Wednesday, February 10, 2010

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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Monday, February 1, 2010

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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Friday, January 8, 2010

Gastric bypass was route to a new life for Sheriff

Milwaukee, WI
A little more than a year has passed since I grazed with John Schroeder at a Christmas party buffet table.

At 375 pounds, John knew this territory well - sandwiches, chips, rich dips, shrimp, desserts. But all that was about to change.

John, a friend of some friends of mine, told me he was having his stomach stapled a few days later. You know, bariatric surgery. The ol' gastric bypass.

His stomach would be reduced from about the size of a football, overinflated in his case, to the size of an egg. I wondered how a guy who clearly lived to eat would possibly manage portions to fit a space that small.

Well, I ran into John at the same party this Christmas and hardly recognized him. He had shed enough pounds, about 130, to build an average-size teenager.

"I'm still heading down," said the 41-year-old Wauwatosan. The married father of two is a Milwaukee County sheriff's deputy assigned to the jail.

His goal is to drop 20 more pounds and settle at 225. After falling off at two to three pounds a week, the weight lately has resisted disappearing a bit more.

You hear so much about how fat America has become, and it has. John Schroeder doesn't want to play that role anymore. This might be your New Year's resolution, too. Again.

A couple years ago, he tried out for TV's "The Biggest Loser," which has turned weight loss into a spectator sport. He got a callback but ultimately was passed over.

He seemed to have the right stuff for the show. John of buffet tables past was always hungry.

"I fit the old mode, I guess, the doughnut shop and that type of thing," he said.

Two hours before dinner, he'd stop at a fast-food drive-through for two big burgers. When the wind was right, he could smell the nearby pizza restaurant and bakery from his backyard spa.

"That would basically put me into a trance. I'd walk out of the hot tub and down the street in my swim shorts and unfortunately end up in the store buying pizza," he said.

Ice cream seemed to call out his name. His daily calorie intake? He had stopped counting. Never a small guy, he watched his weight go north of 300 and stay there.

He once was refused entry to a Disney World ride with his kids because he was too heavy. Airplane seats were brutal. His knees and feet hurt from holding him up. He was reinforcing his buttons with fishing line. The final straw was when he re-injured an old ankle injury from his football-playing days while chasing down a criminal.

John found his way to Craig Siverhus, a general/bariatric surgeon at Columbia St Mary's. In December of 2008, after extensive consultations and even psychological testing, Siverhus performed what's known as Roux-en-Y surgery on John, a common form of gastric bypass first done in the 1960s in the United States.

A small part of the stomach is cut away and stapled to form a pouch to accept food. The rest of the stomach and duodenum are bypassed to limit absorption, and the small intestine is surgically attached to the pouch, Siverhus explained.

The procedure usually results in the loss of 70% to 80% of a person's excess body weight, most of it in the first six months. There are risks. A tiny percentage of patients die. Ulcers and gallstones can appear. Eating sugary foods, pasta, bread or simply too much can make you sick. But Siverhus said the surgery often greatly reduces a patient's risk from high blood pressure and cholesterol, diabetes and sleep apnea.

The surgery can run $25,000 to $30,000. Insurance doesn't always cover it. Luckily for John, his did.

"John was a great candidate. He was very well informed, he was very well motivated to proceed with this, and he was willing to make lifestyle changes that would allow him to succeed with it," the doctor said.

John's wife, Kate, said people sometimes call this weight loss route a quick fix, but she has seen how radically John has changed his habits. Under stress, he might still hit the fridge, but now it's for yogurt rather than a hot dog with all the fixins.

John said Kate occasionally has to remind him to eat. His eyes are still sometimes bigger than his stomach, which isn't saying much. He'll fill a bowl with chili but eat only a small amount. He learned a painful lesson from a Reuben sandwich he chanced on St. Patrick's Day.

Kate said her husband has lost his desire to eat out, but some restaurants will charge him for a child's meal when he flashes his bariatric surgery membership card.

She'd love to lose 30 pounds herself, using traditional dieting, Kate said. People are always telling John how fabulous he looks now. The family bought bikes and plans more trips to the gym this year. Fewer frozen pizzas are on the horizon.

John has spent lots of money on new clothes and work uniforms as the pounds fell off. It's a nice problem to have. His waistline is down to nearly 36 after peaking at 52.

In December, for the first time, all four Schroeders appeared in the family Christmas card. John, who used to hate cameras and mirrors, finally wanted to be included. Recently, John noticed his clavicle peeking out from what had been excess fat, and he had to look online to see what it was.

For John, eating now means a few ounces at a sitting, about a third of a kid's meal or part of a Lean Cuisine dinner. He eats small pieces of fruit, nuts and veggies, and everything has to be chewed to death. It's crucial to drink enough water, but just sips at a time. He has so much more energy, despite eating so little.

What about beer?

"You're not supposed to," he said. "But I'm from Milwaukee so, yes, I'll sneak one in periodically."
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Friday, January 1, 2010

After gastric bypass surgery, couple loses 249 pounds in a year

Chicago, IL
Their daily Starbucks drink of choice was once a Venti Java Chip Frappuccino -- a whopping 600 calories in a cup.

These days, Lorie and Todd Richmond splurge on coffees with Splenda and a dash of half-and-half. But they are more likely to be riding their bikes, shooting hoops with their three kids or shopping for new clothes.

The Chicago Sun-Times featured the Richmonds in a Dec. 22, 2008, story after the couple from northwest Indiana had weight-loss surgery at the University of Chicago Medical Center on the same day.

