Nicole Petro is thrilled with what she's getting for Christmas this year.
The 18-year-old high-school senior is scheduled for gastric bypass surgery five days before Christmas at Barix Clinics of Pennsylvania in Langhorne. At 5 feet, 7 inches tall and 265 pounds, Petro hopes the operation will succeed where diet and other weight-loss programs failed her.
"It's about my future," said Petro, who has been dreaming of having the surgery since she was 15. "I've had a weight problem for eight years."
While Petro is younger than most, her decision to surgically shrink her appetite is becoming more common.
Since 2000, the number of bariatric procedures in Philadelphia's eight-county region surged 350 percent to 2,340 last year, an Inquirer computer analysis of hospital billing records shows.
And Barix, which opened in late 2002, has captured much of that growth. Its surgeons performed one-third of the obesity operations here last year.
"The big sell is that this is all we do," said Alan Brader, a surgeon and the hospital's medical director. "That means a lot to people, especially with the sensationalism surrounding this surgery."
One in three adults in the United States is obese and about 9 million are morbidly obese - with a body mass index (BMI) above 40. A BMI of between 18.5 and 25 is considered healthy.
Obesity is linked to high blood pressure, diabetes, heart disease, breathing problems and other conditions.
Not to mention its impact on lifestyles.
Vicki and Joe Creighton of Newtown decided to go for a his-and-hers operation after vacationing in the Dominican Republic. At 300 pounds, Creighton did not feel good on the beach.
The couple, who have three kids, picked Brader as their surgeon because they were worried about the risks. They each had high blood pressure.
"We both struggled with weight all our lives, but it got out of control as we got older," Vicki Creighton said. "This was a life-changing thing for us."
In the two years since their operations, the couple have lost a combined 179 pounds.
There are two types of obesity surgery - those that reduce consumption by restricting the size of the stomach and those that also bypass parts of the small intestine in order to reduce food absorption.
Both can be done with open incisions or laparoscopically. In the latter, which is less invasive, a surgeon uses a tiny video camera and special instruments inserted through small incisions in the abdomen to do the procedure.
People who get the bypass surgery tend to lose more weight than those who opt for "restriction operations," which wrap a removable band around the stomach to make it smaller.
Forms of the surgery have been available since the 1950s, but it has become dramatically more common as America's weight problem has grown.
A Swedish study published in the New England Journal of Medicine in 2004 found obesity surgery resulted in greater sustained weight loss and more improvement in related health conditions than conventional treatments over a 10-year period.
Most surgeries are covered by health insurance.
A large local insurer said it pays hospitals about $19,000 for a gastric bypass. The federal Centers for Medicare and Medicaid Services said its median payment for obesity surgery is $9,770.
Christina Brown of Ambler said she chose Barix because the hospital specialized in weight-loss operations.
Brown hopes that dropping down from 451 pounds will give her the energy to keep up with her 11- and 12-year-old kids. "I just want to be healthy," she said.
Barix was built for people like her.
Tucked next door to the Oxford Valley Mall, the two-story brick hospital could pass for a suburban office building.
Chairs throughout the hospital are much wider than normal and can comfortably hold someone weighing 700 pounds.
Hospital gowns come super-sized, as do the hospital's stretchers and operating room tables. Even the bathrooms were built to accommodate morbidly obese people, said Margery Seltzer, Barix's vice president for clinical services.
"The entire facility is geared toward larger patients," she said.
Barix generated $9.7 million in patient revenues in the fiscal year that ended on June 30, 2005, according to the Pennsylvania Health Care Cost Containment Council.
The hospital is owned by a private Ypsilanti, Mich., firm that owns three others.
The patients have fared well.
Barix patients were readmitted to hospitals for complications half as often as the regional average, records show.
That might be because Barix doesn't operate on the highest-risk patients, but is probably also due to the experience of its surgeons and staff.
"We find that the high-volume hospitals have lower mortality rates," said William Encinosa, a senior researcher at the federal Agency for Healthcare Research and Quality. "We also found that the surgeon's experience with bariatric surgery is linked with the complication rate."
As with any major operation, obesity surgery has serious risks, including death.
In the first six months of 2005, 12 percent of bariatric surgery patients in this area were readmitted to hospitals for complications. That was down from 18 percent in 2003, hospital billing records show.
Complications ranged from relatively minor, such as nausea and cramps, to potentially serious abdominal hernias and post-operative heart attacks.
More than 95 percent of Barix patients had commercial insurance, compared with less than 80 percent of the patients who got the surgery at the Hospital of the University of Pennsylvania last year.
That suggests Penn was treating sicker patients, said Edward H. Livingston, a bariatric surgeon at the University of Texas Southwestern Medical Center in Dallas. "Really high risk patients are going to have Medicare and Medicaid."
Barix patients also had many fewer serious chronic conditions as those at Penn or Temple University Hospital, according to billing records.
Brader said Barix isn't "cherry-picking."
Patients at high risk for complications belong at a full-service hospital, he said. He attributed Barix's low complication rate to the care provided before, during and after surgery.
"If I do my job right in the operating room," he said, "I can control 95 percent of the complications."
But a lot also depends on how well patients follow doctor's orders, said surgeons at Penn and Temple.
Christian Riley is trying to stick with the program.
Because of health problems, he missed almost a year of high school. He suffered from sleep apnea, asthma and chronic shortness of breath.
At 5 foot 6 and 428 pounds, Riley had a BMI of 69.
In 2004, a couple days after his 17th birthday, Riley underwent a gastric bypass at St. Christopher's Hospital for Children in Philadelphia. Today he weighs less than 300 pounds, goes to college, and dances.
"I still have to keep my weight managed - because just as fast as I lost it, I can gain it back again," he said.
Used with permission of PHILADELPHIA NEWSPAPERS, INC., from the Philadelphia Inquirer Online,
Inquirer Staff Writer Josh Goldstein, Dec. 10, 2006; permission conveyed through Copyright Clearance
Center, Inc.