Gastric bypass surgery as a weight loss intervention for obesity-related health conditions

Gastric Bypass

Weight Management 3 UD Physical/Biological

Physiological Consequences and Health Risks of Excess Body Weight

Description of Concrete Experience: I chose to have gastric bypass surgery because I was dealing with high blood pressure, high cholesterol, and diabetes due to my weight. Over time, my weight had just continued to creep up until it reached a point that made it really dangerous for me. Additionally, back pain, knee pain, and joint pain were always present, and it hurt to walk and move around, so daily life activities were difficult to handle. I got out of breath when walking even short distances, and with that and the joint pain, exercising to lose weight was really not possible for me anymore. Even though I used to exercise, it was not something I could go back to until some of the weight was gone and the stress on my joints was lessened. My primary care doctor told me I would be dead within 10 years if I did not lose weight, so I saw gastric bypass as my only option for potential success. Diets and other methods in the past had not been successful.

Reflections: Looking back on my life, I realize that I was not careful with the way I ate. Eating became a pleasure and a crutch, instead of something that was used for fuel for my body. When I finally came to terms with the way I was eating and how much weight I had gained, I knew it was time to make a change. By that point, though, I was too heavy to get much exercise and the patterns I had gotten into were a big part of my life. Because of that, it was very difficult for me to make the kinds of changes I knew in my heart I should make. That was why I decided to have the surgery, because I knew without it I would only continue to get larger and may not live to see my children grow up.

Generalizations/Principles/Theories: There are several theories about excess body weight and the health consequences that come with it. Numerous studies have shown that people who weigh more have a higher chance of having problems like high blood pressure and high cholesterol. They can also have joint problems, heart disease, diabetes, and a host of other ailments that come along with their extra weight. Of course, not every person who is larger or heavier will have these health conditions, and some people who are heavy can also be relatively healthy. It often depends on their genetics, but also on how well they carry their weight in the sense of how well they can exercise and move around with the weight they have. People who are able to exercise and who stay active are generally healthier than those who are sedentary regardless of their weight, but that is not always the case.

Testing and Application: I tested the idea of needing gastric bypass to lose weight by attempting a number of things first. I tried to exercise but was not successful with it, and I also tried to diet -- but nothing kept the weight off. Usually, I would lose a few pounds, but then I would either stop doing the diet or I would find that I just did not lose any more weight. Once I hit a plateau, I really was not interested in working any harder to lose weight, or was not able to lose more weight because I could not get the exercise I needed to do so. I know that diet and exercise are both important to losing weight and staying healthy, but putting that into practice is not always easy.

Psychosocial Principles in Weight Management

Description of Concrete Experience: I was required to have three visits with a weight management psychologist. This was done to make sure of my reasons for wanting surgery, and to help determine if I really did need the surgery or if there were other options that would have been better for me. Additionally, these visits were to assess my state of mind when it came to my dedication to the surgery and the way I would have to live my life beyond that point. It is a very serious lifestyle change, and I could not just have surgery and that would fix all of my problems. It is a true lifestyle change, and one for which I had to be ready of the psychologist would not approve me. During those visits I was asked about the proper kinds of foods to eat and the portions I was consuming.

Part of the reason behind that was to see if I was understood proper nutrition, even if I did not follow a proper diet. Another part of the reason was to determine whether I understood that I was overeating. Learning about proper portions is very important to someone who is going to undergo gastric bypass, because excessively large portions are generally the reason people have gained too much weight and/or cannot lose the weight they have gained. She also wanted to know about any family history of obesity, and why I really wanted to have the surgery. I told her I wanted to be alive for my wife and two young daughters. There has been obesity in my family, but my entire family is not overweight. The surgery was very important to me because I wanted to be alive to see my children grow up, and also wanted to be there for my wife, whom I love very much.

Reflections: The sessions I had with the weight management psychologist were important to me, although when they first began I was very uncomfortable with them. It is not easy for me to talk to strangers, and talking about my weight and eating habits made me feel as though I was being judged for the poor choices of my past -- and also for the poor choices I was continuing to make. However, once I got through the first session I started feeling more comfortable. I realized the psychologist was not "out to get me" and that I was not being judged. Instead, the psychologist was there to help me and make sure that I was mentally prepared to go through the surgery and understand the lifestyle changes I would have to make afterward. There would be no going back to old eating habits, or I would completely sabotage everything I was trying to do.

