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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

gastric sleeve story

If you look at this blog, you will see the glowing report from a new op on the gastric sleeve. She didn't want the gastric bypass (admits she was 'barely qualified' for WLS by US standards) because she felt it was "too drastic". But although things are rearranged in the gastric bypass, nothing is taken out of the body.

Not true of the sleeve - this drastic surgery calls for the removal of 90 percent or more of the stomach, creating a Frankensteinian pouch which holds only a couple of ounces of food.

The new op goes on to credit her normal weight to the sleeve and the reduction of ghrelin in her blood not realizing that her lack of hunger now, is simply that her stomach is going through a healing process. Human appetite is NOT controlled by one hormone, scientists will tell us and I would ask, how many people are fat because they only eat when hungry anyway?

That ghrelin has anything to do with appetite is merely a theory however, there is a body of evidence suggesting that those with less ghrelin in the system also have less growth hormone and this can cause premature aging. That, they don't tell you in WLS seminars.

Back to the new op, she runs a couple of hours a day and has done a triathlon or two. Since she is working out like those on the "Biggest Loser" she has lost weight like they do. But when she's all healed and finds her lack of a stomach to be more of a liability than an asset, like when eating healthy food like veggies with bulk is difficult which makes many tend toward foods which go down more comfortably like milkshakes, then she will likely leave her glowing testimonials up and not warn newbies of the other side of the story which she has regrettably discovered - all too late.

Some of us call this the "conspiracy of silence", the lack of negative information about weight loss surgery which leads 200,000 people a year to get cut without really knowing what the repercussions might be.

Sadly, the sleeve is viewed as less invasive than the gastric bypass and this is so not true. Since most folks know someone who has had a gastric bypass with a bad result (the least of which was regain), many are now choosing the new guy on the block, the sleeve, as the weight loss surgery panacea.

Still looking for the easy way out. But like the perfect solution, the easy way out doesn't exist and grabbing of something which is being sold like used cars, might make things a lot worse.

CAVEAT EMPTOR.

Remember even the surgeons admit, and most older op WLS patients will tell you that....

"Success with weight loss surgery is 10 percent the surgery, 90 percent the patient" (Dr Terry Simpson, MD and WLS surgeon)

Overweight and Obese Kids eat Less than their slim peers

Totally destroying the image of the fat kid overeating which has been so popular on the American scene, a new study out of Canada found that actually overweight and obese kids ate less calories than their slimmer peers (those of us who have fought a weight issue all of our lives are familiar with this one, having had to watch slim folks down huge portions of pizza while we munch on a carrot!).

The researchers studied over 12000 kids aged 1-17 and had a mathematical formula to adjust for self reporting inaccuracies (parents reported intake for kids 5 and under).

The study was reported on at the Pediatric Academic Sciences 2010 annual meeting. (Note: a sign-in may be required to read this article on Medscape - registrations are free)

"Our study provides the surprising finding that older overweight children report consuming fewer calories than their healthy weight peers. The finding indicates that intervention strategies solely targeting energy intake in older children may face difficulties," study presenter Asheley C. Skinner, PhD, assistant professor of pediatrics, Department of General Pediatrics and Adolescent Medicine at the University of North Carolina at Chapel Hill School of Medicine, told Medscape Pediatrics.

This result was similar to the results of the unpublished studies of activist and educator, Russ Williams. Williams interviewed 6 caterers who had catered conventions for NAAFA (National Assn for Fat Acceptance) as well as many other conventions attended by average weight patrons. He found that 3 of the caterers stated the amount of food consumed at NAAFA conventions was equal to that consumed at other conventions but 3 of the caterers reported that the amount of food consumed at NAAFA conventions was significantly less than consumed at other conventions.

Isn't it time we kill the TV stereotypes and accept that people who become obese may have strong genetic and physical reasons for their size?

Dieting 'Stints' Linked to Heart Problems

Did the headline get your attention? It's one we've all been waiting for and the story of a new study which was reported to suggest this, was carried in many media stories including this one on aol.

According to aolhealth news:

Adopting a strict low-calorie diet can lead to harmful health issues like heart disease, high blood pressure, cancer and diabetes, the Daily Mail reports.

Curious about this, I traced down the study upon which the story was based. The study was published, I found, in "The Journal of Psychosomatic Medicine", and the abstract is available on PubMed.

Unfortunately, this study didn't actually find what some news stories reported.

It was a 3 week study in which they took 121 women, divided them into 3 groups: One group was calorie restricted to 1200 calories daily and the members were asked to journal their food, a second group was provided food to equal 1200 calories a day, so did not have to journal, and the third group did not have to restrict or journal at all (these were the controls).

At the end of 3 weeks, they were asked to provide urine samples and also to fill out a survey about how stressed they felt.

The two calorie restricted groups reported higher levels of stress on their surveys as well as evidenced higher amounts of cortisol in their urine than the controls (cortisol is thought to be the "stress hormone" produced in the "fight or flight" syndrome and pundits have theorized that higher levels of cortisol might cause weight gain but this is strictly theoretical at this point).

Where the media got the "higher risk of heart disease" must be that stress is considered a factor for heart disease as well as numerous other illnesses. Unfortunately, a three week period of stress could hardly be considered as "life threatening".

The study was initiated because the researchers wanted to see if the stress of calorie restriction was a factor in diets being largely ineffective in most people and also if the physical presence of elevated levels of cortisol could possibly be sabotaging efforts to lose weight.

