How Did I Get Here?

26th April 2014

Some people die in accidents through no fault of their own. But in this (mostly) safe society we have built for ourselves, there are few reasons why we shouldn’t live to a ripe old age. For most of us there comes a moment in our life when there is a wake up call about our own mortality. Perhaps you are the fittest, non-smoking, non-substance-abusing, healthy-eating, perfect-weight-range individual in the world in which case I suppose this doesn’t apply to you. As for me…well…

Goodness me why am I writing this? Perhaps this is a justification to anyone who asks. Perhaps it’s a justification to myself. An explanation about how I ended-up where I am and how I’m planning to get out of it. If nothing else it describes my thought processes in this debacle and may be of benefit someday to someone else out there. I honestly don’t know the real reason. For me, that’s weird.

Good God how did I get here?

Stubbornness and a predisposition to addiction I suppose. I have never taken illicit drugs, have never smoked and my addiction to Diet Coke and caffeine is just a blip on my problem radar. Doctors would rejoice perhaps with so few vices and it all sounds good: except for one thing…

I am obese. And I have been for many years according to my BMI.

The concept of a Body Mass Index was thought up by a Belgian by the name of Adolphe Quetelet in the early-mid 1800s and was refined in 1972 by Ancel Keys. Simply put it is a ratio of a persons weight to their height. My BMI currently sits at 40 which is on the line between Severely Obese and Very Severely Obese. I have had a BMI between 35 and 42 for the last 8 years and try as I might I can not reduce it and keep it off.

I’ve been this size for so long that my brain has tuned out the abuse you get from being obese. I’ve had people drive past, wind their window down and yell "Hey fatty" and "Blubber roll" amongst other things. I’ve had corporate meetings with people in suits announce "make way for John…I know you’re hungry…" Yes people in suits are just people and they are sometimes the biggest jerks of all. I’ve been called "Big John", "Big guy", "Big fella" and loads more by people that know my first name. It does hurt of course, but you just learn to bury it. The human need to judge based on appearance is a well understood defect in our species. Knowing that doesn’t make it easier.

That said it’s not really the reason I’m planning what I am. There’s far more to it than that. People that have always been skinny their entire lives struggle to understand what the big deal is. Believe me - I’ve heard all the advice under the sun about how to keep your weight under control from friends, family and strangers just trying to be helpful. None of it worked.

One of the big problems is that people don’t see food as something that can be addictive. You need to eat and unlike taking heroin you will physically die without taking food (although heroin withdrawal may feel like you’re dying apparently). If you haven’t seen the documentary "Super-size me" by Morgan Spurlock, then make time and watch it. In 2004 he documented what happened to him by eating nothing but food from McDonalds for a 30 day period. He gained 11kg and after a week showed signs of addiction to McDonalds food.

I’ve done what most people do in my situation: diet and exercise. With diets I’ve tried again and again but frankly I failed every time and ended up heavier than I was before I started. Recent studies in America suggest that 95% of diets fail with the weight loss regained in 1-5 years. Diets don’t work and there’s a reason they call it the Weight Loss Industry. So far as exercise goes the only time I get to exercise each day is after 8:30pm when all the kids are asleep and I wake up at 4:30am to get ready for work (late nights aren’t an option). I have a 3 hour commute by car/train five days a week. Maybe when the kids are older we can all go to the gym together or go swimming together or something at night. But for now that’s not an option (they’re all 10 years and younger) and I can’t wait until they’re old enough to start.

A little bit of extra weight is okay though right? I mean it’s not that bad? Let’s consider the warning signs that your weight is becoming a problem. I’m not talking about the fact your old clothes don’t fit anymore, you can’t lean forward to tie your shoe laces and so on - those are obvious enough and are more annoying than being an actual problem.

It starts with being out of breath. Every time you do anything other than just a gentle stroll on a level grade. I mean a flight of stairs or two, or a moderate incline you’re attempting to walk up and you’re panting like a dog. I’m carting around 50kg of excess weight and that takes a lot more energy to move around. It destroys fitness because the weight prevents you from obtaining any. That started about 6 years ago.

