Photo Credit: Beth Sheldon-Badore

If you’d have asked me thirty months ago, I doubt I would have said that I’d still be losing weight this far out from surgery. When I researched roux-en-y gastric bypass, I heard so much about the honeymoon phase and how the majority of weight is lost in the first twelve to eighteen months after surgery. And that was the case for me. I lost almost all my weight in the first nine months after my gastric bypass. I’ve pretty much been within 10-15 pounds of my low weight since then. But the scale does keep ticking down, little by little. And I’m not complaining.

But at the same time, I’m not actively pursuing crazy weight loss in the way I did in the beginning. Sure, I still somewhat watch what I eat; I don’t go crazy with carbs. But, more and more, I find myself slightly apathetic towards food. I’m having more “small pouch” days these days, where I’m just not that hungry. I have to admit, this is a strange feeling for me. Even after surgery, I was still a stress and anxiety eater, but lately I’m just not relying on food as a coping mechanism as much. I’ll be interested to see if this trend continues. Now, I’m definitely not apathetic towards caffeine! Do not get between me and my coffee!! You will lose a body part.

Body image is a trip. Always. I’m stuck between recognizing that I am smaller than I’ve ever been and seeing only the misshapen results of massive weight loss. At the moment I’m recognizing the beginnings of a long and lean physique, which I’m appreciating, thanks in large part to the magic of Slimpressions. I’d like to look longer and leaner. Can I have more Slimpressions, please? Reconstructive surgery is not in my future, so this is a reality that I have to deal with, and I’m working on it, but it’s definitely a process.

In the meantime, my regular life rolls on. School is intense. I’m almost halfway through the first semester of my PhD program. Classes are intense, but I like them … for the most part. At the moment, it feels like I will be in school forever. And living in poverty forever. Please tell me this isn’t true.

I’m lucky to have the weight loss surgery world in my real life. I’ve made great friends through the community; I have the pleasure of co-facilitating a local support group. These are things I’d never have imagined when I made the decision to have gastric bypass. I thought I was simply having a medical procedure. Never would I have imagined…

Family Photo -- Clearly Fat and Abused

The debate rose to new levels following the publication of a prominent commentary in the Journal of the American Medical Association by Dr. David Ludwig and Lindsey Murtagh. The two argued that when children are near death as a result of morbid obesity, the state must consider intervening on their behalf. While the practice is certainly uncommon, it has at times occurred both in the U.S. and abroad. Their reasoning rests on the severity of the diseases which accompany morbid obesity. In many cases these conditions will follow children into adulthood. In the most extreme cases, these diseases can even prove fatal before children reach 18. Accordingly, supporters see state intervention as necessary to prevent the death of a child. Those against the practice argue that it is an overreach of governmental authority and the benefits of removal have yet to be proven.

The LA Times presented both sides of the argument, with Dr. Norman Fast arguing for government intervention and David Orentlicher arguing against the practice.

PRO – Norman Fast

Dr. Fast argues that childhood obesity is a condition of child abuse worthy of government action because “[f]or a small number of morbidly obese children, state intervention could be lifesaving.” However, he recommends strict standards for intervention. First, it must be extremely likely that serious harm is imminent. Second, there must be a good chance that the intervention will benefit the child. Finally, government intervention must be a last resort.

It is clear that Dr. Fast is concerned about children: “there is a small percent of severely obese children who are going to die soon if there’s no state intervention.” In his mind, that is where the government must play a role; the state does not intervene simply to correct obesity. Instead, the government must play an active role when a child’s life is at stake. “The goal of state action is not to fix obesity–it’s to prevent death in cases that are the worst of the worst.”

To Dr. Fast, morbid obesity lies at the far end of the spectrum of malnutrition; it is a condition of overnutrition. He makes the point that children are routinely removed from homes for “nutritional neglect” and undernutrition. In his mind, the government should treat all forms of malnutrition–both under- and overnutrition–with the same methods.

Here's the Real Abuse

CON – David Orentlicher

Central to Mr. Orentlicher’s argument is the reality that we do not have any data to support the efficacy of state intervention in cases of child obesity. We simply don’t know whether removing morbidly obese kids from their homes actually works.

Moreover, there are some additional problems with government intervention. First, it places all the blame for childhood obesity on the parents, neglecting other causes such as genetics, environment, and poverty. Second, it neglects to make any attempt at working with the family in a less invasive manner.

