Super morbidly obese. Where do I start?

[Anonymous]

I’m not that PP but I see no reason why you would not continue on semaglutide as a many-year or permanent medication. Personally I think it is crazy that it’s being marketed as a medication only for while people are losing weight. That defies common sense. Listen to the patient experiences: on semaglutide they don’t have constant cravings, they don’t have the drive to eat all the time, they feel satiated, etc. For some of them, that’s the first time in the lives that they’ve ever had that experience, e.g. the experience of a “normal” weight person. It’s incomprehensible to me that doctors can hear that but then expect people to go off the medication and not regain.

The problem I see with lifelong or permanent semaglutide is that it is a dopamine inhibitor, and it can be associated with depression as a result. It also stimulates the pancreatic function so pancreatic function and thyroid has to be monitored. Long term use has to be closely monitored in general. But people who are SMO are already lifetime medical patients as they already have a medically disordered system. I see no reason why a medication that has literally lifesaving impact should be stopped.

[Anonymous]

You might enjoy weight lifting 2x a week with free weights.

Leslie Sansone has great workouts available for walking. Some people don't like to sweat. You can walk indoors.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The first stop is therapy. If you treat all the emotional issues that got you to this weight and has kept you at this weight, you will lose weight without dieting.
-- Trauma survivor and formerly obese person with 20-yr eating disorder who did EMDR + CBT (and a LOT of it).

I don't want to take over this thread with my own question, but I'm curious about your experience. Did you know that your untreated trauma was the reason for your weight issues? I'm also very overweight and I know I have unresolved trauma from my childhood. I've been thinking about finding a trauma therapist and working through it. I have a hard time understanding the connection between my emotions and my weight, but I'm sure there must be an emotional aspect to it. When you started to feel better about yourself, did the eating healthier and being more active come naturally or is it still a constant struggle?

Hi, i’m the PP who wrote this comment.
I had a major trauma at 19 and became a binge eater - and bulimic. I did some therapy, but not enough. One clinician suggested in-patient treatment; in retrospect i regret not doing this (will get to why). I was able to stop throwing up by about age 30. My relationship with food was never normal, but I felt like I had sort of moved on. The bulimia alas also meant you “couldn’t tell” - I remained a completely average weight, neither thin nor fat.
Well, then a variety of awful events in my 30s did a number on me, and I began binging at a rate that caused me to gain about 100 lbs in three years. I lived that way for a decade because I just couldn’t handle staring down my trauma(s) TBH. But I eventually knew - like deeply knew - I had to treat both the trauma and the binge eating. The EMDR was for the trauma. CBT for the eating disorder.

I pretty much lost 50 lbs in a year without trying, then the rest of it by trying. The work is ongoing because without the binging, I felt the full force of my anxiety (that the disordered eating had “medicated”), and it was rough. I am now on both an antidepressant and an anti-anxiety medication. I am strict about exercise and sleep because I learned that anxiety messed with my sleep, and when my sleep is messed with, I’m much more likely to binge. I’ve come a long way on my trauma and am still plugging away at it. Although I am a healthy weight, I’ll always be looking over my shoulder a bit, and I have accepted as much. There was a period where the binge eating was under control but I started picking at my skin, for example - it’s all the same thing, and meant I had more work to do.

There are a lot of well meaning people on here who are like “yep I had no idea how much I was snacking but once I started logging my pretzels and wine I lost 30 lbs!” and that is great and all, but for those of us who have been 100lbs or more overweight, there was absolutely a mental health issue at play far, far beyond “stressful day eating” that needs serious treatment. Good luck OP.

I can relate to soooo much of this!!! I’ve come to accept that I too will always be “looking over my shoulder”. There have been periods where I managed my weight well, periods when I gained weight, and disastrous times like the past 18 months. But even at my lowest adult weight, in my head I was “fat passing for thin”. I have come to accept that I will always, always be dealing with this until I die because almost 40 years of a ducked up relationship with food can at best be managed but it’s not going away. Sometimes I look at other moms and I don’t think I can even imagine what it must be like to exist in a size 6 or 8 body and just walk around taking a moderate amount of space and moving with ease and not carrying this physical and mental weight around. For as long as I can remember (I’m talking childhood) there is this background noise in my head like static that sort of goes over what I just ate, what I’m eating or what I will eat later. It is CONSTANT. Again can’t even imagine what it would be to be able to turn that radio off. So yes, it’s partly about eating less and exercising more but also about so much more than that. These days Im a period of rapid weight gain, doing my best to stabilize things, and worrying about how to be able to move with my kids and also worried about what I can do to not pass this on to them.

Wegovy poster here, I totally agree with all of this and that’s why I’m campaigning for wegovy so much. It can be such a kickstart to see yourself in a different way. I can’t believe that I have lost over 100lbs since I started it. Am I struggling right now not being on it, hell yes! But the last four years have give me a vision of life I thought was impossible. I can’t believe I can get on a rides with my kids at an amusement park! I no longer fear getting on airplanes and asking for the seatbelt extender! Man I cried the first time I got on a plane and didn’t need one! For 15 years I didn’t take pictures with anyone, not my DH, not my babies, not anyone because of my weight. I have NO pictures of me and my children, not even on the day they were born because I was ashamed of how I looked. I have no wedding pictures.

