What Causes Obesity?

The simple reason: calories in - calories out.  If one eats more calories than they burn off, then the extra is stored as excess weight.

What is not so simple, is why an obese person has more calories than they are burning off. This is where the true cause of obesity lies.

Before I give you those reasons, I want to qualify those reasons with this: There are no always or nevers. Meaning one can not say this is always the reason, or this is never the reason. There are going to be exceptions in all things; but my focus is on the common broad-reaching reasons that are true for a large majority of the obese population.

Reasons for excess calories that lead to obesity:

1. Slow Metabolism Some folks have a slower than average metabolism: whether genetic or brought on by years of yo-yo or starvation dieting, slow metabolism affects the body’s ability to burn calories - thus affects weight.
2. Ghrelin This is the hormone that triggers the feeling of hunger. It has been proven that most obese folks have excess amounts of grehlin production.¹ ² Yes, they are truly hungry all the time.

Now the above two reasons are contributing factors, but they’re huge. When I hear someone, referring to the obese, say ‘Why don’t they just stop eating?’ or ‘Why don’t they go on a diet?; it irks me. It’s an ignorant (i.e. uneducated) statement and a broad generalizing prejudiced statement at that.

I would bet that nearly every single obese person has dieted more than the average size person; and in fact, the dieting is one of the contributing causes of obesity! “Dieting” usually involves deprivation; starvation methods of weight loss, that involve too few calories that throw the metabolism into starvation mode where it won’t let go of fat. And if you happen to be one of the unfortunate ones who has a genetically slower metabolism, and you try the deprivation/starvation dieting method - you truly screw up your metabolism to the point where you can gain weight eating very few calories per day. I know - as I was one of those unfortunate few.

I know for a fact that every single person who has had gastric bypass has been on a diet, and most on a supervised diet. This is one of the requirements one must meet before having gastric bypass. So gastric bypass is not the easy way out, or quick fix. It’s the last resort when all other attempts to lose weight have failed. Undergoing major surgery to dissect your stomach down to the size of an egg and remove 5 feet of small intestine and redirect what’s left is most definitely not the ‘easy way out’. It’s painful, costly and has lasting long-term potential for side-effects, if one is not careful and diligent in taking their protein and supplements.

Then you have the ghrelin hormone issue; where you feel like you’re starving - ravenous even - and going without food is nearly impossible. This goes beyond having will power; as your body is literally working against you. This goes beyond normal hunger; this is a hormonal imbalance triggering the ravenous appetite and the need to eat.

Gastric Bypass resolves the ghrelin hormone issue as the part of the stomach that produces the ghrelin is removed during the gastric bypass procedure - for those surgery types that are both restrictive and malabsorptive; such as Roux-en-Y (RNY), the ghrelin issue is resolve immediately when the surgery is done.

However, gastric bypass also helps for those with slow metabolism as it reduces the food intake, and the calories/fat absorption via the malabsorptive component, to bring the caloric intake in line with the body’s metabolic energy needs. Not to mention that by losing the weight, one is then better able to exercise to boost the metabolism even further; where as while obese, exercise is often very difficult to impossible.

Obese people are not lazy, they have a metabolic condition that contributes their obesity. Is every single obese person suffering from one or both of these reasons? No. There are some who just choose to eat too much and not exercise. Like I said, there are no always or nevers and there will exceptions to every rule; but the majority of obese people dieted themselves into obesity. They have a body that’s working against them and they are frustrated, embarassed and often fighting depression and stereotypical prejudices.

It is my hope that this article enlightened those of you who did not know these facts, encouraged those of you struggling with obesity to know it’s not all your fault and I encourage you to see a doctor for help in overcoming your obesity. Gastric bypass may not be the answer for you, but remember: if you keep doing what you’ve always done, you’ll keep getting what you’ve always gotten. Another day doing nothing to seek help for your obesity is another day without progress toward overcoming it. If you are a gastric bypass post-op, I encourage you to reach out and help others - either those in the obese community with questions,  the new post-ops that need mentoring or helping to educate those who do not understand obesity.

Give back and pay it forward.

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¹ The Hunger Hormone, Controlling Ghrelin

² A Matter of Fat; Ghrelin Hormone Promotes Storage of Energy as Fat

Now there’s a suggested link to gastric bypass surgery and cancer prevention! The 20/20 show video provides more details.

I recently addressed the topic of post-op gastric bypass diet on my Squidoo lens, but wanted to go into more detail here on the gastric bypass support aspect of post-op life.

Gastric Bypass Support

If you frequent online support forums, you will notice a majority of the active participants are pre-op through new post-ops. It seems that one year post-op is usually a common time-frame when post-ops’ visits to support forums start to dwindle down to eventually very infrequent to not at all.

Having gone through this phenomenon myself, I know that for me, it was due to getting my ‘life’ back and feeling good enough to get out of the house and go and do things! On one hand, this is a very good thing; but on the other hand, the lack of accountability from those who know and understand this post-op life and body can lead to our downfall into old habits.

I’ve seen it happen over and over again: a post-op, 18 -24 months (or more) out from surgery comes back onto an online support forum devastated because they have gained back 10, 20 or even 50 or more pounds! How could this be? Well, it didn’t happen overnight: it happened one pound at a time just like how we became obese before we had our surgeries. It’s the little, small choices we make that add up and before you know it, they catch up with you and you find yourself dealing with a weight gain issue, or malnourishment issue with labs all out of whack,  you feeling like you’ve been hit by a truck, losing hair again, or worse, such as neurological damage or osteoporosis, all because you haven’t been taking your supplements.

