Today I am sharing an interview with Dr Bat Sheva Marcus about her relationship with food, her body size and her weight loss surgery experience.
Dr Bat Sheva Marcus is a licensed therapist, accredited in sex therapy and bariatrics. She has a PhD in Human Sexuality and a Masters in Jewish Studies from the Jewish Theological Seminary. She is the author of Sex Points: Reclaim Your Sex Life with the Revolutionary Multi-point System and is available for on line therapy consultations on for sex therapy and pre and post-op bariatric therapy. You can reach out to Bat Sheva here
Surgical intervention for weight loss is often seen as taboo, yet it is currently the most effective treatment for severe obesity. Weight loss surgery is a complicated topic, precisely because society judges women simultaneously for their body size, and for the methods they use to determine it. In this interview, I seek to have an intelligent conversation about Bat Sheva’s unique experience.
I met Bat Sheva online and we bonded because we are both psychotherapists. Our friendship deepened when she was a contributor on Feeding Women in the Bible, Feeding Ourselves, for which she wrote a compelling modern commentary about the hard-to-read Biblical story of Dina’s rape.
I am fascinated by stories of female transformation, and about how women engage with food to heal and help themselves live more full lives. My goal here is to make space for people to share real stories about dietary choices and body size change without shame or judgment. Please note that this interview shares photos of Dr. Bat Sheva before and after weight loss surgery. The point of these photos is to show her physical transformation. These photos are not intended to shame people with larger bodies. May we all learn something from Dr Bat Sheva Marcus’ experience.
This interview was recorded in April 5, 2022 using Google Meet and transcribed with Scribbl
What do you think about the idea of loving yourself at any size versus desiring to have a smaller body?
We tend to think of things in black and white in our society. There’s this feeling that “If I love my body, I shouldn’t want it to change… Can I want my body to change and still love my body?” It falls into the same category of food choices – is it possible to be at ease about food choices without feeling like one doesn’t think about their food at all? These topics can get so fuzzy and fraught for people.
I spent many, many years actively working to accept my body – really fighting tremendous cultural norms and a lot of family pressure that ingrained in me a dislike and disdain for people who are overweight.
I spent years in therapy, doing self-work, workshops, trying different techniques. I got to a place where I certainly didn’t hate my body, I accepted it. I worked hard on feeling attractive, buying nice clothing, and moving in the world as an attractive person. I’m blessed to be in a relationship where my husband thought I was beautiful and sexy, just the way I was. I could live like that, but it was still hard to be in a body that was not socially acceptable. When you’re big people make all sorts of assumptions about you.
Something eye-opening happened to me recently. I was talking to somebody and they said “You’re one of the most disciplined and determined people I know.” Five or ten years ago, I wouldn’t have agreed – not because it wasn’t true. But because I didn’t know that I could own it. No matter how much work you do, or what the reality of your lifestyle is, when you are 100 lbs overweight people will look at you like you are crazy if you say you are a disciplined person. They simply can’t conceive of that being the truth.
Given those parameters, I had reached a good place in body image. But physically, my size was taking a toll on me. After I turned 50 or 55, it didn’t matter how much I exercised or how well I ate. There was too much weight on my frame and I couldn’t do some of the things that I love to do. I love to walk. I love to dance. I couldn’t do those things.
And so I made the decision to have the surgery. I think of it as one of the best decisions I ever made, but I did struggle with this idea: “If I like my body, is it okay to have the surgery? Is having the surgery a way of rejecting my body?” That is one of the significant questions that surrounded my decision, and the answer is: we live in the grays.
Being in the Modern Orthodox community has taught me that there aren’t black and white answers. There’s just a lot of questions out there that we are all navigating for ourselves. Things often have pros and cons. There is no right answer for everyone. You need to find the answer that is right for you.
So you loved your body, and you also desired to have a smaller body that could be more functional for you. Can you tell us about your relationship with food and your body before the surgery?
My preteen and teen years were in the 1960s, a post-war time in American society (and British society too) when there was huge emphasis on thinness and exercise. Gyms were opening up for women, and it seemed like every American woman was in Weight Watchers. Dieting was a huge deal in the 1960s.
