Jacqui Thomas calls her family's weight problems a pattern — at 5-feet-4, she topped out at 225 pounds. Her son, Brian, who stands 5 feet 10 inches, once weighed in at 360. Over the years, Jacqui, 61, joined Weight Watchers and Overeaters Anonymous. Dieting helped her drop extra pounds, but she couldn't keep them off. "I kept hoping I would find something that worked," she says.
Her 31-year-old son, on the other hand, had never done anything to control his weight until he learned that he had the beginnings of Type II diabetes. "I couldn't make diets work," he says. "I went to a nutritionist and took off 15 to 20 pounds, but that was it."
Hoping to ward off health problems, Brian resorted to gastric-bypass surgery three years ago. Jacqui opted for lap-band surgery this past September.
Jacqui and Brian represent a growing number of people who are turning to bariatric surgery to help fight their battle with morbid obesity. In 1997, there were 12,000 bariatric patients recorded nationwide; in 2007, that number ballooned to 110,000.
Gastric-bypass surgery divides the stomach, usually the size of a football, into two golf-ball sized parts. During surgery, part of the stomach and the intestines are bypassed, allowing fewer calories to be absorbed. Food intake is drastically reduced, sometimes from a gallon of food a day to a cup.
Bypassing Obesity
Gastric bypass provides amazing metabolic effects," says Dr. Neil Hutcher, medical director of bariatric surgery at Bon Secours St. Mary's Hospital. "That's part of the mechanics of the surgery. It leads to rapid remission of diabetes, elevated cholesterol and bad fats. It also speeds weight loss."
Kelly Toomey, 37, who has had Type II diabetes since the age of 19, chose gastric-bypass surgery when she was experiencing complications from the disease, including diabetic retinopathy, a progressive eye disease that is the leading cause of blindness among adults.
A 2004 study in the Journal of the American Medical Association showed that gastric-bypass surgery resolved Type II diabetes in more than 83 percent of people with morbid obesity.
"I knew if I didn't do something that would more aggressively address the diabetes, I would get worse and worse until I died an early death," Toomey says. When she had the elective surgery in 2004 she weighed 286 pounds — she is now 150 pounds lighter, and her diabetes remains in remission.
Not everyone who wants a gastric bypass is eligible for the surgery, though. It is intended for people who are 100 pounds or more overweight with a body mass index (BMI) of 40 or greater, and have not had success with diets, exercise or weight-loss medications. People with a BMI of 35 who have diabetes, high blood pressure, sleep apnea or other illnesses that would be reduced or eliminated by weight loss are also candidates.
"This surgery is not for someone who wants to lose 20 pounds in order to get into a slinky, black dress," says Dr. David Elliott, bariatric medical director at Henrico Doctors' Hospital. "The surgery is a measure of last resort."
Patients often have to work through the emotional issues tied to weight. "People ignore people who are overweight," observes Hutcher. "Being obese in the marketplace is worse than a glass ceiling of gender and race. It's a cement ceiling. After they've had gastric-bypass surgery, patients talk about what the transformation has meant to them."
Some adolescents who meet the criteria are also undergoing the procedure. "Most [adolescents] require more psychiatric screening as well as preliminary dietary therapy because of their relative lack of maturity," says Dr. James Maher, director of the Minimally Invasive Surgery Center at the Virginia Commonwealth University Medical Center.
Modern Age
Gastric-bypass surgery has evolved since the 1970s, when it was first performed. "The biggest improvement is the introduction of the laparoscopic approach to the surgery, which has reduced both pain and mortality rates," Maher says. "It also eliminates the issue of incisional hernias."
The majority of gastric-bypass surgeries can be done laparoscopically, using small incisions, according to Elliott. "It's a safe, effective operation for someone who needs to lose weight. It can prolong your life."
As with any surgery, there can be short-term and long-term complications. Brian Thomas has experienced only small complications such as gas and diarrhea. "I do get the ‘dumping syndrome' — severe stomach cramps, nausea, diarrhea and dizziness — because my intestines can't handle the same amount of sugar as before," he says.
Other complications include blockage of the stomach or intestines and ulcers. "Some side effects we can fix and a lot are preventable with exercise," says Elliott, who notes that the risk of dangerous complications from the surgery is around 2 percent. "The risk of dying from the operation is about one in 200, or .5 percent."
Most of the people who opt for gastric bypasses — 75 to 85 percent — are female. "Women in many respects are more health conscious than men," Hutcher says. "There is also more social pressure on women to be like Twiggy or Paris Hilton, whoever the current thin person is."
About 85 percent of the patients who undergo the surgery are able to maintain their weight loss by following basic guidelines such as three small high-protein meals a day, no snacking between meals, exercising regularly, and taking daily vitamins and calcium.
For patients like Brian who don't strictly follow the guidelines for nutrition and exercise, the weight can return. After his surgery, Brian dropped to 250 pounds. He now weighs 290. "Your stomach can slowly stretch to the size of a tennis ball," Elliott says. "When that stretches bigger, people regain the weight."
It is because of such setbacks that Hutcher says bariatric surgery is only a tool to help with weight loss. "It's like being a coach," Hutcher says. "You tell someone how to hit the baseball, but they have to swing the bat."
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Lap-Band Surgery
When Jacqui Thomas finally decided to have surgery, she chose lap-band surgery, an operation that restricts only food intake and not food absorption. "Gastric bypass is so drastic," Jacqui says, noting that lap-band surgery is simpler and safer. "I like the fact that the lap-band can be adjusted."
During the surgery, doctors create a golf-ball sized stomach. "It's like a belt around the stomach that can be made tighter or looser by inserting or removing fluid from the band," says Maher.
Criteria for the operation are the same as for gastric-bypass surgery, and patients see dramatic weight loss, even though it's at a slower pace than with gastric bypass. Complications can include band slippage, requiring band removal or replacement. "Bands can erode into the stomach requiring removal," Maher says. "There are also many food intolerances with a band, and the band needs to be adjusted five or more times the first year."
Jacqui, who now weighs 140, has been extremely pleased with the procedure. "It's a powerful tool," she says. "I had very high blood sugar and blood pressure, and now both are normal. I am a breast cancer survivor, and if I kept eating a high-fat diet, the cancer could come back. I feel like in so many ways this surgery has saved my life."
