"Eileen Wells was smiling as she was wheeled into surgery. She was too excited to feel nervous. At 38, she was about to get “a new lease on life,” she says, echoing jargon in weight loss surgery ads. She had seen the before and after pictures in celebrity tabloids, watched the TV infomercials, listened to the patient testimonials and researched online. She was ready to begin her own transformation. At 5 foot 3 and 290 pounds, she was sick of being fat. Her joints ached. Her feet hurt. A stroll through the mall near her home in Greenwood Lake, New York, was enough to leave her sweat-slick and gasping for air. She was anxious to say good-bye to sleep apnea and dieting, ready to take control. And so in March 2005, Wells underwent a laparoscopic gastric bypass. She was grinning right up until the anesthesia knocked her out. ....
But although Wells looked like a satisfied customer, she didn’t feel like one. Seven months after surgery she had developed an agonizing ulcer on the new inner seam between her stomach and intestine, which required a second operation. Not long afterward, Wells recalls eating a bite of tuna steak her husband, Ron, had prepared and doubling over in pain; an ambulance rushed her into surgery yet again, this time for an intestinal hernia — her bowel had snagged on a slit in her abdominal wall. A fourth procedure followed to ease the pain of the abdominal scarring from her previous surgeries. Meanwhile, Wells’s gastrointestinal pain had become so severe that she could barely eat. One day while shoe shopping, she realized she couldn’t flex her right foot. Within weeks her limbs began to tingle, her energy evaporated and her weight plummeted. She stopped menstruating. By late 2006, Wells had shrunk to 105 pounds.
“I feel like I’m dying,” she told Ron. Months of doctors’ visits revealed that Wells had beriberi, a disorder caused by extreme thiamine deficiency. Rarely seen outside 19th-century Asia, it’s present enough among those in the weight loss–surgery world that doctors call it bariatric beriberi.
A so-called shortcut
“I was a model patient! I did everything right!” Wells says today, still in disbelief that after all the hype and hope, her surgery turned out so disastrously. But as she learned the hard way, doing everything right after bariatric surgery is no guarantee of success.
That fact may come as a surprise: With glowing media reports of its health benefits and a roster of celebrity success stories, weight loss surgery is beginning to feel like the miracle cure of the moment. Last year, doctors performed 205,000 bariatric surgeries, marking an 800 percent increase from a decade ago. As of 2004, 82 percent of patients are women, according to the U.S. Agency for Healthcare Research and Quality (AHRQ) in Rockville, Maryland. Weight loss surgeries are poised to become even more popular in the wake of findings that gastric bypass and banding can send type 2 diabetes into remission in many people. A 2007 report from the University of Utah School of Medicine in Salt Lake City found that obese patients who had bypass surgery had a 40 percent reduced risk of dying in the seven years after the procedure, compared with obese people who didn’t have the surgery. Bariatric surgeons are using results like those to make the case for surgery as a preventive measure against cancer, heart disease and diabetes in patients who are severely obese....
Even if patients avoid the major pitfalls, they could be in for a world of intestinal discomfort. Not to mention how difficult it is to retrain yourself to subsist on 3-ounce meals and vitamin pills after surgery. “If you’re here for the quick fix, then this surgery is not for you,” affirms Kelvin Higa, M.D., immediate past president of ASMBS. “This is a serious lifelong commitment.” It’s an adjustment so profound that patients are screened to make sure they’re psychologically up to the task — a test that, according to a recent study in the Journal of Clinical Psychiatry, one-fifth of would-be patients fail.
All this for a surgery that the experts admit is poorly understood. Few randomized, controlled studies (the gold standard of research) have been performed comparing gastric bypass with nonsurgical weight loss therapy. Although initial weight loss can be dramatic — gastric-bypass patients typically shed around 70 percent of excess weight — patients gradually regain 20 to 25 percent of what they lose. For people with extreme obesity, defined as having a body-mass index of 40 or greater, gastric bypass often merely shifts them into the obese category. Obese patients can drop to overweight status (a BMI of 25 to 29.9). Yet fewer than 10 percent of patients achieve a normal BMI of 18.5 to 24.9, reports Lee Kaplan, M.D., director of the Massachusetts General Hospital Weight Center in Boston. Altogether, weight loss surgery remains an uncertain proposition, and although potential patients must meet certain criteria (as the women interviewed for this article did), experts caution that the surgery is definitely not meant for the mainstream. “Because it’s risky, it’s only appropriate for a tiny fraction of people with obesity — the sickest 1 to 2 percent,” Dr. Kaplan says. “The idea that all obese people should get surgery is insane.” Yet that’s the way weight loss surgery is being peddled to the public...
