Monday, December 28, 2009

the Survival of the Half Ton teen ... or his demise?

In our Weight Loss surgery (WLS) informed consent online community (and support for ill long term WLS patients) we lost another former member. She died suddenly - probably sudden heart attack which seems to haunt those who keep their weight off with their bypasses, more than the many who re-gain the weight. She was an extremely talented woman and much beloved by her family including husband, children and grandkids. She was in her early 50's. In my opinion, she died way too early..

Which brings to light the fact, that if people survive their first year after a gastric bypass (4-9 percent do not survive the first year post op according to studies which looked at actual patient records), this does not mean they are "out of danger". I've seen plenty of patients die after a few years. It's often a sudden heart attack and never gets connected with the bypass but one wonders...

Yesterday I watched a very disturbing show about two young men, one who is 19 and the other who was 16, both very obese (over 800 lbs) who got weight loss surgery. The title of the show was "SURVIVAL OF THE HALF TON TEEN".

The 16 year old fared better at least a few months after surgery but the disturbing patient was a 19 year old named Billy Robbins, the only son of parents who had lost their first son after 19 months of life. I'm sure he was or is addicted to food and perhaps mother was something of an enabler however, there is also, a huge genetic factor going on with someone who gets that large and until someone has walked a mile in the mother's shoes, I don't think anyone should judge her.

This surgeon they had, did two major surgeries on this kid in 4 months - the first was cutting about 90 lbs of fat off of him which is very risky and generally not done in the medical community because of the risks involved.

And the second was a sleeve gastrectomy (a surgery in which most of the stomach is cut and removed out of the body - it's not reversible). The surgeon who cut him, told the camera that he was planning "the rest of the gastric bypass" when he's lost another 100 lbs or so. But the fact remains, he's not talking about a gastric bypass because that just bypasses the stomach and does not remove it from the body.

After 2 major, risky surgeries in 4 months, this 19 year old was expected to get up and walk for an hour every day (he still weighed over 500 lbs at the end of the show) and when he was reluctant, the psychologist (apparently the one working for the surgeon) tore into the mother on camera, blaming her for all her son's problems.

Everyone ignored that even a normal sized person after two major surgeries is not up dancing the jig!

Talk about abusive? In my opinion, this surgical group was not only abusive of that poor young man for doing so much risky surgery on him but also of the parents who paid him in good faith.

The surgeon talked about getting that young man down to 200 lbs which is too low for him because he looks like he's around 6'2".

Sadly, the way he looked and considering that the fat removing surgery left him with an incision across his entire abdomen and that he no longer has much of a stomach, I frankly do not expect him to survive. (he vomits frequently... the psychologist also blames that on him being "unwilling to get better" and of course, on his mother) His drastic gastrectomy which removed most of his stomach has repercussions in so much that he doesn't digest food well and also doesn't probably digest some vitamins like B12 - contrary to popular belief the stomach is a critical digestive organ and not just a storage place. As Dr Paul Ernsberger (who teaches nutrition in Case Western Medical School) has written:

"All of the operations, old and new, are based on an incorrect assumption: that the stomach is no more than a passive sac for receiving food. In fact, it is a critical digestive organ and cannot be cut away or bypassed without compromising the digestive process."

The "half ton teen" would have, likely, survived longer without surgery. And of course, when he dies, his death will be blamed on "obesity" and not the so called "life giving" surgery that his parents bought in good faith. And they will probably re-run the show again and again with only a short note at the end (maybe) "in memory of Billy Robbins" which many viewers won't notice.

As for Billy's Mom after dealing with her son's early demise, she will have to watch the psychologist condemning her for just loving her son and trying to do the best for him.

A sad note upon which to end this year.

Addenda: a search for an update on him, pulled up one item - this stated that latest news (about 11 months ago) was that he was getting ready to move to a rehab center and that he had had the "second part of the gastric bypass" (probably some kind of intestinal bypass i.e. the third major surgery) and that he now weighed 420 lbs. This article also blamed Billy's situation on his mother, echoing the judgmental psychologist. Doesn't anyone think for themselves these days?

Saturday, December 12, 2009

5 Medical Reasons to consider Weight Loss surgery

I found the article "Five Medical Reasons to consider weight loss surgery" while going through some old mail and it's interesting to go through the points and see if they are really a valid reason to consider cutting the stomach into two pieces (and bypassing most of it) and cutting the small bowel into three pieces, bypassing the section which digests most vitamins and connecting it all back into an arrangement which is very foreign to the body (it's so much more than as we hear on TV "making the stomach smaller").

The first reason they give is diabetes and truly, this is what scares many folks into a gastric bypass. Here's the quote:

Reversal of Type 2 diabetes " "Because obesity is the primary risk factor for Type 2 diabetes, weight-loss surgery can have a profound impact on the condition," says Dr. Nicholson. Published in the March 2009 issue of The American Journal of Medicine, a study revealed that 82 percent of patients who had weight-loss surgery reversed their diabetes in less than two years, and 62 percent remained diabetes free two years following surgery.

There are many things we should look at in this statement. First of all, 33 percent of type II diabetics were NEVER FAT!

Secondly, there is no such thing as "reversal" of diabetes because it's caused by a gene which makes your muscle cells somewhat resistant to the uptake of insulin. Some think it was an adaption to earlier times when life included a lot more physical work and food was scarce - this adaption allows heavy work with less food.

In fact, none of the researchers on the two studies they are quoting (the Monash Study and the Swedish Obesity study - [S.O.S.]) ever used the word "reversal"... they all used the word "remission" - The idea that anything could "cure" diabetes is purely an invention of the news media.

It should be noted that whereas they reported the early results of the Monash study and S.O.S. wherein 82 percent of the patients after two years, (with gastric bypass OR adjustable lap band) went into remission, they "forgot" to quote the 10 year results of the Swedish Obesity Study where they found that only 36 percent of the diabetics remained "disease free".

What is never mentioned with diabetes is that today's medications and also the ability to test for blood sugar levels, are far superior to the days when people lost limbs and went blind with diabetes - many many less of those type of disabilities are seen NOW with diabetes. My Father-in-law (never fat in his life by the way) had the family diabetes type II - he had lost both of his legs because of it BUT the only way he had to test his blood sugar was with the old urine strips and this only showed whether the sugar level was below 300. Today's sophisticated meters will pretty much give you an idea of your A1C and help you to much better control sugar levels. That being said, most diabetics I've met do NOT test their sugar levels on a daily basis and many medical providers seem to not stress the importance of this.

The medication, Metformin, works on the muscle cells to force them to uptake insulin more normal - they didn't have that back 40 years ago either and yet when they are pushing WLS, they talk about diabetes as if they did not have all these innovations in the field - innovations which make all the difference in the world. Back 30 years ago, the Merck Manual listed the lifespan after being diagnosed with diabetes as 15 years, a number which those advertising WLS still give out. But by 1980, the Merck Manual had changed this and no longer listed diabetes as "life limiting" (because of the superior treatments we have now).

Diabetes is not a disease of "obesity" - it is genetic and also age related. That is, we see a lot more diabetes now because people are living longer. If you have the gene you can delay your coming down with it by watching what you eat and exercising but TV promise that if you don't get fat you won't get it is --- TV. And it seems, that most folks if they live long enough will come down with it. I have an acquaintance who is 94 years old, very slim and when she was 92, she was diagnosed with type II diabetes. She is controlling with diet and exercise (no medication)!

Finally, what is never mentioned is that going on a non surgical program also can keep the sugar levels at normal. For example, my husband following the HAES program (i.e. Health at Every Size - healthy food choices and daily exercise) kept his sugar levels at normal for 13 years after being diagnosed with diabetes in 1994. He went on oral medication when his sugar levels began rising (after a while the pancreas gets "tired") and lately when his doctor said the "I" word (Insulin), he decided to go on the Weight Watchers program and after 5 weeks on the program (only a loss of weight of 12 lbs), his sugar levels were back to normal.

So bottom line, to control diabetes, you do not have to surgically rearrange your GI tract.

The next "reason" given is fertility:

Improved fertility " Although most obese women are not infertile, according to the American Society for Reproductive Medicine, ovulatory functions and pregnancy rates frequently improve significantly after weight loss in obese women.

This doesn't need much explaining... they admit that most fat women are not infertile. But what they forget to say, is being too lean (which happens when WLS patients get ill and cannot eat) is what really destroys fertility.

