The Summer The Rabbi Got Thin

Rabbi Nat Ezray is no longer waiting for the other shoe to drop. Neither are his wife and children, his colleagues, nor his congregation, now that he has undergone life-changing bariatric surgery to help him lose weight and restore his health following several cardiac events.

Having learned the hard way the importance of mindful eating and a healthy, balanced lifestyle, he has made these not only a personal priority, but also a top agenda item at his synagogue.

Rabbi Ezray, the 50-year-old longtime rabbi of Congregation Beth Jacob, a Conservative synagogue in Redwood City, Calif., had been struggling with weight issues since childhood, and in particular since entering rabbinical school in the late 1980s. Despite repeated efforts at dieting and a variety of exercise programs, his weight climbed to a high of 280 pounds by the summer of 2002. In August of that year, Rabbi Ezray suffered a mild heart attack while swimming with his young son. Angioplasty was performed, and two stents were inserted. But only a few months later, two more of his arteries were found to be occluded. Following another cardiac episode the week of his stepdaughter’s bat mitzvah in January 2003, the 5-foot-6 ½- inch rabbi knew it was time to overcome his reluctance and heed his cardiologist’s advice to have gastric bypass surgery.

“I realized that my being afraid of the surgery was based on inappropriate research and misinformation,” Rabbi Ezray said. After talking to Dr. John Morton, an associate professor and the director of bariatric surgery at Stanford University Medial Center, the rabbi was reassured that the laparoscopic procedure would not be as dangerous as he had feared. In fact, Morton has personally performed the surgery more than 1,800 times with no mortality.

“The surgery is not for everyone,” remarked Morton. “But in the right circumstances and in the right hands, it’s a life saver. And we don’t consider it a last resort anymore, but rather a worthwhile intervention.” Individuals can be candidates for the surgery if they have a body-mass index (BMI) of 40 or higher, or a BMI of 35 and obesity-related conditions such as Type 2 diabetes, heart disease and sleep apnea — all of which Rabbi Ezray had. However, a patient must also be assessed for motivation levels in terms of commitment to ongoing psychological counseling, modified eating and regular exercise regimens.

“We take the educational component of this very seriously,” explained Morton. “All surgery is, is a tool. It forces you to follow the rules.” And following the rules following surgery is crucial to keeping the weight off and feeling well, and to “extending the quantity and quality of a person’s life,” as Morton put it. The doctor considers bariatric surgery to have failed (something that he reports has not yet happened in his practice) if a patient does not lose at least one-third of his or her pre-surgery weight.

After Rabbi Ezray underwent Roux-en-Y gastric bypass surgery (RGB) in July 2007, his weight gradually dropped by approximately 80 pounds, and his diabetes and high blood pressure disappeared immediately. (He still takes a low dose of cholesterol medication.)

During the minimally invasive procedure, Morton stapled Ezray’s stomach to create a small pouch that holds less food, and then shaped a portion of his small intestine into a “Y,” connecting it to the stomach pouch so that food being digested would travel directly into the lower part of the small intestine, bypassing the first part of the small intestine (the duodenum) and the first part of the second section of the small intestine (the jejunum). Ezray’s weight loss was a result of both the newly limited size of his stomach and the restriction of the amount of calories and nutrients that are absorbed into his body because of the bypass.

“He looks marvelous, says he feel marvelous, he has completely changed his lifestyle,” remarked Beth Jacob’s president, Greg Sterling. “Our community is thrilled that he is healthy and feels great.

“On a more serious side, not only is he a role model in our community for transforming one’s personal health, he makes personal health an important part of his teaching every year. He gives multiple sermons each year on personal health including openly talking about his story, and he supports and encourages synagogue-wide programs such as yoga, exercise and biking. In addition, he encourages our board of directors to include personal health in our strategy as we consider future programs for the community.”

Rabbi Ezray has served as a support and role model for several congregation members who have also undergone bariatric surgery. As a rabbi and spiritual leader, he is very deliberate about integrating Jewish values of shmirat haguf (taking care of one’s body and physical health) into his new mindful eating habits, and he has encouraged others to do the same. Rabbi Ezray has asked that the food served at kiddushes be both healthy and (when available) have Magen Tzedek certification for ethical kashrut. The religious school did away with packaged, processed foods and now serves things like whole-wheat bagels and apple bread freshly made in the synagogue’s kitchen.

“Health is a mitzvah that we have to safeguard, and eating needs to be seen as a holy act,” the rabbi exclaimed. He was surprised to find out how anxious many in his congregation used to be about his health, and he is grateful for how they have been so supportive of the changes he is trying to make.

Rabbi Ezray said he feels that the most important message he can give his congregants in relation to health and weight, is that “it’s about teshuvah. When we have habits that are not working, we can have new beginnings.” He tries to encourage people to let go of their crippling shame about food, eating and unsuccessful dieting, as he has learned to do. Indeed, Morton pointed out that for individuals with a BMI of greater than 30, non-surgical weight-loss methods will fail over 95 percent of the time due purely to biochemical reasons.

“I had internalized that I was going to die young,” reflected Rabbi Ezray. But now he doesn’t spend his time thinking like that. Instead, he makes sure he spends it exercising at least an hour a day and looking forward to being “an old man enjoying my grandkids.”