Gastric Action: 'Lap-band' surgery for teens gaining acceptance

Charlottesville, VA

Andrew Burrill says that the worst moment occurred last year in his high school cafeteria. Heading for a table, his tray laden with an extra portion of his favorite school lunch, Andrew was intercepted by a teacher who loudly asked, "Are you SURE you should have gotten doubles?" Andrew, who at the time was nearly 5 feet 4 and weighed 260 pounds, burst into tears.

"There were times when I felt I just couldn't go on," recalled Andrew, a sophomore, who lives near Charlottesville, Va. At 15, already a veteran of numerous failed diets, exercise programs and summer "fat" camp, Andrew became convinced that weight-loss surgery, which had transformed the physique of a family friend, was his only hope. He pleaded with his mother for help.

"I had to do this for him, no matter what," recalled his mother, Cheryl Burrill, an IT executive. But when she called hospitals around the country to find a surgeon who would reduce Andrew's stomach from the size of a large grapefruit to the size of an egg, she was told that he was too young and should come back when he turned 18.

Worried about his increasing girth, high blood pressure and severe sleep apnea, Cheryl Burrill said she didn't think her son could wait three years. Scouring the Internet, she found surgeon Eric Pinnar in Reston, Va., who specializes in "lap-band" surgery. Unlike gastric bypass, which involves stapling the stomach and permanently rerouting the intestines, lap-band surgery is reversible and involves the use of an adjustable band to bisect and shrink the stomach.

Last September, Andrew became Pinnar's youngest patient. Since then the surgeon has operated on four other youths under 18; more are planned.

These youths are part of a growing vanguard of extremely obese teenagers who are undergoing bariatric surgery, as the last-ditch weight-loss operations are known. The procedures, designed for those who are 100 pounds or more overweight, have increased dramatically among adults, from 14,000 in 1998 to nearly 178,000 in 2006.

Although a handful of doctors have operated on children and teenagers, some weighing more than 700 pounds, bariatric surgery has been regarded by many doctors as too risky and drastic for patients younger than 18. A 2007 study estimated that 2,744 teens underwent weight-loss surgery between 1996 and 2003, a number that more than tripled between 2000 and 2003. Many pediatricians and pediatric surgeons have been leery of the procedures, which have not been studied in children, require lifetime adherence to a strict dietary regimen, and can cause hazardous nutritional deficiencies and, in rare cases, death.

That opposition appears to be ebbing. Spurred by improvements in technique and studies in adults showing increased longevity and reversal of Type 2 diabetes and other problems, some influential opponents have softened their resistance. At the same time, the National Institutes of Health is financing a study of gastric bypass involving 200 teenagers, while the Food and Drug Administration is sponsoring a trial of the lap band in patients 14 to 17.

Skeptics say they are intrigued by the possibility that early intervention, before years of disordered eating and metabolic damage have taken their toll, might benefit some severely obese teenagers for whom other treatments have failed. Those hopes were buoyed by a small study published last month in the journal Pediatrics, which reported a resolution of Type 2 diabetes among 10 of 11 teenagers who underwent gastric bypass.

Two other factors are fueling the re-evaluation of weight-loss surgery: the relentless increase in childhood obesity and the dismal results of behavioral treatment, consisting of some combination of diet, talk therapy and exercise. Behavioral treatment has a long-term failure rate estimated at roughly 95 percent.

"We know that the vast majority of morbidly obese adolescents become morbidly obese adults and that medical and behavioral therapy doesn't work for them," said Evan Nadler, the director of New York University's minimally invasive pediatric-surgery program who is involved in the FDA lap-band study. "These kids are sick. This is truly a disease, a problem we can treat with the best means we know how. (Surgery) is the only known mechanism for sustained and significant weight loss."

Kurt D. Newman, the surgeon-in-chief at Children's National Medical Center in Washington, says that until recently he regarded weight-loss surgery as "kind of wrong -- more so in a kid." Prodded by his hospital's obesity specialists and faced with a growing number of 13 year olds weighing 300 pounds and a population that has one of the highest rates of pediatric obesity in the country, Newman has reconsidered. He is recruiting a bariatric surgeon for Children's new Obesity Institute.

