Just like individuals addicted to alcohol or drugs it is often necessary for the morbidly obese individual to hit bottom before they do anything about there own addiction.  I hit bottom or you might say got my wake up call on January 2, 2001.  On this day I was at a clients residence when I was hit with a deep pain in the chest and was having difficulty breathing.  For the last week or so I had been fighting a cold and thought that I may have developed a touch of pneumonia.  I figured it would only take me another half-hour to complete my work and then I could go see a doctor so I continued.  After about another minute I realized that I should go to the doctor now and finish the job later.  Embarrassingly I went to the client explained to her the problem I was having and asked to use her phone to call my HMO, Kaiser Permanente.  The client whose daughter is an emergency nurse asked, “Should I call 911?”  I replied, “No, I think I will be able to drive to a clinic.”  I phoned a Kaiser health nurse who asked me to describe my symptoms. The advise nurse told me that it could be my heart and not pneumonia, to hang up and call 911 and have them take me to St. Vincent’s Hospital emergency.  With continued embarrassment I asked the consumer to call 911 for me so that she could give directions to her house, which was out in the country.

Here I was, possibly suffering a hear attack and I was embarrassed because I had to stop before completing my job and was leaving the job in an ambulance.  Embarrassment was an idiotic reaction under the circumstances but that is what I felt.  Within minutes medics from the fire department arrived and were giving me oxygen and treating me.  Within a few more minutes an ambulance crew arrived.  On the way to the hospital the medics on the ambulance were finding symptoms that indicated to them that I had experienced a heart attack and were treating me as they could.

Arriving at emergency I was immediately moved into a room and test were started.  This came as a big surprise to me for a few months later I had driven my wife to emergency as I felt she had experienced a stroked and it took them two hours to see her.  What I learned from this, if you think you have an emergency call 911.

At emergency an EKG was performed, blood test taken, a chest x-ray was made, constant monitoring, nitroglycerin patch applied.  The testing went on for an hour or so and the doctor stated that I did not have pneumonia and that they had not found any positive indications of a heart attack.  I have a hyatal hernia and the doctors stated that they thought I was experiencing a gastric reaction but they were going to keep me overnight for more testing and monitoring.

I was moved into a hospital room.  I asked the nurse to bring me some pajama bottoms and she brought 3 pair but none were large enough to go around my waist.  A bit later I called home to speak with my wife Lynda.  Lynda had been hospitalized recently for a stroke and they had inserted a catheter as she was confined to the bed and could not get up to use the bathroom.  Lynda asked me if I had been castrated? Now I knew that this was a slip of the tongue and she meant catheter, but I still kept my legs crossed the rest of the night.

During the night I require oxygen off and on.  A 24-hour monitor was attached to me, A variety of heart test were performed that night.  They also rolled a huge scale into the room to take my weight (301.1 pounds) Three hundred and one was bad enough, why did they need that point one?

The next morning I saw a doctor who stated that all of my test for heart problems had been negative but they were going to perform an echo-ultrasound and if that was negative a treadmill test.  The echo was negative and I was taken downstairs for the treadmill test.  Now this test is embarrassing in itself.  Here I am a bloated whale with globs of fat hanging around my midsection.  Wires are hooked up to me and I am gasping like the totally out of shape person I was.  Still, I was going to do my best to hit the maximum on the treadmill, as I don’t quit easily.  Huffing and puffing through this test I keep saying continue.  Finally the doctor tells the technician to stop the test.  The doctor then says to me, “You looked down and when someone looks down I figure they are about to get off so I stop the test.”  While I was tired I was disappointed as I felt I could have gone a bit longer even if it killed me.  The doctor informed me that he had stopped the test at 86% of a normal heart range and he saw no indication of a heart problem.

Back in my room my doctor comes in and informs me that I don’t have a heart problem at this time but if I don’t do something about my weight and exercise he can not guarantee that I wont. I was told that I could go home.  The nurse removed the i.v. from my arm and left the room.  He had not removed the heart monitor so I figured no problem I will remove it myself.  Just as I took it off the nurse enters back into the room and says what have you done they will think you died.  I said what do you mean, wasn’t the monitor turned off?  No he replies as he runs out of the room to inform them that it was all a mistake and I was still alive.  When the nurse returned to the room I asked why they had not ran into the room to try and save my life.  The nurse replies, “Sometimes they fall asleep at the controls.”  While I hope that he was kidding, I certainly don’t want to find out at some later date.

This was my wake up call.  I had been given a scary and expensive warning.  I had suffered embarrassment at the clients, my wife had asked if I had been castrated, I had exposed my flabby fat for all to see, and had flat lined (accidentally thank you).  I do not want to face these experiences again and the best odds I have are to get and keep the pounds off and get some exercise.  My doctors and many others had warned me but it took hitting close to bottom.  Bottom is six feet under and I do not want to hit it.