Before the surgery, Lorie weighed 402 pounds, Todd 305.

A year later, Todd is at his goal weight of 207 pounds. He's off cholesterol and blood-pressure medications. Lorie weighs 251 pounds and is confident she can lose another 60 pounds or more to reach her goal.

Together, the two have lost 249 pounds in one year.

"It makes you feel so good that people notice," Lorie said. "For the first time in my life, I don't mind telling people my weight."

The Richmonds' say their quality of life also skyrocketed as their weight decreased.

They vacationed in the Smoky Mountains, hiking and riding roller coasters -- things they couldn't do before.

They bought bikes, and Todd consistently rode about 10 miles every other day throughout the summer. When she started, Lorie could only ride a block before having to stop; by the end of the summer, she took an eight-mile ride.

And when she ran to pick up an errant basketball while shooting baskets with her 7-year-old son, he said words she had never heard before: "I just saw my mom run."

"I almost cried," she said. "I was so happy I could do that with him. It gives me even more drive to keep going."

Dr. Vivek Prachand, an assistant professor of surgery at the University of Chicago Medical Center, performed Lorie's duodenal switch and Todd's gastric bypass.

A duodenal switch involves removing part of the stomach and bypassing much of the small intestine to limit how many calories are absorbed. A gastric bypass shrinks the stomach.

But the surgery alone wouldn't help the Richmonds lose and keep off the weight. They altered their diet and exercise habits -- something they had tried repeatedly in the past but without success.

"You have to recognize the surgery is a tool, it's not a cure," Prachand said. "I only take half the credit for it. You accomplish the other half."

The Richmonds said they were stung by hostile online anonymous critics who said the surgery was "cheating'' and accused the couple of laziness.

Prachand said he has heard all the criticism before, but said they are unfair. He said the surgery is highly effective and corrects multiple medical issues with one procedure.

"What we're dealing with when we're talking about surgery for severe obesity, we're talking about people who are 10 to 15 times heavier than the 10 to 15 pounds all of us have struggled with at one point or another," Prachand said. "Sometimes it's hard to project the added difficulty of that much more."

Beyond the surgery and added exercise, the Richmonds dramatically changed what they ate.

Todd said a year ago, he could "put a buffet out of business."

Now, the couple eat off saucers to help control portions.

They eat small meals consistently throughout the day, including daily breakfast.

And while they haven't abandoned Starbucks completely, they cut out the oversize sweet drinks and other treats -- even though they say they are constantly celebrating.

"This year has been awesome for us," Lorie Richmond said. "There's so much, I want to shout at the rooftops. Life is opening up for us."
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Wednesday, December 23, 2009

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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Sunday, December 6, 2009

Britain’s "most obese teen" is slim after gastric bypass surgery, says would rather be dead

Selby, North Yorks, England
At 19 years of age, Malissa Jones of Selby, North Yorks, England, sees herself as the unhappiest woman alive, whose future is extremely bleak unless she somehow comes up with £20,000 required to undergo cosmetic surgery. At 16, Malissa, Britain’s fattest teen, underwent gastric bypass after doctors told her she only had months to live, and thus became the first person in the world to undergo the surgery. She is now telling Closer magazine she’d rather be dead than live her life as she is now.

Malissa knows that the surgery saved her life, especially since she had her first suspected heart attack at the tender age of 15. Doctors told her at the time that, although risky and not usually done on under-18s, the procedure was the only hope she had to live longer than a few more months. At the time, Jones was diagnosed with angina, had her internal organs compressed, could not move and breathed at night with the help of an oxygen tank. She weighed 34 stone (215 kg) and ate 15,000 calories a day (with the daily recommended intake being of 2,000).

Now, two years later, Malissa has lost 20 stone (127 kg) and her life expectancy is increased. Still, she is depressed and is on medication because she is constantly so ill she can hardly get out of the bed. She says she’s been left with so much excess skin from her weight loss that she truly wishes she had never had the surgery at all – anything, even death, is better than looking like this. She doesn’t have the money to undergo surgery to remove the saggy skin and the NHS will not pay for it.

“I know it sounds ungrateful, but I preferred my body when I was fat. At least it was firm and curvy, not droopy and saggy. I had nice firm arms – now the skin just hangs and I have to cover them up because they look so awful. The NHS won’t remove the skin and I’ll never manage to save £20,000 to have it done privately. The surgery might have saved my life, but I wish I’d never had it done,” Jones says for Closer.

There is tinge of regret though at not having tried to lose the weight the healthy way, with diet and exercise, and especially at having let her problems become so serious. “Although my heart’s healthier and life expectancy is normal, some days I’m too ill to get out of bed. […] I hope people read this and realize gastric surgery isn’t a miracle cure. I wish I’d lost the weight through exercise and healthy eating. I know this operation was life-saving, but the complications I’m suffering now might still kill me. The truth is I feel I’m no better off than I was before,” she says for the same magazine.
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Saturday, November 21, 2009

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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Sunday, November 8, 2009

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,

"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.


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.


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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Tuesday, October 27, 2009

Is gastric bypass surgery a diabetes fix?

Los Angeles, CA

Within days of various weight-loss surgeries, blood sugar levels become easier to manage -- or are normal.
The discovery came about by accident more than a decade ago: Weight-loss surgery often led to dramatic improvements in the control of Type 2 diabetes, often before patients had even left the hospital.

Today, evidence of the connection is so solid that some doctors say surgery should be considered as a treatment for diabetes, regardless of a person's weight or desire to lose weight.

