Lucy

I'm an architect.

Carbonated water was SO hard for me to give up, I'm right there with you. I never was that into soda, but I love fizzy water. Sigh...I've moved on to flat water and I'm dealing. Sometimes I buy carbonated water and I mix it 1/2 and 1/2 with flat water.

This article in today's New York Times pissed me off and I thought others here might be interested in reading another skinny man's inexperienced opinion against WLS: The Stomach-Surgery Conundrum By STEPHEN J. DUBNER and STEVEN D. LEVITT Bariatric Surgery Deborah Kattler Kupetz is a Los Angeles businesswoman and mother of three who tries to watch her weight. That’s why she recently bought two lifelike plastic models of human body fat from a medical-supply company, a one-pound blob and a five-pound blob, and put them on display in her kitchen. By doing so, Kattler Kupetz wouldn’t seem to have much in common with Han Xin, a legendary Chinese general who lived more than 2,000 years ago. But she does. Upon entering one battle, Han assembled his soldiers with their backs to a river so that retreat was not an option. With no choice but to attack the enemy head-on, Han’s men did just that. This is what economists call a commitment device — a means with which to lock yourself into a course of action that you might not otherwise choose but that produces a desired result. While not as severe as Han’s strategy, Kattler Kupetz’s purchase of those fat blobs was a commitment device, too: every mealtime, they force her to envision what a few extra pounds of fat looks like. It is hard to think of anyone who employs commitment devices as avidly as the overweight American. Perhaps you once bought a yearlong gym membership or had a three-month supply of healthful meals delivered to your doorstep. Maybe you joined friends in a group diet or even taped your refrigerator shut. The popular new weight-loss pill Alli, which partly blocks the body’s absorption of fat, is a commitment device with real consequences: a person who takes Alli and then eats too much fatty food may experience a bout of oily diarrhea. So how are all these commitment devices working? Not very well. According to the Centers for Disease Control, one out of every three American adults is obese. Which is why so many people have begun to embrace a far more drastic commitment device, one that Han Xin himself would probably applaud: surgery. This year, more than 200,000 weight-loss, or bariatric, operations will be performed in the United States, a nearly ten-fold increase in just a decade. The most prominent types are gastric bypass and laparoscopic adjustable gastric banding (or “Lap-Band”), although there are a few others. Each one works a bit differently, but the general aim is to reduce the stomach’s capacity and thereby thwart the appetite. If all goes well, bariatric surgery leads to substantial weight loss, especially among the morbidly obese. Marc Bessler, director of the Center for Obesity Surgery at New York-Presbyterian/Columbia University Medical Center, is an innovator in the field who personally performs about 200 bariatric operations a year. Because his own father was morbidly obese, Bessler brings a personal zeal to his work. “The whole time I was growing up, he was so overweight he couldn’t play ball with us,” he says. “He died at age 54 from colon cancer. It may have been picked up late because of his obesity.” Bessler acknowledges that bariatric surgery has a checkered history. “In the past, it killed people, and it didn’t work,” he says. “In the late 1950s and early 1960s, even though it was effective for weight loss, there was lots of complications and mortality. Then in the late ’70s and early ’80s, there were much better surgeries, but they didn’t really work that well. The weight would start coming back.” Technological innovations, especially the use of laparoscopic procedures, have made for considerable gains in safety and efficacy. While the operation is still dangerous in some circumstances — one study found that for a surgeon’s first 19 bariatric operations, patients were nearly five times as likely to die than patients that the surgeon later operated on — the overall mortality rate is now in the neighborhood of 1 percent. But even if bariatric surgery doesn’t kill you, there are things to worry about. The operation often produces complications — physiological ones, to be sure, but also perhaps psychological ones. A significant fraction of postbariatric patients acquire new addictions like gambling, smoking, compulsive shopping or alcoholism once they are no longer addicted to eating. In certain cases, some people also learn to outfox the procedure by taking in calories in liquid form (drinking chocolate syrup straight from the can, for instance) or simply drinking and eating at the same time. Surgery is also a lot more expensive than even the most lavish diet, with a Lap-Band procedure costing about $20,000 and a gastric bypass about $30,000. But Bessler and other bariatric advocates argue that the upsides outweigh the downsides, especially for a morbidly obese patient whose quality of life is already suffering. While asking a bariatric surgeon if bariatric surgery is a good idea might seem akin to asking a barber if you need a haircut — in fact, Bessler does consult for companies in the industry — the data seem to back up his claims: not only do most patients keep off a significant amount of weight but the other medical problems that accompany obesity are also often assuaged. One recent analysis found that 77 percent of bariatric-surgery patients with Type 2 diabetes experienced “complete resolution” of their diabetes after the procedure; the surgery also helps eliminate hypertension and sleep apnea. From an economic standpoint, research suggests that the operation can pay for itself within a few years because a postbariatric patient now requires less medical care and fewer prescriptions. That’s why some insurance companies cover bariatric surgery — as more do, it will likely lead to a further spike in the volume of operations. This is especially good news for the hospitals that have already grown dependent on the significant cash flow that bariatric surgery generates. There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn’t this what progress is all about? On the other hand, why is such a drastic measure called for? It’s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that’s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that “the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn’t changed in that time.” So the cause is, essentially, that people eat too much; and the cure is, essentially, to eat less. But bariatric surgery seems to fit in nicely with the tenor of our times. Consider, for instance, the game shows we watch. The old model was “Jeopardy!,” which required a player to beat her opponents to the buzzer and then pluck just the right sliver of trivial knowledge from her vast cerebral storage network. The current model is “Deal or No Deal,” which requires no talent whatsoever beyond the ability to randomly pick a number on a briefcase. Maybe the problem is that despite all the diets and exercise regimes and gimmicks that have been put into play during our national bout of obesity, the right nonsurgical solution simply hasn’t yet been found. So here’s a suggestion: Hang around your neck a small Ziploc bag containing a towelette infused with an aroma of, well, of something deeply disgusting. (In the interest of not offending anyone who happens to be reading this over Breakfast, we won’t offer specific suggestions, but you can surely conjure a horrid odor on your own.) Every time you’re about to open the refrigerator or look over a menu, unzip the bag and take a whiff. Now that’s a commitment device. Stephen J. Dubner and Steven D. Levitt are the authors of “Freakonomics.” More information on the research behind this column is online at Freakonomics - Opinion - New York Times Blog.

