Lap Band must be removed within 5 years

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

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

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

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

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

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

The Obesity Code - is it really new?

"The Obesity Code", a new book out, while saying it's the final solution to weight problems, is nothing new. And, people, tired of dieting, are buying it rapidly off the shelves, over the internet, or whatever.  I read a few reviews of it while deciding if I needed to add it to my always growing library on Weight Loss.

From what I can see, the meat of "The Obesity Code", pun intended, is intermittent fasting. You can fast...water only, or liquids or a bunch of ways. While I don't know what type of fasting is suggested in the book, it all amounts to basically no food... one day a week or one day a month or ?? 

That's supposed to keep off the weight forever. It's not new because I tried it in the 1970's. I lost about 25 lbs but eventually, I got horrendous cravings, couldn't stomach the fasting part anymore and regained the 30 lbs I'd lost and another 70, probably a result of a lowered metabolism and being really, over, fasting! :)

The only thing that really works to lose the weight and keep it off, is calorie restriction and portion control - for life. Staying away from calorie dense stuff like fast foods is a good idea or use the Gwen Schamblin method for fun foods, (from the book, WEIGH DOWN). That is, take one bite of a fun food, and chew it slowly, savoring it. Because as she rightly, points out, the first bite tastes the best and if we slow down enough to experience this, we can find out that this is very true.  Gwen has kept several pounds off for many years and she enjoys her fun foods also.

We all have to experiment with things and see what works the best for us. 

After trying just about everything else, I realized that calorie restriction and portion control is the only way that worked for me, to lose and keep off weight.  

 In 2008-2010 I lost 112 lbs, and have kept off 107 lbs ever since. I count my calories every day on My Fitness Pal, a great website which offers a free  calorie counter and found that a small bite of treats or even programming small amounts into my day, keeps away the cravings monster.

Eating big portions of veggies with no butter etc, fills you up and no one ever got a weight problem from too many veggies!

Every "diet book" claims it's new and revolutionary because the diet-fatigued, overweight public craves an answer that is easier than daily calorie counting or restricting food amounts in some other way... but in reality, "there is nothing new under the sun".

Latest questionable study on obesity

Obesity signifies a lessor brain, states the latest - shall I say - questionable study.  The cohort was 32 people both men and women and claimed to not included people with known brain damage.  The researchers concluded that (after imaging the brains of the cohort) that people who are overweight have "less gray matter" in their brains and thus lack the mental capability to make good food choices.

Now true, the study was reported in the UK Telegraph (which is the UK equivalent of the US "National Enquirer") i.e. not a real reliable source, but it appears to be a real study.

I really don't have to say much about this study because it is so inane. But I will remind, that some of the greatest brains of this and former centuries, happened to be very overweight i.e. GK Chesterton is one example.  President Taft was so overweight, he got stuck in the bathtub one day. And there are numerous other examples.  Attend a meeting of the high IQ group, MENSA, and you will see many overweight folks, suggesting the opposite of this study i.e. that overweight people might have more powerful brains on the average.  This would be a no brainer (pun intended) - overweight folks are often better nourished than slim folks.  But I would also, know this from experience - there is a lot of obesity in my family.  Mother had a Master's degree, Dad, a PhD and so forth.

Whether a person was obese was decided by BMI (in this study) and we all know BMI isn't an accurate measurement anyway - because it fails to take in consideration, bone structure, musculature and several other factors.

So, where did the researchers go wrong?  Ironically, intelligence cannot be judged by brain imaging - the brain turns out to be one of the last frontiers in medicine and can be a real fooler.

For example, when David Snowden reported on his famous "nun's study" (he actually forensically examined the brains of several Catholic nuns after they died - he had permission, of course), he found rather surprisingly, that nuns with dementia might have large good looking brains. But his greatest surprise came when he dissected the brain of a nun who lived into her 90's.  She was mentally sharp and functional until the date of death and Dr. Snowden was anxious to examine her brain.

To his surprise, her brain was small, less convoluted and more shriveled up than some of the nuns suffering dementia.  

Enough said.  Obviously, one cannot judge intelligence from what a person's brain looks like.  (Photo is of Cheryl Hayworth, gold medalist Olympic weight lifter).

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!

Gastric Sleeve revisited

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

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

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

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

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

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

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

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

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

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

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

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.

Does Obesity really cause brain damage?

Obesity might cause inflammation in the brain, shouts out the latest headliner coming out of the NPR News.

According to the NPR article:

...some provocative research suggests that a part of the problem might be that obesity could change the area of the brain that helps control appetite and body weight.

