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Tuesday, November 4, 2014

Decisions, decisions, decisions......

FRIEND OF A FRIEND:   I'm considering some kind of weight loss surgery in 2015.  I heard I should talk to you first.   
ME:  Sure, what do you want to know?
FRIEND OF A FRIEND:  I have about a thousand questions.  First, I have to decide if I really want to do it.  Second, I need to figure out what kind of surgery.  Third, I need to find the right surgeon who could do it.  

Okay, friends, let's back up a little here...... 
A few weeks ago, a friend asked me if I would be open to talking to her friend who was considering weight loss surgery.  Of course, I said yes.  First, she and I had the phone conversation that you see above.  Considering that she said she had a thousand questions, I thought it best that we meet up in person to talk.
A few evenings ago, this friend of a friend and I met at Starbucks to have our little chat.
Although I never met this friend of a friend and I had no idea what her story was, I was prepared to meet a woman who  was very overweight.  Yes, I was profiling....
How wrong I was!
Who I did meet was a 37 year old woman who clearly did not have a weight issue that could possibly need addressed with weight loss surgery.  She was definitely not 100 pounds overweight (which is the typical criteria that most surgeons use to first evaluate a patient's need).  
After a bit of small talk, I asked her...without judgement....why she was considering weight loss surgery.
Her answer was quite interesting....
She shared that she comes from a very long line of morbidly obese people.  She gave me a quick synopsis of the weight issues of her parents, her grand parents, her siblings, her cousins and on and on....complete with rattling off health histories, relationship issues and other assorted commentaries about the problems they face as morbidly obese people. 
"I can't be like them....."  she finally said. 
To be honest, I was a bit lost for words. 
Because, you know....I did get it. 
But, on the other hand, I was sitting there with a woman who clearly did not need weight loss surgery and who I truly believed would not be cleared to have the surgery by any self-respecting doctor. 
"Well, I am not sure what to say....."  I said, after gathering my thoughts.  "First...have you done any research on the criteria used by doctors to assess the needs of surgery candidates?"   I asked, hoping to initiate a conversation about the fact that she would probably NOT be considered a viable candidate. 
"Yes.  I know I don't fit  weight-wise.  But, I have all the other issues.  Family genes.  High blood pressure.  High cholesterol.  I have gained over 25 pounds in the past 10 years.   My knees hurt. I snore.  I have done every weight loss program on the planet and I still can't lose the weight.  My mind is constantly preoccupied by my weight which makes me depressed and unable to do normal things.  I can't exercise due to the discomfort  and I am out of breath from walking just a flight of steps...."  she said with a very strong sense of conviction.
She had just told me that she tried every weight loss program on the planet and couldn't lose the weight so of course, I wasn't going to ask about her weight loss efforts.  It seemed futile.
I wasn't quite sure where to go with the conversation so I shared my story with her in hopes of helping her to understand where I was coming from and perhaps to spark further conversation about her own situation.
"So, your life is changed due to your surgery?"  she asked.... her question clearly indicating that is what she got out of my story.
"It was the tool that helped me tremendously, yes.  But, I have to tell you honestly that it's not a magic bullet.  I had to work at it every day and I still have to do the work everyday to maintain it.  It is a tool,"   I told her with my own strong sense of conviction.
"Then, maybe a Lap Band isn't for me.  Maybe I need bypass or the sleeve..." she said, seemingly thinking out loud....
"I am sure that they are also tools that can be helpful."  I told her. "How much weight do you want to lose?"  I asked, hoping to spur a more concrete discussion.   
"It's not about really losing the weight.  I guess I want to lose the 25 pounds I gained.  But, I need something to help me NOT TO BECOME MORBIDLY OBESE!"  once again, with conviction.
"Like Angelina Jolie.  She had a mastectomy because she had the gene for breast cancer.  I have the gene for obesity.  I want to stop it while I can.  Before it gets so bad that I can't!"  she shared. 
Again, I wasn't sure where to go with the conversation.  I didn't want to draw the comparisons between cancer and obesity because I do truly believe that obesity can be a life threatening disease just as cancer can be a life threatening disease. 
Here was this woman telling me she wanted to have 'preventative surgery and I was sitting there thinking "there's no way, this is crazy, I don't think weight loss surgery is for you......"
I never want to be that person who sits in judgement of another's decisions when they are working towards better health or a better life and I definitely don't want to be the person who is suspicious of their reasons for their choices........
"Well, I am not sure what at to say to that.  I just have some concerns about you being approved," I finally said. 
"Oh, I don't need insurance approval.  I would pay out of pocket or take a loan depending on how much I need.  I just don't want to go to Mexico but I guess if I had to....."   she reasoned. 
"It's not the insurance thing.  I don't think a doctor will do the surgery unless it's necessary.  You have to go through several evaluations leading up to the surgery. There's a consult with a nutritionist and there's a psych evaluation.   And, they do make you go on some kind of monitored weight loss program prior to approval.  It can be a lengthy and time consuming process..."  I explained. 
She shrugged her shoulders...."well, how will I know if I don't try...right?"  she asked. 
I nodded in a hesitant agreement and asked her if she needed any more information. 
"Yes.  What do you think about me getting this surgery?"  she asked with emphasis on what my personal opinion was. 
I could have given her more opinion than she ever wanted to hear.
But, I refrained.
Part of me was feeling a little frustrated that she didn't have the understanding that there are people like me who truly needed the surgery due to their current issues.  Part me wanted to explain that having weight loss surgery is a decision not to be treated casually and that is important surgery.  It is not cosmetic surgery!  And, I wanted her to know that Weight Loss Surgery is for people who were OBESE....not people who might become OBESE.  There were moments that what I heard her saying was "I just don't want to fat...."   but I was ashamed that I was feeling that way about another person after only one quick encounter and after she shared her story.  
What if everyone who didn't want to be fat decided to get weight loss surgery before they got fat.....?????  Imagine the waiting list!!!!!  The people who really needed  it would be bumped by the people who don't want to be fat!
My mind was swirling with these thoughts.....
Yet.....don't ask me why but I felt a responsibility to try to shake her into thinking about this a little more.  And, I wanted to do it without judgement and without being insensitive to what she believed to be her destiny without the surgery.
"Well, if you want my opinion.....I think that maybe you need to talk at length with your doctor and share everything you have told me about what options are best for you.  I'm not sure if I am the best person to ask since I was obese when I decided on the surgery..." I said, trying not to let my frustration show....
"It's a hard decision, you know.  But, I wonder if you would have had the surgery before you got obese....."   she mused.
Funny thing, I wanted to throw my Chai Latte on her.
And, you know....I never want to waste my Chai Latte......

1 comment:

Barbara said...

Wow. You did a great job navigating that convo. I probably would have been a bit more direct. It's surgery no matter how yo slice it and whether a physician agrees or not it still is a major lifestyle change. It's a challenge for me each and every day. I think you did a great job.