Wednesday, February 27, 2008

A Whole Floor to treat sick WLS patients?

I was talking with a nurse (RN) who works in neuro ICU in a large hospital in our town. I made some comment about those ICU nurses working super hard (they do - each nurse only has 2 patients and even at that, they basically hardly get to sit down during a 12 hour shift).

She surprised me by saying that was NOT the hardest place to work.

I naturally, asked her what could be harder.

She said that this hospital was a center for treating sick gastric bypass patients, having a whole floor dedicated to those patients. She had worked there once, she told me and felt that was the hardest place she'd EVER worked, even harder than neuro ICU.

I asked her why and she answered, "Because the 'gastric bypass gone bad' patients are so ill - it is so sad!"

Keep in mind that neuro ICU is where those patients with brain bleeds, strokes and brain cancer go.

But this nurse was basically saying that as ill as the neuro ICU patients were, the sick gastric bypass patients were even sicker!

Many people choose to have a gastric bypass after talking to a couple of happy post ops (most of whom are less than 2 years out and all of whom are less than 10 years post op), and attending a seminar in which the presenter shows a nice looking drawing of what is done (which doesn't have much resemblance to the real thing), parades some happy new ops and makes promises like "if you don't like it, it can be reversed" (not true) or "you will never have to diet again" (also not true).

They watch shows like BIG MEDICINE where all the episodes have happy endings and sick patients are never shown. Those who are losing TOO much weight. Those suffering from extreme malnutrition who cannot get out of bed. Those who get neuropathy and end up with mobility problems.

Sometimes pre ops ignore people they know who have had a bad result or even have died after weight loss surgery.

That's because the few post ops they get to meet (the happy ones) assure them that the sick people are a rarity and this is a myth they really want to believe.

A friend who is a medical provider told me about one of his patients who weighed over 500 lbs and rolled into his office in a wheelchair. She told him that her daughter had had a gastric bypass 5 years previous. "She's slim now," said the lady, "but she's been frail and sickly ever since." The mother felt being so large and even having to motivate in a wheelchair was better than what her daughter was suffering.

A whole floor just for sick gastric bypass patients. A whole floor of a large hospital. A place we will never hear about on "Big Medicine" or in the media.

Thursday, February 21, 2008

fat people cost more money to treat

The latest spin from the press is how fat people cost less because they don't live as long as slim people... news media has been buzzing about "The costs of Obesity" for some time now.

What is costing billions of dollars in the treatment of obesity is WEIGHT LO
SS SURGERY! The solution seems surprisingly simple. if insurance stops paying for weight loss surgery, and the complications thereof, then healthcare costs will immediately plummet.

A lot of information is missed by the fat-a-phobic media and others who look upon the fat population as a walking gold mine.

1. it's not a given that fat people are sicker than slim people.
2. it's really unfair to accuse fat people of "absenteeism"
3. it's not a given that being thin ensures health.
4. Dr Rudy Leibel states that although there MAY BE (may be... not definitely?) some advantage to being "normal weight" THERE IS NO EVIDENCE that fat people forcing their weight to lower than their setpoint, enjoy that advantage.... NO EVIDENCE? Right from the horse's mouth.
5. There is NO EVIDENCE that fat people have a shorter lifespan than normal weight people. Like I met this nurse yesterday who takes about a size 4 - perfect weight who lives on junk and fast food. Does anyone REALLY think that her diminutive girth will prevent that fast food from gunking up her arteries? It's interesting how people did not notice that in "Super Size Me" Morgan Spurlock ended up (after a month of 5000 calories a day at MickyD's) STILL slightly underweight but had developed FATTY LIVER, hypertension and high cholesterol. i.e. as many epidemiological studies we have to suggest that fat people have shortened lifespans, there are an equal number of epidemiological studies to suggest that there is no significant difference between the lifespan of the overweight or obese and that of people with weights in the so called "normal range".

What EVERYONE is forgetting: We are ALL living longer, fat and slim and there are large numbers of people getting into old age who didn't make it even when I was a young 'un. THAT'S what's costing us money... OLD AGE diseases which we never had to treat in quantity before recently when we developed ways of holding "Old Man Death" up the apple tree for a few years.

Of course, I suppose for the advocates of fat-a-phobia, weight loss surgery (especially gastric bypass) can be a two fer... soak 'em millions for the surgery and complications and then shorten their lifespan... what a boon for the industry... :(

Thursday, February 14, 2008

diet pop - not so diet after all?

