"What's important is psychology." ~ J. Carville

Next up – psychology – July 27.

I was scheduled for a two hour visit. First I took an online assessment. They give you an hour to do that because it’s several hundred questions. Well, it took me like 10 minutes. First, I work with psychological assessments all the time. I am very familiar with them. Second, I am a speed-reader. I don’t see/read one word at a time. I see/read the whole sentence, sometimes the whole paragraph or screen, at a time. When I went back to the desk to tell the secretary I was done, I think she thought I blew it off. She made several comments about how quickly I finished. Whatever, lady, get it over it. But then that meant I had to sit in the waiting room for a long time until it was time to see the psychologist. The BMI waiting room is very interesting. Very. The chairs are HUGE. Everything in the place is huge. It took me awhile to figure that out. All of the furniture is “fat-friendly.” And, it’s a great place to people watch. Young, old, all different sizes, some in wheelchairs, some on oxygen, professionals, retired, all different colors, accompanied by sundry different people. I would catch myself making up stories about them, who they were, where they were from, why they were here… Then Dr. Julie Merrell came to get me for my psychology appointment.

Apparently, psychology is what keeps many interested people from getting approved for surgery.  Weight loss surgery is a life-altering, stressful process. Changes occur both emotionally and physically. This is why a behavioral health evaluation is a requirement – many habits, behaviors, thoughts, and emotions can affect the success of weight loss surgery. The online assessment and the face-to-face interview with the psychologist are meant to assess eating habits, weight history, stress factors, coping patterns, and lifestyle behaviors to determine the patient’s likelihood of success after surgery.

I didn’t like Dr. Merrell during my first visit. She was too thin. What kind of sense does it make to have an extraordinarily thin woman counseling fat people who want to have weight loss surgery? My friend and I would joke that she needed a “two piece and a biscuit.” I also didn’t like her because she pointed out exactly what I needed to change about my eating habits. Ugh. Who wants to hear that?! She quickly identified that I have out of control eating patterns that I need to change, such as binge eating. She asked me to go to a group called BEST (Binge Eating Strategies and Tools) Start. I did not want to go. Hear me clearly: I DID NOT WANT TO GO. It was inconvenient. There were no evening or weekend meeting times. It was only offered at the downtown campus. It was four sessions, just as school was starting and, most importantly, I didn’t think I needed to go. BUT, the psychologist is one of the three people (surgeon, psychologist, dietitian), who must sign off on your file to get approval both from the hospital and from the insurance company, sooooooo… off to the BEST Start group I went. Every Tuesday. In September. From 3:00 to 4:30. Ugh. I hated it. Then, I loved it. I learned how to slow down when I eat. I learned how to eat with purpose and intention. I learned how to reduce my portion sizes. We discussed emotional eating, out of control eating patterns, support groups after surgery, and so much more.

I returned to Dr. Merrell on September 26, after my last BEST Start session, and I liked her much more this time, even though she was still too skinny. She was very pleased with the progress I had made and the reports about me that the group leader had provided. She signed off on my file. Two signatures down, one to go…the dietitian.

“Searching and learning is where the miracle process all begins.” ~ J. Rohn

I have been asked if I will share what the process of getting approved for surgery by the doctor and insurance has been, so I will. Please know that this varies for each individual. If you choose to go to the Cleveland Clinic, it will be somewhat similar to get the doctor’s approval but your insurance company may have different requirements. My experience will at least give you some idea of what to expect. I’m going to post it in chunks because it’s a bit lengthy otherwise.

The process begins by attending a free Weight Loss Surgery Informational Seminar. You can do this in-person or on-line. I did the on-line version at the end of April, 2012. The online seminar was a series of videos, approximately 45 minutes long, followed by questions to make sure you really watched the videos. After that, I completed an On-Line Health Questionnaire. Once those two things were submitted, I was told it would take a couple of weeks for a nurse to review my questionnaire to see if I potentially qualified for weight loss surgery. So I waited…and waited…and nothing came. After almost a month, I called to check the status of my file. I was told it was on the nurse’s desk and I should have something within a few days. I didn’t. I waited another week or so and called again. Again I was told it was on the nurse’s desk and I would have something in a few days. At this point, I decided I wasn’t going to call again. If I got something in the mail, I would move forward with it. If not, I would take that as a sign and let it go. 

In the meantime, I went to lunch with a friend whom I had not seen much of in about a year. He was excited to share some new things in his life, one of which was that he was going to have, as he put it, the “fat surgery.” OMG. “So am I.” Unbeknownst to each other, we had started the process at the same time. We were both waiting to hear back from our initial request.

Finally, in June, I received a packet of information from the Cleveland Clinic Bariatric and Metabolic Institute, including a list of appointments. There are several color-coded “pathways” to weight loss surgery. Mine was green. Since I had no significant medical issues, I had the least amount of special appointments and tests that needed to be done. My friend was a smoker, so he had a few things to do that I did not.We both received our info packets within days of each other and our appointments were set up along the same timeline. We even had the same surgeon!

My first day of appointments was on July 12. I had blood drawn, a chest x-ray, ultrasound of my gallbladder, and an ECG. All of this is necessary to check for general healthiness. Then I met with my surgeon, Dr. Brethauer, and his team. Dr. Brethauer is very friendly and is just a few years older than me. He talked about each of the surgical options and we decided the gastric sleeve was the optimal choice for me. I’ll write about that decision another time.