The study was published in the Journal of Clinical Investigation and since my trust of media reporting on studies is about zero, I decided to look up the original study to see what it really found.

Not surprising, the study report article differed completely from the news article.

In this study, the researchers found that when rats were fed a diet high in fatty foods, even before they became overweight, there was evidence of inflammation in the rat hypothalamus gland, a gland in the brain which is thought to regulate body temperature and metabolism.

The scientists wondered whether humans reacted similarly, so they MRI-ed the brains of 34 humans and found more evidence of damage to the hypothalamus in the 12 humans who were obese than in those humans of normal weight.

Michael Schwartz, one of the researchers on this rat study was very shocked at the results, he told NPR. Schwartz is the head of the Obesity and Diabetes Center of Excellence at the UW School of Medicine.

I do see some possible issues in the study such as, can it be assumed that normal weight humans did not consume as much fatty food as obese humans?

But unlike the media, the scientists commented that this damage may be a factor in developing obesity and not that obesity caused damage as the NPR article stated. The scientists named their article, "Obesity is associated with hypothalamic damage". The media in their typical fashion of misreporting, headlined their article "Could Obesity Change the brain?".

Actually, I am not surprised that the hypothalamus glands of some overweight people might be damaged but of course, the study never stated that the obesity proceeded the damage - either in the rat study or in the human study.

Interestingly, this study may dovetail another recent study which found that a rather alarming percentage of people developed obesity after their tonsillectomies (which may be due to hypothalamic damage). The scientists in that study stated they did not know what caused this but suggested it might be that swollen tonsils caused difficulty in swallowing before they were surgically removed. I was one of those who packed on the pounds after my tonsillectomy and no, I had no difficulty in swallowing before that surgery! I also was very active, spending most of the day, running around, riding my bicycle etc. However, I was more hungry after my tonsillectomy which could be the effects of a damaged hypothalamus.

The study at the UW seems a landmark study, the first which suggests that damage to the hypothalamus might be a factor in obesity, which is a pretty shocking result as Dr Schwartz suggested however, with the media misreporting the study to something totally different, the public may never know what the real study found!

Obviously, the rat brain is quite different from the human brain. And the scientists admitted they cannot really generalize from how the rats reacted, that humans would react in the same manner but they did suggest more research along this line would be appropriate.

As an aside, it would be nice if, for once, the media would consider accurately reporting about the scientific research instead of totally changing what the study was even about. (the photo is of the Olympic weight lifter and medalist, Cheryl Haworth)

Better Watch Out for Those Hot Dogs, says Dr Hu

Does anyone remember the professor/researcher at Harvard Medical School, Dr Frank Hu, who came up with the conclusion that if a person was overweight, exercise did not help them at all?

In 2005, Frank Hu and JoAnn Manson (Harvard) published a study in the JAMA "proving" that an overweight person cannot be physically fit even if they regularly exercise.

This was an epidemiological study (notoriously inaccurate) but it hit the news in a big way. Not surprising since the news thrives on this sort of headline.

Dr Hu and associates have again hit the news with a study which will be published in the "American Journal of Clinical Nutrition".

This study concludes that if you eat red meat at all and especially hot dogs, you have a significantly higher risk of developing diabetes. (the risk factors quoted in the news range from 21% greater risk to 50 percent greater risk).

If we get picky about things, there is a big difference between lean steak and a hot dog but no real proof that either, eaten in moderation will be our demise.

As is with all epidemiological studies, the numbers of the cohort are impressive but we must remember that not enough information was collected specifically for this study. That is, you can prove pretty much anything with an epidemiological study done with an existing cohort - even likely prove that as much as eating a hot dog can raise the risk for diabetes so can that risk be increased by riding a bicycle (assuredly most in the cohort have done both!) :)

But making headlines is what researchers want to do because it assures them of continued funding and the news doesn't want to see what science really comes up with i.e. possibilities that this or that might be true but rather foregone conclusions.

"Scientists", reminds Dr Roy Spencer, PhD and author of "CLIMATE CONFUSION", "are human too", doing what is necessary to obtain funding. Coming up with an attention getting headline is a good way of assuring continued financing for other studies.

The problem is, that some folks perhaps, take studies like this seriously, which isn't a good idea. Rather, it's best to smile and move on and eat our hot dogs and red meat with no worries. Dr Hu's study proves nothing except he likes to get paid, and coming up with a sensational news story is a good way to do that.

The TOGA procedure - new hope for weight loss surgery or ?

A recent announcement stated that the UK had done 450 TOGA procedures for treating obesity.