The selling of a surgery
Before Ellen Marraffino underwent gastric-bypass surgery in December 2003, she attended an information session at a hospital in Orlando, Florida, and was surprised to find a revival-like atmosphere. “They herded us like cattle into this large conference room. There were at least 100 people, all terribly desperate to lose weight,” recalls Marraffino, a 49-year-old former teacher. “They paraded the successful patients, giving them the microphone: ‘I never thought I could wear a size medium in my life, and now I’m so happy and things are wonderful!’ And everyone’s clapping. People were getting all whipped up, and the doctors were selling the surgery,” she adds.
Free seminars have proliferated around the country, as doctors, hospitals and bariatric surgical centers find new ways to promote their services. Add to this the proliferation of billboards, TV ads and websites covered in flashing before and after photos and exclamation-studded enticements, looking more like ads for personal-injury lawyers than for a risky surgery. “Is gastric-bypass surgery right for you? Click here to see if we can help you qualify!” beckons one Houston practice. Another site announces a “competitive packaged price” for gastric banding patients opting to pay out-of-pocket — a route that allows doctors to avoid dealing with insurance and ensures they’ll get paid in full, as insurance companies have strict rules about which candidates qualify and sometimes don’t cover the entire cost. Although self-payers are a small segment of patients, their numbers shot up 62 percent in a two-year span, according to a study by HealthGrades, an organization in Golden, Colorado, that rates the quality of health care providers. That’s a remarkable growth for an elective surgery averaging $25,000.
Meanwhile, the manufacturers of two competing brands of gastric bands — Allergan, which makes the Lap-Band, and Johnson & Johnson, maker of the Realize Band — have taken the unusual step of marketing a major surgery directly to consumers. In November 2006, Allergan introduced a TV campaign for the Lap-Band, and both companies have websites allowing would-be patients to watch or read testimonials from happy customers, link to loan providers before surgery and track their progress afterward. At the Johnson & Johnson site RealizeMySuccess.com, a banding patient can create a 3-D model of herself and see what she might look like after a dramatic weight loss. “It works much like the cosmetic surgery industry: It’s heavily advertised, to patients, especially to women. And there’s lip service being paid to health, but for patients the great motivator is to improve appearance,” asserts Paul Ernsberger, Ph.D., nutrition professor at Case Western Reserve University School of Medicine in Cleveland.
The unadvertised complications
Operating on the obese always presents major challenges. “One of the first tenets you’re taught as a surgical trainee is to fear fat,” Dr. Hutcher says, in part because it crowds the organs and makes it hard to see. Twenty-two percent of bariatric-surgery patients experienced complications before they even left the hospital, findings in the journal Medical Care reveal. Those problems ranged from the life-threatening — such as infection and respiratory failure — to milder complications such as vomiting and diarrhea. And a 2005 Journal of the American Medical Association study found that 20 percent of gastric-bypass patients were rehospitalized the year after surgery, sometimes for follow-up operations. (Those same patients’ hospitalization rate averaged 8 percent in the year before the procedure.) “It’s those additional surgeries you worry about, because there’s a significantly increased risk in repeat operations,” largely due to internal scarring, points out Mass General’s Dr. Kaplan...
When the fat makes its way back
Some bariatric-surgery patients may rationalize any suffering they experience as the cost of losing weight. But even so, they may not keep the pounds off — and the svelte ideal they’re aiming for may be a pipe dream in the first place.
Lisa Tannehill of Grants Pass, Oregon, had high expectations when she had a duodenal switch at age 38. “I’m a big believer in the surgery,” she avers — and remains so despite having to fight through a post-op nightmare of a hernia and a reaction to pain meds. In the first 18 months, she dropped 100 pounds from her 325-pound frame. From there, however, Tannehill’s weight plateaued — and then, to her horror, the pounds began creeping back on. “I didn’t do anything differently!” she says. “I still ate tiny meals!” Nevertheless, six years post-op, Tannehill has leveled off at 240 pounds, a net loss of 85 pounds.
The greatest period of weight loss is the 12 to 18 months after bariatric surgery, after which you start to see weight regain, according to Meena Shah, Ph.D., an obesity researcher at the University of Texas Southwestern Medical Center at Dallas. Her 2006 review of the controlled studies done on the issue revealed that the disease-fighting properties of both bypass and banding surgery go down as patients’ weight goes back up."
See the entire article (worth the read,especially if you are thinking about getting WLS)