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On the Trail of Weight Loss; After Diets Failed to Help, Bariatric Surgery Alters Waukesha Woman's Life

Posted on: Sunday, 23 October 2005, 15:00 CDT

By JACQUELINE SEIBEL

Waukesha Traci Kouhel felt out of control.

As a Waukesha County public health nurse, she knew how to eat. Part of her job is to make sure pregnant women and children are getting proper nutrition information.

She always made sure her two sons, Zakary, 13, and Adam, 9, were eating well.

But when it came to herself, she couldn't control it. She couldn't solve it.

Battling her weight her entire life, Kouhel tried many diets. The first time she joined Weight Watchers she was 12. And the weight came back every time. She did a liquid diet once for nine months and lost 100 pounds. And the weight came back. She did the Atkins Diet, which focused on consuming mostly protein-rich foods. And the weight came back. She did just about every other diet ever written about, and the weight always came back.

"I probably have lost and regained thousands of pounds," Kouhel said.

As Kouhel got older, she became more self-conscious about her weight. She distanced herself from relationships and unfamiliar situations. Trying a new restaurant was out of the question because she feared she wouldn't fit in the chair. She needed a seatbelt extender in a plane, so flying anywhere was too depressing. Her self- esteem was non-existent.

And even though she never asked for them, Christmas gifts from her then-husband consisted of diet books and exercise videos.

The more she weighed, the deeper the isolation. And the more she weighed, the more she became concerned she wouldn't be around for her kids.

At 38, she hit her highest weight of 343 pounds.

In 2002, she began to do her own research on bariatric, or gastric bypass, surgery, a radical, sometimes risky procedure in which a small stomach pouch is created to hold only 1 ounce of food, and about one-third of the small intestine is bypassed so that fewer calories are absorbed.

A very personal matter

Kouhel didn't tell anyone what she was thinking of doing.

In January 2003 she began meeting with physicians at Froedtert Memorial Lutheran Hospital in Wauwatosa who would determine whether she was a candidate for the procedure.

After several physical exams, a psychological exam and insurance requirements, Kouhel was scheduled for surgery on June 2, 2003.

Only a handful of people knew her plans. She told two co-workers in case something happened that would prevent her return to work. And she told her sister because she needed her to take care of her children while she was in the hospital.

"This was a very private and emotional decision," Kouhel said.

It's a decision increasingly made by morbidly obese people, those who are more than 100 pounds overweight and have been given the choice to either change their lifestyle or risk the health consequences that come with obesity.

A Medicare study released last week on bariatric surgery shows that more people die within the first year after surgery than was previously thought.

Some previous studies found death rates to be under 1% among people ages 30 to 50, the most common age group to have the surgery. But in the recent study, 5% of men and nearly 3% of women died within a year.

Kouhel said she knew the risks, but she was on a path to an early death. "I exhausted all my choices," she said.

The number of Americans having weight-loss surgery more than quintupled between 1998 and 2002 from 13,386 to 71,733, according to a study by the federal Agency for Healthcare Research and Quality.

James Wallace, director of the Bariatric Surgery Program at Froedtert, said there are more than 150,000 bariatric procedures per year nationwide. But up to 4% of Americans are considered morbidly obese, so the surgeries are barely making a dent in the public health problem, he said.

Cost factors

And despite the surgery's ability to end the need for diabetic medication, some insurance companies have become reluctant to cover the expensive procedure, Wallace said. The surgery can cost $30,000 to $35,000, he said. But it can be expensive to treat someone with diabetes, he added.

Wallace has been doing the procedure since 1999 and has performed more than 800 weight-loss surgeries.

"It's the best thing I've done in medicine," Wallace said. He can control diabetes, hypertension and increase life expectancy. He asks: How many physicians can say that?

Wallace describes the surgery as only a tool to weight loss, saying much still depends on the patient's willingness to exercise and eat three meals a day with no snacking.

"There's nothing easy about it," he said. "To be successful, you have to make fundamental changes in your life and habits."

Before surgery at Froedtert, prospective patients undergo an orientation and extensive exams, including psychological, to ensure the person is a good candidate for surgery. There is also an extensive follow-up clinic in which the patient is monitored, even years after the surgery.

Part of the discussion is also about the risks of surgery.

Kouhel had complications during her surgery, and her spleen had to be removed. She had to be hospitalized for nine days instead of the few days she expected, and recovery from the surgery was more extensive.

New lease on life

People sometimes fail and regain excess weight, Wallace said. It is easier to control smoking and drinking than it is to control eating, he said.

"Eating behaviors are so deep in our personalities that you have to admire anybody who can pull this off," he said of the surgery and post-surgical procedures.

Kouhel hopes she continues to be one of those who has success. It's been a life-altering experience, she said. At 41 and 180 pounds, she finally feels like she fits in. She now eats to live instead of living for food. She now tastes her food.

Diet restrictions

She can no longer tolerate high fatty foods and she can't drink any water for an hour after eating. Despite the stricter diet, she has no regrets.

"If I had any other disease, I would look for a cure," Kouhel said.

Next month, she will go back for surgery to have excess skin removed from her stomach. The weight of the skin, about 10 pounds, is putting pressure on her back and causing her pain.

Meanwhile, Kouhel is taking pleasure doing activities she has never done before, such as riding a bicycle with her children and crawling on the floor with the children she meets at work.

"I didn't go to this extreme to fail," she said.

Copyright 2005, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

Source: Milwaukee Journal Sentinel

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