Battle Of The Bulge
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CHICAGO (STMW) – According to the American Society for Metabolic & Bariatric Surgery, the number of such procedures in this country rose from 16,800 in 1992 to about 205,000 in 2007, and to 220,000 operations in 2009.
There now are several options for making the stomach smaller as a means to losing weight, and those surgeries have become safer. The ASMBS claims that the risk of death from bariatric surgery is about 0.1 percent, down from 0.4 percent between 1990 and 2000. And, in fact, two studies that came out last week say the older procedure actually is more effective and no riskier than the Lap-Band or sleeve gastrectomy.
It was only a week ago that the Food and Drug Administration approved the Lap-Band for those less obese than previously required. The FDA agreed the technique may be used on patients who have a body mass index as low as 30 and have at least one weight-connected medical condition. Previously, a patient had to have a BMI of 40. The approval would allow an estimated 11 million more Americans to be eligible to have the surgery.
The Lap-Band, made by Allergan Inc., is used to shrink the size of the stomach and limit food intake. During surgery, the band is implanted around the upper part of the stomach. After a patient has recovered from the surgery, the band is injected with saline solution to expand it and remove the amount of food that can be consumed during a meal. The FDA approval will make it more likely that insurance companies will pay for the procedure in patients with a BMI under 35.
Also this month, a study published in the Journal of the American College of Cardiology suggests those who have had gastric bypass surgery can have weight-related heart abnormalities stabilize or partially reverse. The findings coincide with other published reports noting that weight loss surgery can have positive effects on cholesterol levels, diabetes, high blood pressure and sleeping disorders.
Still, there can be complications. According to the ASMBS, those may include blood clots, infection, respiratory arrest, gastrointestinal bleeding, small bowel obstruction and death — most of which are risks with any surgical procedure. (For further reading on these and other complications see the following Web links: http://www.medicare.com/services-and-procedures/bariatric-weight-loss-surgery.html and http://www.msnbc.msn.com/id/26076054/ns/health-diet_and_nutrition/). And the ASMBS’s own data claim that about 30 percent of current patients who have undergone bariatric surgery either have regained the weight they initially lose or decide to reverse the procedure.
But as the following vignettes reveal, weight loss surgery of any kind is not to be taken lightly. These interviews — with a doctor who performs weight-loss surgeries and several patients who have undergone such procedures — show such surgeries should not be seen as a cosmetic ones, are not for everyone, and involve drastic lifestyle changes in order to work.
Dr. Jeffrey Rosen: Surgery a tool, not a cure
In some ways, Dr. Jeffrey Rosen sees the weight struggles of pop singer Carnie Wilson as a prime example of how tough such battles can be.
In 1999, with her small frame carrying 300 pounds, Wilson was in the news for having gastric bypass surgery. While she got down to 150 pounds, she has gained a good portion of weight back, and her weight woes have remained in the tabloids. Late last year, she was fired as a spokesperson for a diet plan after she didn’t stay on it and didn’t lose weight.
As Rosen sees it, any successful fight to control weight means lifestyle changes. And a measure such as gastric bypass surgery is “a tool to help improve someone’s health, not a cure.”
Rosen is the lead surgeon at LifeWeigh Bariatrics and LifeWeigh Health & Fitness, which has offices in west suburban Downers Grove and Merrillville, Ind. He’s been performing these surgeries for more than 12 years. While there are risks with any surgeries, Rosen said, statistics show weight-loss procedures are as safe as gall bladder surgeries.
Wilson helped popularize the gastric bypass procedure, and from 2000 to 2003, Rosen said, his office was quite busy. Insurance companies became more restrictive in allowing claims in 2003, and there was a significant drop in business.
However, in the last three years, many companies have eased restraints on these surgeries, which Rosen said can run from $10,000 to $50,000. Insurance firms are realizing, he said, that allowing such procedures can have a return on investment in just two years, the savings coming from reduced medical bills related to health issues of being overweight.
Late last year, the Food and Drug Administration lowered the bar on how large someone might be to be recommended for certain weight loss procedures. In the last decade, other procedures have come to the fore, too, including Lap-Band and sleeve gastrectomy.
An overwhelming number of people who seek such surgeries have other medical troubles. Rosen said statistics show that of those who follow through, many will see a reduction in the numbers of medicines they will be taking, and see significant reductions in blood pressure, blood sugar, sleep apnea and Type 2 diabetes.
While women used to make up 80 to 90 percent of his business, Rosen said men now are about 30 percent of his patients.
What Rosen’s office stresses is a multidisciplinary approach to weight loss that includes working with registered dietitians and setting up an exercise plan, along with doctor visits. The process includes a psychiatric evaluation and pre-surgery eating plan. Afterward, there are follow-up office visits, as well as group meetings.
