Do gastric bypass patients really live longer than fat people?

In the last couple of days, the headliner news has been that two studies have suggested that gastric bypass patients live longer than fat people.

"Weight loss surgery patients are SIGNIFICANTLY LESS likely to die prematurely" stated an article in the Washington Post.
"This is HUGE!", commented Dr David Flum, to the Washington Post. Dr Flum is a bariatric surgeon.
"It's going to dispel the notion that bariatric surgery is cosmetic surgery and support the notion that it saves lives," boasted Dr. Philip Schauer, another weight loss surgery surgeon who has been prominent in the news articles denying the negative repercussions of bariatric surgery.
"The question as to whether intentional weight loss improves life span has been answered," wrote George Bray, a known enthusiastic advocate of the diet industry.

All well and good but do the two studies they quoted really prove their point?

The answer is no.

In the Swedish Obesity Study (reported in NEJ Dec 23, 2004, vol 351, no. 126) , although 11,000 people applied to be included, only 3900 were accepted to receive weight loss surgery in 1987 when the study was initiated. A matched equal number of controls were selected and given diet advice. The cohort was examined at the 2 year point in the study and at the 10 year point.

At the 2 year point (2 years post op for the weight loss surgery patients), a goodly portion had been "lost to follow up" and only 2010 patients (out of the original 3900) were examined. It's likely that most of these were gastric banding because that was the more often done procedure in the 1980's. Two years is obviously NOT long term follow up.

At the 10 year point, only 627 of the original 3900 were left to examine - the rest had been "lost to followup". And of these 627, only 34 were gastric bypass patients. Of the rest, 400 some were vertical gastric banding and the remainder were adjustable banding.

Since only 16 percent of the weight loss surgery patients were available to examine at the 10 year point, this study poses more questions than answers including the usual question "where are the others?"

Well, we got sort of an answer on this one. Apparently, the 85 percent could be tracked as far as whether they died because of Sweden's nationalized health care records. But that they were "lost for follow up" suggests that their results were even less impressive than the 641 they COULD follow up - i.e. those folks available for follow up had only kept off an average of 16 percent of their weight!

So lets talk about the deaths. A fine analysis by a medical expert solves the mystery. The fat people had a 1.3 percent greater death rate which works out to 100 and some more deaths in the 3900 fat people than in the WLS patients. BUT, apparently, according to the researchers on the the Swedish Obesity study, they did not randomize the study which means instead of taking a random section of fat people, they could pick and choose. And pick and choose they did. Turns out the fat people chosen for this study had 25 percent MORE heart disease, 6.3 percent more diabetes than did those chosen to receive WLS and also the fat folks were an average of 1.5 years older than those who got WLS.

So the S.O.S. if properly interpreted, suggests the opposite of what the news told us... that fat people live significantly longer than WLS patients (and keep in mind most of the cohort in the S.O.S. were gastric banding which has a much lower death rate than gastric bypass). Why? Because there was 25 percent MORE heart disease in the fat people but only a 1.3 greater incidence of death! (To be even with the WLS patients, the fat people should have had a 25 percent greater incidence of death). That causes a hmmm, doesn't it? For details of the analysis please visit here (it's a great blog and you might want to read all the posts!).


The second study took place in Utah. Here 7925 gastric bypass patients were compared to 7925 fat people. The fat people were selected by weight recorded on their driver's licenses.

Researchers found that there were 108 more deaths in the fat people than in the gastric bypass patients (231 deaths in the fat controls, 113 deaths in the gastric bypass patients).

This study seems to have all kinds of problems in my book. First of all, who puts their real weight on their driver's license? Secondly there seems to have been no contact with any kind of medical records on the fat people... the deaths were taken from the death certificates on file. So we have no idea whether the fat people chosen to be the controls were smokers (greatly increases their risk) or yo yo dieters which greatly increases the death risk. We also have no idea of whether they exercised or not which greatly DECREASES the risk of death in people of all sizes. (REF: Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. American Journal of Clinical Nutrition. 1999 Mar;69(3):373-80)

Secondly with regards to the gastric bypass patients, the followup was only 7 years and the serious repercussions of vitamin deficiencies and nutrient shortages in gastric bypass tend to show up after the 10th year post op. Basically this was NOT a long term study.

So these two studies don't prove ANYTHING about longevity after gastric bypass.

And also, the end weight results of both studies were a bit disappointing to some gastric bypass patients. At the 10 year point patients had only retained an average of a 50 - 60 lb weight loss (for those 350 lbs to start with and up). And only 35 percent of patients were still "diabetes free" so the weight loss surgery didn't work really well for diabetes either, it seems.

Meanwhile the ASBS, the professional organization for bariatric surgeons, has renamed themselves to include "metabolic diseases" in anticipation of greatly increasing their client base to normal weight diabetics.

