SueW is a medical researcher, author, violinist and web geek, and grandma to four grandkids and great grandma to Taylor Christina! Visit her blog.
A long term study on weight loss surgery (bariatric surgery or WLS) found no reduction in health care costs on the long term. The study was reported on, in a recent issue of JAMA Surgery (2013). The researchers found higher health care costs in the long term with surgery than with treating obesity, medically.
This is nothing new, of course.
Wrote the researchers in JAMA (Journal of the American Medical Assn) in 2003 that Short term results of surgery are impressive... BUT
"...long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."
This has not changed and yet they are still doing 200,000 of these surgeries a year on people who are desperate and frightened by scare tactics about obesity which are, in NO WAY, supported by studies.
On the contrary, studies have found no direct link between obesity along and morbidity!
And this was the shocking findings of Glenn Gaesser, a slim exercise physiologist who examined 20 years of "obesity studies" but his findings and the findings of many others, have been all but ignored by the mass media, anxious to sell diets and surgery for obesity using scare tactics. Gaesser wrote his results in his book, BIG FAT LIES, a must read for everyone!
The findings of the 2013 study may be because WLS adds health care issues which may be as bad or worse than what it sometimes cures. Additionally, if the patients do not diet and exercise after surgery, they regain the weight in which case they now have the health issues associated with rearranging or interfering with major digestive organs in addition to obesity.
The Association of Bariatric Surgeons (WLS surgeons) had not much in the way of comment other than suggesting not all things may have been taken in consideration or - what I call um...questionable to be polite - that most of the procedures in the study were done open (with a large incision) rather than laparoscopically (using "keyhole" surgery).
What they hope we forget is that first of all, with keyhole surgery, surgeons cannot see as well as they can with open procedures because they are operating with a 2 dimensional view rather than a 3 dimensional view as in open surgery. So on the gastric bypass - and those complex surgeries which rearrange digestive organs, open procedures are less troublesome in the long term - the only advantage of lap surgery is the immediate healing of the incision. This would not have affected the long term results of any study or would have caused the long term results to show more favorably because most of the procedures were performed open.
And second, this type of result has been found in every long term study done on weight loss (bariatric) surgery.
Bottom line - surgery is not effective in maintaining weight loss in patients unless they diet (i.e. count their calories or restrict food in some other way) and exercise. But those behaviors will take weight off without surgery and without all the complications and long term repercussions of surgery.
Al Roker, a gastric bypass patient, told the "Today Show" that in order to keep off his weight, he not only journals his food and counts his calories every day but he also runs 5 miles several times a week!
With regards to the latest study, a weight loss surgery surgeon, Dr Livingston (who when, last I spoke with him, is proudly not a member of the ASBMS), commented:
"Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive. In this era of tight finances and inevitable rationing of healthcare resources, bariatric surgery should be viewed as an expensive resource that can help some patients."
"Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success."
It's sad that they are only questioning these procedures on the basis of cost, money-wise because the cost to patients who suffer complications, lack of weight loss or worse, is so much greater.
The patient pictured above had an uncomplicated surgery and lost a lot of her weight but was regaining by the time the photo was taken in 2007. She died of a heart attack in 2009. The increasing number of early deaths on the long term from these procedures are never mentioned in the Medical Journals.
One lady in her 50's who is very overweight, has stated that she has outlived 48 of her fat friends who had weight loss surgery! Caveat Emptor - let the buyer beware - yes even in medicine.
When they advertise weight loss surgery by giving case histories, there is a small (well, maybe not so small) problem. Many patients die from the surgery which is supposed to induce an artificial case of anorexia so the patient either cannot eat much or as in the more invasive procedures like gastric bypass, cannot eat much and doesn't digest much of what they do eat.
One patient who had been followed since being featured on the first show in 2010, was a Haitian lady named Dominique Lanoise. Lanoise weighed in the 600 lbs range and was bed bound. From what is known about her, she was slim when younger and ended up having 6 children - she apparently gained after pregnancy.
She was a charming lady, who though bedbound, would sway to the music in her bed. The documentary showed her eating large amounts of food, rejecting the diet food (they put her on a 700 calorie diet in order to reduce her for surgery) and kidding with her daughters who adored their mother.
Dominique was convinced that a gastric bypass would save her life and be a quick fix for her obesity problems which she felt was out of her control, so she searched until she found a surgeon willing to operate on her, at her current weight.
She lost weight after surgery and was transferred to a rehab facility but two weeks later, she checked herself out and returned home. A couple of months later, she died, apparently from a heart attack which WLS afficionados assured us was "unrelated" to the surgery.
However, the nutrient shortage from the gastric bypass can raise the risk for heart attack significantly, because the heart is starved from essential nutrients, including protein. That seems the "elephant in the room" when one researches Dominque's story - certainly those providing weight loss surgery do not want to admit that this "life saving surgery" actually hastened her to an early death.
Another TLC patient, Donald, also had weight loss surgery. He was also around 600 or 700 lbs. Donald did try to move after surgery and do what the doctors told him to do. Patients are told that unless they make lifestyle changes (like dieting, counting calories and exercise), the surgery will not work for them. Ironically, those same changes will work for weight loss without invasive surgery.
But then, suddenly and mysteriously, Donald went into a coma and emerged with Guillan Barre or "French Polio" - which put him into a wheelchair. Disease after gastric bypass is common but again providers tell us it's unrelated to denying the body of proteins, fats and vitamins. Last seen, Donald was getting around in a wheelchair and rapidly regaining weight although trying to exercise it off - another myth one sees on TV - exercise doesn't take much weight off us - how well I know about that one. It does make us healthier but it's not really good for weight loss.
That some are still selling a surgery which hasn't been done for years on non obese patients, a surgery which the inventor thereof dropped in 1980 because of the high complication rate, truly amazes me.
There seems a conspiracy of silence among patients as well as providers. Patients who regain and live, are reluctant to tell about their surgeries because both the public and their doctors blame them for their gain. Patients who have become ill from the surgery and live long enough to be reversed and get back normal digestion, are often reluctant to talk about their bad experiences because new ops and providers can get mean to those who talk too negatively about weight loss surgery.
Patients are so sold on this surgery that until they get really ill, they refuse to admit that it has a high complication rate and a higher recidivism rate. When I began to research it in 1999, I was shocked that many studies were on line and told the truth openly, but patients were not reading the studies and only listening to new ops who were excited and seemingly successful. Even successful patients who have suffered difficult complications and talk about them in blogs, have taken a lot of criticism from "the community".
So people continue to jump on the table for a surgery which sounds like the ultimate cure because many do not encounter the "other side", i.e. the dark side especially if they do not have internet access or know where to look.
Informed consent information on all surgeries can be found at:
In conclusion, a friend of mine who weighs over 500 lbs but has refused weight loss surgery, says she's outlived 48 of her friends who had weight loss surgery.
Another weight loss surgery? Oh, excuse me this is "not surgery" say those advocating it.
(Hubby says it looks like a condom for your guts!) :)
Of course it is surgery but there is no incision. That's what they mean by "not surgery". It's stuffed into your mouth, down your esophagus through the lower stomach valve and into the first couple of feet of your small bowel. What it does is prevent a lot of food from being absorbed.
Unlike the good providers who are pushing it say, it does NOT prevent sugar from being absorbed because sugar is mostly absorbed through the mouth and upper part of the stomach. They hope the prospective customer is (a) desperate to lose weight and (b) doesn't know much about the GI tract.
What is prevented from being absorbed is the good stuff, the proteins and fats (yes, you do need some fats to lubricate) but sugar? Absorbs just fine. So much for the resolution of diabetes which is not happening with this device.
If you think you've heard it all, there is more. 100 % of folks who had the "Endo Barrier" implanted, got at least one negative complication.
These can include bowel obstruction or nausea/vomiting or pain, and bleeding. You can also get a fever and "device migration" which means the long plastic tube they inserted, moves down through the GI tract. That might mean an invasive surgery to remove it since your small bowel is some 22 feet long and the lower parts of it are hard to get to. Not nice experience.
The providers admit this is a temporary device and you know what that means - as observed in Australia and places where they are inserting some of these, people tend to regain the lost weight.
So don't let the excited providers, giving a rosy picture of the endo barrier (which they are calling the "gastrointestinal liner") influence you. Likely this device is far more trouble than other procedures and not really effective in the long run.
The new study published in the JAMA of September 19, 2012 (
First of all, the mean BMI of the surgical group was 45. However, the average BMI of the gastric bypass patient is over 50.
At the 6 year point, continue the researchers, 76% of the gastric bypass patients had maintained a weight loss of at least 20% (this was erroneously reported by the news services as 28%). Apparently the 27.7% reported by the news service, actually referred to the weight initially lost and not that maintained!
Doing the math, the average patient, 5'5" likely weighed 270 (BMI 45). If they maintained a weight loss of 20%, they maintained a loss of 54 lbs leaving their weight at 216 and a BMI of 35 i.e. still clinically obese and if they are diabetic, still qualified for weight loss surgery!
And for this modest maintenance, they take the chances of the long term repercussions of severe vitamin deficiencies, including the B complex vitamins which can cause many symptoms from seizures to mental fog and gastro paresis (paralysis of the stomach), leaky bowel, lessened immunity, micro-nutrient shortages (zinc etc) and a host of other issues.
Doing the math on this doesn't make any sense, does it? Of course, the news services and some providers hope you won't do the math!
