Wife's cause of death after gastric bypass surgery still unknown to North Carolina man

North Carolina county official dies after gastric bypass surgery, cause unknown

Fayetteville, NC

A Bladen County commissioner died Saturday of complications from gastric bypass surgery.

Margaret Lewis-Moore, of Clarkton, worked in the Bladen County Schools Central Office as the child drop-out prevention coordinator. She was 55.

Her husband, Marion Moore, said the cause of death had not officially been determined, but Lewis-Moore had undergone gastric bypass surgery in Fayetteville on Tuesday.

She returned home Thursday, but soon fell ill, Marion Moore said. She died at 3 p.m. Saturday.

Lewis-Moore was in her third term on the Board of Commissioners. She was first elected in 2000.

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After bariatric surgery, bus drive loses weight and gains confidence

Tampa Bay, FL

Jackie Chandler, 51, of Thonotosassa is a longtime bus driver with the Hillsborough County School District. She decided last year to have gastric bypass surgery and has lost at least 65 pounds since. She weighed 300 pounds before the surgery.

Chandler is pictured before her surgery, above, and after it, below. Since the surgery, there are things she can't eat, like pasta and ice cream. But her sleep apnea problems have subsided, and her diabetes medications have been cut.Chandler is pictured before her surgery, above, and after it, below. Since the surgery, there are things she can't eat, like pasta and ice cream. But her sleep apnea problems have subsided, and her diabetes medications have been cut.
Chandler is pictured before her surgery, above, and after it, below. Since the surgery, there are things she can’t eat, like pasta and ice cream. But her sleep apnea problems have subsided, and her diabetes medications have been cut.

Every year, about 250,000 people in the United States undergo surgery to lose weight, paying — or having their insurance companies pay — tens of thousands of dollars for procedures that essentially restrict how much food they can take in.

But are the surgeries safe? Do they work? And can they help treat diabetes, hypertension and other conditions caused or made worse by obesity?

Increasingly, the answer in the medical community is yes, yes and yes.

Doctors and others are bolstered by studies like one this month that showed improved outcomes and lower complication rates among Type 2 diabetes.

And they're encouraged by the endorsements of groups like the American Society for Nutrition and the Obesity Society, which called bariatric surgery "the most effective weight-loss therapy for obesity." Or the American Diabetes Association, which last year for the first time recommended bariatric surgery as a treatment option.

"We would not have imagined that day 10 years ago," Tampa bariatric surgeon Michel Murr said of the Diabetes Association's endorsement. "We've seen quite a shift of attitude."

Such acceptance likely will lead to a continued increase in surgeries, but also place greater pressure on public and private insurers to cover more of them.

Still, Murr and others caution that bariatric surgery is a major medical procedure and isn't for everyone, such as children and adolescents, or adults who are overweight but not considered obese. They also don't consider surgery a magic bullet for curing the country's obesity epidemic.

"We only operate on about 250,000 patients a year from a population of 30 million in the U.S. who are obese," Murr said. "In that regard, what are we going to do with the other 29,750,000?"

• • •

Most patients choose either a gastric bypass, which involves cutting and stapling the stomach, or gastric banding, which places an adjustable silicone ring around the top portion of the stomach. In both cases, a smaller pouch is created — the idea being that with less food filling a smaller stomach, patients lose weight.

Acceptance among the medical community has come slowly. Though the first procedures were performed in the 1960s, it was relatively uncommon even through the early 1990s.

"It was a very narrow field," said Murr, who started the bariatric surgery program at Tampa General Hospital in 1998. Primary care doctors weren't referring their obese patients for surgery. And most insurance wasn't covering it.

Murr said a number of factors helped shift the landscape. For one, more Americans were becoming obese. And second, the surgeries became safer and less invasive with the introduction of the laproscopic approach in the 1990s, which used several smaller abdominal incisions instead of a large one. Another major advance was the introduction of adjustable gastric bands in the past decade.

Then came the studies that showed the procedures were safer, had better outcomes and helped reduce or even eliminate chronic conditions associated with obesity. The most recent study appeared this month in Archives of Surgery, which showed lower complication rates and shorter hospital stays for Medicare beneficiaries who had the procedure after Medicare implemented certain criteria for prospective patients.

Medicare covers the procedures for people who are severely obese (body mass index of 35 or higher) and have a condition associated with obesity such as diabetes.

How much has the landscape changed?

"About half of the patients sent to my practice are directed by physicians," says Dr. John Baker, president of the American Society for Metabolic & Bariatric Surgery, who performs about 240 procedures a year at his Little Rock, Ark., practice.

• • •

But what about losing weight through diet and exercise?

Other studies have shown it is possible. The Louisiana Obese Subjects Study released this past month showed successes when placing participants in a structured medically supervised program.

And then there are the morbidly obese contestants on the popular TV show The Biggest Loser, who season after season lose large amounts of weight through improved diet and an intense exercise regimen.

Baker says those successes tend to be few and far between. Plus, "not all of us have a trainer that's going to push us to the limit every day."

• • •

Murr says people like Jackie Chandler are becoming a more typical obesity success story. The 51-year-old Hillsborough County school bus driver struggled with diabetes and sleep apnea and carried 300 pounds on her 5-foot-8 frame before deciding last year to have a gastric bypass surgery. Her BMI was 44.

Her insurance company, Humana, covered the procedure, which Murr said typically costs about $27,000 (gastric band procedures cost about $17,000).

Since Murr performed the surgery last September, Chandler has lost 65 pounds, no longer has trouble sleeping and is taking one medication for diabetes, instead of five.

Though the results so far have been positive, Chandler knows the surgery was just a tool to help her lose weight. The rest, she says, is up to her.

"I can't eat as much as I'd like to," she says. "Can't eat spaghetti anymore. Can't eat ice cream or chocolate." Patients have some dietary restrictions after surgery, and some experience nausea with certain foods.

And it's early. Studies suggest that bariatric patients can regain a significant amount of their lost weight. One 2004 study in the New England Journal of Medicine found that the percentage of weight lost for gastric bypass patients decreased from 38 percent after one year to 25 percent after 10 years.

But, the study notes, the improvement in their chronic conditions such as diabetes mitigated the fact they regained some weight.

Studies have also found that gastric bypass patients can suffer from vitamin and mineral deficiencies if they don't carefully manage their diets.

• • •

Surgeons say there's still a long way to go toward addressing the nation's obesity problem.

The percentage of obese people having bariatric surgery is small. And though surgery is covered for Medicare beneficiaries who meet certain criteria, insurance coverage for the general population is limited.

Humana, for example, doesn't offer it as a standard benefit; rather, it's offered as a buy-up option for employer groups with more than 3,000 members, said Dr. Jill Sumfest, the company's market medical officer for Central Florida. Currently, five groups in Central Florida offer it.

Members need to meet certain age and BMI requirements, and must have participated in a physician-directed weight management program for at least six months in the last two years.

Murr feels that's too restrictive. After all, he says, you don't tell someone that they have to have breast cancer or heart disease for a minimum period before you cover them.

He says Medicare has led the way for coverage; now it's up to private insurance companies and employers to recognize the benefits.

"There are enough studies now that the operation will pay for itself in two to three years . . . with the reduction of costs associated with other illnesses like hypertension, sleep apnea and diabetes," Murr said.

Both Murr and Baker say the real solution lies in comprehensive obesity management programs that include surgery as a choice. They say programs should include ways to curb the rising obesity rates among children and adolescents, such as better nutrition in schools and increased physical activity.