The TOGA procedure offers an "incision-less" weight loss surgery. What is done is basically stapling the stomach from the inside (a surgical instrument is inserted through the mouth).

American surgeons have appeared to not have greeted this procedure with the same enthusiasm as those in the UK.

Click here to see an animation of the TOGA procedure.



A surgeon's description of "minimally invasive" can be misleading to patients. They simply mean no incision. They do not mean the surgery is lightweight or not complex. This procedure calls for stapling the stomach from the inside into a narrow sleeve and step two is narrowing the lower end of the sleeve so food doesn't go through well. This is supposed to cause the patient to feel full with a lot less food.

It's interesting to note that all the procedures and medications are aimed at cutting appetite but since when do people only eat when they are hungry? The type of appetite we mostly have, is in the head and not fixed by feeling full in the tummy.... which may explain why even the more complex procedures are somewhat ineffective in a number of patients.

As the websites about the TOGA do not seem to be recently updated, it seems that the TOGA may not have become popular in the USA yet, and one wonders whether the weight loss results were less than expected or whether there were a lot of complications in the American trials.

Even if the TOGA holds better than the Rose or the StomaPhX, it may cause a lot of discomfort for the patient. In fact, patients complained of a lot of pain with both the Stomaphx and the Rose procedures but not much additional weight loss. And with the Rose and the stomaphx, they had problems with the staples or clips pulling out after a year or so. The tissue inside the stomach is very soft tissue, so it makes sense that staples or clips would not hold well.

Apparently a study in 2008 did not result in the weight losses claimed by the manufacturer. Also as you notice in the quote, even in a small number of patients (6), researchers observed in some cases "Partially stapled sleeves". In other words, in at least a couple of the members of the cohort, the staples had already begun pulling out.

There were no complications; all but 2 instances of procedure-related adverse effects (nausea, vomiting, pain, dysphagia, pharyngitis) resolved within 5 days and none were serious. The most recent follow-up visits (endoscopy at 3 or 6 months) showed persistent full or partial stapled sleeves in all patients. Weight loss averaged 17.5 lb at 1 month and 24.7 lb at 3 months after treatment (excessive weight loss [EWL], 14.9% and 20.5% at the respective time points). At 6 months, average weight loss was 31.1 lb and EWL was 24.9% for 6 patients followed up so far.

Endoscopy. 2008 May;40(5):406-13.

In reading about this procedure, I somehow am reminded of the title of a book that Susan Powter wrote --- "STOP THE INSANITY".

Less Heart risk, gastric bypass - new study

A study which followed 400 gastric bypass patients, found that the average BMI at the 2 year point, was 32, still obese. The study was conducted at the Medical College of Georgia.

That the patients had mostly not lost all their weight was predictable but the study's lead researcher, Dr. Sheldon Litwin, chief of cardiology, reported that the patients had a reduced risk of heart disease.

Explaining that the size and mass of the patients' hearts had greatly decreased, Litwin stated this suggested that their hearts were not working as hard to pump blood and therefore, less "stressed" than before surgery. Dr Litwin also said that the hearts of the patients were more normal size.

The problems with this theory are many - first, the heart is a muscle and working it is not a bad thing which is why many overweight people have strong hearts. Second, what caused the reduction of heart tissue? Was it less stress due to a lower weight (which remember, was for most patients, still in the "obese" range) - or was it that in the first year or so, gastric bypass patients take in very little food (300-500 calories day, thus causing a very rapid weight loss) and what their bodies can no longer get from food, is leeched from their bodies. Protein and iron, both poorly digested in gastricbypass patients especially in the post surgery stage, can be obtained from the heart tissue and this would much more likely explain the loss of heart mass however, loss in this manner would not be a good thing. On the contrary. It is this type of tissue loss which is suspected to be a factor in the heart attacks observed in 25% of anorexics.

I have known several gastric bypass patients to come down with heart disease after surgery (some require a pacemaker for example).

I notice in the article they quote Dr Lee Kaplan saying that only 1 percent of those qualified for weight loss surgery get it. But I'm wondering if that quote was taken out of context because in the Self Magazine article, Dr Kaplan said:

*** "Because it's risky, it's only appropriate for a tiny fraction of people with obesity—the sickest 1 to 2 percent. The idea that all obese people should get [WLS] surgery is insane."
Lee Kaplan, M.D., director of the Massachusetts General Hospital Weight Center in Boston in "Self MAGAZINE: 'The Miracle Weight Loss that isn't' AUG 2008 ***

The article points out that the risk numbers, cholesterol and blood pressure are down on the gastric bypass patients. These numbers also go down in people with terminal cancer. However, I doubt that cancer patients are at lower risk of coronary disease.