Best if you want to have weight loss surgery, to choose a less invasive option but it should be noted that weight loss surgery patients do the same work that non surgical patients do, to keep off the weight. That is, if they do not diet and exercise, they will regain the weight, regardless of how invasive the surgery. Al Roker, a gastric bypass patient, started to regain and told the "Today Show" folks that he not only runs several days a week but also counts his calories every day to keep off his weight. That behavior will keep off weight without any weight loss surgery.
The whole idea of weight loss surgery, how it is sold is, that it will make you normal and you can eat whatever you want and never have a weight problem again. At seminars, they often, parade 2 year (and more recent) post ops who are success stories but the small print on every surgeon's web site and in the consent forms, says you have to diet and exercise to keep off any weight at all. And if you have to diet and exercise, you can do that without surgery!
If it's too good to be true - it probably isn't.
Dr Phil, on a re-run show, aired again this past week, recently featured a lady who had just been named "the World's Heaviest Woman" in the Guiness Book of World Records. She weighs over 700 lbs.
The show was the usual anti obesity show and how this lady, Pauline Potter, was going to die soon and how Dr Phil was going to intervene like the knight in shining armor he feels he is.
The problem with the show was, it was very incorrect in the information given. I understand that reality TV is often not very real but seems that a show like Dr Phil should keep more integrity than that.
Apparently, according to Pauline's own website, she celebrated getting to over 700 lbs and sold videos of her moving around etc on this website. There is no indicator that she's not still selling these!
Also, the show first aired in November 2011 and Pauline and husband claimed they were divorced however, an article in late 2011, mentioned they'd gotten back together again, their love rekindled in L.A. in 2010. Dr Phil had asked on the show if they had problems with intimacy and Pauline said they did not, but in two articles, the ex or now- non ex, admitted that they were afraid to have intercourse because they might break the bed.
Pauline told a couple of reporters she planned to lose 200 lbs in early 2012 because she and her ex - non ex husband wanted to have a child together (she has an older son from another marriage).
And Pauline, who weighed around 643 lbs when she appeared on Dr Phil, weighed over 700 lbs in Jan 2012 so the food Dr Phil had sent her had not appeared to help with her weight loss.
The strangest thing on the show was that Dr Phil introduced a Dr Ted Khalili as a "world renown weight loss expert" and offered Pauline, Dr Khalili's and his office dietician's help in her weight loss. What no one mentioned was that Dr Khalili is a weight loss surgery surgeon in L.A. Pauline did mention in one article that she planned weight loss surgery but this was never mentioned on the Dr Phil show.
And strangest of all, is that the last mention of Pauline I can find is in Feb 2012. Did she die from the weight loss surgery like the poor "Half Ton Mom" did? Did she stay at her present weight or close to it? If anyone has heard where Pauline is recently, do let me know. I very much, hope things went OK for her but having seen so many negative results from weight loss surgery, I cannot help wondering how she is now, especially that I cannot find any recent mention of her on the internet. Also, in the cases of the very obese I've seen, weight loss surgery has not helped them. Often, they ended up gaining a lot of weight back - for example Allen from "Big Medicine" never did get out of his bed or worse yet, the weight loss surgery patients who started out very large, did not live like the "Half Ton Mum" of TLC who died 2 weeks after her gastric bypass.
All this to remind us that TV is for entertainment only - we should really hesitate to believe anything we hear on TV even from a source who seems so reliable, like Dr Phil.
The following is from my notes watching a program called "The Real Skinny" on TLC. (The Real Skinny, program on gastric bypass patients and loose skin on "Discovery Health".)
"after all my hard work, after all the foods I've cut from my diet, I still have to deal with my excess skin... If I have to live like this all my life, I'd rather be fat again. " (male gastric bypass patient)
Dr Katzen has done many loose skin surgeries on gastric bypass patients.. His comments about operating on gastric bypass patients echo what many many other surgeons have said about it. Though being fat is thought to be very unhealthy, the fragility of these weight loss surgery patients raises the question that having a surgery which depletes the body of nutrients might be much more unhealthy that is, the cure seems to be, in some cases, worse than the "disease".
"A lot of surgeons are afraid of these plastic surgeries for a multitude of reasons...these surgeries are very risky surgeries ... I'm taking off a lot of skin, a lot of fat..."
"These patients are higher risk just because of their gastric bypass: they are typically malnourished... Just the fact that you've had gastric bypass increases the risk of bleeding, infection, and wound separation. For a circumferential body lift, I use 1000 to 1500 stitches...these surgeries typically take 8 hours... We pretty literally cut them in half and put them back together." --- Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA
Carnie Wilson, who admitted to have regained up to 250 lbs, 12 years after her gastric bypass surgery, was, none the less, much more fragile, healthwise than she was before surgery. She said she was pre-diabetic and more. It took her 4 weeks to recuperate after her lap band surgery...whereas her recuperation after a much more invasive surgery, gastric bypass, was much faster. That is, she was much more healthy going into her gastric bypass despite weighing almost 300 lbs, (she's 5'1") than when she was when she went into her lap band surgery. The difference was even though she weighed 40 lbs less than she did when she had the bypass, she had been not absorbing many vitamins and nutrients for 12 years.
When my DH had a brain bleed from taking the daily aspirin, there was another lady in the ICU - she had been over 300 lbs before her gastric bypass...her husband told me, tearfully, she was so frail now. She did not survive.
Back to the show, Dr Katzen was shown doing a loose skin surgery on a male patient.
On this patient he did thighs and a circumferential lower body lift. There was a lot of fat left...
"we put him together with a type of super glue...the problem is too much super glue...the drain sucks out the fluid and allows the body to stick together."
"These patients usually exercise a lot to try and get rid of the loose skin but exercise alone won't get rid of the loose skin. That's where I come in."
Dr J. Timothy Katzen, MD plastic surgeon, Los Angeles, CA
There is a lot of pain after these plastic surgeries for a few weeks after. "It's taking a lot longer to recover than I thought it would.". Four weeks after the surgery, the male patient was still not healed. He had a hole in his body about the size of an egg. "I felt wetness and my incision had opened up.", he told the camera crew. He had developed a staph infection in his open wound.
"we can't stitch up the open wound because if there is one germ left in there, they can develop a huge infection i.e. sepsis". Sepsis is a general body-wide infection from which there is a poor survival rate. This patient's relationship with his girl friend was strained, he said, and at filming they were hardly talking to each other. He had a wound vac to suction out the hole.
It took him 6 weeks to heal and he still needed another surgery.
"my friends ask me why I want to go ahead with another surgery when I suffered all those complications, infections etc but I want to finish the job.", he explained.
Both patients have a huge scar which goes all around their bodies.
Note: part of Carnie Wilson's reasoning for having the "band over bypass" surgery is that she's got a job as a spokesperson for Allergan which manufactures the lap band.
The providers have nothing to lose. If the patient regains the weight or gets sick, they blame it on the patient...or quote statistics which suggest this type of reaction is very rare. And if the patient lives and regains, the surgery is no longer mentioned. If the patient dies or becomes very ill, the providers often make the patient afraid to speak out.
"I bury my mistakes" one gastric bypass surgeon joked to me.
In this surgery as in all commodities, it's a case of buyer beware.
"Wilson Phillips Still Hanging on" show on the TV Guide network
A frenzy of people signed up for gastric bypass surgeries. One person who worked for a weight loss surgery surgeon, told the news that every time Carnie Wilson appeared on TV, their phones rang off the hook! The surgical group who did Carnie's surgery, dramatically simulcasting on the internet during her surgery and launching a huge publicity campaign in partnership with the manufacturer of surgical instruments, went from doing 5-7 weight loss surgery procedures a week to doing 12 weight loss surgery procedures a week. The future looked rosy, for Carnie and the Weight Loss surgery industry.
But dark clouds were gathering on the horizon.
Soon after Carnie Wilson's famous quote to the press above, she began regaining the weight, despite fighting hard to keep her weight off, including, hours of exercise, engaging personal trainers, putting salt on desserts so she wouldn't be tempted and publicly humiliating herself, talking about her weight problem. By 2011 when she appeared on the Dr Oz show, she'd regained to her average weight before surgery, about 240 which is a lot for her since she's only 5'1".
Apparently, she lately, had a gastric band placed over her bypass to force a restriction of her food intake, and has lost 30 lbs so far.
The bottom line is the gastric bypass or any weight loss surgery, is no free ride. Just like using a non surgical tool like weight watchers, it's a lot of work on a daily basis for the rest of your life or you will regain the weight and/or get sick! A percentage of gastric bypass patients get sick anyway, even if they do everything right.
Carnie Wilson, like so many others, was given the impression surgery worked automatically and easily.
That so many people embark on weight loss surgery seemingly ill prepared for the reality, can be at least, partially blamed on allowing the mass advertising of surgery without requiring the advertiser to list side effects and disclaimers like "results not typical". Some weight loss surgery surgeons have an annual income of $1.5 million dollars - people have done strange things for much less money than that.
Let's hope the second weight loss surgery procedure will bring her what she's looking for. She's such a beautiful woman and a great singer and somehow all of that tends to get lost in her frantic efforts to get slimmer. To me, that is sad.
Click on this blog link to see photos and story.
In case you haven't heard by now, Dr Oz on Monday, January 23, had a segment about the gastric bypass surgery for weight loss, touting the invasive procedure as a "miraculous cure" for diabetes and hypertension.
In his opening statement, Dr Oz asked, "What if I told you there was miracle that helps you lose weight, lower your risk of cancer and heart disease and most shocking of all, reverse your type II diabetes overnight?"