Next we have this:

- Improvement or elimination of hypertension " A study published in the Journal of the American Medical Association in 2004 stated that hypertension was eliminated in 61.7 percent of weight-loss surgery patients and significantly improved in 78.5 percent of patients.

Hypertension or high blood pressure is still poorly understand and the jury is still out on where one draws the line between "dangerous" and not. For example, I met an 83 year old lady, very slim and very active whose blood pressure EVEN under medication had been extremely high for years (over 200) and she did not look any worse for wear. Also there are different kinds of hypertension. That is if your blood pressure goes down after a weight loss, it probably means it was just higher in order to pump more blood to a larger body. Many very fat people do, in fact, have strong hearts from the extra work and a small autopsy study of 12 individuals, half fat and half lean, found that the fat people did NOT have more clogging in the arteries than the lean people.

That is, if you have clogging, weight loss may not affect your blood pressure at all.

- Easing of joint pain " Weight-loss surgery can ease the pain caused by the stress of extra weight on joints; a 2004 study showed the number of painful joints and other painful areas reported by the obese adults in the study was cut in half six to 12 months after weight-loss surgery. Plus, researchers in Austria have found that weight-loss surgery can help resolve the chronic inflammation associated with rheumatoid arthritis.

First of all, I've seen a lot of folks go into weight loss surgery with huge expectations of the ceasing of joint pain, only to be very disappointed. Seems arthritis happens equally in fat and slim people - the worst arthritics I know are slim people. Osteoarthritis has a lot to do with genetics again. In our family, the worst off is my sister who has never been fat in her life.

But the second part of this claim really confuses me because I heard a lot of stories of gastric bypass patients coming down with autoimmune disorder a few years AFTER their WLS - this is sometimes theorized to be connected with "leaky bowel" syndrome but rheumatologists have told several patients that they expect to see rheumatoid arthritis or Lupus or Raynaud's in many gastric bypass patients by the fifth year post op. I'm not familiar with the Austria study and they didn't give the cite but I suspect it was done on lap band patients and then, only a year or two post op. Since the lap band does not call for the insertion of hundreds of staples nor rearranging of the stomach and small bowel nor malabsorption of vitamins, it's possible it does not carry the same risks in this area as does the gastric bypass.

It would seem a no brainer that reducing the weight on the joints might help arthritis and it might but only in a climate of good food choices and exercise and the latter seems to have much more effect on arthritis than the simple weight loss.

The final claim:

- Increased longevity " Studies at the University of Alabama in Birmingham and at the Erasmus Medical Center in the Netherlands conclude that obesity can cut a person's life span by up to 20 years. Researchers with the Pennington Biomedical Research Center have found that weight-loss surgery for severely obese patients appears to decrease overall mortality.

There is no actual proof that weight loss or weight loss surgery increases longevity or let's say the evidence is weak. There are a couple of rat studies which seemed to suggest that rats which were calorie restricted lived longer than those allowed their fill but several have pointed out that the bigger problem may have been that rats in nature have to exercise quite a bit for every morsel of food which of course, wasn't true in the lab. As one scientist put it "The study only proved that overfed, under-exercised rats did not live as long as rats which exercised and were not over-fed."

Several have pointed out that in getting something like a gastric bypass an individual is trading one health problem for another - that of vitamin deficiency. Back in 1900 when the average lifespan was 45, many people died of the vitamin deficiency diseases like Beri Beri which now are only seen (in the first world) in gastric bypass and duodenal switch patients.

And anecdotally, we have quite a bit of evidence that fat people can outlive weight loss surgery patients. One lady, for example, who describes herself as "super sized", has told me that she has outlived 48 of her fat friends who had weight loss surgery.

Some studies which suggested a slightly longer lifespan for gastric bypass patients, compared them with seriously ill fat patients who were in the hospital for other reasons (I think a comparison with seriously ill lean patients would also find healthy fat people who had bypass living longer).

One study which found a significantly higher suicide rate in post op gastric bypass patients but a slightly (non statistically significant) longer lifespan, compared gastric bypass patients to selected people from the weights on their driver's licenses but then, a survey I took found that most people were greatly exaggerating their weight on their licenses ... that is people who weighed 400 lbs were putting 200 and 300 lbs on their licenses so people of "equal weight" to the bypass patients would, in fact, be in reality, as much as 200 lbs heavier.

Finally two studies of women over 50, who dieted by non surgical means, found that the dieters were 50 percent more likely to have a heart attack than the non dieters even if the non dieters were at a much higher BMI. That is "weight cycling" has always been thought to be highly risky. And most people who diet, regain the weight within 4 years of the diet. (our medical provider sent me these studies years ago and unfortunately, I have misplaced the cites)

The HAES study at USC found that those on HAES not only got their risk numbers down but also stayed on their healthy program and kept their risk numbers down after 2 years whereas the dieters not only regained the weight but ended up with higher risk numbers than before the diet.

Dieting (even without risky surgery) is risky in people over 65 and yet I know many surgeons who DO gastric bypasses on elderly people:

"Despite the fact that almost every study shows that intentional and unintentional weight loss in the elderly results in premature death and disability, the public is continuously barraged with information on the evils of obesity and how food intake should be curtailed," says John Morley, M.D., director of the division of geriatric medicine at Saint Louis University School of Medicine.

Bottom line, weight loss of any kind is not necessarily healthy and doing something like surgery which threatens the body in other ways to achieve weight loss, despite how it's sold on TV, may not deliver what is expected.

The words of the inventor of the gastric bypass perhaps should be taken in consideration:

(Dr Edward Mason:) "For the vast majority of patients today, there is no operation that will control weight to a "normal" level without introducing risks and side effects that over a lifetime may raise questions about its use for surgical treatment of obesity."

***There is no ideal WLS procedure. Both gastric bypass and banding are not without their set of complications. And ... that while solving one problem, perhaps you worsen another.***
Dr. Anthony A. Starpoli, an attending gastroenterologist at Lenox Hill Hospital and director of gastro-esophageal research and endo-surgery at St. Vincent’s Hospital, both in New York City.

***The RNY trades one disease for another: it trades obesity for malabsorption. By re-arranging your guts you sometimes have severe side effects, and can have long-term problems such as iron deficiency anemia, calcium deficiency leading to osteoporosis. (Dr Terry Simpson, MD, WLS surgeon)

Monday, November 30, 2009

Gastric bypass stops appetite? Not according to this study

Remember all the articles about how since gastric bypass patients have less ghrelin in their blood, their appetites are curved?

What they all DIDN'T say is this was a theory. In fact, they have not really figured out what ghrelin does in humans but they know it doesn't work the same way in humans as it does in rats (well you may think some humans are rats but they aren't really!) :)

Recently a clinical study seemed to suggest the opposite... not only did the gastric bypass patients not experience appetite suppression but actually a goodly percentage of those in the study (63 patients) became extremely hungry soon after eating!

A clinical study is the most accurate study there is because this is the type of study where the cohort (participants in the study) are physically examined!

This was not a published study but was reported to the convention of the Professional organization for weight loss surgery surgeons, the ASMBS this past summer.

Here is an article I sent out about this:

After the big news stories claiming that gastric bypass patients have less grehlin which causes appetite suppression, a clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, has suggested this theory is in error, when it found that not only did 80 percent of the gastric bypass patients in their study suffer a ravenous appetite soon after meals, but also experienced the almost uncontrollable urge to eat which did for many result in weight regain after the first year (the study went for 4 years).

The researchers also found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Dr. Roslin reported on this study at the 2009 ASMBS convention, suggesting that the gastric bypass may cause a heightened insulin response due to the rapid emptying of the pouch into the small bowel.

All this caused the researchers to wonder whether the gastric bypass should continue to be the "gold standard" of weight loss surgery.

Roslin's theory is that gastric bypass causes an enhanced insulin response due to the rapid emptying of the pouch.

This may in time, make things difficult for diabetics rather than "cure" them as has been advertised on TV. In truth, many gastric bypass patients find after a few years that they again require their diabetes medication.

This study suggests the gastric bypass might undermine their lessened intake of calories rather than help (most diabetics can keep their sugar levels at normal if they restrict calories slightly.

Bottom line, don't expect a gastric bypass to kill your appetite except during the healing phase (usually takes about a year but some patients heal faster). After that, if you are like many patients, your appetite may not only return but be stronger than it was before surgery.

