Sisters Lorena Garcia, 39, and Alma Garcia, 41, were well aware of the toll that morbid obesity had taken on their health. Alma was suffering from high blood pressure, diabetes and thyroid disease and Lorena had developed degenerative bone disease.
When they scheduled their gastric bypass surgeries at Cedars-Sinai Medical Center on the same day in February 2006, they joined a growing number of severely overweight Americans who are choosing to have weight-loss surgery as a means of improving their quality of life and reducing their risk for life-threatening conditions such as stroke, diabetes, heart disease and hypertension.
Ted Khalili, M.D., director of the Center for Weight Loss Surgery at Cedars-Sinai Medical Center, sees the impact of obesity everyday but now has another perspective on the problem.
"A recent study from the University of Illinois shows that within the next 50 years, life expectancy in the United States is predicted to drop due to obesity. That implies that all the public health measures that were put into effect in the last two decades that contributed to the rise in the expected life span - including antibiotics, refrigeration, clean water and vaccines - are being reversed because of obesity. That really puts the problem into perspective."
According to Khalili, Lorena and Alma were ideal candidates for weight-loss surgery in every sense. They were morbidly obese (more than 100 pounds overweight) and their obesity had significantly affected their health, lifestyle, mobility and longevity.
Both were normal weight while growing up in Tijuana but began to gain excess weight in their teens after they moved with their parents and eight siblings to Los Angeles. "After we got married, (both married men with the last name Garcia), "the weight started going up and up," recalled Lorena. By the time they had children and were in their 30's, both women were carrying more than 100 extra pounds on their 5 foot-plus frames. Alma was suffering from high blood pressure, diabetes and thyroid disease and Lorena had developed degenerative bone disease. Alma was the first to decide to undergo weight-loss surgery and Lorena made her decision soon after. They scheduled their gastric bypass surgeries with Khalili for the same day in February 2006 at Cedars-Sinai.
Over the past 4 1/2 years, Khalili and a team of surgeons specializing in bariatric surgery at Cedars-Sinai have performed more than 1,600 weight-loss surgeries, 80 percent of them Roux-en-Y gastric bypass surgeries in which a small pouch (about thumb-sized) is created from which the rest of the stomach is permanently divided and separated. The small intestine is cut about 18 inches below the stomach and rerouted to the second part of the small bowel. Because the patient cannot eat as much and the food is not absorbed as well as before the surgery, many patients will usually lose about 60 to 70 percent of their excess weight in about one year.
"The hunger sensation is gone for most patients after gastric bypass surgery," explained Khalili, who is also Cedars-Sinai's director of research at the Center for Minimally Invasive Surgery. "Even though patients eat only small amounts of food at a time, they feel satisfied. I like my patients to feel like they have a normal life - they're just eating less. If they feel like they're dieting, that's a recipe for failure."
A second type of bariatric surgery, adjustable gastric lap banding surgery, is also available at Cedars-Sinai. In this procedure, a small pouch is created in the upper part of the stomach by wrapping a band around the stomach to leave only a narrow passage from the newly created pouch and the larger, lower portion of the stomach. Its effect is to reduce how much you can eat at a single meal. It is a simpler surgery than gastric bypass and can easily be adjusted or even reversed.
Weight-loss surgery, like any surgery, can have complications and needs to be carefully considered, cautions Khalili. This is particularly true in the case of gastric bypass surgery, where the patient's eating habits and other lifestyle factors will change quickly and permanently.
According to the most recent estimates of overweight and obesity in the United States by the Centers for Disease Control, between 1980 and 2002 obesity prevalence doubled in adults aged 20 years or older and overweight prevalence tripled in children and adolescents aged six to 19 years. In 2003-2004, approximately 36.8 percent of Mexican Americans were obese compared to 30 percent of non-Hispanic white adults and 45 percent of non-Hispanic black adults. Mexican American women and non-Hispanic black women were significantly more likely to be obese compared with non-Hispanic white women.
Being obese triples the risk of heart disease and produces a tenfold increase in the likelihood of developing diabetes. Other known illnesses caused by obesity are stroke, hypertension, gallbladder disease, osteoarthritis and some forms of cancer.
"Two of the health effects we can measure after surgery and weight loss," explained Khalili, "are that blood pressure can return to normal and diabetes is often eliminated in 80 to 90 percent of our diabetic patients. Also, when we take quality of life surveys we can see a dramatic improvement. The patients feel better about themselves so they're more social. Weight-loss surgery is often a life-changing event."
Both sisters have each lost more than 40 pounds since their surgeries. Lorena has lost approximately 29 percent of her pre-surgery weight and Alma has lost approximately 20 percent of her pre-surgery weight.
Besides eating smaller amounts, they're exercising more. Both sisters and their families can often be seen walking down the street together - they're hard to miss with all nine of them walking together.
When Lorena reaches her weight-loss goal she wants to enter a dance competition and rekindle her memories of dancing folklorico (a traditional Mexican dance) in high school. Alma looks forward to going back to school in preparation for a professional career.
"I don't want to go back to being the person I used to be," said Lorena. We had the surgery for our health, for our families and for the people who care for us. We needed to have this change in our lives, and we're happy we did it."