Finally, they emphasized the diabetes "cure" (really a remission not a cure) which has been observed in 72% of patients at the 2 year point, however, what they don't mention is that the studies have found that by the ten year post op point, most cases of diabetes have returned.

Whatever the case, it seems like the media is using this study to sell the surgery than anything else (as someone on one of my listserves pointed out).

Dying from elective surgery

Surgery used to be something done to save lives. But now it's often done for other reasons like to lose weight.

Recently a 52 year old woman died after a lap band procedure - probably a complication of the general anesthesia required for weight loss surgery. She was only 50 lbs overweight.

In another story, a woman who was 100 lbs overweight opted for liposuction to remove 50 lbs and now has a body which is very deformed even after she spent some $6000 bucks for chiropractic treatment and more.

As Weight Loss surgeries go, the lap band has the best safety record. In this procedure, a band is placed around the top of the stomach to form a "pouch" which fills up quickly. This is supposed to send signals to the brain that you are "full" when you have eaten only a small amount of food. The procedure, unlike the gastric bypass, includes no intestinal bypass and no cutting of the stomach, and unlike the gastric sleeve, does not call for the removal of most of the stomach. In the lap band procedure, things are pretty well left in tact.

But like all the other weight loss surgeries, the lap band has its downsides. Many patients find that if they are not pretty strict about dieting from the get-go, they don't lose any weight. And of course, there are many foods which are delicious and low bulk which slip right through the lap band like Dairy Queen blizzards etc. To feel full if you have a lap band, you have to eat bulky foods and if you do not measure them, you can suffer a repercussion called a distended esophagus (when food overflows the pouch). A distended esophagus can lead to perforation which is a serious life-threatening condition and also is difficult to fix. Finally, in a percentage of patients, the lap band adheres to the stomach but the percentage on the long run may be higher than we have been told.

Sharon Osborne who used the lap band to lose 90 lbs and has kept most of it off, had her lap band removed a couple of years ago. "I was tired of vomiting every day," she explained to the press. Her famous rock star husband, Ozzy, told the press he was sick of listening to his wife upchuck so often.

Obviously, Sharon may not have followed some of the rules all weight loss surgery patients are told to follow about "measure twice, eat once, vomit never" but doesn't the way it's sold on TV make it all look like it works pretty automatically? They never go into details about all the work the patient has to do which is very similar to any weight loss program, even the non surgical ones.

About 5% of people on non surgical weight loss programs can keep off the weight. With weight loss surgery it's only 7% even with more invasive procedures like the gastric bypass. Many weight loss surgery surgeons don't expect patients to keep off any more than half their excess weight on the long run even when they are putting in the work, but again, how many seminars tell that to prospective patients who are typically 100 and 200 lbs over their "goal weight"? I know a person who regained 100 of the 200 lbs initially lost with their gastric bypass and they couldn't for the world, take it off, even with diet and exercise. Apparently their metabolism had been so damaged that eating anything more than 700 calories a day, caused a gain.

How many people would agree to major surgery like weight loss surgery if they knew it would mean a lifetime of dieting and exercise as well as supplements, B12 shots, possible iron infusions, frequent doctor visits and more... and then, to only lose 50 percent of what they initially wanted to lose (for most patients)?

How many people would agree to a gastric bypass if they knew that they had a chance, even a small one, of getting a seizure disorder afterward or reactive hypoglycemia?

How many people would agree to a gastric sleeve surgery (the newest one they are touting) if they knew it called for the removal of 90 percent of their stomach, leaving a pouch the size of a thumb and that if they had any acid in their stomach, they might easily get an ulcer which could quickly ruin the stomach and require the removal of the rest of their stomach or else if they had no acid in their stomach, it could cause all kinds of things including auto-immune disorder (including MS by the way) because of "leaky bowel" syndrome where bacteria from the food eaten is not killed and instead, recirculated into the bloodstream?

How many people would go into a major surgery even with a lower death risk (the lap band has a death risk of 1 in 7000) if they really thought they might be the one to die? As for those surgeries like gastric bypass where the risk of death is much higher (1 in 50 in some studies), how many people would choose this procedure being fully aware of the death risk?

And finally, how many would agree to surgery if they knew they might not die right away but instead become ill, or require additional surgery like losing their colon from sepsis due to perforation (a sometimes repercussion of laparoscopic surgery) or lose their ability to walk?

