A Weight Lifted

Bariatric surgery has given many morbidly obese people a second change at life. In the past few years, the number of bariatric procedures performed has skyrocketed, but it is hardly a quick fix. It takes work and comes with risks.

For nearly 20 years, Melissa Sambenedetto was stuck in a body that she wanted to unzip and run away from. Until two years ago, shopping for a formal dress was depressing; there was little to choose from in her size and the styles left much to be desired. (For her wedding, she even felt fortunate to be able to special-order a dress.) She never thought she'd be able to tie her shoes straight, sit in a booth at a restaurant or keep up with her young nieces and nephews.

That was all before a great weight was lifted off of her — more than 200 pounds, to be exact.

"I got a second chance at life," says Sambenedetto, 34, a patient-service representative for the Cleveland Center for Bariatric Surgery at St. Vincent Charity Hospital. In that job, which became full time in May, she guides obese people through the same challenging but rewarding metamorphosis that she experienced after she had gastric bypass surgery in March 2001 at the center.

At 32, she carried nearly 400 pounds on her 5-foot-8 frame. At 100 pounds overweight for her size, she was morbidly obese. The doctors told Sambenedetto that if she continued in that condition, plagued by the accompanying health problems such as diabetes, arthritis, asthma and sleep apnea, she would be lucky to live another 10 years.

She had tried all of the conventional diets, but they had proven little more than weight-loss yo-yos. She'd drop 100 pounds only to regain 125.

The gastric bypass procedure, however, offered a life-transforming chance to reduce her stomach to the size of a thumb and get her started on a healthy lifestyle. Performed for more than 20 years, gastric bypass surgery has a success rate of approximately 85 percent. By comparison, traditional, over-the-counter diet products and programs, upon which Americans spend $33 billion each year, succeed only about 10 percent of the time.

"My risks for surgery were there, but the risks for my life the way it was going were even higher," Sambenedetto recalls. "By having the surgery, I've probably added 15 to 20 years to my life."

Since undergoing the gastric bypass procedure, she has cut her weight to 180 pounds and dropped from "a tight size 32" to a 14 regular. Most of her other illnesses have vanished. She went from taking more than a dozen medications a day to taking only vitamins.

This fall, her substantial weight loss meant she could try on all of those dresses while preparing for her "graduation" ceremony, an event established four years ago to celebrate St. Vincent's bariatric-surgery patients (people who have undergone one of several weight-loss operations that include gastric bypass) who successfully achieve their weight goal. Held Oct. 4 at the Cleveland Marriott Downtown at Key Center, Sambenedetto's graduation recognized 72 individuals who, together, lost an astonishing 10,300 pounds.

At the festive occasion, Sambenedetto's three sisters beamed when asked about how their sister has turned her life around since her surgery. Once sullen and depressed by her weight and the concomitant stares, snickers and discrimination she experienced, the post-op Sambenedetto emerged as the attractive, vivacious brunette they always knew was inside that cumbersome shell. Now, instead of having to walk in front of her so they can clear obstacles from her path, her sisters marveled at how easily she navigated her way through the crowded main ballroom.

In addition to being proud of her sister's accomplishment, Pamela Pasela says she's happy that St. Vincent is making a big deal out of the graduation, because losing weight is one of the hardest things people can do. "We're getting dressed up for Melissa," she enthuses. "This is cool."


Today, morbid obesity is second only to smoking as the leading cause of preventable death in the United States, killing more than a quarter of a million people annually. Moreover, almost
59 million adult Americans (31 percent) are obese, which is double the number from two decades ago, according to a recent study by the Centers for Disease Control and Prevention.

An obese person is defined as one whose body-mass index, a measurement of weight relative to height, equals 30 or above, with morbid obesity being 40 or above. The CDC's recent survey also found that nearly two-thirds of adults in the U.S. are overweight. Additionally, 15 percent of 16- to 19-year-olds (approximately 9 million teens) are seriously overweight, triple the number from 1980. (Most surgeons will not perform the gastric bypass on anyone under 18, however, since they are not considered physically or emotionally mature enough to undergo the procedure.)

"On every continent of the globe, even including regions where malnutrition is rife, the number of people who are either overweight or obese is rising at an alarming clip," according to a July story in The Wall Street Journal.

Cleveland currently holds the ignominious honor of being ranked the 13th fattest city in the country by Men's Fitness.

Cleveland is also home to two comprehensive bariatric programs, at St. Vincent and University Hospitals of Cleveland, where patients receive pre- and post-operative instruction and support, including access to dietitians, physical therapists, psychiatric professionals and support groups.

Two other hospitals, The Cleveland Clinic Foundation and MetroHealth Medical Center, have surgeons on staff who perform gastric bypass, and other area hospitals are considering venturing into the fastest-growing type of surgery in the United States.

"This is basically a chronic disease of our society, but now there is an effective operation that treats it," says Dr. Helmut Schreiber, medical director and founder of the Cleveland Center for Bariatric Surgery and director of surgery at St. Vincent Charity Hospital.

