AIBU to want DH to consider weight loss surgery.?

[DuckWillow]

Please be gentle here....no fat shaming please.

I’ve been married to DH for nearly 20 years. He was always a very big man but this has never been an issue. He is lovely, kind and gentle and we have a very happy marriage.

Recently I have been worrying about him as his weight which was always high is now affecting his health. The last time he was weighed he was 33 stones which was a shock to him but he is very good at burying his head in the sand and ignoring stuff if it’s a challenge.

He was around 27 stones I think when we met and it’s never been an issue between us. I love him just as he is but I am concerned about his health.

Recently I’ve been watching and reading stuff about bariatric surgery and I wonder if DH would be a candidate. I know it’s a huge decision to make and at present DH is not shut in at home ...he works part time (self employed) doing a job he loves and it helps pay all the bills. I honestly don’t think he could work full time at his weight.

He is now in his early 50s and I am worried about the implications of his weight for the future. I don’t think it would take much to really incapacitate him . His blood pressure is high enough to need medication but beyond that he is healthy.

I am overweight but nowhere near the weight he is...I can shop in normal places for clothes etc. I am also very active as I am a runner which keeps me healthy.

We have a 16 yr old son who is autistic and a normal weight,

I am cooking low fat meals at home but obviously can’t control what’s eaten outside. His job involves travelling with a team of other people (entertainment industry) and let’s just say the wine flows and the food is rich when they are together. It isn’t easy for him to avoid this lifestyle but I feel he is heading to an early grave if thing don’t change. His parents are in their 80s and I know they worry about him too. His siblings are all overweight but again....can shop in normal stores for clothes etc.

Am I worrying too much? I don’t think I am and I really want him to seek help and make a commitment to losing some weight for his own health. I still love him so much and the thought of losing him is more than I can cope with so I don’t often consider it but for the sake of our son I feel we need to be around as long as possible.

You aren't worrying too much, he should be touched that you are so worried.
I would probably suggest counselling, an operation won't help in the long term, he'd lose weight but the issues that cause him to eat would remain.

How does he feel about his weight? This is something he needs to tackle for himself (with your support, of course) so I think if you just blurt out that he could have surgery, he may be very hurt.

Does he talk to you about his weight?

You've not mentioned what non invasive steps he has taken to lose weight?

Bariatric surgery is major surgery. It is a last resort, not first.

Do a lot of research and make an informed decision. It is by no means an easy way out and is a very gruelling (and expensive) procedure.

To be honest I would probably start to try address why he’s eating so much or not sticking to healthy eating outside of the home. If he does have surgery he will still need to eat sensibly to get the weight off.

I’d have a conversation with him and try get him on board to do the likes of slimming world before considering surgery.

YANBU to think he needs to make a change OP. I'm half his weight and very worried about my heart and my general health, which is why I'm making an effort to lose weight. He needs to do this, but I don't see how you can force him. I feel like it will probably take a proper shock like a health scare to spur him into action.

No, you’re not worrying too much at all. He’s not worrying enough. I clicked on the post expecting some vanity related post - at his weight he is at serious risk of death, at any moment, you know it and I’m sure he knows it too. This isn’t a bit of extra weight, this is beyond life threatening. Normally I’d say “he knows what weight he is, you don’t need to tell him” but I feel it’s a very different scenario when his life is genuinely at risk.

Has his weight gradually increased over those 20 years or is the gain recent? I take it you don’t have a physical relationship any more which must be difficult when you love him so much.

Being slim and fit isn’t a guarantee of a long life (my lovely mum was the fittest person I know and she died in her early 60s from cancer) but being this size is pretty much a guarantee of premature death. He has a wife who loves him and a child, he needs to consider how this is for you as well and what it will do to you if he dies.

At his weight, he probably already has issues with his heart and lungs, when did he last see a doctor?

He could potentially lose lots of weight by making small changes - his calorie intake must be huge just to maintain that weight. You say he works part time, how often is he out of the house? If you’re cooking healthy meals, is he eating food you’re unaware of?