Other than the fact that the gastric bypass strains the heart rather than protects the heart (as does any type of invasive surgery), it's interesting to note that the show segment following this rather dramatic announcement, did not mention cancer at all!
The problem with the show is that Dr Oz "forgot" to tell any of the risks of this surgery, which is being done less and less due to the availability of safer options like the lap band which do not call for the surgical dissection of the stomach nor the bypassing of any of the small bowel.
Dr Oz detailed one risk - the fact that patients might regain the weight, but he assured the audience that if patients did what their doctors expected, this would not happen and he emphasized the quick weight loss after surgery, without a reminder that most patients only retain less than 50% of the initial weight loss unless they work very hard at dieting and exercising, two things which will cause weight loss without outdated, risky surgery.
Butch Rosser, a surgeon who recently joined the "gold rush" of weight loss surgery, was also a guest on the show. Rosser had a gastric bypass 3 years ago and has not yet, experienced any repercussions - at least, none that he wanted to talk about on the show.
One of many things which concerned me, was that several things were misrepresented on the show. For example, Dr Oz stated that the gastric bypass was invented in the 1970's - not true - it was invented in 1965 by Dr Edward Mason, who stopped doing his own surgery in 1980 after he found most of his patients to be suffering from severe osteoporosis and more. Mason wrote prolifically about the problem of "metabolic bone disease" in gastric bypass patients but unfortunately, only in medical journals - not in places most prospective patients would visit.
Dr Oz also gave the impression that the gastric bypass was not invasive as far as disturbing digestion, reiterating the myth that the food meets the digestive juices lower in the small bowel. In truth, the bypassed stomach does not produce a lot of acid and when it does, it gets rid of it quickly - since no food in the stomach is how our bodies tell the stomach to release the acid. What acid there is, is more likely to cause an ulcer in the small bowel than to digest food. Also the small bowel does not have the protective qualities of the stomach against the acid erosion and it is unknown whether without the presence of food, the duodenum or first section of the small bowel, also bypassed in the gastric bypass, will neutralize the acid released by the stomach as it does in normal digestion.
All this led Dr Mason to write about the disturbances in digestion the gastric bypass causes:
"I would like to see greater use of simple restriction procedures that do not rearrange these finely balanced mechanisms." U of I Healthcare news
So why did Dr Oz so ardently "sell" the gastric bypass (and bypass the more modern procedures which are also safer like the lap band)?
One can only speculate about this - obviously somewhere along the line, there might have been money changing hands - the misrepresentation of facts can usually be traced to the "money trail". Also, less and less people are opting for the gastric bypass which might be leaving some weight loss surgery surgeons in the need to learn new surgeries, a process no one enjoys.
Whatever the case, it was using television and a lot of misrepresentation to hard sell surgery which is, at the least, ethically challenged.
From the patient and other reactions I've heard, Dr Oz lost some fans after this show segment - people are not quite as naiive about these weight loss surgery procedures as he seems to think they are. One individual wrote me that they had always felt Dr Oz was awesome but after they'd seen this segment on the gastric bypass, they were totally disallusioned with Dr Oz.
And as for Butch Rosser, MD, the gastric bypass surgeon - come lately; when and if he gets longer term repercussions, will he appear on a TV show to tell about this? No bets.
Obesity might cause inflammation in the brain, shouts out the latest headliner coming out of the NPR News.
According to the NPR article:
...some provocative research suggests that a part of the problem might be that obesity could change the area of the brain that helps control appetite and body weight.
The study was published in the Journal of Clinical Investigation and since my trust of media reporting on studies is about zero, I decided to look up the original study to see what it really found.
Not surprising, the study report article differed completely from the news article.
In this study, the researchers found that when rats were fed a diet high in fatty foods, even before they became overweight, there was evidence of inflammation in the rat hypothalamus gland, a gland in the brain which is thought to regulate body temperature and metabolism.
The scientists wondered whether humans reacted similarly, so they MRI-ed the brains of 34 humans and found more evidence of damage to the hypothalamus in the 12 humans who were obese than in those humans of normal weight.
Michael Schwartz, one of the researchers on this rat study was very shocked at the results, he told NPR. Schwartz is the head of the Obesity and Diabetes Center of Excellence at the UW School of Medicine.
I do see some possible issues in the study such as, can it be assumed that normal weight humans did not consume as much fatty food as obese humans?
But unlike the media, the scientists commented that this damage may be a factor in developing obesity and not that obesity caused damage as the NPR article stated. The scientists named their article, "Obesity is associated with hypothalamic damage". The media in their typical fashion of misreporting, headlined their article "Could Obesity Change the brain?".
Actually, I am not surprised that the hypothalamus glands of some overweight people might be damaged but of course, the study never stated that the obesity proceeded the damage - either in the rat study or in the human study.
Interestingly, this study may dovetail another recent study which found that a rather alarming percentage of people developed obesity after their tonsillectomies (which may be due to hypothalamic damage). The scientists in that study stated they did not know what caused this but suggested it might be that swollen tonsils caused difficulty in swallowing before they were surgically removed. I was one of those who packed on the pounds after my tonsillectomy and no, I had no difficulty in swallowing before that surgery! I also was very active, spending most of the day, running around, riding my bicycle etc. However, I was more hungry after my tonsillectomy which could be the effects of a damaged hypothalamus.
The study at the UW seems a landmark study, the first which suggests that damage to the hypothalamus might be a factor in obesity, which is a pretty shocking result as Dr Schwartz suggested however, with the media misreporting the study to something totally different, the public may never know what the real study found!
Obviously, the rat brain is quite different from the human brain. And the scientists admitted they cannot really generalize from how the rats reacted, that humans would react in the same manner but they did suggest more research along this line would be appropriate.
As an aside, it would be nice if, for once, the media would consider accurately reporting about the scientific research instead of totally changing what the study was even about. (the photo is of the Olympic weight lifter and medalist, Cheryl Haworth)
Does anyone remember the professor/researcher at Harvard Medical School, Dr Frank Hu, who came up with the conclusion that if a person was overweight, exercise did not help them at all?
In 2005, Frank Hu and JoAnn Manson (Harvard) published a study in the JAMA "proving" that an overweight person cannot be physically fit even if they regularly exercise.
This was an epidemiological study (notoriously inaccurate) but it hit the news in a big way. Not surprising since the news thrives on this sort of headline.
Dr Hu and associates have again hit the news with a study which will be published in the "American Journal of Clinical Nutrition".
This study concludes that if you eat red meat at all and especially hot dogs, you have a significantly higher risk of developing diabetes. (the risk factors quoted in the news range from 21% greater risk to 50 percent greater risk).
If we get picky about things, there is a big difference between lean steak and a hot dog but no real proof that either, eaten in moderation will be our demise.
As is with all epidemiological studies, the numbers of the cohort are impressive but we must remember that not enough information was collected specifically for this study. That is, you can prove pretty much anything with an epidemiological study done with an existing cohort - even likely prove that as much as eating a hot dog can raise the risk for diabetes so can that risk be increased by riding a bicycle (assuredly most in the cohort have done both!) :)
But making headlines is what researchers want to do because it assures them of continued funding and the news doesn't want to see what science really comes up with i.e. possibilities that this or that might be true but rather foregone conclusions.
"Scientists", reminds Dr Roy Spencer, PhD and author of "CLIMATE CONFUSION", "are human too", doing what is necessary to obtain funding. Coming up with an attention getting headline is a good way of assuring continued financing for other studies.
The problem is, that some folks perhaps, take studies like this seriously, which isn't a good idea. Rather, it's best to smile and move on and eat our hot dogs and red meat with no worries. Dr Hu's study proves nothing except he likes to get paid, and coming up with a sensational news story is a good way to do that.
In case you haven't heard of the Obesity Action Coalition, they are a group determined to rid the world of obesity by way of weight loss surgery. Recently they had a conference which was at least in part, underwritten by Ethicon Endo which manufactures lap (gastric) bands and also surgical instruments for doing gastric bypass. And by at least one of the conferences which is online, it appears they are definitely selling the surgery.
Which of course, is their right. But what I felt compelled to blog about is, while reading through the transcript on line in an easily readable form thanks to "Melting Mama", it struck me how one bariatric surgeon, Dr Stegemann of Texas, appeared to give some misleading answers.
Here are the ones which jumped out at me (there may be others):
Question: "I have high blood pressure and diabetes this runs in my family, can this surgery really help me..."
Dr Stegemann answered "Absolutely. Significant weight loss improves many of the medical problems that come along with carrying extra weight!"
There is some evidence that weight loss can help health but equal evidence that it's lifestyle which is the key and not what you weigh. However, what he didn't say is, there is no evidence that doing something unhealthy or risky to lose weight improves health. And plenty of evidence to the contrary. And the questioner asked about surgery specifically and not generally about weight loss.
When asked which surgical option is the safest, Dr Stegemann's answer was very evasive and very non informative.
He began by saying that all surgery has risks. (no brainer) And then, went on to say that the risks of "most" bariatric surgery operations is similar to gall bladder surgery. While that has been said to be true of the lap band, it is not true of any of the other surgeries. The risks of the gastric bypass surgery have been compared (by the Fresno Hospitals for one) to open heart surgery.
The commentator of the session saw that Dr S had not really answered the lady's question about which option is the safest so he asked the doctor to be more specific.