Although he has been performing bariatric surgeries since 1979, Schreiber switched in 1994 to the Roux-en-Y bypass, now considered the gold-standard procedure by the National Institutes of Health.

Proven to be superior in results to other bariatric procedures such as stomach stapling, the Roux-en-Y can be performed as an open surgery or as a minimally invasive laparoscopic procedure for patients who qualify.

Essentially, the procedure creates a small pouch from the upper portion of the stomach, then connects it directly to the intestines. The remainder of the stomach stays dormant. Patients' dietary intake is restricted to small portions, and they typically must avoid heavy concentrations of sugar or greasy foods, which the intestines cannot absorb directly.

Schreiber brought the center to St. Vincent in 1999, doing 21 procedures that year, while this year he estimates that he and another surgeon, Dr. I.M. Sonpal, will perform approximately 1,000 gastric bypass surgeries. According to the American Society for Bariatric Surgery, more than 57,000 Americans received gastric bypass surgery in 2001, a 29 percent increase from 2000.

"This is the first time that this specialty has been recognized by the major academic centers as the only permanent treatment for morbid obesity," Schreiber says.

As with any major operation, the gastric bypass procedure may involve complications, including a less than 1 percent mortality rate. Approximately 20 percent of patients need additional surgeries to mend complications such as leakage, abdominal hernias or stomach obstructions. According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 30 percent of patients develop nutritional deficiencies such as anemia, which occurs when vitamin B-12 and iron are not absorbed, or osteoporosis and metabolic bone disease due to decreased calcium absorption.

"It's a major surgery and a dangerous surgery," Schreiber says. "So having a skilled surgeon and surgical team in place to get patients through the operation, along with a comprehensive after-care program, is extremely important."

This surgery is considered a last resort for morbidly obese individuals who have not been able to lose weight any other way. It does provide a relatively permanent solution, but patients must commit to changing their lifestyle. They must eat nutritiously and stick to a lifelong regimen of vitamin intake and exercise to reap the full benefits of this operation. Otherwise, they can regain excess weight. To ensure this commitment, programs such as St. Vincent's and University Hospitals' now require patients to first lose at least 10 pounds on a medically supervised diet before approving them for surgery.

"The surgery does about 60 percent of what the patients couldn't do through dieting, but 40 percent of their success is still under their control," Schreiber explains. He adds that successful surgery is defined as losing more than 40 percent of the body weight after two years. Losing more than 60 percent is considered an excellent result.

Health insurance companies have even become more willing to reimburse for the gastric bypass surgery over the past few years. According to Schreiber, the $20,000 average cost for bariatric surgery in the U.S. pales compared to the $117 billion spent each year on obesity-related health-care costs. However, a stringent due-diligence process helps ensure that patients are not just looking for a quick fix without having tried any other weight-loss methods.

Dr. Thomas A. Stellato, chief of the division of general surgery at University Hospitals, directs the bariatric surgery program that he founded four years ago. He says new research published this year in the New England Journal of Medicine demonstrates another reason why the gastric bypass procedures have proven so successful. Scientists have discovered a hormone produced in the stomach called ghrelin, (pronounced grel-in) that causes people to become hungry when their stomach is empty. When people go on a traditional diet, their ghrelin levels increase, which is one of the reasons diets don't work well. Patients who have the bypass surgery, however, no longer experience this effect when their stomachs are empty.

"The bypass is not just a mechanical operation that creates a small pouch so that when you eat you feel full," Stellato says. "It also affects the physiology of the patient, so that when their pouch is empty they don't feel hungry anymore."

Since starting the program at UH in March 1998, Stellato says, the hospital has doubled its volume of gastric bypass procedures each year. He estimates that he and Dr. Peter Halliwell, who handles the laparoscopic surgeries, have handled more than 300 procedures since beginning the program.


Of course, the impact of such a remarkable physical transformation reaches beyond the patient to touch spouses, family and friends. Typically, the effect is positive, but conflicts can also arise because the patient assumes a radically new lifestyle.

"When body image changes, relationships change," says Barbara Lombardo, clinical nurse specialist in adult psychiatric mental health nursing at UH. "Usually, this procedure will reinforce positive relationships, but if there have been some problems in the relationship, then it probably wasn't that strong before the surgery."

For Ken and Lisa Carver, a married couple who both had gastric bypasses, the impact was blessedly positive. Prior to her surgery in July 1999, Lisa's obesity caused her to be infertile. Thirteen months after her surgery, though, she became pregnant. The couple now has a happy, healthy 17-month-old girl. Seeing the success that his wife enjoyed, Ken underwent surgery in April 2002. Although they both lost more than 100 pounds, they follow the recommended approach to only check their weight at doctor visits so that their daily focus is on living a healthy lifestyle, not measuring their weight.

Commenting on America's obsession with weight, Melissa Sambenedetto, who now thoroughly enjoys making her nieces and nephews keep up with her, says the first question people ask her is, "How much did you lose?"

"Don't ask me what I lost, because that doesn't matter," she replies. "Ask me what I've gained. I've gained my life back. I've gained being able to walk the stairs, tie my shoes, walk the parking lot. I've gained my dignity. That's what really counts."

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