Finding freedom: Weight-loss surgery program helps patients regain health, quality of life

By Anne Polta

Staff Writer

Jean Lesteberg is finally wearing makeup again. Shopping for clothes is a treat rather than torture. "I like my freedom. I can do whatever I want when I want," she said. "I can cross my legs again. I just feel better."

Lesteberg, 52, of Murdock, has shed 83 pounds since undergoing gastric bypass surgery last June in Willmar. She is the second person to receive surgical treatment for obesity through a new program offered jointly by Affiliated Community Medical Centers and Rice Memorial Hospital.

The 1-year-old program gives patients and physicians a last-resort option for treating morbid obesity.

The surgery is the most recent strategy to be added to Affiliated's Weight Control Center, which opened in 2003. Providers said it rounds out what the medical community is able to offer patients who need to lose weight, especially those who haven't been successful with less drastic measures.

"This is a disease. There really is a role for surgery," said Dr. Steven Bell. He and Dr. Thomas Lange and Dr. Steven Kidd are the three surgeons at Affiliated who have been trained in gastric bypass surgery.

With more than half the American adult population overweight and as many as 30 percent obese, increasing numbers of people are turning to surgery as their last hope.

Lesteberg is one of them.

Growing up on a farm, "I was my dad's helper. I was very muscular when I was young, very fit," she said.

That changed in adulthood. Her weight soared through each of three pregnancies; each time it became harder to shed the pounds. Ultimately she reached more than 220 pounds.

"I've gone to Weight Watchers. I've done the diet pills. I went to a weight loss clinic for a year. I followed the program and I couldn't lose 20 pounds. I was discouraged," Lesteberg said. "I had the willpower. It just wasn't working for me."

It's a typical story for patients who are seeking gastric bypass surgery, said Kathy Schmoll, the nurse case manager for bariatric surgery patients at Affiliated's Weight Control Center.

It's not uncommon for their metabolism to be wildly disrupted from years of alternately dieting and regaining weight, she said. "For them weight loss becomes a very vicious cycle. The only option left for them is weight-loss surgery."

For many of these patients, it's not just a question of losing a few pounds. Often their long-term health is at stake.

From diabetes to high blood pressure to joint disease, physicians increasingly are dealing with the consequences of obesity, Lange said. "That's what our primary care physicians are seeing. They keep running into treating all those other diseases. They know obesity is a big factor in those."

Local providers recognized there was a need to make weight-loss surgery more available to eligible patients who can benefit from it.

"The question wasn't so much, do we have patients in this area who should have this surgery? The question was should we be providing this surgery?" said Bell. "This at least opens the possibility they can have the surgery in this area."

Providers purposely took a deliberative approach to developing the service. Indeed, they waited to add it until the other components of the Weight Control Center -- nutritional and psychological counseling and exercise -- had been in place for at least a year.

In part, this was in response to ever-tightening requirements for insurance reimbursement.

"The insurance companies want to make sure the patients qualify for the surgery, that they are educated before surgery," Schmoll said. "They want that patient to be followed up. Before they even see the surgeon, we make sure that patient is committed to the program and has begun to make lifestyle and behavioral changes before they have the surgery."

More importantly, local providers wanted to ensure good outcomes for these patients.

"You could just do the surgery and not have any pre-surgical evaluation or post-operative support. I think that can be a disservice to the patient," Lange said. "We wanted to do it well and safely. We're trying to keep the patient's best interest in the forefront."

They also wanted to be sure that the right multidisciplinary approach was in place.

A work group was created with Rice Memorial Hospital, for instance, to make sure that the team caring for patients during their surgery was appropriately trained -- including their sensitivity to the daily struggles that many of these patients deal with. There were critical needs such as larger beds, larger X-ray equipment and so forth.

"We understood it was going to be a slow process. We wanted it to be slow. We wanted to get the best experience out of this that we could," Bell said.

Since the surgery first was offered here a year ago, surgeons have operated on about a dozen patients.

By the time Lesteberg sought gastric bypass surgery, she had been struggling with her weight for more than a decade.

She hated shopping for clothes because nothing fit right. She stopped going upstairs in her home because climbing the steps was too exhausting.

"I was mad at the world, mad at myself," she said. "No matter what I did, I couldn't get rid of it. Nothing worked."

Almost a year later, her life has been transformed. She has lost almost half of her body weight and her waistline has shrunk by 13 inches.

She has rediscovered the pleasure in little things -- being able to hold a grandchild on her lap, planning a weekend shopping trip.

Her self-esteem is way up. "Now I own a full-length mirror. I walk by it daily," she said.

Most patients who opt for weight-loss surgery are seeking to regain a normal life, Schmoll said. "They don't look at the surgery as wanting to be skinny. They want to be healthy again. They want to enjoy life. They want to be with their family. Their quality of life increases so much because they've gotten rid of the weight."

Education and support are critical, however, in helping these patients adjust to their post-surgery selves, she said.

Often they have accumulated years of depression, anger and frustration that need to be exorcised. As they shed the extra pounds, the dynamics of everything from their self-image to their relationship with spouses, family and friends can change.

"They have to learn how to accept positive comments. They've never heard that before. Even how people look at them is so new to them," Schmoll said.

Feelings of loss often hit them within the first month after surgery, she said. "They go through a grieving process. They have given up their best friend -- food."

The psychological support "made a big difference," Lesteberg said. "I got rid of a lot of frustration in that room. The group here is wonderful. They answer everything. They're willing to talk and explain anything. And my husband has been behind me 100 percent."

Lesteberg says she would do it all again "in an instant."

"You're always opening doors and they're getting slammed in your face. This one won't shut on you," she said. "You can open it and keep walking through."