I don't know if that's really worth doing. I think there will be plenty of other NYT readers who will write in what they think. It is, afterall, a free country and the author is entitled to write what he wants. It is an opinion piece and not everyone has to agree with him. I'm not excusing his ignorance, but I also feel the same sort of anger when I read political op-eds with a bias that I don't share.

This is the email I sent to the New York Times: Dear NYTimes, Steven Levitt and Steven Dubner clearly underestimate the grips of food addiction. By minimizing the struggle of obesity they are only contributing to the stereotype that the morbidly obese are simply lazy or lack self-control. Although there has been an increase in obesity over the past 30 years, they fail to differentiate between occasional gluttons and morbidly obese addicts. In the same way that occasional over-drinkers do not need rehab, occasional over-eaters do not require bariatric surgery. It is clear that for most of its recipients, the benefits of bariatric surgery far outweigh the detriments. Although their article suggests that many patients go on to acquire other addictions or "guzzle chocolate syrup", most understand that this is a last resort and accept the fact that this is a tool to aid in changing their bad habits, a new lease on life that they might otherwise not have been so lucky to receive. Those who have bariatric surgery are taking a difficult and often frightening step to improve their health; how dare Levitt and Dubner be so callous and obtuse as to suggest that a foul odor hung around the neck could break such a crippling addiction.

Thanks bigbaby!!!! You don't have much further to go, I'm rooting for you!!!

I just found this thread, woo hoo! This morning my scale read 199.8!!!!! I haven't been below 200 in about 3 years. I am SO excited. Just hoping that the next time I weigh myself it doesn't say 203 because I've been hovering between 202 and 204 for about 2 weeks, argh!!!

mmmm...scotch...

Sweetie, don't be jealous. You've been so succesful! All of us have. I've been banded for almost 6 months and have lost less than 30 lbs. I spent a few months being jealous of everyone else on this site and feeling sorry for myself. Then I had a few more fills, starting getting my ass to the gym every day, and now the weight is slowly starting to come off. I've realized that every day is still a struggle to eat the right thing and work out. But I know that I am doing the right thing and I hope that it continues to work and that it gets a little easier as time goes by. Some days are better than others and that's what we have to hope for.

