Estimated read time: 5-6 minutes
"What is that noise?" people asked Johnny Kelsey when he walked by. The grinding they heard was the decayed ball of his hip bone popping in its socket with his every step. "You need to go to the doctor," they told the 44-year-old truck driver, who weighed 418 pounds.
Kelsey knew what was wrong. It was a condition he'd had since he was four years old when doctors had diagnosed him with Perthes disease, where the head of the femur slowly erodes in the socket due to restricted blood flow. He wore a brace on his left leg and carried a sports waiver at school. "I tried sports as a kid," he recalls. "It caused me endless nights of pain."
His doctors told him to wait until adulthood for hip replacement surgery, and once he reached 21 they told him to hang on until the medical technology improved. He learned to live with the pain until "it became like a roommate." He got married, raised three children, and worked as a truck driver — driving the Utah to California I-15 corridor, a routine he describes as "living Groundhog Day five days a week."
At 44, his condition caught up with him. It wasn't only his hip's horrifying sound effects, but also a sharp, stabbing pain.
A University of Utah Health surgeon told him his hip was one of the worst he'd seen and that it was remarkable he could still walk. In order to do the surgery, Johnny needed to lose over 60 pounds. The doctor sent him to Juliana Simonetti, M.D., co-director of University of Utah Health's Comprehensive Weight Management Program.
Simonetti first encountered obesity working at a community care center in Boston during her residency. Every patient she saw had chronic diseases: pre-diabetes, high cholesterol, blood pressure and weight issues. Patients from lower socio-economic backgrounds were desperate to address their weight issues, spending much-needed money on over-the-counter diet pills that weren't FDA approved.
"Instead of addressing the root causes of weight gain, I felt we were band-aiding," Simonetti says.
Obesity, Simonetti says, has long been seen as a choice. "Just go home, diet and exercise," patients are told, but that won't solve it, she says. "Each patient has unique needs and circumstances."
Medication is key to addressing underlying physiological issues that make it so hard to lose weight, along with behavioral health approaches to addressing psychological issues related to obesity.
The key point is, "There's no magic pill," she says. "What we do is address the underlying issues, and suppress appetite and cravings." There's also bariatric surgery, which involves surgical procedures to reduce weight, such as the sleeve gastrectomy and gastric bypass. There are also temporary, minimally-invasive procedures such as the gastric balloon, where an inflatable silicone balloon is placed in the patient's stomach. It lasts for six months and makes the patient feel fuller.
The Comprehensive Weight Management Program, she says, seeks to bring innovative approaches to obesity medicine. These include helping patients at different stages of their weight loss journey through low-impact exercise classes, group medical visits, mindfulness-based stress-reduction courses, behavioral health referrals and helping patients find cheaper, healthier food options and cooking classes.
It is also one of the very few programs in the country that brings together different specialists to help patients lose weight while treating the complications related to obesity and excess weight. A fatty-liver gastroenterologist and a cardiologist with a background in heart failure address complications that arise for patients who've struggled with obesity long-term.
When Kelsey saw Simonetti, he said he'd tried diets all his life. She sent him to the program's nutritionist, who told him a key problem was when he ate. "I eat one big meal a day," Johnny says. "For me, that was a huge disaster." Instead, he needed to eat every three hours.
He started the day with a protein bar, a few hours later some steamed, vegetables, then three hours after that a protein shake, finishing with chicken and vegetables in the evening.
In the beginning, Simonetti had him focus on healthy eating, although she was also keen he incorporate exercise as soon as his hip pain permitted. While he held to the diet during the week, he'd allow himself to "stray" Sunday mornings: "I like an English muffin right out of the toaster with butter melting on it and a little jelly."
What helped was how encouraging his wife, children and family were, including his parents, his brother and his family. "Everyone around me was just being super-supportive."
At first, he dropped a pound or so a week, then two pounds, then three or four until he was losing 18 pounds a month. Simonetti was shocked. His level of weight loss, he says, was unheard of, unless it was someone who had undergone gastric-bypass surgery. "They were worried I was starving myself," but tests on his body's nutrients showed everything was fine. "It just clicked, I guess."
By the six-month mark, he was down 60 pounds and scheduled the hip surgery, which took place in January 2019. "After the surgery, I realized how badly I had been suffering. It was absolutely incredible the difference. My wife and kids had to remind me my hip was only five days old and settle down a bit."
By December 2019, he had lost a total of 132 pounds, bringing him down to 286 pounds. Losing weight is hard, he acknowledges, "but it can be done. I'm in the worst possible career field you can have to try to lose weight as a truck driver and I did it. You've got to want it."
Kelsey said Simonetti and her team, "offered me the tools and the ways to do it. Most of the time, you go to the doctor and say, 'Doctor, fix me.' But she gave me the tools to fix myself."