Bariatric Surgery as a Product

A thin, grey haired doctor stood behind a podium in the front of the room holding a remote control for the projector. My husband pulled out his notebook, THE notebook, which continues to go with us on every visit to the weight loss clinic. The doctor awkwardly introduced himself and began a power point presentation he’s espoused hundreds of times. The goal of the presentation is a weeding out process. Those who are “serious” and “qualify” to begin a weight loss journey with the clinic have to sit and listen to this doctor, whose lack of sensitivity towards people who are overweight was apparent in his mannerisms, presentation style and the way he answered questions.

He began by showing us a graph to tell us how many factors go into being overweight: endocrine and metabolic systems are not working properly, environment and genetics. When he reached the genetics part, he felt he needed to provide an example of what genetics mean by observing families in Target. He explained that both of his daughters are thin because his wife and himself are thin. “We have thin genetics.” He continued, “The other day, I saw a family who had fat genetics. Both parents were overweight, so as their heavy son put soda into their cart, I thought those are fat genes.”

WHAT?

I felt so badly for the family he was watching and judging in Target. There was no reason to include the soda detail because he was trying to explain how genetics play a role in obesity, not behavior or environment. The use of the soda detail felt cruel. Plus, of all the factors of being overweight, the one I understood without complete explanation was the genetics one.

He explained that severe clinical obesity is a BMI of equal to or greater than 40. The doctor listed several medical conditions that occur when someone’s BMI is that high:  
High Blood Sugar
High Cholesterol
High Blood Pressure
Heart Disease
Loss of 10-15 years of life

Sitting there, at my heaviest weight, my BMI was 56. I was on 2 medications for my high blood pressure and 1 medication for my high blood sugar. He showed us a chart where my BMI number moved beyond morbidly obese to “super morbidly obese.” I didn’t start crying right away due to the shame I felt; that didn’t start until the car ride home.

Instead, shame came in the form of paranoia. I looked down at my body, and I hated it. I felt naked and that everyone was staring at me. My eyes glazed over as the doctor explained how I will earn more money and get better job opportunities if I have the surgery. “Due to widespread discrimination, obese people, especially morbidly obese people are not hired for jobs they are clearly qualified for. Several studies site statics. Imagine the jobs and doors that will open to you.”

As a reminder, this session took place on June 28th, 2016. I thought about how I began my current job on April 25th. It had only been two months since I had been looking for a job. I thought about the rejections I received before taking my current job. Then I began to spiral; I thought about ALL the rejections I have ever received every time I was job hunting in my entire life. I began to blame my past failures, broken dreams and my inability to find a job that fulfills me, challenges me and gives me a sense that I am a part of something important on being super morbidly obese. I realized that I was the fattest person who works at my current company. At that time, there were only 2 women who could ever be classified as overweight, but only by medical standards, not in actual reality. In person, they are beautiful women who probably don’t have to shop in the plus sizes. I began to worry about why I got the job I have and that the people at work must be so disgusted by me. I thought about how I sit by myself at company meetings and get-togethers. The spiral led to the same thought: How could I have let this happen? How could I have gotten so big and I didn’t even notice?

The presentation pulled me from my thoughts as the power point slide listed all the complications that come from obesity:

Diabetes
High Blood Pressure
Sleep Apnea
Arthritis
Depression
High Cholesterol
Menstrual Irregularity
Cancer, especially uterine

The one that stuck out to me was the menstrual irregularity. I was 36 and my husband and I had no plans to have children. We still have no plans to have biological children. My menstrual irregularity wasn’t distressing because of procreation.  No, I was distressed and worried because the excessive bleeding, and the high risk of uterine cancer terrified me, especially as it has affected my family. In future moments of doubt about doing the surgery before I did the surgery, I would squelch that doubt because of the monthly reminder of the time bomb inside of me.

As if fear, money and pure shame had not convinced me why I should have the surgery, the doctor moved onto statistics. Honestly, at this point in the presentation, I was unable to concentrate on anything outside of my thoughts. But my husband had THE notebook, so he was able to share with me weight loss statistics at a time when I was ready to hear them.

According to the doctor, when people diet they lose about 8-12% of their excess body weight. After 5 years, 0 will maintain it. When people are on a weight loss drug they will lose 10% of their excess body weight. After 5 years, 10% maintain it. When people have bariatric surgery they will lose at least 50% of their excess body weight. After 5 years, 100% will maintain it. Now seriously, I do not remember which study he was quoting here, but any time percentages are used, 0% and 100% make me very uncomfortable. There are so many different people and areas of grey that it seems improbable to have such numbers, I think NOW, in retrospect. But, at the time, that 100% made me comfortable. It meant to me that unlike all the diets, the jobs, the dreams, if I had the surgery, I would not fail. And in five years, I would still not be a failure.

I now realize this “information session” about bariatric surgery was also a marketing event for bariatric surgery and the doctor’s weight loss clinic. One of the first steps to selling someone something is to earn their trust. The doctor tried to earn trust by shifting the blame. He used the first graph, which showed why and how we become obese, to say: “You shouldn’t beat yourself up; it’s not your fault.” Somehow I believed he was on my side and understood what it was like when I stepped on the scale to see the highest weight I would ever be.

After I trusted him, he used scare tactics with medical conditions and complications and told me how much his “product” would save me money. He ended with the “weight lost” statistics to prove that I will never lose weight on my own, I will never be able to keep the weight off if I happen to lose weight, so surgery was my only option.  While some of the information the doctor used was factual, it certainly manipulated the audience’s “decision making” in one direction.

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