So, is the goal to get people to manage their weight so they don't get to the point where they need surgery?

"That's too ideal," Murr said.

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Gastric band surgery can help extend lives of obese people, says study

New York, NY

A new study backs up the belief that bariatric surgery is beneficial for losing weight and extending the lives of obese men and women.

But the precise pluses of the procedure vary by individual and are influenced by many variables, including a patient’s age, weight and gender, according to the Guardian.

The research was carried out at the University of Cincinnati Academic Health Center.

In one type of bariatric surgery, a physician wraps a band around the patient’s stomach, reducing its size. Because they feel full faster, people eat less.

Over time, they shed weight, which helps to prevent heart attacks, strokes and type 2 diabetes, according to The Guardian.

Bariatric surgery is typically given to people whose body mass index (BMI) is over 40.

But because any type of surgery comes with risk, including infection, other complications and even death, the study looked at potential positive outcomes versus the inherent danger of undergoing the knife.

Age was a significant variable, since younger patients undergoing surgery are less apt to die from surgery or develop complications.

Researchers found that for a 42-year-old woman with a body mass index of 45, weight-loss surgery could extend her life by up to 3 years.

A 44-year-old man with a BMI of 45, reaped slightly less dramatic results. He could expect to increase his life by 2.6 years after surgery.

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"Gastric Banding" not a stand-alone weight loss solution

Buffalo, NY

Medical Edge from Mayo Clinic
January 8, 2010
DEAR MAYO CLINIC: Lately, I've seen a lot of advertisements for lap band surgery for weight loss. How is this different from bariatric surgery, which I don't hear as much about lately? Does it work? What are the dangers?

ANSWER: Bariatric surgery is a general term used to describe operations that help a person lose weight more consistently and effectively. The two most common types of bariatric surgery performed in the United States are adjustable gastric banding -- sometimes called lap band surgery -- and gastric bypass surgery.

In general, adjustable gastric banding is safe, and serious complications are uncommon. Gastric banding helps people lose weight by restricting the amount of food they can eat. But it's not a stand-alone weight loss solution. For the procedure to be effective, people must be carefully screened to ensure they are good candidates for gastric banding. Follow-up care, along with exercise and healthy eating, also are key to long-term weight loss for people who undergo adjustable gastric banding.

Adjustable gastric banding involves placing a small, inflatable band around the upper part of the stomach to restrict the amount of food that the stomach can hold. The band is filled with fluid that can be added or removed as needed through a small tube (port) placed under the skin. Fluid can be added to constrict the stomach if the band isn't tight enough and allows in too much food. Or, fluid can be removed if the band is too tight and is causing problems such as vomiting.

In gastric bypass surgery, the surgeon staples the stomach to make a small pouch and then connects the pouch to the small intestine, creating a passage (bypass) around most of the stomach, as well as the first section of the small intestine (duodenum).

Both procedures limit the amount of food that can fit in the stomach. Also, after both procedures, people feel full much sooner than normal, which helps decrease the amount of food they eat. One of the noticeable differences between adjustable gastric banding and gastric bypass -- and the one frequently talked about in advertising for gastric banding -- is that gastric bypass surgery usually requires a two-day hospital stay, whereas adjustable gastric banding can be done as an outpatient procedure.

Adjustable gastric banding is a low-risk procedure that's less complex than gastric bypass surgery. But as with any medical procedure, complications are possible. With adjustable gastric banding, complications can include infection of the band or the port, and movement of a portion of the stomach -- that's supposed to be below the band -- up through the band (slippage). The most serious complication associated with adjustable gastric banding is erosion of the band. This occurs when the band works its way inside the stomach, usually as a result of an infection or ulcer. Erosion is very rare, however, occurring in less than 1 percent of gastric banding cases.

Adjustable gastric banding can be an effective way to help people lose weight. It's not for everyone, though. First, if you're considering this procedure, be aware that people who have adjustable gastric banding generally have a slower rate of weight loss than those who have gastric bypass. There's nothing wrong with this, but it is something to consider prior to undergoing the surgery. Average weight loss is about one-third to one-half of a person's excess weight.

Like all bariatric procedures, gastric banding is intended for people who have a body mass index (BMI) of 40 or above or for those who have a BMI between 35 and 40 with a serious weight-related health problem, such as diabetes, high blood pressure or heart disease. In addition, this surgery isn't recommended for people who have certain medical conditions, such as Crohn's disease, large hiatal hernias or connective tissue disorders.

Finally, adjustable gastric banding isn't a cure-all. Follow-up care is critical because all patients need some adjustment of the band after surgery to ensure optimal weight loss. Even after having this operation, patients still need to consistently make good food and exercise choices in order to lose weight. In essence, gastric banding provides people with an opportunity to consistently take in a smaller amount of calories while they're moving forward with the other healthy steps that are necessary to lose weight. -- James Swain, M.D., Gastroenterologic and General Surgery/Director of Bariatric Surgery, Mayo Clinic, Rochester, Minn.

(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge@mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For more information, visit www.mayoclinic.org.)

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Better gastric bypass surgery outcomes linke to preoperative weight loss

Trenton, NJ

Preoperative weight loss is associated with fewer complications after gastric bypass surgery, according to the results of a record review reported in the December issue of Archives of Surgery.

"Despite the improved ability to accurately predict an increase in surgical risk, the optimal preoperative preparation of such high-risk bariatric surgery candidates remains controversial," write Peter N. Benotti, MD, from Saint Francis Medical Center in Trenton, New Jersey, and colleagues.

"Proposed risk-reducing strategies supported by varying degrees of evidence include staged surgical procedures, preoperative gastric balloon placement for weight loss, and preoperative medical weight reduction....Because the major determinant of postoperative length of stay is operative morbidity, we hypothesized that preoperative weight loss will reduce the frequency of surgical complications in patients who undergo bariatric surgery."

At a comprehensive, multidisciplinary obesity treatment center at a tertiary referral center serving central Pennsylvania, the investigators reviewed records of 881 patients undergoing open or laparoscopic gastric bypass surgery from May 31, 2002, through February 24, 2006. Before surgery, all patients underwent a 6-month multidisciplinary program with the goal of achieving a 10% preoperative weight loss. The primary endpoints of the study were loss of excess body weight and rates of total and major complications.

Loss of 5% or more excess body weight was achieved by 592 (67.2%) of the 881 patients and loss of more than 10% excess body weight by 423 patients (48.0%). Compared with patients undergoing laparoscopic gastric bypass surgery (n = 415), those referred for open gastric bypass (n = 466) were generally older (P < .001), had a higher body mass index (P < .001), and were more often men (P < .001). In addition, they had higher total complication rates (P < .001) and major complication rates (P = .03) vs patients undergoing laparoscopic gastric bypass surgery. Increased preoperative weight loss was associated with decreased rates of total complications (P = .004) and, most likely, decreased rates of major complications (P = .06), based on univariate analysis. In a multiple logistic regression model controlling for age, sex, baseline body mass index, and type of surgery, increased preoperative weight loss predicted reduced rates of total complications (P = .004) and major complications (P = .03). "Preoperative weight loss is associated with fewer complications after gastric bypass surgery," the study authors write. "We hope that these findings will be confirmed by prospective, controlled trials and that bariatric surgeons will consider this modality for preoperative risk reduction in selected patients who are deemed high risk for complications after surgery." Limitations of this study include retrospective design, lack of a control group, referral bias, and possible unmeasured confounding variables. In an accompanying invited critique, Patricia L. Turner, MD, from the University of Maryland Medical Center in Baltimore, recommends emphasizing an aggressive preoperative weight loss regimen. "Overall, this article presents the largest study thus far, to our knowledge, which may demonstrate a significant advantage to preoperative weight loss," Dr. Turner writes. "Moreover, the authors did not experience the attrition feared by some surgeons should they require preoperative weight loss of their patients. These findings suggest that consideration be given to incorporating either a suggestion of or the requirement for modest weight loss prior to bariatric surgery as a means of decreasing postoperative complications."

