Teens, weight loss and obesity surgery

Clyde was an ordinary teen. When he was in 7th grade, he was intelligent, talented and liked video games far more than exercise. He lived the American lifestyle. In his family, there aren't many veggies available and a lot of fast food and pizza. He tried the swim team but it didn't appeal and he felt a bit odd in a bathing suit because he was about 15 lbs overweight. And back then, the obesity hype for kids had just started.

When reflecting on High School at the end of his 8th grade year, he told me, "The kids in school are MEAN!" I didn't ask details but assumed that, like all kids who are not the "ideal" size, he had taken his share of teasing and nasty comments. He had, already at that young age, learned to dress in cover up clothing.

Today Clyde is a senior in High School and he is relatively slim.

Is this a success story? I wonder. Because how he did it was NOT through eating 5-9 portions of veggies a day, avoiding fast food and junk food, and trying to do 60-90 minutes of cardio daily. He, instead, continued to live the American lifestyle with some modifications.

He drinks a lot of tea (caffeine speeds up the heart and makes it easier to lose weight and by cutting the calories - it may also, in the long run, be a factor in Parkinson's disease as are all stimulants - see the book, PROZAC BACKLASH for one).

And he smokes cigarettes.

If he went to the doctor, the doctor would probably be pleased at his BMI but at what cost did he attain his "ideal weight"?

Does he know the proven dangers of smoking i.e. hardens the arteries, strains the heart, and shortens lifespan as much as 15 years? Yes he does. "I know it's dangerous," he told me a bit sadly, "but it's hard to stop."

He does not receive any support from his parents. They want him to stop smoking but do not help him to accept himself at his natural size. And they don't understand that when you are a teen in school, the pressure is 1000 times what it is in life and right now, there is a lot of pressure and heat given to all of those who are overweight regardless of age.

The sad thing is most kids will keep within the "normal zone" if they eat healthy, avoid foods like potato chips and fast food which are extremely calorically dense and not particularly nourishing and if they exercise 1-2 hours a day. However, most kids are not really enthusiastic about this type of program and do not often get a good example of a healthy lifestyle at home.

Clyde is not alone. Statistics tell us that more teens are starting to smoke now, than in the 1960's before the dangers of smoking were known.

In considering kids like Clyde, is it really hard to understand that teens simply do not care if they are doing something unhealthy to keep thin because that is most important in the narrow minded society of High School?

Starting with Junior High School, "bulimia clubs" are flourishing, use of "uppers" are common and an alarming percentage of kids are already dieting or more extremely cutting calories. Very often it's the models in the magazines who are blamed, totally ignoring the heat overweight kids get from parents, teachers and the medical profession.

And now, with the encouragement of our wonderful news media and the surgeons who stand to profit, teens who are very overweight, have discovered Weight Loss Surgery.

As recent as a decade ago, the thought of doing something like a gastric bypass on anyone under 18 was considered unethical - inducing vitamin deficiencies in a body which has not yet matured, partially disabling a healthy digestive tract was considered bad medicine but now it's considered good medicine, the surgeons reciting the song of how the teen "was in danger" of a variety of ailments, many of which are non issues or not caused by obesity.

The "Today Show" recently, featured a teen, around 256 lbs who got a gastric bypass. In her before photos she was shown running around a field playing with a dog and smiling. A year later, she had lost 100 lbs and was of "socially acceptable size". But now she was not smiling. Even when the doctor told her she was a success, one saw only a hint of a smile on her face.

"I have to eat very differently now" she told the Today Show, "there are many foods which no longer go down right." She concluded, "It's not an easy road."

The rationale for giving this 17 year old a surgery which cut her stomach into two pieces and her bowel into 3 pieces, rearranging them in a very unnatural manner, a surgery which some studies show to pose a risk of serious complications in 40 percent of patients, by the 8 year point, complications like bowel obstruction, ulcer, pancreatitis and more... the rationale for doing this on the young lady was she had "sleep apnea", "high blood pressure" and "was in danger of going blind" (they never told us what endangered her).

Sleep apnea is a fairly new diagnosis. I don't doubt that some extremely large folks may have breathing problems, but I think the diagnosis of "sleep apnea" in everyone with a BMI over 35, may be way exaggerated.

I had an overweight friend diagnosed of that. She was given a C-PAP machine and found it way too noisy so she gave it back and went on and she was just fine without intervention. I think we CAN stop breathing for a few seconds without a problem and probably many people who are not fat might be doing that also.

So that left the "high blood pressure" (which can be easily regulated by medication) as their sole rationale for ruining this young lady's digestive tract for life, giving her lifetime problems which may really be biting her at the age of 30 when she would be in the prime of life had she not had the surgery, even if she was very overweight.