Wednesday, November 11, 2009

New study on gastric bypass found higher mortality rate

A study of over 850 weight loss surgery patients, 98.5 percent of whom were gastric bypass patients, found that in those of BMI 50 and higher (which is the average size for bariatric surgery patients), 2 percent died within 30 days, another 3.6 percent died within 90 days of surgery and another 5 percent died within a year of surgery.

These patients were operated on in 1 of 12 veteran's hospitals. The mean age was 54 and 70 percent of the cohort were men.

The death rate was higher in those with a BMI of 50 and comorbidities like heart disease, sleep apnea etc.

Researchers Lie et al concluded:

"The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery... These findings also suggest that the risks of bariatric surgery in patients with significant comorbidities, such as congestive heart failure, complicated diabetes and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits in older male patients and those with superobesity (BMI eq or greater than 50)."

Now of course, we know that all providers of gastric bypass will be sure to show their prospective patients this study and discuss not having a gastric bypass if they are over 50 and BMI 50 or higher and/or have heart disease, complex diabetes etc, right?

SOURCE: Arch Surg. 2009;144:914-920

Friday, November 06, 2009

Obesity causes cancer - more "BIG FAT LIES"!

A radio show from the BBC recently featured a metastudy which concluded that obesity "causes" cancer. The researchers opined that 100,000 cases a year can be linked to obesity. According to the Washington Post:

This study, from scientists at the University of Manchester, analyzed 141 articles involving 282,137 cancer cases and 20 different types of malignancies to determine the cancer risk associated with a 5 kilogram-per-meter-squared increase in BMI, roughly the increase that would bump a person from middle-normal weight into overweight.

141 articles isn't that many of course, not withstanding that they can pick and choose which articles to include and also, probably did not have a real accurate measure of BMI from the studies anyway.

It should be noted that over 1.6 million new cases of cancer are diagnosed in the USA every year, so even if their figures were correct that would only be 6 percent of cancers (according to WEBMD.COM) which can be linked to obesity - 94 percent of which can NOT be linked to obesity. The researchers on the program admitted that lifestyle factors like sedentary lifestyle and poor food choices were a player and briefly mentioned "the link between tobacco and cancer" but did not give any figures.

WebMD states that these figures linking obesity and cancer, were "estimated" from existent data (what the calls a "data dredge" study.).

So how does excess fat "cause" cancer? The researchers didn't have an answer for that but opined that fat tissue, produces estrogen. What they didn't tell us is that fat tissue produces the type of estrogen our bodies can use but when we flood our bodies with synthetic pharmaceutical estrogen, this raises the risk of breast cancer FAR MORE than 6 percent.

For example the HERS study on 11,000 women, a double blind study found a 26 percent higher incidence of breast cancer in those in the cohort, on low dose birth control medications. 26 percent OBSERVED in a double blind study which was stopped midterm. Not a tiny 6 percent from "estimated" figures.

Synthetic estrogen was put on the FDA list of carcinogens in 2005.

Finally, it should also be noted that researcher, Dr. Glen Gaesser stated in his book, "BIG FAT LIES" (CA, 2002) that he found in his metastudy of all the obesity research in the previous 20 years, that obese people seemed to get cancer significantly LESS often than non obese people. 40 percent less cancer in the obese, than normal weight people, concluded Gaesser.

Dr Linda Bacon, respected scientist and author of "HEALTH AT EVERY SIZE", was also on the BBC program and started to directly refute the findings with cited studies. As soon as they found she could do this, she was rudely interrupted (twice!). Before they cut her off, she pointed out that for example in a group of 23 studies, only 4 had suggested a significant link between obesity and cancer so she asked how these researchers could conclude from a small percentage like that, that obesity "causes" cancer. They evaded her question, of course.

I wrote the BBC a comment accusing them of dishonesty in news reporting and challenged them to have Dr Bacon on again to tell the REALITY of what the studies on obesity and cancer REALLY show. Perhaps some of you might want to do same.

Until we demand more honesty out of the news services, we won't get it. Fat activist Marilyn Wann was on the same program. Here's the link:

BBC radio program on the so-called "obesity link" to cancer

Tuesday, October 27, 2009

answering rebuttal to gastric bypass post

The following is to answer a comment - this was in two parts and had a lot of quotes in it so would be hard to read and brings up some points which I have answered (and so has Junkfoodscience blog answered) in other blogs but should be answered again to clarify things :

Mikalra who wrote the comment states he/she has no interest in the bariatric industry but since he/she does not identify him/herself I have no way of verifying this. Mikalra (M:) writes:

A study of 10 year post op gastric bypass patients found that 34 percent of those who started with BMI 50 or over, had regained all or most of their weight.
The abstract is here: "The failure rate when all patients are followed for at least 10 years was 20.4% for morbidly obese patients and 34.9% for super obese patients" -- which means, of course, that ~80% of morbidly obese and ~65% of superobese patients were successful.

No that doesn't mean this at all. And they do not define "success". FYI, success with bariatric surgery means keeping off 50 percent of the originally lost weight which still leaves many patients severely or morbidly obese (this is 50 lbs kept off for most patients), but as the Swedish Obesity Study found at the 10 year post op point, patients only tended to keep off an average of 16 percent of the original bodyweight and were, in fact, still High BMI. SOURCE: 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

Secondly, the 35 percent was for BMI 50 which is the average BMI at which folks get a gastric bypass. Exactly why this study concerned the ASBS and they approved some revision procedures (which later turned out to be unsuccessful and temporary and painful i.e. the -through the mouth- stomaphyx and rose procedures)

Third, success is also staying healthy and estimates of acquired co-morbidities from gastric bypass have ranged from 20 percent in the 5 year duration Mayo Clinic study in 2003 to 40 percent in Dr Livingston's study of 800 of his own patients over a 10 year period post op, and can include epilepsy, reactive hyperglycemia and islet cell death, gastroparesis, osteoporosis and auto immune disorder.

As Dr Terry Simpson has stated:

***The RNY trades one disease for another: it trades obesity for malabsorption. By re-arranging your guts you sometimes have severe side effects, and can have long-term problems such as iron deficiency anemia, calcium deficiency leading to osteoporosis. (Dr Terry Simpson, MD, WLS surgeon)

The other study you quoted "long term mortality after gastric bypass" is not an accurate one for many reasons (epidemiological, not randomized etc) and also compared gastric bypass patients against fat people as obtained from driver's license weights only most fat people very much under state their weight on the drivers license so matching weights this way, one is going to be comparing the patients actual start weight with much HIGHER BMI people. Finally, if I remember correctly, the study mostly just followed for 7 years and did NOT take in consideration the 5-9 percent who die within a year of surgery (started following 1-2 years after surgery). I have written about this study in another blog - you may want to look that up.

And no we do NOT have "several" longevity studies on gastric bypass - we only have a couple which you have mostly managed to obtain and those are not real accurate.

Mikalra further wrote:

So yes, there were certainly some risks from gastric bypass, as with any medical procedure -- but overall, it's clear, the health benefits to these very obese patients outweighed the risk.

This is NOT clear at all and why many surgeons are advocating the lap band now which is a much less risky procedure which delivers the same weight loss retention benefits.

Mikalra further wrote:

Moreover, this study included people who had undergone surgery as much as 25 years ago, when the technique was much more experimental; it's reasonable to think that both the techniques, and any counseling or warning signs that need to be followed for optimal patient safety, will have improved by now.

The gastric bypass has not basically changed at all except now they are cutting the stomach into two pieces so it's much harder to reverse than the ones done 25 years ago were. Also 25 years ago, less of the stomach was bypassed which made it a bit safer than now. As Dr Ernsberger has pointed out:

"All of the operations, old and new, are based on an incorrect assumption: that the stomach is no more than a passive sac for receiving food. In fact, it is a critical digestive organ and cannot be cut away or bypassed without compromising the digestive process."

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

Mikalra concluded:

I am personally very concerned about the obesity epidemic. I would like to see a lot more of this epidemic controlled through support for healthy lifestyles in children, but for patients who have already become obese, this is clearly an option that should be seriously considered, based on personal values and risk factor profile, as it provides very substantial health benefits for most very obese patients.

