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Weight alert

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People who are obese have a BMI of over 30.

Are you obese, fat or skinny? Check your body mass index and body fat reading

THE New Straits Times-Cyberjaya Green Ride 2013 is all about encouraging a healthy lifestyle. Physical activity and balanced meals will help you maintain your ideal weight.

One way to find out if your weight falls within the healthy range in relation to your height is by using the body mass index (BMI). You can calculate your BMI by dividing your weight (kg) by the square of your height in metres (BMI = kg/m2),
Due to its ease of measurement and calculation, it is the most widely used diagnostic tool to determine if a person is underweight, overweight or obese.

With the World Health Organisation giving its endorsement for the use of BMI to determine a person’s appropriate weight to their height, it has been used extensively by health practitioners around the world.

A person with BMI of  30 and above is considered obese and those between 25 and 29.9 are overweight. Healthy weight is between 18.5  and 24.9, and underweight is below 18.5.

There are health risks associated with people with underweight and overweight problems. Illness associated with being underweight ranges from simple tiredness due to inadequate energy intake, reduced immunity, infections, anaemia, vitamin deficiencies, thinning of the bones, infertility and heart rhythm irregularities.

While those with high BMI are at risk of high blood cholesterol or other lipid disorders, type 2 diabetes, heart disease, stroke, high blood pressure, certain cancers, gall bladder disease, sleep apnea and snoring, premature death, osteoarthritis and joint disease.

The classification enables health professionals to recognise that people with low BMI may have an eating disorder, or alert them to certain health problems in  a person with high BMI.

To maintain an ideal weight, it is advisable to start on a healthy diet that has a balance of food groups, vitamins and minerals as well as engaging in physical activity.

If you are in the overweight and obese range, losing at least 10 per cent of body weight may bring about desirable health benefits and improved feelings of well-being.

Come to  the Health & Style booth at the New Straits Times-Cyberjaya Green Ride 2013 on Sept 14 at Cyberjaya Lakeside and check your BMI reading.

BP Healthcare Group will set up a mobile diagnostic centre equipped with state-of-the-art equipment for audiometry test, lung function test, resting ECG, body composition analysis, bone mineral density check and body mass index test.

Read more: Weight alert – Health – New Straits Times http://www.nst.com.my/life-times/health/weight-alert-1.348014#ixzz2dq9LjpKQ

via Weight alert – Health – New Straits Times.

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Pupils as young as 7 are obese

obesity1

ALARMING RATE: Excessive food intake and low physical activity to blame

KUALA LUMPUR: CHILDREN as young as 7 are suffering from obesity, no thanks to a combination of poor diet and an increasingly sedentary lifestyle.

Worse still, the number of obese children shows no sign of abating.

The Survey on the Nutritional Status and Dietary Habits of Primary Schoolchildren in Malaysia revealed that as of 2008, 12.8 per cent of primary school pupils were obese. Experts believe that the figures are now even higher.

Obesity prevalence among schoolchildren is also believed to have increased from the 13.7 per cent recorded in the survey.

Prof Winnie Chee, president of the Malaysian Dietitians’ Association, said the problems would be seen in the next generation of schoolchildren.

“Schoolchildren between the ages of 7 and 17 are overweight and obese. Their life expectancy is estimated to decrease by eight months to seven years.”

She said two studies published recently revealed a drastic rise in prevalence of metabolic syndrome among obese children: from 1.3 per cent to 5.3 per cent. This means that there is a greater risk of them developing serious medical conditions.

“This is an alarming rate and trend that will result in children being exposed to chronic diseases. It requires urgent medical intervention.”

Early childhood obesity is linked to many conditions in later life, such as cardiovascular diseases, diabetes and osteoarthritis, and could lead to premature death.

Based on the National Health and Morbidity Survey 2011, about 17 million Malaysians have non-communicable diseases, with 2.6 million suffering from diabetes, 5.8 million from hypertension and 6.2 million from high cholesterol.

