WLS providers misrepresent - who loses?

Occasionally (ok not so occasionally) I listen to an interview with a weight loss surgery provider which misleads from start to finish. And this upsets me and I think it upsets the many providers out there who truly care about their patients and try to follow up and make themselves available. It upsets everyone because it could give folks a very bad impression of providers in general. Folks tend to make decisions based on very limited contact. That is, _if_ their limited contact is a provider like the following one, it could lead to not only bad decisions but also a bad name for the industry.

I actually came across this provider whom I will call DR X, because one of his patients wrote to me and she is not a happy camper. She had a gastric bypass 3 years ago and has been ill ever since and worse yet, she hardly lost any weight from it. This provider who told her it was easily reversed and that he would be there for her, immediately dropped her with his last communication being several rude comments about how she had broken the "tool" and all her illness was her fault. She now is looking for a provider to give her a take-down so she can have some quality of life again and not be so ill.

I am not blaming the surgeon for her illness - it could be that her body just really objected to having her innards so drastically rearranged - many bodies do object to having the stomach cut in two pieces and most of it bypassed and the gut cut into three pieces and put back together in a very different manner than it came from the factory (despite the fact that the media hype tries to convince us that it's a total "walk in the park" and the "weight falls off" etc).

What I do fault the surgeon for, is not supporting her when she did become ill and also she told me that the surgeon really did not give her any detailed instructions on how to manage, what supplements to take, B12 shots and a myriad of other facts gastric bypass patients should be in possession of, before they take the big plunge. To be sick and without a provider who understands can be one of the loneliest positions one can be in and yet, I have met quite a few ill gastric bypass patients in this exact position.

In the radio program I listened to, this provider made the following comments:

When asked if a gastric bypass wasn't a really extreme solution, he answered that living with a BMI of 43 was much more extreme than having a gastric bypass.

I think picking that BMI was an unfortunate choice for him. I lived with a BMI of 44 for quite some time and found that it wasn't extreme at all and that even being in my 60's I was totally not ill or even mobility impaired as he suggests. He never dealt with the fact that the gastric bypass has a 2 in 100 risk of death within 30 days of surgery (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]) and a 2-4 percent risk of dying within the first year plus a 20 percent reoperation rate and a 34 percent risk of gaining all or most of the weight back within 10 years. (Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD) Now that's extreme!

But the comments were about to get better or more um..misleading...

He dismissed all the "bad stories" about gastric bypass comparing pregnancy to gastric bypass "everyone gives them the horror stories. People in general want to share your misery."

I don't have to comment about this one except the least this comment is, is highly insensitive to those folks for whom the WLS does not work or makes them ill. Of course, there is every evidence that this surgeon drops patients who are not happy campers so he may not really be concerned with anyone but those who are happy with the surgery.

And of course, pregnancy is a very natural condition whereas the gastric bypass is a very unnatural condition. That's kind of a no brainer.

Next comment....

He pointed out that all WLS patients had tried dieting and failed but then, made another unfortunate analogy. He stated that "you don't buy a car without taking walks, getting rides from friends, taking the bus and riding a bicycle"

In case Dr X didn't know, most people never try out bikes etc before buying cars - indeed, a large percentage of teens already have cars and use them to drive as short a distance as 1 mile to school which would be a walk for me! And actually, most ill patients have told me that they really didn't give dieting as hard a try as they gave WLS, so perhaps his analogy while unfortunate for proving his case, may have been more correct than he meant!

Finally to make his point which was obviously to go buy a bariatric surgery, hopefully from him he made the classic comment of all times. I quote him here:

"It isn't extreme. I'd much rather have bariatric surgery than being obese. I'd rather have AIDS than diabetes. I know that people don't die from AIDS in the USA anymore..."

Excuse me? People don't die from AIDS anymore? What planet does he live on, I wonder. Has he ever seen a terminal aids patient? There is nothing quite so bad as that. Diabetes while not a walk in the park, is totally no comparison to Aids and I really wonder how a physician can make such a bad error without making it on purpose, hoping the public is extremely ignorant.

Physicians like this scare me because people believe them and can get very hurt by their misrepresentations.

In the course of the discussion, it turned out this surgeon, Dr X, had gained 70 lbs at one time in his life and had lost it by exercise and extreme eating. In other words, some of his judgmental attitudes definitely resemble the ex-smoker who is intolerant of everyone who has not yet given up smoking.

He is not the first surgeon I have encountered who is fat phobic - actually I have over heard remarks from a few WLS surgeons which are extremely disparaging (to say the least) about the patients who provide their bread and butter. One surgeon, for example (who is retired now) told the nurses to not pick up a bariatric patient if they fell. "Just leave them on the floor and call the paramedics and let them deal with it" he told the nurses, an attitude which annoyed even very slim nurses. He was the one who laughed when he said "Oh, if they overeat after surgery, it WILL come up!" I think the vomiting after gastric bypass isn't a laughing matter by any stretch of the imagination. Not withstanding his assumption that all fat people are that way from stuffing themselves which in my observation simply has no relationship to reality.

In the as yet unpublished Russell Williams studies, he asked several caterers who had catered NAAFA conventions where the average BMI is well over 40, how the amount of food consumed compared to those conventions attended by a cross section of the public, many at so called "normal weight". He found that 3 caterers said the fat folks had consumed about the same amount of food as the so called normal weight folks and the other three caterers said that the fat folks had consumed less food than the slimmer folks!

So we wonder does a surgeon's fat phobia spill over to his/her performance in the OR? One would hope not and frankly, I had never considered the possibility, until I watched a "Whipple procedure" which is done for pancreatic cancer and much less invasive than a gastric bypass. The surgeon refused to do it laparoscopically (he said it was too delicate and too much might be injured), he took 5 hours to do it, doing most of the anastomosis with sutures and not with staples and painstakingly, avoided injuring organs, causing a lot of bleeding and not connecting blood vessels. The Whipple procedure provides for cutting a section of the pancreas and a section of the duodenum, the first section of the small bowel which is a small percentage of the digestive tract which is cut and rearranged in a gastric bypass. So I really wondered how they can do a gastric bypass in 30-90 minutes when there is a lot more cutting involved? Is it because fat people considered disposable in our fat phobic society? I was shocked to say the least but in thinking about it, it's logical that fat phobia would carry over, at least in some cases, as does any bias.

If you are considering any of these procedures particularly the gastric bypass (RNY) or duodenal switch/bileopancreatic diversion (DS/BPD), take your time. Get your information from informed consent documents or from a gastroenterologist. Someone who does not stand to profit if you decide to go ahead with it. That's only common sense. Sadly, we often take a lot more time and care, buying a car than we do, buying a surgery.

Biggest losers - the people or the show?

In this month's TIME MAGAZINE was a short article about "Reality shows which aren't really reality" in reviewing a movie about teens.

That phrase struck me because they've been really hawking the new season of the TV show, "THE BIGGEST LOSER". And somehow, for no reason I can fathom, this show is wildly popular.

I not only cannot understand fat people volunteering to be on this show and apparently losing much of their dignity in front of TV cameras but I cannot understand why people watch the show because the dynamics of dropping someone every week often for no apparent reason or the cameras showing these people fighting with each other or wincing during the hours of grueling exercise, all tend to annoy me to the point where I cannot stand to watch the show.

Worse yet was when I did some research on the show and found out that the way they lose so many pounds a week was that they worked out for 5 hours or more a day and were sequestered on a ranch somewhere with personal trainers who appear as if they got their training from the Spanish Inquisition or any other place of torture. They appear to enjoy seeing their clients suffer untold pain to race for the biggest weight loss of the week.

Susan Powter tells us that the body can only process 2 lbs a week of fat so guess what folks who lose 7-10 lbs a week are losing? Muscle tissue, bone mass and organ meat. Not exactly what I would call healthy.

How pray-tell, are these folks going to have a chance to keep the weight off when they get back into the real world and have to do other things besides starve and work out for hours a day? And will the sore muscles and somewhat sadistic personal trainers render them sour on exercise for life? (Studies have shown that moderate exercise is a very good thing!)

