Mike Cianciullo hated the stares.
Whenever his family went out to eat, strangers' eyes would follow -- gawking at the sizes of father and son, judging the food on their plates. At 5 feet 7 inches, Cianciullo weighed 321 pounds. His son, Matt, was 5 feet 3 inches and weighed 333 pounds.
"It's like they'd never seen a fat person before," Cianciullo recalls.
For Mike, the decision to go through with weight loss surgery was about stopping those stares, getting in shape and, most importantly, saving his son's life.
When his dad first approached him about going to a weight loss clinic, 17-year-old Matt Cianciullo was hesitant. Unlike many children who are bullied because of their weight, Matt had a lot of friends and didn't really see his size as an issue.
Matt was more concerned about his dad's health. Mike was on medication for acid reflux disease, hypertension and high cholesterol.
"To think that, that young, I might lose him before I was 20 -- it's not something you want," Matt says. "And I always thought if I kept going down the same path, I would be like him or worse."
Still, Matt was nervous. Surgery seemed dangerous. Maybe, he thought, I'll just try dieting again.
Fear stops many people from getting weight loss procedures done, says Dr. Carson Liu, the Cianciullo's doctor and a bariatric surgeon in Los Angeles. But often the biggest obstacle is denial -- they don't want to admit they can't do it on their own.
"The hardest thing for patients to do is pick up the phone and go see a doctor," Liu says. "They see it as a kind of defeat."
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There are several types of bariatric surgery. Most cost between $18,000 and $30,000.
Gastric bypass has been the "gold standard," Liu says, since the 1990s. With gastric bypass, a new stomach about the size of a golf ball is created laparoscopically by cutting across the top of the stomach and connecting the smaller pouch with the intestines.
Mike knew about gastric bypass but didn't like how invasive it was; he didn't know if he wanted to restructure his internal organs that way. Then he started seeing commercials for Lap-Band.
The Food and Drug Administration approved Allergan Inc.'s Lap-Band Adjustable Gastric Banding System in February 2011. (Liu sits on Allergan's doctor approval board.) The first adjustable gastric band, Ethicon Edno-Surgery Inc.'s REALIZE, was approved in 2007.
Both bands are placed laparoscopically around the upper portion of the stomach in an outpatient procedure that generally takes 45 minutes to an hour. The devices can be tightened or loosened at subsequent doctor's visits, helping patients "feel full faster, eat less and lose weight." And unlike gastric bypass, adjustable gastric band procedures can be easily reversed.
The FDA has approved the Lap-Band for patients over 18 with a BMI over 40, or patients with a BMI over 30 who also have a serious obesity-related condition like high-blood pressure or sleep apnea.
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Mike had a BMI of 50. His son's was 59.
"With all the excess weight on him, it was putting so much stress on his heart," Mike says. "For me this would be a good thing. My son needed it."
Two years, 200 pounds
Shortly after Father's Day 2009, Mike and Matt were ready for surgery. Mike was ready to give up the Italian food he loved as a child; Matt was determined to no longer constantly eat just because he was bored.
They had completed all the prerequisites. Liu asks patients to lose 5 to 10 pounds before undergoing anesthesia, to ensure they're willing to make the serious commitment that's forthcoming. He stresses that the Lap-Band is just a tool to help patients lose weight.
"The main thing we talk about is motivation," Liu says. "If they can't change their lifestyle, they aren't going to lose more than 30 to 40 pounds."