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The Promise of Weight Loss Surgery

Obesity and your health.

Kimberly at one of her many doctor appointments, which are required in order to be approved and cleared for weight loss surgery
Photo credit: Jackie Molloy for The Well
A close up of a man's hairy feet standing on white digital weight scale. The led screen shows a sad face symbol on it.

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Kimberly Falco is outgoing with long dark hair, a glowing olive complexion and a bright smile. She loves teaching her grade schoolers and they love her. But there was a time when it got harder to do, and not because of the kids. “Sometimes I worried about sitting down and breaking the child-sized furniture and being mortified,” she said.

Falco, 27, has gained and lost weight countless times since she was an adolescent. She was vegan for a time. She tried different cleanses and clean eating. She would always lose weight and declare victory. Then the pounds would invariably come back. Last summer, at 5 feet 4 inches, she weighed 255 pounds—correlating to a body mass index, or BMI, of 43. A person with a BMI of 30 or higher is considered obese.

Kimberly at age 8 with her baby sister
Kimberly at age 8 with her baby sister | Photo credit: Courtesy of Kimberly Falco

After gaining 60 pounds in a year, she’d had enough of the weight roller coaster. Last summer, she decided that bariatric surgery was what she needed to shed the stubborn weight and get back to living her life.

“I love who I am as a person, but physically, I wasn’t happy. I started to feel the negative effects of the weight. I was more fatigued. I got winded after short walks. If things continued that way, I’d be on every medication under the sun,” Falco said.

“Why is your butt so big?” a second grader asked. “You need to go to the gym.”

The decision, for her, wasn’t difficult, but it had been a long time coming. There were the health concerns, but there were also the comments: “Why is your butt so big?” a second grader asked. “You need to go to the gym.”

“You’re the most attractive girl I’ve seen over 150 pounds,” a man on an online dating site said. Apparently, he thought that was a compliment.

Falco remembers being in high school and overhearing a family friend comment to her mother, “Your daughter needs to watch her weight. She’s too beautiful to be fat.”

The comments added a weight of their own. She would second-guess herself and her appearance. What were other people thinking? Muttering behind her back?

Her family, at first, was shocked. They worried that it was a drastic approach that wouldn’t pay off. “I know this is a tool, not a magic wand,” Falco said, aware that even with surgery, she’d have to dramatically change her lifestyle. Before she could proceed with surgery, she had to navigate many medical appointments and requirements she had to meet—a psychological evaluation, monthly weigh-ins where she had to demonstrate weight loss or, at least, no weight gain, an endoscopy, and a stress test on a treadmill.

Kimberly at one of her many doctor appointments, which are required in order to be approved and cleared for weight loss surgery
Kimberly at one of her many doctor appointments, which are required in order to be approved and cleared for weight loss surgery | Photo credit: Jackie Molloy for The Well

She would make those appointments during her sessions with her therapist. She wanted accountability. She wanted to stay the course. She was determined to eliminate fast food. She cut back on going out with friends to avoid the empty calories in alcohol. She traded in pizza for cucumber spears sprinkled with Trader Joe’s Everything But the Bagel seasoning or dried beets dipped in hummus.

“Failure isn’t an option,” she said. “I don’t want to die.”

Fat beliefs vs. fat facts

In the United States, more than one in three adults are obese. That’s 93 million people. Add children and that number jumps to 107 million. Just 20 years ago, it was closer to 74 million. Altogether, the majority of Americans are overweight and obese.

Our society’s beliefs about weight—that excess weight is a sign of laziness and lack of self-control—fly in the face of science and the tireless efforts of people like Kimberly to lose weight. These beliefs, and the stigma that results, may actually contribute to the obesity epidemic. The people battling public perceptions of their bodies and characters are brave and defiant, long-suffering and determined. Some endure life-altering surgery while others embrace the word “fat” itself. What they all have in common is the desire to live their lives freely—free from stigma and judgment, free from the threat of severe health conditions, and free to be themselves in a society that insists they don’t deserve it.

Why diets don’t work

In 2013, the American Medical Association (AMA) recognized obesity as a disease, despite the fact that the AMA’s committee tasked with studying the issue recommended against the move. The AMA held that treating obesity itself would improve or eliminate illnesses linked to it including type 2 diabetes, heart disease, sleep apnea and even some types of cancer. Other physician associations have since developed guidelines for treating obesity; from identifying candidates for bariatric surgery to deciding what medications to prescribe to help people lose weight.

