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Barbaric Surgery: it doesn’t work, doesn’t help, and isn’t necessary

January 29, 2013

Trigger warning: Discusses weight loss surgery, adverse events of surgery, psychological problems, suicide, and anti-fat bias.

Following the onslaught of diet ads in the first weeks of January, it is perhaps timely that we’ve just seen a series of new publications about weight loss surgery (WLS). Tell us again how YOUR diet plan works…

But anyway, I have to thank one of my readers for telling me that she misread something I wrote about bariatric surgery, and came up with the much more appropriate barbaric surgery. And thus it shall be known forevermore. So here’s a bit of a round up in what’s happening in the world of barbaric surgery (BS, for short).

Let’s start with “doesn’t work.” An Australian team has just published a review of outcomes from gastric banding over 15 years at their bariatric surgery centre. Over that time, they operated on more than 3,000 patients — the number that was widely reported along with the results of the study. As ever, a closer look tells another story. While they may well have operated on 3,000 patients, 10-year follow-up was only available for around 700, and the much-touted 15-year follow-up applied to just 54 patients. They also had a 16-year follow-up for 14 whole people. Well, almost whole people.

Anyhow, at 15 years the mean “excess weight loss” (i.e., the amount of weight above a BMI of 25) was 47.2%. That’s right, even after going through barbaric surgery, the follow-up surgeries to fix problems (2,000 of them), the malnutrition, the psychological problems, and all that other fun stuff, many of them were still fat. Very fat.

The authors also did a systematic review of the bariatric literature with over 10 years of follow-up. For lap bands, they found seven studies (including their own) comprising an impressive 315 people. Weight loss at maximum follow-up ranged from 33% excess weight to a maximum of 60%. For bypass surgery, they identified nine studies with 582 people at maximum follow-up. Results from this more invasive and irreversible method included excess weight loss ranging from a super impressive 27% to a high of 68% — still only two-thirds of the way to a “normal” BMI. That 27% came from the only study with more than 25 years’ follow-up. Five studies looked at gastroplasty. Mean excess weight loss was around 50%, but they ranged from 62% excess weight loss to a 10% weight gain. Results!

OK, moving on to “doesn’t help.” It has long been known that most people don’t really undergo BS for their health. A 1991 study found that in patients who had lost 100 lbs following BS “patients said they would prefer to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, very bad acne, heart disease, one leg amputated) than to be morbidly obese. All patients said they would rather be normal weight than a morbidly obese multi-millionaire.”

More recent studies have reported similar results, including this one  just published by a team in the US. They surveyed nearly 600 people seeking BS, investigated their current quality of life and included a series of scenarios to identify what they would be prepared to give up to achieve a lower weight. They concluded that over a quarter of patients would accept over a 10% risk of death to achieve their most valued weight. Only two factors had a statistically significant impact on decreased “health utilities”: (1) physical problems with work and daily life due to their weight and (2) obesity stigma. Obviously, any interaction between these two can’t be measured in this type of study. But let’s face it. Many people undergo medical mutilation to avoid the stigma of living in a fat body. It has nothing to do with health.

never apologiseBut perhaps the cruellest cut is that nobody will respect them after they lose the weight either, since they’ll be assumed to have taken the “easy way out,” and are therefore still greedy, lazy, and unable to control themselves. An experimental study where 73 individuals were shown before and after photos of a woman and told that she had lost weight through either diet and exercise or else through barbaric surgery found that presumptions of greediness and laziness associated with being fat remain if you lost the weight through surgery. Other studies have also shown that most people still think of surgery as  the easy way out for people with no self control. And here’s yet another study showing that people judge previously fat, but now thin, people just as harshly as they judge still-fat people. Clearly they were flawed human beings to get themselves into that condition in the first place! 

So perhaps it isn’t entirely surprising that a recently published  systematic review of completed suicides following BS confirmed what had been suspected — that the rates were much higher than in the general population. The review didn’t look at attempted suicides. Most of the included studies did not discuss reasons for suicides, but — in a case of stating the bleeding obvious — psychiatric problems were frequently cited. The authors also noted higher rates of alcoholism/liver failure, drug overdoses, and death by car accident in this population. It’s also well known that psychological problems increase with increasing BMI. There’s been some debate as to whether depressed people “let themselves go” and become fat, or fat people become increasingly depressed, for whatever reason (gee, lemme think). But a 2011 review of the literature shed some light on this issue. I don’t even really need to write it, do I? We know which way this works. And now, the evidence supports it.

And all this misery, for what? I’ve written before about how unhelpful is the focus on weight, how unnecessary it is to become thin in order to become healthier. But then it isn’t really about health. The haters will never accept us, no matter what we look like, and why would we want them to? Let’s finally just live the lives we want, and stop destroying ourselves to try and win acceptance from a group of  people who don’t accept us now, never will, and seem to be proud of the fact.