Then there was the sleep apnoea. My wife had noticed that I was stopping breathing in my sleep and said I should see a doctor about it. I was always tired and irritable and had trouble concentrating, but with a newborn in the house at the time, I put my fatigue down to that. That was until I was called into my managers office at work and told that if I didn’t get my fatigue under control the company would do it for me (i.e. get sleep or you’re fired). I signed up for a sleep study, was diagnosed with Severe Obstructive Sleep Apnoea and started using a CPAP machine. Within a few days of use I felt more normal again. Rested. Centered. Focussed. Years later it’s treating the symptoms but not the cause and I’m still using the CPAP every night and find that I now can’t sleep without it. That started about 3 years ago.

Then there were my feet. I imagine it sounds weird to those not familiar with diabetes, however carrying excess weight can lead to a reduction of blood circulation and a feeling of pins and needles in the body’s extremities which, for many people, starts in their feet. I noticed that I couldn’t stand for long periods of time anymore, nor could I sit on the floor for long periods of time without being in agony. Then one day I became conscious of a tingling sensation in my feet. I was just sitting in a chair - properly and ergonomically adjusted as well. Despite blood tests confirming I did not technically have diabetes yet, how much longer would it be before I did? That started about 6 months ago.

The final straw came just days after Christmas and I’m not ready to talk about it yet. Suffice it to say something inside me snapped. I don’t care about my appearance, my looks or clothing and this isn’t about self-esteem. I am happily married with four beautiful children whom I adore. If I don’t get my weight under control quickly, I won’t be around for much longer. 5-10 years maybe. A history of heart problems in my family doesn’t help my prognosis. What I’m about to do I’m doing because I have a responsibility to care about my own well being and my own future. Not just for my sake but for the sake of my family.

Drastic Times Call For Drastic Measures

On the morning of the 26th of April, 2014 (today) I am booked in to have Gastric Sleeve surgery. (By the time you read this the surgery will most likely be over) It is a keyhole operation that removes the lower half of the stomach and restitches it together, essentially performing two tasks: Reduce the size of the stomach physically and in most cases (though not all) remove physical hunger. You read that right - you stop "feeling" hungry. You still feel the need to eat but this is often referred to as "Head Hunger" when you realise you normally would be munching on something but don’t “feel” hungry in the traditional way. Tummy growls are generally gone (though not in every case) after this procedure.

I have spent close to a year toying with the idea and researching the living you-know-what out of this subject. In the first week of this year I pulled the trigger and booked in for a consultation with the doctor then the specialist and it’s now all set to go.

It’s drastic. It’s an admission that I’ve failed to control my weight using my willpower alone. For whatever judgement I get from strangers about "not having tried hard enough" by other means, my close family support my decision as they know the success rate at keeping the weight off in the long term after this procedure is extremely high compared to any diet. It’s not free either, but as I see it I have no other feasible choices. Sure I could try again with yet another diet. By the time I’ve tried and failed again it could well be too late.

Yes there are risks. There are numerous studies but we’re looking at a 3.2% complication rate where readmission to hospital is required and a 0.19% mortality rate. Complications after 6 months are essentially 0. Because the stomach stretches (it’s designed to after all) if patients ignore their new “full” feeling post-sleeve then stretching can occur and you can end up close to where you started. The figures on that are much more difficult to find, however a random survey on a Facebook page of people that have been sleeved has shown that most people (even 10+ years out) have still kept their weight off.

No walk in the park

I need to have a strict diet of no carbohydrates, no fats, no sugars and minimal protein with only a handful of vegetables permitted for two weeks leading up to the surgery. This reduces the amount of fat in the liver and makes the operation significantly safer. Post operative I’m on liquids for two weeks, purees for the following two weeks and mushy foods two weeks after that before I can try “normal” food again. In short: it’s not going to be fun. This sure as hell isn’t the easy way out of anything - which is a common rebuff I’ve heard levelled at people undertaking this type of surgery.

The end result will be worth it. I should be able to go off my blood pressure medication and hopefully my CPAP machine as well. My whole body will feel lighter and I’ll have more energy but that’s not really what I’m looking forward to the most. I’m looking forward to remembering what a ”full" stomach feels like again.

I’m looking forward to being able to exercise and ride my bicycle again with my kids. I’m looking forward to more challenging bush walks, and as a bonus I should get less insults from the assholes of the world. Most importantly of all though, I’m looking forward to living longer.