[ TO YOUR HEALTH ]
Last-resort surgery Norma Fuqua will celebrate her 59th birthday April 11 with a svelte new look and "a zest for living."
aids the seriously
overweight
With diet and exercise,
a gastric bypass offers hope
to many people burdened by obesityBy Helen Altonn
haltonn@starbulletin.comThe Tripler Army Medical Center nurse practitioner had a gastric bypass operation July 30, 2001, to deal with obesity and prevent serious health problems.
The surgery, combined with diet and exercise, has lopped 113 pounds from Fuqua's 5-foot, 3 1/2-inch frame. She reached her goal of 133 to 135 pounds. She once wore a size 22 and now slips into a size 6 or 8.
"I would say it's the beginning of a new life for me," she said.
She said Dr. Brandt Lapschies "got me where I'm at" with the gastric bypass, but it wouldn't work if she didn't do everything he suggested to change her lifestyle.
Lapschies, who practices at Kuakini Medical Center and the Waianae Coast Comprehensive Health Center, said gastrointestinal or bariatric surgery is a last resort for most people and a "very powerful tool" if coupled with a healthy lifestyle.
Morbid obesity is defined as 100 pounds over ideal body weight or a body mass index of 35 or 40 or more with serious health problems and risks of early death, Lapschies said.
Fuqua said she went from under 100 pounds when she married in 1965 to as high as 260 pounds after three pregnancies and a hysterectomy.
When multiple diets didn't work, she figured it was a genetic problem. She was raised in Atlantic City, N.J., one of 10 children, including six girls. All were heavy, and four sisters died of heart disease, she said. "When I lost my oldest sister three years ago, I knew that was it; I had to do something."
In 25 percent to 30 percent of obesity cases, Lapschies said, "genetics loaded the gun and environment (poor diet and inactivity) pulled the trigger."
An injured ankle tendon led Fuqua to her weight solution. She was in pain four years, wearing a cast, then a brace and special shoes, after falling in the rain at work, she said. She considered ankle surgery, but two doctors told her it might not be necessary if she lost weight.
FL MORRIS / FMORRIS@STARBULLETIN.COM Norma Fuqua has lost 113 pounds after having gastric bypass surgery. She wears size 6 or 8 clothes. Before her surgery, below, she wore size 22 and weighed 246 pounds.
When she saw 300-pound singer Carnie Wilson undergoing a gastric bypass on television in August 1999 at Alvarado Hospital in San Diego, she decided that's what she needed. She pulled up all the Internet information she could and asked her workers' compensation caseworker if the insurance would cover bariatric instead of ankle surgery.
She said the caseworker suggested she go to a support group meeting of Lapschies' patients, and she was so impressed, she scheduled an appointment. He spent 2 1/2 hours explaining everything to her, she said. "He was just so easy to talk to, so I said, 'I'm doing it.'"
Lapschies only offers surgery to people who have failed at diet and exercise.
He requires comprehensive health and physiological evaluations to determine if people are good surgical candidates, and Fuqua underwent a battery of tests for nearly three months.
Fuqua then weighed 246, and her body mass index was 43. Now it's 23, which is regarded as good. Her ankle pain vanished along with the extra weight. "You think I'm going back?" she asked, looking at a pre-surgery photo. "No way am I going back!"
Lapschies said he became interested in gastrointestinal surgery after he went to the Waianae health center in 1995.
"Everybody we were operating on was overweight," he said. "We were seeing people in their 30s who had a physiological age of 60 or 70. It was a cycle spiraling out of control."
He went to Alvarado Hospital in 1999 and trained with Dr. Alan Wittgrove, who devised the minimally invasive laparoscopic approach to bariatric surgery. It involves operating through small incisions instead of open surgery with one long incision.
In a Roux-en-Y gastric bypass, a small pouch the size of a golf ball is created from part of the stomach and separated from the lower part of the stomach. It restricts food intake and gives the person a sense of fullness and satisfaction, Lapschies said.
He returned to San Diego last year and trained for another weight loss technique, called laparoscopic adjustable gastric band. A little ring is placed around the upper part of the stomach to create a small pouch that narrows the connection to the rest of the stomach, he said. A removable balloon inside the band can be tightened or increased as needed, he said.
Gastric bypasses in the United States are expected to increase within a few years to 100,000 from 70,000 last year, Lapschies said. His team is doing 30 to 40 annually, and the number is growing, he said, noting HMSA pays for the gastric bypass but not the adjustable coil.
He said the U.S. success rate is 50 percent loss of excess body fat. His goal is 75 percent, and it's closer to 100 percent for those who comply with the diet and exercise program, he said.
