Do You Know the Health Risks of Being Overweight ?

Do You Know the Health Risks of Being Overweight ?

  • Type 2 diabetes
  • Heart disease and stroke
  • Body Mass Index Table
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease
  • How can I lower my health risks?
  • Additional resources

Weighing too much may increase your risk for developing many health problems. If you are overweight or obese on a body mass index (BMI) chart, you may be at risk for:

  • Type 2 diabetes
  • Heart disease and stroke
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease.

You can lower your health risks by losing as little as 10 to 20 pounds.
Type 2 diabetes
What is it?
Type 2 diabetes used to be called adult-onset diabetes or noninsulin-dependent diabetes. It is the most common type of diabetes in the U.S. Type 2 diabetes is a disease in which blood sugar levels are above normal. High blood sugar is a major cause of early death, heart disease, kidney disease, stroke, and blindness.
How is it linked to overweight?
More than 80 percent of people with type 2 diabetes are overweight. It is not known exactly why people who are overweight are more likely to suffer from this disease. It may be that being overweight causes cells to change, making them less effective at using sugar from the blood. This then puts stress on the cells that produce insulin (a hormone that carries sugar from the blood to cells) and makes them gradually fail.
What can weight loss do?
You can lower your risk for developing type 2 diabetes by losing weight and increasing the amount of physical activity you do. If you have type 2 diabetes, losing weight and becoming more physically active can help you control your blood sugar levels. Losing weight and exercising more may also allow you to reduce the amount of diabetes medication you take.
Heart disease and stroke
What is it?
Heart disease means that the heart and circulation (blood flow) are not functioning normally. If you have heart disease, you may suffer from a heart attack, congestive heart failure, sudden cardiac death, angina (chest pain), or abnormal heart rhythm. During a stroke, blood and oxygen do not flow normally to the brain, possibly causing paralysis or death. Heart disease is the leading cause of death in the U.S., and stroke is the third leading cause.
How is it linked to overweight?
People who are overweight are more likely to suffer from high blood pressure, high levels of triglycerides (blood fats) and LDL cholesterol (a fat-like substance often called the “bad cholesterol”), and low levels of HDL cholesterol (the “good cholesterol”). These are all risk factors for heart disease and stroke. In addition, people with more body fat have higher blood levels of substances that cause inflammation. Inflammation in blood vessels and throughout the body may raise heart disease risk.
What can weight loss do?
Losing 5 to 15 percent of your weight can lower your chances for developing heart disease or having a stroke. If you weigh 200 pounds, this means losing as little as 10 pounds. Weight loss may improve your blood pressure, triglyceride, and cholesterol levels; improve how your heart works and your blood flows; and decrease inflammation throughout your body.
Body Mass Index Table
To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.

