Fighting fat with surgery: pros and cons
There is a gap of six months between my first and second meetings with Wayne Burns, and during that time he has shrunk by 64kg. The physical change is less startling than you might expect.
In the car, as he drives me from the station to his home, near Prescot in Liverpool, north-west England, I can see that there is more space between him and the steering wheel.
There is room for him to take his hands off it and wave them around in the air to demonstrate the wiggle of his intestines, which have been bypassed in the surgery during which 70% of his stomach was removed and thrown away. Otherwise he looks the same, only slightly deflated.
As he approaches the anniversary of the operation, Wayne’s weight has dropped nearly 95kg, from 197kg to 102kg. Things have gone well, but he is curiously downbeat. When you read about these transformations (usually illustrated by a skinny person standing, slimmer-of-the-month-style, in one leg of a voluminous pair of now-discarded trousers), you are left with the impression that the process is a simple transition from fat misery to slender happiness.
Wayne (45) is more circumspect. He does not pretend to feel triumphant or exultant. Losing that much of yourself is a painful business, physically and emotionally, and one that has left him with difficult existential questions.
“I have good days and bad days, to be honest,” he says. “It is such a drastic thing to have happened so quickly. There are times when I have been a bit depressed since the surgery. It is just the overall change I have gone through ... it is a bit overwhelming. I am a completely different person to what I was 12 months ago. There are times when I just do not know who I am any more.”
When I first meet Wayne, in July last year, it is just a fortnight before he is due to undergo a biliopancreatic diversion and duodenal switch. He is anxious, but convinced the drastic step he is about to take is the best way to tackle the weight problem that has made him unhappy since his late teens. He is sitting at home, with his six-month-old daughter, Tiana, who is strapped into a walker, smiling and patting at plastic toys. If his girlfriend, Lindsay Oliver, had left her playing with toys on the floor, that might have been problematic, because Wayne would not be able to lean over and pick her up. If there is one thing that has persuaded him to undergo major surgery, it is the birth of his first child.
“If she is lying on the floor on a mat, I cannot bend down to lift her up. I would struggle to get up holding her. It would really hurt my knees. I cannot take her out to the park. I cannot do the things that a normal dad would do. I hate myself for that.” He has resisted surgery for years, preferring to believe he could lose the weight through his own willpower. He has previously had some dieting success: he once lost 65kg on a Slimming World diet, but put the weight back on in the year.
Recently, however, it has been hard to ignore how ill his weight has made him. He has back problems, high blood pressure, lymphoedema in his legs, cellulitis, sleep apnoea so severe he was waking 10 times a night, until doctors gave him a machine that blows air at his face all night through a mask. Lindsay, who is a nurse, has to bandage the weeping ulcers on his legs. He finds it hard to walk up the 13 steps to his bedroom without getting very out of breath. He has also been finding it harder to do his job properly; as manager of a big electrical goods store, he should be out on the shop floor a lot, but his legs have been hurting too much.
Still, he has had to fight hard to persuade his doctor to refer him for the operation. As cuts to the British health service bite, it has become harder to qualify, and primary care trusts have begun raising ever higher the point at which patients are eligible. “Nice [the National Institute for Health and Clinical Excellence] say you can qualify for surgery if you have a BMI (body:mass index) of 40; local authorities are saying we will not do it unless you have a BMI of 50,” says Tam Fry of the National Obesity Forum. “How bananas is that? It is bad medicine if you are officially required to become a greater glutton to achieve a notional barrier. It is estimated that 500000 people in the United Kingdom could benefit from surgery, but the surgeons and the surgery time are not there to cope.”
When we meet, Wayne is about to begin a pre-op diet to shrink his liver so that it does not get in the way when surgeons cut him open and begin removing his stomach. The operation will take out two-thirds of it, then reroute a large part of his intestines, so that as much as eight metres are bypassed, leaving food to travel through only around 1.5-metres of small intestine – making it much harder for the body to absorb calories. Although the results are usually more dramatic than those produced by gastric bands and balloons, the operation is more complicated and the longer-term potential risks are greater.