Years ago, in 1973, I went to Weight Watchers and lost down to a socially acceptable weight (about 100 lbs less than I weigh now!). And I seemed to be, for the first time, "easily" keeping it off. My secret? 6-8 cans of "Diet Rite Cola" (remember that brand?) a day. Or sometimes more. And a bedtime snack of whipped carnation non fat milk (1/4 cup) sweetened with --- artificial sweetener of course!

Unfortunately while enjoying my smaller size, I found I was getting some strange symptoms in my eyes. Blurs in the field of vision. Pain in the eyeballs. And lumps in the eye lids.

I went to the eye doctor and he wasn't much help. "You have lumps in your eyelids!" he announced, being champion of the obvious.

So I reaccessed what I was doing and "a lot of diet pop" came up. Could THAT be it, I wondered. So I gave up "Diet Rite Cola", cold turkey. And I gave up my nice evening snack of artificially sweetened whipped non fat instant milk. And in a month or so, the lumps in my eyelids disappeared as did the pain in the eyeballs and the blur in the field of vision.

I also pretty well trashed my gall bladder in that dieting stint in 1973 which I found out with a shock when I tried the - then newest thing - the Atkins Diet, had a day and a half of delightful parties in my mouth like cheese quiche and then had the granddaddy of all gall bladder attacks!. Well, that's another show but a common repercussion apparently, of losing a lot of weight on a diet. In fact, in many weight loss surgery patients, they just remove the gall bladder at the time of surgery because they know it's going to go bad anyway. A common repercussion, one of many from dieting which is buried in the medical literature and never talked about in polite company.

The problem with my giving up "Diet Rite" was that without the caffeine load I was getting from the diet cola, I started to feel extreme starvation fatigue (Gina Kolata called it "Primal hunger" in her recent book, "Re-Thinking Thin") It's our body's major production of hormones to force us to eat to gain weight and feel better. Worked for me. I'd felt this kind of fatigue before, (also identified in the Ansel Keyes starvation studies of the 1940's) when I was in my early 20's trying to force my weight to a socially acceptable number and I knew there was only one way to feel better. To eat! So eat I did. I'm not a binge eater. I just ate normally but that caused a 90 lbs weight gain.

The sweetener in Diet Rite Cola was saccharine, then considered "totally safe" despite the fact that it had caused some bladder cancer in the rat studies.

In 1980, another sweetener came out. Aspartame or Nutrasweet. I investigated it, wondering if it would work better than saccharine had done for me. But when I found it could turn into formaldehyde in your body, seemed kind of a no brainer that it was more than a bit toxic. That logical thought process and my observing a member of my online community (BBS in those days) get a case of Multiple Sclerosis rendering her bedfast which "miraculously went away" when she stopped consuming Nutrasweet, were a strong argument in my book to stay away from the chemical! I decided to not consume Nutrasweet or aspartame long before the anti Aspartame folks arose on the net. And to this day, I still remain an aspartame virgin.

My huge weight gain after my first tour of Weight Watchers was my fault of course, or so I believed.

However, a recent story tells us that some of my weight gain might have been because my heavy consumption of artificial sweetener had caused changes in my brain chemistry. ouch!

In fact, they are telling us, drinking only one can of diet soda a day can cause those changes in brain chemistry which can result in not only, weight gain but a significantly higher risk of heart disease.

After 2 large studies showed that people who drink diet pop had a 30 percent greater chance of gaining weight, and a 30 percent greater chance of low HDL cholesterol and/or metabolic syndrome, two heart disease risk factors, we recently have become aware of a rat study out of Purdue which actually showed the brain chemistry changes in the rats.

Too bad for the pop moguls who had just successfully de-valued the large studies of people "well you see, people who drink diet pop tend to eat more and exercise less" they told us. They don't want us to stop buying diet pop because Americans spend $21 billion bucks on it per year.

The pop industry is trying to de-value the Purdue study but it seems to just not go away. Not only that but now ABC news pulled up other things discovered about artificial sweetener - things which seemed to have evaded the news previously. For example, one expert opined that "the acid load delivered by soda of any kind" can be damaging.

The acid load. hmmm. I remember an internet forward stating that Diet Coke was good for cleaning the toilet. I had seen it eat away the tarnish on a penny in seconds after the penny was dropped into a small glass of it. My husband was not surprised at this - "phosphoric acid is a solvent used in some shops to clean tools," he told me. Diet Coke did clean the toilet well, I found out.

And after a lot of my teeth had had the enamel worn away, I read that cola can eat through the enamel on your teeth.

Diet guru Richard Simmons announced about 10 years ago, that when he quit drinking diet soda, he lost 12 lbs without changing anything else. He was largely ignored, of course.

