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Weight-Loss Surgery Cost-Effective Even for Mildly Obese (Oh, Really?)

September 28, 2011
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According to this article in MedPage Today, weight loss surgery (WLS) is cost-effective even for the mildly obese (people with a BMI of 35 to 40). Excuse me while I laugh my ass off.All righty then, I’m done laughing, now it’s time to get down to brass tacks. The full report can be found here.

Treatments for overweight and obesity include dietary therapy, exercise/behavioral interventions, weight loss medications, and bariatric surgery. Yet studies have shown that all of these options except surgery have been ineffective in long-term weight control. In addition to sustained weight loss, surgical treatment provides additional benefits to people with ORDs and reduces relative risk of death.

Well, I have to disagree with, just from personal experience. Risk of death? Yeah, that one’s interesting, and one reference can be found here. In one place, it says that the impact of surgically-induced, long-term weight loss on mortality is unknown. Elsewhere, this study shows that weight-loss surgery significantly decreases overall mortality, as well as the development of new health-related conditions in morbidly obese patients. So which is it? They either don’t know if you live longer with WLS, or you do live longer with WLS. Can’t have it both ways (now do you see why I’m so skeptical when studies say they’ve proved something?).

However, surgery for obesity has shown remarkable results in helping patients to achieve significant long-term weight control. In addition, it is associated with improvement and often resolution of co-morbid conditions, including type 2 diabetes mellitus, systemic hypertension, obesity hypoventilation, sleep apnea, venous stasis disease, pseudotumor cerebri, polycystic ovary syndrome, complications of pregnancy and delivery, gastroesophageal reflux disease, stress urinary incontinence, degenerative joint disease, and non-alcoholic steatohepatitis.

Ummm… yeah, not so much. My WLS caused my venous stasis disease, gastroesophageal reflux, stress urinary incontinence (sorry for TMI), and a few other things not even listed. Remarkable results? Yeah, if you think it’s remarkable that I’m worse off now than I was 14 years ago before I had WLS. Seeing as how I didn’t have type 2 diabetes, hypertension, or high cholesterol before I had my WLS, maybe I should consider myself lucky that I don’t have any of those now, either (/sarcasm).

Now comes the part where they talk about the costs of WLS (I can guarantee you they left out some very important costs, but we’ll get to those in a bit).

Along with substantial health benefits, weight loss surgery has its costs. First of all, like all other surgeries, there are risks of mortality, complications, and side effects, e.g., food intolerance and micronutrient deficiencies. Secondly, it is an expensive procedure. The average cost of surgery exceeds US$13000, with additional costs possible in years following surgery.

According to one reference here costs were $19,794 to $25,355, depending on the type of surgery done (in 2002, and I don’t even want to think what it would cost now with the price of health care today). According to the other reference, and the math I did (0.6% of 11.5 million divided into $948 million costs of WLS), that comes out to $13,739 for 2002. Quite a difference between the two studies, I’d say.

Those “additional costs possible in years following surgery”? They aren’t really addressed in any of the abstracts or full studies I read. I can tell you what the possible additional costs are though, just from reading the Yahoo! group I belong to, OSSG-gone_wrong. Revision surgery (to have the original surgery undone, if possible), taking supplements for the rest of your life, protein shakes for the rest of your life, additional tests for deficiencies, shots for those deficiencies if pills don’t work, surgeries to have twisted intestines/bowels/blockages fixed, hernia repairs, feeding tubes, and the list goes on and on and on.

None of that is inexpensive and all of that is a direct cost of WLS that no one hears about. And that doesn’t even begin to count the cost of treating the complications of WLS (which this study doesn’t even begin to address). Let alone the cost of a WLS patient dying and therefore not being a contributing member of society anymore, let alone the cost to hir family. Those are the invisible costs of WLS, that no study will ever address.