Sober faced, the young girl told the Today Show that it was "so nice to not worry about future health problems." How ironic that the procedure she had is, indeed, going to give her a new set of health problems which she might have never had to worry about.

It's time that the media and also adults stop pressuring our children. If they want to help them, they should encourage exercise (to be healthy) and eating veggies and healthy foods and most important, help them to understand that health and beauty is not about size. But when even our medical profession starts condoning unhealthy ways of getting thinner, things are out of control in my opinion.

On the Today Show, the resident doctor obviously approved of this young girl's gastric bypass. "Today's obese children are in the unique position of really having a shortened lifespan," she told the viewers.

With all due respect, the only reason that might be true is because society is pressuring teens to the extent that they are doing unhealthy things to lose weight, like smoking or gastric bypasses. That's a no brainer, isn't it? Apparently not to many folks.

Bariatric surgery slashes cancer risk?

Latest news - front page for several days - has been that having a gastric bypass can cut cancer risks.

Bariatric surgeons at McGill University compared the records of 1000 patients mostly gastric bypass to 5700 people matched by age, weight and sex who did not have the surgery.

In the surgical group, 2 percent developed cancer and in the non surgical group, 8.5 percent developed cancer.

Although the study is yet unpublished, these bariatric surgeons presented their preliminary findings at the latest meeting of bariatric surgeons of the ASBMS recently. (talk about preaching to the choir).

And isn't it amazing that an unpublished study has made such headlines for several days now?

What is even more amazing is that while Dr Glenn Gaesser found in his metastudy that obese people were 40 percent less likely to develop cancer, how these surgeons found the opposite. Of course 6 percent more cancer isn't really that great although you can express it to sound amazing as MSNBC did .... saying 80 percent greater chance of cancer in the non surgical group.

One of the objections to this study was actually brought up by another bariatric surgeon. Edward Phillips, a bariatric surgeon at Cedars-Sinai Medical Center told the LA Times that patients who have weight loss surgery, are often screened for cancer before surgery. "We may be selecting patients who don't have cancer for surgery, thus biasing the study", he said.

It's hard to judge without seeing the study. For example, a lot of very obese people are yo yo dieters and that weight cycling raises all health risks. Also I am wondering why they had to pick so many obese people to compare. Why not select 1000 fat people to match up with the 1000 WLS patients? Because I bet in 1000 fat people you might not get any cancer at all and that wasn't what they wanted to prove with their study.

The study only ran for 5 years and critics of the study have pointed out that it often takes a cancer many more years to develop than that and that had the study been taken out longer, the results might have been different.

Breast cancer was one of the cancers which they saw less of in the bariatric patients. Could it be that after a gastric bypass, patients were unable to take birth control medication (a major risk factor for breast cancer - that is medications work differently in gastric bypass patients because of the malabsorption issues)? Or that the gastric bypass patients were unable to eat or digest foods with transfat in them (another cancer activator). Also most weight loss surgery surgeons require their patients to quit smoking whereas the fat controls were not necessarily non smokers. Another thing is that most gastric bypass patients can no longer drink alcohol especially the newer ops as they would have been looking at, if the study only ran 5 years - alcohol can be another risk factor for cancer.

There are just too many other factors which could be operational in all of this to assume that it was the surgery and weight loss which explained the 6 percent less cancer in the surgical group.

For example, most gastric bypass patients are told to exercise often in order to help keep off the weight. Exercising can knock the risk of cancer (in anyone of any size) down, 40 percent. Most of the obese controls were probably not exercising regularly.

Ideally the fat controls should have also been matched for exercise, not smoking and dietary modifiations (like the elimination of trans fat in the diet) if the scientists wanted to really see if it was the surgery or the weight loss which explained the less cancer in the surgical group.

A non randomized study always raises red flags. The fat people could have been picked for their cancer risk (i.e. cancer in the family etc).

I guess the thing which rather annoys me about this whole deal (besides the news media making it a headline for the last week or more) is that all the research I've done comes out the opposite...

• Cancer is seen 40 percent less in fat people than in slim people - it has been considered a disease of the slim and yet now they are trying to link it like everything else to obesity.
• Two oncologists have told me that fat people if they get cancer, are much more likely to survive than slimmer people.

So unlike the media is trying to tell us, the "link between obesity and cancer" has not been well proven at all. On the contrary. The American Cancer society has stated that lifestyle (not girth) is a factor in 85 percent of cancers.

Even the release form for gastric bypass used by many surgeons and usually attributed to Kaiser Permanante warns:

Keep In Mind: Slender individuals have adult diabetes. Slender individuals have heart attacks. Slender individuals develop arthritis and have joint problems. Slender individuals have strokes and develop cancer. If obese individuals have these problems more commonly than the slender, it is because the same bad health habits just don't happen to cause obesity in some individuals "fortunate" enough to be slender no matter what they eat. They may be slender but they could very likely die just as early in life as someone who is overweight.****

And obviously those who wrote this release form do believe in bariatric surgery.

