WEIGHTY MATTERS
Living Large
Coming to terms with my sizable senior self
I didn’t know I was that fat until my wife told me.
Back in the mid-2010s, when I was finishing up my 50s, we were driving from Knoxville to Cincinnati to see a Reds game. Somehow the topic of sex came up. I can’t remember any of the conversation except when she revealed, “I’m not attracted to you anymore.”
I knew she was a caring person who hadn’t come to that conclusion carelessly. She had decided to send me a wake-up call: Slim down or the life you know is at risk. She wasn’t trying to be mean; she was just honest. Even though it stung at the time, in retrospect I appreciate that she was straightforward with me.
I already knew I was overweight. I had tried Weight Watchers, the Atkins diet (no carbs allowed! Bacon, yum!), and others. All they did was make me feel defeated.
There’s a reason why the word diet is 75 percent the word die.
In the car that day on I-75, as Kentucky horse country sped by, I was forced to face the truth: I had allowed my prodigious appetite to get the best of me. I had grown to wear XL shirts and pants. Though I had given up beer years before, I also had a distinct gut.
But I never thought I was that fat.
I was wrong. In fact, later, when I went to a bariatric surgeon, I found out I was among the two in five Americans who are obese.
Even worse, at 5’8” and about 250 pounds, the weight of an NFL linebacker, I had a Body Mass Index (BMI) of 38, leading him to diagnose me as “morbidly obese,” a rather nasty term for the overly large.
Measuring BMI is controversial in that it was never originally intended to apply to individuals, just to populations. According to the Australian Broadcasting Company (ABC):
The first thing to know about the BMI is that it was created by a Belgian mathematician — not a doctor or health practitioner.
In the 1830s, Lambert Adolphe Jacques Quetelet set out not to devise a test to quickly diagnose obesity (which was still years away from being widely perceived as a problem), but to find the “l’homme moyen” or the “average man”.
But there were big limitations to Quetelet’s experiment. For one, all the participants were western European men. The experiment also had nothing to do with measuring individual health.
It wasn’t until the 1970s when American physiologist and dietician Ancel Keys and a group of his colleagues promoted Quetelet’s Index as the best available way to quickly screen for obesity that it became what we know today as the BMI.
But like Quetelet, the Keys study didn’t account for all body types. It only measured 7,426 “healthy” men from 12 sample groups. They included American students and professionals, Italian railway workers, men from east and west Finland, Japanese farmers and fishermen, and Bantu men from South Africa.
Even if BMI is a crock, though, there’s no question that Americans have gotten heftier and heftier. Why?
The complete answer is probably complex, but a recent essay in The New York Times by Johann Hari, a British journalist and the author of Magic Pill: The Extraordinary Benefits — and Disturbing Risks — of the New Weight Loss Drugs, puts the blame on all the processed food we eat:
The primary reason we have gained weight at a pace unprecedented in human history is that our diets have radically changed in ways that have deeply undermined our ability to feel sated. My father grew up in a village in the Swiss mountains, where he ate fresh, whole foods that had been cooked from scratch and prepared on the day they were eaten. … The evidence is clear that the kind of food my father grew up eating quickly makes you feel full. But the kind of food I grew up eating, much of which is made in factories, often with artificial chemicals, left me feeling empty and as if I had a hole in my stomach. … This kind of food makes you want to eat more and more. Satiety comes late, if at all.
What hath Big Macs wrought?
Americans, including seniors, have been trying to lose weight forever, many with out much luck. Doctors have emphasized willpower as the answer to losing pounds, which has frustrated countless people who’ve tried to think themselves thin. Individuals and governments spend billions on weight loss without significant results.
Another recent article, in The Atlantic, highlighted that America’s efforts to tighten waistlines through individual effort or government health policy have failed:
In the United States, an estimated 189 million adults are classified as having obesity or being overweight; certainly many millions have … spent decades running on a treadmill of solutions, never getting anywhere. The ordinary fixes — the kind that draw on people’s will, and require eating less and moving more — rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started. New rules for eating have been rolled out and then rolled back. Pills have been invented and abandoned. Laws have been rewritten to improve the quality of people’s diets and curb caloric intake — to make society less “obesogenic” on the whole. Efforts have been made to reduce discrimination over body size in employment settings and in health care. Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.
Moreover, and likely what my wife was trying to say in the car that day, was that my weight was affecting my health. I have a genetic disease that deformed my bones and led to eight joint replacements. The more weight I carried, the harder it was on my hips, knees, and feet to move it around.
I was also likely prediabetic, a precursor to type 2 diabetes. My weight might have led to coronary disease or even a heart attack.
I was a walking time bomb.