"We thought diabetes was an incurable, progressive disease," says Dr. Walter J. Pories, a professor of surgery at East Carolina University and a leading researcher on weight-loss surgery. "It . . . is a major cause of amputations, renal failure and blindness. This operation takes about an hour, and two days in the hospital, and these people go off their diabetes medication. It's unbelievable."

As many as 86% of obese people with Type 2 diabetes find their diabetes is gone or much easier to control within days of having weight-loss surgery, according to a meta-analysis of 19 studies published earlier this year in the American Journal of Medicine (78% of patients with a remission of diabetes and 86.6% with remission or improvement). But experts still aren't sure why obesity surgery helps resolve Type 2 diabetes or how long the effect might last. And they disagree on how big a role surgery should take in treating the illness.

"We are going from seeing the results to understanding why it happens," said Dr. Santiago Horgan, director of the Center for the Treatment of Obesity at UC San Diego.

This much is clear: Patients who have weight-loss surgery begin to lose weight rapidly, which by itself improves Type 2 diabetes, allowing diabetics to more easily control their blood glucose levels. But something else appears to be occurring as well.

There is strong evidence that surgery -- especially gastric bypass surgery, which makes the stomach smaller and allows food to bypass part of the small intestine -- causes chemical changes in the intestine, says Dr. Jonathan Q. Purnell, director of the Bionutrition Unit at Oregon Health & Science University. The small intestine has been thought of simply as the place where digestion occurs.

But researchers now suspect it has other functions related to metabolism. Surgery somehow alters the secretion of hormones in the gut that play a role in appetite and help process sugar normally.

Multiple studies in humans and animals indicate that surgery triggers reductions in ghrelin, the hormone that stimulates hunger, and elevates levels of peptide YY and glucagon-like peptide-1, both of which act as appetite suppressants. Another theory is that surgery might alter the expression of genes that regulate glucose and fatty-acid metabolism.

"There are these known components that improve glucose metabolism," Purnell says. "But there are very likely other things happening as well."

Which procedure?

The effect on diabetes can depend on the type of weight-loss surgery that is performed, says Pories, past president of the American Society for Metabolic and Bariatric Surgery. The highest rates of diabetes remission are seen in people who have gastric bypass -- about 83%.

But diabetes also tends to resolve or improve in 50% to 80% of people who have lap-band surgery, in which a band is placed around the top of the stomach to make it smaller, he says. And there is some evidence that the effect occurs a newer type of weight-loss surgery called gastric sleeve, in which a portion of the stomach is removed so that it takes the shape of a tube or sleeve.

Evidence suggests the effect on diabetes can last for an extended period or even indefinitely, particularly if people don't regain a lot of weight.

"There is durability, but we also know that some people do get the disease back again," Purnell says. "Weight rebound is probably one factor. We also know that diabetes is a progressive disease. It may depend on how long you've been diagnosed with diabetes. If it's early on, I think the durability may be better."

It's not clear yet why people have different responses.

"There is some evidence that African Americans don't respond as well as Caucasians, and men don't respond as well as women," Pories says.

Despite the unknowns, the evidence that a majority of people experience long-term improvement in blood glucose control suggests the surgery could eventually play a greater role in the treatment of obese people with Type 2 diabetes. The majority of American adults with Type 2 diabetes are overweight.

Traditional medical guidelines, which insurers follow, state that weight-loss surgery should be restricted to patients with a body mass index of 35 or greater who have related health problems. But some diabetes and nutrition experts think those recommendations don't go far enough. Several studies are underway, or will soon begin, to examine the benefits of surgery in people with Type 2 diabetes and a BMI of less than 35.

"We may have a cure for diabetes," Santiago says. "So we need to ask how medical therapies and surgery can help each other in the treatment of diabetes."

Studies from several other countries show that surgery also results in remission of diabetes for people who are not morbidly obese. There is even discussion, particularly in other countries, of performing weight-loss surgery for people with Type 2 diabetes who are not overweight.

Not without risks

In the United States, weight-loss surgery is still largely viewed as a cosmetic procedure and obesity as a lifestyle issue, not a chronic disease. Moreover, weight-loss surgery carries risks. The death rate is about one per 200 operations and severe complications can occur, including blood clots, infections related to surgery, and the need for corrective surgery due to leaks at the staple lines.

Other complications include vitamin and mineral deficiencies, dehydration, gallstones, kidney stones, hernia and low blood sugar.

However, a risk-benefit analysis published in April in the Journal of the American Medical Assn. by Purnell and a colleague suggests that if the number of gastric bypass operations performed on diabetic patients increased to 1 million per year, as many as 14,310 diabetes-related deaths might be prevented over five years.

Surgery also leads to other health benefits besides weight loss and better control of diabetes. Patients often see improvements in blood pressure, cholesterol, gastroesophageal reflux disease and sleep apnea.

"Doctors say, 'If I can lower glucose by medications, why send patients to surgery?' " Purnell says. "Surgery, however, allows people to have meaningful and sustained weight loss and their diabetes is better. There are risks involved with surgery, obviously, but it makes sense, to me, to do surgery."

The discovery of the gut hormones that play a role in appetite and insulin regulation may also lead to new medications for Type 2 diabetes, Pories says.

"You can't operate on 31 million Americans," he says. "But if we understood this mechanism and what are the molecules secreted by the intestines that cause diabetes, then we can cure it with a pill. I would not be surprised if, in the next five years, we have new medications."

