Thursday, September 8, 2016

Gone Forever?

"How Long Til I Can Eat This Again?"

The various "support group" message boards for those of us who have undergone bariatric surgery are interesting places. After a few weeks spent following the topics and concerns that get posted there, you begin to notice certain repetitive themes. "How long do I have to wait after surgery before I can start eating all my favorite foods again?" is a popular one. Another one that shows up regularly is some version of this: "Help! I am (X) weeks out from surgery, and I have only lost (Y) pounds! What am I doing wrong?"

But, the topic that tends to really catch my eye is the many versions of this: "I checked the scale this morning, and was down to (X) pounds!! That is (Y) pounds of fat GONE FOREVER!!"

Now, understand me here. Getting on the scale and discovering that you have passed a milestone weight is really exciting. Heck, my weigh-in this Monday put me under 230 pounds and had me smiling all day. But the second half of that celebratory sentence makes me a little nervous - "gone forever" doesn't really mean what many surgery patients seem to think it means.

The subject of recurrence of weight gain after bariatric surgery tends to be acknowledged but not really focused on by your surgical team. But the truth is out there: a high percentage of patients who go through surgery do suffer some amount of regain after the post-surgery honeymoon period ends. 

I really am not trying to be a Debbie Downer - if you lose one hundred pounds after surgery and gain 25 back, you are still 75 pounds ahead of where you were before you started and much healthier than you were to begin with. But the real problem is this: the "GONE FOREVER" mentality that is created during the initial 12 to 18 months of "easy" weight loss runs into the reality of the digestive system resetting after the surgical recovery period is over. Suddenly, that easy weight loss you have been enjoying ceases, and the numbers on the scale start to creep back up. Forever wasn't quite as long as you have thought it was going to be.

So, what causes regain? In a word: comfort. You get used to the easy weight loss of the honeymoon period and start to insert a few of your previously favorite foods here and there. You take a day off from your workout routine and it somehow turns into weeks away from the track or the gym. You stop diligently logging your food intake, and suddenly no longer have any real idea of what your intake is on any given day. There are many paths to regain, many traps along the road ahead.

What many of us fail to realise is that the obese person's body has actually changed over the years of carrying excess weight. Fat is no longer prioritized as a primary food source by the body, usually due to the high amount of carbohydrates entering the system. Fat cells have actually changed size - getting larger and becoming resistant to weight loss. Even our metabolism is in on the act, forcing periods of exhaustion in order to keep the activity level down. All of these things will work together to pounce and slap 10 pounds of extra weight back on our bodies the first time we stop paying attention. This weight gain usually leads to disappointment and depression. And we all know where we turn for comfort when we are depressed: comfort foods. It is a vicious cycle that can lead very quickly to undoing many months of hard, post-surgical work.

The solution? Don't ever look in the mirror and think "gone forever". Instead, be sure that you keep firmly in mind that your previous state of obesity is just waiting, biding its time, and hoping for the chance to re-introduce itself into your life. Keep moving, keep logging, and keep avoiding "empty" calories. You have not signed up for a "One Year and Done" solution. You have committed to a life long change in your behavior. The only forever will be the one you create on a daily basis.

The Correct Answer To The First Question Is "Never",

- Hawkwind

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