Surgery for Weight Loss - is it really a magic bullet?

 

In one test of gastric bypass in rats, many abnormalities were found at autopsy, including damage to the stomach, liver and pancreas from fibrosis (American Journal of Clinical Nutrition 40:293-302, 1984). We don't know whether these progressive abnormalities happen in human patients, because autopsy results have never been reported. Because of a lack of animal testing, the panelists will lack information on the biological effects of these operations.(Paul Ernsberger, Ph.D. Associate Professor of Medicine, Pharmacology and Neuroscience, Case Western Reserve School of Medicine)

 

"By doing this surgery, you're creating a medical disease in the body" says Dr Edward Livingston, director of the University of California At Los Angeles Bariatric Surgery program and with eight years experience, a veteran in the field. "Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating." Ref: p 175, Self Magazine, April 2001 "Would you have surgery to lose weight?"

 

Lately, in the news, we've heard about surgery for weight loss. We are shown photos and films of folks with glowing faces telling us that these surgeries can save our lives and 'give us our life back'. People like Carnie Wilson who gleefully remind us that they lost 160 lbs due to the surgery also tell us that it really didn't hurt (Carnie tells us that she was 'just a bit sore' after surgery - a statement which her aftersurgery photos cause us to question - she, like all the others had a morphene pump - this device allows them as much morphene as they need and generally is only given to patients with excrutiating pain). We are also told that the weight loss is quick and easy. Carnie tells us that it was like she "blinked and the scale went 'WUUP'! ".

The latest wrinkle in this, which we should all, be beginning to recognize as a rather slick advertising campaign, is ads appearing in tabloids which show before and after photos and feature syrupy testimonials of people who love the way they look now and how surgery was the only way they could look like a waif. The ads contain no disclaimers about the dangers of the surgery and only have a short statement that "the NIH has declared bariatric surgery to be an effective treatment of clinical obesity". The ad continues "If you are 100 lbs overweight, bariatric surgery may help you. There IS hope!"

How many folks, almost frantic from the "great obesity epidemic" scare messages on TV, realize that not giving an important fact or two is a very effective way of lying about something. That is, when no dangers or complications of the surgeries are detailed, folks might think there are no dangers to this bariatric surgery!

And like many other ads for the diet industry (and yes Weight Loss Surgery is another diet only it forces the individual to diet by permanently damaging their digestive system), the long term results of this surgery are seldom if ever, even mentioned. It's assumed that once the weight is lost after surgery, it, of course, stays off.

The ad campaign and publicity is working. Everytime Carnie gets on TV, stated one surgeon to a reporter of "Self Magazine", the phones of all Weight Loss Surgery surgeons ring off the hook!

What are the realities of this surgery? Like anything else, reality is quite a bit less attractive than the celluloid image. In a nutshell, here it is:

 

Effectiveness i.e. how long does the weight stay off?

One study done in 1999 of gastric bypasses (the "Hebrew Study") showed that 25 percent of gastric bypass patients had regained all the weight they lost by the 9th year. Reality appears to be that after the first year (which Weight Loss Surgery patients call the "honeymoon" because the weight is rapidly dropping off), most patients are facing weight gain if they don't diet and exercise. But wait, wouldn't diet and exercise have taken off the weight in the first place without any damage to the digestive tract or metabolism? That's correct! So, one might ask, why have surgery just for a quick weight loss? The marketers of surgery have this covered. They inform fat people that unless they have their guts cut up, they will likely die within five years. That's enough to cause many to run to their local gastric bypass surgeon. Of course, those who decided to not run, all see that they are NOT DEAD as predicted, in five years, 10 years or even 30 years when many of their associates who had the surgery have died.

Another thing folks should be aware of. Surgeons count individuals who keep off 40 percent of the initial weight loss as 'successes'. That means you can lose 100 lbs and gain back 60 and STILL be counted by your surgeon as a 'success story'! The Hebrew study showed that only 7 percent of those patients in the study, kept off ALL the weight they initially lost. This is only slightly higher than the stated success rate for dieting which is given as 5 percent!

 

What about the safety of the surgery?

It should be a no brainer that going in to the abdominal cavity and stapling the stomach into two pieces, the active part which may be no larger than a thumb, as well as cutting the intestine and bypassing the part where most vitamins and nutrients are absorbed, is NOT something which the human body appreciates.