What is it?
Cancer occurs when cells in one part of the body, such as the colon, grow abnormally or out of control and possibly spread to other parts of the body, such as the liver. Cancer is the second leading cause of death in the U.S.
How is it linked to overweight?
Being overweight may increase the risk of developing several types of cancer, including cancers of the colon, esophagus, and kidney. Overweight is also linked with uterine and postmenopausal breast cancer in women. Gaining weight during adult life increases the risk for several of these cancers. Being overweight also may increase the risk of dying from some cancers. It is not known exactly how being overweight increases cancer risk. It may be that fat cells make hormones that affect cell growth and lead to cancer. Also, eating or physical activity habits that may lead to being overweight may also contribute to cancer risk.
What can weight loss do?
Avoiding weight gain may prevent a rise in cancer risk. Weight loss, and healthy eating and physical activity habits, may lower cancer risk.
Sleep apnea
What is it?
Sleep apnea is a condition in which a person stops breathing for short periods during the night. A person who has sleep apnea may suffer from daytime sleepiness, difficulty concentrating, and even heart failure.
How is it linked to overweight?
The risk for sleep apnea is higher for people who are overweight. A person who is overweight may have more fat stored around his or her neck. This may make the airway smaller. A smaller airway can make breathing difficult, loud (snoring), or stop altogether. In addition, fat stored in the neck and throughout the body can produce substances that cause inflammation. Inflammation in the neck may be a risk factor for sleep apnea.
What can weight loss do?
Weight loss usually improves sleep apnea. Weight loss may help to decrease neck size and lessen inflammation.
What is it?
Osteoarthritis is a common joint disorder. With osteoarthritis, the joint bone and cartilage (tissue that protects joints) wear away. Osteoarthritis most often affects the joints of the knees, hips, and lower back.
How is it linked to overweight?
Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk for osteoarthritis.
What can weight loss do?
Weight loss can decrease stress on your knees, hips, and lower back, and lessen inflammation in your body. If you have osteoarthritis, losing weight may help improve your symptoms.
Gallbladder disease
What is it?
Gallstones are clusters of solid material that form in the gallbladder. They are made mostly of cholesterol and can sometimes cause abdominal or back pain.
How is it linked to overweight?
People who are overweight have a higher risk for developing gallbladder disease and gallstones. They may produce more cholesterol, a risk factor for gallstones. Also, people who are overweight may have an enlarged gallbladder, which may not work properly.
What can weight loss do?
Weight loss — especially fast weight loss (more than 3 pounds per week) or loss of a large amount of weight — can actually increase your chance of developing gallstones. Modest, slow weight loss of about 1/2 to 2 pounds a week is less likely to cause gallstones.
Fatty liver disease
What is it?
Fatty liver disease occurs when fat builds up in the liver cells and causes injury and inflammation in the liver. It can sometimes lead to severe liver damage, cirrhosis (build-up of scar tissue that blocks proper blood flow in the liver), or even liver failure. Fatty liver disease is like alcoholic liver damage, but it is not caused by alcohol and can occur in people who drink little or no alcohol. The National Digestive Diseases Information Clearinghouse (NDDIC) has more information on fatty liver disease or nonalcoholic steatohepatitis (NASH).
How is it linked to overweight?
People who have diabetes or “pre-diabetes” (when blood sugar levels are higher than normal but not yet in the diabetic range) are more likely to have fatty liver disease than people without these conditions. And people who are overweight are more likely to have diabetes (see Type 2 diabetes above). It is not known why some people who are overweight or diabetic get fatty liver and others do not.
What can weight loss do?
Losing weight can help you control your blood sugar levels. It can also reduce the build-up of fat in your liver and prevent further injury. People with fatty liver disease should avoid drinking alcohol.
How can I lower my health risks?
If you are overweight, losing as little as 5 percent of your body weight may lower your risk for several diseases, including heart disease and diabetes. If you weigh 200 pounds, this means losing 10 pounds. Slow and steady weight loss of 1/2 to 2 pounds per week, and not more than 3 pounds per week, is the safest way to lose weight.
To lose weight and keep it off over time, try to make long-term changes in your eating and physical activity habits. Choose healthy foods, such as vegetables, fruits, whole grains, and low-fat meat and dairy products, more often and eat just enough food to satisfy you. Try to do at least 30 minutes of moderate-intensity physical activity— walking— most days of the week, preferably every day. To lose weight, or to maintain weight loss, you may need to do more than 30 minutes of moderate physical activity daily.
Additional resources
National Cancer Institute
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
Phone: 1-800-4-CANCER ( 1-800-422-6237 )
TTY: 1-800-332-8615
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: 1-800-860-8747 or (301) 654-3327
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-891-5389 or (301) 654-3810
National Heart, Lung, and Blood Institute
NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, Maryland 20892-3675
Phone: 1-877-22-NIAMS ( 1-877-226-4267 ) or (301) 495-4484
TTY: (301) 565-2966

