Weight Loss surgery does not reduce health care costs in the long term.

A long term study on weight loss surgery (bariatric surgery or WLS)  found no reduction in health care costs on the long term.   The study was reported on, in a recent issue of JAMA Surgery (2013).  The researchers found higher health care costs in the long term with surgery than with treating obesity, medically.

This is nothing new, of course.

Wrote the researchers in JAMA (Journal of the American Medical Assn) in 2003 that Short term results of surgery are impressive... BUT

"...long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."
 
 This has not changed and yet they are still doing 200,000 of these surgeries a year on people who are desperate and frightened by scare tactics about obesity which are, in NO WAY, supported by studies.

On the contrary, studies have found no direct link between obesity along and morbidity!
 
And this was the shocking findings of Glenn Gaesser, a slim exercise physiologist who examined 20 years of "obesity studies" but his findings and the findings of many others, have been all but ignored by the mass media, anxious to sell diets and surgery for obesity using scare tactics.  Gaesser wrote his results in his book, BIG FAT LIES, a must read for everyone!

The findings of the 2013 study may be because WLS adds health care issues which may be as bad or worse than what it sometimes cures. Additionally, if the patients do not diet and exercise after surgery, they regain the weight in which case they now have the health issues associated with rearranging or interfering with major digestive organs in addition to obesity.

The Association of Bariatric Surgeons (WLS surgeons) had not much in the way of comment other than suggesting not all things may have been taken in consideration or - what I call um...questionable to be polite - that most of the procedures in the study were done open (with a large incision) rather than laparoscopically (using "keyhole" surgery).

What they hope we forget is that first of all, with keyhole surgery, surgeons cannot see as well as they can with open procedures because they are operating with a 2 dimensional view rather than a 3 dimensional view as in open surgery.  So on the gastric bypass - and those complex surgeries which rearrange digestive organs, open procedures are less troublesome in the long term - the only advantage of lap surgery is the immediate healing of the incision.  This would not have affected the long term results of any study or would have caused the long term results to show more favorably because most of the procedures were performed open.

And second, this type of result has been found in every long term study done on weight loss (bariatric) surgery.

Bottom line - surgery is not effective in maintaining weight loss in patients unless they diet (i.e. count their calories or restrict food in some other way) and exercise.  But those behaviors will take weight off without surgery and without all the complications and long term repercussions of surgery.  

Al Roker, a gastric bypass patient, told the "Today Show" that in order to keep off his weight, he not only journals his food and counts his calories every day but he also runs 5 miles several times a week!

With regards to the latest study, a weight loss surgery surgeon, Dr Livingston (who when, last I spoke with him, is proudly not a member of the ASBMS), commented:

"Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive. In this era of tight finances and inevitable rationing of healthcare resources, bariatric surgery should be viewed as an expensive resource that can help some patients."

"Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success." 

It's sad that they are only questioning these procedures on the basis of cost, money-wise because the cost to patients who suffer complications, lack of weight loss or worse, is so much greater.

The patient pictured above had an uncomplicated surgery and lost a lot of her weight but was regaining by the time the photo was taken in 2007.  She died of a heart attack in 2009.  The increasing number of early deaths on the long term from these procedures are never mentioned in the Medical Journals.  

One lady in her 50's who is very overweight, has stated that she has outlived 48 of her fat friends who had weight loss surgery!  Caveat Emptor - let the buyer beware - yes even in medicine.

Life saving weight loss surgery claims another

Since it's January, there is a big push by those selling weight loss and also for weight loss surgery.  TV is showing a lot of programs on weight loss, and weight loss surgery.

When they advertise weight loss surgery by giving case histories, there is a small (well, maybe not so small) problem.  Many patients die from the surgery which is supposed to induce an artificial case of anorexia so the patient either cannot eat much or as in the more invasive procedures like gastric bypass, cannot eat much and doesn't digest much of what they do eat.

One patient who had been followed since being featured on the first show in 2010, was a Haitian lady named Dominique Lanoise.  Lanoise weighed in the 600 lbs range and was bed bound.  From what is known about her, she was slim when younger and ended up having 6 children - she apparently gained after pregnancy.

