A lifelong quest to lose her dangerous excess weight is leading one Nelson woman to have bariatric surgery in New Delhi. Naomi Arnold reports.
This December, Michelle Allwright will be on Dr Randeep Wadhawan's operating table in New Delhi, having more than half her stomach stapled up, cut off, and pulled out through small holes in her skin.
The Richmond woman has had it with diets, points, plans, good intentions, hope, and failure.
The vertical sleeve gastrectomy she will have in India is her only solution now; and once it's done, there is no going back. She will return home just in time for Christmas.
Allwright's grandmother put her on her first diet in the early 1970s, when she was 12. Named The Microdiet, it consisted of milkshakes and powdered soup. "It was disgusting, and I don't imagine any 12-year-old would find that remotely filling," she says. "It was awful. And it just went downhill from there."
Of English stock originally, Allwright, and countless others of her generation, ate dinner to a backdrop of stories about the Depression and how she must clean her plate at every meal.
"I come from a family of good food, good times, and not in small doses," she says. "I was definitely brought up on too much stodge and dripping. Dripping sandwiches, for God's sake. I mean, they're yummy, with lots of pepper and things - but ..."
As she entered her teens she was wearing clothes bearing the same number as her age: size 16 at age 16, size 18 at 18. Today, she weighs nearly 150 kg and wears a size 26. You're morbidly obese if you have a BMI of over 50; Michelle's is 51. A healthy BMI is between 18.5 and 24.9.
"You get to a point where it's like: A BMI of 51? Hello? There's two of me now, and that's ridiculous," she says. "I'm 41."
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At an event recently, she ran into an acquaintance who had the same procedure in the same hospital with the same surgeon. The woman was unrecognisable; over about 18 months, she had dropped from a size 18-20 to an 8-10.
Allwright would not qualify to have the taxpayer fork out for her operation, and doesn't have the money to have it done privately - up to $35,000.
Organised through medical consultants Forerunners, the total trip is costing her just under $10,000. "One good thing is I won't be eating anything so that should bring the prices down," she jokes.
Her GP at home in Nelson warned her of the general risks of the procedure, but told her to go for it if that was what she wanted.
Medical tourism is big business in India. "You're treated like royalty," Allwright says with a wry laugh. "This is their business. We are the princes and the princesses that are keeping their economy afloat. It's as simple as that."
Her laparoscopic surgeon, Dr Wadhawan, is the director of Fortis Hospital's department of minimal access, bariatric, and gastrointestinal surgery.
He has performed more than 30,000 laparoscopic surgeries in his 21-year career, and patients from other countries include the United States, Canada, the UK and Germany, Nigeria, Kenya, Tanzania, Rwanda, Ghana, South Africa, Congo, Iraq, Kuwait, Dubai, Oman, and Australia.
The department performs between 150 and 200 bariatric procedures every year.
Allwright is comforted by being able to Skype him from New Zealand to find out more about what will be happening to her on his operating table.
"God, could you do that in New Zealand? Not a hope. Imagine that! You can actually have a conversation with your surgeon."
Dr Wadhawan said that about 20 per cent of his patients are foreigners, and the number of New Zealanders he's performed the surgery on would be "in the double digits". He says it's a low-risk procedure that sees most patients losing a third to half their excess body weight within a year.
After a pre-op diet of high-protein shakes, Allwright will leave New Zealand on December 13, spending a night in The Stay Inn. The bed and breakfast, which is 10 minutes' drive from the hospital, specialises in pre- and post-op stays for Westerners.
On her first day she'll undergo a slew of testing, and the following day will have the one-hour procedure.
She'll stay in hospital a further three days, ingesting only liquids, and after a leak test she'll be free to travel. She'll follow a post-op eating plan for six weeks, ingesting only soft foods and eventually move back to normal eating.
The only difference will be that her stomach won't be able to hold much more than half a cup of food.
Allwright and her husband Tony Fowler's three teenage kids have been supportive. "They've seen me struggle psychologically and emotionally and they're all in," she says. "I wasn't sure how they'd react, but it was sweet."
She can't walk far, and has developed skin issues and lower back pain. A family holiday in Melbourne for her 40th saw her struggling to keep up.
"I know I was restricting them from having more fun," she says. "That's where I'm at now. I can't imagine where I will be in 10 years."
She's never got to maintenance stage with her weight, and never remembers not being aware of it.
"You go through stages of going ‘I don't care about my weight, f***the world, but the reality of that is you'll probably put on 5-10kg by saying that," she says.
"Then you go ‘Look at the mess you've got yourself in now'. It's exhausting.
"All diets work," she says. "I'm not a complete fool. But can you maintain them? Are they part of your lifestyle? Can you get to the point where you can live normally? It needs to be sustainable, and you just get this yo-yo. It's not sustainable, you do fall off the wagon and it goes on plus a bit. That's the trap."
Her husband says the surgery is an investment in her future - one he's been watching her struggling to change for years.
"As long as she's happy," he says.
