Biggest Loser - an exercise physiologist weighs in

This is a guest blog by Laura Gideon, an exercise physiologist who was kind enough to write this for us. You can contact her on her website:
www.bamboobalance.com

Q:Who really is “The BIGGEST Loser?” A: The Viewing Audience…
The most “Non- Reality” Show on Television

By: Laura Gideon M.S., CPT Exercise Physiologist & Owner Bamboo Balance LLC –

Fitness Training Company - Los Angeles, CA

From the minute this so called “reality” show came on television, I have been annoyed. With every season that goes by and this show remains on the NBC network, new desperate, unknowing victims are being subjected to cruel punishment (disguised as exercise) and my annoyance grows deeper. The bar keeps getting raised after each “winner” takes home their quarter million dollar prize, cover of People magazine and talk show interviews. Seasons go by and viewers keep tuning in. As long as the ratings stay high, the network and the producers are happy, money‘s being made and who gives a crap about the message being sent.

Well..I DO!

And so do many of my Fitness /Health/ Wellness colleagues out in the real fitness world. We have remained virtually silent and in the background way too long and it is now time to speak up and let the public know what is reality and what is hyped infotainment disguised as Reality TV.

Another season - another the new crop of willing volunteers (or shall I call them victims) line up to get on and bare their souls to millions of TV viewers. Little do these poor unsuspecting, overweight contestants know the danger they will be subjected to physically, mentally, medically and most of all emotionally. The sad part is - that is exactly what the producers want in order to have this show be viewed as “authentic” while pulling at the heart strings of the unsuspecting public. Meanwhile, the actual beating heart muscle of every contestant is being put to a very dangerous test the entire time they are on the ranch. The saying “desperate people do desperate things” is very evident regarding this show. Contestants are clearly desperate and that is what makes them vulnerable and so easy to prey upon.

I recently read an LA Times article published this past November titled “The Biggest Loser: Should you mimic its weight-loss methods at home?” The article included perspectives from experts in the fitness industry (including a kinesiology professor and an IDEA fitness trainer of the year) along with the show’s co-creator/ executive producer and medical consultant. The two opposing opinions could not be more polar opposite with the fitness industry professionals comments airing on the side of “viewers beware this show may cause severe injury or heart attack” to the show’s producer and medical consultant touting that its “inspiring the obese to lose weight and they should not feel hopeless anymore because on this show people learn things no one has taught them before, like how to exercise.” That comment came from the show’s medical consultant.

Has he actually watched the show?

I would love to hear what he has to say when the first contestant actually does die of a heart attack as a result of this show. By the way, is a crash cart within arm’s reach? Do Bob and Jillian have CPR certifications and know how to operate a defibrillator? Unfortunately, it will probably take more than one person to suffer something life threatening before NBC takes notice to the dangers these contestants are subjected to. Apparently a recent stress fracture of the hip of one contestant (Laura) is not enough to send up a red flag. Little does she realize how fortunate she is to be sent packing.

As a fitness professional in this industry for more than 28 years I was curious as to how my colleagues in the health arena felt about this show. The impetus for writing this article came after reading a recent commentary in the IDEA (International Dance Exercise Association) monthly Fitness Journal regarding the “distortion of reality” of the Biggest Loser Show. The comment was written by a well respected fitness professional and educator who’s appalled at this TV reality series, and could not hold in his anger one more moment. Needless to say, I did a happy dance after reading it! -FINALLY…someone was speaking out in our trade journal – YES! His final words: “I am furious that the profession I have cultivated for 28 years is portrayed in this fashion.” I could not agree with him more.

I decided to take the baton and run with it.

I perused the internet to read everything I could about how other fitness professionals felt about this show and the comments were all very similar – mostly disdain. I decided to post a discussion question to my fitness professional groups on LinkedIn (one is the IDEA fitness group): “In your professional opinion what do you think of the show The Biggest Loser and the trainers Bob and Jillian…Do you feel the message being sent to the public is inspiring or dangerous?” The response was over whelming!

These are some of the comments:

“The biggest downside to this show is that it sets up unreal expectations of weight loss”

“As fitness professionals we need to stop associating exercise with punishment! (The simplest example is in public schools where the gym teacher will make a student do pushups when they are fooling around or not performing well).”

“The main problem I have is the lack of risk messaging that I see on the show”

“I am troubled with their choice of incentives for losing weight-using money as a prize encourages people to cheat or lose weight through unhealthy measures such as diuretics”

“The show does not explain often enough that for the average person, obese or not, anything beyond 2pounds of weight loss per week is counterproductive”

“The yelling…it makes for great ratings - but at the expense of what?”

“Great question simple answer…DANGEROUS, DANGEROUS, DANGEROUS.”

I could go on and on, but you get the picture. We are fitness professionals who tune in for five minutes and instantly realize the danger in the message being sent. However the viewing public does not. That is why this show is going into its what? Eighth season? A well informed viewing audience who knows what genuine fitness training is, along with proper nutrition and sustainable healthy weight loss practices, would never buy into this load of crap. All they see is in three months an “amazing” transformation from obese to buff and none of the smoke and mirrors. Viewers don’t see how they are being manipulated through emotional, gut-wrenching stories and crocodile tears to pull at the heartstrings.

Never mind the heartstrings. Here are some things to wrap your brain around….

Scientific fact: Healthy FAT loss is no greater than 2 pounds per week – period. For every 3,500 calories you do not consume or a 500 kcal deficit per day amounts to a 1 pound (fat) weight loss. That’s ONE POUND per week! The shows results are completely unrealistic according to basic human physiology. The weight loss numbers do not add up – it is totally impossible for this rate of FAT loss (which the show alludes to as FAT loss) to occur. Contestants show a supposed 7 day weight (fat) loss sometimes in excess of 20 pounds. A 20 pound weight loss (of FAT) in one week is 70,000 calories, which is a 10,000 calorie deficit PER DAY. An Iron Man athlete would have trouble doing that, even Michael Phelps during the Olympics would have trouble doing that and these people are unfit, overweight individuals NOT elite athletes. They should NOT even be working out 6-8 hours a day! To burn off that amount of calories would mean constant fueling. You can’t exercise 6-8 hours a day without fuel – period. Am I clear here? The contestants are NOT losing fat – they are losing mostly everything but that (like water weight). The people who are actually losing weight slowly with a more realistic number for of weight loss are penalized, humiliated and punished by being sent home with their tail tucked between their legs as if they did something horrible. How sick is that?

Have we as a society become so desensitized that we do not recognize torment and torture to individuals disguised as “made for reality TV?”

These contestants are ridiculed and yelled at by their “trainers” (which by the way is NOT the way you get someone to embrace exercise), asked to participate while being subjected to highly injurious workouts and bated with rewards of being able to choose who gets to be eliminated while being enticed by highly caloric cupcakes. I have seen negligence regularly on the part of both trainers with regard to safety, improper technique and form in execution of movement while resistance training, spinning and kettlebell training in addition to numerous other workout routines. Nutrition education seems to be almost entirely excluded on this show in addition to any emotional (eating) issues being addressed by a professional (which I would think would be of the utmost importance). Don’t you think there are deeply rooted emotional and psychological issues that should be addressed here? What is NOT seen leaves the mind to wonder? When the Biggest Loser does do a “follow up” show they seem to glaze over the fact that most of the contestants have re-gained weight (some almost back to the size they were pre-show) in addition to the feelings of embarrassment that overwhelmed them enough to feel sequestered in their own home.

Why is this show still on the air?

Now tell me. Is this show really about health? Being socially acceptable? Or is it about making bucks by marginalizing a segment of the population based on appearance?

I say it is the latter of the three and wholeheartedly believe that all the real fitness professionals out there would absolutely agree.

Contact Laura at www.bamboobalance.com

Does Gastric bypass lengthen lifespan?

I received a comment on an old blog today and the misunderstandings in it are so great that I felt the need to answer this comment because many others may have the same misconceptions.

