Christie Gets Surgery to Aid Weight Loss

New Jersey Gov. Chris Christie, who has endured both jokes and doubts about his political future because of obesity, says that he has had weight-loss surgery. Christie told the New York Post that he had a gastric banding procedure February 16. This surgery involves placing an adjustable band around the stomach to make it smaller. It makes people feel full faster. This and related procedures are the favored option for very obese people who have not lost weight in other ways. Christie, 50, did not announce that he had the procedure. He answered questions raised by the newspaper. Some commentators have said that health concerns could limit Christie's political future. He has been mentioned often as a potential Republican candidate for president. But Christie told the Post that he got the procedure for the sake of his family, not politics. Christie has never revealed his weight. But he has said that he tried several programs for weight loss. Each time, he gained the weight back. Christie would not say how much he has lost since the procedure. The Associated Press, the New York Times and others reported on the story May 7.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Weight-loss surgery has been hailed as a potential lifesaver for people who are severely overweight. It can dramatically:

• Reduce blood sugar levels
• Lower blood pressure and cholesterol
• Improve sleep apnea (a dangerous pattern of breath holding during sleep)
• Improve heart function

In general, weight-loss surgery is intended for people with a body mass index (BMI) of 40 or higher. They are considered to be very obese. People with a BMI of 35 to 39.9 also may qualify for surgery. They must also have a severe, treatment-resistant medical condition. Such conditions include diabetes, heart problems and sleep apnea.

Some experts suggest that some people with type 2 diabetes and even lower BMI levels (between 30 and 34.9) be considered for surgery.

Whether Governor Christie had weight loss surgery for political reasons or for concerns about his future health, he clearly fits the profile of a good candidate. We don't know his exact weight before surgery. However, the estimate is 300 pounds plus. He is just under 6 feet tall. This gives him a body mass index of at least 41.

Christie also admits to multiple trials in weight-loss programs. He has lost and regained substantial amounts of weight at least a couple of times. But, like more than 95% of obese people, he has regained all the lost pounds and more.

The governor has said he was otherwise in good health. Even if that was correct, his risk of developing problems directly related to obesity was high. At a BMI of greater than 40 and knowing that the surgery appeared uncomplicated for him, Christie surely chose the best and perhaps only treatment option for obesity.

What Changes Can I Make Now?

Today, surgeons generally suggest one of three weight-loss procedures:

• Laparoscopic adjustable gastric banding -- This is the simplest of the three procedures. It is done through small holes in the abdomen. The surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. The person feels full much sooner than before.
• Open Roux-en-Y gastric bypass -- The surgeon cuts into the abdomen and creates a small pouch in the stomach. This bypasses the rest of the stomach. The pouch is hooked to a loop of small intestine beyond the first section of intestine.
• Laparoscopic Roux-en-Y gastric bypass -- There's no large surgical cut. Small holes are made in the abdomen. Cameras are used to guide the instruments. The technique is otherwise similar to the open Roux-en-Y.

Governor Christie opted for the simplest procedure, the stomach banding. For most, this is same-day surgery. Christie's surgery was reported to take only 40 minutes, and he was home later the same day. Recovery moves along quickly.

Christie will check in with his weight-loss surgeon regularly to see if the stomach band needs adjusting. The band can be easily tightened or loosened as needed depending on his rate of desired weight loss and how he feels. Usually weight loss should be slow and steady. He must be sure to get enough vitamins and minerals through diet, supplements or both.

Roux-en-Y surgery leads to greater average weight loss than gastric banding. However, it is a more complicated operation. It also has greater short-term and long-term risks.

What Can I Expect Looking to the Future?

If you are considering weight-loss surgery, realize that you must commit to a lifelong change in the way you eat. Without lifestyle change, surgery will either make you miserable or not result in weight loss. And likely both. This is why people are required to go through at least one structured weight-loss program before they are eligible for surgery.