Thursday, March 27, 2008

Carnie Wilson - failed WLS? I don't think so...

I watched a video this morning, of an interview with Carnie where even with a body suit she admitted to wearing (full length girdle) she looks like she's regained quite a bit of weight. The video introduces her as a "failed gastric bypass". The interesting thing is it was put up by Provider who does - gastric bypass - (but a version of the older form) which like all the other WLS's LIKELY, has the same failure rate (about 34 percent of those with starting BMI of over 50, regain significant amounts of weight according to a 2006 study which followed patients for 10 years) cite: Annals of Surgery. 244(5):734-740, November 2006.Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD Abstract: Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.

However, we are not sure if Carnie would be counted as "failed" because she lost from 299 to 154 so that's a loss of 145 lbs. If she's regained 50 percent of that loss which is approx 73 lbs she would STILL be considered a success, weighing in at 227, which is probably pretty close to what she weighs.

Thus, she may NOT BE a failed gastric bypass. She may be, in fact, in the 70 percent who have and are expected to have, a rebound weight gain of up to 50 percent of what they originally lost.

So then, when in all the medical papers, they state that a 50 percent rebound gain after gastric bypass is EXPECTED and happens in MOST people, why do they call Carnie, failed?

First, most folks can keep off 50 percent of their excess weight WITHOUT surgery and WITHOUT taking the risks associated with gastric bypass especially if they work as hard as Carnie does.

And second, there seems a push among some providers to "discard" healthy gastric bypass patients who are in the 70 percent who have a rebound gain and sometimes in favor of ill patients who had "kept it all off".

For example, a few years back, the now defunct BARIX clinics ran an ad which talked glowingly about an individual's new life. The reality was, according to her own messages before she was picked for the ad, that she had reactive hypoglycemia and was more and more disabled by it and filing for disability. "I find it more and more difficult to talk up this surgery, " she commented in a message shortly before BARIX picked her as a poster kid. The ad suggesting she was slim and healthy appeared in several magazines like "Woman's Circle" and the like.

I also remember a lady who started out over 520 lbs, lost down to 170 and then regained up to 270 or so. She was STILL keeping off over 240 lbs which is way more than 50 percent of what she initially lost, making her a super success story, but she was dismissed from the provider's office in which she worked and told her weight gain was giving prospective patients the wrong message. Last I heard, she was seeking revision which is highly risky and not particularly effective.

Thus, bottom line, Carnie who is more like the AVERAGE gastric bypass patient, may be considered bad publicity for those selling this surgery as something after which, you "will be normal" and "will keep all your weight off" and will " suddenly look like a model with not much work" and will "suddenly be normal and be able to eat what you want without a regain".

A gastric bypass is, we are told done for HEALTH. Carnie was healthy before but she had some fat issues including sleep apnea, all of which, she has told us, have gone away. The only issue she has now is a hernia (she's had that for a while and apparently doesn't want to or hasn't gotten a chance to, get it fixed). She can keep off about 60 to 70 lbs which she never could do previously.

Carnie is NOT a failure, she is a SUCCESS and I feel that pressuring her like that could be endangering her life if she goes for revisions etc.

Gastric bypass is NOT cosmetic surgery. It will not make you thin if you are MOST people. It only makes 7 percent of patients slim and some of those have gotten very ill and cannot eat and others just work hard and never weighed that much to begin with.
It's really important when making this decision to realize that.

I am glad to see this video up on YOUTUBE - not because Carnie's surgery failed but because it can show patients a REALISTIC picture of what can be expected (in MOST patients) from a gastric bypass (of any variety).

Here's the video:

Monday, March 24, 2008

Big Medicine - Big Problems?

The TV show we all love to hate, "Big Medicine" which details two surgeons in Texas, father and son, who "practice Weight Loss surgery together" seems to have run into some problems.

First, in the last episode I watched, they heavily - shall we say - misrepresented a weight loss that is, how much weight was lost as a result of a gastric bypass.

I've seem them do this previously but perhaps not as much as an exaggeration as with this patient.

That is, when she came to see Dr Davis, she weighed in at 335. She told Dr D that her high weight had been 360 but she had apparently been losing some weight on her own. Dr D, as is his protocol with patients to be, put her on a liquid diet to lose some more weight. He states that this liquid diet usually takes care of any fatty liver present and makes the gastric bypass surgery less risky.