Generalizations/Principles/Theories: There are many theories and principles regarding psychosocial development and concerns in people who are overweight or obese. Many of these surround the person's inability to lose weight and why that is the case. There are a number of hypotheses and generalizations that are also made when it comes to these people, including the idea that they must have mental health issues that cause them to overeat. In some cases, this is certainly true. Additionally, some people who are obese became that way as a coping mechanism because they were molested when they were young, or because they were teased, they were depressed, or there were other issues with which they could not cope. Depression and anxiety are often coupled with obesity, as are self-esteem issues and other problems. That does not mean that every person who becomes obese has mental or emotional health issues, though, as some of them do not have specific, underlying causes for the reasons they overeat. I was one of those people, and did not have any diagnosable, underlying issues. I simply overate, and did not control it properly.

Testing and Application: The theories that pertain to psychosocial issues in obese people and those who have gastric bypass can be tested by determining how many people with these issues have underlying mental health conditions or emotional problems that have caused them to overeat. When a person overeats, it is important to understand the triggers that cause that person to overeat. If these triggers are mental or emotional in nature, the person could benefit from psychosocial treatment.

Physiologic Influence of and Recommendations for Aerobic, Anaerobic, and Resistance Training in Weight Management

Description of Concrete Experience: When I first started my weight loss journey, I was not able to exercise at all. My joints hurt too much, and I got out of breath so quickly when I walked that I could not walk far enough or long enough to help me actually lose weight. My aerobic and anaerobic conditioning was terrible, as well, and I was not able to handle resistance training because I could not move comfortably enough to do so. Once I had the surgery, I was able to lose quite a bit of weight very quickly. That made a huge difference in how I felt physically and how I felt mentally, as well. Because I was in less pain and able to move around more, I found that I actually wanted to get back to exercising. I started out by working out in the pool because it was easier at my weight and did not hurt my joints as much. As I lost weight I started going back to working out and training with my football players like I used to, and I walked three miles every day. I am 6'6," and went from 430 lbs. To 275 lbs. Dropping that amount of weight made me feel healthier and much better about myself, and made working out more enjoyable again.

Reflections: Working out again was a very interesting experience for me. I had forgotten what it really felt like to exercise and be healthy. At first it was very difficult, though, because I was so uncertain about what I could safely do. I wanted to get healthy again, but I did not want to harm myself in the process of trying to do so. It was very important to me that I get healthy again, but working out was actually kind of frightening in the beginning. I feared not being able to work out correctly and injuring myself, and I feared a heart attack or something similar that would end my life before I ever had the chance to get it back. Still, I pushed on with my exercise because I knew I was never going to get healthy without it. As time went on, I became braver and more confident about my exercise regimen, which helped me get healthier than I had been in a long time.

Generalizations/Principles/Theories: Exercise is important for weight management. Most people do not deny that, but they also understand that the level of exercise differs between individuals. Some people are simply better able to handle exercise than others, and some people have higher tolerances for exercise than others do. There is nothing wrong with that, of course, because everyone is different. However, it is important to remember that nearly every person can exercise at some level. Even a small bit of exercise is helpful, and over time a higher tolerance for getting exercise can be built up. This is very important to be aware of, because those who want people to exercise (such as personal trainers) have to understand that each person has different limits. When these limits are considered carefully and fairly, people can excel at exercise that truly helps them with weight loss.

Testing and Application: Resistance training on its own is beneficial to people who are attempting to lose weight and/or maintain weight loss, but there is more that can and should be done for these individuals. They need to understand that aerobic and anaerobic conditioning are both vital to good health and weight maintenance. Especially for those who have had gastric bypass surgery, proper exercise habits can help keep them from ending up with weight gain. Long-term success is questionable with gastric bypass surgery, and those who are focused on making sure they maintain a healthy level of weight loss have to remember that exercise needs to be a part of their life. When they focus on only one aspect of it, they will see that they are not getting as much success as they would hope.

Advantages and Disadvantages of the Various Methods for Determining Healthy Weight

Description of Concrete Experience: Now that I have lost a lot of weight, I no longer have diabetes, high cholesterol, or high blood pressure to contend with. These things are not a part of my life anymore, and that means I am healthier and stronger than I was in the past. It has also reduced my back pain and joint pain, so I am able to exercise and also deal with the activities of daily life that eluded me in the past. My clothing is smaller and fits much better, and it is easier for me to drive and get around.

