10
Smoke Signals
By Chris Mercier
or most of her life. Shellev Hanson has
IU struggled with her weight. Like many
1 1 neonle who fall into the category of obese.
I 1 o- 4 - j
she knows all too well the peaks and val
leys of attempted weight loss.
"I would lose weight," she said, hesitantly. "And
then I would gain it back plus five or ten pounds more."
Eating was more than a routine for Hanson; it was
a way of life. Like most people, she needed an outlet
during emotional crises. Some go to the gym, some
go hiking, some kickbox and some even seek therapy.
Hanson ate.
"Eating was my way of dealing with stress," she
lamented. "I was a real binge eater."
Outside, she was and still is known for being an
immensely cheerful, person polite, thoughtful, a
good listener and impeccably friendly. Yet inside
Shelley Hanson resided an insecure woman, one who
was tired of the inconveniences of being overweight.
She never was too fond of having to buy oversized
clothes. Her snoring embarrassed her.
Science supplied an excuse: Obesity is genetic. And
sure enough, hers was a lineage of largeness: her
mother, sister, grandmother and great-grandmother.
But if you know Shelley Hanson, then you know a
woman not too fond of taking the easy way out. And
so she kept looking.
An answer was out there, somewhere.
That answer came through a few friends of hers,
also struggling with their weight, who learned of
bariatric surgery, and faced with few alternatives,
elected to give it a shot. That shot turned out to be the
Holy Grail of weight-loss gastric bypass surgery.
"It's a miracle," Hanson said, with not the least bit
ofhesitation.
It is also ironic, because she had more than a few
misgivings before deciding to go under the knife.
Without a doubt, this surgery is not for even the par
tially squeamish.
"It's kind of icky," she said while providing details.
"But at that time, I was getting pretty nervous about
my health."
That was reason enough, and on December 29, 1999
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knife. She hasn't looked back.
Shelley Hanson weighs in at a pleasant 145 pounds
these days, down quite a ways from 235 one year
ago. And while post-operation life has had its own
ups and downs, Hanson, along with a few other Tribal
asc bypass
Surgery
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iwemi as a Last: Resort
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DATING AGAIN -Tribal member Shelley Hanson's
struggle with her weight caused her to be de
pressed. She lost self-confidence. Now, after
her surgery, she is happy, healthier and rebuild
ing her self-esteem.
members, is convinced that gastric bypass surgery
is the great hope of the future in weight-loss surgery.
Bariatric surgery, to which the gastric bypass be
longs, has existed for decades. Yet no single form of
weight-loss surgery that existed previously worked
as successfully at getting patients to lose weight and
not gain it back.
"It's the only one that works for the morbidly obese,"
said Dr. Latham Flannagan, the Head Surgeon at
the Oregon Center for Bariatric Surgery and the sur
geon who performed the procedure on Hanson.
Flannagan has been working in bariatric surgery
for nearly 25 years now, and he believes wholeheart
edly that gastric bypass, while still evolving, is the
most effective way to lose weight in history.
"I've seen a lot of people attempt various ways to
lose weight. . .hard-core dieting, exercise, clinics," he
said. "And 98 percent of them gain most or more of it
back. Ninety-eight percent," he repeated.
Gastric bypass has more than one form,
yet they all involve the same basic
premise: partitioning off a small portion
of the stomach with surgical staples,
which in effect reduces the holding capacity. Follow
ing the surgery, the stomach has in effect become a
small pouch, and patients have an appetite that is
only a fraction of what it was before. Losing weight
becomes almost arbitrary.
"Once they have this tool," Flannagan said. "They
can do what they want."
Well, he said, they can't really do what they want,
but the point is that patients are given the power to
lose weight, provided they continue to do follow-ups
with their surgeon and stick to the eating regimen.
The eating regimen, both Hanson and Flannagan
agree, may be the hardest part.
The first three weeks following the operation, pa
tients are required to stick to a liquid diet. Their
"meals" consist entirely of "instant breakfast" type
drinks Slim Fast, Ensure or Resource. In between
their five "meals" each day they are to drink plenty
of water and supplement the new diet with vitamins.
After the first three weeks, patients move on to a
high-protein, low-fat diet of pureed food, hoping not
to exceed 500 calories in one day. Maintaining good
hydration and continued supplement of vitamins con
tinue. Solid foods are to be avoided at all costs. As
the digestive process functions less efficiently, even a
small piece of solid food runs the potential to block
the stomach's outlet and induce vomiting.
