Life After the Knife 

Far from being a quick fix, weight-loss surgery is merely the start of an arduous physical and emotional journey.

On Denise Stracner's third date with Andy, a fat woman on a motorized scooter rolled into the Emeryville Starbucks where they sat sipping drinks.

"Can you imagine living like that?" Andy whispered.

"Actually," Denise replied, trying to keep her voice light, "I can."

"What do you mean?" asked Andy, whose name has been changed for this article to protect his privacy. With her stylish shoulder-skimming blonde hair, pale blue eyes, slender frame, and professed penchant for adventure, Denise appeared to have nothing in common with a woman who evidently had trouble walking because of her size.

"I'll tell you later," she said, thinking of the photograph in her car she'd brought along that day for that very purpose. "I promise."

She kept her promise later that day, and the story went like this: Three years earlier, Denise, who stands five foot three, weighed 341 pounds. She had dieted off and on since childhood, yet all she'd ever lost permanently was her gall bladder. That was the result of dropping sixty pounds too fast, which had led to a bout with pancreatitis. She was nevertheless healthy and relatively happy. In November 2003, when she embarked on weight-loss surgery, Denise had a live-in boyfriend, an infant daughter of whom she and her ex-husband shared custody, a lovely house in Castro Valley, and a well-paying job as a nurse. By last June, when she answered Andy's personal ad on Craigslist, she was down to 145 pounds.

That brief snapshot makes the weight-loss ordeal sound painless, but far from it. The common view of these surgeries is that they mark the end of a fat person's problems, when in reality they represent the beginning of a very long process. And it's these post-surgical physical, emotional, and financial travails that we seldom hear about. "When people hear 'weight-loss surgery,' they often think it means taking the easy way out, that it's a quick fix," Denise, 34, explains. "But it's not. Not in any way, shape or form."

Weight-loss, or bariatric, surgery has been around since the 1960s, but recent years have witnessed an explosion in its popularity. Last year, 177,600 Americans had one surgical procedure or another, an increase of nearly fourfold from 2001, according to the American Society for Bariatric Surgery. Most of the patients — about 80 percent — are women, in no small part, experts suggest, because fat women in the United States face a greater social stigma than fat men.

The procedures can offer astonishing benefits for people with obesity-related health problems. According to a recently published research review in The Journal of the American Medical Association, 77 percent were cured of diabetes, 70 percent lowered their cholesterol, 78 percent bid adieu to high blood pressure, and 86 percent no longer suffered from sleep apnea. For obese but otherwise healthy patients, a respite from society's judgment is often reason enough to go under the knife.

Yet the potential downsides are also astonishing. The risk of death, depending on which study you're looking at, ranges from 0.2 to 2 percent — arguably high for an elective procedure. The popular Web site hosts a memorial page listing 132 members who have died since 2000, a mere fraction of the total post-surgical deaths. Up to 20 percent of patients require subsequent operations to address complications. Common side effects include diarrhea, nausea, vomiting, lactose intolerance, signs of nutrient deficiency such as anemia and hair loss, agonizing stomach pain, and shockingly pungent gas and stool. And those who lose weight successfully often have huge folds of excess skin to deal with.

These post-surgical ordeals, and the accompanying emotional adjustments, can persist for many years. Then there's the cost: Even if insurance covers the initial surgery, the price of subsequent cosmetic procedures and myriad dietary supplements required for optimal health can add up quickly. To top it all off, there's no scientific evidence that weight-loss surgery makes people any happier in the long run.

Despite all of this, more and more people are forging ahead. "Even for most people who've had serious complications, some lasting years, they say they'd do it again in a heartbeat," says Dr. Bill Hartman, a San Francisco psychologist who evaluates patients considering bariatric surgery. "For the vast majority of people, their quality of life and health are tremendously improved."

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