One of the "biggest losers" did take an interview a while ago and he said when he had to do real things like work, he ended up re-gaining a significant amount of weight. I suspect that's the fate of most, if not all of the folks on that show. Kind of a no brainer if you think about it. After all, if we lived in the Amazon Jungle without refrigerators, cars and fast food, we'd all be slim. And a large number of us would also be dead.

In 1900 when people worked 12 hours a day for 6 days a week and didn't have refrigerators or fast food or real tasty food (let alone time to eat it) there was little to no obesity. But the average lifespan was 45 years. Now despite the "deadly obesity epidemic" our lifespan is 78 -80 years. Big difference.

Does anyone care about the health of these people which probably is seriously threatened by this type of regime suffered on "The Biggest Loser" show?

Are people aware of the fact that people occasionally die on these reality weight loss /get fit shows?

For example, a gastric bypass patient was picked to be in the Fit TV show "Ship out and Shape Out" She was a pretty lady named Jennifer who had a kindly sweet personality. She had lost a bunch of weight with her surgery but was still over 200 lbs and wanted to lose more. Her personal trainer mentioned she had "health problems" (likely from the bypass). She did not participate in all the exercises and those she did participate in, seemed a big strain on her body. And about 6 months after the show was first aired, she died. (I found that out because when the show re-ran, they had a memorial to her in the credits).

She wasn't the only person on the show who suffered. An over 40's man almost had a heart attack on one of the hikes they took (you cannot just suddenly be fit - you have to work up to it). He got all red in the face, and half collapsed. Not surprising, he didn't show up for the reunion of the group, 3 months after the show was finished filming.

And "Ship out - Shape Out" was tame and conservative compared to the horrors they put the people through on the "Biggest Loser" show.

5 percent of the population can keep their weight off after losing a bunch of it.
95 percent of the population thinks they are in this 5 percent.

Maybe people watch the "Biggest Loser" show because they dream of the weight just dropping off. The same reason, people ignore all the friends who regained or got sick or died with weight loss surgery, ignore the warnings in release forms and hop on the table to have a gastric bypass. They only think about that first year when the weight is automatically dropping off because they are too injured and sick inside to be able to eat much or have an appetite. They don't seem to think about what the 2nd and 3rd year will bring or the 20th year when they might have re-gained most of their weight but still have another set of co morbidities from the weight loss surgery. I've talked to many older post ops who say they are taking more meds now than they did when they were very overweight. But 200,000 people have this surgery yearly (in the USA), seemingly ignoring all the evidence (and the non guarantees from the medical profession about what life with weight loss surgery will really be like or even the expectations of retained weight loss which are not much better than dieting).

I think it's the same thing which inspires people to watch the "Biggest Loser" show. It's a rationalization that a daydream is reality. A rationalization that becomes so strong in some that they are willing to play Russian Roulette with their lives and future rather than face reality. A bit like the movie, "The Matrix" where the reality of humans lying in a bed, having their energy slowly zapped by a machine was totally different from the world the machine created for their brains and how some individuals, when faced with the reality of a somewhat, desolate world, willingly became prisoners of the machine again. "The Matrix" although having a less than great, plot line, was so deep in meaning and significance as to our generation that I've found several books written about it.

Reality shows which are not really reality. Time Magazine said it well. But when that non reality becomes a motivation for people to take insane chances with their lives, it's time to stop and re-think the whole schema.

Maybe the "Biggest Loser" is not the group of people thus tortured for several months for the delight of the TV audience or even the show itself but those who watch the show and begin to believe the myths spewed out therein.

Not a new thing of course. Hitler stated "Say something over and over and people will begin to believe it" Doubtlessly, he would have loved modern communications and manipulative media like TV - scary to think of what he would have done with these powerful tools.

He also said "It is very good for rulers that people do not think" and that was in the 1930's.

The Melborne Monash U study - diabetes and obesity surgery

You have to understand that I consider the adjustable lap band a far superior WLS to any of the earlier procedures. It's much safer (about 10 times safer), inserts no staples into the body, no intestinal bypass (as is true of the gastric bypass) and is adjustable which can be a plus if the person does not experience the loss they wanted. But to sell any WLS with misleading statements bothers me because any WLS is serious surgery, even the lap band. I cannot help it.

I recently found out that the show, "60 MINUTES" is as misleading in Australia as it is in the USA. At least in Australia, they are a bit more civilized than they were in the USA and are advocating the lap band which is a MUCH safer surgery than the gastric bypass and they also pointed out that the sugar levels in diabetes could be reduced through a non surgical program like Weight Watchers. But the transcript of that show does contain a few whoppers (i.e. misleading statements - I'm being polite here) which I'd like to go over here. Also I'd like to talk a bit about the Monash study which is now available to read on the AMA site.

First the 60 minutes show in Australia.

Statement: Weight loss surgery cures diabetes and they quoted the study as a backup and a WLS surgeon also confirming it.

REALITY: That's false. Because diabetes is a genetic disease so only changing your genes will cure it.

Not surprising, the study from Monash did not use the word "cure". They used the word "remission". Here is a statement from their study abstract:

Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group.

We will return to this study later but first more misleading statements from "60 minutes".

statement: "That lifestyle, though, has led to him getting diabetes"

REALITY: FALSE. Diabetes is a gene. While there is some evidence that a healthy lifestyle which includes daily exercise and slight calorie restriction can delay the need for medication, it is also true that 33 percent of type II diabetics have never been fat in their lives and many of those exercise a lot.

statement: "if he doesn't have surgery, the diabetes will get worse"

REALITY: The diabetes will get worse regardless of what treatment he has because it's a gene and the pancreas gets progressively worn out as a person ages.

Statement: that you must lose weight to "cure" the diabetes.

REALITY: As we said before diabetes is a gene and not curable. And if losing weight "cures" diabetes, how do we explain the 33 percent of folks with type II diabetes who have never been fat? (I know several of these myself actually).

Finally: Statement: the suggestion - they didn't say this but strongly implied it - that WLS and/or weight loss would cure the erectile dysfunction often seen with diabetes.

REALITY: Weight loss doesn't do a thing for erectile dysfunction- don't expect a remission on that if you have it.

Now let's talk a bit about the study. It was a randomized study - this is good and appears to have been a clinical study i.e. the cohort were examined periodically by the researchers. Participants were divided into two groups. One group was given diet and exercise advice and the other group was given the same advice with the addition of lap band surgery. No one was paid for participating in the study. And the study lasted 2 years. The results were that whereas a remission of symptoms (as decided by the A1C) was observed in both groups, the percentage of remission was significantly higher in the lap band group. (13 percent in the non surgical group and 73 percent in the surgical group).

As far as the study went, it seemed better designed than some but here are what I see as the shortcomings, some of which could still be "fatal flaws".

• The cohort was small - only 60 people, 55 of whom completed the study at the 2 year point. The researchers themselves stated that larger studies needed to be done.
• None of those in the cohort had been diagnosed diabetes more than 2 years ago i.e. they were very newly diagnosed. This is a time when it's relatively easy with mild lifestyle changes including dietary modifications and cardio at least 5 days a week to keep the A1C at normal. Where the problems really begin is after several years. For example, a diabetic family member kept his A1C normal for 13 years with no medications (after that, he required oral meds).
• Lifestyle changes were self reported so we have no idea if the "controls" in the study i.e. the non ops were really exercising as much as they said. Probably they didn't.
  

We have two things going here. The researchers never claimed a cure - they claimed a remission only. The cure part was a misreprensentation on the part of the media and sadly enough the WLS surgeon interviewed in the media.

Second, we by seredipity found out something very interesting about surgery and diabetes. This family member, my hubby, diagnosed 14 years ago, had a brain hemorrhage in Feb - and no, his team of doctors assured us that it was NOT caused by diabetes or hypertension. He had surgery to insert a shunt to drain his spinal cord fluid and went home a day later. In the ICU, his sugar levels were extremely high - stress was apparently a major factor in that. (another interesting thing we learned about diabetes).

