Weighing the Risks
More than ever, obese patients are turning to gastric bypass surgery. The results can be striking, but it's not a slam-dunk
Even success takes a lot of work. Patients can eat only small amounts of food at a time, and they must maintain a lifelong regimen of vitamins and proper nutrition to stay healthy. Nearly 30 percent of patients develop nutritional deficiencies that lead to conditions like anemia and bone loss.
Even those who eat right may be winning only half the battle. "There are tons of reasons that people eat, and nutrition is low on the list," says Mitchell Roslin, chief of the obesity surgical program at Lenox Hill Hospital in New York. Take Rhonda Redman, a Los Angeles boutique owner who had gastric bypass surgery in 2004. Redman, 49, almost delayed her operation, which is preceded by fasting, after having such a bad day the day before that only a cheeseburger could take away the pain. "It's been harder to deal with some emotional issues since the surgery, because I can't turn to food," says Redman, who has lost more than 100 pounds.
With that in mind, prospective patients are required to undergo counseling so they don't return to their same habits. This is especially true for teenagers, whose ranks among bypass patients are growing. At Lucile Packard, where there is a three-month waiting list to enter the clinic, teens who are candidates for bariatric surgery (a BMI of at least 40 and one severe obesity-related illness) must participate in a six-month program that includes behavior modification, physical therapy, and psychiatric evaluation before they ever meet a surgeon. "We're militant about changing kids' behavior and lifestyle before I get near them," says Albanese.
But patients may find that old eating habits do return. While large portions are not an option, steady grazing or high-calorie foods can put the pounds back on quickly. As patients are reminded: "An M&M a minute adds up." In fact, the average patient, a 5-foot-4 woman at 275 pounds, weighs about 190 pounds three years after the operation. Lighter but still obese. "The surgery is just a tool," says Curry. "It's not a magic cure."
Get in line. You'd never know that from listening to the sales pitches. With an obesity epidemic and doctors eager to cash in on a procedure that can cost upwards of $30,000, bypasses are being marketed like new cars. Small hospitals and independent weight-loss centers are moving aggressively into gastric bypass. Earlier this year, one New York surgeon promised a free operation to the first 10 qualified candidates to show up at the Times Square Brewery on New Year's Day. By 5 a.m., dozens of obese people lined the sidewalk. Dominick Artuso, a bariatric surgeon at the Community Hospital at Dobbs Ferry in Westchester County, N.Y., said he did it to help people whose insurance wouldn't cover the surgery. The publicity, however, was "not a bad thing," says Artuso. "My administrators were smiling from ear to ear."
Weight-loss operations are challenging even for the most-skilled surgeons, since patients are often high-risk cases because of diabetes or heart or lung problems. To master a gastric bypass, a surgeon needs to perform it at least 100 times, according to the ASBS, whose own ranks of active doctors have grown from 367 in 2000 to more than 1,600 this year. Yet virtually any surgeon can hang out a shingle. As a result, ASBS plans to identify "centers of excellence,''facilities that track patient outcomes for a minimum of five years, require that doctors perform at least 125 procedures, offer ongoing physician education, and are fully equipped for life-threatening emergencies.