I’m not a researcher, I admit that. This is the first research paper I’ve read in-depth, and I’m finding it interesting, frustrating, and rage-inducing. The assumptions that are so rage-inducing to me are that coronary heart disease, hypertension, type 2 diabetes, stroke, and dyslipidemia, as well as endometrial, breast, and colon cancers, are only obesity-related diseases. That anyone who has a BMI of less than 25 doesn’t get these diseases and, if they do, they don’t die from them (or not in the vast numbers that fat people do). Give me a fucking break. Just because people have a BMI less than 25 doesn’t mean those people are never going to have any of those diseases and are never going to die from one of them (may or may not, life is a crap shoot, depending on genetics, availability of health care/food, lack of stress, and more factors than I care to name right now).

On to the meta-analyses, which I found interesting. One of the doctors who was involved in two of the studies was the surgeon who did my vertical banded gastroplasty (VBG). This is why I question how valid the follow-up of his patients is (he also did both VBGs on my best friend, who died from her WLS). He doesn’t have a clue how I’m doing with my VBG, since he hasn’t seen me since he took the staples out of my incision six weeks after my surgery (that would have been in November 1997).

He didn’t know Pat had died (six months after her last VBG) until I called him and told him. From everything I had seen of his patients, the only ones he followed for any length of time after their WLS were the ones who were successful at keeping the weight off for three or more years (those were the ones he had come in and talk to prospective WLS patients, the cheerleaders who said how wonderful WLS was, how WLS saved their lives, how they could actually live their lives now that they were thin, etc., etc.). He also taught other surgeons how to do WLS. If he’s an example of how weight loss surgeons follow their patients after surgery, it’s no wonder that there aren’t many studies with results for WLS survivors past five years (and most studies don’t have any results past two or three years).

They searched PubMed using the search terms obesity and surgery for the time frame June 1, 2003 to Nov 1, 2010. After they reviewed those results, they did a second PubMed search, using the search terms obesity, bariatric surgery, weight loss surgery, gastric banding, or RYGB, and the same search timeframe in order to identify as many potentially relevant studies as possible.

They had two levels of screening. The first scanned abstracts for their exclusion criteria, which yielded 11,289 articles. After multiple exclusion screenings, they then retrieved full articles, screened them at the second level for exclusion and inclusion criteria, and data were extracted from 170 articles, which included 53 on weight loss, 50 on mortality, and 27 on comorbid conditions. The mean patient age was almost 45, mean BMI was 46, and 80% of participants were female.

A total of 280315 patients were included in our analysis… Among the studies that had information about obesity-related comorbidities, 21.27% of the patients had type 2 diabetes, 36.17% had hypertension, 15.65% had dyslipidemia, 9.19% had cardiovascular diseases, and 0.47% had strokes.

It’s interesting that they quote percentages for co-morbid conditions, but don’t say if any of those conditions overlap (for example, did a person with type 2 diabetes also have hypertension and/or stroke, therefore being counted 2 or 3 times in those percentages). Notice also how 80% of the patients were female (I’m not even going to get into what this says about our society and its obsession with the female form).

They looked at 27 studies for the meta-analysis of co-morbid conditions. And what did they do with people like me? When I had my WLS, the only co-morbid conditions I had were arthritis and mobility issues due to severe lower back pain that had no diagnosed cause (blood pressure was normal, blood sugar was normal, cholesterol was normal, heart worked fine, lungs worked fine, no heart disease at all).

And I know I’m not the only DEATHFATZ person who was referred for WLS who had good numbers, but was told WLS was a dire necessity or else I’d either die in five years without it (that Vague Future Health Threat) or that no surgeon would replace my arthritic knees because I was too fat. Want to bet that those of us who had good numbers were conveniently left out of the calculations (yeah, yeah, I know, I’m a cynic).

Operative mortality was relatively low in general. Sixty-one studies reported operative mortality rates. The simple pooling across studies estimate for all reported operative mortality was 3.487 deaths per one thousand patients (rounded up to 0.35% in Table 3). The FE and RE estimates were 4.693 and 4.694 deaths per one thousand patients, respectively.

