The Demise of a Great Blog

One of the most honest blogs on WLS (this patient sustained a seizure disorder after her gastric bypass and found 150 other patients who had suffered the same) is apparently closing shop. 

I know the blogger had gotten a lot of pressure from those who wish to cheer-lead the surgery because she had mentioned that several times but it mostly, seems that the more involved she became with providers, the less she seemed to want to blog candidly about what she experienced on the negative side of WLS.  Providers started asking her to speak at their booths, and paid for her trips to conventions... when that started happening, I wondered how long her candid blog would continue - it's difficult - next to impossible, to refuse those types of perks, especially for a young mother whose disability (epilepsy after WLS) kept her from working and that's exactly how those who have had a difficult time with the surgery tend to be silenced - that or settling lawsuits out of court in exchange for the patient's silence about the repercussions from their WLS surgeries. 

I've stuck in so long (since 1999) because I have not had WLS and thus there is nothing they can really offer me to shut up (although I know my name is not spoken with love in many WLS circles).  One patient, Trish Hargis (RIP) called it the "conspiracy of silence". Trish courageously got on "Obesity-help"  which is financed by the WLS industry, as well as wls_uncensored listserve, and talked plainly about what she had experienced but unfortunately, her WLS contributed to her early demise at the age of 54.  I see so many folks go into weight loss surgery without knowing that, at best, with a lot of work on a daily basis and blood work every 6 months etc, the WLS surgery can only offer them a 2% greater chance of keeping their weight off than going at it with a non surgical program like Weight Watchers (Mayo Clinic study early 2000's for one - Swedish Obesity study for another). 

Sorry to see that blog go - it was a good one....

Another one lost

One of the most difficult things with being involved with weight loss surgery patients is when one observes people passing on, way too early.  A couple of years ago, I lost my bestest friend ever (pictured above) - she was a VBG patient which is a stomach stapling only - the surgery worked for her for about 12 years (with a lot of hard work on her part) and then, she got very ill with fibro and lots of other things to the point where in her early 50's, she not only gained weight very easily, eating very little food, but was basically bedfast.  She was a highly intelligent lady and her courage was amazing. She would boldly post about WLS, warning people despite getting numerous "nastigrams" in the mail. We chatted on the phone daily and shared everything with each other.  Then one day her husband called, distraught.  He had come home to find her deceased.  At the age of 54.

I don't understand why folks write nasty emails to people who try to present a realistic view of WLS.  Basically,  it seems, that pre-ops who want to believe the dream and new post ops who have lost a lot of weight and are thrilled at this, seem to feel that people should post nothing negative about WLS least a person might be "denied" this "life saving" surgery. 

Trouble is, in all these years, I've not seen it save any lives - on the contrary.  Cash cow, definitely.. and one WLS surgeon told me laughingly, "I bury my mistakes!"  It's true that dead people don't talk.

Lately, another patient has died, probably earlier than would have, had they not had WLS.  This patient had had the duodenal switch which is a surgery which calls for cutting away 90 percent of the stomach and bypassing most of the small bowel.  They lose weight well but in the long run, it's almost impossible to replace the nutritional deficiencies.  Less than 25% of the surgeons in the USA do the duodenal switch as there are safer procedures available but they don't want to openly diss it either, even if they have stopped doing the procedure because they are worried about lawsuits (and many surgeons have multiple lawsuits pending).

This patient was 57 or 58 years old and had their surgery in year 1999 or 2000 - was very pro surgery and very much angry that I dared to say anything against it.  Was a young person with their life ahead of them and now they are gone like so many other of my WLS friends, died from lack of nutrition, it is thought.

The truth about any WLS is not only do people have to do the same things that non surgical people do to keep off the weight but also, they have to have regular checkups and take a lot of expensive supplements, in other words, work very very hard to keep off the weight, and even then, they might not have a good prognosis.

I have a cousin whose BMI is over 75 - she is 77 years old and going strong.  Had she had WLS, she probably would not have lived to that age.

It's ironic that in this day of super communications, things which should be  communicated, somehow may not be. In other words, if it's too good to be true, it probably isn't.  There is no easy way out and certainly not having surgery to lose weight!

Weight Loss surgery stories or -- ads?

The latest news on Weight Loss surgery reminds us that the media openly admits they don't feel obligated to tell the truth. And often when they report on weight loss surgery, they do sneaky ads.  Weight loss surgery of any kind doesn't really help patients to keep off the weight.  After they have invasive surgery to lose weight, they are told that if they don't diet and exercise, they will not keep off the weight.  But diet and exercise will keep off weight whether someone has had surgery or not.  Medical providers do not give the public "informed consent" for medical procedures.  "If we did tell the public about repercussions," a medical provider friend told me, "they wouldn't have any procedures done!"  As if this is a valid reason for not warning folks what might happen and especially after elective procedures like weight loss surgery.


 Lately in the media, we find a questionable study and a story which emphasizes how a couple keeps off weight - one of them who had a gastric bypass and the other who did it without surgery.

The study looked at se/x after weight loss surgery and declared that it's better after weight loss surgery.  Anyone who knows a significant number of weight loss surgery patients like I do, will ask, "how can this be when erectile dysfunction is very common and especially after gastric bypass?"  Easy answer - the researchers studied women - no men!  The women studied were a couple of years post op - and it was a study in which the cohort were surveyed 1 and 2 years after surgery and reported more reproductive hormones and better se/x!

