MasterChef judge Graham Elliot recently underwent Sleeve Gastrectomy surgery. What I find interesting about his story is not so much his decision to have weight loss surgery, but his choice of the Sleeve Gastrectomy given his career as a professional chef.
Most of Graham’s story is the typical weight loss surgery story. He struggled with his weight for a long time, and was unable to lose weight and keep it off with diet and exercise. He was close to 400 pounds and had high blood pressure. His family history was significant for strokes and heart attacks. He was worried he wouldn’t be around to see his three young sons grow up.
What’s not typical is the fact that he is an award winning, professional chef. His career accomplishments are impressive. He was named one of the ten Best New Chefs of 2004 by Food & Wine Magazine. He became the youngest four-star chef in the U.S. at the age of 27. He has won numerous awards and accolades, including a AAA Five Diamond Award. In 2008 he opened his first restaurant, the eponymous Graham Elliot, which has received three stars from the Chicago Tribune, and two stars in the Michelin Guide. In 2009 he appeared on the TV show Top Chef Masters, and in 2010 he became a judge on the reality show MasterChef. In 2010 he also opened his second Chicago restaurant.
Graham’s decision to have weight loss surgery is easy to understand, despite his love and passion for food, and his career. His weight, at 400 pounds, was impairing his health, his ability to be active with his family, and his likely lifespan. He wanted to change the path he was on, and weight loss surgery is the most effective method by far to do this.
Graham’s decision to have weight loss surgery, fundamentally, was a decision to choose better health and accept the lifelong altered relationship with food that surgery requires. To me this sounds like an easy choice, particularly when factoring in the interests of his wife and three young sons.
The most interesting and instructive part of his story is his choice to have Sleeve Gastrectomy.
The Sleeve Gastrectomy operations involves reducing the size of the stomach from the normal 30-40 ounces to approximately 3-4 ounces. The operation causes weight loss by restricting intake and by changing the biology of how the GI tract functions, which is believed to result in a lowered bodyweight set-point.
Outcomes after Sleeve Gastrectomy are typically quite good. Weight loss averages 70-80% of excess weight. This is comparable to average weight loss outcomes after Gastric Bypass, and better than average weight loss outcomes after LAP-BAND.
So why did Graham choose the Sleeve Gastrectomy over the Gastric Bypass and the LAP-BAND?
The Sleeve Gastrectomy and Gastric Bypass result in better weight loss outcomes, on average, than the LAP-BAND. This could explain why he didn’t choose the band.
Between the Gastric Bypass and the Sleeve Gastrectomy, the Gastric Bypass is the more established and better studied of the two operations, and outcomes are excellent. Because of this the Gastric Bypass is considered to be the gold standard bariatric operation. If he had chosen the bypass, it would have been understandable.
He instead chose the Sleeve Gastrectomy. The reason, almost certainly, is because the Sleeve Gastrectomy is least disruptive to normal eating habits.
Weight loss surgery changes how a person is able to eat, and how a person experiences eating. The magnitude of these changes depends on the magnitude of the surgical changes – the size of the stomach pouch, the characteristics of the stomach pouch outlet, and the redirection of the flow of food through the GI tract.
Look at the table below. The stomach pouch is largest with the Sleeve Gastrectomy, and the pouch outlet is the pylorus, which is the normal muscle sphincter at the bottom of the stomach that regulates how the stomach fills and empties.
Sleeve Gastrectomy anatomy is more similar to normal anatomy than Gastric Bypass or LAP-BAND anatomy, except for the much smaller stomach. More normal anatomy means less disruption to usual eating habits and to the typical eating experience.
For Graham Elliot, whose life and career revolve around food, the Sleeve Gastrectomy was a smart decision. He is now one month postop, and down 56 pounds – see photo below.