My wake up call was also a wake up call to my wife.  Lynda has diabetes and a lot of problems of her own and was in and out of the hospital twice this past year.  Even so, she had difficulty controlling what she ate and drank even when I would try to control what I ate.  These changed things, we were both on a diet now realizing that if we want to reverse any terminally it would have to be now.

Back home we started our diet.  We also gave up coffee, which for me was difficult, as I looked forward to its jolt.  The doctors had previously encouraged me to give up coffee as they felt that it was contributing to my prostate problems, high blood pressure and hiatal hernia problems.  Withdrawal was not as bad as I had figured it would.  While we did switch to decaffeinated coffee I was still getting some caffeine through ice tea and an occasional diet soda.

Today, several years after writing that article I look back and think of the constant yo-yo diet that I continued on after hitting bottom. At the time Lynda passed away, shortly after my own hospitalization I has lost a few pound but soon went back up to about 300 pounds before heading back down again. You see, though I had hit bottom I had not learned how to control my emotions and with those the food would go in and the pounds would go on. Since gastric bypass surgery in July of 2008, I have not become thin but have held my weight at a comfortable level and the doctors tell me I am very healthy. For those of you that hit bottom on your weight loss diets, are tired of yo-yo dieting weight loss surgery is an option that you may want to consider. Surgery alone will not do it though for you must also learn how to control your emotions for even with surgery the weight can be put back on.

Qualifying for a gastric bypass is not as difficult as some would lead you to believe  and you certainly don’t have to be terminally obese to qualify for it. On the other hand it is not as simple as just consulting with a physician and requesting one for it is only for those that are morbidly obese or super obese and even then you may not qualify. There are several guidelines that limit the administering of a gastric bypass procedure to someone. Some of the more common things that restrict any prospective recipient of the procedure are the following: the patient must have been obese for more than five years; the patient must not have a history of alcoholism and psychological disorders.

With gastric bypass surgery there are age restrictions. Commonly the person should not be younger than eighteen years of age or older than sixty-five years old. Even age requirements are changing all the time and do differ among surgical centers, physicians and your physical health, as an example, I was one week short of my 67^th birthday when I underwent gastric bypass surgery.

Most surgical centers and surgeons also require that you have exhausted all other weight-loss measures for yourself. You go under a psychological examination to make sure you are a good candidate for the procedure. You will also undergo a thorough physical not only to determine if you have qualifying conditions such as diabetes, high cholesterol, sleep apnea or high blood pressure but also to make sure that you can handle the surgery for gastric bypass is still a major operation and cannot be taken lightly.

If you do pass all of these tests and have either the insurance coverage or money to cover the surgery you will usually be set up for the procedure. The good news is that many insurance companies along with Medicare do cover much of the cost of gastric bypass surgery for qualified patients.

Here’s a simple explanation of gastric bypass surgery: Gastric bypass surgery is essentially, having your stomach capacity lessened and making your digestive tract skip a part of your small intestine. The procedure creates a small pouch in the upper part of your stomach, usually via surgical staples or a plastic band. This stomach pouch is usually small – it can get to the size a walnut for some procedures. After this pouch is created, the middle of your small intestine, the jejunum, is connected to it. This means your food will skip the main part of your stomach and your duodenum, the upper portion of your small intestine. The result is lower stomach capacity and a lower calorie intake. You will be able to satisfy your appetite more quickly and have fewer calories inside your system, creating a consistent and quick weight loss for you until your body has adapted to it. Over time you will find yourself starting to eat larger amounts than when you first had the surgery so you must continue to be careful for even with surgery you can gain your weight back.

It may sound easy but still it’s a long road after a gastric bypass. After about a four-hour operation you will be under observation for the next few days, while being limited to liquids only so that your stomach can heal. Some people stay in the hospital for up to a week after surgery. My stay was 2 days and 4 days later on my 67^th birthday I was already walking over a mile.

Following surgery you will spend the next several weeks on liquids and soft protein foods. As your new pouch gets use to the strain you will progress to more solid food. The length of time nor the prescribed diet will not be the same for all. You will also be taking many additional vitamins and nutrients for life.

Some individuals will continue to experience side-effects for their whole life. You must still continue to exercise for lower energy intake can be detrimental to your health. Over-eating or eating the wrong foods can cause you to vomit or feel great pain. Gastric bypass is a great tool but not the best tool for all. As a gastric bypass surgery patient that is happy they had the surgery I do here stories of those that are sorry they had it and some say that they would go with the gastric band if they were to do it over. Each and every person considering any type of weight loss surgery should first try diet and exercise, and gastric bypass surgery should be a last resort for anyone who’s suffering from obesity.

