Breaking the Stigma: A Journey Through Bariatric Surgery with Kara John

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Welcome to Change Your Relationship with Food, the podcast hosted by me, Kyla Holley. With many years experience as an eating disorder and bariatric therapist, I know exactly what it takes to help you break free from your diet history and develop a more healthy relationship with food. Please follow this podcast to make sure you don't miss a thing.

Now, I know that some of you listening may have had bariatric surgery, and I know that some of you may actually be thinking about having bariatric surgery, which is why I wanted to get somebody in the show who has lived experience so we can actually talk about this and get someone's opinion who's actually been through the process and get her to reflect on what she made of it through the different stages. So we're lucky enough to have Cara John with us.

She is actually a counsellor in private practice, much like myself, and she actually transitioned into counselling after a successful career in business. And she follows her passion to help people better understand themselves and create meaningful and long-lasting change. She's got a few sort of specialities that she concentrates on, but her lived experience has drawn her mainly towards supporting clients experiencing anxiety,

parenting issues, family life stress, relationships, and disordered eating. so she's a busy woman. So thank you, Cara, for taking the time to come speak to us today. Well, thank you for having me on. I'm very passionate about sharing my story because I feel like unfortunately sometimes there can be shame or embarrassment around this type of thing and I feel like I, you know, I'm in a space to lead the way by sharing my story.

Yeah, absolutely. I'm sure you know, I work in bariatrics. I see a lot of clients every week. And that is something we talk about, that fact that people, a lot of people that come to have surgery don't even tell their partners that they're having it. So there's that level of shame attached to it. Whereas really, if for any other health issue, we would seek medical intervention. And if somebody said to us, well, hey, surgery would really help you here, we wouldn't really think twice about it.

So we need to get rid of that stigma attached to this, definitely. Yes, exactly.

So take me back a little bit to before your surgery and what was going on for you with your relationship with food? And presumably you were trying ups and downs of dieting and lots of things over the years. Yeah. So I've had my surgery a few years ago and I was in my very early forties and I kind of got to the end of my tether. I'm a very, very proactive problem solving person, very optimistic and I felt like I had literally tried everything and I wasn't going to let my health get better.

That point actually started all the way right back to when I was born. I was born a baby that was bigger. I was born into a bigger body, unfortunately, but interestingly, Interestingly, all of my siblings had much more petite frames. And for some reason, the gene pool worked out that I had a lovely, big, strong body. But being born into the 80s, there was, and the 90s, a lot of pressure. That really stick-thin, heroine-chic, tiny, tiny body ideal.

And it was something that I think it was in mid-primary school that someone first said to me that, Hey, you're fat.

And I just remember sort of absorbing this information, like, oh, my body is not okay. Okay. I need to do something about this. And by grade six, my friends and I had a diet club and I shudder now to think of that, you know, these. 11, 12 year old girls sitting around talking about how they can lose weight. And sadly, Sadly, my friends were saying, my mum told me this, and it wasn't just society, it came from our families as well. So that diet culture happened for me very young.

And then, as I said, I'm very, I like to take action, I like to succeed. So I went, right, this is a maths game. This is just calories in, calories out, and getting competitive with myself, right? What's the lowest amount of calories I can have? of whilst burning the most, and then that's not sustainable. So I would push myself way too hard, and then naturally my body would resist.

And then I would, you know, overcompensate and eat too much and then get angry at myself for shame would come in, and then I would start the cycle again. So did your weight go up and down a lot over those years? Yes, of course. And so, you know, I think people know that saying that when you lose weight, it usually comes back with interest.

And, you know, over the years, that's what happened. I would get down and interestingly, again, like I said, my body shape would never ever get to where I felt I should be. I was always, you know, just five more kilos and then it'll be fine. It's just not where my body weight was supposed to be. And so by pushing too hard, you know, it would fight back. And so over time, I just got heavier and heavier and trying everything.

Like, I'm not sure if you remember the cabbage soup diet and low carbs. Oh, I'm afraid I do. Yeah, all of it, all of it. Shapes, this and that.

