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.

5 Medical Reasons to consider Weight Loss surgery

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

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

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

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

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

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

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

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

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

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

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

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

The next "reason" given is fertility:

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

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

Next we have this:

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

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

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

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

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

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

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

The final claim:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Melborne Monash U study - diabetes and obesity surgery

You have to understand that I consider the adjustable lap band a far superior WLS to any of the earlier procedures. It's much safer (about 10 times safer), inserts no staples into the body, no intestinal bypass (as is true of the gastric bypass) and is adjustable which can be a plus if the person does not experience the loss they wanted. But to sell any WLS with misleading statements bothers me because any WLS is serious surgery, even the lap band. I cannot help it.

I recently found out that the show, "60 MINUTES" is as misleading in Australia as it is in the USA. At least in Australia, they are a bit more civilized than they were in the USA and are advocating the lap band which is a MUCH safer surgery than the gastric bypass and they also pointed out that the sugar levels in diabetes could be reduced through a non surgical program like Weight Watchers. But the transcript of that show does contain a few whoppers (i.e. misleading statements - I'm being polite here) which I'd like to go over here. Also I'd like to talk a bit about the Monash study which is now available to read on the AMA site.

First the 60 minutes show in Australia.

Statement: Weight loss surgery cures diabetes and they quoted the study as a backup and a WLS surgeon also confirming it.

REALITY: That's false. Because diabetes is a genetic disease so only changing your genes will cure it.

Not surprising, the study from Monash did not use the word "cure". They used the word "remission". Here is a statement from their study abstract:

Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group.

We will return to this study later but first more misleading statements from "60 minutes".

statement: "That lifestyle, though, has led to him getting diabetes"

REALITY: FALSE. Diabetes is a gene. While there is some evidence that a healthy lifestyle which includes daily exercise and slight calorie restriction can delay the need for medication, it is also true that 33 percent of type II diabetics have never been fat in their lives and many of those exercise a lot.

statement: "if he doesn't have surgery, the diabetes will get worse"

REALITY: The diabetes will get worse regardless of what treatment he has because it's a gene and the pancreas gets progressively worn out as a person ages.

Statement: that you must lose weight to "cure" the diabetes.

REALITY: As we said before diabetes is a gene and not curable. And if losing weight "cures" diabetes, how do we explain the 33 percent of folks with type II diabetes who have never been fat? (I know several of these myself actually).

Finally: Statement: the suggestion - they didn't say this but strongly implied it - that WLS and/or weight loss would cure the erectile dysfunction often seen with diabetes.

REALITY: Weight loss doesn't do a thing for erectile dysfunction- don't expect a remission on that if you have it.

Now let's talk a bit about the study. It was a randomized study - this is good and appears to have been a clinical study i.e. the cohort were examined periodically by the researchers. Participants were divided into two groups. One group was given diet and exercise advice and the other group was given the same advice with the addition of lap band surgery. No one was paid for participating in the study. And the study lasted 2 years. The results were that whereas a remission of symptoms (as decided by the A1C) was observed in both groups, the percentage of remission was significantly higher in the lap band group. (13 percent in the non surgical group and 73 percent in the surgical group).

As far as the study went, it seemed better designed than some but here are what I see as the shortcomings, some of which could still be "fatal flaws".

• The cohort was small - only 60 people, 55 of whom completed the study at the 2 year point. The researchers themselves stated that larger studies needed to be done.
• None of those in the cohort had been diagnosed diabetes more than 2 years ago i.e. they were very newly diagnosed. This is a time when it's relatively easy with mild lifestyle changes including dietary modifications and cardio at least 5 days a week to keep the A1C at normal. Where the problems really begin is after several years. For example, a diabetic family member kept his A1C normal for 13 years with no medications (after that, he required oral meds).
• Lifestyle changes were self reported so we have no idea if the "controls" in the study i.e. the non ops were really exercising as much as they said. Probably they didn't.
  

