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Gastric bypass helps local woman shed pounds

LISA DUPOISE STRUGGLED with her weight for many years. As she realized the job of taking off extra weight was only getting more difficult as she got older she learned about gastric bypass surgery and underwent the procedure this past October. Through increased attention to diet and exercise before surgery and a smaller stomach after, she has lost 65 pounds.

NEW HAVEN — A few weeks ago Lisa Dupoise updated her picture on her Facebook page. This change drew a lot more responses than the usual Facebook update.
“Everyone is asking, ‘Oh, what did you do? What’s your secret?’” Dupoise said. “So I personal messaged many, many people telling them what I’ve done, and out of that I had a few people who are asking about the process for themselves, and I’m like, ‘Ask me, I’ll tell you the good, bad and ugly.’”
What they were so impressed by was the amount of weight Dupoise had lost — 65 pounds since last February.
She has decreased her pant size four times since October, and her shirt size three times.
“I’m only five foot three, so I carried a lot of weight for my little stature,” the New Haven resident said.
Her secret was gastric bypass surgery. It is a procedure that sections off a part of one’s stomach so that it is very small, then reroutes the small intestine to that smaller stomach. With the smaller stomach, the patient simply can’t eat as much.
“They took a section my stomach and they sectioned it off, so my stomach is like the size of an egg,” Dupoise said. “Not like an ostrich egg, but like the size of a chicken egg.”
But that size is what is left after the body works itself out after surgery. Dupoise held up the smallest finger on her hand and said that initially, right after the operation, the part of her stomach that the food arrives at was the size of the tip of her pinky.
Around 200,000 Americans annually have “bariatric” surgery, which includes gastric bypass and other weight loss surgeries. There are several kinds of weight-loss surgery, all of which create a smaller landing zone for food that a person eats. The procedures include:
-Gastric Sleeve Surgery (removal of about 80% of your stomach that leaves a banana-shaped “sleeve” that connects the esophagus to the small intestines)
-Gastric Bypass (separation of the top part of the stomach from the bottom part, and then rerouting the smaller top part directly to the intestines)
-Lap-Band (inflatable band wrapped around stomach to reduce the space for incoming food)
-Duodenal Switch (a portion of the stomach is removed)
-Vertical Banded Gastroplasty (staples close a portion of the stomach to reduce its size)
Dr. John Rabkin, MD, writes on the Bariatric Surgery Source website that gastric bypass surgery is safe, but it does have the same risks as any major surgery. He says that it is safer than having a C-section, and that most patients must learn to deal with complications brought on by their smaller stomach.
Less than 5% of patients suffer from these non-life-threatening diseases, according to Bariatric Surgery Source:
Stomal stenosis (narrowing of the opening from the stomach to your intestine), wound infection, bowel obstruction, leak, and gastrointestinal bleeding.
By the same token, remaining morbidly obese also carries a high risk of a shorter lifespan.
Rabkin cautions that people should not pursue this type of surgery without a full consideration of the complications it will bring. Candidates for the surgery must appreciate that after the procedure they will pretty much be eating only healthy food and that will be in smaller quantities than they are used to — no more binging on junk foods.
“This will be a massive and permanent lifestyle change,” he writes.
Dupoise can attest to the amount of change needed after gastric bypass, but when she started on the road to the surgery she knew she was ready for a big change.
She had been struggling with her weight for some time, including joining Weight Watchers three times in the past two decades. Part of it was the way the extra weight made her look, and part of it was the way it made her feel.
“I’ve been struggling with weight for many years, you know, over 20 years, probably,” said Dupoise, who is 48. “It’s just super hard (to keep the weight off) the older you get — your metabolism is different, you’re not as active. I had a lot of aches and pains, my feet hurt, my body. And obviously the more weight you have those things are gonna hurt more.”
Like many women, Dupoise sees her gynecologist more often than she sees her general practitioner, and it was her gyno who noted the extra pounds Dupoise was carrying. She put the idea for some big weight loss into her head. Dupoise heard the message.
“I was ready,” she said.
In late 2019 she had a serious talk about gastric bypass surgery with her husband, Steve, with whom she co-owns County Tire in Middlebury. Then in January 2020 she attended an informational meeting on the procedure at the Dartmouth Hitchcock Medical Center in Lebanon, N.H., where her insurance would pay for her surgery. After another family discussion, she decided to do it, and started the process in February 2020.
Of course the COVID-19 pandemic came along shortly after Dupoise began that process. But, she said, that didn’t cause too many difficulties. Many of her visits with health professionals had to be done online, instead of in-person, and the procedure was done Oct. 21, about two months later than it might otherwise have.