Now people are beginning to listen. The anti aspartame folks telling us for years, that nutrasweet is an "excitotoxin" (kills brain cells and may be a secondary cause of other ailments like Parkinsonism) or that aspartame delivers a fairly heavy load of methanol into our system (kills liver cells and can cause cirrhosis and after that, can muck up the mitochondria and more) didn't have that much affect on people.

But tell them that diet soda may make you gain weight? That they listen to. Apparently having a dead brain or dying nerve cells isn't a dealbreaker but having a fat body is? 'Nuff said. For once, fat-a-phobia may actually cause us to be healthier.

(Although, they will probably find an equally dangerous chemical to substitute, says my less optimistic side, a chemical which after those selling it tell us it's "safe", people will flock to buy it.)

Sunday, February 10, 2008

Spinning a Good Story on Tragedy

Years ago, I photographed a wedding - a lovely young couple. And two weeks after the wedding, the groom died - fell to his death while hiking the Grand Canyon. That hardly rated an obituary, let alone a news story.

Truth is, of course most deaths never make it beyond the obituary - there are just too many of them. For example, there is at least one death at every marathon and sometimes more when it's a large marathon.

When I was working as a computer software developer, there was a 36 year old who dropped dead on the basketball court. He was in "perfect shape" and his death confused everyone. But even that didn't rate a story in the news.

But there is ONE type of death which DOES rate a news story and that's any death that they can even -remotely- link to "obesity".

Often, regretably they play upon the tragedy of someone's life to sell a diet or surgery or perpetuate a scare about obesity.

For example, one news story this weekend, carried the headline "Grieving mum 'ate herself to death'!" The story goes on to tell us that this lady binge-d food after her 22 year old son died from suicide. "She tried every diet," continues the article saying that finally she had a gastric bypass and died from complications.

Wait a minute. If she died from complications of a gastric bypass how on -earth- did she eat herself to death? Well you see, labors the story, she was fat and so that's why she died from a gastric bypass or that's why she had a gastric bypass? If you start to process the story, it doesn't make sense - she died from the gastric bypass and if she had just stayed fat, she would still be living. That is, had they treated her for the binge eating instead of surgically destroying her digestive tract, she would have lived to possibly have gotten over the tragedy in her life. Instead, the providers used the excuse of her fatness to compound tragedy upon tragedy as she died from the invasive surgery which has been known to be somewhat ineffective in individuals with binge eating disorder.

What the news pundits are hoping is that you won't notice the small mention of the gastric bypass since most of the article is about how she was constantly stuffing her face. And they are right, most folks won't notice it!

The second story was even more sneaky about being fat-a-phobic.

The headline in most news media (and this story went out over the associated press, nationwide) read "Diabetic complains of light-headedness before dying from heart disease"

Just reading the headline, what comes to your mind? I asked my 10 year old granddaughter about this and she basically said that must be diabetes type II or the type often erroneously linked to being fat and that the lady must have been fat.

Now it's a well known fact that most folks in reading the news, do not read much more than the first paragraph. So in this story, the clincher sentence stood by itself about 6 lines into the story.

"At 36, the bride was dead from heart disease."
Only a couple of lines before the end of the article (which most people won't read) we find this:

"She had a previous cardiac episode in her 20s and was a poster child — literally — for juvenile diabetes, relatives and friends said... recalled seeing the poster featuring her on New York subways."
Juvenile diabetes doesn't mean now what it used to - because we are told daily that this obese generation of kids is coming down with diabetes in their childhood.

So the only clue that we have in the whole article is that she was a poster child- literally- for juvenile diabetes i.e. that her posters were in the NY subways.

In other words, she didn't have diabetes type II at all - she had type I which is a totally different disease and not linked to fatness or lifestyle at all (usually the death of the pancreas in type I is caused by a virus or something like that).

Additionally what they don't bother telling us is whether she had a heart condition or not because if she did have a "cardiac episode" (do they mean a heart attack here?) in her 20's, she likely had a heart condition unrelated to the type I diabetes. Her picture was only carried in the NY Daily News which apparently originated the story. And predictably, she was not fat.

But fact remains, most people who read the story will walk away being more scared about diabetes and a willing audience for another series of articles which appeared this weekend telling the public how gastric bypass cures diabetes (it doesn't really - although the sugar levels drop during the fasting phase, the Swedish Obesity study observed at the 10 year post op point that only "35 percent of diabetics were still disease free").

