Wednesday, December 29, 2010

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

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!

Friday, December 03, 2010

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

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?

Friday, November 26, 2010

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

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.

Thursday, November 04, 2010

Weight Loss surgery safer than being fat?

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).

Tuesday, October 05, 2010

Biggest loser premier shows lowest rating ever

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...

Thursday, July 15, 2010

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

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

Saturday, July 10, 2010

New push for gastric bypass for diabetes

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

  1. 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

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

  3. 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.

Friday, June 25, 2010

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

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.

Tuesday, May 25, 2010

gastric sleeve story

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.


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)

Thursday, May 13, 2010

Overweight and Obese Kids eat Less than their slim peers

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?

Monday, April 26, 2010

Dieting 'Stints' Linked to Heart Problems

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 )

Monday, March 08, 2010

New study obese children more likely to die earlier

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.

Wednesday, February 17, 2010

Gastric bypass in teens - why not?

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"

Friday, January 15, 2010

I'm over the "Biggest Loser" Show

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.

Saturday, January 09, 2010

Shrek movies - do they really promote size awareness

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.