“Exercise at 500 pounds was walking to the car from the front door of my house,” explains the six-foot Saridis. “Walking up a flight of stairs was a thought. You would think and plan for it, making sure you didn’t forget anything in your car”. And it’s not as if he hadn’t tried to scale down his weight, which he began packing on at age 14.

Over the next two decades, Saridis tried – and initially succeeded – at almost every diet out there. But the pounds always came back, and then some. He did the infamous diet yo-yo, losing 20, gaining 30; trimming off 40, shooting up 70; carving off 80, ballooning up by 100. “I even got to the point where I was scared to diet,” says Saridis, who knew he was staring heart disease and diabetes in the face. “So here I am, I’m 34 years old, my knees are hurting, I’m wearing orthotics, I’m having difficulty getting out of bed in the morning. I decided something had to be done.”

He went to a Toronto cosmetic clinic for a $17,000 out-of-pocket operation to have a band placed around the opening to his stomach, a procedure that severely limits the amount of food he can ingest. And while the surgery has proved successful – at 221 pounds, the 36-year-old is half the man he was -there were no concurrent services to deal with other issues he struggled with, from proper nutrition to physiotherapy to psychological counselling.

“I left there that day with a stomach that could only hold a hard-boiled egg,” says Saridis, whose typical pre-surgery dinner was as much rice as a plate could hold, topped by two or three chicken breasts, maybe salad to fill up the corners and a 500-millilitre tub of ice cream. Any leftovers were gone before bed.

“But who’s going to fix my mind? … I’m feeling full, but I’m eating with my eyes – and there’s no satiety for my eyes”. Saridis, who owns a drycleaning business, decided he could build a better mousetrap. He invested about $4 million to open the Canadian Institute of Bariatric Options, a private Toronto clinic that provides gastric banding surgery via minimally invasive laparoscopic surgery and related services to promote and sustain weight-loss.

Clients pay $18,000 for the day surgery (which is not provincially insured), periodic tightening of the band as weight is lost, and a year of nutritional, psychological, fitness and chiropractic support. “It’s until they feel OK to stand on their own two legs and deal with things,” he says. “Let’s be honest, we don’t have a secret pill to losing weight, nobody does. What we’re teaching is sensibility, what we’re teaching is practicality and helping to implement it into your life”.

Dr. Nicolas Christou, one of Canada’s most renowned bariatric surgeons, says one thing CIBO is doing right is providing nutritional and other services to help patients make a success of their surgery. But Christou argues that CIBO and similar gastric-banding providers cannot call themselves true bariatric clinics because they offer only a single procedure – and when it comes to the morbidly obese, one size does not fit all.

“Bariatric surgery includes the whole spectrum of procedures that are suitable for the individual patient and include backup procedures if procedure A does not work,” says Christou of McGill University in Montreal, noting that gastric banding carries a significant risk of complications, such as the band slipping down on the stomach or erosion of the tissue it encircles.

North America’s gold-standard surgery is gastric bypass, in which a pouch is created and connected to the small intestine, bypassing the stomach. Another standard surgery is biliopancreatic diversion, which reduces stomach size and allows food to bypass part of the small intestine so fewer calories are absorbed. While both are insured services in most provinces, Christou laments that the notion of “bariatric surgery being covered in Canada has to be taken with a grain of salt.”

Waiting lists for surgery have swelled to inexcusable lengths, he says. The average time in Canada is 5.2 years; his own patients at Montreal’s Royal Victoria Hospital face a 13-year wait. One day a week, Christou operates at the private Weight Loss Surgery clinic, which offers bariatric procedures to non-Quebec residents for $15,000 to $22,000. “Even then, I have a waiting list,” he says. Despite the burgeoning demand and the obvious long-term health benefits of weight reduction, the health-care system is doing little to improve access, Christou says. There are only a dozen or so fully trained bariatric surgeons in the country and the specialty is not attracting more. A major reason, he says, is that the procedure remains near the bottom of hospitals’ surgical priority list: his own hospital gives him only one day of OR time a month.

Such lack of accommodation simply mirrors society’s negative attitudes toward the morbidly obese, Christou believes. “The public perception is that these are big, fat slobs that should be on a diet, and ‘Why should I be paying for their treatment?’ The reality is that they are people that have most likely a genetic predisposition to energy conservation,” who are also subject to “maladaptive socioeconomic factors.”

“And you get these people putting on weight and then they feel more depressed,” he says. “They eat more to feel better, and it’s a vicious circle that cannot be broken other than by the mechanical rearrangement of their gastrointestinal anatomy.” A case in point is five-foot-two Yvonne Holland, who turned to gastric banding after the scale hit 240 pounds, despite repeated and frustrating bouts of dieting.

“I’m feeling like I’m doing something and it’s working,” says Holland, 53, a manager for the City of Kingston, who is down to 205 pounds and wants to take off another 50. “I think, for most people, when you’ve tried things and they’ve not worked, you feel like a failure at the end of the day. … You spiral down. “And people who don’t have weight issues don’t get it. To them it’s easy -and it’s not easy. If it were easy, we wouldn’t be in the position we’re in in this country and in North America where the obesity rates are climbing.”

Given that there are about 900,000 morbidly obese people in Canada, many of them desperate for help, it’s no wonder private clinics are opening to fill the void. Still, CIBO’s surgeon Dr. Monali Misra says gastric banding or any bariatric surgery is not for everybody with weight issues. Patients must have a body mass index of 40 or more, or a BMI of 35-plus with two related illnesses, such as high blood pressure and diabetes, to qualify. Surgery is just a tool that must be combined with healthy eating and exercise to be successful, she says.

“If you take in a high-calorie diet, you’re not going to lose the weight,” says Misra, citing the case of a woman with gastric banding who blended up six Big Macs so she could drink them down. “We operate on the stomach, not the brain,” she quips, stressing that her motivation for doing bariatric surgery is to improve patients’ health; enhancing how they look and feel about themselves is a bonus. “I want them to live longer. And that’s what they need to want as well”.

The Whig Standart