Lakeland Nurse is Pioneering Patient at New LRH Bariatric Institute

Pam Bryan, right, and daughter Laura Walker

Pam Bryan knew she needed to make changes in her life. A nurse with Lakeland Regional Health and a grandmother of eight, she found herself in a cycle of being very overweight and depressed. Years of putting family first and resolutions to improve her own mental and physical health seemed futile. Trying to lose weight – a continual struggle for Bryan – had taken a heavy toll.

“Mentally I didn’t feel good about myself,” Bryan, 63, said. “Physically I didn’t feel good. I had high cholesterol, depression.”

And there were the diets.

“I’ve had a lifetime of yo-yo dieting, doing well for awhile, then gaining again, the weight creeping up and up. The failure of each (diet) is discouraging,” she said.

Then Bryan had a pivotal conversation with her 40-year-old daughter, Laura Walker.

“She told me ‘Mom, please take care of your health. You’re all I’ve got.’”

The conversation was an eye opener, Bryan said, and led her to become a pioneer in Polk County. She was the first to undergo a weight-reducing – and potentially life-saving – surgical procedure at Lakeland Regional Health’s new Institute for Metabolic and Bariatric Surgery and Medicine.

LRH announced on Jan. 27 that Dr. Joseph Chebli would be the medical director of the institute. Bryan agreed to be the first patient.

When Bryan first walked into Chebli’s office, he said she was in a Class 3 stage of obesity.

“It’s the most advanced (stage), with many of the very common comorbidities – sleep apnea, osteoarthritis, high blood pressure – many of the problems that debilitate our patients,” Chebli said.

Polk County’s Obesity Rate

Some recent studies have indicated that Polk County has a serious problem with obesity.

The Florida Department of Health’s FL Health Charts showed that just under 66 percent of Polk County residents were diagnosed as either overweight or obese in 2016, according to an an October 2019 LkldNow article.

The Robert Wood Johnson Foundation’s 2020 County Health Rankings and Roadmaps showed that Polk’s obesity rate was 37 percent of the population, compared with the state of Florida’s 27 percent. That made Polk County among the heaviest in the state.

County leaders are aware of the problem. The 2015 Polk County Community Assessment and the 2016-2017 Polk Community Health Improvement Plan, which used the 2015 findings, outlined healthy weight goals to reduce the body mass index rate to less than the state average.

Bryan was motivated in part by family tragedies. In 2017, she lost her only son.

“Then I lost my only two siblings, my brothers. I realized (Laura) was my only child left,” she said.

In addition, Bryan and her husband are occasional caretakers for one of Walker’s children, who is disabled.

She said, “I’ve got to make a change.”

The thought of taking control of her weight gave Bryan a different life perspective — that of a sassy senior citizen.

“I want to feel good and look good at this stage in my life. I’ve gone from raising my kids to helping raise grandkids,” she said.

“I’m not doing this to make you a runway model.”

Bryan knew she wanted a surgical procedure to be part of her weight-loss treatment, and she knew she wanted Chebli to perform it. She tried a program with another doctor but wasn’t satisfied with the results and kept a watchful eye on Chebli, who eventually opened a Lakeland office in addition to offices in Venice and Brandon.

Pam Bryan and Dr. Joseph Chebli

Chebli, who had treated patients in Lakeland for several years, had developed a close relationship with Lakeland Regional Health.

“I started around 2014 working with some of the employees, mostly nurses at LRH, who found me and started going to Venice to see me,” Chebli said. “Over time we gained a reputation with patients for being meticulous.”

Bryan met with Chebli during his twice monthly office appointments in Lakeland and said he made her feel comfortable with herself.

“I got to know her well over many years,” Chebli said. “She identified with myself and my practice. She was quite determined that I was going to be her surgeon and wait till I got to Lakeland. Something about her was very endearing.”

Bryan had some lingering doubts, asking if she should just accept herself as she was.

“Dr. Chebli told me, ‘This is a health issue. I’m not doing this to make you a runway model,’” she said.

For most weight-loss surgeries, Chebli said the deciding factor for years has been personal appearance. Although surgeries still happen mainly because of weight, the institute emphasizes metabolic disease.

“Type-2 diabetes, elevated cholesterol, osteoarthritis – that’s our focus,” Chebli said. “It’s extremely common that patients have no idea how sick they really are.”

Chebli said it’s not wrong when physicians and hospital programs try to help patients by focusing on appearance. However, he sees a problem in the U.S. with bigotry and discrimination against obesity and diseases that go along with it. He said many patients are repeatedly told to just eat better and exercise.

“The real problem is metabolic dysfunction,” he said.

“There’s a stigma attached to surgery as well,” Chebli said. “Many people think these surgeries are dangerous or drastic. It’s as safe or safer than gallbladder surgery or a hysterectomy.”

LRH’s chief medical officer agrees with Chebli on the safety of these procedures.

“Bariatric surgery is an extremely safe and effective option when diet, exercise and medications have not successfully helped with weight loss, and excess weight is causing serious health problems,” said Timothy J. Regan, LRH Medical Center president.

Types of Weight-Loss Surgery

The Centers for Disease Control defines obesity as a Body Mass Index of 30 or higher for adults older than 20. A BMI of 25 to 29 is within the overweight range. Surgical weight loss is considered when a patient’s BMI is 35 or higher.

In a video on the institute’s webpage, Chebli outlines five weight-loss surgeries, including the two most common, the sleeve gastrectomy, in which about 80 percent of the stomach is removed, leaving a tube-shaped stomach; and gastric bypass, which involves creating a small pouch from the stomach and connecting it directly to the small intestine.

Chebli said the average weight loss is 5 to 15 pounds within 1 to 3 months following surgery.

Part of the hard work for Bryan began in late 2020 in preparation for the January operation. One of her requirements, 30 days prior to surgery, was to consume no more than 28 grams of carbohydrates per day in an effort to shrink her liver.

“I was on a low-carb diet and had lost 40 pounds on my own,” she said. “(Dr. Chebli) was ecstatic that I had lost that much weight. When I saw him in October and November, my BMI had dropped from 41 to 36, on my own.”

Bryan followed other recommended disciplines including nutrition, exercise and being careful not to replace one addiction for another. So, no alcohol. There was a lot of pre-op testing.

“I met with a psychiatrist, a nutritionist and a specialty doctor for sleep apnea,” she said.

Bryan underwent a sleeve gastrectomy on Jan. 28. She said after a week, she had lost 7 pounds. She went back to work Feb. 19, having lost 14 pounds.

“I was happy with that,” she said.

LRH Bariatric Support Group “Weigh to Go!” (online meetings)
April 13, 6- 7 p.m.; April 17, 10-11 a.m. Sign up

Now that she’s back at work without any restrictions, Bryan said she believes the three-week recovery following surgery gave her the time to adjust to changes in food and her overall diet. She acknowledges habits are hard to break.

“My manager was supportive. It has helped. I’m staying on track.”

In her health fitness program, Bryan has started a walking regimen with her daughter and granddaughter, pushing a stroller. She said she may begin resistance training later.

Bryan said she views her surgery and follow-up program as part of a lifelong goal. “It’s not just surgery. Here’s your life. It’s up to you to pick up the tools.”

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