of salmon in Dijon sauce, with the sort of vegetables I really enjoy — that is, asparagus or fennel or brussels sprouts, roasted in olive oil until they’ve been turned into French fries. Or, instead, I might pile that small plate with raw treats. I’ve always liked hummus — to me, that’s party food — so I’ll put some of that together with a chunk of real cheese (none of that ersatz plastic-tasting stuff), a few nuts, baby carrots, red cabbage, maybe a fig… maybe a salad… maybe parsnip fries roasted in olive oil with rosemary from the garden, then sprinkled with salt, pepper, and cumin.

My refrigerator is stocked with attractive and healthy things I may not even get to in time. When I go out to a restaurant with friends, I often order from the appetizer menu, and bring things home. On occasion, a dessert will call my name, and I have made it a rule never to deprive myself — that way lies fed-up-ness. So I take the dessert home and have it in place of a meal the next day. Not perfect nutrition, but it doesn’t happen often, and I never want to feel I’m writing treats out of my life entirely. (My bank has the best chocolate-chunk cookies in the world on a table in the waiting area; I rarely go there, but you may be assured that when I do, one of those big cookies accompanies me into my car, where I indulge to the hilt. Of course, that fills me up, so I have one less “meal” that day.)

I worried when the Christmas season rolled around, a year after surgery; I was capable of eating more regularly now, my stomach pouch had expanded. It’s the gaping fear at the bottom of my new life — maybe I would screw this all up. There were things I wanted to enjoy: chocolate truffles and marrons glace and slices of maple ganache cake. (And at the home of two British neighbors, plum pudding and mince pie… and a sweet creamy thing called brandy butter. Brandy butter! O brave new larder, that has such treasures in it.)

Obviously I couldn’t have all these things at once. So I balanced wherever I could: if I had a truffle on a particular day, I skipped my teaspoon of Greek honey in the morning; and if I had a slice of cake, I skipped a small meal. At the end of the day I was utterly satisfied, but I would step on the scale the next morning with trepidation. In fact, though, over the course of the entire month, I only gained two pounds, and I’d begun the month by losing two pounds, since I knew the season of indulgence was upon us.

Here is what’s different: that strategy worked. I ate sensibly. Not entirely sensibly — there was more sugar and less protein than usual — but sensibly from a caloric standpoint. And when I gained a bit over time, I was able to take it off again.

Neither of those things would have been possible before. Oh, I could have tried the same strategy, but I would have gained one to two pounds overnight instead of over the course of three weeks. And it would have taken several weeks of effort to get it off again — and it wouldn’t have stayed off.

Again, this is what’s difficult to explain to someone who’s been thin all their life; that it’s a difference of where we are on the spectrum. It’s not that food has nothing to do with weight gain. It’s just easier for some people than others. And of course, there’s always a way to blame yourself (or have others blame you) for any weight gain at all, regardless of situation. Even if it’s not a month of indulgence, you can always point to something you ate. (“I did have that handful of grapes… damn, it’s true, fruit contains sugar! Of course I deserved to gain a pound yesterday! I’m a bad person!”)

Each morning when I wake up I wonder if my super powers will be gone, and I’ll be back in the Slough of Despond, where you swim as hard as you can and drown anyway. But so far, the mornings have been kind. In the summer, I rise and do physical therapy exercises for my back. In the early evening, when the sun goes down and the breeze comes up, I take the dogs for an hour-long walk, which ends in sweaty effort as my house is at the top of a long, steep hill. In the winter, the long walk is in the morning. If I start working full-time on a television show again, this will have to stop, but for now I just keep going.

PART SEVEN, YOU GO TO HEAVEN

When you diet, post-surgery, there’s another difference, and I’ll have to back up and explain this one.

I’ve been fat since the age of five or six. By late childhood, I was an adult weight. My brother, eager to engender a little suffering, told a family friend, at the dinner table, that I weighed a hundred and five pounds. I must have been 11 or so. “I was a hundred and five when I was married!” she replied, and laughed raucously.

As an adult, 145 pounds was a dream number to me. Mind you, I was once this weight, briefly. In college, after about a year of dieting. Let’s just say the moment passed quickly.

Post-surgery, friends would occasionally ask if I had a target weight. I didn’t, exactly, but when I thought about it — not dwelling on the impossible — my hope was that maybe, if I were fortunate, with the surgery’s help I could get to, say, 135. If 145 was the best I could achieve, it was still far better than I could normally expect and I would be grateful. But really, there was no point in even thinking about a “target weight.” In a perfect world, sure, I was five foot three and something in the 120s would be nice. In the world as I had always known it, long before you get anywhere near that figure you fall down exhausted and panting on that bed in a cheap hotel in Virginia Beach. You’ve lost, with a great deal of constant effort, thirty or forty or even fifty pounds; you have another fifty to go; and you don’t have the stamina to keep slogging on. A target weight? That was an abstraction. The very idea was presumptuous. A target weight was one of those things that I, as a fat person, was not entitled to, and it would be ridiculous even to think about it.

