Mandatory Weight Loss Surgery?

On an article I was reading, a commenter suggested that Weight Loss Surgery (WLS)  should be mandatory for anyone with a BMI over 40.  (I think that there are a lot of professional athletes who would take exception to this, but that’s another point). Ostensibly this commenter is just concerned about my health and how much money my deatfatz are going to cost the country.

As always, I absolutely respect people’s choices including their choice to have weight loss surgery. That being said, there’s some stuff I don’t get about the health thing.

First, from an intuitive perspective

Lap Band – I just don’t think that my internal organs do their best work when being cut in half by a foreign object.

Gastric Bypass – I think that my internal organs do their best work when they are left whole and in my body. I used to get horrible strep throat and my doctor said that surgery could cure it but at my age (27 at the time) is was pretty risky.  Of course, I solved the problem with non-traditional medicine, but the point is that now at 34 they are perfectly happy to give me a more complicated  surgery with a much lower track record of success.

Questionable Claims

You hear a lot that these surgeries “cure diabetes”.  I don’t have diabetes but I did just read that more information is coming out saying that the claims that the lap band cures diabetes may be completely erroneous.  Instead, studies are showing that the surgery may just mask it.  Charming.

Complications

A team of Belgian Researchers found that “as many as half their patients, followed for at least 12 years, needed to have the band removed in that period. And in more than a quarter, the band had gnawed its way through the wall of the stomach.”  There are issues with the sample size of research methods that cause this study to lack statistical significance, but when I hear “gnawed its way through the walls of the stomach” it’s enough to make me want to ask more questions.

Really, Really Bad Complications

And then there is this.  It is a poster put out by the American Society for Metabolic and Bariatric Surgery for handling surgery patients who come into the emergency room.  The first line I saw said “Bright red blood by mouth or rectum, bloody drainage”.  Yikes – they did not have me at “hello”!

Here is a very well-written blog by someone who had three WLSs and is still fat – certainly not the WLS fairytale we’re so often sold.

I keep going back to the core philosophy of my personal health plan:  Healthy behaviors have the best chance of leading to a healthy body.

So in order to evaluate WLS, I have to ask myself some questions.  (For now I’ll set aside the fact that by every conceivable measure of health I am in perfect health)

  • Do I believe that I would be healthier if I had elective surgery that puts a band around one of my internal organs to constrict its size and function?
  • Do I think that a doctor (whose stands to make 20K from my surgery) has a better plan for the routing of my digestive system than my body does?  (I once had a massage therapist who worked on a lot of ballerinas say to me “I just wish I could be there when they try to explain to their creator that they had a better idea for foot construction than the creator did”.  I feel much the same way about Gastric Bypass)
  • Do I think it’s healthy to eat an amount of food that is consistent with what we see in anorexic patients?
  • Is it a good idea to undergo major surgery which in over forty years has never been shown in proper studies to have any long-term improvements to actual health or that lives are saved or extended.   (For more on this, check out this excellent article on WLS, including links to the report that showed that “three years after surgery, the typical patient is still obese.”)
  • How do I feel about my 68.8% chance of dealing with recurring vomiting and my 10% chance of becoming a chronic vomiter (referred to as “surgical induced bulimia”)?
  • Do I want to volunteer for a surgery which causes somewhere between 2 and 6% of it’s patients to DIE in 30 days after surgery (making it the highest risk elective surgery)

No. No. No. No. No. Hell to the No.  I think that the person who commented that I should be required to have WLS  can go ahead and get it themselves and let me know how it goes, I’ll pass.

Published in: on March 29, 2011 at 8:14 am  Comments (23)  

23 CommentsLeave a comment

  1. I think the bigoted asshat dear sweet so-concerned commenter who feels that people should be forced to have WLS ought to take a long walk off a short pier into a sewage treatment vat hurry along and get their hands removed and their jaw wired shut to prevent them from making any more asinine comments.

