Abby Gronsman, 21, has never been afraid to rock a two-piece bathing suit.
Not when she weighed 250 pounds. And not now, after losing 100 pounds with help from bariatric weight loss surgery.
She’s grateful for the energy she has these days. Grateful for how weight loss has made it easier to pursue fitness goals.
But she has also gained more compassion for those who struggle with obesity.
And she’s more aware than ever of the persistent judgments some people might have about this common health condition.
“I’m always shocked when people tell me that they think my choosing this surgery was somehow taking the easy way out,” Gronsman, of Grand Rapids, Michigan, said. “Nothing could be further from the truth.”
Like many people who fight obesity, she had spent much of her life trying to lose weight.
Her efforts included diets and plenty of physical activity.
The problem, explained Spectrum Health bariatric surgeon Kerianne Holman, MD, is that once the human body becomes obese, the deck is stacked against it.
“More than 95% of the time, once a person had a body mass index greater than 30, diet and exercise aren’t enough to achieve significant or lasting weight loss,” Dr. Holman said.
Normally, the body creates a hormone that tells people when it’s time to stop eating.
“In obese people, that hormone is not able to cross the blood-brain barrier,” she said. “They never feel full.”
For the very few who are able to shed some pounds?
“That weight loss just slows down the metabolism, making it nearly impossible to keep the weight off,” the doctor said.
Time for change
Gronsman’s weight issues started long ago.
“I lost my dad when I was very young,” she said. “And eating helped me when I felt sad or anxious.”
Despite the weight gain, she became the poster child for body positivity.
“Even as I got heavier through my teens, I really didn’t let my weight get in the way of what I wanted to do,” she said.
“I wore what I wanted. I believed then, as I do now, that weight shouldn’t stop you from enjoying life. I’ve always felt comfortable in my skin.”
Her family—her mom, her stepdad and a house full of siblings—all helped.
“They always supported me,” she said. “They never made me feel bad about my weight.”
But the older she got, the more she struggled. She went on antidepressants to help with anxiety.
At 250 pounds, she often felt tired and lethargic.
At 19, after a year of college, she broached the subject with her mom, a nurse practitioner at Spectrum Health.
“Don’t be mad,” her mom, Ana, recalled her daughter texting her from college. “But I think I want to have weight-loss surgery.”
Like many people, Gronsman initially worried that opting for surgery would somehow mean she gave up on diet and exercise.
“I told her, ‘Of course, I wasn’t mad,'” Ana said. “I was happy she was going to do something to take control of her health.
“As a mother, I had always been aware of this fine line. On the one hand, I wanted to empower her to see herself as beautiful no matter what she weighed. And we loved her confidence. But where is that line between health and beauty?”
On Oct. 3, 2019, Gronsman underwent a vertical sleeve gastrectomy. Dr. Holman performed the procedure.
Spectrum Health only performs weight-loss surgeries on patients older than 18, Dr. Holman said.
“So Abby, at 19, was definitely on the younger side,” Dr. Holman said.
But as long as patients demonstrate the maturity to understand the surgery and its implications, younger patients aren’t just good candidates—they’re ideal, she said.
“They often can avoid developing the extremely debilitating co-morbidities that occur in many obese people as they age,” Dr. Holman said.
Gronsman sailed through the procedure.
Still, even though she had prepared herself as much as possible, the days and weeks after surgery weren’t easy.
The first week, her body hurt.
Learning to eat with this new, reduced stomach proved hard work.
“I ate pureed foods for the first month, as I got used to having just half my stomach,” she said.
But payoffs came quickly. Each week brought substantial weight loss.
“After about four weeks, I started noticing that I had so much more energy when I woke up each morning,” she said. “That’s really motivating. I couldn’t wait to work out.”
Those significant weekly reductions in weight continued for a solid seven to eight months, she said.
A new lifestyle
Soon came the challenge of adapting to more moderate losses and the day-to-day grind of monitoring food intake.
After months of dramatic improvements, it can be disorienting to adjust to smaller increments of weight loss.
These days, Gronsman is pleased at her current weight. She’s focusing now on building muscle.
She runs several times a week, 3 and 5 miles.
On Mondays, Wednesdays and Fridays she hits the gym for weight training and works out on the elliptical and stair-step machines.
She’s delighted with her decision to undergo surgery—and she’s supremely proud of losing 100 pounds.
“It’s way more fun to shop for clothes,” she said.
She no longer takes antidepressants and she enjoys going out with her friends in public more.
This has all made her more keenly aware of how harshly the world treats people with obesity.
“Even at my current weight, I still think body positivity is so important,” she said. “I feel bad for these people being judged. I know what it feels like.”
And it’s frustrating to know that, sometimes, “people get shamed for having bariatric surgery. But for me, and many people, it’s absolutely the best option.”
Dr. Holman wishes more people would opt for surgery at a younger age.
“The data shows that they will do better than patients who wait five, 10 or 20 years,” Dr. Holman said.
Another plus: Younger patients can often avoid surgery to remove excess skin after dramatic weight loss, because their skin is more elastic and recovers better.
Still, it’s no small commitment.
Dr. Holman shakes her head at the idea that surgery is an easy out.
“You have to decide every day to make healthy choices, especially early on,” she said.
Post-surgery, patients must be especially mindful of getting enough protein.
“Otherwise, they can lose muscle mass—as well as their hair—during the initial heavy weight-loss period,” she said.
The risk of regaining the weight is real. About 1 in 4 surgery patients put on a significant amount of weight after the first year, according to a study published recently by the International Federation for the Surgery of Obesity.
Current guidelines recommend weight-loss surgery for people classed as morbidly obese, defined as a body mass index of greater than 40.
It is also recommended for those with a BMI of greater than 35 when patients have such health problems as Type 2 diabetes, sleep apnea or high blood pressure.
Primary care physicians are increasingly referring patients to surgery sooner, rather than dismissing it as a last resort.
“In the last five years or so, we’ve seen a change,” Dr. Holman said. “People are considering it earlier. And (primary care physicians) are more likely to recognize weight-loss surgery as a very effective medical therapy.”
Dr. Holman and Gronsman offer the same message to those struggling with the decision: Don’t wait to explore the options.
Dr. Holman is quick to point out the comment many of her patients have made.
“They usually say, ‘I wish I had done this sooner.'”