In this video Dr. Alan Whitgrove is interviewed on Health Matters and discusses how morbid obesity often leads to early death, the benefits of bariatric surgery, the difficulty for morbidly obese individuals to loose and maintain an acceptable weight through dieting and related subjects. This is a good video that will give you a better understanding of bariatric weight loss surgery. You should watch it if you are considering the surgery or know someone else that is.

Most of the statistics presented here represent the economic cost of overweight and obesity in the United States in 1995, updated to 2001 dollars.[10] Unless otherwise noted, these statistics are adapted from Wolf and Colditz,[11] who based their data on existing epidemiological studies that defined overweight and obesity as a BMI > 29. Because the prevalence of overweight and obesity has increased since 1995, the costs today are higher than the figures given here.

Q: What is the cost of overweight and obesity?

A: Total Cost: $117 billion
Direct Cost: $61 billion*
Indirect Cost: $56 billion

*A recent study estimated annual medical spending due to overweight and obesity (BMI >25) to be as much as $92.6 billion in 2002 dollars-9.1 percent of U.S. health expenditures.[12]

Q: What is the cost of lost productivity related to overweight and obesity?

A: The cost of lost productivity related to obesity among Americans age 17 to 64 is $3.9 billion. This value considers the following annual numbers (for 1994):

Workdays lost: $39.3 million
Physician office visits: $62.7 million
Restricted-activity days: $239 million
Bed-days: $89.5 million

Article provided by the National Institute of Health

As I listened to these patients speak I was reminded of how we so often discriminate against others. Discrimination because the person is different than us and in this case severely obese. Regardless of the discrimination, if a person wanted to find beauty they really need to look no further than Andover Village. This facility located in Andover, Ohio is the home to 50 super obese men and women, some of who are nearly a thousand pounds in weight. While I have never been to the facility or spoken with anyone that has it must be a wonderful place with a loving and dedicated staff.

The patients sharing their stories were large in size and in spirit, even though they had surely been through much psychological and physical pain. These people demonstrated positive attitudes that many others regardless of weight need to develop. These patients had learned or were learning to set positive goals as they worked toward weight loss and reestablishing their lives. Day by day they were working towards their goals of loosing weight and becoming stronger so that they could once again maintain more “normal” lives.

An attractive and personable lady told how she had weighed over 700 pounds including a mass growing on one of her legs estimated to be 200 pounds. She mentioned that she is a grazer. While she would eat small portions she was eating all day long so that she was taking in a large amount of food. For those of us listening to her story that believes we are not big eaters for we are grazers we need to take heed. As a grazer we may eat small amounts we may also be eating much more than we believe that we do.

One patient that had weighed over 600 pounds mentioned how he had loved food since he was a child and as a result always been a very large eater. This patient a member of the clergy has lost nearly 200 pounds. Through weight loss and increased activity his mobility had improved. Upon his release he still had a long ways to go to meet his weight and health goals though he was able to drive himself home.

Another patient weighed 849 pounds truly believed to be terminally obese upon arrival to the facility. This young man, unable to walk due to his weight had been given 6 months to live. He had experienced more than one heart attack and his state of health was dreadful. When this program was filmed he was down about 200 pounds in weight and was now able to walk over 500 feet and was increasing his distance each day. This man had a wonderfully positive attitude and had developed an improved out look on life. An attitude that should help him reach his goal of living a normal life.

Yes you wonderful Andover patients, I thank each of you for sharing your story. I wish each of you the very best as you work toward achieving your goals. As we go through our day-to-day lives, let each of us remember that beauty is only “skin deep”. Let us be kind and treat others with respect even though in some way they appear different from us. In Gods eyes we are all the same.

While the western world reads of the desperate problems facing those in developing parts of the world, with drought causing widespread malnutrition, we are seeing one of the most visible, yet most neglected public health problems rise to epidemic proportions on our own doorstep. Obesity. Around 20-25% of the population in the U.K. and the U.S. are clinically obese (i.e. they have a BMI > 30) and around 50% are overweight. Shocking front page headlines are appearing in the national press – “Parents may soon outlive obese children” -and research results are published in the broadsheets. Even in countries such as Japan, famed for their healthy diet, incidence of obesity is rising dramatically.

Apart from the obvious strain on the body when carrying vast amounts of extra weight, more and more research is being conducted into the physiological effects of an abnormally high proportion of body fat. Recent studies have proved the link between the most common (Type II) form of diabetes. Alarmingly, this form of diabetes, previously called adult-onset diabetes, is rising in children. Shedding as little as 9 lb in weight on a diet and exercise program was shown to cut the risk of diabetes by 58%.