"What we are doing, " said "Big D" the dad surgeon candidly in one show, "is creating a situation of malnutrition in our patients!"

So on the day of surgery, after being very conpliant to her liquid diet, she had lost another 17 lbs and weighed in at 318.

They showed her a month later for her follow up visit and at that time, she weighed in at 290, a loss of 28 lbs, 4 weeks after her gastric bypass. While that isn't a bad weight loss, apparently those in charge of the show felt that was not the huge number on the scale which tends to sell the surgery better.

No problem - this is TV so they can change it. They flashed on the screen a before and after photo - The after photo was the usual type cover-up because with a 28 lb weight loss, she didn't look that different (especially considering that most of the weight lost after a gastric bypass because of the low amount of caloric intake, is muscle and bone mass - muscle is compact tissue which does not show much when it's lost). That is, more slimming clothing and a more flattering angle in her "after" photo.

But they openly misrepresented the numbers. They listed her beginning weight as 267 and her weight, 1 month after surgery as 290, with a total weight loss of 70 lbs which they claimed happened in 4 weeks after the gastric bypass. Yes, I stopped the DVR and made sure that was the claim.

This was going one step further than the usual - claiming the high weight and then the current weight and hinting the surgery had been totally responsible when in fact, it never was. I sat staring at the stopped video in amazement about how they could openly misrepresent things when folks' lives were at stake.

After every show, they give a promo of what's on the next show and the show after this one looked interesting. It promised to show us a 20 year gastric bypass patient who had regained all her weight. This is not surprising considering one of the few 10 year studies on gastric bypass done in 2006 suggested a 34 percent failure rate - weight wise with gastric bypass in patients who had BMI's over 50 - that describes most patients seeking gastric bypass! That failure rate is true even though the surgeons generously count a maintained loss of 50 percent of the initial loss as "success" (as small as 40 or 50 lbs kept off in many patients) and keep in mind most patients have the surgery to keep off 100 percent of their excess weight because they can keep off a percentage of excess weight by themselves without surgery! (cite: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD Abstract: Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.)

I thought that show was going to be interesting and looked forward to it. Revisions on Gastric bypasses are highly risky and quite ineffective i.e. either the patient loses only another 20 lbs or so or worse yet, the patient loses too much weight and may require take down.

But my wait was in vain. That show never was aired. In its place, a re-run was shown and the following week, "Big Medicine" had been replaced by another show.

"Big Medicine" has been pulled suddenly from the air with no explanation.

I wrote to TLC asking about it and got a polite form letter back explaining that they received so many letters they just can't answer each one but thanks for writing. TLC has left their area on "Big Medicine" up only when you click to "get the schedule" (when the shows are aired) you get a blank screen. No plans to air it in the near future, it suggests.

Several are asking on the TLC forums, places which are moderated and usually receive a quick response but in this case, no one is talking. No one has answered the questions about where the show disappeared to.

Finally in desperation, I called the Surgeon's offices in Houston. They were polite and friendly - and totally evasive. They didn't know why the show was pulled - "Just probably some scheduling changes" the nice young female voice suggested and they could not say when it would come back on the air. "Probably in a couple of weeks," the lady assured me but when I asked her for a date, she didn't have that. "They don't tell us when the shows will air," she said. I asked her whether there had been a problem with the revision patient in the show which never aired and she said "Oh no! Everything is fine!". I asked her about one of the larger patients who had had his gastric bypass a year ago and who was not walking at the 7 month point post op, opined Dr Garth Davis, because his breasts were weighing him down so they scheduled him for a mastectomy which was done in August 2007. To date, he has lost down to 300 some lbs. "is he walking yet?" I asked. She lowered her voice a bit and mumbled, "n-no." Obviously the reason he was bedfast was not his weight which begs the question whether they should have operated on him at all.