First of all, the study was financed by Ethicon Endo which makes instruments for weight loss surgery - can we say "conflict of interests"?  Secondly no men were studied - had they looked at men, they would have found a different story, especially longer term like over 3 years.  The news story sounds like weight loss surgery is a great deal, but the truth is more sobering - since men were not studied, the fact that many men get ED after weight loss surgery stays unreported (unless you read the long term weight loss surgery communities).  It should be noted that many patients who regain after weight loss surgeries are encouraged to not attend support meetings and not tell those around them that they have had weight loss surgery. Meanwhile many surgeons parade the slim 2 year post ops at support meetings, giving the impression that "everyone" keeps the weight off.  One longer term post op who cannot eat more than 1200 calories a day without gaining, also came down with epilepsy after a gastric bypass and found 150 more patients with the same repercussion - this patient is considering having brain surgery rather than having the gastric bypass reversed, despite the fact that the seizures are likely from vitamin deficiencies which would be fixed with a reversal.

As for the weight loss story, in a story entitled "No Magic Bullet for keeping off the pounds", a couple, both of whom lost a lot of weight, are interviewed.  The man lost weight without surgery and the story emphasizes how he is having a hard time keeping off the weight.  The lady had a gastric bypass and we are told she's kept her weight at 160 lbs for 3 years.  In this story, if the reader looks at the photos, s/he will see that even with a slight weight gain, the man is not only slimmer than the lady but he is in better shape also.  But if the story is read superficially, the take-away message is that people have a much easier time keeping off the weight with weight loss surgery.  

In  other words,  the story hints that weight loss surgery is "the easy way out".  Any weight loss surgery patient will tell you it's definitely not the easy way out and many patients have regained at the 10 years post op point - even with extremely invasive surgeries like gastric bypasses.  This is a reality which may never get to the public if they confine their reading to news media. 

 I am reminded of the patient who called me up, crying, after her gastric bypass.  "They never told me about the side effects," she told me also adding that her surgeon no longer answered her calls.  And for patients who do keep off the weight, how many of them can no longer eat?

Should it really be "buyer beware" when we are talking about surgery after which 2 percent of patients die and 30 percent have serious repercussions including requiring additional surgery?

Guest blog - Daily Life with a gastric bypass

In this guest blog by Lisa Sargese, a college professor, who had a gastric bypass several years ago, she details how it feels to fight one's digestive tract at every meal.  I can relate because I have a bad case of GERD (hiatal hernia) - that and a bad medical procedure I got talked into called an "esphagoplasty", causes me a lot of grief in swallowing anything non liquid as my esophagus is narrowed and very scarred and does not conduct the peristaltic wave very well at all (the foolish procedure I had was that they blew up a balloon in my esophagus to supposedly, help the narrowing from the GERD - they said it would only last 6 months but I could have it done again... as I had a bolus of tuna firmly stuck in my lower esophagus and could not even keep water down, I was not really in a mood to bargain or question the medical profession - I was ready to have it done again, when in 6 months I experienced increased difficulty in swallowing, but then, I met a fellow who had had several of these esphagoplasty procedures and now was so scarred, he had a difficult time swallowing water - I decided against another esophagoplasty).

As people rush to get on the weight loss surgery table, they don't realize what it means to fight your GI tract at every meal, to plan how you are going to "get through" outings in a society where sharing a meal is the glue which brings friends and family together, how it feels to stand in front of some dirty restaurant toilet, trying to "get up" a piece of food which got stuck on the way down. Please read the following - it is very well written and very true.  Lisa has given her kind permission to me to reprint this:

 "A common misunderstanding
of gastric bypass surgery
 is that the pouch causes weight loss
because it is so small,
the patient eats less.
Although that is true for the first six months,
that is not how it works.
Some doctors have assumed that poor weight loss
in some patients is because
they aren't really trying to lose weight.
The truth is it may be because
they haven't learned how to get the "satisfied" feeling
 of being full to last long enough....
 it is NOT the size of the pouch
but how it is used
that makes weight loss maintenance possible."
- Pouch Rules for Dummies

Let me just preface this rant with the declaration that I don't believe weight loss surgery leads to overall good health. It may provide you with short term or drastic weight loss but it will cause side effects that make it not worth the pain and suffering.  Don't bother leaving me a comment to the contrary. I've heard it all. I've been called "bitter" and "a failure" and been yelled at for discouraging people form getting this "life saving surgery". I will glance at your comment and delete it.

That being said, let me tell you about overful pouch syndrome. It feels like dumping but it ain't.  It's when the pouch stretches too far and too much food needs to be processed. The symptoms are frightening: rapid heart pounding, weakness, dizziness, pain, pressure,and a sudden need to raise your legs higher than your heart no matter where you are.

Now, you mean-spirited, pro-wls cheerleaders are going to say that I should have learned by now exactly how much food I can tolerate. Let me school you. I am able to tolerate less and less food over time. I had my rny gastric bypass in 2006. I can now tolerate half of what I could eat when I first started this awful "journey". Different foods cause different reactions under different circumstances. It's always a surprise. I can eat and process less and less food.

One might think this is good news. One might expect me to be delightfully thin by now.

WRONG.

I fight fatigue due to my inability to take in enough food to give me the energy I need to live my life.

