suethsayings

Dr Oz of TV and his infomercial about gastric bypass

2012-01-24T14:17:00.000-08:00

In case you haven't heard by now, Dr Oz on Monday, January 23, had a segment about the gastric bypass surgery for weight loss, touting the invasive procedure as a "miraculous cure" for diabetes and hypertension.

In his opening statement, Dr Oz asked, "What if I told you there was miracle that helps you lose weight, lower your risk of cancer and heart disease and most shocking of all, reverse your type II diabetes overnight?"

Other than the fact that the gastric bypass strains the heart rather than protects the heart (as does any type of invasive surgery), it's interesting to note that the show segment following this rather dramatic announcement, did not mention cancer at all!

The problem with the show is that Dr Oz "forgot" to tell any of the risks of this surgery, which is being done less and less due to the availability of safer options like the lap band which do not call for the surgical dissection of the stomach nor the bypassing of any of the small bowel.

Dr Oz detailed one risk - the fact that patients might regain the weight, but he assured the audience that if patients did what their doctors expected, this would not happen and he emphasized the quick weight loss after surgery, without a reminder that most patients only retain less than 50% of the initial weight loss unless they work very hard at dieting and exercising, two things which will cause weight loss without outdated, risky surgery.

Butch Rosser, a surgeon who recently joined the "gold rush" of weight loss surgery, was also a guest on the show. Rosser had a gastric bypass 3 years ago and has not yet, experienced any repercussions - at least, none that he wanted to talk about on the show.

One of many things which concerned me, was that several things were misrepresented on the show. For example, Dr Oz stated that the gastric bypass was invented in the 1970's - not true - it was invented in 1965 by Dr Edward Mason, who stopped doing his own surgery in 1980 after he found most of his patients to be suffering from severe osteoporosis and more. Mason wrote prolifically about the problem of "metabolic bone disease" in gastric bypass patients but unfortunately, only in medical journals - not in places most prospective patients would visit.

Dr Oz also gave the impression that the gastric bypass was not invasive as far as disturbing digestion, reiterating the myth that the food meets the digestive juices lower in the small bowel. In truth, the bypassed stomach does not produce a lot of acid and when it does, it gets rid of it quickly - since no food in the stomach is how our bodies tell the stomach to release the acid. What acid there is, is more likely to cause an ulcer in the small bowel than to digest food. Also the small bowel does not have the protective qualities of the stomach against the acid erosion and it is unknown whether without the presence of food, the duodenum or first section of the small bowel, also bypassed in the gastric bypass, will neutralize the acid released by the stomach as it does in normal digestion.

All this led Dr Mason to write about the disturbances in digestion the gastric bypass causes:

"I would like to see greater use of simple restriction procedures that do not rearrange these finely balanced mechanisms." U of I Healthcare news

So why did Dr Oz so ardently "sell" the gastric bypass (and bypass the more modern procedures which are also safer like the lap band)?

One can only speculate about this - obviously somewhere along the line, there might have been money changing hands - the misrepresentation of facts can usually be traced to the "money trail". Also, less and less people are opting for the gastric bypass which might be leaving some weight loss surgery surgeons in the need to learn new surgeries, a process no one enjoys.

Whatever the case, it was using television and a lot of misrepresentation to hard sell surgery which is, at the least, ethically challenged.

From the patient and other reactions I've heard, Dr Oz lost some fans after this show segment - people are not quite as naiive about these weight loss surgery procedures as he seems to think they are. One individual wrote me that they had always felt Dr Oz was awesome but after they'd seen this segment on the gastric bypass, they were totally disallusioned with Dr Oz.

And as for Butch Rosser, MD, the gastric bypass surgeon - come lately; when and if he gets longer term repercussions, will he appear on a TV show to tell about this? No bets.

Does Obesity really cause brain damage?

2011-12-29T17:23:00.000-08:00

Obesity might cause inflammation in the brain, shouts out the latest headliner coming out of the NPR News.

According to the NPR article:

...some provocative research suggests that a part of the problem might be that obesity could change the area of the brain that helps control appetite and body weight.

The study was published in the Journal of Clinical Investigation and since my trust of media reporting on studies is about zero, I decided to look up the original study to see what it really found.

Not surprising, the study report article differed completely from the news article.

In this study, the researchers found that when rats were fed a diet high in fatty foods, even before they became overweight, there was evidence of inflammation in the rat hypothalamus gland, a gland in the brain which is thought to regulate body temperature and metabolism.

The scientists wondered whether humans reacted similarly, so they MRI-ed the brains of 34 humans and found more evidence of damage to the hypothalamus in the 12 humans who were obese than in those humans of normal weight.

Michael Schwartz, one of the researchers on this rat study was very shocked at the results, he told NPR. Schwartz is the head of the Obesity and Diabetes Center of Excellence at the UW School of Medicine.

I do see some possible issues in the study such as, can it be assumed that normal weight humans did not consume as much fatty food as obese humans?

But unlike the media, the scientists commented that this damage may be a factor in developing obesity and not that obesity caused damage as the NPR article stated. The scientists named their article, "Obesity is associated with hypothalamic damage". The media in their typical fashion of misreporting, headlined their article "Could Obesity Change the brain?".

Actually, I am not surprised that the hypothalamus glands of some overweight people might be damaged but of course, the study never stated that the obesity proceeded the damage - either in the rat study or in the human study.

Interestingly, this study may dovetail another recent study which found that a rather alarming percentage of people developed obesity after their tonsillectomies (which may be due to hypothalamic damage). The scientists in that study stated they did not know what caused this but suggested it might be that swollen tonsils caused difficulty in swallowing before they were surgically removed. I was one of those who packed on the pounds after my tonsillectomy and no, I had no difficulty in swallowing before that surgery! I also was very active, spending most of the day, running around, riding my bicycle etc. However, I was more hungry after my tonsillectomy which could be the effects of a damaged hypothalamus.

The study at the UW seems a landmark study, the first which suggests that damage to the hypothalamus might be a factor in obesity, which is a pretty shocking result as Dr Schwartz suggested however, with the media misreporting the study to something totally different, the public may never know what the real study found!

Obviously, the rat brain is quite different from the human brain. And the scientists admitted they cannot really generalize from how the rats reacted, that humans would react in the same manner but they did suggest more research along this line would be appropriate.

As an aside, it would be nice if, for once, the media would consider accurately reporting about the scientific research instead of totally changing what the study was even about. (the photo is of the Olympic weight lifter and medalist, Cheryl Haworth)

Better Watch Out for Those Hot Dogs, says Dr Hu

2011-08-10T13:03:00.000-07:00

Does anyone remember the professor/researcher at Harvard Medical School, Dr Frank Hu, who came up with the conclusion that if a person was overweight, exercise did not help them at all?

In 2005, Frank Hu and JoAnn Manson (Harvard) published a study in the JAMA "proving" that an overweight person cannot be physically fit even if they regularly exercise.

This was an epidemiological study (notoriously inaccurate) but it hit the news in a big way. Not surprising since the news thrives on this sort of headline.

Dr Hu and associates have again hit the news with a study which will be published in the "American Journal of Clinical Nutrition".

This study concludes that if you eat red meat at all and especially hot dogs, you have a significantly higher risk of developing diabetes. (the risk factors quoted in the news range from 21% greater risk to 50 percent greater risk).

If we get picky about things, there is a big difference between lean steak and a hot dog but no real proof that either, eaten in moderation will be our demise.

As is with all epidemiological studies, the numbers of the cohort are impressive but we must remember that not enough information was collected specifically for this study. That is, you can prove pretty much anything with an epidemiological study done with an existing cohort - even likely prove that as much as eating a hot dog can raise the risk for diabetes so can that risk be increased by riding a bicycle (assuredly most in the cohort have done both!) :)

But making headlines is what researchers want to do because it assures them of continued funding and the news doesn't want to see what science really comes up with i.e. possibilities that this or that might be true but rather foregone conclusions.

"Scientists", reminds Dr Roy Spencer, PhD and author of "CLIMATE CONFUSION", "are human too", doing what is necessary to obtain funding. Coming up with an attention getting headline is a good way of assuring continued financing for other studies.

The problem is, that some folks perhaps, take studies like this seriously, which isn't a good idea. Rather, it's best to smile and move on and eat our hot dogs and red meat with no worries. Dr Hu's study proves nothing except he likes to get paid, and coming up with a sensational news story is a good way to do that.

what is and what isn't about weight loss surgery

2011-06-26T09:42:00.000-07:00

In case you haven't heard of the Obesity Action Coalition, they are a group determined to rid the world of obesity by way of weight loss surgery. Recently they had a conference which was at least in part, underwritten by Ethicon Endo which manufactures lap (gastric) bands and also surgical instruments for doing gastric bypass. And by at least one of the conferences which is online, it appears they are definitely selling the surgery.

Which of course, is their right. But what I felt compelled to blog about is, while reading through the transcript on line in an easily readable form thanks to "Melting Mama", it struck me how one bariatric surgeon, Dr Stegemann of Texas, appeared to give some misleading answers.

Here are the ones which jumped out at me (there may be others):

Question: "I have high blood pressure and diabetes this runs in my family, can this surgery really help me..."

Dr Stegemann answered "Absolutely. Significant weight loss improves many of the medical problems that come along with carrying extra weight!"

There is some evidence that weight loss can help health but equal evidence that it's lifestyle which is the key and not what you weigh. However, what he didn't say is, there is no evidence that doing something unhealthy or risky to lose weight improves health. And plenty of evidence to the contrary. And the questioner asked about surgery specifically and not generally about weight loss.

When asked which surgical option is the safest, Dr Stegemann's answer was very evasive and very non informative.

He began by saying that all surgery has risks. (no brainer) And then, went on to say that the risks of "most" bariatric surgery operations is similar to gall bladder surgery. While that has been said to be true of the lap band, it is not true of any of the other surgeries. The risks of the gastric bypass surgery have been compared (by the Fresno Hospitals for one) to open heart surgery.

The commentator of the session saw that Dr S had not really answered the lady's question about which option is the safest so he asked the doctor to be more specific.

But the good doctor again appeared to evade (as he did later in the session when someone asked a similar question). He responded by saying: "The most common weight loss surgeries done in the US would be the adjustable gastric band, gastric bypass, and sleeve gastrectomy."

Notice he still never gave the risks of each procedure which was the original question. The moderator gave up and went on.

The next question was asking how it feels to have a lap band.

Dr S's answer is worth quoting:

"The band works by controlling hunger and controlling the amount of food you're able to eat. So, you'll be able to eat the same foods, but smaller amounts will make you feel satisfied."

There is no evidence that putting a band around the top of your stomach does anything to the appetite unless of course the idea of it growing into your stomach (which happens in a number of cases) scares you and you lose your appetite that way.

Also it doesn't control the amount of food either - it just makes it uncomfortable to eat healthy foods like meat, vegetables and fruit. Cake, milkshakes and cookies slip right down and you can eat any amount of these comfortably. (and many patients do).

And there is no evidence that with a band or even a gastric bypass, smaller amounts of food make you satisfied. With the gastric bypass, you spend a long time healing and during that time, just like when you recuperate from any major surgery, you might have less appetite especially as your digestive system has been very rearranged, but after that healing process which may take as long as a year or a few months, the appetite returns (in most patients unless they become seriously ill) with a vengeance. At least one clinical study found that in many gastric bypass patients, the blood sugar levels are "irratic" and many patients experienced "voracious" hunger a couple of months after surgery. (Roslin - who is a bariatric surgeon -Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.)

Dr S went on:

"If you overeat, then you generally feel pain in your chest, usually followed by vomiting."

It really depends on what food you overeat. Mostly, the pain after eating comes from a piece of food like meat, getting stuck and not going down right. The pain part is correct. I've seen it in band patients (also happens in gastric bypass patients). But patients aren't always able to vomit since the bottom of the stomach which pushes the food up is far away from the "stuck" food (and the muscular pylorus - lower stomach valve- which causes vomiting, is totally missing in gastric bypass patients). Usually band patients and gastric bypass patients endure a couple of hours of intense pain before the stuck piece either goes down or comes up. Occasionally a 'scope is required to fix things. Can be scary, can be nasty and is very likely to happen with a piece of badly chewed steak. You can fill up on cake and milkshakes and potatoes all day with no repercussions.

It is true however, if gastric bypass patients overfill the tiny stomach pouch, they will upchuck, often without notice. Again it's not really vomiting because there is no warning or sickness before. The food just comes up. Many learn the feeling and run to the bathroom. But most gastric bypass patients can tell tales about the "barf bags" they carry in the car or upchucking at a restaurant table.

Fooling with such a complex system as the digestive system has a very dark side.

The next question was about the gastric sleeve, a procedure in which 85-90% of the stomach is stapled off and removed from the body.

Dr S admitted there is no long term data about the safety or efficacy of this procedure but said since other stomach surgeries are safe and short term data on weight loss looks good, this surgery is likely safe and effective.

However, Dr Robert Davis of the "Big Medicine" TV show, admitted that the weight loss data with the sleeve had been poor and that's why they had to go to removing so much of the stomach. The recalcitrant stomachs tend to stretch out apparently.

So bottom line, there is no information available about whether this procedure is either safe or effective. There are many things digested in the stomach and from the information we have about the duodenal switch, Dr Hess, the inventor, stated that it was to significantly cut down stomach acid (and reflux) that they went to removing most of the stomach but without enough stomach acid, most of the stomach produced enzymes will not work either (see "digestion" in any Anatomy and Physiology book).

Then Dr S states that "After a gastric bypass, approximately 85% of patients are able to maintain at least 50% excess weight loss long term."

First keep in mind the average weight loss surgery patient is looking to lose 100 lbs so the doctor is saying here that most patients can keep off 50 lbs with a gastric bypass - but is 50 lbs worth the surgical changes to the digestive tract and lifetime vitamin deficiencies? Most folks can keep off 30 lbs with no surgery!

Second, many studies I've seen do not show this high a percentage of patients even keeping off 50% of the excess weight. Some of the studies by bariatric surgeons can be misleading because obviously those who regain (many patients!) do not report in and are listed as M.I.A. and not tallied in the statistics. More likely this statistic is 85% of those who reported back to the doctor can ...

Finally, there is the doctor's statement that: "Studies show that in 80-85% of people who undergo gastric bypass, their Type 2 diabetes resolved."

Studies on TWO YEAR POST OPS found this. However, the one longer term study (10 year post ops) found that only 35% of diabetics remained disease free (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).

There is a lot of good information about repercussions, side effects, post op care etc in this speech so it's worth reading - just watch out for the affore mentioned statements - as they are misleading.

The People of Walmart emails

2011-06-08T02:53:00.000-07:00

Every so often someone sends me an email, entitled "The People of Walmart". Apparently, these are supposed to be uproariously funny. The people pictured are real people and the folks who like these emails, tell me that these people are dressed in - shall we say - less than fashionable outfits and that they "should know better" (and thus, deserve to be ridiculed?). Which isn't true of the greeter above, by the way, who simply is wearing the Walmart uniform.

It is assumed, I guess, that none of these people have computers and thus will never see the emails ridiculing them. However, today, more and more folks do have computers and so if they see photos of themselves in an email with comments like "I can't stop laughing at this", would they be very hurt? I suspect they might and if the world is hurtful enough, why take the chance of hurting someone more than life might have hurt them previously?

And we must ask, does anyone "deserve" to be ridiculed, regardless of what they wear, how old they are or the size of their bodies?

What really bothers me about these mails is the underlying "elephant in the room" which no one wants to mention, and that is that although I'm certain that outlandish clothing is worn by people of all sizes and ages, the only individuals who get pictured in the "People of Walmart" emails, are overweight and/or elderly.

So what are we saying with this email - that people of size or over a certain age, should be "open season" for ridicule? And since many of those who have sent those emails would fall into both those categories (elderly and overweight), are they laughing at their fellow humans in an effect to say "well, look how bad these people look - I know *I* don't look that bad!"?

By laughing at the "people of Walmart" , we seem to be not only reinforcing our negative feelings about our own looks or girth but letting those around us know, it's "ok" to ridicule the elderly and/or people of size. Whereas if we viewed these fellow humans, in the way emphasized in a recent EWTN "Catholic View for Women", looking for the inner beauty instead of judging them by their exterior, we might become more aware of our own inner beauty which is not contingent on having a size 0 figure or being 20 years old!

The other side of the "People of Walmart" emails and the prevalent attitudes about size, is that our children who should be nourishing well, in their developmental stages, are increasingly coming down with eating disorders and/or disordered eating, in a sad effect to avoid being like "the people of Walmart", an object of ridicule. The average 8 year old is already on a diet and restricting the very nutrition they need to grow strong and healthy!

I think we need to realize that these emails are not only hurtful to those who may be pictured in them and hurtful to some of those receiving the emails who wonder when they will be pictured but also, hurtful to the sender who is ridiculing fellow humans on the superficial basis of size and/or age.

Respect for all human beings will build respect for ourselves!

Sick Gastric bypass patient - not so rare

2011-05-04T04:11:00.000-07:00

Malissa Jones of the UK first made the news in 2008 when she became the youngest person to have a gastric bypass in her country. At the time, she weighed over 400 lbs and by her own admission, had a taste for candy and not the greatest food choices. (She told the news, she's consumed 10 chocolate bars in a day!). Typical teenager but with her genetics this type of teen eating did not work. So she had become very obese. Malissa complained about being teased and bullied in school but she apparently had some health problems also. She had trouble breathing and when she was 15, she went to the ER with chest pains which is why the NHS decided to do a gastric bypass on her when she was 17 years old. Typically they don't do bariatric surgery on anyone younger than 18 years old

Her surgery did not initially go easily for her. She was in intensive care for 36 hours but she did survive and began to enjoy her honeymoon year.

In February 2009, she was again interviewed. In a blog which reprinted a news article, now no longer available, it was reported that she had lost over 200 lbs and said that this surgery had saved her life. She weighed around 196 lbs and took a size 14, a great improvement over the size 28 she used to take. She talked about night clubbing and discovering a whole new world. "I've had a lot more boyfriends because I feel much more attractive and confident.", she told the news reporter. She mentioned that she was saving up to have the loose skin removed in a private surgery (it was not covered by the NHS).

But sadly, Camelot wasn't going to last for her.

By December 2009, apparently been unable to save up for the $40K surgery she required (Lower body lift, tummy tuck etc) to remove 28 lbs of loose skin which remained after her quick weight loss, she was not a very happy camper. Life continued on a downward trend, when she became pregnant at the age of 20 but they had to take the baby prematurely because they feared that carrying fullterm might be too risky for Malissa. Henry, a little boy did not survive.

Malissa recently made the news again. She now has been diagnosed anorexic - she weighs only 112 lbs (she's 5'8") and is unable to eat more than 300 calories a day. The news stated she was afraid to eat but she said in addition to being terrified of regaining, she suffers pain and sick stomachs when she tries to eat more food.

There are a number of gastric bypass patients I've met like this - who are unable to eat a couple of years after surgery. This inability to eat is sometimes combined with a phobia of food in general as is the case with Malissa.

One might ask why NHS doesn't give her a reversal and perhaps they have done that, but a reversal won't help the fear of food she has developed since her surgery. Again the NHS is worried for her life. She's much too young to die but this time around there is no surgery which can save her life except intensive psychotherapy.

This is not as unusual a case as providers would like us to think it is. I've actually, met quite a few patients who suffer from something similar to Malissa.

And in a 2001 news article, clinical psychologist and eating disorders expert, JoAnn Mann,RN, told the Fresno Bee,

***"I've seen massive infection, I've seen people hospitalized for malnutrition. I've seen people obsessed with food. I've seen people unable to stop vomiting. I've seen people develop massive eating disorders, I've seen people who are terrified of gaining weight. Terrified. It runs their lives." ***

Dr Jen Berman,a Los Angeles psychotherapist and an expert on eating disorders, has counseled many gastric bypass patients over the years. She told the news media that some patients have developed eating disorders and are afraid that if they eat too much, they will be sick.

***"I have seen people become terrified of food. They feel like their body is out of their control because they lose the weight so fast. I have seen people develop terrible phobias of gaining weight or losing weight." (IBID)***

SO Malissa Jones isn't alone in her food fears, but her road back to health will be a long lonely one, and much harder to trod than it would be had she remained overweight.

Definitely a case (one of many) when the cure is far worse than the original disorder.

bariatric surgery - neither safe nor effective?

2011-05-02T11:43:00.000-07:00

In a metastudy in Canada, researchers found that in initial weight loss, the intestinal bypass was the most effective and running close second was the DS/BPD (also a long limb intestinal bypass but with a greatly reduced stomach) and the minigastric bypass which has a greatly reduced stomach and a bypass of about half the small bowel.

Even bariatric surgeons admit that long intestinal bypasses are associated with liver and kidney failure on the long term.