“Just about everything you think you know about weight is wrong.”

Generally, people still don’t have a good understanding of how obesity works. Just about everything you think you know about weight is wrong. Diets alone—low-carb, keto, Mediterranean, Paleo and all the varieties in between—don’t keep lost weight off over the long term. Exercise, by itself, does not lead to meaningful weight loss and does not keep lost weight off.

That might sound like common sense. Many people think it’s the combination of diet and exercise, not either one alone, that works over time. But even that isn’t as simple as it sounds. The oldest database of people who’ve lost weight and kept it off—The National Weight Control Registry—shows that most, if not all, regained some of the weight they lost.

In the end, diet and exercise, alone or together, almost always lead to weight loss initially, but over time, most people regain the weight.

There are biological reasons for this. Our bodies are designed to maintain weight, not lose it. Normally, your weight is maintained by your central nervous system and appetite hormones in your digestive tract. Signals about hunger or satiety are part of this regulation. If you’re in danger of losing weight, your gut signals the brain to make you hungry. If you’ve had what you need, your gut signals the brain to turn that message off—you feel full. In other words, dieting makes you hungry. Being hungry means you’re likely to eat.

That’s where the second blow of weight loss hits—once you’ve lost weight, the body reduces the amount of energy it expends just keeping you alive. It therefore takes fewer calories to regain weight you’ve lost. It’s a cruel twist of biology called the “metabolic handicap.” Here’s an example of how it works: Dave weighs 220 pounds and consumes 2,200 calories a day. John weighs 200 pounds and eats 2,000 calories a day. Dave lowers his intake to 1,830 calories a day to lose weight. He succeeds and loses 20 pounds. He and John now both weigh 200 pounds. But for Dave to stay at 200 pounds, he must continue to eat fewer calories than John, who can go on eating 2,000 calories a day to maintain his weight.

It’s a hypothetical situation, but it illustrates the problem people who work hard to lose weight face perpetually. Dave will fight continual hunger signals from his gut and brain while his metabolism slows to prevent him from losing any more weight.

“Sure, there are willpower issues with food and behavior, but there are a lot of things we don't understand metabolically and physiologically about what makes somebody fat and what makes somebody who exhibits the same type of behavior thin.”
Larry Gellman, MD

What doctors still don’t know

Larry Gellman, MD, chief of minimally invasive surgery at North Shore University Hospital in Manhasset, NY, says that at the most basic levels, we still don’t understand what makes some people heavy. “Sure, there are willpower issues with food and behavior, but there are a lot of things we don't understand metabolically and physiologically about what makes somebody fat and what makes somebody who exhibits the same type of behavior thin,” he says. “It's the same thing with smokers. Some healthy people say they’ve smoked their whole lives and don’t have problems. How is that?” 

Similarly, there isn’t direct causation from obesity to the host of illnesses associated with it, says Jamy Ard, MD, co-director of the Weight Management Center at Wake Forest Baptist Health in North Carolina. A BMI over 35, he says, does not automatically mean someone has or will have diabetes.

The people Dr. Ard sees at Wake Forest seek a better life. “Weight is impeding their lives, stopping them from doing something they used to do or that they want to do.” And still others are just unhappy with their weight itself. Dr. Ard and the team take a multidisciplinary approach to weight—patients work with dietitians, fitness experts and behavioral health professionals to support treatment, whether that’s managing weight through diet and exercise alone, supplementing with available weight-loss medications, or preparing for bariatric surgery.

Like Dr. Gellman, Dr. Ard says there are still things that just aren’t known yet. Doctors don’t know which approach to start people on. It’s still trial and error. “We’re getting smart about individualizing treatment, but we still don’t have much evidence around which treatment to begin with and what will work best for that patient. We can guesstimate, but I can’t tell you with certainty what one weight loss therapy would be better than another for a given patient.”

