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May 16, 2003/Iyar 14 5763, Vol. 55, No. 38
Surgery provides option for obese
JESSICA BARBER
Staff Writer
Stephanie Helgren grew up with an overweight mother - and still remembers the cruel jokes of her classmates. Helgren, who has had a weight problem herself since the age of 11, was devastated when she saw her own children suffer the same barbs from their peers.
On a Cub Scout trip with her 5-year-old son to Luke Air Force Base last year, Helgren was told she could not view the inside of the F-16 jets because the ladder into the jet cabin was not strong enough to hold her.
Later that same day, Helgren and the troop had lunch at McDonalds, where Helgren could not fit into a booth to have lunch with her son.
"I went to get food and sit at the table, but I couldn't fit," she says. "(My son) was so mortified. He looked at me with big, brown eyes and said, 'Mom, where are you going to sit?' "
Throughout her life, Helgren had tried and failed at every weight loss program she could find, from Weight Watchers to cabbage diets, from medical programs to fads.
Frustrated and desperate to change her life, Helgren decided to pursue a more drastic procedure to lose weight - gastric bypass surgery.
Gastric bypass surgery, used since the late 1970s to help morbidly obese people lose weight, transects the stomach into two pieces, explains Dr. Amy Koler of Weight Intervention and Surgical Healthcare (WISH) in Tempe. During the procedure, surgeons separate the normally football-sized stomach to create a pouch about the size of a golf ball to prevent the patient from overeating. Intestines are rerouted to eliminate the absorption of some fat and calories.
Surgery candidates must meet a number of requirements before they are approved for surgery, Koler explains. Candidates at the WISH center meet with a psychologist, a dietician, an exercise physiologist and the surgeon to determine that they are physically and mentally prepared to undergo the procedure. In addition, candidates must have a Body Mass Index (a ratio of one's height and weight) of at least 40, or of 35 with additional medical problems commonly associated with obesity, such as diabetes, sleep apnea, hypertension or high blood pressure. Patients must also have tried and failed medically guided weight loss programs.
"We've seen in the past a zillion medical treatment options available to obese patients, but their long-term failure rate is about 95 percent," says Koler. "With gastric bypass, statistics have shown there is a 90-percent chance that your weight will come off and stay off permanently."
Helgren, who had the surgery in September 2001 at St. Luke's Hospital in Phoenix, has lost 130 pounds and 101 inches in the 19 months since her surgery. In fact, her experience was so positive that her mother also had the surgery in April 2002, and has since lost 120 pounds.
"People treat me so differently," says Helgren. "I've had men jump out of cars to open doors for me."
Dr. Donald S. Robertson, a bariatric specialist and medical director at the Southwest Bariatric Nutrition Center in Scottsdale, has recommended a few patients for the surgery as a last resort. However, he believes that more traditional means of weight loss are the way to go.
"We are in the middle of an epidemic of obesity and people are grabbing for straws and looking for a quick fix," says Robertson. "(Patients who have the surgery) get instant gratification, but the morbidity rate is fairly high and I've seen them have other complications."
The most common complications, according to Koler, are vitamin deficiencies, post-operative infection associated with any abdominal surgery and psychological effects of fast and dramatic weight loss. The average morbidity rate for the surgery nationwide is 1 in 200 patients, says Koler. At the WISH center, the rate is 1 in 500.
"Our patient population is at a higher risk right off the bat because they are obese," says Koler. "No one wants to have surgery. But the majority of the time, there are no complications."
The surgery takes about 1 1/2 - 3 1/2 hours and usually requires a three-day stay in the hospital. Complete recovery time is about two weeks, says Koler. Gastric bypass surgery at the WISH center usually costs about $19,000-$25,000, although many insurance companies are covering the surgery.
"(Insurance companies) want to see what we want to see," says Koler. "They want to know that the patient is a good candidate and that they have tried other medical treatments and failed. They also want to see that other medical problems will go away as a result of the surgery."
Koler also says losing the weight can add as much as 13-20 years onto life expectancy.
"The biggest complaint we've had from patients is that they wish they (had the surgery) sooner," she says. "But it's a personal choice for each patient. They have to determine if it's worth the risk to potentially improve their life long-term."
Helgren, now a 36-year-old mother of two who has almost reached her goal of losing 140 pounds, wouldn't change a thing about her decision, although she does admit the surgery may not be for everyone.
"I would recommend the surgery if the patient understood that it's a severe decision that is for the rest of your life," she says. "There are a lot of emotional things that go along with the surgery."
"I actually taught one of my kids to ride a two-wheeler a few months ago," she says. "I actually ran down the block beside him. I am optimistic that I will be able to watch my children and grandchildren grow. Before, I didn't think I had a prayer."
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