This is his email address: levittdubner@freakonomics.com I fully intend to write a letter to the New York Times. I will post it here when I do.

Thanks for the support everyone! Let's see if I can stay in Onederland with Thanksgiving in a few days...

The idea of WLS can seem drastic to anyone who doesn't need it. Sometimes it just takes others a little time to get used to the idea. As much as you need and want your husband to support you in this, at the end of the day this is your body and you need to do what you know is best for yourself. I think LauraJ makes a good point, try to express your concern over health issues to him and let him know how much you want and need his support. But when it all comes down, if you know that this is the best thing you can do for yourself, then you need to do it. Good luck.

This morning I hit onederland!!!! Woohooo!!!! FINALLY my fourth fill gave me some restriction and it's working! Oh yeah, and I've been working out like a madwoman, which helps, too. Anyway, I'm so ecstatic to be in the hundreds. The last time my weight began with a "1" was 3 years ago...I love this band.

I have the opposite problem! It's SO hot here between March and October that it's FINALLY cool enough here to walk outside! I'll only be able to do it for a few months until I have to get back inside the air-conditioned gym! LOL! Great news, I have to share it: Today I hit onederland!!!!!!!!!! I am ecstatic!!!!! Finally, after months of not losing, my fourth fill gave me real restriction and I am losing again! Hooray!

Amy, I'm so sorry you got this email. This person is not your friend. She is using your positive changes to feel bad about herself and then blaming you for it. That email is not about you, it is about her. Let her go work out her issues on her own. If she was truly your friend, she will come back to you.

The most important thing is to be grateful and to show them that. Sometimes the job just isn't the right fit and any person who hires employees should know that. I think as long as you are tactful, straightforward, and extremely thankful you will not burn that bridge. You might even want to mention that you would be open to the position in the future if it is ever available again.

I practically live on sashimi right now. I only order the rolls if I am taking it home because they way I eat them is really messy and unattractive -- I poke out the center and eat the fish and veg, leave behind the rice and the nori. That probably defeats the purpose of ordering the roll, but sometimes one needs a change from sashimi

Thanksgiving is one of my favorite holidays, mostly because I love to cook (and I'm damn good at it, which is why I needed this band!).I'm cooking for my husband and I and a few friends. Really low key.

I"ve had a few pints of Guinness since banding with no problems. The only issue I have is that I have to drink it very slow, so it gets warm. Not really an issue with Guinness, but maybe not so great with another beer.

There are so many jerks out there. Don't let any of them make you feel bad about yourself. You are a beautiful woman and you have come so far to let one asshole bring you down. As much as it hurts to be treated that way, you need to be positive and move on -- the only men worth feeling sad about are the good ones. This guy clearly wasn't. Sending you a virtual hug.

I've noticed the effects of alcohol, too. I try not to drink too much these days, mostly because I don't want all the calories, but it's hard to live on Miami Beach and never have a frozen margarita (which is pure sugar, lol). But it's true that one or two is my limit, whereas I used to be able to down at least 5 or 6. Of course, that was also back in the day when I could eat a full plate of calamari and a huge bowl of chips and salsa to soak up all the alcohol! Danbo, I sometimes get bored with cardio, too. I've started taking my workout outside -- walking around my neighborhood instead of on the treadmill at the gym. Sometimes I use that time to call friends and catch up with them. The time definitely passes faster that way. I know you are sometimes on a boat for a while, so that kind-of kills the whole walking around the neighborhood thing, but maybe it would help to find someone you can workout with? You can encourage each other and hold a conversation while you are working out. In a macho manly way, of course

I heart Ben Stein, too (even though he used to work for Nixon) but I couldn't sit through more than 5 minutes of that show -- the models were driving me crazy!

I love whole wheat pasta and I can eat it if I chew really well. But I can only eat a little bit. Barilla is my favorite brand.

I have a hard time with the nori, too.

I tried one from Nectar that was supposed to be iced tea flavor and it was repulsive. Now I use Whole Foods Brand vanilla soy protein powder, but I don't use it much anymore (trying to get protein from food, not powder). But in the early stages of my banding it was a lifesaver. Mixed it with fruit, yogurt, and orange juice for a delicious smoothie.