The survey also showed that 2.6 million adults were obese while more than 477,000 below 18 were overweight.

Chee said environmental factors played a major role in the life of an obese child.

Excessive food intake, low physical activity, family eating habits and lifestyle were contributors, too.

“Obesity in childhood can lead to major health problems in later years. Obese children tend to develop behavioural problems and suffer from low self-esteem.”

Deputy director-general of Health Datuk Dr Lokman Hakim Sulaiman said the nutritional wellbeing of children should be everyone’s responsibility.

“Parents, teachers and schools play a major role in ensuring children’s health.

“The ministry and other agencies had implemented programmes, policies and initiatives to combat obesity in various age groups.

“Major efforts are taken to create a more supportive environment and to make healthier food available to children.”

Both the Health and Education Ministries had implemented eating guidelines for schools.

The implementation of the guidelines was monitored since last year under the key performance indicators entailed in the 10th Malaysia Plan.

Last year, the Health Ministry visited and monitored 2,596 school canteens to ensure compliance with the guidelines.

“The ministry also made it compulsory for canteen operators to display the caloric content of food and beverages. Children must be made aware of the caloric intake, thus, allowing them to choose healthy food,” said Dr Lokman.

He said for children to adopt a healthy lifestyle and eating habit, parents, teachers and canteen operators must become role models.

“If parents lead a healthy lifestyle, the child will lead a better lifestyle, too.”

Studies have shown that family mealtimes have a big impact on how children eat as they grow into adults and make food choices.

A child who has regular family meals at home tends to eat more fruits, vegetables and dairy products.

“Get your child to choose a recipe, cook it with you and then serve it, too. This way, you are educating them on healthy and nutritious home-cooked meals.”

Chee lauded the Health Ministry’s guideline for canteens and believed that it could help all parties on healthy food consumption. She said for schoolchildren to be healthy, emphasis must be given to physical activities.

“The school curriculum should include extra exercise sessions. It should be held two or three times a week for 45 minutes to an hour.”

She said there should be better understanding of how obesity was becoming a burden to schoolchildren.

She added that future health programmes must include families and schools, as outlined in the 2002 World Health Organisation’s technical report, which showed that treatment for obesity was unlikely to succeed if the focus was only on children. Addtional reporting by Sameer Ahmed Shaikh

Read more: Pupils as young as 7 are obese – General – New Straits Times http://www.nst.com.my/nation/general/pupils-as-young-as-7-are-obese-1.343815?cache=03%2F7.210662%2F7.239006%2F7.265008#ixzz2d3HWZ0Qr

via Pupils as young as 7 are obese – General – New Straits Times.

Obese who refuse to exercise ‘could face benefits cut’

Obese child generic
Responsibility for promoting public health will move from the NHS to local authorities in April

Overweight or unhealthy people who refuse to attend exercise sessions could have their benefits slashed, in a move proposed by Westminster Council.

GPs would also be allowed to prescribe leisure activities such as swimming and fitness classes under the idea.

The Tory-controlled council said the aim was to save £5bn from the NHS budget when local authorities take over public health provision from April.

BMA member and GP Dr Lawrence Buckman called the idea “draconian and silly”.

The measures are contained in a report entitled A Dose of Localism: The Role of Council in Public Health, in a link-up between Westminster Council and the Local Government Information Unit (LGiU).

Smart cards

Under the proposals, overweight benefit claimants could have their money docked if they refuse exercise regimes prescribed by doctors.

Smart cards would be brought in to monitor the use of leisure centres, meaning local authorities could reduce welfare payments for those who fail to follow their GP’s advice.

Resident, housing and council tax benefit payments “could be varied to reward or incentivise residents”, the report said.

It claims “early intervention techniques” could help save more lives and money.

These include linking welfare payments to healthy lifestyles and rewarding those who take responsibility for their own health, the report’s authors claim.

Red tape would be cut for “non-alcoholic venues” to encourage a more responsible approach to drinking, which the report says was promised but never delivered by the change to 24-hour licensing laws.

