New study on gastric bypass found higher mortality rate

A study of over 850 weight loss surgery patients, 98.5 percent of whom were gastric bypass patients, found that in those of BMI 50 and higher (which is the average size for bariatric surgery patients), 2 percent died within 30 days, another 3.6 percent died within 90 days of surgery and another 5 percent died within a year of surgery.

These patients were operated on in 1 of 12 veteran's hospitals. The mean age was 54 and 70 percent of the cohort were men.

The death rate was higher in those with a BMI of 50 and comorbidities like heart disease, sleep apnea etc.

Researchers Lie et al concluded:

"The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery... These findings also suggest that the risks of bariatric surgery in patients with significant comorbidities, such as congestive heart failure, complicated diabetes and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits in older male patients and those with superobesity (BMI eq or greater than 50)."

Now of course, we know that all providers of gastric bypass will be sure to show their prospective patients this study and discuss not having a gastric bypass if they are over 50 and BMI 50 or higher and/or have heart disease, complex diabetes etc, right?

SOURCE: Arch Surg. 2009;144:914-920

Obesity causes cancer - more "BIG FAT LIES"!

A radio show from the BBC recently featured a metastudy which concluded that obesity "causes" cancer. The researchers opined that 100,000 cases a year can be linked to obesity. According to the Washington Post:

This study, from scientists at the University of Manchester, analyzed 141 articles involving 282,137 cancer cases and 20 different types of malignancies to determine the cancer risk associated with a 5 kilogram-per-meter-squared increase in BMI, roughly the increase that would bump a person from middle-normal weight into overweight.

141 articles isn't that many of course, not withstanding that they can pick and choose which articles to include and also, probably did not have a real accurate measure of BMI from the studies anyway.

It should be noted that over 1.6 million new cases of cancer are diagnosed in the USA every year, so even if their figures were correct that would only be 6 percent of cancers (according to WEBMD.COM) which can be linked to obesity - 94 percent of which can NOT be linked to obesity. The researchers on the program admitted that lifestyle factors like sedentary lifestyle and poor food choices were a player and briefly mentioned "the link between tobacco and cancer" but did not give any figures.

WebMD states that these figures linking obesity and cancer, were "estimated" from existent data (what the junkfoodscience.blogspot.com calls a "data dredge" study.).

So how does excess fat "cause" cancer? The researchers didn't have an answer for that but opined that fat tissue, produces estrogen. What they didn't tell us is that fat tissue produces the type of estrogen our bodies can use but when we flood our bodies with synthetic pharmaceutical estrogen, this raises the risk of breast cancer FAR MORE than 6 percent.

For example the HERS study on 11,000 women, a double blind study found a 26 percent higher incidence of breast cancer in those in the cohort, on low dose birth control medications. 26 percent OBSERVED in a double blind study which was stopped midterm. Not a tiny 6 percent from "estimated" figures.

Synthetic estrogen was put on the FDA list of carcinogens in 2005.

Finally, it should also be noted that researcher, Dr. Glen Gaesser stated in his book, "BIG FAT LIES" (CA, 2002) that he found in his metastudy of all the obesity research in the previous 20 years, that obese people seemed to get cancer significantly LESS often than non obese people. 40 percent less cancer in the obese, than normal weight people, concluded Gaesser.

Dr Linda Bacon, respected scientist and author of "HEALTH AT EVERY SIZE", was also on the BBC program and started to directly refute the findings with cited studies. As soon as they found she could do this, she was rudely interrupted (twice!). Before they cut her off, she pointed out that for example in a group of 23 studies, only 4 had suggested a significant link between obesity and cancer so she asked how these researchers could conclude from a small percentage like that, that obesity "causes" cancer. They evaded her question, of course.

I wrote the BBC a comment accusing them of dishonesty in news reporting and challenged them to have Dr Bacon on again to tell the REALITY of what the studies on obesity and cancer REALLY show. Perhaps some of you might want to do same.