I can't tolerate protein shakes and never could.

My metabolism has slowed to accommodate my miniscule portions of food. I'm a sluggish, tired, cranky f*ck for a major portion of my day.

I have to load up on sugar and salt just to give me the energy to teach my classes.
When I'm hungry I can never eat enough to truly satisfy my hunger. The overfull pouch symptoms begin before I can get enough food into my body.

And so it goes...

Special occasions are difficult. Going out to eat is difficult. Social eating is difficult.
I have to gauge when I've had enough and put the fork down in time. Since there is a delayed reaction between swallowing and the food reaching my poor pouch, I often take a few bites too many. I pay dearly for every mis-bite.

Different foods produce different levels of discomfort. Sometimes I can eat a big salad. Sometimes I can eat lots of fruit. Sometimes I'm wrong and mere orange juice will cause the symptoms. It's a crap shoot every time I pick up a fork.

This weekend my brother and sister in law are visiting from Vermont. We had a lovely dinner at a Thai fusion place in Montclair. After dinner we went around the corner to Coldstone Creamery. We each got child's portions of dessert. We just wanted a taste. I took one spoonful too many. I had to explain why I was sighing and burping and roughly exhaling as I drove home.

I hate the weight loss surgery sales pitch. I was promised one thing and am experiencing another.

Satiety is not possible with water, I don't care what the literature says.

Protein shakes are odious. I am nauseated by them after the first sip.

All the tricks for feeling satisfied on a subsistence level of food don't work.

Our bodies are more complex than what the wls people want you to believe. Feeling satisfied after a meal is not just a function of the pouch or the stomach. Our bodies signal their need for food in many ways. Trying to cheat that system leads to a deficit, a debt, a bill that we have to pay to our bodies. Living on post-wls diets lead to problems, I don't care what the cheerleaders tell you. Some of them outright lie. Some are experiencing symptoms that their doctors won't admit are directly related to their weight loss surgery. Some are so delirious from being thin they ignore other areas of their physical existence. Many have stalled or gained weight back and disappear from the scene for fear of the shaming that comes from the cheerleaders and the medical people themselves.

My brother and sister in law are here with Theodore and Tilly Bear of the Teddy Bear Monastery founded by my brother. I'd like to enjoy their visit without having the burden of worrying that one bite too many will give me heart attack symptoms. That's not how it goes with wls. I'll be spending huge portions of their visit in major discomfort. I notice it more when I'm with people and when I'm eating outside the home.

Wls is the forever-f*ck-you for being fat. It is the forever-f*ck-you for being convinced that one has an eating disorder that only surgery can keep in check.

Every single time I eat I am reminded of my decision to alter my insides in an effort to be acceptably thin. I am reminded of my decision that I needed surgery to help me manage my eating because I decided I was untrustworthy as a self-caretaker.

Every single time I eat.
Every single day.

by Lisa Sargese, M.A.

Please consider subscribing to Lisa's blog - it's very interesting, inspirational and more!

Gastric bypass - the holy grail of weight loss surgery?

The holy grail of weight loss, is hoping that somehow food will not appeal to us so we will lose weight.  A new study states that weight loss long term ( 10 years) is better after gastric bypass than after getting the lap band.  And why is this?  Because food is not as appealing to gastric bypass patients, the researchers found.

Well, true, a good percentage of gastric bypass patients get reactive hypoglycemia which means you feel really crummy after eating a plethora of foods, not just sweet stuff. (The patients refer to this type of becoming ill as "dumping")

The problem is, if you are getting sick after eating and you lose weight, that doesn't really count.  Because cancer patients and terminal AIDS patients also lose weight from being sick, but it's so not worth getting sick to lose weight.

What they are hoping you don't know about is for one, the Roslin study which found that 3 months after a gastric bypass, the appetite comes back worse than before surgery in many patients.

This clinical study of 63 gastric bypass patients (that means the researcher, a gastric bypass surgeon himself, actually examined the patients), also found that many of these patients had "glucose abnormalities" which would, in part, explain their voracious appetites.

Bottom line - to lose weight by getting sick after you eat?  Life is just too short for that one, you may well find.  5% of people on non surgical diet nutritional programs can keep off the weight.  7% of weight loss surgery patients (all surgeries, several studies) can keep off the weight.  But that extra 2% which isn't very much of a differential, is counting those with "glucose abnormalities" and other health problems after weight loss surgery.

Dr Terry Simpson tells us that success with Weight Loss surgery (any procedure) is 10% the surgery and 90% the patient.

So after taking rather serious and sometimes life threatening risks to have one's digestive tract rearranged, you can see that it is not very much more effective in keeping off weight than is a non surgical program.

Looking at things this way, the seeker should also be aware that merely embracing a healthy lifestyle of mostly wise food choices and cardio exercise 5 days a week will keep you healthy at any weight.(Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. American Journal of Clinical Nutrition. 1999 Mar;69(3):373-80)

Ask yourself, in view of the foregoing, is weight loss surgery really worth the risks?

We get angry letters sometimes....

We get angry letters sometimes ...