But very oddly enough, even after having totally unrelated surgery (but surgery in which he was intubated etc), by the time he got home, his sugar levels totally tanked! So he went on a fun food kick, eating all the things he had been denying himself for 14 years: Dairy Queen, fast food every night, desserts, ice cream whatever. And every morning for about 3 weeks, even with his bad eating and only minimal exercise (not daily), his morning sugar readings were at normal i.e. 80 or so.

But after that on the same non diet, they started to climb and finally he realized it was back on the old program of daily cardio and watching what he eats.

The suspicion remains however, is that somehow surgery seems to affect the sugar levels whether it's WLS or something totally unrelated. No one can really explain it but I think this is only temporary (the only reason WLS patients may sustain it is if they follow the lifestyle changes). And nice as his "honeymoon" with all the "bad foods" and couch potatoing was, I think he would not have chosen as his preference, to have the 13 days in ICU or the brain hemorrhage.

It's a shame that so many people buy the hype from TV without even checking it out (like pulling up the study etc).

As long as people feel there are quick fixes and easy ways out and "something for nothing" there will be snake oil salespersons right there to sell them something. Only with surgery, it may poorly affect the body for the rest of one's life besides possibly not being effective.

I guess my main concern is spewing forth extremely misleading statements about diabetes in order to frighten people into having obesity surgery.

Caveat Emptor - "let the buyer be beware" is a phrase which we seem to have forgotten in today's society driven by media hype.

Teens, weight loss and obesity surgery

Clyde was an ordinary teen. When he was in 7th grade, he was intelligent, talented and liked video games far more than exercise. He lived the American lifestyle. In his family, there aren't many veggies available and a lot of fast food and pizza. He tried the swim team but it didn't appeal and he felt a bit odd in a bathing suit because he was about 15 lbs overweight. And back then, the obesity hype for kids had just started.

When reflecting on High School at the end of his 8th grade year, he told me, "The kids in school are MEAN!" I didn't ask details but assumed that, like all kids who are not the "ideal" size, he had taken his share of teasing and nasty comments. He had, already at that young age, learned to dress in cover up clothing.

Today Clyde is a senior in High School and he is relatively slim.

Is this a success story? I wonder. Because how he did it was NOT through eating 5-9 portions of veggies a day, avoiding fast food and junk food, and trying to do 60-90 minutes of cardio daily. He, instead, continued to live the American lifestyle with some modifications.

He drinks a lot of tea (caffeine speeds up the heart and makes it easier to lose weight and by cutting the calories - it may also, in the long run, be a factor in Parkinson's disease as are all stimulants - see the book, PROZAC BACKLASH for one).

And he smokes cigarettes.

If he went to the doctor, the doctor would probably be pleased at his BMI but at what cost did he attain his "ideal weight"?

Does he know the proven dangers of smoking i.e. hardens the arteries, strains the heart, and shortens lifespan as much as 15 years? Yes he does. "I know it's dangerous," he told me a bit sadly, "but it's hard to stop."

He does not receive any support from his parents. They want him to stop smoking but do not help him to accept himself at his natural size. And they don't understand that when you are a teen in school, the pressure is 1000 times what it is in life and right now, there is a lot of pressure and heat given to all of those who are overweight regardless of age.

The sad thing is most kids will keep within the "normal zone" if they eat healthy, avoid foods like potato chips and fast food which are extremely calorically dense and not particularly nourishing and if they exercise 1-2 hours a day. However, most kids are not really enthusiastic about this type of program and do not often get a good example of a healthy lifestyle at home.

Clyde is not alone. Statistics tell us that more teens are starting to smoke now, than in the 1960's before the dangers of smoking were known.

In considering kids like Clyde, is it really hard to understand that teens simply do not care if they are doing something unhealthy to keep thin because that is most important in the narrow minded society of High School?

Starting with Junior High School, "bulimia clubs" are flourishing, use of "uppers" are common and an alarming percentage of kids are already dieting or more extremely cutting calories. Very often it's the models in the magazines who are blamed, totally ignoring the heat overweight kids get from parents, teachers and the medical profession.

And now, with the encouragement of our wonderful news media and the surgeons who stand to profit, teens who are very overweight, have discovered Weight Loss Surgery.

As recent as a decade ago, the thought of doing something like a gastric bypass on anyone under 18 was considered unethical - inducing vitamin deficiencies in a body which has not yet matured, partially disabling a healthy digestive tract was considered bad medicine but now it's considered good medicine, the surgeons reciting the song of how the teen "was in danger" of a variety of ailments, many of which are non issues or not caused by obesity.

The "Today Show" recently, featured a teen, around 256 lbs who got a gastric bypass. In her before photos she was shown running around a field playing with a dog and smiling. A year later, she had lost 100 lbs and was of "socially acceptable size". But now she was not smiling. Even when the doctor told her she was a success, one saw only a hint of a smile on her face.

"I have to eat very differently now" she told the Today Show, "there are many foods which no longer go down right." She concluded, "It's not an easy road."

The rationale for giving this 17 year old a surgery which cut her stomach into two pieces and her bowel into 3 pieces, rearranging them in a very unnatural manner, a surgery which some studies show to pose a risk of serious complications in 40 percent of patients, by the 8 year point, complications like bowel obstruction, ulcer, pancreatitis and more... the rationale for doing this on the young lady was she had "sleep apnea", "high blood pressure" and "was in danger of going blind" (they never told us what endangered her).

Sleep apnea is a fairly new diagnosis. I don't doubt that some extremely large folks may have breathing problems, but I think the diagnosis of "sleep apnea" in everyone with a BMI over 35, may be way exaggerated.

I had an overweight friend diagnosed of that. She was given a C-PAP machine and found it way too noisy so she gave it back and went on and she was just fine without intervention. I think we CAN stop breathing for a few seconds without a problem and probably many people who are not fat might be doing that also.

So that left the "high blood pressure" (which can be easily regulated by medication) as their sole rationale for ruining this young lady's digestive tract for life, giving her lifetime problems which may really be biting her at the age of 30 when she would be in the prime of life had she not had the surgery, even if she was very overweight.

Sober faced, the young girl told the Today Show that it was "so nice to not worry about future health problems." How ironic that the procedure she had is, indeed, going to give her a new set of health problems which she might have never had to worry about.

It's time that the media and also adults stop pressuring our children. If they want to help them, they should encourage exercise (to be healthy) and eating veggies and healthy foods and most important, help them to understand that health and beauty is not about size. But when even our medical profession starts condoning unhealthy ways of getting thinner, things are out of control in my opinion.

On the Today Show, the resident doctor obviously approved of this young girl's gastric bypass. "Today's obese children are in the unique position of really having a shortened lifespan," she told the viewers.

With all due respect, the only reason that might be true is because society is pressuring teens to the extent that they are doing unhealthy things to lose weight, like smoking or gastric bypasses. That's a no brainer, isn't it? Apparently not to many folks.

Bariatric surgery slashes cancer risk?

Latest news - front page for several days - has been that having a gastric bypass can cut cancer risks.

Bariatric surgeons at McGill University compared the records of 1000 patients mostly gastric bypass to 5700 people matched by age, weight and sex who did not have the surgery.

In the surgical group, 2 percent developed cancer and in the non surgical group, 8.5 percent developed cancer.

Although the study is yet unpublished, these bariatric surgeons presented their preliminary findings at the latest meeting of bariatric surgeons of the ASBMS recently. (talk about preaching to the choir).

And isn't it amazing that an unpublished study has made such headlines for several days now?

What is even more amazing is that while Dr Glenn Gaesser found in his metastudy that obese people were 40 percent less likely to develop cancer, how these surgeons found the opposite. Of course 6 percent more cancer isn't really that great although you can express it to sound amazing as MSNBC did .... saying 80 percent greater chance of cancer in the non surgical group.

One of the objections to this study was actually brought up by another bariatric surgeon. Edward Phillips, a bariatric surgeon at Cedars-Sinai Medical Center told the LA Times that patients who have weight loss surgery, are often screened for cancer before surgery. "We may be selecting patients who don't have cancer for surgery, thus biasing the study", he said.