First point... the writer whose name is Jason, maintains that gastric bypass lengthens lifespan and uses the Swedish Obesity study to prove his point. Here is the quote:

The fact of the matter is that having gastric bypass has dramatically reduced deaths in patients who had the surgery versus patients who didn't! These are in PEER REVIEWED studies, with many patients. Swedish Obesity study on longevity

First of all, 10 years post op is not very long and keep in mind that only 13 percent of the surgical patients had had RNY (gastric bypass)... the rest were some kind of gastric banding. In gastric banding of any kind, there is no intestinal bypass as there is in gastric bypass and also, there is normal digestion in the stomach (although long term data on these patients shows a high percentage of paralysis of the stomach etc after 25 or 30 years). So even if the death rate WAS lower among weight loss surgery patients, this study would NOT prove that the gastric bypass increases longevity!

Second, there were not a significantly higher number of deaths in the controls (those who did not have weight loss surgery) than in the patients. (only 1.3 percent more deaths in the non surgical patients - has to be 2.0 or more to be significant according to statisticians.)

But let's take a closer look at the Swedish Obesity study because I'm going to prove that there was actually a MUCH lower mortality rate in the non surgical group in reality than in the surgical group.

This is because the study was not "randomized" meaning they picked and chose their participants. Here's why NOT randomizing the study makes it flawed as far as comparison between surgical and non surgical patients:

Randomization, where study participants are randomly selected and grouped by chance, is the most important way to help ensure that intervention and control groups are comparable (even in ways researchers may not have considered) and that the participants haven’t been hand-chosen to manipulate the findings towards a predetermined conclusion. Randomization prevents stacking the deck, so to speak. Source: Was This Really Proof that bariatric surgery saves lives

In this study, those chosen for the non surgical group had 25 percent higher incidence of heart disease than the surgical patients. They also had 6 percent more diabetes than the surgical patients and they averaged 18 months older. All of which can raise their risk factors.

And even with all of that, the difference in deaths in the surgical and non surgical group... were 1.3 percent more deaths in the non surgical group... with 25 percent more heart disease in the non surgical group, on the contrary, the non surgical patients were living LONGER than the surgical patients! That is, to be even with the surgical patients, the non surgical group with 25 percent more heart disease coming into the study, should have had 25 percent more deaths but in fact there was only 1.3 percent more deaths in the non surgical group.

So the Swedish Obesity study did not prove that weight loss surgery increases lifespan at all. On the contrary... (ibid)

The second comment Jason made was providing "proof" that calorie restriction prolongs lifespan.

Because we cannot obviously easily study humans for this, all the research "proving" calorie restriction has been done with rats and mice. These small rodents, though handy for study because of their short life span, don't really resemble humans in many ways.

But even among rat and mouse studies, the results are inconclusive or actually against calorie restriction prolonging life.

The study Jason provided was one done at Harvard Medical School. According to the article on this:

Dr. C. Ronald Kahn of the Joslin Diabetes Center at Harvard Medical School and colleagues genetically engineered a mouse that lacked a gene called fat-specific insulin receptor. This change limited the action of insulin on fat cells.

I don't think these genetically altered mice which lived a 30 percent shorter lifespan than the unaltered mice are very relevant to any humans. But if we are to compare, we should compare them to genetically or surgically altered humans i.e. like gastric bypass patients... will they, like the surgically/genetically altered mice, live 30 percent shorter lifespans than non surgically altered humans? One very large lady who refers to herself at "supersized" (over 500 lbs) tells me that she has outlived 48 of her friends who had weight loss surgery!

And other rat studies have found the opposite - i.e. that calorie restricted animals not only don't live as long as those who ate their fill but got sick faster.

The results of the one study which found that rats fed less calories lived longer than rats allowed their fill, have never been repeated. The other researchers who tried this study, found that rats fed less food, died earlier and got sick before dying. (ref: Stewart, Douglas: "Solving the Aging Puzzle" reference to the studies of Dr Stephen Austad, "Smithsonian Magazine", vol 28, no. 10 Jan 10, 1998)

About those studies which suggested calorie restricted rats lived longer, the author pointed out that the conditions were not normal... rats usually exercise to catch their food but the unrestricted rats were allowed as much food as they wanted and generally didn't exercise much during the day. "In other words", he concluded, "those studies only proved that overfed - under exercised rats did not live as long as calorie restricted rats"

Jason concludes by pointing out that:

Also, you severely downplay the health problems of obesity. True you can be obese and be healthy, but if you continue to be morbidly obese you will not be healthy for long. You WILL get diabetes. You WILL have heart problems. These are indisputable.

Sorry Jason but wrong again. Your facts are VERY disputable!

1. diabetes is hereditary and not a disease of obesity, and although it is thought by some scientists, that the eating habits which can cause obesity in some people may be a factor in some cases of diabetes, evidence for this has been inconclusive so far. Also to note: According to the ADA, 33 percent of type II diabetics have never been fat. I know personally 6 type II diabetics who are very slim. Including my father-in-law.

2. heart problems are also not a given for any group of people, not even those with high cholesterol! Many studies have suggested that heart attacks happen, equally, in people of all weights, sizes and cholesterol levels. For example, a gent who bragged to me that being 71, he weighed 150 lbs which is the same he weighed in High School, and that he walked several miles each day and had done that for years, a non smoker with no risk issues, had a major heart attack and needed a quadruple heart bypass. Yet a very obese relative who is 73 years old (BMI over 60) has no heart problems at all!

In conclusion, Jason, you are believing the ads for the diet industry in the media which often say very different things from what science and medicine has observed!

And about calorie restriction, what evidence we have, tends to suggest that unless it is done very carefully the person not restricting too drastically, not wasting any calories in junk food and fast food and taking lots of supplements, calorie restriction can be very unhealthy.

So much for what the media tells us. We should remember that the TV and the mass media is "for entertainment only" although truly their rants about overweight people are often far from being very entertaining.

The following page has some more of what science says about obesity:

Article: Fat Factoids

the obese only have themselves to blame?

Suppose a cancer patient walks into to the doctor and/or oncologist or hospital and before they treat her or maybe instead of treating her, they all say "but you only have yourself to blame!"? Never would happen, right? Even though the American Cancer Society has stated that cancer is 85 percent lifestyle caused!

However with obesity, Dr Rudy Leibel has stated that it is only 40-60 percent lifestyle caused and yet, the obese person going for medical treatment hears it all the time that they "only have themselves to blame".

One of the most ignorant articles I have read in a while (and that's saying something considering how ignorant the media is) was written by someone in the UK named Amanda Platell.



(Photo caption - "self delusion is an obese person's greatest problem" says Amanda)

She writes:

But my mother cooked simple, cheap food for us every night, packed our lunches (sandwiches, a carrot and an apple... is that too hard?) and none of her three children ever had an ounce of fat on them.We swam, ran, climbed trees, played football. We ate healthily and lived healthily.

Well, excuuuuse me Amanda but MY mother cooked healthy, packed our lunches with no sweets and we swam, rode bicycles, climbed trees and played sports and we still were fat, all of us!



And according to the unpublished Russell Williams study, in which he asked 6 catering services which had catered both the NAAFA conventions as well as many other conventions, which group had consumed more food, the answers would have surprised Amanda and others. Three of the caterers said that the fat folks in NAAFA consumed exactly the same amount of food as those of the general population and three of the caterers stated that the folks in NAAFA consumed less food than consumed by other conventions.

It's time for those of us with genes which tend to render us fat, stop taking the nonsense and ignorance from such as Amanda and for that matter, consider stopping taking their advice to disable our digestive tracts also. Instead, we need to embrace our beautiful bodies whatever size they are, live on a healthy program like HAES (read Dr Bacon's book "HEALTH AT EVERY SIZE" if you have not yet read it) and educate the general public about genetics and size and obesity.

See http://healthread.net/obesity.htm

Because if we do not tell society the truth, no one else will and articles like Amanda's will continue to misinform the public. The Amanda's of our society never hesitate to speak out, as we can see.

