Carnie Wilson - failed WLS? I don't think so...

I watched a video this morning, of an interview with Carnie where even with a body suit she admitted to wearing (full length girdle) she looks like she's regained quite a bit of weight. The video introduces her as a "failed gastric bypass". The interesting thing is it was put up by Provider who does - gastric bypass - (but a version of the older form) which like all the other WLS's LIKELY, has the same failure rate (about 34 percent of those with starting BMI of over 50, regain significant amounts of weight according to a 2006 study which followed patients for 10 years) cite: Annals of Surgery. 244(5):734-740, November 2006.Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD Abstract: Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.

However, we are not sure if Carnie would be counted as "failed" because she lost from 299 to 154 so that's a loss of 145 lbs. If she's regained 50 percent of that loss which is approx 73 lbs she would STILL be considered a success, weighing in at 227, which is probably pretty close to what she weighs.

Thus, she may NOT BE a failed gastric bypass. She may be, in fact, in the 70 percent who have and are expected to have, a rebound weight gain of up to 50 percent of what they originally lost.

So then, when in all the medical papers, they state that a 50 percent rebound gain after gastric bypass is EXPECTED and happens in MOST people, why do they call Carnie, failed?

First, most folks can keep off 50 percent of their excess weight WITHOUT surgery and WITHOUT taking the risks associated with gastric bypass especially if they work as hard as Carnie does.

And second, there seems a push among some providers to "discard" healthy gastric bypass patients who are in the 70 percent who have a rebound gain and sometimes in favor of ill patients who had "kept it all off".

For example, a few years back, the now defunct BARIX clinics ran an ad which talked glowingly about an individual's new life. The reality was, according to her own messages before she was picked for the ad, that she had reactive hypoglycemia and was more and more disabled by it and filing for disability. "I find it more and more difficult to talk up this surgery, " she commented in a message shortly before BARIX picked her as a poster kid. The ad suggesting she was slim and healthy appeared in several magazines like "Woman's Circle" and the like.

I also remember a lady who started out over 520 lbs, lost down to 170 and then regained up to 270 or so. She was STILL keeping off over 240 lbs which is way more than 50 percent of what she initially lost, making her a super success story, but she was dismissed from the provider's office in which she worked and told her weight gain was giving prospective patients the wrong message. Last I heard, she was seeking revision which is highly risky and not particularly effective.

Thus, bottom line, Carnie who is more like the AVERAGE gastric bypass patient, may be considered bad publicity for those selling this surgery as something after which, you "will be normal" and "will keep all your weight off" and will " suddenly look like a model with not much work" and will "suddenly be normal and be able to eat what you want without a regain".

A gastric bypass is, we are told done for HEALTH. Carnie was healthy before but she had some fat issues including sleep apnea, all of which, she has told us, have gone away. The only issue she has now is a hernia (she's had that for a while and apparently doesn't want to or hasn't gotten a chance to, get it fixed). She can keep off about 60 to 70 lbs which she never could do previously.

Carnie is NOT a failure, she is a SUCCESS and I feel that pressuring her like that could be endangering her life if she goes for revisions etc.

Gastric bypass is NOT cosmetic surgery. It will not make you thin if you are MOST people. It only makes 7 percent of patients slim and some of those have gotten very ill and cannot eat and others just work hard and never weighed that much to begin with.

It's really important when making this decision to realize that.

I am glad to see this video up on YOUTUBE - not because Carnie's surgery failed but because it can show patients a REALISTIC picture of what can be expected (in MOST patients) from a gastric bypass (of any variety).

Here's the video:

http://www.youtube.com/watch?v=Ad_U8IPsde8

Big Medicine - Big Problems?

The TV show we all love to hate, "Big Medicine" which details two surgeons in Texas, father and son, who "practice Weight Loss surgery together" seems to have run into some problems.

First, in the last episode I watched, they heavily - shall we say - misrepresented a weight loss that is, how much weight was lost as a result of a gastric bypass.

I've seem them do this previously but perhaps not as much as an exaggeration as with this patient.

That is, when she came to see Dr Davis, she weighed in at 335. She told Dr D that her high weight had been 360 but she had apparently been losing some weight on her own. Dr D, as is his protocol with patients to be, put her on a liquid diet to lose some more weight. He states that this liquid diet usually takes care of any fatty liver present and makes the gastric bypass surgery less risky.

"What we are doing, " said "Big D" the dad surgeon candidly in one show, "is creating a situation of malnutrition in our patients!"

So on the day of surgery, after being very conpliant to her liquid diet, she had lost another 17 lbs and weighed in at 318.

They showed her a month later for her follow up visit and at that time, she weighed in at 290, a loss of 28 lbs, 4 weeks after her gastric bypass. While that isn't a bad weight loss, apparently those in charge of the show felt that was not the huge number on the scale which tends to sell the surgery better.

No problem - this is TV so they can change it. They flashed on the screen a before and after photo - The after photo was the usual type cover-up because with a 28 lb weight loss, she didn't look that different (especially considering that most of the weight lost after a gastric bypass because of the low amount of caloric intake, is muscle and bone mass - muscle is compact tissue which does not show much when it's lost). That is, more slimming clothing and a more flattering angle in her "after" photo.

But they openly misrepresented the numbers. They listed her beginning weight as 267 and her weight, 1 month after surgery as 290, with a total weight loss of 70 lbs which they claimed happened in 4 weeks after the gastric bypass. Yes, I stopped the DVR and made sure that was the claim.

This was going one step further than the usual - claiming the high weight and then the current weight and hinting the surgery had been totally responsible when in fact, it never was. I sat staring at the stopped video in amazement about how they could openly misrepresent things when folks' lives were at stake.

After every show, they give a promo of what's on the next show and the show after this one looked interesting. It promised to show us a 20 year gastric bypass patient who had regained all her weight. This is not surprising considering one of the few 10 year studies on gastric bypass done in 2006 suggested a 34 percent failure rate - weight wise with gastric bypass in patients who had BMI's over 50 - that describes most patients seeking gastric bypass! That failure rate is true even though the surgeons generously count a maintained loss of 50 percent of the initial loss as "success" (as small as 40 or 50 lbs kept off in many patients) and keep in mind most patients have the surgery to keep off 100 percent of their excess weight because they can keep off a percentage of excess weight by themselves without surgery! (cite: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD Abstract: Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.)

I thought that show was going to be interesting and looked forward to it. Revisions on Gastric bypasses are highly risky and quite ineffective i.e. either the patient loses only another 20 lbs or so or worse yet, the patient loses too much weight and may require take down.

But my wait was in vain. That show never was aired. In its place, a re-run was shown and the following week, "Big Medicine" had been replaced by another show.

"Big Medicine" has been pulled suddenly from the air with no explanation.

