Robert says he had always told himself, “When I can’t do things because of my weight, I’ll fix it.” He’d always been a runner and went to the gym, but slowly those things got harder and harder. He says that even his golf swing deteriorated because his stomach was literally in the way of the required motion. He stopped hiking and many other physical things that he enjoyed because they had become a struggle.
The decline served as a catalyst that brought Robert to the Center for Weight Management and Bariatric Surgery at Wentworth-Douglass Hospital.
“One year before I enrolled in the Wentworth-Douglass Hospital program I broke my knee ice skating,” he recalls. “My PCP gently tried to point out that it wouldn’t have broken if I weren’t so heavy. Then, while in the pre-op process for the surgery, I broke my other knee.”
Cynthia Paciulli Barbarits, MD, was Robert’s bariatric surgeon. She says she understands the frustration that a lot of her patients experience. She acknowledges that even with the most diligent behavior changes, many of them face uphill battles because of genetic or other predispositions to obesity including age, sex, environmental factors, and what she calls personal biology.
“These people work harder than anybody to try to take that weight off and try everything that they can think of,” she says. “And it’s incredibly demoralizing because they cannot fight their biology. It’s stuck in a cycle that they can’t break free from just by saying, ‘I’m going to eat differently.’ It’s not that easy.”
Dr. Paciulli Barbarits also points out that each person’s microbial ecosystem, or ‘microbiome,’ can bring complex factors to the calculation of how their body digests and metabolizes food.
“The microbiome plays a big, big role,” she says. “It really affects our metabolism a lot. They’ve shown with fecal transplants that if you take stool from an obese adult and put it into a lean adult, there’ve been case studies of the lean adult gaining weight, with all other factors being the same.”
She also acknowledges that the deck is stacked against many people when it comes to what food is available to them.
“Some people are raised in what they call ‘food deserts’ and don’t have access to healthier food. Some people never learn how to cook for themselves. Some people have fallen prey to the food industry’s engineering of things to make you want more. If sugar’s more addictive than cocaine, you’re going to eat sugar and your body craves that.”
Robert says the people that run the Weight Loss Center’s bariatric surgery program have been critical to his success.
“The surgeons, dietitians, the support staff, NPs, PAs, and the staff were so kind, considerate, and seemed to understand me as a person, and not an ‘obese’ person,” he recalls. “They knew my family, even if they hadn’t met them. They knew who I was, my profession; they all went out of their way to be personal. During my weeks before and after the surgery, they were very involved and concerned for me.”
In the 4 years since his surgery, Robert has lost more than 110 pounds, down from his peak of around 365. He’s back to regular hiking, spends hours a day in yoga practice, and says he’s in the best shape of his life.
“Now, I feel like my medical status is not a concern in the near term,” he says. “I expect to see the later stages of life and have lost the anxiety about dying from a heart attack.”
Although Dr. Paciulli says that there’s an advantage to having bariatric surgery before you’ve developed other health issues like diabetes, hypertension, or fatty liver disease, she says people like Robert will typically also see great benefit from the procedure.
“All of those things got better after surgery,” she notes, adding that if a person has a body mass index (BMI) of 35 or higher, surgery may well be their only proven option for successful weight loss. “For 95-plus percent of people, nothing else will work once you're at that BMI,” she says.
Dr. Paciulli also likes to emphasize how much the surgery and accompanying behavior changes can change someone:
“Rob is a great example of someone who's really changed his life in a holistic sense. He found himself, and he is now teaching yoga. Wow. He’s really developed that aspect of himself that he didn't have the capacity to do before.”
She says she wants every patient to know that it's not their fault that they haven't been able to lose their excess weight.
“I think a lot of people carry a lot of shame about that—they've tried, and others around them think they should have been able to do it. They think they should have been able to do it. And so, they naturally feel that shame. But there is truly no place for shame in this—it’s like victim-shaming to do that because there are so many factors that were not ever in their conscious control.”
Robert says he’s observed how differently the world interacts with him as a much less heavy person.
“I noticed people make eye contact, which at first kind of blew me away and confused me. I noticed that people smile more at you after you've lost weight. I thought I was a little bit crazy, but then in our support groups there would be other people talking about the same thing.”
His post-surgery life has been full of little surprises like this, but by now it’s par for the course.
“The biggest surprise was that it worked,” he says. “I truly never actually expected weight loss to happen. I had tried so many things throughout my life to lose weight and none had ever worked.”