It's hard to judge without seeing the study. For example, a lot of very obese people are yo yo dieters and that weight cycling raises all health risks. Also I am wondering why they had to pick so many obese people to compare. Why not select 1000 fat people to match up with the 1000 WLS patients? Because I bet in 1000 fat people you might not get any cancer at all and that wasn't what they wanted to prove with their study.

The study only ran for 5 years and critics of the study have pointed out that it often takes a cancer many more years to develop than that and that had the study been taken out longer, the results might have been different.

Breast cancer was one of the cancers which they saw less of in the bariatric patients. Could it be that after a gastric bypass, patients were unable to take birth control medication (a major risk factor for breast cancer - that is medications work differently in gastric bypass patients because of the malabsorption issues)? Or that the gastric bypass patients were unable to eat or digest foods with transfat in them (another cancer activator). Also most weight loss surgery surgeons require their patients to quit smoking whereas the fat controls were not necessarily non smokers. Another thing is that most gastric bypass patients can no longer drink alcohol especially the newer ops as they would have been looking at, if the study only ran 5 years - alcohol can be another risk factor for cancer.

There are just too many other factors which could be operational in all of this to assume that it was the surgery and weight loss which explained the 6 percent less cancer in the surgical group.

For example, most gastric bypass patients are told to exercise often in order to help keep off the weight. Exercising can knock the risk of cancer (in anyone of any size) down, 40 percent. Most of the obese controls were probably not exercising regularly.

Ideally the fat controls should have also been matched for exercise, not smoking and dietary modifiations (like the elimination of trans fat in the diet) if the scientists wanted to really see if it was the surgery or the weight loss which explained the less cancer in the surgical group.

A non randomized study always raises red flags. The fat people could have been picked for their cancer risk (i.e. cancer in the family etc).

I guess the thing which rather annoys me about this whole deal (besides the news media making it a headline for the last week or more) is that all the research I've done comes out the opposite...

• Cancer is seen 40 percent less in fat people than in slim people - it has been considered a disease of the slim and yet now they are trying to link it like everything else to obesity.
• Two oncologists have told me that fat people if they get cancer, are much more likely to survive than slimmer people.

So unlike the media is trying to tell us, the "link between obesity and cancer" has not been well proven at all. On the contrary. The American Cancer society has stated that lifestyle (not girth) is a factor in 85 percent of cancers.

Even the release form for gastric bypass used by many surgeons and usually attributed to Kaiser Permanante warns:

Keep In Mind: Slender individuals have adult diabetes. Slender individuals have heart attacks. Slender individuals develop arthritis and have joint problems. Slender individuals have strokes and develop cancer. If obese individuals have these problems more commonly than the slender, it is because the same bad health habits just don't happen to cause obesity in some individuals "fortunate" enough to be slender no matter what they eat. They may be slender but they could very likely die just as early in life as someone who is overweight.****

And obviously those who wrote this release form do believe in bariatric surgery.

Additionally, I have seen many get cancer who were very slim. Some of them were very fit like a 53 year old family member. She ran marathons and I'm sure the last time she visited her doctor before she came down with the cancer which was to kill her 3 years later, her doctor proclaimed her totally healthy, at her perfect weight with low risk numbers.

So much for the risk numbers and perfect weight predicting protection against cancer!

I would not take this one to the bank. Many gastric bypass patients can develop a condition called "leaky bowel" wherein bacteria, not killed in stomach acid, enter the small gut and are absorbed along with the food. With this condition causing in many, auto immune disorder like RA and lupus, it is suspected that the immune system of a gastric bypass patient might been impaired by the surgery and not strengthened as these McGill bariatric surgeons would like us to believe.

Brooke Bates revisited

If you remember Brooke Bates, she's the 12 year old who had a lap band put in after having 35 lbs of fat removed by liposuction and dieting (since the age of 3 years old) did not produce the desired results. I, at the time, followed the attitude of the media, which blamed the parents. Frankly my blog was horribly judgmental as I re-read it.

Recently Brooke Bates' mother wrote a feedback to one of my blogs and I feel that it's important enough for her to have a voice in all of this that I decided to reprint her feedback letter here:

BROOKE BATES IS MY DAUGHTER. I WANTED TO LET EVERYONE KNOW THAT WE LOVE HER AND WOULD NEVER DO ANYTHING TO HARM OUR CHILD! WE SAVED HER FROM FUTURE PROBLEMS THAT ARISE FROM BEING OBESE! OBESITY IS NO DIFFERENT THAN A HEART CONDITION OR ANY OTHER ILLNESS! SHE IS HEALTHY AND HAPPY NOW!! DR. ERSEK SAVED HER LIFE PEOPLE! CANT YOU SEE THIS! WE ONLY TOOK HER TO GET THE LAP BAND TO PREVENT FUTURE WEIGHT GAIN. HOW MANY PEOPLE DO YOU KNOW THAT HAVE LOST WEIGHT AND GAINED IT BACK???? IF IT WASNT YOU, THEN I,M SURE YOU KNOW SOMEONE THAT THIS HAS HAPPENED TO! WAKE UP ! MODERN TECHNOLOGY HAS BROUGHT US ALONG WAY AND ITS HIGH TIME PARENTS TRY TO HELP THE CHILDREN AND SCREW EVERYONE ELSE AND WHAT THEY THINK! SINCERELY, CINDY BATES

This of course, argues that the media (and myself) were way too harsh on Brooke's parents for as Cindy pointed out, she loves her daughter deeply and wants the best for her.

First I would like to formally apologize to Mr and Mrs Bates for my judgmental attitudes toward them. Cindy is right... she just had the best in mind for her daughter and was likely, following her medical provider's advice or at least, acting with her medical provider's blessings.

But secondly, I think we all perhaps missed the point and that is that Brooke's parents were as much a victim of an out-of-control diet industry as Brooke herself. And that is sad.

I'm sure that neither Brooke NOR her parents were told that 34 percent of even the more invasive gastric bypass patients regain all or most of the weight loss according to a 2006 study.
(Annals of Surgery. 244(5):734-740, November 2006.
Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)

I'm sure they were not told that in years to come, the lap band can grow into the stomach, causing the necessity for a partial gastrectomy or removal of a part of Brooke's stomach. Even in the most non invasive form (and the lap band is a wonderful improvement over the other WLS procedures available), ANY gastric surgery can upset mother nature in a way that can have repercussions later on.

And doubly sure the Bates family was NOT given the only long term statistics we have on the lap band (and gastric bypass) i.e. the Swedish Obesity study in which it was found at the 10 year post op point, the average amount of weight kept off was only 16 percent of the original weight.
(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)

Brooke's high weight was 220 so that means at 10 years post op, if she is average, she will have kept off 35 pounds after having her band in for 10 years and this she could have done with Weight Watchers or something non invasive.

Recently I read on one of the groups, a new WLS patient who lamented "I cannot eat normally now!" WLS patients must observe rules some of which I also observe because I have a stricture of the esophagus from GERD and a medical procedure which was a bad idea. Some of those rules include 'eat bites the size of a pea', "take time between each bite and chew each bite until it's liquid". But unwritten rules say "no pizza or steak", and "if you want to not get around the surgery, you must find things which are soft but not caloric and that takes a lot of creativity." I frankly find the stricture even at the age of 63, quite a hit on the quality of life and I cannot imagine a 12 year old having to worry about these things and never being able to "have a party in her mouth" as Dr Phil has put it.

Additionally, I know most folks do not know (and many medical providers do not tell us either) that kids who diet, tend to really mess up their metabolisms and that comes back to bite later on. I know - I WAS one of those kids and I kept slim in High School (well normal sized) by severe calorie restriction. But most of my adult life I have weighed well over 200 lbs and if I don't calorie restrict now I keep on gaining (which I did very nicely after my last dieting attempt at the age of 60). Working out daily which I have done for 14 years does in NO WAY prevent me from gaining weight.

I am deeply sorry for any hurt I might have caused Mr and Mrs Bates and Brooke.