Truly some might say "yes" to this but perhaps, not enough people to provide a steady income for many surgeons. (The average weight loss surgery surgeon has an annual income of 1.5 million dollars or more)

Perhaps we should consider going back to reserving surgery for when it's necessary and avoiding it when it's not necessary. Dying or getting a severe disability from a procedure we could have lived without, may not be a good idea for most people.

For sure, those who choose major surgery, should be very sure they ask and get answers for the question, "What can go wrong?" and not just trust new ops or those successful at surgery who may not be sharing the whole story, or least of all, the TV.

All he did to lose weight was eat less and move more?

An article on CNN covers the weight loss of a man who went (they claim) from almost 500 lbs to "one-der-land". The man, Matt Hoover (who ironically is a namesake of one of the Biggest Loser Contestants of the 2005 season), told CNN his weight loss journey lasted 3 years. Most of the article is detailing "how terrible he looked" as a person of size and the usual. Finally a couple of sentences way down in the article tells how he lost the weight.

Predictably, he "ate less and moved more" that is, the article states:

He ate smaller portions and took daily walks. The first 120 pounds came off.

And in case we didn't understand how the weight melted off when he "just got off the couch", he's quoted:

"When you're that big, you can lose weight pretty quickly," he said.

The article goes on to say that Matt plateaued out at 150 lbs over his goal weight and then, joined Weight Watchers and "lost the rest of the weight"

According to this article, Matt had no health problems (or I'm sure they would have mentioned them) and it was all how "bad he looked" which motivated him.

Hey, if a person wants to lose weight (or not lose weight) that's fine - our bodies are ours to do with them what we want.

What I found very objectionable in this article was the following:

1. The article implies that the only reason Matt got up to 470 lbs was because he ate too much and moved too little in other words, "he sat on the couch, eating bons bons all day so no wonder he was so fat", and this idea is I think, what CNN wants to convey to the readers. But the reality about obesity is that according to Dr Rudy Leibel and the scientists who study this stuff, size is mostly genetic.

2. The article gives the impression that once Matt started eating as a "normal person" i.e. not totally overstuffing himself while sitting on the couch, the weight just "dropped off". And that is so not true! For a person who is genetically/physically obese to lose weight and keep it off takes daily vigilance almost to an obsessive level.

To expand on the second point, while the article implied that Matt just had to "get off the couch" (they never did detail what his exercise program consisted of however), ordinary exercise does not keep off any weight if you've got a certain set of genetics - I can personally attest to that one!.

For example, the Matt Hoover from the "BIGGEST LOSER" (not the same guy as in this story, I'm pretty sure) is described in one article as exercising 25 hours a week (he did regain some, it says from his "Biggest Loser" season but is determined to get it off):

Hoover spends 25 hours a week training for the grueling triathlon, which consists of a 2.4-mile open-water swim, a 112-mile bike ride and a marathon 26.2-mile run.

In my research I have found that societies in which there is no obesity, typically move 25-40 hours a week and eat about 1200-1400 calories a day.

Now that's a lot more than just "getting off the couch" and "eating smaller portions".

This type of article is falsely misleading. To the person of size who thinks that they can exercise an hour or so a day and eat a bit less and the weight will drop off, they will be very disappointed when they can actually gain weight eating normal amounts of food even if they do exercise. (How well I know about that one!)

And for those 85% of society who do not have to fight clinical obesity, articles like this just fuel the flames perpetuating the falsehood that shaming people of size is actually "good for them" because they might get motivated to "eat less and more more" and the "weight will drop off", as it did with Matt Hoover who is not the Biggest Loser contestant in this article.

I know people of size who have awesome achievements, careerwise and life-wise and even are very good looking, and yet, feel themselves failures because even though they already "eat less and move more" the weight just doesn't fall off them like it does on people in the newspaper or on TV. These feelings brought on by articles like this CNN article, filled with falsehoods and misleading statements, can lead people to drastic measures including unhealthy diets or even surgery to cripple their digestive system (what Dr Fobi, WLS surgeon calls the gastric bypass) or worse.

In a world which needs more love, isn't it time we enjoy people for who they are and just accept that in a country like ours where food is in easy access, people are going to come in all sizes and so what? What if we were all the same size - it would be pretty boring! (look at manikins for example). :)

Note: the photo included with this blog is Olympic athlete, Cheryl Haworth who won an Olympic medal in Weight Lifting. Like all elite athletes, she trains hard for several hours a day and watches what she eats. She also weighs over 300 lbs. People do come in all sizes and just because someone is a person of size, doesn't mean they lie on the couch all day, eating bons bons.