I couldn’t find anything that showed how they figured operative mortality. Was that patients who died on the operating table? Patients who died while in hospital, before discharge? Patients who died within a month of discharge? What about patients who died within six months, a year, two years of their surgery? I’m betting if they counted WLS patients who died within two years of their surgery, that percentage would be a lot higher (and if they counted the patients who died of complications after 5, 10, 15 years, the number would be so high that people would think long and hard before having this surgery, if they knew what that number was, that is).

Fifty studies and 52 cases contributed to meta-analyses of post-operative complication and reoperation rates. Of these studies, the complication rates ranged from 12% to 14% for weighted mean, FE, and RE estimates. Reoperation rates varied across studies. The reoperation rate was 2.45% when equal reoperation rates between cases were assumed, while the FE and RE estimates were 10.89 and 10.87% respectively.

I still want to know how they can justify WLS as being cost-effective when 12 to 14% of patients have complications that have to be treated (not cheap, see above), at least 2% to 3% of patients require second operations (also not cheap). How do they justify spending an initial $14,000 to $26,000 over treating any possible diseases that a fat person may have? I’m sorry, but $14,000 to $26,000 will pay for a boatload of statins, hypertension meds, etc. Not to mention all the money spent on treating complications that would never have happened had one not had WLS. That money would better be spent on actual health instead of trying to make fat people thin and therefore “healthy.”

Weight and BMI changes were reported in one-third of the studies from which we extracted data. Only studies that reported yearly changes in BMI and their pooled standard deviations or from which pooled standard deviation could be computed were incorporated into our meta-analysis. As shown in Table 3, 57, 34, 12, 8, and 13 cases provided information with regard to first-year (1-y), second-year (2-y), third-year (3-y), fourth-year (4-y), and fifth-year (5-y) change of BMI (ΔBMI), respectively. Both FE and RE estimates showed that the BMI loss after surgery was very persistent within the range from 12 to 17 kg/m2. Two articles based on The Swedish Obese Subjects Study reporting BMI change 10+ years after surgery were excluded from our meta-analysis. The BMI reduction 10 years and 15 years after surgery was still approximately 6.48 and 7.12kg/m2 on average.

This is the part that had me laughing my ass off. “After surgery, BMI decreased by 12 to 17 points.” Yeah, you know why they can say that? I’ll tell you why. When I had my WLS, I weighed 350 lb. at my doctor’s office the day before my surgery. I spent that whole day in the bathroom, getting rid of everything in my system after drinking a gallon of GoLYTELY (yeah, you don’t go lightly at all; to be blunt, you’re shitting your brains out for almost 24 hours).

When I got to the hospital and they weighed me, they said I weighed 370 lbs (yeah, I gained 20 lbs overnight after eating nothing for two days and spending all of one day on the crapper). When I was discharged from the hospital five days later, they said I weighed 300 lbs. Somehow, I had miraculously lost 70 lbs in five days.

So, at 5′ 8″ and 370 lbs. (according to them), I had a BMI of 56.3, and at 300 lbs, I had a BMI of 45.6. That’s a difference of 10.7 BMI points in five days. It’s a miracle, I tell you! (and you wonder why I’m skeptical of this kind of shit?)

If the hospital fudged my numbers to make it look like I weighed more than I actually did and lost more weight than I actually did, how many other people has this happened to? The really sad thing? My surgery was done at the University of Minnesota Medical Center, which you’d think would have more integrity (evidently not when it comes to WLS and statistics).

“The bottom line is that bariatric surgery is cost-effective for at least the mildly obese with or without obesity-related co-morbidities and even cost-saving for the co-morbidly super obese (BMI 50 or higher),” they stated.

It’s funny that they can say this with a straight face, after saying that they omitted the study from Sweden that said WLS patients at 10 and 15 years out had only a BMI loss of 6.48 and 7.12 on average, instead of the initial 12 to 17 BMI loss (means those WLS patients gained back some weight or didn’t lose as much as was expected, no?).