As Obesity Surgery Soars, Patients Weigh Which Method is Best

By MARILYNN MARCHIONE, AP Medical Writer. Associated Press. New York:
Jan 1, 2006. pg. 1
As more people abandon New Year’s resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best.
And researchers are uncovering some surprising trends.
The most common method in the United States – gastric bypass, or stomach-stapling surgery – may be riskier than once thought. Yet surgeons still favor it for people who need to lose weight fast because of heart damage or other serious problems.
A gentler approach favored in Europe and Australia – an adjustable stomach band – can give long-term results that are almost as good and with far fewer risks. It may be the best option for children or women contemplating pregnancy, and is reversible if problems develop.
A radical operation – cutting away part of the stomach and rerouting the intestines – is increasingly being recommended for severely obese people. It gives maximum weight loss but also is the riskiest solution.
A large U.S. government study just got under way to compare all three options.
But regardless of which method is used, studies show an inescapable reality: No surgery gives lasting results unless people also change eating and exercising habits.
“The body just has many ways of compensating, even after something as drastic as surgery,” said Dr. Louis Aronne, director of the weight loss program at Weill-Cornell Medical College.
He is president of the Obesity Society, the largest group of specialists in bariatrics, as this field is known. The group’s recent annual conference in Vancouver featured many studies on surgery’s long-term effects.
Obesity is a problem worldwide. About 31 percent of American adults – 61 million people – are considered obese, with a body-mass index of 30 or more. That’s based on height and weight. Someone 5- foot-4 is obese at 175 pounds; 222 does it for a 6-footer.
Federal guidelines say surgery shouldn’t be considered unless someone has tried conventional ways to shed pounds and is at least 100 pounds over ideal weight, or has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.
More people are meeting those conditions. A decade ago, less than 10,000 such surgeries were done in the United States. That ballooned to 70,000 in 2002 and more than 170,000 in 2005, says the American Society for Bariatric Surgery.
Doctors disagree over which is better: the most popular method, Roux-en-Y gastric bypass, or the adjustable band, which is rapidly gaining fans. Either can be done through a big incision, or laparoscopically with tiny instruments passed through small cuts in the abdomen.
In gastric bypass, a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. They must take protein and vitamin supplements to prevent deficiencies.
The adjustable band has been available in the U.S. only since 2001 but far longer in Europe and Australia where it is dominant. It accounted for 17 percent of U.S. obesity procedures in 2005.
A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.
Deaths from the procedure are only 0.1 percent compared to about 2 percent for gastric bypass. One recent study of Medicare patients found deaths a year after gastric bypass as high as 3 to 5 percent.
The band’s reversibility makes it a better choice for children, some doctors say.
“It’s becoming more well-known and more accepted. Patients like it because it’s less invasive. It’s an easier surgical procedure. It’s safer,” said Georgeann Mallory, executive director of the bariatric society.
“To me it is a very straightforward decision,” said Dr. Paul O’Brien, director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. “I would strongly recommend that the consumer consider the safest effective procedure first,” which is the band, he said.
American doctors have preferred bypass operations because they produce faster, greater weight loss. But new research by O’Brien and others calls that into question.
Combining results on 23,638 patients in 43 published studies, they found that bypasses beat bands for the first three years but were comparable after seven years, with excess weight loss of 55 percent for bypass and 51 percent for bands.
That impressed Dr. Edward Livingston, chief of gastrointestinal surgery at the University of Texas Southwestern Medical Center and chief of bariatric surgery for the Department of Veteran’s Affairs national system.
“I really was not enthusiastic about bands until I came to Dallas from Los Angeles and saw the results from the group that I joined, which where quite good,” he confessed. “What you can accomplish in a year with a gastric bypass you can accomplish in five years with a laparoscopic band.”
Results would improve if Americans copied the Australians and included in the price of the band any future adjustments, Livingston said.
“A key to the success of banding procedures is the followup and working with a patient on their compliance,” he said. “When they come in and they’ve sort of fallen off the wagon, you adjust the band. It really has an amazing effect.”
Bands also appear safer for women attempting pregnancy. Several years ago in Massachusetts, a woman and her 8-month-old fetus died of complications 18 months after gastric bypass surgery. Other pregnancy-related deaths have been reported.
In contrast, another study O’Brien and colleagues presented at the obesity meeting found that pregnancy outcomes for women with stomach bands were comparable to normal-weight women, and better than for obese women without bands.
Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, did a band operation in October for Long Islander Donna Dotzler, who weighed 279 pounds, but wants to do a more drastic surgery for her husband.
“I gave up on New Year’s resolutions maybe five years ago,” said Jim Dotzler, who weighs 479 pounds. “I’m a smart guy. If this were a matter of willpower, I’d have taken care of this a long time ago.”
The operation Roslin has advised for him is BPD, which stands for biliopancreatic diversion, with or without a second procedure called a duodenal switch. Studies show it can cause loss of up to 80 percent of excess body weight for at least as long as 10 years afterward.
Surgeons remove three-fourths of the stomach to leave a sleeve- or banana-shaped organ that is connected to the small intestine, bypassing more of it than a standard gastric bypass does. It can be done in two operations a year apart to reduce its severity and the chances of death, which can be as high as 5 percent.
The “switch” preserves a valve that controls release of food into the intestines from the stomach. These operations account for nearly 5 percent of U.S. obesity surgeries and are growing.
On the horizon are other approaches, like vagus nerve stimulation, to control impulses to eat, and new drugs like rimonabant, which blocks a pleasure center in the brain that makes people want to munch.
“I see the future as combined therapy,” with surgery, medication and other approaches used simultaneously, said Aronne, the obesity society president. “Time will tell what works out best.”
Copyright © Associated Press Jan 1, 2006. Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.