Additionally, I have seen many get cancer who were very slim. Some of them were very fit like a 53 year old family member. She ran marathons and I'm sure the last time she visited her doctor before she came down with the cancer which was to kill her 3 years later, her doctor proclaimed her totally healthy, at her perfect weight with low risk numbers.

So much for the risk numbers and perfect weight predicting protection against cancer!

I would not take this one to the bank. Many gastric bypass patients can develop a condition called "leaky bowel" wherein bacteria, not killed in stomach acid, enter the small gut and are absorbed along with the food. With this condition causing in many, auto immune disorder like RA and lupus, it is suspected that the immune system of a gastric bypass patient might been impaired by the surgery and not strengthened as these McGill bariatric surgeons would like us to believe.

Brooke Bates revisited

If you remember Brooke Bates, she's the 12 year old who had a lap band put in after having 35 lbs of fat removed by liposuction and dieting (since the age of 3 years old) did not produce the desired results. I, at the time, followed the attitude of the media, which blamed the parents. Frankly my blog was horribly judgmental as I re-read it.

Recently Brooke Bates' mother wrote a feedback to one of my blogs and I feel that it's important enough for her to have a voice in all of this that I decided to reprint her feedback letter here:

BROOKE BATES IS MY DAUGHTER. I WANTED TO LET EVERYONE KNOW THAT WE LOVE HER AND WOULD NEVER DO ANYTHING TO HARM OUR CHILD! WE SAVED HER FROM FUTURE PROBLEMS THAT ARISE FROM BEING OBESE! OBESITY IS NO DIFFERENT THAN A HEART CONDITION OR ANY OTHER ILLNESS! SHE IS HEALTHY AND HAPPY NOW!! DR. ERSEK SAVED HER LIFE PEOPLE! CANT YOU SEE THIS! WE ONLY TOOK HER TO GET THE LAP BAND TO PREVENT FUTURE WEIGHT GAIN. HOW MANY PEOPLE DO YOU KNOW THAT HAVE LOST WEIGHT AND GAINED IT BACK???? IF IT WASNT YOU, THEN I,M SURE YOU KNOW SOMEONE THAT THIS HAS HAPPENED TO! WAKE UP ! MODERN TECHNOLOGY HAS BROUGHT US ALONG WAY AND ITS HIGH TIME PARENTS TRY TO HELP THE CHILDREN AND SCREW EVERYONE ELSE AND WHAT THEY THINK! SINCERELY, CINDY BATES

This of course, argues that the media (and myself) were way too harsh on Brooke's parents for as Cindy pointed out, she loves her daughter deeply and wants the best for her.

First I would like to formally apologize to Mr and Mrs Bates for my judgmental attitudes toward them. Cindy is right... she just had the best in mind for her daughter and was likely, following her medical provider's advice or at least, acting with her medical provider's blessings.

But secondly, I think we all perhaps missed the point and that is that Brooke's parents were as much a victim of an out-of-control diet industry as Brooke herself. And that is sad.

I'm sure that neither Brooke NOR her parents were told that 34 percent of even the more invasive gastric bypass patients regain all or most of the weight loss according to a 2006 study.
(Annals of Surgery. 244(5):734-740, November 2006.
Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)

I'm sure they were not told that in years to come, the lap band can grow into the stomach, causing the necessity for a partial gastrectomy or removal of a part of Brooke's stomach. Even in the most non invasive form (and the lap band is a wonderful improvement over the other WLS procedures available), ANY gastric surgery can upset mother nature in a way that can have repercussions later on.

And doubly sure the Bates family was NOT given the only long term statistics we have on the lap band (and gastric bypass) i.e. the Swedish Obesity study in which it was found at the 10 year post op point, the average amount of weight kept off was only 16 percent of the original weight.
(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)

Brooke's high weight was 220 so that means at 10 years post op, if she is average, she will have kept off 35 pounds after having her band in for 10 years and this she could have done with Weight Watchers or something non invasive.

Recently I read on one of the groups, a new WLS patient who lamented "I cannot eat normally now!" WLS patients must observe rules some of which I also observe because I have a stricture of the esophagus from GERD and a medical procedure which was a bad idea. Some of those rules include 'eat bites the size of a pea', "take time between each bite and chew each bite until it's liquid". But unwritten rules say "no pizza or steak", and "if you want to not get around the surgery, you must find things which are soft but not caloric and that takes a lot of creativity." I frankly find the stricture even at the age of 63, quite a hit on the quality of life and I cannot imagine a 12 year old having to worry about these things and never being able to "have a party in her mouth" as Dr Phil has put it.

