Tuesday, May 3, 2016

The Broken Regulator

Credit: New York Times

In my wanderings across the Internet yesterday, I came across a very interesting article on the New York Times website. It seems a study was performed for the Obesity Society Research Journal involving the cast of Season 8 of The Biggest Loser to determine long-term effects of "crash" weight loss programs. Perhaps unsurprisingly, each of the contestants, even the winner, suffered from setbacks and weight regain. What is interesting is the apparent reason for these setbacks: in each case, the contestant's resting metabolism shut way down, so their bodies were no longer burning the same amount of calories to lose weight as before their involvement with the show.

Now, the slowing of metabolism during high-speed weight loss is not a surprise to anyone: it is part of our defense mechanism against starvation. The interesting part is that these metabolisms never "re-regulated" - their bodies, it seems, were fighting to be returned to what had been their previous maximum weights. The metabolic system never got a grip on the fact that they were no longer "starving", and never came out of starvation self-defense mode.

Of course, this brought the whiners out of the woodwork across the 'Net. "Of course, they are broken. They went on Biggest Loser." was the main one I saw. Another favorite was "There is something wrong with this science. The Amount of Calories required by Body Weight - Amount of Calories Ingested = caloric excess or deficit. It is simple math." Yes, but the whole point of the study is that the equation is no longer working for these people that have gone through massive weight loss - even years later. And if you want to call these doctors "bad scientists": here is a link to the paper, published yesterday. Feel free to read it, then email me with whatever problems you found in their premises, methodology or conclusions.

This certainly would explain a phenomenon I have seen for years - I would go on a diet, work out, lose some weight. I would fall into bad habits and regain. But, the next time I tried to diet, reducing my caloric load no longer worked with the previous amount of calories. If I had once reduced to 1800, I now had to reduce to 1500 to see any results. And so on and so on. But, have one bad food day, and I would suddenly gain 5 pounds. It always felt like my body was working against me. According to the premise of this study, it totally was.

Now, buried in the details of the article is the following nugget: those of us who go through bariatric surgery seem to break this cycle - probably due to the radical revisions that take place when undergoing surgery. Here the body is no longer attempting to move the dial "up to 11" on hunger and metabolic function - instead, it is trying to make reduced demands due to the trauma of a large portion of our dietary tract being removed. However, once that healing process ends, it seems we get plugged right back into the same old "losing twice is 4 times as hard" cycle as the rest of the world. Falling back into bad habits post surgery could conceivably result in the ultimate regain of all our lost weight, even with the removal of 80% or more of our stomach. Danger, Will Robinson.

I strongly suggest you take a few minutes and go read the article. It can be a little discouraging, but it highlights one point that is super important to all of us: don't allow yourself to fall back into bad habits, or revisiting the weight loss mountain will only grow more difficult with each ascent.

I Suppose The Weight Loss Mountain Is Really A "Descent",

- Hawkwind

Monday, May 2, 2016

A Bittersweet Birthday

Normally what is happening over on Lor's side of the journey to bariatric surgery is closed off from public view: as I have said before, it is not my story to tell. But, this last weekend was significant enough that I have asked for, and received, Lor's blessing to talk a little bit about what I saw over Lor's final pre-surgery birthday.

Lor's journey to bariatric surgery is significantly different than mine. She is active. She is proud of her looks and her shape. She is a fabulous cook, and especially enjoys baking - bread, pies, cakes, you name it, she is the one that gets the call when someone in the family needs a dessert for a special occasion. She is nowhere close to where I am on the BMI scale, and would be perfectly content to stay there. So, why, then, go through the huge life changes that surgery forces a person through? Why give up freedom to choose her own path, and instead be forced into the regimented lifestyle that she will live with for the rest of her life?

One word: Diabetes. It runs rampant in her family, it has killed several of her loved ones, and despite her youth, she has been struggling with it for years. She has taken the high road and chosen a more difficult lifestyle recommended by her doctors (and her family) so that she can remain healthy and vibrant for decades to come.

She was treated to two different birthday meals over the weekend, one by my parents, and another by her best friend. From my parents, she received a life-saving gift: a new digital scale for us to use in food prep. Our old postage scale had been returning suspicious results for quite a while, and verifying weights between the two demonstrated that we had been WAY off in many of our food measurements in daily prep. (2 oz of Kale does not fill a small child's cereal bowl, for example. It overflows the bowl and creates piles on the counter.) Lunch was filled with encouragement and speculation as to how different her next birthday would be. Though she smiled and laughed, 25+ years of experience with her showed me the tension in her shoulders and her face - her surgery does not represent freedom like mine does. 