Like one of the TV reality show stars quipped when someone called him on a misrepresentation in a so called "reality show".

Well, you cannot believe everything you see on TV!

Push for weight loss surgery even if you have a lower BMI follows study about obesity

A new study of 1.5 million people suggests that obesity, even overweight, shortens your lifespan. So says the study - obese people are 44% more likely to die earlier than those in the so called ideal BMI range.

The findings and size of the new study, which was conducted by researchers at the National Cancer Institute and published in the New England Journal of Medicine, should settle the debate over the relationship between excess weight and the risk of early death

So says Ali Mokdad, Ph.D., a professor of global health at the University of Washington, in Seattle.

According to one report on a local TV station:

The latest research was launched after a controversial 2005 study by the Centers for Disease Control and Prevention that concluded being overweight didn't raise the risk of death; that report included smokers and those with pre-existing illnesses.

The CDC study was actually a re-examining of existent data and an admission that the wrong conclusions had been drawn. It was only controversial among those advocating diets!

In 2005, the CDC reassessed their data, stated one news article in the Seattle Times, and found that 112,000 people (not 300,000 people) had died from obesity related diseases however, they also added that since people with BMIs in the overweight zone (BMI 25-29) live longer than those in the "normal ranges", one had to subtract 86,000 from the 112,000 and that leaves 26,000 people who die from obesity related disease... less than who die from gunshot accidents!

The new study doesn't settle anything because it made the same mistake pointed out by Dr Stephen Blair, PhD, head of the Cooper Institute.

Seems the folks at the Cooper Institute took 30,000 people and found when they added exercise habits to the equation, that fat people who exercise regularly had no greater risk of sickness or death than slim people who exercise - and people who do not exercise regularly, had the same risk, regardless of size - about 44% greater than the exercisers.

I'm sure the pundits are banking on the fact that the public either has a short memory or else, hasn't seen the Cooper Institute studies.

However, some reports on the new study included the remarks of the lead researcher on the Cooper Institute studies, Stephen Blair, PhD:

University of South Carolina obesity researcher Steven Blair said the results were consistent with other studies and the "massive effort" was commendable. But he said there wasn't enough information available about fitness level or physical activity. A proponent of the "fit and fat" theory, Blair said his research has shown that obese people who are tested and deemed fit did not face increased risks of dying.

"If we want to get to the bottom of the health hazards of overweight and obesity, we have to have better data on physical activity," Blair said. "Until we do that, there's uncertainty of how important BMI is as an important predictor of mortality."

Seemingly coincidental to the release of this new study which looks impressive to the unquestioning eye of the public, the Allergan company has petitioned the FDA to lower the weight limit for obtaining the lap band obesity surgery. Right now, only people who are at a BMI of 40 or higher, or 35 with co-morbidities can have their insurance pay for a lap band. Allergan would like to see that minimum weight lowered to a BMI of 35 or 30 with co-morbidities.

Even CNN remarked on the fact that the head of the FDA committee petitioned to lower this weight requirement, owns stock in the Allergan Company! Not only did she not recuse herself (which she should have done!) but the FDA voted that it was "OK" for her to be on this committee as long as she didn't vote!

The lap band is a much safer surgery than the gastric bypass. It's a band placed around the top of the stomach which can be tightened or loosened and is supposed to limit how much a person can eat and thus cause a weight loss. Of course, what it limits (when it's not swollen i.e. some band patients complain of their stomach swelling shut in the morning) are the good bulky foods like veggies. Milkshakes, ice cream and cake go down beautifully. Although unlike the gastric bypass which is greatly troubled by long term vitamin deficiencies in many patients, the lap band is not without its own set of repercussions. A certain percentage of patients experience the band growing into the stomach, thus requiring removal and/or a gastrectomy. Mostly what I hear lap band patients complain about is discomfort and difficulty in keeping off the weight. The difficulty in keeping off the weight complaint, one hears from gastric bypass patients also.

What science really says is, if you cannot keep off the weight, it's healthier to not lose it in the first place as "weight cycling" or "yo yo dieting" raises the risks for heart attacks significantly.

About 5% of the public born with the obesity gene (according to obesity researcher, Rudy Leibel, size is 40-60% genetically determined) can lose and keep off the weight (7% with weight loss surgery according to the Hebrew U Study for one).

For the rest, it is strongly recommended that they consider following the "Health at Every Size" guidelines - Linda Bacon's book on this is excellent!

