Banding procedure seen as a lasting fix for obesity

There was a time when Don Hess would go to a buffet and really load up his plate.

He loved his own cooking and pretty much everybody else's.

And over the course of a few decades, his waistline steadily inflated.

By the time he reached his mid-50s, Hess looked at himself and saw an unhappy, 369-pound man.

"It's one of those things, I think, that it sneaks up on you," he says.

A college administrator in Quincy, Hess watched his health decline as the pounds increased and the diets failed. It got harder to walk. He developed diabetes, high blood pressure and high cholesterol. His diabetes worsened, and he began needing insulin every day.

"I don't think I was going to be around much longer," he recalls, sadly. "I think I was getting near the end."

Hess began flirting with the idea of weight-loss surgery, but it wasn't until last year that the extent of his weight problem really hit home.

There he was, on his dream vacation in the Bahamas, and he just didn't have the stamina to go sight-seeing on foot with his wife.

He spotted a guy on a motorized scooter, and thought, hey, if he got one of those he could get around great.

His next thought was a mental kick in his own backside.

"'Have you completely given up?'" he remembers asking himself. "'If you would lose 50 pounds, you wouldn't NEED one of those.'"

Hess went home and got serious about surgery to help him shed the weight. His insurer balked at covering the procedure his Clinton-based surgeon, Dr. Sidney Rohrscheib, recommended, but eventually caved in after getting a threatening letter from a lawyer.

Last summer, Hess made the trip to Clinton to undergo a gastric banding procedure, in which a silicone band was surgically implanted around the top of his stomach, creating a new smaller stomach area capable of holding just a small amount of food.

Nine months later, Hess considers himself a new man. He's shed 109 pounds and dropped so many waist sizes he's taken to buying his pants at bargain prices on eBay.

Binge eating is a thing of the past because he's just not that hungry any more.

And his health is so much better, he no longer needs medicines for diabetes, cholesterol and high blood pressure.

"As it turns out," he adds, "all my health issues were related to being fat."

The obesity disease

Ask Rohrscheib why patients like Hess can't lose weight through diet and exercise alone, and he'll tell you Americans vastly misunderstand obesity – traditionally seeing it as a weakness of character rather than the serious disease it is.

But statistics alone tell him there are more factors behind obesity than will power.

Currently, two-thirds of U.S. adults are overweight, and 64 million are obese.

Some 15 million adults in the U.S. are morbidly obese, and at risk for an array of medical conditions including type 2 diabetes, coronary heart disease, stroke, hypertension, cancer, asthma, degenerating joints, infertility, chronic headaches, liver disease, sleep apnea and lower back pain.

The American Society for Metabolic & Bariatric Surgery says individual genetics and metabolism play a role in obesity. So do lifestyle and psychological factors that lead people to eat too much, eat the wrong things and exercise too little.

Rohrscheib says Americans don't just eat too much. They also eat way too fast.

It takes a full 20 minutes for the stomach to signal the brain that it's full. But thanks to a busy lifestyle, dinner plates and fast-food bags are emptied long before most people know when they've eaten enough.

"It starts in the first grade," Rohrscheib says. "What's your reward for eating your lunch faster? You get to go to the playground."

What doctors like him see time and time again is that once fat is acquired, it's extremely hard to get rid of.

Rohrscheib draws a jagged, upward-slanting line to illustrate the pattern of weight loss and gain most of his patients experience, with each weight loss followed by a gain of all the pounds lost – plus more.

"Nobody knows for sure, but clearly there's a mechanism that when you diet you become hungrier, and hunger is quite simply the body's own protective measure to guard against starvation," he says. "Any effort at dieting, if the transition to a maintenance diet can't be done successfully, will lead to a state of desiring food in greater quantities."

After obesity reaches the severe level, Rohrscheib contends, it becomes nearly impossible to lose a lot of weight without surgery: Not only does the body start fighting weight loss, but the excess pounds also severely limit a person's ability to exercise.

Christine Brizendine, a 53-year-old case worker in Pana who has shed 90 pounds since June, when she underwent the same kind of procedure that Hess had, remembers the ferocious hunger pains she had at 367 pounds.

It was as if her stomach just roared to be fed, she recalls.

"I used to wake up and be starving and sick if I didn't eat," she adds.

Not for everyone

Weight-loss surgery isn't an option for folks who simply want to drop a pants size or two.

It's a drastic measure intended for people with severe obesity – generally those at least 100 pounds overweight, with a body mass index (a ratio of height and weight) of at least 40 – or in some cases, with a BMI of 35 in combination with a serious health condition.

There are several kinds of weight-loss surgeries, but the two most commonly known types are gastric bypass and gastric banding.

Bypass surgery involves severely reducing the size of the stomach by using staples to create a smaller pouch, then attaching part of the intestine to the smaller stomach to bypass most of the stomach and part of the intestines. Patients wind up eating less and absorbing fewer calories.

Bypass surgery achieves a faster weight loss than gastric banding, Rohrscheib says, but it also carries more risk of serious complications and malnutrition if people lose too much weight too fast.

Rohrscheib says he does nearly all gastric banding procedures these days – a procedure that involves wrapping a silicone band filled with saline around the top area of the stomach, creating a smaller area that limits how much food can be consumed at once and increasing the time it takes for the stomach to be empty.