Childhood obesity does not fit the typical mold of abuse, according to Orentlicher: “We are not talking about an abuse situation where the child could be killed at any moment.” Instead, obesity is a long-term medical problem. It does not have the urgency that typically comes with abusive situations.

Orentlicher recognizes that proponents want to reserve this practice only for the most extreme cases. However, in his opinion, “when we try to implement these kinds of policies and limit them to only the appropriate cases, it just doesn’t work out.” Ultimately, decisions are made in arbitrary ways, and children may be removed from homes in unfair ways. Additionally, he warns that the government might be “too quick to intervene.”

Basically, Orentlicher argues that we are “weighing an almost certain harm against a speculative benefit.” We can’t do that when there are children in the mix.

MY TAKE

The biggest problem I have with state intervention is that it presumes that the government has a fix for childhood obesity, that the state can “cure” these morbidly obese children. Childhood obesity is just as complex, if not more so, as adult obesity; there is no shortage of factors playing a role. Yes, the home environment is one of those factors, but it is certainly not the only variable at play, and it may not even be the most important. Assuming that childhood obesity will be resolved by removing the child from the home drastically oversimplifies the reality.

Part of that reality is that we currently have no effective treatment for childhood obesity. The state doesn’t hold some secret cure for these kids. What is it going to provide to ensure that their health improves? We’ve seen time and time again that diet and exercise alone are no match for morbid obesity. What does the government propose to do differently?

On a personal level, I was a morbidly obese teenager. Was it child abuse? Definitely not. As a family, we tried everything possible to get me to lose weight and, short of that, to keep me as healthy as possible regardless of my weight. This finally culminated in my gastric bypass at age twenty-one. You can’t tell a family’s home life simply by a child’s weight; obesity is far more complex than that. And obesity is not strictly environmental. Rarely is a child obese only because of her parents’ actions.

In the extreme case where a child is near death due to obesity and the home has become an unsafe environment, yes, removal should be considered, but that should be the exception, not the policy.

What do you think? Does fat equal abused? Are there circumstances where obese children should be removed from their parents’ homes?

First, let me admit to a little confusion. When I was first contacted by the folks at Porter Novelli, the firm that handles press for EES, I truly thought someone was going to be interviewing me about my experience on the subject, which was conversations between patients and primary care physicians about obesity and bariatric surgery. It was only a few emails and a day later that I realized that I would be the one conducting the interview. Oops. Blogger fail. Turns out I wasn’t the only one confused about that though… (Melting Mama — Wherein MM Messed Up An Interview Opportunity With EES)

I didn’t receive the press release on the topic until the morning of the interview, and I was given the names of my subjects when my phone rang to connect me to the studio. (Yes, in the future, I should ask for more details up front, but I don’t like to make waves. I’m learning from experience here.) All things considered, it could have gone a whole lot worse, and I filled my allotted five to ten minutes, so I’m marking this down as a win and hoping that EES will want to work with me again.

The study we were discussing was conducted by Harris Interactive and sponsored by Ethicon Endo-Surgery and the Obesity Action Coalition. They surveyed 400 obese adults, 252 adults who had undergone bariatric surgery, and 495 physicians.

One of the surveys most significant findings was that while 80% of obese adults had discussed weight with their health care provider, only 10% of patients who met National Institute of Health guidelines for bariatric surgery had had their doctor recommend it. Nevertheless, 86% of patients who had undergone surgery wished they’d had it sooner. Approximately 50% of doctores felt similarly, wishing they had suggested the surgery to their patients sooner.

However, the doctors surveyed underestimated their patients’ willingness to discuss matters of weight and their receptiveness to discuss possible treatment options, such as bariatric surgery. Doctors felt patients would be too embarrassed to discuss obesity with physicians. However, the survey results suggest that such conversations would have been welcomed by patients.

Among both patients and physicians, the top drawback is the perception that bariatric surgery is dangerous. However, it is important to educate physicians on how minimal these risks really are. When performed at a Center of Excellence, weight loss surgery is as safe or safer than hip replacement, gallbladder removal, and other common surgical procedures.

You can read the full press release here: Patients and PCPs — Survey Press Release.

