Getting irreversible weight-loss surgery has dramatically improvedquality of life.
Recently I went to Tallinn, and paid a bariatric clinic €6,000 to remove 85% of my stomach.
The keyhole procedure was done by Dr Ilmar Kaur, Estonia’s top bariatric surgeon; the price was a five-night medical package which included everything except flights, plus two years aftercare.
It was, quite literally, painless. As well as constructing my gastric sleeve, Dr Kaur also removed a gastric band which I’d had implanted in 2012, and which had turned out to be an expensive waste of time and effort.
Arriving at the clinic, I had blood tests and a consultation with Dr Kaur, who told me that until he’d seen the state of my insides, he was unsure whether he would do a bypass or a sleeve – it depended on internal adhesions from previous surgeries.
The decision would be made during the endoscopy, when I was under general anaesthetic – so I consented to both procedures, not knowing which one it would be until I woke up.
The operation took two hours, and was completely successful.
Before my gastric sleeve surgery, I was 92 kg (14st 7lbs) — fat, but not American fat.
My BMI was around 35, which despite teetering towards the severely obese category, had no co-morbidities — no diabetes or sleep apnoea, normal blood pressure, plus I’m active, teetotal and vegan.
But, for almost 20 years, I have been between 10 and 30 kgs overweight.
I was tired of being fat, and had tried pretty much everything else in terms of weight-loss strategies, from gastric banding to very low calories diets to hypnotherapy to diet pills.
Although in rude health, it seemed inevitable that my joints would suffer as I aged, or that one of the co-morbidities I’d so far been avoiding would pop up.
It was time to take action. So off I went, without telling anyone where I was going or what I was doing — because when it comes to weight loss surgery (WLS), everyone has an opinion, generally unhelpful or uninformed or both. The only opinion I wanted was medical.
Two months later, I am 12kg (1st 12lbs) lighter and my BMI is just under 30 — I am no longer categorised as obese.
My eating has changed radically. I feel full after very small amounts of food, and have to be super-mindful about what I consume in terms of nutrients — lots of superfoods in very reduced quantities.
My weight loss will continue until I reach the correct weight for my height, and will then level out.
I will take a daily vitamin and mineral supplement for the rest of my life, and get B12 injections from my GP every three months.
There are very few downsides, providing I follow the post-op dietary instructions given by the nutritionist at the clinic — eat very slowly, chew for ages, avoid sugar, indigestible foods, chewy foods, carbonated drinks.
The adjustment has not been difficult — I have been learning quickly not to eat too much or too fast because if I do, I feel nauseous.
The psychological relief of no longer being a food slave is indescribable, and my body feels pretty happy about it too.
This goes far deeper than mere vanity – it’s a profound change because with a gastric sleeve (unlike a bypass or a band) there’s no going back.
It’s irreversible. Not that I would ever want my chronic overeating back, or my excess weight.
“I’ve never met anyone who regrets weight-loss surgery,” says John Conneely, bariatric surgeon at the Mater Hospital.
Yet despite Ireland being on track to become the fattest country in the EU by the middle of the next decade - HSE figures from last year show that 37% of the population is overweight, and 23% is obese - there is almost no provision for bariatric surgery here.
Plus there are all kinds of misconceptions about it – that it’s an easy way out, that it’s dangerous, complicated, or for lazy gym-dodging couch potatoes.
As a society, we have a long way to go in terms of understanding obesity, its causes (read The Case Against Sugar by Gary Taubes), and its effective treatments.
“When it comes to bariatric surgery, we are about 20 years behind the rest of the world,” says Conneely.
“There’s very little public funding, and only six bariatric surgeons in the whole of Ireland. Yet these are incredibly cost-efficient procedures, because they save so much money in the long term.
“Perception is slowly changing in the UK, but not yet in Ireland, despite it being stunningly effective surgery that can completely transform lives.
"There’s a misconception that it’s dangerous, yet the global complication rate is between 4% and 5%, which is lower than gall bladder surgery.”
In 2017, research conducted by UCC showed that despite around 92,500 people medically qualifying for WLS, less than one procedure per week was being carried out, meeting less than 0.1% of need.
In Ireland, one person per 100,000 receives WLS, compared with 57 per 100,000 in France.
Going private can cost approximately €15,000, although this is variable; it costs the HSE on average €9,000 per procedure. Or you can travel to other EU countries, where it is considerably cheaper.
To qualify in Ireland for publicly funded surgery, you need to have a BMI of 40 or above.
“With obesity in Ireland, it’s not that there is poor medical care – there is virtually no medical care,” says Conneely.
“There is an incredible double standard – we treat lung cancer caused by smoking and liver disease caused by alcoholism, but in terms of health care, obesity remains the last acceptable form of apartheid.
"In the wider world, the global level of ignorance around obesity is astounding – in another few years we will look back on sugar the way we now view tobacco.”
Meanwhile, my keyhole scars are healing, and with every passing day I have more energy and focus. The best thing is the feeling of lightness and freedom inside my head.
Obesity is not a lifestyle choice of the greedy and the feeble minded - unless you have been there, you really have no idea what it’s like.
It’s like being trapped inside a locked room, except you are the room.
Weight-loss surgery can set you free.
Weigh up your options
Once considered the ideal bariatric surgery for those who didn’t want anything irreversible, the band now accounts for just 5% of weight-loss procedures.
Basically, because it doesn’t work very well.
A silicon doughnut-shaped device is placed around the stomach, reducing its size; quick and easy to fit, and reversible, its major downside is discomfort, cheatability, and ineffective weight loss.
The gold standard of bariatric surgery for over 50 years, the Roux-en-Y bypass reduces the stomach size and reroutes it past a length of small intestine, reducing food absorption and causing rapid weight loss and reversal of co-morbidities such as diabetes, high blood pressure, and sleep apnoea.
Weight loss is dramatic and guaranteed, but patients can suffer psychologically if not adequately prepared.
Anecdotally, alcohol consumption can increase post-bypass.
Originally conceived to prep super-obese patients for bypass surgery when providing a full bypass was too dangerous because of their size, the idea was that patients would lose weight, then return a year later for the bypass.
However, for the past decade the sleeve has been used effectively as a stand-alone procedure — many patients were so happy with their results that they decided against further bypass surgery.
The stomach is reduced by 85%, so that the remaining 15% resembles a tube rather than a bag.
There are fewer negative side effects than with the bypass, which can result in malabsorption of nutrients, and ‘dumping syndrome’, when undigested carbs enter the intestine too quickly, causing vomiting, diarrhoea and dizziness.
Yet, with the sleeve, excess weight loss remains only slightly less (50-65%) after two years, compared with the bypass (60-75%).
“This is the procedure I would have,” says bariatric surgeon John Conneely.
“It’s very easy to live with, and the co-morbidities reduction is the same as with the bypass. And great weight loss too.”