At her heaviest, Khaliah Ali, who is 5 feet, 8 inches, weighed 325 pounds and said she'd spent most of her life yo-yo dieting in an attempt to lose the weight.
Even worse than being an obese American, said the daughter of boxer Muhammad Ali, was being an obese American whose father is a national hero in large part due to his physical prowess.
Finally, three years ago, Khaliah Ali underwent gastric band surgery in which a band is put around the stomach to shrink it. Different from gastric bypass (in which doctors bypass your intestines and staple your stomach), this procedure is less invasive and can be adjusted periodically (the band can be loosened and tightened) depending on one's changing lifestyle.
Khaliah, who is down to 158 pounds, has written a book, called "Fighting Weight," about her surgical success, which she hopes serves as a message to other obese Americans.
You can read a chapter from the book below.
Introduction: Claiming Your Life
Twenty million Americans can't pull an airplane seat belt across their laps. They can't run for a train, can't step into the bathtub without great deliberation, and can't push a child on a swing. Nor can they sit on a bistro chair or other fragile furniture because, quite simply, they'd break it. Most don't dare go to the beach, wear sleeveless shirts, hold out hope for true romance, or enjoy being in public.
All are candidates for weight-loss surgery. Beside the everyday morti?cation of literally not being able to ?t into life, they're susceptible to heart disease, diabetes, arthritis, interruptions in breathing during sleep, and a host of other debilitating, if not life-threatening, conditions.
Still, less than 1 percent of those eligible for obesity surgery come forward, largely because they fear the risks of the operation. I was one of them.
I know ?rsthand the shame of becoming morbidly obese; the lifetime of dieting off pounds, but never enough, and then gaining them all back and more; the aching joints, the inability to walk up a single ?ight of stairs without losing my breath -- all made worse by the fact that I was the daughter of a man who is very famous, in large part, precisely because of his ?tness and physical abilities. I remember well, too, the experience of ?nally coming around to the idea of weight-loss surgery but rejecting it because of the very real possibility that I would die on the table.
Frightened and miserable, I went five years losing and gaining the same ?fty pounds and didn't know which way to turn -- until a wonderful friend steered me toward Drs. George Fielding and Christine Ren, professors at the New York University School of Medicine. My friend told me they performed a type of weight-loss surgery that has been used in Europe for more than a decade but is only now starting to take off in the United States. The results of the surgery are just as spectacular as those of gastric bypass, she said, yet with only one-tenth the rate of life-threatening complications.
Soon, with their record of success and also their hand-holding through my own hand-wringing, they convinced me of the procedure's safety, and I was on the road to slimming down to a goal weight of 150 pounds -- not bad for a woman who's ?ve feet nine inches.
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."
Other bene?ts of gastric banding surgery: the operation takes an hour or less, whereas gastric bypass requires two to three hours under anesthesia. Furthermore, you're out of the hospital in one day (as opposed to two to three days) and back at work within a week. I was on the Today show talking with Ann Curry, Dr. Fielding by my side, just four days after my own procedure. With gastric bypass, it could be up to three weeks before you're able to resume your normal activities.
The recovery goes so fast because the operation does not entail rearranging your internal organs, the way gastric bypass does. As Dr. Ren says, the band simply acts as an effective appetite suppressant without the side effects of appetite-suppressing drugs. "This is not a grandstanding operation," she explains. "It's a very gentle procedure, a facilitator to diet and exercise rather than a body punisher."
Currently, only one out of ?ve weight-loss operations in the United States is a gastric banding, as opposed to four out of ?ve in Europe. Why? One reason is that gastric banding has been standard in Europe since the mid-1990s (and is also easily available in Australia and other countries) but was approved here only in 2001. But beyond that, surgeons do the surgeries they know. While Americans were perfecting the gastric bypass (an operation ?rst performed in the 1960s, after doctors observed that removing part of the stomach as a cancer treatment or ulcer therapy led to weight loss), doctors in other countries were cultivating the gastric band.
THE EASY WAY OUT?
A lot of people believe opting for obesity surgery is taking the easy way out, just one more sign that very fat people lack willpower. Again, I was one of them.
Like both fat and thin people everywhere, I had bought into the idea that thin people have more self-control than heavy ones, that they're more together. In other words, I believed I simply wasn't trying hard enough, couldn't stick with anything, and was living a sloppy, unstructured life and therefore deserved to remain miserable, constantly out of breath, my knees and feet always in pain, and being the subject of people's cruel stares and even crueler comments.
That belief, in fact, was part of the reason I hesitated before un¬dergoing the operation that ?nally helped me lose the weight I needed to lose. It was subtler than the fear but still insistent, and kept wearing me down and making it impossible for me to act. I was convinced that to lose weight by surgery instead of diet and exercise would be "cheating," in short, proof that I hadn't really taken hold of my life and was instead "surrendering" to my lesser self.