I’d ask him to go to the GP and go with him. I know it will be difficult for him but you clearly love him and are very worried about him - maybe ask how he’d feel if things were reversed.

Are your meals low calorie as well as low fat? Is he sticking to any type of low calorie diet?

He needs to eat less than he moves; so unless he'll join a gym, he's going to have to drop his food intake. Hell need to swap to things that are low calorie and filling, like vegetables.

If he won't try that for a decent period, I don't think they'd consider him for surgery. He has to help himself first.

All you can do is express your concerns to him regarding his health. But do it by asking him what's his feeling on? It's really something he has to choose. Pressure from outside may only add to the internal pressure he feels. That's why gentle questioning might help.
You say you are overweight too. What is your BMI?
If you are a runner then there must be a lot of extra food being eaten. There must be a too much food being generally in your household for that to happen. What are the portion sizes at home? Who does the food shopping?

Thank you for your thoughts, yes I know surgery would be a drastic step.
He went to Slimming World but didn’t really embrace it or stick to the plan.

No I wouldn’t blurt out about weight loss surgery but I do think I need to sit down with him and address some of this. He hates being overweight but is almost fatalistic about it in a “this is just how it is” way.

Maybe bariatric surgery isn’t the right thing...the people I’ve seen on TV have been completely shut in and not able to leave home, that’s not DH as he gets out regularly.

Thank you all for your thoughts.

The gain has been gradual over the past twenty years from when we met.

So, the stats for losing weight without weight loss surgery are depressing. If your DH does start to diet he has a 1/1200 chance of achieving a normal BMI. Then he has a 5% chance of maintaining that weight loss, most will put it all back on and more.
Honestly, weight loss surgery is the only sensible route. He also needs to be checked for type 2 diabetes.

First place to start so is addressing why he was unable to stick to an eating plan. Councelling maybe?

It's very very difficult. There's weeks of no solid food, constant vomiting and generally feeling horrible. He needs to exhaust all other options before even considering it.

My DH is currently preparing for bariatric surgery. Where we live you have to visit a nutritionist for six months and cover all other possible causes (endocrinologist, cardiologist, we also got a recommendation from DH's psychiatrist and from an orthopedic surgeon). We did all that, and DH has been approved for surgery at the end of this month.

DH has gone back and forth between wanting the surgery and refusing it, but ultimately it's the only chance he has to lose the weight. Years of tests and various doctors have not helped or found the reason why he keeps putting on weight. It's not an easy decision because his life will change drastically. What he can eat will not be the same after and right now that is sinking in as he is on his last week of normal food before we start the 'liquid phase'. After the surgery it will be trial and error to find out what he can eat and what might give him heartburn for example. He will also have to take a range of supplements. And in approximately two years' time he will have to have cosmetic surgery to remove excess skin. And there is always a possibility that the surgery will fail...

In short, it isn't a decision that should be taken lightly. If your DH is considering it, talk to a doctor and get a referral to a specialist if possible to find out about the different types of surgery and to see what they might entail.

Just saw your update, OP, and wanted to add that most of the people, who get the surgery, go on to have perfectly normal lives after. A friend of ours had hers years ago, lost 50 kg, is fit and healthy, eats normally but smaller portions (she's gone off spicy food, that's all), and is absolutely happy that she had the surgery. We also met some post-OP patients at the clinic when we attended, who were there for their check-up, and none of them regretted their surgery in the slightest.

It is a very personal decision whether the surgery is the right way to go, though.

Youre not being unreasonable !!!he should be worried too....as you know he's at significantly higher risk of dying earlier..

I'm massively overweight. ...not quite your husbands bmi. ..but my bmi is 40 plus...

I've developed diabetes and now have cardiac problems. ..all in last 3 years. I'm too young to be this ill.

I feel I've got no alternative to lose weight as I don't want to die young or be incapacitated with my diabetes. Which many people in my family have died of complications.

