As the Supervisor of Patient Service Operations for the Weight Loss Surgery Program at Washington University School of Medicine in St. Louis, Angie Britt helps patients understand the steps they will take on their weight loss journey. Diets, doctors’ visits and weight loss programs all play a role in preparing for bariatric surgery, and Britt is an expert at teaching patients how to navigate all of this information. Britt’s knowledge comes firsthand: she was a patient in the program six years ago. Britt knows what it is like to be overweight and to have weight loss surgery, and she is committed to helping others through the process with the understanding she gained on her own journey.
“I have been overweight most of my life,” says Britt. In high school, she was an active teen who played sports. She did not see herself as overweight or obese. “I was just thicker than everyone else.”
As time went on, Britt started to notice more weight gain. In college, she saw that she was putting on weight more steadily than she had in high school. When she became pregnant with her son, and continuing after childbirth, Britt gained weight constantly.
“It started to impact me,” she says. “I didn’t like being active. I wouldn’t go somewhere or do something if the chairs would be uncomfortable for my body.” She avoided travel and felt self-conscious in social settings because of her size and the limitations it imposed on her ability. “I avoided those things and just went on with life,” Britt states. “When I met my husband, that was probably the most I’ve weighed in my life.”
The problems stemming from her weight worsened—she had serious knee pain and shortness of breath, making it increasingly difficult for her to enjoy her life. The Centers for Disease Control and Prevention (CDC) notes that medical complications of obesity include arthritis, inflamed veins with blood clots, stroke, and lung, liver and heart disease. Britt began to worry that she may need knee surgery and medications to manage her developing conditions.
A Winding Road
This is when Britt decided to try a weight loss program.
She attended meetings, tried dieting and found some success. While many patients achieve weight loss with an organized program, for Britt, these programs were a temporary fix. “I lost weight, gained it back and, every time, I gained more weight back.”
Next, Britt turned to prescription weight loss pills. At the time, Britt was preparing to be in a wedding party. She wanted to lose weight, and lose it fast.
“The dress was strapless,” she recalls, “and I don’t wear anything strapless at that weight.”
Britt lost 45 pounds very rapidly, due to a combination of the pills and a highly limited diet. In hindsight, she sees that the pills made her feel hyper and the diet was unhealthy.
Both were unsustainable: immediately following the wedding, Britt once again regained the weight. She felt caught in a cycle of weight gain and poor health. The CDC recommends losing weight at a slower, steadier pace—one to two pounds per week—rather than drastic weight loss, for better success.
On one of her frequent visits to her primary care physician, Britt heard something that shocked her at the time. The doctor suggested she consider weight loss surgery.
“Weight loss surgery wasn’t as popular back then,” Britt remembers. Recently, documentaries and media coverage have made bariatric surgery more widely known, but for Britt 20 years ago, it was a foreign concept. She did not believe she was “overweight enough” for surgery. She also had assumptions about the safety of the procedures. There was a stigma about weight loss surgery for Britt, which made any kind of bariatric procedure unimaginable.
“When I left that office visit, I cried,” Britt says. “I was just really sad.”
Changing More Than Careers
Shortly after this episode, Britt came to work at Washington University. She joined the billing department, where she found herself frequently working on appeals from weight loss surgery patients.
“Some of these patients thought their insurance covered bariatric surgery,” Britt says. “They didn’t realize that they had to attend weight loss programs, visit their doctors and keep proper records to get coverage. There were a lot of hurdles for some patients.”
Britt saw ways of improving the process early in a patient’s journey so that they knew how their insurance would cover the procedure.
To better help patients, Britt attended one of the seminars required for weight loss surgery patients at the School of Medicine. She shared information about insurance coverage and approval, then decided to sit in the audience and observe the rest seminar.
Chris Eagon, MD, Director of the Adult and Adolescent Bariatric Surgery Program at Washington University School of Medicine, describes the procedures, processes and recovery periods to prospective patients at informational seminars. These seminars are intended to aid patients in deciding whether weight loss surgery is right for them and, if so, what procedure might best suit their needs.
That seminar changed Britt’s perception of weight loss surgery. Hearing Dr. Eagon’s lecture taught her that the procedures involved less risk than she thought and could in fact help patients at Britt’s body mass index safely and effectively lose weight. Britt was ready to consider weight loss surgery.
“It is for somebody like me,” she realized.
“I wanted to hear what Dr. Eagon was saying,” she says.
Leading by Example
Knowing the requirements she would have to meet in order to qualify for weight loss surgery, Britt got to work. She attended an organized weight loss program, completed assessments with a team of health care professionals and finally had the surgery.
Britt had a laparoscopic sleeve gastrectomy. Sleeve gastrectomy—a procedure involving the removal of a large portion of the stomach, reducing the amount of food a person can eat before feeling full—is among the most popular forms of weight loss surgery.
“Sleeve gastrectomy results in an excess weight loss of 50-60%,” Washington University bariatric surgeon Francesca Dimou, MD, MS, explains. “The procedure leaves a much smaller, banana-shaped portion of the stomach.”
After the operation, which took about an hour, Britt was groggy and sore. Recovery from weight loss surgery is an ongoing process. In the first days, patients require a lot of rest. During the early postoperative stages, there are some limitations on what a patient can safely eat; patients transition through stages of a diet that progress towards reintroducing solid foods.
While on a liquid diet for the first week, it is important to get all of the necessary vitamins. Britt remembers focusing on taking her medication and drinking a lot of water and protein shakes. Following the week of liquid diet, patients move to a pureed diet for two weeks, and then can eat soft foods for the next two weeks.
Once this initial restrictive period is over, you can eat whatever you want, though sticking to a healthy diet will help you continue to lose weight and keep it off.
“I had to do a lot of walking,” Britt says. To regain strength after surgery, she would walk around the house. “During my second week, I started to feel a lot better. I ventured outside, and I walked to the end of my driveway and back.”
Each day, Britt made it further on her walks. Eventually, she reached the park at the end of her block.
“I remember feeling accomplished,” she says. “I was getting stronger and sticking to my diet.”
Ultimately, Britt lost roughly 100 pounds after her operation.
“The first 12 to 18 months postoperatively is when you lose the most weight,” she says. During that time, Britt advises, it is important to stick to your bariatric diet and commit to losing weight. She has reached a stable weight now, which she maintains by following the same advice she offers her patients. “I think we all feel like we could always lose a little more weight,” Britt acknowledges, “but I’m happy with where I am, and I hope to help patients get to a place that they’re happy with, too.”
The journey, from realizing that her weight was negatively impacting her health and lifestyle, to learning about the benefits and risks of bariatric surgery, and finally to having the procedure and losing approximately 100 pounds of excess weight, has taught Britt a lot. She has learned to enjoy what she eats while sticking to a low carb, high protein diet; she has learned that the stigma she previously had regarding weight loss surgery was untrue; and she has learned that managing a healthy weight is not a matter of dropping pounds quickly, but an ongoing journey that continues long after any weight loss surgery. Now, with the memory of struggling to lose weight by every method in the book, and years of experience living successfully with her sleeve gastrectomy, Britt educates future patients who wonder if weight loss surgery might be right for them.