The surgical option: For some, stomach stapling is last hope

[Guest guest]

The surgical option: For some, stomach stapling is last hope

By VIRGINIA ANDERSON

The Atlanta Journal-Constitution

Published on: 01/03/06

Dr. Neil Hutcher wishes he could write headlines, in addition to

doing his day job of cutting into stomach and intestinal tissue to

help people reduce their body fat by hundreds of pounds.

In big, bold letters, Hutcher says he would write: " Surgery cures

diabetes " and " Surgery saves thousands of lives. "

As president of the American Society for Bariatric Surgery, Hutcher

has a duty, as well as financial incentive, to be an apostle of

bariatric surgery, procedures that diminish the size of the stomach

or bypass part of the intestines so that a person must limit how

much food he or she eats. The surgery typically results in dramatic

weight loss, sometimes as much as 250 pounds.

And yet, Hutcher will tell you that his enthusiasm for the procedure

is so strong not because of what it means to him but what it means

to obese patients.

" They are the most grateful patients who have ever walked the face

of the earth, " Hutcher said. " You've given them their life back. "

As millions struggle with obesity, hundreds of thousands of them in

recent years have turned to surgery — despite critics' fears about

procedural complications, aftercare issues and permanent changes in

digestion. Statistics collected by the federal Agency for Healthcare

Research and Quality show the number of gastric bypass surgeries has

jumped dramatically since 1998.

And more patients this year could have the surgery than ever before.

Medicare is scheduled to make a final decision in February about

whether it will pay for the surgery for people over age 65. The

agency said in November that it will pay for the surgery only for

disabled Medicare recipients younger than 65 — not the elderly.

Bariatric surgeons and patients hope they can convince Medicare that

the elderly deserve to have the surgery paid for, too. If Medicare

rules that it will do so, advocates like Hutcher believe that

insurance companies are likely to expand their coverage, which has

been limited for years.

Advocates cite such denial of coverage as an example of obesity bias.

Beth , 37, of Atlanta had bariatric surgery almost five years

ago at Emory University's bariatric surgery center.

Two hundred pounds lighter now, she doesn't look back, except to

remember how difficult her life was before she had surgery.

" I would do it again, no matter what, " said. " I can do

anything I want now. I walk in 10Ks. I can go to the mall. I have a

life. "

and others know that the surgery is also controversial —

socially, culturally and medically.

People who are not fat sometimes are quick to judge those who have

the surgery as lazy or out-of-control. Insurance companies

frequently do not cover the surgery. Its risks are constantly being

analyzed and argued about.

Bariatric surgery came under close scrutiny in October after a

report published in the Journal of the American Medical Association

suggested that the procedure may be riskier than previously thought.

(Advocates said the numbers in the study were suspect because of the

lack of a control group with which to compare those who had the

surgery.)

And the decision to have the surgery is never easy.

Several who have had it said they know that the leaner folks of the

world sneer at them. The surgery symbolizes to many, a lack of

willpower and self-control — a surgical answer to an emotional

problem that a person can't get under control.

battled with weight all her life, she said. Her mother died

when she was 8, and her single father raised her and her siblings.

" He did not know a lot about cooking, and we ate a lot of prepared

foods, fried foods, " said. " He did the best he could, but we

didn't learn how to eat right. "

In middle school, was 5 feet 5 inches tall and weighed 200

pounds, she said. She continued to put on weight until she maxed out

at 384 pounds, plagued with sleep apnea, acid reflux disease,

arthritis and high blood pressure.

" It was a daily chore to arrive home from work and go into the

house, " said. " I remember sitting on a stool in the kitchen,

peeling potatoes because I couldn't stand. I didn't have the energy. "

While credits the surgery with saving her life, she stresses

that the surgery requires willpower and a lifetime of changes. She

must eat differently — several very small meals rather than large

meals — and she cannot eat sugar. She takes supplements, and she

exercises. The changes are lifelong and demanding, she said.

Even so, the health benefits for far outweigh such adjustments.

" Knowing that I'll be able to see my grandchildren makes it all

worthwhile, " said.

And what would she say to critics who believe the surgery is a cop-

out?

" Walk in my shoes for one day, " said.