So what is this saying... if you have a procedure which destroys your ability to digest vitamins and cripples one of the most important organ systems in your body, you might lose a lot of weight in the first year? You can do that with cancer also - without surgery even. :(

The last sentence is interesting - the lap banding was the least effective in initial weight loss but, they admitted, delivered the least amount of adverse repercussions. That being said, many lap banders have to have the bands removed after a few years because eventually, the constant rubbing of the band on the soft tissue of the stomach can partially destroy the stomach.

In the one study which was drawn out to 10 years post op, the Swedish Obesity Study, they found that the average BMI for all surgeries, was 35, still very obese. (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) Which seems to suggest that the more risky surgeries are not any more effective in the long run than the gastric banding which is a lot less risky but none of them are really effective. ("Success with weight loss surgery is 10% the surgery and 90% the patient" Dr Terry Simpson, MD and bariatric surgeon)

Another study found that within 10 years, 34% of those who started with a BMI higher than 50, had regained all or most of the weight. (Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)

Bottom line, there is no shortcut and to keep the weight off everyone has to do the same thing - count calories, make mostly healthy food choices and exercise.

In the Hebrew University study they found that only 7% of gastric bypass patients could keep off all their excess weight (follow up was 6-9 years on 600 patients) and another video from a provider I recently watched, the bariatric surgeon stated that WLS of any kind does not take off all the excess weight and people should not expect to get "slim" from it.

About 5% of people who follow a program, non surgical can keep off all of their excess weight so with risky procedures which all damage the digestive tract, one only gets a 2% greater chance of keeping off all their excess weight unless they diet and exercise or unless the procedure makes a person unable to eat (cancer does that also).

I think maybe more folks should do the math. :(

Here's the abstract on that metastudy:

Obes Rev. 2011 Mar 28. doi: 10.1111/j.1467-789X.2011.00866.x. [Epub ahead of print] Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Padwal R, Klarenbach S, Wiebe N, Birch D, Karmali S, Manns B, Hazel M, Sharma AM, Tonelli M. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Department of Surgery, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, University of Calgary, Calgary, Alberta, Canada. The clinical efficacy and safety of bariatric surgery trials were systematically reviewed. MEDLINE, EMBASE, CENTRAL were searched to February 2009. A basic PubCrawler alert was run until March 2010. Trial registries, HTA websites and systematic reviews were searched. Manufacturers were contacted. Randomized trials comparing bariatric surgeries and/or standard care were selected. Evidence-based items potentially indicating risk of bias were assessed. Network meta-analysis was performed using Bayesian techniques. Of 1838 citations, 31 RCTs involving 2619 patients (mean age 30-48 y; mean BMI levels 42-58 kg/m(2) ) met eligibility criteria. As compared with standard care, differences in BMI levels from baseline at year 1 (15 trials; 1103 participants) were as follows: jejunoileal bypass [MD: -11.4 kg/m(2) ], mini-gastric bypass [-11.3 kg/m(2) ], biliopancreatic diversion [-11.2 kg/m(2) ], sleeve gastrectomy [-10.1 kg/m(2) ], Roux-en-Y gastric bypass [-9.0 kg/m(2) ], horizontal gastroplasty [-5.0 kg/m(2) ], vertical banded gastroplasty [-6.4 kg/m(2) ], and adjustable gastric banding [-2.4 kg/m(2) ]. Bariatric surgery appears efficacious compared to standard care in reducing BMI. Weight losses are greatest with diversionary procedures, intermediate with diversionary/restrictive procedures, and lowest with those that are purely restrictive. Compared with Roux-en-Y gastric bypass, adjustable gastric banding has lower weight loss efficacy, but also leads to fewer serious adverse effects.


PMID: 21438991  [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/21438991

Alli / Orlistat linked to kidney, pancreas damage

2011-04-20T10:59:00.000-07:00

GlaxoSmithKline has announced it's dropping the OTC version of Orlistat i.e. Alli, a diet drug from those drugs they sell. Ironically this announcement came after a study found a link between this drug and kidney damage as well as several cases of pancreatitis (last year the FDA warned of a possibility of liver toxicity from Orlistat):

http://www.gsk.com/media/pressreleases/2011/2011-pressrelease-402902.htm

The study reporting adverse effects of kidney and pancreas damage in a percentage of those using Orlistat or Alli

http://www.medscape.com/viewarticle/740855

Cite: Weir MA, Beyea MM, Gomes T, et al. Orlistat and acute kidney injury: An analysis of 953 patients. Arch Intern Med 2011; 171:703-704. Abstract

New diet drug, Qnexa a breakthrough? NOT!

2011-04-20T04:15:00.000-07:00

Interestingly enough, the news article in many news services including the NY Times, suggesting a "new breakthrough" in obesity drugs, appeared recently - cheerleading a drug which was not approved by the FDA - what's going on?

First of all, it's true that those on a combination of the drugs - topamax and phentermine (i.e. the "PHEN" of the somewhat risky potion - Phen-Fen) lost more weight than those on either one of those drugs or those on placebos (no drugs).

However, the most weight lost on the highest dose of the two drugs, Topamax - a drug used in lower doses for migraine control and Phentermine, was 18 lbs over a period of a year and a month (56 weeks). In other words, that's less than 1/2 lb a week! You can actually lose more weight with a Richard Simmons exercise program and no diet! And without endangering your health with a drug which already has been suspected to cause heart problems and another drug about which people have complained bitterly of the psycho- side effects including dizziness and brain fog!

Not surprising, the studies concluded that the difference in weight loss between those on the drugs and those in the placebo group (the latter lost 5% of their weight), was "of nominal statistical significance". Not exactly earth shaking as the news story would like us to believe, is it!

Furthermore according to an article in the LA Times, this is one of the studies done for FDA approval (which has not been given at this time) and not a new study!

And finally, predictably, it was funded by Vivus, the pharmaceutical which is trying to market the drug.

Notice the little plug about diabetes in the article - diabetics seem the new target group. Using old statistics about diabetic repercussions (like what people in the 1960's before modern medications sometimes suffered), these groups are scaring people with diabetes into drastic and sometimes unsafe solutions.

In a society which allows pharmaceutical companies to advertise risky drugs on the open market, the consumer must be very careful - a wrong decision in buying such a drug might result in a lifetime devastation of one's health - as those who trustingly took Phen-Fen can attest to.

And another revolutionary new surgery for obesity... or is it?

2011-03-03T12:46:00.000-08:00

ABC News broke the story with the headline, "Stomach Pacemaker could help obese lose weight!".

A new device, they continued, recommended for clinically obese people (BMI 35-55) fools you into thinking you are full ... yada yada, yada.

Their poster kid, a young man who lost 20 lbs with the device had "just tried everything" to lose weight and nothing worked until this doctor came along (was the doctor riding a white horse?) with the stomach pacer. The young man lost 22 lbs with it. (OK, all together now... "W-O-W") He's a mail carrier in Germany and 20 years old (one wonders if he had to lose weight at all except to perhaps get a set of washboard abs and "P90X" might have done that more effectively and without surgery).

The British Health Service has approved this device and it's being sold across the European Union although the news articles admitted that none had been placed commercially yet.

The problem here, is the idea of a gastric pacer is neither new nor effective for the population for whom they are suggesting it and the fact that an already physically fit 20 year old lost 22 lbs after it was implanted, might be less than impressive to both patients and/or the American surgeons who were excited about the Transneuronix version in the early 2000's and who personally saw the abysmal failure of the device to be either effective OR safe in the American trials.

There is a new wrinkle to this pacer and that is that it's invasive, much more so than the lap band. How? Because it has two leads, one of which lies on the stomach like the older pacer and another of which is inserted though a hole made in the soft stomach tissue into the stomach (it's supposed to detect when food comes into the stomach and then, it sends a message to the other lead which starts the vibration). This brings in the possibility of leaks and sepsis later on. One does not have to leak much stomach contents into the abdominal cavity to cause serious problems! In contrast, the lap band does not require a hole into the interior of the stomach.

Obviously, some well meaning surgeons are unaware of the hefty lawsuit suffered by Transneuronix after one individual had a nightmarish experience with the older (less invasive) pacer. The surgeons who did not hear about the people involved in the American trials, for whom the pacer was uncomfortable (it vibrated throughout their arms) and ineffective (they lost 5-20 lbs with it), some of whom experienced complications like the pacer traveling to other places in the body and all of whom were revised to gastric bypass or lap band. When the pacer failed totally, it was not headline news as were the announcements of it or the adverts for folks for the trials. In fact, the trials failing didn't hit the news at all. The only reason I know about it, is I was following several of the trials and in touch with some of the participants and I know the person who ended up suing.

If you were unimpressed by the poster kid featured in the news, there is another poster kid on the Abiliti website, another young man - a fire fighter. He lost an "impressive" 15 lbs with the device and from his photo where he looks very slim, he also, may not have been fat to begin with and yet, they are recommending this for clinically obese folks?

Sadly, there have been 65 patients who have had these implanted in 2 trials in the United States, however interestingly enough, in searching the web today, I could find no articles or announcement of the trials nor mention of the surgeons involved. As an MSNBC article stated:

So far, about 65 patients in two studies have received the device from U.S. pacemaker manufacturer Intrapace. Only about half of those have had the pacemaker for at least a year, and most lost about 20 percent of their weight and kept it off.

I really hate to see a repeat of history or worse. For it is said that "who does not study history is doomed to repeat it" but then when our news services do not totally report the story, it makes it hard to study history.

"Conspiracy? No conspiracy - only businessmen doing what businessmen do best, selling product" (Bernie Goldberg,a former network anchor in his book "BIAS") Only this isn't a car or a piece of clothing - this has the potential to hurt humans.

The TOGA procedure - new hope for weight loss surgery or ?

2011-02-15T11:46:00.000-08:00

A recent announcement stated that the UK had done 450 TOGA procedures for treating obesity.

The TOGA procedure offers an "incision-less" weight loss surgery. What is done is basically stapling the stomach from the inside (a surgical instrument is inserted through the mouth).

American surgeons have appeared to not have greeted this procedure with the same enthusiasm as those in the UK.

Click here to see an animation of the TOGA procedure.

A surgeon's description of "minimally invasive" can be misleading to patients. They simply mean no incision. They do not mean the surgery is lightweight or not complex. This procedure calls for stapling the stomach from the inside into a narrow sleeve and step two is narrowing the lower end of the sleeve so food doesn't go through well. This is supposed to cause the patient to feel full with a lot less food.

It's interesting to note that all the procedures and medications are aimed at cutting appetite but since when do people only eat when they are hungry? The type of appetite we mostly have, is in the head and not fixed by feeling full in the tummy.... which may explain why even the more complex procedures are somewhat ineffective in a number of patients.

As the websites about the TOGA do not seem to be recently updated, it seems that the TOGA may not have become popular in the USA yet, and one wonders whether the weight loss results were less than expected or whether there were a lot of complications in the American trials.

Even if the TOGA holds better than the Rose or the StomaPhX, it may cause a lot of discomfort for the patient. In fact, patients complained of a lot of pain with both the Stomaphx and the Rose procedures but not much additional weight loss. And with the Rose and the stomaphx, they had problems with the staples or clips pulling out after a year or so. The tissue inside the stomach is very soft tissue, so it makes sense that staples or clips would not hold well.

Apparently a study in 2008 did not result in the weight losses claimed by the manufacturer. Also as you notice in the quote, even in a small number of patients (6), researchers observed in some cases "Partially stapled sleeves". In other words, in at least a couple of the members of the cohort, the staples had already begun pulling out.

There were no complications; all but 2 instances of procedure-related adverse effects (nausea, vomiting, pain, dysphagia, pharyngitis) resolved within 5 days and none were serious. The most recent follow-up visits (endoscopy at 3 or 6 months) showed persistent full or partial stapled sleeves in all patients. Weight loss averaged 17.5 lb at 1 month and 24.7 lb at 3 months after treatment (excessive weight loss [EWL], 14.9% and 20.5% at the respective time points). At 6 months, average weight loss was 31.1 lb and EWL was 24.9% for 6 patients followed up so far.

Endoscopy. 2008 May;40(5):406-13.

In reading about this procedure, I somehow am reminded of the title of a book that Susan Powter wrote --- "STOP THE INSANITY".

Less Heart risk, gastric bypass - new study

2011-02-05T04:03:00.000-08:00

A study which followed 400 gastric bypass patients, found that the average BMI at the 2 year point, was 32, still obese. The study was conducted at the Medical College of Georgia.

That the patients had mostly not lost all their weight was predictable but the study's lead researcher, Dr. Sheldon Litwin, chief of cardiology, reported that the patients had a reduced risk of heart disease.

Explaining that the size and mass of the patients' hearts had greatly decreased, Litwin stated this suggested that their hearts were not working as hard to pump blood and therefore, less "stressed" than before surgery. Dr Litwin also said that the hearts of the patients were more normal size.

The problems with this theory are many - first, the heart is a muscle and working it is not a bad thing which is why many overweight people have strong hearts. Second, what caused the reduction of heart tissue? Was it less stress due to a lower weight (which remember, was for most patients, still in the "obese" range) - or was it that in the first year or so, gastric bypass patients take in very little food (300-500 calories day, thus causing a very rapid weight loss) and what their bodies can no longer get from food, is leeched from their bodies. Protein and iron, both poorly digested in gastricbypass patients especially in the post surgery stage, can be obtained from the heart tissue and this would much more likely explain the loss of heart mass however, loss in this manner would not be a good thing. On the contrary. It is this type of tissue loss which is suspected to be a factor in the heart attacks observed in 25% of anorexics.

I have known several gastric bypass patients to come down with heart disease after surgery (some require a pacemaker for example).

I notice in the article they quote Dr Lee Kaplan saying that only 1 percent of those qualified for weight loss surgery get it. But I'm wondering if that quote was taken out of context because in the Self Magazine article, Dr Kaplan said:

*** "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 ***

The article points out that the risk numbers, cholesterol and blood pressure are down on the gastric bypass patients. These numbers also go down in people with terminal cancer. However, I doubt that cancer patients are at lower risk of coronary disease.

Finally, they emphasized the diabetes "cure" (really a remission not a cure) which has been observed in 72% of patients at the 2 year point, however, what they don't mention is that the studies have found that by the ten year post op point, most cases of diabetes have returned.

Whatever the case, it seems like the media is using this study to sell the surgery than anything else (as someone on one of my listserves pointed out).

Dying from elective surgery

2011-01-21T03:31:00.000-08:00

Surgery used to be something done to save lives. But now it's often done for other reasons like to lose weight.

Recently a 52 year old woman died after a lap band procedure - probably a complication of the general anesthesia required for weight loss surgery. She was only 50 lbs overweight.

In another story, a woman who was 100 lbs overweight opted for liposuction to remove 50 lbs and now has a body which is very deformed even after she spent some $6000 bucks for chiropractic treatment and more.

As Weight Loss surgeries go, the lap band has the best safety record. In this procedure, a band is placed around the top of the stomach to form a "pouch" which fills up quickly. This is supposed to send signals to the brain that you are "full" when you have eaten only a small amount of food. The procedure, unlike the gastric bypass, includes no intestinal bypass and no cutting of the stomach, and unlike the gastric sleeve, does not call for the removal of most of the stomach. In the lap band procedure, things are pretty well left in tact.

But like all the other weight loss surgeries, the lap band has its downsides. Many patients find that if they are not pretty strict about dieting from the get-go, they don't lose any weight. And of course, there are many foods which are delicious and low bulk which slip right through the lap band like Dairy Queen blizzards etc. To feel full if you have a lap band, you have to eat bulky foods and if you do not measure them, you can suffer a repercussion called a distended esophagus (when food overflows the pouch). A distended esophagus can lead to perforation which is a serious life-threatening condition and also is difficult to fix. Finally, in a percentage of patients, the lap band adheres to the stomach but the percentage on the long run may be higher than we have been told.

Sharon Osborne who used the lap band to lose 90 lbs and has kept most of it off, had her lap band removed a couple of years ago. "I was tired of vomiting every day," she explained to the press. Her famous rock star husband, Ozzy, told the press he was sick of listening to his wife upchuck so often.

Obviously, Sharon may not have followed some of the rules all weight loss surgery patients are told to follow about "measure twice, eat once, vomit never" but doesn't the way it's sold on TV make it all look like it works pretty automatically? They never go into details about all the work the patient has to do which is very similar to any weight loss program, even the non surgical ones.

About 5% of people on non surgical weight loss programs can keep off the weight. With weight loss surgery it's only 7% even with more invasive procedures like the gastric bypass. Many weight loss surgery surgeons don't expect patients to keep off any more than half their excess weight on the long run even when they are putting in the work, but again, how many seminars tell that to prospective patients who are typically 100 and 200 lbs over their "goal weight"? I know a person who regained 100 of the 200 lbs initially lost with their gastric bypass and they couldn't for the world, take it off, even with diet and exercise. Apparently their metabolism had been so damaged that eating anything more than 700 calories a day, caused a gain.

How many people would agree to major surgery like weight loss surgery if they knew it would mean a lifetime of dieting and exercise as well as supplements, B12 shots, possible iron infusions, frequent doctor visits and more... and then, to only lose 50 percent of what they initially wanted to lose (for most patients)?

How many people would agree to a gastric bypass if they knew that they had a chance, even a small one, of getting a seizure disorder afterward or reactive hypoglycemia?

How many people would agree to a gastric sleeve surgery (the newest one they are touting) if they knew it called for the removal of 90 percent of their stomach, leaving a pouch the size of a thumb and that if they had any acid in their stomach, they might easily get an ulcer which could quickly ruin the stomach and require the removal of the rest of their stomach or else if they had no acid in their stomach, it could cause all kinds of things including auto-immune disorder (including MS by the way) because of "leaky bowel" syndrome where bacteria from the food eaten is not killed and instead, recirculated into the bloodstream?

How many people would go into a major surgery even with a lower death risk (the lap band has a death risk of 1 in 7000) if they really thought they might be the one to die? As for those surgeries like gastric bypass where the risk of death is much higher (1 in 50 in some studies), how many people would choose this procedure being fully aware of the death risk?

And finally, how many would agree to surgery if they knew they might not die right away but instead become ill, or require additional surgery like losing their colon from sepsis due to perforation (a sometimes repercussion of laparoscopic surgery) or lose their ability to walk?

Truly some might say "yes" to this but perhaps, not enough people to provide a steady income for many surgeons. (The average weight loss surgery surgeon has an annual income of 1.5 million dollars or more)

Perhaps we should consider going back to reserving surgery for when it's necessary and avoiding it when it's not necessary. Dying or getting a severe disability from a procedure we could have lived without, may not be a good idea for most people.

For sure, those who choose major surgery, should be very sure they ask and get answers for the question, "What can go wrong?" and not just trust new ops or those successful at surgery who may not be sharing the whole story, or least of all, the TV.

All he did to lose weight was eat less and move more?

2010-12-29T10:57:00.000-08:00

An article on CNN covers the weight loss of a man who went (they claim) from almost 500 lbs to "one-der-land". The man, Matt Hoover (who ironically is a namesake of one of the Biggest Loser Contestants of the 2005 season), told CNN his weight loss journey lasted 3 years. Most of the article is detailing "how terrible he looked" as a person of size and the usual. Finally a couple of sentences way down in the article tells how he lost the weight.

Predictably, he "ate less and moved more" that is, the article states:

He ate smaller portions and took daily walks. The first 120 pounds came off.

And in case we didn't understand how the weight melted off when he "just got off the couch", he's quoted:

"When you're that big, you can lose weight pretty quickly," he said.

The article goes on to say that Matt plateaued out at 150 lbs over his goal weight and then, joined Weight Watchers and "lost the rest of the weight"

According to this article, Matt had no health problems (or I'm sure they would have mentioned them) and it was all how "bad he looked" which motivated him.

Hey, if a person wants to lose weight (or not lose weight) that's fine - our bodies are ours to do with them what we want.

What I found very objectionable in this article was the following:

1. The article implies that the only reason Matt got up to 470 lbs was because he ate too much and moved too little in other words, "he sat on the couch, eating bons bons all day so no wonder he was so fat", and this idea is I think, what CNN wants to convey to the readers. But the reality about obesity is that according to Dr Rudy Leibel and the scientists who study this stuff, size is mostly genetic.

2. The article gives the impression that once Matt started eating as a "normal person" i.e. not totally overstuffing himself while sitting on the couch, the weight just "dropped off". And that is so not true! For a person who is genetically/physically obese to lose weight and keep it off takes daily vigilance almost to an obsessive level.

To expand on the second point, while the article implied that Matt just had to "get off the couch" (they never did detail what his exercise program consisted of however), ordinary exercise does not keep off any weight if you've got a certain set of genetics - I can personally attest to that one!.