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Gastric bypass surgery: Couple sticks together through thick and thin

Lehi, UT

A couple in Utah County went under the knife together on a weight loss journey in hopes of losing hundreds of pounds.

The couple is Mike and Lorena Downey. The two took their vows 26 years ago promising to love each other in good times or bad, for better or for worse, in sickness and in health and to see each other through thick and thin.

When they married, in 1983, Mike and Lorena had a combined total weight of just under 300 pounds, but this year they tipped the scales at almost 600 pounds.

“I look in the mirror, I’m not happy with who I see. When I got to 270 pounds it blew my mind. I couldn’t believe it. I was so close to 300 pounds,” said Lorena.

Although the Downeys were happily married with children, their weight slowly started to come between them.

“How could you look at your wife and say you’re not the woman I married, when you’re looking at yourself and saying you’re not the man she married,” said Mike.

The two knew something had to be done and began researching options. In a desperate effort to shed the weight they turned to gastric bypass surgery. After deciding that the surgery’s pros outweighed the cons they chose to do the surgery together.

They went to St. Mark’s hospital where Lorena had her surgery on October 7th and Mike had his one week later.

Gastric bypass surgery is growing more popular every day as America’s obesity epidemic tips the scales. The surgery has been known to save lives but there can also be life changing drawbacks.

Their journey consisted of three trips to the ER during the week of Mike’s surgery and complications for Lorena resulting in two additional surgeries.

Both are fine and after just five weeks the couple has lost nearly 100 pounds. They have been walking everyday and both say they’re feeling better and have more energy.

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3 Years after gastric bypas surgery, man loses 259 pounds and competes in triathalons

St. Petersburg, FL

Three years ago, Chad Soileau was sitting in a roller coaster seat at Six Flags amusement park near Washington, D.C., when he was overcome with panic. He had waited in line for more than an hour for the four-minute ride on the Wild One, but when it came time to buckle up, the seat belt wouldn't fit.

"The attendant walked up and told me I was too big for the ride," recalled Soileau. "She yelled back to her co-workers, 'Bring the tool, we've got a large rider.' "

Five minutes seemed like an eternity as the crew struggled to extend the roller coaster's seat belt.

"Hundreds of people were watching," Soileau said. "It was the most humbling, humiliating experience of my life."

Afterward, Soileau stumbled off the ride and ran to the nearest restroom. "My stomach was in knots," he said. "I vomited for 10 minutes."

On Nov. 14, a very different Soileau will again face an audience — but this one will be cheering his remarkable achievements.

The Louisiana man will be among the 1,500 or so elite athletes who will gather on Clearwater Beach to swim 1.2 miles, bike 56 miles and run 13.1 miles in the Ironman World Championship 70.3. (The name comes from the combined distance of the three events, which is half the distance of the world famous Ironman World Championship held each October in Kona, Hawaii.)

"It has been a long road to get here," said Soileau, 37. "And I still have a long way to go."

Team 464

Despite the trauma of the roller coaster incident, it wasn't until a few months later that Soileau realized the full extent of his obesity.

"I was on the scale at the doctor's office when he asked if I knew how much I weighed," he said. "I figured about 350. He said no, 464."

Soileau couldn't believe he was off by 114 pounds. He made up his mind, then and there, that he would do something about his weight.

On March 22, 2006, he underwent gastric bypass surgery. "I call it my re-birthday," he said.

The surgery came with complications. He developed several blood clots and had to undergo three additional surgeries, including one to have his gallbladder removed and another to repair a twisted bowel and an internal hernia. But Soileau persevered.

Soileau was 34 when he started his weight-loss journey. Overcoming his longtime addiction to food was his first obstacle.

"I used to order double of everything . . . two appetizers, two entrees, two desserts," he said. "When I would go to the drive-through I would pretend there was somebody else in the car because I was ordering so much food."

Weight-loss surgery is no sure bet; plenty of people regain weight after the procedure. But after his surgery, Soileau found it easier to control his urges. (See related story, Page 12.)

"Physically I couldn't eat as much," he said.

The physical changes soon were followed by emotional ones. "After a while I stopped wanting the food,'' he said.

The victories piled up. One day, he discovered he could bend over to tie his shoes. "It was a huge accomplishment for me when I could get in my truck without my stomach hitting the steering wheel," he said.

Soileau set weight goals, which he published on his Web site, www.Team464.com:

"Weigh less than 400 pounds — DONE!''

"Weigh less than 350 pounds — DONE!''

He also kept track of his progress by his pants size: He went from a size 64 to a size 34.

ONE STEP AT A TIME

As he recovered from the surgery and started to drop pounds, he began to exercise.

He started off small, walking back and forth to the stop sign a block from his house. Gradually, his walks got longer and longer. Eventually, he started running, then swimming, then biking.

"I came up with a list of goals for myself," he said. "One of them was to complete a triathlon."

To help him reach his goals, he kept a training log.

"At first it was just a mile, then 2 miles, then 3 miles," he said. "The whole time I dreamed about completing a marathon."

Soileau, who has a girlfriend, works as a Web site designer in New Orleans. He struggles to find time for the one to two hours of daily training a triathlon requires. As for his diet, he focuses on fruits, vegetables, whole grains and lean protein to help power his new physique.

The discipline paid off. In February 2008, Soileau finished the Mardis Gras Marathon in New Orleans with a time of 5 hours and 36 minutes.

IRONMAN

Soileau has completed dozens of road races and triathlons. He was invited by the World Triathlon Corporation to be its guest at this year's event in Clearwater. Officials hope Soileau's story will inspire others to try the sport.

"It is an honor to be here," he said. "What other sport lets you share the course with the pros?"

But despite his success, Soileau doesn't feel as if he has won his battle against obesity. He won't feel victorious, he said, until he completes a full-distance Ironman.

"I will know I won when I step over the finish line and I hear the announcer yell, 'Chad Soileau, you are an IRONMAN!' "

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Beverly Hills bariatric surgeon claims he performs most lap band surgeries

Beverly Hills, CA

Dr. Michael Feiz, lead surgeon at the Beverly Hills Comprehensive Weight Loss Center, has performed more Lap Band surgeries than any other doctor. For overweight Los Angeles residents, Lap Band surgery is the answer they have been looking for to shed the unhealthy weight and return to a more active life. Performed laparoscopic with almost no scarring, Lap Band surgery has the added benefit of enabling the patient to control their weight loss progress. Unlike gastric bypass surgery, Lap Band surgery does not involve the permanent reduction in size of the stomach. Instead, a small cinched section of plastic is placed around the upper area of the stomach, creating a temporarily shrunken stomach area for food to pass through. The other factor that makes Lap Band surgery so unique from gastric bypass is that the Lap Band is connected to a port that enables adjustment of the amount of solid food that can pass through the stomach. Finally, Lap Band
surgery is so attractive because it can be easily reversed by simply removing the Lap Band if something goes amiss.

