A Whole Floor to treat sick WLS patients?

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

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

I naturally, asked her what could be harder.

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

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

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

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

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

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

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

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

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

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

fat people cost more money to treat

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

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

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

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

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

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

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

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

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

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

diet pop - not so diet after all?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Spinning a Good Story on Tragedy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dear Sir,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Big Medicine - some interesting things

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

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

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

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

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

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

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

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

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

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

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

Pizza, Fat and Genetics

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

And I was in the "lucky" 10 percent!

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

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

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

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

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

Maybe there is something to this satiety disorder thing.

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

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

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

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

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

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

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

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

is this a diet blog?

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

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

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

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

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

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

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

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

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

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

I find some things in life rather interesting such as:

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

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

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

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

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

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

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

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

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

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

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

Why are so many weight loss surgery patients on antidepressants?

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

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

A logical question which I began to think about.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

She answers:

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

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

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

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

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

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

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

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

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

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

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

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

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

"An informed patient is a healthy patient"

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

Queen Size movie was a Queen size diet ad

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

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

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

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

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

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

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

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

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

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

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

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

Weight loss surgery ads disguise themselves

I shouldn't write another blog so soon, but an article I saw in Newsweek annoyed me just a bit too much.

It's because the article tries to disguise itself as written by a person who is "concerned" about fat prejudice and trying to "find herself" but is basically, merely, a blatant commercial for gastric bypass surgery.

It appeared in Newsweek Magazine and is entitled "My Secret History". It doesn't say it's a commercial for gastric bypass but it hits all the high points, including a photo of a lovely young lady who has likely had a tummy tuck and a makeover. She greatly resembles the lovely young ladies who smile out from the TV ads for Nutrasystems, telling us how wonderful it is to be slim. Her "before photo" is NOT included at least not in the web version of the article (maybe because she might have been equally lovely weighing 265 at 5'6"???).

In fact this lady DOES tell us how wonderful it is to be slim. For example, the handsome young doctor (ding-dong for point one - she's dating and she's dating MONEY $$$) she went out with, was obviously disgusted at one of his fat patients. Message - this handsome "catch" of a man would NEVER have dated her when she was fat. I'm sure it will never occur to either this lady or the readers that if this guy has such a nasty attitude toward fat patients, will he really accept her when she's pregnant, and/or gains the weight back and/or gets a few wrinkles?

She then describes her Great humiliation of her life. This was when she got her butt stuck in a hanging tire swing at the age of 19. (that's so important - she could have been smaller and gotten stuck also but would have laughed it off).

Not too far down in the article she writes:

I've had nothing but success, healthwise, from the decision to have gastric bypass surgery. I've even run a half-marathon since then (not a superhuman feat by any means, but one almost unimaginable to that girl dangling in that tire).

Oh my, a reference to the tire nightmare again. If that's the worse thing she can pull up about being a teenager in general, she's lived a charmed life, fat or slim!

I'd like to point out that she is not even 1 year out and probably was about 9 months out from her surgery in Feb 2007 when she wrote the article - those magazines have a lag of 2-3 months from writing to publication for non news articles.

The testimonial from the new op who is enamored with the fact that she lost a bunch of weight fast.

The problem is, we can only get sugar out of body fat so when we are only eating 300-500 calories a day during a quick weight loss period, most of what we lose is NOT bodyfat. It weighs heavy on the scale and so we FEEL like we are losing A LOT of weight, but does NOT really reduce our inches that much.

So doing the math, if she lost 135 lbs then only 40 lbs of that was likely, FAT. (about 20-30 percent of the gross loss). The rest was muscle tissue, bone mass (and organ meat) which her body "ate" to provide protein during her "quick weight loss" period. Well, just where do people THINK the NECESSARY calcium, protein and vitamins come from, when we do not eat enough food and have digestive problems?

• B12 and iron from the liver
• iron from the heart
• protein from the muscles
• calcium from the bones

YUM. Not quite the lovely "magic bullet" picture we are getting from the article, is it?

40 lbs???? She didn't need surgery to do THAT. She could have lost that and gained muscle and lost bunches of inches working just as hard as she obviously did (to be able to run a half marathon) WITHOUT the surgeon's knife. Eye opening, isn't it?

One doctor told a gastric bypass patient recently that he had seen many patients suffering the numerous maladies she is enduring, 8 years post op, including auto immune disorder, osteoporosis, anemia requiring iron infusion and more. He said:

"When you bypass the main food and vitamin processing center, there shouldn't be any surprise when deficiencies show up."

