Wielding the Tools to Combat Obesity

| March 1, 2023

by Kellie Armstrong, MSN, RN, CBN

Ms. Armstrong is Program Manager, Center for Bariatric Surgery at The Miriam Hospital in Providence, Rhode Island.

Funding: No funding was provided for this article.

Disclosures: The author reports no conflicts of interest relevant to the content of this article.

Bariatric Times. 2023;20(3–4):20–21.

Hello, I am Kellie Armstrong, MSN, RN, CBN. I would like to share my experience as a bariatric nurse and a bariatric patient. My journey consists of the ongoing treatment of my chronic health condition, the disease of obesity. I am very blessed that I have been able to continue my work in the field of bariatrics for over 23 years. I am celebrating living life for almost 18 years post-Roux-en-Y gastric bypass (RYGB) surgery. 

In 2000, I took care of my first bariatric surgery patient as a staff nurse. Later that year, we started preoperative educational classes for the patients. I also became the “subject matter expert” and started to do staff education. Over the next couple of years, our program grew, and I continued to grow and take on more responsibilities as we developed our program. I always joked around with our surgeon that I was a “fat chick but had great legs and worked 12 to 16 hours shifts all the time.”

So here’s the long, not so short, story of my journey with the disease of obesity. When I was 12 years of age, I attended my first Weight Watchers meeting. I was always the chunky or big girl. I was the one who had the thicker legs and hips. After working with bariatric patients for more than four years, I had a health scare that made me make the decision to start my own bariatric surgery journey. 

In 2004, I went on medical missionary trip to the Dominican Republic. We provided primary medical care and education during the two weeks we were there. One of the villages we visited was in the mountains. To fetch water to help with that day’s lunch preparation, we had to hike to the river to get water. It took me about 45 minutes to get there and over an hour to get back to the village. When I got back to the main area of the village, my heart and my head were pounding. My heart rate was extremely high. I was having an episode of super ventricular tachycardia (SVT) and was in a hypertensive crisis. My heart rate was beating more than 200 times per minute. I do not remember saying the words, but as I was going unconscious, I am told that I said,  “Don’t let my body rot here, get me home to my kids.” When I regained consciousness, the team I was with would not let me walk back down the mountain to return to the truck and our home base. 

I have done a lot of crazy things in my life, but I am petrified of heights. The people I was with made me ride a donkey back down the mountain. If you do not know, donkeys walk awfully close to the edge of the road—something to do with their vision and being able to see where the edge of the road is. There is a picture of me getting on the donkey, and it looks like I am laughing. That was as far from the truth as anything could be. I was crying and begging them to let me walk. I had so much anxiety on the ride down the mountain that I was shaking on the back of the donkey.

Prior to this trip, I was on a liquid diet and lost 65lbs in three months. I stopped the liquid diet a few days before the trip. In the two weeks I was there, I regained a lot of that weight. I was eating for the first time in months and felt like I was making up for lost time. Plus, the food the villagers were feeding us was AMAZING!

I talked with my surgeon when I returned from the trip and told him I was ready. I was afraid I would not live to see my children graduate high school. We believe I weighed about 300lbs at my maximum weight. I weighed about 275lbs when I started the surgery process, and I weighed 265lbs on the day of surgery. 

In 2005, several of the steps that are now mandatory via insurance were not required, but I chose to complete the full process just as we required of any of our patients at that time. It was important to go through the same process they had to go through, so I would fully understand what they and I had to complete to prepare for surgery. I had a RYGB on July 5, 2005. In the first 18 months after surgery, I lost approximately 125lbs. In January 2007, I needed to have surgery to repair an internal hernia. Also, in December 2008, I had to have a ventral hernia repair and another internal hernia repair. 

Prior to my surgery, I could not walk two blocks. I could not climb a flight of stairs. Bending over to pick up stuff I had swept on the floor would make me winded. I had been diagnosed with high cholesterol and high blood pressure, fatty liver, SVT, gastroesophageal reflux disease (GERD), and a few other health conditions, and my hemoglobin A1c was 6 to 7 percent. 

By February 2008, I was going to the gym and working out 4 to 6 times a week. One day, I was walking my dog, and she got away from me. We were headed toward a busy street at an extremely high traffic intersection, and because I was afraid she would be hit by a car, I ran after her. Then, I realized that I was running. I said to myself ,“Oh my God, I am running.” Mind you, it was only a couple of telephone poles in distance, but I did not DIE!!! I started to trot and run after that, adding another telephone pole to my intervals when I went out to run. 

