Dr. George Fielding knows well the appetites of man. For the first 42 years of his life, his own was insatiable—a yawning, gaping feeling he likened to Edvard Munch’s The Scream—and he devoured nearly everything in sight, until he weighed well over 300 pounds. Now, nearly eight years later and more than 100 pounds thinner, he has turned his appetite toward other pursuits. He has set his mind to marrying Dr. Christine Ren, the slender woman with the diamond-cut jaw who shares his medical practice. And, oh yeah, he wants to operate obesity out of existence.
“Quite frankly, my objective is to make the world a thinner place,” said the 49-year-old surgeon in his wide-voweled Aussie brogue as he sat in his beloved’s office on a recent Tuesday afternoon. “My belief about this surgery is, I do it for two reasons: It’s to give fat people a normal life, and to give them a shot at a normal life- span. And in our own little way, that’s what we do.”
Dr. Ren chimed in. “We’ve gotten rid of 241¼2 tons of fat in four years,” she said. “But it’s not so much the surgery is getting popular; the disease is getting worse.”
“There’s about one in eight Americans now—we could actually operate on every eighth American,” Dr. Fielding added in a rush of statistics.
Oh, to hear their pillow talk!
Dr. Fielding and Dr. Ren are two moon-eyed doctors in love. They are also among the leading evangelists in the rising medical crusade against morbid obesity—an impassioned and potentially lucrative crusade that has seen the number of bariatric surgeons balloon in recent years, along with a simultaneous surge in hospital weight-loss programs. Together, with scalpels at the ready, the two doctors preach the gospel of a minimally invasive technique called laparoscopic banding surgery, or “Lap-Band” for short. Dr. Fielding became the proud owner of his own Lap-Band around 1998.
About two years later, in 2000, the two doctors met at a surgical confab in Singapore, where the admiration was immediate, even if attraction wasn’t. He was a pioneer of Lap-Band surgery from Down Under; she was a 33-year-old bariatrics up-and-comer from Queens, who would soon be tapped to launch the New York University Medical Center’s surgical weight-loss program. In 2001, he walked her through her first Lap-Band operation, and before long she was a convert, preaching its benefits on the lecture circuit. Somewhere along the way, they fell in love.
“I think it was just mutual,” said Dr. Ren, 39.
Now, with a new shared practice at N.Y.U., the doctors are determined to catapult the Lap-Band to the next level as well. Though they insist they have no ulterior motive—no stock in Allergan, the Lap-Band’s parent company, for instance—they argue its merits with almost the same passion they reserve for each other. Someday, they said, they would like to see it surpass gastric bypass surgery (think Carnie Wilson) as the new surgical “gold standard.” But as bariatrics fragments into an ever hotter, ever more competitive field, and as everyone from Bill Clinton to the U.S. Surgeon General jumps on the obesity bandwagon, they might find the effort as flush with challenges as promise—and profit.
“My vision of the future—I have two things: I’m going to marry that woman, and I really want to convince at least New Yorkers that this is a valid treatment option, no different than coming to me to have their gall bladder out if they had gall stones,” said Dr. Fielding.
“This is a true epidemic,” he continued. “It’s like you’re in the middle of a Middle Ages epidemic, but at least there’s something you can do about this for people who choose to come for treatment.”
Dr. Fielding delivered these words from a chair in Dr. Ren’s small N.Y.U. office, his black suit hanging too big on his frame, as if he hadn’t fully adjusted to his new, trim self (then again, his shirt was unbuttoned down to his sternum). From time to time, Dr. Ren would weigh in, adding details, providing statistics and sounding remarkably coherent for a woman who hadn’t eaten all day. “I don’t eat breakfast or lunch—I eat only one meal a day, and that’s dinner, because I can’t be bothered to regulate the number of calories,” she said.
Of the two, Dr. Ren, who is the daughter of Chinese and Polish immigrants, is the more outwardly serious. While Dr. Fielding is a mix of jolly bombast and doctorly ego, Dr. Ren is all measured words and careful, scientific exterior. On this particular day, she was dressed in a fluttery silk pantsuit, with ivory, manicured nails—but lest one get the wrong idea, her office was plastered with all the evidence of a badass career: awards, degrees, her recent Crain’s “40 under 40” write-up.
“She’s got the biggest dick at N.Y.U.,” boasted Dr. Fielding during an earlier interview.
In a Lucite box opposite her desk was a football signed in silver by Tiki Barber, a present from a well-connected patient.
The doctor’s patients are a motley bunch, a mix of moneyed Manhattan types and hard-working plus-sized folk. On this particular afternoon, they were packed close and tight into the Ren-Fielding waiting room, their bums fanning comfortably out over the extra-wide cushions on the extra-wide chairs. Predictably, many of these patients were ladies—because “men think they’re invincible,” Dr. Fielding observed—but less predictably, a number of them were sheitel-draped Hasidim, a trend that Dr. Fielding linked to the legacy of the Holocaust, but that may also have as much to do with schmaltz and schmear.
Like any self-respecting physicians, Drs. Ren and Fielding play mum when asked about past patients—though they will acknowledge operating on Khaliah Ali, daughter of the boxing legend Muhammad Ali. They are co-authoring a book with her, to be published next year. But Dr. Fielding isn’t the least bit shy about sharing some of his dream future patients—like Luciano Pavarotti, Mario Batali and Oprah, “when she regains her weight.” The doctors are ardent preachers of the theory that diets are “the biggest crock perpetrated on fat people,” and that no one can sustain more than a 20-pound weight loss.
And they shouldn’t be made to feel guilty when they don’t.
