Speaking out: from diabesity to weight-loss warrior

Kerina Ludwig, Executive Assistant to President of Commercial Services | 04 March 2021

Obesity and diabetes cause more than 4 million deaths worldwide. Determined not to become a statistic, Kerina Ludwig embarked on a weight-loss journey that started with bypass surgery and led to lifestyle changes that have empowered her from the inside out. Here, she shares her story and her advice for driving permanent behavioral changes.

To understand my journey, first, you need to understand the scale of the obesity and diabetes epidemics and how these two different conditions meet and cause chronic complications.

According to the World Health Organization (WHO), more than 4 million people die each year as a direct and indirect result of being overweight or obese. The organization defines obesity as abnormal or excessive fat accumulation that presents a risk to one’s health.1

As rates of obesity continue to rise globally, so have the diagnoses of type 2 diabetes; obesity is the top risk factor for type 2 diabetes, accounting for almost 85% of the risk.

I am still on a journey, so this definitely is not the end of the story.

Surgery is not the easy way out

Like many people living with obesity, I have suffered from weight management issues throughout my life and, sequentially, type 2 diabetes. I have tried every diet known to man, attempting to both lose weight and tackle my health issues, before turning to my last resort: Roux-en-Y gastric bypass surgery (RNYGB).

A common misconception is that gastric bypass surgery is the easy way out. However, nothing could be further from the truth. Before the surgery, you have to commit to making lifelong changes to your diet and lifestyle and achieve a target weight. The monumental effort requires months, and sometimes years, to prepare for surgery—a subject that isn’t often candidly spoken about.

You are tasked with following a strict, full-fledged program that gives you the stamina to succeed as you journey from weight loss to surgery, to post-op recovery.

However, my path wasn’t linear. Within 2 months, I had restarted the program 4 times. My surgeon and I would often joke that the journey felt like a dysfunctional relationship, in which I wanted to leave but kept coming back for more. But rest assured, this is completely normal, especially as many obese people overeat as a way of coping with negative emotions and then unsuccessfully try to commit to a healthier diet—this leads to a negative feedback loop.

Before the surgery, you have to commit to making lifelong changes to your diet and lifestyle.

A complete lifestyle overhaul

Months before surgery, I was assigned to a gastric bypass diet to reduce my liver size so my surgeon could access to my stomach beneath my liver for operation. The diet solely consisted of lean protein and vegetables. I had to eliminate saturated fats and drastically reduce carbohydrate and sugar intake. No dairy, no sugar, no alcohol, no bread, no caffeine, no soda—no fun!

While the diet was bland and relatively unexciting, I was wholly determined to lose the weight with the support of a group of Bariatric Veterans who I credit for providing me with the motivation to do so. By the time I went into surgery, I had lost 37 lbs (2.6 stone).

To complement my new diet regime, I embarked on a new app, Couch to 5k, which the UK’s National Health Service highly endorses and has lots of anecdotal proof of results from those who have completed the program. The app incrementally builds your stamina, strength, and resilience, so you can ultimately break out into a full 5 km run.

Beyond the behavioral changes, a regular week would consist of weight check-ins, psychiatric evaluations, picking up additional vitamins and supplements, visiting my primary doctor, and lab tests. It was vigorous, but never a dull moment! 


I entered this program wholeheartedly, ready for the scheduled date of surgery in May 2020. However, state prioritization of COVID-19 treatments resulted in the shutdown of elective surgeries, delaying my operation until August 2020.

This was frustrating, to say the least. I had committed to months of vigorous pre-op preparation to reach my target liver size and weight-loss goal, only to learn that I had to wait another 4 months. It definitely threw me off, resulting in a short relapse before recommitting myself to my new lifestyle, determined to win the new battle: COVID-19.

I was determined to win, because all my life I’ve wrestled with dieting without a positive outcome. So, I set out a roadmap and sought out a support group and therapist who gave me the mental skills that helped me stay on course.

I gave myself the grace to celebrate how far I had come. I was losing weight and doing the work. I can’t emphasize enough how important it is to adopt the right mindset and celebrate your own achievements, and to tell yourself that, “you can do this, have been doing it, and are making progress.”

Ultimately, I thank COVID-19 because I have been able to control my food better, especially as I was able to work from home without external distractions, allowing me to follow a consistent workout routine and track my food intake—and this has stuck with me to this day.

I can’t emphasize enough how important it is to adopt the right mindset and celebrate your own achievements.