Wayne B, a gastric sleeve patient (and I would bet a "new op") writes the following:

Regarding the concern about nutrient absorption. You don't absorb nutrients in your stomach.. You absorb them in your small intestine and that is not touched by the surgery. Sue W rabbits on about here six years worth of success being enough o prove her point but demands ten years of success from a WLS recipient. Bit of a hypocritical double standard. on gastric sleeve story

Wayne, if you do not DIGEST food in your stomach then you cannot absorb it in your gut.  You digest proteins and fat in the stomach ... And vitamin B12. Before you get so self righteous, wait ten years... Wait until you get post gastrectomy syndrome... I've never met even ONE long term patient who was happy they had the surgery but because they get so much flack from the Weight loss surgery community, many are afraid to speak out...did you ever wonder why there is such a high rate of suicide among weight loss surgery patients or have you not read about that one yet?

Wayne further writes...

"SueW. You sound like a bit of a self righteous b*tch but hey thats your choice. I tried everything, and I mean everything so don't come back with some Whica health drink BS. Gastric sleeve saved my life so how about you crawl back into your health nut whole and leave people who are trying the best they can alone. on gastric sleeve story"

(Note I have left Wayne's original spelling! :) :) ) My word, Wayne, why so defensive that you feel the need to be ad hominem (that means insulting in case you wondered!).  I'm trying to get informed consent to folks like you because I have met countless patients who find about the repercussions of weight loss surgery, after the fact.  About 50% of those who know the risks, will go ahead and have surgery...the other half will skip it... (especially when they find out they need to diet and exercise to keep losing weight or at a lower weight!)  People deserve to know if there are any deal-breakers in the repercussions.  Many people who have surgery think they won't have to count calories etc to keep slim and nothing could be further from the truth.  The more invasive the procedure, the longer a patient might lose his/her appetite but when it does heal, the appetite comes back, with vengeance.

I've been in this for 14 years and from what I've seen, most of the folks who really hawked the surgery, as pre ops and new ops, when they start getting sick, (and often regain the weight), they get quiet and don't warn pre ops about what could happen after surgery.

Bottom line, no weight loss surgery saves your life...YOU save your life!  As Dr Terry Simpson says, "Success with weight loss surgery is 10% the surgery, and 90% the patient!"

And successful weight loss surgery patients do exactly what we non ops do. ...they journal or keep track of their food intake and exercise... Keeping weight off is work on a daily basis whether people have had surgery or not.  But in addition, weight loss surgery patients have to have frequent expensive blood work, drink protein shakes to avoid protein deficiency and take a lot of vitamins in addition to logging their food and exercising.

A sobering fact... A friend of mine who weighs in excess of 550 lbs says she's outlived 48 of her friends who had weight loss surgery.

According to the few studies which have looked at long term patients, only 2% more of wls patients keep off the weight they've lost.  That is 5% of people keep the weight off without surgery.  And 7% of weight loss surgery patients keep off all of their weight.

There is no such thing as "life saving weight loss surgery"... People save their lives, not any weight loss surgery.  Please don't fall for the used car hype!

Weight Loss surgery does not reduce health care costs in the long term.

A long term study on weight loss surgery (bariatric surgery or WLS)  found no reduction in health care costs on the long term.   The study was reported on, in a recent issue of JAMA Surgery (2013).  The researchers found higher health care costs in the long term with surgery than with treating obesity, medically.

This is nothing new, of course.

Wrote the researchers in JAMA (Journal of the American Medical Assn) in 2003 that Short term results of surgery are impressive... BUT

"...long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."
 
 This has not changed and yet they are still doing 200,000 of these surgeries a year on people who are desperate and frightened by scare tactics about obesity which are, in NO WAY, supported by studies.

On the contrary, studies have found no direct link between obesity along and morbidity!
 
And this was the shocking findings of Glenn Gaesser, a slim exercise physiologist who examined 20 years of "obesity studies" but his findings and the findings of many others, have been all but ignored by the mass media, anxious to sell diets and surgery for obesity using scare tactics.  Gaesser wrote his results in his book, BIG FAT LIES, a must read for everyone!

The findings of the 2013 study may be because WLS adds health care issues which may be as bad or worse than what it sometimes cures. Additionally, if the patients do not diet and exercise after surgery, they regain the weight in which case they now have the health issues associated with rearranging or interfering with major digestive organs in addition to obesity.

The Association of Bariatric Surgeons (WLS surgeons) had not much in the way of comment other than suggesting not all things may have been taken in consideration or - what I call um...questionable to be polite - that most of the procedures in the study were done open (with a large incision) rather than laparoscopically (using "keyhole" surgery).

What they hope we forget is that first of all, with keyhole surgery, surgeons cannot see as well as they can with open procedures because they are operating with a 2 dimensional view rather than a 3 dimensional view as in open surgery.  So on the gastric bypass - and those complex surgeries which rearrange digestive organs, open procedures are less troublesome in the long term - the only advantage of lap surgery is the immediate healing of the incision.  This would not have affected the long term results of any study or would have caused the long term results to show more favorably because most of the procedures were performed open.

And second, this type of result has been found in every long term study done on weight loss (bariatric) surgery.

Bottom line - surgery is not effective in maintaining weight loss in patients unless they diet (i.e. count their calories or restrict food in some other way) and exercise.  But those behaviors will take weight off without surgery and without all the complications and long term repercussions of surgery.  

Al Roker, a gastric bypass patient, told the "Today Show" that in order to keep off his weight, he not only journals his food and counts his calories every day but he also runs 5 miles several times a week!