INSURANCE COVERAGE
She checked with her insurance company, MVP, to see if they would cover the procedure. Depending on the type of bariatric surgery, it can cost $27,000 to $40,000. She was lucky enough to pay mostly only co-pays and maybe $100 for some other expenses.
Before gastric bypass surgery, an insurance company often requires documentation of such things as monthly dietary and exercise regimen, medically supervised attempt to loose weight, evaluation by a psychologist to ensure that weight problems aren’t associated with a chemical dependency or eating disorder, assessment of thyroid levels.
Dupoise said her insurance company agreed to pay for gastric bypass surgery because her Body Mass Index, or BMI, was above a certain level. But another requirement before the surgery was that she lose a certain number of pounds, presumably to show that she could be successful with the post-op regimen and change her long-term eating and exercise habit before the surgery. The snag, Dupoise feared, was that if she lost too much weight before the surgery the insurance would not pay.
“So they basically want to know that you are willing to cut out alcohol, cut out sugars, sweets. They want to make sure that you can do some sort of an exercise program and stick with it,” Dupoise said. “Because all of those things are all things you have to do after the surgery. So they … want to make sure that you’re committed.”
An unexpected twist came when Dupoise had a sleep study, which was required by the medical center. She was diagnosed with sleep apnea, and had to start using a CPAP machine at night, which she hopes to discontinue in a few months.
As it turned out, the sleep apnea diagnosis meant that she could loose more pounds pre-surgery and the insurance company would still foot the bill.
“I ended up losing 25 before the surgery,” Dupoise said.

LIFE AFTER SURGERY
Life didn’t return to normal after gastric bypass surgery for Dupoise. Really it never will return to the older normal.
Initially there were the problems anyone would have after surgery: fatigue, recovery. But she was allowed to return to work within two to four weeks (she was back in the office after two weeks because she was needed).
And there was the struggle with learning how to ingest enough calories with a stomach that would fill up in no time and not be ready for another meal for many hours. She doesn’t expect her body to fully adjust to the new size of her stomach for one and a half to two years.
“I don’t feel hungry; I’m never hungry,” she said.
“I have to remember to eat actually … You’ve made your stomach so much smaller, it’s not calling for food. So it takes your body (awhile) to realize that you’ve made this big change to it.”
Dupoise has been told that when a gastric bypass patient’s stomach does figure out the change in a couple years, that is when they tend to gain some weight back.
“It’s normal to gain between 10 to 20 pounds once you’ve reached your lowest weight,” she said.
One unwelcome side effect that Dupoise has had to deal with after surgery is the physical illness she gets when she eats the wrong kinds of foods — too much sugar — or eats too fast for her little stomach.
“You just get sick, you just feel terrible. And you could throw up,” she said. “And throwing up with this kind of a stomach is very different from your typical throw up … Yeah, it’s very, very different. Very strange.”
Dupoise has ended up eating a fair amount of protein and keeping an eye on carbohydrates, sugars and fats. Alcohol is one of the biggest things that she had been told to steer clear of. Part of the reason to stay away from alcohol is because it is empty calories, but part of it is because the intoxicating effects will likely be stronger because there is not a lot of food in one’s system to blunt the effects.
To keep on track, she weighs her self at least once a week (more often, in reality) and she tracks her food intake religiously. That tracking is made easier with an app on her phone. She could do the tracking with pen and paper, but the app makes it easier — in part by allowing her to scan bar codes of some food products, and in part by making calculation based on the inputs.
“It gives me my calories, it gives me my carbs, it gives me my protein, it gives me all of the things I have certain parameters to stay within,” she said. “It gives me a report whenever I need it.
“My biggest hurdle is inputting the information, it is a pain. I’m not gonna lie.”
Dupoise clearly has learned a lot about the food she eats and she keeps track of it meticulously.
She is still getting used to the smaller stomach and finds that she can only eat a very small amount at a time, which limits the number of calories she can consume each day. On a recent day she consumed 965 calories, and the day before it was around 1,100; her target for each day was 1,535 calories.
The U.S. Department of Health says the average woman should eat 1,600-2,400 calories per day; a man, 2,000-3,000.
If Dupoise is eating closer to 1,000 doesn’t really leave any room for junk foods.
In addition to getting enough healthy calories, Dupoise also is limited in how much water she can consume because of the size of her stomach. That’s one more thing she has to track. She often has a protein shake because she can get the protein and the water at one go. Plus she takes nutritional supplements.
“Because I’m not taking in as many calories as a normal person, I have to take what I’m missing in vitamins and supplements,” she said.
Dupoise’s goal is to lose another 10 to 15 pounds. With diet, exercise and support of her loved ones, she is hopeful she can achieve that.
She has some advice for anyone considering gastric bypass surgery:
“It’s definitely not something you want to rush into. It’s something to really look at all of the options, look at all the changes that you’re going to need to make and whether or not you think you could actually make those changes and stick with those changes.
“And if your answer is yes, I highly recommend the surgery and going through the process.”
 

Will insurance cover weight-loss surgery?
Typical insurance company requirement for coverage of some gastric bypass surgery:
• You are 100 pounds or more above ideal weight, or
• You have a Body Mass Index of 40 or greater, or
• You have a Body Mass Index of 35 or greater and suffer from medical problems associated with obesity such as type 2 diabetes, obstructive sleep apnea, coronary artery disease or pulmonary hypertension.
• You have been overweight for at least two years, and
• You have failed all weight-loss attempts including diets, exercise and weight loss programs.

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