Life in General

Part of the reason I’ve been, well, missing lately is that I’ve had very little free time. I got “promoted” at work. I put that in quotation marks because I got all the responsibilities of management without the actual title. Which is fine with me. I’ll only be at my company through the end of the summer, so it doesn’t make sense to give me a title. But, in the past month, I went through a hectic, two-week training for a new position, which I then assumed. Oh, and I sliced part of my finger off too. Right before I left for D.C. My first on-the-job injury. And that was on my manager’s last day. I don’t do anything half-way!

All bandaged up at urgent care

In the meantime, I’m also still trying to do some academic research for a professor, gearing up for starting my PhD program in the fall, and I’ve been house- and dog-sitting for the past month. So, just a bit busy. But I’m still here. And I’ve been busy in the bariatric realm too…

Obesity Action Coalition Day on the Hill

OAC Day on the Hill Participants; Photo Courtesy of the Obesity Action Coalition

On June 20th, the OAC conducted a legislative Day on the Hill. I was lucky enough to be a part of their advocacy efforts. We gathered in Washington on the 19th to coordinate our efforts and hit the ground running on the 20th. Our goal was to urge legislators to include obesity treatments in the essential benefits package of the healthcare bill. I was a part of the Texas coalition, and we had our work cut out for us, as the vast majority of the legislators whose aides we were meeting with are strongly against the healthcare package. Still, everyone we met with was very polite and very interested in our stories. The fact that the four healthy-weight individuals in front of them had lost a combined total of almost 550 pounds certainly grabbed their attention!

You can read my follow-up letter on the event here.

I am a political scientist by training, so this event was right up my alley. I cannot stress the importance of advocacy enough. The OAC does such amazing work for individuals affected by overweight and obesity. The work they do is about so much more than just access to bariatric surgery. I urge each and every one of you to look into their efforts. If you are not yet a member, what’s stopping you? This organization is our voice in Washington. Let’s be heard.

While in D.C., I got to spend time with some of my favorite people…

Shelly (Eggface) was there!

Shelly (The World According to Eggface) flew in from California. I always love the pictures we take together! And, sweet Shelly, she sliced her finger in sympathy for me!

On Sunday, I ran into Toni, Lynnda, and Mike of BariatricTV. We decided to play tourist and took a trolley tour of DC. Of course, it was an entirely spontaneous decision, and I didn’t have a camera with me… But it was a lot of fun!

BBGC North Texas Support Group

Two Bariatric Bad Girls at the First Meeting

The lovely Shana and I took it upon ourselves to start a support group! We both felt that the support groups offered by our doctors were mostly targeted to those closer out from surgery and the weeknight meetings did not fit our hectic schedules. So what’s a bad girl to do? Start a new group, of course! So far, we’ve had three meetings and a ton of fun! For more information, visit our Facebook page.

Spontaneity and Support

One of the gifts the BBGC has given me is a group of friends and a support network that I can call on and lean on just about any time. Whether I’m happy, bored, or upset, these gals and guys are just wonderful. A couple weeks ago, we had some out-of-towners visit Dallas for a weekend of Tex Mex, laughter, support, and karaoke. We couldn’t have had a better time, though we probably could have gotten a little more sleep throughout the visit. Many thanks to Mel, Travis, and Michelle for traveling to meet up with us!

Friday night dinner at Chuy's

We had a great local support group meeting Saturday morning:

Travis spoke on endurance athletics after bariatric surgery.

That evening we hit the town for sushi and karaoke:

Photo Credit: Travis Waddell

It was an awesome weekend and made us all wish we lived closer!

So much so that a couple weeks later, faced with a free day, Shana and I jumped in my car and drove to Austin for the day to visit Travis and his girlfriend Jina. Lovely hosts that they were, they jumped right on board with our spontaneity and showed us around Austin. We had a great dinner at Shady Grove, visited the original Whole Foods, and wandered around the Capitol grounds before we had to head back to Dallas because somebody (ahem — me) had to work the following morning.

Kaitlin & Shana at Whole Foods; Photo Credit: Travis Waddell

Dazed & Confused at the Capitol; Photo Credit: Travis Waddell

It was a great trip, and we’re already planning on returning sometime in August when we can stay a little longer! Thanks for having us, Travis and Jina!