However, I do hope that people reading this will realize that in this confusing, complex world, more than good intentions are needed. We need to become informed ourselves as we may not hear the best advice from the news media (which is an advertising platform), or even from our medical providers when it comes to weight control and healthy lifestyle. For example, if an overweight person goes to the medical provider, they invariably hear "lose weight" but if they smoke cigarettes, they might hear "well you should give up smoking" ** wink wink ** but that's it. Strange considering they have a ton of studies out there suggesting smoking not only is a major cause of heart disease but also, hastens the onset of diabetes and many other ailments, whereas obesity alone has never yet been proven deadly.

Obesity is not a killer. In the release form used by many WLS surgeons and usually attributed to the insurance company, "Kaiser Permanante", they say up front that obesity is NOT a killer but rather, it is bad health habits which can raise the risks for both fat and slim folks. This being said, it should be noted that the increased risk of even fat couch potatoes is minimal according to several studies including those of the Cooper Institute and the bottom line is, heart attacks, strokes and diabetes happen in individuals of all weights:

****Keep In Mind: Slender individuals have adult diabetes. Slender individuals have heart attacks. Slender individuals develop arthritis and have joint problems. Slender individuals have strokes and develop cancer. If obese individuals have these problems more commonly than the slender, it is because the same bad health habits just don't happen to cause obesity in some individuals "fortunate" enough to be slender no matter what they eat. They may be slender but they could very likely die just as early in life as someone who is overweight.****

(Kaiser Permanante Release form for WLS)

And....

*** If you believe this surgery will restore you to complete and normal health you are mistaken. You are trading one nutrition problem for another problem. Obesity alone, does not necessarily kill you...Do not think you know better because you had a friend who had the surgery and did well despite eating whatever they wanted. This is an exception. Given enough time, they will probably put most of the weight back on.

Kaiser permanante release form for gastric bypass/duodenal switch

I plan to delete my earlier blog about Brooke Bates because it is overly judgmental and I did not mean to do that and I absolutely did put the blame in the wrong place. Brooke Bates is healthy today and we applaud her for her hard work for as a WLS surgeon put it, "success with WLS is 10 percent the surgery and 90 percent the patient!" Brooke obviously has put in the work and deserves the credit, however, we cannot help but observe that with better medical advice, she could have avoided disturbing her digestive system and her quality of life.

V-Bloc - new hope or old spin?

Several years ago, they did a study on a device developed, I believe, in Switzerland called the "gastric pacer". Several US Weight loss surgery surgeons jumped on the bandwagon. What this device (implanted in the back - and similar in function to a heart pacemaker) did was send electrical impulses to the vagus nerve of the stomach. No intestines were rearranged, the stomach was not otherwise disturbed and it seemed a really great idea. One surgeon wrote to a listserve "I am testing a device now which will outdate all weight loss surgery in five years!"

I followed the studies on gastric pacing and even interviewed some patients. Unfortunately the results, weightloss-wise, were extremely poor. One patient out of the three studies in one area, lost 70 lbs. One patient lost 100 lbs but became very ill from several things including cancer, partially from the side effects of the device and had to have it removed. The rest in the three studies, either lost very little weight or no weight at all. All of the patients except the two previously mentioned, ended up getting other procedures, either gastric bypass or lap band which they all, down to the man, found not only far more effective with weight loss but also, far more comfortable than the gastric pacer.

But worse yet, this "totally non invasive device" (as it was _heavily_ advertised) had a set of co morbidities of its own, some of which I understand are also true of the heart pacemaker but to a lesser degree.

First, it could travel around in the body causing problems getting where it didn't belong (like heavily inflaming surrounding tissue). The one patient who had to have it removed in an emergency situation, had it travel halfway down her back.

Secondly, the amount of current required to block the vagus nerve turned out to be about 10 times the amount of current required in a heart pacemaker. When the device was working, many patients complained of tingling uncomfortable feelings in their arms.

Third, patients were told it stopped the appetite. But the way it stopped the appetite was to keep the stomach from emptying into the small intestine, a condition well known to GERD patients. What they didn't tell the patients was that if the food just sits in the stomach, it starts to rot and can cause a horrendous case of upset stomach (and burping up, rotten food - I know because I have GERD myself). It can also cause too much stomach acid which splashes into the esophagus and can cause not only heartburn but also a condition of ulcers and sores in the esophagus called "Barrett's Esophagus" which can lead to esophageal cancer - a rather distressing type of cancer.

Fourth, patients were told the battery on the gastric pacer would require changing every 2-9 years which are the statistics on heart pacemakers. But what patients found out was that, because the amount of electrical current required for blocking the vagus nerve, was about 10 times what a heart requires, gastric pacer batteries generally had to be changed every 9 months to a year and that required a small surgery.

And finally, for many patients, disturbing the emptying of the stomach did not cause a great deal of weight loss just like the discomfort (and even stricture) associated with GERD doesn't necessarily cause weight loss either. (Again I can attest to that one - I easily managed a BMI of 44 for years until I found Weight Watchers, even with GERD, and a stricture of the esophagus).

Needless to say, the gastric pacing listserve was closed, the studies of this "utterly hopeful" device having been ended but not without a few lawsuits from sick or upset patients.

But ........

As they say in "infomercials"... but wait! Because the gastric pacer came back in 2005, with a new name, new studies and more heavy advertising! That's right.

In 2005, a small company named EnteroMedics in Minnesota announced that they were working on a type of gastric pacer. The press release included the following:

The company says cutting off the nerve supply may slow down digestion because the stomach doesn't register the food and start the digestive process.

Well, apparently they had begun trials of this device in several cities and like the gastric pacer, they claimed it's totally non invasive. Interestingly enough, the TV blurb on it used a gastric bypass patient to show how great losing weight is and claimed the new gastric pacer (the V-Bloc) "may" work just as well as the gastric bypass.  (Which they soon found out to be not as true - in some studies the weight loss in the controls equaled or exceeded that of the people using the v-Bloc.

So you'd think the second time around, they would have gotten the message.  But apparently they didn't because in Jan 2015, guess what's back!

None other but the V-bloc dolled up with a new name but it's the same old, same old.  They opened a new website for it at: http://www.enteromedics.com/vbloc/

Look quickly because after two or three go-arounds with this device, I suspect the website will be as long lived as the last websites were.  But not until they've sold patients with huge promises of its success.  People cannot remember as far back as 2005, I guess they are reasoning (or hoping?)

The following is from my research in 2005 - I'm quite certain this device has the same issues despite the new name! :)

It was difficult to research the V-bloc. Both the EnteroMedics website and the research study website were very vague about how the device works.

So I called a phone number which stated: "For more information about VBLOC Therapy and the EMPOWER clinical research study, please call the nurse-staffed information line at ......"

I spoke to 2 nurses, one of whom got short with me when I was apparently asking too many questions. She said "really this phone number is merely to identify and qualify patients for the study". To which I answered "well that's NOT what you stated on the website" and I quoted the above. Then I reminded her that as soon as they have advertised the device on TV, then the public has a right to know the details. By the time I spoke to the second nurse (a different lady from the first nurse so they apparently are paying no small fee for having nurses to answer phones!), I had a specific question and was prepared with an answer when she told me the line was just to qualify patients.

I did find out that the chest belt part of V-bloc is the battery pack so apparently one improvement V-Bloc has over the gastric pacer is that to change the battery you don't need the small surgery.

But something else on the EnteroMedics website about what the V-Bloc really does (and this website is not given on the Empower study website either - I had to google it) is a bit unsettling. They admitted that they don't really know how the Vagus nerve interfaces with the appetite but listed the functions of the vagus nerve and it's more than just stopping the peristalsis (the muscular action of the stomach to digest the food and send it to the small bowel). Here is the list of vagus nerve functions which the V-Bloc supposedly stops (from their website) :

The mechanisms responsible for obesity and the role played by the vagal nerves are not yet fully understood. Vagus nerve function appears to play a significant role in enabling multiple mechanisms including:

• Expansion of the stomach as food enters.
• Stomach contractions that break food into smaller particles.
• Release of gastric acid to continue food processing.
• Emptying of the stomach contents into the small intestine.
• Secretion of digestive pancreatic enzymes that enable absorption of calories.
• Sensations of hunger, satisfaction or fullness

In plain terms, the V-bloc not only gives you a horrendous case of indigestion but also can induce a  simulation of "gastroparesis" (stomach not emptying due to partial paralysis), and can interfere with the pancreatic enzymes as well as with stomach acid which will not only affect fat digestion but also protein digestion and vitamin digestion!

