Now, everyone knows that bariatric surgery is a serious undertaking for the patient with its potential for complications (about which much has been written by us in this website). Everyone also knows that liposuction is a simple way of removing body fat without any complications. Some plastic surgeons or slimming centers may encourage this line of thinking by being effusively positive and optimistic about the benefits of the procedure.
The ethical and responsible plastic surgeons (and we know several) clearly know the place of liposuction in the management of the obese patient.
They explain the potential complications of liposuction as including infection, embolism and skin complications. They reserve it largely for spot reduction, a cosmetic indication, avoiding the obese patient who needs more than spot reduction of a few pounds of fat.
Additionally, I have always suspected that post-liposuction, the patient (whose lifestyle usually goes unchecked) puts on more fat that accumulates in other body parts, leading to an unsightly obesity. Today, my suspicion stands vindicated.
As the New York Times reports:

…fat came back after it was suctioned out. It took a year, but it all returned. But it did not reappear in the women’s thighs. Instead, Dr. Eckel said, “it was redistributed upstairs,” mostly in the upper abdomen, but also around the shoulders and triceps of the arms.

However, the human mind likes gratification, even if it lasts all of one year (heck, even one minute of a sweet treat is irresistible), and so the study shows that the women still were happy with the results of the liposuction, in spite of more belly fat than before. Irony.

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Each time, I sigh. It means another ten minute lecture is due on my part. I have to teach an important lesson to the patient (not to mention the family) all over again.

So my lecture goes somewhat like this:

Why are you here? Because eating the way you do has led to a level of obesity that is dangerous to your health and even your very existence. You have suffered endlessly because of your obesity. You have lived through your own self-recrimination, the admonishment of your family, the chiding and teasing of your friends, and countless other miseries unique to the severely obese individual.

Eating the kind of foods the way you have been eating has caused you so many life-threatening diseases like diabetes, sleep apnea and hypertension. Eating sugars and junk has brought you to surgery as a last resort.

So why are you not looking further ahead to being leaner and healthier? Why are you looking back to eating the same kind of way that has made you what you are today? Look at this thing in perspective. You have a whole new life ahead. Plan on how you can make the most of this with your new-found health and look. Liberate yourself from guilt and misery. Focus! The goal is health and leanness, not food. Focus! Look, you are several trouser sizes down! Look, you look great in that new slim-fit T-shirt! Look, people are wide-eyed at your transformation. Look, your husband thinks you are beautiful again!

Don’t miss these achievements. None of this is possible if you think surgery is your destination. It is not. Surgery is your vehicle. It will take you where you would never have dreamed of reaching. But you will do so only if you keep sight of your goals. That is what is called FOCUS.

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At work, your colleagues are eating samosas and cutlets along with sweet tea or coffee from the vending machine. You politely say, “No” to all these, because you know these are not good for you, and you don’t want to eat this junk, anyways. “What’s wrong with you?” your colleagues ask. You mumble about being on a special diet. But this situation is going to come up every now and then. Life will keep throwing up newer situations every day to challenge your status quo, your resolve and your health. Temptations are everywhere. How should you,  the patient, handle this?

Here are some suggstions:

1. Do not be shy of admitting or revealing to people that you have undergone a gastric bypass (or any bariatric procedure). You don’t need to advertise the fact, but do tell those people with whom you are regularly interacting and breaking bread. The truth shall set you free!

2. Once people realise you cannot eat like they do, they will not impose their foods on you. This will make social life far easier and healthier.

3. Avoid people or situations that are not compatible with your freedom of choice. This does not mean I want you to be a social recluse. I am merely asking that you avoid those people who do not have the sense not to force their food choices on the unwilling or unable.

4. Carry a couple of ‘lifesavers‘ — foods that you could just pop out of your bag and eat when you don’t find anything you can eat. Realise that society is still far away from being responsible and user friendly to special populations. Yes, with a small stomach and many medical problems, you are part of a special population.

5. Prepare for a party. This means calling up the host in advance, and specifying your needs (for example, you could ask for a small portion of a salad, a tomato/chicken soup, a small serving of a kebab or grill (paneer/fish/meat). If you cannot ask the host, tell your family member or person accompanying you to find your kind of foods for you, even talking to the host if needed.

6. If all the above are not working, don’t eat anything. This kind of sucks, but not as much as getting sick after eating junk.

Note that the above is more valid for the bypass patient, but also very relevant to the patient of the lap band, and less so for the patient of the sleeve gastrectomy.

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Halfway through my practice, a couple of trucks bearing sand and soil, came to the ground and started dumping them near me. I had to escape the dust and fumes, and abandoned the training.

(An Indian truck looks like this; pic source- from here)
But the disquiet of an incomplete session did not leave me as I proceeded home.

I live on the sixth floor of a building in Kolkata. As a routine, I never use the elevator, as part of my NEAT principle (check out the link).
Today, I decided to make a workout of my return home from the ground floor.
I walked to the floor above with one kettlebell (Kali- the 25 kg bell), ran down and brought back the other one (Sita- the 17 kg). Then I ran all the way down to the ground floor and back up. Now I had to carry one bell to the next floor, run down to two floors below, bring the other bell back, and then run down all the way to the ground floor and back. In other words, whenever both bells were on one floor, I had to run down to the ground floor and back up.
So, to put both bells up from, say the 3rd to the 4th floor, I carried one bell up straight from the 3rd to the 4th, ran back to the 2nd floor, sprinted up (two stairs at a time) to the bell at the 3rd floor, and carried it up to its partner in the the 4th floor. For the next round, I would start by going down to the ground floor and sprinting up all over again.
I calculated the floors and steps run in the few minutes of this workout:
1st- 2
2nd- 3
3rd- 6
4th- 7
5th- 8
6th- 9
TOTAL—35 floors
18 steps per floor—630 total steps up.
I am not calculating the steps run down.
At the end of it, my legs were saying, “PLEASE!!”
I was happy. No excuses training. That is what I want. So, the next time I take 3 kettlebells out, I know I would love the return of the kettlebells home.

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