Additionally, I know most folks do not know (and many medical providers do not tell us either) that kids who diet, tend to really mess up their metabolisms and that comes back to bite later on. I know - I WAS one of those kids and I kept slim in High School (well normal sized) by severe calorie restriction. But most of my adult life I have weighed well over 200 lbs and if I don't calorie restrict now I keep on gaining (which I did very nicely after my last dieting attempt at the age of 60). Working out daily which I have done for 14 years does in NO WAY prevent me from gaining weight.

I am deeply sorry for any hurt I might have caused Mr and Mrs Bates and Brooke.

However, I do hope that people reading this will realize that in this confusing, complex world, more than good intentions are needed. We need to become informed ourselves as we may not hear the best advice from the news media (which is an advertising platform), or even from our medical providers when it comes to weight control and healthy lifestyle. For example, if an overweight person goes to the medical provider, they invariably hear "lose weight" but if they smoke cigarettes, they might hear "well you should give up smoking" ** wink wink ** but that's it. Strange considering they have a ton of studies out there suggesting smoking not only is a major cause of heart disease but also, hastens the onset of diabetes and many other ailments, whereas obesity alone has never yet been proven deadly.

Obesity is not a killer. In the release form used by many WLS surgeons and usually attributed to the insurance company, "Kaiser Permanante", they say up front that obesity is NOT a killer but rather, it is bad health habits which can raise the risks for both fat and slim folks. This being said, it should be noted that the increased risk of even fat couch potatoes is minimal according to several studies including those of the Cooper Institute and the bottom line is, heart attacks, strokes and diabetes happen in individuals of all weights:

****Keep In Mind: Slender individuals have adult diabetes. Slender individuals have heart attacks. Slender individuals develop arthritis and have joint problems. Slender individuals have strokes and develop cancer. If obese individuals have these problems more commonly than the slender, it is because the same bad health habits just don't happen to cause obesity in some individuals "fortunate" enough to be slender no matter what they eat. They may be slender but they could very likely die just as early in life as someone who is overweight.****

(Kaiser Permanante Release form for WLS)

And....

*** If you believe this surgery will restore you to complete and normal health you are mistaken. You are trading one nutrition problem for another problem. Obesity alone, does not necessarily kill you...Do not think you know better because you had a friend who had the surgery and did well despite eating whatever they wanted. This is an exception. Given enough time, they will probably put most of the weight back on.

Kaiser permanante release form for gastric bypass/duodenal switch

I plan to delete my earlier blog about Brooke Bates because it is overly judgmental and I did not mean to do that and I absolutely did put the blame in the wrong place. Brooke Bates is healthy today and we applaud her for her hard work for as a WLS surgeon put it, "success with WLS is 10 percent the surgery and 90 percent the patient!" Brooke obviously has put in the work and deserves the credit, however, we cannot help but observe that with better medical advice, she could have avoided disturbing her digestive system and her quality of life.

V-Bloc - new hope or old spin?

Several years ago, they did a study on a device developed, I believe, in Switzerland called the "gastric pacer". Several US Weight loss surgery surgeons jumped on the bandwagon. What this device (implanted in the back - and similar in function to a heart pacemaker) did was send electrical impulses to the vagus nerve of the stomach. No intestines were rearranged, the stomach was not otherwise disturbed and it seemed the greatest thing since apple pie. One surgeon wrote to a listserve "I am testing a device now which will outdate all weight loss surgery in five years!"

I followed the studies on gastric pacing and even interviewed some patients. Unfortunately the results, weightloss-wise, were extremely poor. One patient out of the three studies in one area, lost 70 lbs. One patient lost 100 lbs but became very ill from several things including cancer, partially from the side effects of the device and had to have it removed. The rest in the three studies, either lost very little weight or no weight at all. All of the patients except the two affore mentioned, ended up getting other procedures, either gastric bypass or lap band which they all, down to the man, found not only far more effective with weight loss but also, far more comfortable than the gastric pacer.

But worse yet, this "totally non invasive device" (as it was _heavily_ advertised) had a set of co morbidities of its own, some of which I understand are also true of the heart pacemaker but to a lesser degree.

First, it could travel around in the body causing problems getting where it didn't belong (like heavily inflaming surrounding tissue). The one patient who had to have it removed in an emergency situation, had it travel halfway down her back.

Secondly, the amount of current required to block the vagus nerve turned out to be about 10 times the amount of current required in a heart pacemaker. When the device was working, many patients complained of tingling uncomfortable feelings in their arms.