I keep saying talk to your doctor about it, because you won’t regret it.

Thanks for your reply. Can I ask why you went off the Wegovy? Part of the struggle I have right now is that I’ve lost weight before but I’ve never kept
It off. I always gain it back plus 10-20lbs. So I’m very close to 300lbs and that’s paralyzing on its own, but I’m almost afraid to even do anything new because I cannot be 320 lbs when I gain it back. That would be devastating. I’m paralyzed by fear at this point. I know it sounds dramatic but I’m at a particularly low point. The struggle with weight is so public and it can be difficult to go through it while everyone that sees me sees how much bigger ive gotten

Sorry it took me so long to reply. My insurance doesn’t cover it. I started taking it in 2020 as a part of the study conducted by NIH and the manufacturer. I have a long post about my experience, search “weight loos semaglutide” in this same diet and exercise. When the study completed, I did gain about 20lbs back, the study doctor prescribed me Rybelsus (the pill form) 14mg. That was covered by insurance for about 7/8 months. Then Wegovy got approved for weight loss. They offered a coupon and I was able to get it for $25 a month for about 7 months. That has expired. My insurance doesn’t cover weight loss medication and it cost about $1200 a month. Canada price is about $600 or $700, but no matter, I can’t afford it. I picked up a second job hoping to swing it, so maybe. I’m also appealing my insurance.

[Anonymous]

I haven’t read the replies. OP, good for you for wanting better, and asking for help! I do know people who have lost that amount of weight and kept it off, reversed their diabetes and greatly improved their health. They all had some version of gastric sleeve or bypass. It’s a long process before the surgery, which can feel frustrating. But it’s the only thing I’ve seen that works. Best of luck to you, whatever you decide.

[Anonymous]

Hi, OP here.

Wanted to say thanks so much for all of the tips and advice. A little update. Went to my first PCP appointment in years on July 1st. Got bloodwork done and as I expected, am Diabetic. Also have PCOS, hypothyroidism, high blood pressure, and low iron. On meds for all and take a daily iron supplement. My weight was 338 on July 1st. Currently at 317. Honestly, haven't done any exercising so I'm sure the meds are a big factor, but have eased off overeating all the time and watch carbs, though I definitely have had days I've ended up eating "bad."

Have an appointment with a nutritionist in a couple weeks and hopefully that'll give me more direction in finding an eating plan that will be suitable for me. Thanks again!

[Anonymous]

Anonymous wrote:Hi, OP here.

Wanted to say thanks so much for all of the tips and advice. A little update. Went to my first PCP appointment in years on July 1st. Got bloodwork done and as I expected, am Diabetic. Also have PCOS, hypothyroidism, high blood pressure, and low iron. On meds for all and take a daily iron supplement. My weight was 338 on July 1st. Currently at 317. Honestly, haven't done any exercising so I'm sure the meds are a big factor, but have eased off overeating all the time and watch carbs, though I definitely have had days I've ended up eating "bad."

Have an appointment with a nutritionist in a couple weeks and hopefully that'll give me more direction in finding an eating plan that will be suitable for me. Thanks again!

What a great update! Keep growing your improving health! Great work!!

[Anonymous]

Anonymous wrote:Hi, OP here.

Wanted to say thanks so much for all of the tips and advice. A little update. Went to my first PCP appointment in years on July 1st. Got bloodwork done and as I expected, am Diabetic. Also have PCOS, hypothyroidism, high blood pressure, and low iron. On meds for all and take a daily iron supplement. My weight was 338 on July 1st. Currently at 317. Honestly, haven't done any exercising so I'm sure the meds are a big factor, but have eased off overeating all the time and watch carbs, though I definitely have had days I've ended up eating "bad."

Have an appointment with a nutritionist in a couple weeks and hopefully that'll give me more direction in finding an eating plan that will be suitable for me. Thanks again!

Great update OP! Hope you continue to feel good about yourself and have more success on your journey!

[Anonymous]

Is morbid obesity always a symptom of a trauma?

[Anonymous]

Anonymous wrote:Gastric sleeve. Totally life changing but you need to really commit to the program. You need to address why you over eat first with a therapist.

PLEASE do not consider gastric sleeve until you’ve given yourself a true commitment and effort to do it the right way for at minimum a year.

Bariatric surgery isn’t as successful as the bariatric surgeons make out - because they only measure weight loss in the immediate years following surgery, they don’t advertise the very high rate of weight regain considering you’ve destroyed your guts and system for absorption of nutrients permanently, and they also don’t advertise the very high rates of transfer addictions to alcoholic, opiates, gambling, shopping to bankruptcy, divorce that are part of the post bariatric surgery reality. And also that a very significant percentage of bariatric patients suffer with depression after surgery because your body changes forever and it’s still incredibly hard to not stuff yourself back into morbid obesity.

