A Sammamish couple has undergone the most drastic and fastest- growing surgical method to lose weight.
Leo Loos leans awkwardly forward over his hips and hugs his wife, Jessica, around her shoulders. They touch cheeks and then gently kiss.
Weighing more than 700 pounds combined, the Sammamish couple must carefully maneuver for such moments of intimacy. Everyday tasks are equally complicated. Leo can’t bend down to tie his shoes. Jessica cannot fit through a turnstile or wrap a towel around herself after a shower.
Thirty months after marrying, Leo finds that his gold wedding band digs painfully into his finger. He keeps wearing it anyway.
Like many of the 6 million Americans who are morbidly obese 100 pounds or more overweight the Looses suffer numerous health problems. Both experience back pain, skin infections and bad circulation. Jessica is a borderline diabetic, and Leo suffers sleep apnea, gallstones and high blood pressure.
Yet Jessica dreams that 18 months from now she will look svelte in a flapper dress when she renews her vows with Leo in Las Vegas. She hopes Leo, dressed in a zoot suit, will look as handsome as he does in his old photos.
In a bid to salvage their health and quality of life, the couple underwent gastric bypass surgery in January, a drastic and irreversible procedure. Staples reduced their stomachs to the size of a golf ball.
Even if all goes well, they will be on a diet of pureed food for three months, and after one year should feel stuffed on a single egg.
Although stomach-reduction surgery began in the United States 35 years ago, its popularity has soared recently. The number of operations tripled over five years to 63,000 in 2002 and is expected to rise to 95,000 this year. Experts cite a growing obesity epidemic and increased awareness of the health risks associated with being overweight.
Celebrity patients like “Today” weatherman Al Roker and pop singer Carnie Wilson also helped bring attention to the surgery.
Yet it remains a procedure of last resort. One to two of every 200 patients die, most often from a leak in the new stomach pouch or from blood clots that develop in the lungs. Side effects can include anemia and short-term hair loss, and patients must take vitamin, calcium and iron supplements for life.
The Looses decided that their ongoing health problems outweighed the surgery’s risks.
Getting their life in order
To prepare for their back-to-back operations, they drew up a will and cleaned out their kitchen. They swapped their big George Foreman grill for a smaller one. They replaced the food overflowing their pantry shelves with board games. They returned their basement freezer to the store and put a new smoothie machine on their countertop.
The night before surgery, the couple had a final feast at Claim Jumpers restaurant in Redmond. They ate buffalo wings and potato skins. Chicken-fried steak. Turkey, sweet ham, crisp smoky bacon. Coffee mocha mud pie with hot fudge, whipped cream and an Oreo crust.
Jessica, who suffers from acid reflux, ate too much. She threw up.
She knows that some people will judge her for being overweight.
“I wish they could walk in our shoes for a couple of days,” she says. “To walk around in public, get criticized and made fun of. Maybe then they would have a different opinion.”
It is not like they haven’t tried every diet and exercise regimen over the years, Jessica said. “Eating becomes like an addiction, and you can’t just quit at the drop of a hat.”
Many faces of obesity
The causes of morbid obesity are complex. While diet and exercise clearly play a role, experts believe genetic factors may be equally important. Social, environmental and psychological factors all contribute.
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Leo, 41, weighed 386.8 pounds immediately before surgery. Always a hearty eater, his weight problems began in his 20s. He grew up in San Diego, with parents of average size, and was 5 feet tall and skinny entering 10th grade. Over the next 18 months he grew 12 inches and gained 100 pounds.
He joined the Army at 17 and exercised regularly. When he left the Army at 20, however, he started eating fast food up to three times a day and quickly gained 70 pounds.
“I stopped exercising, sat in front of the TV and ate for six months. I started knowing I had a problem.”
Jessica’s battle with weight began much younger. Now 26, she was “skin and bones” on her sixth birthday, growing up in Clarkston, in Eastern Washington’s Asotin County, but she started gaining weight in kindergarten. Her parents were overweight.
In second grade, she picked up the nickname “bucktooth fatty.” She weighed 200 pounds when she graduated from Auburn High School.