Third, patients were told it stopped the appetite. But the way it stopped the appetite was to keep the stomach from emptying into the small intestine, a condition well known to GERD patients. What they didn't tell the patients was that if the food just sits in the stomach, it starts to rot and can cause a horrendous case of upset stomach (and burping up, rotten food - I know because I have GERD myself). It can also cause too much stomach acid which splashes into the esophagus and can cause not only heartburn but also a condition of ulcers and sores in the esophagus called "Barrett's Esophagus" which can lead to esophageal cancer - a rather distressing type of cancer.

Fourth, patients were told the battery on the gastric pacer would require changing every 2-9 years which are the statistics on heart pacemakers. But what patients found out was that, because the amount of electrical current required for blocking the vagus nerve, was about 10 times what a heart requires, gastric pacer batteries generally had to be changed every 9 months to a year and that required a small surgery.

And finally, for many patients, disturbing the emptying of the stomach did not cause a great deal of weight loss just like the discomfort (and even stricture) associated with GERD doesn't necessarily cause weight loss either. (Again I can attest to that one - I easily managed a BMI of 44 even with GERD, and a stricture of the esophagus).

Needless to say, the gastric pacing listserve was closed, the studies of this "utterly hopeful" device having been ended but not without a few lawsuits from sick or upset patients.

But ........

As they say in "infomercials"... but wait! Because the gastric pacer is back with a new name, new studies and more heavy advertising! That's right.

In 2005, a small company named EnteroMedics in Minnesota announced that they were working on a type of gastric pacer. The press release included the following:

The company says cutting off the nerve supply may slow down digestion because the stomach doesn't register the food and start the digestive process.

Well, apparently they have begun trials of this device in several cities and like the gastric pacer, they claim it's totally non invasive. Interestingly enough, the TV blurb on it uses a gastric bypass patient to show how great losing weight is and claims the new gastric pacer (the V-Bloc) may work just as well as the gastric bypass.

It's hard to research the V-bloc. Both the EnteroMedics website and the research study website are very vague about how the device works.

So I called a phone number which stated: "For more information about VBLOC Therapy and the EMPOWER clinical research study, please call the nurse-staffed information line at ......"

I spoke to 2 nurses, one of whom got short with me when I was apparently asking too many questions. She said "really this phone number is merely to identify and qualify patients for the study". To which I answered "well that's NOT what you stated on the website" and I quoted the above. Then I reminded her that as soon as they have advertised the device on TV, then the public has a right to know the details. By the time I spoke to the second nurse (a different lady from the first nurse so they apparently are paying no small fee for having nurses to answer phones!), I had a specific question and was prepared with an answer when she told me the line was just to qualify patients.

I did find out that the chest belt part of V-bloc is the battery pack so apparently one improvement V-Bloc has over the gastric pacer is that to change the battery you don't need the small surgery.

But something else on the EnteroMedics website about what the V-Bloc really does (and this website is not given on the Empower study website either - I had to google it) is a bit unsettling. They admitted that they don't really know how the Vagus nerve interfaces with the appetite but listed the functions of the vagus nerve and it's more than just stopping the peristalsis (the muscular action of the stomach to digest the food and send it to the small bowel). Here is the list of vagus nerve functions which the V-Bloc supposedly stops (from their website) :

The mechanisms responsible for obesity and the role played by the vagal nerves are not yet fully understood. Vagus nerve function appears to play a significant role in enabling multiple mechanisms including:

• Expansion of the stomach as food enters.
• Stomach contractions that break food into smaller particles.
• Release of gastric acid to continue food processing.
• Emptying of the stomach contents into the small intestine.
• Secretion of digestive pancreatic enzymes that enable absorption of calories.
• Sensations of hunger, satisfaction or fullness

In plain terms, the V-bloc not only gives you a horrendous case of indigestion but also induces simulations of "gastroparesis" (stomach not emptying due to partial paralysis), interferes with the pancreatic enzymes and interferes with stomach acid which will not only affect fat digestion but also protein digestion and vitamin digestion!

In another place on the same website, it states that the idea for the V-bloc (and probably the gastric pacer also) was that before they had the medication to stop the stomach acid for ulcers, the so called PPIs, they would go in and cut the vagus nerve to help ulcers.

Before the availability of proton pump inhibitors (drugs that reduce the amount of gastric acid released into the stomach for persons with ulcers), surgeons routinely cut the vagus nerves near the stomach to treat ulcers. This procedure is called a "vagotomy." For a period of time following surgery, many of the people who underwent this procedure absorbed fewer calories from fat, lost weight and had decreased appetite.

Notice for a "period of time after surgery". That is, it did not work indefinitely to stop the appetite.