The band is tightened or loosened periodically, just like a belt, as patients lose weight.

Gastric banding works because people undergo both a physiological and a behavioral change, Rohrscheib says.

Think of the band as the tip of a funnel, he advises: If you try to overfill a funnel or cram large pieces of food through the narrow opening at the tip, what you put in is going to come right back up. So people wind up eating slower, eating less and chewing their food more.

Brizendine, who still wants to lose more weight, says a small bowl of cottage cheese or coleslaw for lunch and a tiny dinner is all she wants these days, and she often wakes up in the morning still feeling full from last night's dinner.

"I found out you don't need all that food," she says. "Sometimes I would rather not just bother eating."

Hess, who says he's still a good-sized guy at 260 pounds, wants to get his weight down to 210 to 230. But he's already experienced the thrill of going to a conference and watching people he hasn't seen in a year do a double-take when they see him.

"Some would lower their voices and say, 'Are you OK?'" he says gleefully. "And I'd say, 'I'm way OK!'"

These days, Hess says he'll eat a small bowl of cereal or oatmeal for breakfast and maybe a scoop of cottage cheese or a scoop of tuna salad for lunch. He might treat himself to an old favorite – a burrito and rice – for lunch occasionally, but he probably won't be hungry for dinner later.

"I've developed an aversion to carb-laden foods," Hess says. "And I used to be such a bread nut. I never bother with it any more, the bread being so carb-loaded. It sits in your gut like a bomb."

The day he realized just how OK he'd become was on a trip this spring to Disney World. Hess was able to walk all over the park without huffing and puffing, and when he decided to treat himself to some ice cream, it took just a little bit to satisfy him.

"My wife was afraid that I'd be like a wolf that gets a taste of blood," he remembers, laughing. "But I haven't had any ice cream since, and I haven't wanted any."

It's as if your stomach and brain are rewired after the surgery.

"My whole outlook has changed," he says. "I wasn't a real happy person a lot of the time. There's that old myth that fat people are jolly. Fat people are miserable."

The price of surgery

Weight-loss surgery comes with risks and costs, and so does doing nothing about morbid obesity.

The first gastric banding system, marketed under the trade name LAP-BAND, was FDA approved in 2001 and has since been used in more than 400,000 procedures worldwide, according to LAP-BAND's maker, Allergan Inc.

Gastric banding carries the same risk of death that all surgeries do, the company says. Other risk factors including slippage of the band, nausea and vomiting and blockage of the stomach band outlet. A small number of patients experience an erosion of the band into their stomachs, requiring the bands to be removed.

The cost of doing nothing: Overweight and obesity is associated with 112,000 excess annual deaths in the U.S. and adds $117 billion a year to the nation's health costs, according to the American Society for Metabolic & Bariatric surgery says.

Weight-loss surgery generally costs between $17,000 and $25,000. Medicare expanded its coverage to include a variety of weight-loss procedures in 2006, but younger patients still can encounter obstacles to coverage through private insurers.

Rohrscheib says insurer resistance doesn't make sense to him, given the high cost of treating obesity down the road. For private insurers, the illnesses reduced by a gastric banding procedure make it a two- to three-year return on the cost of the surgery, he said, with the biggest savings coming from reduced diabetes.

Rohrscheib currently performs weight-loss surgeries in Clinton and Chicago and at both Urbana hospitals, but he expects to bring a substantial amount of new weight-loss surgery business to Champaign-Urbana when he opens his own 15,000-square-foot center in a few months.

To be called Olympian Surgical Suites, the new center has been built at 1002 Interstate Drive, C, and Rohrscheib looks to have it open by midsummer.

Rohrscheib will work with two other doctors, plus nurses, dietitians and mental health professionals at the center. Together, he expects them to serve 500 to 1,000 patients a year with weight-loss surgeries and an array of health services needed by people battling obesity – among them cosmetic surgery, mental/behavioral health counseling, diet and nutrition counseling and traditional weight-management programs.

The center will also offer a variety of digestive-system surgeries, Rohrscheib says.

Control weight early

Carol Schriver, regional clinical nutrition manager for Provena hospitals in Urbana and Danville, says exercise and good nutrition are always the best formula for weight loss.

But she acknowledges some people do reach a point with obesity when surgery becomes their best option.

Some obese patients turn to water exercise because it's easier on their joints, she said. Some simply can't exercise, and are further struggling with a metabolism that has been affected by too much yo-yo dieting.

"Some people have dieted so many times, they've just thrown their whole system off," she says.

Schriver says the problem she often sees among people looking to lose weight and keep it off is an unwillingness to make big changes and accept that it's not just going to be a long process – it's a lifelong process.

"Some people come to see us, and they don't want to change their eating habits," she says.

But even surgery-induced weight loss can fail if patients aren't committed to change, Schriver says.

Her advice: If you're battling a weight problem, getting professional help before surgery may be your best option. Consult a dietitian who can come up with an individual eating plan that's right for you.

"It has to be a lifestyle you adapt to," she says.

Are you overweight?

Check your Body Mass Index, a ratio of height and weight, at http://tinyurl.com/b53foz.

Healthy: BMI 18.5-24.9

Overweight: BMI 25-29.9

Obese: BMI 30-34.9

Severely obese: 35-39.9

Morbidly obese: BMI 40 and up

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