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Cindy McMurphy, 50, of Gold Hill hopes that stomach-reduction surgery will help her solve a lifelong weight problem.

Cindy McMurphy has struggled with her weight for as long as she can remember.

"I don't want to be like this. I hate it," the Gold Hill woman said, as she talked about her lifelong struggle with obesity. She's taken diet pills and starved herself. Once she lost 350 pounds; another time, she trimmed 420 pounds off her 5-foot, 7-inch frame.

The weight always came back. Once she got down to 250 pounds, only to balloon back to 600 pounds within two years. Doctors told her that stomach-reduction surgery was probably the only way to permanently eliminate her excess weight and the health problems (such as kidney disease, sleep apnea and arthritis) that occur when the body carries two or three times its normal weight.

McMurphy couldn't afford the surgery, which costs about $30,000 locally, and health insurance rarely covers it.

"They say it's cosmetic," she said.

McMurphy, 50, didn't let her weight keep her from doing what she thought was important.

She worked for 16 years at CERVS, a community service agency.

She collected surplus salmon from fish hatcheries and organized gleaning programs to help hungry families. Oregon Action, a social justice group, once gave her its annual community organizing award for her work on behalf of needy people.

"She's been completely dedicated to working for justice for people and the community," said Rich Rohde, director of Oregon Action.

Last winter, when McMurphy weighed about 500 pounds, she thought she finally had found an answer. In February Medicare announced it would cover stomach-reduction surgery. McMurphy qualified for Medicare after a fall left her disabled four years ago.

She was about to go on the waiting list for surgery at Oregon Health & Science University when Medicare announced that hospitals would have to be certified as a "center of excellence" by a professional accrediting organization before Medicare would pay for a stomach reduction, known as bariatric surgery.

McMurphy's plans had to go on hold while OHSU filed the documents for certification. Approval could come this summer, after a team from the American College of Surgeons visits OHSU, but McMurphy's health is deteriorating while she waits. She was recently hospitalized after an outbreak of cellulitis, a painful skin infection that often afflicts extremely overweight people.

"I'm afraid I could die before I get this surgery," she said.

People as big as McMurphy are different from the vast numbers of Americans who are 10 or 20 or 30 pounds overweight. For her and others who are "morbidly obese" (their weight exceeds their medically recommended weight by at least 100 pounds), physiological changes make the weight almost impossible to lose by ordinary means such as diet and exercise.

"They get to a size where it's almost like going off a cliff," said Dr. Mark Eaton, who does stomach reduction surgery at Southern Oregon Bariatric Center. "No diet or exercise program is going to get them back."

Losing large amounts of weight can be extremely difficult because the body has remarkably sophisticated mechanisms to retain fat. Holding on to extra calories was an evolutionary advantage for most of human history, said Dr. Robert O'Rourke, a bariatric surgeon at OHSU. Food was generally scarce and eating a large quantity of anything was a rare event. People who accumulated a little extra fat survived lean times better than their skinny cousins.

"Our genes have evolved to make every calorie count," he said. "Humans are to some extent hardwired to get fat. Fifty thousand years ago that was an advantage."

Roger Cone, director of the Center for the Study of Weight Regulation and Associated Disorders at OHSU, led research that discovered a mechanism in the brain that regulates weight just like a thermostat regulates the temperature in a house. Researches dubbed this mechanism an "adipostat" (for adipose — fat — and thermostat).

Cone said when the body loses weight, the brain thinks something is wrong and responds by decreasing its metabolic rate and increasing muscular efficiency to limit energy loss.

Unfortunately, the adipostat only works one way ­-- up.

"It can be ratcheted up," he said, as the brain gets acclimated to extra weight, but "there's no known way to set it down, short of bariatric surgery.

"Bariatric surgery re-sets the adipostat down," he said. "Nobody knows why yet."

Cone said most people's metabolic rate adjusts automatically to burn up nearly all the extra calories they consume, which allows most of us to gain only modest amounts of weight over time. "But if you're exposed to an environment where you have unlimited access to vast amounts of tasty calories and don't move, it's very easy to gain weight."

In essence, that's what has happened to millions of people over the past 20 years in many parts of the developed world, where food has become abundant and physical exercise is no longer necessary. The American Obesity Association estimated that 127 million adults in the U.S. are overweight, 60 million obese, and 9 million morbidly obese.

Weight gain isn't always a direct function of food intake, however, said Dr. Bart Duell, an endocrinologist at OHSU. He cited studies that were conducted on prisoners who were paid on the basis of how much weight they gained.

"Some gained 50 or 60 pounds," he said. "Others ate all they could and their weight only went up five or 10 pounds."

Duell and other researchers now believe that most morbidly obese people have a hormonal disorder or genetic mutations that allow them to gain weight easily and impede their efforts to lose it.

Cone already has identified a gene mutation that accounts for about 5 percent of all severe obesity cases. "The other 95 percent have genetic predispositions we haven't discovered yet," he said.

While bariatric surgery is expensive, treating the other health problems ("co-morbidities") that are associated with morbid obesity isn't cheap. Eaton, the Medford surgeon, said the "payoff" for surgery can be as soon as three years.

McMurphy is waiting to hear from OHSU for a surgery date.

"I have tried to fight this disease with every part of my being," she said. "Right now the only thing I know (that will help) is the surgery."