David Ludwig, a pediatric endocrinologist at Boston's Children's Hospital and one of the nation's most prominent obesity experts, has also tempered his opposition. For carefully selected patients who have been treated consistently with other methods and failed, Ludwig said, surgery with appropriate safeguards may be an option. But, he warns, these operations are neither a solution to an urgent public-health problem nor a panacea. Bariatric surgery, he said, "can result in horrendous complications, require repeat surgeries and create a whole new set of medical problems.

Thomas Inge, the chairman of the NIH teen bypass study, directs the nation's oldest weight-loss surgery program, at Cincinnati Children's Hospital Medical Center. Since 2001, 110 adolescents have undergone surgery there, under guidelines issued by the American Academy of Pediatrics.

They must have a body mass index, or BMI, of at least 40 (the equivalent of someone who is 5 feet 4 and weighs 235 pounds) and a serious weight-related health problem such as Type 2 diabetes or high blood pressure. Referral by a pediatrician is required. Patients younger than 18 must have failed organized weight-loss attempts and have achieved most of their growth. All must demonstrate preoperative weight loss on a liquid diet and pass psychological screening tests.

The majority of Inge's patients are girls. One year after surgery, they had lost on average one-third of their excess weight, about 30 pounds for someone 100 pounds overweight, for example. Many remained obese but were no longer morbidly so.

Unlike gastric bypass, which is generally covered by insurance and costs about $25,000, lap-band surgery in teenagers is considered experimental, which means that parents typically must finance it.

To pay for Andrew Burrill's 45-minute procedure, his parents sold a vacation time-share.

Andrew, who has lost 52 pounds since the surgery and now weighs 184, said that the required changes in his diet have not been as difficult as he initially imagined. He said he does not miss the daily two-liter bottle of Mountain Dew he used to chug. And he has learned the hard way that if he eats too much -- more than about a half-cup of food at a time -- he vomits.

Adjusting to his dramatic weight loss has been somewhat tougher. Andrew, whose waist size has dropped from 44 to 34, said he still thinks that he looks enormous when he looks in the mirror.

The best thing has been the reactions of other people. "I haven't had one person stare at me since I got the surgery," he said. "And in PE, it's the first time in my life I don't come in last."

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Weight-Loss Surgery Done With Just A Tiny Scar

Denver, CO

A bariatric surgeon in Denver is now performing weight loss surgery through just one small incision near the belly button. The technique is called SILS or single incision laparoscopic surgery. It's an innovative way of doing adjustable gastric band surgery -- it leaves just a tiny scar.

Dr. Michael Snyder is the first bariatric surgeon in the region to perform the SILS technique.

"I can make about a 3 centimeter incision and do all the work through just that 3 centimeter incision," said Snyder after performing his sixth SILS surgery at Rose Medical Center.

Patient Judy Lucas decided it was right for her. Sixteen years ago, the co-owner of Mutt Puddles Dog Grooming quit smoking and started gaining weight. At 5 feet 3 inches, she weighs 260 pounds.

"I've tried every diet in the book; I own every diet book," said Lucas. "Every day I get home from work, my legs are swollen, my back hurts. It's harder for me to do my job."

That pushed Lucas to weight-loss surgery. She chose to have an adjustable gastric band inserted to restrict her stomach and make her feel fuller. It's an operation normally done laparoscopically through about five small incisions. But using the SILS technique, Dr. Snyder operated through just one small cut near the belly button.

"It doesn't change the operation at all, it just changes the access points," said Snyder.

It was a 45-minute surgery. Lucas went home the same day.

"I think the healing process is going to be a lot easier, " she said.

She has already lost 14 pounds. Her goal is to lose at least 100.

The SILS technique was approved by the Food and Drug Administration in May 2008. It is also being used in removing gall bladders and appendixes.

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Woman files gastric bypass malpractice lawsuit vs. MaineGeneral

Augusta, ME

A northern Maine woman is seeking more than $3 million, alleging a laparoscopic gastric bypass surgery performed on her at MaineGeneral Medical Center in Augusta more than seven years ago was botched.

Opening statements began Wednesday in Kennebec County Superior Court in the case of Donna and Charles DeLong, whose mailing address is Westfield, vs. the hospital and Dr. Padiath A. Aslam.

The DeLongs claim Donna DeLong suffered numerous complications from the surgery and afterward was admitted multiple times to hospitals, including Aroostook Medical Center, for treatment.

The attorney for the DeLongs, Daniel Lilley, is seeking more than $3 million in compensation for the couple.

In one court document, the couple said they suffered an estimated economic loss of $816,452.