Until we demand more honesty out of the news services, we won't get it. Fat activist Marilyn Wann was on the same program. Here's the link:

BBC radio program on the so-called "obesity link" to cancer

answering rebuttal to gastric bypass post

The following is to answer a comment - this was in two parts and had a lot of quotes in it so would be hard to read and brings up some points which I have answered (and so has Junkfoodscience blog answered) in other blogs but should be answered again to clarify things :

Mikalra who wrote the comment states he/she has no interest in the bariatric industry but since he/she does not identify him/herself I have no way of verifying this. Mikalra (M:) writes:

A study of 10 year post op gastric bypass patients found that 34 percent of those who started with BMI 50 or over, had regained all or most of their weight.
The abstract is here: "The failure rate when all patients are followed for at least 10 years was 20.4% for morbidly obese patients and 34.9% for super obese patients" -- which means, of course, that ~80% of morbidly obese and ~65% of superobese patients were successful.

No that doesn't mean this at all. And they do not define "success". FYI, success with bariatric surgery means keeping off 50 percent of the originally lost weight which still leaves many patients severely or morbidly obese (this is 50 lbs kept off for most patients), but as the Swedish Obesity Study found at the 10 year post op point, patients only tended to keep off an average of 16 percent of the original bodyweight and were, in fact, still High BMI. SOURCE: New England Journal of Medicine: Volume 351:2683-2693 December 23, 2004 Number 26 Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery Lars Sjostrom, M.D., Ph.D et al


Secondly, the 35 percent was for BMI 50 which is the average BMI at which folks get a gastric bypass. Exactly why this study concerned the ASBS and they approved some revision procedures (which later turned out to be unsuccessful and temporary and painful i.e. the -through the mouth- stomaphyx and rose procedures)

Third, success is also staying healthy and estimates of acquired co-morbidities from gastric bypass have ranged from 20 percent in the 5 year duration Mayo Clinic study in 2003 to 40 percent in Dr Livingston's study of 800 of his own patients over a 10 year period post op, and can include epilepsy, reactive hyperglycemia and islet cell death, gastroparesis, osteoporosis and auto immune disorder.

As Dr Terry Simpson has stated:

***The RNY trades one disease for another: it trades obesity for malabsorption. By re-arranging your guts you sometimes have severe side effects, and can have long-term problems such as iron deficiency anemia, calcium deficiency leading to osteoporosis. (Dr Terry Simpson, MD, WLS surgeon)

The other study you quoted "long term mortality after gastric bypass" is not an accurate one for many reasons (epidemiological, not randomized etc) and also compared gastric bypass patients against fat people as obtained from driver's license weights only most fat people very much under state their weight on the drivers license so matching weights this way, one is going to be comparing the patients actual start weight with much HIGHER BMI people. Finally, if I remember correctly, the study mostly just followed for 7 years and did NOT take in consideration the 5-9 percent who die within a year of surgery (started following 1-2 years after surgery). I have written about this study in another blog - you may want to look that up.

And no we do NOT have "several" longevity studies on gastric bypass - we only have a couple which you have mostly managed to obtain and those are not real accurate.

Mikalra further wrote:

So yes, there were certainly some risks from gastric bypass, as with any medical procedure -- but overall, it's clear, the health benefits to these very obese patients outweighed the risk.

This is NOT clear at all and why many surgeons are advocating the lap band now which is a much less risky procedure which delivers the same weight loss retention benefits.

Mikalra further wrote:

Moreover, this study included people who had undergone surgery as much as 25 years ago, when the technique was much more experimental; it's reasonable to think that both the techniques, and any counseling or warning signs that need to be followed for optimal patient safety, will have improved by now.

The gastric bypass has not basically changed at all except now they are cutting the stomach into two pieces so it's much harder to reverse than the ones done 25 years ago were. Also 25 years ago, less of the stomach was bypassed which made it a bit safer than now. As Dr Ernsberger has pointed out:

"All of the operations, old and new, are based on an incorrect assumption: that the stomach is no more than a passive sac for receiving food. In fact, it is a critical digestive organ and cannot be cut away or bypassed without compromising the digestive process."