Over the last four years, the portfolios of products available to treat both obesity and diabetes have widely expanded. Xenical from Roche, launched in September 1998, and Reductil from Abbott launched in May last year, have transformed the way obesity is treated in the U.K. Similarly the last three years have seen three new oral products for Type II diabetes, the glitazones or thiazoldinediones, Avandia (GlaxoSmithKline, July 2000) and Actos (Takeda, November 2000), and Starlix, a prandial glucose regulator (Novartis, May 2001).

Considering the cumulative percentage of GPs aware of these products in the first 24 months post launch – Avandia, the first glitazone, achieved high awareness immediately post launch, with around 60% of UK GPs aware four months later. After the first 12 months, 80% of GPs were aware, only increasing slightly in the second year. Actos, launched only four months later, was slower to gain awareness amongst the GP population, and plateaued after the first 12 months at 70%. Of the anti-obesity products, Xenical out performed Reductil (following three years later), consistently gaining awareness in its first two years and reaching a level of 80%.

Examining the detailing of the five products in the first 24 months post launch, similar patterns can be seen, with Avandia utilising GSK’s vast field force resource to outstrip detailing activity for the other products. It is interesting to note that although detailing activity for Starlix was higher than that for Actos or Xenical after month 10, awareness for the product has remained lower.

Given the increasing demand for effective treatment in both obesity and diabetes, it is interesting to look at the levels of GP usage of these products for the first 24 months after their launch. Once again, amongst the diabetes products, Avandia takes the lead, with usage increasing steadily over the two year period as GPs gain confidence with a novel class of product. Usage for Actos, despite good awareness and detailing levels was substantially lower than for Avandia. Starlix, despite a very high level of detailing to GPs, has so far achieved a low breadth of 5% in the U.K. primary care market.

The data for the anti-obesity products is interesting. A lower level of both awareness and detailing for Reductil post launch compared to Xenical, led to a far higher usage. After 12 months, almost 20% of UK GPs had used Reductil, compared to around 8% for Xenical. This is the first indication we can see from this data of the changing attitudes to the treatment of obesity over the last four years.

Opportunities for GPs to write a script for obesity have increased dramatically over the three year time period, from around 2000 in a month to 5000. With the NICE recommendations in March 2001, the main growth happened before the launch of Reductil. Since the launch of Reductil, Xenical has maintained a 60% share of the opportunities. However, growth has not been sustained and opportunities are beginning to flatten off. Is this surprising considering the size of the potential market? One would think so, but negative attitudes towards obese people have lead to limited effective obesity management systems in national health services around the world. The two products currently on the market, although a great step in the treatment of obesity, are not ideal due to some of their side effects and contraindications.

In contrast, the diabetes market is dynamic. Opportunities for GPs to initiate therapy have increased fairly steadily over the last 2 years to around 20,000 in the most recent months. Hopefully the increase in the number of oral diabetic products available for treating Type II diabetes will mean fewer patients having to move onto hormonal therapy and greater control of the disease.
So what do these trends mean for Lantus, the new insulin launched by Aventis this month. Certainly pre-launch awareness, even amongst GPs, has been high. With the increased prevalence of obesity, which looks set only to rise in the coming years, opportunities for a new product in this class will certainly abound.

Currently obesity costs the NHS at least £0.5 bn per year in patient care and £2 bn to the wider economy in for example, sickness absence. Clearly education, both of the general public and the healthcare professionals, is key in order to improve incomplete and often confused knowledge of obesity and the surrounding issues. The developing world must be looking on in wonderment.

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Over the years his weight went up and down as he went from one diet to another. Like so many of us Al admits to loving food. It was mentioned that at his high point of 330 pounds he could eat two Quarter Pounders and 6 Krispy Kremes in a single sitting.

Following gastric bypass surgery Al Roker lost about 130 pounds. Like many he later gained back 25 to 30 pounds and is holding. Weight loss surgery is not a magic bullet and Al works out 2 to 4 times per week to help him maintain his lower weight.

Did Al Roker have his loose skin removed? As he quickly passed over that subject he did infer that he had.

When asked if sex was now better since he has lost the weight, Al joked that it is because he is now getting some.

Asked if he would recommend gastric bypass surgery to others he responded, “This is a decision that each person needs to decide on their own as one in every 200 having the surgery will not survive.”

Just listening to Al Roker talk he sounded to me like a great guy that any of us would be pleased to have as a friend. His openness in discussing morbid obesity can help many from becoming terminally obese. I wish him continued success and hope that he will continue with his openness on the subject of obesity.