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Oliver Varban, left, performing a laparoscopic gastric bypass, one of the most common weight-loss procedures. By Gina Kolata. It was Oct. The next day they were going to have an irreversible operation. Were they on the threshold of a new beginning or a terrible mistake? They were strangers, scheduled for back-to-back bariatric surgery at the University of Michigan with the same doctor. He would cut away most of their stomachs and reroute their small intestines.

They were almost certain to lose much of their excess weight. But despite the drastic surgery, their doctor told them it was unlikely that they would ever be thin. Nearly , Americans have bariatric surgery each year. Yet far more — an estimated 24 million — are heavy enough to qualify for the operation, and many of them are struggling with whether to have such a radical treatment, the only one that le to profound and lasting weight loss for virtually everyone who has it.

It often le to astonishing changes in the way things taste, making cravings for a rich slice of chocolate cake or a bag of White Castle hamburgers simply vanish. Those who have the surgery naturally settle at a lower weight. Over the last year, I followed Keith Oleszkowicz and Jessica Shapiro — a computer programmer and a college student — from their surgeries through the transformations that followed.

The operation, increasingly common as obesity threatens the health of millions of Americans, changes not just the bodies of those who have it, but also their lives: how they see themselves and how they relate to their romantic partners, co-workers and families. As the pounds fell away in a society that harshly judges fat people, Keith and Jessica, two ordinary Americans, would go through an extraordinary experience, one that brought both joys and disappointments.

Jessica, 22, lived with her mother and grandmother in Ann Arbor, Mich. At 5-foot-3 and pounds, she had a difficult life. She needed a seatbelt extender on airplanes. She was unable to cross her legs. She had acid reflux and mild sleep apnea, which meant she woke up at night about seven times an hour. She never had a date and no man ever seemed interested in her. Total strangers lectured her on how to eat.

And she suffered unexpected humiliations, like when she went to an amusement park with friends and the ride attendant pulled her aside and asked her to try pulling the safety bar over her stomach. She tried programs like Weight Watchers, but her urge to eat, as powerful as the urge to breathe when holding your breath, defeated her. It is a drive, obesity researchers say, that people who have never felt it find hard to fathom. He was 40, married with a teenage son, and worked as a programmer at a big automaker.

His wife, Christa, had had the operation two years before, after pondering it for nine years. She lost pounds and felt that her life had been transformed. The complication rate was much higher at that time, and the death rate at one year after surgery was 4. Amir Ghaferi, a bariatric surgeon at the University of Michigan, told me. The one-year mortality rate today is 0. Keith, at 5-foot-9 and pounds, was not as fat as his brother had been, but he was having physical and medical problems.

He somewhat hesitantly listed some of them: His ts hurt; moving around was an effort; he could not bend down to tie his shoes; he had sleep apnea and had to use a continuous positive airway pressure machine to push air into his lungs when he slept; he had high blood pressure.

He had lost 10, 20, 30, even 40 pounds at a time over the years with various diets, but he was plagued with insatiable urges to eat. The weight always came back. But, he stressed, it is not as hard for a guy to be fat as it is for a woman. Researchers have found that there is more prejudice against fat women than against fat men. Still, Keith suffered many indignities. As , he was teased and became so ashamed of his body that he could not bring himself to undress for gym class. So he wore his shorts and T-shirt under his school clothes and spent the rest of the day with those sweaty clothes underneath.

He even had his own amusement park moment, at the same place, Cedar Point in Ohio, where Jessica had been embarrassed. Yet he had a hard time committing to the surgery. It was such a big step, and once it was done, there was no going back. By the day of their surgeries, Oct. They had had medical and psychological tests. They went to counseling and mandatory sessions explaining what was going to happen, and what to expect and how to eat afterward.

They learned that the gastric bypass operation both had chosen it and a procedure called the gastric sleeve are the two main options leaves patients unable to absorb some vitamins and minerals. They would need to take supplements daily for the rest of their lives.

For two weeks before the surgery, Jessica and Keith followed a high-protein liquid diet to shrink their livers. People with obesity often have large, fatty livers that can get in the way during the operation. The day before, Jessica stood at her kitchen counter preparing a mango protein shake with mango flavored Crystal Light and protein powder. It smelled foul. She forced herself to swallow it. At the next morning, a nurse and a surgical resident wheeled Jessica into an operating room on a special wide gurney.

The surgeon, Dr. The screen showed gleaming golden bubbles of fat that were surprisingly beautiful. Her intestines were obscured by fat, so he used a special surgical grasper to gently push the fat aside. It might seem reasonable for Dr. He explained that there is a mile of blood vessels in every pound of fat. He stapled and sealed the pouch with a device that looked like a saw-toothed pair of shears, leaving a shiny metallic edge of staples. Then he grabbed the top of her small intestine and attached it to the stomach pouch. And there was much more of it — his organs were buried in it.

Men tend to have thicker abdominal fat, Dr. Varban said, and it is slipperier, harder to grasp with the laparoscopic instruments. Jessica and Keith spent two nights in the hospital and then were discharged, with instructions to follow a liquid diet for a couple of weeks and then gradually add solid foods. Jessica was surprised by the pain. When she was home, recuperating, she started to have second thoughts about the surgery.

One day, she sat down and cried. For years, surgeons thought weight-loss operations worked because they made the stomach so small that it hardly held any food. And with the bypass operation, they made it even harder for food to be digested. Of course patients lost weight.

A simple surgical treatment, the gastric band, which constricts the stomach, was widely used when it was first approved in but fell out of favor because its effects on weight were variable and almost always smaller than those of the other operations. At a recent meeting of Michigan bariatric surgeons, one doctor asked for a show of hands. Who in the room would refuse to do a gastric band procedure even if a patient asked for it?

Just about every hand in the room went up. Varban said. Even leaving aside the gastric band issue, the idea that the bypass and sleeve surgeries were a mechanical fix, by limiting the amount of food a patient could eat, did not seem right. In contrast, patients who had bypass and sleeve operations reported that they were not particularly hungry afterward, and that their incessant urges to eat vanished.

Even more surprising, their taste for food often changed.

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