I guess since Edward Mason, the inventor of the gastric bypass, left their presidency, they might have forgotten that the reason he thought a "billroth II" (predecessor of today's gastric bypass) would work for fat people was because normal weight patients after a billroth II could not keep their weight at anything close to normal!

Also the expected lifespan (for normal weight patients) after a Billroth II was 15 to 25 years. Since modern medication and treatment there is no expected shortening of lifespan for type II diabetics.

As far as the news media's exaggeration of these NON findings from the two studies, a quote by Stephen Milloy comes to mind:

"But who needs data when you can spoon-feed junk science to a gullible media?"
- Steven Milloy, Fox News

How the Biggest Loser lost 214 lbs

Erik Chopin, 36 years old and winner of the "The biggest loser", revealed in an interview on Fox news how he lost 214 lbs. This was in response to the story on how the cold virus might cause obesity.

"So did a virus cause YOUR obesity?," asked Neil Cavuto
"Well, I don't know," said Erik, "but that would be nice if they'd make a vaccine for obesity - would have saved me a whole lot of work!"

"It's exercise and cutting the calories", Erik said, in answer to how he lost the weight, "Anyone can do it!"

Well, not exactly. When asked HOW MUCH exercise he did, Erik admitted that he did 4 or 5 hours of cardio exercise daily. "It was pretty intense," he admitted, " Basically, while I was on the show, it was my job!"

He apparently continued this killer workout program for a couple of months after he returned home but now has to go to work in a regular job - probably because of something silly like the need to have money to live. So he has geared down his program, he told the reporter... he only does 1 hour of running a day.

And from the tape we watched, he has definitely gained back some weight, so I guess his running one hour a day didn't keep off all the weight as the reporter said it had... The collage (above) shows Erik how he looked after he lost 214 lbs and how he looked a few days ago (in the black shirt) as he appeared on Neil Cavuto show.

One thing which strikes me about all of this. How come when people tell us fat folks "all you have to do is slightly cut the calories and walk for 20 minutes a day and the weight will come off", why did Erik Chopin have to work out 4 and 5 HOURS a day (and cut the calories) for HIS weight to come off?

So anyway, there you have it. Just work out 4 and 5 hours a day and if you are 36 years old, YOU TOO, can look like Erik Chopin DID after his stint on the Biggest Loser. What? Don't have the time? Have to work and do other things besides exercise? Older than 36 years old? Details details.... :)

Sue

Your fat friends can make you fat? III

The full text for the New England Journal of Medicine, "fat is contagious" study is available for free at this url:

http://content.nejm.org/cgi/content/full/357/4/370?query=TOC

The collection of the data seems hit or miss - individuals in the cohort were apparently asked to identify spouse, sibs and at least one close friend. Over the years, some individuals choose a different close friend.

The closest ties of friendship were viewed when two individuals chose each other as close friends. This was identified by the researchers as a "mutual friendship".

The problem with this is the "social network" of any given individual includes far more than merely ONE close friend but rather up to 30 or more close friends. Thus it might be said that the original information which the researchers fed into the computer in order to derive this analysis was erroneous and thus this would make the resulting analysis, invalid. As we say in the computer field "garbage-in/ garbage out".

Also, their results suggested that sibs were LESS likely than friends to "cause" or "influence" obesity in other sibs and spouses were the LEAST likely to influence their spouses as far as weight.

From observation, this result seems very erroneous... spouses OFTEN influence each other's weight as they share mutual cooking, often recreate together and enjoy similar interests... and sibs more often than not, show the same body type as other sibs due to shared genetics... so it seems like their computer generated results came out backward from what the reality might be....

Finally the last sentence of the conclusion is most troubling. From this erroneous study based on a false picture of the social network of the cohort (a picture which only depicts members of the cohort as having only ONE close friend at any given time), these researchers concluded that:

"This highlights the necessity of approaching obesity not only as a clinical problem but also as a public health problem."

It's almost as if this "study" builds and analyzes a false picture of the social network of the individuals of the cohort to come to a conclusion with political overtones based on what is a buzz word to many Americans i.e. "public health", the implications of which in the extreme, could lead to treating overweight people like lepers were treated in the past. That is, falsely portraying obesity as a "contagious disease" in order to perpetuate the ostracism of anyone who is overweight. Hopefully society is not that insane - yet, but this type of thing is a bit chilling to think about, to put it mildly.

Why Am I fat.... Everyone knows why - they THINK

A recent issue of the Discovery Health Newsletter, lists 7 reasons why we are not "losing weight" and it says the usual things ... not having breakfast, no exercise, drinking too much, eating at your desk, skipping all fats, eating late at night and cleaning your plate.

