After surgery, the weight of the world

Linette Freeman knows what people think.

She can see it in the eyes that don’t meet hers. She can hear it in the comments that follow her into restaurant booths.

Three years after friends and family raised nearly $20,000 in a public effort to pay for drastic weight loss surgery, the North Idaho woman knows some people think she failed. They think she’s lazy, she said. They think she’s weak.

They think she didn’t want to do anything about the 460 pounds she carries on her 5-foot-4 frame.

Even worse, they think she didn’t try.

“The hardest thing is when they say, ‘Aren’t you going to have that surgery done?’ ” Freeman said. “And I have to tell them I already did.”

Friday will mark three years since Freeman paid Portland, Ore., doctor Emma Patterson $25,000 to wrap a silicone and saline grommet around the top portion of her stomach.

The procedure, called adjustable gastric banding, was supposed to be Freeman’s last, best hope to reverse a history of obesity that began when she was 5.

“I want the opportunity for a whole new life,” Freeman said in 2003, the year she was among about 25,000 U.S. patients to have the operation, according to figures from the National Institutes of Health. Her effort was documented in The Spokesman-Review.

In a country where 60 percent of adults are overweight and nearly a quarter are obese, Freeman had tried every combination of diet and exercise, even hypnosis. She was convinced surgery was the only solution to shedding more than 300 pounds of excess fat.

Instead, Freeman experienced an ordeal that she said left her sick, tired, obsessed with food – and ultimately as heavy as ever.

After an initial drop of 80 pounds, she stopped losing weight, encountered medical problems and started gaining again. Today, the social worker is back to her pre-operation weight.

“I guess if I had it all to do over again, I guess I would not have had the surgery,” Freeman said last week. “It didn’t work for me. It doesn’t work for a lot of people who weigh 400 pounds.”

Exactly why gastric banding didn’t work – and whether Freeman should have expected it to – is at the heart of questions she’s trying to answer to friends, family, the community and herself.

“I know there’s a lot of people who would have said, ‘If you just would have worked harder, if you just would have followed your program, if you just would have eaten less and moved more,’ ” said Freeman, fixing a dinner of green salad and sugar-free cherry Jell-O in the kitchen of her Hayden home.

“Well, I did follow the program faithfully for 18 months. When my body leveled off, it was amazing to me how much harder it was to lose weight.”

Local weight loss surgery experts said it’s no secret gastric banding isn’t for everyone. Literature from the Journal of the American Medical Association and others shows most patients lose about half their excess body weight in the first year after banding or similar procedures, but some regain weight within five years and most of it within a decade.

Banding is regarded as medically safer than the more invasive gastric bypass procedure, in which a portion of the stomach is rerouted, experts said. But bypass patients typically lose more quickly at first and keep it off longer, said Carol Pielli, a coordinator with the Rockwood Clinic, a Spokane center specializing in weight-loss surgeries.

“You do not lose as much with the banding,” said Pielli, 58, who lost more than 140 pounds after Roux-En-Y gastric bypass surgery three years ago.

Because banding leaves the stomach intact, albeit restricted, the change isn’t as significant, said Heather Miller, program coordinator for Dr. John Pennings of Surgical Bariatrics Northwest in Coeur d’Alene.

“It’s easier to fail with the band than the bypass,” said Miller, whose clinic performed about 250 banding and bypass surgeries last year, double the number of the previous year.

Pennings’ clinic, one of a few in the Inland Northwest, referred Freeman to Patterson, the Portland doctor who performs about two dozen surgeries a month. Patterson said success rates are similar for banding and for bypass.

No matter which operation a patient chooses, weight loss surgery is risky, with a fatality rate of 1 in 200, studies show. Even when patients come through the operation in good shape, following through with significant, sustained weight loss is rarely easy, consultants said. “You’ve got to know you’re in for a lifestyle change,” said Pielli. “I tell people, ‘Don’t sabotage it. It’s a tool, not a quick fix.’ ”

Prospective patients are ready for surgery only when they understand that it is a final effort to reverse or prevent the medical problems that accompany obesity: diabetes, heart disease, cancer and others.

“The No. 1 reason has to be medical,” said Pielli. “For me, I was going to either live or die.”

Those messages were delivered loud and clear before her surgery, Freeman said. “They tell you, but you only hear what you want to hear,” she said.

The aftermath of the procedure was more difficult than Freeman imagined. The list of foods she can tolerate is limited; those she can consume must be smooth or chewed to the point of puree. She can only eat a couple ounces of food at a time. For 18 months after surgery, Freeman vomited 20 to 30 times daily.

As long as the weight was coming off, Freeman remained motivated, she said. But when her loss slowed, and she still weighed more than 380 pounds, she got discouraged. “You get tired; you get worn down,” she said.

In addition to the physical difficulties, the psychological struggle can take a toll. Even losing weight can spark fear of change, said Freeman, who experienced an anxiety attack when she approached 350 pounds.

“The fatter I am, the safer I feel,” she said. “It helps me to feel protected. And it’s extremely unhealthy.”

Freeman reverted to old eating habits, both she and her doctor agreed. The combination of slow weight loss and family losses made her desolate. When a medical problem required a surgeon to loosen Freeman’s band a year ago, she could finally find comfort in food.

“It was like my long-lost best friend had come back to town,” she said.

Meat, crackers, ice cream, Starbucks frappucinos: Freeman ate it all, she said.

“She didn’t do everything she was supposed to do,” Patterson said. “I hate to blame the patient, but it’s how active they are and how much they eat that makes a difference.”

Intellectually, Freeman said, she knows that’s true. She wishes she’d spent the $19,000 raised by co-workers and friends and the $6,000 of her own cash on a personal trainer and a personal chef for the past three years. She figured she’d probably have lost weight without surgery.

But the woman who must buy two airplane seats every time she flies isn’t giving up. Freeman wants to earn a master’s degree and find work as a counselor for obese teenagers and children. She wants to travel. She wants to marry and have children.

The people who care about her want that, too.

“I think it was very sad for Linette to be so disappointed,” said Becky Ewers, 36, of Spokane Valley, who has been Freeman’s best friend since grade school. “I don’t know how to say it, but Linette has never seen life through the eyes of a 120-pound person, so she doesn’t know what she’s missing.”

Freeman’s mother, Barbara, said her heart aches for her daughter, and there are times when she’s not optimistic about the future.

“I don’t think she’s going to lose the weight, you know?” said the 72-year-old Priest River woman. “I keep hoping. I just hope she keeps trying and eventually gets some of it off.”

Patterson, too, said she’s never had a patient who gained weight after surgery lose it through simpler methods.

But Freeman said she’s determined to overcome the burden she has carried since before she knew what “obese” meant. She has rejoined Weight Watchers and reaffirmed her commitment to taking care of herself, she said. Thursday night, she said, she posted a 9-pound loss, for a total of 14 pounds since January.

When her father died last fall of complications related to alcoholism, Freeman said she had an epiphany.

“I realized I do not want to be lying in a nursing home bed with my friends and family standing around saying, ‘I wish you had figured it out,’ ” she said.

Like so many others who struggle with what she believes is an addiction to food, Freeman said she’ll carry on, despite the stares, despite the comments, despite the stigma of not succeeding. Perhaps people who hear her story, she said, will respond with compassion for themselves – and others.

“Everyone has their crutch they lean on,” Freeman said. “The difference is, I carry mine on the outside for the world to see.”

Reach reporter JoNel Aleccia at (208) 765-7124 or by e-mail at jonela@spokesman.com.