Of course, bad girls that we are, Shana and I have been getting into trouble back in Dallas, too. We hit the kitchen on Thursday and cooked up a delicious salmon, red rice, and peach and fresh mozzarella salad:

Please don't drool on your keyboard.

Yes, you can eat real, delicious, healthy food after gastric bypass. It’s not artificially-flavored mushy junk forever!

That’s about it for now. I’ll try to be better about blogging on a regular basis, but I can’t promise that life won’t get in the way! It’s the nature of the beast.

At the age of twenty-one, I had Roux-en-Y gastric bypass (weight loss surgery). Even though I was young, I had already reached 285 pounds, and I was saddled with the comorbidities of obesity. My adolescent body was bearing what should have been the diseases of a much older adult. I was on medications for high cholesterol, asthma, and depression and had been diagnosed with fatty liver disease, high blood pressure, and prediabetes. I was a very sick young woman, and I was in dire need of treatment. For me, the answer was weight loss surgery. Because I was a college student, bariatric surgery was only a viable option for me because I was still on my parent’s excellent health insurance.

Now, two years out from surgery, my story is very different. I no longer openly carry the badges of obesity, and my comorbidities have been alleviated. I am a healthy weight individual. But I am so aware of how different my life could have been based solely on a single clause in my insurance coverage. What if my parents had not been able to afford such generous insurance? What if their coverage had excluded coverage for obesity treatments, as so many plans do? Where would I be now? Would I be pursuing my PhD, when before my surgery I struggled to walk to my undergrad classes without losing my breath? Would I be working full-time, on my feet all day?

People need coverage for obesity treatment — all evidence based treatments, not just surgery. There has to be something to also fill that void between diet/exercise and surgery. For that reason, I am urging your boss to sign Rep. Towns’ letter to HHS Secretary Sebelius to ensure that obesity treatments are covered as essential health benefits. There are lives out there that need saving. Everyone deserves the access that I was able to receive.

Kaitlin Nelson
Dallas, Texas

Link to Towns Sign-on Letter:

https://filemanager.capwiz.com/filemanager/file-mgr/obesityaction/6_0611_Towns_DC_and_Letter_to_Sebelius_re_Obesity.pdf

Beth, Andrea, and I made the decision to fly in on Wednesday to maximize our time together. Living so far apart really is not convenient to our friendship! We were able to catch up a little and relax, then we planned to hit the ground running on Thursday. The conference was at the Palace Station Hotel and Casino, an off-strip location.

The Palace Station (Photo Credit: Andrea Ullberg)

Okay, so maybe hitting the ground running was a bit of an exaggeration. We were all awake at 5:00 AM, Beth and I due to the time difference, and Andrea due to a migraine. (Yes, we really are a fun crowd.) After failing miserably to all back asleep, we got up, got ready, and headed downstairs for breakfast. Kudos to our waitress for understanding that Andrea uses superhuman amounts of Splenda and leaving a coffee cup full of yellow packets. Others would not be so wise.

On the agenda for the day was a visit to the strip. We were still a good two hours away from the first shuttle of the day, but we were too antsy to sit in the hotel for that long. Andrea still wasn’t feeling well, so she stayed behind to rest while Beth and I started to walk. Long story short, I took us on a little accidental detour through industrial Las Vegas. (Sorry, Beth!). Neither Beth nor her feet were too pleased with me. But, ultimately, we made it to our destination in one piece and even found Beth some new shoes on the strip that helped temporarily and will help a lot at future events.

The strip is always unbelievable to me, and this trip was no exception. I simply can’t believe how much decadence and expense is concentrated in that small area. The casinos, the hotels, the shopping, the restaurants. And the people partaking! After wandering for a while, we made it to our first destination, Fashion Show Mall, where we were supposed to meet Andrea, who was planning to take the hotel shuttle. Beth was on a mission to find specific garments for her guest appearance in Diva Taunia’s burlesque show, so we accomplished that and found her some comfier, sturdier shoes.

Then, we met up with Andrea and another WLSer, Linda, and started to wander the strip. We started at the Wynn, admiring the gorgeous flowers, both in and outside of the casino.

Andrea & Me at the Wynn (Photo Credit: Andrea Ullberg)

I had a little Sound of Music moment in the Wynn and, with Beth’s urging, spun around in the middle of the entrance. What can I say? I’m easily convinced. We window shopped in the boutiques of Chanel and Dior, watching others carry out bags with horribly expensive names on them. However, we were content to admire the gorgeous designs of the hotel for free, just taking pictures. The Wynn really was gorgeous.

