To Sleeve (or Not to Sleeve) Series - #8, Pros & Cons of: Surgery vs. Permanent Lifestyle Change Alone

(This is part of a series I posted on my other (formerly anonymous) blog, An index of all posts in this series is located at the bottom of this article.)


If you’ve been following me along over the past couple weeks — you know I just started this blog as a bit of a chronicle and journal of my walk through this part of my life. You also know that I have yet to fully decide, “YES – I’m going to do bariatric surgery!”

I did go to an information session put on by a regional bariatric group a couple weeks ago. And since then I’ve actually spoken to those people on the phone and am scheduled for an initial consult with a dietician and doctor in the middle of June (2015). Of course I’m not the only one at this point who has the option of opting me out — they certainly can disqualify me for a hundred different potential reasons for all I know. But I also know that I can decide to stop the process at any point along the way. I don’t imagine doing that; yet it’s comforting to know that I can.

In this post, I want to explore a little bit some of the pros and cons of surgery vs. no-surgery. Primarily just to help me get my mind straight about everything. Do the risks outweigh the potential rewards? Is the cost (in terms of permanent lifestyle change and social implications) too high for what I’ll get back? Are there intangibles with either that I can only get by pursuing a given path?

So I worked up this little chart — I’m a nerd, I know. And my hope was to compare and visualize the weightiness of each decision path. You’ll see some question marks throughout and that’s because I’m not sure how much to weight some of these items — or if even some of them are true. In any case, this is how it fell for now…

Now — The real question mark in all of this is whether or not I’ll stick to the changed lifestyle if I do the surgery — or If I’d be able to be successful at permanently reducing my weight without surgery (hasn’t happened yet in over 15 years of dieting)… In the end, it comes down to likelihoods — and according to my past path, it seems most likely that trying to do this without surgery is a far more difficult path also one that is more likely to end in little to no success… It also seems that according to the research, surgery is the best option for most people this overweight — yielding the best long term results of any currently known therapy.

If I were to make a chart with those things a little more solidified, the graph would look a little differently… The weight would fall much more firmly on the side of surgery.

However, if I were to beat the odds — really be able to keep my weight off with diet and lifestyle change alone, that would seem like the better option (other than the speed factor) — because I’d avoid all the risks of surgery and permanent body change while still reaping the benefits of lower weight and fewer comorbidiites. This scenario is the less likely one – clearly – but still possible.

The real wildcards then become clear to me…

First — time — surgery is far more likely to yield me into a successful situation within a couple short years than is lifestyle change, which is and will be a very long slog with many more downs than ups arguably. Because I have two little sons who’s childhood is in play here — time IS of the essence. And that isn’t overstating things at all…

The second wildcard isn’t a big deal but it is something. I write in the chart above about how surgery is this definitive, risky, permanent step — it’ll be putting me on a path irrevocably — an adventure of a kind. Sure. There might be dangers. Sure. There might be problems down the road. But it’s doing something about my situation. It’s doing something big. It’s arguably doing the BEST possible thing (according to my family doctor – and now my wife). It kind of has the feel of joining frodo on his quest to return the ring to mordor in the lord of the rings tale (ok 2 nerd references in one post — enough) — I like that. It feels good. It stokes my inner masculine adventurer. Even if there are negative things that come out of it…

I’m not sure if I’m any further along in the process of deciding than I was when I began this blog a couple weeks ago — but I feel as though the stars might be aligning for me to go forward with it.

The rubber will begin to meet the road after my consult in a couple weeks I’d suppose.


To Sleeve (or Not to Sleeve) Series - #6, Food Journaling

(This is part of a series I posted on my other (formerly anonymous) blog,

Over the years I’ve been on many different ‘diets’. As a consequence of some of these (namely Weight Watchers), I had to keep a careful tally of my daily caloric/nutritional intake. This was always a challenge and in some ways contributed to me feeling additionally neurotic about food. (I.e. even though I had been eating far too much before — I wasn’t obsessing about it in between meals, I didn’t feel hungry or deprived, I didn’t have cravings except when it was actually time to decide what to eat). As soon as I started keeping track, it was like every waking moment became ‘food-planning central’.

This past week, I started keeping track pretty carefully once again. This time, however, my intention is that this will be a permanent addition to my life. I’m in the physical shape I’m in part because I often have been so entirely unconscious about my eating. If asked to give an account, for many days I couldn’t even give you a good estimate of quantities or even items I had eaten. It’s like I become a zombie — mindlessly vacuuming up whatever is around me: cold cereal and leftovers, chicken wings and ice cream, smoothies and tall glasses of milk.

At the same time however, I’m also kind of a foodie. Over the past decade I’ve grown in my affinity for cooking. I’m the main chef in my home. I cook almost every day. I plan meals. I look up recipes online. for a season, I watched a lot of TV cooking shows (Alton Brown is my favorite – I identify with the inner nerd). So while I have had moments of pure unconscious inhalation, I also have moments of hyper-consciousness. Loving food entirely too much and feasting entirely too often. If every meal is “special” then no meals are special.

A friend commented to me one time when we were comparing food budgets – “Man, you guys eat better than anyone I know!” I don’t believe malice was intended — but it stung a little, I’ve gotta admit.

One hope in keeping a record of my diet is to help me to internalize — more accurately — food nutrition and values. As I alluded in a previous post, I grew up in a pretty food-literate culture, so I’ve inherited some good bones (proteins, types of carbohydrates, kinds of fats, fiber, whole food vs. processed, micronutrients & trace elements, etc.) — but what I lack is a solid awareness of caloric properties and abilities to accurately estimate quantities.

How many calories are in a cup of strawberries?
I have no idea. I could guess. But it literally would only be that.

How would that compare to say, a cup of spaghetti?
My guess is that spaghetti would have a little more – but I really don’t know – fruit has sugar right?

Chicken breast is a good source of protein, but it isn’t all protein right? It carries calories?
What does a 6oz piece of cooked chicken even look like? How many calories does it have?

I could go on and on…

Maybe I’m not alone in this. But I feel as though this lack of intuitive judgment has been and will continue to be a handicap for me in getting healthy. And so for a good while – I think I’m gonna need accurate assistance to help me along the way. A set of trainers if you will. This morning, I used a measuring cup to measure out fruit that went into my vitamix for a morning smoothie. I wouldn’t know otherwise. Luckily I already have a good set of kitchen tools in this regard.

I really love this adjustable measuring cup from Oxo. Especially if you’re short on space, it does the job of many different smaller sized cups and also helps you guesstimate a little more accurately.

I plan to pick up a better digital kitchen scale — which will help me figure out just how much that chicken breast actually does weigh… I’m not sure if there really is a better way. Cooks Illustrated recommends the OXO one yet again so that might be it.

A third key tool I’m using is my iPhone 5S. There are dozens of apps that offer tools for tracking meals and activity – predict your metabolic burn rate given weight and height – and also offer huge databases of the nutritional content for both commercial and whole foods. I like and this post has a pretty solid overview of 5 current options for food tracking apps. I’m using their second on the list “LoseIt” — and I’m finding it pretty good. But the food database isn’t the best. In the past I’ve used, MyFitnessPal and their database was huge — so I might go back to that.

In any case — this is where the rubber really meets the road and these apps are helpful because they not only provide a compact, organized platform for recording a food diary from day to day. They also contain, within themselves, data on foods — which like I’ve said, is a complete enigma for me (if not many of us).

About 5 days into it, I feel ok. Positive. Hopeful. Eyes opening slowly to my new reality.

I’ve shed a few pounds but who knows where those are from…water? my liver? hopes and dreams?

We shall see what unfolds next.