On a Scale of Life or Death

by Valerie Reitman, Times Staff Writer / Los Angeles Times
Jan 4, 2006
It started with a terrible dream: Cyrus Tehrani had died. At the funeral, his wife and six children wept over his outsized coffin.
That nightmare jolted Joe Guarderas awake. He knew that if his best friend Cyrus, 34, didn’t take drastic action, the dream would become reality.
Cyrus had grown gargantuan. His girth had destroyed his knees, spiked his blood pressure, sapped his breath and landed him in the hospital for several days with severe leg swelling.
Cyrus’ older sister, Sheila Tehrani, 37, was just as big, and just as imperiled. Only a pound separated the siblings: Cyrus weighed 578, Sheila 579.
Guarderas hatched a plan. “If you knew Cyrus was going to die,” Guarderas recalled asking the healthier Sheila, “would you give anything to get him back?”
“In a heartbeat,” Sheila replied.
“Would you give up the house?”
“Of course,” Sheila replied.
Well, said Guarderas, “that’s what you may have to do.”
That conversation late in 2004 launched the Tehranis’ last-ditch attempt to shed the weight that was slowly smothering them. Surgery to slash their food intake would cost at least $25,000 each. With no health insurer willing to pay, the only recourse was to refinance the house they had inherited from their father. Sheila still lives in a studio apartment behind the house.
Sheila researched options on the Internet and made an appointment with one of Los Angeles’ most experienced bariatric surgeons, Dr. Carson Liu.
Liu wondered if it was too late. Had the siblings become so huge that the surgery was too risky?
Vast numbers of Americans face a similar predicament. They have outgrown the weightiest medical description: morbid obesity. About 725,000 to a million people fit in this “super-obese” category.
But even that term is no longer expansive enough for the Tehranis and a fast-rising number of others. Between 140,000 and 400,000 Americans are believed to weigh more than 400 pounds. Liu dubs them the “super-duper” obese.
With a few hundred extra pounds severely straining every bodily organ, they appear to have one last hope: bariatric surgery.
But that surgery poses such grave risks for huge patients that many surgeons refuse to operate on them.
“They are at the end of their lives,” Liu said. “They are being operated on much too late. These are the patients that have bad congestive heart failure — their hearts can’t keep up with their bodies, which are falling apart.”
By the time the Tehranis consulted Liu in early April 2005, they could walk only a few yards before becoming winded. Their arms puffed out like basketballs. Their distended bellies draped to their knees like sandbags. Restaurants with booths, chairs with armrests, airline flights, even clothes from shops catering to big and tall people — all were out of the question. (Cyrus jokes that labels on his clothes couldn’t accommodate all the Xs: he wore 7X shirts over 78-inch-waist pants.)
Stares were as painful as stairs for Sheila.
A pudgy child, she had grown quite heavy by high school, despite the attempts of her father — an engineer who immigrated to the United States from Iran — to police what she ate.
When she was 11, her father sent her to the now-defunct Schick behavioral modification center in Pasadena, where she received tiny electrical shocks as she took bites of a Hostess apple pie. Like the diets before, it didn’t work.
By her late 20s, she no longer could fit behind the wheel of her Toyota pickup truck. She sold it and gave up driving.
She grew more sedentary, rarely leaving her studio apartment in the back of the family house. Instead, she earned money baby-sitting the children whom relatives would take to her home.
Grocery shopping required exercising only her index finger — to dial Vons for delivery.
Cyrus, who as a husky teenager had biked and lifted weights, wedged himself behind the wheel of his Ford Windstar minivan (“thank God for tilt steering,” he says) to commute to Santa Ana, where he still makes DVD masters used to mass-produce movies and music.
The Vietnamese immigrant owners and workers there affectionately rub his belly and call him their Buddha. He calls the men there — and everywhere else — Slim. Other potential employers snubbed him because of his size, he says.
Caring for six children — three of his own with Karen, his wife of seven years, and her three children from a previous marriage — kept him busy.
But his stamina had dwindled. By the time Joe Guarderas talked to Cyrus’ sister, he could barely get out of bed or bend over to tie his shoes. To ease his aches and lower his blood pressure, he downed prescription and over-the-counter pills by the handful.
When he was in the hospital last spring with his leg problems, a cardiologist told him he’d be lucky to live 10 years.
But until Sheila convinced him of the serious health risk after Guarderas’ dream, Cyrus preferred to look at the “funny” side of being fat. He reveled in his young son’s riposte to an unkind remark by his kindergarten friend: “Wow, Gavin, your dad is really fat.”
“My daddy’s not fat,” Gavin shot back. “My daddy’s full of love.”
The Tehranis certainly overate. They loved heaping portions of calorie-rich Persian foods — breads, rice, cheeses and kebabs. Cyrus often ate super-size fast-food combos for lunch and had a weakness for Ben & Jerry’s Chunky Monkey and Chubby Hubby ice cream, at about 600 calories per cup.
“If I knew I’d buy as much Ben & Jerry’s as I have, I’d have bought stock,” said Cyrus, who really packed on the pounds after quitting smoking in his 20s.
The siblings also ate to soothe bouts of depression after the deaths of their parents and a half-sister.
But the siblings and friends insist that they weren’t eating near the Costco-size quantities one would think necessary to be 400 pounds overweight. “It’s not like we were pulling up to a food trough,” Cyrus says.
Sheila said she did none of the things she heard others report at Overeaters Anonymous meetings. “I thought these people were sick, because they were eating out of the trash and were closet eaters,” she said.
All it takes to gain a pound a week is a 500-calorie surplus every day. That’s two Mrs. Fields cookies or a large order of McDonald’s fries.
