http://www.oregonlive.com/news/oreg...93931105170.xml

Heavy baggage for the newly slim

12/27/02

PATRICK O'NEILL

Caliatra Riesterer, a self-confessed touchy person, enjoyed a hug from friends now and then. At 5-feet-5 and 311 pounds, Riesterer thought of herself as motherly, kind and benevolent.

She still does. But the hugs don't come as often. Eighteen months ago, she underwent surgery to shrink her stomach and reroute her small intestine, causing her weight to plummet to 142 pounds.

A few weeks back, a friend told her: "My husband can't hug you now. You're too beautiful."

At 48 and perpetually overweight, Riesterer had never considered herself a threat to anyone's relationship. Her life had been a roller coaster of dieting and giving up on dieting. And she's not looking for male attention, she says: "I have an awesome marriage."

But the hugs?

"They just don't happen anymore." In the eyes of other women -- and men -- "I'm not the mommy type any more," she says.

Riesterer, named Mrs. Multnomah County this year, is one of a growing legion of Americans who are resorting to bariatric surgery to cure life-threatening obesity. As the surgery becomes increasingly common, more people are coming to grips with a sometimes brutal equation: The procedures, which work either by restricting the amount of food a person can eat or by blocking the body's ability to absorb nutrients, can produce astounding weight loss. But they also can change lives in unpredictable and sometimes unsettling ways.

Old friends have fallen by the wayside, Riesterer says, particularly overweight friends who feel uncomfortable around the new, skinnier her.

Riesterer, who heads a Kaiser Permanente support group for patients who are considering or have gone through bariatric surgery, has heard it all. Broken marriages are common. So are affairs. Suicides are rare but not unheard of.

Most previously obese patients say they're delighted with the boost in health and vitality that comes after surgery. But some encounter a difficult period of adjustment as relationships shift and they learn to relate to the world in a new way.

Men and women who once felt they were invisible to the opposite sex begin to have strange and wonderful experiences.

Laurie Kristovich, 49, a Beaverton housewife who lost 140 pounds after surgery at OHSU Hospital, noticed that after a lifetime of obesity, men began holding doors for her.

"They didn't use to do that," she says.

Then there was a recent episode at a store checkout line.

"A man turned around and started to chit-chat with me," she said. "That's never happened." In the old days, she says, men would look through her, not at her.

Jennifer Barlow, a physician's assistant with Kaiser, works with a support group in Longview, Wash. Barlow had the surgery in January 2001 and lost 130 pounds. She talks about an identity crisis that plagues many patients.

"I'd pass a mirror and a lot of times, I wouldn't recognize it as being me," she says.

Old friends who hadn't seen her for a while didn't recognize her. One of her patients refused to believe she was the same person who had treated her the previous year.

"You're treated differently when you start losing the weight," she says. "People who may not have talked to you before will start talking to you."

She says she and others are sometimes angered by the change in attitudes of people around them.

"Suddenly, I'm smarter," she says. "I have something intelligent to say. People listen to me -- people who wouldn't give me the time of day in the past. That's bothersome to me. I'm the same person I was."

The attention can lead to unexpected consequences.

"A lot of marriages break up," she says. "The person who loses weight finds that self-confidence again. They say, 'I'm going to get myself something better.' "

Suicide is rare but also a risk of the weight-loss surgery -- for the patient or a spouse.

Barlow says she can see how a suicide might unfold. An obese woman with low self-esteem might stay in a relationship with a controlling husband. But when she loses weight and finds that other men pay attention to her, she decides to end the marriage. The failed marriage triggers the husband's suicide.

One patient who lost 175 pounds says the surgery gave her the confidence to end a 12-year marriage.

Cara, who asked that her last name not be used, says she "stayed in a marriage a lot longer than I should have."

She thinks her marriage lasted as long as it did because of "my own personal shame and guilt and feeling that I couldn't make it without him."

Cara imagines the shock of drastic weight loss "to be on the order of having a sex-change operation," she says. "You go from being a completely nonsexual person to being a sexual person."

Cara says she's remarrying early next year.

Weight loss also can bring anxiety and depression to those who were sexually abused as children.

Dr. Elliot Goodman, chief of bariatric surgery at Montefiore Medical Center in New York, says some patients who had been abused hid behind obesity to protect themselves from unwanted advances.

"They made themselves less physically attractive and they weren't prepared for the significant body changes" after surgery, he says. "They found it difficult to cope with the new and unanticipated interest."

Although most patients appear to be happy with the results of their procedures, Goodman recently completed a study that found that many patients who seek radical gastric bypass surgery have a mental health problem that warrants evaluation.

He found that 45 percent of patients have a binge eating disorder, which, in some cases, can defeat the purposes of the surgery. In addition, he found that 25 percent of the patients suffered from depression.

Goodman concluded that people who want bariatric surgery should be screened for mental health problems that might become worse during dramatic weight loss.

There are no widely agreed upon standards for psychological screening, he says.

Dr. Donald McConnell, professor of surgery at Oregon Health & Science University, says he doesn't think routine psychological screening is necessary and offers it only if the patient's insurance company requires it or if he has another reason to think it's necessary. The university's program includes optional support groups.

Kaiser Permanente has an extensive screening process, and patients are required to participate in support groups before surgery. The groups include patients who have had surgery as well as those who are waiting. Participants talk about emotional problems they might have that are triggered by food, matters of diet and exercise after surgery as well as the psychological ramifications of rapid weight loss.

Despite the psychological stresses, most patients welcome the surgery as a lifesaving measure, a last-ditch attempt to regain their health.

Laurie Kristovich is irritated with those who imply that the procedure is cosmetic, akin to Botox treatments for wrinkles.

"I wasn't a woman who was trying to get that last 20 pounds off to get into a size 8," she says. "I was trying to save my life."