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TULSA
Raechel Arnold, 17, is standing in front of a full-length mirror at a department store here, trying on a pair of hip-huggers and a shirt with the word ''Victory'' splashed across the front.
It's a message that has special meaning for her.
Raechel has lost 117 pounds since July 23, when she had laparoscopic gastric bypass surgery, which creates a much smaller stomach and rearranges the small intestine.
At 5 feet 10, she weighed 323 pounds and was barely squeezing into a size 24 when she went in for the surgery. Today, five months later, she weighs 206 and is wearing a size 14.
Raechel, a high school junior from nearby Claremore, Okla., decided on the controversial operation because she was desperate. For years she had attempted to lose weight, trying a variety of diets, but nothing worked.
Instead, she kept gaining and she felt her health and her dreams for the future were going downhill.
Today she is happy with her slimmer body and feels much healthier. She insists she couldn't have lost the weight on her own. ''The temptations are just too strong at school, at home. There's just no way,'' she says. ''With the surgery, you just aren't hungry.''
USA TODAY followed Raechel through the operation, featuring her in a front-page story on Aug. 14, and has been monitoring her progress ever since.
The use of gastric bypass surgery on morbidly obese teens ---- those 120 pounds or more over a healthy weight ---- is hotly debated in the medical community.
More than 100,000 people will have weight-loss surgeries, mostly gastric bypasses, this year, according to the American Society for Bariatric Surgery. There are no official numbers on how many teens have had the surgery. A couple hundred have been reported in the medical literature, but far more have been done, surgeons say. Everyone agrees the number is on the rise.
Supporters say the operation can save the lives of those whose excess pounds threaten their health. Severely overweight adolescents are at a greater risk of developing heart disease, diabetes and other diseases, and they are at an increased risk of remaining obese as adults.
But critics say it is setting up teens for a lifetime of malnutrition and other medical problems. Patients are at risk for deficiencies in B vitamins and calcium, they say. No one knows the long-term side effects of the procedure on young people, and many patients may be disappointed if they don't keep the weight off, they say.
Plus, there is a risk of dying during the surgery, which has recently prompted at least two hospitals, one in Boston and one in Rhode Island, to re-evaluate doing them.
Several doctors were so concerned that the wrong teens might seek this major surgery that they developed guidelines for selecting patients. They said candidates should be extremely overweight, with other serious medical complications, and must meet other criteria before going under the knife.
Shopping for a new size
Over the past five months, Raechel lost weight rapidly and moved down through sizes quickly. To save money, she bought one pair of jeans in each size and then washed them every night.
Today's shopping trip is a special treat. Raechel came to Woodland Hills Mall with her mom, Brenda Arnold, and good friend Ashlie Inman, 16, to look for some new smaller-sized clothes.
Raechel and Ashlie are bouncing around the junior department of a JC Penney store. They are oohing and ahhing over clothes, trying on jackets and laughing over messages like ''So much attitude so little time'' that are plastered on the novelty shirts. Raechel picks up one of the tiny T-shirts and says: ''I'm afraid it'll make me look like a sausage roll.''
This is the first time in her life that Raechel has browsed in a junior department. She was always too heavy before and instead went to Lane Bryant or other stores that cater to larger sizes for older women.
Raechel tries on some junior-sized hip-huggers for the first time, and they seem to fit her pretty well, but she wants to lose a few more pounds so they will look even better. So she and Ashlie vow to walk more often at a recreation center. Her goal is to weigh 170 pounds.
As Brenda watches her daughter shop, she gets misty-eyed. ''She's having fun. She never does this.''
Considering the risks
Raechel has been heavy since she was a young child. She comes from a family that has battled weight for years. Both her mom and her father, Jeff, as well as other family members are obese.
Raechel attributes her steady weight gain to her uncontrollable hunger. ''My body was saying it was hungry all the time,'' she says.
Over the years, Raechel and her mom tried different diets, including Atkins, Slim-Fast and Weight Watchers, but while Brenda would drop pounds, Raechel's weight wouldn't budge.
As she got heavier, Raechel's extra pounds exacerbated a foot problem (very high arches that put pressure on the outside of her feet) caused by an inherited neurological disease, Charcot-Marie-Tooth. It made it hard for her to stand or walk for long periods of time. The weight also made it more difficult for her to be taken seriously and shine when she played softball, her favorite sport. Plus, it made her asthma worse.