A pound per week totes up 52 pounds annually. In five years, that’s 260 pounds.
The bigger the Tehranis got, the less they restrained themselves. At their size, what did one extra Krispy Kreme doughnut matter?
Surgeon Liu attributes two-thirds of super-obesity to genetics (many members of the Tehrani family are heavy, though not super-obese) and one-third to eating habits and lack of exercise.
Yo-yo dieting can make it worse.
“There is something that happens when fat cells starve,” Liu said. “It makes people extremely hungry, and they fall off their diets and gain the weight back so fast — and then maybe add an additional 20 pounds.”
Above 300 pounds, the weight seems to accrue even faster, Liu says, without “the patient — or anybody — realizing exactly why.”
Few doctors have a scale that goes beyond 350 pounds. So Cyrus was shocked in April when he stood on Liu’s and it registered 150 pounds more than his last weigh-in four years earlier.
“I knew I had gotten fatter, but I never thought I would break that 500-pound mark,” Cyrus said. “And when I saw 578, I got sick to my stomach.”
Standing 5 feet 11, Cyrus had a weight-to-height ratio, or body mass index, of 81, more than triple the maximum 25 considered healthy for most adults. At 5 feet 2, Sheila had a body mass index of 106.
Cyrus’ health insurer refused to cover weight-loss surgery. Insurance companies typically want documentation that patients have tried dieting. The insurers blanch at the procedure’s mortality rates, and also fear that too many of the 20 million obese patients nationwide will sign up for their plans if they offer the surgery too readily, Liu said.
Sheila has no insurance.
By the time they saw Liu, the Tehranis, inspired by the huge weight losses of NBC weather forecaster Al Roker and singer Carnie Wilson, were convinced they needed a gastric bypass procedure.
But Liu told the Tehranis gastric bypass was too risky for them. Super-obese patients are 10 times more likely to die from bariatric surgery than those who are morbidly obese. And he warned that a serious complication necessitating hospitalization for a month could easily cost $300,000, virtually all the equity in their childhood home.
The only procedure he would do for them was the LAP-BAND® System adjustable gastric banding system, in which a synthetic ring is attached to the upper end of the stomach. Liu has performed more than 1,700 gastric bypasses and 350 using LAP-BAND® Systems. He said he prefers the latter because it is far less drastic and, unlike the bypass, is adjustable and reversible, though weight loss is slower.
If they still wanted a bypass, Liu assured the Tehranis, he would do it — after they each lost 150 pounds with LAP-BAND® Systems.
He instructed the siblings to lose 28 pounds, about 5% of their weight, before the surgery to show their determination, shrink their fatty livers and make the surgery easier.
The Tehranis delayed the start of their diets for a week until after Sheila’s birthday party. After that, they stuck to two protein shakes and one healthful, low-carbohydrate meal a day. In six weeks, Sheila dropped 28 pounds and Cyrus lost 19.
But Liu said he was worried that swelling in Cyrus’ legs might indicate the right side of his heart was failing. He was concerned that Sheila’s fast pulse might mean her heart was starting to give out.
Liu said he needed to conduct tests for congestive heart failure. The overnight stay in the intensive-care unit at Olympia Medical Center, near Beverly Hills, cost the siblings $5,000 each.
On the last day of solid food before the operation, the Tehranis pigged out one last time. Cyrus downed a Tommy’s triple cheeseburger topped off by Chubby Hubby.
Sheila had higher standards. “I’m not investing my last meal on Tommy’s,” she recalled telling Cyrus. She opted for rice and kebabs from Shiraz restaurant in Glendale.
Liu dubbed such binges “last meal syndrome.”
Sheila barely slept the night before she and her bother entered the hospital. Cyrus’ children clung to him as he prepared to leave.
“When you come home, will you be skinny?” 5-year-old Jillian piped up.
He reassured them it wouldn’t be long before he could ride the rides at Disneyland with them — something he’s been too big to do since age 21.
At the hospital, Cyrus and Sheila nervously poked fun at each other. The only children of parents who divorced when they were 3 and 7, they have always been close and see (and tease) each other constantly.
“I told [wife] Karen I have atrophy of the jaw because I’m not chewing nearly as much,” Cyrus told Sheila.
“But you’re still talking,” Sheila shot back.
A nurse asked Cyrus if he had any valuables with him. He looked at Karen.
“Just her,” he said.
“Do you have an advance directive?” the nurse asked.
“She knows what I want,” Cyrus said.
As they were wheeled separately into their intensive care unit rooms, the Tehranis realized they wouldn’t see each other for a while.
“Bye, Fat,” Cyrus said to his sister.
When Liu looked askance, Cyrus explained that “fatso” was a name they fondly split.
“Bye, So,” she said.
Liu worried as he walked out of the hospital that night, not so much about Cyrus, whose health had improved with the weight loss, but about Sheila. Her liver hadn’t shrunk much. So much fat still swathed her overburdened lungs that he worried she might not wake from the anesthesia.
The morning of June 7, their hearts were beating at triple the normal rate. But test results revealed no permanent damage. Liu gave the go-ahead for both.
Sheila was first. As music from David Gray’s “White Ladder” album poured into the operating room, Liu inserted an instrument equipped with a tiny camera into her navel. An image of her insides flashed onto monitors above the operating table.
He inserted three more tong-like cutting and suturing devices into her abdomen.
The long hours that Liu, 40, spent playing video games while growing up chagrined his Chinese immigrant parents, but they paid off professionally. Eyes glued to the monitor, he maneuvered the tools.
It took more than an hour to work through the hardened fat, which looked like yellow gel on the screen. Finally, Liu saw the left lobe of Sheila’s liver, swollen to the size of a five-pound steak from what is normally the size of an orange. The surgeon assisting him pulled it aside to reveal the stomach.