They concluded that

"Dieting may be deleterious to psychological well-being and biological functioning, and changes in clinical recommendations may be in order."

While this is a conclusion we all like to hear (and suspect may be true in many cases), the study had many flaws as far as "proving" this theory.

First, if a person embarks on a lifestyle change and habit changes (in order to restrict calories), the greatest amount of stress will be felt in the first several weeks as they are getting used to the changes and this probably could be said of any healthy lifestyle changes such as indicated in a HAES lifestyle change as well. It has been said, it takes 90 days to form a habit.

However, after the 90 days, the stress levels resulting from any habit changes including calorie restriction, would have to be examined again, because as one gets used to the new program, one's stress levels would be suspected to diminish. (No one has determined whether the higher levels of cortisol in the experimental groups of the 3 week study were from the stress of change or the stress of actual calorie restriction, because the study did not last long enough to really gauge this.)

Secondly it would make a big difference in stress whether the participants in the "intervention" wanted to be on these programs or not. That is, if the women were of average weight or opposed to dieting or had never dieted before, this would make a big difference in the amount of stress experienced in study participants. We are not told this in the abstract - I am, at present, trying to obtain a copy of the study article.

But this again raises the much discussed question, is calorie restriction really unhealthy? The jury seems still out on this one, it appears, with passionate advocates on both sides of the issue.

The following should be considered:

To start with, it's a known fact that in outlying areas where food is not as available as it is in the USA and there is no electricity etc, people do live on about 1200-1400 calories a day and survive well. In fact, it has been theorized that one of the genetic factors explaining why some of us are so weight loss resistant is that our ancestors lived in places like Chihuahua, Mexico and/or Outer Mongolia and we carry those genes.

It also has been observed that in places with no TV for entertainment, and no cars, and people walking to every place they need to go and doing something active for fun like playing running games etc and of course, carrying on a daily life which burns a lot more calories than does life with modern conveniences, that obesity as well as heart disease and diabetes are practically unheard of. For example, the Pima's in Mexico are said to average about 40-50 hours of hard physical labor a week.

It also should be noted that these people are typically eating a diet consisting mostly of veggies and grains with only small amounts of meat.

Quite a bit has been written about this phenomena (ex "The PIMA paradox") in which two genetically identical groups of people have very different bodytypes depending on whether they live in the USA or in outlying places as described above. That being said, the Pima's in AZ were described as "lean and sinew-y" by an observer around 1900.

On the other hand, while it is true that some rat studies have suggested that calorie restricted rats live longer than those allowed their fill, scientists have pointed out that this only shows that overfed under exercised rats succumb faster than those rats which exercised instead of eating all they wanted. And besides us not being rats (and they know we have a different chemical makeup after the Leptin fiasco), it also should be pointed out that rats in the wild have to exercise a lot to obtain their food and again, it's far from eating their fill. They tend to be lean because of this.

Also, those who compare the lack of obesity at the turn of the 20th century forget that people also didn't have a very long lifespan then, (average about 49 years) - however, they often died of infectious disease rather than "old age diseases" so we don't know how long they would have lived with modern sanitation etc.

The picture becomes more and more muddy. If a person can make lifestyle changes and eat a very healthy diet, it might be possible to somewhat calorie restrict without threatening one's health - studying chronic calorie restrictors (CHRON's they call themselves) has suggested this. On the other hand, people who calorie restrict in an unhealthy manner (as often true of dieting) likely, do face health risks and there is quite a bit of research suggesting that the "weight cycling" most dieters tend to do (gain and lose and regain) is highly risky.

The bottom line might be, if calorie restriction takes out one of a person's greatest pleasures (eating does provide many folks with endorphins), it might indeed cause enough stress to actually make things like diabetes and heart disease worse (instead of better as the advocates of dieting keep shouting at us).

There has to be a happy medium... perhaps that IS what Health at Every Size or HAES is all about. (Note: see http://www.lindabacon.org )

New study obese children more likely to die earlier

An article in the news recently, shouted that being obese as a child doubled the risk of premature death (i.e. death before the age of 55).

This was based on a study appearing in the New England Journal of Medicine in the Feb 10, 2010 issue and is online as the full text version, accessible without a subscription.

The news reporting on this study ranged from total misreporting -one source gave the deaths which "counted" as 559 deaths - cohort was 4857 people born from 1945 to 1984 - other sources were more accurate about the 166 deaths in the cohort which "counted". The cohort came from the Gila River Reservation in Arizona.

However, for some reason, (I could speculate on this but I won't) the researchers included deaths from alcholism/drug use and infectious disease in the deaths from which they figured that those who were obese as kids were two times likely to die prematurely of.

The breakdown on the causes of death in the 166 who died prematurely, (which is still a low number) out of the 4857 member cohort was as follows - according to the study article:

A total of 166 deaths were from endogenous causes: 59 were attributed to alcoholic liver disease, 22 to cardiovascular disease, 21 to infections, 12 to cancer, 10 to diabetes or diabetic nephropathy, 9 to acute alcoholic poisoning or drug overdose, and 33 to other causes

Several things should be taken in consideration here. The deaths from those causes which may have an obesity factor in them is only 44 individuals out of the 4857 member cohort i.e. diabetes, cancer and cardiovascular disease. Infections, alcholism, drug poisoning and "other" have no established relationship to obesity at all.