Cost-saving? Is it cheaper to treat the so-called co-morbidities of obesity or to treat the many and varied complications of WLS? The following is a list of complications, and I’ll leave it to you to figure out which is cheaper to treat: dehydration, chronic vomiting and nausea, stroke, heart attack, arrythmia, kidney stones, kidney failure, liver failure, anemia, deficiencies (B-12,potassium, iron, B-1, B-6, etc.), malabsorbtion of supplements (calcium, minerals, nutrients from food), blurred vision, muscle and bone pain, loss of teeth, bleeding gums, rotting teeth due to vomiting requiring root canals, hypoglycemia, headaches, blackouts/seizures, lactose intolorance, injury to spleen during surgery, coma, paralysis/blindness after coma, osteoporosis, burst pouch, lupus, auto-immune disease, looped intestines, ruptured esophagus from vomiting, misfired stapler during surgery, ulcers, pneumonia/lung problems, arthritis, weakness and fatigue from malnutrition, overall pain, metabolic bone disease, food blocking stoma causing severe pain, stoma needing stretched repeatedly, neuropathy, beriberi, put on feeding tubes/PICC lines, fibromyalgia, chronic fatigue, fistulas, atrophy of muscles, hair loss, hernias, blood clots, leaks, peritonitis, heart burn/GERD/acid reflux, bowel obstructions, gallstones and gallbladder removal, severe depression, anxiety, loss of memory, poor concentration, irregular blood pressure, diarrhea, constipation, opening of outer incision which requires packing until healed from the inside out, insomnia/sleep disorders, unforced anorexia and bulemia, gas, silent stroke, vertigo, malnutrition which is the cause of many of the above problems, many end up becoming invalids, and then there is death.

This list continues to grow.

These complications can happen right after surgery, or days, weeks, months, or many years, even when taking all the required supplements.

Besides physical complications there is financial hardship and families who are devastated.

And this study doesn’t even begin to address the quality of life of a WLS survivor. If I were going by my quality of life before WLS and my quality of life after WLS, believe me, I’d take the before for quality purposes, hands down.
That list of complications up there? I can tell you from personal experience that living with some of them sucks dirty ditch water and I wouldn’t wish that on my worst enemy (not even screaming MeMeMeMe Roth).

So that $25,000 that Medicaid spent on my WLS was totes wasted. I’m fatter now than I was before I had WLS, I have had 19 of the complications listed above (before WLS, I only had 2 of them: arthritis and depression).

Cost-effective? I think not.

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15 Comments leave one →
  1. September 28, 2011 11:27 am

    vesta,
    This study fascinated me, primarily because the main author, Graham Colditz, is the same asshole who created the missing “obesity costs $100 billion per year” myth, which I mentioned here. I don’t trust this guy’s ability to objectively calculate cost estimates, so I snagged a copy of the study and read it too.

    For one, their estimation of life expectancy is grossly over-simplified: “For people in the surgical treatment group, life expectancy after surgery was predicted using their post-surgery BMI, ORD [obesity-related disease] status, and their own individual characteristics based on the estimated MPH model. For people who did not undergo surgery, life expectancy was computed similarly to that of the surgery survivors, except we assumed that they remained at the same weight throughout the rest of their lives, and that their ORD status changed with a fixed probability.”

    First of all, as you said, BMI started out at 12 to 17, but long-term BMI was between 6 and 7, indicating that people don’t remain at the same post-surgery BMI. Also, where they suggest that ORD status changed with a fixed probability, it refers to a note that says, “We attempted to conduct a meta-analysis of worsened comorbidity in the non-surgery group, but found literature is parsimonious on this.” So, even the study authors admit there’s no consensus as to the “fixed probability” of ORDs, but they did it anyway.

    I find the study sample interesting too… just 59 of the 124 articles they based their meta-analysis on (which was separate from the 170 they extracted data from) had follow-ups of at least 2 years. So, over half the studies had followups of less than two years. Yeah, not exactly confidence building there. And just 71 of those studies reported operative mortality rates… over half reported NOTHING about the mortality rates of their subjects. And, you’re absolutely right… how they define post-operative death is noticeably absent.

