"After my surgery, the first thing I had to eat was two spoonfuls of
baby food. I immediately had a weird feeling in my belly. Then I
realized, 'Wow, this is what it's like to feel full.' I had never ever
felt that way before," says Judy Watson-Remy, 43, associate photo editor
at Family
Circle,
who underwent weight-loss surgery in the summer of 2002 after having
been overweight her entire life.
Two months after surgery Judy walked into a department store in
Manhattan and tried on a coat. It was too big on her. She began to cry.
"I had never fit into anything in a regular clothing store before," she
says. After years of trying to lose weight, she had finally found her
miracle cure.
Millions of Americans search for a weight-loss miracle. Approximately 80
percent of the population of the United States has been on a weight-loss
diet. Today many are turning to what they feel is their only
choice—going under the knife. In 2002 about 63,000 weight-loss
(bariatric) surgeries were performed in the United States. This year an
estimated 98,000 will be done, according to the Journal of the
American Medical Association.
Is Surgery the Answer?
The seriousness of these operations is not to be understated. "They're
not magic fairy dust," says Christine Ren, M.D., bariatric surgeon at
New York University Medical Center in New York City. "They're merely
tools for people with potentially life-threatening health problems" such
as high blood pressure, diabetes and sleep apnea.
"Weight-loss surgery is the only effective treatment for obesity out
there," adds Dr. Ren. "According to the National Institutes of Health,
people who lose more than 25 pounds through diet, exercise or diet pills
almost always gain it back." According to the NIH, to be eligible for
surgery you must be 100 or more pounds overweight or have a Body Mass
Index of 40 or higher. (To determine your BMI, take your weight in
pounds, divide that number by your height in inches, divide the result
by your height in inches again and multiply by 703.) Someone who's 80
pounds overweight or has a BMI over 35 may be eligible if he or she also
has at least two obesity-related health problems.
Candidates must also show they have tried to lose weight but have been
unsuccessful. Most surgeons require psychiatric evaluations and
nutritional counseling beforehand. A patient also needs to be deemed
healthy enough to handle the dangers of surgery. That risk depends on
many things, including the length of the operation, size of the patient
and type of procedure. "Insurance companies often have stricter
requirements than doctors do," says Diane Crumley, president of Neweigh,
a company in Houston that helps people get insurance approval for
obesity surgery.
One Weapon in the Weight War
When Susan Foster, a former teacher's aide in Olympia, Washington, began
looking into weight-loss surgery 15 years ago, she weighed about 250
pounds. She heard about clinical trials being done on the adjustable
gastric band (now called a "LAP-BAND®" since the procedure involved can
be performed laparoscopically) and decided to have one inserted. (The
Food and Drug Administration approved it in June 2001.) She lost 107
pounds and has been able to keep it off, except for one 15-pound
fluctuation (when she was in an accident and couldn't exercise).
During the procedure, an adjustable silicone band is wrapped around the
upper part of the stomach, dividing it into a small upper pouch above
the band and a larger pouch below. This limits the amount of food that
can be eaten at one time, and results in a feeling of fullness as the
food slowly makes its way through the narrow outlet between the upper
pouch and the rest of the stomach. When the technique is performed
laparoscopically, it requires only a few small abdominal incisions. The
band is adjustable, so afterward a doctor can tighten or loosen it. But
even though it's the least invasive procedure, that doesn't mean it's
risk free. In September of 2002 Brenda Scott, city councilwoman in
Detroit, died of surgical complications three days after having the LAP-BAND® procedure. The mortality rate for the procedure is estimated to be
1 in 2000, usually due to complications.
While patients lose, on average, 55 percent of their excess weight with
the LAP-BAND®, others don't lose much at all. For example, if you favor
calorie-packed sodas, milk shakes and cocktails, you can still consume
large quantities of these since they can easily get through the narrow
outlet between the upper pouch and the rest of the stomach.
The Stomach Stapling Solution
A technique that preceded the LAP-BAND® is vertical banded gastroplasty
(stomach stapling), in which a small pouch is created by stapling the
top of the stomach. Gastroplasty is done through a large incision. After
surgery, only a very small amount of food can be eaten at one time and
it must be chewed thoroughly before swallowing. "Stapling isn't
adjustable like the LAP-BAND®," says Robert Marema, M.D., a bariatric
surgeon based in Fort Lauderdale, Florida. Patients, on average, lose
less weight afterward, and there is a risk that the staples can break
down.
Another Option
The Roux-en-Y gastric bypass (which Watson-Remy and weatherman Al Roker
chose) is considered to be the gold standard for weight-loss surgery,
according to the American Society for Bariatric Surgery and the NIH.
With this procedure, the upper portion of the stomach is stapled,
creating a small pouch so very little can be eaten at one time, explains
Gio Dugay, R.N., N.P., a nurse practitioner in New York City. The pouch
is then connected to a portion of the lower intestine. This causes food
to bypass the lower stomach and upper intestines and go straight to the
lower intestine, so fewer calories are absorbed. Since the pouch created
is tiny, food must be chewed thoroughly before swallowing (to avoid
regurgitation).
Right after surgery, Watson-Remy was able only to eat two tablespoons of
food. "That amount continues to increase," she says. Over time, the
newly formed stomach pouch stretches, and some patients regain weight.
Although there is a high success rate with this type of operation, about
1 in 200 patients die from this procedure. Michael Intelmann, a former
banker from Long Island, lost his wife Darlene as a result of it. "She
suffered postoperative complications and never left the ICU," he says.
She went into renal failure, had a stroke and her heart stopped. "Don't
think weight-loss surgery is a quick fix," he says. "Look what happened
to us."
Riskier Techniques
In biliopancreative diversion (BPD) and BPD with the duodenal switch
(DS), a portion of the stomach is removed. The remaining stomach is then
reconnected to the lowest portion of the intestine. With BPD and BPD/DS,
more food can be consumed because the stomach is left larger than with
the other bariatric surgery methods. But most of it isn't digested
because it goes through only the now-smaller stomach and then to the
lower intestine. Because these procedures cause so much of the intestine
to be bypassed, few nutrients are absorbed than with other methods.
Most patients lose 70 to 85 percent of their excess body weight and
don't regain it. This technique, however, is less frequently used than
other types of surgery because of the high risk for nutritional
deficiencies.
Dee Tinkle, 47, a nurse coordinator in Delano, California, had BPD/DS
surgery three-and-a-half years ago. "I'd tried every diet under the sun
for 18 years," Tinkle says. "This was the only thing that worked for
me." Dee lost 187 pounds and was so pleased with the results that her
daughter, age 28, decided to undergo the same procedure a year later.
Both are still satisfied with the results.
