The Trials And Tribulations Of Weight-Loss Surgery And Nutrition with guest Vincci Tsui MS, RD

Hola amigos! Welcome back!

Weight-loss surgery is a big deal. Does it live up to its promises and expectations? Before you make any assumptions, tune in to learn more about this life-time process.

Highlights of this episode:

• Before Weight-Loss Surgery
• Weight-Loss Surgery Programs
• How to Eat After Surgery
• What Surgery Does Not Consider
• Physical and Emotional Journeys

Guest Bio: 

Vincci Tsui (she/her) is a former bariatric dietitian turned certified intuitive eating counselor and body liberation advocate. She is the author of The Mindful Eating Workbook: Simple Practices for Nurturing a Positive Relationship with Food, and is the Community and Content Associate for Food Psych Programs Inc.

Vincci is passionate about helping people find freedom in their relationship with food and with their body, so that they can confidently step away from diet culture and live life on their own terms. Ultimately, Vincci is on a mission to make dignity, respect, happiness, and health accessible to all bodies.

Vincci takes a collaborative and compassionate approach to nutrition counselling and coaching that is rooted in Health at Every Size, intuitive eating, and mindful eating philosophy. She believes in helping clients learn to listen to their inner wisdom when it comes to making decisions around food, eating, and overall well-being.

Born in Hong Kong and raised in Calgary, Vincci received her Bachelor of Science in Nutritional Sciences from McGill University, and completed the school’s integrated dietetic internship program. She is a proud and active member of the College of Dietitians of Alberta and Dietitians of Canada.

Episode Show Notes: 

Warning! This conversion includes concepts such as BMI, weight, obesity, and weight-loss surgery for the purposes of criticism. However, if these concepts are triggering to you, please feel free to skip this episode. Please note that weight-loss surgery is synonymous with bariatric surgery.

[00:50] Struggles with Eating 

How to eat without binge or binge-like behavior? We believe if you restrict food, in any way, you are likely to binge. This comes up for people seeking weight loss. In David’s new book, Isabelle’s story highlights her struggles with eating following bariatric (or weight-loss) surgery. If you want more content on bariatric surgery, check out Episodes 71 – Anti-Diet Approaches to New Year’s Resolutions with Vincci Tsui and 128 – Is Weight-Loss Surgery Really Worth It? Things You Should Know.

[04:35] Trials and Tribulations Before Weight-Loss Surgery

Even before weight-loss surgery, the diet will be extreme. Surgery centers have different requirements, some require weight-loss before the surgery, which is a dehumanizing process. Some people do not receive education on how to try to lose weight in a healthy way. Before the surgery, it’s required to be on a liquid diet to shrink your liver so the surgeon can more easily access your stomach. This is a controversial suggestion. First, the length of time for a liquid diet can be arbitrary. Second, surgeons can learn how to handle complications during surgery, how necessary is the liquid diet? Knowing how to eat prior to the surgery and then following through with the plan can be extremely difficult.

Weight loss before the liquid diet is really out of touch with the person’s narrative. They are there because they have already tried to lose weight without surgery. This is an example of the dangerous hierarchy and power dynamic between providers and patients.

In the U.S., the insurance companies can change their policies annually, creating different prerequisites for surgery. Sometimes the prerequisites can take up to 18 months, which means some folks experience a change in policy during their journey. In Canada, the process can take years because it’s an elective surgery. In other cases, customers are rushing to surgery. Surgery can be done elsewhere, on a faster timeline, but it does not come with proper support or education. It’s difficult enough with the support.

[17:41] Trials and Tribulations After Weight-Loss Surgery

After weight-loss surgery, a patient’s hospital stay can vary depending on the location, despite the risk of blood clots. The policy decides whether clear or full liquids are appropriate. Eating this way has been compared to baby food. Eating this way, it’s hard to get adequate calories, protein, and other nutrients the body requires no matter its size.

There is nothing magical about the surgery, it’s a malnutrition and restrictive approach. There are emotional and physical challenges. After the surgery, dumping syndrome is likely after eating. The food goes through your system very quickly, which triggers a spike in blood sugar, followed by a drop in blood sugar. Patients can experience clammy hands, nausea, dizziness, and diarrhea. Because sugar can be an irritant, it re-enforces the diet message that carbs are bad.

How to eat becomes a moral question. The patient thinks, “if I have [bad] carbs, I am bad.” If the person is paying out of pocket, that reinforces their emotional investment and self-blame if they cannot follow the diet or lose more weight.

Some doctors really believe they are saving lives through this surgery, but they do not see the emotional and physical side years later. That is healthism, which ignores other aspects of health.

[31:58] Limitations of Weight-Loss Surgery

Limitations after surgery occur with the patient and the provider. Many providers feel like there is only so much they can do to help ease symptoms. Patients are told to eat around ½ to 2/3 cup per meal after a gastric bypass. This means around 1,000-1,200 calories a day, max. The pill burden is very high as well.

After 8-9 months, a patient’s rapid weight loss stops and slows. Vincci sees a lot of comparison statements from her clients, “why I am not losing as much weight as this other people?” “Why I am I not losing as much weight as before?” The blame is always placed on the individual, never the surgery. However, metabolism is not under anyone’s control. Research on weight regain is not well defined in bariatric research studies. Vincci estimates that as many as 1 in 4 people experience weight gain of 15%.  The “Biggest Loser” study showed how slow metabolism becomes post weight loss.

Body anatomy and hormones change after this type of surgery, that research is just now starting to explore. After two years post-surgery, there’s not a lot of data. In private practice, Vincci and David see post bariatric patients with weight regain and constipation. Even without weight regain, people may still have the other complications.

[48:53] Lacking Concepts within Weight-Loss Surgery

Often, people in marginalized groups, like BIPOC, do not have the same access to healthcare as privileged populations.  This is the case within bariatric surgery as well. Also, in BIPOC communities, eating disorders are very misunderstood and under diagnosed. Although ASMBS recommends a psychological screening, they do not outline that eating disorders are a contradiction. Therefore, some centers do not address this issue at all.

[01:01:15] How to Eat Intuitively

Intuitive eating is becoming trendy and is on the radar of post-bariatric patients. However, there is not enough providers in this space. Intuitive eating can be tricky to navigate in general, without the added-on complexity of an altered GI tract from surgery. Vincci says that there is not enough nuance in this space. She recommends reading Roxane Gay’s work. She is a writer who is fat and had bariatric surgery, check out her point of view here.

David and Vincci practice HAES, Health At Every Size, and because of this, they leave space for all types of journeys and want to provide support.

Guest’s Resources:

• Website: vinccitsui.com
• Book: vinccitsui.com/mindfuleatingworkbook
• FB: facebook.com/vinccird
• Twitter: twitter.com/vinccird
• IG: instagram.com/vinccird

Announcements:

Important Dates for David’s book, One Small Bite

Starting April 12 – book available on Kindle now!

April 19 – book available in hardback and paperback

Get Unstuck Group Class

Starts May 10, 2022. There will be an early bird special. Classes are on Zoom, so no travel necessary. Read more and sign up here: https://orozconutrition.com/courses/

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Chop the diet mentality; Fuel Your Body; and Nourish Your Soul!