First of all, news flash, "controlling children's diet" doesn't work. No matter HOW you do it. We know that putting kids on a regular diet does nothing more than injure their metabolism, making them more likely to get fatter when adults. It also injures their self images. But even a less invasive approach such as a friend of mine used... not having things like candy, potato chips et al around, building exercise in their son's daily life and limiting high fat foods does not work. In the case I am thinking of, this individual who kept reasonably slim during his childhood years, as soon as he left home, starting eating all the foods his family never had around and has been clinically obese for the last 20 years or more (he's 40 now).

Secondly, if the gastric bypass introduces NEW comorbidities, what good is it? Are those comorbidities lesser than what they experienced as being fat? In the opinion of several patients I know, they felt healthier BEFORE their gastric bypass than now.

And if the suicide rate among gastric bypass patients is 58 percent greater than among fat people, we must question whether the after surgery quality of life is all that good.

You watch the ads. I see the other side. Countless people who write to me, alone and isolated in their homes, underweight, living in fear or many more, very overweight but also very ill. You cannot make a judgment however well meaning you are, about this surgery until you have seen the entire story.

One super sized friend of mine (over 500 lbs) who is in her 50's (and her slim husband is the one who has had heart problems by the way- not her) has told me that she has OUTLIVED 48 of her fat friends who had weight loss surgery.

Here is just one poem which expresses the pain that some long term patients feel, the pain which never gets to TV or the ads:

(reprinted with permission of the patient)

Sent: Wednesday, August 21, 2002 3:13 PM
Subject: if only...

> oh, sue, I just found your site re: RNY GBP
> if only...
> if only the tears would stop
> if only I knew then half of what i know now
> if only I knew how to turn back the clock
> if only I had not trusted so blindly
> if only I had my life and my love of life back
> if only doctors understood and respected the value of living vs. the lack of value in existing
> if only the effects of malnutrition and slowly starving to death were not so bizarre that people assume and treat me as if I were terrifyingly contagious
> if only I knew someone who could/would reverse, not merely modify, this hell in which I exist
> if only I could hide from that emaciated creature who peeks at me in such a terrified manner when I glance at her reflection
> if only I had not learned so much about medical "error" and the resulting retaliation from the medical world if you dare to whisper those words
> if only I didn't have to hide from the world out of shame and fear
> if only I didn't know so much about PTSD as I do now
> if only I could ever trust another medical care provider
> if only I didn't spend every moment wishing I could die or regretting I did not
> if only I knew how to protect others from the incompetent/unethical animal who did this to me
> if only
> if only
> if only

Saturday, September 26, 2009

Fatter babies caused by estrogens in the air?

A recent Newsweek article opines that the chemicals in the air, namely the so called "phytoestrogens" may be causing today's babies to be more overweight than before.

They quote an impressive sounding statistic:

In 2006 scientists at the Harvard School of Public Health reported that the prevalence of obesity in infants under 6 months had risen 73 percent since 1980.

Pointing out that if more fast food and less exercise could explain the higher prevalence of adult obesity, it was more difficult to explain an increased incidence of obesity in a population (like babies) who don't attend movies, and don't eat fast food and were always "couch potatoes". Must be the chemicals in the air, concludes Newsweek...

I looked up the study - apparently the researcher, Matthew Gillman, MD, is also a pediatrician.

He never even mentioned chemicals in the air as a possible reason for fatter babies but rather concluded after studying "120,000 children younger than 6 years old at 14 Harvard Vanguard Medical Associates practices in eastern Massachusetts from 1980 through 2001" that solving the problem of increased baby weight might lie in:

"Avoiding smoking and excessive weight gain during pregnancy, preventing gestational diabetes, and promoting breastfeeding, all of which researchers have shown to be associated with reductions in childhood overweight."

(remember how a recent article blamed breastfeeding for _increased_ size in infants?)

While I understand that Newsweek must come up with eye catching stories almost on a daily basis which must be difficult, I think the public should realize that stories like this one are just that - eye catching - and not necessarily based on any good science.

One thing which struck me is the entire article is based on the "73 percent increase" in "infant obesity" however, is that really as impressive (or alarming) as it sounds? Probably not. For example, the study found that the incidence of overweight children had "jumped 59 percent" but then the actual numbers on overweight kids, were in 1980: 6.3 percent and in 2001: 10 percent. And this means that in 2001, 90 percent of the children were not overweight, even according to our inflated weight charts which have set the line for "overweight" to much less than it was in 1980.

Less than 3 percent more kids were found to be "overweight" in 2001, not exactly anywhere close to a significantly higher figure even with much more fast food and much less activity!

We should always be on the lookout for statistics which may sound alarming but in reality, are not.

Unfortunately I could not find the actual percentages of overweight babies but I suspect it's not that significantly higher either...

The Newsweek article goes on to cite a string of mouse and rat studies which seem to prove their "chemicals in the air = obesity" theory.

And all to the conclusion that we just might be innocent victims of weight gain, like the caged rats and mice (which also were very "under-exercised" and had a much greater exposure to food than their cousins in natural surroundings), and the fact that we burn 800 calories a day less than did our grandparents and that most of us are consuming high calorie fast foods several times a week, has nothing to do with our being somewhat larger than our grandparents. Nope, it's all the chemicals in the air!

(Forgetting of course, that the phyto-estrogens in the air have not particularly increased since the 1980's - on the contrary, with all the "green" hysteria, there are actually less pollutants like this in the air. I know, details, details... :)

While articles like this are entertaining reading (Americans love to be alarmed), we should not take them too seriously. All news media should carry a warning "for entertainment only - any resemblance to facts is purely coincidental"!

Friday, September 11, 2009

New Scientist Magazine and gastric bypass

In the Sept 2nd issue of the "New Scientist" Magazine, they have an article about gastric bypass.

The article presents the surgery in a very positive light, mentioning virtually no serious repercussions (like reactive hypoglycemia, epilepsy, B12 deficiency leading to pernicious anemia or iron deficiency anemia, ulcer, bowel obstruction etc), advocating it as a "cure" for diabetes as well as obesity:

Clearly these drastic procedures will cut your calorie intake, but here's the strange thing: the operation is much more successful than anyone could have expected. Even though they can't eat as much, people who have undergone surgery are not constantly ravenous, in stark contrast to those dieting through will power alone. It seems the gut normally secretes hormones that make us feel hungry or full, and bypass surgery ramps up production of the ones that make us feel full.

This article also includes long, pseudo scientific explanations of why this surgery "cures" diabetes and makes you feel full - they attribute it to changing gut hormones (of course, they don't say how this occurs and not surprising, they only mention a rat study or two as documentation for their claims).

I say, not surprising, because they really do not know _what_ controls appetite nor exactly what those gut hormones do. And also, the temporary lack of hunger in new ops is easily explained by the sudden difficulty in eating (food can get stuck etc) and the massive healing going on inside after the small bowel and stomach have been cut into pieces and put together in a very different manner from what nature intended.

And interestingly enough, human studies have tended to show that these surgeries are not particularly successful as for maintaining weight loss on the long run. For example:

  • A study of 10 year post op gastric bypass patients found that 34 percent of those who started with BMI 50 or over, had regained all or most of their weight (REF: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)

  • The Swedish Obesity study found that at the 10 year point, the average BMI was 35 evidencing a significant lack of weight loss retention. (REF: 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)

  • the Hebrew University study found that only 7 percent of gastric bypass patients had kept all their weight off- and that 25 percent of patients had regained all their weight back (or more). (REF: Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study) Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew))

But worse yet, a new human study found erratic blood sugar levels in most of the patients studied (clinical study) which caused them to be _ravenously hungry_ soon after meals - this study directly disproving the claim that the gastric bypass somehow changes the gut hormones to kill the appetite.

A clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, has disproven this theory when it found that not only did 80 percent of the gastric bypass patients in their study suffer a RAVENOUS appetite soon after meals, but also experienced the almost uncontrollable urge to eat which did for many result in weight regain after the first year (the study went for 4 years). The researchers also found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Dr. Roslin reported on this study at the 2009 ASMBS convention, suggesting that the gastric bypass may cause a heightened insulin response due to the rapid emptying of the pouch into the small bowel.(ref: Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.)

The so called "cure for diabetes" also attributed to the elusive gut hormones by this article, has only been called a "cure" in the media. Any studies which suggested that weight loss surgery got the blood sugar levels down to normal in diabetics, called it a "remission" and what long term studies we have seen (for example, the Swedish Obesity study), found that at the 10 year post op point, only 36 percent of diabetics were still "diabetes free".