Paul Ernsberger, PhD, Department of Nutrition,
Case Western Reserve School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4906

Mikalra concluded:

I am personally very concerned about the obesity epidemic. I would like to see a lot more of this epidemic controlled through support for healthy lifestyles in children, but for patients who have already become obese, this is clearly an option that should be seriously considered, based on personal values and risk factor profile, as it provides very substantial health benefits for most very obese patients.

First of all, news flash, "controlling children's diet" doesn't work. No matter HOW you do it. We know that putting kids on a regular diet does nothing more than injure their metabolism, making them more likely to get fatter when adults. It also injures their self images. But even a less invasive approach such as a friend of mine used... not having things like candy, potato chips et al around, building exercise in their son's daily life and limiting high fat foods does not work. In the case I am thinking of, this individual who kept reasonably slim during his childhood years, as soon as he left home, starting eating all the foods his family never had around and has been clinically obese for the last 20 years or more (he's 40 now).

Secondly, if the gastric bypass introduces NEW comorbidities, what good is it? Are those comorbidities lesser than what they experienced as being fat? In the opinion of several patients I know, they felt healthier BEFORE their gastric bypass than now.

And if the suicide rate among gastric bypass patients is 58 percent greater than among fat people, we must question whether the after surgery quality of life is all that good.

You watch the ads. I see the other side. Countless people who write to me, alone and isolated in their homes, underweight, living in fear or many more, very overweight but also very ill. You cannot make a judgment however well meaning you are, about this surgery until you have seen the entire story.

One super sized friend of mine (over 500 lbs) who is in her 50's (and her slim husband is the one who has had heart problems by the way- not her) has told me that she has OUTLIVED 48 of her fat friends who had weight loss surgery.

Here is just one poem which expresses the pain that some long term patients feel, the pain which never gets to TV or the ads:

(reprinted with permission of the patient)

Sent: Wednesday, August 21, 2002 3:13 PM
Subject: if only...


> oh, sue, I just found your site re: RNY GBP
> if only...
> if only the tears would stop
> if only I knew then half of what i know now
> if only I knew how to turn back the clock
> if only I had not trusted so blindly
> if only I had my life and my love of life back
> if only doctors understood and respected the value of living vs. the lack of value in existing
> if only the effects of malnutrition and slowly starving to death were not so bizarre that people assume and treat me as if I were terrifyingly contagious
> if only I knew someone who could/would reverse, not merely modify, this hell in which I exist
> if only I could hide from that emaciated creature who peeks at me in such a terrified manner when I glance at her reflection
> if only I had not learned so much about medical "error" and the resulting retaliation from the medical world if you dare to whisper those words
> if only I didn't have to hide from the world out of shame and fear
> if only I didn't know so much about PTSD as I do now
> if only I could ever trust another medical care provider
> if only I didn't spend every moment wishing I could die or regretting I did not
> if only I knew how to protect others from the incompetent/unethical animal who did this to me
> if only
> if only
> if only

Fatter babies caused by estrogens in the air?

A recent Newsweek article opines that the chemicals in the air, namely the so called "phytoestrogens" may be causing today's babies to be more overweight than before.

They quote an impressive sounding statistic:

In 2006 scientists at the Harvard School of Public Health reported that the prevalence of obesity in infants under 6 months had risen 73 percent since 1980.

Pointing out that if more fast food and less exercise could explain the higher prevalence of adult obesity, it was more difficult to explain an increased incidence of obesity in a population (like babies) who don't attend movies, and don't eat fast food and were always "couch potatoes". Must be the chemicals in the air, concludes Newsweek...

I looked up the study - apparently the researcher, Matthew Gillman, MD, is also a pediatrician.

He never even mentioned chemicals in the air as a possible reason for fatter babies but rather concluded after studying "120,000 children younger than 6 years old at 14 Harvard Vanguard Medical Associates practices in eastern Massachusetts from 1980 through 2001" that solving the problem of increased baby weight might lie in:

"Avoiding smoking and excessive weight gain during pregnancy, preventing gestational diabetes, and promoting breastfeeding, all of which researchers have shown to be associated with reductions in childhood overweight."

