Though his quest for weight loss was partly esthetic (for "women to see me as a sex object"), Goldstein, 50, was also motivated by grave health concerns. He suffers from high blood pressure and irregular heartbeat. Eight years ago, when he burgeoned to 320 pounds, his breathing became so labored that "I had a tracheotomy, I had a tube in my neck to breathe."
So it was in sheer desperation that Goldstein checked into the Placentia-Linda Community Hospital near Anaheim, Calif. in January to undergo a revolutionary new weight-control technique. He had a gastric bubble implanted in his stomach by Dr. David Chapman, 36, one of 400 physicians in the U.S. trained to perform the procedure. The gastric bubble, approved by the Food and Drug Administration only last September, is a small plastic balloon that is inserted through the mouth and inflated near the top of the stomach; it makes the patient feel full and eat less.
Since last November, when Chapman first began implanting the bubble, public interest has been "explosive," he says; Goldstein, in fact, was Chapman's 66th patient. FDA eligibility requirements are strict: Gastric bubble candidates must be at least 20 percent overweight and unable to maintain weight loss by dieting and behavior modification. The cost is about $3,000, including dietary counseling. Subsequent implants at four-month intervals (the maximum time the FDA allows one to remain in place) cost about $1,200.
In the gastroenterology lab, Chapman threaded a fiber-optic endoscope down Goldstein's esophagus and into his stomach to assure himself that all was normal. After retracting the scope, he slid the bubble, packed in a clear plastic tube, down the throat. With that, the sedated Goldstein coughed and moaned. "That happens," says Chapman. "He won't even remember it later." Chapman then inflated the bubble and withdrew the inflation catheter. Reinserting the endoscope, he positioned the bubble. Twenty-five minutes after he started, Chapman announced, "That's it."
The rest will be up to the patient. "The bubble is only a device to help the patient stay on a good, medically supervised diet," says Chapman. "A lot depends on motivation."
The gastric bubble was developed over the last ten years by Dr. Mary Garren, now 37 and chief of gastroenterology at Union Hospital in Elkton, Md., and her husband, Dr. Lloyd Garren, 39, an instructor at Philadelphia's Jefferson Medical College. "There is in nature a prototype called the bezoar," Lloyd Garren explains, "a hard clump of either food or plant material that remains in the stomach." Cats, for example, have hair balls. "But bezoars also occur in humans when the stomach-emptying system goes awry, and the chief symptom is weight loss," he adds. "What we essentially did is create a medical bezoar."
The Garrens worked with bioengineers to develop an "elastomeric plastic" that would not be destroyed by gastric acids. Then they designed the bubble so that it would not pass through the stomach, be regurgitated or, if deflated, clog the gastrointestinal tract. (Normally the bubble is deflated and removed through the mouth every four months.) Before submitting the bubble for FDA approval, the Garrens ran a three-year test on 106 chronically obese patients. Previously, despite yearlong medically supervised diets and behavior modification programs, these patients averaged a six-pound weight gain. But when they tried the bubble, the average weight loss after 10 months was 76 pounds. Most have kept the weight off.
After six weeks, Al Goldstein has lost 25 pounds. It's harder than he expected to control his appetite, but, he says, "I am glad I did it because the bubble is a reminder, and I am losing weight. It's a beginning."
The 5'8", 275-pound Al Goldstein, self-professed "food addict" and publisher of Screw magazine, declares that he has tried "everything but stomach stapling" while dieting. "I even went to a lockup program in Naples, Fla.—it was $14,000 for six weeks," he says. "They wanted you to wear dunce caps and give up everything including newspapers. I stayed three days; it was humiliating."