Review- Stress Eater Diet book

I have been asked to take part in a "blog tour" reviewing the book, the Stress Eater Diet by Robert Posner, MD and Linda Hlivka, MBA, C.N. Since I tend to be a stress puppy myself, I was intrigued when approached to review this book.

Robert Posner, co author of the book, is an internist who has apparently run a Weight Loss Clinic in the Washington D.C. area for the last 20 years. Having a theory that weight gain in some people could be caused by an imbalance of serotonin in the brain, he and Linda Hlivka, a nutritionist-chemist, developed a Supplement called Serotonin-Plus. This supplement's ingredients read like a multivitamin but it does have "green tea extract" in it which has been touted in some circles to raise metabolism, and also contains 50 mg of caffeine in each pill (and that has been proven to 'raise metabolism' but is not necessarily a healthy way of doing it). Dr Posner wrote a book published in 2002, advocating this supplement but since then, some groups have de-bunked the green tea theory including consumer group, Center for Science in the public Interest (CSPI). A government document detailing a suit questioning weight loss claims about a drink called Enviga containing green tea extract and caffeine, includes the following:

CSPI's scientists have concluded that "Enviga is just a highly caffeinated and overpriced diet soda, and is exactly the kind of faddy, phony diet aid it claims not to be." [Watchdog group sues Coke, Nestlé for bogus "Enviga claims." CSPI news release, Feb 2007] http://www.cspinet.org/new/200702011.html Meanwhile, Connecticut Attorney General Richard Blumenthal has asked the marketers for copies of all scientific studies, clinical trials, tests, and/or papers that support the calorie-burning claims-and information about any group that may have sponsored the studies. [Attorney General demands that Coca-Cola, Nestle prove claims of 'calorie-burning' beverage. Connecticut Attorney General press release, Feb 5, 2007]

To Dr Posner's credit, he does not include a plug for this supplement in "THE STRESS EATER DIET". In fact, it's not mentioned at all except in the bio of Linda Hlivka which names her as the chemist involved in developing "Serotonin-Plus".

One of my personal frustrations with the book which, by the way, IS a good read with plenty of worthwhile information in it which can help us all to be less stressed, was that for some reason, Dr Posner and Ms Hlivka chose to not include their cites and sources as footnotes in the traditional manner, so although many studies were mentioned, one has no way of knowing when, where or how these studies were done. In the section called "References" at the end of the book, it mentions that cites and references can be found at http://www.stresseaterdiet.com/references.html however that page returns a "not found" error. The few studies listed in the references section are ones we all know about and not the studies supporting the book's theories about Serotonin and weight control.

So I had my work cut out for me. The book is a collection of tips about weight loss i.e. log your food, exercise, reduce stress using yoga and deep breathing etc, eat slowly and more - things which will cause weight loss on any program, but I wanted to check out some of the claims new to me which were as follows:

1. That eating foods high in tryptophan would cause the brain to produce more serotonin and that this is a good thing and one which would aid in weight control

2. That tryptophan is the precursor to serotonin

3. That although carbs are high in tryptophan, they only produce a momentary relief and thus are not as effective as foods like turkey etc i.e. low carb foods.

With reference to number 1, I did find a few articles (not any studies though) that suggest that eating tryptophan rich foods would cause the brain to produce more serotonin and some opinions that this does aid in weight control. Of most interest in that area was an article sent down a listserve for medical providers by a P.A. The article was not from a medical journal but still is interesting because it opined by mixing substances rich in tryptophan and taking anti depressant drugs which are serotonin re-uptake inhibitors (SSRI's) could cause a syndrome called "serotonin syndrome" which according to the article could result in:

• Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.


• Neuromuscular symptoms like muscle spasms, exaggerated reflexes, muscular rigidity, tremors, loss of coordination and shivering.


• Autonomic nervous system symptoms like fever, profuse sweating, rapid heart rate, raised blood pressure and dilated pupils.

Source:February 27, 2007 - PERSONAL HEALTH - A Mix of Medicines That Can Be Lethal
By JANE E. BRODY

While this is obviously extreme and not necessarily a risk with eating a lot of turkey, the article did contain the statement that:

"Although serotonin poisoning can be caused by an antidepressant overdose, it more often results from a combination of an S.S.R.I. or MAOI with another serotonin-raising substance."

And this causes one to wonder whether it's a good idea to fool around with Mother Nature when it comes to brain chemicals at all... even with food sources, a question asked in the book, "PROZAC BACKLASH" by Joseph Glenmullen, MD. Glenmullen opined from his research and working with many patients over a long time span that messing with the serotonin balance in the brain could cause problems such as Parkinsonism.

As for my question of whether Tryptophan IS really the precursor of serotonin, my research suggested that it is generally theorized that, yes, it is at least ONE of the precursors. Again I didn't find any studies but many educated opinions on this.

And finally with reference to question 3, eschewing carbs in favor of low carb meats, I found that the jury is still out on this with at least one very respected researcher at MIT disagreeing with the authors' low carb suggestions.

Dr Judith Wurtman has apparently done a lot of research on carbs and serotonin and in an article carried on the MIT site, Wurtman stated that carbs were essential for good health and that a low carb diet could result in some serious cravings (due to the body's need for carbs). Wurtman feels that stopping carbohydrates could not only affect the brain's serotonin levels but also affect your mood: (Note apparently Wurtman's remarks are based on her years of studies which are available in peer reviewed journals.)

"Wurtman, director of the Program in Women's Health at the MIT Clinical Research Center, and colleagues have found that when you stop eating carbohydrates, your brain stops regulating serotonin, a chemical that elevates mood and suppresses appetite. And only carbohydrate consumption naturally stimulates production of serotonin.

In "The Stress Eater Diet" Dr Posner and Ms Hlivka are not clear as to whether one should go low carb for life because they say you slowly add carbs back after the first week of "induction" (of a 4 week program). However, comments like the following suggest to the reader that carbs in general are not well thought of by the authors:

"pasta has little nutritional value" (page 122)

However, this conflicts with what I have often read and that is that Pasta is rich in B complex vitamins for one, a vitamin which Dr Posner stated he feels is a direct stress reducer, a statement accepted by mainstream medicine.

(And it's well known that one gets much more of the vitamin out of food than out of supplements).

Dr Posner and Ms Hlivka are also very much opposed to eating sugar which is OK but as substitute, they recommend, by brand name, sweeteners like aspartame and splenda which is somewhat controversial now that many studies have shed suspicion on the safety of these chemicals. Even the CSPI, once on the "no sugar" bandwagon i.e. do aspartame instead of sugar, has recanted on this position after the well respected Ramazzini Institute studies which found a link between leukemia and aspartame consumption.

The program in "THE STRESS EATER DIET" recommends cardio exercise which, as folks know, I greatly agree with, and the chapter on exercise is excellent, as is the chapter on stress. Perhaps we have heard some of the suggestions given before but somehow having it all in one place, reminds us that we need to do some of these things to reduce stress in our lives.

I hope that in a future edition of the book, the authors _do_ consider including the cites in a footnoted manner because I think today, most of us being bombarded on a daily basis with all kinds of claims, do question uncited material.

For example, one of the statements I would like to see cited is the authors' claim that 90 percent of those diagnosed with type II diabetes are overweight. The percentages I have read have been that 33 percent of type II diabetics have never been overweight and this has been my own observation also.

All in all, I liked the book - it is readable, well written and interesting, and provides a lot of useful suggestions and some things I did not know even with my having read so many diet books.

And most of all, it is one of the only books which gives us real world practical suggestions on reducing stress which I, in agreeing with the authors, feel is a major factor in many of the ailments we suffer.

As a weight loss program, well, if you do the things they suggest such as, log your food daily, count your calories, measure your portions, substitute low cal food for fast food etc and exercise at least 20 minutes - 30 minutes a day, yes you will lose weight whether you eat foods high in trypophan or not. Unfortunately, studies have suggested only about 5 percent of the public are able to be this vigilant on a long term basis. But even if you don't use "The Stress Eater Diet" as a diet book, I feel reading it can be helpful in getting more healthy and reducing stress.