I was wrong. I was trying hard enough -- my entire life. From the time I was ?ve years old and a friend told me I wouldn't be so "blubbery" if I didn't eat so much blubbery steak, I dieted. I was even trotted out in front of Jane Pauley on the Today show as a nine-year-old as part of a program to slim down overweight kids.
As an adult, I dieted on my own, at one point taking off almost a hundred pounds. But the weight always came back.
Dr. Fielding had gone through the same thing. Fat from childhood, he lost -- and gained -- seventy pounds four times as an adult before opting for the very gastric banding surgery he had already performed on hundreds of others.
Our experience is often true of obese people. They spend more energy on dieting, starving, working to control hunger, than anyone else. And most of them do lose thirty, forty, ?fty pounds -- many times over -- exhibiting a lot more willpower than most thin people have ever had to show.
So what do thin people have over those who are extremely overweight, if not self-control? Luck. Or, more speci?cally, genetic luck. The genes that put their ancestors at grave health risk thousands of years ago, by making it dif?cult to hold on to fat stores in times of food scarcity, are the very genes that are keeping them thin and largely free of health risks today in the face of food overabundance.
Thin and even mildly overweight people often scoff at that notion, as I know all too well. They say that while a person's genes could perhaps cause a weight gain of twenty, thirty, or even ?fty pounds, there's no way someone's genetics could cause her to gain a hundred or more excess pounds. The fault for such obesity, they say, falls on the eater's lack of resolve, not her own particular metabolic circumstances. Not true, and you need only to look at the growing ranks of the obese over the last seventy years to douse such thinking.
As Dr. Fielding likes to tell it, if you had said to your thin, tough grandparents in 1935 that they would be able to sit in their car, make the window go down with a ?ick of a ?nger rather than with a hand crank, and have a nice teenager hand all their grandchildren ?ve thousand calories through the window with none of them making a single move, they'd have told you to stop dreaming. That is, seventy years ago, constant availability of very high-calorie food with no need to expend any calories in order to procure that food was inconceivable, and there were extremely few obese people.
What has changed in the last several decades is not people's level of willpower but our food supply, which has literally become toxic. It's now nothing, as I know intimately, to buy an 1,100-calorie pecan bun from Cinnabon's, an 850-calorie Taco Bell taco salad, a 600-calorie king- size fries, a 400-calorie slice of pizza topped with pepperoni, or a 1,200-calorie pint of superrich ice cream. And there are no more scheduled mealtimes around the table to cue you about when eating starts and when it's over. It's all grazing, all the time. Furthermore, it is more common now to overeat for emotional reasons.
It's at the intersection of these changes that the genetic differences come in. Some people can eat whatever they want whenever they want with no consequences on the scale, or at least not severe consequences. Their metabolic wiring allows them to burn calories faster. Or they may have hormones that are set in such a way that they simply do not get as hungry as other people or as turned on by the sight of food. Others, like me, are not so fortunate. And the not-so-fortunate number keeps growing, because as the food supply keeps getting more and more abundant and concentrated in calories (not to mention more available at every turn), more and more people's genes and metabolisms are losing the ability to withstand the caloric onslaught. Their internal signals are overridden.
In 1980, 15 percent of Americans were obese; now it's more than 30 percent. What has changed is the food, along with the drop in the number of calories people burn in daily activities -- not their characters, genes, willpower, or anything else.
How bad can it get? Ninety percent of human beings have the potential to become obese or morbidly obese. Only about 10 percent are resistant to all the extra calories available. Those lucky 10 percent ?t into one of two analogies. Either they're like Toyotas in a gasoline crisis, getting by perfectly ?ne on less, while the rest of us are like SUVs, guzzling fuel (that happens to be much cheaper than the fuel for our vehicles, a lethal bargain). Or they have SUV appetites but burn their food calories so fast they have Toyota ?gures.
Okay, you might say, some people, maybe even most people, are more vulnerable to becoming very overweight. But why can't obese people diet off the excess pounds? (Or, as I've heard expressed behind my back in audible, disgusted stage whispers, "She could at least lose ?fty pounds.") The answer is not clear-cut and not yet well understood. But the research community is making inroads. One thing that seems apparent is that the threshold for hunger resets once someone becomes very overweight, so the body needs more food more frequently to feel sated. It could also be that the gastrointestinal tract becomes less sensitive to hormones that regulate appetite. Perhaps there's some other biological explanation that's waiting to be discovered. In the meantime, what's known for certain is that while someone who is moderately overweight can successfully shed twenty, thirty, even sometimes forty or ?fty pounds, chasing away seventy, eighty, a hundred or more pounds -- and keeping them off -- is virtually impossible.
That's not to say it never happens. It does. But the success stories are phenomenally rare, much more rare than even many in the medical community are willing to admit. Those photos on magazines at the supermarket checkout of people who have shed a hundred pounds -- it's a statistical fact that only 2 percent of them are able to keep off the weight. And the constant hunger and deprivation those successful 2 percent must put themselves through are often more than anyone should have to bear. It's like living with another kind of eating disorder. Those photos actually do a great disservice, because they only fuel the false notion that if obese people just tried hard enough, they could take off the weight. I know they used to get me down -- after the initial, short-lived spiral into "hopeful."