Oh but there WILL be surprise when the gaggle of desperate fat people running to their surgeons now with the dream of their gastric bypass making them look like the lovely lady in the article, start having those problems. Because no one ever told them about the other side. And media articles like this make folks think surgery is a "magic bullet" instead of what it really is, a medical procedure done for medical reasons when the co morbidities of obesity are thought to be worse than the co mobidities from the gastric bypass.

Did I say co morbidities from the gastric bypass? Yes that is EXACTLY what I said. And what potential patients are never told about in the media advertising.

I hope potential patients will research the internet including the yahoo group which has a membership of close to 2000 members, many of whom have seen the "other side of the mountain" which is never portrayed in the new op interviews in the media:

http://groups.yahoo.com/group/ossg-gone_wrong

And the website:

obesity-info.com

Which contains informed consent information, patient histories and more.

Gastric bypass surgery has become for many longer term patients, what Stephen King prophetically wrote about in the novel "THINNER"

Perhaps, he thought, Houston was right and I'm thinking myself thin ... because that old Gypsy wanted me to. Only now I can't stop. I could make a million bucks writing a response to that Norman Vincent Peale book ... call it The Power of Negative Thinking. But his mind suggested that was a pile of crap. All that gypsy had said was "Thinner". He didn't say "By the power vested in me, I curse you to lose six to eight pounds a week until you die."

Luckily thanks to modern medicine, the picture for gastric bypass patients who have problems in the long term is not as bleak. But gastric bypass is by no means the magic bullet or "easy way out" that the media wants us to believe, either...

The lady pictured in this blog was a close friend of mine, a teacher, a mother and beloved friend who died way too soon. To see her memorial, click here

But it's NOT a diet!

Weight Watchers has a new ad campaign. They tell their viewers that "Diets don't work". Which is true - countless studies suggest that 95 percent of dieters regain the weight within four years of losing it. So that's great but they go on to say "Weight Watchers works". Wait a minute. Weight Watchers is a DIET and they just said "Diets don't work". And Weight Watchers, although one of the healthiest weight loss programs out there, is STILL a DIET.

My personal opinion is, although that seems a good idea, it may backfire on them because if they ADMIT that diets don't work (and everyone knows that Weight Watchers IS a diet) then, folks might get to thinking that maybe it's NOT time to re-join!

Resolutions to "lose weight" were somewhat absent from the numerous New Year's interviews and news articles. And a news article suggests that Americans are AT LEAST as interested in health as they are in thinness. Only 29 percent of those asked, admitting to dieting (but remember many dieters do not admit that a weight loss program is "dieting"). Of course, people may be going underground with their interest in slimness because it's fallen out of style to admit that you want to be slim. However, diets or weight loss programs are STILL being sold as a looks improvement - with smiling slim ladies and a few gents saying how wonderful it is to be slim, how they can buy clothing off the shelves and fit on carnival rides. The usual sound bites.

And despite the word "diet" being a no no now, Diets are going strong in 2008...

Discovery Channel's "body challenge" is one diet which has been heavily advertised. That's 8 weeks long and encourages a quick weight loss with supposedly changing one's habits (an 8 week membership at Bally's is included). But as we all know the quicker you lose the weight, the quicker it comes back. And will people REALLY change their habits in 8 weeks? Questionable.

Of course, the 55 BILLION buck a year diet industry doesn't mind repeat customers, in fact they thrive on repeat customers.

Oklahoma City is being put on a diet by their mayor who brags he wants his people to lose 1 MILLION pounds. (will they gain back 2 million lbs then?). The enthusiastic mayor of OK city has TWO domain names for the program and fancy websites with messages like how much obesity costs. Their program encourages exercise and watching what you eat. The 2600 people who have signed up already, have lost 300 lbs (they say). Nice but 2600 is but a small percentage of those who live in OK city. Perhaps not all residents are that enthusiastic about the major's challenge!

And NutraSystem has a new ad (with plenty of happy smiling slim people) and a new program called Nutrasystem advanced. You get 2 free weeks of food, food is shipped in plain boxes so your mailman doesn't know you are on a (gag) diet and the smiling slim folks in the ad tell us how much they love the food and especially the chocolate. The small print in the ad (which becomes available to those of us who have DVR's and can stop the action) tells us that those used in the ad were "renumerated" i.e. paid, and that they lost weight on the OLD program and that it isn't exactly 2 free weeks - it's more like buy 3 weeks, get on free, twice. Also says the small print, you only get the entre for $10 bucks a day. You have to buy the fruit and veggies. Seems rather pricey to me.

