Fat Chance

Jean Renfro Anspaugh and her friends called him Big Mike. At 6-feet-4-inches, Big Mike was a mountain of a man who topped 400 pounds. Big Mike's wife was an active, physically fit woman, and Jean speculates that this may have given him an added incentive to lose weight. So, in the fall of 1995 at Pitt County Memorial Hospital in North Carolina, Big Mike, who had an enlarged heart, underwent a gastric surgery. And then, to the astonishment of his wife and his friends, Big Mike lost consciousness on the operating room table and never woke up. Big Mike, a husband and father of two, was dead at 35 years old.

It wasn't the first time a surgery to correct obesity had taken a toll on Jean's circle of family and friends. In 1987, Jean's overweight aunt, Beverly Grant, told no one except her husband she was planning a gastric bypass operation at a hospital in Kansas City, Mo. She told relatives that she was merely going in for a "procedure," neglecting to mention that surgeons would be removing a portion of her intestine in an attempt to curtail her weight. On the operating room table, Beverly's lungs filled up with liquid and she died. She was 42.

Now Jean, 47, who moved from Sacramento to Durham, N.C., to lose weight on the "Rice Diet" -- a precursor to exclusionary food diets like Atkins -- is contemplating the newest and most popular form of gastric bypass surgery to date: laparoscopic Roux-en-Y. The two deaths and the experience of another friend who had the surgery, fell sick afterward and underwent 11 hernia operations -- hernias being a common side effect of surgery -- are considerations, but not necessarily deterrents.

"Isn't that weird?" Jean says. "I sold everything I owned to come to Durham to lose weight ... [I think] If I came this far, I can take that other step."

Her motivation for wanting a Roux-en-Y (pronounced ROO-en-why), named after the Swiss surgeon Cesar Roux and the Y-shape incision made from bypassing the stomach to the small intestine, is simple.

"Women my age have been dieting and mostly failing at it all of our lives," says Jean, author of the book Fat Like Us, which chronicles the personal stories of perpetual dieters. "We don't want to live the remainder of our lives fat."

The weight-obsessed American public seems to have spoken: 24 percent of women and 17 percent of men say that they would reduce their life span by three years to be thinner, as reported in Archives of Dermatology.

"Life is so much better when you're thinner," Jean says. "Nothing aches, everything fits, doctors aren't yelling at you. The sun is shining on you."

Gut Reactions

According to the American Society of Bariatric Surgery (ASBS), 45,000 chased the sun this year by electing gastric bypass surgery, up from the 25,000 who went for it in 1995. Also known as "stomach stapling," the surgery involves stapling a portion of a patient's stomach, and then rerouting the smaller part, or pouch, to the intestines, so patients cannot overeat. The pouch, about the size of an egg, can hold about half a cup, or one to five ounces of food, compared to the 50 to 80 ounces of an unstapled stomach. But it is not a cure. Because of the limited food intake, those who undergo the surgery must eat tiny portions for the rest of their lives, and are banned forever from favorite foods like red meat, milk or sweets. Should patients cave in to such forbidden indulgences, they may feel faint, nauseous, sweaty and experience instant diarrhea -- all symptoms of a post-bypass condition known as "dumping."

It can get far, far worse. According to the National Institutes of Health, which in 1991 created the criteria for weight loss surgery patients, one-third of gastric surgery patients develop gallstones, or clumps of cholesterol and other matter that form in the gallbladder. Ten to 20 percent of weight-loss operations require follow-up operations to correct serious complications like abdominal hernias, as well as stretched stomachs and staple line breakage. Others suffer from pneumonia, infection, hair loss, blood clots (embolus), frequent vomiting, diarrhea and nutritional deficiencies because food consumption is restricted.