The Incredible Shrinking Woman
Source: San Diego Magazine
.Most women do not care to reveal their weight, especially if the prefix “over” applies. And most women who aren’t 6 feet 4 inches tall would be dismayed to weigh close to 200 pounds. I’m 5 feet 8 but proud to tell the world I weigh 197.
It’s so much better than 333.
I’m also proud to say I did it “the easy way,” an odd accusation often leveled at those who choose weight-loss surgery—as if there were tremendous virtue in reducing a more difficult way, and as if major surgery and a lifestyle change are easy. Easy or not, the adjustable gastric banding I underwent was an answer to a question I’d been asking much of my life: If I can lose weight, why can’t it stay lost?
Like most considered morbidly obese—a delightful term indicating a medically serious degree of excess weight, usually 100 or more pounds—I had dieted down to a normal size several times. Often I went years wearing sizes 8, 9 or 10, fighting an ongoing battle not to regain. But eventually, the weight always crept back on. And every time, I ended up heavier than my largest weight before.
This rebound talent makes me a good bet to survive famines. Not only do I hoard calories as fat instead of burning them for energy, my body “learns” from each strict diet and tucks a little extra away for a future dearth of food. In today’s land of plenty, such an adaptable metabolism ensures a constant fight against fat—a fight more than half of all Americans are currently losing.
Even more discouraging: More than 90 percent of those who manage to lose considerable weight by dieting are doomed to regain it within five years, according to the National Institutes of Health. Given that scary statistic and my personal history, was there any hope?
It looked like hope soared highest in the operating room. According to the American Society for Bariatric Surgery, weight-loss surgery is “the only proven method of achieving long-term weight control for the morbidly obese.” Granted, that group has a bias—but nothing else I’d tried had worked.
Initially I looked at the gastric bypass, made famous by singer Carnie Wilson and, most recently, Al Roker of Today. I watched two of my family members go through the process, from surgery to goal weight, and envied their incredible, quick results. Although I certainly qualified for the operation based on my weight—at my highest, 333 pounds, roughly twice my ideal size—I was just too healthy to have insurance pay for it. Despite a decade of carrying 50 to 150 extra pounds, my body had not succumbed to any of the diseases or conditions caused or worsened by obesity. Not yet, anyway.
As I resigned myself to waiting a few years while trying to sock away the money to pay for the bypass, I heard of a similar but less complicated operation: adjustable gastric banding (AGB). The more I learned about this procedure, the more grateful I was I’d been delayed in my original quest.
Because AGB doesn’t cut into any organs, as most weight-loss surgery does, its risks are fewer. Basically, it works by cinching the upper part of the stomach into a small pouch, so banded folks get full faster and stay full longer. Though AGB doesn’t offer the speedy loss all but guaranteed by the malabsorption of the bypass, which takes part of the stomach and intestines out of the digestive loop, it also doesn’t present its 1-in-200 chance of death. On my mental set of scales, the choice was easy: Lose 5 to 10 pounds a month with a small chance of complications, or lose two to four times faster with a far greater likelihood of surgery-related mortality (or other unpleasantries).
“You’re having surgery in Tijuana?” After the first few times I got that response, I began downplaying that aspect of my upcoming operation. Early on, I had decided to be very open about the surgery. Having seen how poorly weight problems are understood, even by much of the medical profession, I wanted my choice to be educational for those around me as well as beneficial to me. But it became far easier to discuss the location of my surgeon once I had some success under my (loosening) belt.
Why did I choose Mexico? The primary reason was experience. On June 15, 2001, the day of my surgery, the BioEnterics Lap-Band had been approved by the FDA for U.S. use only 10 days earlier, following clinical trials involving fewer than 1,000 people. Worldwide, however, some form of adjustable gastric band had been in use since 1988. Doctors in Europe, Australia and Mexico had been installing the bands for many years, learning the nuances of the surgery and its aftercare. Dr. Pedro Kuri Santiago, my surgeon in Tijuana, had done several hundred more of these operations than any U.S. doctor.
Another reason: cost. I had even less chance of insurance coverage for a procedure considered investigational than I’d had with the better-known bypass. If I wanted this done in the United States, it would take cash —anywhere from $18,000 to $30,000. In Mexico, it took $8,000.
Not to be discounted was the confidence I gained from reports by other members of an on-line support group. Those who’d had surgery with Dr. Kuri included several nurses who made it clear they wouldn’t settle for substandard conditions. As each gave an in-depth description of the small Tijuana hospital, from its unassuming exterior to its well-equipped operating room, I felt a little better about my choice. By the time I was rolled into surgery, weighing 313 pounds yet grinning about my future, I had no doubts whatsoever.
This ease of mind may account for the supreme ease of my recovery, which I knew was not exactly typical. Though many people return to work as soon as I did—I had the laparoscopic surgery Friday morning and was back in the office Tuesday —very few are lucky enough to also say they had no pain. It felt much like I had done strenuous stretching the day before; within a week, even that soreness was gone. It was an auspicious beginning to a joyful journey.