I decided to visit that weight doctor and ask him about bariatric surgery to take off the extra pounds I’d accumulated. That started a long, hard weight-loss road that included an operation that turned my stomach into a pouch the size of a banana peel.
On March 27, 2017, in my 59th year, I had gastric sleeve surgery, also called sleeve gastrectomy. The operation, done with laparoscopy, removes 50 to 75 percent of the stomach, so that it holds a much smaller amount of food. The idea is that patients like me won’t be able to eat as much, shedding pounds as a result.
(Let me be clear: I am not a doctor or other healthcare professional, just a patient speaking from my personal experience. I am not recommending any treatment for obesity or any medical condition. Always consult a qualified physician before pursuing any treatment.)
Immediately after the operation, I freaked. It hit me that my life would never, ever be the same, that I had done something to my body that was permanent, my own version of a Ben Afleck back tattoo.
I knew the operation would probably extend my life, though. My elderly mother spent years in care facilities among the long-lived. When I visited there, I noticed something that motivated me: no fat people in the old folk’s home.
After the surgery, I followed the complicated instructions about what I could and couldn’t eat. I dutifully counted calories with the My Fitness Pal app, keeping my intake to 1,800 a day, but sometimes going as low as 1,200.
The surgery successfully killed my appetite, though I’m not clear medically how. I no longer spent the day thinking about my next meal.
I dropped 80 pounds in months, going from my highest weight of 250 pounds to a relatively slim 170.
One of the problems of weight-loss surgery is that less food means fewer nutrients, including protein. As suggested by my doctor, I drink one chocolate Premiere Protein Shake each morning, giving me 30 grams of the 100 grams of protein a day the doctor said I need.
To make up for lost nutrients from food, I also take six hard-to-swallow multivitamin pills a day, which, now that I look at the label, includes a whopping 24 vitamins and other ingredients like calcium and iron.
Though the first few years after the surgery were intense, seven years later into my mid-60s life has leveled out and now I mostly eat what I want. Still, I can consume only smaller portions, much less than I did before the surgery, when I could chow down a massive slab of prime rib with woodshed potatoes at Ye Olde Steakhouse.
I am unusual among bariatric patients in that I’ve maintained the weight loss for more than five years, but lately there’s been a setback. I’ve regained some of the pounds I lost (physicians call it “eating your way out” of bariatric surgery). My sweet tooth again got the best of me.
I am mortified. I fought so hard to lose those 80 pounds that I became obsessed. Every scale reading terrified me, but I was able to hover around 170 for a long time.
Today, I’m troubled to say that I have likely put around 15 back on, but I don’t know for sure. I’ve stopped getting on the scale — even at my doctor’s office — because I don’t want to deal with the disappointment and shame of getting chubbier.
Some of the gain is likely just due to age. Many seniors get heavier as they get older. I just turned 66. I fear I now have the pudgy physique of the Pillsbury Dough Boy.
In reality, though, according to the CDC Adult BMI Calculator, I’m just overweight, not obese (or morbidly so). That measurement does not take age into account, and I’d bet that I’m nearer to the average size for a healthy 65+ male.
My weight gain comes at a time when being thin is back in our society, despite the efforts of body positivity activists working to make fatness normal and acceptable. The news is filled with stories about drugs like Ozempic, Wegovy, and Mounjaro, which cause people’s appetites to wane, thus leading to weight loss.
We are playing a weird game of Out the Celebrity on Ozempic. This causes stars who’ve slimmed down to deny they did it with pharmaceuticals. (At least Oprah has come clean.) I wonder, though, why there is a stigma at using medicine to protect your health, as though it’s a personal weakness that weight-loss drug users haven’t lost pounds the “right” way. Having gone through bariatric surgery, I also don’t think that is “cheating.”
Ozempic and the like are just the latest miracle drugs aimed at obesity, but the jury is out about whether they will be a “cure” for America’s weight problem. Who knows what the long-term side effects will be? (Remember fen-phen and the heart-valve problems it caused?)
Slowly, though, I’m working to come to terms with my newly burgeoning body. Within the past few weeks, I’ve finally broken down and bought bigger clothes. I resisted moving from the M-sized ones I was stuffed into, but now I’ve moved on to L. It’s been freeing. I feel more confident in garments that fit.
I hope I can maintain the weight that I’m at in my seniordom, even if I am fuzzy about the exact scale reading. I’m practicing acceptance of aging but need to apply it to acceptance of my sizable self. I’m trying not to obsess about my weight and just enjoy my larger life.
Besides, I’m not that fat.
Randall H. Duckett is writing a book about the emotions of chronic pain and invites fellow sufferers to share their stories. He can be reached at randall@hurtfeelings.life. He is also the author of Seven Cs: The Elements of Effective Writing (available on Amazon); learn more at randallhduckett.com.