The road to weight loss

Kimberly arrived for her cardiac stress test in October, one of the last things she had to do before being cleared for surgery. She removed her black T-shirt printed with the names of the characters from Stranger Things for her echocardiogram. She pulled on a paper dressing gown while a slim nurse in purple gloves pressed sticky electrodes onto Kimberly’s skin. She knew it was part of the process, but it wasn’t comfortable. She stepped onto the treadmill for the stress test. It would last nine minutes, starting with walking flat, then going faster and faster on a rising incline. “I haven’t been as active as I should be,” Kimberly knew. Being on the treadmill felt embarrassing. “It made me very anxious to have to run on that thing in front of strangers.”

Kimberly and Emily Elias, a nurse practitioner who assisted during the stress test
Kimberly and Emily Elias, a nurse practitioner who assisted during the stress test | Photo credit: Jackie Molloy for The Well

She walked for three minutes at a normal pace without an incline. Then, the treadmill sped up and lifted. “That incline was a killer,” she said. She made it to seven minutes. Twenty minutes after the test ended, her heart continued to thump at 105 beats a minute. Once she had the surgery and lost the weight, she’d been told, things like this likely wouldn’t happen anymore.

Doctors had long told Kimberly that weight loss would solve all her problems.

“But if you’re going to tell a vulnerable young girl, a teenager, to lose weight and not help her, it’s like a slap in the face.”
Kimberly Falco

“‘You need to lose weight,’ they’d say, then just, ‘OK bye,’” Kimberly recalled. “They all told me to lose weight, but they didn’t give any tools to do so and then they didn’t check on me to see if what I was doing was working. In some ways, I get it. I have 28 students and I sometimes have difficulty balancing all their needs. So a doctor with hundreds of patients may not be able to check in with all of them.”

“But if you’re going to tell a vulnerable young girl, a teenager, to lose weight and not help her, it’s like a slap in the face,” Kimberly continued. “It felt very demeaning.”

Most doctors didn’t ask any questions or do any tests beyond noting changes in Kimberly’s weight. She’s had an irregular menstrual cycle since middle school and was prescribed birth control for years to regulate it, with mixed success. It wasn’t until she was 27 years old and preparing for bariatric surgery that she was officially diagnosed with both mild sleep apnea and polycystic ovarian syndrome (PCOS)—both conditions are known to cause weight gain. Frustratingly, both conditions also tend to be caused by excess weight.

“It’s a little sad. I let weight do this to my body,” she said. “But at the same time, it’s helpful to know it’s not just me; to know that oh, this is why I’m gaining weight. I tried for so many years to find some kind of explanation.”

If losing weight for the long term is so difficult, then it would seem the solution to the problem is to never have a problem in the first place—just don’t gain too much weight ever.

As with losing weight, that’s easier said than done. “Some people are genetically predisposed to gaining weight,” Dr. Ard explains. But we’re all exposed to an “obesegenic environment.” Even if you’re not predisposed to gaining weight, you’re still in an environment where you don’t have to catch your food. “These days, all the calories you could ever need or want can be delivered to you through your car window. Your genetic makeup, environment, mental health, income level, education, where you live, and all of those factors come into play. It’s not as simple as someone ate too much or someone didn’t exercise enough.”

Dominick Gadaleta, MD, is chief of general surgery at North Shore University Hospital and director of the bariatric surgery program. He is the doctor Kimberly sought out. He says some people gain weight for medical reasons. Some women have been morbidly obese since their first period, around 13 years old, often because of PCOS, which affects the ovaries and fertility and often leads to weight gain. Other patients he has seen may have dramatically changed their activity and eating habits because of trauma—sexual assault, a bad breakup or divorce, a job loss or something as seemingly mundane as a broken leg—that derails their lives. Overweight and obese children are also more likely to stay obese into adulthood and develop diseases like diabetes and cardiovascular diseases at a younger age, according to the Centers for Disease Control and Prevention.

“There’s no blame to go around,” Dr. Gadaleta says, “but for many people it does come down to calories in versus calories out. And life gets in the way of good intentions.”

“A thinner, better version of me”

December arrived and Kimberly finally got her surgery date—January 9. She’d have to go on a liquid diet in the weeks before that, but luckily, she didn’t have to start until after Christmas. After work one night, Kimberly headed to Rust Auditorium at North Shore University Hospital with her mother to hear from people who had weight loss surgery.

