Bariatric Surgery: A Physician’s Perspective as a Patient
by William E. Morris Jr., MD, FACP
Dr. Morris is with the Board of Directors, Peterson Health in Kerrville, Texas.
Funding: No funding was provided for this article.
Disclosures: The author has no conflicts of interest relevant to this article.
Bariatric Times. 2022;19(4):12–13.
Abstract
Obesity is a serious public health crisis in the United States today. Bariatric surgery is an available, although underutilized, treatment for obesity that has the potential to positively impact this crisis. Follow the journey of a physician as he becomes a bariatric surgery patient and what his results have been after six years.
Keywords: Bariatric surgery, obesity, sleeve gastrectomy
Hello. My name is Bill, and I am an addict. I was being killed by my addiction, and I couldn’t overcome it. My addiction is one of the largest public health crises affecting our country today. I was not addicted to drugs, alcohol, or nicotine. I was addicted to eating and flavors. I was a patient with obesity. Fortunately, bariatric surgery has become a viable treatment option for patients with this addiction and obesity, and it helped save my life.
Bariatric surgery has been underutilized for years. While it was first developed over four decades ago, it has been slow to become the standard of care. Bariatric surgery has been evolving over the years, to the point that it should be considered more frequently and earlier in the course of treatment by clinicians for patients with obesity. This treatment has been poorly understood and accepted by most clinicians. Although there is increasing acceptance and more and more data about the benefits of this treatment, it still languishes. This is the story of my journey, how I found my path, and what my results have been.
I am a board-certified internist, and I had been in practice for 39 years when I decided to have my surgery. I have lived in the same medium-sized rural town since 1977. I have practiced in the same 125-bed hospital that entire time. In the early days, I took care of several patients who had received the original ileal-jejunal bypass surgery. I also had to manage all their subsequent complications. From this experience, I was not a fan of weight loss surgery. It took years for me to embrace it positively.
Despite my education, knowledge, and experience, I was a serial failure at sustained weight loss. I had been a skinny kid, and as an adolescent, I filled out to an appropriate weight for my height. Even then, my high school track coach urged me to try to lose 10 pounds, from 170 to 160, in the hopes that I would be faster. In college, I gained 5 to 6 pounds each year and graduated with a weight of about 200 pounds. Medical school was a disaster weight-wise, and I weighed about 230 pounds at the time of graduation. During my internship year, I joined a nationally recognized weight-loss program with a structured eating plan. I had success, getting down to 210 pounds or so, but it didn’t last. In July of 1977, as I tested my brand-new scales in my brand-new office as I was starting my medical practice—I weighed 246 pounds.
During the next 39 years, my weight went as high as 315 pounds and as low as 215 pounds. I tried virtually every diet out there and succeeded at all of them—for 2 to 3 months. And then I failed. Like most yo-yo dieters, I often failed in a fashion that caused me to gain more weight than I had lost. On three occasions, I managed to lose a significant amount of weight and keep it off for 2 to 3 years, the same actual “success” as usual, just a longer timeline. During those protracted periods of healthy weight management, I thought that I had proven that I could do it. In hindsight, all I had proven was that I could fail differently. I even took two weeks off work in 2004 to attend a residential diet and fitness program. They offered all the appropriate help from physicians, dietitians, exercise trainers, and psychologists. I did well at the program, and when I came home, I managed to lose weight very nicely and maintain it for about two years.
Then, I failed again. For the next several years, my weight varied from 245 to 275 pounds, with occasional increases to 295 pounds. I never seriously considered any medical obesity treatment options, other than trying orlistat. The older medications that were available when I first started my practice were very habit-forming, and the conservative medical wisdom at that time was to avoid these medications. The combination of fenfluramine and phentermine caused initial enthusiasm, only to be negated by reports of an increased risk of cardiac valvular problems. Because of that, I didn’t give newer medical options any serious thought.
