Nancy, before surgery, with son Ian. Credit: Nancy Sayles Kaneshiro
A veteran of two weight-loss surgeries, Nancy Sayles Kaneshiro lost 100 pounds and has kept it off. She knows firsthand how maintaining a healthy weight and exercising regularly contribute to general well-being and keep diabetes symptoms at bay. She shared her experience in a phone interview with HealthCentral. If you're contemplating this surgery, she hopes what she says here will help you make an informed decision.
HealthCentral (HC): What was the "it" moment that made you decide to have weight-loss surgery?
Nancy Sayles Kaneshiro (NSK): I'd been thinking about it for a long time, especially after being diagnosed with type 2 diabetes in 2003. I knew that it was definitely related to my being overweight most of my life. Like many who struggle with their weight, I'd tried "everything," including most brand-name diets, and achieved only temporary success.
I had been on three oral medications in an attempt to control my diabetes. During one visit, however, my internist looked at me, shook his head and said, "I don't know what I am going to do with you, because your blood work indicates diabetes is starting to negatively affect your kidneys. If we don't do something soon, insulin is the next step."
I knew inside that things weren't right. I'd taken a vacation earlier and remembered I was drinking water all day. (Excessive thirst is a sign of diabetes.)
I knew that the first order of business, long overdue, was to lose weight. Now. I asked the doctor what he thought about Lap-Band surgery, a minimally-invasive procedure, very popular in the early days of weight-loss surgery, in which a band is placed around the top of the stomach to reduce the amount of food you can eat at one time.
He said, smiling, "Well, I thought you'd never ask." In February 2009 he referred me to bariatric surgeon Scott Cunneen., M.D.
My internist said he hadn't wanted to push anything on me earlier in the game. He didn't say, “'Gee, Nancy, I think you need to lose some weight.” In fact, he thought, “Nancy has a mirror and knows this is a problem."
I had my first weight-loss surgery in September of that year.
HC: You bravely made another major life choice six years later. Tell us about that.
NSK: I was maintaining a considerable weight loss, but ultimately chose to have the band removed. One reason is that I'd developed gallstones, not uncommon with age and long-term unchecked obesity; rapid weight loss can cause them too. Everyone reacts to different weight-loss procedures differently. Personally, I had food get stuck often, causing me to throw up almost daily, which can cause damage if not corrected. In addition, my diabetes numbers were slowly beginning to climb. It appeared that the diabetes remission I had enjoyed as a result of the first surgery was slowly coming to an end.
At the same time Dr. Cunneen performed gallbladder surgery, he also did the gastric sleeve (or sleeve gastrectomy) surgery for weight loss and diabetes control. This procedure removes 80 to 90 percent of the stomach, so I eat much less than ever before. Another plus is that we “sleeve” patients no longer have the part of the stomach that produces ghrelin, the hormone that causes us to be hungry. Performed laparoscopically, this is also a minimally-invasive procedure.
HC: You've said that surgery is just the beginning of the weight-loss process, and of changing behavior to sustain that weight loss.
NSK: The biggest part of the equation is the complete change in one’s relationship with food. I eat tiny portions several times a day, remembering to eat slowly and chew like crazy. But I believe that if I'm only going to eat a little bit, it's going to be delicious, and I focus strongly on what I'm eating. While I still appreciate the enjoyment of food, my stomach's capacity is reduced so much that I sometimes miss that enjoyment. I realize the social aspect of food is significant, but really, it's not the food, it's the company and the experience that count.
I began to exercise after my surgery, five days a week, which I still do now. I get up at 3:30 a.m. and work out. I do 30 minutes of cardio on the elliptical machine, treadmill, and bike, and sometimes I mix them up. I do strength training for my upper body. Fortunately, I got lucky in my choice of a husband — he's very fit, dedicated to healthy eating, works out like a son-of-a-gun, and encourages me.
Out of necessity, I've had to learn a lot about food, knowing that it's not just "sugar" that's a problem for overweight people and people with diabetes. I’m always on the lookout for new recipes that I can adapt for both weight-loss maintenance and diabetes control. Most recently, I’ve discovered healthy shrimp tacos using high-fiber, low-carb tortillas, and stir-fried shrimp. When I see an appealing recipe, I say, "Gee, why don't we try that?" And we do.
HC: This surgery is not for the faint of heart or mind. What do you want to say to people who are contemplating weight-loss surgery?
NSK: I’d like to make it clear that weight-loss surgery is not a quick fix, nor is it the easy way out. It is, however, a tool that may be needed to accomplish a previously unattainable goal. The hardest step we take is the first one through that door for a consultation. Many of us are used to a life of losing weight and gaining it all back again — over and over, as our bodies continually tell us we need more food. I would like people to know that it is possible to get out of that vicious circle.
Now, I walk by the mirror and do a double-take — and it's all good.
HC: What about support? This feels like something you don't want to go through alone.
NSK: Twice a month I attend a post-operative support group for weight-loss surgery patients at the hospital. I feel it's important to touch base often just to stay on track. I also volunteer at a pre-operative group to answer questions from people about to undergo the procedures. They ask things like, "How do you feel now?" and I tell them, "Great!" They ask about going back to work, what the surgeries were like, and much more. I'm happy to answer as someone who's been there and done that. They need encouragement just like I did and I’m happy to be their cheerleader. Paying it forward in this way is as helpful to me as I hope it is to them.
Most of all I tell them surgery handed me 10 years of additional life expectancy. You can’t beat that!
Nancy Sayles Kaneshiro is a book publicist and co-author of four books. The most recent is 21 Things You Need to Know About Diabetes and Weight Loss Surgery, written with Scott Cunneen, M.D., director of metabolic and bariatric surgery at Cedars-Sinai Medical Center in Los Angeles, and published by the American Diabetes Association.