I just opened the bill for veterinarian services provided for my happy and loyal Russian wolfhound, Sergei. He is happy and loyal because he lives like a czar, is fed regularly and enjoys a brisk walk at least twice every day. If I lived as well as my dog, I would be ever so grateful, happy, and loyal. He was pushing his luck, however, when I found that his medical care cost me $1800.00 worth of luck, happiness, and loyalty. He is about five years old and I have had him for one year. He had an ever-so-slight left leg limp or rather a “hitch” in his gait when he entered my life as a rescue through the Borzoi Foundation.. It was initially a concern and it had gradually become worse over a period of eight months. Recently his left leg spread out laterally on a few occasions as he slipped on the hardwood floors. He did not have the strength in his leg to support his sliding body and it really hurt. Being a very sensitive guy, I worry about me and about my dog. I took him to a good veterinarian and was told he had spinal stenosis (narrowing of the spinal bones around the spinal cord). Surgery on his vertebral column was strongly recommended. Sergei was not too keen on the knife idea so we asked for and received a second opinion and more tests. Under anesthesia, my furry companion had a CT scan of his back bone and a myelogram (instill some dye in the spinal canal to look for compression of the cord). Every thing was normal. They tapped a joint just to be complete. While Sergei lapped up some ice cream for being such a good patient, his diagnosis came to me. He had gained forty pounds after being “rescued” but had only grown a few inches. I had the only “Borzoi Gone Beach Ball” in history. I put him on a diet and an augmented exercise program He has lost about twenty pounds, is very active, and is nearly able to slide on the hall carpet without a hitch or a stumble. Some may say it is unreasonable to pay that kind of money for dog care or that I should be ashamed of myself for allowing the dog to get so fat that his weight actually became a health risk. To my critics I say that if you have never loved a fat dog then you are in no position to judge me.

The same is true for the very fat five percent of Americans who may decide to have a surgical procedure to lose weight. Approximately fifty thousand obese patients underwent the expensive ($10,000 or more) and relatively high risk (one per hundred may die from complications) surgery last year. Some highly visible - both in body size and career path - personalities, such as Al Roper of the Today Show and singer Carnie Wilson, have reported their stories and have placed obesity surgery (called “bariatric” surgery in medical parlance) in the public spotlight. Mr. Roper’s story is a very good one because it points out some very important facts regarding the decision to have surgery to lose weight. First, you have to be fat. How fat? There are three ways to answer that question. As Mr. Roper related, if you look like the Bill Cosby’s cartoon character, Fat Albert, you are likely fat enough. Put into numbers, if you are one hundred pounds over your ideal body weight, you qualify. Finally, the scientific answer is based on your body mass index (BMI) that relates your weight to your height. If you have a calculated BMI greater than 35 plus some complications of obesity or have a BMI over 40 without any complications yet, you are fat enough to consider surgery because there is no other effective treatment. Dieting certainly must be tried first but it almost always fails to reduce weight significantly. To calculate your BMI, multiply your weight in pounds by 705 and divide that number by your height squared. For Mr. Roper, at 320 pounds and 5’8” (68 inches) tall, the calculation would look like this: (320 X 705) divided by (68in. X 68 in.) equals a BMI of 40. 7. For your calculations, if your BMI is over 25, you are “overweight.” If your BMI is over 30, you are clinically obese; and if over 35, “morbidly obese” and a candidate for surgery in addition to continued diet and exercise.

The most frequently performed surgical procedure involves creating a stomach pouch about the size of an egg and connecting the pouch to the intestine in such a way as to reduce digestion and absorption of the small amount of food that pass from the tiny gastric pouch. Most patients will lose half of the excess pre-operative weight, i.e. at least fifty pounds. As a consequence of the weight loss, diabetes and blood pressure should improve and heart and lung problems should improve. It is also important to note that disabled obese patients are far more likely to return to work after this surgery. They also live longer as well as healthier than the very obese patients who cannot or will not consider surgery. There are significant risks to the procedure. First, any operation on a very obese patient is dangerous. Pneumonia, blood clots, heart attacks, and wound infections are potentially lethal. The best protection against complications is to seek a qualified surgeon and have the procedure done in a center that does bariatric surgery regularly. Second, bariatric surgery is not covered by all insurance plans. It should be, but it is not. Talk to your insurance company before you have surgery. Third, there are a great many emotional issues that may attend the stress of the operation and that associated with a dramatic change in body size and appearance. Psychological counseling is a very important component of the pre-and post-operative course and most centers will provide this support. For the very obese, surgery is a good answer and actually it is currently the only answer for their life threatening condition. Even though reversal of obesity is surgically possible, is it a reasonable and appropriate choice? Only the people in that situation are qualified to answer that question. Sergei and I would support their decision.