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Mildly Obese Can Benefit from Barbaric Surgery

June 20, 2013

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.

Surgeon

First, Do No Harm

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. 😦

Vesta44

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14 Comments leave one →
  1. Rubyfruit permalink
    June 20, 2013 2:14 pm

    I hope that more “mildly obese” people turn down weight loss surgery too, but my optimism doesn’t hold out that long, because I fit that category. A lot of people I know fit that category. Though unlike me and at least a couple of other people, a lot of the other people I know who fit the “mildly obese” label are also on some diet or another every few months, and I know that at least a couple of them would see weight loss surgery as a way off the dieting carousel for good, even if it’s more like a seatbelt that keeps them strapped on for good. And I’ve mixed my metaphors there, sorry.

    So I also hope for the day when society sees bariatric surgery as the barbaric practice that it is, but I also know that a lot of people will think of it as more of of a golden ticket. I wish I could tell more people that it isn’t, but the ones who need to hear it the most are also the least likely to want to hear it.

  2. nof permalink
    June 20, 2013 2:18 pm

    The title made me shudder, literally.

    I am so furious with all these studies that twist and manipulate the data as much as possible to make WLS look good. It’s bad science and dishonest science and bought-and-paid-for science at its worst.

  3. June 20, 2013 3:12 pm


    And as for the DOCTORS AND SURGEONS who do not look beyond the skewed findings (in studies funded by those who profit from WLS and other weight loss = “health” propaganda), well, frankly, I don’t know how they sleep at night knowing they are perpetuating a GREAT HARM against otherwise no-less-healthy-than-average people…. all for visual aesthetics!! Bastards, all! Human predators! Butchers!

    Yeah, I’m freakin’ pissed off!

  4. Dizzyd permalink
    June 20, 2013 5:07 pm

    Yeah, you and me both, Fab!

  5. June 21, 2013 12:40 am

    Reblogged this on The Cheese Whines and commented:
    The sad thing is, there’s still this part of my mind that immediately thinks “well, now that obesity has been declared a disease, maybe my insurance will cover bariatric surgery, and this will force me to lose weight.” Not because I think that being fat is bad, mmmkay, but so I can become as invisible as I want to be. Of course I will never be young and pretty, and therefore I will never be what I’m supposed to be regardless of my size. But the thought passes through my mind. This is how they will trap people, with the promise of finally being socially acceptable.

    • June 21, 2013 9:59 am

      Cie,

      I feel the same way. There’s a Women & Children’s Clinic here that runs their WLS “success stories” commercials. I fast forward through them (thank goodness for DVR!) as fast as I can, but it seems like I somehow still always see them. I have to actively recite my “mantras” to keep them out of my brain. Sometimes it works, sometimes it doesn’t. As much as I don’t believe that weight loss is a necessary health intervention and as much as I believe that WLS is a barbaric procedure, there is always a part of me that wonders if I could be one of those success stories and what it might be like to finally fit into what society believes I should look like. The lure of that kind of acceptance is very, very strong.

      And I won’t even go into detail about the kind of horror that spawns in me every time I think about the fact that this hospital’s bariatric surgery program is in the Women & Children’s clinic.

    • July 3, 2013 5:54 pm

      There is a lot that can happen that could make you even more isolated though, like constant throwing up or horror farts, dumping syndrome, etc.

  6. Happy Spider permalink
    June 21, 2013 4:23 am

    In your first quote, are you sure they mean 50% to 80% of the person’s total weight? The quote says “excess weight loss” instead of “weight loss” so I wonder if it means 50% to 80% loss of the excess weight, ie the 30-60 pounds of overweight that people in that BMI range supposedly have.
    In a later quote, are you sure that’s a 10 year follow up study? The link says that it is a study of preoperative versus postoperative conditions on patients who had surgery at their clinic over the 10 year period Feb 2000 to May 2010. So the last patients had surgery only 3 years ago. And how do they define postoperative?
    On an unrelated note, they have a lot of nerve in that first quote, talking about 1-year numbers. Everybody knows that’s worthless.

    • June 21, 2013 9:34 am

      Thanks for clarifying, Happy Spider. This was my fault in a hasty editorial move. Sorry for the confusion.

      Peace,
      Shannon

  7. Elizabeth permalink
    June 21, 2013 7:11 am

    You know one of the things I like about this site and other fat activist sites? People aren’t afraid to be angry about things we should all be angry about. I am very tired of people who somehow think we should be reasonable in response to incredibly unreasonable, outrageous practices such as bariatric surgery. Thank you all for your well-placed indignation.

  8. Dizzyd permalink
    June 21, 2013 3:42 pm

    Re: the Jan. 2012 study – I wonder how small or big the ‘improvement’ in all those comorbidities was. It could be as little as 1- 2 percent and they’d go ‘hey! They improved!’ Cie – the part that would scare me is the ‘force me to lose weight’ bit in order to finally become ‘socially acceptable’. If THAT’S what it takes, I’d rather stay an outcast, thank you!

  9. June 22, 2013 7:47 pm

    How low are they going to go? 180lbs, 160lbs, 140? Anyone that doesn’t look stick thin? I hate WLS, I’ve puked enough of my guts out from other illnesses, no thanks. Weight Loss surgeries are today’s lobotomies, torture for the fact. Anything but REAL HELP!

    http://fivehundredpoundpeeps.blogspot.com/2013/01/weight-loss-surgery-medical-treatment.html

    • Dizzyd permalink
      June 23, 2013 3:55 pm

      That sums it up right there – lobotomies. A way to force those who don’t conform to societal expectations to be brought into line. How much you want to bet? Cuz if it was really to help us, I could definitely think of better ways than to slice, dice and julienne your stomach or squeeze it with a rubber band in order to starve you of essential nutrients, cuz all those nutrients have big bad calories!!!!!boogabooga! I get so sick of those stupid commercials all the time for foodstuff where the big draw is it has zero fat and only so-and-so calories! It’s like if you’re so damned afraid of calories and fat, stop eating! That way you don’t have to worry about the dang calories and stuff. The low point of low points is where they have some campaign here in San Jose where they have ads on the side of buses to promote drinking more water, complete with a cute little cartoon beaver to appeal to the kiddies. Now, I’m all for drinking water – as it’s a good source of hydration – but then they have to go and ruin it with one ad saying “Zero Calories!” Like, oh boy! I’m gonna run right out and drink some just for that alone! Morons.

  10. Dizzyd permalink
    July 3, 2013 6:48 pm

    Though I won’t offend anyone who might be so with comparing apples to oranges, this makes me think of what is happening with the followers of Falun Gong in China. This came to mind after I just walked through a gallery of beautiful yet shocking paintings that detail what is happening to these poor people and the horrors of their plight just for simply believing a certain way. Think of it, these horrid practices being foisted onto fat people: the starvation, the butchering of people’s bodies, the dangerous substances we’re asked to ingest all in the name of – not health – but societal conformity. It’s like we’re being told “Why don’t you just submit and become what WE dictate you should be like. It’s for your good. If you do, we promise not to discriminate and stigmatize you. If you don’t, we’ll systematically destroy you, all the while making ourselves look benevolent.”

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