The giant screen before the crowd lit up with a photo of a young woman wearing a purple T-shirt and black capri leggings. A second photo of the same woman appeared on screen, except in the second photo, she was dramatically thinner. “Wow!” the crowd erupted. A moment later, the woman in the photos, Francheska, with long hair and a body-hugging black dress, strode up to the podium in front of the crowd. The slim woman in the black dress smiled and pointed to the side-by-side photos on the screen. “I’m 150 pounds lighter. I lost a whole person,” along with shame, sadness, self-doubt and sickness, she said.

“I’m a thinner, better version of me and life is better than what I could have imagined,” Francheska told the crowd. “For anybody who’s contemplating any kind of weight loss surgery, don’t wait, do it.”

“You see a smile, but there was no happiness there. It was hard to get out of bed and face the world.”
Tom, a bariatric surgery patient

Before her, a man named Tom walked to the podium to cheers, whoops and applause. He spoke about his life before surgery—he’d been 317 pounds, wore pants with a 52-inch waist and had 147/90 blood pressure. He took four different medications. Tom pointed to his before photo. “You see a smile, but there was no happiness there. It was hard to get out of bed and face the world.” Today, Tom was down to a 34-inch waist and his blood pressure was 106/68. He choked up. “I’m glad to finally be the person I always wanted to be,” he said.

Tom’s speech was particularly inspiring to Kimberly during the weight loss surgery event at North Shore University Hospital
Tom’s speech was particularly inspiring to Kimberly during the weight loss surgery event at North Shore University Hospital | Photo credit: Jackie Molloy for The Well

Several more speakers told the crowd of their improbable journeys, with more than one attributing their weight loss surgery to what saved their very lives.

Tom’s testimony resonated with Kimberly most. “His emotion,” she said. “I could really feel it.”

“I am happy,” Kimberly said about her upcoming surgery. “This is the one part of my life holding me back. I’m sick and tired of being tired at 27 years old!”

On the other side of the auditorium, a Zumba class started. People drifted over and stood in a semicircle around the class instructor. A few minutes later, the singer Ciara chanted “Level up! Level up! Levelupleveluplevelup!” over a driving beat as the Zumba instructor and participants rolled their hips and bounced on the balls of their feet.

Zumba had been one of Kimberly’s favorite fitness classes. But it had been a long time since she took a class. She had become more self-conscious about her body and stopped going. Kimberly did not stay for class that night.

Weight bias is a health problem

“I call people fat, not obese,” says Amy Farrell, PhD, professor of American studies and women's gender and sexuality studies at Dickinson College in Pennsylvania. “Obesity is medicalized; we’re already saying that the person has a medical problem,” she explains. “We use fat as a neutral, descriptive term the way we’d say someone has brown hair or that she is tall or short.” Fat isn’t a slight or insult, but a descriptor without values attached to it. Of course, almost anyone in America using the word attaches deeper meaning to it.

Dr. Farrell’s book, Fat Shame, explores the origins of the American preoccupation with weight and disdain for fat and fat bodies. “Surprisingly, it begins in the 1800s,” Dr. Farrell says. “We already see a burgeoning idea that fat is negative.” Fears of fatness, she says, preceded concerns about fat’s effects on health. “Doctors weren’t worried about it. People came to them looking for ways to ensure they stayed slender. They didn’t want their bodies to be a drag on their upward mobility.”

Today, we might think we’d dismiss such thinking out of hand. Dr. Farrell isn’t convinced. “The stigma persists over time because it provides an acceptable way to maintain power hierarchies,” she says.

“Thinness is often perceived to be the result of hard work and discipline; there’s a strong emphasis on personal responsibility and accountability.”
Rebecca Puhl, PhD

Whatever we claim to believe about fat and fat people, our beliefs have real world effects, says Rebecca Puhl, PhD, deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut. “Thinness symbolizes important values in our culture. Thin people are viewed as being attractive, ambitious, desirable, successful. Thinness is often perceived to be the result of hard work and discipline; there’s a strong emphasis on personal responsibility and accountability. But if you have a larger body size, people often assume the opposite—that a larger body reflects lack of personal responsibility and willpower.”

In the healthcare setting alone, bias against patients with obesity hinders effective treatment, discourages people with obesity from seeking medical care for the condition, and might contribute to the epidemic. According to studies, the higher a patient’s BMI, the less desire doctors have to help the patient. Doctors are also more likely to report that treating the patient is a waste of time. People who experience weight bias are more likely to avoid health care, to engage in unhealthy and disordered eating behaviors, to increase food consumption, and to avoid exercise, risking weight gain and maintaining obesity over time.