What strikes me is the ruthlessness of the whole thing. How far will people go to sell a product? Advocating gastric bypass i.e. a partial destruction of the digestive tract, for normal weight or fat diabetics, misrepresenting this invasive surgery as a cure for anything and capitalizing on the tragic death of a newly wed to misreport her illness in order to promote a scare tactic to fat diabetics is more than ethically-challenged.

We've gone far beyond the old "first, do no harm" which doctors used to recite in the Hippocratic Oath. Now, it's more like do anything to sell the product and who cares about how many people are hurt in the process.

Friday, February 01, 2008

Open letter to Rep Mayhall about the no fat people served bill

Representative T. Mayhall, House, Mississippi, USA
re: HOUSE BILL NO. 282

An act to prohibit certain food establishments from serving food to any person who is obese, based on criteria prescribed by the state department of health; to direct the department to prepare written materials that describe and explain the criteria for determining whether a person is obese and to provide those materials to the food establishments; to direct the department to monitor the food establishments for compliance with the provisions of this act; and for related purposes.

Dear Sir,

With all due respect, I think this is a very foolish bill.

First of all, if the BMI limit for serving is set to 29 then, if Governor Schwartzenhagger of California visits your state, he might not be served? (His BMI is 32!) Also if most of the Olympic athletes visit your state, they also could be, under your bill, denied being served. In fact a large segment of the population would be no longer eligible to eat in Mississippi restaurants and this definitely might be damaging to your economy! So I have to believe that the BMI limit will be set higher than 30, like for example at 40. Assuming this, the bill still has many issues which should be addressed.

First, according to the CDC's revised statistics, people who are in the BMI range of 26-35 LIVE LONGER than those in the so called "normal range", probably, opined the CDC, because the so called "normal range" of BMIs are underweight for most people.

Second, according to the 20 and 30 year Cooper Institute studies thousands of people AND the HAES clinical study at USC, the KEY FACTOR to health is lifestyle NOT weight. Even National Geographics in a show which was generally NOT fat friendly, admitted that the scale alone does not tell the story about health and that a person who is normal sized could have viseral fat (that considered unhealthy) while people who are considered "morbidly obese" by the scale i.e. BMI over 40 but who were fit, could be totally healthy with NO viseral fat (like SUMO wrestlers who by the way, might also NOT be served in Mississippi restaurants). And what you may not be aware of is that many studies which suggest that clinical obesity is "deadly" do not give a relative risk factor which is significantly greater in high BMI individuals i.e. the relative risk factor must be above 2.0 to be significant. And as one author pointed out, for as many epidemiological studies which suggest that severe obesity is "deadly", there are an equal number of epidemiological studies which suggest that clinical obesity (BMI over 40) is not much of a risk factor.

Third, will restaurants have to weigh people before they are allowed access to the establishment? Weighing oneself, even for slim people is not necessarily, conducive to buying a lot of food and/or enjoying a night out, and this, if done on a large scale basis, might definitely negatively impact the restaurant industry in Mississippi. That would be political death to the sponsors of the bill especially if large groups of the populace of Mississippi either stopped eating out or traveled across state lines to enhance the economic coffers of neighboring states.

If you watched the movie, "SuperSize ME" you would have seen Morgan Spurlock, the underweight man who ate 5000 calories of fast food daily, for a month, visit the doctor at the end of that month and while still underweight (he only gained less than 20 lbs), his liver was showing evidence of "fatty liver" or cirrhosis, and, his cholesterol and blood pressure were also elevated. So one might ask how not serving overweight people would help those people who are normal sized or underweight whose food choices might be making them ill inside?

Furthermore, I guess I am further, tempted to ask if you feel Mississippi restaurants can NOT serve healthy food that you are so concerned about overweight people eating there as to prohibit them access?

However, since most folks in the USA are beginning to understand that fat is NOT necessarily linked with illness or bad health, and they know that bad food choices are bad even if they don't cause obesity (which is the case in the majority of the populace who are not obese), I have to conclude that health couldn't really be a factor in this attempted denial of access but then, what can be, I am wondering, your motivation for sponsoring this bill?

Perhaps, this is all about allowing restaurants to -not make- "reasonable accommodations", like chairs without arms, for those who are very large and do not fit into booths. And of course, since, disallowing groups of people access to restaurants for non reasons, is something Mississippi has done in the past, I guess your proposed law, that way, would be in the tradition of Ol' Miss!

Or maybe it's something as simple as name recognition since your name AND the bill have been plastered in the headlines across the country. There is something to this even if the name recognition is negative - after all, didn't Will Rogers say "there is no such thing as bad publicity, only publicity"?