And so I met my husband and you know I guess the pressure was less for me I felt a little bit more secure however then I had two beautiful babies and then getting into my later 30s my metabolism started to slow I found myself as heavy as I ever have been and that brings me to that point before surgery, I was, I, I know in my heart, I have tried everything.

I know that I'm not a lazy person. Like I love fitness and I know that, you know, I'm at this point where it felt like I had so much weight to lose that even if I just ate healthy and just normal more cautions and all of that kind of thing, it would be years before I would reach that healthy weight for me. And so I just felt I needed that jump.

Yeah. I often say dieting is the best way to get fat and people kind of laugh at that, but it's absolutely true because when we lose weight, you know, we can lose a little bit of weight, but then when we regain it, we gain it. And some it's, it's this J shaped curve. You can actually see it play out. And there's been a lot of research done behind it where, you know, if we start dieting 20 years later, we're absolutely going to be a lot bigger than when we started. It's a foregone conclusion.

Now, did somebody suggest surgery to it or is it something you heard about and went and researched? It came from me. And, you know, I think where we're at with bariatric surgery now is relatively new.

I think maybe, or quite a few years ago I've heard about you know the balloon where they insert the balloon and that kind of thing and that I've heard negative things about that so I kind of put it on the back burner but then as I sort of did more research I felt like the surgeries were better they were I guess more research behind them. I felt a bit more confident in what was offered. Again, someone who, like, I've always had a bigger appetite.

And this idea, just not being as hungry all the time with the smallest stomach, that appealed to me. Yeah, yeah. And what sort of support did you get? How many years ago was it, first of all, that you had the surgery? It was 2021. Right, okay. Yeah, so mid-COVID. And an interesting side point, I had to increase my private health insurance, and so there was a year gap.

Right. And that might not have been the best for me because in my mind it's, you'll have the surgery soon, you might as well indulge and enjoy it. Also during COVID, wow, I really did put on even more weight beforehand. hand. We see it all the time. We call it the last supper because patients come in and their first ever appointment, they weigh in on their first appointment and we log that weight.

And then leading up to surgery, you see this kind of hump forming where the weight goes up, up, up, up, up. And part of what I do is to reassure them that you're not committing to a lifelong diet.

Because Because a lot of people go into surgery with this assumption that, you know, I've got to eat this now because I won't be able to have it in the future. And they kind of clear their pantry and clear their freezer with this belief that life is never going to be the same again. And of course, on the other side of it, it actually is going to be the same. You can eat a whole variety of things. But I think there's that sort of understandable panic going into surgery.

Yeah, yeah. It's interesting to reflect back. Like, exactly, it's this, I've got to, you know, get it all before I lose this ability. Yeah. So what sort of support did you have? Did you have a whole team behind you that your surgeon supplied? Yeah, so my surgeon was very good. I was referred to a psychologist and I did talk to them about lots of different things. Particularly that whole, the diet cycle that creates the feeling of luck, which is what we're kind of talking about there.

So as I noticed myself eating more, we talked about that and sort of farming my emotions around that, that, you know, there's always going to be enough and it's all going to be okay. So that was helpful. And I also had a dietician, which for me was not as important because you may have picked up, I'm a researcher. I like to get in and look at stuff and I already had a fairly good idea the nutrition side so it was more the emotional relationship to food that I worked on with the psychologist.

Good good and it's really important that you have a whole team I know in times gone by surgeons and I'm talking about a long time ago to be fair surgeons would do the surgery and expect patients to kind of work it out on their own and it wasn't so bad back in the days of the gastric band because the band needed did adjusting. A lot. It meant that the patient was always tied to the surgery.

So you could kind of, you know, if things weren't going well, or if the patient had various challenges, you could kind of work those out as you went. Whereas now most of the procedures are what we call set and forget. So you have the surgery, it's done, there's no adjustment afterwards. And you actually have a really limited time to make sure the patient really knows what they're doing, you've overcome any hurdles or challenges.