A pioneer in successful Lap Band surgery, Dr. Michael Feiz of the Beverly Hills Comprehensive Weight Loss Center has performed the world's most cosmetic Lap Band surgery. With degrees from UCLA, New York Medical College and a residency and fellowship at USC Medical Center and Cedars Sinai, Dr. Feiz is highly trained and skilled in Bariatric and minimally invasive surgery. All prospective Lap Band surgery patients who visit the Beverly Hills Comprehensive Weight Loss Center must first undergo a full 360 degree evaluation of their health - mental and physical - as well as their habits and attitudes toward exercise and food.

Typical Los Angeles Lap Band surgery patients lose multiple pounds per week, but the real success after Lap Band surgery is keeping the weight off. The Beverly Hills Comprehensive Weight Loss Center ensures that their Lap Band surgery patients lose the weight and keep it off. So many people turn to the Beverly Hills Comprehensive Weight Loss Center due to the success rate of this center.

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Single-incision gastric sleeve, gastric bypass surgery alternative

Houston, TX

There's a new weight loss surgery option available in Houston that doctors say is less invasive and allows patients a faster recovery. It could offer patients as much weight loss as the "gold standard" weight loss procedure, gastric bypass.

Denise Abrego-Carter is about to undergo a new procedure to help her lose weight. It's called the single-incision gastric sleeve.

She said, "He guarantees me about 70-80 pounds."

The "sleeve" procedure is similar to the more radical gastric bypass. But unlike gastric bypass, the "sleeve" requires only one incision and is a less complicated surgery.

Dr. Sherman Yu, a Memorial Hermann bariatric surgeon, explained, "With this newer procedure people are actually losing just as much weight as a gastric bypass, but the risks are about half the gastric bypass because we're not rerouting any of the intestines."

Surgeons go through the belly button to do the surgery which allows for less pain, faster recovery and better cosmetic results. It was an attractive idea for patients like Rebecca Hammonds. She had the surgery in May.

"I've seen absolutely fantastic results. I'm so thrilled," she said. "I did not like the idea of having an implantable device inside of me so that's why I didn't go with the band."

Hammonds has already lost 70 pounds in about four months and is thrilled. But what really surprised her were the other health benefits she gained from getting the gastric sleeve procedure.

"The increased energy, how much better I feel," Hammonds said. "Before surgery I had a lot of hip pain and I'd come home from work and I could hardly walk, I was hurting so bad. And now I get home and I can deal with my children and play with them."

For the doctors, that's what makes it all worthwhile.

"People are losing, again, 60, 70, 80 percent of their excess body weight," said Dr. Yu. "But more importantly, really what we focus on is that their medical problems get better."

"I haven't been ill. I haven't been really sick," Hammonds said. "I'm losing weight and feeling great."

Dr. Yu and Dr. Terry Scarborough of Memorial Hermann are the only doctors in Houston performing the single incision gastric sleeve procedure. They are currently training other surgeons around the country how to do it.

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California woman seriously ill after gastric bypass surgery finds hope

Modesto, CA

Tests have shown that Sandi Krueger's golf-ball-sized pouch no longer breaks down the food she eats, but dumps it directly into her small intestine. Before the feeding tube, her attempts to eat caused nausea and she often had dumping syndrome, a reaction when certain foods pass too quickly into the intestine, resulting in sweating, rapid heart beat and weakness.

Her journey began in 2002 with a gastric bypass at Doctors Hospital of Manteca, which later closed its bariatric program. She had constant dumping and severe weight loss, had a falling out with her surgeon and went to the University of California at San Francisco for corrective surgery in 2004.

Her condition improved for several months and then her condition gradually deteriorated. She stopped working as a nursing assistant last year and then UCSF rejected her request for a reversal surgery.

Repairs are complex

She's made the 165-mile trip to Delano because Keshishian accepted her Medi-Cal coverage and he specializes in revising or reversing gastric bypasses. A reversal has some of the same risks as gastric bypass; in addition, the surgeon must deal with scar tissue that grows between the left side of the liver and upper part of the stomach.

"You have to peel the stomach away from the liver," Husted said. "It's tricky and can take a long time."

Many patients who aren't absorbing enough nutrients can improve with counseling and treatment, experts say.

Until her surgery is scheduled, Krueger will stay with the tube- feeding routine — 44 ounces of water mixed with a formula of protein, vitamins and other stuff costing the family $549 a month. With her husband drawing unemployment, it strains the family budget, but at least she feels healthy.

"It is nice to be a mom again," she said. "It feels like I have missed six years of my life."

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Gastric bypass surgery death rates drop, study reveals

Seattle, WA

Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.

The study looked at safety results for gastric bands and stomach stapling at 10 U.S. hospitals specializing in these procedures from 2005 through 2007. For every 1,000 patients, three died during or within a month of their surgery, and 43 had a major complication.

That is much better than the 20 or so deaths per 1,000 patients that studies found just a few years earlier. And it's surely lower than the longer term risk of dying of heart disease, diabetes and other consequences of lugging around more pounds than an obese person's organs can handle, experts say.

Many studies have compared those odds, and "all show a higher risk of dying if you do not have surgical treatment than if you do," said Dr. Eric DeMaria, weight loss surgery chief at Duke University Medical Center.

He had no role in the new study, which was led by Dr. David Flum at the University of Washington in Seattle. Results appear in Thursday's New England Journal of Medicine.

About one-third of American adults are obese, with a body mass index of 30 or more. The index is based on height and weight. Someone who is 5-feet-4 is obese at 175 pounds; a 6-foot person is obese at 222 pounds.

Federal guidelines say obesity surgery shouldn't be considered unless someone has tried conventional ways to shed pounds and has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

Last year, at least 220,000 obesity surgeries were done in the United States, says the American Society for Metabolic & Bariatric Surgery. The most popular method is a gastric bypass in which a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. This can be done with traditional surgery or laparoscopically, through small keyhole incisions.

Another solution is a gastric band. A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

The new study looked at the safety of these methods in 3,412 gastric bypass patients and 1,198 given stomach bands.

Death, serious complications or the need for another procedure occurred in 1 percent of people receiving bands, nearly 5 percent having laparoscopic gastric bypass, and nearly 8 percent of those given a traditional surgical bypass. Maybe

DeMaria cautioned against comparing the numbers, because healthier people may have been steered toward laparoscopic procedures that may not have been an option for others with more health risks.

Complication rates were greater in people with a history of clot problems, sleep apnea and certain other medical issues, the study found.

The federal government paid for the study. Many of the researchers have ties to companies that make obesity treatments, and several have testified in surgery lawsuits.

The results put the spotlight on cost issues, Dr. Malcolm K. Robinson, a surgeon at Harvard Medical School, wrote in an editorial accompanying the study.

"In the past, now outdated bariatric procedures carried unacceptably high risks. The weight loss associated with the procedures was questionable, and the long-term health benefits were unproven," he wrote.

Now, the evidence shows that "surgery is safe, effective, and affordable," because it can lower doctor visits, medication use and other medical expenses, Robinson wrote. However, "the expense of operating on the millions of potentially eligible obese adults could overwhelm an already financially stressed health care system."
On the Net:

* New England Journal: http://www.nejm.org
* National Institutes of Health surgery explanation: http://win.niddk.nih.gov/publications/gastric.htm

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Comedianne Mo'Nique becomes weight loss leader

Philadelphia, PA

Lately, the blogosphere has been blowing up over two big sisters: comedian Mo'Nique and President Obama's pleasingly plump new surgeon general, Dr. Regina Benjamin.

There's so much controversy that I'll need two columns to address it all. First, let's talk about Mo'Nique.

