As a teenager, Lauren Rees knew she was different to the other girls. In high school, she opted out of the uniform dress in exchange for long pants and an oversized t-shirt. She would wear them all year round, no matter how hot, adamant that she couldn’t wear anything else. She was the ‘big’ girl’, if not the biggest, and this held her back. Rees loved school sport and was a talented basketball player. “I was so good, I was going to make the Ranger’s team,” she confidently recalls. But when a boy pointed out her body during a game, she felt rejected. Rees then quit, but she often wonders where she would be if she hadn’t.

Rees is a flourishing 30-year-old and mother of two now, who is among the growing number of Australian’s opting for bariatric surgery.

The weight loss surgery is considered effective in providing meaningful, longer-lasting results for those in larger bodies, compared to dieting and exercise. For most, the decision to elect to have the surgery is not taken lightly. The choice is onerous and difficult. However, it’s commonly viewed as the ‘easy way out’. It’s a notion that disregards the complexities involved. KARLENA SUTCLIFFE explores the factors that influence a larger bodied person to decide on the surgery.

According to Bariatric Surgery Source, there are three major procedures conducted in Australia, though gastric sleeve is the most common. Popularity hinges on the surgery’s ability to produce both greater and faster results. The irreversible operation removes the majority of the stomach; limiting calorie absorption, restricting food consumption and reducing hunger.

To qualify for the surgery, body size is the major decider. A body mass index (BMI) of 35 to 40+ see you eligible for most surgeries, however, weight associated co-morbidities are now also considered. A 2014–15 Weight Loss Surgery in Australia report found 27,000 people had undergone bariatric surgery that financial year – a rate that has more than doubled since 2005-06.

So why is the surgery becoming more popular? The reasons vary.

For Rees, her motivation to have gastric sleeve was multifaceted, but a seed was firmly planted in 2008 when she was 19 years old.

Like most days, Rees had come home on her lunch break but on opening the front door, she knew something was wrong. The house sat undisturbed, dark as the curtains were still drawn. The awful silence filling the house was eventually broken when her mother’s beloved canine cried and scratched to get inside; the poor thing had been outside since dawn. Rees slowly moved up the hallway, wanting to avoid what she feared. She peered into her mum’s room. Her mum was still in bed, the duvet covering her body.

Later Rees discovered that her mum had died from a heart attack. The autopsy revealing ‘death by cardiomyopathy due to morbid obesity’. Rees remembers weeks after, sorting through her mum’s belongings, and finding incomplete forms for gastric sleeve surgery. It was the push Rees needed to investigate the procedure.

Former bariatric care dietitian, Isabel Keeton, believes our culture is likely responsible for the increasing uptake of the surgery. “There is such a focus on health right now in our society,” says Keeton, currently the dietitian for Eating Disorders Victoria and director of Nutrition to Thrive.

And she is right. It’s everywhere you look. We are in a health-obsessed paradigm. And the logic goes, to be healthy, you must be slim. So, what does this mean for the two-thirds of Australian’s that don’t fit the bill? Well, they must do something about it. And they are. Or at least are trying to.

A 2017 national survey conducted by the Dietitians Association of Australia found that almost 50 per cent of Australian adults had attempted weight loss in the past year.

So what happens when the attempts don’t work, or they can’t lose enough weight? They look for alternatives. But what if the problem comes down to a simple misunderstanding. There is no denying that weight loss can reduce disease biomarkers, the case for many bariatric patients. And research continues to find that modest weight loss of 5-10 per cent can be enough to reduce the risk of diseases.

Therefore, Rees didn’t jump at the opportunity for surgery right away. She was determined to lose the weight on her own. “I tried every single diet under the sun,” Rees says, “and I exercised all the time.” She recalls her greatest loss was 20 kilograms. But it wasn’t enough and the high was then meet with the same, reoccurring, low. She would plateau, unable to lose anymore. And with no foods left to restrict or additional time for exercise, and completely exhausted, the jig would be up. Ultimately the weight she lost, and more, would pile back on. And this isn’t uncommon. Research conducted by the National Health and Medical Research Council Australia found that after two-years of dieting, most weight was regained and after five years – the person was back where they were pre-diet. “I never wanted to diet again, that was another point of having the surgery,” Rees say. “The surgery helped me get away from that lifestyle.”

