The stationary bike may work. I’ll visit a friend who has one and see whether I can do it without significant pain.

What I’m doing is recognizing I have an addiction. If snack foods are in my home I will eat them first. Always. Not having them here causes me to eat the healthy fruits and vegetables. I have built in a way to “cheat” by allowing myself to go buy one snack item, such as an ice cream cone or one Coke. That has taken away anything to do with guilt or a sense of failure. Another thing I do is weigh myself infrequently. I don’t own a scale so I check my weight at my doctor’s office. I’m losing only five pounds a month but am very satisfied because I feel much healthier.

I will reveal I had gastroplasty about 25 years ago and went down to a size 6. I kept it off with diet and lots of exercise. As my arthritis got bad and I couldn’t exercise, I began overeating on the foods that go down easily, and I ended up gaining back the 200 lbs lost. So I know a lot about failure.

I can only continue trying to live a healthy life. As to my weight in five years…who knows. I look at this as a lifestyle change and not a diet to endure for a certain length of time. What I’m doing can be done forever. I began doing this 13 months ago to improve my health. The weight loss is wonderful as a secondary goal and will add considerably to better health.

In terms of exercise, Jennifer, you might want to invest in a stationary bike that is recumbent? It seems to work well for me.

Anecdotally is all I go by; I know that’s a big no-no for scientists, but since I’m not one, all I can say is: the story of the woman from your office who has done terribly frightens me more than the other 2, since no one can assure me that I would not have the first woman’s fate.

As for hunger, I’m going by Carnie Wilson, who, as you know, has not been shy about publicizing her gastric bypass and the results of it.

Hunger is a strange thing, I think. One can be “hungry” for a donut w/o actually being hungry. How many people who go for this operation have the kind of hunger for binging on sweets or salty snacks? Probably most if not all of them, I’m guessing. It seems to me that the ability to manage this hunger is very difficult, regardless of weight, but especially for those who are fat. Then there is overeating, and perhaps a gastric bypass makes that less likely, but for how long? The body seems to have ways of adapting.

Also, I don’t think having to rely on vitamin supplements, which are expensive and not as good as being able to get them from food, is so great. Poor absorption of vitamins is also a factor. Groups like OA (12 steps) purport to solve hunger for sweets and snacks, but I’ve seen many a fat person in those groups. Alex mentions her solution, but she will have to see how well she does, after 5 years.

If 90-95% of people regain their lost weight after 5 years, and gastric bypass has so many risks (including the risk of regain), well, so far, I’m not convinced.

Just because I’m fat doesn’t mean I think I should subject myself to an extremely dangerous operation w/extremely unpleasant to very dangerous aftereffects. Still, I wish something would work. We live in a world filled w/food. Not everyone gains a massive amount of weight, but the numbers seem to be going up. Maybe the pollution of our environment is playing a part in this, as hormones get affected by mercury and other nasty things.

I know that I’m very low on vitamin D, so now I’m supplementing. I’ve read that the higher your BMI, the lower you vitamin D stores are likely to be. Imagine if low vitamin D is causing a lot of my obesity, and imagine if I don’t know that, get a gastric bypass and then, after the operation, I can’t absorb vitamin D anymore!

No, there has Got to be more in-depth solving of this obesity puzzle. Time will tell. We might look back at this time of blaming obese people as a time of when ignorance was the norm, not knowledge—or compassion.

My problem is exercise. Severe arthritis, artificial knees and hips, severe pain, on MS Contin, frequent infections…I can’t think of anything I can do that won’t cause severe pain. Even swimming is out due to infections, even staph at times. Do you have any ideas to help me? Thank you!

Jennifer: That’s a tough one. Swimming is what I usually recommend to patients with painful arthritis. Not knowing the details of your pain, it’s difficult for me to recommend an exercise that won’t exacerbate it. Two ideas do come to mind, though: bicycling and yoga.

Alex

I’m dismayed that you recommend the operation, though. It’s extremely dangerous (obesity has potent health risks; does this mean I should endanger my life further by having an extremely dangerous operation—with what appear to be terrible, possibly life-long after-effects of the operation?).

Furthermore, this operation does not take away the *desire* to overeat (which, i think, is less psychological than physiological for extremely fat people, although the 2 are not separate).

How terrible—to have a dangerous operation, possibly live through it—and still feel driven to overeat!

People do not understand that obesity, itself, compels extra calorie intake. I wish they did. You hint at it, in your article, which I find, overall, quite good.

*Please* address the dangers of gastric bypass, as well as its many failures (i.e., still driven to overeat, people who regain their weight, people who suffer vitamin deficiencies or worse, people who die from gastric bypass).

Zara: No doubt about it: bariatric surgery carries risks, including all those you mention. However, the most common complications mentioned in the studies that measure them include anastomosis complications, marginal ulcers, abdominal hernia, and dumping (not minor, but manageable and not life-threatening). Further, a recent article found the complication rates vary by region, suggesting having an experienced surgeon perform the operation is critical. In my own practice, anecdotally, I have one patient who is an absolute disaster after having gone through it. She’s been left with chronic abdominal pain and has suffered severe vitamin deficiencies until it was recognized and she was begun on supplements. On the other hand, also anecdotally, I have two patients who’ve done just spectacularly well. Also, contrary to what you suggest, studies have found that many patients do become less hungry after the operation, suggesting the change in anatomy from the surgery somehow alters physiology and hunger mechanisms in some patients. However, your point is well taken. Bariatric surgery isn’t the kind of thing anyone should enter into lightly without a full knowledge of the risks and benefits.

Alex