Monday, June 16, 2008

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.

7 comments:

vesta44 said...

I hear people who have had any kind of WLS keep saying that WLS is a tool and only as effective as the person wielding it. Yeah, right. Been there done that, and it was a huge failure. Not because I didn't follow dr's orders, but because I was given an experimental tool that no one had a freaking clue how well it would or wouldn't work. The more we learn about all forms of WLS, the more we know that it's a lot like dieting. It works for some, if you don't want to lose more than 50 lbs, but it's not safe, it's not permanent, and the side effects are going to come back and bite you in the ass sooner or later. Will you be any better off than if you had stayed fat, but practiced HAES? Probably not, and that's the sad part of all of this.
Brooke had the surgery because she couldn't lose weight by dieting, and she seems to have done it with the lap-band. Well, come back in 10 years and let us know if she kept the weight off, and is healthy with no side effects. I still say mutilation of your digestive JUST to meet some arbitrary (thin=beauty) ideal is WRONG.

SueW said...

"would a person be better off staying fat and following HAES - health at every size - probably not"

Actually according to a clinical study done at USC, people who "stayed fat" and followed HAES WERE better off, healthwise, than dieters (all of whom in the study regained the weight and ended up less healthy than before). People on HAES also had a much better self image at the end of the two year study. See:

HAES study at USC - Dr Linda Bacon

violet_yoshi said...

Her high weight was 220, this is all cause she was a little chunky like I am? I think that this is another situation involving people being victimized by the weight loss industry and media push. I'm sorry, I don't think 220 pounds is reason enough to get a gastric bypass or lap band.

It doesn't help they now advertise the operation all over TV. Seriously, I still can't understand it. It's an operation, it's not medication. It's a huge medical risk, and they're advertising it like, just come in and get some pounds taken off. Like no big deal. All I can do is *headdesk*.

SueW said...

re: Brooke too slim for WLS

Well, the thought on the part of her parents was the band was a preventative to regaining what she'd lost and I'm sure they had the blessing of their medical provider on this. They are telling us daily, starve...er... diet your kids.

If WLS is risky, is any weight really appropriate for it especially that for the very high BMI folks who might have compulsive eating disorders, the WLS will probably NOT work. Such a large percentage of WLS patients regain the weight.

I think so many of us are victims of the diet industry which only cares about selling more diets etc.

vesta44 said...

Sorry, my wording wasn't very clear. What I meant was that she would have been better off not having the lapband and following HAES instead ("will you be any better off with the lapband or will you be better off if you stay your current size but practice HAES" is what I should have said). I'm not in favor of WLS for anyone, and definitely not for kids who aren't done growing yet.

spacedcowgirl said...

I'm still not at all convinced that her parents don't deserve some of the blame. If I remember correctly, at the time the media storm occurred, both of them and especially her father expressed reservations about having a fat daughter that IMO went beyond simply being concerned about her health. People need to face their ugly prejudice that is really driving them to seek WLS for themselves or their children.

I know there's no proof of this yet, but I still say that surgically rearranging your digestive system (which I realize the Lap-Band does not do per se, but other WLS does) must have a greater negative impact on your health and longevity in the long term than simply being fat. I doubt you can screw with your body's basic functioning like that and not pay a health price of some kind.

Finally, her long-term outcome with the Lap-Band may be up in the air, but sadly I don't think WW or any other diet would have been any more effective. She would have been better off not being hounded about her weight and diet by doctors (and yes, her parents) from such an unbelievably young age. It makes me so sad to think about all the fat kids today who could be normal, healthy eaters if they'd just been left alone rather than judged and encouraged to diet. Now it's considered routine to practice disordered eating behaviors and think of food as the enemy throughout your entire life. I know you weren't condoning dieting for Brooke, Sue, but I just wanted to point out that I wouldn't be surprised if the Lap-Band actually was her "best" hope for long-term weight loss since dieting's record is so dismal. But as you and others said, that doesn't make the LB a "good," "healthy," or even all-that-likely-to-succeed option.

SueW said...

To Isabelle who left 4 comments unrelated to this blog about how great the raw food vegan diet is - first of all, you need to write your own blog because this blog is NOT a platform for questionable diets and secondly, they are finding that without animal proteins, vegans are developing B12 shortages etc. So, you may be best to do some more research on this raw food vegan diet because many have found it lacking in basic nutrients. Whatever the case, I suggest you open your own blog where you can expound upon it to your heart's delight! :)