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Wednesday, October 14, 2009

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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Laparoscopic gastric bypass surgery helps man shed obesity

St. Louis, MO
Two years ago, Herb Simmons tipped the scales at 497 pounds.

"As the years snuck up on me I noticed it was getting harder to get around," he says. "I couldn't leave home in the morning without soaking my knees in Ben Gay."

He was suffering from sleep apnea, atrial fibrillation and hypertension. Getting from his car to his house was an exhausting, stop-and-go process because he'd rest every few feet to catch his breath. He needed an extra seat belt on airplanes and a chair without arms in restaurants.

Simmons says he didn't eat big meals, but admits to snacking on chips and slurping sugary colas every day. He says he's been on every diet known to man.

"I once lost 100 pounds on OPTIFAST and regained 200," he says. "I was a yo-yo dieter."

In 2007, he attended a bariatric seminar to learn more about Lap-Band surgery, a laparoscopic procedure to place a silicone band around the top of the stomach. The band reduces the amount of food the stomach can hold so patients eat less. Simmons made an appointment with one of the surgeons, Dr. Van L. Wagner, of Heart of America Bariatrics in Lemay. He was surprised when Wagner recommended gastric bypass instead.

Gastric bypass uses staples to make the stomach smaller, then reroutes food past part of the small intestine. Patients feel full sooner, and absorb fewer calories and nutrients.

With a Lap-Band, patients lose only between 50 and 70 pounds in the first year then often taper off on weight loss, Wagner says. With gastric bypass they almost always lose between 200 and 250 pounds in two years.

"Bypass is usually a better option for patients who are sicker, older and have higher weights," Wagner says. "And Herb was extreme on several of those things so banding would not have provided the weight loss he needed."

Wagner performed laparoscopic gastric bypass surgery on Simmons Sept. 19, 2007, at St. Alexius Hospital.

Gastric bypass comes with risks, including developing gallstones and nutritional deficiencies.

Simmons takes calcium and vitamin pills and drinks protein shakes to prevent malnutrition. Two weeks after surgery, he began walking, first up and down the sidewalk in front of his house, then on a quarter-mile track. At first he couldn't walk a lap without stopping to rest several times. Within a few months, he was walking two miles. Now, he walks three to five miles every afternoon and bicycles three to five miles every evening.

He also eats a lot less, especially high-fat, sugary foods.

"It can cause dumping syndrome, which makes you want to lock yourself in a room for hours," Simmons says. WebMD describes the syndrome as a shock-like state that lasts for 30 to 60 minutes after small, easily absorbed food particles are rapidly dumped into the digestive system. Symptoms include a clammy sweat, butterflies in the stomach, a pounding pulse, cramps and diarrhea.

Simmons says his triglyceride and cholesterol levels have plummeted, his sleep apnea has dissipated and his blood pressure medications are one-fourth the dose they were before surgery. His legs no longer swell and his knees feel fine.

He credits ongoing counseling by Wagner and St. Alexius' NewStart program for his success. Both offer emotional support, nutritional guidance and ongoing education.

Last month, Simmons celebrated the second anniversary of his surgery by walking 3.7 miles as part of the Walk From Obesity event in Creve Coeur.

"After my wedding anniversary, my surgery date is the second-most important anniversary for me," Simmons says.

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Sunday, September 13, 2009

Patient bleeds to death after gastric band surgery

A mother told to lose weight to avoid serious health problems died hours after surgery to fit her with a gastric band.

Susan Alderson had three litres of blood in her abdomen and had bled to death, a post mortem found.

Experts had advised the 49-year-old to have the band fitted, a procedure which reduces the size of the stomach.

Susan Alderson received gastric band surgery at the former Derby City General Hospital in January. She later bled to death

But after the operation, which was also to repair a hernia, Mrs Alderson suffered internal bleeding, which claimed her life, an inquest was told.

Mrs Alderson, a diabetic who weighed more than 16 stone, was told by dieticians she would need the surgery to help prevent other potentially life-threatening illnesses.

She was admitted to the former Derby City General Hospital in January.

The hearing, attended by Mrs Alderson's husband and son, was told the operation went ahead without complications and Mrs Alderson appeared to be recovering well.

Derby Coroner's Court heard she started bleeding internally hours later, leading to a cardiac arrest and her death the next morning.

Paul Leeder, who carried out the operation, said: 'I had never experienced any problems with patients having severe complications. I had not had a death either before that operation or since.'

He said Mrs Alderson's body mass index (BMI), which determines whether a patient has a healthy body weight by measuring their height and weight, was 44, classing her as morbidly obese.

A patient who weighs too much in comparison to their height is in danger of developing problems such as strokes, heart problems, arthritis and an increased risk of cancer.

Mr Leeder said: 'Mrs Alderson had been on a low-calorie diet but had only lost four kilogrammes (nine pounds).

'The three options were for her to carry on as she was, without surgery, to have a gastric bypass or to have the gastric band.

'The risk of bleeding, risk of death and failure rate of the procedure were explained. But the long-term benefits of sustained weight loss would have far outweighed the risks involved with the surgery.'

After surgery, Mrs Alderson, of Sinfin, Derby, was moved into a recovery area, where her blood pressure started to drop.

Doctors gave her injections to help boost her blood pressure but, later that evening, it started to drop again. She was moved to a higher dependency ward and appeared to be recovering.

Mrs Alderson was later transferred to a 'step-down' ward, where she suffered a heart attack and later died.

Her post mortem examination found between two-and-a-half to three litres of blood collected in her abdominal wall, close to the repaired hernia.

