I was 17 when I lay on the operating table, wincing in pain as the anesthesia needle pierced the taut skin on the back of my hand. It was 2007, and the obesity epidemic was omnipresent, marking me a dangerous statistic. The size of my body, I was told, would eventually lead me into severe illness, such as heart disease and diabetes, unless something were done about it. I thought that this procedure would save my life.
I was first diagnosed as obese at 8 years old. By 10, I was on my first diet, eating low-calorie pretzels at lunch while my friends ate Oreos. By 14, I was visiting my pediatrician once a week so she could track my weight and lecture me about self-control. By 16, I was prediabetic. Two months after my 17th birthday, I got bariatric laparoscopic banding surgery: A reversible, inflatable device was placed around the top portion of my stomach, creating a smaller “pouch” and limiting the amount of food I could consume. The procedure had been approved by the Food and Drug Administration only for adults, but given the increasing obesity rates among children, the FDA sought to test this surgery among adolescents in a financed study. Adolescents who were diagnosed as “morbidly obese” (with a BMI over 40) and who had tried other means to lose weight, such as dieting or pharmaceuticals, met the criteria.
The specific surgery I got, the gastric lap band, reached its peak in 2008, with 35,000 surgeries performed that year. The gastric band is rarely performed now due to its high rates of complication and failure. More invasive and permanent surgeries, such as gastric bypass and the gastric sleeve, are more commonly used today.
Now those invasive surgeries are officially recommended for kids as young as 13 by the American Academy of Pediatrics, which recently issued the first edition of a set of guidelines to treat childhood obesity. The document advises that the families of children as young as 2 years old receive intensive health behavior and lifestyle treatment as a preventive measure against possible obesity, and recommends medication or surgery for older kids who have been unable to reduce their weight with other efforts. This 73-page report urges providers to see obesity as a chronic illness and treat it as such: with aggressive intervention.
As I drove to work last week, I listened to an episode of the New York Times’ The Daily on the guidelines, in which medical reporter Gina Kolata acknowledges that not every child with a high BMI will have health problems and, moreover, that insurance often won’t pay for less-invasive options like counseling or even semaglutides like Wegovy. She defends the prospect of irreversible surgery this way: “There’s widespread discrimination against people with obesity, and children and adolescents often suffer mightily. … It’s a big burden for a child.”
For me, weight stigmatization, along with a lack of attention to my psychological well-being, was the burden. I worry for the 1 in 5 children who meet the cutoff for aggressive weight treatment, because of what aggressive weight treatment did to me.
In the years following my surgery, I did lose weight. And I was thrilled. I could finally be seen as normal, not an outcast for my problem body. But by the time I was 23, I had begun having side effects from the surgery, such as frequent vomiting, heartburn, and inability to eat. After an upper endoscopy, I found out I had gastritis, esophagitis, and gastroesophageal reflux disease, all of which are potential side effects of the lap band, because when you have a small stomach and a constricted opening, food and acid can have trouble going in the correct direction through your body. It was then I realized that the surgery that was supposed to cure my obesity problem had done a poor job of addressing the underlying issue, which comprised a tangle of mental health and environmental challenges.
After I was diagnosed with these gastrointestinal health issues, I took matters into my own hands. I wanted to find out how this had happened and why I’d been diagnosed as obese in the first place. Through my research on lap-band forums and Googling of symptoms (“Why can’t I stop eating?”), I discovered the diagnosis of binge-eating disorder, first incorporated into the Diagnostic and Statistical Manual of Mental Disorders in 2013, half a decade after my surgery. The criteria seem to fit: eating a large amount of food in a short amount of time, eating past the point of fullness, eating when not hungry. When I was growing up, I learned only briefly about anorexia and bulimia. It had been clear that if you weren’t purging or successfully becoming thin with restriction, it wasn’t an eating disorder—you were just fat and needed to diet.
I began therapy, and opened past wounds I had tried to ignore. My disordered behavior with food had developed as a coping skill to deal with my dysfunctional family environment and my undiagnosed anxiety disorder, and it had eventually progressed to mental illness. But in all of my visits to doctors, dietitians, and diet coaches, no one had ever asked me what was wrong in my family, in my mind, or in the culture around me.
After this realization at 23, my behaviors with food changed. But not for the better. I became hypervigilant, restricting my calorie intake, over-exercising, and purging multiple times a day. I didn’t want to be seen as fat anymore. I didn’t want to be an obesity statistic.
My health took a turn for the worse. I became severely dehydrated and orthostatic, and I began vomiting blood. I knew I was sick, but at least I was thin.
I lived like this, until I realized I couldn’t any longer. I wouldn’t survive. I needed more serious help, and I went to various eating-disorder treatment centers to stop the cycle and move toward recovery.
Today, about 45 million Americans go on a diet each year. The diet industry makes $71 billion annually, and its offerings have a dismal track record—in fact, restricting your food intake can slow down your metabolism, which can lead to weight gain. What’s more, we’ve known for a long time about the psychological distress that intense dieting can cause: In a 1944 University of Minnesota “starvation” study, 36 healthy men were put on a six-month low-calorie restrictive diet. The results revealed striking physical and psychological effects on the participants: They experienced an obsession with food and exhibited disordered eating behaviors, such as guzzling water to feel full and cutting food into small bites to make it last longer. Astonishingly, these psychological effects didn’t always go away; after the experiment ended, some participants found themselves binge eating. Though I come from a stable, middle-class family, I related to this distress, which started for me with dieting in my childhood, eating “good” foods during the day and then gorging on “bad” foods at night. My weight was a symptom of the dysfunction around me.
I wonder whether, had doctors ever looked past my body and asked me how I felt about food, my body, my family, and my life, that would have prevented me from going through undiagnosed eating disorders and winding up with a BMI that qualified me for weight-loss surgery.
My fear of the implementation of the new guidelines—in particular the surgery piece of them—is not only the physical consequences like side effects, but the psychological consequences. Up till recently, my life was defined by my weight, because I was taught from an early age that my weight was what defined me. My obsession with weight loss, stemming from early dieting, did not lead me to be happier or healthier, as the doctors promised me at 17. It left me with more problems to untangle as an adult. The band around my stomach has loosened, and it does not affect my day-to-day life. But I worry for the children who will have permanent bariatric surgeries before they really understand their relationship with food, and self-worth.