Fat of the land

How overweight would you have to be to consider surgery? And what exactly would it involve? Nick Bradshaw gets the answers from a surgeon struggling to keep up with demand from obese British menfat-and-overweight

Just before midnight along the corridor from Operating Theatre 2, consultant surgeon Roger Ackroyd stares at his bloodshot eyes in the changing room mirror. “I’ve got to cut down,” he sighs. It’s the end of a working day that started at 7am. “I don’t think I can keep this up.” But he knows that cutting down is not an option. This is a man who is very much in demand.
MrAckroyd is based at the Royal Hallamshire and runs a private practice nearby at the Thornbury Hospital. He operates on men and women considered “morbidly obese”— people whose Body Mass Index (BMI) is over 40 (15 points over the threshold of what is considered “normal”). “Morbidly” may sound dramatic, but it’s a fair appraisal. These are the people for whom the Grim Reaper is sharpening his scythe. And that’s where Mr Ackrovd comes in. He makes very fat people very much thinner. Very quickly.

When not performing surgery on the esophagus, gall bladder, hernias and gastric cancer, he performs obesity surgery or, to give it its proper name, bariatric surgery. The most common form is a gastric bypass, an operation that reroutes food so it circumnavigates the stomach, inducing weight loss. This surgery can have startling results, with many patients losing between half and three-quarters of their body weight within six months. MrAckroyd now has one of the biggest bariatric practices in the country. Private patients from all over the UK are lining up to pay C8, 000-410,000 per operation. “There aren’t that many surgeons who do obesity surgery— somewhere in the region of 15-20 nationwide,” he says. “And only about half of us have big practices.”

Despite the size of his practice, he is only dealing with the cherry atop a large, calorie-laden cake. Sheffield has a serious obesity problem, but then so does the rest of the UK. The British Obesity Surgery Patient Association estimates that around 800-900 bariatric procedures are performed each year— 20 times more than five years ago. Yet as hard as they try to plug this giant fleshy dam with their dexterous fingers, surgeons like Mr Ackroyd are struggling to keep up.

The British public is getting bigger, with the number of overweight and obese people doubling every five to ten years. The figures are grim: 60% of British adults are now classified as overweight, obese, or morbidly “Gravity helps us get the organs into the best position,” explains Mr Ackroyd.

During the operation, intricate procedures are combined with plenty of pushing and prodding. Thanks to the camera and lights, the operation can be watched on screen. An already large belly is filled with carbon dioxide so the graspers, shears, suction irrigators, and what looks like a harpoon gun, but is actually a surgical stapler, can move freely. At one point a petite theatre nurse uses all her strength to hold the heavy swollen paunch in position. She’s drawn the short straw today. Just before the first incision was made, she had to brush the patient’s belly with iodine to sterilize it — an aerobic workout in itself.

Some of the instruments don’t seem long enough to reach their destination. One doctor says bigger patients mean they will soon need a stronger operating table. It doesn’t help when the patient is a man. “If you were new to this, you’d definitely want your first cases to be women,” says Mr Ackroyd as he sears through the thick, lumpy, yellow fat, filling the air with the whiff of barbecued pork. Getting through it all is physically demanding. “It’s a lot harder to do this surgery on men,” he explains. “The distribution of body fat is different in the two sexes. A woman has a very fat abdominal wall but less fat around the bowel and stomach. In men it’s the opposite, so when you operate you have a tougher time battling through fat to reach where you need to be.”

Mr Hydes’ bypass goes to plan. The eggcup-sized stomach pouch is formed. Part of the intestine is brought up to meet it and the two are joined, providing a quick exit for the small amount of food that will be let through. A leak test is performed — no blue liquid seeps out. Good. The instruments can be removed and the holes on Hyde’s belly can be stapled shut. Less than two hours after the first incision, the operation is over and he is wheeled off to the recovery room. Meanwhile Mr Ackroyd heads for the changing room, looking like he’s run a marathon.