Aslam, represented by attorney Mark Lavoie, and the hospital, represented by Robert Newton, deny the allegations.

Lavoie told jurors that Aslam had done the surgery properly and that Donna DeLong suffered complications after straining herself playing with her son's dog within hours of being discharged.

Lavoie also said a medical practice screening panel -- set up to evaluate the merits of claims against physicians and surgeons -- found Aslam's actions met the standard of care.

In a ruling prior to the trial, Justice Nancy Mills ruled that Aslam was an independent contractor and not an employee of the hospital. "Defendant MaineGeneral Medical Center is not liable for any negligence on the part of Defendant Padiath A. Aslam, M.D.," she wrote.

Aslam was initially licensed as a medical doctor in Maine in 1970 and is currently working at Rumford Hospital with Rumford Hospital Surgical Associates. He is licensed to practice in Maine until Feb. 28, 2010.

He has not been subject to any disciplinary actions in Maine or in Vermont, where he also was licensed from 1970 to 2006.

Selecting the 11-member jury took all day Tuesday, and trial is expected to last three weeks. More than a dozen boxes full of files related to the case were stacked up against a railing in the back of the courtroom.

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Married couple has bariatric surgery together

Poughkeepsie, NY

Married couples do lots of things together.

Sometimes, that involves activities designed to get healthier, such as exercising and eating better.

Trish and Jeff Tryon decided to take that one step further: They had gastric bypass operations on the same day.

In Part Three of The Early Showseries "HeartScore" on Wednesday, correspondent Debbye Turner Bell introduced viewers to the couple from Poughkeepsie, in upstate New York, determined to lose large amounts of weight to improve their health and up their odds of living long lives.

It used to Jeff, a take volunteer firefighter, four minutes to get into his gear. Now, he can do in half that time.

Trish, an EMT instructor, also struggled. "I would walk down the hallway and I'd have to sit," she told Turner.

They were both morbidly obese, medically defined as more than 100 pounds overweight. Jeff was 440 pounds. Trish weighed in at 399.

For her, it was a life threatening situation. She suffered from high blood pressure, high cholesterol, and heart problems.

After several failed diets, they explored weight loss surgery and decided to have gastric bypass procedures together.

"Without this operation," says Dr. Laura Choi, a surgeon at Danbury Hospital, in Connecticut, "it was very difficult for them to change their lifestyle."

An emotional Jeff recalled that Choi said, "You have a choice. Sign a contract to have the surgery and add 25 years to your life. Or sign a contract with a funeral home."

The Tryons had their operations in November. A small pouch was created in their stomachs, and their small intestines re-routed to the new, smaller stomachs. It's "worked out beautifully" for them, Choi says, because they have instant support with each other, and they both they recovered very quickly. "You can see it in their faces," she adds. "You can see how excited they are about shedding the pounds, being able to do those everyday things they love to do."

Since the surgery, they eat very small portions. No more sweets or fried foods.

In just three months, Trish has a hundred pounds and Jeff, 81.

His legs don't hurt anymore and now, when he drives the firehouse ambulance, he no longer worries about his belly getting in the way. And she can walk much better.

They've lost weight and gained a whole new life. "It made our love bond very close," Jeff says.

"I know now that I am going to be around to see my son get married and have kids," Trish said, beginning to cry, "and I didn't think I was going to do that before."

Before the surgery, she was taking 14 pills every day for the long list of health issues her weight was causing. She's now off all her medications.

"Contrary to what a lot of people believe about gastric bypass surgery and other types of surgery, it's not the easy way out," Choi observes. "The long-term success essentially depends on how well a person is able to change their lifestyle, and their outlook and relationship with food."

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Bariatrics surgery increases fertility of women and men

Pittsburgh, PA

Melody and Phillip McIntyre, both morbidly obese, tried unsuccessfully for three years after their 2003 marriage to have a child before Mrs. McIntyre decided to try a gastric bypass in hopes of increasing her fertility. Some obstetric nurse friends had told her they had seen "many success stories after the surgery."

And so Mrs. McIntyre, a nurse at UPMC-Horizon in Greenville who lives in West Middlesex, Mercer County, headed to Allegheny General Hospital for an appointment with surgeon Dr. Joseph Colella, director of the hospital's bariatric center.

"That was the first question I asked. I said, 'I want to have a baby. Can you help me?' " Mrs. McIntyre recalled.

