Madhu Rangraj, MD, of Sound Shore Medical Center in New Rochelle, NY, on Performing Gastric Bypass Surgery on Five Severely Obese Members of the Same Family

Madhu Rangraj, MD, Sound Shore Medical Center

Photo by Chris Ware

From left to right, the family members are: Benedetto Salvatore, Sr., Mark Salvatore, Benedetto Salvatore, Jr., Janet Salvatore, and Donna Salvatore

Genetic factors—plus years of overindulging together on pasta dishes, meat, and bread—dealt a miserable blow to the waistlines and overall health of three generations of the Salvatore family in New Rochelle. But, as a family, they made a drastic decision to beat their obesity and medical complications by having weight-loss surgery.

Within a one-year period, Madhu Rangraj, MD, director of surgery and chief of metabolic and bariatric surgery at Sound Shore Medical Center, operated on six members of the oversized Italian-American clan, whose genes and eating habits had undermined their health. According to Dr. Rangraj, it is not uncommon these days for multiple overweight individuals in a family to elect to go under the knife. “We have had several families like this on whom we’ve operated,” he says. What’s unusual in this case is the timing.

The saga begins with Janet Salvatore, the 65-year-old family matriarch, who, at her heaviest, carried 247 pounds on her 5’2” frame. Over the years, diet and exercise regimens worked to some extent. She’d lose 15 to 20 pounds at a time but always gained the weight back—a classic “yo-yo” dieter. As a result of the excess weight, she was hypertensive and borderline diabetic. Her dress size?  Janet doesn’t even know. She never wore dresses but sported stretchy pants and T-shirts in a men’s XXL.

Janet was initially skeptical about having gastric bypass surgery, a stomach-reducing procedure, but she had a friend who successfully had lost weight that way. On her primary-care physician’s recommendation, she attended an informational meeting, and “before you know it, I was on my way to surgery.” Her surgery took place in February 2009, and as the weight began to melt away, her health improved and she set the course for others in the family to make the move. A month later, her son, Mark, had the surgery. Her husband, Tom, took the plunge that April, and other family members soon followed, including son Benny, daughter-in-law Donna, and grandson Benny, Jr. “Once they saw my results, they wanted to do it, too,” she says. Now, Janet is trimmer (160 pounds), her blood pressure is in check, and she feels so much better.

Weight-loss surgery generally is reserved for people who are severely obese—100 pounds or more over their ideal weight—and those who are somewhat less obese but have serious co-existing medical conditions. Sound Shore’s guidelines stipulate that patients have a body mass index (BMI) over 40 or a BMI over 35, together with another medical condition, such as diabetes, high blood pressure, or difficulty sleeping. (As an example, an adult who is 5’7” and 255 pounds has a BMI of 40.) Candidates should have failed previous weight-loss attempts and be committed to making a lifestyle change. Prior to surgery, patients meet with a psychologist and dietician to assess their readiness and prep them for what lies ahead.

In this case, each family member was severely obese, with BMIs over 40, and four of them had diabetes and hypertension, conditions that often go hand-in-hand with obesity. Janet’s own mother was always heavy, as was her grandmother.

Today, Tom, the family’s 66-year-old patriarch, has a size 34 waist, down from 52 before surgery. He’s employed as a security guard and reports that he’s moving around like a 25-year-old.  Janet’s grandson, after dropping more than 100 pounds from a starting weight of 300 pounds, has a job in the seafood department of A&P—and a girlfriend. Her daughter-in-law, who opted for a non-permanent gastric banding procedure, has lost 62 pounds. Collectively, the six family members tipped the scales at more than 1,600 pounds at the beginning of their journey, but, since having surgery, they’ve dropped 550 pounds. Now, the meals around which they gather fuel their bodies in a healthful way. Instead of beef, they have turkey meatloaf with roasted vegetables. Sunday’s pasta-and-meatball dinner was swapped out for lasagna with wheat matzo with a low-fat or fat-free ricotta and fat-free mozzarella.

“I think you should salute the family that had the courage to go through something like this together,” Dr. Rangraj says. These are high-risk elective procedures, he says. According to a government study published in 2009, the risk of dying six months after surgery is 0.5 percent, while the rate of complications among patients hospitalized for bariatric surgery is about 15 percent. On the other hand, studies indicate that the surgery can greatly enhance patients’ quality of life.

Not only is the Salvatore family’s medication intake greatly reduced, notes Dr. Rangraj, but “they’re participating in their longevity.”



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