I was 17 when I lay on the operating table, wincing as the anesthetic needle pierced the taut skin on the back of my hand. It was 2007 and the obesity epidemic was omnipresent, marking me with a dangerous statistic. I was told that my body size would eventually lead to serious illnesses like heart disease and diabetes unless something was done about it. I thought this procedure would save my life.
I was first diagnosed with obesity at age 8. At 10, I was on my first diet, eating low-calorie pretzels for lunch while my friends ate Oreos. At 14, I was visiting my pediatrician once a week so he could track my weight and give me lessons in self-control. At 16 he was prediabetic. Two months after my 17the birthday, I had bariatric lap band surgery: a reversible inflatable device was placed around the top of my stomach, creating a smaller “pouch” and limiting the amount of food I could eat. The procedure had been approved by the Food and Drug Administration for adults only, but given rising rates of obesity among children, the FDA sought to test this surgery among adolescents in a funded study. Adolescents who were diagnosed as “morbidly obese” (with a BMI greater than 40) and who had tried other means of losing weight, such as diets or drugs, met the criteria.
The specific surgery I had, gastric banding, peaked in 2008, with 35,000 surgeries made that year. Gastric banding is rarely performed now due to its high complication and failure rates. More invasive and permanent surgeries, such as gastric bypass and gastric sleeve, are used more frequently today.
Now those invasive surgeries are officially recommended for children as young as 13 by the American Academy of Pediatrics, which recently issued the first edition of a set of guidelines to treat childhood obesity. The document advises that families of children up to 2 years of age receive intensive behavioral health and lifestyle treatment as a preventative measure against possible obesity, and recommends medication or surgery for older children who have been unable to reduce their weight with other efforts. This 73-page report urges providers to view obesity as a chronic disease and treat it as such: with aggressive intervention.
As I was driving to work last week, I heard an episode of the New York Times The newspaper about the guidelines, in which medical reporter Gina Kolata acknowledges that not all children with a high BMI will have health problems, and furthermore, that insurance often doesn’t cover less invasive options like counseling or even semaglutides like Wegovy. She defends the possibility of irreversible surgery in this way: “There is widespread discrimination against people with obesity, and children and adolescents often suffer greatly. … It is a great burden for a child.”
For me, weight stigma, coupled with a lack of attention to my psychological well-being, was the burden. I worry about him 1 in 5 children who meet the threshold for aggressive weight treatment, because of what aggressive weight treatment did to me.
In the years after my surgery, I lost weight. And I was excited. I was finally able to be seen as normal, not an outcast to my troubled body. But when I turned 23, I started having side effects from the surgery, like frequent vomiting, heartburn, and an inability to eat. After an upper GI endoscopy, I found out I had gastritis, esophagitis, and gastroesophageal reflux disease, all of which are possible side effects of the gastric bandBecause when you have a small stomach and a constricted opening, food and acid can have trouble going the right way through your body. It was then that I realized that the surgery that was supposed to cure my obesity problem had done a poor job of addressing the underlying problem, which included a tangle of mental health and environmental issues.
After I was diagnosed with these GI health issues, I took matters into my own hands. I wanted to know how this had happened and why I had been diagnosed with obesity in the first place. Through my research on gastric banding forums and searching for symptoms on Google (“Why can’t I stop eating?”), I discovered the diagnosis of binge eating disorder, first incorporated into the Diagnostic and Statistical Manual of Mental Disorders in 2013, half a decade after my surgery. He criteria seem to fit: eating a large amount of food in a short period of time, eating past the point of fullness, eating when not hungry. As a child, I only learned briefly about anorexia and bulimia. It was clear that if you weren’t successfully purging or losing weight with the restriction, it wasn’t an eating disorder, you were just fat and needed to diet.
I started therapy and opened up past wounds that I had tried to ignore. My disordered eating behavior had developed as a coping skill to deal with my dysfunctional home environment and undiagnosed anxiety disorder, eventually progressing to mental illness. But in all my visits to doctors, dietitians, and diet coaches, no one had asked me what was wrong with my family, my mind, or the culture around me.
After realizing this at 23, my eating behaviors changed. But not for the better. I became hypervigilant, restricting my calorie intake, exercising too much, and purging multiple times a day. I no longer wanted to be seen as fat. I didn’t want to be an obesity statistic.
My health worsened. I became severely dehydrated and orthostatic, and started vomiting blood. I knew she was sick, but at least she was thin.
I lived like this, until I realized that I couldn’t take it anymore. I would not survive. I needed more serious help and went to various eating disorder treatment centers to stop the cycle and move towards recovery.
Today, about 45 million Americans go on a diet every year. The diet industry does $71 billion annuallyand their offerings have a lousy record—in fact, restricting your food intake can slow down your metabolism, which can lead to weight gain. What’s more, we’ve known for a long time about the psychological distress that intense dieting can cause: at a 1944 University of Minnesota.”starvationIn the study, 36 healthy men followed a restrictive, low-calorie diet for six months. The results revealed surprising physical and psychological effects on the participants: they experienced an obsession with food and exhibited disordered eating behaviors, such as swallowing water to feel full and cutting food into small bites to make it last longer. Surprisingly, these psychological effects did not always go away; after the experiment ended, some participants binged on food. Although I come from a stable, middle-class family, I related to this angst, which began for me with dieting in my childhood, eating “good” foods during the day and then binging on “bad” foods at night. My weight was a symptom of the dysfunction that surrounded me.
I wonder if, if doctors had ever looked beyond my body and asked how I felt about food, my body, my family, and my life, that would have prevented me from going through undiagnosed eating disorders and ending up. with a BMI that qualified me. for weight loss surgery.
My fear of the implementation of the new guidelines, particularly the surgery part of them, is not just the physical consequences like side effects, but also the psychological consequences. Until recently, my life was defined by my weight, because since I was little I was taught that my weight was what defined me. My obsession with losing weight, derived from early diets, did not lead to me being happier or healthier, as the doctors promised me at the age of 17. It left me with more problems to unravel as an adult. The band around my stomach has loosened and does not affect my day to day. But I do worry about children who will have permanent bariatric surgeries before they really understand their relationship with food, and Self esteem.
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