A clinical study at USC found that those following the Health at Every Size, guidelines without a focus on weight loss - ended up healthier than those who dieted - this study is highly respected and the cohort was followed for two years. Linda Bacon was one of the researchers and the other researcher was Julie Stern who is a member of the Weight Watchers scientific committee. Undoubtedly, Stern is not opposed to dieting and yet confirmed the results of this study which headlined "Non-dieters more successful at boosting health than dieters, study finds".

Isn't it time to "stop the insanity" and focus on real health which is determined by healthy food choices about 80% of the time and regular aerobic exercise?

Biggest Loser "Where are they now" show was blew some smoke screens

Lately the reality show, "The Biggest Loser" in which they sequester several clinically obese people, put them through grueling workouts of 5 hours or more a day and greatly curtail their food intake to effect quick weight loss, has come under no small amount of criticism.

It has caused a hue and cry among personal trainers and especially exercise physiologists who feel that the training given on the show is not only somewhat sadistic but sheds a negative light on personal trainers in general who try to teach people a healthy lifestyle.

Possibly what is most upsetting to the producers of the show (which apparently has versions in several other countries besides the USA) is the fact that the ratings of the show now in its 10th season, have fallen drastically, which can be a death knell for any TV show.

So tonight, NBC aired a show which promised to catch us up with what former contestants on the "Biggest Loser" are doing now and did they regain the weight, but actually seemed more of a "damage control" effort to try and convince the viewing public that what is done on the "Biggest Loser" is really a good thing and has changed lives.

Injury on the show has apparently (and rightly so) upset the public so the show dealt with that issue. The 9th season featured as the first challenge, a 1 mile run for clinically obese folks who had not exercised in quite a while and ended up with one of them, Tracy Yukich collapsing and being air lifted to the hospital where she remained for a week or more.

Dr H went to her home to visit and they relived the incident where she collapsed. Tracey's eyes filled up with tears when she watched the video and she commented that she thinks about this every day. She also said, "here I was 37 years old and almost - well gone."

Tracy is slim now and writes cheerfully on her facebook fan page that:

The Biggest Loser has changed my life. I never dreamed I would be at my college weight again. I am so grateful for all that have touched my life and helped me through this journey.

Tracy's website claims that she collapsed from heat stroke but that she was in the hospital for two weeks after, seems there might have been more wrong. Tracy uses her Biggest Loser fame and that she's kept the weight off, to do motivational speaking now.

On the catch-up show we watched on Wednesday night, they didn't say what happened to Tracey. The only explanation given by Dr H was that she was so fat, she had fat everywhere. Tracy weighed 250 lbs at 5'2" which while clinically obese, wasn't exactly the largest contestant either.

In researching this, I found out that likely what she had was "Rhabdomyolysis", a condition of muscle injury where the muscles break down releasing a chemical which injures the kidneys and can cause kidney failure.

The outcome of this illness (which also can happen with statin drugs by the way) is unclear according to the NIH:

The outcome varies depending on the extent of kidney damage. Acute kidney failure occurs in many patients. Treatment soon after rhabdomyolysis begins will reduce the risk of chronic kidney damage.
People with milder cases may return to normal activity within a few weeks to a month or more. However, some continue to have problems with fatigue and muscle pain.

According to another article, Tracey was restricted while on the ranch for any workouts, even in the pool so while she may be training for a marathon now, she may still have residual damage to her kidneys.

Quite a bit more than the "heatstroke" claimed.

Another contestant in that same season, Abby, got an early injury to her tibia and was also restricted from the grueling workouts and challenges.

Injury in the contestants was not really discussed in Wednesday's show though, which was filled with praise and emotionally filled statements of how the "Biggest Loser" was changing lives. Dr H. actually claimed that this reality show had found "the answer" to obesity and should get the Nobel Peace Prize. (Yes he said this with a straight face!).

Another problem which has cropped up is Ryan Benson. He was the season one winner who told all on his Myspace - about how he dehydrated himself for the final weigh-in using techniques he'd learned in wrestling and how he re-gained 30 lbs (just water weight) in the week after the finale.

The show ended with featuring the 9 winners of the "Biggest Loser" in a healthy Thanksgiving dinner (which although everyone oohed and aahed about how great the food was, it didn't look real appealing to me). Ryan Benson was at the dinner and said how he re-gained all the weight because he'd gone back to his old habits and how he was so inspired at seeing the other winners, some of whom looked a lot heavier than when they won the show. Erik Chopin claimed to have lost the 122 lbs he regained and although he looked a bit slimmer than he did when he appeared on the Season 9 finale, he didn't look anything close to how he looked when he won the show.