And then, somewhere in a quiet corner amidst all the noise of all the diet (oops NOT DIET - weight loss) groups advertising is HAES, Health at Every Size. The only program which has been suggested by CLINICAL studies to really work to help people GET HEALTHY. HAES is where you try to eat healthy and exercise a few times a week and don't fret about your weight. Because we know that DIETS DON'T WORK for most people. HAES, unlike diets, DOES work.

Problem is, I think just about EVERY American knows how to lose weight and what they SHOULD be doing for health but many choose to not do it. And maybe, that's ok too. It's nothing to feel guilty about, because for as many epidemiological studies which suggest that being obese is dangerous, there are an equal number of epidemiological studies which suggest that obesity really isn't a big factor in health, one way or another.

One of my favorite things to think about is this:

On the Titanic, destined to sink that night, how many women denied themselves desserts due to "watching their weight"? And if they had it to do over, would they have skipped that dessert?

So take a walk a few times a week, try to eat more veggies, don't fret about your weight and .... enjoy your dessert because you never know when it will be your last.

Big Medicine revisited

People may remember a blog I wrote in June 2007 in which I accused the TV show "BIG MEDICINE" of being an infomercial for weight loss surgery.

In retrospect, now that I have watched the first season of this Discovery channel show twice, I will say that if you watch it carefully, it actually shows some instances which give a clue about how risky this surgery (gastric bypass) IS.

For example, the one large lady in the last or second to the last episode who was rejected for WLS, was told by Dr Garth (the young WLS surgeon) that he did not feel it safe to operate on her because she lived too far away and did not have any family to support her (she had moved from one of the Southern states to Houston in hopes of getting the surgery). He went on to say something about how he had to bring one of his recently post op gastric bypass patients back to the hospital four times and pointed out to her that if that was her, living an hour away from the hospital, she could die.

In another show, Dr Davis senior remarks that the gastric bypass is basically creating a situation of malnutrition in a patient and that SOME patients would be better off remaining fat. Big admission.

And finally, each episode has one patient who has HAD a gastric bypass and ended up with very little muscle tissue (the body in starvation in the quick weight loss period eats its own muscle to obtain the protein it needs on a daily basis - if it did not do this the patient would die). These 1-4 year post ops especially the larger weight losers were shown sans clothing and looked like melted candles with a very unusual shape. Some needed several plastic surgery procedures and STILL after all of that pain and work (and risk) felt the need to cover up their bodies.

I have heard this from countless patients... those going in with a looks expectation especially, that they say they looked worse AFTER surgery than before.

A sad thing especially as some of the muscle which has been wasted in the starvation/quick weight loss period does not seem to be able to be rebuilt (perhaps because even when the weight loss stops, there are still hundreds of nutrients which gastric bypass patients cannot digest and cannot supplement through injection or sublingually).

So the bottom line is that I think the show has the potential of informing prospective patients about things they might not think about or read about before but unfortunately many will see only the end story which is the usual gushy "I'm so happy now, I can buy clothing off the shelves, I can ride on carnival rides" which one hears from some of the new post ops.... these stories tend to make people forget all the darker possibilities in their desperate hope that this surgery will magically heal them of obesity.

I did receive a letter responding to this blog which I'd like to share with you. It's obviously from a gastric bypass new op and reads:

Wow - This is some great research. To site articles from 15 years ago. Hate to tell you, but surgery has advanced since then. Also doctors such as Drs Davis will not do surgery on patients just because the want it. The patient has to meet certain criteria. You make it sound as though a person who is 20lbs overweight will get this surgery, then die. I'm certainly glad you have no weight issue yourself. Otherwise you might know what it feels like to be sick and in pain all the time. Oh and by the way-My surgery was a success, and I plan on keeping it that way. I did my research so I know how to make that happen.

I would like to respond here. I quoted three studies - one dated 2002 and one dated 2003 and true, the Hebrew University Study in 1992, however, studies published later such as the Swedish Obesity study published in the NEJM Dec. 23, 2004 issue showed similar results as to weight loss (or lack thereof). At the 10 year point, the 541 patients who were available for followup, had only kept off an average of 16 percent of their original weight. (BTW, that same report stated that only 35 percent of the diabetic patients were still - at the 10 year post op point - "disease free").