Actress-comedian Mo'Nique Imes Jackson, author of "Skinny Women Are Evil" and "Skinny Cooks Can't Be Trusted," has lost 40 pounds. Rumors have been flying that she had gastric bypass surgery, which she flat- out denies. But that hasn't appeased the size-acceptance camp, whose members are angrily abuzz about the weight loss she disclosed in a recent interview with Jet magazine.

In the interview, Mo'Nique says she knew it was time to lose weight when her husband, Sidney Hicks, watched her step off the scale at 262 pounds and said, "Baby, that's too much, and I want you for a lifetime."

Now the 5-foot-6-inch star is making the necessary sacrifices and has vowed to get her weight down to 200 pounds.

"This was truly making the commitment to watch what I eat and commit to working out," she said. "I stopped eating red meat. I want to say to big people, 'Let's be healthy big people. Everybody can't be a size 0, but let's be healthy.' "

Her efforts are worthy of applause. So why the criticism?

It is true that for years, this fat and fabulous one has been a champion for size acceptance. She has made a generous living dissing so-called "skinny bitches" while encouraging fat women to stay, well, fat.

Mo was always the first to say how proud she was to be representing for the big girls. So is this some sinister plan she's made to unleash an internal skinny bitch who's been dying to get out?

I don't think so.

Quite frankly, it has always stupefied me why the plus-size community feels betrayed when a plus-size celebrity - or a friend, for that matter - decides to slim down. Why are efforts at living a healthier lifestyle viewed as a personal affront?

Mo'Nique shouldn't be shunned for losing weight. Even if she reaches her goal of 200 pounds, she'll have a BMI of 32.3, which still makes her medically obese.

Would size acceptance groups prefer that Mo'Nique eat herself into disease, disability or death?

I suspect that fat advocates' swagger and confidence is really false bravado. Embracing your size does not make your health problems disappear. None of us has the luxury of throwing in the towel on a healthy lifestyle of daily exercise and good nutrition.

From where I sit on the front lines, it's clear we cannot continue this masquerade. And this is especially true for black folks. Black women, who have the highest overweight and obesity levels of any U.S. population, cannot afford false bravado. We need solutions. We need to keep it real with ourselves and take control of our health.

Why can't we be honest with ourselves and admit that being overweight or obese is not healthy? Why don't we understand that this hits the black community especially hard?

It's not healthy to carry an extra 20 pounds, let alone 100 pounds. Our bodies are just not designed for this type of trauma.

I have seen enough premature death, disease and disability in the black community to confirm the truth. I don't even have to cite the statistics on this, but I will.

If you are still on the fence about where black women are on the obesity front, then check this out:

_ African Americans, particularly African-American women, need to protect themselves against the ravages of obesity, which strikes us harder than any other group.

According to the Centers for Disease Control and Prevention Web site, 31.2 percent of African Americans were obese in 2001, up from 19.3 percent from the previous decade. That's a whopping increase in just 10 years. And experts say that today, half of all African-American women are obese.

_ African Americans suffer disproportionately from heart disease, hypertension, and diabetes, among other lifestyle-related diseases.

Surely, Mo'Nique is aware of all this. Now she's on the precipice of change.

Mo'Nique has the extraordinary potential to save some lives. Her decision to tackle her weight may influence more women to take charge of their health.

Can you imagine it? Maybe, just maybe, Mo'Nique is going to help lead the battle against obesity. Could she be the one to kick-start Obama's new health initiative? And will she get some help, perhaps, from a recent Obama appointee?

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New study claims gastric bypass and gastric banding weight-loss surgery safe

St. Louis, MO

Obese patients who undergo weight-loss surgery have a low risk of dying or developing complications that require a second surgery or longer hospital stay, a study found.

About 4.1 percent of 4,610 people in the study who had either gastric bypass surgery or gastric banding developed at least one major complication in the 30 days after surgery, according to research published today in the New England Journal of Medicine. Those who underwent gastric banding had fewer complications.

Weight-loss surgery has soared in popularity in the U.S. The number of such operations rose more than tenfold to about 171,000 in 2005 from about 16,200 in 1994, according to an editorial in the journal. The data shows that, at least in the short term, these procedures are relatively safe and future research may help identify which surgery is best for a particular patient, said study author Bruce Wolfe, a professor of surgery at Oregon Health and Science University in Portland, in a telephone interview. Based on the findings, he said, "the surgery is basically safe."

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Gastric bypass surgery using robots reduce pain and speed recovery

Phoenix, AZ

Gastric bypass surgery has gone robotic at one Arizona hospital.

Using robots, doctors at Banner Gateway Medical Center can perform the surgery from inside the person's body, KPHO-TV reported.

"The robot allows you to perform the surgery (not only) in high definition, but also in three dimensions," said chief of surgery Dr. Rob Schuster.

Schuster said the procedure is less invasive and painful and it cuts the risk of infection.

Doctors use state-of-the-art technology with a three-dimensional image of the surgical area. The display controls the surgical instruments, working with the doctors' hands, wrists and eyes in real time.

"It really allows us to perform a more precise and perfect operation," Schuster said.

Schuster said the new procedure will result in shorter hospital stays and shorter recovery times, so patients are able to return more quickly to their normal routines.

Banner Gateway Medical Center is one of only a handful of hospitals in the country that use this technology.

KPHO's report did not address any additional costs or risks from the assisted surgery.

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Weight-loss surgery may decrease the risk of cancer in women

from CancerConsultants.com

Researchers from Sweden have reported that weight-loss surgery (bariatric surgery) was associated with a reduced incidence of cancer in obese women but not in obese men. The details of this study appeared in an early online publication in Lancet Oncology on June 24, 2009.[1]

Previous studies have suggested that obesity increases the risk of developing cancers of colon, rectum, liver, gallbladder, pancreas, breast, uterus, cervical, ovary, and kidney as well as lymphoid tumors such as non-Hodgkin’s lymphoma and multiple myeloma. It has been estimated that obesity increases the cancer death rate in men and women by more than 50%. It has been suggested that obesity causes 14% of all cancer deaths in men and 20% of all cancer deaths in women in the United States.

Weight loss surgery is usually the last resort for morbidly obese individuals when diets fail. Weight loss surgery refers to various procedures that restrict nutrient intake such as bands or bypasses. (See Wikipedia [http://en.wikipedia.org/wiki/Bariatric_surgery] for descriptions of the various surgical procedures currently being used.)

The current study evaluated the risk of cancer in 2,010 obese patients with a body mass index greater than 34 kg/m2 in men and greater than 38 kg/m2 in women who underwent weight loss surgery. Outcomes were compared with 2,037 controls who were comparably obese but did not opt for weight loss surgery. The median follow-up of this study was over 10 years.

* Weight loss surgery was associated with a 20 kg weight loss over the 10 years of observation compared with a 1.3 kg gain in controls.
* There were 117 cancers in the surgery group and 169 in the control group.
* There were 79 cancers in women in the surgery group and 130 in the control group.
* There were 39 cancers in men in the surgery group and 39 in the control group.
* Similar results were obtained when cancers developing in the first three years from surgery were excluded.

These authors concluded: “Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men.”

Comments: This is the first study to document a decreased risk of cancer following significant weight loss. It is very interesting that this decreased risk was limited to women. This may suggest that cancers in women are more hormonally dependent than in men. It has been speculated that hormones produced by fat may be the cause of increased breast, uterine, and ovarian cancer risk in obese individuals.

References:

[1] Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncology [early online publication]. June 24, 2009.