The doctor’s own “simple” prescription—Lap-Band surgery—first won approval by the Food and Drug Administration in 2001, several years after foreign surgeons, like Dr. Fielding, had already embraced it. Unlike gastric-bypass surgery, it doesn’t require any snipping of intestines or rerouting of major bodily pathways, but instead works like a kind of internal belt that shrinks the stomach from, say, the size of a honey dew down to a plum. This belt is made of silicone and looks surprisingly like a piece of calamari—except that, unlike calamari, it comes equipped with an internal inflatable balloon and is attached to a “port.” This port allows the doctors to inject or remove saline into the belt from time to time, depending on whether a patient wants more or less freedom to chow.
The whole procedure is done laparoscopically—meaning it is done inside the body, with the help of small video cameras, rather than by opening the patient’s belly—and it costs somewhere north of $20,000. Some insurance companies pay readily, while others have begun to pull back as they recognize a growing illness—a move the doctors call “very cruel.”
Nonetheless, they continue to push for it.
“I say at all my information sessions: I’m this ex-footballer who lives like a size-six girl. I eat one meal a day …. I’m never hungry,” said the ever-voluble Dr. Fielding. “And if you make a fat person not hungry, you make ’em thin. It’s as simple as that.”
Dr. Ren, usually the more reserved of the two, joined in with her own ode to the Lap-Band’s merits. “First of all, it’s very, very safe. If you’re looking for a treatment option for public health, for the masses … you want it to be safe,” she said. “The other thing is, physiologically, it’s the only thing that gives appetite suppression with appetite satiety. The other procedures don’t really have that.”
Not everyone is convinced, however, by these tales of safety, satiety and triumph over obesity. Over at the National Association to Advance Fat Acceptance, the organization’s spokeswoman, Peggy Howell, took issue with the very idea of the “invasive mutilating of healthy organ and tissue” surgeries that doctors have begun selling to generously proportioned patients. “We subscribe to the healthy-at-every-size philosophy,” she said.
And within the medical world, while many doctors argue for a role for surgery—as a treatment for diabetes, if nothing else—they disagree on the best way to go about it.
“Contrary to the gastric bypass, [Lap-Band surgery] does not have a significant effect on your appetite,” said Dr. Neil Hutcher, president of the American Society for Bariatric Surgery. “All it does is limit your ability at any one time to eat.”
Added Dr. Michel Gagner, chief of laparoscopic and bariatric surgery at Weill Cornell Medical Center, “The concern was that we [saw] the erosion of the band inside the stomach, and it was only a few cases, and now we’re seeing them in a greater percentage…. I think the doctors’ reputation is high, but it’s a bit dangerous to be identified with one procedure.”
To all these criticisms, the love-doctors responded with their own statistics, studies and patient-based evidence. They cited the “20-fold risk differential” between banding and bypass surgery. They referenced data showing that, over time, weight loss is the same for gastric bypass and banding. And, of course, there is Dr. Fielding’s own feel-good story.
From the time he was a tyke growing up in Brisbane, Australia, Dr. Fielding was what they called a big boy. He saw his first fat doctor when he was still in grade school, flubbed his first diet shortly thereafter, and still recalls those cruel schoolyard days when he was called “every name for ‘fat’ you could ever think of.”
“If you’re fat, you’ve just got to do everything better,” he said during one early conversation with The Observer. “It doesn’t matter whether you’re some fat kid from the Bronx or you’re Harvey Weinstein—you’re still a fat kid.”
Nor did adulthood dull his appetite. He tried high-carb diets, low-carb diets, Pritikin and starvation. He chomped Zoloft, Adifax, Phentermine, Optifast. And still he got to the point where he could no longer cross his legs. By the time he was 41, he was taking 11 medications for everything from asthma and blood pressure to reflux, depression, cholesterol and atrial fibrulation. “In simple terms, being fat really sucks,” he said. “The other thing you don’t understand is the sheer horror of constant hunger.”
And then—yes, here it comes—he asked a fellow surgeon to perform the same Lap-Band surgery on him that he had been performing on patients for several years. First 60 pounds disappeared; then, as time went on, another 60 “dripped off.” One by one, he said goodbye to his medications. And—huzzah!—he met Dr. Ren, though he denies that his weight loss had anything to do with it.
“Man, I have always thought women would be interested in me!” he said with a burst of laughter that seemed to come right from Down Under.
In February 2005, Dr. Fielding left his country—and his four kids—to join Dr. Ren in New York. So far, they insist, neither is competitive and neither is bored. Business is “booming”—“not to put too fine a point on it,” said Dr. Fielding—and the F.D.A. recently approved them to do Lap-Bands on ample-bodied teens. One poor boy weighed in at 550 pounds and was already showing signs of high cholesterol, high blood pressure and depression.
And still, those surgery-birds somehow find time for romance. They go traveling and fly-fishing, fine-dining and wine-collecting. They have even started talking marriage, though they won’t get specific for the press beyond saying “sooner rather than later.”
But even so, work has a way of creeping in. On the day they spoke to The Observer, they were eagerly looking forward to spending the weekend at the Kentucky Derby, that annual American rite of fast horses and faster bets. (Dr. Ren is a part owner of two racehorses, including the daughter of the 1998 Belmont Stakes winner, Victory Gallup.) It was supposed to be a fun weekend away from the operating room, but previous vacations had taught them that it wasn’t always so easy to escape their work.
“I have never seen so many obese people in my life. It’s just God’s truth. Middle America is just a vision of what’s going to happen to the rest of this country,” said Dr. Fielding. “I should take a stack of business cards.”