Having surgery to lose weight may seem like "the easy way out," but it’s anything but, as Julia Nathan can attest. After dropping 110 pounds, she needed a second operation—to remove seven pounds of excess skin—before she felt comfortable in her body.
A lot of people think weight loss surgery is a cop-out. I’ve been heavy my entire life, so when I lost 110 pounds, I wasn’t surprised that old friends wanted to know how I’d made such a change. But when I told some of them I’d had weight loss surgery—and then plastic surgery to remove excess skin—I was surprised when some of them just said, "Oh," like they were disappointed. A few people even said things like, "Well, you still look great," as though I had cheated my way to better health. I just smiled and thanked them. But what I was thinking was, "If only you knew what it took to get here."
I’m 28 now and have been dealing with people’s assumptions about my weight for most of my life. By the time I was 10, I was overweight; during my late teens and early 20s, I watched the scale go from 200 to past 250 pounds. Even though I’m tall—5 foot 8—that put my health in danger. Did I eat too much? Absolutely. But that’s because I was hungry all the time. I ate lots of vegetables, lean dairy, and whole grains. No matter what I was eating, though, I ate too much of it. Food also became a source of comfort, and overeating became a habit.
I attended Weight Watchers for the first time when I was just 12. Over the years, I tried all sorts of other diets, too. Each time, I’d drop some weight, only to quickly gain it back, and then some.
I was at the gym five days a week, trying Pilates, weights, the elliptical, and anything else that sounded interesting. And since I live in New York City, I walked everywhere. My blood pressure was great, but all that activity didn't make a dent in my weight. I also constantly felt achy and tired.
By my early 20s, I had tried just about everything. Deep down, I refused to believe I was simply destined to be fat. So I started seeing a weight loss doctor at New York University. She put me on medication to help me lose weight, but still the scale wouldn’t budge.
Then, during the summer of 2014, I was taken off the medication right before I went on a several-weeks-long trip to Japan. While there, I ate lots of fish and veggies, but I still came back 16 pounds heavier. The medication I’d been taking was effective, but all it had done was help me maintain a weight I didn’t want to maintain. At that point, I decided I had to do something more drastic. That’s when I decided to see a bariatric surgeon.
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Weighing the options
I was at an all-time high of 278 pounds when I met Christine Ren-Fielding, MD, chief of bariatric surgery at NYU Langone Medical Center. My other doctor had explained that because I was obese and had already tried to lose weight with diet and exercise, I was a good candidate for surgery. And the fact that I was young and healthy—with no complications like diabetes—meant I would likely have good results.
But no matter how healthy you are, weight loss surgery is major surgery, and Dr. Ren-Fielding didn't sugarcoat that. One of the things that gave me pause was learning I might need plastic surgery to remove excess skin after losing weight. Sagging skin can not only look unappealing but also cause issues such as infection. Dr. Ren-Fielding told me that the recovery from plastic surgery may be more painful than the recovery from bariatric surgery. Still, my biggest fear was that I would become a different person post-surgery. Don’t get me wrong: I didn't like being heavy, but I was funny and a people person. I was used to honing my personality rather than my appearance. I was afraid that after such a big change, I’d give off a different energy.
Taking the plunge
At first, I thought about getting a Lap-Band—an inflatable device that goes around your stomach—because the procedure is reversible. But then I thought, "No, if I’m going to make a change, it’s going to be permanent." I decided on the gastric sleeve, a procedure that removes 80 percent of your stomach. This forces you to eat less—otherwise you risk vomiting, diarrhea, or even ripping your stomach lining—and also likely cuts down on the production of ghrelin, a hunger-causing hormone that’s released in the stomach. I knew a procedure that addressed my hunger was what I really needed.
I saw Dr. Ren-Fielding for several consultations during the fall of 2014. I also had to meet with a psychologist and a nutritionist to make sure I was mentally prepared to change my eating habits and my life. The minute I got the green light, I scheduled my surgery for January. I still had all the same fears, but it was sort of like standing at the edge of a diving board: Sometimes you just have to jump. I felt I had to do it quickly so I wouldn’t talk myself out of it.
