Written by Jenni Murray


Weighing up gastric surgery

Having looked at her long-term health options, Jenni Murray has decided to go under the knife to tackle her fat problem.

bariatric 2, credit Jenny Rollo

Photo by Jenny Rollo.

Fat: it’s become the worst sin known to woman and, believe me, I’ve heard the word in recent years more times than I care to recall.

From the driver who cuts me up on the road, from the cyclist who wobbles across the pavement in front of me, from the guy who bumps into me in the supermarket. I make a justifiable complaint and the response is fired back with poisonous, unconstrained venom: “Fat bitch!” “Fat cow!” “Fat cunt!” And there’s often another ‘F’ word added to precede the fat.

Alternatively, you can add “greedy” into the mix; “Greedy fat bitch” is a familiar one. It’s generally assumed that if you fit the fat description – and I do – you’re the one that ate all the pies. But it’s not necessarily the excessive consumption of pies that’s the root of the problem. There are many more factors leading to obesity than simply being greedy or lazy or both.

I’m not much of an overeater, although I am quite fond of a few chips from time to time. And what am I going to say to the first rate chef who appears on Woman’s Hour to cook the perfect Black Forest gateau? “Sorry, I don’t eat cake.” Of course not.

As for exercise: I walk my dogs on a daily basis, swim twice a week and do yoga and pilates. So not entirely sedentary, stuck in front of the computer.

So, take genetics, for instance. I come from a long line of women, on both sides of the family, who had healthy but never excessive appetites, but who nevertheless became as round as they were long as they got older.

When it began to happen to me after two children and the decades began to pass, I dieted like mad, determined not to turn into one of those women I used to deride as “having let herself go.” My dieting history became legend.

I’ve tried them all: cabbage soup; Atkins, Dukan; 5:2. I’ve lost stones through sheer effort and willpower. Then, goal achieved, I’d start to relax and begin to eat normally, thinking I could maintain a healthy weight by taking care and succumbing only occasionally to the chips, a pudding and that extra glass of wine.

“It’s generally assumed that if you fit the fat description – and I do – you’re the one that ate all the pies.”

But then you discover the body’s chemistry is a highly complex mechanism and dieting may actually be bad for you. The evidence suggests that a body senses it’s been put into starvation mode and will do its best to lay down fat for the future as soon as it gets a chance. Hence the yo-yo process so many of us go through, finding we put on more excess weight after a drastic diet than we had when we started.

It all becomes so dispiriting; and you know Kate Moss had it so wrong when she said, “Nothing tastes as good as skinny feels.” She’d clearly never tasted my granny’s Yorkshire puddings or my mother’s chocolate cake.

Yet the science is beginning to provide us with answers that do offer some comfort to those of us made guilty for being – let’s not mince words – frankly obese.

Research published recently by Professor Lora Heisler at Aberdeen University revealed something they’ve dubbed “the lazy brain”. The theory goes that, as we grow older, the cells that control appetite become less efficient, leading to a mistaken assessment of the amount of food our bodies need.

bariatric 3, credit Gesine Kuhlmann

Photo: Gesine Kuhlmann.

As we age, we tend to need less food because we move around less than we did in the days when we were chasing around after children and probably couldn’t afford a car. But our brains fool us into thinking we need to eat more to feel full – hence middle-aged spread and the tendency to put on more and more weight. It was as I turned 50 that I began to resemble a blown-up balloon. Bingo!

Interestingly, the research seems to echo a conversation I’d had recently with Dr Billy White, a consultant paediatrician who specialises in obesity and diabetes in children and teenagers. “Bariatric surgery,” he said, “is really the only answer in older people where the weight problem is difficult to shift and is potentially having a serious effect on other aspects of health: breast cancer; Type 2 diabetes; heart and vascular problems.” There are three types of bariatric surgery: the gastric band, the bypass and the sleeve – all designed to reduce the size and function of the stomach. The band is reversible. The by-pass and the sleeve are not.

It was pretty much what my GP had also said when he expressed concerns about my reduced mobility, raised glucose in the blood (not yet type 2 diabetes, but possibly leading the way) and the pressure on my two metal hips. I’ve already had the breast cancer and don’t want a repeat performance of that.

Dr Smith said something the GP hadn’t mentioned: “The reason bariatric surgery works so well – and the bypass of the stomach is more effective than the gastric band – is not just because it reduces the amount of food your restricted stomach can consume; it has an effect on the complex hormone system that controls appetite and body weight. We find, just a week after a bypass, all evidence of type 2 is gone. Also, curiously, after surgery, we often find patients’ tastes change. They seem to have less craving for sweet and starchy foods and choose healthier options naturally.”

“I come from a long line of women who had healthy but never excessive appetites, but who nevertheless became as round as they were long as they got older.”

The more I discussed the benefits of bariatric surgery with him and with other patients who’d had it, and the more I looked at the sheer horror of my burgeoning waistline in my swimsuit, the more convinced I became that it was clearly the option for me if I were to avoid the threat to my wellbeing I was literally carrying around with me.

So my decision to go for surgery is not, as lots of people might assume, a quick fix for vanity’s sake – welcome as it would be to fit into a size 12 swimsuit again. It’s to, hopefully, extend my life span.

NICE, the National Institute of Care and Health Excellence, has approved such treatments for those with a BMI of 30 to 35 who have type 2 diabetes and those with a BMI of more than 40. The economic evidence shows it’s a no-brainer for the NHS, with the operation shown to pay for itself within two to three years.

So, I’m going to do it. I’m about to meet my consultant to discuss which form of bariatric surgery will suit me best. I’ll be saving my life and a ton of tax payers’ money in the long run. No type 2 diabetes, no amputation of damaged limbs, less risk to my heart and the joy of increased mobility without pain. What’s not to like?

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Written by Jenni Murray

Best known for her work on BBC Radio 4’s Women’s Hour, journalist and broadcaster Jenni Murray is never afraid to have an opinion.