Bariatric Surgery: Lose Weight, Gain Health

Advanced procedures curb obesity and reduce related risks from chronic conditions

“Food was the center of everything,” said Denine Timlin, who grew up in an Italian home where pasta and bread were staples. “I became overweight as a young adult and always struggled with extra pounds,” she said. “Overeating was always an issue.”

Then in 2016 Timlin had an epiphany. While poolside, she and three girlfriends decided to celebrate their 40th birthdays the following year with an island vacation.

Frustrated by years of unsuccessful dieting, Timlin remembers comparing herself to “my skinny girlfriends, all size zero to four.” She thought: “I can’t possibly enjoy myself being the heavy one and never feeling comfortable in my own skin. I’m tired of feeling bad for myself.”

That’s when Timlin turned to Greenwich Hospital’s nationally accredited bariatric surgery program, which features a multidisciplinary team with board-certified surgeons, a program coordinator, dietitian, psychologist, specially trained nurses and a physical therapist. She had a laparoscopic procedure called sleeve gastrectomy. Surgeons removed roughly 85 percent of her stomach, creating a sleeve-shaped organ about the size of a small banana, which limited her food intake.

“I was 248 pounds and now weigh 136,” she proudly said, “and went from a size 26 to a size four.”

A public health epidemic

Ashutosh Kaul, MD, the bariatric program’s medical director, said cases like Timlin’s are increasingly common, as the rise in obesity continues. Studies show bariatric surgery can be an effective tool to tackle obesity and, in some cases, can resolve chronic health issues. “Obesity has become the largest public health issue affecting our country,” he said. “More than 1,000 people die from obesity and obesity-related illnesses every day.”

According to the Centers for Disease Control and Prevention, obesity impacts nearly 36 percent of adults and 17 percent of youth. It’s also a major contributor to some of the leading causes of death, including diabetes, heart disease, stroke and certain types of cancer. The estimated annual medical costs associated with obesity in the United States are $190 billion, while Americans spend more than $3 billion on weight-loss programs.

“There’s a social stigma attached to obesity, as well. People think it’s their fault,” said Dr. Kaul. “But we view obesity as a disease. We recognize that losing weight is critical to the patient’s overall wellness and quality of life.”

Preparing for the big day

Once patients consider bariatric surgery, often in coordination with a primary care physician, Cheryl Williams, RD, a registered dietitian and the program coordinator, guides them through a comprehensive education and clearance process. It begins by attending a free preoperative seminar at the hospital conducted by one of the team’s five surgeons, followed by separate appointments with a registered dietitian, pulmonologist, cardiologist and psychologist.

The psychological consultation is a vital step. During a single session, the patient addresses changes in lifestyle and eating behavior that will be expected prior to and after surgery, said Joshua Hrabosky, PsyD, the team’s clinical psychologist.

“These are well-established habits, such as binge eating, that are at the core of why a person is overweight,” he explained. The idea is to deal with challenges before surgery so they don’t reoccur afterward. “We also explore other weight-loss programs the patient has tried, their physical activities, sleep behavior, medications and current or past mental health diagnoses, such as depression or anxiety,” he said.

During her clearance process, Timlin discovered she had acid reflux, sleep apnea and an iron deficiency. The acid reflux and sleep apnea disappeared after surgery.

According to Anthony Maffei, MD, Timlin’s lead surgeon along with Dr. Kaul, patients who have a sleeve gastrectomy “tend to lose 60 to 70 percent of their excess body weight. But the resolution of obesity-related diseases is also profound.

As surgeons, we’re excited to help patients put medical conditions such as diabetes, high blood pressure and sleep apnea into remission.”

No longer hiding

Timlin said her surgery went smoothly, noting that she was walking a few hours later. Twelve days later, she was hosting Christmas festivities for 20 people.

“At first, I ate about two ounces of food at a sitting,” said Timlin, who lost 40 pounds in the first month and reached her current weight within 10 months. “Now I’m eating up to eight ounces per meal. There are no foods I can’t eat, and I never feel hungry.”

Nonetheless, Timlin has cut pasta and bread from her new diet, opting for high-protein foods and vegetables. She has a protein shake for breakfast, protein and vegetables for lunch and dinner, and snacks on nuts, cheese and hummus. She tries to exercise regularly and takes vitamins for an iron deficiency.

“Everything is portion controlled, and since I lost so much weight, I am careful not to put it back on, so I ensure I am eating healthy and the right amount.” She reminds herself daily that surgery is “not the answer, but a tool.”

Although willpower helped Timlin achieve her weight-loss goals, she also regularly attended the program’s post- operative support groups and met with Dr. Maffei and a nutritionist periodically during the first year.

Most importantly, she and her girlfriends traveled to Aruba last November.

“We had the time of our lives,” said Timlin, who enjoyed parasailing and beach volleyball. “The old me would never do such things!”

She even borrowed a shirt from one of her “skinny” friends during their vacation. “It was an emotional experience. I finally love how I look and feel. I realized I can start living at 40. Today I’m happy, comfortable, more confident, and I don’t have to hide anymore.”