Bariatric surgery is no cure-all for obesity – I know, because I've had it

http://www.theguardian.com/commentisfree/2014/jul/14/bariatric-surgery-no-cure-all-obesity

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I am probably one of the few people in the UK who is both a long-term bariatric patient and a professional specialising in the field of weight-loss surgery. Fourteen years ago, when I was a size 32, work and everyday tasks – even getting in and out of the bath – proved challenging. I developed avoidance tactics to minimise physical discomfort and the resultant sweating, soreness or breathlessness. Supermarket shopping meant parking as close to an entrance as possible, and always using a trolley, simply so I could lean on it. I had sores from my flesh rubbing together in the summer, and at the time I had weight-loss surgery, in 2000, buying clothes online was not an option, so my choices were severely limited.

Last week, new NHS draft guidelines suggested gastric bands and other bariatric surgery could be made available to 800,000 additional people to help address the increasing problem of type 2 diabetes. This is associated with being overweight, and the National Institute for Health and Care Excellence (Nice) has proposed lowering the threshold for bariatric surgery. This would mean that type 2 diabetics with a BMI of 30, rather than 35, would potentially be eligible.

Having lost weight through bariatric surgery, you might expect me to be in favour of this. But what problems would it solve? Will it address the social and cultural issue of readily available, relatively cheap food? It is hardly likely to address the insistent marketing ploys of large companies. Will it tackle why some of us are highly geared to use food and eating as a reward, or the production and provision of overly large portions? Will it stop food or a large latte being consumed on the hoof? Walk outside and note how obvious and subliminal triggers related to food and fluid surround us. We need to change our culture as well.

Those of us who have had surgery realise that neither the surgical process nor weight loss provides a simple solution. Surgery does not cure diabetes, although it might cause remission. Surgery does not cure the almost guaranteed osteoarthritis of those who are significantly overweight.

When I stepped into the then virtually unknown world of weight loss surgery, I had the naive belief that weight loss surgery would be an easy, simple, swift and permanent way to be thin. I would be asleep, and would wake up as a new person who would rapidly shrink, either unable to eat or not wanting to eat.

It had taken me more than 40 years to become the shape and size I was, and there were many reasons I had chosen to self-soothe or medicate using food. At the time I had no understanding of the psychological, emotional, physical and practical process that would follow surgery. I only wanted to be thin – and two years after my surgery I had lost nine and a half stone.

Weight-loss surgery changes your anatomy internally, but it cannot bypass previously learned behaviours. My weight wasn't the result of being tied down and force-fed; I chose to eat as a form of self-soothing, self-medication and pleasure. I genuinely believed I did not eat huge amounts of food and was resistant to accepting responsibility for how I cared for my body or how I dealt with stress and wellbeing. I avoided exercise, cooked and ate huge massive amounts and had little "me" time – when I was fat, I felt I wasn't worth my own time.

To maintain or achieve a healthy shape and size, surgery has to be one of a range of approaches, along with others such as yoga, pilates, counselling, personal therapy, nutritional review, treatment of allergies and medical issues. For me, the process has primarily involved accepting responsibility for my health and wellbeing.

There are new things to contend with once you change size and shape. My skin became too big for my frame and it was my responsibility to choose to whether do something about it. The NHS may be able to fund reconstructive plastic surgery following injury or congenital conditions, but it is highly unlikely to fund redundant skin removal following weight-loss surgery.

To make bariatric operations available to more people, the NHS will have to change. Even now, people who fall into the "agreed Nice criteria" are unable to access the multi-disciplinary approach necessary for this surgery to be successful. There is not enough funding, too few appropriately trained staff, psychology departments which are overstretched or simply unable to work one to one for more than a limited number of sessions. Are we all prepared to put our hands into our pockets and make substantially higher national insurance payments?

More contentiously, any treatment being included in a state-financed health system means difficult decisions. Do I stand before a 30-year-old soldier who has lost a limb and seeks funding for physio or a prosthesis? Does a tummy tuck come before a skin graft for a child who has suffered burns?

Thank goodness the proposal is currently a draft document, as it raises so many emotive points. Do people have a "right" to surgery? Has anyone costed long-term aftercare for surgical patients? The cost of related metabolic disease down the line? Re-operation, high-dependency bed use? The NHS must take all these things into account too.

Medicare in the US is facing the same dilemma and forecasts that type 2 diabetes and the resulting costs will crush the system, as predicted in the UK. It has used weight-loss surgery more widely than Britain for years. Has it really helped? It's worth noting that I am still as likely, if not more likely, to develop age-related or obesity-related disease such as type 2 diabetes.

Would I do it again? It's been a tough journey but a revealing one. Learning how to be a person in a "regular" body has been interesting. I have had counselling and therapeutic input. I have paid for everything from start to finish, and am so glad that I did it when I did.

As I walk the dog four or five miles a day, it has taken me all these years to get out of a fat-lady mind set. I can kayak, enjoy life and food more than ever.

Paradoxically, having not been diabetic when I had the surgery, I am possibly pre-diabetic now. What would Nice say about that situation? I have no "right" to be thin. I accept I may regain some weight, and have, and only I can deal with that. There is no fairy godmother waving her magic scalpel for me – I've used that one up.