Not even the time Mary Ellen Swartz broke a chair in the middle of a store. Not even the time an airplane had to turn around after leaving the gate, with a plane full of passengers, to retrieve a lap-belt extension for her. Not even the time she got stuck in the booth at a restaurant and it took her then-husband 10 minutes to pull her out while other patrons stared.
“Not one of those was incentive enough to lose weight,” said Swartz, 63, of Petoskey. “It wasn’t enough to stop eating.”
 

‘I knew I was going to die’

At 5’1”, Swartz’s weight kept climbing and climbing over the years until she reached 450 pounds, leaving her unable to do much comfortably. Her knees and joints ached, it was difficult to get around, go grocery shopping, do much of anything. She was living in Cleveland at the time her weight reached its all-time high, and the only place she could get weighed was a trucking facility.
Eventually divorcing, Swartz moved to Gaylord in 1995 where she worked as an LPN at Tendercare, a 15-bed ventilator unit facility. Eventually, she couldn’t make it from room to room to see patients without being short of breath herself, and she resorted to doing her rounds in a wheelchair.
“The less you do, the less you can do,” said Swartz. The other ladies on staff helped her as much as they could, grocery shopping for her and helping with on-the-job tasks.
She had reached a level with her weight that even though she was not eating tremendous amounts of food, her body could not lose weight.
After having tried numerous diets through the past with little or no success, Swartz’s situation was growing dire.
“I was extremely morbidly obese,” she said. “I was lucky that I didn’t have cardiac problems, but I had developed diabetes. I did not want to have to give myself shots every day.”
In 2001, she opted for gastric bypass at a Bariatric Treatment Center in Flint. Petoskey’s Northern Michigan Regional Hospital, where she is now employed as an LPN in the acute rehabilitation unit, does not offer the surgical procedure.
The procedure was, in her mind, her last hope.
“I knew I was going to die,” said Swartz. “I knew I was killing myself.”
 

Before and after

Prior to the surgery, patients are required to meet with a psychologist to discuss expectations, lifestyle changes and outcomes. “They want to make sure you’re not doing it become a Playboy Bunny, or to please your husband,” Swartz said. “You have to be doing it for yourself.”
During gastric bypass surgery, doctors staple off a small pouch of the stomach and cut portions of the intestines and bowel to reroute the digestive tract. Swartz’s stomach pouch was reduced to hold 3 ounces; a normal stomach can hold about a half-gallon of contents.
Because her stomach was made considerably smaller, she only recently has become able to eat a whole sandwich at one sitting. Her typical daily diet includes beans, nuts, oatmeal, fresh fruit, peanut butter sandwich or tuna, vegetables and small portions of meat.
In the first few months post-op, Swartz’s weight dropped dramatically, leaving her by 2003 with huge amounts of hanging skin. She recalled having to “roll up her skin” to fit it all into clothing.
She underwent plastic surgery in 2003 that resulted in removal of 30 pounds of excessive skin. She also had double-knee replacement surgery in 2005, completing the process of becoming a new, more active person.
In many cases, because of the bypass around the body’s digestive mechanisms that help process, absorb and breakdown foods, patients like Swartz will need to take supplements for calcium and other nutrients. Protein-rich foods like steak and prime rib can also make a gastric bypass patient vomit immediately after eating, because they’re difficult to digest. She’s also unable to drink alcohol without staggering immediate effects, and is lactose-intolerant now as well.
Because she did not consistently take the suggested calcium supplements, Swartz said she has developed osteoporosis, and she has broken her arm twice since the surgery, most recently on a parasailing trip to South Padre Island — an activity that wouldn’t have been possible a few years ago.
“Everyone says, ‘How’d you break your arm parasailing?’” Swartz said. “Actually, I was walking on the beach and I fell down.”
Having dropped 300 pounds to-date, even breaking her arm doesn’t seem to get her down.
“I feel fantastic, energized,” Swartz said. “I cannot even give it a number on a scale of 1 to 10.”
 

