The Tempting Part
Paige’s thorough research left her no doubt about the risks she’d face, but she wanted to hear about the potential benefits, too. And she liked what she learned.
Several studies show that surgery for weight loss can produce a number of major health improvements, including easing the sometimes excruciating pain caused by extra stress on joints.
“It is not uncommon for obese patients with OA to come in for bariatric surgery in a wheelchair because of pain, failed joint replacements and lack of mobility – all due to excess weight – and within a year walk free of even a cane,” says Walter Pories, MD, chief of the Metabolic Institute at East Carolina University in Greenville, North Carolina, and one of the authors of the 2004 review published in JAMA.
Losing weight via bariatric surgery may also help resolve chronic inflammation associated with rheumatoid arthritis (RA), diabetes and heart disease. Studies performed over the last several years by researchers in Austria show that the level of C-reactive protein (CRP) and other cytokines linked closely to inflammation decrease significantly after bariatric surgery.
Within a matter of weeks after the operation, the body begins to produce and appropriately absorb insulin and manage glucose more effectively. Indeed, in a study of 608 morbidly obese people with diabetes who had weight loss surgery, 99 percent of them were able to normalize their blood glucose level.
“We don’t yet know exactly why the body responds so well to bariatric surgery, but it does,” says Dr. Jamal.
Reality: Surgery and Beyond
When preparing patients for life after bariatric surgery, Dr. Jamal and Dr. Pories make sure patients have realistic expectations.
“Bariatric surgery patients do not become ‘normal,’ thin people; they become lighter, healthier people. A patient who weighs 300 pounds won’t get to 110 but may get down to 200 and eliminate or decrease their need for medications to treat diabetes, high cholesterol, high blood pressure and arthritis pain,” says Dr. Pories.
Paige says she was realistic. “I knew having surgery would not be taking the easy way out.” She knew radical and challenging lifestyle changes were part of the deal.
On December 29, 2005, Paige’s surgeon made five incisions on her abdomen and placed a restrictive plastic band at the top of her stomach.
After a one-night stay in the hospital, she was home and on a full liquid diet for two weeks. She could take in only about four liquid ounces per meal. “I could eat anything that melted in my mouth, like gelatin or yogurt. After a while, I was going crazy for something even semi-solid. I would have been happy to chew anything.” After the first two weeks, she was free to eat anything that could be pureed in a blender – and you’d be amazed at how much can be pureed, she says.
Six weeks after the surgery, Paige returned to the doctor for her first “fill,” a saline injection through the port in her abdomen to tighten the band. “It feels a little weird but is not painful or uncomfortable,” she says. Adjustments are made every six weeks. Surgeons will tighten a patient’s band if she is not losing four to five pounds per month, and it’s loosened if the patient is not able to eat one-half cup of food at a time. Since her surgery, Paige has had four “fills,” or procedures, to tighten her band.
“I’ve had major surgery amounting to mechanical portion control that will alter the way I will eat for the rest of my life,” says Paige. “I can take in only one-half to one cup of food at each meal.”
She has learned to be patient when eating. “I have to chew food until it’s nearly gone,” she says. “If I don’t, or if I eat too much, the food stays above the band, in the esophagus. It’s really uncomfortable for a while.”
Paige doesn’t drink liquids during her meals, otherwise she feels full immediately and isn’t able to take in any nutrition. “But I do drink hot tea or have some warm soup before every meal, to soften the band a little and make it more comfortable. Then I make sure I eat protein first. If I have room, I eat some veggies and then carbs. Desserts and treats are out,” she says. “There’s just no room to splurge on foods that don’t provide real nutrition, and I no longer crave them.”
Control, At Last
Two months after her surgery, Paige had declared, “I officially love my band.” Over the next months she took joy in the many signs that she and her body were really changing: She bought an XL (not an XXL) coat, no longer cared what the scale read, and no longer felt incessant hunger – she actually had to remind herself to eat.
Nearly a year after her surgery, Paige is careful to follow her doctor’s orders: She takes her vitamins and exercises regularly. She has lost enough weight to bring her BMI down out of the obese range (from 39 to 29.9). Her sleep apnea improved just six weeks after the surgery, so she no longer snores. And about three months after her procedure, her blood pressure improved and her knees stopped hurting. Now, she says, she has more energy and looks forward to going to the gym instead of dreading exercise.
“The nicest surprise is that I keep losing. I’m so much healthier. If I could have just one other wish come true, I’d wish I had done it sooner. After years of thinking nothing will work, I finally feel like I can control my body and my life,” she says.