So as you can see, two times as many in a small group like 44 is not very many. And in fact, had they considered, for example, which of the 44 rode bicycles as kids, they might have found a highly significant relationship between early bicycle riding and premature death!

I am always reminded of something Science News editor Stephen Milloy quipped some time ago:

"But who needs data when you can spoon-feed junk science to a gullible media?"

Postscript: 166 premature deaths out of 4857 individuals may be a lower figure than in those who do not live on the (Native American) reservation which might suggest that reservation living might be less stressful than living elsewhere (something I've long suspected since working in a Pima Indian mission several years ago).

Also, anecdotally, I've known several who died premature deaths but none of these were obese - several were smokers however (including my own slim father who died several years before my obese mother and mother's death was a suicide). My husband's cousin was married to a person who had no risk factors at all not even smoking i.e. he ate healthy, exercised daily and was very lean. 15 years younger than she is, he died several years ago, a premature death (heart attack). She who has a high BMI, just celebrated her 74th birthday.

Gastric bypass in teens - why not?

A recent article in the LA Times quoted a Dr Brandt as saying, about overweight teens that:

"But these kids are dying! We’ve created something in our society we have to undo."

Dr Brandt believes in doing the gastric bypass on young kids (even as young as 14 years old) despite the fact that this surgery (based on a procedure for ulcers invented in 1888 by Theodore Billroth and no longer done for ulcers) bypasses not only most of the stomach but also the first segment of small bowel where most vitamins are digested.

Brandt expressed "doubt" about the much safer adjustable lap band because:

"The band is a human-made device that could be in place for a lifetime, and as such carries a risk of scarring and malfunction"

I wonder why Dr Brandt thinks it's better to cut the stomach into two pieces and the small bowel into 3 pieces and reconnect in such a way which is causing 3 world vitamin deficiency diseases in 1st world kids. (ref: Bariatric Beriberi by Charlotte Gollobin1 and William Y Marcus, Obesity Surgery, Volume 12, Number 3 / June, 2002, Pages 309-311)

Not withstanding placing 300-400 staples into the digestive tract which is what happens in the gastric bypass - the staples, unlike the lap band, are not removable!

According to the Fresno Bee expose in 2001, patients do die from gastric bypass and not only the 2 percent who die within a month of surgery(REF: Dr David Flum - 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])

According to some, many more patients die than admitted by either providers or the media. The Fresno Bee wrote:

"the deaths, by and large, do not occur in the operating room, or in the hours immediately following surgery. They happen in the days, weeks and months after surgery, when patients return home and find themselves coming apart from the inside -- sometimes leaking from the abdomen."

And this is better than the lap band which calls for no cutting up of the stomach or cutting up and bypassing of the small bowel and is fully reversible? Which delivers a similar weight loss to the bypass at the 3 year post op point also?

It should be noted that the gastric bypass, in patients with a BMI of over 50, has a 34% failure rate (i.e. 34 percent of these regain all or most of the weight... see: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD )

I am thinking of the lady who was down to 85 lbs and got her gastric bypass undone. A year later, she is still slim but has color back in her face, is healthy and like so many others who got their surgery undone, she feels her life began the day she woke up from reversal surgery.

Frankly, I sometimes wonder if the average WLS provider's $250,000 - $500,000 a year salary has anything to do with the zeal of some to rush children into surgery modifying the digestive system for life or perhaps the fact that gastric bypass surgeons don't generally, have to do the follow up on gastric bypass like they do on the lap band - gastric bypass follow-up is typically, done by the emergency rooms and gastro-enterologists, many of the latter who are very against these procedures.

One local hospital told me they have an entire floor set up for sick gastric bypass patients! And most ER nurses I've talked to, say a goodly percentage of their nightly visitors are gastric bypass patients with repercussions. Most of the nurses I've talked to, are against that procedure also.

And these surgeons are saying we should allow this on 14 year old kids?

I keep remembering the 22 year old young man who was featured in a news article a few years ago - he'd had bypass surgery at the age of 18. At the age of 22, he was at his ideal weight and was pictured smiling, sitting on a tractor. The article also said that his bones were as porous as an 80 year old's... at the age of 22!

Calcium is one of the nutrients which gastric bypass patients can no longer digest - the calcium which is typically building up the bones of young folks will now be leeched from their bones after their WLS. They can take calcium supplements but we only digest about 2 percent of these and the rest is excreted and can cause kidney stones among other things.

That's the side you don't read in the news or hear about in seminars.

Hopefully parents will put a stop to this because kids only think about one thing and that is "fitting in", but teens I've seen post op with the gastric bypass, sit in the TV studio unsmiling because I'm sure no one told them about the spontaneous vomiting perhaps sitting in a restaurant with their friends (I'm sure this is less socially acceptable than being fat) or the myriad of foods they no longer can tolerate, nor being knocked on their butt after doing something so innocent as eating a piece of their birthday cake.

A recent photo of a "gastric bypass birthday cake" I saw, had the writing on the cake "sorry you cannot have any of this".

And I'm sure no one ever told them about the fact that they might get seizures from the vitamin deficiencies caused by the surgery (seizures are definitely not socially acceptable among teens) or have to sit for hours in the oncology section of the hospital getting infused iron peridically or having irratic blood sugar levels from reactive hypoglycemia (unlike diabetes, there is no medication for that condition).

A clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.

I wonder if anyone warned these teens that when they dare to eat something like a breast of chicken and don't take an hour to eat it slowly, it might get stuck in the stoma (opening of the pouch stomach into the small bowel) and hurt like heck for the next two hours until it either passes or they have to be scoped to make it pass.

Maybe that's why at least some of them are depressed after surgery. Suddenly a young healthy teen enjoying life, has a serious disability to contend with. Isn't this a bit much to burden anyone with, let alone a person who is supposed to be in the "carefree years"?

"You don't really know what the outcome is," said Dr. Edward Livingston, chairman of gastrointestinal and endocrine surgery at the University of Texas Southwestern Medical Center at Dallas. "You talk about the benefit being that it prevents kids from terrible chronic disease later in life. But some of them are going to regain weight. Some of them are going to have long-term complications and we won’t find out until later."

Dr Livingston has been one of the bariatric surgeons who speaks out about the drawbacks of the gastric bypass even for adults.

His study of 800 gastric bypass patients a few years ago, found a high percentage of repercussions and he wrote for Self Magazine in 2001:

"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)

Brittany Caesar, who had a gastric bypass 6 years ago and now weighs 170 lbs, described sitting down at her favorite lunch of two cheeseburgers, two orders of fries and a Coke and hearing a friend say to her "Why do you eat so much? It's not normal". Caesar fled to the washroom determined to lose weight, feeling very wounded by this comment. "Food was my best friend," she told reporters, adding that her whole family was fat. Caesar was over 400 lbs on the day she had her weight loss surgery. Now she is 20 years old and 175 lbs, but the article did not say whether she had had repercussions or has osteoporosis or osteopenia.

Are the possible repercussions worth the lower weight?

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

Especially as in Dr Simpson's almost 30 years of doing these WLS procedures, he found that it was true of all of his patients, regardless of which procedure that:

"Success with Weight Loss surgery is 10 percent the surgery and 90 percent the patient".

Dr Kaplan, was more blunt about weight loss surgery:

"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 in "Self" detailed some long term patients, many of whom were not happy campers several years after surgery.

If we are really, worried about getting our children healthier, Dr Pattie Thomas, PhD, a scientist, suggests some good ways of doing so in her article, "7 Better Ways to Help America's children than Making Fat Kids Skinnier"

I'm over the "Biggest Loser" Show

Jillian described this last week's episode as her very favorite (2nd week in Season 9) and asked people to give her feedback on her Facebook page. All the feedback I read was positive.

My reaction was totally different. The show went over the top in my book.

First part of it, was psychologically abusing the contestants one by one. Dr Huizenga was in charge of that. Although none of them have any real co-morbidities, that didn't stop him from giving them dire predictions of where they will be in the next few years, i.e. diabetic, aging prematurely or dead. He mixed this message with strong suggestions that they were hurting their loved ones by being overweight.

And Dr Huizenga managed to get all the falsehoods about obesity in this part. "That was so enlightening" said some folks who gave Jillian the feedback on her Facebook fanpage.

Each participant, male and female alike was ripped apart psychologically and ended up crying. It was not pretty. I finally fast forwarded through the rest of it after being thoroughly nauseated. Abuse of any one and especially psychological abuse leaves lasting scars. And why was it necessary? These people have all shown good faith by coming to the ranch in the first place.

Next was the challenge - usually that's kind of fun but for this one, their first challenge in their second week (so they are not fit yet and still probably the heaviest group they're ever had on the BL) was a bit ugly. They were asked to walk on a 3 inch balance beam across the swimming pool to deposit beachballs in a basket on the other side. The winners got immunity from the weigh-in. The losers got a 2 lb penalty at the weigh-in.

Keep in mind that the balance beam the 89 lb gymnasts walk on is four inches wide.

To their credit, most of them struggled through this challenge but one older lady who is petrified of the water tried and tried and just couldn't do it. She finally fell on her face on the concrete around the pool and got an ambulance ride. She was ok but had a bruised face and a black eye.

Jillian took this lady later and helped her to learn to float. I suppose that's supposed to make it OK that she was forced to do the challenge which petrified her and ended up getting her hurt. Surely she won't be the first injury. Injury is common among the contestants on the Biggest Loser who immediately start running and other things they should NOT be doing at their size.

Finally was the "last chance workout" (the last workout before the weigh-in). Jillian and Bob delighted in "beating up" the contestants, screaming at them to go faster, harder. Two of them told them TV cameras that they hurt all over from last week and now they had to workout harder and it was sheer pain. The pain showed on the faces of most of the contestants. Some were crying and screaming back at Jillian and Bob. It was here that I had enough of their pain and fast forwarded to the weigh-in (which always takes long because there are several commercials - someone told me that there is only about 45 minutes of viewing time in a 2 hour show like the Biggest Loser).

Of the team which fell "below the yellow line" (didn't lose "enough weight"), was a mother and her daughter. The mother asked to go home.

I notice something interesting in those eliminated. They shed a few tears at the moment of elimination when the blond lady host announces "Sorry to say you are NOT the Biggest Loser and must leave campus immediately" But 24 hours later when they are arriving home, there is invariably a look of enjoyment - and yes, relief on their faces.

It's kind of like hitting your head against the wall. Feels so good when it stops.