Dr Andrew Hitchcock, consultant pathologist at Royal Derby Hospital, said it was not clear where the bleeding had originated.

Dr Hitchcock said Mrs Alderson's medical cause of death was internal bleeding, related to the hernia repair and gastric band operation.

Recording a narrative verdict, deputy coroner Louise Pinder gave the cause of death as intra-abdominal haemorrhage and incisional repair and gastric band application.

Miss Pinder said: 'She had no particular interest in losing weight for interests of vanity, this was very much a medically-based decision.'

A spokesman for Derby Hospitals, said: 'Our thoughts are with Mrs Alderson's family.

'Any surgery carries a risk and in Mrs Alderson's case the risks were higher due to her high BMI, severe diabetes, liver problems and a hernia repair.

'These factors meant that when Mrs Alderson developed complications, her blood did not clot in the normal way.

'The coroner said that the clinical team could not have foreseen the tragic outcome in Mrs Alderson's case.'

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Tuesday, August 25, 2009

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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Wednesday, August 19, 2009

Obese student seeks charitable donations for gastric bypass surgery

Seattle, WA
A Seattle college student doesn't want to be the "biggest" man on campus and has started a Web site asking for donations to help him get gastric bypass surgery.

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Sunday, July 26, 2009

Gastric bypass surgery malpractice: Fatal malpractice at NY hpspital unreported

Coney Island, NY
On July 17, 2006, Robert Asta had gastric bypass surgery at Coney Island Hospital. Six days later, the 54-year-old cook was dead.

Internal hospital records reveal a "foreign object" was left inside his body postsurgery, but for the year 2006, Coney Island Hospital reported zero cases in which a foreign object was mistakenly left in a patient after surgery.

Robert's son, Michael, was devastated. It was a surgery Michael didn't want him to have, but Asta desperately wanted to lose weight. The 6-foot, 375-pounder had tried all kinds of diets with little success.

"My life has never been the same. We were supposed to go into business together," Michael Asta said. "My family is heartbroken."

Asta never told his family what he was planning.

"None of us would have let him go," Michael Asta said.

The son said his father told him about the surgery a day after the operation — and said he was in a great deal of pain.

Robert called the hospital, but was told that pain after such an operation is a normal part of the recovery process.

Then on July 20, Asta received a call from the hospital asking him to come in for some further testing after lab tests came back with abnormal results.

The hospital found a piece of surgical tubing in material removed from Asta's body — an indication something had been left inside Asta postsurgery.

A CT scan was taken and the results were inconclusive. On July 23, Michael Asta received a call from his father's long-time girlfriend.

"She told me to come over because, she said, 'He feels very cold and I think he's dead,'" Asta said. When Asta arrived, his father was dead.

In response to the News' questions, the city Health & Hospitals Corp. insisted it didn't need to report this incident as "foreign object left in body" – a specific reporting category. Instead it was reported merely as "unexpected death."

HHC said surgical tubing was not left inside Asta, but an internal Coney Island Hospital document dated Aug. 22, 2006, that the family obtained in its lawsuit states, "Foreign Object left in body during surgical operation."

The autopsy report lists the cause of the death as a postoperative infection in the abdominal cavity that involved "retention of surgical tubing" in a surgical specimen.

Manner of death is listed as "therapeutic complication." Though the hospital didn't admit wrongdoing, the family's malpractice claim was settled for $675,000.

Asta left behind three adult children and two grandchildren.

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Monday, June 29, 2009

New study finds gastric bypass surgery not more risky for senior citizens than young

Dallas, TX

About 26% of seniors 65 and older in U.S. are obese, nearly 40% are overweight, putting them at a higher risk for Type 2 diabetes, high blood pressure and heart disease
Morbidly obese seniors, age 65 and over, who had laparoscopic gastric bypass surgery lost nearly 76 percent of their excess weight after two years and had low complication rates and short hospital stays comparable to younger surgical patients, according to a new study presented today at the 26th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

“Bariatric surgery in the older population is underutilized because of a misperception that old age alone puts patients at higher risk for complications and mortality,” said Joseph Kuhn, MD, co-author and director of General Surgical Research at Baylor University Medical Center in Dallas, TX.

“We found seniors can benefit just as much as younger people from bariatric surgery without taking on additional risk.”

In one of the largest series of laparoscopic gastric bypass surgeries performed on elderly patients, researchers from Baylor University Medical Center analyzed a prospective database of 100 patients over age 65 and compared safety and outcomes to a younger population.

All patients had laparoscopic gastric bypass surgery between January 2005 and July 2008.

Prior to surgery, older patients demonstrated higher operative risk profiles compared to their younger counterparts in relation to -
● sleep apnea (45% vs. 34%),
● Type 2 diabetes (65% vs. 33%) and
● hypertension (81% vs. 57%).

Older patients ranged in age from 65 to 77 with an average BMI of 45, and younger patients ranged in age from 18 to 64 with an average BMI of 47.

Post-operative excess body weight loss (EWL) and complication rates were comparable in both groups.

At 12 and 24 months, both lost nearly the same amount of weight -- patients over age 65 showed 75.9 percent EWL after one year and 75.5 percent after two years; patients under 65 showed 77.8 percent EWL after one year and 79.2 percent after two years.

Neither group reported any deaths in the two-year follow-up period.

Post-operative complications were -
● low: bleeding (>65 1% v. < 65 1.3%),
● pulmonary infections (>65 3% v. <65 1.3%),
● cardiac (>65 2% vs. <65 0.36%) and
● wound infections (>65 1% v. <65 1.7%).

