Higher rate heart attack and suicide after gastric bypass

In the gastric bypass, the stomach is very compromised and the duodenum, a vital part of digestion, is bypassed.  This is why it causes nutritional deficiencies in most patients.

Yesterday's broadcast "My 600 lb life", was unsettling, especially in my watching it for the second time.  I'm assuming because the patient died from heart disease, soon after they had stopped following him, they haven't shown this episode much because of the possible negative effects on the audience of prospective surgical patients.

What was interesting to me is that he apparently, had heart disease before surgery because during his excess skin removal surgery, he suffered a total cardiac arrest.  "I actually died on the table," the patient tells the camera, but they were able to resuscitate him.

He called his resuscitation, a miracle but a year or two after these procedures, he had a heart attack while driving a school bus and crashed the school bus.  He was D.O.A. when he got to the hospital. We weren't told how many kids were injured but since he'd had a heart attack a year or two earlier, while driving a shuttle bus, one questions why he was again driving and then, a school bus.  One of many questions with this case.

One question that arises was - was this person who obviously already had heart disease, really a good candidate for a procedure like the gastric bypass which tends to raise the risk of heart disease? 

A study published in the "Archives of Surgery" in 2007, found that gastric bypass actually increased the risk of both heart attack and suicide in post ops.  The study examined the records of 16,683 weight loss surgeries among Pennsylvania residents.  They found a substantial number of excess deaths attributed to both heart disease and suicide.  As post surgery time increased, the researchers continued, so did the death rates with heart disease topping the list.  The bariatric industry basically ignored the study, pointing out that these ailments are higher among the obese anyway.

The Dr on TV requires prospective patients to lose 50 to 100 lbs before surgery which they all diligently do, pointing out that diet and exercise are needed to continue weight loss after surgery, but of course, diet and exercise also work well to effect a weight loss without surgery and often, the patient, anxious for the surgery, loses weight at a faster rate before surgery, than after.

When the gastric bypass was promulgated in the 1960's, it was thought that the stomach controls appetite and thus, mutilating this vital digestive organ, would help the person to control their overeating.

They didn't realize then, that the stomach, although a key player in the digestion of proteins, fats and vitamin B12, does NOT control the appetite centers which we now know, are located in the brain.  Moderns who have the gastric bypass are disappointed that their cravings (which originate in the brain) have not been affected by the surgery.

Interestingly, if we look at the repercussions of the gastric bypass more closely, we see that although the weight loss effects are temporary (according to TV bariatric surgeon, Dr Nowzaradan), the complications not only last much longer but increase in the years after surgery.

Happily, less and less surgeons are doing gastric bypass - hopefully, we will see the end of this invasive but not that effective procedure in the near future.

One doctor told his patients to diet and exercise before surgery and then, when they'd had a substantial weight loss, he told them "Now, go home and continue what you are doing!  You don't need surgery!"

Surgery for weight loss

A sad thing for me is when weight loss surgery post ops come back and say "Oh Sue, I wish I'd listened to your warnings".

The warnings I've posted can actually be found on most weight loss surgeons' websites but they aren't in a very prominent place.

Moreover, people want to believe there is a quick way to doing this weight loss thing - so maybe many folks don't look for the small print like 1-2% of gastric bypass patients die within 30 days of surgery or like undermining the delicately balanced system we have for nourishing our bodies with the hundreds of nutrients we need on a daily basis, isn't a very good idea.   As one doctor put in it in a book I read in the 1970's, this type of thing is similar to trying to run our cars on French perfume... how long would they run? Sadly, we often treat our cars better than we treat our bodies! 

The body adapts in a way to various forms of starvation, but of course does not last very well in the long run as it starts to consume protein and macro nutrients from itself, like the brain, the heart, calcium from the bones etc.

It's meant as a short term way to survive a starvation period and not for something in the long term.

I remember when I started studying this stuff in 1990.  I called a medical provider, an intelligent well educated one, and asked him to tell me what he knew about the GI tract. He gave me a short basic explanation.  I asked for more details but he said that was all they got in medical school!

I ended up reading bunches of books and medical journals to get the rest of the information, a research which took more than 10 years of study (not counting the many books etc I read before my specific study on weight loss surgery - I'd been studying weight control since the 1970's and still am studying it).  Sadly, this is not easily available to the public and apparently many medical providers don't have the time or ? to study this in more detail.

Eating healthy and exercising at least 5 days a week (the only thing which strengthens our hearts is cardio exercise or as it was formerly called, "aerobic exercise") is the best way to go.  That's what they say if one studies the subject and I can attest from personal experience, it works.

Eating healthy usually means avoiding fast or fatty foods and eating mostly veggies and some fruits.