Doctors weigh in

Dr. Todd Sheperd, of Primary Care Sports Medicine in Petoskey, is one local physician who works with morbidly obese patients.
Through his years in private practice in the Upper Peninsula and now in Petoskey, he has treated patients suffering from morbid obesity and has helped them get their lives back on track.
He called Michigan’s rate of overweight residents and obesity “unbelievable.”
“The diagnosis of type-two diabetes in the pediatric level is exponentially growing,” Sheperd said. “And the number of adults who are classified as morbidly obese has grown exponentially in the last 20 years as well.
“There’s not been a shift in the human genome. It’s clearly a lifestyle issue, in the United States in particular.”
During his time in the UP, Sheperd had two articles published on obesity management in the Journal of Family Practice, and he also penned a supplement regarding management of the morbidly obese. His interest stemmed from an inconsistent treatment spectrum he noticed in managing care for the obese.
But his knowledge also comes from common-sense observations about the lifestyles of many Americans today. For instance, a super-sized meal can pack 1,200 calories. “If you were a professional athlete, it would take you two hours of training to work that off,” he said.
The key to reversing morbid obesity is catching it while a person is in their youth, not their 20s and 30s when “you’ve missed the opportunity,” Sheperd said. “The opportunity in the U.S. is to prevent it in the first place.”
Getting those who are obese to get moving can be a challenge in treating them. “Some of them are so overweight they have trouble actually exercising. They’re embarrassed to go to the pool. A lot of them see themselves as so far past gone that it’s almost not worth the effort (to them),” Sheperd said.
Discrimination of the overweight persists as well in a society that covets thinness, adding to the struggle. “People who are obese are two or three times more likely to be unemployed,” the doctor noted.
Gastric bypass is becoming the more standardized recommendation for the morbidly obese, he said. “If their BMI is 42 and they’ve already been through Weight Watchers and Jenny Craig, then you really have to have that conversation, to think about something more invasive,” Sheperd said.
For the morbidly obese, diet pills and many commercial weight-loss programs don’t have lasting effects, he added.
“You can hang your hat on the fact that (gastric bypass) surgery will be the one thing that will offer sustained weight loss over five to 10 years,” Sheperd said.
The onus remains on the patient, however, to work to keep the pounds off.
“Any surgical fix isn’t a fix, it’s a tool,” he said. “There are people I know that have had gastric bypass and still don’t make good choices with their diets. The people who do the best, in my practice, are the ones that go into it knowing what needs to be done: Exercise, make good choices, and high-protein, complex carbohydrate meals are essential. That doesn’t change.”
 

Medical weight management

Dr. Todd Decker, with Bayside Family Medicine in Petoskey, is a co-director of the hospital’s Medical Weight Management Program, which targets obese area residents.
He echoed Sheperd’s comments about the risks of obesity and the growing trend in America, resulting in increasing back and knee and joint problems, arthritis, diabetes, heart disease, high blood pressure and risk for stroke.
While lifestyle is a major player, genetics also plays a role in a person’s weight. “You also have to have the environmental factors. The big issue driving it in this country right now is that some people have the genetic predisposition, and then you throw a poor environment on top of it. Unfortunately as a country, we are growing and growing.”
Hospital staff developed the medical weight loss program to help combat the trend locally, Decker said.
There are two aspects of the program. Optifast is more aggressive and strictly monitored by Decker and co-director Dr. Laurie Kane and a team of nurses, nutritionists, behaviorists and others. “That program is really designed for people generally in the morbidly obese category, or they could be obese with an underlying health problem,” Decker said.
The Optitrim program is not as closely monitored and is geared toward those who are mildly overweight or obese without other major health problems. Residents can join the program by physician or self-referral.
Still, the programs aren’t the complete solution; the patient needs to take responsibility as well.
“Whether it’s a medically monitored or bariatric program, I don’t care what you do — you can undo it if you don’t deal with the underlying issues,” Decker said. “It might be an eating disorder, making very poor food choices, not getting routine physical exercise, depression. And until you really focus on and deal with those issues, you’re not going to be successful in the long run.”
Developing coping strategies is another avenue presented in the medical weight loss program, a track patients need to remain focused on for future success. “Some people try to get in touch with Weight Watchers or Overeaters Anonymous, something to stay accountable to help maintain their weight,” Decker said. “That’s the whole crux, if you don’t have that support aspect in place, the success rate is miserable. If you add a long-term maintenance program into play, it improves that success rate astronomically.”
 
For information on the Medical Weight Management Program at Northern Michigan Regional Hospital, call HealthAccess at (800) 248-6777.