Tipped scales, changed lives
So here we are, with a deep-seated biological drive to eat everything in sight, little incentive to exert ourselves, and a host of other factors conspiring to keep us from burning calories. Is there any way at all to literally tip the scales in our favor?
That’s what Beverly Johnson wanted to know when, discouraged and desperate, she expressed her frustration to primary care physician Charisse Gencyuz, M.D., who had been working with her on weight management for more than a year.
“Dr. Gencyuz told me about the bariatric surgery program and gave me a referral so I could attend an informational meeting, just to find out if it was something I might be interested in,” Johnson recalls. With a body mass index of 40.7, Johnson met the program’s criterion of having a BMI of at least 40 (35 for those with weight-related health problems), and she had been under medical supervision for weight loss for at least six months, as also required.
A few weeks later, Johnson attended the meeting and came away “really impressed” by the presentations. “They went into so much depth about the different procedures, the pros and cons and the chances of this or that happening,” Johnson says. She left with a thick information packet that she read all the way through as soon as she got home.
“After I read it, I thought, ‘Wow, I could actually do this program and succeed, and be happy with me,’ ” Johnson says. Still, she didn’t rush into the surgery. She gave herself several months to consider whether it was right for her and whether she could make the necessary commitment.
“When I told people I was thinking about bariatric surgery, they said, ‘You’re taking the easy way out.’ But there is nothing easy about it,” Johnson says. Before being accepted into the program, patients must undergo medical, nutritional and psychological evaluations, compile relevant health records and fill out piles of paperwork. Once accepted, there are still more requirements: meetings with the surgeon, nurse, physician assistant and anesthesiologist; educational sessions on exercise and nutrition; and support group meetings. Patients also must follow a prescribed diet for several weeks before surgery, with the goal of losing at least 15 pounds. Such pre-op weight loss shrinks the liver, making surgery easier, and has been shown to boost weight loss after surgery. Sticking to the diet also gets patients in the habit of eating differently, which is essential after bariatric surgery, and demonstrates their commitment to making the kinds of lifestyle changes that are necessary for success.
The U-M program offers three types of bariatric surgery, all of which are appropriate only for the “heaviest of the heavy” — the three percent of the U.S. population whose BMI is 40 or greater, which generally translates into being overweight by at least 100 pounds, Birkmeyer says. The types of surgery differ not only in how they’re performed, but also in how they accomplish weight loss, how much weight loss they typically produce, and the lifestyle adjustments and possible complications that come with them.
But overall, bariatric surgery — now the second-most commonly performed abdominal surgery in the U.S. — results in a loss of 40 to 70 percent of excess weight and is becoming so safe that deaths and serious complications are rare, Birkmeyer says. Since 2006, he and his wife Nancy Birkmeyer, Ph.D., a clinical epidemiologist, have headed the Michigan Bariatric Surgery Collaborative, which compiles statistics on the 5,000 or so bariatric procedures performed annually in the state and is funded by Blue Cross Blue Shield of Michigan.
“We track obvious things like rates of complications and things that happen around the time of surgery, but we also track the effects of bariatric surgery on people’s lives over the long term, in terms of weight loss, quality of life and improvement in other aspects of their health,” Birkmeyer said. “The goal is partly to help insurers make good decisions about what to cover, but we also do it to ensure that surgery is being done safely and as effectively as possible.” Surgeons from the 24 hospitals involved in the program meet quarterly to review the data and share knowledge.
“By comprehensively tracking our data, feeding that data back and getting surgeons to learn from each other about practices, our mortality rate has gone down, down, down,” Birkmeyer says. “It’s almost zero now. In the entire calendar year of 2009, there were only two deaths from bariatric surgery out of more than 6,300 cases in Michigan.”
The statistics document successes, but they don’t tell the full story of changed lives that Birkmeyer witnesses when he sees patients on follow-up visits.
“By the time I see patients back at two months after surgery, and they’ve lost their first 50 pounds, they’re already off their diabetes and blood pressure medications and taking half the number of pills they were taking before,” he says. “When I see them at six to 12 months, I hardly recognize them. Women who haven’t worn makeup in 15 years are all made up, and they’ve traded their sweat pants for new wardrobes. These patients are getting jobs, starting to date again, going to graduate school. It’s so remarkable to see how empowered they are and how differently people feel about themselves as a reflection of just their weight.”
Count Beverly Johnson as one of those people. Seven months after her gastric bypass surgery, she had lost 99.5 pounds of the 109 pounds she hoped to lose, and she was back to wearing a size 10.
“I feel good,” Johnson says, “Really, really good. When I get tired now, I know it’s because I’ve been running like a little crazy person, not because I’m trying to tote all that weight around while I’m doing the running. And when I look in the mirror now, I think, ‘I know that woman; I recognize who she is. She was lost up under there somewhere, but now I’ve found her. I’ve found her, and I’m so, so happy.’ ”