Tuesday, June 28, 2016

Misleading study finds that gastric bypass is a good idea?

Most people only read the first paragraph of a news article and the media takes advantage of that fact, assuming most folks will not read the rest of the article and only a very small percentage will research the article.  Therefore, the news media can inform the public of anything they want to sell, pretty much assuring that their disinformation will hit the target audience.

The first paragraph of a recent Reuters news service article reads: 

"Ten years after gastric-bypass weight-loss surgery, patients in a recent study had managed to keep off much of the weight they'd lost."

That sounds impressive but even reading the rest of the article raises rather large doubts - for example they were only able to contact a little more than half the original patients who got RNY between 1985 and 2004.  The cohort was 1087 patients and they were able to contact 651 of them.  That raises the big question of how hard did they try to contact the cohort - did they, for example, check and see which ones had died?  (Obituaries are public domain and easily searchable on the internet).

And despite the impressive sounding first paragraph, 10 years after an invasive surgery which is known to cause malnutrition etc, patients contacted had only kept off 25% of their excess weight.  That is, if the excess weight was 100 lbs, then at the 10 year point, they only were 25 lbs lighter than when they had the surgery - hardly worth an invasive surgery which has a higher mortality rate than open heart surgery.

Another questionable thing, is, this was a contact by phone - in other words, the patients they did contact, self reported the results and it's common knowledge that patients when self reporting, especially after elective surgical procedures, can be extremely inaccurate or leave out very pertinent facts - like for example, it appears non of the patients were asked if they had metabolic bone disease, a common repercussion of gastric bypass surgery.

At the time of their surgeries, 59% had high blood pressure... but 10 years later, that percentage had only gone down a few points i.e. 47% still had high blood pressure, a risk factor for many things including stroke.

It appears that many surgeons are, for some reason, not learning the newer procedures like gastric sleeve which are safer than gastric bypass.

And one might question whether surgery is any longer a viable option since newer research suggests that the appetite centers are in the brain and not in the GI tract.  It should be noted that Dr Nowzaradan of TLC TV fame, admitted in an honest moment, that 5 years after a gastric bypass the surgery is no longer effective as far as weight loss.

Sadly most folks who read the Reuters article will only read the first paragraph and thus be impressed, perhaps making a life changing decision which while a questionable treatment for obesity, might endanger their health for life.

Saturday, May 21, 2016

Losing and regaining weight

So there is this lady I know on the internet. She lost over 200 lbs and attributed it to Weight Watchers and dancing.  I followed her as she posted a video of her getting her lifetime membership award at Weight Watchers and as she started to lead a dance class at a local gym.  She was a real inspiration in my own weight loss journey. And she was even featured in a TV story.

That was in 2009 and I saw a recent video of her - she's still dancing and is fit, but she seems to have regained at least 100 lbs or more.  I starred at her, astonished,  because somehow, I guess I thought she would never again, regain.  I do admire her for still getting out there and teaching dancing though.

In truth, damaged metabolisms can happen for all reasons, including too much dieting. Experts have said that, with every diet, our metabolism shrinks down a few hundred calories a day. And those like me, who had tonsillectomies in the 1950's and 1960's often, got damage to the pituitary gland which tends to greatly lower the metabolism. Bottom line, many of us do not have to really overeat, to gain back the weight.  In fact, if we eat the "normal American diet", even on a moderate basis, we can easily regain the weight and then some, as I found out in my numerous attempts to diet.

This time, I have kept off the 106 lbs for over 6 years. How?  I count every calorie that goes into my mouth.  (we joke that "if it goes internal, it goes in the journal").

What is sad, is that no medical provider has ever told me that I might have to count calories for the rest of my life if I wanted to keep off the weight.  Neither did they tell me that some folks become overweight just by eating normally.  (Society's image is, that if a person is fat, it means they do nothing but sit on the couch eating bon-bons and medical providers, many of them, seem to agree with this image).

Is it worth it to me, to count my calories to keep off the weight?  Yes it is to me,  because I am healthier at a BMI of 27 than I was at a BMI of over 40 and I fit in auditorium chairs and other places better and I don't have to have a wardrobe in 3 sizes and I do not get any negative feedback from medical providers... but it's a matter of preference and lifestyle and anyway, I think we should all accept each other for the beautiful humans we are and not quibble about weight or other superficial things.