I grew up in a home where there was a lot of focus on food and body size. Sadly, in my family there was abuse that centered on food. The idea of being fat was just anathema to my parents – my father in particular. He had grown up in a house where there was an obsession with his mother staying thin. Then he married my mother who always struggled a bit with her weight – her mother had been morbidly obese, and died early of diabetes.
My father was an incredibly controlling man, and food intake is very controllable in a child. I think he felt – and I’m not sure that he was wrong – that I could be more successful in life if he could make sure that I was thin. My father’s attitude wasn’t unusual for that time. What was unusual was that it was a man doing it. You can hear many, many horror stories about mothers putting their daughters on diets during this period of American history.
I would get weighed every week, from when I was about 10 until I was 15 years old. I would get hit if my weight went up. My entire life revolved around my weight, my body size and food. My father would tell me what I could eat. When I went away for high school, I would go away for the week and binge, eating everything I could find, then come home for weekends and be starved. I was hungry – my soul was hungry and my body was hungry.
Unsurprisingly, I ended up with a terrible cycle of binging and starving, binging and starving although I never vomited. As an older teen and in my early 20’s, I would put myself on severely restricted diets of many sorts and then, as would be expected, ultimately they were unsustainable. My “resolve” would collapse and I would binge and eat everything in sight. I walked around with terrible self-loathing that I couldn’t subsist on 1000 calories a day, or stick to only eating vegetables. That went on until my early 20s, when I started finding the people who wrote about emotional eating – people like Geneen Roth and Carole Munter.
These writers talked about giving yourself permission to eat things. They talked about learning to be kind to yourself around food and they talked about learning to manage dieting and binging cycles. I remember a particular quote from Geneen Roth which blew my mind because it was so resonant for me: For every diet, there is an equal and opposite binge. I resolved to try and break my unhealthy eating patterns. At one stage, I remember bringing all the “forbidden” food into my life. I bought as much cake, candy, and cookies as I could eat at any given time. I would buy more boxes than I knew I could eat, and, if I ate it all, I’d replace it with more. The only restriction was that I had to eat it consciously, aware and lovingly. This was one of the scariest things I had ever done around food. I was afraid I would blow up. But strikingly, after a few months, the binging on specific foods ended because I was no longer afraid of foods. I did gain some weight during this period – but strikingly, not a huge amount, and the freedom from “food fear” was worth every pound. You will never hear me say “I can’t keep that in the house”. It’s just not relevant to me anymore. . Then I did work over the next few years trying to learn not to eat for emotional reasons.
For the next 15 or 20 years, I spent my life learning to eat in a way that nourished my body: finding out what my body wanted at any given time, learning to balance what my body wanted short-term versus what I thought my body might want more long termI was largely successful, but looking back, I was missing the biology piece of this. In the ten years, we have started understanding so much more about hormones and about microbiomes and how that has a dramatic effect – it can be almost uncontrollable for people. It’s important to make sure you’re eating to nourish your body. You’re entitled to eat food, and food can be a pleasure.
Somewhere around my second pregnancy, when I was 32-33, my weight stabilized about 240 pounds and stayed there. I may have gone up or down 10-20 pounds. Maybe it crept up slowly over the years, but basically I wasn’t losing weight. The theory of “health at every size” says that if you’re eating well and moving your body, it should revert to whatever size it was meant to be. I remember sitting in the parking lot, talking to my husband and crying once because I was working out and eating really well and I said: “You know, I’m just not losing weight”. He said, “Maybe this is your set weight?” And I’m like, it’s not possible! How is it possible that a five foot one woman has a set weight of 230 pounds?! It’s not possible!
But he was right – my body weight had been set within the same range for years. Maybe some of it was biological, some of it was years of binging and starving, binging and starving. For whatever reason my body was set at that weight. It took many years after that, and after my second son’s wedding, when I couldn’t dance at the wedding the way I wanted,that I decided it was time to look into surgery.
How has this whole experience affected your sense of mind-body precision? Has it changed how you understand the signals your body is sending you, and the choices you make in response?
I’m always saying to people, I’m not eating very differently now at 140 pounds than I was eating at 240. I was eating lots of fresh fruits and vegetables, lots of protein. A very, very low amount of refined carbohydrates. I allowed myself to have them when I really wanted them, but I felt better when I was not eating processed food.