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

And earlier in 2007, the ASBS, (the weight loss surgeons professional organization) in endorsing a new revision procedure called "STOMAPHYX", admitted that 30 percent of gastric bypass patients gain all or most of the weight back (thus the ASBS felt there was a need for this procedure which is less invasive than other types of revision).

It should be noted that the inventor of the gastric bypass, Edward Mason, who after his initial follow up has recommended people have RESTRICTIVE ONLY surgery (like the gastric band) because of the inherent vitamin deficiencies of the gastric bypass, has written several articles with that recommendation, one of the most recent ones being in 2003 for the U of I healthletter, reminding that we know a lot more now, about the digestive tract than we did in 1965 when he adapted the gastric bypass from the 1880's billroth II surgery - this article included the following:

Bypassing the first part of the intestine interferes with normal absorption of critical nutrients and causes complications related to vitamin and mineral deficiencies such as anemia (iron deficiency) and metabolic bone disease (calcium and vitamin D deficiency).

These side effects led Mason to develop a simpler procedure known as vertical banded gastroplasty, which he began performing in 1980. Vertical banded gastroplasty reduces the region of the stomach that can initially receive food, but does not alter the rest of the digestive process.

" The future of weight loss surgery rests in greater use of simple stomach restriction procedures like vertical banded gastroplasty, which preserve the normal weight-maintenance mechanisms of the body," Mason said. "If simple restriction procedures did not produce sufficient weight loss, it was always my inclination to work with the patient to solve other problems affecting weight loss rather than going to a more radical procedure."

http://www.uihealthcare.com/news/news/2003/04/14obesitysurg.html

The writer of the letter assumes I have no weight problem myself. This is only partially true. I am, according to BMI standards, 120 lbs overweight but this is NOT a problem for me. Overweight does not automatically mean "sick" just as much as slim does not automatically mean "healthy". The writer apparently managed to miss the many studies including one published recently which point out that fitness determines lifespan and NOT fatness (or thinness). This study which hit the news on Dec 4, 2007 (even discoveryhealth news - home of the National body challenge DIET and Dr Oz of "You on a diet" fame) clearly suggested (AGAIN) that a fat person who exercised regularly was expected to live MUCH LONGER than a slim person who did NOT exercise and that the amount of exercise a person does predicts lifespan REGARDLESS OF WEIGHT.

So have I fought the battle of weight all 63 years of my life - the answer is yes but because I have also exercised for the last 14 years without stop, my weight is NOT a problem. See - weight but not a "weight problem".

I must say however, that the so called "risks" of obesity even in a person who does NOT exercise seem basically unproven. That is, although there are a bunch of epidemiological studies suggesting a fat person is under greater risk of illness etc there are an EQUAL amount of epidemiological studies which suggest that being under risk more involves things like being HUMAN and/or what we eat and/or how much we exercise rather than whether we are fat or not.

Finally the writer of the letter assures me that SHE will NOT fail with her gastric bypass because SHE did the research before and knows how to do the aftercare.

Surely if she remains faithful to all the rules suggested for post op gastric bypass patients including regular exercise, protein drinks and B12 / B6 injections at least once a week, and she gets a measure of luck mixed in, she has a better chance of avoiding serious repercussions at least for the first several years or so.

However, that being said, I also know gastric bypass patients who did all of the above but just by the luck of the draw, ended up fighting rather difficult health issues like post gastric bypass hypoglycemia (that's where you can "dump" i.e. feel faint and ill - after every meal) and bowel obstruction. I also know gastric bypass patients several years post op who have faithfully exercised and strictly watched what they ate and STILL regained a significant amount of weight.

How the body will react in the long run to such a drastic "re-plumbing" of the digestive system is unknown before the surgery which is why the American Medical association warned physicians to alert patients about the "unknowns" of the surgery to avoid lawsuits and the "ethical haze":

"The ethical haze surrounding bariatric procedures is not unknown in surgery", said Laurence B. McCullough, PhD, a professor of medicine and medical ethics at Baylor College of Medicine in Houston, Texas.

"This is the classic problem in surgery-innovation without the research to guide it. So all this should be brought under experimental protocols," McCullough said. "That's how you handle the conflict of interest make sure you tell the patient, 'The procedure is investigational; we don't know if it will help you."'

1762 JAMA, April 9, 2003-VoL 289, No. 14

In that same issue of the Journal of the American Medical association (JAMA), they commented that although the early results are impressive, the repercussions and even whether the weight stays off are unknown:

" Short-term outcomes are impressive-patients undergoing bariatric surgery maintain more weight loss compared with diet and exercise. Comorbidities such as type 2 diabetes can be reversed. But long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."