We live in a society that places the onus of weight upon the individual. I’ve witnessed these conversations continuously. But from my personal experience and observations there are many factors such as genetic, psychological, environmental, metabolic, economic and political that influence our weight, typically beyond our control. Therefore, seeing bariatric surgery as the simple route is unfair. Perhaps these ideas originate from people in privileged positions, who haven’t had to experience life in a larger body?

Rees witnessed the impact of genetics first hand growing up. She was big, so was her mum, her aunties, basically all the women in her family. But not her brother. He ate the same food, had the same life but he was always slender and still is. Despite this, Rees’s mum carried the blame for her daughters’ weight.

For Tommy Brown, a spirited 33-year-old and father of one, the decision to have gastric sleeve was similar. He had tried everything to lose weight. After years of failed attempts, exhausting all his options and feeling helpless, he finally accepted medical support. “I was addicted to food to the point I was lying to people and even myself,” he says. Brown believes the surgery has now put him on the right path.

For many people living in bigger bodies, the physical limitations are unbearable. Carrying the extra weight can make exercise, daily activities and normal bodily functions challenging. “The physical limitations of being big are just awful,” Rees says. She vividly remembers finding it difficult to breathe when lying down. “But I feel like I can do anything now,” she says. “I can swim, run, go to the beach.” Brown also relates to this, he has found himself returning to his younger identity; fit and active.

We live in a fat phobic environment so it’s no surprise that people in larger bodies are treated poorly. The World Health Organisation has reported that weight stigma is a fundamental cause of health inequalities, adding to the burdens already encountered by those in bigger bodies. And the stigma comes from all angles; from educators to employers to health professionals and friends.

This is something Rees connects with. “I loved my mum to the end of the earth, but she was the fat mum and people judged her for that,” she says. When Rees was in a larger body, she was too paranoid to exercise in the streets. She knew being ‘big’ meant that people looked at her a certain way. She was constantly up for judgement.  “When you are in a bigger body and you hear people laugh, you just think they are laughing at you,” she says. “I don’t think like that anymore.”

Your first impressions of Rees would probably be that she is a fashionista. Wearing a short, navy, satin dress that gently hugs her body, she sits elegantly tapping her freshly manicured nails, the colour of snow, while blinking her Priscilla Presley lashes. But it wasn’t always like that. In a larger body, Rees couldn’t let her inner style soar. “Literally you just wear anything you can possibly find and that fits you,” she says. Despite more brands making plus sized clothes, they still have size limits and come with a hefty price tag. A plain white fashion t-shirt can set you back as much as $70. Another way in which larger people are taken advantage of.

But Rees doesn’t believe that stigma pushed her to have her surgery. “I still think being comfortable in my own skin would make me do it,” she says. And Brown agreed. “I chose the surgery not because of body shaming but because of how I felt in my own skin,” he says.

Regardless of the reasons, Keeton believes: “People are realising that weight loss is so difficult and for other reasons this surgery is often thought of as a quick fix, but it is not at all a quick fix, it’s a life-long decision, which can be successful for a lot of people, but they need to know that it is a lot of work.”

Rees is eager to break the shame around opting for the surgery and she wants more people to acknowledge that it’s not the easy option.

“Of course, there have been some easy things about it but there have also been some really hard things,” she says. “I still have to make conscious decisions about what I am putting in my mouth, I still have to be active and move my body.”

To date, Rees has lost half her body weight with no intention of losing more. “I’m where my body wants to be,” she says. “This is literally the first time in my life where I don’t have to worry about weight loss.”

Grateful for the free head-space, Rees now hopes to truly move on with her life and find her purpose, without being weighed down by the complexities of living in a bigger body.