I wrote to TLC asking about it and got a polite form letter back explaining that they received so many letters they just can't answer each one but thanks for writing. TLC has left their area on "Big Medicine" up only when you click to "get the schedule" (when the shows are aired) you get a blank screen. No plans to air it in the near future, it suggests.

Several are asking on the TLC forums, places which are moderated and usually receive a quick response but in this case, no one is talking. No one has answered the questions about where the show disappeared to.

Finally in desperation, I called the Surgeon's offices in Houston. They were polite and friendly - and totally evasive. They didn't know why the show was pulled - "Just probably some scheduling changes" the nice young female voice suggested and they could not say when it would come back on the air. "Probably in a couple of weeks," the lady assured me but when I asked her for a date, she didn't have that. "They don't tell us when the shows will air," she said. I asked her whether there had been a problem with the revision patient in the show which never aired and she said "Oh no! Everything is fine!". I asked her about one of the larger patients who had had his gastric bypass a year ago and who was not walking at the 7 month point post op, opined Dr Garth Davis, because his breasts were weighing him down so they scheduled him for a mastectomy which was done in August 2007. To date, he has lost down to 300 some lbs. "is he walking yet?" I asked. She lowered her voice a bit and mumbled, "n-no." Obviously the reason he was bedfast was not his weight which begs the question whether they should have operated on him at all.

"Perhaps they are faced with a lawsuit," suggested my engineer husband whose cleverness I really enjoy. I had not even considered that possibility but now as I think of it, that's a rather good possibility. Gastric bypass surgeons often weather many lawsuits because the gastric bypass has a high failure rate and a high complication rate combined with less than inpressive results especially in the longer term (more than 3 years post op). One study of 10 year gastric bypass patients found that only 7 percent were able to keep off all the weight they lost. This isn't much better than diets and at least you can walk away from a diet. (cite: (Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study) Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew))

I googled "Big Medicine" this morning and found that on one site, people were asking some questions about it and the gastric bypass in general. One letter suggested that some of the plastic surgery patients looked less than great after surgery and that one lady might have had a reason for a lawsuit - her implants had ended up in the wrong place. This writer went on to say that one of the patients, a man, looked like death warmed over after his gastric bypass.

So people are asking questions about it.

It remains a mystery for now.

There are many mysteries connected with this surgery. Dr Paul Ernsberger, PhD and associate professor of nutrition at Case Western medical school, detailed one of those most baffling mysteries on the Donahue show a few years back. He stated:

Well, the gold standard in medicine is the controlled clinical trial. We don't go subjecting 100,000 people to a surgical procedure without doing a controlled clinical trial or dozens of clinical trials, and then looking at the results. Do you know how many clinical trials have been published on weight-loss surgery or gastric bypass? Zero. None of them have compared it to clinical conservative treatment and found it to be superior for life expectancy or for anything else other than, you know, risk factors.
A number of trials have been started, and the final results have never been reported. We have to ask, you know, why haven't we seen the final results? I think it's because it's bad news.

Perhaps what we think is a mystery about the gastric bypass or the sudden and unexplained disappearance of "Big Medicine" (in addition to a couple of the new shows never being aired) is really also, bad news.

The cost of obesity and other spin

It's good to know how to interpret spin - that's the newspaper word for what Orwell called "Newspeak".

For example, we are told that obesity contributes to 100,000 deaths each year. Now that sounds like a lot except it's only a drop in the bucket in the total yearly deaths.

In 2002, in the USA, the death toll was 2,400,300. Since obesity apparently contributed to 100,000 of these, that means obesity _did not_ contribute to 2,300,300 deaths. Expressed in percentages, that's 4 percent of the deaths per year, obesity had a part in! Which means obesity did not have a part in 96 percent of the deaths per year!

Looks a bit different if we look at the whole picture, doesn't it? Why do we even think obesity is any kind of "problem"? Maybe the real problem are those who wish to sell us obesity solutions?

Even if we take the older figure of obesity contributes to 300,000 deaths a year, that's still 2.1 million deaths that obesity doesn't contribute to, isn't it.

The latest spin we are hearing is how expensive obesity is and how if we just lose 10 lbs we will save the health care system, millions.

The only way obesity can get expensive is with weight loss surgery. The average weight loss surgery costs 15,000 and they can cost as much as $50,000 and guess who pays for it.

Especially considering that in folks with BMI's over 50 (which most people seeking weight loss surgeries are), there is a 34 percent failure rate according to several studies.

Here's the cite for one of these studies - this is not available on the web (we wouldn't want folks seeking weight loss surgery to see stuff like this, would we?)

Annals of Surgery. 244(5):734-740, November 2006.
Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD

Abstract:
Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.

As you can see, this was a study on gastric bypass which is supposed to be so powerful in keeping off weight!

Actually, the longer a person lives, the more expensive their health care costs so if people of size really don't live as long as slim folks, then they would cost less, says an AP story which circulated recently.

LONDON - Preventing obesity and smoking can save lives, but it doesn’t save money, researchers reported Monday.

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

“It was a small surprise,” said Pieter van Baal, an economist at the Netherlands’ National Institute for Public Health and the Environment, who led the study. “But it also makes sense. If you live longer, then you cost the health system more.”

Doing the math, thin people if they do live the longest, are going to cost us the most money!

Smoking contributes to 400,000 deaths a year... that's still over 2 million deaths than neither smoking nor obesity contribute to.

Back to the gastric bypass, it kills off 2 percent of those who have it, within 30 days of surgery so would that outweigh the outrageous cost per surgery, most of which is paid for by insurance and premiums are passed down to other insured? (cite: death rate 2 percent within 30 days of surgery from 62,000 patients: report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study])

Wait, I'm getting more and more confused here. If living longer costs the system more money and obesity contributes to only 4 percent of the 2.4 millions deaths a year, why are people even worried about obesity?

It's the people who live the longest who are going to cost the health care system the most.

Bottom line. The news media is not gospel. Look at the big picture and spin quickly falls apart.

And for heavens sake, don't base a surgical decision on media spin!

If the RNY is so risky, why do they keep doing it?

I recently received a very thoughtful comment by someone researching WLS and decided that since many other folks may have similar questions, I would try to address the issues this individual raised.

First, Daisy asks:

If RNY is so harmful to the organism why do doctors still continue to indicate it?

The answer here is not a simple one so bear with me.

First, those who advocate the RNY are often those who are not involved in the long term follow up of their patients (most RNY follow up is done by Emergency Rooms, hospitalists and gastroenterologists). These individuals are impressed by the early results and may not be aware of the long term results (which admittedly are hard to ferrit out due to the lack of long term studies and the unavailability, for whatever reason, of many patients after 5 or 10 years). They also may feel that even though the vitamin deficiencies which cannot be supplemented, may shorten the lives of RNY patients, that untreated obesity, may shorten their lives even more.

