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New surgery for obesity offers advantages to many
By Anne Barnard, Globe Staff, 7/31/2001
Young became the first person in New England to receive a weight-loss device called the Lap-Band, a silicone strip that looks and feels something like a flea collar and creates a bottleneck near the top of the stomach that will make it harder for Young to overeat. It is adjustable and reversible - the latest evolution in the menu of weight-loss surgeries that doctors now perform on 30,000 obese Americans each year.
Young, 30, saw her weight soar to nearly 300 pounds in her college days. She sees the surgery as a weapon against the sleep apnea and joint pain that leave her exhausted, the Fenway Park seats she has trouble fitting into, the blind date who told her, ''If you were thin, I would date you.''
But there is one problem it won't solve: The doubts some people have about using surgery to correct what is still often viewed as a behavioral problem.
''Society needs to get away from this concept of, `You did this to yourself. We shouldn't have insurance pay for operations to prevent you from the behavior you're doing that's hurting you,''' said Dr. Scott Shikora, who helped perform the surgery. ''I don't think it's that simple.''
For years, surgeons have been performing stomach-reduction surgery on patients who have been unable to lose weight by other means. Today, most of those are gastric bypasses, which close off much of the stomach and small intestine and make it physically impossible to eat more than a few bites at a time. The new device, approved in June by the Food and Drug Administration after a three-year study, has less dramatic results, since patients can still sneak excess calories.
For patients like Young, who has managed to change her eating habits but remains obese, the band has advantages. It can be enlarged to allow more food, or removed altogether. This makes it attractive to younger women who want to have children someday and are concerned about the vitamin deficiencies that can result from the more drastic bypass surgery.
But Young, who lives in South Boston and works as a secretary at Fleet Boston Financial Corp., worries what friends will think, saying, ''It's not just about vanity.''
More than 11 million Americans are morbidly obese - more than 100 pounds overweight and at risk for diabetes, heart disease, and other serious health problems, costing billions of dollars in increased medical bills. For many, weight loss is not just a matter of will power. Genes are a factor, Shikora said.
But surgery isn't for everyone. There can be complications: In the Lap-Band trials in the United States, half the patients suffered from nausea and vomiting, 24 percent had the band slip and 25 percent had it removed because of side effects. In three years, patients lost 36 percent of their excess weight on average, while gastric bypass patients lose two-thirds. In Europe, where the Lap-Band has been used for years, and where diets are less fatty, the results are closer to 50 percent, Shikora said.
That underscores that doctors can't ignore other solutions, he said, noting that medications, counseling, dieting, and exercise are all stressed at the hospital's obesity consult program, where he is surgical director.
Nevertheless, obesity surgery has become a big business. The maker of Lap-Band is BioEnterics Corp., a subsidiary of Inamed Corp. that targeted the $1 billion obesity surgery market. The hospital hopes to raise its profile in the field, where Shikora is already well known.
When the Lap-Band was approved, Shikora, 42, knew just who should be its poster child. Young was so ideal, he said, that the hospital agreed to foot the $14,000 bill after her insurer, Blue Cross Blue Shield, deemed it experimental and suggested a gastric bypass instead. (A onetime deal, he stressed.)
Getting ready to go out the Friday night before her surgery, Young talked about her plans with a frank, confident air. She wore a white sleeveless top, black capri pants, girlish mules, pink eye shadow and lavender nail polish that, she lamented, would have to come off for the operation.
But she knew that in an hour, when she walked into a restaurant to meet ''my perfect little every-guy-likes friend,'' her self-assurance would melt away.
''The way I look is just not acceptable,'' she said.
Since her 30th birthday, when she made the decision to change, she has worked with Tufts-New England Medical Center's obesity clinic to lose more than 30 pounds. But she wants to lose 125 more, which is why Monday morning found her on the operating table, her stomach a white rectangle framed by blue sheets.
Dr. George Fielding, an Australian surgeon paid by BioEnterics to train other doctors, performed the surgery as Shikora assisted. They used minimally invasive techniques, threading a camera through a tiny incision and using it as a guide as they inserted tools, and then the band itself, through the holes.
The television screen showed yellow, then pink, then yellow as they probed through layers of fat and muscle. Then they were inside the abdominal cavity. A metal hook pushed the shiny, dark liver out of the way, revealing the stomach: a pink, veiny sac.
Using tiny alligator clips to hold the tissue, they tunneled around the top of the stomach, being careful not to nick the spleen. They maneuvered the band through, fastened it like a belt buckle, and stitched a flap of the stomach over it to hold it in place. Finally, just below the skin in Young's abdomen, they implanted a ''port'' connected to the band by a tube. In four weeks, doctors will inject saline solution through the port to inflate the band.
Exactly how that physical curb on her eating habits will change Young's life is a matter of suspense. But on Friday, one thing was clear to her: ''When I come back,'' she said, ''I'm going to be different.''
This story ran on page B1 of the Boston Globe on 7/31/2001.
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