She was a charming lady, who though bedbound, would sway to the music in her bed.  The documentary showed her eating large amounts of food, rejecting the diet food (they put her on a 700 calorie diet in order to reduce her for surgery) and kidding with her daughters who adored their mother.

Dominique was convinced that a gastric bypass would save her life and be a quick fix for her obesity problems which she felt was out of her control, so she searched until she found a surgeon willing to operate on her, at her current weight.

She lost weight after surgery and was transferred to a rehab facility but two weeks later, she checked herself out and returned home.  A couple of months later, she died, apparently from a heart attack which WLS afficionados assured us was "unrelated" to the surgery.

However, the nutrient shortage from the gastric bypass can raise the risk for heart attack significantly, because the heart is starved from essential nutrients, including protein.  That seems the "elephant in the room" when one researches Dominque's story - certainly those providing weight loss surgery do not want to admit that this "life saving surgery" actually hastened her to an early death.   

Another TLC patient, Donald, also had weight loss surgery.  He was also around 600 or 700 lbs.  Donald did try to move after surgery and do what the doctors told him to do.  Patients are told that unless they make lifestyle changes (like dieting, counting calories and exercise), the surgery will not work for them. Ironically, those same changes will work for weight loss without invasive surgery.

But then, suddenly and mysteriously, Donald went into a coma and emerged with Guillan Barre or "French Polio" - which put him into a wheelchair.  Disease after gastric bypass is common but again providers tell us it's unrelated to denying the body of proteins, fats and vitamins.  Last seen, Donald was getting around in a wheelchair and rapidly regaining weight although trying to exercise it off - another myth one sees on TV - exercise doesn't take much weight off us - how well I know about that one. It does make us healthier but it's not really good for weight loss.

That some are still selling a surgery which hasn't been done for years on non obese patients, a surgery which the inventor thereof dropped in 1980 because of the high complication rate, truly amazes me.

There seems a conspiracy of silence among patients as well as providers.  Patients who regain and live, are reluctant to tell about their surgeries  because both the public and their doctors blame them for their gain.  Patients who have become ill from the surgery and live long enough to be reversed and get back normal digestion, are often reluctant to talk about their bad experiences because new ops and providers can get mean to those who talk too negatively about weight loss surgery.

Patients are so sold on this surgery that until they get really ill, they refuse to admit that it has a high complication rate and a higher recidivism rate.  When I began to research it in 1999, I was shocked that many studies were on line and told the truth openly, but patients were not reading the studies and only listening to new ops who were excited and seemingly successful.  Even successful patients who have suffered difficult complications and talk about them in blogs, have taken a lot of criticism from "the community".

So people continue to jump on the table for a surgery which sounds like the ultimate cure because many do not encounter the "other side", i.e. the dark side especially if they do not have internet access or know where to look.

Informed consent information on all surgeries can be found at:
http://obesitysurgery-info.com   

In conclusion, a friend of mine who weighs over 500 lbs but has refused weight loss surgery, says she's outlived 48 of her friends who had weight loss surgery.      

gastrointestinal liner - or endo barrier

Another weight loss surgery? Oh, excuse me this is "not surgery" say those advocating it.

(Hubby says it looks like a condom for your guts!) :)

Of course it is surgery but there is no incision. That's what they mean by "not surgery". It's stuffed into your mouth, down your esophagus through the lower stomach valve and into the first couple of feet of your small bowel. What it does is prevent a lot of food from being absorbed.

Unlike the good providers who are pushing it say, it does NOT prevent sugar from being absorbed because sugar is mostly absorbed through the mouth and upper part of the stomach. They hope the prospective customer is (a) desperate to lose weight and (b) doesn't know much about the GI tract.

What is prevented from being absorbed is the good stuff, the proteins and fats (yes, you do need some fats to lubricate) but sugar? Absorbs just fine. So much for the resolution of diabetes which is not happening with this device.

If you think you've heard it all, there is more. 100 % of folks who had the "Endo Barrier" implanted, got at least one negative complication.