How Support Groups Help

They help in two primary ways:

1. Accountability. If you have others who are going to hold you accountable in your post-op journey, you are more likely to stick with the gastric bypass diet, nutrition supplementation and exercise to keep you healthy.
2. Education. Even though you know a lot about being a post-op, bariatric surgery is still an evolving medical field. What surgeon’s recommended for post-op care and nutritional supplementation 5 years ago, is not the same as today. These changes effect you, even if your surgeon did not tell you these same things at that time. Surgeons are learning too!

Offline or Online Support

I personally feel that both is best. There will be times you can’t make an offline/in-person support group due to weather, other committments or whatever. So having an online support group that’s always there is ideal.

But, offline support, where you are looking folks in the eyeball, can not be matched with online support. If folks are going to actually see you, it’s hard to hide the truth in how you’re really doing and how well you’re staying on track.

That said, I love online support groups too. There are many fine forums where you can connect with long-term post-ops who have given their time to helping those new to this life. They are paying it forward and helping, just as someone else helped them. You may very well find a wider variety of help online than offline, depending on where you live and what offline support is available to you.

Whether you can obtain the ideal gastric bypass support situation with both offline and online support; it is essential that you do seek out and participate in a gastric bypass support group.  It will help your long-term success, and health, as a gastric bypass post-op.

Online Support Resources

A few of my favorites.

Renewed Reflections

ObesityHelp.com Graduates Forum

Living After WLS Neighborhood

Thinner Times forum

Gastric Bypass Info Central (yahoo group)

Graduate OSSG (Obesity Surgery Support Group - yahoo group)

Christian WLS Friends (yahoo group)

Gastric Bypass Nutrition Resources
Veriuni Advanced Liquid Nutrition - 98% absorbability liquid multi-vitamins

Supreme Whey Protein - uses hydrolyzed whey peptides for highest bioavailability

Floradix Iron & Herbs - natural liquid iron

Call to Action: get connected with a gastric bypass support group today.

Are you currently part of a gastric bypass support group? Is it online or offline - or do you belong to both?  I’d love to hear your weight loss story and why you are, or are not, part of a support group. Post your comments below.

So a few months later, my levels were low again and this time we use Venofer, which is given once per week over 5 weeks, instead of in one 5 hour dose like Infed. I did not notice any side effects during my first round of infusions with Venofer, which ended in June 2008.

Now here it is January 2009 and I’m needing an infusion once again. Go in last week and get my first of five Venofer and for three days felt ‘blah’: tired, ran a slight fever and generally felt unwell. I did not actually connect it to the infusion at all - because so much flu is going around, thought I was getting sick with a virus.

Fast forward to yesterday. I go in for my second round of Venofer and about halfway through the dose, started feeling ‘blah’ again: as in tired, weak, then started getting a headache, dizzy and really feeling bad. My arm was hurting where the infusion was going in. I mentioned that I didn’t feel well and what had happened last week - more as a side comment; but when she double-checked possible side-effects for Venofer initially - malaise was one. Mmmm? So she checks my blood pressure and it was way up 142/115. It was only 115/80 when I got there. She checked further into allergic reactions and I had nearly every one, except anaphalactic shock!

By the time we put all this together, my infusion was done (they only take 30 minutes). She got the IV out right away, called my doctor and he ordered steroids and tons of bloodwork. They kept me for a bit and I then went home.

We will wait on the bloodwork and I will converse with my doctor before I have any more infusions. I believe there is only Ferrilicit left to use - that’s pretty much it, as I believe most others are generics of the name brands.

I’ve read that many continue with the iron infusions, with side effects, and just take the steroids and Benedryl IV to counteract those. Not sure I’m comfortable doing that, as my symptoms seem to get progressively worse each time.

Unfortunately as a gastric bypass post-op, we especially have a nearly impossible time absorbing iron. The upper part of the small intestine is where the majority of iron is absborbed by the body - we no longer have that. So it’s difficult for us to absorb what we need with the short length of small intestine we have left. I’m 4.5 years post-op and have been battling this for about 1.5 years; even though I took iron supplements from day one after my surgery. It just isn’t enough.

If you are a gastric bypass post-op that had a malabsorptive procedure, I’d be very intersted to hear how your bloodwork is coming out and in particular what your iron and ferritin levels are and what supplements you’re taking. Getting the right form and amount of nutritional supplements is truly an art form!

Please post your comments or your experiences below.

You are not alone.

Craig Thompson has done a fine job in his ebook Weight Loss Surgery Secrets. Here’s a synopsis of the book:

If you tried to get your insurance carrier to pay for weight loss surgery and were declined, don’t lose hope. Your insurance company didn’t turn you down because they don’t pay for weight loss surgery; they pay for it every day. Your insurance company turned you down because you didn’t ask them correctly. I’m serious, and I can teach you how to get approved.

It is possible to still get insurance approval. Don’t give up hope of getting your weight loss surgery. Order Weight Loss Surgery Insurance Secrets today to find out tips on how.

So what do you think:  would you have WLS performed through your mouth?!

See you at the April 19th meeting! 

I do believe I’m going to get one of these!!  If this will work in keeping me (or YOU!) on track in drinking enough water, then I’m all for it. 

I am a Certified ObesityHelp Support Group Leader and will be leading the support group. Please join us!