(remember how a recent article blamed breastfeeding for _increased_ size in infants?)

While I understand that Newsweek must come up with eye catching stories almost on a daily basis which must be difficult, I think the public should realize that stories like this one are just that - eye catching - and not necessarily based on any good science.

One thing which struck me is the entire article is based on the "73 percent increase" in "infant obesity" however, is that really as impressive (or alarming) as it sounds? Probably not. For example, the study found that the incidence of overweight children had "jumped 59 percent" but then the actual numbers on overweight kids, were in 1980: 6.3 percent and in 2001: 10 percent. And this means that in 2001, 90 percent of the children were not overweight, even according to our inflated weight charts which have set the line for "overweight" to much less than it was in 1980.

Less than 3 percent more kids were found to be "overweight" in 2001, not exactly anywhere close to a significantly higher figure even with much more fast food and much less activity!

We should always be on the lookout for statistics which may sound alarming but in reality, are not.

Unfortunately I could not find the actual percentages of overweight babies but I suspect it's not that significantly higher either...

The Newsweek article goes on to cite a string of mouse and rat studies which seem to prove their "chemicals in the air = obesity" theory.

And all to the conclusion that we just might be innocent victims of weight gain, like the caged rats and mice (which also were very "under-exercised" and had a much greater exposure to food than their cousins in natural surroundings), and the fact that we burn 800 calories a day less than did our grandparents and that most of us are consuming high calorie fast foods several times a week, has nothing to do with our being somewhat larger than our grandparents. Nope, it's all the chemicals in the air!

(Forgetting of course, that the phyto-estrogens in the air have not particularly increased since the 1980's - on the contrary, with all the "green" hysteria, there are actually less pollutants like this in the air. I know, details, details... :)

While articles like this are entertaining reading (Americans love to be alarmed), we should not take them too seriously. All news media should carry a warning "for entertainment only - any resemblance to facts is purely coincidental"!

New Scientist Magazine and gastric bypass

In the Sept 2nd issue of the "New Scientist" Magazine, they have an article about gastric bypass.

The article presents the surgery in a very positive light, mentioning virtually no serious repercussions (like reactive hypoglycemia, epilepsy, B12 deficiency leading to pernicious anemia or iron deficiency anemia, ulcer, bowel obstruction etc), advocating it as a "cure" for diabetes as well as obesity:

Clearly these drastic procedures will cut your calorie intake, but here's the strange thing: the operation is much more successful than anyone could have expected. Even though they can't eat as much, people who have undergone surgery are not constantly ravenous, in stark contrast to those dieting through will power alone. It seems the gut normally secretes hormones that make us feel hungry or full, and bypass surgery ramps up production of the ones that make us feel full.

This article also includes long, pseudo scientific explanations of why this surgery "cures" diabetes and makes you feel full - they attribute it to changing gut hormones (of course, they don't say how this occurs and not surprising, they only mention a rat study or two as documentation for their claims).

I say, not surprising, because they really do not know _what_ controls appetite nor exactly what those gut hormones do. And also, the temporary lack of hunger in new ops is easily explained by the sudden difficulty in eating (food can get stuck etc) and the massive healing going on inside after the small bowel and stomach have been cut into pieces and put together in a very different manner from what nature intended.

And interestingly enough, human studies have tended to show that these surgeries are not particularly successful as for maintaining weight loss on the long run. For example:

• A study of 10 year post op gastric bypass patients found that 34 percent of those who started with BMI 50 or over, had regained all or most of their weight (REF: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)


• The Swedish Obesity study found that at the 10 year point, the average BMI was 35 evidencing a significant lack of weight loss retention. (REF: New England Journal of Medicine: Volume 351:2683-2693 December 23, 2004 Number 26 Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery Lars Sjostrom, M.D., Ph.D et al)


• the Hebrew University study found that only 7 percent of gastric bypass patients had kept all their weight off- and that 25 percent of patients had regained all their weight back (or more). (REF: Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study) Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew))

But worse yet, a new human study found erratic blood sugar levels in most of the patients studied (clinical study) which caused them to be _ravenously hungry_ soon after meals - this study directly disproving the claim that the gastric bypass somehow changes the gut hormones to kill the appetite.

A clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, has disproven this theory when it found that not only did 80 percent of the gastric bypass patients in their study suffer a RAVENOUS appetite soon after meals, but also experienced the almost uncontrollable urge to eat which did for many result in weight regain after the first year (the study went for 4 years). The researchers also found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Dr. Roslin reported on this study at the 2009 ASMBS convention, suggesting that the gastric bypass may cause a heightened insulin response due to the rapid emptying of the pouch into the small bowel.(ref: Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.)

The so called "cure for diabetes" also attributed to the elusive gut hormones by this article, has only been called a "cure" in the media. Any studies which suggested that weight loss surgery got the blood sugar levels down to normal in diabetics, called it a "remission" and what long term studies we have seen (for example, the Swedish Obesity study), found that at the 10 year post op point, only 36 percent of diabetics were still "diabetes free".

Additionally, as observed in a friend of mine who was diagnosed diabetes, 16 years ago - six weeks on the Weight Watchers Momentum program reduced his sugar levels to normal also even though he only had lost 12 lbs of weight and still was significantly obese.

Any gastric bypass patient will tell you that this surgery is NOT the "easy way out" but in fact not only takes a lot of work to maintain weight loss but also to make sure one gets vitamins, supplements, B12 shots and iron infusions (which patients need as time goes on) and close medical followup required. Gastric bypass has been observed to cause some alarming repercussions in many patients over 6 or 7 years post op.

In fact even a significant number of newly operated gastric bypass patients suffer repercussions:

In a radiologists' study, they looked at 72 gastric bypass patients and found by CT scanning, that 41 of the 72 patients i.e. 56 percent) had some 62 "abnormalities" in their digestive tract. The "abnormalities" included leaks, hernia, spleen and kidney damage, hematoma, bowel obstruction and distended excluded stomach. (REF: Diagnostic Imaging - September 2, 2004)

And if healthy food choices, slight calorie restriction combined with exercise, can reduce sugar levels even in a diabetic diagnosed many years ago, one would wonder why a person should even consider getting one's digestive system permanently surgically changed.

Articles like this one in the "New Scientist" do a lot of harm in misleading people to make permanent changes in their organ systems, a move which many find does NOT work real well for them but can give them a whole new set of co-morbidities and a lot of grief.

Update on second person to have brain surgery for weight loss

Carol Poe, 60 years old, had had a "stomach stapling" (probably a VBG) and later was "revised" to a gastric bypass. Her original weight was almost 500 lbs - she's 5'2" and she still weighed 287 lbs when she went in to surgery. Apparently neither of the weight loss surgeries she had, had "worked" and of course, dieting hasn't worked either so Poe happily offered herself as a guinea pig for a new brain surgery which is supposed to kill the appetite. Neurosurgeon, Dr Don Whiting of West Virginia University is the one testing the procedure.

This surgery calls for two deep probes to be placed in her brain and 2 pace makers to be placed in her chest. The pace makers send out electrical currents to the probes and this supposedly kills her appetite. Her surgery lasted 3 hours and she was awake for the entire thing because when they place the probes they have to make sure they don't injure something else or take away any of her abilities.

She appeared on the Oprah show today (the show was originally aired in April) and said that after 2 months, she had lost a whopping (NOT) 11 lbs. She told Oprah that she didn't have any cravings and that she was eating a more healthy diet and that she is now going to the gym.

It should be noted that just going to the gym for two months could have explained the weight loss and that if she's only lost 11 lbs in two months even with going to the gym, she's not really cut down her food intake very much which suggests the surgery may not be cutting the appetite the way they hoped it would.