These can include bowel obstruction or nausea/vomiting or pain, and bleeding. You can also get a fever and "device migration" which means the long plastic tube they inserted, moves down through the GI tract. That might mean an invasive surgery to remove it since your small bowel is some 22 feet long and the lower parts of it are hard to get to. Not nice experience.

The providers admit this is a temporary device and you know what that means - as observed in Australia and places where they are inserting some of these, people tend to regain the lost weight.

So don't let the excited providers, giving a rosy picture of the endo barrier (which they are calling the "gastrointestinal liner") influence you. Likely this device is far more trouble than other procedures and not really effective in the long run.

Bariatric surgery safe and effective?

We've been there before.  Every so often they have a new study "proving" gastric bypass (particularly) is "safe and effective".  And when one looks at the studies more closely, one sees, that studies which turn out with positive results are not exactly, what they seem to be.

The new study published in the JAMA of September 19, 2012 (

Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; et al.

JAMA. 2012;308(11):1122-1131. doi:10.1001/2012.jama.11164)  is no exception.  The American Medical Assn, publisher of this journal, offers a free read on this study (because it's basically an advertisement for gastric bypass surgery).

First of all, the mean BMI of the surgical group was 45.  However, the average BMI of the gastric bypass patient is over 50.

At the 6 year point, continue the researchers, 76% of the gastric bypass patients had maintained a weight loss of at least 20% (this was erroneously reported by the news services as 28%).  Apparently the 27.7% reported by the news service, actually referred to the weight initially lost and not that maintained! 

Doing the math, the average patient, 5'5" likely weighed 270 (BMI 45).  If they maintained a weight loss of 20%, they maintained a loss of 54 lbs leaving their weight at 216 and a BMI of 35 i.e. still clinically obese and if they are diabetic, still qualified for weight loss surgery!

And for this modest maintenance, they take the chances of the long term repercussions of severe vitamin deficiencies, including the B complex vitamins which can cause many symptoms from seizures to mental fog and gastro paresis (paralysis of the stomach), leaky bowel, lessened immunity, micro-nutrient shortages (zinc etc) and a host of other issues.

Doing the math on this doesn't make any sense, does it?  Of course, the news services and some providers hope you won't do the math!

Best if you want to have weight loss surgery, to choose a less invasive option but it should be noted that weight loss surgery patients do the same work that non surgical patients do, to keep off the weight. That is, if they do not diet and exercise, they will regain the weight, regardless of how invasive the surgery.  Al Roker, a gastric bypass patient, started to regain and told the "Today Show" folks that he not only runs several days a week but also counts his calories every day to keep off his weight. That behavior will keep off weight without any weight loss surgery.

The whole idea of weight loss surgery, how it is sold is, that it will make you normal and you can eat whatever you want and never have a weight problem again. At seminars, they often, parade 2 year (and more recent) post ops who are success stories but the small print on every surgeon's web site and in the consent forms, says you have to diet and exercise to keep off any weight at all. And if you have to diet and exercise, you can do that without surgery!

If it's too good to be true - it probably isn't.

Dr Phil's sneaky ad for weight loss surgery

Dr Phil, on a re-run show, aired again this past week, recently featured a lady who had just been named "the World's Heaviest Woman" in the Guiness Book of World Records.  She weighs over 700 lbs.

The show was the usual anti obesity show and how this lady, Pauline Potter, was going to die soon and how Dr Phil was going to intervene like the knight in shining armor he feels he is.

The problem with the show was, it was very incorrect in the information given. I understand that reality TV is often not very real but seems that a show like Dr Phil should keep more integrity than that.

Apparently, according to Pauline's own website, she celebrated getting to over 700 lbs and sold videos of her moving around etc on this website. There is no indicator that she's not still selling these!

Also, the show first aired in November 2011 and Pauline and husband claimed they were divorced however, an article in late 2011, mentioned they'd gotten back together again, their love rekindled in L.A. in 2010.  Dr Phil had asked on the show if they had problems with intimacy and Pauline said they did not, but in two articles, the ex or now- non ex, admitted that they were afraid to have intercourse because they might break the bed.

