stomach stapling

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 Moore, 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," Moore said. "I can do anything I want now. I walk in 10Ks. I can go to the mall. I have a life."

Moore 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.

Moore 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," Moore said. "He did the best he could, but we didn't learn how to eat right."

In middle school, Moore 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," Moore said. "I remember sitting on a stool in the kitchen, peeling potatoes because I couldn't stand. I didn't have the energy."

While Moore 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 Moore far outweigh such adjustments.

"Knowing that I'll be able to see my grandchildren makes it all worthwhile," Moore said.

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

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

 
 
 
 

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