"Perhaps they are faced with a lawsuit," suggested my engineer husband whose cleverness I really enjoy. I had not even considered that possibility but now as I think of it, that's a rather good possibility. Gastric bypass surgeons often weather many lawsuits because the gastric bypass has a high failure rate and a high complication rate combined with less than inpressive results especially in the longer term (more than 3 years post op). One study of 10 year gastric bypass patients found that only 7 percent were able to keep off all the weight they lost. This isn't much better than diets and at least you can walk away from a diet. (cite: (Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study) Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew))

I googled "Big Medicine" this morning and found that on one site, people were asking some questions about it and the gastric bypass in general. One letter suggested that some of the plastic surgery patients looked less than great after surgery and that one lady might have had a reason for a lawsuit - her implants had ended up in the wrong place. This writer went on to say that one of the patients, a man, looked like death warmed over after his gastric bypass.

So people are asking questions about it.

It remains a mystery for now.

There are many mysteries connected with this surgery. Dr Paul Ernsberger, PhD and associate professor of nutrition at Case Western medical school, detailed one of those most baffling mysteries on the Donahue show a few years back. He stated:

Well, the gold standard in medicine is the controlled clinical trial. We don't go subjecting 100,000 people to a surgical procedure without doing a controlled clinical trial or dozens of clinical trials, and then looking at the results. Do you know how many clinical trials have been published on weight-loss surgery or gastric bypass? Zero. None of them have compared it to clinical conservative treatment and found it to be superior for life expectancy or for anything else other than, you know, risk factors.
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.

Perhaps what we think is a mystery about the gastric bypass or the sudden and unexplained disappearance of "Big Medicine" (in addition to a couple of the new shows never being aired) is really also, bad news.

Tuesday, March 18, 2008

The cost of obesity and other spin

It's good to know how to interpret spin - that's the newspaper word for what Orwell called "Newspeak".

For example, we are told that obesity contributes to 100,000 deaths each year. Now that sounds like a lot except it's only a drop in the bucket in the total yearly deaths.

In 2002, in the USA, the death toll was 2,400,300. Since obesity apparently contributed to 100,000 of these, that means obesity _did not_ contribute to 2,300,300 deaths. Expressed in percentages, that's 4 percent of the deaths per year, obesity had a part in! Which means obesity did not have a part in 96 percent of the deaths per year!

Looks a bit different if we look at the whole picture, doesn't it? Why do we even think obesity is any kind of "problem"? Maybe the real problem are those who wish to sell us obesity solutions?

Even if we take the older figure of obesity contributes to 300,000 deaths a year, that's still 2.1 million deaths that obesity doesn't contribute to, isn't it.

The latest spin we are hearing is how expensive obesity is and how if we just lose 10 lbs we will save the health care system, millions.

The only way obesity can get expensive is with weight loss surgery. The average weight loss surgery costs 15,000 and they can cost as much as $50,000 and guess who pays for it.

Especially considering that in folks with BMI's over 50 (which most people seeking weight loss surgeries are), there is a 34 percent failure rate according to several studies.

Here's the cite for one of these studies - this is not available on the web (we wouldn't want folks seeking weight loss surgery to see stuff like this, would we?)

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

Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.
As you can see, this was a study on gastric bypass which is supposed to be so powerful in keeping off weight!

Actually, the longer a person lives, the more expensive their health care costs so if people of size really don't live as long as slim folks, then they would cost less, says an AP story which circulated recently.

LONDON - Preventing obesity and smoking can save lives, but it doesn’t save money, researchers reported Monday.

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

“It was a small surprise,” said Pieter van Baal, an economist at the Netherlands’ National Institute for Public Health and the Environment, who led the study. “But it also makes sense. If you live longer, then you cost the health system more.”

Doing the math, thin people if they do live the longest, are going to cost us the most money!

Smoking contributes to 400,000 deaths a year... that's still over 2 million deaths than neither smoking nor obesity contribute to.

Back to the gastric bypass, it kills off 2 percent of those who have it, within 30 days of surgery so would that outweigh the outrageous cost per surgery, most of which is paid for by insurance and premiums are passed down to other insured? (cite: 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])

Wait, I'm getting more and more confused here. If living longer costs the system more money and obesity contributes to only 4 percent of the 2.4 millions deaths a year, why are people even worried about obesity?

It's the people who live the longest who are going to cost the health care system the most.

Bottom line. The news media is not gospel. Look at the big picture and spin quickly falls apart.

And for heavens sake, don't base a surgical decision on media spin!

Monday, March 03, 2008

If the RNY is so risky, why do they keep doing it?