But the good doctor again appeared to evade (as he did later in the session when someone asked a similar question). He responded by saying: "The most common weight loss surgeries done in the US would be the adjustable gastric band, gastric bypass, and sleeve gastrectomy."
Notice he still never gave the risks of each procedure which was the original question. The moderator gave up and went on.
The next question was asking how it feels to have a lap band.
Dr S's answer is worth quoting:
"The band works by controlling hunger and controlling the amount of food you're able to eat. So, you'll be able to eat the same foods, but smaller amounts will make you feel satisfied."
There is no evidence that putting a band around the top of your stomach does anything to the appetite unless of course the idea of it growing into your stomach (which happens in a number of cases) scares you and you lose your appetite that way.
Also it doesn't control the amount of food either - it just makes it uncomfortable to eat healthy foods like meat, vegetables and fruit. Cake, milkshakes and cookies slip right down and you can eat any amount of these comfortably. (and many patients do).
And there is no evidence that with a band or even a gastric bypass, smaller amounts of food make you satisfied. With the gastric bypass, you spend a long time healing and during that time, just like when you recuperate from any major surgery, you might have less appetite especially as your digestive system has been very rearranged, but after that healing process which may take as long as a year or a few months, the appetite returns (in most patients unless they become seriously ill) with a vengeance. At least one clinical study found that in many gastric bypass patients, the blood sugar levels are "irratic" and many patients experienced "voracious" hunger a couple of months after surgery. (Roslin - who is a bariatric surgeon -Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.)
Dr S went on:
"If you overeat, then you generally feel pain in your chest, usually followed by vomiting."
It really depends on what food you overeat. Mostly, the pain after eating comes from a piece of food like meat, getting stuck and not going down right. The pain part is correct. I've seen it in band patients (also happens in gastric bypass patients). But patients aren't always able to vomit since the bottom of the stomach which pushes the food up is far away from the "stuck" food (and the muscular pylorus - lower stomach valve- which causes vomiting, is totally missing in gastric bypass patients). Usually band patients and gastric bypass patients endure a couple of hours of intense pain before the stuck piece either goes down or comes up. Occasionally a 'scope is required to fix things. Can be scary, can be nasty and is very likely to happen with a piece of badly chewed steak. You can fill up on cake and milkshakes and potatoes all day with no repercussions.
It is true however, if gastric bypass patients overfill the tiny stomach pouch, they will upchuck, often without notice. Again it's not really vomiting because there is no warning or sickness before. The food just comes up. Many learn the feeling and run to the bathroom. But most gastric bypass patients can tell tales about the "barf bags" they carry in the car or upchucking at a restaurant table.
Fooling with such a complex system as the digestive system has a very dark side.
The next question was about the gastric sleeve, a procedure in which 85-90% of the stomach is stapled off and removed from the body.
Dr S admitted there is no long term data about the safety or efficacy of this procedure but said since other stomach surgeries are safe and short term data on weight loss looks good, this surgery is likely safe and effective.
However, Dr Robert Davis of the "Big Medicine" TV show, admitted that the weight loss data with the sleeve had been poor and that's why they had to go to removing so much of the stomach. The recalcitrant stomachs tend to stretch out apparently.
So bottom line, there is no information available about whether this procedure is either safe or effective. There are many things digested in the stomach and from the information we have about the duodenal switch, Dr Hess, the inventor, stated that it was to significantly cut down stomach acid (and reflux) that they went to removing most of the stomach but without enough stomach acid, most of the stomach produced enzymes will not work either (see "digestion" in any Anatomy and Physiology book).
Then Dr S states that "After a gastric bypass, approximately 85% of patients are able to maintain at least 50% excess weight loss long term."
First keep in mind the average weight loss surgery patient is looking to lose 100 lbs so the doctor is saying here that most patients can keep off 50 lbs with a gastric bypass - but is 50 lbs worth the surgical changes to the digestive tract and lifetime vitamin deficiencies? Most folks can keep off 30 lbs with no surgery!
Second, many studies I've seen do not show this high a percentage of patients even keeping off 50% of the excess weight. Some of the studies by bariatric surgeons can be misleading because obviously those who regain (many patients!) do not report in and are listed as M.I.A. and not tallied in the statistics. More likely this statistic is 85% of those who reported back to the doctor can ...
Finally, there is the doctor's statement that: "Studies show that in 80-85% of people who undergo gastric bypass, their Type 2 diabetes resolved."
Studies on TWO YEAR POST OPS found this. However, the one longer term study (10 year post ops) found that only 35% of diabetics remained disease free (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).
There is a lot of good information about repercussions, side effects, post op care etc in this speech so it's worth reading - just watch out for the affore mentioned statements - as they are misleading.
Every so often someone sends me an email, entitled "The People of Walmart". Apparently, these are supposed to be uproariously funny. The people pictured are real people and the folks who like these emails, tell me that these people are dressed in - shall we say - less than fashionable outfits and that they "should know better" (and thus, deserve to be ridiculed?). Which isn't true of the greeter above, by the way, who simply is wearing the Walmart uniform.
It is assumed, I guess, that none of these people have computers and thus will never see the emails ridiculing them. However, today, more and more folks do have computers and so if they see photos of themselves in an email with comments like "I can't stop laughing at this", would they be very hurt? I suspect they might and if the world is hurtful enough, why take the chance of hurting someone more than life might have hurt them previously?
And we must ask, does anyone "deserve" to be ridiculed, regardless of what they wear, how old they are or the size of their bodies?
What really bothers me about these mails is the underlying "elephant in the room" which no one wants to mention, and that is that although I'm certain that outlandish clothing is worn by people of all sizes and ages, the only individuals who get pictured in the "People of Walmart" emails, are overweight and/or elderly.
So what are we saying with this email - that people of size or over a certain age, should be "open season" for ridicule? And since many of those who have sent those emails would fall into both those categories (elderly and overweight), are they laughing at their fellow humans in an effect to say "well, look how bad these people look - I know *I* don't look that bad!"?
By laughing at the "people of Walmart" , we seem to be not only reinforcing our negative feelings about our own looks or girth but letting those around us know, it's "ok" to ridicule the elderly and/or people of size. Whereas if we viewed these fellow humans, in the way emphasized in a recent EWTN "Catholic View for Women", looking for the inner beauty instead of judging them by their exterior, we might become more aware of our own inner beauty which is not contingent on having a size 0 figure or being 20 years old!
The other side of the "People of Walmart" emails and the prevalent attitudes about size, is that our children who should be nourishing well, in their developmental stages, are increasingly coming down with eating disorders and/or disordered eating, in a sad effect to avoid being like "the people of Walmart", an object of ridicule. The average 8 year old is already on a diet and restricting the very nutrition they need to grow strong and healthy!
I think we need to realize that these emails are not only hurtful to those who may be pictured in them and hurtful to some of those receiving the emails who wonder when they will be pictured but also, hurtful to the sender who is ridiculing fellow humans on the superficial basis of size and/or age.
Respect for all human beings will build respect for ourselves!
Malissa Jones of the UK first made the news in 2008 when she became the youngest person to have a gastric bypass in her country. At the time, she weighed over 400 lbs and by her own admission, had a taste for candy and not the greatest food choices. (She told the news, she's consumed 10 chocolate bars in a day!). Typical teenager but with her genetics this type of teen eating did not work. So she had become very obese. Malissa complained about being teased and bullied in school but she apparently had some health problems also. She had trouble breathing and when she was 15, she went to the ER with chest pains which is why the NHS decided to do a gastric bypass on her when she was 17 years old. Typically they don't do bariatric surgery on anyone younger than 18 years old
Her surgery did not initially go easily for her. She was in intensive care for 36 hours but she did survive and began to enjoy her honeymoon year.
In February 2009, she was again interviewed. In a blog which reprinted a news article, now no longer available, it was reported that she had lost over 200 lbs and said that this surgery had saved her life. She weighed around 196 lbs and took a size 14, a great improvement over the size 28 she used to take. She talked about night clubbing and discovering a whole new world. "I've had a lot more boyfriends because I feel much more attractive and confident.", she told the news reporter. She mentioned that she was saving up to have the loose skin removed in a private surgery (it was not covered by the NHS).
But sadly, Camelot wasn't going to last for her.
By December 2009, apparently been unable to save up for the $40K surgery she required (Lower body lift, tummy tuck etc) to remove 28 lbs of loose skin which remained after her quick weight loss, she was not a very happy camper. Life continued on a downward trend, when she became pregnant at the age of 20 but they had to take the baby prematurely because they feared that carrying fullterm might be too risky for Malissa. Henry, a little boy did not survive.
Malissa recently made the news again. She now has been diagnosed anorexic - she weighs only 112 lbs (she's 5'8") and is unable to eat more than 300 calories a day. The news stated she was afraid to eat but she said in addition to being terrified of regaining, she suffers pain and sick stomachs when she tries to eat more food.
There are a number of gastric bypass patients I've met like this - who are unable to eat a couple of years after surgery. This inability to eat is sometimes combined with a phobia of food in general as is the case with Malissa.
One might ask why NHS doesn't give her a reversal and perhaps they have done that, but a reversal won't help the fear of food she has developed since her surgery. Again the NHS is worried for her life. She's much too young to die but this time around there is no surgery which can save her life except intensive psychotherapy.
This is not as unusual a case as providers would like us to think it is. I've actually, met quite a few patients who suffer from something similar to Malissa.
