By Aubrey J. Kirby, The Star Press

Muncie, IN (AP) – Brian McDonnel was discouraged – and a little embarrassed – as he sat in a waiting room before his MRI.

It wasn’t because of what tore his meniscus. That happened when he got out of his truck one day and his knee felt like it snapped.

The dread was more from that which he thinks the injury developed. His knee had been through wear and tear. The Southside High School and Ball State graduate was 543 pounds at the time, carrying extra weight that added pressure to his joints. (He hasn’t determined it as a cause of the torn meniscus, but he believes it surely played a role.)

This was about as heavy as McDonnel had ever been. Not too far off from qualifying for TLC’s “My 600-lb Life,’’ he notes, inching closer to immobility. He blames his habits, his love for food and lack of daily exercise.

It’s not that McDonnel hadn’t been working to fix it. He knew how to lose a significant amount of weight. He had “seen this movie before,’’ as he puts it. Three times actually. And a consistent factor in all those stories is that he always gained it back. At 21 years old, he went from 340 to 200 pounds. Pushing 30 years old, he dropped nearly 300 pounds. Another seven years later, he dropped 200.

He had tried “7,000 to 8,000 diets,’’ some that would last for a week. Others that would last until his ride into work.

“I never made a true lifestyle change,’’ McDonnel said. “So I think that’s why I failed.’’

So there he was, in the waiting room of his MRI, back to where he started. And McDonnel panicked. What if I can’t fit in the MRI machine? Or worse, what if I break the MRI machine?

“Everybody would know it, and that weighed heavily on me to think about that stuff,’’ McDonnel said.

He decided this time would be the last he would ever get to this point. So, after the MRI he chose a weight-loss method that would hold him more accountable than he had ever been.

McDonnel wasn’t alone. According to stateofobesity.org, in 2016, 32.5 percent of adults in Indiana were considered obese, having a Body Mass Index (BMI) of more than 30. McDonnel’s BMI – a measure of body fat using height and weight – was more than 40, which made him a candidate for Roux-en-Y gastric bypass surgery. According to IU Health surgeon Dr. Ambar Banerjee, McDonnel had medical issues in the foreseeable future. Because he was getting to where he couldn’t be very active, surgery was a viable option.

Gastric bypass surgery shrinks the size of the upper part of the stomach to that of a small pouch, thus reducing food intake. That pouch is then attached to part of the small intestine, and the food bypasses the rest of the stomach.

“The small pouch allows the patient to eat little and feel full, so they’re not hungry all the time, and that leads to smaller portion sizes and weight loss,’’ Banerjee said. “The rerouting of the intestine leads to malabsorption as well. And that malabsorption, not absorbing all the nutrients, leads to further weight loss.’’

He added that hormonal changes within the abdominal cavity also lead to correction of metabolic problems like type 2 diabetes, high blood pressure and high cholesterol.

“Going under the knife’’ wasn’t in McDonnel’s original plan. A discussion with a colleague, along with his desire to get healthy for his nephews, convinced McDonnel that it would lead him to the lifestyle change he always needed. And it motivated him. Actually, his motivation is what Banerjee said made McDonnel stand out from other patients with whom he has worked.

In mid-October of 2016, McDonnel started IU Health’s bariatric program at 543 pounds. Prerequisite for surgery was that he needed to drop at least 50 pounds. In about seven months and some change, he lost 50 pounds, and a lot of change. A total of 212 pounds, to be exact.

At 331 pounds, he had the surgery at IU Health North in Carmel, in May of 2017.

McDonnel’s original goal when he first signed up for surgery was 215 pounds. Today, he sits at 168. He’s actually working to gain weight in the form of muscle.

There is a stigma associated with the surgery that helped get him here, McDonnel said. That he took the easy way out. He cheated.

He tells those who think that to look at his daily routine.

While many are halfway through a full night’s slumber, he wakes up to his alarm clock at 3:15 a.m. His feet are on the treadmill by 4 a.m. He is showered and off to work a little after 6:30 a.m. And he repeats that six times a week. He also maintains a strict diet of 2,600 calories a day.

“It’s not a magic bullet. It’s hard.’’ McDonnel said. “I lost a lot of weight before but that didn’t cost anything. It was my own grit and hard work. If I waste that, that’s on me. Good job, dummy.

“But you go in there and spend a lot of money, and get your guts rewired, you fail then, well now what do I do?’’

That accountability, he said, has solidified that lifestyle change. With his surgery also came a team of experts in other related fields who helped guide him through the weight loss journey: a psychologist, a dietitian, nurses. That support system will continue with ongoing follow-up appointments.

Now, is bariatric surgery for everyone? No, Banerjee said. To qualify for IU Health’s surgery Banerjee said candidates must have a BMI of 40 or above without any medical problems associated with the added weight, such as diabetes, or a BMI of at least 35 with medical problems.

Like any surgery, bariatric surgery holds risk. Banerjee said many of the candidates who qualify for the surgery are in poor health, and that already heightens risk of complications. He added that it boils down to this: “If the risks are higher than the benefits we can provide, then they are not going to get bariatric surgery.’’

Plus, as shown by McDonnel, maintaining the weight is a major commitment. Failure to follow could lead to internal problems such as stomach pain and heart palpitations. Basically, “you feel like you’re dying,’’ McDonnel said, if you go too far off track.

That’s why IU Health’s program has a multidisciplinary approach. It’s designed to prevent just that.

“If someone has started going off track and gaining some of the weight back, we can catch that sooner than later, and help to redirect them what was causing them to gain weight,’’ Banerjee said.

For many patients, like McDonnel, Banerjee said the reward can be worth it, that surgery transforms lives in a small amount of time, turning people into completely different individuals.

“They are doing stuff that they never thought they could do, as simple as playing with the kids and grandchildren, tying shoelaces, going outside,’’ Banerjee said. “Very simple things that we don’t normally pay lots of attention to but that makes a lot of difference.’’

Banerjee suggests those who might be intimidated, but are still interested, talk to a bariatric surgeon about the options.

Meanwhile, McDonnel sits in his office at IU Health Ball Memorial Hospital’s Maria Bingham Hall, two years and 375 pounds later. He points outside of the door.

“Just from here to the restroom. What’s that? Fifty steps? I would get winded from that,’’ he said.

McDonnel just turned 44 years old with what he calls a much better outlook on life. And he’s confident he won’t gain the weight back because, ironically, he’d have too much to lose if he did.

Since McDonnel had the surgery at IU Health North, IU Health BMH has expanded the services in its bariatric program. Mandy Puckett, manager of clinical nutrition and weight management systems at IU Health BMH, said the local program has been around since 2006 and in 2008 started gastric band procedures, which she said essentially is placing a band around the top portion of the stomach to help control the quantity of food. In January of this year, the program added gastric sleeve procedures, where 60-70 percent of the stomach is removed.

Image: Brian McDonnel had surgery, but it wasn’t a ‘magic bullet’