Individual responsibility is a particularly American value, but it greatly oversimplifies how complex weight is. The cycle of weight loss and regain is so predictable that doctors call obesity a chronic disease, one with periods of remission and control (weight loss) followed by relapse (weight gain). Anyone battling obesity is likely to lose weight and gain it back over and over for the rest of their lives, like someone battling addiction or living with diabetes. That very cycle, however, often reinforces the personal accountability narrative, Dr. Puhl says. And it spills out from the healthcare setting.

Currently, people who face weight stigma or discrimination have few options for recourse. “It’s legal in most places in the U.S. to discriminate against people because of their weight,” Dr. Puhl says. “Without legislation, people can face weight discrimination at virtually every stage of the employment cycle—from getting hired to getting fired.” Michigan is the only state in the U.S. that includes body weight in its civil right protections.

Dr. Puhl says people need support, not stigma, from every segment of society. A model for shifting societal attitudes is the anti-smoking movement. With cigarettes, the behavior of smoking was stigmatized, not the person. Smoking was bad, but smokers weren’t. Lawsuits and public health campaigns went after the tobacco companies, not smokers. The smokers were often framed as victims of the tobacco companies’ deceit. “But with weight,” Dr. Puhl explains, “our society tells us that you must be thin to be accepted, then we’re inundated with messages to eat high-calorie foods all day. Then we blame people for gaining weight. This is both a social injustice and a public health issue.”

Dr. Ard echoes the point. “Weight loss won’t eliminate weight bias,” he says. “But eliminating bias may lead to weight loss.”

“I’m going to eat like everyone else”

Tanya Fields got ready for her strength-training workout at her neighborhood gym. “I love lifting weights,” she says. She laced up her gray Nikes with the fluorescent pink Swoosh, then paused a moment to snap a selfie for her Instagram followers with the caption: “A bitch is a smooth 11 pounds lighter and imma keep going hard. Not to be skinny, but to feel good and present in my body.”

Fields’ medical record describes her as morbidly obese. “Who made up that term?” she asks. “And why do I have to own it?” Her doctor sent her to take a weight management class where she received instruction on meal planning. But the lessons were extremely rigid, failing to take into account real life, like family celebrations, holidays and culture. “I live in a heavily Latino, Caribbean community in the Bronx. Rice is a staple of people’s diets. In this class, we were limited to a half cup. What about lamb or mutton? All they told us to eat was chicken and fish. It’s not realistic.”

Before Thanksgiving, the instructor asked the class what they planned to have on the holiday. Fields scoffed at the replies of “salad” or “small portions.” She answered honestly, “I’m going to do what everybody else across the country does—eat until I fall asleep.” The instructor, she says, looked aghast.

Fields knows that her family history of conditions commonly associated with obesity, including diabetes and heart disease, increases her risks of developing these illnesses. At 38, she’s already prediabetic. Raising her six children, and enduring the intense physical work of running an urban farm, she notices that her knees hurt more than they used to. She is not opposed to weight loss. On the contrary, she knows losing weight would mitigate some of her health risks. But she also wants people to know, including doctors, that people don’t need their weight to become the center of every conversation they have.

“I changed doctors frequently because they didn’t listen. For fat people, going to the doctor is traumatic.”
Tanya Fields

“My weight has nothing to do with why I got strep throat,” she says. “I changed doctors frequently because they didn’t listen. They just talked about weight and, even then, had nothing helpful to offer. For fat people, going to the doctor is traumatic.”

Even outside of the doctor’s office, criticism of bodies like hers is relentless. “Society makes you feel invisible, undesirable, makes you feel like a freak,” she says. “They’ll even insult the people who find us attractive, like ‘there must be something wrong with them—it must be a fetish.’”

Her own friends will throw around fat insults in her presence, even though they aren’t talking about her directly. “Fat bias and fat phobia are so ingrained, nobody wants to hear it. No one wants it pointed out to them,” Fields says. “But doctors know it. And they know the toll it takes.” The solution, she says, is for doctors to break the silence. “We need more advocates in the medical community to speak openly about fat bias.”

