Jackie was a 67-year-old woman weighing ~102kg but was quite short so her BMI was over 35. She also had quite severe asthma. Beneath all of this, she had some pretty major challenges. She used to work but had to stop to look at them, so she felt isolated and exhausted. The negative cycle of stress, isolation, poor sleep, low-quality high-calorie snack diet was clearly taking its toll as she was getting recurrent asthma exacerbations, was putting on the weight, felt she hated her weight and was socially embarrassed which led to further social isolation and depression.
We both knew she had to lose weight and look after her lifestyle factors, otherwise, she would just get physically and psychologically worse. But she found any changes too demanding on her already demanding life. She needed something major to break this cycle.
As things got worse we opened up the conversation about bariatric surgery which she could use some of her savings to pay for. It was not a small decision and we discussed it in detail. It is always crucial to be fully informed when proceeding with surgery so I encouraged her to review the detail from the surgeon and ask questions. She saw her surgeon and they decided to go ahead. Within 2 months she had lost over 20kg, felt more energy, her asthma had improved, and she was happy to start going out again. After 5-6 months she continued her healthy eating programs and had lost 38kg and felt great in both mind and body. She felt clearer in her mind as well and more able to problem solve her difficult social circumstances.
There is little doubt in my mind that for her – and for select others – surgery is a reasonable choice. Some people need that major input, and if it works for them, that is fine. Jackie felt guilty about it before the operation because “if I have surgery it means I am too weak to lose weight by myself”. We discussed this a lot so I cannot summarise everything we said but the shorter version is there is no shame in needing help, everyone does at some point in their life. We need to let go of this “perfect” concept. We are all imperfect, and an imperfect yet successful reality is far better than a perfect dream.