    But here’s the real kicker: “Weight and BMI changes were reported in one-third of the studies from which we extracted data.” Really? Only a third of weight loss surgery studies actually reported the changes in weight and BMI? What the fuck? Wouldn’t this sort of information be CENTRAL to any study of WLS? That’s like having a meta-analysis of studies on smoking cessation in which only a third of the studies actually reported smoking cessation rates!

    And while they boast of the sample size (280,315 patients), the sample size of those with ORDs is pretty small by comparison (5,469 patients), even if you assume that each of those ORDs is unique and not overlapping (which they typically do), as you mentioned.

    And their conclusion is also ridiculous: “Our results suggest that bariatric surgery in general is cost-effective for obese people with BMI greater than 35kg/m.” This includes those WITHOUT ORDs. They even go on to make the case that WLS is cost effective for those with a BMI over 30!

    But their data suggests otherwise… total costs of having a BMI over 35 without ORDs is $96,473 with the surgery versus $31,689 without. And with ORDs, that cost is $83,964 with surgery versus $52,044 without. Those costs only draw close to each other for those with BMI over 50 plus ORDs ($91,000 versus $89,000), while those with a BMI over 50 without ORDs are still paying the price ($84,0000 versus $56,000).

    But where they claim the cost effectiveness lies is in the Quality-adjusted life expectancy (QALY). Wikipedia defines QALY as the “measure of disease burden, including both the quality and the quantity of life lived. It is used in assessing the value for money of a medical intervention.”

    So, even when assessing whether the surgical intervention is worth it, the QALY in this study is not all that significant, and the cost of life years for those without ORDs is incredibly costly ($4,832 versus $27,876 for a BMI between 40 and 50).

    None of this deters the authors from drawing the rosiest of conclusions: WLS is cost effective for ALL FATTIES EVERYWHERE!

    This is yet another insidious attempt to shift WLS from a last resort to a cosmetic procedure, and I’m not surprised that Colditz is spearheading the effort.

    Great find, vesta, and great analysis!

    Peace,
    Shannon

  2. Kala permalink
    September 28, 2011 12:23 pm

    I think there’s something seriously wrong with how our society treats a surgery that either permanently or temporarily reroutes and alters the behavior of internal organs. I think I’d rather be obese and know that my GI tract worked properly, than a little less fat and not be quite so sure. And in the end, the assumptions about what is healthy are kind of ridiculous. The assumption is that if you are thinner, you are healthier, but I guess it doesn’t matter if your hair is falling out and you have a whole host of other problems.

    If we look at health in a big picture sort of way, how many of these post-WLS people are actually healthier now than they were before? That’s a study I’d be more interested in seeing, rather than the whole “Does crippling someone’s digestive system make them lose weight, yes or no?”

    • September 28, 2011 1:08 pm

      Kala,
      I was thinking the same thing. They seem to be measuring health and quality of life strictly by BMI. So, if you go from a BMI of 50 to, let’s say, 40, they assume you have the same health as a person with a BMI of 40 who never had surgery. Research doesn’t even confirm that’s true with traditional diets and we know that the metabolism of a 140 pound person who has lost 100 pounds (or less) is not the same as the metabolism of a 140 pound person who has been that weight all their life.

      These are major questions that need answers before we can even begin to entertain the idea of making this surgery available to people of lower BMIs, or even those with higher BMIs and no comorbidities. Of course, that’s not how the FDA regulates medical devices, is it?

      Peace,
      Shannon

      • Kala permalink
        September 28, 2011 2:06 pm

        I can’t image how we would think removing or reducing functionality of major organ systems is a good idea under anything but the most dire of life threatening circumstances. For example, to remove a kidney because of failure, or to remove a chunk of colon because of cancer. I can imagine how WLS could be a viable option for people so disabled that they can no longer get up and move on their own, but other than that, I don’t really see it.

        Also the whole, food is evil paradigm. We applaud surgery that basically makes it hard or impossible to eat, certainly to eat normally or healthily. Why exactly are those who are or were obese supposed to be eating a caloric limited diet for the foreseeable future (is it a punishment for ever having been fat at all)? I recall Shaunta’s article (either here or on her website, I don’t remember) talking about how her friends were proud of not eating breakfast, or not eating at all. I can’t imagine another time in history, other than our own, where anyone was treating food like it was poison. I’d think only people who truly thought that somehow food was poison, could possibly advocate for WLS for people who are “mildly obese”.