The doctor answered "of course," talked to her and her husband about how obesity affects fertility, then suggested the same operation for Mr. McIntyre, a residential adviser for mental health patients. It was advice he followed after a cardiologist got his heart function working well enough to undergo surgery in April 2007, when he was 35 years old.

Mrs. McIntyre had her laparoscopic procedure in late October 2006 and then settled back to follow medical advice that female bariatrics patients wait a year to a year and a half -- or maybe even two years -- before trying to get pregnant in order to ensure there are no complications.

But it was Mr. McIntyre who had a complication during his 2007 procedure, hemorrhaging because his spleen had been traumatized. In going back in to find and stop the bleeding, doctors found a cancerous kidney tumor that they watched for a year before removing it all last April.

By that time, Mrs. McIntyre, now 34, was pregnant with little Trent, who was born Dec. 6. He was conceived just five months after she went off birth control.

Leslie Gore's story is even more amazing. The 24-year-old Penn Hills woman was told when she was 16 that she probably never would get pregnant because she had polycystic ovarian syndrome, a problem in which a woman's hormones are out of balance. Treated with hormones to induce periods, she steadily packed on the weight until she reached 285 pounds on a 5-foot-3 frame for a body mass index in the high 40s to low 50s.

Mrs. Gore, who is a pregnancy caseworker for Unison Health Plan, went to Dr. Dan Gagne (pronounced ga-NYAY), director of West Penn Hospital's Bariatric Surgery Center, for two reasons: in hopes of having a child and of getting healthy enough to live to raise him.

The surgery on Jan. 8, 2008 worked beyond her and husband Tyrone's wildest dreams: She got pregnant in October while still taking birth control pills. The baby is due July 4.

"We were both floored. We were completely caught off-guard," Mrs. Gore said.

She called Dr. Gagne to pass on the news and, she remembered, got this response: "I'm not surprised. Congratulations."

No wonder.

Since West Penn's bariatrics center opened in July 1999, Dr. Gagne said, "we've had at least 39 women get pregnant after bariatric surgery." Those are women who delivered full-term babies, he said, adding that at least five in the practice are pregnant now.

"Some of them had had previous pregnancies; a lot did not. A lot had diagnoses of polycystic ovary disease ... We had several who had had problems getting pregnant that did get pregnant."

Dr. Colella has had similar experience at Allegheny General and so has Dr. Anita Courcoulas at UPMC, where she is director of minimally invasive bariatric and general surgery.

"It's over 30 and that would be in six years," Dr. Colella said, "and those are the ones I know about who had infertility problems who moved on to successful conception and delivery."

One couple was so grateful that they named their son Joseph.

Dr. Courcoulas said the number of women who have become pregnant after weight loss surgery at UPMC's center in Magee-Womens Hospital is "definitely in the hundreds" but noted that the big number is due in large part to the size of the UPMC practice. "Just at Magee we do 1,100 weight-loss operations a year."

Though one recent medical bulletin from the Practice Committee of the American Society for Reproductive Medicine declared that "most obese women are not infertile," it also goes on to say, "Conversely, ovulatory function and pregnancy rates frequently improve significantly after weight loss in obese anovulatory women."

Certainly, the experiences of the Pittsburgh bariatrics doctors are that many presurgical patients are at least less fertile than normal.

"The take-home message is that fertility is certainly improved." said Dr. Ronald Thomas, director of maternal fetal medicine at AGH, whose department collaborated with Dr. Colella's on two published studies about pregnancy outcomes after the laparoscopic gastric bypass known as Roux-en-Y.

"In one article we talked about the fact that the typical advice is wait two years and stabilize before getting pregnant and the problem is many get pregnant after six, seven or eight months. ...

"[What happens is] patients begin to ovulate and get pregnant without trying to. The fertility comes back roaring into place. These patients don't realize their fertility markedly improves."

Hormones involved

Why does this happen? Doctors interviewed all cited changes in hormonal activity post-weight loss.

"A lot of times it seems to be the interplay of female hormones and fat," Dr. Gagne said. "Just as we see improvement in other health problems, this too happens in weight loss."

"I agree with that," Dr. Courcoulas said, "but we don't know exactly how."

"There's a dramatic change in the way hormones in the body are regulated after they lose all the fat cells," Dr. Colella said. "It's called the hypothalamic-pituitary axis, and its interaction with the ovaries gets reset to normal function so women begin to experience the normal circulation of hormones that trigger ovulation that occurs each month. ...