Lindsay (34) has been very encouraging, having been through the same procedure in May 2009; as a result of the surgery, her weight has dropped from 184kg to 108kg. She is convinced the operation will make Wayne happier, too. At the moment, despite having a good job, a home, a baby and a supportive girlfriend, he feels miserable.
Wayne spends a lot of his time avoiding doing things that make him feel embarrassed. He has stopped going to football matches because he can no longer get through the turnstiles. On the rare occasion that they go out to eat, he will not look at the menu outside the restaurant, but will peer in through the window to see how big the seats are. Usually he prefers not to go out. He has lost touch with a lot of his friends. “I avoid social situations; I make excuses. I will not go to parties. I put this protective bubble around myself, to make sure I do not get hurt.” When Wayne talks about his problem, he seems to fall back on the language of the self-help groups and slimmers’ classes he is attending with Lindsay.
Wayne can trace how his eating became out of control. As a child he was never overweight. “Then I got introduced to pubs. Originally it was a bit of a beer belly. I am someone who, when they have had a few drinks, needs something to eat, so then I would have a takeaway.
“My parents are overweight and both retired early because of ill-health. My mum is an old-fashioned mum, who feeds you for love. I do not mean that it is her fault in any way, but for her the idea of love is to make sure that you are fed.”
Gradually his eating became unstoppable. “When I get up I have toast, six or eight pieces, white toast, butter and jam. I will have Coke or Pepsi in the morning, a two-litre bottle, probably half of that for breakfast. I enjoy every bit of food I eat, but then I feel guilty, then the only thing that will make me feel better again is eating, then I feel bad again. I go to work and at lunch I’ll have McDonald’s, maybe a large Big Mac meal, with large fries, milkshake, Coke.”
He does not snack during the day, but in the evening, before he met Lindsay, he might have picked up a takeaway on the way home, “a pizza, or a Chinese or an Indian, or something from the chip shop, maybe some beers, some wine. I am pretty much a night eater: I would have my tea at 6pm, then something at the end of the night, some more toast, or maybe another takeaway. I might dial one in around 11pm.
Sore and tired
“You put more weight on when you are living by yourself: there is no one else to look at you, criticise you or make you feel bad about it. I was on my own, so could pretty much do what I wanted. I was okay for money, I did not have any commitments, I did not have a gorgeous baby to buy stuff for.”
Since Wayne has been with Lindsay, his diet has improved, but he has noticed that he does not seem to have a full-up switch. “If we have sausage casserole tonight, I will have six sausages and a plate of mash, piled high,” he says, and Lindsay interrupts: “An hour later he will probably say, ‘Is there any left?’ And he will finish it.”
I call Wayne six days after the operation to see how he is feeling. “I am very sore and tired,” he says. “That is all really. I have seven holes in my stomach which have been stapled up.” Bruising covers his stomach, fading from dark purple to yellow-green. The pain of the procedure has been dulled by morphine. The five-hour operation was performed by the same surgeon who trimmed Lindsay’s stomach in 2009.
For the moment Wayne is on a special liquidised post-operation diet to give his stomach a chance to adapt: mashed-up cauliflower cheese, Weetbix, yoghurt. In the two weeks before the operation, he lost 13kg on the strict preparatory diet, and has shed another 6kg in the past week. “I can have four or five teaspoons of a liquidised meal, then I feel myself full up. I cannot take big bites. For the first few days I felt it just stuck in my throat, just sat there. I got bad wind.” Most of Wayne’s colleagues think he is on holiday because he has not told them he is having surgery. Instead, he is sitting on the sofa with the baby on his knee.
When we meet at Wayne’s home in December, six months after the operation, he remembers how terrible he felt in the immediate aftermath.
“I felt quite lousy,” he says. “I was miserable, in pain, and there was the fact that I could not eat properly. I had a moment a couple of weeks after surgery when I thought, ‘What the hell have I done to myself?’ It’s an irreversible procedure – not like the gastric band – with the worry about the complications that might come if you do not take care of yourself ... You have to manage your diet properly for the rest of your life.”