I've lost 10 kgs so far ..no where near enough but it is a start.

I think most nhs bariatric services insist you manage to lose 5 per cent of your starting weight before even being considered for surgery.

I know several people who've had the surgery...they've all lost 10 stone plus and look fab...

But ...you can never eat normally again.

It takes real commitment .

The nhs doesn't do excess skin surgery AFAIK. ...someone I know paid privately to have it removed....it almost killed her as she had multiple pulmonary embolism....several days in ICU...she is young ....late 20s.

Please look at the Michael Moseley books...

I found what helped me was saying refusal to beat myself up about what I had eaten...but just to keep an eye on my total weekly calories. ...that's been really helpful.
Also knowing what your danger points /times are .
Fir me. ..when my sugars are crashing. ..so I keep bananas /chopped carrots to hand so I don't eat biscuits /chocolates

Tread carefully, OP. Most of what is 'known' about body weight is bullshit, a mix of conformation bias, the massive scam that is the slimming industry, and a profound prejudice against people who are seen as enjoying themselves.
Most diets fail, and an obsession with dieting and horror of fatness are far more damaging than eating what you want and not giving a fuck.

It's so difficult to support our loved ones and try to find ways to deal with issues like this. My DH is ~25 stone and it's been a topic now and then, but between grief and his work, it's been a challenge. He's taking it a bit step by step. I'm not sure how well it's going to go, but as others said, these sorts of steps often have to be taken anyways even if going down the major surgery route, which my DH is trying to avoid.

As a first start idea, there are quite a few people online who have lost a lot of weight as well as personal trainers online that have videos that might be an easier way of broaching weight loss as a topic. John David Glaude (his online stuff is 'obese to beast'), James Smith, and Michelle McDaniels are among my favourites, but there are plenty of others. Finding someone who informs and inspires rather than depresses with 'I'll never get there' can be tricky, but it's a big part of my getting healthier and helping my DH.

At his weight it’s pretty much a given that he won’t manage to lose weight to and keep it off without surgery.
His knees will soon give up, if they haven’t already started to. Then he’ll gain even more weight.

He absolutely should go and ask for a referral for surgery.
(He can always change his mind before the operation day, nothing is set in stone just by getting in the system).

You are not BU to want your DH to consider bariatric surgery and you are not BU to worry about his health.
I'm a doctor and see many patients in preparation for this surgery (sleeve gastrectomies as well as bypasses). I live and work in Europe, so procedures and cover by insurance will be different where I am.
We expect people to show a years worth of diet diaries, regular exercise, a psychological assessment and blood tests to rule out other endocrine problems causing the excess weight.
This is to get into the right frame of mind before having this life changing surgery. That applies to people with a BMI between 35-50.
If BMI is above 50 kg/m2 we start treatment without delay.
This is major surgery, but it's also very safe with an experienced surgeon and most of all it's the only real chance for people above a certain weight to reduce their weight long term.
You can advise your husband on all of this and support him. Ultimately it's entirely his choice.

Bariatric surgery is great if the individual is in the right headspace to want to change. Your DH would need to commit to living a different sort of life afterwards. For example, it can be a struggle to do things you normally take for granted - drinking anything fizzy (even sparkling water), going to the toilet, eating anything with sugar in, drinking alcohol. I can't tolerate more than one or two alcoholic drinks or I am on the floor (although one of my best party tricks is also that 20 minutes after I stop drinking I am actually sober enough to pass a breath test, no matter how much I've consumed). I have been constipated for 7 years. I can't eat potatoes or bread. If I eat sugary food I get dumping syndrome which is like having the flu.

The side effects are uncomfortable but the positives for me outweigh the negatives, I just wish I had been more prepared for the nature of the changes I would have to adjust to. Eating more healthily and smaller portion sizes is only one part of it.