A societal problem

The science is clear: Excess weight is linked with health problems. Losing weight tends to lower the risk. Losing weight, for example, has been shown to reduce the risk of some cancers, reduce arthritis-related pain and even cure type 2 diabetes and sleep apnea. But is the weight the primary health problem, or does weight stigma contribute more to poor health outcomes?

“It may work the same way being black or poor is linked to poor health outcomes,” Dr. Farrell says. “There is nothing inherently unhealthy about being black or poor. But these conditions—stigma, discrimination, mistreatment by the medical community, poor access to decent medical care—these are the factors that worsen health.”

“You can’t be healthy and obese. Being that heavy is not an option.”
Larry Gellman, MD

Dr. Gellman, however, says excess weight is a health problem in and of itself. “I’ve had people come to see me who are 400 pounds and they say they’re the healthiest 400-pound person you’ll ever meet. I say, great, then what are you doing here?” he counters. “You can’t be healthy and obese. Being that heavy is not an option.”

But Dr. Gellman agreed that overweight and obese people are underserved by the medical community and that may contribute to their overall health problems. “They don’t go to doctors,” he says. “Doctors don’t like to see them. They say they don’t have health problems, but that’s likely because they haven’t been properly examined.”

To Dr. Farrell, that’s the real problem. “Physicians are people too,” she says. “They are products of our culture. They’re immersed in it.”

The easy way out?

New Year’s Eve was day six of Kimberly’s pre-surgery liquid diet. “It felt like day 60,” she said. Living at home, the scent of family meals—savory, spiced Puerto Rican dishes or steamy, rich Italian foods—were impossible to ignore. But Kimberly was resolute. She made her own broth with leeks, onions, herbs and turkey. She learned that her favorite flavor of Ensure was Cafe Mocha. “I don’t want anything to stand in my way.”

Kimberly was required to be on a liquid diet in the weeks before her surgery
Kimberly was required to be on a liquid diet in the weeks before her surgery | Photo credit: Jackie Molloy for The Well

Sameera Khan is a registered dietitian and physician’s assistant working with the bariatric team consisting of Dr. Gadaleta, Dr. Gellman, and Charmaine Gentles, a nurse practitioner. In September at Northwell Health’s North Shore University Hospital, Khan leaned over her laptop to prepare her presentation ahead of the bariatric surgery support group meeting. Her energy was electric as she talked quickly about the people who’ll arrive shortly. “I love what I do,” she beamed.

Khan started a Facebook group for the practice’s patients, a safe space to talk about their experiences post-surgery without the clinical stuff. The 445 members share recipes. They discuss the flavors of protein shakes to try or avoid. They vent their frustrations. They cheerlead for each other whenever someone posts about their weight loss. They talk about the “rules” of bariatric surgery including no carbonated drinks, no straws, no smoking. 

When people began to arrive, Khan greeted each of them warmly by name.

“Look at you!” she said to one woman as she admired her outfit. “Did you go shopping?”

“No,” the woman replied. “This is something I couldn’t fit in before.”

“Good for you!” Khan exclaimed.

“It does feel good,” the woman said.

The attendees greeted each other with hugs, kisses and comments like “Look at this skinny girl!” Some attendees were just a few weeks out from surgery while others were 10 years post-op. 

Eighteen people took every seat at the conference room table. That night, Khan wanted to talk to them about “speed bumps” they encountered after surgery. More than one person talked about “grazing,” or snacking just to snack. Others were disappointed by how slowly the weight was coming off, while their siblings ate junk food and lost weight seemingly without effort.

“This is an absolute lifestyle change,” Khan said. “Sometimes the entire family has to adapt the surgery patient’s new lifestyle.”

Surgery wasn’t magic, she said, and support of loved ones and friends was a big factor in success.

To those who don’t know much about it, bariatric surgery is often deemed “the easy way out,” but the path to surgery is anything but. Most people seeking surgery have to endure a battery of medical exams and a psychological evaluation. They must demonstrate that they can lose weight on their own. Heavier people might have to lose a substantial amount of weight just to be physically strong enough to endure the surgery itself, a seeming contradiction since the inability to lose weight on their own is often why they seek bariatric surgery in the first place.

Even after surgery, patients will have to alter the way they eat for the rest of their lives. Temporary hair loss post-surgery is common, often due to hypothyroidism or low levels of protein and iron. Familiar foods may suddenly smell or taste bad, including water. Acid reflux and bad breath are also fairly common due to dehydration, ketosis, or food remaining too long in the new, small pouch made from the stomach. 

