TUESDAY, May 14 (HealthDay) -- More overweight Americans than ever seem to be shedding pounds through surgery that shrinks their body's digestive system, making it harder to eat and process large meals or foods rich in fats and sugars.
However, for Tanya Dyce Lovelace, losing weight was a secondary concern. She had the surgery because she wanted a baby.
Surgeons who perform the operation, known as gastric bypass surgery, say chronically obese women have discovered the rapid weight loss provided by the procedure also can fulfill their dreams of motherhood.
Lovelace, 31, underwent the surgery in March 1999 after suffering irregular menstruation her entire life due to her obesity. At the time of surgery, she weighed 270 pounds.
Within months, the Brooklyn, N.Y., woman was pregnant. She gave birth to a son in August 2000 and had a daughter three weeks ago.
"Even now, it almost brings tears to my eyes," said Lovelace, who now weighs 200 pounds. "Wanting something all your life and then being told it probably won't happen, and then getting it -- it's going to make me cry now, thinking about it."
Gastric bypass surgery reduces the stomach's capacity to 1/20th of its original size and shortens the small intestine to lower the amount of calories absorbed during digestion, said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in Manhattan and the man who performed Lovelace's operation.
The surgery generally is used only to help morbidly obese people, who carry so much weight it can cause diabetes, infertility, sleep apnea and other diseases. Doctors generally define a person suffering from morbid obesity as weighing at least two times their ideal weight.
Approximately 75,000 people are expected to have the operation this year, according to the American Society of Bariatric Surgery. That would be up from about 45,000 in 2001 and 25,000 three or four years ago.
There is concern among obstetricians that gastric bypass surgery might cause fetal malnutrition, as the expectant mothers have been surgically altered to digest less food.
Roslin said women undergoing the surgery are warned to scrupulously use birth control, as their reproductive system could restart at any time, and to wait until their digestive system has adjusted to the changes before attempting pregnancy.
"Our advice is to wait at least a year," Roslin said. "We don't want them to have a gastric bypass, and then get pregnant two weeks later."
Lovelace says she underwent gastric bypass surgery after her older sister had the procedure and was pregnant with twins less than a year later.
Her sister, Amrhu Dyce, 38, first sought the surgery after hearing from a girlfriend it was a good way to lose weight. She weighed 306 pounds at the time, and suffered from diabetes. Dyce already had a son.
Roslin performed the surgery on Dyce in April 1998. She gave birth to twins in August 1999. She now weighs 174 pounds.
All of the children born to the two sisters showed no signs of malnutrition, Roslin said, although he admitted he would rather have had both women hold off on their pregnancies.
"You play the cards you're dealt, and everything turned out fine," he said.
People interested in pursuing gastric bypass surgery should understand the procedure involves a complicated, intrusive operation that requires up to a week of recovery in a hospital and a lifelong change of eating habits, said Dr. Arthur Frank, medical director for the weight management program at George Washington University.
"It's good surgery. It's gotten a good deal more sophisticated in recent years. But it should very much be reserved as a last resort, when all other kinds of weight loss programs fail," Frank said.
The sisters agree the surgery requires a complete change of lifestyle. Both say they have experienced "dumping," a sick feeling that happens when the patient eats either too much food or food rich in fats or sugars.
Lovelace recalls experiencing horrible cramps after eating a bag of potato chips six weeks after the surgery, cramps so bad she ended up calling an ambulance.
"I really thought I was opening up from the inside out," she said. "That's how bad the pain was. I started to throw up, which alleviated some of it."
Dyce says she went through a stage of anger and depression after getting sick a few times from eating things like chocolate ice cream.
"I was angry because I couldn't eat what I wanted to eat; I was depressed because I couldn't eat what I wanted to eat," she said. "It took maybe about a year before I came to terms and decided, I can't keep making myself sick by eating things I can?t eat."
Both sisters said they would still recommend the surgery to others, particularly people who are very obese.
"I would tell them to go ahead and do it," Dyce said. "But I would tell them that there is no way you will ever eat the same way again."
What To Do
For more information on obesity surgery, the American Society for Bariatric Surgery has some comprehensive guidelines.
Or check out your own BMI and information on weight guidelines at the National Institutes of Health.
