Author: MillaPhatLife

Hello! I am a behaviour change specialist and a multi-passionate entrepreneur living that Phat Life in London, UK. My weight has been a life-long struggle, although, despite living in a highly fat-phobic society, I eventually overcame bulimia. Following a knee injury and nearly 36 months in isolation during the Covid-19 pandemic, I made a life-changing decision to have bariatric surgery in 2022. With this blog, I want to share my life journey before and after surgery. If my experience can comfort, inspire or offer support to one other person – it is a win.  ♥ M

Navigating the Road To Bariatric Surgery – Part 1 (2)

The decision to have bariatric surgery was nearly twenty years in the making. When I eventually decided to pursue gastric surgery, I seized immediate action. I had a face(mask)-to-face(mask) appointment with a doctor at my GP (General Practitioner) surgery within a few days, which was impressive considering we were in the middle of the pandemic lockdown. I could tell that the young doctor had not done a referral for bariatric treatment before, but they were very supportive and knew better than to ask if I’d tried ‘eating a bit less and moving a bit more’. The National Health Service (NHS) rule in England is that patients should receive consultant-led treatment within 18 weeks of referral. However, since it was in the middle of the Covid pandemic, I asked how long the referral to the consultant might take. They could not tell me, but I understood and didn’t feel discouraged. It felt amazing to have taken that first step.

I didn’t know at that point that in England, you have to go through a 12-month Healthy Weight programme before an actual referral goes to the specialist consultant. I found this out weeks later, and I assume the doctor didn’t know either since they didn’t tell me (and I had asked many questions). The NHS website doesn’t mention that a Healthy Weight (HW) programme is a pre-condition for surgery – this made me angry. It had been such an emotional decision, and I was devastated. Mainly because I knew there wasn’t anything within the programme that would be new to me. I have successfully lost a lot of weight several times over the years; also, I have done so much work with myself through self-help and therapy that I was ready. Completing a 12-month programme before even going on the waiting list for surgery felt like a cold slap in the face. Why prolong the suffering and the associated comorbidity risks?

The HW programme involved regular sessions with a therapist, a physical activity coach, and a dietitian and frequent weigh-ins. As it was during the pandemic, all sessions apart from the weigh-in were over the phone. You are expected to lose at least 5% of your body weight. Although I was miffed, to say the least, having to complete the programme course, I have to say that all the practitioners I interacted with throughout the twelve months were lovely, professional, caring and supportive people.

My Body Mass Index (BMI) was very high, one of the markers for when a referral can be made sooner than twelve months. If your circumstances are considered ‘higher risk’, they can refer you after six- or nine months. I was referred after six months. However, you must complete the 12-month HW programme simultaneously with any pre-surgery treatment the consultant prescribes. This may sound confusing, so I will clarify. Only the specialist consultant can assess if you are suitable for surgery. Thus, you don’t go on the waiting list for the actual surgery until the consultant has assessed your suitability, and then there is a wait for surgery. Pre-Covid, the waiting time for surgery was around 18 months. Hence, that is why the programmes can overlap.

I find the process incredibly ridiculous and, to a degree – condescending; it is a very blanket approach. If all goes smoothly and you are lucky, the time frame from seeing your GP to getting surgery is about two and a half years. From a public health perspective, bariatric surgery is a cost-effective treatment of obesity with long-standing projective improvements in health and reductions in comorbidities. Several reviews support this (Welbourne et al., 2016). However, achieving sustained weight loss through non-surgical strategies has proven ineffective (Fildes et al., 2015; Wing et al., 2005). If you haven’t already, I want to encourage you to go back one step and read and watch the video explaining ‘Set Point Theory’ in my previous blog post – ‘(Mis)Understanding Obesity’.

Despite significant support for bariatric surgery, the treatment seems inaccessible for many people suffering from obesity. The current 4-tier process is tedious; GPs cannot refer patients directly to specialists, which doesn’t set patients up for optimal results. 64% of the UK population is overweight, with 28 % and 3% being obese and morbidly obese, respectively, within that figure (NHS Digital 2020a). That number is staggering, one of the highest in Europe. However, surprisingly the annual rate of bariatric surgeries is low compared to other European countries. For example, in 2019/20, only 5,741 surgeries were performed in England (NHS Digital’s National Obesity Audit Dashboard). In Sweden, with a population significantly lower (c. 10 million) than England (c.55 million), 4,700 people received bariatric surgery in 2019 alone (Näslund et al., 2022). It displays a very different approach to using bariatrics to stem obesity and lowering comorbidities.

I was fast-tracked, my referral was sent to the specialist consultant six months into the HW programme, and I had just completed the 12 months in July 2022 when I first saw the specialist consultant in August – 15 months after initially seeing the GP. That’s when I received cold slap number 2 – they told me the waiting time for surgery would be 3 to 5 years. The consultant was embarrassed. Due to surgeries being sanctioned for a long time during the pandemic, they were behind, with an increasing waiting list.

Not that it was a huge surprise that there would be some waiting time, but 3 to 5 years was beyond believable. Truth be told, I was already extremely fed up with waiting. I’d lost my sister prematurely to lung cancer during the first quarter of being on the HW programme, and I was not prepared to play around with my health anymore. I was fortunate to be able to seek private treatment, an option that is not feasible for most people.