And we, I don't know about where you went, but we released them about a year after surgery. So that, you know, hopefully we've seen them through that first year and we were pretty confident that they can do things on their own because now you've got this forever and we need the skills to be able to manage it, which is the most important thing.

How has your relationship with food changed since the surgery? What effect has it had? Quite a lot of an effect. You talked about that first year, which I agree is really important to create the habits. But it's interesting that even quite a few years later, I noticed that I catch myself putting too much on my plate. So being mindful of really what do I actually need, not what is habit. And then the other thing that's been a huge change for me is being so much more in tune with my body.

And my hunger cues because with all of those years of measuring what should I eat based on this arbitrary calculation of priorities, I had really trained myself for decades to ignore am I actually hungry or has my diet told me to eat something now.

When you have the surgery, injury it's much harder to ignore feeling full because it just hits you eating slower so it's not a sudden hit but then just noticing okay this is enough food and whilst the rest of it looks delicious I can pop that in the fridge and I can still have it later I'm not going to say no to myself but it's not what my body needs right now and I think when when we're in those dieting years, we don't get the sort of the cognitive space to be able to realize that because

there's this constant panic of, I must lose weight, I must count calories, I must do this, I must do that. And we don't actually relax enough to be able to truly say, okay, let's feel this, let's think about it, let's be more intuitive. And I think the surgery gives you the space to be able to do that.

Now, another common thing, and I wonder if this is for you, I don't know if you've experienced this. A lot of people say even though they've lost a lot of weight, they don't necessarily see it in the mirror and they don't necessarily feel like they're a smaller person. Would that be true for you?

100% yes so definitely that whole takes a while for your mind to catch up with the other really funny thing is the notice when I have my I might have overindulged a bit it does sort of trigger that I guess older feeling of you've eaten too much you're you know you should be ashamed of yourself and it's almost like I feel bigger when I might have overindulged a bit even though So overindulging isn't like sitting down to a huge binge. It's just a bit more.

But there is still that old echo past there. And I truly don't think that ever disappears, certainly with everybody I've spoken to and everything I've read about this. And I've tried to work out something that's similar in life because people say to me, I've got body dysmorphia. And I go, well, hold on, let's actually look at what's going on. And it's just this prolonged feeling of being in a bigger body, even though logically, intelligently, you absolutely know you're not anymore.

You've got a rough idea of what you weigh and what size clothes you wear. But the feeling that you're the biggest person in the room kind of is residual. It never leaves. And I liken it to this idea that no matter how old we get, there's always a part of us that still feels like we're 16. You know, that part inside that sort of says, you know, when an old song comes on or something where it's a really visceral kind of feeling that you're still young and you're still vibrant.

And I haven't lost that. And I'm getting older now.

Yeah and and i think this is the same that having been a bigger person you never really, forget that you never forget the feeling of that yeah and that's such a salient point for me because, i when we talk about lived experience i really feel that to my bone what it's like navigating the world as the bigger person and it's simple things like sitting on a train and that thought lot that goes through your mind that I need to find a seat with a stair next to it because I'm

bigger and you know just walking around and how people perceive you it's just this shadow behind you that you're always thinking about it and you're right it sort of does leave that mark yeah and I feel it's a unique thing it's difficult to unlearn that stuff so what sort of advice would you give to someone who's thinking of surgery?

I think it's a decision, it's an individual decision. I was lucky enough that my surgery went really, really smoothly. I had no real side effects and my surgeon, whilst my stomach is a lot smaller, it's still a reasonable size. So if I go out for dinner, people might think I'm a light eater, but I don't look odd. So I feel very, very normal. I feel like, like I said, just no massive side effects. I am aware that not everyone has that experience.

And so I think it's about sitting down and almost doing the figures and thinking about, for me, I thought about, okay, the effects on my health. I was fortunate not to have any side effects from obesity at the time, but I knew very soon that could happen. and the increased rates of cancer and the low energy. I have young kids and not being able to do things with them and just the uncomfortableness of being quite overweight, the aches and pains.