That being said, I think that medical providers should give better advice on how to lose weight and keep it off (I suspect it usually requires counting calories, measuring and journaling food intake for those of us with pituitary damage or "those genetics") instead of blaming us for being overweight.  Experts say that our size is 60% genetic and there may be some 40 genes involved  (Dr Rudy Leibel, obesity expert for example).  Bottom line - who we are should not be determined by our size!

Monday, March 28, 2016

Fit to Fat to Fit on TV?

There is a series on "A & E" TV called "Fit to Fat to Fit".  The show has two protagonists.  One of them is an overweight person (usually quite overweight like over 300 or 400 lbs) and a personal trainer.  The personal trainer is usually very slim and fit and decides to put on some weight so he or she can "understand" how it "feels to be fat" (as the show states).

One of the shows I saw, had a lady who really did usually, watch her weight and was able to gain 40 lbs rather easily. But two of the shows had a male personal trainer who obviously was naturally slim (while eating healthy but having "cheat food" every so often).  When the male personal trainers tried to gain weight, they had to work very hard at it, eating 5000 calories or more a day and even at that, they could not gain much more than 20 or 30 lbs and didn't look overweight at all.  They too, however, at that point, said they now could understand how it felt to be "fat".

What annoys me, especially about the latter two shows, is that everyone I've known who is able to gain large amounts of weight (including me!), has genetic and metabolic issues which TV shows like the A&E programs do not take into consideration at all. Science does acknowledge this. For example, obesity scientist, Dr Rudy Leibel states that 60% or more of our size is genetic and/or physical rather than what we eat.

TV star, Al Roker, who had a gastric bypass, has told his audience that he does count his calories and also does 45 minutes of running several times a week.  He's not the exception - he's the rule.  Surprisingly, a study which included members of NAAFA, a social club for people of size as well as average size people, found that NAAFA members actually consumed considerably less food at meetings and banquets than did those of average size.

But sadly, TV which is the informing source of most folks who do not have the time to read, is telling a fairy tale.  People on TV asked how they got so fat, invariably say they eat too much but their "too much" is often less than the amounts that average size folks eat - those who do not become overweight.

I get very weary of TV shows blaming overweight people for their size.  Surely true that an overweight person can keep to a so called average size but it takes lots of work, including saying "no" to any type of fast food, in addition to counting caloric intake (and I mean writing it down or keeping it in the computer - the latter is made more pleasant by great clients such as "My Fitness Pal" etc).

I feel shows like "Fit to Fat to Fit" do a great deal of damage to folks who do have genetic factors and physical factors contributing to their size.  I know about this on a personal basis.  I was very active as a child and kept slim...until I had a tonsillectomy and right after that, I started gaining quickly despite not changing my level of activity (in fact, after, I was more active after surgery, because I wasn't sick in bed all the time like I was before surgery).

Later on, much later on, like when I was in my 40's, still pondering why I gained weight after my tonsillectomy, I read that 50-60% of kids who had tonsillectomies in the 1950's and 1960's, sustained damage to the pituitary gland which of course, would adversely, affect the metabolism.

So, after blaming myself for so many years for my "weight problem", I realized I had a medical reason why I gain weight so easily and since then, I, ironically, have been able to compensate for my lower metabolism through mild calorie restriction and have managed to lose and keep off 106 lbs since 2010.

Shows like "Fit to Fat to Fit" should be balanced out by a more realistic portrayal of obesity, and the genetic and physical factors involved, instead of intimating that all fat people do nothing but sit on the couch "eating bon bons".  Society as a whole would be better off.  Because the truth makes everyone free.

Thursday, March 10, 2016

Diet Pills?

pillz, pillz, pillz don't work for losing weight!

A blog reader (who probably didn't bother reading either my blog or the blog she was advertising) left a message in the comments here, advertising a new weight loss pill.  When I looked at the ingredients of this medication, it was old home week - a couple of nutrients (which don't promote weight loss) and other chemicals I had encountered previously, many times, Ad nauseam...which have been well proven as ineffective for long term weight loss and some of which pose a risk to the heart etc.

