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Losing Big

Weight-loss surgery can give patients
a second chance at a healthy life
Sunday, October 24, 2004 | 12:00 a.m. CDT; updated 3:56 p.m. CDT, Sunday, June 29, 2008

Walking down the hall at Vanderbilt Medical Center in Tennessee, Kiesha McGaughy called out to her old boss, whom she hadn’t seen since moving to Columbia from Nashville in 2000.

“It’s me!” said McGaughy, 33, an administrative assistant in the MU computer sciences department.

Donna Seiger didn’t recognize her former employee. It had been four years — and 100 pounds. After undergoing gastric bypass surgery in November, McGaughy, who once weighed nearly 300 pounds, not only felt like a new person, she looked like one, too.

An estimated 64 million Americans are obese. Increasingly, they’re turning to weight-loss surgery, a procedure that is becoming more popular as new technology emerges.

According to the American Obesity Association, obesity increases the risk of death among diabetics and those with heart disease by 50 percent. So for some, weight-reduction surgery isn’t simply a cosmetic procedure; it’s a matter of life and death.

Cindy Latimer, a 40-year-old sales administrator from Columbia, was never overweight as a child. She started gaining weight in college and watched her weight steadily increase when she secured a job behind a desk and switched from an active to a sedentary lifestyle.

Latimer tried to do something about the weight, adhering to her motto of personal responsibility.

“It’s up to you to do something,” she said. “There’s no ‘woe is me’ until you’re making steps to fix it.”

Her steps were significant. For years, she went to dietitians who prescribed medications and vitamin B shots four times a week and regimented diets such as Atkins and Weight Watchers.

But the weight always came back. “Everybody who’s overweight knows what it takes because they’ve done it so many times,” Latimer said.

Latimer views birthdays like most people view New Year’s Day. She sees them as a time to make resolutions for the coming year.

When she turned 38, she decided to buy a house. Exactly one year later, she signed the papers. That same day, another idea popped in her head: She wanted to have weight-loss surgery before turning 40.

At 347 pounds, Latimer knew the time for action had come. She knew if she had the surgery, it would not only lower her weight but also lower her likelihood of contracting diabetes.

She was only too familiar with the killer disease, which runs in her family. Her mother was diagnosed with diabetes at age 35 and died at 56 after being on dialysis and having a finger and both legs amputated. A

“It’s a devastating disease when you see someone you love die from it,” Latimer said.

AALatimer had weight-loss surgery in late June. She’s already felt a boost in energy and has lost 50 pounds.

Medical benefits

In response to a surge in interest, University Hospital recently hired two renowned weight-loss surgeons and opened the MU Weight Loss Center.

Roger de la Torre, one of the new hires, helped pioneer a new way of performing traditional gastric bypass surgery. With his technique, a laparoscope is used, allowing smaller incisions.

For de la Torre, weight-loss surgery was new territory. He had previously used the device on hernia patients.

“In the first six to eight weeks, there’s a pound to a pound-and-a-half lost per day, and in the first eight months to a year, expect 100 pounds lost,” said de la Torre, who operated on McGaughy and Latimer. “It depends on where you started.”

McGaughy started at 291 pounds. As a young adult, she watched her weight creep up, going from a size nine or 10 to size 20 in one summer.

When McGaughy got to size 26, she simply refused to buy clothes anymore. She said another determining factor in her decision to get surgery was her cholesterol level: 429.

“When I was 19 or 20, they told me I could die at any time, McGaughy said. “And after I had my daughter at 21, they told me I needed to do something about the weight and cholesterol because I could have a heart attack just walking down the street.”

Finally, at 32, McGaughy had surgery. That was in November. In the ensuing 11 months, she’s lost 100 pounds and now wears a size 14.

She was ecstatic to have lost the weight, but even more heartening was the news from her family doctor.

“After being on medication for my cholesterol for 17 years, I just got the news … that it’s at 205. For me, it’s normal,” she said.

After the surgery, McGaughy reduced her daily pill intake from 13 to two. She no longer has problems with acid reflux, arthritis, asthma and diabetes.

Patients rid their bodies of illnesses and diseases after surgery, sometimes before any actual weight loss, said de la Torre and his medical partner, Stephen Scott.

“People undergo this operation who are Type 2 diabetic and are taking oral hypoglycemic or insulin. The day after surgery, even though they haven’t lost any weight, patients may need half their insulin or less oral hypoglycemic,” de la Torre said. “There’s something about the operation, how food no longer traverses certain parts of the stomach and certain parts of the small intestine which may inhibit or promote certain polypeptides that help in the treatment of diabetes.”