1762-JAMA, April 9, 2003-VoL 289, No. 14

I thank this gastric bypass patient for reading my blog and for writing to me and wish her the best of luck with her surgery.

New "Prevent childhood obesity" initiative forgets some things

Today we got the news that Laura Bush (our First Lady) saluted the announcement of a new initiative to prevent "childhood obesity" and promote "healthy weight".

Although I generally like the Bush administration, what I do NOT like is that they are even MORE in bed with the pharmaceuticals and the diet industry than are the Democrats. I guess they really believe in this stuff because the President with a healthy cholesterol level of 170 is , believe it or not, exposing himself to muscle weakness risks and cancer risks by taking one of the statin drugs.

There are two problems with the childhood obesity "epidemic". Judging on 2 large survey studies (you know how accurate epidemiological survey studies are.... NOT), the CDC came up with the following:

According to the Centers for Disease Control and Prevention, data from two National Health and Nutrition Examination Surveys (NHANES) (1976-1980 and 2003-2004) show that prevalence of childhood overweight is increasing. For children aged 2-5 years, the prevalence increased from 5.0 percent to 13.9 percent; for those aged 6-11 years, prevalence increased from 6.5 percent to 18.8 percent; and for those aged 12-19 years, prevalence increased from 5.0 percent to 17.4 percent.

Well that's all well and good but even the worse stats such as those for those kids aged 12-19 years old put "obese" kids at a MINORITY. 19 percent obese means that 81 percent of the kids ARE NOT obese.

The other problem is, of course, that the BMI scale, an outdated inaccurate scale which was invented in the 1850's which does NOT take into consideration, muscle, gender or bone mass, puts many who are NOT obese into the "obese" area...

Finally when we think of "obese" we think of those very large kids like "the Maury Show" features from time to time (you know the ones they put in diapers and give donuts to before they show them on TV and berate the parents for "childhood abuse"?). But "obese" is medically defined as any BMI over 30.

For example, some very slim but muscular Hollywood stars and many Olympic athletes are also classified as "obese" (including the governor of California).

So no one is really sure whether those "classified" as "obese" by weight are really obese or just very muscular and/or big boned.

In any case, by any measurement, the majority of kids ARE NOT OBESE. Has anyone asked the question, why start a weight based initiative when MOST of the kids are not obese?

What this is ESSENTIALLY doing is making ALL kids including the non obese ones, utterly paranoid about BECOMING obese. Disturbing reports from the UK and Australia, both of which have stressed weight based initiatives against "childhood obesity" stated that a raising percentage of kids 12 and up are dieting, vomiting, starting smoking and doing other unhealthy things to avoid the "dreaded" obesity because the bottom line is that any kid who has a "normal" BMI will be accepted as living a healthy lifestyle REGARDLESS of how that "normal" BMI was attained.

One of the kids on a "National Body Challenge show" who was very slim asked their nutritionist why HE had to eat the "healthy food" because he wasn't fat. I have met several people who feel that they don't have to eat healthy because they are not fat therefore they assume they are healthy. Also several people who smoke who feel they are healthy because they are not fat regardless of the fact that smoking is directly associated with 400,000 deaths a year and 95 percent of chronic lung disease.

When I was a kid, they were hung up on the one number classification of IQ. Despite the many drawbacks of IQ tests and the numerous talents they do NOT test (IQ scales were never meant to be a one number fits all), children were judged and branded by their IQ number and many children were emotionally scarred for life because of this judgment. Now the one number gauge of worth is BMI.

So have these initiatives inspired kids to exercise or eat more veggies and eschew fast foods, potato chips, French fries and the like? NO WAY! Kids are MORE sedentary today than ever, they fill up on junk food and fast food and avoid good food.

So if we THINK we are giving kids the message they ought to live eat more healthy and exercise more, we are badly mistaken. The message we are giving kids is as long as they are slim, they can be as sedentary as they want and stuff junk food all day and all is ok.

Meanwhile, we are seeing outbreaks of childhood diseases which were only a memory in my day, like whooping cough, among vaccinated kids, and even things like cancer and sudden heart attack are on the rise in our kids. Maybe, just maybe, a factor in this might be that they are undernourished for fear of "obesity" (which 81 percent or more never had to worry about anyway)?

One wonders if society will ever learn to use their brains. Or are THOSE brains getting starved out also?