The bypass is just the beginning

I used to be very forgiving towards myself with food. There would be excuse after excuse and reason after reason to start my diet the next day. Procrastination and my “yes” attitude were the key barriers to taking control of my diet and making good choices. But you soon learn that there isn’t ever a perfect time to start, and that saying “no” is sometimes necessary for your own wellbeing – this includes saying no to certain foods and saying no to other people’s opinions. Learning these lessons has allowed me to win my life back. Now, I can make choices that keep me on track in the long run.

Before surgery, I didn’t enjoy running and only enjoyed lifting weights in the gym. I can now easily run 5 km (3.1 miles) within an hour and can do an 8 km run (5 miles) in 1.25 hours. To keep my momentum up, I am continuing my training to achieve the next goal of a 10 km (6.2 miles) run.

Since the surgery, I have lost a further 58 lbs (4.1 stone). I am continuing to experience the real benefits from the behavioral changes instilled in me by my healthcare team before surgery. Post-surgery, it feels like a physical and mental weight has been lifted off my shoulders.

I’m continuously in awe of my ability to exercise without pain in my limbs anymore, and I have uncovered dormant energy that I never knew I had. I often suffered from “brain fog”, always felt fatigued, and had such fluctuating blood sugar levels that my health and productivity were affected.

I am currently coaching my bariatric support group in a 90-day exercise challenge to habitualize physical activity and promote sustained behavioral change. Consistency promotes progress, which in turn continues to support motivation in a positive feedback loop.

With the average working parent only being able to allot 3 hours a week of exercise around work, childcare, and other essential daily activities—along with limited options for exercising during the pandemic—it can be difficult to prioritize working out. But if we really try, we can all get creative and find a routine we can stick to that ensures we ultimately achieve our goals.

Queen of the “to-go” box

Completely altering your lifestyle and sustaining the change is always a massive challenge. Coming to terms with my new diet was the biggest learning curve for me throughout this journey.

Post-surgery, the size of my stomach shrank considerably. I could only handle liquid foods for the first few days before weaning on to pureed foods and soft foods.

Today, I can safely say that I can eat most foods without an issue. However, I still have issues with dense foods that contain added antibody hormones—such as chicken. Strangely, my taste buds also changed post-surgery and I’ve transitioned from disliking fish to it becoming a staple lean protein option in my diet, and only sparingly eating beef and pork.

My portion sizes have drastically reduced, which is especially evident when I have a meal out. Amongst my loved ones, I am now Queen of the “to-go” box because I can’t eat everything on my plate anymore! On average, it takes me three sittings to finish a “normal” meal today.

A key change that affects everyone post-surgery is the reduction in absorption of specific vitamins and minerals in the stomach, which is due to the physical alterations from the bypass surgery. I always carry an issued card that details dietary considerations and the supplements I take daily.


Kerina’s daily supplement intake

Coming to terms with the new me

I was lucky to have been assigned a therapist at the start of my program to discuss body dysmorphia and imposter syndrome, which is extremely common amongst those who have undergone bariatric surgery.

Body dysmorphia is a mental health disorder characterized by an obsessive-compulsive focus on a perceived flaw or flaws in the body. Often, the flaw is only perceived by the individual and it is not something other people notice.

Imposter syndrome is defined by a collection of feelings of inadequacy that persist despite evident success. Individuals often deal with chronic self-doubt and feel fraudulent, unable to externalize their competence however successful they actually are.

With support from my therapist, I am now learning to accept compliments and be a motivator for others; and I am finally coming to terms with and accepting my new body and identity. Whilst I still have “fat girl doubts” from time to time, I recognize it as a mental game that I’m always bound to win at.

Today, I am 7 months post-op and feel amazing and proud of myself, inside and out. However, I am still on a journey, so this definitely is not the end of the story.

If I’ve got any advice for you, here it is: you have to love yourself and recognize that you are making drastic changes in your life because you value your health and wellbeing. You are the only one who can motivate, change, and be that healthy and productive person you long to be. Others can be a source of motivation, but you are the only person who can put 1 foot in front of the other and get moving. If I can eat right, lose weight, have surgery, and continue to exercise during the pandemic, you should be able to as well.

Others can be a source of motivation, but you are the only person who can put one foot in front of the other and get moving.

At Fishawack Health, insight informs all of the work that we do. Patient journeys highlight barriers to treatment and opportunities to improve the patient experience. Get in touch at newbusiness@fishawack.com to find out how we can help you.


  1. https://www.who.int/health-topics/obesity#tab=tab_1

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