|
|||
   |
|||
News Article
Suggested Links:
Losing Weight, Seeking Health
Contra Costa Times
Gastric bypass surgery is a life-saving tool for morbidly obese patients
By Joan Morris
CONTRA COSTA TIMES
The surgery is drastic and irreversible. It is not wholly accepted or approved by society in general. And although complications are rare, it can have debilitating side effects that have led to death.
Yet an increasing number of obese Americans are undergoing gastric bypass surgery each year. They see the operation as a last chance for a so-called normal life, free of the pounds that rob them of health and self-esteem.
This year, about 40,000 people are expected to undergo weight loss surgery; doctors estimate 90,000 will have it next year. The increasing interest in weight loss surgery is partly based on publicity surrounding those who have undergone the operation, partly because insurance companies are now more willing to pay for it and partly because doctors now routinely perform the surgery laparoscopically, reducing recovery time by weeks.
Three years ago, Carnie Wilson -- member of the Wilson Phillips singing group and daughter of Beach Boy Brian Wilson -- had her gastric bypass surgery narrated over the Internet. She has since maintained a monthly journal documenting her progress.
In March, NBC weatherman Al Roker secretly had the surgery. Earlier this month, as his 100-pound weight loss became apparent to viewers, Roker went public about having the surgery.
Those who believe the surgery is drastic and dangerous are concerned that having celebrity endorsements will encourage others to attempt it, but those who support the operation as a life-saving tool for morbidly obese patients say the attention will help educate people about what the surgery can and cannot do.
The operation, known among practitioners as bariatric surgery, produces rapid and amazing results, but it is not a quick, easy solution. Anne Timberlake, a nurse and manager for John Muir/Mt. Diablo Health System's weight loss surgery program, said the operation is a tool to assist dangerously overweight people find a permanent solution to obesity.
"It's not a cosmetic surgery," Timberlake said. "It is considered medically necessary, and those are the key words. It is an elective surgery, but it's considered medically necessary."
The most common type of bariatric surgery being performed is the Roux-en-Y procedure in which a small portion of the stomach is stapled off, forming a pouch about the size of a thumb. Then a portion of small intestine is bypassed, which reduces calorie absorption as the food moves along a shortened route to the large intestine.
Those who have the operation are told to eat three small meals a day that are heavily based on protein. They must supplement their diet with vitamins to prevent malnourishment, and they must take the supplements the rest of their lives. Patients also receive psychotherapy to address eating issues.
Weight loss is rapid, and most patients lose 75 percent of their excess weight within a year. For reasons not fully understood, experts say, few people lose all the weight they want, and it is extremely rare for a person to drop below healthy limits.
The key, doctors say, is that the substantial weight loss is enough to "cure" adult onset diabetes and high blood pressure, as well as ease other ailments associated with obesity.
Surgeons follow strict guidelines in determining who should have the surgery and what type of surgery is needed. People who are 100 pounds or more overweight and who have a body mass index (BMI) of 40 or higher may qualify for bariatric surgery. Patients whose body mass index is 35 to 40 may qualify if they have two or more life-threatening or life-altering diseases, such as diabetes, high blood pressure or heart disease.
They must also have tried to lose weight the conventional way and exhibit the classic symptoms of morbid obesity; that is, they have repeatedly lost weight only to regain it quickly. The inability to keep weight off is a sign the person has morbid obesity and possibly a genetic disposition for weight gain.
Although insurance agencies continue to tighten requirements for the surgery, making patients provide proof of repeated dieting failures, more companies and HMOs are approving the operation, citing long term health benefits.
Overweight people are at a greater risk for disease and premature death. The risks associated with being obese exceed the risks of the surgery, Timberlake said. However, the scales tip the other direction in people who are less than 100 pounds overweight. Their risks of disease and death are not as great as the risks of having the surgery.
While the surgery produces amazing results, the overriding reason for having it is for health, not vanity.
"It has nothing to do with whether someone can wear a size 4 or not," Timberlake said. "Some will after the surgery, but that's not our goal."
Kate Bond was more than 100 pounds overweight and said she felt invisible most of the time.