With regards to the latest study, a weight loss surgery surgeon, Dr Livingston (who when, last I spoke with him, is proudly not a member of the ASBMS), commented:

"Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive. In this era of tight finances and inevitable rationing of healthcare resources, bariatric surgery should be viewed as an expensive resource that can help some patients."

"Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success." 

It's sad that they are only questioning these procedures on the basis of cost, money-wise because the cost to patients who suffer complications, lack of weight loss or worse, is so much greater.

The patient pictured above had an uncomplicated surgery and lost a lot of her weight but was regaining by the time the photo was taken in 2007.  She died of a heart attack in 2009.  The increasing number of early deaths on the long term from these procedures are never mentioned in the Medical Journals.  

One lady in her 50's who is very overweight, has stated that she has outlived 48 of her fat friends who had weight loss surgery!  Caveat Emptor - let the buyer beware - yes even in medicine.

Life saving weight loss surgery claims another

Since it's January, there is a big push by those selling weight loss and also for weight loss surgery.  TV is showing a lot of programs on weight loss, and weight loss surgery.

When they advertise weight loss surgery by giving case histories, there is a small (well, maybe not so small) problem.  Many patients die from the surgery which is supposed to induce an artificial case of anorexia so the patient either cannot eat much or as in the more invasive procedures like gastric bypass, cannot eat much and doesn't digest much of what they do eat.

One patient who had been followed since being featured on the first show in 2010, was a Haitian lady named Dominique Lanoise.  Lanoise weighed in the 600 lbs range and was bed bound.  From what is known about her, she was slim when younger and ended up having 6 children - she apparently gained after pregnancy.

She was a charming lady, who though bedbound, would sway to the music in her bed.  The documentary showed her eating large amounts of food, rejecting the diet food (they put her on a 700 calorie diet in order to reduce her for surgery) and kidding with her daughters who adored their mother.

Dominique was convinced that a gastric bypass would save her life and be a quick fix for her obesity problems which she felt was out of her control, so she searched until she found a surgeon willing to operate on her, at her current weight.

She lost weight after surgery and was transferred to a rehab facility but two weeks later, she checked herself out and returned home.  A couple of months later, she died, apparently from a heart attack which WLS afficionados assured us was "unrelated" to the surgery.

However, the nutrient shortage from the gastric bypass can raise the risk for heart attack significantly, because the heart is starved from essential nutrients, including protein.  That seems the "elephant in the room" when one researches Dominque's story - certainly those providing weight loss surgery do not want to admit that this "life saving surgery" actually hastened her to an early death.   

Another TLC patient, Donald, also had weight loss surgery.  He was also around 600 or 700 lbs.  Donald did try to move after surgery and do what the doctors told him to do.  Patients are told that unless they make lifestyle changes (like dieting, counting calories and exercise), the surgery will not work for them. Ironically, those same changes will work for weight loss without invasive surgery.

But then, suddenly and mysteriously, Donald went into a coma and emerged with Guillan Barre or "French Polio" - which put him into a wheelchair.  Disease after gastric bypass is common but again providers tell us it's unrelated to denying the body of proteins, fats and vitamins.  Last seen, Donald was getting around in a wheelchair and rapidly regaining weight although trying to exercise it off - another myth one sees on TV - exercise doesn't take much weight off us - how well I know about that one. It does make us healthier but it's not really good for weight loss.

That some are still selling a surgery which hasn't been done for years on non obese patients, a surgery which the inventor thereof dropped in 1980 because of the high complication rate, truly amazes me.

There seems a conspiracy of silence among patients as well as providers.  Patients who regain and live, are reluctant to tell about their surgeries  because both the public and their doctors blame them for their gain.  Patients who have become ill from the surgery and live long enough to be reversed and get back normal digestion, are often reluctant to talk about their bad experiences because new ops and providers can get mean to those who talk too negatively about weight loss surgery.

Patients are so sold on this surgery that until they get really ill, they refuse to admit that it has a high complication rate and a higher recidivism rate.  When I began to research it in 1999, I was shocked that many studies were on line and told the truth openly, but patients were not reading the studies and only listening to new ops who were excited and seemingly successful.  Even successful patients who have suffered difficult complications and talk about them in blogs, have taken a lot of criticism from "the community".

So people continue to jump on the table for a surgery which sounds like the ultimate cure because many do not encounter the "other side", i.e. the dark side especially if they do not have internet access or know where to look.

Informed consent information on all surgeries can be found at:
http://obesitysurgery-info.com   

In conclusion, a friend of mine who weighs over 500 lbs but has refused weight loss surgery, says she's outlived 48 of her friends who had weight loss surgery.      

gastrointestinal liner - or endo barrier

Another weight loss surgery? Oh, excuse me this is "not surgery" say those advocating it.

(Hubby says it looks like a condom for your guts!) :)

Of course it is surgery but there is no incision. That's what they mean by "not surgery". It's stuffed into your mouth, down your esophagus through the lower stomach valve and into the first couple of feet of your small bowel. What it does is prevent a lot of food from being absorbed.

Unlike the good providers who are pushing it say, it does NOT prevent sugar from being absorbed because sugar is mostly absorbed through the mouth and upper part of the stomach. They hope the prospective customer is (a) desperate to lose weight and (b) doesn't know much about the GI tract.