Would this book make a good addition to your library? I would say, probably so. I know I found it rather enlightening.

Where you get it: The Stress Eater Diet Website

Other blogs participating in the "blog tour" can be found here!

re-visit - diabetes and weight loss surgery

If you listen to the TV, you will hear that weight loss surgery (either gastric bypass or lap band) "cures" diabetes. You will see happy patients less than 2 years post op dramatically throwing out their medication.

Remember TV is NOT the truth. Not even close.

We have two studies available which looked at diabetes and weight loss surgery.

The first was the Swedish Obesity Study. It compared weight loss surgery patients to people trying to diet. It was NOT randomized and as a matter of fact, those chosen to be in the NON patient group had MORE diabetes and MORE heart disease. The surgeries used in this study were gastric bypass and gastric banding.

At the two year point, they recorded a 73 percent remission in those patients with diabetes.

But at the 10 year point, only 36 percent of the patients remained "diabetes free". That means for most of them, the diabetes had returned. We have no longer term results than this.

Also this study did NOT look at the number of gastric bypass patients who got reactive hypoglycemia which is less treatable than diabetes (caused by the death of the islet cells of the pancreas). One 13 year post op recently remarked that "most gastric bypass patients eventually get this problem."

Finally the Swedish Obesity study found that at the 10 year point the "average" BMI among the weight loss surgery patients was 35. Still clinically obese.

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

graph showing percentage of patients in remission from diabetes at the 2 and 10 year points


The second study was the "Monash Study". This study was randomized sort of. It did not take any diabetics who were diagnosed more than 2 years before surgery. (and we all know that moderate lifestyle changes without weight loss can bring A1C back to "normal" in the first few years after diagnosis).

It did not study patients any more than two years post op. They found at the 2 year post op point, 73 percent of patients were in remission (and the researchers used remission and not cure!) which is the same that the Swedish Obesity study found.

Monash Melbourne study link


The TV ran with it. The Monash Study used adjustable lap band patients. And the word "remission". The TV said they were gastric bypass and used the word "cure".

I have heard some Weight Loss surgery surgeons use the word "cure" also and the ASBS is now trying to recommend gastric bypass for overweight patients with diabetes (i.e. BMI 30 or more). Those patients tend to fare badly post op. Somehow their bodies do not adapt as well as heavier patients.

Speaking of Weight Loss retention: The third study we should look at is the Utah study which found that 34 percent of patients whose start BMI was over 50, regained all or most of their weight within 10 years.

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

Bottom line, weight loss surgery is not effective unless you diet, count calories and exercise (which will keep weight off without surgery) and it does NOT cure diabetes - no study ever found that and the only place reporting a diabetes "cure" is TV which is selling the surgery or some surgeons who are also selling the surgery.

Biggest Loser - revisited

As you'all know here, if I am wrong, I will gladly admit it. And people have written comments to show me the error of my ways and if I see merit in what they say, I am more than glad to admit I was in error.

I guess my humble blog has gotten the attention of one of the winners on "the Biggest Loser" show, second season, Pete Thomas. Thomas lost a lot of weight in a 9 months - 185 lbs and apparently if his blog is to be believed, he's kept it all off (but of course, Eric Chopin didn't tell his cyberfriends how much he had regained so that's why I say this with a grain of salt.... IF his blog is true).

Be that as it may, he is ANGRY at me. Very angry and has written a long comment which raises some issues that I think I should address in my main blog. So here goes:

Pete writes:

"You are doing such a poor job in your analysis. The media does want to see failure."

Ignoring the insult, (and to use Pete's phraseology, "it doesn't take a big leap in intelligence" to realize that ad hominem is a faulty argument tool), I feel Pete is very wrong. The media did NOT to this day, cover much about Eric Chopin's massive weight gain nor the weight gain of other "big losers". And there is a good reason for this. The media is driven and financed by the diet industry, a billion dollar industry of which "the Biggest Loser Show" is of course, a part (it sells products when folks watch the show unless they fast forward through the commercials like I do and not a lot of folks DO that). And the diet industry is pushing the myth that "all of us" can "get the body we always wanted" just by buying this or that diet when in fact studies have found (all of them have FOUND THIS, PETE) that 95 percent of people who diet to lose weight, regain the weight within 5 years! And the results of weight loss surgery are not much better - even with a permanent change to the body, 93 percent of patients cannot keep all the weight off! And most patients still end up in the severely to clinically obese zone and then WITH a new set of comorbidities. (the Swedish Obesity study and others). I've given these cites in some of my other blogs so won't labor through them here.

Pete gives as his reason for his belief that the media is highlighting failure as this:

"It does not take a giant leap of intelligence to see this. Look at the local news or national news – How much positive vs negative news do you see? The media thrive on success and more so on FAILURE!"

True, negativity and fear dominate the media EXCEPT when it comes to selling product and that means the DIET INDUSTRY so most of what we see on the media is SUCCESS to perpetuate the myth that "most people can successfully keep off the weight". As I mentioned before, I saw no mention of Eric Chopin in the news and a search of Google news I did right now, came up with the following message:

Your search - "eric chopin" - did not match any documents.

So I am wondering, Pete, if your theory is true and the media is highlighting failure in weight loss, why didn't Eric's appearing on the Oprah show even warrant a SMALL mention in the news?

And according to Pete's biography on his website, he's appeared rather often in this media which he says "highlights failure"

"He has appeared on ABC's The View, The 700 Club, and eXtra as well as being featured in People Magazine, Runners World, TV Guide, The Detroit Free Press, inTouch Weekly and Real Health."

Next Pete you are getting a bit confused here when you wrote:

"One successful author I know says ANY publicity is good publicity. He FRAMED BAD reviews of his book! Be assured – your blog qualifies as good publicity."

Doubtless you were referring to the saying sometimes attributed to Will Rogers but apparently said by many that "there is no such thing as bad publicity, only publicity".

First of all, I think you are overrating the nuisance value of my humble blog so if that's your worry, please don't worry... I'm sure no one on the show or in charge of the show would be convinced by this blog. First of all, the show is a cash cow and you will find that people _really don't care_ whether it's healthy or "right" if it's bringing in the bucks. First American TV principle... that you have not encountered this, leads me to wonder what planet have you been living on? :)

Secondly, actually there IS such a thing as bad publicity... Joyce Brothers said that and we can see that bad publicity helped greatly in defeating Sarah Palin in the recent election. Her name was on every lip so she got plenty of publicity, all bad.

And third, if you feel that my blog is good publicity then it should help your business of "motivational speaking" and thus, why are you so angry at me? I must say, you seem to be contradicting yourself a bit (well more than a bit).

So bottom line, my blog may be bad publicity for the show but as long as the ratings soar (whether people who watch it LIKE the show or not), the networks will run the show (and sell the sponsor's products). And people wanting to believe the myth that "all of us can have the body we always wanted" will continue to call you for "motivational speaking" right?

You then accused me of being ignorant so you wrote patronizingly:

"So let me educate you a little – Oprah called Eric – Remember! He turned her down initially. It is a known fact that contestants regularly turn down the media ‘When they start gaining their weight back’. You just don’t know that because your not knowledgeable enough on these things. So let me help you."

First of all, Pete, seems you didn't read my blog very well because I SAID that Oprah had called Eric previously and that he'd turned down the appearance (what he said on the "Oprah" show). Perhaps you might be the one needing help in reading things a bit more carefully. And by the way, Pete, in the statement of yours "Your not knowledgeable" I think you meant to say "YOU'RE not knowledgeable", right?

You further wrote:

"Oprah called a lot of us a few months back and those of us familiar with the process KNEW exactly where the show was going."

Have you counted the number of POSITIVE "amazing weight loss" shows Oprah has done? It way exceeds the couple of "weight loss problem" shows she's done.

"Misery loves company. My opinion - Oprah wanted company in her own struggles (or rather her producers choose to portray it as such)."