And in a 2001 news article, clinical psychologist and eating disorders expert, JoAnn Mann,RN, told the Fresno Bee,
***"I've seen massive infection, I've seen people hospitalized for malnutrition. I've seen people obsessed with food. I've seen people unable to stop vomiting. I've seen people develop massive eating disorders, I've seen people who are terrified of gaining weight. Terrified. It runs their lives." ***
Dr Jen Berman,a Los Angeles psychotherapist and an expert on eating disorders, has counseled many gastric bypass patients over the years. She told the news media that some patients have developed eating disorders and are afraid that if they eat too much, they will be sick.
***"I have seen people become terrified of food. They feel like their body is out of their control because they lose the weight so fast. I have seen people develop terrible phobias of gaining weight or losing weight." (IBID)***
SO Malissa Jones isn't alone in her food fears, but her road back to health will be a long lonely one, and much harder to trod than it would be had she remained overweight.
Definitely a case (one of many) when the cure is far worse than the original disorder.
In a metastudy in Canada, researchers found that in initial weight loss, the intestinal bypass was the most effective and running close second was the DS/BPD (also a long limb intestinal bypass but with a greatly reduced stomach) and the minigastric bypass which has a greatly reduced stomach and a bypass of about half the small bowel.
Even bariatric surgeons admit that long intestinal bypasses are associated with liver and kidney failure on the long term.
So what is this saying... if you have a procedure which destroys your ability to digest vitamins and cripples one of the most important organ systems in your body, you might lose a lot of weight in the first year? You can do that with cancer also - without surgery even. :(
The last sentence is interesting - the lap banding was the least effective in initial weight loss but, they admitted, delivered the least amount of adverse repercussions. That being said, many lap banders have to have the bands removed after a few years because eventually, the constant rubbing of the band on the soft tissue of the stomach can partially destroy the stomach.
In the one study which was drawn out to 10 years post op, the Swedish Obesity Study, they found that the average BMI for all surgeries, was 35, still very obese. (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) Which seems to suggest that the more risky surgeries are not any more effective in the long run than the gastric banding which is a lot less risky but none of them are really effective. ("Success with weight loss surgery is 10% the surgery and 90% the patient" Dr Terry Simpson, MD and bariatric surgeon)
Another study found that within 10 years, 34% of those who started with a BMI higher than 50, had regained all or most of the weight. (Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD)
Bottom line, there is no shortcut and to keep the weight off everyone has to do the same thing - count calories, make mostly healthy food choices and exercise.
In the Hebrew University study they found that only 7% of gastric bypass patients could keep off all their excess weight (follow up was 6-9 years on 600 patients) and another video from a provider I recently watched, the bariatric surgeon stated that WLS of any kind does not take off all the excess weight and people should not expect to get "slim" from it.
About 5% of people who follow a program, non surgical can keep off all of their excess weight so with risky procedures which all damage the digestive tract, one only gets a 2% greater chance of keeping off all their excess weight unless they diet and exercise or unless the procedure makes a person unable to eat (cancer does that also).
I think maybe more folks should do the math. :(
Here's the abstract on that metastudy:
Obes Rev. 2011 Mar 28. doi: 10.1111/j.1467-789X.2011.00866.x. [Epub ahead of print] Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Padwal R, Klarenbach S, Wiebe N, Birch D, Karmali S, Manns B, Hazel M, Sharma AM, Tonelli M. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Department of Surgery, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, University of Calgary, Calgary, Alberta, Canada. The clinical efficacy and safety of bariatric surgery trials were systematically reviewed. MEDLINE, EMBASE, CENTRAL were searched to February 2009. A basic PubCrawler alert was run until March 2010. Trial registries, HTA websites and systematic reviews were searched. Manufacturers were contacted. Randomized trials comparing bariatric surgeries and/or standard care were selected. Evidence-based items potentially indicating risk of bias were assessed. Network meta-analysis was performed using Bayesian techniques. Of 1838 citations, 31 RCTs involving 2619 patients (mean age 30-48 y; mean BMI levels 42-58 kg/m(2) ) met eligibility criteria. As compared with standard care, differences in BMI levels from baseline at year 1 (15 trials; 1103 participants) were as follows: jejunoileal bypass [MD: -11.4 kg/m(2) ], mini-gastric bypass [-11.3 kg/m(2) ], biliopancreatic diversion [-11.2 kg/m(2) ], sleeve gastrectomy [-10.1 kg/m(2) ], Roux-en-Y gastric bypass [-9.0 kg/m(2) ], horizontal gastroplasty [-5.0 kg/m(2) ], vertical banded gastroplasty [-6.4 kg/m(2) ], and adjustable gastric banding [-2.4 kg/m(2) ]. Bariatric surgery appears efficacious compared to standard care in reducing BMI. Weight losses are greatest with diversionary procedures, intermediate with diversionary/restrictive procedures, and lowest with those that are purely restrictive. Compared with Roux-en-Y gastric bypass, adjustable gastric banding has lower weight loss efficacy, but also leads to fewer serious adverse effects.
PMID: 21438991 [PubMed - as supplied by publisher]
GlaxoSmithKline has announced it's dropping the OTC version of Orlistat i.e. Alli, a diet drug from those drugs they sell. Ironically this announcement came after a study found a link between this drug and kidney damage as well as several cases of pancreatitis (last year the FDA warned of a possibility of liver toxicity from Orlistat):
The study reporting adverse effects of kidney and pancreas damage in a percentage of those using Orlistat or Alli
Cite: Weir MA, Beyea MM, Gomes T, et al. Orlistat and acute kidney injury: An analysis of 953 patients. Arch Intern Med 2011; 171:703-704. Abstract
Interestingly enough, the news article in many news services including the NY Times, suggesting a "new breakthrough" in obesity drugs, appeared recently - cheerleading a drug which was not approved by the FDA - what's going on?
First of all, it's true that those on a combination of the drugs - topamax and phentermine (i.e. the "PHEN" of the somewhat risky potion - Phen-Fen) lost more weight than those on either one of those drugs or those on placebos (no drugs).
However, the most weight lost on the highest dose of the two drugs, Topamax - a drug used in lower doses for migraine control and Phentermine, was 18 lbs over a period of a year and a month (56 weeks). In other words, that's less than 1/2 lb a week! You can actually lose more weight with a Richard Simmons exercise program and no diet! And without endangering your health with a drug which already has been suspected to cause heart problems and another drug about which people have complained bitterly of the psycho- side effects including dizziness and brain fog!
Not surprising, the studies concluded that the difference in weight loss between those on the drugs and those in the placebo group (the latter lost 5% of their weight), was "of nominal statistical significance". Not exactly earth shaking as the news story would like us to believe, is it!
Furthermore according to an article in the LA Times, this is one of the studies done for FDA approval (which has not been given at this time) and not a new study!
And finally, predictably, it was funded by Vivus, the pharmaceutical which is trying to market the drug.
Notice the little plug about diabetes in the article - diabetics seem the new target group. Using old statistics about diabetic repercussions (like what people in the 1960's before modern medications sometimes suffered), these groups are scaring people with diabetes into drastic and sometimes unsafe solutions.
In a society which allows pharmaceutical companies to advertise risky drugs on the open market, the consumer must be very careful - a wrong decision in buying such a drug might result in a lifetime devastation of one's health - as those who trustingly took Phen-Fen can attest to.
ABC News broke the story with the headline, "Stomach Pacemaker could help obese lose weight!".
A new device, they continued, recommended for clinically obese people (BMI 35-55) fools you into thinking you are full ... yada yada, yada.
Their poster kid, a young man who lost 20 lbs with the device had "just tried everything" to lose weight and nothing worked until this doctor came along (was the doctor riding a white horse?) with the stomach pacer. The young man lost 22 lbs with it. (OK, all together now... "W-O-W") He's a mail carrier in Germany and 20 years old (one wonders if he had to lose weight at all except to perhaps get a set of washboard abs and "P90X" might have done that more effectively and without surgery).
The British Health Service has approved this device and it's being sold across the European Union although the news articles admitted that none had been placed commercially yet.
The problem here, is the idea of a gastric pacer is neither new nor effective for the population for whom they are suggesting it and the fact that an already physically fit 20 year old lost 22 lbs after it was implanted, might be less than impressive to both patients and/or the American surgeons who were excited about the Transneuronix version in the early 2000's and who personally saw the abysmal failure of the device to be either effective OR safe in the American trials.
There is a new wrinkle to this pacer and that is that it's invasive, much more so than the lap band. How? Because it has two leads, one of which lies on the stomach like the older pacer and another of which is inserted though a hole made in the soft stomach tissue into the stomach (it's supposed to detect when food comes into the stomach and then, it sends a message to the other lead which starts the vibration). This brings in the possibility of leaks and sepsis later on. One does not have to leak much stomach contents into the abdominal cavity to cause serious problems! In contrast, the lap band does not require a hole into the interior of the stomach.
Obviously, some well meaning surgeons are unaware of the hefty lawsuit suffered by Transneuronix after one individual had a nightmarish experience with the older (less invasive) pacer. The surgeons who did not hear about the people involved in the American trials, for whom the pacer was uncomfortable (it vibrated throughout their arms) and ineffective (they lost 5-20 lbs with it), some of whom experienced complications like the pacer traveling to other places in the body and all of whom were revised to gastric bypass or lap band. When the pacer failed totally, it was not headline news as were the announcements of it or the adverts for folks for the trials. In fact, the trials failing didn't hit the news at all. The only reason I know about it, is I was following several of the trials and in touch with some of the participants and I know the person who ended up suing.