Many surgeons answer the longevity question (i.e. how long you live after a gastric bypass) as Dr Wittgrove of the Alvarado Clinic did in the online interviews at the time of Carnie Wilson's gastric bypass:

Question: Dr. Wittgrove, I really need to know about how this surgery will effect me when I am old (70, 80 and 90's)

Dr. Alan Wittgrove: Hopefully you will live that long..... People who are morbidly obese don't have long life spans... Ideal body weight tables were based on actuarial data.... It is commonly known that people who are morbidly obese die earlier than those who are not morbidly obese.

One study by Dr David Flum which was delivered before a group of obesity surgeons but for some reason, never published in peer reviewed journals, which carefully examined 62,000 hospital records of RNY patients, did find an alarmingly high death rate in these patients. The researchers found that 1 in 50 RNY patients die within 30 days of surgery. And another 3-9 percent (depending on age and other factors) die within the first year. But when Flum and associates compared this to a group of 2000 obese patients who had been hospitalized for other reasons, they found a slightly higher death rate in the obese patients than in the RNY and concluded that, risky as the RNY was, the risk may be higher for untreated obesity.

The problem with that conclusion, as having been pointed out by several other researchers, was that comparing the RNY patients to any critically ill patients, even slim ones, would have yielded a similar result that is, it is predictable that among critically ill patients of any weight, the death rate will be higher than among healthy fat people who are in the hospital to have WLS. (report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study]

It is unknown whether obesity really shortens your life or not, although lifestyle factors i.e. amount of exercise, quality of diet, stress factors may have an effect on health and even how long you live regardless of what you weigh.

For as many epidemiological studies which are available which suggest that obesity does effect longevity, there are an equal number of epidemiological studies which suggest that obesity alone does not affect your lifespan.

And the few clinical studies we have available, suggest that lifestyle alone is what seems to affect lifespan and health regardless of what someone weighs and also that obesity alone doesn't seem to have that much effect, one way or another on lifespan or even health.

This story of what science really says about obesity is not seen in the media because, perhaps the media is more "marketing oriented".

The second reason why some surgeons continue to advocate the RNY may be because the public is demanding quick weight loss at any cost. It is true that some patients, even those who are very ill from the repercussions of the RNY, are still happy to not be fat anymore due to the societal pressures on the overweight population. It is also a fact that because of the massive healing internally after the digestive tract has been so drastically (and yes, permanently) rearranged, takes about a year and during that year, that, and also that patients find it somewhat uncomfortable to eat at all (food getting stuck, vomiting etc), often causes early post op RNY patients to lose their appetites - these end up eating very few calories a day i.e. 300-500 and some of what they eat is not absorbed. This is why some surgeons called the RNY "surgically induced anorexia" The idea of not having an appetite and the weight dropping off quickly and easily, is of course, highly attractive to folks who have struggled with diets for many years. However, those RNY patients in the 3rd and 4th year often end up on the same diets which didn't work before only the years of fasting and semi fasting have greatly lowered their metabolism.

Many people can read the informed consent information, can read the testimonies of patients who are extremely ill for life from WLS and still request WLS. I personally know of cases where family members have died and the sibs still go ahead with the surgery. This may be a simple case of human nature - what drives many who choose to use tobacco also - the idea that "if it's bad, it won't happen to me."

In this scenario, a better way to make a decision would be to consider all the possibilities and ask if this would be ok with you. That is 'reactive hypoglycemia' - would you be ok if that happened to you? etc.

People want to believe the dream that a surgery can change a fat person into a slim one. However, any surgeon will tell you that the RNY is for making very fat people, somewhat less fat because after the first or second year, most patients experience a rebound gain of 50 percent or more of what they originally lost. Keep in mind that the medical profession considers even a small weight loss as something which will lower health risks.

And the underlying reason why most folks do something about obesity remains "improving looks" although we cover our quest for looks with a thin veneer of "health".

Often the medical profession has advocated unhealthy practices, especially in a field where there is not much research. Classic was the cover of a Journal of the American Medical Association in the 1930's, which featured a photo of a group of doctors smoking cigarettes! Cigarette ads in the 1950's were still featuring medical advocacy of smoking like "more doctors recommend Camels than any other cigarette!"

Even today, many medical providers do not aggressively attack the smoking habit as they do, obesity, despite the fact that the proofs for the dangers of smoking are now, well documented and the proofs for obesity risks are not well documented at all.

Your second question:

have you ever assisted a patient who had complications due to the RNY surgery? And if yes, were these complications caused just because of the procedure itself or did the patients have some previous condition, such as diabetes or high blood pressure or high cholesterol level?

Yes, I have assisted many ill longer term patients and in most cases, their problems were strictly due to the repercussions of their weight loss surgery. Things like "Leaky gut" causing auto immune disorder, bowel obstructions and ulcers in the small bowel due from the leakage of stomach acid (the small bowel does not have a protective covering against acid from the stomach) and those vitamins like calcium which cannot be successfully supplemented resulting in maladies such as osteoporosis etc.

Problems like this are predictable because of the nature of the surgery and are not unknown in the medical profession because there is a long history with a similar surgery done to treat ulcers in the first segment of small bowel. This surgery upon which the RNY was based, is called the "Billroth II" and the mere mention of this procedure causes many medical providers to pale due to the various illnesses resulting from it, however, the surgery was considered preferable to the death which an ulcer in the small bowel would have caused.

It's a no brainer that when a major organ system is so greatly re-arranged as done in the RNY, that there will be serious repercussions from the surgery itself. Those who claim "no repercussions" are never the medical providers but rather those early term patients who are still somewhat concepting the surgery as a "magic bullet".

You further commented:

the floor for sick WLS patients... Why is it such a difficult floor? It takes me a lot to believe that it can be more difficult than a floor crowded with patients who have terminal diseases.

This is hard to understand from the outside but severely modifying such an important organ system so that it works differently can cause painful, terrible suffering. The best way you can get a feel for some of this, is to read the messages on the "gone wrong" group suggested by one of those who commented:

ossg-gone_wrong

This group is rapidly approaching a membership of 2000, many of whom have had dreadful experiences with the RNY.

Another comment of yours:

your campaign against RNY made me think that it is a totally irreversible process and those who submit themselves to it are condemned to live ill for the rest of their life, when this is not true. Complications exist in all kinds of surgeries.

First, can you see where not all surgeries are the same? For instance, the death rate in gall bladder surgery is about 1 in 7000 people - the same as one finds with the lap band.

Secondly, the RNY is irreversible and if you carefully research you will find this to be true. The only procedure they can do with a "gastric bypass gone bad" (as medical providers call it) is to reconnect the small bowel and arrange the organs in a manner similar to the VBG or stomach stapling only. It's kind of a no brainer that you cannot remove 300 staples from a stomach which has been resectioned into 2 pieces.

