January 14, 2000


Gastric Bypass Surgery Helping Her Succeed Where Millions Fail

UC NEWSSERVICE

Until recently, just walking her dogs left her uncomfortable and out of breath.

The soft-spoken woman carried 386 pounds on her six-foot frame. Her decade-long struggle with obesity was clearly a losing battle. But now, after taking a step many would consider drastic, Amelia Williams of Oakland is succeeding where millions continue to fail.

"I feel like the energetic person that I am is no longer trapped inside," says Williams.

The source of Williams weight problem may be unusual in degree, but not in kind. Heredity plays a part. Her mother, father, aunts, uncles, grandparents and four of five siblings are or were obese. Many died early of obesity-associated complications such as diabetes, high blood pressure and heart disease.

Diet has a role, too. When the 36-year-old Williams arrived in the Bay Area 12 years ago, she did not abandon traditions, including good cooking and big eating, that she had learned while raised in a small community in Northern Louisiana.

Very obese people have shorter-than-average life spans and a higher incidence of hypertension, diabetes, joint disease, heart disease, sleep apnea and cancer of the endometrium, colon, prostate, and breast. Williams had already developed hypertension.

Like the vast majority of dieters, Williams experienced fleeting success with dieting, but always regained the weight she lost. She was reluctant to try weight-loss drugs. Fortunately, at her job as a quality assurance coordinator for a company that provides mental health care, one of the medical staff told her about a surgical procedure used to curb appetite. The procedure involves stapling the stomach so that only a small portion remains through which food can pass.

"I did quite a bit of research on it," Williams says. "A good friend who is a psychiatrist put me in touch with a woman who had undergone the procedure and who was happy with the results." When it came to finding out more about the surgery, Williams was the driving force that steered her primary care practitioner along the learning curve. Her health care provider eventually referred her to gastroenterologist James Ostroff and surgeon Marco Patti at the UCSF Medical Center.

As a result of the procedure, called the Rouxen-Y gastric bypass, all food entering the stomach is routed into a small pouch that can hold only about four tablespoons at a time. The surgeon attaches a segment of the small intestine to the pouch so that food can move through the digestive tract. "The pouch is quickly stretched during a small meal, which causes a feeling of fullness," Patti explains.

Ostroff, nurse practitioner Karen Bagatelos, a cardiologist and a psychiatrist screen and counsel all potential candidates for surgery. To be considered, a patient must be very obese -- roughly 100 pounds overweight.

Candidates for this major surgery must lose about 10 percent of their body weight beforehand to demonstrate the motivation to change eating behaviors and to exercise. About half go through with the surgery. Those who do receive ongoing counseling, including help in meal-planning from a dietician.

After the bypass (which in the near future Patti will perform less invasively using a laparoscope), patients spend from three to five days in the hospital. They must severely restrict their diets for several more weeks. Even after recovery, eating becomes a different experience.

Bypass recipients essentially remain on a diet for the rest of their lives. This is made easier by the fact that eating the wrong foods (like ice cream and crumbly junk food) or too much food will cause vomiting or diarrhea. They must also take vitamin supplements, because nutrient absorption will not be as efficient as before surgery. When eating a balanced, high-fiber, low-fat diet, they normally will have the appetite to consume no more than 1,000 calories per day.

Patti, who has performed the surgery on more than four dozen patients over the past two and one-half years, says about 95 percent of them have lost weight and kept it off.

"I felt that this was my last chance," Williams says. She lost 36 pounds before her bypass on September 8, and has been losing more than five pounds per week since then. Patients who undergo the procedure typically reach a stable weight in about two years, around which time the pouch begins to expand a bit. Having instituted lifestyle changes, they usually remain heavy, but no longer obese or plagued with the health complications caused by obesity.

Williams now enjoys learning a new way of cooking, and she can exercise more comfortably -- riding a stationary bike, for instance.

"There's no turning back," she says. And with renewed energy, dogs in tow, she walks on.

For more information about this procedure, please call the gastroenterology office at UCSF at 415/502-2112.

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