I did not yet set up the Biggest Loser for recording next week. I think I've had my fill. After watching several seasons, each successive one which has featured heavier, less fit, older contestants, and watching those folks on the ranch slowly get battered, physically, emotionally and psychologically, I've had enough of that show.

And a sad thought comes to mind. If these were not fat people, what is done on the ranch would be illegal. For example, in the 1960's when similar things though not near as abusive, were done in the "EST" seminars on a weekend to managers, the "EST" group got in serious trouble.

No one seems to care about the fat people on the Biggest Loser though. And that is the real tragedy.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A sad note upon which to end this year.

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

5 Medical Reasons to consider Weight Loss surgery

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

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

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

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

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

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

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

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

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

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

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

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

The next "reason" given is fertility:

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

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

Next we have this:

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

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

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

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

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

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

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

The final claim:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gastric bypass stops appetite? Not according to this study

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

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

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

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

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

Here is an article I sent out about this:

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

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

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

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

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

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

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

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

New study on gastric bypass found higher mortality rate

A study of over 850 weight loss surgery patients, 98.5 percent of whom were gastric bypass patients, found that in those of BMI 50 and higher (which is the average size for bariatric surgery patients), 2 percent died within 30 days, another 3.6 percent died within 90 days of surgery and another 5 percent died within a year of surgery.

These patients were operated on in 1 of 12 veteran's hospitals. The mean age was 54 and 70 percent of the cohort were men.

The death rate was higher in those with a BMI of 50 and comorbidities like heart disease, sleep apnea etc.

Researchers Lie et al concluded:

"The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery... These findings also suggest that the risks of bariatric surgery in patients with significant comorbidities, such as congestive heart failure, complicated diabetes and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits in older male patients and those with superobesity (BMI eq or greater than 50)."

Now of course, we know that all providers of gastric bypass will be sure to show their prospective patients this study and discuss not having a gastric bypass if they are over 50 and BMI 50 or higher and/or have heart disease, complex diabetes etc, right?

SOURCE: Arch Surg. 2009;144:914-920

Obesity causes cancer - more "BIG FAT LIES"!

A radio show from the BBC recently featured a metastudy which concluded that obesity "causes" cancer. The researchers opined that 100,000 cases a year can be linked to obesity. According to the Washington Post:

This study, from scientists at the University of Manchester, analyzed 141 articles involving 282,137 cancer cases and 20 different types of malignancies to determine the cancer risk associated with a 5 kilogram-per-meter-squared increase in BMI, roughly the increase that would bump a person from middle-normal weight into overweight.

141 articles isn't that many of course, not withstanding that they can pick and choose which articles to include and also, probably did not have a real accurate measure of BMI from the studies anyway.

It should be noted that over 1.6 million new cases of cancer are diagnosed in the USA every year, so even if their figures were correct that would only be 6 percent of cancers (according to WEBMD.COM) which can be linked to obesity - 94 percent of which can NOT be linked to obesity. The researchers on the program admitted that lifestyle factors like sedentary lifestyle and poor food choices were a player and briefly mentioned "the link between tobacco and cancer" but did not give any figures.

WebMD states that these figures linking obesity and cancer, were "estimated" from existent data (what the junkfoodscience.blogspot.com calls a "data dredge" study.).

So how does excess fat "cause" cancer? The researchers didn't have an answer for that but opined that fat tissue, produces estrogen. What they didn't tell us is that fat tissue produces the type of estrogen our bodies can use but when we flood our bodies with synthetic pharmaceutical estrogen, this raises the risk of breast cancer FAR MORE than 6 percent.

For example the HERS study on 11,000 women, a double blind study found a 26 percent higher incidence of breast cancer in those in the cohort, on low dose birth control medications. 26 percent OBSERVED in a double blind study which was stopped midterm. Not a tiny 6 percent from "estimated" figures.

Synthetic estrogen was put on the FDA list of carcinogens in 2005.

Finally, it should also be noted that researcher, Dr. Glen Gaesser stated in his book, "BIG FAT LIES" (CA, 2002) that he found in his metastudy of all the obesity research in the previous 20 years, that obese people seemed to get cancer significantly LESS often than non obese people. 40 percent less cancer in the obese, than normal weight people, concluded Gaesser.

Dr Linda Bacon, respected scientist and author of "HEALTH AT EVERY SIZE", was also on the BBC program and started to directly refute the findings with cited studies. As soon as they found she could do this, she was rudely interrupted (twice!). Before they cut her off, she pointed out that for example in a group of 23 studies, only 4 had suggested a significant link between obesity and cancer so she asked how these researchers could conclude from a small percentage like that, that obesity "causes" cancer. They evaded her question, of course.

I wrote the BBC a comment accusing them of dishonesty in news reporting and challenged them to have Dr Bacon on again to tell the REALITY of what the studies on obesity and cancer REALLY show. Perhaps some of you might want to do same.

Until we demand more honesty out of the news services, we won't get it. Fat activist Marilyn Wann was on the same program. Here's the link:

BBC radio program on the so-called "obesity link" to cancer

answering rebuttal to gastric bypass post

The following is to answer a comment - this was in two parts and had a lot of quotes in it so would be hard to read and brings up some points which I have answered (and so has Junkfoodscience blog answered) in other blogs but should be answered again to clarify things :

Mikalra who wrote the comment states he/she has no interest in the bariatric industry but since he/she does not identify him/herself I have no way of verifying this. Mikalra (M:) writes:

A study of 10 year post op gastric bypass patients found that 34 percent of those who started with BMI 50 or over, had regained all or most of their weight.
The abstract is here: "The failure rate when all patients are followed for at least 10 years was 20.4% for morbidly obese patients and 34.9% for super obese patients" -- which means, of course, that ~80% of morbidly obese and ~65% of superobese patients were successful.