‘Emotional issues’

British Medical Association GP committee chairman Dr Buckman, a GP in north London, called the proposals “some of the silliest things I’ve heard in a long time”.

 

A fast-food generation need support in the long term”

Susannah GilbertSpokeswoman, Big Matters

“When I was first told about this I thought it was a joke,” he said.

He added: “The best way [councils] can intervene is to stop restaurants and fast-food chains providing the kind of food that make people put on weight, and interfere with the way foods are sold in shops.”

Obesity support organisation Big Matters spokeswoman Susannah Gilbert said: “It would be fairer to use the money to support people rather than to penalise people.

“Any plans for health should be holistic,” she added. “Some people have emotional issues to do with food.

“A fast-food generation need support in the long term.”

But Jonathan Carr-West, acting chief executive of the LGiU, said the proposals offered “a win-win” solution.

He said the proposals were about “finding innovative ways to both improve people’s lives so they don’t suffer from these conditions, while also saving money for the public purse”.

“We have to look at ways of managing demand, of helping people not to need such expensive health interventions,” he said.

He said the proposals would “help people lead healthier, happier lives”.

Westminster council leader Philippa Roe said: “This report contains exactly the sort of bright, forward-thinking and radical ideas that need to be looked at.

“The potential improvements to the nation’s health and to the public purse could be significant.”

But the change to local authority control over public health has led many councils to voice concerns about how much money they will get and the formula that central government will use to allocate funding.

The public health funding announcement was originally expected on 19 December.

BBC

Obese parents court trouble

Universiti Putra Malaysia’s consultant and gastroenterology head of unit head Associate Professor Dr Loong Yik Yee with senior reporter Azlan Abu Bakar during the NST Live programme yesterday.

DANGER: They have a higher chance of getting overweight children

 

KUALA LUMPUR: PARENTS on the heavier side have been advised to adopt a healthier lifestyle to prevent their children from becoming overweight or obese.

Universiti Putra Malaysia’s consultant and gastroenterology unit head Associate Professor Dr Loong Yik Yee said individuals from obese families should put in more effort to combat weight issues which led to health problems.

“Parents who are obese have a higher chance of getting obese children and a higher risk of medical complications,” he said during the New Straits Times Live session at Balai Berita yesterday.

He said an overweight or obese person had a higher risk of getting diabetes, heart attack, high blood pressure, as well as cancer.

Dr Loong said obesity in Malaysia had been climbing steadily over the past 20 years.

“The prevalence of obesity among those aged 18 years and above increased from 4.4 per cent in 1996 to 12.3 per cent in 2004 and to 14 per cent in 2006.”

It was reported earlier that 43 per cent of adults, 20 per cent of teenagers and 26 per cent of primary schoolchildren were either overweight or obese.

Three million Malaysians have been diagnosed with diabetes, a disease closely associated with obesity, heart attack, high blood pressure, stroke and cancer.

Dr Loong said parents who were not into exercise would influence children to follow suit.

“Children should be educated from a young age to adopt healthy eating habits and lifestyles as most behavioural patterns become a habit when they grow older,” he said, adding that tackling weight problems of adults was a little too late.

“When one is obese at a younger age, the risk of developing complications later in life is higher as one’s weight will increase further.”

He said the treatment of those who suffered from obesity due to genetics was not different from others.

“They would only have to put in more effort as they have genetic factors going against them.”

In 2006, the National Health Morbidity Survey found that 43.1 per cent of the adult population was overweight, with 14 per cent of them obese.

Dr Loong said the prevalence of obesity was highest among Malays (13.6 per cent) and Indians (13.5 per cent) followed by the indigenous group of Bumiputera Sarawak (10.8 per cent) and Chinese (8.4 per cent), while the indigenous group of Bumiputera Sabah had the lowest prevalence of 7.3 per cent.

Read more: NST

 

Expert warns comfort eating can become a form of addiction


By AUDREY EDWARDS and LIM WEY WEN

PETALING JAYA: Comfort eating may be a way to “de-stress” for some Malaysians, but an expert has warned that the habit is similar to getting addicted to drugs or computer games.

