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Mike and Lori Noble stand with a photo of themselves from before significant weight loss aided by gastric sleeve surgeries. Justin Guido/Butler Eagle

Gastric bypass no 'easy way out' for weight loss

He played center on special teams for the University of Pittsburgh in the late 1980s and early '90s. Football brought him from the 220s to the 270s, but after graduating he dropped the extra weight.

Then, life happened. Jim Royal got older, and he began steadily packing back on the pounds, this time as fat, not muscle.

He didn't stop at 270. At his “maximum density,” as he calls it, the Cranberry Township man weighed 384 pounds.

He tried everything to slim down, but nothing would work for long before the fat returned.

Today, at 50, the man on his driver's license looks a little like him, but with a lot more neck tacked on. Everything is too round, too full and too, well, dense.

The real him is back down to his college weight. Pre-football.

“Some people don't even know who I am until I speak, and they recognize my voice,” Royal said. “I never thought I was an ego guy, but, well, there are sometimes when I like to go places where people haven't seen me in a long time.”

Ask him what changed, and he'll tell you “everything.” Royal eats different, cooks different, works different.

That, and he had most of his stomach cut out.

Talk to the average gastric bypass surgery patient — or, more commonly, a gastric sleeve surgery — and they'll tell you they worked their tail off, spent a large sum of cash, experienced physical pain, endured strangers and friends shaming them, and had to almost entirely give up bread. Delicious, soft, beautiful bread.

They also all seem to say the same thing: the surgery changed their life.

Bypass By The Numbers

A map of 2014-16 obesity rates published by the Pennsylvania Department of Health shows a state cut in half, with a few exceptions. People in the western portion are obese at higher rates than out east.

Butler County is a notable exception with a 29 percent obesity rate, one percentage point below the state average from that time.

Butler's neighbors show the western influence: Venango possessed a 34 percent rate, Clarion a 35, Armstrong a 35, Lawrence a 34. The counties with the highest rates claimed the state's southwest corner with rates hitting 39 percent.

Dr. Meng-G Martin Lee, a bariatric surgeon for Butler Health System, said the region's high rates contribute to his program's existence.

“There's certainly a need in the community for this type of surgery,” Lee said.

The department couldn't provide figures on how many customers they perform the surgery on, but Lee estimated that their team consults with four or five potential new patients a day. Not all get a surgery or are even eligible, but many move ahead with it.

There's another reason why they get so many clients: Only about 7 percent of Butler County residents aged 18 to 64 are without health insurance, according to the same state data. The rate is among Pennsylvania's lowest, and it's well below the state's overall 11 percent rate.

All the bariatric patients who shared their experiences for this story relied on insurance to front much of the cost. A husband and wife who had the surgery together ran through their entire out of pocket maximum amount. Including insurance payments, they paid about $10,000 out of pocket for the process.

Bariatric surgery in general costs between $15,000 and $25,000 on average, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Most BHS patients have insurance coverage for it, but a few pay in cash.

Gastric bypass is the name people know, but 93 percent of such surgeries performed by Lee's department are actually gastric sleeves. Bypasses are reserved for patients with acid reflux symptoms. They used to also offer gastric bands, which represent the lower end of the NIDDK's cost range, but the practice is largely being abandoned industry-wide.

What Comes First

For Shelley Oesterling of Butler Township, surgery was the last ditch effort. She'd tried it all: diets, exercise regiments, group programs. She'd lose a bit, then gain it all back eventually.

Kelly Jo Best-Conti, the coordinator of BHS' bariatric program, is most of their patients' first point of contact. Oesterling's story isn't uncommon, she said. They call the phenomenon “yo-yoing.”

“People usually see me when they have failed all other diet and exercise programs,” Best-Conti said.

Oesterling met with BHS staff, then launched into a laundry list of tests, screenings and weight loss techniques. Generally, insurance policies require verification that a patient is working out, dieting and otherwise trying for six months before such a surgery is covered.

Folks like Oesterling get mental evaluations, nutritionist help and sleep studies, to name a few.

“This isn't something you jump into,” she said. “This is a lifestyle change.” Lori and Mike Noble of Butler Township experienced the same. Both got a gastric sleeve on Oct. 15. They wanted to recover together, and even turned their eventual weight loss into a mild competition.

Before their change, Mike in particular had rough eating habits. He works a high-stress cyber security job at Alcoa, and would spend the whole day without eating. Then, he'd come home at night and eat enough for several people. He could solo a large pizza, easy, he said.

“Used to be I could demolish a gallon of milk a day,” Mike said.

But when he and Lori signed on for the surgery, they also signed up for 1,200 calorie a day diets, starting immediately.

“If you want to have pizza for dinner, you have to plan your whole day around that pizza,” Lori said.

The Surgery

The act itself of gastric bypasses and sleeves isn't quite as invasive as one would think. Small cuts are aided by a camera, leaving only a little scar behind on the patient's abdomen.

In the sleeve surgery, Lee explained, they use a device to cut and staple the stomach, removing the discard by squeezing it out of a small incision.

BHS keeps its patients in the hospital two nights after the surgery. Patients are weaned onto solid foods slowly, after weeks of liquid-only diets followed by pureed-food diets.

The surgeries remove 75 to 85 percent of their recipients' stomach. Besides being physically smaller, the change affects hormone balances in the stomach, according to Best-Conti, significantly lessening feelings of hunger.

What Comes After

Royal, the football player, lost about 140 pounds in a year. Oesterling dropped 90. Mike and Lori are still shedding pounds.

They've all developed their tricks. Oesterling uses only tiny bowls, and she keeps a plastic Easter egg in her kitchen to remind her about how much her stomach can comfortably hold.

Royal rises at about 3:50 a.m. each morning to walk. On his last birthday, he made a day out of it and walked 14 miles.

For portion control on the go, he eats little cups of baby food.

Lori hits a weight-machine and the treadmill in the mornings. The Nobles switched out their kitchen sets for little pieces, too.

Dr. Lee said it's the overwhelming progress he sees that makes him enjoy his job.

“The majority of patients go through a transformation,” Lee said. “Sometimes we don't even recognize them between appointments.”

Lee's patients all agreed that there's a stigma attached to such surgeries. Lee said he believes the stigma is fading, but his patients all hear the phrase “the easy way out” sometimes.

“There was nothing easy about it,” Lori said.

Many local bariatric patients attend a BHS support group. Royal said the monthly meetings are like a “booster shot” for him.

Royal in particular has many happy stories to tell. There's the time his wife accidentally packed his 13-year-old son's pants in his suitcase, and he managed to squeeze in and wear them to work all day.

And then there was the time his daughter simply hugged him.

“She said dad,” Royal said, wiping his eyes. “I can get my arms all the way around you.”