No that doesn't mean this at all. And they do not define "success". FYI, success with bariatric surgery means keeping off 50 percent of the originally lost weight which still leaves many patients severely or morbidly obese (this is 50 lbs kept off for most patients), but as the Swedish Obesity Study found at the 10 year post op point, patients only tended to keep off an average of 16 percent of the original bodyweight and were, in fact, still High BMI. SOURCE: New England Journal of Medicine: Volume 351:2683-2693 December 23, 2004 Number 26 Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery Lars Sjostrom, M.D., Ph.D et al


Secondly, the 35 percent was for BMI 50 which is the average BMI at which folks get a gastric bypass. Exactly why this study concerned the ASBS and they approved some revision procedures (which later turned out to be unsuccessful and temporary and painful i.e. the -through the mouth- stomaphyx and rose procedures)

Third, success is also staying healthy and estimates of acquired co-morbidities from gastric bypass have ranged from 20 percent in the 5 year duration Mayo Clinic study in 2003 to 40 percent in Dr Livingston's study of 800 of his own patients over a 10 year period post op, and can include epilepsy, reactive hyperglycemia and islet cell death, gastroparesis, osteoporosis and auto immune disorder.

As Dr Terry Simpson has stated:

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

The other study you quoted "long term mortality after gastric bypass" is not an accurate one for many reasons (epidemiological, not randomized etc) and also compared gastric bypass patients against fat people as obtained from driver's license weights only most fat people very much under state their weight on the drivers license so matching weights this way, one is going to be comparing the patients actual start weight with much HIGHER BMI people. Finally, if I remember correctly, the study mostly just followed for 7 years and did NOT take in consideration the 5-9 percent who die within a year of surgery (started following 1-2 years after surgery). I have written about this study in another blog - you may want to look that up.

And no we do NOT have "several" longevity studies on gastric bypass - we only have a couple which you have mostly managed to obtain and those are not real accurate.

Mikalra further wrote:

So yes, there were certainly some risks from gastric bypass, as with any medical procedure -- but overall, it's clear, the health benefits to these very obese patients outweighed the risk.

This is NOT clear at all and why many surgeons are advocating the lap band now which is a much less risky procedure which delivers the same weight loss retention benefits.

Mikalra further wrote:

Moreover, this study included people who had undergone surgery as much as 25 years ago, when the technique was much more experimental; it's reasonable to think that both the techniques, and any counseling or warning signs that need to be followed for optimal patient safety, will have improved by now.

The gastric bypass has not basically changed at all except now they are cutting the stomach into two pieces so it's much harder to reverse than the ones done 25 years ago were. Also 25 years ago, less of the stomach was bypassed which made it a bit safer than now. As Dr Ernsberger has pointed out:

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

Paul Ernsberger, PhD, Department of Nutrition,
Case Western Reserve School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4906

Mikalra concluded:

I am personally very concerned about the obesity epidemic. I would like to see a lot more of this epidemic controlled through support for healthy lifestyles in children, but for patients who have already become obese, this is clearly an option that should be seriously considered, based on personal values and risk factor profile, as it provides very substantial health benefits for most very obese patients.

First of all, news flash, "controlling children's diet" doesn't work. No matter HOW you do it. We know that putting kids on a regular diet does nothing more than injure their metabolism, making them more likely to get fatter when adults. It also injures their self images. But even a less invasive approach such as a friend of mine used... not having things like candy, potato chips et al around, building exercise in their son's daily life and limiting high fat foods does not work. In the case I am thinking of, this individual who kept reasonably slim during his childhood years, as soon as he left home, starting eating all the foods his family never had around and has been clinically obese for the last 20 years or more (he's 40 now).

Secondly, if the gastric bypass introduces NEW comorbidities, what good is it? Are those comorbidities lesser than what they experienced as being fat? In the opinion of several patients I know, they felt healthier BEFORE their gastric bypass than now.

And if the suicide rate among gastric bypass patients is 58 percent greater than among fat people, we must question whether the after surgery quality of life is all that good.

You watch the ads. I see the other side. Countless people who write to me, alone and isolated in their homes, underweight, living in fear or many more, very overweight but also very ill. You cannot make a judgment however well meaning you are, about this surgery until you have seen the entire story.

One super sized friend of mine (over 500 lbs) who is in her 50's (and her slim husband is the one who has had heart problems by the way- not her) has told me that she has OUTLIVED 48 of her fat friends who had weight loss surgery.

Here is just one poem which expresses the pain that some long term patients feel, the pain which never gets to TV or the ads:

(reprinted with permission of the patient)

Sent: Wednesday, August 21, 2002 3:13 PM
Subject: if only...


