What's that noise? , People asked Johnny Kelsey as he passed. The grinding they heard was the rotten ball of their hip bones exploding in their cavity with each step. "You need to go to the doctor," the 44-year-old truck driver was told, weighing 418 pounds.
Kelsey knew what was wrong. It was a condition he had since he was four when doctors diagnosed Perthes disease, where the head of the femur slowly erodes into the cavity due to restricted blood flow. He wore an orthopedic device on his left leg and wore a sports exemption at school. "I tried the sport as a child," he recalls. "It caused me endless nights of pain."
His doctors told him to wait until adulthood for hip replacement surgery, and once he turned 21 he was told to wait until medical technology improved. He learned to live with pain until he "became a roommate." He married, raised three children and worked as a truck driver, driving the I-15 corridor from Utah to California, a routine he describes as "living Groundhog Day five days a week."
At 44, his condition reached him. It was not only the horrible sound effects of his hip, but also a sharp and stabbing pain.
A health surgeon at the University of Utah told him that his hip was one of the worst he had seen and that it was remarkable that he could still walk. To perform the surgery, Johnny needed to lose more than 60 pounds. The doctor sent him to Juliana Simonetti, M.D, co-director of the Comprehensive Weight Control Program at the University of Utah Health.
Simonetti first encountered obesity working in a community care center in Boston during his residency. Every patient he saw had chronic diseases: prediabetes, high cholesterol, blood pressure and weight problems. Patients from lower socioeconomic backgrounds were desperate to address their weight problems, spending much-needed money on over-the-counter diet pills that were not approved by the FDA.
"Instead of addressing the root causes of weight gain, I felt we were helping with a bandage," says Simonetti.
Obesity, says Simonetti, has always been seen as an option. "Just go home, go on a diet and exercise," patients are told, but that won't solve it, she says. "Each patient has unique needs and circumstances."
Medication is key to addressing the underlying physiological problems that make it so difficult to lose weight, along with behavioral health approaches to address the psychological problems related to obesity.
The key point is: "There is no magic pill," she says. "What we do is address the underlying problems and suppress appetite and cravings." There is also bariatric surgery, which involves surgical procedures to reduce weight, such as sleeve gastrectomy and gastric bypass. There are also minimally invasive temporary procedures, such as the gastric balloon, where an inflatable silicone balloon is placed in the patient's stomach. It lasts six months and makes the patient feel fuller.
The Comprehensive Weight Control Program, he says, seeks to bring innovative approaches to obesity medicine. These include helping patients at different stages of their weight loss journey through low-impact exercise classes, group medical visits, stress reduction courses based on mindfulness, behavioral health referrals and helping Patients find cheaper and healthier food options and cooking classes.
It is also one of the few programs in the country that brings together different specialists to help patients lose weight while treating complications related to obesity and excess weight. A fatty liver gastroenterologist and a cardiologist with experience in heart failure address the complications that arise for patients who have fought against long-term obesity.
When Kelsey saw Simonetti, he said he had tried diets all his life. She sent him to the program nutritionist, who told him that a key problem was when he ate. "I eat a great meal a day," says Johnny. "For me, that was a big disaster." Instead, I needed to eat every three hours.
He started the day with a protein bar, a few hours later some steamed vegetables, then three hours later a protein shake, ending with chicken and vegetables at night.
At first, Simonetti made him concentrate on healthy eating, although she also liked to incorporate the exercise as soon as her hip pain allowed. While maintaining the diet during the week, he was allowed to "go astray" on Sunday mornings: "I like an English cupcake that comes out of the toaster with melted butter and some jelly."
What helped was how encouraging his wife, children and family were, including his parents, his brother and his family. "Everyone around me was being super supportive."
At first, he lost a pound about a week, then two pounds, then three or four until he lost 18 pounds a month. Simonetti was surprised. His level of weight loss, he says, was unknown, unless he was someone who had undergone gastric bypass surgery. "They were worried that I was starving," but the tests on their body's nutrients showed that everything was fine. "He just clicked, I guess."
At six months, he lost 60 pounds and scheduled the hip surgery, which took place in January 2019. After the surgery, I realized how much I had been suffering. The difference was absolutely incredible. My wife and children had to remind me that my hip was only five days old and that it calmed down a bit.
By December 2019, he had lost a total of 132 pounds, which reduced him to 286 pounds. Losing weight is difficult, he acknowledges, but it can be done. I am in the worst possible professional field, you can try to lose weight as a truck driver and I did it. You have to want it. "
Kelsey said Simonetti and his team "offered me the tools and the ways to do it. Most of the time, you go to the doctor and you say," Doctor, fix me. "But she gave me the tools to fix me."
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