Case In Point

A 21-year-old woman stood 5'8" and weighed 303 pounds, which made her 160 pounds over her ideal body weight and she had a body mass index of 46.

Dr. Anthone notes that in addition to weight, candidates for this procedure are evaluated based on their body mass index, which is an equation that measures the body's surface area. A normal body mass index is between 20 and 25, a number greater than 40 is considered morbidly obese and greater than 50 is "super morbidly" obese.

Because of her weight, this woman presented with hypertension, arthritis, irregular periods and was hyperglycemic (diabetic). She had failed at the "traditional" weight loss programs, including a stay at an inpatient weight loss clinic. While she did lose some weight she never kept it off, gaining the weight back quickly, which is a common pattern in-patients with obesity.

Dr. Anthone's work-up includes an upper GI, Chest x-ray, ultrasound of the gallbladder, EKG and cardiac stress tests. A pulmonary function test is also performed to ensure patients can undergo three to four hours of surgery under anesthesia. Five years after her operation, Dr. Anthone's patient, weighs 154 pounds. Her health status has improved dramatically, and for the first time ever, she feels her life has normalized. In fact, her operation was so successful that her mother subsequently underwent the procedure.

Genetic Obesity

This "family involvement" in the distal gastric bypass is not unique. Dr. Anthone notes that this familial tendency towards morbid obesity substantiates his personal belief that obesity is a genetic problem. "I believe genetics is the main factor in many patients, who are obese, especially if they were obese as children," he points out. "Previous studies of twins with obese parents who are adopted into different families seem to substantiate this: one twin is adopted by thin parents and the other twin by obese parents - both twins grow up to obese adults. I think metabolism plays a large role, although we don't know how as yet. Maybe these individuals are more efficient absorbers of food; maybe it is linked to insulin production. More research needs to be done to unravel this mystery."

"This genetics connection is in sharp contrast to individuals who were not obese until adulthood," Dr. Anthone adds. "Their weight increases usually can be traced to an inciting factor that caused them to gain weight such as divorce, quitting smoking, or a death in the family. This is more of a behavioral problem, not a genetics one. Unfortunately, there is no blood test to definitely say a patient has genetic obesity. However, the first question I ask patients in my initial consultation is 'Were you obese as a child?' If the patient answers yes, then I have a pretty good idea that we are dealing with a genetic problem."

Susan (not her real name) exemplifies a genetic predisposition to obesity. Since she can remember, she always has been overweight, yet she is not an overeater. She has perceived a noticeable slow-down in her metabolism since her teen years, and in the past decade has gained more than 150 pounds. Unlike some patients, Susan has never been emotionally bothered by her obesity; it is part of her life, and it has never come in the way of pursuing her dreams. She currently is "very happily married" and a graduate of the USC nursing program. Her dangerously high blood pressure attracted her to Dr. Anthone's surgery.

"I went to the student health center at school because my nose would not stop bleeding, the result of my hypertension," Susan says. "The health center director warned me that my blood pressure problem would kill me and said I had to take some weight off. He suggested I touch base with Dr. Anthone." Susan, who weighed 360 pounds, underwent the distal gastric bypass procedure in December 1993, lost more than 100 pounds, and her blood pressure has dropped. She has nothing but praise for Dr. Anthone. "He is a wonderful, skillful physician with an excellent beside manner," she says. "He is always available to answer my questions, and if he doesn't know the answers, he doesn't pretend to know. I truly respect him."

One question Dr. Anthone asks his patients a few weeks and months postoperatively is, on a scale of one to 10, how much food can they eat. Initially, most patients respond with a 1, 2, or 3, while those a year or more post-surgery are eating at an 5 (about half what they expect to eat). Susan estimates that she can eat about an 8. And while she does not do as much eating, she does not feel deprived. "I have always had a good body image,"; she says, "I'm just very pleased that my health is improving."