A couple of days later, I was talking to one of the dietitians that I worked with, she told me she was a race director for a local 5k. She encouraged me to sign up for the race. I thought that there was no way I could run a 5k; I was barely doing a few telephone poles at a time at that point. But then I trained for it and completed the 5k in April of that year. 

About a week after that race, I was talking to another friend who was a Team in Training (an organization that raisies funds for the Leukemia and Lymphoma Society) participant. She told me about the Nike Women’s Marathon that was being held in San Francisco that year. Team in Training was looking for people to raise funds and participate in the event. I told her I would go to an informational session about it because my ex-husband had a young nephew who had been diagnosed with leukemia. I originally signed up to race the half marathon (13.1 miles). Within a couple of months into the training, the coach and the team captains convinced me that I could complete the full marathon. With their encouragement and support, I switched my registration to the full marathon. On October 19, 2008, I completed the 26.2 miles of the Nike Women’s Marathon. It was hard and so exhilarating all at the same time. 

Since that time, I have completed over 250 different kinds of events, from fun runs with my grandkids to completing two Ironman races. In case you do not know, an Ironman consists of a 2.4 mile swim and 112 mile bike ride, and then you run a marathon—or in my case walk, run, trot, walk, walk, trot, run, beg for it to end, stop a few times to refill my water bottle and go to the porta potty, run some more, walk, pet a few dogs along the route, stop and hug a couple of friends, meet and talk with some incredible people I met along the way, encourage others and accept encouragement from them, and then TROT, head held high, with less than 30 minutes left in the allotted time across the finish line, ending with a little leap in the air in 17 hours or less. 

I might never win a race, and I am okay with that. I do not do these races and events to be the first to cross the finish line. I do them “Because I Can Now.” I am a back of the pack girl. My goal is to finish and encourage others on the way to that finish line. And I am winning the war against obesity. 

It is important to know that even though I had weight loss surgery and participate in road races and other events, this disease is still a daily struggle for me. I was not cured because I had surgery and lost weight. When I was training for my first Ironman in 2013, I weighed about 155lbs. When I did my second one, I weighed 175lbs. In November 2020, I had excess skin around my abdomen and back, and I also had liposuction on my hips. I honestly believe that my weight loss surgery is one of the tools that I have in my toolbox. I continue to work on my health and wellness. 

Prior to my surgery, I never felt like I was full or satisfied with eating until I felt like I was stuffed to the gills or that I could feel it in my throat. I was always hungry. I would pretty much eat three large meals a day and graze all day long, as well. I was able to consume large portions of food. An average dinner would have been a 12-inch submarine sandwich, large fries, a dozen or so hot wings, at least two or three pieces of pizza, and probably some sort of dessert. On top of that, I would also have at least one 40oz diet Coca-Cola and an extra-extra-large iced coffee (that is 32oz of coffee with 7–9 shots of creamer and about 8–10 spoonfuls of sugar). It was difficult for me to relearn what it meant to be full. I had to learn what it meant and felt like to be satisfied with what I was eating or drinking. There were and still are times when if I am not paying attention or mindfully eating, I will eat too much or too quickly. I am happy to say that my tool of surgery still works, and my body tells me when I do this. Thank goodness I learned early to listen to my body better, but it was still a trial-and-error process.

Since the onset of the COVID-19 pandemic, with working crazy hours and not being able to participate in the events and classes I was used to doing, I had a weight reoccurrence of about of 23lbs. Some of my previous health conditions were starting to return. I got scared and on January 5, 2022, I received some results of my yearly lab work and weighed in at just under 199lbs. I immediately made an appointment with our obesity medicine doctor and joined our medical weight loss program, The Healthy Way Program. It is based on intuitive eating. I restarted my daily body training/movement routine. Over the next several weeks, I had started to see some weight loss and improvements in my health conditions and labs. Then in March, I added medications to my toolbox. My obesity medicine doctor prescribed Wegovy (semaglutide). The once weekly injections started that month. Since then, I have lost 34.4lbs (as of January 19, 2023), and my lab work is all back to normal.

Retraining my brain, surgery, medications, body movement, and working on myself are all tools that I have in my toolbox. The battle against the disease of obesity is a lifelong journey. I do not believe that any of these tools will cure my obesity, but I do believe that this toolbox gives me the ability to help myself to stay healthy and doing what I love to do: chasing my grandkids, taking them on amazing adventures, feeling comfortable in my own skin, feeling confident when I am in front of my patients and when publicly speaking about weight loss surgery and the treatments for the disease of obesity, walking around Disney Word and going on all the rides, traveling the world and completing all kinds of running, walking, swimming, and biking events. I greatly appreciate having and using all the tools that are available for me.

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