“You want to make yourself feel good. It’s like doing drugs or playing computer games or even watching three to four movies in a row,” said Universiti Kebangsaan Malaysia’s Health Psychology Programme lecturer Assoc Prof Dr Alvin Ng Lai Oon.

Comfort eating is when one consumes food to relieve stress.

It is sometimes referred to as “emotional eating”.

He said there could also be a link between comfort eating and being overweight or obese.

“Comfort food is a part of life and people use it to regulate their emotions.

“If they cannot manage their emotions in other ways, it can lead to overeating or unnecessary eating,” he said.

“The food they eat may not be healthy but it makes them feel better. So, there is a higher risk of being overweight or obese,” said Dr Ng, adding that it was also related to people who were underweight or had a normal body weight.

He said an indication that someone was into comfort eating was when they had the urge to eat or “feel bad” if they did not, or had irrational thoughts like eating out of fear their mothers would disown them.

Another indication is needing to eat within a short period after having a full meal.

“They claim to feel hungry or have low blood glucose levels when it is not necessarily true, but it gives them a good reason to eat.”

There are currently no local studies to show the number of people who comfort eat.

Dr Ng said most people did not see it as being a problem until they became overweight or obese.

He advised those who sought comfort in food to get counselling to overcome their emotional problems or have a network of friends and family who are “appointed” to tell the person that he or she is comfort eating and to stop doing so.

“It is not advisable to substitute comfort food with normal meals as it leads to sabotaging efforts to maintain or lose weight.

“It would be better to do physical activities than eat,” said Dr Ng.

Meanwhile, Nutrition Society of Malaysia president Dr Tee E Siong said chocolate and ice cream were two of the most common comfort foods.

“I suppose if one finds that a specific food can bring comfort, it is not a real problem,” he said.

“It is important though to explain to the individual the dangers of excessive consumption of certain high-calorie foods.”

Read More: The Star

Young, Obese and in Surgery

Though Shani Gofman had been teased for being fat since the fourth grade, she had learned to deal with it.

She was a B student and in the drama club at school. She had good friends and a boyfriend she had met through Facebook. She even showed off her curves in spandex leggings and snug shirts.

When her pediatrician, Dr. Senya Vayner, first mentioned weight-loss surgery, Ms. Gofman was 17, still living with her parents in Bensonhurst, Brooklyn, her bedroom decorated with glow-in-the-dark stars because she was afraid of the dark.

There was no question, at 5-foot-1 and more than 250 pounds, she was overweight. But she resisted, saying she could diet.

“I’ll lose weight,” Ms. Gofman assured her doctor.

Dr. Vayner said, prophetically, “It’s not your fault, but you’re not going to be able to do it.”

Along with the obesity epidemic in America has come an explosion in weight-loss surgery, with about 220,000 operations a year — a sevenfold leap in a decade, according to industry figures — costing more than $6 billion a year. And the newest frontier is young patients like Ms. Gofman, who allowed The New York Times to follow her for a year as she had the operation and then embarked on a quest to lose weight, navigating challenges to her morale, her self-image and her relationships with family members and friends.

But the long-term effectiveness of weight-loss surgery, particularly stomach banding, the procedure Ms. Gofman had, is still in question. And the push toward surgery on the young has brought some resistance from doctors who say it is too drastic to operate on patients whose bodies might still be developing and who have not been given much time to lose pounds on their own.

“I think it’s pretty extreme to change the anatomy of a child when you haven’t even tackled the other elements,” said Dr. Wendy M. Scinta, a family practitioner in Manlius, a suburb of Syracuse, who specializes in pediatric weight loss. Unlike with older patients, she said, “there is not a huge rush to fix it or they will die.”