I’m eating pretty much exactly the same way now, which is why this feels so miraculous to me. I think the surgery allowed me to reset. What I’m seeing now, almost three years out – and this difference is also shown in the data – the surgery disables a lot of the hormones, like the leptin and the ghrelin, that affect your hunger and satiety. For the first six months after that surgery, I just didn’t think about food very much.
It was like the most bizarre experience: I could take or leave food. It was like a revelation to see what that was like! And it wasn’t like I was simply having so much fun losing weight that I didn’t care about food. It was like whatever it is that signals in your brain, “there’s food here,” was gone. Over the course of a year or two, many of those food signals returned. I do notice food again, but, as before the surgery, I’ve learned to nourish my body in the best way possible.
Some days now I might think, “Oh my God, I really want to eat donuts.” So I’ll say to myself, “Okay. Are you hungry?” I discovered before the surgery, and it became crystal clear after, that when my body is shouting for simple processed carbs, it means I am hungry – regardless of whether I’ve already recognised the hunger signal or that I “feel” hungry So when the cookies or the scones are blinking at me, “Eat me!” I’ll be like, “Oh, am I hungry? Okay, well, you can have one but why don’t we eat something more nourishing first?” And I’ll eat an omelet or a big salad with tuna, and then I’ll decide if I still have the desire for the simple processed carbs – sometimes I do, often I don’t. And if I do, I happily eat them!
Going through the entire process has allowed me to see how real this stuff is. It’s not just a simple case of “Will Power”, hormones play a huge part. I did a year’s program and I got certified as a bariatric counselor. I’m just delving deep into the Microbiomes now and it’s fascinating. I don’t know what I’m gonna do with this qualification, but I feel so passionate about it.
How did you first come across the idea of weight loss surgery, and how did you decide that this was the right choice for you?
About 6 years ago, I heard a news program in a cab which mentioned a scientific study which found that within 48 hours, the diabetes of people who went through bariatric surgery had completely resolved. I remember thinking to myself, “OMG. How can that be? If it was all about changing the quantities that you eat, it would take a long time for your diabetes to resolve. What is it about, if the surgery is not just a matter of making your stomach smaller, right? It’s about something else happening.”
The idea of having surgery had been kind of floating around, but, you know, I was really resistant to the idea of surgery. But then my second son got married and I was so sad because I couldn’t really dance in the way I liked to. My legs started hurting very early on in the evening. I didn’t feel like I had to accept living this way just because I was doing the best I could.
There was a weight loss clinic where I go for my other medical care. Let me tell you, I was so, so nervous to go in there – I just thought I’d go in and get judged again. I can’t tell you how many nutritionists and doctors treat you like you’re lying when you tell them what you actually eat and how you move. They just don’t seem to believe you.
So I went to see a doctor there who turned out to be lovely, and she really listened to me pour out my whole story. She said, “Listen, there are some meds that we could use and they may take off 10-20% of your weight. But the truth is, for the kind of weight loss you’re looking for, the only thing we’ve seen working is the surgery.” And I was like, “Does it really work?” because, if I’m being honest, I was pretty skeptical. And she said, “I see this weight loss surgery working all the time and you’re an ideal candidate because you’re not expecting this to do all the work for you.”
You usually need to log six months of seeing a nutritionist before the insurance companies will pay for the surgery. She got me in to see a nutritionist straight away so that if I did end up deciding to do it, the clock would have already started from that day. And I was so glad she did.
You have to get approvals from a therapist, a cardiologist, a pulmonologist – that was a whole other story. My first question to the nutritionist was, “Do you think I’m too old for the surgery?” She laughed at me:, “What are you talking about?!” I was 57 – when I think about that now, I just sort of laugh. It felt like such a bigger deal than it really was. I realized quite quickly that I had a lot of years left – even if I had 15 or 20 years more to live in the way that I wanted to live, it was going to work.
I was so ready for that surgery. I don’t want to underplay it, but they do it laparoscopically now and it was so easy. I was in the hospital on Monday. I came home on Tuesday morning. I was walking a mile by Wednesday.
It was one of the easiest surgeries I’ve ever done. I’m now talking about having surgery to get all the extra skin removed and I’m much more nervous about that – that’s really cutting skin and that hurts, you know.
