Weight-Loss Surgeon: Christie-Style Secrecy Common, Stigma Lingers
I'm not sure which is grabbier news: That New Jersey Governor Chris Christie underwent weight-loss surgery in February or that he felt compelled to keep the operation secret until The New York Post was about to publish a story about it.
I asked Dr. Daniel B. Jones, director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center and a Harvard professor of Surgery, for his perspective. He began by emphasizing that all patients are entitled to privacy about their health care, including a governor. He went on:
That said, it is not uncommon for patients, when they have weight loss surgery, to say, 'I don't want anyone to know about this.' We try to get patients over that hump as part of the pre-operative evaluation.
As physicians, we really want patients to identify: Who's your support group? Who's your champion? If your spouse doesn't know what you're doing, they'll bring junk food into the house; if family members don't know, they may think you're not eating enough. So we really want some core people to know what's going on. That said, most people do have a core group but don't want other people to know.
We don't know the reason but we think there's still sort of a stigma to having weight-loss surgery. So even though we're doing 150,000 weight-loss operations a year [in the United States], there's the idea that if you have a weight-loss operation you're somehow 'taking the easy way out.' You're kind of 'cheating.' You're just not tough enough to do the diet and exercise required for weight loss. You're somehow 'weak,' right?
We even see this with gastric bypass patients who, six months after surgery, when they've lost 100 pounds and they're healthier and more mobile, they still ask themselves, 'Should I have done this without an operation?'
So this is sort of normal. In fact, I had a nurse — this was a real clandestine operation. She came in with a separate name, only a bare-minimum number of people got to know who it was. It was done in complete secrecy, but three to four months later, after her lap band was working, the whole hospital knew she'd had it. So what happens is, you reach a point of 'Everyone can know.'
I quote people a 40-percent chance that the band over their lifetime will need to be repaired, revised or removed.
The other part of it is a concern that you might fail. And the pressure's kind of high. So once you're winning, everyone likes to share success. Not everyone knows whether they’re going to achieve it. You have to remember, everyone who's had a weight loss operation has, by definition, already been on multiple diets — that's a requirement for any operation in an accredited bariatric program. It's very common for people to have lost 15 or 50 or 100 pounds, and for one reason or another they've gained back even more. It has to do with our physiology. It's not about willpower.
The body has a set point and whether you like it nor not, your body hovers there. So if you diet in the traditional sense and knock the weight down, your body thinks you're somehow starving it. And the first chance it gets, it fires off chemicals that not only push you back to where you started, it sets your new set point higher. We call this yo-yo-ing.
Whether it's the band or the sleeve or the bypass, [weight-loss operations] do things that make it possible for people to get the weight off and keep it off.
It undermines that physiology. [...] Diet and exercise only work for about 5 percent of people who get it off and keep it off. The vast majority of us who diet end up getting heavier, to the point that today, obesity is the leading disease, causing hypertension, Type 2 diabetes, sleep apnea, it's linked to certain cancers, back pain, knee pain...The good news is that if you get the weight off, most of these things go into remission and not only do you live better, you live longer.
But mightn't Christie, I asked, have added to the stigma by keeping his operation secret?
I would say, look, here's a guy who's been honest enough to admit he has a health problem. He's brave enough to seek a solution he thinks will work for him. And I would applaud him for going public because he's going to make it easier for other people to step up and address their issues.
So he's done what you want from a leader. He hasn't said he's perfect; he's said, 'I have a problem. I'm addressing it. And if my talking about it makes it easier for you, great.' I'm not from his state, but I'd vote for him and if he decides to run nationally, I'll get an opportunity.
A final question: Could his surgery end up harming his health in the future?
Every 20 to 30 pounds he loses, he's going to have more energy, feel healthier, sleep better, be more on his game. So weight loss will help his health for sure. I think you've got to realize that the lap band typically allows you to lose 50 percent of your extra weight. So if you're 150 pounds overweight, the goal is to try to get 75 pounds off. But 75 pounds is like seven bowling balls — that's a lot of weight to take off, and will improve your overall health considerably.
The key thing is for him to see his doctor, and have band adjustments when needed to tighten or loosen the band. In order to make this work, it's not easy — he has to make good choices throughout his day, avoid sweets in large proportions, and alcohol, and do all the things you do on a diet. The lap band is typically a tool to help you not eat those big portions, but you have to make the decision to eat healthier and exercise more, just like on a diet.
When someone asks a doctor or surgeon, 'Is there any chance of anything going wrong?' the answer is always yes. I quote people a 40-percent chance that the band over their lifetime will need to be repaired, revised or removed. So it may not always be there, but if he can get the weight off and get into a lifestyle that works for him, that would be great. Not that you can't have complications with the band, but there would be no reason it would slow him down from taking the highest office.
Readers? Thoughts? Personally, I can't help imagining White House dinners with very small portions...