Another study on gastric bypass

Every so often, a new study comes out, presumably "proving" how effective the gastric bypass is.  That's because this surgery is a huge cash cow for the medical field and less and less folks are having it - because of the post op, high complication and death rate (never mentioned in the studies of course). And because at the end of the day, it's not even very effective for weight loss.

This study which appeared in NEJM, was similar to the others.  Sounds very impressive - it was a 12 year observational study they tell us - as the surgery was shown as slightly effective for weight loss and very effective for diabetics.  Let's remember that patients are told if they don't diet and exercise, they won't lose any weight even after an invasive surgery like the gastric bypass but of course, diet and exercise work well without risking one's life to have a gastric bypass, thus the first thing they slip by us, is not distinguishing those who dieted and exercised (which would have caused a weight loss without surgery) from those who didn't.  

If we break down the study, you will see, it's not what it seems to be.  Here's a money quote:

In the study by Adams et al., despite a wide variation in change in body weight across the sample, 360 of 387 patients (93%) in the surgery group maintained at least a 10% weight loss from baseline to year 12, 271 (70%) maintained at least a 20% weight loss, and 155 (40%) maintained at least a 30% weight loss. Only 4 of 387 patients (1%) in the surgery group had regained all their postsurgical weight loss. 

First of all, a 10% weight loss on a 300 lb person is only 30 lbs. But secondly, of course, the high death rate for this surgery (5% in the first month after surgery) is not counted and also even a 30% weight loss is not very impressive. Also, the gastric bypass, more often than not, causes malnutrition which can cause weight loss. (The important parts of the digestive tract are severely undermined or bypassed)  To be fair, they should eliminate all members of the cohort who are suffering from hypoglycemia or malnutrition but of course, they never do that.  

For diabetes, it looks even more impressive:

In the surgery group followed by Adams et al., remission of type 2 diabetes was observed in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. Of the 62 patients in the surgery group who had initial remission at 2 years and had 12-year follow-up data, 69% remained free of type 2 diabetes at 12 years. Successful remission of type 2 diabetes was strongly predicted by baseline medication status.

But let's look at how they pick the cohort (study participants). Usually, they pick folks who are - what is called - pre diabetic. Which means they don't have diabetes yet, and if and when they come down with diabetes, it's several years before it gets really bad.  Additionally, malnutrition after the gastric bypass helps with this aspect too.  It's well known that starvation or semi starvation will cause diabetes, especially early diabetes, to go into remission.  Bottom line, starvation or semi starvation with a non mutilated digestive tract is safer than that caused by a mutilated digestive tract and causes a better weight loss than invasive outdated surgery.

The study was funded by the diabetes assn and it's a known fact that the funding does influence the results of the study. 

In other words, it's the same old trick - the hope that the public will believe this, rather than do research or question, and rush out to buy the surgery. Because the bottom line is, although they should not even DO this outdated, risky and not real effective surgery anymore, it's a big cash cow.  Buyer beware, especially in a "for profit" medical provider setup.

Lap Band must be removed within 5 years

New research found that the lap band, previously considered the safest weight loss surgery procedure, "must be removed within 5 years to avoid complications". (Obese Surg. Published online January 12, 2017)

The complications are not available in the abstract but from my research, I can detail some of them.  Most prominent, is the fact that the stomach is muscular organ and the muscular movement of the stomach tends to cause the band to damage the place at the top of the stomach if left in for longer than a couple of years.

One of the doctors who does the gastric bypass, published photos of the stomach, bleeding and raw from the rubbing of the band.  Of course, the gastric bypass does damage to the GI tract from the get-go.

What we should remember about all these procedures, is the concept of weight loss surgery is an old one, before we knew the appetite centers are in the brain, which is why even Dr Nowzaradan, the TV weight loss surgeon, admits that any surgery (unless you get sick from it) is ineffective on the long term.

The facts are what we'd rather not accept.  Counting calories or points on the long term is the only way to control weight and it must be done carefully as to not get malnutrition. And even more unacceptable in our fat phobic world is that a person can be overweight and healthy if they exercise regularly (cardio, stretching and strength training) and eat healthy (the low fat diet is still the healthiest).

That being said can obesity bite on the long term?  Sadly, it can. But due to things like clogged arteries (from eating high fat or fast food).  Another no win situation of a body made to survive in eras before the American lifestyle.

Weight Loss surgery and dieting

I have heard many folks sign up for weight loss surgery because they feel they will "never have to diet again".  The next step is they go to a "seminar" held by the surgeon they are thinking of hiring. But the seminars are really mostly selling sessions for the surgery (I can only think of one surgeon who actually gives very informed consent seminars, detailing risks as well as benefits - this does not cut the number of people who go to him - on the contrary, they appreciate the info!).

Today, I met a lady who had had a gastric bypass in Oct 2015 and had recently attended a weight loss group meeting. (and keep in mind, most surgeons are doing the less invasive sleeve now).  She had lost 80 lbs but lamented that no one had noticed her weight loss.  "But I lost it fast," she added.  That prompted me to ask her how and that's when she said she'd had a gastric bypass.  I explained that a fast weight loss like that was mostly muscle and that's why it didn't show a lot of reduction in size.  She looked sad and said that she knew that.  She was NOT told that surgery would not take off that much fat and she'd have to diet to do that - and she'd already been back to the hospital because she had developed ulcers after surgery and couldn't keep anything down so had needed more surgery.   I can't help wondering if, had this lady been informed of the risks, she might have gone a different route.

But the sad thing was she really didn't lose much fat with the surgery despite her inability to eat much and ended up joining the weight loss group, even - with having had the surgery.

I gave her my web site and also, some of the informed consent info she should have had before surgery.  "The advantage of a gastric bypass", I concluded, "is, it is reversible and you should probably consider having it reversed."  She told me her surgeon had told her only the sleeve was reversible (it's not reversible, because they cut off most of your stomach and throw it in the garbage i.e. "send it to pathology" as the surgeons call it). I said, "no, it's the opposite - the gastric bypass is reversible" and I told her how they reversed it., explaining that a reversal would still provide her with some restriction but give her normal digestion back.  Hopefully she will consider having it reversed.  I told her she might have to go to another surgeon to have this done.

Some surgeons send pre ops to my website to obtain informed consent information but obviously this lady's surgeon had neither given her informed consent info nor did he send her to my website.  Because the 80 lbs she lost was mostly muscle, she still was very overweight.