What is prevented from being absorbed is the good stuff, the proteins and fats (yes, you do need some fats to lubricate) but sugar? Absorbs just fine. So much for the resolution of diabetes which is not happening with this device.

If you think you've heard it all, there is more. 100 % of folks who had the "Endo Barrier" implanted, got at least one negative complication.

These can include bowel obstruction or nausea/vomiting or pain, and bleeding. You can also get a fever and "device migration" which means the long plastic tube they inserted, moves down through the GI tract. That might mean an invasive surgery to remove it since your small bowel is some 22 feet long and the lower parts of it are hard to get to. Not nice experience.

The providers admit this is a temporary device and you know what that means - as observed in Australia and places where they are inserting some of these, people tend to regain the lost weight.

So don't let the excited providers, giving a rosy picture of the endo barrier (which they are calling the "gastrointestinal liner") influence you. Likely this device is far more trouble than other procedures and not really effective in the long run.

Bariatric surgery safe and effective?

We've been there before.  Every so often they have a new study "proving" gastric bypass (particularly) is "safe and effective".  And when one looks at the studies more closely, one sees, that studies which turn out with positive results are not exactly, what they seem to be.

The new study published in the JAMA of September 19, 2012 (

Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; et al.

JAMA. 2012;308(11):1122-1131. doi:10.1001/2012.jama.11164)  is no exception.  The American Medical Assn, publisher of this journal, offers a free read on this study (because it's basically an advertisement for gastric bypass surgery).

First of all, the mean BMI of the surgical group was 45.  However, the average BMI of the gastric bypass patient is over 50.

At the 6 year point, continue the researchers, 76% of the gastric bypass patients had maintained a weight loss of at least 20% (this was erroneously reported by the news services as 28%).  Apparently the 27.7% reported by the news service, actually referred to the weight initially lost and not that maintained! 

Doing the math, the average patient, 5'5" likely weighed 270 (BMI 45).  If they maintained a weight loss of 20%, they maintained a loss of 54 lbs leaving their weight at 216 and a BMI of 35 i.e. still clinically obese and if they are diabetic, still qualified for weight loss surgery!

And for this modest maintenance, they take the chances of the long term repercussions of severe vitamin deficiencies, including the B complex vitamins which can cause many symptoms from seizures to mental fog and gastro paresis (paralysis of the stomach), leaky bowel, lessened immunity, micro-nutrient shortages (zinc etc) and a host of other issues.

Doing the math on this doesn't make any sense, does it?  Of course, the news services and some providers hope you won't do the math!

Best if you want to have weight loss surgery, to choose a less invasive option but it should be noted that weight loss surgery patients do the same work that non surgical patients do, to keep off the weight. That is, if they do not diet and exercise, they will regain the weight, regardless of how invasive the surgery.  Al Roker, a gastric bypass patient, started to regain and told the "Today Show" folks that he not only runs several days a week but also counts his calories every day to keep off his weight. That behavior will keep off weight without any weight loss surgery.

The whole idea of weight loss surgery, how it is sold is, that it will make you normal and you can eat whatever you want and never have a weight problem again. At seminars, they often, parade 2 year (and more recent) post ops who are success stories but the small print on every surgeon's web site and in the consent forms, says you have to diet and exercise to keep off any weight at all. And if you have to diet and exercise, you can do that without surgery!

If it's too good to be true - it probably isn't.

Dr Phil's sneaky ad for weight loss surgery

Dr Phil, on a re-run show, aired again this past week, recently featured a lady who had just been named "the World's Heaviest Woman" in the Guiness Book of World Records.  She weighs over 700 lbs.

The show was the usual anti obesity show and how this lady, Pauline Potter, was going to die soon and how Dr Phil was going to intervene like the knight in shining armor he feels he is.

The problem with the show was, it was very incorrect in the information given. I understand that reality TV is often not very real but seems that a show like Dr Phil should keep more integrity than that.

Apparently, according to Pauline's own website, she celebrated getting to over 700 lbs and sold videos of her moving around etc on this website. There is no indicator that she's not still selling these!

Also, the show first aired in November 2011 and Pauline and husband claimed they were divorced however, an article in late 2011, mentioned they'd gotten back together again, their love rekindled in L.A. in 2010.  Dr Phil had asked on the show if they had problems with intimacy and Pauline said they did not, but in two articles, the ex or now- non ex, admitted that they were afraid to have intercourse because they might break the bed.

Pauline told a couple of reporters she planned to lose 200 lbs in early 2012 because she and her ex - non ex husband wanted to have a child together (she has an older son from another marriage).

And Pauline, who weighed around 643 lbs when she appeared on Dr Phil, weighed over 700 lbs in Jan 2012 so the food Dr Phil had sent her had not appeared to help with her weight loss.

The strangest thing on the show was that Dr Phil introduced a Dr Ted Khalili as a "world renown weight loss expert" and offered Pauline, Dr Khalili's and his office dietician's help in her weight loss. What no one mentioned was that Dr Khalili is a weight loss surgery surgeon in L.A.  Pauline did mention in one article that she planned weight loss surgery but this was never mentioned on the Dr Phil show.

