Fasting during Ramadan was harder this year for this Philly woman – but that's a byproduct of her weight-loss success

"A lot of things had become difficult for me to do, even simple tasks like tying my shoe, taking a shower, walking up a flight of steps without getting winded, walking around the mall without getting winded, or even going to amusement parks and not even being able to even sit on the rides, which is embarrassing, to say the least," Gamble said. "So I was just like, 'Something has to change.' Those things that were difficult for me to do, or that I couldn't do even, I can do now."

She purposely planned her surgery for last May, after Ramadan had ended, because she knew she would have to radically change her diet and the way she ate and drank. For the first six weeks after surgery, like all bariatric patients, Gamble was on a liquid diet. Then she advanced to a diet of pureed food and eventually to solid food again. Because 75% to 80% of her stomach was removed during the sleeve gastrectomy to limit the amount she could ingest at one time, Gamble had to learn to wait 30 minutes between drinking and eating and two minutes between bites of food.

Normally, Gamble has the whole day to take her time with her new eating and drinking plan. But during Ramadan, which ends Saturday, Gamble has had to hydrate and eat at the required, slower pace in the predawn and post-sunset periods of each 24-hour-cycle. Her care team at Jefferson Abington Hospital helped her figure out how to prepare for this sacred time of fasting and to do it in a way that keeps Gamble on the path to lose another 60 pounds, bringing her down to her goal of 220, she said.

Even without fasting, some bariatric surgery patients struggle to take in enough fluids post surgery because their stomach volume has been constricted, said Dr. Kristin M. Noonan, bariatric surgeon and program director of general surgery residency at Jefferson Abington Hospital. As a precaution, they do not do bariatric surgery on people who intend to fast in the near future. About two patients a year who are going to observe Ramadan come through her practice, so her team takes that into consideration when planning their surgeries, Noonan said.

Gamble said she felt nervous going into her first Ramadan since the surgery.

"I didn't know what to expect or how I would do," she said about having to condense and confine her slower paced eating and drinking to the beginning and end of each day.

"Before I would just eat quickly and rush the food down," Gamble said. "But now, even if you're hungry and you try to eat fast, and you didn't wait at least those two minutes before you took another bite, your throat and your chest will let you know."

'Obesity is a disease,' but bariatric surgery is life-saving

Bariatric surgery is the most effective, long-term treatment for obesity, Noonan said. Jefferson Health offers laparoscopic bariatric procedures, which are less invasive than open surgery. To be considered for bariatric surgery at Jefferson Health, patients must be 18 or older and have a body mass index of 40 or higher, or have a BMI of 35 or above with weight-related medical conditions such as type 2 diabetes, high blood pressure or heart problems.

Even though some people may view weight loss surgery as "elective," Noonan sees it differently.

"Obesity is a disease," she said. "It's a very bad disease that collaborates with a lot of other bad diseases — diabetes, hypertension, high cholesterol, fatty liver, sleep apnea. All of those things are sucking your quality and quantity of life. Treating the underlying cause, which is the obesity, helps ameliorate all of those other things. ... It's surgery to save your life."

With a starting BMI above 60, Gamble's life expectancy was 10 years, Noonan said. GLP-1 medications, such as the weight-loss drugs Ozempic and Wegovy, were not the most effective choice for Gamble, because she had to lose such a significant amount of weight, Noonan said.

"It wasn't like, 'Oh, I have to lose 30 or 40 pounds,'" Gamble said. "No. It was a lot of weight that I had to lose, so I thought more of a long-term decision was best."

Some people don't like the idea of monthly injections that the weight-loss drugs require. "And while the drugs have only been out for a couple of years, it's very, very clear that the minute you stop, the hunger comes back, and the weight is going to come roaring back," Noonan said.

But bariatric surgery is not a "magic fix," Noonan said. It's a tool in a larger weight-loss program that the team at Jefferson Health helps patients adopt. They offer weeks of education to prepare patients not just for the surgery, but also for lifestyle and dietary changes that they need to make.

People who fully engage with the program, on average, lose 50% to 70% of excess body weight following bariatric surgery. And people who have weight loss surgery often see dramatic improvements, even reversals, in diabetes and high blood pressure, Noonan said.

Gamble is one of her success stories, Noonan said.

"She's really knocked it out of the park."

Obesity often prevents people from seeking care

Often, the patients Noonan operates on have been evading doctors, she said.

"It's very well known that morbidly obese patients tend to seek preventative health measures far less frequently than the normal weight people, so they're at higher risk of cancer, not just from having the obesity, but because they're not getting screened," Noonan said. "They're not getting mammograms, not getting colonoscopies, and that is partially a sort of personal embarrassment that I don't want to be crammed into the mammogram machine. 'I don't want to be too big for the gurney in the hospital.'

"And on top of that, a lot of obese patients have had very poor experiences in health care and face that stigma from other health care providers who don't see obesity as a disease, who see it as a character flaw or weakness, 'you're a lazy slob' kind of thing."

Gamble said she avoided seeing doctors before she had bariatric surgery, because they focused on her weight.

"I didn't want to talk about it, so you don't want to go, because the physician is not going to let you leave the office without talking about your weight," Gamble said.

At Noonan's office, the gowns were the appropriate size, and the recliners were the right fit. And once she lost the first 60 pounds after surgery, she felt even more motivated to keep going, Gamble said.

"I feel younger, if that makes sense," she said. "Having all that weight on you will definitely make you feel older than you are."

Before she lost 150 pounds, she had chronic knee and back pain, and a foot issue that required she wear a boot at night – all problems that have disappeared, Gamble said.

"I didn't have mirrors in my house for years … because I didn't like how I looked," Gamble said. "That's another form of denial, just to avoid it. 'I'm just going to avoid the mirrors.' That's not the resolution to the problem."