Other than the battery pack (it's carried on a case the size of a compact disc, one nurse told me) worn around the chest (which I suspect might be inconvenient at times) which is an improvement over surgery every nine months to change the battery, it seems the V-bloc is pretty much the "same dog, different fleas" as the devastatingly unsuccessful and risky in its own way, gastric pacer. And something which the TV said has been added i.e. wires in the esophagus (I don't know how accurate the TV report is but since the Enteromedics folks are not giving much information, it's all we have).

"He who does not study history, is doomed to repeat it" and "doing the same thing repeatedly hoping for a different result is insanity" (said Albert Einstein) so take a tip from those who struggled and suffered with the gastric pacer a few years ago, and skip the V-Bloc! It apparently interferes with digestion as much as the gastric bypass and does not even produce good weight loss results for most people.

At best scenario, the weight loss promised is 15-20 percent of the bodyweight in the first year. Doing the math, 15 percent of 300 lbs is 45 lbs. And likely the real results will be more like 10 percent or less. (as they were with all trials on the gastric pacer).

Surely a horrendous case of indigestion, food rotting in the stomach, heartburn and nausea may slow the appetite but at what price? You can do that without expensive electrical devices and multiple wires implanted in your body.

bogus claims in the news - gastric bypass extends life?

Today I was chatting with some friends and someone brought up that some media column writer said you didn't have to put mayonnaise in the fridge. Mayonnaise has eggs in it for one and in my experience, gets rancid fast if not refrigerated. Everyone in the discussion did feel that it _should_ be refrigerated and since a media person said it didn't have to be, everyone seemed to feel that must be right.

Media is seldom if ever right. If they are not selling something, they often do poor research (this is partially because of tight deadlines which precludes doing careful research so they often look up the subject in other media articles which are just as poorly researched - a case of the blind leading the blind?). But the fact remains that too many people actually believe what the media prints regardless of how "over the top" it is!

Case in question. Here is a paragraph I found in one of the blog searches:

A Gastric Bypass Really Can Extend Your Life

If you are contemplating having a gastric bypass then a recent US study might just help you to make up your mind. The study looked at no fewer than 16,000 obese people and found that when people in the study group opted for gastric bypass surgery their long-term mortality rate dropped by as much as 40%. This should not really be a surprise since weight loss surgery also cures, or at least improves, a host of other conditions such as high blood pressure and diabetes and the change in diet and increase in exercise which follows surgery has got to be a good thing. Nevertheless, it is always nice to see what we already know put down in black and white as confirmation.

Of course the study is not cited and it all sounds good - if you don't think about it. A gastric bypass provides for the stomach to be cut into two pieces - one tiny piece which becomes the "pouch" and the rest of it (about 90 percent or more) which is bypassed along with the attached first segment of small bowel. The bowel is cut into pieces and rearranged in a way very different from the way nature made it. All this causes a quick weight loss during the first year or so and lifelong problems including vitamin deficiencies, osteoporosis, anemia, protein deficiencies and much more.

As Dr Terry Simpson put it:

***The RNY [gastric bypass] 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)

So how would this extend your life? Well, the idea here is that fatness is so deadly that any way to slim down regardless of unhealthy it is, is better than being fat. But there are no real studies which prove fatness in itself is deadly! And when they mention all these ills which are supposedly exacerbated by fat, does anyone question that slim people have the same ills i.e. high blood pressure, diabetes etc? I think the problem is people don't question something they read in the media. And that is where the problem starts.

But let's take a closer look at the study they referred to. It was one led by a WLS surgeon, Dr David Flum and he found in the study (which the media happily ignores) that the first month after a gastric bypass, 2 percent die and that another 5-7 percent of patients die within the first year (these were older patients so had bodies less tolerant to the extreme internal rearrangement done in the gastric bypass).

So how does he conclude that gastric bypass extends life? He compared these 16000 healthy fat people in for gastric bypass to 2000 seriously ill fat people in the hospital for other reasons and observed that since there were a small number of more deaths among the seriously ill fat people than the gastric bypass patients, that meant that the gastric bypass must have extended the lives of those who got it.

What he hoped the public would not realize is that had he compared the gastric bypass patients to 2000 seriously ill slim people in the hospital for other reasons, he would have also found that the healthy fat people who had gastric bypass survived better than the seriously ill slim folks. So would that mean that slim people should have a gastric bypass to "extend" their lives?

In another blog article
A nice looking couple is pictured. They are fat but not terribly so - they are both having gastric bypass surgery. The lady, it said, has high blood pressure even with being on 4 medications and the man has bad knees ("worn out from carrying all that weight").

Here's another which should be questioned. Most of the people I know with really bad knees are not fat. Some have never been fat in their lives - so how did their knees get bad without the "great weight" weighing down on them? And if a person's blood pressure is that high with 4 meds, did they really think a gastric bypass is going to bring it down that much? Again I know several slim people with very high blood pressure. The bottom line is, will introducing a surgical disease into their digestive tract make their health better? Perhaps or perhaps not - it all depends on whether their present comorbidities are greater than the comorbidities added by the bypass. But the media tells us that the bypass is some kind of magic bullet which fixes all ills and no one questions this and that is what is of concern.

