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Minnesotans of the Year

One is a surgeon, the other a publisher. For five decades, Henry and Emilie Buchwald have transformed lives—one patient, one book, at a time.

Minnesotans of the Year
Photo by Joe Treleven

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On the University of Minnesota campus in Minneapolis, two names are emblazoned on different monuments about a hundred yards apart: Emilie Buchwald and Henry Buchwald. Married 52 years, they have given life to four daughters, thousands of patients, and more than a million books. Both have been publicly hailed as geniuses. And though thousands of students pass those monuments every day, most have no idea that because of Henry they might live longer and because of Emilie they have something more ennobling to read than the self-help hit He’s Just Not That Into You.

Henry is a surgeon, a professor, and a researcher at the University of Minnesota. He has been at the U since 1960, when he was discharged from Air Force duty as a flight surgeon. For his early work on surgical control of cholesterol, he was honored in 1991 on the floor of the U.S. Senate. For his current work in bariatric, or obesity, surgery—once pejoratively known as stomach stapling—the 74-year-old is internationally recognized as a leader, an advocate both for surgery’s use in battling the weight-gain epidemic and for obesity’s classification as a disease like any other.

Emilie is the founding editor of Milkweed Editions, a nonprofit press in Minneapolis that has long been recognized as one of the country’s leading literary publishers—an achievement that earned her the McKnight Foundation’s Distinguished Artist Award in 2002. Emilie left Milkweed three years ago when she thought Henry was going to retire. But Henry didn’t retire, so at age 71, she has begun a new venture: the Gryphon Press, which just a few months ago published the first two books in what she hopes will be a new niche in children’s literature—picture books that advocate a humane relationship with animals instead of dressing up the critters in ruffled frocks.

From most angles, surgery and publishing appear as disparate as, well, obesity and animals. But Emilie’s mission—to transform people through literature—is not so far from Henry’s. What could be more life-changing, after all, than shedding hundreds of pounds? Or more humane than adding years to a life? The Buchwalds have different means, but a similar end—leaving a better world than the one they were born into. And now, at the culmination of their careers, they are confronting two issues currently confounding the country.

ON A WEDNESDAY MORNING at the U of M Medical School, several dozen people are assembled in the surgical conference room. Nearly all of them are female and white. Several require wheelchairs. Sporting a preponderance of sweatpants, most do not look so different from the hospital workers outside the room or the pedestrians on the street. And they aren’t—according to the Centers for Disease Control and Prevention, two out of three American adults are just like them: overweight or obese.

Photo by Joe Treleven

This is an information session for people considering bariatric surgery, a variety of procedures that result in stomach reduction and, it is hoped, the eventual loss of a tremendous amount of weight. Henry and his colleagues hold these sessions at the U several times each month, drawing more and more attendees. The surgery’s popularity has ballooned more than 400 percent in this country during the last decade, with 12,775 procedures performed in 1998 and 600,000 surgeries estimated for 2011.

An extremely tan woman with tall boots and long, blonde hair—an employee of the U’s health center—opens the session with a discussion of post-surgery nutrition. She had the operation herself recently and shrank from a size 22 to 2. Someone asks whether she was worried about reaction to her choice to have the procedure. “You mean from the ‘normal’ population?” she responds. “I was super-paranoid.” The people in this room belong to a community of sorts, with its own lingo and a you’re-among-friends candor. The health worker, for instance, fields some casual criticism that not enough of the chairs in the room are “obesity-friendly”—that is, chairs with extra support and without armrests. “I was so waiting for someone to fall through the chairs,” she jokes.

Henry sweeps in, with a doctor’s hurried pace and distinguished air that belies the fact that he’s easily the smallest person in the room. Henry stands about 5-foot-5, with a bit of a hunch now, but his bedside manner is commanding, if compassionate. “He is a straight shooter,” wrote a past patient on a website where the formerly obese discuss bariatric surgeons. “I told him I was leaning toward the DS [duodenal-switch] procedure, and Dr. Buchwald’s response was, ‘Son, there is no leaning toward; it’s not like we can change our mind once we open you up.’ ” Another gushed, “He is a sweetie!” Speaking to the prospective patients, Henry is mostly blunt: “You have a disease,” he tells the group. “You overeat. You are hyper-metabolizers—you take in calories and convert them to fat. It’s the way you were born, just like hair color.”