  2. Isn’t it amazing how people can make such recommendations that they have no real clue about? Wow.

  3. I don’t know if you just knew I would chime in on this of course, with how well known I’ve made on your blog that the reason why I’m so anti-wls is because my life was ruined by it.
    Because I know so many people who’ve had the surgery thousands because of the internet, hundreds though because I used to belong to a large local wls support and social group, of people who are 9+ years out and most of us have had some to all regain, and complications and some have elected to have revisions. Because I am more immersed then most size acceptance advocates and fat activists in the wls world, I have friends both real life and social network who feel wls was the best thing to happen to them,between experience,study I know more about weight loss surgeries and am kept in the loop with having friends who are wls advocates. But more often then not most people regret the surgery, or blame themselves if it fails. My bariaric surgeon, is nationally ranked surgeon as a surgeon, not specifically although that’s what he does, bariatric surgery. It wasn’t his incompetence that caused my complications it was the nature of the surgery. Having my stomach stapled, a new pouch created and intestines bypassed. Because my gastric bypass was laproscopic it in itself wasn’t painful. The last 7 years of my life have been extremely painful, so much so that while I was reversed 6 months ago, and thats a major invasive surgery, I will never be whole again, and a lot of my complications will be with me for the rest of my life.
    I had no fear by the time I had my reversal, though, I was in such severe pain all the time and had already been quite physically and emotionally disabled that I was more afraid of not having the reversal(which wasn’t an option, I was at risk of dying from gi bleeds as I have major ulcers that started to perforate and bleed) as well as severe nutritional deficiencies and reactive hypoglycemia.
    that’s the joke that when people use diabetes as reason to perform wls, as most of us get hit with reactive hypoglycemia. no one knows no matter how compliant they are, how their body is going to reactive when your digestive system has been so intrusively altered. Most bypass and duodental switch patients end up with neurological and auto immune disorders, and because of the malabsorbtion problems it can cause, it can’t necessarily be controlled by meds at least, orally as you can malabsorb medications as well as nutrients too.
    This is an aesthetic issue pure and simple. I only know a handful of people out of thousands who’s lives were better after surgery as I do believe that some people have imminent health dangers due to their weight, I just don’t think that being of weight itself is a health issue and there has never been any extensive studies on how people are damaging their bodies to get or stay thin. And lots of thin of people have diabetes, high cholestrol and pulmonary hypertension.
    The problem is you ae going to continually have people seduced by the few who’s lives are positively changed and then have enough plasic surgery to conform to what most of societies ideal of beauty is. Most people who’ve had wls even if they say they had it for health reasons, aren’t posting pictures or charts of their lowered cholestrol levels, they are posting before and afters of their transformations. There is a whole shitload of things that people don’t realize that changes once you have wls, it just doesn’t change your weight, even without health complications, it changes your relationships, everything and lots of times it’s not for the better.
    I went into the surgery with low to normal bp, abnormally low cholestrol level and no blood sugar issues. I had surgery because I was fat all my life, borderline morbidly obese, I actually had to gain weight to qualify,not much though.
    That’s why I am so passionate about the work you do Ragen, if we can have people not measure their self esteem by what they weigh on the scale, when people like you call out people like Jennifer Hudson or other stars who were heavy and lost weight saying they couldn’t do anything or didn’t have a life prior to their weight loss, everything about what you do proves them wrong. Your strong, your healthy and athletic and graceful, you defy as well as other activists of what people like to blame on fat because they can’t get past the aesthetic issues they have with it. That’s why I promote when I can the work you do, the work Shannon, Joy Nash, Rebecca, Jennifer Jonassen, Pattie Thomas and Linda Bacon do. You help to see that the “war on obesity” is really a war against the obese. If we can instill healthy behaviors and self acceptance and tolerance and appreciation for all body types, when people are young, hopefully people wont be mutilating their digestive systems, sticking fingers down their throats and hating themselves because someone says they take up too much space.
    Sorry so wordy.. I can’t help not be.. Outside of being able to type wordy long responses on this subject can’t do much else, like ride a bike, drive a car or work like I did before my gastric bypass. I don’t want anyone to go through what I did, and I have actually know people personally and have friends from day 1 who were much sicker then I’ve been.

    • thanks for this…a new circle of firends of mine are TOTALLY pro wls with at least 5 in the “honeymoon” phase and 3 others working on getting ready for it. any arguments i give them fall on deaf ears. they dismiss it by say “oh thats OLD technology. the gastric bypass is great, with less complication than lap banding.” i want to scream and shout at them that the gastric bypass is irreversable and what happens when they hate it? when theyr hair falls our…or they bleed inside….or they puke the rest of their life after eating…but everyone is so brainwashed by the commercials and the success of those in the honeymoon phase you cant convince them its a dirty trick and lie. no one hears that side, and tis pathetic, and possibly unethical.