Over the next year and a half, the joy just kept arriving, sometimes in unexpected ways. Perhaps most profound was the realization that my excess weight really wasn’t all my fault. I had spent a lot of years blaming myself, thinking I had little discipline (never mind the time I spent 10 months on liquids or the two years I went without candy). Once the driving appetite that had been with me since childhood was dialed down, letting me experience a full stomach as a signal to stop instead of still telling me more food was needed, I could see how much of my weight problem my physiology had caused and how much was the result of my habits. (I’m not disclaiming all responsibility; few people get to be morbidly obese who don’t overindulge in food to some extent. But it was much easier to control such impulses—and the impulses themselves diminished—once my brain was finally receiving the proper information from my stomach.)
There were lesser joys, too, such as the return to form-fitting clothing. Oh, the wonderfully awful problem of constantly “undergrowing” my clothes! At the one-year point, I celebrated the fact I no longer wore any size with an X in it. A few months later, I had the mixed pleasure and mourning of giving away outfits now much too big —and that I knew I would never need again.
Although I had not been physically impacted greatly by my previous weight, it had made me cautious in some ways, so I loved knowing I didn’t have to be afraid to run up steps. I’m also pleased I’ve drastically decreased my chances of developing diabetes and heart disease, both of which have already affected too many members of my family.
During one memorable San Diego Magazine staff meeting as I approached the three-digits-lost mark, I was presented a dozen roses “for bringing less to the job” than I used to. This sort of loving support from friends, family and coworkers is another advantage I feel lucky to have; many who look into weight-loss surgery struggle not just with their own doubts but with others’ skepticism, sometimes outright cruelty. Many doctors as well as laymen still do not believe that obesity is a disease, not a character flaw; many simply don’t understand why diet and exercise alone can’t be the cure. One reason I was willing to publish this quite personal story was the hope of educating them otherwise.
When the magazine’s executive editor brought up the idea of this article, I demurred at first. Although I’d dropped 100-plus pounds, I hadn’t then even reached my minimum goal (which was to have my weight begin with a 1), and I wasn’t sure I wanted to declare myself a success so publicly when I still had a ways to go. My weight-loss rate had slowed considerably—one of the few benefits of my former size is that I burned many extra calories simply carrying around the excess poundage—and it became harder to predict when I’d get to the size I was after.
Yet I soon realized I was a success, even needing another 30 to 40 pounds gone to reach my ultimate goal of weighing 167. At 203 pounds, I’d crossed the dividing line from obese —a body-mass index greater than 30 —to merely overweight. (Who would have believed anyone would be so happy to be deemed overweight?) At 197, I’ve now lost more than 80 percent of my excess weight since the day I tipped the scales at 333. Every bariatric surgeon I know would swell with pride to claim such numbers for all of his or her weight-loss surgery patients.
But every bit as important as the figures—and my increasingly svelte figure—is what I have proved to myself: Change is possible, even fun. It’s a lesson I’m applying to other areas of my “band-new” life as the future opens up far more paths to me than I once saw. Against most odds, I’ve won by being a loser.
Frequently Asked Questions
Jumping on the Bandwagon
Does health insurance pay for this procedure?
As adjustable gastric banding becomes better known, thanks in part to outspoken banded celebrities like MTV’s infamous Sharon Osbourne and rock star Ann Wilson, more insurance companies are covering it, but usually it’s still a battle. Often, if a company will cover the bypass, it’ll pay for the band—but patients may have to appeal a few times to get that result. San Diego attorney Walter Lindstrom’s Obesity Law & Advocacy Center specializes in helping weight-loss surgery wanna-bes get approval
Do people have to be morbidly obese to have the surgery?
U.S. qualifications are stricter than in other countries, beginning with a body-mass index of 40 or higher (morbid obesity); 35 (severe obesity) if there are co-morbidities—conditions made worse by excess weight. Doctors also look at the patient’s history to determine if there are other reasons weight cannot be successfully lost.
Do you have to give up any foods?
Although this varies by individual, most banded people can eat almost anything they wish—just in much smaller quantities than before. (Optimum weight loss includes avoidance of ultra-high-calorie items, of course.) Many have some trouble with foods that clump easily, such as moist white rice or doughy bread; these items can temporarily block the opening into the “lower” stomach.
Is the Lap-Band the only adjustable gastric band?
There are three types commonly used around the world, but the BioEnterics Lap-Band, made by Inamed, is the only one currently approved for use in this country.
Do San Diego doctors perform this surgery?
At press time, at least two local surgeons had been trained in the procedure but had not yet implanted any bands. Several in Southern California have, however. Find nearby doctors—including those in Mexico—through Inamed’s surgeon locator at www.lap-band.com.
How can I learn more?
Put the words “adjustable gastric band” into any Internet search engine. There are also many patient-based support/information groups, international as well as local, in Yahoo! Groups .