Lapping History —
It’s become a sort of mantra for me: saddened, but not surprised.
This time, it’s in response to Chris Christie getting the Lap-Band.
Predictably, the press went wild with speculation over Christie’s obvious presidential ambitions. Just as predictably, Jon Stewart pushed back against the hyperventilating punditry by simplifying Christie’s justification:
Why else would a 50-year-old man with young children and a loving family take steps to address obesity and extend his life? Why else? It is a classic presidential run tell… Can’t a guy get healthy without the prognosticators? “Oh, what does it mean?” It means he doesn’t feel well and wants to feel better.
Of course, Stewart’s assessment is also speculation. That’s the thing about personal health: you can’t determine the motives behind such a drastic, personal health choice unless you can peek inside the head of the chooser.
The fact is, you can’t divide motivations into mutually exclusive camps of professional ambition versus personal health concerns. It’s far more complicated than that.
Whatever the reason Christie chose the Lap-Band, it’s his choice. He no doubt researched his options and consulted medical professionals to choose a weight loss surgery that he felt comfortable getting. He even spoke with NFL coach Rex Ryan about the Lap-Band Ryan got in March 2010.
My main concern over the media scrutiny is that the actual, complicated story of Lap-Band is being obfuscated by the more sensational question of Christie’s motivation. As with my open letter to Kevin Smith, my primary concern in addressing these issues is that a comprehensive picture is painted for both the people involved, and those who are observing the media’s attempt at explaining the surgery.
In this case, the underlying question is about the efficacy and safety of Lap-Band surgery. As always, the media half-asses the details, duped by surgery-friendly research that is funded by Allergan, the makers of the Lap-Band. You can refresh your memory with this post I wrote about Allergan’s plan for unfat Americans.
In a nutshell, the Food and Drug Administration (FDA) approved the Lap-Band for those with a BMI over 30 who have at least one health issue correlated with obesity (e.g., high blood sugar, blood pressure or cholesterol). The problem is that the FDA relied on just one unpublished study that was funded by Allergan.
Dr. Joseph J. Cullen, professor of surgery at the University of Iowa Hospitals and Clinics in Iowa City, was on the FDA’s device panel and he voted against expanding the eligibility criteria Cullen has criticized the FDA’s handling of the review (PDF):
The FDA did a poor job presenting other data from some European and US studies that showed no benefit. I was really disappointed in the FDA’s review.
It turns out, Cullen isn’t the only one frustrated by the dependence upon Allergan-funded studies to tout the safety and efficacy of the Lap-Band. While researching the Lap-Band, I came across a January 2013 WebMD article titled “Lap-Band Shown Effective for Long-Term Weight Loss”. The article focused on “the largest and longest study yet” which was funded by Allergan. She passes along the Lap-Band-friendly talking points provided by the researcher:
He says gastric banding offers an effective, reversible, long-term solution for weight loss as long as patients get good follow-up care and are willing to carefully control the way they eat.
It’s only on the second page of the story that readers learn about the troubling history of the Lap-Band:
A 2011 study from Belgium found that the bands eroded in 1 in 3 patients, while 60% required additional surgeries… Four years ago, as many as 40% of weight loss surgeries performed at Lenox Hill Hospital in New York involved gastric banding, says Mitchell Roslin, MD, who is chief of obesity surgery. Today, the figure is closer to 3%. “Last year we took out 80 bands and converted them to other procedures,” he says. “Patients do well in the short term, but they tend to have problems later on.”
Also buried on the second page is the fact that Lap-Band sales have fallen from $300 million in 2011 to half that figure, leading Allergan to announce it was “looking to sell its weight loss surgery division.”
And this is supposed to be an article that touts the long-term benefits of the Lap-Band. But the fact is, we already knew that Lap-Band is an overwhelming failure from the vast trove of long-term studies we’ve got from Europe.
For example, there’s the 10-year study that included a headline that said Lap-Band surgery had “High Long-Term Complication and Failure Rates.” The study found that one-third of those who had the Lap-Band suffered major complications and the authors concluded quite emphatically:
Only about 60% of the patients without major complication maintain an acceptable [excess weight loss (EWL)] in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), [laparoscopic gastric banding] should no longer be considered as the procedure of choice for obesity.
Another 14-year study found similar reoperation rates and pathetic long-term weight loss maintenance:
After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up.
There’s even a two-year study where half the subjects had the band removed and the authors concluded that the Lap-Band is “not a recommended method for super-obese patients and we believe that a BMI greater or equal to 50 kg/m(2) is a contra-indication for this procedure.” Chris Christie has a BMI over 50, I guaran-damn-tee it. But did his surgeons advise him on any of these studies that seem to suggest that Lap-Band is a losing proposition?
Not only is the Lap-Band unsafe and ineffective, but there’s a possibility that it does long-term damage to your esophagus as well. Although gastric reflux initially improves in the short term, one of the few long-term studies about the effects of Lap-Band on the esophagus found a disturbing trend. Esophageal dysmotility disorders, which causes difficulty in swallowing, regurgitation of food and a spasm-type pain, were present in over two-thirds of the 167 patients who underwent the procedure.
If you Google “esophageal cancer lap-band” you’ll find those who have had the surgery and those who are considering the surgery discussing a correlation between the two. But as one Lap-Band cheerleader said, “Even if there is a higher risk, just think of all the diseases you are preventing from having the band! To me that outweighs it!”
Having a friend who died four years ago from esophageal cancer at the age of 41, I’m going to say no. No it does not.
And yet, despite all this evidence, there’s Jon Stewart defending Governor Christie for choosing to “get healthy.”
Because in this day and age, doing something, anything to lose weight is considered healthier than not losing weight. The mere fact that Christie chose a surgery that has a well-documented history of doing more harm than good is an indication that he is (a) on the path to health and (b) presidential material.
Both sides of the debate have it wrong. This decision will have serious, long-term health consequences for Governor Christie aside from the weight loss (although, as a popular, fairly famous public figure, he may have access to a more experienced medical team than the average American). But the media has ignored the evidence in favor of praising the fact that he has taken action.
What’s worse, once Governor Christie loses 50, 75, 100 pounds, then he will become a walking, talking advertisement for the Lap-Band, even while Allergan is having a fire sale to offload its struggling product.
The only net positive I can see coming from all this is that if Chris Christie does become the next President of the United States (and God help us all if he does), then we may have the first fat advocate in the White House. Even though he has made this decision, Christie still understands how difficult it is to be a fat person in America. Christie recently talked to Politico about being fat:
It’s really the only still-acceptable form of discrimination in our country is against people who are overweight… Most people are ignorant on the subject. What happens when you get into public life… you just have to learn to deal with it. Anytime you’re trying to educate people about it, if you yourself are overweight, then most people who aren’t informed on the subject just think you’re making excuses for yourself. Most people think it’s just an issue of willpower or that kind of thing and it’s a heck of a lot more complicated than that. Anyone who has had these problems over the years knows that.
While the “still-acceptable form of discrimination” claim is questionable, the rest of his comment is dead on. Chris Christie is swimming in the same toxic environment that pressures us all to do something, anything to lose weight, and the fact that he caved to an ineffective and harmful surgery is evidence that we’re all susceptible the pressure to take drastic measures.
Nobody should have to undergo surgery to prove their qualifications as a politician. Nobody should have to attach medical devices to their stomach to feel like they are a good and loving parent. But this is the world we live in, where fat is a black and white issue and anything is preferable to the stigma of fat.