  3. September 28, 2011 1:10 pm

    All the horrid things I’ve heard about WLS have made me decide against it and I thank people like you for telling the truth. They never talk about the people who get it and then die either. I remember seeing an extreme case where the woman had been in an auto accident, was bedbound, and ended up weighing approximately 900 pounds. After she had the WLS that she had been hoping for so many years to have, she was dead within 2 weeks. Her body couldn’t tolerate it.
    Yet this is still pushed as a viable solution to something that in most cases isn’t even a problem, just a body type that this society has chosen to scapegoat.

  4. Emerald permalink
    September 28, 2011 1:36 pm

    Thanks for this. We need to see more ‘anti’ information getting out there.

    There was a discussion this morning on BBC Woman’s Hour about WLS in young people. Teenagers. You can listen to it here: http://www.bbc.co.uk/programmes/b0151ndl#p00kqv8l (you can skip directly to the relevant segment of the program).

    Apart from the fact that ‘Dr’ Haslam (I’m sorry, I work with MDs and I really hesitate to give him the honor of that title) appears to believe that the human body stops needing a full food intake to grow and develop at adolescence, that he doesn’t seem to realize that type II diabetes in teenagers is still almost vanishingly rare, and that he’s written a book on the cultural history of obesity catchily titled ‘Fat, Gluttony and Sloth’, he’s also a chair of the National Obesity Forum, a supposedly objective think-tank. You can judge what kind of organisation they are from where they get their funding:
    http://www.powerbase.info/index.php/Globalisation:National_Obesity_Forum_-_Funding

    What kind of world do we live in where people like this are allowed to make decisions about the long-term health of young people? When is anyone going to cotton on to this? Sorry if this is a little OT, but it makes me angry. And scared, a little. When I hear about WLS being recommended for all fat people, I’m tempted to say ‘over my dead body’, but perhaps that’s too close to the truth.

  5. Bree permalink
    October 1, 2011 10:05 am

    This morning I read on Ragen’s blog that Allergan, who makes LapBand, is trying to recruit Congress into labeling obesity as a disease and to advocate for more access to weight loss surgery and other weight loss methods. Allergan is calling itself “CHOICE” (Choosing Health Over Obesity and Inspiring Change Through Empowerment). So in other words, all fat people need to be told they are a disease, just based on weight alone. They really must be desperate for more cash for their LapBands if they’re trying to get the government involved. Hopefully the “keep big government out of our lives” clan will refuse to get on board.

  6. MissFay permalink
    October 1, 2011 2:46 pm

    My cousin had gastric bypass and suffered all sorts of complications. A friend of mine got the lap band and she’s doing fine. I am sorta being forced into getting some sort of WLS. I need knee replacements and they won’t do it until I get under 200 pounds Right now I’m around 320. My knees can’t take that much weight as I am only 5’2″ and small boned. My only other choice is a wheel chair. It really sucks!

    My doctor thinks I should get the lap band done on me.

    I think it is wrong that they are trying to medicalize obesity. My fat is fine, it’s my knees that are the problem and I am not convinced that a knee replacement at my weight would be unsuccessful. I NEED my knee joint replaced. I don’t need weightloss surgery but I really feel like I have no other choice. Does anyone know if I can go to Canada and get this done?

    • vesta44 permalink
      October 1, 2011 7:30 pm

      MissFay – I would be looking for another orthopedic surgeon. I’m 5′ 8″ and weigh 395 lbs and my orthopedic surgeon isn’t having any problems with the prospect of replacing my knees when the time comes, and I don’t have to lose any weight first (I’m in Minnesota). He said that as long as I’m healthy enough for surgery, do the exercises necessary before surgery to strengthen the muscles that support the knee, and do the physical therapy after surgery, he doesn’t see that my weight will be a problem (I’m also almost 58 years old). So definitely get a second or even third or fourth opinion before going through with any kind of WLS.
      In spite of what they tell you, the odds of you being healthy enough for knee replacement surgery after WLS aren’t good. So if you have WLS, lose a lot of weight, and end up with debilitating complications, they will still refuse to replace your knees, and you’ll have ruined your health for nothing. Not a risk I’d be willing to take, frankly.