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Studies underway to determine why obesity surgery thins bones

from Red Orbit

Experts say melting fat from obesity surgery somehow thins bones and even suggest that patients who undergo these procedures might have twice the average person's risk for a fracture, and are more likely to break a hand or foot, The Associated Press reported.

Further research is now under way to see if The Mayo Clinic's finding is significant. But specialists say uncovering long-term side effects from bariatric surgery and how to counter them takes on new urgency as more and more overweight people are electing to try it.

Dr. Shonni Joy Silverberg of Columbia University told last week's annual meeting of The Endocrine Society that these procedures are now being sold as a panacea.

"It is of heightened importance to find the answers to these questions," he said.

And perhaps the only positive thing you'll ever hear a doctor say about too much fat is that obesity actually is considered protective against bone-weakening osteoporosis.

Mayo bone-metabolism expert Dr. Jackie Clowes said overweight people are starting out better than most of us when it comes to staving off osteoporosis.

Therefore, researchers are working towards answering whether those who undergo the procedures really end up with worse bones, or just go through a transition period as their bones adjust to their new body size.

In the United States, some 15 million people are classified as extremely obese (100 pounds or more overweight). With rampant diabetes and other health problems, surgery is fast becoming the preferred treatment.

Options include stomach stapling called gastric bypass to less invasive stomach banding procedures, where patients tend to lose between 15 percent and 25 percent of their original weight — dramatically improving diabetes symptoms.

The American Society for Metabolic and Bariatric Surgery shows that more than 1.2 million U.S. patients have undergone the surgery in the past decade, 220,000 in the last year alone.

Now large National Institutes of Health studies on both adults and teens are underway to find more data on how patients fare many years after the surgeries.

However, doctors know that radical weight loss can speed bone turnover until the breakdown of old bone outpaces the formation of new bone.

A year after gastric bypass, adults' hip density drops as much as 10 percent, raising concern about a common fracture site of old age, according to more recent studies.

And while almost half of peak bone mass develops during adolescence, more research is needed to determine if teen bones react similarly.

The Mayo team is comparing the medical records of nearly 300 adults who've had bariatric surgery with similarly aged Minnesotans who haven't, to see if such changes translate into fractures.

Mayo's Dr. Elizabeth Haglind told the endocrinology meeting that a quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years. That group had twice the average risk six years after the surgery.

Interestingly, the surgery recipients had three times the risk of hand and foot fractures than their Minnesota neighbors.

Dr. Scott Shikora, president of the bariatric surgeons group, said he was shocked at the numbers because he hasn't seen a significant fracture problem in his own practice.

Shikora estimates about half of surgery patients follow their doctor’s advice to take extra calcium and vitamin D, and other research suggests higher doses may be needed anyway as the obese tend to start out with vitamin D deficiency.

“Don't skip checkups, where doctors monitor bone health, and aggressively treat nutrient deficiencies,” Clowes advised.

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No scars: New TOGA obesity surgery goes through mouth

Chicago, IL

Doctors are testing a new kind of obesity surgery without any cuts through the abdomen, snaking a tube as thick as a garden hose down the throat to snap staples into the stomach. The experimental, scar-free procedure creates a narrow passage that slows the food as it moves from the upper stomach into the lower stomach, helping patients feel full more quickly and eat less.

Doctors say preliminary results from about 200 U.S. patients and 100 in Europe look promising.

After about 18 months, obese European patients have lost an average of about 45 percent of their body weight, said Dr. Gregg Nishi, a surgeon at Cedars-Sinai Medical Center in Los Angeles. He discussed the European and U.S. studies during a Chicago conference this week for digestive disease specialists.

The procedure is only being done in the studies, which recently ended enrollment. Makers of the device used in the operation plan to seek federal approval if the research continues to go as planned.

While the two studies are still under way and only brief details are being released, Nishi said results so far are slightly better than typical results from with conventional stomach stapling.

Risks include perforating the esophagus, as Nishi said happened to a patient at another center, but otherwise, he said, there have been no major complications.

Some study patients have lost weight after unknowingly undergoing fake procedures — sedation and the tube, but no stapling. Results comparing them with the real thing aren't yet available.

Liliana Gomez, an administrative coordinator at Cedars-Sinai, was among the first Americans to have the scarless obesity surgery last year, as a test case for the U.S. study. She had planned on more invasive conventional surgery until learning that doctors at her hospital were studying the scarless stapling technique.

"When I found out it was going to be oral, through your mouth, I was like, 'Wow, that's kind of different,'" she said.

Since her operation in August, Gomez has lost about 40 pounds and dropped from size 22 to size 16.

The 35-year-old mother of three has a long way to go — she's still obese according to body mass index standards. But Gomez says she has cut her meal portions by more than half and still feels full, and is optimistic she'll continue to lose weight.

The new method is part of a medical movement to perform surgery through body openings such as the nose, mouth and vagina instead of making cuts. The idea is to reduce chances of infection and pain, and speed recovery. With no scars, there are cosmetic advantages, too.

Gomez had considered a gastric bypass operation, a more complex kind of stomach stapling, but worried about risks from that surgery. It reduces the stomach to the size of a golf ball and reroutes the digestive tract.

Whether done through one large abdominal incision or several tiny ones, gastric bypass is far more invasive and increases chances for malnutrition because it repositions how the stomach attaches to the intestines to restrict calorie absorption.

Another popular weight-loss surgery option involves putting an adjustable band around the top part of the stomach to create a small pouch.

The experimental method Gomez had is the oral version of a different kind of stomach surgery, which reduces the size of the stomach with staples but doesn't reroute the digestive system.

Surgery is generally considered a last-resort treatment for obesity, which affects more than 15 million Americans. Still, demand is high. More than 200,000 Americans are expected to have conventional forms of obesity surgery this year, according to the American Society for Metabolic & Bariatric Surgery.

Dr. Scott Shikora, the society's president, called the oral procedure exciting and innovative, but said, "It is too early for us to say this is going to be a breakthrough."

Shikora said many U.S. obesity surgeons prefer the rerouting surgery or flexible bands, and that it remains to be seen whether the oral method has the same drawbacks as more outmoded stapling procedures.

The U.S. study is taking place at 10 centers. Patients will be followed for at least one year, with final results expected in 2010. They are randomly selected to undergo either the operation or a sham procedure.

Nishi said of 25 patients enrolled at his hospital, 17 got the real treatment, with no complications.

"I'm very impressed with it," Nishi said. So far, it looks like "a viable alternative," he said.

Satiety Inc., a California company that created the medical devices used in the technique, is paying for the research. Nishi said he has no financial ties to the company.

At Washington University School of Medicine in St. Louis, where the first U.S. procedure was done last summer, about 30 patients have undergone the treatment. Side effects have been minimal, including sore throats, nausea and some abdominal pain lasting less than a week, said Dr. J. Christopher Eagon. He said weight loss results from his center aren't yet available.

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New procedure for obesity surgery - enter through mouth, no scars

Denver, CO

A new kind of obesity surgery without any cuts in the abdomen is being tested in small experimental groups. In this surgery the stomach is stapled by means of a tube that has been put down the throat of the patient. Preliminary results from US and European studies look promising.

In the experimental procedure the stomach is stapled to create a narrow passage that slows the food down as it moves through the stomach. This helps the patients feel full after eating small amounts of food and as a result eat less. Stapling the stomach is not a new technique, but this procedure is unique as there are no scars.

About 300 patients have undergone this new procedure. If all goes well, the makers of the tube, which is as thick as a garden hose, plan to seek federal approval of the device. This procedure is part of a move by the medical community to perform surgeries through body openings instead of incisions. The goal is to reduce chances of infection, pain, and speed recovery as well. Obviously, with no scars there are cosmetic advantages as well.