Listed first was a form of Phentermine.  Perhaps older readers may remember this drug,  as a part of a weight loss combination, "PhenFen" which was taken off the market because it was not only, ineffective on the long term but more importantly, risked the health of those who took the medication. Phentermine speeds up the heart because years ago, it was thought that would cause weight loss but actually, it more endangers the heart than what it's supposed to do.  And as the wife of a spouse experiencing heart problems (he recently got heart bypass surgery), I would definitely state you don't want to mess up your heart for anything and especially, an ineffective weight loss drug.

Calcium and L-Carnitine are nutrients, Caffeine is totally ineffective as a weight loss drug (or else all the coffee drinkers would be slim!) and again, it's hard on the heart, and finally Chromium Picolinate, a substance that was thought to be effective for weight loss in the 1990's (I had a friend who desperately did not want to do Weight Watchers so she tried every new diet pill) but I have never seen it work as a good weight loss drug and several studies greatly questioned its effectiveness.

The blog this individual linked, supposedly an informational about this drug, was full of misinformation and included a photo of one of the Biggest Loser TV show winners (who, of course, did NOT use weight loss pills to lose her weight).  Although there was a passing mention that pregnant ladies and anyone on medication should consult a medical provider before taking this medication, the blog claimed the drug is "totally safe" etc etc. And by the way, this medication is not inexpensive - for a bottle of 30 pills, they want $69 bucks.

Bottom line - if you see an ad for a weight loss drug, run the other way.  It's likely healthier to remain "of size" than take drugs to lose weight - drugs don't work on the long run and as you can see above, many ingredients are likely to be, risky to your health.

Like the singer stated "There is no easy road to a place worth going."  And the time folks spend on ineffective (and risky) practices for weight loss, would be much better used on programs like Weight Watchers (i.e. sensible programs), or just getting healthy by making healthy food choices and starting a regular cardio exercise program.

Thursday, February 11, 2016

More Weight Loss Surgery ads on TV disguised as shows

Filmed in High Def and artistic cinematography and certainly scripted (as all "reality TV" is), the show, "My 600 lb life" is certainly watched by many and the producer who is the son of a Houston weight loss surgery surgeon, is definitely going to the bank.  A great improvement on earlier shows like the old series "Big Medicine", artistically speaking, one can be certain these shows have the same effect on the TV audience as the earlier offerings.  After every show on weight loss surgery, more than one weight loss surgery clinic remarked that their phones were "ringing off the hook" with prospective buyers.

  People featured on "My 600 lb life" i.e. the patients, not only do not get compensated for their appearance on the shows, but they also, have to pay for their weight loss surgery and/or skin removal surgeries.  There has been some speculation that the patients get a bit of a discount on the procedures but a couple of thousand bucks off on surgeries which can cost from $15,000.00 and up, isn't much of a financial aid.

This season, a new show has been added.   They call it, "Skin Tight" and is ostensibly about the plastic surgery that weight loss surgery patients (who lose the weight too fast for the skin to respond) often need.  Truly (and as the show portrays), many weight loss surgery patients have so much loose skin that they feel their bodies are more uncomfortable than they were when they were at their starting weight. 

The photography in "Skin Tight" is interesting.  The so called "skin surgeries" are long and very painful, a fact which is (of course) omitted from the show. Most patients I've talked to, describe it as more painful than the original weight loss surgery.  The skin surgeries involve long incisions and long hours under anesthesia and long healing.  But of course, the patients seen on "Skin Tight" all smilingly say it was totally, worth it because they "look so good" now.

However, if you watch the cinematography closely, you will notice that the patients who have undergone "skin surgeries" (most of them, have multiple procedures), are photographed from the front in the before photos and from the side or even covered up in  clothing in the after photos.  So even though the smiling patient says (according to the script) how wonderful life is, I wonder if the long scars and months of pain are really so wonderful.

It bothers me a lot how much of a business, the medical field has become.  Often, more expensive procedures are sold when a less expensive procedure (or no procedure) would do fine.  And often, despite the glowing reports we see on TV, the end result is fraught with problems and/or repercussions. 