However, there are disadvantages to gastric bypass surgery that are important to understand, as well. I need to take a multivitamin each day for the rest of my life and must always be careful with what I eat and how much I eat at one time. If I do not get my vitamins I do not get proper nutrition, which can put me at risk of other medical conditions and problems. Proper nutrition comes from multivitamins and also from making sure I get enough protein in my diet without eating "junk" food that will only provide me with empty calories. I vomit if I eat too much or eat the wrong things, and I have loose skin from my weight loss journey. These things are frustrating, but they are small prices to pay for the benefits I have received from the surgery. I can have the excess skin removed at a later date, and the vomiting is a very good reminder to me that keeps me from eating too much.

Reflections: When I first had the gastric bypass, I was very excited about the surgery overall. I wanted to get it done because I knew it would help me lose weight and allow me to feel better and more healthy. I was also nervous, though, because I knew that I could end up with more problems than I started with. Not everyone is successful with gastric bypass surgery, and some people do not make it through the surgery at all. There was a risk of that, and a risk of complications at a later date, but those things were worth it to me, since I knew that it was really my last and only chance to have a better life. Reaching a healthy weight is very important to me, and as long as my doctor feels I am at a healthy weight, I will not worry about what others think of my journey.

Generalizations/Principles/Theories: Understanding what a "healthy" weight is can be complicated. There are BMI charts and other tables that provide all different kinds of information. Additionally, if a person goes to several different doctors, each and every doctor may provide a different opinion of whether that person was a healthy weight or not. With that in mind, a person's weight can easily be argued as to whether it is healthy or whether that person weighs too much or too little. Because of the discrepancies in what makes a person's weight healthy, it is generally best to stick with one doctor's opinion of health and proper weight. Generally, that should be the doctor who performed the gastric bypass, because he or she has the best knowledge of where the person started and where he or she has managed to get to within his or her weight loss journey.

Testing and Application: Talking with different doctors and other medical professionals, along with visiting different websites that provide medical information, can be a good test of how many different opinions a person will get. With the large number of opinions being given, a person will quickly find that he or she may not be getting the entire story when it comes to what a healthy weigh really is. A healthy weight for each person is slightly different depending on how much muscle they have and other factors, so it is really not possible to set a specific guideline that is accurate for each person of a particular gender and height. More has to be taken into account.

The Hazards of Various Fad Weight Loss Diets

Description of Concrete Experience: In my efforts to lose weight, I tried both the Aktins diet and NutriSystem, but neither one was successful for me in the long run. I was able to lose a little bit of weight each time, but I quickly gained it back -- and sometimes I gained more weight than I had lost. Atkins, NutriSystem, Weight Watchers, and all of those types of diets are fads, and they do not always work for everyone. For me, they were unsuccessful and I did not stick with them for very long.

Reflections: When I look back on the diets I tried before my gastric bypass surgery, I can easily see that I sabotaged myself quite easily a number of times. I was not good at following the diets that I tried, and I really did not believe in their ability to help me lose weight long time. Overall, I also often thought that I really did not need to lose that much weight, and I was in denial about my actual size. Once I got past that denial issue and realized I had to do something to save my life and reduce my weight, I was more willing to say that the diets were not the problem. But I do still think a realistic program of exercise and moderate eating is better than an actual "diet."

Generalizations/Principles/Theories: Diets come and go, and many of them are fads from the very beginning. The real way to lose weight and keep it off, whether a person has had a gastric bypass or not, is to focus on healthy foods in realistic portions, and also spend time exercising. Even a little bit of exercise is helpful, and once a person makes exercise a part of his or her life, it becomes easier to keep exercising more in the future. When that is coupled with healthy foods and portions that are accurate and not as large as many people eat today, weight loss can occur and can also be maintained.

Testing and Application: Testing and experimenting with diets is one way to determine what works for each person. I addressed this issue early on, before I decided gastric bypass was my only choice. The diets I experimented with did not work for me, and I did not have success with them. That was unfortunate, because I really wanted them to work. Most people, though, want the diet to work but only if they do not have to put a lot of effort into it. When people are very dedicated to losing weight, they try a number of diet plans and sometimes find something that works for them. Overall, though, a person has to adopt a plan of overall healthy eating and exercise in order to be successful in weight loss and maintenance.