Not eating healthy and exercising raises our risks for heart disease, stroke, thrombosis and more.  I've lived through this thing of heart disease and clogged arteries - not in myself but in my hubby who never heard from a medical provider about a heart healthy diet or how important aerobic exercise is. I made him exercise daily but he only did 20 minutes most days.  Never-the-less, that 20 minutes is probably the reason why he's still living albeit required five major surgeries to fix his heart and clear out the clogging from his arteries. 

And all this, while seeing medical providers regularly and paying lots of bucks - where were the warnings he should have gotten?  

And basically, not looking for the quick way out of a weight problem because there is no quick way that is healthy and works.  Terminal cancer patients don't have a weight problem but I suspect most of us would not want to go there.  But having one's stomach and bowels cut up and/or rearranged in a very unnatural manner, as done in surgeries for weight loss, isn't a good idea either.

As Beverly Sills has said "there is no quick road to a place worth going!"

Thoughts about the TV show "My 600 lb life"

As I watch the TV show, "My 600 lb life", I see many issues .... Elephants in the room, things left unsaid like, the fact that at least 2 of the patients featured on this show, ended up with severe complications such as neuropathy and guillian barre (which the provider attributed to "obesity" even though it was after the gastric bypass that these folks suffered these complications). One  patient uses a wheelchair now (he could walk before his gastric bypass). Another 2 patients that I know of, died a couple of years after surgery which is before they would have died without surgery.  (The bus driver featured in the first or second season, died about two years after his gastric bypass - he had a massive heart attack while driving a school bus.)

First, it seems many of the patients feel the 'before surgery' diet is temporary but in truth, weight loss surgery does NOT fix a damaged metabolism...that is the patient will have to stay on the 1200-1400 calorie diet for life if they want to keep off the weight... it bothers me that many patients don't seem to understand this and so their weight loss after surgery greatly slows down or in some cases, they gain.

Second, with weight loss surgery, there may be a large initial (after surgery) weight loss as the person cannot eat because there is a healing process going on, but after the surgery is healed, the appetite (which is centered in the brain) comes back strongly.

When weight loss surgery was invented in the 1960's, medicine thought the appetite centers were in the stomach and by making the stomach very small, that would control the appetite... Studies and a greater level of knowledge that we have now, have taught us that the appetite centers are in the brain and the size of the stomach makes little to no difference in how hungry most individuals feel... This means that the entire theory upon which weight loss surgery is based, may be outdated.  So one wonders why some providers still do the invasive procedures like gastric bypass?. Well, surgery is a cash cow for providers, unfortunately... and sadly, many patients who have become ill with gastric bypass or have regained, are made to feel ashamed if they speak out.  One of my friends called this a "conspiracy of silence".  She, a weight loss surgery patient herself, died at the young age of 54.  She had been ill with her surgery and bed-bound for several years before her death.

Do providers know that surgery does little to nothing to control the appetite for most folks?  Unclear... They really might think that the surgery helps... To keep up with all the advances in medicine, a provider would have to spend all his or her free time reading...

Most of all, one cannot gain to a very heavy weight, unless one has some serious physical metabolic issues going on.  And no one seems to acknowledge this, although it can be found in medical literature .... And especially not the provider on the TV show, "My 600 lb life"...who assumes that every one of these patients is really stuffing him/herself. However, a revealing study found that members of NAAFA, a fat acceptance group, actually consumed less food at conventions than their thin cohorts!  It's true that people who get very overweight may overeat at times, but basically, most of them eat like many other Americans who do not become extremely obese... And yet these people are made to feel like they are total pigs when it comes to eating. I can't help wondering why providers don't seem to know more about metabolic issues which can cause obesity... 

I stumbled upon my metabolic issue...after spending a lifetime wondering why, if I ate like most around me, I became very overweight... A goodly percentage of folks who had tonsillectomies in the 1950's and 1960's got pituitary damage after surgery... My tonsillectomy was in 1953 and right after surgery, I began putting on weight...That is, before this procedure, I, being very active, was on the slim side, however, after surgery...eating the same amount and with just as much activity as before, I gained weight...

So in digging through medical literature (for years literally), I found the reason why I gain so easily.  Now why don't providers let us know about this, I'm wondering...like those folks on "My 600 lb life", the provider really takes them to task, when they gain weight...

To defend Dr Nowzardan, it's possible he doesn't know about the latest research...he's 72 years old and this may be one reason why people of this age (over 70) should be retired... I am 71 and yes, I do NOT have the brain power I did when I was, even in my 60's, and trust me, it drives me nutz!  To paraphrase Buddy on "Cake Boss" , one might say with emphasis, "It's the aging process, baby!"

Undoubtedly, some of us, like me and those folks on the TV show, "My 600 lb life" have no set point and thus, we can gain easily up to astronomical weights, without especially overeating, at least not more than most Americans who do not gain so easily...

I've tried to explain all this to providers... And most of them naysay what I am telling them. 

Metabolic differences and pituitary damage from procedures like tonsillectomies,  seems  something which, apparently, is not included in the medical school curriculum...

