A challenge: Losing weight to avoid the surgeon's knife

The question before us is: can a 53 years old, morbidly obese man lose enough weight to positively impact his health and avoid gastric bypass surgery?  I intend to use this blog to publicly explore that question.  I am a type two diabetic with a family history of heart disease, diabetes, and obesity.  Can I make the changes in my diet and lifestyle that will undo years of bad habits and faulty thinking, or must I resign myself to radical surgery that will artificially limit the amount of food I can ingest?

Perhaps a little background is in order.  I am 5 foot 10 inches tall and weighed 273.5 pounds as my last doctor's visit. This is more than 100 pounds over my ideal weight and gives me a Body Mass Index of 40, well beyond what is considered healthy.  Since I was diagnosed with diabetes more than four years ago, I have been able to manage my diabetes with a bunch of pills every day, and by injecting slow acting insulin before bed each night. While this regime has kept my diabetes under control, the amount of insulin I need to take each night has been slowly increasing. This is bad sign, as it indicates I am becoming more resistant to insulin. Additionally, it seems to be much harder to lose the weight than it once was. I have tried moderately cutting back my daily calories and getting regular exercise. In the past, this would be enough for me to drop some pounds.  Now, my weight doesn't seem to want to drop off. My doctor said this is probably a result of the insulin. How ironic, the medicine that is controlling my illness is slowing my ability to reverse it.  Given my apparent increasing insulin resistance, both my family doctor and my endocrinologist have recommended that I consider bariatric surgery, specifically a gastric bypass.

So, with my physician's referral in hand, I sat through the mandatory information session sponsored by my hospital's bariatric surgery center.  The presentation was very informative. The surgeon outlined the six month screening process of supervised dieting, exercise, and psychological evaluations that are required before they would consider conducting the surgery.  She described the various surgical options such as the lab band or sleeve gastronomy, but strongly recommended that I undergo a complete gastric bypass. The thinking is that the other forms of bariatric surgery are not nearly as efficacious in addressing chronic diabetes.  Essentially, they would surgically reroute my digestive system, making a much smaller stomach and by-passing much of my intestines, hence the name.

The orientation seminar asserted surgery has a significant chance of completely reversing my diabetes. Essentially, the surgery limits how much you can eat at one time. According to the seminar, I could expect to lose (and keep off) about 70% of my excess weight after a gastric bypass.  However, this surgery is not without its risks and it is a very radical solution to the problem. The orientation did not try to undersell the significant risks from surgery. Instead, they pointed out that the risks from surgery may be warranted by significantly lowering of the risk of death due to complications from chronic diabetes.

At the end of the information session, a former patient talked of her experience with the bariatric procedure. The patient explained how she had been morbidly obese since she was 14. She said she had struggled with type-two diabetes for her entire adult life.  When her diabetes began to worsen as she turned 30, she decided to get the gastric bypass her doctor had been recommending.  Now, four years after the surgery, she obviously was much thinner and healthier than the woman in the "before" pictures.  She said her diabetes was gone and that she was very satisfied with her new post-operative diet. She said her surgically altered stomach makes it very unpleasant for her to eat more than a small portion of anything at any one meal. She also said she becomes physically ill if she eats anything with too high of a sugar content such as cake frosting or ice cream. The surgery has created a negative feedback loop that triggers discomfort, nausea, and cramping if she resorts to unhealthy eating habits.  She said the combination of the feeling of satisfaction along with the post-surgery aversion to sweet foods has enabled her to maintain her diet in an effortless fashion. She said that this was unlike all the other diet and exercise programs she tried and failed at.

Following the orientation session, I completed the required forms and submitted the paperwork to the hospital Bariatric Center to enroll myself in the pre-surgery counselling program.  Because morbid obesity with chronic diabetes is such a common diagnosis, the bariatric center may take up to a month to fit me into the schedule for the next step, a mandatory supervised diet and exercise program.

However, I have decided not to wait to begin the supervised diet.  Instead, I have begun a self-initiated diet in which I will try to limit myself to no more than 1800 calories per day.  This is a probably half of my normal calorie intake, and is much less than my "typical weight-loss diet mode" calorie limit of 2500 calories. However, 1800 calories is 300 calories more than the total calories I will be expected to consume after the bariatric surgery.  Because the total daily calorie count for the diet is relatively low, I will be logging all the foods I eat using a program that helps me also track my nutrient levels. Anyone who is interested in my diet or progress on my weight loss goal can see it at  Mike Summers' Public Diet and Activity Log. In addition, I intend to use this blog to narrate my journey to lose this weight, or if I fail that, with my experience with the surgery.

So, the question at the moment is can I maintain such a radical diet to lose the weight and thus avoid having the surgery?  I don't know, but my initial results from the diet have been surprisingly good.  I began the 1800 calorie a day diet on 17 July when I weighed 273 pounds.  As of yesterday, I had easily remained below the daily calorie limit, and I had lost 12 pounds. So, I am now down to 261 pounds. Another noticeable impact from the diet is that I have seen a significant decrease in the amount of insulin I take each night. This is probably not related to my modest weight loss to date. Instead, it is probably related to the significant drop carbohydrates in my diet as cutting empty carb calories is how I have stayed below my daily calorie limit.   Of course, it is easy to keep on the diet for a few weeks.  The real test will be if I can sustain a true change in my eating habits over the long haul.  Wish me luck, and check back here again from time to time to see my progress.