September 18, 2008

Weight-Loss Surgery is Only Half the Battle

By Jane E. Brody

Sara Sloan could be the star of an advertisement for weight- reduction surgery. This 58-year-old retired teacher from Brooklyn had been "the heaviest kid in kindergarten, heavy my whole life," she said, until she underwent gastric bypass surgery in May 2004 and lost 128 pounds in less than a year.

"I had tried just about everything to lose weight: Weight Watchers, Overeaters Anonymous, even speed when doctors were prescribing it in the '60s," Sloan recalled. "I'd lose weight, but then gain it back and eventually topped out at 258 pounds on a 5- foot-1-inch frame," or 117 kilograms on a 1.5 meter frame, "in the winter of '03-'04."

For more than two and a half years she has maintained her new weight of 130 pounds, within a 3-pound range, by following all the rules suggested for people who undergo bariatric surgery, which in most cases reduces the stomach to a tiny pouch and bypasses part of the small intestine.

"I can't imagine going through this surgery, then letting yourself gain the weight back," Sloan said recently. "I've been on seven cruises since the bypass without gaining."

Her method? Discipline and determination. "None of this is rocket science," she said. "I keep a food diary every day and hand it in to a nutritionist I see once a month. I don't go crazy weighing and measuring everything, but I eat child-size portions - a 6-year-old child, not a 10-year-old. I eat slowly and chew my food thoroughly.

"I eat pretty much a whole variety of foods and drink wine occasionally. But I don't eat high-sugar foods like ice cream and candy except once in a while, and I can't tolerate fried foods at all. I carry cereal bars and small baggies of cashews for snacks. When I eat out, I take home most of the meal and repackage it into proper portion sizes."

And she exercises. "They do tell you to walk a lot, at least 15 minutes three times a week, which is not adequate exercise for anyone," she said. "I swim laps five days a week, lift weights a couple of times a week and walk a tremendous amount. I don't own a car."

If not for the scars on her legs and abdomen where excess skin was removed after her weight loss, no one would ever guess that this lean, well-muscled woman was once terribly obese.

About 15 million Americans are morbidly obese, with a body mass index of 40 or more. Last year, the American Society of Metabolic and Bariatric Surgery estimates, 205,000 people underwent surgery to help them lose 100 or more pounds that they had been unable to shed and keep off any other way.

The various types of operations reduce the amount people can consume at a given time and the amount of digested food they can absorb, by creating a much smaller stomach and bypassing part of the small intestine.

Weight-loss surgery is a major operation, and like all surgeries carries a risk of complications, during and after the procedure. Barring any complications, nearly all patients lose a lot of weight - about three-fourths of their extra pounds within a year. A study published Monday in The Archives of Surgery found that poor weight loss after surgery resulted from having diabetes or a larger stomach pouch created surgically.

For those who do lose most of their excess weight, overall health improves and the chance of dying prematurely falls significantly.

But not everyone who undergoes this surgery shares Sloan's dedication to weight maintenance, and years later many start to regain the weight they lost. A nationwide survey by Harris Interactive released in June queried 409 bariatric surgery patients and found that those who followed post-surgical guidelines most closely lost more weight initially and kept more of the weight off in the next five years.

"Surgery is not an instant cure for morbid obesity," said Dr. Philip Schauer, bariatric surgeon at the Cleveland Clinic and past president of the bariatric society. "Up to 15 percent lose a lot of weight initially, then gain weight back. The difference between a great result and a good result is aftercare."

"Patients do best," he continued, "when they participate in a program that provides continuing education, psychological counseling, diet and nutrition support. Exercise matters absolutely. One of the best predictors of success is the degree to which the individual has a regular exercise program."

Ann Ellis, also from Brooklyn, said that after her gastric bypass in August 2002, she lost 125 of the 250 pounds she was carrying on her 5-foot frame, but her weight now hovers around 160.

"The first few years were a real high, with everyone congratulating me on the weight loss," she recalled. "Then after about three years, the euphoria wanes and some of the old bad habits start to kick in. I've always been an emotional eater. But I don't want to go back to where I was, so I'm now working hard not to eat improperly and I'm weighing myself every day." Ellis does not see a nutritionist. Nor does she exercise, though she can now move a lot faster than she could before the surgery.

The controlling feature of bariatric surgery, which encompasses all the types of weight-loss surgery, is similar to that of the drug Antabuse for treating alcoholism: If you eat too much, you throw up. And after gastric bypass surgery, sugary foods usually cause diarrhea.

But an operation does not cure underlying psychological factors that prompt many obese people to overeat or eat the most fattening foods.

Sharon Clapp of St. Paul lost half of her body weight, 150 pounds, after bariatric surgery in 1999. But during an emotionally challenging period when she suffered from depression, she said, "I ate nothing but sugar and fat and gained back about 25 pounds."

A psychologist helped her through the emotional problems. She then returned to eating "the right kinds of foods," as she put it, and has lost 15 of those pounds.

"Food is not such a big player in my life anymore," she said. "I don't have the appetite and longing for it. But I think if you don't know why you're eating, you shouldn't do the surgery."

Originally published by The New York Times Media Group.

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