Sue

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.)

Gastric bypass patients should consider reversal!

The good news is most surgeons have stopped doing the gastric bypass by now and have switched to the gastric sleeve which is a much safer procedure and just as effective as the bypass with weight loss (not very effective unless the patient diets and exercises which of course, works very well without surgery).

The bad news is many surgeons are not saying anything to bypass patients like telling them to consider getting their procedures reversed (which would effectually give them a gastric sleeve).  The reason they are not saying anything to the thousands of gastric bypass patients is, that would be like admitting the gastric bypass was a bad idea which it was, big time!  Mason who invented the procedure, stopped doing them in the 1970's because he said the repercussions were too great but he only wrote about this in medical literature.

Surgeons are afraid to tell you the gastric bypass is a bad procedure because of the possible lawsuits they might get (most WLS surgeons are facing up to 5 lawsuits at any given time!).  But if you are a bypass patient, consider getting the reversal procedure - you will still have restriction but will be able to digest vitamins again, hopefully...

We need some 100 micronutrients a day (which cannot be supplemented) plus a bunch of macronutrients like B12 etc which cannot be efficiently supplemented.  None of which the gastric bypass patient can digest.

As one WLS surgeon said, he "buries his mistakes".  Literally.  Dead people don't talk and live gastric bypass patients are afraid to detail the gnarley side effects of this surgery.

In the UK, they force a reversal of the gastric bypass after a couple of years - that's because the govt picks up the tab for all the side effects which kick in long term... if you are a gastric bypass patient, consider getting a reversal.  If you lost weight and kept it off, it wasn't the surgery, it was YOUR WORK and you can continue that without the bad side effects of surgery.

I have digestive problems from a lifelong case of GERD - they are very annoying albeit nothing like bypass patients suffer, but trust me, since I was clinically obese until 2010, digestive problems didn't help in the least, to keep my weight off.  (In 2010, I hit my Weight Watchers goal and lifetime membership - and have kept off 106 lbs ever since, being on program)

We did not become overweight because our digestive systems worked.  Just saying

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!)

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....

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?

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.

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.

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

In the latest from (who else) the ASBMS (the professional organization for bariatric surgeons), they presented a study in which they compared the records of 587 gastric bypass patients to 189 patients who were eligible for surgery but did not have it because insurance had denied them.

In one of the LA Times blogs, some details on the study are given.

The study went for three years and at the end of three years, they pointed out that of those who did not have a gastric bypass, 40 percent went on to develop high blood pressure, 34 percent developed sleep apnea and 20 percent developed GERD (gastro esophagal reflux disorder).

The researchers concluded that if folks thus qualified, are turned down by their insurance for these procedures, they become sicker than those who have the surgery.

This study has not, so far, qualified as "peer reviewed" although they may have plans to publish later but I can see many flaws.

First of all, the numbers are not even - many more gastric bypass patients than non surgical patients. For a real comparison, the numbers should be even.

Secondly, as studies have suggested, sleep apnea, although can be exacerbated by size, is not caused by obesity and the latest advice is for patients to keep their C-Pap machines even if they lose a lot of weight.

Third, GERD is definitely not caused by being overweight at all. It's usually caused by a hiatal hernia which causes a lot of problems including slow motility etc. That being said, I have personal experience with the fact that calorie restriction will keep GERD at bay long before you lose any weight. Calorie restriction seems the treatment of choice for it. Therefore, it's not surprising that the gastric bypass patients kept their GERD at bay while the non patients did not.

And finally, the so called "risk numbers" including blood pressure are also low in terminal cancer and AIDS patients and yet, are these really not at risk for heart disease?

But the problems of the study don't end there. What the researchers didn't compare was the number of bowel obstructions, twisted bowel, kidney stones, plugged stomas and other problems likely suffered by a rather alarming percentage of gastric bypass patients which were likely not suffered by those who did not have surgery.

What about comparing the number of those who got reactive hypoglycemia or epilepsy after gastric bypass with those in the non surgical controls?

That is, if one is comparing the amount of illness in both groups, should not all illness be included?

Gastric bypass has gotten some bad publicity lately with Carnie Wilson, the poster child regaining a lot of weight and Al Roker admitting that unless he exercises vigorously and counts his calories, he also regains (but this is the same thing that non surgical folks have to do to maintain or lose weight) and so I feel the study was mostly to get folks to think of gastric bypass in a more positive manner so that they might consider visiting their local surgeon. As the article in the blog notes, only 1 percent of those "qualified" for gastric bypass end up getting the procedure, a number which might alarm some providers.

This study reminds me of the first thing a friend of mine was taught in a class on de-coding studies i.e. "98 percent of studies are flawed for one reason or another".

As in all studies, we should always keep in mind the funding source and also, that what is not said or what is omitted, is sometimes as important as what is reported on.