The official ASBS claim is that 1 in every 1000 Weight Loss Surgery patients dies on the operating table or three days after surgery (this is called a "table death" by the medical community). Even with this claim, this makes Weight Loss Surgery more dangerous than just about any other surgery out there except open heart surgery. For example, in appendectomies, 1 out of every 100,000 or more, dies on the table. Even liposuction which is considered one of the most dangerous surgeries there is, has a table death rate of 1 out of every 5000 surgeries, much safer than a gastric bypass!

That being said, I have only met two WLS surgeons whose table death rate is as low as 1 in 1000 surgeries. Most of the surgeons who have been interviewed in the media claim a table death rate of 2 in every 600 surgeries!

When we consider the death rate short term and long term, the view gets muddy. The ASBS claim is that the death rate is very low. However, I've personally encountered three individuals who died 3-9 months after surgery, clearly as a side effect of the surgery but their deaths were blamed on obesity or some other factor. This, of course, greatly skews the statistics about how many actually die from these procedures.

More unsettling is the fact that few post operative Weight Loss Surgery patients of longer term are to be found. They have been doing the gastric bypass for over 20 years - there should be thousands of happy posties floating around but this just isn't the case. Everyone in the Weight Loss Surgery community ASSUMES these posties are out "somewhere" enjoying life but no one knows of more than a handful of post operative long termers.

We do not have clear statistics on long term mortality because no studies have been done for this. One problem in the studies of over five years is finding the post operative Weight Loss Surgery patients to participate!

And we must ask, would a death from a known side effect of Weight Loss Surgery, like cirrosis of the liver, be blamed on the surgery if it happened 20 years after the fact? Likely not.

We do have some statistics on another surgery - the surgery which the gastric bypass was based on, the Billroth II. The Billroth II (named after the inventor) was done for ulcers of the duodenum (the part of the small gut directly connected to the stomach) and it was a rather common surgery up until they discovered better medications to treat ulcers.

Because the Billroth II is a necessary surgery rather than an "elective" cash cow surgery, studies have been done on the long term side effects and have revealed that the length of life after a billroth II is expected to be about 15-20 years, although some Billroth II-ers do live longer - I actually encountered one who lived to the age of 90! The surgery, still much less destructive of the digestive tract than the gastric bypass, is known to be beset with long term complications among which are partial malnutrition.

In fact, Edward Mason, when he noticed that 30 percent of his Billroth II patients could not maintain normal weight after this surgery, got the idea that the surgery would work for his morbidly obese patients. The first gastric bypasses, done in the late 1960's, were modified Billroth II's - the current RNY gastric bypass was an additional modification to prevent the bile reflux often seen in the Billroth II, but it also causes unneutralized stomach acid dumps into the small gut which could eventually cause bowel obstruction (a common long term side effect of Weight Loss Surgery).

Mason, upset at the complication rate of the Gastric bypass, advocated the stomach stapling without the intestinal bypass from 1980 on (the "Vertical Banded Gastroplasty" or VBG). While rather uncomfortable and limiting in what a person can eat, the VBG has less long term complications then does the gastric bypass. And there are a few most long term posties of the VBG to be found although most around after 20 years are large again and have complications similar to those found in bulimia (tooth decay, distention of the esophagus etc)

And now, the FDA has approved the adjustable band. This procedure, popular in Europe, is much safer than stapling the stomach however, people are surprized at the fact that recent criticisms of the band have stated that one can get nasty infections or stomach perforations or weight regains from the band. Quadruple those and add a bunch for the gastric bypass!

The most effective Weight Loss Surgery is still an intestinal bypass - a surgery where most of the small gut is bypassed so you absorb very little of what you eat. Modern intestinal bypasses, sold under the name of "Duodenal Switch" or "BPD", are combined with stomach staplings to cut down the dumping of unneutralized acid into what small gut remains. The connections are made with more finesse and there is less diarrhea (only 1-2 caustic acid bowel movements a day). But a rose is a rose by any other name. And likely the liver failure seen with the older intestinal bypasses is also seen in long term modern intestinal bypasses . You cannot find but a handful of long term BPDers around either, despite the fact that this surgery has also been done for over 20 years.

The bottom line? Dangerous surgery is - well - dangerous! That's a no brainer. The difference is that dangerous surgery for Weight Loss, is sold like used cars - folks who don't let us know about the dangers until we experience them in our own lives. Only now, instead of our car dying on the road, it's WE who might die and sometimes not all that rapidly.

Is being thin worth anything, even to risk our lives? We should re-examin our feelings about this and should remember that cancer and AIDS also cause a massive weight loss however, that does not mean we would want to have those illnesses!

 

Sue Widemark

http://gastricbypass.netfirms.com