More obese Irish people are choosing the surgical option as gastric bypass surgery is now available on the HSE. Angie Mezzetti reports
'Try telling an addict to score in moderation or to inject only 'healthy heroin' and not after 6pm."
This is how Frances (not her real name) describes what it was like to suffer from a compulsive eating disorder which caused her to put on five stone in four years after her children were born. She got caught in a stressful spiral of eating, while trying to keep up with four small children, a husband and a demanding job and her weight went up to 22 stone. "I was a size 32 and I had to take pain killers at night to get to sleep because my feet hurt so much."
Not being able to do the normal things with her children hurt most. "If I went to the beach I wouldn't sit down in case I could not get up. Even at the funfair I had to bring a teenager along to go on the rides with the children," she says.
Frances is on the road to recovery from her eating condition thanks, she says, to the psychological counselling she received at Loughlinstown Hospital's weight management clinic. She also had a gastric bypass performed there using keyhole surgery.
After she saw the clinic's psychologist, Ruth Yoder, she says she never looked back. "She turned my life around even if I had never had the surgery," she says. "The whole team of dietician, physiotherapist, doctor and psychologist showed such understanding. Even if I'd never had the surgery I cannot stress the importance of the psychological counselling enough. They showed me that I had to put my own emotional needs first and that everything did not have to be perfect."
Obesity is the last socially sanctioned prejudice, Yoder says. "People think they have the right to hurl abuse at obese people for having an eating problem. Patients who are obese are largely invisible and some rarely leave the house because they face such comments and stares. It seems that it is fair game to openly mock people who are obese because it is seen as self-imposed," she says.
Pats on the stomach followed by comments asking her when she was due were typical of the type of thing Frances had to put up with before she went to the clinic. Once, a friend of her husband said in Frances's hearing: "I don't care what she looks like, she's great craic" as though this were a compliment.
Sandra Nweke, who has also had the stomach bypass surgery in Loughlinstown, says people used to stare at what she was putting in her trolley in the supermarket. She would recommend the clinic to anyone, even if they didn't want the bypass.
The psychological assessment was a very important part of the process, not only for Sandra, but also for her husband. "They brought the two of us in for counselling beforehand as my husband was concerned that my feelings for him might change when I lost the weight."
In one year, she has lost 12 stone. Her weight will continue to drop until it stabilises in about six months' time. She goes to the gym five times a week and does water aerobics. "My goal is to be lying on a beach in a bikini for my 40th birthday."
When a patient attends the weight management clinic initially, they will have a consultation with the doctor and will meet a dietician and a physiotherapist who can assist with muscular skeletal problems, as obesity can cause problems with joints and mobility.
"Psychological assessment is very important," says Yoder. "If patients don't deal with the underlying issues causing them to overeat, surgery is not likely to help. They have to find another way to deal with their problems, otherwise they will just turn to another form of addiction, like smoking or drinking."
Some patients are completely unaware that they use food to address their issues. "We caution people that surgery is not going to be a magic bullet that will solve everything. They will still have the same spouse, the same home and mortgage." Access to the psychological services are lifelong.
Obesity is still a big problem in Ireland, according to Dr Donal O'Shea, medical director of the unit in Loughlinstown. "Health education is not getting through, the referral rate is increasing, the size is getting bigger and the age of people being referred is getting younger." The latest childhood data shows that 10,000 additional children are becoming obese each year.
Losing weight is difficult, O'Shea believes. And he agrees that there is a huge genetic component to weight management. "The body sees any weight loss as a threat and will defend it. Only significant sustained lifestyle change will result in weight loss."
Gastric bypass surgery is being carried out at Loughlinstown at the rate of about two-three a month. To date, they have operated on 70 people. It is only an option for men over 21 stone and women over 19 stone.
While it is the only guaranteed effective treatment for morbidly obese patients, it is not something to be done lightly, O'Shea says, as there are risks with any kind of surgery and there can also be unpleasant consequences. "There will be lots of food that they will no longer tolerate. They will feel very full even after a glass of water and hair thinning is a common occurrence."
Not everyone who is eligible for surgery in Loughlinstown actually wants it. "Only half of patients offered the possibility of a bypass will opt for it," says O'Shea. The emphasis for the clear majority of people attending the clinic is on conservative weight management.
Long-term care is part of the programme and there are three check-ups in the first year. All patients are put on a course of vitamin supplements, iron and calcium. Lifestyle change is necessary to maintain those lost pounds.
O'Shea expresses concern that anyone considering going abroad to have the operation may not be given adequate psychological and medical assessment. "People need to be screened. It would be a disaster to do surgery on anyone with a binge eating disorder."
Some patients, who have attended Loughlinstown after undergoing the operation abroad, say psychological counselling was not a feature of their foreign treatment. Some had a one or two-day assessment before their surgery, only routine blood testing and a 'hand wave' at psychology. "This is a life-changing procedure which needs life-long medical follow-up," he says.
Patrick Cosgrove, who had the surgery in Leeds almost two years ago, has set up a business to help other obese people get the gastric bypass surgery done abroad. He was 32 stone and was super obese with a body mass index of 71 when he started inquiring about surgery. He had been attending St James's Hospital and was on a waiting list for five years.
He tried to get transferred to the weight management clinic in Loughlinstown to no avail. Before his operation he had one consultation with the medical team in Leeds. The surgery cost him €22,000 but he says it was worth it. "Other people spend a lot more on their cars and think nothing of it."
After the operation he says the weight loss was steady for the first 16 months and almost two years on, he weighs just over 13 stone. So many people were asking him about the operation, he has set up an advice service.
"I have 50 people clamouring for surgery, many of them have dates from now till September. We are working as middle men and can help people depending on what they want," he says.
"For people with only two or three stone to lose, we recommend gastric banding. For those with a lot of weight to lose - eight stone and over - we recommend bypass surgery."
His company offers to book the consultation with the doctor in Leeds, surgery, flights for the patient and their partner, all accommodation for the week and taxi fares for £15,000 (€22,000). Counselling is not part of the service.
"Generally when people come to us they are at the end of their tether and [ if] they are willing to make that commitment we take them on," he says. "We have had three people here in Leeds this week for open stomach gastric bypass surgery and a day-and-a-half later they are up and moving around."
Patrick's company claims to have helped 39 people to have the procedure done in its first year of business.
Ruth Yoder says the evidence shows that, without counselling, two years after their dramatic weight loss, people will revert to their pre-surgical levels of depression and anxiety if they have not dealt with the underlying cause. However, more people are likely to be able to avail of the surgery in Loughlinstown in the coming years as increased funding is being provided by the HSE.
New medical and support staff are being appointed and they have made alterations to the infrastructure in the hospital to accommodate larger patients.
The average wait to be seen in the clinic up to now was four years. "With the new funding we are hoping to clear the backlog in 18 months. Once you are on the programme and seen by the team, surgery can be an option in two-three months," says O'Shea.
Surgery is by no means the easy option, Sandra Nweke believes. "You have to take your time and look after yourself to do it right and be mentally prepared. I am so grateful as they have given me my life back."