Then: “Do you have a target weight?” the nurse practitioner asked, when I went in for one of my follow-ups. I’d already lost about two-thirds of my weight by then. There was a long pause. Then I said, hesitantly, “Um… 125?” She briskly replied, “That would put you statistically right in the middle of a healthy weight for your height. I see no reason you couldn’t get there by the end of the year.”

One-twenty-five? It was beyond my ability to grasp. It was otherworldly.

And that’s the final difference between life before and after: metaphorically speaking, there’s not only no waking up in Utah, no three steps backward — there’s also no Virginia Beach. That is, there’s no here-I-give-up-and-lie-down-exhausted point.

The weight loss just continues. You could do this forever!

As the numbers on the scale went down, I’d try to accept them in a bemused way. My brain was in a state of shocked disbelief at the figures. While walking my dogs through the hills, I’d quietly sing — because I am a person who makes up nonsense songs for the dogs, let’s keep this between you and me — “Doobledy doobledy dee! A hundred and thirty-three! Doobledy doubledy doo! A hundred and thirty-two!”

By late August I was singing, “Double-dee double-dee doo! A hundred and twenty-two point two!”

My allergist said to me, “How’s it going? You must feel great after losing all that weight.” “I do!” “Back trouble gone?” “Well, no.” “Energy must be up, though, right?” “Well… no.” He gave me a look that said: and what was the benefit here? I said, “When I take the dogs out for a walk, I feel like I’m flying.”

Also: my high blood pressure disappeared. Now, you may think that makes sense — you lose the weight, you’re healthier, right? But eerily, this happens for many people immediately after surgery. When you’re still your overweight self. While I was still in the hospital, one of my nurses told me to keep checking my BP when I got home, and not to bother with a pill if I didn’t need it. I said, “Seriously? I haven’t lost the weight yet!” I’d only had surgery two days before! She said, “Keep checking.” And she was right; aside from a couple of days in that first month, my BP was suddenly normal. The surgery can also potentially cure diabetes, just as quickly. I am not making this up. We’re only beginning to grasp how little we know about the control hormones have over our bodies.

As my weight just kept drifting down, it dawned on me… I could consciously stop losing weight. It’s not a matter of helplessly giving up at whatever point I can go no further, until I find the strength for another round someday. I could control the number where I ended up. Unnatural, impossible thought! Hmm, 119 seems slender enough, doesn’t it? Looks like a good parking space! Perhaps I’ll stop here! It reminded me of something an investment banker told me long ago, when he was talking about retiring young: “After all, how much money do you need?” How slender did I have to be, after all? It was up to me to decide that. Not some broken switch in my body that was blinking a number it wanted to force me back to.

To me, that setpoint spin was the most important thing to come out of surgery. More important than stomach size itself.

The weight loss went on — because it could. One hundred fifteen. One hundred thirteen. These days I’m usually between 112 and 115, more or less, US size 6 or 8 in clothes. After my second surgery to remove excess skin, I’ll probably be a size 4 (or possibly 2, but that’s just freaky to me).

Interesting note: when my last pilot script got picked up to shoot, it was, as they had warned me, “like getting shot out of a cannon with your hair on fire.” There was no time for regular meals, or even planned grazing; I carried protein shakes and bars around with me and did what I could, but I still dropped to 108. So I understand, from this side of the divide, why that executive producer I mentioned earlier thought that starting a new show was the time to diet. But I also know, from the other side, that I would not have lost weight in this situation, before surgery.

Back then, I would have been exhausted and hungry and insane, and I would have thought, “I need to take care of myself! I need a maple oat-nut scone, with lots of icing.” Now I think, “I need to take care of myself! Maybe I’ll put some green tea matcha in this protein shake.”

So here I am, swimming back and forth among the same three or four pounds, getting on the scale every day, eating a little more or a little less. Eternal vigilance is the price of this new body.

And it is new. Over the years, I’ve sometimes heard the phrase “large-boned” as a euphemism for “fat.” I’d always think, well, that’s not me. I was clearly small-boned — only five-three, with small, delicate hands. I just had a lot of meat on those small bones.

