Gastric Bypass: using map-reduce to lose over 50% of your weight

Disclaimer: the series of events I am going to be discussions is by no means a reflection of what should happen during your Gastric Bypass surgery preparation. This article aims to be a story about how the system works in my home country (Brazil) and how I leveraged it to achieve what was necessary for my well being.

Before and After (exactly 24 months after surgery)

How I came about gastric bypass surgery

For far too long I suffered with my weight. Weight issues run in my family. Until the age of 20, I was a bit overweight (5kg/11lb over) but nothing major for a 1.61m/5'3ft woman.

As I moved away from home and started working full time and going to college at night, healthy habits were impossible to keep for me. Maintaining this rhythm for 4 years lead me to use food as a comfort mechanism to compensate for parts of my life that weren’t going well. Using food as an emotional crutch led to a 20kg weight gain in about 18 months (that’s somewhere around 44lbs).

For years I tried diets, medicine, everything under the sun to help me shed the weight. Looking back on it, it is very hard to cure something mental through physical means.

Weight gain comes with a lot of other problems:

  • sleep apnea;
  • polycystic ovary syndrome (it makes the condition worse);
  • gastric reflux;
  • steatosis (this means fat on your liver, not good, baby).

There are tons of other stuff like urinary stress incontinence that can be a bit embarrassing if you are having pneumonia and can’t hold your coughs (been there, done that).

At the time, I had been going to the same endocrinologist for the past 3 years and we discussed the Gastric Bypass surgery a couple times, but when I would comment at home and get no support with people saying to me: “I know someone who did and died”, or: “You will have so much extra skin”. In the end I was always putting it aside, it was easy to be dismissive about it.

By August 2014 I ballooned to 105 kg/231lb. Everything was hard: walking, buying clothes that didn’t make me look like an old lady, etc. Everything most of us take for granted in everyday life felt like a conscious effort. Social pressure took its toll: the looks on the train, the snark, the way people would analyze things I ate… After 2 long years of being in a deep depression and not leaving my house, I came to a breaking point.

I remember clearly the day of a Brazilian game, during the World Cup, when a lady pushed me to get out of the train (it was full). As I was about to leave the train car as well, I said to her: “I am about to leave too, just wait”. She started calling me names, saying that if I didn’t have a fat ass and just shut my mouth I wouldn’t occupy that much space. I remember people looking at me, silent, no one objected. I left the station crying. I am not a wilting flowers by any stretch of the imagination, but at the time, I could not retort. The constant fat phobia had never crystallized as much until that day. It was time to make a change in my life and I looked into the surgery.

The rules

There are rules to having a this type of surgery in Brazil. You may fit between two categories:

If you have a BMI over 40.0

You are already qualified to do the surgery.

If you have a BMI between 35.0 and 39.9

You can do the surgery if:

  • You can prove your tried to lose weight for the past 2 years
  • You have any other obesity comorbidity associated to it (like diabetes)

I fit on the second category because my BMI was of 39.9 and I had at least 3 of those associated diseases.

What you need once you are qualified

After confirming that you are qualified to have this surgery, you need:

  • A referral from an endocrinologist saying you tried to lose weight for the past years;
  • A psychiatric evaluation from a psychologist or psychiatrist attesting you are mentally stable to do the surgery;
  • A dietitian evaluation of how your diet current is and how it will be after the surgery;
  • The gastric surgeon’s evaluation;
  • The pulmonologist’s evaluation to see if you don’t have any risks of your lungs collapsing during the operation;
  • A cardiologist final evaluation (after looking at all the other doctors evaluations and exams) saying what the risk of you having a cardiac arrest during surgery is.

Beating the average: going through a 6 months process in less than 45 days

On the 3rd of March of 2015, I decided to go through the process to get the surgery. I saw this surgery as the chance to start with a clean slate. It was the opportunity to get a new start. I called my mom, and she was happy to support me.

I decided to get 2 opinions about gastric surgeons. Since I was active on Facebook groups discussing this surgery, I found 2 doctors and one for the 5th of March and another one for 9th of March.

Turns out, I preferred the second surgeon. My Endocrinologist gave me the evaluation fast, knowing that I was finally taking her advice. At that time I also made an appointment to get the psychiatric evaluation from my regular doctor but he could only see me at the end of the month. He assured me he would help me get the evaluation since he was following me through the past year.

As a side note, It is important to say that Brazilian public healthcare is complicated. To do this same procedure it takes from 2 to 5 years. There is a waiting list and booking tests and exams always demands another queue. I was fortunate enough to work for a good company that had 100% insurance coverage and one of their best plans. In the end my calendars looked something like this:

March 2015 Calendar
April 2015 Calendar

The calendar names indicate the date I made the appointment (click the calendar to see full image). Those appointments would unavoidably cause other appointments because exams were necessary.

Here is a summarized view of the calendar:

Summarised version of calendar

Mapping and Reducing timelines

One could argue I did parallel processing and buffering setting up the appointments even before seeing the specialist. I knew I would need an endoscopy exam, knowing it had the potential to take too long, I did the appointment even before the doctor asked. That was true for most of the exams, for the other ones, queuing up was the only way to go.

I was lucky in others, the sleep exam, polysomnography, they would have only for months in advance, but someone dropped out last minute and they asked me if I was available (sure!).

Talking to other people that went through the same thing I did, they all take 6 months to 2 years to get the whole thing done. And this is really important, engage yourself in Facebook groups about the subject, get advice. One thing I will tell you, there is no right recipe to this journey. Everyone I talked about had different somehow.

Some people took a while to get the psych evaluation, and this is really important, you need to be stable to be able to be sure to make such life changing decision. Depending on the technique, the Sleeve for instance, is irreversible. Mine is reversible, but extremely hard to do and there isn’t many documented cases. My advice for you that is going through this is: find your triggers, discover why you eat. Is it something purely metabolic? Why do you want to this, is it just to be thin and pretty? Or your health is so compromised you need help?

People ask me why I was in a hurry. Indeed I took less than 45 days to go through the motions, but without the company support (thanks Scup/Sprinklr!) and my mom’s it would not be possible go through all of that. My resolve was set in stone, I had finally realized in how much suffering I was. I didn’t recognized myself, it took me years to see through that, but once I made up my mind I knew it was the right thing to do.

I don’t regret the craziness for a second, it wasn’t easy the postoperative (this alone makes a whole new blog post), but now 30 months after it I tell you it was the best thing I ever did in my life: it gave myself back to me. I am 100% me again, even after eliminating 52.38% of me in the process.

Post updated on the 6th of November of 2017.