Chris Christie: Fit to Be President?

The psychological and political aftermath of the governor's weight-loss surgery

Memo to Chris Christie: You've got a new contract with life -- under some pretty favorable terms.

The New Jersey governor and possible 2016 Republican presidential contender quietly underwent lap-band surgery three months ago, the New York Post revealed Tuesday. In light of my own open gastric-bypass surgery five years ago, I have some idea what he's going through now.

For many, if not most, people who are obese, surgical intervention to reconfigure the stomach, or to reconstruct the entire digestive tubing, is the only way to reverse significant weight gain. Although most symptoms of obesity can be treated with medication, and many obese people can lead long and productive lives, surgery and the subsequent weight loss gives them a dramatically higher chance of improving the quality of their years.

In February, Christie asked a doctor to insert a silicone band around his stomach, limiting the amount of food he can eat at one setting. He will feel full more quickly, and the hormones ghrelin and leptin (among others) will signal satiety faster, making it harder for him to eat more than his stomach will allow. Weight loss will come rapidly. He has already lost 40 pounds in three months, the Post reports.

Lap-band surgery is getting safer, but it is not a one-and-done procedure. The stomach expands, pushing back against the silicone, and Christie will need more (though less invasive) surgeries to tighten the band over time. Had he chosen a more drastic intervention, like open gastric-bypass surgery, his weight loss would have been faster and perhaps even more permanent; that procedure still promises the highest rate of long-term success. In 2008, a doctor in Washington made a four-inch incision below by sternum, split open my abdominal cavity, and rewired the way I process food. Today, I weigh about 145 pounds -- down from 235 before the surgery.

Christie chose the lap-band procedure because the open surgery, which has a slightly higher risk of death but fewer long-term complications, is more dangerous for the morbidly obese, although a good surgeon can mitigate the potential problems. Full gastric-bypass surgery is pretty much irreversible, while the gastric band can be adjusted. Bypass surgery leaves the stomach intact, but all food is digested elsewhere, which can make for some pretty interesting episodes in a restaurant. There are certain foods that I can't eat, particularly those with high concentrations of sugar, and certain medicines, like aspirin, that will bore a hole in my intestines should I take them. Christie, in contrast, will be able to eat whatever he wants.

Post-surgery recovery can be painful, but the hardest adjustment is psychological. It may sound weird, but it isn't easy letting go of the fat person you once were. Your weight and appearance change rapidly; the person you stare at in the mirror becomes somewhat foreign to you. People around you treat you differently, and even within relationships, spouses and significant others often modify their own body-image expectations to keep pace with yours. I don't want to speculate on Christie's sex life, but one of the biggest sources of post-surgery psychological stress is the expectation people have that the quality of their sex life will improve quickly. (We do want our presidential candidates and governors to be sexually fulfilled, I would assume.)

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Marc Ambinder is an Atlantic contributing editor. He is also a senior contributor at Defense One, a contributing editor at GQ, and a regular contributor at The Week.

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