Studies in the US and Europe are still underway, so only brief details are being released. According to Dr. Gregg Nishi, a surgeon at Cedars-Sinai Medical Center, results so far are slightly better than typical results from conventional stomach stapling. In the European study, over the course of 18 months the patients have lost an average of 45 percent of their body weight. Final results from the US study, which is taking place at ten centers, are expected in 2010.

Demand for obesity surgery is high in the US with more than 15 million obese Americans. According to the American Society for Metabolic & Bariatric Surgery more than 200,000 Americans are expected to undergo conventional forms of obesity surgery this year. Existing procedures are far more invasive. Gastric bypass changes how the stomach attaches to the intestine which increases the chances for malnutrition while restricting calorie absorption. Another popular procedure involves putting an adjustable band around the top part of the stomach.

Dr. Scott Shikora, president of American Society for Metabolic & Bariatric Surgery, called the oral procedure exciting and innovative, but said, "It is too early for us to say this is going to be a breakthrough."

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Hospital criticized over death of 420-pound woman after gastric bypass surgery

Manchester, UK

A 420 pound woman who had a gastric bypass operation died at a hospital where staff hadn't been properly trained to care for obese patients.

Janice Barnardo, 46, was the first patient to undergo the weight-loss surgery at Tameside Hospital and was taken back in to repair problems with the surgery five days later.

A Stockport inquest heard staff were not trained to operate adapted beds for patients recovering from the surgery.

Miss Barnardo's bed - specially designed to provide support for overweight patients - had been left unplugged for two days. It was called a bariatric bed after the branch of medicine that deals with obesity.

Sections of the beds can be raised and lowered automatically to keep patients comfortable and prevent bed sores. Pathologist Andrew Yates said the cause of death was heart failure, gross obesity, high blood pressure, diabetes, asthma and pressure sores.

Jane Doyle, surgical ward manager, said staff had not been trained to operate bariatric beds. She said: "The hospital's bariatric policy was in draft form and had not been finalised."

Elaine Hughes said when her sister, Miss Barnardo, was put on a ward after leaving intensive care she felt unhappy.

Mrs Hughes said: "When she came back from the intensive care unit at Tameside, Janice was put in a bed at an angle at the end of a long ward.

"The first thing you saw coming on to the ward was Janice in a huge bed. She felt like she was in a freak show.

"We asked that she be moved to a side ward. That was so cramped we could not get around the bed." Miss Barnardo, from Mossley, had the operation in February 2007 and required surgery to repair a leak five days later. By the end of the following month, surgeon Abduljalil Benhamida discharged her to Shire Hill, Glossop, for rehabilitation.

But Miss Barnardo later developed deep bed sores and in May 2007 she returned to Tameside with septicaemia and later died.

Coroner John Pollard recorded a verdict of misadventure. He criticised nursing notes and said he would write to the chief executives of the local NHS trusts highlighting his concerns. After the inquest, Mrs Hughes said: "Janice's problems started on ward 15 at Tameside Hospital. Staff were not trained to care for bariatric patients."

A spokeswoman for Tameside Hospital Trust said: "This case highlights the complex medical and psychological rehabilitation needs of patients undergoing surgery of this nature and the need for careful assessment, planning and co-ordination of services to minimise the risk of similar problems in the future."

Jill Pinington, of Tameside and Glossop primary care trust, said: "Since Miss Barnardo's death an audit has shown a significant improvement in standards of documentation and note-keeping."

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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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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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Medicare Announces Final Coverage Policy for Bariatric Surgery as a Diabetes Treatment

Washington, D.C.

The Centers for Medicare & Medicaid Services (CMS) announced today a clarification in its policy for Medicare coverage of bariatric surgery as a treatment for certain beneficiaries with type 2 (or non-insulin-dependent) diabetes.

The decision specifies type 2 diabetes as one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese, as long as the surgery is furnished at a CMS-approved facility. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese. Normal body-mass index is considered to be between 18.5 and 25.

“Medicare beneficiaries who are morbidly obese may face tremendous health complications,” said CMS Acting Administrator Charlene Frizzera. “Today’s coverage decision assures that beneficiaries who are morbidly obese can access safe, effective weight loss options to help prevent these complications.”

As part of today’s decision, CMS announced bariatric surgery will not be covered by Medicare when it is used to treat type 2 diabetes in a beneficiary with a BMI below 35. While recent medical reports claimed that bariatric surgery may be helpful for these patients, CMS did not find convincing medical evidence that bariatric surgery improved health outcomes for these non-morbidly obese individuals.

“Limiting coverage of bariatric surgery in type 2 diabetic patients who are not considered clinically obese is part of Medicare’s ongoing commitment to ensure access to the most effective treatment alternatives with good evidence of benefit, while limiting coverage where the current evidence suggests the risks outweigh the benefits,” said Barry Straube, M.D., CMS Chief Medical Officer and Director of the agency’s Office of Clinical Standards & Quality.

In 2006, CMS expanded coverage of bariatric surgery for Medicare beneficiaries who received surgery in high-volume centers from highly qualified surgeons (as certified by the American College of Surgeons or the American Society for Bariatric Surgery, and as reported on the Medicare Coverage Web site).

Under the 2006 decision, to be considered for coverage, Medicare beneficiaries were required to have a BMI of 35 or higher, and to have exhibited a serious health condition in addition to morbid obesity, such as hypertension, coronary artery disease, or osteoarthritis.

In that same decision, CMS covered four types of bariatric surgery procedures: gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. No other bariatric surgery procedure is currently covered.

Today’s decision memorandum is available on CMS’ Coverage Web site at:
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=219

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Gastric bypass surgery’s complications can be devastating for some patients

Modesto, CA

Sandi Krueger of Turlock, Calif., dropped 120 pounds with weight-loss surgery, but she is hardly a success story.

The 2002 surgery led to chronic malnutrition and anemia. As the pounds melted away, so did her life.

With a sunken face and protruding collar bones, she is too weak to work and spends most afternoons on the couch wrapped in a blanket.

She has thoughts of giving up, but wants to be there for 12-year-old daughter Megan and 19-year-old son Dustin.

“It’s not acceptable leaving me like this,” said the 103-pound Krueger, who at 38 looks closer to 50. “I’ve gone to doctor after doctor and basically they don’t help me.”

According to studies on bariatric surgery, patients with long-term complications are in the minority and disastrous outcomes such as Krueger’s are rare. But with 200,000 weight-loss surgeries being performed each year, she and other patients believe the long-term complications deserve more attention.

Looking for hope

Krueger’s options appear to be running out. Her anemic blood hasn’t been responding to iron shots and she was told last month that she can’t have the gastric bypass reversed.

“This isn’t a life,” said Robert De Kasha, her brother. “If she doesn’t find an answer, she is just going to fade away.”

Spurred by a national epidemic of obesity, bariatric surgery has become a standard of care for people with weight-related health issues. It has improved the lives of people who suffered from diabetes, high blood pressure, sleep apnea and other issues, experts say. No one is sure why some bariatric patients fare better than others.

The stomach-shrinking surgery has risks, such as leaks that can cause life-threatening infections, hernias and bowel obstructions. After the surgery, patients are expected to follow nutritional and lifestyle guidelines to achieve weight loss and avoid trouble with their altered digestive tracts.