Liu positioned the inflatable LAP-BAND® System so it cinched her stomach into an asymmetrical hourglass shape, with 98% of the stomach below the band.
At 11 a.m., Liu finished the 2 1/2 -hour procedure. It had taken five times longer than usual.
“I’m hungry,” the fit, 6-foot, 1-inch Liu declared. He repaired to the hospital’s cafeteria for a two-hour break.
Cyrus’ abdominal wall was softer and his liver much smaller. Liu finished his procedure in just 50 minutes. The Tehranis went home the next day.
The LAP-BAND® System, which narrowed the stomach opening from the size of a silver dollar to the size of a dime, made the siblings feel stuffed. At first, they could down just liquids, then soft foods, like tofu and yogurt.
For the first month, Sheila was depressed. “I don’t know what it was — whether it was that food was always my outlet and now it was taken away or if it was because, being healthy all my life, this was the most I’d ever seen a doctor,” she said.
But she dropped 22 pounds by the time they next saw Liu, two weeks after surgery.
At a family cookout soon after, Cyrus and Sheila could eat only about one-third of a chicken breast and some green beans each.
By mid-July, Cyrus began to pull ahead; he had dropped 48 pounds in five weeks, 83 pounds total. Sheila had dropped 28 pounds, for a total of 61.
Sheila mentioned to Liu that she had eaten pasta and bread, albeit in tiny portions.
He reacted with horror.
“You ate bread?”
He told her it was time to tighten the LAP-BAND® System.
“He’s punishing me for eating bread,” she joked as Liu filled a syringe and pumped saline into the barely visible port opening in her chest, which was attached to the LAP-BAND® System device.
Cyrus began walking more around the neighborhood with his children.
Two months after the surgery, both Tehranis had dropped below 500 pounds. Cyrus had lost 97 pounds and Sheila 85. The whole family rented an RV and went camping at Lake Perris, the siblings’ first camping trip since they were kids.
At their October appointment, Sheila told Liu she needed “a LAP-BAND® System for my mind,” something to choke off the emotional issues and the habits that drove her to eat.
Sheila considered it a victory that she got by with just one tiny box of Junior Mints for Halloween. Cyrus carried his children’s trick-or-treat bags but abstained.
On the eve of the family’s Thanksgiving potluck dinner, Sheila made chocolate chip and gingerbread cookies, without sampling any batter, and ate only a few the next day. Cyrus ate some turkey and splurged on a dollop of homemade cranberry sauce.
He has become downright militant about sweets and starches, much to Sheila’s chagrin. She believes that eating a little of something she loves will prevent her from feeling deprived, then binging.
Cyrus has become zealous about going to Bally’s gym in Pasadena several nights a week to lift weights and walk on the treadmill. His children are asleep when he returns home.
“Every day I wake up and look into the faces of my motivation,” Cyrus said of them.
It has been six months since the surgery. At their most recent appointment, early in December, Cyrus registered the loss of 19 more pounds, while Sheila showed a gain of 1 1/2 pounds. All told, Cyrus had lost 146 pounds and Sheila, 101.
Sheila was disappointed but refused to let Liu tighten the LAP-BAND® System. She already had trouble eating meat and told him it was painful to down more than half a cup of food at a time.
“There’s only so much you can eat, even if you do eat crap,” she said.
Liu told her she must start exercising. She vowed to get a treadmill. Cyrus suggested an elliptical trainer.
“Are you kidding?” she replied. “I’d start a fire with my calves” rubbing together.
Cyrus, meanwhile, complained to Liu that he was losing muscle as well as fat, despite his workouts and increased protein intake.
” ‘Boohoo, I’m losing weight,’ ” Sheila mocked.
She later said she felt “like we’re having two completely different experiences. He stands up at support group meetings — and he happens to be wearing a T-shirt that says ‘I had an IQ test and it came out negative’ — and he’s saying, ‘It’s all mental.’ He’s like, ‘Don’t eat it, don’t do it.’ I don’t know if it’s because he’s a man and I’m a woman, but I’m much more emotional.”
Though everyone praises her accomplishment, Sheila said she still imagines them thinking, “Oh, my God; you’re still so fat.”
The one thing the siblings — who were down to 432.6 and 477.6 pounds as of Dec. 7 — do agree on is how much the weight loss has changed their lives. “It’s amazing how much more energy I have now,” Cyrus said. “I’ve lost a whole person.”
Their faces look healthier. Sheila walked up a steep hill at Eagle Rock Hillside Park on Thanksgiving with the rest of the clan. She played in the inaugural Tehrani kickball game — though her 3-year-old niece served as pinch runner. For the first time in years, she went Christmas shopping, spending a few hours walking around the Glendale Galleria with her best friend.
Cyrus has lost 20 inches from his waist. He no longer needs medications and his blood pressure is nearly normal.
A few weeks after the operation, Karen called Guarderas to thank him for saving Cyrus’ life.
On New Year’s Eve, she reflected on how much better life is now that Cyrus can join the rest of the family in so many activities.
She choked up as she recalled the cardiologist’s grim 2004 warning that Cyrus wasn’t likely be around much longer and how she tried to protect the children from that prediction.
They sensed the looming threat, she believes: Jillian hated to leave Cyrus’ side, not wanting to go to kindergarten, sometimes even trying to sneak home. Now, she loves school.
And so the Tehranis don’t mind paying $730 more each month for the next 30 years to pay off the $100,000 home-equity loan they took out to pay for their transformation and the surgery they may need in the future to cut off the folds of skin. Said Sheila: “Oh, my God, we are so lucky we had the option…. How do you put a price on your life?”
The Times will follow the Tehranis’ progress with occasional articles in the paper and on The writer can be reached at
Copyright © 2006 Los Angeles Times. All right reserved. Republished with permission.