Additionally, as observed in a friend of mine who was diagnosed diabetes, 16 years ago - six weeks on the Weight Watchers Momentum program reduced his sugar levels to normal also even though he only had lost 12 lbs of weight and still was significantly obese.

Any gastric bypass patient will tell you that this surgery is NOT the "easy way out" but in fact not only takes a lot of work to maintain weight loss but also to make sure one gets vitamins, supplements, B12 shots and iron infusions (which patients need as time goes on) and close medical followup required. Gastric bypass has been observed to cause some alarming repercussions in many patients over 6 or 7 years post op.

In fact even a significant number of newly operated gastric bypass patients suffer repercussions:

In a radiologists' study, they looked at 72 gastric bypass patients and found by CT scanning, that 41 of the 72 patients i.e. 56 percent) had some 62 "abnormalities" in their digestive tract. The "abnormalities" included leaks, hernia, spleen and kidney damage, hematoma, bowel obstruction and distended excluded stomach. (REF: Diagnostic Imaging - September 2, 2004)

And if healthy food choices, slight calorie restriction combined with exercise, can reduce sugar levels even in a diabetic diagnosed many years ago, one would wonder why a person should even consider getting one's digestive system permanently surgically changed.

Articles like this one in the "New Scientist" do a lot of harm in misleading people to make permanent changes in their organ systems, a move which many find does NOT work real well for them but can give them a whole new set of co-morbidities and a lot of grief.

Tuesday, August 25, 2009

Update on second person to have brain surgery for weight loss

Carol Poe, 60 years old, had had a "stomach stapling" (probably a VBG) and later was "revised" to a gastric bypass. Her original weight was almost 500 lbs - she's 5'2" and she still weighed 287 lbs when she went in to surgery. Apparently neither of the weight loss surgeries she had, had "worked" and of course, dieting hasn't worked either so Poe happily offered herself as a guinea pig for a new brain surgery which is supposed to kill the appetite. Neurosurgeon, Dr Don Whiting of West Virginia University is the one testing the procedure.

This surgery calls for two deep probes to be placed in her brain and 2 pace makers to be placed in her chest. The pace makers send out electrical currents to the probes and this supposedly kills her appetite. Her surgery lasted 3 hours and she was awake for the entire thing because when they place the probes they have to make sure they don't injure something else or take away any of her abilities.

She appeared on the Oprah show today (the show was originally aired in April) and said that after 2 months, she had lost a whopping (NOT) 11 lbs. She told Oprah that she didn't have any cravings and that she was eating a more healthy diet and that she is now going to the gym.

It should be noted that just going to the gym for two months could have explained the weight loss and that if she's only lost 11 lbs in two months even with going to the gym, she's not really cut down her food intake very much which suggests the surgery may not be cutting the appetite the way they hoped it would.

She's Whiting's second patient and he wants to do another soon. One of the requirements to be a guinea pig for this surgery, is to have had a gastric bypass (which apparently failed to cause a good weight loss), Whiting told the press in April. Don said he has to make sure the surgery is effective and safe.

Why Oprah decided to give this procedure her seal of approval by having the patient on her show (with Dr Oz) is unknown. But she made it clear on her show that she had no plans of having this brain surgery.

Carol Poe looks like she's survived the surgery well (Dr Whiting stated that there is a 1 in 100 chance of stroke or even death with this surgery) and she told Oprah that the loss of the 11 lbs has made it easier for her to move around and mow her grass. But likely, rather than the 11 lbs, it's been her trips to the gym which have made the difference in her ability to move better. Minus 11 lbs she still weighs 276 lbs at 5'2".

Dr Whiting expects to get FDA approval for this procedure in the next 2 years however, if Carol's lack of weight loss is any indicator, his path for approval may not be easy.

A similar surgery is used for Parkinson's disease but of course, long term repercussions with the new weight loss surgery could include the pacemakers moving around in the body or forming abscesses, brain damage from the flow of electricity into the brain and more.

Friday, August 07, 2009

Weight Loss surgery death rates down? No evidence of this!

An article on aol news with the headline of "Obesity Surgery death rates low" reads:

-Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.

Sounds good, doesn't it? Now you can have a gastric bypass and have it only be as risky as gall bladder surgery i.e. 1 death in 7000 surgeries.

But wait! First of all the study didn't exactly say that at all.

The finding of the study, another Dr David Flum study to be published in the NEJ on August 13th, which looked at the medical records of 3,412 gastric bypass patients and 1,198 given stomach bands i.e. adjustable lap band, was that there were 3 deaths in 1000 patients so that's still _a lot_ more risky than gall bladder surgery.

Flum's own studies of 62,000 gastric bypass patients 6 years ago, found that 1 in 50 died within 30 days.

The "less deaths now" are attributed to "newer methods" and lap surgery. However, if you average the very LOW death rate of the adjustable lap band surgery in with gastric bypass, that's far more likely where the lower death rate figures come from.

That is the death rate on adjustable lap band surgery is 1 in 7000 or the same as a gall bladder surgery. And I sincerely doubt the death rate on gastric bypass has been reduced that much in the 6 years since Flum's other study (report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study]) which was never formally published and which concluded by comparing desperately ill fat people hospitalized for other reasons than WLS, that even with such a high death rate it was slightly more risky to be fat than to have a gastric bypass.

It's called "cooking the books" and it's easy to see how they arrived at those figures. In 1198 lap bands, there were likely no deaths! And in 3412 gastric bypasses, there were likely 68 deaths within 30 days of surgery, however they probably took the table death figure which is 1 percent so that's 34 deaths.

Now lump them all together and that's 34 deaths in 4610 WLS surgeries or 8 deaths in 1000 surgeries. That's still more than the 3 per 1000 surgeries they are claiming so more cooking must have occurred. Simply, I have read nothing about the study being randomized and greatly suspect it was not randomized which means they could pick and choose the members of the cohort. That is, at the 10 hospitals they studied, there were likely far more patients than 4610 who had WLS but many were not included in the study for this or that reason.

Anyway, you get the gist. The gastric bypass isn't likely, any safer than it was in Dr Flum's study, 6 years ago. They just because the results from the 2003 study which studied 62,000 cases of gastric bypass done in one hospital, didn't look so good (2 percent death rate within 30 days).

Fortunately for those providing gastric bypass, few will "do the math" or notice that the study was not 'randomized'. Unfortunately for those patients who have gastric bypass which Dr Terry Simpson emphasizes is over 100 years old (is essentially a modified Billroth II surgery originally done for duodenal ulcer), many may go in thinking that by some magic, the gastric bypass is now "safer".

I would suggest those who question, go to Dr Simpson's website and listen to the part of his online seminar about why he prefers the lap band to the gastric bypass and duodenal switch.

Sunday, July 19, 2009

If it doesn't work the first time, get cut again

When people talk about Weight loss surgery, they never talk about the long term outcome. Or if they do, it's vague.

Long term patients (over 10 years which isn't that long term) tend to be slimmer. What they don't say is studies have found most still are very obese and some with a BMI over 40.

And one study found that 34 percent of gastric bypass patients who start in at BMI 50 or over, regain all or most of the weight within 10 years of surgery. (Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)

A bit different picture from the slim enthusiastic new ops who are paraded at the seminars or on TV's shows like "BIG MEDICINE".

And what is the solution that medicine offers? Get cut again.

Shorten the bowel so virtually nothing is absorbed. Well that works except everyone I know who's had that one is a rather sick person. As a favorite surgeon says "fat and healthy trumps thin and sick anytime".

Or pleat the stomach from the inside. That is painful, destroys the lining of the stomach, doesn't hold in place for over a year and hasn't really worked for anyone I know.

Or get rid of more of your stomach (a popular one for those who have had duodenal switch). What? People regain with DS/BPD's? Oh yes, big time.

Does it work? Maybe. Hard to tell because generally the regainers are made to feel ashamed and fade into the background.

I actually know several people who have had multiple weight loss surgeries and still are seeking more procedures! Some of these folks have had 7 surgeries after the original WLS.

I also know several folks who have had "revisions" (that's what the surgeries following the original weight loss surgeries are called) who are pretty sick.

A surgeon friend of mine says "success with weight loss surgery is 10 percent the surgery, 90 percent the patient".

How many people I wonder, actually have this surgery with the idea that they will have to work just as hard as someone on any other diet, to keep the weight off i.e. diet, count calories, measure and exercise in addition to getting blood work and dealing with the repercussions of a digestive tract which doesn't work the way it used to because it's been all rearranged inside.

