The first thing you notice about Lizzie Lee is her skin. Her face is so luminescent, so flawless you want to touch it to check she’s real person, not an airbrushed cosmetics ad. Coupled with the shaggy blonde bob, vast toothy smile, gregarious chatter and lithe figure, and you have a 38-year-old who, more likely than not, will be the most attractive woman in any room she enters. And, boy, does she work it. “I’m always being complimented,” she grins. “I had to walk through the factory at work yesterday and one of the men said, ‘You realize you’re making everyone’s day walking through here’. I love the attention and make the most of it.”
It hasn’t always been so. The first thing you used to notice about Lizzie Lee was her size. That tends to happen when you weigh 19 stone. It all began 14 years ago, when she didn’t get round to losing the baby weight after having her son. Then her partner left her. A single mum, she was forced to work long hours to make ends meet and would spend her evenings, prostrate, exhausted, on the sofa, eating chocolate. Then her father was struck down by a prolonged terminal illness, and Lizzie spent her weekends driving hundreds of miles from her Hampshire home to his hospice in the north, and back again, surviving on a diet of service station burgers and chips. She grew steadily larger, and at intervals she would try – and fail at – various diets. Then, at the age of 34 and 19 stone, she took drastic action. “My mum sent me a recent photo of me, her and my nanna. My grandmother used to be a Tiller girl but her and mum are both
Obesity levels among British adults currently stand at 26 per cent, up from around 1 per cent in the 1960s, according to Department of Health figures. Of those who are actively trying to do something about it, an increasing number of the most overweight are pinning their hopes on bariatric surgery. The two most common operations are gastric banding, which reduces the size of the stomach by placing a band around it, and the gastric bypass, which involves creating a small pouch within the stomach, to which food is rerouted. The end result of both procedures is the stomach becomes fuller from much smaller quantities of food. Obesity surgery was first recommended in the UK by NICE (National Institute for health and Clinical Excellence) in 2002 as a last resort for the morbidly obese if all other weight loss methods had failed. The British Medical Journal this year reported a tenfold increase in operations since then, but the figures are still tiny: of the 1m people who currently meet the criteria for surgery, only 3,600 received it on the NHS last year. There simply isn’t the capacity to meet the demand – although proponents argue that conducting bariatric surgery on a morbidly obese person now will save the NHS money in the long run, as that person is then less likely to suffer obesity-related illnesses such as diabetes, heart disease and high blood pressure.
For those fortunate enough to get the surgery on the NHS or who have the money to pay for it privately, like Lizzie, those first post-op months are a euphoric time as the weight quickly melts away – 5, 6, 7 stone in the first six months is standard. It makes for an incredible, dramatic physical transformation. You get slim, you live happily ever after. At least that’s how it’s supposed to end, but of course nothing in life is that simple. Losing weight is just the prologue, learning to live as a slim person is the crux of the story. As the physical journey ends, the psychological one begins. Lizzie says: ”I’ve always eaten emotionally and surgery doesn’t change that, it just takes the hunger away. Whatever’s in your head before you have the operation is still there afterwards.” She describes standing in the supermarket in tears, grieving for food. “I felt bereft. That enjoyment from shopping, from the rituals of buying, cooking and eating food was gone. It was a horrible feeling. Food was my crutch and it had been taken away. At first you can only have liquids and things like mashed potato until your stomach adjusts. It was a couple of years before I could have chicken again and even now I can barely eat steak or bread. I can only eat small quantities – I can never finish a starter and a main course at a restaurant. You get such an upset stomach if you overdo it – I remember going for a nice walk in the park with my son a few months after the operation and we both had an ice lolly. We had to run immediately back to the house as it went straight through me. It was awful.” Her weight loss also threw up other unexpected problems. As the pounds peeled away, so did her female friends. “Post-op I started getting fewer and fewer calls. I still keep asking a really good friend of mine about meeting up, but it’s been over a year now. She knew me at my biggest and she’s big too. She’s told me how she feels about her size and I think she just doesn’t want to see me slim, so she fobs me off. I’d probably feel the same if I was in her situation.”
Ashamed by what she feels is the stigma attached to weight-loss surgery, Lizzie has only told a handful of friends about her operation, maintaining to most people that she did it through diet and exercise. “I don’t want people to judge, I don’t want people to think I’ve cheated. And I feel a failure about it – I didn’t do it of my own accord.” She’s not especially close to her mother and has yet to tell her. “I’m a bit scared that if she asks me why… it would be a hard thing to say that I saw that photo and didn’t want to look like… I don’t think she needs to know.”
I’m astonished to discover that, 4 years on from spending almost £10,000 on her surgery, Lizzie is now attending Weight Watchers. “I want to lose about half a stone,” she says ruefully. “I got married 18 months ago and I was slimmer then than I am now. I thought surgery would be it for me, I thought it would be a magic wand, but it is possible to cheat a bypass. I eat lots of crisps, I graze.” She weighs herself every morning; so frequently is she in the vicinity of her bathroom scales that her husband Mike leaves Post-It note messages on them for her. At 5’7, she is a size 10, with a beautiful hourglass figure, yet – like every woman I’ve ever met – she’s critical of her appearance. “Women always want to be slimmer, don’t they?” she shrugs.