“Easy way out? That’s the most ridiculous thing in the world,” says Dr. Gellman.

“You change the narrative for yourself. You take back control of your life.”
Larry Gellman, MD

Dr. Gellman likens weight loss after bariatric surgery to a “born again” religious experience. Thoughts they had a hundred times a day when they were at their highest weight, they no longer have. Everything from noticing when a new pair of pants becomes tight, to grabbing a handful of their bellies while looking disappointed in the mirror, to griping about aching knees, may only take fractions of a second, but they add up. When those moments aren’t happening, people feel transformed. “You change the narrative for yourself. You take back control of your life,” Dr. Gellman says.

The specter of weight gain looms even after surgery. Up to 30 percent of bariatric surgery patients regain the weight, according to Dr. Gellman. He also points out that only about 3 percent of obese people will lose and maintain weight with diet and exercise alone. At North Shore University Hospital, they follow the surgery patients for years. Before surgery, they work to prepare patients for the long haul, after the euphoria of the initial weight loss wears off. Dr. Gellman encourages his patients to think about what their weight stopped them from doing or experiencing and go for it. 

“Put yourself and your trips to the gym into your calendars just like your spouse’s work trip or your kids’ soccer practices and oboe lessons,” he says. “You’ve got to take better care of yourself.”

The end of the beginning

Kimberly and her mother arrived at the hospital early on January 9 while it was dark, the trees outside still blazing with holiday lights. Kimberly got dressed for surgery and kept it light. “I can’t wait to take a long nap!” she joked about being under the anesthesia.

Kimberly and her mother on the morning of Kimberly’s surgery
Kimberly and her mother on the morning of Kimberly’s surgery | Photo credit: Jackie Molloy for The Well

When the team was ready, Kimberly hugged her mother and left for the operating room. Dr. Gadaleta and his team were scrubbed in and waiting. She lay under the spotlights on the operating table. 

Dr. Gadaleta and team prep for Kimberly’s surgery
Dr. Gadaleta and team prep for Kimberly’s surgery | Photo credit: Jackie Molloy for The Well

Dr. Gadaleta worked efficiently as country music played in the background. The surgery was laparoscopic, four slim, robotic arms inserted through her abdomen. A portion of Kimberly’s stomach was removed. It took six months and a dozen medical appointments to get here, but the procedure itself would last just over an hour. 

Upon waking in recovery, Kimberly’s midsection felt like she just finished the toughest ab workout of her life. She felt good, just thirsty, but had to wait a bit before she could drink water. Her mother arrived in recovery just after 10am. Dr. Gadaleta instructed Kimberly to get up and move a little as soon as possible. She’d only need to stay in the hospital overnight.

Before surgery, she wondered if she’d miss the sensation of eating while on the liquid diet. Before that, she wondered if she’d miss some of her favorite foods, like the rice and pigeon peas or the pastelón her Puerto Rican aunt served over the holidays. After surgery, she just felt grateful to have done it. Now, she could move on to her new life and leave behind the heaviness of the old one.

Four days after surgery, Kimberly returned to work. “I feel good,” she told her co-workers, who knew she had bariatric surgery, but she was tired as expected. She also told her students, who then helped her pick things up and carried them for her so she wouldn’t have to. Rather than awkward and limiting, it was a welcome restart. “They’re so happy for me,” she said, “They’re so supportive.”

A full month out from surgery, Kimberly has lost 29 pounds. She started wearing her purple Fitbit again and is counting her steps, thinking of ways to add more including walking around her classroom when reading aloud to her students. Her family is encouraged by her journey and making small changes to eat healthier. A relative is now seriously considering bariatric surgery.

Kimberly before surgery on the left and four-weeks after surgery on the right
Kimberly before surgery on the left and four-weeks after surgery on the right | Photo credit: Courtesy of Kimberly Falco

“It feels good to know that this isn’t just for me,” she says. “If I can encourage someone else to change their lives and rethink how they manage their weight, then it’s even more worth it.”

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Published March 5th, 2019
A close up of a man's hairy feet standing on white digital weight scale. The led screen shows a sad face symbol on it.

See if you're at risk for an early and preventable death.