Jessica said she had a terrible relationship with her mother and sought solace in food. She also battled depression from a young age. These days she takes several medications for her condition, diagnosed recently as bipolar disorder.
The couple met at Microsoft five years ago when Jessica began temping there. Leo had begun a year earlier, capitalizing on his lifelong interest in computers.
Their relationship began casually “friends with benefits,” as they describe it but they quickly fell in love.
When they both started working the graveyard shift, they would go to Denny’s together after work. “I felt safe around him; he made me feel special,” Jessica said.
The two can rattle off the diets they have tried over the years: low calorie, low fat, low calorie and low fat, no fat, fasting, high protein. They have tried Slim Fast, Jenny Craig, Dexatrim and Xenadrine. They have periodically exercised on treadmills and stationary bikes. But even when they lost weight for a time, they always gained it back.
Leo watched a co-worker go through the surgery and steadily lose weight. After researching the procedure, the couple made a pact to undergo bypass surgery together and support each other through the recovery. But some doubts lingered.
“What if he is in love with a fat person and doesn’t love a thin person?” Jessica wondered aloud.
Preparing for surgery
Two nights before the operation, Leo and Jessica attend a potluck with new friends from the nonprofit support group EMOSS Evergreen Morbid Obesity Surgery Support. Microsoft has donated a building for the evening, and about 75 people attend including medical professionals and many patients who have been through the surgery in the past 18 months.
All but one of the patients are women. Some bring meatballs and comfort foods; most arrive with salads and snacks. A sign next to portioned servings of cocoa mousse announces: *52 calories *6 grams carbohydrate *2 grams fat.
The evening concludes with a before-and-after show. “Before” pictures are displayed on an overhead screen while the women parade on a makeshift catwalk.
The differences are staggering. The women announce the weight they have lost: “50 pounds,” “140 pounds,” “190 pounds.” Jana Waight and her daughter Jenisa had surgery on the same day in July 2001, and together have lost more than 300 pounds.
“You are treated totally differently,” says Jana. “Men open doors for you. People actually look you in the eyes.”
Average patients can expect to lose at least one-third of their weight within a year, according to Georgeann Mallory, executive director of the American Society for Bariatric Surgery.
That is far better odds than any diet. Even after 14 years, most keep off at least half of their excess weight.
After surgery, patients are put on a fluid-only diet for a week, then must eat just one-third of a cup of pureed food each meal for three months. Even years later, they should be eating much smaller amounts than an average-sized person. Those who do not follow the dietary guidelines after surgery can end up gaining weight in some cases every pound they initially lose.
One woman at the potluck, Frances Phelps of Seattle, said she paid $13,000 for her bypass because her insurance did not cover the procedure.
Coverage varies with each employer and insurer. Some policies recognize obesity surgery as a medical necessity; others exclude coverage. Some patients end up paying for follow-up plastic surgery to reduce unsightly and unhealthy skin folds.
The Looses only needed medical confirmation that they were dangerously overweight. But others are required to go through extensive testing before insurance coverage is granted. That is to ensure they physically need the surgery and are mentally prepared to alter their habits afterward.
One woman at the potluck, Rose Pietromonaco of Redmond, said she has lost 448 pounds after two bypass operations. Her initial surgery 28 years ago was improved upon with more modern surgery techniques last September, she said. She once weighed 692 pounds.
The moment arrives
Jessica and Leo arrive at Overlake Hospital Medical Center for surgery just after 6 a.m. Jan. 23. Jessica has a final cigarette, saying she is kicking her pack-a-day habit as part of her new life.
Already waiting are Mary Miller and Cyndee Alverson, friends from the support group who have both been through successful bypass operations. Even with all the people around her, Jessica is clearly nervous.
She chats about concerts, television and her wedding to keep her mind off the operation. She dons her surgical gown and is weighed at 323.1 pounds. Medical staff members come and go, taking blood samples.
