Victory over Obesity
At 359 pounds, 37-year-old Veronica Roselle had tried every diet on the market,
from Weight Watchers to Jenny Craig. Nothing worked. She had outgrown her size
32 pants and could barely walk from her bedroom to the kitchen.
"I was absolutely at the end of my rope," she tells ABCNEWS. "I
didn't want to live." Finally, she turned to Dr. Rafael Capella, a gastric
bypass surgeon in New Jersey who has performed 3,000 of the stomach-stapling
operations. "For the severely overweight," says Capella, "chances
of losing weight with a diet are minimal, practically nonexistent." Capella
and his son Joseph, who share a practice, say they are inundated by inquiries
from obese people desperate for the surgery — despite the risks, which include
blood clots, complications, and even death.
In just two months after her surgery, Veroncia was 60 pounds lighter. Within a
year, she was down from 359 to 175 pounds. The weight loss continued, and now
she wears a size 4. Her surgery, subsequent weight loss and new outlook on life
inspired 11 of her obese family members and close friends to have the surgery
themselves.
Dr. Joseph Capella and Veronica Roselle discussed the benefits and risks of the
surgery in an online chat with our viewers. A transcript of the event follows.
MODERATOR
Dr. Capella, who is a good candidate for gastric bypass surgery?
DR. JOSEPH CAPELLA
The qualifications for the typical patient is somebody who is 100 pounds
overweight. However, a patient could qualify for the surgery if they have other
medical conditions related to obesity, in which case they could be as little as
75 pounds overweight. The other criteria used is the patient should have a body
mass index of 40 or more. Once again, however, if they have other significant
medical problems, their body mass index could be as low as 35.
MODERATOR
Tell us about the risks involved.
DR. JOSEPH CAPELLA
Risks of surgery include: complications including pulmonary embolism (or blood
clots to the lungs); leaks from the gastric pouch; wound infections and, in very
rare instances, death. The mortality rate nationally is about 1 in 400. However,
in the hands of an experienced bariatric surgeon, it can be as low as 1 in 800.
The leak rate nationally is from half a percent to 3 percent. However, in
experienced hands, it should be close to zero percent.
VERONICA ROSELLE
I've had no medical complications, although I did have hernia which was taken
care of when I had my body lift.
Tambo1 asks:
Can this surgery be performed if someone has other health issues such as high
blood pressure or diabetes?
DR. JOSEPH CAPELLA
Absolutely. A large percentage of our patients suffer from either hypertension
or diabetes. These, in fact, are reasons to do the surgery. Weight loss usually
either cures or significantly improves these medical conditions. The gastric
bypass operation, in fact, cures many different medical problems, including, as
mentioned, diabetes, hypertension, sleep apnea, gastroesophageal reflux.
VERONICA ROSELLE
I suffered from reflux prior to my surgery, where I was taking two Zantac every
night before I went to bed. And my mother had debilitating rheumatoid arthritis.
My aunt and uncle both suffered from high blood pressure and were pre-diabetic.
Now, all three are off all medications and are completely normal.
DR. JOSEPH CAPELLA
Diabetics typically can be off insulin within weeks of the surgery.
MODERATOR
Keri asks: "I'm scared of going under the knife. Did you feel this
way? What made you confident in the surgeon you chose?"
VERONICA ROSELLE
I was petrified. The last time I was in the hospital was when I was born. I had
never had a broken bone in my life. But after speaking to many of Dr. Capella's
patients, bringing my own internist to the informational meeting, and most
importantly, after meeting Dr. Capella and knowing how many times he had
performed the surgery, I was completely confident that not only was I going to
wake up, but that the surgery would be successful.
Aline Dunkin asks:
Was the surgery painful? How long did it take you to get back to normal
functions?
VERONICA ROSELLE
The surgery was painful. I did the surgery the traditional way, which in
layman's terms means my stomach was cut open from my breast bone to my belly
button. In other words, I did not do the surgery laparoscopically, like Carnie
Wilson. The greatest benefit to doing surgery the traditional way, is that you
are in and out of surgery in 55 minutes — which might be an option for people
who have significant medical problems and may not withstand a longer surgical
procedure. I felt like I had a butcher knife in my stomach. I'd like to be
honest to potential patients, because past patients were honest with me about
the pain. But after three or four weeks, I was exercising and walking normally.