Dinner was at a local sushi house, and was a whole different experience. Her best friend also suffers from pretty severe dietary restrictions, and here the conversation was able to deal with fears and doubts realistically - with a pro who has been there and done that in having to make changes to her life that were forced upon her by health issues. I am sure the bottle of sake didn't hurt the spirit of full disclosure much. Here, too, was another comforting thing: this was not the last time Lor would ever be able to eat at this particular restaurant. Though California rolls will vanish from the future menu, many other things (sashimi, for example) will not have to. For the first time in weeks, we were not having a "food funeral" at a restaurant. The difference in atmosphere was huge: here was a place we would be returning, not another thing we were waving goodbye to.

All weekend long she was deluged with messages from friends and calls from family members, all saying the same thing: we are proud of you and we support what you are doing for yourself. And, by the way, happy birthday. It was amazing to watch. I am always proud of her, but this weekend I was really proud of the community around her - admiring, encouraging, uplifting. You have made me very proud to also be a member of the "Loralia Fan Club."

Wishing Everyone Had Friends And Family Like Lor's,

- Hawkwind

Friday, April 29, 2016

The Expertise of the Internet

Photo Credit: MikeFx... via Compfight cc

I spend a lot of time on bariatric surgery message boards and chat rooms, not really interacting a whole lot, but instead gathering experiences and emotions from people who are involved in the bariatric surgery process. And, just like the rest of the Internet, I encounter what seems to be a higher than average ratio of flakeazoids to normal people.

Yesterday presented a good example. A conversation was taking place talking about "dangerous" foods post-surgery. You know, ice cream, mashed potatoes, tiramisu - things that are easy to eat a lot of, even considering a stomach reduced in volume. Then some well-meaning person mentioned the danger of drinking soft drinks or other carbonated beverages - that the stomach pouch/sleeve may expand in size.

And, suddenly, the place went berserk, filled with pissed-off people trying to shout down this poster with comments effectively stating that "the stomach can't expand" and "that's just a myth" and so on. Their source of information? Some posts on YouTube.

I did not get involved at all in this conversation (see: Wrestling With Pigs), though I did feel bad for the helpful poster. But I also didn't bother checking out the YouTube videos. Why not? A couple of reasons. Firstly, the stomach by design expands and contracts. My personal experience tells me that any substance that stretches will eventually get stretched to a size larger than what it began at. (Laundry, anyone?)

More importantly, though, is the fact that the stomach re-sizing is a phenomenon accepted by the medical community at large. Evidence has been presented to demonstrate it, papers have been written about it, surgical procedures exist to correct it. Not to mention the fact that both my surgeon AND Lor's surgeon mentioned the carbonation phenomenon to us during each of our initial consultations. If we are going to ignore our surgeons in favor of the advice of "some dude on the Internet", what the hell are we doing in a doctor's office anyway?

The voices of the 'Net have replaced the phenomenon that used to be known as "some guy I met in a bar". The general premise is the same - if you look long enough, you are going to find a person that believes in something. UFOs, the hoaxed Moon landing, the great government cover-up of Stomachs Not Really Stretching...you get the picture. The problem with the Net is that it is so easy to find someone with a contrarian opinion. And if all you really want after your surgery is a Coke or a beer, you are going to find someone on the Internet to tell you that it is really ok, the whole "stomach stretching" thing is just an urban myth anyway. Problem solved. At least until you discover you've started regaining weight and can't figure out why that might be...

If you are going through ANY type of medical condition, listen to your doctor(s). Yes, perform research as well, get second opinions, perform medical due diligence. But trust your sources. Check out medical credentials, look for published papers, do your research only on websites that are fact checked, etc. Do not trust your health and well being to some guy with a Webcam and some time on his hands. He may be the same guy that goes to bed wearing a tinfoil hat to prevent the NSA from stealing his thoughts. Just sayin'.

Have an awesome weekend, I will catch you all on the other side.

Now, About That Whole Loch Ness Monster Thing...

- Hawkwind

Thursday, April 28, 2016

The Summer That Wasn't

Photo Credit: Jerry Fornarotto via Compfight cc

It is the last week of April - usually time to think about things like Mother's Day, the Diamondbacks' position in the NL West (3rd place, at 11-12), and our plans for the summer. This year, our normal plans for summer activities have been thrown totally into chaos and madness by the relentless approach of my Vertical Sleeve Gastrectomy surgical date, and all the minutiae that accompany it.

Our semi-annual trip to watch the Rockies play the D-Backs in Denver? Probably not going to happen. Camping trips? Find me a week on my calendar that isn't filled with support group meetings, appointments with the nutritionist or other pre-surgical items, and then we'll talk about heading into the Great Outdoors. Double down on all these dates to represent Lor's surgical timeline, and watch the days and weeks of the calendar fill up. The weeks leading up to surgery are filled with pre-surgical items galore, and the weeks following it will be filled with recovery, liquid diets and restrictions on how much a person can lift. Overall, not a prescription for a fun-filled summer.  