Somehow, in reading this type of stuff for the umpteenth time, it touched a raw nerve in me. I would like to observe that many of us very fat folks DO ALL the right things and STILL do not lose weight. And many slim folks do ALL of those (wrong) things above and don't gain weight or gain very little weight.

Many people actually believe that fatness is mostly caused by overeating and not exercising. Despite the fact that a huge percentage of the public regularly overeats and regularly does not exercise and STILL are not very fat - only 15 percent of the population is clinically obese.

I personally know two people in the 500 lbs range who REGULARLY exercise and have not lost much weight - one lady who was swimming a mile several times a week (and being a swimmer I KNOW how many laps that is ... a LOT) And I even know personally a few gastric bypass patients who have a very restricted diet and exercise daily and are still weighing over 300 lbs!

So why is society so clueless? I think because they are NOT genetically obese and don't understand what it's like. And perhaps because many fat people also believe the myth that they "made themselves" that way, not realizing that however they have overeaten, if they didn't have the right set of genes they would NOT be the size they are (and most of them perceive themselves overeating much more than they really do).

Call me a hopeless optimist but I believe that armed with knowledge, we people of size can change society through a grassroots education effort .... but first we must believe in ourselves!

"Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has"
Margaret Mead

Latest insanity against people of size

Seems the latest insanity from some insurance companies is to force people not at a certain weight or cholesterol level to pay an extra amount of bucks per month for insurance or to give them a ridiculously high deductible like $5000 a year.

...Starting in 2009, Clarian Health Partners will charge employees as much as $30 every two weeks unless they meet weight, cholesterol and blood-pressure guidelines that the company deems healthy.

Employers are getting serious about penalizing workers "because they've run out of other options" said Joe Marlowe, senior vice president at Aon Consulting, a national benefits consulting firm.

Locally, the Los Angeles Unified School District, which has 90,000 employees, is researching financial incentives and disincentives to help bring down healthcare costs.

UnitedHealthcare, a nationwide insurer, introduced a plan this month that, for a typical family, includes a $5,000 yearly deductible that can be reduced to $1,000 if an employee isn't obese and doesn't smoke.

Last summer, a similar plan was offered to county workers in Benton County, Ark. The $2,500-a-year deductible can be reduced to $500 if a worker meets low height-to-weight ratios during yearly on-site physicals. (According to federal guidelines, a man who is 6 feet tall is considered obese if he weighs 221 pounds or more. A 5-foot-6 woman is obese if she weighs more than 185 pounds.)

Thomas Dunlap, the county's benefits administrator, said the plan had witnessed a nearly 30% drop in claims — and provoked changes in the workplace.LA Times story

Well, of course they received a reduction in claims... if there is such a high deductible... hello?

I wrote to the reporter of this LA Times story pointing out the following:

It's a well known fact that:

1. heart attacks happen in people with all cholesterol levels- high and low
2. statin drugs to lower cholesterol levels have umpteen side effects
   1. significantly raise the cancer risk ..see
      1. http://www.freewebs.com/stopped_our_statins
         
      2. http://www.cancer.gov (talks about risks of lowering coQ10 levels
   2. cause muscle problems and now are suspected to raise the risk of type II diabetes
3. obesity by itself isn't a risk - it's the LIFESTYLE which causes the risks i.e. fat and slim couch potatos have a 40 percent greater risk of heart attack than slim and fat exercisers (Cooper Institute studies of 29,000 people for one)
4. Forcing people to diet is not only fruitless since 95 percent regain the weight within 4 years of losing it but also:
1. Weight cycling or yo yo-ing weight increases the heart attack risk by 50 percent
2. Dieting itself, not only increases heart disease risk but other risks as well even if the so called "risk numbers" improve
   

I have a better idea to cut costs! If the insurance companies discontinued financing all the unnecessary surgeries being done which are both expensive and in some cases (like gastric bypass) extremely risky and riddled with complications which are expensive to treat, they could not only significantly lower their costs but also improve health - if that was what they were interested in.But I think rather they are in bed with the docs and hospitals to make money and making the public pay MORE for it and could care less about public health.

I was contacted today, by a 31 year old who just had a gastric bypass. When she saw the list of possible complications which her doctor gave her AFTER surgery, she freaked out. "I have 3 children and don't want to be sick" she said to me, weeping over the phone and added "how can they call this surgery 'lifesaving'?"

It should be noted that the so called "risk numbers" which these insurance companies are demanding to be low or else they are overcharging clients - these risk numbers are also low in terminal cancer patients and AIDS patients but can we really say they are less at risk for comorbitities?

This new insurance scheme seems just another way of raising the rates of the average person to increase the revenue for the medical and pharaceutical industry.

Hanging out with fat people can make YOU fat - 2

I know I already did a blog on this study but since it is an ongoing news item, I feel compelled to talk more about it, what the scientists might have meant to do (which was totally misunderstood partially because of an error on the part of the scientists) and more.