Not many. I suspect most who have the surgery, have a dream in mind, fueled by the TV and the new ops they have met - a dream which has little resemblance to the reality, a dream where all the weight just falls off and then the person is "normal". But dreams are dreams and reality is reality.

Isn't it better to find out about reality before you get your body changed forever?

Friday, May 08, 2009

Brain pacemaker to lose weight?

The Dr Oz newletter featured a lady named Carol who recently appeared on the Oprah Show. Carol is 5'2" and 287 lbs, and 60 years old. A good looking woman of size who looks young for her age and healthy. Like many people of size, she had tried every diet in the book (apparently her highest weight was 490 lbs). She had also had weight loss surgery -- twice. She had a Vertical Banded Gastroplasty and later, she revised to a gastric bypass.

You'd think she'd figured out that weight loss surgery doesn't work for many people to keep the weight off in the long run and maybe found something healthy like HAES (Health at Every Size) just to stay healthy especially since a clinical study found over a period of 2 years than people on the HAES program without a focus on weight loss, reduced their health risks much better than dieting. REF: Non-dieters more successful at boosting health than dieters, study finds

But there seems no end to people's desperation to lose weight in a society which constantly conveys the message of "never too rich, never too thin". Despite the fact that tried and true surgery like gastric bypass had not worked to make her slim, Carol decided to try - yet more- surgery. Only this time the surgery she picked is an experimental brain surgery! An invasive procedure about which the article observed:

"Before this procedure becomes widely available, Dr. Whiting says he and his colleagues have to prove it's effective and safe."

Carol is only the second person in the USA who has had this surgery which is a variation of surgery sometimes done to relieve the symptoms of Parkinson's Disease. The three hour surgery is done while the person is awake. "The brain feels no pain" says Dr Oz.

About this surgery, Dr Don Whiting, one of the inventors states:

"Everybody knows people who have had heart pacemakers to have their heart work better," he says. "This is like a brain pacemaker that we hope changes the electric signals and the chemicals into the brain to give you a better metabolism."

So far changing the brain chemicals even in a more well known setting like Parkinson's, has not been real successful. And we don't really know where the appetite center is or whether the brain totally controls it. Obesity researchers like Dr Rudy Leibel from years of study, seem to feel that appetite is a complex feeling which is controlled by several structures including the thyroid gland, the pituitary gland and more.

What everyone seems to constantly forget, is that if humans only ate when they were hungry, most would not be overweight! We have free will to choose to eat when we want to and eating is a pleasure to be enjoyed at celebrations, at social events and more. And that is very unlike animals in which the appetite is controlled solely by instinct. So why do researchers use animals like rats to make "rules" for human appetite anyway? (Other than it sells to the media and brings in research funding)

So if we are eating when we are not hungry and appetite has been observed by scientists to be controlled by several places in the body, why use a reconfigured Parkinson's surgery to help a person lose weight?

Because they CAN and because there will always be people who are so desperate that they will take amazing risks with their bodies and money can be made.

This new surgery implants two electrodes deep into the brain. The leads are run around the head and neck to the chest and connect to two small pacemakers which are turned on when the brain heals (about 3 months). The pacemakers (unlike heart pacemakers) are putting out electrical current all the time.

Treating Parkinson's is a bit different scenario. The brain chemicals are already disarrayed and the person is experiencing difficult symptoms, sometimes not controllable by medication.

But to pour electric current into a healthy brain on a theory that it might stop the appetite, seems insanity to me. Has anyone asked questions like whether the constant flow of current will damage the brain? Might cause a disarray of brain chemicals which could lead to Parkinson's and more? Might damage other things like memory, cognitive abilities or ? It is said that epilepsy which causes a short surge of electric current (and natural electric current - not from batteries!) in the brain can cause brain damage. I have to wonder what a constant flow of current will do in a year, 2 years or more.

I am thinking of actress and former Mousekateer, Annette Funicello who had the same brain surgery as Michael J. Fox - she had it to stop the shaking she was getting with Multiple Sclerosis and went from a fairly functional person, partially dependent on a wheelchair but still able to walk a bit, to a person who is totally wheelchair dependent, has lost bladder control, has lost the ability to speak and more. If you haven't seen her in a while, that's why.

It seems really questionable to do this type of surgery to a lady who is totally healthy, and only fat. But then, she, believing in the myth, gave her permission. She looks like an intelligent lady (and young for her age) but what drives a person to be this desperate, I wonder. Was it the constant battering of the TV telling us that fat will kill us in 3 years? Or maybe the constant verbal abuse fat people get from many members of the medical profession.

I cannot forget when a friend was in the hospital - the stoma on her WLS had totally closed and she was vomiting even her own saliva. A surgeon naturally realized she needed to have her WLS undone as her stoma would not stay open despite years of endoscopies etc. While she was waiting to be wheeled into the OR, a partner of the surgeon came into her room, a slim slip of a woman. She said to my friend, rather scornfully, "You realize when you get this undone, you will gain 100 lbs!" My friend had already regained all her weight and then some. Imagine how cruel to tell that to a sick person. By the way, the proposed weight gain never happened - my friend gained all of 10 lbs when she had her WLS undone.

Carol who volunteered for the brain surgery, appeared on the Oprah Show. She had had the current turned on for 9 weeks (2 months) and had lost 11 lbs (which is around 5.5 lbs a month or slightly over 1 lb a week). She told Oprah that she had been making better food choices and going to the gym and "could do things she hadn't done in a long time".

It sounds like this loss was a function of her cognitive brain rather than the pacemakers but what will her prognosis be? I have heard of some pretty nasty side effects with the gastric pacer which only put an electrode on the stomach (not the brain).

Most of all, I wonder when we will start using those brains that now surgeons want to mess with and realize that there is no magic bullet - only bullets which kill and disable.

Monday, April 27, 2009

When you don't know, estimate

In the realm of weight loss surgery, we have a kind of new phenomena in medicine. Instead of real results, we have the estimate. That is, when a claim about weight loss surgery is unproven, then studies are offered, estimating what that claim MIGHT be.

Take the 2006 Mayo Clinic study on heart disease and bariatric surgery (study results were presented in Atlanta at ACC '06, the scientific sessions of the American College of Cardiology.). According to this study, the claim is made that having gastric bypass surgery reduces the chance of dying of a heart attack within 10 years post op.

The study took 197 people with a BMI of 40 or over and/or a BMI of 35 with a cardiac risk who had RNY gastric bypass and followed them for 3.3 years. It compared a control group of 163 people who had enrolled for a weight loss program (non surgical).

Predictably, since gastric bypass patients, are likely to have a very low caloric intake during the first few years post operative, the so called risk factors, cholesterol, A1C and blood pressure are likely to go way down.

And equally predictably, these same numbers in the controls on a diet, would initially go down somewhat but be back where they were due to the likely regain in the second and third year, after dieting.

Which is what the researchers found. That is, in the control group - the blood pressure, A1C and cholesterol ended up pretty much the same after 3 years but in the gastric bypass patients, within 3.3 years, these numbers were still "down".

And from this, the researchers announced that having bariatric surgery was estimated to significantly decrease your 10 year risk of heart disease. Whereas if you just go on a diet (like the 163 controls) your risk of heart disease in 10 years would remain about the same.

Other than, from these figures, it's obvious that the folks in the gastric bypass group had a higher risk to begin with (37 percent) than the controls (30 percent), and it was not taken in consideration that the diet group probably regained the lost weight faster than the gastric bypass patients so that in 3 years they likely were a similar weight to their start weight, the interesting word in this all, is "estimated".

We should keep in mind that there is a high rate of regain in gastric bypass patients (34 percent among patients with a BMI of 50 or higher, regained all or most of the weight, a 10 year study found -- REF: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD) but it takes a bit longer than the regain in dieters. A classic example of this is Ron, from the TV show, "THE BIGGEST LOSER" who had a gastric bypass several years ago and had regained almost all his weight, weighing in at almost 500 lbs.

But besides all it's other deficiencies, the Mayo Clinic study really proves nothing since the "risk numbers" are also very low in people with terminal cancer and AIDS and yet, I don't think we can say those folks (usually slim by the way) are at less risk for anything including heart attack.

That is, the jury is still out on how much the so called "risk numbers" can predict heart disease.