For example, the Matt Hoover from the "BIGGEST LOSER" (not the same guy as in this story, I'm pretty sure) is described in one article as exercising 25 hours a week (he did regain some, it says from his "Biggest Loser" season but is determined to get it off):

Hoover spends 25 hours a week training for the grueling triathlon, which consists of a 2.4-mile open-water swim, a 112-mile bike ride and a marathon 26.2-mile run.

In my research I have found that societies in which there is no obesity, typically move 25-40 hours a week and eat about 1200-1400 calories a day.

Now that's a lot more than just "getting off the couch" and "eating smaller portions".

This type of article is falsely misleading. To the person of size who thinks that they can exercise an hour or so a day and eat a bit less and the weight will drop off, they will be very disappointed when they can actually gain weight eating normal amounts of food even if they do exercise. (How well I know about that one!)

And for those 85% of society who do not have to fight clinical obesity, articles like this just fuel the flames perpetuating the falsehood that shaming people of size is actually "good for them" because they might get motivated to "eat less and more more" and the "weight will drop off", as it did with Matt Hoover who is not the Biggest Loser contestant in this article.

I know people of size who have awesome achievements, careerwise and life-wise and even are very good looking, and yet, feel themselves failures because even though they already "eat less and move more" the weight just doesn't fall off them like it does on people in the newspaper or on TV. These feelings brought on by articles like this CNN article, filled with falsehoods and misleading statements, can lead people to drastic measures including unhealthy diets or even surgery to cripple their digestive system (what Dr Fobi, WLS surgeon calls the gastric bypass) or worse.

In a world which needs more love, isn't it time we enjoy people for who they are and just accept that in a country like ours where food is in easy access, people are going to come in all sizes and so what? What if we were all the same size - it would be pretty boring! (look at manikins for example). :)

Note: the photo included with this blog is Olympic athlete, Cheryl Haworth who won an Olympic medal in Weight Lifting. Like all elite athletes, she trains hard for several hours a day and watches what she eats. She also weighs over 300 lbs. People do come in all sizes and just because someone is a person of size, doesn't mean they lie on the couch all day, eating bons bons.

Like one of the TV reality show stars quipped when someone called him on a misrepresentation in a so called "reality show".

Well, you cannot believe everything you see on TV!

Push for weight loss surgery even if you have a lower BMI follows study about obesity

2010-12-03T02:46:00.000-08:00

A new study of 1.5 million people suggests that obesity, even overweight, shortens your lifespan. So says the study - obese people are 44% more likely to die earlier than those in the so called ideal BMI range.

The findings and size of the new study, which was conducted by researchers at the National Cancer Institute and published in the New England Journal of Medicine, should settle the debate over the relationship between excess weight and the risk of early death

So says Ali Mokdad, Ph.D., a professor of global health at the University of Washington, in Seattle.

According to one report on a local TV station:

The latest research was launched after a controversial 2005 study by the Centers for Disease Control and Prevention that concluded being overweight didn't raise the risk of death; that report included smokers and those with pre-existing illnesses.

The CDC study was actually a re-examining of existent data and an admission that the wrong conclusions had been drawn. It was only controversial among those advocating diets!

In 2005, the CDC reassessed their data, stated one news article in the Seattle Times, and found that 112,000 people (not 300,000 people) had died from obesity related diseases however, they also added that since people with BMIs in the overweight zone (BMI 25-29) live longer than those in the "normal ranges", one had to subtract 86,000 from the 112,000 and that leaves 26,000 people who die from obesity related disease... less than who die from gunshot accidents!

The new study doesn't settle anything because it made the same mistake pointed out by Dr Stephen Blair, PhD, head of the Cooper Institute.

Seems the folks at the Cooper Institute took 30,000 people and found when they added exercise habits to the equation, that fat people who exercise regularly had no greater risk of sickness or death than slim people who exercise - and people who do not exercise regularly, had the same risk, regardless of size - about 44% greater than the exercisers.

I'm sure the pundits are banking on the fact that the public either has a short memory or else, hasn't seen the Cooper Institute studies.

However, some reports on the new study included the remarks of the lead researcher on the Cooper Institute studies, Stephen Blair, PhD:

University of South Carolina obesity researcher Steven Blair said the results were consistent with other studies and the "massive effort" was commendable. But he said there wasn't enough information available about fitness level or physical activity. A proponent of the "fit and fat" theory, Blair said his research has shown that obese people who are tested and deemed fit did not face increased risks of dying.

"If we want to get to the bottom of the health hazards of overweight and obesity, we have to have better data on physical activity," Blair said. "Until we do that, there's uncertainty of how important BMI is as an important predictor of mortality."

Seemingly coincidental to the release of this new study which looks impressive to the unquestioning eye of the public, the Allergan company has petitioned the FDA to lower the weight limit for obtaining the lap band obesity surgery. Right now, only people who are at a BMI of 40 or higher, or 35 with co-morbidities can have their insurance pay for a lap band. Allergan would like to see that minimum weight lowered to a BMI of 35 or 30 with co-morbidities.

Even CNN remarked on the fact that the head of the FDA committee petitioned to lower this weight requirement, owns stock in the Allergan Company! Not only did she not recuse herself (which she should have done!) but the FDA voted that it was "OK" for her to be on this committee as long as she didn't vote!

The lap band is a much safer surgery than the gastric bypass. It's a band placed around the top of the stomach which can be tightened or loosened and is supposed to limit how much a person can eat and thus cause a weight loss. Of course, what it limits (when it's not swollen i.e. some band patients complain of their stomach swelling shut in the morning) are the good bulky foods like veggies. Milkshakes, ice cream and cake go down beautifully. Although unlike the gastric bypass which is greatly troubled by long term vitamin deficiencies in many patients, the lap band is not without its own set of repercussions. A certain percentage of patients experience the band growing into the stomach, thus requiring removal and/or a gastrectomy. Mostly what I hear lap band patients complain about is discomfort and difficulty in keeping off the weight. The difficulty in keeping off the weight complaint, one hears from gastric bypass patients also.

What science really says is, if you cannot keep off the weight, it's healthier to not lose it in the first place as "weight cycling" or "yo yo dieting" raises the risks for heart attacks significantly.

About 5% of the public born with the obesity gene (according to obesity researcher, Rudy Leibel, size is 40-60% genetically determined) can lose and keep off the weight (7% with weight loss surgery according to the Hebrew U Study for one).

For the rest, it is strongly recommended that they consider following the "Health at Every Size" guidelines - Linda Bacon's book on this is excellent!

A clinical study at USC found that those following the Health at Every Size, guidelines without a focus on weight loss - ended up healthier than those who dieted - this study is highly respected and the cohort was followed for two years. Linda Bacon was one of the researchers and the other researcher was Julie Stern who is a member of the Weight Watchers scientific committee. Undoubtedly, Stern is not opposed to dieting and yet confirmed the results of this study which headlined "Non-dieters more successful at boosting health than dieters, study finds".

Isn't it time to "stop the insanity" and focus on real health which is determined by healthy food choices about 80% of the time and regular aerobic exercise?

Biggest Loser "Where are they now" show was blew some smoke screens

2010-11-26T02:32:00.000-08:00

Lately the reality show, "The Biggest Loser" in which they sequester several clinically obese people, put them through grueling workouts of 5 hours or more a day and greatly curtail their food intake to effect quick weight loss, has come under no small amount of criticism.

It has caused a hue and cry among personal trainers and especially exercise physiologists who feel that the training given on the show is not only somewhat sadistic but sheds a negative light on personal trainers in general who try to teach people a healthy lifestyle.

Possibly what is most upsetting to the producers of the show (which apparently has versions in several other countries besides the USA) is the fact that the ratings of the show now in its 10th season, have fallen drastically, which can be a death knell for any TV show.

So tonight, NBC aired a show which promised to catch us up with what former contestants on the "Biggest Loser" are doing now and did they regain the weight, but actually seemed more of a "damage control" effort to try and convince the viewing public that what is done on the "Biggest Loser" is really a good thing and has changed lives.

Injury on the show has apparently (and rightly so) upset the public so the show dealt with that issue. The 9th season featured as the first challenge, a 1 mile run for clinically obese folks who had not exercised in quite a while and ended up with one of them, Tracy Yukich collapsing and being air lifted to the hospital where she remained for a week or more.

Dr H went to her home to visit and they relived the incident where she collapsed. Tracey's eyes filled up with tears when she watched the video and she commented that she thinks about this every day. She also said, "here I was 37 years old and almost - well gone."

Tracy is slim now and writes cheerfully on her facebook fan page that:

The Biggest Loser has changed my life. I never dreamed I would be at my college weight again. I am so grateful for all that have touched my life and helped me through this journey.

Tracy's website claims that she collapsed from heat stroke but that she was in the hospital for two weeks after, seems there might have been more wrong. Tracy uses her Biggest Loser fame and that she's kept the weight off, to do motivational speaking now.

On the catch-up show we watched on Wednesday night, they didn't say what happened to Tracey. The only explanation given by Dr H was that she was so fat, she had fat everywhere. Tracy weighed 250 lbs at 5'2" which while clinically obese, wasn't exactly the largest contestant either.

In researching this, I found out that likely what she had was "Rhabdomyolysis", a condition of muscle injury where the muscles break down releasing a chemical which injures the kidneys and can cause kidney failure.

The outcome of this illness (which also can happen with statin drugs by the way) is unclear according to the NIH:

The outcome varies depending on the extent of kidney damage. Acute kidney failure occurs in many patients. Treatment soon after rhabdomyolysis begins will reduce the risk of chronic kidney damage.
People with milder cases may return to normal activity within a few weeks to a month or more. However, some continue to have problems with fatigue and muscle pain.

According to another article, Tracey was restricted while on the ranch for any workouts, even in the pool so while she may be training for a marathon now, she may still have residual damage to her kidneys.

Quite a bit more than the "heatstroke" claimed.

Another contestant in that same season, Abby, got an early injury to her tibia and was also restricted from the grueling workouts and challenges.

Injury in the contestants was not really discussed in Wednesday's show though, which was filled with praise and emotionally filled statements of how the "Biggest Loser" was changing lives. Dr H. actually claimed that this reality show had found "the answer" to obesity and should get the Nobel Peace Prize. (Yes he said this with a straight face!).

Another problem which has cropped up is Ryan Benson. He was the season one winner who told all on his Myspace - about how he dehydrated himself for the final weigh-in using techniques he'd learned in wrestling and how he re-gained 30 lbs (just water weight) in the week after the finale.

The show ended with featuring the 9 winners of the "Biggest Loser" in a healthy Thanksgiving dinner (which although everyone oohed and aahed about how great the food was, it didn't look real appealing to me). Ryan Benson was at the dinner and said how he re-gained all the weight because he'd gone back to his old habits and how he was so inspired at seeing the other winners, some of whom looked a lot heavier than when they won the show. Erik Chopin claimed to have lost the 122 lbs he regained and although he looked a bit slimmer than he did when he appeared on the Season 9 finale, he didn't look anything close to how he looked when he won the show.

The show was supposed to convince us that those who had been contestants on the "Biggest Loser" had had their lives changed, had gone on to make careers of motivational speaking etc and how they were living the dream. But it was unconvincing. Some of the contestants in telling about their lives and their experience on the "Biggest Loser", wept while they were talking, suggesting they may still be emotionally damaged from the experience.

Out of some 200 people who had been contestants for the show, only 35 were "caught up with" and most of them were from seasons 8 and 9. But 35 had not kept off all the weight. As we know, Ryan Benson was back to his original weight and Erik Chopin was somewhat up in weight. A couple more had obvious regains. So that leaves only a few like Tracey, Alli, Tara, Mike who had kept it all off. About 7 percent or less of those who had been contestants on the show.... Hardly as Dr H claimed, a "cure" for obesity.

Will it work to save the show's dropping ratings? Only time will tell. That several have spoken out against the training and other issues (like Kai who was not mentioned at all) is hard to blow a smoke screen over. Emotionally and physically injuring obese people is not really acceptable in any circles, not even the most fat phobic ones.

Weight Loss surgery safer than being fat?

2010-11-04T12:22:00.000-07:00

Is Weight Loss surgery really, safer than being fat? That's the conclusion of a Weight Loss surgery surgeon from Baylor, at least.

In a video on the ABC website from "Good Morning America" this surgeon who is head of the Baylor Weight Loss surgery unit, does give that impression. In the video, he not only advocates ALL WLS for not only clinically obese, but also for "lower weights" i.e. for people with a BMI of 30 and over. While not openly misrepresenting, one could easily get the wrong impression of WLS from this video.

For example:

When asked about the risks, he brushed the question off with a "it depends" and changed the subject. Later he focused on the difference between having open surgery and lap surgery, giving the impression that that's the only concern about weight loss surgery which is so not true.

He also, said the surgeries done today are less risky than done 10 years ago. That's true but only of the lap band. The RNY - gastric bypass is basically the same risk (it hasn't changed). And today's RNY with transsection of the stomach, may actually be more risky than the older loop gastricbypass which left a larger pouch and did not cut the stomach into two pieces.

It makes a difference which procedure is done - the death risk with the lap band is 1 in 5000 or less. (One study in Australia found no deaths in 10,000 patients). The death risk with the gastric bypass is 2% within 30 days of procedure and 4-9% within the first year (According to the David Flum studies of 62,000 patient records)

They have no data as to weight maintenance over 10 years post op (1 study of 100 patients went 12-15 years post op) but that 10 year post op data they have suggests that most patients after gastric bypass have an average BMI of 35 and that was the same with all procedures. In the small study of 12-15 year post op gastric bypass patients, 68% suffered involuntary vomiting, 68% had suffered a plugged stoma so it was not complication free at all.

Many are frightened into surgery by thinking they are under less risk having surgery than remaining fat however, there is no evidence that this is true.

Even the release form for gastric bypass (which is given to prospective patients so it's not "anti WLS") warns about this:

****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

(I know many slim people who have type II diabetes)

One doctor interviewed for "Self Magazine" 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 ***

I am reminded of a quote from one of the patients featured on the show about weight loss surgery, "Big Medicine" (which disappeared rather suddenly from the scene and so far has not gone into re-runs). The show filmed him being sent home and them bringing a gurney which was too small etc etc. He later wrote that this was all staged and he had never been sent home from the hospital (I think the idea of this drama was to emphasize how insurance sometimes did not pay for WLS). When people on the forum expressed surprise that a so called reality show had staged a scene, he wrote back "Well, you don't believe everything you see on TV, do you?"

Especially when it comes to risky surgery, prospective patients are encouraged to research the studies or to consult a gastroenterologist first... (someone who does not stand to profit by a decision in favor of surgery).

Biggest loser premier shows lowest rating ever

2010-10-05T03:31:00.000-07:00

An article on the Philly burbs tells how the show, "The Biggest Loser" suffered a significant loss in the ratings - 25% down. The article asks in the conclusion, "is it because Americans are tired of being reminded how obese they are?"

No, I don't think that's it at all. I think it's because of those former contestants who have spoken out about the sadistic methods of training used in the show, the long hours of workouts and the psychological abuse contestants get. The last one to "sing" who said she got an eating disorder after being on the ranch, might have signed the death nell for the show.

That and the fact that Ryan Benson, the winner of the first season has admitted he's regained to a higher weight than his original weight (not withstanding his open admission on his "myspace website" about how he clinched his win using techniques of dehydration he learned, back in his days as a High School wrestler - and how he gained 30 lbs the week after the big win).

Or maybe it was Erik Chopin appearing on the Oprah Show, almost back to his original weight. The Biggest Loser tried to do damage control by having trainer Bob, visit Erik and Erik admitting it was just all his fault. Bob extracted a promise from Erik to be back to a better weight by the finale but that never materialized. Maybe some of the viewers were looking for that event and didn't "forget about it" as the show producers likely hoped.

Perhaps it was the couple who appeared on Carnie's quiz show who got married but both admitted quite a bit of regain.

Or the contestant who told the press that the week before the finale, she had lived on diet jello all week.

There is also, a growing number of personal trainers who are very much against the way the "loser" contestants are treated by Jillian and Bob - they say it gives folks the wrong idea about personal training in general. And there have been articles in industry magazines which were critical of the personal training on the show. Likely some of this filtered down to their clients.

The show has received enough "bad publicity" to spoil the magic image of the weight somehow magically falling off the contestants.

Everyone knows if you starve and work out many hours a day, you will lose weight but that isn't even healthy, and rapid re-gain is likely. No magic in that at all. On the contrary...

New diet pills - easy weight loss or just a health risk

2010-07-15T05:26:00.001-07:00

There are three new diet pills which are being boasted about in the news as safe and effective.

In a nutshell, no they are neither safe nor particularly effective but the media is sure are doing the hard sell on them. Will people remember the phen-fen fiasco which has caused a relatively rare deadly disorder, pulmonary hypertension to be something we hear about all too often? Will they remember that even a medication like Xenical (Alli') can cause malabsorption of fat soluble vitamins and fecal incontinence? (without much weight loss).

Or will they line up to get these new medications which are really more older ones, just recycled?

Take a look: Pillz Pillz Pillz - Easy weight loss or just another health risk

New push for gastric bypass for diabetes

2010-07-10T03:46:00.001-07:00

I have noticed a new media campaign hawking gastric bypass for diabetes. And not only that but also they are suggesting this surgery (which Rudy Leibel called "draconian") for those folks who are not especially overweight.

The articles are misleading like this one on MSNBC. For example this article states that:

Scientists in recent years have discovered that diabetes all but disappears in some obese patients soon after the operation.

No scientist ever wrote that "diabetes disappears". No scientist ever used the word "CURE" either. What they stated was that after any weight loss surgery including the less invasive gastric band, the sugar levels seem to go down in 72 percent of diabetics at the two year post op point.

(And some of the surgeons admitted that they didn't know if the after surgery fasting caused the sugar levels to go down or the surgery itself!)

Additionally, the one study which did a follow up at the 10 year point after surgery found that only 36 percent of the diabetics still had sugar levels in the so called "normal" range.[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]

What continues to amaze me is that they are still doing a surgery, which is a more invasive version of one invented in 1888 (for the treatment of duodenal ulcers) and about which the inventer, Dr Edward Mason, stated in 1980, after extensive patient follow up, that it was too risky even for those patients who were clinically obese. Mason wrote:

"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."

Dr Mason advocated a less invasive surgery which did not interfere with the digestion of vitamins.

The gastric bypass, says Kaiser Permanante's release form, causes vitamin deficiencies in nearly 100 percent of patients.

Gastric surgery for weight loss causes nutritional deficiency in nearly 100% of individuals who have it done. The most common deficiencies are Vitamin B12, Iron, Calcium, Magnesium, Carotene (beta-carotene and other carotene vitamins) and potassium.

Some of these vitamins and nutrients can only be supplemented intravenously. Others cannot be supplemented and the deficiencies can be either disabling or life threatening in the long run.

The surgeons I have asked about lifespan after a gastric bypass have been evasive, implying that a gastric bypass patient might live longer than a clinically obese person but again, science has not proven this at all.

Dr Mason, in 1965, thought this surgery would work for the clinically obese because his normal weight patients who had this surgery, had a difficult time keeping their weight at a normal level.

However, followup suggested it was too riddled with complications and even as late as 2006, Dr Mason wrote that since the mid 1990s scientists have learned a great deal about "the biochemical mechanisms that influence food intake and weight".

" I would like to see greater use of simple restriction procedures that do not rearrange these finely balanced mechanisms," Mason added in an article he wrote for the U of I healthletter.

And in July 2010, 30 years after Dr Mason first advocated not doing the gastric bypass even for clinically obese people, the media is campaigning for diabetics to have this surgery?

The worst thing is that

Blood sugar levels can be controlled in diabetics through lifestyle changes - often without medication for several years after diagnosis (my hubby kept his sugar levels at normal without meds for the first 15 years after diagnosis

Medication works well without invasive surgery especially if combined with a few lifestyle changes

As stated before, the few long term studies we have, suggest that the gastric bypass isn't very effective in the long run for many patients, at either keeping weight off or controlling diabetes

Not only does the recommendation of gastric bypass to control diabetes make no sense to me - it seems, more than somewhat ethically challenged.

If you don't have a gastric bypass you will get sick?

2010-06-25T19:07:00.001-07:00

In the latest from (who else) the ASBMS (the professional organization for bariatric surgeons), they presented a study in which they compared the records of 587 gastric bypass patients to 189 patients who were eligible for surgery but did not have it because insurance had denied them.

In one of the LA Times blogs, some details on the study are given.

The study went for three years and at the end of three years, they pointed out that of those who did not have a gastric bypass, 40 percent went on to develop high blood pressure, 34 percent developed sleep apnea and 20 percent developed GERD (gastro esophagal reflux disorder).