After surgery, patients also will be on a lifelong diet that stresses eating half-cup portions, six times a day, taking 20 to 30 minutes to eat. No liquids are consumed for a half-hour before eating and a half-hour afterward. Carbonated beverages are disallowed because of their effect on a readjusted digestive system.
Such an approach also allows for people who follow the program to feel more satiated when eating. In fact, Rosen said most people could benefit from eating more slowly and in smaller portions spread out over the day.
Those who have undergone weight-loss surgery can become ill if they don’t adhere to their restricted diets. While that may reinforce why they should eat the way they do, Rosen said there is evidence that surgeries also lead to changes in the body’s metabolism, thereby having other health benefits beyond weight loss.
Rosen noted that in Europe and South America, “rearranging” procedures already are being used to treat diseases such as diabetes, by changing the way organs connect. Such work is in its earliest stages, he added, and probably will not be available in this country for another five years.
To find other doctors in the Chicago area performing bariatric surgery, see http://www.surgicalreview.org/locate.aspx#srchResults and http://www.asbp.org/apps/find_a_weight_loss_doctor/index.php?state=IL.
Becky Firszt: A teacher learns a new lifestyle
A lifelong resident of northwest suburban Elgin, Becky Firszt, 33, is married and the mother of two young children. It’s because of her family that this fourth-grade teacher in Elgin School District U46 decided to have gastric bypass surgery.
“… I wanted to be involved with my kids, and I couldn’t keep up with them,” Firszt said. “I was unhappy, and I was always tired.”
Firszt had “always been thick” as a child, but being involved in sports and marching band helped keep her weight down in high school. She “really struggled with losing weight” after having her children.
At 5 feet 5 inches tall, Firszt reached 300 pounds, and “finally decided to go ahead with the process after I came to find out I had Type 2 diabetes.
“I was so disappointed with myself being 32 and having this disease. How could I have done this to myself?” she asked.
In August, Firszt had gastric bypass surgery and has lost 75 pounds thus far. Insurance paid for 90 percent, she said, “but I had to jump through a lot of hoops.”
Getting used to the progressive six-week diet was the biggest challenge. “Each few weeks, you slowly add more food to your diet,” she said. “The first few weeks were hard. I was so sick of eating pudding and Jell-0. But now I can almost eat anything (in small portions), and I am happy.”
She also has been walking to get fit, and soon will add weight training to her exercise routine. Since surgery, she said she has the diabetes under control.
“This process has shown me how much I missed and to seize every moment of the day. Carpe diem!” she said.
Mark Thompson: A salesman opts for the Lap-Band
Mark Thompson, 37, of west suburban Naperville, who is 5 feet 11 inches tall, has been overweight most of his life, and once tipped the scales at 317 pounds.
“Like a lot of Americans,” he said, “years of very little to no exercise and eating way too much of the wrong types of foods resulted in my being overweight.”
Thompson contemplated weight-loss surgery for many years and “was always intimidated by the side effects of traditional surgeries like gastric bypass.” That’s why he opted for the Lap-Band procedure.
The biggest difference, he said, is this method doesn’t involve removing any internal organs. “But by placing a small ring around the top portion of the stomach, it essentially creates a pouch at the top of the stomach” that holds about a half-cup of food, he explained.
Thompson had his surgery in August 2010 and is down to about 265 pounds, with a goal of reaching 230 pounds.
He eats six times a day, consuming 1,200 to 1,500 calories per day. He also does cardio and weight workouts six to seven times a week.
While insurance from his employer picked up the tab, support from his family — including wife Jennifer and three children — played a key role in helping Thompson adjust to his new lifestyle.
With his blood pressure and cholesterol levels now within an acceptable range, “Overall, I feel like a new person,” Thompson said, “and am excited to be around a little bit longer for my family.”
The Bennetts: A couple’s experience
Dave and Chris Bennett, of northwest suburban Itasca, admit their struggle with weight could be blamed on being couch potatoes.
Genetics might also play a role for 57-year-old Chris, a graduate of Elgin’s St. Edward Central Catholic High School. Her sister, Mary, 62, also had gastric bypass surgery, as has niece Becky Firszt.
Another big factor: “We liked to eat. Not junk food, but in quantities,” said Dave, 63.
Not helping was the fact Dave, now unemployed, was traveling as an account executive and eating business dinners.
Being a records clerk for the Itasca Police Department, Chris had to deal with the temptation of snacks being left for all to eat.
Their eating led to a point where Dave, at 5 feet 6 inches, weighed 358 pounds; and Chris, at 5 feet 4 inches, weighed 245 pounds. Health issues included Type 2 diabetes, high blood pressure and high cholesterol. Dave also developed sleep apnea and slept with the aid of a machine.
So, in 2003, the couple decided to have gastric bypass surgery, just a few months apart. Chris made the decision in part because of hereditary factors. For Dave, “I didn’t have a choice. My doctor strongly suggested I do this.”
In the years since the surgeries, the couple admit they sometimes struggle. Winter is hard, especially at Christmas, when Dave was making holiday candy for friends and family.