For example, several studies have suggested that heart attacks happen in people of all cholesterol levels. So much for cholesterol predicting heart attacks.

Diabetes risk factors have more to do with heredity and lifestyle than girth and with today's array of medical treatments for diabetes, it is no longer listed as shortening life span. Diabetics are thought to be in higher risk for heart attack but other than a few epidemiological studies using old or existent data, this remains mostly unproven.

Yet based on these numbers, the researchers tell us that the risk of heart attack if you do not have a gastric bypass, is significantly higher. They estimate it.

The sad thing is people make their decisions to re-configure their digestive systems permanently, based on "studies" like this which really found no unpredictable results and tell us nothing other than the researchers' estimates.

And I noticed the Mayo Clinic study because today at the Woman's expo, I chatted with a general surgeon from the Mayo Clinic who had switched to doing weight loss surgery, 3 years ago and still thought it was the greatest thing since apple pie and she refused to even listen to my quoting some studies which brought the efficacy of bariatric surgery greatly into question. She tried to dissuade me from continuing, by sneering at me and when that didn't work, she walked away saying she didn't want to have this conversation.

And this person is encouraging fat people to have weight loss surgery? A person who refuses to listen to what the studies (not the "estimates") really say? Like several others, she was unaware of the large percentage of gastric bypass patients who eventually end up iron deficient, protein deficient, with vitamin deficiency diseases like beri beri, with peripheral neuropathy and many other ailments, in addition to weight regain. And worse yet, she wanted to remain unaware. That's the part which concerns me.

Surgery to create illness and maybe even shorten life. That's a new wrinkle isn't it especially as some still call the gastric bypass, "lifesaving surgery".

Despite what the TV says, fat people who do not exercise and are very fat, may only slightly, shorten their lives like being a "light smoker" might, according to Dr Paul Ernsberger, an associate professor at Case Western Medical School. So the usual scare tactic stated to fat people i.e. that if you don't have surgery, you are doomed to die within 5 years, is totally untrue! And for some folks, remaining overweight, might be a much better quality of life than grappling with not only vitamin deficiency disease and things like bowel obstruction and more but also possibly a shortened lifespan.

"I have outlived 48 of my fat friends who had weight loss surgery" says Daphne who describes herself as a "super sized" lady.

These days, not everyone who has the title "MD" may be concerned about your future or may have enough knowledge to know how the procedure, he/she might be doing on you, will effect your future or longevity. We as patients must be aware of this. Times have changed from the family doctor who came out to the house and was only concerned with getting us well.

No wonder Dr Kaplan stated:

"Because it's risky, it's only appropriate for a tiny fraction of people with obesity—the sickest 1 to 2 percent. The idea that all obese people should get [WLS] surgery is insane."
Lee Kaplan, M.D., director of the Massachusetts General Hospital Weight Center in Boston in "Self MAGAZINE: 'The Miracle Weight Loss that isn't' AUG 2008

Friday, April 17, 2009

Biggest Loser - an exercise physiologist weighs in

This is a guest blog by Laura Gideon, an exercise physiologist who was kind enough to write this for us. You can contact her on her website:

Q:Who really is “The BIGGEST Loser?” A: The Viewing Audience…
The most “Non- Reality” Show on Television

By: Laura Gideon M.S., CPT Exercise Physiologist & Owner Bamboo Balance LLC –

Fitness Training Company - Los Angeles, CA

From the minute this so called “reality” show came on television, I have been annoyed. With every season that goes by and this show remains on the NBC network, new desperate, unknowing victims are being subjected to cruel punishment (disguised as exercise) and my annoyance grows deeper. The bar keeps getting raised after each “winner” takes home their quarter million dollar prize, cover of People magazine and talk show interviews. Seasons go by and viewers keep tuning in. As long as the ratings stay high, the network and the producers are happy, money‘s being made and who gives a crap about the message being sent.

Well..I DO!

And so do many of my Fitness /Health/ Wellness colleagues out in the real fitness world. We have remained virtually silent and in the background way too long and it is now time to speak up and let the public know what is reality and what is hyped infotainment disguised as Reality TV.

Another season - another the new crop of willing volunteers (or shall I call them victims) line up to get on and bare their souls to millions of TV viewers. Little do these poor unsuspecting, overweight contestants know the danger they will be subjected to physically, mentally, medically and most of all emotionally. The sad part is - that is exactly what the producers want in order to have this show be viewed as “authentic” while pulling at the heart strings of the unsuspecting public. Meanwhile, the actual beating heart muscle of every contestant is being put to a very dangerous test the entire time they are on the ranch. The saying “desperate people do desperate things” is very evident regarding this show. Contestants are clearly desperate and that is what makes them vulnerable and so easy to prey upon.

I recently read an LA Times article published this past November titled “The Biggest Loser: Should you mimic its weight-loss methods at home?” The article included perspectives from experts in the fitness industry (including a kinesiology professor and an IDEA fitness trainer of the year) along with the show’s co-creator/ executive producer and medical consultant. The two opposing opinions could not be more polar opposite with the fitness industry professionals comments airing on the side of “viewers beware this show may cause severe injury or heart attack” to the show’s producer and medical consultant touting that its “inspiring the obese to lose weight and they should not feel hopeless anymore because on this show people learn things no one has taught them before, like how to exercise.” That comment came from the show’s medical consultant.

Has he actually watched the show?

I would love to hear what he has to say when the first contestant actually does die of a heart attack as a result of this show. By the way, is a crash cart within arm’s reach? Do Bob and Jillian have CPR certifications and know how to operate a defibrillator? Unfortunately, it will probably take more than one person to suffer something life threatening before NBC takes notice to the dangers these contestants are subjected to. Apparently a recent stress fracture of the hip of one contestant (Laura) is not enough to send up a red flag. Little does she realize how fortunate she is to be sent packing.

As a fitness professional in this industry for more than 28 years I was curious as to how my colleagues in the health arena felt about this show. The impetus for writing this article came after reading a recent commentary in the IDEA (International Dance Exercise Association) monthly Fitness Journal regarding the “distortion of reality” of the Biggest Loser Show. The comment was written by a well respected fitness professional and educator who’s appalled at this TV reality series, and could not hold in his anger one more moment. Needless to say, I did a happy dance after reading it! -FINALLY…someone was speaking out in our trade journal – YES! His final words: “I am furious that the profession I have cultivated for 28 years is portrayed in this fashion.” I could not agree with him more.

I decided to take the baton and run with it.

I perused the internet to read everything I could about how other fitness professionals felt about this show and the comments were all very similar – mostly disdain. I decided to post a discussion question to my fitness professional groups on LinkedIn (one is the IDEA fitness group): “In your professional opinion what do you think of the show The Biggest Loser and the trainers Bob and Jillian…Do you feel the message being sent to the public is inspiring or dangerous?” The response was over whelming!

These are some of the comments:

“The biggest downside to this show is that it sets up unreal expectations of weight loss”

“As fitness professionals we need to stop associating exercise with punishment! (The simplest example is in public schools where the gym teacher will make a student do pushups when they are fooling around or not performing well).”

“The main problem I have is the lack of risk messaging that I see on the show”

“I am troubled with their choice of incentives for losing weight-using money as a prize encourages people to cheat or lose weight through unhealthy measures such as diuretics”

“The show does not explain often enough that for the average person, obese or not, anything beyond 2pounds of weight loss per week is counterproductive”

“The yelling…it makes for great ratings - but at the expense of what?”

“Great question simple answer…DANGEROUS, DANGEROUS, DANGEROUS.”

I could go on and on, but you get the picture. We are fitness professionals who tune in for five minutes and instantly realize the danger in the message being sent. However the viewing public does not. That is why this show is going into its what? Eighth season? A well informed viewing audience who knows what genuine fitness training is, along with proper nutrition and sustainable healthy weight loss practices, would never buy into this load of crap. All they see is in three months an “amazing” transformation from obese to buff and none of the smoke and mirrors. Viewers don’t see how they are being manipulated through emotional, gut-wrenching stories and crocodile tears to pull at the heartstrings.

Never mind the heartstrings. Here are some things to wrap your brain around….