      • erylin, they are going by the fact the duodenal switch and the roux-en-y are purposely malabsorbtive by bypassing intestinal tract,saying other surgeries are safer, I had my rny in 12-2001, my surgeon still performs it the same way, however the lap band and the newer surgery the vertical sleeve gastrectomy, any wls becomes malabsorbtive if the there is a complication, and the sleeve is so new. with the sleeve they remove 80% of the stomach, which makes it IRREVERSIBLE. My roommate when I had my gastric bypass reversed(undone) had a lap band reversed which is normally an outpatient procedure, because her band would slip and started adhering to her liver, she had a cardiac history so they kept overnight she also had problems with chronic vomiting due to band restriction. It’s a forever surgery in terms of complications whether they are moderate to severe, it however is not necessarily a forever surgery in guarantee of health and weight loss regardless of weight loss surgery people elect to have. There is no guarantee that a reversal of rny can be enough for most to ever be normal, it just reduces the chances greatly, of dying for those of us who have had major complications.. There are people so fat phobic though in the wls community that they can have maintained their weight loss, but due to complications years down the road with gastric bypass/rny need their gastric bypass reversed, and even though they are thin, they will elect to have a lap band or a sleeve to ensure they never gain weight again, in my case where I had almost gained all my weight back from 2007-2009, lost half my regain in 2010, I would have never thought about revising to another surgery nor would have my surgeon, respecting my anti-wls stance, which that I give him credit for would have suggested…Unfortunately the people/patients who are “superstars” in the wls field really sell the surgery for the surgeons. A lot of people who do sick now have internet outlets, but a lot are afraid to come out because they are embarrassed or shamed that they failed their surgeries not the other way around, their surgeries failed US. Now that they are doing the the lap band on teenagers and Allergan will most likely be successful in getting the FDA to lower the BMI requirements for to qualify for a lap band you are going to see a whole new population grow much sicker then the few people who truly have health issues due to their weight by having various wls out there.

  4. My mom had her stomach stapled back in the mid-80s. Prior to that she had eating disorders but the stomach stapling increased them. In 1992 a car accident put her in a wheelchair and I became her caretaker until I simply couldn’t do it any longer in 2000. The more I hear about the long term problems with stomach stapling, the more I’m convinced that hers was the beginning of a lot of her problems. My mom has had probably close to 50 surgeries. Honestly I’ve lost count. Most of them were due to gastrointestinal blockages and infections. What I went through dealing with my mom and learning her negative habits with eating and body image make me oppose WLS.

    • I also had a stapled tummy in the 1985 and it was no pleasure ever… never a success. I have had ill health since and am 55 now with chronic heart failure. I am still overweight and really I cannot recommend this to any person!!! I can rather plead with anyone considering it that they must pleaseeeeee not do it!!!!

  5. I’m just so boggled and car-crashed on the idea of making any kind of surgery mandatory, I just… I’m honestly having trouble coming up with something other than “You know who ELSE believed in inflicting surgery on people against their will and without their consent? Does ‘Germany, early 1940s’ ring a bell?”

  6. Last night and this morning ABC news ran a story about the international diabetes association recommending wls as a cure for diabetes.The “expert” in the story was the head of a bariatric clinic, who stated that blood sugars may drop within hours of surgery and patients never need insulin again.Of course they featured an example patient who two years after her surgery was declared “diabetes-free”. She is now slim and fit. Dr Besser bemoaned the fact that many insurace plans don’t cover this surgery which “saves lives, and saves health costs!” No negative or contradictory information about wls surgery was mentioned, no negative personal stories, just a glowing beacon of hope for all the obese diabetics out there. I guess that means thin diabetics are still SOL… oh wait,there aren’t any thin diabetics right? Only fatties get type 2 diabetes(drips w/sarcasm). Ugh, makes me sick. Seems like wls is being pushed more and more these days. Makes me think of when lobotomies were all the rage.Scary stuff. I just don’t get why doctors always think they have all the answers. In every generation, you see some kind of treatment embraced by the medical community, only to be discredited later. And yet, every new treatment is the “breakthrough”! If the pattern of history holds true, some accepted theories and treatments today will become the phrenology and lobotomies of the future.I think wls will be one of those things, but only when the evidence against it becomes too overwhelming to deny. Bleah. I hate to think how many people could be harmed by then… I think I’ll keep my guts, and just stay fat.