But the surgery felt like a gift from God. All of a sudden the weight just started coming off, and coming off, and coming off, in a way that I couldn’t have imagined. All my years of struggling and analyzing and trying to figure this out. All of a sudden I felt like it was just fixing itself.
What were some of the considerations in your decision making process?
I made sure that I went in with very realistic expectations, in terms of:
- my expectations about the amount of weight I might lose
- whether I would keep the weight off
- how my life might change
- and how I would be able to eat and socialize afterwards.
Generally people lose about a third of their body weight, and I knew that many people also gained much of that back. I didn’t expect to gain a lot of it back myself because I already understood and was thoughtful about all this stuff. But even if I gained back half of it, I decided it would still be worth it to me.
I didn’t expect it to change my whole life – and it hasn’t. Of course, the way people respond to me feels very different now. And things like not having to ask for a seat belt extension on an airplane make moving through the world so much easier. But I didn’t want to go in feeling like it was going to change my whole life.
Under the heading of “crazy thoughts you have before the surgery”, and this will sound rather silly, I remember the one time I thought I couldn’t do the surgery. It was when they told me I couldn’t drink seltzer after the surgery. But I lived on seltzer. The nutritionist looked at me like, are you serious? I was really, really scared that I wouldn’t be able to eat like a normal person or be sociable with people. But I eat perfectly normally now. I may eat small portions of things and I’m trying really hard not to push myself, I don’t want to stretch my stomach, but I eat a perfectly “normal” diet, with normal food and I even allow myself seltzer once in a while.
As an Orthodox woman, how did your religious life or views factor in your decision?
Being able to eat Shabbat meals with people was an important factor. And, of course I still can! I eat smaller quantities of food now but that feels ok. I think we’re part of a society [in the United States] where there’s just so much food around us all the time. From a practical perspective, being around food all the time and other people over consuming food all the time adds an extra layer of anxiety to eating.
The second thing I’m gonna say is very different. There are messages in the Jewish community that tell us we shouldn’t really be focused on our body. That life is about spiritual things and that it’s very superficial if we are focused on our body. And I want people to hear that actually, it’s really okay to be focused on both parts of ourselves, because God wants that. My years as a sex therapist have helped me clarify how important it is for us to be able to balance a health concern for the physical pleasures as well as our spirituality.
As a professional sex therapist, one might assume that you are comfortable physically, or at least not beholden to a set of physical “hang-ups”. How does this idea speak to your desire to have weight loss surgery, and the physical results we might presume you hoped to experience?
I’m gonna approach this question from two different angles:
First, people are going to assume that I like my body much better now, thinner, 1000 pounds lighter. To a large degree, that’s true. There’s something really nice about being able to feel my hips – I could never feel them before.
There are parts of my body that I liked a lot better before the surgery. There are parts that are less robust and full and just hang more. But that is okay. All of life is a trade-off
I always say this to women and it’s totally true: Your sex life is not dependent on your size. I had a great sex life when I was bigger. I know a lot of really large women who have amazing sex lives. Your sex life depends on how you feel about your body. If you feel like you’re sexy, and you’re with a partner that feels like you’re sexy, then you don’t need a smaller body.
Now can I move around a little better? Yes, and that’s amazing, and that makes sex more fun and I’m happy about that. I have more energy and I no longer have to sleep with a sleep apnea machine. All of those things are true and that is going to impact on your sex life, like anything else.
Your sex life is composed of what is happening in your body, and what you think about in your head. Your hormones also affect what you’re thinking about, and that affects how you behave sexually. Our head and our body are constantly in concert. Learning how to manage our emotions and experiences – while we understand that much of that may be coming from our physiology, our hormones, or microbiome – this is what my book was all about. There are myriad ways in which we are being affected by our sex life. And I think that’s true about food as well.
When did you have your surgical procedure, and what procedure did you have? How did you prepare yourself emotionally/physically for the surgery?
I had the sleeve in 2019. They cut away basically 80% of the stomach – they didn’t rejigger any of my intestines.
I had done so much of the preparation work already, worked out the emotional eating and the patterns of my eating. This is all important work to do before you do the surgery. The woman who wrote Overcoming Over Eating was a therapist and I saw her for nine years. So I felt like I had really worked out the emotional piece of this. We never work out everything, right? We don’t, that’s just life. We wouldn’t be human.