***** "By doing this surgery, you're creating a medical disease in the body. Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating."
(Dr Edward Livingston, bariatric surgeon in Self Magazine, 4-2001) *****

Today I saw an ad for something about diabetes featuring as a poster kid, Randy Jackson. I did a double take. Jackson had a gastric bypass a year or two ago and that was supposed to have cured his diabetes (if you believe what the media tells us). I read the ad carefully. It said he was taking less diabetes meds now after his bypass but that is a totally different story than his diabetes getting "cured".

Fact remains, we are suffering from many old age diseases including worn out knees and high blood pressure because now we are living to the age where people start wearing out, fat or slim.

I commented on the widespread practice of smoking in Indonesia. "Doesn't that shorten their lifespan," I asked my hubby. He answered, "They don't live long enough to die from the repercussions of smoking."

I have known countless people who had gastric bypass to fix their knees only to find that the malnutrition and vitamin deficiencies made things worse if anything.

We need to start questioning seriously what we read in the media. If we follow their advice to not refrigerate our mayonnaise, we might get an upset stomach. But if we follow their advice to get a gastric bypass, the repercussions can be much more devastating.

Dr Oz sells out to the Weight loss surgery industry!

I looked forward to Dr Oz's new program "The Oz Files" on Discovery Health. This week's episode was entitled "Defeating Obesity". Dr Oz is a cardiac surgeon and although some of the things he has said about obesity are questionable, I felt he was basically mainstream health conscious.

But the Oz Files was a great disappointment. Interestingly enough, Dr Roizen, his partner who has joined him on most other shows was missing. As the show wore on, I had to wonder whether Dr Roizen didn't approve of the slant of the show which was doing anything but advocating health!

The scenario of the show was that four fat people were picked to lose a lot of weight in 6 months. Located all over the country, they were given little guidance on how to do this - just cameos with Dr Oz cooking a healthy food or telling them they should exercise. Instead of guidance in a more healthy lifestyle, the people were told things like their bodies were dying from the obesity (untrue) and if they didn't lose weight immediately, they would get diabetes (untrue - how does Dr Oz explain the 33 percent of type II diabetics who have never been fat in their lives?) and that the "omentum" was "poisoning" their livers and kidneys.

The "Omentum" has been a favorite of Dr Oz's. If you look it up on the web, it appears a sort of sheathing for the abdominal cavity but beyond that, no one knows what it really does so Dr Oz declaring that it somehow poisons the organs in a fat person, is more than a bit over the top since this is NOT based on science.

Bottom line, the four people were made to feel terrible about their weight, and their future but only told to "eat less and exercise more" (wow, what a revelation! NOT).

One of them had a gastric bypass. She was 5'6" and not even 300 lbs.

One of them was "lagging" on her weight loss after a couple of months so was put on the diabetic medication, Metformin to help kill her appetite. To put a healthy person on a diabetic specific medication is very questionable.

And the two other people, battled it alone. It was emphasized throughout the show that they were not doing their part in losing the weight. Also the husband of the gastric bypass patient was taken to task for "not keeping up with his wife", Dr Oz, totally ignoring that the quick weight loss period in a gastric bypass patient is NOT from living healthy but simply from fasting because they cannot eat due to the massive surgical changes made to their digestive tracts.

At the end of 6 months, the results were predictable and Dr Oz announced them with glee.

The gastric bypass patient had lost 70 lbs (but remember, less than 30 lbs of that was likely fat because gastric bypass patients are on a fasting diet the first few months after surgery as their bodies heal - their bodies can only get sugar out of body fat and must cannibalize muscle and bone and organs for the rest, a fact totally ignored by Dr Oz who gleefully pointed out how the gastric bypass patient lost that weight through "changing her lifestyle to diet and exercise" and how he applauded her because she did what she needed to do and "partnered with science".

The person on metformin lost 45 lbs and Oz "lauded" her also saying she was now a slim person (she wasn't really). But the fact is, without medication that her body did not need, she would _not_ have lost that much weight and when the medication is discontinued she will likely gain back.

The other two people did not do well on their weight loss, but Oz patronizingly said they learned a lot from participation.

The content message of the show was clearly, the only way a person can lose a large amount of weight is having a gastric bypass!

Where is the "healthy lifestyle" here? Vitamin deficiencies on the long term which made the inventor of the gastric bypass stop doing the surgery he invented, in 1980? 40 percent serious complications within five years of surgery? And worse yet, we now have two studies which found that the weight loss at the 10 year point after a gastric bypass was somewhat unimpressive. 16 percent of the original weight? (Swedish Obesity Study).