Aren't YOU assuming something about Oprah i.e. her being "miserable"? She's never been extremely large and she's sold a bunch of magazines and shows with her latest "confessions". And I do not see Oprah appearing on shows like "The Biggest Loser" which regularly humiliate people of size. Bottom line, there is no evidence that she's feeling miserable at all. Only that she's a very clever TV show host who knows how to get the audience's attention.

After that, you wrote:

"I will leave you to your ignorance on that one and I will just continue to laugh from a distance."

And I ask why you have to laugh at me at all and if life being so slim is so wonderful, why are you so angry? Happy people don't write angry, ad hominem letters like you wrote me. A psychologist might have a field day with your letter, Pete. :)

Then you ask:

"WHY is the type of weight loss on the show unhealthy?"

That you don't know, suggests you may be the one who lacks knowledge especially that you mentioned no one has shown you any evidence of this... incredible since evidence exists all over the internet and in many books that quick weight loss is unhealthy.

Your body cannibalizes organs and muscles with a quick weight loss and lowers your metabolism so that you will gain more quickly. Since you are apparently was unaware of the tons of stuff available written about this, you may be more amenable to watching a video than reading an article or book, so I will provide a video explaining the process:

http://www.youtube.com/watch?v=zC0gnUwmBg0

I would also recommend Dr Linda Bacon's book, "HEALTH AT EVERY SIZE" which well covers obesity research.

Additionally, working out so hard and so long every day (and in most cases, high impact) is foolish and ASKING for injury... just ask the personal trainer at your local gym about this. Again much has been written about this on the medical and fitness sites... if you haven't yet seen it, you obviously do NOT want to see it. Because it's easy to find.

The show not only sacrifices health for audience appeal (no one wants to see someone lose slowly on a healthy program - that's boring) but also, it humiliates people of size. Again, if you do not see this, perhaps you don't WANT to see it and nothing I write will convince you...

One more thing you brought up ... you wrote:

"You believe that size does not matter and it is ok to be morbidly obese."

This statement is way too general. But I don't think I said this in any of my blogs. Fact remains however, that for every study which suggests a danger in being clinically obese, there is another study which suggests NO LINK between clinical obesity _alone_ and morbidity but rather other lifestyle factors instead... food choices, whether the person yo yo's the weight or stays steady and a host of things, even things like stress and anxiety.

Dr Rudy Leibel, probably one of the most respected obesity researchers, stated in a speech to the NIH that "there probably is some advantage to being of normal BMI but it is UNCLEAR whether someone forcing their weight to a lower range than their bodies want, enjoys that advantage".

Now, Pete, I have provided some sources and clarified what I have written and of course, I invite comment but if you DO comment, I hope you will do so more respectfully than your last comment as I feel insulting comments do little to enlighten folks who are reading this. Provide me with facts and cites and I will listen. Your anecdotal "I know all about the show" attitude is not really what I call unbiased observation especially since you apparently walked away with a tidy sum of money. I can understand that you do not like it when the show is criticized for being unhealthy or for exploiting fat people (although some of the Biggest Loser candidates have talked about that themselves), and while I understand your point of view, your anecdotal information does not qualify for scientific data. I hope you understand that.

Overall, I think we can discuss something, even disagreeing upon various aspects and still remain adult and civil, yes?

Biggest loser - not?

Again we return to the controversial TV show everyone hates to watch. That's because Eric Chopin, one of the winners of the "Biggest Loser" who lost the most amount of weight, appeared on the Oprah show yesterday.Oprah had invited him a few months ago to one of her "amazing weight loss shows" to tell his weight loss story. But he declined the offer, saying he couldn't get off from work.

"I lied about that" he told Oprah yesterday. The truth was Eric Chopin has regained 107 lbs of the 214 lbs he initially lost. He said he decided to reveal the truth to his fans after Oprah's courageous move of revealing her 40 lb weight gain (which she has exploited in her "O" magazine as well as the last two weeks of her show and I guess plans webcasts as well - leave it to Oprah to dis-arm the tabloids while upping the ratings of her show... no wonder she's one of the richest people in the country - she's very clever to say the least!)

How did Eric gain the weight? Well, he didn't really know - it just crept up on him, he said. Perhaps the fact that he wasn't working out 5 hours a day like he was on the "Biggest Loser" ranch, helped.

In an earlier interview which I did blog about, I said Eric looked like he had gained some and then, he told the interviewer that when he was on "The Biggest Loser" that WAS his job but once he got back into the REAL world, he didn't have the time or energy to exercise all those hours a day.

On Oprah, Eric looked ashamed of himself, the old "I did this to myself" and Oprah, now the world's most renown expert on "falling off the wagon" consoled him that 2009 would be a better year and she said it shouldn't be about the number on the scale (which is a laugh because of course, that's ALL what it's about).

But should Eric or any of the "Biggest losers" who were unable to maintain the loss really be blamed? It's quite possible that the only thing "they did to themselves" was offer themselves up to be on the show.

Perhaps everyone should take a second look at the methods used in the "Biggest Loser" show. The people do back breaking workouts for several hours a day, and they also cut the calories (they wear counters which log their steps - these are uploaded into the computer and then, they have to log their food).

Eric told Oprah that he hating working out but he was athletic in High School. Oprah has always hated working out so she commiserated there. "Does anyone LIKE working out?" she asked, grimacing and the audience laughed.

But I have often wondered if those personal trainers on the "Biggest Loser" by putting these people through such pain (in order to win the show) have turned these people AGAINST working out for life... Workouts became for them, nothing BUT pain (the latest "biggest loser", a 30 some year old, told "The Today Show" that just before she won the show, she had packed all her bags to go home because she couldn't take it any longer and her young body hurt all over). But workouts shouldn't BE pain... aerobic workouts are supposed to be pleasant and can be fun. In the normal schema, workouts are NOT for "losing weight" but for health and as an aging person, I can attest to the fact that my hubby and my workout habits HAVE kept us healthier despite some health issues we have.

Eric told Oprah that people had warned him that keeping the weight off is the hardest part. He said he had scoffed at the warnings saying "you ever lose 214 lbs in 6 months?" but added that he found out those who had warned him were right.

After mistreating his body as the show did, it's not surprising that he regained but I don't feel HE should be blamed but rather the show. And yet, people keep lining up to BE on the show and they talk about "saving their lives".

Killing their metabolisms and working out for 5 hours a day doesn't sound life saving to me. On the contrary.

In the Game show hearings (the $64,000 question show in which contestants were given the answers), in defense, the TV exec told the Congress members that he didn't see what the problem was. "People won money, contestants had fun and the audience was entertained - everyone won!" Few seemed to realize the deceit involved could become a slippery slope into shows in which really nobody won and people COULD be hurt.

Perhaps we have arrived there with shows which exploit human beings.

dying from a surgery which might not work anyway

The doctor gently told the family to dis-robe and remove their jewelry. They were standing outside a modern facility and were told that they would be released but first were to be allowed to take a shower so they would be presentable to their loved ones. The people wondered if this doctor could be trusted because he worked with their jailers but surely since he was a doctor, he had their best interest in mind. Most of all, they WANTED to trust him. So they suppressed their fears and doubts. Showering would be nice, they thought since, they had not had this luxury during their time there. After taking off their clothing, they filed into the what looked like a community shower. They might have had hopes of "getting their lives back" because this is what they were told by those who led them into the building. Somehow one thinks they might have been in denial about things because their jailers were not really into saving their lives. But people will believe what they WANT to believe and they wanted to believe the nightmare would end with their shower. Standing in front of the shower head, they looked forward to living normally again. But no water came out of the shower head. Instead a deadly gas filled the air tight building. Their "release" was only by death. This was Nazi Germany.

And the kindly doctor who led them into the "shower" to their death, was on hand to sign the death certificates and report that he had further "taken care of the Jewish problem".

