Photos from Washington Post Online

My intuition says that Oprah already is seriously looking into weight-loss surgery. The media mogul  as the WPost’s Robin Givhan calls her, has all the money in the world to battle fat. She’s had the cook and the trainer and the healthy eating and the workouts, and millions of fan/friends cheering her on. Her system worked, and it’s not working. For insights, read the WPost’s Robin Givhan’s column: We Share Your Loss, And Your Gain. 

I assume that Oprah and her researchers have looked at the stats for banding and paid attention to the fact that when your tiny stomach starts to stretch again, the bands can be tightened. More to the point, why wouldn’t she get banded? And keep training? And keep eating healthy?

If Oprah goes the surgical route, expect a surge of sign-ups. Imagine what will happen to the two-year waiting list in Utah. (Just look at sales of Amazon’s e-reader, the Kindle. Oprah said it was her favorite gadget and it’s been sold-out since November.) 

Cathy Note:

Starting last April, when two doctors that I highly respect, with different specialities, in different cities talked about weight-loss surgery, I blogged: Here’s a trend.

The gucked-up layout and the endless, goofy metaphors make You on a Diet: The Owner’s Manual for Waist Management a pain to read. 

However, this book is a classic and it should be read. (The recipes are good, too.)

In their last chapter, best-selling authors Dr. Michael Roizen, Cleveland Clinic, and Dr. Mehmet Oz, New York Presbyterian-Columbia University, promote weight-loss surgery and detail the strengths and weaknesses of gastic bypass v. banding. 

They nail it right away: ”Most people view weight-loss surgery the way they view steroids in sports–that it’s cheating, its unnatural, it’s an unfair advantage, it’s cutting corners….

“Some people simply can’t lose weight like everyone else and often beat themselves up about being undisciplined or out of control. Many are very disciplined, successful, and in control in other aspects of their lives but are just wired different in the weight department. Finally, there’s a real alternative for people who are incapable of succeeding without help: weight-loss surgery.”

Roizen and Oz continue, ”Think for a second: if you had prostate or breast cancer (which both have about the same risk of death per year for people over fifty as does a waist size of 38 for women and 45 for men, with risks like high blood pressure, sleep apnea, diabetes, and cholesterol problems), you’d take action. You’d talk to doctors, you’d schedule surgery to remove the tumors, and you’d make lifestyle changes that would help lower the chance that you’d ever contract the disease again. You wouldn’t pop a cough drop, then throw up your hands in defeat if menthol weren’t the magic tumor killer. You’d get professional–even drastic–help. You would even let someone cut you open if the therapy was effective…”

The two doctors warn that all of surgical options require permanent diet and exercise changes. Or, as they write: “[A] Diet Myth [is] that if you have gastric bypass surgery, you never need to worry about dieting again.”

Note: To take your waist measurement, Roizen and Oz recommend putting the tape measure at the point of your belly button. 

Photo credit: Amazon.com

SALT LAKE CITY, Utah — My step-cousin’s cousin begged her doctors for a gastric bypass during a gall bladder emergency last year, and her doctors agreed. 

RESULT: “Jean” has lost 120 pounds. 

For the first time in her life, she feels full, she says. She went through a post-surgery spell where she thew up (”dumped” in weight-loss jargon), but that didn’t bother her, and dumping passed.

Jean ate one french-fried onion ring and a small salad during lunch with our mutual cousin last month. To my eyes, she looked like the mature woman I would have expected from my memories of a glamorous, big-city teenager come to visit our ranch in northern Wyoming. Jean still is attractive and she still dresses with flair. On that cool fall day, she wore a long-sleeved shirt and slacks with a dramatic belt. Her neck and face are normally wrinkled for a well-preserved woman approaching 70.

I can imagine Jean wanting to lose 10 pounds–I do, too– but I can not imagine a double-sized Jean.

And now that she looks healthy and normal, what happened to her stretched skin? A Brazilian friend’s cousin who had the bypass several years ago, had her body tucked–if “tucking” is what you’d call cutting away swathes of skin. 

Jean says her skin hangs in folds, especially on her stomach, but she says she doesn’t care. “No one sees my body anyway.”

I wonder. Will this thought last? Is this the old, big Jean? Or, is this simply a realistic assessment of the road ahead for a long-divorced grandmother?

_________

Note: My step-cousin says it costs $20,000 to jump the weight-loss surgery queue in Utah. 

