Better Living Through Weight Loss

Weatherman Al Roker and singer Carnie Wilson are the poster children. We are fixated by tales of their dramatic weight loss and amazed as they display the jeans they wore before undergoing gastric bypass surgery. Roker talks about his compulsive exercise sessions during the wee hours of the morning prior to his daily stint on NBC's "Today." Wilson poses nude and tells interviewers about her plans for plastic surgery.

Then, we wonder why we're going through the day-to-day slog of counting carbs, attending meetings and sending away for exercise videos. Wouldn't it be much simpler to just say, "Sign me up"? Wouldn't it be easier to endure three hours of surgery for a lifetime of being svelte? It doesn't sound too hard. In fact, it sounds downright simple.

Not so, cautions Dr. Raymond Gagliardi, director of bariatric surgery at the Northern Ohio Bariatric Center at Parma Community General Hospital. Gagliardi says he is adamant in his belief that bariatric surgery should be limited to those who are morbidly obese, a condition defined as being 100 pounds or more overweight with a body mass index (the measure of body weight relative to height) of 40 or more (as compared to the normal index of 18.5 to 25).

"A person may also qualify if they experience significant health problem such as diabetes, hypertension or sleep apnea ... the big three," he adds.

Since more than 100 diseases or conditions affect the morbidly obese — including arthritis, diabetes and gird — Gagliardi says, "the ideal candidate is 40 or over with a health condition, [someone] who has tried less risky ways to lose weight and failed."

Perhaps the most sobering reality is that this is not a quick fix. Behavior modification, exercise and dietary changes are vital to its success. Education, Gagliardi says, is the key.

Program manager and physiologist Robert Hetzel agrees. "I encourage our patients to exercise as soon as they walk in the door," he says. "There is no reason why they should not start early on."

Exercise, nutrition and consulting are core components of the Northern Ohio Bariatric Center program. Hetzel is organizing exercise programs with Parma Hospital's fitness centers and YMCAs. Gagliardi says the personal relationship that Parma Community General's team of surgeons, a dietitian and a physiologist have with the patients is the program's strong suit.

"It is a pleasure taking care of people who are so highly motivated," Gagliardi says. "Bob conducts support groups very similar to AA meetings. ... And there are numerous times when people will stand and tell stories about how this has changed their lives."

More than 100,000 bariatric surgeries were performed in the United States last year, compared to just 40,000 a few years earlier. Gagliardi cites a recent Wall Street Journal article indicating that there is an 80 percent long-term success rate associated with the procedure.

Nearly 70 such operations have been performed at Parma Community General thus far. All have been successful. Some have been the two- to three-hour "open procedure." Others have been baroscopic, a less-invasive procedure resulting in less recuperative time.

Gagliardi says insurance companies are beginning to recognize the link between obesity and severe health problems and are slowly changing their coverage. The age spectrum is gradually being extended on both ends, too. Physicians are now considering each Xerson individually. Gagliardi has already performed surgery on patients in their 60s.

Acknowledging that pharmaceutical companies continue to "look for magic diet pills," he says that the future may involve a multifaceted approach to weight loss that combines pharmaceuticals, bariatric surgery, education and, of course, exercise.

"Tackling obesity and seeing it as a link to so many different things is extremely exciting work," Gagliardi says. "There are whole families getting healthier because one member has had this surgery."

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