Third, as for living ill for the rest of their lives, this also is true. Here is a quote from a WLS surgeon who is still doing the RNY:

"By doing this surgery, you're creating a medical disease in the body. Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating."
(Dr Edward Livingston, bariatric surgeon in Self Magazine, 4-2001)

Note his terminology... "medical disease" etc.

it takes me a lot to believe that a doctor would recommend it if he/she was aware that it wouldn't bring any benefits in the future.

You have to realize the manner of thinking in the medical profession and that is, for the moment, not necessarily for the future, for many reasons, one of which is that if a questionable procedure is done now, it is possible that problems occurring in the future will be able to be handled by newer treatments. (and it is true that treatments are being developed daily which are changing the face of medicine).

There is a whole body of research which suggests that people never have to lose weight for health and that any type of losing weight program, even one which seeks a healthy lifestyle, poses some pretty serious risks, especially if done again and again as is the case with 95 percent of the public.

The following blog presents a summary of that research and does provide the cites:

the case against dieting

I hope this has, in part, answered some of your questions and I do invite you to research those websites I have provided.

Further research can be done at:

obesitysurgery-info.com

A Whole Floor to treat sick WLS patients?

I was talking with a nurse (RN) who works in neuro ICU in a large hospital in our town. I made some comment about those ICU nurses working super hard (they do - each nurse only has 2 patients and even at that, they basically hardly get to sit down during a 12 hour shift).

She surprised me by saying that was NOT the hardest place to work.

I naturally, asked her what could be harder.

She said that this hospital was a center for treating sick gastric bypass patients, having a whole floor dedicated to those patients. She had worked there once, she told me and felt that was the hardest place she'd EVER worked, even harder than neuro ICU.

I asked her why and she answered, "Because the 'gastric bypass gone bad' patients are so ill - it is so sad!"

Keep in mind that neuro ICU is where those patients with brain bleeds, strokes and brain cancer go.

But this nurse was basically saying that as ill as the neuro ICU patients were, the sick gastric bypass patients were even sicker!

Many people choose to have a gastric bypass after talking to a couple of happy post ops (most of whom are less than 2 years out and all of whom are less than 10 years post op), and attending a seminar in which the presenter shows a nice looking drawing of what is done (which doesn't have much resemblance to the real thing), parades some happy new ops and makes promises like "if you don't like it, it can be reversed" (not true) or "you will never have to diet again" (also not true).

They watch shows like BIG MEDICINE where all the episodes have happy endings and sick patients are never shown. Those who are losing TOO much weight. Those suffering from extreme malnutrition who cannot get out of bed. Those who get neuropathy and end up with mobility problems.

Sometimes pre ops ignore people they know who have had a bad result or even have died after weight loss surgery.

That's because the few post ops they get to meet (the happy ones) assure them that the sick people are a rarity and this is a myth they really want to believe.

A friend who is a medical provider told me about one of his patients who weighed over 500 lbs and rolled into his office in a wheelchair. She told him that her daughter had had a gastric bypass 5 years previous. "She's slim now," said the lady, "but she's been frail and sickly ever since." The mother felt being so large and even having to motivate in a wheelchair was better than what her daughter was suffering.

A whole floor just for sick gastric bypass patients. A whole floor of a large hospital. A place we will never hear about on "Big Medicine" or in the media.

fat people cost more money to treat

The latest spin from the press is how fat people cost less because they don't live as long as slim people... news media has been buzzing about "The costs of Obesity" for some time now.

What is costing billions of dollars in the treatment of obesity is WEIGHT LOSS SURGERY! The solution seems surprisingly simple. if insurance stops paying for weight loss surgery, and the complications thereof, then healthcare costs will immediately plummet.

A lot of information is missed by the fat-a-phobic media and others who look upon the fat population as a walking gold mine.

1. it's not a given that fat people are sicker than slim people.

2. it's really unfair to accuse fat people of "absenteeism"

3. it's not a given that being thin ensures health.

4. Dr Rudy Leibel states that although there MAY BE (may be... not definitely?) some advantage to being "normal weight" THERE IS NO EVIDENCE that fat people forcing their weight to lower than their setpoint, enjoy that advantage.... NO EVIDENCE? Right from the horse's mouth.

5. There is NO EVIDENCE that fat people have a shorter lifespan than normal weight people. Like I met this nurse yesterday who takes about a size 4 - perfect weight who lives on junk and fast food. Does anyone REALLY think that her diminutive girth will prevent that fast food from gunking up her arteries? It's interesting how people did not notice that in "Super Size Me" Morgan Spurlock ended up (after a month of 5000 calories a day at MickyD's) STILL slightly underweight but had developed FATTY LIVER, hypertension and high cholesterol. i.e. as many epidemiological studies we have to suggest that fat people have shortened lifespans, there are an equal number of epidemiological studies to suggest that there is no significant difference between the lifespan of the overweight or obese and that of people with weights in the so called "normal range".

What EVERYONE is forgetting: We are ALL living longer, fat and slim and there are large numbers of people getting into old age who didn't make it even when I was a young 'un. THAT'S what's costing us money... OLD AGE diseases which we never had to treat in quantity before recently when we developed ways of holding "Old Man Death" up the apple tree for a few years.

Of course, I suppose for the advocates of fat-a-phobia, weight loss surgery (especially gastric bypass) can be a two fer... soak 'em millions for the surgery and complications and then shorten their lifespan... what a boon for the industry... :(

diet pop - not so diet after all?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Spinning a Good Story on Tragedy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Open letter to Rep Mayhall about the no fat people served bill

Representative T. Mayhall, House, Mississippi, USA
re: HOUSE BILL NO. 282

An act to prohibit certain food establishments from serving food to any person who is obese, based on criteria prescribed by the state department of health; to direct the department to prepare written materials that describe and explain the criteria for determining whether a person is obese and to provide those materials to the food establishments; to direct the department to monitor the food establishments for compliance with the provisions of this act; and for related purposes.

Dear Sir,

With all due respect, I think this is a very foolish bill.

First of all, if the BMI limit for serving is set to 29 then, if Governor Schwartzenhagger of California visits your state, he might not be served? (His BMI is 32!) Also if most of the Olympic athletes visit your state, they also could be, under your bill, denied being served. In fact a large segment of the population would be no longer eligible to eat in Mississippi restaurants and this definitely might be damaging to your economy! So I have to believe that the BMI limit will be set higher than 30, like for example at 40. Assuming this, the bill still has many issues which should be addressed.

First, according to the CDC's revised statistics, people who are in the BMI range of 26-35 LIVE LONGER than those in the so called "normal range", probably, opined the CDC, because the so called "normal range" of BMIs are underweight for most people.