I recently received a very thoughtful comment by someone researching WLS and decided that since many other folks may have similar questions, I would try to address the issues this individual raised.

First, Daisy asks:
If RNY is so harmful to the organism why do doctors still continue to indicate it?
The answer here is not a simple one so bear with me.

First, those who advocate the RNY are often those who are not involved in the long term follow up of their patients (most RNY follow up is done by Emergency Rooms, hospitalists and gastroenterologists). These individuals are impressed by the early results and may not be aware of the long term results (which admittedly are hard to ferrit out due to the lack of long term studies and the unavailability, for whatever reason, of many patients after 5 or 10 years). They also may feel that even though the vitamin deficiencies which cannot be supplemented, may shorten the lives of RNY patients, that untreated obesity, may shorten their lives even more.

Many surgeons answer the longevity question (i.e. how long you live after a gastric bypass) as Dr Wittgrove of the Alvarado Clinic did in the online interviews at the time of Carnie Wilson's gastric bypass:

Question: Dr. Wittgrove, I really need to know about how this surgery will effect me when I am old (70, 80 and 90's)

Dr. Alan Wittgrove: Hopefully you will live that long..... People who are morbidly obese don't have long life spans... Ideal body weight tables were based on actuarial data.... It is commonly known that people who are morbidly obese die earlier than those who are not morbidly obese.
One study by Dr David Flum which was delivered before a group of obesity surgeons but for some reason, never published in peer reviewed journals, which carefully examined 62,000 hospital records of RNY patients, did find an alarmingly high death rate in these patients. The researchers found that 1 in 50 RNY patients die within 30 days of surgery. And another 3-9 percent (depending on age and other factors) die within the first year. But when Flum and associates compared this to a group of 2000 obese patients who had been hospitalized for other reasons, they found a slightly higher death rate in the obese patients than in the RNY and concluded that, risky as the RNY was, the risk may be higher for untreated obesity.

The problem with that conclusion, as having been pointed out by several other researchers, was that comparing the RNY patients to any critically ill patients, even slim ones, would have yielded a similar result that is, it is predictable that among critically ill patients of any weight, the death rate will be higher than among healthy fat people who are in the hospital to have WLS. (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]

It is unknown whether obesity really shortens your life or not, although lifestyle factors i.e. amount of exercise, quality of diet, stress factors may have an effect on health and even how long you live regardless of what you weigh.

For as many epidemiological studies which are available which suggest that obesity does effect longevity, there are an equal number of epidemiological studies which suggest that obesity alone does not affect your lifespan.

And the few clinical studies we have available, suggest that lifestyle alone is what seems to affect lifespan and health regardless of what someone weighs and also that obesity alone doesn't seem to have that much effect, one way or another on lifespan or even health.

This story of what science really says about obesity is not seen in the media because, perhaps the media is more "marketing oriented".

The second reason why some surgeons continue to advocate the RNY may be because the public is demanding quick weight loss at any cost. It is true that some patients, even those who are very ill from the repercussions of the RNY, are still happy to not be fat anymore due to the societal pressures on the overweight population. It is also a fact that because of the massive healing internally after the digestive tract has been so drastically (and yes, permanently) rearranged, takes about a year and during that year, that, and also that patients find it somewhat uncomfortable to eat at all (food getting stuck, vomiting etc), often causes early post op RNY patients to lose their appetites - these end up eating very few calories a day i.e. 300-500 and some of what they eat is not absorbed. This is why some surgeons called the RNY "surgically induced anorexia" The idea of not having an appetite and the weight dropping off quickly and easily, is of course, highly attractive to folks who have struggled with diets for many years. However, those RNY patients in the 3rd and 4th year often end up on the same diets which didn't work before only the years of fasting and semi fasting have greatly lowered their metabolism.

Many people can read the informed consent information, can read the testimonies of patients who are extremely ill for life from WLS and still request WLS. I personally know of cases where family members have died and the sibs still go ahead with the surgery. This may be a simple case of human nature - what drives many who choose to use tobacco also - the idea that "if it's bad, it won't happen to me."

In this scenario, a better way to make a decision would be to consider all the possibilities and ask if this would be ok with you. That is 'reactive hypoglycemia' - would you be ok if that happened to you? etc.

