Help or Hindrance?

Published in August 2013 Issue             

New Jersey Governor Chris Christie said when he turned 50 in September he was "confronted" by his own "mortality" and for the sake of his wife and children he "needed to take a more significant step to try to get my weight under control so that I could have a really active next half of my life."

That significant step, he revealed, was gastric band surgery. Headlines roared across the world, "Chris Christie Had Secret Weight-Loss Surgery," "New Jersey Governor Christie has Surgery to Reduce Weight," and "Chris Christie Admits to Lap-Band Surgery," to name a few.

Much was made of why he had it. Does it mean he will run for president in 2016? Others questioned his choice of procedure. Why a gastric band over other operations? And the questions kept coming. Why did he keep it a secret? How quickly will he lose the weight? Who paid for the surgery? What if he fails?

At his initial press conference, Christie had an answer. He said, "With all due respect to everybody here, your opinions on this issue don’t matter a whole hell of a lot to me. It's nobody's business other than mine. If I had a choice, I wouldn't have ever talked about it."

But as a celebrity politician, a potential presidential candidate and frequent target of jokes about his weight, the tough talking, tell-it-like-it-is governor kept talking about how he didn't want to talk. "I want to make this really clear. I do not see myself, nor do I care to be a role model in this regard for anyone. This is an intensely personal issue for people."

He added, "I'm not going to be one of those guys who's going to write a book or, if I'm successful, run around TV shows and take a victory lap and say: Look at me. I know how hard this is. And I am not going to talk down to people who are going through this struggle like I am every day."

But the intense interest in Christie's surgery continued over the next several days and weeks, and Christie found himself in high profile interviews with NBC News' Brian Williams, Today's Matt Lauer and People magazine.

In People, he said, "I don’t want to be a proselytizer about this: 'Look at me, I’ve defeated it, why don’t you.' The only reason I’ve answered questions about my weight is because I don’t want people to feel self-conscious about whatever challenge they have."

He was cautious about how much weight he had lost since the operation, since previous non-surgical attempts at weight loss were only temporary.  "I've had past success that has lapsed back," he said. "So I'm leery of victory laps. But this seems, at least for the first 13 weeks, to be getting at the root of the problem, which is that I was hungry all the time."

Though Christie is leery of discussing his surgery, it hasn't stopped the late night comedians from talking about it. David Letterman barbed, "New Jersey Governor Chris Christie had stomach surgery so he won't be so big. His family gave him a choice. They said, 'Look, you either have that surgery or get your own ZIP code.'"

Comedian Bill Maher said, "Chris Christie revealed a couple months ago that he had lap band surgery. They're speculating that he did this because they're thinking he's going to run for president in 2016, and he couldn't unless he lost a lot of weight, and this procedure accomplishes that because it surgically pinches off your stomach so you just can't eat. Because that’s what you want in a president, someone with absolutely no will power, someone who says 'I can literally not contain myself.'"

The more serious media coverage of Christie's operation, however, provided the public with a greater understanding of the evidence supporting the safety and effectiveness of bariatric surgery, the range of surgical options, the health issues associated with obesity, and even the difficulties "ordinary" Americans may have obtaining insurance coverage for the surgery.

ASMBS President Jaime Ponce, MD, commented at the time, "Governor Christie made an important personal decision to take control over his obesity. Now it's time for our health care system to make that same treatment option available to all people who suffer from the disease of obesity."

Christie joins a growing list of celebrities including weatherman Al Roker, former American Idol judge Randy Jackson, television personality Star Jones and NFL coach Rex Ryan, who have turned to bariatric surgery after a lifetime of struggle with obesity. Each time, their announcement is followed by a burst of publicity that catapults obesity and bariatric surgery into the national conversation, raising awareness, understanding and inspiration, but at times also prompting confusion, online vitriol, discrimination or stigma.

"It's a double-edged sword. Without question celebrities can play a great role in bringing bariatric surgery to light and potentially motivate others to consider surgery. When they’re candid with their experiences, they communicate the importance of weight loss to their health and quality of life," said David Sarwer, PhD, professor of Psychology in Psychiatry and Surgery at the Perelman School of Medicine at the University of Pennsylvania and ASMBS Integrated Health member. "However, it can be dangerous when we look at them as role models. We forget how different their lives can be from ours," Dr. Sarwer added.

While most Americans do not have the fame and fortune that often comes with being a celebrity, they do share the struggle, stigma and life-threatening health conditions related to the disease of obesity.

Randy Jackson had bariatric surgery about 10 years ago, after the first season of American Idol. In press reports, Jackson said getting diagnosed with type 2 diabetes in 2001 was the "final straw" that sent him on the path toward bariatric surgery about two years later.

Mathias A.L. (MAL) Fobi, MD, who has operated on his share of celebrities including Etta James, Jennifer Holiday and Roseanne Barr, was Jackson's surgeon and though it's been about 10 years since he performed the surgery, he still gets calls based on fluctuations in Jackson's weight.