"The way we understand it in our world is the fat cells are an estrogen-producing engine and it overwhelms the axis and stops it from producing two hormones, follicle stimulating hormone and luteinizing hormone, and those two hormones are the ones responsible for triggering ovulation. So if they're not made in the appropriate amount in the appropriate time you don't get a normal ovulation event.

"And there also may be some changes in the lining of the uterus that make it less likely to allow implantation if an egg gets fertilized, but most commonly it's that they don't ovulate."

Dr. Scott Kauma, reproductive endocrinologist and director of the Jones Institute for Reproductive Medicine at the West Penn Allegheny Health System, theorized that resumed ovulation "might have to do with decreasing insulin resistance. It may be decreased circulating testosterone levels as they're losing weight or some unknown metabolic changes that stimulate the body to ovulate better. None of this is certain."

He said there's a similar uncertainty about why heavier women respond differently to other treatments, such as in vitro fertilization: "... the amount of medicine you need to use to get women to respond appropriately is much higher and pregnancy rates are lower. When I see the the pregnancy rates [of IVF] ... you're not guaranteed a pregnancy, but if you're obese the likelihood of getting pregnant compared to normal weight women is less."

Obese men are much less likely to undergo bariatric surgery because of fertility issues, but only because they are less likely to have the surgery at all. "There's an 8-2 ratio, women to men," Dr. Colella said, "but that's not because obesity is contained to women but because men are reluctant to seek help in specialty practices. The prevalance of obesity is roughly the same between men and women."

Helping men

And, Dr. Kauma said, men's fertility also is affected by their overweight.

"The heavier you are, the more of a problem you have with a lower sperm count," he said. "It may be that men who are heavy may have more estrogen floating around their bodies. The fat will convert testosterone to estrogen, and the estrogen tends to decrease the signals to the testes, which increase the sperm."

The other problem is that fat enveloping the scrotum elevates the temperature, affecting manufacturing of sperm. "The testes are in the scrotum because it's cooler there, which works better for sperm production," Dr. Kauma explained.

Though he was most interested in getting healthy and living long enough to raise a child, Phillip McIntyre said he had been told by two doctors that his fertility would be improved "and it was in the back of my mind that it would help."

Dr. Courcoulas also said she has "a couple [male patients] in the works right now [with improved fertility] as one of the reasons they're pursuing surgery."

Weight loss achieved through diet or a preferred combination of diet and exercise also would improve fertility, but, Dr. Kauma said, "90 percent of people who diet have trouble keeping it off. ...

"The most successful way to lose weight and keep it off for good is gastric bypass or banding."

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Woman has gastric bypass surgery, changes lifestyle and loses 125 pounds

Mt. Vernon, IL

A couple of years ago, Brittny Knight decided once and for all that she wanted to lose weight. Now that she has lost 125 pounds, Knight said she continues to work toward her goal in order to live life to the fullest.

Knight said that when she was younger a childhood disease caused her to gain weight. Although she received leg surgeries, Knight continued to play sports in middle school and high school. About 10 years ago Knight said she lost a substantial amount of weight, but later in her career, it was harder to remain active with her traveling job.

“With the job I wasn’t really able to exercise and I grabbed fast food a lot so I put the weight back on pretty rapidly,” Knight said. “I was tired of being unhappy, depressed and not as outgoing as I once was. I just wanted to get this weight off and be more active in live again – live life again.”

At this point, Knight decided to have gastric bypass surgery at St. Alexius Hospital in St. Louis. Although she said this surgery is not a “cure-all,” it did serve as “a little boost to get me in the right direction.”

“I kind of thought, ‘If I have this surgery it’s going to end it all,’ but that’s not necessarily true,” Knight said. “There are stipulations you have to go by. Exercise, eating right and changing my whole mental outlook on making myself healthy is what got me where I am.

“It’s a complete mental overhaul with yourself and you have to make it work. If you’re not in the right state of mind, you’re not going to be successful.”

To help reach her goal, Knight joined Curves and said she continues to work out four to five times each week. Knight also exercises by walking on weekends and throughout the summer.

Knight also eats healthier now and keeps a mental note of what she eats each week. If she’s having a craving for something like chocolate, Knight said she buys a Reese's candy bar but will only eat half. Knight noted she has also incorporated more protein into her diet, and is careful about dishes covered in cheese or sauces, and salad toppings such as croutons and dressing.

