Excerpt: Khaliah Ali's 'Fighting Weight'

I have a debt of gratitude to Drs. Fielding and Ren that can never be repaid. How can you repay someone for giving you your life? So, when they asked me to do this book with them as a way of dramatizing what a very obese person goes through -- and how she can come out "the other side" -- I was thrilled to take part. Please be aware as you read that while the story is mine, all the scienti?c facts, ?gures, research, and medical explanations are theirs.

THE EUROPEAN SOLUTION TO OBESITY

The type of procedure I underwent is called laparoscopic adjustable gastric banding, or gastric banding, for short. (You can also call it stomach banding, because that's what it is.) It doesn't involve stapling your stomach and cutting your intestine in two, as does gastric bypass -- the surgery chosen by such notables as Carnie Wilson and Al Roker. Instead, it's relatively low-tech as operations go. A band is simply placed around the stomach and periodically tightened to reduce hunger sensations, as well as limit the amount of food you can process at one time. That's it.

The operation was perfected by Dr. Fielding, who developed the technique that is presently used worldwide to implant the band. It offers myriad advantages over gastric bypass.

1. It's reversible. If you don't like the band, you can have it removed. Gastric bypass, by contrast, is a decision you usually can't go back on because the complication rate for reversing the surgery is too risky.

2. Low rate of postoperative problems. There are fewer adverse effects from the operation and even fewer deaths -- one in two thousand, as opposed to gastric bypass's one in two hundred.

3. More patient follow-up because you need to have the band tightened every so often. It's a simple outpatient procedure that involves no anesthesia, just an injection of watery solution that thickens the band so it can wrap a little tighter around the stomach. I've had mine tightened a number of times now. It's about as eventful as getting your teeth cleaned.

4. No hunger. With gastric bypass, hunger eventually returns because the stomach softens up, or "stretches," and there's nothing that can be done, which is why the weight of most people who have gastric bypass drifts upward again. With gastric banding, the periodic band tightening keeps hunger at bay forever so the weight can keep coming off as you need, and stay off. Even dieting plateaus don't sabotage the weight-loss effort. Usually, when obese people reach a plateau and stop losing weight for a while, the hunger combined with the disappointment of not seeing the scale needle move downward decreases motivation, so weight starts to creep back up. I know the pattern all too well. But with the band, the plateau is bearable. It can be waited out until the next drop in pounds because there's no hunger involved.

5. No dumping. With gastric bypass, eating even a tiny amount of a sugary food, less than a single bite's worth, can cause dumping -- a precipitous drop in blood sugar that results in the sweats, nausea, and often a very scary feeling of panic.

I know people who have gone through it. It doesn't happen after banding surgery.

6. No nutritional de?ciencies. With gastric bypass, you have to take vitamin and mineral supplements for the rest of your life because the surgery creates permanent nutrient malabsorption. With gastric banding, a simple multivitamin that millions of Americans already take is recommended to provide nutritional "insurance."

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