Second, according to the 20 and 30 year Cooper Institute studies thousands of people AND the HAES clinical study at USC, the KEY FACTOR to health is lifestyle NOT weight. Even National Geographics in a show which was generally NOT fat friendly, admitted that the scale alone does not tell the story about health and that a person who is normal sized could have viseral fat (that considered unhealthy) while people who are considered "morbidly obese" by the scale i.e. BMI over 40 but who were fit, could be totally healthy with NO viseral fat (like SUMO wrestlers who by the way, might also NOT be served in Mississippi restaurants). And what you may not be aware of is that many studies which suggest that clinical obesity is "deadly" do not give a relative risk factor which is significantly greater in high BMI individuals i.e. the relative risk factor must be above 2.0 to be significant. And as one author pointed out, for as many epidemiological studies which suggest that severe obesity is "deadly", there are an equal number of epidemiological studies which suggest that clinical obesity (BMI over 40) is not much of a risk factor.

Third, will restaurants have to weigh people before they are allowed access to the establishment? Weighing oneself, even for slim people is not necessarily, conducive to buying a lot of food and/or enjoying a night out, and this, if done on a large scale basis, might definitely negatively impact the restaurant industry in Mississippi. That would be political death to the sponsors of the bill especially if large groups of the populace of Mississippi either stopped eating out or traveled across state lines to enhance the economic coffers of neighboring states.

If you watched the movie, "SuperSize ME" you would have seen Morgan Spurlock, the underweight man who ate 5000 calories of fast food daily, for a month, visit the doctor at the end of that month and while still underweight (he only gained less than 20 lbs), his liver was showing evidence of "fatty liver" or cirrhosis, and, his cholesterol and blood pressure were also elevated. So one might ask how not serving overweight people would help those people who are normal sized or underweight whose food choices might be making them ill inside?

Furthermore, I guess I am further, tempted to ask if you feel Mississippi restaurants can NOT serve healthy food that you are so concerned about overweight people eating there as to prohibit them access?

However, since most folks in the USA are beginning to understand that fat is NOT necessarily linked with illness or bad health, and they know that bad food choices are bad even if they don't cause obesity (which is the case in the majority of the populace who are not obese), I have to conclude that health couldn't really be a factor in this attempted denial of access but then, what can be, I am wondering, your motivation for sponsoring this bill?

Perhaps, this is all about allowing restaurants to -not make- "reasonable accommodations", like chairs without arms, for those who are very large and do not fit into booths. And of course, since, disallowing groups of people access to restaurants for non reasons, is something Mississippi has done in the past, I guess your proposed law, that way, would be in the tradition of Ol' Miss!

Or maybe it's something as simple as name recognition since your name AND the bill have been plastered in the headlines across the country. There is something to this even if the name recognition is negative - after all, didn't Will Rogers say "there is no such thing as bad publicity, only publicity"?

Whatever your motivation for drafting this bill, what you might not have thought about is perhaps, the families of those large people might ALSO stop patronizing restaurants who deny access to their fat relatives or might seek those restaurants which DO serve all people and thus it might become very non advantageous for a restaurant to choose to comply with your bill, wouldn't it. And the bottom line would be starving out small business persons and I believe when you are reaching into their pocketbooks, that tends to be a bad move politically, in this country where economics is so important!

I cannot help wondering that since you have had strong ties to a large pharmaceutical company in the past, perhaps this is all about selling folks diet pills so they can eat out. I understand that the corporation from which you retired, Merck, is working on a new "hot" diet pill based on marajuana - perhaps you are helping to sell this (since their current diet pill has received some bad publicity for being damaging to the heart)? Said somewhat tongue in cheek but, ok, couldn't resist asking. Pharmaceuticals have done some "over the top" moves to sell medications!

I guess you know by now, that this bill has made great news and your state has become the "laugh of the day" across the USA. Congrats on that. What do you do for an encore? ** smile **

best,
SueW
learn about obesity - what science REALLY Says:
http://healthread.net/obesity.htm

Big Medicine - some interesting things

Big Medicine, the TV show about Weight Loss surgery (WLS) always ends on a happy note, with grinning post ops saying how much they love their gastric bypasses and this last episode was no exception. We saw a 478 lb bus driver visit the fire station because although he loves his bus driving job (in case his boss watches the show!) his dream is to be a fire fighter. We are told that he lost 101 lbs in a few months after his gastric bypass, the producers hoping that we will forget that he lost from 579 to 536 on the liquid diet -before- his gastric bypass. Actual weight loss was 57 lbs after his gastric bypass which is good but not -quite- as impressive as it is if they add the weight that he lost on the liquid diet. What's a little exaggeration between friends, right?

We also saw a 2 year post op gastric bypass patient who got plastic surgery for oversized legs who said he was happy to go into the "normal man's store" and buy clothing "off the shelf". Trouble was he was in a "BIG MAN'S WAREHOUSE" so probably could have gotten clothing off the shelves at his original weight of 535 lbs. "I lost 230 lbs" he said - it was 220 before plastic surgery on his legs and he said his weight loss had been at a standstill for several months. Dr Garth said that maybe this plastic surgery would get his weight loss restarted. But the "window of opportunity" has closed for this man so weight loss from this point will be the old fashioned way involving a diet. Trouble is, he was likely not told that before surgery. In the several weeks after his plastic surgery, he had NOT lost any more weight.

Thing is they show his before photo where he weighed 545 and his after photo where he weighed (it said) 215 lbs (and I stopped the DVR to check that too!) and weight loss of 230 lbs. I guess they are hoping no one watching will do the math... his current weight would be 315 lbs!

All the wizardry and small oops's aside, there were some interesting things which one who is listening carefully, might notice.

The man who got plastic surgery had -lymphodema- (the plastic surgeon did mumble that a couple of times) and so we all know that cutting that off doesn't necessarily cure it especially in someone who is still clinically obese (which of course, they are not supposed to be after this magical surgery).

Couple that with the gal who had her bypass 3 years ago and was regaining her weight. "I don't get full anymore after a meal" she told us. She went to the surgeon to see if anything was wrong - pouch stretched etc.

This of course, poses a dilemma to the producers - if they find something wrong with the pouch, they preserve the myth that if everything is in tact, patients will never have a weight problem again -but- it also could reflect not so well on the doctors. However, if nothing is wrong with the pouch then the audience might get the message that the surgery stops working after a few years which is of course, the case with many patients.

The producers decided to take the latter route and showed a scene in which slim Mary Jo, the staff psychologist, was telling the lady how it was all her fault that she regained because she's off track etc etc etc. Mary Jo's solution: keep a food journal and diet. Hmmm but isn't a gastric bypass supposed to make it so folks "never have to diet again"? After all, if they had been successful on diets, they would not have gone for the bypass in the first place. (which is a comment I hear repeatedly on the gastric bypass regain support lists!)

Finally after Dr Garth was called in to look at the 2 year 315 lb patient's lymphodema, he walks out and tells Dr DelMonico (the plastic surgeon) "Well, gotta go and make more patients for you!"

Somehow that remark seemed more than a bit inappropriate but gives an inkling just how some in the medical profession view the process - as a money making deal.

