Ed Bishop always liked taking pictures.
But at more than 350 pounds and with aching knees, it became nearly impossible for him to maneuver to get the right shot.
So he put the camera down, and literally limped away from the hobby he loved.
Today, however, after successful weight loss surgery and two knee replacement operations at Penn Medicine Princeton Health, Bishop is back to doing what he loves.
“Since I lost the weight and had the second knee surgery, I’m back at it,” the 70-year-old information technology instructor said. “I don’t need a cane, and I can get down on one knee and move around.”
Individuals like Bishop, who struggled with severe obesity for years, are often advised to lose weight before joint replacement surgery to reduce complications and improve outcomes.
Yet for many patients, diet and exercise alone are not enough to achieve the weight loss they need. This is where bariatric surgery can help.
“While diet and exercise are important components of any weight loss plan, in many cases the most effective treatment for obesity is bariatric surgery,” said Lisa Dobruskin, MD, medical director for the Center for Bariatric Surgery & Metabolic Medicine at Princeton Health. “Bariatric surgery can jumpstart weight loss and help patients who may not otherwise qualify for joint replacement surgery.”
More Than Cosmetic
Obesity is an epidemic in the United States.
Over 40 percent of American adults meet criteria for obesity, which is defined as having a body mass index (BMI) of 30 or more, according to the Centers for Disease Control and Prevention. Nine percent of those have a BMI of 40 and above, which is considered severe obesity.
More than a cosmetic issue, obesity is a chronic and complex disease.
“Obesity is a disease state that is caused primarily by biology and environment, not behavior,” said Colleen Tewksbury, PhD, MPH, RN, senior research investigator and bariatric program manager at Penn. “The public perception is that obesity is driven by behavior, and that’s not accurate.”
Like other complex diseases, obesity usually requires medical treatment.
“If you have a biological issue, you typically need a biological solution,” Tewksbury said. “Research has shown that bariatric surgery is an effective treatment for severe obesity and other associated medical conditions.”
Lose Weight, Recover Faster
When it comes to joint replacement, studies have show that having a higher BMI can lead to worse outcomes, explained Harvey Smires, MD, a board certified orthopedic surgeon at Princeton Health’s Jim Craigie Center for Joint Replacement.
Smires noted that patients who have obesity are more likely to have other diseases, such as high blood pressure, diabetes and sleep apnea, all of which can make surgery riskier.
“The infection risk triples in patients with a BMI over 40 and goes up eight times in patients with a BMI of 50 or above,” Smires said. “If a joint replacement becomes infected, it requires reoperation and sometimes a two- stage revision, which is difficult even for someone who is a healthy weight.”
Obesity can also inhibit mobility and range of motion, which are important to recovering from joint replacement. Moreover, the extra weight puts an added burden on the artificial joint.
“People who lose weight prior to joint replacement surgery recover faster and have fewer complications,” Smires said.
Bishop knows that firsthand.
Better All Around
Smires, using robotic-assisted technology, performed both of Bishop’s knee surgeries, but prior to the second he recommended Bishop lose some weight and referred him to Dobruskin.
At the time, Bishop weighed 359 pounds and had a BMI of 50.
“I was embarrassed by my weight,” Bishop said. “Going out to restaurants. Being judged. Buying clothes was awful.”
As a patient at the Center for Bariatric Surgery & Metabolic Medicine, Bishop met with a multidisciplinary team of bariatric surgeons, nutritionists, psychologists, and exercise physiologists who helped guide him through his weight loss journey.
Bishop underwent laparascopic sleeve gastrectomy, a surgical weight loss procedure in which about 75 percent of the stomach is removed, leaving 25 percent of the original capacity. The remaining stomach resembles a narrow tube or sleeve, hence the name.
Additionally, sleeve gastrectomy eliminates the portion of the stomach that produces a hormone that stimulates hunger, further supporting weight loss efforts. In other words, sleeve gastrectomy helps people feel fuller faster so they eat less.
Two months after the procedure Bishop’s weight was down by 33 pounds, enough to enable him to have his knee replaced.
“My recovery was less painful and quicker the second time around,” Bishop said. “I was able to bend and straighten my knee into place faster than after the first surgery, and the residual pain in my other knee went away too.”
What’s more is that Bishop, who now weighs 199 pounds, feels better all around.
His sleep apnea has improved, and according to his cardiologist, his heart is healthier too. His weight loss has led to fewer episodes of proximal atrial fibrillation. He also noted that he doesn’t fall like he used to.
“When you’re overweight and you lose your balance, the weight just takes you down,” Bishop said.
Bishop doesn’t think about food as much as once did. He pays attention to portion sizes and is aware of the calories he consumes. He has learned to eat slowly.
“Food is no longer the first thing on my mind,” said Bishop, who now enjoys eating moderate portion sizes. “I can have what I want to eat just in a different way. “
Being healthier has also provided Bishop peace of mind, knowing that he’ll be able to continue caring for his wife, who is a quadriplegic. They’ve been married for 47 years.
Bishop and has wife have taken several trips to Arizona, where Bishop especially enjoys photographing the sun rising over the desert.
“She’s the reason I want to stick around,” Bishop said. “We have a lot more sunrises to see.”