The researchers concluded that if folks thus qualified, are turned down by their insurance for these procedures, they become sicker than those who have the surgery.

This study has not, so far, qualified as "peer reviewed" although they may have plans to publish later but I can see many flaws.

First of all, the numbers are not even - many more gastric bypass patients than non surgical patients. For a real comparison, the numbers should be even.

Secondly, as studies have suggested, sleep apnea, although can be exacerbated by size, is not caused by obesity and the latest advice is for patients to keep their C-Pap machines even if they lose a lot of weight.

Third, GERD is definitely not caused by being overweight at all. It's usually caused by a hiatal hernia which causes a lot of problems including slow motility etc. That being said, I have personal experience with the fact that calorie restriction will keep GERD at bay long before you lose any weight. Calorie restriction seems the treatment of choice for it. Therefore, it's not surprising that the gastric bypass patients kept their GERD at bay while the non patients did not.

And finally, the so called "risk numbers" including blood pressure are also low in terminal cancer and AIDS patients and yet, are these really not at risk for heart disease?

But the problems of the study don't end there. What the researchers didn't compare was the number of bowel obstructions, twisted bowel, kidney stones, plugged stomas and other problems likely suffered by a rather alarming percentage of gastric bypass patients which were likely not suffered by those who did not have surgery.

What about comparing the number of those who got reactive hypoglycemia or epilepsy after gastric bypass with those in the non surgical controls?

That is, if one is comparing the amount of illness in both groups, should not all illness be included?

Gastric bypass has gotten some bad publicity lately with Carnie Wilson, the poster child regaining a lot of weight and Al Roker admitting that unless he exercises vigorously and counts his calories, he also regains (but this is the same thing that non surgical folks have to do to maintain or lose weight) and so I feel the study was mostly to get folks to think of gastric bypass in a more positive manner so that they might consider visiting their local surgeon. As the article in the blog notes, only 1 percent of those "qualified" for gastric bypass end up getting the procedure, a number which might alarm some providers.

This study reminds me of the first thing a friend of mine was taught in a class on de-coding studies i.e. "98 percent of studies are flawed for one reason or another".

As in all studies, we should always keep in mind the funding source and also, that what is not said or what is omitted, is sometimes as important as what is reported on.

gastric sleeve story

2010-05-25T09:05:00.000-07:00

If you look at this blog, you will see the glowing report from a new op on the gastric sleeve. She didn't want the gastric bypass (admits she was 'barely qualified' for WLS by US standards) because she felt it was "too drastic". But although things are rearranged in the gastric bypass, nothing is taken out of the body.

Not true of the sleeve - this drastic surgery calls for the removal of 90 percent or more of the stomach, creating a Frankensteinian pouch which holds only a couple of ounces of food.

The new op goes on to credit her normal weight to the sleeve and the reduction of ghrelin in her blood not realizing that her lack of hunger now, is simply that her stomach is going through a healing process. Human appetite is NOT controlled by one hormone, scientists will tell us and I would ask, how many people are fat because they only eat when hungry anyway?

That ghrelin has anything to do with appetite is merely a theory however, there is a body of evidence suggesting that those with less ghrelin in the system also have less growth hormone and this can cause premature aging. That, they don't tell you in WLS seminars.

Back to the new op, she runs a couple of hours a day and has done a triathlon or two. Since she is working out like those on the "Biggest Loser" she has lost weight like they do. But when she's all healed and finds her lack of a stomach to be more of a liability than an asset, like when eating healthy food like veggies with bulk is difficult which makes many tend toward foods which go down more comfortably like milkshakes, then she will likely leave her glowing testimonials up and not warn newbies of the other side of the story which she has regrettably discovered - all too late.

Some of us call this the "conspiracy of silence", the lack of negative information about weight loss surgery which leads 200,000 people a year to get cut without really knowing what the repercussions might be.

Sadly, the sleeve is viewed as less invasive than the gastric bypass and this is so not true. Since most folks know someone who has had a gastric bypass with a bad result (the least of which was regain), many are now choosing the new guy on the block, the sleeve, as the weight loss surgery panacea.

Still looking for the easy way out. But like the perfect solution, the easy way out doesn't exist and grabbing of something which is being sold like used cars, might make things a lot worse.

CAVEAT EMPTOR.

Remember even the surgeons admit, and most older op WLS patients will tell you that....

"Success with weight loss surgery is 10 percent the surgery, 90 percent the patient" (Dr Terry Simpson, MD and WLS surgeon)

Overweight and Obese Kids eat Less than their slim peers

2010-05-13T18:19:00.000-07:00

Totally destroying the image of the fat kid overeating which has been so popular on the American scene, a new study out of Canada found that actually overweight and obese kids ate less calories than their slimmer peers (those of us who have fought a weight issue all of our lives are familiar with this one, having had to watch slim folks down huge portions of pizza while we munch on a carrot!).

The researchers studied over 12000 kids aged 1-17 and had a mathematical formula to adjust for self reporting inaccuracies (parents reported intake for kids 5 and under).

The study was reported on at the Pediatric Academic Sciences 2010 annual meeting. (Note: a sign-in may be required to read this article on Medscape - registrations are free)

"Our study provides the surprising finding that older overweight children report consuming fewer calories than their healthy weight peers. The finding indicates that intervention strategies solely targeting energy intake in older children may face difficulties," study presenter Asheley C. Skinner, PhD, assistant professor of pediatrics, Department of General Pediatrics and Adolescent Medicine at the University of North Carolina at Chapel Hill School of Medicine, told Medscape Pediatrics.

This result was similar to the results of the unpublished studies of activist and educator, Russ Williams. Williams interviewed 6 caterers who had catered conventions for NAAFA (National Assn for Fat Acceptance) as well as many other conventions attended by average weight patrons. He found that 3 of the caterers stated the amount of food consumed at NAAFA conventions was equal to that consumed at other conventions but 3 of the caterers reported that the amount of food consumed at NAAFA conventions was significantly less than consumed at other conventions.

Isn't it time we kill the TV stereotypes and accept that people who become obese may have strong genetic and physical reasons for their size?

Dieting 'Stints' Linked to Heart Problems

2010-04-26T05:23:00.000-07:00

Did the headline get your attention? It's one we've all been waiting for and the story of a new study which was reported to suggest this, was carried in many media stories including this one on aol.

According to aolhealth news:

Adopting a strict low-calorie diet can lead to harmful health issues like heart disease, high blood pressure, cancer and diabetes, the Daily Mail reports.

Curious about this, I traced down the study upon which the story was based. The study was published, I found, in "The Journal of Psychosomatic Medicine", and the abstract is available on PubMed.

Unfortunately, this study didn't actually find what some news stories reported.

It was a 3 week study in which they took 121 women, divided them into 3 groups: One group was calorie restricted to 1200 calories daily and the members were asked to journal their food, a second group was provided food to equal 1200 calories a day, so did not have to journal, and the third group did not have to restrict or journal at all (these were the controls).

At the end of 3 weeks, they were asked to provide urine samples and also to fill out a survey about how stressed they felt.

The two calorie restricted groups reported higher levels of stress on their surveys as well as evidenced higher amounts of cortisol in their urine than the controls (cortisol is thought to be the "stress hormone" produced in the "fight or flight" syndrome and pundits have theorized that higher levels of cortisol might cause weight gain but this is strictly theoretical at this point).

Where the media got the "higher risk of heart disease" must be that stress is considered a factor for heart disease as well as numerous other illnesses. Unfortunately, a three week period of stress could hardly be considered as "life threatening".

The study was initiated because the researchers wanted to see if the stress of calorie restriction was a factor in diets being largely ineffective in most people and also if the physical presence of elevated levels of cortisol could possibly be sabotaging efforts to lose weight.

They concluded that

"Dieting may be deleterious to psychological well-being and biological functioning, and changes in clinical recommendations may be in order."

While this is a conclusion we all like to hear (and suspect may be true in many cases), the study had many flaws as far as "proving" this theory.

First, if a person embarks on a lifestyle change and habit changes (in order to restrict calories), the greatest amount of stress will be felt in the first several weeks as they are getting used to the changes and this probably could be said of any healthy lifestyle changes such as indicated in a HAES lifestyle change as well. It has been said, it takes 90 days to form a habit.

However, after the 90 days, the stress levels resulting from any habit changes including calorie restriction, would have to be examined again, because as one gets used to the new program, one's stress levels would be suspected to diminish. (No one has determined whether the higher levels of cortisol in the experimental groups of the 3 week study were from the stress of change or the stress of actual calorie restriction, because the study did not last long enough to really gauge this.)

Secondly it would make a big difference in stress whether the participants in the "intervention" wanted to be on these programs or not. That is, if the women were of average weight or opposed to dieting or had never dieted before, this would make a big difference in the amount of stress experienced in study participants. We are not told this in the abstract - I am, at present, trying to obtain a copy of the study article.

But this again raises the much discussed question, is calorie restriction really unhealthy? The jury seems still out on this one, it appears, with passionate advocates on both sides of the issue.

The following should be considered:

To start with, it's a known fact that in outlying areas where food is not as available as it is in the USA and there is no electricity etc, people do live on about 1200-1400 calories a day and survive well. In fact, it has been theorized that one of the genetic factors explaining why some of us are so weight loss resistant is that our ancestors lived in places like Chihuahua, Mexico and/or Outer Mongolia and we carry those genes.

It also has been observed that in places with no TV for entertainment, and no cars, and people walking to every place they need to go and doing something active for fun like playing running games etc and of course, carrying on a daily life which burns a lot more calories than does life with modern conveniences, that obesity as well as heart disease and diabetes are practically unheard of. For example, the Pima's in Mexico are said to average about 40-50 hours of hard physical labor a week.

It also should be noted that these people are typically eating a diet consisting mostly of veggies and grains with only small amounts of meat.

Quite a bit has been written about this phenomena (ex "The PIMA paradox") in which two genetically identical groups of people have very different bodytypes depending on whether they live in the USA or in outlying places as described above. That being said, the Pima's in AZ were described as "lean and sinew-y" by an observer around 1900.

On the other hand, while it is true that some rat studies have suggested that calorie restricted rats live longer than those allowed their fill, scientists have pointed out that this only shows that overfed under exercised rats succumb faster than those rats which exercised instead of eating all they wanted. And besides us not being rats (and they know we have a different chemical makeup after the Leptin fiasco), it also should be pointed out that rats in the wild have to exercise a lot to obtain their food and again, it's far from eating their fill. They tend to be lean because of this.

Also, those who compare the lack of obesity at the turn of the 20th century forget that people also didn't have a very long lifespan then, (average about 49 years) - however, they often died of infectious disease rather than "old age diseases" so we don't know how long they would have lived with modern sanitation etc.

The picture becomes more and more muddy. If a person can make lifestyle changes and eat a very healthy diet, it might be possible to somewhat calorie restrict without threatening one's health - studying chronic calorie restrictors (CHRON's they call themselves) has suggested this. On the other hand, people who calorie restrict in an unhealthy manner (as often true of dieting) likely, do face health risks and there is quite a bit of research suggesting that the "weight cycling" most dieters tend to do (gain and lose and regain) is highly risky.

The bottom line might be, if calorie restriction takes out one of a person's greatest pleasures (eating does provide many folks with endorphins), it might indeed cause enough stress to actually make things like diabetes and heart disease worse (instead of better as the advocates of dieting keep shouting at us).

There has to be a happy medium... perhaps that IS what Health at Every Size or HAES is all about. (Note: see http://www.lindabacon.org )

New study obese children more likely to die earlier

2010-03-08T09:46:00.001-08:00

An article in the news recently, shouted that being obese as a child doubled the risk of premature death (i.e. death before the age of 55).

This was based on a study appearing in the New England Journal of Medicine in the Feb 10, 2010 issue and is online as the full text version, accessible without a subscription.

The news reporting on this study ranged from total misreporting -one source gave the deaths which "counted" as 559 deaths - cohort was 4857 people born from 1945 to 1984 - other sources were more accurate about the 166 deaths in the cohort which "counted". The cohort came from the Gila River Reservation in Arizona.

However, for some reason, (I could speculate on this but I won't) the researchers included deaths from alcholism/drug use and infectious disease in the deaths from which they figured that those who were obese as kids were two times likely to die prematurely of.

The breakdown on the causes of death in the 166 who died prematurely, (which is still a low number) out of the 4857 member cohort was as follows - according to the study article:

A total of 166 deaths were from endogenous causes: 59 were attributed to alcoholic liver disease, 22 to cardiovascular disease, 21 to infections, 12 to cancer, 10 to diabetes or diabetic nephropathy, 9 to acute alcoholic poisoning or drug overdose, and 33 to other causes

Several things should be taken in consideration here. The deaths from those causes which may have an obesity factor in them is only 44 individuals out of the 4857 member cohort i.e. diabetes, cancer and cardiovascular disease. Infections, alcholism, drug poisoning and "other" have no established relationship to obesity at all.

So as you can see, two times as many in a small group like 44 is not very many. And in fact, had they considered, for example, which of the 44 rode bicycles as kids, they might have found a highly significant relationship between early bicycle riding and premature death!

I am always reminded of something Science News editor Stephen Milloy quipped some time ago:

"But who needs data when you can spoon-feed junk science to a gullible media?"

Postscript: 166 premature deaths out of 4857 individuals may be a lower figure than in those who do not live on the (Native American) reservation which might suggest that reservation living might be less stressful than living elsewhere (something I've long suspected since working in a Pima Indian mission several years ago).

Also, anecdotally, I've known several who died premature deaths but none of these were obese - several were smokers however (including my own slim father who died several years before my obese mother and mother's death was a suicide). My husband's cousin was married to a person who had no risk factors at all not even smoking i.e. he ate healthy, exercised daily and was very lean. 15 years younger than she is, he died several years ago, a premature death (heart attack). She who has a high BMI, just celebrated her 74th birthday.

Gastric bypass in teens - why not?

2010-02-17T02:40:00.000-08:00

A recent article in the LA Times quoted a Dr Brandt as saying, about overweight teens that:

"But these kids are dying! We’ve created something in our society we have to undo."

Dr Brandt believes in doing the gastric bypass on young kids (even as young as 14 years old) despite the fact that this surgery (based on a procedure for ulcers invented in 1888 by Theodore Billroth and no longer done for ulcers) bypasses not only most of the stomach but also the first segment of small bowel where most vitamins are digested.

Brandt expressed "doubt" about the much safer adjustable lap band because:

"The band is a human-made device that could be in place for a lifetime, and as such carries a risk of scarring and malfunction"

I wonder why Dr Brandt thinks it's better to cut the stomach into two pieces and the small bowel into 3 pieces and reconnect in such a way which is causing 3 world vitamin deficiency diseases in 1st world kids. (ref: Bariatric Beriberi by Charlotte Gollobin1 and William Y Marcus, Obesity Surgery, Volume 12, Number 3 / June, 2002, Pages 309-311)

Not withstanding placing 300-400 staples into the digestive tract which is what happens in the gastric bypass - the staples, unlike the lap band, are not removable!

According to the Fresno Bee expose in 2001, patients do die from gastric bypass and not only the 2 percent who die within a month of surgery(REF: Dr David Flum - death rate 2 percent within 30 days of surgery from 62,000 patients: 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])

According to some, many more patients die than admitted by either providers or the media. The Fresno Bee wrote:

"the deaths, by and large, do not occur in the operating room, or in the hours immediately following surgery. They happen in the days, weeks and months after surgery, when patients return home and find themselves coming apart from the inside -- sometimes leaking from the abdomen."

And this is better than the lap band which calls for no cutting up of the stomach or cutting up and bypassing of the small bowel and is fully reversible? Which delivers a similar weight loss to the bypass at the 3 year post op point also?

It should be noted that the gastric bypass, in patients with a BMI of over 50, has a 34% failure rate (i.e. 34 percent of these regain all or most of the weight... see: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD )

I am thinking of the lady who was down to 85 lbs and got her gastric bypass undone. A year later, she is still slim but has color back in her face, is healthy and like so many others who got their surgery undone, she feels her life began the day she woke up from reversal surgery.

Frankly, I sometimes wonder if the average WLS provider's $250,000 - $500,000 a year salary has anything to do with the zeal of some to rush children into surgery modifying the digestive system for life or perhaps the fact that gastric bypass surgeons don't generally, have to do the follow up on gastric bypass like they do on the lap band - gastric bypass follow-up is typically, done by the emergency rooms and gastro-enterologists, many of the latter who are very against these procedures.

One local hospital told me they have an entire floor set up for sick gastric bypass patients! And most ER nurses I've talked to, say a goodly percentage of their nightly visitors are gastric bypass patients with repercussions. Most of the nurses I've talked to, are against that procedure also.

And these surgeons are saying we should allow this on 14 year old kids?

I keep remembering the 22 year old young man who was featured in a news article a few years ago - he'd had bypass surgery at the age of 18. At the age of 22, he was at his ideal weight and was pictured smiling, sitting on a tractor. The article also said that his bones were as porous as an 80 year old's... at the age of 22!

Calcium is one of the nutrients which gastric bypass patients can no longer digest - the calcium which is typically building up the bones of young folks will now be leeched from their bones after their WLS. They can take calcium supplements but we only digest about 2 percent of these and the rest is excreted and can cause kidney stones among other things.

That's the side you don't read in the news or hear about in seminars.

Hopefully parents will put a stop to this because kids only think about one thing and that is "fitting in", but teens I've seen post op with the gastric bypass, sit in the TV studio unsmiling because I'm sure no one told them about the spontaneous vomiting perhaps sitting in a restaurant with their friends (I'm sure this is less socially acceptable than being fat) or the myriad of foods they no longer can tolerate, nor being knocked on their butt after doing something so innocent as eating a piece of their birthday cake.

A recent photo of a "gastric bypass birthday cake" I saw, had the writing on the cake "sorry you cannot have any of this".

And I'm sure no one ever told them about the fact that they might get seizures from the vitamin deficiencies caused by the surgery (seizures are definitely not socially acceptable among teens) or have to sit for hours in the oncology section of the hospital getting infused iron peridically or having irratic blood sugar levels from reactive hypoglycemia (unlike diabetes, there is no medication for that condition).

A clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.

I wonder if anyone warned these teens that when they dare to eat something like a breast of chicken and don't take an hour to eat it slowly, it might get stuck in the stoma (opening of the pouch stomach into the small bowel) and hurt like heck for the next two hours until it either passes or they have to be scoped to make it pass.

Maybe that's why at least some of them are depressed after surgery. Suddenly a young healthy teen enjoying life, has a serious disability to contend with. Isn't this a bit much to burden anyone with, let alone a person who is supposed to be in the "carefree years"?

"You don't really know what the outcome is," said Dr. Edward Livingston, chairman of gastrointestinal and endocrine surgery at the University of Texas Southwestern Medical Center at Dallas. "You talk about the benefit being that it prevents kids from terrible chronic disease later in life. But some of them are going to regain weight. Some of them are going to have long-term complications and we won’t find out until later."

Dr Livingston has been one of the bariatric surgeons who speaks out about the drawbacks of the gastric bypass even for adults.

His study of 800 gastric bypass patients a few years ago, found a high percentage of repercussions and he wrote for Self Magazine in 2001:

"By doing this surgery, you're creating a medical disease in the body. Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating."
(Dr Edward Livingston, bariatric surgeon in Self Magazine, 4-2001)

Brittany Caesar, who had a gastric bypass 6 years ago and now weighs 170 lbs, described sitting down at her favorite lunch of two cheeseburgers, two orders of fries and a Coke and hearing a friend say to her "Why do you eat so much? It's not normal". Caesar fled to the washroom determined to lose weight, feeling very wounded by this comment. "Food was my best friend," she told reporters, adding that her whole family was fat. Caesar was over 400 lbs on the day she had her weight loss surgery. Now she is 20 years old and 175 lbs, but the article did not say whether she had had repercussions or has osteoporosis or osteopenia.

Are the possible repercussions worth the lower weight?

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)

Especially as in Dr Simpson's almost 30 years of doing these WLS procedures, he found that it was true of all of his patients, regardless of which procedure that:

"Success with Weight Loss surgery is 10 percent the surgery and 90 percent the patient".

Dr Kaplan, was more blunt about weight loss surgery:

"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

The article in "Self" detailed some long term patients, many of whom were not happy campers several years after surgery.

If we are really, worried about getting our children healthier, Dr Pattie Thomas, PhD, a scientist, suggests some good ways of doing so in her article, "7 Better Ways to Help America's children than Making Fat Kids Skinnier"

I'm over the "Biggest Loser" Show

2010-01-15T11:35:00.000-08:00

Jillian described this last week's episode as her very favorite (2nd week in Season 9) and asked people to give her feedback on her Facebook page. All the feedback I read was positive.

My reaction was totally different. The show went over the top in my book.