Greatly contrasting with the positive attitude on the "Big Medicine" show was a letter I received today - her spouse had a gastric bypass 6 months ago and has had nothing but medical problems since, and she is at the end of her rope. I get 1-2 of these every week. And I don't think you will ever see -those- patients on "Big Medicine" because the surgery making someone very ill is still a -big secret!.

Pizza, Fat and Genetics

My 12 year old granddaughter is as slim as a rail. Not "skinny" but just perfect... looks great in pants etc. Like I never did, never was. And she basically eats what she wants too. Fast food, pizza, whatever. Even according to the fat-a-phobes, she is apparently like 90 percent of the other kids because the so called "obesity epidemic" only affects 10 percent of kids!

And I was in the "lucky" 10 percent!

I remember those darned kids who lived on pizza and coke when we were in High School and never had a weight problem. I had to starve, literally, to get down to 135-140 and then the minute I stopped starving I gained right up to 170. (And I'm 5'5" so I'm somewhat altitudinally challenged). Unlike these modern kids, pizza and coke was basically never in the house for us - neither candy except at Christmastime and Easter. We had apples and oranges for snacks.

Pretty much through elementary school, I did 2 hours daily of bicycle riding or skating or playing ball (after school that is, and during school, we had P.E. daily and also active recesses - something kids do not have now).

In High School, I was in intramurals twice a week (played volleyball or tennis or badminton or had trampoline), I swam during my study halls and I walked home from school, 3 miles every day with books and a violin. I also walked to stores and/or my violin students homes (what I did to make a few bucks in High School) That kept me at a weight of 170 lbs, unless I starved (ate about 500-800 calories a day) so I DID starve to stay within a somewhat normal size in High School. No breakfast, no lunch and then, a small supper... can we say "eating disorder" sports fans? Of course no pizza and very little coke. My High School social life was spent in watching others stuff their faces with goodies with apparently no worries about "getting fat".

So, my 12 year old granddaughter told me that they had pizza the other night. Now she's somewhat active but not near as active as I was, riding my bicycle for hours etc - Just out of curiosity, I asked her if pizza filled her up. She answered "Oh yes!" and I said "how much pizza do you have to eat because you are full" and she answered "about 1 and 1/2 pieces!"

I remember distinctly, not only did pizza NOT fill me up but left me with hidden hunger and a sick stomach if I ate more than a bite. And that to fill me up, took at least 3 or 4 pieces of pizza. And at 400 calories a slice, that's a bunch of calories to consume at one time.

Maybe there is something to this satiety disorder thing.

So now I eat mostly veggies, still no pizza, fast food, candy or junk food. And I exercise at least 40 minutes of cardio a day and often more. That to keep at a svelte (not) 250 lbs. (I'm not counting the half hour of yoga I do daily because that's not "fat burning" - actually seems nothing is fat burning for me!)

I talk about this because I see in the papers daily and on TV, slim people expounding about how ALL fat people eat too much and move too little. The latest study (maybe I should put that in quotes!) tells us that you should diet when you are pregnant because if you have a big baby, you are "dooming" your child to a "miserable" lifetime of obesity.

Well, ironically enough, I -ate- during my pregnancy (gained 40 lbs), was clinically obese when I delivered by natural childbirth - I also exercised daily during my pregnancy so was a fit fat mom. I had a normal sized baby who was an Apgar 10 (that's a scoring system from 1 to 10, 10 being the highest score a baby can get meaning no birth defects and perfect healthwise).

So much for the "diet during pregnancy - deliver a small baby" myth. Add that to the numerous myths we hear daily about obesity - like the one which states that -all- fat people eat too much and move too little.

And my 12 year old granddaughter, you know the one with the ideal figure? She weighed 9 lbs at birth and now can eat anything she wants and still is slim without being overly active (like I was).

The name of the game here is -genetics! As geneticist Rudy Leibel states "Size is 40-80 percent genetically controlled".

Genetics, the big "G" word that no one wants to put in the media because we people of size are not only a great target for derision and bad examples, we also are a great market for the diet industry which has now "ballooned" to 55 billion bucks a year just in the USA.

That's a twofer - two for the price of one. Verbally abuse fat people then sell them a diet, over and over again. No wonder the 90 percenters who do not have to deal with clinical obesity are not wild about stopping -that- gravy train!

is this a diet blog?

I had a gent leave a comment here, saying he just loved the content of this blog. And then, in the next sentence, he advertised his favorite -diet- site.

And I am wondering about this. I'd love to believe his first sentence but I have to say that if he's read my blog at all, how could he ever think I would be amenable to advertising a diet blog?

To paraphrase one of my favorite movie characters (the bad cricket in one of the ant movies) "Do -I- -Look- like a person who is into diets?"

I am actually a fat gurl (well, not such a girl maybe) who is 120 lbs overweight, lives a healthy lifestyle without the worry of pleasing the scale OR medical providers with fat-a-phobia, who seems to be outliving many of my slimmer friends.

And I must say that in my long life of 63 years, I have -never- seen a good result of any kind of dieting.

Maybe that's kind of a no brainer because when you diet, you deny your body nutrients and put your body into starvation mode - how ever can this be healthy?

I've known people who lost 70-100 lbs .... and then came down with cancer (and died). And I've known people who lost 30 lbs only to regain 70 lbs. In fact most people I've known who have lost weight, are lucky if they -only- regain what they lost. I've known people who restrict calories to low amounts, run marathons, have low risk numbers, are congratulated by every doctor they see and then, come down with their last illness in their 40's and 50's and die a couple of years later.

My so called risk numbers are not low. They are not extremely high but according to the fat-a-phobics, way to high for me to be so doggoned healthy. My cholesterol's about 250 (of course my HDLs are 56 and the ratio is "correct"), my LDLs are 139, my blood pressure is 140/90 on a good day (without medications).

Frankly I'm not sure this is anything to worry about (and worrying about it may be much more dangerous to my health than my numbers not fitting in to the ever decreasing "perfect numbers") Because the risk numbers are also very low in anorexics, and terminal AIDS and cancer patients yet can we really say they are "at less risk"?

Oh and my waist measurement is um.... generous. Not the equator but way into the area which Dr Oz says is highly risky.

I find some things in life rather interesting such as:

1. a dear friend of mine who describes herself as "super sized" has outlived 48 of her large friends who had weight loss surgery

2. my slim father was always given a good bill of health by the medical community while my BBW mother was told she was on the brink of death because of her weight and yet, my slim Dad (also a lifelong smoker) died suddenly of a heart attack when he was 63 and my high BMI Mom was still going strong at the age of 68 when she decided they had lied to her and obesity was -not- going to kill her so she used a more traditional method to hasten her demise - a gun.

3. a relative who is in her 70's is super sized and diabetic and very healthy - travels all over the world, takes cruises and only quit working last year.

According to the diet industry-driven media, all this is not supposed to be.