We have two things going here. The researchers never claimed a cure - they claimed a remission only. The cure part was a misreprensentation on the part of the media and sadly enough the WLS surgeon interviewed in the media.

Second, we by seredipity found out something very interesting about surgery and diabetes. This family member, my hubby, diagnosed 14 years ago, had a brain hemorrhage in Feb - and no, his team of doctors assured us that it was NOT caused by diabetes or hypertension. He had surgery to insert a shunt to drain his spinal cord fluid and went home a day later. In the ICU, his sugar levels were extremely high - stress was apparently a major factor in that. (another interesting thing we learned about diabetes).

But very oddly enough, even after having totally unrelated surgery (but surgery in which he was intubated etc), by the time he got home, his sugar levels totally tanked! So he went on a fun food kick, eating all the things he had been denying himself for 14 years: Dairy Queen, fast food every night, desserts, ice cream whatever. And every morning for about 3 weeks, even with his bad eating and only minimal exercise (not daily), his morning sugar readings were at normal i.e. 80 or so.

But after that on the same non diet, they started to climb and finally he realized it was back on the old program of daily cardio and watching what he eats.

The suspicion remains however, is that somehow surgery seems to affect the sugar levels whether it's WLS or something totally unrelated. No one can really explain it but I think this is only temporary (the only reason WLS patients may sustain it is if they follow the lifestyle changes). And nice as his "honeymoon" with all the "bad foods" and couch potatoing was, I think he would not have chosen as his preference, to have the 13 days in ICU or the brain hemorrhage.

It's a shame that so many people buy the hype from TV without even checking it out (like pulling up the study etc).

As long as people feel there are quick fixes and easy ways out and "something for nothing" there will be snake oil salespersons right there to sell them something. Only with surgery, it may poorly affect the body for the rest of one's life besides possibly not being effective.

I guess my main concern is spewing forth extremely misleading statements about diabetes in order to frighten people into having obesity surgery.

Caveat Emptor - "let the buyer be beware" is a phrase which we seem to have forgotten in today's society driven by media hype.

diet pop - not so diet after all?

Years ago, in 1973, I went to Weight Watchers and lost down to a socially acceptable weight (about 100 lbs less than I weigh now!). And I seemed to be, for the first time, "easily" keeping it off. My secret? 6-8 cans of "Diet Rite Cola" (remember that brand?) a day. Or sometimes more. And a bedtime snack of whipped carnation non fat milk (1/4 cup) sweetened with --- artificial sweetener of course!

Unfortunately while enjoying my smaller size, I found I was getting some strange symptoms in my eyes. Blurs in the field of vision. Pain in the eyeballs. And lumps in the eye lids.

I went to the eye doctor and he wasn't much help. "You have lumps in your eyelids!" he announced, being champion of the obvious.

So I reaccessed what I was doing and "a lot of diet pop" came up. Could THAT be it, I wondered. So I gave up "Diet Rite Cola", cold turkey. And I gave up my nice evening snack of artificially sweetened whipped non fat instant milk. And in a month or so, the lumps in my eyelids disappeared as did the pain in the eyeballs and the blur in the field of vision.

I also pretty well trashed my gall bladder in that dieting stint in 1973 which I found out with a shock when I tried the - then newest thing - the Atkins Diet, had a day and a half of delightful parties in my mouth like cheese quiche and then had the granddaddy of all gall bladder attacks!. Well, that's another show but a common repercussion apparently, of losing a lot of weight on a diet. In fact, in many weight loss surgery patients, they just remove the gall bladder at the time of surgery because they know it's going to go bad anyway. A common repercussion, one of many from dieting which is buried in the medical literature and never talked about in polite company.

