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Before and After Weight-Loss Surgery

Gastric bypass, banding are options for obesity

Bariatric surgery to lose weight. Before and after pictures of Joyce Lewis.

After bariatric surgery to combat obesity, Joyce Lewis stands in front of the outfit she wore in her "before" picture. — Courtesy of Joyce Lewis

Life after surgery

"Bariatric surgery is really just a tool," says Campos. "People still have to change the way they eat and the way they live." Because surgery drastically limits the size of the stomach and in some cases interferes with absorption, it's crucial for people to choose nutritious foods. Most bariatric programs require patients to receive diet and physical activity counseling before the operation. Many work with patients afterward to monitor their progress.

To date, more than 1 million people in the United States have undergone bariatric surgery. But experts still debate whether surgery to alter the digestive tract is a rational solution to the growing epidemic of obesity around the world.

"When I put on my public health hat, I have to admit that it seems crazy," says Flum. "But I'm a clinician. I treat patients who have tried everything else, who have type 2 diabetes and other complications of obesity, and they're desperate. This is the only thing we can offer that allows for a cure."

Still, living with a gastric band or a bypass isn't easy. "You really have to make an effort," says Julie Hartje. At first she could eat only very small amounts of pureed foods. Recently she's begun to introduce string cheese, scrambled eggs, cottage cheese and small pieces of vegetables to her diet.

Solid food has to be carefully chewed or she can't keep it down. To get enough protein, she drinks two protein shakes a day. Like most bariatric surgery patients, she's also on a regimen of vitamin and mineral supplements to avoid deficiencies. But even some pills are too large to digest, so she has to take them in liquid form.

Alcohol, carbonated drinks and caffeinated beverages are all banned. For the first six months after surgery, she carefully avoided drinking any liquids for a half-hour before and after eating, to make sure that her digestive tract could absorb nutrients from solid food. She now has to wait for two hours after a meal to drink water or other liquid. "That's been hard for me," she says.

But she's lost 60 pounds, far more than she's ever lost by dieting. Before the operation, she had to give herself seven shots of insulin a day — 400 units in all — to control her blood sugar levels. She's down to just two shots of 10 units each a day. Eventually, she hopes, her diabetes may go away completely.

"For me, I have to say, it's been nothing short of miraculous," Hartje says.

Peter Jaret is a freelance writer living in Petaluma, Calif.

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