“Everything cool, then?” asks the Looses’ surgeon, Dr. David Simonowitz, a veteran of more than 2,000 stomach surgeries. “Yes,” Jessica replies. Knowing his predilection for coffee, she secretly tapes a note to her belly promising the surgeon a free latte if he finishes the procedure within an hour.
Jessica is given a general anaesthetic and is placed on a surgeon’s table, her belly covered with an iodine solution. Beatles music plays.
Simonowitz places a large metal ring, like an oversize bicycle sprocket, on her stomach. Assisted by Dr. Charlie Flake, he makes a 9-inch incision from her ribs toward her bellybutton, peeling back the flesh and attaching it to the sprocket with clamps.
What follows is like a dance. Surgical technician Jason Bowdle hands equipment back and forth to Simonowitz and Flake with dexterity and flourish. Using a slender plastic tool, the surgeons staple off the new stomach pouch, cutting it away from the remaining stomach and trimming the new pouch to shape.
Perhaps the strangest part comes when the surgeons test the new stomach. They pump air into the pouch, then pour a pitcher of water on top. They check for air bubbles in much the same way an auto technician checks a tire for punctures. Then they pull a piece of small intestine up and attach it to the new pouch, completing the bypass.
The surgeons suck out the water and stitch Jessica up. The whole operation takes less than 45 minutes.
Simonowitz goes back to the pre-op room to tell Leo everything has gone well, just before Leo goes under anaesthetic.
Leo’s weight is concentrated in his stomach, and the surgeons must operate around it, their arms disappearing almost up to their elbows as they work.
Leo also has his gallbladder removed. In recent years he’s suffered several attacks of gallstones. When the surgeons remove Leo’s gallbladder, they discover a huge stone, the size of a quail’s egg and hard as a rock.
When Leo wakes up, he is in pain. “Ow. It hurts,” he says over and over before his pain medication takes effect.
Starting a new life
Two days after surgery, Leo and Jessica are walking short laps around the hospital ward. After three days, they return home. Nine days later, Simonowitz removes the couple’s external staples and gives them the go-ahead to start eating pureed food. Jessica quickly develops a favorite: a mix of mashed potatoes, spaghetti sauce, parmesan cheese and chicken broth.
Jessica can no longer stomach her bipolar medication and begins an emotional roller-coaster ride that likely will continue until she can take the medicine again with solid food in late April. She has doubts about whether she has done the right thing.
“The diet is hard,” she says. “I don’t want to go back to eating pizza or junk food, but it is hard to find anything appetizing in the blender.”
She also begins smoking again. “I am not going to stress about it right now,” she says. “I have enough to deal with, with the surgery.”
Leo’s mom, Pat Loos, is up from San Diego to help take care of them. Once scared, she now thinks the surgery is the best thing Leo has ever done. During one outing “he was not breathing hard and his face was not turning beet red,” she said.
Jessica and Leo look at photographs of themselves before the operation. “That’s so sad,” Jessica says. It’s as if she is already talking about another person. The couple are walking a mile or so each day and sticking to the diet, although both develop colds from their lowered immune systems.
Twenty-four days after the operation, Leo has lost 47 pounds and Jessica 40 pounds for the first time in four years she weighs less than 300. Already their faces look slimmer. They go shopping for a new set of scales and a pair of suspenders so that Leo’s pants will stay on.
On Valentine’s Day, Jessica joins friends at Bellevue Square mall for her first-ever makeover. She has dyed her hair a more vibrant blonde and is moved to tears after fitting into a size 14-16 top.
But that night she needs to take Leo to the emergency room at Overlake after his stitches become infected. Leo is given antibiotics but is back at Overlake the next day in serious pain. This time the infected area bursts; hospital staff members clean out the wound.
The incident is a scare for both of them. And until the wound completely heals, they can no longer cuddle. Both say they’re glad they went through the surgery, but they realize there will be many difficulties ahead.
“I actually still have doubts,” Jessica says. “I guess I romanticized the whole thing, thinking that after getting out, every day would be lovely and we would be losing all this weight. I didn’t remember reality was going to hit.”
Nick Perry: 206-515-5639 or firstname.lastname@example.org