The problem with my giving up "Diet Rite" was that without the caffeine load I was getting from the diet cola, I started to feel extreme starvation fatigue (Gina Kolata called it "Primal hunger" in her recent book, "Re-Thinking Thin") It's our body's major production of hormones to force us to eat to gain weight and feel better. Worked for me. I'd felt this kind of fatigue before, (also identified in the Ansel Keyes starvation studies of the 1940's) when I was in my early 20's trying to force my weight to a socially acceptable number and I knew there was only one way to feel better. To eat! So eat I did. I'm not a binge eater. I just ate normally but that caused a 90 lbs weight gain.

The sweetener in Diet Rite Cola was saccharine, then considered "totally safe" despite the fact that it had caused some bladder cancer in the rat studies.

In 1980, another sweetener came out. Aspartame or Nutrasweet. I investigated it, wondering if it would work better than saccharine had done for me. But when I found it could turn into formaldehyde in your body, seemed kind of a no brainer that it was more than a bit toxic. That logical thought process and my observing a member of my online community (BBS in those days) get a case of Multiple Sclerosis rendering her bedfast which "miraculously went away" when she stopped consuming Nutrasweet, were a strong argument in my book to stay away from the chemical! I decided to not consume Nutrasweet or aspartame long before the anti Aspartame folks arose on the net. And to this day, I still remain an aspartame virgin.

My huge weight gain after my first tour of Weight Watchers was my fault of course, or so I believed.

However, a recent story tells us that some of my weight gain might have been because my heavy consumption of artificial sweetener had caused changes in my brain chemistry. ouch!

In fact, they are telling us, drinking only one can of diet soda a day can cause those changes in brain chemistry which can result in not only, weight gain but a significantly higher risk of heart disease.

After 2 large studies showed that people who drink diet pop had a 30 percent greater chance of gaining weight, and a 30 percent greater chance of low HDL cholesterol and/or metabolic syndrome, two heart disease risk factors, we recently have become aware of a rat study out of Purdue which actually showed the brain chemistry changes in the rats.

Too bad for the pop moguls who had just successfully de-valued the large studies of people "well you see, people who drink diet pop tend to eat more and exercise less" they told us. They don't want us to stop buying diet pop because Americans spend $21 billion bucks on it per year.

The pop industry is trying to de-value the Purdue study but it seems to just not go away. Not only that but now ABC news pulled up other things discovered about artificial sweetener - things which seemed to have evaded the news previously. For example, one expert opined that "the acid load delivered by soda of any kind" can be damaging.

The acid load. hmmm. I remember an internet forward stating that Diet Coke was good for cleaning the toilet. I had seen it eat away the tarnish on a penny in seconds after the penny was dropped into a small glass of it. My husband was not surprised at this - "phosphoric acid is a solvent used in some shops to clean tools," he told me. Diet Coke did clean the toilet well, I found out.

And after a lot of my teeth had had the enamel worn away, I read that cola can eat through the enamel on your teeth.

Diet guru Richard Simmons announced about 10 years ago, that when he quit drinking diet soda, he lost 12 lbs without changing anything else. He was largely ignored, of course.

Now people are beginning to listen. The anti aspartame folks telling us for years, that nutrasweet is an "excitotoxin" (kills brain cells and may be a secondary cause of other ailments like Parkinsonism) or that aspartame delivers a fairly heavy load of methanol into our system (kills liver cells and can cause cirrhosis and after that, can muck up the mitochondria and more) didn't have that much affect on people.

But tell them that diet soda may make you gain weight? That they listen to. Apparently having a dead brain or dying nerve cells isn't a dealbreaker but having a fat body is? 'Nuff said. For once, fat-a-phobia may actually cause us to be healthier.

(Although, they will probably find an equally dangerous chemical to substitute, says my less optimistic side, a chemical which after those selling it tell us it's "safe", people will flock to buy it.)

Spinning a Good Story on Tragedy

Years ago, I photographed a wedding - a lovely young couple. And two weeks after the wedding, the groom died - fell to his death while hiking the Grand Canyon. That hardly rated an obituary, let alone a news story.