It certainly isn't all bad. To celebrate all the usual parties and get-togethers we would normally have with my family over the summer (Mother's Day, Father's Day, 4th of July, my birthday), we are instead having one "catch-all" holiday over Memorial Day weekend. We will fill it with small portions of foods we will no longer be able to eat, alcohol we will be restricted from for the rest of the year (and my last beers EVER), and everyone's last interaction with Lor and I before our surgeries. Call it my family "Before Picture". By the last day of summer, Lor and I will both be out of surgical recovery, probably back on normal foods, and heading into our new lives together. And the holiday season this year should be pretty cool as well.

And next summer? Next summer will be awesome. All the activities I have held us back from for so long because of my size will now be open to us. We can participate in the Albuquerque 5K Run For The Zoo. We will head to South Dakota to visit our friends there, since I should no longer be miserable during long car rides. When we go camping, we will actually be able to get out into the woods and hike instead of sitting around the campfire. Heck, we might even get on a plane and fly somewhere, since I should no longer be dealing with the problem of taking up 1.5 seats on an airplane. We might even go to Phoenix, to watch some games there - something I currently avoid like the plague because there is nothing more miserable than an obese person in Phoenix during baseball season. Trust me on this one.

All this long term future gained, for the sacrifice of a few months this year. I may not happy about the sacrifice of summer right now, but I would bet dollars to donuts that I will have a very different opinion about things come Summer 2017.

Still Undecided About My Last Beer Ever,

- Hawkwind

Wednesday, April 27, 2016

The Power of Motivation

Photo Credit: Universidad Polit├ęcnica de Madrid via Compfight cc
Mornings like this happen to me every once in a while. Normally, I get out of bed and head straight to the blog, full of fire and creative energy.

Today, I sat and stared at the screen, read through a couple other blogs, played some Hearthstone (new release happened yesterday), and just generally dicked around.

What, you may ask, does this have to do with gastric surgery/obesity/health/etc?

On the face of it, not much. But what happens if the thing I am supposed to be doing is not writing, but exercising? Or prepping a meal for the household? Or facing yet another day post-surgery, when it seems like every single person around me gets to do what they want, and eat what they want, while I am so restricted?

How, in short, do I stay motivated?

For a lot of people, photos work. When they are down about what they are having to do to stay healthy, they take a look at a pre-surgical photo and decide they never want to look (and feel) like that again. An example:

Please forgive my low-rent side-by-side. A Graphics Artist I am not.

Later in life I can use BOTH of these as motivators, I suppose. Even at 24 pounds down, I still look like I have a loooong way to go. Maybe I can post this on the fridge wherever I live to remind me to make better food choices. And on my phone, to remind me to buy better stuff at the store. And on my computer, so I won't get lazy.

Emotional motivators work too - many of my fellow bariatric patients tend to use their families as motivators: "I have to stay healthy so I can provide for my family...so I can see my kids grow up...so I can play with my grandkids."  You get the picture. While many of us tend to be a little lazy when it comes to self-care, very few of us can deal with the idea of letting our loved ones down.

Not enough? How about some goal-based motivation? A bunch of people on the message boards and blogs I follow set themselves an athletic event in the future as a life goal demonstrating their success at weight loss - usually a 5K run. Others choose a specific outfit that they want to be able to fit into at the end of their weight loss - a dress, a swimsuit, maybe a tailored suit. (Mine is a pair of 38-inch waistline button-down 501s.) A tangible, measurable thing that can be focused on as the goal. Reach that goal? Awesome - create a new one. You can keep that going indefinitely.

Writers are frequently given the same piece of advice on how to deal with "writer's block": Sit down and write something. When you are lacking motivation, do the same thing - take that first step into whatever it is you are struggling with. The second step will be easier. Same for the third. Eventually, you will have gotten through the very thing that initially seemed like an impassable obstacle. Remind yourself that you are doing this for your own good, focus on your motivation, then move forward. It is as simple (and as difficult) as that.

Now Trying To Find Motivation To Wash The Dishes,

- Hawkwind

Tuesday, April 26, 2016

Seeking: One Fat Hero

Photo Credit: Tolagunestro via Compfight cc

In the time when I am not gaming, creating blog articles, or reading, I write fiction. Like, quite a bit. Since being fitted with a C-PAP a couple years back I tend to have incredibly vivid dreams, and the last ones before I get up in the morning always seem to involve the same set of characters. So, I have created a mythology of sorts around these characters, and write little vignettes involving them. But, after I woke up and wrote down my notes this morning, it struck me - there are no overweight characters in these stories.