There is no doubt in my mind that the public wants these surgical procedures because being of size in our society is considered worse than anything else.  But it seems that surgeons face a rather interesting dilemma.  Either they do invasive surgeries like the gastric bypass  which, albeit causes a large weight loss quickly (mostly muscle - good tissue you don't want to lose), can, in the long run, cause patients,  to suffer, many complications and can even shorten lifespan because of the malnutrition of fats and proteins and the lack of some 100 micro-nutrients a day which no longer can be digested.  Or they do the safer weight loss surgeries like the lap band or the gastric sleeve which do not offer the desired quick weight loss but also do not cause the complications of the more invasive surgeries.  

Surgeons who do the latter, often have to offer their patients diet plans including shakes etc.  But the truth of the matter is, that all weight loss surgery patients will not lose the weight unless they diet and exercise - these two things which, of course, cause a weight loss without surgery.

Best to remember the Buddy Valasco ("Cake Boss") statement, "It's TV, Baby!"

Or to recall a testimony by one of the major TV networks in the 1950's when they were caught cheating on the quiz shows.  Said one of the CEO's, "Well, the people were entertained, we made money and no one was hurt!"  

Unfortunately with today's shows, featuring weight loss surgeries, although the public is entertained, many people are hurt.  A sad thing to sacrifice a human's quality of life and longevity, for entertainment.

Thursday, January 14, 2016

Thoughts about the TV show "My 600 lb life"

As I watch the TV show, "My 600 lb life", I see many issues .... Elephants in the room, things left unsaid like, the fact that at least 2 of the patients featured on this show, ended up with severe complications such as neuropathy and guillian barre (which the provider attributed to "obesity" even though it was after the gastric bypass that these folks suffered these complications). One  patient uses a wheelchair now (he could walk before his gastric bypass). Another 2 patients that I know of, died a couple of years after surgery which is before they would have died without surgery.  (The bus driver featured in the first or second season, died about two years after his gastric bypass - he had a massive heart attack while driving a school bus.)

First, it seems many of the patients feel the 'before surgery' diet is temporary but in truth, weight loss surgery does NOT fix a damaged metabolism...that is the patient will have to stay on the 1200-1400 calorie diet for life if they want to keep off the weight... it bothers me that many patients don't seem to understand this and so their weight loss after surgery greatly slows down or in some cases, they gain.

Second, with weight loss surgery, there may be a large initial (after surgery) weight loss as the person cannot eat because there is a healing process going on, but after the surgery is healed, the appetite (which is centered in the brain) comes back strongly.

When weight loss surgery was invented in the 1960's, medicine thought the appetite centers were in the stomach and by making the stomach very small, that would control the appetite... Studies and a greater level of knowledge that we have now, have taught us that the appetite centers are in the brain and the size of the stomach makes little to no difference in how hungry most individuals feel... This means that the entire theory upon which weight loss surgery is based, may be outdated.  So one wonders why some providers still do the invasive procedures like gastric bypass?. Well, surgery is a cash cow for providers, unfortunately... and sadly, many patients who have become ill with gastric bypass or have regained, are made to feel ashamed if they speak out.  One of my friends called this a "conspiracy of silence".  She, a weight loss surgery patient herself, died at the young age of 54.  She had been ill with her surgery and bed-bound for several years before her death.

Do providers know that surgery does little to nothing to control the appetite for most folks?  Unclear... They really might think that the surgery helps... To keep up with all the advances in medicine, a provider would have to spend all his or her free time reading...

Most of all, one cannot gain to a very heavy weight, unless one has some serious physical metabolic issues going on.  And no one seems to acknowledge this, although it can be found in medical literature .... And especially not the provider on the TV show, "My 600 lb life"...who assumes that every one of these patients is really stuffing him/herself. However, a revealing study found that members of NAAFA, a fat acceptance group, actually consumed less food at conventions than their thin cohorts!  It's true that people who get very overweight may overeat at times, but basically, most of them eat like many other Americans who do not become extremely obese... And yet these people are made to feel like they are total pigs when it comes to eating. I can't help wondering why providers don't seem to know more about metabolic issues which can cause obesity... 

I stumbled upon my metabolic issue...after spending a lifetime wondering why, if I ate like most around me, I became very overweight... A goodly percentage of folks who had tonsillectomies in the 1950's and 1960's got pituitary damage after surgery... My tonsillectomy was in 1953 and right after surgery, I began putting on weight...That is, before this procedure, I, being very active, was on the slim side, however, after surgery...eating the same amount and with just as much activity as before, I gained weight...

