Saturday, December 12, 2009

5 Medical Reasons to consider Weight Loss surgery

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

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

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

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

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

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

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

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

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

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

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

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

The next "reason" given is fertility:

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

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

Next we have this:

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

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

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

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

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

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

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

The final claim:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


MigiziNse-ikwe said...

"Finally, what is never mentioned is that going on "HAES" (Health at Every Size") also causes most diabetes to go into remisssion. HAES includes making wise food choices and limiting junk food etc and exercising 4-5 days a week (cardio)."

VERY interesting! I'm a person who is at risk for developing typeII diabetes later in life and would like to know where this bit of info comes from. I know that if I eat well and regularly that I can try and keep diabetes at bay, but I wasn't aware that if it actually develops I could put the condition in remission.

Ashley said...

On fatness, weightloss, and infertility:

While I am by no means a doctor or a scientist, there appears to be a perfectly plausible explanation for the link between fatness and infertility and subsequent regaining of fertility with weightloss. It's called PCOS. One of the big things PCOS does (besides make you infertile) is make you gain a ton of weight. Uncontrolled weight gain is sign that your PCOS is, well, not controlled. Many women, once they get on metformin or alter their diet, lose weight and regain fertility. Which tells me that gaining control of PCOS is associated with (not caused by) weight loss, and control of PCOS leads to improved fertility.

Of course, that means that standard line of treatment for PCOS patients is to bully them into losing weight. I have PCOS, gained 30 pounds in 2 years, and suffered through 2 years of infertility. Got on metformin, didn't lose a single pound, and quickly got pregnant with my now 6 month old. PCOS is not acting up, though I'm still fat.

Sue Joan said...

Actually came from personal experience but I had read it like in places like Susan Powter etc. It worked for my husband.... I had to change the blog because one of the scientists corrected me that they didn't have peer reviewed evidence on the statement... the revised blog is a bit clearer on it...


Mike Hunt said...

According to CBS News the death rate form Gastric bypass for all patients is 1 in 50.

Mike Hunt said...

We need to be honest here. Fat women should not get pregnant. I know you don't want to hear that but the rate of birth defects is simply too high.

As an FA I am attracted to fat women but I am going to marry and a thinling. I want my kids to be healthy.

Sue Joan said...

We really don't have any hard statistics about "birth defects" but I think you will get an argument about your premise that fat women bear children with birth defects. My mother was fat when she carried me and I was born just fine and with a good head on my shoulders to boot. I was fat when I carried our son and he was born an "apgar 10" baby i.e. perfect in all medical aspects (and he was just under 40 when he got his PhD and has fathered 4 beautiful, gifted children - both he and DIL are people of size).

Furthermore, many women keep thin though calorie restriction and most do so NOT be totally restricting themselves to healthy foods therefore fat people might well be better nourished than slim folks.

I respect your decision to marry whomever you want but restricting your life partner to a size may not only be a bad decision, it certainly is depersonalizing to the woman, reducing her to a mere object.