Bariatric surgery is an essential tool in treating obesity, along with medication and prevention programmes. However, it cannot be ignored that a vast proportion of the population is overweight and obese in most developed countries. Food availability, quality of food, physical activity and stress levels all played a part in getting us where we are today. In the UK National Bariatric Surgery Registry 2020 report, Batterham and Zakari describe obesity as “an impaired physiological state driven by a combination of discrete genetic, hormonal, and metabolic disorders alongside environmental triggers”.

Thus, it is a substantial and complex quest to conquer the so-called obesity crisis.  

  • Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. American Journal of Public Health. September 2015, Vol 105, No. 9
  • NHS Digital, National Obesity Audit Dashboard
  • The UK National Bariatric Surgery Registry; Third Registry Report 2020. p17
  • Näslund E, Ottosson J, Våge V, Sundbom M, Mala T. Scandinavian Obesity Surgery Registry’ Annual Report Norway and Sweden Third joint report: 2019-21. June 2022.
  • Welbourne R, le Roux CW, Owen-Smith A, Wordsworth S, Blazeby JM. Why the NHS should do more bariatric surgery; how much should we do? British Medical Journal 2016; 353:i1472
  • Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1):222S—225S

My Decision To Go For Bariatric Surgery

By no means am I suggesting that surgery is for everyone. However, if you, like myself, have struggled with your weight for a long time and are tired of weight yo-yo-ing, I recommend looking into it. My post-surgery journey has just started (2 months post-op); the journey to get there was long, but I can already say it has been life-changing.

I also want to accentuate that having a bigger body is absolutely nothing wrong. If you are happy, healthy and comfortable in your skin (and body), I want you to know that you are valuable, beautiful and deserving of all that life has to offer just the way you are. Don’t let that mean, self-doubting inner critic or society tell you anything different. Love yourself, and do you.

My decision to go for bariatric surgery came after years of lugging around a vast amount of extra weight, and I’d reached a point where I felt ‘enough is enough’. The Covid-19 pandemic was the nail in the coffin. I’d already gained more weight leading up to the pandemic due to a knee injury that had seen my activity levels plummet. So I decided to bury the coffin filled with past feelings of failures, shame and inadequacy, doubts and fears and let it go. In my head, I heard Marianne Williamson’s voice “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure”. 

For years I had been resistant to even considering bariatric surgery because I found it difficult to accept that I needed help beyond the changes that I knew I had the power to implement for myself. I can do meal plans and exercise programmes; I have a Bachelor of Science degree in Nutrition and Exercise Science and a Master of Science degree in Public Health Nutrition. On top of that, I am an experienced behaviour change specialist. My inner voice was constantly telling me, ‘You should do better. You know better.’ Which was often backed up by a meaner version saying, ‘you don’t deserve better’. 

In 2004, or possibly 2005, I attended an obesity action conference in London where a consultant did a presentation on weight loss surgery. Although I always had that internal battle that I should be able to do it myself, I also knew that weight loss surgery was not the solution for me then. Bariatric surgery is not a quick fix. Like many people who have been overweight or obese for a long time, I had a dysfunctional relationship with food. Which, at the core of things, had nothing to do with food. I knew I had to heal that relationship to successfully shed the weight for good. It took years of working on myself to understand the emotional wound I had, do the work, and start healing it. Eventually, I reached a crossroads where I had to either keep carrying on my life feeling rubbish about my body and allowing the weight to get in the way of living the life I wanted for myself OR ask for help.

The trigger to make that first doctor’s appointment to discuss bariatric surgery was following a telephone conversation I had at the end of May 2021 with a family member that was two weeks post-op gastric sleeve surgery. They were open to personal questions, and the conversation unveiled common (misguided) feelings of shame and failure to ‘resort to’ bariatric surgery. However, we had witnessed the tremendous transformation in both the physical and mental well-being of another family member who’d had a gastric sleeve surgery a couple of years earlier. We both agreed it had inspired us and wavered our resistance to considering surgery as a solution. So as soon as I put the phone down, I called my GP (General Practitioner) surgery to make an appointment.

I felt incredibly empowered by my decision to move forward; I embraced the fact that I could not do it alone. There was no reason for me to deny an opportunity to change my life. There is no badge of honour for not asking for help when you need it. ♥ M

(Mis)Understanding Obesity

There are so many misconceptions about people that are overweight or obese. It is not helped by a diet and beauty culture that shuns bodies that are bigger. There are literally thousands of methods, meal- and exercise plans and influencers claiming to have the answers to making you slimmer and more attractive. Many punish themselves by going on extreme diets that make all the promises about thinness and beauty only for you to regain the weight, plus more, down the line. It is a vicious circle that can take a toll on your mental well-being.

A common compliment is “have you lost weight? you look great”, clearly suggesting that the shedding of the weight has made you look better, reinforcing the culture of ‘thinner is more beautiful’. Of course, if you have really made an effort with diet and exercise, a compliment like that can be a real boost because, to an extent, we are all conditioned to believe in the unrealistic beauty ideals set by diet culture.

My personal journey with my body weight has been a long road. I have been overweight since childhood, and it really spiralled upwards in my 30s and onwards. My go-to-diet has always been Weight Watchers. I have lost a lot of weight on several occasions following their method. However, each and every time, I have not only regained the weight but always put on more.

This insightful YouTube video explains the ‘set point’ theory and why, despite huge efforts to lose weight, traditional ‘dieting’ fails.

https://youtu.be/tadJ0XccRL8