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Surgery helps a liberal lawmaker eat conservatively

If the usual rigors of serving in Congress were not enough, Rep. Jerrold Nadler, D-N.Y., has for years struggled with the personal torment of being so overweight that he cannot make it up a single flight of stairs to the second floor of the Capitol to vote on the House floor. He uses the elevator instead.

"I can't tell you how many people _ complete strangers _ have come up to me and said, "Congressman, you're doing a great job, and I want you to continue to be my congressman, so you have to lose weight,"' he said. "Imagine how that makes you feel."

Now, after decades of health-threatening obesity and futile dieting, Nadler has taken a more aggressive course. During the recess in early August, he underwent stomach-reduction surgery at Mount Sinai Hospital in Manhattan, following in the steps of a small but growing number of people who are overweight, including Al Roker, NBC's Today weatherman.

Nadler peaked at 338 pounds before the surgery, whereas Roker peaked at 320 pounds. But Roker is 5 feet 8 inches tall, while Nadler is 5 feet 4 inches. He was so obese he long ago gave up riding the subway in New York to avoid the tiring climb up and down the steps.

Nadler, 55, said he took this radical step after realizing that his life depended on it. "I want to live to see my grandchildren grow up," he said. "How many grossly overweight 80-year-olds do you know?"

The results have been striking: Nadler has shed 61 pounds and taken in his suits three times. He even surprised himself the other day when he walked more than 30 blocks from his district office in Lower Manhattan to Penn Station. In the past, he avoided walking even a few blocks.

Since the operation, Nadler said he has had to change his eating habits drastically because he feels terribly uncomfortable if he eats too much. In the past, he would typically consume a salad, a bowl of onion soup, a 14-ounce ribeye steak with french fries, vegetables, bread and butter and a dessert, and wash it down with Diet Coke. He also snacked constantly _ on Oreo cookies, Fig Newtons, frankfurters and even tuna and chicken salad sandwiches.

"I'd be constantly noshing in the cloakroom," he said.

These days, Nadler will order a 4-ounce steak sandwich, discard the Kaiser roll and eat only three quarters of the meat. (He will have vegetables only if he has room _ and he skips dessert and has nothing to drink.) He also has stopped snacking. "Snacks are out," he said. "What I do now is munch on ice cubes."

Nadler, who became known nationally for his staunch defense of President Bill Clinton during impeachment, also is trying to be more active and less sedentary. His usual breakfast, a tuna or chicken salad sandwich with tomatoes and mayonnaise, is now out of the question.

People have begun to notice the difference in the congressman, who has frequently been the target of cruel humor in his nine years in the House, even among those who respect his formidable intellect and sharp political instincts. (In 1998, for example, Sen. Alfonse D'Amato, R-N.Y., referred to him as "Jerry Waddler" in a private meeting of politicians, a remark that later became public.)

Nadler said that while he has publicly shrugged off such incidents, he was terribly wounded by them.

The surgery Nadler underwent is becoming increasingly popular, at a time when diet, exercise and weight-loss drugs have failed to counter the rising tide of obesity in America. From 1999 to 2000, 35.2 percent of Americans were obese or extremely obese, according to a recent issue of the Journal of the American Medical Association. In addition, it reported, 64.5 percent of Americans were overweight.

Nadler, who believes genetics plays a role in obesity since his identical twin brother is obese, said he had tried several ways to lose weight. Routine exercise. Liquid diets. Weight Watchers. A monthlong stay at the Duke University weight-loss center in Durham, N.C. And even fen-phen, the popular diet pill combination that was linked to problems with heart valves. But nothing worked.

The surgery is not a quick or easy cure. It is as painful and as risky as any major abdominal operation. It forces people to make major changes in the way they eat, makes them extremely ill or terribly uncomfortable if they eat too much and places them at risk for nutritional deficiencies.

But it is highly effective. No drug or diet has led to the large and lasting weight loss that the surgery has helped most patients achieve, medical experts say. In many cases, people lose 100 pounds.

"It's not a risk I took lightly," Nadler said, citing statistics showing one out of 200 people die as a result of the procedure. "But on the other hand, I've been struggling with weight all my life. It's frustrating."

By the time Nadler decided to have the procedure, his health had deteriorated considerably. "He was already very sick when we saw him," said Dr. Michel Gagner. "He had multiple diseases from his obesity."

Gagner said the procedure was a variation of a more common stomach operation performed in the United States. The more common procedure involves stapling shut most of the stomach and creating a small, 1-ounce pouch that severely restricts the amount of food a patient can eat. Then the upper portion of the small intestine is bypassed to reduce the calories and nutrients the body absorbs.

The operation Nadler had simply narrows the stomach into a "sleeve" that can take as much as 3 ounces of food. The sleeve is then connected to the lower half of the small intestine, for the reduction of calories the body absorbs.

Gagner said that the procedure offers "super obese" patients a better chance of taking off large amounts of weight and keeping it off. He noted this procedure was developed to prevent the kind of weight gain that such patients experience two to five years after undergoing the more traditional operation.

"It allows for more natural eating patterns," Gagner said. "People can eat more normally, but they are not going to absorb as many calories."

In the end, Nadler said, what persuaded him to undergo surgery was some gentle prodding from his wife, Joyce Miller, who pulled information about the operation off the Internet, and the advice of a friend who had had the surgery.

Nadler said he probably should have had the operation a few years ago. "I've been overweight for my entire adult life," he said. "I've fought it. I've tried Weight Watchers. I've tried everything. But it didn't work."

Now, he's hoping to reach his ideal weight, about 160 pounds, and transform his life in the process. "I was extremely, morbidly obese," he said. "Now I'm only morbidly obese. I'm getting there."

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