Most patients will have “dumping syndrome” at some point, when food passes too quickly from the tiny stomach pouch into the small intestine. Because the stomach hasn’t broken down the food, the person gets a rush of blood sugar, rapid heartbeat, sweating and nausea.

Other patients may have iron and vitamin B-12 deficiencies years after surgery. All bariatric patients need to take vitamin supplements for life.

A nationwide study released in 2006 concluded that bariatric surgery complications are common. By examining insurance claims for 2,522 surgeries, researchers with the federal Agency for Healthcare Research and Quality found that 40 percent of patients had complications in the six months after surgery, about double the rate in previous studies.

The complications ranged from the minor to the severe, including dumping syndrome, problems with the bariatric connections, hernias, infections and pneumonia. Post-surgery problems sent 18 percent of patients back to the hospital, some for costly readmissions or corrective surgery.

The agency contends that surgical advances recently have lowered the complication rate to 30 percent, still high for an elective procedure, said William Encinosa, lead author of the study.

“Anytime you can cut into the intestine, you have a risk of complications,” he said. “Clearly there are benefits for people who are morbidly obese, but these patients need to know what they are getting into.”

Live longer

Less is known about complications years after the surgery, although a 10-year Swedish study found many patients kept the weight off and had increased longevity.

Krueger, who once worked two jobs as a nursing assistant, sought treatment for an injured back in 2002. A specialist suggested that the 5-foot, 250-pound woman lose weight through bariatric surgery to deal with the back problem, she said.

She had what’s called a Roux-en-Y gastric bypass at Doctors Hospital of Manteca, Calif. To perform the common procedure, surgeons create a small pouch from the stomach and make a connection between the bottom of the pouch and a section of small intestine.

Most of the stomach and part of the intestine are bypassed, so the person feels full after a few bites of food and the intestine absorbs fewer nutrients.

Krueger, weighing 219 by the time of surgery, lost weight quickly as dumping syndrome made her sick for months. When she went to the doctor with complaints, he urged her to stick with the dietary instructions and take supplements, she said.

Bariatric surgeries were discontinued at Doctors Hospital of Manteca, so Krueger sought help from specialists at University of California at San Francisco Medical Center. In 2004, surgeons there corrected a problem from the initial surgery and, as her strength returned, she got up on water skis for the first time.

She gained 22 pounds, then her troubles returned and she bottomed out at 98 pounds.

With her body starved of nutrients, her blood sugar dropped so low she was admitted to Emanuel Medical Center for a week of monitoring, she said.

Tests have shown that her pouch no longer holds food but dumps it directly into the small intestine. Even if she eats five times a day, she doesn’t get the protein and other nutrients she needs.

She’s tried protein bars and countless other foods and even finds that fish is hard on her digestive tract. Daughter Megan brings her toast and crackers because she knows those are easy on her stomach.

Krueger said it’s heartbreaking for her daughter to see her tired and faint all the time. She has lost hair, her teeth are decaying, and she’s often out of breath.

To treat her anemia, she’s had a blood transfusion and three rounds of iron infusions. A reaction to the last infusion caused her blood pressure to plummet and nurses to come to her aid.

Second thoughts

Last year, she was considered for having the gastric bypass reversed at UCSF, but doctors told her in December that it was too dangerous. They were concerned that her remaining stomach would have inadequate blood flow and would rot, she said.

“That day was hard for me,” she said. “I don’t know what is ahead. I feel my life has been taken from me.”

Dr. Guilherme Campos, director of bariatric surgery at UCSF, said about 1 percent to 4 percent of the center’s patients suffer from nutritional deficiencies over the long term. The UCSF center has dieticians and other staff to work with patients with malnutrition. Reversal operations are major procedures and are done as a last resort, he said.

The surgeon contended that bariatric surgery is an effective way to treat morbid and superobesity, the main reason university hospitals have adopted the treatment in recent years.

“The benefits by far outweigh the risks that are associated with the procedure,” he said.

While many patients sing the praises of weight-loss surgery, including television personalities Al Roker and Star Jones, some patients say they’ve had a tough time.

Donna Sellers, 61, of Modesto, said four members of her family had weight-loss surgery with mixed results. Her husband and younger daughter lost weight with no complications. But Donna shed weight too fast and suffered from dumping, malnutrition and dehydration the first year after her 2004 surgery at Memorial Medical Center.

Attempts to eat made her feel sick and sweat profusely, even though she followed the guidelines to eat pureed food and take small bites, she said. She went from 246 pounds to 123 in six months and landed in the emergency room, where she was treated for dehydration for several hours, she said.

She finally discovered she could eat chicken and Swiss cheese, and force-fed herself. To deal with the hot flashes of dumping syndrome, she laid on the cold floor tiles of her kitchen to eat meals, she said.

Five years after the surgery, she still is forcing herself to eat and is relying on her nursing training to maintain her weight in the 130s.

“I eat three or four bites and then wait 10 minutes and eat some more,” she said. “I eat a scrambled egg for breakfast, and tomorrow a scrambled egg makes me sick.”

She said one of her daughters had the same post-surgery troubles, as well as a calcium deficiency resulting in dental problems.

A 2001 surgery in Southern California saved Alycsha Bostic of Merced, Calif., from sleep apnea and asthma attacks. But she developed hernias requiring two operations and iron deficiencies that cause headaches and dizziness.

Losing 160 pounds boosted her fertility and she got pregnant twice despite being on birth control, she said. Doctors put a port in her chest to feed iron into her blood during pregnancy. Her ferrous levels are a third of normal since her second child was born in 2007.

Bostic, 34, hopes doctors can figure how to get more iron into her system — and she needs another hernia operation.

“I am so tired of having surgery,” said Bostic, who talks with other bariatric patients with complications. “We’ve all had hair loss. I still get dumping syndrome. If I don’t chew my food 50 times, it collects at the bottom on my esophagus and I throw up.”

More than 3,000 weight-loss surgeries have been performed at Memorial Medical Center in Modesto since 2003.

Deana Chiarchianis, health center manager, said the post-surgery complications at the hospital are far lower than the numbers in the AHRQ report. The study considered data before widespread use of laparoscopic techniques, which have reduced problems such as surgical wound infections and hernias, she said.

The hospital tries to ensure good outcomes by evaluating and educating surgical candidates, including a psychological assessment of their ability to cope with the surgery. It also stresses post-surgery guidelines such as teaching patients to prevent dumping through the proper choice of foods.

“They need to understand that the surgery is a tool and the patient is responsible for complying with the recommendations for follow-up, nutrition, exercise and behavior change,” she said.

Dr. Kelvin Higa, a Fresno, Calif., surgeon and past president of the American Society for Metabolic and Bariatric Surgery, said it’s important for patients to have lifelong follow-up with their surgeons. Usually, there are surgical options for patients with severe complications such as Krueger’s.

“Any patient that has those problems should not be sitting there. They should seek help,” he said. “Almost invariably we can take these patients and adjust their anatomy to take care of their nutritional issues.”

Krueger said her poor health has taken a toll on family life. No longer does she take Megan to cheerleading and dance classes. She and her husband have postponed their dream of building a home.

Krueger worked as long as she could at Emanuel Medical Center last year to keep her health benefits, but ran out of strength. Her primary care doctor is trying to line her up with a nutritionist or hematologist who accepts Medi-Cal.

A feeding tube could be next if she loses more weight, which reminds her of a 32-year-old bariatric patient at a care facility where she worked.

“She had a feeding tube and it really bothered me,” Krueger said. “If I don’t get better, I know my organs will take a toll. If they would put me on the operating table to take me back to 250 pounds, I would do it.”

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