Meanwhile, society keeps buying this message that we -must- starve ourselves to a certain weight despite increasing evidence that not only does dieting -not- work but several studies suggest it is a risk practice to diet. But then, why would starvation, practiced or environmental be healthy?

Lately evidence keeps pouring in that our 65 percent fat society is actually living -longer- than society did in days of yore before the deadly obesity hit us.

For example, yesterday a news item told us that we just are -not- seeing the deaths from heart disease we expected. In fact, heart disease deaths have "plummeted" the article says, continuing to warn us that due to the obesity they are going to get worse. But wait, the obesity is already here and they are plummeting? Is this like the killer bees which never arrived or the Y2K which was supposed to shut the the world which -never- happened or the bird flu pandemic which we have been waiting for, for 4 years now? Media spin to get our attention so we buy diet products?

In the last couple of years, the average lifespan, in case you didn't notice, has been creeping ... down? Nope, in fact it's been creeping upwards. Last year we were told that women could be expected to live until 80 now.

Has anyone noticed that before the days of obesity, like at the turn of the 20th century, the average lifespan was 45? Back then, people got lots of exercise, they did not have any transfat or fast food and obesity was just about unheard of. Yet the average lifespan was so low.

Maybe just maybe (heresy alert) we are -designed- to be chubby animals in an environment where food is abundant?

Do I -look- like I support diets? Perish the thought. My philosophy is more like "eat dessert first because life is too short"!

Why are so many weight loss surgery patients on antidepressants?

A friend sent me an article today from one of the large medical sites. The article was authored by Drs Roizen and Mehmet Oz (of "You On A Diet" and Oprah show fame). Although they are two of my favorite health authors, they sometimes do not distinguish between when they are giving facts and when they are expounding on their theories.

This article talked about gut hormones and how they can affect the moods and my friend, a gastric bypass patient, asked if this was the reason why so many longer term gastric bypass patients require anti-depressant medication.

A logical question which I began to think about.

Truth is, no one knows why, although several studies done by psychologists have suggested that gastric bypass surgery seems to cause more psychological problems and relationship problems than it cures (despite what the TV ads tell us).

However, in pondering this, I came up with a few of my own theories. For what they are worth (probably not much) - I am not a psychologist and I don't even play one on TV.

I think so many gastric bypass patients are on anti depressants for the following reasons (and this is -my- opinion, not scientific fact - how's that for a disclaimer?):

1. Many people including those who become severely overweight are handling some of their stressful situations with food (it's a well known fact that a goodly portion of the population can medicate with food without becoming severely overweight although this is something the diet industry works earnestly to keep secret). For some, the consumption of food causes the production of endorphins (our body's natural -feel good- pain killer which actually has a similar structure to the opioid drugs). This, in some folks, can actually function as an anti depressant. When the person is severely calorie restricting in dieting or gastric bypass surgery and not able to use food as a comfort, they miss that "anti depressant". And of course, foods which are low calories are generally not the ones which produce endorphins (like broccoli).

2. Gastric bypass pre ops are never warned that in order to keep some weight off (in some people) the doctors will be giving them a disability of the digestive tract. Gastric bypass is sold as a fix rather than the introduction of one illness which hopefully causes less pain than the one it's supposed to cure.

"By doing this surgery, you're creating a medical disease in the body. Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating."
(Dr Edward Livingston, bariatric surgeon in Self Magazine, 4-2001)

So when they wake up with a disability, they are totally unprepared... never expecting they would be coping with new illness. And to make things worse, there is no help for them. No one takes them through the four stages of getting used to a disability (similar to the four stages of mourning) because no one wants to admit that gastric bypass -is- a disability.

Generally speaking, disabilities you cannot see, tend to cause problems with doctors and friends alike. People are often, overly considerate at the sight of a wheelchair but not considerate at all to someone who is struggling to walk on their feet (who may need the help much more than someone who has become mobile via a wheelchair). Likewise for a doctor confronted by a gastric bypass patient with gut pain or stomach pain which likely has a real underlying physical cause. It's so less troublesome to say "it's in your head" and prescribe anti depressants which only are a bandaid, than it is to try and unravel the complexities of illness which drastically cutting up and rearranging your stomach and gut can cause.

3. The high number of marriages which break up after WLS is similar to the high number of marriages which break up after a person gets, for example, multiple sclerosis or a spinal cord injury. The spouse sometimes, can not handle the disability and what goes along with it... visits to the ER, illness and/or inconvenience plus the pain and suffering which accompanies this. Many marriages may be more based on the fact that they like to have fun together rather than the "better or worse" principle and so when the "worse" comes along, it can do damage to the well being of the couple. Additionally, the couple was never expecting anything but an almost magical "cure" to obesity when the patient got WLS and so, both are shocked and unprepared at the reality.

4. As mentioned before, people tend to lack sympathy for disabilities which are not obvious to the casual observer, as is true of those in the digestive tract. To make things worse, the person might "look good" and be "the picture of health" according to what we are told - slim - so what on earth is their problem, people wonder. That the patient is often sick a lot, losing efficiency at work, depressed, suffering pain and more must be in their head because they are slim, right? The gastric bypass patient who has regained a lot of weight, fares even worse. One often hears horror stories of patients with serious physical problems, having their medical providers tell them that all their problems would be solved if they -only- could lay down their fork, the provider totally ignoring a potentially serious problem the patient is complaining about!

5. Somehow, a disability which seems a result of a decision one has made, is worse than one which happens by luck of the draw. But, truth is, that many patients were -not- aware that they were, in fact, chosing a disability because the media sells the gastric bypass as a medical cure for diabetes, and whatever illness people have, as well as a fix for being socially unacceptable i.e. fat. So when illness and repercussions occur, the patient has an easy time agreeing with the medical providers and the rest of the WLS community in saying that somehow -they- caused the problems they are having. This is depressing to think about and may explain the reactive depression which many patients suffer. That is, they blame themselves but somehow can not -do- anything to help the situation.

6. Ok, perhaps Dr Oz and Roizen's theory of gut hormones being disarranged might play into the equation too. I wouldn't doubt it. The drastic rearrangement of digestive organs is bound to cause severe repercussions. That seems a no brainer.

7. And last but not least, many people were depressed before surgery and those providers who promised that being slim or losing weight would solve all problems were simply not even close to the reality.

Whatever the case, people who decide on gastric bypass surgery should be totally aware of all the repercussions which can occur by making sure they have informed consent, and that they understand that this is the type of medical procedure which "breaks" one thing (the digestive system) to hopefully fix another thing "obesity" and that they will be dealing with new disabilities and co-morbidities even if their procedures go well for them.

I feel that medical providers who tend to not give us lay folk informed consent (one medical provider told me "if we gave informed consent, no one would ever have anything done") need to consider distinguishing between those surgeries which are essential for survival, and those which are elective. I think they also need to trust us more - that we can do research and that we can know what will work best for us even if our answer to their proposed medical procedure is negative.

