I was 54 years old, and reviewing my retirement savings. Would I have enough to retire? Well, I figured, I weigh 346 pounds, so I'll probably die before I run out of money. That made me sit up straight. About that time, I saw a Health Politics e-mail from Mike Magee, and an article by Atul Gawande in The New Yorker, on obesity. Both said that bariatric surgery was the only effective treatment for morbid obesity. So I investigated bariatric surgeons, and found the one with the most experience. An initial seminar provided the basics on obesity. I realized, or really understood, that obesity is a disease.

In 2005, I had a Roux-en-Y gastric bypass operation. A psychological evaluation told me I was headstrong, and I needed to follow their recommendations for the surgery to work. So, I took that headstrong attitude and decided to put it to work. Since then, I've lost 185 pounds, and gone from a body mass index of 59 to 28 kg per m². I walk every day, play racquetball, take vitamins, and get lots of protein. For the first time in my life, my body isn't fighting my efforts to be healthy. I feel great. There have been adjustments. I had strictures twice, and had to have several plastic surgeries to get rid of excess skin. I'll always have to be careful of when, what, and how much I eat. Bariatric surgery is a tool, not a cure.

Would I do it again? Absolutely. I have hope where there was once hopelessness, and health where there was once a bad back and aching knees and feet. I don't miss dreading getting onto an airplane and asking for a seatbelt extension, trying to find clothes that fit, and not being able to walk more than five minutes. Bariatric surgery has given me another chance at life, at being healthy, and at having the whole life that others take for granted.—j.c., 58

COMMENTARY

Years ago, when bariatric surgery was just beginning to receive attention, my view of this approach to weight loss was skeptical. I felt that people who were morbidly obese needed to change their diet and exercise patterns, and take responsibility for their situation. However, after witnessing several of my patients improve their health and their lives with bariatric surgery, I realized that my attitude had been one of discrimination and blame, without really being able to offer any significant help. Most people who are morbidly obese find it difficult to exercise. They can only decrease their caloric intake so far, and without being able to burn more calories, they are stuck. Usually they have developed a poor self-image, and often are demoralized by the way they feel about themselves and by the way others treat them–including their doctors. Persons who are motivated to make lifestyle changes in preparation for and after the surgery, can usually reduce or eliminate medications for diabetes, hypertension, gout, hyperlipidemia, and, often, depression. Obesity is a complex disease with a large overlay of emotion, genetics, and lifestyle habits. It can be conquered, and for selected patients, surgery has been an opportunity to regain control over their lives.