The bottom line with surgery is, it really, isn't that effective for weight loss.  This lady told me she thought it would kill her appetite but it hadn't done this and I explained that this is because they now know, the appetite control center is in the brain, not the stomach (as formerly thought in the 1960's when these surgeries were first conceived of).

As for the gastric bypass, it's very effective at greatly diminishing the ability to digest proteins and fats (and yes, we do need some fats) which is why most surgeons have switched to the sleeve which, albeit invasive, is much less invasive than the older surgeries.

Another interesting thing - when I told this lady who had had the gastric bypass that I knew several 300 lbs gastric bypass patients, she looked shocked - she didn't know that so many had regained the weight, although she was already having trouble with this.

All I can do here is *sigh*.  How I wish everyone would have the informed consent information that they need to really make the best decision for them.  Informed consent after the fact, can be bitter but this lady had several friends, also of size and I'm sure my information helped them in case they were considering surgery.... (the photo is of my friend who died in 2006 from the aftermath of the weight loss surgery she'd had in the 1990's. - she spent her last days, before her untimely death, warning folks to not have weight loss surgery.)

Weight loss balloon - a good or very bad idea?

The news today, announced a "new" device, for losing weight. Basically, the patient swallows a pill which is attached to a long tiny tube catheter device.  When it gets down to the stomach, the medical provider pumps distilled buffered water into the pill through the catheter, which causes it to swell, not leaving much room in the stomach for food.  This is supposed to make the patient feel full and want to eat less.  The water in the device supposedly, leaks out in about 4 months ("if all goes well") and then the deflated pill passes hopefully, through the digestive tract and out through the bowel. As the article stated:

"If all goes as planned, the resulting grapefruit-sized (19-ounce) ball of water fills the stomach and significantly curbs the amount of food someone can eat before feeling satiated."

     This was tested on 30 some patients, who lost an average of 22 lbs.  And has not been approved by the FDA as yet.
     They are advertising it as "non invasive" and non surgical.
     But (and there always is a "but" right?), from where I sit, I can see lots of problems with it - like for example, a non food item like that could cause an gastric obstruction or other problems,  and... what if it doesn't deflate, what if it doesn't "pass out" through bowel, like it's supposed to etc etc.
     And the idea that a full stomach makes us feel like eating less is thought to be somewhat erroneous as we now are pretty certain, the appetite originates in the brain and NOT the stomach.  And that means, even if you have this device in your stomach, you still can be very hungry (and very frustrated if you cannot eat much or the food you ate isn't going down right... another 'elephant in the room' not discussed in the promo).
     One of the patients on my discussion group, had a type of balloon device and he suffered so much with it that he considered the invasive gastric bypass as far more comfortable.
     This device costs anywhere from $6000 to $10,000 bucks and insurance will not cover it.
     As the old saying goes "buyer beware" (and DH added "If it doesn't work, you can't just bring it back to the store!")

New old program for WLS patients?

I went to a seminar on Weight Loss this morning - the weight loss surgery surgeon involved, meant well - he wanted to provide his patients with a program to do after surgery - the need of which was witnessed by the fact that most of the folks in the room, either gastric sleeve or lap band post ops,  were still quite overweight (although there were a couple of pre ops in the room also).  The surgeon also, has some problems with midline obesity and this, he says, is the latest thing that is working for him but he'd only lost 15 lbs and still had some 15-20 lbs to lose (which he has all in his waist).  He is a believer in low carbing but like many of my friends, that, alone, had not worked for him.  (Dr Atkins the founder of the low carb diet as we know it, explained in his last book that calories do count and you can gain just as much weight on too much of no carb foods as you can on carbs, a fact which has not been seen much in the media - if at all.  Also Dr Atkins had heart disease, which is again, a fact which has not often been seen in the mass media.).

The so called "protocol" seemed to me, a rehash of other low cal diets  - similar to the old "Dr Simeon program from the 1950's... in the first stage, you cut the calories down drastically (which of course, damages the metabolism) - they have some kind of protein drink you buy (and also you can intake your protein in other types of product which they also sell.  They have 3 stages of this program and in the maintenance stage you can again eat carbohydrates in small quantities. Although sugar is portrayed as the demon in this program - the latest thing in diet plans - apparently aspartame - nutrasweet which is somewhat toxic and far more unhealthy than sugar ever thought of being, is "ok".

The new twist is, this company seems to be targeting physicians (many of whom sadly, know little about weight loss science and regard obesity as a medical problem for which a solution - pills or surgery - can solve and be a cash cow at the same time).

I asked the guy hawking this product - what about maintenance... and he said he would talk about it later.  He dismissed it with "well, when you creep up in weight as 'we all do', you go back on the "protocol" for a week or two and take off (crash off?) the weight."  He gained some popularity in the room when he said that people don't have to exercise with this "protocol".  In fact, he went on to say that even if people were working out a lot, it was advised they did not work out while on the low calorie part of the protocol.

As we all know, yo yo syndrome is the best way to really mess up the metabolism and which causes most folks to be more overweight after repeated attempts at crashing off weight.  But they didn't talk about metabolism, of course.  Also if you weight cycle as small an amount as five or ten pounds several times, it not only raises the risk for heart disease but also causes the individual to end up with a higher percentage of body fat.

Here's how it works... when you lose weight on a very low cal diet, you only lose 30% bodyfat - the rest of what you lose is muscle and bone (tissue you do NOT want to lose).  However when you regain even as little as 5 or 10 lbs, it's all bodyfat (no muscle).  The salesperson telling us about this diet, said "everyone's weight creeps up!"

Bottom line is, this diet is quite pricey - according to the physician's website (which is more honest about the cost than the manufacturer's website)... Start up fees are $279 dollars and when you go off the "protocol" and regain and want to go back on "the protocol" for a couple of weeks, it costs $108 dollars a week.

Consider that this "protocol" is being sold to people who have already invested thousands of dollars in weight loss surgery.  Looking around the room at the people who attended this meeting most of whom had had weight loss surgery, and were still very overweight, it was clear that weight loss surgery often is ineffective for permanent weight loss.

A weight loss journey with a lap band can be difficult

Melonie on the Rikki Lake show

 Melonie had a lap band in 2012 (approx) and she lost over 100 lbs in about 6-9 months. She loved her band in 2013 when she posted this video, saying it had given her a lot of restriction and was a great tool.  Would she have it again though? - even at that time she said "Probably not". She described it as "high Maintenance" - she had very tight fills (up to 7 cc) although she said she liked how you could adjust it. She also said that when she had lost her weight, she could feel her port (where a lap bander gets their "fills" to tighten or loosen the band) and that was uncomfortable - apparently she had a revision surgery to move the port but it still bothered her, she said.  

Unable to afford plastic surgery for all the loose skin, Melonie opted out to go to South America - She appeared on the Rikki Lake show, saying this had been a major mistake - they did several procedures including abdominoplasty, lower body lift and lipo suction in one 8 hour session.  And sent her home to the US with several drains and a lot of pain.

In a later video, made approx January 2014, she described a rather horrendous experience with her lap band when it slipped, causing excruciating pain and finally getting to the point where it prevented her from even drinking water.  She finally, went to the ER and they removed the band, saying that her stomach had begun to erode and that she'd made it to removal just in time...  She admitted that during her weight loss process and maintenance, she vomited a lot which is a "no no" with any weight loss surgery and especially with the lap band - vomiting can do a lot of damage including rip out internal stitches or in the case of the lap band, cause slippage.  As my weight loss surgery surgeon friend says "Measure twice, eat once, vomit never!" 

She did keep most of her weight off without her band although having to have it removed caused her a lot of emotional pain and in an update video, showed a body shot where she looked really good.

What folks don't understand about any weight loss surgery, is that the patient does most of the work (90% of the work, says one weight loss surgery surgeon). And that even the safer procedures can bite in the long run. 

Gastric Sleeve revisited

The sleeve gastrectomy is the popular procedure these days.  Those promoting this surgery suggest it's safer than the gastric bypass because no bowel is bypassed.  But the problem with the procedure is that in order to promote weight loss, surgeons must cut away 90-95% of the stomach, leaving a remnant about twice as long as your thumb and the same size.

True to the "conspiracy of silence" about weight loss surgery, the dark side of this procedure has been mostly not told.

But as the procedure gets more popular, the dark side is emerging.

Some patients are beginning to tell their stories and there is a very dark side to this surgery - one patient mentioned that it's very difficult to get in even the minimum of 6 glasses of water daily and describes the shock of seeing brown urine (extremely dehydrated and hard on the kidneys). 

This makes sense because this procedure retains the lower stomach valve but the tiny thumb sized stomach doesn't really conduct the peristaltic wave very well so perhaps the valve which is dependent on the muscular movement of the stomach, doesn't really work very well (probably why they did not include it in the gastric bypass).  A swallow or two fills the tiny stomach and takes a while to empty - think of the difficulty of swallowing water slowly, a swallow or two at a time and it becomes a real chore just to get even a glass or two of water in, during the day.

Additionally, the tiny stomach likely does not do much digesting of either proteins or fats (we do need some fats) or calcium or B12.

Finally, patients describe a constant and very serious case of GERD or gastric reflux and well as problems with leaks and "fistulas".  The tiny size of the stomach would also tend to cause a detention of the esophagus, a problem seen in the gastric bypass also.

If the patients keep the weight off, it's by starvation and / or dehydration and/or illness - this is anything but healthy!

Patients should realize that doing something unhealthy is not worth getting the weight off - especially as there is no reversal possible of this procedure since the part of the stomach removed is discarded

.
The sleeve gastrectomy is a permanent change to the stomach in other words...

Bottom line, all that glitters is not only not gold but may not even be really glittering when you live with it... Caveat Emptor - or "let the buyer beware".

Gastric bypass on TLC TV show

My dearest friend in life, Trish, who died way too early, from complications of a WLS she had had several years previous.  I still miss her and this blog is dedicated to her.

 

The Long Island Medium is a show on TLC about a lady who supposedly talks to dead people. The following article is not arguing whether or not she really is contacting the dead but rather that this week's show was mostly dedicated to a mother of a gastric bypass patient who died after his surgery... Following are the highlights:

Theresa Caputo, who is the "Long Island Medium" was doing a group reading at a restaurant.

She hesitated for a moment and then asked one of her general questions which tend to encourage people to tell her about their deaths in the family etc.

Theresa said "I want to talk about the young man who passed in a tragedy."

A woman in the back of the room, raised her hand quickly.

Theresa, facing her, said, " Your son has been gone for some time..."

The woman whose name is Elaine, answered: "Eleven years."

Continuing, Elaine added: "LJ was my only child - I waited a lifetime for him - now that he's gone, a piece of me is gone."

Therese, pausing for a moment, said: "Your son says it was difficult for you, his mother, because it was a total freaky thing."  (in retrospect - this was something she probably said because the son had passed from complications of WLS - as sort of a disclaimer. Like all reality shows, I'm sure this show is somewhat scripted and it has been written that Theresa Caputo spends some time with each person to be "read" on the show, before taping the show.)

Elaine described her son as a football star in college, admitting she had saved his jerseys from his participation in the sport.

Elaine then continued with: "I never expected LJ to die...LJ was 6'1" and 443 lbs... he had gastric bypass surgery. Obviously there's a risk with any surgery
but LJ's surgery was supposed to be 'textbook' and after the surgery, he seemed to be ok but then a month later, he started having complications..."

The complications put him back in the hospital and soon he required the necessity of life support machines.  Elaine did not specify what the complications were but the attending physicians all stated they were a result of his gastric bypass surgery.

In July, a month after LJ's surgery, his mother had to make the difficult decision to turn off the life support machines and even now, 11 years later, she said, weeping,  that there isn't a day, every day, that she doesn't re-live that moment.

" I go through it every day... he passed away from complications - it was sepsis" Elaine said adding that
"I kissed his eyes, his hands and his feet.", after he had died.

When the doctor broke the bad news that their son was in cardiac arrest to Elaine and her husband, her husband had a heart attack on the spot.  Although he survived that heart attack, he died 18 months later.

Theresa described Elaine as having a shattered soul...and Elaine agreed with her.

Bottom line, no one really talks about the relatives, the family of gastric bypass patients who pass on, but from the few I've met, they seem broken up about it for years after the fact... perhaps because weight loss surgery is an elective surgery and often their adult progeny are healthy before surgery albeit overweight, (in this case, the son was a star athlete).  Watching a kid die has been said to be the worst thing a parent can witness.

This particular show can probably be seen on Netflix or even somewhere on the web - or wait for the re-runs.  (photo is the blog author in 2009 trying to ask a WLS provider at a Women's Expo about complications of WLS and getting nowhere!)

Permanent Weight loss only Possible with Surgery?

 

 

So say the providers in the latest article circulating the net...  that the ONLY way to keep off weight is to have one's stomach basically deleted!

 

Frankly, this article seems like it's another plug for surgery (picturing the usual midline shots of overweight people, of course) because they say permanent weight loss is just about impossible unless you get surgery preferably the surgery "du jour" now, the gastric sleeve which in most cases, calls for the removal of 95% of the stomach, leaving things wide open for not only nutritional deficiencies like B12 which is digested in the stomach but lack of necessary fats and more. (You can supplement protein if you drink protein drinks but things like calcium from supplements is not used well and can cause kidney stones - I found that out the hard way). Yes people can live without a stomach but how well they live, is questionable.

And the sleeve, unlike the gastric bypass, is in no way, reversible.  If people do some research on weight loss surgery, they might find that if it were so great, why do they have to keep coming up with "new procedures" (when the old procedures not only don't work for most people in the long run but also tend to cause rather gnarly health problems.)....

One individual who did stay slim and seemed the poster child for a drastric weight loss surgery which took out not only most of their stomach but most of their small bowel too, found out when they fell and broke several bones, that they had an extreme case of osteoporosis despite being careful about supplementing.

Watching a gastric sleeve surgery is interesting - the picture is worth 1000 words? As they staple away most of the stomach, leaving something about as big as your thumb (and about twice as long as your thumb), they take what looks like the stomach and toss it into a pan destined for "pathology" (i.e. the step before it becomes garbage).

And that's why if people have the gastric sleeve, even if they get very sick, there is no chance for reversal of this surgery.  As surgeon, Dr Terry Simpson puts it, "fat and healthy greatly beats slim and sick!"

Truth be known, even with basically no stomach, most people end up regaining weight and if you read the fine print on the surgical sites, the surgeons EXPECT people ... most people to regain at least 50% of what they lost... so... if you lose 100 lbs with the surgery, your surgeon will expect you to regain at least 50 lbs which still makes you significantly overweight even though you will be a success in the surgeon's book!

It has always amazed me how open surgeons are about these er...drawbacks to surgery.... how it's not going to work unless you diet and exercise (well that works without surgery too!).... how it causes repercussions....how 1% of patients die in the first month,  how if people eat too much, it comes up again (they joke about that).  And of course, there are lots of things one can eat too much of like milkshakes which go down well.

And yet people still keep opting for surgery - only to find out the sad truth later on - that with or without surgery, keeping weight off requires OUR OWN surgery to the brain - how well I know about that one.

"There is no easy road to a place worth going" (Beverly Sills)

Questionable studies on obesity and weight loss surgery abound

Yet another eye catching headline hit recently.  "Obesity primes the colon for cancer!", it triumphantly announced.

And what was this "landmark study" you might ask?  They fed mice lard and then tested, and only the ones which were fat, had the "markers" for cancer.  Huh?  Are people supposed to believe this would apply to humans? 

Although we might have our suspicions about some humans, I can safely say we are NOT mice and a mouse GI tract barely resembles a human GI tract, if at all, and also, the mice which got fat, didn't get cancer -they only "had the markers" for cancer which means they might or might not get cancer by the time their short lives are ended.

If that's not questionable enough, try the the following study - the headline on this was about how Weight Loss surgery "cures" diabetes.  This study was on humans however, among those who had had a gastric bypass (which forces starvation for the first couple of years - starvation will always bring blood sugar levels down), barely more than 1/3 of the patients saw a remission, even in the first three years after surgery.

I wouldn't call those results impressive, especially considering that gastric bypass is so invasive.  Among patients who had the sleeve gastrectomy, the popular "surgery du jour" which only reduces the stomach (to the size of a thumb and about twice as long as a thumb), only 25% experienced a remission of their diabetes in the first three years.  Keeping in mind that without a stomach, digestion of fats and proteins is basically, not happening and patients must for the rest of their lives, consume protein drinks which are expensive, not paid by insurance and not good tasting to avoid protein deficiency diseases which have not been seen since the 1800's... they should also take B12 shots at least once a week since a greatly reduced stomach likely no longer digests vitamin B12 which can cause many and varied problems.... this doesn't seem worth the expense and pain of surgery for the small number of remissions of diabetes early on.

In a buyer, seller's society, consumers must be careful of what they buy -to avoid the myths seen on TV etc - and sadly, for post ops who experience one of the many complications, there is little available to support them.

Definitely, "buyer beware!" or...
  If it's too good to be true, it probably isn't...

The Demise of a Great Blog

One of the most honest blogs on WLS (this patient sustained a seizure disorder after her gastric bypass and found 150 other patients who had suffered the same) is apparently closing shop. 

I know the blogger had gotten a lot of pressure from those who wish to cheer-lead the surgery because she had mentioned that several times but it mostly, seems that the more involved she became with providers, the less she seemed to want to blog candidly about what she experienced on the negative side of WLS.  Providers started asking her to speak at their booths, and paid for her trips to conventions... when that started happening, I wondered how long her candid blog would continue - it's difficult - next to impossible, to refuse those types of perks, especially for a young mother whose disability (epilepsy after WLS) kept her from working and that's exactly how those who have had a difficult time with the surgery tend to be silenced - that or settling lawsuits out of court in exchange for the patient's silence about the repercussions from their WLS surgeries. 

I've stuck in so long (since 1999) because I have not had WLS and thus there is nothing they can really offer me to shut up (although I know my name is not spoken with love in many WLS circles).  One patient, Trish Hargis (RIP) called it the "conspiracy of silence". Trish courageously got on "Obesity-help"  which is financed by the WLS industry, as well as wls_uncensored listserve, and talked plainly about what she had experienced but unfortunately, her WLS contributed to her early demise at the age of 54.  I see so many folks go into weight loss surgery without knowing that, at best, with a lot of work on a daily basis and blood work every 6 months etc, the WLS surgery can only offer them a 2% greater chance of keeping their weight off than going at it with a non surgical program like Weight Watchers (Mayo Clinic study early 2000's for one - Swedish Obesity study for another). 

Sorry to see that blog go - it was a good one....

Weight Loss surgery stories or -- ads?

The latest news on Weight Loss surgery reminds us that the media openly admits they don't feel obligated to tell the truth. And often when they report on weight loss surgery, they do sneaky ads.  Weight loss surgery of any kind doesn't really help patients to keep off the weight.  After they have invasive surgery to lose weight, they are told that if they don't diet and exercise, they will not keep off the weight.  But diet and exercise will keep off weight whether someone has had surgery or not.  Medical providers do not give the public "informed consent" for medical procedures.  "If we did tell the public about repercussions," a medical provider friend told me, "they wouldn't have any procedures done!"  As if this is a valid reason for not warning folks what might happen and especially after elective procedures like weight loss surgery.


 Lately in the media, we find a questionable study and a story which emphasizes how a couple keeps off weight - one of them who had a gastric bypass and the other who did it without surgery.

The study looked at se/x after weight loss surgery and declared that it's better after weight loss surgery.  Anyone who knows a significant number of weight loss surgery patients like I do, will ask, "how can this be when erectile dysfunction is very common and especially after gastric bypass?"  Easy answer - the researchers studied women - no men!  The women studied were a couple of years post op - and it was a study in which the cohort were surveyed 1 and 2 years after surgery and reported more reproductive hormones and better se/x!

First of all, the study was financed by Ethicon Endo which makes instruments for weight loss surgery - can we say "conflict of interests"?  Secondly no men were studied - had they looked at men, they would have found a different story, especially longer term like over 3 years.  The news story sounds like weight loss surgery is a great deal, but the truth is more sobering - since men were not studied, the fact that many men get ED after weight loss surgery stays unreported (unless you read the long term weight loss surgery communities).  It should be noted that many patients who regain after weight loss surgeries are encouraged to not attend support meetings and not tell those around them that they have had weight loss surgery. Meanwhile many surgeons parade the slim 2 year post ops at support meetings, giving the impression that "everyone" keeps the weight off.  One longer term post op who cannot eat more than 1200 calories a day without gaining, also came down with epilepsy after a gastric bypass and found 150 more patients with the same repercussion - this patient is considering having brain surgery rather than having the gastric bypass reversed, despite the fact that the seizures are likely from vitamin deficiencies which would be fixed with a reversal.

As for the weight loss story, in a story entitled "No Magic Bullet for keeping off the pounds", a couple, both of whom lost a lot of weight, are interviewed.  The man lost weight without surgery and the story emphasizes how he is having a hard time keeping off the weight.  The lady had a gastric bypass and we are told she's kept her weight at 160 lbs for 3 years.  In this story, if the reader looks at the photos, s/he will see that even with a slight weight gain, the man is not only slimmer than the lady but he is in better shape also.  But if the story is read superficially, the take-away message is that people have a much easier time keeping off the weight with weight loss surgery.  

In  other words,  the story hints that weight loss surgery is "the easy way out".  Any weight loss surgery patient will tell you it's definitely not the easy way out and many patients have regained at the 10 years post op point - even with extremely invasive surgeries like gastric bypasses.  This is a reality which may never get to the public if they confine their reading to news media. 

 I am reminded of the patient who called me up, crying, after her gastric bypass.  "They never told me about the side effects," she told me also adding that her surgeon no longer answered her calls.  And for patients who do keep off the weight, how many of them can no longer eat?

Should it really be "buyer beware" when we are talking about surgery after which 2 percent of patients die and 30 percent have serious repercussions including requiring additional surgery?

Gastric bypass - the holy grail of weight loss surgery?

The holy grail of weight loss, is hoping that somehow food will not appeal to us so we will lose weight.  A new study states that weight loss long term ( 10 years) is better after gastric bypass than after getting the lap band.  And why is this?  Because food is not as appealing to gastric bypass patients, the researchers found.

Well, true, a good percentage of gastric bypass patients get reactive hypoglycemia which means you feel really crummy after eating a plethora of foods, not just sweet stuff. (The patients refer to this type of becoming ill as "dumping")

The problem is, if you are getting sick after eating and you lose weight, that doesn't really count.  Because cancer patients and terminal AIDS patients also lose weight from being sick, but it's so not worth getting sick to lose weight.

What they are hoping you don't know about is for one, the Roslin study which found that 3 months after a gastric bypass, the appetite comes back worse than before surgery in many patients.

This clinical study of 63 gastric bypass patients (that means the researcher, a gastric bypass surgeon himself, actually examined the patients), also found that many of these patients had "glucose abnormalities" which would, in part, explain their voracious appetites.

Bottom line - to lose weight by getting sick after you eat?  Life is just too short for that one, you may well find.  5% of people on non surgical diet nutritional programs can keep off the weight.  7% of weight loss surgery patients (all surgeries, several studies) can keep off the weight.  But that extra 2% which isn't very much of a differential, is counting those with "glucose abnormalities" and other health problems after weight loss surgery.

Dr Terry Simpson tells us that success with Weight Loss surgery (any procedure) is 10% the surgery and 90% the patient.

So after taking rather serious and sometimes life threatening risks to have one's digestive tract rearranged, you can see that it is not very much more effective in keeping off weight than is a non surgical program.

Looking at things this way, the seeker should also be aware that merely embracing a healthy lifestyle of mostly wise food choices and cardio exercise 5 days a week will keep you healthy at any weight.(Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. American Journal of Clinical Nutrition. 1999 Mar;69(3):373-80)

Ask yourself, in view of the foregoing, is weight loss surgery really worth the risks?

We get angry letters sometimes....

We get angry letters sometimes ...

Wayne B, a gastric sleeve patient (and I would bet a "new op") writes the following:

Regarding the concern about nutrient absorption. You don't absorb nutrients in your stomach.. You absorb them in your small intestine and that is not touched by the surgery. Sue W rabbits on about here six years worth of success being enough o prove her point but demands ten years of success from a WLS recipient. Bit of a hypocritical double standard. on gastric sleeve story

Wayne, if you do not DIGEST food in your stomach then you cannot absorb it in your gut.  You digest proteins and fat in the stomach ... And vitamin B12. Before you get so self righteous, wait ten years... Wait until you get post gastrectomy syndrome... I've never met even ONE long term patient who was happy they had the surgery but because they get so much flack from the Weight loss surgery community, many are afraid to speak out...did you ever wonder why there is such a high rate of suicide among weight loss surgery patients or have you not read about that one yet?

Wayne further writes...

"SueW. You sound like a bit of a self righteous b*tch but hey thats your choice. I tried everything, and I mean everything so don't come back with some Whica health drink BS. Gastric sleeve saved my life so how about you crawl back into your health nut whole and leave people who are trying the best they can alone. on gastric sleeve story"

(Note I have left Wayne's original spelling! :) :) ) My word, Wayne, why so defensive that you feel the need to be ad hominem (that means insulting in case you wondered!).  I'm trying to get informed consent to folks like you because I have met countless patients who find about the repercussions of weight loss surgery, after the fact.  About 50% of those who know the risks, will go ahead and have surgery...the other half will skip it... (especially when they find out they need to diet and exercise to keep losing weight or at a lower weight!)  People deserve to know if there are any deal-breakers in the repercussions.  Many people who have surgery think they won't have to count calories etc to keep slim and nothing could be further from the truth.  The more invasive the procedure, the longer a patient might lose his/her appetite but when it does heal, the appetite comes back, with vengeance.

I've been in this for 14 years and from what I've seen, most of the folks who really hawked the surgery, as pre ops and new ops, when they start getting sick, (and often regain the weight), they get quiet and don't warn pre ops about what could happen after surgery.

Bottom line, no weight loss surgery saves your life...YOU save your life!  As Dr Terry Simpson says, "Success with weight loss surgery is 10% the surgery, and 90% the patient!"

And successful weight loss surgery patients do exactly what we non ops do. ...they journal or keep track of their food intake and exercise... Keeping weight off is work on a daily basis whether people have had surgery or not.  But in addition, weight loss surgery patients have to have frequent expensive blood work, drink protein shakes to avoid protein deficiency and take a lot of vitamins in addition to logging their food and exercising.

A sobering fact... A friend of mine who weighs in excess of 550 lbs says she's outlived 48 of her friends who had weight loss surgery.

According to the few studies which have looked at long term patients, only 2% more of wls patients keep off the weight they've lost.  That is 5% of people keep the weight off without surgery.  And 7% of weight loss surgery patients keep off all of their weight.

There is no such thing as "life saving weight loss surgery"... People save their lives, not any weight loss surgery.  Please don't fall for the used car hype!

Weight Loss surgery does not reduce health care costs in the long term.

A long term study on weight loss surgery (bariatric surgery or WLS)  found no reduction in health care costs on the long term.   The study was reported on, in a recent issue of JAMA Surgery (2013).  The researchers found higher health care costs in the long term with surgery than with treating obesity, medically.

This is nothing new, of course.

Wrote the researchers in JAMA (Journal of the American Medical Assn) in 2003 that Short term results of surgery are impressive... BUT

"...long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."
 
 This has not changed and yet they are still doing 200,000 of these surgeries a year on people who are desperate and frightened by scare tactics about obesity which are, in NO WAY, supported by studies.

On the contrary, studies have found no direct link between obesity along and morbidity!
 
And this was the shocking findings of Glenn Gaesser, a slim exercise physiologist who examined 20 years of "obesity studies" but his findings and the findings of many others, have been all but ignored by the mass media, anxious to sell diets and surgery for obesity using scare tactics.  Gaesser wrote his results in his book, BIG FAT LIES, a must read for everyone!

The findings of the 2013 study may be because WLS adds health care issues which may be as bad or worse than what it sometimes cures. Additionally, if the patients do not diet and exercise after surgery, they regain the weight in which case they now have the health issues associated with rearranging or interfering with major digestive organs in addition to obesity.

The Association of Bariatric Surgeons (WLS surgeons) had not much in the way of comment other than suggesting not all things may have been taken in consideration or - what I call um...questionable to be polite - that most of the procedures in the study were done open (with a large incision) rather than laparoscopically (using "keyhole" surgery).

What they hope we forget is that first of all, with keyhole surgery, surgeons cannot see as well as they can with open procedures because they are operating with a 2 dimensional view rather than a 3 dimensional view as in open surgery.  So on the gastric bypass - and those complex surgeries which rearrange digestive organs, open procedures are less troublesome in the long term - the only advantage of lap surgery is the immediate healing of the incision.  This would not have affected the long term results of any study or would have caused the long term results to show more favorably because most of the procedures were performed open.

And second, this type of result has been found in every long term study done on weight loss (bariatric) surgery.

Bottom line - surgery is not effective in maintaining weight loss in patients unless they diet (i.e. count their calories or restrict food in some other way) and exercise.  But those behaviors will take weight off without surgery and without all the complications and long term repercussions of surgery.  

Al Roker, a gastric bypass patient, told the "Today Show" that in order to keep off his weight, he not only journals his food and counts his calories every day but he also runs 5 miles several times a week!

With regards to the latest study, a weight loss surgery surgeon, Dr Livingston (who when, last I spoke with him, is proudly not a member of the ASBMS), commented:

"Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive. In this era of tight finances and inevitable rationing of healthcare resources, bariatric surgery should be viewed as an expensive resource that can help some patients."

"Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success." 

It's sad that they are only questioning these procedures on the basis of cost, money-wise because the cost to patients who suffer complications, lack of weight loss or worse, is so much greater.

The patient pictured above had an uncomplicated surgery and lost a lot of her weight but was regaining by the time the photo was taken in 2007.  She died of a heart attack in 2009.  The increasing number of early deaths on the long term from these procedures are never mentioned in the Medical Journals.  

One lady in her 50's who is very overweight, has stated that she has outlived 48 of her fat friends who had weight loss surgery!  Caveat Emptor - let the buyer beware - yes even in medicine.

what is and what isn't about weight loss surgery

In case you haven't heard of the Obesity Action Coalition, they are a group determined to rid the world of obesity by way of weight loss surgery. Recently they had a conference which was at least in part, underwritten by Ethicon Endo which manufactures lap (gastric) bands and also surgical instruments for doing gastric bypass. And by at least one of the conferences which is online, it appears they are definitely selling the surgery.

Which of course, is their right. But what I felt compelled to blog about is, while reading through the transcript on line in an easily readable form thanks to "Melting Mama", it struck me how one bariatric surgeon, Dr Stegemann of Texas, appeared to give some misleading answers.

Here are the ones which jumped out at me (there may be others):

Question: "I have high blood pressure and diabetes this runs in my family, can this surgery really help me..."

Dr Stegemann answered "Absolutely. Significant weight loss improves many of the medical problems that come along with carrying extra weight!"

There is some evidence that weight loss can help health but equal evidence that it's lifestyle which is the key and not what you weigh. However, what he didn't say is, there is no evidence that doing something unhealthy or risky to lose weight improves health. And plenty of evidence to the contrary. And the questioner asked about surgery specifically and not generally about weight loss.

When asked which surgical option is the safest, Dr Stegemann's answer was very evasive and very non informative.

He began by saying that all surgery has risks. (no brainer) And then, went on to say that the risks of "most" bariatric surgery operations is similar to gall bladder surgery. While that has been said to be true of the lap band, it is not true of any of the other surgeries. The risks of the gastric bypass surgery have been compared (by the Fresno Hospitals for one) to open heart surgery.

The commentator of the session saw that Dr S had not really answered the lady's question about which option is the safest so he asked the doctor to be more specific.

But the good doctor again appeared to evade (as he did later in the session when someone asked a similar question). He responded by saying: "The most common weight loss surgeries done in the US would be the adjustable gastric band, gastric bypass, and sleeve gastrectomy."

Notice he still never gave the risks of each procedure which was the original question. The moderator gave up and went on.

The next question was asking how it feels to have a lap band.

Dr S's answer is worth quoting:

"The band works by controlling hunger and controlling the amount of food you're able to eat. So, you'll be able to eat the same foods, but smaller amounts will make you feel satisfied."

There is no evidence that putting a band around the top of your stomach does anything to the appetite unless of course the idea of it growing into your stomach (which happens in a number of cases) scares you and you lose your appetite that way.

Also it doesn't control the amount of food either - it just makes it uncomfortable to eat healthy foods like meat, vegetables and fruit. Cake, milkshakes and cookies slip right down and you can eat any amount of these comfortably. (and many patients do).

And there is no evidence that with a band or even a gastric bypass, smaller amounts of food make you satisfied. With the gastric bypass, you spend a long time healing and during that time, just like when you recuperate from any major surgery, you might have less appetite especially as your digestive system has been very rearranged, but after that healing process which may take as long as a year or a few months, the appetite returns (in most patients unless they become seriously ill) with a vengeance. At least one clinical study found that in many gastric bypass patients, the blood sugar levels are "irratic" and many patients experienced "voracious" hunger a couple of months after surgery. (Roslin - who is a bariatric surgeon -Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.)

Dr S went on:

"If you overeat, then you generally feel pain in your chest, usually followed by vomiting."

It really depends on what food you overeat. Mostly, the pain after eating comes from a piece of food like meat, getting stuck and not going down right. The pain part is correct. I've seen it in band patients (also happens in gastric bypass patients). But patients aren't always able to vomit since the bottom of the stomach which pushes the food up is far away from the "stuck" food (and the muscular pylorus - lower stomach valve- which causes vomiting, is totally missing in gastric bypass patients). Usually band patients and gastric bypass patients endure a couple of hours of intense pain before the stuck piece either goes down or comes up. Occasionally a 'scope is required to fix things. Can be scary, can be nasty and is very likely to happen with a piece of badly chewed steak. You can fill up on cake and milkshakes and potatoes all day with no repercussions.

It is true however, if gastric bypass patients overfill the tiny stomach pouch, they will upchuck, often without notice. Again it's not really vomiting because there is no warning or sickness before. The food just comes up. Many learn the feeling and run to the bathroom. But most gastric bypass patients can tell tales about the "barf bags" they carry in the car or upchucking at a restaurant table.

Fooling with such a complex system as the digestive system has a very dark side.

The next question was about the gastric sleeve, a procedure in which 85-90% of the stomach is stapled off and removed from the body.

Dr S admitted there is no long term data about the safety or efficacy of this procedure but said since other stomach surgeries are safe and short term data on weight loss looks good, this surgery is likely safe and effective.

However, Dr Robert Davis of the "Big Medicine" TV show, admitted that the weight loss data with the sleeve had been poor and that's why they had to go to removing so much of the stomach. The recalcitrant stomachs tend to stretch out apparently.

So bottom line, there is no information available about whether this procedure is either safe or effective. There are many things digested in the stomach and from the information we have about the duodenal switch, Dr Hess, the inventor, stated that it was to significantly cut down stomach acid (and reflux) that they went to removing most of the stomach but without enough stomach acid, most of the stomach produced enzymes will not work either (see "digestion" in any Anatomy and Physiology book).

Then Dr S states that "After a gastric bypass, approximately 85% of patients are able to maintain at least 50% excess weight loss long term."

First keep in mind the average weight loss surgery patient is looking to lose 100 lbs so the doctor is saying here that most patients can keep off 50 lbs with a gastric bypass - but is 50 lbs worth the surgical changes to the digestive tract and lifetime vitamin deficiencies? Most folks can keep off 30 lbs with no surgery!

Second, many studies I've seen do not show this high a percentage of patients even keeping off 50% of the excess weight. Some of the studies by bariatric surgeons can be misleading because obviously those who regain (many patients!) do not report in and are listed as M.I.A. and not tallied in the statistics. More likely this statistic is 85% of those who reported back to the doctor can ...

Finally, there is the doctor's statement that: "Studies show that in 80-85% of people who undergo gastric bypass, their Type 2 diabetes resolved."

Studies on TWO YEAR POST OPS found this. However, the one longer term study (10 year post ops) found that only 35% of diabetics remained disease free (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).

There is a lot of good information about repercussions, side effects, post op care etc in this speech so it's worth reading - just watch out for the affore mentioned statements - as they are misleading.

Sick Gastric bypass patient - not so rare

Malissa Jones of the UK first made the news in 2008 when she became the youngest person to have a gastric bypass in her country. At the time, she weighed over 400 lbs and by her own admission, had a taste for candy and not the greatest food choices. (She told the news, she's consumed 10 chocolate bars in a day!). Typical teenager but with her genetics this type of teen eating did not work. So she had become very obese. Malissa complained about being teased and bullied in school but she apparently had some health problems also. She had trouble breathing and when she was 15, she went to the ER with chest pains which is why the NHS decided to do a gastric bypass on her when she was 17 years old. Typically they don't do bariatric surgery on anyone younger than 18 years old

Her surgery did not initially go easily for her. She was in intensive care for 36 hours but she did survive and began to enjoy her honeymoon year.

In February 2009, she was again interviewed. In a blog which reprinted a news article, now no longer available, it was reported that she had lost over 200 lbs and said that this surgery had saved her life. She weighed around 196 lbs and took a size 14, a great improvement over the size 28 she used to take. She talked about night clubbing and discovering a whole new world. "I've had a lot more boyfriends because I feel much more attractive and confident.", she told the news reporter. She mentioned that she was saving up to have the loose skin removed in a private surgery (it was not covered by the NHS).

But sadly, Camelot wasn't going to last for her.

By December 2009, apparently been unable to save up for the $40K surgery she required (Lower body lift, tummy tuck etc) to remove 28 lbs of loose skin which remained after her quick weight loss, she was not a very happy camper. Life continued on a downward trend, when she became pregnant at the age of 20 but they had to take the baby prematurely because they feared that carrying fullterm might be too risky for Malissa. Henry, a little boy did not survive.

Malissa recently made the news again. She now has been diagnosed anorexic - she weighs only 112 lbs (she's 5'8") and is unable to eat more than 300 calories a day. The news stated she was afraid to eat but she said in addition to being terrified of regaining, she suffers pain and sick stomachs when she tries to eat more food.

There are a number of gastric bypass patients I've met like this - who are unable to eat a couple of years after surgery. This inability to eat is sometimes combined with a phobia of food in general as is the case with Malissa.

One might ask why NHS doesn't give her a reversal and perhaps they have done that, but a reversal won't help the fear of food she has developed since her surgery. Again the NHS is worried for her life. She's much too young to die but this time around there is no surgery which can save her life except intensive psychotherapy.

This is not as unusual a case as providers would like us to think it is. I've actually, met quite a few patients who suffer from something similar to Malissa.

And in a 2001 news article, clinical psychologist and eating disorders expert, JoAnn Mann,RN, told the Fresno Bee,

***"I've seen massive infection, I've seen people hospitalized for malnutrition. I've seen people obsessed with food. I've seen people unable to stop vomiting. I've seen people develop massive eating disorders, I've seen people who are terrified of gaining weight. Terrified. It runs their lives." ***

Dr Jen Berman,a Los Angeles psychotherapist and an expert on eating disorders, has counseled many gastric bypass patients over the years. She told the news media that some patients have developed eating disorders and are afraid that if they eat too much, they will be sick.

***"I have seen people become terrified of food. They feel like their body is out of their control because they lose the weight so fast. I have seen people develop terrible phobias of gaining weight or losing weight." (IBID)***

SO Malissa Jones isn't alone in her food fears, but her road back to health will be a long lonely one, and much harder to trod than it would be had she remained overweight.

Definitely a case (one of many) when the cure is far worse than the original disorder.

bariatric surgery - neither safe nor effective?

In a metastudy in Canada, researchers found that in initial weight loss, the intestinal bypass was the most effective and running close second was the DS/BPD (also a long limb intestinal bypass but with a greatly reduced stomach) and the minigastric bypass which has a greatly reduced stomach and a bypass of about half the small bowel.

Even bariatric surgeons admit that long intestinal bypasses are associated with liver and kidney failure on the long term.

So what is this saying... if you have a procedure which destroys your ability to digest vitamins and cripples one of the most important organ systems in your body, you might lose a lot of weight in the first year? You can do that with cancer also - without surgery even. :(

The last sentence is interesting - the lap banding was the least effective in initial weight loss but, they admitted, delivered the least amount of adverse repercussions. That being said, many lap banders have to have the bands removed after a few years because eventually, the constant rubbing of the band on the soft tissue of the stomach can partially destroy the stomach.

In the one study which was drawn out to 10 years post op, the Swedish Obesity Study, they found that the average BMI for all surgeries, was 35, still very obese. (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) Which seems to suggest that the more risky surgeries are not any more effective in the long run than the gastric banding which is a lot less risky but none of them are really effective. ("Success with weight loss surgery is 10% the surgery and 90% the patient" Dr Terry Simpson, MD and bariatric surgeon)

Another study found that within 10 years, 34% of those who started with a BMI higher than 50, had regained all or most of the weight. (Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)

Bottom line, there is no shortcut and to keep the weight off everyone has to do the same thing - count calories, make mostly healthy food choices and exercise.

In the Hebrew University study they found that only 7% of gastric bypass patients could keep off all their excess weight (follow up was 6-9 years on 600 patients) and another video from a provider I recently watched, the bariatric surgeon stated that WLS of any kind does not take off all the excess weight and people should not expect to get "slim" from it.

About 5% of people who follow a program, non surgical can keep off all of their excess weight so with risky procedures which all damage the digestive tract, one only gets a 2% greater chance of keeping off all their excess weight unless they diet and exercise or unless the procedure makes a person unable to eat (cancer does that also).

I think maybe more folks should do the math. :(

Here's the abstract on that metastudy:

Obes Rev. 2011 Mar 28. doi: 10.1111/j.1467-789X.2011.00866.x. [Epub ahead of print] Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Padwal R, Klarenbach S, Wiebe N, Birch D, Karmali S, Manns B, Hazel M, Sharma AM, Tonelli M. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Department of Surgery, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, University of Calgary, Calgary, Alberta, Canada. The clinical efficacy and safety of bariatric surgery trials were systematically reviewed. MEDLINE, EMBASE, CENTRAL were searched to February 2009. A basic PubCrawler alert was run until March 2010. Trial registries, HTA websites and systematic reviews were searched. Manufacturers were contacted. Randomized trials comparing bariatric surgeries and/or standard care were selected. Evidence-based items potentially indicating risk of bias were assessed. Network meta-analysis was performed using Bayesian techniques. Of 1838 citations, 31 RCTs involving 2619 patients (mean age 30-48 y; mean BMI levels 42-58 kg/m(2) ) met eligibility criteria. As compared with standard care, differences in BMI levels from baseline at year 1 (15 trials; 1103 participants) were as follows: jejunoileal bypass [MD: -11.4 kg/m(2) ], mini-gastric bypass [-11.3 kg/m(2) ], biliopancreatic diversion [-11.2 kg/m(2) ], sleeve gastrectomy [-10.1 kg/m(2) ], Roux-en-Y gastric bypass [-9.0 kg/m(2) ], horizontal gastroplasty [-5.0 kg/m(2) ], vertical banded gastroplasty [-6.4 kg/m(2) ], and adjustable gastric banding [-2.4 kg/m(2) ]. Bariatric surgery appears efficacious compared to standard care in reducing BMI. Weight losses are greatest with diversionary procedures, intermediate with diversionary/restrictive procedures, and lowest with those that are purely restrictive. Compared with Roux-en-Y gastric bypass, adjustable gastric banding has lower weight loss efficacy, but also leads to fewer serious adverse effects.

PMID: 21438991  [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/21438991