Eileen Wells was smiling as she was wheeled into surgery.
She was too excited to feel nervous.
She was ready to begin her own transformation.
At 5 foot 3 and 290 pounds, she was sick of being fat.
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.
(An increasingly popular alternative, gastric banding, cinches in the stomach to restrict its capacity.)
The rearrangement required Wells to radically overhaul her eating habits.
She learned to eat tiny, frequent meals, cutting her food into pencil erasersized bites.
But although Wells looked like a satisfied customer, she didn’t feel like one.
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.
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 sparked by extreme thiamine deficiency.
“I was a model patient!
I did everything right!”
But as she learned the hard way, doing everything right after bariatric surgery is no guarantee of success.
Last year, doctors performed 205,000 bariatric surgeries, marking an 800 percent increase from a decade ago.
Some of these malnourished patients experience bizarre neurological problems, as Wells did.
Even if patients avoid the major pitfalls, they could be in for a world of intestinal discomfort.
“This is a serious lifelong commitment.”
All this for a surgery that the experts admit is poorly understood.
Obese patients can drop to overweight status (a BMI of 25 to 29.9).
“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.
“They herded us like cattle into this large conference room.
And everyone’s clapping.
People were getting all whipped up, and the doctors were selling the surgery,” she adds.
“Is gastric-bypass surgery right for you?
Click here to see if we can help you qualify!”
beckons one Houston practice.
That’s a remarkable growth for an elective surgery averaging $25,000.
“That should be the headline: Surgery Cures throw in 2 Diabetes!”
“This is about disease, and disease going away.
To think we’re out there as pseudo-plastic surgeons, that’s totally bass-ackwards.”
Either way, more doctors are entering the field.
“It’s daunting to some doctors how much you have to spend on the follow-up program.
Not everyone’s doing what they should,” Dr. Higa says.
In the worst cases, Dr. Hutcher says, doctors outright lie by making impossible guarantees in their ads.
“‘Permanent weight loss.’
There ain’t no such animal as no risk,” he says.
“If you see a doctor’s website that says these things, run like hell.”
Operating on the obese always presents major challenges.
Twenty-two percent of bariatric-surgery patients experienced complications before they even left the hospital, findings in the journalMedical Carereveal.
Those problems ranged from the life-threateningsuch as infection and respiratory failureto milder complications such as vomiting and diarrhea.
(Those same patients' hospitalization rate averaged 8 percent in the year before the procedure.)
“It felt like everything inside me had ruptured.”
They are so common that many bariatric surgeons remove the gallbladder during the initial surgery.
Gallbladder flare-ups are the least of a patient’s post-op worries.
Tammy Cormier of Mamou, Louisiana, found that out the hard way.
In October 2003, doctors diagnosed a bowel obstruction after Cormier developed the worst pain of her life.
“It was worse than childbirth,” she remembers.
Doctors knocked her out and wheeled her into surgery to fix the problem.
In the hospital, tests revealed another bowel obstruction.
The last thing she remembers is being rushed into surgery.
She woke up three days later in intensive care, hooked up to a ventilator.
“All I could think about was ending up back on that ventilator,” she says.
And then there are the true GI disasters, such as the horror Dana Boulware went through.
Almost immediately after her banding procedure in January 2003, Boulware started having trouble keeping food down.
“It was like surgically induced bulimia,” says Boulware, a 46-year-old data entry specialist in Houston.
Then it would come right up."
Still, she considers herself lucky.
Boulware’s best friend had a similarly unhappy gastric-band experience but was determined to give surgery another try.
She died days later of sepsis.
Some bariatric-surgery patients may rationalize any suffering they experience as the cost of losing weight.
In the first 18 months, she dropped 100 pounds from her 325-pound frame.
“I didn’t do anything differently!”
“I still ate tiny meals!”
Why isn’t weight loss more lasting?
“Post-op, these people grieve for the loss of food,” Arioli says.
“Food is their comfort.
These are some serious eaters.”
A patient’s hunger returns, because the body has achieved that lower set point.
“The surgery changes our physiology, the way the body responds to food.
What they lose is what they lose, and they can’t expect to lose any more.”
Figuring out the mysteries of bariatric surgery has become an urgent new frontier.
“We need to figure out why it works, so we can eliminate it.
If we do this right, we won’t be doing surgery for obesity in 50 years.”
Months of surgeries and nutrition therapy failed to pull Eileen Wells out of her downward spiral.
“I was a skeleton, just wasting away,” she remembers.
“My doctor told me that if I didn’t gain weight, I might die.”
Some experts argue that, unfortunately, bariatric procedures are not truly reversible.
Removing a gastric band is easier than reversing a bypass.
“But I’m alive,” Cormier says wistfully.
“Do I regret having gastric-bypass surgery?
Yes, I regret it,” Wells admits.
“I thought I was doing something to change my life for the better.
But it made me feel a hundred times worse.”
Photo Credit: Courtesy of subject