I felt like I had been on a diet for my whole life and had always eventually failed. I was succeeding in every other part of my life, and my continued failures with my weight just didn’t fit in. I was really frustrated and primed to do something different. In October 2012, I attended a continuing medical education (CME) conference in New York City (NYC). One of the sessions was an update in bariatric surgery. It was a presentation of the data from a study on gastric sleeve surgery that was being done at one of the NYC medical schools. The data showed very good weight loss with very low complication rates, at least during the study. The most fascinating data to me revolved around the number of insulin-requiring people with Type 2 diabetes who were able to leave the hospital after only a few days, on no insulin. This seemed truly revolutionary! As a patient with obesity, hypertension, and diabetes, I was intrigued. I started reading more studies about bariatric surgery. Over time, I learned that the results that had intrigued me were indeed real, reproduceable, and durable. During this same time, bariatric surgery in general and gastric sleeve in particular started being more and more accepted by mainstream medicine. Yet, still I vacillated. I again decided to try one more time with another diet and exercise plan. I had the same, predictable results. IS THIS NOT INSANITY?
In January 2016, I heard a bariatric surgeon from a nearby large city give a presentation on gastric sleeve surgery. He once again confirmed that all the data that had excited me in 2012 was real. He and his partners were generating the same data in their practice. His presentation that day solidified my intention to have surgery. It was time for me to act on my new knowledge! I spoke to the surgeon after his presentation and found out more about his practice, his partners, and how he cared for his patients. After a discussion with my wife and my internist, I started the process. On February 1, 2016, I called to make an appointment.
Getting started was not a simple process. I had preoperative appointments with the surgeon, his nurse practitioner, a dietitian, and a psychologist. I was started on a preoperative eating plan while appropriate preoperative testing was done. I, like most other patients, was impatient to have the surgery. The process went very smoothly, and time went by much more quickly than I had anticipated. I was so glad that I had a team to help me and that they were arranging every test and appointment each step of the way. Finally, on April 19, 2016, I had laparascopic gastric sleeve surgery. The surgery and immediate postoperative course went very well. I made the progression through the sequential eating plans until I reached what was called “The New Normal” eating plan without consequence. I just used the word “finally,” but there is nothing final about the surgery. The surgery is just the beginning of the real journey, which is a lifelong commitment. Regular appointments with all members of the bariatric team, including the surgeon, primary care physician, dietitian, and psychologist are of paramount importance. Even the most well-motivated patients need consistent follow-up and support.
So, what have been my results after six years? I have reached my initial goal weight of 190 pounds three times; I have almost reached my new goal of 180 pounds once. My weight loss has not been linear. I have had three significant episodes of backsliding, with a weight gain each time of 15 to 25 pounds. These episodes were not the result of my surgery not working. They were the fault of my letting a few old habits creep back into my life. Rather than giving up each time, I chose, with the support of my wife, family, and bariatric team, to focus more on my goal. I decided to do a root cause analysis to determine the cause of each failure and how to correct it. This approach always worked.
My hypertension is well controlled on less medicine, and my lipids are ideal on one-quarter of my previous statin dose. My diabetes is in remission. My fasting blood sugar, which was 130mg/dL on no medication on my second postoperative day, is now 90 to 100mg/dL on no medication. My glycohemoglobin is about five percent, and my obstructive sleep apnea is much better. With my weight loss, I was able to have both of my knees replaced. With new knees, I have been able to dramatically improve my exercise. My health and fitness are the best they have been since I was 40 years of age. I still want to get to that new goal of 180 pounds and to maintain it. I hope by reaching that weight and increasing my exercise, I can get off more medications for my hypertension. My mental health is much better. I always said I was happy, but I wasn’t always being honest with myself or those around me. I feel more confident in social interactions, and my knees and back have improved enough that I look forward to going to parties when the COVID-19 pandemic has improved.
Bariatric surgery is an outstanding treatment for patients with obesity and other metabolic disturbances. It might even be a potential cure. Make no mistake, it is not magical. The patient must still do the right things, but surgery helps them do these things successfully. Many clinicians and patients are reluctant to utilize this tool, and that needs to change. The procedures are safe, with a relatively easy recovery. The postoperative course is easier than it seems when you first hear about it. The rewards can be huge and life-altering. Bariatric surgery probably shouldn’t be the first choice for most patients, but it must no longer be the final, last-ditch choice for any patient. It is time to use all available clinical modalities to help patients with obesity fight their addiction and start impacting this public health crisis.
Category: Commentary, Past Articles
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