In 2006, Ray, a very large person, blogged for a year how he felt a radical type of weight loss surgery was going to "magically" save his life. To their credit, several bariatric surgeons refused to operate on him. He weighed close to 500 lbs and was still mobile (he drove a truck) but was in kidney failure from diabetes and required dialysis three times a week. One of the surgeons who refused him was Dr Baltazar of Spain who tried to explain to Ray that he didn't have a prayer of surviving weight loss surgery. But Ray bought the hype he had heard on some of the discussion groups and TV. He truly believed that Weight loss surgery would somehow make him slim and "normal". He did not speak well of those doctors who refused to operate on him and finally, he found someone who WOULD operate. Because insurance did not pay, Ray's grandma went to her savings to come up with the $50,000 for Ray's surgery. Ray's last letter before surgery, expressed hope that he would "get his life back" after surgery and he went into the hospital, confident and optimistic.

But after surgery, several other organs joined his failing kidneys and went into failure. He was awake, awake enough to realize that what those doctors who refused him surgery had warned about, was happening. His surgery was not going to save his life. On the contrary. People who went to see him, described him as very depressed before he died about 3 weeks after his weight loss surgery.

Ray may not have had the life he wanted before surgery (dialysis isn't everyone's first choice of a fun thing to do) but he _had_ a life. He drove his truck, he held his nieces and nephews, he saw his Grandma, he still could get around. Instead of giving Ray his life back, the bariatric surgery had denied him of the life he had.

TV just showed another similar case. Renee Williams was a pretty lady who at 29 years old, looked young. She had been bedfast for 4 years, partially due to a crushed leg from a car accident. And she had gained weight to 900 lbs. She video blogged and said she wanted to "get her life back" and do more things with her two kids. Like Ray, she had contacted many surgeons who refused to operate on her because she was too big a risk. But finally she found a surgeon who agreed to do a gastric bypass on her. After her bypass, he came out smiling at her family. "The surgery went well," he told them. Visiting Renee after she woke up, this surgeon said to her "and you will soon be skinny". And in the next 3 weeks, she lost 60 lbs. But then one night she had a sudden heart attack. The surgery HAD been too much for her. Her older daughter said tearfully that her mother had been her best friend.

"I know I have 100 percent chance of dying in the next year," Renee told her video blog.

But seems with the gastric bypass, Renee didn't even have a year to live but only weeks.

And Manual Uribe who refused the offer of a gastric bypass, and only a hundred lbs or so less than Renee, is still living albeit still bedfast. (It's a no brainer that walking is a lot more than being slimmer - many muscles must be developed before that even should be attempted.)

Somehow, I feel Renee's life was wasted and that she was given false promises because this drastic invasive surgery is not even that effective on larger people. One of the few studies we have which looked at many patients 10 years post op, found that 34 percent of them with a BMI over 50 regained all or most of the weight they lost.

We to date, have no data on weight loss 20 years after gastric bypass despite the fact that gastric bypasses have been done for 40 years. Why is that, some wonder. Dr Paul Ernsberger, associate professor of nutrition at Case Western Medical school, opined:

"A number of trials have been started, and the final results have never been reported. We have to ask, you know, why haven't we seen the final results? I think it's because it's bad news." (Dr Ernsberger on "The Donahue Show")

When these very large people showed hesitation about the surgery, this surgeon (now under lawsuit for the death of another patient) paraded a woman who had had a gastric bypass and lost 400 lbs. "It's the best decision I ever made in my life," this patient who works for the surgeon as a "liaison" said, enthusiastically. But that woman is only two years post op. We should remember that 6 months after Big Pete Herida appeared on Oprah and said how losing 600 lbs with his gastricbypass had "saved his life", Herida died of congestive heart failure.

And then there is another lady I know who weighs in excess of 500 lbs who is in her 50's and not real mobile. She says she's _outlived_ 48 of her friends who had Weight Loss surgery. One never hears about that on TV.

There is some evidence that losing a lot of weight even slowly, may be more of a strain on the heart than NOT losing it.

What really upset me was the misrepresentations going on.

"If Renee survives this surgery, she will lose 700 lbs" stated Renee's surgeon to the TV cameras.

None of the very large folks I know, have lost more than 400 or 500 lbs with gastric bypass (many have lost less) and most of them regain a significant amount of weight (if they live) within 4 or 5 years.

"Renee only had a year to live" was another thing we heard a lot on the TV show and no one can predict that at all. Surely it's not real healthy to be in bed weighing 900 lbs but who really can predict the lifespan of anyone. Telling her that seemed more like a misrepresentation in order to scare her into surgery.

And the worst thing was the spin they put on the show "If Renee had been accepted for surgery earlier, things would have been different. She called many doctors and begged them to help her."

This seems to suggest that those surgeons who were ethical enough to NOT operate on her were somehow guilty of her death.

"The show has inspired many to call for help - to not wait until it is 'too late' like Renee did. " the show told us detailing two other patients, both of whom got bypasses but are still in bed.

It's way past time to realize that what we hear on TV may not, and probably IS NOT the truth. TV makes only a commitment to entertain, not to tell the truth.

During the trials after the game show scans in the 1950's, one of the producers shrugged his shoulders when confronted with their lies, giving contestants the answers etc (there is a movie called "QUIZ SHOW" which details this famous case). "Well," said the producer, "no one was hurt. The contestants won money and the people were entertained."

Now with today's spin, giving people false hopes about surgery which may not even help them (and may cause their death), can we really say anymore that "no one is being hurt"?

Surgeons pressured based on flawed studies

Based on a couple of studies suggesting increased lifespan in weight loss surgery patients, those studies being short and inconclusive and not randomized and flawed, surgeons are being pressured to do gastric bypass surgery on people of all ages. A recent news article quotes one surgeon who was being pressured to operate on people as old as 78 years old (which is ridiculous because a lot of evidence suggests that doing gastric bypass on anyone over 60 is a risky deal and may SHORTEN - not lengthen lifespan).

"I am being asked to operate on 78-year-olds with co-morbidities of heart disease and diabetes," said Dr. Edward H. Phillips, executive vice chairman of the Department of Surgery and a surgeon at the Center for Weight Loss at Cedars-Sinai Medical Center in Los Angeles. Phillips questions whether these patients will benefit..."

The surgeon continued...

"So, while it is obvious a 30-year-old will benefit, at what age is too old?" he asked.

Problem being it's NOT obvious at all that a 30 year old will even benefit from losing weight without surgery, let alone having a surgery which causes vitamin deficiencies for life and more ...

***Gastric surgery for weight loss causes nutritional deficiency in nearly 100% of individuals who have it done. The most common deficiencies are Vitamin B12, Iron, Calcium, Magnesium, Carotene (beta-carotene and other carotene vitamins) and potassium.****

Kaiser Permanante Release form for gastric bypass

All the studies I know about which suggested an increased lifespan for gastric bypass patients were flawed. One study (David Flum (Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study)
compared 62,000 healthy fat people who entered the hospital for gastric bypass to 3000 seriously ill fat people who were hospitalized for other reasons (had he compared the gastric bypass patients to 3000 seriously ill slim people hospitalized for other reasons, I'm sure he would have found that the healthy fat people outlived the seriously ill slim people also). This same study was the one which found that the real death rate of gastric bypass patients was 2 in 100 or 1 in 50 died within 30 days of surgery and another 2-6 percent (depending on age) died within the first year. Did he average those deaths in with results? Probably not.

And the Utah study which compared 9500 gastric bypass patients with 9600 "seriously fat people" who applied for drivers licenses and found a "40 percent less death rate among gastric bypass patients". (Long-Term Mortality after Gastric Bypass Surgery Ted D. Adams, Ph.D., M.P.H., Richard E. Gress, M.A., Sherman C. Smith, M.D., R. Chad Halverson, M.D., Steven C. Simper, M.D., Wayne D. Rosamond, Ph.D., Michael J. LaMonte, Ph.D., M.P.H., Antoinette M. Stroup, Ph.D., and Steven C. Hunt, PhD.) In this study, there were several flaws. First of all, most people lie by a lot on their drivers' licenses about their weight... and the heavier they are, the more they shave off. In a survey I did of fat people, I found most over 300 lbs were putting their weight as 100 lbs less than they really weighed which means finding people of "comparable weight" based on driver's license weights, weren't really comparable because actually, they were likely much heavier than their WLS counterparts.

