Some call it a shortcut. A copout. A cheat.
Jooyeun (Joanne) Chung, M.D., and her patients call it a life-altering, sometimes life-saving, assist in the pursuit of better health and quality of life. There have long been stigmas attached to bariatric surgery—which comes in a few different forms and is often referred to, inaccurately, as “stomach stapling”—because our media-driven, gossip-driven culture tends toward the assumption that any weight loss is being pursued for aesthetic purposes. Such stigmas are both the cause and the effect of a celebrity such as former “The View” host Star Jones publicly denying she’d had gastric bypass, when in fact she had.
Many other famous folks, from Randy Jackson to Roseanne Barr to Al Roker to local notables such as Jets coach Rex Ryan and Governor Chris Christie, have been open and honest about their decisions to have the surgery. And most people who’ve had one of the bariatric procedures, famous or not, try to overcome the stigmas by divulging their primary motivation: to be healthier and live longer, not to look better. (Although, if fitting into smaller jeans accompanies the longer, healthier life, most patients won’t complain.)
Everyone who has ever had bariatric surgery will agree on one thing: It’s hard work. It’s not so much a secret path around the mountain as it is a pickaxe that makes the arduous task of climbing the mountain a little more achievable.
“A lot of people think, I’m going to go for bariatric surgery, and it’s like swallowing a magic pill, I’m going to lose all this weight, and that’s the way I’m going to be for the rest of my life. It’s not so. It’s only a tool,” says Jooyeun Chung, M.D. the medical director of the Metabolic & Weight Loss Center at Capital Health Medical Center-Hopewell. “I keep emphasizing that with my patients: I give them a tool and as much support as possible in the following months and years to help them succeed.”
Understanding the Options
Dr. Chung performs three different types of bariatric surgery at Hopewell:
• Laparoscopic gastric bypass—frequently referred to as stomach stapling—has been around for three decades and alters the digestion process by separating a small pouch from the rest of the stomach.
• Laparoscopic adjustable band placement, also known as adjustable gastric band or simply “lap band,” which separates the stomach into a larger and a smaller segment via a silicone band wrapped around the upper stomach.
• Laparoscopic sleeve gastrectomy, known in layman’s terms as “the sleeve,” actually removes a large portion of the stomach, reducing it to about 25 percent of its prior size.
Which procedure works best depends on the patient. For example, gastric bypass tends to have particularly positive effects for patients with diabetes or hypertension. The lap band is slowly being phased out because the band itself sometimes causes complications and needs to be removed, but some patients prefer it because the surgery is reversible.
Whichever procedure a patient chooses, the challenge he or she undertakes is substantial. And the hard work doesn’t start when a patient comes out of surgery. It starts at least six months before that.
The first step for a person considering bariatric surgery is determining whether they qualify, a process based on simple math. A prospective patient’s body mass index (BMI) is calculated using his or her height and weight. “One of the common questions that I get from patients is, ‘I weigh so many pounds, do I qualify?’” says Dr. Chung. “They don’t understand that in the bariatric surgery world, we talk in terms of BMI.”
To qualify, a patient must have a BMI of 40 or above. (To give you a sense of what that looks like, a 5’6″ person weighing 250 pounds has a BMI of 40.3.) However, if the patient has an obesity-related condition, such as diabetes, high blood pressure, sleep apnea, asthma, or coronary artery disease, he or she can qualify with a BMI between 35 and 40. The numbers do not vary from one doctor to another; these are the criteria set forth by the National Institutes of Health in the mid ’90s, and insurance companies adhere to them rather rigidly. Needless to say, not many candidates are able to go through with the procedure if their insurance isn’t covering it.
If a patient has the minimum BMI required to qualify, the next steps are two evaluations: one from either a psychiatrist or psychologist and one from a bariatric dietitian. “We then have subsequent dietician sessions,” explains Caroline Lazur, a registered dietitian at Hopewell.
The object of all of these evaluations is to make sure there are no undiagnosed psychological illnesses or eating disorders and that patients have an understanding of the process that awaits and the appropriate support system to help them through it.
Go With Your Gut
Lynn O’Brien had no problem qualifying from a BMI perspective when she first met with Dr. Chung in 2011. She was 5’2″, 372 pounds, and had a BMI of 68.0. The process got much tougher from there, however. “When I met Dr. Chung,” O’Brien recalls, “she was like, ‘Lynn, you need to lose at least 50 pounds before I’m even going to consider surgery.’ She wanted commitment from me—which is understandable.”
In the first month, O’Brien gained weight. “Dr. Chung was going to throw me out of the program,” O’Brien says. “She’s a nice person, but she’s also honest.” The next month, through exercise and improved diet, O’Brien lost more than 10 pounds. So it continued for several months, and even though she put on two pounds over the holidays, Dr. Chung had seen what she needed to see and approved O’Brien for the sleeve gastrectomy.
