Mildly Obese Can Benefit from Barbaric Surgery
Trigger warning: All about weight loss surgery.
Every time I see one of these headlines, all I can think is not just “No,” but “Oh hell NO!” It really makes me wonder if the weight loss surgery industry is taking such a huge a hit from so many DEATHFATZ people who have finally said “Fuck you” to WLS that they’re having to recommend it to smaller and smaller people. This article, “Mildly Obese Can Benefit From Gastric Band,” is a recently-accepted, but not yet published, meta-analysis of WLS studies using subjects with a BMI of 35 and under. To put this in context, check out Kate Harding’s excellent BMI Illustrated project, where you can see that Kate Harding and Joy Nash have a BMI of 34. This study recommends the Lap-Band for those who look like these 1, 2, 3 “obese” women. It doesn’t say whether all subjects had comorbidities or not, only that “[t]here is encouraging suggestions that comorbidities show partial/total resolution.”
In a review of six studies, the mean percentage excess weight loss ranged from 52.5 to 78.6 after 1 year, according to Sanjay Agrawal, MS, FRCS, of Homerton University Hospital in London, England, and colleagues.
Now, I realize that with a BMI of under 35, losing anywhere from 50% to 80% of “excess body weight” would put a person into the so-called “normal” weight range and make them *GASP* thin, but is it really necessary?
Further, patients who received the so-called laparoscopic adjustable gastric band (LAGB) saw significant to total reduction in comorbidities such as diabetes, depression/anxiety, arthritis, hyperlipidemia and respiratory disorders, the research team reported online in the journal Surgery for Obesity and Related Diseases.
Ah yes, resolution of comorbidities is being cited again, with nothing said about how many patients resolved their health issues or how long that resolution lasts. Want to bet it’s not a lifetime resolution? Want to bet that as soon as the weight starts coming back, so do the comorbidities?
While lapband surgery normally has been indicated for the most obese patients with body mass index above 35, the data showed success and few complications for patients who were generally 30 to 60 pounds overweight, said Phil Schauer, MD, of the Bariatric & Metabolic Institute Institution at Cleveland Clinic.
Fuck me! If I was only 30 to 60 lbs over what they consider my “ideal” weight, I’d tell them to take their WLS and shove it up their asses. That any comorbibities I might have could be treated with things much less drastic than their WLS, with fewer side effects than their WLS, and that actually work far longer than their WLS.
“We’re beginning to see now surgical procedures, not just the banding, but other weight loss procedures, even the sleeve gastrectomy and gastric bypass, be applied to patients who are not severely obese, people in this BMI range 30-35,” Schauer said.
Oh, hell NO! Lap-banding is bad enough, but sleeve gastrectomy and gastric bypass for that BMI range? FUCK NO! I guess so many fat people have decided that getting WLS is not the way to handle their health that Schauer is gunning for smaller and smaller people. Is Health at Every Size® making that huge of a bite into your profits?
Because claiming that WLS resolves comorbidities in barely-obese people isn’t going to cut it either. After all, we have actual published reports from Schauer’s colleagues that tell us what long-term resolution looks like. A January 2012 study by the Bariatric & Metabolic Institute Institution at Cleveland Clinic reported over a ten year period on 42 patients with a BMI between 30 and 35 who got one of three laparoscopic surgeries: gastric sleeve (24 patients), gastric bypass (8 patients), or Lap-Band (10 patients).
Of these 42 patients, 25 (60%) had type 2 diabetes, 1 patient was glucose intolerant, 27 (64%) had arterial hypertension, 25 (60%) had dyslipidemia, 17 (40%) had sleep apnea, and 8 (19%) had osteoarthritis. The postoperative findings included a mean BMI of 26.5 kg/m(2) and a mean weight loss of 41.4 lb. Of the 25 diabetic patients, 5 (20%) gained remission and 12 (48%) improvement of their diabetic status. The single patient with glucose intolerance showed improvement. Of the 27 patients with arterial hypertension, 9 (33%) showed remission and 13 (52%) improvement. Dyslipidemia resolved in 5 patients (20%) and improved in 13 (52%). Obstructive sleep apnea resolved in 10 (59%) and improvement was seen in 1 patient (6%). Finally, osteoarthritis resolved in 1 patient (12%) and improved in 5 (63%).