The worst thing wrong with this study is the way it LOOKS i.e. 40 percent more deaths sounds impressive until one looks at the facts.... there were 57 deaths in the control group (the non surgical) and 37 deaths in the gastric bypass patients so that is only 20 deaths more in the controls and they did NOT count the gastric bypass patients who died immediately after surgery or within the first year after surgery. They took them at the 5 year point when those who probably survived the first few years were going to survive. Had they taken them (as they should have done) right after surgery, I'm certain they would have found that the mortality rate was much higher among gastric bypass patients. They also did not count long term patients either - only 5 years post surgery which is before the co morbidities like anemia etc show up in many patients.

Definitely not a study to "prove" anything about the lifespan of gastric bypass patients and nothing to justify doing surgery on elderly with heart conditions etc.

And so far, there isn't even any "proof" that losing weight will prolong lifespan. Two studies of over 50 year olds, all obese - one group which dieted and the other which maintained their current weight, found that the dieters had a 50 percent greater chance of heart attack than the controls. For as many studies that suggest that obesity is "dangerous" there are an equal number of studies which suggest that obesity alone does not pose co morbidities and co morbidities are either contingent on lifestyle or "serendipity".

Even the release form for gastric bypass warns about this:

****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)

It's time Americans realized that anything in the mass media is for "entertainment only" and NOT a good source of information, especially for making medical decisions.

art credit: art in photo by Char - used with permission

diabetes but what type?

What is the cause of type 2 diabetes? We all can answer that by rote much as we can recite TV ads for cereals from the 1960's. "being fat and/or gaining weight and bad eating habits".

Well, then, what causes type 1 diabetes? "that's when your immune system or something else destroys cells in your pancreas".

Where things seem to get confusing is how they distinguish between two. I used to think it was something like "if your father had diabetes or your mother or your grandmother, it's type 2 because type 1 is obviously not hereditary". Or maybe if you walk into the doctor and have a blood sugar reading of 1000, at the first reading, you might have type 1. Or if you are a kid, of course, it's type 1 because kids don't get type 2 (that's why it's called "adult onset diabetes" dummy - didn't you know that from the 1950's?... ok I'm being sarcastic here... I admit it. My bad)

But a recent Discovery Health CME was extremely confusing. A young ballerina (15 years old) came in with a blood sugar reading of 400. Now _that_ seems to suggest she has a partially functioning pancreas, doesn't it, especially since her mother also has diabetes also...which suggests a genetic factor, very typical of type 2 diabetes or insulin resistance, right?

But it appears that because both the mother and daughter are very slim and eat healthy etc (well supposedly - many slim people actually do NOT eat healthy - they just "get away" with eating poorly), and the girl is a kid (15 years old) it must be type 1 diabetes, decides the doctor and puts this kid on 7 shots of insulin a day (and 8 pricks).

Later, you see the kid with some friends, one of whom asks "but you look so good, how come you have diabetes?"

"no no no no no no no!" exclaims the young girl, "I don't have that kind of diabetes that fat people get!" (she wrinkles her nose in disgust as she utters the words "fat people".) "I have type 1 diabetes!" Listening to this, I cringed.

And I wonder. Did they ever try her on metformin? Did it ever occur to her medical providers that insulin resistance which is a gene, can occur in a slim person also? Is it worth it to these people to not "brand" them as "fat" or "formerly fat"? Obviously if metformin worked, wouldn't that be a whole lot better quality of life for the young girl to take a couple of pills a day than to take 7 shots of insulin throughout the day and test her sugar "umpteen" times? Also, metformin is a better treatment - she's essentially being treated the same way they treated diabetics in the '50's and '60's.

I have a friend who is slim. But his mother was extremely overweight. So he noticed the usual signs of diabetes - thirsty, and so forth. He went to the doctor and because of his age and girth, got diagnosed with type I diabetes (and his mother by the way, had diabetes type 2). Was on insulin for several years until some smart doctor decided to try metformin and now, he only takes one insulin shot a day and pills which is a whole lot nicer.

My question to medical providers - are you really in tune with the fact that a slim person can have type 2 diabetes because it's essentially a genetic disorder? Even if they are not fat (because fat is largely genetic as well)? Or are you putting young kids through a horrible medical regimen just to assure their parents and/or them that they do not have the "fat person" kind of diabetes?

Fat phobia hurts everyone - even slim people. And that is why we _all_ have to fight it.

If you come in with a blood sugar level of less than 800, even if you are a kid or slim, ask your medical provider to try metformin (the pills) first. Because 33 percent of type 2 diabetics are slim - never were fat in their lives - and those are the ones we know about. How many more type 2 diabetics who were misdiagnosed because they were young and/or slim are there around?

a buzz of bogus studies on fat and weight loss surgery

So you are wondering why I have not blogged in a while. Truth being we have been lately inundated with fat and weight loss surgery studies which are obviously flawed. And sometimes it feels like mentioning them is similar to trying to lower the level of the ocean by taking out tea cups full of water.

This morning I saw a study which was questionable enough that I had to report on it. It appeared in the JAMA that is, the Journal of the American Medical Assn, Nov 19 2008. (here I recall the issue of the same magazine - after numerous studies had already suggested smoking was unhealthy - which pictured several doctors on the cover, all smoking cigarettes as an accompaniment to an article about how cigarette smoking was a healthy way to lower stress!).

The Conclusion of this latest study was that women who get pregnant after gastric bypass, have LESS complications in their pregnancies.

First thing to question is it comes from the Rand Corporation, the same group which, a few years ago, announced that one of their studies had suggested that smoking was less dangerous than being fat (this was based on a few thousand people called by telemarketers and asked 8 questions, including height, weight, age, whether they smoked and 6 more about their health). Needless to say, even the diet industry no longer quotes THIS study.

Second, two complications were mentioned - gestational diabetes and high blood pressure (the latter which isn't really a complication of pregnancy anyway).

What is NOT mentioned is that these do not necessarily affect the baby at all (I can attest to that personally knowing a lady who had gestational diabetes and delivered perfect, healthy bright kids).

The researchers, we are told, looked at 75 studies which they selected out of 260 studies. And likely they only selected the ones which gave them the favorable results they wanted.

Some studies I've seen, which suggested the gastric bypass patients tend to have smaller babies and a higher rate of still borns, even if they DO NOT have gestational diabetes or high blood pressure, were likely not selected to be "reviewed".

It's kind of a no brainer that if the mother is not digesting vitamins, it might negatively affect the baby.

Another show called "Extreme bodies" on the Discovery Channel, might have been an infomercial for Dr Rabkin and the Duodenal Switch/Bileo Pancreatic diversion. Ironically, the patients shown in the film were still rather large and Manny Yarborough, the ex Sumo wrestling champ who is up to 750 lbs now (after keeping up his exercise after retiring from the ring for a while) and has decided to NOT have WLS. He states in the end of the film that his friend who died from WLS, told him on his death bed, to "not let them do that to you". So far, he's taken this advice.

The new non surgical WLS which isn't - non surgical!

You have probably seen by now, the media hype. "New WLS - no cutting needed".

Transoral Gastroplasty the so called TOGA procedure, has already been hawked in the media as the latest and greatest.

What the TOGA is, is that they stick a bunch of flexible staplers down your esophagus and pleat part of the inside of your stomach (with staples) into a small pouch:

The TOGA System (Satiety, Inc), a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch (similar to other restrictive pouches) along the lesser curve of the stomach.

The news media lost no time in hawking this as the latest and greatest WLS with no cutting:

Unlike other bariatric procedures, the TOGA does not require any incisions. That translates into quicker recover times, shortened hospital stays, and a decreased risk of complications.

