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:

ossg-gone_wrong

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:

obesitysurgery-info.com