In the first two months after the operation, he threw up maybe 20 times or so; usually because he ate bigger quantities than his reshaped stomach could cope with, but sometimes from something as insignificant as drinking a glass of water. But he is beginning to feel better.
The family has been on holiday to Egypt and, for the first time since he can remember, he felt brave enough to take off his top. Even though he is still at the big end of what clothes manufacturers call normal, he can go to regular shops. Instead of having to rest his computer on his stomach, he now has a lap for his laptop. He slightly misses pizzas, but finds if he orders a thin one he is no longer able to eat it all; he eats more fish instead.
Unexpectedly, though, Lindsay, who is two years ahead of him in the process, is feeling fed up with the after-effects of the operation. It has helped her to shed a lot of the weight she built up when she stopped being an athlete (she was a teenage shot- put champion), but she has been left with large folds of excess skin that do not disappear with exercise.
“I am not vain by any stretch of the imagination, certainly not, but I do not feel as feminine as I thought I would. You lose your femininity after the operation; you have a flat chest. Your stomach is hanging over your pelvic area.” For Wayne, though, things are much more positive. “It is a miracle cure,” he says.
Plans for the future
“Probably the best thing is being able to be a better dad to my kids,” he says. “I feel like I can do anything. I can make plans for the future; I would not have done that before.” He likes being able to take the kids out now on bikes and scooters. “I would not have been able to do that before. I would have been tired by the time we got to the park gates.”
He was thrilled recently when he was able to put a sock on without thinking about it, for the first time in decades; until recently he had to heave an enormous breath in, rest his leg at an uncomfortable angle on the bed and try to hook the sock over his toes, or he would ask Lindsay to do it for him. “This is a lifetime change I have brought on myself. I am sorry I did not do it sooner.”
But he has been a bit taken aback by people’s responses to his dramatic weight loss. “People come up to me and say, ‘What is your secret?’ There is a bit of negativity when you tell people you had surgery. There is a look in their eyes – ‘Oh, so you cheated.’ Some people think it is the easy way out, but that is so far from the reality.”
The operation is designed to promote malabsorption of food, so if patients are not careful, they can begin to suffer from malnutrition. If they fail to get enough protein, they risk developing osteoporosis, eyesight problems, complications with the liver, kidneys and bones. This is partly why many bariatric surgeons avoid the operation in favour of less radical procedures.
Wayne has to eat 150g of protein a day for the rest of his life, which is not as easy as it sounds: there is only 6g in an egg, 12g in a chicken breast. He has to fortify his milk with Marvel powder and now eats little and often, taking small tubs of nuts with him to work. He has a notepad in which he keeps track of what he has eaten. If he is worried he has not had enough protein, he will take a foul-tasting liquid protein shot. He needs to have his blood analysed regularly to make sure he is getting the right nutrients.
“It is hard work, I am not going to lie,” Wayne says. “I am quite an organised person but I find it hard to make sure I have eaten enough. You need to be constantly thinking about yourself and what you are eating ... I still have head hunger, when you want to eat more than your body needs; I still have cravings for the food I have always eaten, which made me this size in the first place.” Mostly, the past few months have made him focus on how he let himself put on so much weight. “I blame myself a lot. I know it is my fault. There is a lot of guilt – why have I done this to myself? I am cross that I let my body go this way when I knew it was wrong, it was unhealthy.
“If I understood why it happened, it probably would not have happened. I have trawled through everything for a trigger. I got in a rut. You blink and five years goes past. The thing that made me unhappy was being overweight. The thing that made me happy was eating.”
Although the surgery has worked, and his prospects for having a healthy life are vastly improved, getting thinner continues to be a mental strain. Lindsay says she thinks he is still feeling “disgusted with himself”. She adds: “People think you would be ecstatic, but it is not all a bed of roses once you have lost the weight. He is still in torment about how he got into this state.
Wayne agrees. “It is hard to deal with because it is such a psychological, emotional change,” he says. “I have to get to know myself again.” – © Guardian News & Media 2012