Sometimes when she goes to restaurants, Knight laughingly said she is reminded of Meg Ryan in “When Harry Met Sally” when she is ordering food and takes awhile because she’s very particular about what she wants.

“Everybody says that keeping a journal of what you eat and how much you exercise during the week is a good way to keep track and it helps you in losing weight,” Knight said. “I’ve tried keeping journals and diaries but I get kind of busy and lose track. I do keep a mental thought in my head as to what I’ve eaten and where my calories are for the day.”

Knight said that observing what she eats and how often she exercises each week also helps her when she is having a hard time losing weight. If she skipped a workout or ate something not as healthy, Knight knows how to change the next week in order to stay closer to her plan.

Throughout her journey, Knight has found it’s important to put yourself first at times in order to maintain a healthy lifestyle.

“Losing weight is something that someone must be really serious about,” Knight said. “Sometimes you have to let certain things go and say “no” once in a while to take care of yourself. If you’re not healthy, you’re not going to be able to take care of people around you.”

Eventually Knight would like to participate in a 5K or 10K walk, and she is also aiming to lose 50 more pounds. Along with support from her family, friends and coworkers, Knight said watching TV shows including “The Biggest Loser” has motivated her to reach her goals.

“It’s been an inspiration to see that they were where I was and had some of the same emotions I had about myself,” Knight said. “Watching them get to their goal weight and succeed makes me want to do even more for myself, too. Even though I’m not going to win $250,000, it’s just all about the self-esteem and the energy. I already feel like I’ve won some type of lottery anyway because I feel so much better about myself, and doing this has made me much stronger.”

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Three Illinois sisters lose over 300 pounds after gastric bypss surgery

Joliet, IL

One sister bikes, one walks the trails and one works out on the treadmill.

All of them now living healthier and happier lives after undergoing bariatric weight loss surgery at Silver Cross Hospital last July. Together, the three sisters have already lost more than 300 pounds.

“One of the reasons we decided to have the surgery was because our mom was overweight and died at age 68 of congestive heart failure,” Sandra Schmidt said. “Our dad was thrilled when we told him and is so proud of all of us that we have stayed committed to losing weight.”

Inspired by a co-worker who had weight-loss surgery, Sandra told her sisters, Andrea Russell and Pamela Bricker, about it. They decided to attend a free informational seminar held at Silver Cross.

“This was a great way to learn about the entire process,” Andrea said. “Once I learned what my options were, my apprehensions were alleviated and I became more determined to live a healthier life. Plus it has been a great support having my sisters to talk to during the entire process.”
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Their surgeon Dr. Christopher Joyce and his partner, Dr. Brian Lahmann, have performed over 1,000 weight loss procedures, including laparoscopic gastric bypass, Lap-Band and the new REALIZE gastric band system.

A Bariatric Center of Excellence, as well as a Blue Cross Blue Shield of Illinois Blue Distinction Center for Bariatric Surgery, the Silver Cross Hospital's program has a 0 percent operative mortality (death) rate and an extremely low complication rate. And patients lose an average of 86 percent of their excess body weight within four years after gastric bypass surgery.

“Our patients benefit from a multidisciplinary approach," Dr. Joyce said. "We screen them very carefully to ensure their success and safety."

Pamela says you have to be determined to stick to the program, but the support is there to help you succeed.

"We couldn't have found a better program. Dr. Joyce, his staff and the nurses at Silver Cross were all so kind, supportive and down-to-earth. We wouldn't have been so successful in our weight loss if it were not for them," Pamela said.

"Obesity is a medical condition, just like heart disease or diabetes,” Dr. Joyce stresses. “Unfortunately, there is a lot of prejudice against obese people, but this surgery can help them lose weight, and most importantly, keep it off."

“Prior to my surgery, I suffered from high blood pressure and cholesterol, diabetes and painful joints. Now I'm not taking any of those medications,” Pamela said.

“I've lost weight that I never could lose,” added her sister Andrea.

“I should have done the surgery years ago because I wasted my 40s being overweight,” Sandra said. “My life has changed dramatically. I used to have foot problems and now I don't, and my stamina is so much stronger, enabling me to play with my 7-month-old grandson.”

“The sisters are a wonderful example of how life-changing bariatric surgery can be,” Dr. Joyce. said. “Their new passion for life truly shows when you talk with them.”

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