The weight loss miracle that isn't
New evidence of the health benefits of gastric-bypass surgery has doctors eager to recommend it. But some people say the risks are being greatly underplayed. Read the scary truth about a growing trend.
By Sabrina Rubin Erdely
From the August 2008 issue
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.
From the menu of weight loss (bariatric) operations, Wells had chosen the Roux-en-Y bypass, the most popular option in the United States. The surgery sectioned off her stomach to a thumb-sized sac—sharply limiting the amount of food Wells could eat—then connected it to a deeper portion of her small intestine, to limit absorption of the calories she did consume. (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 eraser–sized bites. On her doctor's orders, to replace nutrients no longer absorbed by her digestive tract, she faithfully swallowed a multivitamin, calcium and B12 supplements and two protein shakes daily. Soon she resembled the women in those weight loss infomercials: Fifteen months post-op, Wells had lost an amazing 160 pounds—more than half her body weight—bringing her down to a trim 130.
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.
But despite the growing popularity of obesity surgery—and the general perception that it's a shortcut to thinness and good health—it's no easy path. The American Society for Metabolic & Bariatric Surgery (ASMBS) in Gainesville, Florida, puts gastric-bypass surgery's death rate at between 1 in 1,000 and 1 in 200. In one AHRQ study, 4 in 10 patients developed complications within the first six months, including vomiting, diarrhea, infections, hernias and respiratory failure. Up to 40 percent of gastric-bypass patients can suffer nutritional deficiency, potentially resulting in anemia and osteoporosis; seizures and paralysis have been reported in extreme cases. 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. 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.
New evidence of the health benefits of gastric-bypass surgery has doctors eager to recommend it. But some people say the risks are being greatly underplayed. Read the scary truth about a growing trend.
By Sabrina Rubin Erdely
From the August 2008 issue
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.
From the menu of weight loss (bariatric) operations, Wells had chosen the Roux-en-Y bypass, the most popular option in the United States. The surgery sectioned off her stomach to a thumb-sized sac—sharply limiting the amount of food Wells could eat—then connected it to a deeper portion of her small intestine, to limit absorption of the calories she did consume. (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 eraser–sized bites. On her doctor's orders, to replace nutrients no longer absorbed by her digestive tract, she faithfully swallowed a multivitamin, calcium and B12 supplements and two protein shakes daily. Soon she resembled the women in those weight loss infomercials: Fifteen months post-op, Wells had lost an amazing 160 pounds—more than half her body weight—bringing her down to a trim 130.
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.
But despite the growing popularity of obesity surgery—and the general perception that it's a shortcut to thinness and good health—it's no easy path. The American Society for Metabolic & Bariatric Surgery (ASMBS) in Gainesville, Florida, puts gastric-bypass surgery's death rate at between 1 in 1,000 and 1 in 200. In one AHRQ study, 4 in 10 patients developed complications within the first six months, including vomiting, diarrhea, infections, hernias and respiratory failure. Up to 40 percent of gastric-bypass patients can suffer nutritional deficiency, potentially resulting in anemia and osteoporosis; seizures and paralysis have been reported in extreme cases. 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. 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.