Bariatric surgeon Dr Shaw Somers is an NHS consultant who also works privately at Streamline Surgical. He was Lizzie Lee’s surgeon, and has carried out operations on over 2000 patients in the last 12 years. His team offers rigorous pre- and post- op counselling to every patient, many of whom decline. “Once the initial weight-loss celebration period is over, there is the ‘now what?’ thing,” he says. “For some patients it’s really scary. They think, ‘I’ve lost the old me I’ve grown to be comfortable with and now I have to cope with a different me.’ The problem with surgery is that it does work a bit like magic at first, and some patients expect it to continue to do so.” Somers has seen many cases where a patient who over-eats due to an addictive nature replaces that addiction for another, such as alcohol or gambling. And he reports one-third of patients in stable relationships see their partnership disintegrate post-surgery. “A common scenario is the husband realizes he doesn’t like his newly confident wife who likes to go out and enjoy herself. He preferred her when she sat at home and did the cooking.” Professor David Haslam, a member of ESCO (Experts in Severe and Complex Obesity), says that while the vast majority of people who have obesity surgery enjoy a far healthier, happier life, there is an increased suicide rate among bariatric patients. “This happens when the wrong people are having surgery without the appropriate steps [such as counselling] in place. If they think their life is shit because they’re fat and they lose weight and realize their life is shit for other reasons, it can tip them over the edge.”
Sarah Watkins is someone else who knows the story doesn’t end when you buy your first pair of skinny jeans. Today, this softly spoken a 29-year-old nurse from Leigh, Lancashire weighs around 9 stone and is a size 8. She is tanned, toned and pretty, but there’s something about the way she stoops slightly when she stands and hold her hands protectively across her torso that suggests a woman not at ease with her body. But then perhaps that body has taken a bit of getting used to. Just two years ago, Sarah was six stone heavier than she is today. Towards the end of her third pregnancy (after having two sons of her own, she acted as a surrogate mother), she suffered agonizing gallstones, due, she believes, to a diet that saw days when she’d eat an entire 1kg bar of chocolate. A few days after giving birth, she dusted down her scales, took a deep breath and tentatively stepped on. “I was 16 stone. I just stood there thinking, ‘How the hell have I got to this point? It was like a switch going on – I had to do something about it. I realized during the pregnancy it wasn’t just a cosmetic thing, it was affecting my health. I got a bin bag, opened the fridge and the cupboards and threw out every single piece of fatty food.” And so began a weight loss regime that would see her lose six stone in only nine months. She ate 3 healthy meals and two snacks per day, joined a gym and went 5 times a week, and – having trawled health and diet magazines for tips – began religiously drinking two bottles of Skinny Water a day. The low calorie-drink contains chromium, a trace mineral believed to help suppress the appetite and reduce sugar cravings.
Once she hit her weight loss target, Sarah enjoyed a family holiday in Mexico, wearing bikinis and short skirts for the first time, and a celebratory girls’ night out, surrounded by friends telling her how fantastic she looked. And then? The comedown began. “Becoming confident has been a long process,” she says. “It’s like your new body isn’t
Sarah marvels – and despairs – at the power that comes with slimness. “It’s awful really – you are invisible when you’re big, even though there’s more of you. When I’m at work, there are a couple of male doctors who always offer me a tea and make an effort to talk now. I think, well, you never made me a drink when I was big. It upsets me because I’m still the same person inside that I was before. It hurts to think they people don’t want to know you as a person, they’re just interested in the packaging. If you are slim, people think better of you.”
A sentiment which is echoed by Louise Kean, a 35-year-old published novelist and head of a London film production agency. She recalls bumping into an old work acquaintance at a party, shortly after she lost seven stone. “He said, ‘Sorry I don’t think we’ve met’. And I said, ‘We have, it’s Louise Kean. I’ve lost a bit of weight.’ He shouted, ‘WHAT?! No way!’ Then he called over one of his colleagues to gawp at me, saying, ‘Look it’s Louise Kean – remember how she used to look? Well, look at her now.’ He thought he was paying me a compliment, like, ‘you were hideous before but you’re OK now’. I went home and cried my eyes out. I thought, that’s still
In the six years since her initial weight loss, Louise’s size has fluctuated. She’s currently a size 14-16. “The ups and downs of your weight become open to public debate. I hate the fact people think I still can’t control my weight. It’s like, [patronizing tone] ‘Poor girl, she’s at the mercy of food. She was strict for a while but she can’t help herself now.’ The fact is if I lose or put on weight now, I’m in control of it. When I was at my slimmest, I wouldn’t even eat a tiny piece of cheese and I was addicted to exercise. I don’t want a joyless life. I like to eat nice things, I like wine. Now I know what I’m doing – it’s fine. I’ve thought so much about it over the years, I’m at peace with it now.”
