Weight loss, they say, is a matter of math - burn more calories than you take in, and voila, the pounds peel away. But sometimes there's a glitch in that equation, especially when it applies to people who are seriously obese.
Consider the case of David Stewart, a 56-year-old Cleveland high school teacher who had struggled with his weight since childhood. When shopping for back-to-school jeans, he says his twin brother "always bought slim-cut. I always had to get huskies." As the years went on, Stewart tried different diets - he lost, then gained back, a bunch of weight on fen-phen, the infamous 1990s diet drug that was ultimately linked to heart disease. As for working out, with 246 pounds on his 5-foot-9 frame, Stewart says there were few exercises he could do "without feeling like I was going to pass out."
Meanwhile, his weight-related health conditions - high blood pressure, severe sleep apnea and asthma - became dire. At his annual checkup last year, Stewart says, "My doctor told me, 'If you don't do something about this, one of these is going to kill you,' and that got my attention." He had his stomach stapled at the Cleveland Clinic in November 2012. Two weeks post-surgery, he already lost 34 pounds. And today, he's at about 150 pounds. "I stuck very closely to what [my care providers] told me to eat and all of their recommendations, plus I joined the YMCA, and I work out at least five days a week," he says. "I feel fantastic."
With obesity rates at epidemic proportions in this country - more than one-third of U.S. adults are obese, according to the Centers for Disease Control and Prevention - weight-loss surgeries can provide a life-saving option for people suffering from severe complications that can stem from obesity. However, the surgeries are rather rare, especially for men. Women comprise about 80 percent of weight-loss surgery patients, and men typically opt for surgery only after their weight has led to serious health conditions, say experts in the field.
"Men tend to wait longer to pursue a surgical option to help with weight control," for example, when they "can no longer function at their jobs or with their daily activities," says Anita Courcoulas, a bariatric (weight loss) and general surgeon at the University of Pittsburgh Medical Center's Magee-Womens Hospital. "This is changing in the last several years with the recognition of the many health benefits of bariatric surgery, especially the treatment of Type 2 diabetes, and both more men and women are seeking surgery to help improve their health."
According to Shawn Garber, director of the New York Bariatric Group, there are roughly 200,000 weight-loss surgeries nationwide each year, an upswing from pre-recession levels. In his own practice, he says the volume was up by 50 percent just last year.
The American Society for Metabolic & Bariatric Surgery reports that the number of weight-loss surgeries peaked at 200,000 per year in 2008 and 2009 and then fell in 2010 - the last year for which it has data - to 150,000 to 160,000 surgeries. The group notes that those numbers reflect just 1 percent of the population eligible for weight-loss surgery.
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To be eligible for the surgery, a candidate must be considered morbidly obese, Garber says. In general, though this depends on the specific weight-loss surgery, a candidate would need a body mass index, a measurement based on height and weight, of 40. That would translate to 294 pounds for someone who is 6 feet tall, and 218 pounds for someone who is 5-foot-2, Garber says.
The least risky and least invasive option, laproscopic band, or lap-band, surgery made headlines when New Jersey Gov. Chris Christie had the procedure in February. The surgery, which can be reversed, involves wrapping an adjustable silicone band around the top of the stomach, Garber says. Another option is a procedure known as a sleeve gastrectomy, which removes 70 percent of the stomach, folding it into a long tube or sleeve. Finally, gastric bypass is the most involved and riskiest of the surgeries, as it entails stapling and dividing the stomach and reconnecting the intestines, he says.
In every case, the choice is "never cosmetic," Garber says. "It's always for medical reasons. We do it to give them healthier, longer lives."
According to the American Society of Metabolic & Bariatric Surgery, patients lose up to 60 percent of their former weight six months after surgery and 77 percent of their weight a year later. The society states that the surgeries also help to "prevent, improve or resolve more than 40 obesity-related disesase or conditions including Type 2 diabetes, heart disease and certain cancers."
For Stewart's part, his asthma, sleep apnea and blood pressure problems have all disappeared. "All of my health issues have completely reversed, every single one of them," he says. Meanwhile, he also feels a lot more confident. As a coworker told him recently, he carries himself differently, with his head up and his posture straight.
However, experts emphasize that the surgery is just the first step toward recovery, and success hinges on a dedicated effort involving nutrition, fitness and necessary support.
"You can't just do the surgery alone and expect to have good long-term outcomes," says Stacy Brethauer, the Cleveland Clinic surgeon who treated Stewart. As Brethauer explains, only once patients have the surgery can they then get healthy through diet and exercise. "Once people reach a certain point in terms of their weight and comorbidities," or related disorders, "diet and exercise alone is ineffective," he says.
As Garber puts it, surgery "is not the easy way out. It's the only way out."