SCOTT SIMON, Host:
This fall in a series called Living Large, NPR's exploring how life is changing in a country where one in three people is obese. A place you can see that change is the marketplace. Americans today spent $61 billion a year on everything from diet pills and exercise videos to meal plans, health club memberships and medical treatments. Today, NPR's Carrie Kahn examines one more lucrative segment of the weight loss market: surgery.
CARRIE KAHN: If you want to learn about the risks and benefits of going under the knife to lose weight, there's a great place to go in Los Angeles - and it's not a Beverly Hills doctor's office.
BIG BOY: ...stick around your radio, Big Boy's Neighborhood, Power 106.
KAHN: Check out L.A.'s popular hip-hop station and its larger-than-life DJ.
BOY: Yes, my name is Big Boy from Power 106, Big Boy Radio Networks.
KAHN: Are you going to tell me your real name?
KAHN: Big Boy, seldomly referred to as Kurt Anderson, used to be really big.
BOY: I had gotten all the way up to like an 8X shirt and size 66 pants. So, my whole life I've always been big. It just went from big to bigger till I got to my biggest.
KAHN: Five hundred and 20 pounds. At that weight, Anderson posed provocatively for a photo in his underwear. It was plastered on billboards all around town. He was Big Boy and famous, but Anderson says he knew he wouldn't last at that weight.
BOY: I was 33 years of age, I was over 500 pounds, and you start to ask yourself, like, man, do you have more years behind you than you have in front of you? Do you see any 66-year-old, 500-pound men? You don't.
KAHN: Anderson says after years of failed dieting, he decided on gastric bypass surgery.
AMIR MEHRAN: There's really nothing in the field of medicine that can match what surgery can do for these patients.
KAHN: Dr. Amir Mehran is the director of bariatric surgery at UCLA. He points out there are many different types of bariatric surgery, from removing large portions of a patient's stomach to just restricting it so less food can get in. Mehran says each procedure has its risks and benefits.
MEHRAN: The surgery is not a quick fix. It's not a magic pill. All it is, it's a very strong tool. And depending on the surgery, some are stronger, some are weaker.
KAHN: Big Boy had what is known as the duodenal switch. More than 70 percent of his stomach was removed, and his intestines were rerouted. Eight years later, he maintains his weight right around 200 pounds. But Big Boy wasn't, isn't the only overweight personality at Power 106. Three others have had bariatric surgery. Joe Grande chose the Lap-Band.
UNIDENTIFIED WOMAN: Body percent fat went down again.
KAHN: Grande, whose real name is Joe Lopez, is at his doctor's office. He's stripped down in his underwear and hooked up to a small machine measuring his body weight, fat and metabolic weight.
UNIDENTIFIED MAN: You're doing great.
KAHN: He really is. It's been four years since Lopez had a small device secured around the top of his stomach. When inflated, the gastric band restricts the stomach so only a small amount of food can get in.
JOE LOPEZ: Everybody always said, Joe, you carry your weight well. Because, I mean, I always looked like a football player. It wasn't like I just carried it in my stomach. You know, my weight was all around me. I mean, I looked like Shrek, basically. And people love Shrek.
KAHN: But unlike Shrek, Lopez had diabetes, high blood pressure and gout. Both his parents died in their 50s from complications due to diabetes. Lopez says he tried dieting and exercise for years. The lowest he could ever get down to on his own was 285 pounds. Eventually, he would gain it back and more. He had a lot of long-learned bad habits.
LOPEZ: You know, eating that rich Mexican food and just, you know, 10 carbs for dinner. It's like, OK, we are having beans, fideo, rice and other rice. You grow up going my mom was the best cook ever. Everything was wrapped in bacon and it was awesome. Thanks for the diabetes. Love you.
KAHN: Within three weeks of surgery, Lopez's diabetes and high blood pressure were gone. After taking medication for five years, he threw out all his pills. Lopez lost 125 pounds and became a spokesman for several bariatric surgery centers. But not everyone is happy with the Lap-Band. At the UCLA surgery clinic, doctors won't use it. They say they don't like the idea of leaving a foreign object in the body indefinitely. And there are objections to the aggressive advertising used by some surgeons.
(SOUNDBITE OF AD)
WOMAN: If you want to change your life like I did, pick up the phone and call 1-800-GET-THIN.
WOMAN: (Singing) Your new life begins. Call 1-800-GET-THIN.
KAHN: Critics say the ads focus more on getting thin than getting healthy. These spots in Get Thin billboards blanket L.A. - I see three on my daily commute. Some surgeons tied to the advertising campaign are being sued by relatives of patients who've died after having the Lap-Band implanted. Other patients are suing, claiming false advertising. In the last two years, five Southern California patients have died after having Lap-Band surgery at clinics tied to the ads. The clinics deny any connection.
David Pyott, the CEO of Allergan, which manufactures the Lap-Band said the company does not condone the ad campaigns.
DAVID PYOTT: We don't always agree with the tone of some of those advertisements by our customer. But we're not the advertising police.
KAHN: Pyott says thousands of Lap-Bands have been implanted in patients. It is a safe, simple and successful way for people to lose weight.
PYOTT: It's a mechanical way of controlling hunger. After a couple of hundreds of calories of food intake, to say I am satisfied, I can take a break.
KAHN: Despite the safety reassurances, the American Society for Metabolic and Bariatric Surgery is also concerned that the message to obese clients overemphasizes cosmetics and appearance. Society President Robin Blackstone, performs between 300 to 400 gastric surgeries a year at her Scottsdale, Arizona clinic. Even though, she says surgery should be the last resort, not something decided after seeing a billboard.
ROBIN BLACKSTONE: It causes people to continue to have an image about thinness rather than about health.
KAHN: Blackstone says patients should be wary about going to a surgeon that only offers one type of surgical treatment.
For Big Boy, Kurt Anderson, it's been many years of doctor's visits and dealing with side effects after he had most of his stomach removed in the gastric bypass. On the day I saw him, he was struggling with edema, his lower legs were swollen.
KURT ANDERSON: I'm still going through medical problems. I'm at the doctor all the time, all the time. You know what I'm saying? I mean like, like I've got to go to the doctor today.
KAHN: And he says he's still tempted by fatty food. He said the big box of donuts that is frequently on the table at the radio station calls out to him.
Joe Lopez, who lost 125 pounds with the Lap-Band, says he still has an eating problem too. Lopez says once he even had the doctor loosen his Lap-Band. He was going on his honeymoon and wanted to indulge.
LOPEZ: Because I went to an all-inclusive resort and I wanted to eat a little more. So I asked my doctor to if I could get it adjusted and I gained, like 20 pounds. And it shows. Left to my own devices, I can gain about 20 pounds in a couple weeks.
KAHN: Once back, he had it tightened and dropped the extra weight.
Such success stories have helped propel the number of bariatric surgeries performed every year - more than 200,000 annually and that number could grow higher.
Allergan, the maker of the Lap-Band, recently got FDA approval to market the device to people needing to lose as little as 50 pounds. And the company is waiting for approval for its use in another obese group - teenagers.
Carrie Kahn, NPR News.