But now I’m suddenly the size my body was originally designed to be. Good lord, but I’m a little slip of a thing! Or a damned scrawny woman, depending on my mood of the moment. I have a longer neck than I ever imagined. Where did that come from? Who is that person in the mirror? I’m a medium/small in most clothes, and when I have the second of two surgeries to remove excess skin, I’ll probably emerge from it even smaller. When I see a shirt hanging in my closet doorway, it’s with a sense of the unreal — it looks like doll clothes. How could somebody fit into that? (A thought I have had, through the years, on seeing other women’s blouses and bras and thongs.) (By the way, as a side-effect of the first surgery to remove excess skin, I now have perky little breasts. Heaven knows I never had them at any other point in my life.)

I place my hand on my hip and it feels bony. Where there had only ever been soft, now there is hard. Gone is the voluptuous curve of cushiony flesh; I am angular instead. Sharp hips, sharp shoulder blades, a shockingly evident ribcage when I lie down. Not my body at all, an alien thing. I grew up reading science fiction, and often wondered how it would feel to wake up in someone else’s body; now I’m as close as I am likely to come. I’m like the hero in the old TV show Quantum Leap, who would jump at odd moments into other people’s bodies and lives. The word “petite” is used a lot by those who see me. “I had no idea you were so petite!” “When I saw you coming up the street, I wouldn’t have known who you were! You’re so petite!” “You’re so petite, what happened to you?” a producer I had not seen in a long time asked, when we met at a conference. I said, wonderingly, “I lost 130 pounds! I could slice bread with these shoulder blades!”

You know who likes angular women? Fashion designers.

For most of my life, I’ve only been able to buy clothing from a few sources. Since the weight loss, I discovered the Neiman Marcus “Last Call” sales site, and was lost to all sense and decorum. I emerged untold dollars later, with a burgeoning and dangerous taste for fashion. I didn’t know I had it in me. Mind you, I’d finally accepted my inner aesthete when I first bought my house and began combing the web for furnishings, and I have strong opinions on things like the details of art deco and William Morris’s contributions to the late-Victorian world. But I’d always had to leave my body out of my aesthetic preferences.

If you’re fat, you don’t really have the option of high fashion. Stella McCartney and Lily Pulitzer do not design for you. (Eileen Fisher does, to an extent, bless her, though the sizes don’t run as high as I was at my peak.)

Each new possibility was a little mind-blowing. One day I found the Anthropologie catalogue in my mailbox and thought, “Oh, I should look through it, sometimes they have nice ceramic dinnerware.” And then I suddenly thought: “You could buy clothes here.” I could. Buy clothes. In spite of the ethereal children they have modeling in these pages. Dear god in heaven.

I could buy clothes anywhere.

I still vibrate with the strangeness of this knowledge.

Many are the Regency novels I’ve read by Georgette Heyer and others — stories about young ladies in the early 1800s who are brought to London, taken to the dressmaker, and prepared for their come-out ball where they will be launched upon society. The first long dress I bought for my new, alien, slender body was a sleeveless midnight blue silk by Eileen Fisher. I looked at it in wonder. I had often seen long summer dresses on other women and thought how graceful they were, and how I wished I could wear one. But it was not for me.

Suddenly, at the age of sixty, I felt as if I were launched upon society.

Fun skirts? Possible. Short shirts and jackets that don’t have to come down to my thighs? Ha ha, possible, take that, universe. I could buy this, and this, and this… and this one too… the amount of money I spent makes me dizzy.

So: I am an alien. An alien who can walk the dogs for miles. In charming clothes, with no need for blood pressure medication. It’s all a bit disorienting, but I think I will stay on this planet for a while, and walk my dogs among you.

3 thoughts on “WEIGHT-LOSS SURGERY AND TRANSFORMATION, FINAL PART

  1. I, too, had been seriously obese all my life. I had bypass surgery in 2007 and promptly dropped 150 lbs. I did stop about 20 lbs over my ideal weight, but my Dr tells me that recent research shows that people – especially women – who are moderately obese survive longer than thin people on average.
    I can still eat moderate amounts of pretty much anything I choose, but three years ago I came up with end stage renal disease – not associated with the obesity but more likely with the large amounts of NSAIDS I took for many years for early onset arthritis – and ended up on dialysis. One consequence is that I have to avoid foods high in phosphorus (dairy, nuts, chocolate, seeds, whole wheat, ect.) This makes healthy eating more difficult, but I’m still not gaining.
    So, the surgery works over the long term!

  2. I’ve enjoyed reading your weight loss journey – you are a good writer. I used to work with patients getting weight loss surgery – you’ve done such a good job outlining everything that happens before, during and after that I wish I could have pointed the patients to your blog, they would have found it very reassuring.

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