> oh, sue, I just found your site re: RNY GBP
> if only...
> if only the tears would stop
> if only I knew then half of what i know now
> if only I knew how to turn back the clock
> if only I had not trusted so blindly
> if only I had my life and my love of life back
> if only doctors understood and respected the value of living vs. the lack of value in existing
> if only the effects of malnutrition and slowly starving to death were not so bizarre that people assume and treat me as if I were terrifyingly contagious
> if only I knew someone who could/would reverse, not merely modify, this hell in which I exist
> if only I could hide from that emaciated creature who peeks at me in such a terrified manner when I glance at her reflection
> if only I had not learned so much about medical "error" and the resulting retaliation from the medical world if you dare to whisper those words
> if only I didn't have to hide from the world out of shame and fear
> if only I didn't know so much about PTSD as I do now
> if only I could ever trust another medical care provider
> if only I didn't spend every moment wishing I could die or regretting I did not
> if only I knew how to protect others from the incompetent/unethical animal who did this to me
> if only
> if only
> if only

Fatter babies caused by estrogens in the air?

A recent Newsweek article opines that the chemicals in the air, namely the so called "phytoestrogens" may be causing today's babies to be more overweight than before.

They quote an impressive sounding statistic:

In 2006 scientists at the Harvard School of Public Health reported that the prevalence of obesity in infants under 6 months had risen 73 percent since 1980.

Pointing out that if more fast food and less exercise could explain the higher prevalence of adult obesity, it was more difficult to explain an increased incidence of obesity in a population (like babies) who don't attend movies, and don't eat fast food and were always "couch potatoes". Must be the chemicals in the air, concludes Newsweek...

I looked up the study - apparently the researcher, Matthew Gillman, MD, is also a pediatrician.

He never even mentioned chemicals in the air as a possible reason for fatter babies but rather concluded after studying "120,000 children younger than 6 years old at 14 Harvard Vanguard Medical Associates practices in eastern Massachusetts from 1980 through 2001" that solving the problem of increased baby weight might lie in:

"Avoiding smoking and excessive weight gain during pregnancy, preventing gestational diabetes, and promoting breastfeeding, all of which researchers have shown to be associated with reductions in childhood overweight."

(remember how a recent article blamed breastfeeding for _increased_ size in infants?)

While I understand that Newsweek must come up with eye catching stories almost on a daily basis which must be difficult, I think the public should realize that stories like this one are just that - eye catching - and not necessarily based on any good science.

One thing which struck me is the entire article is based on the "73 percent increase" in "infant obesity" however, is that really as impressive (or alarming) as it sounds? Probably not. For example, the study found that the incidence of overweight children had "jumped 59 percent" but then the actual numbers on overweight kids, were in 1980: 6.3 percent and in 2001: 10 percent. And this means that in 2001, 90 percent of the children were not overweight, even according to our inflated weight charts which have set the line for "overweight" to much less than it was in 1980.

Less than 3 percent more kids were found to be "overweight" in 2001, not exactly anywhere close to a significantly higher figure even with much more fast food and much less activity!

We should always be on the lookout for statistics which may sound alarming but in reality, are not.

Unfortunately I could not find the actual percentages of overweight babies but I suspect it's not that significantly higher either...

The Newsweek article goes on to cite a string of mouse and rat studies which seem to prove their "chemicals in the air = obesity" theory.

And all to the conclusion that we just might be innocent victims of weight gain, like the caged rats and mice (which also were very "under-exercised" and had a much greater exposure to food than their cousins in natural surroundings), and the fact that we burn 800 calories a day less than did our grandparents and that most of us are consuming high calorie fast foods several times a week, has nothing to do with our being somewhat larger than our grandparents. Nope, it's all the chemicals in the air!

(Forgetting of course, that the phyto-estrogens in the air have not particularly increased since the 1980's - on the contrary, with all the "green" hysteria, there are actually less pollutants like this in the air. I know, details, details... :)

While articles like this are entertaining reading (Americans love to be alarmed), we should not take them too seriously. All news media should carry a warning "for entertainment only - any resemblance to facts is purely coincidental"!

New Scientist Magazine and gastric bypass

In the Sept 2nd issue of the "New Scientist" Magazine, they have an article about gastric bypass.

The article presents the surgery in a very positive light, mentioning virtually no serious repercussions (like reactive hypoglycemia, epilepsy, B12 deficiency leading to pernicious anemia or iron deficiency anemia, ulcer, bowel obstruction etc), advocating it as a "cure" for diabetes as well as obesity:

Clearly these drastic procedures will cut your calorie intake, but here's the strange thing: the operation is much more successful than anyone could have expected. Even though they can't eat as much, people who have undergone surgery are not constantly ravenous, in stark contrast to those dieting through will power alone. It seems the gut normally secretes hormones that make us feel hungry or full, and bypass surgery ramps up production of the ones that make us feel full.

This article also includes long, pseudo scientific explanations of why this surgery "cures" diabetes and makes you feel full - they attribute it to changing gut hormones (of course, they don't say how this occurs and not surprising, they only mention a rat study or two as documentation for their claims).

I say, not surprising, because they really do not know _what_ controls appetite nor exactly what those gut hormones do. And also, the temporary lack of hunger in new ops is easily explained by the sudden difficulty in eating (food can get stuck etc) and the massive healing going on inside after the small bowel and stomach have been cut into pieces and put together in a very different manner from what nature intended.