Scientific fact: Healthy FAT loss is no greater than 2 pounds per week – period. For every 3,500 calories you do not consume or a 500 kcal deficit per day amounts to a 1 pound (fat) weight loss. That’s ONE POUND per week! The shows results are completely unrealistic according to basic human physiology. The weight loss numbers do not add up – it is totally impossible for this rate of FAT loss (which the show alludes to as FAT loss) to occur. Contestants show a supposed 7 day weight (fat) loss sometimes in excess of 20 pounds. A 20 pound weight loss (of FAT) in one week is 70,000 calories, which is a 10,000 calorie deficit PER DAY. An Iron Man athlete would have trouble doing that, even Michael Phelps during the Olympics would have trouble doing that and these people are unfit, overweight individuals NOT elite athletes. They should NOT even be working out 6-8 hours a day! To burn off that amount of calories would mean constant fueling. You can’t exercise 6-8 hours a day without fuel – period. Am I clear here? The contestants are NOT losing fat – they are losing mostly everything but that (like water weight). The people who are actually losing weight slowly with a more realistic number for of weight loss are penalized, humiliated and punished by being sent home with their tail tucked between their legs as if they did something horrible. How sick is that?

Have we as a society become so desensitized that we do not recognize torment and torture to individuals disguised as “made for reality TV?”

These contestants are ridiculed and yelled at by their “trainers” (which by the way is NOT the way you get someone to embrace exercise), asked to participate while being subjected to highly injurious workouts and bated with rewards of being able to choose who gets to be eliminated while being enticed by highly caloric cupcakes. I have seen negligence regularly on the part of both trainers with regard to safety, improper technique and form in execution of movement while resistance training, spinning and kettlebell training in addition to numerous other workout routines. Nutrition education seems to be almost entirely excluded on this show in addition to any emotional (eating) issues being addressed by a professional (which I would think would be of the utmost importance). Don’t you think there are deeply rooted emotional and psychological issues that should be addressed here? What is NOT seen leaves the mind to wonder? When the Biggest Loser does do a “follow up” show they seem to glaze over the fact that most of the contestants have re-gained weight (some almost back to the size they were pre-show) in addition to the feelings of embarrassment that overwhelmed them enough to feel sequestered in their own home.

Why is this show still on the air?

Now tell me. Is this show really about health? Being socially acceptable? Or is it about making bucks by marginalizing a segment of the population based on appearance?

I say it is the latter of the three and wholeheartedly believe that all the real fitness professionals out there would absolutely agree.

Contact Laura at

Wednesday, April 08, 2009

Does Gastric bypass lengthen lifespan?

I received a comment on an old blog today and the misunderstandings in it are so great that I felt the need to answer this comment because many others may have the same misconceptions.

First point... the writer whose name is Jason, maintains that gastric bypass lengthens lifespan and uses the Swedish Obesity study to prove his point. Here is the quote:

The fact of the matter is that having gastric bypass has dramatically reduced deaths in patients who had the surgery versus patients who didn't! These are in PEER REVIEWED studies, with many patients. Swedish Obesity study on longevity

First of all, 10 years post op is not very long and keep in mind that only 13 percent of the surgical patients had had RNY (gastric bypass)... the rest were some kind of gastric banding. In gastric banding of any kind, there is no intestinal bypass as there is in gastric bypass and also, there is normal digestion in the stomach (although long term data on these patients shows a high percentage of paralysis of the stomach etc after 25 or 30 years). So even if the death rate WAS lower among weight loss surgery patients, this study would NOT prove that the gastric bypass increases longevity!

Second, there were not a significantly higher number of deaths in the controls (those who did not have weight loss surgery) than in the patients. (only 1.3 percent more deaths in the non surgical patients - has to be 2.0 or more to be significant according to statisticians.)

But let's take a closer look at the Swedish Obesity study because I'm going to prove that there was actually a MUCH lower mortality rate in the non surgical group in reality than in the surgical group.

This is because the study was not "randomized" meaning they picked and chose their participants. Here's why NOT randomizing the study makes it flawed as far as comparison between surgical and non surgical patients:

Randomization, where study participants are randomly selected and grouped by chance, is the most important way to help ensure that intervention and control groups are comparable (even in ways researchers may not have considered) and that the participants haven’t been hand-chosen to manipulate the findings towards a predetermined conclusion. Randomization prevents stacking the deck, so to speak. Source: Was This Really Proof that bariatric surgery saves lives

In this study, those chosen for the non surgical group had 25 percent higher incidence of heart disease than the surgical patients. They also had 6 percent more diabetes than the surgical patients and they averaged 18 months older. All of which can raise their risk factors.

And even with all of that, the difference in deaths in the surgical and non surgical group... were 1.3 percent more deaths in the non surgical group... with 25 percent more heart disease in the non surgical group, on the contrary, the non surgical patients were living LONGER than the surgical patients! That is, to be even with the surgical patients, the non surgical group with 25 percent more heart disease coming into the study, should have had 25 percent more deaths but in fact there was only 1.3 percent more deaths in the non surgical group.

So the Swedish Obesity study did not prove that weight loss surgery increases lifespan at all. On the contrary... (ibid)

The second comment Jason made was providing "proof" that calorie restriction prolongs lifespan.

Because we cannot obviously easily study humans for this, all the research "proving" calorie restriction has been done with rats and mice. These small rodents, though handy for study because of their short life span, don't really resemble humans in many ways.

But even among rat and mouse studies, the results are inconclusive or actually against calorie restriction prolonging life.

The study Jason provided was one done at Harvard Medical School. According to the article on this:

Dr. C. Ronald Kahn of the Joslin Diabetes Center at Harvard Medical School and colleagues genetically engineered a mouse that lacked a gene called fat-specific insulin receptor. This change limited the action of insulin on fat cells.

I don't think these genetically altered mice which lived a 30 percent shorter lifespan than the unaltered mice are very relevant to any humans. But if we are to compare, we should compare them to genetically or surgically altered humans i.e. like gastric bypass patients... will they, like the surgically/genetically altered mice, live 30 percent shorter lifespans than non surgically altered humans? One very large lady who refers to herself at "supersized" (over 500 lbs) tells me that she has outlived 48 of her friends who had weight loss surgery!

And other rat studies have found the opposite - i.e. that calorie restricted animals not only don't live as long as those who ate their fill but got sick faster.

The results of the one study which found that rats fed less calories lived longer than rats allowed their fill, have never been repeated. The other researchers who tried this study, found that rats fed less food, died earlier and got sick before dying. (ref: Stewart, Douglas: "Solving the Aging Puzzle" reference to the studies of Dr Stephen Austad, "Smithsonian Magazine", vol 28, no. 10 Jan 10, 1998)

About those studies which suggested calorie restricted rats lived longer, the author pointed out that the conditions were not normal... rats usually exercise to catch their food but the unrestricted rats were allowed as much food as they wanted and generally didn't exercise much during the day. "In other words", he concluded, "those studies only proved that overfed - under exercised rats did not live as long as calorie restricted rats"

Jason concludes by pointing out that:

Also, you severely downplay the health problems of obesity. True you can be obese and be healthy, but if you continue to be morbidly obese you will not be healthy for long. You WILL get diabetes. You WILL have heart problems. These are indisputable.

Sorry Jason but wrong again. Your facts are VERY disputable!

1. diabetes is hereditary and not a disease of obesity, and although it is thought by some scientists, that the eating habits which can cause obesity in some people may be a factor in some cases of diabetes, evidence for this has been inconclusive so far. Also to note: According to the ADA, 33 percent of type II diabetics have never been fat. I know personally 6 type II diabetics who are very slim. Including my father-in-law.

2. heart problems are also not a given for any group of people, not even those with high cholesterol! Many studies have suggested that heart attacks happen, equally, in people of all weights, sizes and cholesterol levels. For example, a gent who bragged to me that being 71, he weighed 150 lbs which is the same he weighed in High School, and that he walked several miles each day and had done that for years, a non smoker with no risk issues, had a major heart attack and needed a quadruple heart bypass. Yet a very obese relative who is 73 years old (BMI over 60) has no heart problems at all!

In conclusion, Jason, you are believing the ads for the diet industry in the media which often say very different things from what science and medicine has observed!

And about calorie restriction, what evidence we have, tends to suggest that unless it is done very carefully the person not restricting too drastically, not wasting any calories in junk food and fast food and taking lots of supplements, calorie restriction can be very unhealthy.

So much for what the media tells us. We should remember that the TV and the mass media is "for entertainment only" although truly their rants about overweight people are often far from being very entertaining.

The following page has some more of what science says about obesity:

Article: Fat Factoids