After patients’ weight loss surgery, her work really begins

McCall Barrick is a nurse practitioner at the Emerson Center for Weight Loss in Concord.Josh Reynolds for The Boston Globe

You won’t hear any fat jokes in the offices of Emerson Hospital’s Center for Weight Loss. Patients are treated with respect, and furnishings are designed for a bigger clientele: weight scales go up to half-a-ton, larger chairs hold up to 750 pounds, and doorways are wider. As obesity reaches epidemic proportions — more than a third of US adults are obese — more bariatric surgeries are being performed at health care centers like Emerson in Concord. What was once considered a high-risk and last-resort measure is now a common procedure that is touted as relatively safe.

Emerson Hospital does about 400 weight-loss surgeries a year on patients who are at least 100 pounds overweight. Often, they’ve tried every diet and are frustrated and ashamed. They choose bariatric surgery because it restricts the amount of food the stomach can hold, but it’s not “the easy way out,” as often thought, McCall Barrick said.

Barrick is a nurse practitioner who assists in Emerson’s operating room and consults with patients. Post-surgery, they can have unexpected issues. They may have excess skin hanging off their bodies — sometimes as much as 30 pounds of surplus flesh — and taste preferences can change forever. Hair can thin because of nutritional deficiencies.

Some patients have a “last supper” or “food funeral” for their final regular meal, saying goodbye to carbohydrates and sugar. Many find that the surgery radically changes not only the way they eat but every aspect of their lives, from health to relationships. Barrick, who formerly worked in thoracic surgery (lung and chest), was surprised by the emotional element of her job when she started at Emerson two years ago. The Globe spoke with her about what it’s like to see patients lose up to 150 pounds or more after a gastric bypass.

“I see patients from all walks of life: doctors, stay-at-home moms, attorneys, truck drivers, people on disability. They have similar stories: they’ve tried Weight Watchers, Jenny Craig, low-calorie diets, low-carb, prescription medication, over-the-counter supplements, psychological counseling, on and on. They might have lost 50 pounds, then gained back 20, or lost 30 pounds and gained back everything.

“And obesity has a lot of related medical issues, including diabetes, hypertension, sleep apnea, even cancer. Patients come in desperate and motivated to make changes. I’m the first to say, though, that surgery is not a magic bullet. It doesn’t change behavioral patterns — it takes effort every single day. Bariatric procedures change the stomach and the intestine so a person feels full more quickly, but this doesn’t mean your cravings will go away.

“I’ve worked in surgery for much of my career, so I am very familiar with what happens in operating rooms. In our OR, I typically control the camera, which is inserted through small incisions in the abdomen. We have a screen where we view the internal organs, including the intestines, stomach, liver, spleen, and kidney. It’s really remarkable and puts things in perspective about how the digestive system works.

“The sleeve gastrectomy, in particular, fascinated me initially, as we remove part of the stomach so it’s smaller. I thought it was an unusual concept to cut out part of the stomach, but it makes sense physiologically — it helps with hormone regulation and food restriction.

“It’s not all over after surgery — our patients continue to see us indefinitely, as it holds them accountable for their lifestyle choices. One patient continues to come to us 15 years after surgery; she was one of the first people in the country to get the gastric bypass. She’s a stay-at-home mom who weighed about 300 pounds and now is about 180 pounds. It’s the seemingly minor changes that make a huge difference in her life. She is able to get on airplanes, go on hikes with her kids, and enjoy roller coasters.

“Another patient celebrates her surgery date as a ‘birthday’ because it was the day her new life started. Others run marathons, sky dive, have babies, and say that they are able to wear their wedding rings again, or merely cross their legs. One person simply said: ‘I fit.’ I’m much more empathetic now and understand that being obese has so many implications.

“As for myself, yes, like many people, I’ve sometimes struggled with my weight off and on, but that’s why I like working here. There are no cookies or cake in the break room, and we accept all kinds of bodies. I don’t even own a weight scale. It’s never good to get too focused on the numbers.

“Instead, ask yourself, ‘What’s your energy level? What’s your activity level?’ I honestly don’t even remember the last time I weighed myself.”