From what I understand, that recovery period is even a little longer than
normal. I know people who have gone back to work two weeks after surgery.
DR. JOSEPH CAPELLA
We currently advocate the traditional, open technique for gastric bypass. The
procedure has fewer complications than the laparoscopic technique and lasts
about one third the time. But most importantly, there is no long term data for
the laparoscopic gastric bypass technique, especially with the super obese, that
can be compared to the open technique. Issues of scars really should be
secondary to concerns of safety and long-term weight loss.
VERONICA ROSELLE
Thirteen months after my gastric bypass surgery, Dr. Joseph Capella, a board
certified plastic surgeon, performed a body lift on me, which means my stomach
was pulled down and 13 pounds of excess skin was cut off. My thighs and buttocks
were lifted up. Hence, my gastric bypass scar now goes from underneath my new
belly button just to the top of my pubic line. So I have no scar at all from my
breast bone down to my belly button. I do have a scar that wraps around my body
from the body lift which has healed beautifully and is fading with time.
DR. JOSEPH CAPELLA
Following massive weight loss, patients typically have not only loose abdominal
skin and muscles, but loose skin along the thighs and buttocks. Simply doing a
tummy tuck is insufficient. These individuals need to have their thighs and
buttocks addressed as well. Tightening of the abdominal muscles can markedly
improve the patient's contour.
VERONICA ROSELLE
Following the body lift, my self confidence and appearance improved
dramatically. I now have a flat, hard toned belly, a firm rear — and I feel
like a million bucks!
DR. JOSEPH CAPELLA
The body lift is a very powerful aesthetic and functional procedure which is
probably underutilized in the United States.
Daphne in Austin, Texa, asks:
After speaking to many patients, I understand the first 2 - 6 weeks are very
hard to deal with. What should I be prepared for?
VERONICA ROSELLE
As Dr. Capella had warned me, I was very depressed in the first two weeks after
the surgery, even questioning why I had done it. The reason for that was the
pain I was suffering and coming to the realization that I could no longer eat
the quantities of food I used to eat. For the first seven to eight weeks I was
on a diet that consisted of baby food, jell-O and cottage cheese — in other
words, no solid food whatsoever. That was difficult. But as I started to get
physically stronger, and started to lose weight, I knew I had done the right
thing and I adapted to my new "diet." After seven weeks, I slowly
started to introduce new and simple foods into my diet and today I can basically
eat anything I want in small portions.
Leslie asks:
Are there any foods that you cannot eat due to the surgery?
VERONICA ROSELLE
In the first few months after the surgery, I found it difficult to eat meat,
pasta and rice. But as time went on, and I learned to take smaller bites and eat
slowly (both of which are key). I'm pretty comfortable now eating almost all
foods.
Sandy in Port Charlotte, FL asks:
Do you have to maintain a vigorous exercise schedule?
VERONICA ROSELLE
Personally, I do. I am very grateful and happy that I'm now between a size 4 and
6. But to maintain it is hard work (which I enjoy, by the way). I do
cardiovascular exercise 4-6 days a week, and I strength train (lifting weights)
3 times a week. I'm also now a certified personal trainer. I love what exercise
and strength training does for my body and mind, and I encourage everyone to do
it. The gastric bypass surgery is far from a magic bullet. It does take exercise
and proper nutrition to lose the weight and maintain your new body weight.
Lyndia asks:
I had stomach stapling surgery five years ago. I lost 100 pounds but then gained
it all back within the past year. My stomach has since stretched back out. What
is the risk of having the surgery again?
DR. JOSEPH CAPELLA
Patients following gastric bypass should not regain all of their lost weight.
This is very unusual in our hands. However, as I mentioned before in the open
versus laparoscopic discussion, it's critical the operation be performed in a
certain way. We perform the operation along the lesser curvature part of the
stomach which is the least stretchable part of the stomach. For this reason, our
average patient maintains 75 percent of their excess weight off at five years.
