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.

In the worst scenario, patients may regain all their presurgery weight or die, either on the operating room table, or from complications following surgery. The ASBS reports that three to five people out of 1,000 who undergo gastric bypasses die. But Miriam Berg, president of the Council on Size and Weight Discrimination (CSWD) claims that doctors aren't honestly reporting cases where their patients die as a result of the surgery.

"We've run into some situations where the death certificate [was changed] to say someone 'died from obesity,'" Berg says. "Doctors are hush-hush about this. They learn from their mistakes, but also the public never finds out about them."

And that's part of the problem. Most gastric bypass patients don't know that the surgeons performing gastric bypasses do not take any specific "boards" or examinations testing their knowledge and skills of the actual surgery.

"Almost every surgeon does a different operation," noted Paul Ernsberger, an obesity researcher at Case Western Reserve University, in a published commentary in response to a reporter's request for his opinion on weight loss surgeries. "If the surgery was so wonderful, why are all the surgeons experimenting with different techniques?"

Many doctors are acutely aware of the risks to patients and carefully study a patient's profile before performing the operation, like Dr. Pamela Foster, a clinical assistant professor of surgery at Stanford University and director of the Stanford Center for Bariatric Surgery. To ensure that she has the ideal surgical candidate, Foster sticks to a patient's Body Mass Index (BMI), which measures a patient's weight to height ratio and determines their obesity. A surgery candidate must have a BMI of 40 or above. Foster also considers the gravity of their co-morbidities, or conditions resulting from severe obesity, such as diabetes, sleep apnea and high blood pressure and high blood cholesterol. She also requires patients to lose excess weight prior to the surgery so that the surgery is less risky for the patient, and is adamant about monitoring a patient post-surgery. Dr. Foster says she has never had a Roux-en-Y gastric-bypass patient die.

"Most of my patients work and have families and lives and interests," Foster says. "We have to make sure that they make it to the other side. I worry because it's such a difficult operation."

However, there are few long-term studies conducted on the outcome of gastric bypass patients, and some clinics and hospitals provide surgery patients with insufficient or no follow-up care, says Berg of the CSWD.

Star Studded

Because the surgery is so expensive -- it costs anywhere from $25,000 to $30,000 -- and because most insurance providers don't cover the surgery (they classify the operation as cosmetic rather than medically necessary), would-be patients dole out their own cash.

"It's becoming more consumer-driven," says Dr. Greg Adams, a general surgeon at Valley Medical Center in San Jose.

Adams refuses to do gastric bypasses because he "doesn't want to perform psychic surgery." He insists on gastric bypass only as a means to improve someone's health but not self-image.

"I think it's a plan of controlled starvation," he says.

For those trying in vain to lose weight by exhausting food diets and modes of exercise, it's a plan whose perceived benefits outweigh the risks. But much of the marketing campaign is led by the wrong people, Berg says. Current bypass idol, Carnie Wilson, daughter of Beach Boy Brian Wilson and former songbird for the '90s pop trio Wilson Phillips, recently trumpeted her 150-pound weight loss and new size 6 frame on the covers of People and US Weekly. The dangerous message to the yo-yo dieters of the world is this: live or die, risky or not -- if Carnie can, so can I.

But new lives rarely carry with them a 100 percent guarantee. During his homerun derby, San Francisco Giant Barry Bonds dedicated home run no. 68 to Franklin Bradley, 37, a close friend and bodyguard, who died unexpectedly from routine stomach surgery. It turned out to be a gastric bypass operation.

Weighing In

Karrie Colette, a San Jose resident, talks about her life in two eras: pre-gastric bypass surgery and post-gastric bypass surgery. Presurgery Karrie was 353 pounds -- always hungry, never satisfied, tired and overheated. Her once favorite McDonald's lunch menu: quarter-pounder, two Big Macs, SuperSized chocolate shake and large fries. Her genes automatically rubber-stamped her as overweight; her father, mother and older sister were all built that way.

Then Karrie developed a condition known as Gastro-Esophageal Reflux Disease (GERD), which induced a gagging reflex, forcing Karrie to vomit all her meals. A friend who had the gastric bypass told her surgery might be the best option. So after researching the details, Karrie began imagining a fat-free life. On Aug. 16, 1999, at Alvarado Hospital Medical Center -- where Carnie Wilson had her surgery only a week before -- she got it. In two years, Karrie has lost 150 pounds.

Jean, on the other hand, is still thinking about her gastric bypass. She has plenty of questions for her potential attending surgeon at Duke University Hospital.

"I don't know if I'll ever go through with it," Jean says. "I'm leaving my options open. Everyone I've talked to [who has had the surgery] said they'd do it in a heartbeat."

Karrie doesn't hesitate. She's slimmer, she survived, and now, she's added years to her life span because she isn't obese anymore.

"Would I do it again?" Karrie asks. "In a heartbeat. In a heartbeat."

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