Never Diet Again Sigs

8 Comments leave one →
  1. fatology101 permalink
    January 29, 2013 1:44 pm

    Thats because being fat has NOTHING to do with food. I had the lap band in 2005. What a waste of time and money. Cant wait to have it taken out. Food gets stuck all the time. It is awful.

  2. Maggie permalink
    January 30, 2013 11:26 am

    This information needs to get out into the mainstream media! Of course it won’t because it’s all about cashing in on people’s hopes. Maybe insurance companies will stop paying for them when they see how ineffective they are…?

  3. Jodi Baum permalink
    January 31, 2013 10:10 am

    I worked in an adult psych unit for 9 months and had multiple pt’s who claim gastric bypass surgery ruined their lives. One had a feeding tube because she was so thin and couldn’t absorb the nutrients needed to survive. Another was a social worker, she was denied the surgery by her insurance and paid cash to her doctor whom also did not recommend the surgery, but apparently performed it anyway. She now has so many health problems from the surgery that she is homeless and unable to work. Not to mention that she is now addicted to pain meds and is now one of the worst drug seekeers I have ever dealt with. I don’t know if her body wasn’t absorbing the meds but if I was to take her meds, it would kill me, it was sad to see. Most were admitted for attempted suicide and all said if they had it to do over again, they would not have had the surgery. I know many people who have had the surgery and I can’t say that I would want to deal with the stress that they go through with relationship problems, medical problems and self esteem issues. Talking to people who have had the surgery has really opened my eyes, it is barbaric.

    • The Real Cie permalink
      February 1, 2013 5:07 am

      People dealing with chronic, severe pain develop a tolerance to pain meds. What they take (and still often don’t find relief) would knock most of us out.
      These are some real horror stories, and yet this knowledge is being swept under the rug. Those getting the money for performing these surgeries don’t care whose lives they destroy.

      • Dizzyd permalink
        December 2, 2014 1:17 pm

        That’s because they don’t see us as people who deserve to be treated with dignity and respect. So why should they care what they do to us?

  4. Isabel permalink
    August 13, 2014 11:08 am

    I love this site. But one of these days I’d like to speak as to how gastric bypass saved my life (and arguably also that of my father to whom I was later able to donate a kidney because I was just under the bmi limit). My doctor promised a 10% weight loss, he said that that was all that was needed to alleviate my “comorbidities”. He implied that if I was trying to achieve supermodel weight I needed to find a different doctor because that’s not what he was about. 10 years later, at 230, I’m still clinically obese but have kept off more than 25% of the weight without dieting obsessively (I did increase my exercise, although there were rough periods when I couldn’t muster the time or energy). I have had virtually no side effects. I feel that if more wls surgeons were like mine, wls would not be so maligned by the fat acceptance movement. I feel very strongly about supporting this movement, and it is helping me to participate in life in a fat body rather than spend the rest of my life obsessing about weight loss. I hope that people like me can participate in this revolution despite decisions we made a decade ago…that we honestly don’t regret. Many people are healthy and strong at 320 lbs, but I wasn’t strong enough and without going into detail was positive that I would die soon at that weight.

  5. Isabel permalink
    August 13, 2014 11:09 am

    Oops I guess I made the speech I was saving for one of these days…

  6. August 13, 2014 11:26 am

    Hi Isabel,

    Thank you so much for sharing your experience, and I’m glad it worked out so well for you and your father. I agree that more surgeons should be like the one you had, but I imagine rates of surgery would go down a lot – most people are sold on the super-transformation that almost never happens. I’m also really glad that you are not suffering the after effects of surgery.

    Sadly, many of us in this community know far too many people for whom that was not the case, or know the people they left behind. I doubt you and I disagree that WLS is over-used and over-sold and that the potential risks are under-reported. If, being aware of all relevant information a person decides to go ahead and choose WLS, that is entirely their decision. What many of us are fighting for is that these people are able to give true informed consent, which is often not the case.

    I know some people who are healthy and strong at over 300 lbs, but there are probably not as many as there could be, because heavier people are lied to and discriminated against, keeping them tied into unhealthy lifestyles (including yo-yo dieting in yet another ever more extreme attempt to become thin, this time) thinking that is what is needed to improve their health, and self-loathing, which is also really really bad for you. We here are fighting for real information, real options, respect for all, irrespective of size.

    I do gather that some people who have had WLS are treated poorly in certain SA communities. I think I’m safe in saying that nobody in this community would behave like that. We are fighting for acceptance for ALL bodies, whatever they currently look like or the history of their owner.

    Ang 🙂

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