First part of it, was psychologically abusing the contestants one by one. Dr Huizenga was in charge of that. Although none of them have any real co-morbidities, that didn't stop him from giving them dire predictions of where they will be in the next few years, i.e. diabetic, aging prematurely or dead. He mixed this message with strong suggestions that they were hurting their loved ones by being overweight.

And Dr Huizenga managed to get all the falsehoods about obesity in this part. "That was so enlightening" said some folks who gave Jillian the feedback on her Facebook fanpage.

Each participant, male and female alike was ripped apart psychologically and ended up crying. It was not pretty. I finally fast forwarded through the rest of it after being thoroughly nauseated. Abuse of any one and especially psychological abuse leaves lasting scars. And why was it necessary? These people have all shown good faith by coming to the ranch in the first place.

Next was the challenge - usually that's kind of fun but for this one, their first challenge in their second week (so they are not fit yet and still probably the heaviest group they're ever had on the BL) was a bit ugly. They were asked to walk on a 3 inch balance beam across the swimming pool to deposit beachballs in a basket on the other side. The winners got immunity from the weigh-in. The losers got a 2 lb penalty at the weigh-in.

Keep in mind that the balance beam the 89 lb gymnasts walk on is four inches wide.

To their credit, most of them struggled through this challenge but one older lady who is petrified of the water tried and tried and just couldn't do it. She finally fell on her face on the concrete around the pool and got an ambulance ride. She was ok but had a bruised face and a black eye.

Jillian took this lady later and helped her to learn to float. I suppose that's supposed to make it OK that she was forced to do the challenge which petrified her and ended up getting her hurt. Surely she won't be the first injury. Injury is common among the contestants on the Biggest Loser who immediately start running and other things they should NOT be doing at their size.

Finally was the "last chance workout" (the last workout before the weigh-in). Jillian and Bob delighted in "beating up" the contestants, screaming at them to go faster, harder. Two of them told them TV cameras that they hurt all over from last week and now they had to workout harder and it was sheer pain. The pain showed on the faces of most of the contestants. Some were crying and screaming back at Jillian and Bob. It was here that I had enough of their pain and fast forwarded to the weigh-in (which always takes long because there are several commercials - someone told me that there is only about 45 minutes of viewing time in a 2 hour show like the Biggest Loser).

Of the team which fell "below the yellow line" (didn't lose "enough weight"), was a mother and her daughter. The mother asked to go home.

I notice something interesting in those eliminated. They shed a few tears at the moment of elimination when the blond lady host announces "Sorry to say you are NOT the Biggest Loser and must leave campus immediately" But 24 hours later when they are arriving home, there is invariably a look of enjoyment - and yes, relief on their faces.

It's kind of like hitting your head against the wall. Feels so good when it stops.

I did not yet set up the Biggest Loser for recording next week. I think I've had my fill. After watching several seasons, each successive one which has featured heavier, less fit, older contestants, and watching those folks on the ranch slowly get battered, physically, emotionally and psychologically, I've had enough of that show.

And a sad thought comes to mind. If these were not fat people, what is done on the ranch would be illegal. For example, in the 1960's when similar things though not near as abusive, were done in the "EST" seminars on a weekend to managers, the "EST" group got in serious trouble.

No one seems to care about the fat people on the Biggest Loser though. And that is the real tragedy.

Shrek movies - do they really promote size awareness

2010-01-09T07:18:00.001-08:00

On the surface, the Shrek series of animated movies seems to promote size acceptance. The so called hero of these movies is a fat green troll who is as noble as he is ugly. The lady he marries who first looks like a typical model type is actually a troll herself and turns into one when they get married. Like her husband, she's fat also.

There was always something which niggled me about these movies and after watching Shrek III, I thought it through.

I realized that not only is Shrek ugly looking but he's more than a bit uncouth (he IS a troll after all).

Everyone else in the movie is either a cute animal or very slim, nice looking humans - Shrek and wife are the only fat trolls.

Considering that, under the surface, Shrek does the opposite of what one might think. On an unconscious level, it connects "fat" with not only "ugly" but "uncouth" as well and it's pouring these connections into the unconscious minds of the viewers, the most pernicious type of brain washing and especially into the impressionable minds of kids.

I suspect if I had small kids I might not encourage them to watch these movies - more fat-a-phobia and negative connotations of people of size, we do not need.

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

2009-12-28T10:13:00.000-08:00

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?

5 Medical Reasons to consider Weight Loss surgery

2009-12-12T00:50:00.000-08:00

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)

Gastric bypass stops appetite? Not according to this study

2009-11-30T10:58:00.000-08:00

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.

http://www.medpagetoday.com/MeetingCoverage/ASMBS/14874

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.

New study on gastric bypass found higher mortality rate

2009-11-11T10:53:00.000-08:00

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

Obesity causes cancer - more "BIG FAT LIES"!

2009-11-06T01:42:00.000-08:00

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 junkfoodscience.blogspot.com 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

answering rebuttal to gastric bypass post

2009-10-27T12:37:00.000-07:00

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

Fatter babies caused by estrogens in the air?

2009-09-26T02:02:00.000-07:00

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"!

New Scientist Magazine and gastric bypass

2009-09-11T00:34:00.000-07:00

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.

Update on second person to have brain surgery for weight loss

2009-08-25T17:29:00.000-07:00

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.

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

2009-08-07T17:34:00.000-07:00

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 uh..re-computed 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.

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

2009-07-19T17:36:00.001-07:00

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?

Brain pacemaker to lose weight?

2009-05-08T00:31:00.000-07:00

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.

When you don't know, estimate

2009-04-27T03:39:00.000-07:00

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

Biggest Loser - an exercise physiologist weighs in

2009-04-17T17:44:00.000-07:00

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:
www.bamboobalance.com

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 www.bamboobalance.com

Does Gastric bypass lengthen lifespan?

2009-04-08T01:31:00.000-07:00

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

the obese only have themselves to blame?

2009-02-28T11:12:00.000-08:00

Suppose a cancer patient walks into to the doctor and/or oncologist or hospital and before they treat her or maybe instead of treating her, they all say "but you only have yourself to blame!"? Never would happen, right? Even though the American Cancer Society has stated that cancer is 85 percent lifestyle caused!

However with obesity, Dr Rudy Leibel has stated that it is only 40-60 percent lifestyle caused and yet, the obese person going for medical treatment hears it all the time that they "only have themselves to blame".

One of the most ignorant articles I have read in a while (and that's saying something considering how ignorant the media is) was written by someone in the UK named Amanda Platell.

(Photo caption - "self delusion is an obese person's greatest problem" says Amanda)

She writes:

But my mother cooked simple, cheap food for us every night, packed our lunches (sandwiches, a carrot and an apple... is that too hard?) and none of her three children ever had an ounce of fat on them.We swam, ran, climbed trees, played football. We ate healthily and lived healthily.

Well, excuuuuse me Amanda but MY mother cooked healthy, packed our lunches with no sweets and we swam, rode bicycles, climbed trees and played sports and we still were fat, all of us!

And according to the unpublished Russell Williams study, in which he asked 6 catering services which had catered both the NAAFA conventions as well as many other conventions, which group had consumed more food, the answers would have surprised Amanda and others. Three of the caterers said that the fat folks in NAAFA consumed exactly the same amount of food as those of the general population and three of the caterers stated that the folks in NAAFA consumed less food than consumed by other conventions.

It's time for those of us with genes which tend to render us fat, stop taking the nonsense and ignorance from such as Amanda and for that matter, consider stopping taking their advice to disable our digestive tracts also. Instead, we need to embrace our beautiful bodies whatever size they are, live on a healthy program like HAES (read Dr Bacon's book "HEALTH AT EVERY SIZE" if you have not yet read it) and educate the general public about genetics and size and obesity.

See http://healthread.net/obesity.htm

Because if we do not tell society the truth, no one else will and articles like Amanda's will continue to misinform the public. The Amanda's of our society never hesitate to speak out, as we can see.

Review- Stress Eater Diet book

2009-02-23T12:18:00.000-08:00

I have been asked to take part in a "blog tour" reviewing the book, the Stress Eater Diet by Robert Posner, MD and Linda Hlivka, MBA, C.N. Since I tend to be a stress puppy myself, I was intrigued when approached to review this book.

Robert Posner, co author of the book, is an internist who has apparently run a Weight Loss Clinic in the Washington D.C. area for the last 20 years. Having a theory that weight gain in some people could be caused by an imbalance of serotonin in the brain, he and Linda Hlivka, a nutritionist-chemist, developed a Supplement called Serotonin-Plus. This supplement's ingredients read like a multivitamin but it does have "green tea extract" in it which has been touted in some circles to raise metabolism, and also contains 50 mg of caffeine in each pill (and that has been proven to 'raise metabolism' but is not necessarily a healthy way of doing it). Dr Posner wrote a book published in 2002, advocating this supplement but since then, some groups have de-bunked the green tea theory including consumer group, Center for Science in the public Interest (CSPI). A government document detailing a suit questioning weight loss claims about a drink called Enviga containing green tea extract and caffeine, includes the following:

CSPI's scientists have concluded that "Enviga is just a highly caffeinated and overpriced diet soda, and is exactly the kind of faddy, phony diet aid it claims not to be." [Watchdog group sues Coke, Nestlé for bogus "Enviga claims." CSPI news release, Feb 2007] http://www.cspinet.org/new/200702011.html Meanwhile, Connecticut Attorney General Richard Blumenthal has asked the marketers for copies of all scientific studies, clinical trials, tests, and/or papers that support the calorie-burning claims-and information about any group that may have sponsored the studies. [Attorney General demands that Coca-Cola, Nestle prove claims of 'calorie-burning' beverage. Connecticut Attorney General press release, Feb 5, 2007]

To Dr Posner's credit, he does not include a plug for this supplement in "THE STRESS EATER DIET". In fact, it's not mentioned at all except in the bio of Linda Hlivka which names her as the chemist involved in developing "Serotonin-Plus".

One of my personal frustrations with the book which, by the way, IS a good read with plenty of worthwhile information in it which can help us all to be less stressed, was that for some reason, Dr Posner and Ms Hlivka chose to not include their cites and sources as footnotes in the traditional manner, so although many studies were mentioned, one has no way of knowing when, where or how these studies were done. In the section called "References" at the end of the book, it mentions that cites and references can be found at http://www.stresseaterdiet.com/references.html however that page returns a "not found" error. The few studies listed in the references section are ones we all know about and not the studies supporting the book's theories about Serotonin and weight control.

So I had my work cut out for me. The book is a collection of tips about weight loss i.e. log your food, exercise, reduce stress using yoga and deep breathing etc, eat slowly and more - things which will cause weight loss on any program, but I wanted to check out some of the claims new to me which were as follows:

1. That eating foods high in tryptophan would cause the brain to produce more serotonin and that this is a good thing and one which would aid in weight control

2. That tryptophan is the precursor to serotonin

3. That although carbs are high in tryptophan, they only produce a momentary relief and thus are not as effective as foods like turkey etc i.e. low carb foods.

With reference to number 1, I did find a few articles (not any studies though) that suggest that eating tryptophan rich foods would cause the brain to produce more serotonin and some opinions that this does aid in weight control. Of most interest in that area was an article sent down a listserve for medical providers by a P.A. The article was not from a medical journal but still is interesting because it opined by mixing substances rich in tryptophan and taking anti depressant drugs which are serotonin re-uptake inhibitors (SSRI's) could cause a syndrome called "serotonin syndrome" which according to the article could result in:

Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.

Neuromuscular symptoms like muscle spasms, exaggerated reflexes, muscular rigidity, tremors, loss of coordination and shivering.

Autonomic nervous system symptoms like fever, profuse sweating, rapid heart rate, raised blood pressure and dilated pupils.

Source:February 27, 2007 - PERSONAL HEALTH - A Mix of Medicines That Can Be Lethal
By JANE E. BRODY

While this is obviously extreme and not necessarily a risk with eating a lot of turkey, the article did contain the statement that:

"Although serotonin poisoning can be caused by an antidepressant overdose, it more often results from a combination of an S.S.R.I. or MAOI with another serotonin-raising substance."

And this causes one to wonder whether it's a good idea to fool around with Mother Nature when it comes to brain chemicals at all... even with food sources, a question asked in the book, "PROZAC BACKLASH" by Joseph Glenmullen, MD. Glenmullen opined from his research and working with many patients over a long time span that messing with the serotonin balance in the brain could cause problems such as Parkinsonism.

As for my question of whether Tryptophan IS really the precursor of serotonin, my research suggested that it is generally theorized that, yes, it is at least ONE of the precursors. Again I didn't find any studies but many educated opinions on this.

And finally with reference to question 3, eschewing carbs in favor of low carb meats, I found that the jury is still out on this with at least one very respected researcher at MIT disagreeing with the authors' low carb suggestions.

Dr Judith Wurtman has apparently done a lot of research on carbs and serotonin and in an article carried on the MIT site, Wurtman stated that carbs were essential for good health and that a low carb diet could result in some serious cravings (due to the body's need for carbs). Wurtman feels that stopping carbohydrates could not only affect the brain's serotonin levels but also affect your mood: (Note apparently Wurtman's remarks are based on her years of studies which are available in peer reviewed journals.)

"Wurtman, director of the Program in Women's Health at the MIT Clinical Research Center, and colleagues have found that when you stop eating carbohydrates, your brain stops regulating serotonin, a chemical that elevates mood and suppresses appetite. And only carbohydrate consumption naturally stimulates production of serotonin.

In "The Stress Eater Diet" Dr Posner and Ms Hlivka are not clear as to whether one should go low carb for life because they say you slowly add carbs back after the first week of "induction" (of a 4 week program). However, comments like the following suggest to the reader that carbs in general are not well thought of by the authors:

"pasta has little nutritional value" (page 122)

However, this conflicts with what I have often read and that is that Pasta is rich in B complex vitamins for one, a vitamin which Dr Posner stated he feels is a direct stress reducer, a statement accepted by mainstream medicine.

(And it's well known that one gets much more of the vitamin out of food than out of supplements).

Dr Posner and Ms Hlivka are also very much opposed to eating sugar which is OK but as substitute, they recommend, by brand name, sweeteners like aspartame and splenda which is somewhat controversial now that many studies have shed suspicion on the safety of these chemicals. Even the CSPI, once on the "no sugar" bandwagon i.e. do aspartame instead of sugar, has recanted on this position after the well respected Ramazzini Institute studies which found a link between leukemia and aspartame consumption.

The program in "THE STRESS EATER DIET" recommends cardio exercise which, as folks know, I greatly agree with, and the chapter on exercise is excellent, as is the chapter on stress. Perhaps we have heard some of the suggestions given before but somehow having it all in one place, reminds us that we need to do some of these things to reduce stress in our lives.

I hope that in a future edition of the book, the authors _do_ consider including the cites in a footnoted manner because I think today, most of us being bombarded on a daily basis with all kinds of claims, do question uncited material.

For example, one of the statements I would like to see cited is the authors' claim that 90 percent of those diagnosed with type II diabetes are overweight. The percentages I have read have been that 33 percent of type II diabetics have never been overweight and this has been my own observation also.

All in all, I liked the book - it is readable, well written and interesting, and provides a lot of useful suggestions and some things I did not know even with my having read so many diet books.

And most of all, it is one of the only books which gives us real world practical suggestions on reducing stress which I, in agreeing with the authors, feel is a major factor in many of the ailments we suffer.

As a weight loss program, well, if you do the things they suggest such as, log your food daily, count your calories, measure your portions, substitute low cal food for fast food etc and exercise at least 20 minutes - 30 minutes a day, yes you will lose weight whether you eat foods high in trypophan or not. Unfortunately, studies have suggested only about 5 percent of the public are able to be this vigilant on a long term basis. But even if you don't use "The Stress Eater Diet" as a diet book, I feel reading it can be helpful in getting more healthy and reducing stress.

Would this book make a good addition to your library? I would say, probably so. I know I found it rather enlightening.

Where you get it: The Stress Eater Diet Website

Other blogs participating in the "blog tour" can be found here!

re-visit - diabetes and weight loss surgery

2009-02-05T07:15:00.000-08:00

If you listen to the TV, you will hear that weight loss surgery (either gastric bypass or lap band) "cures" diabetes. You will see happy patients less than 2 years post op dramatically throwing out their medication.

Remember TV is NOT the truth. Not even close.

We have two studies available which looked at diabetes and weight loss surgery.

The first was the Swedish Obesity Study. It compared weight loss surgery patients to people trying to diet. It was NOT randomized and as a matter of fact, those chosen to be in the NON patient group had MORE diabetes and MORE heart disease. The surgeries used in this study were gastric bypass and gastric banding.

At the two year point, they recorded a 73 percent remission in those patients with diabetes.

But at the 10 year point, only 36 percent of the patients remained "diabetes free". That means for most of them, the diabetes had returned. We have no longer term results than this.

Also this study did NOT look at the number of gastric bypass patients who got reactive hypoglycemia which is less treatable than diabetes (caused by the death of the islet cells of the pancreas). One 13 year post op recently remarked that "most gastric bypass patients eventually get this problem."

Finally the Swedish Obesity study found that at the 10 year point the "average" BMI among the weight loss surgery patients was 35. Still clinically obese.

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

graph showing percentage of patients in remission from diabetes at the 2 and 10 year points

The second study was the "Monash Study". This study was randomized sort of. It did not take any diabetics who were diagnosed more than 2 years before surgery. (and we all know that moderate lifestyle changes without weight loss can bring A1C back to "normal" in the first few years after diagnosis).

It did not study patients any more than two years post op. They found at the 2 year post op point, 73 percent of patients were in remission (and the researchers used remission and not cure!) which is the same that the Swedish Obesity study found.

Monash Melbourne study link

The TV ran with it. The Monash Study used adjustable lap band patients. And the word "remission". The TV said they were gastric bypass and used the word "cure".

I have heard some Weight Loss surgery surgeons use the word "cure" also and the ASBS is now trying to recommend gastric bypass for overweight patients with diabetes (i.e. BMI 30 or more). Those patients tend to fare badly post op. Somehow their bodies do not adapt as well as heavier patients.

Speaking of Weight Loss retention: The third study we should look at is the Utah study which found that 34 percent of patients whose start BMI was over 50, regained all or most of their weight within 10 years.

SOURCE: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD

Bottom line, weight loss surgery is not effective unless you diet, count calories and exercise (which will keep weight off without surgery) and it does NOT cure diabetes - no study ever found that and the only place reporting a diabetes "cure" is TV which is selling the surgery or some surgeons who are also selling the surgery.

Biggest Loser - revisited

2009-01-16T10:13:00.000-08:00

As you'all know here, if I am wrong, I will gladly admit it. And people have written comments to show me the error of my ways and if I see merit in what they say, I am more than glad to admit I was in error.

I guess my humble blog has gotten the attention of one of the winners on "the Biggest Loser" show, second season, Pete Thomas. Thomas lost a lot of weight in a 9 months - 185 lbs and apparently if his blog is to be believed, he's kept it all off (but of course, Eric Chopin didn't tell his cyberfriends how much he had regained so that's why I say this with a grain of salt.... IF his blog is true).

Be that as it may, he is ANGRY at me. Very angry and has written a long comment which raises some issues that I think I should address in my main blog. So here goes:

Pete writes:

"You are doing such a poor job in your analysis. The media does want to see failure."

Ignoring the insult, (and to use Pete's phraseology, "it doesn't take a big leap in intelligence" to realize that ad hominem is a faulty argument tool), I feel Pete is very wrong. The media did NOT to this day, cover much about Eric Chopin's massive weight gain nor the weight gain of other "big losers". And there is a good reason for this. The media is driven and financed by the diet industry, a billion dollar industry of which "the Biggest Loser Show" is of course, a part (it sells products when folks watch the show unless they fast forward through the commercials like I do and not a lot of folks DO that). And the diet industry is pushing the myth that "all of us" can "get the body we always wanted" just by buying this or that diet when in fact studies have found (all of them have FOUND THIS, PETE) that 95 percent of people who diet to lose weight, regain the weight within 5 years! And the results of weight loss surgery are not much better - even with a permanent change to the body, 93 percent of patients cannot keep all the weight off! And most patients still end up in the severely to clinically obese zone and then WITH a new set of comorbidities. (the Swedish Obesity study and others). I've given these cites in some of my other blogs so won't labor through them here.

Pete gives as his reason for his belief that the media is highlighting failure as this:

"It does not take a giant leap of intelligence to see this. Look at the local news or national news – How much positive vs negative news do you see? The media thrive on success and more so on FAILURE!"

True, negativity and fear dominate the media EXCEPT when it comes to selling product and that means the DIET INDUSTRY so most of what we see on the media is SUCCESS to perpetuate the myth that "most people can successfully keep off the weight". As I mentioned before, I saw no mention of Eric Chopin in the news and a search of Google news I did right now, came up with the following message:

Your search - "eric chopin" - did not match any documents.