And strangest of all, is that the last mention of Pauline I can find is in Feb 2012.  Did she die from the weight loss surgery like the poor "Half Ton Mom" did?  Did she stay at her present weight or close to it?  If anyone has heard where Pauline is recently, do let me know. I very much, hope things went OK for her but having seen so many negative results from weight loss surgery, I cannot help wondering how she is now, especially that I cannot find any recent mention of her on the internet.  Also, in the cases of the very obese I've seen, weight loss surgery has not helped them. Often, they ended up gaining a lot of weight back - for example Allen from "Big Medicine" never did get out of his bed or worse yet, the weight loss surgery patients who started out very large, did not live like the "Half Ton Mum" of TLC who died 2 weeks after her gastric bypass.

All this to remind us that TV is for entertainment only - we should really hesitate to believe anything we hear on TV even from a source who seems so reliable, like Dr Phil.

Plastic Surgery after weight loss surgery

RNY-loose skin-

The following is from my notes watching a program called "The Real Skinny" on TLC.  (The Real Skinny, program on gastric bypass patients and loose skin on "Discovery Health".)

"after all my hard work, after all the foods I've cut from my diet, I still have to deal with my excess skin...  If I have to live like this all my life, I'd rather be fat again. " (male gastric bypass patient)

Dr Katzen has done many loose skin surgeries on gastric bypass patients.. His comments about operating on gastric bypass patients echo what many many other surgeons have said about it. Though being fat is thought to be very unhealthy, the fragility of these weight loss surgery patients raises the question that having a surgery which depletes the body of nutrients might be much more unhealthy that is, the cure seems to be, in some cases, worse than the "disease".

"A lot of surgeons are afraid of these plastic surgeries for a multitude of reasons...these surgeries are very risky surgeries ... I'm taking off a lot of skin, a lot of fat..."

"These patients are higher risk just because of their gastric bypass: they are typically malnourished... Just the fact that you've had gastric bypass increases the risk of bleeding, infection, and wound separation. For a circumferential body lift, I use 1000 to 1500 stitches...these surgeries typically take 8 hours... We pretty literally cut them in half and put them back together." --- Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA

Carnie Wilson, who admitted to have regained up to 250 lbs, 12 years after her gastric bypass surgery, was, none the less, much more fragile, healthwise than she was before surgery.  She said she was pre-diabetic and more.  It took her 4 weeks to recuperate after her lap band surgery...whereas her recuperation after a much more invasive surgery, gastric bypass, was much faster.  That is, she was much more healthy going into her gastric bypass despite weighing almost 300 lbs, (she's 5'1") than when she was when she went into her lap band surgery.  The difference was even though she weighed 40 lbs less than she did when she had the bypass, she had been not absorbing many vitamins and nutrients for 12 years.

When my DH had a brain bleed from taking the daily aspirin, there was another lady in the ICU - she had been over 300 lbs before her gastric bypass...her husband told me, tearfully, she was so frail now.  She did not survive.

Back to the show, Dr Katzen was shown doing a loose skin surgery on a male patient.

On this patient he did thighs and a circumferential lower body lift. There was a lot of fat left...

"we put him together with a type of super glue...the problem is too much super glue...the drain sucks out the fluid and allows the body to stick together."

"These patients usually exercise a lot to try and get rid of the loose skin but exercise alone won't get rid of the loose skin.  That's where I come in."

Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA

There is a lot of pain after these plastic surgeries for a few weeks after. "It's taking a lot longer to recover than I thought it would.". Four weeks after the surgery, the male patient was still not healed. He had a hole in his body about the size of an egg. "I felt wetness and my incision had opened up.", he told the camera crew. He had developed a staph infection in his open wound.

"we can't stitch up the open wound because if there is one germ left in there, they can develop a huge infection i.e. sepsis". Sepsis is a general body-wide infection from which there is a poor survival rate. This patient's relationship with his girl friend was strained, he said, and at filming they were hardly talking to each other.  He had a wound vac to suction out the hole.

It took him 6 weeks to heal and he still needed another surgery.

"my friends ask me why I want to go ahead with another surgery when I suffered all those complications, infections etc but I want to finish the job.", he explained.

Both patients have a huge scar which goes all around their bodies.

Note: part of Carnie Wilson's reasoning for having the "band over bypass" surgery is that she's got a job as a spokesperson for Allergan which manufactures the lap band.

The providers have nothing to lose. If the patient regains the weight or gets sick, they blame it on the patient...or quote statistics which suggest this type of reaction is very rare.  And if the patient lives and regains, the surgery is no longer mentioned.  If the patient dies or becomes very ill, the providers often make the patient afraid to speak out.

"I bury my mistakes" one gastric bypass surgeon joked to me.

In this surgery as in all commodities, it's a case of buyer beware.

Research sources:

Www.TLC.com/therealskinny

"Wilson Phillips Still Hanging on" show on the TV Guide network

Carnie Wilson - 2nd weight loss surgery

Carnie Wilson, singer and daughter of Beach Boy, Brian Wilson (pictured in red dress in photo with her singing group);  got a RNY gastric bypass, 12 years ago. She lost 150 lbs initially, and told the press, "It was so easy -- it was like I blinked my eyes and the scale went WHUUP!". 

A frenzy of people signed up for gastric bypass surgeries. One person who worked for a weight loss surgery surgeon, told the news that every time Carnie Wilson appeared on TV, their phones rang off the hook!  The surgical group who did Carnie's surgery, dramatically simulcasting on the internet during her surgery and launching a huge publicity campaign in partnership with the manufacturer of surgical instruments, went from doing 5-7 weight loss surgery procedures a week to doing 12 weight loss surgery procedures a week.  The future looked rosy, for Carnie and the Weight Loss surgery industry.

