Heather Wisdom

"I've always been a big person," Heather Wisdom says, "but not this big." She's referring to pictures of herself in her early twenties, standing nearly six feet tall and weighing almost 400 pounds. "A lot of health and emotional problems hit me all at once, and I didn't handle them very well," Heather explains. "But when I gained 100 pounds in just six months, that's when we knew I really had a problem."

Heather copes with polycystic ovary syndrome — a genetic disorder that causes hormone and metabolic imbalances. Symptoms vary between patients but commonly include a predisposition for weight gain and obesity. Making things even more difficult, at the time of diagnosis Heather was battling severe depression and had suffered a back injury that prevented her from exercising.

"My husband Jeff was really frustrated," Heather recalls. "I mean, I wasn't a thin person when we met, but I'd gained so much weight, so fast. Even in a good relationship like ours, that's a delicate subject, and neither of us knew how to handle it. I spent a lot of time crying. I read books about being happy with your body and loving yourself as a big person. And Jeff was really supportive. But we were scared, because the weight wouldn't come off, no matter what I did."

Heather sought help from Dr. Lori Roust, a physician in the Division of Endocrinology at Mayo Clinic in Arizona. But despite months of strong medications to control Heather's metabolic disorder coupled with nutrition counseling and exercise assistance, her bodyweight remained unchanged. "I had lost weight in the past," Heather says, "but losing as much as I needed to this time seemed impossible. I just didn't think I could do it."

Dr. Roust felt that Heather was a prime candidate for bariatric, or weight loss, surgery, and suggested a meeting with Dr. James Swain, a physician and surgeon in Mayo Clinic's Department of General Surgery. But Heather chose to continue seeking non-surgical solutions for her weight problem. "In my mind, surgery was really the last option," she says. Unfortunately, the weight wouldn't come off — and everyday life just seemed to get worse.

Putting things in perspective

Heather Wisdom, before her surgery (April 2004) and after (December 2006). Heather lost nearly 200 pounds, and in the latter picture is pregnant with fraternal twins.

"I remember one time we were taking a flight," Heather recalls, "and because of my size, we had to buy two seats for me. The flight was overbooked and the airline staff kept trying to board extra passengers. And I had to say over and over again — loudly so that everyone could hear — 'No, I bought this seat. I'm so large, I take up both seats.' It was just awful."

Experiences like this, coupled with Dr. Roust's urging, finally moved Heather to begin seriously researching weight loss surgery. "By the time I met with Dr. Swain in April 2003," Heather says, "I knew exactly what questions to ask, and he had all the right answers." Heather especially appreciated Mayo Clinic's conservative approach to bariatric surgery. "Dr. Swain said to me, 'If I don't think you'll be successful, I won't perform the procedure.' Other doctors had simply been concerned with how I would pay for the operation. But at Mayo Clinic, the surgeons' salaries remain the same whether or not they operate. The only thing Dr. Swain had motivating him was a desire to help me and ensure I did well. And I loved that."

Equally important to Heather was the fact that many patients come to Mayo Clinic for correction of problems caused by weight loss surgery performed elsewhere. Mayo Clinic is one of the only facilities to offer correction of bariatric surgery-related problems.

"The surgery was a big decision, because it changes a lot of things," Heather explains. "For me, there are certain foods I can't eat ever again, like things with lots of sugar in them. Pumpkin pie, for example. And lots of family traditions revolve around food." Heather and Jeff solved the dilemma by making a pros and cons list. "We listed the best and worst potential outcomes of my having the surgery. And eventually we were weighing living longer and someday having children against never eating pumpkin pie again. When we put it in that perspective, I thought, 'To not have this surgery is stupid.'"

Dramatic change

Despite the way it's often portrayed in TV and magazine advertisements, weight loss surgery is not a miracle procedure. Patients must make changes to their daily eating and exercise habits, or they may regain weight over time. Mayo Clinic provides a number of educational and preparatory programs for potential bariatric surgery patients, including nutritional counseling, psychiatric evaluations, and a 12-week behavior modification program. Mayo also provides bariatric surgery support groups: open forums where patients come together to share information. Various speakers including surgeons, endocrinologists, dieticians, and physical therapists often attend.

Heather completed the pre-operative programs successfully, and underwent surgery in April 2004. Bariatric surgery is generally performed laparoscopically, through several small incisions. The abdominal cavity is inflated with a neutral gas to provide room for the surgeons to work around the organs, and a tiny camera and slender surgical instruments are carefully inserted through the incisions. Minimally invasive surgery eases discomfort and promotes patient recovery, with bariatric surgery patients generally remaining in the hospital for two days and returning to work within three weeks.

"After surgery, the last thing I wanted to do was eat," Heather recalls. Her digestive system was eased back into use first through a liquid diet, and then pureed foods before moving back to solid fare. "It was a slow process to learn and understand my body's new signals that I'm full — they're so different from before. It's very easy to eat too much, too fast." Heather carefully monitors her daily food intake and returns to Mayo Clinic for regular follow-up evaluations.

What about the polycystic ovarian syndrome? "Once I lost all the excess bodyweight," Heather says, "all the other symptoms went away. I don't have insulin or hormone problems anymore. I sometimes wonder, 'Why didn't I have this done sooner?' But there's nothing I can do about that wasted time. At least now I'm in a position to help others." And that's exactly what Heather does, volunteering with Mayo support groups to help fellow bariatric surgery patients handle the changes dramatic weight loss brings to their everyday lives.

"Suddenly losing a lot of weight means you have to re-learn how to function socially," Heather explains. "People used to ignore me even though they couldn't avoid me because I was larger than life. So post-surgery, I had to learn how to think differently about my interactions with them, and I also had to learn to think differently about myself.

"About six months after my surgery, I had lost around 100 pounds," Heather relates. "I was in a store, and I walked past a girl and thought, 'I have a shirt just like hers. It looks really cute on her.' And then I noticed the girl was going my way. It wasn't until I got close enough to reach out and touch her that I realized she was my reflection in a mirror."

Even now — several years later — Heather still gets excited over seemingly little things, like being able to sit in a chair at the movies, or being able to shop for normal-sized clothes. "Having this surgery has changed everything," she gushes. "I'm finally able to enjoy all the little things that other people take for granted."