Two’s a Trend is on target–sort-of. Five weeks after I wrote about weight loss surgery as a trend, the Washington Post featured the surgery. But the Post’s angle was what to do when the first, gastric bypass stops working. (Writer Larry Lindner pinpointed the surge in gastic bypass as happening back to 1998 to 2001 — was I asleep, or what!) 

Seven years later, Lindner comes down on the side of the newer, adjustable banding technique as the better surgery because the band can be tightened again if someone starts to overeat and stretch their stomach. 

About 20 to 40 percent of the gastric bypass patient do just that, according to Lindner. Some of these people are returning to the operating table to get banded. 

Sounds like weight loss surgery is a failure. Except, it isn’t. I predict that it is becoming mainstream–the numbers are too compelling for patients and insurance companies. Says Lindner: “Bypass patients lose 60 to 80 percent of excess weight, and 60 to 80 percent of those patients keep off at least two-thirds of the weight they lose. Such people often experience a near-complete reversal of diabetes, sleep apnea, high cholesterol, high blood pressure, arthritis pain and a host of other health-compromising problems, frequently going from several prescription drugs a day to none.”

Linder’s latest book is “Fighting Weight. How I Achieved Healthy Weight Loss with ‘Banding,’ a New Procedure That Eliminates Hunger–Forever.” Nine Reviews on Amazon, mostly positive. 

Today I looking at large people with new eyes. Now I think: When they are going to get their stomach banded and finally be able to lose weight?  And I wonder: What will be the cut-off point for stomach banding in, say, five years. Right now, the patient may need to lose 100 pounds, but what about those who need to lose 80 or 60 or 40? How can someone take that kind of weight off and keep it off. I should lose 10 and I still haven’t done it, and actually, I’m 17 pounds up from my college weight.

What changed my mind about stomach surgery?

The attitudes of two doctors that I highly respect (and so do many others.)

Several months ago, I asked a beautiful young doctor I know what she is going to advise her overweight patients. She has a double speciality–internal medicine and psychiatry–and plans to practice in Wisconsin, which has a 20.9% obesity rate.  Her answer surprised me. ”Stomach surgery is the only thing that results in real weight loss.” 

I’d thought stomach surgery was something gross, if not weird, and left people with lots of diarrhea and other side-effects. This doctor is an expert in mind-body wellness, and that’s what she recommends. I tucked her comments into my memory bank.  

Then…recently, during my annual check-up, I read a flyer from Sibley [Hospital] Center for Weight Loss Surgery, tucked among the breast cancer pamphlets in the waiting room. The flyer quotes the Journal of the American Medical Association that “on average, surgery resolves or improves diabetes: 86%, high blood pressure: 78%, obstructive sleep apnea: 85% and high cholesterol: 70%.” 

It turns out that my cancer surgeon, who for years has been on the Washingtonian’s list of top doctors in the region, is assisting another surgeon in their group with stomach banding.* That surprised me. The major improvements in health after stomach surgery surprised me. It appears that banding doesn’t result in as rapid weight loss as a gastric by-pass, but the weight loss is slower. [*Medical term is "Laparoscopic Adjustable Gastric Banding (Lap-Band)"]

I like these kinds of surprises, when a problem that seems impossible to solve turns out to be solvable. 

More reading also shows that when people end up with a stomach the size of a walnut, they have to drastically change their eating habits or they get nauseated and/or have pain.  (U of Rochester  | Stanford | Sibley [DC]

The Latest Surgical Technique

The WPost noted on Sept. 21, that doctors are experimenting with going through the mouth or the vagina for stomach surgery for obesity. [The article was about "natural orifice surgery," which primarily is bringing gall bladders up through the mouth. Now that's gross!]

Note: Illustration from Sibley Hospital.

Wendy Brown fell in love and got engaged to an Albanian working in a Greek bar, she told the WPost in October, 2007, complaining that she couldn’t get him a fiancé visa.

I was intrigued. I didn’t realize Albanian immigrants were doing low-level jobs in Greece.

I mentioned this to the sister-in-law of my cousin. She told me that several years ago, the owner of her travel agency, the divorced grandmother of six, married a younger Albanian bartender in Greece and brought him home to the Rockies. “I don’t care whether he’s just marrying me for a green card,” she told her friends when she returned from her vacation. “I am happy.” They’re still together.

The next morning at the gym, I mentioned this mini-micro trend to a widow friend who amused us each morning with tales of her diligent search for a mate. “Why don’t you skip Greece and go directly to Albania on your next trip?” I asked.

She wasn’t amused. A few months later, she fell in love with a man she met on e-harmony, about 12 years older and very compatible. She glows, they are happy.