Due to the age and overall health status of the older group, researchers noted it was particularly interesting to also find length of hospital stays (1.9 vs.1.3 days) and 30 day readmissions rates (6% vs. 7.4%) to be so comparable.

About 26 percent of people 65 and older in the U.S. are obese and another nearly 40 percent are overweight, putting them at a higher risk for Type 2 diabetes, high blood pressure and heart disease. Since 1990, the prevalence of obesity has increased more than 50 percent in the elderly.

“The population is getting older and unfortunately more obese, so we will see a corresponding increase in the number of patients over 65 who are eligible for bariatric surgery and surgery needs to be an option for them,” said Christopher Willkomm, MD, study co-investigator from Baylor University Medical Center.

People who are morbidly obese are generally 100 or more pounds overweight, have a BMI of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as Type 2 diabetes, heart disease or sleep apnea.

According to the ASMBS, more than 15 million Americans are considered morbidly obese and in 2008 an estimated 220,000 people had some form of bariatric surgery. The most common methods of bariatric surgery are laparoscopic gastric bypass and laparoscopic adjustable gastric banding (LAGB).

The ASMBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits.

It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information about the ASMBS, visit

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Sunday, May 17, 2009

Gastric Bypass surgery: Pros and Cons

Tulsa, OK
Gastric bypass surgery is growing more popular every year as America's obesity epidemic tips the scales. Even the elderly, and people with health problems are turning to this surgical solution to obesity.

It is a surgery that saves lives. But some also warn there can be life-changing drawbacks.

"These were 26 - and I wear a size 8 now," said Leslie Blunt as she proudly showed off the pants she will never wear again thanks to gastric bypass surgery. She has lost 140 pounds. "It works. It does. You live a healthier life," she added.

Micah Anderson chose gastric bypass surgery when his weight ballooned to 500 pounds. "Lost little over 200 pounds - easy," he told 2News anchor Karen Larsen. "I'm happy with myself. More confidence."

While gastric bypass is known for bringing on drastic weight loss, what many do not realize are specific changes it may cause for an individual, along with health benefits.

"A lot of this junk food they were eating before - their taste has disappeared they don't want it anymore," according to Dr. Luis Gorospe, gastric bypass surgeon at Bailey Medical Center in Owasso. Both Anderson and Blunt went to Dr. Gorospe for surgery. His patients come from surrounding states, drawn by his surgery success rate, the promise of dramatic weight loss and the immediate health benefits of gastric bypass.

"If they have diabetes - 70 percent of these patients wake up with normal blood sugar and will not require medications - forever," Dr. Gorospe said.

Studies show gastric bypass may improve or even eliminate such health problems as:

Leslie Blunt says she is living proof, "I don't have high blood pressure. I don't have diabetes. I am pill free."

However, Micah Anderson tells a different story. "I'll vomit maybe not every week - but if something doesn't agree it does come right back up."

When surgeons create a tiny new stomach for patients, vomiting is a common problem when patients eat too much, too fast - until they get used to their new, smaller stomach. Micah says he expected that - but then he started fainting - once behind the wheel of his car.

Anderson's wife Katie said, "The passing out has happened four times. Spells where he could potentially pass out... weekly!"

Frightened by the potential danger such episodes represented, the Andersons began researching online and discovered other gastric bypass patients having such problems.

"Describing the same kind of drunk-like symptoms, incoherent, can't talk, slurring the speech. and people were experiencing the same things," Katie added.

The Andersons say they went to numerous doctors and nutritionists, trying to find a physician who was experienced with gastric surgery side effects. After trial and error, they say they have finally found the right doctor to care for Micah. As a result, Micah now follows a diet carefully crafted to meet his personal needs. He eats every two hours, consumes plenty of protein and takes vitamins.

"For me its lack of eating. I forget to eat and that's what causes my issues. It's partially my fault as much as it is the surgery," Micah said. "If I don't follow the rules like they tell you - you do have issues."

Doctor Gorospe agreed. He said healthy eating - the same issue obese patients struggle with before gastric bypass - is more important than ever after surgery. "If you follow the rules, this surgery will be successful," Dr. Gorospe said.

Because some patients do encounter issues following surgery, and with their new lifestyle, Doctor Gorospe offers monthly support groups. "I make it a point of being there," he said. "I want to be available to my patients." The meetings offer patients an opportunity to share their stories and talk with Dr. Gorospe.

Micah did attend the monthly meetings. However, some of his problems did not occur until several years following the procedure. As a result of his struggle, the Anderson's suggest to those considering gastric bypass surgery: do plenty of research, know the rules they will have to live by, and read up on potential side effects.

"There is a list and, by golly, one of those things on the list will affect you," Katie Anderson said. "They just need to tell you flat out - you are trading one set of issues for another set of issues."

However, when asked if he would have the surgery again, Micah's answer is, "Unfortunately, yes." He went on to say he is pleased with his more than 200 pound weight loss. His joints ache less when he gets out of bed in the morning, and it is easier to be active.

Leslie Blunt agrees. Now, this svelte hair stylist says work is easy. No more suffering from carrying too much weight while being on her feet each day. Plus, she loves buying clothes with her new look and the fact that she is setting a good example for her young children by living a healthier lifestyle.

In fact, Leslie says gastric bypass surgery is the best thing she ever did for herself. "Yes! I would do it over and over and over again! I never want to be that way again."

