Now you see me… now you see less of me

NOTE: This article was first published in Summer 2020 in Issue 9 of our Kidney Matters magazine

Choosing to lose a few kilos and making the decision to change your whole attitude to food in order to lose a great deal of weight, are two entirely different prospects. Here, Keith Bucknall describes his life-long relationship with food and his decision to commit to an NHS weight-loss plan in order to be considered fit enough for a transplant.

I was born in 1959 weighing 2.72 kg (6lb 7oz).Throughout my childhood I never went hungry and had a mum who cooked lovely things like sausages and mash, egg and chips, and of course, roast Sunday dinners. I would describe myself then as a plump child, who was made fun of for being fat throughout my school years. I felt so conscious of my weight that I dreaded going to swimming lessons or having to shower after attempting to do ‘sports’.

I realise now that when I was sad I would eat and then the sadness would leave me for a little while. That process carried on right up to recent times. When I was first diagnosed with chronic kidney disease (CKD) in the 90s my consultant mentioned something about watching my weight, and I of course responded, yes I would. Over time my kidney function decreased and my weight increased.

The wake-up call

By the time my eGFR was in single figures, weight loss would do little to help me. So I began dialysis to keep me alive. My weight made it really uncomfortable sitting for four hours, even the bariatric chairs for the big people were no better.

I have a letter from my consultant dated 5 July 2016, sent after a biopsy, in which he says, “I don’t think there are any reversible findings here and he will progress to end stage renal failure in the next 12 months or more…. His weight is now 137kg (21st 8lb) and I have suggested he needs to lose 22kg (3st 7lb) before we can discuss a transplant.”

I had a fistula made in July that same year and ended up on dialysis on 26 December. All of the stuff surrounding dialysis overtook my weight worries. Indeed, I probably ate more to compensate for all the new feelings and fears.

Each time I saw my consultant he mentioned my weight and each time I said I would try to lose some. Over my lifetime I have tried the Cabbage Soup Diet, Atkins, counting ‘syns’.... but was too embarrassed to go to Weight Watchers. I had some success through the NHS Weight Management Service and lost weight, but decided I didn’t want surgery to lose weight because ‘I have willpower!!’

I finally accepted the fact that I needed proper help once again and approached my GP who referred me back to NHS Weight Management. I was accepted on to the programme. I live in Devon and received amazing support from Livewell Southwest. They provided me with tools to help me understand my eating habits and gave me the opportunity to do exercises that didn’t make me feel awkward and were set at a pace I could realistically manage. The regular meetings were filled with good eating tips and time to share stories with others in the group. The best bit was that we were all in the same boat so there was no judgement or ‘fat shaming’.

The range of support began with an induction session where I met a specialist weight management nurse. The whole team is made up of nurses, dietitians, physiotherapists, clinical psychologist and a consultant who was the weight-loss surgeon. All areas were covered and after each meeting I went away feeling empowered to get the weight off and, more importantly, began to feel the health benefits of being part of this programme. I became expert at reading food labels, and also became ‘portion aware’. I had eaten such big plates of food that the re-education was so important. After my surgery, all that I had gone through in preparation made complete sense and I still have support from the whole team.

Taking responsibility

The programme is intense and needs your commitment. They understand you will have ups and downs, but they allow a self-understanding of why you eat and how you eat. Mindfulness is used to encourage you to enjoy food and to slow down eating (although I still find that really hard). You are regularly weighed and are given tools to manage eating. All of it is designed to get YOU to take responsibility and prepare for a total change in eating habits. I competed the course and was offered surgery to permanently reduce the size of my stomach. This is not something you do lightly and they have you talk to psychologists and people who have been through the procedure. My surgery took place on 16 November 2017.

A letter from my consultant dated 8 May 2018 said, ‘Keith has lost approximately 35kg (5st 7lb) following bariatric surgery and has never felt better. His blood pressure has fallen to 115/57 and I have suggested he stops his amlodipine. Keith is due to see the surgeons in the Transplant Assessment Unit tomorrow”.

How am I now? Well, I was added to the transplant waiting list on 18 June 2018 at 11:30. My current dry weight is around 90kg (14st). I am now bony and find plastic chairs very hard on my bottom. I once wore 53 inch trousers, now I wear a 38 inch. I once had a chest measurement of 52 inches, now I measure 42 inches (or maybe smaller - I am told former fat people still see themselves as fat).

And a final serious message… if I had not lost the weight I don’t think I would be here today. Thanks always to the whole NHS team that keeps me going