So I am wondering, Pete, if your theory is true and the media is highlighting failure in weight loss, why didn't Eric's appearing on the Oprah show even warrant a SMALL mention in the news?

And according to Pete's biography on his website, he's appeared rather often in this media which he says "highlights failure"

"He has appeared on ABC's The View, The 700 Club, and eXtra as well as being featured in People Magazine, Runners World, TV Guide, The Detroit Free Press, inTouch Weekly and Real Health."

Next Pete you are getting a bit confused here when you wrote:

"One successful author I know says ANY publicity is good publicity. He FRAMED BAD reviews of his book! Be assured – your blog qualifies as good publicity."

Doubtless you were referring to the saying sometimes attributed to Will Rogers but apparently said by many that "there is no such thing as bad publicity, only publicity".

First of all, I think you are overrating the nuisance value of my humble blog so if that's your worry, please don't worry... I'm sure no one on the show or in charge of the show would be convinced by this blog. First of all, the show is a cash cow and you will find that people _really don't care_ whether it's healthy or "right" if it's bringing in the bucks. First American TV principle... that you have not encountered this, leads me to wonder what planet have you been living on? :)

Secondly, actually there IS such a thing as bad publicity... Joyce Brothers said that and we can see that bad publicity helped greatly in defeating Sarah Palin in the recent election. Her name was on every lip so she got plenty of publicity, all bad.

And third, if you feel that my blog is good publicity then it should help your business of "motivational speaking" and thus, why are you so angry at me? I must say, you seem to be contradicting yourself a bit (well more than a bit).

So bottom line, my blog may be bad publicity for the show but as long as the ratings soar (whether people who watch it LIKE the show or not), the networks will run the show (and sell the sponsor's products). And people wanting to believe the myth that "all of us can have the body we always wanted" will continue to call you for "motivational speaking" right?

You then accused me of being ignorant so you wrote patronizingly:

"So let me educate you a little – Oprah called Eric – Remember! He turned her down initially. It is a known fact that contestants regularly turn down the media ‘When they start gaining their weight back’. You just don’t know that because your not knowledgeable enough on these things. So let me help you."

First of all, Pete, seems you didn't read my blog very well because I SAID that Oprah had called Eric previously and that he'd turned down the appearance (what he said on the "Oprah" show). Perhaps you might be the one needing help in reading things a bit more carefully. And by the way, Pete, in the statement of yours "Your not knowledgeable" I think you meant to say "YOU'RE not knowledgeable", right?

You further wrote:

"Oprah called a lot of us a few months back and those of us familiar with the process KNEW exactly where the show was going."

Have you counted the number of POSITIVE "amazing weight loss" shows Oprah has done? It way exceeds the couple of "weight loss problem" shows she's done.

"Misery loves company. My opinion - Oprah wanted company in her own struggles (or rather her producers choose to portray it as such)."

Aren't YOU assuming something about Oprah i.e. her being "miserable"? She's never been extremely large and she's sold a bunch of magazines and shows with her latest "confessions". And I do not see Oprah appearing on shows like "The Biggest Loser" which regularly humiliate people of size. Bottom line, there is no evidence that she's feeling miserable at all. Only that she's a very clever TV show host who knows how to get the audience's attention.

After that, you wrote:

"I will leave you to your ignorance on that one and I will just continue to laugh from a distance."

And I ask why you have to laugh at me at all and if life being so slim is so wonderful, why are you so angry? Happy people don't write angry, ad hominem letters like you wrote me. A psychologist might have a field day with your letter, Pete. :)

Then you ask:

"WHY is the type of weight loss on the show unhealthy?"

That you don't know, suggests you may be the one who lacks knowledge especially that you mentioned no one has shown you any evidence of this... incredible since evidence exists all over the internet and in many books that quick weight loss is unhealthy.

Your body cannibalizes organs and muscles with a quick weight loss and lowers your metabolism so that you will gain more quickly. Since you are apparently was unaware of the tons of stuff available written about this, you may be more amenable to watching a video than reading an article or book, so I will provide a video explaining the process:

http://www.youtube.com/watch?v=zC0gnUwmBg0

I would also recommend Dr Linda Bacon's book, "HEALTH AT EVERY SIZE" which well covers obesity research.

Additionally, working out so hard and so long every day (and in most cases, high impact) is foolish and ASKING for injury... just ask the personal trainer at your local gym about this. Again much has been written about this on the medical and fitness sites... if you haven't yet seen it, you obviously do NOT want to see it. Because it's easy to find.

The show not only sacrifices health for audience appeal (no one wants to see someone lose slowly on a healthy program - that's boring) but also, it humiliates people of size. Again, if you do not see this, perhaps you don't WANT to see it and nothing I write will convince you...

One more thing you brought up ... you wrote:

"You believe that size does not matter and it is ok to be morbidly obese."

This statement is way too general. But I don't think I said this in any of my blogs. Fact remains however, that for every study which suggests a danger in being clinically obese, there is another study which suggests NO LINK between clinical obesity _alone_ and morbidity but rather other lifestyle factors instead... food choices, whether the person yo yo's the weight or stays steady and a host of things, even things like stress and anxiety.

Dr Rudy Leibel, probably one of the most respected obesity researchers, stated in a speech to the NIH that "there probably is some advantage to being of normal BMI but it is UNCLEAR whether someone forcing their weight to a lower range than their bodies want, enjoys that advantage".

Now, Pete, I have provided some sources and clarified what I have written and of course, I invite comment but if you DO comment, I hope you will do so more respectfully than your last comment as I feel insulting comments do little to enlighten folks who are reading this. Provide me with facts and cites and I will listen. Your anecdotal "I know all about the show" attitude is not really what I call unbiased observation especially since you apparently walked away with a tidy sum of money. I can understand that you do not like it when the show is criticized for being unhealthy or for exploiting fat people (although some of the Biggest Loser candidates have talked about that themselves), and while I understand your point of view, your anecdotal information does not qualify for scientific data. I hope you understand that.

Overall, I think we can discuss something, even disagreeing upon various aspects and still remain adult and civil, yes?

Biggest loser - not?

2009-01-13T12:04:00.000-08:00

Again we return to the controversial TV show everyone hates to watch. That's because Eric Chopin, one of the winners of the "Biggest Loser" who lost the most amount of weight, appeared on the Oprah show yesterday.Oprah had invited him a few months ago to one of her "amazing weight loss shows" to tell his weight loss story. But he declined the offer, saying he couldn't get off from work.

"I lied about that" he told Oprah yesterday. The truth was Eric Chopin has regained 107 lbs of the 214 lbs he initially lost. He said he decided to reveal the truth to his fans after Oprah's courageous move of revealing her 40 lb weight gain (which she has exploited in her "O" magazine as well as the last two weeks of her show and I guess plans webcasts as well - leave it to Oprah to dis-arm the tabloids while upping the ratings of her show... no wonder she's one of the richest people in the country - she's very clever to say the least!)

How did Eric gain the weight? Well, he didn't really know - it just crept up on him, he said. Perhaps the fact that he wasn't working out 5 hours a day like he was on the "Biggest Loser" ranch, helped.

In an earlier interview which I did blog about, I said Eric looked like he had gained some and then, he told the interviewer that when he was on "The Biggest Loser" that WAS his job but once he got back into the REAL world, he didn't have the time or energy to exercise all those hours a day.

On Oprah, Eric looked ashamed of himself, the old "I did this to myself" and Oprah, now the world's most renown expert on "falling off the wagon" consoled him that 2009 would be a better year and she said it shouldn't be about the number on the scale (which is a laugh because of course, that's ALL what it's about).

But should Eric or any of the "Biggest losers" who were unable to maintain the loss really be blamed? It's quite possible that the only thing "they did to themselves" was offer themselves up to be on the show.

Perhaps everyone should take a second look at the methods used in the "Biggest Loser" show. The people do back breaking workouts for several hours a day, and they also cut the calories (they wear counters which log their steps - these are uploaded into the computer and then, they have to log their food).

Eric told Oprah that he hating working out but he was athletic in High School. Oprah has always hated working out so she commiserated there. "Does anyone LIKE working out?" she asked, grimacing and the audience laughed.

But I have often wondered if those personal trainers on the "Biggest Loser" by putting these people through such pain (in order to win the show) have turned these people AGAINST working out for life... Workouts became for them, nothing BUT pain (the latest "biggest loser", a 30 some year old, told "The Today Show" that just before she won the show, she had packed all her bags to go home because she couldn't take it any longer and her young body hurt all over). But workouts shouldn't BE pain... aerobic workouts are supposed to be pleasant and can be fun. In the normal schema, workouts are NOT for "losing weight" but for health and as an aging person, I can attest to the fact that my hubby and my workout habits HAVE kept us healthier despite some health issues we have.

Eric told Oprah that people had warned him that keeping the weight off is the hardest part. He said he had scoffed at the warnings saying "you ever lose 214 lbs in 6 months?" but added that he found out those who had warned him were right.

After mistreating his body as the show did, it's not surprising that he regained but I don't feel HE should be blamed but rather the show. And yet, people keep lining up to BE on the show and they talk about "saving their lives".

Killing their metabolisms and working out for 5 hours a day doesn't sound life saving to me. On the contrary.

In the Game show hearings (the $64,000 question show in which contestants were given the answers), in defense, the TV exec told the Congress members that he didn't see what the problem was. "People won money, contestants had fun and the audience was entertained - everyone won!" Few seemed to realize the deceit involved could become a slippery slope into shows in which really nobody won and people COULD be hurt.

Perhaps we have arrived there with shows which exploit human beings.

dying from a surgery which might not work anyway

2009-01-03T01:07:00.000-08:00

The doctor gently told the family to dis-robe and remove their jewelry. They were standing outside a modern facility and were told that they would be released but first were to be allowed to take a shower so they would be presentable to their loved ones. The people wondered if this doctor could be trusted because he worked with their jailers but surely since he was a doctor, he had their best interest in mind. Most of all, they WANTED to trust him. So they suppressed their fears and doubts. Showering would be nice, they thought since, they had not had this luxury during their time there. After taking off their clothing, they filed into the what looked like a community shower. They might have had hopes of "getting their lives back" because this is what they were told by those who led them into the building. Somehow one thinks they might have been in denial about things because their jailers were not really into saving their lives. But people will believe what they WANT to believe and they wanted to believe the nightmare would end with their shower. Standing in front of the shower head, they looked forward to living normally again. But no water came out of the shower head. Instead a deadly gas filled the air tight building. Their "release" was only by death. This was Nazi Germany.

And the kindly doctor who led them into the "shower" to their death, was on hand to sign the death certificates and report that he had further "taken care of the Jewish problem".

In 2006, Ray, a very large person, blogged for a year how he felt a radical type of weight loss surgery was going to "magically" save his life. To their credit, several bariatric surgeons refused to operate on him. He weighed close to 500 lbs and was still mobile (he drove a truck) but was in kidney failure from diabetes and required dialysis three times a week. One of the surgeons who refused him was Dr Baltazar of Spain who tried to explain to Ray that he didn't have a prayer of surviving weight loss surgery. But Ray bought the hype he had heard on some of the discussion groups and TV. He truly believed that Weight loss surgery would somehow make him slim and "normal". He did not speak well of those doctors who refused to operate on him and finally, he found someone who WOULD operate. Because insurance did not pay, Ray's grandma went to her savings to come up with the $50,000 for Ray's surgery. Ray's last letter before surgery, expressed hope that he would "get his life back" after surgery and he went into the hospital, confident and optimistic.

But after surgery, several other organs joined his failing kidneys and went into failure. He was awake, awake enough to realize that what those doctors who refused him surgery had warned about, was happening. His surgery was not going to save his life. On the contrary. People who went to see him, described him as very depressed before he died about 3 weeks after his weight loss surgery.

Ray may not have had the life he wanted before surgery (dialysis isn't everyone's first choice of a fun thing to do) but he _had_ a life. He drove his truck, he held his nieces and nephews, he saw his Grandma, he still could get around. Instead of giving Ray his life back, the bariatric surgery had denied him of the life he had.

TV just showed another similar case. Renee Williams was a pretty lady who at 29 years old, looked young. She had been bedfast for 4 years, partially due to a crushed leg from a car accident. And she had gained weight to 900 lbs. She video blogged and said she wanted to "get her life back" and do more things with her two kids. Like Ray, she had contacted many surgeons who refused to operate on her because she was too big a risk. But finally she found a surgeon who agreed to do a gastric bypass on her. After her bypass, he came out smiling at her family. "The surgery went well," he told them. Visiting Renee after she woke up, this surgeon said to her "and you will soon be skinny". And in the next 3 weeks, she lost 60 lbs. But then one night she had a sudden heart attack. The surgery HAD been too much for her. Her older daughter said tearfully that her mother had been her best friend.

"I know I have 100 percent chance of dying in the next year," Renee told her video blog.

But seems with the gastric bypass, Renee didn't even have a year to live but only weeks.

And Manual Uribe who refused the offer of a gastric bypass, and only a hundred lbs or so less than Renee, is still living albeit still bedfast. (It's a no brainer that walking is a lot more than being slimmer - many muscles must be developed before that even should be attempted.)

Somehow, I feel Renee's life was wasted and that she was given false promises because this drastic invasive surgery is not even that effective on larger people. One of the few studies we have which looked at many patients 10 years post op, found that 34 percent of them with a BMI over 50 regained all or most of the weight they lost.

We to date, have no data on weight loss 20 years after gastric bypass despite the fact that gastric bypasses have been done for 40 years. Why is that, some wonder. Dr Paul Ernsberger, associate professor of nutrition at Case Western Medical school, opined:

"A number of trials have been started, and the final results have never been reported. We have to ask, you know, why haven't we seen the final results? I think it's because it's bad news." (Dr Ernsberger on "The Donahue Show")

When these very large people showed hesitation about the surgery, this surgeon (now under lawsuit for the death of another patient) paraded a woman who had had a gastric bypass and lost 400 lbs. "It's the best decision I ever made in my life," this patient who works for the surgeon as a "liaison" said, enthusiastically. But that woman is only two years post op. We should remember that 6 months after Big Pete Herida appeared on Oprah and said how losing 600 lbs with his gastricbypass had "saved his life", Herida died of congestive heart failure.

And then there is another lady I know who weighs in excess of 500 lbs who is in her 50's and not real mobile. She says she's _outlived_ 48 of her friends who had Weight Loss surgery. One never hears about that on TV.

There is some evidence that losing a lot of weight even slowly, may be more of a strain on the heart than NOT losing it.

What really upset me was the misrepresentations going on.

"If Renee survives this surgery, she will lose 700 lbs" stated Renee's surgeon to the TV cameras.

None of the very large folks I know, have lost more than 400 or 500 lbs with gastric bypass (many have lost less) and most of them regain a significant amount of weight (if they live) within 4 or 5 years.

"Renee only had a year to live" was another thing we heard a lot on the TV show and no one can predict that at all. Surely it's not real healthy to be in bed weighing 900 lbs but who really can predict the lifespan of anyone. Telling her that seemed more like a misrepresentation in order to scare her into surgery.

And the worst thing was the spin they put on the show "If Renee had been accepted for surgery earlier, things would have been different. She called many doctors and begged them to help her."

This seems to suggest that those surgeons who were ethical enough to NOT operate on her were somehow guilty of her death.

"The show has inspired many to call for help - to not wait until it is 'too late' like Renee did. " the show told us detailing two other patients, both of whom got bypasses but are still in bed.

It's way past time to realize that what we hear on TV may not, and probably IS NOT the truth. TV makes only a commitment to entertain, not to tell the truth.

During the trials after the game show scans in the 1950's, one of the producers shrugged his shoulders when confronted with their lies, giving contestants the answers etc (there is a movie called "QUIZ SHOW" which details this famous case). "Well," said the producer, "no one was hurt. The contestants won money and the people were entertained."

Now with today's spin, giving people false hopes about surgery which may not even help them (and may cause their death), can we really say anymore that "no one is being hurt"?

Surgeons pressured based on flawed studies

2008-12-18T14:50:00.000-08:00

Based on a couple of studies suggesting increased lifespan in weight loss surgery patients, those studies being short and inconclusive and not randomized and flawed, surgeons are being pressured to do gastric bypass surgery on people of all ages. A recent news article quotes one surgeon who was being pressured to operate on people as old as 78 years old (which is ridiculous because a lot of evidence suggests that doing gastric bypass on anyone over 60 is a risky deal and may SHORTEN - not lengthen lifespan).

"I am being asked to operate on 78-year-olds with co-morbidities of heart disease and diabetes," said Dr. Edward H. Phillips, executive vice chairman of the Department of Surgery and a surgeon at the Center for Weight Loss at Cedars-Sinai Medical Center in Los Angeles. Phillips questions whether these patients will benefit..."

The surgeon continued...

"So, while it is obvious a 30-year-old will benefit, at what age is too old?" he asked.

Problem being it's NOT obvious at all that a 30 year old will even benefit from losing weight without surgery, let alone having a surgery which causes vitamin deficiencies for life and more ...

***Gastric surgery for weight loss causes nutritional deficiency in nearly 100% of individuals who have it done. The most common deficiencies are Vitamin B12, Iron, Calcium, Magnesium, Carotene (beta-carotene and other carotene vitamins) and potassium.****

Kaiser Permanante Release form for gastric bypass

All the studies I know about which suggested an increased lifespan for gastric bypass patients were flawed. One study (David Flum (Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study)
compared 62,000 healthy fat people who entered the hospital for gastric bypass to 3000 seriously ill fat people who were hospitalized for other reasons (had he compared the gastric bypass patients to 3000 seriously ill slim people hospitalized for other reasons, I'm sure he would have found that the healthy fat people outlived the seriously ill slim people also). This same study was the one which found that the real death rate of gastric bypass patients was 2 in 100 or 1 in 50 died within 30 days of surgery and another 2-6 percent (depending on age) died within the first year. Did he average those deaths in with results? Probably not.

And the Utah study which compared 9500 gastric bypass patients with 9600 "seriously fat people" who applied for drivers licenses and found a "40 percent less death rate among gastric bypass patients". (Long-Term Mortality after Gastric Bypass Surgery Ted D. Adams, Ph.D., M.P.H., Richard E. Gress, M.A., Sherman C. Smith, M.D., R. Chad Halverson, M.D., Steven C. Simper, M.D., Wayne D. Rosamond, Ph.D., Michael J. LaMonte, Ph.D., M.P.H., Antoinette M. Stroup, Ph.D., and Steven C. Hunt, PhD.) In this study, there were several flaws. First of all, most people lie by a lot on their drivers' licenses about their weight... and the heavier they are, the more they shave off. In a survey I did of fat people, I found most over 300 lbs were putting their weight as 100 lbs less than they really weighed which means finding people of "comparable weight" based on driver's license weights, weren't really comparable because actually, they were likely much heavier than their WLS counterparts.

The worst thing wrong with this study is the way it LOOKS i.e. 40 percent more deaths sounds impressive until one looks at the facts.... there were 57 deaths in the control group (the non surgical) and 37 deaths in the gastric bypass patients so that is only 20 deaths more in the controls and they did NOT count the gastric bypass patients who died immediately after surgery or within the first year after surgery. They took them at the 5 year point when those who probably survived the first few years were going to survive. Had they taken them (as they should have done) right after surgery, I'm certain they would have found that the mortality rate was much higher among gastric bypass patients. They also did not count long term patients either - only 5 years post surgery which is before the co morbidities like anemia etc show up in many patients.

Definitely not a study to "prove" anything about the lifespan of gastric bypass patients and nothing to justify doing surgery on elderly with heart conditions etc.

And so far, there isn't even any "proof" that losing weight will prolong lifespan. Two studies of over 50 year olds, all obese - one group which dieted and the other which maintained their current weight, found that the dieters had a 50 percent greater chance of heart attack than the controls. For as many studies that suggest that obesity is "dangerous" there are an equal number of studies which suggest that obesity alone does not pose co morbidities and co morbidities are either contingent on lifestyle or "serendipity".

Even the release form for gastric bypass warns about this:

****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)

It's time Americans realized that anything in the mass media is for "entertainment only" and NOT a good source of information, especially for making medical decisions.

art credit: art in photo by Char - used with permission

diabetes but what type?

2008-12-16T03:51:00.000-08:00

What is the cause of type 2 diabetes? We all can answer that by rote much as we can recite TV ads for cereals from the 1960's. "being fat and/or gaining weight and bad eating habits".

Well, then, what causes type 1 diabetes? "that's when your immune system or something else destroys cells in your pancreas".

