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Gastric Bypass Surgery: Two Patients' Stories

separator Severely obese people-those whose body mass index is higher than 40-who have been unable to lose weight through diet and exercise are sometimes candidates for a procedure called gastric bypass surgery. Generally, severely obese men are at least 100 pounds overweight, and women at least 80 pounds overweight.

The surgery works by restricting food intake and/or interrupting the digestive process. We talked with two people who've had the surgery, KJ and her co-worker, Mike. There are several types of gastric bypass surgery, and KJ and Mike had what's called the roux-en-Y procedure, which is the most common and the most invasive. For this operation,

A stomach pouch is created by stapling or surgical banding. This small pouch restricts the amount of food that can be eaten.

Next, a Y-shaped section of the small intestine is attached to the pouch. This allows food to bypass segments of the small intestine.

Normally, these segments of the small intestine absorb a great deal of calories and nutrients. Bypassing them severely reduces this absorption.

After having the surgery, people typically can consume only ½ to 1 cup of food at time for the rest of their lives.

Not a quick fix

Gastric bypass surgery isn't a miracle procedure. Long-term success depends on patient's motivation and behavior. And as with any surgery, there are possible side effects such as nutritional deficiencies, stretching of the pouch, breakdown of the staple lines and "dumping syndrome," which occurs when food moves too quickly through the small intestines. Dumping syndrome can cause nausea, weakness, faintness, sweating and occasionally diarrhea.

KJ and Mike talked with us about what led them to have the procedure and what life is like afterwards.

KJ and Mike: A "food addict," a snacker

Mike claims he had an addiction to food. "I would eat a whole box of cookies while I was watching TV," he says. "Sometimes I'd eat out of pure boredom. I'd eat without realizing how much I was eating.

"I would try dieting to some extent, but it never lasted."

KJ, Mike's co-worker, says, "I wasn't a binger, but I definitely liked to snack. I feel like, for me, being obese was like a disease. My mother and siblings struggle with weight. In a way, it seems like there are two parts to eating-there's the food, and then there's what your body does with the food. I think my body puts on weight with the same food that might not cause another person to gain weight."

KJ was tired of spending her life unhappy with her weight. "Basically, I tried to lose weight for 40 years," she says. "I didn't have a lot of physical problems, but I was tired all the time. I could get tired just walking down the hall."

She tried diet after diet and was never able to keep the weight off successfully. She had reached 326 pounds when, after a lot of research and discussions with her doctor, she had gastric bypass surgery on October 11, 2000. She had the surgery, she says, "as a last resort."

She started losing weight immediately. "The first year is the biggest window of opportunity as far as losing weight," KJ explains. "Then it slows down after that."

Meanwhile, KJ's co-worker, Mike, was up to 440 pounds. He took medications for type 2 diabetes and for high cholesterol. Just walking was difficult for Mike. "I had a handicapped sticker on my car," Mike says. "When I went to sporting events, once I sat down I wouldn't stand up until the end of the game because it was so difficult to get out of the seat.

"I saw KJ's success with the surgery. She had done all the research and told me all about it, and I guess I was a typical male. It was like, 'Sounds great. I want to go for it.' "

Mike had the surgery on April 25, 2001.

KJ's boyfriend and mother were supportive of her decision. Her friends were a little afraid for her though. "I'd tell them I was going to have the operation and they'd say, 'Are you sure you want to do that? Why don't you come on Weight Watchers® with me instead?'

" Mike's wife was supportive as well. "She met me when I was a football player. I weighed about 260 pounds. I've always been a big guy, and she's always loved me for who I am. But she supported my decision. In fact, after the surgery, she told me she always feared for my longevity. We'd talk about our retirement, but she didn't believe I'd live to old age."

Were they scared to have the surgery? Mike says he felt a little bit of fear but he was ready.

KJ says, "I was scared. I cried all the way."

Recovery from surgery

At the recommendation of their doctor, before the surgery they had each lost about 10 percent of the weight they wanted to lose. Their doctor explained that this helps to prepare your body get into weight loss mode, and it helps you recover more quickly from the surgery.

For the first three weeks after the surgery, patients are on a liquid diet. Pureed foods are allowed after the first week.

Were they in a lot of pain afterwards?

"It wasn't that bad," says KJ. "The incision was painful, but they give you lot of pain medication. And they have you up and walking around a couple hours after the procedure."

Mike says, "I woke up hungry. I also wanted a cigarette." Mike says he's planning on quitting smoking now that the surgery's over with. "One vice at a time," he says.