One percent to 2 percent of all weight-loss, or bariatric, operations are on patients under 21, but studies are under way to gauge the outcomes of surgery on children as young as 12. Allergan, the maker of the popular Lap-Band, a surgically inserted silicone band that constricts the stomach to make the patient feel full quickly, is seeking permission from the Food and Drug Administration to market it to patients as young as 14, four years younger than is now allowed. Hospitals across the country have opened bariatric centers for adolescents in recent years.

Doctors who are open to operating on younger patients note there is substantial evidence that dieting frequently fails.

“Most of us have witnessed the medical establishment provide the same advice over and over again to kids who are overweight — they just need to diet and play more outside,” said Dr. Thomas Inge, a professor of surgery and pediatrics at the University of Cincinnati, who is participating in a National Institutes of Health study of weight-loss surgery on teenagers. “I wish it were that simple.”

25 Minutes, and It’s Done

Ms. Gofman has been overweight for almost as long as she can remember. The boys on the school bus made fun of her. In school pictures, she never wanted to be shown sitting. “I wanted to be standing with people blocking me,” she said.

After her doctor proposed surgery, she tried to lose weight but failed miserably, gaining 30 pounds in eight months. Maybe, she said, she secretly wanted to qualify for “the easy way out.”

In December 2010, Ms. Gofman, who had just turned 19, and her mother arrived at the office of Dr. Danny Sherwinter, the wiry, fast-talking chief of bariatric surgery at Maimonides Medical Center in Brooklyn, for a consultation. Ms. Gofman was nervous but eager.

She had been sold on the Lap-Band, the only operation Dr. Sherwinter performs, because it is reversible and relatively low risk. She weighed in at 271 pounds, with a body mass index of 51, well above the minimum B.M.I. of 40, or 35 for people with at least one other related health problem, that was required for the use of the Lap-Band. (In February, the F.D.A. reduced the minimum B.M.I. for patients with another problem to 30, the threshold of obesity.)

Ms. Gofman’s mother asked what would happen if her daughter wanted to get pregnant. The band would be decompressed, Dr. Sherwinter said, and “basically you’re a normal pregnant woman, eating your pickles and ice cream.”

“Yummy,” Ms. Gofman said.

“What about the skin?” her mother, Judith, asked, meaning loose skin that might develop after weight loss.

“That’s going to be an incredible conversation,” Dr. Sherwinter said. “Let’s just get there first.”

He told Ms. Gofman that, going by the averages, she could expect to lose about 40 percent of her excess weight, or 70 to 80 pounds. “Which is better than any diet out there,” he said. “We’d be looking for you to come in around 200.”

But, he warned, “If you don’t follow along the average way, like have a milk shake every night or don’t exercise at all, you will end up in the worser half.”

Dr. Sherwinter asked her to prepare for surgery by going on a liquid diet. But she privately reasoned, “I’m about to have surgery, so I might as well enjoy myself.”

Ms. Gofman showed up at the hospital at 6 a.m. on Dec. 22, 2010, after staying up with friends the night before, too nervous to sleep. She kept asking the nurses and doctors to reassure her that she would wake up after the surgery. Her parents and her boyfriend, Abie Feldman, were by her side.

A friend sent her a text message: “We’re not fat. We’re professional eaters. Why should we be punished for our profession?” Ms. Gofman laughed.

By 8 a.m., she was under anesthesia. Dr. Sherwinter marked five points in black ink on her stomach, then used a knife to make five tiny slits, the largest about half an inch wide, through the layers of skin and fat.

He distended her abdomen with carbon dioxide so there would be more space to work, and asked for music, soft rock, to be turned on.

The operation was done laparoscopically, using a camera and surgical instruments inserted through the incisions, while Dr. Sherwinter watched on a video screen. He wrapped the band around the neck of Ms. Gofman’s stomach and cinched it with a ridged buckle, like the type on swimming goggles.

Dr. Sherwinter wrapped part of the stomach around the band and stitched it into place, to prevent the band from slipping. On the screen, the white ring, prominently labeled “Allergan,” looked like a spaceship that had landed in alien territory.