I am confused. Is Dr Oz really deluding himself that the gastric bypass is a healthy and effective way to lose weight? Perhaps but if that is so, he's in for a rude awakening when he finds out the dark side of the surgery, how few people can stay healthy and keep off the weight.

Or is it as Dr Ernsberger once wrote:

"In my experience, most physicians, especially academic physicians, disapprove of these operations. However, they will only admit this in private, because of an unwritten law in medicine that forbids one to speak ill of another's procedure. Thus, there is no one with an MD after their name who will appear on camera and criticize the operation."

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

In any case, I am very disappointed in Dr Oz that he could make a show which only had a thin veneer of teaching health and actually was just- yet another- infomercial for gastric bypass.

Can you be fat and fit? Latest spin says "No"

Based on a "data dredge" study (meaning they took existent data which was not designed for THAT study so is outdated and also doesn't usually have the right information), some of those in the diet industry are now telling us that we cannot be fat and fit.

The study, like other epidemiological studies boasted big numbers, 39,000 women classified as normal weight, overweight or obese (BMI 30 or over). It was published in the Archives of Internal Medicine, April 28, 2008 issue.

I looked up the article, because the news service headlines read "Fitness does not reduce risk if you are fat". The media told us that people who were obese had a 50 percent greater rate of heart attack even if they exercised than people who were not obese.

If the study had really suggested this, it would be very questionable ... the exercise habits were self reported and people often exaggerated their level of fitness (mostly exaggerate it!). Also overweight and obese women are often weight cycling (popularly called "yo yo dieting") because the body produces all kinds of hormones to force weight gain if it thinks your weight is too low (and too low varies for every different body). And of course, several CLINICAL studies have suggested that any kind of dieting increases heart disease risk by 50 percent.

However, in looking up the abstract, the study did NOT suggest that there was no benefit for an obese person to be fit. On the contrary, the last line of the abstract reads:

The risk of CHD associated with elevated body mass index is considerably reduced by increased physical activity levels.

The media ignored this statement and picked up the next line in the conclusion:

However, the risk is not completely eliminated, reinforcing the importance of being lean and physically active.

Ok, that's fine except it is a meaningless statement because a reduction in risk doesn't mean no risk... regardless of weight. However, it made a great statement for the media to base yet another article of misinformation on.

Now if we look at the study further, we find that although researchers wanted the expenditure of 1000 calories in exercise a week (which isn't very much... about 3 x a week, 40-60 minutes each time), the average expenditure in calories in exercise for those considered "active" (remember this is self reported) was 550 calories a week which isn't for most people, even twice a week. And even that small amount, said the researchers, reduced the risk of CHD significantly regardless of weight (34 percent, they stated).

It should be remembered that many people feel NON cardio is exercise to be counted like gardening and likely reported that as "activity" even if it didn't fit in the categories which were basically cardio exercise (I guess gardening could be reported in the "walking" category if you stretched it).

So although this wasn't the best designed study (to put it mildly) the results were not what the news media reported them to be. Exercise does significantly reduce the heart disease risk... regardless of weight.

Rudy Leibel, obesity researcher said "there probably is a benefit to being of 'normal weight' but there is no proof that people forcing their weight down below their set point enjoy that advantage". This is kind of a no brainer and I have no problems with it. Although right now, according to CDC statistics, people in the BMI category of 25-35 are living longer than those in the so called "normal weight" category.

Another strange thing in our society is that although most of us have had friends who exercise a lot of cardio, are lean but smoke cigarettes, drop dead rather early in life, I have not noticed any studies suggesting what we already know to be true - that smoking may cancel out the good effects of exercise in some individuals (regardless of weight or fitness level).

And in fact, many people who smoke, are doing so to keep their weight down because they are under the false conclusion that doing anything unhealthy is better than being fat. And of course, where do they learn that but from our media.

The Cooper Institute studies of 50,000 people over the last 30 years or so, suggested that people who were obese and fit had only a 00.08 greater risk of heart disease than those who were normal weight and fit. And those studies also suggested that being lean (under normal weight) was at the highest risk even if fit. But of course you will never see that in the media which is, bottom line, hard selling a diet.

One more comment about this study. Most people do not keep up a fitness program more than a year or two but in a self reported study, those people may not have reflected the change (stopping exercising) in their surveys.

Exercise greatly cuts risk of illness regardless of what people weigh but cutting risks doesn't mean no risk, of course. And to enjoy that reduction of risk, people must make cardio at least 3 times a week (and 5 times a week is way better) a part of their lives FOR life.

And it seems the greatest risk to our health may be believing the media which when not lying, is incorrectly reporting health topics.