I left the Clinic that day feeling overwhelmed. I had just been poked and prodded for hours and had discussed cutting off most of my stomach with a stranger. At this point, very few people knew about my decision to investigate the surgery. I felt very alone and didn’t have anyone to talk to about it, but that was my choice. My advice to anyone considering the surgery would be: tell someone you trust from the very beginning. Take that person with you to your appointments. It’s helpful to share the emotional and informational load. As a single person, I tend to do too much on my own. It has always been difficult for me to ask for help. In hindsight, I would have shared this sooner and included more people along the way for my own emotional well-being. Honestly, with even those that knew, I didn’t “share.” I would simply say, “I have an appointment on Tuesday” and that was it. I didn’t talk about the excitement and stress and fear and everything else. I kept that inside and I shouldn’t have done that. Lesson learned.

“There is no greater agony than bearing an untold story inside you.” ~ M. Angelou

So, I’m having the fat surgery. Big deal. Why blog about it? Why do I need to talk about it? 

Before I was a counselor, I was an English teacher. Before I was an English teacher, I was a reader and a writer and a lover of words. I began reading when I was two - yes... two... no lie - ask my mom. In recent years, I have gotten away from writing, other than that damn dissertation - that's enough to put anyone off writing for awhile - but, now, I am feeling words bubbling up and spilling out of me. I need to give them some place to go. 

Why this? Why write about my fatness and, hopefully, my thinness? What I have learned over the six months that I have been involved with the Cleveland Clinic Bariatric and Metabolic Institute (BMI), is that the general public has a lot of misconceptions about weight loss surgery. And, if you’ve never struggled with your weight, you may have a lot of misconceptions about what it’s like to be overweight. Many people know someone who has had weight loss surgery but it’s somewhat taboo to talk about it. I don’t think it should be. So I want to write about my experience as a fat person, as a person having weight loss surgery, and then as a thin(ner) person to attempt to alleviate some of those misconceptions and answer those questions. I also think weight loss surgery is an under-utilized tool. If people knew more about it, understood the risks and benefits and how to maneuver through the insurance approval process, I think many weight-related health issues could be resolved and quality of life could be improved for many people.

So, ask away. I’m not shy (anymore). Feel free to post your questions here or on my Facebook page. If you would like to send them privately, please email me or private message me on Facebook and I will post the question anonymously and then answer it.

"No one knows what to say in the loser's locker room." ~M. Ali

I have been fat my whole life. Seriously. My. Whole. Life. I carried “baby fat” around for about 20 years before my mom finally conceded to the fact that I was just fat. I actually had a cousin who called me “Fat Girl” like that was my name. In all fairness, he was fat too and I called him “Fat Boy” but I digress…

I could complain A LOT about how difficult it is to be fat in today’s society but it really is my own fault. I don’t like to exercise. I don’t have the greatest eating habits. I snack a lot. My life is sedentary. I talk for a living. My hobbies are couch-related. I have settled very comfortably into being fat but it’s not fun. Fat takes a toll on one’s body and I’ve been fortunate so far. I haven’t developed some of the more life-threatening, obesity-related health concerns…yet.

I have dieted, sometimes quite successfully. If you’ve known me for any length of time, you know about my tremendous success with the Jenny Craig program…twice…which lasted for the duration of my involvement with the program. I’ve done Weight Watcher’s, HCG, cabbage soup, Atkin’s, low carb, carb-lover’s, you name it – I’ve done it. I’ve also been a dues-paying member of pretty much every gym in the northeast Ohio area. And, yet, I’m still fat. Technically, I am obese. I have, at times, been “morbidly obese.”  That’s got to stop.

Recently, I, once again, began weighing my options, no pun intended. I turned to research and books, as I usually do. What I read was that people who have been as fat as I have been for as long as I have been have only a 2% chance of losing a significant amount of weight and keeping it off. Boy, don’t I know that to be true! More and more, I read about the tremendous success of weight loss surgery. With weight loss surgery, people who have been as fat as I have been for as long as I have been have a 60% chance of losing a significant amount of weight and keeping it off. Hmmm… I like those odds…

In late April, I contacted the Cleveland Clinic’s Bariatric and Metabolic Institute to learn more about surgical options. It took FOREVER to have my file reviewed by the nursing staff. I had to call twice and check the status of my request. Finally, I received a list of appointments to begin the evaluation process. The journey began on July 12. On October 15, I was finally cleared and approved for surgery by the Clinic. Today, I received approval from Medical Mutual, my health insurance provider. I have scheduled a Sleeve Gastrectomy for December 19, 2012. This is not the lap-band. It is not the gastric bypass. Google it.

Most people have an opinion about weight loss surgery. Some people think the risks are not worth it. Others think it’s the “easy way out.” I’m an intelligent person. I do my research. To me, the benefits of this surgery far outweigh (hee hee) the risks of continuing to be fat. The surgery is much less risky than some other crazy things people do to lose weight – things that I have done to try to lose weight. I am now and will continue to be under the care of one of the best doctors in the world, and his team, as I go through this process. Additionally, this is definitely not going to be easy. Even getting this far hasn’t been easy.

I will need supportive, positive people around me through my recovery and as I make the necessary lifestyle changes in the months to come. Please feel free to follow my journey if you can be one of those people.