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A Last Resort for the Obese

Surgery: Procedure that reduces stomach size helps some but is no panacea, doctors say.


The drastic surgical procedure with the unnerving nickname, "stomach stapling," was Nan Coulter's last best hope. She was too desperate to feel nervous about it.

At 5 feet, 8 inches tall and nearly 400 pounds, Coulter's weight was closing in on 400 pounds. Her body mass index, a measurement of height and weight, was 61, nearly double the number considered morbidly obese.

The 37-year-old telecommunications executive was so exhausted from lugging around hundreds of extra pounds that she fell asleep at her desk twice a day and spent most weekends in bed. At night she wore a special apnea mask to prevent her from dying in her sleep when she stopped breathing. Her weight also was a cause of her asthma, dangerously high blood pressure, incipient diabetes and years without a period.

Coulter was so fat she couldn't fit into a nonhandicapped stall in a public bathroom, a coach seat on an airplane or a booth in a restaurant. She drove with difficulty, her chest mashed against the steering wheel. People stared at her and pointed, or acted as though she were invisible. Her family was embarrassed to be seen with her; on infrequent visits home, her parents monitored her every bite.

"I figured I had nothing to lose and I was going to die unless I did something," recalled Coulter, a veteran of innumerable failed diets and weight-loss regimens.

Spurred by a friend's experience, in December 1998 Coulter flew from Portland, Ore., where she was then living, to her native North Carolina for surgery to permanently reduce the size of her stomach.

Coulter was supposed to spend three days in a Durham hospital recuperating from the operation that was supposed to cost about $20,000. Instead, she was hospitalized for a month, much of it in intensive care, battling internal hemorrhaging followed by a massive infection, both of which nearly killed her. Her medical bills totaled $100,000.

Now, 14 months after surgery, Coulter has lost 115 pounds and dropped 12 clothing sizes. She no longer needs the apnea mask or her asthma inhaler. Her blood pressure, blood sugar and menstrual cycle are completely normal. She has so much energy that she regularly wakes up at 5:30 a.m. Her life no longer revolves around food.

"Surgery was the best decision I ever made," said Coulter, who weighs 270 pounds, ticking off the myriad triumphs of her new life, including her new-found ability to cross her legs. "It has permanently changed my life. Even if I don't lose any more weight, I'd be very happy."

Ranks of Morbidly Obese Doubled in a Decade

It's not surprising that surgery for obesity, known as bariatric surgery, has become increasingly popular. Even though weight loss is a $33-billion-a-year industry, Americans have never been fatter: One in five is obese, defined as being 30 or more pounds overweight. The ranks of the fattest, those who are morbidly or severely obese (the terms are used interchangeably) because they are at least 100 pounds overweight, have doubled in the last 10 years. Many have been fat all their lives and come from families in which obesity is common.

Being fat is not only a source of enormous emotional pain and stigma, but also one of the leading causes of premature death. Being overweight or obese is linked to a staggering array of disabling and expensive diseases: several kinds of cancer, heart problems, high blood pressure, arthritis, asthma, diabetes, stroke and infertility among them. Scientists know that many, but not all, of these conditions can be ameliorated by losing weight.

But as anyone who has tried to banish as little as 5 pounds knows, losing weight is hard--and weight loss usually doesn't last. It is estimated that 95% of diets fail, largely because maintaining weight loss involves changing a lifetime of bad habits.

That's particularly true for the morbidly obese, who have dozens, if not hundreds, of pounds to lose. Many people who are severely obese, Nan Coulter among them, can recount a litany of diets, drugs, therapies and bizarre and even dangerous remedies to which they've resorted. Most are yo-yo dieters, some of whom lose huge amounts of weight--sometimes 100 pounds or more--only to regain it all. Others have simply given up and gotten progressively fatter.

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