Weight Loss Surgery If you've had it, or are considering it, share your discussions here

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Old 06-12-2002, 08:08 PM   #1  
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Default Article: Newsweek.. The Diet of Last Resort

The Diet of Last Resort
Date: 06-10-2002; Publication: Newsweek; Author: By Joseph Contreras and David Noonan With Mary Carmichael


The Diet of Last Resort: Thanks to a popular and gruesome operation, Alberto Guerrero lost 150 pounds and gained a new life. This year, more than 60,000 people may do the same. By Joseph Contreras and David Noonan With Mary CarmichaelEdition: U.S. Edition Section: Society
Perhaps the hardest thing about Alberto Guerrero's long-running battle with obesity was the simple act of going to sleep. His huge belly pushed up against his diaphragm when he went to bed, and breathing problems kept him awake for two or three nights at a stretch before he finally succumbed to exhaustion and slept through the night. Over the years, the Miami nurse had tried Weight Watchers and workouts at a local gym, but the unwanted pounds just kept coming back. His weight problems, the result of zealous overeating, dated back to his childhood. The 5-foot-9 Guerrero, who peaked at 358 pounds in 1998, gave up hope of ever resembling or living like a normal person. Then a friend told him about an operation, known as a gastric bypass, that cured her obesity by shrinking her stomach to a fraction of its original size. Guerrero, over the objections of his mother, went to Dr. Robert Marema for the surgery in May of last year. Over the ensuing 12 months he shed 150 pounds; he now weighs 192 pounds with a 34-inch waist, down from 54 inches. The 48-year-old father of five looks and feels like a new man. "The real question is whether you want to keep on living like that," says the svelte Guerrero. "Everything has really changed." Most of all his stomach, which is now about the size of his thumb.

Twenty-seven percent of Americans are obese, and for a rising number of them gastric-bypass surgery is the last-ditch solution to intractable weight woes. An estimated 47,200 procedures were performed last year- -more than double the number for 1997--and the American Society for Bariatric Surgery (ASBS) expects about 62,400 patients to have their stomachs surgically shrunken in 2002. (Bariatrics is the field of medicine that deals with the overweight.) The number of doctors who perform the surgery--for fees as high as $4,000--is booming as well. Celebrities like pop singer Carnie Wilson and Blues Traveler harmonica player John Popper have become no-longer-larger-than-life walking billboards for the operation. The insurance industry is also driving the trend. Rather than wait until their obese policyholders develop serious weight-related problems like heart failure, some companies are easing their rules to cover the surgery before people come down with such terrible diseases. A recent IRS ruling that makes it easier to deduct the cost of the surgery should also increase its popularity.

The operation itself is simple and elegant, in a gruesome sort of way. Most specialists use a procedure known as the Roux-en-Y that reduces the patient's stomach, normally about the size of three clenched fists, by as much as 99 percent. The surgeon detaches the esophagus from the stomach and reattaches it to the small intestine, creating a tiny pouch. Most surgeons attach an inflatable ring to this mini- stomach to slow the flow of food to the rest of the digestive tract. Patients who have the operation feel almost instantly full after eating very little food, and they continue to feel sated for a much longer period of time because the ring keeps the stomach from emptying at a normal rate. Except for carbonated beverages, there are no restrictions on what patients can consume once they have healed from the surgery. They simply eat less food, less often. Guerrero still enjoys bean soup and ham sandwiches.

Bariatric surgery is not suitable for just anybody battling a bulge. Most specialists accept only morbidly obese patients, defined as those who exceed their ideal weight by at least 100 pounds. Candidates for the surgery should be under 60, with no serious psychological or medical illnesses, and have a history of failed weight-loss attempts. The surgery carries risks. About three out of every 200 patients die during surgery or shortly after; the leading cause of death is infection due to leaking sutures. Roughly 8 percent of patients develop serious but nonfatal complications, such as vomiting and ulcers. Glitches are common enough that nurses in some hospitals have coined the acronym GBGB--shorthand for gastric bypass gone bad. And even when the operation works, it doesn't always work out. A few patients end up asking their surgeons to undo the downsizing because they miss their old eating ways.

While it's not hard to find a surgeon to do the operation, finding an experienced one can be a little trickier. The thriving and lucrative field of bariatric surgery is attracting lots of doctors who may lack the required level of technical proficiency or the proper support system for their patients. Apart from the credentialing committees of individual hospitals, there is no governing body that regulates bariatric surgery. Only about 200 surgeons have bothered to get certified by the American Board of Bariatric Medicine (ABBM), a voluntary step. A further 624 have joined the American Society for Bariatric Surgery, also voluntarily. Experts urge patients to investigate the background and medical qualifications of a self-proclaimed bariatric specialist. "It's not just a matter of surgical technique," says ABBM chairperson Dr. Eneida Roldan. "Pre- and postoperative care is needed and not all [practices] are equipped to provide that. Patients will get hurt in the long run."

Guerrero has been spared that fate. He no longer has problems getting to sleep at night, and he's learned to live without the ice cream, cheese and other snacks that once inflated him. He still goes to restaurants with his wife, but the two-course meals he used to devour are history. Now they share a single appetizer and a single entree. This sometimes requires a pre-prandial round of negotiations. "The way you eat is definitely different," says Guerrero. "Now we have to have a discussion about what we're going to order." And yes, he takes small bites. But that's a small price to pay for a whole new life.


By Joseph Contreras and David Noonan With Mary Carmichael, The Diet of Last Resort. , Newsweek, 06-10-2002, pp 46.
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Old 06-12-2002, 09:51 PM   #2  
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i think it's also important to check out the hospital. if it has an obesity program of some sort, the chances are better that the hospital staff is accustomed to dealing with extremely heavy patients, and have the appropriate equipment, such as wider wheelchairs.

the surgeon can do the operation, but it's the nurses and other staff members who will pull you through the whole thing and get you out the door!!!
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