Bariatric patient loses 300 lbs and gains years of life

In 2010, Ron Garrison, of South Haven, Ind., reached his peak weight of nearly 500 pounds – and not for lack of trying to slim down. For nearly two decades the military veteran had tried the gamut of weight loss approaches, from medically-supervised diets and exercise plans to online schemes promising dramatic results. Nothing worked; he continued to gain weight and, with it, health complications.

With a body mass index of nearly 67, Garrison suffered from type 2 diabetes, high cholesterol, high blood pressure and more. The former firefighter got to the point he could no longer fit into the gear and had to give up his job. When he joined the Masonic Lodge and saw a photo of himself in a tuxedo, he realized the gravity of his situation for the first time. That same year, despite taking nearly 12 medications to keep his health under control, Garrison was given a startling prognosis – only three years left to live. The father of one decided it was time to consider bariatric surgery.

"I was going to die," Garrison said. "It wasn't a matter of 'if' but 'when.' My son had just been born and I thought, 'I have to be around for him.'"

Garrison began researching surgical options and identified the biliopancreatic diversion with duodenal switch, commonly just referred to as duodenal switch or DS, as his preferred procedure. He turned to the only regional institution that successfully performs such bariatric procedures: The University of Chicago Medicine's Center for the Surgical Treatment of Obesity. To this day, UChicago Medicine is one of just a few institutions that offers DS. The University of Chicago Medicine has pioneered research investigating the procedure and is an international leader in teaching this technique to practicing surgeons.

Everybody's obesity and life circumstances are different. It takes a conversation and collaborative decision-making to pursue the best options.

Garrison underwent a comprehensive multidisciplinary evaluation and was found to be an excellent candidate for DS. Director of Minimally Invasive Surgery, Vivek N. Prachand, MD, performed Garrison's duodenal switch on Oct. 28, 2011. The surgery, combined with significant lifestyle changes, helped Garrison get his weight down to about 195 pounds by 2013 -- a loss of more than half his body mass.

"The important thing to keep in mind regarding obesity surgery," Prachand said, "is not what the person loses, but rather what the individual gains."

The center of individualized care

The Center for the Surgical Treatment of Obesity has achieved the highest levels of accreditation for safety and quality, including the national bariatric surgery certification from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. One of the center's objectives is to help patients prepare for the life changes involved in bariatric surgery and to be successful in both reaching and maintaining their results. In addition to the surgeons, a team of nurses, nutritionists, psychologists, social workers and care coordinators support patients each step of the way.

"We are the only center that offers the full spectrum of operations and provides individualized recommendations," Prachand said. "Everybody's obesity and life circumstances are different. It takes a conversation and collaborative decision-making to pursue the best options."

The Center for the Surgical Treatment of Obesity offers four types of minimally invasive bariatric procedures – DS, vertical sleeve gastrectomy, roux-en Y gastric bypass and adjustable gastric banding or Lap-Band. Of the four bariatric procedures, DS has the best outcomes in alleviating diabetes and helping the most severely obese patients achieve a healthier weight.

A life-changing process

DS is an innovative procedure that first reduces the size of the stomach by more than 75 percent to a narrow tube through a procedure known as sleeve gastrectomy. Food and digestive fluids within the small intestine are then rerouted to decrease appetite and reduce the absorption of some of the calories ingested in the diet, particularly those derived from fat.

Once Garrison's surgical procedure was complete, he began the lifelong journey of adjusting his life to meet the demands of his altered anatomy. He strictly follows a modified low-carbohydrate diet with a strong emphasis on high-protein foods, and he has eliminated carbonated beverages. Additionally, to avoid nutritional deficiencies, Garrison takes several daily vitamin supplements. He also committed to frequent follow-up appointments for several years and a regular exercise regimen.

The level of care goes far beyond the standard doctor-patient relationship. Everyone cares about your success, and they are going to save your life.

"The level of care goes far beyond the standard doctor-patient relationship. Everyone cares about your success, and they are going to save your life."
"It's a major lifestyle change," he said. "You have to be ready mentally and physically. Surgery is just a tool -- one step of the process. Then you have to change the way you eat, what you eat, get used to taking vitamins and take in enough protein each day. It's a life-changing process, and it totally changed mine."

The military veteran started gaining weight in 1986 after an injury and was unable to combat his obesity through conventional methods, due largely to biological challenges. Many overweight and obese people face similar struggles to sustain significant weight loss. Lifestyle changes alone rarely bring dramatic and sustained success for the severely obese, Prachand said.

"Most people can relate to the major effort involved in losing just 15-20 pounds," Prachand said. "The people we help have 10 times that much weight to lose, which is a whole different ballgame."

Often the surgeons and staff wait until patients can show a commitment to lifestyle changes through medically-managed weight loss attempts before moving ahead with surgery. Positive momentum prior to a procedure will help get the patients in a healthy frame of mind and ready to take on new challenges.

Another chance at life

In just weeks, Garrison began to see dramatic physical changes. He dropped 81 pounds in less than a month and broke 200 pounds in just under one year. He's maintained his weight loss for more than two years. Additionally, Garrison no longer takes medications for any obesity-related illnesses and is in diabetic remission. He also returned to volunteer firefighting as a way of "giving back to the community for God and Dr. Prachand giving me another chance at life," he said.

His dramatic life transformation never would've been possible without the entire University of Chicago Medicine team supporting him.

"The people involved in the obesity center treat you like a family member," Garrison said. "They were with me every step of the way. The level of care goes far beyond the standard doctor-patient relationship. Everyone cares about your success, and they are going to save your life."