The couple also had to adjust to the sometimes painful “dumping syndrome.” If too much food is eaten or too quickly, food enters the small intestine largely undigested. This can lead to vomiting, bloating, diarrhea, cramping and fatigue.
Still, the two have mostly settled into their new eating and exercise routine. When Dave turned 60, he challenged himself to a 25-mile bike ride — a goal he fell short of by just three miles due to a rainstorm. The two also enjoy walking, and Chris rides her bike to work whenever she can.
Dave’s pants size went from a 60 waist to a 34, and his shirt size shrank from a 4X to a medium. Chris has her weight remaining between 155 to 163 pounds.
“We see what we did as only a tool,” she said. “It’s up to us to keep the weight off. And we’ve learned there are no bad foods, just bad quantities.”
Colleen Sehy: A stress eater makes lifestyle changes
Colleen Sehy, 47, remembers being thin as a child. About 15 years ago, she began her struggles with weight, and eventually hit 272 pounds.
“I was a stress eater — and I’m a grant writer, with deadlines,” said the 5-foot-3-inch Naperville mom of three grown children.
Sehy noted her weight contributed to a host of health issues, including high blood pressure, high blood sugar, sleep apnea, and fatty liver. It also made her asthma worse.
“I always felt sick,” she said.
Sehy tried many diets, and originally went to LifeWeigh to lose weight by nonsurgical means. But after dropping only 15 pounds more than four months into the program, she opted for the gastric bypass in December of 2009.
She recalls dealing with swelling in the first few months, and vomiting — “which is a real good deterrent from overeating,” Sehy said.
It was trial and error at first — and tough. Even a celebratory glass of champagne — because of its carbonation — can cause trouble for her rewired digestive system.
But as pounds shed, even exercise became more enjoyable. Now Sehy can do a 2.5-mile power walk on an indoor track, and her target heart rate has improved. She’s even working with a personal trainer at the L.A. Fitness in Naperville.
With her new, slower eating routine more of a habit now, Sehy said she notices how people around her “inhale food.”
As the weight came off, medical issues also waned. Sehy said she no longer has blood pressure and blood sugar troubles, nor woes with liver enzymes or acid reflux. She’s down from three to one medications for asthma. She still deals with sleep apnea, but doctors have told her that condition has a genetic component.
“The toughest part? It’s all so worth it, and actually not as hard as I thought,” Sehy said.
Marty Neilson: A nurse’s story
As a medical professional, Marty Neilson of Aurora understood the hazards of remaining overweight.
Prior to having gastric bypass surgery in March 2009, Neilson reached a weight of 268 pounds. While her insurance required she must have two life-threatening conditions, she struggled with obesity, diabetes, sleeping issues, elevated cholesterol and blood pressure.
“Years ago, my doctor told me I had to take control of my life and my weight. In her words, I was killing myself, and if I continued with my weight and my diabetes out of control she was going to divorce me … she would not be my physician any longer.”
At the time, those words hurt. But the doctor knew her patient would take those warnings seriously. “You could say at that point it was the wake-up call for me,” Neilson said.
But it was a battle the 59-year-old Neilson said she has been having all of her life. Heavy even as a child, she began dieting around the age of 10. All through nursing school, Neilson tried fad diets and even fasting.
“When I got pregnant with my first of three children, who was born in 1983, my doctor had told me I had lost too much weight. You never tell a fat person to gain weight. By the next visit, I had gained 20 pounds and gained 60 pounds during the pregnancy,” she said.
The fight to keep off the pounds continued with a string of big-name diet systems. Her decision to have the surgery was supported by her family who, she said, “helped me with changing my lifestyle of eating and encouraged my exercise.” Her husband even learned to cook to meet her post-surgery needs.
Neilson said her modified diet includes eating six small meals per day, and “when I am full, I stop eating.”
Her exercise regime three times a week includes water aerobics, weights and walking at least five miles a week when weather permits.
While each person’s results are different after surgery, Neilson said she “has been very fortunate” not to have experienced many side effects.
These days, at 150 pounds, “my nutritional status is excellent,” she said. And she’s especially pleased that she is “almost ready to give up the insulin completely.”
Still, Neilson, who works at Dryer Medical Clinic in Aurora, knows there is no panacea for weight control.
While her mother was thin, her father was a large man, and “one of my brothers, who is now 61, was overweight and has been able to control it through diet alone, but he works very hard at it,” Neilson said.
Another brother, on the other hand, lost more than 160 pounds after having the bypass surgery, and then started packing it all back on because he did not have the appropriate post-surgery support.
Neilson attributes her success to support from coworkers, friends, family, and the team at the clinic she used for her procedure and follow-up work.
For those considering surgical options for weight loss, Neilson offered this advice: “Go to meetings on the topic and talk to others that have had it done. Ask questions and look for answers to see if it is right for you.”