With her 30th birthday looming, Marla Clark decided to take control of her lifelong weight problem once and for all. So she booked an appointment with a Bellevue surgeon to discuss...
With her 30th birthday looming, Marla Clark decided to take control of her lifelong weight problem once and for all. So she booked an appointment with a Bellevue surgeon to discuss gastric bypass surgery.
When the Enumclaw woman, beaming with excitement, walked into a support group where prospective patients meet surgical success stories, she imagined the procedure would answer her prayers. Eyeing the group’s leader, a spiky-haired woman who dropped from size 28 to size 2 in 20 months, Clark envisioned shedding 100 pounds from her more than 250-pound frame.
She was startled from her reverie when, like vets trading battle tales, patients began sharing their most repellent postsurgery stories: vomiting, diarrhea, wound infections, hernias and hair falling out in clumps.
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This was far from the glamour Clark had expected.
“My mind was pretty much made up to do the surgery, but then what they said settled in and scared me. I don’t want to be sick like that,” she said after changing her mind the next day.
And with the surgery’s risk of death estimated at one to two per 200 patients, Clark, the mother of a toddler and an 8-year-old, says that’s a risk she just can’t take.
“A family member said to me, ‘You are really willing to leave behind two children to be thin?’ That was a real eye-opener,” she says.
For now, Clark says, she plans to put some miles on the treadmill.
“I need to get weight off, but this wasn’t the answer I thought it was,” she says. “If I were 500 pounds and couldn’t get out of bed, then maybe, but I’m not to that point. I’m still healthy and mobile, so there’s no point to risk it right now.”
For many people considering obesity surgery, before-and-after photos speak much louder than complication checklists.
With the popularity of the drastic operation soaring across the nation, critics are concerned that its risks are being overlooked. Advocates counter that the far greater risk is remaining obese.
Gastric bypass, so named because it reroutes part of the small intestine around much of the stomach, is done through a long incision down the abdomen or sometimes through a small puncture with a scope. The upper stomach is closed off with staples, reducing the functioning stomach from the size of a football to a shot glass. The small intestine is cut from below the original stomach and reconnected to the upper pouch.
Pounds melt off for most patients because the new, tiny stomach fills with just a few bites, and because food travels a shorter digestive route skipping the lower stomach and upper small intestine so less of it is digested and absorbed by the body.
Other weight-loss surgeries involve constricting the stomach with an adjustable silicone band or bypassing most of the small intestine. But gastric bypass surgery, considered the gold standard, is the most popular form of obesity surgery.
The National Institutes of Health has embraced the operation as the only consistently effective method of weight loss for people who are morbidly obese, or at least 100 pounds overweight.
Yet the American Society for Bariatric Surgery estimates one in 200 patients dies from the surgery. Dr. E. Patchen Dellinger, chief of general surgery at the University of Washington Medical Center, says he surveyed Washington surgeons and found the risk to be about double that, or one in 100.
Either way, the rate is significantly higher than that for most elective surgeries. For instance, liposuction carries a one-in-47,000 risk of death. Gastric bypass is about as dangerous as gallbladder surgery but three times safer than a heart bypass.
Maryanne Bodolay, director of the National Association to Advance Fat Acceptance, questions why surgeons are willing to operate for weight loss even while refusing to perform other operations on obese people because they deem them too risky.
About 7 percent of gastric-bypass patients suffer from complications, including infections, blood clots that travel to the lungs, respiratory failure and hernias, and many require second or third operations. One in three develops gallstones caused by rapid weight loss and needs gallbladder surgery. Each of those additional surgeries multiplies the risks.
Even for those who get through the operation relatively unscathed, it’s not easy. Many vomit several times a day for the first couple of months, and 30 percent suffer from nutritional deficiencies such as anemia because their bodies aren’t absorbing enough vitamins and minerals; they must take supplements the rest of their lives.
Another common side effect of surgery one that particularly repelled Clark is known as dumping syndrome. When some people who’ve had the surgery eat refined sugars and starches such as chocolate or pasta, the food flies into the small intestine too quickly, causing an episode of sweating, nausea, heart palpitations and sometimes diarrhea. Some patients embrace the effect because it compels them to avoid junk food.
After going through all that, about 10 to 15 percent of patients don’t lose much weight or gain it back quickly. And for many, the pounds start creeping back after a couple of years.
“It’s important people be realistic,” Dellinger says. “Most people who are operated on lose a lot of weight but still end up heavy. If they lose one-third of their weight, they may still end up at 200 pounds.”
If most people aren’t going to shrink down to their dream weight, and the surgery carries such serious risks, why do it?
It’s not a cosmetic procedure, it’s a life-saving one, says Dr. Richard Thirlby, who performs about 120 gastric-bypass surgeries per year at Virginia Mason Medical Center.
“Ideal body weight is not a term conceived by Cosmopolitan magazine,” he says. “It’s from life-insurance companies who found when you get above that, people don’t live as long.”
Government guidelines approve the surgery only for the morbidly obese that’s 6 million Americans and those who aren’t quite as heavy but have serious obesity-related health problems.
Because they are at much higher risk for a variety of health conditions, including heart disease, diabetes and sleep apnea, severely obese people have a fourfold higher risk of dying, Thirlby says.
Paul Ernsberger, a professor of nutrition at Case Western Reserve University in Cleveland, says the surgery’s proponents have exaggerated the risk of obesity. Morbid obesity takes seven to 10 years off someone’s life expectancy, he says, so they’ll die in their late 60s rather than their 70s.
“A typical patient is a 30-year-old woman, so if she doesn’t have surgery now she will likely live another 30 years. But she’s treated as if she’s going to die any minute,” he says.
Plus, he says, all of the diseases associated with obesity have effective treatments. “So what they’re really saying is it’s better to have your intestines rearranged and throw up several times a week than to take pills for blood pressure or diabetes.”
But Dr. Richard Atkinson, president of the American Obesity Association, says that such arguments ignore the tremendous emotional pain of obesity.
He cites a decade-old study in which researchers posed a series of “would-you-rather” questions to four dozen people who had lost more than 100 pounds through surgery. They found 100 percent of patients said they would prefer to be deaf than their previous weight, 91.5 percent would rather have a leg amputated and nearly 90 percent would rather be blind.
“Can you imagine how painful it is to be fat in America, so that 89 percent of people would rather be blind?” he says. “For people who have that kind of pain, the risks of obesity surgery are well worth it.”
Julia Sommerfeld: 206-464-2708 or firstname.lastname@example.org