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).


Regina said...

Wow. That's all I can say about that doctor who so gleefully glossed over the very real statistics that deem WLS risky for even the healthiest of patients. Nevermind the fact that there are very few long term studies that follow these patients and truly portray the 'quality' of their life as they age. He just seems to be in denial, and clinging to the ONLY thing that can cause rapid initial weight loss for most people. One word for him: DE-NIAL!

And that Kaiser Permanente disclaimer form? I applaud it for it's dose of reality, even though most patients don't seem to actually read the thing, let alone absorb the impact of their statements. I do find it contradictory that in the same excerpt you quoted, the following paragraph from the same section seems to contradict itself massively: "As doctors, we are nearly always told, “I am willing to take the risk of dying from this surgery because it is better than going on like this” and “I don’t want to be a model. I Just want my health back”. All but a very few of these people later cry about the fact that they did not lose all the weight they wanted to lose. They are unhappy even though their health is improved. Many of them come back and want other cosmetic tune-ups like liposuction, tummy tucks and skin removal from their arms. Kaiser Permanente does not have a cosmetic surgery benefit. Save some of the money you are not spending on food for these elective procedures."

Especially that last sentence! Even though the form states that slender people have health problems too, it ASSumes that fat people just spend oodles of money on food! AAAARGH!! The stereotyping is making my head spin! Nevermind the FACT that a person who has had this surgery will need to spend money on special foods, vitamins, health care and tests...which is most likely more costly than 'food'! It just reinforces to me once again, that science doesn't know how to make permanent and safe weight loss occur, and should focus their research more on ways of providing better treatment to people at their current size instead of shaming them and making life-threatening assumptions about their lifestyle.

wriggles said...

suggests that most patients after gastric bypass have an average BMI of 35

This might be funny if it wasn't so unnerving, I feel like he's soliciting for volunteers, he said he didn't know whether the-large pinch of salt- 'benefits' would spread to those weighing less than the current recommendations.

I find it astounding that someone can make such a revolutionary claim-that people are healthier the less their major organs function- and no one else in the field of science medicine or anatomy seems to have anything to say about it.

It's as if he's asserting some underlying belief that if men like himself had created the human body, they'd have done a better job.

Is there anything that can happen with regard to fat that causes the engagement of any other intellectual discipline, or are we all just a seperate species now?

Kate said...

I know several people who have had WLS and I don't think a single one of them knew the actual risks, they were far to focused on how they were going to look.

I'm glad there are some docs like Dr. Kaplan. A few years ago, my rheumatologist asked if I had looked into weight loss surgery when I was talking to him about my weight back in my obsessive dieting days (I brought up my weight, not him, he's never haranged me about my weight). When I told him about some of the actual risks, he was shocked.

Sue Joan said...

Unfortunately, many folks feel that doctors must know about the risks because they are physicians but truth be known, many non gastro docs do not know about the risks and actually are grateful when you inform them. I spent a couple of hours detailing all the risks to one GP who had never heard of this previously. Also if folks go to positive places, they may ask for risks but don't hear about them. There still is a silence among patients for fear people might be "talked out" of surgery and then, when patients get repercussions, they often are silenced on the so called "positive sites". Thanks for all your comments, they are appreciated!