After the surgery, both KJ and Mike needed three weeks to recover before they went back to work. They both have desk jobs, which probably accounts for their getting back so quickly. Mike says, "I knew that KJ took three weeks off before coming back. I wanted to be a macho guy and come back a lot quicker, but there was no way. I really needed all that time."

Life after surgery

For KJ, it's been more than a year since the surgery. She wondered how she would handle the holidays last year, her first since the operation. "I was fine," she says. "It didn't bother me at all. Everyone around me was eating, and I couldn't, but it didn't bother me. It was still new, and I was happy I was losing weight. Believe it or not, I even watched the Food Network on TV."

Before the surgery, KJ had asthma and allergies, and she took preventative medication for her asthma. She no longer has to take the asthma drugs. While she doesn't exercise regularly, she does feel a tremendous difference in her energy level and her ability to get around.

Mike no longer takes diabetes medications because he's able to control his condition with diet. He's off the cholesterol medication now too.

"I'm ecstatic," says Mike. "Mentally, psychologically, physically, I feel great. I can go to a sporting event and sit in the chairs comfortably. I'm not a regular exerciser, but I get more exercise than ever before. I just put a floor down in my house. I built a deck. I could never have done that before."

What about food now?

Eating is different now for KJ and Mike. They're limited to about ½ cup to ¾ cup of food at a time. And they have to chew their food slowly and carefully before swallowing. When they go out to lunch together, they share the entrée and still have food left over.

People who've had gastric bypass surgery experience what's called "dumping syndrome" when they eat more food than their stomachs can handle. Mike describes dumping syndrome as hot sweats and feeling "yucky." He has particular difficulty with sweets. More than one tiny candy bar can make him feel sick.

But for Mike, not being able to eat a lot at once is a small price to pay for feeling so much better.

KJ says she went through a "bit of mourning" after her surgery. I felt like, "I love food, and now it's gone. It'll never be the same." She's put that behind her now. "Food is good again," she says. "I just can't have that much."

What about their weight?

"We don't like that question," says KJ.

"We actually try not to focus on the numbers too much," says Mike. "Our doctor recommends that. The main thing is that we feel good, we're healthy, we're active. We try not to get sucked into the idea that we have to be at a certain number to be happy."

But they will reveal how much they've lost, even though they don't like to talk about it much. Mike has lost 160 pounds since the surgery, KJ 146. That's after the 10 percent they lost before the surgeries.

KJ says she's still not exactly where she wants to be in terms of weight, but Mike is pleased. "I have people at work coming up to me asking me when I'm going to stop losing weight."

Surgery is a tool, not a cure

Mike and KJ both stress that gastric bypass surgery isn't a cure for obesity. KJ says, "This isn't a cure, it doesn't fix your head. I'm at the point now where the weight loss has slowed down, and I could actually gain weight again. I might not be able to eat a whole pizza all at once, but I could nibble on it all day long. I'm always telling myself, 'Okay, you've gone through so much, don't wreck it now. Keep your act together.' "

Mike agrees. He could nibble all day too. The good thing for Mike and KJ is they see each other at work all day. When Mike wants to eat one of those tiny candy bars, he often goes to KJ's office and she talks him out of it.

They also belong to a support group for people who have had the surgery and those who are considering it. Both feel that the support group is invaluable, although Mike acknowledges that he'd like it if there were a few more men there. Far more women undergo the gastric bypass procedure, which accounts for the imbalance at the support group.

Because of the decreased nutrient absorption after the surgery, Mike and KJ take quite a few nutritional supplements every day, including a multi-vitamin, B12 and calcium. They also have to drink a lot of water.

Neither one of them has had any major side effects, although KJ admits to having "a lot of skin hanging."

What would Mike and KJ say to people thinking of having the surgery?

Mike, who's still losing weight and hasn't reached a plateau the way KJ has, says that he would tell anyone to "go for it."

But KJ is a little more cautious. "Don't look at it as a miracle. It's a tool," says KJ. You still need to watch what you eat. And if you can lose weight any other way, you should try that first."

For information about gastric bypass surgery, including risks, benefits, descriptions of who is and who is not a candidate, etc., visit the National Institute of Diabetes and Digestive and Kidney Disorders (http://www.niddk.nih.gov/health/nutrit/pubs/gastsurg.htm



Source:
National Institute of Diabetes and Digestive and Kidney Disorders, December 2001



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