When Every Diet Fails, the Radical Solution

I am a man in his thirties, a happily partnered, fairly successful writer living in Washington, D.C. A few weeks ago, as I was blissfully and safely under general anesthesia, a surgeon knifed through the fat and muscles of my abdominal cavity, choked off a tiny part of my stomach as if it were a balloon animal, and attached it directly to my small intestine. This small new passageway is my new "Y" shaped-stomach and digestive path, called a Roux-limb, giving the procedure its name: Roux-en-y gastric bypass. It took my surgeon, Joe Afram, about an hour and fifteen minutes. It takes surgeons an average of 100 procedures to reduce error and mortality rates to acceptable levels; Afram is the Mozart of this procedure, having performed 4,000 gastric bypasses throughout 25 years of practice. I was in good hands.

The journey to this day, and the days of pain, adjustment, and reward that came afterward, will be the subject of this diary. I'm a fairly discreet person, and it took the editors of this site some coaxing to convince me to share my thoughts. For one thing, I wasn't initially convinced that the readers of a site devoted to the pleasure of cuisine would care about the experience of someone who had come to use food like a drug. For another, even though the incidence of gastric bypass surgery has increased by several orders of magnitude over the past several years, a social stigma remains -- think of all the jokes Al Roker and Star Jones had to endure. Without underestimating my readers, I'll bet that most of you believe that gastric bypass surgery is a cosmetic procedure, is for people who lack willpower, or who want to find an easy way to lose weight.

The first thing I learned is how much of a crock that notion is: preparing for, undergoing, and recovering from the surgery was much harder than any diet I've ever been on. And the bio-psycho-social model of obesity is something people who aren't obese don't spend much time thinking about. Many of the patients I met at Dr. Afram's office are anything but lazy or of weak character: they are mothers and fathers, work in intense-high-profile, high-powered jobs, have battled significant co-morbid medical conditions for years, and have spent years struggling to understand why the thousands of dollars they've spent on exercise programs, fasting diets, nutritionists, psychologists, Jenny Craig, and Healthy Choice haven't worked.

Don't worry; I'm going to save my proselytizing for the first and last post of the diary. Over the next few weeks and months, I intend to write a fairly straightforward account of what happened to me and is happening to me, in near-real time -- emotional, psychological, and way gastronomic. I think this will help me organize my thoughts, and I hope that they can help the reader who is curious about weight loss surgery -- its effects, benefits, drawbacks, and sociological implications.

This article available online at:

http://www.theatlantic.com/health/archive/2009/03/when-every-diet-fails-the-radical-solution/1721/