Study: Gastric Band Works Better than 500-Calorie Diet

by Nanci Hellmich / USA Today
May 2, 2006
Adjustable gastric banding is much more effective long-term than a very low-calorie diet for people who are about 50 pounds overweight, a study shows.
Medical guidelines support this surgical procedure — which puts a band around the top of stomach to create a feeling of fullness — in patients who are extremely obese, about 100 or more pounds over a healthy weight, or those who are almost as overweight and have serious medical conditions, such as type 2 diabetes.
Researchers at Monash University Medical School in Melbourne, Australia, recruited 80 patients who were on average 52 pounds over a healthy weight. Half had the laparoscopic adjustable gastric band surgery.
The other half followed a medical program that included a variety of strategies such as a very-low-calorie diet (500 calories a day) with liquid meal replacements, prescription weight-loss medication and behavioral therapies.
Findings in today’s Annals of Internal Medicine:
After six months, both the surgery patients and the low-calorie dieters lost an average of 14% of their starting weight.
After two years, the gastric band patients lost 22% of their starting weight. That was about 87% of their excess weight, or roughly 45 pounds. They also showed marked improvement in their health and quality of life.
At the end of two years, the dieters had regained much of their lost weight but were still 5.5% below their starting weight. They had lost 22% of their excess weight, or about 12 pounds.
Researchers are still analyzing the weight-loss data. “I’m very happy that the gastric band patients are continuing to maintain their weight loss,” says lead author Paul O’Brien, director of the university’s Centre for Obesity Research and Education. Since the study, he received grants from INAMED Health, maker of the LAP-BAND® System.
In this study, the surgery was as safe as the diet program, but O’Brien notes the procedure does carry risks, and some may need follow-up procedures, such as readjusting the band position. The surgery costs $14,000 to $18,000 in the USA, he says.
Insurance companies vary widely in coverage of gastric banding or gastric bypass, a more complex surgery that creates a much smaller stomach and rearranges the small intestine. Average cost: $26,000. Under certain conditions, Medicare covers both surgeries.
Many surgeons in the USA use gastric bypass because bypass patients lose more weight overall and lose it faster, says Neil Hutcher, president of the American Society for Bariatric Surgery and a surgeon in Richmond, Va.
Thomas Wadden, an obesity expert at the University of Pennsylvania School of Medicine in Philadelphia, says gastric banding “is a very effective procedure, but it’s not a rational, cost-effective solution to the epidemic of obesity.”
“Because we have limited health-care dollars, we have to decide how best to invest them. Are we going to provide bariatric surgery for a relatively small number of people or instead invest in the prevention of obesity so our children hopefully won’t need this surgery?”
Copyright © 2006 USA Today. All rights reserved. Republished with permission.
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Getting a grip on obesity

by Loretta Grantham / Palm Beach Post
November 12, 2006
Many patients pondering weight-loss surgery, such as Margaret Kendall, say the thought of slicing, stapling and rerouting their digestive system is more than they can stomach. Read more.

Study: Gastric band works better than 500-calorie diet

by Nanci Hellmich / USA Today
May 2, 2006
Adjustable gastric banding is much more effective long-term than a very low-calorie diet for people who are about 50 pounds overweight , a study shows. Medical guidelines support this surgical procedure — which puts a band around the top of stomach to create a feeling of fullness — in patients who are extremely obese , about 100 or more pounds over a healthy weight , or those who are almost as overweight and have serious medical conditions, such as type 2 diabetes. Read more.

On a Scale of Life or Death

by Valerie Reitman / Los Angeles Times
Jan 4, 2006
It started with a terrible dream: Cyrus Tehrani had died. At the funeral, his wife and six children wept over his outsized coffin. That nightmare jolted Joe Guarderas awake. He knew that if his best friend Cyrus, 34, didn’t take drastic action, the dream would become reality. Cyrus had grown gargantuan. Read more.

Diet: As obesity surgery soars, patients weigh which method is best

By Marilynn Marchione / Associated Press
Jan 1, 2006
As more people abandon New Year’s resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best. And researchers are uncovering some surprising trends. The most common method in the United States – gastric bypass, or stomach-stapling surgery – may be riskier than once thought. Read more.
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Getting a Grip on Obesity