All people seemed to see was the fat, not the person, she said. Bond said she felt overlooked and ignored; if strangers bothered to notice her at all, it usually was with a contemptuous eye.
Yet that was only part of the reason Bond decided almost two years ago to undergo gastric bypass surgery. Having just turned 50, she knew that without doing something, she might not make it to 60.
Bond, who had her surgery in January 2001, is a nurse. She spent quite a while caring for patients who had undergone the surgery before deciding to have it herself. She has lost 100 pounds and now helps with a support group for people considering the surgery and those who have gone through it.
"I can't begin to tell you what it's done to my self-esteem," Bond said. "To be fat is to be invisible. People look right through you like you don't even count. That doesn't happen anymore. I don't have to prove myself anymore."
Bond said people have mixed reactions to her surgery. Society in general tends to be critical of overweight people, conveying the message that if they would only get off the couch and stop eating, they could be slender. And while lack of exercise and poor diet do produce obesity, they are not the only reasons.
Overweight people in recent years have launched a counterattack. Magazines for large women and groups such as the National Association to Advance Fat Acceptance have attempted to instill self-esteem and self-acceptance in overweight people. NAAFA also has led the way in fighting discrimination against the obese.
NAAFA officially is opposed to bariatric surgery. In its position paper, the organization says, "There is no conclusive evidence that gastrointestinal surgery for weight loss increases longevity or improves overall health. There are a tremendous number of deaths and severe complications associated with weight-loss surgeries."
"Further, NAAFA believes that the psychosocial suffering that fat people face is more appropriately relieved by social and political reform than by surgery."
Bond's own sister disapproved of her surgery, although she was supportive of her decision.
"Her feeling was that we should be fat and be proud," Bond said. "'Don't let society push you into this.' And I felt that way, too. But if you're real honest with yourself, it's not a matter of being fat and proud. It's a matter of living, of being healthy."
After seeing how well Bond did, her sister had the surgery 11 months later.
Even with all the publicity surrounding the surgery, the operation remains steeped in reproach. That is one of the reasons why Ann D., a Walnut Creek woman, has not told most of her friends, co-workers and clients about her surgery.
"It's so personal," Ann said. "But there's such a stigma. It's part of the judging thing. People think you should have the willpower to lose weight on your own. It will be easier to tell them after they see the accomplishment."
Ann weighed 302 pounds when she went in for the surgery -- the first performed at the weight loss surgery center at Mt. Diablo Medical Center. She had the surgery in September and has lost 50 pounds. People are starting to notice, she said, but are not quite sure what the change is.
Having the surgery was not an easy decision nor one she made quickly. She studied it for more than four years, following Carnie Wilson's progress and reading highly detailed medical studies and reports. She had decided to have the surgery in North Carolina but then learned a center was opening in Concord, so she waited several months until the center was ready.
Ann enjoys the thought of being slender, but for her, she wanted better health and to get off the diet-go-round. She was having trouble going up and down stairs at her house, and everything she did just seemed to get more exhausting.
Ann's weight gain started with pregnancies. She would diet and lose the weight, but she would quickly regain it. She would lose 25 pounds and gain back 40, she said. Lose 40 and gain 60.
"I can't tell every overweight person they should have the surgery," Ann said, "but I can say it was the right decision for me. It has given me a whole new outlook on facing the rest of my life. The prospect of living 20 to 25 years at 300 pounds or more is overwhelming. This really did save my life."
FOR MORE INFORMATION
• John Muir/Mt. Diablo Health System's weight loss surgery program, www.jmmdhs.com/index.php/weight_loss.html
• Northern California Weight Loss Surgery Support Group, www.obesitysurgerysupport.org
• Association for Morbid Obesity Support, www.obesityhelp.com
• National Association to Advance Fat Acceptance, www.naafa.org
• American Society for Bariatric Surgery, www.asbs.org
------------------------------------------------------------------------
Joan Morris is a features writer. Reach her at 925-977-8479 or e-mail jmorris@cctimes.com.
(Posted December 2, 2002)