It's all her fault that she got a repercussion of WLS

In my favorite WLSer blog, "Melting Mama" , Beth details how some "rocket scientists" are accusing her of -causing- her reactive hypoglycemia. "You ate too many carbs" they tell her.

She answers:

"I'm currently diagnosed as a reactive hypoglycemic, and The Cause IS my Roux En Y Gastric Bypass. I do not know if I have nesidioblastosis, because that is tested by doing an arterial calcium stimulation test to the pancreas, which is probably in my future if my episodes of hypoglycemia do not improve with medication and diet, or get worse.

Seriously, though, do you really, truly, think that eating carbohydrates CAUSED this?

It's a fair question, I guess, but, really? If that were the case - everyone around me should be dead."

I hate it when patients get a repercussion of the bypass and both the WLS community AND medical providers blame -them-.

For example the other day, I phoned a 9 year post op gastric bypass patient who had been repeatedly told she was a failure. She had originally lost 150 lbs (from 320 to 170) but had had a rebound gain of 85 lbs. In addition, she has anemia requiring iron infusions a few times a year. She is a very compliant patient, following carefully the rules for post gastric bypass including taking her supplements, getting regular medical follow-up and watching what she eats.

The bottom line though is that she is -keeping off-, 70 lbs - something she likely, would not be able to do without WLS.

She was extremely surprised when I told her she was a textbook success. Repercussions like anemia are expected in some patients (after all, the part which digests iron has been bypassed in a gastric bypass) and surgeons write in the medical papers that they expect most patients to have a 50-60 percent rebound gain within a few years of surgery.

The problem is that this is -seldom- what the patient has been told. Most patients have been to seminars where the small percentage of patients who can remain slim after their surgery have been paraded, thus strongly suggesting that this is or can be, a cosmetic procedure to make them _look_ better and fit in better. They are told things like "if you don't like this you can have it reversed" (- not - true - the gastric bypass is considered a -permanent- change to the body) or "You will never have a weight problem again" (very not true - post WLS patients of any procedure are -expected- to diet and exercise to maintain their weight loss and only a small percentage will maintain the -entire- weight loss, that is, most will regain a significant amount of weight).

One patient who had regained it all and complains that anything she eats will cause more gain, was told by a medical provider:

"You are regaining weight because your body is in starvation mode from the malnutrition caused by the WLS"

Kind of a no brainer so why aren't -more- patients told this? Simple - because in my observations when patients are told the full informed consent information about Weight Loss Surgery, only 50 percent or less of those who were originally investigating, go ahead with the procedure. Even many who are keeping off as much as 100 lbs feel that the repercussions they got like neuropathy were -not- worth suffering the comorbities caused by the surgery.

And if you do the math, if half of those seeking WLS, decide against it, that means they will -only- be doing 100,000 WLS surgeries a year instead of 200,000. While 100,000 WLS procedures sounds like a lot, it's not what will keep the providers in the style to which they have become accustomed.

Whatever, the case, patients have a right to know the informed consent information, before surgery - if nothing else than to be able to answer the naysayers who will blame them if they get normal and usual repercussions after their WLS procedures.

"An informed patient is a healthy patient"

(Note the pictured person is not a gastric bypass patient but rather a fashion model)

Queen Size movie was a Queen size diet ad

Recently Lifetime aired a movie called "Queen Sized" about a very fat High School lady who was nominated for Homecoming queen as a joke and then, decides to run. A good summation of the plot of the movie, stars, movie trailer and short analysis can be found here.

About the only positive thing I found in the movie was the main character played by Nikki Blonsky, was really fat and actually wore somewhat youngish clothing.

But the movie was actually anti fat and perpetuating the same tired old myths about fatness over and over.

Based on a real incident which happened in 2004 in Detroit to Allie Burris, various facts about Burris were changed in order to push the anti fat agenda. Whereas Burris' Dad died of asthma, a non fat related disorder, Maggie's dad died of diabetes which is said to be fat related (it is genetically related rather than fat related but it's one of the sound bites they use to scare people into dieting). Throughout the movie, although we are reminded that it - isn't nice - to make fun of fat people, we are also reminded that Maggie should lose weight to save herself from the deadly diabetes which killed her Dad.

In the real incident, Burris got the support of the other High Schoolers and got elected to Homecoming Princess (she was supposedly elected so they could jeer while she was riding in the parade but her ride was without incident). In the movie Maggie got the support of a lot of her contemporaries who were tired of the lady who usually won, but when Maggie stood up to accept the honor, she was almost unanimously booed.

Supposedly, the audience was told she brought that upon herself when she took a TV interview and acted fat and proud. "We want the old Maggie back" said several kids to her. That is, the Maggie who hated herself and thought she was a failure and buried her sorrows in food -that's the one the High Schoolers liked, NOT the new Maggie who actually thought she could do something. Ostensibly some kids who worked in her campaign got angry at her because she didn't mention them as having a part, on TV but they helped, the movie gave us the impression, because they "felt sorry for her" and not because she had any attributes worth anything.

Everyone else in Maggie's family was Hollywood slim and the movie clearly suggested that Maggie was fat because she was out of shape (they showed her running and puffing, walking and not being able to keep up with the other kids and so forth, implying the only exercise she did was opening the fridge plus the arm exercise of putting the food in her mouth). Maggie was also fat, the film showed us, because everytime something went wrong, she ate - all of the wrong things of course. Never did so much as a veggie pass over her lips.

The usual stereotypes we all are familiar with. People are fat because they eat too much and move too little. Only like other stereotypes, these are equally erroneous. There are plenty of slim High Schoolers with binge eating disorder and plenty of fat High Schoolers who are like I was - exercising MORE than the average person (I walked EVERYWHERE I went, I swam during my study halls, I ran from class to class) and STILL only achieving a somewhat large-normal size by starvation. Society doesn't want to admit fatness is mostly genetic because then they couldn't have their fat-a-phobia in comfort. But science says that size IS genetic. The "Queen Sized" movie did not teach people that however. On the contrary.

Interestingly enough, all the high schoolers were shown as slim and perfect looking. I guess the makers of that movie hoped we wouldn't ask difficult questions like "where are all these fat kids that the obesity epidemic mongers are telling us about?" Two fat kids in a large school? Where is the epidemic and why do we have to be "worried" if only 2 out of 1000 kids is fat? Guys, you cannot have it both ways!

"Queen Sized" wasn't even that interesting to watch. It dragged in several places. I fast forwarded through the commercials but I'm told the diet industry was advertising a lot.

The end of the movie was like the rest of it. Maggie goes back to being humble and carefully finds all the candy she has hidden in her room and throws it in the garbage so the audience is consoled with the fact that she has finally decided to get with the crowd and lose weight.

If you haven't seen this movie, I don't think you've missed anything but more of the same dose of fat-a-phobia we get on a daily basis. It was just cleverly (or not so cleverly) cloaked in a different wrapper.