  7. Thanks for this excellent blog – I have written a research article on WLS and diabetes and was not aware of the Marina et al study at the U of Washington which seems a rather important study! Lisa W who commented above – please fill out contact form at my website – I can put up your story and many will see it. Trying to identify patients who have had problems – there seems a lot of them out there, many of whom are not speaking out.

  8. I am 6 years post gastric bypass. I am still fat, at 275 lbs at 5’6″. BUT please compare: Before surgery: 430 lbs, I used a CPAP machine for sleep apnea, I was insulin-dependent diabetic and on three oral diabetic meds as well, was on two blood pressure meds, and had two inhalers. I could only shop in stores that offered handicapped carts because I could not walk far enough to grocery shop. I could not climb stairs at all. Now: no sleep apnea, no diabetes, I have a normal A1C with NO meds, I take ONE blood pressure med. I walk at least a mile at least three times a week, and in the summer on weekends, average a 10-15 mile hike 2-3 times a month. I will never be THIN, but I am healthy, and for me that’s what its all about.

  9. My aunt at gastric bypass and somehow she still gained all her weight back.

  10. My writing professor recently told me about a close family friend that underwent WLS. Healthy guy, mid-40s, cop – he just elected to have the surgery for cosmetic reasons. During the surgery, something was sliced that shouldn’t have been, and he bled to death on the operating table. Just that fast.

    I’m currently at a BMI of around 40. I’m flat-out horrified to think that some bariatric expert would mandate WLS “for my health”, and then make a mint when I am forced to comply. Which brings up: How would they enforce it? No health care ever again until WLS? What an absolutely bone-chilling thought.

  11. I find it very interesting that I posted a WLS-positive comment here and it never showed up, while more anti-WLS comments have been posted. Your bias is showing. I admire people with strong convictions one way or another. But when you will only entertain one position, and not even hear from the other side, it usually means you cannot defend your own.

    • Ragen doesn’t need me to come to her defense, but since I can’t sleep and I’m here I will say something. Ragen has said numerous times that this is her sandbox and therefore if we wish to play in it then we have to play by her rules. One of the biggest of these rules is that if she feels that a comment could be considered inflammatory or triggering she has the right to not allow it to let it through moderation. This is not a news story put out by what we hope to expect a unbiased view, but a personal blog. Yes her posts are well researched but they are a matter of her interpretation of the studies as well as personal experience. Yes she is presenting a unpopular view. This does not however, mean that she is intrinsically right or wrong. It simply means that she understands the value of good science and study.

      Congratulations if you have made a choice that has worked out for you. I mean that sincerely. That doesn’t mean it will work for everyone.

      Ragen, I throw myself on your mercy. if I have gone completely off base and have instead found myself in the cheap seats then I implore you to feel free to delete this comment. My feelings won’t be hurt in the least.

      • Hi Karen,

        I think you hit the nail on the head and thanks for the support. Everything that you said is correct, what’s funny about this situation was that I never purposefully didn’t approve her comment, it just took me a while to get to it! C’est la vie.

        ~Ragen

    • Patricia,

      Your impatience and rudeness are showing. Some people are regular posters and their posts get approved automatically. I have to approve new posters manually. I’m not a professional blogger – I’m a corporate CEO, I dance competitively as a professional, and I choreograph and dance in a cabaret troupe, while maintaining a professional athlete’s workout schedule, so sometimes it takes me a while to get things approved. Imagine my joy to log in to approve comments and find this little piece of…sunshine.

      Since you took the time to comment, let me give you a few minutes of my full attention. First, I’m not trying nor do I feel the need to, “defend” my position. Predominantly because this blog is about my choices – I’m not trying to tell anyone else how to live, and I’m certainly not soliciting recommendations on my health from random people on the internet (you’ll notice that throughout the blog I always use “I” statements and that I specifically said “As always, I absolutely respect people’s choices including their choice to have weight loss surgery.”).

      My “bias” was the ENTIRE point of the blog – I will never get weight loss surgery for the reasons that I stated. The fact that I’m “biased” (also known as drawing a logical conclusion based on solid research and my common sense) against weight loss surgery is a big flaming sack of duh. My choice in no way affects or threatens your choice or the choice of others unless you decide to let it.