  7. MissFay permalink
    October 2, 2011 3:54 am

    For my height Vesta I am much shorter than you and I have a small frame. I have checked with other surgeons and they are all telling me the same thing.

    I read up on the gastric bypass and it causes all sorts of health problems cause you can’t get the nutrients you need but that is not the case with the lap band. It just restricts how much you can eat. I did lose about 12 pounds because they said I have to lose weight before the surgery. At least with the band I can have it reversed if need be.

    I scoured the net and I can’t find anything that says the gastric band will make me a bad candidate for knee replacement but I may opt for the wheel chair because both the Zimmer and DePuy implant have a huge failure rate.

    Can you post a link about how having the Lap Band can make me a poor candidate for knee surgery? I’d like to show my doctor that so that maybe they will make an exception in my case. I’m really not sure if it is the doctors that won’t do it or the insurance company. I need to find that out.

    In my case my legs are very splayed from all the fat on my thighs and that combined with the small joints and my weight makes me a bad candidate for knee replacement surgery.

    I read here http://www.sciencedaily.com/releases/2010/01/100129151758.htm that patient gain weight after knee replacement surgery.

    I have to look into this more but as of now I may have the gastric band. I have to do something — some days the pain is unbearable.

    • vesta44 permalink
      October 2, 2011 2:22 pm

      Miss Fay – It would depend on who does your lapband surgery, what type of lapband you have, and if you have any complications from the surgery – and there are complications from lapbanding. The biggest one is death, it’s been all over the news, that 1-800- GET-THIN in Los Angeles has had several people die right after getting the lapband and they’re being sued (and it’s Allergan’s lapband that’s being used, if I recall).
      As far as the lapband restricting how much you can eat, yeah, it restricts how much solid food you can eat at one time, but it doesn’t restrict things like ice cream and milk shakes. So if you aren’t prepared to restrict everything you eat, you can eat around the lapband and it won’t do you a bit of good as far as weight loss is concerned. If you’re determined to work with the lapband, you’d be just as well off going on a restricted calorie diet and following that religiously until you’ve lost the weight the doctors want you to lose. But I have to say, just from my own experience with restricting calories, after a while, it doesn’t matter how much you restrict, you’re going to lose a certain amount of weight and then your body is going to say “fuck this, I’m done with starving, there’s a famine out there, so I’m going to hang on to every calorie I get and store it as fat.” You’ll stop losing weight no matter how little you eat, and you won’t be able to lose any more (been there done that, I gained weight on 500 calories a day, that’s why I don’t diet anymore, my metabolism is screwed 7 ways to Sunday from all the yo-yoing).
      As for complications of lapbanding, the lapband can erode your stomach, it can be overgrown by your stomach, it can perforate your stomach, it can be overfilled and the opening from the small upper pouch to the rest of your stomach will be too restricted for any food to pass (causing nausea and vomiting), or it can be underfilled which makes the opening too large and allows you to eat too often because you don’t get full as quickly and you get hungry quicker. There are others, but I don’t have the link to them and can’t find it. Those complications and death would be enough to make me think twice. You’re only 6″ shorter than I am, and almost 80 lbs lighter than I am, so I don’t see why those doctors are having such a hissy fit. My husband had one of his knees replaced 2 years ago, and I can assure you, he hasn’t gained weight since he had it done (and he has type 2 diabetes to boot, not to mention that he’s 5′ 10″ and 265 lbs and the VA didn’t even quibble about replacing his knee at his then age of almost 54).