Henry explains the differences between the three procedures he performs—gastric bypass (by far the most popular, in which the stomach is stapled to divide and shrink it), vertical banding (stomach stapling with the addition of a rubber ring to slow the flow of food into the stomach, holding it up long enough to make a person feel full), and the duodenal switch (in which part of the stomach is actually removed). While he has the body cavity open, Buchwald says, he’ll also take out the gall bladder if it has gallstones in it, and fix any hernias. “And if the ladies want their tubes tied, I can do that, too,” he quips.

Of course, there are risks. “You can die,” Buchwald tells his audience. Bariatric surgery has a mortality rate of less than half a percent—far better than cancer treatment, though still one in 200. About 80 percent of patients have excellent results. Some need a second surgery, and others “out-eat” the operation, continuing to pack in too many calories to benefit from the treatment.

To many, obesity surgery seems extreme. Even Henry, who has performed thousands of the procedures, equates it to attacking the problem with a hammer. “It’s a stupid way to treat this disease,” he says, “but it works.” He’ll argue, in fact, that it’s the only tool his profession has at the moment to help the morbidly obese, those for whom diets, drugs, and exercise work poorly if at all. He’s also quick to note that despite the surgery’s current boom, only 2 percent of those eligible for the surgery are having it done. “People say [the surgery] is out of hand, that we’re doing too much of it,” he says. “But would the American public tolerate treating just 2 percent of people with AIDS or cancer or diabetes?”

During the information session, Henry ticks off some of the problems associated with obesity: sleep apnea (in which people repeatedly stop breathing during sleep), diabetes, arthritis, gallstones, and many forms of cancer, including those of the breast, ovary, prostate, liver, and colon. “The sum total is that if you’re a woman you give up nine years of living, 12 for men,” he says. And then he lists obesity’s other evils: “Obesity isn’t fun. There is a social, marital, sexual prejudice.” The obese have more trouble finding work than other people, he says. “[Employers] think you’re unsightly. And you’re expensive—they don’t think you can do the same day’s work.” After obesity surgery, these associated problems often disappear along with the weight.

Around the room, there are plenty of nodding heads. For these people, obesity isn’t just a disease, it’s a stigma. And worse: “It’s the last socially permissible prejudice in America,” Henry says.

HENRY AND EMILIE experienced discrimination as soon as they were born to Jewish families in Vienna—Henry in 1932, Emilie in 1935. As children, they were running for their lives, fleeing the atrocities that would culminate in the Holocaust.

Photo by Joe Treleven

Henry arrived in the United States with his mother in 1938. His father was forced to wait, trapped by the U.S. quota system, which favored the emigrants of certain nations over others. In 1939, after several hazardous escapes from the Nazis, Henry’s father finally joined his family in New York City—at the same time Emilie and her parents arrived. In fact, they arrived on the same boat.

The families met years later, when they happened to rent vacation homes across the street from one another in the Catskills. Henry was then 17; Emilie not quite 14. Five years later, in 1954, they married. Over the next few years, Henry finished medical school at Columbia University, served in the Air Force, and accepted a residency at the University of Minnesota, which was then basking in the glow of having pioneered the world’s first open-heart surgery. Surgery did not have the negative connotation here that it did in New York. (“Smart ones go into medicine, dumb ones go into surgery—they’re technicians,” Henry recalls of the East Coast attitude then.) He also was enticed by the U’s policy of allowing residents to do research—a rare thing out East. Emilie, too, ended up at the U, teaching Shakespeare just as the English department was blossoming.

Life in Minnesota was an adjustment for a Jewish couple in a famously Lutheran land, though mostly a positive one. The day the Buchwalds arrived in Minneapolis, they accidentally drove into the Aquatennial parade, and a policeman pulled them over. Accustomed to brusque New York cops, they were pleasantly surprised when the officer simply asked if they wanted to park somewhere and enjoy the festivities. “We knew then that it would be very different living here,” Emilie recalls.

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