I'm glad we are in Germany and don't have to deal with the NHS for this... Here, our health insurance (which is not a private one) covers the surgery and then also the cosmetic surgeries afterwards (we will have to apply for these after two years, but if the weight is stable they will cover everything).

Also, the aim is to be able to eat quite normally once the post-OP phase is over. DH's surgeon explained that some patients go off some foods afterwards - he says he has several meat-eaters turn vegetarian or go off sweet things, for example. What has to happen is that the patients eat healthy, balanced meals and stop eating as soon as they feel full. I'm actually looking at meal suggestions for the post-OP phase, once the liquid diet is finished, and the suggestions include a lot of things I cook anyway.

A family friend has recently had a gastric sleeve after a failed gastric band (they managed to burst it). The good part is that they've lost 6 stone, and can move easier and the medical reason for the operation is improving. The down part? They need their gallbladder removing, their hair has fallen out, their nails are brittle and yellow from mineral deficiency. They vomit daily, have problems with stomach acid. And the appeal of eating 3 small ramekins of low fat food has worn off completely. They deeply regret it and are miserable.

I'd encourage him with baby steps. Losing 1lb a week would mean nearly 4 stone in a year without really trying and he would have far more chance at keeping it off. The amount of calories he must get through would mean even cutting down a small amount could lead to weight loss.

Tread carefully, OP. Most of what is 'known' about body weight is bullshit, a mix of conformation bias, the massive scam that is the slimming industry, and a profound prejudice against people who are seen as enjoying themselves.
Most diets fail, and an obsession with dieting and horror of fatness are far more damaging than eating what you want and not giving a fuck

This is just not true and such dangerous advice. I find it really concerning that there is a growing body of people who want to push this message. Being 33 stone is profoundly damaging to your body. Your risk of certain cancers is much higher as fat is hormonally active for one. The OP's partner is at risk of dying from his obesity if he doesn't change his life and is facing joint pain and heart disease and diabetes which can all be very limiting. Binging on cheap quality, environmentally damaging 'food' is not fun or enjoyable. It's pumped full of shit and leaves you lethargic and with awful indigestion if you eat lots of it.

OP I think you should talk properly to your partner as he has to want this. I personally hate weight loss surgery but I think once you're over a certain size it is a very useful tool. From the people I know who've had it (they definitely weren't housebound before they had their surgery btw) it does require willpower still and if you don't drastically change your life, people do regain years down the line. Your partner has to want this for himself like any addict does. It's a big life change.

Can I just offer one piece of advice? A low fat diet really isn't going to help your partner. Fat fills you up, it has lots of nutrients in it and it tastes good. We're supposed to eat it. I think diets fail so much because they're too restrictive and taking fat out your diet makes you hungry. By all means count calories but his diet should include avocadoes and full fat milk and butter and things like nut butters in moderation. I've lost over 100 pounds and things got radically easier when I put fat back in my diet. I felt ill not eating it but only realised that after. Now I eat fat with each meal and it makes it easy to go hours until my next meal. I barely think about food these days - low fat eating made me binge as I was always hungry. Michael Mosley is fantastic too and people find his plans easy to follow. He gets your eating really well and tbh the only way to keep weight off long term is to enjoy your food and eat good quality stuff. Restriction is going to make you fail.

You’re right to be worried but unreasonable to want you husband to consider surgery. I say that as someone who has had a gastric bypass.

It is not a solution it is just a tool. You’re a success if you keep off 60% of your excess weight. I’m 10 years out and lost probably over 100% of the weight I should have and it still gradually gone back on. I’m now about 1.5 stone above where I should be (not bmi but excess weight).

It is hard. I had a very straight forward op, but your whole life turns upside down after. There are some fantastic fb groups out there, but it is for your husband to investigate, not you. One of the biggest issues is change to relationships after wls - would you be prepared for that?

In any event it’s a long slog to get it these days and you need a great gp. In my case it was my gp who suggested it and I heard her - anyone else and I would have been mortally offended and run to a chocolate bar!!