The causes of obesity are multiple but critical in most cases is the mind-body link. Cutting most of your stomach out will reduce hunger hormone ghrelin and cause so many unpleasant side effects that you’ll lose a lot of weight fast by simply struggling to eat for several months. But eventually your body heals and the psychological reasons behind eating are still there. CBT is critical if you want to be successful long term on weight gain. Add more veggies and fruits and water. Start moving your body, and don’t give up if it hurts - get really good sneakers for walking I love my Sauconys and if walking is too uncomfortable at first, swimming is a good alternative as is water aerobics and there are plenty of heavy people there no need for shame.

It will take a long time to get where you want to be - 2 years minimum if you keep with it. It is best for the weight to come off slowly and steadily while you move your body - that’s the best chance to reduce the appearance of saggy skin. Also weight lifting and resistance bands can work on toning you as you lose and you can do both at home if you don’t care for the gym scene.

Good luck! I’m on a similar journey so we can travel parallel paths. I decided to reject the push for bariatric after I spend half a year reading and researching - reading a lot on the online support groups to see the struggles of people with all the bad effects they don’t advertise at the surgeon’s office. I figured I owed it to myself to do an honest year of taking care of me before permanently altering my insides. You probably do too, although get checked by the GP to see how bad your numbers are before you decide.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Gastric sleeve. Totally life changing but you need to really commit to the program. You need to address why you over eat first with a therapist.

PLEASE do not consider gastric sleeve until you’ve given yourself a true commitment and effort to do it the right way for at minimum a year.

Bariatric surgery isn’t as successful as the bariatric surgeons make out - because they only measure weight loss in the immediate years following surgery, they don’t advertise the very high rate of weight regain considering you’ve destroyed your guts and system for absorption of nutrients permanently, and they also don’t advertise the very high rates of transfer addictions to alcoholic, opiates, gambling, shopping to bankruptcy, divorce that are part of the post bariatric surgery reality. And also that a very significant percentage of bariatric patients suffer with depression after surgery because your body changes forever and it’s still incredibly hard to not stuff yourself back into morbid obesity.

The causes of obesity are multiple but critical in most cases is the mind-body link. Cutting most of your stomach out will reduce hunger hormone ghrelin and cause so many unpleasant side effects that you’ll lose a lot of weight fast by simply struggling to eat for several months. But eventually your body heals and the psychological reasons behind eating are still there. CBT is critical if you want to be successful long term on weight gain. Add more veggies and fruits and water. Start moving your body, and don’t give up if it hurts - get really good sneakers for walking I love my Sauconys and if walking is too uncomfortable at first, swimming is a good alternative as is water aerobics and there are plenty of heavy people there no need for shame.

It will take a long time to get where you want to be - 2 years minimum if you keep with it. It is best for the weight to come off slowly and steadily while you move your body - that’s the best chance to reduce the appearance of saggy skin. Also weight lifting and resistance bands can work on toning you as you lose and you can do both at home if you don’t care for the gym scene.

Good luck! I’m on a similar journey so we can travel parallel paths. I decided to reject the push for bariatric after I spend half a year reading and researching - reading a lot on the online support groups to see the struggles of people with all the bad effects they don’t advertise at the surgeon’s office. I figured I owed it to myself to do an honest year of taking care of me before permanently altering my insides. You probably do too, although get checked by the GP to see how bad your numbers are before you decide.

You are incorrect regarding bariatric surgery outcomes. They absolutely do long-term studies; there are many of them out there. I’m not sure where you are getting your information but it seems quite exaggerated to me.

[Anonymous]

My employee's son (a 19 year old) died of bariatric surgery.

He made it through the surgery but died about a month later from complications.

He had the surgery at 19 because he wanted to be normal.

It is still very sad for the family.

I'd definitely research the surgeon.

[Anonymous]

Anonymous wrote:Begin by walking 30 minutes today. I don’t care if you do it in 2- 15 minute segments or in one segment. I don’t care if you have to do it this evening with a flashlight. Then, overtime we can increase your cardio activity and introduce light weights. For today, you should try to drink 8-8 ounce glasses of water. These changes can be immediate. We can work on your diet when you go to the grocery store next.

This person nailed it. Just two simple things. Move + water. Hungry? Drink water. Hungry again? Put on trainers and get out that front door. Maybe consider chewing gum if you feel the need to bite/chew. Hard candy is also low on calories in moderation.

This means no insurance hassles, no medication complications to worry about, no scheduling, no surgery. Try it for a couple of weeks and see how you feel?

[Anonymous]

OP, good job on your weight loss and with your visit with your PCP!

[Anonymous]

OP I’m impressed by you - so many people don’t take the steps you are taking! And it is all about baby steps.

Advice abounds, but I’ll just say please don’t do anything to lose the weight that you can’t sustain every day for the rest of your life. That’s the only way it works.

There are two interesting podcasts, and they each have a different approach, but both are done by women who lost well over 100 pounds: Half Size Me, and Losing 100 Pounds with Corinne Crabtree. You might find them a inspiring. I listen to them on my walks.

[Anonymous]

OP, thank you for coming back and updating and congratulations on your wonderful start. We are rooting for you and wish you the best!