So in digging through medical literature (for years literally), I found the reason why I gain so easily.  Now why don't providers let us know about this, I'm wondering...like those folks on "My 600 lb life", the provider really takes them to task, when they gain weight...

To defend Dr Nowzardan, it's possible he doesn't know about the latest research...he's 72 years old and this may be one reason why people of this age (over 70) should be retired... I am 71 and yes, I do NOT have the brain power I did when I was, even in my 60's, and trust me, it drives me nutz!  To paraphrase Buddy on "Cake Boss" , one might say with emphasis, "It's the aging process, baby!"

Undoubtedly, some of us, like me and those folks on the TV show, "My 600 lb life" have no set point and thus, we can gain easily up to astronomical weights, without especially overeating, at least not more than most Americans who do not gain so easily...

I've tried to explain all this to providers... And most of them naysay what I am telling them. 

Metabolic differences and pituitary damage from procedures like tonsillectomies,  seems  something which, apparently, is not included in the medical school curriculum...


Saturday, January 02, 2016

Weight Loss surgery and dieting

I have heard many folks sign up for weight loss surgery because they feel they will "never have to diet again".  The next step is they go to a "seminar" held by the surgeon they are thinking of hiring. But the seminars are really mostly selling sessions for the surgery (I can only think of one surgeon who actually gives very informed consent seminars, detailing risks as well as benefits - this does not cut the number of people who go to him - on the contrary, they appreciate the info!).

Today, I met a lady who had had a gastric bypass in Oct 2015 and had recently attended a weight loss group meeting. (and keep in mind, most surgeons are doing the less invasive sleeve now).  She had lost 80 lbs but lamented that no one had noticed her weight loss.  "But I lost it fast," she added.  That prompted me to ask her how and that's when she said she'd had a gastric bypass.  I explained that a fast weight loss like that was mostly muscle and that's why it didn't show a lot of reduction in size.  She looked sad and said that she knew that.  She was NOT told that surgery would not take off that much fat and she'd have to diet to do that - and she'd already been back to the hospital because she had developed ulcers after surgery and couldn't keep anything down so had needed more surgery.   I can't help wondering if, had this lady been informed of the risks, she might have gone a different route.

But the sad thing was she really didn't lose much fat with the surgery despite her inability to eat much and ended up joining the weight loss group, even - with having had the surgery.

I gave her my web site and also, some of the informed consent info she should have had before surgery.  "The advantage of a gastric bypass", I concluded, "is, it is reversible and you should probably consider having it reversed."  She told me her surgeon had told her only the sleeve was reversible (it's not reversible, because they cut off most of your stomach and throw it in the garbage i.e. "send it to pathology" as the surgeons call it). I said, "no, it's the opposite - the gastric bypass is reversible" and I told her how they reversed it., explaining that a reversal would still provide her with some restriction but give her normal digestion back.  Hopefully she will consider having it reversed.  I told her she might have to go to another surgeon to have this done.

Some surgeons send pre ops to my website to obtain informed consent information but obviously this lady's surgeon had neither given her informed consent info nor did he send her to my website.  Because the 80 lbs she lost was mostly muscle, she still was very overweight.

The bottom line with surgery is, it really, isn't that effective for weight loss.  This lady told me she thought it would kill her appetite but it hadn't done this and I explained that this is because they now know, the appetite control center is in the brain, not the stomach (as formerly thought in the 1960's when these surgeries were first conceived of).

As for the gastric bypass, it's very effective at greatly diminishing the ability to digest proteins and fats (and yes, we do need some fats) which is why most surgeons have switched to the sleeve which, albeit invasive, is much less invasive than the older surgeries.

Another interesting thing - when I told this lady who had had the gastric bypass that I knew several 300 lbs gastric bypass patients, she looked shocked - she didn't know that so many had regained the weight, although she was already having trouble with this.

All I can do here is *sigh*.  How I wish everyone would have the informed consent information that they need to really make the best decision for them.  Informed consent after the fact, can be bitter but this lady had several friends, also of size and I'm sure my information helped them in case they were considering surgery.... (the photo is of my friend who died in 2006 from the aftermath of the weight loss surgery she'd had in the 1990's. - she spent her last days, before her untimely death, warning folks to not have weight loss surgery.)