Pauline told a couple of reporters she planned to lose 200 lbs in early 2012 because she and her ex - non ex husband wanted to have a child together (she has an older son from another marriage).

And Pauline, who weighed around 643 lbs when she appeared on Dr Phil, weighed over 700 lbs in Jan 2012 so the food Dr Phil had sent her had not appeared to help with her weight loss.

The strangest thing on the show was that Dr Phil introduced a Dr Ted Khalili as a "world renown weight loss expert" and offered Pauline, Dr Khalili's and his office dietician's help in her weight loss. What no one mentioned was that Dr Khalili is a weight loss surgery surgeon in L.A.  Pauline did mention in one article that she planned weight loss surgery but this was never mentioned on the Dr Phil show.

And strangest of all, is that the last mention of Pauline I can find is in Feb 2012.  Did she die from the weight loss surgery like the poor "Half Ton Mom" did?  Did she stay at her present weight or close to it?  If anyone has heard where Pauline is recently, do let me know. I very much, hope things went OK for her but having seen so many negative results from weight loss surgery, I cannot help wondering how she is now, especially that I cannot find any recent mention of her on the internet.  Also, in the cases of the very obese I've seen, weight loss surgery has not helped them. Often, they ended up gaining a lot of weight back - for example Allen from "Big Medicine" never did get out of his bed or worse yet, the weight loss surgery patients who started out very large, did not live like the "Half Ton Mum" of TLC who died 2 weeks after her gastric bypass.

All this to remind us that TV is for entertainment only - we should really hesitate to believe anything we hear on TV even from a source who seems so reliable, like Dr Phil.

Plastic Surgery after weight loss surgery

RNY-loose skin-

The following is from my notes watching a program called "The Real Skinny" on TLC.  (The Real Skinny, program on gastric bypass patients and loose skin on "Discovery Health".)

"after all my hard work, after all the foods I've cut from my diet, I still have to deal with my excess skin...  If I have to live like this all my life, I'd rather be fat again. " (male gastric bypass patient)

Dr Katzen has done many loose skin surgeries on gastric bypass patients.. His comments about operating on gastric bypass patients echo what many many other surgeons have said about it. Though being fat is thought to be very unhealthy, the fragility of these weight loss surgery patients raises the question that having a surgery which depletes the body of nutrients might be much more unhealthy that is, the cure seems to be, in some cases, worse than the "disease".

"A lot of surgeons are afraid of these plastic surgeries for a multitude of reasons...these surgeries are very risky surgeries ... I'm taking off a lot of skin, a lot of fat..."

"These patients are higher risk just because of their gastric bypass: they are typically malnourished... Just the fact that you've had gastric bypass increases the risk of bleeding, infection, and wound separation. For a circumferential body lift, I use 1000 to 1500 stitches...these surgeries typically take 8 hours... We pretty literally cut them in half and put them back together." --- Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA

Carnie Wilson, who admitted to have regained up to 250 lbs, 12 years after her gastric bypass surgery, was, none the less, much more fragile, healthwise than she was before surgery.  She said she was pre-diabetic and more.  It took her 4 weeks to recuperate after her lap band surgery...whereas her recuperation after a much more invasive surgery, gastric bypass, was much faster.  That is, she was much more healthy going into her gastric bypass despite weighing almost 300 lbs, (she's 5'1") than when she was when she went into her lap band surgery.  The difference was even though she weighed 40 lbs less than she did when she had the bypass, she had been not absorbing many vitamins and nutrients for 12 years.

When my DH had a brain bleed from taking the daily aspirin, there was another lady in the ICU - she had been over 300 lbs before her gastric bypass...her husband told me, tearfully, she was so frail now.  She did not survive.

Back to the show, Dr Katzen was shown doing a loose skin surgery on a male patient.

On this patient he did thighs and a circumferential lower body lift. There was a lot of fat left...

"we put him together with a type of super glue...the problem is too much super glue...the drain sucks out the fluid and allows the body to stick together."