"Do I get calls?  I hear things like, 'your boy Randy looks like he's gaining a little weight' or 'he's still looking good.' It's amazing," said Dr. Fobi, who had gastric bypass himself in 2011 and has since lost nearly 70 pounds and has seen his diabetes, sleep apnea, gout and back problems go into remission.

"Celebrities want people to focus on their talent, not their weight. But because they are so much in the public eye, they can't avoid it," Dr. Fobi said. "However, really without exception, they all talk about what hard work it is and that they wish they would have done it (surgery) sooner. Concerns over what the surgery will mean for their careers are trumped by what the surgery can mean for their health."

Carnie Wilson weighed about 300 pounds and in press reports described herself as "someone who kind of gave up, and was out of control" before having gastric bypass surgery in 1999. While most celebrities remain quiet, even secretive, about their plans for surgery, Wilson was different. Her surgery was broadcast live over the Internet. About 500,000 people watched as ASMBS Past President Alan Wittgrove, MD, performed the surgery and took viewers inside his operating room.

"It was certainly unprecedented," said Dr. Wittgrove of the Wittgrove Bariatric Center. "But we approached it with the same care and attention we do every surgery. It's the same operation and we have a proven system that works. We were only doing it on a bigger stage."

Dr. Wittgrove says reaction after the surgery was overwhelmingly positive, from both health professionals and patients. It put bariatric surgery on the map at a time when there was little understanding and even greater fear and stigma. For many, the "mysteries" of bariatric surgery were revealed and offered new hope.

"I think it saved a huge number of people, who for the first time realized they had an option. They started to think, 'I can live longer. I can live better. There is an option,'" Dr. Wittgrove said. "It certainly helped reduce the stigma around surgery. In the old days, it was clandestine. Patients would come in almost embarrassed. Now there is more openness."

America responded to Wilson. She was relatable. They shared in her journey through the years. To Wilson's credit, she didn't portray bariatric surgery as a magic bullet or that her struggle with obesity was finally over. She told USA Today a year after the procedure, "The surgery is a tool to assist in helping you get back your health, but you have to participate in your wellness by really being aware of what you eat." Wilson would also frequently discuss her new eating habits and exercise regimen, her attendance at support groups, as well as the psychological and emotional challenges she faced in her life.

Though she lost nearly half her body weight with the first surgery, Wilson said pregnancy and motherhood "derailed" her weight loss and she regained about two-thirds of what she lost over the years. In 2012, she made headlines again when she announced to the world that she had another operation -- this time gastric band surgery. "It was the right decision for me and I'm doing really well so far," Wilson told People magazine after the procedure. "It's all about taking good care of myself."

Wilson's second surgery focused the spotlight on the realities of keeping weight off, even after surgery. NBC News Chief Medical Editor Dr. Nancy Snyderman commented that bariatric surgery works over the long term only when patients totally change their lifestyles. In the same article on the Today show's website, Robin Blackstone, MD, the ASMBS president at the time said though not common, "in effect, she's added something to her first surgery. It gave her enough of a boost to get her weight down."

It would be months before Al Roker would publicly discuss the gastric bypass operation he had in 2002. He said In TIME magazine, "It's a very complex decision that people have to make for themselves, not because somebody on TV made
that decision."

Over the years though, Roker has opened up about his surgery and how hard he works to keep the weight off and stay healthy. He even grabbed headlines again earlier this year when in an interview with Dr. Nancy Snyderman on Dateline he may have shared a little too much information. Roker recounted that during a visit to the White House, about a month after the surgery, "I pooped my pants. Not horribly, but enough that I knew." This admission led to news stories about the "not-so-glamorous" side effects of weight loss surgery.

So do the ups and downs of celebrity surgeries help or hurt public understanding and action on obesity? According to world-renowned communication expert Irving Rein, PhD, professor of Communication Studies at Northwestern University and author of 12 books, including High Visibility, a groundbreaking study of image making, the answer depends on individual circumstances.

"Where a person is on his or her journey determines the level of influence of the celebrity. For some, it could be a tipping point, for others it may cause additional consideration and for others, it could be absolutely meaningless," said Dr. Rein. "People don't come to the conclusion to have surgery out of the blue. It's more of a cumulative effect. It is quite likely that a non-famous person, like their doctor or a friend who had the surgery and a combination of other factors, including health status, financial standing and risk tolerance, are greater influencers than any
individual celebrity."

Nonetheless, it is clear that public and media scrutiny remain on a celebrity's weight loss well after bariatric surgery. For people with obesity, how many can put aside the fact that Al Roker had bariatric surgery every time they see him do the weather? Bariatric surgery celebrities are walking billboards for life after surgery. Are they keeping the weight off? Does their health continue to improve? Patients and potential patients will continue to watch these celebrities on the screen and read about them in the newspapers, and hopefully the spotlight will shine enough light for people to treat their own obesity, even when the cameras are off.