She's Whiting's second patient and he wants to do another soon. One of the requirements to be a guinea pig for this surgery, is to have had a gastric bypass (which apparently failed to cause a good weight loss), Whiting told the press in April. Don said he has to make sure the surgery is effective and safe.

Why Oprah decided to give this procedure her seal of approval by having the patient on her show (with Dr Oz) is unknown. But she made it clear on her show that she had no plans of having this brain surgery.

Carol Poe looks like she's survived the surgery well (Dr Whiting stated that there is a 1 in 100 chance of stroke or even death with this surgery) and she told Oprah that the loss of the 11 lbs has made it easier for her to move around and mow her grass. But likely, rather than the 11 lbs, it's been her trips to the gym which have made the difference in her ability to move better. Minus 11 lbs she still weighs 276 lbs at 5'2".

Dr Whiting expects to get FDA approval for this procedure in the next 2 years however, if Carol's lack of weight loss is any indicator, his path for approval may not be easy.

A similar surgery is used for Parkinson's disease but of course, long term repercussions with the new weight loss surgery could include the pacemakers moving around in the body or forming abscesses, brain damage from the flow of electricity into the brain and more.

Weight Loss surgery death rates down? No evidence of this!

An article on aol news with the headline of "Obesity Surgery death rates low" reads:

-Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.

Sounds good, doesn't it? Now you can have a gastric bypass and have it only be as risky as gall bladder surgery i.e. 1 death in 7000 surgeries.

But wait! First of all the study didn't exactly say that at all.

The finding of the study, another Dr David Flum study to be published in the NEJ on August 13th, which looked at the medical records of 3,412 gastric bypass patients and 1,198 given stomach bands i.e. adjustable lap band, was that there were 3 deaths in 1000 patients so that's still _a lot_ more risky than gall bladder surgery.

Flum's own studies of 62,000 gastric bypass patients 6 years ago, found that 1 in 50 died within 30 days.

The "less deaths now" are attributed to "newer methods" and lap surgery. However, if you average the very LOW death rate of the adjustable lap band surgery in with gastric bypass, that's far more likely where the lower death rate figures come from.

That is the death rate on adjustable lap band surgery is 1 in 7000 or the same as a gall bladder surgery. And I sincerely doubt the death rate on gastric bypass has been reduced that much in the 6 years since Flum's other study (report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study]) which was never formally published and which concluded by comparing desperately ill fat people hospitalized for other reasons than WLS, that even with such a high death rate it was slightly more risky to be fat than to have a gastric bypass.

It's called "cooking the books" and it's easy to see how they arrived at those figures. In 1198 lap bands, there were likely no deaths! And in 3412 gastric bypasses, there were likely 68 deaths within 30 days of surgery, however they probably took the table death figure which is 1 percent so that's 34 deaths.

Now lump them all together and that's 34 deaths in 4610 WLS surgeries or 8 deaths in 1000 surgeries. That's still more than the 3 per 1000 surgeries they are claiming so more cooking must have occurred. Simply, I have read nothing about the study being randomized and greatly suspect it was not randomized which means they could pick and choose the members of the cohort. That is, at the 10 hospitals they studied, there were likely far more patients than 4610 who had WLS but many were not included in the study for this or that reason.

Anyway, you get the gist. The gastric bypass isn't likely, any safer than it was in Dr Flum's study, 6 years ago. They just uh..re-computed because the results from the 2003 study which studied 62,000 cases of gastric bypass done in one hospital, didn't look so good (2 percent death rate within 30 days).

Fortunately for those providing gastric bypass, few will "do the math" or notice that the study was not 'randomized'. Unfortunately for those patients who have gastric bypass which Dr Terry Simpson emphasizes is over 100 years old (is essentially a modified Billroth II surgery originally done for duodenal ulcer), many may go in thinking that by some magic, the gastric bypass is now "safer".

I would suggest those who question, go to Dr Simpson's website and listen to the part of his online seminar about why he prefers the lap band to the gastric bypass and duodenal switch.