If you were unimpressed by the poster kid featured in the news, there is another poster kid on the Abiliti website, another young man - a fire fighter. He lost an "impressive" 15 lbs with the device and from his photo where he looks very slim, he also, may not have been fat to begin with and yet, they are recommending this for clinically obese folks?
Sadly, there have been 65 patients who have had these implanted in 2 trials in the United States, however interestingly enough, in searching the web today, I could find no articles or announcement of the trials nor mention of the surgeons involved. As an MSNBC article stated:
So far, about 65 patients in two studies have received the device from U.S. pacemaker manufacturer Intrapace. Only about half of those have had the pacemaker for at least a year, and most lost about 20 percent of their weight and kept it off.
I really hate to see a repeat of history or worse. For it is said that "who does not study history is doomed to repeat it" but then when our news services do not totally report the story, it makes it hard to study history.
"Conspiracy? No conspiracy - only businessmen doing what businessmen do best, selling product" (Bernie Goldberg,a former network anchor in his book "BIAS") Only this isn't a car or a piece of clothing - this has the potential to hurt humans.
The TOGA procedure offers an "incision-less" weight loss surgery. What is done is basically stapling the stomach from the inside (a surgical instrument is inserted through the mouth).
American surgeons have appeared to not have greeted this procedure with the same enthusiasm as those in the UK.
Click here to see an animation of the TOGA procedure.
A surgeon's description of "minimally invasive" can be misleading to patients. They simply mean no incision. They do not mean the surgery is lightweight or not complex. This procedure calls for stapling the stomach from the inside into a narrow sleeve and step two is narrowing the lower end of the sleeve so food doesn't go through well. This is supposed to cause the patient to feel full with a lot less food.
It's interesting to note that all the procedures and medications are aimed at cutting appetite but since when do people only eat when they are hungry? The type of appetite we mostly have, is in the head and not fixed by feeling full in the tummy.... which may explain why even the more complex procedures are somewhat ineffective in a number of patients.
As the websites about the TOGA do not seem to be recently updated, it seems that the TOGA may not have become popular in the USA yet, and one wonders whether the weight loss results were less than expected or whether there were a lot of complications in the American trials.
Even if the TOGA holds better than the Rose or the StomaPhX, it may cause a lot of discomfort for the patient. In fact, patients complained of a lot of pain with both the Stomaphx and the Rose procedures but not much additional weight loss. And with the Rose and the stomaphx, they had problems with the staples or clips pulling out after a year or so. The tissue inside the stomach is very soft tissue, so it makes sense that staples or clips would not hold well.
Apparently a study in 2008 did not result in the weight losses claimed by the manufacturer. Also as you notice in the quote, even in a small number of patients (6), researchers observed in some cases "Partially stapled sleeves". In other words, in at least a couple of the members of the cohort, the staples had already begun pulling out.
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.
Endoscopy. 2008 May;40(5):406-13.
In reading about this procedure, I somehow am reminded of the title of a book that Susan Powter wrote --- "STOP THE INSANITY".
A study which followed 400 gastric bypass patients, found that the average BMI at the 2 year point, was 32, still obese. The study was conducted at the Medical College of Georgia.
That the patients had mostly not lost all their weight was predictable but the study's lead researcher, Dr. Sheldon Litwin, chief of cardiology, reported that the patients had a reduced risk of heart disease.
Explaining that the size and mass of the patients' hearts had greatly decreased, Litwin stated this suggested that their hearts were not working as hard to pump blood and therefore, less "stressed" than before surgery. Dr Litwin also said that the hearts of the patients were more normal size.
The problems with this theory are many - first, the heart is a muscle and working it is not a bad thing which is why many overweight people have strong hearts. Second, what caused the reduction of heart tissue? Was it less stress due to a lower weight (which remember, was for most patients, still in the "obese" range) - or was it that in the first year or so, gastric bypass patients take in very little food (300-500 calories day, thus causing a very rapid weight loss) and what their bodies can no longer get from food, is leeched from their bodies. Protein and iron, both poorly digested in gastricbypass patients especially in the post surgery stage, can be obtained from the heart tissue and this would much more likely explain the loss of heart mass however, loss in this manner would not be a good thing. On the contrary. It is this type of tissue loss which is suspected to be a factor in the heart attacks observed in 25% of anorexics.
I have known several gastric bypass patients to come down with heart disease after surgery (some require a pacemaker for example).
I notice in the article they quote Dr Lee Kaplan saying that only 1 percent of those qualified for weight loss surgery get it. But I'm wondering if that quote was taken out of context because in the Self Magazine article, Dr Kaplan said:
*** "Because it's risky, it's only appropriate for a tiny fraction of people with obesity—the sickest 1 to 2 percent. The idea that all obese people should get [WLS] surgery is insane."
Lee Kaplan, M.D., director of the Massachusetts General Hospital Weight Center in Boston in "Self MAGAZINE: 'The Miracle Weight Loss that isn't' AUG 2008 ***
The article points out that the risk numbers, cholesterol and blood pressure are down on the gastric bypass patients. These numbers also go down in people with terminal cancer. However, I doubt that cancer patients are at lower risk of coronary disease.
Finally, they emphasized the diabetes "cure" (really a remission not a cure) which has been observed in 72% of patients at the 2 year point, however, what they don't mention is that the studies have found that by the ten year post op point, most cases of diabetes have returned.
Whatever the case, it seems like the media is using this study to sell the surgery than anything else (as someone on one of my listserves pointed out).
Surgery used to be something done to save lives. But now it's often done for other reasons like to lose weight.
Recently a 52 year old woman died after a lap band procedure - probably a complication of the general anesthesia required for weight loss surgery. She was only 50 lbs overweight.
In another story, a woman who was 100 lbs overweight opted for liposuction to remove 50 lbs and now has a body which is very deformed even after she spent some $6000 bucks for chiropractic treatment and more.
As Weight Loss surgeries go, the lap band has the best safety record. In this procedure, a band is placed around the top of the stomach to form a "pouch" which fills up quickly. This is supposed to send signals to the brain that you are "full" when you have eaten only a small amount of food. The procedure, unlike the gastric bypass, includes no intestinal bypass and no cutting of the stomach, and unlike the gastric sleeve, does not call for the removal of most of the stomach. In the lap band procedure, things are pretty well left in tact.
But like all the other weight loss surgeries, the lap band has its downsides. Many patients find that if they are not pretty strict about dieting from the get-go, they don't lose any weight. And of course, there are many foods which are delicious and low bulk which slip right through the lap band like Dairy Queen blizzards etc. To feel full if you have a lap band, you have to eat bulky foods and if you do not measure them, you can suffer a repercussion called a distended esophagus (when food overflows the pouch). A distended esophagus can lead to perforation which is a serious life-threatening condition and also is difficult to fix. Finally, in a percentage of patients, the lap band adheres to the stomach but the percentage on the long run may be higher than we have been told.
Sharon Osborne who used the lap band to lose 90 lbs and has kept most of it off, had her lap band removed a couple of years ago. "I was tired of vomiting every day," she explained to the press. Her famous rock star husband, Ozzy, told the press he was sick of listening to his wife upchuck so often.
Obviously, Sharon may not have followed some of the rules all weight loss surgery patients are told to follow about "measure twice, eat once, vomit never" but doesn't the way it's sold on TV make it all look like it works pretty automatically? They never go into details about all the work the patient has to do which is very similar to any weight loss program, even the non surgical ones.
About 5% of people on non surgical weight loss programs can keep off the weight. With weight loss surgery it's only 7% even with more invasive procedures like the gastric bypass. Many weight loss surgery surgeons don't expect patients to keep off any more than half their excess weight on the long run even when they are putting in the work, but again, how many seminars tell that to prospective patients who are typically 100 and 200 lbs over their "goal weight"? I know a person who regained 100 of the 200 lbs initially lost with their gastric bypass and they couldn't for the world, take it off, even with diet and exercise. Apparently their metabolism had been so damaged that eating anything more than 700 calories a day, caused a gain.
How many people would agree to major surgery like weight loss surgery if they knew it would mean a lifetime of dieting and exercise as well as supplements, B12 shots, possible iron infusions, frequent doctor visits and more... and then, to only lose 50 percent of what they initially wanted to lose (for most patients)?
How many people would agree to a gastric bypass if they knew that they had a chance, even a small one, of getting a seizure disorder afterward or reactive hypoglycemia?
How many people would agree to a gastric sleeve surgery (the newest one they are touting) if they knew it called for the removal of 90 percent of their stomach, leaving a pouch the size of a thumb and that if they had any acid in their stomach, they might easily get an ulcer which could quickly ruin the stomach and require the removal of the rest of their stomach or else if they had no acid in their stomach, it could cause all kinds of things including auto-immune disorder (including MS by the way) because of "leaky bowel" syndrome where bacteria from the food eaten is not killed and instead, recirculated into the bloodstream?
How many people would go into a major surgery even with a lower death risk (the lap band has a death risk of 1 in 7000) if they really thought they might be the one to die? As for those surgeries like gastric bypass where the risk of death is much higher (1 in 50 in some studies), how many people would choose this procedure being fully aware of the death risk?
And finally, how many would agree to surgery if they knew they might not die right away but instead become ill, or require additional surgery like losing their colon from sepsis due to perforation (a sometimes repercussion of laparoscopic surgery) or lose their ability to walk?