But dark clouds were gathering on the horizon.

Soon after Carnie Wilson's famous quote to the press above, she began regaining the weight, despite fighting hard to keep her weight off, including, hours of exercise, engaging personal trainers, putting salt on desserts so she wouldn't be tempted and publicly humiliating herself, talking about her weight problem. By 2011 when she appeared on the Dr Oz show, she'd regained to her average weight before surgery, about 240 which is a lot for her since she's only 5'1".

Apparently, she lately, had a gastric band placed over her bypass to force a restriction of her food intake, and has lost 30 lbs so far.

The bottom line is the gastric bypass or any weight loss surgery, is no free ride.  Just like using a non surgical tool like weight watchers, it's a lot of work on a daily basis for the rest of your life or you will regain the weight and/or get sick!  A percentage of gastric bypass patients get sick anyway, even if they do everything right.

Carnie Wilson, like so many others, was given the impression surgery worked automatically and easily.



That so many people embark on weight loss surgery seemingly ill prepared for the reality, can be at least, partially blamed on allowing the mass advertising of surgery without requiring the advertiser to list side effects and disclaimers like "results not typical".  Some weight loss surgery surgeons have an annual income of $1.5 million dollars - people have done strange things for much less money than that.

Let's hope the second weight loss surgery procedure will bring her what she's looking for.  She's such a beautiful woman and a great singer and somehow all of that tends to get lost in her frantic efforts to get slimmer. To me, that is sad.

Click on this blog link to see photos and story.

Dr Oz of TV and his infomercial about gastric bypass

In case you haven't heard by now, Dr Oz on Monday, January 23, had a segment about the gastric bypass surgery for weight loss, touting the invasive procedure as a "miraculous cure" for diabetes and hypertension.

In his opening statement, Dr Oz asked, "What if I told you there was miracle that helps you lose weight, lower your risk of cancer and heart disease and most shocking of all, reverse your type II diabetes overnight?"

Other than the fact that the gastric bypass strains the heart rather than protects the heart (as does any type of invasive surgery), it's interesting to note that the show segment following this rather dramatic announcement, did not mention cancer at all!

The problem with the show is that Dr Oz "forgot" to tell any of the risks of this surgery, which is being done less and less due to the availability of safer options like the lap band which do not call for the surgical dissection of the stomach nor the bypassing of any of the small bowel.

Dr Oz detailed one risk - the fact that patients might regain the weight, but he assured the audience that if patients did what their doctors expected, this would not happen and he emphasized the quick weight loss after surgery, without a reminder that most patients only retain less than 50% of the initial weight loss unless they work very hard at dieting and exercising, two things which will cause weight loss without outdated, risky surgery.

Butch Rosser, a surgeon who recently joined the "gold rush" of weight loss surgery, was also a guest on the show. Rosser had a gastric bypass 3 years ago and has not yet, experienced any repercussions - at least, none that he wanted to talk about on the show.

One of many things which concerned me, was that several things were misrepresented on the show.  For example, Dr Oz stated that the gastric bypass was invented in the 1970's - not true - it was invented in 1965 by Dr Edward Mason, who stopped doing his own surgery in 1980 after he found most of his patients to be suffering from severe osteoporosis and more.  Mason wrote prolifically about the problem of "metabolic bone disease" in gastric bypass patients but unfortunately, only in medical journals - not in places most prospective patients would visit.

Dr Oz also gave the impression that the gastric bypass was not invasive as far as disturbing digestion, reiterating the myth that the food meets the digestive juices lower in the small bowel.  In truth, the bypassed stomach does not produce a lot of acid and when it does, it gets rid of it quickly - since no food in the stomach is how our bodies tell the stomach to release the acid.  What acid there is, is more likely to cause an ulcer in the small bowel than to digest food.  Also the small bowel does not have the protective qualities of the stomach against the acid erosion and it is unknown whether without the presence of food, the duodenum or first section of the small bowel, also bypassed in the gastric bypass, will neutralize the acid released by the stomach as it does in normal digestion.

All this led Dr Mason to write about the disturbances in digestion the gastric bypass causes:

"I would like to see greater use of simple restriction procedures that do not rearrange these finely balanced mechanisms." U of I Healthcare news

So why did Dr Oz so ardently "sell" the gastric bypass (and bypass the more modern procedures which are also safer like the lap band)?

One can only speculate about this - obviously somewhere along the line, there might have been money changing hands - the misrepresentation of facts can usually be traced to the "money trail". Also, less and less people are opting for the gastric bypass which might be leaving some weight loss surgery surgeons in the need to learn new surgeries, a process no one enjoys.

Whatever the case, it was using television and a lot of misrepresentation to hard sell surgery which is, at the least, ethically challenged.

From the patient and other reactions I've heard, Dr Oz lost some fans after this show segment - people are not quite as naiive about these weight loss surgery procedures as he seems to think they are.  One individual wrote me that they had always felt Dr Oz was awesome but after they'd seen this segment on the gastric bypass, they were totally disallusioned with Dr Oz.

And as for Butch Rosser, MD, the gastric bypass surgeon - come lately;  when and if he gets longer term repercussions, will he appear on a TV show to tell about this?  No bets.