      Had you managed a modicum of patience your comment would have been approved tonight without incident and you could have smoothly joined the discussion. That being said, I also don’t feel compelled to give anyone a voice on my site unless I want to. I don’t seek out people who disagree with me and post on their sites, and I only allow people to do that here when I feel like it. This isn’t a public forum or a debate, it’s my blog. Get it?

      ~Ragen

  12. You want to know what is even funnier still? When my email alert on my phone when wacky with alert after alert I actually said out loud to myself, “oh, Ragen must have gotten a moment to push some comments through moderation.” Literally that was the first thing that went through my head and I was right, lol.

  13. It’s almost 3:00 in the morning, and I’m sitting here unable to get even a half-cup of water down. 14 months ago, I had lap-band surgery and I’ve lost 130 pounds. Everybody says I’m gorgeous again. I’m 5’8″ and as of this morning I’m down to 128 pounds. I’m sure I’ll weigh even less tomorrow. But guess what? I’m miserable. I have no quality of life. For the past 10 days, I haven’t been able to eat ANYTHING without extreme pain and vomiting within 10 minutes. I have a constant nagging pain under my right ribcage, (my liver) and there is an occasional searing pain between my shoulder blades. When I lie on my back and palpate my now sunken abdomen, I can feel thick ropes of scar tissue snaking around my port and the top of my stomach where the band is. But now I’m really scared. For the past 48 hours or so, I haven’t even been able to keep liquid down. My heart pounds every time I go up my stairs, and I feel faint when I stand up. Despite my so-called success, I cannot ever recommend this barbaric procedure. It makes me sick to see the billboards and hear the mindless jingles on TV about “your new life beginning” when I have to run from the table to make it to the bathroom. Lately I’ve had to reassure my daughter that mommy will be okay because I can’t hide my constant vomiting from her. I’m afraid to go to sleep because I know it will only be a few hours before I awake violently chocking on regurgitated stomach acid. A couple of months ago I had all but two ml of liquid removed from my band because of my problems. I was told at the time that I probably had a “slipped band”, but that removing most of the restriction would likely fix things. Really?! My problems have grown progressively worse. I was told when I was pre-op that slipped bands were now rare because of improved surgical techniques. I wish I had asked, “How rare?”…I can see no point in going on like this. The only thing to be gained will be a nice, thin corpse and a normal-sized casket. I’m going to my surgeon’s office this morning and demanding that they take this thing out! Wisdom and good will to all of us who are trying to come to terms with weight, health and body-image issues.

    • I’m so sorry that this was your experience – thank you for sharing it here so that people can hear this side of the lap-band story. I wish you the absolute best of luck and hope that you are feeling much better very soon.

      ~Ragen

    • I don’t know how your appointment went,I hope you post something when it did. When I had my reversal of my rny, my roomate had her band removed because it started slipping, and adhering her liver,band slippage and too tight bands are complications not necessarily mutually exclusive, hopefully if you are really sick they will take you band out, because there is so long one’s body can withstand being so violently ill from the vomiting and not eating, we are so predisposed to finding adipose not attractive, especially those who surround ourselves in wls land, we don’t realize until we see people not inside that world and gain others perspective how sickly we really look because some of the people in wls world are some of the most fat phobic people out there. anyways if you like you can email me privately at angelsbare@aol.com, if its ok with Ragen, as its not my intention to hijack her blog… you can find me on Facebook that way too if you like. I am so sorry you are going through this… Hugs, Lisa..

    • The fact that you have not been able to eat for ten days or drink for two scares the hell out of me. I hope you are getting the medical help and compassion you need. PLEASE post and let us know how you are doing,I’m really worried about you and I’ll bet everyone who has read your post is too.

  14. I deeply appreciate the dialogue on this topic. I work on a surgery floor that specialized in the oppression of fat people (wls). We see patients after the fact, but always wish they would visit before as the post-op complication rates are high and severe.

    I am attaching a link to a release required by one surgeon (not associated with my facility, else people might choose differently), in the hopes that it might serve and support anyone considering the surgery.

    Thanks to everyone willing to share their stories and to each who continue to live well in the bodies we have today.

    http://www.peopleofsize.com/articles/23/Weight-Loss-Surgery-release-form


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