In another place on the same website, it stated that the idea for the V-bloc (and probably the gastric pacer also) was that before they had the medication to stop the stomach acid for ulcers, the so called PPIs, they would go in and cut the vagus nerve to help ulcers.

Before the availability of proton pump inhibitors (drugs that reduce the amount of gastric acid released into the stomach for persons with ulcers), surgeons routinely cut the vagus nerves near the stomach to treat ulcers. This procedure is called a "vagotomy." For a period of time following surgery, many of the people who underwent this procedure absorbed fewer calories from fat, lost weight and had decreased appetite.

Notice for a "period of time after surgery". That is, it did not work indefinitely to stop the appetite.

Other than the battery pack (it's carried on a case the size of a compact disc, one nurse told me) worn around the chest (which I suspect might be inconvenient at times) which is an improvement over surgery every nine months to change the battery, it seems the V-bloc is pretty much the "same dog, different fleas" as the devastatingly unsuccessful and risky in its own way, gastric pacer. And something which the TV said has been added i.e. wires in the esophagus (I don't know how accurate the TV report is but since the Enteromedics folks are not giving much information, it's all we have).

The new device might have a smaller battery....

"He who does not study history, is doomed to repeat it" and "doing the same thing repeatedly hoping for a different result is insanity" (said Albert Einstein) so take a tip from those who struggled and suffered with the gastric pacer a few years ago, and consider waiting on the V-Bloc! Its predecessors interfered with digestion as much as the gastric bypass but did not even produce good weight loss results for most people.

At best scenario, the weight loss promised is 15-20 percent of the bodyweight in the first year. Doing the math, 15 percent of 300 lbs is 45 lbs. And likely the real results will be more like 10 percent or less. (as they were with all trials on the gastric pacer).

Surely a horrendous case of indigestion, food rotting in the stomach, heartburn and nausea may slow the appetite but at what price? You can do that without expensive electrical devices and multiple wires implanted in your body.

If you did not come here from the new blog - it's been re-introduced in 2015 ... click here to see the new blog on it...

bogus claims in the news - gastric bypass extends life?

Today I was chatting with some friends and someone brought up that some media column writer said you didn't have to put mayonnaise in the fridge. Mayonnaise has eggs in it for one and in my experience, gets rancid fast if not refrigerated. Everyone in the discussion did feel that it _should_ be refrigerated and since a media person said it didn't have to be, everyone seemed to feel that must be right.

Media is seldom if ever right. If they are not selling something, they often do poor research (this is partially because of tight deadlines which precludes doing careful research so they often look up the subject in other media articles which are just as poorly researched - a case of the blind leading the blind?). But the fact remains that too many people actually believe what the media prints regardless of how "over the top" it is!

Case in question. Here is a paragraph I found in one of the blog searches:

A Gastric Bypass Really Can Extend Your Life

If you are contemplating having a gastric bypass then a recent US study might just help you to make up your mind. The study looked at no fewer than 16,000 obese people and found that when people in the study group opted for gastric bypass surgery their long-term mortality rate dropped by as much as 40%. This should not really be a surprise since weight loss surgery also cures, or at least improves, a host of other conditions such as high blood pressure and diabetes and the change in diet and increase in exercise which follows surgery has got to be a good thing. Nevertheless, it is always nice to see what we already know put down in black and white as confirmation.

Of course the study is not cited and it all sounds good - if you don't think about it. A gastric bypass provides for the stomach to be cut into two pieces - one tiny piece which becomes the "pouch" and the rest of it (about 90 percent or more) which is bypassed along with the attached first segment of small bowel. The bowel is cut into pieces and rearranged in a way very different from the way nature made it. All this causes a quick weight loss during the first year or so and lifelong problems including vitamin deficiencies, osteoporosis, anemia, protein deficiencies and much more.

As Dr Terry Simpson put it:

***The RNY [gastric bypass] 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)

So how would this extend your life? Well, the idea here is that fatness is so deadly that any way to slim down regardless of unhealthy it is, is better than being fat. But there are no real studies which prove fatness in itself is deadly! And when they mention all these ills which are supposedly exacerbated by fat, does anyone question that slim people have the same ills i.e. high blood pressure, diabetes etc? I think the problem is people don't question something they read in the media. And that is where the problem starts.

But let's take a closer look at the study they referred to. It was one led by a WLS surgeon, Dr David Flum and he found in the study (which the media happily ignores) that the first month after a gastric bypass, 2 percent die and that another 5-7 percent of patients die within the first year (these were older patients so had bodies less tolerant to the extreme internal rearrangement done in the gastric bypass).

So how does he conclude that gastric bypass extends life? He compared these 16000 healthy fat people in for gastric bypass to 2000 seriously ill fat people in the hospital for other reasons and observed that since there were a small number of more deaths among the seriously ill fat people than the gastric bypass patients, that meant that the gastric bypass must have extended the lives of those who got it.

What he hoped the public would not realize is that had he compared the gastric bypass patients to 2000 seriously ill slim people in the hospital for other reasons, he would have also found that the healthy fat people who had gastric bypass survived better than the seriously ill slim folks. So would that mean that slim people should have a gastric bypass to "extend" their lives?

In another blog article
A nice looking couple is pictured. They are fat but not terribly so - they are both having gastric bypass surgery. The lady, it said, has high blood pressure even with being on 4 medications and the man has bad knees ("worn out from carrying all that weight").

Here's another which should be questioned. Most of the people I know with really bad knees are not fat. Some have never been fat in their lives - so how did their knees get bad without the "great weight" weighing down on them? And if a person's blood pressure is that high with 4 meds, did they really think a gastric bypass is going to bring it down that much? Again I know several slim people with very high blood pressure. The bottom line is, will introducing a surgical disease into their digestive tract make their health better? Perhaps or perhaps not - it all depends on whether their present comorbidities are greater than the comorbidities added by the bypass. But the media tells us that the bypass is some kind of magic bullet which fixes all ills and no one questions this and that is what is of concern.

***** "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) *****

Today I saw an ad for something about diabetes featuring as a poster kid, Randy Jackson. I did a double take. Jackson had a gastric bypass a year or two ago and that was supposed to have cured his diabetes (if you believe what the media tells us). I read the ad carefully. It said he was taking less diabetes meds now after his bypass but that is a totally different story than his diabetes getting "cured".

Fact remains, we are suffering from many old age diseases including worn out knees and high blood pressure because now we are living to the age where people start wearing out, fat or slim.

I commented on the widespread practice of smoking in Indonesia. "Doesn't that shorten their lifespan," I asked my hubby. He answered, "They don't live long enough to die from the repercussions of smoking."

I have known countless people who had gastric bypass to fix their knees only to find that the malnutrition and vitamin deficiencies made things worse if anything.

We need to start questioning seriously what we read in the media. If we follow their advice to not refrigerate our mayonnaise, we might get an upset stomach. But if we follow their advice to get a gastric bypass, the repercussions can be much more devastating.

Dr Oz sells out to the Weight loss surgery industry!

I looked forward to Dr Oz's new program "The Oz Files" on Discovery Health. This week's episode was entitled "Defeating Obesity". Dr Oz is a cardiac surgeon and although some of the things he has said about obesity are questionable, I felt he was basically mainstream health conscious.

But the Oz Files was a great disappointment. Interestingly enough, Dr Roizen, his partner who has joined him on most other shows was missing. As the show wore on, I had to wonder whether Dr Roizen didn't approve of the slant of the show which was doing anything but advocating health!

The scenario of the show was that four fat people were picked to lose a lot of weight in 6 months. Located all over the country, they were given little guidance on how to do this - just cameos with Dr Oz cooking a healthy food or telling them they should exercise. Instead of guidance in a more healthy lifestyle, the people were told things like their bodies were dying from the obesity (untrue) and if they didn't lose weight immediately, they would get diabetes (untrue - how does Dr Oz explain the 33 percent of type II diabetics who have never been fat in their lives?) and that the "omentum" was "poisoning" their livers and kidneys.