The surgery is a "tool" for her, she says. "It's not a magic bullet. You still have to exercise and all the rest, but it's the best tool I can find for me that's a permanent solution."
Allwright is entertaining and self-deprecating, but she admits she's nervous about people's reactions when she reveals her story. Since she has told a few people about her plans, she's had several approach her on the sly to find out more. Because being fat and not being able to do anything about it is quite normal in New Zealand. The obesity rate is rising steadily over the past 15 years, from 19 per cent in 1997 to 28 per cent in 2011-12. Sixty-five per cent of adults and a third of our children are obese or overweight.
Despite there being no cost-effectiveness studies on publicly-funded bariatric surgery in New Zealand, American studies have found the initial cost of surgery was completely recovered in two to five years.
University of Otago professor Andre van Rij, a bariatric surgeon at Dunedin Hospital, says weight-loss surgeries are much more accepted today than they have been in the past.
"The ministry is taking it more seriously, doctors are more aware of it, and are sending their patients for more surgery than they were 10 years ago."
For the morbidly obese, and particularly those who are diabetic, "it's the only option".
He points out that even if morbidly obese patients are placed on a very tight, supervised dietary programme with psychological support, the chance of them losing weight are about 5 to 10 per cent.
"These operations do some remarkable things in the body in stopping people feeling hungry. It's one of the hardest things in dieting."
The operation was low risk in the right setting, though he cautioned that those having the procedure performed privately overseas did not have the follow-up care they would receive in New Zealand, and subsequent issues would fall on taxpayers.
"When something goes wrong or they need extra attention or encouragement, they're sent back to public hospitals."
Wellington bariatric surgeon Richard Stubbs has been performing the procedures longer than anyone in the country, and agrees that surgery is the only way that people with major weight problems are likely to get a solution.
"If somebody's looking for a real answer, they need surgery," he says. "The problem in this country is that the public system is not delivering much in the way of surgery and this is pretty much confined to diabetics or those with a lot of troubles."
Conversely, he believes the best candidates are people who don't have those problems. "They're younger and have more of their life ahead of them and more of their life they can change."
However, he says people who travel overseas for major surgery take a risk of major complications. "People who travel overseas are going to sometimes get caught out, and if they do, they're going to get caught out pretty badly," he says. Major abdominal surgery has the capacity for people to become "seriously unwell", and he says that although the standard of medical care in India can be extremely high, there are also vast differences in the delivery of health care between hospitals. He's also wary of Indian hospitals advertising to first-world patients to make money off them.
"I would discourage it. On the other hand, I understand the desperation people feel."
Although it's a large chunk of change to pay, she feels lucky to have the support and funds to go through with it. Both she and Fowler come from lower socio-economic backgrounds; she was a minimum-wage caregiver for years, a solo mum with three kids. Fowler was an electrician and retrained as a pilot, and Allwright went back to school at 37 to enable her to take up her position with Nelson Marlborough Institute of Technology as an applied business tutor.
"It wouldn't have happened 10 years ago. I feel lucky that I'm in the position I am, that we've worked hard for what we've got, and the opportunity has arisen."
Fairfax spoke to a 35-year-old Waikato woman who had the same procedure in the same hospital three years ago.
Arriving in India was a big cultural shock - and so was the hospital, she says. "They have an international patients' department but you're put in a room with six or seven others - there's no privacy. But the medical system, even if it was differently run, was superb.
"I was thinking: ‘Am I getting scammed, is this dodgy?' But the whole procedure was fantastic. The doctor was really good; he has done a lot of surgeries over there, whereas a lot of our doctors here haven't done a lot of them."
She also says she felt supported by the hospital in arranging follow-up care if it was needed, but she did not have any complications.
Since then she's lost 50kg, dropping from 116kg to around 65kg, and has become more confident. She's particularly enjoying being more active.
"It's changed my life in many ways," she says. "If you've never been overweight you don't realise how tiring exercise is on your body.
"People think ‘Can't you go for a walk?' but you get so tired, dragging around an extra 50kg on your body every day."
Her energy levels are "through the roof" and she loves going out. "Before, I was too paranoid or embarrassed. I didn't want to venture far from the house. Now I'm out everywhere."
She can eat anything she wants these days, but less of it - for breakfast on the day she talked to us she had a piece of toast and a poached egg. "Once you go through something like [surgery], you do change your eating habits. A few people have had it and put the weight back on. But because you have an eating problem, you have to use the surgery as a major tool. It's not a miracle solution. It is all about moderation, it really is."
Allwright is looking forward to having a body and brain that no longer treats food as a drug.
"All that counting, the portions, the food, feeling hungry, emotional eating - it's all gone," she says. "What a relief. Imagine that. I don't know what it's like, but that's what I'm looking forward to - not having that as the foremost thing in your head every day, every hour you're awake."
She won an award at work this year, and last Christmas a relative asked her if she ever patted herself on the back and congratulated herself for doing well.
"I said no. Because this is the one thing I can't do. Academically, I'm fine, I've got a degree. But this is my mountain. It's the one thing I can't beat. And it's the one thing I want to beat."
