TAMPA, Fla. — With 360 pounds hanging on his 5-foot-7 frame, Robert Stratiff was in sad shape.
He had heart problems, poor circulation, wasted knees and sleep apnea that kept him awake most nights. Miserable at age 69, he knew he wasn't long for the world unless he did something drastic. And soon.
So in February 2002, the Colonial Heights, Va., resident had gastric-bypass surgery to lose weight, with Medicare picking up the cost. Because he couldn't eat as much, the weight dropped off faster than he could believe. Exercising got easier.
Now the retired Army colonel who flew helicopters in Vietnam is down to a svelte 170 pounds and swims a mile in the pool four or five times a week to keep fit. He's since had heart bypass surgery and a knee rebuilt. All the other medical problems disappeared with the pounds.
"I knew I was not going to make it if I didn't have that done," Stratiff, now 73, said of the weight-loss surgery. "My health was on a toboggan anyway, and it would have gone down hill quicker. I wouldn't have lived."
Medical advancements are helping Americans live longer, but a fast-food culture and sedentary lifestyles are making us fatter than ever. People who are morbidly obese — at least 100 pounds overweight — are increasingly opting for some form of gastric bypass surgery as a last resort.
That includes seniors like Stratiff who are seeking to improve their health and quality of life for the years they have left.
Recent research suggests seniors can benefit from weight-loss surgery as much as younger people and maybe more. One study, from Columbia University's Center for Obesity Surgery in New York, found that patients over 60 got the same benefits from the surgery and had a comparable rate of postoperative complications as younger people.
A soon-to-be published study of 27 gastric-bypass patients 65 and older who had surgery at the University of South Florida and the University of Miami also showed the procedure produced good results and improved quality of life with about the same rate of mortality and complications as seniors who have heart-bypass and hip replacement surgery. That's a mortality rate of about 2 percent to 4 percent, double the death rate for younger gastric-bypass patients.
"We know it corrects the diabetes, it corrects the hypertension, it takes away the sleep apnea, it fixes the heartburn reflux, it makes their knees and joints last longer," said Dr. Michel Murr, a bariatric surgeon at the University of South Florida who has performed nearly 1,000 of the procedures. "All of this is medicine."
One of his patients, Sandra Ainbinder of Myakka City near Sarasota, said she weighed a little over 400 pounds when she chose to have the surgery last year at age 68. She'd lost weight on any number of diets but always gained it back plus more. She was sick, embarrassed and rarely left the house because she could barely walk.
She was rejected by one surgeon because of her age before being accepted by the University of South Florida doctors, with Medicare paying for the surgery.
"It's not a pleasant thing to go through," Ainbinder said. "It's a serious piece of surgery. If there was any other way to do it, I would have done it. But I felt I had to. I was going to die if I didn't do this."
Sixteen months later, Ainbinder is down to 259 and is still losing. Many of her medical conditions either improved or went away. She's got more energy and is looking forward to exercising more after knee-replacement surgery.
"I should be able to join the human race, and I'm looking forward to be being able to walk down the block," she said.
The American Society for Bariatric Surgery, based in Gainesville, Fla., said 140,000 people in the United States had some sort of weight-loss surgery last year, most of them gastric bypass — reducing the size of the stomach to limit food intake. The number has grown by about 50 percent a year since 1998.
Doctors estimate that elderly people make up 1 percent to 2 percent of the total, but they expect that percentage to keep growing as Americans live longer and grow larger.
A study last year in the Journal of the American Geriatric Society estimated that obesity in those age 60 and older will increase from 32 percent in 2000 to 37 percent in 2010. Men ages 65 to 74 and women 55 to 64 are the age groups with the highest prevalence of being overweight and obese.
Many private insurance companies cover bariatric surgery, finding it cheaper than long-term treatment of obesity-related health problems, such as diabetes and high blood pressure. Cost of the surgery starts at about $20,000.
Still, the inherent risks in what is indisputably a major operation keep some surgeons from performing the procedure on older people.
Armed with the recent studies showing that the surgery is safe and effective for many seniors, the society for bariatric surgery is trying to make it easier for older people to get it. Earlier this year, the group petitioned Medicare to develop uniform coverage guidelines and include other types of operations, including less-invasive keyhole surgery that require only small incisions in the stomach wall.
Medicare coverage of weight-loss surgery currently is decided from region to region. "It's kind of a crap shoot," said Dr. Harvey Sugerman, a past president of the society.
Weight-loss surgery has pitfalls for patients of any age. Recovery can be slow and uncomfortable, and a drastic and permanent change of diet is necessary. Stratiff, for instance, said he hasn't had a French fry since before his operation. He gets sick if he eats anything with too much sugar.
Still, he has no regrets.
"I never look back on the decision and second-guess it," he said. "It was the best thing for me to do. It was the only thing for me to do."