Two years removed from her surgery, O’Brien now weighs less than 200 pounds. Shortly after speaking to Real Woman in December, she was scheduled for plastic surgery to address the loose skin left behind by the extreme weight loss.
O’Brien admits she’s still having trouble following the post-surgery diet. The sleeve forces portion control—“My stomach is the size of two fingers, and yours is the size of a fist. You can hold food. I can’t hold food,” she says—but it doesn’t force quality control.
The cornerstones of the diet, according to Lazur, are “mindful, conscious eating,” excessive chewing (at least 25 chews of every mouthful) to slow yourself down and help with digestion, eliminating grazing or snacking, and eating your protein first to make sure you don’t run out of stomach space before getting to the good stuff.
“Sometimes patients and I will make it a rule that anytime they’re eating something, they have to be sitting down at a table,” Lazur says. “With our lifestyle, being on the go, a lot of patients end up snacking in their cars or skipping meals or things like that. Scheduling meals is really important.”
For O’Brien, giving up bread and other carbohydrates was, and still is, difficult, but with 180 pounds having fallen off and finding herself now able to get up and down stairs with greater ease, it’s a sacrifice she’s able to continue making.
The Right Fit
Every patient is unique, and Amy Berkeley’s story is very much different from Lynn O’Brien’s. When she was 20 years old, Berkeley lost about 100 pounds from about 260 and kept it off for years, until she began having children. She couldn’t drop the pregnancy weight—not even when training for triathlons, which she did numerous times. So in her early 40s, Berkeley looked into bariatric surgery. The problem was, at 5’7½” and 240 pounds, she had a BMI of 37.0 and no correlating medical conditions.
“Dr. Chung had to really advocate for me,” Berkeley recalls. While her BMI was technically too low to qualify, because of Berkeley’s long history of unsuccessful but earnest dieting efforts, an exception was ultimately made, and Berkeley had the sleeve gastrectomy. In combination with the fact that she began training for a triathlon immediately after recovering from her surgery in 2011, Berkeley lost weight quickly and has spent most of the last two years within a few pounds of her self-described “feel-good weight,” 160 pounds. “My eating habits were pretty healthy to begin with,” Berkeley says. “There was a brief period of time after the surgery where I needed to learn how to adjust the amount of food I was eating, and I think I threw up once or twice. But otherwise, it was a pretty straightforward process. I didn’t have to change my eating habits much. It was the perfect operation for me.”
What was “straightforward” for Berkeley is anything but for most patients, many of whom don’t make the necessary adjustments to their lifestyle and either don’t lose the weight, or lose it but eventually put it back on. “Patients have to diet, and they have to exercise post-operatively,” Dr. Chung says. “If they don’t change the way they eat—let’s say they continue to have grazing behavior, or they’re good for the first year or so, then go back to eating high-fat, high-calorie food—the weight’s just going to come right back. That’s why our program is different and has follow-up sessions built in to it. We provide ongoing support in the months and years following surgery to help the patient reach her goals.”
That’s why patients continue to see the program’s dietitian at regular intervals. Lazur meets with her patients two weeks after the surgery, then at the one-, three-, six-, nine-, 12-, and 18-month marks, and then every year following that. “We basically tell them, ‘We’re in this together, for life,’” Lazur says. The program at Hopewell will also soon include support groups and a monthly newsletter with healthy recipes.
As with any major abdominal surgery or any surgery requiring general anesthesia, a bariatric procedure comes with some risks. Dr. Chung discusses them in detail in her free information session. “The primary goal is to lengthen their life span and enable them to enjoy those years medication-free, with a better quality of life,” says Dr. Chung. “I make it pretty clear to all the patients that the surgery is not designed to make them skinny. People have honestly come into my office and told me, ‘I can’t wait to fit into size 4.’ If they say that, I turn them down, because their focus is completely off.”
“If you’re doing this for aesthetic reasons, you should probably think twice, because it’s not going to make you like a runway model,” Berkeley seconds. “I don’t know that I would go through major surgery if it was just about looks. But for health, I definitely would. I would treat it as any other major health issue in your life—like, if you had gallstones, you would have your gallbladder out. I view this
very much as a medical procedure for a medical condition, not as a tummy tuck.”
The lesson from those who’ve been through bariatric surgery is that it’s better to feel good than to look good. Nobody embodies that spirit more than Lynn O’Brien, who has halved her body weight, gotten a new job, and changed her outlook on life. “Before the surgery, I could barely get up and down the stairs,” she admits. “This year, I couldn’t wait for snow to fall so I could get out and shovel it. Everything’s so different now, energy-wise. I can park my car across the street instead of having to be right in front of the building,” O’Brien says. “I don’t have to make other people get out of the car and get things for me. I do things for myself now.
“I love the fact that I’ve done what I’ve done.”