The "Omentum" has been a favorite of Dr Oz's. If you look it up on the web, it appears a sort of sheathing for the abdominal cavity but beyond that, no one knows what it really does so Dr Oz declaring that it somehow poisons the organs in a fat person, is more than a bit over the top since this is NOT based on science.

Bottom line, the four people were made to feel terrible about their weight, and their future but only told to "eat less and exercise more" (wow, what a revelation! NOT).

One of them had a gastric bypass. She was 5'6" and not even 300 lbs.

One of them was "lagging" on her weight loss after a couple of months so was put on the diabetic medication, Metformin to help kill her appetite. To put a healthy person on a diabetic specific medication is very questionable.

And the two other people, battled it alone. It was emphasized throughout the show that they were not doing their part in losing the weight. Also the husband of the gastric bypass patient was taken to task for "not keeping up with his wife", Dr Oz, totally ignoring that the quick weight loss period in a gastric bypass patient is NOT from living healthy but simply from fasting because they cannot eat due to the massive surgical changes made to their digestive tracts.

At the end of 6 months, the results were predictable and Dr Oz announced them with glee.

The gastric bypass patient had lost 70 lbs (but remember, less than 30 lbs of that was likely fat because gastric bypass patients are on a fasting diet the first few months after surgery as their bodies heal - their bodies can only get sugar out of body fat and must cannibalize muscle and bone and organs for the rest, a fact totally ignored by Dr Oz who gleefully pointed out how the gastric bypass patient lost that weight through "changing her lifestyle to diet and exercise" and how he applauded her because she did what she needed to do and "partnered with science".

The person on metformin lost 45 lbs and Oz "lauded" her also saying she was now a slim person (she wasn't really). But the fact is, without medication that her body did not need, she would _not_ have lost that much weight and when the medication is discontinued she will likely gain back.

The other two people did not do well on their weight loss, but Oz patronizingly said they learned a lot from participation.

The content message of the show was clearly, the only way a person can lose a large amount of weight is having a gastric bypass!

Where is the "healthy lifestyle" here? Vitamin deficiencies on the long term which made the inventor of the gastric bypass stop doing the surgery he invented, in 1980? 40 percent serious complications within five years of surgery? And worse yet, we now have two studies which found that the weight loss at the 10 year point after a gastric bypass was somewhat unimpressive. 16 percent of the original weight? (Swedish Obesity Study).

I am confused. Is Dr Oz really deluding himself that the gastric bypass is a healthy and effective way to lose weight? Perhaps but if that is so, he's in for a rude awakening when he finds out the dark side of the surgery, how few people can stay healthy and keep off the weight.

Or is it as Dr Ernsberger once wrote:

"In my experience, most physicians, especially academic physicians, disapprove of these operations. However, they will only admit this in private, because of an unwritten law in medicine that forbids one to speak ill of another's procedure. Thus, there is no one with an MD after their name who will appear on camera and criticize the operation."

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

In any case, I am very disappointed in Dr Oz that he could make a show which only had a thin veneer of teaching health and actually was just- yet another- infomercial for gastric bypass.

Can you be fat and fit? Latest spin says "No"

Based on a "data dredge" study (meaning they took existent data which was not designed for THAT study so is outdated and also doesn't usually have the right information), some of those in the diet industry are now telling us that we cannot be fat and fit.

The study, like other epidemiological studies boasted big numbers, 39,000 women classified as normal weight, overweight or obese (BMI 30 or over). It was published in the Archives of Internal Medicine, April 28, 2008 issue.

I looked up the article, because the news service headlines read "Fitness does not reduce risk if you are fat". The media told us that people who were obese had a 50 percent greater rate of heart attack even if they exercised than people who were not obese.

If the study had really suggested this, it would be very questionable ... the exercise habits were self reported and people often exaggerated their level of fitness (mostly exaggerate it!). Also overweight and obese women are often weight cycling (popularly called "yo yo dieting") because the body produces all kinds of hormones to force weight gain if it thinks your weight is too low (and too low varies for every different body). And of course, several CLINICAL studies have suggested that any kind of dieting increases heart disease risk by 50 percent.

However, in looking up the abstract, the study did NOT suggest that there was no benefit for an obese person to be fit. On the contrary, the last line of the abstract reads:

The risk of CHD associated with elevated body mass index is considerably reduced by increased physical activity levels.

The media ignored this statement and picked up the next line in the conclusion:

However, the risk is not completely eliminated, reinforcing the importance of being lean and physically active.

Ok, that's fine except it is a meaningless statement because a reduction in risk doesn't mean no risk... regardless of weight. However, it made a great statement for the media to base yet another article of misinformation on.

Now if we look at the study further, we find that although researchers wanted the expenditure of 1000 calories in exercise a week (which isn't very much... about 3 x a week, 40-60 minutes each time), the average expenditure in calories in exercise for those considered "active" (remember this is self reported) was 550 calories a week which isn't for most people, even twice a week. And even that small amount, said the researchers, reduced the risk of CHD significantly regardless of weight (34 percent, they stated).

It should be remembered that many people feel NON cardio is exercise to be counted like gardening and likely reported that as "activity" even if it didn't fit in the categories which were basically cardio exercise (I guess gardening could be reported in the "walking" category if you stretched it).

So although this wasn't the best designed study (to put it mildly) the results were not what the news media reported them to be. Exercise does significantly reduce the heart disease risk... regardless of weight.

Rudy Leibel, obesity researcher said "there probably is a benefit to being of 'normal weight' but there is no proof that people forcing their weight down below their set point enjoy that advantage". This is kind of a no brainer and I have no problems with it. Although right now, according to CDC statistics, people in the BMI category of 25-35 are living longer than those in the so called "normal weight" category.

Another strange thing in our society is that although most of us have had friends who exercise a lot of cardio, are lean but smoke cigarettes, drop dead rather early in life, I have not noticed any studies suggesting what we already know to be true - that smoking may cancel out the good effects of exercise in some individuals (regardless of weight or fitness level).

And in fact, many people who smoke, are doing so to keep their weight down because they are under the false conclusion that doing anything unhealthy is better than being fat. And of course, where do they learn that but from our media.

The Cooper Institute studies of 50,000 people over the last 30 years or so, suggested that people who were obese and fit had only a 00.08 greater risk of heart disease than those who were normal weight and fit. And those studies also suggested that being lean (under normal weight) was at the highest risk even if fit. But of course you will never see that in the media which is, bottom line, hard selling a diet.

One more comment about this study. Most people do not keep up a fitness program more than a year or two but in a self reported study, those people may not have reflected the change (stopping exercising) in their surveys.

Exercise greatly cuts risk of illness regardless of what people weigh but cutting risks doesn't mean no risk, of course. And to enjoy that reduction of risk, people must make cardio at least 3 times a week (and 5 times a week is way better) a part of their lives FOR life.

And it seems the greatest risk to our health may be believing the media which when not lying, is incorrectly reporting health topics.

60 minutes LIES about gastric bypass

Apparently, some surgeons are getting worried about the lap band taking over the top spot in bariatric surgery (why ever would that be? Because it's ten times safer than the gastric bypass and equally effective?).

So the media is blitzing us with gastric bypass propaganda.

The latest was on the TV show, "60 Minutes". This show presented more than misinformation. In some places they out and out -lied!

Here are some of the more outrageous claims:

Claim: that gastric bypass "cured" diabetes. To "prove" this they had 8 newly post op patients on (the longest out post op was 1 year). "How many of you had diabetes before surgery?" the news anchor asked. And they all raised their hands. "How many of you have diabetes now?" she asked and none of them raised their hands. "Wow!" she said, hoping the audience would be just as impressed.

Reality: The few studies which have looked at longer term gastric bypass patients are more sobering. For example, the Swedish Obesity Study which studied patients 10 years post op, found that at that point, only 35 percent of the weight loss surgery patients were "diabetes free". That's a long way from "curing" diabetes especially as they are trying to push gastric bypass on normal weight people with diabetes now. (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)


Claim: Then they showed doctors wheeling someone out of surgery and stated that before any weight was lost, in a gastric bypass patient, the blood sugar levels were down to normal.

