Lifetime Committment

LIFETIME COMMITTMENT
By ROBERTA MALLARD


Melinda is planning her wedding for late summer next year. At 80
pounds overweight, she wants to slim down and fit into her four-sizes-
too-small wedding dress. She will use her dream gown as motivation in
what will be her first attempt at weight loss.

Chad just got back from the doctor. His blood pressure was
dangerously high, he was diagnosed as a Type II diabetic, and the
scale showed a shocking 420 pounds. He must lose 210 pounds.

With today's over-abundant sources of advice, ads and articles on
regaining normal weight and health, folks like Melinda and Chad have
multiple choices.

After consulting with a physician, they might choose to restrict
calories and increase aerobic and weight-bearing exercise, or work
with a nutritionist or perhaps submit to a bariatric procedure.

Bariatric surgeries include Gastric Bypass, (dividing the stomach
into a small upper pouch and a larger, lower pouch and rearranging
the small intestine to allow both sections to connect) and Gastric
Banding or Lap Band surgery (a gastric band, an inflatable, silicone
prosthetic device, is placed around the top portion of the stomach to
create a small pouch, usually by laparoscopic surgery).

Paul O'Brien is director of the Center for Obesity Research and
Education at Monash University in Melbourne, Australia with
associations with The Institute of American Gastric Banding (True
Results) with offices in Richardson and Hurs, TX.

According to O'Brien, a patient like Melinda might be a candidate for
bariatric surgery because she is obese, but because she has not tried
nonsurgical, caloric restriction and exercise for three to five years
as a weight-loss method she is not eligible.

On the other hand, a man like Chad who is morbidly obese and has life
threatening conditions such as diabetes and high blood pressure is a
viable candidate even though he has been attempting weight loss for
only a year.

If Chad chooses gastric bypass, he should lose about 66 percent of
his extra weight in two years. He must learn to chew his one-half-cup
meals slowly and take special supplements as this operation
interferes with absorption of nutrients. If he chooses banding, he
will have the small meals and the weight loss will be slightly less
with fewer possible complications.

In both options, according to Dr. Augustus Lyon a surgeon with
Arlington Memorial Hospital, conditions like Chad's diabetes and high
blood pressure should abate by 90 percent.

Both surgeons agree that follow-up and commitment to the bariatric
lifestyle is critical. Post-operation patients are required to engage
in exercise and weight training to build health and muscle mass.

Since both bypass and lap band are permanent for lifetime, precluding
complications, yearly check-ups are required. These evaluations
determine general health and check for complications such as
nutritional deficiencies, adhesions, bowel blockages and lung or vein
problems.

Because weight loss is rapid, particularly with bypass, those who
have less elasticity in their skin may need plastic surgery to
correct the folds of skin which create huge upper-arm flaps and
stomach flaps which can hang down to the knees.

Patrick Chen, a plastic surgeon with Harris Methodist Hospital, Fort
Worth, said that more patients are coming to see him as a result of
weigh-loss surgery.

Several factors contribute skin becoming loose, Chen said. "Age is a
factor as are genetics and how quickly the patient gained and lost
weight. Loose skin can lead to infection, bleeding and skin
breakdown," he said.

Chen said that plastic surgery options may include breast
augmentation, face, buttock and thigh lifts, tummy tucks and upper-
arm skin-fold removal.

Lyons said that the benefits of bariatric surgery outweigh the risk
and said he chose the field because of the rate of success. He sees
folks, like Chad, who lose weight and become healthy again.

"My patients seem happy and excited," said Lyons. "One of my patients
told me she was so excited to buy clothes at the Banana Republic for
the first time."