Three months following surgery, patients begin the
routine of "fluid loading." Because the meal sizes
have increased to two to four ounces, more liquid is
necessary in order to dilute the food particles and
maintain a fluid balance in their system. Patients
drink as much water as their new pouch can hold 15
minutes prior to each meal. Furthermore, 90 min
utes after each meal they should drink more water
and other low-calorie liquids.
Six months after the surgery, patients can resume
some kind of a normal diet. But naturally their appe
tite is considerably reduced, and the few ounces of food
they are permitted to eat will be predominantly meat.
One aspect of the post-op regimen not to be over
looked, however, is the addition of exercise to the daily
routine. Patients are advised to begin exercising 45
to 60 minutes a day. Exercise is of paramount im
portance following the surgery because the body shifts
into a starvation mode, and thus reduces the rate of
calorie use, which contradicts the nature of the op
eration. Most patients are expected to walk two or three
miles a day within months of the surgery, in order to
burn up what few calories they ingest and facilitate
the weight-loss. No other aspect of the post-op regi
men, Flannagan said, seems to pose a bigger chal
lenge for patients.
"Some people have a hard time with that," he said,
noting that many patients don't exercise at all. "But
that's their decision."
"They'll still continue to lose weight," he added.
"But not as much if they'd exercise."
Flannagan maintains that no great amount of dis
cipline is needed after the surgery in order to main
tain weight-loss. But he also understands why pa
tients can stray, because the surgery, like obesity
itself, can ultimately be involuntary.
Americans, as a whole, form perhaps the
heaviest populations on the planet. Ac
cording the U.S. Bureau of the Census,
i approximately 58 million Americans (22
percent of the population) can be correctly catego
rized as obese. According to Flannagan, five percent
of the U.S. population is morbidly obese.
An uncountable number of surveys will tell you that
most Americans are overweight. But there is a major
distinction between overweight and obese. Clinically
speaking, a person who possesses an excess of body fat
that impairs their general health is considered obese.
When the impairment becomes severe, that is what
can be classified as morbid obesity.
During the last decade, obesity has increased so
dramatically in the U.S. that the Journal of the
American Medical Association has seen fit to decree
it an epidemic. And considering the health implica
tions of obesity that may not be an inaccurate term.
Since the mid 1980s, no other health problem other
than cigarette smoking can be said to cause as many
deaths as obesity. And that is simply because so
many other diseases can spring forth from the condi
tion. Diabetes, cardiovascular disease, hypertension,
cancer and not to mention the psychological burden
all combine to make obesity quite dangerous.
Causes of obesity are many physical inactivity,
excessive caloric intake and most commonly, genet
ics. "I would say that most of the time, it is not psycho
logical, not because people are lazy," Flannagan said.
"It's genetic and they really can't help it."
Genetics certainly play a big role for obe
sity in the Native American community.
A study of the Pima Indians in Arizona
by the Center for Disease Control lent cre
dence to the theory that many Natives are victims of
the "thrifty gene." Geneticist James Neel first pro
posed the theory in 1962 after speculating why such a
huge percentage of the Pimas population was mor
" bidly obese. Neel's theory is based on the fact that for
thousands of years populations who relied on farming,
hunting and fishing for food, like many Native Ameri
cans, experienced alternating periods of abundance and
of famine. In order to survive, their metabolism evolved
in a manner so they would store fat more easily, that
they might not starve during famines.
Their highly economic metabolism has still not
adjusted to the ever-abundance and richness of west
ern food. And as they no longer need to work as hard
physically on a day-to-day basis, and enjoy a high fat
diet, the once helpful thrifty gene has become a bane.
Flannagan knows from personal experience the
validity of the thrifty gene theory. He lived on the
isle of Tonga for four months, and estimates that
three-fourths of the island's inhabitants are obese.
"Like Native Americans, they subsisted on a diet
with very little fat fruits, vegetables and fish," he
said. "When they were introduced to Western food,
especially beef, they couldn't help but become fat."
"You ask does the thrifty gene' affect Native Ameri
cans?" he said. "Absolutely."
Although Flannagan champions the cause of many
obese Americans, he is not about to suggest that gas
tric bypass is advisable for everyone. In fact, he views
it in many ways as a "last resort" solution.
"People should try other forms of weight-loss first,
some respond quite well to medication," he said.
"When all else fails, then gastric bypass surgery is
the last available option."