Pattie Kappen knew there was another person inside of her.
That woman was confident and fit. She could hike all 8 1/2 miles of the Liberty Lake Loop Trail, including the ascent to the waterfall. Crossing a parking lot didn’t leave her wheezing for breath. She never worried about squeezing through narrow doorways.
But for years, Kappen lived with a different reality. She was morbidly obese, carrying more than 400 pounds on a 5-foot, 6-inch frame.
“This person who was inside of me, I always knew she was there. It was how to let her come out,” Kappen said.
Today, the 37-year-old Spokane resident weighs 175 pounds. She’s no longer diabetic. She doesn’t need high blood-pressure medication anymore. And she’s become an avid hiker.
The path to losing 250 pounds included gastric bypass surgery, which Kappen qualified for through insurance offered under Washington’s Medicaid expansion.
Kappen also quit smoking, changed her lifestyle and diet, and saw a counselor to help her deal with past abuse. After being molested as a child, Kappen said, food became a coping mechanism.
“People don’t realize why you’re fat. They judge. I hated that,” she said.
Kappen was profiled in The Spokesman-Review in 2015, after she lost 38 pounds in preparation for the gastric bypass surgery.
She’d walked into a CHAS Health clinic a year earlier, determined to kick a two-pack-a-day habit and get down to a healthy weight. Without major changes, Kappen – who has a teenage son – knew she was facing a shortened lifespan.
“My worst fear was that I was going to die fat. Or, I could die trying to change my life,” she said.
‘Medically necessary’ surgery
Death rates climb with obesity, said Dr. Saurabh Khandelwal, director of the bariatric surgery center at the University of Washington Medical Center, where Kappen had gastric bypass surgery in December 2015.
When people’s body mass index rises above 35 – the threshold for morbid obesity – the risk of dying from any cause more than doubles in men and women, Khandelwal said.
“You start to see all these diseases crop up: high blood pressure, diabetes, sleep apnea,” he said.
At the time of her surgery, Kappen’s body mass index was in the low 60s.
In Washington, adult Medicaid patients have been eligible for bariatric surgery since 2005. To qualify, the surgery must be deemed “medically necessary” for the patient. Prior authorization is required, and patients go through psychological testing as part of the screening.
“The surgery really is for people who cannot lose weight,” Khandelwal said. “If someone is able to get down to a healthy weight without surgery, that is by far the ideal situation.”
But as people pack on pounds, returning to a normal weight gets harder, Khandelwal said. The body has a metabolic memory, and it fights weight loss.
After bariatric surgery, keeping the weight off requires sticking to a carefully regimented diet and exercising at least 30 minutes each day.
“It’s not some magical operation that works on its own,” Khandelwah said. “It’s daily work and daily commitment.”
Stomach size of an apple
For Kappen, being obese meant daily humiliations – a seat belt didn’t fit, a chair was too small, a corner was too tight.
“Society is not forgiving,” she said. “Not when you’re fat.”
For years, low esteem sabotaged her efforts to change, Kappen said. She could hear the negative whispers in her mind: “Pattie, you’re not worth it. You’re never going to do this. Eat that cupcake.”
Kappen credits CHAS Health’s smoking cessation program for helping her embark on positive life changes.
“Quitting smoking for me was the defining moment,” she said. “I knew this wasn’t me anymore.”
She started exercising, graduating from 15 minutes on the treadmill to walks around her South Hill neighborhood with Ross Kappen, who was her husband at the time. She also transformed her diet, focusing on lean meats, whole grains and fruits and vegetables.
After the surgery, Kappen’s good habits continued. Her stomach is about the size of an apple now, which requires carefully monitored food intake. Over a seven-month period, she lost more than 200 pounds.
“As soon as they told me I could get up and walk, I was walking,” she said. “I was so motivated. It was life changing.”
She celebrated the milestones, buying new pants and shirts after dropping multiple sizes, and documenting the walks, which gradually turned into hikes.
“When you’re fat, you think, ‘I walked from the car into Wal-Mart,’ ” Kappen said. Even short distances feel like an accomplishment. “Now, I think, ‘I just hiked seven miles.’ That’s crazy.”
Hiking to the Liberty Lake waterfall last summer with her son and former husband was a special occasion. She’d tried to reach the waterfall multiple times but always had to turn back.
Kappen is still about 40 pounds away from her weight goal of 135, which would put her at the median body mass index for her height. The remaining pounds will come off more slowly, but Kappen doesn’t mind. She feels up to the challenge.
The months since the gastric bypass surgery have had their difficulties. A friend rushed Kappen back to Seattle last September for emergency surgery. She had developed a bleeding ulcer, which occurs in about 5 to 10 percent of patients who have the surgery.
Kappen’s marriage to her high school sweetheart ended. As she embarked on major changes, Kappen and her husband realized they wanted different things out of life. They split amicably and both remain involved in their son’s life.
After years of being a stay-at-home mom, Kappen is pondering options for going back to school and working. But she has the confidence she lacked in the past.
“I’m a whole new person now,” she said.
Kappen frequently talks about her experiences to people she meets. By telling her story, she hopes to encourage others who are struggling to lose weight, quit smoking or deal with past abuse.
“I know your journey, baby,” she often thinks. “I know you can do it.”