Gastric bypass

When obesity reaches morbid levels, some people are opting for major surgery

When obesity reaches morbid levels, some people are opting for major surgery

October 07, 2002|by KATE COLEMAN

"I've always been a big person," says Richard LaVelle of Boonsboro.

An eight-pounder at birth, he weighed 75 pounds at age 4, 275 in eighth grade, and 340 pounds when he graduated from high school.

LaVelle, 25 years old, is tall - 6-feet-7-inches tall. The last time he was weighed, he tipped the scales at 600 pounds.

He's tried to lose weight - many, many times - in different ways, including dieting and diet medications.

After graduating from college, LaVelle got a job as a security guard in Oct. 1999. In the next year and a half, his weight went from 400 to more than 500 pounds. By last November, LaVelle couldn't fit into his uniforms and was fired.


His weight affects more than his employment. LaVelle was physically active as a kid and played football in high school and college. Up until a couple of years ago he lifted weights and he could jog - if only for two or three minutes at a time.

Now he has trouble walking, trouble fitting behind the steering wheel of his truck. He is "waterlogged." His ankles are the size his calves used to be, his calves the size of his thighs. His thighs each measure 40 inches. He has heartburn, high blood pressure, and because his organs have to work so hard to support his size, he says his heart, liver and kidneys are enlarged.

He doesn't like to eat in restaurants. "I am so self-conscious. A lot of people don't understand," he says.

LaVelle's family doctor referred him to Holy Cross Hospital in Silver Spring, Md., for gastric bypass surgery. He is a candidate for the Roux-en-Y gastric bypass which surgically staples the stomach, reducing its capacity from a normal 80 ounces, to 1 ounce. The surgery also alters digestion by redirecting the small intestine, bypassing some of the area in which food would meet up with digestive juices, resulting in reduced food absorption.

Because of his size, doctors have not yet determined whether he will be eligible for laparoscopic surgery that uses a fiberoptic scope and a video monitor and several small - smaller than 1/2-inch - incisions. LaVelle has attended support groups at the hospital and talked to patients who have had the surgery. He has undergone a battery of tests. He is aware of the risks and challenges the operation will present.

LaVelle is a candidate for weight loss surgery because his Body Mass Index - BMI - classifies him as having clinically severe or morbid obesity. BMI describes body weight in relation to height and is strongly correlated with total body fat content in adults.

BMI of 25 to 29.9 is identified as overweight. BMI of 30 and above is considered obese. Richard LaVelle's BMI is 64. He meets another criterion for the surgery: He is more than 100 pounds overweight.

Obesity is the disease of this century, says surgeon Michael Schweitzer, M.D., who performs bariatric - obesity - surgery at Sinai Hospital of Baltimore.

Ninety-seven million Americans are overweight or obese, according to the National Institutes of Health.

Health problems, including high blood pressure, high blood cholesterol, type 2 diabetes, coronary heart disease, as well as stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems and cancers can accompany excess weight.

NIH estimates that annual costs connected with obesity-related disease approach $100 billion in the United States. Obesity is a major cause of preventable death in the United States and it is on the rise. "The rates are staggering," Schweitzer says.

Obesity involves many factors - genetic, environmental, cultural, says Schweitzer. "It's not so easy as just don't eat."

But gastric bypass surgery - even when done laparoscopically - is major abdominal surgery, Schweitzer says. Candidates must be psychologically stable and compliant, he says, and he takes care to fully inform them of risks.

Because the surgery reduces absorption of nutrients, patients must take vitamin and mineral supplements daily - for the rest of their lives.

Nelson L. Ferreira, M.D., of Digestive Disorders Consultants in Hagerstown has patients who have obesity. "No matter how hard they try, they can't lose weight," he says.

But he never has referred patients for gastric bypass surgery. One of his concerns is the potential for anemia. Because foods are processed differently, iron is not converted and cannot be absorbed, he says.

For people who have clinically severe obesity, that risk must be weighed against the other health risks they face.

In April, Schweitzer performed the laparoscopic Roux-en-Y bypass on Kris Miller of Greencastle, Pa.

Miller, who weighed more than 300 pounds, had tried "everything" to lose weight - liquid diets, Weight Watchers, diet pills. She suffered from hypertension and was becoming uncomfortable in her work as an operating room nurse at Washington County Hospital.

Miller, 40, has lost about 100 pounds since the surgery. Although she has had to deal with some unpleasant side effects, including ulcers and having her esophagus dilated more than once, Miller says she'd have the surgery again.

"It's been well worth it."

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