How it works

Laparoscopic Roux-En-Y, considered the gold standard of weight-loss surgery, involves six incisions along the abdomen. The traditional procedure, known as open Roux-En-Y, involves a single long incision. The smaller incisions of the laparoscopic technique reduce healing time and scarring.

During the procedure, the stomach is divided in two. The smaller section is the size of an egg, holding 4 ounces. This is the new stomach.

The small intestine is also divided and connected to the new stomach. When the new pouch gets full, food moves through the small intestine, but the body doesn’t start to absorb calories until it hits a place lower on the intestine that now has a Y-shape.

“The procedure works on a twofold mechanism,” de la Torre said. “You feel full after eating fewer calories, and you absorb fewer calories because of the bypass part.”

Not only does the procedure allow shorter recovery times for patients, it’s also a better tool for the doctors.

“We can do the surgery better laparoscopically,” Scott said. “We can see better, be more precise. And now that we have the experience, I would much prefer to do the procedure laparoscopically rather than open.”

Patients are placed on a strict liquid diet after surgery to ensure there are no complications. McGaughy said she was barely consuming 500 calories a day.

“They start with liquids for a week, move up to protein shakes for two weeks, then they can eat soft foods in one month, and about a month after that, they can begin to eat normal foods,” Scott said.

Scott and de la Torre are working with a third doctor, Thomas Fogarty of Palo Alto, Calif., to make obesity surgery less invasive. Their goal is to perform gastric bypass surgery endoscopically. This procedure would eliminate the need for general anesthesia, with only a tube passed through the mouth.

Changing their lives

One of the lessons patients who have undergone bypass surgery have learned is that the effort it takes to lose weight is truly a lifestyle change. They can no longer eat without careful consideration of each bite. Everything they eat must be weighed — literally and figuratively.

“When you eat something that makes you feel like crap, you learn not to do that ever again,” McGaughy said.

For McGaughy, a more typical meal these days is half of a chicken sandwich or a few bites of pasta.

With a reduced appetite, going out to eat means always asking for a doggie bag, even if she orders the kids’ meal, she said.

“At the beginning the hardest part is the mind hunger because you smell food and you think, ‘I can take a bite of it’ — no you can’t,” McGaughy said.

One of the things patients are told to do is drink protein shakes or eat protein bars whenever possible to ensure they receive proper nutrients. Another fear is that a patient will just not eat enough because he or she is not hungry.

“As long as I have some water, I’m fine,” McGaughy said. “I’ve gone all day without eating and just never thought about it because I wasn’t hungry.”

And then there’s the flip side – eating small meals or snacks too often, possibly causing the stomach to stretch back out.

At her six-month checkup, McGaughy was told to stop eating six small meals a day and cut back to three. That way, she wouldn’t be as likely to overeat.

Before surgery, McGaughy was told she might live to be 35. Now she’s looking far ahead — into her 80s.

Latimer also now thinks about food in an entirely different way.

“I eat to stay healthy,” she said. “I no longer enjoy food like I used to.”

A common fear among patients is the possibility of death during the operation or because of complications. Two percent of gastric bypass patients don’t survive the procedure.

McGaughy had a different concern.

“I wasn’t so much afraid of dying as I was going bald,” she said.

Protein deficiency often causes patients to lose some hair during recovery.

Latimer, who recently started to lose some of her hair, prepared a will before the surgery. But even the thought of death didn’t stop her.

“I’m risking my life either way,” she said. “But if I do get the surgery, at least I have the chance to get healthy.”

Latimer doesn’t have a target weight in mind but says she wouldn’t mind getting down to a size 10 again. For her, it’s about regaining her life, she said.

“Activities I like have slipped away from me,” she said. “I’ve been limited in my life.”

By her next birthday, she hopes to go to Europe, something she avoided before the surgery because she knew it would require lots of walking.

McGaughy also counts the ability to do as she pleases one of the greatest rewards of the surgery.

“As wonderful as I feel, if I don’t ever make it back to 145-150 pounds, I’m OK,” she said. “I can breathe, walk, ride a ride at Six Flags. Before, I wouldn’t even try, and now I can ride with my daughter.”

For McGaughy, there’s no gratification quite like a mirror. After the surgery, she found an outfit at her mother’s house from her senior year in high school. It was one McGaughy never thought she would fit into again.

Fifteen years later, she cried as she looked in the mirror and saw herself zipped and buttoned in the same outfit.

But despite their success, MU’s new weight-loss surgeons emphasized that obesity is not a disease that can be treated solely through a medical procedure or even weight loss.

“Surgery is part of the treatment, but it is not the whole treatment,” Scott said. “We tell our patients we’re not curing their disease and that any operation we do is a tool you’re going to use to help control your disease. Nurses, dietitians, physicians, therapists, psychologists are all other tools we give to patients.”


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