After surgically altering, if not outright mutilating, their healthy stomachs, these barely obese patients had a shockingly low long-term resolution rate for diabetes, high blood pressure, osteoarthritis and high cholesterol, despite being on the cusp of “normal.” The only health issue that had a resolution in over half the patients was sleep apnea.
The bariatric surgeons’ conclusion? “Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity.” While achieving statistical significance, it sure as hell doesn’t seem like a significant resolution to me.
Unlike that study, this as-yet unpublished study has a curious methodology:
Researchers conducted a systematic search up to September 30, 2011 using Medline and Embase databases. Among the studies, one was a randomized controlled trial and five were retrospective studies with prospectively collected databases.
Patients were ages 16 to 76, and the majority (80%) were female. Mean preoperative BMI ranged from 32.7-33.9, (range 25.1-35). All surgeons used the LAPBAND System (Allergan, Irvine, California, USA) to perform laparoscopic adjustable gastric banding with standardized techniques. Follow-up ranged from 30 days to 5 years.
Only one was a randomized controlled trial, while the others were retrospective studies. Retrospective studies susceptible to confounding issues and selection bias, especially if not well-controlled for patients who are lost to followup Successful patients are more likely to followup. Of course all those surgeons used Allergan’s Lap-Band system (can I just restate how rage-inducing this is to me?). How many of these six studies were funded by Allergan or some other I’m wondering about that follow-up: “ranged from 30 days to 5 years.” How many of the original 515 patients are included in this five-year followup, I wonder? I’m betting it’s a minute fraction, and that a much larger percentage were only followed for 30 days to 1 year. Makes the following numbers seem a bit optimistic to me.
Weight loss data were available for five of six studies, with mean percentage excess weight loss at each time point of:
- 1 year postop, 52.5 to 78.6
- 2 years postop, 57.6 to 87.2
- 3 years postop, 53.8 to 64.7
- 4 years postop, 68.8 (only one study had data on years 4 and 5)
- 5 years postop, 71.9
Without reviewing the six studies used to come to these conclusions, we’re left taking the word of the bariatric surgeons who wrote it..
With regard to complications, only one patient of the 515 (0.19%) developed wound infection, while 20 out of 515 (3.9%) patients developed band slippage/migration. Five of these were treated successfully by band deflation, six underwent band revision, and four patients required band removal.
Also, two out of 515 patients (0.39%) developed band erosion and both patients subsequently underwent band removal. Seven out of 515 (1.4%) developed port leaks.
There was no immediate/early mortality reported in any of the studies, although one death was reported in one study, at 20 months postoperatively, due to sepsis secondary to gastric perforation of a dilated gastric pouch.
So 31 patients out of 515 had complications, up to and including death. Tell me again how WLS is cheaper than being fat?
The study was limited by the small number of included studies and by the short- to medium-term follow-up data available. But the researchers still concluded that their findings suggest that gastric banding “is safe and feasible with good short-term outcomes in mildly obese patients,” adding that there’s also a favorable effect on obesity-related comorbidities.
However, they warned that there’s still a “paucity of data on this group of patients, and long-term outcomes need to be evaluated further.”
Ya think? And notice that the authors found bariatric surgery in the barely-obese has “good short-term outcomes.” Who cares about good short-term outcomes of this mutilation when the whole point is that it’s supposed to “cure” the diseases caused by fat?
I long for the day when society looks back at bariatric surgery and calls it what it really is — barbaric surgery. Sad to say, I don’t think I’ll live long enough to see it. 😦