Reality: This claim is true - the sugar levels immediately do go down in many gastric bypass patients right after surgery but their explanation - something about a gut hormone being affected was bogus. Truth is, anyone who is fasting, has low sugar levels. In fact, many who go on the Weight Watchers program which is a sensible diet (as diets go) also see their sugar levels go down. Mystery solved and nothing really to do with the gastric bypass. The bottom line is that diabetics who have been diagnosed less than 10-14 years ago, can fairly easily get normal sugar levels using diet and exercise, and might not need medication. Diabetics diagnosed more than 10-14 years ago will probably need medication, gastric bypass or not.

They did say that 80 percent (not 100 percent) of the new ops have low sugar levels - those are likely the more recently diagnosed.

Claim: Having finished with diabetes they moved on to cancer. In one of the segments, the news lady asked how many cancers were associated with obesity and the guest, an epidemiologist gave her a laundry list. "I guess it would be easier to ask how many cancers were NOT associated with obesity!" the news anchor says, dramatically.

Reality: In the next sentence, however, the epidemiologist tells us that obesity is a factor in 100,000 deaths from cancer each year. There is really no hard proof for this but if you do the math, deaths from cancer each year according to the CDC, are 550,000 individuals. So what percentage of those deaths, according to the epidemiologist, have a factor of obesity in them? Not even 20 percent... 18 percent. That means that 82 percent of cancer deaths do not have a factor of obesity involved. This would seem to suggest that obesity is not a really "important" factor in cancer, wouldn't it?

It should be mentioned that Glenn Gaesser found in his metastudy of obesity studies that obese people are 40 percent less likely to get cancer than non obese people. (BIG FAT LIES by Glenn Glaesser, CA, 2002) And I have heard from 2 oncologists that fat people are 50 percent more likely to survive cancer than slim people (that's one of those - what is it now - 15 obesity paradoxes?).

Also any study I've ever looked at which named obesity as a factor in cancer in the conclusion of the study, talked about lifestyle (and not obesity) in the body of the study... the conclusion assumed that all people who have unhealthy lifestyles must be obese.

The biggest whopper was yet to come. Neil Hutcher, former president of the ASBMS was asked about early mortality rate with gastric bypass. "Well," he said, "a couple of years ago, it used to be 1 in 100 but now it's about 1 in 1000".

Of course we've heard all kinds of statistics from the ASBMS so I'm not sure where Dr Hutcher was getting his information. Six or seven years ago, the ASBMS claimed the early death statistic on gastric bypass was 1 in 1000 and continued that claim even after no doctor or peer reviewed study stated this! So was Hutcher saying by his statement that 2 or 3 years ago when early gastric bypass deaths were 1 in 100 that the ASBMS was um... misrepresenting the truth when they claimed it was 1 in 1000?

Whatever the case, there is absolutely no foundation in peer reviewed studies that the early death statistics with the gastric bypass are 1 death in 1000 surgeries.

For example, the David Flum Studies of 2003 which is one of the most accurate studies because Flum actually studied 62,000 hospital records of gastric bypass patients, found that 2 in 100 died within 30 days of gastric bypass surgery and another 2-4 percent of patients died during the first year after gastric bypass surgery. (SOURCE: 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] )

Most surgeons who had a low death statistic, claimed 1 death in 200 surgeries but that was before the Flum studies.

Moving on, Hutcher said that 1 death in 1000 was about the same risk level as gall bladder surgery. I'm sure gastroenterologists will not love him for this statement which is entirely incorrect! Gall bladder surgery carries a death risk of 1 death every 7000 surgeries and is about the same risk level as the adjustable lap band.

The only good thing I can say about this show is they admitted that patients tend to lose only 30 percent of their weight so "few patients end up thin". This was noticed by some WLS afficionados who were not happy about those percentages.

I'm sorry to say this, but for the news about a risky medical procedure which is rapidly becoming out dated, to be that inaccurate, is more that ethically challenged. It's morally bankrupt because people may go and have this surgery based on the misinformation in that show and many will die or get sick.

What are we doing to our teens?

Most teens I talk to, feel they are fat, even though they are not.

Several teens I know personally, started smoking to control their weight.

Somehow we are _not_ getting across the message that smoking has been _proven_ health threatening and are concentrating on giving folks the message that obesity is _extremely_ health threatening even though there is virtually NO scientific evidence that obesity alone is health threatening at all.

How much of a problem are eating disorders among teens and pre-teens? If you look at youtube.com, there are huge numbers of videos which advertise themselves as "thinspiration". These videos either show slim young women squeezing what small amount of fat they have on their bodies in disgust or else, are slide shows of super slim fashion models and actresses. Often the songs which accompany the videos give mixed messages. One song begs "SOS me - rescue me" while another song states that no one notices that her body is falling apart.

One young woman who is 21 years old, and said her latest dieting effort began with her wanting to "get her body back" after having her son, started uploading videos in August 2007. Her first video made while she was smoking a cigarette, had her talking a lot about how she cared for her skin. But in the end of the video, she admitted that she had a problem with eating and also showed us a piece of tape covering a scar she made on herself when she was 16 ("S" for sinner, she said) and how she covered it all the time now. "Smoking is bad" she admitted but then added that she smoked a lot during her 'fasts'.

Another video made in early late 2007 by the same woman, was all text. It told how she had been in a mental hospital because of a suicide attempt. How from the age of 16 and on, she had tried all kinds of drugs in a desperate attempt to lose weight. And how she was going to rehab and get well now (but not take any prescription drugs). "I want to get my son back" she wrote, "he's 3 years old!". Another video showed a visit with a bright eyed 3 year old boy, her son. The video was entitled "I miss my son".

Sadly her rehab didn't work- a recent video talked about her 40 day fast which would end April 11, 2008. Two body shots showed that she had lost quite a bit of weight since she uploaded her first video - she looks like the typical anorexic in those shots. But this fast is not about her eating disorder, she tells us - it's to "gain control". She is allowing herself 1 glass of juice a day and the rest, non calorie drinks like coffee, tea and water. She is continuing this for 40 days, during which she will exercise and get control and save up the money (if she can get a job) to get a pole and start pole dancing. "Weight doesn't matter" she keeps saying adding how she discarded her scale.

One of the comments to this video states:

binges are bad! i was doing well, eating at the most, 300 calories a day, but, then i tried to fast and the binge monster came to me and i ate until i exploded although some people say it wasn't that much food. but all you have to do when you want to binge, is look in the mirror and tell yourself how it will ruin this progress! and then eat an apple or whatever and then wait. tell yourself if you're still hungry in 10 min that you will eat. chances are, you can control your binge better. but you are lucky if you can purge after. it doesn't work for me :(

NOTE: what she suggests in the above quote is a version of what Weight Watchers calls "the 20 minute rule". How much of this comes from our general obsession with dieting and a diet industry which makes a larger profit than even the pharmaceutical companies?

Several feel that anorexia and bulimia are more widespread than we'd like to think. It is usually blamed on fashion models and slim actresses however, most people who are dieting or restricting calories mention health as their first concern. An article in a London newspaper, suggests that there are many internet sites which encourage young women to starve themselves to be very slim:

The UK article suggested that 1 percent of teens have an eating disorder but an estimate from an Australian newspaper stated that 1 in 8 teens has some kind of disordered eating.

What is confusing is that most teens who are restricting (and often over exercising, will not admit it. On the contrary, they say they "eat a lot" while getting slimmer and slimmer. And instead of a cause for concern, slimmer teens are often rewarded with getting more clothing and perks from their family, as well as compliments from their classmates and often, a lack of concern from their medical providers while the fat teen is teased, often not rewarded by the parents and constantly battered by the media as well as medical providers to "lose weight or die". And we wonder why these teens start smoking to "control their weight"? They are following what _we_ are telling them... that _anything_ is more healthy than being overweight!

Ironically, it's the fat teen who is often much more well nourished than those trying to keep what is considered an "ideal weight" (which the CDC has said may be underweight for most people).

And again I ask - will the insanity ever end?