And so I thought about all of that and then I thought about the benefits and then I thought about the risks. And for me, my calculation said it was better for me to do the surgery. So I think everyone needs to look at their own circumstances and make their own choices.

Absolutely. And it's interesting what you were saying, because a lot of, I've noticed, I've been 15 years in bariatrics. And at the beginning, we had a lot more patients who were in a much larger body that had all those comorbidities. And now we're actually treating people sooner. So I think people are sort of saying to themselves, why wait till I have all these side effects? Why wait until my health is really, really suffering? And also why wait until I'm in my 60s, for instance?

And more people are kind of grabbing the opportunity now and saying, no, I don't want all those complications. What can I do to prevent them? So it's become much more of a preventative measure, even though there's guidelines still in place. Obviously, we don't perform surgery on people with low BMIs, for instance, as a preventative measure.

So there's certain guidelines in place. But more and more people are choosing this option as a sort of positive move so that they can not have to end up in those situations, which is interesting, I think. Yeah, like I said, it's been such a good decision for me. I wish that on other people if that's what they want.

Absolutely. And most surgeons now go through quite an extensive, not a vetting process, but a preoperative process where, I mean, certainly the practice I work at, they meet me twice, they meet the dietician about three times, they meet the surgeon twice, and they get numerous opportunities to talk through any doubts, to talk through the risks, to talk through how life might be afterwards and what sort of expectations that they're going to have.

And I think we do a reasonable job at informing them beforehand.

And I know in the past, if I've picked up a patient where you can see they've got doubts or you can see that maybe they're being pushed into surgery, I've had a couple of those in the past where they're sort of saying well you know my wife wants me to have this or you know someone's kind of doing the pushing I have talked people out of it in the past and I've said look you have to be a hundred percent sure that this is for you otherwise you know delay

there's no urgency here you don't have to have the surgery now you don't have to have it ever if you don't want to. But it's really important that people go into it with 100% commitment and positivity. Hopefully, to get a good result.

Now, look, I'd like to finish on a fun bit, which I've put in recently, because I don't want it to be all serious. And what I'm finishing with is what would be your favourite meal and who would you share it with? And it Well, I mean, you say fun. This is probably not super fun, but I would like to have a meal with my mum. She passed away about 13 years ago, but time has passed and I just want to catch up with her. I just want to sort of have one of the meals.

And keep in mind, I said I was an 80s baby. She used to make these Maggi sausage casserole and it was just like this really mild, mild sausage curry and you're very Aussie and over rice and she used to put sultanas with bananas in there.

So quite horrific in retrospect but childhood comfort food so sit down and eat that with her and just have a catch-up because you know where I was when I last spoke to her so much things have changed I've become a mother myself and I've had all of these other big changes in my life and it would just be really great to have a chat. That sounds fantastic. It's a bit unfair that you would get her to do the cooking though.

I mean, as I said, it's a childhood memory and, you know, I guess I was kind of maybe a bit of a sport child and mum did stuff for me. So she did one more thing for me. Fantastic. I'm sure she'd be delighted to do you a sausage casserole. Excellent. Well, look, thank you so much for chatting to me today.

I really hope if someone is maybe thinking about surgery and they've got some questions and they're trying to sort of build up the momentum to actually go and find out for themselves that maybe this has given them a little bit of insight into what to expect and what sort of process they might go through in the meantime. So thank you so much for doing that. And we will actually put a little link in the episode notes to link to Cara's business. Where are you based, Cara?

Well, I'm based in Maribena, but I do see clients Australia-wide online. Fantastic. So if anyone wants to chat to Cara, I'll put her details in the notes. And thanks once again for listening this week. Thank you so much for your company today. I would also love it if you could follow this podcast.

It really does mean a lot to me. also we have a six-week online change your relationship with food course that you can take just visit www.acfeb.com and click on the ACFEB and me courses link there's also a journal and a workbook available on Amazon and you'll find that link in our bio I really hope you can join me again next week goodbye. Music.