Whatever weight I lost always came back, whatever effort I put into it always back?red. Even the most extraordinary effort was no match for the tenacity of my obese body. The hunger my body engendered was like the subject in Edvard Munch's painting The Scream. It was constant; it was maddening; it always got the better of me.
DAMNED ONLY IF YOU DON'T
I suffered countless indignities because of society's accusing ?nger, compounding the physical and emotional misery my weight caused -- poor treatment and withering stares from salespeople, askance looks from physicians in examining rooms, a smug unwillingness of people to hold open an elevator door, all adding to the severe depression and social isolation. When I ?nally did opt for surgery, a lot of people blamed me once again, for going the route of a quick ?x rather than doing the hard work. It was like I was trying to get out of my "punishment." I was damned for not being able to lose weight without medical intervention and then damned again for availing myself of the tool that allowed me to achieve what the entire world said I should have been achieving my whole life. But even the National Institutes of Health have gone on record saying that for morbidly obese people, surgery is the only hope. The American College of Surgeons and other health-promoting organizations support obesity surgery, too. Medicare, the health insurance program for older people, now pays for it (and private health insurers often follow Medicare's lead, which means there's a good chance that more and more health insurance companies will begin to reimburse for the procedure).
Besides, it's not a quick ?x. After obesity surgery, you still have to eat healthfully. You still have to exercise. You still have to pay attention to your body's signals every single day. The difference is that the surgery creates a level playing ?eld. It ?nally gives very large people the tool that everyone else takes for granted -- the ability to not feel hungry every minute of every day so that they can once and for all get their eating under control.
In other words, if you do choose gastric banding, you're not ducking responsibility. You're not surrendering, and you're not weak. You're ?nally taking charge by making use of a device that can help you. You're claiming the life that everybody else kept telling you how to live.
That's what I want to talk to you about -- claiming, or enrolling in, your own life. Think about the fruitless battles you can do with your body over years, over decades, then making a choice for allowing your body to cooperate with you so that all your thwarted dreams can become your reality. That's a choice I ?nally made, not in surrender and weakness but in ?erce, levelheaded determination, and it has not damned me. It sustains me. I've never been happier than I am now.
It goes way beyond the frivolous things, like being able to wear whatever I want, although I take great pleasure in details like that. But what I also love is being able to walk into a room and not get snickered at. I love having the energy to play catch with my son, to take him trick-or-treating on Halloween and not feel self-conscious, to present a business idea to a team of investors without feeling that my weight is more convincing of the idea's failure than my words of its success. I love getting to live many years more than I might very well have been destined to live as a morbidly obese person. Most of all, I love being at peace with myself.
As for any person who has dealt with obesity, it was not an easy journey. And being a daughter of one of the world's most famous and admired people didn't shield me. In fact, in certain ways it only put me more in the spotlight, perhaps in more negative ways than other people of size. From the time I was in grade school, I was taunted by peers, even hit by other kids, because I was "big" and therefore could "?ght like my father."
Nothing could have been further from the truth. I hung back, partly because I was a gentle kid but also because I wouldn't have been able to bear drawing that kind of attention to myself. Not now. I like being with other people, whether it's hanging out with friends, conducting business, or making a speech to raise money for a charitable organization. And I like being romantically available, as well as available to participate in physical activities, which had always been closed to me before. That is, I like where my journey has taken me, and continues to take me.
I realize it's not the same for all large people, and that not all of them are even intent on losing weight. Some, while they may at one or more points in their lives have tried to slim down, have joined what is commonly called the Size Acceptance Movement. Despite the profound bigotry against them (it is still acceptable to loathe fat people openly, to make fun of them, to deny them jobs and promotions), despite all the health risks, they are able to make peace with their bodies and de-emphasize the role of eating and weight in their lives. They ?nd a way to move forward even while dealing with the physical and societal limitations. To them, I -- and Drs. Fielding and Ren -- say, "Our best to you." No one should ever be pushed into doing anything she or he doesn't want to.
But most very large people are very unhappy about their bodies, their health, their looks, the prejudice against them. They would do anything if only they could lose the weight. They think about it every waking moment. That's who I'm talking to in this book. And I, who previously had not even been able to experience physical intimacy without artfully draping myself so as to be more or less hidden from view at those very moments when a person is supposed to feel free and unfettered, am here to tell you that you don't have to live that way. You can change the course of your journey, too.
I know, because my story is your story. While the details may be different, you'll recognize the arc of despair. You'll see, however, that you can rewrite all the chapters yet to come.
This excerpt is printed with permission from the publisher. Published by HarperCollins. Copyright © 2007 Khaliah Ali.