People want to believe the dream that a surgery can change a fat person into a slim one. However, any surgeon will tell you that the RNY is for making very fat people, somewhat less fat because after the first or second year, most patients experience a rebound gain of 50 percent or more of what they originally lost. Keep in mind that the medical profession considers even a small weight loss as something which will lower health risks.

And the underlying reason why most folks do something about obesity remains "improving looks" although we cover our quest for looks with a thin veneer of "health".

Often the medical profession has advocated unhealthy practices, especially in a field where there is not much research. Classic was the cover of a Journal of the American Medical Association in the 1930's, which featured a photo of a group of doctors smoking cigarettes! Cigarette ads in the 1950's were still featuring medical advocacy of smoking like "more doctors recommend Camels than any other cigarette!"

Even today, many medical providers do not aggressively attack the smoking habit as they do, obesity, despite the fact that the proofs for the dangers of smoking are now, well documented and the proofs for obesity risks are not well documented at all.

Your second question:

have you ever assisted a patient who had complications due to the RNY surgery? And if yes, were these complications caused just because of the procedure itself or did the patients have some previous condition, such as diabetes or high blood pressure or high cholesterol level?
Yes, I have assisted many ill longer term patients and in most cases, their problems were strictly due to the repercussions of their weight loss surgery. Things like "Leaky gut" causing auto immune disorder, bowel obstructions and ulcers in the small bowel due from the leakage of stomach acid (the small bowel does not have a protective covering against acid from the stomach) and those vitamins like calcium which cannot be successfully supplemented resulting in maladies such as osteoporosis etc.

Problems like this are predictable because of the nature of the surgery and are not unknown in the medical profession because there is a long history with a similar surgery done to treat ulcers in the first segment of small bowel. This surgery upon which the RNY was based, is called the "Billroth II" and the mere mention of this procedure causes many medical providers to pale due to the various illnesses resulting from it, however, the surgery was considered preferable to the death which an ulcer in the small bowel would have caused.

It's a no brainer that when a major organ system is so greatly re-arranged as done in the RNY, that there will be serious repercussions from the surgery itself. Those who claim "no repercussions" are never the medical providers but rather those early term patients who are still somewhat concepting the surgery as a "magic bullet".

You further commented:

the floor for sick WLS patients... Why is it such a difficult floor? It takes me a lot to believe that it can be more difficult than a floor crowded with patients who have terminal diseases.
This is hard to understand from the outside but severely modifying such an important organ system so that it works differently can cause painful, terrible suffering. The best way you can get a feel for some of this, is to read the messages on the "gone wrong" group suggested by one of those who commented:


This group is rapidly approaching a membership of 2000, many of whom have had dreadful experiences with the RNY.

Another comment of yours:

your campaign against RNY made me think that it is a totally irreversible process and those who submit themselves to it are condemned to live ill for the rest of their life, when this is not true. Complications exist in all kinds of surgeries.
First, can you see where not all surgeries are the same? For instance, the death rate in gall bladder surgery is about 1 in 7000 people - the same as one finds with the lap band.

Secondly, the RNY is irreversible and if you carefully research you will find this to be true. The only procedure they can do with a "gastric bypass gone bad" (as medical providers call it) is to reconnect the small bowel and arrange the organs in a manner similar to the VBG or stomach stapling only. It's kind of a no brainer that you cannot remove 300 staples from a stomach which has been resectioned into 2 pieces.

Third, as for living ill for the rest of their lives, this also is true. Here is a quote from a WLS surgeon who is still doing the RNY:

"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)
Note his terminology... "medical disease" etc.

it takes me a lot to believe that a doctor would recommend it if he/she was aware that it wouldn't bring any benefits in the future.
You have to realize the manner of thinking in the medical profession and that is, for the moment, not necessarily for the future, for many reasons, one of which is that if a questionable procedure is done now, it is possible that problems occurring in the future will be able to be handled by newer treatments. (and it is true that treatments are being developed daily which are changing the face of medicine).

There is a whole body of research which suggests that people never have to lose weight for health and that any type of losing weight program, even one which seeks a healthy lifestyle, poses some pretty serious risks, especially if done again and again as is the case with 95 percent of the public.

The following blog presents a summary of that research and does provide the cites:

the case against dieting

I hope this has, in part, answered some of your questions and I do invite you to research those websites I have provided.

Further research can be done at: