Gastric balloon update and lawsuit

Did you have a gastric balloon weight loss procedure???

The Food and Drug Administration (FDA) issued a safety alert concerning gastric balloon systems after there were five "unanticipated deaths" from 2016 to the present that occurred in patients who had liquid-filled intragastric balloon systems inserted.

Gastric balloon procedures are considered "minimally invasive" FDA approved procedures that are used for treating obesity because the device is inserted through the mouth and requires no surgical incision.  But of course, it's still invasive. All the reported deaths occurred within a month of the procedure but apparently, many other people suffered serious complications from these devices.

Overview: Gastric Balloon Deaths Lead to FDA Warning

Gastric balloons, also called intragastric balloons or weight loss balloons, were approved by the FDA in 2015. There are currently two gastric balloons on the market: the Orbera Intragastric Balloon System by Apollo Endo Surgery, approved in August 2015 and the ReShape Integrated Dual Balloon System made by ReShape Medical, approved in July 2015.

Four of the reported deaths were of patients who had the Orbera weight loss balloon implanted and the fifth death was a patient who had the ReShape gastric balloon. All of the deaths took place within a month of when the gastric balloons were implanted. Three of the deaths took place within one to three days of implantation.

The FDA says that it does not yet know if the deaths were caused by the devices themselves or were caused by the insertion procedure when the intragastric balloons were implanted.

There were two additional deaths reported during the same time period that the federal agency says may also be linked to gastric balloon complications. One death was caused by a gastric perforation in a patient that had the Orbera Intragastric Balloon System, and the other death was caused by esophageal perforation in a patient who had the ReShape Integrated Dual Balloon System implanted.

How Gastric Balloons Work

Intragastric balloons are one of the many gastric procedures that exist to treat obesity. In some cases, patients with type-2 diabetes were able to reverse their disease after a gastric procedure, but only immediately after the procedures. Studies of patients several years after surgery found most diabetics were no longer, diabetes free. Many gastric procedures, such as a gastric bypass, are considered invasive surgical procedures and are not done as often as before because of the high complication and death rate in follow up studies.

Intragastric balloons are implanted without the need for a surgical incision therefore were sold as a "non surgical procedure". They were implanted via a scope down the esophagus through the mouth.  Once in the stomach, they are filled with fluid and are left in the stomach for 6 months.

The Orbera gastric balloon system uses one balloon. The ReShape system uses two.

Through this procedure, patients typically lose a third of their weight in 6 months.

Gastric Balloon Side Effects & Complications

Gastric balloon systems were advertised as having fewer risks than traditional bariatric surgery but this may be misleading as the balloons can cause several nasty complications and in fact, the FDA recently issued a warning because five deaths were connected to the gastric balloon.

The FDA first issued a safety report in February 2017 concerning gastric balloons after receiving "multiple reports" of two different serious complications linked to the weight loss procedure:

1. Spontaneous over-inflation: The federal agency said that several dozen patients have suffered from over-inflation problems, leading them to need to have the device to be removed prematurely. Symptoms of over-inflation include: abdominal pain, swelling/distention of the abdomen, breathing difficulty, and vomiting. In some cases, over-inflation has occurred nine days after the procedure. This complication occurred mostly in patients with the Orbera weight loss balloon system, but it has also occurred in patients with the ReShape system. At the time this alert was posted, the FDA said that over-inflation was not listed on the current warning label for the devices and that ER personnel and other healthcare professionals may not be aware of the problem.

2. Acute Pancreatitis: Both the Orbera and ReShape weight loss balloons have been linked to acute pancreatitis. The FDA says that this side effect has been caused by "the compression of gastrointestinal structures created by the implanted balloon(s)." In all of the patients who suffered from acute pancreatitis, the devices had to be removed prematurely, and in a handful of cases, the patients had to be hospitalized. This gastric balloon side effect occurred in some patients within days of having the device implanted. Symptoms include: severe abdominal and back pain. Acute pancreatitis is also not listed as a possible complication of gastric balloon devices, which means medical professionals may not be aware of it, leading to inappropriate or delayed treatment.

Gastric Balloon Class Action Lawsuit

If you or a loved one has suffered from complications following a gastric balloon procedure, you may be entitled to compensation. Learn more by filling out the form on this page or calling 1-(855)-JONES-LAW (1-855-566-3752) for a free case evaluation. 

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The Dark Side of the Gastric Sleeve

There are apparently several famous people who got gastric sleeve or sleeve gastrectomy. It looks good. It's not a gastric bypass, so other than undermining protein and fat digestion in the stomach (some surgeons remove 90% of the stomach and put delicately, "send it to pathology"... in other words, discard it), the duodenum which is one of the main digestive organs is left in tact and after all, sleeve gastrectomy is or seems a less risky surgery than gastric bypass et al.

But the gastric sleeve appears to have a darker side. The stomach which is now, about as big as your thumb and twice as long as your thumb, doesn't hold much of anything...for example, patients describe difficulty in drinking liquids and some have observed brown urine from dehydration etc.

Mama June Shannon, mother of the cute little girl who starred on "Here Comes Honey Boo Boo" TV Show, was quite overweight although likely not, the 450 lbs she claimed, had the gastric sleeve.

She said it was an, a lot more painful process than she expected as she also had a couple of skin removal surgeries but on tonight's show, "Mama June, From Not to Hot", she was able to strut her stuff at her ex hubby's "Sugar Bear's" wedding. June was never married to Sugar Bear as she was likely still married to the father of one of her other kids but they made a commitment ceremony last season on Honey Boo Boo's show.

On tonight's show, Mama June, apparently healed from her multiple surgeries, thin and blond, went to her ex's wedding and after, had a fun burning of her old large clothing.  Since June and her daughters have moved into a new rather nice home (TV pays well!), she and friends went out to the middle of the woods for the burning ceremony. However, when she went back home afterward, she suddenly, got very sick. They rushed her to the ER, complaining of severe abdominal pain.  She lived and they promise that next week's show, will feature the entire story of what happened to her. She was in enough pain that she couldn't stand up.

One thing I've seen happen with the sleeve, is a staple line leakage. A patient I know, had to go through multiple surgeries to fix that and included in the dark side of the sleeve, is the fact that unlike the gastric bypass, there is no way to reverse it.

Bottom line, none of these surgeries are really effective because we now know the appetite centers are in the brain...thus surgery or no surgery, we can only lose weight and keep it off by reconfiguring our thinking processes and living in a jungle of high fat, high calorie food, this is never an easy process.  Even Dr Now of the TV show, "My 600 lb Life", admits that surgery is only effective IF the patient diets and exercises...which is, of course, effective without surgery.

So why do they still do weight loss surgery? Because it's a cash cow. The average weight loss surgery surgeon makes $1.5 million bucks a year. People have done strange things for much less than that!

I felt bad for Mama June...she was a happy, reasonably healthy, overweight person and now, she has all sorts of issues with her mutilated digestive tract. 

It's a vicious circle. Providers generally don't follow post ops and complications from all surgeries, are handled by emergency medicine. Overweight people, desperate to lose weight, tend to not do the research they should do, relying on their providers to inform them but without following up on post ops, the providers may not know much more of the long term repercussions than do the patients.

Buyer, beware...be very careful in surgically removing or mutilating the stomach.  That our digestive systems work, wasn't the reason we gained weight and disabling it, is likely to cause more problems than we bargained for.

Misleading study finds that gastric bypass is a good idea?

Most people only read the first paragraph of a news article and the media takes advantage of that fact, assuming most folks will not read the rest of the article and only a very small percentage will research the article.  Therefore, the news media can inform the public of anything they want to sell, pretty much assuring that their disinformation will hit the target audience.

The first paragraph of a recent Reuters news service article reads: 

"Ten years after gastric-bypass weight-loss surgery, patients in a recent study had managed to keep off much of the weight they'd lost."

That sounds impressive but even reading the rest of the article raises rather large doubts - for example they were only able to contact a little more than half the original patients who got RNY between 1985 and 2004.  The cohort was 1087 patients and they were able to contact 651 of them.  That raises the big question of how hard did they try to contact the cohort - did they, for example, check and see which ones had died?  (Obituaries are public domain and easily searchable on the internet).

And despite the impressive sounding first paragraph, 10 years after an invasive surgery which is known to cause malnutrition etc, patients contacted had only kept off 25% of their excess weight.  That is, if the excess weight was 100 lbs, then at the 10 year point, they only were 25 lbs lighter than when they had the surgery - hardly worth an invasive surgery which has a higher mortality rate than open heart surgery.

Another questionable thing, is, this was a contact by phone - in other words, the patients they did contact, self reported the results and it's common knowledge that patients when self reporting, especially after elective surgical procedures, can be extremely inaccurate or leave out very pertinent facts - like for example, it appears non of the patients were asked if they had metabolic bone disease, a common repercussion of gastric bypass surgery.

At the time of their surgeries, 59% had high blood pressure... but 10 years later, that percentage had only gone down a few points i.e. 47% still had high blood pressure, a risk factor for many things including stroke.

It appears that many surgeons are, for some reason, not learning the newer procedures like gastric sleeve which are safer than gastric bypass.

And one might question whether surgery is any longer a viable option since newer research suggests that the appetite centers are in the brain and not in the GI tract.  It should be noted that Dr Nowzaradan of TLC TV fame, admitted in an honest moment, that 5 years after a gastric bypass the surgery is no longer effective as far as weight loss.

Sadly most folks who read the Reuters article will only read the first paragraph and thus be impressed, perhaps making a life changing decision which while a questionable treatment for obesity, might endanger their health for life.

Fit to Fat to Fit on TV?

There is a series on "A & E" TV called "Fit to Fat to Fit".  The show has two protagonists.  One of them is an overweight person (usually quite overweight like over 300 or 400 lbs) and a personal trainer.  The personal trainer is usually very slim and fit and decides to put on some weight so he or she can "understand" how it "feels to be fat" (as the show states).

One of the shows I saw, had a lady who really did usually, watch her weight and was able to gain 40 lbs rather easily. But two of the shows had a male personal trainer who obviously was naturally slim (while eating healthy but having "cheat food" every so often).  When the male personal trainers tried to gain weight, they had to work very hard at it, eating 5000 calories or more a day and even at that, they could not gain much more than 20 or 30 lbs and didn't look overweight at all.  They too, however, at that point, said they now could understand how it felt to be "fat".

What annoys me, especially about the latter two shows, is that everyone I've known who is able to gain large amounts of weight (including me!), has genetic and metabolic issues which TV shows like the A&E programs do not take into consideration at all. Science does acknowledge this. For example, obesity scientist, Dr Rudy Leibel states that 60% or more of our size is genetic and/or physical rather than what we eat.

TV star, Al Roker, who had a gastric bypass, has told his audience that he does count his calories and also does 45 minutes of running several times a week.  He's not the exception - he's the rule.  Surprisingly, a study which included members of NAAFA, a social club for people of size as well as average size people, found that NAAFA members actually consumed considerably less food at meetings and banquets than did those of average size.

But sadly, TV which is the informing source of most folks who do not have the time to read, is telling a fairy tale.  People on TV asked how they got so fat, invariably say they eat too much but their "too much" is often less than the amounts that average size folks eat - those who do not become overweight.

I get very weary of TV shows blaming overweight people for their size.  Surely true that an overweight person can keep to a so called average size but it takes lots of work, including saying "no" to any type of fast food, in addition to counting caloric intake (and I mean writing it down or keeping it in the computer - the latter is made more pleasant by great clients such as "My Fitness Pal" etc).

I feel shows like "Fit to Fat to Fit" do a great deal of damage to folks who do have genetic factors and physical factors contributing to their size.  I know about this on a personal basis.  I was very active as a child and kept slim...until I had a tonsillectomy and right after that, I started gaining quickly despite not changing my level of activity (in fact, after, I was more active after surgery, because I wasn't sick in bed all the time like I was before surgery).

Later on, much later on, like when I was in my 40's, still pondering why I gained weight after my tonsillectomy, I read that 50-60% of kids who had tonsillectomies in the 1950's and 1960's, sustained damage to the pituitary gland which of course, would adversely, affect the metabolism.

So, after blaming myself for so many years for my "weight problem", I realized I had a medical reason why I gain weight so easily and since then, I, ironically, have been able to compensate for my lower metabolism through mild calorie restriction and have managed to lose and keep off 106 lbs since 2010.

Shows like "Fit to Fat to Fit" should be balanced out by a more realistic portrayal of obesity, and the genetic and physical factors involved, instead of intimating that all fat people do nothing but sit on the couch "eating bon bons".  Society as a whole would be better off.  Because the truth makes everyone free.

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.

Big Push for Weight Loss surgery

Tom holds photo of his daughter who died shortly after her gastric bypass - parents of patients who die or become sick, suffer very much for years after

In case you haven't noticed, there has been a big push for Weight Loss surgery in the mass media.  A Fox News article announced that "diet and exercise may not be enough to lose weight" and goes on to state that the "only proven effective treatment for obesity in the long term, is surgery."  Proven?  Hardly.  While it's true that about 5% of dieters can keep off the weight, having surgery only increases that percentage by 2% i.e. 7% of bariatric patients can keep their weight off (Mayo Clinic study, Swedish Obesity study and several others).  Hardly worth reconfiguring the digestive tract in a very unnatural manner which will deny the person much of their digestive ability.

On TV, the old "Big Medicine" shows have been regurgitated under the title "My Weight is Killing Me".  This show, although more honest about how surgical patients have to diet and exercise after surgery (which works, by the way, without surgery), still portrays surgery as "the only way" for people who are clinically obese.

Another show, "My 600 lb life" produced by Dr Younan Nowzaradan, MD (a bariatric - weight loss surgery surgeon), portrays patients who are 600 - 700 lbs - all of them "need" surgery, of course, according to the show... and after they slim down with surgery to a "svelte" 400 or 500 lbs, their lives are supposedly saved.  The show seems to ignore that weights of 400 and 500 lbs are still considered clinically obese, only now after surgery, the patient is not digesting some 100 micro-nutrients (like zinc, etc) which we need on a daily basis to stay healthy.  Not withstanding the patient after a gastric bypass is also not digesting well, macronutrients like proteins and fats.

Interestingly enough, a recent show about a lady named Susan, followed her as she lost 150 lbs before surgery and then, after surgery (gastric bypass), very little more weight and very slowly.  One wonders why they didn't just tell her to go home and continue what she was doing instead of mutilating her stomach and bowel... Well, I guess that's a no brainer - the surgeon takes home $5000 bucks (at least) with every surgery.... so if s/he does five surgeries a week - that's one a day with 2 rest days, his/her weekly pay is $250,000.00!  People have done odd things for far less money than this.

Several studies including some 30 year studies on 30,000 people by the Cooper Institute, have found that it's not weight that endangers health but rather lifestyle and that anyone with a healthy lifestyle (i.e. making healthy food choices most of the time and exercising at least 5 days a week for 20 minutes or more) can live a long life even if their weight is in the obese or clinically obese range.

That being said, Dr Rudy Leibel pointed out that obesity is mostly genetic (60% genetic).  Also being from a family where several relatives were or are overweight, I can attest to the fact that most lived long healthy lives - without having their digestive tract surgically altered.

One of my husband's cousins is celebrating her 80th birthday - she has been clinically overweight all of her adult life and totally healthy (well, in her late 70's, she had a hip replacement surgery).

There are some advantages to calorie restriction - for me, my severe GERD goes into remission as long as I mildly calorie restrict but to say "everyone" needs a digestive tract which no longer works well, is not logical...  We did not get overweight because our GI tract worked and so rendering it somewhat non- functional will only add to the original problem... another no brainer.

If you are considering Weight Loss surgery, please visit this website....  (http://obesitysurgery-info.com)  It gives informed consent information about weight loss surgery - you will find it quite different from what you see on TV but then, remember, TV is for entertainment, not for good education!

Life saving weight loss surgery claims another

Since it's January, there is a big push by those selling weight loss and also for weight loss surgery.  TV is showing a lot of programs on weight loss, and weight loss surgery.

When they advertise weight loss surgery by giving case histories, there is a small (well, maybe not so small) problem.  Many patients die from the surgery which is supposed to induce an artificial case of anorexia so the patient either cannot eat much or as in the more invasive procedures like gastric bypass, cannot eat much and doesn't digest much of what they do eat.

One patient who had been followed since being featured on the first show in 2010, was a Haitian lady named Dominique Lanoise.  Lanoise weighed in the 600 lbs range and was bed bound.  From what is known about her, she was slim when younger and ended up having 6 children - she apparently gained after pregnancy.

She was a charming lady, who though bedbound, would sway to the music in her bed.  The documentary showed her eating large amounts of food, rejecting the diet food (they put her on a 700 calorie diet in order to reduce her for surgery) and kidding with her daughters who adored their mother.

Dominique was convinced that a gastric bypass would save her life and be a quick fix for her obesity problems which she felt was out of her control, so she searched until she found a surgeon willing to operate on her, at her current weight.

She lost weight after surgery and was transferred to a rehab facility but two weeks later, she checked herself out and returned home.  A couple of months later, she died, apparently from a heart attack which WLS afficionados assured us was "unrelated" to the surgery.

However, the nutrient shortage from the gastric bypass can raise the risk for heart attack significantly, because the heart is starved from essential nutrients, including protein.  That seems the "elephant in the room" when one researches Dominque's story - certainly those providing weight loss surgery do not want to admit that this "life saving surgery" actually hastened her to an early death.   

Another TLC patient, Donald, also had weight loss surgery.  He was also around 600 or 700 lbs.  Donald did try to move after surgery and do what the doctors told him to do.  Patients are told that unless they make lifestyle changes (like dieting, counting calories and exercise), the surgery will not work for them. Ironically, those same changes will work for weight loss without invasive surgery.

But then, suddenly and mysteriously, Donald went into a coma and emerged with Guillan Barre or "French Polio" - which put him into a wheelchair.  Disease after gastric bypass is common but again providers tell us it's unrelated to denying the body of proteins, fats and vitamins.  Last seen, Donald was getting around in a wheelchair and rapidly regaining weight although trying to exercise it off - another myth one sees on TV - exercise doesn't take much weight off us - how well I know about that one. It does make us healthier but it's not really good for weight loss.

That some are still selling a surgery which hasn't been done for years on non obese patients, a surgery which the inventor thereof dropped in 1980 because of the high complication rate, truly amazes me.

There seems a conspiracy of silence among patients as well as providers.  Patients who regain and live, are reluctant to tell about their surgeries  because both the public and their doctors blame them for their gain.  Patients who have become ill from the surgery and live long enough to be reversed and get back normal digestion, are often reluctant to talk about their bad experiences because new ops and providers can get mean to those who talk too negatively about weight loss surgery.

Patients are so sold on this surgery that until they get really ill, they refuse to admit that it has a high complication rate and a higher recidivism rate.  When I began to research it in 1999, I was shocked that many studies were on line and told the truth openly, but patients were not reading the studies and only listening to new ops who were excited and seemingly successful.  Even successful patients who have suffered difficult complications and talk about them in blogs, have taken a lot of criticism from "the community".

So people continue to jump on the table for a surgery which sounds like the ultimate cure because many do not encounter the "other side", i.e. the dark side especially if they do not have internet access or know where to look.

Informed consent information on all surgeries can be found at:
http://obesitysurgery-info.com   

In conclusion, a friend of mine who weighs over 500 lbs but has refused weight loss surgery, says she's outlived 48 of her friends who had weight loss surgery.      

Carnie Wilson - 2nd weight loss surgery

Carnie Wilson, singer and daughter of Beach Boy, Brian Wilson (pictured in red dress in photo with her singing group);  got a RNY gastric bypass, 12 years ago. She lost 150 lbs initially, and told the press, "It was so easy -- it was like I blinked my eyes and the scale went WHUUP!". 

A frenzy of people signed up for gastric bypass surgeries. One person who worked for a weight loss surgery surgeon, told the news that every time Carnie Wilson appeared on TV, their phones rang off the hook!  The surgical group who did Carnie's surgery, dramatically simulcasting on the internet during her surgery and launching a huge publicity campaign in partnership with the manufacturer of surgical instruments, went from doing 5-7 weight loss surgery procedures a week to doing 12 weight loss surgery procedures a week.  The future looked rosy, for Carnie and the Weight Loss surgery industry.

But dark clouds were gathering on the horizon.

Soon after Carnie Wilson's famous quote to the press above, she began regaining the weight, despite fighting hard to keep her weight off, including, hours of exercise, engaging personal trainers, putting salt on desserts so she wouldn't be tempted and publicly humiliating herself, talking about her weight problem. By 2011 when she appeared on the Dr Oz show, she'd regained to her average weight before surgery, about 240 which is a lot for her since she's only 5'1".

Apparently, she lately, had a gastric band placed over her bypass to force a restriction of her food intake, and has lost 30 lbs so far.

The bottom line is the gastric bypass or any weight loss surgery, is no free ride.  Just like using a non surgical tool like weight watchers, it's a lot of work on a daily basis for the rest of your life or you will regain the weight and/or get sick!  A percentage of gastric bypass patients get sick anyway, even if they do everything right.

Carnie Wilson, like so many others, was given the impression surgery worked automatically and easily.



That so many people embark on weight loss surgery seemingly ill prepared for the reality, can be at least, partially blamed on allowing the mass advertising of surgery without requiring the advertiser to list side effects and disclaimers like "results not typical".  Some weight loss surgery surgeons have an annual income of $1.5 million dollars - people have done strange things for much less money than that.

Let's hope the second weight loss surgery procedure will bring her what she's looking for.  She's such a beautiful woman and a great singer and somehow all of that tends to get lost in her frantic efforts to get slimmer. To me, that is sad.

Click on this blog link to see photos and story.

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.

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.

the Survival of the Half Ton teen ... or his demise?

In our Weight Loss surgery (WLS) informed consent online community (and support for ill long term WLS patients) we lost another former member. She died suddenly - probably sudden heart attack which seems to haunt those who keep their weight off with their bypasses, more than the many who re-gain the weight. She was an extremely talented woman and much beloved by her family including husband, children and grandkids. She was in her early 50's. In my opinion, she died way too early..

Which brings to light the fact, that if people survive their first year after a gastric bypass (4-9 percent do not survive the first year post op according to studies which looked at actual patient records), this does not mean they are "out of danger". I've seen plenty of patients die after a few years. It's often a sudden heart attack and never gets connected with the bypass but one wonders...

Yesterday I watched a very disturbing show about two young men, one who is 19 and the other who was 16, both very obese (over 800 lbs) who got weight loss surgery. The title of the show was "SURVIVAL OF THE HALF TON TEEN".

The 16 year old fared better at least a few months after surgery but the disturbing patient was a 19 year old named Billy Robbins, the only son of parents who had lost their first son after 19 months of life. I'm sure he was or is addicted to food and perhaps mother was something of an enabler however, there is also, a huge genetic factor going on with someone who gets that large and until someone has walked a mile in the mother's shoes, I don't think anyone should judge her.

This surgeon they had, did two major surgeries on this kid in 4 months - the first was cutting about 90 lbs of fat off of him which is very risky and generally not done in the medical community because of the risks involved.

And the second was a sleeve gastrectomy (a surgery in which most of the stomach is cut and removed out of the body - it's not reversible). The surgeon who cut him, told the camera that he was planning "the rest of the gastric bypass" when he's lost another 100 lbs or so. But the fact remains, he's not talking about a gastric bypass because that just bypasses the stomach and does not remove it from the body.

After 2 major, risky surgeries in 4 months, this 19 year old was expected to get up and walk for an hour every day (he still weighed over 500 lbs at the end of the show) and when he was reluctant, the psychologist (apparently the one working for the surgeon) tore into the mother on camera, blaming her for all her son's problems.

Everyone ignored that even a normal sized person after two major surgeries is not up dancing the jig!

Talk about abusive? In my opinion, this surgical group was not only abusive of that poor young man for doing so much risky surgery on him but also of the parents who paid him in good faith.

The surgeon talked about getting that young man down to 200 lbs which is too low for him because he looks like he's around 6'2".

Sadly, the way he looked and considering that the fat removing surgery left him with an incision across his entire abdomen and that he no longer has much of a stomach, I frankly do not expect him to survive. (he vomits frequently... the psychologist also blames that on him being "unwilling to get better" and of course, on his mother) His drastic gastrectomy which removed most of his stomach has repercussions in so much that he doesn't digest food well and also doesn't probably digest some vitamins like B12 - contrary to popular belief the stomach is a critical digestive organ and not just a storage place. As Dr Paul Ernsberger (who teaches nutrition in Case Western Medical School) has written:

"All of the operations, old and new, are based on an incorrect assumption: that the stomach is no more than a passive sac for receiving food. In fact, it is a critical digestive organ and cannot be cut away or bypassed without compromising the digestive process."

The "half ton teen" would have, likely, survived longer without surgery. And of course, when he dies, his death will be blamed on "obesity" and not the so called "life giving" surgery that his parents bought in good faith. And they will probably re-run the show again and again with only a short note at the end (maybe) "in memory of Billy Robbins" which many viewers won't notice.

As for Billy's Mom after dealing with her son's early demise, she will have to watch the psychologist condemning her for just loving her son and trying to do the best for him.

A sad note upon which to end this year.

Addenda: a search for an update on him, pulled up one item - this stated that latest news (about 11 months ago) was that he was getting ready to move to a rehab center and that he had had the "second part of the gastric bypass" (probably some kind of intestinal bypass i.e. the third major surgery) and that he now weighed 420 lbs. This article also blamed Billy's situation on his mother, echoing the judgmental psychologist. Doesn't anyone think for themselves these days?

Gastric bypass stops appetite? Not according to this study

Remember all the articles about how since gastric bypass patients have less ghrelin in their blood, their appetites are curved?

What they all DIDN'T say is this was a theory. In fact, they have not really figured out what ghrelin does in humans but they know it doesn't work the same way in humans as it does in rats (well you may think some humans are rats but they aren't really!) :)

Recently a clinical study seemed to suggest the opposite... not only did the gastric bypass patients not experience appetite suppression but actually a goodly percentage of those in the study (63 patients) became extremely hungry soon after eating!

A clinical study is the most accurate study there is because this is the type of study where the cohort (participants in the study) are physically examined!

This was not a published study but was reported to the convention of the Professional organization for weight loss surgery surgeons, the ASMBS this past summer.

Here is an article I sent out about this:

After the big news stories claiming that gastric bypass patients have less grehlin which causes appetite suppression, a clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, has suggested this theory is in error, when it found that not only did 80 percent of the gastric bypass patients in their study suffer a ravenous appetite soon after meals, but also experienced the almost uncontrollable urge to eat which did for many result in weight regain after the first year (the study went for 4 years).

The researchers also found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Dr. Roslin reported on this study at the 2009 ASMBS convention, suggesting that the gastric bypass may cause a heightened insulin response due to the rapid emptying of the pouch into the small bowel.

All this caused the researchers to wonder whether the gastric bypass should continue to be the "gold standard" of weight loss surgery.

Roslin's theory is that gastric bypass causes an enhanced insulin response due to the rapid emptying of the pouch.

This may in time, make things difficult for diabetics rather than "cure" them as has been advertised on TV. In truth, many gastric bypass patients find after a few years that they again require their diabetes medication.

This study suggests the gastric bypass might undermine their lessened intake of calories rather than help (most diabetics can keep their sugar levels at normal if they restrict calories slightly.

http://www.medpagetoday.com/MeetingCoverage/ASMBS/14874

Bottom line, don't expect a gastric bypass to kill your appetite except during the healing phase (usually takes about a year but some patients heal faster). After that, if you are like many patients, your appetite may not only return but be stronger than it was before surgery.