Whatever your motivation for drafting this bill, what you might not have thought about is perhaps, the families of those large people might ALSO stop patronizing restaurants who deny access to their fat relatives or might seek those restaurants which DO serve all people and thus it might become very non advantageous for a restaurant to choose to comply with your bill, wouldn't it. And the bottom line would be starving out small business persons and I believe when you are reaching into their pocketbooks, that tends to be a bad move politically, in this country where economics is so important!

I cannot help wondering that since you have had strong ties to a large pharmaceutical company in the past, perhaps this is all about selling folks diet pills so they can eat out. I understand that the corporation from which you retired, Merck, is working on a new "hot" diet pill based on marajuana - perhaps you are helping to sell this (since their current diet pill has received some bad publicity for being damaging to the heart)? Said somewhat tongue in cheek but, ok, couldn't resist asking. Pharmaceuticals have done some "over the top" moves to sell medications!

I guess you know by now, that this bill has made great news and your state has become the "laugh of the day" across the USA. Congrats on that. What do you do for an encore? ** smile **

learn about obesity - what science REALLY Says:

Big Medicine - some interesting things

Big Medicine, the TV show about Weight Loss surgery (WLS) always ends on a happy note, with grinning post ops saying how much they love their gastric bypasses and this last episode was no exception. We saw a 478 lb bus driver visit the fire station because although he loves his bus driving job (in case his boss watches the show!) his dream is to be a fire fighter. We are told that he lost 101 lbs in a few months after his gastric bypass, the producers hoping that we will forget that he lost from 579 to 536 on the liquid diet -before- his gastric bypass. Actual weight loss was 57 lbs after his gastric bypass which is good but not -quite- as impressive as it is if they add the weight that he lost on the liquid diet. What's a little exaggeration between friends, right?

We also saw a 2 year post op gastric bypass patient who got plastic surgery for oversized legs who said he was happy to go into the "normal man's store" and buy clothing "off the shelf". Trouble was he was in a "BIG MAN'S WAREHOUSE" so probably could have gotten clothing off the shelves at his original weight of 535 lbs. "I lost 230 lbs" he said - it was 220 before plastic surgery on his legs and he said his weight loss had been at a standstill for several months. Dr Garth said that maybe this plastic surgery would get his weight loss restarted. But the "window of opportunity" has closed for this man so weight loss from this point will be the old fashioned way involving a diet. Trouble is, he was likely not told that before surgery. In the several weeks after his plastic surgery, he had NOT lost any more weight.

Thing is they show his before photo where he weighed 545 and his after photo where he weighed (it said) 215 lbs (and I stopped the DVR to check that too!) and weight loss of 230 lbs. I guess they are hoping no one watching will do the math... his current weight would be 315 lbs!

All the wizardry and small oops's aside, there were some interesting things which one who is listening carefully, might notice.

The man who got plastic surgery had -lymphodema- (the plastic surgeon did mumble that a couple of times) and so we all know that cutting that off doesn't necessarily cure it especially in someone who is still clinically obese (which of course, they are not supposed to be after this magical surgery).

Couple that with the gal who had her bypass 3 years ago and was regaining her weight. "I don't get full anymore after a meal" she told us. She went to the surgeon to see if anything was wrong - pouch stretched etc.

This of course, poses a dilemma to the producers - if they find something wrong with the pouch, they preserve the myth that if everything is in tact, patients will never have a weight problem again -but- it also could reflect not so well on the doctors. However, if nothing is wrong with the pouch then the audience might get the message that the surgery stops working after a few years which is of course, the case with many patients.

The producers decided to take the latter route and showed a scene in which slim Mary Jo, the staff psychologist, was telling the lady how it was all her fault that she regained because she's off track etc etc etc. Mary Jo's solution: keep a food journal and diet. Hmmm but isn't a gastric bypass supposed to make it so folks "never have to diet again"? After all, if they had been successful on diets, they would not have gone for the bypass in the first place. (which is a comment I hear repeatedly on the gastric bypass regain support lists!)

Finally after Dr Garth was called in to look at the 2 year 315 lb patient's lymphodema, he walks out and tells Dr DelMonico (the plastic surgeon) "Well, gotta go and make more patients for you!"

Somehow that remark seemed more than a bit inappropriate but gives an inkling just how some in the medical profession view the process - as a money making deal.

Greatly contrasting with the positive attitude on the "Big Medicine" show was a letter I received today - her spouse had a gastric bypass 6 months ago and has had nothing but medical problems since, and she is at the end of her rope. I get 1-2 of these every week. And I don't think you will ever see -those- patients on "Big Medicine" because the surgery making someone very ill is still a -big secret!.