This study published in the New England Journal of medicine, which found that having fat friends raised the probability of YOU gaining weight, was likely, originated to point out that if you 'hang out' with friends who like to go out and eat huge gourmet meals, you are more likely to gain weight than if you have friends who are on a diet and eat at "soup or salad". And indeed, the Washington Post's "Lean Plate" club addressed the study from that angle.

However, the way that the study was done rendered the findings, invalid. The researchers used methods not appropriate for that type of study, and data which was generalized existent data and therefore lacking many details which might have changed the outcome (called a "data dredge" study). And the news media took the study in a more global sociological setting, instead of realizing what the actual bottom line of the study was probably meant to be i.e. that being around friends who indulge in a lot of rich eating OR drinking to excess OR using party drugs or gaming or hunting or playing music can be an influence on how much YOU indulge in these things. That's kind of a no brainer and one cannot help asking why they needed a study to prove that!

It also wrongly assumed that if you have friends who enjoy eating a lot of food, they will likely be fat. In truth, as an overwhelming body of scientific research has suggested, fatness may be as genetic or close to it, as the color of your hair.

For example, if you have ever seen those eating contests, most of the people IN THEM are slim and only one or two are very fat, thus suggesting that many people can eat large amounts of food without it affecting their girth.

Unfortunately, what this study published in the NEJ may do, is, effectually promote discrimination against people of size possibly because the researchers SPECIFIED fat people instead of more correctly specifying people who enjoy eating a lot of food which can include fat OR slim people. But then, using that generalized set of data, how would they discern how much the individuals of the cohort ate? It was a quick and sloppy solution to assume that it was the fat people who were the ones overeating - but a quick and sloppy solution tends to result in a quick and sloppy study with invalid conclusions. That's a no brainer also.

It should be noted that in the (unpublished as yet) Williams studies which polled catering companies, used to cater the conventions for fat activist groups, the researcher, educator, Russell Williams, found that 50 percent of the caterers stated that the fat people at the convention ate the SAME amount as those of the general population at other conventions and 50 percent of the caterers stated that the fat people ATE LESS food than those of the general population! The study is still, as we speak, ongoing...

Noteworthy was an article which highlighted a group of studies overwhelmingly suggesting the genetic underpinnings to size and fatness:

>>The report released by the New England Journal
> of Medicine is flawed. These ...researchers took collected
> data from an existing study whose focus was not on weight and size,
> the same study just used to report that diet soda is just as bad for
> you as regular soda, did some data mining and presented selected
> results tailored to support their own prejudices. None of their
> statistics are standard. ...
> As an example of the misinformation, this report stated, "The fact
> that the increase in obesity during this period cannot be explained
> by genetics." More and more legitimate research is finding the
> genetic link to size. Let's look at an example. Studies by Dr.
> Albert Stunkard of the University of Pennsylvania showed that:
>
> * 70 percent of the variation in peoples' weights may be
> accounted for by inheritance, meaning weight is more strongly
> inherited than nearly any other condition, including mental illness,
> breast cancer or heart disease.
>
> * There is a clear relation between the body-mass index of
> biologic parents and the weight class of adoptees, suggesting that
> genetic influences are important determinants of body fatness.
>
> * There is no relation between the body-mass index of adoptive
> parents and the weight class of adoptees, suggesting that childhood
> family environment has little or no effect on body size."
>
> * Identical twins have nearly identical body mass indexes,
> whether they have been reared apart or together.
>
> Bob Schwartz, author of Diets Don't Work found that by putting his
> thin clients on weight-loss diets, they gained weight. Maybe we
> should take a closer look at the influence of weight loss dieting.
> Quite possibly when thin friends go on diets with their fat friends
> to lend their support, they end up gaining weight. It has already
> been proven that pounds lost plus additional pounds are regained
> after one has stopped the severe restrictions of weight loss dieting
> in more than 95% of dieters

from a press release from www.NAAFA.org

I hope that people will not take this study seriously except for what likely was the original intention - choose your friends wisely - if you spend a lot of time with friends who are gambling, chances are that's what YOU will be doing with them which may or may not be how you REALLY want to be spending your time. In the same vein, if you have friends who love to do dinner and serve large amounts of gourmet food, you may be faced with either sitting there and watching them eat or over-indulging yourself. We have a slim friend who is a gourmet cook and always wanted to invite us for dinner. When we went I ate sparingly - he got insulted and never invited us again. Oh well. :)

If you want to spend more time exploring this study further, here are some excellent resources:

http://suethsayings.blogspot.com/2007/07/fat-friends-make-you-fat.html

http://junkfoodscience.blogspot.com/2007/07/oh-what-tangled-web-we-weave-sir-walter.html

http://womeasure.wordpress.com/2007/07/27/your-friends-make-you-fatnot/