Physically, I was keeping myself in as good a shape as I could. I had a trainer and I swam. Going into this, people should know that there’s work to do.
About a month after the surgery, when I was bringing in solid foods, I was trying to figure out how to make that work. I was doing Google searches and seeing people who were keeping blog diaries. I was so horrified, there were people a month out of surgery talking about, “Oh you know, I went to Atlantic City and I got a burrito but I could only eat two bites of it, and I could only do two margarita shots!” As though that was great because the weight was still coming off. And remember thinking, “This can’t possibly work long term for you because you’ve done no work in terms of understanding nutrition, understanding what your body needs, understanding how to help yourself. You’re just hoping that the surgery will make you able to eat everything in smaller quantities, and that’s only going to work so long.”
I think the work that has to be done is in understanding the nutritional issues, understanding your particular body and how it responds. No two people are the same. You have to consider your own physiology and psychology to understand what you need to do to prepare for this surgery.
Obviously this surgery has a very clear, visible, physical outcome. But how does the outward appearance affect the internal experience, and vice versa? What physical and emotional effects have you experienced?
There’s a huge relief at being able to walk through the world feeling like I’m not being judged. There’s a level of anger at all those years of being judged. People say to me, “Oh, you lost 90 pounds, you’re really disciplined!” I’m like, “Argh! I was just as disciplined when I was 90 pounds heavier!” There’s a part of me that’s really angry about that.
I’m sort of struggling with what I like to wear. Where’s the line between pretty and sexy? When we dress and go out in the world, we’re projecting ourselves, our clothing is essentially a costume – and that’s different for me now than what it was 90 pounds ago.
Also, I see people who are very heavy and I want to put my arms around them and say, “I want to help you,” and I mean it in a loving way, but it is also judgmental. I’m struggling, like all of us, with the mixed emotions, the different parts that come out in a situation like this.
We live in a time where there’s been a lot of talk about not commenting on people’s bodies. On one hand that is really, really good. And on the other hand, it’s a little weird. You can’t talk about bodies at all. I joke around with my friends that if I meet a woman who’s 50 or over, they’ll be like, “Oh my God, you look amazing. How did you do this? It’s amazing. What’s the surgery? How did you lose that weight? Tell me. You look amazing. Tell me, what’d you do?”
Then I see my 30 year old niece, who hasn’t seen me in two years or my daughters friends who I haven’t seen before the pandemic. And it’s clear that I look totally different. And when they see me now, they look really taken aback, they stumble for a moment and then they say something like , “Oh, hi. You changed your hair color?” Because it’s not acceptable to mention my body, my weight. And I get it, and I appreciate their sensitivity. But honestly, neither approach is great.
What really makes me happy is when somebody says to me, “Hi, wow, you look good. How are you feeling? ,” or “You look so different, how are you feeling?” Give me an opening to talk about it.
Six months ago, I said to my niece at the end of our meal, “You haven’t asked anything at all about my weight or how my life has changed.” And my niece said, “Well, I kind of feel like, if you wanted to talk about it, you would.” I’m very close to her, so OK I could have said, “Let’s talk about this.” But It’s hard to bring up without sounding narcissistic and it’s like the elephant is in the room and nobody wants to raise the subject.
We shouldn’t be judgmental about people’s bodies. We shouldn’t be obsessed with people’s bodies. But we should be able to talk about our bodies in a reasonable and thoughtful way.
How have people around you responded to your choice to alter your body size?
For the most part, everybody seems very supportive. I haven’t heard anything negative, but it could be that I’m so happy and comfortable in this decision that I wouldn’t notice it if someone said something negative! The hardest part for me is seeing friends who are struggling with their weight blaming themselves. I’m trying so hard to articulate to them: “There are things way beyond your control.” It’s so hard for me to convince them of that, and that’s really painful for me.
I have a really close friend who’s not obese, but quite heavy, and she eats really well, she exercises and she keeps feeling like she must be doing something that is causing her size to stay the same. I remember that feeling – like it must have been that one piece of pie that I ate three weeks ago. But it isn’t. And it has nothing to do with that. Right now, this is where your body is at. And if you are eating normally, your weight will fluctuate. Stop blaming yourself. We all live in this huge well of shame and blame. I see women stuck in that and I don’t know how to help them. That is really frustrating to me, and it feels a little unfair that I’m out of that now – I suppose it is a form of survivor’s guilt in a way.
