Losing weight, gaining life
Teen undergoes 'last-resort' gastric bypass surgery after all else fails
August 5, 2004
BY Kimberly Fornek
Sixteen-year-old Charlie Fabrikant knows he is overweight, and he has never felt better.
The Buffalo Grove High School junior stands 5 feet 10 inches tall and weighs 245 pounds. But that weight feels awfully good to him, because Fabrikant weighs 105 pounds less than he did seven months ago.
Fabrikant accomplished the dramatic weight loss with the help of an operation that reduced his stomach from normal football-size to the size of a golf ball.
In gastric bypass surgery, surgical steel staples are used to seal off a portion of the stomach. The surgeon connects a portion of the small intestine to the newly created pouch in the stomach, thus bypassing the rest of the stomach and reducing the amount of calories and nutrients that are absorbed from the food.
"It makes a small, gastric pouch, which restricts how much someone can eat," said Phillip Rosett, a general surgeon who performs gastric bypasses at Rush North Shore Medical Center in Skokie. A person who had the procedure, "in the beginning can eat a little more than a shot glass" equivalent of food at one time, Rosett said. Gradually, the amount increases to servings of about one-half cup.
"I knew there are risks in any kind of surgery," said Fabrikant, who underwent a gastric bypass in December at the Weight Intervention and Surgical Healthcare (WISH) Center at the Provena Mercy Center in Aurora. "I chose it because I knew the path I was heading on would lead to an early death."
Fabrikant knew three other people who had successful gastric bypass surgery, including his mother, Wendy, in 2001.
"I hoped it would work for me," he said.
Out of options
Charlie Fabrikant has tried to lose
weight by more conventional methods.
"I went to hospitals and tried their diets. I
went to Weight Watchers. I've taken pills. I went to
doctors that treated obesity,"
Charlie said. "Ever since I've been in the third
grade, I've at least been on a diet, maybe not a hospital-sponsored
diet, but I've always been watching my weight. It depresses
you.
"Most of the blame has to fall on me," he said. "I can't blame it on my mom or the doctors or my brother. It's me."
But even when Charlie diligently followed a diet, his weight loss would slow to a quarter-pound in one week.
"I remember those weeks," he said. "It gets discouraging." Then he would eat when he became depressed. "It's a vicious cycle."
When Charlie was 12 and 13 years old, he already weighed 250 pounds. He was 13 when he accompanied his mother to the seminars the WISH Center holds as preparation for gastric bypass patients. Charlie wanted to be there to support his mother, but he also wanted information about the procedure, which he considered as "a last-resort" solution for obesity.
Obesity a 'disease'
Rosett started doing gastric bypasses about a year ago. (He did not perform Charlie's procedure.) He decided to undergo the training for the surgery because he recognized the health benefits it brought to obese people. He has done the procedure on between 10 and 20 patients from his medical practice in Skokie.
"I was convinced obesity was a disease and needs to be treated as a disease, not just as a group of people who eat too much," Rosett said.
Although complications can occur with any kind of surgery, "the changes that take place physiologically" after gastric bypass make the risks worthwhile for some obese patients, said Rosett.
"There are a host of bad things that go along with morbid obesity -- diabetes, high blood pressure, sleep apnea -- all have their own set of problems. Over 90 percent (of gastric bypass patients) will be cured of those conditions," said Rosett.
The majority of Rosett's gastric bypass patients are women in their 20s to 40s. But Rosett is not against doing the procedure on younger patients. While some people may think a teenager is too young to give up on dieting and exercising, Rosett believes some people are genetically programmed to gain weight. In many cases, "they are not eating anymore than a person of normal weight. It's a condition where their bodies respond differently to different stimuli."
"There are hormonal mediators in our brains that tell us to stop eating," Rosett said. An obese person's brain may send signals "to eat more fat." If a person's body is programmed to gain weight, Rosett doesn't see why a young person should not undergo the surgery as a teenager to spare feelings of isolation or embarrassment that often accompany obesity at a time when the teenager may be most sensitive to the way others react.
Rosett does not recommend a gastric bypass for young people who are still experiencing growth spurts, because their bodies need adequate nutrition.
"I would say anyone who has not reached puberty would be too young to have the surgery," he said.
Mom's feelings
Wendy Fabrikant said she did not tell her son he should have bypass surgery, even though she had lost 85 pounds after her stomach was stapled.
"Because if he wasn't happy with the outcome, I didn't want him to feel that I had pushed him into it," she said. "I never encouraged him. I supported him."
But Wendy is happy with the results of Charlie's bypass.
"His asthma is better. His joints are better," she said. "His sleep apnea is gone. That's why we went into this."
To want the surgery merely to improve your appearance is "shallow," Wendy said. "It's because of everything else healthwise."
Charlie's twin brother, Sam, sees the difference. Charlie "is a lot more active. He is the one dragging me out (to shoot baskets and exercise). He has more energy, and socially he is a lot better." Sam would like to shed some of his 270 pounds, too, but so far he has not decided to have the surgery. "I'm keeping my options open," he said.
Who pays?
The total cost for Wendy's and Charlie's surgeries was about $60,000, and not all insurance plans cover the procedure.
"A significant number of insurance companies do not cover this surgery," said Rosett. "Insurance companies want to see documentation that a patient has tried at least one year of a medically approved weight-loss program and has failed."
Wendy and Charlie Fabrikant had both tried to lose weight on a medically approved diet for at least a year before they opted for bypass surgery. When Wendy went to the WISH Center at Good Samaritan Hospital in Downers Grove in 2001, she was seeking treatment out of her insurance plan's network, so her insurance company paid only a portion of the cost.
The family was initially denied coverage last year for Charlie's gastric bypass before Wendy appealed the decision and the insurance company covered the procedure.
Screening candidates
Adults who want a gastric bypass at the WISH Center must participate in a 10-week program to make sure they are ready for the surgery and the effect it will have on their life. For minors like Charlie, the preparation and screening, which included individual consultations with psychologists, dietitians and exercise trainers, and counseling, lasted six months.
"They give you coping strategies and ways to get around emotional eating," said Charlie. "It's preparation for after the surgery. You try and practice it. Sometimes it would work, sometimes it wouldn't."
Now Charlie is determined to keep losing weight. He exercises 40 minutes every day either outdoors or on his treadmill.
"I don't want to go back to the way I was," he said. "That's what is pushing me to lose more."
Source:www.pioneerlocal.com
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