And interestingly enough, human studies have tended to show that these surgeries are not particularly successful as for maintaining weight loss on the long run. For example:

• A study of 10 year post op gastric bypass patients found that 34 percent of those who started with BMI 50 or over, had regained all or most of their weight (REF: Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)


• The Swedish Obesity study found that at the 10 year point, the average BMI was 35 evidencing a significant lack of weight loss retention. (REF: New England Journal of Medicine: Volume 351:2683-2693 December 23, 2004 Number 26 Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery Lars Sjostrom, M.D., Ph.D et al)


• the Hebrew University study found that only 7 percent of gastric bypass patients had kept all their weight off- and that 25 percent of patients had regained all their weight back (or more). (REF: Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study) Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew))

But worse yet, a new human study found erratic blood sugar levels in most of the patients studied (clinical study) which caused them to be _ravenously hungry_ soon after meals - this study directly disproving the claim that the gastric bypass somehow changes the gut hormones to kill the appetite.

A clinical study of 63 gastric bypass patients by Mitchell Roslin and associates, has disproven this theory when it found that not only did 80 percent of the gastric bypass patients in their study suffer a RAVENOUS appetite soon after meals, but also experienced the almost uncontrollable urge to eat which did for many result in weight regain after the first year (the study went for 4 years). The researchers also found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Dr. Roslin reported on this study at the 2009 ASMBS convention, suggesting that the gastric bypass may cause a heightened insulin response due to the rapid emptying of the pouch into the small bowel.(ref: Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.)

The so called "cure for diabetes" also attributed to the elusive gut hormones by this article, has only been called a "cure" in the media. Any studies which suggested that weight loss surgery got the blood sugar levels down to normal in diabetics, called it a "remission" and what long term studies we have seen (for example, the Swedish Obesity study), found that at the 10 year post op point, only 36 percent of diabetics were still "diabetes free".

Additionally, as observed in a friend of mine who was diagnosed diabetes, 16 years ago - six weeks on the Weight Watchers Momentum program reduced his sugar levels to normal also even though he only had lost 12 lbs of weight and still was significantly obese.

Any gastric bypass patient will tell you that this surgery is NOT the "easy way out" but in fact not only takes a lot of work to maintain weight loss but also to make sure one gets vitamins, supplements, B12 shots and iron infusions (which patients need as time goes on) and close medical followup required. Gastric bypass has been observed to cause some alarming repercussions in many patients over 6 or 7 years post op.

In fact even a significant number of newly operated gastric bypass patients suffer repercussions:

In a radiologists' study, they looked at 72 gastric bypass patients and found by CT scanning, that 41 of the 72 patients i.e. 56 percent) had some 62 "abnormalities" in their digestive tract. The "abnormalities" included leaks, hernia, spleen and kidney damage, hematoma, bowel obstruction and distended excluded stomach. (REF: Diagnostic Imaging - September 2, 2004)

And if healthy food choices, slight calorie restriction combined with exercise, can reduce sugar levels even in a diabetic diagnosed many years ago, one would wonder why a person should even consider getting one's digestive system permanently surgically changed.

Articles like this one in the "New Scientist" do a lot of harm in misleading people to make permanent changes in their organ systems, a move which many find does NOT work real well for them but can give them a whole new set of co-morbidities and a lot of grief.

Update on second person to have brain surgery for weight loss

Carol Poe, 60 years old, had had a "stomach stapling" (probably a VBG) and later was "revised" to a gastric bypass. Her original weight was almost 500 lbs - she's 5'2" and she still weighed 287 lbs when she went in to surgery. Apparently neither of the weight loss surgeries she had, had "worked" and of course, dieting hasn't worked either so Poe happily offered herself as a guinea pig for a new brain surgery which is supposed to kill the appetite. Neurosurgeon, Dr Don Whiting of West Virginia University is the one testing the procedure.

This surgery calls for two deep probes to be placed in her brain and 2 pace makers to be placed in her chest. The pace makers send out electrical currents to the probes and this supposedly kills her appetite. Her surgery lasted 3 hours and she was awake for the entire thing because when they place the probes they have to make sure they don't injure something else or take away any of her abilities.

She appeared on the Oprah show today (the show was originally aired in April) and said that after 2 months, she had lost a whopping (NOT) 11 lbs. She told Oprah that she didn't have any cravings and that she was eating a more healthy diet and that she is now going to the gym.

It should be noted that just going to the gym for two months could have explained the weight loss and that if she's only lost 11 lbs in two months even with going to the gym, she's not really cut down her food intake very much which suggests the surgery may not be cutting the appetite the way they hoped it would.

She's Whiting's second patient and he wants to do another soon. One of the requirements to be a guinea pig for this surgery, is to have had a gastric bypass (which apparently failed to cause a good weight loss), Whiting told the press in April. Don said he has to make sure the surgery is effective and safe.

Why Oprah decided to give this procedure her seal of approval by having the patient on her show (with Dr Oz) is unknown. But she made it clear on her show that she had no plans of having this brain surgery.

Carol Poe looks like she's survived the surgery well (Dr Whiting stated that there is a 1 in 100 chance of stroke or even death with this surgery) and she told Oprah that the loss of the 11 lbs has made it easier for her to move around and mow her grass. But likely, rather than the 11 lbs, it's been her trips to the gym which have made the difference in her ability to move better. Minus 11 lbs she still weighs 276 lbs at 5'2".

Dr Whiting expects to get FDA approval for this procedure in the next 2 years however, if Carol's lack of weight loss is any indicator, his path for approval may not be easy.

A similar surgery is used for Parkinson's disease but of course, long term repercussions with the new weight loss surgery could include the pacemakers moving around in the body or forming abscesses, brain damage from the flow of electricity into the brain and more.