I’m not really worried about the surgery itself. From what I’ve read, this is one of the safest significant surgeries, and the risks of diabetes and obesity are significantly greater than the risks of the surgery. The fact that Kaiser pays the full cost (at least on my plan) also suggests that they feel that the overall risk/benefit ratio is heavily in favor of the surgery.
My main concern is willpower. My relationship with food is not very healthy; I eat somewhat compulsively, for emotional comfort and out of boredom. There have been times when I have felt as though it is really not under my control–I have found myself snacking, knowing I should stop, *wanting* to stop, and yet continuing to eat. I’ve spoken to a therapist about it, and I have had success in controlling it for extended periods before…but not long term. Of course, my understanding is that this surgery is meant to help with exactly that problem. Still, long-term success here is going to be absolutely dependent on strict control while establishing a newer, healthy relationship to eating.
That’s one of the reasons I chose the bypass versus the sleeve (the other being its better effects on diabetes). The bigger restriction on stomach volume and the tendency to produce unpleasant side effects when one overeats will (I hope) provide some reinforcement to my learning a new relationship with food.
I mentioned some of this to the psychiatrist I saw as part of the preoperative screening. I explained that I was trying to find a different source of emotional comfort, to replace eating when I am stressed. Interestingly, she said that many people find that that’s less of a concern than they thought; that one of the effects of the surgery is a change in psychological relationship to food. It has deep and profound (and not yet fully understood) effects on appetite, probably via changes in hunger and satiety hormones, among other things. I’ve heard a few similar stories from people who have had this surgery–that they no longer have all the same cravings. I sure hope that’s true.
But of course, food has a much bigger role in our lives than that. It’s a huge social factor; eating together is one of the biggest (and, as far as I can tell, most universal) ways we bond. The advent of hugely individualized dietary restrictions has become a source of humor, and I think it’s partially due to its impact on this fundamental social ritual. Offering one’s guests food is a very deep and basic part of hospitality; how does one do so when this person is on the paleo diet, this person is gluten free, this one is vegan, and this one is on a fifteen day juice cleanse? It’s humorous, and stressful for anyone who has tried to feed a group.
I really don’t want to be one of those people, but after this surgery, I’m going to have some pretty strict dietary limitations. I am worried about finding a way not to be a burden on gatherings. I am fortunate enough to have a super-supportive wife, kids, and immediate family, which will help.