I was 17 when I lay on the operating table, wincing in pain as the anesthetic needle pierced the stretched skin on the back of my hand. It was 2007, and the obesity epidemic was rampant, making me a dangerous statistic. My body size, I was told, would eventually lead to serious illnesses, such as heart disease and diabetes, unless something was done about it. I thought this procedure would save my life.
I was first diagnosed with obesity when I was 8 years old. At 10 I was on my first diet, eating low calorie pretzels for lunch while my friends ate Oreos. When I was 14, I visited my pediatrician once a week so she could track my weight and talk to me about self-control. At 16, I was prediabetic. Two months after I turned 17e birthday, I had laparoscopic bariatric surgery: A reversible inflatable device was placed around the upper part of my stomach, creating a smaller “pocket” and limiting the amount of food I could eat. The procedure had been approved by the Food and Drug Administration only for adults, but given rising obesity rates in children, the FDA sought to test this surgery in adolescents in a funded study. Teens diagnosed as “morbidly obese” (with a BMI over 40) and who had tried other means to lose weight, such as diet or pharmaceuticals, met the criteria.
The specific surgery I had, gastric banding, peaked in 2008, with 35,000 surgeries performed that year. Gastric banding is rarely performed today due to its high rate of complications and failures. More invasive and permanent surgeries, such as gastric bypass and gastric sleeve, are more commonly used today.
Now, these invasive surgeries are officially recommended for children as young as 13 by the American Academy of Pediatrics, which recently released the first edition of a set of guidelines for treating childhood obesity. The document advises that families with children as young as 2 receive intensive behavioral and lifestyle treatment as a preventative measure against possible obesity, and recommends medication or surgery for older children. who have not been able 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.
On my way to work last week I listened to an episode of The New York Times The Daily on the guidelines, in which medical journalist Gina Kolata acknowledges that not all children with a high BMI will have health problems and, moreover, that insurance often won’t pay for less invasive options like counseling or even semaglutides like Wegovy. She thus defends the prospect of irreversible surgery: “There is widespread discrimination against obese people, and children and adolescents often suffer enormously. … It’s a big burden for a child.
For me, weight stigma, along with a lack of attention to my psychological well-being, was the burden. I worry about 1 in 5 kids reaching the threshold for aggressive weight therapy, because of what aggressive weight therapy has done to me.
In the years following my operation, I lost weight. And I was delighted. I could finally be seen as normal, not an outcast for my problem body. But by the time I was 23, I had started having side effects from the surgery, such as frequent vomiting, heartburn, and inability to eat. After an upper endoscopy, I found out that I had gastritis, esophagitis, and gastroesophageal reflux, all of which are potential side effects of the abdominal band, because when you have a small stomach and narrowed opening, food and acid may struggle to pass. in the right direction through your body. It was then that I realized that the surgery that was supposed to cure my obesity problem had failed to address the underlying problem, which included a tangle of mental health and environmental issues.
After being diagnosed with these gastrointestinal health issues, I took matters into my own hands. I wanted to know how it happened and why I was diagnosed with obesity in the first place. Through my research of the lap-band forums and Google search of symptoms (“Why can’t I stop eating?”), I discovered the diagnosis of binge eating, first integrated in the Diagnostic and Statistical Manual of Mental Disorders in 2013, half a decade after my operation. The criteria seem to match: eating a large amount of food in a short time, eating beyond the point of satiety, eating without feeling hungry. When I was growing up, I only learned about anorexia and bulimia briefly. It was clear that if you weren’t purging or getting thin with 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 behavior with food had developed as a coping skill to cope with my dysfunctional home environment and my undiagnosed anxiety disorder, and it eventually evolved into a mental illness. But in all my visits to doctors, dietitians, and diet coaches, no one ever asked me what was wrong with my family, my mind, or the culture around me.
After this realization at age 23, my behavior with food changed. But not for the better. I became hypervigilant, limiting my calorie intake, exercising too much, and purging multiple times a day. I didn’t want to be considered fat anymore. I didn’t want to be an obesity statistic.
My health deteriorated. I became severely dehydrated and orthostatic, and started vomiting blood. I knew I was sick, but at least I was thin.
I lived like this, until I realized I couldn’t 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, approximately 45 million Americans follow a diet each year. The diet industry earns $71 billion a year and its offerings have a dismal track record. In fact, restricting your food intake can slow down your metabolism, which can lead to weight gain. What’s more, we’ve long known about the psychological distress intense dieting can cause: In a 1944 University of Minnesota “starvation” study, 36 healthy men were put on a low-calorie restrictive diet for six months. The results revealed striking physical and psychological effects on the participants: they felt an obsession with food and exhibited disordered eating behaviors, such as drinking water to feel full and cutting food into small bites to feel full. make it last longer. Surprisingly, these psychological effects did not always disappear; after the experiment ended, some participants found themselves overeating. Although I come from a stable, middle-class family, I felt this distress, which started for me with dieting as a child, eating “good” foods during the day, and then gorging myself on ” bad” foods at night. My weight was a symptom of the dysfunction around me.
I wonder if doctors had ever looked beyond my body and asked me how I felt about food, my body, my family and my life, that would have kept 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, in particular their surgical component, is not only the physical consequences like the side effects, but the psychological consequences. Until recently, my life was defined by my weight, as I was taught from an early age that my weight was what defined me. My obsession with weight loss, stemming from early dieting, didn’t lead me to be happier or healthier like doctors promised me at 17. It left me with more issues to sort out as an adult. The band around my stomach has loosened and it does not affect my daily life. But I worry about the kids who will have permanent bariatric surgeries before they really understand their relationship to food, and self-esteem.