<h2>Fat’s chance</h2>
Martyn Brough, 31, had a gastric bypass in February 2004. Martyn is not your typical fat boy slimmed. A martial-arts enthusiast as a young adult, he was the one member of his family who wasn’t big. That all changed when he was diagnosed with testicular cancer, at 25. “The chemotherapy and steroids did it,” he explains. “My body took a battering and I started getting bigger.” This is a common side effect, as steroids cause fat deposits and chemotherapy promotes water retention. By the time Mr Ackroyd saw him, he weighed 26st (165kg). “It got to the point where if someone sat next to me in the front of the car, I’d be half on their seat too,” he says. “I’ve always liked my food, but I did a lot of training, so the amount I ate was never a problem. I used to bum off the calories.”

These days he’s half the man he used to be, currently hovering around 13 stone (83kg). “In the first two weeks I lost 11/2 stone. At first I bought tracksuit bottoms with elasticized waists. Once I went back to work, I had to buy new dothes every two weeks. Before the op I had a 56in waist, now it’s 36in. I can go to normal shops rather than outsize shops where I had to pay more than double for clothes. People I’ve not seen for a while don’t always recognize me. When I glance at a mirror and compare how I look now to how I was a year ago, I can’t help but think, ‘Hook awesome.”‘

He can expect to lose at least another 61b (2.5kg) when he has cosmetic surgery to remove the excess skin that hangs around his stomach following his drastic weight loss. Many patients have numerous cosmetic procedures to get rid of the excess skin left behind after obesity surgery. Martyn thinks he’ll only need one operation as, regardless of his size, he never stopped going to his gym ¬the Sheffield Thai Boxing Gymnasium.

“I thought I was fit, but at that size you can’t be. Now it takes me forever to warm up. When I was big, I’d sweat loads in three minutes,” he recalls. “Sometimes I forget I’m not big anymore and can’t understand why I can’t lift the same weights. Some strength may have gone, but the increase in stamina I’ve gained since losing the weight is unbelievable.”
So does he think bariatric surgery mean it’s OK to be greedy, as you can get things sorted on the operating table? Martyn shakes his head: “If you love food and binging, after the op you can’t do that. If I did, I’d be violently sick”

“Although it’s an easy way to lose weight, it’s also drastic. For me, the risks of the operation were worth taking. How much longer would I have lived anyway? What quality of life would I have had? I didn’t want to be the guy who gets up, goes to work, comes home, and then doesn’t move from the sofa all night. Before the op, I couldn’t do much with my kids other than put them on my knee and read them stories. If I couldn’t do anything with them when I was 26st, what would I have been like as I got bigger? Now we go for walks and play football.”

Mr Ackroyd agrees: “People see the surgery as a quick fix. It isn’t. It’s a big operation with associated risks. In most cases, the amount of calories and the volume of food you can have is severely restricted so you can’t eat what you like. You have to make a drastic difference to the way you eat, but in return, the weight loss you can expect is phenomenal.”

<h2>Let it be light</h2>
Two weeks after his surgery, Roger Hydes is at home surveying a fridge that now contains lots of yoghurt pots and purées, including a bowl of puréed braised steak. “There’s very little you can’t eat if you’re willing to liquidize it,” he says. “Certain things I’ll never be able to eat again, like nuts. But you weigh things up. If your health’s suffering because of your size, you’ve got to do something about it. And if that means big steaks and nuts are off the menu, that’s the price you pay.”

As a veteran of gastric bypass surgery, Martyn can offer some comfort to Roger, who has a sore stomach, trapped wind, and faces purées for at least the next few weeks. “I’m surprised at how much the operation affects you psychologically,” says Martyn. “I used to love chips and really enjoyed pizza. For the first few months after the operation, you’re cautious about what to eat, but even now that everything’s fine, I don’t desire foods like that. I don’t miss food that I used to crave.”

Roger has already noticed a difference in his appearance. In the weeks ahead he will see major changes in his physique and enjoy significantly better health. If he follows the advice of Mr Ackroyd, his dieticians and psychologists, he can look forward to an active life. His surgeon, meanwhile, should get some sleep. He needs all the rest he can get. Thanks to our growing population, he faces some busy times ahead.