Where things seem to get confusing is how they distinguish between two. I used to think it was something like "if your father had diabetes or your mother or your grandmother, it's type 2 because type 1 is obviously not hereditary". Or maybe if you walk into the doctor and have a blood sugar reading of 1000, at the first reading, you might have type 1. Or if you are a kid, of course, it's type 1 because kids don't get type 2 (that's why it's called "adult onset diabetes" dummy - didn't you know that from the 1950's?... ok I'm being sarcastic here... I admit it. My bad)

But a recent Discovery Health CME was extremely confusing. A young ballerina (15 years old) came in with a blood sugar reading of 400. Now _that_ seems to suggest she has a partially functioning pancreas, doesn't it, especially since her mother also has diabetes also...which suggests a genetic factor, very typical of type 2 diabetes or insulin resistance, right?

But it appears that because both the mother and daughter are very slim and eat healthy etc (well supposedly - many slim people actually do NOT eat healthy - they just "get away" with eating poorly), and the girl is a kid (15 years old) it must be type 1 diabetes, decides the doctor and puts this kid on 7 shots of insulin a day (and 8 pricks).

Later, you see the kid with some friends, one of whom asks "but you look so good, how come you have diabetes?"

"no no no no no no no!" exclaims the young girl, "I don't have that kind of diabetes that fat people get!" (she wrinkles her nose in disgust as she utters the words "fat people".) "I have type 1 diabetes!" Listening to this, I cringed.

And I wonder. Did they ever try her on metformin? Did it ever occur to her medical providers that insulin resistance which is a gene, can occur in a slim person also? Is it worth it to these people to not "brand" them as "fat" or "formerly fat"? Obviously if metformin worked, wouldn't that be a whole lot better quality of life for the young girl to take a couple of pills a day than to take 7 shots of insulin throughout the day and test her sugar "umpteen" times? Also, metformin is a better treatment - she's essentially being treated the same way they treated diabetics in the '50's and '60's.

I have a friend who is slim. But his mother was extremely overweight. So he noticed the usual signs of diabetes - thirsty, and so forth. He went to the doctor and because of his age and girth, got diagnosed with type I diabetes (and his mother by the way, had diabetes type 2). Was on insulin for several years until some smart doctor decided to try metformin and now, he only takes one insulin shot a day and pills which is a whole lot nicer.

My question to medical providers - are you really in tune with the fact that a slim person can have type 2 diabetes because it's essentially a genetic disorder? Even if they are not fat (because fat is largely genetic as well)? Or are you putting young kids through a horrible medical regimen just to assure their parents and/or them that they do not have the "fat person" kind of diabetes?

Fat phobia hurts everyone - even slim people. And that is why we _all_ have to fight it.

If you come in with a blood sugar level of less than 800, even if you are a kid or slim, ask your medical provider to try metformin (the pills) first. Because 33 percent of type 2 diabetics are slim - never were fat in their lives - and those are the ones we know about. How many more type 2 diabetics who were misdiagnosed because they were young and/or slim are there around?

a buzz of bogus studies on fat and weight loss surgery

2008-11-25T11:23:00.000-08:00

So you are wondering why I have not blogged in a while. Truth being we have been lately inundated with fat and weight loss surgery studies which are obviously flawed. And sometimes it feels like mentioning them is similar to trying to lower the level of the ocean by taking out tea cups full of water.

This morning I saw a study which was questionable enough that I had to report on it. It appeared in the JAMA that is, the Journal of the American Medical Assn, Nov 19 2008. (here I recall the issue of the same magazine - after numerous studies had already suggested smoking was unhealthy - which pictured several doctors on the cover, all smoking cigarettes as an accompaniment to an article about how cigarette smoking was a healthy way to lower stress!).

The Conclusion of this latest study was that women who get pregnant after gastric bypass, have LESS complications in their pregnancies.

First thing to question is it comes from the Rand Corporation, the same group which, a few years ago, announced that one of their studies had suggested that smoking was less dangerous than being fat (this was based on a few thousand people called by telemarketers and asked 8 questions, including height, weight, age, whether they smoked and 6 more about their health). Needless to say, even the diet industry no longer quotes THIS study.

Second, two complications were mentioned - gestational diabetes and high blood pressure (the latter which isn't really a complication of pregnancy anyway).

What is NOT mentioned is that these do not necessarily affect the baby at all (I can attest to that personally knowing a lady who had gestational diabetes and delivered perfect, healthy bright kids).

The researchers, we are told, looked at 75 studies which they selected out of 260 studies. And likely they only selected the ones which gave them the favorable results they wanted.

Some studies I've seen, which suggested the gastric bypass patients tend to have smaller babies and a higher rate of still borns, even if they DO NOT have gestational diabetes or high blood pressure, were likely not selected to be "reviewed".

It's kind of a no brainer that if the mother is not digesting vitamins, it might negatively affect the baby.

Another show called "Extreme bodies" on the Discovery Channel, might have been an infomercial for Dr Rabkin and the Duodenal Switch/Bileo Pancreatic diversion. Ironically, the patients shown in the film were still rather large and Manny Yarborough, the ex Sumo wrestling champ who is up to 750 lbs now (after keeping up his exercise after retiring from the ring for a while) and has decided to NOT have WLS. He states in the end of the film that his friend who died from WLS, told him on his death bed, to "not let them do that to you". So far, he's taken this advice.

The new non surgical WLS which isn't - non surgical!

2008-10-21T12:26:00.000-07:00

You have probably seen by now, the media hype. "New WLS - no cutting needed".

Transoral Gastroplasty the so called TOGA procedure, has already been hawked in the media as the latest and greatest.

What the TOGA is, is that they stick a bunch of flexible staplers down your esophagus and pleat part of the inside of your stomach (with staples) into a small pouch:

The TOGA System (Satiety, Inc), a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch (similar to other restrictive pouches) along the lesser curve of the stomach.

The news media lost no time in hawking this as the latest and greatest WLS with no cutting:

Unlike other bariatric procedures, the TOGA does not require any incisions. That translates into quicker recover times, shortened hospital stays, and a decreased risk of complications.

Decreased risk of complications? Well, partially true. That is, decreased risk of complications from incisions like hernia and wound healing. We won't talk about complications which may arise from stapling the interior soft tissue of the stomach and of course, other complications which generally arise from WLS.

Other sites have called this procedure 'non surgical'. Again the term may be misleading - that just means there is no incision. But it certainly IS surgery. For example, if a surgeon does a vaginal hysterectomy would that be "non surgery" just because there was no incision?

Below is the best description I could find of it - Medscape news (requires free membership in Medscape to read this)

http://www.medscape.com/viewarticle/555586

There were no complications; all but 2 instances of procedure-related adverse effects (nausea, vomiting, pain, dysphagia, pharyngitis) resolved within 5 days and none were serious. The most recent follow-up visits (endoscopy at 3 or 6 months) showed persistent full or partial stapled sleeves in all patients. Weight loss averaged 17.5 lb at 1 month and 24.7 lb at 3 months after treatment (excessive weight loss [EWL], 14.9% and 20.5% at the respective time points). At 6 months, average weight loss was 31.1 lb and EWL was 24.9% for 6 patients followed up so far.

According to Dr. Scott, "Gaps between staple lines [negatively] affected weight loss. The gaps were dependent on stomach anatomy. As we gained more experience with the instruments and the procedure, we made adjustments, and weight loss increased."

... Dr. Scott reports a financial relationship with Satiety, Inc. Dr. Zundel reports financial relationships with Ethicon and Inamed.

One is left with many questions about this procedure. First of that, that's soft tissue inside the stomach and also has a lot of important digestive cells, much softer than rather than the outside of the stomach which is stapled. Secondly the Rose and Stomaphyx procedures which are used to revise gastric bypass patients who have experienced regain, apparently have a problem with the tacks (Stomaphyx) or sutures (Rose) coming out. The Stomaphyx has been all but dropped because the tacks came out pretty soon. (The two patients I know personally who had it say not only was it ineffective in helping them to lose weight again but had a painful aftermath). In doing the Rose procedure, surgeons tell patients the sutures are only guaranteed for a year after surgery.

And a major issue ... the Vertical Banded Gastroplasty which is more permanent than the TOGA but similar in concept, was EXTREMELY ineffective for keeping weight off.

I have known one patient who kept off her weight for 9 years but after that, it started piling on as she became increasingly ill with autoimmune disorder and a host of other things (which many of her medical team DID attribute to repercussions of her WLS). At the 22 year point when this patient had to have her pouch amputated because her stoma stayed shut and she could not even swallow saliva, she was 15 lbs heavier than she had been on the day of her WLS, 22 years ago.

Typical of these patients are things like losing all their teeth, gastroparesis and atrophic gastritis and more.

(see: http://obesitysurgery-info.com/post-gastrectomy-symptoms.htm )

It's true that the VBG was safer than the gastric bypass (which is why Mason invented it- he wrote) and many of those patients are still around at the 25 year point but I have not met one long termer VBG who is a happy camper. On the contrary.... and every one of them has regained all the weight.

Of course, this TOGA procedure has no silastic band and no stoma. But even after a few months they found (by their own admission): "partially stapled sleeves". In other words, the staples seem to last less time than the sutures....

What damage does this do to the patient's stomach, I wonder....

Studying history is helpful here. The vertical banded gastroplasty which seemed much more permanent was neither effective in the long run nor complication free. For instance here is a patient case history with endoscopic photos:

http://obesitysurgery-info.com/vbg_patricia.htm

And even the horizontal gastroplasty which was extremely ineffective as far as weight loss, had its own set of long term complications which interestingly enough resemble the VBG long term. Here is a case history of a 30 year post op horizontal gastroplasty patient. NOTE: although she is very ill, she has been told that any type of take down or reversal will destroy her stomach and put her under risks of dying on the table:

http://obesitysurgery-info.com/savage.htm

NOTE: both these courageous patients have requested of me that I include their real names AND their photos because they very much wish to warn those considering similar surgery....

The weight loss seems typical of what we have seen with other gastroplasties. Even in the medscape article, the average loss per week by the 6th month was 5 lbs per month or approx 1 lb a week. (this was omitted from the media hype about the procedure - how surprising!) :)

So I would wonder why do they even run a trial of this because it seems doom to fail, even at keeping off the weight any length of time.

The answer may be in the funding they are getting from the manufacturers...

Dr. Scott reports a financial relationship with Satiety, Inc. Dr. Zundel reports financial relationships with Ethicon and Inamed.

And of course, as Roy Spenser remarks in "CLIMATE CONFUSION" (he was senior scientist and climatologist for NASA), any newspaper reporter will jump at "big news" (like "NEW WLS") in hopes of the typically elusive Pulitzer Prize. "Scientists are human" writes Roy continuing that proclamation of "truths" is likely to get scientists, more and better funding. But writes Roy, dourly:

"If you want possible explanations of nature, go to science. If you want truth, go to church!" (Spencer, Roy, PhD: CLIMATE CONFUSION, NY, 2008)

Bariatric surgery, stress eating, marginal ulcer and PTSD

2008-09-22T12:15:00.000-07:00

Here is something not talked about EXCEPT in medical journals (where it's OFTEN talked about): (from Melting Mama's blog)

... [she] had roux en y gastric bypass a couple years back. She's been having burning "acid" pain and discomfort and took her concerns to her Bariatric Surgeon. He says it's a "Marginal Ulcer." The doctor said there will be NO denying when it perforates, and to get to the hospital.

My reaction here is that many Weight Loss surgery (WLS) post ops especially longer term post ops, are living with a form of "Post Traumatic Stress syndrome" - i.e. when things "just happen" to you suddenly, rather unusual things which do not happen with such regularly, frequency or severity to the general public, or like the individual above, you are WAITING for "things to happen", it tends to cause a type of stress which can lead to catastrophic thinking (and fear and anxiety) on a daily basis.

Again this is NEVER discussed at pre op seminars and seldom discussed when post op depression (which many post ops I know, have) is encountered. They are given medications which they may or may not absorb and sent home. If they eat to help their stress, they are often verbally abused by medical providers.

Meanwhile the ads and promos and seminars for WLS continue to brag that it will help depression to lose weight with WLS! I guess they hope folks won't read some of the yahoo listserves where longer term post ops hang out....

Also, I know cases where overeating has gotten folks through periods of extreme trial and stress, in their lives when, without this method of stress management, they might have had nervous or physical breakdowns.

Again, medicine almost never acknowledges stress and how it can be the MOST devastating thing to a person's health - much MORE devastating than some extra pounds (to put it mildly).

One person on another list talked about being recently hospitalized for "being suicidal". I've known this person for quite some time now, and she is usually an upbeat, cheerful, optimistic person and also of very high intelligence. So when I heard she had been thinking of the ultimate bad ending, I was more than a bit shocked. Did anyone ever consider that her "suicidal ideation" might be because of her gastric bypass which not only did NOT produce the weight loss she was promised (despite her being a model patient) but also has caused numerous NEW comorbidities which are difficult to impossible, to treat? I bet not one person who has treated my friend ever asked these questions. :(

By the way, the Junkfoodscience blog has an excellent analysis of the latest study suggesting that bariatric surgery (weight loss surgery) is more cost effective for insurance companies than treating obesity. I love her title "No evidence that bariatric surgeries save healthcare costs or save lives" Seems this study has more holes in it than swiss cheese. Bravo to this blog and its author for exposing these um...less than scientifically sound (how's that for politically correct) studies!

Finally by way of news, the young lady who made the headlines a while ago for getting a lap band (after lipo suction etc) in her early teens, appeared on the new show, "The Doctors". Seems she (not the parents!) is looking to get more plastic surgery. "I want my arms done," she told those watching the show, pinching a small bit of skin under her arms. She admitted she wanted a few other procedures also. I found myself wondering whether she, like so many of us, is getting into the "hooked on plastic surgery" thing. Of course, this attitude seen in many American women, keeps plastic surgeons in business, but so often the bottom line is the inner feeling that "I will never look good enough" a possibly correllary of which is "I will never BE good enough". Many people who get WLS are also motivated by looks and highly disappointed with the results when they don't come out looking like the air brushed models in the magazine with totally flat abs etc, even if the surgery produces a weight loss close to the so called "ideal". This young lady, now at the age of 15, remains a lovely naturally good looking young lady who, because of societal pressure, may well not be enjoying what nature gave her, and just the exhilaration of being young with her life ahead of her, instead looking for happiness in places where perhaps happiness may not be found. Should she be looking for inner happiness which may make her feel a lot better than yet-more surgery?

WLS providers misrepresent - who loses?

2008-09-12T13:35:00.000-07:00

Occasionally (ok not so occasionally) I listen to an interview with a weight loss surgery provider which misleads from start to finish. And this upsets me and I think it upsets the many providers out there who truly care about their patients and try to follow up and make themselves available. It upsets everyone because it could give folks a very bad impression of providers in general. Folks tend to make decisions based on very limited contact. That is, _if_ their limited contact is a provider like the following one, it could lead to not only bad decisions but also a bad name for the industry.

I actually came across this provider whom I will call DR X, because one of his patients wrote to me and she is not a happy camper. She had a gastric bypass 3 years ago and has been ill ever since and worse yet, she hardly lost any weight from it. This provider who told her it was easily reversed and that he would be there for her, immediately dropped her with his last communication being several rude comments about how she had broken the "tool" and all her illness was her fault. She now is looking for a provider to give her a take-down so she can have some quality of life again and not be so ill.

I am not blaming the surgeon for her illness - it could be that her body just really objected to having her innards so drastically rearranged - many bodies do object to having the stomach cut in two pieces and most of it bypassed and the gut cut into three pieces and put back together in a very different manner than it came from the factory (despite the fact that the media hype tries to convince us that it's a total "walk in the park" and the "weight falls off" etc).

What I do fault the surgeon for, is not supporting her when she did become ill and also she told me that the surgeon really did not give her any detailed instructions on how to manage, what supplements to take, B12 shots and a myriad of other facts gastric bypass patients should be in possession of, before they take the big plunge. To be sick and without a provider who understands can be one of the loneliest positions one can be in and yet, I have met quite a few ill gastric bypass patients in this exact position.

In the radio program I listened to, this provider made the following comments:

When asked if a gastric bypass wasn't a really extreme solution, he answered that living with a BMI of 43 was much more extreme than having a gastric bypass.

I think picking that BMI was an unfortunate choice for him. I lived with a BMI of 44 for quite some time and found that it wasn't extreme at all and that even being in my 60's I was totally not ill or even mobility impaired as he suggests. He never dealt with the fact that the gastric bypass has a 2 in 100 risk of death within 30 days of surgery (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]) and a 2-4 percent risk of dying within the first year plus a 20 percent reoperation rate and a 34 percent risk of gaining all or most of the weight back within 10 years. (Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD) Now that's extreme!

But the comments were about to get better or more um..misleading...

He dismissed all the "bad stories" about gastric bypass comparing pregnancy to gastric bypass "everyone gives them the horror stories. People in general want to share your misery."

I don't have to comment about this one except the least this comment is, is highly insensitive to those folks for whom the WLS does not work or makes them ill. Of course, there is every evidence that this surgeon drops patients who are not happy campers so he may not really be concerned with anyone but those who are happy with the surgery.

And of course, pregnancy is a very natural condition whereas the gastric bypass is a very unnatural condition. That's kind of a no brainer.

Next comment....

He pointed out that all WLS patients had tried dieting and failed but then, made another unfortunate analogy. He stated that "you don't buy a car without taking walks, getting rides from friends, taking the bus and riding a bicycle"

In case Dr X didn't know, most people never try out bikes etc before buying cars - indeed, a large percentage of teens already have cars and use them to drive as short a distance as 1 mile to school which would be a walk for me! And actually, most ill patients have told me that they really didn't give dieting as hard a try as they gave WLS, so perhaps his analogy while unfortunate for proving his case, may have been more correct than he meant!

Finally to make his point which was obviously to go buy a bariatric surgery, hopefully from him he made the classic comment of all times. I quote him here:

"It isn't extreme. I'd much rather have bariatric surgery than being obese. I'd rather have AIDS than diabetes. I know that people don't die from AIDS in the USA anymore..."

Excuse me? People don't die from AIDS anymore? What planet does he live on, I wonder. Has he ever seen a terminal aids patient? There is nothing quite so bad as that. Diabetes while not a walk in the park, is totally no comparison to Aids and I really wonder how a physician can make such a bad error without making it on purpose, hoping the public is extremely ignorant.

Physicians like this scare me because people believe them and can get very hurt by their misrepresentations.

In the course of the discussion, it turned out this surgeon, Dr X, had gained 70 lbs at one time in his life and had lost it by exercise and extreme eating. In other words, some of his judgmental attitudes definitely resemble the ex-smoker who is intolerant of everyone who has not yet given up smoking.

He is not the first surgeon I have encountered who is fat phobic - actually I have over heard remarks from a few WLS surgeons which are extremely disparaging (to say the least) about the patients who provide their bread and butter. One surgeon, for example (who is retired now) told the nurses to not pick up a bariatric patient if they fell. "Just leave them on the floor and call the paramedics and let them deal with it" he told the nurses, an attitude which annoyed even very slim nurses. He was the one who laughed when he said "Oh, if they overeat after surgery, it WILL come up!" I think the vomiting after gastric bypass isn't a laughing matter by any stretch of the imagination. Not withstanding his assumption that all fat people are that way from stuffing themselves which in my observation simply has no relationship to reality.

In the as yet unpublished Russell Williams studies, he asked several caterers who had catered NAAFA conventions where the average BMI is well over 40, how the amount of food consumed compared to those conventions attended by a cross section of the public, many at so called "normal weight". He found that 3 caterers said the fat folks had consumed about the same amount of food as the so called normal weight folks and the other three caterers said that the fat folks had consumed less food than the slimmer folks!

So we wonder does a surgeon's fat phobia spill over to his/her performance in the OR? One would hope not and frankly, I had never considered the possibility, until I watched a "Whipple procedure" which is done for pancreatic cancer and much less invasive than a gastric bypass. The surgeon refused to do it laparoscopically (he said it was too delicate and too much might be injured), he took 5 hours to do it, doing most of the anastomosis with sutures and not with staples and painstakingly, avoided injuring organs, causing a lot of bleeding and not connecting blood vessels. The Whipple procedure provides for cutting a section of the pancreas and a section of the duodenum, the first section of the small bowel which is a small percentage of the digestive tract which is cut and rearranged in a gastric bypass. So I really wondered how they can do a gastric bypass in 30-90 minutes when there is a lot more cutting involved? Is it because fat people considered disposable in our fat phobic society? I was shocked to say the least but in thinking about it, it's logical that fat phobia would carry over, at least in some cases, as does any bias.

If you are considering any of these procedures particularly the gastric bypass (RNY) or duodenal switch/bileopancreatic diversion (DS/BPD), take your time. Get your information from informed consent documents or from a gastroenterologist. Someone who does not stand to profit if you decide to go ahead with it. That's only common sense. Sadly, we often take a lot more time and care, buying a car than we do, buying a surgery.