From the Wynn, we went to the Palazzo and the Venetian, which are both attached. More expensive stores and gorgeous design. We stopped for lunch at a restaurant called I <3 Burgers, where I once again failed to even finish my half of a meal. Yes, at over two years out, I still have a good deal of restriction. Andrea and Beth can both attest to that.

We spent a lot of time in the Venetian, which is just gorgeous. We could have stood and listened to the gondoliers sing all day. However, none of us were willing to shell out the $16/person it cost to ride. That’s what happens when the broke bloggers travel to events. We watch and listen, but don’t partake. We spend our money on food and coffee, not entertainment.

Kaitlin & Beth at the Venetian (Photo Credit: Andrea Ullberg)

By the time we were finished wandering through the Venetian, we were all exhausted. We tried to catch the shuttle back to the hotel, but the instructions on the website were flat-out wrong and outdated, so we ended up taking a cab.

After a little rest, we ventured downstairs for a quick dinner at Subway. (Thanks, Liz!) We took a quick stop at the penny slots, where I won $42 off of $2 borrowed from Andrea, so we both ended up $20 richer for the night. Later that night, we might Rob from Former Fat Dudes, who is just as nice a guy in real life as he is online. We all headed over to the Stratosphere to watch Ian from the BTV Forums literally jump off the top of the building to raise money for the WLSFA. Insane! Once that was over, the bad girls were more than ready to go to bed. After all, it was about 11:00 PM.

Friday ended up being another day on the strip day. This time, Andrea, Beth, and I were joined by Rob, Linda, and Shelly (Eggface), for even more fun! We picked up where we had left off, hitting Treasure Island, the Mirage, and the Bellagio (and probably even more that I’m forgetting). Once again, everything was just beautiful. I was especially fond of the gardens in the Bellagio. Some of my favorite pictures of the trip came from that location.

Shelly, Kaitlin & Beth at the Bellagio (Photo Credit: Andrea Ullberg)

We didn’t stay out as long on Friday, as we had to go back to the hotel to get ready for the evening’s opening reception, sponsored by Celebrate Vitamins. Beth stole Andrea’s camera to take pictures of the event, and Andrea and I sat in the back with our soon-to-be favorite vendor, Amy of Slimpressions.

Friday evening saw many awards handed out and … a wedding! Diva Taunia and Rob got married! It was a very sweet ceremony and a happy occasion for all. After the wedding, there was some mingling. We didn’t stay too long, knowing that we would need to be back at 6:00 the next morning to set up our table.

And that 6:00 hour came quick. But the BBGC rose to the occasion, and our table looked great!

Beth, Andrea & Kaitlin at the BBGC Table

We had Click samples, WLS Vitagarten Lab Tracker Notebooks, BBGC advocacy sheets, and BBGC t-shirts and bracelets. Plus your cheery bariatric bad girls themselves! It was a blast talking to our fellow WLSers throughout the day. We had a great turnout at our table.

I also got to go over and model some Slimpressions shapewear on the BTV cameras during the day. I’ll have a full review later in the week, but I’ve got to tell you, this stuff is amazing! I was wearing Target shapewear before, and I thought it was doing a good job, but it doesn’t even begin to compare AT ALL. Not even close. You get what you pay for.

I realized partway through the event that I also officially had my master’s degree. I officially graduated with my M.A. in Political Science on Saturday. So, I’ve got letters behind my name. Not that they mean that much in the grand scheme of things since I’ll start work towards my Ph.D. in August, but still. I’ve got another degree.

After working the table all day, we grabbed dinner at the casino’s Mexican restaurant before heading upstairs to change for the evening’s gala, which was sponsored by Bariatric Advantage. It featured entertainment by the Diva Taunia Dolls (and some special guests, including Beth and Lynnda and Toni from BTV) and then some very loud music. The burlesque show was a hoot, but we ended up going somewhere a bit quieter with some new friends to chat instead of watching the drunken dancing that had started up toward the end.

Overall, I had a great time in Vegas. I was very sad to leave, mostly because of how hard it is for me to say goodbye to my dear friends. I talk to them every day, but it is not the same as being able to hug them or turn to them and ask a question.