Truly some might say "yes" to this but perhaps, not enough people to provide a steady income for many surgeons. (The average weight loss surgery surgeon has an annual income of 1.5 million dollars or more)
Perhaps we should consider going back to reserving surgery for when it's necessary and avoiding it when it's not necessary. Dying or getting a severe disability from a procedure we could have lived without, may not be a good idea for most people.
For sure, those who choose major surgery, should be very sure they ask and get answers for the question, "What can go wrong?" and not just trust new ops or those successful at surgery who may not be sharing the whole story, or least of all, the TV.
An article on CNN covers the weight loss of a man who went (they claim) from almost 500 lbs to "one-der-land". The man, Matt Hoover (who ironically is a namesake of one of the Biggest Loser Contestants of the 2005 season), told CNN his weight loss journey lasted 3 years. Most of the article is detailing "how terrible he looked" as a person of size and the usual. Finally a couple of sentences way down in the article tells how he lost the weight.
Predictably, he "ate less and moved more" that is, the article states:
He ate smaller portions and took daily walks. The first 120 pounds came off.
And in case we didn't understand how the weight melted off when he "just got off the couch", he's quoted:
"When you're that big, you can lose weight pretty quickly," he said.
The article goes on to say that Matt plateaued out at 150 lbs over his goal weight and then, joined Weight Watchers and "lost the rest of the weight"
According to this article, Matt had no health problems (or I'm sure they would have mentioned them) and it was all how "bad he looked" which motivated him.
Hey, if a person wants to lose weight (or not lose weight) that's fine - our bodies are ours to do with them what we want.
What I found very objectionable in this article was the following:
1. The article implies that the only reason Matt got up to 470 lbs was because he ate too much and moved too little in other words, "he sat on the couch, eating bons bons all day so no wonder he was so fat", and this idea is I think, what CNN wants to convey to the readers. But the reality about obesity is that according to Dr Rudy Leibel and the scientists who study this stuff, size is mostly genetic.
2. The article gives the impression that once Matt started eating as a "normal person" i.e. not totally overstuffing himself while sitting on the couch, the weight just "dropped off". And that is so not true! For a person who is genetically/physically obese to lose weight and keep it off takes daily vigilance almost to an obsessive level.
To expand on the second point, while the article implied that Matt just had to "get off the couch" (they never did detail what his exercise program consisted of however), ordinary exercise does not keep off any weight if you've got a certain set of genetics - I can personally attest to that one!.
For example, the Matt Hoover from the "BIGGEST LOSER" (not the same guy as in this story, I'm pretty sure) is described in one article as exercising 25 hours a week (he did regain some, it says from his "Biggest Loser" season but is determined to get it off):
Hoover spends 25 hours a week training for the grueling triathlon, which consists of a 2.4-mile open-water swim, a 112-mile bike ride and a marathon 26.2-mile run.
In my research I have found that societies in which there is no obesity, typically move 25-40 hours a week and eat about 1200-1400 calories a day.
Now that's a lot more than just "getting off the couch" and "eating smaller portions".
This type of article is falsely misleading. To the person of size who thinks that they can exercise an hour or so a day and eat a bit less and the weight will drop off, they will be very disappointed when they can actually gain weight eating normal amounts of food even if they do exercise. (How well I know about that one!)
And for those 85% of society who do not have to fight clinical obesity, articles like this just fuel the flames perpetuating the falsehood that shaming people of size is actually "good for them" because they might get motivated to "eat less and more more" and the "weight will drop off", as it did with Matt Hoover who is not the Biggest Loser contestant in this article.
I know people of size who have awesome achievements, careerwise and life-wise and even are very good looking, and yet, feel themselves failures because even though they already "eat less and move more" the weight just doesn't fall off them like it does on people in the newspaper or on TV. These feelings brought on by articles like this CNN article, filled with falsehoods and misleading statements, can lead people to drastic measures including unhealthy diets or even surgery to cripple their digestive system (what Dr Fobi, WLS surgeon calls the gastric bypass) or worse.
In a world which needs more love, isn't it time we enjoy people for who they are and just accept that in a country like ours where food is in easy access, people are going to come in all sizes and so what? What if we were all the same size - it would be pretty boring! (look at manikins for example). :)
Note: the photo included with this blog is Olympic athlete, Cheryl Haworth who won an Olympic medal in Weight Lifting. Like all elite athletes, she trains hard for several hours a day and watches what she eats. She also weighs over 300 lbs. People do come in all sizes and just because someone is a person of size, doesn't mean they lie on the couch all day, eating bons bons.
Like one of the TV reality show stars quipped when someone called him on a misrepresentation in a so called "reality show".
Well, you cannot believe everything you see on TV!
A new study of 1.5 million people suggests that obesity, even overweight, shortens your lifespan. So says the study - obese people are 44% more likely to die earlier than those in the so called ideal BMI range.
The findings and size of the new study, which was conducted by researchers at the National Cancer Institute and published in the New England Journal of Medicine, should settle the debate over the relationship between excess weight and the risk of early death
So says Ali Mokdad, Ph.D., a professor of global health at the University of Washington, in Seattle.
According to one report on a local TV station:
The latest research was launched after a controversial 2005 study by the Centers for Disease Control and Prevention that concluded being overweight didn't raise the risk of death; that report included smokers and those with pre-existing illnesses.
The CDC study was actually a re-examining of existent data and an admission that the wrong conclusions had been drawn. It was only controversial among those advocating diets!
In 2005, the CDC reassessed their data, stated one news article in the Seattle Times, and found that 112,000 people (not 300,000 people) had died from obesity related diseases however, they also added that since people with BMIs in the overweight zone (BMI 25-29) live longer than those in the "normal ranges", one had to subtract 86,000 from the 112,000 and that leaves 26,000 people who die from obesity related disease... less than who die from gunshot accidents!
The new study doesn't settle anything because it made the same mistake pointed out by Dr Stephen Blair, PhD, head of the Cooper Institute.
Seems the folks at the Cooper Institute took 30,000 people and found when they added exercise habits to the equation, that fat people who exercise regularly had no greater risk of sickness or death than slim people who exercise - and people who do not exercise regularly, had the same risk, regardless of size - about 44% greater than the exercisers.
I'm sure the pundits are banking on the fact that the public either has a short memory or else, hasn't seen the Cooper Institute studies.
However, some reports on the new study included the remarks of the lead researcher on the Cooper Institute studies, Stephen Blair, PhD:
University of South Carolina obesity researcher Steven Blair said the results were consistent with other studies and the "massive effort" was commendable. But he said there wasn't enough information available about fitness level or physical activity. A proponent of the "fit and fat" theory, Blair said his research has shown that obese people who are tested and deemed fit did not face increased risks of dying.
"If we want to get to the bottom of the health hazards of overweight and obesity, we have to have better data on physical activity," Blair said. "Until we do that, there's uncertainty of how important BMI is as an important predictor of mortality."
Seemingly coincidental to the release of this new study which looks impressive to the unquestioning eye of the public, the Allergan company has petitioned the FDA to lower the weight limit for obtaining the lap band obesity surgery. Right now, only people who are at a BMI of 40 or higher, or 35 with co-morbidities can have their insurance pay for a lap band. Allergan would like to see that minimum weight lowered to a BMI of 35 or 30 with co-morbidities.
Even CNN remarked on the fact that the head of the FDA committee petitioned to lower this weight requirement, owns stock in the Allergan Company! Not only did she not recuse herself (which she should have done!) but the FDA voted that it was "OK" for her to be on this committee as long as she didn't vote!
The lap band is a much safer surgery than the gastric bypass. It's a band placed around the top of the stomach which can be tightened or loosened and is supposed to limit how much a person can eat and thus cause a weight loss. Of course, what it limits (when it's not swollen i.e. some band patients complain of their stomach swelling shut in the morning) are the good bulky foods like veggies. Milkshakes, ice cream and cake go down beautifully. Although unlike the gastric bypass which is greatly troubled by long term vitamin deficiencies in many patients, the lap band is not without its own set of repercussions. A certain percentage of patients experience the band growing into the stomach, thus requiring removal and/or a gastrectomy. Mostly what I hear lap band patients complain about is discomfort and difficulty in keeping off the weight. The difficulty in keeping off the weight complaint, one hears from gastric bypass patients also.
What science really says is, if you cannot keep off the weight, it's healthier to not lose it in the first place as "weight cycling" or "yo yo dieting" raises the risks for heart attacks significantly.
About 5% of the public born with the obesity gene (according to obesity researcher, Rudy Leibel, size is 40-60% genetically determined) can lose and keep off the weight (7% with weight loss surgery according to the Hebrew U Study for one).
For the rest, it is strongly recommended that they consider following the "Health at Every Size" guidelines - Linda Bacon's book on this is excellent!
A clinical study at USC found that those following the Health at Every Size, guidelines without a focus on weight loss - ended up healthier than those who dieted - this study is highly respected and the cohort was followed for two years. Linda Bacon was one of the researchers and the other researcher was Julie Stern who is a member of the Weight Watchers scientific committee. Undoubtedly, Stern is not opposed to dieting and yet confirmed the results of this study which headlined "Non-dieters more successful at boosting health than dieters, study finds".
Isn't it time to "stop the insanity" and focus on real health which is determined by healthy food choices about 80% of the time and regular aerobic exercise?
Lately the reality show, "The Biggest Loser" in which they sequester several clinically obese people, put them through grueling workouts of 5 hours or more a day and greatly curtail their food intake to effect quick weight loss, has come under no small amount of criticism.