Truth is, of course most deaths never make it beyond the obituary - there are just too many of them. For example, there is at least one death at every marathon and sometimes more when it's a large marathon.

When I was working as a computer software developer, there was a 36 year old who dropped dead on the basketball court. He was in "perfect shape" and his death confused everyone. But even that didn't rate a story in the news.

But there is ONE type of death which DOES rate a news story and that's any death that they can even -remotely- link to "obesity".

Often, regretably they play upon the tragedy of someone's life to sell a diet or surgery or perpetuate a scare about obesity.

For example, one news story this weekend, carried the headline "Grieving mum 'ate herself to death'!" The story goes on to tell us that this lady binge-d food after her 22 year old son died from suicide. "She tried every diet," continues the article saying that finally she had a gastric bypass and died from complications.

Wait a minute. If she died from complications of a gastric bypass how on -earth- did she eat herself to death? Well you see, labors the story, she was fat and so that's why she died from a gastric bypass or that's why she had a gastric bypass? If you start to process the story, it doesn't make sense - she died from the gastric bypass and if she had just stayed fat, she would still be living. That is, had they treated her for the binge eating instead of surgically destroying her digestive tract, she would have lived to possibly have gotten over the tragedy in her life. Instead, the providers used the excuse of her fatness to compound tragedy upon tragedy as she died from the invasive surgery which has been known to be somewhat ineffective in individuals with binge eating disorder.

What the news pundits are hoping is that you won't notice the small mention of the gastric bypass since most of the article is about how she was constantly stuffing her face. And they are right, most folks won't notice it!

The second story was even more sneaky about being fat-a-phobic.

The headline in most news media (and this story went out over the associated press, nationwide) read "Diabetic complains of light-headedness before dying from heart disease"

Just reading the headline, what comes to your mind? I asked my 10 year old granddaughter about this and she basically said that must be diabetes type II or the type often erroneously linked to being fat and that the lady must have been fat.

Now it's a well known fact that most folks in reading the news, do not read much more than the first paragraph. So in this story, the clincher sentence stood by itself about 6 lines into the story.

"At 36, the bride was dead from heart disease."

Only a couple of lines before the end of the article (which most people won't read) we find this:

"She had a previous cardiac episode in her 20s and was a poster child — literally — for juvenile diabetes, relatives and friends said... recalled seeing the poster featuring her on New York subways."

Juvenile diabetes doesn't mean now what it used to - because we are told daily that this obese generation of kids is coming down with diabetes in their childhood.

So the only clue that we have in the whole article is that she was a poster child- literally- for juvenile diabetes i.e. that her posters were in the NY subways.

In other words, she didn't have diabetes type II at all - she had type I which is a totally different disease and not linked to fatness or lifestyle at all (usually the death of the pancreas in type I is caused by a virus or something like that).

Additionally what they don't bother telling us is whether she had a heart condition or not because if she did have a "cardiac episode" (do they mean a heart attack here?) in her 20's, she likely had a heart condition unrelated to the type I diabetes. Her picture was only carried in the NY Daily News which apparently originated the story. And predictably, she was not fat.

But fact remains, most people who read the story will walk away being more scared about diabetes and a willing audience for another series of articles which appeared this weekend telling the public how gastric bypass cures diabetes (it doesn't really - although the sugar levels drop during the fasting phase, the Swedish Obesity study observed at the 10 year post op point that only "35 percent of diabetics were still disease free").

What strikes me is the ruthlessness of the whole thing. How far will people go to sell a product? Advocating gastric bypass i.e. a partial destruction of the digestive tract, for normal weight or fat diabetics, misrepresenting this invasive surgery as a cure for anything and capitalizing on the tragic death of a newly wed to misreport her illness in order to promote a scare tactic to fat diabetics is more than ethically-challenged.

We've gone far beyond the old "first, do no harm" which doctors used to recite in the Hippocratic Oath. Now, it's more like do anything to sell the product and who cares about how many people are hurt in the process.