The operation took less than two hours; when I woke up, I was surprised by how good I felt. I spent the night at the hospital and then went to my father’s house to recover. My gut was sore but not in pain. The most difficult part of the gastric sleeve procedure was the liquid diet you have to follow two weeks before and two (or more) weeks after surgery to make sure your stomach doesn’t tear. During those weeks, I started having an allergic reaction to all the whey protein shakes I was drinking.
But here’s the thing: Though I was consuming only 600 to 800 calories a day, I was never hungry; it was like that switch had been turned off.
Even after I started eating solid food and upped my intake to 1,200 to 1,600 calories a day, the weight came off so fast that it was mind-blowing. I dropped 40 pounds in just a few months. I started exercising again in the spring, which helped me put on some of the lean muscle mass I had lost after surgery. My weight loss slowed to one to two pounds a week, which my surgeon said was right on target.
Shortly after I lost the first 45 pounds, I picked up a 45-pound plate at the gym—and almost dropped it. I couldn’t believe I had been carrying around that much extra weight on my body! And somewhere between losing 60 and 90 pounds, I was covered with bruises because I kept bumping into things. It was like I lost my spatial intelligence for a while. I had to get used to moving around in a smaller body.
By Christmas of 2015, I had lost 100 pounds. When Dr. Ren-Fielding told me I didn’t need to lose any more weight, I was shocked—no one had ever said that to me before.
A second surgery
A year after surgery, I had so much energy and was happy to feel satisfied after eating small portions. But I didn’t feel great about the loose skin around my belly. It hung over the waist of everything, even skirts. When I saw my reflection as I was standing sideways in front of a mirror, the person staring back at me didn’t match the way I felt.
I met with several plastic surgeons and decided to be treated by Eduardo Rodriguez, MD, chair of plastic surgery at NYU. He was kind and confident, and I liked how up-front he was about the risks of the surgery and how hard recovery could be. In March 2016, he removed nearly seven pounds of loose skin from my abdomen and breasts and tightened up the muscles in my abdominal wall.
I felt way worse after waking up from that surgery than I did after the gastric sleeve: The pain in my abdomen was constant and more severe. I have a hard time with pain medication, and just a few days after my surgery, the medication I was taking made me throw up. You’re supposed to be cautious when you sneeze, and there I was, vomiting. I was terrified that I had ripped myself open. It was one of the scariest moments of my life—but thankfully, I was fine.
I took a full month off work. (I’m a writer and I also design jewelry.) Recovery was tough, even after the pain subsided: You can’t really stand up straight for a few weeks, and simple choices, like whether to take a shower or use the bathroom, become big decisions because you have to be so careful with your incisions.
But the first time I was able to stand in front of the mirror and see that my stomach no longer stuck out, I knew I had made the right decision. My scars are long and visible, especially the one that runs from one hip to the other. But I think of them as badges of honor. They remind me of what I went through and how proud I am to have taken action to improve my life.
Holding on to myself
Dropping 40 percent of my body weight has changed a lot more than the clothes I can wear. I never used to be able to run, because my stomach bounced so much. Now I run a few times a week. My old eating habits are a distant memory: I can’t eat too much without getting a stomachache, so even if I wanted to have a big meal (which luckily I don’t), it’s not an option. Every day, I eat something good for me, like a green salad, and something that makes me happy, like a few bites of my favorite lemon cookies. The one thing that hasn’t changed is my personality. I’m the same person I always was, only healthier.
Dr. Ren-Fielding told me my body will want to gain weight back. I’m going to have to eat carefully and exercise for the rest of my life to make sure that doesn't happen. Sometimes that feels overwhelming, even scary. But a friend of mine recently said to me, "Julia, you’ve been doing this for almost a year and a half; you know how to do it now." And she’s right. I’ve got this.
As told to Camille Noe Pagán