So more than a year ago, Raechel and her mother began investigating gastric bypass surgery. They went to a bariatric surgeon in Tulsa, who then referred Raechel to Alan Wittgrove, medical director of the bariatric program at Alvarado Hospital Medical Center in San Diego. He has been operating on teens for 10 years and has found that they lose an average of 100 or more pounds the first year.
''Clearly, she has done very well,'' Wittgrove says of Raechel. Sometimes adolescents lose more weight after the surgery than adults do, possibly because teens haven't ''broken down their metabolic system with years and years of yo-yo dieting,'' he says.
He predicts that Raechel will lose another 30 to 45 pounds if she plays softball and becomes more active.
Still, the surgery was not without complications. After the operation, she ended up back in the hospital with pneumonia. It's a risk because patients often don't move enough or breathe deeply enough afterward, and Raechel's asthma added to her risk.
The cost of gastric bypass is about $25,000. Insurance coverage depends on the severity of the patient's obesity and varies by provider and state. But Raechel's surgery may end up costing much more because she met with two surgeons in different cities, and she had complications. The final numbers aren't in on what the insurance company will cover, but her family has paid about $3,400.
Side effects of surgery
Since the surgery, Raechel has dramatically changed the way she eats and has followed the advice of Wittgrove and his staff. She drinks lots of water, avoids snacking, takes supplements (a multivitamin, B12 and calcium) and eats protein first at meals so she'll feel full longer and preserve lean muscle mass during the rapid weight loss.
She eats two meals a day, about one cup to two cups of food each time. For breakfast, she has about half of a small sausage, egg and cheese biscuit. Dinner is often grilled chicken, steak, chili, a hamburger (without most of the bun) or whatever the rest of her family is eating. She sometimes has a few vegetables such as green beans.
She doesn't eat on the run but sits down and relaxes for meals. ''I can't eat while moving around. If I swallow too quickly, it will hurt really badly. There's too much going down in that small hole at one time.''
Raechel does get hungry. ''Everything looks good.'' But when she eats, she gets full more quickly than she used to. And she still has cravings for things like chicken fried steak. ''I eat a bite or two and then I'm over it.''
Raechel was never a big sweets eater, but she's definitely not as tempted now because of the possibility of experiencing a condition called ''dumping syndrome,'' basically an intolerance to sugar and other sweet foods and beverages. When gastric bypass patients eat sweets or sugar, they may develop nausea or vomiting, dizziness, abdominal cramping or diarrhea.
After Thanksgiving dinner, which included turkey and dressing, she felt a little tired and had some hot flashes. ''I definitely didn't overeat, but there were too many carbohydrates and fats in what I did eat.''
One time, when she drank too much orange juice, she ended up with hot flashes, feeling really tired and lying down on the couch. Since then, she's limited herself to about one-eighth of a cup of juice.
Before Raechel's surgery, Brenda thought she was doing a pretty good job when it came to her family's eating habits. She bought both healthy fare and junk foods. But now in hindsight she believes they were eating portions that were too large. ''Even when we were eating the right foods, the sizes were huge. That was just not necessary.''
Things have changed. ''Our portions are much different. They are smaller, like hers,'' says Brenda, who has lost 31 pounds herself since her daughter's surgery. ''We don't do second helpings.''
Plus, Brenda's not buying as many groceries as she used to and keeps only a few snack foods such as chips and cookies in the house.
The impact of change
The 117-pound weight loss has improved Raechel's mobility. Now she's able to jog several laps around the track at school, something she couldn't do a few months ago. She plans to play competitive softball this spring and go out for the high school team next fall.
Prior to the operation, Raechel dreamed of being a pitcher on a college softball team. Now, she has other aspirations. She has decided that she wants to focus more on studying when she's in college and possibly pursuing a degree in medicine or law.
Says Brenda, ''Her possibilities have opened up so much. Her world is so different.''
Raechel is getting compliments from other kids. Some girls tell her they are jealous that she has lost so much weight.
One guy came up to her at school and said, ''You look stunning. Wow! You don't even look like the same person.''
The weight loss has changed Raechel's outlook on life.
''She didn't have much hope ahead of her before, and now she does,'' Brenda says.
''I love seeing her smile, seeing her laughing every day about something. She wasn't happy with herself before, and she is now.''
Adds Raechel: ''I know that I'm looking better and feeling better. I'm more outgoing.
''It's great knowing that when I get up tomorrow, I'll be even more different. I'm always changing.''
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