When Matt Carmack, age 55, reflects on his relationship with weight over his lifetime, he begins by saying, “I guess I’ve been husky all my life — I wore ‘size husky’ pants in grade school.”
Once Matt graduated from high school and later, married his wife, Kelli, he says, “That’s when the weight really packed on.”
Gaining weight happened quickly as he was surrounded by many good cooks in his family who made delicious, homemade meals regularly. "I was around good food and I found it hard to resist,” he says.
As time passed, Matt knew he had to lose the weight he had gained. Over time, he tried any fad diet that was on the market. “I’d lose 40 or 50 pounds, then ‘it’ would find me again and I’d put the weight back on — and more.”
At the peak, Matt’s weight was 403 pounds and he was wearing a size 5X shirt.
In addition, when he was in his early 40s, Matt began to experience pain in his knee joints. “I saw an orthopaedic doctor who was using injections to relieve the pain. “I was receiving shots regularly – initially about every six months.” After several years of injections, effectiveness of the medicine began to wear off. “After about three months, I knew that it was time for another injection because the pain became much worse.”
The Final Straw
The final straw broke in 2018 during Matt’s appointment with Todd C. Kelley, MD, UC Health orthopaedic surgeon and associate professor in the Department of Orthopaedics and Sports Medicine at the University of Cincinnati College of Medicine. “Matt originally came to me in 2013, and he was, in his mind, ready for knee replacement surgery,” says Dr. Kelley.
But Matt’s weight prevented him from moving forward with that surgery. “We want all of our patients to do well after a surgical procedure,” Dr. Kelley states, “However, performing surgery on a patient who has obesity and who has a high BMI, means that the risk of complications is much, much higher.” Those risks include blood clots, heart attacks, infection and healing issues. “Before having surgery, we often ask patients to quit smoking in order to gain control of their diabetes and/or to lose weight. Joint implants must survive and do well in the body to allow patients to get up, move and do physical therapy.”
The other critical fact is that a knee implant can only hold so much weight. Dr. Kelley is supportive and positive when he encourages his patients to lose weight. “For some people, the reason is metabolism, for some, it’s a thyroid disorder and for others, it’s a psychological challenge.” He adds, “My role is in talking with patients about weight loss is more about listening than lecturing.”
“Before we perform the surgery, we need people to be under a body mass index of 40 (the high end of the scale), and post-surgery, we want them to continue to lose weight and then maintain the weight loss long term.”
Matt’s weight continued to shift up and down. “Finally, Dr. Kelley told me, ‘Matt, your knees are now bone on bone. You need joint surgery and you’re going to have to get the weight off in order to do so.’” Dr. Kelley understands that taking weight off can be tough, and a lot of people just need some help.
Dr. Kelley suggested that Matt connect with the UC Health Weight Loss Center to explore the possibility of having bariatric surgery — to lose the weight once and for all.
“I actually had been to several weight loss seminars, but never went through with it,” said Matt. “But at the time, I just couldn’t give up soda — I was drinking a 2-liter bottle every day.” Another ritual he admits was stopping on his way to work to buy Bavarian cream donuts.
“I was miserable before I had the surgery and lost the weight,” said Matt. “When I walked, I was sweating buckets — my shirts were always wet. I was out of breath and wasn’t able to talk. I let myself go, and I did it to myself.”
Then, in 2017, a coworker who was planning to attend a UC Health weight loss information seminar asked him to come along. Matt went once more and listened more intently. Something seemed to click in his mind and he continued on with the process, completing the prerequisite nutritional therapy, diet instructions, psychological review and perioperative preparation in order to have the surgery.
Ready for Surgery
After successfully completing all requirements, Matt’s gastric sleeve surgery was performed by Jonathan R. Thompson, MD, UC Health bariatric surgeon and assistant professor in the Department of Surgery at the UC College of Medicine, on April 15, 2019 — his birthday. “My wife asked me if I was sure that I wanted to have surgery on my birthday. I told her that I wanted it to be a birthday present to myself — and it was the best birthday gift I have ever had.”
“The weight-loss surgery process begins and ends with education, training, coaching, encouragement and empathy,” Dr. Thompson explains. “Behavioral change is hard. The environment doesn’t help as we are all surrounded by terrible food options. Weight-loss surgery is not an alternative to having healthy eating and exercise habits — those are required. Matt embraced every aspect of the process and his results speak for themselves. I tell patients that the surgery is actually the easiest part of the process.”
“Matt attended several seminars before finally enrolling in the program, which is very common,” said Dr. Thompson. “A lot of this hesitation is patients becoming mentally prepared for the commitment. We want our patients to be ready so they have lifelong success; however, they should not wait to start the process — and people with a BMI greater than 40 should not wait. No weight loss intervention comes close to the success of a multidisciplinary weight loss program that includes bariatric surgery.”