Biggest losers - the people or the show?

2008-08-22T09:18:00.000-07:00

In this month's TIME MAGAZINE was a short article about "Reality shows which aren't really reality" in reviewing a movie about teens.

That phrase struck me because they've been really hawking the new season of the TV show, "THE BIGGEST LOSER". And somehow, for no reason I can fathom, this show is wildly popular.

I not only cannot understand fat people volunteering to be on this show and apparently losing much of their dignity in front of TV cameras but I cannot understand why people watch the show because the dynamics of dropping someone every week often for no apparent reason or the cameras showing these people fighting with each other or wincing during the hours of grueling exercise, all tend to annoy me to the point where I cannot stand to watch the show.

Worse yet was when I did some research on the show and found out that the way they lose so many pounds a week was that they worked out for 5 hours or more a day and were sequestered on a ranch somewhere with personal trainers who appear as if they got their training from the Spanish Inquisition or any other place of torture. They appear to enjoy seeing their clients suffer untold pain to race for the biggest weight loss of the week.

Susan Powter tells us that the body can only process 2 lbs a week of fat so guess what folks who lose 7-10 lbs a week are losing? Muscle tissue, bone mass and organ meat. Not exactly what I would call healthy.

How pray-tell, are these folks going to have a chance to keep the weight off when they get back into the real world and have to do other things besides starve and work out for hours a day? And will the sore muscles and somewhat sadistic personal trainers render them sour on exercise for life? (Studies have shown that moderate exercise is a very good thing!)

One of the "biggest losers" did take an interview a while ago and he said when he had to do real things like work, he ended up re-gaining a significant amount of weight. I suspect that's the fate of most, if not all of the folks on that show. Kind of a no brainer if you think about it. After all, if we lived in the Amazon Jungle without refrigerators, cars and fast food, we'd all be slim. And a large number of us would also be dead.

In 1900 when people worked 12 hours a day for 6 days a week and didn't have refrigerators or fast food or real tasty food (let alone time to eat it) there was little to no obesity. But the average lifespan was 45 years. Now despite the "deadly obesity epidemic" our lifespan is 78 -80 years. Big difference.

Does anyone care about the health of these people which probably is seriously threatened by this type of regime suffered on "The Biggest Loser" show?

Are people aware of the fact that people occasionally die on these reality weight loss /get fit shows?

For example, a gastric bypass patient was picked to be in the Fit TV show "Ship out and Shape Out" She was a pretty lady named Jennifer who had a kindly sweet personality. She had lost a bunch of weight with her surgery but was still over 200 lbs and wanted to lose more. Her personal trainer mentioned she had "health problems" (likely from the bypass). She did not participate in all the exercises and those she did participate in, seemed a big strain on her body. And about 6 months after the show was first aired, she died. (I found that out because when the show re-ran, they had a memorial to her in the credits).

She wasn't the only person on the show who suffered. An over 40's man almost had a heart attack on one of the hikes they took (you cannot just suddenly be fit - you have to work up to it). He got all red in the face, and half collapsed. Not surprising, he didn't show up for the reunion of the group, 3 months after the show was finished filming.

And "Ship out - Shape Out" was tame and conservative compared to the horrors they put the people through on the "Biggest Loser" show.

5 percent of the population can keep their weight off after losing a bunch of it.
95 percent of the population thinks they are in this 5 percent.

Maybe people watch the "Biggest Loser" show because they dream of the weight just dropping off. The same reason, people ignore all the friends who regained or got sick or died with weight loss surgery, ignore the warnings in release forms and hop on the table to have a gastric bypass. They only think about that first year when the weight is automatically dropping off because they are too injured and sick inside to be able to eat much or have an appetite. They don't seem to think about what the 2nd and 3rd year will bring or the 20th year when they might have re-gained most of their weight but still have another set of co morbidities from the weight loss surgery. I've talked to many older post ops who say they are taking more meds now than they did when they were very overweight. But 200,000 people have this surgery yearly (in the USA), seemingly ignoring all the evidence (and the non guarantees from the medical profession about what life with weight loss surgery will really be like or even the expectations of retained weight loss which are not much better than dieting).

I think it's the same thing which inspires people to watch the "Biggest Loser" show. It's a rationalization that a daydream is reality. A rationalization that becomes so strong in some that they are willing to play Russian Roulette with their lives and future rather than face reality. A bit like the movie, "The Matrix" where the reality of humans lying in a bed, having their energy slowly zapped by a machine was totally different from the world the machine created for their brains and how some individuals, when faced with the reality of a somewhat, desolate world, willingly became prisoners of the machine again. "The Matrix" although having a less than great, plot line, was so deep in meaning and significance as to our generation that I've found several books written about it.

Reality shows which are not really reality. Time Magazine said it well. But when that non reality becomes a motivation for people to take insane chances with their lives, it's time to stop and re-think the whole schema.

Maybe the "Biggest Loser" is not the group of people thus tortured for several months for the delight of the TV audience or even the show itself but those who watch the show and begin to believe the myths spewed out therein.

Not a new thing of course. Hitler stated "Say something over and over and people will begin to believe it" Doubtlessly, he would have loved modern communications and manipulative media like TV - scary to think of what he would have done with these powerful tools.

He also said "It is very good for rulers that people do not think" and that was in the 1930's.

The Melborne Monash U study - diabetes and obesity surgery

2008-07-23T11:50:00.000-07:00

You have to understand that I consider the adjustable lap band a far superior WLS to any of the earlier procedures. It's much safer (about 10 times safer), inserts no staples into the body, no intestinal bypass (as is true of the gastric bypass) and is adjustable which can be a plus if the person does not experience the loss they wanted. But to sell any WLS with misleading statements bothers me because any WLS is serious surgery, even the lap band. I cannot help it.

I recently found out that the show, "60 MINUTES" is as misleading in Australia as it is in the USA. At least in Australia, they are a bit more civilized than they were in the USA and are advocating the lap band which is a MUCH safer surgery than the gastric bypass and they also pointed out that the sugar levels in diabetes could be reduced through a non surgical program like Weight Watchers. But the transcript of that show does contain a few whoppers (i.e. misleading statements - I'm being polite here) which I'd like to go over here. Also I'd like to talk a bit about the Monash study which is now available to read on the AMA site.

First the 60 minutes show in Australia.

Statement: Weight loss surgery cures diabetes and they quoted the study as a backup and a WLS surgeon also confirming it.

REALITY: That's false. Because diabetes is a genetic disease so only changing your genes will cure it.

Not surprising, the study from Monash did not use the word "cure". They used the word "remission". Here is a statement from their study abstract:

Remission of type 2 diabetes was achievedby 22 (73%) in the surgical group and 4 (13%) in the conventional-therapygroup.

We will return to this study later but first more misleading statements from "60 minutes".

statement: "That lifestyle, though, has led to him getting diabetes"

REALITY: FALSE. Diabetes is a gene. While there is some evidence that a healthy lifestyle which includes daily exercise and slight calorie restriction can delay the need for medication, it is also true that 33 percent of type II diabetics have never been fat in their lives and many of those exercise a lot.

statement: "if he doesn't have surgery, the diabetes will get worse"

REALITY: The diabetes will get worse regardless of what treatment he has because it's a gene and the pancreas gets progressively worn out as a person ages.

Statement: that you must lose weight to "cure" the diabetes.

REALITY: As we said before diabetes is a gene and not curable. And if losing weight "cures" diabetes, how do we explain the 33 percent of folks with type II diabetes who have never been fat? (I know several of these myself actually).

Finally: Statement: the suggestion - they didn't say this but strongly implied it - that WLS and/or weight loss would cure the erectile dysfunction often seen with diabetes.

REALITY: Weight loss doesn't do a thing for erectile dysfunction- don't expect a remission on that if you have it.

Now let's talk a bit about the study. It was a randomized study - this is good and appears to have been a clinical study i.e. the cohort were examined periodically by the researchers. Participants were divided into two groups. One group was given diet and exercise advice and the other group was given the same advice with the addition of lap band surgery. No one was paid for participating in the study. And the study lasted 2 years. The results were that whereas a remission of symptoms (as decided by the A1C) was observed in both groups, the percentage of remission was significantly higher in the lap band group. (13 percent in the non surgical group and 73 percent in the surgical group).

As far as the study went, it seemed better designed than some but here are what I see as the shortcomings, some of which could still be "fatal flaws".

The cohort was small - only 60 people, 55 of whom completed the study at the 2 year point. The researchers themselves stated that larger studies needed to be done.
None of those in the cohort had been diagnosed diabetes more than 2 years ago i.e. they were very newly diagnosed. This is a time when it's relatively easy with mild lifestyle changes including dietary modifications and cardio at least 5 days a week to keep the A1C at normal. Where the problems really begin is after several years. For example, a diabetic family member kept his A1C normal for 13 years with no medications (after that, he required oral meds).
Lifestyle changes were self reported so we have no idea if the "controls" in the study i.e. the non ops were really exercising as much as they said. Probably they didn't.

We have two things going here. The researchers never claimed a cure - they claimed a remission only. The cure part was a misreprensentation on the part of the media and sadly enough the WLS surgeon interviewed in the media.

Second, we by seredipity found out something very interesting about surgery and diabetes. This family member, my hubby, diagnosed 14 years ago, had a brain hemorrhage in Feb - and no, his team of doctors assured us that it was NOT caused by diabetes or hypertension. He had surgery to insert a shunt to drain his spinal cord fluid and went home a day later. In the ICU, his sugar levels were extremely high - stress was apparently a major factor in that. (another interesting thing we learned about diabetes).

But very oddly enough, even after having totally unrelated surgery (but surgery in which he was intubated etc), by the time he got home, his sugar levels totally tanked! So he went on a fun food kick, eating all the things he had been denying himself for 14 years: Dairy Queen, fast food every night, desserts, ice cream whatever. And every morning for about 3 weeks, even with his bad eating and only minimal exercise (not daily), his morning sugar readings were at normal i.e. 80 or so.

But after that on the same non diet, they started to climb and finally he realized it was back on the old program of daily cardio and watching what he eats.

The suspicion remains however, is that somehow surgery seems to affect the sugar levels whether it's WLS or something totally unrelated. No one can really explain it but I think this is only temporary (the only reason WLS patients may sustain it is if they follow the lifestyle changes). And nice as his "honeymoon" with all the "bad foods" and couch potatoing was, I think he would not have chosen as his preference, to have the 13 days in ICU or the brain hemorrhage.

It's a shame that so many people buy the hype from TV without even checking it out (like pulling up the study etc).

As long as people feel there are quick fixes and easy ways out and "something for nothing" there will be snake oil salespersons right there to sell them something. Only with surgery, it may poorly affect the body for the rest of one's life besides possibly not being effective.

I guess my main concern is spewing forth extremely misleading statements about diabetes in order to frighten people into having obesity surgery.

Caveat Emptor - "let the buyer be beware" is a phrase which we seem to have forgotten in today's society driven by media hype.

Teens, weight loss and obesity surgery

2008-07-08T13:25:00.001-07:00

Clyde was an ordinary teen. When he was in 7th grade, he was intelligent, talented and liked video games far more than exercise. He lived the American lifestyle. In his family, there aren't many veggies available and a lot of fast food and pizza. He tried the swim team but it didn't appeal and he felt a bit odd in a bathing suit because he was about 15 lbs overweight. And back then, the obesity hype for kids had just started.

When reflecting on High School at the end of his 8th grade year, he told me, "The kids in school are MEAN!" I didn't ask details but assumed that, like all kids who are not the "ideal" size, he had taken his share of teasing and nasty comments. He had, already at that young age, learned to dress in cover up clothing.

Today Clyde is a senior in High School and he is relatively slim.

Is this a success story? I wonder. Because how he did it was NOT through eating 5-9 portions of veggies a day, avoiding fast food and junk food, and trying to do 60-90 minutes of cardio daily. He, instead, continued to live the American lifestyle with some modifications.

He drinks a lot of tea (caffeine speeds up the heart and makes it easier to lose weight and by cutting the calories - it may also, in the long run, be a factor in Parkinson's disease as are all stimulants - see the book, PROZAC BACKLASH for one).

And he smokes cigarettes.

If he went to the doctor, the doctor would probably be pleased at his BMI but at what cost did he attain his "ideal weight"?

Does he know the proven dangers of smoking i.e. hardens the arteries, strains the heart, and shortens lifespan as much as 15 years? Yes he does. "I know it's dangerous," he told me a bit sadly, "but it's hard to stop."

He does not receive any support from his parents. They want him to stop smoking but do not help him to accept himself at his natural size. And they don't understand that when you are a teen in school, the pressure is 1000 times what it is in life and right now, there is a lot of pressure and heat given to all of those who are overweight regardless of age.

The sad thing is most kids will keep within the "normal zone" if they eat healthy, avoid foods like potato chips and fast food which are extremely calorically dense and not particularly nourishing and if they exercise 1-2 hours a day. However, most kids are not really enthusiastic about this type of program and do not often get a good example of a healthy lifestyle at home.

Clyde is not alone. Statistics tell us that more teens are starting to smoke now, than in the 1960's before the dangers of smoking were known.

In considering kids like Clyde, is it really hard to understand that teens simply do not care if they are doing something unhealthy to keep thin because that is most important in the narrow minded society of High School?

Starting with Junior High School, "bulimia clubs" are flourishing, use of "uppers" are common and an alarming percentage of kids are already dieting or more extremely cutting calories. Very often it's the models in the magazines who are blamed, totally ignoring the heat overweight kids get from parents, teachers and the medical profession.

And now, with the encouragement of our wonderful news media and the surgeons who stand to profit, teens who are very overweight, have discovered Weight Loss Surgery.

As recent as a decade ago, the thought of doing something like a gastric bypass on anyone under 18 was considered unethical - inducing vitamin deficiencies in a body which has not yet matured, partially disabling a healthy digestive tract was considered bad medicine but now it's considered good medicine, the surgeons reciting the song of how the teen "was in danger" of a variety of ailments, many of which are non issues or not caused by obesity.

The "Today Show" recently, featured a teen, around 256 lbs who got a gastric bypass. In her before photos she was shown running around a field playing with a dog and smiling. A year later, she had lost 100 lbs and was of "socially acceptable size". But now she was not smiling. Even when the doctor told her she was a success, one saw only a hint of a smile on her face.

"I have to eat very differently now" she told the Today Show, "there are many foods which no longer go down right." She concluded, "It's not an easy road."

The rationale for giving this 17 year old a surgery which cut her stomach into two pieces and her bowel into 3 pieces, rearranging them in a very unnatural manner, a surgery which some studies show to pose a risk of serious complications in 40 percent of patients, by the 8 year point, complications like bowel obstruction, ulcer, pancreatitis and more... the rationale for doing this on the young lady was she had "sleep apnea", "high blood pressure" and "was in danger of going blind" (they never told us what endangered her).

Sleep apnea is a fairly new diagnosis. I don't doubt that some extremely large folks may have breathing problems, but I think the diagnosis of "sleep apnea" in everyone with a BMI over 35, may be way exaggerated.

I had an overweight friend diagnosed of that. She was given a C-PAP machine and found it way too noisy so she gave it back and went on and she was just fine without intervention. I think we CAN stop breathing for a few seconds without a problem and probably many people who are not fat might be doing that also.

So that left the "high blood pressure" (which can be easily regulated by medication) as their sole rationale for ruining this young lady's digestive tract for life, giving her lifetime problems which may really be biting her at the age of 30 when she would be in the prime of life had she not had the surgery, even if she was very overweight.

Sober faced, the young girl told the Today Show that it was "so nice to not worry about future health problems." How ironic that the procedure she had is, indeed, going to give her a new set of health problems which she might have never had to worry about.

It's time that the media and also adults stop pressuring our children. If they want to help them, they should encourage exercise (to be healthy) and eating veggies and healthy foods and most important, help them to understand that health and beauty is not about size. But when even our medical profession starts condoning unhealthy ways of getting thinner, things are out of control in my opinion.

On the Today Show, the resident doctor obviously approved of this young girl's gastric bypass. "Today's obese children are in the unique position of really having a shortened lifespan," she told the viewers.

With all due respect, the only reason that might be true is because society is pressuring teens to the extent that they are doing unhealthy things to lose weight, like smoking or gastric bypasses. That's a no brainer, isn't it? Apparently not to many folks.

Bariatric surgery slashes cancer risk?

2008-06-27T00:33:00.000-07:00

Latest news - front page for several days - has been that having a gastric bypass can cut cancer risks.

Bariatric surgeons at McGill University compared the records of 1000 patients mostly gastric bypass to 5700 people matched by age, weight and sex who did not have the surgery.

In the surgical group, 2 percent developed cancer and in the non surgical group, 8.5 percent developed cancer.

Although the study is yet unpublished, these bariatric surgeons presented their preliminary findings at the latest meeting of bariatric surgeons of the ASBMS recently. (talk about preaching to the choir).

And isn't it amazing that an unpublished study has made such headlines for several days now?

What is even more amazing is that while Dr Glenn Gaesser found in his metastudy that obese people were 40 percent less likely to develop cancer, how these surgeons found the opposite. Of course 6 percent more cancer isn't really that great although you can express it to sound amazing as MSNBC did .... saying 80 percent greater chance of cancer in the non surgical group.

One of the objections to this study was actually brought up by another bariatric surgeon. Edward Phillips, a bariatric surgeon at Cedars-Sinai Medical Center told the LA Times that patients who have weight loss surgery, are often screened for cancer before surgery. "We may be selecting patients who don't have cancer for surgery, thus biasing the study", he said.

It's hard to judge without seeing the study. For example, a lot of very obese people are yo yo dieters and that weight cycling raises all health risks. Also I am wondering why they had to pick so many obese people to compare. Why not select 1000 fat people to match up with the 1000 WLS patients? Because I bet in 1000 fat people you might not get any cancer at all and that wasn't what they wanted to prove with their study.

The study only ran for 5 years and critics of the study have pointed out that it often takes a cancer many more years to develop than that and that had the study been taken out longer, the results might have been different.

Breast cancer was one of the cancers which they saw less of in the bariatric patients. Could it be that after a gastric bypass, patients were unable to take birth control medication (a major risk factor for breast cancer - that is medications work differently in gastric bypass patients because of the malabsorption issues)? Or that the gastric bypass patients were unable to eat or digest foods with transfat in them (another cancer activator). Also most weight loss surgery surgeons require their patients to quit smoking whereas the fat controls were not necessarily non smokers. Another thing is that most gastric bypass patients can no longer drink alcohol especially the newer ops as they would have been looking at, if the study only ran 5 years - alcohol can be another risk factor for cancer.

There are just too many other factors which could be operational in all of this to assume that it was the surgery and weight loss which explained the 6 percent less cancer in the surgical group.

For example, most gastric bypass patients are told to exercise often in order to help keep off the weight. Exercising can knock the risk of cancer (in anyone of any size) down, 40 percent. Most of the obese controls were probably not exercising regularly.

Ideally the fat controls should have also been matched for exercise, not smoking and dietary modifiations (like the elimination of trans fat in the diet) if the scientists wanted to really see if it was the surgery or the weight loss which explained the less cancer in the surgical group.

A non randomized study always raises red flags. The fat people could have been picked for their cancer risk (i.e. cancer in the family etc).

I guess the thing which rather annoys me about this whole deal (besides the news media making it a headline for the last week or more) is that all the research I've done comes out the opposite...

Cancer is seen 40 percent less in fat people than in slim people - it has been considered a disease of the slim and yet now they are trying to link it like everything else to obesity.
Two oncologists have told me that fat people if they get cancer, are much more likely to survive than slimmer people.

So unlike the media is trying to tell us, the "link between obesity and cancer" has not been well proven at all. On the contrary. The American Cancer society has stated that lifestyle (not girth) is a factor in 85 percent of cancers.

Even the release form for gastric bypass used by many surgeons and usually attributed to Kaiser Permanante warns:

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.****

And obviously those who wrote this release form do believe in bariatric surgery.

Additionally, I have seen many get cancer who were very slim. Some of them were very fit like a 53 year old family member. She ran marathons and I'm sure the last time she visited her doctor before she came down with the cancer which was to kill her 3 years later, her doctor proclaimed her totally healthy, at her perfect weight with low risk numbers.

So much for the risk numbers and perfect weight predicting protection against cancer!

I would not take this one to the bank. Many gastric bypass patients can develop a condition called "leaky bowel" wherein bacteria, not killed in stomach acid, enter the small gut and are absorbed along with the food. With this condition causing in many, auto immune disorder like RA and lupus, it is suspected that the immune system of a gastric bypass patient might been impaired by the surgery and not strengthened as these McGill bariatric surgeons would like us to believe.