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Wednesday, May 6, 2009

Woman's decision to undergo gastric bypass changes her life

Harrisburg, PA
Corinna Van Hine's moments of reckoning with her weight were mounting. At 30, she was out of breath when she walked with her husband, often avoiding hills. Shopping for women's clothes was a thing of the past, and she was buying from the racks in men's departments instead. She could barely squeeze into seats at movie theaters or amusement parks.

The worst setback was when her 320-pound frame kept her from horseback riding, a passion since she was 5 years old. "It really limited me because you have to have a big enough horse to handle your weight," Van Hine said. "My weight had gotten to a point where it wasn't safe for the horse for me to be riding it."

That's when the Steelton woman decided enough was enough. After years of shedding pounds through dieting and exercise only to regain the weight and sometimes more, she hit the books and Internet for any information on weight-loss surgeries.

It eventually led Van Hine to Penn State Milton S. Hershey Medical Center's Surgical Weight Loss Program, where patients go through an extensive evaluation before undergoing six months of medically supervised weight loss prior to approved surgery. In March 2006, she attended an informational session with surgeons who explained the types of surgery offered -- Roux-en-Y gastric bypass surgery and laparoscopic adjustable gastric banding -- the risks involved and what to expect afterward. Van Hine left the meeting feeling more confident than she had in a long time.
Vince CassaroSince gastric bypass surgery, Van Hine has lost 115 pounds. She also eats better and exercises, often for a 2-mile walk with Callie, her dog, in and around her Swatara Township home.

Although she had lost 60 to 70 pounds on her own in 2001, she was sidelined by a broken collarbone, and the weight became increasingly difficult to keep off. "I said to myself, 'This is probably my only answer out of it,'" Van Hine said. "I thought, at 30 years old, I can't be doing this my whole life -- losing it and gaining it back. It hurts too much to be yo-yoing back and forth again and again."

Ann M. Rogers, a physician and the director of Hershey's weight loss program, said Van Hine is one of hundreds who have turned to its surgeries to lead healthier lives. About 80 percent of the patients are women, all of whom are severely obese -- 100 pounds over their ideal weight or a body mass index greater than 40 -- with health issues linked to their weight, Rogers said.

Like Van Hine, most candidates also are well informed about the surgeries before they walk in the hospital's doors. "I'd say 99.9 percent of them are ready to go with surgery by the time they come to our informational sessions," Rogers said. "Most of them have already spent years trying to lose weight. No matter how much they are able to lose, they invariably gain it back and then some. They simply can't keep it off."

In December 2006, after months of preparation and restricted dieting, Van Hine was wheeled in for a laparoscopic Roux-en-Y gastric bypass, in which doctors create a small pouch and bypass a portion of a patient's intestines through several small incisions.

Weight loss occurs rapidly in the first six months following surgery and slowly tapers off 18 to 24 months afterward. Patients can expect to lose an average of 77 percent of their excess body weight within a year after surgery, according to experts. As with any surgery, however, the procedure carried its risks, and they weighed on Van Hine's mind.

Death can occur in about 1 percent of gastric bypass surgeries, and less severe complications can arise in 10 percent of cases. Surgical risks include intestinal leakage and internal bleeding, while all surgeries carry the risk of pneumonia, heart attack and blood clots.

Fortunately, Van Hine said, she escaped any serious complications and, to her surprise, didn't feel much pain when she awoke from her surgery." I was shocked that I didn't feel bad. It didn't hurt, but it felt like I had done some sit-ups," she said. "I didn't use any pain medication by the second day."

There were challenges ahead, Van Hine said, and she was mentally prepared for it. For weeks, she would have to live on a liquid-only, protein diet. Small amounts of foods would come in several months. "I've gotten sick a few times," Van Hine said, usually because she didn't chew her food long enough. "That's the tool of the surgery. It's your body saying, 'No, you can't eat that.'"

As of October, Van Hine has dropped nearly 115 pounds, taking her from a size 32 to 14 or 16 --in the women's departments. The real payoff though: She is finally feeling more like herself.

"Mentally, I never felt like a fat person. Finally, the person I was in my head and the person I am on the outside are ... becoming closer together. It feels like being let out of jail."

Before surgery, Corinna ate more than the average person -- when she wasn't dieting over the years, that is. It wasn't uncommon for her to go through fast-food drive-throughs for loaded hamburgers and greasy fries. She also didn't know "when to say when" during dinners. Today, her appetite is very satisfied with smaller amounts of food, and she can still enjoy her favorite prime rib -- she just has to chew it to death before swallowing.

She's not concerned about losing more weight because she's happy at her current level. If she loses more, great. If she doesn't, that's fine, too. She is well aware that she has to exercise and keep a healthy diet to maintain the surgery's results.
Vince CassaroJason Van Hine, Corinna's husband, has lost 40 pounds with his wife. He didn't undergo surgery; he's just exercising and eating better.

Van Hine's husband, Jason, didn't realize how overweight his wife was until he recently stumbled upon some old photographs. "She kind of looked miserable," he said. "I didn't see that when I took those pictures then."

The couple now exercises together at a local gym, enjoys walks and is working to restore their old home.

"A lot of people think this a quick and easy fix, and it's not at all," she said. "It's a massive lifestyle change. You need to be committed to it. You can build a house with a hammer, but the hammer is not going to do the work by itself. You've got to choose to use the tool."

Surgical treatments

There are three ways that bariatric surgery may promote weight loss in obese patients:

• Decreasing food intake (restriction).
• Causing some food to be poorly digested or absorbed (malabsorption).
• Combination of restriction and malabsorption.