It has caused a hue and cry among personal trainers and especially exercise physiologists who feel that the training given on the show is not only somewhat sadistic but sheds a negative light on personal trainers in general who try to teach people a healthy lifestyle.
Possibly what is most upsetting to the producers of the show (which apparently has versions in several other countries besides the USA) is the fact that the ratings of the show now in its 10th season, have fallen drastically, which can be a death knell for any TV show.
So tonight, NBC aired a show which promised to catch us up with what former contestants on the "Biggest Loser" are doing now and did they regain the weight, but actually seemed more of a "damage control" effort to try and convince the viewing public that what is done on the "Biggest Loser" is really a good thing and has changed lives.
Injury on the show has apparently (and rightly so) upset the public so the show dealt with that issue. The 9th season featured as the first challenge, a 1 mile run for clinically obese folks who had not exercised in quite a while and ended up with one of them, Tracy Yukich collapsing and being air lifted to the hospital where she remained for a week or more.
Dr H went to her home to visit and they relived the incident where she collapsed. Tracey's eyes filled up with tears when she watched the video and she commented that she thinks about this every day. She also said, "here I was 37 years old and almost - well gone."
Tracy is slim now and writes cheerfully on her facebook fan page that:
The Biggest Loser has changed my life. I never dreamed I would be at my college weight again. I am so grateful for all that have touched my life and helped me through this journey.
Tracy's website claims that she collapsed from heat stroke but that she was in the hospital for two weeks after, seems there might have been more wrong. Tracy uses her Biggest Loser fame and that she's kept the weight off, to do motivational speaking now.
On the catch-up show we watched on Wednesday night, they didn't say what happened to Tracey. The only explanation given by Dr H was that she was so fat, she had fat everywhere. Tracy weighed 250 lbs at 5'2" which while clinically obese, wasn't exactly the largest contestant either.
In researching this, I found out that likely what she had was "Rhabdomyolysis", a condition of muscle injury where the muscles break down releasing a chemical which injures the kidneys and can cause kidney failure.
The outcome of this illness (which also can happen with statin drugs by the way) is unclear according to the NIH:
The outcome varies depending on the extent of kidney damage. Acute kidney failure occurs in many patients. Treatment soon after rhabdomyolysis begins will reduce the risk of chronic kidney damage.
People with milder cases may return to normal activity within a few weeks to a month or more. However, some continue to have problems with fatigue and muscle pain.
According to another article, Tracey was restricted while on the ranch for any workouts, even in the pool so while she may be training for a marathon now, she may still have residual damage to her kidneys.
Quite a bit more than the "heatstroke" claimed.
Another contestant in that same season, Abby, got an early injury to her tibia and was also restricted from the grueling workouts and challenges.
Injury in the contestants was not really discussed in Wednesday's show though, which was filled with praise and emotionally filled statements of how the "Biggest Loser" was changing lives. Dr H. actually claimed that this reality show had found "the answer" to obesity and should get the Nobel Peace Prize. (Yes he said this with a straight face!).
Another problem which has cropped up is Ryan Benson. He was the season one winner who told all on his Myspace - about how he dehydrated himself for the final weigh-in using techniques he'd learned in wrestling and how he re-gained 30 lbs (just water weight) in the week after the finale.
The show ended with featuring the 9 winners of the "Biggest Loser" in a healthy Thanksgiving dinner (which although everyone oohed and aahed about how great the food was, it didn't look real appealing to me). Ryan Benson was at the dinner and said how he re-gained all the weight because he'd gone back to his old habits and how he was so inspired at seeing the other winners, some of whom looked a lot heavier than when they won the show. Erik Chopin claimed to have lost the 122 lbs he regained and although he looked a bit slimmer than he did when he appeared on the Season 9 finale, he didn't look anything close to how he looked when he won the show.
The show was supposed to convince us that those who had been contestants on the "Biggest Loser" had had their lives changed, had gone on to make careers of motivational speaking etc and how they were living the dream. But it was unconvincing. Some of the contestants in telling about their lives and their experience on the "Biggest Loser", wept while they were talking, suggesting they may still be emotionally damaged from the experience.
Out of some 200 people who had been contestants for the show, only 35 were "caught up with" and most of them were from seasons 8 and 9. But 35 had not kept off all the weight. As we know, Ryan Benson was back to his original weight and Erik Chopin was somewhat up in weight. A couple more had obvious regains. So that leaves only a few like Tracey, Alli, Tara, Mike who had kept it all off. About 7 percent or less of those who had been contestants on the show.... Hardly as Dr H claimed, a "cure" for obesity.
Will it work to save the show's dropping ratings? Only time will tell. That several have spoken out against the training and other issues (like Kai who was not mentioned at all) is hard to blow a smoke screen over. Emotionally and physically injuring obese people is not really acceptable in any circles, not even the most fat phobic ones.
Is Weight Loss surgery really, safer than being fat? That's the conclusion of a Weight Loss surgery surgeon from Baylor, at least.
In a video on the ABC website from "Good Morning America" this surgeon who is head of the Baylor Weight Loss surgery unit, does give that impression. In the video, he not only advocates ALL WLS for not only clinically obese, but also for "lower weights" i.e. for people with a BMI of 30 and over. While not openly misrepresenting, one could easily get the wrong impression of WLS from this video.
When asked about the risks, he brushed the question off with a "it depends" and changed the subject. Later he focused on the difference between having open surgery and lap surgery, giving the impression that that's the only concern about weight loss surgery which is so not true.
He also, said the surgeries done today are less risky than done 10 years ago. That's true but only of the lap band. The RNY - gastric bypass is basically the same risk (it hasn't changed). And today's RNY with transsection of the stomach, may actually be more risky than the older loop gastricbypass which left a larger pouch and did not cut the stomach into two pieces.
It makes a difference which procedure is done - the death risk with the lap band is 1 in 5000 or less. (One study in Australia found no deaths in 10,000 patients). The death risk with the gastric bypass is 2% within 30 days of procedure and 4-9% within the first year (According to the David Flum studies of 62,000 patient records)
They have no data as to weight maintenance over 10 years post op (1 study of 100 patients went 12-15 years post op) but that 10 year post op data they have suggests that most patients after gastric bypass have an average BMI of 35 and that was the same with all procedures. In the small study of 12-15 year post op gastric bypass patients, 68% suffered involuntary vomiting, 68% had suffered a plugged stoma so it was not complication free at all.
Many are frightened into surgery by thinking they are under less risk having surgery than remaining fat however, there is no evidence that this is true.
Even the release form for gastric bypass (which is given to prospective patients so it's not "anti WLS") 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
(I know many slim people who have type II diabetes)
One doctor interviewed for "Self Magazine" stated:
*** "Because it's risky, it's only appropriate for a tiny fraction of people with obesity—the sickest 1 to 2 percent. The idea that all obese people should get [WLS] surgery is insane."
Lee Kaplan, M.D., director of the Massachusetts General Hospital Weight Center in Boston in "Self MAGAZINE: 'The Miracle Weight Loss that isn't' AUG 2008 ***
I am reminded of a quote from one of the patients featured on the show about weight loss surgery, "Big Medicine" (which disappeared rather suddenly from the scene and so far has not gone into re-runs). The show filmed him being sent home and them bringing a gurney which was too small etc etc. He later wrote that this was all staged and he had never been sent home from the hospital (I think the idea of this drama was to emphasize how insurance sometimes did not pay for WLS). When people on the forum expressed surprise that a so called reality show had staged a scene, he wrote back "Well, you don't believe everything you see on TV, do you?"
Especially when it comes to risky surgery, prospective patients are encouraged to research the studies or to consult a gastroenterologist first... (someone who does not stand to profit by a decision in favor of surgery).
An article on the Philly burbs tells how the show, "The Biggest Loser" suffered a significant loss in the ratings - 25% down. The article asks in the conclusion, "is it because Americans are tired of being reminded how obese they are?"
No, I don't think that's it at all. I think it's because of those former contestants who have spoken out about the sadistic methods of training used in the show, the long hours of workouts and the psychological abuse contestants get. The last one to "sing" who said she got an eating disorder after being on the ranch, might have signed the death nell for the show.
That and the fact that Ryan Benson, the winner of the first season has admitted he's regained to a higher weight than his original weight (not withstanding his open admission on his "myspace website" about how he clinched his win using techniques of dehydration he learned, back in his days as a High School wrestler - and how he gained 30 lbs the week after the big win).
Or maybe it was Erik Chopin appearing on the Oprah Show, almost back to his original weight. The Biggest Loser tried to do damage control by having trainer Bob, visit Erik and Erik admitting it was just all his fault. Bob extracted a promise from Erik to be back to a better weight by the finale but that never materialized. Maybe some of the viewers were looking for that event and didn't "forget about it" as the show producers likely hoped.
Perhaps it was the couple who appeared on Carnie's quiz show who got married but both admitted quite a bit of regain.
Or the contestant who told the press that the week before the finale, she had lived on diet jello all week.
There is also, a growing number of personal trainers who are very much against the way the "loser" contestants are treated by Jillian and Bob - they say it gives folks the wrong idea about personal training in general. And there have been articles in industry magazines which were critical of the personal training on the show. Likely some of this filtered down to their clients.
The show has received enough "bad publicity" to spoil the magic image of the weight somehow magically falling off the contestants.
Everyone knows if you starve and work out many hours a day, you will lose weight but that isn't even healthy, and rapid re-gain is likely. No magic in that at all. On the contrary...