By Loretta Grantham
Palm Beach Post Staff Writer
Sunday, November 12, 2006
Many patients pondering weight-loss surgery, such as Margaret Kendall, say the thought of slicing, stapling and rerouting their digestive system is more than they can stomach.
“I consider gastric bypass to be the last straw,” says Kendall, referring to the procedure that accounts for about 70 percent of U.S. bariatric surgeries (and the choice of Carnie Wilson and Al Roker, celebrities who went public with their decision).
But at 315 pounds, the Royal Palm Beach teacher was desperate. She’d tried so many diets, she says, that the letter she wrote to her insurance company outlining her weight-loss attempts was six pages long.
Kendall, 46, attended a JFK Medical Center seminar on the LAP-BAND® System, an adjustable silicone ring that’s placed around the upper portion of the stomach to limit food intake and boost fullness.
“As soon as I heard about the reversibility and the less invasive feature of the band, I was interested,” she says. “But my primary thing was that it didn’t have anything to do with the intestines. When they said that, I got a lot more comfortable.”
So comfortable, in fact, that she’s having a LAP-BAND® System implanted this month, joining an increasing number of people who’re willing to accept slower initial weight loss in exchange for a less drastic operation that doesn’t alter their anatomy.
“The LAP-BAND® System has gone from 0 to approximately 25 percent of bariatric operations in about five years,” says Dr. Philip Schauer, president of the American Society for Bariatric Surgery. “That’s pretty rapid. It definitely has found a niche.”
The Lap-Band® System, developed by Inamed (which was acquired by Allergan in April), received FDA approval in June 2001 and is the only gastric band used in the United States. Its name comes from “laparoscopic banding,” which means the device is designed to be implanted with instruments passed through small cuts in the abdomen rather than through a full incision.
Rocker wife and reality TV matriarch Sharon Osbourne was an early success story after getting a band in 1999 at Cedars-Sinai Medical Center in Los Angeles during FDA trials. She lost 125 pounds and has regained just 15.
Although the LAP-BAND® System is relatively new in the United States and still gaining acceptance by initially wary insurance companies, gastric banding (there are other versions beside the LAP-BAND® System) has been popular in Europe for more than a decade.
Studies vary, but in general, LAP-BAND® System patients drop about 45 percent of their excess weight the first year after surgery. Patients who have gastric bypass, which involves stapling off a small pouch from the rest of the stomach and attaching it to the small intestine (therefore “bypassing” some intestine and decreasing calorie absorption), lose as much as 70 percent the first year.
Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, likens the choice to picking stocks: The higher-yield procedure carries more risk.
Dr. Andrew Larson at JFK Medical Center in Atlantis, however, doesn’t think the risk is worth it. Research shows that after seven years, both surgeries achieve comparable results — 51 percent of excess weight for bands and 55 percent for bypass.
“The operation is quicker,” he says, referring to the LAP-BAND® System. “You don’t have to cut the stomach, you don’t have to cut the small intestine, you don’t have to cut anything. This eliminates complications caused by leakage at the connections. Remember there are two connections with the bypass, and both of them have to heal properly. Also when you reroute the bowel, you create potential blockages down the road, and that’s a lifelong concern.”
Larson, who’s been at JFK for two and a half years, is trained in gastric bypass but only does LAP-BAND® System.
“If somebody’s 100 pounds overweight, is a long-term difference of 5 pounds or so enough to justify a much higher surgical risk?” he says.
John Hoffmann, however, was more than 200 pounds overweight. The Boynton Beach construction project manager chose the bypass on the advice of a surgeon at the Cleveland Clinic in Weston.
“He recommended that I have it because with the bypass you don’t absorb as many calories,” says Hoffmann, 41, who had the operation in April and is down 170 pounds from his top weight of 432. “He thought it would be a better choice for me because I’m more of an emotional eater.”
LAP-BAND® System critics say patients can cheat the band — in other words, indulge in large quantities of high-calorie soft foods such as milkshakes — because it only restricts the opening to the stomach, which remains its original size.
“You have to be careful with patient screening,” says registered nurse Patricia Specian, bariatric surgery program coordinator at Wellington Regional Medical Center, which plans to start offering the LAP-BAND® System next summer. (JFK and West Boca Medical Center are the only hospitals currently using the band in Palm Beach County and the Treasure Coast.)
“If you’re someone who can’t say no, then the LAP-BAND® System isn’t going to work for you,” she says. “You could eat all day long. If you have gastric bypass, you experience dumping syndrome, and that holds you back.”
Specian is talking about the nausea, cramps, vomiting and heart palpitations that occur when some bypass patients eat foods that are high in sugar or fat. Most people who resort to weight-loss surgery hope they get the unpleasant syndrome, which is a strong deterrent to overeating. But there’s no guarantee.
Robert Grant, president of Allergan Medical, a division of the company that makes the LAP-BAND® System, says that despite the criticism, “there’s no evidence that the device is less effective for ‘sweet eaters’ and ‘bingers.’ ”
But it’s important, he adds, “that a patient is fully informed about post-surgery dietary requirements, lifestyle changes and band adjustments to achieve an optimal outcome.”
In short: You can’t gobble vats of chocolate pudding and drop pounds.
Bariatric psychologist Melodie Moorehead, who works with JFK patients, stresses that neither procedure is foolproof.
“It’s natural, when you’ve fought obesity your whole life, to come in and want magic,” says Moorehead, whose main office is in Fort Lauderdale. “But part of the help we give patients is the awareness that the band is just the beginning, and many changes have to take place.”
Schauer says the American Society for Bariatric Surgery doesn’t formally recommend either procedure, leaving the decision up to patients and their doctors.
“The LAP-BAND® System is definitely an effective and safe weight-loss procedure that’s less invasive with a lower rate of major complications,” he says. “It’s an important tool in a toolbox that includes changes in exercise and eating habits.”
Regina Ortega, 37, a Royal Palm Beach bookkeeper who lost 150 pounds after bypass surgery two years ago, echoes Schauer’s analogy. (She chose bypass, she explains, “because I was afraid I’d end up convincing the doctor to loosen the band so I could eat more.”)
“Gastric bypass is a tool, just like the band,” she says. “Whether you reroute your body with the bypass or you strap your stomach with a LAP-BAND® System, you still have to learn new coping skills because you can’t turn to food.”
Staff researcher Angelica Cortez contributed to this story.