The show was supposed to convince us that those who had been contestants on the "Biggest Loser" had had their lives changed, had gone on to make careers of motivational speaking etc and how they were living the dream. But it was unconvincing. Some of the contestants in telling about their lives and their experience on the "Biggest Loser", wept while they were talking, suggesting they may still be emotionally damaged from the experience.

Out of some 200 people who had been contestants for the show, only 35 were "caught up with" and most of them were from seasons 8 and 9. But 35 had not kept off all the weight. As we know, Ryan Benson was back to his original weight and Erik Chopin was somewhat up in weight. A couple more had obvious regains. So that leaves only a few like Tracey, Alli, Tara, Mike who had kept it all off. About 7 percent or less of those who had been contestants on the show.... Hardly as Dr H claimed, a "cure" for obesity.

Will it work to save the show's dropping ratings? Only time will tell. That several have spoken out against the training and other issues (like Kai who was not mentioned at all) is hard to blow a smoke screen over. Emotionally and physically injuring obese people is not really acceptable in any circles, not even the most fat phobic ones.

Biggest loser premier shows lowest rating ever

An article on the Philly burbs tells how the show, "The Biggest Loser" suffered a significant loss in the ratings - 25% down. The article asks in the conclusion, "is it because Americans are tired of being reminded how obese they are?"

No, I don't think that's it at all. I think it's because of those former contestants who have spoken out about the sadistic methods of training used in the show, the long hours of workouts and the psychological abuse contestants get. The last one to "sing" who said she got an eating disorder after being on the ranch, might have signed the death nell for the show.

That and the fact that Ryan Benson, the winner of the first season has admitted he's regained to a higher weight than his original weight (not withstanding his open admission on his "myspace website" about how he clinched his win using techniques of dehydration he learned, back in his days as a High School wrestler - and how he gained 30 lbs the week after the big win).

Or maybe it was Erik Chopin appearing on the Oprah Show, almost back to his original weight. The Biggest Loser tried to do damage control by having trainer Bob, visit Erik and Erik admitting it was just all his fault. Bob extracted a promise from Erik to be back to a better weight by the finale but that never materialized. Maybe some of the viewers were looking for that event and didn't "forget about it" as the show producers likely hoped.

Perhaps it was the couple who appeared on Carnie's quiz show who got married but both admitted quite a bit of regain.

Or the contestant who told the press that the week before the finale, she had lived on diet jello all week.

There is also, a growing number of personal trainers who are very much against the way the "loser" contestants are treated by Jillian and Bob - they say it gives folks the wrong idea about personal training in general. And there have been articles in industry magazines which were critical of the personal training on the show. Likely some of this filtered down to their clients.

The show has received enough "bad publicity" to spoil the magic image of the weight somehow magically falling off the contestants.

Everyone knows if you starve and work out many hours a day, you will lose weight but that isn't even healthy, and rapid re-gain is likely. No magic in that at all. On the contrary...

New diet pills - easy weight loss or just a health risk

There are three new diet pills which are being boasted about in the news as safe and effective.

In a nutshell, no they are neither safe nor particularly effective but the media is sure are doing the hard sell on them. Will people remember the phen-fen fiasco which has caused a relatively rare deadly disorder, pulmonary hypertension to be something we hear about all too often? Will they remember that even a medication like Xenical (Alli') can cause malabsorption of fat soluble vitamins and fecal incontinence? (without much weight loss).

Or will they line up to get these new medications which are really more older ones, just recycled?

Take a look: Pillz Pillz Pillz - Easy weight loss or just another health risk

Shrek movies - do they really promote size awareness

On the surface, the Shrek series of animated movies seems to promote size acceptance. The so called hero of these movies is a fat green troll who is as noble as he is ugly. The lady he marries who first looks like a typical model type is actually a troll herself and turns into one when they get married. Like her husband, she's fat also.

There was always something which niggled me about these movies and after watching Shrek III, I thought it through.

I realized that not only is Shrek ugly looking but he's more than a bit uncouth (he IS a troll after all).

Everyone else in the movie is either a cute animal or very slim, nice looking humans - Shrek and wife are the only fat trolls.

Considering that, under the surface, Shrek does the opposite of what one might think. On an unconscious level, it connects "fat" with not only "ugly" but "uncouth" as well and it's pouring these connections into the unconscious minds of the viewers, the most pernicious type of brain washing and especially into the impressionable minds of kids.

I suspect if I had small kids I might not encourage them to watch these movies - more fat-a-phobia and negative connotations of people of size, we do not need.