In addition we place a band around the pouch which does not allow the connection
between the pouch and small intestine to enlarge over time, something that could
lead to late weight gain. A gastric bypass needs to be performed in a certain
way in order to maintain long term weight loss.
MODERATOR
You say most patients keep 75 percent of the weight off after five years. What
about after 10 or 15 years?
DR. JOSEPH CAPELLA
Up to 10 years, our data shows patients may regain approximately 10 percent of
that lost weight (which means 65 percent of their excess weight is kept off).
Our own data only goes back 10 years. There are other data that show that
between 15 and 20 years, 50 percent (on average) of the excess weight is kept
off.
VERONICA ROSELLE
After three years post-surgery, I can definitely consume more than I could right
after the surgery. But I still tend to vomit if I overeat. The bottom line is if
you overfill your pouch, you're going to throw up. The food has nowhere to go.
It is imperative that you listen to your body, and that when you're truly full,
you stop eating. I've learned that I tend to have a problem with vomiting if I
go back for second helpings without waiting long enough in between eating.
jbobo143 asks:
Can you still carry a baby after the surgery and not have any out of the
ordinary pregnancy problems?
DR. JOSEPH CAPELLA
Morbidly obese patients typically have irregular menses and have difficulties
becoming pregnant. Weight loss, in fact, increases fertility and makes women
have regular menses. My father has had hundreds of children born to women
following gastric bypass with normal pregnancies and deliveries. He encourages
women to wait one year following the surgery before becoming pregnant.
Missey asks:
How much in total did the surgery and post surgery cost?
DR. JOSEPH CAPELLA
Most insurance companies cover the cost of the surgery. For patients who do not
have insurance, or those coming from abroad, the procedure at our facility costs
$18,000. At other facilities, it may cost more.
MODERATOR
From Stephanie: "Did you have to fight the insurance company to pay for the
surgery? Any tips for me?"
DR. JOSEPH CAPELLA
With the appropriate medical consultations, insurance companies should cover the
cost of the surgery. Insurance companies are starting to recognize that paying
for the cost of weight reduction surgery can be a savings compared to paying for
the cost of chronic medical problems that obese people often face throughout
their lifetimes.
VERONICA ROSELLE
I personally didn't have to fight my insurance company at all. They covered the
whole procedure.
Jonathan asks:
Dr. Capella, do you ever worry that the bypass surgery gives otherwise lazy
overweight people an "easy" way out at the expense of health care
insurance?
DR. JOSEPH CAPELLA
The vast majority of morbidly obese individuals have a genetic predisposition to
obesity and typically have tried many diets with little long-term success,
spending thousands of dollars. Weight reduction surgery is the only viable
option with long-term scientific data demonstrating success.
VERONICA ROSELLE
For me, it was a drastic step for a desperate situation after 25 years of trying
to lose weight every other conceivable way, only to lose and gain hundreds of
pounds. The most important thing for all people looking into this surgery to
realize is how important behavior modification is after the surgery — to first
lose weight and then maintain it. It is hard work and far from an easy way out,
and your life completely changes.
MODERATOR
Veronica, how has your life changed since the operation?
VERONICA ROSELLE
I now have a life. Prior to my surgery, all I did was sleep, work and eat —
never having a social life or leaving my house and becoming a virtual recluse
with no self-esteem or self-worth. After losing 220 pounds, having my body lift,
engaging in exercise and becoming a personal trainer, I now enjoy socializing,
shopping for clothes and basically living — not having to worry about standing
out in society as an obese glutton. I continue to learn all that I can about
health, exercise and nutrition, and I can honestly say I look forward to each
and every day. I am grateful to God, Dr. Capella and my family for my new life.
DR. JOSEPH CAPELLA
If you want to learn more about weight reduction surgery and plastic surgery
procedures following weight loss, visit our Web site: www.drcapella.com.
MODERATOR
Thanks to all those who joined the live chat.
Moderated by ABCNEWS.com's Saira Stewart