What are your favorite foods/meals to eat now?
High fat works really well for me. I eat tons of vegetables. After the surgery I was so limited in what I could eat. I had to focus on eating protein and sometimes I couldn’t even finish my kale and asparagus – all the things I loved. The nutritionist was laughing at me because I was missing all my veggies. Honestly, I focus on eating lots of vegetables and enough protein.. My favorite food is full fat, plain yogurt with berries or bananas. Very dark chocolate – I love that. I do eat bread and cookies, but they are add-ons to my diet. I eat about 80% of my diet from real foods, and beyond that I try not to think about food too much.
What wisdom/advice can you share with anyone who is considering weight loss surgery?
It sounds trite for me to say,” Don’t think of it as solving your whole problem. You have to deal with this on other levels as well,” but that’s really true.
Learn how to eat intuitively – so that your body gets what it needs – before the surgery, and deal with whatever anger you have about that. If that means you can’t eat donuts every day – if you’re angry about that, deal with it. I don’t feel angry about that anymore because I allowed myself to eat as many donuts as I wanted for a while. Then I didn’t want them so much anymore and they receded into the background of my life. Once in a while when I want a donut, I have a donut, right? Deal with those issues while you’re waiting for the surgery.
I follow social media regularly, so once in a while when I check in I’ll see somebody who’s recovering from an eating disorder saying they’re doing “health at every size.” But they’re just eating whatever their body wants at that moment. The problem is that for some people eating simple carbs affects their blood sugar, resulting in a need to eat more and more often. Eating whatever you want in the moment with absolutely no thoughtfulness is not truly intuitive eating, its urge eating.
My second advice would be as soon as possible , get moving. Figure out what you love to do and move, because your body was meant to move. Exercise is not even the right word. Get the hell out! Stop driving to the store, park far away, just move – because you’re gonna find something that you love to do. I took up hula hooping! Find something you love to do and weave the moving into your life. The movement will help your mood, your blood sugar and your weight.
Final Thoughts on weight loss surgery after this interview
When I interviewed Bat Sheva, I felt strongly that her weight loss surgery was a way of reclaiming her body for herself and honoring the way she wanted to move in the world today.
Sadly, for many of us, our relationship with our body is the result of what has been done to us as children and adolescents. Part of the journey for all of us is to release ourselves from what has been done to us by working on our relationship with food and creating new food behavior patterns.
The other issue that really stood out to me is the years of judgment that Bat Sheva endured because of her body size. The public generally believe that obesity is caused by a lack of personal willpower and discipline, when the truth is that obesity is a chronic disease and a global epidemic of our times.
Weight loss surgery is currently considered medicine’s most effective treatment for severe obesity. Batsheva had done all the necessary emotional work and behavior modification to make this surgery successful in the long term.
The key things I learnt from Bat Sheva’s weight loss surgery experience:
This interview contributed such a rich and insightful voice to the topic of weight loss, weight management, body size and body image. I am so thankful to Bat Sheva for sharing her nuanced, intelligent and considered ideas with our community. Here are my main takeaways from what she had to share:
- Have realistic expectations: weight loss surgery is not a magic cure, and it won’t change your whole life.
- Move for pleasure – enjoy your body, identify ways of moving that feel good, and weave them throughout your life.
- Understand nutrition – work out what your body needs to feel and operate well, and get used to fuelling it that way.
- Interpret hunger cues from urge impulses – discover what is beneath a strong and often sudden urge to choose simple carbs. Respond to the true bodily cue first, then consider if you still want or need to answer the urge.
- Talk about bodies without judgment – don’t be afraid to talk about your body or someone else’s. Be sure that you are not acting or speaking out of judgment.
You can reach out to Bat Sheva Marcus here firstname.lastname@example.org
How about you? Was this a new perspective on weight loss surgery for you?
What parts of Bat Sheva’s interview were the most important for you?
What did you learn from reading this interview?
I would love to hear your responses in the comments.
This interview was recorded in April 2022 using Google Meet and transcribed with Scribbl
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