We all love a transformation narrative – an arduous personal journey in which our heroine emerges fitter, stronger, better-looking. This story arc dominates popular culture, from fairy tales to X Factor contestants to female celebrities kicking their errant husbands into touch. But what I learned from talking to these women who’ve lost life-changing amounts of weight is that you can’t neatly storyboard their experiences. There’s no universal outcome. There’s no clearly signposted path they all take once they’ve reached their target weight, once they’ve been photographed standing, lithe and grinning, inside a ridiculously giant pair of trousers left over from their fat days. There is all the help in the world to lose weight. There is less help to address how to live your life, and to adjust to the changes, afterwards. Yet there was one subject that drew a consensus of opinion and experience. When asked if they missed anything about being big, every woman talked wistfully about the days when they could eat what the hell they liked without feeling guilty. After extreme weight loss comes eternal vigilance, a fact that Carol Lucking, 41, a businesswoman from St Annes-on-sea and Dena Ryness, 33, a Manchester-based nutritionist, have come to learn. Carol decided to lose weight after reeling in horror at being approached by a recruiter for the local ladies’ rugby team. She did the lemon detox plan, which meant replacing her evening meal with a potion made from Madal Bal Natural Tree Syrup, fizzy water, fresh lemon juice and cayenne pepper. Coupled with healthier food choices – salads instead of sandwiches for lunch – and thrice-weekly workouts at the gym, she dropped almost five stone, and is now a neat size 10, down from a size 20 three years ago. Funny and forthright, the mother-of-two describes herself as ‘far happier, more creative and more confident’ since losing weight, but at the back of her mind lurks a little voice, asking ‘what if…? ‘ “I have this irrational fear that one morning I’ll wake up and go, Oh god where has that stone come from?” she says. “The weight I lost follows me around like a stalker. It’s waiting for me, hovering above me, like an angry spirit.” Dena used to be a size 18 but after losing 6.5 stone, she’s now a size 8. Always a chubby child, she took action in her early 20s after being forced to pay £400 for a bespoke dress to wear to a friend’s wedding because she couldn’t find anything that fitted her on the high street. Over a four year period, she took up kickboxing, ran marathons and overhauled her eating habits – and as a result, her career. Fascinated by the changes to her body, she gave up her City job as a marketing director to retrain as nutritionist and set up Beautiful Active Nourished, a low-calorie bakery and patisserie. In person, Dena exudes drive and determination. “The bottom line is I want to stay fit and slim so I have to stay disciplined,” she says firmly. “If I’m not disciplined, I will gain a bit of weight and I’ll have to be happy with that. There is a trade-off – you can’t have everything.” She’s been known to go running on Christmas morning so she can then eat what she wants during the day. She admits to annoying her in-laws by requesting healthy dishes when visiting them for dinner. “I think I am less fun now I’m slim,” she says. “I hardly drink now, for example, because I’d rather have the calories in food. If I occasionally say, ‘I fancy a G&T’, everyone around me gets really over-excited and encourages me to have one.” She’s experienced problems with friendships. “When I first started and I was bigger than everyone else, everyone was very encouraging. Once it got to the point that I was in the same territory as them, weight-wise, they were somewhat less supportive,” she says wryly. “People started telling me I was looking too thin and that I exercised too much. Women are competitive with each other – it’s as simple as that. They felt threatened by it.” Like Carol, Dena found her brain has taken time to catch up with the changes to her body. “My younger sister is getting married later this month, and my first thought when she announced the wedding was. ‘Ooh I need to lose some weight.’ But I don’t. It’s just the first thing that comes to mind every time I’m invited to an event. I’m not sure that will ever change.”
As weight falls away, new muscles, contours and cheekbones come into focus, but so, it seems, do all manner of unforeseen issues, problems and regrets. Broadly speaking, everyone I spoke to firmly believes their life, on balance, is enhanced now they are slimmer. They are more confident, they can attract men more easily, they can play on the climbing frame with their children, they can walk down the street without someone hurling abuse at them, they are not suffering from crippling back pain. To a large degree, it is a no-brainer – it is better, in so many ways, to be thin than fat. Yet the personal psychology of becoming slim and the changing dynamics it brings to the slimmer’s relationships with those around them should not be underestimated. And this is against a backdrop of increasing numbers attempting this transformative journey – as Professor Haslam points out, the obesity epidemic has dug in its heels. “If things do change, it will take generations. We’re not going to suddenly un-invent the wheel and start walking everywhere, we’re not going to suddenly change that toxic environment”. As more and more people grow dissatisfied of a life where they have to buy two seats on the aeroplane when they go on holiday, demand for extreme fat-busting measures is set to explode. Says Dr Somers: “Weightloss surgery started off as an offshoot for me, now it makes up the majority of my work. People come to us feeling we’re their last hope. They grasp at surgery thinking it’ll take them from where they are now to being happier. They don’t really understand that the thing that’s going to make them happy is not the weight loss per se, it’s adjusting to an entirely different life.”