Richard E Getting Off the Weight Cycle

“I would probably be dieting all the way into my 60s and be truly miserable as health condition after health condition started to mount. Now I take nothing but a single allergy pill each day, and I couldn’t be happier.”

Richard Episcopo is the first to admit that he was never a skinny person. He struggled with his weight all through his school years and well into adulthood. At his 1991 wedding when he was 24, he weighed 217 pounds. By the time he was 52, he weighed 354 pounds.

While his weight never caused him to be bedridden or prevented him from being an active father to his two children, Richie and Gina, it was starting to affect his life in alarming ways. “I’d be falling asleep at work at 2 p.m. or while I was driving,” he says. “I was always sore or hurting, and sleep apnea kept me from getting more than three hours of shut-eye a night.”

He had tried a variety of diets and programs, but each attempt became part of a vicious cycle that led to even more weight gain. “I would lose 10, gain 15; lose 20, gain 30; lose 40, gain 50,” he says. “You get pretty disgusted with that over time.” When he wasn’t diet-cycling, he was consuming far more food than his body could handle.

A tragedy on a cold, wet afternoon in summer 2020 convinced Richard that he needed to take more decisive action. He was heading outside to walk the Yorkie-mix puppy that he and his family had just adopted from a local breeder. As he descended the steps, the dog ran in front of him and tangled his legs with the leash. Richard fell on top of the puppy, and his weight killed the animal instantly.

“That was the day I knew: God had sent me that dog to save my life, and I had to wake up and make a change now,” he says. That day, Richard phoned a friend who works in disease management at Robert Wood Johnson University Hospital (RWJUH) Hamilton and asked her to recommend a surgeon he could consult about weight loss surgery.

A Minimally Invasive Solution

Ragui Sadek, MD, FACS
Ragui Sadek, MD, FACS

The friend connected Richard with bariatric surgeon Ragui Sadek, MD, FACS, Director, Metabolic and Bariatric Surgery at RWJUH Hamilton and Clinical Assistant Professor of Surgery at Rutgers Robert Wood Johnson Medical School. During his consultation with Richard, Dr. Sadek recommended a type of bariatric surgery known as laparoscopic sleeve gastrectomy.

This surgery reduces the size of the stomach so that patients eat smaller meals and decrease calorie consumption. In addition to paring down food volume, the procedure can lower risks from obesity-related metabolic conditions. “Richard had morbid obesity and a slew of medical problems, including high blood pressure and high cholesterol, and he was at risk for diabetes and heart disease,” Dr. Sadek says.

During the minimally invasive procedure, surgeons access the stomach through several small incisions and use a camera and various instruments to reshape the stomach and remove tissue containing cells that secrete a hungerstimulating hormone. Typically, the operation takes 45 minutes to an hour, and patients leave the hospital in less than 24 hours. Following surgery, about three-quarters of patients maintain their weight loss and keep it off for five years or more, Dr. Sadek says.

Proper preparation for surgery is a crucial element of long-term success. Richard followed a specific diet two weeks prior to the procedure that significantly reduced his calorie intake as well as certain foods like sweets and carbohydrates. “It was pretty much lean protein and vegetables,” Richard says. “About two days before the surgery, I had to switch to an entirely liquid diet.” Though he admits to a few slips along the way, “I was totally committed,” he says.

A Weight Lifted

The surgery went better than Richard dreamed. “I got there at 6 a.m., went into surgery at 7:30, was out, up and dressed by 9:30 and was walking around the hospital taking business calls by that afternoon,” he says. He was discharged the next morning and went back to work that day.

Richard has dropped 142 pounds and feels more alive than ever before. “My energy level is through the roof, my everyday activities are unbelievable, I’m totally alert the entire day and I’m sleeping six to seven hours uninterrupted each night,” he says. “While in my mind, part of me still thinks, ‘fat,’ I eat significantly smaller portions.”

The biggest difference he sees is his ability to not overindulge. “If I’m craving a cheesecake, I will eat three bites,” he says. “Portions are more like normal portions.”

Richard can’t imagine what his life would have been like had he not gone ahead with surgery. “I would probably be dieting all the way into my 60s and be truly miserable as health condition after health condition started to mount,” he says. “Now I take nothing but a single allergy pill each day, and I couldn’t be happier.”

Learn more about weight loss surgery at RWJUH Hamilton.