Robert DeLeo is one of the most powerful men in Massachusetts. As House speaker, he presides over 159 members and wields authority over nearly every facet of lawmaking on Beacon Hill.
Yet there was one domain over which the 65-year-old Winthrop native had little control: his weight.
DeLeo tried counseling, exercise, and medications. At 255 pounds, the 5-foot-9-inch speaker, who often gasped for air as he made his daily rounds, would periodically embark on yet another diet, lose 20 pounds, and gain it all back.
“I felt like a complete failure,” DeLeo said. “I felt like I failed myself. I felt like I failed my family. I felt like I failed my constituents because this is something I could have controlled. This was in my power.”
Finally, after three years working with specialists at Massachusetts General Hospital, DeLeo made a difficult decision. On Aug. 3, doctors removed nearly 80 percent of DeLeo’s stomach in an operation known as gastric sleeve surgery, currently the most common type of weight-loss surgery among the legions of Americans who battle obesity.
In the first month, he has shed roughly 40 pounds. It hasn’t been easy.
DeLeo has survived on a largely liquid diet for much of the past month, only recently adding in tiny servings of egg, tuna, and chicken salad, and fruit, all the while yearning for pasta, pizza, and Kentucky Fried Chicken.
“You have no idea what it’s like to be sitting with someone, and you’re having a bowl of soup with vegetables, and right across from you they’re eating a triple hamburger with french fries and onion rings,” he said.
Before his operation, DeLeo, a 25-year veteran of the State House, never realized how many political functions are steeped in food. All he wanted to do when he recently came back to work was cancel any luncheons or dinner meetings.
But he knew he couldn’t hide forever. Nor could he escape the awkward moments, like when he recently ventured out with colleagues who were used to seeing him eat with gusto. He suddenly appeared much thinner, and was ordering chopped salads, and not clearing his plate.
Before now, DeLeo hadn’t spoken publicly about his surgery, or even shared the news with many colleagues, because he is still struggling to come to grips with it himself.
“Surgery to me made me feel like a failure,” DeLeo said Friday, sitting in his State House office, relaxed and noticeably thinner, with the puffiness and flush in his face replaced by a tanned glow.
“When the doctor first said, ‘I think your only answer is surgery,’ I think I said, ‘Well doctor, if I do nothing but eat salad for breakfast, lunch, and dinner for the next year, can I avoid surgery?’ And he says, ‘You and I both know that’s not going to work.’ ”
It was an urgent plea from his children that finally jolted DeLeo.
After years of cajoling from his son, Robert, 32, a marathoner who offered to supervise an exercise program for his father, and Rachele, 28, a nurse who shared health tips, DeLeo found himself staring at a stark prospect.
His children approached after a family gathering and asked to speak with him. DeLeo had always been there for them, coaching their sports teams, cheering them on at games, never missing school events. But, they said, they were deeply worried he would not be there for their children.
DeLeo pauses as he recalls the encounter, tearing up, and stopping several times to regain his composure.
“They very much wanted me to be a part of that, and they felt the way I was going, I might not,” he said. “They felt that their children would be much better if they got to know who their grandfather is and what he is all about.”
DeLeo’s guilt and feelings of failure about his inability to lose weight are hardly unique, said Dr. W. Scott Butsch, an obesity medicine specialist at Mass. General’s Weight Center, and one of four specialists, including a dietitian, psychologist, and surgeon, who treated the speaker.
“There is an incredible amount of weight discrimination in our society,” Butsch said. “When you have somebody who is trying to alter his weight, and sees it is not changing, and then have society that believes it is a behavioral problem, you have a lot of self-blame.”
Nearly 70 percent of Americans are overweight or obese. And while the overall prevalence has remained steady in recent years, the percentage who are significantly overweight has steadily increased.
Now, researchers are realizing some significantly overweight people need more than diet and exercise to lose weight. While much remains unknown about the complex digestive system, scientists are learning that the cascade of proteins, hormones, and bacteria thought to regulate the sense of hunger and feelings of fullness work differently in some people.
In much the same way diabetics cope with something called insulin resistance, making them unable to regulate sugar in their blood, researchers believe some extremely overweight patients battle leptin resistance, in which their bodies do not respond to this appetite-controlling hormone, Butsch said.
Scientists think the surgery DeLeo underwent produces results not just because the stomach is dramatically reduced. They believe the procedure alters the bacteria in the gut, changing a person’s metabolism and even the signals that tell the brain it’s time to stop eating.
While DeLeo has already lost 40 pounds in one month, Butsch said it’s likely most of that weight loss stems from the severely limited diet needed in the weeks after surgery to protect the healing stomach.
The full bacteria-changing benefits of the surgery take months to kick in, Butsch said. By then, DeLeo will be able to eat more normal foods, and likely no longer crave large portions.
Already, DeLeo, who has been speaker since 2009, says he feels more energized than ever, is ready to go back to work, and has no plans on stepping down.
“I feel even more at the top of my game,” said DeLeo, long known as a workaholic. That type A personality is something his doctors also want him to work on, encouraging him to take more time off.
That seems unlikely any time soon. But DeLeo said he has changed his thinking about weight. He finds himself watching people more closely as he walks around, wondering about the swirl of emotions among those who are overweight.
“Inside, they are probably going through some real difficulties in terms of how they may look. They may be going through some real difficulties in terms of how they may feel,” DeLeo said.
“They should realize that there are things out there, from medication, to exercise, to operations that can help them,” he said. “Instead of sitting back and thinking nothing can be done about this, they should go to their doctor, and talk to their family, because they can do something about it. They can hopefully change their lives for the better.”
Kay Lazar can be reached at Kay.Lazar@globe.com