It’s about staying on the ball

Two men sitting outside in a park in front of a laptop

Alexander, 45 years old

“In the past, people knew me only as the fat boy; now, they now me by name.”

Weighing too much has been an issue for me since I was a kid. For a long time, I had my weight somewhat under control. As a teenager, I played soccer two or three times a week. That worked out okay. I was always a little stockier than the others, but that was no problem.

Major weight gain after military service

I ended up in the military by accident. Then I stayed for twelve years. That whole time, I fought against weight gain. But because we exercised a lot, I was able to keep my weight down to about 105 to 110 kilograms. That was alright.

But after I was discharged, every job I held involved a lot of sitting. That’s when it started: My weight went up to nearly 160 kg.

Actually, I felt okay back then. I didn't have any problems, I felt good, and I had convinced myself that I didn’t weigh that much, and that there were other people who were much heavier than I was. But deep down, I knew that I was doing poorly, and that being overweight was bad for my health. I did feel the weight, especially in my bones, and in my tendons and ligaments. That’s a major strain on the body, after all. I don’t even remember how I managed everything back then. Over time, you get very good at glossing things over. It’s hard to stop doing that. I always told myself that all I needed to do was lose 5 kg, and then things would be alright. But instead of losing weight, I kept gaining it.

With diets, I lost 30 kg or 40 kg every now and then. As soon as I stopped dieting, I would gain weight again. I don’t even remember how many kilos I lost and gained back in those seven to eight years.

When I switched jobs again, I noticed that I ate even more when I was stressed. At that time, I did a lot of traveling and would always come home late. I wouldn’t cook but would often order one or even two pizzas.

A life-changing experience

In 2009, I had a life-changing experience: I was at a construction site and had to walk a longer distance. When I got back to my car, I could have used an oxygen tent and a doctor. I was drenched in sweat and I had serious cardiovascular problems. That was the moment I knew I had to do something.

After that experience, I saw a medical nutritionist. As a result of that visit, I started seeing a nutritional therapist and getting physically active again. About 18 months after making these changes, my blood work results had improved, I had become fitter, and I felt much better. But I hadn’t lost much weight.

Weight loss surgery as a treatment option

In 2010, I saw a surgeon to talk about the option of weight loss surgery. For a long time, I hadn’t been sure whether it was the right choice for me. At the time, I knew some people who had had weight loss surgery. Some had complications after surgery. It’s a serious decision that you shouldn’t take lightly. For one thing, it’s major surgery. Also, you need to make changes to your lifestyle after the surgery for it to be successful. After considering the pros and cons for a long time, I decided to have the surgery. I had tried to lose weight on my own for a long time, and it just wasn't working. To me, surgery was the very last option, but it was still an option.

The operation

The health insurer approved my application for cost coverage of gastric surgery. I had surgery in early 2011. Before the surgery, I weighed 160 kg.

In the first six to eight weeks after surgery, I ate only liquid and pureed food. My weight dropped by a lot, very quickly. After about ten weeks, I had already lost 25 kg.

When you lose so much weight, you also lose a lot of muscle, and your skin sags a little. That’s why I started exercising again. I went to a fitness studio about two to three times a week. I stuck to it, and, after surgery, reduced my weight from 160 to 85 kg.

After losing so much weight, I had large skin folds. My body changed. But over time, they went away pretty well; I was lucky.

My weight after the surgery

I’ve now gained back some weight. I weigh 101 kg and am trying to drop below 100 kg. In my mind, I sugarcoated this slow weight gain again. When I got up to 108 kg again, I had a minor panic attack. It was the same pattern again. Your head doesn’t get operated on, after all. The whole surgery is pointless if I'm not able to change my habits.

Due to the weight I lost after surgery, others saw me very differently. Before, they often only knew me only as the fat guy, but now they know me by name. People see me very differently, and I’m no longer discriminated against. I was often frustrated by the looks and questions I got, and I dealt with it by raiding the fridge.

The first few months after surgery, losing weight is so easy. You get used to keep losing weight. But at some point, you reach a tipping point. If you then gain weight again, there’s a risk of feeling like a failure and being ashamed for gaining weight. Which is nonsense! There might be physical reasons why you’re gaining weight again, like your smaller stomach expanding over time. So, if you gain a larger amount of weight again, I think it’s very important to have a doctor check on you. It’s really important to stick to the changes in your diet and habits.

Life after surgery

Having surgery was the best decision I could make even though it caused some problems. I never had ulcers before; now I have one once in a while.

Due to the , I also have to take vitamin and mineral supplements.

My sense of taste has changed after surgery, too: I can taste spices much better now. Cooking is a lot more fun. We cook almost exclusively with fresh spices now.

I completely changed my diet after surgery. The surgery limits the amount of food you can eat. If I eat too much, I’m punished right away. The food gets stuck in the entrance to my stomach. That causes a lot of pressure and pain. And if I eat way too much, I have to vomit. That’s really unpleasant.

My gastric sometimes has a mind of its own, too: Some things I can’t eat any longer, and my intolerances change regularly. Things I can eat one day, I may not be able to the next, and vice versa.

I still see myself as fat

The scales say that I’m no longer obese, but overweight. But actually, I still see myself as fat. Today, if I go somewhere and see chairs with armrests, I immediately worry about fitting in them. Or when I go clothes shopping, I automatically go to the XXXL department. Somehow, that’s automatic and ingrained in my mind.

Doctors and therapists can’t take the weight away, they can only show me a way to deal with stress and frustration, for example.

I had problems tying my shoes. Climbing stairs and carrying heavy things, like a case of water, kept getting more difficult. I had back pain, and in the summer, I always sweat a lot when I took a walk. Those problems are gone now!

At the moment, I keep finding reasons not to exercise. That’s an area I have to work on again. I want to get back to regularly exercising.

From the very start, I talked openly about the issue of surgery with my family. And everyone accepted it, too.

It’s extremely important to prepare for this kind of surgery. It won’t work to simply tell yourself, I’ll go to the hospital, have surgery, and then everything will be okay. You have to get ready for it and get good follow-up care. Sharing experiences in a support group before and after surgery helped me a lot, too.

The surgery has a major impact on your life. It really should be the last resort after you’ve tried out everything else and have prepared really well.

But surgery doesn’t relieve you of your responsibility for yourself: It’s about staying on the ball, taking time for yourself, and investing in getting moving. It’s my life, after all, and I want to make a change.


Our real-life stories summarize interviews with people who are affected by the medical condition. Our interview partners have given us permission to publish their stories. We would like to express our sincere thanks to them.

The real-life stories give an insight into how other people cope and live with a medical condition. Their opinions and comments are not recommendations by IQWiG.

Please note: The names of our interview partners have been changed to protect their identity. The photos are of models.

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Created on November 23, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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