Doctor changes shape of Hollywood heavyweights (and others) with dramatic weight-loss procedure

FAT jokes are the bread and butter of comedy. Laughing about fat and trying to lose it is the double-edged sword in the national obsession with weight.

Although fat may be funny to some, it's deadly to others. Complications from obesity cause nearly 300,000 deaths a year Severely obese patients--those 100 pounds or more over ideal weight--often try pills, liquid diets, herbal diets and shots only to lose and gain the same 25 pounds again and again. Ridiculed and scorned, those who fight the fat battle are often made to feel ashamed for their inability to lose weight. There is another solution today for the severely obese person. It's not a fad diet and it promises to keep the weight off permanently. The solution? Surgery.

More than 20,000 persons per year opt to have controversial weight-loss surgery to reverse their lifelong weight problem.

Dr. Mathias A. L. (Mal) Fobi, a board-certified general and bariatric surgeon who has treated more than 6,000 patients, is one of the leading obesity surgeons in the country. And he averages nearly 10 surgeries weekly. His patients travel from points throughout the world--Chile, Israel, Japan and the United States--for the surgery.

Fobi's success has prompted the famous and the anonymous to seek his procedure. Television star and talk-show host Roseanne was afraid she would soon reach 300 pounds. Even after years of diet therapy, liposuction, tummy tucks and other surgeries, she was still 230 pounds. "I was contributing to a billion-dollar industry," she said of the diet industry on her show. After investigating a lot of options, she chose to have Fobi's surgery and says it changed her life. She says her daughter also had the surgery.

Actress JoMarie Payton, who starred as mom Harriette Winslow on the hit sitcom Family Matters' for nine years, lost 145 pounds after the Fobi Pouch surgery. Before her surgery in 1985, she says she weighed 283 pounds. Health problems prompted her regular physician to refer her to Fobi. "It was the best thing that ever happened to me," she says now. "I tell everybody you don't have to walk around miserable, fat and unhealthy." Payton is newly married, recently released her first jazz CD, Southern Shadows, and has a recurring role on the hit sitcom Moesha.

Although Fobi's work has proven effective in many patients, some patients and medical officials say there are possible drawbacks that should be considered. Noted singer and actress Jennifer Holliday weighed more than 300 pounds when she had the procedure in 1990. Although pleased with her dramatic weight loss, she says she has experienced complications from the procedure, including a chronic Vitamin B-12 deficiency. "When I had the surgery I did not care whether I lived or died," she says today. "If I had cared about myself more, I would not have had the surgery." Holliday advises making the surgery a last resort. "I continue to suffer health problems as a result of this surgery. My fear that I could cause others affliction or maybe to even lose their lives has kept me from telling more people about the surgery."

As the medical director of the Center for Surgical Treatment of Obesity for the past 16 years, Fobi has made numerous contributions toward the technological advances of weight loss surgery, including developing his innovative "Fobi Pouch for Obesity" operation. Fobi says the most common long-term complications from the operation include vitamin deficiencies of calcium, iron, folic acid, B1 and B12. "All patients have to take these vitamin supplements for the rest of their lives," he says.

The Fobi Pouch operation for obesity is one of the many modifications of the gastric-bypass operation. In his procedure, the amount of food that can be consumed at one time is reduced by decreasing the size of the stomach. The body then burns stored fat, resulting in a weight loss of approximately 10 to 20 pounds per month for the first year.

More than 75 percent of Fobi's patients use private insurance to pay for the operation that averages about $10,220. The operation and follow-up care can exceed $20,000. In California, Medicaid and Medical pay a small amount for about 18 percent of his patients. Because of the mental stress of obesity, part of his follow-up treatments include monthly interaction with support groups for patients as they lose the weight.

Fat is a medical problem, not a cosmetic problem and not a character flaw, says the surgeon whom Roseanne and others credit with changing their lives.

"Obesity does not have to be a death sentence," Fobi says.

Although critics call him arrogant, the outspoken and confident surgeon claims a 95 percent success rate with his operation. This means that 95 percent of the patients who were tracked for five years had maintained the loss of at least 40 percent of their excess weight.

And Fobi doesn't just work with the moderately obese. "My patients are often the biggest patients," he says. He has operated on several patients who weighed over 700 pounds. "These are patients who have tried every diet under the sun without success," he says. For severely obese patients, nonsurgical methods just don't work, he says. "Read my medical material and it will tell you categorically for the morbidly obese, nonsurgical treatment (i.e., diets) gives you a 98 percent failure rate."

Fobi cautions patients, however, that his procedure is considered major surgery and that there are risks of complications from the surgery and even a slight risk of death that he estimates at 0.5 percent. "The risks of the surgery are lower than those of the health problems associated with their severe obesity," he says.

Among the doctor's major success stories is David Stroup, who was an extremely ill man when he came to Fobi in 1996. He weighed 63,5 pounds, was in and out of the hospital, and suffered from blood clots, high blood pressure, heart failure and other problems. Today at 191 pounds he is the smallest he has been since he was a child. "I cannot mentally or physically remember being the size I am now," he says. "I could wear ms, dad's clothes in 5th grade." At his heaviest, his largest-sized pants were size 72 with an elastic waist.

Stroup lost 400 pounds and says his life has changed dramatically. He has been able to return to work; he has begun to date; and his health has dramatically improved. "I have energy now," he says. "I can exercise and work out."

Stroup is typical of most obese patients who have battled weight all of their lives. In fact, Fobi says obesity is an inherited tendency that needs to be further researched. "To be overweight you must have three things: You have to have the genetic makeup; there has to be food available; and you have to be able to afford it. You must have all three components," he says.

Georgia Sarantopoulos weighed 315 pounds when she had the surgery in 1993. She was a chunky child and never went out to the high school dances or functions and tried every fad diet, as well as diet pills and shots, acupuncture and hypnotherapy she says. "I hated going to the mall, and I had no energy," she says. There were also medical problems that were exacerbated by her weight, she adds. Today her life has changed, and she's traveling and doing all the things she always wanted to do. "All of a sudden people want to talk to you; they find you interesting," she says. "You go on a job interview and people actually listen to you and not look at your exterior." Also for the first time in her life, she is receiving attention from men. There is a new man in her life now. "I was very shy at first, but now I am getting used to it," she says. Both her parents had the surgery as well.

Fobi says the problem of obesity, is increasing by 5 to 10 percent and that he's seeing more fat children and more fat adults. He doesn't exclude patients based on age and has performed the surgery on patients as young as 9 and as old as 74. By the way, the 9-year-old was 5-foot-9 and 300 pounds.

Minority populations are particularly susceptible to severe obesity, particularly Black men and women, who are, Fobi says, leading the increasingly high rates of obesity in the general population.