      • MissFay permalink
        October 2, 2011 9:42 pm

        I feel like I’m between a rock and a hard place. I have to do something. I’d rather face one surgery than two. One doctor told me that by just losing weight my knees would feel a lot better and that there are some non surgical treatments. Weight is only part of the problem for me. I carry a lot of weight in my hips and legs. I have that classic pear shape and I think that is why my diabetes is not that bad and why I have no major cardiovascular disease.

        I really need to balance out the risks vs rewards when it comes to getting weight loss surgery and gastric band looks like the safest but I need to decide if the risks are acceptable.

        I did not start getting heavy until I was 20. I’m 36 now. I began putting on weight after I was raped. I had counseling and that helped some but I think I turned to food for comfort and to make me unattractive to men but when I learned that rape is not about sex but about brutality I began to think different. I was not consciously thinking that getting fat would insulate me from men but after I got big I just didn’t stop eating. I still have issues about men and dating but I do date.

        I do have a few friends who did dieted and have done really well. One went
        vegan and the others did other things. To be honest I have never tried to lose weight until recently and all I have done is stopped having convenience store lattes and bakery items and I really don’t feel deprived so far. I also have been eating multi-grained breads and I have been drinking more water. I may see how that goes. I have a bit more energy. I think cutting out that white sugar and flour may be why. I may do water aerobics at the Y but not for weight loss but for health. Now that I have more energy I feel like moving more.

        Well Vesta, you gave me a lot to think about. I appreciate you sharing your
        perspective and experience. I’m still on the fence but for now I will see how dieting works for me. So far so good.

        Vesta, have you ever tried body wraps? I ask because the culprit for my knees is the girth of my thighs. A girlfriend told me that she lost two inches on her thighs having a body wrap. Do you know if that’s safe?

  8. vesta44 permalink
    October 2, 2011 9:58 pm

    MissFay – I’ve never tried body wraps, their claims always seemed to be of the “too good to be true” variety. As for their safety/efficacy, this is what I found when I did a search:

    Experts disagree on the safety and efficacy of weight loss body wraps, even when administered by professionals in reputable spas and salons. In an article published by American Fitness Professionals & Associates, Mark Occhipinti writes that tissue compression resulting from weight loss body wraps can restrict blood flow to internal organs.

    So, from that, it seems to me that any inches lost would be from the flesh being compressed, nothing else (not burning calories or using up stores of fat), and that could be problematic. You have nerves and major blood vessels that run up and down your thighs, and somehow, I don’t think it would be a good idea to compress them (restricted blood flow isn’t good, neither are pinched nerves).
    I would continue with the healthy direction you’re going with your food choices, and see how the water aerobics work for you. I know when I’m in the water, my back doesn’t hurt and I can stand for hours that way, but my arthritic knee still hurts from the walking I do in the water (then again, I’m almost to the bone-on-bone point with the one knee that really hurts).

    • MissFay permalink
      October 2, 2011 11:39 pm

      I am checking into this for my knees. http://www.freeyourknees.com/ It sounds safe. Maybe it will help you.

      I always wondered about the wraps. I was told that the wraps cause the fat to be burned first in the area when they are placed because it increases blood flow but that could be mumbo jumbo.

      I know that if my breasts were so heavy that they were causing me back problems insurance would pay for breast reduction so I am thinking that maybe I could get lipo for my thighs. Thigh reduction? That makes the most sense. Like I said before, the weight is only part of the problem. My legs are splayed and it is effecting the knee joints and ligaments. I really want to avoid any surgery and knee replacement surgery scares me more than the lap band. I don’t think I can get knee surgery now anyway.

      • October 3, 2011 9:38 pm

        I feel really bad for you, I wish I had something useful to tell you. Maybe if you want to consider WLS, maybe you should just do the liquid diet that’s required for a bit a see how that feels? It’s just a suggestion, please, other readers, feel free to tell me I’m an idiot for even suggesting it because I may well be and I’m not afraid to be told so.

        Water aerobics is a good suggestion, you might want to try deep water aerobics, then you’ll have no weight on your legs. But that’s not an option if you can’t swim very well (you do it on a noodle or with a floaty belt, but most places also require you to be comfortable in deep water).

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