Weighing the Options
By Julie Wernau (The Lyme Times, May 4, 2005)

When Kathy Krewsky needed to ask for a seat belt extender on the plane ride to Florida last April, it scared her into making the biggest decision of her life. "I never thought the seat belt wouldn't fit me," she said, speaking through her friend and American Sign Language interpreter. "I was so embarrassed because my daughter was watching me." Kathy, 39, was 303 pounds, and her health problems were mounting -- high blood pressure, borderline diabetes, and sleep apnea. Just walking around her home in Waterford was enough to leave her breathless. Kathy, who works at the U.S. Naval Submarine Base in Groton, had tried every diet program in the book. For months, she quietly researched her options, only telling her husband after she'd decided to go forward with gastric bypass surgery -- an invasive surgery that forces weight loss by shrinking the stomach down from a football-sized container to a golf ball-sized sack and reconstructing the intestines. Six months ago, Kathy, who has been deaf since birth, was the first deaf person in the state to undergo gastric bypass and says she hopes to inspire others in the deaf community who are morbidly obese. "Before I had this surgery, my kids could not put their arms around me," says Kathy, 183 pounds and free of her former health problems. "Now they can do it and keep saying, 'Look, I can put my arms around you now.' It touched my heart, and I knew I made the right decision."

Joe Basileo essentially grew up in an Italian restaurant. His family owned a pizzeria in Long Island, where he worked after school. On his birthday last week, the 35-year-old owner of Illiano's Grill in Niantic recalled an essay he wrote in college that asked him to explore a scent from his youth. He chose the smell of fish cooking on his parents' stove, a memory that conjured feelings of family and joyous times. "Food becomes ingrained in memories and feelings," Joe said. By the time he was 33 years old, Joe's weight had crept up to a dangerous level. At 428 pounds, he'd tried most weight-loss plans, but could never find the time or energy to exercise while working 10 to 12 hours at the restaurant. "It's not like I chose or ever wanted to be overweight," he said. After 10 days on the Atkins diet and no bread or pasta, Joe was miserable. He was beginning to feel like he'd have to give up everything just to be thin. That's when his brother, Anthony, at the suggestion of a customer, started dieting at Thin's In in Waterford. By the time Anthony had lost 100 pounds and wasn't miserable, Joe was willing to give it a try. "My big fear was that I was going to be suffering and starving myself," he said. "... I'm eating more now than what I was eating before." Now 207 pounds, Joe has been going to weekly one-on-one sessions with Thin's In owner, Dianne Rubin, since December 2003. Illiano's runs daily Thin's In specials in keeping with the program and Joe feels like he has a new lease on life. "I eat here every day," he said. "I still eat here every day. There is a sensible way to eat Italian."

Both Kathy's and Joe's body weights classified as morbidly obese, a term defining those with a Body Mass Index (BMI) over 40. Obesity (BMI over 30) afflicts one-third of the U.S. population, according to the National Health and Nutrition Examination Survey. While health and government agencies have long cited the high costs of obesity -- estimated at $117 billion a year -- the most effective means of belaying those costs has been a subject of debate and controversy. Studies find bariatric surgery to be the most effective means to long-term weight loss; however, the cost is $15, 000 - $30,000 per procedure. Earlier this year, nearly all of Connecticut's health insurers stopped covering the surgeries, leaving patients like those of Dr. Jonathan Aranow, director of the Middlesex Hospital Center for Obesity Surgery, without coverage. Aranow, who is one of about 13 bariatric surgeons in the state, performed about 250 weight loss procedures last year, including Kathy's. He says, although the procedure pays for itself within three years as both insurers and patients recoup medical costs from cured obesity-related illnesses, insurance companies find that patients switch insurers every 1.5 years, sending those rewards to other insurers, some of whom never pay out for the procedure. Although Kathy made it before the coverage dropped, Aranow said the move will be "tragic" for future candidates, 50 percent of whom he expects will not be able to afford the procedure. "Every one of my patients has a story like Kathy," he said. "... Their lives are restored." A bill to require Connecticut's insurers to cover bariatric surgery didn't make it out the door this session, but a handful of other states (Georgia, Indiana, Maryland and Virginia) have passed similar laws. "None of these bills go through in a two-week period," said Aranow, who had a hand in fashioning the bill. "It takes years to get things through."

Gastric bypass surgery is not without risk, Some 1.4 percent will die from the procedure and patients are put on heavily restrictive diets for the rest of their lives. Kathy may eat the equivalent of about three cups of food per day; anything else is in danger of coming back up. She cannot drink water with meals, but rather has to drink it 30 minutes before or after a meal to be sure the food will fit in her stomach. "It's not the same as regular throwing up," she said, motioning to her mouth. "The food just comes up. Like projectile." As a result of the surgery, Kathy cannot indulge in high-sugar foods or high-fat food without getting extremely ill, a common side effect of a restructured intestine, which can no longer absorb certain foods, said Aranow. Although Kathy no longer takes any prescription medications, she must drink protein-laced water and take vitamins and shots of vitamin B. Plus, she is actively involved in an online obesity support group and sees a personal trainer, Linda Nenninger at Advantage Personal Training in East Lyme, three days a week. She still has 40 pounds to lose. "This is not a quick fix," said Kathy. "You get out of this surgery what you put into it. It is hard work to succeed and change for life. I have to exercise every day, completely change my lifestyle and my relationship with food -- so that it is no longer my best friend."

Joe is one of the rare few to have found success on a traditional weight loss program. Even his brother, Anthony, has gained back much of the weight he'd lost. A widely cited study, the Swedish Obese Subjects intervention trial, found that after eight years, those who tried non-surgical weight loss procedures had actually gained 0.8 percent of their total body weight versus a 16 percent decrease in surgical patients. Joe said that although he considered surgery, he found it too restrictive for his lifestyle. A couple of weeks ago, he spent three days in Las Vegas with friends and said he was definitely not on a diet. He came back 6 pounds heavier. "They lied to me," he said. "They told me what happens there, stays there." For Joe, being able to indulge once in a while was every bit as important as losing weight, and he does not regret his decision.

Either way, both Kathy and Joe have seen the greatest change in their self-esteems, not their waistlines. On a cruise two weeks ago, Kathy said her husband had to keep track of her. She enjoyed the new attention she got as men opened doors for her, smiled at her and paid her other attention. "She does not like looking in the mirror. This is something she's had to overcome," said Nenninger, leading Kathy through a rigorous, hour-long exercise program last week. For each exercise, Linda communicated using the few words Kathy taught her to sign, touching her shoulder to make her work harder. The two talked for weeks over e-mail before Kathy's first session and still communicate over e-mail daily. "I knew because Kathy was deaf, I had to explain to her all this equipment before we met," Nenninger said, as Kathy huffed through a set of back exercises, signing to her trainer that she talked too much. At opening time at Illiano's last week, Joe fielded a phone call from his mother, wishing him a happy birthday. Briefly lapsing into Italian, Joe explained, "It's my mother. She wants to know when I'm going to get married." When he and his friends go out to a bar, Joe said, he doesn't hide in the corner anymore, he said. He's more confident. Joe exercises by walking every day to the supermarket and back and has encouraged his brother to get back on the program. "Now we call, we're all of a sudden this little sewing circle, gossiping about little recipes," he laughed.