For all of you that weren’t there, I wish you had been. It’s such a treat to meet online friends. I can’t wait to meet more of my virtual friends at this year’s OH events!

A 5’2″ woman weighing 254 pounds today told me she eats “hardly anything.” I guess that might be true if “anything” means the whole cow.

While Binkley received support from some of her followers who felt that overweight people should control their food intake just like smokers should control their cigarettes, she also received quite the backlash.

One follower felt it was a betrayal of her patient’s trust:

To tweet that as a care provider? Completely unethical.

Others addressed the basic attitude of publicly mocking obesity on the Internet:

(Make sure to visit McNee over at Former Fat Dudes!)

Binkley’s response to the drama she started was rather dismissive:

Obesity is a complex problem, Dr. Binkley. We’re not going to fix it so simply, with just a pill or a procedure. And that’s coming from a girl who had bariatric surgery. You don’t wave a magic wand and watch your patient drop fifty pounds before your eyes. But mocking them in an online forum does no good either. It simply serves to make you feel superior.

The reality is that we know we are at. Usually, what you view as denial isn’t; it’s shame. Because we know we’re overweight. But it’s not an easy problem to fix. And the heavier you get? The more the odds are stacked against you. But the more likely society is to judge you as lazy and out of control. And, unfortunately for anyone who has been in that position, doctors are very much a part of society.

When you’re morbidly obese, doctors are apt to talk at you, rather than to you. You are your obesity, your medical problems, rather than a living, breathing human being. I’ve seen this change dramatically as I’ve lost the weight. I’ve somehow become a human again in the eyes of doctors. I get to have a voice, a say in my medical care. They ask me questions and listen to my answers.

Dr. Binkley claims her intention was to demonstrate the risks of obesity during pregnancy, when the fetus has no control over its mother’s eating habits. However, her tweet never mentioned that her patient was pregnant nor that she had any obesity-related health conditions. Instead, she raised the issue of the woman’s weight solely to poke fun at her eating habits, something that was wholly unnecessary and unethical.

Still, Binkley maintains her goals were benign:

I never meant to offend anyone, and I feel very sorry.

But what will she do when faced with obese patients in the future? Will she offer compassion or condemnation?

Source: KSL News

The report also lists the benefits of bariatric surgery, especially highlighting its cost-effectiveness. This is troublesome, because if surgery is so beneficial, why are men receiving it at such a lower rate than women?

It is true that women have a higher rate of obesity, but the rates are not so disparate as to explain the discrepancy. In England, for example, 4% of men have a BMI greater than 35, as compared to 6% of women. In the US, 35.5% of women are obese (BMI > 30), as compared to 32.2% of men.

The question is, are doctors less likely to offer male patients the option of weight loss surgery, or are men less likely to accept bariatric surgery as an option?

Source: Men’s Health Forum

Weight Loss Surgery Bloggers from Across the Country

I was honored to be invited to this event. It still shocks me that I have readers beyond my parents. (And some days I’m surprised Mom and Dad have stuck with me!) It was a treat to sit in the same room with the bloggers that I read when I was researching weight loss surgery, and with women I now count among my best friends.

Beth (MeltingMama), Me, and Andrea (WLSVitagarten)

The theme that resonated most with me was the need for advocacy. There are so many myths and barriers surrounding bariatric surgery. Advocacy is about education, and about correcting misinformation. The Obesity Action Coalition (OAC) was one of the weekend’s sponsors. The OAC is an organization that works tirelessly to advocate on behalf of people affected by obesity. If you aren’t already a member, what are you waiting for?

Walking Across the Brooklyn Bridge, Something We Couldn't Have Done Before Surgery

I came back from this trip reinvigorated, ready to give back to this community that means so much to me. Because you are my people. I felt it in New York, just like I’ve felt it in the past. There’s something about bariatric surgery that bonds us. We don’t have to explain every little thing anymore. It’s simply understood. There is something worthwhile in a community like that. But every community needs advocates. Are you willing to be one?

With Andrea (WLSVitagarten), One of My Favorite Advocates

Disclaimer: My travel and hotel expenses were covered were covered by Ethicon Endo-Surgery.

Note: My trip was sponsored by Ethicon Endo-Surgery.