The ugly truth about having a gastric bypass: The frank diary from an obesity nurse
By Sandra Walsh 00:36 BST 22 May 2012, updated 00:36 BST 22 May 2012
The ugly truth about having a gastric bypass: The frank diary from an obesity nurse
Over 5.5 million Britons are now officially obese.
It’s a grim statistic: obesity can lead to arthritis and breathing difficulties as well as heart disease, stroke and cancer.
This is also costing the NHS dearly — it spends an astonishing £4 billion a year on treating obesity.
An increasingly popular option is stomach-shrinking surgery.
To qualify for this treatment on the NHS you must have a body mass index of 40, or between 35 and 40 and also have type 2 diabetes or high blood pressure.
Surgery is said to be the cheaper alternative in the long run and, last month, Scottish doctors said that unless more gastric ops were performed, the NHS would be bankrupted by the costs of diabetes and obesity care.
But is it just the ‘easy’ option?
We asked a nurse working on an obesity (or ‘bariatric’) ward at a large NHS hospital in the south of England to keep a diary for a week.
We have chosen not to reveal her name or the patients’ to protect their identities.
My first patient of the day is Michelle. Aged 47, she weighs 28st. Her body mass index is over 50, compared with a reading of 18 to 25 for an average woman of healthy weight.
Michelle is sitting on one of our reinforced high-backed chairs wearing a hospital gown as big as a sheet; her stomach rests on the floor in front of her.
It’s quite a sight but this is my third stint on the ward so I’m used to seeing the ‘super obese’.
There are four beds in the unit — most hospital bays have six but here each bed is the size of a double bed, and two adults could fit comfortably on the armchairs. I feel like Alice In Wonderland after she’s been shrunk.
Amazingly, Michelle is able to get up from her chair without help, unlike many other patients. But she has to lift her stomach and hold it in her arms like a duvet.
She tells me she’d always been big but really piled on the pounds when she had children.
She felt lonely and the more depressed she became, the more she ate. Now hugely overweight, she has type 2 diabetes.
But I feel only sympathy for her. She’s about to have gastric bypass surgery — and that’s not an easy option. The op is irreversible.
Michelle will lose most of her weight in three to four months but every bite she takes will make her feel nauseous. She’ll never eat normally again.
Even when she does reach a normal weight, no one who’s had this surgery is going to look like a glamour model.
Patients are left with unsightly folds of flesh hanging from their bodies — and unless they can afford cosmetic surgery, they’ll be stuck with it.
Then there’s the risk they will die on the operating table. One in 200 patients dies within a month of surgery.
Their airways could be obstructed while under anaesthetic, they could get a blood clot, or go into cardiac arrest. I think all this is hitting home as Michelle talks about the op.
She is quite tearful and keeps saying she can’t believe it has come to this.
‘At least you’re doing something about it now,’ I say, but she’s right.
I’m all for the surgery but there must be a better way to get people to lose weight before it gets to this stage.
We give all patients a daily bed bath and change their sheets. This means waiting until at least four staff are available as we’d never manage one patient on our own.
Today we have to deal with Dave, a 30st man waiting for a gastric bypass.
He’s quite rude and defensive, but most of the men on the ward are like that; maybe women are more comfortable with accepting medical help.
Two of us try to wash him and the other two hold him steady and lift his flesh. It’s no easy task. He can’t lift his arms high enough to expose his armpits so it’s impossible to clean there.
He smells and closer inspection reveals he has a fungal infection, which is quite common among the super obese.
To protect the skin rubbing, leading to sores, we use Sudocrem — the nappy rash cream. I use a whole pot for Dave. He’ll need prescription medication, too.
We ask him to roll over on to his side and hold the bed rail. I feel nervous the rail will give way — someone his size could cause me serious damage.
Once we’ve positioned a sling under him, we hook it on to a hoist and lift him above the bed to change the sheets.
‘I don’t need my sheets changed,’ he complains.
‘I wish you’d stop fussing.’ I’m not offended because I can see he’s embarrassed he has to go through this.
Michelle is back from theatre. She’s had her bypass — the most invasive but effective procedure available for patients who need to lose weight.
This involved keyhole surgery to staple part of her stomach to form a smaller stomach — greatly reducing the amount she can eat — and a section of her intestine was then bypassed, so she absorbs fewer calories from what she does eat.
She’ll need vitamin supplements to prevent malnutrition for the rest of her life.
And eating high-fat foods could cause her immense pain — this is due to ‘dumping’, where food enters the small intestine largely undigested. The body struggles to cope, causing diarrhoea, nausea and vomiting.
Now, back in the ward three hours after her surgery, Michelle is tired and her incision scars are painful. I sort out her painkilling medication and she smiles and thanks me.
She looks relieved it’s all over but really the hard part is only just beginning.
Meanwhile, we’re waiting for the arrival of a 50st man.
Usually, patients arrive in a normal ambulance, but as this man’s so heavy, there’s talk about using a lorry. In the end it’s decided a reinforced ambulance will do with a second team of paramedics and medical staff travelling behind.
Engineers have also been called in to adjust the lift so it can withstand the man’s weight. Goodness knows how much all this is costing.
When the man finally arrives on the unit, he’s exhausted. Like the other patients undergoing surgery, he’s been on a special high-protein diet for a couple of weeks.
This will help shrink his liver, making it easier for the surgeon to gain access to the stomach.
If the patients don’t stick to the diet they can’t have the surgery. In hospital the patients are given the same portion sizes as those on other wards.
I talk to grumpy Dave while doing some routine checks. He opens up and tells me his story. It’s quite a typical one.
He used to be a plumber but thanks to his junk-food diet got so fat he found it difficult to fit under people’s sinks. Then his knees got so painful he had to give up work.
Stuck on incapacity benefit and with no self-esteem, his weight ballooned until now, aged 38, he weighs 30 stone.
‘I hate sponging off the state. I want to get back to work,’ he tells me.
‘That’s why I’m here.’
Meanwhile, Michelle has her first real food since her op.
‘I never thought I’d say this but I don’t feel like eating,’ she says.
She’s thirsty but she’s not allowed a drink at mealtimes as the liquid would fill up her reduced stomach space. She’ll have to separate food from drink for the rest of her life.
Her daughter’s here to see her today. She must be in her late teens and already has a weight problem.
With a family history of obesity, the likelihood of a person becoming obese can shoot up by 25 to 30 per cent.
Elsewhere I have to help another patient after she’s been on the commode. It’s my job to clean her up as she can’t reach. It can take ten minutes or more when patients are this big.
‘I’m sorry to put you to all this trouble, dear,’ she says as I settle her back in her chair.
It must be a disgusting job for you.’ The shame she feels is written all over her face.
‘That’s what I’m here for,’ I tell her.
I had an argument with my friend Katie last night. She asked how I could bear to work with obese people.
‘They expect to be able to eat what they like then get the NHS to sort it out,’ she complained.
As I told Katie, the problem is these people aren’t greedy, they are addicted to food in the way some people are to alcohol, cigarettes and worse. It’s a mental health issue.
And this surgery could save the NHS billions. A gastric bypass costs £8,000 to £10,000 but research shows it pays for itself within a year in terms of savings in treating obesity-related illnesses.
But pro-bypass surgeons face an uphill battle to convince the public it’s a good idea — it’s often hard to convince their medical colleagues, too.
But what’s the alternative?