For that matter, I am hard pressed to think of overweight central characters in any story I have read, and I read a lot. I can think of fat and jovial innkeepers, large menacing bikers, and a bunch of lazy and obese programmers - but not a single overweight hero. It is as if the burden of carrying the story forward is so great that it acts like a constant cardio workout for these people, ensuring that they stay slim (or, in some cases, muscular.)

Even the oversized secondary characters in most stories aren't treated well. They are frequently used as a kind of comic relief - a mental visual gag if you will: Let's all laugh at the fatso as he tries to run away from danger. (Example: Any "slasher" horror film ever made.) Other times heavy individuals are used as more sinister characters: the overweight person is too lazy to achieve his goals as normal folks do, so uses treachery instead - the mercenary programmer from Jurassic Park is an excellent example. Very rarely, obesity is treated as a threatening quality - the previously mentioned "huge biker" would qualify. The original "Kingpin" character from Marvel comics comes to mind in this category. (Though a fine actor, Vincent D'Onofrio can hardly be described as obese, so his depiction of the Kingpin does not qualify here.)

In a sense, I get it. When we experience stories, especially when we read, we want to idealize the characters. We want to take their positive characteristics and find them reflecting off the fractal planes and edges of our own lives, hoping to recognize something "heroic" in ourselves. We do not necessarily want to see that which we don't like about ourselves highlighted in our entertainment. But seriously - in the "real world" of the United States more than half of us are overweight. Why don't the demographics of our entertainment reflect that?

More to the point, why don't my demographics hold up? Why are my stories filled with active, muscular men and size 6 women? In real life I like large women - I do not prefer the body style that "looks like a teenage boy with plums in his shirt pockets." (Spider Robinson) So, why am I not creating these characters? What flaw lies in me, and apparently in other authors, that does not allow for the creation of more realistic body types?

I am still troubled by this, and still don't have an answer yet. But, the next time I sit down to write, I know I will be aware of my previous failures here, and hopefully can begin to correct them. Maybe spotting this weakness now, before any of my fiction is ever published, is the best outcome I could have hoped for.

Still Angry At My Subconscious,

- Hawkwind

PS - Just thought of an obese central character: Don Corleone, from The Godfather. But he isn't exactly heroic, is he?

Monday, April 25, 2016

Resistance Training

So, over the weekend, I ended up adding a little extra weight to my exercise regimen. No, I didn't have an all-you-can-eat pizza party last week or anything like that. No, what I did instead was this:

Some background: Vixen, the dog pictured above, has had a very sore butt for over a year now. It is so sore that she will not use the bathroom unless "helped" by taking her for a walk. So, for over a year now, I have been having to walk her every single day. She seems to equate being walked on a leash with taking care of her digestive business, so she spends a few moments in discomfort, then continues on her way, happily exploring the neighborhood. Weird.

Now, before the howls of outrage start, we have already taken her to the vet. Several times in the last year. The vets are just as mystified as we are as to what the problem is. In fact, we are going back to the vet's office today to pick up yet another medication to try on her to see if we can bring her some permanent relief.

Back to the picture above: our walks had typically been just under half a mile - just around the block where we live works out to .44 miles. This has been pretty much the only type of exercise I have been able to do, and even something this minor has tended to take me about 20 minutes, putting me on pace for a leisurely 1.2 miles/hour walking speed. Carrying 300 pounds around any distance is hard.

However, since Lor joined our walks and I started the pre-surgical diet the walks have been getting a little longer (and a little faster) every day. Yesterday morning, we made the decision that we were going to try a new, slightly longer route. Everything was going swimmingly until, at about 1.2 miles in, Vixen sat down, and refused to go any further. She had enough walking for one day, thank you very much.

Undaunted, we stuffed her in the backpack and walked the rest of the way home. I was surprised at how calm she was - just sorta hanging out, watching the sights, no resistance or struggle at all. I was also surprised at how much I felt a 5 pound Chihuahua on my shoulders and back. You wouldn't think 5 pounds would amount to much, but boy, did I know she was there. Guess it is time to start adding some push-ups to the old fitness routine.

If you have a family dog and are finding it difficult to get motivated to start a daily workout, walking your dog is a perfect entry point. Every single day I have had no choice but to get up off my ass and take her for a cruise around the neighborhood. I am allowed no excuses, no "I don't feel like going to the gym today", no other lame arguments as to why I shouldn't get active on any particular day - the dog has to be walked, and that is that. Though I feel bad for her butt-related problems, I am also kind of grateful that this has forced mobility on me all this time - I might be at 350+ if I had not been doing any physical activity at all. Now there is a sobering thought.

Wondering What Will Happen When We Get To 5 Miles A Day,

- Hawkwind