Decreased risk of complications? Well, partially true. That is, decreased risk of complications from incisions like hernia and wound healing. We won't talk about complications which may arise from stapling the interior soft tissue of the stomach and of course, other complications which generally arise from WLS.

Other sites have called this procedure 'non surgical'. Again the term may be misleading - that just means there is no incision. But it certainly IS surgery. For example, if a surgeon does a vaginal hysterectomy would that be "non surgery" just because there was no incision?

Below is the best description I could find of it - Medscape news (requires free membership in Medscape to read this)

http://www.medscape.com/viewarticle/555586

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

According to Dr. Scott, "Gaps between staple lines [negatively] affected weight loss. The gaps were dependent on stomach anatomy. As we gained more experience with the instruments and the procedure, we made adjustments, and weight loss increased."

... Dr. Scott reports a financial relationship with Satiety, Inc. Dr. Zundel reports financial relationships with Ethicon and Inamed.

One is left with many questions about this procedure. First of that, that's soft tissue inside the stomach and also has a lot of important digestive cells, much softer than rather than the outside of the stomach which is stapled. Secondly the Rose and Stomaphyx procedures which are used to revise gastric bypass patients who have experienced regain, apparently have a problem with the tacks (Stomaphyx) or sutures (Rose) coming out. The Stomaphyx has been all but dropped because the tacks came out pretty soon. (The two patients I know personally who had it say not only was it ineffective in helping them to lose weight again but had a painful aftermath). In doing the Rose procedure, surgeons tell patients the sutures are only guaranteed for a year after surgery.

And a major issue ... the Vertical Banded Gastroplasty which is more permanent than the TOGA but similar in concept, was EXTREMELY ineffective for keeping weight off.

I have known one patient who kept off her weight for 9 years but after that, it started piling on as she became increasingly ill with autoimmune disorder and a host of other things (which many of her medical team DID attribute to repercussions of her WLS). At the 22 year point when this patient had to have her pouch amputated because her stoma stayed shut and she could not even swallow saliva, she was 15 lbs heavier than she had been on the day of her WLS, 22 years ago.

Typical of these patients are things like losing all their teeth, gastroparesis and atrophic gastritis and more.

(see: http://obesitysurgery-info.com/post-gastrectomy-symptoms.htm )

It's true that the VBG was safer than the gastric bypass (which is why Mason invented it- he wrote) and many of those patients are still around at the 25 year point but I have not met one long termer VBG who is a happy camper. On the contrary.... and every one of them has regained all the weight.

Of course, this TOGA procedure has no silastic band and no stoma. But even after a few months they found (by their own admission): "partially stapled sleeves". In other words, the staples seem to last less time than the sutures....

What damage does this do to the patient's stomach, I wonder....

Studying history is helpful here. The vertical banded gastroplasty which seemed much more permanent was neither effective in the long run nor complication free. For instance here is a patient case history with endoscopic photos:

http://obesitysurgery-info.com/vbg_patricia.htm

And even the horizontal gastroplasty which was extremely ineffective as far as weight loss, had its own set of long term complications which interestingly enough resemble the VBG long term. Here is a case history of a 30 year post op horizontal gastroplasty patient. NOTE: although she is very ill, she has been told that any type of take down or reversal will destroy her stomach and put her under risks of dying on the table:

http://obesitysurgery-info.com/savage.htm

NOTE: both these courageous patients have requested of me that I include their real names AND their photos because they very much wish to warn those considering similar surgery....

The weight loss seems typical of what we have seen with other gastroplasties. Even in the medscape article, the average loss per week by the 6th month was 5 lbs per month or approx 1 lb a week. (this was omitted from the media hype about the procedure - how surprising!) :)

So I would wonder why do they even run a trial of this because it seems doom to fail, even at keeping off the weight any length of time.

The answer may be in the funding they are getting from the manufacturers...

Dr. Scott reports a financial relationship with Satiety, Inc. Dr. Zundel reports financial relationships with Ethicon and Inamed.

And of course, as Roy Spenser remarks in "CLIMATE CONFUSION" (he was senior scientist and climatologist for NASA), any newspaper reporter will jump at "big news" (like "NEW WLS") in hopes of the typically elusive Pulitzer Prize. "Scientists are human" writes Roy continuing that proclamation of "truths" is likely to get scientists, more and better funding. But writes Roy, dourly:

"If you want possible explanations of nature, go to science. If you want truth, go to church!" (Spencer, Roy, PhD: CLIMATE CONFUSION, NY, 2008)

Bariatric surgery, stress eating, marginal ulcer and PTSD

Here is something not talked about EXCEPT in medical journals (where it's OFTEN talked about): (from Melting Mama's blog)

... [she] had roux en y gastric bypass a couple years back. She's been having burning "acid" pain and discomfort and took her concerns to her Bariatric Surgeon. He says it's a "Marginal Ulcer." The doctor said there will be NO denying when it perforates, and to get to the hospital.

My reaction here is that many Weight Loss surgery (WLS) post ops especially longer term post ops, are living with a form of "Post Traumatic Stress syndrome" - i.e. when things "just happen" to you suddenly, rather unusual things which do not happen with such regularly, frequency or severity to the general public, or like the individual above, you are WAITING for "things to happen", it tends to cause a type of stress which can lead to catastrophic thinking (and fear and anxiety) on a daily basis.

Again this is NEVER discussed at pre op seminars and seldom discussed when post op depression (which many post ops I know, have) is encountered. They are given medications which they may or may not absorb and sent home. If they eat to help their stress, they are often verbally abused by medical providers.

Meanwhile the ads and promos and seminars for WLS continue to brag that it will help depression to lose weight with WLS! I guess they hope folks won't read some of the yahoo listserves where longer term post ops hang out....

Also, I know cases where overeating has gotten folks through periods of extreme trial and stress, in their lives when, without this method of stress management, they might have had nervous or physical breakdowns.

Again, medicine almost never acknowledges stress and how it can be the MOST devastating thing to a person's health - much MORE devastating than some extra pounds (to put it mildly).

One person on another list talked about being recently hospitalized for "being suicidal". I've known this person for quite some time now, and she is usually an upbeat, cheerful, optimistic person and also of very high intelligence. So when I heard she had been thinking of the ultimate bad ending, I was more than a bit shocked. Did anyone ever consider that her "suicidal ideation" might be because of her gastric bypass which not only did NOT produce the weight loss she was promised (despite her being a model patient) but also has caused numerous NEW comorbidities which are difficult to impossible, to treat? I bet not one person who has treated my friend ever asked these questions. :(

By the way, the Junkfoodscience blog has an excellent analysis of the latest study suggesting that bariatric surgery (weight loss surgery) is more cost effective for insurance companies than treating obesity. I love her title "No evidence that bariatric surgeries save healthcare costs or save lives" Seems this study has more holes in it than swiss cheese. Bravo to this blog and its author for exposing these um...less than scientifically sound (how's that for politically correct) studies!

Finally by way of news, the young lady who made the headlines a while ago for getting a lap band (after lipo suction etc) in her early teens, appeared on the new show, "The Doctors". Seems she (not the parents!) is looking to get more plastic surgery. "I want my arms done," she told those watching the show, pinching a small bit of skin under her arms. She admitted she wanted a few other procedures also. I found myself wondering whether she, like so many of us, is getting into the "hooked on plastic surgery" thing. Of course, this attitude seen in many American women, keeps plastic surgeons in business, but so often the bottom line is the inner feeling that "I will never look good enough" a possibly correllary of which is "I will never BE good enough". Many people who get WLS are also motivated by looks and highly disappointed with the results when they don't come out looking like the air brushed models in the magazine with totally flat abs etc, even if the surgery produces a weight loss close to the so called "ideal". This young lady, now at the age of 15, remains a lovely naturally good looking young lady who, because of societal pressure, may well not be enjoying what nature gave her, and just the exhilaration of being young with her life ahead of her, instead looking for happiness in places where perhaps happiness may not be found. Should she be looking for inner happiness which may make her feel a lot better than yet-more surgery?