The operation took about 25 minutes. Child Health Plus, a state insurance plan for low-income families, covered the $21,369 cost. Medicaid in almost every state and many private health plans now cover bariatric surgery, often more readily than diet or exercise plans.

On many days, Dr. Sherwinter performs three or four operations in a row. “She’s a relatively skinny woman, which makes it easier,” he said of Ms. Gofman, using a jarring description for a woman who was 160 pounds overweight. “When you get to the larger men, it becomes more difficult.”

Long-Term Questions

Ms. Gofman’s procedure, called laparoscopic adjustable gastric banding, constitutes about 39 percent of all bariatric surgeries. The other two main types are Roux-en-Y gastric bypass, which involves stapling the stomach into a tiny pouch and rearranging the bowel, and sleeve gastrectomy, which involves removing most of the stomach and turning what is left into a thin tube.

The risks of all the operations have declined, partly because surgeons are now more experienced and using less-invasive techniques, like laparoscopy, but also because they are beginning to operate on thinner, healthier patients.

One in 2,000 gastric banding patients, or 0.05 percent, and 1 in 900 gastric bypass patients die during or immediately after surgery, according to William Encinosa, a senior economist at the federal Agency for Healthcare Research and Quality who analyzed 161,000 surgical records for 2009. For open — not laparoscopic — bypass surgeries, studies have put the death rate within 30 days as high as 2 percent. About 1 percent of banding patients and 3 percent of bypass patients develop major complications, like blood clots or perforation of the bowel, Dr. Encinosa said.

Allergan, which also makes Botox, so dominates the banding market that Lap-Band is often used as a generic name, like Kleenex or Band-Aid. But its push to win F.D.A. approval to market to younger patients comes amid early evidence that gastric banding may produce poor long-term results.

A Belgian study of adult patients found that nearly half had their bands removed within 12 years for various reasons, according to the study’s principal author, Dr. Jacques Himpens: they did not lose much weight; they regained what they had lost; they had frequentheartburn or vomiting; or the band would slip or perforate the stomach.

A German study found that 30 percent of patients needed new operations within 14 years, some because they wanted bands removed, and others because of complications like slippage.

Another study in Australia found that one-third of operations on teenagers required follow-up surgeries within two years, often because of “pouch dilation,” when the stomach above the band becomes enlarged, which can happen if the patient does not follow the regimen and tries to eat too much.

Cathy Taylor, a spokeswoman for Allergan, noted that the studies involved small sample sizes: the adult ones had fewer than 300 patients combined, and the Australian study, two dozen. Ms. Taylor said that the adult studies did not reflect recent improvements in the band and in surgical techniques, and that the complications in the teenage study were not serious.

Stomach enlargement, she said, “speaks to the importance of additional education for the adolescent to understand the importance of adhering to the new eating program.”

But that, said Diana Zuckerman, a psychologist and president of the National Research Center for Women and Families, goes to the heart of why teenagers are bad candidates for bariatric surgery: they are often immature, rebellious and uninterested in long-term consequences.

“It’s not just you can’t eat Thanksgiving dinner,” Dr. Zuckerman said. “You’re going to have to have this tiny little meal for the rest of your life.”

A more critical question is whether surgery can lead to malnutrition, particularly in bypass patients because their shortened digestive tracts absorb fewer nutrients, which could affect bone growth, sexual maturation and other development.

“Kids across the country are getting this surgery, and we need to know the consequences,” said Dr. Mary Horlick, project scientist for the National Institutes of Health, which is sponsoring a study of bariatric surgery in about 250 teenagers.

Surgeons who operate on teenagers say the alternative is worse: a lifetime of obesity, ostracism and diseases like diabetes. Dr. Jeffrey L. Zitsman, director of the center for adolescent bariatric surgery at NewYork-Presbyterian/Morgan Stanley Children’s Hospital, says that among the biggest obstacles are pediatricians and family doctors, nearly half of whom, according to a recent medical journal article, say they would never refer a teenager for obesity surgery.

But Dr. Zitsman said: “These kids are sick, and they’re going to get sicker. It’s like having a precancerous condition that you can treat rather than waiting till it’s cancer.”