"These patients usually exercise a lot to try and get rid of the loose skin but exercise alone won't get rid of the loose skin.  That's where I come in."

Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA

There is a lot of pain after these plastic surgeries for a few weeks after. "It's taking a lot longer to recover than I thought it would.". Four weeks after the surgery, the male patient was still not healed. He had a hole in his body about the size of an egg. "I felt wetness and my incision had opened up.", he told the camera crew. He had developed a staph infection in his open wound.

"we can't stitch up the open wound because if there is one germ left in there, they can develop a huge infection i.e. sepsis". Sepsis is a general body-wide infection from which there is a poor survival rate. This patient's relationship with his girl friend was strained, he said, and at filming they were hardly talking to each other.  He had a wound vac to suction out the hole.

It took him 6 weeks to heal and he still needed another surgery.

"my friends ask me why I want to go ahead with another surgery when I suffered all those complications, infections etc but I want to finish the job.", he explained.

Both patients have a huge scar which goes all around their bodies.

Note: part of Carnie Wilson's reasoning for having the "band over bypass" surgery is that she's got a job as a spokesperson for Allergan which manufactures the lap band.

The providers have nothing to lose. If the patient regains the weight or gets sick, they blame it on the patient...or quote statistics which suggest this type of reaction is very rare.  And if the patient lives and regains, the surgery is no longer mentioned.  If the patient dies or becomes very ill, the providers often make the patient afraid to speak out.

"I bury my mistakes" one gastric bypass surgeon joked to me.

In this surgery as in all commodities, it's a case of buyer beware.

Research sources:

Www.TLC.com/therealskinny

"Wilson Phillips Still Hanging on" show on the TV Guide network

Carnie Wilson - 2nd weight loss surgery

Carnie Wilson, singer and daughter of Beach Boy, Brian Wilson (pictured in red dress in photo with her singing group);  got a RNY gastric bypass, 12 years ago. She lost 150 lbs initially, and told the press, "It was so easy -- it was like I blinked my eyes and the scale went WHUUP!". 

A frenzy of people signed up for gastric bypass surgeries. One person who worked for a weight loss surgery surgeon, told the news that every time Carnie Wilson appeared on TV, their phones rang off the hook!  The surgical group who did Carnie's surgery, dramatically simulcasting on the internet during her surgery and launching a huge publicity campaign in partnership with the manufacturer of surgical instruments, went from doing 5-7 weight loss surgery procedures a week to doing 12 weight loss surgery procedures a week.  The future looked rosy, for Carnie and the Weight Loss surgery industry.

But dark clouds were gathering on the horizon.

Soon after Carnie Wilson's famous quote to the press above, she began regaining the weight, despite fighting hard to keep her weight off, including, hours of exercise, engaging personal trainers, putting salt on desserts so she wouldn't be tempted and publicly humiliating herself, talking about her weight problem. By 2011 when she appeared on the Dr Oz show, she'd regained to her average weight before surgery, about 240 which is a lot for her since she's only 5'1".

Apparently, she lately, had a gastric band placed over her bypass to force a restriction of her food intake, and has lost 30 lbs so far.

The bottom line is the gastric bypass or any weight loss surgery, is no free ride.  Just like using a non surgical tool like weight watchers, it's a lot of work on a daily basis for the rest of your life or you will regain the weight and/or get sick!  A percentage of gastric bypass patients get sick anyway, even if they do everything right.

Carnie Wilson, like so many others, was given the impression surgery worked automatically and easily.



That so many people embark on weight loss surgery seemingly ill prepared for the reality, can be at least, partially blamed on allowing the mass advertising of surgery without requiring the advertiser to list side effects and disclaimers like "results not typical".  Some weight loss surgery surgeons have an annual income of $1.5 million dollars - people have done strange things for much less money than that.

Let's hope the second weight loss surgery procedure will bring her what she's looking for.  She's such a beautiful woman and a great singer and somehow all of that tends to get lost in her frantic efforts to get slimmer. To me, that is sad.

Click on this blog link to see photos and story.