Over the course of his entire life, Matthew Castillo has lost 3,000 pounds. At one point, he lost 165 pounds, then gained it back, lost 100, gained it back, and then lost another 80. “Every year, I’d do good, and then I go back up (in weight),” Castillo tells TODAY.com. It was a lifelong cycle he couldn’t escape.
The reason? His feelings toward food, he says. “I get so excited when it was, like, feeding time. … It’s just something that was innate in me.” Food, he adds, calmed him, and when he wasn’t eating, anxiety and negative feelings ate at him instead.
His routine included eating fast, late at night and ending nights out with a 4 a.m. meal at a diner. His only inclination to put the fork down came when he felt physical discomfort. “I never stopped eating when it was enough. I always felt like I needed that full feeling.”
Castillo wanted to change, but his methods weren’t working, he realized. His attachment to food was too strong for him to overcome on his own. He was at a standstill until a co-worker presented him with an idea.
A New Option
While Castillo’s weight regularly fluctuated, his lifestyle was always active. “In 10th grade, I was 250 pounds,” Castillo recalls. “But strong, going to the gym and stuff like that.”
He kept up movement throughout his adult life, playing football, basketball, softball and handball, but when he reached 598 pounds, he felt himself slowing down. “When you start breathing heavy and, you know, you can’t run,” Castillo struggled with resolving the issue.
A friend from work came through with a solution for the then-48-year-old. “I always knew about the surgery,” says Castillo, but this friend gave him the referral that he used to connect with a bariatric surgeon who could perform a single anastomosis duodenal ileostomy — SADI for short.
“So I actually went to a couple of doctors, and they told me that I’d have to lose 200 or 250 pounds before they would even do the surgery on me, which, at that point, why would I need the surgery if I could lose 200 or 250 pounds on my own? So I was getting a little discouraged,” Castillo recalls. “And then I got referred to Dr. Buchin.” And Dr. David Buchin was different.
Buchin still required Castillo to lose weight because he was nearly 600 pounds, and “operating at that BMI, it can be dangerous,” Buchin, director of bariatric surgery at Huntington Hospital, tells TODAY.com. But he didn’t ask Castillo to lose as much as the other doctors. So, Castillo followed a liquid diet for six weeks before surgery and lost 100 pounds.
“A liquid diet helps him to drop more weight, but also shrinks the size of the liver, (making it) a lot easier for us to operate on you,” says Buchin. The liver rests on top of the stomach, so during surgery, Buchin had to retract the liver to operate on the stomach. Castillo’s reducing the size of his liver, sometimes enlarged with fat in those with obesity, gave the surgeon more visibility.
Castillo’s SADI in September 2024 began like they all do, with a gastrectomy, the partial removal of the stomach. Next came the bypass, when Buchin connected Castillo’s now smaller stomach to the last section of Castillo’s small intestine, bypassing a large portion of it. “That allows your intestine to absorb more nutrients,” according to the Cleveland Clinic.
The procedure went well. Castillo spent just two days in the hospital and didn’t feel much pain.
Lifestyle Changes
After two weeks on another liquid diet, and a soft-food diet after that so as not to perforate or stretch his smaller stomach, Castillo has resumed eating foods he loves, just much less of them.
His focus, he says, is protein. It’s Buchin’s, too. The surgeon recommends Castillo aim to eat between 80 and 100 grams of protein daily with a mix of complex carbs, vegetables and fruit. Castillo struggles to hit this protein goal at times, sometimes feeling nauseated after a certain amount of food, but he’s getting the hang of it, sticking to certain foods. These include eggs and cheese in the morning, tuna salad for lunch, and turkey or chicken for dinner. Snacks are usually a rotation of cucumbers, grapes and bananas.
Now, at 273 pounds, Castillo is making progress toward his goal weight of 200 to 220 pounds.
Where he once struggled to climb the stairs in his home and required frequent breaks when he cleaned, he’s now easily fixing up his yard and going to the gym three to four times per week. “I’m just much more active,” he says. The ulcers Castillo developed on his legs due to his prior weight are much improved, too.
But the surgery wasn’t a magic fix, says Castillo. It’s improved his quality of life and given him the weight loss he’s always wanted, but he hopes to continue to better his eating habits and says his legs “still have some issues that I’m dealing with, but hopefully all that stuff gets better.”