And there are success stories. One of Dr. Inge’s patients, Kelsie Blackwell, had gained weight after getting a cancerous brain tumor that is now in remission. She had bypass surgery at 16, and dropped to 130 pounds from 215. She has maintained that weight for three and a half years. “She became much more social after the surgery,” her mother, Tawana Blackwell, said.

Seeing Results

Ms. Gofman arrived for her first postoperative visit 13 days after the surgery, stylishly dressed in a bias-cut black sweater, blue pants and short snow boots. The scale read 251 pounds, 20 pounds below that of her last weigh-in.

But her mood did not match. “You know how you said I can have mashed potatoes a little bit,” she told Dr. Sherwinter. “I measured it. I didn’t feel full at all. Then I was bad. I ate a little bit more and a little bit more, and I still didn’t feel full, but I stopped.”

Ms. Gofman wanted a “fill” of her band, an infusion of saline to make it even more constricting, even though Dr. Sherwinter had told her to wait six weeks before tightening it. She then confessed that she had also eaten a dumpling skin.

“That’s probably not the best thing to do,” Dr. Sherwinter said. “Dumplings are fried and have mongo calories.”

“I’m just so nervous to fail my own diet,” she said. “There’s a diner downstairs from my apartment, and a Dunkin’ Donuts.”

“The key is moderation, having a little mashed potato but not a portion,” he said.

“I’m not good at moderation,” she replied.

Later, waiting on the elevated subway platform for the train to work, Ms. Gofman brooded about how her surgery had upset the rhythms of the household. “My mother doesn’t cook so much if there is no one to eat it,” she said.

Three weeks later, she was down 8 more pounds, to 243. She had shrunk to size 20 from 26 and had bought several pairs of jeans. She had joined a gym and had bought a swimsuit.

“Friends give me compliments,” she told the physician assistant, Elana Guzman. “I go out more. It’s easier walking upstairs. Exercising is not as hard. I fit into a lot of clothes I didn’t fit into before.”

Ms. Gofman raised her shirt and Ms. Guzman inserted a needle into a port that Dr. Sherwinter had planted in her abdomen. Ms. Guzman squirted three cubic centimeters of saline solution, one-tenth of an ounce, into the band, which holds 10 cubic centimeters.

By June, Ms. Gofman was down to 237 pounds.

Bumps in the Road

Then summer came. Ms. Gofman took a free trip to Israel with other teenagers. She missed her clinic visits, and often ate on the run.

She would wolf down her food, and then she would run to the bathroom to vomit or sit in pain waiting for it to make its way through the band. “I couldn’t even have a single little sandwich without embarrassing myself and going to the bathroom,” she said.

To her dismay, she discovered that “all the fattening foods” — chips, chocolate — went down easily. “Apples and bread are hard,” she said. “It’s annoying how hungry I was.”

Ms. Gofman started to feel judged by some of her friends. “Some will ask a dumb question, like, how’s the surgery going?” she said. She felt like telling them, “You obviously can tell it’s stalled, right?”

By fall, she had canceled her gym membership because it was too expensive. When the hospital urged her to come in for a visit, she said she was busy. But the truth was that she had aged out of the child health insurance program, and she was embarrassed to be gaining weight.

She finally confessed to the hospital that she could not pay. The physician assistant told her they would “work it out.”

Ms. Gofman, who has just turned 20, saw Dr. Sherwinter in November. She had regained not quite half of what she had lost. He did not scold or blame her. He tightened her band, so it now took an hour and a half to force down two scrambled eggs.

She does not want to reveal how much she weighs, but she is fighting constant hunger, and progress is slow.

Her boyfriend consoles her, she said: “I say, ‘I can’t wait till I’m skinny,’ and he says, ‘You’re beautiful the way you are.’ ”

“A version of this article appeared in print on January 8, 2012, on page A1 of the New York edition with the headline: Young, Obese and in Surgery.”

New York Times

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