The Roux-Y Gastric Bypass is the surgical procedure offered at Penn State Hershey Medical Center. It provides gastric restriction combined with some malabsorption. Both the open and laparoscopic surgical procedures are available.

Open gastric bypass surgery can now be performed through a 6- to 8-inch midline incision. This operation is restrictive in nature but also creates a "dumping physiology." A 30- to 60-cc gastric pouch is created using several staple lines. The gastric pouch is drained into a segment of jejunum (small intestine) and "bypasses" the distal stomach and duodenum.

The small gastric pouch is "restrictive" and consumption of excessive carbohydrate rich liquids causes "dumping" or abdominal discomfort. The result is sustained weight loss of 50 percent excess body weight in more than 80 percent of patients. Gastric bypass is associated with iron and vitamin B12 deficiency, therefore patients must take supplemental vitamins after surgery.

You're not eligible: If your body mass index is below 35, you are not eligible for this surgical procedure. To find your body mass index, type the term into any Internet search engine to come up with a calculator.

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Friday, April 24, 2009

Gastric bypass: One man's journey

Baltimore, MD
Obesity is a condition that can cause all sorts of serious health and social problems, and they're all too familiar for an 11 News photographer who decided to have gastric bypass surgery.

Obesity can affect many things in life, including fitting into a movie seat, traveling on an airplane or going to a baseball game. They were problems long-time photographer Howard Melnick has been familiar with his entire life. 11 News decided to follow him on his journey through gastric bypass surgery.

Howard Melnick's Interview
Dr. Thomas Magnuson interview

Melnick has struggled with his weight all his life. He said it's tough carrying around heavy equipment, especially when he weighs more than 400 pounds.

"I was the fat kid who was about 10 minutes behind everybody else on the track. I was the fat kid who couldn't do chin-ups," he said.
Howard Melnick
Photographer Howard Melnick chose to get gastric bypass surgery.

His obesity has led to hypertension, sleep apnea and serious knee problems.

"My knees are shot -- just shot, and I need my knees (for work)," he said.

Finally, Melnick and his wife, Debbie, decided he would have bariatric surgery, or gastric bypass.

"It's the curse of my life. With Debbie, we love our lives today ... except for the weight," Melnick said.

Melnick's wife said she was fully supportive of his decision, but still worried because it was a big surgery.

"I'm very nervous, probably more than he is," she said.

Dr. Thomas Magnuson, the chief of general surgery at Johns Hopkins Bayview Hospital, said the surgery would take about three hours to complete and told Melnick the procedure has come a long way since it was first developed.
"Twenty years ago, people would lose weight then gain it back in two years (after gastric bypass). Now, they're more durable," said Dr. Thomas Magnuson

"They're a lot safer and they work better and last long-term. Twenty years ago, people would lose weight then gain it back in two years. Now, they're more durable -- a lifetime," Magnuson said.

Melnick could eventually lose many of the medical conditions caused by his obesity, Magnuson said.

After extensive counseling on nutrition, lifestyle and exercise, Melnick had his surgery.

"It hurts when I sit up and lay back down, but when I'm walking, not so much. They had me up last night," Melnick told 11 News the day after his surgery.

One week later, doctors said the surgery went well, and Melnick said he had already lost about eight pounds and was feeling great.

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Friday, April 3, 2009

Family demand answers after gastric bypass death

Macclesfield, UK
The family of a woman who died following a gastric bypass are demanding answers into her death.

Suzanne Wrighton, aged 59, died on May 30, 2008, less than 36 hours after having three operations at The Regency Hospital in Macclesfield.

Mrs Wrighton, who lived in Moreton Road, Crewe, decided to go in for the surgery paid for by the NHS at the private hospital because she was overweight and suffered from back pain.

Her husband Brian, aged 64, yesterday told an inquest into her death at Macclesfield Town Hall that he and his wife had been to two consultations prior to the operation and had been told there was a one per cent chance of fatality.

He said: "Suzanne had suffered from back pain for a long time. It started after she had a car crash in 1987. She had two operations on her spine but she still suffered from pain and she put on weight because she couldn't exercise.

"She decided on a bypass rather than a band. We know there is a risk with any operation but the risks we were told about weren't enough to worry her."

The inquest heard that after the first operation on May 28 Mrs Wrighton was in severe pain.

The following day consultant surgeon William Brough decided to perform a second operation to find out what the problem was but it wasn't until May 30 after the third operation that he found Mrs Wrighton had suffered a bleed.

Mr Brough said: "This was a rare complication that could not have been seen beforehand.

"It is the first time I have heard of a bleed from the staple line."

Mr Brough said that since Mrs Wrighton's death the hospital has altered protocol to ensure that all patients no matter how ill they are will have blood tests the day after the operation.

Mrs Wrighton died from adult respiratory distress syndrome (ARDS), which is when the lungs become filled with fluid and can't function properly.

Deputy coroner for Cheshire Janet Napier recorded a verdict of death due to complications following an operation for weight loss.

After the inquest Mr Wrighton, said: "We will be speaking to our solicitor and launching a complaint against the hospital. We are not happy with how Suzanne was treated. She was screaming out in pain most of the time she was in the hospital."

Suzanne's daughter-in-law Tammy Buxton, from Burslem, said: "The inquest hasn't really answered our questions.

"We still don't know why they failed to find the bleed until after the third operation.

"We have got to the bottom of the reason why she died. We don't want other families to go through the same pain and trauma we've been through."

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Tuesday, March 3, 2009

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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